Effects of loneliness and isolation on cardiovascular diseases:a two sample Mendelian Randomization Study

BACKGROUND Loneliness and isolation are associated with multiple cardiovascular diseases(CVDs),but there is a lack of research on whether they were causally linked.We conducted a Mendelian Randomization(MR)study to explore causal relationships between loneliness and isolation and multiple CVDs.METHODS Single nucleotide polymorphisms associated with loneliness and isolation were identified from a genome-wide association study(GWAS)of 455,364 individuals of European ancestry in the IEU GWAS database.Summary data for 15 CVDs were also obtained from the IEU GWAS database.We used three MR methods including inverse variance weighting,MR-Egger,and weighted median estimation to assess the causal effect of exposure on outcomes.Cochran's Q test and MR-Egger intercept test were used to evaluate the heterogeneity and pleiotropy.RESULTS MR analysis showed that loneliness and isolation were significantly associated with essential hypertension(OR=1.07,95%CI:1.03-1.12),atherosclerotic heart disease(OR=1.04;95%CI:1.02-1.06),myocardial infarction(OR=1.02;95%CI:1-1.04)and angina(OR=1.04;95%CI=1.02-1.06).No heterogeneity and pleiotropy effects were found in this study.CONCLUSIONS Causal relationship of loneliness and isolation with CVDs were found in this study.

Status of cardiovascular disease in China

Cardiovascular disease(CVD)has become the leading cause of death and disability in the global population and imposes a significant economic burden on global health systems.Prevalent cases of total CVD nearly doubled from 271 million in 1990 to 523 million in 2019,and the number of CVD deaths steadily increased from 12.1 million in 1990,reaching 18.6 million in 2019.The global trends for disabilityadjusted life years and years of life lost also increased significantly,and years lived with disability doubled from 17.7 million to 34.4 million over that period.

Unveiling shared genetic pathways in cardiovascular diseases:towards personalized therapies and holistic treatment approaches

Cardiovascular diseases(CVDs),encompassing diverse pathologies such as atherosclerosis,hypertension,cardiomyopathy,arrhythmia,and valvular diseases,represent a significant public health challenge,severely undermining human health[1].According to the World Health Organization,CVDs claimed approximately 17.9 million deaths in 2019,representing 32%of all global deaths[2,3].The risk of CVDs morbidity and mortality increases with age,with the majority of CVDs and deaths occurring in elderly aged 75 years and older[4,5].In developed nations,CVDs are the principal cause of mortality,while in developing countries,they are a leading cause of death as well.

Different clinical characteristics and outcomes of hypertrophic cardiomyopathy with and without hypertension:seeking the truth

OBJECTIVE To determine the different clinical characteristics and outcomes of hypertrophic cardiomyopathy(HCM)patients with and without hypertension(HT).METHODS A total of 696 HCM patients were included in this study and all HCM diagnoses were confirmed by the genetic test.Patients were analyzed separately in the septal reduction therapy(SRT)cohort and the non-SRT cohort.The primary endpoint was cardiovascular death and the secondary endpoint was all-cause death.Outcome analyses were conducted to evaluate the associations between HT and outcomes in HCM.Medications before enrollment and at discharge were collected in the post-hoc analyses.RESULTS HCM patients without HT were younger,had a lower body mass index,were more likely to have a family history of HCM,and had a smaller left ventricular(LV)end-diastolic diameter than those with HT in both cohorts.A thicker LV wall,a higher level of N-terminal pro-B-type natriuretic peptide,and a higher extent of LV late gadolinium enhancement were additionally observed in patients without HT in the non-SRT cohort.The presence of HT did not alter the distribution pattern of late gadolinium enhancement,as well as the constituent ratio of eight disease-causing sarcomeric gene variants in both cohorts.Outcome analyses showed that in the non-SRT cohort,patients without HT had higher risks of cardiovascular death(HR=2.537,P=0.032)and all-cause death(HR=3.309,P=0.032).While such prognostic divergence was not observed in the SRT cohort.Further post-hoc analyses in the non-SRT cohort found that patients without HT received fewer non-dihydropyridine calcium channel blockers and angiotensinconverting enzyme inhibitors/angiotensin receptor blockers before enrollment and at discharge.CONCLUSIONS HCM patients without HT had worse clinical conditions and higher mortality than patients with HT overall,which may result from active medical therapy in HT patients.Active SRT may have a substantial de-risking effect on patients meeting the indications.

Validation of the Simplified Chinese-character Version of the International Physical Activity Questionnaire-Long Form in Urban Community-dwelling Adults:a Cross-sectional Study in Hangzhou,China

Objective To assess the test-retest reliability and criterion validity of the Simplified Chinese-character version of the International Physical Activity Questionnaire Long form （IPAC）.-L） in urban community-dwelling adults in Hanghzou, China. Methods A total of 158 eligible participants aged 25-59 years from 6 neighbourhoods in two central districts of Hangzhou completed the IPAQ-L questionnaire twice within a 7-day interval. Half of the subjects wore pedometers during the first 7 days. Test-retest reliability was examined by comparing the first （Day 1） and the second （Day 9） survey of IPAQ-L Criterion validity was assessed by comparing IPAO,-L with pedometer data. Results Modest to good test-retest reliability was found with intraclass correlation coefficients of 0.67 for total PA, 0.37 to 0.73 for specific dimensions, and 0.56 to 0.71 for different intensities of PA. Total PA measured by IPAO.-L was moderately correlated with exercise levels （partial r = 0.27, P = 0.020） and walking distance （partial r = 0.31, P = 0.007）, which were measured by a pedometer, after adjusting for gender, age, educational attainment and employment status. Conclusion Our results indicate that the IPAO.-L is a reliable and validated measure for assessing physica activity levels in this population and possibly the adult population in other mainland Chinese cities.

Risk factors of distal segment aortic enlargement after complicated type B aortic dissection

Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a multivariate analysis was performed to find potential factors predictive of DSAE.Methods:A single-center retrospective study was performed from 1999 to 2016.Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears.Based on the diameter of the distal segment of the uncovered aorta,we assigned patients to an enlargement group and a non-enlargement group.Data extracted from the medical records included demographic and clinical characteristics and followup computed tomography angiography data.The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period.Results:For the 333 patients,all-cause mortality was 38(11.41%),and 76(22.82%)patients underwent reintervention.A total of 70(21.02%)patients experienced DSAE,among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention.Multivariate analysis reviewed independent risk factors of postoperative DSAE,including current smoking,the residual length of the patent false lumen,the postoperative number of dissection tears in the thoracic aorta and type III aortic arch;as well as protective factors,including the application of a restrictive bare stent(RBS),the length of covered stent in the descending thoracic aorta,and the distance from the residual first tear to the left subclavian artery(LSA).Conclusion:DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit,the residual length of patent false lumen,the postoperative number of dissection tears in the thoracic aorta and the aortic arch type.Meanwhile,RBS usage,the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.

Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents:A Meta-analysis and Systematic Review

Objective The benefit of short-term dual antiplatelet therapy(DAPT) following second-generation drug-eluting stents implantation has not been systematically evaluated. To bridge the knowledge gap,we did a meta-analysis to assess the efficacy of ≤6 months versus ≥12 months DAPT among patients with second-generation drug-eluting stents. Methods We searched online databases and identified randomized controlled trials that assess the clinical impact of short-term DAPT(≤6 months) published before March 3,2016. The efficacy endpoints included the incidence of all-cause death,myocardial infarction,cerebrovascular accidents,and definite or probable stent thrombosis. Safety endpoint defined as major bleeding was also evaluated and discussed. Results We included 5 trials that randomized 9473 participants(49.8%,short-term DAPT duration vs. 50.2%,standard duration). A total of 9445(99.7%) patients reported the efficacy endpoints,and the safety endpoint was available from 4 studies(n=8457). There was no significant difference in efficacy endpoints between short-term and standard DAPT duration(≥12 months) [risk ratio(RR) 0.96; 95% confidence intervals(CI),0.80-1.15]. Short-term DAPT duration did not significantly increase the individual risk of all-cause death,myocardial infarction,cerebrovascular accidents,or definite or probable stent thrombosis. Although short-term DAPT obviously reduced risk of major bleeding compared with standard DAPT(RR 0.53; 95% CI,0.29-0.96),significant publication bias was found when accessing the safety endpoint of the 4 studies(Egger's test,P=0.009). Conclusions The efficacy of short-term DAPT was comparable with that of standard duration DAPT.DAPT less than 6 months may be appropriate for patients receiving second-generation drug-eluting stents implantation.

Impact of baseline blood pressure on all-cause mortality in patients with atrial fibrillation:results from a multicenter registry study

Background:The ideal blood pressure(BP)target for patients with atrial fibrillation(AF)is still unclear.The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF.Methods:This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011.All participants were followed for 1 year±1 month.The primary endpoint was all-cause mortality.Results:During the follow-up,276(13.9%)all-cause deaths occurred.Kaplan-Meier curves showed that a systolic blood pressure(SBP)110 mmHg or>160 mmHg was associated with a higher risk of all-cause mortality(log-rank test,P=0.014),and a diastolic blood pressure(DBP)<70 mmHg was associated with the highest risk of all-cause mortality(log-rank test,P=0.002).After adjusting for confounders,the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP110 mmHg(hazard ratio[HR],1.963;95%confidence interval[CI],1.306-2.951),and DBP<70 mmHg(HR,1.628;95%CI,1.163-2.281).In the restricted cubic splines,relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations(non-linear P<0.001 and P=0.010,respectively).The risk of all-cause mortality notably increased at a lower baseline SBP and DBP.Conclusions:Having a baseline SBP110 mmHg or DBP<70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF.An excessively low BP may not be an optimal target for patients with AF.

Cardiac amyloidosis presenting as pulmonary arterial hypertension:A case report

BACKGROUND Pulmonary hypertension is a rare cardiopulmonary disease,with an insidious onset that usually worsens rapidly.Amyloid light chain(AL)amyloidosis is a rare systemic disease caused by extracellular deposition of pathologic,insoluble,and proteinaceous fibrils in organs and tissues;however,it is difficult to diagnose given its varied and nonspecific symptoms.To date,rare cases of amyloidosis with pulmonary hypertension have been reported.Of note,the optimal treatments for cardiac amyloidosis complicated with pulmonary hypertension remain unclear.CASE SUMMARY We report a case of a 51-year-old woman who presented with progressively worsening dyspnea.Transthoracic echocardiography indicated severe pulmonary hypertension.Twenty-seven months after first admission,the patient returned with symptoms of progressive heart failure.A myocardial tissue sample stained with Congo red was positive,and the patient was ultimately diagnosed with AL amyloidosis with cardiac involvement.CONCLUSION Although pulmonary hypertension may be idiopathic,it is frequently associated with other conditions.In rare cases,pulmonary hypertension can be a complication of AL amyloidosis,which should be seriously considered in any adult presenting with nonspecific signs or symptoms of cardiac distress.

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012‒2015)

Background Heart failure(HF)is a leading cause of hospitalization and mortality for older chronic kidney disease(CKD)patients.However,the epidemiological data is scarce.We aimed to determine the prevalence of left ventricular(LV)dysfunction and HF,and to explore the risk factors for HF among those patients.Methods This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015.A total of 5,808 participants aged≥65 years were included in the analysis.Self-reported history of HF and any other cardiovascular diseases was acquired.2-D and Doppler echocardiography were used to assess LV dysfunction.CKD was defined as either estimated glomerular filtration rate(eGFR)<60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio(ACR)≥30 mg/g.Results Among CKD patients aged≥65 years,the weighted prevalence of HF,heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with reduced ejection fraction(HFrEF)was 4.8%,2.5%,0.8%,and 1.7%,respectively.The weighted prevalence of HF was 5.0%in patients with eGFR<60 mL/min per 1.73 m2,and was 5.9%in patients with ACR≥30 mg/g.The prevalence of LV systolic dysfunction was 3.1%,and while it was 8.9%for moderate/severe diastolic dysfunction.Multivariate analysis showed that smoking was significantly associated with the risk of HF.Furthermore,age,smoking,and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.Conclusions The prevalence of HF and LV dysfunction was high in older patients with CKD,suggesting that particular strategies will be required.

China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction： Study Design

Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adverse events and patient-reported outcomes （PROs）. Methods： The China Patient-centered Evaluative Assessment of Cardiac Events （PEACE）-Prospective AMI Study will enroll 4000 consecutive AM I patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to docunlent their treatment, recovery, and outcomes. Details of patients＇ medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1 - and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics. Conclusion： The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient＇s experiences and outcomes alter AMI in China and seiwe as a foundation for quality improveinent activities.

“中国心血管病人生活质量评定问卷”常模的测定(英文)

目的：就高血压、冠心病、充血性心力衰竭（CHF）患者测定＂中国心血管病人生活质量评定问卷＂（CQQC）的常模,并分析其影响因素。方法：采用整群随机抽样的方法,对地跨中国各大区的19个城市28所医院的7937名对象的生活质量进行调查,建立全国常模,并比较性别、年龄、运动、心理状态、教育、家庭以及医疗条件所致的差异。结果：1、正常人平均得分（国家常模）为（95.74±23.21）分;2、高血压患者平均得分为（73.75±23.62）,高血压3级患者生活质量（69.06±21.78）明显低于其他患者（P〈0.01）;3、冠心病患者的平均得分为（64.67±20.59）,其中不稳定型心绞痛患者的生活质量（55.37±18.62）最差（P〈0.01）;4、CHF患者的平均得分为（40.36±17.24）,显著低于高血压和冠心病患者（P〈0.01）;5、影响因素：（1）性别、年龄：所有人的总体得分为（71.41±27.8）分,男性得分非常显著高于女性（P=0.000）;正常人随着年龄增加,得分逐渐减少（P〈0.05）,除≥70岁组,其他各年龄组男性得分显著高于女性得分（P〈0.05）;（2）运动：参加运动者的得分（72.64±21.87）非常显著高于未参加运动者（66.91±23.13）,P=0.000;（3）心理：心理健康者的得分（70.13±25.66）非常显著高于心理有障碍者（68.91±20.44）,P=0.001;（4）其他：受教育程度越高,得分越高;家庭成员为1个人的得分明显低于2人组和3人及以上组的得分;自费患者的得分低于医保或公费患者的得分（P〈0.05~〈0.001）。结论：本研究样本量大,数据可靠;中国心血管病人生活质量评定问卷能反映年龄、性别、运动、心理、家庭、受教育程度、医疗条件和疾病对生活质量的影响,条目简短明了,可操作性好,值得推广。

A Novel Perspective on Histopathology Provides Novel Insights into Surgical Effects in Pulmonary Atresia,Ventricular Septal Defect,and Major Aortopulmonary Collateral Arteries:A Case-Series Study

Background:Never had literatures characterized the relationship between the property of major aortopulmonary collateral arteries(MAPCAs)and outcomes of selective unifocalization of pulmonary atresia with ventricular septal defects and MAPCAs.Methods:This is a case-series study.Thirteen patients were included.Angiographybased assessment was conducted to determine whether collateral arteries should be unifocalized or treated with intraoperative ligature.Specimens were collected and stained by HE and ET+VG.Results:Twelve patients underwent one-stage unifocalization at a median age of 37 months(range:6–228 months)and a median weight of 14.0 kg(range:5.0–49.0 kg),which produced a favorable right ventricle to aortic systolic pressure ratio of no more than 0.5 except in one patient who died.Patients were divided into three groups:Group 1(n=6),had no native pulmonary arteries,and collateral arteries supplied all pulmonary blood;Group 2(n=6)presented dysplastic native pulmonary arteries on one or both sides,and in some lung lobes or segments,blood was supplied only by collateral arteries;Group 3(n=1)had well-developed left and right pulmonary arteries,and collateral arteries,and pulmonary arteries provided blood flow to the same segments.Pathological reports demonstrated two types of collateral arteries:Elastic arteries presented an arborization distribution similar to native pulmonary artery walls,while muscular arteries showed high resistance and distortion.We selectively unifocalized single-supply collateral arteries with morphologic features based on the arborization distribution.Conclusions:We found that there were two kinds of MAPCAs with different histology,and we performed selective UF for MAPCAs that might belong to the elastic artery.Selective unifocalization achieved a low right ventricle to aortic systolic pressure ratio and favorable surgical effects.

组织多普勒速度并不完全独立于前负荷:一项针对经血液透析的尿毒症患者人群的研究

目的:在尿毒症患者中,研究经常规血液透析(HD)体液容量减少后局部组织多普勒速度的变化。组织多普勒速度是否确实独立于前负荷?

Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population

Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high genetic risk.

Composition and Functional Capacity of Gut Microbes are Associated with Arterial Stiffness:A Prospective Study

Objective:Arterial stiffness is an important predictor of cardiovascular disease.Microbial diversity in the gut has been shown to be associated inversely with arterial stiffness in Caucasian populations.However,due to the different profiles of the gut microbiota among ethnicities,the relationship between gut-microbiota dysbiosis and the progression of arterial stiffness merits further investigation.This study aimed to investigate the association between the composition and functional capacity of the gut microbiota and the progression of arterial stiffness.Methods:“Shotgun”metagenomics sequencing were undertaken in 96 individuals from a hypertension-associated gut-microbiota study in the Kailuan cohort,who measured brachial-ankle pulse wave velocity(baPWV)and provided fecal samples between September 2014 and February 2015 at Kailuan General Hospital and 11 affiliated hospitals.The different composition and functional capacity of the gut microbiota were compared between individuals without arterial stiffness(normal arterial stiffness group,baPWV<1,400 cm/s,n=27)and participants with arterial stiffness(increased arterial stiffness group,baPWV≥1,400 cm/s,n=69)at baseline.These participants were followed up prospectively for a mean duration of 2.6 years,and 50 underwent a repeat baPWV measurement.Associations between the gut microbiota and severity and progression of arterial stiffness were assessed using MaAsLin2 software after adjustment for age,sex,and mean arterial blood pressure and correction for multiple testing.Gene“catalogs”were aligned to the Kyoto Encyclopedia of Genes and Genomes(KEGG)database to obtain information for potential functional capacities of the gut microbiota.Results:In this study,14 genera and 50 species of bacteria were identified to be abundant in participants with normal arterial stiffness compared with those with increased arterial stiffness.Of 14 genera,the prevalence of beneficial bacteria of the genera Leadbetterella and Cytophaga was correlated inversely with baPWV(P<0.05).Analyses of functional capacity revealed gut-microbial dysfunctions in the synthetic processes of“threonine dehydratase”“hypothetical protein”“mannosyl transferase”and“type-IV secretion-system proteins”in individuals suffering from arterial stiffness.During follow-up,bacteria of the proinflammatory genera Escherichia,Shigella,and Ruegeria were enriched in individuals with increased baPWV.Functional analyses showed that 26 KEGG orthologs of gut microbes were associated with an increase in baPWV and involved in“carbohydrate metabolism”“amino acid metabolism”and“protein families related to genetic information processing.”Conclusions:The composition and functional capacity of the microbial community in the gut of people suffering from arterial stiffness differed from those in individuals not suffering from arterial stiffness.Our data provide a new direction for the causality of the host-gut microbiota in arterial stiffness.

残余胆固醇与心血管、癌症死亡率的相关性:一项全国性队列研究

The health significance of triglyceride-rich lipoproteins,also known as remnant cholesterol,has been increasingly recognized.However,evidence of their associations with cause-specific mortality in the general population was previously insufficient.To explore these associations and their heterogeneities across subgroups,a prospective cohort study was conducted including 3,403,414 community-based participants from China HEART,an ongoing government-funded public health program throughout China,from November 2014 through December 2022.The study assessed mortality risk of all-cause mortality,cardiovascular disease(CVD)mortality(including mortality from ischemic heart diseases(IHD),ischemic stroke(IS),and hemorrhagic stroke(HS),separately),and cancer mortality(including lung cancer,stomach cancer,and liver cancer,separately).During the 4-year follow-up,23,646 individuals died from CVD(including 8807 from IHD,3067 from IS,and 5190 from HS),and 20,318 from cancer(including 6208 from lung cancer,3013 from liver cancer,and 2174 from stomach cancer).Compared with individuals with remnant cholesterol<17.9 mg/d L,multivariable-adjusted mortality hazard ratios(HRs)for individuals with remnant cholesterol≥27.7 mg/d L were 1.03(1.00–1.05)for all-cause mortality,1.17(1.12–1.21)for CVD(1.19(1.12–1.27)for IHD mortality,and 1.22(1.09–1.36)for IS mortality),and 0.90(0.87–0.94)for allcancer mortality(0.94(0.87–1.02)for lung cancer,0.59(0.53–0.66)for liver cancer,and 0.73(0.64–0.83)for stomach cancer).In summary,this study revealed a correlation between increased remnant cholesterol levels and an elevated risk of cardiovascular disease mortality,as well as a reduced risk of mortality for certain types of cancer.

Effect of Chinese Herbal Medicine for Activating Blood Circulation and Detoxifying on Expression of Inflammatory Reaction and Tissue Damage Related Factors in Experimental Carotid Artery Thrombosis Rats

Objective：To observe the pharmaceutical effect of Chinese drugs for activating blood circulation （Xiongshao Capsule,XSC,芎芍胶囊）and for activating blood circulation and detoxification（Xiongshao Capsule and Huanglian Capsule,XSHLC,黄连胶囊）in terms of the indices of thrombosis,inflammatory reaction and tissue damage related factors in experimental carotid artery thrombosis rats.Methods：Fifty Wistar rats were randomly divided into the sham operation group,the model group,the Simvastatin group（SG）,the activating blood circulation（ABC）group,and the activating blood circulation and detoxifying（ABCD）group,with 10 rats in each group.Simvastatin（1.8 mg/kg）,XSC（0.135 g/kg）and XSHLC（0.135 g/kg）were administered to Simvastatin,ABC and ABCD group by gastrogavage,and an equal volume of normal saline was given to the sham operation group and the model group.After 2 weeks of successive medication,the rats in the model and all drug therapy groups were made into experimental carotid artery thrombosis model.The serum levels of matrix metalloproteinases（MMP-9）,tissue inhibitors to metalloproteinase（TIMP-1）,granule membrane protein-140（GMP-140）,tissue-type plasminogen activator（t-PA）,high-sensitivity C-reactive protein（hs-CRP） and interleukin-6（IL-6）were detected with enzyme-linked immunoassay 24 h later.Results：Compared with the model group,the levels of serum GMP-140,hs-CRP,IL-6 and MMP-9 were significantly decreased,and the level of t-PA was significantly increased in the ABC and ABCD group（P〈0.05）,while the level of serum hs-CRP in ABCD group decreased significantly compared with that in the ABC group（P〈0.05）.Conclusions：Chinese drugs both for activating blood circulation and for activating blood circulation and detoxifying have good effects on regulating indices of thrombosis,inflammatory reaction and tissue damage in experimental carotid artery thrombosis rats.The effect of activating blood circulation and detoxifying drugs on regulating the level of serum hs-CRP is superior to that of activating blood circulation drug alone.

Prevention and control of HIV/AIDS in China:lessons from the past three decades

In the past 37 years,human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)has undergone various major transmission routes in China,with the world most complex co-circulating HIV-1 subtypes,even the prevalence is still low.In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection,China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing,which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection.China has been providing free antiretroviral therapy(ART)since 2003,which covered>80%of the identified patients and achieved a viral suppression rate of 91%.To bend the curve of increasing the disease burden of HIV and finally end the epidemic,China should consider constraining HIV spread through sexual transmission,narrowing the gaps in identifying HIV cases,and the long-term effectiveness and safety of ART in the future.

Efficacy of integrated Traditional Chinese Medicine and anti-retroviral therapy on immunological nonresponse in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: a Meta-analysis of randomized controlled trials

OBJECTIVE:To explore the efficacy of integrating Traditional Chinese Medicine(TCM)and anti-retroviral therapy(ART),a customized combination of different classes of medications which was also called cock-tail treatment,on the immunological nonresponse(INR)in people living with human immunodeficiency virus(HIV)(PLWH).METHODS:Relevant literature in databases such as China National Knowledge Infrastructure Database(CNKI),Wanfang Digital Journal,Chinese Medical Journal Database(CMJD),Chinese Biomedical Literature Database(CBM),Pub Med,Cochrane,and Embase was reviewed by two independent investigators.Data were extracted from the studies according to the eligible criteria and analyzed using Review Manager 5.3.RESULTS:Nine randomized controlled trials(RCTs)with 1078 patients were analyzed.Our analyses showed that CD4 T cell counts in the treatment group improved compared with that in the control group[mean difference(MD)=13.51,95%confidence interval(CI):7.42-19.60,P<0.0001].There was no significant difference between the treated and control groups after 3 months(MD=25.31,95%CI:-2.78 to 53.41,P=0.08).However,after 6 and 12 months,the response of the treatment group was superior to the control group(MD=27.45,95%CI:7.09-47.81,P=0.008 and MD=27.34,95%CI:6.31–48.37,P=0.01,respectively).The clinical efficacy of the treatment group was also higher than that of the control group(RR=1.75,95%CI:1.16-2.65,P=0.007).However,CD45 RO and CD45 RA T cell counts did not differ significantly between the two groups(MD=12.37,95%CI:-6.71 to 31.45,P=0.20 and MD=5.67,95%CI:-3.00 to14.35,P=0.20,respectively).CONCLUSION:The combined treatment strategy of integrated TCM and Western Medicine promotes long-term reconstitution of the immune system and thus,is beneficial and has potential use for improving INR in PLWH.However,large-scale RCTs are required to provide evidence for optimal intervention strategies.