Evaluation and spatial-temporal evolution of ecosystem service value of cascade hydropower project reservoir area in the Jinsha River, China.

The Jinsha River basin, full of hydropower resources, is the largest hydropower energy base in China. From 2005 to 2018, four giant cascade hydropower stations (Wudongde, Baihetan, Xiluodu, and Xiangjiaba) were built along the Jinsha River. The reservoir area of four hydropower stations involves 26 counties (districts). The ecological environment of the reservoir area has a close relationship with hydropower projects, and ecosystem service value is an important standard to measure the quality of the ecological environment. Taking the reservoir area formed by four cascade hydropower stations in Jinsha River (Jinsha River Reservoir Area, JRRA) as the research object, the essay analyzed the spatial and temporal pattern of ecosystem service value in the reservoir area in 2005, 2010, 2015, and 2018. The results showed that (1) The ecosystem service value of JRRA reached 94 billion yuan in 2018, and the forestland took the largest proportion of ecosystem service value, accounting for 46.93%, followed by grassland, water area, cropland, and unused land. (2) From 2005 to 2018, the total ecosystem service value in JRRA increased by 3.374 billion yuan, and the spatial pattern of ecosystem service value showed a spatial distribution characteristic of high in the middle and low on both sides, and the spatial distribution had significant positive autocorrelation. (3) Because the area of water increased a lot, the ecosystem service value of JRRA showed a trend of overall increase which mainly occurred in the 3-km buffer zone along the river. The results further proved that the implementation of hydropower projects could improve the ecosystem service function in the reservoir area and provide technical support for the sustainable utilization of land resources and ecological compensation in the reservoir area.

Cu4Ti4-oxo clusters functionalized by in situ - generated 2,2'-biphenolate ligands from the oxidative coupling of phenols.

Herein, we report a twisted cubic Cu(I)4Ti(IV)4-oxo cluster stabilized by in situ - formed 2,2'-biphenolate ligands from the oxidative coupling of phenols. The 2,2'-biphenolate-functionalized Cu(I)4Ti(IV)4O4 cluster shows short Cu⋯C contacts and exhibits smaller HOMO-LUMO gaps than those of reported Ti(IV)4O4.

Glycochenodeoxycholate Affects Iron Homeostasis via Up-Regulating Hepcidin Expression.

Increasing hepcidin expression is a vital factor in iron homeostasis imbalance among patients with chronic kidney disease (CKD). Recent studies have elucidated that abnormal serum steroid levels might cause the elevation of hepcidin. Glycochenodeoxycholate (GCDCA), a steroid, is significantly elevated in patients with CKD. However, the correlation between GCDCA and hepcidin has not been elucidated. Decreased serum iron levels and increased hepcidin levels were both detected in patients with CKD in this study. Additionally, the concentrations of GCDCA in nephropathy patients were found to be higher than those in healthy subjects. HepG2 cells were used to investigate the effect of GCDCA on hepcidin in vitro. The results showed that hepcidin expression increased by nearly two-fold against control under 200 µM GCDCA treatment. The phosphorylation of SMAD1/5/8 increased remarkably, while STAT3 and CREBH remained unchanged. GCDCA triggered the expression of farnesoid X receptor (FXR), followed with the transcription and expression of both BMP6 and ALK3 (upward regulators of SMAD1/5/8). Thus, GCDCA is a potential regulator for hepcidin, which possibly acts by triggering FXR and the BMP6/ALK3-SMAD signaling pathway. Furthermore, 40 C57/BL6 mice were treated with 100 mg/kg/d, 200 mg/kg/d, and 300 mg/kg/d GCDCA to investigate its effect on hepcidin in vivo. The serum level of hepcidin increased in mice treated with 200 mg/kg/d and 300 mg/kg/d GCDCA, while hemoglobin and serum iron levels decreased. Similarly, the FXR-mediated SMAD signaling pathway was also responsible for activating hepcidin in liver. Overall, it was concluded that GCDCA could induce the expression of hepcidin and reduce serum iron level, in which FXR activation-related SMAD signaling was the main target for GCDCA. Thus, abnormal GCDCA level indicates a potential risk of iron homeostasis imbalance.

Synthesis, Structure, and Light Absorption Behaviors of Prismatic Titanium-Oxo Clusters Containing Lacunary Lindqvist-like Species.

Exploring new structural types of polyoxotitanium clusters (PTCs), especially those containing classical polyoxometalates structures, has always been the focus of research in the field of metal-oxo clusters. In this work, we present the synthesis and characterization of three prismatic PTCs: namely, Ti8(µ2-O)3(µ4-O)2(OnPr)6(HOnPr)2(L1)8 (PTC-237; H2L1 = 3,5-di-tert-butylcatechol), Ti12(µ2-O)6(µ3-O)8(OnPr)6(L2)12(L3)2 (PTC-238; HL2 = 1-adamantanecarboxylic acid, HL3 = 2-picolinic acid), and [Ti18(µ2-O)4(µ3-O)16(µ5-O)2(OiPr)18(L3)8](L3)2 (PTC-239). Single-crystal X-ray diffraction analyses indicate that the construction of these prismatic PTCs is based on a stepwise interlayer assembly of {Ti3} and {Ti4} substructures. The diameters of their core skeletons are in the range between 0.9 and 1.3 nm. In particular, lacunary Linqvist-like {Ti4} and {Ti5} building units are found to exist in the structures of PTC-237 and PTC-239. According to the solid-state UV-vis diffuse reflectance measurements, the absorption band of 3,5-di-tert-butylcatecholate-functionalized PTC-237 shifts toward the visible-light region, giving a smaller optical band gap of 1.56 eV in comparison to PTC-238 (3.36 eV) and PTC-239 (3.25 eV).

Coronary artery calcification and risk of mortality and adverse outcomes in patients with COVID-19: a Chinese multicenter retrospective cohort study.

Background: Coronary artery calcification (CAC) is an independent risk factor of major adverse cardiovascular events; however, the impact of CAC on in-hospital death and adverse clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains unclear. Objective: To explore the association between CAC and in-hospital mortality and adverse events in patients with COVID-19. Methods: This multicenter retrospective cohort study enrolled 2067 laboratory-confirmed COVID-19 patients with definitive clinical outcomes (death or discharge) admitted from 22 tertiary hospitals in China between January 3, 2020 and April 2, 2020. Demographic, clinical, laboratory results, chest CT findings, and CAC on admission were collected. The primary outcome was in-hospital death and the secondary outcome was composed of in-hospital death, admission to intensive care unit (ICU), and requiring mechanical ventilation. Multivariable Cox regression analysis and Kaplan-Meier plots were used to explore the association between CAC and in-hospital death and adverse clinical outcomes. Results: The mean age was 50 years (SD,16) and 1097 (53.1%) were male. A total of 177 patients showed high CAC level, and compared with patients with low CAC, these patients were older (mean age: 49 vs. 69 years, P < 0.001) and more likely to be male (52.0% vs. 65.0%, P = 0.001). Comorbidities, including cardiovascular disease (CVD) ([33.3%, 59/177] vs. [4.7%, 89/1890], P < 0.001), presented more often among patients with high CAC, compared with patients with low CAC. As for laboratory results, patients with high CAC had higher rates of increased D-dimer, LDH, as well as CK-MB (all P < 0.05). The mean CT severity score in high CAC group was also higher than low CAC group (12.6 vs. 11.1, P = 0.005). In multivariable Cox regression model, patients with high CAC were at a higher risk of in-hospital death (hazard ratio [HR], 1.731; 95% CI 1.010-2.971, P = 0.046) and adverse clinical outcomes (HR, 1.611; 95% CL 1.087-2.387, P = 0.018). Conclusion: High CAC is a risk factor associated with in-hospital death and adverse clinical outcomes in patients with confirmed COVID-19, which highlights the importance of calcium load testing for hospitalized COVID-19 patients and calls for attention to patients with high CAC. Supplementary Information: The online version contains supplementary material available at 10.1007/s42058-021-00072-4.

Brain morphometric abnormalities in boys with attention-deficit/hyperactivity disorder revealed by sulcal pits-based analyses.

AIM: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with widespread brain morphological abnormalities. Here, we utilized a sulcal pits-based method to provide new insight into the atypical cortical folding morphology in ADHD. METHODS: Sulcal pits, the locally deepest points in each fold, were first extracted from magnetic resonance imaging data of 183 boys with ADHD (10.62 ± 1.96 years) and 167 age- and gender-matched typically developing controls (10.70 ± 1.73 years). Then, the geometrical properties of sulcal pits were statistically compared between ADHD and controls. RESULTS: Our results demonstrated that the number of sulcal pits was reduced and confined to the superficial secondary sulci in the ADHD group relative to controls (P < .05). We also found that ADHD boys were associated with significantly increased pit depth in the left superior frontal junction, circular insular sulcus, right inferior frontal junction, and bilateral cingulate sulcus, as well as significantly decreased pit depth in the bilateral orbital sulcus (P < .05, corrected). CONCLUSION: The experimental findings reveal atypical sulcal anatomy in boys with ADHD and support the feasibility of sulcal pits as anatomic landmarks for disease diagnosis.

Risk factors for adverse clinical outcomes with COVID-19 in China: a multicenter, retrospective, observational study.

Background: The risk factors for adverse events of Coronavirus Disease-19 (COVID-19) have not been well described. We aimed to explore the predictive value of clinical, laboratory and CT imaging characteristics on admission for short-term outcomes of COVID-19 patients. Methods: This multicenter, retrospective, observation study enrolled 703 laboratory-confirmed COVID-19 patients admitted to 16 tertiary hospitals from 8 provinces in China between January 10, 2020 and March 13, 2020. Demographic, clinical, laboratory data, CT imaging findings on admission and clinical outcomes were collected and compared. The primary endpoint was in-hospital death, the secondary endpoints were composite clinical adverse outcomes including in-hospital death, admission to intensive care unit (ICU) and requiring invasive mechanical ventilation support (IMV). Multivariable Cox regression, Kaplan-Meier plots and log-rank test were used to explore risk factors related to in-hospital death and in-hospital adverse outcomes. Results: Of 703 patients, 55 (8%) developed adverse outcomes (including 33 deceased), 648 (92%) discharged without any adverse outcome. Multivariable regression analysis showed risk factors associated with in-hospital death included ≥ 2 comorbidities (hazard ratio [HR], 6.734; 95% CI; 3.239-14.003, p < 0.001), leukocytosis (HR, 9.639; 95% CI, 4.572-20.321, p < 0.001), lymphopenia (HR, 4.579; 95% CI, 1.334-15.715, p = 0.016) and CT severity score > 14 (HR, 2.915; 95% CI, 1.376-6.177, p = 0.005) on admission, while older age (HR, 2.231; 95% CI, 1.124-4.427, p = 0.022), ≥ 2 comorbidities (HR, 4.778; 95% CI; 2.451-9.315, p < 0.001), leukocytosis (HR, 6.349; 95% CI; 3.330-12.108, p < 0.001), lymphopenia (HR, 3.014; 95% CI; 1.356-6.697, p = 0.007) and CT severity score > 14 (HR, 1.946; 95% CI; 1.095-3.459, p = 0.023) were associated with increased odds of composite adverse outcomes. Conclusion: The risk factors of older age, multiple comorbidities, leukocytosis, lymphopenia and higher CT severity score could help clinicians identify patients with potential adverse events.

Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study.

BACKGROUND: A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. METHODS: This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. RESULTS: Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. CONCLUSIONS: During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.

Amino-Polyalcohol-Solvothermal Synthesis of Titanium-Oxo Clusters: From Ti6 to Ti19 with Structural Diversity.

As is known, amino-polyalcohol ligands are usually used as sacrificial agents in photocatalytic reactions. And polyoxo-titanium clusters (PTCs) are molecular modes of titanium dioxide, one of the most important photocatalysts. In order to help understand the intrinsic coordination feature of amino-polyalcohol toward titanium-oxo species, we carried out the research of constructing PTCs with amino-polyalcohol ligands. In view of the low melting point of amino-polyalcohol, they have been directly applied as reaction mediums. Under this new synthetic method, a series of PTCs have been successfully obtained, namely, Ti6(µ2-O)2(OCH2CH2O)2(O iPr)4(dea)6·HO iPr (deaH2 = diethanolamine, PTC-171), Ti9(µ2-O)2(µ3-O)4(tea)2(O iPr)8(dea)5(teaH3 = triethanolamine, PTC-172), Ti11(µ3-O)10(µ4-O)(O iPr)14(dea)4 (PTC-173), Ti19(µ2-O)6(µ3-O)12(dea)18Cl4 (PTC-174), and Ti19(µ2-O)6(µ3-O)12(dea)18(NO3)4·(H2O)6 (PTC-175). Their structures are determined by single-crystal X-ray diffraction analysis. It is worth noting that PTC-174 and PTC-175 are not only the first Ti19 examples of crystalline PTCs, but also currently the largest PTCs compounds in the amino-polyalcohol system. Moreover, the solid-state UV-vis spectra of these PTCs were recorded. And their applications in photocurrent responses were also investigated. This work provides an interesting method for the preparation of amino-polyalcohol base PTCs and would also benefit the mechanism interpretation of the photocatalytic processes of titanium oxide materials.

Epidemiologic Investigation of Burn Patients in Sichuan Province, China.

BACKGROUND We investigated the epidemiology of patients admitted to the Burn Center of West China Hospital during 2011-2016, to provide measures for burn prevention. MATERIAL AND METHODS We conducted a retrospective review of patients admitted to the Burn Center of West China Hospital during 2011-2016. We collected information on patient demographics, burn etiology, burn extent, place of injury, education level, and burn knowledge of patients. RESULTS A total of 1323 patients (1033 males and 290 females), mean age 35.4 years (range 10 days to 91 years), were admitted to our burn center. Among all patients, 214 were children aged 0-14 years, 998 were adults aged 15-59 years, and 111 were elderly adults over age 60 years. Scalds were the predominant cause of pediatric burns; however, flame burns were most common among adults and elderly patients. The injury location varied by age, with most burns occurring at work among adults; however, most children and elderly patients were burned at home. Educational levels were lower among adults from rural areas than those from urban areas, but both groups had little first aid knowledge. Furthermore, rural patients had received less vocational education and training than urban patients. CONCLUSIONS There has been a decrease in burn incidence in Sichuan Province. Flame injury should be a focus of attention in all age groups. Prevention programs for adults in the workplace are imperative. Burn prevention programs should continue to improve living conditions, especially for elderly people.

Population Pharmacokinetics and Bayesian Estimation of Mycophenolic Acid Exposure in Chinese Renal Allograft Recipients After Administration of EC-MPS.

The aim of the present study is to establish a population pharmacokinetic (PPK) model of mycophenolic acid (MPA) and limited sampling strategy models for the estimation of MPA exposure in Chinese adult renal allograft recipients following oral administration of enteric coated mycophenolate sodium (EC-MPS). A total of 74 sets of full pharmacokinetic profiles and 47 sets of MPA-sparing samples were collected from 102 renal transplant recipients who received oral EC-MPS. The MPA concentration was determined by an enzyme-multiplied immunoassay technique, and the pathophysiologic data were recorded. The PPK model was constructed using nonlinear mixed-effects modeling, and the limited sampling strategy models for MPA were established by using multiple regression analysis and the maximum a posteriori Bayesian assay based on 2 to 4 sampling time points following EC-MPS administration. The pharmacokinetics of MPA were best described by a 2-compartment model with a first-order absorption process and a lag time of absorption. The clearance of MPA was 12.3 ± 1.14 L/h. Comedicating with cyclosporine A was found to have a significant impact on the clearance/bioavailability of MPA (P < .01). Sampling strategies consisted of plasma concentration at 1.5, 2, 4 (C1.5-C2-C4) hours and 1.5, 2, 4, 6 (C1.5-C2-C4-C6) hours after EC-MPS administration were shown to be suitable for the estimation of the MPA area under the concentration-time curve in these patients. The PPK model was acceptable and can describe the pharmacokinetics of MPA in Chinese renal transplant recipients administered EC-MPS. The area under the concentration-time curve of MPA in Chinese renal transplant recipients could be estimated through a limited sampling strategy method, based on which individualized immunosuppressive regimens could be designed.

Synthesis and structural characterization of a dumbbell-like phenylphosphonate-stabilized Ti7-oxide cluster.

In recent years, crystalline polyoxotitanium clusters (PTCs) have attracted increasing attention as a new kind of promising crystalline material. In this work, a PTC stabilized by phenylphosphonate ligands, i.e. hexa-µ-isopropanolato-hexaisopropanolatodi-µ3-oxido-hexa-µ3-phenylphosphonato-heptatitanium tetrahydrate, [Ti7(µ3-O)2(O3P-Phen)6(OiPr)12]·4H2O [PTC-54; H2O3P-Phen is phenylphosphonic acid, C6H5PO(OH)2, and HOiPr is isopropanol, C3H7OH], was obtained successfully through a facile one-step solvothermal reaction. The dumbbell-like core structure of PTC-54 can be described as two trinuclear {Ti3(µ3-O)} building units combined together by six phenylphosphonate ligands and one additional Ti atom, giving rise to a Ti7 cluster. Adjacent molecules of PTC-54 are further connected through π-π interactions between the phenyl groups to form a supramolecular one-dimensional chain.

[Clinical features and gene mutations of primary immunodeficiency disease: an analysis of 7 cases].

This research investigated the clinical features of immunodeficiency disease and the features of the mutation of its pathogenic genes. All 7 patients were boys aged 5 months to 4 years and 6 months and had a history of recurrent respiratory infection and pneumonia, low levels of IgM and IgG, and abnormal absolute values or percentages of lymphocyte subsets. High-throughput sequencing showed c.1684C>T mutations in the BTK gene in patient 1 and IVS8+2T>C splice site mutations in the BTK gene in patient 2. Both of these mutations came from their mothers. Patients 3, 4, and 5 had mutations in the IL2RG gene, i.e., c.298C>T, IVS3-2A>G, and c.164T>A, among which c.164T>A mutations had not been reported. Patient 6 had c.204C>G mutations in the RAG2 gene. Patient 7 had complex heterozygous mutations of c.913C>T and c.824G>A in the RAG2 gene, which came from his father and mother, respectively. Patients with immunodeficiency disease have abnormal immunological indices, and high-throughput sequencing helps to make a definite diagnosis.

Night Sleep Duration and Risk of Cognitive Impairment in a Chinese Population: A Cross-sectional Study.

OBJECTIVE: Although sleep is one of the most important health-related behavioral factors, the association between night sleep duration and cognitive impairment has not been fully understood. A cross-sectional study was conducted with a random sample of 2,514 participants (⋝ 40 years of age; 46.6% women) in China to examine the association between night sleep duration and cognitive impairment. METHODS: Night sleep duration was categorized as ⋜ 5, 6, 7, 8, or ⋝ 9 h per night. Cognitive function was measured using the Mini-Mental State Examination. A multivariate regression analysis was used to analyze the association of night sleep duration with cognitive impairment. A total of 122 participants were diagnosed with cognitive impairment. RESULTS: A U-shaped association between night sleep duration and cognitive impairment was found. The odds ratios (95% confidence intervals) of cognitive impairment (with 7 h of daily sleep being considered as the reference) for individuals reporting ⋜ 5, 6, 8, and ⋝ 9 h were 2.14 (1.20-3.83), 1.13 (0.67-1.89), 1.51 (0.82-2.79), and 5.37 (1.62-17.80), respectively (P ⋜ 0.01). CONCLUSION: Short or long night sleep duration was an important sleep-related factor independently associated with cognitive impairment and may be a useful marker for increased risk of cognitive impairment..

Enantioselective Synthesis of Functionalized 4-Aryl Hydrocoumarins and 4-Aryl Hydroquinolin-2-ones via Intramolecular Vinylogous Rauhut-Currier Reaction of para-Quinone Methides.

A novel strategy for the asymmetric construction of functionalized 4-aryl-3,4-dihydrocoumarins and 4-aryl-3,4-dihydroquinolin-2-ones via an intramolecular vinylogous Rauhut-Currier reaction of para-quinone methides (p-QMs) under the bifunctional catalysis of chiral amine-phosphine is described. This intramolecular mode for the catalytic enantioselective 1,6-conjugate addition of p-QMs has been explored for the first time, delivering two types of synthetically important heterocycles in high yields and enantioselectivites.

Time-cumulated blood pressure exposure and incident impairment of glucose tolerance and diabetes mellitus.

BACKGROUND: With the marked increase in the prevalence of diabetes mellitus, it was the purpose of our study to assess a potential association of time-cumulated exposure to systolic (CumSBP) and of diastolic blood pressure (CumDBP) with onset of impaired glucose tolerance and diabetes mellitus. METHODS: The prospective investigation included participants of the longitudinal Kailuan Study with three baseline examinations in 2006-2007, 2008-2009 and 2010-2011, re-examination in 2012-2013, and no diabetes mellitus at baseline. Cumulative blood pressure (BP) was calculated as cumBP = [(BP1 + BP2)/2 × time1-2] + [(BP2 + BP3)/2 × time2-3]. Based on cumSBP, the study population was stratified into four groups (cumSBP < 480mmHgxyear;n = 15,339; 480mmHgxyear ≤ cumSBP < 520mmHgxyear;n = 7214; 520mmHgxyears ≤ cumSBP < 560mmHgxyears;n = 5675; and cumSBP ≥ 560mmHgxyears;n = 10,576). RESULTS: After adjusting for demographic, anthropomorphic, biochemical, socioeconomic and lifestyle parameters and as compared with the first group, the second, third and fourth group showed a significantly higher incidence of diabetes (P-trend < 0.001;hazard ratio (HR);95% confidence interval (CI):1.28(1.08,1.51),1.54(1.29,1.84), and 2.33(1.98,2.73), respectively), higher incidence of impairment of glucose tolerance (P-trend < 0.001;HR;95% CI1.17(1.02,1.33), 1.43(1.25,1.64), and 2.09(1.85,2.37), respectively), and higher incidence of diabetes developing out of an impairment of glucose tolerance (P-trend < 0.001;HR;95% CI:1.22(0.97,1.54),1.47(1.16,1.86), and 2.01(1.62,2.50), respectively). An increase in cumSBP by 10 mmHg/year or an increase in cumDBP by 5 mmHg/year was associated with a hazard ratio of incident diabetes of 1.04 (95% CI:1.03,1.04) and 1.02(1.02,1.03), respectively, with a hazard ratio of incident impairment of glucose tolerance of 1.04(95% CI:1.03,1.04) and 1.03(95% CI:1.02,1.03), respectively, and with a hazard ratio of incident diabetes developing from impairment of glucose tolerance of 1.04(95% CI:1.03,1.04) and 1.03(95% CI:1.02,1.03), respectively. CONCLUSIONS: Time-cumulated exposure to elevated blood pressure was significantly associated with an elevated incidence of impaired glucose tolerance and diabetes.

Ideal cardiovascular health score and incident end-stage renal disease in a community-based longitudinal cohort study: the Kailuan Study.

OBJECTIVES: To investigate an association between ideal cardiovascular health metrics (CVH) and the risk of developing end-stage renal disease (ESRD). SETTING: Community of Kailuan in Tangshan/China. PARTICIPANTS: We examined in a community-based longitudinal cohort study 91 443 participants without history of stroke or myocardial infarction at baseline in 2006-2007, with a glomerular filtration rate (GFR) ≥15 mL/min at baseline, and who participated in at least 1 of 3 follow-up examinations in 2008-2009, 2010-2011 and 2012-2013. INTERVENTIONS: CVH was measured by 7 key health factors (smoking, body mass index, physical activity, healthy dietary score, total cholesterol blood concentration, blood pressure, fasting blood glucose) each of which ranged between 'ideal' (2) and 'poor' (0). With a maximal CVH score of 14, the study participants were divided into categories of <5, 5-9 and 10-14 points. PRIMARY AND SECONDARY OUTCOME MEASURES: CHV, incidence of ESRD. RESULTS: Incidence of ESRD ranged from 7.06‰ in the lowest CVH category to 2.34‰ in the highest CVH category. After adjusting for age, sex, educational level, income, alcohol consumption and GFR, the lowest CVH category as compared with the highest CVH category had a significantly higher risk of incident ESRD (adjusted HR 2.87; 95% CI 1.53 to 5.39). For every decrease in group number of the cum-CVH score, the risk of ESRD increased by 20% (HR 1.20; 95% CI 1.13 to 1.28). The effect was consistent across sex and all age groups. CONCLUSIONS: A low CVH score significantly increased the risk of incident ESRD. Risk factors for cardiovascular events may also be associated with an increased risk for kidney failure.