Ferulic Acid Prevents Nonalcoholic Fatty Liver Disease by Promoting Fatty Acid Oxidation and Energy Expenditure in C57BL/6 Mice Fed a High-Fat Diet.

There is a consensus that ferulic acid (FA), the most prominent phenolic acid in whole grains, displays a protective effect in non-alcoholic fatty liver disease (NAFLD), though its underlying mechanism not fully elucidated. This study aimed to investigate the protective effect of FA on high-fat diet (HFD)-induced NAFLD in mice and its potential mechanism. C57BL/6 mice were divided into the control diet (CON) group, the HFD group, and the treatment (HFD+FA) group, fed with an HFD and FA (100 mg/kg/day) by oral gavage for 12 weeks. Hematoxylin and eosin (H&E) staining and Oil Red O staining were used to evaluate liver tissue pathological changes and lipid accumulation respectively. It was demonstrated that FA supplementation prevented HFD-induced NAFLD, which was evidenced by the decreased accumulation of lipid and hepatic steatosis in the HFD+FA group. Specifically, FA supplementation decreased hepatic triacylglycerol (TG) content by 33.5% (p < 0.01). Metabolic cage studies reveal that FA-treated mice have elevated energy expenditure by 11.5% during dark phases. Mechanistically, FA treatment increases the expression of rate-limiting enzymes of fatty acid oxidation and ketone body biosynthesis CPT1A, ACOX1 and HMGCS2, which are the peroxisome proliferator-activated receptors α (PPARα) targets in liver. In conclusion, FA could effectively prevent HFD-induced NAFLD possibly by activating PPARα to increase energy expenditure and decrease the accumulation of triacylglycerol in the liver.

Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study.

BACKGROUND: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. METHODS: A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. RESULTS: Mean follow-up of the 20 995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77-0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective. CONCLUSIONS: Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants.

Protocol for the economic evaluation of the China Salt Substitute and Stroke Study (SSaSS).

INTRODUCTION: Cardiovascular diseases (CVDs) are the leading causes of death and disability worldwide. Reducing dietary salt consumption is a potentially cost-effective way to reduce blood pressure and the burden of CVD. To date, economic evidence has focused on sodium reduction in food industry or processed food with blood pressure as the primary outcome. This study protocol describes the planned within-trial economic evaluation of a low-sodium salt substitute intervention designed to reduce the risk of stroke in China. METHODS AND ANALYSES: The economic evaluation will be conducted alongside the Salt Substitute and Stroke Study: a 5-year large scale, cluster randomised controlled trial. The outcomes of interest are quality of life measured using the EuroQol-5-Dimensions and major adverse cardiovascular events. Costs will be estimated from a healthcare system perspective and will be sought from the routinely collected data available within the New Rural Cooperative Medical Scheme. Cost-effectiveness and cost-utility analyses will be conducted, resulting in the incremental cost-effectiveness ratio expressed as cost per cardiovascular event averted and cost per quality-adjusted life year gained, respectively. ETHICS AND DISSEMINATION: The trial received ethics approval from the University of Sydney Ethics Committee (2013/888) and Peking University Institutional Review Board (IRB00001052-13069). Informed consent was obtained from each study participant. Findings of the economic evaluation will be published in a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02092090).

Benchmark dose assessment for coke oven emissions-induced telomere length effects in occupationally exposed workers in China.

Telomeres are DNA-protein structures that protect chromosome ends from degradation and fusion, which are shortened by oxidative stress, for example air pollution including benzene, toluene, Coke Oven Emissions (COEs), and so on. As a biomarker of health and disease, telomere length is associated with cardiovascular, diabetes and cancers. The aim of this study was to estimate the effects of COEs exposure on telomere length and the benchmark dose (BMD) of COEs. A total of 542 coke oven workers and 235 healthy controls without exposure to toxicants were recruited. Quantitative PCR was used to determine the telomere length in human peripheral blood leukocytes DNA. Propensity scoring was used to match coke oven workers to healthy controls. Linear regression models and trend tests were used to the relationship between COEs exposure and telomere length. Telomere length in COEs exposed group 0.764 (0.536, 1.092) was significantly shorter than that in the control group 1.064(0.762, 1.438), (P < 0.001). There were significantly dose-response relationships between COEs exposure and telomere damage with telomere length as a biomarker. A BMDL value lower than the present occupational exposure limits (OELs) of COEs exposure was evaluated using the BMD approach in coke oven workers. Our results suggested that shorter telomere length is related to occupational exposure to COEs and the level of COEs exposure lower than the current national OELs in China and many other countries could induce telomere damage.

Caregiver-Delivered Stroke Rehabilitation in Rural China.

Background and Purpose- Stroke disability is a major health burden in rural China where rehabilitation services are inadequate. We aimed to determine the effectiveness of a novel nurse-led, caregiver-delivered model of stroke rehabilitation in rural China. Methods- A multicenter prospective, randomized open, blinded outcome assessed, controlled trial was conducted in 3 rural county hospitals in China: Zhangwu, Liaoning Province (Northeast); Qingtongxia, Ningxia Hui Autonomous Region (Northwest); and Dianjiang, Chongqing Municipality (Southwest). Adult patients (age 18-79 years) with residual disability (Barthel Index score ≤80/100) after a recent acute stroke were randomized to a new service model or usual care. The new intervention was multifaceted and was based on a task-shifting / training-the-trainers model, supported by a custom-designed smartphone application, where patients and caregivers received evidence-based in-hospital education and stroke rehabilitation training (focus on mobility, self-care, and toileting), delivered by trained nurses before hospital discharge, and 3 postdischarge support telephone calls. Outcome assessments were undertaken before hospital discharge and at 3 and 6 months. Primary outcome was physical functioning (Barthel Index scores) at 6 months, assessed by research staff blind to treatment allocation, adjusted for baseline covariates in an intention-to-treat analysis. Secondary outcomes included measures of mobility, health-related quality of life, mood, and caregiver burden. The study included a process evaluation that assessed intervention fidelity. Results- From November 2014 to December 2016, 246 stroke patients were randomized to intervention (n=118) or control (n=128) groups. There was no statistically significant difference in adjusted 6-month Barthel Index scores between groups (70.1 versus 74.1, mean difference, -4.0 [95% CI, -10.0 to 2.9]), nor any differences across the other outcome measures. Process evaluation interviews revealed that the intervention was desirable and positively accepted by nurses, caregivers, and patients but was considered too complex despite efforts to simplify materials for the rural context. Key strategies identified for future studies included the use of community health workers, smartphone application enhancement, and simpler and more frequent training for nurses, caregivers, and patients. Conclusions- A novel nurse-led, digital supported, caregiver-delivered stroke rehabilitation program did not improve patient physical functioning after stroke in rural China. Further stroke rehabilitation research suitable for resource-poor settings is required, with several components being suggested through stakeholder interviews in our study. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02247921.

Attribute Selection Based on Constraint Gain and Depth Optimal for a Decision Tree.

Uncertainty evaluation based on statistical probabilistic information entropy is a commonly used mechanism for a heuristic method construction of decision tree learning. The entropy kernel potentially links its deviation and decision tree classification performance. This paper presents a decision tree learning algorithm based on constrained gain and depth induction optimization. Firstly, the calculation and analysis of single- and multi-value event uncertainty distributions of information entropy is followed by an enhanced property of single-value event entropy kernel and multi-value event entropy peaks as well as a reciprocal relationship between peak location and the number of possible events. Secondly, this study proposed an estimated method for information entropy whose entropy kernel is replaced with a peak-shift sine function to establish a decision tree learning (CGDT) algorithm on the basis of constraint gain. Finally, by combining branch convergence and fan-out indices under an inductive depth of a decision tree, we built a constraint gained and depth inductive improved decision tree (CGDIDT) learning algorithm. Results show the benefits of the CGDT and CGDIDT algorithms.

Ethnic Disparity in Annual Healthcare Expenditures for Type 2 Diabetes Mellitus in Ningxia, China.

BACKGROUND: The incidence of type 2 diabetes mellitus (T2DM) and its complications has been increasing worldwide with an increasing provision of long-term medications and health services. This study aimed to assess the healthcare costs for T2DM patients for vulnerable ethnic minority. METHODS: A cross-sectional study was conducted from October 13, 2016, to June 19, 2017, in two public hospitals in Ningxia, China. Eligible Hui and Han inpatients were recruited and interviewed. Ethnic disparities in annual healthcare expenditures for T2DM measured from a societal perspective and its associations of expenditures with other factors were analyzed by linear and quantile regressions. RESULTS: Ethnic disparities in annual healthcare expenditures for T2DM were demonstrated, mainly reflecting differences in the cost of productivity loss. The quantile of annual healthcare expenditure showed significant ethnic disparities in T2DM patients with complications. At the 10th to 50th quantiles of healthcare expenditures, Hui patients had significantly lower expenditures than Han patients in both unadjusted and adjusted models. Non-significant difference in expenditures between Hui and Han patients was found at the 90th quantile of expenditure in the unadjusted model, but significantly higher expenditures for Hui patients were shown when adjusted for socioeconomic and clinical factors. CONCLUSION: T2DM Hui patients faced significantly higher expenditures than Han patients when the costs of healthcare were high. Appropriate national policy considering the issue of ethnic minority should be further explored to improve health and subsidize economic burden for T2DM patients.

Use of Smartphone for Verbal Autopsy.

Traditionally, verbal autopsies (VA) are collected on paper-based questionnaires and reviewed by physicians for cause of death assignment, it is resource intensive and time consuming. The Population Health Metrics Research Consortium VA questionnaires was made available on an Android-based application and cause of death was derived using the Tariff method. Over one year, all adult deaths occurring in 48 villages in 4 counties were identified and a VA interview was conducted using the smartphone VA application. A total of 507 adult deaths were recorded and VA interviews were conducted. Cardiovascular disease was the leading cause of death (35.3%) followed by injury (14.6%) and neoplasms (13.5%). The total cost of the pilot study was USD28 835 (USD0.42 per capita). The interviewers found use of smartphones to conduct interviews to be easier. The study showed that using a smartphone application for VA interviews was feasible for implementation in rural China.

A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale.

RATIONALE: Stroke is the leading cause of death and disability in rural China. For stroke patients residing in resource-limited rural areas, secondary prevention and rehabilitation are largely unavailable, and where present, are far below evidence-based standards. AIM: This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery, and evaluate its feasibility and effectiveness in rural China. METHODS AND DESIGN: This 2-year randomized controlled trial is being conducted in 2-3 county hospitals located in northwest, northeast, and southwest China. Eligible and consenting stroke inpatients (200 in total) have been recruited and randomized into either a control or intervention group. Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group. They also provide telephone follow-up care three times post discharge. The recruitment, baseline, intervention, follow-up care, and evaluation are guided by the RECOVER mobile phone app specifically designed for this study. STUDY OUTCOME: The primary outcome is patients' Barthel Index (activities of daily living: mobility, self-care, and toileting) at 6 months. Process and economic evaluation will also be conducted. DISCUSSION: The results of our study will generate initial high-quality evidence to improve stroke care in resource-scarce settings. If proven effective, this innovative care delivery model has the potential to improve the health and function of stroke patients, relieve caregiver burden, guide policy-making, and advance translational research in the field of stroke care.

[Pollution Characteristics and Ecological Risk Assessment of PAHs in Water and Fishes from Daqing Lakes].

The concentrations of 16 polycyclic aromatic hydrocarbons (PAHs) in 30 water samples and 5 tissues (gill, liver, brain, kidney and muscle) of 36 fishes which were collected from 18 typical lakes of the Daqing lakes group, China were measured between February and April 2012. The results of PAHs concentrations in the water showed that the range of total concentrations was 0.2-1.21 µg x L(-1) and the highest concentration was found in the Yueliangpao Lake. Clustering analysis of statistical method was used to classify the concentrations of PAHs in the water of 18 lakes, and PAHs source and evaluation of ecological risk in different lake groups were obtained respectively based on the analysis of PAHs ratio and the species sensitivity distributions method. The results of cluster analysis about PAHs concentrations in the water of 18 lakes showed that all the lakes were divided into 4 lake groups. Yueliangpao (YLP) and dongdahai (DDH) lakes were respectively divided into a separate group and the other 14 lakes were divided into two groups named XHH group and DQSK group. PAHs in the water of lakes were mainly from wood and coal burning except that the PAHs of the water in YLP group was caused by oil contamination. According to the surface water quality standard of the world and China, the concentrations of PAHs in the water of 4 lake groups all exceeded the standard variously. The PAHs concentrations of most water samples in YLP group and XHH group exceeded the 16 PAHs limit value of Environmental Protection Agency (US EPA) standard, especially, the concentration of Benz[a] pyrene with the strongest carcinogenicity of YLP group exceeded Chinese surface water quality standard. While in the DQSK lake group and the DDH lake group, several PAHs contaminations of water samples exceeded the standard. The tested and statistical results of 16 PAHs concentrations in 5 tissues of Cyprinus carpio and Hypophthalmichthys molitrix fish species in Daqing lakes showed the concentrations of anthracene in the gill tissue of Cyprinus carpio were significantly greater than those in the Hypophthalmichthys molitrix, while other 15 PAHs concentrations had no difference between the two species. Among the different tissues of Hypophthalmichthys molitrix or Cyprinus carpio, the concentrations of PAHs in the liver and kidney tissues which are the important tissues of PAHs accumulation were significantly greater than those in the muscle, gill and brain tissues of fish because of their pervasion ability of pollutants. The results of ecological risks of PAHs in water samples to different aquatic organism species and health risk of PAHs to human through the consumption of fish showed that low ecological risk to aquatic organism species and health risk of PAHs in the muscle of Hypophthalmichthys molitrix and Cyprinus carpio to human were observed in the 4 lake groups.

Will China's Cooperative Medical System fail again? Insight from farmer satisfaction survey.

This paper studied the sustainability of China's New Rural Cooperative Medical System (NCMS) by evaluating the satisfaction rate of its participants-the farmers. The study related the overall satisfaction of the farmers to their satisfaction with the four different aspects of the program. It also identified which personal and program attributes affect the farmers' satisfaction rate. Survey data of 1278 households from 66 counties in Shandong Province of China were collected in 2011 using a multi-stage stratified cluster-sampling method. To overcome the nepotistic barriers in rural China, field surveys in each township were conducted by university students from the same place. Data were analyzed using multiple regressions and structural equation modeling method. The results showed that 86% of the farmers were either satisfied or very satisfied with the NCMS and 82% indicated their intention to continue participating in the program. Aside from its financial benefits, both the publicity and reimbursement procedure of the program were found to be significant factors in influencing the satisfaction of the farmers. Majority of the participants held positive opinions toward the NCMS, contradicting the negative assessments made by many previous studies. Given the high proportion of farmers willing to continue with the program, it is likely to be sustainable in the near future. Greater publicity and education efforts should be made to make the farmers better informed about the program, and measures should be taken to improve its reimbursement procedure and the setting of the premium level.

[Distribution and potential ecological risk assessment of heavy metals in sediments of Zhalong Wetland].

This study investigated the concentrations of heavy metals in the sediments of the Zhalong Wetland using ICP-MS, analyzed their spatial distributions, evaluated the potential ecological risk, and explored the pollution sources and environmental influencing factors. The results can be summarized as the followings: (1) The concentrations of Hg, Cd, As, Cu, Pb, Zn and Cr were 0.065, 0.155, 10.26, 18.20, 21.35, 52.08 and 46.47 mg x kg(-1), respectively, which were all above the soil background values of the Songnen Plain. Their spatial distributions were distinctly different. The concentration of heavy metals in the north was higher than that in the south, and the east was higher than the west. Particularly in the eastern region, the concentrations of Hg and Cd were 20.8 and 32.4 times the minimum values of the whole area. And in the core zone, the concentration was relatively low. (2) The sequence of the potential ecological risk posed by the metals was Hg > Cd > As > Pb > Cu > Cr > Zn. The average potential ecological risk index (RI) of the Zhalong Wetland was 171.9 (ranged from 76.9-473.5), suggesting a moderate ecological risk. However, the potential ecological risk was extremely high in the east which should be treated as the major heavy metal pollution prevention site in the future. (3) Except for Hg and Pb, the concentrations of all heavy metals were significantly correlated to each other, indicating that those heavy metals had homology. (4) Organic matter was the major environmental influencing factor. However, the trend of land salinization in the Zhalong Wetland has been intensified, indicating a higher risk of heavy metal releasing from the sediments, to which the local authorities should pay enough attention.

Assessment of carotid atherosclerosis in type 2 diabetes mellitus patients with microalbuminuria by high-frequency ultrasonography.

The aim of this study is to evaluate carotid atherosclerosis in patients of type 2 diabetes mellitus with microalbuminuria (MA) by high-frequency ultrasonography. Two hundred and fifty patients of type 2 diabetes mellitus were divided into two groups according to urinary albumin excretion rate (UAER): normoalbuminuria group (130 cases) and microalbuminuria group (120 cases). The intimal-medial thickness (IMT) and the atherosclerotic plaques of carotid artery were observed in both groups by high-frequency ultrasound. Fasting blood glucose (FBG), hemoglobin A1c, and lipid profiles were measured. The values of IMT of microalbuminuria group were significantly higher than those of normoalbuminuria group (P < 0.05). In univariate analysis, IMT was positively and significantly associated with age (r = 0.265, P < 0.05), waist circumference (r = 0.263, P < 0.05), body mass index (r = 0.285, P < 0.05), systolic blood pressure (r = 0.276, P < 0.05), UAER (r = 0.359, P < 0.05), HbA1c (r = 0.462, P < 0.05) and, duration of diabetes (r = 0.370, P < 0.05). In multivariate linear regression analysis, UAER and HbA1c were independent predictors of IMT (P < 0.05 for all). In the two groups, the rate of soft plaques was higher than that of dense plaques and calcified plaques. In conclusion, there is a significant association between microalbuminuria and IMT which is regarded as the early sign of carotid atherosclerosis in type 2 diabetic patients.

Assessment of carotid arterial wall elasticity in type 2 diabetes mellitus patients with microalbuminuria by real-time ultrasound elastography.

The aim of this study was to evaluate carotid arterial wall elasticity in type 2 diabetes mellitus (T2DM) with microalbuminuria by real-time ultrasound elastography. Two hundred and ten T2DM patients were divided into two groups according to levels of urinary albumin excretion (UAE): T2DM without microalbuminuria (T2DM1 group, 120) and T2DM with microalbuminuria (T2DM2 group, 90). The right common carotid arteries were examined by real-time ultrasound elastography. The strain ratio (SR, blood to arterial wall strain ratio) was calculated by dividing the strain value of the blood by that of the carotid arterial wall. The correlation between SR and general data was analyzed. The mean SR value ± SD of T2DM2 group was significantly higher than that of T2DM1 group (P < 0.05). SR was positively and significantly correlated with UAE, HbA1c, and systolic blood pressure (r = 0.456,0.435,0.235, P < 0.05 for all). The mean value ± SD of UAE, HbA1c, 2hPG, BMI, and TC of T2DM2 group was significantly higher than that of T2DM1 group (P < 0.05 for all). In conclusion, there is an association between microalbuminuria and carotid arterial wall elasticity in T2DM patients.

Assessment of tobacco control advocacy behavioural capacity among students at schools of public health in China.

OBJECTIVES: To evaluate student tobacco control advocacy behavioural capacity using longitudinal trace data. METHODS: A tobacco control advocacy curriculum was developed and implemented at schools of public health (SPH) or departments of public health in seven universities in China. Participants comprised undergraduate students studying the public health curriculum in these 13 Universities. A standardised assessment tool was used to evaluate their tobacco control advocacy behavioural capacity. Repeated measures analysis of variance, paired t tests and paired χ² tests were used to determine differences between dependent variables across time. Multivariate analysis of variance (MANOVA) and multivariate logistic regression were used to assess treatment effects between intervention and control sites. RESULTS: Respective totals of 426 students in the intervention group and 338 in the control group were available for the evaluation. Approximately 90% of respondents were aged 21 years or older and 56% were women. Findings show that the capacity building program significantly improved public health student advocacy behavioural capacity, including advocacy attitude, interest, motivation and anti-secondhand smoke behaviours. The curriculum did not impact student smoking behaviour. CONCLUSIONS: This study provides sufficient evidence to support the implementation of tobacco control advocacy training at Chinese schools of public health.

[The mean energy of electron determined by atomic hydrogen emission line in EACVD].

The process of atomic hydrogen emission in EACVD is simulated by Monte Carlo method. A method of determining the mean energy of electron is given by the ratio of atomic hydrogen emission line. The result is of great importance to determining the mean energy of electron in situ in the process of diamond film deposited by EACVD. Then, high quality diamond films can be obtained by controlling the conditions of technology efficiently.