Objective To study the age-dependent relationship between body mass index(BMI)and cognitive impairment in rural population aged 40 years and above.Methods From October 2014 to March 2015,people aged 40 years and above,who lived in two natural villages in Huyi District of Xi'an,were selected as the research subjects.Their general demographic information,lifestyle,medical history,family history,physical examination,and biochemical examination were collected.Mini-Mental State Examination(MMSE)was used to evaluate global cognitive function.Cognitive impairment was defined as an MMSE score lower than the cutoff value,specifically,scores ≤17 for subjects who were illiterate,scores ≤20 for subjects with primary school education,and scores ≤24 for subjects with junior high school education or above.The age-dependent relationship between BMI and cognitive impairment was discussed using stratified analysis,restricted cubic spline(RCS),and multivariate Logistic regression.Results We included a total of 1 792 subjects in the analysis,of whom 230(12.8％)were diagnosed with cognitive impairment.There were 726 males(40.5％);the average age was(55.53±9.92)years,ranging from 40 to 85 years,1 193 subjects aged 40-59 years(66.6％),and 599 subjects aged ≥60 years(33.4％).The average BMI was(25.29±3.14)kg/m2.In the total population,BMI index was fitted as restricted cubic splines in the Logistic regression model,and other confounding factors were corrected.The results showed that BMI index was significantly correlated with cognitive impairment(Poverall=0.023),and there was a trend of nonlinear relationship(P nonlinear=0.097).The specific relationship was that with BMI=25 kg/m2 as the reference(OR=1),when BMI index was＜25 kg/m2,the OR value increased as BMI index decreased.However,when BMI index was ≥25 kg/m2,the OR value did not change significantly as BMI index increased.The population was divided into two subgroups according to age(40-59 years vs.≥60 years).Stratified analysis showed that in the ≥60 years old subgroup,cognitive impairment had significant correlation with BMI index(Poverall=0.038,Pnonlinear=0.097),and the changing trend of the correlation was similar to that of the overall population.By contrast,in the 40-59 years old subgroup,BMI index was not significantly associated with cognitive impairment(Poverall=0.722,Pnonlinear=0.738).Conclusion The relationship between BMI and cognitive impairment is affected by age.No significant association is found in the middle-aged population of 40-59 years old,but there may be a nonlinear association in the elderly population over 60 years old.Specifically,with BMI=25 kg/m2 as the boundary,as BMI decreases,the risk of cognitive impairment gradually increases.As BMI further increases,the risk of cognitive impairment does not change significantly even though it reaches the obesity level.

Objective To study the age-dependent relationship between body mass index(BMI)and cognitive impairment in rural population aged 40 years and above.Methods From October 2014 to March 2015,people aged 40 years and above,who lived in two natural villages in Huyi District of Xi'an,were selected as the research subjects.Their general demographic information,lifestyle,medical history,family history,physical examination,and biochemical examination were collected.Mini-Mental State Examination(MMSE)was used to evaluate global cognitive function.Cognitive impairment was defined as an MMSE score lower than the cutoff value,specifically,scores ≤17 for subjects who were illiterate,scores ≤20 for subjects with primary school education,and scores ≤24 for subjects with junior high school education or above.The age-dependent relationship between BMI and cognitive impairment was discussed using stratified analysis,restricted cubic spline(RCS),and multivariate Logistic regression.Results We included a total of 1 792 subjects in the analysis,of whom 230(12.8％)were diagnosed with cognitive impairment.There were 726 males(40.5％);the average age was(55.53±9.92)years,ranging from 40 to 85 years,1 193 subjects aged 40-59 years(66.6％),and 599 subjects aged ≥60 years(33.4％).The average BMI was(25.29±3.14)kg/m2.In the total population,BMI index was fitted as restricted cubic splines in the Logistic regression model,and other confounding factors were corrected.The results showed that BMI index was significantly correlated with cognitive impairment(Poverall=0.023),and there was a trend of nonlinear relationship(P nonlinear=0.097).The specific relationship was that with BMI=25 kg/m2 as the reference(OR=1),when BMI index was＜25 kg/m2,the OR value increased as BMI index decreased.However,when BMI index was ≥25 kg/m2,the OR value did not change significantly as BMI index increased.The population was divided into two subgroups according to age(40-59 years vs.≥60 years).Stratified analysis showed that in the ≥60 years old subgroup,cognitive impairment had significant correlation with BMI index(Poverall=0.038,Pnonlinear=0.097),and the changing trend of the correlation was similar to that of the overall population.By contrast,in the 40-59 years old subgroup,BMI index was not significantly associated with cognitive impairment(Poverall=0.722,Pnonlinear=0.738).Conclusion The relationship between BMI and cognitive impairment is affected by age.No significant association is found in the middle-aged population of 40-59 years old,but there may be a nonlinear association in the elderly population over 60 years old.Specifically,with BMI=25 kg/m2 as the boundary,as BMI decreases,the risk of cognitive impairment gradually increases.As BMI further increases,the risk of cognitive impairment does not change significantly even though it reaches the obesity level.

Objective To explore the influencing factors of the vaginal birth after cesarean section (VBAC), and establish a model for predicting the risk of trial of the trial of labor after cesarean section (TOLAC). Methods From January 2016 to December 2018, total 694 pregnant women who underwent TOLAC in Northwest Women's and Children's Hospital were retrospectively analyzed. Those cases were divided into two groups according to the mode of delivery: the VBAC group and the failed TOLAC group. At the same time, 700 cases in the elective repeat cesarean section (ERCS) group were randomly selected as control group. The influencing factors of VBAC were analyzed by univariate and multivariate logistic regression, and the pregnancy outcomes between the three groups were compared. Results (1) The VBAC rate was 76.1% (528/694) and 166 women underwent the failed TOLAC (23.9%, 166/694). (2) Univariate analysis found that, the pre-pregnancy body mass index (BMI) [(22.0±3.0),(23.3±2.7) kg/m2], the previous vaginal delivery history [10.4%(55/528),3.6%(6/166)], the cervical score (5.2±1.9,4.3±1.6) and the neonatal birth weight [(3 315 ± 468), (3 484 ± 274) g] of the VBAC group were significantly different from the failed TOLAC group (P<0.05). (3) The comparison of pregnancy outcomes: the neonatal birth weight was (3 315± 468) g, and the intrapartum hemorrhage volume was (255 ± 121) ml in the VBAC group, which were significantly lower than those in the failed TOLAC group [intrapartum hemorrhage (325 ± 173) ml] and the ERCS group [(3 572±344) g, (281±125) ml], there were statistically significant differences in the comparison among the three groups (all P<0.05). Two cases of bladder injury occurred during cesarean section in the TOLAC failure group (1.2%,2/166). The rates of the blood transfusion, puerperal infection, 5-minute Apgar score and neonatal ICU admission among the three groups were no statistically significantly different (all P>0.05). There was no maternal or perinatal death. (4) Multivariate logistic regression analysis showed that the delivery age of pregnant women ( OR=0.92, 95% CI : 0.87-0.98), pre-pregnancy BMI ( OR=0.92, 95% CI :0.86-0.98), vaginal delivery history ( OR=3.31, 95% CI : 1.35-8.01), cervical score ( OR=1.29, 95% CI :1.13-1.42) and the birth weight of the neonates <3 300 g ( OR=3.15, 95% CI : 2.02-4.90) were independent influencing factors for VBAC. The area under curve of the receiver operating characteristic curve was 0.74. Conclusions The influencing factors of VBAC are delivery age, pre-pregnancy BMI, vaginal delivery history, cervical score and neonatal birth weight <3 300 g. The adequate individualized management and assessment of the TOLAC may be helpful to improve the VBAC rate.

OBJECTIVETo evaluate the efficacy and safety of Tongxinluo Capsule (, TXL) for patients with cardiac syndrome X (CSX).

METHODSRandomized controlled trials (RCTs) regarding TXL in the treatment of CSX were searched in Chinese Biomedicine Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, PubMed, EMBASE, Cochrane Central Register of Controlled Trial, websites of the Chinese and International Clinical Trial Registry platform up to June 30, 2015. The intervention was either TXL alone or TXL combined with conventional treatment, while the control intervention was conventional treatment with or without placebo. Data extraction, methodological quality assessment and data analyses were performed according to the Cochrane criteria. The primary outcome was a composite event of death, acute myocardial infarction (AMI), angina requiring hospitalization, revascularization, and heart failure. The secondary outcome measures were angina symptom improvement, electrocardiograph (ECG) improvement, and serum endothelin-1 (ET-1) level. The adverse events were also recorded. RevMan 5.3 software was applied for data analyses.

RESULTSTwelve RCTs (696 patients) were included. Compared with conventional treatment, the addition of TXL to conventional treatment showed some benefits on relieving angina symptoms [risk ratio (RR): 1.46, 95% confidence interval (CI) (1.25, 1.71), P<0.01], and improving ECG [RR: 1.45, 95% CI (1.21, 1.74), P<0.01]. The pooled result did not support a benefit of TXL on reducing the incidence of primary outcome [RR: 0.20, 95% CI (0.02, 1.61), P=0.13]. In addition, TXL decreased serum ET-1 concentration of CSX patients [standardized mean number:-1.63, 95% CI (-2.29,-0.96), P<0.01]. No serious adverse events were reported.

CONCLUSIONSTXL documents potential benefits on attenuating angina symptoms, improving ECG and decreasing serum ET-1 level for CSX patients. However, more rigorous RCTs with high quality are needed to confirm its efficacy and safety.

Capsules ; Cardiovascular Diseases ; diagnostic imaging ; drug therapy ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Electrocardiography ; Endothelin-1 ; blood ; Humans ; Middle Aged ; Outcome Assessment (Health Care) ; Publication Bias ; Syndrome

Objective: To explore the association between maternal respiratory infection in early pregnancy and gestational age of single live birth. Methods: A face to face questionnaire survey was conducted among child bearing aged women in 30 counties (district) of Shaanxi province selected through stratified multistage sampling. Propensity score (PS) matched (1∶1) analysis was used to match participants with respiratory infections to those without respiratory infections. A multilevel linear model was used to investigate the association between respiratory infections and gestational age. Through the control of the confounders step by step, three models were established in this study: model 1 for the variable of respiratory infections before PS matching, model 2 was adjusted for variables in model 1 plus some other individual differences of mother and baby, and model 3 for the variable of respiratory infections after PS matching. Results: Of 28 848 child bearing aged women surveyed, 3 676 (12.74%) had respiratory infections in early pregnancy. After PS matching, 2 762 pairs were matched. Analysis with model 1 indicated that a decrease of 0.111 week (P<0.001) in gestational age was associated with a respiratory infection during the first trimester. Analysis with model 2 and model 3 indicated that a decrease of 0.058 week (P=0.025) and a decrease of 0.076 week (P=0.036) were associated with respiratory infection during the first trimester, respectively. Conclusion: The respiratory infection during the first trimester was associated with the decrease of the gestational age of newborn.
Bacterial Infections/epidemiology* ; Child ; China/epidemiology* ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Mothers ; Pregnancy ; Pregnancy Trimester, First ; Propensity Score ; Respiratory Tract Infections/epidemiology*

Objective To predict the incidence of birth defects in Xi'an using the auto-regressive integrated moving average product seasonal model.Methods In Xi'an,the trend of the incidence of birth defects was analyzed and tested from October 2009 to August 2015.Using the data from September to December 2015,the actual birth defects were compared with the model fitting data to evaluate the predictive performance of the model.Multiple seasonal ARIMA model was then fitted under time series to predict the incidence of birth defects in 2016.Results Seasonal effect was seen in the incidence of birth defects in Xi'an.A multiple seasonal ARIMA(0,0,1) (0,1,1)12 was established.The mean of absolute error and the relative error were 9.5 and 0.084,respectively,when compared to the simulated number of patients from September to December in 2015,suggesting that ARIMA (0,0,1) (0,1,1)12 has a better predictive ability.Results under the prediction of multiple seasonal ARIMA model showed that the number of patients in 2016 was similar to that of 2015 in Xi'an,with a slight increase and a decrease in the peak value.Conclusion Multiple seasonal ARIMA(0,0,1)(0,1,1)12 model could be used to successfully predict the incidence of birth defects in Xi'an.

Objective To explore the relationship between first trimester pregnancy infection and congenital malformation in the cardiovascular system.Methods A hospital-based study was conducted from June 2014 to June 2016.Totally 1618 mothers of infants with cardiovascular system malformation and normal infants were interviewed through a face-to-face questionnaire survey.A propensity score-matched study was conducted to investigate the association between first trimester pregnancy infection and congenital malformation in the cardiovascular system.Results All important covariates were balanced after matching.First trimester pregnancy infection increased the risk of congenital malformation in the cardiovascular system,single congenital malformation in the cardiovascular system and multi-congenital malformation in the cardiovascular system.After matched,the OR values were 1.65 (95％ CI:1.21-2.24;P=0.001),1.50 (95％ CI:1.02 2.20;P=0.037),and 1.90 (95％ CI:1.18-3.06;P=0.008),respectively.Conclusion First trimester pregnancy infection increases the risk of congenital malformation in the cardiovascular system.Avoiding infectious diseases during the first trimester in pregnancy is important in decreasing the incidence of congenital malformation in the cardiovascular system.

Objective To explore the relationship of four kinds of lifestyle factors,namely,prenatal passive smoking,hair dyeing or perming,exposure to noise,living in a house renovated in the past one year,with congenital heart disease.Methods A hospital-based case-control study was conducted.Totally 270 mothers in the case group and 1633 mothers in the control group were interviewed through a face-to-face questionnaire survey.A generalized linear model was employed to investigate the association between congenital heart disease and prenatal lifestyle factors.Results Both in Model 1 and Model 2,prenatal hair dyeing or perming had no association with congenital heart disease.On the other hand,prenatal passive smoking,exposure to noise and living in a house renovated in the past one year all increased the risk of congenital heart disease.After adjustment for all confounders,the OR values were 1.771 (95％ CI:1.079-2.909),2.079 (95％ CI:1.310-3.298),and 2.494 (95％ CI:1.511-4.116),respectively.Conclusion Prenatal passive smoking,exposure to noise and living in a house renovated in the past one year are the risk factors for congenital heart disease.It is very important to avoid such factors during pre-pregnancy and pregnancy.

Objective To explore the effect of maternal animal sourced food intake during pregnancy on neonate birth weight and provide scientific basis for guiding the reasonable diet intake in pregnant women and increasing neonate birth weight.Methods Data were derived from a cross-sectional project of "the prevalence and risk factors of birth defects in Shaanxi province",which were conducted in 30 counties in Shaanxi province from July to November in 2013.A stratified multistage random sampling method was used to select women who were pregnant between January 2010 and December 2013 for a random semi-quantitative food frequency questionnaire survey to collect the data on the frequency and amount of food consumption on animal protein sources and the data of newborns.Children aged 0-1 years and their mothers were selected as the study subjects.The generalized linear model was used to analyze the relationship between the neonate birth weight and maternal animal sourced food intake during pregnancy,and by using neonate birth weight as dependent variable,food intake frequency as independent variable,three adjustment models were established for stratified analysis.Results Totally 11 459 participants were involved in this study.The average birth weight of newborn was (3 279.9 ± 454.6) g,the average weekly intake of animal sourced foods was 4.00 times for egg,1.50 times for meat,3.00 times for dairy foods,0.50 times for fish and 5.00 times for overall animal sourced foods in pregnant women.Without stratification,three models shown that meat and overall animal sourced food intake had effects on neonate birth weight.After adjustment for gestational weeks,maternal age,social and demographic factors and others,meat intake increased by 1 time a week,the increase of neonate birth weight was about 5.26 (95％ CI:1.32-9.20) g,and the overall animal food increased by 1 times a week,the average neonate birth weight increased by 3.24 (95％ CI:1.09-5.39) g.Stratified analysis showed that meat and overall animal sourced food always had more influences on baby girls and those living in rural area.In the region classification,the overall animal sourced food intake had more influences on women living in northern area and Guanzhong area of Shaanxi,and meat intake had greater influence on women living in southern Shaanxi.And the influences were positive,the more animal sourced foods were taken,the greater the birth weight increased.Conclusion Animal sourced food intake during pregnancy would benefit the increase of neonate birth weight.It suggests that pregnant women should pay more attention to the intake of animal sourced food.

Objective To study the relationship between homocysteine (Hcy)and carotid atherosclerosis in patients with cer-ebral infarction.Methods During January and November 2013,281 patients with cerebral infarction from Affiliated Hospital of Yan’an University were provided the blood samples as cerebral infarction group,140 healthy volunteers served as control group.Serum Hcy was detected by enzymatic cycle assay.According to the results of carotid artery ultrasonography,cerebral infarction group was divided into five groups:artery normal group,intimal thickening group,soft plaque group,mixed plaque group and hard plaque group.The statistically significance was analyzed by SPSS 19.0.Results The serum Hcy level of cer-ebral infarction group was 19.78 ± 5.21 μmol/L,significantly higher than the control group 10.24 ± 3.33 μmol/L (P <0.001).The serum Hcy levels of control group,artery normal group,intimal thickening group,soft plaque group,mixed plaque group and hard plaque group were 10.24±3.33,15.20±2.99,17.03±1.85,25.44±4.24,19.65±4.74 and 18.31 ±3.67 μmol/L respectively.The differences between groups were statistically significant in addition to intimal thickening group and hard plaque group (P =1.106).The positive rates were 16.4%,53.7%,87.1%,95.7%,83.1% and 77.3% re-spectively,the groups which in cerebral infarction group compared with control group,the differences were statistically sig-nificant (P <0.001).Conclusion Hcy played an important role in the occurrence and development of cerebral infarction. Lower serum Hcy concentration,may be an effective way to prevent carotid atherosclerosis and cerebral infarction.