Comprehensive understanding of developmental origins of health and disease concepts: Early intervention to non-communicable diseases in China

Introduction Mortality due to various kinds of noncommunicable diseases (NCDs) has become an increasing focus of attention in recent years.1 With rapidly increasing globalization, lifestyles in low-and middle-income countries increasingly include high-fat diets and inadequate physical exercises are resulting in an increased worldwide burden of NCDs.2,3 A study by the International Diabetes Federation (IDF) showed that about 382 million people had diabetes in 2013, and this will rise to 592 million by 2035.The number of people with type 2 diabetes is increasing in every country, and 80％ of people with diabetes live in low-and middle-income countries.The burden of NCDs and the prevalence of related risk factors such asoverweight and diabetes have also increased in China over the past decades.In 2005, NCDs accounted for an estimated 80％ of deaths and 70％ of disability-adjusted life-years lost in China.

Report on Cardiovascular Health and Diseases in China 2023:An Updated Summary

Since 1990,China has made considerable progress in resolving the problem of“treatment difficulty”of cardiovascular diseases(CVD).The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors,and this situation is further worsened due to the accelerated aging population in China.CVD remains one of the greatest threats to the health of Chinese residents.In terms of the proportions of disease mortality among urban and rural residents in China,CVD has persistently ranked first.In 2021,CVD accounted for 48.98%and 47.35%of deaths in rural and urban areas,respectively.Two out of every five deaths can be attributed to CVD.To implement a national policy“focusing on the primary health institute and emphasizing prevention”and truly achieve a shift of CVD prevention and treatment from hospitals to communities,the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the“Report on Cardiovascular Health and Diseases in China”annually since 2005.The 2024 report is established based on representative,published,and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys,randomized controlled clinical trials,large sample registry studies,and typical community prevention and treatment cases,along with data from some projects undertaken by the National Center for Cardiovascular Diseases.These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.

Report on Cardiovascular Health and Diseases in China 2022:an Updated Summary

In the past 30 years,the accessibility and quality index of medical care have made remarkable progress in China,ranking the first among middle-income countries.Many cardiovascular technologies are at or near the world's leading level,and significant progress has been achieved in China solving the problem of“treatment difficulty”of cardiovascular diseases(CVD).However,due to the prevalence of unhealthy lifestyles among Chinese residents,a huge population with CVD risk factors,accelerated population aging,and other reasons,the incidence and mortality rate of CVD are still increasing,and the turning point of the decline in disease burden has not appeared yet in China.In terms of proportions of disease mortality among urban and rural residents,CVD still ranks the first.In 2020,CVD accounted for 48.00%and 45.86%of the causes of death in rural and urban areas,respectively;two out of every five deaths were due to CVD.It is estimated that the number of current CVD patients in China is around 330 million,including 13 million stroke,11.39 million coronary heart disease,8.9 million heart failure,5 million pulmonary heart disease,4.87 million atrial fibrillation,2.5 million rheumatic heart disease,2 million congenital heart disease,45.3 million peripheral artery disease,and 245 million hypertension cases.China has entered a new stage of transformation from high-speed development to high-quality development,and the prevention and control of CVD in China should also shift from previous emphasis on scale growth to strategies focusing more on strategic and key technological development in order to curb the trend of increasing incidence and mortality rates of CVD.

Report on Cardiovascular Health and Diseases in China 2021:An Updated Summary

In 2019,cardiovascular disease(CVD)accounted for 46.74%and 44.26%of all deaths in rural and urban areas,respectively.Two out of every five deaths were due to CVD.It is estimated that about 330 million patients suffer from CVD in China.The number of patients suffering from stroke,coronary heart disease,heart failure,pulmonary heart disease,atrial fibrillation,rheumatic heart disease,congenital heart disease,lower extremity artery disease and hypertension are 13.00 million,11.39 million,8.90 million,5.00 million,4.87 million,2.50 million,2.00 million,45.30 million,and 245.00 million,respectively.Given that China is challenged by the dual pressures of population aging and steady rise in the prevalence of metabolic risk factors,the burden caused by CVD will continue to increase,which has set new requirements for CVD prevention and treatment and the allocation of medical resources in China.It is important to reduce the prevalence through primary prevention,increase the allocation of medical resources for CVD emergency and critical care,and provide rehabilitation services and secondary prevention to reduce the risk of recurrence,re-hospitalization and disability in CVD survivors.The number of people suffering from hypertension,dyslipidemia and diabetes in China has reached hundreds of millions.Since blood pressure,blood lipids,and blood glucose levels rise mostly insidiously,vascular disease or even serious events such as myocardial infarction and stroke often already occured at the time of detection in this population.Hence,more strategies and tasks should be taken to prevent risk factors such as hypertension,dyslipidemia,diabetes,obesity,and smoking,and more efforts should be made in the assessment of cardiovascular health status and the prevention,treatment,and research of early pathological changes.

Human embryonic stem cells as an in vitro model for studying developmental origins of type 2 diabetes

The developmental origins of health and diseases(DOHaD)is a concept stating that adverse intrauterine environments contribute to the health risks of offspring.Since the theory emerged more than 30 years ago,many epidemiological and animal studies have confirmed that in utero exposure to environmental insults,including hyperglycemia and chemicals,increased the risk of developing noncommunicable diseases(NCDs).These NCDs include metabolic syndrome,type 2 diabetes,and complications such as diabetic cardiomyopathy.Studying the effects of different environmental insults on early embryo development would aid in understanding the underlying mechanisms by which these insults promote NCD development.Embryonic stem cells(ESCs)have also been utilized by researchers to study the DOHaD.ESCs have pluripotent characteristics and can be differentiated into almost every cell lineage;therefore,they are excellent in vitro models for studying early developmental events.More importantly,human ESCs(hESCs)are the best alternative to human embryos for research because of ethical concerns.In this review,we will discuss different maternal conditions associated with DOHaD,focusing on the complications of maternal diabetes.Next,we will review the differentiation protocols developed to generate different cell lineages from hESCs.Additionally,we will review how hESCs are utilized as a model for research into the DOHaD.The effects of environmental insults on hESC differentiation and the possible involvement of epigenetic regulation will be discussed.

Maternal low protein diet and fetal programming of lean type 2 diabetes

Maternal nutrition is found to be the key factor that determines fetal health in utero and metabolic health during adulthood.Metabolic diseases have been primarily attributed to impaired maternal nutrition during pregnancy,and impaired nutrition has been an immense issue across the globe.In recent years,type 2 diabetes(T2D)has reached epidemic proportion and is a severe public health problem in many countries.Although plenty of research has already been conducted to tackle T2D which is associated with obesity,little is known regarding the etiology and pathophysiology of lean T2D,a variant of T2D.Recent studies have focused on the effects of epigenetic variation on the contribution of in utero origins of lean T2D,although other mechanisms might also contribute to the pathology.Observational studies in humans and experiments in animals strongly suggest an association between maternal low protein diet and lean T2D phenotype.In addition,clear sex-specific disease prevalence was observed in different studies.Consequently,more research is essential for the understanding of the etiology and pathophysiology of lean T2D,which might help to develop better disease prevention and treatment strategies.This review examines the role of protein insufficiency in the maternal diet as the central driver of the developmental programming of lean T2D.

Medical Image Fusion Based on Anisotropic Diffusion and Non-Subsampled Contourlet Transform

The synthesis of visual information from multiple medical imaging inputs to a single fused image without any loss of detail and distortion is known as multimodal medical image fusion.It improves the quality of biomedical images by preserving detailed features to advance the clinical utility of medical imaging meant for the analysis and treatment of medical disor-ders.This study develops a novel approach to fuse multimodal medical images utilizing anisotropic diffusion(AD)and non-subsampled contourlet transform(NSCT).First,the method employs anisotropic diffusion for decomposing input images to their base and detail layers to coarsely split two features of input images such as structural and textural information.The detail and base layers are further combined utilizing a sum-based fusion rule which maximizes noise filtering contrast level by effectively preserving most of the structural and textural details.NSCT is utilized to further decompose these images into their low and high-frequency coefficients.These coefficients are then combined utilizing the principal component analysis/Karhunen-Loeve(PCA/KL)based fusion rule independently by substantiating eigenfeature reinforcement in the fusion results.An NSCT-based multiresolution analysis is performed on the combined salient feature information and the contrast-enhanced fusion coefficients.Finally,an inverse NSCT is applied to each coef-ficient to produce the final fusion result.Experimental results demonstrate an advantage of the proposed technique using a publicly accessible dataset and conducted comparative studies on three pairs of medical images from different modalities and health.Our approach offers better visual and robust performance with better objective measurements for research development since it excellently preserves significant salient features and precision without producing abnormal information in the case of qualitative and quantitative analysis.

生命早期肠道菌群异常参与发育源性骨质疏松症发生的研究进展

骨质疏松症(osteoporosis,OP)的发生与生命早期骨发育密切相关,是一种发育起源疾病。本文总结了OP发育起源相关的文献报道,提出其发生机制可能与生命早期肠道菌群异常有关。同时,简要阐明了生命早期肠道菌群的组成特征及其影响因素,并系统阐述了生命早期肠道菌群异常参与发育源性OP相关的临床与实验室研究。最后,鉴于生命早期肠道菌群在骨骼发育中的重要作用,从益生菌/益生元两方面总结生命早期干预肠道菌群策略对宿主生长发育及骨量的影响,为防治发育源性OP提供新思路与新策略。

关注环境、立足疾病的大型出生队列研究平台

基于健康与疾病的发展起源学说,上海交通大学医学院附属新华医院启动了生命早期疾病与健康的大型科学研究——“上海优生队列”和“千天计划”,利用专业的知识和视角,聚焦生命早期1000天,关注母亲孕期和宝宝出生后的健康、社会及理化环境、营养等多方面环境因素,为发育源性疾病的预防和治疗提供研究依据。

妊娠期不良暴露对子代骨骼肌功能影响的研究进展

骨骼肌作为机体最重要的肌肉之一,在维持机体代谢功能、能量稳态、运动功能和内分泌功能中发挥重要作用。妊娠期是人体骨骼肌生成和发育的关键时期。妊娠期母体遭受到的不良环境暴露会对子代骨骼肌的健康产生不同的影响。妊娠期肥胖会通过影响胎儿骨骼肌代谢及炎症相关通路的改变介导子代骨骼肌中脂质形成;妊娠期高糖高脂等不良饮食习惯会影响子代骨骼肌线粒体的自噬功能,降低子代骨骼肌质量;妊娠期营养缺乏会通过影响子代骨骼肌的表观遗传学修饰影响其发育;妊娠糖尿病可能通过上调子代骨骼肌中微RNA(miR)-15a和miR-15b水平影响其功能;妊娠期环境内分泌干扰物暴露可能通过干扰子代骨骼肌胰岛素受体相关信号通路损害骨骼肌功能。本文综述了临床和模式动物研究中妊娠期母体不良暴露对子代骨骼肌功能的影响及可能机制,以期为子代骨骼肌出生缺陷的防治提供科学依据。

健康和疾病的发育起源理论研究进展

基于生活环境、健康和疾病在分子水平上密切相关的核心理念,健康和疾病的发育起源(developmental origins of health and disease,DOHaD)理论为健康与疾病间的关联研究提供了全新视角。该理论通过多学科、多领域的知识互通,追溯不同的生活经历如何影响生命全过程中的健康和疾病风险。成人期疾病的敏感窗口期不再局限于妊娠前和妊娠期,分娩期至成年早期也成为暴露因素发挥作用的重要时段。母源性/父源性因素、环境因素、新生儿出生状况、儿童期代谢情况等能够通过影响表观遗传、代谢和免疫调控、氧化应激等,改变发育程序并对子代远期健康产生正向或负向影响。因此,为实现健康促进,需要同步推进早期生命阶段预防、后期随访及健康干预的关口前移,以期有效降低成年期疾病风险,提升生命全周期健康水平。综述DOHaD领域最新研究进展对阐明人类发展早期阶段发生的不良事件影响健康和疾病模式及发现有效干预措施具有积极意义。

Epigenetic mechanisms involved in developmental nutritional programming

The ways in which epigenetic modifications fix the effects of early environmental events,ensuring sustained responses to transient stimuli,which result in modified gene expression patterns and phenotypes later in life,is a topic of considerable interest.This review focuses on recently discovered mechanisms and calls into question prevailing views about the dynamics,position and functions of epigenetic marks.Most epigenetic studies have addressed the long-term effects on a small number of epigenetic marks,at the global or individual gene level,of environmental stressors in humans and animal models.In parallel,increasing numbers of studies based on high-throughput technologies and focusing on humans and mice have revealed additional complexity in epigenetic processes,by highlighting the importance of crosstalk between the different epigenetic marks.A number of studies focusing on the developmental origin of health and disease and metabolic programming have identified links between early nutrition,epigenetic processes and long-term illness.The existence of a self-propagating epigenetic cycle has been demonstrated.Moreover,recent studies demonstrate an obvious sexual dimorphism both for programming trajectories and in response to the same environmental insult.Despite recent progress,we are still far from understanding how,when and where environmental stressors disturb key epigenetic mechanisms.Thus,identifying the original key marks and their changes throughout development during an individual's lifetime or over several generations remains a challenging issue.

Diabetes in migrants and ethnic minorities in a changingWorld

On a worldwide scale, the total number of migrants exceeds 200 million and is not expected to reduce, fuelled by the economic crisis, terrorism and wars, generating increasing clinical and administrative problems to National Health Systems. Chronic non-communicable diseases(NCD), and specifically diabetes, are on the front-line, due to the high number of cases at risk, duration and cost of diseases, and availability of effective measures of prevention and treatment. We reviewed the documents of International Agencies on migration and performed a Pub Med search of existing literature, focusing on the differences in the prevalence of diabetes between migrants and native people, the prevalence of NCD in migrants vs rates in the countries of origin, diabetes convergence, risk of diabetes progression and standard of care in migrants. Even in universalistic healthcare systems, differences in socioeconomic status and barriers generated by the present culture of biomedicine make high-risk ethnic minorities under-treated and not protected against inequalities. Underutilization of drugs and primary care services in specific ethnic groups are far from being money-saving, and might produce higher hospitalization rates due to disease progression and complications. Efforts should be made to favor screening and treatment programs, to adapt education programs to specific cultures, and to develop community partnerships.

Health 3.0—The patient-clinician “arabic spring” in healthcare

A growing number of citizen-patients and clinicians use Communication and Self-Managed Health Technologies (CSMHT) in their relationship. Doing so, they shift from the current paradigm of dependency to a co-responsibility paradigm in healthcare. Facing the runaway utilization of health services, we need to think “outside the box” to unblock the system. A Health 3.0 development model of governance that position patients as primary members of the clinicians’ team is presented to map this institutional transformation. At the practical level, an MD 3.0 relational model and a Citizen-Patient 3.0 behavioral profile are presented.

Childhood Exposure to Air Pollution as a Potential Contributor of Chronic Non-Respiratory Inflammatory Disorders: A Longitudinal Prospective Cohort Study in Hamilton, Canada

This study examines the relationship between childhood exposure to air pollution and diagnosis with chronic non-respiratory health outcomes in adulthood. This prospective cohort study uses data collected in the 1970/1980s from 395 children, including exposure to air pollution. Over thirty years later, a survey collected data on various health outcomes, including diagnosis with arthritis, high blood pressure, long-term skin conditions, and hay fever allergies. Logistic regression modeling was performed to examine the relative contribution of childhood exposure to air pollution on chronic non-respiratory health outcomes in adulthood. Childhood exposure to SO2 emerged as a significant predictor of arthritis (OR = 2.73, 95% CI 1.20 - 6.18) and high blood pressure (OR = 2.82, 95% CI 1.23 - 6.47). Other significant predictors include respiratory symptoms during childhood, family income during childhood and adulthood, property tenure, employment status, residential exposures, life events, physical activity, and body mass index. Childhood exposure to air pollution did not emerge as a significant predictor of long-term skin conditions or hay fever allergies. Findings contribute to the debate on the health effects of air pollution, indicating that the health impacts of childhood exposure to air pollution may include chronic inflammatory disorders in adulthood.

上海市公共卫生重点学科建设与人才培养的实践与思考:以2020—2022年上海市疾病预防控制中心承担项目为例

目的以上海市疾病预防控制中心承担项目为例,对上海市公共卫生重点学科建设与人才培养的实践进行客观评估,总结项目实施经验,完善项目评估机制,强化学科发展与人才培养对上海市健全公共卫生应急管理体系的支撑作用。方法基于学科建设验收评估申请书,通过定量、定性方法对学科建设期间的项目基本情况、学科建设成效、跨机构科研协作、参与公共卫生实践以及人才培养与建设等进行描述和分析。结果各学科团队承担的科研项目级别较高,较好促进了学科创新发展;各学科团队注重公共卫生实践与应用能力建设,实现了科研成果的转化落地;上海市疾病预防控制中心和复旦大学在论文发表合作网络中占据了主要地位,在多部门科研协作中发挥了重要作用;专业机构和高等院校的合作促进了公共卫生复合型人才培养。结论上海市公共卫生重点学科建设与人才培养取得了良好成效。

辅助生殖技术与儿童发育可塑性的研究进展

辅助生殖技术(ART)的出现使许多不孕不育个体获益,同时采用ART生育的儿童生长、发育和健康的潜在长期后果也备受关注。采用ART生育儿童的晚期心脏疾病患病风险显著增加,因此在明确ART有效性、安全性前,必须谨慎使用ART。为进一步完善ART,应将长期随访研究结果用于新技术开发中。此外,详细ART登记处信息以及围生期、儿童健康诊所、学校数据均有助于更好地了解采用ART生育儿童的生长和健康状况,从而为完善ART提供可靠依据。

“治未病”探析与思考

"治未病"是中医学的重要思想之一,亦是指导我们治疗疾病与养生保健的关键原则之一。两千年后的今天,在各种疾病和亚健康问题肆虐的情形下,"治未病"为人类提出超前性的现世指导。该文将从治未病的哲学渊源、具体涵义、指导意义及基因启示等方面作了简要探析、思考。

健康和疾病的发育起源

20世纪90年代,基于临床流行病学的一些发现,英国学者David Barker教授最早提出健康和疾病的发育起源这一概念。目前发现,几乎所有的成人慢性疾病,例如代谢性疾病、心血管疾病、肿瘤等都与发育早期的环境有关。这个假说得到了大量临床流行病学和动物实验等基础研究的证实。它的意义在于,在临床上,有这样一个"窗口期",通过合理的规范孕妇的营养和行为,以及合理的出生后早期营养,能够避免胎儿和婴儿暴露于不良的环境中,从而降低他们成年后发生慢性疾病的风险。因此健康和疾病的发育起源这一概念有现实的临床意义。

选择性胎儿宫内生长受限与代谢异常的关系——基于气相色谱-飞行时间质谱的脐血代谢组学研究

目的探讨单绒毛膜双羊膜囊双胎选择性宫内生长受限(sIUGR)的脐血代谢物构成及生长受限胎儿与正常胎儿的代谢差异。方法采用单卵双胎配对设计,通过气相色谱-飞行时间质谱进行sIUGR双胎脐血代谢组学检测,采用主成分分析和偏最小二乘法判别分析(PLS-DA)对质谱数据建模,对变量投影重要度(VIP)值>1的差异点进行非参数检验,寻找差异代谢物。结果 sIUGR大小胎儿脐血血浆样品点在PLS-DA得分图中存在分离趋势。通过对VIP值大于1的差异点进行Wilcoxon符号秩检验及数据库比对,筛选出10种体现出大小胎儿代谢差别的脐血潜在标志物,在生长受限胎儿脐血代谢水平上调的代谢物包括山梨醇、肌醇、甘氨酸、吡啶甲酸,下调的包括亮氨酸、缬氨酸、棕榈酸、硬脂酸、胆固醇和肌酸。结论 sIUGR生长受限胎儿与正常胎儿的脐血代谢物构成存在差异,可能与碳水化合物、氨基酸及脂代谢异常相关。