OBJECTIVE: This study aimed to explore the association between body mass index (BMI) and mortality based on the 10-year population-based multicenter prospective study. METHODS: A general population-based multicenter prospective study was conducted at four sites in rural China between 2013 and 2023. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between BMI and mortality. Stratified analyses were performed based on the individual characteristics of the participants. RESULTS: Overall, 19,107 participants with a sum of 163,095 person-years were included and 1,910 participants died. The underweight (< 18.5 kg/m ²) presented an increase in all-cause mortality (adjusted hazards ratio [ aHR] = 2.00, 95% confidence interval [ CI]: 1.66-2.41), while overweight (≥ 24.0 to < 28.0 kg/m ²) and obesity (≥ 28.0 kg/m ²) presented a decrease with an aHR of 0.61 (95% CI: 0.52-0.73) and 0.51 (95% CI: 0.37-0.70), respectively. Overweight ( aHR = 0.76, 95% CI: 0.67-0.86) and mild obesity ( aHR = 0.72, 95% CI: 0.59-0.87) had a positive impact on mortality in people older than 60 years. All-cause mortality decreased rapidly until reaching a BMI of 25.7 kg/m ² ( aHR = 0.95, 95% CI: 0.92-0.98) and increased slightly above that value, indicating a U-shaped association. The beneficial impact of being overweight on mortality was robust in most subgroups and sensitivity analyses. CONCLUSION This study provides additional evidence that overweight and mild obesity may be inversely related to the risk of death in individuals older than 60 years. Therefore, it is essential to consider age differences when formulating health and weight management strategies.
Humans ; Body Mass Index ; China/epidemiology* ; Male ; Female ; Middle Aged ; Prospective Studies ; Rural Population/statistics & numerical data* ; Aged ; Follow-Up Studies ; Adult ; Mortality ; Cause of Death ; Obesity/mortality* ; Overweight/mortality*

OBJECTIVE: To explore the functional roles and underlying mechanisms of neferine in the context of angiotensin II (Ang II)-induced hypertension and vascular dysfunction. METHODS: Male mice were infused with Ang II to induce hypertension and randomly divided into treatment groups receiving neferine or a control vehicle based on baseline blood pressure using a random number table method. The hypertensive mouse model was constructed by infusing Ang II via a micro-osmotic pump (500 ng/kg per minute), and neferine (0.1, 1, or 10 mg/kg), valsartan (10 mg/kg), or double distilled water was administered intragastrically once daily for 6 weeks. A non-invasive blood pressure system, ultrasound, and hematoxylin and eosin staining were performed to assess blood pressure and vascular changes. RNA sequencing and network pharmacology were employed to identify differentially expressed transcripts (DETs) and pathways. Vascular ring tension assay was used to test vascular function. A7R5 cells were incubated with neferine for 24 h and then treated with Ang II to record the real-time Ca²⁺ concentration by confocal microscope. Immunohistochemistry (IHC) and Western blot were used to evaluate vasorelaxation, calcium, and the extracellular signal-regulated kinase (ERK)1/2 pathway. RESULTS: Neferine treatment effectively mitigated the elevation in blood pressure, pulse wave velocity, aortic thickening in the abdominal aorta of Ang II-infused mice (P<0.05). RNA sequencing and network pharmacology analysis identified 355 DETs that were significantly reversed by neferine treatment, along with 25 potential target genes, which were further enriched in multiple pathways and biological processes, such as ERK1 and ERK2 cascade regulation, calcium pathway, and vascular smooth muscle contraction. Further investigation revealed that neferine treatment enhanced vasorelaxation and reduced Ca²⁺-dependent contraction of abdominal aortic rings, independent of endothelium function (P<0.05). The underlying mechanisms were mediated, at least in part, via suppression of receptor-operated channels, store-operated channels, or voltage-operated calcium channels. Neferine pre-treatment demonstrated a reduction in intracellular Ca²⁺ release in Ang II stimulated A7R5 cells. IHC staining and Western blot confirmed that neferine treatment effectively attenuated the upregulation of p-ERK1/2 both in vivo and in vitro, which was similar with treatment of ERK1/2 inhibitor PD98059 (P<0.05). CONCLUSIONS Neferine remarkably alleviates Ang II-induced elevation of blood pressure, vascular dysfunction, and pathological changes in the abdominal aorta. This beneficial effect is mediated by the modulation of multiple pathways, including calcium and ERK1/2 pathways.
Animals ; Angiotensin II ; Male ; Benzylisoquinolines/therapeutic use* ; Network Pharmacology ; Blood Pressure/drug effects* ; Sequence Analysis, RNA ; Mice ; Hypertension/chemically induced* ; Mice, Inbred C57BL ; Calcium/metabolism*

Objective To explore the efficacy of"internet+"family doctor contract service model on controlling risk factors related to atherosclerotic cardiovascular disease(ASCVD)such as hypertension,dyslipidemia,and diabetes in young and middle-aged patients in the community.Methods A total of 231 young and middle-aged patients with ASCVD who were contracted and treated regularly in Shanghai Yangpu District Xinjiangwancheng Community Health Service Center from Jan to Dec 2020.According to the different intervention models,they were divided into the traditional group receiving the conventional family doctor contract service and the Internet group taking"internet+"family doctor contract service mode for intervention.The systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),low density lipoprotein(LDL-C),triglyceride(TG)and total cholesterol(TC)were compared within and between the two groups before intervention,three months after intervention,and one year after intervention,to evaluate the control effects of the two intervention modes.Results The 231 patients,of which 113 cases in traditional group and 118 cases in Internet group,were recruited in the study.there were no significant differences in gender,age and proportions of hypertension,diabetes and dyslipidemia between the two groups.Before intervention,there were no significant differences in systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC between the two groups.Three months after intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the two groups were significantly lower than those before the intervention(all P<0.05),and the systolic blood pressure and diastolic blood pressure of the Internet group were significantly lower than those of the traditional group(all P<0.05),but there was no significant difference between the two groups in FPG,LDL-C,TG and TC.One year after the intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the patients in the two groups decreased significantly compared with those before intervention(all P<0.05),while the Internet group decreased more significantly(all P<0.05).Conclusion Compared with the traditional contract model,"internet+"family doctor contract service had better management effect on ASCVD-related risk factors in young and middle-aged patients in the community,and benefits the patients to a higher degree.

The engineering application of microbially induced carbonate precipitation(MICP)is limited by pH-dependent conformational dynamics of urease.Focusing on the α-subunit urease from Sporosarcina pasteurii,this study integrated conductivity experiments and constant-pH molecular dynamics simulations to analyze active site conformational dynamics and catalytic function across pH 3-11.Results showed that under neutral conditions(pH 7-8),key histidine residues(HIS139/HIS249)exhibited minimal dis-placement(＜0.5 ?),the longest hydrogen bond lifetime(＞8 ps),highest conformational stability(root mean square deviation,RMSD:0.15-0.18 nm),and optimal catalytic activity(conductivity change rate:0.03 mS/cm·min-1,CaCO3 precipitation:3.84 g).Extreme pH(pH 3/11)induced structural collapse(displacement up to 1.8 ?)and complete activity loss.Simulations revealed that neutral pH sta-bilizes a protonation-dependent cooperative allosteric network by maintaining active site cavity volume(～120 ?3)and moderate conformational coherence(correlation coefficient～0.8).This work deciphers the molecular mechanism of pH-regulated urease dynamics through protonation states,providing theoreti-cal support for MICP applications in acidic mine tailing remediation and alkaline soil stabilization.

The engineering application of microbially induced carbonate precipitation(MICP)is limited by pH-dependent conformational dynamics of urease.Focusing on the α-subunit urease from Sporosarcina pasteurii,this study integrated conductivity experiments and constant-pH molecular dynamics simulations to analyze active site conformational dynamics and catalytic function across pH 3-11.Results showed that under neutral conditions(pH 7-8),key histidine residues(HIS139/HIS249)exhibited minimal dis-placement(＜0.5 ?),the longest hydrogen bond lifetime(＞8 ps),highest conformational stability(root mean square deviation,RMSD:0.15-0.18 nm),and optimal catalytic activity(conductivity change rate:0.03 mS/cm·min-1,CaCO3 precipitation:3.84 g).Extreme pH(pH 3/11)induced structural collapse(displacement up to 1.8 ?)and complete activity loss.Simulations revealed that neutral pH sta-bilizes a protonation-dependent cooperative allosteric network by maintaining active site cavity volume(～120 ?3)and moderate conformational coherence(correlation coefficient～0.8).This work deciphers the molecular mechanism of pH-regulated urease dynamics through protonation states,providing theoreti-cal support for MICP applications in acidic mine tailing remediation and alkaline soil stabilization.

Objective To explore the efficacy of"internet+"family doctor contract service model on controlling risk factors related to atherosclerotic cardiovascular disease(ASCVD)such as hypertension,dyslipidemia,and diabetes in young and middle-aged patients in the community.Methods A total of 231 young and middle-aged patients with ASCVD who were contracted and treated regularly in Shanghai Yangpu District Xinjiangwancheng Community Health Service Center from Jan to Dec 2020.According to the different intervention models,they were divided into the traditional group receiving the conventional family doctor contract service and the Internet group taking"internet+"family doctor contract service mode for intervention.The systolic blood pressure,diastolic blood pressure,fasting plasma glucose(FPG),low density lipoprotein(LDL-C),triglyceride(TG)and total cholesterol(TC)were compared within and between the two groups before intervention,three months after intervention,and one year after intervention,to evaluate the control effects of the two intervention modes.Results The 231 patients,of which 113 cases in traditional group and 118 cases in Internet group,were recruited in the study.there were no significant differences in gender,age and proportions of hypertension,diabetes and dyslipidemia between the two groups.Before intervention,there were no significant differences in systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC between the two groups.Three months after intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the two groups were significantly lower than those before the intervention(all P<0.05),and the systolic blood pressure and diastolic blood pressure of the Internet group were significantly lower than those of the traditional group(all P<0.05),but there was no significant difference between the two groups in FPG,LDL-C,TG and TC.One year after the intervention,the systolic blood pressure,diastolic blood pressure,FPG,LDL-C,TG and TC of the patients in the two groups decreased significantly compared with those before intervention(all P<0.05),while the Internet group decreased more significantly(all P<0.05).Conclusion Compared with the traditional contract model,"internet+"family doctor contract service had better management effect on ASCVD-related risk factors in young and middle-aged patients in the community,and benefits the patients to a higher degree.

Objective To investigate the effect and mechanism of miR-195-5p on myocardial fibro-sis in rats with atrial fibrillation(AF).Methods A total of 72 male SD rats were randomly divid-ed into control group,AF group,negative control group,miR-195-5p inhibitor group,recombinant adeno-associated virus serotype 9(rAAV9)group(miR-195-5p inhibitor+rAAV9-negative con-trol),and combination group[miR-195-5p inhibitor+rAAV9-siRNA-SMAD homolog 7(Smad)],with 12 rats in each group.Except for the control group,the rats in the other groups were inflicted to construct AF model.After receiving corresponding intervention measures,elec-trocardiography was conducted to record the incidence and the duration of AF.HE staining and Masson staining were used to observe the pathological changes and fibrosis in the myocardial tis-sues,respectively.qRT-PCR was applied to detect the mRNA levels of miR-195-5p and Smad7,and Western blotting was performed to detect the expression of TGF-β1,Smad2,p-Smad2,Smad3,p-Smad3,Smad7,Collagen-Ⅰ and Collagen-Ⅲ in the myocardial tissues.Dual luciferase assay was used to verify the regulatory effect of miR-195-5p on Smad7.Results Compared with the control group,the AF group had significantly higher AF incidence(75.0％vs 0)and longer duration(27.02±2.65 s vs 0 s),larger collagen volume fraction(CVF)[(14.47±0.89)％vs(2.12±0.35)％],and increased expression levels of miR-195-5p(3.27±0.21 vs 1.00±0.10),TGF-β1(0.76±0.08 vs 0.23±0.04),Collagen-Ⅰ(0.58±0.07 vs 0.20±0.04),Collagen-Ⅲ(0.46±0.05 vs 0.11±0.02),p-Smad2/Smad2(0.92±0.10 vs 0.37±0.05),and p-Smad3/Smad3(0.65±0.06 vs 0.14±0.03),but notably decreased expression of Smad7 at mRNA(0.32±0.06 vs 1.02±0.09)and protein(0.19±0.03 vs 0.58±0.07)levels in the myocardial tissues(P＜0.05).The AF incidence and duration,CVF,miR-195-5p level,and protein levels of TGF-β1,Collagen-Ⅰ,Colla-gen-Ⅲ,p-Smad2/Smad2,and p-Smad3/Smad3 were significantly decreased,and the mRNA and protein levels of Smad7 were significantly increased in the miR-195-5p inhibitor group than the AF group and the negative control group(P＜0.05).The combined treatment increased the inci-dence and duration of AF,CVF,myocardial TGF-β1,Collagen-Ⅰ,Collagen-Ⅲ,p-Smad2/Smad2 and p-Smad3/Smad3 expression levels,and decreased the mRNA and protein expressions of Smad7 when compared with the miR-195-5p inhibitor group and the rAAV9 group(P＜0.05).Conclusion Down-regulation of miR-195-5p alleviates myocardial fibrosis in AF rats probably by targeting Smad7 to inhibit TGF-β1 signaling.

Objective To investigate the effect and mechanism of miR-195-5p on myocardial fibro-sis in rats with atrial fibrillation(AF).Methods A total of 72 male SD rats were randomly divid-ed into control group,AF group,negative control group,miR-195-5p inhibitor group,recombinant adeno-associated virus serotype 9(rAAV9)group(miR-195-5p inhibitor+rAAV9-negative con-trol),and combination group[miR-195-5p inhibitor+rAAV9-siRNA-SMAD homolog 7(Smad)],with 12 rats in each group.Except for the control group,the rats in the other groups were inflicted to construct AF model.After receiving corresponding intervention measures,elec-trocardiography was conducted to record the incidence and the duration of AF.HE staining and Masson staining were used to observe the pathological changes and fibrosis in the myocardial tis-sues,respectively.qRT-PCR was applied to detect the mRNA levels of miR-195-5p and Smad7,and Western blotting was performed to detect the expression of TGF-β1,Smad2,p-Smad2,Smad3,p-Smad3,Smad7,Collagen-Ⅰ and Collagen-Ⅲ in the myocardial tissues.Dual luciferase assay was used to verify the regulatory effect of miR-195-5p on Smad7.Results Compared with the control group,the AF group had significantly higher AF incidence(75.0％vs 0)and longer duration(27.02±2.65 s vs 0 s),larger collagen volume fraction(CVF)[(14.47±0.89)％vs(2.12±0.35)％],and increased expression levels of miR-195-5p(3.27±0.21 vs 1.00±0.10),TGF-β1(0.76±0.08 vs 0.23±0.04),Collagen-Ⅰ(0.58±0.07 vs 0.20±0.04),Collagen-Ⅲ(0.46±0.05 vs 0.11±0.02),p-Smad2/Smad2(0.92±0.10 vs 0.37±0.05),and p-Smad3/Smad3(0.65±0.06 vs 0.14±0.03),but notably decreased expression of Smad7 at mRNA(0.32±0.06 vs 1.02±0.09)and protein(0.19±0.03 vs 0.58±0.07)levels in the myocardial tissues(P＜0.05).The AF incidence and duration,CVF,miR-195-5p level,and protein levels of TGF-β1,Collagen-Ⅰ,Colla-gen-Ⅲ,p-Smad2/Smad2,and p-Smad3/Smad3 were significantly decreased,and the mRNA and protein levels of Smad7 were significantly increased in the miR-195-5p inhibitor group than the AF group and the negative control group(P＜0.05).The combined treatment increased the inci-dence and duration of AF,CVF,myocardial TGF-β1,Collagen-Ⅰ,Collagen-Ⅲ,p-Smad2/Smad2 and p-Smad3/Smad3 expression levels,and decreased the mRNA and protein expressions of Smad7 when compared with the miR-195-5p inhibitor group and the rAAV9 group(P＜0.05).Conclusion Down-regulation of miR-195-5p alleviates myocardial fibrosis in AF rats probably by targeting Smad7 to inhibit TGF-β1 signaling.

Tricuspid regurgitation(TR)is a common heart valve disease.According to the pathogenesis,TR can be divided into primary(organic)and secondary(functional)regurgitation,of which functional TR accounts for more than 90%.Patients with severe TR have poor prognosis and poor drug treatment,and surgery(valvuloplasty)is the main treatment.At present,transcatheter edge-to-edge tricuspid valve repair(T-TEER)has become an essential program of transcatheter treatment for TR,providing minimally invasive treatment for TR patients who cannot undergo surgery or are at high risk of surgery.T-TEER reduces the degree of regurgitation by clamping leaflets,and is currently in the early stage of research and development exploration and clinical validation,mainly for functional TR.T-TEER devices have also made significant progress(TriClip,PASCAL),and Chinese-made novel-designed T-TEER devices are also undergoing clinical trials(DragonFly-TTM,SQ-Kyrin-TTM,NeoBlazarTM).This paper reviews the current applications and research progress of T-TEER.

The construction of a medication safety culture is important for medication safety management and rational drug use.The construction of medication safety culture standards is formulated based on relevant national policies and regulations,accreditation standards for hospitals,expert opinions,the current situation,and the development trend of the healthcare industry.With scientificity,general applicability,instructive guidance,and practicality,they standardized basic requirements,management processes,and improvement of the construction of medication safety culture.To facilitate understanding and the implementation of the standards,we describe the process of standards formulation and explain the key points of the standards.