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.

2023 China Guidelines for Lipid Management.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among urban and rural residents in China, and elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for ASCVD. Considering the increasing burden of ASCVD, lipid management is of the utmost importance. In recent years, research on blood lipids has made breakthroughs around the world, hence a revision of China guidelines for lipid management is imperative, especially since the target lipid levels in the general population vary in respect to the risk of ASCVD. The level of LDL-C, which can be regarded as appropriate in a population without frisk factors, can be considered abnormal in people at high risk of developing ASCVD. As a result, the "Guidelines for the prevention and treatment of dyslipidemia" were adapted into the "China Guidelines for Lipid Management" (henceforth referred to as the new guidelines) by an Experts' committee after careful deliberation. The new guidelines still recommend LDL-C as the primary target for lipid control, with CVD risk stratification to determine its target value. These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle, be used as an initial line of treatment, followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, as necessary. The new guidelines provide guidance for lipid management across various age groups, from children to the elderly. The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

2023 Chinese guideline for lipid management.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among urban and rural residents in China, and elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for ASCVD. Considering the increasing burden of ASCVD, lipid management is of the utmost importance. In recent years, research on blood lipids has made breakthroughs around the world, hence a revision of Chinese guideline for lipid management is imperative, especially since the target lipid levels in the general population vary in respect to the risk of ASCVD. The level of LDL-C, which can be regarded as appropriate in a population without frisk factors, can be considered abnormal in people at high risk of developing ASCVD. As a result, the "Guidelines for the prevention and treatment of dyslipidemia" were adapted into the "Chinese guideline for Lipid Management" (henceforth referred to as the new guidelines) by an Experts' committee after careful deliberation. The new guidelines still recommend LDL-C as the primary target for lipid control, with cardiovascular disease (CVD) risk stratification to determine its target value. These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle, be used as an initial line of treatment, followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, as necessary. The new guidelines provide guidance for lipid management across various age groups, from children to the elderly. The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012-2015).

BACKGROUND: Heart failure (HF) is a leading cause of hospitalization and mortality for older chronic kidney disease (CKD) patients. However, the epidemiological data is scarce. We aimed to determine the prevalence of left ventricular (LV) dysfunction and HF, and to explore the risk factors for HF among those patients. METHODS: This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015. A total of 5, 808 participants aged ≥ 65 years were included in the analysis. Self-reported history of HF and any other cardiovascular diseases was acquired. 2-D and Doppler echocardiography were used to assess LV dysfunction. CKD was defined as either estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio (ACR) ≥ 30 mg/g. RESULTS: Among CKD patients aged ≥ 65 years, the weighted prevalence of HF, heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) was 4.8%, 2.5%, 0.8%, and 1.7%, respectively. The weighted prevalence of HF was 5.0% in patients with eGFR < 60 mL/min per 1.73 m2, and was 5.9% in patients with ACR ≥ 30 mg/g. The prevalence of LV systolic dysfunction was 3.1%, and while it was 8.9% for moderate/severe diastolic dysfunction. Multivariate analysis showed that smoking was significantly associated with the risk of HF. Furthermore, age, smoking, and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction. CONCLUSIONS: The prevalence of HF and LV dysfunction was high in older patients with CKD, suggesting that particular strategies will be required.

[Pollution Characteristics of OPEs in the Surface Water and Sediment of the Jinjiang River in Chengdu City].

New GC-MS methods were developed for seven typical organophosphate esters (OPEs) including tri-n-butyl phosphate (TnBP), tris (2-ethylhexyl) phosphate (TEHP), tributoxyethyl phosphate (TBEP), triphenyl phosphate (TPhP), tri (2-chloroethyl) phosphate (TCEP), trichloropropyl phosphate (TCPP) and tridichloropropyl phosphate (TDCPP). These methods were used to quantify their concentrations in the surface water and sediment from the Jinjiang River, Chengdu. The recoveries of the target substances were 76%-119% (surface water)and 83%-126% (sediments). Total OPEs (Σ7OPEs) ranged from 689.09 to 10623.94 ng·L-1, with the mean of 3747.58 ng·L-1 in the surface water. The pollution level of each monomer was in the order TBEP > TCEP > TPhP > TEHP > TCPP > TnBP. TBEP was the predominant pollutant, accounting for 36.50%-95.90% of the Σ7OPEs concentrations. The contents (dw) of the Σ7OPEs ranged from 25.52 to 296.00 ng·g-1 in sediments, and TBEP was also the main pollutant in these samples. No significant correlation existed between the concentrations of OPEs in the surface water and sediments. Alkyl OPEs were the main pollutants in the surface water and sediments. The distribution of OPEs was influenced by the source of emissions and environmental attributes. The pairs TCPP and TnBP, TBEP and TEHP, and TCEP and TPhP might have common sources in the surface water.

Protection of Facial Nerves During Acoustic Neuroma Surgery.

The objective of this study was to summarize the experience about the protection of the facial nerve in surgery for acoustic neuroma surgery with the aim to improve the retention of facial nerve function and the quality of life. Forty-two patients with acoustic neuroma were recruited from the year 2010 to 2013. Using microsurgical techniques, the tumors were resected through the suboccipital approach over the posterior edge of the sigmoid sinus, and intraoperative electrophysiological monitoring of the facial nerve function was performed. The House-Brackmann (H-B) grading was used to evaluate the facial nerve function evaluation postoperatively. Total tumor resection was achieved in 32 cases, and partial resection in 10 cases, without any intraoperative deaths. Also facial nerves were retained in 35 of 42 cases (83.33 %). One week after surgery, the facial nerve H-B grading was grade I in 8 cases, grade II in 15 cases, grade III in 12 cases, grade IV in 6 cases, and grade V in 1 case. The key to improved protection of the facial nerve during acoustic neuroma surgery includes a complete understanding of the anatomy of the cerebellopontine angle, proper use of microsurgical techniques, and intraoperative electrophysiological monitoring of the status of facial nerve functions to avoid damage to the nerves.

Coexistence of aneurysmal subarachnoid hemorrhage and surgically identified pituitary apoplexy: a case report and review of the literature.

INTRODUCTION: A ruptured aneurysm associated with a pituitary apoplexy is rare. We present the first case report of the coexistence of a ruptured posterior communicating aneurysm with a surgically discovered pituitary apoplexy where the pituitary apoplexy had not been diagnosed by a pre-operative computerized tomography scan. CASE PRESENTATION: A 31-year-old right-handed Chinese woman began to experience severe headache, vomiting and blurred vision which continued for two days. On admission to the hospital, a brain computerized tomography scan demonstrated a small amount of increased signal in the basal cisterns; no evidence of intrasellar and suprasellar lesions was seen. The appearance of her brain suggested aneurysmal subarachnoid hemorrhage. She had nuchal rigidity and reduced vision. There was no extra-ocular palsy and no other neurological deficit. Our patient had no stigmata of Cushing's syndrome or acromegaly. During an interview for further history, she reported normal menses and denied reduced vision.Cerebral digital subtraction angiography was subsequently performed, which revealed a 6mm left posterior communicating aneurysm. Urgent left pterional craniotomy was performed. The left ruptured posterior communicating artery aneurysm was completely dissected prior to clipping. At surgery, a suprasellar mass was discovered, the tumor bulging the diaphragma sella and projecting anteriorly under the chiasm raising suspicion of a pituitary tumor. The anterior part of the tumor capsule was opened and a necrotic tumor mixed with dark old blood was removed. The appearance suggested pituitary apoplexy.Histopathology revealed pituitary adenoma with evidence of hemorrhagic necrosis. Our patient made a good recovery. CONCLUSION: Our case report proves that pituitary apoplexy can be coexistent with the rupture of a posterior communicating aneurysm. This association should be considered when evaluating any case of aneurysm. A normal computerized tomography scan does not exclude pituitary apoplexy. Pre-operative magnetic resonance imaging interpretation is required if a pituitary apoplexy is suspected. Craniotomy allows a coexisting aneurysm and pituitary apoplexy to be simultaneously treated.

Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: a meta-analysis of observational studies.

AIMS: An association between obstructive sleep apnoea (OSA) and atrial fibrillation (AF) has been established. However, studies on the role of OSA in AF recurrence after catheter ablation have yielded conflicting results, and the effect of OSA treatment by continuous positive airway pressure (CPAP) on the success rate of AF catheter ablation is indeterminate. The aim of this meta-analysis was to investigate the rate of AF recurrence after catheter ablation in patients with AF with or without OSA and to evaluate the relationship between CPAP therapy and AF recurrence. METHODS AND RESULTS: We performed an online search and identified five studies involving 3743 patients with AF. Patients with OSA had a 31% greater risk of AF recurrence after catheter ablation than did patients without OSA [relative ratio (RR) = 1.31, P = 0.00], and this risk increased by 57% in patients with OSA not undergoing CPAP therapy (RR = 1.57, P = 0.00). However, CPAP users had a risk of AF recurrence similar to that of patients without OSA (RR = 1.25, P = 0.37), and this similarity was maintained even after the removal of study heterogeneity (RR = 0.99, P = 0.39). CONCLUSION: Obstructive sleep apnoea was associated with AF recurrence after catheter ablation. The efficacy of catheter ablation for AF was similar between patients without OSA and patients with OSA undergoing CPAP treatment.

A single-site retrospective study of pediatric arterial ischemic stroke etiology, clinical presentation, and radiologic features.

BACKGROUND: Stroke occurs upon obstruction of cerebral blood circulation and is clinically characterized by sudden onset symptoms. Advanced age is the main risk factor of stroke, but cases of pediatric stroke have been rarely reported. This study aimed to determine the etiology, clinical presentation, and radiologic features of neurological deficit for pediatric arterial ischemic stroke (PAIS). METHODS: The medical records of 42 PAIS patients (age range: 9 months to 13 years) treated at Wuhan Children's Hospital between July 2007 and January 2011 were retrospectively reviewed. Infarction location was first determined by craniocerebral computed tomography and magnetic resonance (MR) imaging. The stenotic or occluded main cerebral arteries and/or branches were determined by MR angiography and digital subtraction angiography. RESULTS: The majority of the 42 PAIS cases (66.7%, n = 28) were ≤ 3 years old (vs. >3 years old: 33.3%, n = 14; P<0.05), but the male: female ratio was similar in both groups (P > 0.05). The most frequently reported signs and symptoms for both age groups were limited physical activity followed by convulsions and delirium, but convulsions were more prevalent in children ≤ 3 years-old. Children > 3 years-old mainly experienced the limited physical activity symptoms, including hemiparalysis, aphasia, and ataxia. For all 42 cases, the most frequent etiologies were infections (38.1%, n = 16), iron deficiency anemia (16.7%, n = 7), and moyamoya syndrome (11.9%, n = 5). The predominant infarcts among all cases were middle cerebral artery (63.6%, n = 21) and basal ganglia (64.3%, n = 27). CONCLUSIONS: PAIS occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom. The overall etiologies of PAIS may be different from those of adult stroke and the involved regions may be distinguishing features of PAIS or its different forms, but more research is required.

Serum total adiponectin level and the risk of cardiovascular disease in general population: a meta-analysis of 17 prospective studies.

OBJECTIVE: Many studies have assessed the association between serum adiponectin and the risk of cardiovascular disease (CVD), yet whether adiponectin is an independent risk factor for CVD remains controversial. We performed a meta-analysis of 17 prospective epidemiologic studies to evaluate this relationship in the general population. METHODS: PubMed and Embase databases were searched through June 2012 to identify studies meeting a priori inclusion criteria, in addition to conducting a secondary reference review. Two principle investigators respectively extracted the information with either fixed-effect model or random-effect model to calculate the relationship between adiponectin and the risk of CVD. RESULTS: We summarized 17 prospective studies with a total of 23,717 participants. Overall, higher serum adiponectin was related to an increased risk of ischemic stroke: pooled risk ratio (RR) of 1.34 [95% confidence intervals (CI): 1.06-1.69] with no heterogeneity (Q = 1.23; P = 0.541). Serum adiponectin was not related to coronary heart disease (CHD) or CVD: pooled RR of 0.96 (95% CI: 0.85-1.08) and 1.00 (95% CI: 0.89-1.13), respectively. CONCLUSIONS: Increased serum adiponectin was related to an elevated risk of ischemic stroke, but there was no clear evidence indicating a positive relationship between adiponectin and the risk of CHD or CVD.

A community-based investigation on restless legs syndrome in a town in China.

OBJECTIVE: To assess the prevalence and severity of restless legs syndrome (RLS) in a town in China and to explore potential factors correlated with the severity of the disease. METHODS: Face-to-face home interviews were conducted among a random sample of 2101 residents in one town in China, all aged 16 years and above. An individual questionnaire was administered to all participants to obtain a diagnosis of RLS and other information. An additional questionnaire was then handed out to each patient diagnosed with RLS to collect information on RLS severity and potential factors correlating with RLS severity. RESULTS: The prevalence of RLS in the studied population was 7.2%. The prevalence in women was significantly higher than in men and increased with age. Diabetes mellitus, anemia, arthritis, and varicose veins were also associated with RLS. Among the 152 patients, 21.7% were classified as having severe RLS. Multiple correlation analysis reveals that RLS severity was positively correlated with longer disease duration, number of cigarettes smoked per day, and level of work-related physical activity, but negatively correlated with level of leisure time physical activity. CONCLUSIONS: RLS is common in the studied population. Lifestyle factors may be associated with RLS severity.

[The current situation of blood pressure control and the influencing factors on hypertensive patients in residential communities of China].

OBJECTIVE: To understand the situation of blood pressure control and the major factors influencing the programs among those hypertensive patients living in the communities from different parts of China. METHODS: A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained under the requirement of this protocol to manage the hypertensive patients. In this study, the hypertensive patients who had been registered in the project centers from Beijing, Hebei, Gansu, Jiangsu, Zhejiang, Guangdong provinces, were selected as the study subjects, and the baseline data for these patients was analyzed. RESULTS: By the end of 2010, a total of 242 182 patients were registered. The mean age was 61.0 ± 10.5, with 48.5% of them being males. The overall control rate of blood pressure was 27.4%. The control rate was significant lower among patients who were in lower age group, being male, with higher BMI, smoking, drinking or with more salt consumption. However, the control rate was significant higher among those patients who had family history of hypertension, always undertook physical exercise or receiving medical treatment. CONCLUSION: The blood pressure control rate for community hypertensive patients in China was still in a relatively low level. Standardization management measures should be strengthened so as to improve the rate of control on high blood pressure.

[Association between chronic kidney disease and cardiovascular events in middle-to-old-aged Chinese population].

OBJECTIVE: This study aimed to determine the relationships between estimated glomerular filtration rate (eGFR) and cardiovascular events. METHODS: 2500 residents aged more than 40 years old were selected from Shougang community, Shijingshan district, in Beijing. 2315 of them took part in the survey. First morning urinary sample was collected for all the participants. Albumin and creatinine were measured and eGFR was calculated using simplified MDAD formula. Cardiovascular risk factors were also investigated. The participants were followed up for 4 years, and all-cause mortality and cardiovascular events were collected. The subjects were divided into three groups according to eGFR [ml/(min·1.73 m(2))]: < 60, 60 - 90, > 90. Cox regression model was used to analyze the relationships between eGFR, all events, and cardiovascular events after adjusting for confounders. RESULTS: The prevalence of eGFR < 60 was 3.3%. The incidence rates of cardiovascular events were 43.9, 21.8 and 11.5/1000 person-years among three groups, and the incidence rates of all events (all-cause mortality and cardiovascular events) were 53.7, 28.8 and 14.6/1000 person-years, respectively. After adjusting for age, gender, smoking, body mass index, serum lipids, diabetes mellitus, cardiovascular disease, the hazard risk (HR) for cardiovascular events was 1.29 (95%CI: 0.85 - 1.96) in eGFR < 60 group and 2.14 (95%CI: 1.02 - 4.50) in 60 ≤ eGFR < 90 group, when compared with the eGFR > 90 group; the HR for all events were 1.25 (95%CI: 0.86 - 1.81) and 1.95 (95%CI: 1.00 - 3.80), respectively. CONCLUSION: In the population studied, eGFR < 60 seemed an independent predictor for cardiovascular events and all-cause events.

[Hypertension Control in Communities (HCC): evaluation result of blood pressure management among hypertensive].

OBJECTIVE: To determine the effects related to community-based standardized blood pressure management programs on the control of hypertension. METHODS: A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained using this protocol and required to manage hypertensive patients according to the protocol. Patients were treated on therapeutic life style change or/and medication, and followed up based on the criteria of risk stratification. The control rate of hypertension was evaluated after 1 year. Effect of intervention (EI) was estimated as '1 year rate (mean)' minus the number showed at the baseline. RESULTS: By the end of 2008, a total of 29 411 hypertensive patients (47.2% for male, mean age 61.4 +/- 10.9 years) with full information had been under management for one year according to the protocol. Among all patients, 8.9% were classified as under low risk, 50.8% as moderate risk and 40.3% as high and very high risk showed in baseline data. After standardized management, the EI of smoking, drinking and systolic/diastolic blood pressure were -7.1% (P < 0.05), -7.3% (P < 0.05), and -14.8-8.3 mm Hg (P < 0.05), respectively. However, EI of overweight/obesity was 0.3% (P > 0.05). For all patients, the control rate rose to 74.7%, with EI as 53.1%, and all of the sub-groups, including age, risk stratification, had significant increases. The longer the management was under, the higher the control rate was seen. Results from the multivariate logistic regression showed that older age, male and having higher blood level were adverse factors for the undertaking the control and management programs of hypertension. CONCLUSION: Results from our study showed that standardized management could significantly improve the program on the control of hypertension at the community level, in China.

[Relationship between serum prostate-specific antigen levels and body mass index in Beijing men over 50 years of age].

OBJECTIVE: To investigate the relationship between body mass index (BMI) and serum prostate specific antigen (PSA). METHODS: A cross-sectional study was performed at community of Beijing in men over 50 years old. Height, weight and PSA (both serum TPSA and FPSA) were assessed in 1573 men. According to the redefined World Health Organization (WHO) criterion for Asia Pacific Region, BMI was categorized as light weight (BMI < 18.5 kg/m2), normal (18.5 kg/m2 < or = BMI < 23.0 kg/m2), overweight (23.0 kg/m2 < or = BMI < 25.0 kg/m2), obese (25.0 kg/m2 < or = BMI < 30.0 kg/m2) and severe obese (BMI > or = 30 kg/m2). SPSS 13.0 was used in BMI and PSA statistical analysis. RESULTS: Mean age was (64 +/- 10) years, mean BMI (24 +/- 3) kg/m2, PSA median 1.0 (0.6 - 1.9) microg/L and mean prostate volume(30 +/- 18) ml. BMI classification: low weight 54 cases (3.43%), normal weight 441 (28.04%), overweight 423 patients (26.89%), obesity 597 patients (37.95%) and severe obesity 58 (3.69%). We adjusted the low weight group and severe obesity group into normal group and obesity group respectively for small sample capacity. After adjustment, there was no significance difference (P = 0.75) between PSA level of normal group and that of obesity group. However, the PSA level of normal group and overweight group versus obesity group respectively, there were significant differences (P = 0.002, 0.010). After adjusting for age and prostate volume, the correlation between BMI and PSA was negative. BMI showed no significant correlation with PSA in different age groups. CONCLUSION: BMI and PSA were negatively correlated. BMI should be considered as a factor (esp. for obese or severe obese) in man undergoing prostate cancer screening.

[Prevalence and trend of metabolic syndrome in middle-aged Chinese population].

OBJECTIVE: To analyze the current prevalence of metabolic syndrome (MS) and its trend in the past 5 years in China. METHODS: In 2004-2005, cross-sectional sampling surveys were conducted in 13 research populations from southern and northern parts, urban and rural areas in China, with internationally standardized criteria and measurement. 1000-2000 participants for each group, even number of man and women, were examined. Out of them, there were 13,732 participants aged 35-59 years. Comparison was made for 10 populations with comparable data in 1998 to observe the trend in the past 5 years. MS was defined according to Chinese Medical Association Diabetes Branch definition set in 2004. RESULTS: The prevalence of MS was 12.1%. The adjusted prevalence was higher in men (13.9%) than in women (8.5%), higher in residents from the northern (15.0%) than the southern (6.8%) and from urban (11.3%) than rural (10.1%). Out of the participants with MS, 60.4% were with obesity, high blood pressure or with dyslipidemia. Comparing with data in 1998, the adjusted prevalence rates of MS in 2004-2005 had a significantly increase (10.0% vs. 7.2%, P<0.05), in men than in women, in residents from the northern part than in the south (P<0.05). Regardless the geographic areas as from the north or south, from urban or rural, the mean levels of triglyceride, body mass index and waist circumference were higher in 2004-2005 than that in 1998. CONCLUSION: The prevalence of MS was increasing in middle aged Chinese population. Prevention and treatment of obesity, high blood pressure and dyslipidemia were effective ways to control MS.

Registry and survival study in chinese patients with idiopathic and familial pulmonary arterial hypertension.

BACKGROUND: To evaluate the clinical features and survival data of patients with idiopathic pulmonary arterial hypertension (PAH) and familial PAH in Chinese patients. METHODS: Seventy-two patients with idiopathic PAH and familial PAH were enrolled in the study from 1999 to 2004 and were classified into two groups according to World Health Organization (WHO) functional class (I/II and III/IV). Clinical and hemodynamic data were recorded. RESULTS: The mean age of the 72 patients was 35.9 years with female patient/male patient ratio of 2.4:1. A significant difference was identified in the clinical presentation between two WHO functional class groups at baseline. Echocardiography showed a mean pulmonary systolic pressure of 98 mm Hg. Left ventricular end-diastolic diameter was significantly smaller in the group of patients in WHO functional class III/IV than in those in class I/II group. After follow-up for a mean (+/- SD) duration of 40.1 +/- 20.0 months, the survival rates at 1, 2, 3, and 5 years were 68.0%, 56.9%, 38.9%, and 20.8%, respectively. A significant difference was identified in survival rate between the class I/II and class III/IV groups (p = 0.02 [log rank test]). CONCLUSIONS: The baseline characteristics and survival rates of our cohort study are close to those of the National Institutes of Health Registry in the 1980s, and the 1-year survival rate is obviously lower for patients in this registry than for those in the French registry between 2002 to 2003. Lack of effective treatment was the main cause of poor survival in this study. Our results support the need of an appropriate treatment strategy for this devastating disease in China.

[Evaluation on the case management program of hypertension in Zhongguancun community, Beijing].

OBJECTIVE: To explore a suitable model regarding community-based case management of hypertension in the urban areas. METHODS: Based on the guidelines set by the Chinese Hypertension League (CHL), the goal of case management of hypertension was set as: to maintain blood pressure at the normal range. Family doctors were guided to take care of case management. Hypertension patients who had been contracted to the family doctors were followed by a team of family doctors for half a year. RESULTS: After the 6-month intervention, the rate of hypertension under control had increased from 50.44% to 69.84% (P < 0.0001) while the means of systolic blood pressure decreased by 3.72 mm Hg and diastolic blood pressure decreased by 2.67 mm Hg (P < 0.0001) respectively. The means of SBP decreased by 8.59 mm Hg and diastolic blood pressure decreased by 5.26 mm Hg in patients whose baseline blood pressure were not under control. The rates of smoking, higher salt intake and no physical exercise had significantly decreased (P < 0.05). The mean number of hospital visits in the six-month follow-up period was 7.69 +/- 2.37. The "rate of control" among those who had followed schedule was higher than that of those who were not on schedule (P < 0.0001). The rate among those who had followed the schedule tended to have increased with aging and the level of education (P < 0.001). CONCLUSION: The community-based case management program on hypertension played an important and effective role in the control of hypertension in urban areas. Patients received great benefit when following the guidance from their doctors.

[A study on the association between tea consumption and stroke].

OBJECTIVE: The aim of the study was to investigate the association between tea consumption and stroke. METHODS: A cross sectional study was conducted in autumn, 1998. The subjects were from 12 provinces in China. 15 groups of populations were selected by cluster randomized sampling and each group had about 1000 persons, aged from 35 to 60 years old. 14 212 subjects had complete data for analysis. Data regarding tea drinking would include drinking status, dose and type of teas. Logistic regression was used to analyze the association between tea consumption and stroke. RESULTS: There was a strong inverse correlation between tea drinking and stroke after adjusting other risk factors of stroke (P < 0.05). The odds ratio (OR) of stroke was 0.60 [95% confidence interval (CI): 0.42 - 0.85] for subjects who drank tea compared to those who did not. Increased amount of tea consumption per month was associated with decreased stroke prevalence. The association for tea consumption over 150 gram per month and stroke was statistically significant (P < 0.05) with an OR value of 0.56 (95% CI: 0.36 - 0.89). Analytical results indicated that the OR value was 0.24 (95% CI: 0.06 - 1.01) for black tea and other tea (P = 0.05). The OR value was 0.35 (95% CI: 0.18 - 0.72) for green tea (P < 0.01), and 0.75 (95% CI: 0.51 - 1.11) for jasmine tea (P > 0.05). CONCLUSION: Tea drinking was independently associated with prevalence of stroke which might play a role in the prevention of the disease.