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Background:The caries patterns of the first permanent molars (FPMs) among schoolchildren had not been adequately evaluated, and researchers paid no attention to the distributions of fully-erupted FPMs number and proportion in Shenzhen children.Objective:To quantitatively assess the eruption stages and dental caries patterns of the FPMs for the total students as well as the subgroups.Methods:A 3-year school-based epidemiological investigation was undertaken by dentists to examine the eruption stages and dental caries patterns of the FPMs, involved the second-grade students from 132 primary schools in Baoan District of Shenzhen, China.Results:Among 95809 schoolchildren aged 6–8 years, 86.51% individuals had fully erupted the Tooth #16, 87.15% for #26, 89.30% for #36, and 88.81% for #46 (c2=475.033,Pvs78.43%;Pc2=3322.810,Pvs25.68%;PConclusions:Most schoolchildren aged 6–8 years have fully erupted the FPMs, with a relatively high prevalence of FPMs caries in Shenzhen.

Existing PM2.5-morbidity studies using daily mean concentration as exposure metric may fail to capture intra-day variations of PM2.5 concentrations, resulting in underestimated health impacts to some extent. This study introduced a novel indicator, daily excessive concentration hours (DECH), defined as sums of per-hourly excessive concentrations of PM2.5 against a specific threshold within a day. PM2.5 DECHs were separately calculated as daily concentration-hours >8, 10, 15, 20, and 25 μg/m3 (abbreviations: DECH-8, DECH-10, DECH-15, DECH-20, and DECH-25). We adopted a time-stratified case-crossover design with conditional logistic regression models to compare risks of hospitalizations for chronic obstructive pulmonary disease (COPD) associated with PM2.5 mean and DECHs in Shenzhen, China. We observed highly comparable PM2.5-COPD associations using exposure metrics of daily mean and DECHs with above-defined thresholds. For instance, PM2.5 mean and DECHs showed similar increases in risks of COPD hospitalization for an interquartile range rise in exposure, with odds ratio estimates of 1.26 (95% confidence interval: 1.06–1.50) for PM2.5 mean, 1.24 (1.05–1.46) for DECH-10 and 1.21 (1.06–1.39) for DECH-25, respectively. Findings remained robust after further adjusting for gaseous pollutants (e.g., SO2, NO2, CO, and O3) and meteorologic factors (e.g., wind speed and air pressure). Our study strengthened the evidence that DECHs could come be as a novel exposure metric in health risk assessments associated with short-term exposure to ambient PM2.5.

Statement of problem The comparative efficacy of antifungal drugs on oral candidiasis remains unclear. Purpose The purpose of this Bayesian network meta-analysis was to investigate the efficacy of antifungal drugs on oral candidiasis. Material and methods Databases, including PubMed, The Cochrane Library, and Web of Science, were accessed from the dates of their establishment to October, 2018, to collect randomized controlled trials (RCTs) of different antifungal drugs for oral candidiasis. A network meta-analysis was then conducted by using R and Stata 12.0 software programs. Results A total of 31 RCTs involving 4042 participants were included. The meta-analysis showed that, in the treatment of oral candidiasis in reducing the mycological cure rate, itraconazole capsules, itraconazole oral solution, miconazole buccal tablets, miconazole oral gel, clotrimazole, fluconazole, ketoconazole, nystatin, and amphotericin B were better than a placebo. Miconazole oral gel, fluconazole, and ketoconazole were better than nystatin. The network meta-analysis also showed that the effects of antifungal drugs in reducing the mycological cure rate in oral candidiasis were better than those of a placebo: itraconazole capsule (OR=1.20, 95% CrI: 1.07-1.34), itraconazole oral solution (OR=1.50, 95% CrI: 1.14-1.86), miconazole buccal tablet (OR=2.80, 95% CrI: 1.20-4.50), miconazole oral gel (OR=2.90, 95% CrI: 1.70-4.30), clotrimazole (OR=3.80, 95% CrI: 1.65-5.95), fluconazole (OR=2.40, 95% CrI: 1.10-3.80), ketoconazole (OR=3.40, 95% CrI: 1.76-7.04), nystatin (OR=2.50, 95% CrI: 1.43-3.57), and amphotericin B (OR=2.60, 95% CrI: 1.91-3.29). The SUCRA values for each antifungal drug were as follows: placebo (6.80%), itraconazole capsule (51.2%), itraconazole oral solution (75.2%), miconazole buccal tablet (34.4%), miconazole oral gel (76.9%), clotrimazole (64.8%), fluconazole (79.3%), ketoconazole (50.7%), nystatin (15.7%), and amphotericin B (44.4%). Conclusions Antifungal drugs have efficacy in the treatment of oral candidiasis. The effect of fluconazole in reducing the risk of the mycological cure rate in oral candidiasis was better than that of other drugs.

Epithelial-mesenchymal transition (EMT)-related genes play an important role in immunosuppression. However, the correlations of EMT-related genes to prognosis and tumor-infiltrating lymphocytes in different cancers remain unclear. TCGA, GEO databases were used to analyze the expression, prognosis, and immune infiltration of EMT markers in cancer. RT-qPCR, immunohistochemistry, and western blot were used to analysis the expression and prognosis of SNAI1 in gastrointestinal cancers. High SNAI1 expression was closely related with poorer overall survival in gastrointestinal cancers in TCGA cohort. High SNAI1 expression was closely related with poorer overall survival in gastrointestinal cancers, and was validated in GEO database. Simultaneously, high expression of SNAI1 correlates with clinical relevance of gastric cancer. Moreover, SNAI1 expression was associated with tumor-infiltrating immune cells in gastrointestinal cancers. In addition, RT-qPCR, immunohistochemistry, and western blot showed SNAI1 expression was higher in gastrointestinal cancers compared to the normal tissues. Finally, high SNAI1 expression was closely related with poorer overall survival and correlates with clinical relevance of gastrointestinal cancers in an independent validation cohort. In summary, the results approaches to suggest that SNAI1 can be used as a prognostic biomarker for determining prognosis and immune infiltration in gastrointestinal cancers.

Objective: To explore the clinical benefits of Biyuan Tongqiao granules (BTG) combined with mometasone furoate nasal spray (MFNS) on the symptoms of children with allergic rhinitis (AR). Methods: Seventy-eight children with AR who visited the Pediatric Department of our hospital from May 2019 to May 2020 were selected and randomly divided into the BTG group (treated with BTG alone), MFNS group (treated with MFNS alone), and combined group (children with the combined use of BTG and MFNS), with 26 cases in each group. The nasal symptoms and oculonasal symptoms were evaluated and observed at baseline and 2 months after treatment. Results: Children in the combination group had significantly lower total nasal symptom score (TNSS), total non-nasal symptom score (TNNSS) scores, and visual analogue scale (VAS) scores than those with BTG alone and MFNS alone (P

Background Numerous studies have consistently demonstrated that high body mass index (BMI) is related to elevated serum alanine aminotransferase (ALT) among adults, but little is known about the association regarding adolescents, especially in China. In this study, we aimed to investigate the association between BMI and ALT activity among Chinese adolescents. Methods A school-based cross-sectional study was performed among nine high schools in Shenzhen, China between February 2017 and June 2018. A generalized linear-regression model adjusting for age and gender was conducted, and bivariate correlation analysis between ALT and BMI was also performed. Results A total of 7,271 adolescents aged from 9 years to 17 years were enrolled. Height, weight, BMI, and ALT were higher among boys than among girls (all P Conclusions We found a significant BMI−ALT relationship. BMI at 20.5 kg/m2 may be a cut-off for evaluating serum ALT. BMIs ≥27.1 kg/m2 for boys and ≥24.9 kg/m2 for girls were linked to an elevated ALT activity for Shenzhen adolescents.

Background Ambient particulate matter (PM) has been linked to adverse health outcomes, but evidence is still relatively limited for emergency department visits (EDVs). Most prior studies used daily mean PM as exposure assessment regardless of within-day variations, which might underestimate the potential acute health effects. In this study, we evaluated the hourly associations between PM and EDVs, so as to further understand the very short-term impacts of PM on EDVs. Methods Hourly data for all-cause EDVs, air pollutants and meteorological factors were collected from Shenzhen, China, between March 1, 2015 and February 28, 2018. A time-stratified case-crossover design with conditional logistic regression analysis was performed to assess the hourly associations between PM and EDVs, adjusting for hourly mean temperature and relative humidity. Subgroup analyses stratified by gender, age and clinic department were conducted to identify vulnerable populations. We further classified the whole year into warm (April to September) and cold (October to March of the next year) months to evaluate seasonal effect modification. Results Hourly mean all-cause EDVs peaked at 9 a.m. and 7 p.m., while PM2.5 and PM10 peaked at 8 a.m. and 8 p.m. The hourly associations between PM and EDVs appeared immediately and persisted for about 10 hours. All-cause EDVs increased 0.72% (95% confidence interval (CI): 0.33, 1.12) and 0.72% (95% CI: 0.45, 0.99) associated with per 10 μg/m3 rise in PM2.5 and PM10 at lag 0–10 h, respectively. Stronger effects of PM2.5 and PM10 on EDVs were observed among younger groups (age Conclusions Our study provided hourly perspective for the short-term associations between PM exposure and increased EDVs. The adverse impacts of PM on EDVs were only identified in cold season, and young people suffered more from both PM2.5 and PM10 exposures. These findings may have valuable implications for public policy promotion on air cleaning, as well as hospital management in optimizing allocation of resources on PM-sensitive conditions.

Cardiovascular disease (CVD) is a leading threat to global public health. Although associations between temperature and CVD hospitalization have been suggested for developed countries, limited evidence is available for developing countries or rural residents. Moreover, the effect of apparent temperature (AT) on the spectrum of cause-specific CVDs remains unknown. Based on 2,024,147 CVD hospitalizations for rural residents from eight regions in Fujian Province, China, during 2010-2016, a quasi-Poisson regression with distributed lag non-linear model was fitted to estimate the AT effect on daily CVD hospitalization for each region, and then pooled in a meta-regression that included regional indicators related to rural residents. Stratified analyses were performed according to the cause of hospitalization, sex and age groups. Finally, we calculated the fraction of CVD hospitalizations attributable to AT, as a reflection of the burden associated with AT. The heat effect appeared at lag 0-1 days, with 19% (95% CI, 11-26%) increased risk of CVD hospitalization, which was worse for ischemic heart disease, heart failure, arrhythmias and ischemic stroke. The decreased AT was associated with increase of hemorrhagic stroke at lag 0-28 days. People aged 65 and above suffered more from the heat effect on cardiovascular and cerebrovascular diseases. Regions with a lower gross value of agricultural production, rural residents' per capita net income, number of air conditioners and water heaters were more susceptible. A large number of hospitalizations were attributable to heat for most subcategories. High AT level increased CVD hospitalization, and the subcategories had different susceptibilities. The effects were modified by individual and regional characteristics. These findings have important implications for the development of targeted interventions and for hospital service planning.

BACKGROUND Prediabetes is associated with an increased risk of cardiovascular diseases and all-cause mortality. No research in China has evaluated the prevalence of prediabetes among children and adolescents using the HbA1c criterion or the combined FPG-or-HbA1c diagnostic criterion, and researchers paid no attention to the distributions of blood glucose in Shenzhen, especially for juveniles. METHODS We conducted a school-based cross-sectional study based on the first-year students from 17 primary, middle, and high schools. Prediabetes was defined as FPG of 5.6-6.9 mmol/L or HbA1c of 5.7%-6.4%. The crude and standardized prevalence of prediabetes with 95% confidence interval (95% CI) was estimated. RESULTS A total of 7519 participants, aged 6 to 17 years, were included. For all subjects, the crude prevalence (95% CI) of prediabetes was 1.49% (1.21-1.77), 8.72% (8.08-9.36), and 9.80% (9.13-10.47) by the FPG-only, HbA1c-only, and FPG-or-HbA1c criteria, respectively. Based on the 2010 Shenzhen census population, the standardized prevalence was 1.56% (males 1.85%, females 1.19%), 11.05% (males 11.47%, females 10.53%), and 12.19% (males 13.01%, females 11.15%) by the corresponding criteria. The proportion of prediabetes was higher for males than females, and the prevalence decreased with grade for males but increased for females. The association of BMI and prediabetes was U-shaped curve, indicating higher rates of prediabetes for underweight and obesity people. CONCLUSIONS The blood glucose status of children and adolescents in Shenzhen is worrisome, and the early detection and management of prediabetes are imperative. This article is protected by copyright. All rights reserved.

Existing PM

Background Ambient PM1 (particulate matter with aerodynamic diameter ≤1 μm) is an important contribution of PM2.5 mass. However, little is known worldwide regarding the PM1-associated health effects due to a wide lack of ground-based PM1 measurements from air monitoring stations. Methods We collected daily records of hospital admission for respiratory diseases and station-based measurements of air pollution and weather conditions in Shenzhen, China, 2015–2016. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate hospitalization risks associated with short-term exposures to PM1 and PM2.5. Results PM1 and PM2.5 showed significant adverse effects on respiratory disease hospitalizations, while no evident associations with PM1–2.5 were identified. Admission risks for total respiratory diseases were 1.09 (95% confidence interval: 1.04 to 1.14) and 1.06 (1.02 to 1.10), corresponding to per 10 μg/m3 rise in exposure to PM1 and PM2.5 at lag 0–2 days, respectively. Both PM1 and PM2.5 were strongly associated with increased admission for pneumonia and chronic obstructive pulmonary diseases, but exhibited no effects on asthma and upper respiratory tract infection. Largely comparable risk estimates were observed between male and female patients. Groups aged 0–14 years and 45–74 years were significantly affected by PM1- and PM2.5-associated risks. PM-hospitalization associations exhibited a clear seasonal pattern, with significantly larger risks in cold season than those in warm season among some subgroups. Conclusions Our study suggested that PM1 rather than PM1–2.5 contributed to PM2.5-induced risks of hospitalization for respiratory diseases and effects of PM1 and PM2.5 mainly occurred in cold season.

Background Screening for elevated serum alanine aminotransferase (ALAT) can help identifying individuals at the risks of chronic and metabolic diseases, but blood collection is invasive and cannot be widely used for investigations. Considered as simple and inexpensive screening indices, individual characteristics and anthropometric measurements can be measured in a large crowd and may be important surrogate markers for ALAT levels. This study aimed to examine the diagnostic performance of individual characteristics and anthropometric parameters as predictive factors for discerning an elevated ALAT activity among Shenzhen children and adolescents. Methods A school-based screening study was performed from 9 high schools in Shenzhen during February 2017 and June 2018. Receiver operating characteristic curve was used to examine the diagnostic performance of each variable for detecting elevated ALAT. Results Altogether 7271 students aged 9–17 years were involved. The proportion of elevated ALAT greatly increased with increasing classification of BMI-z. By the sex-specific cut-offs for elevated ALAT (30 U/L boys; 19 U/L girls), BMI showed the highest area under the curve of 0.789 (95% CI 0.765–0.812) and followed by weight (0.779 [0.755–0.802]), BMI-z (0.747 [0.722–0.772]), height (0.622 [0.597–0.647]), and age (0.608 [0.584–0.632]), while height-z was not capable. With the cut-off of 67.8 kg for weight and 22.6 kg/m2 for BMI, the accuracy to identify elevated ALAT was 87.1% for weight and 82.9% for BMI. Conclusions The presence of elevated ALAT was more common in overweight or obese children and adolescents. BMI and weight had the superiority of detecting elevated ALAT, followed by BMI-z, height, and age.

Background Screening for elevated serum alanine aminotransferase (ALT) can help identifying individuals at the risks of chronic and metabolic diseases, but blood collection is invasive and cannot be widely used for investigations. Considered as simple and inexpensive screening indices, anthropometric measurements can be measured in a large crowd and may be important surrogate markers for ALT levels. Among adolescents, few studies focused on the diagnostic performance of anthropometric parameters such as body mass index (BMI) and BMI z-score as predictive factors for discerning an elevated ALT activity. We sought to fill this knowledge gap among Shenzhen adolescents.Methods A school-based study was performed from 9 high schools in Shenzhen during February 2017 and June 2018. Receiver operating characteristic curve was used to examine the diagnostic performance of each measurement.Results Altogether 7271 adolescents aged 9−17 years were involved. The proportion of elevated ALT greatly increased with increasing classification of BMI-z. By the sex-specific cut-offs for elevated ALT (30 U/L boys; 19 U/L girls), BMI showed the highest area under the curve of 0.789 (95% CI 0.765-0.812) and followed by weight (0.779 [0.755-0.802]), BMI-z (0.747 [0.722-0.772]), height (0.622 [0.597-0.647]), and age (0.608 [0.584-0.632]), while height-z was not capable. With the cut-off of 67.8 kg for weight and 22.6 kg/m2 for BMI, the accuracy was 87.1% for weight and 82.9% for BMI.Conclusions The presence of elevated ALT was more common in overweight or obese adolescents. BMI and weight had the superiority of detecting elevated ALT, followed by BMI-z, height, and age.

Background Temperature change between neighboring days (TCN), an indicator to reflect sudden temperature variation, has been identified as an independent risk factor for human health by small-scale studies. However, the adverse impact of TCN on mortality and effect modification are insufficiently studied, and a larger multi-cities analysis at national level is needed to provide an insightful knowledge. Methods Using daily mortality and meteorological data from 106 communities of United States during 1987 to 2000, we employed a quasi-Poisson regression with distributed lag non-linear model to quantitatively estimate the effect of TCN on mortality for each community and a multivariate meta-analysis to pool the community-specific estimates. Results At national level, a monotonic increasing curve of TCN–mortality association was observed, which indicated that negative TCN (temperature decrease from the previous day) was associated with reduced mortality and positive TCN (temperature increase) elevated the risk of mortality. The relative risk for lag 0–21 days was 0.63 (95% confidence interval: 0.59–0.68) for extremely negative TCN (1st percentile) and 1.46 (1.39–1.54) for extremely positive TCN (99th percentile) on non-accidental mortality. We also found prominent effects of extreme TCNs on mortality for cardiovascular, respiratory, pneumonia, and COPD diseases. People ≥ 75 years and those with respiratory disease, especially pneumonia-deaths, were identified as a particularly vulnerable population to TCN. The TCN–mortality association was modified by season and region. Conclusions A positive TCN was associated with an elevated risk of mortality in United States, with different effect patterns by region and season. Identification of the effect modifiers presented a significantly stronger influence on older adults and those with respiratory disease.

We aimed to explore whether there were cold and heat temperature adverse effects on years of life lost (YLL) for non-accidental mortality in Yuxi, a southwest plateau region of China. From data for 89,467 non-accidental deaths over an 8-year study period, we used a general linear regression model combined with a distributed lag non-linear model to assess the burden of disease non-accidental mortality due to ambient temperature with the YLL indicator. We estimated the mean YLL change per 1 °C decrease from the 25th to 1st percentile mean temperature as the cold effect and per 1 °C increase from the 75th to 99th percentile as the heat effect. The 95% empirical confidence intervals (eCIs) were calculated by using a bootstrap simulation method. The exposure–response curve between average temperature and YLL was U-shaped. The cold effect peaked at the first day after exposure and disappeared at 2 weeks, and the heat effect only lasted for the first 3 days. A per 1 °C decrease from the 25th to 1st mean temperature percentile was associated with an increase of 15.6 (95% eCI: 2.4, 22.9) in YLL for non-accidental diseases, and the cumulative effects due to cold were stronger in contrast to that attributed by heat. Cold temperature had a significant impact on YLL among the subgroups, with higher YLL in cardiovascular disease, stroke, males, Han nationality, married, and those engaged in agriculture than their corresponding categories. An increasing death burden of non-accidental in Yuxi of China due to cold temperature was demonstrated, and the association was also modified by specific disease causes and individual features.

Ambient PMWe collected daily records of all-cause emergency department visits (EDVs) and ground measurements of ambient air pollutants and meteorological factors in Guangzhou and Shenzhen, China, 2015-2016. Case-crossover design and conditional logistic regression models were used to comparatively assess the short-term effects of ambient PMPMOur study added comparative evidence for increased EDVs risks associated with short-term exposures to ambient PM

Ambient PMWe collected daily records of hospital admission for respiratory diseases and station-based measurements of air pollution and weather conditions in Shenzhen, China, 2015-2016. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate hospitalization risks associated with short-term exposures to PMPMOur study suggested that PM

ObjectiveTo examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China.MethodsUsing daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature–mortality association with the assessment of attributable fraction and number. We calculated attributable fractions and deaths with 95% empirical CIs (eCIs), that were due to cold and heat, defined as temperatures below and above the median temperature, and for mild and extreme temperatures, defined by cut-offs at the 2.5th and 97.5th temperature percentiles.ResultsWe analysed 89 467 non-accidental deaths; 4131 were attributable to overall temperatures, with an attributable fraction of 4.75% (95% eCI 2.33% to 6.79%). Most of the mortality burden was caused by cold (4.08%; 0.86% to 7.12%), whereas the burden due to heat was low and non-significant (0.67%; −2.44% to 3.64%). Extreme cold (1.17%; 0.58% to 1.69%) was responsible for 24.6% (ie, 1.17% divided by 4.75%) of the total death burden. In the stratification analyses, attributable risk due to cold was higher for cardiovascular than respiratory disease (6.18% vs 3.50%). We found a trend of risk of increased death due to ambient temperatures with increasing age, with attributable fractions of 1.83%, 2.27% and 6.87% for age ≤64, 65–74 and ≥75 years old, respectively. The cold-related burden was slightly greater for females, farmers, ethnic minorities and non-married individuals than their corresponding categories.ConclusionsMost of the burden of death was attributable to cold, and specific causes and individual characteristics might modify the mortality burden attributable to ambient temperatures. The results may help make preventive measures to confront climate change for susceptible population in this region.

Background Despite contributing to the majority of ambient fine particles (PM2.5), PM1 (particulate matter [PM] with aerodynamic diameter ≤1 μm) remains poorly studied in terms of its acute effects on cardiovascular diseases (CVDs) in China. This study aims to evaluate the short-term associations of size-specific PMs (i.e., PM1, PM2.5, and PM10) exposures with hospital admissions for CVDs in a southern Chinese metropolis. Methods We collected 5,969 records of hospital admissions for CVDs and daily average concentrations of air pollutants and weather conditions in Shenzhen from January 1st 2015 to December 31st 2017. We adopted a time-stratified case-crossover design and conditional logistic regression models to assess short-term associations between size-specific PMs and CVD hospitalizations along different exposure days. Results During the study period, annual average concentrations of PM1, PM2.5, and PM10 were 18.7, 27.8, and 45.4 μg/m3, respectively. Compared to PM2.5 and PM10, PM1 exhibited a generally stronger association with CVD hospitalizations. Hospital admissions for CVDs increased by 6.7% (95% confidence interval: 1.2–12.5%), 4.5% (0.4–8.7%), and 3.4% (0.5–6.3%), corresponding to per 10-μg/m3 rise in exposure to PM1, PM2.5, and PM10 at lag 03 days. In our stratified analyses by CVD sub-causes, size-specific PMs showed consistent effects on hypertension but no evident association with ischemic heart disease (IHD) and stroke. Seasonal analysis revealed significantly larger PM-associated risks among IHD patients in cold months (October–March). Nevertheless, in warm months (April–September), the older group (aged 65+ years) was more prone to adverse effects of PM1 exposure at lag 0 day. Conclusion Short-term exposure to size-specific PMs, PM1 in particular, may trigger incidences of CVD hospitalization. To effectively mitigate adverse effects of particulate pollution, evidence-based PM1 standards should be developed as well in Chinese less-polluted megacities.

Background Breakfast is commonly described as the most important meal of the day; however, we have little information regarding its relevance for childhood overweight and obesity in southern mainland China. This study aimed to assess the association between breakfast preferences, consumption location and overweight and obesity for children in Shenzhen. Methods Among 6126 children (median age 7.2 years) at primary schools, 3504 were finally included after a questionnaire survey and physical examination. Ten commonly consumed foods/beverages for breakfast in southern China were exposure variables, and consumption location, total energy demographic and other dietary characteristics were covariates in logistic regression to determine the effect of breakfast preferences on overweight and obesity, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results Probability of overweight/general obesity was inversely associated with children eating plain congee for breakfast (adjusted OR 0.689, 95% CI 0.566–0.838), restricted to boys after stratification. Probability of overweight/general obesity and central obesity was positively associated with usually eating steamed rice roll for breakfast (OR 1.309, 95% CI 1.090–1.571 and OR 1.351, 95% CI 1.064–1.717, respectively), but the effect on overweight/obesity remained statistically significant for only boys after stratification. Eating steamed rice roll for breakfast and eating out for breakfast had an additive interaction on overweight/obesity. Additionally, eating bread for breakfast had a mild favorable effect on overweight/obesity but only for girls. Conclusions Keeping a healthy weight might benefit children who eat plain congee or bread for breakfast in China. However, frequent consumption of steamed rice roll for breakfast and especially eating out could contribute to overweight and obesity. Thus, we need to promote a healthier breakfast pattern among children in southern China to reduce the odds of obesity.

Background Consistent evidence has shown excess mortality associated with cold temperature, but some important details of the cold–mortality association (e.g. slope and threshold) have not been adequately investigated and few studies focused on the cold effect in high-altitude areas of developing countries. We attempted to quantify the cold effect on mortality, identify the details, and evaluate effect modification in the distinct subtropical plateau monsoon climate of Yuxi, a high plateau region in southwest China. Methods From daily mortality and meteorological data during 2009–2014, we used a quasi-Poisson model combined with a “natural cubic spline–natural cubic spline” distributed lag non-linear model to estimate the temperature–mortality relationship and then a simpler “hockey-stick” model to investigate the cold effect and details. Results Cold temperature was associated with increased mortality, and the relative risk of cold effect (1st relative to 10th temperature percentile) on non-accidental, cardiovascular, and respiratory mortality for lag 0–21 days was 1.40 (95% confidence interval: 1.19–1.66), 1.61 (1.28–2.02), and 1.13 (0.78–1.64), respectively. A 1 °C decrease below a cold threshold of 9.1 °C (8th percentile) for lags 0–21 was associated with a 7.35% (3.75–11.09%) increase in non-accidental mortality. The cold–mortality association was not significantly affected by cause-specific mortality, gender, age, marital status, ethnicity, occupation, or previous history of hypertension. Conclusions There is an adverse impact of cold on mortality in Yuxi, China, and a temperature of 9.1 °C is an important cut-off for cold-related mortality for residents.

The magnetic and the magnetocaloric properties of Tm 4 PdMg and Tm 4 PtMg have been investigated. A second order magnetic phase transition from a paramagnetic to a ferromagnetic state was observed for Tm 4 PdMg and Tm 4 PtMg at the Curie temperatures of T C ∼6.0 and 4.5 K, respectively. A large reversible magnetocaloric effect was observed for both compounds at low temperature. For a magnetic field change of 7 T, the values of maximum magnetic entropy change (–Δ S M max ), refrigerant capacity ( RC ) and relative cooling power ( RCP ) are 18.0 J/kg K, 319 J/kg and 414 J/kg for Tm 4 PdMg, and 16.5 J/kg K, 275 J/kg and 353 J/kg for Tm 4 PtMg, respectively.

Background Ambient PM2.5 has been identified as the top leading cause of risk-attributable deaths worldwide, particularly in China. Evidence suggested that PM1 contributed the most majority of PM2.5 concentrations in Chinese cities. However, epidemiologic knowledge to date is of wide lack regarding PM1-associated health effects. Methods We collected daily records of all-cause emergency department visits (EDVs) and ground measurements of ambient air pollutants and meteorological factors in Guangzhou and Shenzhen, China, 2015–2016. Case-crossover design and conditional logistic regression models were used to comparatively assess the short-term effects of ambient PM1, PM2.5, and PM10 on EDVs. Stratified analyses by gender, age and season were performed to identify vulnerable groups and periods. Results PM1, PM2.5 and PM10 were all significantly associated with increased EDVs in both cities. Population risks for EDVs increased by 2.2% [95% confidence interval, 1.8 to 2.6] in Guangzhou and 1.7% [1.0 to 2.4] in Shenzhen, for a 10 μg/m3 rise in PM1 at lag 0–1 days and lag 0–4 days, respectively. Relatively lower risks were found to be associated with PM2.5 and PM10. PM-EDVs associations exhibited no gender differences, but varied across age groups. Compared with adults and the elderly, children under 14 years-of-age suffered higher PM-induced risks. Results from both cities suggested greatly significant effect modification by season, with consistently stronger PM-EDVs associations during cold months. Conclusions Our study added comparative evidence for increased EDVs risks associated with short-term exposures to ambient PM1, PM2.5 and PM10. Besides, PM-associated effects were significantly stronger among children and during cold months.

Background Research argued that daily excessive concentration hours (DECH) could be more informative through accounting for within-day variations, when assessing population-level exposure to ambient fine particle (PM2.5). However, few studies have comparatively investigated PM2.5-associated risks using DECH and two common metrics of daily mean and hourly peak concentration. Methods We collected daily records of all-cause emergency department visits (EDVs) and hourly data on air pollutants and meteorological factors from Shenzhen, China, 2015–2018. According to guidelines proposed by the World Health Organization, DECH was calculated by summing up daily concentrations exceeding 25 μg/m3. Based on time-stratified case-crossover design, we adopted conditional logistic regression models to assess short-term attributable risks of EDVs associated with PM2.5 using three exposure metrics. Results DECH and daily average of PM2.5 strongly elevated risks of EDVs, while less evident associations were observed using hourly peak metric. Estimated excess relative risks at lag 0 day were 0.56% (95% confidence interval [CI]: 0.21 to 0.91), 0.69% (95% CI: 0.25 to 1.13) and 0.37% (95% CI: 0.02 to 0.76), respectively, associated with an interquartile range increase in DECH (420.2 μg/m3), 24-h average (24.9 μg/m3) and hourly peak concentration (38 μg/m3). More emergency visits could be attributed to DECH than daily mean PM2.5, with attributable fractions of 2.02% (95% CI: 1.42 to 2.61) and 1.09% (95% CI: 0.69 to 1.49), respectively. Conclusions This study added evidence for increased risk of EDVs associated with exposure to ambient PM2.5. DECH was a potential alternative exposure metric for PM2.5 assessment, which may have implications for future revision of air quality standards.

Background Temperature variability (TV) is closely associated with climate change, but there is no unified TV definition worldwide. Two novel composite TV indexes were developed recently by calculating the standard deviations of several days’ daily maximum and minimum temperatures (TVdaily), or hourly mean temperatures (TVhourly). Objectives This study aimed to compare the mortality risks and burden associated with TVdaily and TVhourly using large time-series datasets collected from multiple locations in China, United Kingdom and United States. Methods We collected daily mortality and hourly temperature data through 1987 to 2012 from 63 locations in China (8 communities, 2006–2012), United Kingdom (10 regions, 1990–2012), and USA (45 cities, 1987–2000). TV-mortality associations were investigated using a three-stage analytic approach separately for China, UK, and USA. First, we applied a time-series regression for each location to derive location-specific TV-mortality curves. A second-stage meta-analysis was then performed to pool these estimated associations for each country. Finally, we calculated mortality fraction attributable to TV based on above-described location-specific and pooled estimates. Results Our dataset totally consisted of 23, 089, 328 all-cause death cases, including 93, 750 from China, 7,573,716 from UK and 15, 421, 862 from USA, respectively. In despite of a relatively wide uncertainty in China, approximately linear relationships were consistently identified for TVdaily and TVhourly. In the three countries, generally similar lag patterns of TV effects were consistently observed for TVdaily and TVhourly. A 1 °C rise in TVdaily and TVhourly at lag 0–7 days was associated with mortality increases of 0.93% (95% confidence interval [CI]: 0.12, 1.74) and 0.97% (0.18, 1.77) in China, 0.33% (0.15, 0.51) and 0.41% (0.21, 0.60) in UK, and 0.55% (0.41, 0.70) and 0.51% (0.35, 0.66) in USA, respectively. Larger attributable fractions were estimated using TVdaily than those using TVhourly, with estimates at 0–10 days of 3.69% (0.51, 6.75) vs. 2.59% (0.10, 5.01) in China, 1.14% (0.54, 1.74) vs. 0.98% (0.55, 1.42) in UK, and 2.57% (1.97, 3.16) vs. 1.67% (1.15, 2.18) in USA, respectively. Our meta-regression analyses indicated higher vulnerability to TV-induced mortality risks in warmer locations. Conclusions Our study added multi-country evidence for increased mortality risk associated with short-term exposure to large temperature variability. Daily and hourly TV exposure metrics produced generally comparable risk effects, but the attributable mortality burden tended to be higher using TVdaily instead of TVhourly.

Compared with relative risk, attributable fraction (AF) is more informative when assessing the mortality burden due to some environmental exposures (e.g., ambient temperature). Up to date, however, available AF-based evidence linking temperature with mortality has been very sparse regionally and nationally, even for the leading mortality types such as cardiorespiratory deaths. This study aimed to quantify national and regional burden of cardiorespiratory mortality (CRM) attributable to ambient temperature in the USA, and to explore potential socioeconomic and demographic sources of spatial heterogeneity between communities. Daily CRM and weather data during 1987-2000 for 106 urban communities across the mainland of USA were acquired from the publicly available National Morbidity, Mortality and Air Pollution Study (NMMAPS). We did the data analysis using a three-stage analytic approach. We first applied quasi-Poisson regression incorporated with distributed lag nonlinear model to estimate community-specific temperature-CRM associations, then pooled these associations at the regional and national level through a multivariate meta-analysis, and finally estimated the temperature-AF of CRM and performed subgroup analyses stratified by community-level characteristics. Both low and high temperatures increased short-term CRM risk, while temperature-CRM associations varied by regions. Nationally, the fraction of cardiorespiratory deaths caused by the total non-optimum, low, and high temperatures was 7.58% (95% empirical confidence interval, 6.68-8.31%), 7.15% (6.31-7.85%), and 0.43% (0.37-0.46%), respectively. Greater temperature-AF was identified in two northern regions (i.e., Industrial Midwest and North East) and communities with lower temperature and longitude, higher latitude, and moderate humidity. Additionally, higher vulnerability appeared in locations with higher urbanization level, more aging population, less White race, and lower socioeconomic status. Ambient temperature may be responsible for a large fraction of cardiorespiratory deaths. Also, temperature-AF of CRM varied considerably by geographical and climatological factors, as well as community-level disparity in socioeconomic status.

We have successfully synthesized LaFe11.6Si1.4Hy/Bi composites by cold pressing together with vacuum annealing technology, and systematically investigated the microstructure, magnetism, mechanical performance, and magnetocaloric properties. LaFe11.6Si1.4Hy particles are well surrounded by metallic Bi, without the formation of new phase. The maximum values of the volumetric magnetic entropy change -&Delta, SM are as high as 51, 49, and 35 mJ/cm3K around 263 K, for the composites with 5, 10 and 15 wt % Bi contents, respectively. The maximum value of the compressive strength for LaFe11.6Si1.4Hy/Bi composites increased continuously from 155 to 358 MPa with increasing Bi content, from 0 to 15 wt %.

OBJECTIVEIntracerebral hemorrhage (ICH) is associated with a poor prognosis and high mortality, but no study has elucidated the association between glycemic variability (GV) and functional outcome in ICH. The authors of this study aimed to determine whether GV is a predictor of 30-day functional outcome in ICH patients.METHODSThe study recruited 366 patients with first-ever acute-onset ICH in the period during 2014 and 2015. Fasting blood glucose was assessed on admission and with 7-day continuous monitoring. Glycemic variability was calculated and expressed by the standard deviation (GluSD) and coefficient of variation (GluCV). Patients were divided into groups of those with diabetes mellitus (DM), stress hyperglycemia (SHG), and normal glucose (NG). Functional outcome was measured using the modified Rankin Scale.RESULTSThe numbers of patients with DM, SHG, and NG were 108 (29.5%), 127 (34.7%), and 131 (35.8%), respectively. As compared with the DM patients, those with SHG had higher mortality (29.9% vs 15.7%, p < 0.05) and a poorer prognosis (64.6% vs 52.8%, p < 0.05). Poor prognosis was associated with both high GluSD (OR 1.54, 95% CI 1.19–1.99) and high GluCV (1.05, 1.02–1.09), especially in the DM group. The area under the receiver operating characteristic curve was greater for the GluSD (OR 0.929, 95% CI 0.902–0.956) and the GluCV (0.932, 0.906–0.958) model than the original model (0.860, 0.823–0.898) in predicting a poor outcome.CONCLUSIONSStress hyperglycemia may be associated with increased mortality and a poor outcome in ICH, and increased GV may be independently associated with a poor outcome, particularly in ICH patients with DM.

The existing definitions of metabolic syndrome (MetS) may not be fully appropriate for the Shantou population because of ethnic and regional differences. We sought to establish a 95% multivariate medical reference range (MMRR) model for diagnosing MetS in Shantou adults and to evaluate the prevalence of MetS by the MMRR, JCDCG (the Chinese Guidelines) and International Diabetes Federation (IDF) criteria. A total of 4,580 participants were recruited in Shantou, southern China. We developed a MMRR model based on the combinatorial indicatrixes method for three categorized indicatrixes. According to the developed MMRR criteria, men (women) in Shantou have MetS by meeting 3 or more of the following: waist circumference ≥89 (81) cm; triglycerides level ≥1.73 (1.64) mmol/L; high-density lipoprotein cholesterol level ≤1.07 (1.05) mmol/L; blood pressure ≥138/89 (136/85) mmHg; and fasting plasma glucose ≥5.8 (5.7) mmol/L. The agreement of the MMRR with JCDCG and IDF criteria was “substantial” (both κ > 0.68), but the recommended reference values and proportion of individual components of MetS defined by the 3 criteria differed. The population-based MMRR criteria may be appropriate for diagnosing MetS in Shantou population and the model might be useful for generalization to other geographic regions.

Background Consistent evidence has shown that high diurnal temperature range (DTR) is associated with excess mortality, but little is known about the subgroups in the association. We aimed to identify the effect modifiers, including individual characteristics and specific mortality causes, of the association in a high plateau region with large DTR and extensive ethnic minorities in China. Methods We conducted a case-only analysis in 77,319 non-accidental deaths in Yuxi during 2007–2014, and evaluated the effect modifiers of the association of high DTR exposure and mortality. All non-accidental deaths were divided into cardiovascular, respiratory, and “other” causes. High DTR days were defined as ≥ 90th percentile of DTR. Results Risk of mortality on high DTR days was associated with age 75–84 years (odds ratio 1.07; 95% confidence interval 1.01–1.14) and ≥ 85 years (1.16; 1.08–1.24) as compared with age ≤ 64 years. The risk of the association was less for the Dai ethnic minority than Chinese Han (0.85; 0.75–0.96). Farmers (1.08; 1.03–1.14) and people with hypertension (1.09; 1.02–1.16) showed greater risk of dying on high DTR days than non-farmers and people without hypertension, respectively. Compared with “other” mortality causes, the risk was greater with cardiovascular causes (1.09; 1.04–1.15), notably ischemic heart disease (1.16; 1.08–1.25) and myocardial infarction (1.18; 1.08–1.29) in heart disease (1.11; 1.04–1.17), and ischemic stroke (1.17; 1.06–1.28) in stroke deaths (1.09; 1.03–1.15), as well as chronic bronchitis (1.22; 1.11–1.33) and chronic obstructive pulmonary disease (1.12; 1.05–1.20) in respiratory deaths (1.11; 1.04–1.18). Conclusions Individual characteristics and specific mortality causes can modify the association of high DTR and mortality. This knowledge may help in better targeting the vulnerable populations and developing more effective intervention strategies.