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Summary Background Stroke is a leading cause of death and disability worldwide. Despite considerable improvements in diagnosis and treatment, little is known about the short-term and long-term prognosis after a first stroke in low-income and middle-income countries, including China. We aimed to assess the short-term and long-term risk of recurrent stroke and mortality after a first stroke for each of the major pathological stroke types. Methods This population-based cohort study included adults aged 35–74 years without disability who were recruited to the China Kadoorie Biobank (CKB). A baseline survey was conducted in ten geographical areas (five urban, five rural) in China, and participants had clinical measurements recorded. Participants were followed up by monitoring death registries and by electronic linkage to health registries and health insurance claims databases, with follow-up until Jan 1, 2017. Participants were excluded from analyses if they had a previous history of stroke, transient ischaemic attack, or ischaemic heart disease at baseline. All incidences of fatal and non-fatal stroke during the study period were recorded by type (ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and unspecified type). Primary outcome measures were 28-day mortality, recurrent stroke, major vascular events (recurrent stroke, myocardial infarction, or vascular death), vascular mortality, and all-cause mortality. Findings Of 512 715 individuals in the CKB, 489 586 participants without previous ischaemic heart disease and stroke at recruitment were included, of whom 45 732 (42 073 [92%] confirmed by brain imaging) had a stroke during the study period. The mean age was 59·3 years (SD 9·8) for participants who had a stroke (54% women) and 50·8 years (10·3) for participants with no stroke (60% women). 36 588 (80%) of the incident cases of stroke were ischaemic stroke, 7440 (16%) were intracerebral haemorrhage, 702 (2%) were subarachnoid haemorrhage, and 1002 (2%) were an unspecified stroke type. 28-day mortality was 3% (95% CI 3–4) for ischaemic stroke, 47% (46–48)for intracerebral haemorrhage, 19% (17–22; 52% for rural areas and 32% for urban areas) subarachnoid haemorrhage, and 24% (22–27) for unspecified stroke. Among participants who survived stroke at 28 days, 41% (41–42) had recurrent stroke at 5 years (ischaemic stroke 41% [41–42], intracerebral haemorrhage 44% [42–46], subarachnoid haemorrhage 22% [18–27], unspecified stroke type 40% [35–44]) and mortality at 5 years was 17% ([17–18] ischaemic stroke 16% [15–16], intracerebral haemorrhage 28% [26–29], subarachnoid haemorrhage 16% [12–20], unspecified stroke type 15% [12–19]). After a first ischaemic stroke, 91% of recurrent strokes were also ischaemic stroke; after an intracerebral haemorrhage, 56% of recurrent strokes were intracerebral haemorrhage, and 41% of recurrent strokes were ischaemic stroke. Interpretation After a first stroke, the risk of recurrence or death within 5 years was high among this population of Chinese adults. Urgent improvements to secondary prevention of stroke in China are needed to reduce these risks. Funding Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Chinese Ministry of Science and Technology, National Natural Science Foundation of China. Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

This study focused on how adding ionic liquids (IL) affects composting humification. During the warming and thermophilic phases, addition of IL increased precursors content, and increased the polymerization of humus (HS) at later stages. Furthermore, the final HS and humic acid (HA) content of experimental groups (T) groups 129.79 mg/g and 79.91 mg/g were higher than in control group (CK) 118.57 mg/g and 74.53 mg/g, respectively (p 0.05). IL up-regulated the gene abundance of metabolism for carbohydrate and amino acid (AA), and promoted the contributions of Actinobacteria and Proteobacteria, which affected humification. The redundancy analysis (RDA) results showed that the citrate-cycle (TCA cycle)(ko0020), pentose phosphate pathway (ko00030), pyruvate metabolism (ko00620), glyoxylate and dicarboxylate metabolism (ko00630), propanoate metabolism (ko00640), butanoate metabolism (ko00650) positively correlated with HA and HI. HA and humification index (HI) positively correlated with AA metabolic pathways, and fulvic acid (FA) was negatively correlated with these pathways. Overall, metabolism for carbohydrate and AA metabolism favored compost humification. ILs improved metabolism for carbohydrate and amino acid metabolism, thus enhancing humification.

Background Although fresh fruit consumption has well recognised health benefits, substantial uncertainties remain about its potential effects on incident diabetes and, among those with diabetes, the risks of death and vascular complications. We aimed to assess the associations of fresh fruit consumption with the risk of incident diabetes and diabetic vascular complications. Methods The China Kadoorie Biobank Study is a prospective cohort study with 512 891 Chinese adults aged 30–79 (mean 51·5, SD 10·7) years recruited from ten diverse localities across China between June 25, 2004, and July 15, 2008. At baseline and during the two subsequent resurveys (conducted from June to October, 2008, and from August, 2013, to September, 2014), data on fresh fruit consumption were collected with interviewer-administered electronic questionnaires. Deaths and information on hospital admissions were collected through linkages with death and disease registries and national health insurance claim databases. For each disease endpoint (including incident diabetes and, among baseline diabetics, mortality and hospital admissions of diabetic vascular complications) associated with fresh fruit consumption, we used Cox regression analysis to derive adjusted hazards ratios (HRs), adjusting for age, sex, region, education, income, smoking, alcohol consumption, physical activity, survey season, family history of diabetes, BMI, and consumption of meat, dairy products, and preserved vegetables. Ethics approval was granted by ethics committees or institutional review boards at the University of Oxford, the Chinese Center for Disease Control and Prevention, the Chinese Academy of Medical Sciences, and all participating regions, and all participants provided written informed consent. Findings During a mean of 7·2 years (SD 1·3) of follow-up, 9504 new diabetes cases were recorded in 482 591 participants without self-reported or screen-detected diabetes at baseline. In 30 300 (5·9%) participants who had diabetes at baseline, 3389 deaths, 9746 macrovascular events requiring hospital admission, and 1345 microvascular events were recorded. 96 586 (18·8%) of all participants reported daily consumption of fresh fruit (consumers) and 32 775 (6·4%) never or rarely consumed fresh fruit (non-consumers). The proportion of non-consumers was about three times higher in participants with baseline self-reported diabetes (17·9% [2893 of 16 162]) than in those with screen-detected diabetes (6·8% [958 of 14 138]) or no diabetes (6·0% [28 924 of 482 591]). In participants without diabetes at baseline, the adjusted HR for incident diabetes was 0·88 (95% CI 0·83–0·93) for daily consumers versus non-consumers, with a clear dose–response relation with the amount consumed. This association was consistent across subgroups of participants at different levels of diabetes risk. In participants with diabetes at baseline, increased fresh fruit consumption was associated with reduced risks of death and major vascular diseases, with adjusted HRs per daily portion being 0·83 (0·74–0·93) for all-cause mortality, 0·87 (0·82–0·93) for macrovascular complications, and 0·72 (0·61–0·87) for microvascular complications. The associations were similar in patients with self-reported diabetes and those with screen-detected diabetes, and were not modified by diabetes onset age, duration, or treatment. Interpretation In Chinese adults, higher fresh fruit consumption was associated with a significantly lower risk of diabetes and, in those who already had diabetes, lower risks of death, and major vascular complications. Funding Kadoorie Charitable Foundation (Hong Kong, China), UK Wellcome Trust, Chinese National Natural Science Foundation, British Heart Foundation, UK Medical Research Council, and Cancer Research UK.