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Objective: The objective of this study is to investigate the gene-gene interactions associated with NSCL/P among DNA repair genes., Design: This study included 806 NSCL/P case-parent trios from China. Quality control process was conducted for genotyped single nucleotide polymorphisms (SNPs) located in six DNA repair genes ( ATR , ERCC4 , RFC1 , TYMS , XRCC1 and XRCC3 ). We tested gene-gene interactions with Cordell's method using statistical package TRIO in R software. Bonferroni corrected significance level was set as P  = 4.24 × 10 -4 . We also test the robustness of the interactions by permutation tests., Setting: Not applicable., Patients/participants: A total of 806 NSCL/P case-parent trios (complete trios: 682, incomplete trios: 124) with Chinese ancestry., Interventions: Not applicable., Main Outcome Measure(s): Not applicable., Results: A total of 118 SNPs were extracted for the interaction tests. Fourteen pairs of significant interactions were identified after Bonferroni correction, which were confirmed in permutation tests. Twelve pairs were between ATR and ERCC4 or XRCC3 . The most significant interaction occurred between rs2244500 in TYMS and rs3213403 in XRCC1 ( P  = 8.16 × 10 -15 )., Conclusions: The current study identified gene-gene interactions among DNA repair genes in 806 Chinese NSCL/P trios, providing additional evidence for the complicated genetic structure underlying NSCL/P. ATR , ERCC4 , XRCC3 , TYMS and RFC1 were suggested to be possible candidate genes for NSCL/P., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

There is limited and inconsistent evidence for the association of statin therapy and statin treatment patterns with the risk of recurrent intracerebral hemorrhage (ICH) in patients with prior ICH. To assess the association of statin therapy and its intensity, type, initiation time, and discontinuation with the risk of recurrent ICH and mortality in Chinese patients with ICH. Patients with newly diagnosed ICH in the Beijing Employee Medical Claims Data database from 2010 to 2017 were included. Post-ICH statin users (post-diagnosis only) and nonusers (never), statin discontinuers (pre-diagnosis only) and continuers (pre- and post-diagnosis) were matched on a 1:1 propensity score, respectively. Adjusted Cox proportional risk models were used to estimate the risk ratios for ICH readmission and mortality under various statin patterns. A total of 2668 post-ICH statin users and 2668 nonusers without a history of statin use were enrolled. Post-ICH statin users had a lower risk of ICH readmission (HR, 0.57; 95% CI 0.48, 0.69) and all-cause death (0.56: 0.49, 0.63) than nonusers. Low/moderate-intensity treatment was associated with a 63% lower risk of recurrent ICH compared with nonusers (0.37: 0.29, 0.46), whereas high-intensity treatment did not reduce the risk (0.93: 0.74, 1.16). Both low/moderate-intensity (0.42: 0.36, 0.48) and high-intensity statins (0.57: 0.48, 0.69) were associated with a lower risk of all-cause mortality. The risk of ICH readmission was 53% (0.47: 0.30, 0.74) lower with adherence to rosuvastatin than with atorvastatin. Only starting medication within 30 days of the first diagnosis of ICH reduced the risk of ICH readmission (0.49: 0.40, 0.60). Among patients with a history of statin use, 1807 discontinuing and 1,807 continuing users of statins were included. The risk of ICH readmission (4.00: 3.32, 4.80) and the risk of all-cause death (4.01: 3.57, 4.50) were substantially increased in statin discontinuation compared with continued statin use. Statin therapy after ICH was associated with lower risks for ICH readmission and all-cause mortality compared with non-statin therapy, especially at low/moderate intensity and early initiation of statins after ICH. Adherence to rosuvastatin was associated with a lower risk of recurrence of ICH than atorvastatin. Among patients with a statin history prior to ICH, discontinuation of statins after ICH was associated with increased risk of ICH recurrence and death., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Comorbidities of coronavirus disease 2019 (COVID-19)/coronary heart disease (CHD) pose great threats to disease outcomes, yet little is known about their shared pathology. The study aimed to examine whether comorbidities of COVID-19/CHD involved shared genetic pathology, as well as to clarify the shared genetic variants predisposing risks common to COVID-19 severity and CHD risks., Methods: By leveraging publicly available summary statistics, we assessed the genetically determined causality between COVID-19 and CHD with bidirectional Mendelian randomization. To further quantify the causality contributed by shared genetic variants, we interrogated their genetic correlation with the linkage disequilibrium score regression method. Bayesian colocalization analysis coupled with conditional/conjunctional false discovery rate analysis was applied to decipher the shared causal single nucleotide polymorphisms (SNPs)., Findings: Briefly, we observed that the incident CHD risks post COVID-19 infection were partially determined by shared genetic variants. The shared genetic variants contributed to the causality at a proportion of 0.18 (95% CI 0.18-0.19) to 0.23 (95% CI 0.23-0.24). The SNP (rs10490770) located near LZTFL1 suggested direct causality (SNPs → COVID-19 → CHD), and SNPs in ABO (rs579459, rs495828), ILRUN(rs2744961), and CACFD1(rs4962153, rs3094379) may simultaneously influence COVID-19 severity and CHD risks., Interpretation: Five SNPs located near LZTFL1 (rs10490770), ABO (rs579459, rs495828), ILRUN (rs2744961), and CACFD1 (rs4962153, rs3094379) may simultaneously influence their risks. The current study suggested that there may be shared mechanisms predisposing to both COVID-19 severity and CHD risks. Genetic predisposition to COVID-19 is a causal risk factor for CHD, supporting that reducing the COVID-19 infection risk or alleviating COVID-19 severity among those with specific genotypes might reduce their subsequent CHD adverse outcomes. Meanwhile, the shared genetic variants identified may be of clinical implications for identifying the target population who are more vulnerable to adverse CHD outcomes post COVID-19 and may also advance treatments of 'Long COVID-19.', (© 2023. The Author(s).)

Background Diabetic kidney disease (DKD) is a common diabetic complication and increases the complexity of diabetes management. No prospective study has focused on the association between DKD and Life's Essential 8 (LE8). Our study aims to examine the association between LE8 and DKD risk. Methods and Results A total of 7605 participants, aged 54.32±9.77 years, and 4688 participants, aged 56.11±10.38 years, were included in the longitudinal and trajectory analyses, respectively, from 2006 to 2020. The DKD was confirmed using data collected during each follow-up. LE8 was based on 4 health behaviors and 4 health factors. The range of each metric was 0 to 100, and the overall LE8 score was calculated as the unweighted average of all 8 component metric scores. The trajectories of LE8 during 2006 to 2010 were classified using latent mixture models. Cox models and restricted cubic splines were applied. After a median follow-up of 12.41 and 6.71 years in longitudinal and trajectory analyses, respectively, the DKD incidence decreased, with the LE8 level increasing ( P -trend<0.05), and the linearity assumption for this relationship ( P -nonlinear=0.685) had been satisfied. Adjusted hazard ratios (HRs) for the highest tertile were 0.77 (95% CI, 0.69-0.87) and 0.70 (95% CI, 0.62-0.78) in baseline and time-updated LE8 scores, respectively, compared with the lowest tertile. Adjusted HR was 0.53 (95% CI, 0.41-0.69) for the stable-high pattern compared with the stable-low pattern. Conclusions Although LE8 is an indicator of cardiovascular health, the beneficial impact of a high LE8 score is also evident in the protection of renal health among patients with diabetes.

Background: Aspiration pneumonia (AP) is difficult to diagnose and has poor outcomes. This case-control study aimed to explore the risk factors and delineate the antibiotic usage for AP., Methods: Inpatients diagnosed with community-acquired pneumonia (CAP) from 2013 to 2017, enrolled in the urban employee basic medical insurance program in Beijing, were included and classified into the AP ( N  = 2,885) and non-AP ( N  = 53,825) groups. Risk factors were identified by logistic regression., Results: Older age (compared to 18-64 years, OR for 65-79 years: 4.3, 95% CI: 3.8-4.9; OR for >80 years: 6.3, 95% CI: 5.6-7.2), male (OR: 1.4, 95% CI: 1.3-1.5), cerebrovascular disease (OR: 3.1, 95% CI: 2.8-3.5), dementia (OR: 2.0, 95% CI: 1.8-2.1), vomiting (OR: 1.4, 95% CI: 1.2-1.7), Parkinson's disease (OR: 2.1, 95% CI: 1.8-2.4), and epilepsy (OR: 3.2, 95% CI: 2.8-3.7) were associated with an increased risk of AP. 92.8% of the AP patients received antibiotic therapy. Among them, patients treated with broad-spectrum antibiotics, antibiotics for injection, and combined antibiotics accounted for 93.3%, 97.9%, and 81.7%, respectively., Conclusions: Older age, male, and several comorbidities were independent risk factors for AP, and combined antibiotics treatments are common, which merits attention in accurate detection of AP in a high-risk population., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Tianming Zhao et al.)

Background: Previous evidence yielded contradictory findings on the relationship between metformin and anemia. This study aims to assess whether metformin use is associated with iron-deficiency anemia (IDA) risk in patients with type 2 diabetes (T2D) in Beijing, China., Methods: Overall, 60,327 newly diagnosed T2D patients were included based on a historical cohort study design. The information pertaining to these patients was gathered from the Beijing Medical Claim Data for Employees Database. These patients were then categorized into the metformin and non-metformin groups and matched on a 1:1 propensity score based on their initial antidiabetic prescription. The Cox proportional hazards models were utilized to calculate the incidences and the hazard ratios (HRs)., Results: The study enrolled 27,960 patients with type 2 diabetes, with 13,980 patients in each of the initial glucose-lowering prescription groups: metformin and non-metformin. During a median follow-up period of 4.84 years, 4832 patients developed IDA. The incidence of IDA was significantly lower in the metformin group (26.08/1000 person-years) than in the non-metformin group (43.20/1000 person-years). Among the three groups divided by the proportion of days covered by metformin, we found a negative correlation between the proportion of days covered by metformin and the risk of IDA. The risk of IDA in patients with a proportion of days covered by metformin of <20%, 20-79%, and ≥80% was 0.43 (0.38, 0.48), 0.37 (0.34, 0.42), and 0.91 (0.85, 0.98), respectively, compared to the non-metformin group. We also performed subgroup analyses and sensitivity analyses: the incidence of IDA in the metformin group was lower than that in the non-metformin group in all subgroups, and the protective effect was more significant in subgroups of patients aged ≥65, with Charlson comorbidity index (CCI) ≥2, and with gastric acid inhibitor use., Conclusions: In Chinese patients with T2DM, metformin treatment was associated with a decreased risk of IDA admission, and this risk responded positively to the proportion of days covered by metformin. These findings suggest that metformin may have a pleiotropic effect on IDA in patients with type 2 diabetes. Our study has important clinical implications for the management of patients with diabetes and other conditions that increase the risk of IDA.

Background: Metformin treatment is associated with vitamin B12 deficiency, which is a risk factor for neuropathy. However, few studies have examined the relationship between metformin treatment and diabetic peripheral neuropathy (DPN), and the available findings are contradictory. We aimed to assess whether metformin treatment is associated with DPN in patients with type 2 diabetes mellitus (T2DM) in Beijing, China., Methods: All patients with newly diagnosed T2DM between January 2010 and September 2012 in the Medical Claim Data for Employees database were included. Metformin treatment was defined as any record of metformin prescription. The average daily dose of metformin during follow-up was calculated. DPN was defined as DPN admissions occurring after a diagnosis of T2DM in the database. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models., Results: Among 49,705 T2DM patients, 1,933 DPN events were recorded during a median follow-up of 6.36 years. The crude incidence rates were 7.12 and 3.91 per 1000 person-years for patients treated with metformin (N=37,052) versus those not treated (N=12,653). Patients treated with metformin had an 84% increased risk of DPN compared with patients not using metformin (HR, 1.84; 95% CI, 1.62, 2.10). The daily dose was positively associated with DPN risk (HR, 1.48; 95% CI, 1.46, 1.51; P for trend <0.001). The risk of DPN was 1.53-fold (1.30, 1.81) and 4.31-fold (3.76, 4.94) higher in patients with daily doses of 1.0-2.0 g and >2.0 g, respectively, than in patients who did not receive treatment. Patients aged less than 60 years had a higher risk of DPN (P<0.05 for interaction test). Among patients taking vitamin B12 at baseline, there was no increased risk of DPN in the metformin group (1.92: 0.79, 4.69)., Conclusions: In Chinese patients with T2DM, metformin treatment was associated with an increased risk of DPN admission and this risk responds positively to the daily dose of metformin. In particular, metformin use was a major risk factor for DPN in younger patients. Concomitant use of vitamin B12 may avoid the increased risk of DPN associated with metformin use., 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., (Copyright © 2023 Yang, Yu, Wu, Chen, Wang, Wang, Qin, Wu, Wu and Hu.)

Region-based methods are currently achieving state-of-the-art performance for monocular 3D object tracking. However, they are still prone to fail in cases of partial occlusions and ambiguous colors. We propose a novel region-based method to tackle these problems. The key idea is to derive a pixel-wise weighted region-based cost function using contour constraints. First, we propose a novel region-based cost function using search lines around the object contour, which is more efficient than previous region-based cost functions using signed distance transform, and in the meantime can deal with partial occlusions and ambiguous colors more effectively. Second, we propose an optimal searching strategy to search the object contour points in cluttered scenes, and then use the object contour points to detect partial occlusions and ambiguous colors. Third, we propose a pixel-wise weight function based on color and distance constraints of the object contour points, and integrate it into the proposed region-based cost function to reduce the negative impact of partial occlusions and ambiguous colors. We verify the effectiveness and efficiency of our method on challenging public datasets. Experiments demonstrate that our method outperforms the recent state-of-the-art region-based methods in complex scenarios, especially in the presence of partial occlusions and ambiguous colors.

Introduction: Statins are lipid-lowering drugs and starting treatment has been associated with DNA methylation changes at genes related to lipid metabolism. However, the longitudinal pattern of how statins affect DNA methylation in relation to lipid levels has not been well investigated., Methods: We conducted an epigenetic association study in a longitudinal Swedish twin sample in previously reported lipid-related CpGs (cg10177197, cg17901584 and cg27243685). First, we applied a mixed-effect model to assess the association between blood lipids (total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), total triglyceride (TG)) and DNA methylation. Then, we performed a piecewise latent linear-linear growth curve model (LGCM) to explore the long-term changing pattern of lipids and methylation in response to statin treatment. Finally, we used a bivariate autoregressive latent trajectory model with structured residuals (ALT-SR) to analyze the cross-lagged effects in different lipid-CpG pairs in statin users and non-users., Results: We replicated the associations between TC, LDL, HDL and DNA methylation level in cg17901584 and cg27243685 (P values ranged from 4.70E-12 to 1.84E-04). From the piecewise LGCM, we showed that TC and LDL significantly decreased in statin users before treatment started and then remained stable. For non-statin users, we only found a slightly significant decreasing trend for TC and TG. We observed a similar dynamic pattern for methylation levels at cg27243685 and cg17901584. Before statin initiation, cg27243685 showed a significantly increasing trend and cg17901584 a decreasing trend, but post-treatment, there were no additional changes. From the ALT-SR model, we found TG levels to be significantly associated with the DNA methylation level of cg27243685 at the next measurement in statin users (estimate = 0.383, 95% CI: 0.173, 0.594, P value < 0.001)., Conclusions: Longitudinal blood lipid and DNA methylation levels change after statin treatment initiation, where the latter is mostly a response to alterations in lipid levels and not vice versa., (© 2022. The Author(s).)

Although UV light-switchable luminescent films are of importance for application in soft optical devices and anticounterfeiting labels, there are still challenges in developing such films integrated with outstanding luminescent property, high self-healing efficiency, and simultaneously excellent mechanical strength. Herein, double-network (DN) luminescent films are designed and constructed via an intermolecular hydrogen bond crosslinking strategy of poly(ethylene glycol) (PEG) in sulfur quantum dots (S-QDs) and polyurethane (PU), where S-QDs ("stone" one) play dual roles of acting both as a soft segment to crosslink another segment PU ("bird" one) and also as the origin of a luminescence center ("bird" two) in films. In addition, lanthanide(III) complexes (LnCs, Ln═Eu 3+ , Tb 3+ ) are employed as another emission source to embed in the films and switch the emission colors of DN films from the multicolor (red-yellow-green) of LnCs to the blue color of S-QDs by changing the ultraviolet excitation wavelength from 254 to 365 nm. It is worth noting that the crosslinking network strategy can effectively prevent S-QDs and LnCs from aggregating or leaking and enable both luminescence centers to homogeneously distribute, resulting in luminescent DN films possessing extraordinary UV light-switchable luminescence, improved mechanical property, and excellent self-healing ability. This work presents a viable method for the design and fabrication of luminescent films with multifunctional applications in flexible robotics, wearable devices, and dual-luminescent anticounterfeiting materials.

Glucosamine is widely used around the world and as a popular dietary supplement and treatment in patients with osteoarthritis in China; however, the real-world cardiovascular risk of glucosamine in long-term use is still unclear. A retrospective, population-based cohort study was performed, based on the Beijing Medical Claim Data for Employees from 1 January 2010 to 31 December 2017. Patients newly diagnosed with osteoarthritis were selected and divided into glucosamine users and non- glucosamine users. The glucosamine users group was further divided into adherent, partially adherent, and non-adherent groups according to the medication adherence. New-onset cardiovascular diseases (CVD) events, coronary heart diseases (CHD), and stroke, were identified during the observational period. COX proportional regression models were used to estimate the risks. Of the 685,778 patients newly diagnosed with osteoarthritis including 240,419 glucosamine users and 445,359 non-users, the mean age was 56.49 (SD: 14.45) years and 59.35% were females. During a median follow-up of 6.13 years, 64,600 new-onset CVD, 26,530 CHD, and 17,832 stroke events occurred. Glucosamine usage was significantly associated with CVD (HR: 1.10; 95% CI: 1.08−1.11) and CHD (HR: 1.12; 95% CI: 1.09−1.15), but not with stroke (HR: 1.03; 95% CI: 0.99−1.06). The highest CVD risk was shown in the adherent group (HR: 1.68; 95% CI: 1.59−1.78), followed by the partially adherent group (HR: 1.26, 95% CI: 1.22−1.30), and the non-adherent group (HR: 1.03; 95% CI: 1.02−1.05), with a significant dose−response relationship (p-trend < 0.001). In this longitudinal study, adherent usage of glucosamine was significantly associated with a higher risk for cardiovascular diseases in patients with osteoarthritis.

Objectives: This study assessed the associations between long-term trajectories of percentage of energy from fat (PEF) and obesity among Chinese adults. Methods: Longitudinal data collected by the China Health and Nutrition Survey from 1991 to 2015 were analyzed. A body mass index ≥28.0 was defined as general obesity. Participants’ baseline PEF levels were categorized as lower than the recommendation of the Chinese Dietary Guideline (<20%), meeting the recommendation (20−30%), and higher than the recommendation (>30%). Patterns of PEF trajectories were identified by latent class trajectory analysis for overall participants and participants in different baseline PEF groups, respectively. Cox proportional hazards regression models with shared frailty were used to estimate associations between PEF and obesity. Results: Data on 13,025 participants with 72,191 visits were analyzed. Four patterns of PEF trajectory were identified for overall participants and participants in three different baseline PEF groups, respectively. Among overall participants, compared with “Baseline Low then Increase Pattern” (from 12% to 20%), participants with “Baseline Normal-Low then Increase-to-High Pattern” (from 20% to 32%) had a higher hazard of obesity (hazard ratio (HR) and 95% confident interval (CI) at 1.18 (1.01−1.37)). Compared with the “Stable Pattern” group (stable at around 18% and 22%, respectively), participants with “Sudden-Increase Pattern” (from 18% to 30%) in the baseline group whose PEF levels were lower than the recommendation and those with “Sudden-Increase then Decrease Pattern” (rapidly increased from 25% to 40%, and then decreased) in the baseline group who met the recommendation had higher hazards of obesity (HRs and 95% CIs being 1.65 (1.13−2.41) and 1.59 (1.03−2.46), respectively). Conclusions: Adults with a trajectory that involved a sudden increase to a high-level PEF had a higher risk of general obesity. People should avoid increasing PEF suddenly.

Background: Evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with cardiovascular diseases (CVDs). However, the results are inconsistent, and the causality remains to be established., Objective: We aimed to investigate the potential causal relationship between NAFLD and CVDs, including arterial stiffness, coronary artery disease, heart failure, stroke, ischemic stroke and its subtypes using two-sample Mendelian randomization (MR)., Methods: Genetic instruments were used as proxies for NAFLD. Publicly available summary-level data were obtained from the UK Biobank, the CARDIoGRAMplusC4D Consortium, the MEGASTROKE Consortium, and other consortia. Six complementary MR methods were performed, including inverse variance weighted method (IVW), MR-Egger, weighted median, weighted mode, MR-PRESSO, and MR-RAPS., Results: NAFLD was significantly associated with arterial stiffness (β = 0.04 [95%CI, 0.02-0.06], P = 5.53E-04). Moreover, the results remained consistent and robust in the sensitivity analysis. As for heart failure, the IVW method suggested that NAFLD was significantly associated with heart failure (OR = 1.08, 95%CI: 1.02-1.14, P = 0.005) in the absence of pleiotropy. However, there were no significant associations of NAFLD with coronary artery disease, stroke, ischemic stroke, or any ischemic stroke subtype., Conclusion: The MR study supported the causal effect of NAFLD on arterial stiffness. However, the study did not provide enough evidence suggesting the causal associations of NAFLD with heart failure, coronary artery disease, and any stroke subtypes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Near vision (NV) is essential to visual quality of individuals, and could be affected by different factors and changed gradually with the development of society. An update estimates is needed. Our study aims to investigate the age-trends in and sociodemographic characteristics associated with uncorrected near vision acuity (UNVA) in people ≥50 years in southern China., Methods: A population-based, cross-sectional survey on the eye health status of residents in both inland and coastal areas of Fujian Province, southern China was performed by Eye Institute and Affiliated Xiamen Eye Center of Xiamen University. People aged ≥50 years (10,044 subjects) in Fujian province were recruited according to the cluster sampling design by Fujian eye cross sectional study (FJES) group. The contents of the questionnaire survey included age, gender, education, occupation and other socioeconomic status. UNVA and slit lamp examination were performed for the participants in the field survey. Analysis of variance (ANOVA) was applied to compare the mean among groups of normally distributed parameters of UNVA and the chi-square (χ 2 ) test was used to compare the proportion., Results: Among the baseline participants, 8,211 (81.8%) attended follow-up examinations. The sample had a mean age of 64.4 years [standard deviation (SD) =8.9], and 4,836 of the participants were female (58.9%). The average UNVA values for males and females were 0.29±0.18 and 0.28±0.17, respectively (P=0.000). UNVA gradually decreased with age and plateaued between 65 and 80 years old. There were significant differences in the mean values of UNVA associated with different occupations (P=0.000). UNVA was significantly different among people with different education levels (P=0.000). The average UNVA in people in coastal areas was 0.28, while that in people in inland areas was 0.29 (P=0.006). People in urban areas appeared to have better UNVA on average (0.29) than those in rural areas (0.27; P=0.000)., Conclusions: After age 50, NV was reduced gradually. Age, gender, education, occupation, income and geographical factors may affect the NV performance of adults, which should be taken into account to achieve a good management of vision quality., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-1526/coif). The authors have no conflicts of interest to declare., (2022 Annals of Translational Medicine. All rights reserved.)

Purpose: To describe the objective and design of the Fujian Eye Study and to introduce the general characteristics and vision condition of this study., Methods: The Fujian Eye Study (FJES) is a population-based cross-sectional survey on the public eye health status of residents over 50 years old in the entire Fujian Province of Southern China, which contains both urban and rural areas and coastal and inland regions. 10,044 participants were enrolled using a two-stage cluster sampling design and underwent a questionnaire and a series of standard examinations both physical and ocular. The main subgroups of data collection included age, sex, region, refractive error, education background, income, eating habits, smartphone usage in the dark, complaints of eye discomfort, history of chronic diseases, consumption of tobacco, alcohol, or tea., Results: 8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects) and rural populations (3533 subjects) and coastal residents (6434 subjects) and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39 (SD 8.87) years (median 64 years; range 50-98 years). 227 (3.33%) had vision impairment (VI), 195 (2.87%) had low vision and 14 (0.21%) were blind. The mean presenting near visual acuity (PNVA) was 0.28 (0.17), the mean presenting distance visual acuity (PDVA) was 0.61 (0.30), and the mean best corrected visual acuity (BCVA) was 0.82 (0.28)., Conclusions: The FJES collected detailed questionnaire information and overall ocular and physical examinations, which provide the opportunity to identify risk factors and images of VI and eye diseases and to evaluate their associations with chronic diseases and basic personal information., (© 2022. The Author(s).)

Background: This population-based, cross-sectional study aimed to assess the correlation between near vision and smartphone usage among people aged ≥50 years in China., Methods: This study was performed on the ocular health status of residents in Fujian Province, Southeast China. People aged ≥50 years were recruited. The main contents of the survey for the residents included socioeconomic status, uncorrected near visual acuity (UNVA), refractive state, as well as a questionnaire about smartphone usage and visual quality., Results: Smartphone adoption accounted for 67.7% (4,702 individuals) of the total population, which decreased with age in the elderly. Smartphone owners had a higher average UNVA of 0.31±0.18 than non-smartphone owners (0.23±0.14), and the difference was statistically significant (P<0.001). Individuals who used smartphones for a long time usually had better UNVA (Pearson correlation coefficient 0.144, P<0.001). The rates of complaints of distance vision loss, near vision loss, ocular surface discomfort in smartphone users were significantly higher than that of non-users (P<0.001). Also, smartphone adoption and visual quality differed between urban and rural respondents., Conclusions: Smartphone adoption and usage time in the elderly significantly decreased with age and UNVA, and the performance of visual impairment was not consistent in urban and rural areas.

Background: Glaucoma is a leading cause of irreversible vision loss worldwide. Increased intraocular pressure (IOP) is widely recognized as the most important modifiable risk factor for the development of glaucoma. In order to arouse people's attention to glaucoma, this study set out to describe IOP and its related factors in adults living in urban and rural areas of Fujian, a coastal province in southern China., Methods: A population-based cross-sectional study (the Fujian Eye Study) was conducted from May 2018 to October 2019. The study enrolled 10,044 residents of Fujian aged 50 years and over to participate in a questionnaire and a series of physical and ocular examinations, such as height, weight, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), visual acuity (VA), IOP, slit lamp and fundus examinations. Participants were divided into subgroups by age, sex, region, refraction, and other characteristics. IOP was measured with the handheld iCare rebound tonometer., Results: A total of 8,211 individuals were included, of whom 8,153 underwent IOP examination. The mean IOP was 13.88±3.46 mmHg (median, 14 mmHg; range, 5-57 mmHg). Multiple regression analysis revealed that IOP was associated with age, sex, refraction, SBP, living in an inland area, smartphone use in the dark, and a history of chronic diseases. However, IOP was statistically independent of living in an urban or rural area, body mass index, DBP, tobacco use, alcohol use, and tea consumption., Conclusions: Additional vision-related policies targeting younger women, people with high SBP, myopia, and chronic diseases, and those living in inland areas are needed in future.

Background: Studies on DNA methylation have the potential to discover mechanisms of cardiovascular disease (CVD) risk. However, the role of DNA methylation in CVD etiology remains unclear., Results: We performed an epigenome-wide association study (EWAS) on CVD in a longitudinal sample of Swedish twins (535 individuals). We selected CpGs reaching the Bonferroni-corrected significance level (2 [Formula: see text] 10 -7 ) or the top-ranked 20 CpGs with the lowest P values if they did not reach this significance level in EWAS analysis associated with non-stroke CVD, overall stroke, and ischemic stroke, respectively. We further applied a bivariate autoregressive latent trajectory model with structured residuals (ALT-SR) to evaluate the cross-lagged effect between DNA methylation of these CpGs and cardiometabolic traits (blood lipids, blood pressure, and body mass index). Furthermore, mediation analysis was performed to evaluate whether the cross-lagged effects had causal impacts on CVD. In the EWAS models, none of the CpGs we selected reached the Bonferroni-corrected significance level. The ALT-SR model showed that DNA methylation levels were more likely to predict the subsequent level of cardiometabolic traits rather than the other way around (numbers of significant cross-lagged paths of methylation → trait/trait → methylation were 84/4, 45/6, 66/1 for the identified three CpG sets, respectively). Finally, we demonstrated significant indirect effects from DNA methylation on CVD mediated by cardiometabolic traits., Conclusions: We present evidence for a directional association from DNA methylation on cardiometabolic traits and CVD, rather than the opposite, highlighting the role of epigenetics in CVD development.

Little is known about the influence of ambient fine particulate matter (PM 2.5 ) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0-10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM 2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m 3 increase in PM 2.5 concentrations on lag days 0-2 corresponded to a 0.64% (95% confidence interval: 0.55-0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m 3 increase in PM 2.5 concentrations on lag days 0-3 corresponded to a 0.82% (95% confidence interval: 0.67-0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM 2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations.

Objective: We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema., Methods: From April 2017 to December 2018, 533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study. Univariate analysis was performed to explore and define the risk factors. A scoring system was then established on the basis of odds ratio values in the regression analysis., Results: The additive scoring system values ranged from 6 to 22. The receiver operating characteristic (ROC) curve of this scoring system showed a sensitivity and specificity of 83.3% and 57.3%, respectively, to predict the risk of lymphedema at a cut-off of 15.5 points; the area under the curve was 0.736 (95% confidence interval: 0.662-0.811), with χ 2  = 5.134 ( P  = 0.274) for the Hosmer-Lemeshow test., Conclusions: The predictive efficiency and accuracy of the scoring system were acceptable, and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema., Competing Interests: The authors declare no conflict of interest., (© 2020 Chinese Nursing Association. Production and hosting by Elsevier B.V.)

Background: Identifying subjects with a high risk of ischemic stroke is fundamental for prevention of the disease. Both genetic and environmental risk factors contribute to ischemic stroke, but the underlying epigenetic mechanisms which mediate genetic and environmental risk effects are not fully understood. The aim of this study was to explore whether DNA methylation loci located in the ATP-binding cassette G1 (ABCG1) and apolipoprotein E (APOE) genes, both involved in the metabolism of lipids in the body, are related to ischemic stroke, using the Fangshan/Family-based Ischemic Stroke Study in China. We also tested if these CpG sites were associated with early signs of cardiovascular atherosclerosis (carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and brachial-ankle pulse wave velocity (baPWV))., Results: DNA methylation at the cg02494239 locus in ABCG1 was correlated with ischemic stroke after adjusting for gender, previous history of diabetes and hypertension, smoking, drinking, body mass index, and blood lipid levels (above vs below mean, OR = 2.416, 95% CI 1.024-5.700, P = 0.044; 75-100% percentile vs 0-25% percentile, OR = 4.461, 95% CI 1.226-16.225, P = 0.023). No statistically significant associations were observed for the cg06500161 site in ABCG1 and the cg14123992 site in APOE with ischemic stroke. The study detected that hypermethylation of the ABCG1 gene was significantly associated with cIMT, hypermethylation of the APOE gene was significantly related to ABI, and methylation of the APOE gene was statistically negatively correlated with baPWV. The above relationships demonstrated gender differences., Conclusions: These findings suggest that epigenetic modification of ABCG1 and APOE may play a role in the pathway from disturbed blood lipid levels to the development of cardiovascular diseases. Future prospective validation of these findings is warranted.

Evidence on the prescription patterns of antihypertensive drug use in children and adolescents in China is scarce. A descriptive analysis of the Beijing Medical Claim Data, which covered over 95% of the urban residents, was conducted to investigate antihypertensive prescribing patterns and trends in children and adolescents aged under 18 from 2009 to 2014 in Beijing, China. An additional meta-analysis of trends in hypertension prevalence was conducted to compare trends with antihypertensive medications.A total of 11,882 patients received at least 1 prescription for antihypertensive drugs from 2009 to 2014. The number of annual antihypertensive users increased from 2009 to 2012, then declined steadily until 2014, which was consistent with the trend of the hypertension prevalence estimated from the meta-analysis. β-receptor blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors were the 3 most commonly prescribed antihypertensive drugs. More boys took the antihypertensive drugs than girls. For users aged under 3 years, thiazide diuretics, α-receptor blockers, and angiotensin-converting enzyme inhibitors were the most prescribed drugs, while β-receptor blockers, thiazide diuretics were the most used drugs for users above 3 years.In conclusion, antihypertensive drug prescribing for children and adolescents increased from 2009 to 2014, with different characteristics in different subgroups.

Background & Aims: To clarify the relationship between different breastfeeding duration and postpartum weight retention through meta-analysis., Methods: In this study, all relevant studies that described the effect of breastfeeding duration on postpartum weight retention were identified from Pubmed, Cochrane, and WANGFANG databases and so on (1960-2016). This meta-analysis had been registered in International Prospective Register of Systematic Reviews (CRD42016038409)., Results: Fourteen cohort studies involving 66 comparisons were included. Compared with bottle-feeding mothers, breastfeeding mothers had significantly lower postpartum weight retention of -0.38 kg (95% confidence interval: -0.64, -0.11 kg). Subgroup analysis showed that, mothers who were primipara, less than 30 years old or normal pre-pregnancy body mass index had lower postpartum weight retention. When breastfeeding duration were stratified into <12 weeks, 12 weeks-24 weeks, 24 weeks-48 weeks, and ≥48 weeks, postpartum weight retention in breastfeeding women presented a U-shaped trend: a decline during early breastfeeding duration (year 1) (from 0.23 kg at < 12 weeks to -1.58 kg at 24-48 weeks) and then an increase in the follow-up duration (from -1.58 kg at 24-48 weeks to -0.97 kg at more than 48 weeks)., Conclusions: Our results indicated that breastfeeding including exclusive breastfeeding and mixed breastfeeding were inversely related to postpartum weight retention. The decreasing influence of breastfeeding was more significant when the lactating mothers were less than 30 years old, primipara, normal pre-pregnant body mass index, or breastfeeding duration for 6-12 months., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Carotid intima-media thickness (CIMT) is a good surrogate for atherosclerosis. Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. We aim to investigate the relationships between homocysteine (Hcy) related biochemical indexes and CIMT, the associations between Hcy related SNPs and CIMT, as well as the potential gene-gene interactions. The present study recruited full siblings (186 eligible families with 424 individuals) with no history of cardiovascular events from a rural area of Beijing. We examined CIMT, intima-media thickness for common carotid artery (CCA-IMT) and carotid bifurcation, tested plasma levels for Hcy, vitamin B6 (VB6), vitamin B12 (VB12) and folic acid (FA), and genotyped 9 SNPs on MTHFR, MTR, MTRR, BHMT, SHMT1, CBS genes. Associations between SNPs and biochemical indexes and CIMT indexes were analyzed using family-based association test analysis. We used multi-level mixed-effects regression model to verify SNP-CIMT associations and to explore the potential gene-gene interactions. VB6, VB12 and FA were negatively correlated with CIMT indexes (p < 0.05). rs2851391 T allele was associated with decreased plasma VB12 levels (p = 0.036). In FABT, CBS rs2851391 was significantly associated with CCA-IMT (p = 0.021) and CIMT (p = 0.019). In multi-level mixed-effects regression model, CBS rs2851391 was positively significantly associated with CCA-IMT (Coef = 0.032, se = 0.009, raw p < 0.001) after Bonferoni correction (corrected α = 0.0056). Gene-gene interactions were found between CBS rs2851391 and BHMT rs10037045 for CCA-IMT (p = 0.011), as well as between CBS rs2851391 and MTR rs1805087 for CCA-IMT (p = 0.007) and CIMT (p = 0.022). Significant associations are found between Hcy metabolism related genetic polymorphisms, biochemical indexes and CIMT indexes. There are complex interactions between genetic polymorphisms for CCA-IMT and CIMT.

Background: A fixed-dose combination (FDC) of four compounds, hydrochlorothiazide 12.5 mg, triamterene 12.5 mg, dihydralazine 12.5 mg and reserpine 0.1 mg (HTDR), is widely used as an antihypertensive treatment in China. Although HTDR has been used in China for more than 30 years, there have been few comprehensive evaluations of this treatment., Objective: The aim of this study was to investigate the long-term efficacy and tolerability of HTDR in Chinese patients with essential hypertension., Methods: This was a 36-month, community-based, open-label surveillance study, conducted in the Huangpu District (Shanghai, China). The study was based in local primary healthcare settings. Subjects were recruited if they had essential hypertension, were aged ≥35 years at the time of enrolment, were expected to remain in the area for 3 years, and were able to provide informed consent. Patients who had secondary hypertension, myocardial infarction or stroke within 6 months of screening, impaired renal or hepatic function, history of cardiomyopathy or chronic heart failure, or were pregnant or lactating were excluded. HTDR was administered as one or two tablets per day in the morning. If necessary, additional hydrochlorothiazide was added. Blood pressure (BP) was measured at baseline and throughout the 36-month surveillance period every 3 months. Biochemical indicators (e.g. fasting blood glucose, plasma lipid parameters, plasma sodium and potassium, plasma uric acid and serum creatinine) were also measured, and adverse events were noted. BP reductions and the rate at which patients achieved BP targets (systolic BP [SBP] <140 mmHg and diastolic BP [DBP] <90 mmHg) throughout the period were determined. Subgroup analyses by sex and age were also conducted., Results: A total of 1529 patients (550 male, 979 female; mean age 65.7 years) entered the study. After the 36-month treatment period, 93.1% of patients had achieved the SBP target, 97.9% had achieved the DBP target, and 92.1% had achieved both. The mean decreases in SBP and DBP were 15.3 mmHg and 9.9 mmHg, respectively. Overall, 127 adverse events in 119 patients (7.8%) occurred during the follow-up period, most of which were mild to moderate. Plasma lipid profiles were improved after 24 months of treatment. In addition, a significant increase in plasma potassium and a significant reduction in plasma uric acid were seen., Conclusion: HTDR was found to have good long-term efficacy and tolerability in Chinese patients with essential hypertension.

Aerosol time-of-flight mass spectrometry (ATOFMS) measurements provide continuous information on the aerodynamic size and chemical composition of individual particles. In this work, we compare two approaches for converting unscaled ATOFMS measurements into quantitative particle mass concentrations using (1) reference mass concentrations from a co-located micro-orifice uniform deposit impactor (MOUDI) with an accurate estimate of instrument busy time and (2) reference number concentrations from a co-located aerodynamic particle sizer (APS). Aerodynamic-diameter-dependent scaling factors are used for both methods to account for particle transmission efficiencies through the ATOFMS inlet. Scaling with APS data retains the high-resolution characteristics of the ambient aerosol because the scaling functions are specific for each hourly time period and account for a maximum in the ATOFMS transmission efficiency curve for larger-sized particles. Scaled mass concentrations obtained from both methods are compared with co-located PM(2.5) measurements for evaluation purposes. When compared against mass concentrations from a beta attenuation monitor (BAM), the MOUDI-scaled ATOFMS mass concentrations show correlations of 0.79 at Fresno, and the APS-scaled results show correlations of 0.91 at Angiola. Applying composition-dependent density corrections leads to a slope of nearly 1 with 0 intercept between the APS-scaled absolute mass concentration values and BAM mass measurements. This paper provides details on the methodologies used to convert ATOFMS data into continuous, quantitative, and size-resolved mass concentrations that will ultimately be used to provide a quantitative estimate of the number and mass concentrations of particles from different sources.