Abstract Background Patients with metabolic syndrome (MS) have a higher incidence of cardiovascular disease (CVD), but the possible mechanisms are not fully understood and further exploration of the possible factors influencing the high incidence of CVD in patients with MS is still needed. Objectives This study aims to examine the association between fetal famine exposure and the risk of CVD in adulthood with MS. Methods Of 13,744 MS patients free of CVD selected from the Kailuan Study in 2006 (referred as the baseline survey) were included in the study. China suffered a severe famine from 1959 to 1962, so the participants born during this period were classified as the uterine famine exposed group. All patients were born between January 1, 1949, and December 31, 1974. Based on the date of birth, all patients were divided into the no-exposed group (born between January 1, 1963, and December 31, 1974), uterine famine exposed group (born between January 1, 1959 and December 31, 1962), and childhood famine exposed group (born between January 1, 1949 and December 31, 1958). After following up to December 31, 2019, the weighted Cox regression analysis model was used to calculate the effect of early life famine exposure in MS individuals on the risk of CVD in adulthood. Results During the 12.12 years of follow-up, the incidence of CVD was 5.87%, 10.13%, and 10.90% in the no-exposed group, uterine famine exposed group, and childhood famine exposed group, respectively. Compared with participants in the no-exposed group, the CVD risk and stroke risk increased in participants in the uterine famine exposed group (for CVD, HR: 1.32, 95% CI 1.04–1.67; for stroke, HR:1.37, 95% CI 1.05–1.79), but not in childhood famine exposed group. However, the increased CVD risks were only observed in females or smokers. No increased MI risks were observed for participants in the uterine famine exposed group or childhood famine exposed group. Conclusions Our findings suggested that exposure to famine during uterine life might increase the risk of CVD in adulthood in participants with MS.

Background: Lifestyles generally change across the life course yet no prospective study has examined direct associations between healthy lifestyle trajectories and subsequent cardiovascular disease (CVD) or all-cause mortality risk. Methods: Healthy lifestyle score trajectories during 2006–2007, 2008–2009, and 2010–2011 were collated through latent mixture modeling. An age-scale based Cox proportional hazard regression model was implemented to calculate hazard ratios (HR) with corresponding 95% confidence intervals (CI) for developing CVD or all-cause mortality across healthy lifestyle trajectories. Results: 52,248 participants were included with four distinct trajectories identified according to healthy lifestyle scores over 6 years i.e., low-stable ( n = 11,248), high-decreasing ( n = 7,374), low-increasing ( n = 7,828), and high-stable ( n = 25,799). Compared with the low-stable trajectory, the high-stable trajectory negatively correlated with lower subsequent risk of developing CVD (HR, 0.73; 95% CI, 0.65–0.81), especially stroke (HR, 0.70; 95% CI, 0.62–0.79), and all-cause mortality (HR, 0.89; 95% CI, 0.80–0.99) under a multivariable-adjusted model. A protective effect for CVD events was observed only in men and in those without diabetes, while a reduced risk of all-cause mortality was observed only in those older than 60 years, though interactions were not statistically significant. Marginally significant interactions were observed between the changing body mass index (BMI) group, healthy lifestyle score trajectories and stratified analysis. This highlighted an inverse correlation between the high-stable trajectory and CVD in BMI decreased and stable participants as well as all-cause mortality in the stable BMI group. The low-increasing trajectory also had reduced risk of CVD only when BMI decreased and in all-cause mortality only when BMI was stable. Conclusions: Maintaining a healthy lifestyle over 6 years corresponds with a 27% lower risk of CVD and an 11% lower risk in all-cause mortality, compared with those engaging in a consistently unhealthy lifestyle. The benefit of improving lifestyle could be gained only after BMI change is considered further. This study provides further evidence from China around maintaining/improving healthy lifestyles to prevent CVD and early death.

Background: The reference intervals of thyroid hormone will change at different stages of pregnancy because of physiological alterations. On the other hand, the reference intervals of hyroid hormone will also change in different detection systems due to manufacturer’s methodology as well as different race. The objective in this study was to establish the assay method- and trimester-specific reference intervals for thyroid stimulating hormone, free thyroxine, and free triiodothyronine for pregnant women in the Chengdu. Methods: A prospective, population-based cohort study involved 23701 reference samples of pregnant women during the three trimesters and 8646 non-pregnant women with pre-pregnancy clinical and laboratory tests. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid stimulating hormone, free thyroxine, and free triiodothyronine at each trimester of pregnant women according to ATA Guidelines. Results: The reference interval of thyroid stimulating hormone in the 2.5th and 97.5th percentiles has a significant increasing trend from first trimester, to second trimester, and to third trimester, which was 0.08-3.79 mIU/L for first trimester, and 0.12-3.95 mIU/L for second trimester, and 0.38-4.18 mIU/L for third trimester, respectively ( P < 0.001). However, the reference intervals of free thyroxine and free triiodothyronine in the 2.5th and 97.5th percentiles have significant decreasing trends from first trimester, to second trimester, and to third trimester, which were 11.87-18.83 pmol/L and 3.77-5.50 pmol/L for first trimester, and 11.22-18.19 pmol/L and 3.60-5.41 pmol/L for second trimester, and 10.19-17.42 pmol/L and 3.37-4.79 pmol/L for third trimester, respectively (both P < 0.001). Conclusion: It is necessary to establish assay method- and trimester-specific reference intervals for thyroid stimulating hormone, free thyroxine, and free triiodothyronine because the reference intervals of these thyroid hormones are significantly different at different stages of pregnancy.

Background: No study has explored the modification effect of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and risk of cardiovascular disease (CVD) so far. We aim to examine the effect of ICVHMs on the association between exposure to famine early in life and the risk of CVD in adulthood. Methods: A total of 61,527 participants free of CVD were included in this study from the Kailuan Study. All participants were divided into three groups, included nonexposed, fetal-exposed, and childhood-exposed groups. Cox regression was used to estimate the effect of famine exposure and ICVHMs on CVD risk. Results: After a median of 13.0 (12.7–13.2) years follow-up, 4,814 incident CVD cases were identified. Compared with nonexposed participants, the CVD risk increased in participants with fetal famine exposure (hazard ratio [HR]: 1.21; 95% CI: 1.07–1.37), but not in childhood famine-exposed participants. After stratifying by the number of ICVHMs, the increased CVD risk associated with fetal famine exposure was only observed in participants with less ICVHMs ( ≤ 2) (HR: 1.30; 95% CI: 1.11–1.52, P for interaction=0.008), but disappeared in those with three or more ICVHMs. The modified effect of ICVHMs was sex specific (P for sex interaction = 0.031). Conclusions: Exposing to famine in the fetal period could increase the risk of CVD in late life; however, ICVHMs might modify the effect of famine exposure on CVD risk, especially in men.

Li et al. pointed out that the uncontrolled age differences between exposed and control groups in our study may explain most of effects attributed to the famine. Due to the inherent limitations of the study, the age of the participants differs between groups in our study. The fetal famine-exposed group and early-childhood famine-exposed group were 3 or 6 years older respectively than the unexposed group. As stated by Li et al., the incidence of ischemic stroke increases with age, the effect of Chinese famine on risk of ischemic stroke may be attributed to the uncontrolled age differences.

BACKGROUND AND PURPOSE:Epidemiological studies have reported an association between famine exposure and increased risk of cardiovascular disease. However, it is unclear whether fetal exposure to the Great Chinese Famine of 1959 to 1961 was associated with risk of ischemic stroke in midlife.METHODS:A total of 17,787 participants of the Kailuan study, who were free of cardiovascular disease and cancer at baseline (2006) were enrolled in the study. All participants were divided into three groups: unexposed (born between 1 October 1962 and 30 September 1964, used as the reference group in current analyses), fetal exposure (born between 1 October 1959 and 30 September 1961), and early childhood exposure (born between 1 October 1956 and 30 September 1958). Incident ischemic stroke cases between 2006 and 2017 were confirmed by review of medical records. Cox proportional hazards regression was applied to analyze the effect of fetal famine exposure on ischemic stroke risk.RESULTS:During the mean (10.4 ± 2.2) years of follow-up, 547 incident ischemic stroke cases were identified. After adjustment for potential confounders, the hazard ratio (HR) for ischemic stroke was 1.45, and the 95% confidence interval (CI) was 1.14, 1.84 for fetal famine-exposed compared with unexposed individuals. Similar associations were observed in men (adjusted HR: 1.40; 95% CI: 1.08, 1.80) and overweight individuals (adjusted HR: 1.56; 95% CI: 1.18, 2.07), but not in their counterparts. The results of the early childhood-exposed group were similar to the above.CONCLUSIONS:Our findings support an association between fetal malnutrition and higher risk of ischemic stroke in adulthood.

Background and aims: Undernutrition in early life may have a lifelong effect on adult health. The conclusions on the association of exposure to famine with the risk of hypertension were inconsistent. The aim of this study was to examine the association of exposure to the Chinese famine with incident hypertension. Methods and results: Data were obtained from the China Health and Nutrition Survey. All included participants were divided into five birth cohorts: no exposure, born in or after 1962 (N = 2 088); fetal exposure, between 1959 and 1961 (N = 880); early childhood exposure, between 1956 and 1958 (N = 1 214); mid-childhood exposure, between 1953 and 1955 (N = 1 287); and late childhood exposure, between 1949 and 1952 (N = 1 445). Hypertension was defined as SBP/DBP >= 140/90 mmHg, use of hypertensive medications, or a self-reported diagnosis. A total of 6 914 participants were included. The exposure to famine decreased the incidence of hypertension (P = 0.0018, 0.0001, <0.0001, and <0.0001; HR: 0.715, 0.686, 0.622, and 0.527, respectively) in males. Similarly, the exposure to famine might also decrease incident hypertension in the rural areas (P = 0.0013, < 0.0001, < 0.0001, and < 0.0001; HR: 0.735, 0.706, 0.679, and 0.539, respectively). There were interaction effects between famine severity and exposure to famine in early (P = 0.024) and late childhood (P = 0.009). Conclusion: Exposure to the Chinese famine decreased the incidence of hypertension, especially in males and in the rural areas. Furthermore, the exposure postponed the age at the onset of hypertension. (C) 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Four styles of work not only affect the Party's work, but also affect the improvement of the quality of the frontline teachers at universities and colleges and the improvement of teaching quality. This paper conducts an in-depth analysis of the four styles of work existing in the frontline teachers at universities and colleges and their impact. And appropriate corrective measures and methods are proposed, which is not only conducive to the development of teachers themselves, but also conducive to the improvement of teaching standards, helping to train talents, thus promoting the healthy development of society and science.

This study explored the factors that influence respondents' willingness to pay (WTP) for CO2 mitigation under climate change. A questionnaire survey combined with contingent valuation and psychometric paradigm methods were conducted in the city of Suzhou, Jiangsu Province in China. Respondents' traditional demographic attributes, risk perception of greenhouse gas (GHG), and attitude toward the government's risk management practices were established using a Tobit model to analyze the determinants. The results showed that about 55% of the respondents refused to pay for CO2 mitigation, respondent's WTP increased with increasing CO2 mitigation percentage. Important factors influencing WTP include people's feeling of dread of GHGs, confidence in policy, the timeliness of governmental information disclosure, age, education and income level.

OBJECTIVE:To evaluate the effect of CYP11B2 gene -344T/C polymorphism on renin-angiotensin-aldosterone system (RAAS) activity and blood pressure in response to hydrochlorothiazide (HCTZ) treatment in Han Chinese patients with essential hypertension.METHODS:Eight hundred and twenty-nine patients with mild/moderate essential hypertensive were enrolled. All subjects had their antihypertensive medications withdrawn. After two weeks of wash-out period with placebo, each patient was given 12.5 mg of HCTZ per day for the next six weeks. Physical, biochemical measurements, and the activity of RAAS were taken at the end of the wash-out period (baseline) and 6-week diuretic therapy period. Changes in systolic and diastolic blood pressure were analyzed for association with interaction between genotypes at CYP11B2 -344T/C polymorphism and gender.RESULTS:A total of 776 patients completed the study. 17.5% of subjects have achieved blood pressure normalization after six weeks treatment. For male patients, the aldosterone level with CC genotype was significantly higher than that of those with TT or TC genotype. Following the HCTZ treatment, the blood pressure response in patients with CC genotype was less obvious than that in others, whilst the increase of aldosterone level was greater. For female patients, no association was found between CYP11B2 -344T/C polymorphism and aldosterone level. Following the HCTZ treatment, the blood pressure response in patients with CC genotype was greater than others, whilst the increase of aldosterone activity was less apparent.CONCLUSION:In males, the -344T/C polymorphism of CYP11B2 gene is associated with aldosterone level, and the change of aldosterone level was greater, the blood pressure response was weaker after HCTZ treatment. In females, there was no association between this polymorphism and aldosterone level. The change of aldosterone level and blood pressure response to HCTZ were different from that in males.

OBJECTIVE:To carry out a nationwide epidemiologic survey on the neonates in urban hospitals with an attempt to understand the disease spectrum and treatment outcomes of hospitalized neonates in China.METHODS:The clinical data of 43,289 hospitalized neonates from 86 hospitals in 47 Chinese cities (22 provinces) between January 1, 2005 and December 31, 2005 were retrospectively analyzed.RESULTS:The male:female ratio was 1.73:1. Premature infants accounted for 26.2% of the hospitalized neonates, which was higher than that reported in 2002 (19.7%). The top three diseases during the neonatal period were jaundice, pneumonia, and hypoxic-ischemic encephalopathy. The incidences of pneumonia, meconium aspiration syndrome, and bilirubin encephalopathy in term infants were higher than those in premature infants, while the incidences of asphyxia, respiratory distress syndrome, and pulmonary hemorrhage in term infants were lower than those in premature infants. The incidences of asphyxia, small for gestational age infant, and wet lung were higher in neonates whose mother had pregnancy induced hypertension. The outcomes of these hospitalized neonates included: recovered, 63.9%; improved, 27.3%; discharged due to the family's own decisions, 7.6%, and died, 1.2%. Nearly half (46.4%) of the neonatal death occurred within 24 hrs after admission.CONCLUSION:The incidence of premature birth shows an increasing trend among hospitalized neonates. Since the neonatal deaths mainly occur within 24 hrs after admission, monitoring during this period should be enhanced.

To evaluate the interaction between the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and gender with individual blood pressure response to hydrochlorothiazide (HCTZ) in hypertensives, we enrolled 829 mild-moderate hypertensive patients. All subjects were given HCTZ (12.5 mg) orally each day for 6 weeks. A total of 776 patients completed the study. There was statistically significant interaction between the effects of genotype and gender on systolic (P = 0.002) and diastolic (P = 0.048) response after adjusting for covariables. Moreover, in each gender, the genotype that was associated with the greatest blood pressure response to HCTZ (DD homozygotes in men and II homozygotes in women) was also associated with the greatest increase in serum ACE activity in response to HCTZ. The results suggest that the I/D polymorphism of the ACE gene is associated with interindividual differences in the blood pressure response to a low dose of a diuretic in a gender-specific manner in the Han Chinese population with hypertension.