The combined effects of arteriosclerosis and diabetes on cardiovascular disease risk.

The morbidity and mortality of cardiovascular disease (CVD) rank first among common diseases. Arteriosclerosis and diabetes are risk factors for CVDs, which influence each other. However, their combined effects on CVDs are still unclear. In this study, people who participated in brachial-ankle pulse wave velocity (baPWV) testing and the annual physical examination of the Kailuan Group Finance Co., Ltd., from January 1, 2010, to December 31, 2020, were selected, and their anthropometric, biochemical and epidemiological data were collected. The participants were divided into four groups according to diabetes and arteriosclerosis diagnosis and follow-up. Cox proportional hazards regression and subdistribution hazard models were used to analyse the combined effects of arteriosclerosis and diabetes on CVDs. Multiple sensitivity analyses were also performed. A total of 59,268 Asian populations were selected, including 14,425 females (28.11%) with an average age of 48.10 (± 12.72) years. During follow-up, 1830 subjects developed CVDs (mean follow-up period, 4.72 years). The cumulative incidence rates of the healthy control, diabetes, arteriosclerosis, and comorbidity groups were 5.04% (807/38781), 15.17% (253/3860), 17.04% (465/5987), and 25.59% (305/2684), respectively. The results of multivariate Cox regression analysis showed that compared with the healthy control group, the risk of CVD in the diabetes, arteriosclerosis, and comorbidity groups was significantly increased. Their HR values were 1.88 (95% CI 1.62-2.18), 1.40 (95% CI 1.23-1.60), and 2.10 (95% CI 1.80-2.45), respectively. The results of the sensitivity analysis were robust. For each one standard increase in fasting blood glucose or baPWV, the HR values for CVDs were 1.16 (95% CI 1.12-1.20) and 1.22 (95% CI 1.16-1.28), respectively. The results indicated that both arteriosclerosis and diabetes lead to an increased risk of CVDs. The risk of CVDs, coronary atherosclerotic heart disease, heart failure, stroke, coronary artery bypass grafting and ischemic stroke in patients with arteriosclerosis and diabetes was significantly higher than that in patients with arteriosclerosis or diabetes alone. Therefore, the primary prevention of CVDs in patients with arteriosclerosis complicated with diabetes needs more attention.

The Effectiveness of a Self-management Program of Bowel Dysfunction in Patients With Mid and Low Rectal Cancer After Sphincter-Preserving Surgery: A Pilot Randomized Controlled Trial.

BACKGROUND: Most patients with mid and low rectal cancer passively react to bowel symptoms after sphincter-preserving surgery (SPS), and their self-management behaviors are scarce in the Chinese patient population. OBJECTIVE: The aim of this study was to evaluate the effect of a self-management program for bowel symptoms in patients with mid and low rectal cancer after SPS. METHODS: A convenient sampling method was used to recruit patients with mid and low rectal cancer after SPS in gastric wards from 2 tertiary hospitals in Beijing, China. Ninety-five patients (intervention, n = 47; control, n = 48) were recruited. The intervention group received a predetermined self-management program plus routine postoperative care; the control group received only routine care in the ward. Data on patients' bowel symptoms, quality of life, and bowel symptom self-management behaviors were collected at baseline and at 3 and 6 months postoperatively using questionnaires. A generalized estimating equation was adopted to examine group effect and time effect. RESULTS: Bowel symptoms and quality of life in both the intervention and control groups of patients improved significantly 6 months after SPS compared with baseline (time effect, P < .001). The total score of patients' bowel symptom self-management behaviors and the score of the therapeutic domain increased significantly in the intervention group compared with those in the control group (group effect, P = .009). CONCLUSIONS: Self-management programs could help prompt patients' self-management behaviors, but the extent to which they impact patients' bowel symptoms requires further investigation. IMPLICATIONS FOR PRACTICE: The bowel dysfunction self-management program could alter the behavior of patients. It also effectively improves self-management strategies for bowel symptoms.

Visual acuity of urban and rural adults in a coastal province of southern China: the Fujian Eye Study.

AIM: To evaluate the vision status and sociodemographic associations of visual acuity (VA) in an urban and rural population in a coastal province of southern China. METHODS: The Fujian Eye Study, a population-based cross-sectional study, was performed from May 2018 to October 2019. Totally 10 044 participants over 50 years old from all nine cities in Fujian Province were enrolled, and underwent a questionnaire and a series of standard physical and ocular examinations. VA was measured by E Standard Logarithmic Visual Acuity Chart (GB 11533-1989). Data was double entered with EpiData v3.1 for data collation and Stata/SE statistical software v15.1 was used to analyze the data. RESULTS: Totally 8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects), rural populations (n=3533), coastal residents (n=6434), and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39±8.87y (median 64y; range 50-98y). The mean presenting VA was 0.61±0.30 (0.23±0.27 logMAR), and the mean best corrected visual acuity (BCVA) was 0.82±0.28 (0.08±0.19 logMAR). In the multiple regression analysis, BCVA was significantly correlated with several socioeconomic and biologic factors, including age (P<0.001), education level (P<0.001), income (P=0.005), rural residency (P<0.001), inland residency (P=0.001) and refractive error (P<0.001), while sex (P=0.194) was independent with BCVA. CONCLUSION: Accessible services and eye health policies targeting the elderly, people with high myopia and people living in rural or inland areas are needed.

CDH13 Genetic Polymorphisms, Adiponectin and Ischemic Stroke: a Chinese Family-based Sib-pair Study.

OBJECTIVE: To understand the relationships between CDH13 (T-cadherin) genetic polymorphisms, adiponectin levels and ischemic stroke, and possible interactions between CDH13 polymorphisms and other risk factors. METHODS: We recruited 342 Chinese ischemic stroke sib pairs. We genotyped rs4783244 and rs7193788 on CDH13 using time-of-flight mass spectrometry genotyping technology and measured total and high-molecular weight (HMW) adiponectin levels. We investigated associations between SNPs and ischemic stroke, and interactions between SNPs and other risk factors using multi-level mixed-effects regression model. RESULTS: In individuals without ischemic stroke, CDH13 rs4783244 was associated with total adiponectin levels (per T: Coef = -0.257, P = 0.001). CDH13 rs7193788 was associated with total adiponectin levels (per A: Coef = -0.221, P = 0.001) and HMW adiponectin levels (per A: Coef = -0.163, P = 0.003). rs7193788 was significantly associated with ischemic stroke (GA/AA vs. GG: OR = 1.55, 95% CI: 1.07 to 2.24, P = 0.020) after Bonferroni correction (α = 0.025). There was an interaction between rs7193788 and diabetes (P = 0.036). Compared to diabetes-free individuals with rs7193788 GG genotype, diabetes patients with rs7193788 GA/AA genotypes had higher risks for ischemic stroke (OR = 2.64, 95% CI: 1.58-4.40, P < 0.001). CONCLUSION: CDH13 genetic polymorphisms are associated with adiponectin levels and ischemic stroke. An interaction is found between CDH13 SNP and diabetes for ischemic stroke.

[Data of the quantitative orofacial somatosensory functions of healthy subjects and its influence factors analysis].

OBJECTIVE: To establish the preliminary somatosensory data stratified by gender, age group, and sites in the trigeminal region through standardized quantitative sensory testing on healthy individuals, and to evaluate the effects of gender, age, and sites on somatosensory functions. METHODS: The standardised QST battery developed by the German Research Network on Neuropathic Pain consists totally of 13 different parameters. A total of 70 healthy individuals participated. The subjects were stratified into two groups according to age: younger group (16 female, 16 male, age 24-40 years old) and elder group (20 female, 18 male, age 41-69 years old). The test was performed bilaterally over the infraorbital, mental, and hand regions. RESULTS: The preliminary orofacial somatosensory data stratified by gender, age group, and sites were presented. Female were more sensitive than male for most of the parameters (P<0.05). Age had a significant effect on most of the parameters (P<0.05), the younger group was more sensitive compared with the elder group (P<0.01) for heat pain threshold (HPT): younger group (38.07±2.94) °C, elder group (39.85±3.52) °C; warmth detection threshold (WDT): younger group (1.40±0.74) °C, elder group (1.89±1.14) °C; mechanical detection threshold (MDT): younger group (0.73±1.66) mN, elder group (1.41±2.82) mN; pressure pain threshold (PPT): younger group (171.71±92.51) kPa, elder group (196.36±73.73) kPa; cold pain threshold (CPT): younger group (25.90±5.38) °C, elder group (21.64±6.78) °C; cold detection threshold (CDT): younger group (-0.97±0.55) °C, elder group (-1.36±0.90) °C, and wind-up ratio (WUR): younger group (3.33± 2.20), elder group (2.67±1.68). The inverse results were demonstrated for mechanical pain threshold (MPT): younger group (111.50±88.93) mN, elder group (104.49±94.94) mN; mechanical pain sensitivity (MPS): younger group (6.96±5.61), elder group (8.93±6.53), and vibration detection threshold (VDT): younger group (7.44±0.52) scale, elder group (7.55±0.48) scale (P<0.05). Somatosensory function was site dependent (P<0.001), the two trigeminal sites (infraorbital and mental) were more sensitive than the hand for CDT, HPT, WDT, thermal sensory limen (TSL), MDT, MPT, MPS, and PPT (P<0.001), but the inverse result was observed for VDT (P<0.001). CONCLUSION: The preliminary orofacial somatosensory data of Han Ethnicity stratified by gender, age group, and sites were established. The study evaluated the effects of gender, age and sites on orofacial somatosensory functions by employment standardized quantitative sensory testing.

Linkage and association between interleukin-6 gene polymorphisms and ischemic stroke: a family-based study in the northern Chinese Han population.

BACKGROUND: Numerous genetic risk factors of ischemic stroke (IS) have been reported from both candidate gene and genome-wide strategies with inconsistent results. The objective of this study was to confirm the relationship between 10 previously identified single-nucleotide polymorphisms (SNPs) and IS in the Chinese population. METHODS: A family-based study was conducted in a rural area of Beijing, with a total of 227 IS families with 622 participants recruited. Both linkage and association analyses were performed, with all the sibling pairs derived from the 227 families analyzed using the sib-pair test of model-free linkage to assess linkage between SNPs and IS, with association analyses including a family-based association test (FBAT) and generalized estimating equations (GEE). RESULTS: Nonparametric linkage analysis revealed that the rs1800796 polymorphism in the interleukin-6 (IL-6) gene is significantly linked to the small arterial occlusion (SAO) subtype (p=0.022), while the rs7193343 polymorphism in the ZFHX3 gene is linked to IS (p=0.002) under the dominant model. Significant allelic associations were identified between the G allele of rs1800796 and IS (p=0.042) and the SAO subtype (p=0.025) in the FBAT. The GEE method revealed that the G allele of rs1800796 increased IS risk by 1.55-fold (95% 95% confidence interval [CI]: 1.01, 2.37; p=0.043) and 2.43-fold (95% CI: 1.32, 4.45; p=0.004) in the SAO subtype in the dominant model, which correlated with the significant associations detected in the FBAT. CONCLUSIONS: In this study, we confirmed that the SNP of rs1800796 in the IL-6 gene is related to IS and the SAO subtype using different statistical approaches. These findings could contribute to identifying individuals with a high IS risk.

The impact of lipid-metabolizing genetic polymorphisms on body mass index and their interactions with soybean food intake: a study in a Chinese population.

OBJECTIVE: To evaluate the association of known polymorphisms in the lipid metabolic pathway with body mass index (BMI), and estimate their interactions with soybean food intake. METHODS: A community-based cross-sectional survey was conducted in a Chinese Han population. BMI, soybean food intake, and single nucleotide polymorphisms of rs599839, rs3846662, rs3846663, rs12916, rs174547, rs174570, rs4938303, and rs1558861 were measured in 944 subjects. A multivariate logistic regression was used to analyze the association of the studied polymorphisms with BMIs. The expectation-maximization algorithm was employed to evaluate the extent of linkage disequilibrium between pairwise polymorphisms. The gene-environment interaction was assessed in the general multifactor dimensionality reduction model. RESULTS: The polymorphisms of rs3846662 and rs3846663 were associated with 10% highest BMIs when comparing to the 10% lowest values both in individuals and haplotype-based association tests. Although no statistically significant gene-environment interactions were found, people with the haplotype composed of C allele in rs3846662 and T allele in rs3846663 and low frequency of soybean intake had significantly higher risk to overweight and obesity as compared with those with the haplotype consisting of T allele in rs3846662 and C allele in rs3846663 and highly frequent soybean food intake, with an odds ratio of 1.64 (95% confidence interval: 1.15-2.34, P<0.01) after adjusting for the common confounders. CONCLUSION: Our study has suggested that rs3846662 and rs3846663 may be the potential candidate polymorphisms for obesity, and their effect on the pathogenesis could be mediated by the frequency of soybean food intake.

[Association study between PDE4D gene polymorphism and ischemic stroke].

OBJECTIVE: To investigate the linkage and association between rs966221 (SNP 83) in PDE4D gene with stroke and related traits in ischemic stroke families. METHODS: Ischemic stroke families including ischemic stroke patients and their siblings and/or parents were recruited. Generalized estimating equation (GEE) was used to adjust for with-in family correlations and other potential confounding factors. Non-parameter linkage analysis and family based association test (FBAT) were applied to explore the relationship between rs966221 polymorphism and ischemic stroke together with its related traits. RESULTS: In the study 276 ischemic stroke families with totally 776 participants were enrolled. Apolipoprotein B (apoB), carotid intima media thickness (cIMT), high-density lipoprotein cholesterol and blood pressure were associated with ischemic stroke. In family based association test, after being adjusted for related chronic diseases, rs966221 C allele was found to be associated with cIMT in the dominant model (P=0.019), TT genotype (P=0.019) and CT genotype (P=0.007) were associated with cIMT significantly. After being adjusted for potential confounding factors, evidence of linkage was observed for rs966221 with apoB (P<0.001), high-sensitivity C-reactive protein (P=0.003) and systolic blood pressure (P=0.036). CONCLUSION: Abnormal serum lipid, blood pressure and increasing cIMT were associated with ischemic stroke, and linkage was observed for with apoB, high-sensitivity C-reactive protein, and systolic blood pressure; rs966221 C allele was probably associated with cIMT.

[Case-control study of risk factors in age-related macular degeneration].

OBJECTIVE: To examine the potential influence factors of age-related macular degeneration (AMD). METHODS: A nationwide multicenter case-control study conducted between Jan. 2008 and May 2010. A total of 545 AMD patients and 480 controls, aged 50 years or older consented to participate in the study. Questionnaires were designed to collect information about demographic characteristics (age, gender), family history, disease history, and behavior factors (smoking, drinking). Moreover, physical examinations, biochemical examinations and ophthalmology examinations were conducted for each participant. RESULTS: The subjects who had AMD family history were 4.21 times more likely to have AMD (P<0.001). The subject who had the history of tracheitis /asthma were 1.87 times more likely to have AMD (P=0.008). Both smoking and drinking were risk factors to AMD (OR= 1.91,P < 0.001; OR=1.53, P = 0.003, respectively). Total protein (P = 0.004), high-density lipoprotein cholesterol ester (P = 0.016) and apolipoprotein A1 (P = 0.012) were associated with AMD. CONCLUSION: Family history, smoking, drinking and history of tracheitis /asthma are the risk factors of AMD. Total protein, high-density lipoprotein cholesterol ester and apolipoprotein A1 are associated with AMD.

[Mendelian randomization study of the relationship between high-density lipoprotein cholesterol and age-related macular degeneration].

OBJECTIVE: To explore genetic variants robustly associated with high-density lipoprotein cholesterol (HDL-C) by Mendelian randomization analysis and to examine its causal association with age-related macular degeneration (AMD). METHODS: AMD cases and controls were selected from several hospitals nationwide. Their AMD was diagnosed by eye examination, serum HDL-C levels were examined by blood tests, and other informations were also collected including demographic characteristics, high risk behaviors and so on. The genetic loci hepatic lipase gene (LIPC) rs10468017 was used as instrumental variables for HDL-C. RESULTS: The study population contained hospital-based 545 AMD patients and 480 controls. The LIPC genotypes were unrelated to all potentially confounding factors measured in this study. In conventional multivariable analyses, the HDL-C level was positively associated with AMD. The odds ratio was 2.00 (95%CI: 1.41-2.86). Instrumental variable analyses (Mendelian randomization approach) showed an increasing odds ratio of HDL-C and AMD, which was 7.15 (95%CI: 0.80-64.13). CONCLUSION: Being different with previous observational analysis, this study did not support the status of increasing serum HDL-C level as a risk factor for AMD by Mendelian randomization analysis.

Clinical observation of physiological and psychological reactions to electric stimulation of the amygdaloid nucleus and the nucleus accumbens in heroin addicts after detoxification.

BACKGROUND: Stereotactic surgery has been used to treat heroin abstinence in China since 2000 by ablating the amygdaloid nucleus (AMY) and the nucleus accumbens (NAc), which also provides opportunity to identify the relationship between these nuclei and addiction. Our study aimed to explore the physiological and psychological effects of electrically stimulating the AMY and the NAc in heroin addicts after detoxification by observing changes of heart rate, arterial pressure and occurrence of euphoria similar to heroin induced euphoria. METHODS: A total of 70 heroin addicts after detoxification were recruited, and 61 of them were eligible to be given stereotactic surgery for heroin abstinence. The operation was carried out after determining the coordinates of all target nucleuses, and stimulation was performed at the AMY and the NAc solely or jointly. Heart rate, arterial pressure and occurrence of euphoria similar to heroin induced euphoria were recorded and analyzed. RESULTS: The average heat rate was (66 ± 10) beats/min before electric stimulation, and significantly increased to (84 ± 14) beats/min during stimulation, and changed to (73 ± 12) beats/min 10 minutes after stimulation. There was a significant elevation of the average arterial pressure from 83 mmHg before stimulation to 98 mmHg during the stimulation, and it then decreased to 90 mmHg after stimulation. Forty-three of the 61 patients showed intense euphoria similar to heroin induced euphoria. The largest number (118/186) of euphoric responses occurred when the AMY and the NAc were stimulated at the same time. Odds ratio was 5.4 (95%CI: 2.4 - 11.9, P < 0.0001) to quantify the association. Results from a Logistic regression model showed a positive correlation between unilateral stimulation of either the AMY or NAC and induction of euphoria (OR > 1), especially when the left AMY or left NAc was stimulated (P < 0.05). CONCLUSIONS: Our data are consistent with existing results that the AMY and the NAc are related to addiction. Different roles in drug dependence would be suggested according to the location of the AMY and NAc.

[A community-based epidemiologic study on gastroesophageal reflux disease in Haidian district of Beijing].

OBJECTIVE: To explore the prevalence of gastroesophageal reflux disease (GERD) and its symptoms in Haidian district of Beijing, identify its associated risk factors and analyze the relations between GERD and history of other diseases. METHODS: 2615 residents of 18-80 years old were selected to participate in the study by multi-stage sampling from Haidian district from June and September in 2008. Questionnaires were distributed to obtain the information on demographic characteristics, diseases history and the reflux disease questionnaire (RDQ). RESULTS: The prevalence of GERD in the population was 8.4% (220/2615), and the prevalence of heartburn, reflux, both heartburn and reflux were 1.0% (25/2615), 6.2% (163/2615) and 1.2% (32/2615), respectively. Multi-factor analysis showed rural area (OR = 2.237, 95%CI: 1.422 - 3.517), female (OR = 1.456, 95%CI: 1.085 - 1.955), high education (OR = 1.242, 95%CI: 1.001 - 1.542), pressure (OR = 1.277, 95%CI: 1.089 - 1.497), bad emotional status (OR = 1.320, 95%CI: 1.046 - 1.665), and family history of gastrointestinal disorders (OR = 1.594, 95%CI: 1.075 - 2.365) were significantly associated with GERD. Rural area (OR = 2.481, 95%CI: 1.278 - 4.818), female (OR = 1.747, 95%CI: 0.902 - 3.386), drinking (OR = 1.838, 95%CI: 0.916 - 3.690), no exercise (OR = 2.091; 95%CI: 1.131 - 3.867) and bad emotional status (OR = 1.657, 95%CI: 1.123 - 2.446) were significant risk factors for heartburn. Rural area (OR = 2.171, 95%CI: 1.326 - 3.556), female (OR = 1.505, 95%CI: 1.102 - 2.056), high education (OR = 1.347, 95%CI: 1.063 - 1.706), pressure (OR = 1.317, 95%CI: 1.113 - 1.558), bad emotional status (OR = 1.266, 95%CI: 0.992 - 1.616), and family history of gastrointestinal disorders (OR = 1.739, 95%CI: 1.163 - 2.600) were significantly associated with reflux symptom. History of diseases such as inflammatory bowel disease, anxiety, depression, peptic ulcer, gastritis, and renal diseases were found to be significantly related to GERD and its symptoms. CONCLUSION: This area has epidemic of GERD, which was related to mental problems and unhealthy life style, and should be paid more attention by conducting effective community-based interventions.

[Cost-effectiveness analysis on compound anti-hypertensive tablets for primary hypertension].

OBJECTIVE: To compare the cost-effectiveness of two anti-hypertensive therapy regimens, Compound anti-hypertensive tablets and other common anti-hypertensive agents, in the treatment program of Primary Hypertension. METHODS: We conducted a cost-effectiveness analysis based on a community trial. Two communities' primary hypertensive patients were enrolled to receive different therapy drugs: Compound anti-hypertensive tablets (Group A) or other common anti-hypertensive agents (Group B). Blood pressure, medicine used, and adverse drug reactions were observed and recorded for one year, and then cost-effectiveness ratio of the two groups and incremental ratio were calculated. We considered a 30% drug price fluctuating load to make the sensitivity analysis. RESULTS: 2505 cases were enrolled with 1529 cases in group A and 976 cases in group B. The cost-effectiveness ratios were 418.1 and 1057.7 for Group A and B respectively while the incremental cost-effectiveness of Group B vs. Group A was 19 202.2. The results were insensitive to variation in the costs of drugs over clinically reasonable ranges. CONCLUSION: Compound anti-hypertensive tablets appeared to be relatively cost-effective when compared to common drugs for the treatment of primary hypertension.

[Study on the long-term efficacy and safety of medicine named 'Beijing Hypertensive No. 0' in patients with primary hypertension].

OBJECTIVE: To assess the antihypertensive effect and safety on medicine named 'Beijing Hypertensive No. 0' in a three-year treatment of primary hypertension. METHODS: A community-based intervention study was conducted. The antihypertensive effects and adverse events were observed. RESULTS: 4000 patients with primary hypertension were randomly divided into two groups with 1529 patients treated with 'Beijing Hypertensive No. 0' and 976 patients treated with other antihypertensive drugs, among which 946 and 853 patients in the two groups completed the three-year study. After treatment, the systolic blood pressure decreased 13 mm Hg and 7 mm Hg while diastolic blood pressure decreased 8 mm Hg and 4 mm Hg in the 'No. 0' group and controlled group respectively. After three years of treatment, 90.0% and 79.5% in the 'No.0' group and in the control group had reached the BP 'fulfillment criteria', which were much higher than the baseline data. Side effects occurred in 33/1274 (2.6%) cases during three years' treatment with most commonly seen as dizziness, headache, palpitation and weakness. No serious adverse reactions occurred. There were some positive effects after treated by 'No. 0', including 0.13 mmol/L decrease of TC, 0.70 mmol/L decrease of LDL-C and an average 0.12 mmol/L increase of HDL-C. All of these changes were statistically significant. There were also opposite effects as 0.13 mmol/L increase of TG, 0.24 mmol/L increase of K+, and 0.88 mmol/L increase of Na+ on average, which were also statistically significant. CONCLUSION: Compared with the conventional treatment, this treatment of 'Beijing Hypertensive No.0' was more convenient, safe and effective in treating mild to moderate primary hypertension in the community.