Prognostic implications of heart failure stages among Chinese community populations: insight from a nationwide population-based study.

Background: In light of high burden of heart failure (HF) in China, studies of prognostic implication of HF stages are important. We aimed to evaluate the relationship between HF stages and mortality risk in Chinese community populations. Methods: Nationwide representative populations aged ≥35 years (n = 23,284, mean age 56.9 years, women 53.2%) were enrolled from 2012 to 2016. According to the international HF guidelines, participants were divided into stage A, B and C, and those who did not qualify these stages were categorized as apparently-healthy group. Association between HF stages and all-cause, cardiovascular [CV] and non-CV death was evaluated using multivariable-adjusted Cox proportional regression analysis. Findings: During a median follow-up of 4.7 years (109,902.8 person-years), 1314 deaths occurred. Age-adjusted incidence rate of all-cause death was 5.3 in apparently-healthy, 7.8 in stage A, 8.6 in stage B and 24.6 in stage C groups per 1000 person-years. In reference to apparently-healthy group, adjusted hazard ratio for all-cause death was 1.90 (95% CI: 1.47-2.45), 2.43 (95% CI: 1.89-3.13) and 6.40 (95% CI: 4.56-8.99) for stage A, B and C. Advancing HF stages were associated with increasing risks for all-cause, CV and non-CV death (P-trend <0.05). For all-cause death, population attributable fraction due to stage A, B and C were 21.2%, 33.4% and 4.9%, accounting for 1,933,385, 3,045,993 and 446,867 deaths in China in 2018. Interpretation: Advancing HF stages were associated with increasing risk mortality. Development and implementation of early screening and targeted interventions are urgently needed to reduce HF burdens in China. Funding: This work was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant 2017-I2M-1-004), the Projects in the Chinese National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.: 2011BAI11B01), and the Project Entrusted by the National Health Commission of the People's Republic of China (NHC2020-609).

Association Between the Improvement of Knowledge, Attitude and Practice of Hypertension Prevention and Blood Pressure Control-A Cluster Randomized Controlled Study.

BACKGROUND: Hypertension-related knowledge, attitude and practice (KAP) of hypertensive patients can affect the awareness, treatment and control of hypertension. However, little attention has been paid to the association between the change of hypertension preventive KAP and blood pressure (BP) control in occupational population using longitudinal data. We assess the effectiveness of a workplace-based multicomponent hypertension intervention program on improving the level of KAP of hypertension prevention, and the association between improvement in KAP and BP control during intervention. METHODS: From January 2013 to December 2014, workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20) using a cluster randomized control method. All employees in each workplace were asked to complete a cross-sectional survey to screen for hypertension patients. Hypertension patients in the intervention group were given a 2-year workplace-based multicomponent hypertension intervention for BP control. The level of hypertension prevention KAP and BP were assessed before and after intervention in the two groups. RESULTS: Overall, 3331 participants (2658 in the intervention group and 673 in the control group) were included (mean [standard deviation] age, 46.2 [7.7] years; 2723 men [81.7%]). After 2-year intervention, the KAP qualified rate was 63.2% in the intervention groups and 50.1% in the control groups (odds ratio = 1.65, 95% CI, 1.36∼2.00, P < .001). Compared with the control group decreased in the qualified rate of each item of hypertension preventive KAP questionnaire, all the items in the intervention group increased to different degrees. The increase of KAP score was associated with the decrease of BP level after intervention. For 1 point increase in KAP score, systolic blood pressure (SBP) decreased by .28 mmHg and diastolic blood pressure (DBP) decreased by .14 mmHg [SBP: ß = -.28, 95%CI: -.48∼-.09, P = .004; DBP: ß = -.14, 95%CI: -.26∼-.02, P = .024]. SBP and DBP was significantly in manual labor workers (SBP: ß = -.34, 95%CI: -.59∼-.09, P = .008; DBP: ß = -.23, 95%CI: -.38∼-.08, P = .003), workers from private enterprise, state-owned enterprise (SOE) (SBP: ß = -.40, 95%CI: -.64∼-.16, P = .001; DBP: ß = -.21, 95%CI: -.36∼-.06, P = .005) and a workplace with an affiliated hospital (SBP: ß = -.31, 95%CI: -.52∼-.11, P = .003; DBP: ß = -.16, 95%CI: -.28∼-.03, P = .016). The improvement of knowledge (SBP: ß = -.29, 95%CI: -.56∼-.02, P = .038; DBP: ß = -.12, 95%CI: -.29∼.05, P = .160), as well as attitude (SBP: ß = -.71, 95%CI: -1.25∼-.18, P = .009; DBP: ß = .18, 95%CI: -.23∼.59, P = .385) and behavior (SBP: ß = -.73, 95%CI: -1.22∼-.23, P = .004; DBP: ß = -.65, 95%CI: -.97∼-.33, P < .001) was gradually strengthened in relation to BP control. CONCLUSION: This study found that workplace-based multicomponent hypertension intervention can effectively improve the level of hypertension preventive KAP among employees, and the improvement of KAP levels were significantly associated with BP control. TRIAL REGISTRATION: Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

Time trends in the burden of low back pain and its associated risk factors in China from 1990 to 2019.

Background: From 1990 to 2019, low back pain (LBP) was the leading cause of years lived with disability (YLDs) in China. However, the change patterns of LBP and its risk factors in China remain unclear. Methods: Data from the Global Burden of Disease Study 2019 were used. We used the join-point regression model and age-period-cohort analysis to evaluate the time trends of attributable risk factors on the burden of LBP. Results: In 2019, the risk factors included in this analysis accounted for 4.36 million YLDs of LBP, representing 42.2% of all YLDs of LBP in China, with 2.86 million due to occupational ergonomic factors, 1.74 million due to smoking, and 0.46 million due to high body mass index (BMI). The age-standardized YLD rates of LBP showed downward trends during 1990-2019, while there was a faster decline between 1990 and 1994. The curves of local drifts, which reflected the average annual percentage change across age groups, showed an increasing trend with age for high BMI and smoking, and a downward trend for occupational ergonomic factors. The YLD rates for LBP increased dramatically with age for high BMI, while it reached a peak at 40-60 years old for occupational ergonomic factors, and 65-80 years old for smoking. The period and cohort rate ratios of LBP YLD decreased in the past 3 decades for occupational ergonomic factors and smoking, while increased for high BMI. Conclusions: Our results provided strong evidence that there were diverse changing patterns for different risk factors, highlighting the need for risk-specific strategies. The translational potential of this article: China has the largest senior population and the fastest aging population in the world. Given that LBP typically occurs in the senior population, there would be an increasing LBP burden on China's health system. This suggests that effective strategies for LBP prevention should be strictly implemented in China, particularly in the senior population, which is of crucial translational potential.

Effects of loneliness and isolation on cardiovascular diseases: a two sample Mendelian Randomization Study.

BACKGROUND: Loneliness and isolation are associated with multiple cardiovascular diseases (CVDs), but there is a lack of research on whether they were causally linked. We conducted a Mendelian Randomization (MR) study to explore causal relationships between loneliness and isolation and multiple CVDs. METHODS: Single nucleotide polymorphisms associated with loneliness and isolation were identified from a genome-wide association study (GWAS) of 455,364 individuals of European ancestry in the IEU GWAS database. Summary data for 15 CVDs were also obtained from the IEU GWAS database. We used three MR methods including inverse variance weighting, MR-Egger, and weighted median estimation to assess the causal effect of exposure on outcomes. Cochran's Q test and MR-Egger intercept test were used to evaluate the heterogeneity and pleiotropy. RESULTS: MR analysis showed that loneliness and isolation were significantly associated with essential hypertension (OR = 1.07, 95% CI: 1.03-1.12), atherosclerotic heart disease (OR = 1.04; 95% CI: 1.02-1.06), myocardial infarction (OR = 1.02; 95% CI: 1-1.04) and angina (OR = 1.04; 95% CI =1.02-1.06). No heterogeneity and pleiotropy effects were found in this study. CONCLUSIONS: Causal relationship of loneliness and isolation with CVDs were found in this study.

Association of persistent postoperative hyperglycemia with mortality after elective craniotomy.

OBJECTIVE: The influence of persistent postoperative hyperglycemia after craniotomy has not yet been explored. This study aimed to investigate the hypothesis that persistent postoperative hyperglycemia is associated with mortality in patients undergoing an elective craniotomy. METHODS: This study included adult patients (age ≥ 18 years) undergoing an elective craniotomy between January 2011 and March 2021 at the West China Hospital, Sichuan University. Peak daily blood glucose values measured within the first 7 days after craniotomy were collected. Persistent hyperglycemia was defined by two or more consecutive serum glucose levels of mild, moderate, or severe hyperglycemia. Normoglycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia were defined as glucose values of ≤ 6.1 mmol/L, > 6.1 and ≤ 7.8 mmol/L, > 7.8 and ≤ 10.0 mmol/L, and > 10.0 mmol/L, respectively. RESULTS: This study included 14,907 patients undergoing an elective craniotomy. In the multivariable analysis, both moderate (adjusted OR 3.76, 95% CI 2.68-5.27) and severe (adjusted OR 3.82, 95% CI 2.54-5.76) persistent hyperglycemia in patients were associated with higher 30-day mortality compared with normoglycemia. However, this association was not observed in patients with mild hyperglycemia (adjusted OR 1.32, 95% CI 0.93-1.88). Interestingly, this association was observed regardless of whether patients had preoperative hyperglycemia. There was no interaction between moderate or severe hyperglycemia and preexisting diabetes (p for interaction = 0.65). When postoperative peak blood glucose values within the first 7 days after craniotomy were evaluated as a continuous variable, for each 1-mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.17 (95% CI 1.14-1.21). Postoperative blood glucose (area under the curve [AUC] = 0.78) was superior to preoperative blood glucose (AUC = 0.65; p < 0.001) for predicting mortality. Moderate and severe persistent hyperglycemia in patients were associated with an increased risk of deep venous thrombosis (adjusted OR 3.20, 95% CI 2.31-4.42), pneumonia (adjusted OR 2.77, 95% CI 2.40-3.21), myocardial infarction (adjusted OR 4.38, 95% CI 3.41-5.61), and prolonged hospital stays (adjusted OR 1.43, 95% CI 1.29-1.59). CONCLUSIONS: In patients undergoing an elective craniotomy, moderate and severe persistent postoperative hyperglycemia were associated with an increased risk of mortality compared with normoglycemia, regardless of preoperative hyperglycemia.

Association between short-term daily temperature variability and blood pressure in the Chinese population: From the China hypertension survey.

BACKGROUND: We aimed to evaluate the impacts of short-term daily temperature variability (DTV) on blood pressure (BP) among participants with normotension, prehypertension, and hypertension, respectively, and explore the effects in different climate zones and seasons. METHODS: A representative population sample (n = 397,173) covering the subtropical, temperate continental, and temperate monsoon zones was obtained from the China Hypertension Survey. DTV was calculated as the standard deviation of daily minimum and maximum temperatures during the exposure days. The linear mixed effect regression model was used to estimate the associations between DTV exposure and BP among normotension, prehypertension, and hypertension, respectively, and further stratified analysis was performed by climate zones and seasons. RESULTS: After adjustment for confounders, per interquartile range (IQR) increase in DTV (2.28 °C) at 0-6 days of exposure was associated with an increase of 0.41 mmHg (95 % confidence interval [CI]: 0.07, 0.75) in systolic BP (SBP) and 0.41 mmHg (95 % CI: 0.09, 0.72) in pulse pressure (PP) among hypertensive participants in the subtropical zone. Similarly, DTV exposure was associated with an increase of 0.31 mmHg (95 % CI: 0.06, 0.55) in SBP and 0.59 mmHg (95 % CI: 0.24, 0.94) in PP among prehypertensive participants in the temperate continental zone. Additionally, during the warm season, DTV was positively associated with SBP among populations with prehypertension and hypertension, and with PP among all three populations. CONCLUSION: Short-term DTV exposure was associated with an increase in SBP and PP among hypertensive and prehypertensive participants in the subtropical zone and the temperate continental zone. In addition, positive associations of DTV with SBP and PP were observed among participants with prehypertension and hypertension in the warm season. Comprehensive health education and effective intervention strategies should be implemented to mitigate the effects of temperature variations on BP, particularly among prehypertensive and hypertensive populations.

Elevated lactate dehydrogenase predicts pneumonia in spontaneous intracerebral hemorrhage.

Background: Although a variety of risk factors for pneumonia after spontaneous intracerebral hemorrhage have been established, an objective and easily obtainable predictor is still needed. Lactate dehydrogenase is a nonspecific inflammatory biomarker. In this study, we aimed to assess the association between lactate dehydrogenase and pneumonia in spontaneous intracerebral hemorrhage patients. Methods: Our study was a retrospective, multicenter cohort study, undertaken in 7562 patients diagnosed with spontaneous intracerebral hemorrhage from 3 hospitals. All serum Lactate dehydrogenase was collected within 7 days from admission and divided into four groups as quartile(Q). We conducted a multivariable logistic regression analysis to assess the association of Lactate dehydrogenase with pneumonia. Results: Among a total of 7562 patients, 2971 (39.3%) patients were diagnosed with pneumonia. All grades of elevated lactate dehydrogenase were associated with increased raw and risk-adjusted risk of pneumonia. Multiple logistic regression analysis showed odds ratios for Q2-Q4 compared with Q1 were 1.21 (95% CI, 1.04-1.42), 1.64(95% CI, 1.41-1.92), and 1.92 (95% CI, 1.63-2.25) respectively. The odds ratio after adjustment was 4.42 (95% CI, 2.94-6.64) when lactate dehydrogenase was a continuous variable after log-transformed. Conclusions: Elevated lactate dehydrogenase is significantly associated with an increase in the odds of pneumonia and has a predictive value for severe pneumonia in patients with pneumonia. Lactate dehydrogenase may be used to predict pneumonia events in spontaneous intracerebral hemorrhage patients as a laboratory marker.

Dose-response association between physical activity and blood pressure among Chinese adults: a nationwide cross-sectional study.

OBJECTIVES: The aim of this study was to examine the dose-response associations of physical activity with blood pressure (BP) and hypertension risk among Chinese adults. METHODS: Derived from the national community-based China Hypertension Survey database during 2012--2015, a total of 203 108 residents aged at least 18 years were included. Individual-level physical activity was evaluated using a standardized questionnaire, and minutes of metabolic equivalent tasks per week (MET-min/week) were calculated, integrating domain, intensity, frequency, and duration. Multivariable linear and logistic regressions were used to estimate associations of physical activity with BP and hypertension risk, and restricted cubic spline regressions were performed for their nonlinear dose-response relationships. RESULTS: Overall, the median total physical activity (TPA) was 3213.0 MET-min/week and the prevalence of physical inactivity was 14.8%. TPA was negatively associated with BP. Increasing TPA levels was related to a steep decrease in systolic BP, up to approximately 2500 MET-min/week, with more modest benefits above that level of TPA. Higher levels of domain-specific and intensity-specific physical activity were found to be associated with lower BP levels and hypertension risk, except for the association between vigorous-intensity physical activity and systolic BP. We found that TPA within the range of 2000--4000 MET-min/week, a higher frequency and shorter duration were inversely associated with diastolic BP levels. CONCLUSION: Total, domain-specific, and intensity-specific physical activity were inversely related to BP levels, respectively, in a dose-response fashion. Of a given amount, higher-frequency, shorter-duration, and lower-intensity physical activity produced more beneficial effects.

Coupling Direct Atmospheric CO2 Capture with Photocatalytic CO2 Reduction for Highly Efficient C2H6 Production.

As massive amounts of carbon dioxide (CO2) have been emitted into the atmosphere causing severe global warming problems, developing carbon-negative techniques to control atmospheric CO2 concentrations is enormously urgent. Herein, by coupling the direct atmosphere CO2 capture adsorbent ZSM-5 with the CO2 reduction photocatalyst NiV2Se4, we present the first synergistic approach for concentrating and converting atmospheric CO2 into C2 solar fuels. A C2H6 yield of 1.85 µmol g-1 h-1 has been achieved in the air, outperforming state-of-the-art direct atmospheric CO2 conversion photocatalysts. Comprehensive characterizations show that ZSM-5 enhances CO2 capture from the atmosphere, improving the interfacial interaction of CO2 on the NiV2Se4 surface for C-C coupling of CH3* to form C2H6. This work demonstrates the first example of integrating direct CO2 capture material with a CO2 reduction photocatalyst for atmospheric CO2 capture and utilization, which paves the way for the negative-carbon technology development under worldwide carbon-neutral pressure.

Association of anemia with mortality in young adult patients with intracerebral hemorrhage.

This study aimed to examine the association of hemoglobin concentration with a 90-day mortality of young adult patients with ICH in a large retrospective cohort. A retrospective observational study was conducted between December 2013 and June 2019 in two tertiary academic medical centers in China. We defined patients with hemoglobin concentration < 80 g/L as severe anemia and 80-120/130 g/L as mild to moderate anemia. We also defined patients with hemoglobin concentration > 160 g/L as high hemoglobin. Associations of hemoglobin and outcomes were evaluated in multivariable regression analyses. The primary outcome was mortality at 90 days. We identified 4098 patients with ICH who met the inclusion criteria. After adjusting primary confounding variables, the 90-day mortality rate was significantly higher in young patients with severe anemia (OR, 39.65; 95% CI 15.42-101.97), moderate anemia (OR, 2.49; 95% CI 1.24-5.00), mild anemia (OR, 1.89; 95% CI 1.20-2.98), and high hemoglobin (OR, 2.03; 95% CI 1.26-3.26) group than in young patients of the normal group. The younger age was associated with a higher risk of death from anemia in patients with ICH (P for interaction = 0.01). In young adult patients with ICH, hemoglobin concentration was associated with 90-day mortality, and even mild to moderate anemia correlated with higher mortality. We also found that in ICH patients with anemia, younger age was associated with higher risk.

Preoperative hematocrit levels and postoperative mortality in patients undergoing craniotomy for brain tumors.

Background: Abnormal hematocrit values, including anemia and polycythemia, are common in patients undergoing craniotomy, but the extent to which preoperative anemia or polycythemia independently increases the risk of mortality is unclear. This retrospective cohort study aimed to examine the association between preoperative anemia and polycythemia and postoperative mortality in patients who underwent craniotomy for brain tumor resection. Methods: We retrospectively analyzed data from 12,170 patients diagnosed with a brain tumor who underwent cranial surgery at West China Hospital between January 2011 and March 2021. The preoperative hematocrit value was defined as the last hematocrit value within 7 days before the operation, and patients were grouped according to the severity of their anemia or polycythemia. We assessed the primary outcome of 30-day postoperative mortality using logistic regression analysis adjusted for potential confounding factors. Results: Multivariable logistic regression analysis reported that the 30-day mortality risk was raised with increasing severity of both anemia and polycythemia. Odds ratios for mild, moderate, and severe anemia were 1.12 (95% CI: 0.79-1.60), 1.66 (95% CI: 1.06-2.58), and 2.24 (95% CI: 0.99-5.06), respectively. Odds ratios for mild, moderate, and severe polycythemia were 1.40 (95% CI: 0.95-2.07), 2.81 (95% CI: 1.32-5.99), and 14.32 (95% CI: 3.84-53.44), respectively. Conclusions: This study demonstrated that moderate to severe anemia and polycythemia are independently associated with increased postoperative mortality in patients undergoing craniotomy for brain tumor resection. These findings underscore the importance of identifying and managing abnormal hematocrit values before craniotomy surgery.

An Ultraflexible Electrode Array for Large-Scale Chronic Recording in the Nonhuman Primate Brain.

Single-unit (SU) recording in nonhuman primates (NHPs) is indispensible in the quest of how the brain works, yet electrodes currently used for the NHP brain are limited in signal longevity, stability, and spatial coverage. Using new structural materials, microfabrication, and penetration techniques, we develop a mechanically robust ultraflexible, 1 µm thin electrode array (MERF) that enables pial penetration and high-density, large-scale, and chronic recording of neurons along both vertical and horizontal cortical axes in the nonhuman primate brain. Recording from three monkeys yields 2,913 SUs from 1,065 functional recording channels (up to 240 days), with some SUs tracked for up to 2 months. Recording from the primary visual cortex (V1) reveals that neurons with similar orientation preferences for visual stimuli exhibited higher spike correlation. Furthermore, simultaneously recorded neurons in different cortical layers of the primary motor cortex (M1) show preferential firing for hand movements of different directions. Finally, it is shown that a linear decoder trained with neuronal spiking activity across M1 layers during monkey's hand movements can be used to achieve on-line control of cursor movement. Thus, the MERF electrode array offers a new tool for basic neuroscience studies and brain-machine interface (BMI) applications in the primate brain.

Cardiovascular disease and all-cause mortality associated with individual and combined cardiometabolic risk factors.

BACKGROUND: Previous studies have investigated the association between cardiometabolic risk factors and cardiovascular disease (CVD), but evidence of the attributable burden of individual and combined cardiometabolic risk factors for CVD and mortality is limited. We aimed to investigate and quantify the associations and population attributable fraction (PAF) of cardiometabolic risk factors on CVD and all-cause mortality, and calculate the loss of CVD-free years and years of life lost in relation to the presence of cardiometabolic risk factors. METHODS: Twenty-two thousand five hundred ninety-six participants aged ≥ 35 without CVD at baseline were included between October 2012 and December 2015. The outcomes were the composite of fatal and nonfatal CVD events and all-cause mortality, which were followed up in 2018 and 2019 and ascertained by hospital records and death certificates. Cox regression was applied to evaluate the association of individual and combined cardiometabolic risk factors (including hypertension, diabetes and high low-density lipoprotein cholesterol (LDL-C)) with CVD risk and all-cause mortality. We also described the PAF for CVD and reductions in CVD-free years and life expectancy associated with different combination of cardiometabolic conditions. RESULTS: During the 4.92 years of follow-up, we detected 991 CVD events and 1126 deaths. Hazard ratio were 1.59 (95% confidential interval (CI) 1.37-1.85), 1.82 (95%CI 1.49-2.24) and 2.97 (95%CI 1.85-4.75) for CVD and 1.38 (95%CI 1.20-1.58), 1.66 (95%CI 1.37-2.02) and 2.97 (95%CI 1.88-4.69) for all-cause mortality, respectively, in participants with one, two or three cardiometabolic risk factors compared with participants without diabetes, hypertension, and high LDL-C. 21.48% of CVD and 15.38% of all-cause mortality were attributable to the combined effect of diabetes and hypertension. Participants aged between 40 and 60 years old, with three cardiometabolic disorders, had approximately 4.3-year reductions life expectancy compared with participants without any abnormalities of cardiometabolic disorders. CONCLUSIONS: Cardiometabolic risk factors were associated with a multiplicative risk of CVD incidence and all-cause mortality, highlighting the importance of comprehensive management for hypertension, diabetes and dyslipidemia in the prevention of CVD.

Socioeconomic inequalities in dementia burden related to high body mass index, 2005-2018: findings from 1.25 million Chinese adults.

Background: Dementia has become a major public health concern worldwide, but comprehensive assessments of dementia burden attributable to high body mass index (BMI) in China have not been done. Methods: We used a temporal-spatial Bayesian hierarchical model to estimated BMI levels based on 1.25 million Chinese. We estimated dementia burden attributable to high BMI by age, sex, year, and socioeconomic development in terms of deaths and years of life lost (YLLs) and assessed the effect of population ageing. Findings: The average age-standardised BMI was 24.58 kg/m2 and 24.15 kg/m2 for men and women in 2018, respectively. 12,901 (95% UI, 10,617-15,420) dementia deaths were attributable to high BMI in China in 2018, with 5417 deaths from man and 7421 deaths from woman. The attributable age-standardised YLL rates for dementia increased 27% from 2005 to 2018. The attributable age-standardised mortality rates increased with human development index. People aged 80 years and older had the highest attributable mortality rate, and the rate decreased with decreasing age. Population ageing was an important component of the increase in dementia death. Interpretation: The rapid increase and large inequality highlighted the urgent need for evidence-based policies and interventions. We therefore call for establishing stronger anti-dementia strategies to promote the healthy ageing. Funding: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.

Air pollution attenuated the benefits of physical activity on blood pressure: Evidence from a nationwide cross-sectional study.

INTRODUCTION: Although physical activity (PA) has multiple health benefits, the inhaled dose of fine particulate matter (PM2.5) during PA may increase. The trade-off between harmful effects of PM2.5 exposure and protective effects of PA remain unclear. Our study aims to examine the joint effects of PA and PM2.5 exposure on blood pressure (BP) in Chinese adults. METHODS: A total of 203,108 adults aged ≥ 18 years from the China Hypertension Survey study (2012-2015) were included. Individual-level PA was assessed as minutes of metabolic equivalent tasks per week (MET-min/week). The average weekly PM2.5 exposures were estimated by using a spatial resolution of 10 km, integrating multiple data sources, including monitoring values, satellite measurements and model simulations. BP was measured with a professional portable BP monitor. Generalized linear regressions were used to estimate joint associations and to further explore two-dimensional nonlinear associations. RESULTS: The median PA and 4-week PM2.5 average exposures were 3213.0 MET-min/week and 47.8 µg/m3, respectively. PA was negatively associated with BP, while PM2.5 exposure was positively with BP. The associations between PA and systolic BP were significantly modified by PM2.5 exposure (Pinteraction < 0.001). Compared with inactive participants under low PM2.5 exposure, those with highest level of PA under low PM2.5 exposure had a 0.90 (95 % CI: 0.53, 1.26) mmHg decrease in systolic BP, whereas they had a 0.48 (95 % CI: 0.07, 0.89) mmHg increase under high PM2.5 exposure. When PM2.5 exposure was approximately > 25 µg/m3, the joint exposure to total PA and PM2.5 was associated with an increase in systolic BP. CONCLUSIONS: The benefits of PA on BP were counteracted by high PM2.5 levels.

Air pollution is associated with abnormal left ventricular diastolic function: a nationwide population-based study.

BACKGROUND: Air pollution is a growing public health concern of global significance. Till date, few studies have explored the associations between air pollutants and cardiac imaging phenotypes. In this study, we aim to explore the association of ambient air pollution and abnormal left ventricular diastolic function (ALVDF) among a large-scale free-living population. METHODS: The participants were from a national representative large-scale cross-sectional study, i.e., the China Hypertension Survey (CHS), 2012-15. After exclusion, 25,983 participants from 14 provinces and 30 districts in China were included for the final analysis. The annual average ambient PM2.5, PM10 and NO2 concentrations were obtained from the chemical data assimilation system (ChemDAS). The clinical evaluation of left ventricular function was conducted in the survey field which was based on echocardiography. Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009). RESULTS: The mean age of 25,983 participants was 56.8 years, 46.5% were male, and the crude prevalence of GradeI-III ALVDF were 48.1%, 1.6% and 1.1%, respectively. The ORs (95% CI) for ALVDF in the fully adjusted model were 1.31 (1.11-1.56), 1.11 (1.01-1.21) and 1.18 (0.90-1.54) for an increase of 10 µg/m3 of PM2.5, PM10 and NO2, respectively. And for different grades of ALVDF, elevated concentration of PM2.5 and PM10 exposures significantly increased the risk of gradeIinstead of gradeII ~ III ALVDF. There was a positive linear and "J" shape concentration-response association between annual average ambient PM2.5 and NO2 and the ALVDF risk assessed by the restricted cubic spline. The exposure level of most participants to PM10 was less than 130 µg/m3, and the risk of ALVDF increased significantly with the concentration rise. CONCLUSIONS: This large-scale nationwide population study demonstrated a significantly positive association between ambient PM2.5, PM10 and NO2 with ALVDF, especially for mild ALVDF. The functional abnormality may partially explain the enhanced cardiovascular morbidity and mortality associated with air pollution, which highlights the importance of appropriate interventions to reduce ambient air pollution in China.

Obesity Paradox for Postoperative Mortality in Young Chinese Patients Undergoing Craniotomy for Brain Tumor Resection.

BACKGROUND: There is little evidence regarding the association of body mass index (BMI) with postoperative mortality after craniotomy, especially in the Asian population. Our study aimed to explore the association between BMI and postoperative 30-day mortality in Chinese patients undergoing craniotomy for brain tumor resection. METHODS: This large retrospective cohort study, Supplemental Digital Content 9, http://links.lww.com/JNA/A634 collected data from 7519 patients who underwent craniotomy for brain tumor resection. On the basis of the World Health Organization obesity criteria for Asians, included patients were categorized as underweight (<18.5 kg/m2), normal weight (18.5 to 22.9 kg/m2), overweight (23to 24.9 kg/m2), obese I (25 to 29.9 kg/m2), and obese II (≥30 kg/m2). We used a multivariable logistic regression model to explore the association between different BMI categories and 30-day postoperative mortality. In addition, we also conducted stratified analyses based on age and sex. RESULTS: Overweight (adjusted odds ratio 0.63, 95% CI 0.40-0.99) and obese I (adjusted odds ratio 0.44, 95% CI 0.28-0.72) were associated with decreased 30-day postoperative mortality compared with normal-weight counterparts. Such associations were prominent among younger (age younger than 65 y) patients but not older patients, and there was an interaction between age and overweight versus normal weight on mortality (P for interaction=0.04). CONCLUSIONS: We found that among Chinese patients undergoing craniotomy for brain tumors, there was a J-shaped association between BMI and postoperative 30-day mortality, with lowest mortality at 27 kg/m². Moreover, in young patients, overweight and obese I were both associated with decreased risk of 30-day mortality.

Association between intraoperative steroid and postoperative mortality in patients undergoing craniotomy for brain tumor.

Background: Despite the widespread use of intraoperative steroids in various neurological surgeries to reduce cerebral edema and other adverse symptoms, there is sparse evidence in the literature for the optimal and safe usage of intraoperative steroid administration in patients undergoing craniotomy for brain tumors. We aimed to investigate the effects of intraoperative steroid administration on postoperative 30-day mortality in patients undergoing craniotomy for brain tumors. Methods: Adult patients who underwent craniotomy for brain tumors between January 2011 to January 2020 were included at West China Hospital, Sichuan University in this retrospective cohort study. Stratified analysis based on the type of brain tumor was conducted to explore the potential interaction. Results: This study included 8,663 patients undergoing craniotomy for brain tumors. In patients with benign brain tumors, intraoperative administration of steroids was associated with a higher risk of postoperative 30-day mortality (adjusted OR 1.98, 95% CI 1.09-3.57). However, in patients with malignant brain tumors, no significant association was found between intraoperative steroid administration and postoperative 30-day mortality (adjusted OR 0.86, 95% CI 0.55-1.35). Additionally, administration of intraoperative steroids was not associated with acute kidney injury (adjusted OR 1.11, 95% CI 0.71-1.73), pneumonia (adjusted OR 0.89, 95% CI 0.74-1.07), surgical site infection (adjusted OR 0.78, 95% CI 0.50-1.22) within 30 days, and stress hyperglycemia (adjusted OR 1.05, 95% CI 0.81-1.38) within 24 h after craniotomy for brain tumor. Conclusion: In patients undergoing craniotomy for benign brain tumors, intraoperative steroids were associated with 30-day mortality, but this association was not significant in patients with malignant brain tumors.

Workplace-based primary prevention intervention reduces incidence of hypertension: a post hoc analysis of cluster randomized controlled study.

BACKGROUND: A workplace-based primary prevention intervention be an effective approach to reducing the incidence of hypertension (HTN). However, few studies to date have addressed the effect among the Chinese working population. We assessed the effect of a workplace-based multicomponent prevention interventions program for cardiovascular disease on reducing the occurrence of HTN through encouraging employees to adopt a healthy lifestyle. METHODS: In this post hoc analysis of cluster randomized controlled study, 60 workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20). All employees in each workplace were asked to complete a baseline survey after randomization for obtaining sociodemographic information, health status, lifestyle, etc. Employees in the intervention group were given a 2-year workplace-based primary prevention intervention program for improving their cardiovascular health, including (1) cardiovascular health education, (2) a reasonable diet, (3) tobacco cessation, (4) physical environment promotion, (5) physical activity, (6) stress management, and (7) health screening. The primary outcome was the incidence of HTN, and the secondary outcomes were improvements of blood pressure (BP) levels and lifestyle factors from baseline to 24 months. A mix effect model was used to assess the intervention effect at the end of the intervention in the two groups. RESULTS: Overall, 24,396 participants (18,170 in the intervention group and 6,226 in the control group) were included (mean [standard deviation] age, 39.3 [9.1] years; 14,727 men [60.4%]). After 24 months of the intervention, the incidence of HTN was 8.0% in the intervention groups and 9.6% in the control groups [relative risk (RR) = 0.66, 95% CI, 0.58 ~ 0.76, P < 0.001]. The intervention effect was significant on systolic BP (SBP) level (ß = - 0.7 mm Hg, 95% CI, - 1.06 ~ - 0.35; P < 0.001) and on diastolic BP (DBP) level (ß = - 1.0 mm Hg, 95% CI, - 1.31 ~ - 0.76; P < 0.001). Moreover, greater improvements were reported in the rates of regular exercise [odd ratio (OR) = 1.39, 95% CI, 1.28 ~ 1.50; P < 0.001], excessive intake of fatty food (OR = 0.54, 95% CI, 0.50 ~ 0.59; P < 0.001), and restrictive use of salt (OR = 1.22, 95% CI, 1.09 ~ 1.36; P = 0.001) in intervention groups. People with a deteriorating lifestyle had higher rates of developing HTN than those with the same or improved lifestyle. Subgroup analysis showed that the intervention effect of BP on employees with educational attainment of high school above (SBP: ß = - 1.38/ - 0.76 mm Hg, P < 0.05; DBP: ß = - 2.26/ - 0.75 mm Hg, P < 0.001), manual labor workers and administrative worker (SBP: ß = - 1.04/ - 1.66 mm Hg, P < 0.05; DBP: ß = - 1.85/ - 0.40 mm Hg, P < 0.05), and employees from a workplace with an affiliated hospital (SBP: ß = - 2.63 mm Hg, P < 0.001; DBP: ß = - 1.93 mm Hg, P < 0.001) were significantly in the intervention group. CONCLUSIONS: This post hoc analysis found that workplace-based primary prevention interventions program for cardiovascular disease were effective in promoting healthy lifestyle and reducing the incidence of HTN among employees. TRIAL REGISTRATION: Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.

Predictive model of acute kidney injury after spontaneous intracerebral hemorrhage: A multicenter retrospective study.

BACKGROUND AND OBJECTIVES: Acute kidney injury is a common comorbidity in patients with intracerebral hemorrhage. Although there are predictive models to determine risk of AKI in patients in critical care or post-surgical scenarios or in general medical floors, there are no models that specifically determine the risk of AKI in patients with ICH. METHODS: Clinical features and laboratory tests were selected by previous studies and LASSO (least absolute shrinkage and selection operator) regression. We used multivariable logistic regression with a bidirectional stepwise method to construct ICH-AKIM (intracerebral hemorrhage-associated acute kidney injury model). The accuracy of ICH-AKIM was measured by the area under the receiver operating characteristic curve. The outcome was AKI development during hospitalization, defined as KDIGO (Kidney Disease: Improving Global Outcomes) Guidelines. RESULTS: From four independent medical centers, a total of 9649 patients with ICH were available. Overall, five clinical features (sex, systolic blood pressure, diabetes, Glasgow coma scale, mannitol infusion) and four laboratory tests at admission (serum creatinine, albumin, uric acid, neutrophils-to-lymphocyte ratio) were predictive factors and were included in the ICH-AKIM construction. The AUC of ICH-AKIM in the derivation, internal validation, and three external validation cohorts were 0.815, 0.816, 0.776, 0.780, and 0.821, respectively. Compared to the univariate forecast and pre-existing AKI models, ICH-AKIM led to significant improvements in discrimination and reclassification for predicting the incidence of AKI in all cohorts. An online interface of ICH-AKIM is freely available for use. CONCLUSION: ICH-AKIM exhibited good discriminative capabilities for the prediction of AKI after ICH and outperforms existing predictive models.