Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

The interaction effect of grip strength and lung function (especially FVC) on cardiovascular diseases: a prospective cohort study in Jiangsu Province, China

OBJECTIVE Lung function and grip strength(GS)are associated with cardiovascular disease(CVD),but whether these risk factors interact to affect CVD is unknown.This study aimed to explore the interactions between lung function and GS with major CVD(defined as fatal/non-fatal myocardial infarction,stroke,and heart failure)incidence.METHODS We conducted a prospective cohort study on the Chinese population in Jiangsu Province.Cox proportional haz-ards models were used to explore the associations between GS,lung function,and major CVD incidence.RESULTS A total of 5967 participants were included in our study;among them,182 participants developed major CVD.Parti-cipants with low forced vital capacity(FVC)had a higher risk of major CVD(hazard ratio(HR)=1.45;95%confidence interval(CI):1.05-2.01;P<0.05)compared with normal FVC.The risk of major CVD incidence(HR=0.54;95%CI:0.35-0.83;P<0.01)was significantly lower in participants with high GS than in individuals with low GS.The interaction between FVC and GS for major CVD incidence(P=0.006)was statistically significant.Compared with normal FVC participants with high GS,low FVC parti-cipants with low GS had the highest risk of major CVD incidence(HR=2.50;95%CI:1.43-4.36;P<0.01).CONCLUSION Among people with low FVC,the risk of major CVD is lower with high GS.Participants with low FVC and low GS have the highest risk of major CVD.Therefore,more attention should be paid to the incidence of major CVD in individu-als with low FVC,especially those who have lower GS.

Different strategies for ultra-early reperfusion therapy in anterior circulation acute ischemic stroke safety and effectiveness of the comparative observation

Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.

Dose-response associations,physical activity intensity and mortality risk:A narrative review

Physical activity is consistently associated with reduced mortality,decreased risk for non-communicable diseases,and improved mental health in observational studies.Randomized controlled trials and observational Mendelian randomization studies support causal links between physical activity and health outcomes.However,the scarcity of evidence from randomized controlled trials,along with their inherent challenges like exposure contrasts,healthy volunteer biases,loss to follow-up,and limited real-world dose-response data,warrants a comprehensive approach.This review advocates synthesizing insights from diverse study designs to better understand the causal relationship between physical activity,mortality risk,and other health outcomes.Additionally,it summarizes recent research since the publication of current physical activity recommendations.Novel observational studies utilizing device-measured physical activity underscore the importance of every minute of activity and suggest that all intensity levels confer health benefits,with vigorous-intensity potentially requiring lower volumes for substantial benefits.Future guidelines,informed by device-measured physical activity studies,may offer refined age-specific recommendations,emphasize vigorous-intensity physical activity,and include daily step counts as a simple,easily assessable metric using commercial wearables.

Incidence,mortality and survival of female breast cancer during 2003-2011 in Jiangsu province,China

Objective： To assess the incidence, mortality and survival status of female breast cancer in Jiangsu province of China. Methods： Population-based cancer registry data in Jiangsu province were collected during 2003-2011. Crude rates, age-specific rates, age-standardized rates and annual percent changes of incidence and mortality were calculated to describe the epidemiologic characteristics and time trends. Patients diagnosed from 2003 to 2005 were chosen for analyzing the survival status of breast cancer. Results： From 2003 to 2011, 17,605 females were diagnosed with breast cancer and 4,883 died in selected registry areas in Jiangsu province. The crude incidence rate was 25.18/100,000, and the age-standardized rates by Chinese population （ASRC） and by world population （ASRW） were 19.03/100,000 and 17.92/100,000, respectively. During the same period, the crude mortality rate was 6.98/100,000 and the ASRC and ASRW were 4.93/100,000 and 4.80/100,000, respectively. From 2003 to 2011, the incidence and mortality increased with annual percent change of 11.37% and 5.78%, respectively. For survival analysis, 1,392 patients in 7 areas were identified in 2003-2005 and finished 5 years of follow-up. Survival rates were found to decrease with survival years, the 5-year observed survival rate was 45.9% and the relative survival rate was 52.0%. We also found that the survival rate varied across the province, which was lower in the north and higher in the south of Jiangsu province. Conclusions： Breast cancer has become a significant public health problem in Jiangsu province and China. More resources should be invested in primary prevention, earlier diagnosis and better health services in order to increase survival rates among Chinese females.

Development and Validation of a Model for Predicting Diabetic Nephropathy in Chinese People

Objective To develop a risk model for predicting later development of diabetic nephropathy （DN） in Chinese people with type 2 diabetes mellitus （T2DM） and evaluate its performance with independent validation. Methods We used data collected from the project ＇Comprehensive Research on the Prevention and Control of Diabetes＇, which was a community-based study conducted by the Jiangsu Center for Disease Control and Prevention in 2013. A total of 11,771 eligible participants were included in our study. The endpoint was a clear diagnosis of DN. Data was divided into two components： a training set for model development and a test set for validation. The Cox proportional hazard regression was used for survival analysis in men and women. The model＇s performance was evaluated by discrimination and calibration. Results The incidence （cases per 10,000 person-years） of DN was 9.95 （95% CI; 8.66-11.43） in women and 11.28 （95% CI; 9.77-13.03） in men. Factors including diagnosis age, location, body mass index, high-density-lipoprotein cholesterol, creatinine, hypertension, dyslipidemia, retinopathy, diet control, and physical activity were significant in the final model. The model showed high discrimination and good calibration. Conclusion The risk model for predicting DN in people with T2DM can be used in clinical practice for improving the quality of risk management and intervention.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Association of Dietary Carotenoids Intake with Skeletal Fluorosis in the Coal-burning Fluorosis Area of Guizhou Province

Objective To explore whether the intake of dietary carotenoids could protect against skeletal fluorosis in Guizhou province in which coal-burning fluorosis is endemic. Methods A case-control study of 196 patients with skeletal fluorosis and 196 age and gender-matched controls was conducted in Zhijin, Guizhou Province. Face-to-face interviews were conducted to assess habitual dietary intake using a 75-item food frequency questionnaire and various covariates with structured questionnaires. Urinary fluoride was measured using an ion-selective electrode method. The genotype of superoxide dismutase 2（SOD2） rs11968525 was detected by Taq Man method. Results We observed significant dose-dependent inverse associations of skeletal fluorosis with intake of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids（P-trend = 0.002 to 0.018）, whereas α-carotene and β-cryptoxanthin intakes were not found to be related to skeletal fluorosis, after adjustment for potential confounders. The adjusted ORs and 95% CI of skeletal fluorosis for the highest versus lowest quartile were 0.30（0.10, 0.86） for β-carotene, 0.23（0.08, 0.66） for lycopene, 0.26（0.10, 0.75） for lutein/zeaxanthin and 0.34（0.14, 0.74） for total carotenoids（all P-trend ＆lt; 0.05）. Stratified analyses showed that the protective effects of lutein/zeaxanthin and total carotenoids on skeletal fluorosis were more evident for individuals with the AG＋AA genotypes of SOD2（rs11968525）. Conclusion Increased intakes of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids are independently associated with a lower risk of coal-burning skeletal fluorosis. SOD2（rs11968525） polymorphisms might modify the inverse associations between dietary carotenoids and skeletal fluorosis.

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.

Comparison of different gastric bypass procedures in gastric carcinoma patients with type 2 diabetes mellitus

AIM:To determine the effect of different Roux-en-Y gastric bypass procedures in gastric carcinoma patients with type 2 diabetes mellitus.METHODS:A retrospective analysis of the clinical data of 54 patients with gastric cancer and type 2 diabetes mellitus treated in the Department of General Surgery from January 2006 to June 2013 was conducted.The patients underwent gastrectomy using different Rouxen-Y gastric bypass procedures(traditional,n=26;modified,n=28).Fasting plasma glucose(FPG),two hour postprandial blood glucose(2 h PBG)and hemoglobin A1c(Hb A1c)were analyzed before surgery(0 mo)and 1,3 and 6 mo after surgery.RESULTS:FPG and 2 h PBG levels were significantlydecreased 1 mo after surgery in the traditional Rouxen-Y gastric bypass group(FPG 7.5±1.3 vs 10.7±1.2,P<0.05)(2 h PBG 10.2±1.8 vs 13.8±3.2,P<0.05).FPG and 2 h PBG levels were significantly decreased after surgery in the modified Roux-en-Y gastric bypass group(FPG 6.9±1.2 vs 10.5±1.1,6.5±1.3 vs 10.5±1.1,6.4±1.2 vs 10.5±1.1,P<0.05)(2 h PBG9.9±2.2 vs 14.1±2.9,9.2±2.4 vs 14.1±2.9,8.9±2.6 vs 14.1±2.9,P<0.05).Compared with the levels before surgery,Hb A1c levels were significantly decreased 3 and 6 mo after surgery(7.2±1.1 vs 10.5±1.1,5.5±1.1 vs 10.5±1.1,P<0.05).Significant differences between the two groups regarding FPG,2 h PBG and Hb A1c concentration were observed 3 and 6mo after surgery(FPG 10.1±1.5 vs 6.5±1.3,10.3±1.4 vs 6.4±1.2,P<0.05)(2 h PBG 13.1±2.8 vs 9.2±2.4,13.6±3.1 vs 8.9±2.6,P<0.05)(Hb A1c 10.1±1.4 vs 7.2±1.1,10.5±1.3 vs 5.5±1.1,P<0.05).CONCLUSION:Modified Roux-en-Y gastric bypass can improve glucose metabolism in type 2 diabetic patients with gastric cancer.

Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults:A prospective cohort study

Purpose:This study aimed to examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults.Methods:This prospective cohort study involved 768 community-dwelling Spanish older adults(78.8±4.9 years,mean±SD;53.9% females)from the Toledo Study for Healthy Aging(2012-2017).The number of steps per day and step cadence(steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline.Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality.Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality.Results:Included participants walked 5835± 3445 steps/day with an intensity of 7.3± 4.1 steps/min.After adjusting for age,sex,body mass index(BMI),education,income,marital status and comorbidities,higher step count(hazard ratio(HR)=0.95,95% confidence interval(95%CI:0.90-1.00,and HR=0.87,95%CI:0.81-0.95 per additional 1000 steps) and higher step intensity(HR=0.95,95%CI:0.91-0.99,and HR=0.89,95%CI:0.84-0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk,respectively.Compared to the group having low step volume and intensity,individuals in the group having high step volume and intensity had a lower risk of hospitalization(HR=0.72,95%CI:0.52-0.98) and all-cause mortality(HR=0.60,95%CI:0.37-0.98).Conclusion:Among older adults,both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk.Increasing step volume and intensity may benefit older people.

Inverse relations between Helicobacter pylori infection and risk of esophageal precancerous lesions in drinkers and peanut consumption

BACKGROUND Helicobacter pylori(H. pylori) is a Gram-negative bacterium found in the upper digestive tract. Although H. pylori infection is an identified risk factor for gastric cancer, its role in esophageal squamous cell carcinoma(ESCC) remains a topic of much debate.AIM To evaluate the association between H. pylori infection and the risk of precancerous lesions of ESCC, and further explore the association between dietary factors and the risk of H. pylori infection.METHODS Two hundred patients with esophageal precancerous lesions(EPL) aged 63.01 ± 6.08 years and 200 healthy controls aged 62.85 ± 6.03 years were included in this case-control study. Epidemiological data and qualitative food frequency data were investigated. Enzyme-linked immunosorbent assay measuring serum immunoglobulin G antibodies was used to determine H. pylori seropositivity. An unconditional logistic regression model was used to assess the association between H. pylori infection and EPL risk dichotomized by gender, age, and the use of tobacco and alcohol, as well as the association between dietary factors and the risk of H. pylori infection.RESULTS A total of 47(23.5%) EPL cases and 58(29.0%) healthy controls had positive H. pylori infection. An inverse relation between H. pylori infection and the risk of EPL was found in the group of drinkers after adjustment for covariates [odds ratio(OR) = 0.32, 95% confidence interval(95%CI): 0.11-0.95]. Additionally, peanut intake was significantly associated with a decreased risk of H. pylori infection(OR = 0.39, 95%CI: 0.20-0.74).CONCLUSION Our study suggested that H. pylori infection may decrease the risk of EPL for drinkers in a rural adult Chinese population, and the consumption of peanut may reduce the risk of H. pylori infection. These findings should be framed as preliminary evidence, and further studies are required to address whether the mechanisms are related to the localization of lesions and alcohol consumption.

Response to McAvoy and Tudor-Locke on their commentary on our manuscript:“Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults:A prospective cohort study”

Dear Editor,We have read with interest the commentary by McAvoy and Tudor-Locke on our article entitled "Association of accelerometer-derived step volume and intensity with ho spitalizations and mortality in older adults:A prospective cohort study". The authors expressed some concerns about our methodology used to define accelerometer-derived step intensity and the analytical approach applied in our study.

Cut-off Values of Diagnostic Indices to Detect Iron Deficiency in Chinese Breast-fed Infants

Iron deficiency anemia is one of the most prevalent nutritional deficiency worldwide. The commonly used cut-off values for identifying iron deficiency are extrapolated from older children and may not be suitable for infants. Therefore, our study aimed to establish appropriate cut-off values for the evaluation of iron status in Chinese infants. Pregnant women who delivered at 〉37 gestational weeks with normal iron status were recruited. Later, infants with normal birth weight and who were breastfed in the first 4 months were selected. Blood samples were collected to assess hemoglobin, serum ferritin, soluble transferrin receptor, mean corpuscular volume and free erythrocyte protoporphyrin. Cut-offs of all iron indices were determined as the limit of 95% confidence interval.

Potential importance of early treatment of SARS-CoV-2 infection in intestinal transplant patient: A case report

BACKGROUND Predispositions for severe coronavirus disease 2019(COVID-19)are age,immunosuppression,and co-morbidity.High levels of maintenance immunosuppression render intestinal transplant(ITx)patients vulnerable for severe COVID-19.COVID-19 also provokes several gastroenterological pathologies which have not been discussed in ITx,so far.CASE SUMMARY During the second European COVID-19 wave in November 2020,an ITx recipient was admitted to the hospital because of electrolyte disturbances due to dehydration.Immunosuppression consisted of tacrolimus,azathioprine,and low-dose corticosteroids.During hospitalization,she tested positive on screening COVID-19 nasopharyngeal polymerase chain reaction swab,while her initial test was negative.She was initially asymptomatic and had normal inflammatory markers.Tacrolimus levels were slightly raised,as Azathioprine was temporarily halted.Due to elevated Ddimers at that time,prophylactic low-molecular weight heparin was started.Seven days after the positive test,dyspnea,anosmia,and C-reactive protein increase(25 mg/L)were noted.Remdesivir was administered during 5 d in total.High stomal output was noted in two consecutive days and several days thereafter.To exclude infection or rejection,an ileoscopy and biopsy were performed and excluded these.Four weeks later,she was discharged from the hospital and remains in good health since then.CONCLUSION Early eradication of severe acute respiratory syndrome coronavirus 2 in ITx recipients may be warranted to prevent acute rejection provocation by it.

Exploratory study of highly susceptible to SARS-CoV-2 populations

The coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),is threatening public health.The human angiotensin-converting enzyme 2(ACE2)has a remarkably high affinity binding to SARS-CoV-2.This study explored whether certain populations,including obese and cancer patients,are susceptible to SARS-CoV-2.The expression pattern of ACE2 in normal and tumor tissues of cancer patients was compared by the search for network database and re-analysis of pubic data.The level of ACE2 expression in normal adipose tissue was higher than that in normal lung tissue,which indicated the adipose tissue might be vulnerable to SARS-CoV-2;the levels of ACE2 expressed by adipocytes and adipose progenitor cells were similar between non-obese individuals and obese individuals(BMI>29),but obese individuals have more adiposes so as to increase the number of ACE2-expressing cells;the expression of ACE2 in tumor tissues posed by five different types of cancers increased significantly compared with that in adjacent tissues.Therefore,we proposed the following hypothesis:the obese individuals and five types of cancer patients might have a higher risk of SARS-CoV-2 infection,which might become the target population of SARS-CoV-2 infection in the future.

Osteocyte Egln1/Phd2 links oxygen sensing and biomineralization via FGF23

Osteocytes act within a hypoxic environment to control key steps in bone formation.FGF23,a critical phosphate-regulating hormone,is stimulated by low oxygen/iron in acute and chronic diseases,however the molecular mechanisms directing this process remain unclear.Our goal was to identify the osteocyte factors responsible for FGF23 production driven by changes in oxygen/iron utilization.Hypoxia-inducible factor-prolyl hydroxylase inhibitors(HIF-PHI)which stabilize HIF transcription factors,increased Fgf23 in normal mice,as well as in osteocyte-like cells;in mice with conditional osteocyte Fgf23 deletion,circulating i FGF23 was suppressed.An inducible MSC cell line(‘MPC2’)underwent FG-4592 treatment and ATACseq/RNAseq,and demonstrated that differentiated osteocytes significantly increased HIF genomic accessibility versus progenitor cells.Integrative genomics also revealed increased prolyl hydroxylase Egln1(Phd2)chromatin accessibility and expression,which was positively associated with osteocyte differentiation.In mice with chronic kidney disease(CKD),Phd1-3 enzymes were suppressed,consistent with FGF23 upregulation in this model.Conditional loss of Phd2 from osteocytes in vivo resulted in upregulated Fgf23,in line with our findings that the MPC2 cell line lacking Phd2(CRISPR Phd2-KO cells)constitutively activated Fgf23 that was abolished by HIF1αblockade.In vitro,Phd2-KO cells lost iron-mediated suppression of Fgf23 and this activity was not compensated for by Phd1 or-3.In sum,osteocytes become adapted to oxygen/iron sensing during differentiation and are directly sensitive to bioavailable iron.Further,Phd2 is a critical mediator of osteocyte FGF23 production,thus our collective studies may provide new therapeutic targets for skeletal diseases involving disturbed oxygen/iron sensing.

Urban-Rural Disparity in Mortality Patterns of Respiratory Diseases Among Older Adults—China,1987-2021

What is already known about this topic?Respiratory diseases(RDs)are the primary cause of death in older adults in China.However,there is limited evidence regarding the disparity in mortality rates of RDs between urban and rural areas among the elderly population.What is added by this report?The age-standardized mortality rate(ASMR)due to RDs in the elderly population in both urban and rural areas of China has shown a consistent decrease.This trend is observed in both males and females.However,there was no significant change in the average annual percentage of ASMR for pneumonia among the urban elderly population and rural elderly men throughout the study period.What are the implications for public health practice?Efforts should be made in China to reduce mortality from chronic lower respiratory disease and pneumonia among the elderly,particularly in urban populations.

From London buses to activity trackers:A reflection of 70 years of physical activity research

In 1953,Morris et al.^(1)published their ground-breaking findings among London bus drivers and conductors,linking physical activity to a major chronic disease for the first time.This seminal paper marked the birth of a new field—physical activity epidemiology.^(1)Since then,the field has flourished,evidenced by mounting scientific publications.^(2)Our knowledge about the role of physical activity in disease prevention has expanded from coronary heart disease in Morris et al.’s^(1)initial study to dozens of additional diseases and conditions,such as diabetes,cancers,and dementia.^(3)More than 7 decades and thousands of publications later,we critically reflect on several aspects of the progress in physical activity epidemiology.

Alcohol consumption and metabolic syndrome among Shanghai adults: A randomized multistage stratified cluster sampling investigation

AIM: To examine the relations of alcohol consumption to the prevalence of metabolic syndrome in Shanghai adults. METHODS: We performed a cross-sectional analysis of data from the randomized multistage stratified cluster sampling of Shanghai adults, who were evaluated for alcohol consumption and each component of metabolic syndrome, using the adapted U.S. National Cholesterol Education Program criteria. Current alcohol consumption was defined as more than once of alcohol drinking per month. RESULTS: The study population consisted of 3953 participants (1524 men) with a mean age of 54.3 ± 12.1 years. Among them, 448 subjects (11.3%) were current alcohol drinkers, including 405 males and 43 females. After adjustment for age and sex, the prevalence of current alcohol drinking and metabolic syndrome in the general population of Shanghai was 13.0% and 15.3%, respectively. Compared with nondrinkers, the prevalence of hypertriglyceridemia and hypertension was higher while the prevalence of abdominal obesity, low serum high-density-lipoprotein cholesterol (HDL-C) and diabetes mellitus was lower in subjects who consumed alcohol twice or more per month, with a trend toward reducing the prevalence of metabolic syndrome. Among the current alcohol drinkers, systolic blood pressure, HDL-C, fastingplasma glucose, and prevalence of hypertriglyceridemia tended to increase with increased alcohol consumption. However, low-density-lipoprotein cholesterol concentration, prevalence of abdominal obesity, low serum HDL-C and metabolic syndrome showed the tendency to decrease. Moreover, these statistically significant differences were independent of gender and age.CONCLUSION: Current alcohol consumption is associated with a lower prevalence of metabolic syndrome irrespe- ctive of alcohol intake (g/d), and has a favorable influence on HDL-C, waist circumference, and possible diabetes mellitus. However, alcohol intake increases the likelihood of hypertension, hypertriglyceridemia and hyperglycemia. The clinical significance of these findings needs further investigation.