Analysis of risky sexual behaviors among male college students who were sexually active in Sichuan, China: a cross-sectional survey.

BACKGROUND: Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions. METHODS: The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex. RESULTS: The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84-11.93; age20-21, AOR = 3.26, 95%CI: 2.04-5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69-3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33-2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03-1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44-0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16-0.43) and confident (AOR = 0.48, 95%CI: 0.34-0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82-4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07-2.20), respectively. CONCLUSION: Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.

Spicy food consumption is associated with abdominal obesity among Chinese Han population aged 30-79 years in the Sichuan Basin: a population-based cross-sectional study.

BACKGROUND: Few animal experiments and volunteer-based intervention studies have showed a controversial effect of spicy foods on abdominal obesity. We aimed to examine the association between spicy food frequency, spicy flavor, and abdominal obesity among Chinese Han population in the Sichuan Basin which area eating spicy foods relatively often. METHODS: A cross-sectional analysis was conducted using the Sichuan Basin baseline data from the China Multi-Ethnic Cohort (CMEC) study, including data from electronic questionnaires, anthropometric measurements and blood sample collection. A total of 40,877 adults (22,503 females) aged 30-79 years were included in the final analysis. Multivariable logistic regression yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for abdominal obesity associated with the strength of spicy flavor and frequency of spicy food intake. RESULTS: The prevalence of daily spicy food eating was 47.3% in males and 52.7% in females, the percentages of abdominal obesity were 52.3%, 48.8%, 51.6% and 55.5% in the spicy food intake subgroups of never, 1-2 days/week, 3-5 days/week and 6-7 days/week, respectively. Compared with males who never consumed spicy food, the adjusted ORs (95% CIs) in the 1-2 days/week, 3-5 days/week and 6-7 days/week subgroups were 1.21 (1.09, 1.34), 1.35 (1.21, 1.51), and 1.35 (1.25, 1.47), respectively (Ptrend < 0.001). The corresponding odds ratios for females were 0.95 (0.87, 1.05), 1.14 (1.03, 1.26), and 1.25 (1.16, 1.35), respectively (Ptrend < 0.001). Similarly, compared with no spicy flavor, the adjusted ORs (95% CIs) of mild, middle, and strong spicy strength for abdominal obesity in males were 1.27 (1.17, 1.38), 1.51 (1.37, 1.67), and 1.36 (1.11, 1.67) respectively (Ptrend < 0.001). The corresponding odds ratios for females were 1.14 (1.06, 1.23), 1.27 (1.15, 1.40), and 1.32 (1.06, 1.65), respectively (Ptrend < 0.001). CONCLUSIONS: The data indicated that spicy food consumption was a risk factor for abdominal obesity among Chinese adult population in the Sichuan Basin. The results need to be approved by large cohort studies.

Predictors of health-related quality of life among older adults living with HIV in Thailand: results from the baseline and follow-up surveys.

The current longitudinal study consisted of baseline and follow-up surveys among older adults living with HIV (OALHIV) in Thailand. The health-related quality of life (HRQoL) was assessed using the Medical Outcomes Study HIV (MOS-HIV) questionnaire. We performed multiple linear regression analysis to document correlates of HRQoL at baseline and the predictors of the changes in HRQoL at follow-up. Of the 364 participants recruited at baseline; 327 (89.9%) completed the follow-up survey. The mean (SD) Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were respectively 49.8 (7.3) and 53.2 (6.4). There was a significant increase in the mean score of most of the MOS-HIV domains, ranging between 1.3 for the PHS and 26.9 for the energy/fatigue dimension. In contrast, the mean score significantly decreased by 4.1 and 10.3 points, respectively for the cognitive and social functioning. Female gender was a predictor of the decline in social (ß = -11.37; P = 0.031) and cognitive (ß = -8.05; P = 0.002) functioning at follow-up, while being married was related to an increase of in the score of energy/fatigue (vitality) (ß = 5.98; P = 0.011) at follow-up. Physical exercise was associated with an increase in social functioning (ß = 9.38; p = 0.042). Overall the HRQoL of OALHIV improved or was maintained over time.

A comparison of socio-behavioral risk factors between HIV-infected and non-infected older adults in Northern Thailand.

There is a shift in the demographic profile of people living with HIV toward older age groups. The current study compares alcohol use, smoking, and physical exercise between HIV-infected and non-infected older adults recruited in 12 community hospitals in Chiang Mai Province, Northern Thailand. Participants in the two groups were 50 years and above, matched by age and gender. The sample included 364 participants in each of the groups. Older adults living with HIV were less likely to report drinking alcohol in the past year (AOR, 0.55; CI, 0.34-0.89, P = 0.015) and more likely to report being currently engaged in physical activities (AOR, 2.58; CI, 1.77-3.76, P < 0.001). There was no difference between the two groups in terms of "current smoking status". Older adults living with HIV were healthier than their non-infected counterparts in terms of the socio-behavioral risks.

Recreational Drug Use, Polydrug Use and Sexual Behaviors Among Men Who Have Sex With Men in Southwestern China: A Cross-Sectional Study.

Although recreational drug use is associated with risky sexual behaviors and HIV infection among men who have sex with men (MSM), it is unclear to what extent these behaviors and outcomes differ between single-drug users and polydrug users in China. This is a cross-sectional study conducted from July to September 2016 among MSM in three cities of Sichuan Province, China. Multinomial logistic regression was performed to examine factors correlated with single-drug and polydrug use. A total of 1,122 participants were included in the study. Overall, 28% of MSM have ever used recreational drugs, of whom 64.0% were single-drug users, and 36.0% were polydrug users. Factors associated with both single-drug and polydrug use included: receptive sexual role (single-drug use: AOR = 1.79, 95% CI: 1.05-3.07; polydrug use: AOR = 6.00, 95% CI: 2.54-14.17), engaging in group sex (AOR = 2.23, 95% CI: 1.28-3.87; AOR = 4.68, 95% CI: 2.41-9.08), frequent alcohol use (AOR = 3.11, 95% CI: 1.75-5.52; AOR = 6.41, 95% CI: 2.50-16.47), seeking partners mainly by Internet (AOR = 4.87, 95% CI: 3.31-7.17; AOR = 4.58, 95% CI: 2.58-8.14), history of STIs (AOR = 1.86, 95% CI: 1.08-3.21; AOR = 3.32, 95% CI: 1.77-6.26) and HIV infection (AOR = 1.76, 95% CI: 1.02-3.02; AOR = 3.19, 95% CI: 1.62-6.26). Our findings suggest the urgent need for HIV and STIs prevention programs among MSM in China to integrate strategies that mitigate recreational drug use.

Prevalence of poppers use and its sexual risks among men who have sex with men in southwestern China: a cross-sectional study.

BACKGROUND: To investigate the prevalence of poppers use and its relationship with sexual risk behaviors among men who have sex with men (MSM) in southwestern China. METHODS: This cross-sectional study was conducted in three cities of southwestern China between July and September 2016. Anonymous questionnaire survey was administered to collect data on demographics, drug use, sexual behaviors, history of STIs and HIV infection. Logistic regression analysis was performed to explore factors correlated with sexual risk behaviors including group sex and unprotected anal intercourse (UAI). RESULTS: Of the 1122 participants included in the study, 24.1% reported a history of poppers use. 11.6% MSM reported ever engaging in group sex and 36.2% participants reported UAI with non-regular male partners in the past 12 months. Multivariate logistic analysis showed that age > 25 (OR = 2.96, 95% CI 1.87-4.68), seeking sex partners through the internet (OR = 3.16, 95% CI 1.59-6.29), preferring receptive anal intercourse (OR = 1.91, 95% CI 1.12-3.26) and ever using poppers (OR = 1.88, 95% CI 1.25-2.83) were positively associated with engaging in group sex. Lower levels of education (OR = 1.93, 95% CI 1.33-2.80) and ever using poppers (OR = 1.44, 95% CI 1.01-2.05) were significantly correlated with UAI with non-regular partners. CONCLUSIONS: The study suggested poppers was prevalent among MSM and its use was significantly associated with sexual risk behaviors. Given high prevalence of HIV among this subpopulation, comprehensive measures are needed to decrease poppers use and its potential risk for HIV transmission in southwestern China.

Prevalence and associated factors of depressive and anxiety symptoms among HIV-infected men who have sex with men in China.

HIV-positive men who have sex with men (HIVMSM) face severe stigma and high levels of stressors, and have high prevalence of mental health problems (e.g., depression and anxiety). Very few studies explored the role of positive psychological factors on mental health problems among HIVMSM. The present study investigated the prevalence of two mental health problems (anxiety and depression), and their associated protective (gratitude) and risk (enacted HIV-related stigma, and perceived stress) factors among HIVMSM in China. A cross-sectional survey was conducted among 321 HIVMSM in Chengdu, China, by using a structured questionnaire. Over half (55.8%) of the participants showed probable mild to severe depression (as assessed by the Center of Epidemiologic Studies Depression scale); 53.3% showed probable anxiety (as assessed by the General Anxiety Disorder scale). Adjusted logistic regression models revealed that gratitude (adjusted odds ratio (ORa = 0.90, 95% confidence intervals (95% CI) = 0.86-0.94) was found to be protective, whilst perceived stress (ORa = 1.17, 95% CI = 1.12-1.22) and enacted stigma (ORa = 7.72, 95% CI = 2.27-26.25) were risk factors of depression. Gratitude (ORa = 0.95, 95% CI = 0.91-0.99) was also found to be protective whilst perceived stress (ORa = 1.19, 95% CI = 1.14-1.24) was a risk factor of anxiety. Gratitude did not moderate the associations found between related factors and poor mental health. It is warranted to promote mental health among HIVMSM, as depression/anxiety was highly prevalent. Such interventions should consider enhancement of gratitude, reduction of stress, and removal of enacted stigma as potential strategies, as such factors were significantly associated with depression/anxiety among HIVMSM.

Interventions for dysphagia in oesophageal cancer.

BACKGROUND: Most patients with oesophageal and gastro-oesophageal carcinoma are diagnosed at an advanced stage and require palliative intervention. Although there are many kinds of interventions, the optimal one for the palliation of dysphagia remains unclear. This review updates the previous version published in 2009. OBJECTIVES: The aim of this review was to systematically analyse and summarise the efficacy of different interventions used in the palliation of dysphagia in primary oesophageal and gastro-oesophageal carcinoma. SEARCH METHODS: To find new studies for this updated review, in January 2014 we searched, according to the Cochrane Upper Gastrointestinal and Pancreatic Diseases model, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and CINAHL; and major conference proceedings (up to January 2014). SELECTION CRITERIA: Only randomised controlled trials (RCTs) were included in which patients with inoperable or unresectable primary oesophageal cancer underwent palliative treatment. Different interventions like rigid plastic intubation, self-expanding metallic stent (SEMS) insertion, brachytherapy, external beam radiotherapy, chemotherapy, oesophageal bypass surgery, chemical and thermal ablation therapy, either head-to-head or in combination, were included. The primary outcome was dysphagia improvement. Secondary outcomes included recurrent dysphagia, technical success, procedure related mortality, 30-day mortality, adverse effects and quality of life. DATA COLLECTION AND ANALYSIS: Data collection and analysis were performed in accordance with the methods of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group. MAIN RESULTS: We included 3684 patients from 53 studies. SEMS insertion was safer and more effective than plastic tube insertion. Thermal and chemical ablative therapy provided comparable dysphagia palliation but had an increased requirement for re-interventions and for adverse effects. Anti-reflux stents provided comparable dysphagia palliation to conventional metal stents. Some anti-reflux stents might have reduced gastro-oesophageal reflux and complications. Newly-designed double-layered nitinol (Niti-S) stents were preferable due to longer survival time and fewer complications compared to simple Niti-S stents. Brachytherapy might be a suitable alternative to SEMS in providing a survival advantage and possibly a better quality of life, and might provide better results when combined with argon plasma coagulation or external beam radiation therapy. AUTHORS' CONCLUSIONS: Self-expanding metal stent insertion is safe, effective and quicker in palliating dysphagia compared to other modalities. However, high-dose intraluminal brachytherapy is a suitable alternative and might provide additional survival benefit with a better quality of life. Some anti-reflux stents and newly-designed stents lead to longer survival and fewer complications compared to conventional stents. Combinations of brachytherapy with self-expanding metal stent insertion or radiotherapy are preferable due to the reduced requirement for re-interventions. Rigid plastic tube insertion, dilatation alone or in combination with other modalities, and chemotherapy alone are not recommended for palliation of dysphagia due to a high incidence of delayed complications and recurrent dysphagia.

Life's Essential 8, Life's Simple 7 and the odds of hyperuricaemia: results from the China Multi-Ethnic Cohort Study.

Objective: Life's Essential 8 (LE8) is a new comprehensive metric based on Life's Simple 7 (LS7). Few studies have investigated the association between LE8 and the odds of hyperuricaemia (HUA). This study examined the association between LE8, LS7 with odds of HUA. Methods: We cross-sectionally analysed data from the China Multi-Ethnic Cohort (CMEC) study. LE8 and LS7 were categorized as low, moderate and high. The CMEC provided an ideal and unique opportunity to characterize the association between LE8, LS7 and the odds of HUA. Results: Of the 89 823 participants, 14 562 (16.2%) had HUA. A high level of LE8 was associated with lower odds of HUA after full adjustment. The adjusted odds ratios (ORs) were 1 (reference), 0.70 (95% CI 0.67, 0.73) and 0.45 (0.42, 0.48) across low, moderate and high LE8 groups, respectively (Ptrend < 0.001). Similar results were observed in LS7 and HUA. The adjusted ORs were 1 (reference), 0.68 (95% CI 0.65, 0.71) and 0.46 (95% CI 0.43, 0.49) across low, moderate and high LS7 groups, respectively (Ptrend < 0.001). There were significant interactions between LE8 and age, gender, ethnicity and drinking habits on HUA. Receiver operating characteristics analysis showed that the area under the curve for LE8 and LS7 were similar (0.638 and 0.635, respectively). Conclusion: This study indicated a clearly inverse gradient association between the cardiovascular health metrics LE8 and LS7 and the odds of HUA.

Ambient PM2.5 Components Are Associated With Bone Strength: Evidence From a China Multi-Ethnic Study.

CONTEXT: The relationship between the components of particulate matter with an aerodynamic diameter of 2.5 or less (PM2.5) and bone strength remains unclear. OBJECTIVE: Based on a large-scale epidemiologic survey, we investigated the individual and combined associations of PM2.5 and its components with bone strength. METHODS: A total of 65 906 individuals aged 30 to 79 years were derived from the China Multi-Ethnic Cohort Annual average concentrations of PM2.5 and its components were estimated using satellite remote sensing and chemical transport models. Bone strength was expressed by the calcaneus quantitative ultrasound index (QUI) measured by quantitative ultrasound. The logistic regression model and weighted quantile sum method were used to estimate the associations of single and joint exposure to PM2.5 and its components with QUI, respectively. RESULTS: Our analysis shows that per-SD increase (µg/m3) in 3-year average concentrations of PM2.5 (mean difference [MD] -7.38; 95% CI, -8.35 to -6.41), black carbon (-7.91; -8.90 to -6.92), ammonium (-8.35; -9.37 to -7.34), nitrate (-8.73; -9.80 to -7.66), organic matter (-4.70; -5.77 to -3.64), and soil particles (-5.12; -6.10 to -4.15) were negatively associated with QUI. In addition, these associations were more pronounced in men, and people older than 65 years with a history of smoking and chronic alcohol consumption. CONCLUSION: We found that long-term exposure to PM2.5 and its components may lead to reduced bone strength, suggesting that PM2.5 and its components may potentially increase the risk of osteoporosis and even fracture. Nitrate may be responsible for increasing its risk to a greater extent.

Gender Differences in the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese.

BACKGROUND: Limited information is available regarding risky sexual behavior among college students with different sexual orientations. AIM: The aim of this study was to examine the gender differences in the association between sexual orientation and risky sexual behavior among Chinese college students with sexual experience. METHODS: With a self-assessment questionnaire, we conducted a cross-sectional survey among 73,800 students from 25 vocational colleges (3-year colleges) in the Sichuan province of China. Multivariate logistic regression models were used to examine the association between sexual orientation and risky sexual behavior among students with sexual experience. OUTCOMES: The main outcome measures used regarding risky sexual behavior are the following: condom use in the last sexual intercourse, early sexual debut, and having multiple sexual partners. RESULTS: 12,711 students with sexual experience were included. Sexual minority students were more likely to have an early sexual debut (For male students, homosexual: OR = 1.88, P < .001; bisexual: OR = 1.96, P < .001; unsure: OR = 1.68, P < .001. For female students, homosexual: OR = 1.87, P < .01; bisexual: OR = 2.07, P < .01; unsure: OR = 1.53, P < .05), and less likely to use condoms in their last sexual intercourse (except for homosexual male students) (For male students, bisexual: OR = 0.65, P < .01; unsure: OR = 0.60, P < .001. For female students, homosexual: OR = 0.21, P < .001; bisexual: OR = 0.54, P < .001; unsure: OR = 0.68, tP < .05). There are gender differences in the association between sexual orientation and having multiple sexual partners. Male sexual minorities were more likely to have multiple sexual partners than heterosexual students (homosexual: OR = 2.06, P < .001; bisexual: OR = 1.66, P < .001; unsure: OR = 1.31, P < .05), while the same result was only observed in bisexual female students (OR = 1.46, P < .01). CLINICAL IMPLICATIONS: Sexual health education professionals should consider the sexual orientation of students when providing counseling services or educational intervention, especially for male students and LGBT ones. STRENGTHS & LIMITATIONS: We examined gender differences in the association between sexual orientation and risky sexual behavior among college students with sexual experience. However, the ability for the cross-sectional survey to address causality is limited, and will be further tested in cohort studies. CONCLUSION: Gender and sexual orientation affect the likelihood of risky sexual behavior among China's college students, and gender differences in the association between sexual orientation and risky sexual behavior should be noticed. Li Y, Zhou D, Dai Y, et al. Gender Differences of the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese. Sex Med 2022;10:100547.

Increased allostatic load associated with ambient air pollution acting as a stressor: Cross-sectional evidence from the China multi-ethnic cohort study.

BACKGROUND: Allostatic load measures the cumulative biological burden imposed by chronic stressors. Emerging experimental evidence supports that air pollution acting as a stressor activates the neuroendocrine system and then produces multi-organ effects, leading to allostatic load. However, relevant epidemiological evidence is limited. OBJECTIVES: We aim to explore the relationships between chronic exposure to ambient air pollution (PM1, PM2.5, PM10, and O3) and allostatic load in Chinese adults. METHODS: This cross-sectional study included 85,545 participants aged 30-79 from the baseline data of the China Multi-Ethnic Cohort (CMEC). Ambient air pollution levels were evaluated by a satellite-based random forest approach. The previous three-year average exposure concentrations were calculated for each participant based on the residential address. The outcome allostatic load was identified through the sum of the sex-specific scores of twelve biomarkers belonging to four major categories: cardiovascular, metabolic, anthropometric, and inflammatory parameters. We performed statistical analysis using a doubly robust approach which relies on inverse probability weighting and outcome model to adjust for confounding. RESULTS: Long-term exposure to ambient air pollution was significantly associated with an increased risk of allostatic load, with relative risk (95% confidence interval) of 1.040 (1.024, 1.057), 1.029 (1. 018, 1. 039), and 1.087 (1.074, 1.101) for each 10 µg/m3 increase in ambient PM2.5, PM10, and O3, respectively. No significant relationship was observed between chronic exposure to PM1 and allostatic load. The associations between air pollution and allostatic load are modified by some intrinsic factors and non-chemical stressors. The people with older, minority, lower education, and lower-income levels had a significantly higher allostatic load induced by air pollution. CONCLUSIONS: Chronic exposure to ambient PM2.5, PM10, and O3 may increase the allostatic load. This finding provides epidemiological evidence that air pollution may be a chronic stressor, leading to widespread physiological burdens.

Dietary patterns and cardiometabolic risks in diverse less-developed ethnic minority regions: results from the China Multi-Ethnic Cohort (CMEC) Study.

Background In Western developed countries, food-based dietary patterns have been associated with the risk of cardiometabolic diseases, but little is known about such associations in less developed ethnic minority regions (LEMRs), where the cardiometabolic disease burden is growing rapidly and food patterns differ substantially. Methods Between May 2018 and September 2019, we recruited 99556 participants aged 30-79 years from the China Multi-Ethnic Cohort (CMEC) Study. We measured habitual dietary intake with validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for two of the most studied a priori dietary patterns, i.e., Dietary Approaches to Stop Hypertension (DASH) and alternative Mediterranean (aMED) style diets, and three a posteriori dietary patterns. Four cardiometabolic risks, including hypertension, diabetes, dyslipidaemia and metabolic syndrome (MetS), were newly diagnosed by medical examination and blood tests. We estimated adjusted odds ratios (OR) relating various dietary pattern scores to cardiometabolic risks using marginal structural models under the guidance of directed acyclic graphs. For the above associations, we further calculated the proportion mediated by overweight (PM) using regression-based mediation analysis for better public health implications. Findings The final study sample consisted of 68834 participants. Among them, we newly diagnosed 12803 hypertension, 3527 diabetes, 16342 hyperlipidaemia, and 8198 MetS cases. Overall, all 5 dietary patterns showed considerable associations with risks of hypertension and MetS. Comparing the highest with the lowest quintiles, the DASH score showed the strongest inverse associations with risks of hypertension (OR=0.74, 95% CI:0.70-0.79; PM=10%) and MetS (OR=0.79, 95% CI:0.74-0.85; PM=35%); conversely, scores of the localized a posteriori Yunnan-Guizhou plateau dietary pattern in LEMRs showed the strongest positive associations with risks of hypertension (OR=1.44, 95% CI:1.35-1.52; PM=10%) and MetS (OR=1.35, 95% CI:1.26-1.46; PM=33%), with all P values for trend <0.001. These associations were consistent in various subgroups defined by sex, age, smoking and physical activity, but with magnitudes that differed substantially across different ethnic regions and urbanicity. By investigating the single-component effects of dietary patterns, the dairy intake component contributed a major proportion to the beneficial effects of DASH (41.9% for hypertension and 100.5% for MetS). Interpretation Substantial socioeconomic status and ethnic disparities in diet quality and related cardiometabolic risks were seen in LEMRs, with hypertension being the top diet-related cardiometabolic risk. Our findings support that DASH provides superior dietary guidance compared to aMED for reducing cardiometabolic risks in LEMRs. In particular, the dairy intake encouraged by DASH may produce considerable beneficial effects. Funding This study was funded by the National Key R&D Program of China; full funding sources listed in the acknowledgements.