Background Although previous studies have suggested that left ventricular ejection fraction (LVEF) adjusted by left ventricular mass (LVM) might improve prognostic risk stratification of cardiac events, few prospective cohort studies have examined its clinical implications. We assessed the predictive ability of LVEF indexed to LVM, body surface area (BSA), and body mass index for the cardiac event risk. Methods We conducted a 5.52‐year cohort study on the association between LVEF indexed to LVM and cardiac events among 4266 participants with mildly reduced or preserved LVEF. Multivariable Cox regression analysis incorporating restricted cubic spline functions evaluated the predictive ability of LVEF, LVEF/LVM, and other indexed measures. Results After multivariable Cox regression adjustment, LVEF/LVM, LVEF/LVM/BSA, and LVEF/LVM/body mass index remained significantly associated with cardiac events (all P<0.05), whereas LVEF alone was not (P=0.569). Restricted cubic spline analysis identified a nonlinear approximately U‐shaped relationship for both LVEF/LVM and LVEF/LVM/BSA (both P for nonlinearity<0.001). Compared with the middle reference group, participants in the low LVEF/LVM (hazard ratio [HR], 2.00 [95% CI, 1.08–3.71]) and low LVEF/LVM/BSA (HR, 2.13 [95% CI, 1.11–4.07]) groups had significantly higher risks. While the high groups showed nonsignificant differences (LVEF/LVM: HR, 1.41 [95% CI, 0.68–2.95]; LVEF/LVM/BSA: HR, 1.39 [95% CI, 0.65–2.99]), the observed risk pattern indicated that values outside the ranges of 4.72 to 5.53/kg (LVEF/LVM) and 19.7 to 24.3 m2/kg2 (LVEF/LVM/BSA) suggested a higher cardiac event risk. Conclusions LVEF indexed to LVM provides better cardiac event risk stratification than LVEF alone in individuals with mildly reduced or preserved ejection fraction.

Objectives Ischemic cerebrovascular disease (ICVD) is one of the most common and severe complications in systemic lupus erythematosus (SLE). We aim to explore the risk factors for ICVD in SLE and to assess their associated clinical characteristics. Methods In this study, 44 lupus patients with ICVD (ICVD-SLE) and 80 age- and sex-matched lupus patients without ICVD (non-ICVD-SLE) who were hospitalized in our center between 2014 and 2021 were enrolled. A comprehensive set of clinical and socio-demographic data was recorded. In the ICVD-SLE group, the modified Rankin score (mRS) at 90 days after the occurrence of ICVD, the brain MRI, and arterial ultrasonography findings were collected. Group comparisons were made with continuous variables using an independent t-test or the Mann–Whitney test, and with categorical variables using the chi-square test or Fisher exact test. Multivariate logistic regression analysis was performed to identify the risk factors for ICVD in SLE. Patients with ICVD-SLE were divided into three subgroups according to the gradations of intracranial arterial stenosis (ICAS). The subgroup comparisons were performed by one-way ANOVA test or Kruskal–Wallis test. Results Of the 44 patients with ICVD, 45% had a large-vessel ischemic stroke, 50% had a symptomatic lacunar stroke, and 9% had a transient ischemic attack. 2 (4.5%) had both large-vessel ischemic stroke and symptomatic lacunar stroke. Multivariate logistic regression analysis showed that cutaneous vasculitis (OR=7.36, 95% CI=2.11–25.65), anticardiolipin antibody (aCL) (OR=4.38, 95% CI=1.435–13.350), and lupus anticoagulant (LA) (OR=7.543,95% CI=1.789–31.808) were the risk factors, and hydroxychloroquine (HCQ) therapy (OR=0.198, 95% CI=0.078–0.502) was the protective factor, after controlling for confounders. During the analysis of the subgroups, no significant difference was observed between the patients in the group without internal carotid arterial occlusion (ICAS) and those with severe ICAS except for diagnostic delay. However, patients in the moderate ICAS group were older when SLE occurred (P<0.01), had a longer diagnostic delay (P<0.01), a lower percentage of hypocomplementemia (P=0.05) and steroids and HCQ therapy (P=0.01, P=0.05, respectively), a trend toward lower mRS score, but a higher incidence of carotid atherosclerotic plaque (P<0.01), when compared with the other two subgroups. Conclusion Cutaneous vasculitis and antiphospholipid antibodies (aPLs) are associated with an increased risk of ICVD, while HCQ therapy may provide protection against ICVD in SLE. The ICVD in younger lupus patients is associated with complement-mediated inflammation and poorer outcome, and require immunosuppressive therapy, whereas the ICVD in elderly patients are characterized by moderate ICAS and carotid atherosclerotic plaques.

The prevalence and risk factors of intracranial atherosclerotic stenosis (ICAS) located in the anterior circulation (AC) and posterior circulation (PC) has been scarcely noted in the general population. We aimed to determine ICAS prevalence and risk factor profile of AC and PC in a representative population. Data were from the China Hypertension Survey of Beijing. In total, 4800 people aged 35 years or older were enrolled in this subsurvey for ICAS, and 3954 participants were eligible for analysis. ICAS was assessed by transcranial Doppler. The prevalence of ICAS in AC was much greater than that in PC (11.9% vs. 4.2%), and subjects with ICAS in PC were 3.9 years older than those with ICAS in AC. Multivariable logistics regression showed that the odds of hypertension and diabetes increased by 79% (OR: 1.79, 95% CI: 1.40–2.27) and 35% (OR: 1.35, 95% CI: 1.04–1.75) in those with AC vascular lesions and by 3.35 times (OR: 3.35, 95% CI: 2.49–4.50) and 71% (OR: 1.71, 95% CI: 1.19–2.46) in those with PC vascular lesions compared with those without vascular lesions. Most modifiable vascular risk factors for ICAS appeared to exert similar magnitudes of risk for PC to AC lesions.

Abstract The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure (PP) is still controversial. Using data from 1257 participants without a history of cardiovascular disease, who were followed for 4.84 years, we performed multivariable Cox regression analyses to assess how systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP contribute to risks of cardiovascular events and all‐cause death. Among all participants, SBP and PP were significantly associated with the risks of cardiovascular events and all‐cause death (all p < .05). DBP was not significantly associated with the risk of all‐cause death; rather, it was only associated with a marginally significant 1% increased risk for cardiovascular events (p = 0.051). In participants aged < 65 years, DBP was significantly associated with a 3% increased risk for cardiovascular events (hazard ratio [HR]: 1.03, 95% confidence interval [95% CI]: 1.01–1.06). The association between PP and cardiovascular events appeared to be J‐shaped in comparison to participants with the lowest‐risk PP (50–60 mmHg), with adjusted HRs of 1.71 (95% CI: 1.03–2.85), 1.63 (95% CI: 1.00–2.68), and 2.13 (95% CI: 1.32–3.43) in the <50, 60.0–72.5, and ≥72.5 mmHg subgroups, respectively. The optimal cutoff points of a wide PP for predicting the risks of cardiovascular events and all‐cause death were 70.25 and 76.25 mmHg, respectively. SBP and PP had a greater effect on cardiovascular risk, whereas DBP independently influenced cardiovascular events in middle‐aged participants. Considerable PP alterations should be avoided in antihypertensive treatment.

BACKGROUNDIncreased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.METHODSThis prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death.RESULTSOver a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01−2.08) for incident CVD events and 1.55 (95% CI: 1.04−2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28−4.65), 2.07 for stroke events (95% CI: 1.01−4.29), 8.33 for coronary events (95% CI: 1.10−63.11), and 2.31 for all-cause death (95% CI: 1.15−4.62).CONCLUSIONSHyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Objective: To explore the association of depression, as well as untreated hypertension or diabetes with all-cause death in community-based postmenopausal women in Beijing.Methods: A cohort of 863 community-based postmenopausal women with no history of cardiovascular heart disease (CHD), stroke, cancer, or dementia was investigated on 20 July-28 September 2009 at baseline. Depression was diagnosed using the 30-item Center for Epidemiologic Studies Depression (CES-D) scale with CES-D >= 11. Meanwhile, data on health behavior, physical comorbidity, and social support at baseline were collected. These individuals were followed up from 20 July to 30 August 2014. All-cause mortality and cause of death were surveyed.Results: After a median follow-up of 4.97 years, 120 subjects died of all-cause. Twenty-four died of stroke, 19 died of myocardial infarction, 21 died of cancer. The others died of aging, infection, and accident. Depression and untreated HP were significantly associated with all-cause mortality in Cox models after full adjustment for all of the potential confounders (Depression HR: 2.16, 95%CI: 1.35-3.46; Untreated hypertension HR: 1.84, 95%CI: 1.12-3.02). However, negative correlation of untreated diabetes on all-cause mortality was observed in this population (HR: 1.36, 95%CI: 0.75-2.49). When depression was co-existing with hypertension/diabetes, the HR for mortality elevated significantly (Depression co-existing with hypertension HR = 3.87, 95% CI: 2.07-7.23; Depression co-existing with diabetes HR = 5.02, 95% CI: 1.5-16.79).Conclusions: It is suggested we should take sufficient care of postmenopausal females with depression and control blood pressure and glucose more effectively.

Objective:To explore the diagnostic value of the serial position effect combined with delayed recall of auditory verbal learning test in diagnosing the elderly patients with different levels of cognitive impairment.Methods:A total of 310 subjects were enrolled and divided into three groups: the normal control group(NC group, n=128), the mild cognitive impairment group(MCI group, n=133)and the mild Alzheimer's disease group(mild AD group, n=149)matched for gender, age and education level.Comprehensive neuro-psychological tests were performed on all subjects, and the Auditory Verbal Learning Test-Huashan version(AVLT-H)was used to analyze the serial position effect.Results:There were significant differences in the primacy effect of the second and third time of immediate recall, short-term and long-term delayed recall among the three groups( P<0.05), but no difference was found in the recency effect between the MCI and mild AD groups( P>0.05). The long-term delayed primacy effect combined with the short-term delayed recall showed a better validity to distinguish those elderly subjects with different levels of cognitive impairment than other memorial indexes, and the correlative sensitivity and specificity were 83.21% and 71.43%(NC group vs.MCI group), 85.71% and 92.86%(NC group vs.mild AD group), 66.67% and 75.57%(MCI group vs.mild AD group), respectively. Conclusions:The long-term delayed primacy effect combined with the short-term delayed recall can assist in distinguishing elderly patients with different levels of cognitive impairment.

目的 系统评价连花清瘟胶囊/颗粒临床应用中的药品不良反应(adverse drug reaction,ADR)报告率及特征.方法 检索收集中国知网、万方数据、维普网、SinoMed数据库和PubMed、Embase从建库至2020年7月7日中有关连花清瘟胶囊/颗粒ADR研究,并对ClinicalTrials.gov及中国临床试验注册中心相关注册研究进行了筛查,对符合纳入标准的文献用Cochrane ADR方法组评估伤害证据质量要素的推荐意见评价文献质量,并用STATA软件进行单组率Meta分析.结果 共纳入180项试验,12039例患者,报告ADR 531例,总ADR报告率为2.37％(95％CI:1.64％～3.21％).ADR报告率随发表时间逐渐升高,尤其是随机对照试验(RCT)研究.ADR主要症状为胃肠系统损害(361例/67.98％)、神经系统损害(36例/6.78％)和皮肤及其附件损害(29例/5.46％).联合用药(2.79％)较单用连花清瘟(1.92％)ADR报告率高.结论 应加强连花清瘟在临床使用过程中的用药监测,以减少ADR发生.

目的 探讨北京市年龄≥35岁人群高血压与外周动脉疾病(PAD)的关系.方法 2013年7月至2014年12月采用分层多阶段随机抽样的方法对北京四个区县年龄≥35岁居民进行上臂血压及踝臂血压测量,共检测5 126人.结果 高血压组PAD的患病率明显高于无高血压组(6.5％比3.1％,P＜0.05).Logistic回归分析结果显示,在校正年龄、性别、体质量指数(BMI)、吸烟、糖尿病、血脂代谢异常以及降压药物的使用后,与正常血压人群相比,正常高值、1级高血压、2级高血压、3级高血压其患PAD的OR(95％ CI)分别为1.38(0.87～2.19)、1.68(1.04～2.73)、2.10(1.18～3.73)、5.08(2.57～10.08).将收缩压设定为连续变量分析,结果显示收缩压每升高10 mm Hg,PAD患病风险增加19％ (OR=1.19,95％CI 1.09～1.30);收缩压为120～139、140～159、≥160 mm Hg组患PAD的风险分别为收缩压＜120 mm Hg组的1.29(95％ CI 0.83～2.01)、1.61(95％ CI 1.01～2.60)、2.75(95％ CI 1.65～4.60);趋势检验P＜0.001;而PAD患病风险与舒张压则关系不明显.在高血压患者中,高血压未治疗组、治疗后未达标组、治疗达标组的PAD患病风险分别为无高血压组的1.45(0.98～2.14)、1.93(1.34～2.78)、1.23(0.83～1.82).结论 高血压可增加PAD患病风险,收缩压升高为PAD的独立危险因素;控制高血压患者升高的血压可以控制PAD患病的风险.

The association between blood pressure and intracranial artery stenosis (ICAS) in different age groups has not been elucidated. Using data from the "China Hypertension Survey," we conducted a cross-sectional analysis of the association between blood pressure parameters and ICAS. In this study, participants older than 35 years were selected by stratified, multistage random sampling. Blood pressure was measured repeatedly at rest, and ICAS was assessed by transcranial doppler ultrasound. Binary logistic regression analysis was used to demonstrate the association between different blood pressure indicators and ICAS. Of the 3640 participants included (mean age 63 +/- 13 years old, 57.8% female), systolic blood pressure (SBP) and pulse pressure (PP) were associated with ICAS in the general population; the multivariable adjusted odds ratio (OR) and corresponding 95% confidence interval (95% CI) of ICAS and multivessel stenosis were 1.32 (1.21, 1.45) and 1.29 (1.14, 1.46) per standard deviation (SD) increase in SBP and 1.44 (1.30, 1.59) and 1.52 (1.33, 1.74) for PP, respectively. Further analysis of this association in different age groups revealed inconsistent results between SBP and ICAS. Prehypertension (120 <= SBP < 140) could predict ICAS in the older group but not in the younger group, and the positive association between SBP and multivessel stenosis disappeared in the younger age group (P > .05 in all SBP subgroups). In conclusion, SBP and PP could not only identify ICAS in the middle-aged and elderly population but could also provide some information about ICAS burden; however, these associations need to be interpreted differentially based on age subgroup.

Background/objectives: Functional disability (FD) is common after stroke and associated with the occurrence of future adverse events; however, whether FD is as strong a risk factor as comorbid vascular risk factors for cardiovascular events and death is unclear. Methods: Consecutive patients 3-6 months after index ischemic stroke were assessed at baseline and followed up for documented new cardiovascular events (recurrent stroke, acute myocardial infarction, and sudden death) and death within 5 years. Comorbidity of vascular risk factors was stratified as low or intermediate-to-high risk according to the Stroke Prognostic Instrument II. Four mutually exclusive cohorts were identified (1) intermediate-to-high risk only, n = 505, (2) FD only, n = 78, (3) both intermediate-to-high risk and FD, n = 264, and (4) low risk and no FD, n = 240. Results: The incidence of cardiovascular events was lowest in patients free of FD with low risk, followed by patients with FD alone, intermediate-to-high risk alone, and both. Compared with intermediate-to-high risk only, patients free of FD with low risk had a significantly lower adjusted hazard ratio (HR) (HR: 0.56, 95% confidence interval [CI]: 0.33-0.94), patients with FD only had a similar HR (HR: 0.47, 95% CI: 0.19 -1.18), and patients with both FD and intermediate-to-high risk had a significantly higher HR (HR: 2.13, 95% CI: 1.53-2.98) of cardiovascular events. A similar trend but a larger HR was noted for all-cause death. Conclusion: FD 3-6 months after ischemic stroke is a risk equivalent to comorbidity of conventional vascular risk factors for the incidence of cardiovascular events and mortality of all-cause death.

BACKGROUND:The association between homocysteine and cardiovascular diseases (CVD) and all-cause death was inconclusive. A community-based prospective cohort study was carried out in Beijing to evaluate this association in elderly population for more effective clinical prediction and primary prevention of CVD.PATIENTS AND METHODS:Participants were randomly selected from Beijing, China. Questionnaire survey, physical examinations, and laboratory tests were carried out to collect baseline information and investigate clinical characteristics. Each participant was predetermined to be followed by 5 years. CVD events and death were collected as primary variables. A Cox regression analysis was performed to assess the risk of CVD events, CVD death, and all-cause death contributed by homocysteine as well as some other risk factors.RESULTS:A total of 1257 participants with an average age of 69.16 years were enrolled in this study. After adjusting for confounders, the hazard ratios (HRs) and 95% confidence intervals of CVD event, CVD death, and all-cause death caused by intermediate-to-severe hyperhomocysteinemia as compared with normal homocysteine levels were 1.68 (95% CI 1.06-2.67), 1.97 (95% CI 0.95-4.29) and 2.02 (95% CI 1.26-3.24), respectively. Intermediate-to-severe hyperhomocysteinemia increased the risks of CVD event (HR 2.07, 95% CI 1.01-4.26) and all-cause death (HR 3.08, 95% CI 1.56-6.07) among male participants. However, the positive association was not statistically significant among female participants (HR 1.59, 95% CI 0.83-3.04 for CVD event and HR 0.90, 95% CI 0.52-6.07 for all-cause death). Every 5μmol/L increment in homocysteine concentration was shown to be associated with a 4% (HR 1.04, 95% CI 1.01-1.07) and 5% (HR 1.05, 95% CI 1.01-1.07) higher risk of CVD events and all-cause death in all participants. There was no significant association between moderate hyperhomocysteinemia and the risk of the CVD events and all-cause death.CONCLUSION:Intermediate-to-severe hyperhomocysteinemia was significantly associated with CVD events and all-cause death in elderly population without a history of ischemia or congestive heart failure (CHF). The positive association was pronounced among males.

A stroke prediction model based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project was developed. We compared its predictive ability with the revised Framingham Stroke Risk Score (R-FSRS) for 5-year stroke incidence in a community cohort of Chinese adults, namely the Beijing Longitudinal Study of Aging (BLSA). Calibration, discrimination, and recalibration were used to compare the predictive ability between the two prediction models. Category-less net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values were also assessed. During a mean follow-up duration of 5.1 years, 106 incidents of fatal or non-fatal strokes occurred among 1,203 participants aged 55–84 years. The R-FSRS applied to our cohort underestimated the 5-year risk for stroke in men and women. China-PAR performed better than the R-FSRS in terms of calibration (men, R-FSRS: χ2-value 144.2 [P < 0.001], China-PAR: 10.4 [P = 0.238]; women, R-FSRS: 280.1 [P < 0.001], China-PAR: 12.5 [P = 0.129]). In terms of discrimination, R-FSRS and China-PAR models performed modestly in our cohort (C-statistic 0.603 [95% CI: 0.560–0.644] for men using China-PAR and 0.568 [95% CI: 0.524–0.610] using the R-FSRS; the corresponding numbers for women were 0.602 [95% CI: 0.564–0.639] and 0.575 [95% CI: 0.537–0.613). The recalibrated China-PAR model significantly improved the discrimination in C statistics and produced higher category-less NRI and IDI for stroke incidence than the R-FSRS. Although China-PAR fairly estimated stroke risk in our cohort, it did not sufficiently identify adults at high risk of stroke. Caution would be exercised by practitioners in applying the original China-PAR to Chinese older adults. Further studies are needed to develop an adequate prediction model based on the recalibrated China-PAR or to find new risk markers which could upgrade this model.

Aim: To evaluate the association between kidney dysfunction and cardiovascular disease (CVD) events in a middle-aged and elderly population in China. Materials and methods: In July 2009, a baseline survey of health status was performed in adults aged 55 years and older from Beijing, China. Occurrence of CVD events and mortality in subjects free of CVD at baseline was recorded in a 5-year follow-up period until December 2014. The association of mild (eGFR(CKD-EPI) 45 - 59 mL/min/1.73m(2)) and moderate to severe (eGFR(CKD-EPI) < 45 mL/min/1.73m(2)) kidney dysfunction with adverse outcomes were analyzed with Cox regression analysis. Results: A total of 1,257 subjects were included in the final analysis. The risk of CVD events in those with mild kidney dysfunction increased by 65% (HR: 1.65, 95% CI: 1.04 - 2.62) as compared to those with normal kidney function. Subjects with both hypertension and CKD experienced more significantly increased risk of CVD events (adjusted HR = 1.87, 95% CI 1.17 - 2.97) and stroke (adjusted HR = 2.24, 95% CI 1.24 - 4.04). Pulse pressure (PP) >= 60 mmHg was the strongest risk factor for stroke in patients with CKD, with the adjusted HR value of 1.98 (95% CI 1.08 - 3.64). Conclusion: Moderate to severe kidney dysfunction was an independent risk predictor of CVD events. Among subjects with hypertension or poorly controlled blood pressure level, the presence of CKD significantly increased the risks of CVD events and stroke.

Urinary Alzheimer-associated neuronal thread protein (AD7c-NTP) is elevated in early Alzheimer's disease (AD) and mild cognitive impairment, and is considered a biomarker for the early diagnosis of AD. However, it has not yet been investigated whether urinary AD7c-NTP is elevated with increases in blood biochemical indicators related to AD risk factors. We recruited 2180 participants, aged 35-93 years, from communities of four districts in Beijing. Blood biochemical indicators, including blood glucose, blood lipids, renal function, and highsensitivity C-reactive protein, were measured using routine methods. Urinary AD7c-NTP was detected using an enzyme-linked immunosorbent assay AD7c-NTP kit. In the general population, there were no significant differences in urinary AD7c-NTP levels in subjects with different Mini-Mental State Examination levels or C-reactive protein values. After adjusting for age and sex, there were significant differences in urinary AD7c-NTP levels between different education levels, marital statuses, blood glucose, blood lipids, and kidney function. There was a negative correlation between urinary AD7c-NTP levels and serum creatinine (r = -0.128). There was a positive correlation between urinary AD7c-NTP levels and HbA1c (r = 0.104), insulin (r = 0.101), and triglycerides (r = 0.093). Urinary AD7c-NTP might be useful as a potential indicator to predict AD risk.

Objective: Obesity-related disease risks may vary depending on whether the subject has metabolically healthy obesity (MHO) or metabolically unhealthy obesity (MUO). At least 5 definitions/criteria of obesity and metabolic disorders have been documented in the literature, yielding uncertainties in a reliable international comparison of obesity phenotype prevalence. This report aims to compare differences in MHO and MUO prevalence according to the 5 most frequently used definitions. Methods: A random sample of 4,757 adults aged 35 years and older (male 51.1%) was enrolled. Obesity was defined either according to body mass index or waist circumference, and the definitions of metabolic abnormalities were derived from 5 different criteria. Results: In MHO, the highest prevalence was obtained when using the homeostasis model assessment (HOMA) criteria (13.6%), followed by the Chinese Diabetes Society (11.4%), Adult Treatment Panel III (10.3%), Wildman (5.2%), and Karelis (4.2%) criteria; however, the MUO prevalence had an opposite trend to MHO prevalence. The magnitude of differences in the age-specific prevalence of MHO and MUO varied greatly and ranked in different orders. The proportion of insulin resistance for MHO and MUO individuals differed significantly regardless of which metabolic criterion was used. Conclusion: The prevalence of MHO and MUO in the Chinese population varies according to different definitions of obesity and metabolic disorders.

BACKGROUND AND OBJECTIVES Previous studies on the importance of metabolic syndrome (MS) as a cardiovascular risk factor had not focused on older Chinese adults. The present study analyzed the association of MS with carotid atherosclerosis and the risk of cardiovascular events in Chinese adults. METHODS AND STUDY DESIGN Data of a representative cohort study with 5-year follow-up were used. Community-dwelling people (n=1257) aged ≥55 years without cardiovascular disease (CVD) at baseline were followed up from 2009 to 2014. MS was defined based on the Chinese Diabetes Society criteria under the Chinese Medical Association. Multiple regression analyses were performed to examine the associations of MS with atherosclerosis and CVD events, with adjustment for confounding factors. RESULTS In a multivariate logistic regression model with adjustment, MS was closely related to common carotid artery intima-media thickness (CCA-IMT) (1.62; 95% CI: 1.19-2.21) and carotid plaque presence (1.38; 95% CI: 1.01-1.89), but not with carotid artery stenosis. At the end of the 5-year follow- up, compared with subjects without MS, hazard ratios and 95% confidence intervals for the different risks in subjects with MS were 1.86 (1.02-3.29) for myocardial infarction (MI), 1.39 (1.01-2.05) for stroke, 1.52 (1.02- 2.37) for CVD death, and 1.13 (0.62-2.58) for total death, after adjusting for age, gender, smoking, drinking, physical activity, uric acid, high-sensitivity C-reactive protein, dietary factors and carotid atherosclerosis status. CONCLUSIONS MS was significantly associated with IMT and the presence of carotid plaque and with positively increased risks of MI, stroke, and CVD mortality independent of CVD risk factors in older Chinese adults.

目的 评价北京地区中老年人群肾功能水平及不同肾功能水平时心血管疾病(CVD)及其危险因素的患病情况.方法 采用分层、分段、随机、整群的抽样方法,抽取北京市怀柔区、大兴区、宣武区55岁及以上人群作为调查对象,于2009年7～9月对2468名55岁以上中老年人进行调查,其中完成实验室检查1458人,以这部分人群作为研究对象进行分析.以慢性肾脏病流行病学合作组(CKD-EPI)提出的CKD-EPI公式估算肾小球滤过率(eGFR),根据2012年全球改善肾脏病预后委员会(KDIGO)指南规定的慢性肾脏病(CKD)诊断及分期标准,将研究对象分为3组:肾功能正常组[eGFR≥60 ml/(min·1.73m2)],肾功能轻至中度损伤组[eGFR45～59 ml/(min·1.73m2)],肾功能中至重度损伤组[eGFR<45 ml/(min·1.73m2)],比较各组研究对象特征及不同肾功能水平相关CVD及其危险因素的患病情况.结果 ①1458名中老年人群中,eGFR平均值为(56.45±13.46)ml/(min·1.73m2),且eGFR平均值随着年龄的增长而降低.随着肾功能的减低,3组之间女性所占比率逐渐升高.②肾功能水平越低,高血压病、血脂紊乱、肥胖患者所占比率越高,3组间比较差异均具有统计学意义(P<0.01).③高血压患者肾功能水平低于非高血压患者,在心肌梗死患者、血脂紊乱患者和肥胖患者中亦得出同样的结果(P<0.01).结论 ①中老年人群肾功能水平普遍降低,并且随着年龄的增长呈现逐渐下降的趋势.②中老年人群中,肾功能水平的降低与CVD及其危险因素密切相关,说明在C K D患者中C V D普遍存在.

Background Hospital-acquired infection (HAI) is a serious complication of neurosurgery. In recent years, the medical body has paid increasing attention to this issue. Aim We investigated the status of HAIs in patients who had undergone surgery for intracranial aneurysms and analysed their risk factors. Methods A retrospective analysis was carried out on the medical records of 542 patients with intracranial aneurysms after they were admitted for neurosurgery at Xuanwu Hospital of Capital Medical University between January and December 2016. Cases studied were divided into an infection group and a control group. Logistic regression analysis of the data was carried out. Findings Of the 542 patients with intracranial aneurysms who underwent surgery, 77 HAIs occurred in 64 patients, with an infection prevalence of 11.8% and prevalence of infection cases of 14.2%. Logistic regression showed that an admission Glasgow Coma Scale (GCS) score of less than 8 points (odds ratio = 4.261, 95% confidence interval 1.102–16.476), hyperglycaemia (2.759, 1.159–6.564), hypothermia treatment (6.557, 2.244–19.159), and central venous catheterisation (CVC) (8.853, 2.860–27.398) were independent risk factors for HAIs in patients with intracranial aneurysm who underwent surgery. Conclusion Being comatose upon hospital admission, having hyperglycaemia or hypothermia, and indwelling CVC are major risk factors for HAIs in patients undergoing surgery for intracranial aneurysms.

We explored the bidirectional association between depressive symptoms and measures of carotid atherosclerosis. This study included 1155 participants aged 55 years and older. Depressive symptoms was assessed by 30-item Geriatric Depression Scale (GDS-30) score. Common carotid artery intima-media thickness (CCA-IMT), carotid plaques and carotid stenosis were measured at both common carotid arteries using an edge detection system. In part 1, we explored the risk of CCA-IMT on depressive symptoms. We identified a significantly increased risk of depressive symptoms with the severity of carotid atherosclerosis. ORs (95%CI) of CCA-IMT thickening, carotid plaque and carotid stenosis for depressive symptoms were 1.48(0.72-3.03), 2(1.03-3.85) and 5.29(2.16-12.97) comparing with normal CCA-IMT in adjusting all potential risk factors models. When using carotid atherosclerosis as a continuous variable, the OR for depressive symptoms was 1.32 (95%CI 1.16-1.49) with every 0.1mm elevated in CCA-IMT after adjustment for all potential confounders. In part 2, we explored the risk of depressive symptoms on carotid atherosclerosis. We found elevated depressive symptoms significantly increased the risk of carotid atherosclerosis in multi-factor adjusted models [OR (95%CI): 1.65(1.10-2.47)]. When using depressive symptoms as a continuous variable, the ORs for carotid artery atherosclerosis were 1.32 (95%CI 1.16-1.49) with every 1 GDS-30 score elevated after adjustment for all convenient risk factors. The current study demonstrated the bidirectional links of carotid atherosclerosis measures with depressive symptoms. More cohort study and clinical trial focusing on the issue need to be explored in the future.