ObjectivesThis study aims to provide a comprehensive analysis of the burden of Type 2 diabetes (T2D) attributable to behavioral risks.MethodsUtilizing the Global Burden of Disease (GBD) 2021 data for secondary modeling, we analyzed the burden of T2D attributable to behavioral risks, stratified by age, gender, risk factors, and regions. A Bayesian age-period-cohort (BAPC) model projected burden trajectories from 2022 to 2050 under the continuation of historical trends.ResultsFrom 1990 to 2021, global deaths and DALYs of T2D attributable to behavioral risks increased by 133.87% and 187.68%. The greatest rises in ASMR and ASDR occurred in Eastern Europe, Central Asia, and Southern Sub-Saharan Africa. Dietary risks remained the primary contributor, whereas the T2D burden attributable to high alcohol use exhibited the steepest increase from 1990 to 2021. The global ASMR and ASDR increased exponentially with age and were consistently higher in males. Projections from the BAPC model indicate that ASDR is expected to continue increasing through 2050.ConclusionT2D burden attributable to behavioral risks is increasing rapidly, underscoring the need for targeted interventions and public health education.

BACKGROUND:This study aimed to investigate the relationship of high-altitude environmental features and ethnic Tibetan background with myopia. METHODS:This cross-sectional study was conducted at highland and lowland sites. The highland sites were located on the Chinese Tibetan Plateau, approximately 4000 m above sea level. A total of 3634 Tibetans and 377 Hans were included in the highland group. The lowland group was from the Yaoxi community, in Wenzhou City, located 10-20 m above sea level, where 176 Han individuals were included. Non-cycloplegic spherical equivalent refraction (SER) and biochemical function tests were measured. RESULTS:Age-specific myopia prevalence was highest in highland Hans, followed by lowland Hans and highland Tibetans. Among participants in the highland group, including Tibetans and Hans, increased risk of moderate and high myopia was associated with gender [OR (95% CI): 0.47 (0.23, 0.97) for females], education level [OR (95% CI): 3.62 (1.76, 7.45) for middle school education and above], and elevated mean haemoglobin per red blood cell (MCH) [OR (95% CI): 8.04 (1.04, 62.34)]. Among Han participants in both groups, only elevated mean corpuscular volume (MCV) [OR (95% CI): 5.91 (1.00, 34.92)] was associated with increased risk of moderate and high myopia. CONCLUSIONS:The higher prevalence of myopia in Hans compared to Tibetans, and in highland Hans compared to lowland Hans, suggests that both ethnicity and high-altitude environment influence myopia development, potentially through gene-environment interactions. Elevated MCV and MCH levels, particularly in highland Hans, may serve as biomarkers for risk, warranting further investigation.

Background:The global prevalence of type 2 diabetes mellitus (T2DM) has risen significantly since 1990, contributing substantially to mortality and posing a major public health challenge. While overweight/obesity and insulin resistance, commonly reflected by the triglyceride-glucose (TyG) index, are established risk factors for the development of T2DM, their individual and combined effects on mortality among patients with T2DM remain incompletely elucidated. This study aimed to evaluate the associations between body mass index (BMI) and the TyG index with all-cause and cardiovascular disease (CVD) mortality in a large clinical cohort of type 2 diabetes mellitus (T2DM) patients. Methods:This retrospective cohort study included 15,796 T2DM adults (aged >18 years) from two hospitals in China (2010-2023). The primary outcome was all-cause mortality, with a mean follow-up duration of 2.8 years. BMI was categorized as normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (≥30 kg/m2). The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multiple Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality. Results:Among 15,796 participants, 1,665 deaths were recorded, including 629 CVD-related deaths. Overweight and obesity were associated with lower all-cause mortality risk (aHR: 0.73, 95% CI: 0.65-0.81 and aHR: 0.86, 95% CI: 0.74-1.00, respectively). Higher TyG index quartiles (Q3 and Q4) were associated with decreased mortality risk (aHR: 0.85, 95% CI: 0.74-0.98; aHR: 0.84, 95% CI: 0.72-0.97). The protective effect of a higher BMI was more pronounced in patients aged 60 years or older. Conclusion:Our findings revealed that BMI and the TyG index are associated with mortality risk in T2DM patients, particularly in older patients. However, these findings are observational and do not imply causality or validate prognostic use. Further studies using causal inference methods are necessary to inform clinical guidelines.

Background:Diabetic kidney disease (DKD) is a multifactorial complication of diabetes involving mitochondrial dysfunction and immune cell infiltration. However, the causal relationships remain unclear. Methods:We applied Mendelian randomization (MR) and single-cell RNA sequencing (scRNA-seq) to investigate the roles of mitochondrial gene expression and immune cells in DKD. Additionally, peripheral blood mononuclear cells (PBMCs) from DKD patients were analyzed for differential gene expression. Results:Higher expression of mitochondrial genes PCCB, ACADM, ADHFE1, OCIAD1, and FIS1 increased DKD risk, while genes like NT5DC2, ATP5MC3, and GLYCTK decreased risk. Immune traits, including human leukocyte antigen (HLA)-DR + plasmacytoid dendritic cells (pDCs), mediated the effects of mitochondrial dysfunction on DKD. scRNA-seq revealed significant downregulation of ATP5MC3, GLYCTK, and NT5DC2 in podocytes (PODOs) and tubular cells in DKD kidneys, alongside increased infiltration of helper T cells, B cells, dendritic cells (DCs), and plasma cells. PBMC analysis highlighted the upregulation of proinflammatory genes (CXCL2, CXCL3, and others) in DKD patients. Conclusion:This study highlights the complex interplay between mitochondrial dysfunction and immune cell infiltration in DKD pathogenesis. Key mitochondrial genes and immune traits identified here offer novel therapeutic targets such as ATP5MC3, GLYCTK, and DC pathways.

AIMS:The existing literature indicates that oleic acid (OA) is the most prevalent monounsaturated fatty acid (MUFA) in both diet and plasma, known for its beneficial impact on insulin resistance and inflammation. However, its role in diabetic retinopathy (DR) remains unclear. This study aims to elucidate the association between OA and DR and explore its potential in DR detection. METHODS:We conducted a two-center, propensity score-matched case-control study, including 69 type 2 diabetes (T2D) patients with diagnosed DR (cases) and 69 matched T2D individuals without DR (control), in China from August 2017 to June 2018. Multiple logistic regression models analyzed the association between MUFAs and DR. The impact of 7 distinct MUFAs on DR was examined using elastic net regression (ENET), weighted quantile regression (WQS), and Bayesian kernel machine regression (BKMR), focusing on key lipid biomarkers. The diagnostic utility of these biomarkers was assessed by calculating the AUC. RESULTS:A significant negative correlation was found between MUFAs and DR, with OA identified as pivotal by ENET, WQS, and BKMR. The adjusted OR and 95% CI for DR were 0.25 (0.09, 0.69) for subjects in the 2nd tertile of OA and 0.11 (0.04, 0.30) for the 3rd tertile, compared to the lowest tertile. These results were consistent across subgroup and sensitivity analyses. The AUC (95% CI) for OA alone was 0.72 (0.63, 0.81), increasing to 0.77 (0.69, 0.85) when combined with other covariates. CONCLUSIONS:Our findings reveal a robust inverse relationship between plasma OA levels and DR risk, suggesting that OA could serve as a valuable biomarker for identifying type 2 diabetic patients with DR.

Background Dyslipidemia is increasingly common in people living with HIV (PLHIV), thereby increasing the risk of cardiovascular events and diminishing the quality of life for these individuals. The study of blood lipid metabolism of PLHIV has great clinical significance in predicting the risk of cardiovascular disease. Therefore, this study aims to examine the blood lipid metabolism status of HIV-infected patients in Huzhou before and after receiving highly active antiretroviral therapy (HAART) and to explore the impact of different HAART regimens on dyslipidemia.Method PLHIV confirmed in Huzhou from June 2010 to June 2022 was included. The baseline characteristics and clinical data during the follow-up period were collected, including some blood lipid indicators (total cholesterol and triglycerides) and HAART regimens. A multivariate logistic regression model and the generalized estimating equation model were used to analyze the independent effects of treatment regimens on the risk of dyslipidemia.Result The overall prevalence of dyslipidemia among PLHIV after HAART was 70.11%. PLHIV receiving lamivudine (3TC) + efavirenz (EFV) + zidovudine (AZT) had a higher prevalence of dyslipidemia compared to those receiving 3TC+EFV+tenofovir disoproxil fumarate (TDF). In a logistic analysis adjusted for important covariates such as BMI, age, diabetes status, etc., we found that the risks of dyslipidemia were higher with 3TC+EFV+AZT (dyslipidemia: odds ratio [OR] = 2.09, 95% confidence interval [Cl]: 1.28-3.41; TG >= 1.7: OR = 2.40, 95%Cl:1.50-3.84) than with 3TC+EFV+TDF. Furthermore, on PLHIV that was matched 1:1 by the HAART regimens, the results of the generalized estimation equation again showed that 3TC+EFV+AZT (TG >= 1.7: OR = 1.84, 95%Cl: 1.10-3.07) is higher for the risk of marginal elevations of TG than 3TC+EFV+TDF.Conclusion The prevalence of dyslipidemia varies according to different antiretroviral regimens. Using both horizontal and longitudinal data, we have repeatedly demonstrated that AZT has a more adverse effect on blood lipids than TDF from two perspectives. Therefore, we recommend caution in using the 3TC+EFV+AZT regimen for people at clinical risk of co-occurring cardiovascular disease.

Objective To evaluate the effectiveness of standardised antiretroviral therapy (ART) among different HIV subtypes in people living with HIV/AIDS (PLWHA), and to screen the best ART regimen for this patient population.Design A retrospective cohort study was performed, and PLWHA residing in Huzhou, China, between 2018 and 2020, were enrolled.Setting and participants Data from 625 patients, who were newly diagnosed with HIV/AIDS in the AIDS Prevention and Control Information System in Huzhou between 2018 and 2020, were reviewed.Analysis and outcome measures Data regarding demographic characteristics and laboratory investigation results were collected. Immune system recovery was used to assess the effectiveness of ART, and an increased percentage of CD4+ T lymphocyte counts >30% after receiving ART for >1 year was determined as immunopositive. A multiple logistic regression model was used to comprehensively quantify the association between PLWHA immunological response status and virus subtype. In addition, the joint association between different subtypes and treatment regimens on immunological response status was investigated.Results Among 326 enrolled PLWHA with circulating recombinant forms (CRFs) CRF01_AE, CRF07_BC and other HIV/AIDS subtypes, the percentages of immunopositivity were 74.0%, 65.6% and 69.6%, respectively. According to multivariate logistic regression models, there was no difference in the immunological response between patients with CRF01_AE, CRF07_BC and other subtypes of HIV/AIDS who underwent ART (CRF07_BC: adjusted OR (aOR) (95% CI) = 0.8 (0.4 to 1.4); other subtypes: aOR (95% CI) = 1.2 (0.6 to 2.3)). There was no evidence of an obvious joint association between HIV subtypes and ART regimens on immunological response.Conclusions Standardised ART was beneficial to all PLWHA, regardless of HIV subtypes, although it was more effective, to some extent, in PLWHA with CRF01_AE.

OBJECTIVES:COVID-19 epidemics often lead to elevated levels of depression. To accurately identify and predict depression levels in home-quarantined individuals during a COVID-19 epidemic, this study constructed a depression prediction model based on multiple machine learning algorithms and validated its effectiveness.METHODS:A cross-sectional method was used to examine the depression status of individuals quarantined at home during the epidemic via the network. Characteristics included variables on sociodemographics, COVID-19 and its prevention and control measures, impact on life, work, health and economy after the city was sealed off, and PHQ-9 scale scores. The home-quarantined subjects were randomly divided into training set and validation set according to the ratio of 7:3, and the performance of different machine learning models were compared by 10-fold cross-validation, and the model algorithm with the best performance was selected from 15 models to construct and validate the depression prediction model for home-quarantined subjects. The validity of different models was compared based on accuracy, precision, receiver operating characteristic (ROC) curve, and area under the ROC curve (AUC), and the best model suitable for the data framework of this study was identified.RESULTS:The prevalence of depression among home-quarantined individuals during the epidemic was 31.66% (202/638), and the constructed Adaboost depression prediction model had an ACC of 0.7917, an accuracy of 0.7180, and an AUC of 0.7803, which was better than the other 15 models on the combination of various performance measures. In the validation sets, the AUC was greater than 0.83.CONCLUSIONS:The Adaboost machine learning algorithm developed in this study can be used to construct a depression prediction model for home-quarantined individuals that has better machine learning performance, as well as high effectiveness, robustness, and generalizability.

Early screening and administration of DKD are beneficial for renal outcomes of type 2 diabetic patients. However, the current early diagnosis using the albuminuria/creatine ratio (ACR) contains limitations. This study aimed to compare serum lipidome variation between type 2 diabetes and early DKD patients with increased albuminuria through an untargeted lipidomics method to explore the potential lipid biomarkers for DKD identification. 92 type 2 diabetic patients were enrolled and divided into two groups: DM group (ACR < 3 mg/mmol, n = 49) and early DKD group (3 mg/mmol ≤ ACR < 30 mg/mmol, n = 43). Fasting serum was analyzed through an ultraperformance liquid mass spectrometry tandem chromatography system (LC-MS). Orthogonal partial least-squares discriminant analysis (OPLS-DA) and univariate and multivariate analysis were performed to filter differentially depressed lipids. Receiver operating characteristic (ROC) curves were used to estimate the diagnostic capability of potential lipid biomarkers. We found that serum phospholipids including phosphatidylserine (PS), sphingomyelin (SM), and phosphatidylcholine (PC) were significantly upregulated in the DKD group and were highly correlated with the ACR. In addition, a panel of two phospholipids including PS(27:0)-H and PS(30:2e)-H showed good performance to help clinical lipids in early DKD identification, which increased the area under the curve (AUC) from 0.568 to 0.954. The study exhibited the serum lipidome variation in early DKD patients, and the increased phospholipids might participate in the development of albuminuria. The panel of PS(27:0)-H and PS(30:2e)-H could be a potential biomarker for DKD diagnosis.

Tobacco smoking is a major known risk factor for lung cancer. While micronutrients, especially those involved in maintaining DNA integrity and regulating gene expression, may be protective, research on this association is limited. This report aimed to investigate associations of total folate, 5‐methyltetrahydrofolate (5‐mTHF) and vitamin B12 with incident risk of lung cancer, and whether the associations vary by smoking status. A nested case‐control study with 490 incident lung cancer cases and 490 controls matched by age (±1 year), sex, residence, and center, drawn from a community‐based prospective study in China, was conducted from 2016 to 2019. 5‐mTHF accounted for the majority of total folate. Only 4.4% had detectable unmetabolized folic acid. Lung cancer cases had lower levels of 5‐mTHF compared to controls. There was an inverse, nonlinear association between 5‐mTHF and lung cancer, which persisted after adjustment for covariables ( P for trend = .001). Compared to the lowest 5‐mTHF quartile, those in higher quartiles had lower risks of lung cancer: second quartile OR = 0.65; 95% CI: 0.45‐0.93; third quartile OR = 0.50; 95% CI: 0.34‐0.74; fourth quartile OR = 0.56; 95% CI: 0.38‐0.83. This inverse association was more pronounced among ever smokers; consistently, the highest risk of lung cancer (OR = 3.21, 95% CI: 1.97‐5.24) was observed among ever smokers with low 5‐mTHF levels compared to participants who never smoked and had higher 5‐mTHF levels. Vitamin B12 was not associated with lung cancer risk. In this sample of Chinese adults without confounding by unmetabolized folic acid, higher levels of 5‐mTHF were associated with lower risk of incident lung cancer.

目的 基于可解释性机器学习算法构建糖尿病视网膜病病变(diabetic retinopathy,DR)的早期识别模型,并探讨SHAP(SHapley Additive exPlanations)在脂质组学数据中的应用.方法 基于本项目组的DR靶向脂质组学数据,通过可解释性机器学习的方法进行特征筛选;在建立糖尿病视网膜病变的早期识别模型后,通过全局、特征和个体三个层面对模型进行解释,并将SHAP值转换成概率以增强可解释的能力.结果 本研究筛选出了 5 种内源性脂质代谢物,构建了一个性能较为优秀的糖尿病视网膜病变的早期识别模型,并成功使用SHAP及概率解锁了模型.结论 脂质代谢物质可以应用于糖尿病视网膜病变的早期识别;SHAP在进行黑盒模型的解锁时表现出色,且有较高的实践应用价值.

AIM:To quantify the association between serum sarcosine and diabetic retinopathy (DR) using weighted gene co-expression network analysis (WGCNA).METHODS:We measured serum metabolites in 69 pairs of type 2 diabetes (T2D) patients with and without DR matched by age, gender, body mass index（BMI and HbA1c, using a propensity score matching-based approach. To identify modules and metabolites linked to DR, pathway analysis was performed using WGCNA, the Kyoto Encyclopedia of Genes and Genomes and Small-Molecule Pathway Database. The association of sarcosine with DR was estimated by restricted cubic spline and conditional logistic regression models. Its joint effects with covariates on DR were also extensively examined.RESULTS:With per interquartile range elevation of sarcosine, the adjusted odds ratio (AOR) of DR significantly decreased by 67% (AOR: 0.33, 95% confidence interval [CI]: 0.19-0.58). Similar results were also found in the tertile analysis. Compared with those in the first tertile of sarcosine, the AOR significantly decreased by 54% (AOR: 0.46, 95% CI: 0.18-1.17) and 78% (AOR: 0.22, 95% CI: 0.08-0.59) for subjects in the second and third tertiles, respectively. Compared with subjects with lower sarcosine and lower HDL-C levels, those with higher sarcosine and lower HDL-C levels had the lowest odds of DR (OR: 0.13, 95% CI: 0.04, 0.43).CONCLUSIONS:Serum sarcosine was inversely related to DR, especially in T2D patients with insufficient HDL-C. This study provides insights on a possible novel target for DR precision prevention and control, as well as a better understanding of the DR mechanism.

Although previous studies have suggested that hemoglobin is related to the health status of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA), the role of anemia in mortality remains unclear. This study aimed to comprehensively quantify the effect of anemia on the mortality risk of PLWHA. In this retrospective cohort study, we thoroughly estimated the effect of anemia on PLWHA mortality, using data collected from January 2005 to June 2022 in the Huzhou area, in 450 subjects extracted from the database of the China Disease Prevention and Control Information System and matched them using a propensity score matching approach to balance potential confounding bias. The potential exposure-response relationship between anemia, hemoglobin concentration, and the mortality of PLWHA was also carefully estimated. A series of subgroup analyses, including interaction analysis, was further conducted to validate the robustness of the effect of anemia on PLWHA death risk. Anemia was significantly associated with an elevated death risk in PLWHA, with an increase of 74% (adjusted hazard ratio [AHR]: 1.74; 95% confidence interval [CI]: 1.03-2.93; p = 0.038) in those with anemia after adjusting for potential confounders. PLWHA with moderate or severe anemia had a higher risk of death, with an 86% increase (AHR = 1.86; 95% CI: 1.01-3.42; p = 0.045). Meanwhile, the AHR tended to increase by 85% on average (AHR = 1.85, 95% CI: 1.37-2.50; p < 0.001) with a per standard deviation (SD) decrease in plasma hemoglobin. Consistent relationships between plasma hemoglobin and the risk of death were further observed in the results from multiple quantile regression models, restricted cubic spline regression models, and a series of subgroup analyses. Anemia is an independent risk factor for HIV/AIDS-related mortality. Our findings may provide new insights into the relevance of PLWHA administration to public health policy, which demonstrate that this low-cost and routinely measured marker (hemoglobin) can be a marker of poor prognosis even before the start of HAART.

L-cysteine (L-Cys) plays an important role in many physiological processes. The previously reported methodologies for L-Cys detection have many drawbacks, and thus the development of specific/sensitive approaches is crucial for its direct/quick assay in food matrices. Herein, silicon quantum dots (SiQDs) and glutathionestabilized copper nanoclusters (CuNCs) were successfully synthesized and integrated as a ratiometric fluorescent probe for assay L-Cys assay in milks. The fluorescence of SiQDs was quenched by CuNCs through fluorescence resonance energy-transfer process. Upon addition of L-Cys, the 440-nm fluorescence of SiQDs changed insignificantly, while the 650-nm fluorescence of CuNCs decreased significantly. Ratiometric fluorescence signal was linear in the L-Cys concentration range of 0.25 mu M to 2.5 mM with a detection limit of 75 nM and visual color changes from red to blue. The probe can realize rapid and portable detection without the participation of intermediate ions, and has good selectivity and accuracy for L-cysteine in milk samples.

Background: The burden of chronic diseases and associated morbidities and mortalities are rapidly rising in China. Nutrition and lifestyle are major contributors. Currently, there is a paucity of strong evidence to guide optimal intake of macronutrients and micronutrients for primordial, primary, and secondary prevention of chronic diseases among diverse populations and across life stages in China. Evidence is also lacking on the KAP (Knowledge, Attitude, and Practice) in Chinese populations to inform effective behavior interventions. The China Precision Nutrition and Health-KAP Real World Study (CPN-KAPS) intends to establish a cohort and conduct research in real-world settings to improve KAP and advance precision nutrition. Methods: The CPN-KAPS is a long-term, multicenter, prospective, observational, real-world study that will enroll at least a million adults who meet the inclusion criteria. Each participant will be expected to attend at least 5 follow-up visits (once a year). The primary endpoints include nutritional status and the occurrence, progression, and prognosis of numerous chronic diseases such as cardiovascular and cerebrovascular disease, tumors, chronic kidney disease, Alzheimer’s disease, digestive system diseases, diabetes, mortality, and results of the health KAP survey. Secondary endpoints include malnutrition and changes in various chronic disease-related biomarkers and pharmacoeconomic indicators. Results: The CPN-KAPS is still in a formative stage, but we anticipate this study will establish a rich database and biorepository. These resources will create enormous opportunities for scientific discoveries and clinical public health translation. Conclusion: This large-scale, observational, prospective and real-world research will be of great significance and value for an in-depth understanding of China’s nutrition and health status, to provide precision nutrition intervention strategy for the prevention and treatment of chronic diseases in Chinese Population.

Background and purpose:Acylcarnitines (ACars) are important for insulin resistance and type 2 diabetes (T2D). However, their roles in diabetic retinopathy (DR) remain controversial. In this study, we aimed to investigate the association of ACars with DR and their values in DR detection.Methods:This was a two-center case-control study based on the propensity score matching approach between August 2017 to June 2018 in Eastern China. Multivariable logistic regression models were applied to estimate the association of plasma ACars with DR. Differential ACars were screened by models of least absolute shrinkage and selection operator, elastic net, and weighted quantile sum regression, and their roles in DR identification were further evaluated by the area under the receiver operating curve (AUC).Results:Eight of twenty plasma ACars (8:0, 12:0, 12:1, 14:1, 16:2, 18:0, 18:2 and 18:3) were associated with DR, while only ACar 8:0 was selected by three variable selection methods. As compared to those with the 1st tertile of ACar 8:0, the adjusted odds ratio (OR) and 95% confidence interval (CI) of DR were 0.22 (0.08, 0.59) and 0.12 (0.04, 0.36) for subjects in the 2nd and 3rd tertiles, respectively (P for trend < 0.001). Consistent associations were also observed in both restricted cubic spline regression models and subgroup analyses. AUC (95% CI) were 0.74 (0.66, 0.82) for ACar 8:0 alone and 0.77 (0.70, 0.85) for ACar 8:0 combined with covariates.Conclusions:Our findings suggest higher ACar 8:0 is significantly associated with a decreased risk of DR, which provides a unique window for early identification of DR.

Background: Metabolic disorder affects the risk of developing diabetic retinopathy (DR). However, the relationship is insufficiently investigated. The paper is to identify modules and metabolites linked to DR and quantify the association between the serum sarcosine and DR.Methods: In this study, ultra-performance liquid chromatography-electrospray ionization-tandem mass 3system was used to measure serum metabolites in 69 pairs of type 2 diabetes (T2D) with and without DR matched by PSM. WGCNA, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Small Molecule Pathway Database (SMPDB) were used to identify modules and metabolites linked to DR. The association between the sarcosine and DR was estimated by restricted cubic spline, conditional logistic regression models.Results: Lower serum sarcosine was not just apparently linked to DR but had a synergistic effect with abnormal high density lipoprotein cholesterol (HDL-C) on DR. With per interquartile range elevation of sarcosine, adjusted odds ratio (AOR) of DR significantly decreased by 67% (AOR: 0.33, 95%CI: 0.19-0.58). Similar results were also found in the tertile analysis. When comparing with those in the 1st tertile of sarcosine, AOR of DR significantly decreased by 54% (AOR: 0.46, 95% CI: 0.18-1.17) and 78% (AOR: 0.22, 95% CI: 0.08-0.59) for subjects in the 2 nd and 3 rd tertiles, respectively.Conclusions: Our findings strongly suggests that serum sarcosine is inversely related to DR, especially in T2D with abnormal HDL-C. This study also provides novel insights on a possible new target for DR precision control.Funding Information: This study was supported by the National Nature Science Foundation of China (82070833), the Major Project of the Eye Hospital of Wenzhou Medical University (YNZD201602), Natural Science Foundation of Zhejiang Province (LZ19H020001) and the Scientific and technological innovation activity (new talent) plan for college students in Zhejiang Province (2021R413062, 2021R413075). Part of this work was also funded by Zhejiang Provincial Key Research & Development Program (2021C03070).Declaration of Interests: We declare no conflicts of interests.Ethics Approval Statement: Procedures of the present study strictly followed the tenets of the Declaration of Helsinki. The protocol had been carefully reviewed and approved by the Ethics Committee of the Eye hospital of Wenzhou medical university (Number: KYK (2017) 46) and confirmed by the two associated hospitals before the start of this study. All participants were voluntary and provided written informed consent in advance.

Background: Associations between vitamin D and stroke remain inconsistent. One major risk factor for stroke is high blood glucose, but the role it plays in this association is not well studied. Objectives: We aimed to evaluate the individual association between plasma 25-hydroxyvitamin D [25(OH)D] and risk of first stroke stratified by fasting blood glucose (FBG), and the joint associations between plasma 25(OH)D, glycemic status, and first stroke in hypertensive adults. Methods: This study was a nested, case-control design utilizing data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 591 first stroke cases (of which 475 were ischemic stroke, 114 were hemorrhagic stroke, and 2 were uncertain type) and 591 matched controls. The age range of the study population was 45-75 y. The normal FBG (NFG) group had FBG <5.6 mmol/L, and the impaired FBG (IFG) group had FBG >= 5.6 mmol/L and <7.0 mmol/L. Diabetes was defined as participants with FBG >= 7 mmol/L or who were receiving treatment with hypoglycemic agents. ORs (95% CIs) were calculated using unconditional logistic regression models. Results: Multivariable adjusted models revealed an inverse association between quartiles of 25(OH)D and risk of first stroke among participants with NFG, but the opposite trend was observed for those with IFG or diabetes. The largest ORs (>2) were observed among patients with diabetes, compared with the reference group of NFG and high 25(OH)D. Those with NFG and low 25(OH)D (OR = 1.73, 95% CI: 1.22 to 2.44) or those with IFG and high 25(OH)D (OR = 1.74, 95% CI: 1.14 to 2.67) both had a higher risk of total stroke. There was a significant interaction between 25(OH)D and a combined group of IFG and diabetes (P = 0.001). Similar results were observed for ischemic stroke. Conclusions: In a hypertensive population, the relation between plasma 25(OH)D and risk of first stroke was significantly modified by FBG.

AIM: To investigate the effects of school-based comprehensive intervention on myopia development in elementary school children. METHODS: As a part of the Wenzhou Epidemiology of Refraction Error Study, there were 1524 participating elementary students (730 girls, 47.9%) in grades 1 to 3 from three campuses of one school, aged 7.3±0.9y, who were examined twice every year for a 2.5y follow up period. Comprehensive intervention and other reminders were given at school every semester for the intervention group. The control group did not receive comprehensive intervention and did not have reminders of it. RESULTS: There were 651 students in the intervention group [mean age 7.3±0.9y; 294 (45.2%) girls] and 737 students in the control group [mean age 7.2±0.9y; 346 (46.9%) girls]. Overall mean myopia progression during the 2.5y follow-up was -0.49±1.04 diopters (D) in the intervention group and -0.65±1.08 D in the control group (P=0.004). The majority that not get myopia at baseline spherical equivalent (SE≤-1.0 D). Their mean myopia progression during the 2.5y follow-up was -0.37±0.89 D in the intervention group and -0.51±0.93 D in the control group (27.5% reduction, P=0.009); Overall, mean axial length elongation was less in the intervention group (0.56±0.32 mm) than in the control group (0.61±0.38 mm, 10.5% reduction, P=0.009). The percentage of close reading distance (<30 cm) in the intervention group was less than in the control group (73.4% vs 76.2%, P<0.001), the percentage of everyday perform eye exercises in the intervention group was more than in the control group (27.8% vs 20.7%, P<0.001) 30mo later. CONCLUSION: The comprehensive intervention program at elementary school has a significant alleviating effect on myopia progression for children during the 2.5y follow-up, especially for those non-myopia at baseline.