In a study involving 451,665 adults in China, higher levels of fruit consumption were associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary ...and nondietary factors, with significant reductions in cardiovascular risk.
Cardiovascular disease is a leading cause of premature death and disability worldwide and is responsible for more than 17 million deaths annually, with approximately 80% of the disease burden in low- and middle-income countries, such as China.
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A low level of fruit consumption is a major risk factor for cardiovascular disease, accounting for an estimated 104 million disability-adjusted life-years worldwide in 2010,
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including approximately 30 million in China.
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However, these estimates were based mainly on findings from Western studies, with little reliable evidence from China and other developing countries, where diet, lifestyle factors, and disease patterns differ substantially from those . . .
Calcination has been a major means for the preparation of diatomite filter aids because it improves the permeability of filter aids. However, the pore structure and silica phase of diatomite could be ...destroyed or altered during thermal processing, which seriously restrains the properties of diatomite filter aids. In the present work, the calcination of diatomite was carried out to investigate its effect on silica phase transition in diatomite. Diatomite with a certain particle size distribution as raw material was sintered in a muffle furnace at a temperature from 200 °C to 1200 °C with or without flux (7 wt% Na2CO3). The phase evolution and microstructure of diatomite were investigated by thermal analysis (TG and DSC), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and transmission electron microscopy (TEM). The results showed that the opal in diatomite began converting to cristobalite at 1000 °C without flux and the transformation temperature was reduced by 200 °C by adding flux. In addition, there was about 64.02% content of quartz in diatomite converting to cristobalite as the calcination temperature increased from 1100 °C to 1200 °C by flux calcination. It was considered to be a universal phenomenon that the opal in diatomite transformed into cristobalite under high-temperature calcination due to their similar microcrystalline structure. Furthermore, the quartz in raw diatomite was inclined to transform into cristobalite rather than tridymite, mainly owing to the existence of crystal nucleus of cristobalite formed from opal-cristobalite phase transition. The findings in this paper improve understanding of silica phase transition in diatomite upon calcination.
•The thermal processing of diatomite by calcination or flux calcination was carried out in detail.•The amorphous opal in diatomite transforms into cristobalite at 1000 °C without flux adding.•The flux can facilitate the transformation of opal in diatomite to cristobalite by calcination.•The quartz in diatomite is inclined to transform into cristobalite rather than tridymite upon calcination.
Summary Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in ...previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Methods Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40–79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35–74 years (second study), with follow-up during 1991–99 (mid-year 1995) and 2006–14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Findings Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 95% CI 1·24–1·41 vs 1·65 1·53–1·79; rural: RR 1·13 1·09–1·17 vs 1·22 1·16–1·29), as did the smoking-attributed fraction of deaths at ages 40–79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79–2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11–16·15), lung cancer (RR 3·78, 2·78–5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66–2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively, 10%, 5%, 2%, and 1% (3097/30 943, 3265/62 246, 2339/97 344, and 1068/111 933). The smoker versus non-smoker RR of 1·51 (1·40–1·63) for all female mortality at ages 40–79 years accounted for 5%, 3%, 1%, and <1%, respectively, of all the female deaths in these four successive birth cohorts. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China. Interpretation Smoking will cause about 20% of all adult male deaths in China during the 2010s. The tobacco-attributed proportion is increasing in men, but low, and decreasing, in women. Although overall adult mortality rates are falling, as the adult population of China grows and the proportion of male deaths due to smoking increases, the annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050, unless there is widespread cessation. Funding Wellcome Trust, MRC, BHF, CR-UK, Kadoorie Charitable Foundation, Chinese MoST and NSFC
Genetic variants and lifestyle factors have been associated with gastric cancer risk, but the extent to which an increased genetic risk can be offset by a healthy lifestyle remains unknown. We aimed ...to establish a genetic risk model for gastric cancer and assess the benefits of adhering to a healthy lifestyle in individuals with a high genetic risk.
In this meta-analysis and prospective cohort study, we first did a fixed-effects meta-analysis of the association between genetic variants and gastric cancer in six independent genome-wide association studies (GWAS) with a case-control study design. These GWAS comprised 21 168 Han Chinese individuals, of whom 10 254 had gastric cancer and 10 914 geographically matched controls did not. Using summary statistics from the meta-analysis, we constructed five polygenic risk scores in a range of thresholds (p=5 × 10−4 p=5 × 10−5 p=5 × 10−6 p=5 × 10−7, and p=5 × 10−8) for gastric cancer. We then applied these scores to an independent, prospective, nationwide cohort of 100 220 individuals from the China Kadoorie Biobank (CKB), with more than 10 years of follow-up. The relative and absolute risk of incident gastric cancer associated with healthy lifestyle factors (defined as not smoking, never consuming alcohol, the low consumption of preserved foods, and the frequent intake of fresh fruits and vegetables), was assessed and stratified by genetic risk (low quintile 1 of the polygenic risk score, intermediate quintile 2–4 of the polygenic risk score, and high quintile 5 of the polygenic risk score). Individuals with a favourable lifestyle were considered as those who adopted all four healthy lifestyle factors, those with an intermediate lifestyle adopted two or three factors, and those with an unfavourable lifestyle adopted none or one factor.
The polygenic risk score derived from 112 single-nucleotide polymorphisms (p<5 × 10−5) showed the strongest association with gastric cancer risk (p=7·56 × 10−10). When this polygenic risk score was applied to the CKB cohort, we found that there was a significant increase in the relative risk of incident gastric cancer across the quintiles of the polygenic risk score (ptrend<0·0001). Compared with individuals who had a low genetic risk, those with an intermediate genetic risk (hazard ratio HR 1·54 95% CI 1·22–1·94, p=2·67 × 10−4) and a high genetic risk (2·08 1·61–2·69, p<0·0001) had a greater risk of gastric cancer. A similar increase in the relative risk of incident gastric cancer was observed across the lifestyle categories (ptrend<0·0001), with a higher risk of gastric cancer in those with an unfavourable lifestyle than those with a favourable lifestyle (2·03 1·46–2·83, p<0·0001). Participants with a high genetic risk and a favourable lifestyle had a lower risk of gastric cancer than those with a high genetic risk and an unfavourable lifestyle (0·53 0·29–0·99, p=0·048), with an absolute risk reduction of 1·12% (95% CI 0·62–1·56).
Chinese individuals at an increased risk of incident gastric cancer could be identified by use of our newly developed polygenic risk score. Compared with individuals at a high genetic risk who adopt an unhealthy lifestyle, those who adopt a healthy lifestyle could substantially reduce their risk of incident gastric cancer.
National Key R&D Program of China, National Natural Science Foundation of China, 333 High-Level Talents Cultivation Project of Jiangsu Province, and China Postdoctoral Science Foundation.
In this article, a hypersonic target electromagnetic (EM) scattering echo model combined with the inhomogeneous zonal medium model (IZMM) and the classical scattering center model (SCM) is proposed ...with a distributed satelliteborne array radar as the detection platform. A parallel physical optics (PO) method is used for multiview inverse synthetic aperture radar (ISAR) imaging of a moving hypersonic target covered with plasma sheath based on the analysis of high-resolution range profile in the S-X ultrawideband range, reconstructing 2-D EM scattering echo data (the target) and motion compensation. The results show that the surface of the inhomogeneous plasma sheath flow field is an excitation layer with random and irregular fluctuation characteristics, which increases the false scattering centroid of the 1-D range profile of the hypersonic target and can interfere with and disrupt the radar localization of the target along the radial direction. In addition, shallow scattering of EM waves occurs in the plasma sheath, and the average signal intensity of the target can gradually reduce from 0.5 <inline-formula> <tex-math notation="LaTeX">\times \,\,10^{-5} </tex-math></inline-formula> at 60 km and 20 Ma to 0.1 <inline-formula> <tex-math notation="LaTeX">\times \,\,10^{-5} </tex-math></inline-formula> at 30 km and 20 Ma, with a fivefold weakening of the overall scattered echo signal. In particular, the faster the hypersonic target travels at 30-km altitude, the weaker the imaged scattered echo signal becomes, with the average intensity of the imaged signal weakening by approximately threefold from 15 to 25 Ma. This study provides considerable technical support and data assurance to establish a synthetic aperture radar (SAR) automatic target recognition (ATR) database, and the findings of this study can be used as a reference for fine-structure feature analysis of hypersonic targets for feature extraction and the classification and identification of targets.
IMPORTANCE: In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. OBJECTIVES: To ...assess the proportional excess mortality associated with diabetes and estimate the diabetes-related absolute excess mortality in rural and urban areas of China. DESIGN, SETTING, AND PARTICIPANTS: A 7-year nationwide prospective study of 512 869 adults aged 30 to 79 years from 10 (5 rural and 5 urban) regions in China, who were recruited between June 2004 and July 2008 and were followed up until January 2014. EXPOSURES: Diabetes (previously diagnosed or detected by screening) recorded at baseline. MAIN OUTCOMES AND MEASURES: All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratio (RR) comparing individuals with diabetes vs those without diabetes at baseline. RESULTS: Among the 512 869 participants, the mean (SD) age was 51.5 (10.7) years, 59% (n = 302 618) were women, and 5.9% (n = 30 280) had diabetes (4.1% in rural areas, 8.1% in urban areas, 5.8% of men, 6.1% of women, 3.1% had been previously diagnosed, and 2.8% were detected by screening). During 3.64 million person-years of follow-up, there were 24 909 deaths, including 3384 among individuals with diabetes. Compared with adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100 000; adjusted RR, 2.00 95% CI, 1.93-2.08), which was higher in rural areas than in urban areas (rural RR, 2.17 95% CI, 2.07-2.29; urban RR, 1.83 95% CI, 1.73-1.94). Presence of diabetes was associated with increased mortality from ischemic heart disease (3287 deaths; RR, 2.40 95% CI, 2.19-2.63), stroke (4444 deaths; RR, 1.98 95% CI, 1.81-2.17), chronic liver disease (481 deaths; RR, 2.32 95% CI, 1.76-3.06), infections (425 deaths; RR, 2.29 95% CI, 1.76-2.99), and cancer of the liver (1325 deaths; RR, 1.54 95% CI, 1.28-1.86), pancreas (357 deaths; RR, 1.84 95% CI, 1.35-2.51), female breast (217 deaths; RR, 1.84 95% CI, 1.24-2.74), and female reproductive system (210 deaths; RR, 1.81 95% CI, 1.20-2.74). For chronic kidney disease (365 deaths), the RR was higher in rural areas (18.69 95% CI, 14.22-24.57) than in urban areas (6.83 95% CI, 4.73-9.88). Among those with diabetes, 10% of all deaths (16% rural; 4% urban) were due to definite or probable diabetic ketoacidosis or coma (408 deaths). CONCLUSIONS AND RELEVANCE: Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.
Placental growth factor (PGF), soluble fms-like tyrosine kinase 1 (sFLT1) and asymmetric dimethylarginine (ADMA) are involved in the pathogenesis of preeclampsia. Abnormal maternal sFLT1, PGF and ...ADMA levels are detectable weeks before the onset of preeclampsia.
To investigate sFLT1, PGF and ADMA in the first trimester of pregnancy as predictors of preeclampsia.
In this prospective nested case-control study, 740 pregnant women enrolled at 12-16 weeks of gestation and followed up until 6 weeks after delivery at the Shanghai First Maternity and Infant Health Hospital of Tongji University between January 2010 and December 2012. Forty-four women developed preeclampsia. Urinary proteins were measured using 24-hour collection or dipsticks. sFLT1, PGF and ADMA were measured by ELISA in the first trimester. Pulsatility index (PI) was measured by Doppler ultrasound in the second trimester.
First-trimester serum sFLT1 and ADMA levels of women who developed preeclampsia were significantly higher compared with women with normal pregnancies (sFLT1: 0.321 ± 0.023 vs. 0.308 ± 0.019 ng/ml, P = 0.001; ADMA: 0.86 ± 0.16 vs. 0.68 ± 0.20 μM, P < 0.001). First-trimester serum PGF levels of women who developed preeclampsia were significantly lower than in women with normal pregnancies (115.72 ± 32.55 vs. 217.30 ± 74.48 pg/ml, P < 0.001). Multiple logistic regression and receiver-operating characteristic curves identified first-trimester PGF and ADMA to be sensitive and selective predictors of preeclampsia (area under the curve AUC: 0.902), as well as second-trimester uterine artery pulse index (AUC: 0.836).
In the first trimester, maternal serum sFLT1, PGF and ADMA levels, as well as second-trimester uterine artery PI, could predict preeclampsia.
The present study examined whether there is an age-related difference in judging egocentric distances. In 4 experiments, both younger and older observers judged the physical distance of an object on ...a ground plane and reported their judgments by verbal report and by blind rope pulling. Overall, we found that (a) younger observers in general underestimated egocentric distance and showed foreshortening; (b) older observers judged more egocentric distance than younger observers and did not show foreshortening; and (c) this age-related difference was not due to an age-related difference in scaling or output calibration (Experiment 2), the use of eye height information (Experiment 3), or the use of texture gradient information (Experiment 4). These results may be accounted for by differences in perceived slant of the ground surface or a greater reliance on pictorial cues with increased age.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
IMPORTANCE: When combusted indoors, solid fuels generate a large amount of pollutants such as fine particulate matter. OBJECTIVE: To assess the associations of solid fuel use for cooking and heating ...with cardiovascular and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: This nationwide prospective cohort study recruited participants from 5 rural areas across China between June 2004 and July 2008; mortality follow-up was until January 1, 2014. A total of 271 217 adults without a self-reported history of physician-diagnosed cardiovascular disease at baseline were included, with a random subset (n = 10 892) participating in a resurvey after a mean interval of 2.7 years. EXPOSURES: Self-reported primary cooking and heating fuels (solid: coal, wood, or charcoal; clean: gas, electricity, or central heating), switching of fuel type before baseline, and use of ventilated cookstoves. MAIN OUTCOMES AND MEASURES: Death from cardiovascular and all causes, collected through established death registries. RESULTS: Among the 271 217 participants, the mean (SD) age was 51.0 (10.2) years, and 59% (n = 158 914) were women. A total of 66% (n = 179 952) of the participants reported regular cooking (at least weekly) and 60% (n = 163 882) reported winter heating, of whom 84% (n = 150 992) and 90% (n = 147 272) used solid fuels, respectively. There were 15 468 deaths, including 5519 from cardiovascular causes, documented during a mean (SD) of 7.2 (1.4) years of follow-up. Use of solid fuels for cooking was associated with greater risk of cardiovascular mortality (absolute rate difference ARD per 100 000 person-years, 135 95% CI, 77-193; hazard ratio HR, 1.20 95% CI, 1.02-1.41) and all-cause mortality (ARD, 338 95% CI, 249-427; HR, 1.11 95% CI, 1.03-1.20). Use of solid fuels for heating was also associated with greater risk of cardiovascular mortality (ARD, 175 95% CI, 118-231; HR, 1.29 95% CI, 1.06-1.55) and all-cause mortality (ARD, 392 95% CI, 297-487; HR, 1.14 95% CI, 1.03-1.26). Compared with persistent solid fuel users, participants who reported having previously switched from solid to clean fuels for cooking had a lower risk of cardiovascular mortality (ARD, 138 95% CI, 71-205; HR, 0.83 95% CI, 0.69-0.99) and all-cause mortality (ARD, 407 95% CI, 317-497; HR, 0.87 95% CI, 0.79-0.95), while for heating, the ARDs were 193 (95% CI, 128-258) and 492 (95% CI, 383-601), and the HRs were 0.57 (95% CI, 0.42-0.77) and 0.67 (95% CI, 0.57-0.79), respectively. Among solid fuel users, use of ventilated cookstoves was also associated with lower risk of cardiovascular mortality (ARD, 33 95% CI, −9 to 75; HR, 0.89 95% CI, 0.80-0.99) and all-cause mortality (ARD, 87 95% CI, 20-153; HR, 0.91 95% CI, 0.85-0.96). CONCLUSIONS AND RELEVANCE: In rural China, solid fuel use for cooking and heating was associated with higher risks of cardiovascular and all-cause mortality. These risks may be lower among those who had previously switched to clean fuels and those who used ventilation.
Metabolically healthy obesity (MHO) and its transition to unhealthy metabolic status have been associated with risk of cardiovascular disease (CVD) in Western populations. However, it is unclear to ...what extent metabolic health changes over time and whether such transition affects risks of subtypes of CVD in Chinese adults. We aimed to examine the association of metabolic health status and its transition with risks of subtypes of vascular disease across body mass index (BMI) categories.
The China Kadoorie Biobank was conducted during 25 June 2004 to 15 July 2008 in 5 urban (Harbin, Qingdao, Suzhou, Liuzhou, and Haikou) and 5 rural (Henan, Gansu, Sichuan, Zhejiang, and Hunan) regions across China. BMI and metabolic health information were collected. We classified participants into BMI categories: normal weight (BMI 18.5-23.9 kg/m²), overweight (BMI 24.0-27.9 kg/m²), and obese (BMI ≥ 28 kg/m²). Metabolic health was defined as meeting less than 2 of the following 4 criteria (elevated waist circumference, hypertension, elevated plasma glucose level, and dyslipidemia). The changes in obesity and metabolic health status were defined from baseline to the second resurvey with combination of overweight and obesity. Among the 458,246 participants with complete information and no history of CVD and cancer, the mean age at baseline was 50.9 (SD 10.4) years, and 40.8% were men, and 29.0% were current smokers. During a median 10.0 years of follow-up, 52,251 major vascular events (MVEs), including 7,326 major coronary events (MCEs), 37,992 ischemic heart disease (IHD), and 42,951 strokes were recorded. Compared with metabolically healthy normal weight (MHN), baseline MHO was associated with higher hazard ratios (HRs) for all types of CVD; however, almost 40% of those participants transitioned to metabolically unhealthy status. Stable metabolically unhealthy overweight or obesity (MUOO) (HR 2.22, 95% confidence interval CI 2.00-2.47, p < 0.001) and transition from metabolically healthy to unhealthy status (HR 1.53, 1.34-1.75, p < 0.001) were associated with higher risk for MVE, compared with stable healthy normal weight. Similar patterns were observed for MCE, IHD, and stroke. Limitations of the analysis included lack of measurement of lipid components, fasting plasma glucose, and visceral fat, and there might be possible misclassification.
Among Chinese adults, MHO individuals have increased risks of MVE. Obesity remains a risk factor for CVD independent of major metabolic factors. Our data further suggest that metabolic health is a transient state for a large proportion of Chinese adults, with the highest vascular risk among those remained MUOO.
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