[Mediating effect of hypertension on risk of stroke associated with hyperuricemia]

Objective: To investigate the association between hyperuricemia and the risk for stroke occurrence, as well as the mediating effect of hypertension on this association. Methods: In this study, the China Chronic Diseases and Nutrition Surveillance system in 2015 was used as baseline data. We identified hospital admissions for stroke using the electronic homepage of inpatient medical records from 2013-2020, and death data were obtained from the 2015-2020 National Mortality Surveillance System. A retrospective cohort was established after matching and linking the database. The Cox proportional hazard regression model was used to analyze the relationship between hyperuricemia and the risk of stroke and its subtypes. Restricted cubic spline analysis was conducted to examine the dose-response relationship between serum uric acid levels and the risk for stroke. Mediation analysis was performed to investigate the mediating effect of hypertension on the association between hyperuricemia and the risk for stroke and its subtypes. Subgroup analyses were conducted based on gender and age groups. Results: A total of 124 352 study subjects were included, with an accumulative follow-up time of 612 911.36 person-years. During the follow-up period, 4 638 cases of stroke were found, including 3 919 cases of ischemic stroke and 689 cases of hemorrhagic stroke. The incidence density of stroke was 756.72 per 100 000 person-years, 641.37 per 100 000 person-years for ischemic stroke, and 114.60 per 100 000 person-years for hemorrhagic stroke. Multivariable Cox proportional hazards regression models showed that after adjusting for covariates, compared to those without hyperuricemia, individuals with hyperuricemia had a 16% higher risk for stroke [hazard ratio (HR)=1.16, 95%CI: 1.06-1.27], a 12% higher risk of ischemic stroke (HR=1.12, 95%CI: 1.01-1.24), and a 39% higher risk of hemorrhagic stroke (HR=1.39, 95%CI: 1.11-1.75). Mediation analysis showed that hypertension partially mediated the associations between hyperuricemia and the risk for stroke, ischemic stroke, and hemorrhagic stroke, with mediation proportions of 36.07%, 39.98%, and 25.34%, respectively. The mediating effect is pronounced in the male population and individuals below 65. Conclusion: Hyperuricemia is a risk factor for stroke, and hypertension partially mediates the effect of hyperuricemia on stroke.

[The prevalence of insufficient physical activity and the influencing factors among Chinese adults in 2018]

Objective: To understand the prevalence of insufficient physical activity among adults aged ≥18 years in China and to explore the influencing factors. Methods: The China Chronic Disease and Risk Factor Surveillance was conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥18 years. A questionnaire including Global Physical Activity Questionnaire was used to collect information about the participants' demographic characteristics and physical activity through face-to-face interview. A total of 183 769 participants completed the survey. After complex data weighting, the prevalence of insufficient physical activity, occupation, transportation, and leisure-time physical activity time was analyzed. Multivariate logistic regression models were used to analyze the influencing factors related to insufficient physical activity. Results: The prevalence of insufficient physical activity among adults aged ≥18 years was 22.3% (95%CI: 20.9%-23.7%) in China in 2018, with males [24.4% (95%CI: 23.0%-25.8%)] significantly higher than females [20.2% (95%CI: 18.6%-21.8%)]. Adults aged 70 years and above [28.4% (95%CI: 26.9%-29.9%)] were significantly higher than adults in other age groups, followed by adults aged 18-29 years [26.4% (95%CI: 24.4%- 28.3%)] and 30-39 years [23.4% (95%CI: 21.5%-25.3%)], and tended to increase with increasing education and total sedentary behavior time (P<0.001). The weekly occupation, transportation, and leisure-time physical activity time appeared 958.6 (95%CI: 911.4-1 005.8) minutes, 234.5 (95%CI: 224.7- 244.2) minutes, and 88.6 (95%CI: 83.5-93.7) minutes, respectively. Multivariate logistic regression analysis showed that males, adults living in rural areas or northern China, ≥70 years, with junior high school education, an annual household income per capita <6 000 yuan and institutional/clerical/ technical occupation and longer total sedentary behavior time were related to a higher prevalence of insufficient physical activity. Conclusions: In China, over one-fifth of the adults had lower physical activity levels. Adults who are male, young adults, more educated, institutional/clerical/technical occupation, and with more extended total sedentary behavior are the populations that need to be focused on to promote physical activity-related health.

[Cardiovascular health status of Chinese adults based on "Life's Essential 8" score]

Objective: To assess the cardiovascular health status of adults in China by using the "Life's Essential 8" score, and provide reference for the development and improvement of cardiovascular disease prevention and control policies and measures. Methods: Chronic Disease and Nutrition Surveillance was conducted in 298 counties/districts in 2015 in 31 provinces (autonomous regions, municipalities) across China, multi-stage stratified cluster random sampling was used to select 45 households in each village or neighborhood, and 20 households were further selected to conduct dietary surveys. In this study, a total of 70 093 adults aged ≥20 years who completed the dietary survey and had complete information were included, their cardiovascular health status were assessed by using the "Life's Essential 8" score, a cardiovascular health scoring standard released by the American Heart Association in 2022. All results were adjusted using complex design-based sampling weights to achieve a better estimate of the population. Results: In 2015, the overall cardiovascular health score of Chinese adults aged ≥20 years was 73.3±12.6, the score was significantly higher in women (77.9±11.6) than in men (68.7±11.8), and higher in urban area (74.5±12.8) than in rural area (71.9±12.2), the differences were significant (P<0.001). It was estimated that about 0.25% (95%CI: 0.16%-0.33%) of adults in China had cardiovascular health score of 100, and 33.0% (95%CI: 31.6%-34.3%), 63.2% (95%CI: 62.1%-64.3%), and 3.9% (95%CI: 3.5%-4.2%) of adults had high, moderate and low cardiovascular health scores, respectively. The proportion of those with high cardiovascular health scores was relatively low in men, those with low education level, those with low income, those living in rural areas, and those living in southwest China (P<0.001). Of the eight factors, diet had the lowest mean score (46.0, 95%CI: 44.7-47.3), followed by blood pressure (59.4, 95%CI: 58.2-60.6) and tobacco exposure (61.4, 95%CI: 60.6-62.2). Conclusions: The cardiovascular health status of two-thirds of adult population in China needs to be improved. Diet, tobacco exposure, and blood pressure are the factors affecting the cardiovascular health of Chinese population, to which close attention needs to be paid, and men, rural residents, and those with lower socioeconomic status are key groups in cardiovascular health promotion.

[Analysis on trend of health examination rate and influencing factors in adults in China, 2010-2018]

Objective: To understand the health examination rate and its changing trend in adults in China from 2010 to 2018, identify the main factors affecting the health examination rate and provide data support for decision making of health intervention. Methods: Data from China Chronic Disease and Risk Factor Surveillance in 2010, 2013, 2015 and 2018 were used. After complex weighting of the data, the rates of health examination, its changing trends and reasons for receiving health examination in adults were analyzed. Average annual percent change (AAPC) was used to describe the changing trend. Anderson model was used as the analysis framework. Multivariate logistic regression model was used to identify the influencing factors for the health examination rate. Results: From 2010 to 2018, the health examination rate in adults increased from 28.2% (95%CI: 24.8%-31.6%) to 41.0% (95%CI: 38.9%-43.1%, P for trend <0.001), the AAPC was 5.47%, the annual average increase was more obvious in those with lower education level and lower income level and in those living in rural area and in western China. In 2018, people received health examination mainly due to providing without charge by community (36.7%) and working unit (28.5%). The results of multivariate analysis showed that being women, age ≥45 years, education level of junior high school or above, living in urban areas, medical insurance, annual income ≥24 000 RMB, suffering from multiple chronic diseases, non-smoking, drinking, adequate physical activity were positive factors for receiving health examination. Conclusion: The rate of health examination in adults increased in China during 2010-2018, and the main reason for receiving health examination is free of charge.

[Associations between glycated hemoglobin and glucose indicators in adults in areas at different altitude in China]

Objective: To explore the associations of glycated hemoglobin (HbA1c) with FPG and oral glucose tolerance test 2-hour (OGTT-2 h) in areas at different altitude in China. Methods: Subjects who participated in 2018-2019 China Chronic Disease and Risk Factor Surveillance and had no prior type 2 diabetes diagnosis were included. Subsequently, they were categorized into three groups based on altitude of living area (<2 000, 2 000- and ≥3 000 m). With adjustment for intracluster correlation, multivariable linear regression analysis was performed to evaluate the associations of HbA1c with FPG and OGTT-2 h in the context of HbA1c was normal (<5.7%) or abnormal (≥5.7%). Furthermore, the shape of relationships between HbA1c and glucose indicators was examined using restricted cubic spline. Finally, receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA1c for diabetes. Results: A total of 157 277 subjects were included in the analysis. While FPG and OGTT-2 h levels gradually decreased with increase of altitude, HbA1c level was similar among the three groups. When HbA1c was <5.7%, its association with FPG and OGTT-2 h was weak and no obvious difference was observed among the three groups. When HbA1c was ≥5.7%, the FPG and OGTT-2 h increased by 15.45% (95%CI:14.71%- 16.18%) and 24.54% (95%CI:23.18%-25.91%) respectively per one standard deviation increase in HbA1c in group in area at altitude <2 000 m. However, the FPG and OGTT-2 h increased by 13.08% (95%CI:10.46%-15.76%) and 21.72% (95%CI:16.39%-27.31%), respectively, in group in area at altitude 2 000- m, and increased by 11.41% (95%CI:9.32%-13.53%) and 20.03% (95%CI:15.38%- 24.86%), respectively, in group of altitude ≥3 000 m. The restricted cubic spline indicated that the curve showing the association of HbA1c with FPG and OGTT-2 h was flat when HbA1c was <5.7%, but showed a positive linear relationship when HbA1c was ≥5.7%. The area under curve for detecting diabetes was 0.808 (95%CI:0.803-0.812) in group of altitude <2 000 m and 0.728 (95%CI:0.660-0.796, P=0.022) in group of altitude ≥3 000 m. The relevant optimal cutoff value of HbA1c was 5.7%, with a sensitivity of 65.4% and a specificity of 83.0%, and 6.0%, with a sensitivity of 48.3% and a specificity of 93.7%, respectively. Conclusions: When HbA1c was ≥5.7%, the association between HbA1c and glucose indicators became weaker as the increase of altitude. In the area at altitude ≥3 000 m, it may not be appropriate to use HbA1c in the diagnosis of diabetes.

[Blood glucose levels and the relationship of body mass index and circumference with blood glucose in China]

Objective: To describe and compare blood glucose levels in adults aged 18 years old and above in China and explore the relationship between BMI and waist circumference with blood glucose. Methods: China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method selected permanent residents aged 18 years and above. Information on demographics, behavior-related risk factors, BMI, waist circumference, and blood glucose were collected through a face-to-face questionnaire, physical measurement, and laboratory examination. After complex weighting of data, they described the blood glucose levels of people with different characteristics and explored the relationship of BMI and waist circumference with blood glucose by multiple linear regression model analysis. Results: A total of 177 816 adults were included in the study. The average fasting blood glucose and average glycosylated hemoglobin were (5.73±1.46) mmol/L and (5.37±0.83) %, with people aged 60 years old and above group highest than that of other, with males higher than females (P<0.001); and urban was higher slightly than rural for the average of average glycosylated hemoglobin (P<0.001). The average fasting blood glucose and average glycosylated hemoglobin increased with increased BMI and waist circumference (P<0.001). Results from multiple linear regression model analysis showed that: 1) for each increase in BMI unit and waist circumference, the fasting glucose levels increased by 0.019 mmol/L and 0.008 mmol/L (all P<0.001) in those not diagnosed with diabetes, 2) by 0.021 mmol/L (P=0.163) and 0.014 mmol/L (P=0.004) in those newly detected as diabetes, and 3) by 0.028 mmol/L (P=0.088) and 0.023 mmol/L (P<0.001) in those self-reported as having been diagnosed as diabetes, respectively. However, glycosylated hemoglobin levels increased: 1) by 0.015% and 0.006% in those not diagnosed as diabetes (all P<0.001), 2) by 0.050% and 0.019% in those newly detected as diabetes (all P<0.001), and 3) by 0.033% and 0.019% in those self-reported as having been diagnosed as diabetes (all P<0.001), respectively. These associations with waist circumference were more robust than with BMI. Conclusions: Adults not diagnosed with diabetes with abnormal BMI or waist circumference are the key population for prevention and control. Measures improving the awareness rate of waist circumference should be taken to maintain average blood glucose in various groups.

[Blood glucose measurement in Chinese adults, 2018]

Objective: To analyze the status of measuring the blood glucose among Chinese residents aged 18 years and above and to provide a scientific basis for evaluating the Healthy China Initiative. Methods: China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method selected permanent residents aged 18 years and above. Questionnaires collected demographic characteristics, blood glucose measurements, and significant chronic disease prevalence. Body measurements were conducted to collect body height, weight, and waist circumference; Fasting venous blood was collected from participants to measure FPG before OGTT-2 h was obtained among participants without a self-reported history of diagnosed diabetes. The analysis included 177 904 residents aged 18 and above. After being weighed, the blood glucose measurement rates of adults in different groups were compared. Results: Among adults who had not been diagnosed with diabetes, The blood glucose measurement rates of regular, prediabetes, and newly detected elevated blood glucose within 12 months were 32.0% (95%CI: 30.5%-33.5%), 39.5% (95%CI: 37.4%-41.6%) and 43.8% (95%CI: 41.0%-46.4%), respectively. The measurement rates were higher in females than males; urban was higher than rural. The blood glucose rates increased with age, education, and BMI. These differences were significant (P<0.05). Among the adults with diabetes, the blood glucose measurement rate within six months was 89.6% (95%CI: 88.4%-90.8%); the measurement rate was higher in females than in males and higher in the west than in east and central regions of China, with statistical significance (P<0.05). Among adults in the study who did not have 1 or 2 or ≥3 major chronic diseases, the blood glucose measurement rates within six months were 19.6% (95%CI: 18.4%-20.7%), 41.8% (95%CI: 40.1%-43.5%), 58.9% (95%CI:57.0%-60.7%),71.9% (95%CI: 69.0%-74.9%), respectively. The blood glucose measurement rate was on the rise and increased with the number of comorbidities (P<0.001). The blood glucose measurement rate of adults who did not have 1 or 2 major chronic diseases was higher in urban areas than in rural areas. The blood glucose rates increased with age, education, and BMI and the differences were significant (P<0.05). The blood glucose measurement rate of adults with ≥3 major chronic diseases was higher in females than in males (P<0.001), and there was no difference among other groups (P>0.05). Conclusion: It is necessary to promote blood glucose measurement in residents aged 18 years and above in China. Relevant departments should strengthen the publicity and education to promote regular blood glucose measurement for high-risk populations to improve the efficiency of preventing and treating diabetes and its complications.

[Awareness and influencing factors on weight and waist circumference among adult Chinese residents in 2018]

Objective: To understand the awareness of weight and waist circumference and their influencing factors among residents aged ≥18 years in China and provide a reference for the development of relevant prevention and treatment policies and evaluation of intervention effects. Methods: We selected 298 counties (districts) from the 31 provinces (autonomous regions and municipalities) which participated in the 2018 China Chronic Disease and Risk Factor Surveillance program and included 194 779 permanent residents aged ≥18 years. To obtain the demographic characteristics of the study population, we used a multi-stage stratified whole-group random sampling method, questionnaires, and physical measurements. In this study, 179 045 people who completed the survey and had complete information on weight and waist circumference awareness were used as the study subjects. The weight awareness rate and waist circumference awareness rate were calculated by gender stratification, age, urban-rural, and education level groups. A multi-factor logistic regression model was used to analyze the influencing factors related to weight and waist circumference awareness of residents aged ≥18 years. Results: The weight awareness rate of adult residents in China in 2018 was 45.4% (95%CI: 41.9%-48.9%), higher among men [46.2% (95%CI: 42.5%-49.8%)] than women [44.6% (95%CI: 41.1%-48.2%)], and in urban areas [54.3% (95%CI: 49.3%-59.3%)]. The highest weight awareness rate appeared in residents with low BMI grouping [49.9% (95%CI: 44.3%-55.6%)], and the weight awareness rate in residents with undiagnosed central obesity, hypertension, and diabetes was higher than that of residents with diagnosed diabetes, with statistically significant differences (P<0.05). The waist circumference awareness rate of adult residents was 11.6% (95%CI: 9.7%-13.4%), higher in women [12.8% (95%CI: 10.8%-14.8%)] than in men [10.3% (95%CI: 8.6%-12.0%)], higher in urban [14.6% (95%CI: 11.7%-17.4%)] than in rural [8.3% (95%CI: 6.5%-10.2%)], and the waist circumference awareness rate was higher among residents with confirmed diabetes than those with undiagnosed diabetes, with statistically significant differences (P=0.020). The difference was statistically significant (P<0.001). The weight and waist circumference awareness rate increased with education level and annual per capita household income. Multi-factor logistic regression analysis suggested that urban, highly educated, high per capita annual household income and health check-up residents may have higher weight and waist circumference awareness rates among adult residents in China. Conclusion: Less than half of the adult residents in China know their weight status, and only about one-tenth know their waist circumference. Rural residents, those with low education levels and low annual per capita household income, and those who are obese need to be given prioritized attention. The relevant government departments should strengthen the popularization of the importance of weight and waist circumference on health and improve the awareness of our residents about their waist circumference and weight.

[Analysis of blood pressure measurement among Chinese adults in 2018]

Objective: To analyze the blood pressure measurement of Chinese adult residents in 2018 and provide a scientific basis for early detection and intervention of hypertension. Methods: In 2018, China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties (districts) of 31 provinces (autonomous regions, municipalities) across the country, using a multi-stage stratified cluster random sampling method to survey permanent residents aged 18 years and above. We selected 184 509 people and carried out a face-to-face questionnaire survey and body measurement method to collect demographic data, major chronic diseases, and blood pressure measurement information of the survey subjects. Blood glucose and blood lipid-related indicators were obtained by laboratory testing. There were 170 551 adult residents included in the study after excluding abnormal and missing data for key variables. After complex weighting, blood pressure detection rates and detection times in people with different blood pressure levels and other diseases were analyzed. SAS 9.4 software was used to perform the χ²-test and trend test. Results: Among adult residents in China, the proportions of those with normal blood pressure, commonly recognized 'high' blood pressure, and newly detected hypertension who had their blood pressure tested within three months were 44.4%, 50.4%, and 52.6%, respectively. The proportions all appeared higher in women than in men (all P<0.05), in urban than in rural areas (all P<0.05), and showed an increasing trend with age (all P<0.001); The proportion of these three populations who had never had their blood pressure measured was 27.6%, 24.2%, and 23.5% respectively. The proportion of people with diagnosed hypertension who had their blood pressure tested within seven days was 44.0%, 51.4% in urban areas, higher than 37.7% in rural areas (P<0.001), and the proportion of people who had their blood pressure tested increased with education, per capita annual income and BMI (all P<0.001). Conclusions: The behavior of regular self-monitoring of blood pressure among adult residents in China still needs to be improved, especially among men and rural areas. Relevant health promotion and education should be strengthened. More targeted policies and measures should be developed to improve blood pressure measurement behavior in people with normal high blood pressure and other high-risk groups to control elevated blood pressure effectively.

[Effects of ursolic acid on oxidative stress and inflammatory factors in a rat model of AR after PM2.5 exposure]

Objective: To investigate the effects of ursolic acid (UA) on oxidative stress and inflammatory factors in a rat model of AR after PM2.5 exposure. Methods: Sixty healthy female SD rats were randomly divided into five groups: normal control group (NC group), PM2.5 unexposed AR group (AR group), PM2.5 exposed AR group (ARE group), UA intervention AR group (AR+UA group), and UA intervention PM2.5 exposed AR group (ARE+UA group), with 12 rats in each group. AR model was performed by a basal sensitization with intraperitoneal injection of ovalbumin (OVA) and followed by nasal instillation. PM2.5 exposure was carried out by inhalation exposure system at a concentration of 200 μg/m³ for 3 h/d for 30 days. UA intervention group was given UA intragastric administration at 20 mg/(kg·d). AR symptoms including sneezing, nasal scratching and nasal secretion of rats in each group were observed. The activities of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) in nasal mucosa were tested. The pathological changes of nasal mucosa were observed by HE staining. The levels of OVA-sIgE, IL-6 and IL-17 in serum were measured by enzyme-linked immunosorbent assay (ELISA). Protein microarray was used to measure the expression of multiple inflammation cell factors in nasal mucosa. Statistical analysis was performed with SPSS 20.0. Results: After UA intervention, the frequency of nasal sneezing, scratching and nasal secretion in ARE+UA group were lower than those of ARE group (P<0.05). Pathological examination of nasal mucosa showed that ARE+UA group had less inflammatory granulocyte infiltration and less pathological damage to the epithelial layer than ARE group. The activities of SOD in nasal mucosa of ARE+UA group were higher than those of ARE group ((50.10±3.09) U/mg vs (20.13±1.30) U/mg, F value was 597.54, P<0.01). The contents of MDA in nasal mucosa of ARE+UA group were lower than those of ARE group ((57.78±12.36) nmol/g vs (124.12±9.40) nmol/g, F value was 115.51, P<0.01). The expression levels of OVA-sIgE, IL-6 and IL-17 proteins were lower in the ARE+UA group than those in ARE group ((11.61±0.27) ng/ml vs (20.30±0.67) ng/ml, (47.59±15.49) pg/ml vs (98.83±10.98) pg/ml, (623.30±8.75) pg/ml vs (913.32±9.06) pg/ml, F value was 283.42, 80.45, 683.73, respectively, all P<0.01). After UA intervention, protein microarray analysis showed that the expression of IL-4, IL-6, IL-13, chemokine CXCL7, IL-1α, IL-1β, MMP-8 and MCP-1 in ARE+UA group was decreased compared with ARE group while IFN-γ and IL-10 increased (all P<0.01). Conclusion: UA can reduce the aggravated AR symptoms and pathological damage of nasal mucosa, inhibit oxidative stress and release of inflammatory factors after PM2.5 exposure, and thus plays a protective role in the pathological damage of AR induced by PM2.5 exposure.

[Study on community health management and control of hypertension in patients aged 35 years and above in China, 2015]

Objective: To understand the current status of community health management, treatment and control of hypertension in patients aged 35 years and above in China in 2015, and identify the influencing factors. Methods: Using the questionnaire survey results and physical measurement information collected by China Chronic Diseases and Nutrition Monitoring System in 2015, hypertension patients aged 35 years and above diagnosed at township health center level (community health service centers) or above were selected as the research subjects. The patients were complexly weighted to analyze their general characteristics, community health management, treatment and control status. Results: This study included 23 974 hypertension patients aged 35 years and above diagnosed by medical and health institutions at township level and above in 2015. After complex weighting, the community health management rate of hypertension patients aged 35 years and above was 54.10% (95%CI: 51.02%-57.17%), the standardized community management rate was 45.72% (95%CI: 42.93%-48.51%), the treatment rate was 88.16% (95%CI: 87.00%-89.31%), and the control rate was 22.67% (95%CI: 21.25%-24.09%), the treatment control rate was 27.76% (95%CI: 26.09%-29.42%). Multivariate analysis showed that patients in urban areas as well as in rural areas who were aged over 65 years old (OR=1.40, 95%CI: 1.05-1.87; OR=3.11, 95%CI: 2.22-4.36), taking medicine as prescribed (OR=2.15, 95%CI: 1.46-3.15; OR=1.35, 95%CI: 1.13-1.62), monitoring blood pressure (OR=2.34, 95%CI: 1.88-2.90; OR=3.10, 95%CI: 2.72-3.53) were more willing to accept community health management of hypertension. Urban hypertension patients with high education level (OR=0.51, 95%CI: 0.39-0.66), moderate alcohol consumption (OR=0.69, 95%CI: 0.57-0.84) or excessive alcohol consumption (OR=0.73, 95%CI: 0.58-0.92) had a poor acceptance of community hypertension management. Overweight (OR=0.74, 95%CI: 0.61-0.91; OR=0.83, 95%CI: 0.71-0.98), obesity (OR=0.54, 95%CI: 0.45-0.65; OR=0.67, 95%CI: 0.54-0.83) patients in urban areas as well as in rural areas with hypertension had poor blood pressure control, and patient taking medication as prescribed (OR=4.58, 95%CI: 3.16-6.63; OR=2.84, 95%CI: 2.18-3.69) had better blood pressure control. Urban hypertension patients in central China (OR=0.74, 95%CI: 0.61-0.89) or with excessive alcohol consumption (OR=0.72, 95%CI: 0.54-0.97) had poor blood pressure control while urban hypertension patients with other chronic diseases (OR=1.22, 95%CI: 1.04-1.44) and participating in standardized hypertension community management (OR=1.29, 95%CI: 1.06-1.58) had better blood pressure control.Rural hypertension patients who located in central and western China (OR=0.71, 95%CI: 0.58-0.87; OR=0.62, 95%CI: 0.47-0.80), with moderate alcohol consumption (OR=0.81, 95%CI: 0.67-0.98), taking salt more than 6 g per day (OR=0.80, 95%CI: 0.69-0.93) had poor blood pressure control, and the rural hypertension patients who underwent blood pressure monitoring (OR=1.38, 95%CI: 1.18-1.61) had better blood pressure control. Conclusions: The community health management of hypertension in patients aged 35 years and above has been improved in China, but there is still a certain gap between the control of hypertension and related indicators. It is necessary to take multi standardized intervention measures for the better prevention and control of hypertension.

[Association between alcohol consumption and insomnia in employed floating population in China]

Objective: To explore the relationship between alcohol consumption and insomnia among 18-59 years old employed floating population in mainland China, and provide scientific basis for the relevant policies to improve the sleep status of employed floating population from the perspective of alcohol consumption. Methods: Data were from Chinese Floating Population Chronic Disease Surveillance (2012). Floating population were selected from industries in 170 counties and districts of 31 provinces/autonomous regions, and Xinjiang Construction Corps in mainland China by using the stratified multistage cluster sampling. Demographic information, behavioral risk factors, insomnia, social pressure and chronic diseases were collected through using the face-to-face questionnaire. After complex weighting of the data, a multivariable logistic regression was used to explore the sleep status and its influencing factors among the employed floating population. Results: A total of 48 499 subjects were included in the analysis. The proportions of the employed floating population who never drank alcohol, drank small amount, and drank excessively were 48.3%, 41.8% and 9.9%, respectively. The prevalence of insomnia among the general, male and female employed floating population was 28.6%, 25.8% and 32.3%, respectively. The prevalence of insomnia among the employed floating population aged between 45 and 59 years old (32.2%) was higher than that in the population aged between 18 and 44 years old (28.2%). The multivariable logistic regression analysis showed that after adjusting confounding factors, compared with the employed floating population who never consumed alcohol as the reference group, the OR values of insomnia for the employed floating population with moderate drinking and excessive drinking were 1.40 and 1.53, respectively. The OR values of insomnia for the male and female employed floating population with moderate drinking were 1.28 and 1.53. The OR values of insomnia for the male and female employed floating population with excessive drinking were both 1.46. The OR values of insomnia for the population aged 18-44 years and 45-59 years with excessive drinking were 1.41 and 1.27. The OR values of insomnia for the population aged 18-44 years and 45-59 years with excessive drinking were 1.55 and 1.37. Conclusion: Small amount of drinking and excessive drinking are associated with insomnia among the employed floating population in mainland China. The association between excessive drinking and insomnia is stronger than that between small amount of drinking and insomnia.

[Study on construction and application of technology system of chronic diseases and risk factor surveillance in China]

To study and establish a set technology systems of sampling, investigation, quality control, and data analysis of complex sampling for chronic diseases and risk factor surveillance in China based on the requirements of the WHO and China's national conditions, and provide evidence for the policy making and prevention and control evaluation of chronic diseases and technical support for the research of chronic diseases. Through the study of complex sampling technique, adjustment of surveillance points and evaluation of their representatives, a national and provincial representative surveillance system and a complex weighted data analysis were established. According to the relevant plans, actions, and policies in China and other countries, the surveillance content and index system were studied and constructed, which was in line with China's national conditions, "1 + X" steps surveillance, covering the content of questionnaire , physical measurement, and laboratory testing. Based on modern information technology, a three-level platform of information collection and a multi-center laboratory quality control technology system were established, including sampling, information collection, biological sample management, quality control, and result display. Relying on the above research techniques, a national epidemiological investigation was conducted in China, which covered cerebrovascular disease, mental disorders, digestive system disease, and diabetes complications, to obtain the national representative data. This study reflected the innovation of "combination of medicine and prevention" and multi department cooperation in the fields of clinical medicine and public health and provided some big data for the health policy making and the evaluation of the effects of chronic disease prevention and control.

Identification of a new azoreductase driven prodrug from bardoxolone methyl and 5-aminosalicylate for the treatment of colitis in mice

For local treatment of ulcerative colitis, a new azoreductase driven prodrug CDDO-AZO from bardoxolone methyl (CDDO-Me) and 5-aminosalicylate (5-ASA) was designed, synthesized and biologically evaluated. It is proposed that orally administrated CDDO-AZO is stable before reaching the colon, while it can also be triggered by the presence of azoreductase in the colon to fragment into CDDO-Me and 5-ASA, generating potent anti-colitis effects. Superior to olsalazine (OLS, a clinically used drug for ulcerative colitis) and CDDO-Me plus 5-ASA, CDDO-AZO significantly attenuated inflammatory colitis symptoms in DSS-induced chronic colitis mice, which suggested that CDDO-AZO may be a promising anti-ulcerative colitis agent.

[Analysis of cervical cancer screening and related factors in China]

Objective: To study the cervical cancer screening rate and related factors among women in China. Methods: In 2015, Chinese Chronic Diseases and Risk Factors Surveillance in Adults was conducted in 298 counties or districts using the multistage stratified cluster sampling in China. The study investigated 91 348 women aged 20 years or older who lived in the local at least 6 months in the past year. We collected the information about cervical cancer screening and socio-demographic factors through face-to-face interview. The screening rate was calculated by the complex sampling design and populating weighting. Rao-Scott χ2 was used to test the differences in screening rates within subgroups. Multivariable logistic regression was used to explore the factors associated with the uptake of cervical cancer screening. Results: The mean age of participants was (51±14) years old. The cervical cancer screening rate was 23.6% (n=21 346), and there was a significant difference in the screening rates among age groups. The cervical cancer screening rate in women aged 40-49 years was 34.8% (n=7 043). There was significant difference in the screening rates among geographic areas and the highest screening rate was 27.9% (n=6 707) in the eastern China. The more likelihood of uptake of cervical cancer screening was significantly associated with living in high-income regions, higher education, non-agriculture employment, higher household income, having medical insurance, and having health check-up during the past three years, and the cervical screening rate was higher (all P<0.05) . Conclusion: The cervical cancer screening rate is low in China and there was significant difference in the age and geographic areas. The uptake of cervical cancer screening is associated with local economic status, household income, education, employment, health insurance, and health check-up.

A carrier-free anti-inflammatory platinum (II) self-delivered nanoprodrug for enhanced breast cancer therapy

Cisplatin is one of the most used first-line anticancer drugs for various solid tumor therapies. However, cisplatin-based chemotherapy can induce tumor cells to secrete excessive prostaglandin E2 (PGE2) catalyzed by cyclooxygenase-2 (COX-2), which, in turn, counteracts its chemotherapeutic effect and further accelerates tumor metastasis. Here, we report a carrier-free self-delivered nanoprodrug based on platinum (II) coordination bonding coupled with tolfenamic acid (Tolf) (named Tolfplatin). Tolfplatin can spontaneously assemble into uniformly sized nanoparticles (NPs) with a high drug-loading capacity. Compared with cisplatin, Tolfplatin NPs can facilitate cellular uptake, significantly decrease PGE2 secretion by COX-2 inhibition, which further downregulate tumorous anti-apoptotic and metastasis-associated proteins, thereby efficiently inducing apoptotic cell death and significantly inhibit tumor metastasis in vitro and in vivo. Therefore, as the carrier-free nanoprodrug, Tolfplatin NPs are promising anti-tumoral agents to inhibit tumor proliferation and metastasis by enriching the function and promoting the anti-tumor activity of cisplatin.

Nitric oxide donating anti-glaucoma drugs: advances and prospects

Glaucoma is a disease that causes irreversible blindness. Reducing intraocular pressure (IOP) is the main treatment at present. Nitric oxide (NO), an endogenous gas signaling molecule, can increase aqueous humor outflow facility, inhibit aqueous humor production thereby reducing IOP, as well as regulate eye blood flow and protect the optic nerve. Therefore, NO donating anti-glaucoma drugs have broad research prospects. In this review, we summarize NO-mediated therapy for glaucoma, and the state of the art of some NO donating molecules, including latanoprostene bunod in market and some other candidate compounds, for the intervention of glaucoma, as well as prospects and challenges ahead in this field.

[Status of sleep and influencing factors in employed floating population in China]

Objective: To understand the sleep status and related influencing factors among 18-59 years old employed floating population and to provide evidence for policy development. Methods: Data were gathered from the Chinese Floating Population Chronic Disease Surveillance (2012) program. Floating population were selected through multistage clustering sampling method and stratified by industries from China. Information on demographics, behavior-related risk factors, sleep duration and social pressure etc., were collected through face-to-face interview on questionnaires. After complex weighting of data, multivariable logistic regression method was used to explore the sleep status and related influencing factors among these employed floating people. Results: A total of 43 521 subjects were included in the study. The average sleep duration per day was 7.77 h, with females (7.87 h) higher than males (7.69 h). The prevalence of insufficient sleep was 12.3% (95%CI: 11.8%-12.7%), with 45-59 years old group (21.2%) higher than that of the 18-year olds (11.2%). Results from the multivariable logistic regression analysis showed that factors as gender, age, marital status, education, occupation, inflowing area, behavior-related risk factors, BMI, social pressure, self-rated health status and self-reported chronic diseases were the main factors that affecting the rates of sleep deficiency in this population. The prevalence rate of insufficient sleep was 1.18 times higher (95%CI: 1.07-1.31) in males than that in females, and 1.22 (95%CI: 1.11-1.33) times higher in smokers than that in the non-smokers, 1.31(95%CI: 1.16-1.49) times higher in excessive drinkers than that of the normal population, 1.46 (95%CI: 1.29-1.65) times and 1.33 (95%CI: 1.18-1.50) times in those with heavier workload and stress than those without. Conclusion: The prevalence of insufficient sleep among the employed floating population was affected by multiple factors that called for more attention by different departments of the government.

Design, synthesis, and biological evaluation of ligustrazine/resveratrol hybrids as potential anti-ischemic stroke agents

To search for potent anti-ischemic stroke agents, a series of tetramethylpyrazine (TMP)/resveratrol (RES) hybrids 6a-t were designed and synthesized. These hybrids inhibited adenosine diphosphate (ADP)- or arachidonic acid (AA)-induced platelet aggregation, among them, 6d, 6g-i, 6o and 6q were more active than TMP. The most active compound 6h exhibited more potent anti-platelet aggregation activity than TMP, RES, as well as positive control ticlopidine (Ticlid) and aspirin (ASP). Furthermore, 6h exerted strong antioxidative activity in a dose-dependent manner in rat pheochromocytoma PC12 cells which were treated with hydrogen peroxide (H₂O₂) or hydroxyl radical (·OH). Importantly, 6h significantly protected primary neuronal cells suffered from oxygen-glucose deprivation/reoxygenation (OGD/R) injury, comparable to an anti-ischemic drug edaravone (Eda). Together, our findings suggest that 6h may be a promising candidate warranting further investigation for the intervention of ischemic stroke.

[Correlation between hypertension label and self-rated health in adult residents in China]

Objective: To study the correlation between hypertension label and self-rated health (SRH) in adults aged ≥18 years in China. Methods: Data were from 2013 Chronic Non-communicable Disease and Risk Factor Surveillance Project. The project collected the information through multi stage stratified cluster sampling, face-to-face questionnaire survey and on-site body measurement. The SRH status of the adults was inquired according to the recommendation of Behavioral Risk Factor Surveillance System (BRFSS) in the United States. Blood pressure measurement was performed by using OMRON HBP-1300 electronic sphygmomanometer. Surveymeans and surveyfreq processes were used to describe the general characteristics of the sample population. The cumulative odds logit model was implemented by the processes of surveylogistic to analyze the association between hypertension label and self-rated health in adults in China. Results: A total of 173 008 subjects were included in this study. Hypertension was associated with poorer SRH (OR=1.29, 95%CI: 1.22-1.35, P<0.001), but this association was eliminated by adjustment for hypertension label (P=0.670). Hypertension label was associated with poorer SRH (OR=2.09, 95%CI: 1.96-2.23, P<0.001) and the association was still significant even after adjusting for actual hypertension status (OR=2.08, 95%CI: 1.94-2.23, P<0.001). In hypertension group, those with hypertension label had poorer SRH than those without hypertension label (OR=2.18, 95%CI: 2.02-2.36, P<0.001). In normal blood pressure group, those with hypertension label had poorer SRH than those without hypertension label (OR=1.89, 95%CI: 1.64-2.18, P<0.001). Men's SRH was more sensitive to hypertension label, especially in hypertension group (OR=2.20, 95%CI: 1.98-2.45, P<0.001). The results were all adjusted for demographic factors, smoking status, alcohol consumption, physical activity and chronic diseases. Conclusions: Hypertension label is associated with self-rated health independently in adults in China. The diagnosis of hypertension should strictly follow the latest guidelines.

[Self-body weight measurement in overweight and obese adults in China, 2013]

Objective: To investigate the status of self-measurement of body weight in overweight and obese adults in China and identify the related factors. Methods: A total of 87 670 adults were enrolled in this study, who were selected through multi stage cluster random sampling from 177 099 residents aged ≥18 years in 302 surveillance areas in China where the fourth chronic non-communicable disease and related factor surveillance project was conducted in 2013. The information about their demographic characteristics and body weight measurement were collected by using questionnaire. Their body height, body weight, waist circumstance and blood pressure were measured respectively through physical examination. Fasting venous blood samples were obtained and assayed for FPG, TC, TG, LDL-C and HDL-C levels. Venous blood samples after 75 g glucose intake were obtained and assayed for OGTT-2h level. The proportion of self-body weight measurement were analyzed after complex sample weighting. Results: The proportion of overweight and obese adults who had self-body weight measurement within 1 week, 1 month and 1 year were 18.9%, 23.0% and 30.2%, respectively. The proportion of those having self-body weight measurement within 1 week was higher in men than in women, and lowest in ≥60 years old group (P<0.05). The proportion of overweight and obese adults who had never measured their body weight was 20.5%, the proportion was higher in women than in men, and highest in ≥60 years old group (P<0.05). Older age (OR=0.73, 95%CI: 0.64-0.82) was risk factor for self-body weight measurement; female (OR=1.11, 95%CI: 1.03-1.19), higher education level (junior college and above OR=3.79, 95%CI: 2.89-4.97), high- income (OR=1.61, 95%CI: 1.31-1.98), dyslipidemia (OR=1.13, 95%CI: 1.04-1.23), diabetes (OR=1.15, 95%CI: 1.03-1.30) were the protective factors for self-body weight measurement. Conclusion: It is necessary to promote self-body weight measurement in overweight and obese adults in China. Targeted health education should be carried out for different groups to encourage regular self-body weight measurement to maintain healthy body weight.

[A study regarding the control attempts on body weight and related factors among overweight and obese adults in China, 2013]

Objective: To understand the control attempts of body weight and its related factors among overweight and obese adults in China. Methods: Data was from the 2013 Chinese Chronic Diseases and Risk Factors Surveillance Program, which covered 302 surveillance sites. 179 570 adults, selected through multistage stratified cluster sampling method, were interviewed. Demographic characteristics and weight-control attempts were collected via face-to-face interview. BMI, waist circumstance and blood pressure were individually measured under physical examination. Venous blood samples were obtained and tested for FPG, OGTT-2h, TC, TG, LDL-C and HDL-C. A total of 87 545 overweight and obese patients were included in this study, with the exclusion of 152 patients having the missed critical information. Rates on weight control and attempts were analyzed, using the complex weighting on samples to represent the overall overweight and obese adults in China. Results: The rate of weight-control attempts was 16.3% (95%CI: 14.9%-17.7%). Among all the 12 133 patients who had undergone weight-control measures, the proportions of different attempts were as follows: diet (40.9%, 95%CI: 38.4%-43.3%), combination of diet and physical activity (31.5%, 95%CI: 28.9%-34.0%), physical activity (22.8%, 95%CI: 21.0%-24.6%) and drug control (1.3%, 95%CI: 1.0%-1.7%). Factors as: being female (OR=1.26, 95%CI: 1.15-1.38), at younger age (18-44 years old, OR=1.51, 95%CI: 1.31-1.74), with high education levels (college degree or above, OR=4.52, 95%CI: 3.76-5.43), having high annual income (≥24 000 Yuan, OR=1.94, 95%CI: 1.63-2.30) etc., appeared as favorable factors for taking the measures vs. rural residency (OR=0.63, 95%CI: 0.55- 0.72) as the unfavorable one. Conclusion: The rate of weight-control attempts appeared low among the overweight and obese adults who were affected by factors as age, education and income level. Personalized intervention measures should be carried out for people with different characteristics.

[Study of epidemiological characteristics of metabolic syndrome and influencing factors in elderly people in China]

Objective: To estimate the prevalence of MS in elderly people aged ≥60 years and its related factors in China and provide scientific evidence for prevention and control of MS in the elderly. Methods: Data used in this study were obtained from the 2013 Chinese Chronic Diseases and Risk Factor Surveillance Program. A total of 50 497 people aged ≥60 years were selected and interviewed through multistage stratified cluster sampling at 298 surveillance sites in 31 provinces. According to the Chinese MS diagnostic criteria proposed by the Chinese Medical Association Diabetes Branch in 2017, the prevalence rates of different MS forms were compared, and the main related factors were analyzed. Results: The prevalence rate of MS was 36.9% (95%CI: 35.4-38.5). The prevalence rate was higher in urban area than in the rural area, higher in females than in males, higher in eastern area than in western area. The prevalence rate of MS in elderly people aged ≥70 years was lower than that in those aged 60-69 years. The rate in the elderly with higher education and income levels was higher than that in the elderly with lower socioeconomic level. The comparison of the prevalence of the five forms of MS in the elderly showed that hypertension had the highest prevalence rate (72.8%), followed by hyperglycemia (41.7%) and central obesity (37.6%). The prevalence rates of hypertriglyceridemia and low HDL-C were 25.8% and 17.5%. The risk for MS in women was 1.20 times higher than that in men. Age, gender, education level, living area and urban or rural residence were the main factors influencing the prevalence of MS. Smoking, drinking and physical activity levels were correlated with MS. Conclusions: The risk for MS was higher in women than in men in China's elderly population, and the risk was related to socioeconomic level and life behaviors. It is recommended to carry out lifestyle interventions, such as increasing exercise and having reasonable diet for the elderly patients with MS. Hypertension and diabetes patients also need to be treated with drugs to reduce the risk of cardiovascular disease morbidity and mortality.

[Study of the prevalence and disease burden of chronic disease in the elderly in China]

Objective: To understand the prevalence and disease burden of major chronic diseases in the elderly in China and provide scientific basis for the prevention and control of chronic diseases and for the rational allocation of health resources. Methods: We analyzed the prevalence of chronic diseases in residents aged ≥60 years in China by using national and provincial surveillance data of chronic diseases and related risk factors in China. We conducted the analysis on the burden of chronic diseases in the elderly in China by using the data of global burden of disease. Results: The prevalence rates of hypertension, diabetes and hypercholesterolemia were 58.3%, 19.4% and 10.5% respectively in residents aged ≥60 years in China. Up to 75.8% of the residents aged ≥60 years had at least one chronic disease. The prevalence rate was higher in women than in men, higher in urban area than in rural area. With the increase of age, the prevalence rate of chronic diseases also increased. The top three chronic diseases with heavy disease burden in residents aged ≥70 years were stroke, myocardial infarction, cancer and chronic obstructive pulmonary disease. Conclusion: The prevalence of major chronic diseases in the elderly is high with three quarters of the elderly suffering from at least one chronic disease, and the burden of chronic diseases is increasing.

[The definition of heat-wave based on mortality risk assessment in different regions of China]

Objective: To identify the definition of heat wave based on mortality risk assessment in different regions of China. Methods: Daily mortality (from China Information System for Disease Control and Prevention) and meteorological data (from National Meteorological Information Center in China) from 66 counties with a population of over 200 000 were collected from 2006-2011. With the consideration of climate type and administrative division, China was classified as seven regions. Firstly, distributed lag non-linear model (DLNM) was used to estimate community-specific effects of temperature on non-accidental mortality. Secondly, a multivariate meta-analysis was applied to pool the estimates of community-specific effects to explore the region-specific temperature threshold and the duration for definition of heat wave. Results: We defined regional heat wave of Northeast, North, Northwest, East, Central and Southwest China as being two or more consecutive days with daily mean temperature higher than or equal to the P(64), P(71), P(85), P(67), P(75) and P(77) of warm season (May to October) temperature, respectively, while the thresholds of temperature were 21.6, 23.7, 24.3, 25.7, 28.0 and 25.3 ℃. The heat wave in South China was defined as five or more consecutive days with daily mean temperature higher than or equal to the P(93) (30.4 ℃) of warm season (May to October) temperature. Conclusion: The region-specific definition of heat wave developed in our study may provide local government with the guidance of establishment and implementation of early heat-health response systems to address the negative health outcomes due to heat wave.

[Co-prevalence of chronic disease risk factors and influencing factors in floating population in China]

Objective: To investigate the prevalence and co-prevalence of tobacco use, excessive alcohol use, insufficient intake of vegetable and fruit, physical inactivity, and overweight or obesity in floating population and influencing factors in China, 2012. Methods: Data from the 2012 China Chronic Disease Risk Factor Survey in Floating Population in China were used. In this survey, 48 704 people aged 18-59 years in floating population were selected through stratified multistage clustering sampling in 170 counties and districts from 31 province (autonomous regions and municipalities) and Xinjiang Production and Construction Corps. The gender specific prevalence and co-prevalence of five risk factors were estimated, and the rank sum test was used for result comparison. Results: Among the people surveyed, 27.4% had one risk factor, 37.1% had two risk factors, 28.5% had ≥3 risk factors. The prevalence or co-prevalence of risk factors were positively correlated with age (P<0.05), income level (P<0.05) and migration time (P<0.05), and negatively correlated with educational level (P<0.05). People who were males, in Han ethnic group, engaged in construction and from other provinces were more likely to have more risk factors (P<0.05). Conclusion: The prevalence and co-prevalence of tobacco use, excessive alcohol use, insufficient intake of vegetable and fruit, physical inactivity and overweight or obesity were high in floating population in China, suggesting that it is necessary to strengthen the comprehensive behavior intervention in floating population.

Hypoxia alleviation-triggered enhanced photodynamic therapy in combination with IDO inhibitor for preferable cancer therapy

Photodynamic therapy (PDT) has attracted growing attention in the field of cancer therapy due to its non-invasive intervention and initiation of antitumor immune responses by use of non-toxic photosensitizers (PS) and topical light irradiation. However, inherent hypoxia and immunosuppression mediated by checkpoints in tumors severally impair the efficacy of PDT and PDT-induced immunity. Herein, a multi-functional nanoplatform is rationally constructed by fluorinated polymer nanoparticle saturated with oxygen in advance, which simultaneously encapsulated PS (Ce6) and an indoleamine 2,3-dioxygenase (IDO) inhibitor (NLG919). In particular, the tumor hypoxic microenvironment is obviously relieved and much more reactive oxygen species (ROS) is generated by fluorinated nanoparticle compared with alkylated polymer nanoparticle as a control in vitro and in vivo, this is mainly because the fluorinated polymers are endowed with high oxygen carrying capacity which also contributed to the relief of hypoxia. Meanwhile, compared to PDT alone, the co-encapsulation of IDO inhibitor and PS can further greatly enhance efficacy for inhibiting the growth of primary and abscopal tumors via enhanced T cell infiltration. This study can provide a convenient and practical strategy for enhancing the therapeutic effect of PDT and relieving immune suppression, in turn affording clinical benefits for cancer treatment.

[Medical treatment seeking behaviors and its influencing factors in employed floating population in China]

Objective: To understand medical treatment seeking behaviors and its influencing factors in employed floating population in China and provide evidence for the development of health service policies for floating population. Methods: Data were from the national chronic disease and risk factor surveillance (floating population part) in 2012. Floating population were selected through multistage clustering sampling stratified by industries in 170 counties and districts from 31 provinces (autonomous regions, municipality directly under the central government) and Xinjiang Production and Construction Corps in the mainland of China. Information on demographic basic information, health status and health seeking behaviors six months before the investigation were collected through face-to-face questionnaire interview. The people aged 18-59 who had physical discomfort in the past six months was analyzed. After complex weighted analysis, multinomial logistic regression model was used to analyze the health seeking behavior and its influencing factors in the employed floating population. Results: A total of 11 134 suitable people aged 18-59 years were included in the study. The number and proportion of the people seeking medical treatment, having self-treatment and having no treatment were 4 950 (44.5%), 3 880 (34.8%) and 2 304 (20.7%), respectively. Multinomial logistic regression analysis showed that women were 1.275 times (95%CI: 1.100-1.477) more likely to seek medical treatment compared with men. The medical treatment seeking rates of floating population in the eastern, central and western areas were 2.153 times (95%CI: 1.669-2.777), 2.310 times (95%CI:1.777-3.002), 2.177 times (95%CI: 1.695-2.796) higher than that of floating population in northeastern area. In terms of seeking treatment, the proportion of the floating population with annual income of more than 25 000 yuan was 1.255 times (95%CI: 1.088-1.448) higher than that of the floating population with annual income of 25 000 yuan or less than 25 000 yuan. The proportion of the floating population with severe physical discomfort within the past six months was 8.076 times (95%CI: 6.091-10.707) higher than that of the floating population without severe physical discomfort and the proportion of the floating population who participated in medical insurance in both original living places and current living places was 1.566 times (95%CI: 1.250-1.961) higher than that of the floating population who did not participate in medical insurance in two places. The incidence ratio of medical care seeking and self-treatment in new generation of floating population was 1.369 (95%CI: 1.157-1.619) and 1.240 (95%CI: 1.042-1.475) compared with old generation of floating population. Compared with the widowed/divorced/separated, the incidence ratio of medical treatment seeking and self-treatment for the married/cohabited was 1.590 (95%CI: 1.057-2.391) and 1.815 (95%CI: 1.209-2.725). The more severe physical discomfort, the higher level medical institutions they chose (P<0.05). Conclusions: The treatment rate in medical institutions of employed floating population was low in China. Gender, generation of floating population, marital status, area, annual income, severity of physical discomfort in past six months and the way to participate in medical insurance were the main factors affecting the medical treatment seeking behaviors of employed floating population.

Establishment and Characterization of Pemetrexed-resistant NCI-H460/PMT Cells

BACKGROUND

Pemetrexed (PMT) is a multitargeted antifolate agent that is used for treating patients with Non-Small Cell Lung Cancer (NSCLC). However, patients have presented clinical responses of drug resistance to PMT.

OBJECTIVE

This study aimed to explore the underlying mechanisms of PMT resistance in NSCLC cells.

METHODS

PMT-resistant NCI-H460/PMT cells were established by treating with PMT in a concentrationescalation manner. MTT assay and colony formation were performed to detect cell proliferation. Immunofluorescence was used to detect the expression of Ki-67. Transwell assay was performed to measure cell migration ability. qPCR and Western blot were used to detect the mRNA and protein expression levels of indicated genes. Small interfering RNAs (siRNA) were used to knockdown ATP binding cassette subfamily B member 1 (ABCB1) and Thymidylate Synthase (TYMS).

RESULTS

This study showed that compared with the parental cells, the NCI-H460/PMT cells displayed weakened proliferation and enhanced cell mobility. In addition, the NCI-H460/PMT cells demonstrated cellular senescence, which might result in PMT resistance. The NCI-H460/PMT cells exhibited cross-resistance to other chemotherapeutics, including fluorouracil, paclitaxel, doxorubicin, etoposide and gemcitabine, possibly because of the upregulated expression of ABCB1. However, the ABCB1 knockdown by siRNA failed to eradicate PMT resistance. Moreover, TYMS, a target of PMT, was obviously upregulated in the resistant cells. The genetic silence of TYMS partially abrogated PMT resistance, suggesting that the overexpression of TYMS was a key resistant mechanism of PMT.

CONCLUSION

The overexpression of TYMS was an important resistance mechanism of PMT for KRAS-mutated NCI-H460 cells. Cross-resistance to other chemotherapeutics should be considered in addressing PMT resistance.

[Study on relationship between prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure level in adults in China]

Objective: To study the relationship between blood pressure level and major risk factors for cardiovascular diseases in adults in China. Methods: A total of 179 347 adults aged ≥18 years were recruited from 298 surveillance points in 31 provinces in China in 2013 through complex multistage stratified sampling. The survey included face to face interview and physical examination to collect information about risk factors, such as smoking, drinking, diet pattern, physical activity, overweight or obesity, and the prevalence of hypertension. The blood pressure was classified into 6 levels (ideal blood pressure, normal blood pressure, normal high blood pressure and hypertension phase Ⅰ, Ⅱ and Ⅲ). The relationship between the prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure was analyzed. Results: The adults with ideal blood pressure, normal blood pressure, normal high pressure, hypertension phase Ⅰ, Ⅱ and Ⅲ accounted for 36.14%, 22.77%, 16.22%, 16.43%, 5.97% and 2.48%, respectively. Among them, the blood pressure was higher in men, people in Han ethnic group and those married, and the blood pressure was higher in those with older age, lower income level and lower education level, the differences were all significant (P<0.05). Whether taking antihypertensive drug or not, co-prevalence of risk factors influenced the blood pressure levels of both sexes (P<0.05), and the blood pressure levels of those taking no antihypertensive drug was influenced more by the co-prevalence of risk factors. Finally, multiple logistic analysis showed that the risks for high blood pressure in adults with 1, 2 and ≥3 risk factors were 1.36, 1.79 and 2.38 times higher, respectively, than that of the adults without risk factor. Conclusion: The more the risk factors for cardiovascular disease in adults, the higher their blood pressure were. It is necessary to conduct comprehensive behavior intervention targeting ≥ 2 risk factors for the better control of blood pressure in general population.

[Multilevel logistic regression analysis on hypercholesterolemia related risk factors among adults in China]

Objective: To investigate the prevalence of hypercholesterolemia among Chinese adults in different geographic areas, and to analyze the related factors. Methods: China Chronic and Non-Communicable Disease and Risk Factor Surveillance was conducted in 2013, based on 298 counties/districts in 31 provinces of Chinese mainland. The adults aged 18 years old were randomly selected using multi-stage stratified clustering sampling method. Information on chronic disease and risk factors was collected using face-to-face questionnaire interview and physical measurement. Blood samples were collected by local staffs. Serum total cholesterol (TC) was determined using standard method in a central laboratory. After excluding 565 participants missing key variables and 1 558 participants with abnormal TC values, a total of 174 976 participants were included. Weighted prevalence of hypercholesterolemia was calculated. Hypercholesterolemia related individual or geographic determinants were defined using multilevel logistic regression. Results: The prevalence of hypercholesterolemia in Chinese adults age 18 years old and above was 6.9% (95%CI: 6.4%-7.3%), ranged from 3.0% (95%CI: 2.5%-3.4%) in the northwest of China to 14.2% (95%CI: 12.9%-15.5%) in the south (χ(2)=183.42, P<0.001). The prevalence of hypercholesterolemia was higher in 6 provinces including Tianjin, Liaoning, Fujian, Guangdong, Guangxi, and Hainan (≥9.0%), but lower in 7 provinces including Shanxi, Shannxi, Gansu, Qinghai, Ningxia, Xinjiang, and Tibet (<3.9%). There was a 1.27 fold variation in hypercholesterolemia prevalence by provincial level, and 72.5% of the geographical variation in hypercholesterolemia prevalence was account for by area-level determinants. With multilevel logistic analysis, the individual risk factors associated with hypercholesterolemia included aging, higher education level or annual household income per capita, regular drinking, too much red meal intake, inactivity, overweight or obesity. For geographic factors, residents living at south China, counties/districts with higher urbanization rates, higher education level or lower standardized death rates were more likely to have hypercholesterolemia (all P<0.05). Conclusion: The prevalence of hypercholesterolemia was high in Chinese adults, it was different between regions and related with characteristics of population, individual behaviors and geographical regions.

[Relations between cigarette smoking and chronic diseases of Chinese adults in 2013]

Objective: To explore the relations between the prevalence of multiple chronic diseases and cigarette smoking behavior in the Chinese adults. Methods: Based on the results: from the 2013 Chronic Disease Risk Factor Surveillance (NCD Surveillance), 176 534 Chinese residents aged 18 years and above, covering 298 counties (districts) in 31 provinces, was randomly recruited, using the multi-stage stratified clustering sampling method. Information on demographics, cigarette smoking (status, quantity and period) was obtained through face-to-face interviews and questionnaires. Anthropometric data and blood samples were collected and properly stored for analysis. Results In total, 175 386 adults were included for statistical analyses, with 42.7% as males and 57.3% as females. The prevalence rates of hypertension, high total cholesterol and high triglycerides were 30.4%, 7.2% and 18.0% in male smokers, 35.6%, 14.0%, 10.3% and 15.9% in female smokers respectively, which were all higher than those in the respective non-smokers. Male smokers were found under lower risk on hypertension, but 19% higher on total glycerides when compared with non-smokers of the same sex(OR=1.19, 95%CI:1.10-1.30), when multiple risk factors were under control. Male current smokers with more than 20 cigarettes per day have 41% (OR=1.41, 95%CI: 1.28-1.55) higher risk of high TG than non-smokers. Female smokers presented 40% (OR=1.40, 95%CI: 1.15-1.70) higher risk in high glycerides than the non-smokers. Specifically, women smoking longer than 20 years have 60% (OR=1.60, 95%CI: 1.31-1.95) higher risk of high TG than women smoking less than 20 years. Conclusions: Prevalence rates of certain chronic diseases were seen higher in smokers of both genders. People with longer history of smoking or being heavier smokers, appeared at advanced risk on developing chronic diseases.

Synthesis and evaluation of 2-cyano-3, 12-dioxooleana-1, 9(11)-en-28-oate-13β, 28-olide as a potent anti-inflammatory agent for intervention of LPS-induced acute lung injury

The present study was designed to synthesize 2-Cyano-3, 12-dioxooleana-1, 9(11)-en-28-oate-13β, 28-olide (1), a lactone derivative of oleanolic acid (OA) and evaluate its anti-inflammatory activity. Compound 1 significantly diminished nitric oxide (NO) production and down-regulated the mRNA expression of iNOS, COX-2, IL-6, IL-1β, and TNF-α in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Further in vivo studies in murine model of LPS-induced acute lung injury (ALI) showed that 1 possessed more potent protective effects than the well-known anti-inflammatory drug dexamethasone by inhibiting myeloperoxidase (MPO) activity, reducing total cells and neutrophils, and suppressing inflammatory cytokines expression, and thus ameliorating the histopathological conditions of the injured lung tissue. In conclusion, compound 1 could be developed as a promising anti-inflammatory agent for intervention of LPS-induced ALI.

[Geographical variation and related factors in prediabetes prevalence in Chinese adults in 2013]

Objective: To investigate the geographical variation of prediabetes in adults in different regions of China, and to analyze the related factors of prediabetes. Methods: Data was obtained from China Chronic Disease and Related Risk Factor Surveillance in 2013. The surveillance adopted multiple-stage stratified cluster random sampling method, which sampled 177 099 residents aged above 18 years old among 298 surveillance points in 31 provinces of Chinese Mainland. Questionnaire interview was used to obtain demographic variables, personal living style, and socio-economical information. Physical examination was conducted and fasting venous blood sample and (oral glucose tolerance test-2 hours, OGTT-2 h) venous blood sample were obtained from the participants. A total of 171 567 residents aged 18 and above were included in the analysis. The prevalence of prediabetes was analyzed by provinces and by China's geographical regions, after complex weighting. Multilevel logistic models were established to explore the related factors of prediabetes on the area level and individual level. Results: The prevalence of prediabetes among residents aged 18 and above was 16.6% (95%CI: 15.6%-17.6%) in China. The prevalence of prediabetes was the highest (18.3%) in the south China and lowest (13.1%) in the northwest area. The difference of the prevalence in different areas were not statistically significant (P=0.510). If categorized the prevalence of prediabetes into 5 groups by quintile, Hainan, Jilin, Shandong, Anhui, Hunan and Chongqing were in the highest group of prevalence of prediabetes (18.6%-22.7%), and Tibet, Qinghai, Gansu, Ningxia, Guizhou, and Jiangxi were in the lowest group (7.6%-12.6%). The variance of prevalence of prediabetes on the county level (MOR: 1.60 (95%CI:1.53-1.67)) was more diverse than the province level (MOR: 1.21(95%CI:1.08-1.29)) and higher than the street level (1.23 (95%CI:1.14-1.30)). Several factors increased risk of pre-diabetes, including smoking, hazardous drinking and harmful drinking, drinking in the past 30 days, overweight, obesity, central obesity, sugary drink intake, hypertension, high total cholesterol, high triglycerides, high blood low-density lipoprotein cholesterol, low blood high-density lipoprotein cholesterol (all P<0.05). After adjusted the above variables, 92.5% of variance of prediabetes prevalence conld be explained on the provincial level. Conclusion: The geographical distribution of prediabetes in adults in China differed by geographic areas, and it significantly varied on the county level. The related variables included demographic variables, personal behavior, and geographic related variables.

Synthesis and anti-hepatocellular carcinoma activity of novel O2-vinyl diazeniumdiolate-based nitric oxide-releasing derivatives of oleanolic acid

Considering that high levels of nitric oxide (NO) exert anti-cancer effect and the derivatives of oleanolic acid (OA) have shown potent anti-cancer activity, new O²-vinyl diazeniumdiolate-based NO releasing derivatives (5a-l, 11a-l) of OA were designed, synthesized, and biologically evaluated in the present study. These derivatives could release different amounts of NO in liver cells. Among them, 5d, 5i, 5j, 11g, 11h, and 11j released more NO in SMMC-7721 cells and displayed stronger proliferative inhibition against SMMC-7721 and HepG2 cells than OA and other tested compounds. The most active compound 5j showed almost 20-fold better solubility than OA in aqueous solution, released larger amounts of NO in liver cancer cells than that in normal ones, and exhibited potent anti-hepatocellular carcinoma activity but little effect on the normal liver cells. The inhibitory activity against the cancer cells was significantly diminished upon addition of an NO scavenger, suggesting that NO may contribute, at least in part, to the activity of 5j.

[Survey of degree of passive smoking exposure and related risk awareness in adults in China, 2013]

Objective: To understand the passive smoking exposure level and related risk awareness in adults in China in 2013. Methods: A face-to-face questionnaire survey was conducted in 179 570 adults selected through multistage cluster sampling from Chinese chronic disease and risk factors surveillance sample population (2013) in 302 surveillance sites. The effective sample size was 176 179 adults. After comprehensive weighting of the samples, the passive smoking exposure level and the awareness rate of related risks were analyzed. Results: The passive smoking exposure rate was 52.8% (95%CI: 51.2%-54.4%) and the rate decreased with age (χ(2)=515.8, P<0.000 1). The exposure rate was highest in persons engaged in commercial services (61.6%, 95%CI: 58.6%-64.5%). The awareness rate of related risks was 67.9% (95%CI: 65.8%-69.9%). The awareness rate was higher in urban area (77.0%, 95%CI: 75.0%-79.1%) than in rural area (60.0%, 95%CI: 57.7%-62.4%), in males (69.8%, 95%CI: 67.8%-71.7%) than in females (65.9%, 95%CI: 63.7%-68.1%). The awareness rate of three related diseases in urban residents (49.8%, 95%CI: 47.3%-52.4%) were higher than that in rural residents (37.9%, 95%CI: 35.4%-40.5%); the awareness rate of passive smoking related lung cancer was highest (88.5%, 95%CI: 87.5%-89.5%), followed by lung disease in children (70.0%, 95%CI: 68.1%-71.9%), the awareness rate of passive smoking related heart disease was lowest (46.8%, 95%CI: 44.6%-49.1%). Conclusion: The passive smoking exposure level is relatively high in adults in China, and the awareness rate of passive smoking exposure risks, especially heart disease, is low.

Myocardial elastogram using a fast mapping algorithm

Ultrasound myocardial elastography is a promising technique to estimate regional myocardial function. In this study, we proposed a fast mapping method to map myocardial elastogram. A nude mouse's heart was scanned in supine position by an ultrasound system. The parasternal long-axis view of the heart and the ultrasound radio frequency (RF) signals were acquired for dynamic estimation of myocardial elasticity. The displacement and strain were calculated using analytic minimization (AM) and linear polynomial curve fitting method, respectively. The fast mapping method was proposed to map myocardial elastogram. The results display the contraction of myocardium intuitively. The method in this study is proved to have a potential to estimate viable myocardium in the future.

[Lagged effects of diurnal temperature range on mortality in 66 cities in China: a time-series study]

Objective: To estimate the effect of daily diurnal temperature range (DTR) on mortality in different areas in China. Methods: A time series study using the data collected from 66 areas in China was conducted, and Meta-analysis was used to analyze the estimates of associations between DTR and daily mortality. Modifying effects of extremely low and high DTR-mortality relationship by season and socioeconomic status (SES) were also evaluated respectively. Cumulative excess risk (CER) was used as an index to evaluate the effects. Results: The information about 1 260 913 registered deaths were collected between 1 January 2006 and 31 December 2011, we found the relationship between extreme DTR and mortality was non-linear in all regions and the exposure-response curve was J-shaped. In central and south areas of China, the result indicated the obvious acute effect of extremely high DTR, and the mortality effect in central area (CER=5.1%, 95% CI: 2.4%-7.9%) was significant higher than that in south area (CER=4.5%, 95% CI: 1.7%-7.3%). Regarding to the modification of seasons, the cumulative mortality effect of DTR in cold season (CER=5.8%, 95%CI: 2.5%-9.2%) was higher than that in hot season (CER=3.1%, 95%CI: 1.1%-5.1%). Generally, deaths among the elderly (≥75 years) were associated more strongly with extremely high DTR. Conclusions: The mortality effects of extremely DTR in different areas and seasons showed different characteristics, that in central area and in cold season it was significantly stronger. After modified by season and SES, DTRs were the greatest threat to vulnerable population, especially to the elderly (≥75 years). Therefore, more attention should be paid to vulnerable groups and protection measures should be taken according to the local and seasonal conditions.

[Study on effects of community-based management of hypertension patients aged ≥35 years and influencing factors in urban and rural areas of China, 2010]

OBJECTIVE

To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.

METHODS

The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project. The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project. By face-to-face questionnaire survey and health examination, the information of the subjects' demographic characteristics, risk factors, complications, involvement in community-based management of hypertension, anti-hypertension treatment, blood pressure, body height, waistline and body weight were collected. In this study, Rao-Scott χ(2) test was used to compare the variations among sub-groups. Taylor series linearization method was used to estimate the prevalence rate. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.

RESULTS

A total of 5 120 subjects were recruited in the analysis. The proportion of those receiving management for more than two years was 36.57%, and it was higher in urban area(44.56%)than in rural area(31.79%, P<0.05); In the past 12 months, 6.17% and 14.46% of the patients received no blood pressure measurement and drug therapy advice respectively, but there were no significant differences between urban group and rural group(P>0.05); In the past 12 months, the proportions of the patients receiving diet and physical activity advice were 84.25% and 84.90% respectively, and the proportions were higher in urban group than in rural group(P<0.05); In the past 12 months, the proportions of the subjects receiving tobacco and alcohol use advice were 78.41% and 77.80% respectively, and the proportions were higher in rural group than in urban group(P<0.05). In urban area, the subjects receiving standardized management had lower SBP(142.79±17.39)mmHg, lower DBP(84.26±9.49)mmHg and higher blood pressure control rate(49.77%)than those receiving no standardized management(P<0.05); while in rural area, no difference was found in BP control between the patients receiving and receiving no standardized management(P>0.05). In urban area, the influencing factors for BP control among the subjects receiving community based management were educational level, annual income, body weight, hypertension management mode, times of receiving BP measurement, times of receiving antihypertensive medicine advice and receiving physical activity advice; while in rural area, the influencing factors for BP control among the subjects receiving community based management were annual income, body weight, family history of hypertension, antihypertensive medicine awareness, times of receiving antihypertensive medicine advice and receiving diet advice.

CONCLUSION

The effects of community-based standardized management of hypertension were better in urban area than in rural area, and the quality of the services of community-based hypertension management was lower in rural area than in urban area.

[Management of diabetes patients aged ≥35 years in disease surveillance areas in China]

Objective: To investigate the community-based management of diabetes patients aged ≥35 years in China. Methods: The subjects from 2013-2014 Chronic Non-communicable Disease and Risk Factor Surveillance in China were used in this study, those who were aged ≥35 years and diagnosed by doctors in hospitals at community level or above were selected through clustering sampling. Questionnaire was used to collect the data of subjects' general information, health status, the treatment and the control of blood glucose. Blood samples were taken from the subjects to detect the fasting blood glucose level and blood glucose level at 2 hours after oral administration of glucosum anhydricum. The subjects were weighted according to complex sampling scheme to calculated the different rates and 95%CI. The Rao-scott χ² test was performed to test the differences in rates between the subgroups. Results: The survey indicated that among the 10 056 diabetes patients aged ≥35 years and diagnosed with diabetes, 4 609 received management service in communities. After being weighted, the management rate of diabetes patients was 45.0% (95% CI: 40.8%-49.2%). Females (46.9%, 95% CI: 42.8%-51.0%) had higher management rate than males (43.0%, 95% CI: 38.1%-47.9%). The management rate was higher in rural area (50.4%, 95%CI: 46.3%-54.5%) than in urban area (41.6%, 95%CI: 35.5%-47.6%). There was a significant age specific difference in the proportion of patients receiving management services (χ²=21.0, P<0.01), the rate of management was highest in the patients aged ≥65 years (49.2%, 95%CI: 43.6%-54.7%), but lowest in the patients aged 35-44 years (35.2%, 95% CI: 27.9%-42.4%). The overall standardized management rate of diabetes patients in communities was 16.7% (95% CI: 13.7%-19.7%). The proportion of urban patients receiving standardized management service (19.7%, 95% CI: 15.3%-24.1%) was higher than that of rural patients (12.8%, 95% CI: 9.8%-15.8%). The overall treatment rate of diabetes patients in communities was 95.8% (95%CI: 94.8%-96.9%). The treatment rate was higher in females (97.0%, 95%CI: 96.0%-98.0%) than that in males (94.5%, 95%CI: 92.7%-96.4%). The control rate of blood glucose in diabetes patients receiving management in communities was 34.6% (95%CI: 31.5%-37.6%), and the highest blood glucose control rate was in the patients aged ≥65 years (38.2%, 95%CI: 33.4%-43.0%), while the lowest blood glucose control rate was in the patients aged 45-54 years (34.4%, 95% CI: 26.7%-42.0%). Conclusions: Both the standardized management rate and blood glucose control rate were low in the diabetes patients aged ≥35 years in China. It is necessary to strengthen the allocation of medical resources in communities and standardized diabetes management.

[The burden of disease attributed to low bone mineral density among population aged ≥40 years old in China, 1990 and 2013]

Objective: To identify cause-specific death and attributed burden of low bone mineral density in China among population aged ≥40 years old , 1990 and 2013. Methods: By using data from Global Burden of Disease(GBD)2013, this study analyzed death caused by low mineral density, and disability-adjusted life years(DALY)among population aged 40 and above in China(not including Taiwan, China). This study also analyzed DALY by composition of injury which due to low bone mineral density. It also analyzed changes in DALY by provinces in China, 1990 and 2013. An average world population age-structure for the period 2000- 2025 was adopted to calculate the age standardized rates. Results: In 2013, there were 38.1 thousands male and 30.7 thousands female who aged 40 and above dead due to low bone mineral density in China. The burden of injury caused by low bone mineral density was more sever in male than female, which accounted for 1.525 million DALY in male and 0.873 million DALY in female. In 1990, low bone mineral density attributed transportation and accidental injury caused 0.794 million and 0.567 million DALY losses, respectively. In 2013, low bone mineral density attributed transportation and accidental injury caused 1.421 million and 0.951 million DALY losses, respectively. Compared to 1990, DALY losses caused by transportation and accidental injury, increased by 79.1% and 67.6%, respectively. In 1990, DALY rate losses due to low bone mineral density attributed transportation and accidental injury were 68.1 per 100 000 and 48.7 per 100 000, respectively. In 2013, DALY rate losses due to low bone mineral density attributed transportation and accidental injury were 102.0 per 100 000 and 68.2 per 100 000, respectively. Compared to 1990, DALY rates which caused by transportation and accidental injury, increased by 49.8% and 40.2%, respectively. According to the ranking of standardized DALY rate in 2013 by provinces, the top 3 provinces, which standardized DALYs attributed to low bone mineral density lost the most, were Zhejiang Province(2.6 per 100 000), Jiangsu Province(2.4 per 100 000), and Fujian Province(2.2 per 100 000). Compared to 1990, the standardized rate of DALY decreased in 27 provinces, while the DALY rate increased in only 6 provinces which included Ningxia Hui Autonomous Region, Qinghai Province, Hebei Province, Guangxi Zhuang Autonomous Region, and Henan Province and Xinjiang Uygur Autonomous Region. Conclusion: This study found that the burden of health losses attributed to it was higher in men than in women. Compared to 1990, DALY rates decreased in most of the provinces, however, the rates of losses of DALY which caused by transportation and accidental injury were still increasing.

[Expenditure in outpatient department and pharmacy on patients with hypertension and the influence from community health management program]

OBJECTIVE

To explore the impact of health management programs on hypertension related to their cost of the hypertensive, so as to provide evidence for related policy-making.

METHODS

Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps. Information regarding hypertensive patients were collected through a questionnaire. Two-part model was used to analyze the influence from health management scheme.

RESULTS

This study included 11 294 participants who were 35 years old or beyond, with 4 904 (43.42%) males and 6 390 (56.58%) females. The median cost from the outpatient was 100 (30-200) Yuan, and the cost of patients under management program were significantly lower than those without (P<0.05). Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P>0.05). Regarding the calculation on the outpatient cost, results showed that the patients under the management program were more likely to practice 'outpatient-medical-behavior' (OR =2.50, 95% CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients. Hypertensive patients from the urban areas were more likely to adopt 'medical behavior'(OR=1.31, 95% CI:1.18-1.45) which was 1.69 times of the costs from the rural patients. RESULTS of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10, 95% CI:1.01-1.20) and was 1.19 times the costs of the rural patients.

CONCLUSION

Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.

Polymorphisms and DNA methylation level in the CpG site of the GHR1 gene associated with mRNA expression, growth traits and hormone level of half-smooth tongue sole (Cynoglossus semilaevis)

The objectives of the present study were to estimate the GHR1 gene mutations and methylation status of CpGs, and whether those mutations and methylation were involved in the regulation of GHR1 gene expression, hormone level and growth traits in half-smooth tongue sole (Cynoglossus semilaevis). Identification of single-nucleotide polymorphisms was performed on 43 male fish. Through polymerase chain reaction-single-strand conformation polymorphism and sequencing, two SNPs were found. SNP1 [c.G1357A (p.Val376Ile)] creating one CpG site located in exon 8 was named L1 locus, and SNP2 (c.G1479A) located in exon 9 was named L2 locus. Individuals were divided into three genotypes, AA, AG and GG according to L1 locus (GG genotype had one more CpG site because of the mutation), and into two genotypes, AA- and GG-based on L2 locus. The results showed that only L1 locus was significantly associated with body weight (P < 0.01), gonad weight (P ≤ 0.05), triiodothyronine (T3) level (P ≤ 0.05) and mRNA expression (P < 0.01). At L1 locus, newly created CpG site in GG genotype was highly methylated (93.3 %), while there was no difference of methylation level in the other two CpG sites among three genotypes. AA genotype and AG genotype having higher T3 level were significantly different (P ≤ 0.05) from GG genotype. There were significant differences among body weights of AA, AG and GG genotypes (P < 0.01). Gonad weights of AA genotype and AG genotype were significantly lower than GG genotype. The GHR1 mRNA expression of GG genotype was significantly lower than AA and AG genotypes (P < 0.01). These implied that mutations and methylation status of GHR1 gene might influence the hormone level, growth traits and gene expression in male half-smooth tongue sole and the L1 locus could be regarded as a potential candidate genetic and epigenetic marker in half-smooth tongue sole selection.

Functional response properties of VIP-expressing inhibitory neurons in mouse visual and auditory cortex

Despite accounting for about 20% of all the layer 2/3 inhibitory interneurons, the vasoactive intestinal polypeptide (VIP) expressing neurons remain the least thoroughly studied of the major inhibitory subtypes. In recent studies, VIP neurons have been shown to be activated by a variety of cortico-cortical and neuromodulatory inputs, but their basic sensory response properties remain poorly characterized. We set out to explore the functional properties of layer 2/3 VIP neurons in the primary visual (V1) and primary auditory cortex (A1), using two-photon imaging guided patch recordings. We found that in the V1, VIP neurons were generally broadly tuned, with their sensory response properties resembling those of parvalbumin (PV) expressing neurons. With the exception of response latency, they did not exhibit a significant difference from PV neurons across any of the properties tested, including overlap index, response modulation, orientation selectivity, and direction selectivity. In the A1, on the other hand, VIP neurons had a strong tendency to be intensity selective, which is a property associated with a subset of putative pyramidal cells and virtually absent in PV neurons. VIP neurons had a best intensity that was significantly lower than that of PV and putative pyramidal neurons. Finally, sensory evoked spike responses of VIP neurons were delayed relative to pyramidal and PV neurons in both the V1 and A1. Combined, these results demonstrate that the sensory response properties of VIP neurons do not fit a simple model of being either PV-like broadly tuned or pyramidal-like narrowly tuned. Instead, the selectivity pattern varies with sensory area and can even be, as in the case of low sound intensity responsiveness, distinct from both PV and pyramidal neurons.

Revealing the contribution of Cytochrome P450 to salt-sensitive hypertension using DNA microarray

BACKGROUND

Salt sensitivity is an important cause of hypertension which is a major public health problem. This study aimed to investigate the contribution of Cytochrome P450 (CYP) to salt-sensitive hypertension with microarray data and bioinformatics analysis.

METHODS

Gene expression data set GSE4800 was downloaded from Gene Expression Omnibus database, including 6 gene chips from 3 Dahl salt sensitive (DS) rat samples and 3 Lewis (LEW) rat samples. Raw data were preprocessed and normalized, and then differentially expressed genes (DEGs) were identified with Limma package. Interaction network was constructed by employing STRING (Search Tool for the Retrieval of Interacting Genes) tool. GO (Gene Ontology) enrichment analysis was performed using FuncAssociate tool and pathway analysis was carried out by EASE (Expressing Analysis Systematic Explorer). BLAST (Basic Local Alignment Search Tool) was applied to explore the sequence homology among CYP3A genes in rat and human based on multiple alignments.

RESULTS

A total of 1264 DEGs, including 1082 up-regulated genes and 182 down-regulated genes were identified between DS and LEW samples. CYP3A2 and CYP3A9 were selected to construct the protein interaction network, which comprised 1653 pairs of interaction relationship among 100 genes. Functional analysis showed that CYP3A2 and CYP3A9 were most significantly related to oxidation reduction and metabolism of xenobiotics by cytochrome P450. Furthermore, the CYP3A2 and CYP3A9 genes in rats had high homology with genes CYP3A4and CYP3A5 in human beings.

CONCLUSIONS

CYP3A4 and CYP3A5 may contribute to salt-sensitive hypertension in human which may act as biomarkers for this disease.