Genome-Wide Analysis of Cotton MYB Transcription Factors and the Functional Validation of GhMYB in Response to Drought Stress.

MYB transcription factors play important roles during abiotic stress responses in plants. However, little is known about the accurate systematic analysis of MYB genes in the four cotton species, Gossypium hirsutum, G. barbadense, G. arboreum and G. raimondii. Herein, we performed phylogenetic analysis and showed that cotton MYBs and Arabidopsis MYBs were clustered in the same subfamilies for each species. The identified cotton MYBs were distributed unevenly on chromosomes in various densities for each species, wherein genome-wide tandem and segment duplications were the main driving force of MYB family expansion. Synteny analysis suggested that the abundant collinearity pairs of MYBs were identified between G. hirsutum and the other three species, and that they might have undergone strong purification selection. Characteristics of conserved motifs, along with their consensus sequence, promoter cis elements and gene structure, revealed that MYB proteins might be highly conserved in the same subgroups for each species. Subsequent analysis of differentially expressed genes and expression patterns indicated that most GhMYBs might be involved in response to drought (especially) and salt stress, which was supported by the expression levels of nine GhMYBs using real-time quantitative PCR. Finally, we performed a workflow that combined virus-induced gene silencing and the heterologous transformation of Arabidopsis, which confirmed the positive roles of GhMYBs under drought conditions, as validated by determining the drought-tolerant phenotypes, damage index and/or water loss rate. Collectively, our findings not only expand our understanding of the relationships between evolution and function of MYB genes, but they also provide candidate genes for cotton breeding.

Personal and household PM2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries.

BACKGROUND: Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. OBJECTIVE: To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. METHODS: As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. RESULTS: The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) µg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10-5 m-1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. CONCLUSIONS: We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.

Association between 9p21.3 genomic markers and coronary artery disease in East Asians: a meta-analysis involving 9,813 cases and 10,710 controls.

Recently, genome-wide association studies on coronary artery disease (CAD) identified a series of associated single-nucleotide polymorphisms (SNPs) in an intergenic region of chromosome 9p21.3, near the CDKN2A and CDKN2B genes. We investigated the association of this locus with CAD in 12 case-control studies of East Asians and undertook a meta-analysis for effect size, heterogeneity, publication bias, and strength of evidence. English and Chinese language articles were tested for 9p21.3 SNPs with coronary heart/artery disease or myocardial infarction as primary outcomes. Included articles also provided race, numbers of participants, and data to compute an odds ratio (OR). Articles were excluded if reporting other outcomes (e.g., stroke). Thirty-five articles were initially identified and 12 were included. Independent extraction was performed by two reviewers and consensus was reached. SNP rs1333049, rs2383206 and rs10757278 representing the 9p21.3 locus, were genotyped in 12 case-control studies involving a total of 9,813 patients and 10,710 controls. For rs1333049 (8 data sets), using a fixed-effects model, the summary OR was 1.29 (95 % CI, 1.23-1.36, P = 0.001). For rs2383206 (6 data sets), using a fixed-effects model, the summary OR was 1.24 (95 % CI, 1.18-1.31, P = 0.001). For rs10757278 (6 data sets), using a random-effects model, the summary OR was 1.34 (95 % CI, 1.21-1.50, P = 0.001). In addition, we defined the haploblock structure of SNPs within the region of 9p21.3 in China population in one study. This broad replication provides unprecedented evidence for association between genetic variants at chromosome 9p21.3 and risk of CAD in East Asians.

Relationships between anthropometric adiposity indexes and bone mineral density in a cross-sectional Chinese study.

BACKGROUND CONTEXT: Previous studies have reported conflicting results for the relationships between anthropometric adiposity indexes and bone mineral density, based on dual-energy X-ray absorptiometry (DXA). However, few studies were published based on quantitative computed tomography (QCT), especially for Chinese population. PURPOSE: To evaluate the associations of spine bone mineral density (BMD) with body mass index (BMI), waist circumstance (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI) using QCT. STUDY DESIGN/SETTING: A Cross-sectional study. PATIENT SAMPLE: Around 3,457 participants in multiple communities across 7 administrative regions of China. OUTCOME MEASURES: Spine BMD was measured using QCT, and the classification of osteoporosis was defined as follows: 1) osteoporosis if BMD <80mg/cm3, 2) osteopenia if BMD 80-119 mg/cm3, and 3) normal bone mass if BMD≥120 mg/cm3. METHODS: This study was conducted using convenient sampling between 2013 and 2017. Multivariable linear regression model and logistic regression models were used for the associations of continuous and categorical BMD, respectively. RESULTS: Around 3,405 participants were included in the final analyses, including 1,272 males and 2,133 females, with spine BMD of 111.00±35.47 mg/cm3 and 99.38±40.60 mg/cm3, respectively. Spine BMD decreased significantly with the increase of ABSI in females (adjusted ß, -5.74; 95% confidence interval [CI], -8.50 to -2.98), and this trend also was kept in females aged at less than 60 years (adjusted ß, -14.54; 95% CI, -20.40 to -8.68), and females with age ≥60 years (adjusted ß, -7.59; 95% CI, -10.91 to -4.28). However, this inverse association was observed only in males with age ≥ 60 years (adjusted ß, -5.19; 95% CI, -10.08 to -0.29). Except ABSI, negative associations of Spine BMD with WC (adjusted ß, -0.46; 95% CI, -0.77 to -0.15), WHR (adjusted ß, -6.25; 95% CI, -10.63 to -1.86), WHtR (adjusted ß, -6.80; 95% CI, -11.63 to -1.97) were shown in females aged at <60 years, and positive association with BMI in males with age ≥60 years (adjusted ß, 0.92; 95% CI, 0.29-1.55). CONCLUSIONS: ABSI had more remarkable association with spine BMD, compared with the other four indexes.

Associations of estimated 24-h urinary sodium excretion with mortality and cardiovascular events in Chinese adults: a prospective cohort study.

OBJECTIVE: To investigate the associations of sodium excretion with blood pressure, mortality and cardiovascular diseases in Chinese population. METHODS: We studied 39 366 individuals aged 35-70 years from 115 urban and rural communities in 12 centers across mainland China. Trained research staff conducted face-to-face interview to record baseline information of all participants based on questionnaires, and collected their morning fasting urine samples to estimate 24-h sodium excretion (24hUNaE). Multivariable frailty Cox regression accounting for clustering by centre was performed to examine the association between estimated 24hUNaE and the primary composite outcome of death and major cardiovascular events in a Chinese population. RESULTS: Mean 24hUNaE was 5.68 (SD 1.69) g/day. After a median follow-up of 8.8 years, the composite outcome occurred in 3080 (7.8%) participants, of which 1426 (3.5%) died and 2192 (5.4%) suffered from cardiovascular events. 24hUNaE was positively associated with increased SBP and DBP. Using the 24hUNaE level of 4-4.99 g/day as the reference group, a 24hUNaE of either lower (<3 g/day) or higher (≥7 g/day) was associated with an increased risk of the composite outcome with a hazard ratio of 1.22 (95% confidence interval: 1.01-1.49) and 1.15 (95% confidence interval: 1.01-1.30), respectively. A similar trend was observed between 24hUNaE level and risk of death or major cardiovascular events. CONCLUSION: These findings support a positive association between estimated urinary sodium excretion and blood pressure, and a possible J-shaped pattern of association between sodium excretion and clinical outcomes, with the lowest risk in participants with sodium excretion between 3 and 5 g/day.

Application of the kurtosis statistic to the evaluation of the risk of hearing loss in workers exposed to high-level complex noise.

OBJECTIVE: Develop dose-response relations for two groups of industrial workers exposed to Gaussian or non-Gaussian (complex) types of continuous noises and to investigate what role, if any, the kurtosis statistic can play in the evaluation of industrial noise-induced hearing loss (NIHL). DESIGN: Audiometric and noise exposure data were acquired on a population (N = 195) of screened workers from a textile manufacturing plant and a metal fabrication facility located in Henan province of China. Thirty-two of the subjects were exposed to non-Gaussian (non-G) noise and 163 were exposed to a Gaussian (G) continuous noise. Each subject was given a general physical and an otologic examination. Hearing threshold levels (0.5-8.0 kHz) were age adjusted (ISI-1999) and the prevalence of NIHL at 3, 4, or 6 kHz was determined. The kurtosis metric, which is sensitive to the peak and temporal characteristics of a noise, was introduced into the calculation of the cumulative noise exposure metric. Using the prevalence of hearing loss and the cumulative noise exposure metric, a dose-response relation for the G and non-G noise-exposed groups was constructed. RESULTS: An analysis of the noise environments in the two plants showed that the noise exposures in the textile plant were of a Gaussian type with an Leq(A)8hr that varied from 96 to 105 dB whereas the exposures in the metal fabrication facility with an Leq(A)8hr = 95 dB were of a non-G type containing high levels (up to 125 dB peak SPL) of impact noise. The kurtosis statistic was used to quantify the deviation of the non-G noise environment from the Gaussian. The dose-response relation for the non-G noise-exposed subjects showed a higher prevalence of hearing loss for a comparable cumulative noise exposure than did the G noise-exposed subjects. By introducing the kurtosis variable into the temporal component of the cumulative noise exposure calculation, the two dose-response curves could be made to overlap, essentially yielding an equivalent noise-induced effect for the two study groups. CONCLUSIONS: For the same exposure level, the prevalence of NIHL is greater in workers exposed to non-G noise environments than for workers exposed to G noise. The kurtosis metric may be a reasonable candidate for use in modifying exposure level calculations that are used to estimate the risk of NIHL from any type of noise exposure environment. However, studies involving a large number of workers with well-documented exposures are needed before a relation between a metric such as the kurtosis and the risk of hearing loss can be refined.

Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study.

BACKGROUND: Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use. METHODS: In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35-70 years (n=156 625) were recruited from 110 803 households, in 604 communities and 22 countries; availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys. FINDINGS: Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88·2%) of 127 pharmacies in upper-middle-income countries, 179 (86·1%) of 208 pharmacies in lower-middle-income countries, 44 (64·7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93·8%) pharmacies in high-income countries, 51 (40·2%) pharmacies in upper-middle-income countries, 61 (29·3%) pharmacies in lower-middle-income countries, seven (10·3%) pharmacies in lower-income countries, and 67 (76·1%) of 88 pharmacies in India. We estimated 0·7% of households in high-income countries and 26·9% of households in low-income countries could not afford metformin and 2·8% of households in high-income countries and 63·0% of households in low-income countries could not afford insulin. Among the 13 569 (8·6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74·0%) participants reported diabetes medicine use in high-income countries compared with 143 (29·6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines. INTERPRETATION: Availability and affordability of essential diabetes medicines are poor in low-income and middle-income countries. Awareness of these global differences might importantly drive change in access for patients with diabetes. FUNDING: Full funding sources listed at the end of the paper (see Acknowledgments).

Comparison of clinic and ambulatory blood pressure in response to antihypertensive drugs in Chinese patients.

OBJECTIVE: To compare the difference between 24-h ambulatory blood pressure (ABP) and trough clinic blood pressure (CBP) after 8 weeks of therapy. METHODS: The study used meta-regression analysis to summarize three randomized, double-blind, active controlled trials in order to compare the difference between the magnitude of the reduction in 24-h average ABP and CBP Patients. Chinese patients with seated diastolic blood pressure (SDBP) 95-115 mmHg and ambulatory diastolic blood pressure (ADBP) > or =85 mmHg. RESULTS: The average age of 126 patients was 47.7 +/- 8.3 years, ranging from 25 to 67 (95 males and 31 females). All regimens reduced 24-h ABP and CBP after 8 weeks of treatment. In the 126 patients the baseline 24-h SBP and DBP values (142.7/94.4 mmHg) were markedly lower than those for clinic values (152.6/102.6 mmHg; P<0.0001). Similarly, the 24-h SBP and DBP values (132.7/87.7 mmHg) in week 8 were markedly lower than the clinic values (138.9/92.7 mmHg; P<0.0001). The differences between the treatment-induced reductions in 24-h ABP and CBP were statistically significant (the difference was 3.7/3.3 mmHg for SBP/DBP, P=0.0069/P<0.0001). CONCLUSION: All regimens significantly reduced seated CBP and ABP. The effect of antihypertensive treatment was greater on CBP than that on ABP, suggesting that assessment on effectiveness of an antihypertensive treatment using CBP readings only has to be carefully interpreted, and a more systematic application of ABP monitoring should be adopted.

[Efficacy of monotherapy with 15 antihypertensive agents in treating essential hypertension assessed by 24-hour ambulatory blood pressure monitoring].

OBJECTIVE: To evaluate the efficacy of the monotherapy of 15 agents in treating essential hypertension. METHODS: After 2-week wash-out, a total of 370 patients with seated diastolic blood pressure 95-114 mmHg and seated systolic blood pressure < 180 mmHg were randomized to different therapeutic groups. 24-hour ambulatory blood pressure monitoring was performed before medication and at the end of 8 weeks. RESULT: All the agents significantly reduced the 24 hour mean blood pressures after treatment except doxazosin, terazosin, and torasemide. CONCLUSION: The result suggested that the angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers and long-acting calcium antagonists were effective in treating essential hypertension, while the low-dose doxazosin, terazosin and torasemide can be used for combination therapy but not for monotherapy.

[Adjustment of dose-response relationship of industrial impulse noise induced high frequency hearing loss with different exchange rate].

OBJECTIVE: To explore a new method to evaluate the dose-response relationship between the noise exposure and prevalence of noise induced high frequency hearing loss. METHODS: Physical examination and questionnaire survey were conducted among 32 mechanical workers, 12 males and 20 females, aged 35.1 +/- 7.2, exposed to industrial impulse noise (impulse noise group), and 163 textile workers, 82 males and 81 females, aged 31.5 +/- 8.7, exposed continuous noise (continuous noise group). SH-126 dosimeter was used to measure the A weighted equal sound level in continuous eight working hours (L(Aeq.8h)) so as to evaluate the individual noise exposure. Cumulative noise exposure (CNE) was calculated with the values of L(Aeq.8h) and noise working year adjusted by different exchange rates (ERs) for each worker. Hearing threshold was measured by audiometer with routine method and adjusted by age and gender according to GBZ49-2002. High frequency hearing loss was diagnosed based on the GBZ49-2002 for each worker. RESULTS: According to the equal energy rule, with the ER = 3 the CNE of the impulse noise group was [103.2 dB (A).year +/- 4.2dB (A).year], significantly lower than that of the continuous noise group [110.6 +/- 6.0 dB (A).year, P < 0.05]. With the ER = 5.5, the CNE of the impulse noise group was 110.3 +/- 6.6 dB (A).year, not significantly different from that of the continuous noise group [110.6 +/- 6.0 dB (A).year]. The high frequency hearing loss prevalence of the impulse noise group was 68.8%, not significantly different that of the continuous noise group (65%, P > 0.05). Trend chi square test showed significant differences in the relationship between CNE and hearing loss prevalence among the impulse noise group with the ER = 3, the impulse noise group with the ER = 5.5, and continuous noise group (all P < 0.01). With the ER = 3, the high frequency hearing loss prevalence of the impulse noise group with the CNE of 100-104 dB (A).year was 76.9%, significant higher than that of the continuous noise group (30.4%, P < 0.05); and the high frequency hearing loss prevalence of the impulse noise group with the CNE of 105-108 dB (A).year was 90.9%, significantly higher than that of the continuous noise group (50.0%, P < 0.05). With the ER = 5.5, there was no difference in the prevalence of high frequency hearing loss between the continuous noise group and impulse noise group. Logistic regression model showed that with the ER = 3, the dose-response curve of the impulse noise group presented a left shift and with a slope sharper than that of the continuous noise group. With the ER increasing the dose-response curve of the impulse noise group showed a right shift and with a gradually lowering slope. When the ER equaled to 6 in the impulse noise group and equaled to 3 in the continuous noise group, the two dose-response curves were almost superposed. CONCLUSION: Impulse noise causes more serious damage in causing high frequency hearing loss than continuous noise according to equal energy rule. Increasing the ER value in the impulse noise group adjusts the dose-response curve to be close to that of the continuous noise group.

[Relationship between sample size and variation of means for personal noise exposure in weaving workers].

OBJECTIVE: To explore the relationship between sample size and variance of means for personal noise exposure in weaving workers as to contributing evidence for establishing personal noise exposure measurement guideline. METHODS: A personal noise exposure measurement database from a group of weaving workers was used in the randomized re-sampling data analysis. The sampling cases were one number selecting from one to fifteen at each randomized re-sampling procedure. The randomized re-sampling was one thousand times from original personal noise exposure measurement database to get one thousands of re-sampling database. One thousands of L(Aeq.8 h) mean were calculated by re-sampling databases. The variation of randomized re-sampling means was analyzed for different re-sampling numbers. RESULTS: The change for narrow trend of maximum, minimum, 95 percent number, 5 percent number of L(Aeq.8 h) mean was faster when randomized re-sampling number was smaller in variation vs randomized re-sampling number curve analysis. After that, the change for narrow trend of L(Aeq.8 h) mean was smooth for increasing the randomized re-sampling numbers. The 95% - 5% of L(Aeq.8 h) mean was about half for randomized re-sampling four cases (3.30 dB) vs one case (7.40 dB), and about one third for seven cases (2.44 dB), and about one fourth for eleven cases (1.85 dB). CONCLUSION: The sample size in personal noise exposure measurement guideline could be selected from four to eleven.

Hypertension prevalence, awareness, treatment, and control in 115 rural and urban communities involving 47 000 people from China.

BACKGROUND: Identification and treatment of hypertension in China remain suboptimal despite high prevalence of hypertension and increasing incidence of stroke and myocardial infarction. OBJECTIVE: This study reported blood pressure levels, prevalence, awareness, treatment, and control rates of hypertension, in addition to drug treatments in China. METHODS: This is a country-specific analysis of 45 108 individuals, average age 51.4 (standard deviation 9.6) (35-70) years, enrolled between 2005 and 2009, from 70 rural and 45 urban communities in 12 provinces. RESULTS: Among 18 915 (41.9% overall population) hypertensive participants, 7866 (41.6%) were aware, 6503 (34.4%) treated but only 1545 (8.2%) controlled. Prevalence of hypertension was higher, but awareness, treatment, and control were lower in rural than urban residents. Prevalence of hypertension was highest in eastern (44.3%), intermediate in central (39.3%), and lowest in western regions (37.0%). Awareness was higher in central (44.3%) and eastern (42.4%) but lower in western regions (37.0%). Similar patterns were observed in treatment rates, 37.7% central, 35.2% eastern, and 26.7% in western regions with control rates of 8.3% in eastern, 7.6% central, and 5.3% west regions. Of 4744 participants receiving documented treatments, 37.5% received traditional combination drugs alone, 55.4% western drugs alone and 7.1% combination of traditional combination drug in addition to western drugs. CONCLUSION: In China, hypertension is common, and while recent studies suggest some improvements, more than half of affected individuals were unaware that they had hypertension. Rates of control remain low. National programs effective in preventing and controlling hypertension in China are urgently needed.

[Relationship between impulse noise and continuous noise inducing hearing loss by dosimeter measurement in working populations].

OBJECTIVE: To compare the dose-response relationship differences between impulse noise exposure workers and continuous noise exposure workers in prevalence of noise inducing hearing loss using dosimeter measurement. METHODS: Thirty-two mechanical workers in a workshop were selected as impulse noise group and 163 textile workers in a textile factory as continuous noise group. SH-126 dosimeter was used to measure A weighted equal sound level of eight hours (L(Aeq.8 h)) during full working duration with equal energy rule for the selected workers. The cumulative noise exposure (CNE) was calculated by L(Aeq.8 h) and noise working years with equal energy rule for each worker. Hearing thresholds were measured by audiometer by routine method and adjusted by age and gender with GBZ49 - 2002. Hearing loss was diagnosed by GBZ49 - 2002 for each worker. RESULTS: CNE of impulse noise group [(103.2 +/- 4.2) dB (A) .year] was found lower than the continuous noise group [(110.6 +/- 6.0) dB (A) .year] by significance, P < 0.05. The hearing loss prevalence of impulse noise group (68.8%) was similar as continuous noise group (65%) without significance, P > 0.05. Strata analysis showed the hearing loss prevalence in 100 - 104 dB (A) .year and 105 - 109 dB (A) .year of impulse noise group was double than that of continuous noise group (76.9%, 90.9% vs 30.4%, 50.0%), P < 0.05. The chi-square test showed a relationship between CNE and hearing loss prevalence that was in high significance (P < 0.01) in both impulse noise group and continuous noise group. Logistic regression model showed the dose-response relationship curve of impulse noise group was left shift and sharp slope. CONCLUSION: The damage of impulse noise on hearing loss was much more than that of continuous noise according to equal energy rule of dosimeter data.

Physical activity levels, sport activities, and risk of acute myocardial infarction: results of the INTERHEART study in China.

Physical activity (PA) during leisure time has been inversely associated with cardiovascular disease risk in the Western populations. We evaluated PA at work and leisure time in relation to acute myocardial infarction (AMI) in Chinese population. We conducted a hospital-based case-control study. The cases had first AMI (n = 2909). The controls (n = 2947) were matched to the cases in age and sex. The odds ratios (ORs) of leisure-time PA for strenuous exercise compared to mainly sedentary was 0.74 (95% confidence interval [CI]: 0.61-0.90) and for moderate exercise it was 0.96 (95% CI: 0.85-1.08). Multivariate adjustment did not substantially alter the association. The ORs of work-related PA for heavy PA compared to mainly sedentary was 1.44 (95% CI: 1.06-1.94), for climbing and lifting was 1.00 (95% CI: 0.77-.30), and for walking was 0.90 (95%CI: 0.75-1.07). Leisure-time PA was protective for AMI risk compared to sedentary lifestyles in a population in China.

Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study

BACKGROUND: Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use. METHODS: In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35­70 years (n=156625) were recruited from 110803 households, in 604 communities and 22 countries; availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys. FINDINGS: Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88·2%) of 127 pharmacies in upper-middle-income countries, 179 (86·1%) of 208 pharmacies in lower-middle-income countries, 44 (64·7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93·8%) pharmacies in high-income countries, 51 (40·2%) pharmacies in upper-middle-income countries, 61 (29·3%) pharmacies in lower-middle-income countries, seven (10·3%) pharmacies in lower-income countries, and 67 (76·1%) of 88 pharmacies in India. We estimated 0·7% of households in high-income countries and 26·9% of households in low-income countries could not afford metformin and 2·8% of households in high-income countries and 63·0% of households in low-income countries could not afford insulin. Among the 13 569 (8·6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74·0%) participants reported diabetes medicine use in high-income countries compared with 143 (29·6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines.

[Adaptive designs for clinical trial].

OBJECTIVE: In order to provide readers with general concepts and methodology on adaptive designs for clinical trial. METHODS: Definition of adaptive designs for clinical trial and basic idea of adaptive adjustment were introduced through an example. RESULTS: The relationship between adaptive designs and group sequential design was summarized. Ways to embody two basic statistical rules of clinical trial under adaptive adjustments setting were also introduced. CONCLUSION: Adaptive designs provided clinical trial with a great flexibility, which could greatly improve the efficiency of clinical trial.

Evaluation of individual susceptibility to noise-induced hearing loss in textile workers in China.

The authors applied noise exposure and audiometry information collected on 156 Chinese textile workers to develop a method of identifying individuals susceptible to noise-induced hearing loss. They estimated noise-induced hearing threshold shift (NIHTS) by averaging the adjusted hearing thresholds at 3, 4, and 6 kHz of both ears, and they fitted a quadratic model to describe the dose-response relationship between cumulative noise exposure and NIHTS. The residual between the actual NIHTS and the model-predicted NIHTS indicated susceptibility. A comparison of the 20% of the subjects with the greatest residuals (those who were susceptible to hearing loss) with the 20% of the subjects with the smallest residuals (those who were resistant to hearing loss) revealed that the former had poorer hearing, although the noise exposures were similar. The identified susceptible individuals also had the poorest hearing thresholds within each subgroup of homogenous noise exposures. With their model-based procedure, the authors were able to identify individuals susceptible to noise-induced hearing loss from subjects with heterogeneous noise exposures.