Spatial heterogeneity of socio-economic determinants of typhoid/paratyphoid fever in one province in central China from 2015 to 2019.

BACKGROUND: Typhoid fever and paratyphoid fever are one of the most criticial public health issues worldwide, especially in developing countries. The incidence of this disease may be closely related to socio-economic factors, but there is a lack of research on the spatial level of relevant determinants of typhoid fever and paratyphoid fever. METHODS: In this study, we took Hunan Province in central China as an example and collected the data on typhoid and paratyphoid incidence and socio-economic factors in 2015-2019. Firstly spatial mapping was made on the disease prevalence, and again using geographical probe model to explore the critical influencing factors of typhoid and paratyphoid, finally employing MGWR model to analysis the spatial heterogeneity of these factors. RESULTS: The results showed that the incidence of typhoid and paratyphoid fever was seasonal and periodic and frequently occurred in summer. In the case of total typhoid and paratyphoid fever, Yongzhou was the most popular, followed by Xiangxi Tujia and Miao Autonomous Prefecture, Huaihua and Chenzhou generally focused on the south and west. And Yueyang, Changde and Loudi had a slight increase trend year by year from 2015 to 2019. Moreover, the significant effects on the incidence of typhoid and paratyphoid fever from strong to weak were as follows: gender ratio(q = 0.4589), students in ordinary institutions of higher learning(q = 0.2040), per capita disposable income of all residents(q = 0.1777), number of foreign tourists received(q = 0.1697), per capita GDP(q = 0.1589), and the P values for these factors were less than 0.001. According to the MGWR model, gender ratio, per capita disposable income of all residents and Number of foreign tourists received had a positive effect on the incidence of typhoid and paratyphoid fever. In contrast, students in ordinary institutions of higher learning had a negative impact, and per capita GDP shows a bipolar change. CONCLUSIONS: The incidence of typhoid and paratyphoid fever in Hunan Province from 2015 to 2019 was a marked seasonality, concentrated in the south and west of Hunan Province. Attention should be paid to the prevention and control of critical periods and concentrated areas. Different socio-economic factors may show other directions and degrees of action in other prefecture-level cities. To summarize, health education, entry-exit epidemic prevention and control can be strengthened. This study may be beneficial to carry out targeted, hierarchical and focused prevention and control of typhoid fever and paratyphoid fever, and provide scientific reference for related theoretical research.

Hysteresis effects of different levels of storm flooding on susceptible enteric infectious diseases in a central city of China.

BACKGROUND: Recently, attention has focused on the impact of global climate change on infectious diseases. Storm flooding is an extreme weather phenomenon that not only impacts the health of the environment but also worsens the spread of pathogens. This poses a significant challenge to public health security. However, there is still a lack of research on how different levels of storm flooding affect susceptible enteric infectious diseases over time. METHODS: Data on enteric infectious diseases, storm flooding events, and meteorology were collected for Changsha, Hunan Province, between 2016 and 2020. The Wilcoxon Rank Sum Test was used to identify the enteric infectious diseases that are susceptible to storm flooding. Then, the lagged effects of different levels of storm flooding on susceptible enteric infectious diseases were analyzed using a distributed lag nonlinear model. RESULTS: There were eleven storm flooding events in Changsha from 2016 to 2020, concentrated in June and July. 37,882 cases of enteric infectious diseases were reported. During non-flooding days, the daily incidence rates of typhoid/paratyphoid and bacillary dysentery were 0.3/100,000 and 0.1/100,000, respectively. During flooding days, the corresponding rates increased to 2.0/100,000 and 0.8/100,000, respectively. The incidence rates of both diseases showed statistically significant differences between non-flooding and flooding days. Correlation analysis shows that the best lags for typhoid/paratyphoid and bacillary dysentery relative to storm flooding events may be 1 and 3 days. The results of the distributed lag nonlinear model showed that typhoid/paratyphoid had the highest cumulative RR values of 2.86 (95% CI: 1.71-4.76) and 8.16 (95% CI: 2.93-22.67) after 4 days of general flooding and heavy flooding, respectively; and bacillary dysentery had the highest cumulative RR values of 1.82 (95% CI: 1.40-2.35) and 3.31 (95% CI: 1.97-5.55) after 5 days of general flooding and heavy flooding, respectively. CONCLUSIONS: Typhoid/paratyphoid and bacillary dysentery are sensitive enteric infectious diseases related to storm flooding in Changsha. There is a lagging effect of storm flooding on the onset of typhoid/paratyphoid and bacillary dysentery, with the best lagging periods being days 1 and 3, respectively. The cumulative risk of typhoid/paratyphoid and bacillary dysentery was highest at 4/5 days lag, respectively. The higher of storm flooding, the higher the risk of disease, which suggests that the authorities should take appropriate preventive and control measures before and after storm flooding.

Association between Age at Menarche and Hyperhomocysteinemia among Women in Hunan, China: A Cross-Sectional Study.

Background: We aim to examine the relationship between age at menarche and hyperhomocysteinemia in women in Hunan Province. Methods: Participants were required to complete a questionnaire that included age at menarche, lifestyle habits, other baseline information, and blood biochemical parameters in a cross-sectional study. The association between hyperhomocysteinemia and age at menarche was examined by Multivariable adjusted logistic regression. Results: A cohort of 2008 women with a mean age of 60.11 years (aged from 18.0 to 88.0 years) was included in this study. After adjustment for confounding factors such as age, the results showed that the risk of hyperhomocysteinemia among women whose age at menarche were over 16 years was 2.543 (1.849, 3.469) times higher than the risk among women whose age at atmenarche were less than 14 years, and 2.656 (1.882, 3.748) times more likely to have hypertension than women with menarche at 14 years. Besides, the odds ratios of diabetes, hyperlipidemia, and obesity were elevated in women older than 16 years of age at menarche (OR = 1.924, p < 0.001; OR = 1.491, p = 0.014; OR = 1.670, p = 0.022). Conclusions: Our findings suggest that late menarche tends to be associated with a high risk of hyperhomocysteinemia and its associated set of diseases such as hypertension, diabetes, hyperlipidemia, and obesity in women in Hunan, China. This association tends to differ across birth cohorts. Therefore, adequate attention of menarcheal age may be able to predict diseases in elderly females.

Ginsenoside-Rg1 attenuates sepsis-induced cardiac dysfunction by modulating mitochondrial damage via the P2X7 receptor-mediated Akt/GSK-3ß signaling pathway.

Ginsenoside-Rg1 (G-Rg1), a saponin that is a primary component of ginseng, is effective against inflammatory diseases. The P2X purinoceptor 7 (P2X7) receptor is an ATP-gated ion channel that is predominantly expressed in immune cells and plays a key role in inflammatory processes. We investigated the role of G-Rg1 in sepsis-related cardiac dysfunction and the underlying mechanism involving the regulation of the P2X7 receptor. We detected cell viability, cytotoxicity, cellular reactive oxygen species (ROS) levels, and mitochondrial membrane potential (MMP) with or without G-Rg1 in lipopolysaccharide (LPS)- or hypoxia/reoxygenation (H/R)-induced H9c2 cell models of ischemia/reperfusion injury. We applied cecal ligation and puncture (CLP) to induce a mouse model of sepsis and measured the survival duration and cardiac function of CLP mice. Next, we quantified the ROS level, MMP, respiratory chain complex I-IV enzymatic activity, and mitochondrial fusion in CLP mouse heart tissues. We then investigated the role of G-Rg1 in repairing LPS-induced cell mitochondrial damage, including mitochondrial superoxidation products. The results showed that G-Rg1 inhibited LPS- or H/R-induced cardiomyocyte apoptosis, cytotoxicity, ROS levels, and mitochondrial damage. In addition, G-Rg1 prolonged the survival time of CLP mice. G-Rg1 attenuated LPS-induced superoxide production in the mitochondria of cardiomyocytes and the excessive release of cytochrome c from mitochondria into the cytoplasm. Most importantly, G-Rg1 suppressed LPS-mediated induction of proapoptotic Bax, activated Akt, induced GSK-3ß phosphorylation, and balanced mitochondrial calcium levels. Overall, G-Rg1 activates the Akt/GSK-3ß pathway through P2X7 receptors to inhibit sepsis-induced cardiac dysfunction and mitochondrial dysfunction.

Early life exposure to the Chinese Famine of 1959 - 1961 is an independent risk factor of adulthood elevated homocysteine, hyperuricemia, high LDL, and hypertension.

Famine exposure in early life was associated with cardiovascular diseases in later life. Whether biochemical surrogates of cardiovascular diseases, such as homocysteine and uric acid, are also associated with famine exposure is unknown so far. Data were derived from a population-based cross-sectional study in the Hunan Province of China, which was heavily affected by the Famine in 1959 - 1961. A total of 1,150 adults born between 1952 and 1964 were selected, and 5 cohorts were defined: no exposure, fetal, early childhood, mid-childhood, and late childhood exposure. Compared with the no-famine exposure group, participants exposed to famine in their fetal period had a higher risk of high homocysteine in adulthood with OR of 2.21 (95% CI: 1.01 - 4.83), whereas famine exposures in early, mid, or late childhood were not significantly associated with high homocysteine in adulthood. Similarly, participants in the fetal famine exposure group had a 1.59-fold higher risk of hyperuricemia (OR = 2.59, 95% CI: 1.07 - 5.30) and a 2.03-fold higher risk of high low-density lipoprotein cholesterol (LDL) (OR = 0.03, 95% CI: 1.35 - 6.78) in adulthood compared to those without famine exposure, respectively. We furthermore conducted a meta-analysis including 16 studies regarding the association between fetal famine exposure and adulthood hypertension, including our study. The meta-analysis, including 34,804, subjects showed that fetal famine exposure is associated with a higher risk of adulthood hypertension (OR = 1.22, 95% CI: 1.07 - 1.40). Taken together, fetal famine exposure is related to higher odds of cardio-metabolic risk factors, such as high homocysteine, hyperuricemia, and LDL as well as hypertension, suggesting that undernutrition during fetal life may affect metabolism of homocysteine, uric acid, and LDL in adulthood.

Effect of Blood Flow Rate on the Accuracy of Central Venous Pressure Measurement during Continuous Renal Replacement Therapy.

BACKGROUND: The objective of this study was to study the influence of extracorporeal blood flow rate (BFR) on the accuracy of central venous pressure (CVP) measurement during continuous renal replacement therapy (CRRT). METHODS: Eligible patients were randomly divided into 3 groups based on the location of catheters used for their CRRT and CVP measurement. CVP levels measured at increased extracorporeal BFR (from 0 to 300 mL/min) in the normal and reverse positions of inlet and outlet lines connected to the CV catheter (CVC) in the course of the CRRT session were collected. RESULTS: CVP levels measured at different extracorporeal BFRs did not significantly differ between and among the 3 groups. Inversion of inlet and outlet lines connected to the catheters did not affect the accuracy of CVP measurement. BFR had a negative correlation with inflow/access pressure but a positive correlation with outflow/return pressure. Neither inflow pressure nor outflow pressure was correlated with CVP. CONCLUSIONS: Extracorporeal BFR has no influence on the accuracy of CVP measurement during CRRT with the net machine balance adjusted to zero regardless of the location of the catheter and the connection method between catheters and CRRT lines. Thus, CRRT does not need to be discontinued to obtain an accurate CVP measurement.

Estradiol-17ß inhibits homocysteine mediated damage by promoting H2 S production via upregulating CBS and CSE expression in human umbilical vein endothelial cells.

Associated with reduced hydrogen sulfide (H2 S) production in Hcy metabolic disorders, Plasma Hcy accumulation can bring about vascular dysfunction. Nevertheless, recently proposed therapies for vascular damage by estrogen could contribute to promoting endogenous hydrogen sulfide production. This study explores whether estrogen can come into play in protection in hyperhomocysteinemia and hypertensive patients at a population level, and then analyses the specific mechanism of estrogen protection in homocysteine (Hcy)-treated human umbilical vein endothelial cells (HUVECs) at the foundational level. A case-control study, conducted on 1277 female hypertension and non-hypertensive patients from Hunan Provincial People's Hospital, showed that the Hcy concentration of hypertensive patients emerged higher than that of healthy controls (P < .001), and that of estrogen was the reverse (P < .001). Estrogen had a negative correlation with systolic blood pressure and plasma Hcy concentration. HUVECs were treated with estrogen and Hcy in the basic experimental part, and 17ß-estradiol (E2ß) stimulated proliferation and inhibited damage in Hcy-treated umbilical vein endothelial cells. Treatment with Hcy dampens the expression of cystathionine ß-synthase (CBS) and cystathionine γ-lyase (CSE) then cuts down H2 S production in cultured HUVECs, however, E2ß reverses this process. To sum up, we have demonstrated a significant correlation between estrogen, Hcy concentration and systolic blood pressure reduction, which is bound up with Hcy metabolism and endogenous hydrogen sulfide production. The role of E2ß was further strengthened by CBS and the CSE inhibitor through overthrowing the change in hydrogen sulfide of Hcy-treated HUVECs.

Chili Consumption and Risk of Gastric Cancer: A Meta-Analysis.

Chili peppers are loved by people all over the world and have been indispensable vegetable for three meals a day. However, reports about the association between chili consumption and gastric cancer (GC) risk have been conflicting. So, we carried out this meta-analysis to evaluate the effect of chili consumption on the risk of GC. Medline, PubMed, Web of science, Embase, Cochrane Library databases were systematically searched until May 2019. Heterogeneity among studies was examined using Q and I2 statistics. Combined odds ratio (OR) with their 95% confidence interval (CI) were calculated using a random- or fixed-effects model. All data were analyzed using STATA 15.1 software. 13 studies (3,095 cases and 4,761 controls) were included in the meta-analysis. A 1.96-fold increased risk of GC was shown for the moderate-high chili consumption (OR = 1.96, 95%CI =1.59-2.42). Dose-response analysis showed a significant nonlinear association of GC risk with capsaicin intake (pnon-linearity <0.05) and suggested a significant positive association between high chili consumption and GC risk (OR = 2.28, 95%CI = 1.76-2.96) but not moderate chili consumption (OR = 0.72, 95%CI = 0.36-1.41). Sensitivity analysis and publication bias test results indicated that no publication bias and the results were reliable (Egger's: P = 0.288). Evidence from this meta-analysis suggested that a higher level of chili consumption may be associated with an increased incidence of GC. More studies are warranted to confirm the association between chili consumption and the risk of GC.

Association between the uric acid and hypertension in community-based Chinese population: stratified analysis based on body mass index and age.

Many studies have shown that uric acid was related to hypertension. However, the association dependence on body mass index (BMI) or age was unclear. This study was performed with a group of 4012 Chinese population aged 30 to 92 years old. Subjects were divided into four groups according to the quartiles of uric acid (UA) concentration [First group: ≤ 231 µmol/L (reference), Second group: 231-289 µmol/L, Third group: 289-362 µmol/L, Fourth group: > 362 µmol/L]. Hypertension was defined as newly measured blood pressure ≥ 140/90 mmHg or taking antihypertensive drugs. Stratified analysis based on BMI (< 28 kg/m2 vs ≥ 28 kg/m2) and age (< 60 years old vs ≥ 60 years old) to analyze the association between UA and hypertension. Subjects were 54.50 (45.00, 63.00) years old, and 40.98% were male, 38.33% were hypertension. Adjusted odds ratios (95% confidence intervals) for the association of UA and hypertension were 2.226 (1.662, 2.980), 4.340 (3.253, 5.790), 5.898 (4.434, 7.845) and 6.557 (4.927, 8.727) in the four groups among ≥ 60 years old respectively comparing with first group among < 60 years old. Adjusted odds ratios (95% confidence intervals) for the association between UA and hypertension were 2.170 (1.236, 3.808), 5.260 (3.267, 8.468), 9.056 (5.509, 14.888) and 3.730 (2.529, 5.550) in the four groups among BMI ≥ 28 kg/m2 respectively comparing with first group among BMI < 28 kg/m2. Uric acid was significantly associated with the hypertension. The association was stronger among subjects ≥ 60 years old or BMI ≥ 28 kg/m2.

Association of serum VLDL level with hyperhomocysteinemia in hypertensive patients: A cross-sectional study.

BACKGROUND: Increasing evidence suggests that hyperhomocysteinemia (HHcy) and hyperlipidemia have been recognized as two independent risks for cardiovascular disease. However, the association between hyperlipidemia and HHcy in hypertensive patients has not been systemically elucidated. The aim of this study was to investigate the relation between very low-density lipoprotein (VLDL) and HHcy in hypertensive patients. METHODS: From July 2013 to March 2014, a large cross-sectional study was performed using 4012 participants from urban and rural communities in Hunan province, China. Participants underwent accurate assessment of lipid profiles, homocysteine (Hcy), anthropometric, blood pressure, and other biochemical indicators. RESULTS: Among 1257 participants with hypertension, 626 (49.80%) were men and 631 (50.20%) were women. In total, 1081 (86.00%) of the participants were found to have HHcy, of which 559 (44.47%) were men and 522 (41.53%) were women. In the univariate analysis, the OR for patients with hypertension associated with hyperhomocysteinemia was significantly enhanced as the quartiles of the Log VLDL were increased. OR for quartile 4 was significantly higher than that for quartile 1 (OR = 3.7, 95% CI: 2.6-5.1; P< .001). Additional adjustment for the confounding variables did not reduce the ORs for the association between the Log VLDL and hypertension associated with hyperhomocysteinemia (OR = 3.8, 95% CI: 2.7-5.5; P< .001; OR = 4.3, 95% CI: 1.6-11.8; P= .004, respectively). We also conducted analyses with Log VLDL as a continuous variable. Each unit increase in the Log VLDL was associated with the 1.3-fold increased risk of hypertension associated with hyperhomocysteinemia (95% CI: 1.9-2.9; P< .001). Adjusting for Cr, TG, TC, and HDL did not affect the relationship. CONCLUSIONS: Our data indicate that the Log VLDL concentrations appear to be an independent contributor to hypertension associated with hyperhomocysteinemia, even after adjusting for age and other covariables. The utility of the Log VLDL as a diagnostic, prognostic, and therapeutic indicator for the disease warrants further investigation. ABBREVIATIONS: HHcy: hyperhomocysteinemia; Hcy: homocysteine; VLDL: very low-density lipoprotein; CVD: cardiovascular disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; BMI: body mass index; ALT: alanine aminotransferase; Cr: creatinine; UA: uric acid; TG: triglycerides; TC: total cholesterol; HDL: high-density lipoprotein; LDL: low-density lipoprotein; FBG: fasting blood glucose; CRP: C-reactive protein; MTHFR: methylene tetrahydrofolate reductase; NO: nitric oxide; HDL-C: high-density lipoprotein cholesterol.

The HO-1 Signal Prevents HMGB1-Mediated Activation of NLRP3 Inflammasomes in Lipopolysaccharide-Induced Acute Lung Injury In Vitro.

BACKGROUND: Current treatments of lipopolysaccharide (LPS)-induced acute lung injury (ALI) are unsatisfactory due to the insufficient understanding of the pathogenesis of LPS-induced ALI. The NLRP3 inflammasome is an essential part of the innate protection system and is involved in LPS-induced ALI; however, comprehensive understanding of molecular pathogenesis of the disease is lacking. Our study explored the effect of heme oxygenase-1 (HO-1) on NLRP3 inflammasomes in vitro. METHODS: Alveolar macrophages (NR8383) were preincubated with high-mobility group box-1 (HMGB1) or HO-1 CRISPR plasmids before LPS stimulation. Then, we detected the effect of HO-1 on NLRP3 inflammasomes. RESULTS: Our study demonstrates that the activation of HO-1 represses the level of NLRP3 inflammasomes and the subsequent increases of the level of IL-1ß. Moreover, NLRP3 inflammasome activation was sensitive to the HMGB1 activity, and HO-1 was able to reduce the amount of HMGB1 released. Furthermore, downregulation of NLRP3 inflammasomes was related to NADPH quinone oxidoreductase 1 (an HO-1-related gene). CONCLUSIONS: Our study clarifies the constrained coordination of the HO-1 signal in the HMGB1-mediated activation of NLRP3 inflammasomes in NR8383 alveolar macrophages after LPS stimulation.

Research about the optimal strategies for prevention and control of varicella outbreak in a school in a central city of China: based on an SEIR dynamic model.

Varicella is an acute respiratory infectious diseases, with high transmissibility and quick dissemination. In this study, an SEIR (susceptible-exposed-infected-recovered) dynamic model was established to explore the optimal prevention and control measures according to the epidemiological characteristics about varicella outbreak in a school in a central city of China. Berkeley Madonna 8.3.18 and Microsoft Office Excel 2010 software were employed for the model simulation and data management, respectively. The result showed that the simulated result of SEIR model agreed well with the reported data when ß (infected rate) equal to 0.067. Models showed that the cumulative number of cases was only 13 when isolation adopted when the infected individuals were identified (assuming isolation rate was up to 100%); the cumulative number of cases was only two and the TAR (total attack rate) was 0.56% when the vaccination coefficient reached 50%. The cumulative number of cases did not change significantly with the change of efficiency of ventilation and disinfection, but the peak time was delayed; when δ (vaccination coefficient) = 0.1, m (ventilation efficiency) = 0.7 or δ = 0.2, m = 0.5 or δ = 0.3, m = 0.1 or δ = 0.4 and above, the cumulative number of cases would reduce to one case and TAR would reduce to 0.28% with combined interventions. Varicella outbreak in school could be controlled through strict isolation or vaccination singly; combined interventions have been adopted when the vaccination coefficient was low.

Effects of meteorological factors on the incidence of mumps and models for prediction, China.

BACKGROUND: Mumps is an acute respiratory infectious disease with obvious regional and seasonal differences. Exploring the impact of climate factors on the incidence of mumps and predicting its incidence trend on this basis could effectively control the outbreak and epidemic of mumps. METHODS: Considering the great differences of climate in the vast territory of China, this study divided the Chinese mainland into seven regions according to the administrative planning criteria, data of Mumps were collected from the China Disease Prevention and Control Information System, ARIMA model and ARIMAX model with meteorological factors were established to predict the incidence of mumps. RESULTS: In this study, we found that precipitation, air pressure, temperature, and wind speed had an impact on the incidence of mumps in most regions of China and the incidence of mumps in the north and southwest China was more susceptible to climate factors. Considering meteorological factors, the average relative error of ARIMAX model was 10.87%, which was lower than ARIMA model (15.57%). CONCLUSIONS: Meteorology factors were the important factors which can affect the incidence of mumps, ARIMAX model with meteorological factors could better simulate and predict the incidence of mumps in China, which has certain reference value for the prevention and control of mumps.

Effect of coffee consumption on dyslipidemia: A meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: Dyslipidemia is a common metabolic disease worldwide and also an important predisposing factor for cardiovascular diseases (CVDs). Coffee is loved by people all over the world; however, the association between coffee consumption and blood lipids has yielded inconsistent results. So we carried this meta-analysis to explore the effects of coffee consumption on blood lipids. METHODS AND RESULTS: Medline, PubMed, Web of science, Embase, and Cochrane Library databases were systematically searched until April 2020. Combined weighted mean differences (WMD) with their 95% confidence interval (CI) were calculated using random-effects models, and between-study heterogeneity was assessed by Cochran's Q test and I2 statistics. Subgroup analysis and meta-regression analysis were also conducted to explore the potential heterogeneity. A total of 12 RCT studies involving the association between coffee consumption and blood lipid levels were included in the meta-analysis. The pooled results showed that coffee consumption significantly increased total cholesterol (TC) (WMD: 0.21 mmol/L, 95% CI: 0.04; 0.39, P = 0.017), triglyceride (TG) (WMD: 0.12 mmol/L, 95% CI: 0.03; 0.20, P = 0.006) and low-density lipoprotein (LDL-C) (WMD: 0.14 mmol/L, 95% CI: 0.05; 0.24, P = 0.003) while had no significant effect on high-density lipoprotein (HDL-C) (WMD: -0.01 mmol/L, 95% CI: -0.06; 0.04, P = 0.707). Dose-response analysis results revealed significant positive nonlinear associations between coffee consumption and the increase in TC, LDL-C, and TG levels. CONCLUSIONS: Evidence from this meta-analysis suggested that coffee consumption may be associated with an elevated risk for dyslipidemia and CVDs. So a reasonable habit of coffee consumption (<3 cups/d) is essential for the prevention of dyslipidemia.

Prognostic value of plasma HMGB1 in ischemic stroke patients with cerebral ischemia-reperfusion injury after intravenous thrombolysis.

BACKGROUND: To investigate the value of plasma high mobility group box protein 1 (HMGB1) in evaluating the prognosis of cerebral ischemia-reperfusion injury (CIRI) in ischemic stroke patients. METHODS: 132 ischemic stroke patients were recruited. Before and after thrombolytic therapy at 2 h, 6 h, 12 h, 24 h, and 36 h, the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) were recorded. The Modified Rankin scale (mRS) was used to assess the prognosis at 3 months. RESULTS: The NIHSS score, GCS score and plasma HMGB1 level peaked at 6 h after thrombolytic therapy, and plasma HMGB1 level was positively correlated with infarct volume and NIHSS score, and negatively correlated with GCS score. Plasma HMGB1 level at 6 h had the highest value in identifying patients with poor unfavorable functional outcome after 3 months, with a sensitivity of 86.8% and a specificity of 74.0%. Logistic regression results showed that plasma HMGB1 had a strong association with unfavorable functional outcome [odds ratio (OR) =1.621, P<0.001]. After adjusting for infarct volume and NIHSS score did not attenuate the association (OR=1.381, P=0.005). Finally, we found that plasma HMGB1 at 6 h had the highest value in identifying patients with non-survival after 3 months (χ2=28.655, P<0.001). Logistic regression results showed that plasma HMGB1 had a strong association with non-survival (OR=2.315, P<0.001). After adjusting for infarct volume and NIHSS score did not attenuate the association (OR=2.013, P<0.001). CONCLUSION: Plasma HMGB1 exerts a good predictive value for CIRI in ischemic stroke patients, and its increased expression is correlated with worse prognosis.

The study on the early warning period of varicella outbreaks based on logistic differential equation model.

Chickenpox is a common acute and highly contagious disease in childhood; moreover, there is currently no targeted treatment. Carrying out an early warning on chickenpox plays an important role in taking targeted measures in advance as well as preventing the outbreak of the disease. In recent years, the infectious disease dynamic model has been widely used in the research of various infectious diseases. The logistic differential equation model can well demonstrate the epidemic characteristics of epidemic outbreaks, gives the point at which the early epidemic rate changes from slow to fast. Therefore, our study aims to use the logistic differential equation model to explore the epidemic characteristics and early-warning time of varicella. Meanwhile, the data of varicella cases were collected from first week of 2008 to 52nd week of 2017 in Changsha. Finally, our study found that the logistic model can be well fitted with varicella data, besides the model illustrated that there are two peaks of varicella at each year in Changsha City. One is the peak in summer-autumn corresponding to the 8th-38th week; the other is in winter-spring corresponding to the time from the 38th to the seventh week next year. The 'epidemic acceleration week' average value of summer-autumn and winter-spring are about the 16th week (ranging from the 15th to 17th week) and 45th week (ranging from the 44th to 47th week), respectively. What is more, taking warning measures during the acceleration week, the preventive effect will be delayed; thus, we recommend intervene during recommended warning weeks which are the 15th and 44th weeks instead.

Health care and risk of adverse pregnancy outcomes among diabetic women: an updated meta-analysis.

PURPOSE: Diabetic women appear to have adverse pregnancy outcomes. Although there were two meta-analyzes that examined the association between health care and adverse pregnancy outcomes, their results were limited because they only included congenital anomaly and perinatal mortality, and they did not clarify the detailed situations of diabetes and health care. This meta-analysis aims to completely evaluate the effects of health care in improving adverse pregnancy outcomes among diabetic mothers. METHODS: CNKI, EMBASE, Web of Science, and PubMed databases were searched for eligible studies up to December 2017, without any restrictions. Relevant cohort studies characterizing the relationship between health care and adverse pregnancy outcomes were selected for inclusion in the meta-analysis. We also screened the reference list of relevant studies. The fixed-effect models or random-effect models were used to calculate the risk estimates. The potential sources of heterogeneity were explored by stratified and sensitivity analyzes. RESULTS: Twenty-one studies with 6685 cases were included in our analysis. Health care was associated with significantly decreased risk of congenital anomaly (RR 0.237; 95% CI 0.166-0.338), perinatal death (RR 0.457; 95% CI 0.294-0.712), large for gestational age (LGA) (RR 0.794; 95% CI 0.640-0.986), and neonatal hypoglycemia (RR 0.672; 95% CI 0.486-0.929). Publication bias was not found in most results, with the exception of congenital anomaly and small for gestational age (SGA). CONCLUSION: Health care is associated with decreased risk of congenital anomaly, perinatal death, LGA, neonatal hypoglycemia.

An association of serum ALT with elevated blood pressure in senior adults: a case-control study.

Hypertension is a major risk factor for cardiovascular diseases in China; hence, identifying good serum markers might provide cost benefits in terms of reducing morbidity rates. In this population-based case-control study, participants were recruited from five districts in Hunan province, and 416 cases were matched with an equal number of controls. Markers related to elevated blood pressure were assessed: Body Mass Index, total cholesterol, triglycerides, fasting blood glucose, and creatinine. Three potential serum markers homocysteine (HCY), C-reactive protein (CRP), and alanine aminotransferase (ALT) were dichotomized as normal or high level. Binary logistic regression was used to determine odds ratios (ORs) and 95% confidence intervals (CIs). The findings showed that ALT is a powerful serum marker for predicting high risk of high blood pressure with OR = 2.94, 95% CI (1.44-6.02), while there were no significant differences between cases and controls for HCY and CRP. Additionally, it seems likely that high concentrations of HCY conferred a protective effect against elevated blood pressure. When adjusted for sex, ORs for hypertensive females were nearly five times higher than for hypertensive males (OR = 4.34, 95% CI = 1.17-16.04). The study strongly supports findings showing ALT is a potential indicator for patients with hypertension.

The effect of cumulative exposure with unhealthy lifestyles on the H-type hypertension among Chinese adults: a community-based, propensity-score-matched, and case-control study.

Objective: To assess whether cumulative exposure of unhealthy lifestyles is associated with HTH in Chinese adults and to explore the combination of unhealthy lifestyles. Methods: This study combined a community-based cross-sectional study with a 1:1 matched case-control study using propensity scores among adults in six randomly selected districts from Hunan Province, China. We recruited 5,258 people, of whom 4,012 met the criteria. Lifestyles and personal characteristics were collected by a questionnaire. Lifestyle score was calculated using cigarette smoking, heavy alcohol consumption, inactive exercise, unhealthy diet and abnormal BMI. HTH was defined as having a diagnosis of essential hypertension with Hcy ≥ 15 umol/L. Logistic regression models and multivariate analyses were used to explore the associations. We calculated odds ratios (ORs) and attributable risk proportion (ARP) for the association of HTH with lifestyle score. The dose-response relationship was evaluated using restricted cubic splines method. Results: Of the 4,012 adults, 793 had HTH, with a population prevalence of 19.8%. In the propensity-score-matched case-control study, 1,228 (614 cases and 614 controls) were included, and those with at least four unhealthy lifestyle factors had a higher risk of HTH than those with 0 unhealthy lifestyle factor (adjusted OR = 2.60, 95%CI:1.42-4.78), with an ARP of the cumulative exposure of unhealthy lifestyle was 28.23% (95% CI: 6.34-37.86%). For three unhealthy lifestyles group, the combination of heavy alcohol consumption, unhealthy diet and BMI ≥24 Kg/m2 was most associated with HTH (OR = 7.49, 95%CI: 1.12-50.08). For four unhealthy lifestyles group, the combination of smoking, heavy alcohol consumption, unhealthy diet and BMI ≥24 Kg/m2 had the greatest correlation with HTH (OR = 3.75, 95%CI: 1.24-7.38). Notably, there was a monotonically increasing curve (J-shaped) relationship between unhealthy lifestyles and the risk of HTH (p = 0.014). Conclusion: Our findings suggest that there was a significant cumulative exposure effect of unhealthy lifestyles on the risk of HTH, with the largest effect combination being heavy alcohol consumption, unhealthy diet and BMI ≥24 Kg/m2. Targeted interventions that reducing heavy alcohol consumption, quitting smoking, promoting physical activity and a healthy diet, and keep a normal BMI could substantially reduce the burden of HTH.

Effective intervention of brucellosis prevention in developing countries: A dynamic modelling study.

Objective: Brucellosis has a considerable impact on human health and the economy in developing countries. In China, the biggest developing country, brucellosis shifted spread of the epidemic from northern to southern regions. Understanding the transmission characteristic of brucellosis on Hunan province, located in central China, is of great significance for successful control. Methods: We developed a multi-population and multi-route dynamic model (MPMRDM), which is an animal-human-environment coupled model. The model is an extension of the SEIR model, taking into account direct transmission and indirect transmission. We used the model to explore the spread of brucellosis and evaluate the effectiveness of various intervention strategies. Results: The animal-to-animal transmission rate was the highest at 5.14 × 10-8, while the environment-to-person transmission rate was the lowest at 9.49 × 10-12. The mean R0 was 1.51. The most effective intervention was taking personal protection, followed by shortening the infection period. Shortening the infection period combined with personal protection is the most effective two-combined intervention strategy. After any comprehensive intervention strategy was implemented, TAR dropped by 90% or more. Conclusion: The results demonstrate that animal transmission route is essential for controlling human brucellosis. Strengthening personal protection, early detection, and early treatment can effectively control the trend of brucellosis. These results can provide an important reference for optimizing brucellosis intervention plans.