Association Between Sleep Duration and Stroke in Different Status of Metabolic Syndrome: A Cross-Sectional Study in Shanghai Adult Residents.

Purpose: This study aimed to investigate the relationship between sleep duration (SD) and stroke, and examine the effects of SD on stroke with or without metabolic syndrome (Mets) and its components among the adult residents in Shanghai, China. Participants and Methods: A total of 20,245 participants (51.72% male, mean age 44.66 years) were included from Shanghai Chronic Disease and Risk Factors Surveillance (SCDRFS) in 2017. The weighted logistic regressions were performed to examine the associations between SD and stroke in different status of Mets and its components. Results: The mean SD was 7.51±0.03 h/d. After adjusting for all the potential factors, SD<6 h/d (OR=1.73, 95% CI: 1.35-2.20) or ≥10 h/d (OR=1.66, 95% CI: 1.08-2.57) was significantly positively associated with stoke in the total participants; moreover, in the non-Mets group, only SD<6 h/d (OR=1.77, 95% CI: 1.19, 2.64) significantly increased the risk of stroke; while, in the Mets group, SD<6 h/d (OR=1.80, 95% CI:1.17-2.76) and ≥10 h/d (OR=1.97, 95% CI: 1.00-3.88) both had a positive significantly association with stoke. In addition, the effects of SD<6 h/d on stroke were more pronounced among those with high WC (OR=2.24, 95% CI: 1.40-3.58) and high TG (OR=2.60, 95% CI: 1.86-3.62), and the effects of SD≥10 h/d on stroke were more evident among those with high TG (OR=2.28, 95% CI: 1.02-5.08) and high FBG (OR=2.58, 95% CI: 1.30-5.10). Conclusion: Both short and long SD were significantly positively associated with stroke in the total participants, and the associations were stronger in the Mets group; conversely, in the non-Mets group, only short SD was significantly positively associated with stroke, and no significant association was observed between long SD and stroke. Therefore, more precise sleep measures may be needed to prevent stroke according to the different status of Mets.

BmK NT1-induced neurotoxicity is mediated by PKC/CaMKâ ¡-dependent ERK1/2 and p38 activation in primary cultured cerebellar granule cells.

Voltage-gated sodium channels (VGSCs) represent molecular targets for a number of potent neurotoxins that affect the ion permeation or gating kinetics. BmK NT1, an α-scorpion toxin purified from Buthus martensii Karch (BMK), induces excitatory neurotoxicity by activation of VGSCs with subsequent overloading of intracellular Ca2+ in cerebellar granule cells (CGCs). In the current study, we further investigated signaling pathways responsible for BmK NT1-induced neurotoxicity in CGCs. BmK NT1 exposure induced neuronal death in different development stages of CGCs with similar potencies ranging from 0.21-0.48 µM. The maximal neuronal death induced by BmK NT1 gradually increased from 25.6% at 7 days in vitro (DIVs) to 42.1%, 47.8%, and 67.2% at 10, 13, and 16 DIVs, respectively, suggesting that mature CGCs are more vulnerable to BmK NT1 exposure. Application of Ca2+/calmodulin-dependent protein kinase Ⅱ (CaMKⅡ) inhibitors, KN-62 or KN-93, but not Ca2+/calmodulin-dependent protein kinase kinase (CaMKK) inhibitor, STO-609, completely abolished BmK NT1-induced neuronal death. Moreover, BmK NT1 exposure stimulated CaMKⅡ phosphorylation. BmK NT1 also stimulated extracellular regulated protein kinases 1/2 (ERK1/2) and p38 phosphorylation which was abolished by tetrodotoxin demonstrating the role of VGSCs on BmK NT1-induced ERK1/2 and p38 phosphorylation. However, BmK NT1 didn't affect c-Jun N-terminal kinase (JNK) phosphorylation. In addition, both ERK1/2 inhibitor, U0126 and p38 inhibitor, SB203580 attenuated BmK NT1-induced neuronal death. Both PKC inhibitor, Gö 6983 and CaMKⅡ inhibitor, KN-62 abolished BmK NT1-induced ERK1/2 and p38 phosphorylation. Considered together, these data demonstrate that BmK NT1-induced neurotoxicity is through PKC/CaMKⅡ mediated ERK1/2 and p38 activation.

Incident rate and risk factors for tuberculosis among patients with type 2 diabetes: retrospective cohort study in Shanghai, China.

OBJECTIVE: To examine the incident rate of tuberculosis (TB) and its associates among adults with type 2 diabetes in Shanghai, China. METHODS: We conducted a retrospective cohort study among 170 399 patients with type 2 diabetes aged ≥18 years who were registered in Shanghai community-based diabetes management system between 2004 and 2009. Their TB status was tracked until 31 December 2014. Cox regression was performed to identify the risk factors for TB. RESULTS: We documented 785 new TB cases during 654 977 person-years of follow-up. The incident rate of TB was 224.20 (206.69, 243.16) per 100 000 person-years among men and 51.34 (44.75, 58.92) per 100 000 person-years among women. A 1-unit increase of BMI was associated with a risk reduction in 16% (P < 0.01) for men and a 14% (P < 0.01) reduction for women. TB cases were more likely to be insulin-dependent [men: hazard ratio = 2.13 (1.29, 3.53); women: 3.28 (1.28, 8.39)] and had a poor glucose level initially [men: 1.21 (1.15, 1.27); women: 1.27 (1.18, 1.37)]. The risk factor for TB specific to men was a young age at diagnosis of diabetes, and the protective factor specific to women was actively engaging in physical activity. CONCLUSIONS: TB incident rate among patients with type 2 diabetes was substantially higher among men than among women. The risk of TB was reversely associated with initial BMI. The severity of poor glucose control among patients with diabetes was also linearly associated with the risk of TB.

Differentiating the associations of waist circumference and body mass index with cardiovascular disease risk in a Chinese population.

It is not known which obesity index best explains variations in cardiovascular disease risk across populations. The objective of this study was to differentiate the associations of waist circumference (WC) and body mass index (BMI) with cardiovascular disease risk in a Chinese population. Cardiovascular risk factors, WC, and BMI were measured in 13 817 adults aged more than 18 years in Shanghai. Higher WC tertiles were associated with higher blood pressure and higher cholesterol, triacylglycerol, and glucose concentrations within each tertile of BMI and vice versa. The odds ratios (ORs) of hypertension, dyslipidemia, and metabolic syndrome increased with successive WC (or BMI) tertiles after adjustment for BMI (or WC) and several covariates. However, BMI tertiles were not associated with the ORs of diabetes after adjustment for WC. WC may be better than BMI as an alternative measure of body fatness or fat distribution for predicting diabetic risks in Chinese adults.

Combining glycosylated hemoglobin A1c and fasting plasma glucose for diagnosis of type 2 diabetes in Chinese adults.

BACKGROUND: Glycosylated hemoglobin A1c (HbA1c) has been applied to identify type 2 diabetes (T2DM) in the U.S. and European countries. It has not been used in China mainly due to lack of a standardized approach to measure HbA1c, short of knowledge about racial-specific standard and deficiency of an optimal cut-off point. METHODS: To evaluate combination of HbA1c and fasting plasma glucose (FPG) in diagnosing T2DM in Chinese adults, a multistage sampling cross-sectional study was conducted in Shanghai, China, in 2009. The FPG measurement, HbA1c assay, and oral glucose tolerance test (OGTT) were performed in 6,661 Chinese adults (3057 men, 3604 women) who had no prior history of diabetes to identify the unrecognized T2DM. RESULTS: A total of 454 participants were identified as T2DM based on the 1999 World Health Organization (WHO) diagnostic criteria. Of these patients, 239 were detected using an FPG ≥ 7.0 mmol/l and 141 were further identified using an HbA1c ≥ 43 mmol/mol (6.1%), achieving a sensitivity of 83.7% and a specificity of 89.3% for combining use of FPG and HbA1c. In subjects at high risk of diabetes, the combining use of FPG and HbA1c produced a higher sensitivity and an improved positive predictive value (PPV), and had a satisfactory specificity and negative predictive value (NPV). CONCLUSIONS: The combining use of FPG and HbA1c is a potential screening and diagnosis approach for T2DM in Chinese adults, especially among those at high risk of the disease.

Relationships between indices of obesity and its cardiovascular comorbidities in a Chinese population.

BACKGROUND: Current definitions of overweight/obesity and central adiposity guidelines are based on Western populations, and may not be appropriate for the Chinese population. More data among Chinese are needed to address this issue. We aimed to identify cut-offs for body mass index (BMI) and waist circumference that confer increased risk of cardiovascular disease in a Chinese population in Shanghai. METHODS AND RESULTS: A representative, cross-sectional sample of 13,817 adults aged >18 years was studied in Shanghai. In men and women, blood pressure (systolic and diastolic), total cholesterol, low-density lipoprotein-cholesterol, triacylglycerol, and glucose values were incrementally higher and mean high-density lipoprotein-cholesterol values were incrementally lower with increased BMI and waist circumference. Both the point at which sensitivity equaled specificity and the shortest distance in the receiver operating characteristic curves for hypertension, dyslipidemia, diabetes, or >or=2 of these risk factors generally suggested a BMI cut-off value of 24 kg/m(2) for both men and women, and a waist circumference cut-off value of 85 cm for men and 80 cm for women. CONCLUSIONS: A BMI cut-off of 24 kg/m(2) for both men and women, and a waist circumference cut-off of 85 cm for men and 80 cm for women might be appropriate for use in identifying adults at high risk of developing cardiovascular disease and serve as public health action thresholds in Shanghai residents.