中国糖尿病发病率和检出率地域性差异——98058例成年受试者数据多水平空间分析

目的探究中国糖尿病发病率和检出率地域性差异。方法选取分布在中国大陆162个地区的98058例18岁以上成年受试者的自述报告和生物学数据(90.5%反馈率),采用美国糖尿病协会糖尿病诊疗标准评估受试者的糖尿病症状,根据先前诊断结果 ,做出其是否患有糖尿病的判断。以各省为单位,使用分区统计图表法评估各调研数据结果的地域性差异。应用多元logistic回归分析法,校正个体和地域层级的差别后,评估每个结果出现的概率。结果各省糖尿病患者的地理分布反映出中国糖尿病发病率和检出率地域性差异。校正年龄、性别和城市/农村社会经济状况等因素后,糖尿病发病率自东北部向北部,从8.3%(95%CI 7.2%,9.7%)上升至12.7%(11.1%,14.6%)。从较好社会经济状况(socioeconomic circumstances,SEC)的城市到农村较差社会经济状况的县/区,糖尿病发病率呈下降趋势,分别为13.1%(12.0%,14.4%)和8.7%(7.8%,9.6%)。校正健康知识水平和个人原因两个因素后,地域性差异仍具有统计学意义。仅三分之一的糖尿病患者在接受此次测试前有糖尿病诊断史,但此结果因地域不同而不同。校正年龄、性别和城市/农村SEC后,糖尿病检出率自北向西南从40.4%(34.9%,46.3%)下降至15.6%(11.7%,20.5%)。与较好SEC县市的40.8%(37.3%,44.4%)检出率相比,农村较差SEC地区的检出率最低,仅为20.5%(17.7%,23.7%)。糖尿病检出率的地域性差异并不完全是个体差异造成的。结论加强防控糖尿病意识,提高检测准确率应从地域性因素出发。

Associations of sleeping patterns and isotemporal substitution of other behavior with the prevalence of CKD in Chinese adults

Studies have found a U-shaped relationship between sleep duration and chronic kidney disease(CKD)risk,but limited research evaluated the association of reallocating excessive sleep to other behavior with CKD.We included 104538 participants from the nationwide cohort of the Risk Evaluation of Cancers in Chinese Diabetic Individuals:A Longitudinal Study,with self-reported time of daily-life behavior.Using isotemporal substitution models,we found that substituting 1 h of sleeping with sitting,walking,or moderate-to-vigorous physical activity was associated with a lower CKD prevalence.Leisure-time physical activity displacement was associated with a greater prevalence reduction than occupational physical activity in working population.In stratified analysis,a lower CKD prevalence related to substitution toward physical activity was found in long sleepers.More pronounced correlations were observed in long sleepers with diabetes than in those with prediabetes,and they benefited from other behavior substitutions toward a more active way.The U-shaped association between sleep duration and CKD prevalence implied the potential effects of insufficient and excessive sleep on the kidneys,in which the pernicious link with oversleep could be reversed by time reallocation to physical activity.The divergence in the predicted effect on CKD following time reallocation to behavior of different domains and intensities and in subpopulations with diverse metabolic statuses underlined the importance of optimizing sleeping patterns and adjusting integral behavioral composition.

Therapeutic strategies against bacterial biofilms

The emergence of multi-drug resistance makes bacterial infection a major threat to public health and economy.The formation of bacterial biofilms is one of the main reasons of bacterial resistance.The complexity of chemical composition and physical structure makes the elimination of mature biofilms a difficult problem.The highly antibiotic resistant property of biofilms urgently calls for potent antimicrobial agents and novel antibiofilm strategies.Researchers have made a lot of efforts in this field.Here we review the current strategies to eliminate mature biofilms and progress in related drug delivery nanosystems,with the aim of inspiring researchers to design new antibiofilm systems.

Small-molecule anti-COVID-19 drugs and a focus on China's homegrown mindeudesivir(WV116)

The coronavirus disease 2019(COVID-19)pandemic has stimulated tremendous efforts to develop therapeutic agents that target severe acute respiratory syndrome coronavirus 2 to control viral infection.So far,a few small-molecule antiviral drugs,including nirmatrelvir-ritonavir(Paxlovid),remdesivir,and molnupiravir have been marketed for the treatment of COVID-19.Nirmatrelvir-ritonavir has been recommended by the World Health Organization as an early treatment for outpatients with mild-to-moderate COVID-19.However,the existing treatment options have limitations,and effective treatment strategies that are cost-effective and convenient for tackling COVID-19 are still needed.To date,four domestically developed oral anti-COVID-19 drugs have been granted conditional market approval in China.These drugs include azvudine,simnotrelvir-ritonavir(Xiannuoxin),leritrelvir,and mindeudesivir(VV11).Preclinical and clinical studies have explored the efficacy and tolerability of mindeudesivir and supported its early use in mild-to-moderate COVID-19 cases at high risk for progression.In this review,we discuss the most recent findings regarding the pharmacological mechanism and therapeutic effects focusing on mindeudesivir and other small-molecule antiviral agents for COVID-19.These findings will expand our understanding and highlight the potential widespread application of China's homegrown anti-COVID-19 drugs.

Serum uric acid and risk of incident diabetes in middle-aged and elderly Chinese adults: prospective cohort study

The association between serum uric acid and the risk of incident diabetes in Chinese adults remains unknown.This study aimed to investigate this association in a community-dwelling population aged≥40 years in Shanghai,China.Oral glucose tole3rance test was conducted during baseline and follow-up visits.Relative risk regression was utilized to examine the associations between baseline gender-specific serum uric acid levels and incident diabetes risk.A total of 613(10.3%)incident diabetes cases were identified during the follow-up visit after 4.5 years.Fasting plasma glucose,postload glucose,and glycated hemoglobin A1c during the follow-up visit progressively increased across the sex-specific quartiles of serum uric acid(all Ps<0.05).The incidence rate of diabetes increased across the quartiles of serum uric acid(7.43%,8.77%,11.47%,and 13.43%).Multivariate adjusted regression analysis revealed that individuals in the highest quartile had 1.36-fold increased risk of diabetes compared with those in the lowest quartile of serum uric acid(odds ratio(95%confidence interval)=1.36(1.06−1.73)).Stratified analysis indicated that the association was only observed in women.Accordingly,serum uric acid was associated with the increased risk of incident diabetes among middle-aged and elderly Chinese women.

New definition of metabolic dysfunction-associated fatty liver disease with elevated brachial-ankle pulse wave velocity and albuminuria: a prospective cohort study

A new definition of metabolic dysfunction-associated fatty liver disease(MAFLD)has recently been proposed.We aim to examine the associations of MAFLD,particularly its discordance from non-alcoholic fatty liver disease(NAFLD),with the progression of elevated brachial-ankle pulse wave velocity(baPWV)and albuminuria in a community-based study sample in Shanghai,China.After 4.3 years of follow-up,778 participants developed elevated baPWV and 499 developed albuminuria.In comparison with the non-MAFLD group,the multivariable adjusted odds ratio(OR)of MAFLD group for new-onset elevated baPWV was 1.25(95%confidence interval(CI)1.01–1.55)and 1.35(95%CI 1.07–1.70)for albuminuria.Participants without NAFLD but diagnosed according to MAFLD definition were associated with higher risk of incident albuminuria(OR 1.77;95%CI 1.07–2.94).Patients with MAFLD with high value of hepamet fibrosis score or poor-controlled diabetes had higher risk of elevated baPWV or albuminuria.In conclusion,MAFLD was associated with new-onset elevated baPWV and albuminuria independently of body mass index,waist circumference,and hip circumference.Individuals without NAFLD but diagnosed as MAFLD had high risk of albuminuria,supporting that MAFLD criteria would be practical for the evaluation of long-term risk of subclinical atherosclerosis among fatty liver patients.

Early-life famine exposure,adulthood obesity patterns,and risk of low-energy fracture

Malnutrition in early life increases the risk of osteoporosis,but the association of early-life undernutrition combined with adulthood obesity patterns with low-energy fracture remains unknown.This study included 5323 community-dwelling subjects aged⩾40 years from China.Early-life famine exposure was identified based on the participants’birth dates.General obesity was assessed using the body mass index(BMI),and abdominal obesity was evaluated with the waist-to-hip ratio(WHR).Low-energy fracture was defined as fracture occurring after the age of⩾40 typically caused by falls from standing height or lower.Compared to the nonexposed group,the group with fetal,childhood,and adolescence famine exposure was associated with an increased risk of fracture in women with odds ratios(ORs)and 95%confidence intervals(CIs)of 3.55(1.57–8.05),3.90(1.57–9.71),and 3.53(1.05–11.88),respectively,but not in men.Significant interactions were observed between fetal famine exposure and general obesity with fracture among women(P for interaction=0.0008).Furthermore,compared with the groups with normal BMI and WHR,the group of women who underwent fetal famine exposure and had both general and abdominal obesity had the highest risk of fracture(OR,95%CI:3.32,1.17–9.40).These results indicate that early-life famine exposure interacts with adulthood general obesity and significantly increases the risk of low-energy fracture later in life in women.