Beneficial associations between outdoor visible greenness at the workplace and metabolic syndrome in Chinese adults.

BACKGROUND: Greenness surrounding residential places has been found to significantly reduce the risk of diseases such as hypertension, obesity, and metabolic syndrome (MetS). However, it is unclear whether visible greenness exposure at the workplace has any impact on the risk of MetS. METHODS: Visible greenness exposure was assessed using a Green View Index (GVI) based on street view images through a convolutional neural network model. We utilized logistic regression to examine the cross-sectional association between GVI and MetS as well as its components among 51,552 adults aged 18-60 in the city of Hangzhou, China, from January 2018 to December 2021. Stratified analyses were conducted by age and sex groups. Furthermore, a scenario analysis was conducted to investigate the risks of having MetS among adults in different GVI scenarios. RESULTS: The mean age of the participants was 40.1, and 38.5% were women. We found a statistically significant association between GVI and having MetS. Compared to the lowest quartile of GVI, participants in the highest quartile of GVI had a 17% (95% CI: 11-23%) lower odds of having MetS. The protective association was stronger in the males, but we did not observe such differences in different age groups. Furthermore, we found inverse associations between GVI and the odds of hypertension, low high-density lipoprotein cholesterol, obesity, and high levels of FPG. CONCLUSIONS: Higher exposure to outdoor visible greenness in the workplace environment might have a protective effect against MetS.

Fabrication and characterization of polymer optical waveguide Bragg grating for pulse signal sensing.

Polymer materials have the advantages of a low Young's modulus and low-cost preparation process. In this paper, a polymer-based optical waveguide pressure sensor based on a Bragg structure is proposed. The change in the Bragg wavelength in the output spectrum of the waveguide Bragg grating (WBG) is used to linearly characterize the change in pressure acting on the device. The polymer-based WBG was developed through a polymer film preparation process, and the experimental results show that the output signal of the device has a sensitivity of 1.275 nm/kPa with a measurement range of 0-12 kPa and an accuracy of 1 kPa. The experimental results indicate that the device already perfectly responds to a pulse signal. It has significant potential application value in medical diagnostics and health testing, such as blood pressure monitoring, sleep quality monitoring, and tactile sensing.

Microring structure for flexible polymer waveguide-based optical pressure sensing.

Flexible pressure sensors provide a promising platform for artificial smart skins, and photonic devices provide a new technique to fabricate pressure sensors. Here, we present a flexible waveguide-based optical pressure sensor based on a microring structure. The waveguide-based optical pressure sensor is based on a five-cascade microring array structure with a size of 1500 µm × 500 µm and uses the change in output power to linearly characterize the change in pressure acting on the device. The results show that the device has a sensing range of 0-60 kPa with a sensitivity of 23.14 µW/kPa, as well as the ability to detect pulse signals, swallowing, hand gestures, etc. The waveguide-based pressure sensors offer the advantages of good output linearity, high integration density and easy-to-build arrays.

Association of fat mass and fat-free mass with all-cause and cause-specific mortality in Asian individuals: A prospective cohort study.

OBJECTIVE: The study's objective was to investigate the association of fat mass index (FMI) and fat-free mass index (FFMI) with all-cause mortality and cause-specific mortality in the Chinese population. METHODS: A total of 422,430 participants (48.1% men and 51.9% women) from the Taiwan MJ Cohort with an average follow-up of 9 years were included. RESULTS: The lowest (Q1) and highest (Q5) quintiles of FMI and FFMI were associated with increased all-cause mortality. Compared with those in the third quintile (Q3) group of FMI, participants in Q1 and Q5 groups of FMI had hazard ratios and 95% CI of 1.32 (1.24-1.40) and 1.13 (1.06-1.20), respectively. Similarly, compared with those in Q3 group of FFMI, people in Q1 and Q5 groups of FFMI had hazard ratios of 1.14 (1.06-1.23) and 1.16 (1.10-1.23), respectively. In the restricted cubic spline models, both FMI and FFMI showed a J-shaped association with all-cause mortality. People in Q5 group of FFMI had a hazard ratio of 0.72 (0.58-0.89) for respiratory disease. CONCLUSIONS: The mortality risk increases in those with excessively high or low FMI and FFMI, yet the associations between FMI, FFMI, and the risk of death varied across subgroups and causes of death.

General practitioner residents' experiences and perceptions of outpatient training in primary care settings in China: a qualitative study.

OBJECTIVES: The implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions of this training. This study aimed to explore the experiences and perceptions of GP residents regarding outpatient training in primary care settings in China and provide insights and recommendations to enhance training quality. DESIGN: A qualitative descriptive study employing in-depth interviews. SETTING: Two community healthcare centres (CHCs) that implement outpatient training programmes for GP residents in Zhejiang Province, China. PARTICIPANTS: In total, 20 GP residents affiliated with 14 CHCs and two hospitals across Zhejiang Province and Guizhou Province who had completed outpatient training in either CHC for over 1 month. RESULTS: Of the 20 participants in this study, 11 (55%) were women, and the mean age was 28 years. GP residents completed the process of consultation, physical examination and therapy independently; subsequently, the community preceptors provided feedback based on their clinical performance and modelled their clinical skills. The benefits perceived by GP residents included improved clinical skills and confidence in practice, and they learned approaches to maintaining good relationships with patients. They preferred dealing with complex cases, discussions with peers and the indirect supervision of community preceptors in the training session. Residents recommended that measures be taken to improve the training quality regarding patient selection and recruitment, clinical skills in the training session, and assessment of clinical performance. CONCLUSIONS: The outpatient training in primary care settings provides constructive opportunities for GP residents to improve their professional competencies. Although the current training sessions and the abilities of community preceptors largely satisfy the needs of GP residents, further research is needed to evaluate the effectiveness of training and explore approaches to improve its quality.

6-Year trajectory of fasting plasma glucose (FPG) and mortality risk among individuals with normal FPG at baseline: a prospective cohort study.

BACKGROUND: Higher fasting plasma glucose (FPG) levels were associated with an increased risk of all-cause mortality; however, the associations between long-term FPG trajectory groups and mortality were unclear, especially among individuals with a normal FPG level at the beginning. The aims of this study were to examine the associations of FPG trajectories with the risk of mortality and identify modifiable lifestyle factors related to these trajectories. METHODS: We enrolled 50,919 individuals aged ≥ 20 years old, who were free of diabetes at baseline, in the prospective MJ cohort. All participants completed at least four FPG measurements within 6 years after enrollment and were followed until December 2011. FPG trajectories were identified by group-based trajectory modeling. We used Cox proportional hazards models to examine the associations of FPG trajectories with mortality, adjusting for age, sex, marital status, education level, occupation, smoking, drinking, physical activity, body mass index, baseline FPG, hypertension, dyslipidemia, cardiovascular disease or stroke, and cancer. Associations between baseline lifestyle factors and FPG trajectories were evaluated using multinomial logistic regression. RESULTS: We identified three FPG trajectories as stable (n = 32,481), low-increasing (n = 17,164), and high-increasing (n = 1274). Compared to the stable group, both the low-increasing and high-increasing groups had higher risks of all-cause mortality (hazard ratio (HR) = 1.18 (95% CI 0.99-1.40) and 1.52 (95% CI 1.09-2.13), respectively), especially among those with hypertension. Compared to participants with 0 to 1 healthy lifestyle factor, those with 6 healthy lifestyle factors were more likely to be in the stable group (ORlow-increasing = 0.61, 95% CI 0.51-0.73; ORhigh-increasing = 0.20, 95% CI 0.13-0.32). CONCLUSIONS: Individuals with longitudinally increasing FPG had a higher risk of mortality even if they had a normal FPG at baseline. Adopting healthy lifestyles may prevent individuals from transitioning into increasing trajectories.

A quantitative analysis of marine heatwaves in response to rising sea surface temperature.

It has been proven that marine heatwaves (MHWs) have increased in frequency, duration, and intensity over the past few decades, and this trend will accelerate further under continued global warming. While more intense and frequent MHWs are an expected consequence of rising sea surface temperatures (SSTs) under continued global warming, it remains unclear to what degree per Celsius warming trend of SSTs contributes to the changes in the MHW metrics. Here, we focus on how the MHW metrics evolve with the SST warming trend by using an adaptive data analysis method based on observational datasets covering the past four decades. We find that the globally averaged increasing rates of the annual MHW frequency, duration, and maximum intensity are approximately 3.7 events, 7.5 days, and 2.2° Celsius per degree Celsius of SST rise, respectively. The increasing rates for the annual MHW days and the fraction of the spatial extents to the global ocean affected by MHWs are approximately 58.8 days and 13.9 % per degree Celsius of SST rise, respectively. Based on these observational-based increasing rates and the projected SST warming from the selected Coupled Model Intercomparison Project Phase 6 (CMIP6) models, the spatial distributions of changes in annual MHW days, frequency, and cumulative intensity are projected to exhibit 2-fold, 4-fold, and 6 to 8-fold increases under the three socioeconomic pathways (i.e., SSP126, SSP245, and SSP585), respectively. The globally averaged annual MHW days will increase to approximately 224.2 ± 26.9 days, and the largest changes are projected to occur in the northeast Pacific, the North Atlantic, the south Indian Oceans, and parts of the Southern Ocean, with approximately 14.8 ± 5.7 % of the global ocean reaching a permanent MHW state by the end of the twenty-first century under SSP585.

Global 3-hourly wind-wave and swell data for wave climate and wave energy resource research from 1950 to 2100.

Ocean wave climate, including wind waves and swells, is essential to human marine activities and global or regional climate systems, and is highly related to harnessing wave energy resources. In this study, a global 3-hourly instantaneous wave dataset was established with the third-generation wave model MASNUM-WAM and wind forcings derived from the products of the First Institute of Oceanography-Earth System Model version 2.0, the climate model coupled with wave model, under the unified framework of the Coupled Model Intercomparison Project phase 6. This dataset contains 17 wave parameters, including the information associated with wave energy and spectral shape geometries, from one historical (1950-2014) simulation and three future (2015-2100) scenario experiments (ssp125, ssp245, and ssp585). Moreover, all the parameters can be accessed separately in the form of wind waves and swells. The historical results show that the simulated wave characteristics agree well with satellite observations and the ERA5 reanalysis products. This dataset can provide the community with a unique and informative data source for wave climate and wave energy resource research.

Temporal changes in serum uric acid and risk for metabolic syndrome: a longitudinal cohort study.

BACKGROUND: Studies suggested elevated serum uric acid (SUA) levels are associated with metabolic syndrome (MetS). However, it remains unclear whether baseline SUA and temporal changes predict MetS. The study aimed to investigate the association of baseline SUA and its temporal longitudinal changes with subsequent risk of MetS. METHODS: We conducted a retrospective longitudinal cohort study among 44,176 healthy participants aged 18 years and older without MetS at enrollment. The baseline levels and longitudinal changes of SUA were categorized by gender-specific quintiles. Participants were followed to identify newly developed MetS. We employed Cox model to investigate the relationship between SUA and MetS in men and women separately. RESULTS: During a median follow-up of 2.4 years, 5461 (12.36%) participants developed MetS. After adjustment of demographic, major clinical factors, a higher level of baseline SUA was associated with a significant higher risk of MetS. The corresponding HRs (95% CIs) comparing participants at extreme quintiles were 2.59 (2.32, 2.88) in men and 2.87 (2.41, 3.43) in women. Larger longitudinal absolute increase in SUA was also related to an increases risk of MetS (top vs bottom quintile, 1.70 [1.53, 1.89] in men and 1.94 [1.65, 2.28] in women), regardless the level of baseline SUA. Similarly, the HRs about SUA longitudinal percentage changes were 1.74 (1.56, 1.94) in men and 2.01 (1.69, 2.39) in women, respectively. Moreover, we observed the highest risk of MetS among participants with both higher baseline SUA and larger longitudinal increase in SUA. CONCLUSION: Higher baseline SUA and larger temporal increase in SUA independently predicted risk of MetS, highlighting the importance of longitudinal SUA monitoring and management for primary prevention of MetS in the general population.

Arctic Ocean Amplification in a warming climate in CMIP6 models.

Arctic near-surface air temperature warms much faster than the global average, a phenomenon known as Arctic Amplification. The change of the underlying Arctic Ocean could influence climate through its interaction with sea ice, atmosphere, and the global ocean, but it is less well understood. Here, we show that the upper 2000 m of the Arctic Ocean warms at 2.3 times the global mean rate within this depth range averaged over the 21st century in the Coupled Model Intercomparison Project Phase 6 Shared Socioeconomic Pathway 585 scenario. We call this phenomenon the "Arctic Ocean Amplification." The amplified Arctic Ocean warming can be attributed to a substantial increase in poleward ocean heat transport, which will continue outweighing sea surface heat loss in the future. Arctic Amplification of both the atmosphere and ocean indicates that the Arctic as a whole is one of Earth's regions most susceptible to climate change.

Spatiotemporal propagating decadal signal of ocean heat content and thermocline depth identified in the tropical Pacific.

Tropical Pacific decadal variability (TPDV) and its mechanisms are essential for understanding long-term variations in global climate. The spatiotemporal pattern of this decadal variation has yet to be clarified. Here, on the basis of observational data with the help of the adaptive data analysis method, we extracted and investigated the spatiotemporal evolution of the tropical Pacific decadal variability in upper ocean heat content (UOHC) and thermocline depth. The tropical decadal signal propagated eastward along the equator from the western Pacific to the eastern Pacific after the 1970s, with a speed of 4-5 cm s-1 yielding a decadal oscillation of approximately 11-13 years. This decadal variability of the thermocline fluctuations (UOHC) was proven to be closely correlated with western wind anomalies since the 1970s and may have been induced by the regime shift of the Pacific decadal oscillation. These peaks of decadal signals corresponded well with the strong El Niño-Southern Oscillation (ENSO) events, reflecting nonlinear rectification of ENSOs on TPDV. Moreover, the TPDV showed a modulating signal on moderate and weak ENSO events.

Seasonal to decadal spatiotemporal variations of the global ocean carbon sink.

The global ocean has absorbed approximately 30% of anthropogenic CO2  since the beginning of the industrial revolution. However, the spatiotemporal evolution of this important global carbon sink varies substantially on all timescales and has not yet been well evaluated. Here, based on a reconstructed observation-based product of surface ocean pCO2 and air-sea CO2  flux (the MPI-SOMFFN method), we investigated seasonal to decadal spatiotemporal variations of the ocean CO2  sink during the past three decades using an adaptive data analysis method. Two predominant variations are modulated annual cycles and decadal fluctuations, which account for approximately 46% and 25% of all extracted components, respectively. Although the whole summer to non-summer seasonal difference pattern is determined by the Southern Ocean, the non-summer CO2  sink at mid-latitudes in both hemispheres shows an increasing trend (a total increase of approximately 1.0 PgC during the period 1982-2019), while it is relatively stable in summer. On decadal timescales for the global ocean carbon sink, unlike the weakening decade (1990-1999) and the reinvigoration decade (2000-2009) in which the Southern Ocean plays the dominant role, the reinforcement decade (2010-2019) is mainly the result from the weakening source effect in the equatorial Pacific Ocean. Our results suggest that except for the Southern Ocean's role in the global ocean carbon sink, the strengthening non-summer's sink at mid-latitudes in both hemispheres and the decadal or longer timescales of equatorial Pacific Ocean dynamics should be fully considered in understanding the oceanic carbon cycle on a global scale.

Glycosylated Hemoglobin as an Age-Specific Predictor and Risk Marker of Colorectal Adenomas in Non-Diabetic Adults.

Background: Diabetes is a risk factor for colorectal neoplasms. The association between the level of glycosylated hemoglobin (HbA1c) and the risk of colorectal adenomas (CRAs) in non-diabetic adults needs to be investigated. Methods: A cross-sectional study was performed on non-diabetic adults with normal HbA1c level who underwent colonoscopy between January 2010 and December 2016 during health check-ups in our hospital in China. The association between HbA1c level and CRAs was assessed by multiple logistic regression models stratified by age group (<40, ≥40 and <50, and ≥50 years old). The age group-specified thresholds for HbA1c on elevated risk of CRAs were estimated using the piecewise logistic regression. Results: Among the 2,764 subjects, 445 (16.1%) had CRA. The prevalence of CRA varied across the three age groups. A higher HbA1c level was found to be significantly associated with increased CRA risk in the 40-50 years group (odds ratio [OR]=1.70, 95% confidence interval [CI] 1.04-2.78, p=0.035) after adjusting for other related factors, while this association was borderline significant among the 50 years and older group (OR=1.57, 95% CI 0.97-2.54, p=0.067). Based on the piecewise logistic regression analysis results, the thresholds for HbA1c on elevated risk of CRA were 5.44% for the 40-50 years group and 4.81% for the 50 years and older group, respectively. Conclusions: Higher levels of HbA1c, even within the normal range, were associated with elevated CRA risk among non-diabetic adults. The threshold effects of HbA1c on the risk of CRA varied across different age groups, and early screening colonoscopy might be needed for individuals in their 40s and with HbA1c levels ≥5.44%.

High NAFLD fibrosis score in non-alcoholic fatty liver disease as a predictor of carotid plaque development: a retrospective cohort study based on regular health check-up data in China.

PURPOSES: There is increasing concern regarding cardiovascular risk in non-alcoholic fatty liver disease (NAFLD) patients with liver fibrosis. This study aims: (1) to assess the association between NAFLD and liver fibrosis status and the development of carotid plaque (CP), and (2) to identify CP risk factors among general population with different baseline NAFLD and liver fibrosis status. METHODS: This retrospective cohort study included 14,288 adult participants who went for regular health check-ups between 2014 and 2019, in one hospital in Zhejiang, China. NAFLD was diagnosed by abdominal ultrasound and the NAFLD fibrosis score (NFS) was calculated to reflect the extent of liver fibrosis. Cox proportional hazards analyses were applied to assess the risk of CP development across groups with different baseline NAFLD and NFS status. RESULTS: NAFLD participants with high NFS had higher risk of CP compared to non-NAFLD participants (adjusted hazard ratio 1.68, 95% confidence interval [CI] 1.43-1.96, p < .001). Progression from NAFLD free and NAFLD with low NFS to NAFLD with high NFS are associated with 1.56-fold (95% CI 1.21-2.01, p = .001) and 1.43-fold (95% CI 1.11-1.84, p = .006) increased risk of CP, respectively. Risk factors associated with CP vary based on baseline NAFLD and NFS status. Among NAFLD participants with high NFS, hypertension is the only significant risk factor after adjustment for other potential influencing factors. CONCLUSIONS: NAFLD and liver fibrosis status can be an independent predictor for CP development regardless of metabolic abnormalities. Hypertension is a major risk factor for CP development among NAFLD patients with high NFS.KEY MESSAGESNon-alcoholic fatty liver disease (NAFLD) and liver fibrosis status can be an independent predictor for development of carotid plaque.Progression from NAFLD free and NAFLD with low NAFLD fibrosis score (NFS) to NAFLD with high NFS are associated with increased risk of carotid plaque.Risk factors associated with carotid plaque vary based on baseline NAFLD and NFS status, and hypertension plays the most important role among patients with NAFLD and high NFS.

Diagnostic Value of Serum Pepsinogen Levels for Screening Gastric Cancer and Atrophic Gastritis in Asymptomatic Individuals: A Cross-Sectional Study.

BACKGROUND: Pepsinogens (PGs) can be used for gastric cancer (GC) screening, but the cutoff levels vary among studies, and PG levels are influenced by numerous factors. The aim of this article is to examine the diagnostic value of PG levels and Helicobacter pylori (Hp) status for GC and atrophic gastritis screening in asymptomatic individuals undergoing health checkup in China. PATIENTS AND METHODS: This was a multicenter cross-sectional study of subjects who underwent health checkup from 10/2016 to 10/2018 at nine International Healthcare Centers in China. All participants underwent gastroscopy and pathological examination, serum PG, 13C-urea breath test, and/or Hp serological current infection marker rapid test, all on the same day. PG-related parameters were analyzed in different Hp subgroups and regions. RESULTS: The patients were grouped as non-atrophic (NAG, n = 1,590), mild to moderate atrophic (MAG, n = 273), severe atrophic (SAG, n = 49), and GC (n = 10). The serum PG levels in these groups decreased with increasing pathological severity. In the same pathological groups, PGI and PGII levels were higher in the Hp-positive subgroup, while PGR (PGI/PGII ratio) was lower (P < 0.05). The best cutoff values for atrophy diagnosis were PGI ≤73.1 ng/ml and PGR ≤9.8, for severe atrophy were PGI ≤63.9 ng/ml and PGR ≤9.09, and for GC was PGR ≤4.7 (all P < 0.05 and area under the curve >0.7). The cutoff points varied with Hp status and China regions. CONCLUSION: Serum PG levels might be used for the screening of gastric atrophic gastritis lesions. The results suggest that different cutoff values should possibly be used in different Hp status groups and geographical regions, but it will have to be validated in future studies. Future studies should also examine the value of PG levels for GC detection.

ANKRD22 Drives Rapid Proliferation of Lgr5+ Cells and Acts as a Promising Therapeutic Target in Gastric Mucosal Injury.

BACKGROUND & AIMS: Rapid gastric epithelial progenitor cell (EPC) proliferation and inflammatory response inhibition play key roles in promoting the repair of gastric mucosal damage. However, specific targets inducing these effects are unknown. In this study, we explored the effects of a potential target, Ankyrin repeat domain 22 (ANKRD22). METHODS: An acute gastric mucosal injury model was established with Ankrd22-/- and Ankrd22+/+ mice by intragastric administration of acidified ethanol. Organoid culture and flow cytometry were performed to evaluate the effects of ANKRD22 on leucine-rich repeat-containing G-protein-coupled receptor 5-positive (Lgr5+) gastric EPC proliferation. The mechanisms by which ANKRD22 affects gastric EPC proliferation and inflammatory responses were explored by mitochondrial Ca2+ influx and immunoblotting. Candidate ANKRD22 inhibitors then were screened virtually and validated in vitro and in vivo. RESULTS: After acute gastric mucosal injury, the number of Lgr5+ gastric EPCs was increased significantly in Ankrd22-/- mice compared with that in Ankrd22+/+ mice. Moreover, Ankrd22 knockout attenuated inflammatory cell infiltration into damaged gastric tissues. ANKRD22 deletion also reduced mitochondrial Ca2+ influx and cytoplasmic nuclear factor of activated T cells in gastric epithelial cells and macrophages, which further induced Lgr5+ gastric EPC proliferation and decreased macrophage release of tumor necrosis factor-α and interleukin 1α. In addition, a small molecule, AV023, was found to show similar effects to those produced by ANKRD22 deletion in vitro. Intraperitoneal injection of AV023 into the mouse model promoted the repair of gastric mucosal damage, with increased proliferation of Lgr5+ gastric EPCs and visible relief of inflammation. CONCLUSIONS: ANKRD22 inhibition is a potential target-based therapeutic approach for promoting the repair of gastric mucosal damage.

Serum pepsinogen levels in different regions of China and its influencing factors: a multicenter cross-sectional study.

BACKGROUND: The aim of this study is to investigate the difference of serum pepsinogen (PG) baseline levels in different regions of China and its influencing factors. METHODS: From October 2016 to October 2018, asymptomatic health checkup people who underwent nasal endoscopy in nine health management centers in different regions of China were collected. Lifestyle questionnaires were conducted, and serum PG and gastroscopy were performed. The differences in PG levels in baseline population (OLGA-0 grade) were studied according to geographical subregions of China. SPSS software was used for statistical analysis. RESULTS: 1922 patients were included in the final analysis. Compared with the non-atrophy (OLGA-0) group, PGR levels in atrophy group (OLGA-I to IV) were significantly decreased with the atrophy degree (p < 0.05). A total of 1590 baseline people (OLGA-0) were included in the study, including 254 from South China, 574 from East China, 210 from Southwest China, 332 from Northeast China, and 220 from Central/Northern China. There were significant differences in baseline PGI levels among the five regions (p < 0.05). The PGII levels were also different among the five regions, except for Central/Northern versus Southern China. PGR (PGI/PGII ratio) levels in Southern China were higher than other four regions. Further studies were conducted on the related factors that might affect the baseline PG level, which was affected by nationality, dietary habits, smoking, Helicobacter pylori infection and other related factors. CONCLUSION: Influenced by many factors, the baseline PG levels are different in different regions of China. In the follow-up studies of PG cut-off value, different PG cut-off value based on region may be more effective in the screening of gastric cancer and precancerous lesions in China.

The poleward enhanced Arctic Ocean cooling machine in a warming climate.

As a cooling machine of the Arctic Ocean, the Barents Sea releases most of the incoming ocean heat originating from the North Atlantic. The related air-sea heat exchange plays a crucial role in both regulating the climate and determining the deep circulation in the Arctic Ocean and beyond. It was reported that the cooling efficiency of this cooling machine has decreased significantly. In this study, we find that the overall cooling efficiency did not really drop: When the cooling efficiency decreased in the southern Barents Sea, it increased in the northern Barents and Kara Seas, indicating that the cooling machine has expanded poleward. According to climate model projections, it is very likely that the cooling machine will continue to expand to the Kara Sea and then to the Arctic Basin in a warming climate. As a result, the Arctic Atlantification will be enhanced and pushed poleward in the future.

Iron chelators reverse organ damage in type 4B hereditary hemochromatosis: Case reports.

RATIONALE: Hereditary hemochromatosis (HH) is a hereditary disorder of iron metabolism. It is classified into 4 main types depending on the underlying genetic mutation: human hemochromatosis protein (HFE) (type 1), hemojuvelin (HJV) (type 2A), HAMP (type 2B), transferrin receptor-2 (TFER2) (type 3), and ferroportin (type 4). Type 4 HH is divided into 2 subtypes according to different mutations: type 4A (classical ferroportin disease) and type 4B (non-classical ferroportin disease). Type 4B HH is a rare autosomal dominant disease that results from mutations in the Solute Carrier Family 40 member 1 (SLC40A1) gene, which encodes the iron transport protein ferroportin. PATIENT CONCERNS: Here we report 2 elderly Chinese Han men, who were brothers, presented with liver cirrhosis, diabetes mellitus, skin hyperpigmentation, hyperferritinaemia as well as high transferrin saturation. DIAGNOSIS: Subsequent genetic analyses identified a heterozygous mutation (p. Cys326Tyr) in the SLC40A1 gene in both patients. INTERVENTIONS: We treated the patient with iron chelator and followed up for 3 years. OUTCOMES: Iron chelator helped to reduce the serum ferritin and improve the condition of target organs, including skin, pancreas, liver as well as pituitary. LESSONS: Type 4B HH is rare but usually tends to cause multiple organ dysfunction and even death. For those patients who have difficulty tolerating phlebotomy, iron chelator might be a good alternative.

Usefulness of controlled attenuation parameter and liver stiffness measurement for detecting increased arterial stiffness in asymptomatic populations in China.

In recent studies, vibration-controlled transient elastography (FibroScan) has been reported as an alternative noninvasive approach for measuring liver steatosis and fibrosis. The present study aimed to investigate the feasibility of FibroScan controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) in the detection of increased arterial stiffness in asymptomatic populations in China.A retrospective cohort recruiting 4747 asymptomatic patients with no underlying causes of liver disease and having FibroScan and brachial-ankle pulse wave velocity (baPWV) during wellness check-up was covered. Nonalcoholic fatty liver disease (NAFLD) was defined as a CAP ≥238 dB/m. NAFLD with significant fibrosis was defined as an LSM ≥7.3 kPa in the presence of NAFLD. Increased arterial stiffness was determined as a BaPWV ≥1.4m/second.Among the 4747 study participants, 1596 subjects (33.6%) suffered from increased arterial stiffness. The prevalence of increased arterial stiffness progressively increased across CAP quartiles and LSM quartiles in NAFLD (23.5%, 30.8%, 38.3%, 43.7%, P < .001 and 33.1%, 36.8%, 40.4%, 48.2%, P < .001, respectively). After conventional cardiovascular risk factors were adjusted (age, sex, overweight, diabetes mellitus, hypertension, hypercholesterolemia, and current smoking habits), multivariate logistic regression analysis revealed that CAP (odd ratio [OR] = 1.005; 95% confidence interval [CI]: 1.003-1.006; P < .001), NAFLD (OR = 1.427; 95% CI: 1.212-1.681; P < .001), LSM in NAFLD (OR = 1.073; 95% CI: 1.023-1.125; P = .003), and significant fibrosis in NAFLD (OR = 1.480; 95% CI: 1.090-2.010; P = .012) were independently associated with increased arterial stiffness. Furthermore, in a multivariate logistic regression analysis, OR (95% CI) for the maximal vs. the minimal quartile of CAP was 1.602 (1.268-2.024), and that of LSM in NAFLD was 1.362 (1.034-1.792) after adjustment for the above-mentioned risk factors. Notably, NAFLD and significant fibrosis in NAFLD were significantly correlated only with increased arterial stiffness in subjects without hypertension or diabetes mellitus after adjustment for the above-mentioned risk factors.CAP-defined NAFLD and LSM-defined significant fibrosis in NAFLD showed significant and independent relationships with increased arterial stiffness even after adjustment for conventional cardiovascular risk factors, which can be conducive to stratifying relative risk of subjects having undergone screening assessment for cardiovascular disease.