An online cryogenic distillation system for the removal of krypton and radon from xenon was designed and constructed for PandaX-4T, a highly sensitive dark matter detection experiment. The krypton content in a commercial xenon product is expected to be reduced by 7 orders of magnitude with 99% xenon collection efficiency at a flow rate of 10 kg/h by design. The same system can reduce radon content in xenon by reversed operation, with an expected radon reduction factor of about 1.8 in PandaX-4T under a flow rate of 56.5 kg/h. The commissioning of this system was completed, with krypton and radon operations tested under respective working conditions. The krypton concentration of the product xenon was measured with an upper limit of 8.0 ppt.

目的 了解金昌队列人群脑卒中的发病状况,探讨糖尿病及FPG与脑卒中发病之间的联系,为有效控制糖尿病、预防脑卒中的发生提供科学依据.方法 以金昌队列为研究平台,采用前瞻性队列研究的方法分析糖尿病及FPG水平与脑卒中发病风险间的关系,运用限制样条法拟合FPG水平与脑卒中发病风险间的剂量反应关系.结果 本研究共纳入32736例研究对象,平均随访2.2年后,脑卒中累积发病率为8.77‰,其中糖尿病组脑卒中发病率为23.38‰,高于对照组发病率6.67‰.调整混杂因素后,糖尿病患者和空腹血糖受损人群中脑卒中的发病风险分别是对照组的2.257倍(HR=2.257,95％ CI:1.658～3.072,P＜0.001)和1.396倍(HR=1.396,95％CI:1.039～1.877,P=0.027).以FPG＜ 5.6 mmol/L作为对照组,控制混杂因素后,总人群中FPG≥5.6 mmol/L组和FPG≥6.1 mmol/L组脑卒中的发病风险分别增加48.1％(HR=1.481,95％CI:1.040～2.108,P=0.030)和49.3％(HR=1.493,95％ CI:1.044～2.136,P=0.028);当FPG≥7.0 mmol/L时,男性和女性脑卒中的发病风险分别是对照组的1.614倍(HR=1.614,95％ CI:1.068～2.438)和2.742倍(HR=2.742,95％ CI:1.355～5.547).在总人群和女性中FPG与脑卒中发病风险间呈非线性剂量反应关系,男性中FPG与脑卒中发病风险间呈线性剂量反应关系.结论 糖尿病是脑卒中的独立危险因素,且FPG水平与脑卒中的发病风险间存在剂量反应关系.

Objective: To assess the efficacy of Da Chaihu decoction combined with metformin tablets on patients with type 2 diabetes compared with metformin alone.Methods: This systematic review and meta-analysis is written based on 2020 PRISMA Extension for Chinese Herbal Medicines 2020 (PRISMA-CHM 2020) reporting guidelines. We reviewed all the relevant studies from a search of the following databases from inception to February 2022 without any language restriction: Excerpta Medica Database (EMBASE), Google Scholar, PubMed, Cochrane Library, China National Knowledge Infra-structure (CNKI), VIP Information, Wanfang Data, and the Chinese Biomedical Literature Database(CBM). Data were extracted and the quality was independently evaluated by two reviewers, based on the inclusion and exclusion criteria. Data were analyzed using the Cochrane software RevMan 5.3.Results: Six randomized controlled trials comprising 516 participants were included. The meta-analysis revealed the Da Chaihu decoction combined with metformin tablets group was significantly superior to the metformin tablets group in terms of fasting blood glucose(FPG) (-0.66 mmol/L; 95 % CI (con-fidence intervals) [-1.28, -0.04]), plasma glucose 2 h after meal (2-h PG) (-1.18 mmol/L; 95 % CI [-1.94,-0.42]) in six RCTs, body mass index (BMI) (-3.07 mmol/L; 95 % CI [-6.89, 0.75]) in three RCTs, glycosylated hemoglobin (HbAlc) (-0.36 mmol/L; 95 % CI [-1.04, 0.31]) in three RCTs, and triglycerides (TG) (-0.76 mmol/L; 95 % CI [-1.37,-0.15]) in two RCTs. In two RCTs, there were significant differences in terms of total cholesterol (TC) (-0.97 mmol/L; 95 % CI [-1.18,-0.76]). Conclusions: Very low-quality research shows that Da Chaihu decoction combined with metformin tablets exert a certain level of efficacy on patients with type 2 diabetes compared with metformin alone. However, random sequence generation methodology was reported in five studies leading to the low quality of the included studies. None of the six studies depicted the blinding method, allocation concealment, selective reporting, and assessed the purity and potency of the product. This observation requires verification through high-quality, multi-center, double-blinded randomized controlled trials, and assesses the purity and potency of the product.

An efficient cryogenic distillation system was designed and constructed for the PandaX-4T dark matter detector based on the McCabe-Thiele method and the conservation of mass and energy. This distillation system is designed to reduce the concentration of krypton in commercial xenon from 5 × 10-7 to ∼10-14 mol/mol with 99% xenon collection efficiency at a maximum flow rate of 10 kg/h. The offline distillation operation has been completed and 5.75 tons of ultra-high purity xenon was produced, which is used as the detection medium in the PandaX-4T detector. The krypton concentration of the product xenon is measured with an upper limit of 8.0 ppt. The construction, operation, and stable purification performance of the cryogenic distillation system are studied with the experimental data, which is important for theoretical research and distillation operation optimization.

We present a systematic determination of the responses of PandaX-II, a dual phase xenon time projection chamber detector, to low energy recoils. The electron recoil (ER) and nuclear recoil (NR) responses are calibrated, respectively, with injected tritiated methane or 220Rn source, and with 241Am-Be neutron source, in an energy range from 1-25 keV (ER) and 4-80 keV (NR), under the two drift fields, 400 and 317 V/cm. An empirical model is used to fit the light yield and charge yield for both types of recoils. The best fit models can describe the calibration data significantly. The systematic uncertainties of the fitted models are obtained via statistical comparison to the data.

Objective: To investigate the relationship of triglyceride (TG), fasting blood glucose (FPG) and triglyceride glucose product index (TyG) with the incidence of hypertension, and provide basic data for the prevention and treatment of hypertension in the population. Methods: A total of 23 581 individuals who met the research criteria in Jinchang cohort were selected as the research subjects, the Cox proportional hazard model was used to analyze the relationship of TG, FPG, and TyG with the risk of hypertension. A stratified analysis was conducted by sex. Results: After adjusting for confounding factors, compared with the normal TG group, the HR(95%CI) of the elevated TG margin group and the elevated group were 1.16 (1.01-1.34) and 1.49 (1.30-1.70), respectively in the total population. Among men, they were 1.13 (1.01-1.27) and 1.17 (1.06-1.30), and among women, they were 1.05 (0.88-1.26) and 1.06 (0.88-1.28). Compared with the normal FPG group, the HR (95%CI) of the FPG-impaired group were 1.29 (1.13-1.48) in the total population, 1.26 (1.08-1.48) in men and 1.59 (1.14-2.21) in women. Taking the lowest quartile array as a reference, the HR (95%CI) of the highest quartile array of TyG was 1.73 (1.45-2.07) in the total population, 1.32 (1.14-1.53) in men and 1.87 (1.37-2.54) in women. TG, FPG had a nonlinear dose-response relationship with the risk of hypertension, while TyG had a linear correlation with the risk of hypertension. Conclusions: Higher TG, FPG, and TyG levels are independent risk factors for the incidence of hypertension. People with higher TG, FPG and TyG are at high risk for hypertension, to which close attention should be paid in the prevention and treatment of hypertension.

Objective: To explore the relationship between lipid indicators and the incidence of diabetes, and to compare the diabetes prediction and identification power of traditional lipid combined lipid indicators, in order to explore the best alternative indicators for identifying and predicting diabetes. Methods: Based on the Jinchang cohort, a nested case-control study was conducted in 1 025 new cases of diabetes after excluding patients with malignant tumor and related endocrine, circulatory system disease, then an age (±2 years), gender matched 1∶1 control group of 1 025 cases was set to analyze the relationship between the incidence of diabetes and lipid parameters. Results: Among the traditional lipid parameters, the fourth quartile of TG, TC, and LDL-C indicated higher risks of developing diabetes, which was 14.00 times (95%CI: 9.73-20.15), 2.15 times (95%CI: 1.65-2.79) and 1.66 times (95%CI: 1.29-2.14) than that of the first quartile, respectively. The risk of developing diabetes indicated by the fourth quartile of HDL-C was 0.21 times than that indicated by the first quartile (95%CI: 0.15-0.28). In the combined lipid parameters, the fourth quartile of TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C indicated higher risks of developing diabetes, which was 14.86 times (95%CI: 10.35-21.34), 8.12 times (95%CI: 5.94-11.01), 5.85 times (95%CI:4.34-7.88) and 5.20 times (95%CI: 3.85-7.03) than that indicated by the first quartile, respectively. The areas under the ROC curve of TG, TC, HDL-C, LDL-C, TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C were 0.76 (95%CI: 0.74-0.78), 0.59 (95%CI: 0.57-0.61), 0.67 (95%CI: 0.65-0.69), 0.57 (95%CI: 0.55-0.59), 0.77 (95%CI: 0.75-0.78), 0.73 (95%CI: 0.71-0.75), 0.69 (95%CI: 0.67-0.71) and 0.66 (95%CI: 0.64-0.68), respectively. The optimal diabetes predicting point cuts of TG, TC, HDL-C, LDL-C, TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C were 1.40, 4.70, 1.28, 3.25, 1.17, 3.43, 2.46, and 3.58 mmol/L, respectively. Conclusions: Lipid metabolic disorder is a risk factor for diabetes. TG and TG/HDL-C are the good lipid metabolism indicators for the prediction of diabetic.

Objective: To explore the relationship of body mass index and blood pressure with the incidence of diabetes in Jinchang cohort. Methods: We designed a nested case-control study, a total of 29 572 workers who had no history of diabetes in baseline survey in Jinchang cohort were selected as the study cohort from June 2011 to December 2013. After 2 year follow-up, 1 021 workers with first diagnosed diabetes were selected as the case group, after 1∶1 matching according to the same gender and age ±2 years among those without diabetes, circulatory system, or endocrine system diseases during the same follow-up period, 1 021 controls was selected and 2 042 subjects were finally included. We used multivariate conditional logistic regression model, additive interaction model and multiplicative interaction model to explore the relationship of body mass index and blood pressure with the incidence of diabetes. Results: After adjusting for factors such as occupation, alcohol use, family history of diabetes, hyperuricemia, hypercholesterolemia, hypertriglyceridemia, low-HDL cholesterolemia and high-LDL cholesterolemia, multivariate conditional logistic regression analysis showed that the risk of diabetes increased with body mass index and blood pressure. Hypertension and overweight/obesity had a multiplicative interaction on the incidence of diabetes. The risks of diabetes in men and women with hypertension and overweight/obese were 2.04 times (95%CI: 1.54-2.69) and 3.88 times (95%CI: 2.55-5.91) higher than those in men and women with normal body weight and blood pressure, respectively. In the combination of BMI and blood pressure, obese individuals with SBP≥160 mmHg were 4.57 times (95%CI: 2.50-8.34) more likely to have diabetes than those with normal BMI and SBP, obese individuals with DBP≥90 mmHg were 3.40 times (95%CI: 2.19-5.28) more likely to have diabetes than those with normal BMI and DBP. Conclusions: Overweight/obesity and hypertension can increase the risk of diabetes. Health education about body weight and blood pressure controls should be strengthened to reduce the risk of diabetes.

Many studies have demonstrated that elevated serum uric acid independently increases the risk of developing hypertension. However, the role of insulin resistance in the relationship between serum uric acid and hypertension is still unelucidated. Based on a prospective cohort study, we aimed to examine the longitudinal link between serum uric acid and hypertension and whether this relationship was mediated by insulin resistance. Overall, 21,999 participants without hypertension or gout at baseline with a mean age of 46 ± 13 years in the Jinchang Cohort were included in our study. Adjusted Cox-regression analyses and mediation analyses were performed to assess the risk of hypertension by serum uric acid quartile distribution and whether insulin resistance mediated the association between serum uric acid and hypertension. During the first follow-up period, 3080 participants developed hypertension. After controlling for covariates, compared with the lowest quartile of serum uric acid, the risk of hypertension in the highest quartile was 1.21 (1.06, 1.38) in the overall population. The risks for males and females were 1.14 (1.00–1.29) and 1.30 (1.08–1.56), respectively. The correlation between serum uric acid and hypertension was especially observed in younger people (<30 years). The mediating effects of insulin resistance were 0.058 (0.051, 0.065), 0.030 (0.025, 0.036) and 0.056 (0.047, 0.065), and the proportions mediated were 39.73, 36.59 and 38.62% in the overall, male and female populations, respectively. Elevated serum uric acid levels are associated with an increased risk of incident hypertension, and insulin resistance may play a mediating role in the relationship between serum uric acid and hypertension.

目的 改良编制《门诊/住院患者满意度调查问卷》,并检验其信效度.方法 在文献检索、专题小组讨论的基础上筛选问卷条目. 2018年8月,采用方便抽样的方法选取兰州市某三级甲等专科医院、社区医院、高等医学院内工作的专家6名作为函询对象. 2018年11月采用方便抽样法,选取兰州市某三级甲等专科医院门诊与住院各50例患者为预调查对象,对改良编制的《门诊/住院患者满意度调查问卷》的维度和条目进行预调查并进行信效度测试.结果 《门诊/住院患者满意度调查问卷》的信效度均较高.主成分法分别提取了1个公因子,即服务态度与过程对总体评价有显著影响.结论 《门诊/住院患者满意度调查问卷》具有良好的信度和效度,可作为医疗机构对患者服务满意度调查的评价工具.

目的 系统评价镉与儿童孤独症的相关性.方法 计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、VIP、WanFang Data和CBM数据库,搜集关于镉与儿童孤独症相关性的病例-对照研究,检索时限均为建库至2019年7月.由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 共纳入8个病例-对照研究.Meta分析结果显示,无论标本来源为全血、尿液还是头发,儿童孤独症病例组与对照组镉浓度的差异均无统计学意义[MD全血=0.17,95％CI(-0.06,0.39),P=0.15;MD尿液=-0.43,95％CI(-1.44,0.58),P=0.4;MD头发=-0.08,95％CI(-0.52,0.36),P=0.72].结论 当前证据显示,镉浓度与儿童孤独症发生并无相关性.受纳入研究数量和质量限制,上述结论尚需更多高质量研究予以验证.

目的 探讨男性人群糖尿病与单纯性肾囊肿的关系.方法 采用巢式病例对照研究方法,以金昌队列随访男性人群中所有新发单纯性肾囊肿且未患有相关肾病以及各研究因素资料完整的病例为病例组,共627例,以随访男性人群未患单纯性肾囊肿且未患有相关肾病以及各资料完整的人群按照病例组基线年龄进行1∶2频数匹配后共纳入对照1 254例;应用多因素非条件Logistic回归模型分析糖尿病与单纯性肾囊肿的关系,采用限制三次样条法分析空腹血糖与单纯性肾囊肿的剂量反应关系.结果 病例组三酰甘油和高密度脂蛋白胆固醇水平低于对照组(P＜0.05),体重指数、收缩压、舒张压、空腹血糖和血尿酸水平均高于对照组(P＜0.05).多因素非条件Logistic回归分析结果显示,在调整了文化程度、体重指数、血尿酸、高血压之后,糖尿病的OR[95％CI]为1.604[1.095,2.349],空腹血糖浓度为5.0～5.9、6.0～6.9、≥7.0mmol/L时,相对于空腹血糖浓度＜ 5.0 mmol/L时,单纯性肾囊肿的OR[95％CI]分别为1.311[1.041,1.651]、1.345[0.939,1.926]、1.676[1.158,2.426],随着空腹血糖水平的增加,单纯性肾囊肿的发病风险呈上升趋势(P趋势=0.004).限制三次样条法分析结果显示,男性人群空腹血糖水平与单纯性肾囊肿发病风险之间呈非线性剂量反应关系(P整体＜0.000 1,P非线性=0.0013).结论 糖尿病是男性人群单纯性肾囊肿的危险因素,空腹血糖水平越高,单纯性肾囊肿的发病风险越大.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解"一带一路"沿线中亚、南亚、独联体国家前瞻性自然人群队列研究的建立和发展情况,与荷兰队列进行比较,为今后"一带一路"国家的队列研究建设提供参考依据。方法收集PubMed数据库中中亚、南亚、独联体等20个国家自数据库收录起始日期至2019年3月1日发表文献中的队列研究,经过2次筛选后对选定的队列进行二次检索,获取队列关键信息,分析中亚、南亚、独联体"一带一路"国家前瞻性自然人群队列的建设与发展情况,并与荷兰队列进行对比分析。结果中亚、南亚、独联体20个国家共有211项研究人群≥1 000人的队列研究,其中,国家内队列研究164项（77.73%）,国际多中心队列研究47项（22.27%）。经二次检索后选定的"一带一路"国家的6项前瞻性自然人群队列研究与荷兰的9项前瞻性自然人群队列研究进行对比分析,结果显示,在数量上,"一带一路"国家的2项队列研究为单一国家队列,荷兰的9项队列研究均为单一国家队列;在规模上,"一带一路"国家的2项队列研究对象&gt; 100 000人,荷兰的2项队列研究对象&gt; 100 000人;在建立时间上,"一带一路"国家建立最早的2项队列研究均建立于20世纪90年代初期,荷兰建立最早的3项队列研究均建立于20世纪80年代;在产出文章上,"一带一路"国家产出文章数量最多的队列研究文章发表数为400篇,荷兰产出文章数量最多的队列研究文章发表数为1 500篇。结论相对于荷兰而言,"一带一路"沿线中亚、南亚、独联体国家的前瞻性自然人群队列研究整体数量少、规模小、文章产出低、队列发展较为局限。</span>

Objective:To share related knowledge and experiences with countries along the line, literature regarding current cohort studies was summarized. Distribution, establishment and development of cohort studies among large prospective general population were analyzed in 17 countries of Western Asia and the 16 countries of Central and Eastern Europe.Methods:Literature review was conducted to collect basic information on cohort studies, with descriptive study used to analyze the characteristics of these cohort studies.Results:There were 562 cohort studies with sample size as more than 1 000 stated in Western Asia and Central and Eastern Europe, including 468 (83.27 %) carried out in the nation itself and 94 (16.73 %) with international multicentered collaboration. According to the nature of cohort studies, 347 (61.74 %) were etiologically based. As for the contents involved, 310 (55.16 %) of them targeted on chronic/non-communicable diseases, 125 (22.24 %) concentrated on maternal and child health. Among those on chronic/non-communicable diseases, 51 (16.45 %) were on cancers and 83 (26.77 %) on cardiovascular disease studies. There appeared 10 large prospective cohort studies targeting on general population, mainly ongoing in Iran and European countries, with a duration of 8-29 years, including 4 of them with sample size as more than 50 000. In terms of the contents, epidemiological investigation, physical examination and biological samples collection took the major parts. Few papers were published in 9 out of the 10 cohort studies at the early stage of those projects but the number of papers increased annually and stabilized to certain extent. Conclusions:The regional distribution of cohort studies carried out in countries from the Western Asia and Central and Eastern European areas appeared unbalanced. Contents of these designs would mainly involve etiological studies, with focus on non-communicable diseases as cancer, cardiovascular disease, diabetes, respiratory diseases, mental and psychological diseases, and maternal and infant health etc.. However, only few large prospective cohort studies would base on general population.

Objectives: To explore the incidence of diabetes under different indicator and interaction between metabolic index and liver enzyme index for diabetes mellitus. Methods: This study based on the Jinchang cohort, which is a prospective cohort included 48,001 subjects at baseline. To compare the incidence of diabetes under different metabolic indexes and liver enzyme indexes; Cox proportional hazard model was used to analysis the risk of diabetes with different metabolic indexes and liver enzymes indexes; The multiplicative model was used to analyze the interaction between different metabolic indexes and liver enzymes indexes for diabetes. Results: With the increase of TC, TG, ALT and AST, the incidence of diabetes gradually increased(p<0.05), with the increase of HDL-C level, the incidence of diabetes gradually decreased(p<0.05).With the increase of TC, TG, LDL-C, ALT, AST and GGT, the risk of diabetes were rising(p<0.05), and the increase of HDL-C reduced the risk of diabetes. In men, the interaction between TC and TG, TC and ALT, TG and ALT, ALT and GGT are positively and multiply; which HR(95%CI) was 6.71 (1.66∼27.04),20.62(9.50∼44.76),10.23(6.42∼16.29) and 6.63(4.38∼10.04), respectively. In women, TC and TG, ALT and GGT are positively and multiply, they also play a synergistic role in the risk of diabetes, and the HR(95%CI) was 6.75(2.12∼21.50) and 15.93(4.95∼51.25), respectively. Conclusion: TC, TG, LDL-C,ALT, AST and GGT were risk factors for the incidence of diabetes, and HDL-C was a protective factor for the incidence of diabetes. In the male population, the interaction of TC and TG, TC and ALT, TG and ALT, ALT and GGT were all positively multiplied. In the female population, TC and TG, ALT and GGT were positively multiplied by the interaction. Disclosure P. Huang: None. J. Yang: None. W. Huang: None. N. Liu: None. R. Wang: None. R. Zhang: None. Z. Bai: None. Y. Bai: None. N. Cheng: None. M. Wang: None. S. Zheng: None. Funding National Institutes of Health (1R01ES02908201A1); Lanzhou University (2018LDBRZD008)

Gallstones is a very common gastrointestinal disease,?involving?the?formation?of?masses?in?the?gall bladder or biliary tract, due to abnormally high concentrations of cholesterol or bilirubin in the bile[1]. There is a 10％–20％? prevalence of gallstones worldwide, and >?20％? of patients with gallstones show clinical symptoms, implying a substantial disease burden[1]. Metabolic syndrome (MS) comprises a series of cardiovascular risk factors, including obesity, abnormal lipid metabolism, high blood glucose or insulin resistance, and hypertension[2]. The prevalence of MS in China increased from 0–10％? in 2002[3]? to 24.2％? in 2014[4]. The prevalence of MS ranges from 10％? to 84％across the world, with nearly 30％? of people in the United States and one in four in Europe having this syndrome[5].

目的 探讨队列人群尿酸与单纯性肾囊肿(SRC)的关系.方法 采用巢式病例对照的研究方法,病例组和对照组均来自同一职业队列且按照基线年龄分布进行1∶2频数匹配,该人群SRC发病的影响因素和不同尿酸物质的量浓度对SRC的发病风险研究均采用非条件Logistic回归模型进行单因素和多因素分析;采用限制三次样条法分析尿酸物质的量浓度与SRC的剂量反应关系.结果 病例组男性占比远高于女性占比,病例组尿酸物质的量浓度高于对照组(P＜0.05).多因素非条件Logistic回归分析结果显示,在调整相关因素后,总人群尿酸物质的量浓度分别为400～499、≥500 μmol/L时,相对于尿酸物质的量浓度＜ 300 μmol/L时,其SRC的发病风险和95％CI分别是1.547[1.215,1.969]、1.991[1.259,3.149];男性人群尿酸物质的量浓度分别为300～399、400～499、≥500μmol/L时,相对于尿酸物质的量浓度＜300 μmol/L时SRC的发病风险和95％CI分别是1.372[1.022,1.785]、1.629[1.198,2.215]、2.099[1.278,3.448];且尿酸物质的量浓度越高,总人群和男性人群SRC发病风险越高(P趋势 ＜0.001).限制三次样条分析结果显示,总人群和男性人群尿酸物质的量浓度与SRC发病风险之间呈正向线性剂量反应关系(P整体＜0.05,P非线性＞0.05).结论 尿酸是金昌队列总人群和男性人群SRC的危险因素,随尿酸物质的量浓度的升高,SRC的发病风险增大.

Exposures to heavy metals play a role in the etiopathogenesis of diabetes. Epidemiological studies investigating a potential sex-specific linkage between manganese (Mn) exposures and glucose homeostasis are rare. We comprehensively estimated the associations of blood and urinary Mn levels with fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), homeostasis model assessment for insulin resistance (HOMA-IR), insulin, and estimated glomerular filtration rate (eGFR) among 1417 adults in the US National Health and Nutrition Examination Survey (NHANES) 2011-2016. We further examined the potential heterogeneities by sex and joint-effects of multiple metal exposures by the Bayesian kernel machine regression (BKMR). Among women, we found positive linear relationships between urinary Mn with FPG (P-overall = 0.003, P-nonlinear = 0.817) and HbA1c (P-overall = 0.023, P-nonlinear = 0.854). Among men, J-shaped relationships were observed between blood Mn with HOMA-IR (P-nonlinear = 0.042) and insulin (P-nonlinear = 0.014). For eGFR, positive linear relationships were obserned among women for blood Mn (P-nonlinear = 0.549) and among both men and women for urinary Mn levels. The joint-effects of urinary Mn with molybdenum (Mo) on FPG and HbA1c, urinary Mn with cadmium (Cd) and cesium (Cs) on eGFR, and blood Mn with Cd and lead (Pb) on eGFR were detected. In summary, blood and urinary Mn levels were independently associated with glucose levels, insulin resistance and kidney function with potential sex-dependent heterogeneities. These findings emphasize the probable role of Mn in the regulation of glucose metabolism and kidney function, and confirm the need for more studies on sex-specific risk of diabetes. (C) 2020 Published by Elsevier Ltd.

Background To study the association between anthropometric measurements and the risk of diabetes and impaired fasting glucose (IFG) and compare body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) to determine the best indicator and its optimal cutoffs for predicting type 2 diabetes and IFG. Methods A Chinese prospective (2011-2019) cohort named the Jingchang cohort that included 48 001 participants was studied. Using Cox proportional hazard models, hazard ratios (HRs) for incident type 2 diabetes or IFG per 1 SD change in BMI, WC, and WHtR were calculated. Area under the curve (AUC) was compared to identify the best anthropometric variable and its optimal cutoff for predicting diabetes. Results The association of BMI, WC,0 and WHtR with type 2 diabetes or IFG risk was positive in the univariate and multivariable-adjusted Cox proportional hazard models. Of all three indexes, the AUC of BMI was largest and that of WC was smallest. The derived cutoff values for BMI, WC, and WHtR were 24.6 kg/m(2), 89.5 cm, and 0.52 in men and 23.4 kg/m(2), 76.5 cm, and 0.47 in women for predicting diabetes, respectively. The derived cutoff values for BMI, WC, and WHtR were 23.4 kg/m(2), 87.5 cm, and 0.50 in men and 22.5 kg/m(2), 76.5 cm, and 0.47 in women for predicting IFG, respectively. Conclusions Our derived cutoff points were lower than the values specified in the most current Asian diabetes guidelines. We recommend a cutoff point for BMI in Asians of 23 kg/m(2) and for WC a cutoff point of 89 cm in men and 77 cm in women to define high-risk groups for type 2 diabetes; screening should be considered for these populations. Highlights We observed significant and positive associations of the risk of type 2 diabetes with BMI, WC and WHtR, and we identified BMI as the best obesity predictor for diabetes. Our derived cutoff points were lower than the values specified in the most current Asian diabetes guidelines, and we recommend a cutoff point for BMI in Asians of 23 kg/m(2) and a cutoff point for WC of 89 cm in men and 77 cm in women to define high-risk groups for type 2 diabetes; screening should be considered for these populations.