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Per- and polyfluoroalkyl substances (PFAS) have attracted worldwide attention as one of persistent organic pollutants; however, there is limited knowledge about the exposure concentrations of PFAS-contained ambient particulate matter and the related health risks. This study investigated the abundance and distribution of 32 PFAS in fine particulate matter (PM 2.5 ) collected from 93 primary or secondary schools across the Pearl River Delta region (PRD), China. These chemicals comprise four PFAS categories which includes perfluoroalkyl carboxylic acids (PFCAs), perfluoroalkyl sulfonic acids (PFSAs), perfluoroalkyl acid (PFAA) precursors and PFAS alternatives. In general, concentrations of target PFAS ranged from 11.52 to 419.72 pg/m 3 (median: 57.29 pg/m 3 ) across sites. By categories, concentrations of PFSAs (median: 26.05 pg/m 3 ) were the dominant PFAS categories, followed by PFCAs (14.25 pg/m 3 ), PFAS alternatives (2.75 pg/m 3 ) and PFAA precursors (1.10 pg/m 3 ). By individual PFAS, PFOS and PFOA were the dominant PFAS, which average concentration were 24.18 pg/m 3 and 6.05 pg/m 3 , respectively. Seasonal variation showed that the concentrations of PFCAs and PFSAs were higher in winter than in summer, whereas opposite seasonal trends were observed in PFAA precursors and PFAS alternatives. Estimated daily intake (EDI) and hazard quotient (HQ) were used to assess human inhalation-based exposure risks to PFAS. Although the health risks of PFAS via inhalation were insignificant (HQ far less than one), sufficient attention should be levied to ascertain the human exposure risks through inhalation, given that exposure to PFAS through air inhalation is a long term and cumulative process., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To investigate the associations between 24-hour urinary sodium excretion (24hUNaE) and all-cause mortality in adult Northern Chinese population. Methods: Data from this study were derived from the prospective urban and rural epidemiology (PURE) study in north China. Baseline information of all participants were obtained by face to face interview through trained research staffs based on questionnaires, and morning fasting urine samples of participants were collected to estimate 24hUNaE and 24-hour potassium excretion (24hUKE). Multivariable frailty Cox regression models were used to explore the association between 24hUNaE (<3.00, 3.00-3.99, 4.00-4.99, 5.00-5.99 and ≥6 g/d) and all-cause death. Results: A total of 27 310 participants were included in this study. The mean 24hUNaE was (5.84±1.73) g/d. After a median follow-up of 8.8 years, 1 024 participants died (3.7%), including 390 cardiovascular related deaths and 591 non-cardiovascular related deaths. The cause of death of the remaining patients could not be determined. Using 24hUNaE level of 4.00-4.99 g/d as the reference group, after fully adjustment, 24hUNaE ≥6.00 g/d was associated with an increased risk of all-cause death ( HR =1.24, 95% CI : 1.02-1.49) and cardiovascular related death ( HR =1.39, 95% CI : 1.02-1.88). 24hUNaE<3.00 g/d was associated with increased risk of all-cause mortality ( HR =1.38, 95% CI : 0.96-1.99). There was no significant association between 24hUNaE and non-cardiovascular related death. Furthermore, using the combination of 24hUNaE 4.00-4.99 g/d and 24hUKE≥2.11 g/d as the reference group, the highest risk occurred in participants with the combination of low sodium (<3.00 g/d) and low potassium (<2.11 g/d). Conclusion: 24hUNaE equal or higher than 6 g/d or lower than 3 g/d is associated with increased risk of all-cause mortality and cardiovascular related death in Northern Chinese population. Besides, moderate sodium intake in combination with increased potassium intake might reduce the risk of all-cause death.

Over more than three decades New Zealand (NZ) has abolished its racially-biased immigration policy and changed to select immigrants based on personal merits, since 1997 new Chinese immigrants from China have become the second-largest immigrant group in NZ. Reflecting the rapid changes in Mainland Chinese society, different waves of Chinese immigrants have arrived in NZ during the past three decades, each carrying distinctive characteristics. Despite the magnitude of this immigrant population both globally and in NZ, the subethnicities of these immigrants have never been conceptualised theoretically. Based on the digitally- enhanced research techniques together with ethnographically-based study, the paper aims to remedy this research gap in Chinese diaspora studies. Two theoretical concepts are used in this research. The first is the concept of sub-ethnicity which refers to finer boundaries drawn within an ethnic group by nationality, language, region of origin, class, or other distinctions. The second is the concept of ethnoburb - a model of ethnic settlement where the suburban ethnic communities and clusters of associated residential areas and business districts in large metropolitan cities are highly concentrated. This research considers these two concepts are correlated to each other since certain ethnoburb has particular attraction to certain sub-ethnic group; and vice versa, certain subethnic group intends to gather in same ethnoburb unintentionally or unconsciously. Applying these concepts, the research considers Albany as an example of a distinctive Chinese ethnoburb for the China-born new immigrants, especially for the most recent arrivals. The paper makes theoretical contribution to understand the complementarity between these two concepts and their methodological implementation towards studying new Chinese migration., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The purpose of this study was to examine the correlation between fasting blood glucose and new-onset hypertension and examine any synergistically effect modification with multiple risk factors., Methods: We conducted post-hoc analyses of repeated-measures data in the original Dongzhi osteoporosis cohort study. In total, 3985 participants without hypertension aged 25-64 years were included in the current analyses. Generalized estimating equation models were used to assess the relationship between fasting blood glucose and risk of new-onset hypertension after adjusting for pertinent covariates and autocorrelations among siblings., Results: 393 men (19.4%) and 398 women (20.3%) without hypertension at the baseline developed hypertension by the end of the study period. Compared to lower baseline fasting blood glucose levels (Q1-Q3: < 5.74 mmol/L; clinical cut points: < 5.6 mmol/L), higher baseline fasting blood glucose levels (Q4: ≥ 5.74 mmol/L; clinical cut points: ≥ 5.6 mmol/L and < 7.0 mmol/L) increased the risk of new-onset hypertension significantly [(OR: 1.54, 95% CI 1.19-1.98, P < 0.001); (OR: 1.38, 95% CI 1.09-1.75, P = 0.008)] in women. Additionally, a stronger significant association was found in women with elevated fasting blood glucose on risk of new-onset of hypertension with higher total cholesterol (≥ 5.2 mmol/L) [(OR: 2.76; 95% CI: (1.54, 4.96), P < 0.001)]. However, no association was found between fasting blood glucose and risk of new-onset hypertension in men., Conclusions: High fasting blood glucose may be significantly associated with risk of new-onset hypertension in Chinese women, especially in women with higher total cholesterol. Further randomized studies are needed to confirm our findings., (© 2021. The Author(s).)

Objective: This analysis was performed to evaluate the efficacy and the safety of rivaroxaban-aspirin combination therapy in secondary prevention of major adverse cardiovascular events in Chinese patients enrolled in the COMPASS trial. Methods: COMPASS was a prospective, international multi-center and randomized controlled trial. From September 2014 to February 2017, 1 086 patients with stable coronary artery disease and peripheral artery diseases were recruited from 31 centers in China. Patients were randomly assigned to separately receive the therapy of rivaroxaban (2.5 mg twice a day) plus aspirin (100 mg once a day,) group ( n =366), rivaroxaban (5 mg twice a day) alone group ( n =365), and aspirin (100 mg once a day) alone group ( n =355). Baseline information such as age, sex, etc. of all three groups was collected. Finally, 1 081 patients were followed up successfully, with the follow-up rate 99.5% and the average follow-up time was 19 months. The primary efficacy endpoint was the composite of cardiovascular death, myocardial infarction and stroke. The primary safety endpoint was major bleeding evaluated by modified International Society on Thrombosis and Haemostasis criteria. Results: Age of patients was (64.2±8.3) years and there were 293 male in rivaroxaban plus aspirin group. Age of patients was (63.8±9.0) years, and there were 301 male patients in rivaroxaban alone group. Age of patients was (63.6±8.8) years, and there were 282 male patients in the aspirin alone group. The incidences of primary efficacy endpoint occurred in 9 cases (1.5%) in rivaroxaban with aspirin group, 21 cases (3.7%) in rivaroxaban alone group and 14 cases (2.5%) in aspirin alone group. Meanwhile, the incidences of primary safety endpoint occurred in 6 cases (1.0%) in rivaroxaban with aspirin group, 9 cases (1.6%) in rivaroxaban alone group and 7 cases (1.2%) in aspirin alone group. The net clinical benefit events were 10 cases (1.7%) in rivaroxaban with aspirin group, 22 cases (3.9%) in rivaroxaban alone group and 15 cases (2.7%) in aspirin alone group ( P >0.5%). Conclusions: The combination of rivaroxaban with aspirin can be safe and effectively used for the secondary prevention in Chinese patients with stable coronary artery disease and peripheral artery diseases.

Background: The relationship between mortality and the primary diagnosis in AF patients is poorly recognized. The purpose of the study is to compare the differences on mortality in patients with a primary or secondary diagnosis of AF and to identify risk factors amenable to treatment., Methods: This was a prospective cohort study using data from the Chinese AF registry. For admitted patients, a follow-up was completed to obtain the outcomes during 1 year., Results: A total of 2015 patients with confirmed AF were included. AF was the primary diagnosis in 40.9% (n = 825) of them. 78.9% (n = 939) of the secondary AF diagnosis patients and 55.5% (n = 458) of the primary AF diagnosis patients were sustained AF. Compared with primary AF diagnosis group, the secondary AF diagnosis group was older with more comorbidities. At 1 year, the unadjusted mortality was much higher in the secondary AF diagnosis groups compared with the primary AF diagnosis groups. In Cox regression analysis with adjustment for confounding factors, patients with secondary AF diagnosis were associated with an increased mortality (relative risk 1.723; 95% CI: 1.283 to 2.315, p < .001). On multivariate analysis, age ≥ 75, LVSD, COPD, and diabetes were independent predictors of mortality in patients with primary AF diagnosis, while for the secondary AF diagnosis group, the risk factors were age ≥ 75, heart failure, and previous history of stroke., Conclusions: Patients presenting to ED with secondary diagnosis of AF were suffering from higher mortality risks compared with primary AF diagnosis patients. Physicians should distinguish these two groups in clinical practice., (© 2020 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)

The time trends regarding the etiology of renal artery stenosis (RAS) are changing, but few investigations have focused on these issues. This study aimed to analyze the time trends regarding the etiology of RAS in a large patient sample from the China Center for Cardiovascular Disease. Consecutive inpatients with RAS from January 1999 to December 2016 were enrolled in this study. The etiologic diagnosis of RAS was based on established criteria. We retrospectively analyzed the time trends regarding the etiology of RAS during an 18-year period. A total of 2905 patients with RAS were enrolled. There were 2393 (82.4%) patients with atherosclerosis (AS), 345 (11.9%) with Takayasu arteritis (TA), 126 (4.3%) with fibromuscular dysplasia (FMD), and 41 (1.4%) with other causes. Among all patients (n = 2905), patients aged ≤ 40 years (n = 450), patients aged >40 years (n = 2455), female patients (n = 1097), male patients (n = 1808), female patients aged >40 years (n = 808), and male patients aged >40 years (n = 1647), there were a gradual increase in the proportion of atherosclerotic RAS (P < 0.05), a gradual decrease in the proportion of RAS caused by TA (P < 0.05), and almost no change in the proportion of RAS caused by FMD during the 18-year period (P > 0.05). The data show that the primary causes of RAS are AS, TA, and FMD. The proportion of RAS caused by AS and TA gradually increased and decreased, respectively, over time, and the proportion of RAS caused by FMD showed no significant change., (©2018 Wiley Periodicals, Inc.)

Objective: Elevated resting heart rate (RHR) has been shown to be a risk marker for cardiovascular disease. Results from studies on the effects of RHR in large arteries are limited to the functional changes of those arteries, while the association between RHR and aortic diameter remains largely understudied., Methods: This was a cross sectional study of hypertensive Chinese adults from rural areas. The maximum infrarenal aortic diameter (maxIAD) from renal arteries to the iliac bifurcation was obtained by ultrasound. MaxIADs in different RHR groups were compared in males and females separately because of the significant differences between sexes. Multiple regression analysis was used to determinate the correlation between RHR and maxIAD. Further interactions between three factors (BMI, smoking, and anti-hypertensive regimens) and RHR for maxIAD were examined using subgroup analysis., Results: 19,200 subjects were enrolled in the study, with an average age of 64.8±7.4 years and 61.6% females. Only 22 cases (0.11%) were detected with AAA, with males (n = 17) presenting a higher AAA incidence than females (n = 5). In subjects ≥65 years, there were 18 (0.19%) AAA, and 15 (83.3%) had a history of smoking. In the total subjects, the mean maxIAD ranged from 15.7±2.1 mm to 15.2±2.2 mm as RHR changed from the lowest quartile to the highest (≥84 bpm) in males, with a similar tendency observed in females. The correlation coefficient of RHR on maxIAD was -0.17 in males and -0.12 in females. Further subgroup analysis revealed that smoking exaggerated the correlation between RHR and maxIAD, but only in females., Conclusions: A low AAA incidence was observed in this hypertensive Chinese population. There was a negative association between RHR and maxIAD, potentially exaggerated by smoking, especially in females., (Copyright © 2015. Published by Elsevier Ltd.)

There is lack of data about patient characteristics, practice patterns, and long-term adverse outcomes in patients with atrial fibrillation (AF) attending emergency departments (EDs) in China. A total of 2016 patients from 20 representative EDs were included. During 1 year, all-cause mortality was 291 (14.6%) cases, stroke/noncentral nervous system systemic embolism rate was 159 (8.0%) cases, and major bleeding was 26 (1.3%) cases. Heart failure, the major cause of mortality, accounted for 43.0% of deaths. Of 375 (18.6%) patients who used warfarin at baseline, only 217 (57.9%) patients were still on anticoagulation therapy during 1-year follow-up. Compared with the patients who continued on warfarin, the mortality rate was higher in those who did not continue (15.9% vs 5.5%, P < .001). Patients seen in ED with AF appear to have a high incidence rate of long-term all-cause mortality and inadequate anticoagulation rate., (© The Author(s) 2014.)

Background: Atrial fibrillation (AF) disproportionately affects older adults. However, direct comparison of clinical features, medical therapy, and outcomes in AF patients aged 65-74 and ≥ 75 years is rare. The objective of the present study was to evaluate the differences in clinical characteristics and prognosis in these two age-groups of geriatric patients with AF., Materials and Methods: A total of 1,336 individuals aged ≥ 65 years from a Chinese AF registry were assessed in the present study: 570 were in the 65- to 74-year group, and 766 were in the ≥ 75-year group. Multivariable Cox hazards regression was performed to analyze the major adverse cardiac events (MACEs) between groups., Results: In our population, the older group were more likely to have coronary artery disease, hypertension, previous stroke, cognitive disorder, or chronic obstructive pulmonary disease, and the 65- to 74-year group were more likely to have valvular heart disease, left ventricular systolic dysfunction, or sleep apnea. The older patients had 1.2-fold higher mean CHADS2 (congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke) scores, but less probability of being prescribed drugs. Compared with those aged 65-74 years, the older group had a higher risk of death (hazard ratio 2.881, 95% confidence interval 1.981-4.189; P<0.001) or MACE (hazard ratio 2.202, 95% confidence interval 1.646-2.945; P<0.001) at the 1-year follow-up. In multivariable Cox analyses, secondary AF diagnosis, a history of chronic obstructive pulmonary disease, and left ventricular systolic dysfunction were independent predictors of MACE in the older group., Conclusion: Patients aged ≥ 75 years had a worse prognosis than those aged 65-74 years, and were associated with a higher risk of both death and MACE.

Purpose: Through analysis, the elastograms characteristics of breast lesions of Chinese women, a suitable diagnostic standard of quasistatic ultrasound elastography (UE) for Chinese women was proposed., Methods: From June 2010 to March 2012, 1036 consecutive female patients (mean age, 44 years old) with breast lesions were recruited into a multicenter retrospective study, which involved 8 centers across China. Each institutional ethic review board approved the study, and all the patients gave written informed consent. All breast lesions underwent ultrasound and UE examination. Two radiologists analyzed the elastograms and separated the elastograms into 10 types. A final diagnosis was made on the basis of histologic findings. The characteristics of the elastograms were analyzed. Receiver operating characteristic curves were plotted for evaluating the diagnostic performance. Sensitivity, specificity, and accuracy were calculated. Differences in sensitivity, specificity, and accuracy were tested by using the McNemar test., Results: There were 1150 lesions (593 benign, 557 malignant). There was a highly significant correlation between the elastogram color distribution and the percentage of malignant lesions, with a value of 0.92 (2P < .0001). Through analysis the different malignant percentages in different elastogram types, UE diagnostic standard was proposed, which was correlated with the blue percentage in the elastogram. The specificity, sensitivity, and accuracy of UE were 86.4%, 80.8%, and 83.5%, respectively. The specificity and accuracy of UE were higher than with ultrasound. The area under the curve was 0.86., Conclusion: UE could give valuable assessment in the diagnosis of breast lesions. The proposed UE diagnostic standard was suitable for Chinese women., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Both AMBI and M-AMBI could effectively assess the benthic ecological status of estuaries and coastal systems with soft sediments, and show the response of benthic communities to human pressures and natural changes. To monitor the ecological status of Yangtze River Estuary, macroinvertebrate samples and environmental data were collected in April 2009. Results showed that the benthic habit of Yangtze River Estuary was disturbed to various degrees, especially in the watersheds of Hangzhou Bay, coastal areas of Zhoushan islands and in the inner part of Yangtze River Estuary, which was related to land resourced discharges, eutrophication and large amounts of coastal projects. No significant difference was found between the calculation results of AMBI and M-AMBI based on density and biomass, as indicated by one-way Analysis of Variance (ANOVA). Compared with AMBI, M-AMBI could be more effective to assess the ecological status of Yangtze River Estuary because M-AMBI matched the community structure and environmental variables better. Moreover, according to results of Pearson correlation and linear regression analysis, significant negative relationships were found between the eutrophication index both in the surface and bottom water layers and M-AMBI, but no significant relationship was found between the eutrophication index and AMBI. Therefore, M-AMBI could be more suitable in indicating the eutrophication stress of Yangtze River Estuary.

Objective: We investigated the incidence of human parvovirus B19 (HPV B19) infection after renal transplantation as well as the risk of anemia and renal allograft damage among infected transplant recipients in China., Methods: We selected 114 patients at 1-18 months after renal transplantation for detection of HPV B19 DNA copies compared with a control population. Renal function and hematopoiesis were compared between infected and noninfected groups., Results: Twenty-seven patients diagnosed with HPV B19 infection during follow-up (18.75%),which was a significantly higher number than among the general population over the same period. Infected versus nonaffected patients exhibited a significantly higher incidence of anemia and urinary abnormalities in addition to significantly lower values of hemoglobin, higher serum creatinine concentrations, and lower glomerular filtration rates. The 2 groups did not differ in the types or doses of calcineurin inhibitor (CNI) immunosuppressants. Two cases of pure red cell aplasia (PRCA) as confirmed using bone marrow biopsy, were observed in the infected group. They displayed HPV B19 DNA copy numbers >10(7)/mL and segmental mesangial cell proliferation on renal biopsy. The PRCA cases were cured with immunomodulatory therapy., Conclusions: The HPV B19 infection rate was significantly higher among renal transplant recipients than normal controls. Infections correlated with damage to the renal allograft, which may in turn cause PRCA. Immunomodulation therapy was effective to treat this complication of HPV B19 infection., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To characterize hypertensive patients living in metropolitan cities in China., Methods: This was a cross-sectional survey conducted in Beijing, Shanghai and Guangzhou. The eligibility criteria included outpatients 35-85 years of age with a systolic blood pressure (SBP) of ≥140 mmHg or a diastolic blood pressure (DBP) of ≥90 mmHg or both and/or patients receiving antihypertensive medications. The patients' demographic characteristics, medical history and findings of physical examinations, laboratory tests and cardiovascular imaging (i.e., ultrasonic cardiogram) were included in the survey. Risk stratification and the rate of hypertension control were evaluated., Results: A total of 25,336 individuals were surveyed, of which 79.1% were from cardiology clinics and 51.8% were male hypertensives. The average SBP/DBP was 139.3±18.6/82.3±12.0 mmHg. The mean age was 63.6±11.5 years. The mean BMI was 25.1±3.8 kg/m(2). Among the men, 55.9% had a waist circumference of >90 cm. Among the women, 50.9% had a waist circumference of >85 cm. The percentages of patients with diabetes mellitus, heart disease and cerebral vascular disease were 20.3%, 39.2% and 10.4%, respectively. The smoking rate was 17.6%. Overall, 60.9% of the patients were in the very high risk group. While 97.7% of the patients were receiving antihypertensive drug therapy, only 40.2% had controlled SBP/DBP (i.e., under 140/90 mmHg). The control rate was statistically higher in Beijing and Shanghai than in Guangzhou and among older patients than among younger patients (43% among the patients >75 years of age vs. 28.1% among the patients 35-45 years of age)., Conclusion: In Beijing, Shanghai and Guangzhou, most hypertensive patients have various cardiovascular risk factors and cardiovascular diseases. High blood pressure is not under appropriate control in all cases, especially among young hypertensives and patients living in Guangzhou city. Approaches designed to target multiple risk factors and concomitant cardiovascular diseases and boost the hypertension control rate are warranted.

Background: Many researches report that low socioeconomic status (SES) is associated with a higher risk of coronary heart disease (CHD). This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction (AMI) in the Chinese population, and to compare the difference in this association between northern and southern regions in China., Methods: We conducted a case-control study. Cases were first AMI (n = 2909). Controls (n = 2947) were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation., Results: Low levels of education (8 years) were more common in cases compared to controls (53.4% and 44.1%; P = 0.0001). After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population (P = 0.0005). The odds ratio (OR) associated with education of 8 years or less, compared with more than 12 years (trade school/college/university) was 1.33 (95%CI 1.12 - 1.59), and for education of 9 - 12 years 1.04 (95%CI 0.88 - 1.33). The proportion of higher income population was more in controls than cases (39.4% and 35.3%). Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 (95%CI 1.67 - 3.39) in women, and 1.18 (95%CI 0.99 - 1.42) in men (P = 0.0001, for heterogeneity). The interaction between levels of education and different regions was significant (P = 0.0206, for interaction)., Conclusion: Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.

We evaluated 4-year data set to assess the trophic state and limiting factors of the Three Gorges Reservoir (TGR) during the experimental impounding period (September 2005 to September 2007) and the normal operating period (September 2008 to September 2010). The results indicated that there had been appeared new characteristics in spatial and temporal distribution of trophic state indices after impoundment. The trophic state indices (TSI(TP)) showed increased trend after the TGR impoundment during the study area, but TSI(TN) and TSI(SD) had no significant changes after the TGR impoundment. The values of TSI(CHL) showed increased trend after the TGR impoundment in S1, and the values of TSI(CHL) did not show obvious changes in S2, S3 and S4 after the TGR impoundment. The values of TSI(TN), TSI(TP) and TSI(SD) show similar spatial variances with the highest value in S4, followed in a descending order by S3, S2 and S1. TSI(CHL) in the S2 and S3 were higher than that in S1 and S4. According to the characteristics of water level, the operational period of the TGR classified into following four stages: stage I (pre-November-April), stage II (May-July), stage III (July-September) and stage IV (September-November). The values of TSI(TN) and TSI(TP) in the Daning River and the TGR mainstream showed similar seasonal variances with the highest value in the stage II and III, followed in a descending order by stage I and IV. The values of TSI(CHL) varied substantially among the four stages, with the highest value in stage III, followed by stage II, IV and I. The trophic state indices differences were getting smaller between the four stages after the TGR impoundment. Using Carlson's two-dimensional approach, deviations of the TSI(S) indicated that factors other than phosphorous and nitrogen limited algal growth and that nonalgal particles affected light attenuation. These findings were further supported by the significant correlation among the values of TSI and hydrological factors.

Diatom, as a kind of autotrophic photosynthetic eukaryotic algae, is an important primary producer in aquatic ecosystem, and can reflect the average status of water environment. As the bio-indicators of the environment, Nitzschia communis, Navicula minuscula, and Gomphonema parvulum can indicate the eutrophication of waters, whereas Gomphonema angustum, Epithemia adnata, and Diatoma moniliformis can indicate the oligotrophication of waters. Cyclotella bodanica, Neidium affine, and Eunotia exigua are all the eosinophilic species that can indicate waters acidity, Aminutissimum nodusa can indicate water's Cu concentration, and Synedra ulna can indicate the Zn concentration in waters. Some other diatoms can also indicate water' s contamination. This paper reviewed the research progress on the applications of diatom and diatom indices in river health assessment, pointed out the related existing problems, and put forward some future research directions, e. g., further perfect the classification and identification of diatoms, broadly carry out the researches of diatom indices upon different areas and conditions, pay more attention to the screening of diatom bio-integrality indices, and establish a benchmark which suits for the assessment of water quality.

Objective: To understand the situation of blood pressure control and the major factors influencing the programs among those hypertensive patients living in the communities from different parts of China., Methods: A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained under the requirement of this protocol to manage the hypertensive patients. In this study, the hypertensive patients who had been registered in the project centers from Beijing, Hebei, Gansu, Jiangsu, Zhejiang, Guangdong provinces, were selected as the study subjects, and the baseline data for these patients was analyzed., Results: By the end of 2010, a total of 242 182 patients were registered. The mean age was 61.0 ± 10.5, with 48.5% of them being males. The overall control rate of blood pressure was 27.4%. The control rate was significant lower among patients who were in lower age group, being male, with higher BMI, smoking, drinking or with more salt consumption. However, the control rate was significant higher among those patients who had family history of hypertension, always undertook physical exercise or receiving medical treatment., Conclusion: The blood pressure control rate for community hypertensive patients in China was still in a relatively low level. Standardization management measures should be strengthened so as to improve the rate of control on high blood pressure.

Based on the analysis of macrobenthos samples collected from Bohai Bay, China in 2011 and the data obtained from the nearly the same sampling area during last six years, as well as the hydrological conditions, nutrients and dissolved oxygen, the characteristics of the changes in macrobenthos communities and their response to environmental variables were derived. Results showed that the distribution of the values of species number, abundance, biomass, richness index and diversity index reflected a gradient from the coastline to the open sea with the higher values concentrated at the open sea in the north part of Haihe estuary. The macrobenthos communities showed an obvious fluctuation over last six years, composed of three nodes. The first time node was in 2005 and 2008, the total species number, abundance and biomass maintained relatively high; the second time node was in 2009 and 2010, the values of the above three indices were the lowest in the three time nodes due to the increasing anthropogenic disturbances and natural changes; the third time node was in 2011, the values of the above three indices were the highest since many effective environmental protection measures had been carried out, indicating that the macrobenthos communities were recovered to a certain degree. The integrated impacts from the physical, chemical and biological variables induced by natural changes and anthropogenic disturbances, such as over-fishing, coastal land reclamation and sewage discharge were the triggers for the changes of macrobenthos communities. Furthermore, the variation characteristics of macrobenthic communities and environmental factors were generally in accordance with each other.

Objective: The aim of the present study was to evaluate the agreement, mean difference, prevalence, and control rates of arterial hypertension between clinic (i.e. office) and home blood pressure (BP) measurements in a general population. Variations in home BP between morning and evening measurements and the dynamic changes during 7 days of measurements were also examined., Methods: A total of 200 participants were selected from three communities in the Beijing area. Patients underwent a clinical interview and measurement of both clinic and home BP. Thresholds for elevated clinic and home BP were defined as at least 140/90 and 135/85 mmHg., Results: Systolic and diastolic BP measured at clinic was higher than at home; the mean difference was 3.1/1.6 mmHg in all participants and 6.2/1.1 mmHg in hypertensive patients. With home BP monitoring, the first day of monitoring showed the highest and most varied (as reflected by standard deviation) BP readings. Home diastolic BP was significantly higher in the morning (76.6 ± 10.1 mmHg) than in the evening (74.2 ± 9.8 mmHg, P<0.0001), but home systolic BP was not. The prevalence of hypertension was higher when estimated by clinic versus by home BP (53.0 vs. 39.6%, P=0.025); and the control rate of hypertension tended to be lower when estimated by clinic versus by home BP (56.1 vs. 64.1%, P=0.24). The overall agreement between clinic and home BP in diagnosis of hypertension was 80.3% (κ coefficient: 0.6)., Conclusion: The present study in 200 Chinese demonstrates that BP is higher (a) at the clinic setting compared with at home and (b) on the first day of initiating home BP monitoring. There is moderate agreement between clinic and home BP in diagnosing hypertension. As home BP measurements may best represent the 'true' BP level in normotensives and hypertensives, its use in clinical practice should be promoted.

The events of red tide were collected in Yangtze River Estuary and adjacent waters from 1972 to 2009. Based on geographic information system (GIS) analysis on the temporal and spatial distribution of red tide, the distribution map was generated accordingly. The results show: (1) There are three red tide-prone areas, which are outside the Yangtze River estuary and the eastern of Sheshan, Huaniaoshan-Shengshan-Gouqi, Zhoushan and the eastern of Zhujiajian. The red tide occurred 174 times in total, in which there were 25 times covered the area was larger than 1 000 km2. After 2000, the frequency of red tide were significantly increasing; (2) The frequent occurrence of red tide was in May (51% of total occurrence) and June (20% of total occurrence); (3) In all of the red tide plankton, the dominant species were Prorocentrum danghaiense, Skeletonema costatum, Prorocentrum dantatum, Nactiluca scientillans. The red tides caused by these species were 38, 35, 15, 10 times separately.

The impact of CYP3A5*3, a CYP3A5 nonexpresser genotype, on inhibitory effects of diltiazem on tacrolimus metabolism has not been assessed. In retrospective study, when coadministered with diltiazem, mean increments in dose-adjusted C(0D7), C(max) and AUC(0-12 h) for tacrolimus were larger in CYP3A5 expressers than in CYP3A5 nonexpressers (48.7 vs 3.7%, 31.7 vs 17.2% and 38.2 vs 18.5%, respectively). Subsequently, a prospective study was carried out, patients were randomized to algorithm-predicted dosing or standard dosing. For CYP3A5 expressers, an algorithm guided by CYP3A5 and diltiazem significantly reduced tacrolimus maintenance dosage (P=0.009) and improved the accuracy of tacrolimus initial dose, resulting in reduction in out-of-range C(0) after initial dose (P=0.002) and dose adjustments (P=0.004). However, for CYP3A5 nonexpressers, primary end points were not achieved, and tacrolimus-sparing effect of diltiazem was not remarkable. Our study results show that CYP3A5 genotype-guided tacrolimus-diltiazem combination is a promising therapy in renal transplant recipients in the early postoperative stage.

Background: Most data about psychological factors relating to acute myocardial infarction (AMI) were obtained from studies carried out in western countries. Results from small descriptive cross-sectional studies in China were inconclusive. The aim of this study was to explore possible associations between psychological risk factors and AMI among the Chinese population with a large-scale case-control study., Methods: This study was part of the INTER-HEART China study, itself part of the large international INTER-HEART study of cardiovascular risk factors. In this case-control study, 2909 cases and 2947 controls were recruited from 17 cities. Psychological stress, negative life events, depression and controllability of life circumstances were assessed., Results: Cases reported more psychological stress at home or work and odds ratios (ORs) were 3.2 (95%CI 2.1 - 4.9) for permanent stress and 2.1 (95%CI 1.5 - 2.8) for several periods of stress respectively. More cases experienced depression compared with controls (19.6% vs. 9.3%) and ORs were 2.2 (95%CI 1.9 - 2.6). Subjects with 1, 2 and 3 or more depressive symptoms had increased risk of AMI by 2.1, 2.2 and 2.6 fold, respectively, i.e., more depressive symptoms were associated with higher risks of AMI (P for trend < 0.0001). Women had a greater risk of AMI from depression (OR 3.0, 95%CI 2.2 - 4.0) compared to men (OR 2.0, 95%CI 1.6 - 2.4), P for interaction = 0.0364. Negative life events in subjects were associated with increased risk of AMI, OR 1.7 (95%CI 1.4 - 2.0) for one event and 1.8 (95%CI 1.3 - 2.4) for two or more events. High levels of controllability of life circumstances reduced the risk for AMI (OR 0.8, 95%CI 0.7 - 1.0)., Conclusions: Several psychological factors were closely associated with increased AMI risk among Chinese population. Psychological stress had a greater AMI risk in men but depression was more significant among women.

The 2010 Chinese guidelines for the management of hypertension is an update of the previous versions in 2005 and 1999. A guideline committee of nearly 100 members appointed by the Chinese Hypertension League (CHL) and the National Centre for Cardiovascular Disease (NCCD), in collaboration with the Chinese societies of cardiology, nephrology, neurology, gynecology and endocrinology, convened on several occasions and discussed the guidelines, drafted by a core writing group. The prevalence of hypertension has been increasing in China for decades, and reached 18.8% in the year 2002. The rates of awareness, treatment and control for hypertension patients remain low compared to high income countries, in spite of substantial improvements since 1991. In some communities, the control rate of hypertension increased up to 60%. The mortality rate of stroke, which is the major complication of hypertension in the Chinese population, gradually decreased during the period, more so in urban areas than in rural areas for the middle-aged and elderly populations; in the younger age groups, however, it increased. As hypertension is a "cardiovascular syndrome", the management strategy should be based on the overall risk of cardiovascular disease estimated with all related risk factors, target organ damage and co-morbidity of patients. The target blood pressure is set at SBP/DBP < 140/90 mm Hg (1 mm Hg = 0. 133 kPa) in uncomplicated hypertension; < 150/90 mm Hg for the elderly (> or = 65 years) or, if tolerable, < 140/90 mm Hg; and < 130/80 mm Hg for those with diabetes, coronary heart disease or renal disease. For these high risk patients, the management should be individualised. In general, lifestyle modification, such as sodium restriction, smoking cessation, moderation of body weight and alcohol consumption, and increasing dietary potassium intake and physical activity, should be implemented for prevention and control of hypertension. Five classes of antihypertensive drugs, including calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin type II receptor blockers, diuretics and beta-blockers, as well as single pill combinations of these agents, can be used for initial and maintenance of antihypertensive treatment. Several populations require special attention in the prevention and control of hypertension, such as children and adolescents, the elderly, pregnant women, and patients with various cardiovascular complications. Since health-care policies and resources vary substantially from one place to another, two levels of recommendations of management are proposed: a sophisticated and a basic, allowing doctors-in-charge to manage their patients in a more feasible way.

Objective: To provide a scientific evidence for the identification of the section Cruciata Gaudin., Methods: Seed morphology of the section Cruciata Gaudin in different regions from Gansu were studied by means of scanning electronic microscopy (SEM)., Results: The seeds of section Cruciata Gaudin had relative conformability in terms of shape,size and ornamentation. But the reticulate cell of Gentiana dahurica was obviously wider than those of other species., Conclusion: This study provides some useful information for classification and identification of section Cruciata Gaudin.

Objective: To observe the clinical characteristics, treatment options and outcome of diabetic patients with non-ST elevation acute coronary syndromes (NSTEACS)., Methods: Consecutive patients admitted with NSTEACS from 38 centers in north China were enrolled. Medical histories, clinical characteristics, treatments and outcomes were evaluated and follow-up was made at 6, 12, and 24 months after their initial hospital admission. Cumulative event rates were compared between diabetic and non-diabetic patients., Results: There were 420 diabetic patients out of 2294 NSTEACS patients (18.3%). Diabetic patients were older [(64.9 ± 6.7) years vs. (62.3 ± 8.6) years, P < 0.01], more often women (48.1% vs. 35.3%, P < 0.05) and were associated with higher baseline comorbidities such as previous hypertension, myocardial infarction, congestive heart failure and stroke than non-diabetic patients. The incidence of antiplatelet therapy (92.1% vs. 95.0%, P < 0.05), coronary angiography (30.0% vs. 36.3%, P < 0.05) and revascularization (12.1% vs.18.8%, P < 0.05) was lower in patients with diabetes than non-diabetic patients. In hospital and 2-year mortality as well as the incidence of congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death were substantially higher in diabetic patients compared with non-diabetic patients. Multivariate Cox regression analysis revealed that age ≥ 70 years, diabetes, previous myocardial infarction, previous congestive heart failure, systolic blood pressure less than 90 mm Hg (1 mm Hg = 0.133 kPa) and heart rate more than 100 bpm at admission were risk factors for 2-year death., Conclusion: In NSTEACS, diabetes is associated with higher rate of in-hospital and 2-year death, congestive heart failure and composite outcomes of myocardial infarction, stroke, congestive heart failure and death. Diabetes mellitus is a major independent predictor of 2-year mortality post NSTEACS. Status of antiplatelet therapy, coronary angiography and revascularization should be improved for diabetic patients with NSTEACS during hospitalization.

Objective: To compare the impact of the first 24 hours mean blood glucose (MBG) level and admission glucose (AG) during hospitalization on the short term mortality and combined end point events in patients with ST-segment elevation acute myocardial infarction (STEMI)., Methods: A total of 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset were included. Plasma glucose was measured at admission, 6 and 24 hours after admission, respectively. The MBG level through the first 24 hours for each patient was calculated. Patients were stratified into six groups according to their MBG levels: < 4.5, 4.5 - 5.5, 5.6 - 7.0, 7.1 - 8.5, 8.6 - 11.0 and > 11.0 mmol/L. The incidence of all-cause mortality and combined end point of death, re-infarction, cardiogenic shock, recurrence ischemia, and stroke at 7 days and 30 days post hospitalization were analyzed. Nested models were compared to determine whether logistic regression models that included MBG provided a significantly better fit than logistic regression models included AG., Results: Compared with the MBG of 4.5 - 5.5 mmol/L group, 7-day and 30-day mortality and combined end point events increased in proportion to plasma MBG level increase. Multivariate logistic regression analysis showed that elevated MBG (equal or greater than 7.1 - 8.5 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. Nested models analysis showed that the prognostic impact of MBG is superior to AG (P < 0.001) on predicting 7-day and 30-day mortality and combined end point events in this patient cohort., Conclusion: Elevated MBG (≥ 7.1 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. MBG is superior to AG on predicting short-term prognosis in this patient cohort.

Objective: To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS)., Methods: We analyzed data from Chinese patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables., Results: The overall 30-day mortality of STEMI complicated by CS among the 517 patients [(68.5 ± 10.3) years and 57.6% male] was 62.3%. Logistic regression analysis showed that the independent risk factors of death included age (OR = 1.46, 95%CI: 1.18 - 1.81), anterior infarction (OR = 2.01, 95%CI 1.29 - 3.11), admission glucose level > 7.8 mmol/L (OR = 2.17, 95%CI: 1.26 - 3.73), serum sodium concentration < 130 mmol/L (OR = 2.21, 95%CI: 1.21 - 4.04), left ventricular ejection fraction (LVEF) < 40% or sever left ventricular dysfunction (LVD) (OR = 3.78, 95%CI: 2.28 - 6.27), no emergency revascularization (OR = 3.53, 95%CI: 1.20 - 10.41) and diuretics use (OR = 1.90, 95%CI: 1.21 - 2.97). Analysis using baseline clinical variables showed that the first five risk factors mentioned above were also the baseline risk factors fro death. The receiver operating characteristic curve for predicting the death of the two models was 0.81 (95%CI: 0.77 - 0.86) and 0.80 (95%CI: 0.75 - 0.84), respectively., Conclusion: The 30-day mortality of patients with STEMI complicated by CS was over 60%. Age, anterior infarction, admission glucose level >7.8 mmol/L, serum sodium concentration < 130 mmol/L, left ventricular ejection fraction (LVEF) < 40% and no emergency revascularization were independent risk factors associated with 30-day mortality.

Objective: To investigate the blood pressure control rate and related influencing factors in hypertensive outpatients., Methods: In this multicentre, cross-sectional registration survey, hypertensive outpatients were recruited from department of cardiology, nephrology and endocrinology of 92 tertiary hospitals in 22 cites across China. Each centre enrolled more than 50 hypertensive outpatients aged 18 years or older between 20 April 2009 and 31 May 2009. Outpatients were surveyed by clinical interview with BP measurement and questionnaire., Results: A total of 5086 subjects were enrolled, 2032 in department of cardiology, 1510 in department of endocrinology and 1544 in department of nephrology, 27.1% and 25.3% patients were in Grade 2 or Grade 3 hypertension, 37.2% patients were complicated with diabetes, 22.4% with coronary artery disease, and 18.4% with renal-dysfunction. Overall, controlled BP was achieved in 30.6% patients. The control rate was 45.9% in uncomplicated hypertensive patients, 31.3% in hypertensive patients with coronary artery disease, 14.9% in patients with diabetes, and 13.2% in patients with renal-dysfunction. Calcium channel blocker (56.6%) and angiotensin-II receptor blockers (32.0%) were the most frequently used medications. The mean number of antihypertensive agents prescribed per patient was 1.73, over 54.1% patients were treated with more than 2 antihypertensive drugs. Combination therapy or single-pill combination with various anti-hypertensive components was prescribed to 8.3% and 12.7% hypertensive patients as initial therapy. Multiple logistic regression analysis showed that lower BMI, no alcohol intake, free medical care, no diabetes, no renal-dysfunction, lipid-lowering therapy, shorter interval of visiting physicians, regular taking antihypertensive medications, physical activity were the factors related to satisfactory blood pressure control rate in hypertensive outpatients., Conclusions: Blood pressure control rate among Chinese hypertensive outpatients was increased compared with epidemiological survey in 2002. BMI, co-morbidities, lower combination treatment rate, poor compliance were the key reasons for lower BP control rate. Increased use of combination therapy instead of monotherapy should be encouraged to hypertensive outpatients to improve BP control rate.

Objective: To analyze the clinical characteristics of living-related kidney transplantation (LRKT)., Methods: From January, 2004 to December, 2008, 175 LRKT were performed including 63 cases (36%) of parent-child relations and 49 cases (28%) of sibling relations between the recipients and donors. Out of 175 donors, 52 were 50 years old or above, 4 had microscopic hematuria (including 2 with also hypertension), 2 had kidney stone, and 2 had high body mass index (BMI). Zero-point graft biopsy was performed in 59 donors, and abnormalities were found in 15 of them. The recipients were at the age of 33-/+10.5 years, and the primary diseases are mainly dominant glomerular nephritis (72.6%, 127/175), and with a few cases of diabetes (4%, 7/175) and hypertensive nephropathy (4%, 7/175)., Results: Serum creatinine of the donors was 102-/+22.5 micromol/L at 7 days postoperatively, and 92-/+19.1 micromol/L at one month. One recipient died of severe pulmonary infection. Two recipients underwent graft nephrectomy due to anastomotic stenosis with concomitant acute graft rejection and renal arterial embolism. The one-year survival rates of the patients and grafts were 99.3% and 98.2%, respectively. The incident rates of accelerated rejection and acute rejection were 1.1% and 14.9%, respectively. Other complications included impaired liver function (22.3%), infection (9.7%) and leucopenia (4.6%). The renal arterial stenosis occurred in 2.3% (4/175) of the recipients., Conclusions: The recipients of living-related and cadaveric kidney transplant have different primary kidney disease spectrums. Differential diagnosis and treatment of acute rejection and renal artery or anastomotic stenosis can be of vital importance. Marginal donor kidneys with appropriate inclusion criteria can be safely used for transplantation. With good short-term patient and graft survival, LRKT needs further study to evaluate its long-term effect.

Objective: To identify the risk factors associated with increased combined end points (including death, new myocardial infarction and stroke) of patients with non-ST elevation acute coronary syndrome in China., Methods: Patients with non-ST elevation acute coronary syndrome hospitalized in 38 hospitals in China were included in this registry study as part of an international multicentre registry-OASIS. Data including clinical characteristics, previous medical history, therapeutic procedure and follow-up medicines, were collected and analyzed. The follow up period was two years. Cox regression model was used to analyze the association between multiple risk factors and combined end points., Results: From April 1999 to December 2001, 2294 eligible patients were enrolled nationwide and 2294 patients finished the 2 years follow up (mean age: 62.8 +/- 8.3 years and 62.3% males). The mortality was 7.6% (174/2294), 168 new myocardial infarction and 93 stroke were recorded during follow up and the combined end point events was 365 (15.9%) at the end of the two year's follow-up. Forty-eight factors were analyzed by Cox regression model to determine the impact of these factors on the occurrence of end point event. Risk factors that promoting end points were: thrombolysis during hospitalization, heart rate more than 120 bpm at admission, current smoker, history of PTCA, length of the first hospitalization, intravenous nitrate use during hospitalization, history of heart failure, low molecular weight heparin or subcutaneous heparin use during hospitalization, former smoker, calcium antagonist use during hospitalization, history of hypertension or coronary artery disease, recurrent angina pectoris during hospitalization and age by the first hospitalization. Protective factors that reducing end point were: normal ECG at admission, use of oral nitrate, anti-platelet medicine, calcium antagonist, lipid lowering agents and angiotensin converting enzyme inhibitor during follow-up period., Conclusion: The two-years incidence of combined endpoints of death, new myocardial infarction and stroke in patients with non-ST elevation acute coronary syndromes is 15.9% in China. Fifteen factors are associated with increased and 8 factors (mostly related to regular medication use) are associated with reduced occurrence of endpoints during follow up in this cohort.

A benthic index of biotic integrity (B-IBI) was developed for application in estuaries health assessment of the Yangtze Estuary and its adjacent waters. Benthic macro-invertebrate samples were collected from 41 stream sites (13 non-degraded stations and 28 degraded stations) in the Yangtze Estuary and its adjacent waters in July, 2005. The analyses of the range of index value distribution, Pearson correlation and judgment ability were performed on fourteen candidate metrics. Six biological metrics were selected for the establishment of B-IBI, which were Shannon-Wiener index, the species number, total density, total biomass, Carapace Animals density percentage and Echinoderms density percentage. B-IBI was obtained by sum up all these indices after which were transformed into a uniform score by using the ratio scoring method. Base on 50 percentile of B-IBI value in reference sites, the criteria of health ranking was determined. The proposed criteria of benthic-index of biotic integrity were as follows: B-IBI > 2.48 was regarded as health, 1.86-2.48 sub-health, 1.24-1.86 fair, 0.62-1.24 poor, and B-IBI < 0.62 very poor. Assessing with these criteria, the results showed that among the 41 sites in Yangtze Estuary and its adjacent waters, 7 sites were health, 2 sites were sub-health, 8 sites were fair, 8 sites were poor and 16 sites were very poor. An independent data set sampled in June of 2006 was used to validate the index, the results indicated that final combined index correctly classified 89% of stations in the validation data set.

There is a paucity of data concerning the metabolic syndrome (MetS) in families with familial combined hyperlipidemia (FCHL), familial hypertriglyceridemia (FHTG), familial hypercholesterolemia (FH) and normolipidemic families in China. This study investigated the prevalence of MetS in these families and explored potential factors relevant to MetS. We recruited 70 families with 560 individuals > or = 20 years of age, including 43 FCHL families with 379 individuals, 3 FHTG families with 30 individuals, 16 FH families with 102 individuals and 8 normolipidemic families with 49 individuals. The definition of MetS is determined using modified criteria of National Cholesterol Education Program substituting body mass index for waist circumference. MetS is identified in 60.7% of FCHL patients and 71.4% of FHTG patients. The prevalence of MetS in family members is 36.7% for FCHL, 33.3% for FHTG, 17.6% for FH and 16.3% for normolipidemic families, with an odds ratio (OR) of 2.97 (95% CI 1.29-7.07, P=0.007) in FCHL families compared with normolipidemic families. Apolipoprotein B (apoB) is associated with MetS by multiple logistic analysis with an OR of 1.05 (1.03-1.07, P<0.001) in FCHL families, OR of 1.26 (1.03-1.55, P=0.026) in FHTG and OR of 1.07 (1.01-1.12, P=0.014) in FH families, independent of variables including age, gender, apolipoprotein A1, and low density lipoprotein cholesterol. Apolipoprotein A1 provided an OR of 0.95 (0.94-0.97, P<0.001) in FCHL families and OR of 0.94 (0.90-0.97, P=0.011) in FH families, but neither in FHTG nor in normolipidemic families (both P>0.05). Thus, apoB may be regarded as a relevant factor in the assessment of MetS in FCHL, FHTG and FH families. However, this finding needs to be verified by prospective studies in diverse ethnicities and warrants additional studies to elucidate possible mechanisms linking apoB to MetS.

Familial combined hyperlipidemia (FCHL), with a marked elevation of apolipoprotein B (apoB), is estimated to cause 10-20% of premature coronary artery disease. However, little data are available to demonstrate the associations of apoB with pulse pressure and glucose levels in FCHL families in China. This study was to investigate the potential influence factors for blood pressure and glucose phenotypes in FCHL families by multiple linear regression analysis. We recruited 147 FCHL relatives and 90 spouses, aged 30 to 60 years, from 42 Chinese families with FCHL. Our results showed that triglyceride and low density lipoprotein cholesterol were associated with fasting glucose levels (all P<0.05). Body mass index and glucose significantly correlated to systolic blood pressure, diastolic blood pressure, and mean arterial pressure, respectively (all P<0.05). Furthermore, apoB was significantly related to pulse pressure and glucose in FCHL families (all P<0.05). Thus, this study demonstrates that apoB is significantly associated with pulse pressure and glucose levels in FCHL families. Accordingly, our data suggest that apoB may be a candidate risk marker for pulse pressure and glucose in FCHL populations.

Background: Apolipoprotein E (apoE) polymorphism is associated with changes in the lipoprotein profile of individuals with familial combined hyperlipidemia (FCHL), but its effects on the lipoprotein profiles of members of Chinese families with FCHL remain uncertain., Methods and Results: 43 FCHL families (n=449) and 9 normolipidemic families (n=73) were recruited to assess the influence of apoE polymorphism on plasma lipids. The relative frequency of the epsilon4 allele in affected and unaffected FCHL relatives, spouses and normolipidemic members was 13.8%, 5.3%, 9.1% and 6.8%, respectively, with a significantly higher frequency in affected FCHL relatives, compared with unaffected FCHL relatives or normolipidemic members (p=0.0002 or p=0.029). In FCHL relatives, the apoE4 subset (E4/4 and E4/3) exhibited significantly higher levels of apoB, total cholesterol and low-density lipoprotein-cholesterol (LDL-C) than did the apoE3 (E3/3) subset, especially in women (all p<0.05), and there was significant elevation of LDL-C concentrations in men only (p<0.05). In men, the apoE2 (E3/2) subset indicated a decreased level of apoB and increased apoA1 compared with those in the apoE3 subset (p<0.05)., Conclusions: ApoE polymorphism appears to be associated with variance of the lipoprotein phenotype in Chinese families with FCHL.

Kidney transplantation (KTx) recipients are at a higher risk of oncogenesis when compared to the general population. Sirolimus (SRL), a potent immunosuppressant, has shown promising antineoplastic effects in vitro and in vivo. This study retrospectively analyzed the neoplasm occurrence and the efficiency of SRL on unresectable malignancies in South Chinese KTx recipients. Thirty-three (1.64%) of 2017 patients who received KTx from January 1984 to December 2004 developed neoplasms at 4 to 117 months posttransplant, mostly in digestive organs (33.3%), the hematologic system (15.2%), or the skin (12.1%). The most common type was liver cancer (24.2%), followed by skin cancer, lymphoma, and thyroid cancer (9.1%). The median survival times were 41.5 and 6.0 months for those who did (n = 10) receive radical surgery or did not (n = 23), respectively. The 20-month survival rates were 70.0% versus 13.0% (P < .01). For unresectable patients, the median survival time of those treated with SRL (n = 8) was 14.5 months compared to 3.0 months for those who did not (n = 15). The survival rates at 12(th) and 20(th) months were 75.0% and 37.5% in the SRL group and 6.7% and 0% in the non-SRL group (P < .05). In conclusion, when compared with Western studies, a lower incidence and unique location pattern (liver cancer-dominant) are characteristics of de novo posttransplant neoplasms in South Chinese KTx recipients. Early diagnosis and feasible radical surgery are favorable for prognosis, and SRL is a treatment of choice for KTx recipients with neoplasms.

Objective: To analyze the current use of reperfusion strategies and the outcomes of patients with ST elevation acute coronary syndromes (ACS) in China., Methods: A total of 518 consecutive patients (371 male and 147 females, mean age 65 +/- 11) with ST elevation ACS or newly discovered left bundle branch block were registered from 20 hospitals from 5 regions (ranging from large regional centre hospitals to small county hospitals) in China. Patient general characteristics, reperfusion patterns and outcomes were analyzed. Patients were followed up for 3 months., Results: The median time from pain onset to presentation at the hospital was 4 hours. Pre-hospital delay > 12 hours was found in 20% patients. Fifty-six percent patients (292/518) underwent reperfusion therapy (134 with primary percutaneous coronary intervention and 158 with fibrinolysis). The median time from admission to reperfusion (door-to-needle) was 65 min in fibrinolysis group and 110 min (door-to-cath) in primary PCI group respectively. Urokinase was used in 67% (106/158) patients underwent fibrinolysis. Multivariate logistic regression analysis showed that age >/= 75 years (P < 0.01), previous myocardial infarction (P < 0.01) and history of congestive heart failure (P < 0.05) were associated with no reperfusion therapy. Mortality and congestive heart failure rates were significantly higher in patients with no reperfusion therapy not only at discharge (P < 0.01) but also at 3 months (P < 0.01) compared to patients underwent reperfusion. The incidence of combined outcomes (death or MI, and death, MI or Strobe) was also higher in patients without reperfusion therapy at 3 months (all P < 0.01) compared to patients underwent reperfusion. There were no differences on combined outcomes between fibrinolysis and primary PCI subgroups., Conclusion: Reperfusion therapy was the primary treatment of choice to improve the outcomes of patients with ST elevation ACS. Strategies to increase reperfusion therapy rate for ST elevation ACS are urgently needed in China.

Background: Despite previous randomised trials of early beta-blocker therapy in the emergency treatment of myocardial infarction (MI), uncertainty has persisted about the value of adding it to current standard interventions (eg, aspirin and fibrinolytic therapy), and the balance of potential benefits and hazards is still unclear in high-risk patients., Methods: 45,852 patients admitted to 1250 hospitals within 24 h of suspected acute MI onset were randomly allocated metoprolol (up to 15 mg intravenous then 200 mg oral daily; n=22,929) or matching placebo (n=22,923). 93% had ST-segment elevation or bundle branch block, and 7% had ST-segment depression. Treatment was to continue until discharge or up to 4 weeks in hospital (mean 15 days in survivors) and 89% completed it. The two prespecified co-primary outcomes were: (1) composite of death, reinfarction, or cardiac arrest; and (2) death from any cause during the scheduled treatment period. Comparisons were by intention to treat, and used the log-rank method. This study is registered with ClinicalTrials.gov, number NCT 00222573., Findings: Neither of the co-primary outcomes was significantly reduced by allocation to metoprolol. For death, reinfarction, or cardiac arrest, 2166 (9.4%) patients allocated metoprolol had at least one such event compared with 2261 (9.9%) allocated placebo (odds ratio [OR] 0.96, 95% CI 0.90-1.01; p=0.1). For death alone, there were 1774 (7.7%) deaths in the metoprolol group versus 1797 (7.8%) in the placebo group (OR 0.99, 0.92-1.05; p=0.69). Allocation to metoprolol was associated with five fewer people having reinfarction (464 [2.0%] metoprolol vs 568 [2.5%] placebo; OR 0.82, 0.72-0.92; p=0.001) and five fewer having ventricular fibrillation (581 [2.5%] vs 698 [3.0%]; OR 0.83, 0.75-0.93; p=0.001) per 1000 treated. Overall, these reductions were counterbalanced by 11 more per 1000 developing cardiogenic shock (1141 [5.0%] vs 885 [3.9%]; OR 1.30, 1.19-1.41; p<0.00001). This excess of cardiogenic shock was mainly during days 0-1 after admission, whereas the reductions in reinfarction and ventricular fibrillation emerged more gradually. Consequently, the overall effect on death, reinfarction, arrest, or shock was significantly adverse during days 0-1 and significantly beneficial thereafter. There was substantial net hazard in haemodynamically unstable patients, and moderate net benefit in those who were relatively stable (particularly after days 0-1)., Interpretation: The use of early beta-blocker therapy in acute MI reduces the risks of reinfarction and ventricular fibrillation, but increases the risk of cardiogenic shock, especially during the first day or so after admission. Consequently, it might generally be prudent to consider starting beta-blocker therapy in hospital only when the haemodynamic condition after MI has stabilised.

Objective: To analyze the clinical characteristics and management of the patients with ST segment elevation myocardial infarction (STEMI) in China., Methods: As part of the international multicentre CREATE Study, the clinical data of 7510 patients with STEMI presenting their symptoms within 12 hours of onset who were hospitalized in 274 centers throughout China from July 2001 through July 2004, aged 62.7, were collected to be analyzed., Results: 99.3% of these patients had STEMI, and 0.7% had new left bundle-branch block. 11.5% of them underwent percutaneous coronary intervention (PCI), 52.5% underwent thrombolytic therapy, and 0.1% coronary artery bypass grafting. All types of reperfusion therapy were carried out to 62.4% of the patients during the hospitalization. The medication therapy used was similar to those in the previous Registry report. The composite of all-cause mortality, re-infarction, and stroke within the first 7 days was 10.3% and the all-cause mortality within 30 days was 11.1%., Conclusion: The clinical characteristics and management of the STEMI patients in China have been described. The age of onset of STEMI is 62 years on average. The most common complication is hypertension, and diabetes mellitus is relatively rare. rt-PA was used rarely mainly because of the expensive price. A large proportion of patients in China receive reperfusion, which is worth recommendation. Active intervention should be carried out in the early stage after infarction.

Objectives: To investigate the effects of blood pressure lowering treatment on stroke recurrence among Chinese patients with previous cerebrovascular diseases., Methods: Patients were eligible if they had a history of stroke or transient ischaemic attack (TIA) within the previous 5 years. Participants had no definite indication or contraindication for study drugs. There were no blood pressure entry criteria. This study was a large-scale randomised, double-blind, placebo controlled clinical trial. After 4 weeks run-in period, 1520 randomised patients received either ACE inhibitor-perindopril (+ diuretic-indapamide) treatment or matching placebo for 4 years. The primary study outcome was stroke event. Secondary outcomes included cardiovascular death, myocardial infarction, all-cause death and blood pressure., Results: Ssven hundred and sixty-two were assigned active treatment and 758 assigned placebo. The characteristics of randomised patients of active and control groups were similar. In active and control groups: 70.8% and 70.5% were male, 93.8% and 93.4% had a history of stroke (haemorrhagic or cerebral infarction). Baseline mean blood pressure in the active and control groups were 145.3 +/- 20.2/86.8 +/- 11.1 mm Hg and 145.3 +/- 20.3/87.2 +/- 10.8 mm Hg, and mean age were 63.9 +/- 7.5 and 63.8 +/- 7.7 years, respectively. Blood pressure in those assigned active treatment was reduced on average 14/6 mm Hg more than placebo at 4 years. During double-blind treatment, active treatment reduced stroke recurrence (8.8% vs 19.4%) by 55% (P < 0.001), myocardial infarction (1.4% vs 2.8%) by 48% (P = 0.070), cardiovascular mortality (3.6% vs 6.6.%) by 45% (P = 0.010), and all-cause mortality (6.3% vs 9.8%) by 36% (P = 0.010). These benefits were achieved similarly in all subgroups: male or female, middle-aged or elderly, with or without hypertensive, cerebral infarct or haemorrhagic stroke., Conclusion: 4 years of blood pressure lowering treatment was beneficial in Chinese patients with previous cerebrovascular diseases.

Objective: To identify the influencing factors of surviving time of patients with non-ST elevation acute coronary syndromes in China., Methods: The data of patients with non-ST elevation acute coronary syndromes hospitalized in 38 hospitals in China, including clinical characteristics, therapeutic procedure, and major events at hospitalization and two years' follow-up period, were collected and analyzed as part of an international multicentre registry--OASIS. No particular intervention was needed in patients' therapy. The needed data were recorded by filling in the Case Report Forms offered by Canadian Cardiovascular Collaboration according to the protocol. Cox regression model was used to analyze the association with survival and multiple factors recorded., Results: From April 1999 to December 2001, 2294 patients with non-ST elevation acute coronary syndromes were enrolled in 38 Chinese hospitals nationwide, two years' follow-up had been finished among 2188 of which with a mean age of 62.8 +/- 8.3 and 62.3% being male. The clinical diagnosis at admission was unstable angina in 88.5% of the patients and was non Q-wave myocardial infarction in the remaining 11.5%. The number of death totaled up to 174 with a mortality of 7.6% by the end of the two years' follow-up. The most common cause of death was severe arrhythmia or sudden death (92 cases, 52.9%). More than 70 factors had been analyzed by Cox regression model in order to determine which might influence survival. Risk factors that reduced lifetime were: frequencies of myocardial infarction during follow-up period, stroke during hospitalization, thrombolysis during hospitalization, frequencies of heart failure during follow-up period, heart failure during hospitalization, frequencies of stroke during follow-up period, history of myocardial infarction, times of hospitalization because of non-cardiovascular disease during follow-up period, history of diabetes mellitus, duration of the first hospitalization, and age by the first hospitalization. Protective factors that prolonged lifetime were the frequencies of using oral anticoagulant, anti-platelet medicine, nitrate, and lipid lowering agents during follow-up period., Conclusion: The most common cause of death in patients with non-ST elevation acute coronary syndromes is severe arrhythmias or sudden death in China. Several factors influence the survival of patients. The effects of most factors in this study are similar to those founded by previous evidence based medical study.

Objective: To analyze the relationship between sudden death and death from arrhythmia and multiple risk factors in patients with non-ST elevation acute coronary syndromes in two years of follow-up in China., Methods: This study was a part of an international multicentre registry-Organization to Assess Strategies for Ischemic Syndromes (OASIS). The patients admitted to the hospital with non-ST elevation acute coronary syndrome were enrolled. No particular intervention was given for the treatment. All patients had been followed-up for two years. The patients' clinical characteristics, therapeutic regimes and major events during hospitalization and two years' follow-up period were recorded by filling in Case Report Forms according to the protocol offered by Canadian Cardiovascular Collaboration. Cox regression model was used to analyze the association with the most common causes of death and multiple factors recorded., Results: From April 1999 to December 2001, 2294 cases were enrolled in 38 hospitals in China nationwide. Among them 2188 patients two years follow-up was accomplished. The mean age of the patients was (62.8+/-8.1) years. Male gender was dominant (62.3%). The clinical diagnosis at admission was unstable angina in 88.5% of the patients and non Q-wave myocardial infarction(MI) in the remaining 11.5%. The mortality was 7.6% with total deaths of 174 by the end of 24-month follow up. The most common cause of death was severe arrhythmias or sudden death (92 cases, 52.9%). More than 70 factors were analyzed by Cox regression model in order to determine which were the predominant factors of death. Major risk factors that predisposed to death were: number of episodes of MI during follow-up period, re-MI within 24 hours during hospitalization, heart failure during hospitalization, previous history of MI, recurrent angina pectoris during hospitalization, the duration of hospitalization, and patient age. Protective factors that reduced the chance of death were: the frequency of using nitrate, frequency of taking anti-platelet medicine or beta-blocker during follow-up period., Conclusion: In China, the most common cause of death in patients with non-ST elevation acute coronary syndromes is severe arrhythmias or sudden death, and it is related with the severity of coronary artery disease and the age of patients in majority of cases. Some factors that influence survival are similar to those established by previous evidence based medicine.

Objective: To analyze the characteristics, treatment, and natural course during two years of the patients with acute coronary ischemic syndrome (ACS) without ST elevation in China as a part of the international multicentre registry of acute ischemic syndrome, Organization to Assess Strategies for Ischemic Syndromes (OASIS)., Methods: 2294 patients with ACS without ST elevation, including unstable angina pectoris and non-Q-wave myocardial infarction, aged 63 +/- 8, 62.3% being males, were registered and observed for 2 years based on informed consent in the northwest, north, and northeast China. The specific clinical protocols for patients were decided by the attending physicians without outside intervention. The patients' clinical characteristics, treatments, major events in hospital, and natural course of disease during the period of two years were recorded by filling in Case Report Forms offered by Canadian Cardiovascular Collaboration., Results: 89.8% of the patients showed abnormal ECG. The most probable clinical diagnosis on admission was unstable angina in 88.5% of the patients and non-Q-wave myocardial infarction in the other 11.5%. 56.2% of the patients had past history of coronary artery disease, and nearly half of them had myocardial infarction. 57.4%, 18.3%, 47.6%, and 7.1% of them had the prior history of hypertension, diabetes, cigarette smoking and stroke respectively. During hospitalization, anti-platelet therapy and nitrate were used in 94.5% and 96.6% of the cases respectively, and 67.5%, 57.4%, and 59.1%t of them took beta-blockers, calcium antagonists and angiotensin-converting enzyme inhibitor (ACEI) respectively simultaneously. The medication rate dropped by 20.2% approximately 50.2% after discharge from hospital. During the two-year follow up the therapeutic rates of anti-platelets, nitrates, beta-blockers, calcium antagonists, and ACEI were 73.8%, 69.4%, 43.9%, 35.8%, and 31.6% respectively. During the 2 years 43.1%, 23.1%, and 8.2% of the patients underwent coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery (CABG) respectively. The two-year total mortality was 8.0%. The most common causes of death were severe arrhythmias or sudden death with an incidence of 4.3%. The major events were refractory angina, heart failure, new MI, stroke, and major bleeding with incidence rates of 29.4%, 15.4%, 7.9%, 4.8%, and 0.3%, respectively., Conclusion: Most patients with acute ischemic syndrome without ST elevation in China are diagnosed as unstable angina. The patients with acute ischemic syndrome are diagnosed as unstable angina mostly in China. More than half of the patients are treated with anti-platelets, nitrates, beta-blockers, calcium antagonists, and ACEI during hospitalization. The medication rate gradually decreases after discharge. The two-year mortality is 8.0%. The most common causes of death include severe arrhythmias and sudden death.

Objective: To investigate the influencing factors of blood pressure phenotypes and the distribution of FDH in FCHL families., Methods: Forty-two FCHL families with 435 members, 147 consanguine members and 90 members without consanguinity from Beijing area were studied. Eleven of the 42 FCHL families (26.2%) were identified as families with FDH syndrome. Stepwise regression analysis was used to analyze the association between the target variables and blood pressure phenotypes, such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), of the 237 FCHL members aged 30 to 60 years., Results: The prevalence of dyslipidemic hypertension in the FCHL relatives was significantly higher than that in the spouses (29.9% versus 8.9%, P < 0.01), with an odds ratio of 3.37 (95% CI 1.44 to 8.14). In the FCHL families body mass index (BMI), age and blood sugar were independent contributors to SBP, DBP, and MAP, respectively (all P < 0.05). Age and apolipoprotein B (apoB) were important contributors to pulse pressure (both P < 0.05)., Conclusions: BMI and glucose are significant contributors to different phenotypes of blood pressure. Moreover, apoB is a significant contributor to pulse pressure in FCHL families.

Since 1959 the investigations on prevalence of hypertension and studies on the prevention and treatment of this disease have been carried out. The vascular mechanism of hypertension and the depressor effect of Chinese traditional herbs were also studied in Chinese Academy of Medical Sciences. The results revealed that: (1) The prevalence of hypertension in Chinese adults increased from 7.73% in 1979 to 11.26% in 1991, both much higher than that in 1959 (5.11%). The rate of awareness, treatment and control was only 26.3%, 12.1%, and 2.8% respectively. The risk factors of hypertension included overweight and alcohol drinking. High sodium, low potassium, low calcium, and low animal protein diet were also very important risk for elevation of blood pressure. Hypertension was the most important causal risk factor of coronary heart disease and stroke. (2) Hypertension diagnosis and staging criteria were established in 1959. Secondary hypertension was found to constitute 1.1% among community hypertensive patients. The new concept of aortitis was formed and found to be the most common cause of renal vascular hypertension. Patient education together with low dose compounds of antihypertensive drugs was implicated widely. Randomized clinical trials Syst-China, Post-stroke Antihypertensive Treatment Study, Chinese Acute Stroke Trial, and Chinese Cardiac Study 1 demonstrated benefits of treatment for hypertensive, stroke or acute myocardial infarction affordable by Chinese population at large. (3) A series of functional changes and abnormalities with evident hereditary characteristics were found in the processes of cellular Ca2+ transportation, utilization, metabolism and their modulation of the vascular smooth muscle in SHR, and SHRsp, which seem to be the principal cause of the increase in peripheral vascular resistance in hypertension. (4) Alkaloid of Rauwolfia verticilata and Ligustrazine had marked depressor effect. Flavones of Radix Pueraricae could reduce the cardiac and cerebral ischemic damage and symptoms in hypertensive patients.

Objective: To analyse the characteristics and therapies of patients with acute ischemic syndrome in China., Methods: This study is part of the international multicentre registry for acute ischemic syndrome. Since April 1999, the data of patients admitted to designated hospitals with acute ischemic cardiac chest pain were collected by filling in Case Report Forms offered by the Canadian Cardiovascular Collaboration. The main clinica l characteristics and in hospital events of the patients were recorded., Results: Fifteen hundred and nine cases of acute ischemic syndrome from 34 hospitals nationwide were enrolled in the registry (including unstable angina and non Q-wave myocardial infarction). The mean age of the patients was 62.3. Male dominance (62.2%) was noted. The percentages of patients with chest pain at presentation and abnormal ECG were 47.8% and 89.5%, respectively. The most common clinical diagnosis on admission was unstable angina, accounting for 91.3% of the patients and non Q-wave myocardial infarction (MI), accounting for the other 8.7%. During hospitalization, the following interventions were given: thrombolytic therapy in 50 cases (3.3%), coronary angiography in 528 cases (35.0%), percutaneous transluminal coronary angioplasty (PTCA) in 253 cases (16.8%) and coronary artery bypass graft surgery (CABG) in 62 cases (4.1%). Nitrate (oral or patch ) and anti-platelet therapy were used in 1460 cases (96.8%) and 1441 cases (95.5%), respectively. The incidence of in hospital major events was 18.8%, in cluding 18 deaths (1.2%), with the most common causes being severe arrhythmias and sudden death., Conclusions: Patients with acute ischemic syndrome in China have mostly been diagnosed as cases of unstable angina. A relatively high PTCA rate but low CABG rate was noted in China. The most common cause of in hospital death is severe arrhythmias or sudden death.

Objective: The pooled results of four large-scale clinical trials of antihypertensive treatments carried out in China were assessed, with an overall study population of 10,457 patients., Methods: The fixed effect model was used for data analysis., Results: A pooled analysis at the individual level showed that the average time of treatment was 3.4 years, after which an average reduction in blood pressure of 9/4 mmHg was found. The meta-analysis showed that stroke was reduced by 36% (95% CI 25%-46%, P < 0.001), cardiovascular death and total deaths were reduced by 22% and 20% respectively (P < 0.05) and total cardiovascular events were significantly reduced by 33% (P < 0.001). However, the reduction in coronary heart disease (CHD) was much smaller and was not statistically significant (P > 0.05), whereas the significant reduction in stroke was epidemiologically expected., Conclusion: The benefit of antihypertensive treatment obtained was mostly due to a reduction in the incidence of stroke.

In INTERSALT, the International Cooperative Study on Electrolytes and Blood Pressure, three centres located in the People's Republic of China (PRC) had distinctive patterns of BP and of life style variables that, in INTERSALT overall, were found to relate to BP. The PRC centres had low body mass index (BMI) and alcohol consumption but high urinary sodium and sodium/potassium ratio (Na/K). Compared with 45 other INTERSALT centres, average BMI was 22.7 vs. 25.4 and alcohol consumption was 32% vs. 61%, with heavy drinking 3% vs. 14%. However, Na/K in the PRC was 6.7 vs. 3.2 in the other centres. This combination of factors may underlie the BP pattern observed. While mean BP in the PRC was lower than in the 45 centres (-7.0 mmHg SBP, -5.6 mmHg for DBP), this was counterbalanced by other findings. Upward slope of systolic pressure with age was 45% greater for the PRC than the other centres and 24% greater for diastolic pressure. As a result, although percentage hypertensive for ages 20-49 years for the PRC was half that in the 45 centres (6% vs. 12%), by age 50-59 years the prevalence was 31% in the PRC and 38% in the other centres. Hypertension prevalence in Tianjin, with highest Na/K in INTERSALT (7.6) was 40% for ages 50-59 years. While sample size in individual centres does not provide power to demonstrate aetiological relationships, these findings permit formulation of the following hypothesis: although lower body mass and lower alcohol intake may counteract to some degree impact of high salt intake, such intake over decades eventually takes its toll on BP.