The Effect of Blood Lipid Profiles on Chronic Kidney Disease in a Prospective Cohort:Based on a Regression Discontinuity Design

Objective Previous studies on the association between lipid profiles and chronic kidney disease(CKD)have yielded inconsistent results and no defined thresholds for blood lipids.Methods A prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted.Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD.A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD.Results Over a median follow-up time of 2.2(0.5,4.2)years,648(2.00%)subjects developed CKD.The lipid profiles that were significantly and linearly related to CKD included total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),TC/HDL-C,and TG/HDL-C,whereas lowdensity lipoprotein cholesterol(LDL-C)and LDL-C/HDL-C were nonlinearly correlated with CKD.TC,TG,TC/HDL-C,and TG/HDL-C showed an upward jump at the cutoff value,increasing the risk of CKD by 0.90%,1.50%,2.30%,and 1.60%,respectively,whereas HDL-C showed a downward jump at the cutoff value,reducing this risk by 1.0%.Female and participants with dyslipidemia had a higher risk of CKD,while the cutoff values for the different characteristics of the population were different.Conclusion There was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China,while TG,TC/HDL-C,and TG/HDL-C showed a stronger risk association.The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.

Metal Exposure and Risk of Diabetes and Prediabetes among Chinese Occupational Workers

Objective To study the association between metal exposure and risk of diabetes and prediabetes among Chinese workers exposed to metals.Methods We used data obtained from the baseline survey of the Jinchang Cohort Study of workers in Jinchang Industry,the largest nickel production company in China.A total of 42,122 workers ≥20 years of age were included in the study.A standardized,structured questionnaire was used to collect epidemiological information.Physical examinations and laboratory tests were conducted to evaluate the health status of the participants and to measure various biomarkers including blood sugar,lipids,and urinary metal concentrations.Logistic regression was used to study the association between occupational groups categorized according to the measured metal levels(office workers,low-level;mining/production workers,mid-level;and smelting/refining workers,high-level)and risk of diabetes and prediabetes.Results The overall prevalence of diabetes and prediabetes was 7.5% and 16.8%,respectively.The adjusted odds ratios for diabetes among mining/production workers and smelting/refining workers compared to office workers were 1.5(95% CI:1.3,1.7)and 3.8(95% CI:3.4,4.3),respectively.No association was observed between these occupational groups and prediabetes in this study.Conclusion Occupations associated with higher levels of metal exposure were associated with an increased risk of diabetes in this cohort.More studies are needed to confirm this observed association.

Estimation Study of New Cancer Cases and Deaths in Wuwei, Hexi Corridor Region, China, 2018

Population-based cancer registration data were collected to estimate the cancer incidence and mortality in Wuwei, Hexi Corridor Region, China in 2018. We used the 2011-2013 data to predict the number of new cases and deaths in 2018 and the 2003-2013 data to analyze trends in cancer incidence and mortality. The goal is to enable cancer prevention and control directions. Our results indicated that stomach cancer is the most common cancer. For all cancers combined, the incidence and mortality rates showed significantly increasing trends（＋2.63% per year; P 〈 0.05 and ＋1.9% per year; P 〈 0.05）. This study revealed a significant cancer burden among the population of this area. Cancer screening and prevention should be performed after an epidemiological study of the cause of the cancer is completed.

Efficacy of electroacupuncture on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass:a systematic review and Meta-analysis

OBJECTIVE:To evaluate the efficacy of electroacupuncture(EA)intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).METHODS:Eight databases,including Pub Med,Embase,the Cochrane Library,Web of Science,Chinese Bio Medical Literature Database,China National Knowledge Infrastructure Database,Wanfang Data,China Science and Technology Journal Database,and two clinical trial registries,were searched.All randomized controlled trials(RCTs)related to EA intervention in cardiac surgery with CPB were collected.Based on the inclusion and exclusion criteria,two researchers independently screened articles and extracted data.After the quality evaluation,RevMan 5.3 software was used for analysis.RESULTS:Fourteen RCTs involving 836 patients were included.Compared with the control treatment,EA significantly increased the incidence of cardiac automatic rebeat after aortic unclamping[relative risk(RR)=1.15,95%confidence interval(CI)(1.01,1.31),P<0.05;moderate].Twenty-four hours after aortic unclamping,EA significantly increased the superoxide dismutase[standardized mean difference(SMD)=0.96,95%CI(0.32,1.61),P<0.05;low],and interleukin(IL)-2[SMD=1.33,95%CI(0.19,2.47),P<0.05;very low]expression levels and decreased the malondialdehyde[SMD=-1.62,95%CI(-2.15,-1.09),P<0.05;moderate],tumour necrosis factor-α[SMD=-1.28,95%CI(-2.37,-0.19),P<0.05;moderate],and cardiac troponin I[SMD=-1.09,95%CI(-1.85,-0.32),P<0.05;low]expression levels as well as the inotrope scores[SMD=-0.77,95%CI(-1.22,-0.31),P<0.05;high].There was no difference in IL-6 and IL-10 expression levels.The amount of intraoperative sedative[SMD=-0.31,95%CI(-0.54,-0.09),P<0.05;moderate]and opioid analgesic[SMD=-0.96,95%CI(-1.53,-0.38),P<0.05;low]medication was significantly lower in the EA group than in the control group.Moreover,the postoperative tracheal intubation time[SMD=-0.92,95%CI(-1.40,-0.45),P<0.05;low]and intensive care unit stay[SMD=-1.71,95%CI(-3.06,-0.36),P<0.05;low]were significantly shorter in the EA group than in the control group.There were no differences in the time to get out of bed for the first time,total days of antibiotic use after surgery,or postoperative hospital stay.No adverse reactions related to EA were reported in any of the included studies.CONCLUSIONS:In cardiac surgery with CPB,EA may be a safe and effective strategy to reduce myocardial ischaemia-reperfusion injury and speed up the recovery of patients after surgery.These findings must be interpreted with caution,as most of the evidence was of low or moderate quality.More RCTs with larger sample sizes and higher quality are needed to provide more convincing evidence.

Predictive value of total cholesterol to high-density lipoprotein cholesterol ratio for chronic kidney disease among adult male and female in Northwest China

Background: Studies have found that the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) was associated with the development of chronic kidney disease (CKD). However, the relationship in different genders was rarely discussed. The aim of this study was to explore this relationship and assess its predictive power for both males and females.Methods: Based on a prospective cohort platform in northwest China, 32,351 participants without CKD were collected in the baseline and followed up for approximately 5 years. Cox proportional hazard model and restricted cubic spline regression analysis were performed to investigate the association between TC, HDL-C, TC/HDL-C and CKD in adult female and male. The clinical application value of the indicators in predicting CKD was evaluated by the receiver operator characteristic curve.Results: During a mean follow-up of 2.2 years, 484 males and 164 females developed CKD. After adjusted for relevant confounders, for every one standard deviation increase in TC, HDL-C and TC/HDL-C, the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CKD were 1.17 (1.05-1.31), 0.84 (0.71-0.99), and 1.15 (1.06-1.25) for males, 0.94 (0.78-1.13), 0.58 (0.35-0.95), and 1.19 (1.01-1.40) for females, respectively. The results also showed that TC, HDL-C, and TC/HDL-C were associated with CKD in a linear dose-response relationship. The TC/HDL-C had the largest area under the curve (AUC) compared to TC and HDL-C, and the AUC among the females was larger than that among males.Conclusions: The TC/HDL-C was significantly associated with CKD in adult males and females and has better clinical value in predicting CKD than TC and HDL-C, especially in females.

Effects of Outdoor Temperature on Blood Pressure in a Prospective Cohort of Northwest China

Objective The relationship between outdoor temperature and blood pressure(BP) has been inconclusive. We analyzed data from a prospective cohort study in northwestern China to investigate the effect of outdoor temperature on BP and effect modification by season.Methods A total of 32,710 individuals who participated in both the baseline survey and the first follow-up in 2011–2015 were included in the study. A linear mixed-effect model and generalized additive mixed model(GAMM) were applied to estimate the association between outdoor temperature and BP after adjusting for confounding variables.Results The mean differences in systolic blood pressure(SBP) and diastolic blood pressure(DBP)between summer and winter were 3.5 mm Hg and 2.75 mm Hg, respectively. After adjusting for individual characteristics, meteorological factors and air pollutants, a significant increase in SBP and DBP was observed for lag 06 day and lag 04 day, a 0.28 mm Hg(95% CI: 0.27–0.30) per 1 °C decrease in average temperature for SBP and a 0.16 mm Hg(95% CI: 0.15–0.17) per 1 °C decrease in average temperature for DBP, respectively. The effects of the average temperature on both SBP and DBP were stronger in summer than in other seasons. The effects of the average temperature on BP were also greater if individuals were older, male, overweight or obese, a smoker or drinker, or had cardiovascular diseases(CVDs), hypertension, and diabetes.Conclusions This study demonstrated a significant negative association between outdoor temperature and BP in a high-altitude environment of northwest China. Moreover, BP showed a significant seasonal variation. The association between BP and temperature differed by season and individuals' demographic characteristics(age, gender, BMI), unhealthy behaviors(smoking and alcohol consumption), and chronic disease status(CVDs, hypertension, and diabetes).

Dynamic Changes in DNA Damage and Repair Biomarkers with Employment Length among Nickel Smelting Workers

Our study explored the dynamic changes in andthe relationship between the DNA damage marker8-hydroxy-2＇-deoxyguanosine （8-OHdG） and theDNA repair marker 8-hydroxyguanine DNAglycosidase 1 （hOGG1） according to the length ofoccupational employment in nickel smeltingworkers. One hundred forty nickel-exposedsmelting workers and 140 age-matched unexposedoffice workers were selected from the Jinchangcohort. The 8-OHdG levels in smelting workers wassignificantly higher than in office workers （Z=-8.688,P〈0.05） and the 8-OHdG levels among nickelsmelting workers in the 10-14 y employment lengthcategory was significantly higher than among allpeers. The hOGG1 levels among smelting workerswere significantly lower than those of non-exposedworkers （Z=-8.948, P〈0.05）. There were significantdifferences between employment length andhOGG1 levels, with subjects employed in nickelsmelting for 10-14 y showing the highest levels ofhOGG1. Correlation analysis showed positivecorrelations between 8-OHdG and hOGG1 levels（r=0.413; P〈0.01）. DNA damage was increased withemployment length among nickel smelting workersand was related to the inhibition of hOGG1 repaircapacity.

Diurnal Temperature Range and Daily Emergency Room Admissions among the Elderly in Beijing,China

In recent years, more attentions have been paid to the association between climate change and human health. Increasing and more variable global surface temperature is one of the key climatic change factors which have been consistently reported about the effect on human health. So far, more researches have revealed that temperature lead not only to direct deaths and illnesses but also to aggravation of cardiovascular and respiratory diseases. Typically, the relationship between temperature and mortality or morbidity is V-, U-, or J- shaped, with optimum temperature corresponding to the lowest point in the temperature mortality curve.

Occupational exposure to heavy metals, alcohol intake, and risk of type 2 diabetes and prediabetes among Chinese male workers

Objective: Both exposure to heavy metals and alcohol intake have been related to the risk of type 2 diabetes (T2D). In this study, we aimed to assess the potential interactions between metal exposure and alcohol intake on the risk of T2D and prediabetes in a cohort of Chinese male workers. Methods: We conducted a cross-sectional analysis of 26,008 Chinese male workers in an occupational cohort study from 2011 to 2013. We assessed metal exposure and alcohol consumption at baseline in these workers who were aged ≥20 years. Based on occupations which were categorized according to measured urine metal levels, multiple logistic regression analyses were used to evaluate the independent and joint effects of metal and alcohol exposure on the risk of T2D and prediabetes. Results: Risks of T2D (Ptrend= 0.0 0 1 ) and prediabetes (Ptrend = 0.001) were significantly elevated with increasing number of standard drinks per week, years of drinking, and lifetime alcohol consumption. An adjusted odds ratio (OR) of 6.1 (95% confidence interval [CI]: 4.8-7.8) was observed for the smelting/refining workers (highest metal exposure levels) who had the highest lifetime alcohol consumption (>873 kg)(Pinteraction = 0.018), whereas no statistically significant joint effect was found for prediabetes (Pinteraction =0.515). Conclusions: Both exposures to metal and heavy alcohol intake were associated with the risk of diabetes in this large cohort of male workers. There was a strong interaction between these two exposures in affecting diabetes risk that needs to be confirmed in future studies.

Heavy Metal Assessment among Chinese Nonferrous Metal-exposed Workers from the Jinchang Cohort Study

Environmental exposure to heavy metals has been linked to a wide range of human health hazards. We detected the levels of 15 metals in urine samples from 500 representative sub-samples in an ongoing occupational cohort study （Jinchang Cohort） to directly evaluate metal exposure levels. Fifteen metals, namely As, Ba, Be, Cd, Cs, Cr, Co, Cu, Pb, Mn, Ni, Se, TI, U, and Zn, were detected by inductively coupled plasma quadruple mass spectrometry. The results showed that median creatinine adjustment and geometric mean urinary metal levels were higher in the heavy metal-exposed group, except Se and Zn, than other reported general or occupational populations. Further studies should address the effects of heavy metals on human health.