[Cause and control of non-sampling error in China National Human Biomonitoring Program]

The size of the non-sampling error is directly related to the accuracy and reliability of the sampling survey result. This paper studied the non-sampling errors generated during the sampling process of the China National Human Biomonitoring Program(CNBP), mainly including the sampling frame error, non-response error and measurement error. The program reduced the influence of the non-sampling error on the quality of the survey effectively by scientifically designing the sampling scheme and questionnaire, strengthening investigator trainings and standardizing the data review, which could be used to provide reference for the control of non-sampling errors in public health monitoring projects in China.

[Research progress of ambient air pollution and human health in China]

As one of the major environmental and health problems in China, ambient air pollution has attracted substantial public concerns. This paper reviews the current evidence on air pollution and population health in China, including acute health effect studies, chronic health effect studies, disease burden, and interventions studies. Future research directions are also discussed.

[Study on the current situation of China's First List of Rare Diseases based on 15 million hospitalizations]

Objective: To investigate and analyze the distribution of 121 diseases of China's First List of Rare Diseases based on hospitalized patients of tertiary hospitals and to explore the current situation of rare diseases in China. Methods: Based on previous data of study from Beijing Society of Rare Diseases, a comparison between China's First List of Rare Diseases and the survey list from the pre-study was performed. Descriptive analysis was carried out on the current situation of rare diseases on hospitalizations in 96 tertiary hospitals from year of 2014 to 2015. Results: Nineteen out of 121 diseases on China's First List of Rare Diseases were not included in the rare diseases survey list of Beijing Society of Rare Diseases. The total number of other 102 rare disease cases was 54 468, accounting for 0.35% of the inpatients during the same period. The top ten most and least cases with rare disease were demonstrated in this study. The number of the top ten most cases was 37 977, accounting for 0.25% of the inpatients during the same period. The number of the top ten least cases was 24, accounting for 0.000 16% of the inpatients during the same period. The top most five types of rare diseases counted on the provinces and municipalities were Beijing, Hunan, Shanghai, Shandong and Guangdong. The top five most cases of rare diseases counted on the provinces and municipalities were Beijing, Shanghai, Guangdong, Shandong and Hubei. The age distribution showed that the cases with rare diseases aged 25-64 years accounted for 45.8%, and the cases in children aged 0-14 accounted for 28.6%. The top ten readmission rate ranged from 28.42% to 64.88%. Conclusions: This study preliminarily investigates the number, type, province and municipality distribution, age distribution, and readmission rate of 121 rare diseases from China's First List of Rare Diseases in the hospitalized patients of tertiary hospitals, which provides important data for registration study, medical and drug policy making and other relevant work on rare diseases in China in the future.

[Follow-up study of body mass index and risk of cognitive impairment among elderly adults aged ≥65 years old from longevity areas of China]

Objective: To discuss the relationship between body mass index (BMI) and cognitive impairment among elderly adults aged ≥65 years old from longevity areas of China. Methods: A total of 2 439 elderly adults from 8 longevity areas were included in our baseline survey by answering questionnaire and taking body measurements and blood biochemical examinations in 2012. In the follow-up study in 2014, we studied the cognitive impairment status among the 1 135 elderly adults aging ≥65 years old. Multivariate logistic regression model was used to analyze the relationship between BMI and cognitive impairment risk. Results: 113 participants were defined as cognitive impairment, with a positive rate at 10.0%. The positive rate in group of underweight, normal weight, and overweight and obese elderly were 22.2% (51/230), 7.5% (47/629), 5.4% (15/276). The rate of cognitive impairment in groups of low BMI (<19.7 kg/m(2)), middle BMI (19.7-23.1 kg/m(2)) and high BMI (>23.1 kg/m(2)) were separately 17.7% (66/372), 7.1% (27/379) and 5.2% (20/384) (P<0.001). Every 1.0 kg/m(2) increase in BMI, the risk of cognitive impairment would significantly decreased by 7% (RR(95%CI): 0.93(0.87-0.99)). Compared with participants with middle BMI level, the group of low BMI participants was associated with a significantly increased risk of cognitive impairment (RR (95% CI): 1.98(1.14-3.44)); while there was no significant association was observed in the high BMI group (RR(95%CI): 1.15(0.57-2.32)). Compared with elderly in normal weight, the elderly with under weight was in higher risk of cognitive impairment (RR (95%CI: 2.19(1.31-3.66)) and there was no significant association found between the elderly with overweight (RR(95%CI): 1.18(0.58-2.38)). Conclusion: Among the elderly ≥65 years old from longevity area, low BMI level and underweight were associated with the increased risk of cognitive impairment.

[A review on the research progress related to ambient air pollution and depression]

It is reported that depression has caused heavy disease burden across the world, with an possible association between ambient air pollution and depressive symptoms. In this paper, we reviewed relative literature in this field and summarized the research events on association between ambient air pollution and depression, both in China and abroad and found that the results of the existed studies were inconsistent, with most studies showing that there existed a positive correlation between the exposure of air pollution and depression, but few studies showing the negative correlation or no correlation between the two.

[Progress in research of relationship between heavy metal exposure and cardiovascular disease]

Heavy metal is one of pollutants existed widely in the environment, its relationship with cardiovascular disease has attracted more and more attention. In this review, the concentrations of heavy metals, including lead, cadium and asenic, in the body from several national surveillance networks and the epidemiological studies on the effects of the exposure of three heavy metals on cardiovascular system were summarized. It is suggested to strengthen nationwide surveillance for body concentrations of heavy metals in general population in order to provide baseline data for quantitative evaluation of the risk of heavy metal exposure on cardiovascular disease.

[Association between air pollution and cognitive function in the elderly]

Cognition disorders is one of the most important factors affecting the elderly. Impaired cognitive function caused by the elderly daily self-care ability decreased, the elderly in China cause serious social, psychological and economic burden. The purpose of this review is to summarize the current evidence on main air pollutants(SO(2), NO(2), CO, PM(2.5) and PM(10), black carbon)and cognitive function in elderly. The study found that exposure to air pollution, especially particulate matter, is associated with cognitive disorders n in the elderly. However, the existence of such correlations requires reasonable physiological mechanisms. Future studies also require a large number of longitudinal cohorts to investigate air pollution in association with cognitive impairment . There is a need for parallel toxicological and epidemiological studies to elucidate mechanisms and pathways of action.

[Association between biomarkers and activities of daily living in the elderly ≥65 years old from longevity areas in China]

Objective: To explore the association between biomarkers and activities of daily living (ADL) in the elderly over 65 years old from longevity areas in China. Methods: A total of 2 439 people from 8 longevity areas were included in our baseline survey in 2012. Using questionnaires, body measurements, and blood biochemical examinations, information on demographics characteristic, life style, ADL, blood pressure and biomarkers were collected. Based on these six items of ADL (bathing, dressing, indoor activities, toileting, eating, bowel and bladder control), we constructed a dichotomous indicator for ADL. A respondent was defined as ADL disabled if any difficulty in one or more of the above six activities was reported. Information were collected in the follow-up in 2014 using the same questionnaires and examinations. We excluded information on the elderly who lacked ADL or biomarkers test results or with ADL disability at baseline study. Finally 938 elderly people over 65 years old were included in this analysis. Multivariate logistic regression model was used to analyze the influence factors of ADL disability. Results: During the 2-year follow-up, 100 (10.7%) participants developed into ADL disability, with a rate at 10.7%. Multivariate logistic regression analysis indicated that each year increase in age or each 1 mmHg (1 mmHg=0.133 kPa) increase in systolic blood pressure (SBP) would cause the risk of ADL disability to increase 9% or 1%, whose OR (95%CI) were separately 1.09 (1.06-1.12), 1.01 (1.00-1.02). Han nationality or cognitive impairment increased the risk of ADL disability, whose OR (95%CI) values were separately 4.90 (1.13-21.24), 2.47 (1.44-4.25), while increased lymphocyte count (>1.60×10(9)/L), being married, or participating in recreational activities decreased the risk of ADL disability, whose OR (95%CI) values were separately 0.51 (0.31-0.82), 0.52 (0.28-0.96), 0.43 (0.23-0.80). Conclusion: In the elderly elevated lymphocyte count was associated with lower risk of ADL disability. In addition, incresed age, increased SBP, unmarried, Han nationality or cognitive impairment were associated with the increasing risk of ADL disability in older people, while participating in recreational activities would reduce the risk.

[Study on handgrip strength of elderly ≥60 years old from longevity areas in China]

Objective: To assess the status of handgrip strength of elderly population from longevity areas in China, and to analyze the correlative factors of handgrip strength of elderly people. Methods: Data from Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2012 was used, from which1 967 participants aged ≥60 years old with valid data of grip strength value from 8 Chinese longevity areas were included. Information on demographics characteristic, life style and health status was collected using questionnaires. The handgrip strength of both left and right hands were measured by grip dynamometer. The different characteristics of group of participants with different grip strength were compared and then analyzed by adopting the Cumulative odds Logistic regression model to identify main factors associated with hand grip strength. Results: The P(50) (P(25)-P(50)) of hand grip strength of elderly people from the eight longevity areas was 20 (11-28) kg; The hand grip strength of males was 26 (18-34) kg, which was higher than that of females(14 (9-20) kg) (P<0.001). Cumulative odds Logistic regression model showed that the hand grip strength of females was lower than males, whose β value (95%CI) was-1.22 (-1.43--1.00). The elderly who was at a higher age, smoking, drinking or with anemia, had a comparatively lower handgrip strength, whose β (95%CI) value were separately-0.08(-0.09~-0.07),-0.29(-0.56~-0.02),-0.54(-0.80~-0.28), and-0.41(-0.62~-0.20). And the elderly who had a higher boby mass index, drinking tea and outdoor activities, had a comparatively higher handgrip strength, whose β(95%CI) value were separately 0.28 (0.15-0.40), 0.25(0.03-0.47) and 0.51(0.30-0.71). Conclusion: Age and gender were the main correlative factors, lifestyles and physical conditions might also be correlative factors of hand grip strength of the elderly from longevity areas in China.

[Association between serum albumin and cognitive performance in elderly Chinese]

Objective: To explore association between serum albumin level and cognitive performance in elderly Chinese. Methods: All the subjects aged ≥65 years in the 8 longevity areas in Chinese longitudinal health longevity survey (CLHLS) were invited to participate the biomedical indepth CLHLS study, information about subjects' demographic characteristics, lifestyle, prevalence of diseases and health status was collected through household-interview. The cognitive performance was assessed with Mini Mental State Evaluation (MMSE) scale. Health examination was conducted by medical personnel and fasting venous blood samples were collected to detect the levels of triglycerides, total cholesterol, fasting glucose, creatine and blood albumin. MMSE score was compared and the trend was analyzed with generalized linear model. Association between albumin concentration and cognitive impairment was analyzed by logistic regression model. Results: Generalized linear model showed that adjusted MMSE score increased from 23.22 in the lowest quartile group to 25.07 in the highest quartile group (P for linear trend <0.001). Logistic regression analysis results showed that the higher albumin level was associated with the lower risk of cognitive impairment (P< 0.001), the OR decreased linearly with the increasing level of albumin (P<0.01), with the OR (95%CI) for the lower, higher and highest quartile groups was 0.64(0.45-0.91), 0.60(0.40-0.89) and 0.43(0.27-0.69), respectively, compared with the lowest quartile group. Conclusion: High level of serum albumin was associated with low risk of cognitive impairment.

[Attaching importance to study on acute health risk assessment and adaptation of air pollution and climate change]

Air pollution and climate change have become key environmental and public health problems around the world, which poses serious threat to human health. How to assess and mitigate the health risks and increase the adaptation of the public have become an urgent topic of research in this area. The six papers in this issue will provide important and rich information on design, analysis method, indicator selection and setting about acute health risk assessment and adaptation study of air pollution and climate change in China, reflecting the advanced conceptions of multi-center and area-specific study and multi-pollutant causing acute effect study. However, the number and type of the cities included in these studies were still limited. In future, researchers should further expand detailed multi-center and multi-area study coverage, conduct area specific predicting and early warning study and strengthen adaptation study.

[Simulation study of air quality health index in 5 cities in China: 2013-2015]

Objective: To construct the air quality health index (AQHI) by inclusion of air pollutants PM(2.5) and O(3) in Guangzhou, Shanghai, Xi' an, Beijing, Shenyang, and explore scientificity and feasibility of its application in China. Methods: The daily average concentrations of PM(2.5) and O(3) in air, and daily average mortality from 2013 to 2015 in the 5 cities in China, the exposure-response coefficients of PM(2.5) and O(3) and total mortality from Meta studies in China were used to construct local AQHI. The health risk levels of air pollution in the 5 cities were calculated and compared with the characteristics of single pollutant concentrationof PM(2.5) or O(3). Results: In the 5 cities, the average concentration of PM(2.5) was highest in Beijing (82 μg/m(3)) and lowest in Guangzhou (46 μg/m(3)). And the average concentration of O(3) was highest in Shanghai (72 μg/m(3)) and lowest in Xi' an (45 μg/m(3)). In all the cities, the average concentration of PM(2.5) was highest in winter and lowest in summer. In summer, the average concentration of O(3) was lowest. But the health risk level of AQHI showed that the 5 cities had higher frequency of low or medium risk averagely. And Beijing had the highest frequency of high risk in summer (5.69%). Xi' an had the highest frequency of extremely high risk in winter (1.63%). Conclusions: In this study, AQHI could be constructed by using air PM(2.5) and O(3) concentration data which can be obtained in many areas in China. The application of this index is scientific and feasible in China.

[Impact of PM2.5 on daily outpatient numbers for respiratory diseases in Shenzhen, China]

Objective: To assess the association between the concentration of the air pollutant PM_2.5 and daily outpatient visits for respiratory disease. Methods: All records of daily outpatient visits to three hospitals in Shenzhen from January 1 to December 31, 2013 were collected. Daily air pollution monitoring and meteorology data from the same period were also collected in Shenzhen. The data were analyzed using a semiparametric generalized additive model with Poisson distribution of time series analysis controlling for long-term and seasonal trends, flu, DOW, public holidays, and meteorological factors. The excess risk(ER)of respiratory disease and its 95% CI value were calculated, along with the incremental increase of 10 μg/m³ in PM_2.5 concentration. Results: Number of outpatient visits for respiratory diseases totaled 1 428 672(daily range: 1 790-5 228). The annual average PM_2.5 concentration was 40.2 μg/m³(daily range: 7.2-137.1 μg/m³). The lag1 factor had the most significant impact on the lag effect. We estimated that a 10 μ g/m³ increase in day-before PM_2.5 concentration was associated with a 1.809%(95% CI: 1.709%-1.909%)ER of visits for respiratory disease. After controlling for other pollutants(NO₂, CO, and O₃), the effect remained stable. When NO₂, CO, and O₃ were introduced separately, for every 10 μg/m³ rise in PM_2.5 concentration, the excess risk of daily outpatient visits for respiratory disease was 1.814%(95% CI: 1.706%-1.923%), 2.780%(95% CI: 2.668%-2.892%), and 1.513%(95% CI: 1.403%-1.624%), respectively. With simultaneous control of NO₂ and O₃, NO₂ and CO, and CO and O₃, for every 10 μg/m³ rise in PM_2.5 concentration, the excess risk of respiratory disease was 1.369%(95% CI: 1.242%-1.497%), 2.709%(95% CI: 2.590%-2.828%), and 2.577%(95% CI: 2.452%-2.702%), respectively. With simultaneous control of NO₂, CO, and O₃, for every 10 μg/m³ rise in PM_2.5 concentration, the excess risk of respiratory disease was 2.370%(95% CI: 2.231%-2.509%). Conclusions: PM_2.5 can increase the risk of outpatient visits for respiratory disease in Shenzhen.

[Correlative factors related to the density of Meriones unguiculatus in the Meriones unguiculatus plague foci of Hebei province, 2001-2013]

OBJECTIVE

To explore the yearly, monthly and habitat-related distribution and their relations with Meriones unguiculatus density in the Hebei Meriones unguiculatus plague foci, from 2001 to 2013.

METHODS

Data related to Meriones unguiculatus was gathered through the monitoring programs set up at the national and provincial Meriones unguiculatus plague foci in Hebei province, from 2001 to 2013. According to the yearly density of Meriones unguiculatus, criteria set for the three groups under study, were as follows:'high-risk group'-when the rodent density was≥1.00 under rodents/hm(2),'warning group'-when the rodents/hm(2)>rodent density> 0.20,'standard group'-when rodents/hm(2) rodent density≤0.20 rodents/hm(2). Differences of habitats and monthly distribution among the three groups were compared, under the Kruskal-Wallis H rank sum test while their relations were under the multiple correspondence analysis.

RESULTS

The Meriones unguiculatus densities were higher than 1.00 rodents/hm(2), far above the set national standards, in the monitoring area, between 2001 and 2005. From 2005, though the rodent densities began to decrease, however, figures from 2008 to 2013 were still among 0.20 to 1.00 rodents/hm(2). The distribution of habitats in the three groups showed that the Meriones unguiculatus densities were all different in habitats and the difference was statistically significant (P<0.05). The highest median densities were all in the arable land, with maximum value of high-risk group appeared the highest (20.50 rodents/hm(2)) in the wasteland. Monthly distribution showed that the Meriones unguiculatus densities were different and the difference was statistically significant (P<0.05) in the high-risk and standard groups but not statistically significant in the warning group. Data from the multiple correspondence analysis showed that there was a strong aggregation among wasteland, in April and June, while the warning group was associated with weather in July and the arable land.

CONCLUSIONS

When the density became higher than 1.00 rodents/hm(2), the risk on animal plague increased in Hebei Meriones unguiculatus plague foci. Based on the distribution of Meriones unguiculatus, programs should be set to monitor the rodent in arable land and wasteland, in April and June, to reduce the prevalence of animals plague.

[National health strategies in the world and its enlightenment to build healthy China]

The national health strategy is a reflection of a country on overall value and development vision of national health, and conducting this strategy will enhance and promote national development and people's welfare. In the current situation of building Healthy China during the 13th Five-Year Plan, it is important to learn experiences in this area from developed countries. This article mainly presents detailed introduction of the formulation, the implementation and the characteristics of National Health Strategies from the United States, United Kingdom and Japan, and also presents suggestions for the construction of Healthy China.

[Association between oxygen saturation and cognitive function in older adults from longevity areas in China]

OBJECTIVE

To explore the relationship between oxygen saturation (SpO2) and cognitive function in older adults from longevity areas in China.

METHODS

A total of 2 285 participants aged ≥65 years according to the 2012 Chinese Longitudinal Healthy Longevity Survey were included in this study. Among them, 1 739 participants aged 65-99 years were randomly selected, and 546 participants aged ≥100 years were totally involved. A standardized questionaire was used to collect the information of demographic characteristics, life styles, disease history, etc. Cognitive function was evaluated using the Mini Mental State Examination Scale. Arterial oxygen saturation and heart rate were measured by pulse oximetry. Differences in cognitive function between the low SpO2 group (<0.94) and normal SpO2 group (≥0.94) were analyzed, and logistic regression models were used to analyze the relationship between SpO2 and cognitive function.

RESULTS

The total score of cognitive function was 22.6±9.7 for the 1 922 participants in the normal SpO2 group, and 18.8 ± 11.0 for the 363 participants in the low SpO2 group (t=6.11, P<0.001). The proportion of cognitive impairment in the low SpO2 group was 36.6% (n=133), and 22.9% (n=441) in the normal SpO2 group (χ(2)=30.44, P<0.001). RESULTS from stepwise logistic regression analysis showed that the risk of cognitive impairment increased with each year of increased age (OR 1.07; (95% CI: 1.05-1.09), P<0.001). Low SpO2, vision disorders, impaired activities of daily living, dyslipidemia, unmarried status, and lack of exercise were also associated with increased risk of cognitive impairment (OR 1.64; (95% CI: 1.11-2.43), OR 1.73; (95% CI: 1.27-2.35), OR 3.54; (95% CI: 2.62-4.79), OR 1.38; (95% CI: 1.02-1.86), OR 2.05; (95% CI: 1.34-3.13), OR 1.83; (95% CI: 1.13-2.97), respectively, P<0.05). Stratified analysis by age group showed that the association between SpO2 and cognitive impairment was most significant in participants aged ≥90 years (OR 1.58; (95% CI: 1.09-2.28), P=0.016).

CONCLUSION

Low oxygen saturation was associated with higher risk of cognitive impairment in our population of elderly adults.

[The key problems in the population exposure assessment of hazardous chemicals accidents]

Serious accidents of hazardous chemicals can cause a variety of acute or chronic impairment in human health. The effects of hazardous chemicals on human health can be identified by carrying on population exposure assessment. Through analyzing the domestic and overseas population exposure assessment cases related to hazardous chemicals accidents, we summarized that the base and key of the population exposure assessment were to identify the characteristics of the chemicals , delimit the area and the population exposed to the chemicals, and collect the data of the monitored chemicals and the population health in the polluted area.

[Follow-up study on the effects of lipid ratios on all-cause mortality among elderly adults in longevity areas of China]

OBJECTIVE

To explore the association between lipid ratios and all-cause mortality among elderly adults aged 80 years and older living in longevity areas of China.

METHODS

A total of 874 participants in the Chinese Longitudinal Healthy Longevity Survey during June 2009 were included in our baseline survey. Lipid concentrations were measured and lipid ratios including LDL-C/HDL-C, TG/HDL-C, and atherosclerosis index (AI) were calculated at baseline, and the information on questionnaires, body measurement, and blood biochemical profiles was collected. Survival time and survival status were followed up in August 2012. Subjects were stratified into three groups (low, middle and high) by tertiles of lipid ratios. All-cause mortality was calculated. Cox regression models were used to assess the association of lipid ratios with mortality.

RESULTS

During 38 months of follow-up, a total of 427 participants had died, 378 participants survived, and 69 participants were lost to follow-up; overall mortality was 50.5%. For these participants, P50 (P25-P75) values for LDL-C/HDL-C were 1.68 (1.22-2.05), 1.85 (1.34-2.16), and 1.78 (1.33-2.08), respectively (H=6.93, P=0.025); values for TG/HDL-C were 1.00 (0.79-1.34), 1.20 (0.97-1.53), and 1.23 (0.95-1.72), respectively (H=9.18, P=0.008). AIs were 2.12 (1.72-2.61), 2.27 (1.84-2.75), and 2.13 (1.80-2.58), respectively (H=6.37, P=0.041). Values for 38-month all-cause mortality were 53.1%, 50.0%, and 44.0% among participants with low, middle, and high LDL-C/HDL-C ratios (<1.39, 1.39-1.92, ≥1.92), respectively (χ(2)=7.54, P=0.024); these values were 54.8%, 46.4%, and 45.3% among participants with low, middle, and high AIs (<1.83, 1.83-2.39, ≥2.39), respectively (χ(2)=6.67, P=0.035). Each 1 unit increase of LDL-C/HDL-C, TG/HDL-C , and AI corresponded to a 17%, 15%, and 13% decrease in 38-month all-cause mortality, respectively; adjusted HRs were 0.83 (0.72-0.97), 0.85 (0.74-0.99), and 0.87 (0.76-0.99), respectively. Compared with participants who had low LDL-C/HDL-C ratios, high ratios were associated with lower risk of mortality (HR 0.88; (95% CI: 0.78-0.99)). Compared with low AIs, middle and high values were associated with lower risk of mortality HRs (95%CI) were 0.84 (0.72-0.98) and 0.87 (0.78-0.98);respectively.

CONCLUSION

LDL-C/HDL-C, TG/HDL-C, and AI were negatively associated with all-cause mortality among elderly adults aged 80 years and older living in longevity areas of China.

[Association between the hypersensitive C-reactive protein and activities of daily living among elderly adults in longevity areas of China]

OBJECTIVE

To explore the association between the hypersensitive C-reactive protein (hs-CRP) and activities of daily living (ADL) in elderly adults in longevity areas of China.

METHODS

This analysis included data on 2 352 adults aged ≥65 years from eight longevity areas from the Chinese Longitudinal Healthy Longevity Survey in 2012. We excluded information on adults who lacked ADL or blood test data; the final study population comprised 2 227 elderly adults. Using questionnaires, body measurement, and blood biochemical examination, information on demographic characteristics, lifestyle, ADL, blood pressure, blood lipids, and biomarkers was collected. Study participants who were able to independently carry out the six kinds of activities of daily living (bathing, dressing, indoor activities, toileting, eating, bowel and bladder control) comprised the normal ADL group, and those who could not were included in the impaired ADL group. A multivariate logistic regression model was used to analyze factors influencing ADL impairment.

RESULTS

Among the 2 227 participants, 1 674 (75.2%) were included in the normal ADL group and 553 (24.8%) in the impaired ADL group. Among all participants. Adults in the normal ADL group had lower hs-CRP levels (P50 (P25-P75)=0.88; 0.38-2.29 mg/L) than those in the impaired ADL group (1.27; 0.47-4.28 mg/L); (Z=- 4.71, P<0.001). Participants in the normal ADL group also had lower hs-CRP elevation rates (214; 12.8%) than those in the impaired ADL group (125; 22.6%); (χ(2)= 31.06, P<0.001). Multivariate logistic regression analysis indicated that each age increase of one year increased the risk of ADL impairment by 1.08 times (OR 1.08 (95%CI: 1.07-1.10); P<0.001). Participants with increased hs-CRP levels, those of Han nationality, and participants with a previous history of stroke had a higher risk of ADL impairment (OR(95% CI) values were 1.42(1.04-1.94), 1.87(1.13-3.08), 2.81(1.87-4.23); P<0.05). Elderly adults who participated in recreational activities had a lower risk of impaired ADL (OR 0.29 (95%CI: 0.22-0.38); P<0.001).

CONCLUSION

In this study among elderly adults living in longevity areas of China, hs-CRP levels were related to ADL and elevated hs-CRP was associated with a higher risk of ADL impairment.

[Role of electrocardiogram in predicting cardiac resynchronization therapy response]

OBJECTIVE

To explore the role of electrocardiogram(ECG)in predicting cardiac resynchronization therapy (CRT) response.

METHODS

This study retrospectively analyzed ECG of 92 CRT patients, who received CRT therapy from 2001 to 2013 in our center and were followed up for 6 months. The patients were divided into responder group (n=64) and non-responder group (n=28). The baseline and 6-month data including QRS width, heart rhythm and axis variation were analyzed. The definition of responder is left ventricular end systolic volume (LVESV) reduction ≥15% within 6 months after CRT. After CRT therapy, the ventricular activation was changed as left to right (frontal plane), posterior to anterior and axis changed in a clockwise direction. The change in more than two directions was defined as prominent axis change. Logistic analysis was performed to analyze the role of ECG in predicting CRT response.

RESULTS

(1) Baseline parameter comparison between the two groups: the proportion of female and LBBB is significantly higher (P<0.01; P=0.04), while the proportion of atrial fibrillation/flutter (Af/AF) is significantly lower (P<0.01) in responder group than in non-responder group. The pre-CRT average QRS duration is much wider in responder group than in non-responder group (P=0.01). (2) Comparison of follow-up with baseline results in two groups: NYHA heart function level, 6 minutes walking distance, QRS duration, LVEF, LVESV improved significantly (P<0.01) post-CRT in responder group. In non-responder group, the QRS duration and LVESV deteriorated significantly (P=0.02, P<0.01), while post-CRT NYHA heart function level improved significantly. In responder group, pre-CRT ECG axis of 53 patients (82.8%) pointed to left and 58 patients (90.6%) pointed to posterior; post-CRT ECG axis of 49 patients (76.6%) pointed to right and 30 patients (40.6%) pointed to anterior. In non-responder group, pre-CRT ECG axis of 25 patients (89.3%) pointed to left and 24 patients (85.7%) pointed to posterior; post-CRT ECG axis of 17 patients (60.7%) pointed to right and 12 patients (42.9%) pointed to anterior. Post-CRT, the proportion of ECG axis prominent change was significantly higher in responder than in non-responder group (62.5%(40/64) vs. 32.1%(9/28), P=0.007). (3)Predicting value: pre-CRT QRS width ≥140 ms (OR=4.97, 95% CI 1.53 to 16.13, P=0.008)and post-CRT prominent axis change (OR=5.1, 95% CI 1.67 to 15.5, P=0.004)were found to be independent predictors of CRT responders. Af/AF pre-CRT was associated with reduced CRT response (OR=0.25, 95% CI 0.08 to 0.80, P=0.02).

CONCLUSIONS

ECG may play a role in predicting CRT response. QRS width and Af/AF before CRT and ECG axis change post-CRT could be used to predict CRT response.

[Regulative mechanisms of oxidative stress in kidney in diabetic nephropathy and interventional effects of Chinese herbal medicine]

In the development of diabetic nephropathy (DN), reactive oxygen specie (ROS) over much in vivo leads to oxidative stress(OS)-related renal injuries, which are characterized by the structural and functional changes in glomerular and renal tubular cells in morphology. The regulative approaches of OS involve the several signaling pathways, in which, both p38 mitogen-activated protein kinase (MAPK) signaling pathway and adenosine monophosphate-activated protein kinase (AMPK) signaling pathway play the important roles as the target of anti-oxidants. The interventional actions of Chinese herbal compound prescriptions and the extracts of single Chinese herbal medicine (CHM) on OS in the kidney in DN include regulating the balance between ROS and antioxidants, reducing the production of AGEs, inhibiting the expression of growth factors and intervening the activity of signaling pathways.

Ureic clearance granule, alleviates renal dysfunction and tubulointerstitial fibrosis by promoting extracellular matrix degradation in renal failure rats, compared with enalapril

ETHNOPHARMACOLOGICAL RELEVANCE

Chinese herbal compound prescription has a unique therapeutic action on chronic kidney disease (CKD) in China. In clinics, Uremic Clearance Granules (UCG), a compounded Chinese patent medicine, has been frequently used to treat chronic renal failure (CRF) patients for nearly 30 years, however, the deep therapeutic mechanisms involved in vivo remain a challenge. This study aims to demonstrate the effects and mechanisms of UCG on renal dysfunction and tubulointerstitial fibrosis by regulating extracellular matrix (ECM) degradation and transforming growth factor (TGF)-beta1/Smad signaling activity in vivo, compared with enalapril.

MATERIALS AND METHODS

Twenty-six rats were randomly divided into 4 groups, a sham-operated group (Sham group), a vehicle-intervened group (Vehicle group), a UCG-treated group (UCG group) (5g/kg/day) and an enalapril-treated group (Enalapril group) (20mg/kg/day). The rats with renal failure were induced by adenine (150 mg/kg/day) and unilateral ureteral obstruction (UUO), and killed on day 35 after the administration. Proteinuria, urinary N-acetyl-beta-D-glucosaminidase (UNAG), blood biochemical parameters, renal morphological changes, collagen type IV (CIV), matrix metalloproteinase (MMP)-2, MMP-9 and tissue inhibitors of metalloproteinase (TIMP)-1, as well as the key molecular protein expressions in TGF-beta1/Smad signaling pathway were observed, respectively.

RESULTS

Adenine administration and UUO induced severe renal damages, as indicated by renal dysfunction, proteinuria and the marked histopathological injuries in the tubules and interstitium, which were associated with MMP-2/TIMP-1 imbalance and TGF-beta1/Smad signaling activity, as shown by up-regulation of the protein expressions of TGF-beta1, TGF-beta receptor type I (RI), TGF-beta receptor type II (RII), Smad2/3, phosphorylated-Smad2/3 (p-Smad2/3) and Smad4, as well as down-regulation of the protein expression of Smad7 in the kidney. UCG treatment, however, significantly not only attenuated renal dysfunction and tubulointerstitial fibrosis, but also improved the protein expressions of MMP-2, TIMP-1, TGF-beta1, TGF-beta RI, p-Smad2/3, Smad4 and Smad7 in the kidney. Besides, the effects of UCG were stronger than those of enalapril partly.

CONCLUSION

UCG similar to enalapril, is renoprotective via ameliorating renal dysfunction and tubulointerstitial fibrosis in the renal failure model. The potential mechanisms by which UCG exerts its therapeutical effects in vivo are through promoting ECM degradation and regulating MMP-2/TIMP-1 balance or signaling molecular activity in TGF-beta1/Smad pathway in the kidney. These findings suggest that UCG treatment is undoubtedly useful in preventing the progression of CRF.

Torasemide reduces dilated cardiomyopathy, complication of arrhythmia, and progression to heart failure

The aim of this study was to analyze the incidence and types of arrhythmia and their relationship with the severity and prognosis of chronic heart failure (CHF) in patients with dilated cardiomyopathy (DCM), and to investigate the therapeutic effect of torasemide versus furosemide on CHF and incidence of arrhythmia. DCM patients with NYHA cardiac function II-IV were continuously monitored using a 24-h dynamic electrocardiogram (Holter), and arrhythmia incidence was analyzed by computer automatic analysis combined with manual assessment. In total, 125 participants were evenly divided into two groups: torasemide group which received 10 mg oral torasemide once daily) and regular anti-heart failure treatment (N=65), and furosemide group which received torasemide (20 mg once daily orally) and regular antiheart failure treatment (N=60). Another 60 normal healthy persons served as the normal control group. Incidence and severity of arrhythmia increased when degree of CHF was elevated. Size of left atrium was related to atrial fibrillation and size of left ventricle was related to malignant arrhythmia. At 3 months after treatment, cardiac function in both groups improved and incidence and severity of arrhythmia in both groups were reduced. However, left ventricular ejection fraction (LVEF) was higher in the torasemide group than in the furosemide group, while incidence of arrhythmia was lower in the torasemide group. Arrhythmias frequently occurred in patients with DCM and HF. Type of cardiac arrhythmia is closely related to ventricular enlargement and cardiac function grade. Torasemide is better for improving cardiac function to reduce arrhythmia and CHF compared to furosemide.

[Clinical implication of urinary protein markers in diabetic nephropathy and interventional effects of Chinese herbal medicine]

In clinic, some urinary protein makers can dynamically and noninvasively reflect the degree of renal tubular injury in patients with diabetic nephropathy (DN). These urinary biomarkers of tubular damage are broadly divided into two categories. One is newfound, including kidney injury molecule-1 (Kim-1), neutrophil getatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP) and cystatin C (CysC); the other one is classical, including beta2 microglobulin (beta2-MG), retinal binding protein (RBP) and N-acetyl-beta-D-glucosaminidase (NAG). It is reported that, the increases in urinary protein markers are not only closely related to the damage of tubular epithelial cells in DN patients, but also can be ameliorated by the treatment with Chinese herbal compound preparations or Chinese herbal medicine. Recently, although urinary proteomics are used in the protein separation and identification, the traditional associated detection of urinary protein markers is more practical in clinic. At present, it is possible that the associated detection of urinary biomarkers of glomerular and tubular damages may be a feasible measure to reveal the clinical significance of urinary protein markers in DN patients and the interventional effects of Chinese herbal medicine.