[A survey on the implementation of cardiovascular surgery for congenital heart disease in China between 2017 and 2021].

Objective: To investigate the inplementation of cardiovascular surgery for congenital heart disease (CHD) in China. Methods: A cross-sectional study was carried out. The CHD cardiovascular surgery data collected by the Chinese Society of Extracorporeal Circulation from 2017 to 2021 in 31 provinces (autonomous regions/municipalities) of China were retrospectively reviewed, the implementation of CHD cardiovascular surgery in different provinces, regions, general/specialized hospitals, and different age groups (whether≤18 years old) were summarized, and the correlation analysis between the number of surgeries carried out in each province/region and the gross regional product and the number of the regional population was performed. Results: Between 2017 and 2021, the annual volume of CHD cardiovascular surgery was 77 120, 77 634, 81 161, 62 663 and 71 492, respectively, showing a decreasing trend. Meanwhile, the proportion of CHD patients aged≤18 years who underwent cardiovascular surgery also showed a downward trend, from 79.8% (61 557/77 120) in 2017 to 58.6% (41 871/71 492) in 2021 (P=0.027). The number of surgical cases varied greatly among different provinces, including 4 provinces with≥5 000 cases and 9 provinces with 2 000-5 000 cases. In the five years, the number of CHD cardiovascular surgeries in Central and East China was the largest, accounting for 41.1%-45.5% of the total surgical cases. The proportion of CHD surgery cases≤18 years old was the highest in Southwest China (69.7%-87.4%) and the lowest in Northeast China (28.2%-68.9%). Except for 2021, the number of cases carried out by each region between 2017 and 2020 was correlated with the gross regional product (r=0.929, 0.929, 0.893 and 0.964, respectively, all P<0.05) and the population (r=0.821, 0.893, 0.821 and 0.857, respectively, all P<0.05). Hospitals that performed more than 100 operations (20.5%±1.2% of the total number of hospitals) completed 86.2%±1.2% of the total number of operations in China during the 5-year period. In 2017 and 2021, the number of CHD cardiovascular surgeries preformed in children's/women's and children's specialized hospitals accounted for 24.3% (18 772/77 120) and 23.8% (17 012/71 492) of the total number of cases in China, respectively. Conclusions: From 2017 to 2021, the number of cardiovascular surgery for CHD decreases slightly, but the proportion of surgery for adult CHD patients increases significantly.There is a strong correlation between the number of CHD operations in each region and their economic development status. The scale of CHD cardiovascular surgery performed in children's hospitals/women's and children's hospitals accounts for about a quarter of the total volume in China.

Assessment of surgical outcomes and oncological safety for submental artery perforator flap reconstruction after ablation of oral cancer.

The submental artery perforator flap (SAPF) has been a new option for the intraoral reconstruction of oral squamous cell carcinoma (OSCC) patients in recent years, but its surgical outcomes have not been well assessed. We compared the surgical outcomes and oncological safety of SAPF reconstruction for medium-sized soft-tissue defects after the ablation of primary oral cancer with traditional submental island flaps (SIF) and anterolateral thigh perforator flaps (ALTPF). Fifty-one SAPFs, 30 SIF, and 74 ALTPF were reviewed for the intraoral medium-sized reconstructions after the ablation of oral cancer from our institutional clinical oncological databases. We performed comparative assessments on the variables of surgical outcome and oncological safety among the 3 cohorts. A Kaplan-Meier estimate of survival for each flap was calculated. Operating time was significantly reduced in the SIF and SAPF groups than ALTPF (p = 0.021 and 0.014, respectively). Flap thickness of SAPF was the significantly thinnest (mean 0.5 cm) among three groups. The common complications of donor site for both SAPF and SIF group were incision dehiscence and orocutaneous fistula. There was no significant difference in disease-free survival (DFS) among the 3 groups. However, several OSCC patients with the SIF reconstruction were found to have recurrences with a metastatic lymph node under the flap after the first operation. SAPF could be a versatile choice of the intraoral reconstruction for the medium-sized soft-tissue defects after the ablation of oral cancer.

Systematic differences among never, occasional and moderate alcohol users in southern China, and its use in alcohol research: a cross-sectional study.

BACKGROUND: Western observational studies show moderate alcohol use, compared with never use, positively associated with health. Moderate users differ systematically from others, making these observations vulnerable to confounding. Observations from other contexts may help distinguish whether these associations are confounded. To assess whether southern Chinese would provide a more suitable setting to examine the association of moderate alcohol use with health, we compared never alcohol users with moderate alcohol users and occasional users in this setting. METHODS: We used age-adjusted multinomial regression to assess sex-stratified associations of alcohol use (never, occasional (<1 occasion/week), moderate (≤140 g ethanol/week for women and ≤210 g for men)) with health attributes and indicators in the Guangzhou Biobank Cohort Study (2003-2008) (n=26 361). RESULTS: Among men, moderate alcohol users, when compared with never users, had slightly lower socioeconomic position and unhealthier lifestyle. Conversely, occasional alcohol users, when compared with never users, had higher socioeconomic position and healthier lifestyle. Among women, when compared with never users, both occasional and moderate users had higher socioeconomic position and healthier lifestyle. However, all alcohol users for both sexes, when compared with never users, were more likely to be ever smokers and to be exposed to secondhand smoke. CONCLUSIONS: Observations in alcohol epidemiology may be affected by confounding due to contextually specific systematic differences. Results from a particular setting should not be interpreted as causal unless they are verified in different populations and, preferably, in non-observational studies.

Assessment of genomic imprinting of PPP1R9A, NAP1L5 and PEG3 in pigs.

Imprinted genes play significant roles in the regulation of fetal growth and development, function of the placenta, and maternal nurturing behaviour in mammals. At present, few imprinted genes have been reported in pigs compared to human and mouse. In order to increase understanding of imprinted genes in swine, a polymorphism-based approach was used to assess the imprinting status of three porcine genes in 12 tissue types, obtained from F1 pigs of reciprocal crosses between Rongchang and Landrace pure breeds. In contrast to human and mouse homologues, porcine PPP1R9A was not imprinted, and was found to be expressed in all tissues examined. The expression of porcine NAP1L5 was detected in pituitary, liver, spleen, lung, kidney, stomach, small intestine, skeletal muscle, fat, ovary, and uterus, but undetectable in heart. Furthermore, porcine NAP1L5 was paternally expressed in the tissues where it's expression was observed. For PEG3, pigs expressed the paternal allele in skeletal muscle, liver, spleen, kidney, and uterus, but biallele in heart, lung, fat, stomach, small intestine, and ovary. Our data indicate that tissue distribution of the three gene differs among mammals, and the imprinting of NAP1L5 and PEG3 is well conserved.

Childhood meat eating and inflammatory markers: the Guangzhou Biobank Cohort Study.

BACKGROUND: We hypothesized that socio-economic development could, via nutritionally driven levels of pubertal sex-steroids, promote a pro-inflammatory state among men but not women in developing countries. We tested this hypothesis, using recalled childhood meat eating as a proxy for childhood nutrition, in southern China. METHODS: We used multivariable linear regression in the Guangzhou Biobank Cohort Study phase 3 (2006-8) to examine the adjusted associations of recalled childhood meat eating, <1/week (n = 5,023), about once per week (n = 3,592) and almost daily (n = 1,252), with white blood cell count and its differentials among older (≥ 50 years) men (n = 2,498) and women (n = 7,369). RESULTS: Adjusted for age, childhood socio-economic position, education and smoking, childhood meat eating had sex-specific associations with white blood cell count and lymphocyte count, but not granulocyte count. Men with childhood meat eating almost daily compared to <1/week had higher white blood cell count (0.33 109/L, 95% confidence interval (CI) 0.10 to 0.56) and higher lymphocyte count (0.16 109/L, 95% CI 0.07 to 0.25). Adjustment for obesity slightly attenuated these associations. CONCLUSION: If confirmed, this hypothesis implies that economic development and the associated improvements in nutrition at puberty may be less beneficial among men than women; consistent with the widening sex differentials in life expectancy with economic development.

Leg length and age of puberty among men and women from a developing population: the Guangzhou Biobank Cohort study.

OBJECTIVES: Leg length and relative leg length are considered to be reliable markers of prepubertal living conditions. Cessation of leg growth, driven by estrogen, occurs earlier in puberty in girls than boys. We hypothesized that leg length and relative leg length, as sitting height to leg ratio, might have sex-specific associations with age of puberty. METHODS: We used multivariable linear regression in 10,046 older (>or=50 years) Chinese from the Guangzhou Biobank Cohort Study (Phase 3) to examine the associations of recalled age of puberty (women: age of menarche, and men: mean age of first nocturnal emission, voice breaking, and first pubic hair) with subischeal leg length, sitting height to leg ratio, and sitting height. RESULTS: Leg length and sitting height to leg ratio had different associations with age of puberty in men and women (P-values for interaction <0.001), but sitting height did not. Per year earlier puberty, legs were longer among men by 0.09 cm (95% confidence interval (CI) 0.01-0.18) and shorter among women by -0.16 cm (95% CI -0.20 to -0.12). Further adjustment for age, hip size (as a marker of buttock fat), and several markers of childhood conditions did not obviate the difference in association by sex. CONCLUSIONS: Adult leg length and relative leg length (sitting height to leg ratio) may be biomarkers of different exposures in men and women, with corresponding implications for their interpretation as a biomarker of early life exposures.

An overview of the Guangzhou biobank cohort study-cardiovascular disease subcohort (GBCS-CVD): a platform for multidisciplinary collaboration.

The Guangzhou Biobank Cohort Study (GBCS, n=30 519, age >or=50 years) was established to examine the effects of genetic and environmental influences on health problems and chronic disease development. Guangzhou is undergoing massive economic development, but from a baseline that had remained unchanged for millennia. The Cardiovascular Disease Subcohort (GBCS-CVD) consists of 2000 participants who have been intensively phenotyped including a range of surrogate markers of vascular disease, including carotid artery intima-media thickness, cerebral artery stenoses, arterial stiffness, ankle-to-brachial blood pressure index and albuminuria, as well as coagulatory and inflammatory markers. Plasma and leukocytes are stored in liquid nitrogen for future studies. Preliminary demographic data show the female volunteers are younger than the male ones, but present with greater levels of adiposity including central obesity (31 vs 16%). Women had more body fat (33 vs 24%) and associated levels of adipokines. Despite this, body mass index and hip circumferences were similar, which contrasts with Caucasian populations. Men had more physician-diagnosed vascular disease (6.1 vs 2.5%), hypertension (42 vs 34%) and hyperglycaemia (36.6 vs 29.6%) than the women, but were less insulin resistant. In men, smoking (40 vs 2%) and drinking alcohol (67 vs 50%) was more common and they also had lower energy expenditures. The genotype distributions of the 15 typed single nucleotide polymorphisms were all in Hardy-Weinberg equilibrium. This article describes the rationale and methodology for the study. Given the comprehensive characterization of demographic and psychosocial determinants and biochemistry, the study provides a unique platform for multidisciplinary collaboration in a highly dynamic setting.

Are height and leg length universal markers of childhood conditions? The Guangzhou Biobank cohort study.

OBJECTIVE: In developed western populations longer legs have been shown to be a marker of better early childhood conditions. In the first generations to experience the epidemiologic transition and associated economic development, epigenetic constraints on growth might preclude improved childhood conditions from increasing leg growth or height. DESIGN, SETTING AND PARTICIPANTS: Multivariable linear regression was used to assess the association of parental growth environment, proxied by parental literacy, and childhood conditions, proxied by parental possessions, with leg length, sitting height and height in a cross-sectional sample from 2005-6 of 9998 Chinese people aged at least 50 years from phase 2 of the Guangzhou Biobank Cohort Study. MAIN RESULTS: Adjusted for age and sex, the association of childhood conditions with leg length and height varied with parental literacy (interaction p values <0.01 and 0.03), but not for sitting height (p value 0.43), with statistically significant trends (p values <0.01) for parental possessions to be associated with longer legs and greater height only in the offspring of two literate parents where legs were longer by 0.56 cm (95% CI 0.27 to 0.86) and height greater by 1.16 cm (95% CI 0.74 to 1.58) for participants with most, compared with least, parental possessions in childhood. CONCLUSIONS: Epigenetic influences originating in earlier generations may constrain growth during the infancy and/or childhood phases in very recently developed populations. Neither height nor leg length should be assumed to be consistent proxies of early life environment with corresponding implications for economic history, the aetiology of some chronic diseases and the monitoring of population health.

Is leg length a biomarker of childhood conditions in older Chinese women? The Guangzhou Biobank Cohort Study.

OBJECTIVE: In developed western populations longer legs have been shown to be a biomarker of better early childhood conditions. It was hypothesised that in transitioning populations better childhood conditions may bring forward puberty and thus decrease leg length, counteracting the overall positive effect of a favourable childhood environment on leg growth. DESIGN: Structural equation modelling was used to assess the interrelationship of age, education, father's job, age of menarche and leg length in a cross-sectional sample of 7273 Chinese women aged at least 50 years from the Guangzhou Biobank Cohort Study. RESULTS: Leg length had no significant association with education or father's occupation on bivariable testing. After including age of menarche in the model, education was associated with longer legs (0.45 cm longer per 10 years of education, 95% CI 0.20 to 0.71). Education was also associated with younger age of menarche (1.21 years younger per 10 years of education, 95% CI 1.09 to 1.34), which was in turn associated with shorter legs (0.23 cm shorter per year of menarche earlier, 95% CI 0.18 to 0.27). CONCLUSIONS: In older Chinese women leg length is not a universal biomarker of childhood conditions, when proxied by her educational level and father's occupation. Nutritionally driven epigenetic influences operating over generations may constrain growth in very recently developed populations. Given the impact of childhood conditions on health, and the dearth of long-term records outside the industrialised world, a greater understanding of the influences on growth in the developing world is required.

Life-course origins of social inequalities in metabolic risk in the population of a developing country.

In countries that have been industrialized for a long time, but not always elsewhere, low socioeconomic position (SEP) is associated with ischemic heart disease in men. The authors hypothesized that socioeconomic development could, via pubertal sex steroids, promote an atherogenic lipid profile and body shape in men but not in women. Therefore, they examined the associations of SEP with ischemic heart disease risk in a developing-country population. The authors used multivariable regression to examine the associations of SEP with the metabolic syndrome and its components in 9,746 Chinese adults aged >/=50 years from the Guangzhou Biobank Cohort Study, phase 2, recruited in 2005-2006. After adjustment for age, smoking, alcohol use, and physical activity, high SEP at each of three life stages, proxied by parental possesions in childhood, education, and longest held-occupation, was inversely associated with the metabolic syndrome in women but not in men. Higher SEP in men was associated with lower pulse pressure and fasting plasma glucose level but also with greater waist circumference and a lower high density lipoprotein cholesterol level. With socioeconomic development, diet-related hormonal changes at puberty may outweigh the usual protective effect of social advantage in men, with corresponding implications for boys currently undergoing the nutrition transition in the developing world.

Application of breath-hold T2-weighted, first-pass perfusion and gadolinium-enhanced T1-weighted MR imaging for assessment of myocardial viability in a pig model.

The purpose of this study was to correlate the abnormal signal area on various magnetic resonance (MR) images to the infarct area on pathologic examination and to assess the myocardial viability on the basis of MR images. T2-weighted, first-pass perfusion, and delayed gadolinium-enhanced T1-weighted images were used as "one-stop examinations" in a pig model of reperfused myocardial infarction. The results of each MR image were compared with those of 2,3, 5-triphenyltetrazolium chloride (TTC) staining. The abnormal signal areas on T2-weighted and Gd-enhanced T1-weighted images were larger than the infarct areas on TTC staining (34.7% and 32.3% vs. 28.3%; P< 0.05), whereas the nonperfused areas on perfusion images were correlated (25.6% vs, 28.3%; P = 0.139). Electron microscopic examination showed severely distorted ultrastructures in the infarct areas and mildly damaged ultrastructures in the peri-infarct areas. Perfusion images probably reflected the infarct areas, whereas T2-weighted and Gd-enhanced T1-weighted images seemed to include peri-infarct as well as infarct areas.

[The value of Sm-153-EDTMP for treatment of metastatic bone pain and improving quality of life].

Sm-153-EDTMP (ethylenediaminetetramethylene phosphonic acid), a beta-particle and gamma-emitting radionuclide, was used for pain control of bone metastasis. Fourty patients with bone metastasis were administrated a single intravenous injection of 29.6 MBq/kg (0.8mCi/kg), and 7 of them received more than one injection. No obvious side effect was observed. The skeletal images obtained with Sm-153-EDTMP were similar to that of Tc-99m-MDP SPECT images. Follow up study (at least 30 days) revealed bone pain relief and improved quality of life in 82.5% of the treated patients.

Preliminary observations on the epidemiology of bovine ephemeral fever in China.

Bovine ephemeral fever (BEF) is a viral disease of cattle and water buffalo recognised for the first time in China in 1955. The disease has been endemic in south China with 13 epidemics since 1955, seven epidemics reaching central China and one extending into north-east China (40 degrees N). The outbreaks have been seasonal with all occurring in the warmer summer/autumn months of June to October when possible insect vectors are active. Reports of clinical disease were confirmed as BEF by the detection of virus-neutralising antibody. The economic impact of the disease includes loss of milk production, late-term abortions and the loss of draught animal power.