Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain.
We conducted ...an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia.
A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval CI, 0.77 to 0.96; P = 0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P = 0.76).
Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090.).
•The habitat suitability model is coupled with the two-dimensional high-precision hydrodynamic model.•Finite volume method (FVM) with Godunov type is adopted to solve the two-dimensional hydrodynamic ...process.•Habitat suitability model is constructed by habitat suitability index based on IFIM theory.•The introduction of GPU acceleration technology greatly improves the simulation efficiency.
The habitat suitability model is coupled with the two-dimensional high-precision hydrodynamic model in this paper. In the model, finite volume method (FVM) with Godunov type is adopted to solve the two-dimensional hydrodynamic process, which has good robustness and second-order temporal and spatial accuracy; Habitat suitability model is constructed by habitat suitability index based on IFIM theory. Meanwhile, the introduction of GPU acceleration technology greatly improves the simulation efficiency. Combined with the results of River2D, the results of this model have good accuracy. The model was applied to simulate the spawning habitat of Gymnocypris eckloni in the lower reaches of a hydropower station in the Upper Yellow River, and the reasonable discharged flow of hydropower station required for a good spawning habitat was 74 m3/s. It increased by 53.377% compared with the average annual discharge in May of the natural river. The evaluation of the spawning habitat of Gymnocypris eckloni provides a scientific basis for protecting the integrity of river ecosystem in this paper.
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Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed.
We ...sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China.
This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups.
Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p<0.001), and sodium to potassium ratio declined by 15% (-0.9, -1.2 to -0.5; p<0.001). Mean blood pressure differences were -1.1 mm Hg systolic (-3.3 to +1.1; p = 0.33) and -0.7 mm Hg diastolic (-2.2 to +0.8, p = 0.35) and the difference in the proportion with hypertension was -1.3% (-5.1 to 2.5, p = 0.56).
There were clear differences in population sodium and potassium intake between villages that were most likely a consequence of increased use of salt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved.
Clinicaltrials.gov identifier: NCT01259700.
•Long-term air pollutant exposures may contribute to cardiac conduction abnormalities.•PM2.5 may be the most stable pollutant reflecting the associations.•People with specific characteristics are ...more susceptible to the adverse effects.
Evidence regarding the effects of long-term and high-level ambient air pollution exposure on cardiac conduction systems remains sparse.
To investigate the associations of long-term exposure to air pollution and cardiac conduction abnormalities in Chinese adults and explore the susceptibility characteristics.
In 2017, a total of 27,047 participants aged 18–80 years were recruited from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH). The three year (2014–2016) average pollutant concentrations were assessed by a spatial statistical model for PM2.5 and air monitoring stations for PM10, SO2, NO2, O3 and CO. Residential proximity to a roadway was calculated by neighborhood analysis. Associations were estimated by two-level generalized linear mixed models. Stratified analyses related to demographic characteristics, health behaviors, and cardiometabolic risk factors were performed. Two-pollutant models were used to evaluate the possible role of single pollutants.
We detected significant associations of long-term air pollutant exposure with increased heart rate (HR), QRS and QTc, such that an interquartile range increase in PM2.5 was associated with 3.63% (95% CI: 3.07%, 4.19%), 1.21% (95% CI: 0.83%, 1.60%), and 0.13% (95% CI: 0.07%, 0.18%) changes in HR, QRS and QTc, respectively. Compared to the other pollutants, the estimates of PM2.5 remained the most stable across all two-pollutant models. Similarly, significant associations were observed between living closer to a major roadway and higher HR, QRS and QTc. Stratified analyses showed generally greater association estimates in older people, males, smokers, alcohol drinkers, and those with obesity, hypertension and diabetes.
Long-term exposure to ambient air pollution was associated with cardiac conduction abnormalities in Chinese adults, especially in older people, males, smokers, alcohol drinkers, and those with cardiometabolic risk factors. PM2.5 may be the most stable pollutant to reflect the associations.
A large-scale CNC boring machine would not be complete without a column. The tortoise shell is chosen as the bionic prototype, and the column structure is optimized using the bionic optimization ...design approach, using the column of a thg6920 boring machine as the research object. The structural similarity between the completed turtle shell and the boring machine column is 0.796, according to the fuzzy method. The structural optimization and topological optimization of the column imitating turtle shell are carried out with the ANSYS Workbench, and the bionic column model is established, and then the static analysis and modal analysis are carried out. After bionic optimization and topology optimization, the weight of the column is reduced from 87061 kg to 82107 kg, the maximum stress is reduced to 3.8637 MPa, the maximum stress is reduced by 28.9% compared with the original column, and the specific stiffness and specific strength are increased by 20.65% and 29.4%, respectively. The column structure has also achieved good optimization results in stiffness, strength, and stability.
The prevalence of hypertension is high among Chinese adults, thus, identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention ...strategies.
The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017, and they were nonrandomly split into the training set and validation set based on location. Multivariable logistic regression analysis was performed to develop the diagnostic prediction model, which was presented as a nomogram and a website with risk classification. Predictive performances of the model were evaluated using discrimination and calibration, and were further compared with a previously published model. Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model.
The Lasso regression analysis identified the significant predictors of hypertension in the training set, and a diagnostic model was developed using logistic regression. A nomogram with risk classification was constructed to visualize the model, and a website ( https://chris-yu.shinyapps.io/hypertension_risk_prediction/ ) was developed to calculate the exact probabilities of hypertension. The model showed good discrimination and calibration, with the C-index of 0.789 (95% confidence interval CI: 0.768, 0.810) through internal validation and 0.829 (95% CI: 0.816, 0.842) through external validation. Decision curve analysis demonstrated that the model was clinically useful. The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population.
This study developed and validated a diagnostic model for hypertension prediction in Gansu Province. A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.
Unsupervised domain adaptation (UDA) person re-identification (Re-ID) is to enhance the discriminability of Re-ID tasks in the target domain by leveraging labeled source domain data and unlabeled ...target domain data. Employing clustering as a mean to generate pseudo labels has emerged as a successful approach for addressing UDA Re-ID tasks. However, clustering may be disturbed by data noise when generating pseudo labels, resulting in unstable quality of pseudo labels. In addition, persons with similar colored clothing can also affect the recognition accuracy of the model. To address these aforementioned issues in UDA Re-ID, we propose a Cluster-based Dual-branch Contrastive Learning (CDCL) approach. In CDCL, we design partially grayed images as input and utilize two-branch network structure to reduce the effect of upper-body clothing color on model recognition. Based on the two-branch network architecture, we additionally propose a cluster refinement method to improve the confidence of pseudo labels, which selects samples with high similarity, i.e., samples with weighted distance between subclass samples less than a threshold, and thus makes pseudo labels more reliable. The proposed CDCL has shown its effectiveness through experimental results, achieving an mAP accuracy of 81.5%.
AimsTo investigate the prevalence, ethnic differences and associated risk factors for pterygium in Han and Manchu populations aged 40–79 years in Hebei province, China.DesignCross-sectional study, as ...a part of the China National Health Survey.SettingHebei province, China.ParticipantsA multistage cluster sampling method with urbanisation level-based stratification was used to select participants for this study. A total of 4591 individuals over 40 years were recruited for this study. Inclusive criteria: (1) residents who had been living in Hebei for more than 1 year; (2) Han individuals with both parents being Han, or Manchu individuals with both parents being Manchu; (3) underwent ophthalmic examinations and (4) information in the questionnaire was complete.Main outcome measuresMultiple logistic regression analysis was used to evaluate the association between pterygium prevalence and factors of interest.ResultsA total of 3790 individuals (2351 Hans and 1439 Manchus) met the study criteria, of which 248 were diagnosed with pterygium (6.5%). There was no significant difference between the prevalence rates in Hans (6.2%) and Manchus (7.2%) (p=0.232). Multivariate analysis revealed that the risk factors for grade 2 or higher pterygium were increasing age (p<0.001) and rural residence (OR 1.83; 95% CI 1.11 to 3.02; p=0.018), while the protective factors include gender (female) (OR 0.58; 95% CI 0.37 to 0.88; p=0.011), cigarette smoking (OR 0.53; 95% CI 0.34 to 0.83; p=0.005) and myopia (OR 0.50; 95% CI 0.33 to 0.77; p=0.002). Premature menopause (OR 2.66; 95% CI 1.05 to 6.72; p=0.038) increased the risk of grade 2 or higher pterygium in females, while higher high-density lipoprotein (HDL) (OR 1.94; 95% CI 1.08 to 3.47; p=0.027) was a risk factor of grade 2 or higher pterygium in males.ConclusionThe overall prevalence of pterygium in Han and Manchu population in Hebei, China was approximately 6.1%. There were no differences in the prevalence of pterygium between Hans and Manchus, and the race was not a risk factor. This is the first study to report on the positive association between premature menopause and pterygium in females and between higher HDL levels and pterygium in males.
As part of the China National Health Survey, the objective of this study was to explore the prevalence, patterns, and influencing factors of smoking, and understand reasons for smoking cessation ...among adults in Hebei Province, central China. Using a multi-stage stratified cluster sampling method, 6,552 adults (2,594 males) aged 20-80 were selected in 2017. Demographic, socioeconomic, and tobacco use information were collected by questionnaire interview. The prevalence of ever-smoking, current smoking, and ex-smoking was 28.94, 21.08, and 7.86%, respectively. Male participants had a much higher prevalence of ever-smoking and current smoking (67.39 and 48.77%) than females (3.74 and 2.93%). In male participants, the daily cigarette consumption was 16.61, and the mean age of smoking initiation was 20.95, decreasing with birth year (27.50 in people born before 1946 vs. 17.9 for those born after 1985,
for trend < 0.001). Over 40% of male ever-smokers initiated regular smoking before 20. Compared with never drinking, the ORs (95% CI) of ever-smoking for low, moderate, and high alcohol consumption in male participants were 1.44 (1.11-1.86), 2.80 (1.91-4.11), and 2.40 (1.72-3.33), respectively. Among 479 male ex-smokers, 50.94% stopped smoking because of illness and 49.06% by choice. Among male ex-smokers, hypertensive men were more likely to quit smoking than the normotensive individuals (OR: 1.48, 95% CI: 1.13-1.96). For CVD patients, this effect was estimated as 2.27 (95% CI: 1.56-3.30). This study revealed a high prevalence of ever-smoking, especially in men, in a representative population in central China. Health education focus on tobacco control could be integrated with alcohol consumption reduction to achieve additional benefit.
IntroductionCardiovascular diseases (CVDs) are the leading causes of death and disability worldwide. Reducing dietary salt consumption is a potentially cost-effective way to reduce blood pressure and ...the burden of CVD. To date, economic evidence has focused on sodium reduction in food industry or processed food with blood pressure as the primary outcome. This study protocol describes the planned within-trial economic evaluation of a low-sodium salt substitute intervention designed to reduce the risk of stroke in China.Methods and analysesThe economic evaluation will be conducted alongside the Salt Substitute and Stroke Study: a 5-year large scale, cluster randomised controlled trial. The outcomes of interest are quality of life measured using the EuroQol-5-Dimensions and major adverse cardiovascular events. Costs will be estimated from a healthcare system perspective and will be sought from the routinely collected data available within the New Rural Cooperative Medical Scheme. Cost-effectiveness and cost-utility analyses will be conducted, resulting in the incremental cost-effectiveness ratio expressed as cost per cardiovascular event averted and cost per quality-adjusted life year gained, respectively.Ethics and disseminationThe trial received ethics approval from the University of Sydney Ethics Committee (2013/888) and Peking University Institutional Review Board (IRB00001052-13069). Informed consent was obtained from each study participant. Findings of the economic evaluation will be published in a peer-reviewed journal and presented at international conferences.Trial registration numberClinicalTrials.gov Registry (NCT02092090).
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