BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate...BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.展开更多
Tuberculosis is one of the top killer diseases in the globe. The aim of this study was to explore the geographic distribution patterns and clustering characteristics of the disease incidence in terms of both space and...Tuberculosis is one of the top killer diseases in the globe. The aim of this study was to explore the geographic distribution patterns and clustering characteristics of the disease incidence in terms of both space and time with high relative risk locations for tuberculosis incidence in Beijing area. A retrospective space-time clustering analysis was conducted at the districts level in Beijing area based on reported cases of sputum smear-positive pulmonary tuberculosis (TB) from 2005 to 2014. Global and local Moran’s I, autocorrelation analysis along with Ord (Gi*) statistics was applied to detect spatial patterns and the hotspot of TB incidence. Furthermore, the Kuldorff’s scan statistics were used to analyze space-time clusters. A total of 40,878 TB cases were reported in Beijing from 2005 to 2014. The annual average incidence rate was 22.11 per 100,000 populations (ranged from 16.55 to 25.71). The seasonal incidence occurred from March to July until late autumn. A higher relative risk area for TB incidence was mainly detected in urban and some rural districts of Beijing. The significant most likely space-time clusters and secondary clusters of TB incidence were scattered diversely in Beijing districts in each study year. The risk population was mainly scattered in urban and dense populated districts, including in few rural districts.展开更多
Objective:This general non-systematic review aimed to gather information on reported statistical models examing the effects of meteorological factors on coronavirus disease 2019(COVID-19)and compare these models.Metho...Objective:This general non-systematic review aimed to gather information on reported statistical models examing the effects of meteorological factors on coronavirus disease 2019(COVID-19)and compare these models.Methods:PubMed,Web of Science,and Google Scholar were searched for studies on"meteorological factors and COVID-19"published between January 1,2020,and October 1,2022.Results:The most commonly used approaches for analyzing the association between meteorological factors and COVID-19 were the linear regression model(LRM),generalized linear model(GLM),generalized additive model(GAM),and distributed lag non-linear model(DLNM).In addition to these classical models commonly applied in environmental epidemiology,machine learning techniques are increasingly being used to select risk factors for the outcome of interest and establishing robust prediction models.Conclusion:Selecting an appropriate model is essential before conducting research.To ensure the reliability of analysis results,it is important to consider including non-meteorological factors(e.g.,government policies on physical distancing,vaccination,and hygiene practices)along with meteorological factors in the model.展开更多
Introduction:In November 2021,the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant was identified as the variant of concern and has since spread globally,replacing other cocirculating variant...Introduction:In November 2021,the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant was identified as the variant of concern and has since spread globally,replacing other cocirculating variants.To better understand the dynamic changes in viral load over time and the natural history of the virus infection,we analyzed the expression of the open reading frames 1ab(ORF1ab)and nucleocapsid(N)genes in patients infected with Omicron.Methods:We included patients initially admitted to the hospital for SARS-CoV-2 infection between November 5 and December 25,2022.We collected daily oropharyngeal swabs for quantitative reverse transcriptase-polymerase chain reaction tests using commercial kits.We depicted the cycle threshold(Ct)values for amplification of ORF1ab and N genes from individual patients in age-specific groups in a time series.Results:A total of 480 inpatients were included in the study,with a median age of 59 years(interquartile range,42 to 78;range,16 to 106).In the<45-year-old age group,the Ct values for ORF1ab and N gene amplification remained below 35 for 9.0 and 11.5 days,respectively.In the≥80-year-old age group,the Ct values for ORF1ab and N genes stayed below 35 for 11.5 and 15.0 days,respectively,which was the longest among all age groups.The Ct values for N gene amplification took longer to rise above 35 than those for ORF1ab gene amplification.Conclusion:The time to test negative varied among different age groups,with viral nucleic acid shedding taking longer in older age groups compared to younger age groups.As a result,the time to resolution of Omicron infection increased with increasing age.展开更多
AIM: To investigate the effects of proteins purified from sweet potato storage roots on human colorectal cancer cell lines. METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Hoechst 33...AIM: To investigate the effects of proteins purified from sweet potato storage roots on human colorectal cancer cell lines. METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Hoechst 33258 nuclear staining and Boyden transwell chamber methods were used to determine whether purified sweet potato protein (SPP) from fresh sweet potato roots affected proliferation, migration and invasion, respectively, of human colorectal cancer SW480 cells in vitro . The inhibitory effects of SPP on growth of human colorectal cancer HCT-8 cells intraperitoneally xenografted in nude mice and spontaneous lung metastasis of murine Lewis lung carcinoma 3LL cells subcutaneously transplanted in C57 BL/6 mice were also investigated in vivo . RESULTS: SPP inhibited the proliferation of SW480 cells in a dose-dependent manner, with an IC 50 value of 38.732 μmol/L (r2 = 0.980, P = 0.003) in the MTT assay. Hoechst 33258 nuclear staining further revealed inhibition of cell viability and induction of apoptosis by SPP. The transwell assay disclosed significant reduction in migrated cells/field by 8 μmol/L SPP (8.4 ± 2.6 vs 23.3 ± 5.4, P = 0.031) and invaded cells/field through the ECMatrix by 0.8 μmol/L SPP, compared with the control (25.2 ± 5.2 vs 34.8 ± 6.1, P = 0.038). Both intraperitoneal (ip) and intragastric (ig) administration of SPP led to significant suppression of growth of intraperitoneally inoculated HCT-8 cells in nude mice to 58.0% ± 5.9% (P = 0.037) and 43.5% ± 7.1% (P = 0.004) of the controls, respectively, after 9 d treatment. Bloody ascites additionally disappeared after ip injection of trypsin inhibitor. Notably, ig and ip administration of SPP induced a significant decrease in spontaneous pulmonary metastatic nodule formation in C57 BL/6 mice (21.0 ± 12.3 and 27.3 ± 12.7 nodules/lung vs 42.5 ± 4.5 nodules/lung in controls, respectively, P < 0.05) after 25 d treatment. Moreover, the average weight of primary tumor nodules in the hind leg of mice decreased from 8.2 ± 1.3 g/mice in the control to 6.1 ± 1.4 g/mice in the ip group (P = 0.035). CONCLUSION: SPP exerts significant antiproliferative and antimetastatic effects on human colorectal cancer cell lines, both in vitro and in vivo .展开更多
Objective To explore the association between body mass index(BMI)and all-cause mortality among the elderly in Beijing.Methods This analysis was based on the Beijing multidimensional longitudinal study of aging(BLSA),w...Objective To explore the association between body mass index(BMI)and all-cause mortality among the elderly in Beijing.Methods This analysis was based on the Beijing multidimensional longitudinal study of aging(BLSA),which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012.BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality.Cox proportional hazard models were used to obtain the hazard ratios(HRs)for BMI and BMI changes in the overall population and in specific stratified populations.Results During follow-up,1,164 deaths were recorded;BMI-mortality curve was U-shaped,with the lowest mortality at a BMI of approximately 25 kg/m^2.After adjusting for gender,age,smoking,drinking and some pre-existing diseases,HRs for underweight,overweight and obesity compared with normal weight were 1.372(95%CI:1.154-1.631),0.767(95%CI:0.666-0.884)and 0.871(95%CI:0.830-1.246),respectively.HR for BMI drop was 3.245(95%CI:0.824-12.772)in the underweight group and 1.892(95%CI:0.830-1.246)in the normal weight group,HR for BMI rise was 1.795(95%CI:1.243-2.591)in normal weight group and 1.962(95%CI:1.202-3.203)in the overweight group.Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality.展开更多
Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study ...Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.展开更多
AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 20...AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 2009 and March 2012,11female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled.Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage.Efficacy was assessed in terms of the success rate and surgical complications.SF-36 quality of life(QOL)scores and Wexner fecal incontinence scores were compared before and after surgery.RESULTS:The fistulas healed in 14 patients after gracilis muscle transposition;the initial healing rate was73.7%.Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5patients:4 healed and 1 failed,and postoperative fecal diversions were performed for the patient whose treatment failed.At a median follow-up of 17 mo,the overall healing rate was 94.7%.Postoperative complications occurred in 4 cases.Significant improvement was observed in the quality outcomes framework scores(P<0.001)and Wexner fecal incontinence scores(P=0.002)after the successful healing of complex RVFs or RUFs.There was no significant difference in SF-36 QOL scores between the initial healing group and irrigationsuction-assisted healing group.CONCLUSION:Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs.QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.展开更多
Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease in Asia.Several studies have shown that NAFLD is associated with obesity,insulin resistance,type 2 diabetes,hypertension,hyperlipidemia,and meta...Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease in Asia.Several studies have shown that NAFLD is associated with obesity,insulin resistance,type 2 diabetes,hypertension,hyperlipidemia,and metabolic syndrome(MS)[1].Several studies concluded that indicators such as body mass index(BMI),waist circumference(WC)。展开更多
Immunoglobulin G(IgG)is the most abundant plasma glycoprotein and a prominent humoral immune mediator.Glycan composition affects the affinity of IgG to ligands and consequent immune responses.The modification of IgG N...Immunoglobulin G(IgG)is the most abundant plasma glycoprotein and a prominent humoral immune mediator.Glycan composition affects the affinity of IgG to ligands and consequent immune responses.The modification of IgG N-glycosylation is considered to be one of the various mechanisms by which sex hormones modulate the immune system.Although the menstrual cycle is the central sex hormonerelated physiological process in most women of reproductive age,IgG N-glycosylation dynamics during the menstrual cycle have not yet been investigated.To fill this gap,we profiled the plasma IgG Nglycans of 70 healthy premenopausal women at 12 time points during their menstrual cycles(every 7 days for 3 months)using hydrophilic interaction ultra-performance liquid chromatography(HILIC-UPLC).We observed cyclic periodic changes in the N-glycosylation of IgG in association with the menstrual cycle phase and sex hormone concentration in plasma.On the integrated cohort level,the modeled average menstrual cycle effect on the abundance of IgG N-glycosylation traits was low for each trait,with the highest being 1.1%for agalactosylated N-glycans.However,intrapersonal changes were relatively high in some cases;for example,the largest difference between the minimum and maximum values during the menstrual cycle was up to 21%for sialylated N-glycans.Across all measurements,the menstrual cycle phase could explain up to 0.72%of the variation in the abundance of a single IgG glycosylation trait of monogalactosylation.In contrast,up to 99%of the variation in the abundance of digalactosylation could be attributed to interpersonal differences in IgG N-glycosylation.In conclusion,the average extent of changes in the IgG N-glycopattern that occur during the menstrual cycle is small;thus,the IgG N-glycoprofiling of women in large sample-size studies can be performed regardless of menstrual cycle phase.展开更多
Life requires more than nucleic acids and proteins;sweet sugar molec ules could be ano ther life code beyond the central dogma of molecular biology.There are four equally important major building blocks of life:nuclei...Life requires more than nucleic acids and proteins;sweet sugar molec ules could be ano ther life code beyond the central dogma of molecular biology.There are four equally important major building blocks of life:nucleic acids(DNA and RNA),proteins,carbohydrates(glycans),and lipids.The first two are also known as the first and second alphabets of biology,following the principle of the"central dogma"of transcription(DNA to RNA)and trahslation(RNA to protein).However,the latter two crucial components,glycans and lipids,are missing from biology's central dogma Regarding the communi-cation between glycans and lipids,there may be a yet-to-be-discovered law:Does a paracentral dogma exist?This commentary focuses on glycans,the third alphabet of life,and their role in the sociomateriality of the cell,which provides a novel dimension of medical science-glycomedicine.展开更多
1.Introduction,While classical laboratory and animal data have long established cannabinoid genotoxicity,it is only recently,with the application of modern analytical techniques,that the scale of epidemiological disea...1.Introduction,While classical laboratory and animal data have long established cannabinoid genotoxicity,it is only recently,with the application of modern analytical techniques,that the scale of epidemiological disease that may be attributable to cannabinoid exposure has been revealed.The importance and urgency of this work is heightened by the increased cannabis use that is accompanying the relaxation of legislation around cannabis use in many places,the widespread global movement toward cannabis legalization,and the general increase in the cannabinoid potency of available strains.Building on an original pathfinding epidemiological study of congenital anomalies in Hawaii,the United States[1]and confirmed by similar findings from Colorado in the United States,Canada,and Australia[2-4],contemporary studies in the United States and Europe have found that 46/62 and 90/95 congenital anomalies[5,6],respectively,are causally related to various metrics of cannabinoid exposure.Similar studies of cancer in the United States and Europe have found that 25/28 and 33/40 cancers,respectively,could be related to indices of cannabinoid exposure[7].Importantly,there was an almost complete overlap of findings wherever data allowed comparison.Recent investigations have utilized mixed effects,panel,robust,and spatiotemporal regression modeling;inverse probability weighting;and expected values(E-values)as primary tools of causal inference[5-7].The E-value measures the extent to which an association can be ascribed to confounding by other extraneous covariates[8].It has a 95%confidence interval(CI).Values greater than 9 are considered high[9].展开更多
Summary What is already known about this topic?Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)continues to evolve,the clinical manifestations resulting from different SARS-CoV-2 variants may demonstrate si...Summary What is already known about this topic?Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)continues to evolve,the clinical manifestations resulting from different SARS-CoV-2 variants may demonstrate significant variation.What is added by this report?We conducted a comparative analysis of the clinical features associated with SARS-CoV-2 Omicron subvariants BF.7.14 and BA.5.2.48 infections.The results of our study indicate that there are no substantial differences in clinical manifestations,duration of illness,healthcare-seeking behaviors,or treatment between these two subvariants.What are the implications for public health practice?Timely identification of alterations in the clinical spectrum is crucial for researchers and healthcare practitioners in order to enhance their comprehension of clinical manifestations,as well as the progression of SARS-CoV-2.Furthermore,this information is beneficial for policymakers in the process of revising and implementing appropriate countermeasures.展开更多
Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here...Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here,we present the evidence-based guideline suitable for the Chinese population.Methods Literature search of PubMed and Cochrane library(from January 1964 to June 2019)was done.After thorough discussion among the writing group members,recommendations were listed and summarised.This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.Results This evidence-based guideline was written in three parts:controlling the risk factors of stroke,utilisation of antiplatelet agents and assessing the risks of first-ever stroke.All recommendations were listed along with the recommending classes and levels of evidence.Conclusions This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China.Controlling related risk factors,appropriately using antiplatelet agents,assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.展开更多
Background::Cumulative blood pressure(BP),a measure incorporating the level and duration of BP exposure,is associated with the risk of cardiovascular disease(CVD).However,the level at which cumulative BP could signifi...Background::Cumulative blood pressure(BP),a measure incorporating the level and duration of BP exposure,is associated with the risk of cardiovascular disease(CVD).However,the level at which cumulative BP could significantly increase the risk remains unclear.This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD,and to examine whether the association is independent of BP levels at one examination.Methods::Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed.Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007.Cardiovascular events(including coronary heart disease and stroke)occurring from 2007 to 2018 were registered.Adjusted hazard ratios(HRs)for CVD incidence associated with quartiles of cumulative systolic blood pressure(SBP)and diastolic blood pressure(DBP)were calculated.Results::Of the 2429 participants,42.9%(1042)were men,and the mean age in 2007 was 62.1±7.9 years.Totally,207 CVD events occurred during the follow-up from 2007 to 2018.Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD(P<0.001).Compared with the lowest quartile of cumulative SBP,the HR for CVD was 1.03(95%confidence interval[CI]:0.59-1.81),1.69(95%CI:0.99-2.87),and 2.20(95%CI:1.21-3.98)for the second to the fourth quartile of cumulative SBP,and 1.46(95%CI:0.86-2.48),1.99(95%CI:1.18-3.35),and 2.08(95%CI:1.17-3.71)for the second to the fourth quartile of cumulative DBP,respectively.In further cross-combined group analyses with BP measurements in 2007,15-year cumulative BP levels higher than the median,that is,1970.8/1239.9 mmHg·year for cumulative SBP/DBP,which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years,were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.Conclusion::Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.展开更多
The relationship between air pollution and cerebrovascular disease has become a popular topic,yet research findings are highly heterogeneous.This study aims to investigate this association based on detailed individual...The relationship between air pollution and cerebrovascular disease has become a popular topic,yet research findings are highly heterogeneous.This study aims to investigate this association based on detailed individual health data and a precise evaluation of their exposure levels.The integrated models of generalized additive model,land use regression model and back propagation neural network were used to evaluate the exposure concentrations.And doubly robust additive model was conducted to explore the association between cerebrovascular disease and air pollution after adjusted for demographic characteristics,physical examination,disease information,geographic and socioeconomic status.A total of 25097 subjects were included in the Beijing Health Management Cohort from 2013 to 2018.With a 1µg/m^(3)increase in the concentrations of PM_(2.5),SO_(2)and NO_(2),the incidence risk of cerebrovascular disease increased by 1.02(95%CI:1.008–1.034),1.06(95%CI:1.034–1.095)and 1.02(95%CI:1.010–1.029)respectively.Whereas CO exposure could decrease the risk,with an odds ratio of 0.38(95%CI:0.212–0.626).In the subgroup analysis,individuals under the age of 50 with normal BMI were at higher risk caused by PM2.5,and So2 was considered more hazardous to women.Meanwhile,the protective effect of CO on women and those with normal BMI was stronger.Successful reduction of long-term exposure to PM2.5,SO_(2)and NO_(2)would lead to substantial benefits for decrease the risk of cerebrovascular disease especially for the health of the susceptible individuals.展开更多
Introduction There is a downward trend of stroke-related mortality in the USA.By reviewing all published articles on stroke mortality in China,we analysed its trend and possible factors that have influenced the trend....Introduction There is a downward trend of stroke-related mortality in the USA.By reviewing all published articles on stroke mortality in China,we analysed its trend and possible factors that have influenced the trend.Methods Both English and Chinese literatures were searched on the mortality of stroke or cerebrovascular diseases in China.Potential papers related to this topic were identified from PubMed,Medline,Embase,Cochrane Library,Wanfang Database,SINOMED and China National Knowledge Infrastructure databases.Results Comparing the results from the most recent population-based epidemiological survey and databank from the national Center for Disease Control and Prevention,the age-adjusted stroke mortality rate has shown a downward trend among both urban and rural population in the past 30 years in China.Comparing with 30 years ago,the rate of stroke mortality has decreased by more than 31%in urban/suburban population and 11%in rural population.In men,the age-adjusted stroke mortality rate decreased by 18.9%and in women by 24.9%between 1994 and 2013.Factors that may have contributed to the trend of decreased stroke mortality rate include(1)improved healthcare coverage and healthcare environment;(2)improved treatment options and medical technology;(3)support by government to educate the public on stroke and stroke prevention;and(4)improved public knowledge on stroke.Conclusions The age-adjusted stroke mortality rate in China has shown a downward trend among both urban and rural population in the past 30 years.The major influencing factors that helped in reducing stroke mortality in China included improved healthcare coverage,healthcare environment,the updated treatment options and modern medical technology.展开更多
基金supported by the National Key Research and Development Program of China(2022YFC 3602501)the Pfizer Inc.(New York,USA)offices in Beijing,China。
文摘BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.
文摘Tuberculosis is one of the top killer diseases in the globe. The aim of this study was to explore the geographic distribution patterns and clustering characteristics of the disease incidence in terms of both space and time with high relative risk locations for tuberculosis incidence in Beijing area. A retrospective space-time clustering analysis was conducted at the districts level in Beijing area based on reported cases of sputum smear-positive pulmonary tuberculosis (TB) from 2005 to 2014. Global and local Moran’s I, autocorrelation analysis along with Ord (Gi*) statistics was applied to detect spatial patterns and the hotspot of TB incidence. Furthermore, the Kuldorff’s scan statistics were used to analyze space-time clusters. A total of 40,878 TB cases were reported in Beijing from 2005 to 2014. The annual average incidence rate was 22.11 per 100,000 populations (ranged from 16.55 to 25.71). The seasonal incidence occurred from March to July until late autumn. A higher relative risk area for TB incidence was mainly detected in urban and some rural districts of Beijing. The significant most likely space-time clusters and secondary clusters of TB incidence were scattered diversely in Beijing districts in each study year. The risk population was mainly scattered in urban and dense populated districts, including in few rural districts.
基金funded by the National Natural Science Foundation of China(8177120753)the China-Australia International Collaborative Grant(NHMRC APP1112767,NSFC 81561128020)Zheng Y L and Guo Z were supported by the Edith Cowan University Higher Degree by Research Scholarship(ECU-HDR ST10469322 and ST10468211).
文摘Objective:This general non-systematic review aimed to gather information on reported statistical models examing the effects of meteorological factors on coronavirus disease 2019(COVID-19)and compare these models.Methods:PubMed,Web of Science,and Google Scholar were searched for studies on"meteorological factors and COVID-19"published between January 1,2020,and October 1,2022.Results:The most commonly used approaches for analyzing the association between meteorological factors and COVID-19 were the linear regression model(LRM),generalized linear model(GLM),generalized additive model(GAM),and distributed lag non-linear model(DLNM).In addition to these classical models commonly applied in environmental epidemiology,machine learning techniques are increasingly being used to select risk factors for the outcome of interest and establishing robust prediction models.Conclusion:Selecting an appropriate model is essential before conducting research.To ensure the reliability of analysis results,it is important to consider including non-meteorological factors(e.g.,government policies on physical distancing,vaccination,and hygiene practices)along with meteorological factors in the model.
基金Funded by National Key R&D Program of China(2021ZD0114103)the Capital's Funds for Health Improvement and Research(2022-4G-30117)the Beijing Science and Technology Planning Project of Beijing Science and Technology Commission(Z211100002521015 and Z211100002521019).
文摘Introduction:In November 2021,the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant was identified as the variant of concern and has since spread globally,replacing other cocirculating variants.To better understand the dynamic changes in viral load over time and the natural history of the virus infection,we analyzed the expression of the open reading frames 1ab(ORF1ab)and nucleocapsid(N)genes in patients infected with Omicron.Methods:We included patients initially admitted to the hospital for SARS-CoV-2 infection between November 5 and December 25,2022.We collected daily oropharyngeal swabs for quantitative reverse transcriptase-polymerase chain reaction tests using commercial kits.We depicted the cycle threshold(Ct)values for amplification of ORF1ab and N genes from individual patients in age-specific groups in a time series.Results:A total of 480 inpatients were included in the study,with a median age of 59 years(interquartile range,42 to 78;range,16 to 106).In the<45-year-old age group,the Ct values for ORF1ab and N gene amplification remained below 35 for 9.0 and 11.5 days,respectively.In the≥80-year-old age group,the Ct values for ORF1ab and N genes stayed below 35 for 11.5 and 15.0 days,respectively,which was the longest among all age groups.The Ct values for N gene amplification took longer to rise above 35 than those for ORF1ab gene amplification.Conclusion:The time to test negative varied among different age groups,with viral nucleic acid shedding taking longer in older age groups compared to younger age groups.As a result,the time to resolution of Omicron infection increased with increasing age.
基金Supported by The Earmarked Fund for China Agriculture Research System, No. CARS-11-B-19"Technique of Processing and Utilization for Plant Proteins" from China-Argentina Science and Technology Cooperation Program, No. 2010DFA32690+1 种基金Grant from the Capital Medical University, No. 2009ZR03 and No. 2012ZR17the Importation and Development of High-Caliber Talents Project of Beijing Municipal Institutions
文摘AIM: To investigate the effects of proteins purified from sweet potato storage roots on human colorectal cancer cell lines. METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Hoechst 33258 nuclear staining and Boyden transwell chamber methods were used to determine whether purified sweet potato protein (SPP) from fresh sweet potato roots affected proliferation, migration and invasion, respectively, of human colorectal cancer SW480 cells in vitro . The inhibitory effects of SPP on growth of human colorectal cancer HCT-8 cells intraperitoneally xenografted in nude mice and spontaneous lung metastasis of murine Lewis lung carcinoma 3LL cells subcutaneously transplanted in C57 BL/6 mice were also investigated in vivo . RESULTS: SPP inhibited the proliferation of SW480 cells in a dose-dependent manner, with an IC 50 value of 38.732 μmol/L (r2 = 0.980, P = 0.003) in the MTT assay. Hoechst 33258 nuclear staining further revealed inhibition of cell viability and induction of apoptosis by SPP. The transwell assay disclosed significant reduction in migrated cells/field by 8 μmol/L SPP (8.4 ± 2.6 vs 23.3 ± 5.4, P = 0.031) and invaded cells/field through the ECMatrix by 0.8 μmol/L SPP, compared with the control (25.2 ± 5.2 vs 34.8 ± 6.1, P = 0.038). Both intraperitoneal (ip) and intragastric (ig) administration of SPP led to significant suppression of growth of intraperitoneally inoculated HCT-8 cells in nude mice to 58.0% ± 5.9% (P = 0.037) and 43.5% ± 7.1% (P = 0.004) of the controls, respectively, after 9 d treatment. Bloody ascites additionally disappeared after ip injection of trypsin inhibitor. Notably, ig and ip administration of SPP induced a significant decrease in spontaneous pulmonary metastatic nodule formation in C57 BL/6 mice (21.0 ± 12.3 and 27.3 ± 12.7 nodules/lung vs 42.5 ± 4.5 nodules/lung in controls, respectively, P < 0.05) after 25 d treatment. Moreover, the average weight of primary tumor nodules in the hind leg of mice decreased from 8.2 ± 1.3 g/mice in the control to 6.1 ± 1.4 g/mice in the ip group (P = 0.035). CONCLUSION: SPP exerts significant antiproliferative and antimetastatic effects on human colorectal cancer cell lines, both in vitro and in vivo .
基金supported by the Beijing Natural Science Foundation(7131002)the Key Projects in the National Science&Technology Pillar Program in the Twelfth Five-year Plan Period of China(2011BAI08B01)the Beijing Municipal Natural Science Foundation(Serial Number:7122016)
文摘Objective To explore the association between body mass index(BMI)and all-cause mortality among the elderly in Beijing.Methods This analysis was based on the Beijing multidimensional longitudinal study of aging(BLSA),which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012.BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality.Cox proportional hazard models were used to obtain the hazard ratios(HRs)for BMI and BMI changes in the overall population and in specific stratified populations.Results During follow-up,1,164 deaths were recorded;BMI-mortality curve was U-shaped,with the lowest mortality at a BMI of approximately 25 kg/m^2.After adjusting for gender,age,smoking,drinking and some pre-existing diseases,HRs for underweight,overweight and obesity compared with normal weight were 1.372(95%CI:1.154-1.631),0.767(95%CI:0.666-0.884)and 0.871(95%CI:0.830-1.246),respectively.HR for BMI drop was 3.245(95%CI:0.824-12.772)in the underweight group and 1.892(95%CI:0.830-1.246)in the normal weight group,HR for BMI rise was 1.795(95%CI:1.243-2.591)in normal weight group and 1.962(95%CI:1.202-3.203)in the overweight group.Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality.
基金We appreciate all the participants and their relatives in the study. And we will thank to the members of the survey teams from the Jidong community. The authors thank the staff of the Recovery Medical Technology Development Co., Ltd for their important efforts. This study was supported by grants from National Key Research and Development program of China （2016YFC1300300）, National Natural Science Foundation of China （Nos.81270186, 81400229）, Scientific Technology Program of Beijing City （Z1411070025 14103）.
文摘Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.
基金Supported by National Natural Science Foundation of China,No.81372586
文摘AIM:To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas(RVFs)and rectourethral fistulas(RUFs).METHODS:Between May 2009 and March 2012,11female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled.Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage.Efficacy was assessed in terms of the success rate and surgical complications.SF-36 quality of life(QOL)scores and Wexner fecal incontinence scores were compared before and after surgery.RESULTS:The fistulas healed in 14 patients after gracilis muscle transposition;the initial healing rate was73.7%.Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5patients:4 healed and 1 failed,and postoperative fecal diversions were performed for the patient whose treatment failed.At a median follow-up of 17 mo,the overall healing rate was 94.7%.Postoperative complications occurred in 4 cases.Significant improvement was observed in the quality outcomes framework scores(P<0.001)and Wexner fecal incontinence scores(P=0.002)after the successful healing of complex RVFs or RUFs.There was no significant difference in SF-36 QOL scores between the initial healing group and irrigationsuction-assisted healing group.CONCLUSION:Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs.QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.
基金the National Key R&D Program of China[2016YFC0900600/2016YFC0900604]The Capital Health Development Special Fund,Health Management Cohort Study Based on Beijing Health Checkup Data[2018-1-2241]Database source:China Cohort Consortium,the Beijing Health Management Cohort Study[CCC2018050804]。
文摘Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease in Asia.Several studies have shown that NAFLD is associated with obesity,insulin resistance,type 2 diabetes,hypertension,hyperlipidemia,and metabolic syndrome(MS)[1].Several studies concluded that indicators such as body mass index(BMI),waist circumference(WC)。
基金funded by National Natural Science Foundation of China(8177120753)China-Australia International Collaborative Grant(NHMRC APP1112767,NSFC 81561128020)to Wei Wang+1 种基金Zhiyuan Wu was supported by the China Scholarship Council(201908110447)Yulu Zheng and Zheng Guo were supported by the Edith Cowan University Higher Degree by Research Scholarship(ECU-HDR ST10469322 and ST10468211).
基金funded by the European Structural and Investment Funds grant for the Croatian National Centre of Research Excellence in Personalized Healthcare(KK.01.1.1.01)Australia-China International Collaborative Grant(NHMRC APP1112767-NSFC 81561128020)+1 种基金National Natural Science Foundation of China(81773527 and 81573215)the European Structural and Investment Funds CEKOM(KK.01.2.2.03.0006).
文摘Immunoglobulin G(IgG)is the most abundant plasma glycoprotein and a prominent humoral immune mediator.Glycan composition affects the affinity of IgG to ligands and consequent immune responses.The modification of IgG N-glycosylation is considered to be one of the various mechanisms by which sex hormones modulate the immune system.Although the menstrual cycle is the central sex hormonerelated physiological process in most women of reproductive age,IgG N-glycosylation dynamics during the menstrual cycle have not yet been investigated.To fill this gap,we profiled the plasma IgG Nglycans of 70 healthy premenopausal women at 12 time points during their menstrual cycles(every 7 days for 3 months)using hydrophilic interaction ultra-performance liquid chromatography(HILIC-UPLC).We observed cyclic periodic changes in the N-glycosylation of IgG in association with the menstrual cycle phase and sex hormone concentration in plasma.On the integrated cohort level,the modeled average menstrual cycle effect on the abundance of IgG N-glycosylation traits was low for each trait,with the highest being 1.1%for agalactosylated N-glycans.However,intrapersonal changes were relatively high in some cases;for example,the largest difference between the minimum and maximum values during the menstrual cycle was up to 21%for sialylated N-glycans.Across all measurements,the menstrual cycle phase could explain up to 0.72%of the variation in the abundance of a single IgG glycosylation trait of monogalactosylation.In contrast,up to 99%of the variation in the abundance of digalactosylation could be attributed to interpersonal differences in IgG N-glycosylation.In conclusion,the average extent of changes in the IgG N-glycopattern that occur during the menstrual cycle is small;thus,the IgG N-glycoprofiling of women in large sample-size studies can be performed regardless of menstrual cycle phase.
文摘Life requires more than nucleic acids and proteins;sweet sugar molec ules could be ano ther life code beyond the central dogma of molecular biology.There are four equally important major building blocks of life:nucleic acids(DNA and RNA),proteins,carbohydrates(glycans),and lipids.The first two are also known as the first and second alphabets of biology,following the principle of the"central dogma"of transcription(DNA to RNA)and trahslation(RNA to protein).However,the latter two crucial components,glycans and lipids,are missing from biology's central dogma Regarding the communi-cation between glycans and lipids,there may be a yet-to-be-discovered law:Does a paracentral dogma exist?This commentary focuses on glycans,the third alphabet of life,and their role in the sociomateriality of the cell,which provides a novel dimension of medical science-glycomedicine.
文摘1.Introduction,While classical laboratory and animal data have long established cannabinoid genotoxicity,it is only recently,with the application of modern analytical techniques,that the scale of epidemiological disease that may be attributable to cannabinoid exposure has been revealed.The importance and urgency of this work is heightened by the increased cannabis use that is accompanying the relaxation of legislation around cannabis use in many places,the widespread global movement toward cannabis legalization,and the general increase in the cannabinoid potency of available strains.Building on an original pathfinding epidemiological study of congenital anomalies in Hawaii,the United States[1]and confirmed by similar findings from Colorado in the United States,Canada,and Australia[2-4],contemporary studies in the United States and Europe have found that 46/62 and 90/95 congenital anomalies[5,6],respectively,are causally related to various metrics of cannabinoid exposure.Similar studies of cancer in the United States and Europe have found that 25/28 and 33/40 cancers,respectively,could be related to indices of cannabinoid exposure[7].Importantly,there was an almost complete overlap of findings wherever data allowed comparison.Recent investigations have utilized mixed effects,panel,robust,and spatiotemporal regression modeling;inverse probability weighting;and expected values(E-values)as primary tools of causal inference[5-7].The E-value measures the extent to which an association can be ascribed to confounding by other extraneous covariates[8].It has a 95%confidence interval(CI).Values greater than 9 are considered high[9].
基金Supported by the National Key Research and Development Program of China(2021ZD0114103).
文摘Summary What is already known about this topic?Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)continues to evolve,the clinical manifestations resulting from different SARS-CoV-2 variants may demonstrate significant variation.What is added by this report?We conducted a comparative analysis of the clinical features associated with SARS-CoV-2 Omicron subvariants BF.7.14 and BA.5.2.48 infections.The results of our study indicate that there are no substantial differences in clinical manifestations,duration of illness,healthcare-seeking behaviors,or treatment between these two subvariants.What are the implications for public health practice?Timely identification of alterations in the clinical spectrum is crucial for researchers and healthcare practitioners in order to enhance their comprehension of clinical manifestations,as well as the progression of SARS-CoV-2.Furthermore,this information is beneficial for policymakers in the process of revising and implementing appropriate countermeasures.
文摘Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here,we present the evidence-based guideline suitable for the Chinese population.Methods Literature search of PubMed and Cochrane library(from January 1964 to June 2019)was done.After thorough discussion among the writing group members,recommendations were listed and summarised.This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.Results This evidence-based guideline was written in three parts:controlling the risk factors of stroke,utilisation of antiplatelet agents and assessing the risks of first-ever stroke.All recommendations were listed along with the recommending classes and levels of evidence.Conclusions This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China.Controlling related risk factors,appropriately using antiplatelet agents,assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.
基金the National Key Research and Development Program of China(No.2016YFC0900902)the Capital’s Funds for Health Improvement and Research(No.020-1-1051and the Beijing Nova Programme Interdisciplinary Cooperation Project(No.Z191100001119017)).
文摘Background::Cumulative blood pressure(BP),a measure incorporating the level and duration of BP exposure,is associated with the risk of cardiovascular disease(CVD).However,the level at which cumulative BP could significantly increase the risk remains unclear.This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD,and to examine whether the association is independent of BP levels at one examination.Methods::Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed.Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007.Cardiovascular events(including coronary heart disease and stroke)occurring from 2007 to 2018 were registered.Adjusted hazard ratios(HRs)for CVD incidence associated with quartiles of cumulative systolic blood pressure(SBP)and diastolic blood pressure(DBP)were calculated.Results::Of the 2429 participants,42.9%(1042)were men,and the mean age in 2007 was 62.1±7.9 years.Totally,207 CVD events occurred during the follow-up from 2007 to 2018.Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD(P<0.001).Compared with the lowest quartile of cumulative SBP,the HR for CVD was 1.03(95%confidence interval[CI]:0.59-1.81),1.69(95%CI:0.99-2.87),and 2.20(95%CI:1.21-3.98)for the second to the fourth quartile of cumulative SBP,and 1.46(95%CI:0.86-2.48),1.99(95%CI:1.18-3.35),and 2.08(95%CI:1.17-3.71)for the second to the fourth quartile of cumulative DBP,respectively.In further cross-combined group analyses with BP measurements in 2007,15-year cumulative BP levels higher than the median,that is,1970.8/1239.9 mmHg·year for cumulative SBP/DBP,which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years,were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.Conclusion::Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.
基金the National Natural Science Foundation of China(No.81773512).
文摘The relationship between air pollution and cerebrovascular disease has become a popular topic,yet research findings are highly heterogeneous.This study aims to investigate this association based on detailed individual health data and a precise evaluation of their exposure levels.The integrated models of generalized additive model,land use regression model and back propagation neural network were used to evaluate the exposure concentrations.And doubly robust additive model was conducted to explore the association between cerebrovascular disease and air pollution after adjusted for demographic characteristics,physical examination,disease information,geographic and socioeconomic status.A total of 25097 subjects were included in the Beijing Health Management Cohort from 2013 to 2018.With a 1µg/m^(3)increase in the concentrations of PM_(2.5),SO_(2)and NO_(2),the incidence risk of cerebrovascular disease increased by 1.02(95%CI:1.008–1.034),1.06(95%CI:1.034–1.095)and 1.02(95%CI:1.010–1.029)respectively.Whereas CO exposure could decrease the risk,with an odds ratio of 0.38(95%CI:0.212–0.626).In the subgroup analysis,individuals under the age of 50 with normal BMI were at higher risk caused by PM2.5,and So2 was considered more hazardous to women.Meanwhile,the protective effect of CO on women and those with normal BMI was stronger.Successful reduction of long-term exposure to PM2.5,SO_(2)and NO_(2)would lead to substantial benefits for decrease the risk of cerebrovascular disease especially for the health of the susceptible individuals.
文摘Introduction There is a downward trend of stroke-related mortality in the USA.By reviewing all published articles on stroke mortality in China,we analysed its trend and possible factors that have influenced the trend.Methods Both English and Chinese literatures were searched on the mortality of stroke or cerebrovascular diseases in China.Potential papers related to this topic were identified from PubMed,Medline,Embase,Cochrane Library,Wanfang Database,SINOMED and China National Knowledge Infrastructure databases.Results Comparing the results from the most recent population-based epidemiological survey and databank from the national Center for Disease Control and Prevention,the age-adjusted stroke mortality rate has shown a downward trend among both urban and rural population in the past 30 years in China.Comparing with 30 years ago,the rate of stroke mortality has decreased by more than 31%in urban/suburban population and 11%in rural population.In men,the age-adjusted stroke mortality rate decreased by 18.9%and in women by 24.9%between 1994 and 2013.Factors that may have contributed to the trend of decreased stroke mortality rate include(1)improved healthcare coverage and healthcare environment;(2)improved treatment options and medical technology;(3)support by government to educate the public on stroke and stroke prevention;and(4)improved public knowledge on stroke.Conclusions The age-adjusted stroke mortality rate in China has shown a downward trend among both urban and rural population in the past 30 years.The major influencing factors that helped in reducing stroke mortality in China included improved healthcare coverage,healthcare environment,the updated treatment options and modern medical technology.
