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Background: Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder. The occurrence of TTP subsequent to an emergent aortic valve replacement after a TAVR procedure is exceedingly uncommon with only a few reported cases worldwide., Case Presentation: We report the case of a 70-year-old female patient diagnosed with aortic insufficiency. Following a transcatheter aortic valve replacement, she underwent emergency aortic valve replacement under cardiopulmonary bypass on the subsequent day due to heart valve displacement. The postoperative diagnosis revealed TTP and symptomatic treatment involving plasma exchange was administered. After demonstrating steady improvement, the patient was eventually discharged., Conclusion: Aortic valve replacement after TAVR is a high-risk procedure and increases susceptibility for developing secondary TTP. The diagnosis and treatment of secondary TPP is considerably challenging, and early diagnosis with symptomatic treatment including plasma exchange can increase patient survival., (© 2024. The Author(s).)

Background: Cardiovascular-kidney-metabolic (CKM) health is affected by social determinants of health, especially education. CKM syndrome has not been evaluated in Chinese population, and the association of education with CKM syndrome in different sexes and its intertwined relation with lifestyles have not been explored., Objective: We aimed to explore the association between educational attainment and the prevalence of CKM syndrome stages in middle-aged and older Chinese men and women as well as the potential role of health behavior based on Life's Essential 8 construct., Methods: This study used data from the nationwide, community-based REACTION (Risk Evaluation of Cancers in Chinese diabetic individuals: a longitudinal study). A total of 132,085 participants with complete information to determine CKM syndrome stage and education level were included. Educational attainment was assessed by the self-reported highest educational level achieved by the participants and recategorized as low (elementary school or no formal education) or high (middle school, high school, technical school/college, or above). CKM syndrome was ascertained and classified into 5 stages according to the American Heart Association presidential advisory released in 2023., Results: Among 132,085 participants (mean age 56.95, SD 9.19 years; n=86,675, 65.62% women) included, most had moderate-risk CKM syndrome (stages 1 and 2), and a lower proportion were at higher risk of CKM (stages 3 and 4). Along the CKM continuum, low education was associated with 34% increased odds of moderate-risk CKM syndrome for women (odds ratio 1.36, 95% CI 1.23-1.49) with a significant sex disparity, but was positively correlated with high-risk CKM for both sexes. The association between low education and high-risk CKM was more evident in women with poor health behavior but not in men, which was also interactive with and partly mediated by behavior., Conclusions: Low education was associated with adverse CKM health for both sexes but was especially detrimental to women. Such sex-specific educational disparity was closely correlated with health behavior but could not be completely attenuated by behavior modification. These findings highlight the disadvantage faced by women in CKM health ascribed to low education, underscoring the need for public health support to address this inequality., (© Yi Ding, Xianglin Wu, Qiuyu Cao, Jiaojiao Huang, Xiaoli Xu, Youjin Jiang, Yanan Huo, Qin Wan, Yingfen Qin, Ruying Hu, Lixin Shi, Qing Su, Xuefeng Yu, Li Yan, Guijun Qin, Xulei Tang, Gang Chen, Min Xu, Tiange Wang, Zhiyun Zhao, Zhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Li Chen, Qiang Li, Zhen Ye, Yinfei Zhang, Chao Liu, Youmin Wang, Tao Yang, Huacong Deng, Lulu Chen, Tianshu Zeng, Jiajun Zhao, Yiming Mu, Shengli Wu, Yuhong Chen, Jieli Lu, Weiqing Wang, Guang Ning, Yu Xu, Yufang Bi, Mian Li. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Nationwide estimates of the impact of common modifiable risk factors on mortality remain crucial. We aim to assess the influence of social determinants, lifestyle, and metabolic factors on mortality in 174,004 adults aged ≥40 years from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. We reveal that 17 modifiable factors are independently associated with mortality, accounting for 64.8% of all-cause mortality, 77.4% of cardiovascular mortality, and 44.8% of cancer mortality. Low education emerges as the leading factor for both all-cause and cancer mortality, while hypertension is predominant for cardiovascular mortality. Moreover, low gross domestic product per capita and high ambient particulate matter with a diameter of <2.5 μm (PM 2 .5 ) air pollution account for 7.8% and 4.3% for all-cause mortality, respectively, using a different method. Gender-specific analyses reveal distinct patterns, with women's mortality primarily associated with social determinants and men exhibiting stronger associations with lifestyle factors. Targeted health interventions are essential to mitigate mortality risks effectively in China., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Long-chain free fatty acids (FFAs) are associated with risk of incident diabetes. However, a comprehensive assessment of the associations in normoglycemic populations is lacking., Objectives: Our study aimed to comprehensively investigate the prospective associations and patterns of FFA profiles with diabetes risk among normoglycemic Chinese adults., Methods: This is a prospective nested case-control study from the China Cardiometabolic Disease and Cancer Cohort (4C) study. We quantitatively measured 53 serum FFAs using a targeted metabolomics approach in 1707 incident diabetes subjects and 1707 propensity score-matched normoglycemic controls. Conditional logistic regression models were employed to estimate odds ratios (ORs) for associations. Least Absolute Shrinkage and Selection Operator (LASSO) penalty regression and quantile g-computation (qg-comp) analyses were implemented to estimate the association between multi-FFA exposures and incident diabetes., Results: The majority of odd-chain FFAs exhibited an inverse association with incident diabetes, wherein the ORs per SD increment of all 7 saturated fatty acids (SFAs), monounsaturated fatty acid (MUFA) 15:1, and polyunsaturated fatty acid (PUFA) 25:2 were ranging from 0.79 to 0.88 (95% CIs ranging between 0.71 and 0.97). Even-chain FFAs comprised 99.3% of total FFAs and displayed heterogeneity with incident diabetes. SFAs with 18-26 carbon atoms are inversely linked to incident diabetes, with ORs ranging from 0.81 to 0.86 (95% CIs ranging between 0.73 and 0.94). MUFAs 26:1 (OR: 0.85; 95% CI: 0.76, 0.94), PUFAs 20:4 (OR: 0.84; 95% CI: 0.75, 0.94), and 24:2 (OR: 0.87; 95% CI: 0.78, 0.97) demonstrated significant associations. In multi-FFA exposure model, 24 FFAs were significantly associated with incident diabetes, most of which were consistent with univariate results. The mixture OR was 0.78 (95% CI: 0.61, 0.99; P = 0.04159). Differential correlation network analysis revealed pre-existing perturbations in intraclass and interclass FFA coregulation before diabetes onset., Conclusions: These findings underscore the variations in diabetes risk associated with FFAs across chain length and unsaturation degree, highlighting the importance of recognizing FFA subtypes in the pathogenesis of diabetes., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Context: Emerging studies have revealed associations between dietary medium-chain fatty acids (MCFAs) and glucose homeostasis. However, the relationship between serum MCFAs and the incidence of diabetes, and potential interactions with genetic predisposition, remains unclear in prospective cohort studies., Objective: To investigate associations and genetic susceptibility between serum MCFAs and diabetes risk., Methods: We investigated baseline serum MCFAs (n=5) in a nested case-control study comprising incident diabetes cases (n=1,707) and matched normoglycemic control subjects (n=1,707) from the China Cardiometabolic Disease and Cancer Cohort Study. Associations between MCFAs and type 2 diabetes mellitus (T2DM) were examined, both overall and stratified by diabetes genetic susceptibility. Genetic risk scores (GRS) were calculated based on 86 T2DM-associated genetic variants., Results: In the fully adjusted conditional logistic regression model, serum octanoic acid and nonanoic acid exhibited inverse dose-response relationships with diabetes risk, showing odds ratios (95% confidence intervals) of 0.90 (0.82-0.98) and 0.84 (0.74-0.95), respectively. Subgroup analysis demonstrated that inverse associations between MCFAs and incident diabetes were more pronounced among individuals with physical inactivity (Pinteraction = 0.042, 0.034, and 0.037, for octanoic, nonanoic and decanoic acid, respectively). Moreover, inverse associations of octanoic acid with diabetes risk were notably enhanced among individuals with high genetic risk compared to those with low genetic risk. Significant interactions were observed between octanoic acid and GRS on T2DM risk (Pinteraction = 0.003)., Conclusions: These findings provide evidence supporting inverse associations between serum MCFAs and T2DM risk, and reveal potential interplay between genetic susceptibility and circulating octanoic acid in modulating diabetes risk., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background/aims: : Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China., Methods: : A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators., Results: : Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders., Conclusions: : In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Aims/introduction: To analyze the association between HbA1c level and the risk of all-cause mortality in community patients with type 2 diabetes mellitus, and to provide a scientific basis for the management of type 2 diabetes mellitus in the community., Materials and Methods: Based on a Zhejiang rural community type 2 diabetes mellitus cohort, a total of 10,310 patients with type 2 diabetes mellitus with complete baseline and follow-up data were selected. The Cox proportional hazards regression model and the restricted cubic spline model were used to evaluate the relationship between the HbA1c level and the risk of all-cause mortality., Results: During a mean follow-up of 5.5 years, 971 patients died. With HbA1c levels of 6.5-7.0% as the reference, after adjusting for relevant confounding factors, the HR(95%CI) of all-cause mortality with HbA1c levels of <5.5%, 5.5-6.5%, 7.0-8.0%, 8.0-9.0%, and ≥9.0% were 1.53 (1.08-2.15), 0.97 (0.79-1.21), 1.14 (0.92-1.41), 1.44 (1.14-1.83), and 2.08 (1.68-2.58), respectively. The HbA1c level was associated with the risk of all-cause mortality in a "J-shaped" manner. The risk of all-cause mortality was lowest when the HbA1c was 6.5-7.0%, and increased significantly when the HbA1c was ≥ 8.0% and the HbA1c was < 5.5% (P < 0.05). The risk of all-cause death in the HbA1c 5.5-6.5% group and the 7.0-8.0% group was not significant compared with the reference group (P > 0.05)., Conclusions: The HbA1c levels were associated with the risk of all-cause mortality in type 2 diabetes mellitus in a "J-shaped" manner, a too high or a too low HbA1c level could increase the risk of death. Attention should be paid to the individual evaluation of patients and the setting of appropriate glycemic control goals., (© 2024 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Objective: This study describes the association between taste preference for salt and actual salt intake, thus guiding and refining personal and public health campaigns designed to lower salt intake in China., Methods: A cross-sectional survey of 1489 residents aged 18 to 69 years was conducted in 2017 in China. A multistage random sampling strategy was used, and a combination of questionnaires and physical and laboratory measurements were conducted to collect baseline characteristics and knowledge, attitudes, and behavior (KAB) related to salt. A 24 h urine collection was obtained for sodium and potassium excretion analysis. Participants were divided into two groups, light taste preference and salty taste preference, according to their answer to the question "Compared to others, how do you think your taste preference is for salt?"., Results: The mean age of the 1489 participants was 46.26 years, 48.9% were males, over 1/3 (35.7%) were identified as hypertensive, and 317 (21.3%) self-reported a salty taste preference. The mean of 24 h urinary sodium excretion was 167.32 mmol/24 h, corresponding to 9.79 g salt/d intake, and the sodium-to-potassium ratio (Na/K) was 4.90. The 24 h urinary sodium excretion of salty taste preference (177.06 mmol/24 h) was significantly higher than that of light taste preference (164.69 mmol/24 h). The multiple logistic regression analysis showed that the salty taste preference group had significantly higher 24 h urinary sodium ( ORa (95% CI ) = 1.004(1.002-1.006)), diastolic blood pressure (DBP), proportion of greasy food preference, and drinking levels, but lower potassium excretion, response levels to most KAB questions, and regular physical activity compared to the light taste preference group., Conclusion: Self-reported taste preference for salt predicted actual salt intake, which was verified by 24 h urinary sodium monitoring. Taste preference for salt could be used as a proxy for intake in terms of targeted salt intake, nutrition, and health education.

Background: The triglyceride glucose (TyG) index has been associated with an increased risk in breast cancer. However, this association remains unclear among the Chinese population. This study aimed to investigate whether the TyG index is associated with the risk of prevalent breast cancer in Chinese women., Methods: This cross-sectional study included 142,184 women from the REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal) Study, which recruited adults aged 40 years or older from 25 centers across mainland China between 2011 and 2012. The TyG index was calculated according to the formula: Ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). Multivariable-adjusted logistic regression models were used to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) regarding the associations between the TyG index and breast cancer., Results: Multivariable-adjusted logistic regression analysis showed that compared with the lowest quartile of the TyG index, the highest quartile of the TyG index was significantly associated with an increased risk of prevalent breast cancer, with an OR (95% CI) of 1.61 (1.19-2.17). In the stratified analysis, the association of each 1 SD increase in the TyG index with risk of prevalent breast cancer was more dominant in individuals with menarche at age 13-17, those who were postmenopausal, those with a history of breastfeeding, and those who had two to four children, with the ORs (95% CIs) of 1.35 (1.09-1.68), 1.27 (1.05-1.54), 1.26 (1.05-1.52), and 1.32 (1.08-1.62), respectively. Moreover, among those without discernible insulin resistance (homeostatic model assessment-insulin resistance [HOMA-IR] ≥2.5), hyperglycemia and dyslipidemia, each 1 SD increase in the TyG index was associated with a 1.36-fold increase in breast cancer risk, with an OR (95% CI) of 2.36 (1.44-3.87)., Conclusion: The TyG index is significantly associated with the prevalent breast cancer risk among middle-aged and elderly Chinese women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewers YM and PB declared a shared parent affiliation with the authors JL, XW, SW, LL, XJ, CH, HQ, HL, RZ, ML, YX, MX, TW, ZZ, JZ, MD, GN, WW, YB, YC, YZ, and QS and the reviewer JY declared a shared parent affiliation with the author LY to the handling editor at the time of review., (Copyright © 2024 Wu, Wang, Lin, Jia, Hu, Qi, Lin, Zheng, Li, Xu, Xu, Chen, Zeng, Hu, Ye, Shi, Su, Yu, Yan, Wang, Zhao, Zheng, Qin, Wan, Chen, Dai, Tang, Gao, Shen, Gu, Luo, Qin, Chen, Hou, Huo, Li, Wang, Zhang, Liu, Wang, Wu, Yang, Deng, Zhao, Mu, Ning, Wang, Bi, Chen and Lu.)

Aims: To assess the excess risk of cardiovascular disease (CVD) associated with different criteria for metabolic health, and the interplay of body size, insulin sensitivity and metabolic health with CVD risk., Materials and Methods: We conducted a prospective study involving 115 638 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Metabolic health was defined using three different definitions: (1) insulin sensitivity defined by homeostatic model assessment of insulin resistance index; (2) absence of metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria; and (3) simultaneous absence of metabolic abnormalities (diabetes, hypertension, dyslipidaemia). The primary endpoint was a composite of incident CVD events comprising the first occurrence of myocardial infarction, stroke, heart failure, or cardiovascular death., Results: During a mean 3.61-year follow-up period, obese individuals with insulin sensitivity (multivariable-adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.37-2.08), or without metabolic syndrome (HR 1.46, 95% CI 1.13-1.89) still exhibited increased CVD risks, when compared to their normal-weight counterparts. Otherwise, those with obesity but simultaneous absence of metabolic abnormalities demonstrated similar CVD risk compared to normal-weight individuals (HR 0.91, 95% CI 0.53-1.59). CVD risk increased with the number of abnormalities across body mass index categories, regardless of insulin sensitivity., Conclusions: This study emphasizes the need for refined definitions of metabolic health and advocates for meticulous screening for metabolic abnormalities to reduce cardiovascular risks, even in individuals with normal weight and insulin sensitivity., (© 2024 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Studies have found a U-shaped relationship between sleep duration and chronic kidney disease (CKD) risk, but limited research evaluated the association of reallocating excessive sleep to other behavior with CKD. We included 104 538 participants from the nationwide cohort of the Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study, with self-reported time of daily-life behavior. Using isotemporal substitution models, we found that substituting 1 h of sleeping with sitting, walking, or moderate-to-vigorous physical activity was associated with a lower CKD prevalence. Leisure-time physical activity displacement was associated with a greater prevalence reduction than occupational physical activity in working population. In stratified analysis, a lower CKD prevalence related to substitution toward physical activity was found in long sleepers. More pronounced correlations were observed in long sleepers with diabetes than in those with prediabetes, and they benefited from other behavior substitutions toward a more active way. The U-shaped association between sleep duration and CKD prevalence implied the potential effects of insufficient and excessive sleep on the kidneys, in which the pernicious link with oversleep could be reversed by time reallocation to physical activity. The divergence in the predicted effect on CKD following time reallocation to behavior of different domains and intensities and in subpopulations with diverse metabolic statuses underlined the importance of optimizing sleeping patterns and adjusting integral behavioral composition., (© 2023. Higher Education Press.)

Background: The association between weight change during early adulthood and cardiometabolic diseases remains uncertain in Chinese population. Whether the association varies with comprehensive cardiovascular health (CVH) in midlife assessed by "Life's Essential 8" has not been characterized. We aim to examine the associations of early adulthood weight change and midlife "Life's Essential 8" CVH status with cardiometabolic outcomes in a Chinese cohort., Methods: The study participants were from the China Cardiometabolic Disease and Cancer Cohort (4 C) Study. This analysis included 72,610 middle-aged and older participants followed for a median of 3.6 years. At baseline, the participants recalled body weight at age 20 and 40 years, and we calculated change in weight and BMI between 20 and 40 years of age. Health behaviors information in "Life's Essential 8" was collected by questionnaire, and health factors were measured in the study center. During follow-up, we ascertained incident cardiovascular events based on medical records, and diagnosed incident diabetes according to the American Diabetes Association 2010 criteria., Results: 72,610 study participants were included with a mean age of 56.0 ± 8.8 years and 29% of them were males. Weight gain of more than 10 kg between 20 and 40 years of age was associated with 22% increased risk of incident cardiovascular events (HR: 1.22; 95%CI: 1.04-1.43) and 38% increased risk of diabetes (HR: 1.38; 95%CI: 1.25-1.53) compared to stable weight. Besides, the association of weight gain more than 10 kg in early adulthood with cardiometabolic risk was even stronger in those with low CVH score in midlife (HR: 2.44; 95%CI: 2.01-2.97 for incident cardiovascular events; HR: 2.20; 95%CI: 1.90-2.55 for incident diabetes) or with few ideal cardiovascular health metrics in midlife., Conclusions: Our study indicated that weight gain in early adulthood was associated with significantly increased risk of cardiometabolic diseases. And the association could be stronger in those with poor CVH profiles in midlife. These findings confirmed the significance of weight management during early adulthood and suggested that individuals who experienced substantial weight gain in early life should be encouraged to maintain good CVH status in Chinese population., (© 2023. The Author(s).)

Background and Aims: There are no clear conclusions as to whether heart failure (HF) and coronary heart disease (CAD) increase the risk of erectile dysfunction (ED).In our study, we used Mendelian randomization (MR) analysis to discover a causal relationship between HF, CAD and ED., Methods: Single nucleotide polymorphisms (SNPs) associated with HF, CAD and ED were obtained from the MRC IEU Open Genome-Wide Association Study (GWAS) database.After a series of screenings, the remaining SNPs were selected as instrumental variables (IVs) for HF and CAD for MR analysis to assess the relationship between genetically predicted HF or CAD and the pathogenesis of ED.Among them, we used the random-effects inverse variance weighted (IVW) method as the primary analysis method.Finally, Cochran's q-test, funnel plots, MR-Egger regression, Leave-one-out method and MR-PRESSO were used for sensitivity analysis., Results: In the IVW method, there was no significant causal relationship between genetically predicted HF and CAD and the incidence of ED.(HF: OR = 1.17, 95% CI 0.99-1.39; p = 0.074;CAD: OR = 1.08, 95% CI 0.99-1.17, p = 0.068)。The results of sensitivity analyses supported our conclusion that no horizontal pleiotropism was found., Conclusion: This study did not find a causal relationship between HF or CAD and ED in European populations, which requires further in-depth research., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The coexistence of bla NDM-1 with other resistance determinants is rarely reported for Providencia rettgeri . Therefore, this study investigates the phenotypic and genetic characteristics of a multidrug-resistant P. rettgeri strain YQ150713., Methods: P. rettgeri YQ150713 was identified as carrying bla NDM-1 . S1-pulsed-field gel electrophoresis (S1-PFGE), Southern blotting, and conjugation experiments were used to determine plasmid characteristics. An antimicrobial susceptibility test was conducted. The complete genomic sequence of YQ150713 was obtained using Illumina NovaSeq 6000 and Oxford nanopore platforms. To further characterize the phylogenetic structure of P. rettgeri YQ150713, average nucleotide identity (ANI) and phylogenetic analyses were conducted., Results: The S1-PFGE, Southern blot, and conjugation assays have confirmed that the isolate P. rettgeri YQ150713 contains the bla NDM-1 gene on a conjugative plasmid pYQ150713-NDM-1. Antimicrobial susceptibility testing has indicated that strain YQ150713 was resistant to various common antibiotics, except aztreonam and fosfomycin. Bioinformatics analysis has further shown that pYQ150713-NDM-1 was a novel plasmid with a size of 265,883 bp, and bla NDM-1 and bla OXA-10 were co-located on it. Phylogenetic analysis suggesting P. rettgeri has spread widely throughout the world., Conclusion: In this study, bla NDM-1 and bla OXA-10 were co-localized on a novel plasmid pYQ150713-NDM-1 with a horizontal transfer function. To reduce the risk of the dissemination of such P. rettgeri isolates in clinical settings, more surveillance will be required in the future., Competing Interests: The authors of this article have no conflict of interest., (© 2023 Li et al.)

Although studies have estimated the associations of PM 2.5 with total mortality or cardiopulmonary mortality, few have comprehensively examined cause-specific mortality risk and burden caused by ambient PM 2.5 . Thus, this study investigated the association of short-term exposure to PM 2.5 with cause-specific mortality using a death-spectrum wide association study (DWAS). Individual information of 5,450,764 deaths during 2013-2018 were collected from six provinces in China. Daily PM 2.5 concentration in the case and control days were estimated by a random forest model. A time-stratified case-crossover study design was applied to estimate the associations (access risk, ER) of PM 2.5 with cause-specific mortality, which was then used to calculate the population-attributable fraction (PAF) of mortality and the corresponding mortality burden caused by PM 2.5 . Each 10 μg/m 3 increase in PM 2.5 concentration (lag03) was associated with a 0.80 % [95 % confidence interval (CI): 0.73 %, 0.86 %] rise in total mortality. We found greater mortality effect at PM 2.5 concentrations < 50 μg/m 3 . Stratified analyses showed greater ERs in females (1.01 %, 95 %CI: 0.91 %, 1.11 %), children ≤ 5 years (2.17 %, 95 %CI: 0.85 %, 3.51 %), and old people ≥ 70 years. We identified 33 specific causes (level 2) of death which had significant associations with PM 2.5 , including 16 circulatory diseases, 9 respiratory diseases, and 8 other causes. The PAF estimated based on the overall association between PM 2.5 and total mortality was 3.16 % (95 %CI: 2.89 %, 3.40 %). However, the PAF was reduced to 2.88 % (95 %CI: 1.88 %, 3.81 %) using the associations of PM 2.5 with 33 level 2 causes of death, based on which 250.15 (95 %CI: 163.29, 330.93) thousand deaths were attributable to short-term PM 2.5 exposure across China in 2019. Overall, this study provided a comprehensive picture on the death-spectrum wide association between PM 2.5 and morality in China. We observed robust positive cause-specific associations of PM 2.5 with mortality risk, which may provide more precise basis in assessing the mortality burden of air pollution., 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 The Authors. Published by Elsevier Inc. All rights reserved.)

Prediabetes and its pathophysiology remain important issues. We aimed to examine the cluster characteristics of prediabetes and explore their associations with developing diabetes and its complications based on 12 variables representing body fat, glycemic measures, pancreatic β cell function, insulin resistance, blood lipids, and liver enzymes. A total of 55,777 individuals with prediabetes from the China Cardiometabolic Disease and Cancer Cohort (4C) were classified at baseline into six clusters. During a median of 3.1 years of follow-up, significant differences in the risks of diabetes and its complications between clusters were observed. The odds ratios of diabetes stepwisely increase from cluster 1 to cluster 6. Clusters 1, 4, and 6 have increased chronic kidney diseases risks, while the prediabetes in cluster 4, characterized by obesity and insulin resistance, confers higher risks of cardiovascular diseases compared with others. This subcategorization has potential value in developing more precise strategies for targeted prediabetes prevention and treatment., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023. Published by Elsevier Inc.)

Aim: We aimed to examine risks of major cardiovascular events (MACEs), renal outcomes, and all-cause mortality in type 2 diabetes mellitus (T2DM) patients with different diabetic kidney disease (DKD) subtypes., Methods: A total of 36,509 participants with T2DM recruited from 20 community sites across mainland China were followed up during 2011-2016. DKD subtypes were categorized based on albuminuria (urinary albumin-to-creatinine ratio, UACR ≥ 30 mg/g) and reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m 2 ) as Alb - /eGFR - , Alb + /eGFR - , Alb - /eGFR + , and Alb + /eGFR + . Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of developing clinical outcomes in DKD subtypes., Results: More than half (53.5%) of participants with diabetes and reduced eGFR had normal UACR levels (Alb - /eGFR + ), termed as non-albuminuria DKD. These patients had a modest increase in the risks of MACEs (hazard ratio, HR 1.42 [95% CI 1.08;1.88]) and mortality (HR 1.42 [1.04;1.92]) compared with patients without DKD, whereas CKD progression was not significantly increased (HR 0.97 [0.60;1.57]). Participants with albuminuria (Alb + /eGFR - or Alb + /eGFR + ) had higher risks of clinical outcomes. Subgroup analysis revealed that the associations between non-albuminuria DKD and risks of MACEs and mortality were more evident in those aged <65 years., Conclusion: Non-albuminuria DKD accounts for more than half of DKD cases with low eGFR in Chinese diabetes patients. Diabetes patients with albuminuria are at higher risks of developing clinical outcomes and warrant early intervention, as well as patients with non-albuminuria DKD with age < 65 years., Competing Interests: Declaration of Competing Interest The authors declared no conflicts of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Although previous studies suggest that amino acids (AAs) and microbiota-related metabolites (MRMs) are associated with type 2 diabetes mellitus (T2DM), the results remain unclear among normoglycemic populations. We test 28 serum AAs and 22 MRMs in 3,414 subjects with incident diabetes and matched normoglycemic controls from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. In fully adjusted logistic regression models, per SD increment of branched-chain AAs, aromatic AAs, asparagine, alanine, glutamic acid, homoserine, 2-aminoadipic acid, histidine, methionine, and proline are positively associated with incident T2DM. In the MRM panel, serum carnitines, N-acetyltryptophan, and uric acid are positively associated with incident T2DM. Causal mediation analyses indicate 34 significant causal mediation linkages, with 88.2% through obesity and lipids. Variances explained in the serum metabolites are modestly limited in the comprehensive catalog of risk factor-metabolite-diabetes associations. These findings reveal that systematic AAs and MRMs change profile before T2DM onset and support a potential role of metabolic alterations in the pathogenesis of diabetes., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Many studies demonstrate a J-shaped association between blood pressure and cardiovascular diseases (CVDs), but the findings are plagued by confounding from other traditional cardiovascular risk factors (CVRFs). Our aims were to examine the associations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with CVD in individuals without major CVRFs and whether there were thresholds for the association., Methods: In the 4C study (China Cardiometabolic Disease and Cancer Cohort), 36 042 CVRF-free participants without CVD, diabetes, dyslipidemia, hypertension, or smoking were identified during 2011 to 2012. Among CVRF-free participants, 17 476 CVRF-preferable individuals with better glycemic (fasting glucose, <110 mg/dL; 2-hour post-load glucose, <140 mg/dL) and lipid profile (total cholesterol, <200 mg/dL; LDL [low-density lipoprotein] cholesterol, <130 mg/dL) were selected. The total person-years of follow-up for CVRF-free subjects and CVRF-preferable subjects were 130 147 and 63 573 person-years, respectively. Information on the development of major CVDs was collected during 2014 to 2016. Cox proportional hazard models were performed to estimate the risks for incident CVD by SBP and DBP groups, respectively., Results: We found that both baseline SBP and DBP presented significantly linear associations with CVD risks in CVRF-free and CVRF-preferable participants. There is significant increase in the CVD risk among CVRF-free participants with baseline SBP level of 110 to 119 mm Hg (hazard ratio, 1.79 [95% CI, 1.19-2.71]), 120 to 129 mm Hg (hazard ratio, 2.03 [95% CI, 1.36-3.03]), and 130 to 139 mm Hg (hazard ratio, 2.15 [95% CI, 1.40-3.28]) compared with SBP <110 mm Hg. Significant increases were also observed for DBP level of 80 to 89 mm Hg (hazard ratio, 1.43 [95% CI, 1.03-1.97]) compared with DBP <70 mm Hg. Similar results were observed in CVRF-preferable participants., Conclusions: SBP and DBP with levels currently considered normal were significantly and linearly associated with incident CVD without thresholds above 110/70 mm Hg among Chinese adults without major CVRFs.

Purpose: This study aimed to clarify the association of soy intake with cardiovascular disease (CVD) and all-cause mortality., Methods: We conducted a prospective cohort study in a Chinese population composed of 97,930 participants aged ≥ 40 years old without CVD at baseline in 2011. Habitual soy intake over a period of 12 months was evaluated using a food frequency questionnaire. All participants were classified into four groups based on their soy food consumption levels: < 15, 15-29, 30-59, and ≥ 60 g/day, with the lowest category as the reference group. Follow-up was conducted between 2014 and 2016 to assess CVD incidence and all-cause mortality since baseline, which was collected from the local mortality and disease registers of the National Disease Surveillance Point System and National Health Insurance System. The Cox proportional hazards regression models were used to analyze the relationship of soy intake with later CVD events and all-cause mortality., Results: During 350,604 person-years of follow-up (median [interquartile range]: 3.16 [2.98, 4.77] years), 2523 total CVD events and 1473 all-cause mortalities were documented. After controlling for covariates, the hazard ratios (95% confidence intervals) for total CVD events across increasing soy intake levels were 1.03 (0.93-1.14); 0.96 (0.86-1.07); and 0.86 (0.75-0.98; p for trend = 0.0434), while those for all-cause mortality were 0.88 (0.77-1.02); 0.86 (0.74-1.00); and 0.83 (0.69-0.99; p for trend = 0.0084)., Conclusion: High soy intake was associated with a reduced risk of total CVD events and all-cause mortality among a Chinese population., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Whether smoking modifies the associations of diabetes and risk factor management with subsequent risk of cardiovascular disease (CVD), and whether the smoking related CVD risk differs among people with and without diabetes are unclear. This study aimed to examine the associations and interactions of smoking, diabetes, and risk factor management in relation to incident CVD., Methods: This nationwide, population-based, prospective cohort study of 20 communities from various geographic regions recruited adults aged 40 years or older during 2011-2012. The follow-up survey was conducted between 2014 and 2016. This study included 126,181 participants who were free from CVD at baseline., Results: Study participants included 19,397 current smokers (15.4%), 6,049 former smokers (4.8%), and 100,735 never smokers (79.8%). Mean (SD) age ranged from 55.8 (8.6) years to 60.7 (9.1) years. Compared with never smokers, heavy smokers exhibited a greater risk of CVD events among participants with diabetes (multivariable-adjusted hazard ratio [HR], 1.45; 95% CI, 1.17-1.78) than among participants without diabetes (HR, 1.20; 95% CI, 1.01-1.42; P for interaction = 0.006). Compared with participants without diabetes, participants with diabetes who were never smokers and had 5 or more controlled risk factors showed no significantly excess CVD risk (HR, 0.93; 95% CI, 0.71-1.22), but the cardiovascular benefits from risk factor management were counteracted among participants with diabetes who were current smokers (HR, 1.28; 95% CI, 0.77-2.14) or former smokers (HR, 1.22; 95% CI, 0.66-2.28)., Conclusions: Smoking and diabetes interacted with each other in relation to increased risk of CVD events, and the beneficial effect of risk factor management on CVD risk among participants with diabetes was attenuated by current or former smoking., (© 2022. The Author(s).)

Background: The updated definition of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA) is an important paradigm shift and has lead to extensive discussion. We aimed to examine the association between the updated blood pressure (BP) categories and the risk of cardiovascular diseases (CVDs) with potential modifications from other cardiovascular health metrics (CVHMs)., Methods: This prospective study included 91,204 participants ≥40 years recruited from 20 community sites across mainland China. Participants were followed up during 2010-2016 for CVD events including nonfatal myocardial infarction, stroke, heart failure, and cardiovascular death. BP categories were defined according to the 2017 ACC/AHA guideline and CVHMs included smoking, physical activity, diet, body-mass index, total cholesterol, and fasting glucose., Findings: Overall, 1,985 major CVD events occurred during a mean follow-up of 3.7 years. Having more ideal CVHMs significantly reduced the risk of CVD events in both stage 1 and stage 2 hypertension. Compared with participants without hypertension, participants having ≥4 ideal CVHMs were no longer associated with an increased CVD risk in stage 1 hypertension (HR=1·04; 95% CI=0·83-1·31), but less so in stage 2 hypertension (HR=1·90, 95% CI=1·70-2·13). Such pattern of association was more evident in participants aged <60 years ( P for interaction <0·05)., Interpretation: Stage 1 hypertension defined by the ACC/AHA identifies individuals at increased CVD risk, which can be attenuated by achieving more preferable cardiovascular health, especially in adults aged <60 years., Competing Interests: None., (© 2021 Published by Elsevier Ltd.)

Aims/hypothesis: We aimed to evaluate the effect of NAFLD on the risk of incident cardiovascular disease (CVD) and estimated glomerular filtration rate (eGFR)-based chronic kidney disease (CKD), and further test the joint effects and interactions between NAFLD status and individual metabolic element, as well as the total 'ABCs' metabolic goal achievement, on the CVD and CKD risk among 101,296 patients with prediabetes or diabetes from a prospective cohort study., Methods: We conducted the study based on the China Cardiometabolic Disease and Cancer Cohort (4C) study, a large-scale, population-based prospective cohort. After excluding alcohol abuse and other cause of hepatic diseases, we used fatty liver index (FLI) ≥ 60 as a proxy of NAFLD and stratified the probability of fibrosis by aspartate transaminase/alanine transaminase ratio (AAR) with cut-offs of 0.8 and 1.4. 'ABCs' metabolic goal was defined as subjects who had HbA1c < 6.5% (A), SBP/DBP < 130/80 mmHg (B), and LDL-C < 100 mg/dL (C). During 3.8 years follow-up, we validated 2340 CVD events based on medical records and identified 1943 participants developed CKD based on centrally tested eGFR., Results: The multivariable adjusted hazard ratios (HRs) were 1.15 (95% confidence interval (CI), 1.05-1.27) for CVD events and 1.33 (95% CI, 1.20-1.48) for CKD among NAFLD patients, compared with participants without NAFLD. Of NAFLD patients, relative to individuals with low AAR (<0.8), those with high AAR (≥1.4) were more likely to experience CVD events [1.62 (1.21-2.18)] and CKD [1.63 (1.17-2.28)]. Participants with NAFLD and comorbid poorly controlled metabolic risk factors had higher risk of CVD events or CKD than having either alone, with a significant interaction between poor glycemic control and NAFLD on the risk of vascular complications., Conclusions: NAFLD was associated with incident CVD and CKD among patients with prediabetes or diabetes. Such associations were substantially modified by the comprehensive achievement of metabolic goal., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Abstract: With the rapid development of medical technology, the use of electrosurgical instruments is dramatically increased in various types of surgery. However, the damage of the insulation layer of the reusable electrosurgical instrument often causes surgical accidents. The procedures of packaging and cleaning contribute to many damages to insulating layer of reusable electrosurgical instruments.Various types of reusable electrosurgical instruments were detected for insulation failures, conduction failures, short-circuit by using a high-voltage detector, DIATEG (Morgate company). In addition, reusable electrosurgical instruments were detected for insulation failures after packaging and cleaning by different procedures.13.1% (129/740) electrosurgical instruments had an insulation test failure; 6.2% (9/146) monopolar wires were with conduction failure; and 7.7% (16/207) bipolar wires were with short-circuit. Different packaging and cleaning procedures contribute to various degrees of damages to insulating property of reusable electrosurgical instruments.Insulation failure was a wide problem of reusable electrosurgical instruments, while fixed packaging method and mild cleaning procedures result in fewer damages to insulating property of reusable electrosurgical instruments., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: National investigations on age-specific modifiable risk factor profiles for cardiovascular disease (CVD) and mortality are scarce in China, the country that is experiencing a huge cardiometabolic burden exacerbated by population ageing., Methods: This is a nationwide prospective cohort study of 193,846 adults in the China Cardiometabolic Disease and Cancer Cohort Study, 2011-2016. Among 139,925 participants free from CVD at baseline, we examined hazard ratios and population-attributable risk percentages (PAR%s) for CVD and all-cause mortality attributable to 12 modifiable socioeconomic, psychosocial, lifestyle, and metabolic risk factors by four age groups (40-<55 years, 55-<65 years, 65-<75 years, and ≥75 years)., Findings: Metabolic risk factors accounted for 52·4%, 47·2%, and 37·8% of the PAR% for CVD events in participants aged 40-<55 years, 55-<65 years, and 65-<75 years, respectively, with hypertension being the largest risk factor. While in participants aged ≥75 years, lifestyle risk factors contributed to 34·0% of the PAR% for CVD, with inappropriate sleep duration being the predominant risk factor. Most deaths were attributed to metabolic risk factors (PAR% 25·3%) and lifestyle risk factors (PAR% 24·6%) in participants aged 40-<55 years, with unhealthy diet and diabetes being the main risk factors. While in participants aged ≥55 years, most deaths were attributed to lifestyle risk factors (PAR% 26·6%-41·0%) and socioeconomic and psychosocial risk factors (PAR% 26·1%-27·7%). In participants aged ≥75 years, lifestyle risk factors accounted for 41·0% of the PAR% for mortality, with inappropriate sleep duration being the leading risk factor., Interpretation: We identified age-specific modifiable risk profiles for CVD and all-cause mortality in Chinese adults, with remarkable differences between adults aged ≥75 years and their younger counterparts., Funding: National Natural Science Foundation of China., Competing Interests: The authors declare no conflicts of interest., (© 2021 The Author(s).)

Background: In an effort to provide greater financial protection from the risk of large medical expenditures, China has gradually added catastrophic medical insurance (CMI) to the various basic insurance schemes. Tongxiang, a rural county in Zhejiang province, China, has had CMI since 2000 for their employee insurance scheme, and since 2014 for their resident insurance scheme. Methods: Compiling and analysing patient-level panel data over five years, we use a difference-in-difference approach to study the effect of the 2014 introduction of CMI for resident insurance beneficiaries in Tongxiang. In our study design, resident insurance beneficiaries are the treatment group, while employee insurance beneficiaries are the control group. Findings: We find that availability of CMI significantly increases medical expenditures among resident insurance beneficiaries, including for both inpatient and outpatient spending. Despite the greater financial protection, out-of-pocket expenditures increased, in part because patients accessed treatment more often at higher-level hospitals. Interpretation: Better financial coverage for catastrophic medical expenditures led to greater access and expenditures, not only for inpatient admissions-the category that most often leads to catastrophic expenditures-but for outpatient visits as well. These patterns of expenditure change with CMI may reflect both enhanced access to a patient's preferred site of care as well as the influence of incentives encouraging more care under fee-for-service payment. Funding: Stanford University's Freeman Spogli Institute for International Studies' Policy Implementation Lab and a Shorenstein Asia Pacific Research Center faculty research award provided funding for this project. Chinese translation of the abstract (Appendix 1) ., Competing Interests: All authors declare no competing interests. The funding sources played no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication., (© 2021 The Author(s). Published by Elsevier Ltd.)

Background: The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline used eGFR and urinary albumin-creatinine ratio (ACR) to categorize risks for CKD prognosis. The utility of KDIGO's stratification of major CVD risks and predictive ability beyond traditional CVD risk prediction scores are unknown., Methods: To evaluate CVD risks on the basis of ACR and eGFR (individually, together, and in combination using the KDIGO risk categories) and with the atherosclerotic cardiovascular disease (ASCVD) score, we studied 115,366 participants in the China Cardiometabolic Disease and Cancer Cohort study. Participants (aged ≥40 years and without a history of cardiovascular disease) were examined prospectively for major CVD events, including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death., Results: During 415,111 person-years of follow-up, 2866 major CVD events occurred. Incidence rates and multivariable-adjusted hazard ratios of CVD events increased significantly across the KDIGO risk categories in ASCVD risk strata (all P values for log-rank test and most P values for trend in Cox regression analysis <0.01). Increases in c statistic for CVD risk prediction were 0.01 (0.01 to 0.02) in the overall study population and 0.03 (0.01 to 0.04) in participants with diabetes, after adding eGFR and log(ACR) to a model including the ASCVD risk score. In addition, adding eGFR and log(ACR) to a model with the ASCVD score resulted in significantly improved reclassification of CVD risks (net reclassification improvements, 4.78%; 95% confidence interval, 3.03% to 6.41%)., Conclusions: Urinary ACR and eGFR (individually, together, and in combination using KDIGO risk categories) may be important nontraditional risk factors in stratifying and predicting major CVD events in the Chinese population., (Copyright © 2021 by the American Society of Nephrology.)

Although numerous studies have investigated premature deaths attributable to temperature, effects of temperature on years of life lost (YLL) remain unclear. We estimated the relationship between temperatures and YLL, and quantified the YLL per death caused by temperature in China. We collected daily meteorological and mortality data, and calculated the daily YLL values for 364 locations (2013-2017 in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces, and 2006-2011 in other locations) in China. A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates (YLL/100,000 population), and a multivariate meta-analysis model was used to pool location-specific associations. Then, YLL per death caused by temperatures was calculated. The temperature and YLL rates consistently showed U-shaped associations. A mean of 1.02 (95% confidence interval: 0.67, 1.37) YLL per death was attributable to temperature. Cold temperature caused 0.98 YLL per death with most from moderate cold (0.84). The mean YLL per death was higher in those with cardiovascular diseases (1.14), males (1.15), younger age categories (1.31 in people aged 65-74 years), and in central China (1.34) than in those with respiratory diseases (0.47), females (0.87), older people (0.85 in people ≥75 years old), and northern China (0.64) or southern China (1.19). The mortality burden was modified by annual temperature and temperature variability, relative humidity, latitude, longitude, altitude, education attainment, and central heating use. Temperatures caused substantial YLL per death in China, which was modified by demographic and regional characteristics., Competing Interests: The authors declare no competing interests., (© 2020 The Author(s).)

Background: Several studies have investigated the associations between ambient temperature and years of life lost (YLLs), but few focused on the difference of life loss attributable to temperature among different socioeconomic development levels., Objectives: We investigated the disparity in temperature-YLL rate relationships and life loss per death attributable to nonoptimal temperature in regions with various development levels., Methods: Three hundred sixty-four Chinese counties or districts were classified into 92 high-development regions (HDRs) and 272 low-development regions (LDRs) according to socioeconomic factors of each location using K-means clustering approach. We used distributed lag non-linear models (DLNM) and multivariate meta-analysis to estimate the temperature-YLL rate relationships. We calculated attributable fraction (AF) of YLL and temperature-related average life loss per death to compare mortality burden of temperature between HDRs and LDRs. Stratified analyses were conducted by region, age, sex and cause of death., Results: We found that non-optimal temperatures increased YLL rates in both HDRs and LDRs, but all subgroups in LDRs were more vulnerable. The disparity of cold effects between HDRs and LDRs was significant, while the difference in heat effect was insignificant. The overall AF of non-optimal temperature in LDRs [AF = 12.2, 95% empirical confidence interval (eCI):11.0-13.5%] was higher than that in HDRs (AF = 8.9, 95% eCI: 8.3-9.5%). Subgroups analyses found that most groups in LDRs had greater AFs than that in HDRs. The average life loss per death due to non-optimal temperature in LDRs (1.91 years, 95% eCI: 1.72-2.10) was also higher than that in HDRs (1.32 years, 95% eCI: 1.23-1.41). Most of AFs and life loss per death were caused by moderate cold in both HDRs and LDRs., Conclusions: Mortality burden caused by temperature was more significant in LDRs than that in HDRs, which means that more attention should be paid to vulnerable populations in LDRs in planning adaptive strategies.

The associations between different combinations of metabolic abnormalities and the risk of all and site-specific cancers remain unclear. We aimed to estimate the association and interplay between serum cholesterol, glycemic status and risk of cancer in the China Cardiometabolic Disease and Cancer Cohort (4C)-Study, a nationwide, multicenter, prospective, population-based study. The investigation was performed in 137,884 participants during 2014-2016. Incident cancer was defined as the first occurrence of any type cancer of all sites during follow-up. After 510,164 person-years of follow-up, 1,710 were detected as incident cancer after exclusion of participants diagnosed as cancer within 6 months from baseline. A relatively low level of LDL cholesterol (<100 mg/dl) was related to a significant higher risk of incident cancer [1.20 (1.08-1.34); P=0.0007]. Diabetic individuals have a significantly higher risk of incident cancer, especially those with poorly glycemic control. Diabetic participants with both lower levels of LDL cholesterol and poorly glycemic control were at a higher risk of incident cancer [1.42 (1.10-1.81); P=0.006]. Our study showed a positive association of cancer risk with low-level LDL cholesterol and diabetes and found that participants with both lower levels of LDL cholesterol and poorly controlled diabetes had the higher risk of incident cancer, which indicates the compelling need of achieving glycemic control goal and maintaining appropriate LDL cholesterol levels., Competing Interests: None., (AJCR Copyright © 2020.)

Background: National investigations on the interaction of insulin resistance, β-cell dysfunction, and obesity with the development of diabetes are scarce in China. We aimed to investigate the individual and joint associations of insulin resistance and β-cell dysfunction with incident diabetes, and to examine the modifying effect of BMI and waist circumference on these associations among adults with normal glucose tolerance and with prediabetes., Methods: In this nationwide, population-based, prospective cohort study, we analysed data from the China Cardiometabolic Disease and Cancer Cohort Study, which recruited adults aged 40 years or older during 2011-12 (baseline) and invited participants to attend follow-up visits in 2014-16. Patients with diabetes at baseline, missing data for baseline measures of glucose tolerance status, missing data for baseline homoeostasis model assessment (HOMA) indexes, missing data for baseline covariates, and missing data for measures of glucose tolerance status at follow-up visits were excluded. At baseline and follow-up visits, a comprehensive set of questionnaires, clinical measurements, oral glucose tolerance tests, and laboratory examinations were carried out following standardised protocols. Glucose tolerance status and prediabetes were defined according to the American Diabetes Association 2010 criteria. In the main analysis, we examined the contributions of insulin resistance (HOMA of insulin resistance [HOMA-IR]) and β-cell dysfunction (HOMA of β-cell function [HOMA-B]) to diabetes risk, and evaluated the impact of obesity on these associations., Findings: 94 952 participants (31 517 men and 63 435 women) were included in the analysis. High HOMA-IR was associated with a greater hazard of diabetes (quartile 4 vs 1: hazard ratio [HR] 6·70, 95% CI 6·08-7·39; per unit increase in Z score: HR 2·17, 95% CI 2·10-2·24) than low HOMA-B (quartile 1 vs 4: 4·08, 3·72-4·48; per unit decrease in Z score: 1·92, 1·85-2·00). Approximately 24·4% (95% CI 23·6-25·2) of the incident diabetes could be attributed to insulin resistance and 12·4% (11·2-13·7) could be attributed to β-cell dysfunction. The HRs for diabetes were 1·83 (95% CI 1·72-1·95) per unit increase in Z score of HOMA-IR and 2·03 (1·86-2·21) per unit decrease in Z score of HOMA-B among participants with normal weight; the corresponding HRs for diabetes were 2·02 (1·93-2·11) and 1·88 (1·79-1·98) among participants with obesity (p interaction =0·0091). These associations and interactions were similar for participants with normal glucose tolerance or prediabetes., Interpretation: Insulin resistance shows a stronger association with incident diabetes than does β-cell dysfunction in Chinese adults, and this association pattern was more prominent among adults with obesity. Given the limitations of HOMA indexes as surrogate measures of insulin resistance and β-cell dysfunction, these findings should be interpreted with caution., Funding: National Natural Science Foundation of China., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: To identify potential molecular targets for lung cancer intervention and diagnosis, we analyzed the differential miRNA expression of peripheral blood between lung cancer patients and healthy controls., Methods: Three pairs of cases' and controls' peripheral blood samples were evaluated for miRNA expression by microarray. 12 miRNAs were selected for RT-PCR validation and target genes prediction. In addition, 4 miRNAs were selected for future validation by RT-PCR in a large sample of 145 cases and 55 frequency-matched healthy controls., Results: A total of 338 differentially expressed miRNAs were screened and identified by microarray. According to the fold changes, the top ten upregulated miRNAs were hsa-miR-124-3p, hsa-miR-379-5p, hsa-miR-3655, hsa-miR-450b-5p, hsa-miR-29a-5p, hsa-miR-200a-3p, hsa-miR-542-3p, hsa-miR-138-5p, hsa-miR-219a-2-3p, and hsa-miR-4701-3p, and the top ten downregulated miRNAs were hsa-miR-34c-5p, hsa-miR-135a-5p, hsa-miR-132-3p, hsa-miR-3178, hsa-miR-4449, hsa-miR-4999-3p, hsa-miR-1246, hsa-miR-4424, hsa-miR-1252-5p, and hsa-miR-24-2-5p. RT-PCR verification of the 12 miRNAs revealed that 5 of 8 upregulated miRNAs, 2 of 4 downregulated miRNAs showed a significant difference between the cases and controls (P < .05). A large number of target genes and their functional set showed overlapping among the 453 predicted target genes of the 12 miRNAs (P < .01). RT-PCR in the large sample confirmed the significant differential expression level of hsa-miR-29a-5p, hsa-miR-135a-5p, hsa-miR-542-3p, and hsa-miR-4491 between cases and controls (P < .05), and three of these microRNA, except hsa-miR-29a-5p, were significant after Bonferroni correction for adjustment of multiple comparisons., Conclusion: There was a significant difference in miRNAs expression in the peripheral blood between lung cancer patients and healthy controls, and 4 miRNAs were validated by a large-size sample., (© 2019 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals, Inc.)

Background: We investigated the current temporal trends of suicide in Zhejiang, China, from 2006 to 2016 to determine possible health disparities in order to establish priorities for intervention., Methods: We collected mortality surveillance data from 2006 to 2016 from the Zhejiang Chronic Disease Surveillance Information and Management System from the Zhejiang Provincial Centre for Disease Control and Prevention. We estimated region-specific and gender-specific suicide rates using joinpoint regression analyses to determine the average annual percentage change (AAPC) and its 95% CI., Results: The crude suicide rate declined from 9.64 per 100 000 people in 2006 to 4.86 per 100 000 in 2016, and the age-adjusted suicide rate decreased from 9.74 per 100 000 in 2006 to 4.14 per 100 000 in 2016. During 2006-2013, rural males had the highest suicide rate, followed by rural females, urban males, and urban females, while after 2013, urban males suicide rates surpassed rural female suicide rates, and became the second highest suicide rate subgroup. The rate of suicide declined in all region-specific and/or gender-specific subgroups except among urban males between 20 and 34 years of age. Their age-adjusted suicide rate AAPC greatly increased to 28.39 starting in 2013 compared with an AAPC of -13.47 from 2006 to 2013., Conclusions: The suicide rate among young urban males has been alarmingly increasing since 2013, and thus, researchers must develop targeted effective strategies to mitigate this escalating loss of life., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Uncertainty remains regarding the predictive value of various glycemic measures as they relate to the risk of diabetes and its complications. Using the cutoffs recommended by the American Diabetes Association's 2010 criteria, we determined the associations of fasting plasma glucose (FPG), 2-h postload glucose (2h-PG), and HbA 1c with the outcomes., Research Design and Methods: Baseline medical history, FPG, 2h-PG, and HbA 1c were obtained from a population-based cohort of 193,846 adults aged ≥40 years in China during 2011-2012. A follow-up visit was conducted during 2014-2016 in order to assess incident diabetes, cardiovascular disease (CVD), cancer, and mortality., Results: We documented 8,063 cases of diabetes, 3,014 CVD-related events, 1,624 cases of cancer, and 2,409 deaths during up to 5 years of follow-up. Multivariable-adjusted risk ratios (95% CIs) of diabetes associated with prediabetes based on FPG of 100-125 mg/dL, 2h-PG of 140-199 mg/dL, or HbA 1c of 5.7-6.4% (39-47 mmol/mol) were 1.60 (1.43-1.79), 2.72 (2.43-3.04), and 1.49 (1.36-1.62), respectively. Restricted cubic spline analyses suggested J-shaped associations of FPG, 2h-PG, and HbA 1c levels with CVD, cancer, and mortality. Multivariable-adjusted hazard ratios (95% CIs) associated with untreated diabetes based on FPG ≥126 mg/dL, 2h-PG ≥200 mg/dL, or HbA 1c ≥6.5% (48 mmol/mol) were 1.18 (1.05-1.33), 1.31 (1.18-1.45), and 1.20 (1.07-1.34) for CVD; 1.10 (0.92-1.32), 1.44 (1.25-1.67), and 1.08 (0.92-1.28) for cancer; and 1.37 (1.20-1.57), 1.57 (1.41-1.76), and 1.33 (1.17-1.52) for mortality, respectively. 2h-PG remained significantly associated with outcomes in models including FPG and HbA 1c as spline terms. Furthermore, 2h-PG significantly improved the ability of the C statistic to predict diabetes, CVD, and mortality., Conclusions: 2h-PG remains independently predictive of outcomes in models including FPG and HbA 1c . Therefore, in addition to FPG and HbA 1c , routine testing of 2h-PG should be considered in order to better assess the risks of outcomes., (© 2019 by the American Diabetes Association.)

Background: Currently, the studies on the relationship between type 2 diabetes and platelets indicators were carried out on a selective small sample population generally. Large sample studies in this area are rare, especially in Chinese population. In this study, we aimed to investigate the relationship between type 2 diabetes and the mean platelet volume (MPV), platelet count (PLT) and platelet distribution width (PDW)., Methods: This is a cross-sectional analysis of the routine health examination data from 20128 participants with complete baseline data in Yinzhou District 2013. The detection of indicators in this study was completed by automatic hematology analyzer., Results: The PDW and PLT were not significantly different between diabetic group and non-diabetic group, (16.00% vs. 16.00%, P =0.88, and 194*10 9 /L vs. 196*10 9 /L, P =0.05 respectively). The MPV was significantly higher in diabetic group (9.3fl vs. 9.2fl, P <0.05). MPV was an independent risk factor of diabetes mellitus (Unadjusted OR=1.07 (95% CI: 1.03, 1.11), Adjusted for age, sex OR=1.07 (95% CI: 1.02, 1.12)). The adjusted odds ratio of diabetes rose with increasing MPV levels and were most pronounced in subjects with MPV levels exceeding the 90th percentile (MPV ≥10.70 fl, Crude or=1.23 adjusted or=1.19)., Conclusion: There was no relationship between the presence of diabetes with PDW and PLT. The MPV was independently associated with the presence of diabetes., Competing Interests: Conflict of Interests The authors declare that there is no conflict of interest.

Objective: To estimate the disease burden of type 2 diabetes in population in Zhejiang in 2013., Methods: According to the method in global burden of disease study (GBD) 2010, the related disability adjusted life years (DALYs), years of life lost (YLL) and years lived with disability (YLD) were calculated by using the incidence, prevalence and mortality data of type 2 diabetes in population in Zhejiang and DISMODⅡ., Results: The overall DALYs of type 2 diabetes was 5.36 per 1000 population, which was higher in women (5.49 per 1000) than in men (5.24 per 1000), The population in urban area had higher DALYs (5.47 per 1000) than those in rural area (5.42 per 1000). The DALYs in old population was high, which peaked in age group 80-84 years (32.63 per 1000) with YLL/YLD of 0.62. The disease burden of type 2 diabetes was mainly caused by disability., Conclusion: The YLL of type 2 diabetes in Zhejiang was higher than the national average level.

Objective: To understand the association between type 2 diabetes and the risk of cancers., Methods: Data related to type 2 diabetes mellitus (T2DM) cases and cancer cases were collected from Zhejiang Chronic Disease Surveillance Information and Management System (CDSIMS) , between January 1, 2007 and December 31, 2013. Cumulative incidence and relative risk (RR) with 95% confidence interval (CI) were calculated., Results: From 2007 to 2013, a total of 327 268 T2DM and 7 435 cancer cases were respectively reported and 778 439 person-years completed the followed-up program. Among the T2DM patients, incidence of cancers was 955.12 per 100 000, with standardized incidence as 458.05 per 100 000. Compared with people without T2DM, the risk of cancer incidence increased in T2DM patients (RR=1.68, 95%CI: 1.68-1.70). Risk appeared the highest in 20-39 year age group but decreased when the increase of age. In addition, the increased risk was still significant in T2DM patients aged ≥60 years (RR=1.21, 95%CI: 1.18-1.25)., Conclusion: Results from the study suggested that T2DM was associated with the increased risk of cancers, statistically.

Objective: To explore the association between sleep duration and stroke in adults., Methods: Baseline data of 57 704 subjects who were aged 30-79 years and enrolled into China Kadoorie Biobank (CKB) study from Tongxiang county, Zhejiang province were analyzed. Multiple logistic regression analysis was conducted to investigate the putative association between sleep duration and stroke after adjusting for potential confounders., Results: The mean age of the subjects was (53.15 ± 10.20) years in males and (51.72 ± .69) years in females, respectively. There were 14.43% of males and 15.30% of females reporting sleep durations ≤ 6 hours per day and 5.39% of males and 5.95% of females reporting long duration of sleep (≥ 10 hours per day). The prevalence of stroke was 0.92% in males compared with 0.44% in females. The prevalence of stroke showed a U-shaped distribution with sleep duration. Compared with 7 hours sleep duration per day, long sleep duration (≥ 10 hours per day) was associated with stroke. The odds ratios (OR) were 2.11 (95%CI: 1.32-3.37) for males and 2.13 (95%CI: 1.24-3.65) for females after adjusting for age, socioeconomic status, health behaviors and health status. No statistical significant association was found between short sleep duration and stroke. Meanwhile, frequent sleep snoring was found to be associated with stroke in females (OR=1.63, 95% CI: 1.11-2.40)., Conclusion: Longer sleep duration was found to be associated with higher risk of stroke in both males and females. Frequent sleep snoring would increase the risk of stroke in females.

Objective: To investigate the epidemiologic characteristics and factors associated with the avoidance of activity, that induced by fear of falling in the community-dwelling elderly so as to provide evidence for preventing elderly from falling and to increase the quality of life., Methods: A cross-sectional study was conducted in 1 972 elderly in Zhejiang. Data were collected through face-to-face interview. Both Univariate and multivariate logistic regression models were used to explore the related factors on the avoidance of activity induced by fear of falling., Results: Of the 1 972 elderly, 43.15% (95% CI: 40.97%-45.34%) appeared avoidance of activity induced by fear of falling. There were no significant difference between males (41.79%, 95% CI: 38.61%-44.98%) and females (44.36%, 95% CI: 41.34%-47.38%), with χ² = 1.32, P > 0.05. The corresponding figures of the 60-69 years group, 70-79 years group and the ≥ 80 years group were 37.07%, 44.87% and 59.04%, respectively (Trend χ² = 48.93, P < 0.01). Of those elderly who ever fell in the past 12 months, 51.94% (95% CI: 46.34%-57.53%) of them were afraid of falling which would lead to avoid of engaging in physical activities. Of the elderly who had no histories of falling in the past 12 months, 41.52% (95% CI: 39.14%-43.89%) feared of falling and avoided engaging in related activities (χ² = 11.56, P < 0.01). Results from the Multivariate logistic regression analysis showed that the related factors would include general/poor perceived health status (OR = 1.53-1.69), impaired vision (OR = 1.95-2.98), impaired hearing (OR = 1.77), use of assistive devices (OR = 2.71), osteoporosis (OR = 3.35), dizziness (OR = 3.05), age ≥ 80 years old (OR = 1.56) and the level of received education., Conclusion: Avoidance of physical activity induced by fear of falling among community-dwelling elderly was commonly seen. Health education and intervention measures should be strengthened to the elderly, so as to encourage them to engaging in physical activities and to improve their quality of life.

Objective: To explore the association between socioeconomic status (SES) and blood pressure control in diagnosed hypertension patients., Methods: The database of Zhejiang provincial survey on metabolic syndrome which implemented in 2010 in which prior hypoertensive patients were brought into this sutdy. Descriptive statistics were applied to test the distributive differences of relevant factors (age, sex, marital status, hypertension duration, BMI, education level, per capita household yearly income, smoking, alcohol drinking, fruit and vegetable intake) between patients with optimally-controlled blood pressure and those without. The SES of diagnosed hypertension patients was measured separately by two common indicators: education level and the per capita household yearly income. Univariate and multivariate logistic regression models were used to differentiate the association between those two SES indicators and blood pressure control, and the trend of the association was also tested., Results: Totally, 2 394 hypertension patients were diagnosed and identified. Of the patients analysed, the overall mean was (61.53 ± 10.64) years, and 55.7% (1 334 cases) had ≤ 5 years' disease duration. 1 090 achieved optimal blood pressure control, which accounted for a proportion of 45.5%. 1 676 had elementary school education and below, accounting for 70.1%. The patients with per capita household yearly income of < 5 000 Yuan and 5 000-14 999 Yuan groups were 401 (29.4%) and 690 (50.5%) respectively. 416 (17.4%) were smokers and 541 (22.6%) were alcohol drinkers. Based on the statistical tests, we found that the distributions of age, marital status, hypertension duration, body mass index, smoking and alcohol drinking were different between two groups (t or χ² values were 4.57, 5.44, 6.40, 6.21, 5.99, 3.98, respectively, all P values were < 0.05). Optical blood pressure control in higer education level group was significantly better than that of in lower education level (χ² = 12.65, P < 0.001), and there was no statistical significance association between per capita household yearly income and optimal blood pressure control (χ² = 2.78, P = 0.249). Multivariate logistic regression models revealed that, of those two SES indicators, a positive association was shown between education level and optimal blood pressure control: compared with patients in the category of 'elementary school and below, those of 'junior high school and above observed an OR of 1.40 (95% CI: 1.09-1.81). And in further trend χ² test, we identified a trend of such association (χ² trend = 12.74, P = 0.002). However, no significant association has been recognized between per capita household yearly income and optimal blood pressure control: compared with patients in the category of < 5 000 Yuan group, those of 5 000-14 999 Yuan and ≥ 15 000 Yuan groups had OR of 0.93 (95% CI: 0.72-1.20) and 1.04 (95% CI: 0.83-1.31) respectively., Conclusion: Among all diagnosed hypertension patients, those with lower education level have poorer blood pressure control and should be labelled as the key population for intense health education and standardized management to improve their blood pressure control status.

Objective: To survey the incidence of acute coronary events (nonfatal acute myocardial infarction and death from coronary heart disease), and analyze the trend and distribution characteristics in permanent residents aged 25 years and more across 30 surveillance regions of Zhejiang province from 2010 to 2012., Methods: Through databases matching and duplicate checking, this study incorporated the register module of coronary disease and the cause of death register module in Zhejiang provincial information system for chronic non-communicable diseases surveillance and management. The distribution of incidence was calculated across gender, age groups, regions and times., Results: A total of 31 872 person-time acute coronary events were identified. The gender- and age-standardized mean annual incidence was 81.56 per 100 000 people in overall population, with 94.33 in males and 68.27 in females. Age-standardized incidence was 87.90 and 77.36 per 100 000 people in urban and rural area, respectively. Urban area had higher incidence rate than rural in each of the three years, and had obvious trend of increasing (P < 0.001) compared with rural area (P = 0.331). Incidence rate also increased significantly with age (P < 0.001).In addition, compared with women, men had higher incidence in each age group (all P < 0.001). The incidence rate increased rapidly in population older than 75 years old. The highest incidence was observed in age group ≥ 85 years old, with 2 371.67 and 1 873.92 per 100 000 in males and females, respectively. Apparent seasonal trend was observed for acute coronary events, which was low in summer and high in winter., Conclusions: Quantity and incidence for acute coronary events in residents aged 25 years and more of Zhejiang surveillance regions increased during 2010 to 2012. Male had higher incidence than female, and the incidence in urban areas was higher compared with rural areas. Residents older than 75 years old were high risk population of events, and winter was the high-occurrence season.

Objective: To understand the prevalence of dyslipidemia among non-overweight adults and related factors in Zhejiang province., Methods: A total of 10 868 non-overweight adults (aged ≥18 years and BMI<24.0 kg/m²) included in a population-based cross-sectional survey on metabolic syndrome in Zhejiang province in 2010 were selected to conduct questionnaire survey, health examination and blood fat detection., Results: The overall prevalence of dyslipidemia in this population was 41.38%. The prevalence was significantly higher in males (43.19%) than in females (39.84%) (χ² = 12.53, P < 0.001). The prevalence of dyslipidemia significantly decreased in males (trend χ² = 47.61, P < 0.001) but increased in females (trend χ² = 3.88, P < 0.05) with age. There was no significant difference in the prevalence between urban area (41.21%) and rural area (41.49%) (χ² = 0.08, P = 0.774). Multiple logistic regression analysis showed that sex, family history of chronic diseases, smoking, alcohol use, high meat and egg diet, cooking with animal oil, physical activity, central obesity and BMI were factors related to prevalence of dyslipidemia., Conclusion: The prevalence of dyslipidemia was high among the non-overweight adults in Zhejiang, and family history, smoking, high-fat diet, physical inactivity, central obesity seemed to be the major risk factors.

Objective: To assess the cardiovascular disease-related risk levels among hypertensive people in Zhejiang., Methods: Subjects were selected from local residents aged ≥18 years old, using the multi stage stratified-random sampling method. All participants accepted physical examinations including blood tests for lipids, fasting blood glucose, 2 hours blood glucose and physical measurements for obesity and blood pressure in the year 2010., Results: Totally, 17 437 subjects were finally included in the study, in which 5 227 were diagnosed as having hypertension, with 'grade one hypertension' the majority. Cardiovascular disease-related risk factors would include older age (male >55 years, female >65 years), smoking, abnormal fasting glucose, impaired glucose tolerance, abnormal TC, abnormal HDL-C, abdominal obesity and obesity, with rates as 42.78% , 20.89%, 5.31%, 8.35%, 9.87%, 35.66%, 40.55% and 13.93%. Most of the hypertensive people had two (30.44%) or three risk factors (29.96%). Proportions of low, medium, high or very high risks were 9.70% , 47.71% , 18.81% and 23.78% , respectively in those people with hypertension. Significant differences on cardiovascular risk stratification were found between age groups, sex and regions. There were also statistically significant differences noticed, regarding the levels of cardiovascular disease related risks between in patients aware or unaware of the diseases, under control or uncontrolled of the situation., Conclusion: People under high risk or very high risk on cardiovascular disease did exist in Zhejiang, especially in those 60-year-olds, males and urban residents.

Objective: To investigate the joint association of adiposity, physical activity, sedentary leisure time and job intensity on diabetes and impaired glycoregulation., Methods: Data was from the 2010 Zhejiang survey and 17 437 adults ( ≥18 years) were examined. Logistic regression was used in this cross-sectional study., Results: Under the same level of sedentary leisure time, adiposity anticipants showed an OR of 2.52-2.75 times for people with diabetes than those with normal or underweight BMI, and anticipants with highest WC having an OR of 2.09-3.71 times than those with the lowest WC. With the same level of physical activity, those adiposity anticipants had an OR of 2.19-5.98 times for diabetes than those with normal or underweight BMI, and anticipants with the highest WC had an OR of 3.10-6.25 times than those with the lowest WC. Anticipants who had no physical activity but with adiposity. BMI had an OR of 3.21 times than those with normal or underweight BMI, but there was no significant difference between diabetes and BMI in those that practising physical activities. Within the 3 levels of physical activity, participants that practising no physical activity, had an OR of 1.68-4.23 times for diabetes than those who were physically active when WC was used as a measure for adiposity., Conclusion: Controlling weight and waist seemed more important than improving physical activity or reducing sedentary leisure time in the prevention program on diabetes. WC was better measure on the risks for adiposity-related diabetes than BMI, especially when physical activity was under consideration.

Objective: To conduct a survival analysis of gastric cancer patients according to the data of population-based cancer registry during 2005-2010 in Zhejiang Province in order to provide information for prognosis assessment and control of this disease., Methods: The deadline of the last follow-up of 26, 536 patients was December 31st, 2012. Cumulative observed survival rate (OSR) and expected survival rate were calculated by life table and Hakulinen method., Results: the 1-, 3-, and 5-year OSR were 58.51%, 39.07%, and 33.08%, and the 1-, 3-, and 5-year relative survival rates (RSR) were 60.24%, 42.90%, and 39.03%, respectively. The 1-, 3-, and 5-year relative survival rates of males vs. females were 60.49% vs. 59.65%, 42.88% vs. 42.96%, and 38.76% vs. 39.64%, respectively, statistically with non-significant differences (χ(2) = 0.13, P > 0.05) between them. The 5-year OSR and RSR of urban patients were 39.15% and 46.30%, and the 5-year OSR and RSR of rural patients were 30.81% and 36.32%, with statistically significant differences between them (P < 0.05). The 15-44 age group had a better relative survival rate., Conclusions: The survival rate of gastric cancer patients in Zhejiang Province is low. Work of cancer prevention and control should be strengthened. The wide variation in gastric cancer survival rates between urban and rural patients indicates that priority should be given to rural areas in allocating medical and public health resources.

Objective: To describe the survival status and to analyze the factors associated with mortality on first-ever stroke patients., Methods: The first-ever stroke patients registered in 2009 were collected from "Zhejiang provincial information system for NCDs' surveillance and management". Survival status and the cause of death through active and passive follow-up programs, were collected. Kaplan-Meier methods were used for survival description. Monovariant and multivariant Cox's proportional hazard regression models were used to analyze risk factors on mortality., Results: A total of 78 189 patients, who suffered from cerebral infarctions (ICD-10:I63), intracerebral haemorrhages(I61), subarachnoid haemorrhages (I60) and unspecified strokes (I64), accounted for 61.65%, 30.42%, 2.32% and 5.62%, were recruited. 33 265 cases died during the period of this study. 27 147 cases were stroke related, accounted for 81.61%. 6 122 cases died on the same day, with one-day case fatality as 7.83% and the overall 28-day case fatality as 21.01%. The survival rates from one-year to four-year were 72.04% , 68.92%, 66.27% and 64.29%, respectively. The four-year survival rates of I63, I61, I60 and I64 were 80.06%, 50.15%, 71.80% and 21.41%, respectively. Effect of the model showed that the risk factors associated with mortality were age, gender, educational level, the diagnosis and quality of the hospitals on treatment, hypertension and the types of stroke incidences. Age had interacted with gender (P < 0.001). Results from the 'single effect' showed that males had higher risk than females in those younger than 75 years old, but vice versa in those older than 75 of age., Conclusion: Patients appeared very high risk of death in both acute and sub-acute phases. Factors including age, gender, educational level, both quality on diagnosis and treatment of the hospitals, clinical types of hypertension and stroke etc. were at risk, associated with prognosis of the disease.

Objective: To explore the relationship between level of glucose metabolism and risk of cancer incidents., Methods: 10 079 aged ≥ 40, local residents in Jiashan were enrolled by stratified cluster sampling method in 2011. All the subjects accepted retrospective investigation on incidents of diabetes mellitus and cancers plus blood testing for level of glucose metabolism. Differences between glucose metabolism level and cancer incidence were analyzed by trend Chi-square test., Results: The prevalence of cancers in female diabetes mellitus patients was 268.79 per 100 000, higher than in males-124.31 per 100 000 (χ² = 4.012 2, P < 0.05). The incidence rates of cancers in groups of normal glucose regulation (NGR), impaired glucose regulation (IGR), and diabetes mellitus (DM) patients were 77.32 per 100 000, 115.40 per 100 000 and 204.08 per 100 000, respectively. The incidence of cancers in local residents who were older than 40 years had increased with the decrease of glucose regulation ability. The subjects were divided into three groups by FPG, 2h-PG and HbA1c levels respectively and the incident risks on cancers under each index increased 30.0%, 39.0% and 62.4%, respectively. Compared to the general population, the cancer incidence in DM group increased 1.67 times and 2.62 times increase in women but did not show significant difference in men (χ² = 0.524 0, P > 0.05). Breast and colorectal cancers were the most common tumors that accompanied with DM, and their incidence increased along with the decrease of glucose regulation ability. The incidence rates of breast and colorectal cancer in T2DM were 2.36 and 1.87 times more than in general population, and the incidence rates of female patients had an increase of 2.53 and 6.74 times, respectively., Conclusion: The cancer incidence was higher in DM group than in the non-DM group while the incidence rates of both breast and colorectal cancer were relevant to the levels of glucose metabolism.

Objective: To provide reference information for prognosis and control of female cancers by analyzing survival rates of breast, cervical and ovarian cancer patients during 2005-2010 in Zhejiang province., Methods: The morbidity and mortality data of 18 133 breast, cervical and ovarian cancer patients whose information were registered in health surveillance zone during 2005-2010 in Zhejiang were analyzed. The December 31(st), 2012 was set as the deadline of survival time. Observed survival rate (OS) and relative survival rate (RS) were calculated using SURV3.01 software and comparison between survival rates was conducted through Hakulinen's likely hood ratio test., Results: The 5-year OS of breast cancer, cervical cancer, and ovarian cancer were 76.89%, 70.79%, 2.59%, respectively during 2005-2010 in Zhejiang province. The 5-year RS of the three cancers were 80.26%, 73.89%, 55.17%, respectively. The 5-year RS of breast cancer, cervical cancer, and ovarian cancer in urban area were 83.11%, 77.87%, and 57.22% and 78.00%, 72.21%, and 53.83% in rural areas, respectively. The overall RS of urban patients was higher than the rural's (χ(2) = 24.98, 11.55 and 6.62, respectively, all P values < 0.05). The 5-year RS of breast cancer, which was grouped by age, showed that the 15-44 years group was the highest (83.40%), while 65-77 years group was the lowest (74.67%). The 5-year RS of cervical cancer decreased with age, with a 41.73% decrease from 83.83% (15-44 years group) to 42.10% ( ≥ 75 years group). The 15-44 years group showed the highest 5-year RS of ovarian cancer (74.30%), while ≥ 75 years group was the lowest (41.80%)., Conclusion: The prognosis of breast cancer and cervical cancer were relatively optimistic, while the ovarian cancer was not. The prognosis of female cancer patients in urban areas were better than in rural areas.