Objective: To explore the relationship between body weight changes from early adulthood to middle age and the prevalence of hypertriglyceridemia by large-scale cardiovascular risk factor investigation.
Methods: A total of 15 population groups from China multi-center collaborative study of cardiovascular epidemiology in 1998 were enrolled. There were approximately 1000 participants in each group including 50% of each male and female at the age of (35-59) years which was deifned as middle age. The participants were surveyed for cardiovascular risk factors including the body weight and body mass index (BMI) at the age of 25 years which was deifned as early adulthood. The participants were divided into 4 groups based on BMI at early adulthood: Low body weight group, BMI < 18.5 kg/m2, Normal body weight group, BMI (18.5-23.9) kg/m2, Overweight group, BMI (24-27.9) kg/m2 and Obese group, BMI ≥ 28 kg/m2. The changes of body weight from early adulthood to middle age were calculated by body weight at present minus body weight at 25 years; according to the differences, participants were divided into another set of 6 groups: differences < -7.5 kg, (-7.5 to -2.6) kg, (-2.5 to 2.5) kg, (2.6 to7.5) kg, (7.6 to 12.5) kg and > 12.5 kg. The relationship between body weight status at 25 years of age with subsequent changes and the prevalence of hypertriglyceridemia were investigated.
Results: A total of 13883 participants finished the investigation.①The prevalence of hypertriglyceridemia by 4 BMI groups were at 22.8%, 26.0%, 27.4% and 30.8% respectively (the trend ofP<0.01).②The prevalence of hypertriglyceridemia by 6 age differences groups were at 12.5 %, 14.0 %, 17.8 %, 24.2 %, 31.5 % and 40.9 % respectively (the trend ofP<0.01). Multivariate Logistic regression analysis indicated that overweight and obesity at the age of 25 years with subsequent weight gain were positively related to the risk of hypertriglyceridemia at the middle age (the trend ofP<0.01).
Conclusion: Overweight and obesity in early adulthood with subsequent weight gain were independently related to the risk of hypertriglyceridemia at the middle age in our survey.

Objective: To investigate the prevalence of anxiety symptoms among high grade primary school students in Guangzhou and their correlation with family functioning and parental parenting styles, so as to provide theoretical basis and guidance for family based interventions for children s anxiety symptoms. Methods: From June to September 2022, a multi stage cluster random sampling method was employed to select 5 396 students from grades 4 to 6 in 13 primary schools in Guangzhou. The Family Functioning Assessment Scale for Children, Parental Bonding Instrument, and Spence Children s Anxiety Scale Short Version were used for the survey. Inter group comparison was analysed by t test or analysis of variance. Linear regression analysis was used to explore the effects of family function and parental parenting styles on anxiety symptoms in primary school students. Results: The average score for anxiety symptoms among high grade primary school students in Guangzhou was (11.63±10.88). In terms of parenting styles, mothers scored higher than fathers in the dimensions of "care" (25.63±4.92) and "control" (5.08±2.58) compared to fathers ( 24.74± 5.50, 5.00±2.51) ( t =15.80, 4.21, P <0.01). However, there was no statistically significant difference in the scores of parents on the dimension of "encouragement of independence"（12.98±4.06,13.05±3.95)( t =-1.77， P >0.05）. After adjusting for general demographic characteristics, the results of linear regression analysis showed that primary school students family functioning ( B =0.47) and parental "control" ( B =0.67, 0.75) were positively associated with anxiety symptoms scores ( P <0.01). Meanwhile, parental "care" ( B =-0.53,-0.55) and "encouragement of independence" ( B =-0.62,-0.68) were negatively associated with anxiety symptom scores ( P <0.01). These associations remained statistically significant even after further adjusting for family functioning ( P <0.01). Conclusions Family functioning, parenting styles are closely associated with anxiety symptoms among high grade primary school students. Positive family functioning and parenting styles may mitigate childhood anxiety symptoms, whereas excessive parental control may increase the risk of childhood anxiety symptoms.

Objective: To investigate the relationship between exercise and serum lipid level in middle-aged population. Methods: Based on “multicenter collaborative study of cardiovascular epidemiology” research, a total of 3482 subjects at the age of (35-59) years from urban and rural areas of Beijing and Guangzhou were enrolled in this study. According to daily energy expenditure of exercise (EEexer), the participants were divided into 3 groups: No exercise group, (daily) EEexer below median group and (daily) EEexer above median group. The type and duration of exercise were collected by the questionnaire, daily EEexer was calculated and the relationship between exercise and serum lipid level was estimated by covariance analysis. Results: There were 47.1% (807/1712) male and 41.1% (727/1770) female participants having exercise. With controlled age, area, education level, smoking, drinking, BMI and energy expenditure of physical activity outside of exercise (EEPA), serum levels of TC, LDL-C, non-HDL-C and TG were decreased in women by elevated EEexer groups accordingly, and among them, there were significant differences in LDL-C and non-HDL-C levels between groups, P<0.05; compared with No exercise group, in female daily EEexer above median group, LDL-C and non-HDL-C levels decreased about 0.14 mmol/L,P=0.0063 and 0.14 mmol/L, P=0.0155 respectively; while in men, TC, LDL-C, non-HDL-C and TG levels showed a decreasing trends by elevated EEexer groups but with no statistical significance. No association was found for HDL-C in men and women. Conclusion: Serum levels of LDL-C and non-HDL-C were lower in female daily EEexer above median group than No excise group, the effects were independent from working and other physical activities.

Objective:To explore the association between the intake and changes in various types of food and the changes in blood pressure in patients with mild to moderate hypertension.Methods:Mild to moderate hypertension participants with complete baseline and outcome data were included from DECIDE-Diet study, a multicenter, randomized controlled trial. Dietary records and blood pressure measurements at both 7-day run-in (baseline) and 28-day intervention phases were collected for enrolled participants. Blood pressure change was defined as the difference between blood pressure at the end of trial and the baseline blood pressure. Baseline intake of food was the average daily intake during the run-in period, and the intake increment was defined as the difference between the average intake during the trial period and the average intake during the run-in period. After adjusting for age, sex, study center, intervention groups, baseline body mass index (kg/m 2), antihypertension medication use, and baseline total calorie intake, a linear regression model was used to analyze the associations of the before-after-intervention change in blood pressure with baseline intake and intake increment of foods. Results:A total of 258 patients with mild to moderate hypertension were included, including 133 males, aged (56.5±9.9) years. (1) After adjusting for confounding factors, there was no significant association between baseline intake of food and baseline blood pressure (all P>0.05). The blood pressure change was negatively associated with baseline intakes of tubers, vegetables, and vegetable oils but positively with baseline intake of meats; and was negatively associated with intake increment of whole grains and fish (all P<0.05). (2) The multiple linear regression analysis showed that baseline intake of vegetables ( β=-0.021, P=0.004), vegetable oils ( β=-0.260, P=0.002), and increment in intake of fish ( β=-0.128, P=0.026) were all significantly associated with changes in systolic blood pressure; baseline intake of vegetables ( β=-0.017, P=0.002), vegetable oils ( β=-0.182, P=0.001), dairy products ( β=0.021, P=0.022), and increment in intake of fish ( β=-0.092, P=0.010) were all significantly associated with changes in diastolic blood pressure. Conclusion:Increasing the intake of whole grains, vegetables, vegetable oils, and fish and decreasing the intake of meat may be beneficial for blood pressure control in patients with mild to moderate hypertension.

Objective To evaluate the accuracy of simple anthropometric parameters in diagnosing obesity in children in Guangzhou. Methods A cross-sectional study, including 465 children aged 6-9 years, was carried out in Guangzhou. Their body height and weight, waist circumference (WC) and hip circumference were measured according to standard procedure. Body mass index (BMI), waist to hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Body fat percentage (BF%)was determined by dual-energy X-ray absorptiometry. Multiple regression analysis was applied to evaluate the correlations between age-adjusted physical indicators and BF%, after the adjustment for age. Obesity was defined by BF%. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of the indicators for childhood obesity. Area under-ROC curves (AUCs) were calculated and the best cut-off point that maximizing'sensitivity+specificity-1'was determined. Results BMI showed the strongest association with BF% through multiple regression analysis. For'per-standard deviation increase' of BMI, BF%increased by 5.3%(t=23.1, P<0.01) in boys and 4.6%(t=17.5, P<0.01) in girls, respectively. The ROC curve analysis indicated that BMI exhibited the largest AUC in both boys (AUC=0.908) and girls (AUC=0.895). The sensitivity was 80.8% in boys and 81.8% in girls, and the specificity was 88.2%in boys and 87.1%in girls. Both the AUCs for WHtR and WC were less than 0.8 in boys and girls. WHR had the smallest AUCs (<0.8) in both boys and girls. Conclusion BMI appeared to be a good predicator for BF%in children aged 6-9 years in Guangzhou.

Objective To investigate the effect of ligustrazine on autophagy-related proteins Beclin 1,LC3 and P62 after spinal cord ischemia-reperfusion injury.Methods A total of 48 SD rats were randomly divided into sham operation group,model group,ligustrazine group and 3-MA group.The rats were intraperitoneally injected with ligustrazine injection 0.16 mg/kg in the Ligustrazine group,the rats were intraperitoneally injected with 3-methyladenine injection 0.015 mg/kg in the inhibitor group,and the rats were intraperitoneally injected with normal saline of equal volume in the sham operation group and model group.Spinal cord ischemia-reperfusion model was established in all groups except sham-operated group after administration.After molding behavioral scores were scored after 3 and 6 hours of ischemia,and the expression of Beclin 1,LC3 and P62 was detected by immunohis-tochemistry.Results After 3 and 6 hours,compared with the model group,the behavioral score (3 h:2.33 ± 0.58 vs.0.67 ± 0.58,6 h:3.33 ± 0.58 vs.1.33 ± 0.58) of the rats in ligustrazine group significantly increased (P＜0.05).Compared with the model group,the expression of Beclinl (3 h:348.00×104± 0.27×104 vs.659.00×104± 0.11×104;6 h:38.00×104± 0.19×104 vs.557.00×104± 0.26×104),LC3 (3 h:357.00×104± 0.48×104 vs.686.00×104± 0.33×104'6 h:334.00×104± 0.51×104 vs.673.00×104 ± 0.22×104),P62 (3 h:357.00×104 ± 0.48×104 vs.830.00×104 ± 0.48×104;6 h:315.00×104 ± 0.12× 104 vs.591.00× 104± 0.36× 104) in ligustrazine group were significantly decreased (P＜0.05).Conclusions The ligustrazine may regulate autophagy in two directions and protect nerve cells.

Objective To explore the relationship between weight status in early adulthood and body weight change at middle age in adults and type 2 diabetes mellitus (T2DM).Methods The data of 14 population samples from China Multicenter Collaborative Study of Cardiovascular Epidemiology conducted in 1998 were used.Approximately 1 000 men and women in each sample were surveyed for cardiovascular disease risk factors,including body weight at age 25 years.The body mass index (BMI) at the age 25 years was calculated.The association between body weight in early adulthood and body weight change at middle age and T2DM was examined by using logistic regression model.Results The incidence of T2DM in low weight group (BMI＜ 18.5 kg/m2),normal weight group (BMI:18.5-23.9 kg/m2),overweight group (BMI:24.0-27.9 kg/m2) and obese group (BMI:≥28.0 kg/m2) at 25 years old were 2.4％(30/1 263),2.8％(266/9 562),4.0％(70/1 739) and 6.4％ (7/110),respectively (P value for trend＜0.01).The incidence of T2DM for adults with weight change ＜-7.5 kg,-7.5--2.6 kg,-2.5-2.5 kg,2.6-7.5 kg,7.6-12.5 kg and ＞ 12.5 kg at middle age were 2.5％ (18/712),1.3％(21/1 629),2.1％(48/2 330),2.3％(59/2 585),3.7％(94/2 518),and 4.6％(133/ 2 900) respectively.(P value for trend ＜0.01),Multivariate logistic regression analysis showed that overweight and obesity at age 25 years and subsequent weight gain were positively correlated with T2DM after adjusted other risk factors (all P values for trend ＜0.01).Conclusion Overweight and obesity in early adulthood and weight gain at middle age were both independently associated with the increased risk of T2DM in middle-aged men and women.

Objective: To explore the relationship between overnight urinary sodium to potassium ratio and the risk of cardiovascular disease (CVD). Methods: A subsample of 10 percent of the participants (35-59 years old) from the People's Republic of China-United States Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology (prospective survey) were used. Three consecutive overnight urine samples were collected in the autumn of 1983-1984 and the spring in 1985-1986, respectively. Urinary sodium and potassium were detected and calculated for 8 hours excretion. The occurrences of cardiovascular events were recorded in 2 years interval from 1987-1988 until December 31, 2005. Participants were divided into first ratio group, second ratio group, and third ratio group based on the tertiles of sodium to potassium ratio. Cox proportional hazard regression model was used to determine the relationship between sodium to potassium ratio and risk of CVD. In addition, participants were divided into 2 subgroups by the median of overnight urinary sodium and potassium, and then combined each other for 4 subgroups including low sodium-low potassium group, low sodium-high potassium group, high sodium-low potassium group, and high sodium-high potassium group, to explore the relationship between different sodium-potassium combinations and the risk of CVD. Results: A total of 954 participants were included in the final analysis, of whom 459 (48.1%) were males. There were 318 cases in the first, second and third ratio group, respectively. There were 347 cases in low sodium-low potassium group and high sodium-high potassium group, and 130 cases in low sodium-high potassium group and high sodium-low potassium group. After a median follow-up of 18.6 (18.3, 19.3) years, cardiovascular events occurred in 81 participants, including 64 stroke and 20 coronary heart disease events. Multivariate analysis showed that comparing with the first ratio group, the hazard ratios (HR) in the second and the third ratio groups were 2.04 (95%CI 1.06-3.95, P=0.034) and 2.07 (95%CI 1.07-4.03, P=0.032), respectively. The CVD risk in low sodium-low potassium group was 24% higher than the low sodium-high potassium group (reference), but this result did not reach statistical significant level (P=0.685). The risks in high sodium-high potassium group (HR=3.32, 95%CI 1.26-8.76,P=0.015) and high sodium-low potassium (HR=3.04, 95%CI 1.05-8.83, P=0.041) group were both significantly increased. Conclusions Overnight urinary sodium to potassium ratio is positively correlated with the risk of cardiovascular events. High urinary sodium plays a more important role for the increased risk of cardiovascular events than low potassium.

Objective To explore the relationship between early adulthood weight status and body weight changes from early adulthood to middle age and high-density lipoprotein cholesterol (HDL-C) level.Methods Data were obtained from China Multicenter Collaborative Study of Cardiovascular Epidemiology Study,which was conducted in 1998,15 participants population samples aged from 35-59 years old from 12 provinces were selected by random cluster sampling.Approximately 1 000 men and women in each sample population were surveyed for cardiovascular disease risk factors,body weight at age 25 from all participants were also obtained.Body mass index (BMI) at the age of 25 years was calculated with the weight at 25 years and the height measured during the survey,participants were divided into underweight (BMI ＜ 18.5 kg/m2,n =1 331),normal-weight (18.5 kg/m2 ≤BMI ＜24 kg/m2,n =10 400),overweight (24 kg/m2 ≤BMI ＜ 28 kg/m2,n =2 019) and obesity (BMI≥28 kg/m2,n =133) groups.Weight change was defined as the difference between the body weight at the age of 25 and at the survey and was grouped into ＜-7.5 kg (n =903),-7.5--2.6kg (n=1 883),-2.5-2.5 kg (n=2573),2.6-7.5 kg (n=2786),7.6-12.5 kg (n =2 674) and ＞ 12.5 kg (n =3 064).The association of body weight status in early adulthood and body weight change from early adulthood to middle age with HDL-C level was examined by logistic regression model.Results The prevalence of low HDL-C in underweight,normal weight,overweight and obesity groups at age of 25 years were 10.7％ (143/1 331),15.5％ (1 612/10 400),16.3％ (330/2 019) and 24.8％ (33/133),respectively (P for trend ＜ 0.01).The prevalence of low HDL-C for adult weight change were 8.8％ (79/903),8.0％ (151/1 883),10.5％ (269/2 573),13.4％ (373/2 786),19.1％ (511/2 674),and 24.0％ (735/3 064) (P for trend ＜0.01)for weight change of ＜-7.5 kg,-7.5--2.6 kg,-2.5-2.5 kg,2.6-7.5 kg,7.6-12.5 kg and ＞ 12.5 kg,respectively.Multivariate logistic regression showed that overweight and obesity at age of 25 years and subsequent weight gain till middle age were positively correlated with low HDL-C after adjusted other risk factors(all P for trend ＜ 0.01).Conclusion Overweight and obesity in early adulthood and significant adult weight gain from early adulthood to middle age were both independently associated with marked increases in the risk of low HDL-C in middle-aged Chinese men and women.Thus,body weight control at early adulthood could be a key strategy to reduce the incidence of low HDL-C at middle-aged population.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).