Objectives:To investigate the association between social determinants of health(SDOH)and incident stroke and analyze the main risk factors for stroke among resident with different SDOH levels. Methods:From 2012 to 2015,30 036 residents(≥35 years old)from 30 districts in 14 provincial-level administrative divisions in China were enrolled this study based on stratified multi-stage-random-sampling method.The prevalence of cardiovascular diseases and related risk factors were investigated,and stroke events were followed up in 2018 to 2019.Principal component analysis was performed to establish SDOH scores based on 9 indicators related to socioeconomic and healthcare resources,participants were divided into low SDOH group(n=8 343)when it was≥-2.01 to<-1.14,middle SDOH group(n=7 257)when it was≥-1.14 to<0.10,and high SDOH group(n=8 457)when it was≥0.10 to≤5.79.Multivariate Cox regression was applied to estimate the association of SDOH levels with incident stroke.The random survival forest method was used to analyze the major risk factors in different SDOH levels. Results:A total of 24 057 participants were finally included,669(2.8%)participants developed stroke during a mean of(4.7±0.8)years follow-up.The incidence densities of stroke in the low,medium,and high SDOH groups were 468.39,628.85,and 700.39/100 000 person-years,respectively(Pdifference<0.05,Ptrend=0.01).Compared with individuals with low SDOH level group,fully HR for incident stroke among those with medium and high were 1.91(95%CI:1.54-2.36)and 1.59(95%CI:1.30-1.95),respectively(Ptrend<0.001).Advanced age is the primary risk factor for stroke in the population,especially in districts with high SDOH level.In districts with medium SDOH level,diabetes is an important risk factor for stroke.High blood pressure and alcohol consumption are important modifiable risk factors in low SDOH level districts. Conclusions:Present study shows that higher levels of SDOH are associated with increased risk of stroke.The main risk factors for stroke differ among participants with different SDOH level districts.Targeted interventions should be implemented to improve the prevention and treatment of stroke in populations with different levels of SDOH.

Phlegm and dampness are endogenous,rise and fall with Qi,reach the limbs,diffuse the whole body,and form obesity.Regulating phlegm dampness with traditional Chinese medicine can realize the early prevention and treatment of obesity.Intestinal microbiota participates in a variety of human metabolic processes.Regulating intestinal microbiota is a new way to prevent and treat obesity.Taking the close relationship between intestinal flora and its metabolites,obesity and phlegm dampness theory as the breakthrough point,and based on the existing research results,this paper discusses the possible role of intestinal microbiota and its metabolites in the formation of phlegm dampness and the prevention and treatment of obesity,It is considered that the common intestinal microbiota and its metabolites of different individuals with obesity caused by phlegm dampness may be used as specific indicators to become the new micro identification basis of obesity phlegm dampness theory.It is proposed that intestinal microbiota and its metabolites will become the key point of obesity phlegm dampness theory research,which will provide a new explanation for obesity prevention and control research,and expand new research fields for the connotation of TCM phlegm dampness theory.

Objective:To investigate the level change of serum total n-terminal propeptide of type Ⅰ precollagen (t-PINP) /type Ⅰ collagen carboxy-terminal peptide (beta-CTX) ratio, 25-hydroxyvitamin D (25-hydroxyvitamin D, 25 (OH) ) ratio, and 25-hydroxyvitamin D in elderly women with differentiated thyroid cancer (DTC) after surgery and its value in the prevention and treatment of osteoporosis (OP) .Methods:From Jan. 2020 to May. 2021, 112 elderly female postoperative DTC patients treated with thyroid stimulating hormone (TSH) suppression in Department of Endocrinology of Wenzhou Hospital of Integrative Medicine were collected for a prospective study, and the incidence of OP after 1 year of treatment was counted, and according to the incidence of OP, they were divided into incidence group ( n=78) and non-incidence group ( n=34). The general information, thyroid parameters [TSH, free triiodothyronine (FT3), free thyroxine (FT4) ], bone mineral density (BMD), and serum t-titrosine (BMD) were compared between the two groups. SPSS22.0 software was used, and the counting data was described by examples χ2 test. Grade data was expressed in u, Ridit test was used, measurement data was described in mean±standard deviation ( ±s), t test was used, Pearson correlation coefficient model was used to analyze postoperative thyroid index and serum t-PINP/β- Correlation between CTX ratio and 25 (OH) D level, and serum t-PINP after 1 year of treatment was analyzed through interaction/β- The role of CTX ratio and 25 (OH) D level in OP occurrence. Results:The incidence of OP after 1 year of TSH suppression treatment in 112 elderly female post-DTC patients in this study was 69.64% (78/112) ; serum TSH levels (0.63±0.19) mIU/ml after 1 year of treatment in patients who developed OP were lower than those in patients who did not develop OP (0.81±0.22) mIU/ml, and serum FT3 (6.15±1.71) pmol/ml and FT4 levels (24.63±4.28) pmol/ml were higher than those of patients without OP (4.32±1.29) pmol/ml and (20.36±3.70) pmol/ml ( t1=4.391, t2=5.581, t3=5.050,all P<0.05) .Serum t-PINP/β-CTX ratio (130.27±18.09) and 25 (OH) D level (20.18±4.15) ng/ml after 1 year of treatment in patients with OP were lower than those in patients without OP (148.56±20.37) and (23.36±4.36) ng/ml ( t1=4.733, t2=3.672, both P<0.05) ; serum TSH levels were positively correlated with serum t-PINP/β-CTX ratio and 25 (OH) D levels, and serum FT3 and FT4 levels were negatively correlated with serum t-PINP/β-CTX ratio and 25 (OH) D levels after 1 year of treatment in patients with OP ( P<0.05) ; low serum t-PINP/β-CTX ratio after 1 year of treatment expression, and low 25 (OH) D levels showed a positive interaction in OP occurrence in a superphase multiplicative model ( P<0.05) . Conclusion:Serum t-PINP/β-CTX ratio and 25 (OH) D level are closely associated with the occurrence of OP after DTC in elderly women, and postoperative monitoring can help prevent and treat OP.

OBJECTIVE To optimize the processing technology of honey bran-fried Atractylodis Rhizoma， and to compare the anti-gastric ulcer effect before and after processing. METHODS Combing with entropy-weight and technique for order preference by similarity to ideal solution model， L（9 34） orthogonal experiment design was adopted to optimize the processing technology of honey bran-fried Atractylodis Rhizoma using the comprehensive score of the contents of atractylone， β-cineole， atractylenolide Ⅲ and atractylodine as evaluation index， using the ratio of excipients to medicine， frying temperature and frying time as factors. The validation tests were conducted. The gastric ulcer model of mice was induced by intragastrical administration of anhydrous ethanol； using Compound aluminum hydroxide tablet as positive control， anti-gastric ulcer effect of Atractylodis Rhizoma was compared with that of honey bran-fried Atractylodis Rhizoma using the contents of serum inflammatory factors [interleukin-2 （IL-2）， IL-6， tumor necrosis factor-α （TNF-α）]， ulcer index and inhibitory rate of gastric ulcer as evaluation indexes. RESULTS The optimal processing technology of honey bran-fried Atractylodis Rhizoma was as follows：ratio of adjuvant and medicinal materials of 3∶10 （g/g）， frying temperature at 140 ℃ and frying time of 4 min. Results of 3 validation tests showed that the contents of 4 components （including atractylone）， in honey bran-fried Atractylodis Rhizoma processed by the optimal technology kept stable （RSDs were 3.47%-5.80%， n＝3）； the comprehensive scores were 95.53%-95.89% （RSD＝0.21%， n＝3）. Atractylodis Rhizoma and honey bran-fried Atractylodis Rhizoma could increase the serum content of IL-2 in mice， but reduce serum contents of IL-6 and TNF-α to varying degrees； honey bran-fried Atractylodis Rhizoma could significantly decrease its ulcer indexes （P＜0.05 or P＜ 0.01）； the improvement effect of honey bran-fried Atractylodis Rhizoma on the above indicators was generally better than that of the same dosage of Atractylodis Rhizoma （P＜0.05 or P＜ 0.01）. The inhibitory rates of low-dose， medium-dose and high-dose Atractylodis Rhizoma and honey bran-fried Atractylodis Rhizoma to gastric ulcer in mice were 9.18%， 19.30%， 30.70%， and 50.32%， 61.39%， 53.16%， respectively. CONCLUSIONS The optimal processing technology of honey bran-fried Atractylodis Rhizoma is stable and feasible， and the anti-gastric ulcer effect of Atractylodis Rhizoma has been enhanced after being fried with honey bran.

Objective:To investigate the prevalence of albuminuria in Chinese residents aged >35 years and its potential association with cardiovascular disease (CVD).Methods:A total of 34 647 Chinese subjects aged ≥35 years were selected by stratified multi-stage random sampling from 2012 to 2015. Data were collected through questionnaires, physical examinations, and laboratory tests. Albuminuria was categorized into 3 types according to urinary albumin-to- creatinine ratio: normal (<30 mg/g), microalbuminuria (MAU, 30-300 mg/g), and macroalbuminuria (≥300 mg/g). Measurement data were expressed as xˉ±s, and t-tests were used for comparisons between indicators. Qualitative data were expressed as rate or constituent ratio, and the χ2 test or Kruskal-Wallis test was used to examine differences. Logistic regression was used for multivariate analyses. SAS 9.4 software was used for statistical analyses, and P<0.05 was considered statistically significant. Results:The prevalence of abnormal albuminuria was 19.1%; the prevalence was 17.2% for MAU and lower in males (13.8%) than females (20.1%, P<0.01). The risk of CVD was higher among subjects with MAU ( OR=1.23, 95% CI 1.12-1.35) and macroalbuminuria ( OR=1.86, 95% CI 1.50-2.32). When MAU was complicated by hypertension and diabetes mellitus, the CVD risk was 1.76 times higher. Conclusions:The prevalence of MAU is high among Chinese subjects aged 35 years and over. Those with MAU have higher CVD risk, especially those with hypertension and diabetes mellitus.

Objective:To investigate the relationship between single nucleotide polymorphism (SNPs) of Zeste homolog enhancer 2 (EZH2) gene and the risk of breast cancer.Methods:Recruiting 1 039 breast cancer patients and 1 040 controls at 22 referral hospitals nationwide in China, the genotype distribution of 3 SNPs loci of EZH2 genes was observed to detect the correlation between different genotypes and the risk of breast cancer genotypes EZH2 expression in breast cancer tissues and its correlation with patient prognosis were analyzed using breast cancer data from the database.Results:EZH2 rs6464926 CC genotype was compared with TT genotype (TT vs. CC: OR=1.362, 95% CI: 1.063-1.746, P=0.015) and dominant model (TC+TT vs .CC: OR=1.22, 95% CI: 1.004-1.483, P=0.045) .In women with BMI ≥24 kg/m 2, the TC genotype ( P=0.050), TT genotype ( P=0.025) and dominant model (TC+TT, P=0.021) of rs6464926 locus were significantly different from CC genotype in cancer risk. rs6464926 was correlated with EZH2 gene expression ( P=6.89E-47). EZH2 gene is highly expressed in breast cancer tissues, and patients with high expression were associated with shorter OS ( HR=1.27, P=0.013), DMFS ( HR=1.37, P<0.01), and RFS ( HR=1.44, P<0.01). Conclusions:The polymorphism rs6464926 of EZH2 gene is associated with breast cancer susceptibility in Chinese women. rs6464926 might regulate breast cancer risk and prognosis by changing EZH2 expression.

Objective:To investigate the efficacy of lanthanum carbonate versus calcium acetate in the treatment of hyperphosphatemia in patients receiving maintenance hemodialysis. Methods:A total of 202 patients with chronic renal failure who received maintenance hemodialysis in Department of Nephrology, Yiwu Central Hospital from March 2016 to January 2017 were included in this study. These patients were on dialysis for ≥ 6 months with blood phosphorus level > 1.78 mmol/L before dialysis. They were randomly divided into the lanthanum carbonate ( n = 100) and calcium acetate ( n =102) groups. Two patients in the lanthanum carbonate group withdrew from the study due to intolerance of vomiting. All patients were treated for 9 months. During the study period, low calcium dialysate was rationally used, and strict dietary phosphate restriction was applied. The changes in serum phosphorus, calcium and parathyroid hormone contents before and after treatment were compared between the two groups, and they were compared between before and after treatment in each group. Results:During the treatment, the average dose of phosphate binder was 1 500 mg/d in the lanthanum carbonate group and 3 335 mg/d in the calcium acetate group. There were no significant differences in general demographic data and biochemical indexes between the two groups (both P > 0.05). No significant differences in dietary phosphorus content and dialysate calcium concentration were observed between the two groups (both P > 0.05). In the calcium acetate group, blood phosphorus content decreased from (2.12 ± 0.35) mmol/L before treatment to (1.55 ± 0.24) mmol/L after treatment ( t = 13.43, P < 0.01). In the lanthanum carbonate group, blood phosphorus content decreased from (2.14 ± 0.3) mmol/L before treatment to (1.45 ± 0.17) mmol/L after treatment ( t = 20.01, P < 0.01). In the lanthanum carbonate group, the difference in blood phosphorus content between before and after treatment was (0.69 ± 0.29) mmol/L, which was significantly higher than that in the calcium acetate group [(0.57 ± 0.37) mmol/L, t = 2.553, P < 0.01]. Hypercalcemia did not occur in both groups, and there were no significant differences in carotid intima thickening and presence of calcified plaque between the two groups (both P > 0.05). Conclusion:Under the premise of effectively implementing rational low calcium dialysate use and strict dietary phosphate restriction, both calcium acetate and lanthanum carbonate can effectively reduce the blood phosphorus level in patients undergoing maintenance hemodialysis. Lanthanum carbonate has better effect in reducing serum phosphorus level than calcium acetate, but it is likely to produce gastrointestinal reactions. Neither treatment method bears the risk of hypercalcemia.

Objective: To evaluate the effects of standardized management of hypertension on blood pressure control of hypertension patients with diabetes mellitus in workplace population. Methods: Taking the type and size of workplace into consideration, 61 work sites were selected in different provinces by using epidemiological field trial method. In each selected province, 2-4 work sites with similar economic and medical conditions were chosen, among which 1-3 were designated as the intervention group and the other one as the control group. In total, 443 patients with hypertension and diabetes mellitus were included, with 347 patients in the intervention group and 96 patients in the control group. After training, doctors conducted standardized management for patients in the intervention group for a period of 24 months, following up with them regularly once a month, and recorded changes in blood pressure, risk factors, target organ damage, and treatment, while the control group had no special intervention, and relevant information was collected only at baseline and 24 months. Blood pressure, blood pressure control rate, and blood glucose changes were compared between the two groups. Results: After receiving standardized management of hypertension, the control rate of hypertension for patients with both hypertension and diabetes mellitus in the intervention group increased from 24.2% to 63.7% (P<0.05) and the participants’ blood pressure also significantly decreased, by 10.2 (11.9-8.4) mmHg (1 mmHg=0.133 kPa) for systolic blood pressure and 7.7 (8.8-6.6) mmHg for diastolic blood pressure (P<0.05); moreover, the blood glucose also decreased slightly (P<0.001). In addition, the control rate of blood pressure increased to 63.7% with the increase of management time. In the control group, the control rate of hypertension increased to 46.9% (P<0.05) and the systolic and diastolic blood pressure decreased by 5.6 (8.9-2.2) and 4.5 (6.6-2.4) mmHg (P<0.05). Conclusions The standardized management of hypertension in the workplace can effectively reduce overall blood pressure levels and improve the control rate of hypertension in the working population.

Objective: To identify the incidence of hypertension, overweight/obesity in middle-aged population in China, and explore their impact on cardiovascular events. Methods: From 2009 to 2010, 12 areas were sampled in China, and about 1 000 subjects aged 35 - 64 from each area were enrolled to collect the basic information, physical examination and blood tests were also performed. From 2016 to 2017, data from 8 835 subjects, who completed the 6 years follow-up, were analyzed.Blood pressure and body mass index(BMI) at both baseline and the follow-up, as well as incidence of hypertension, overweight and obesity, were calculated. Cox proportional hazard model was used to investigate the impacts of hypertension, overweight and obesity on cardiovascular events after adjusting confounders. Results: At the end of follow-up, both BMI and systolic and diastolic blood pressure increased significantly compared with the baseline levels (all P<0.001). The cumulative incidence of hypertension, overweight and obesity within 6 years was 39.3%(1 146/2 918), 11.5%(406/3 544) and 4.3%(302/7 025), respectively. Compared with subjects with both normal BMI and blood pressure, people with overweight, obesity, hypertension, overweight with hypertension, and obesity with hypertension faced significantly increased risk of cardiovascular disease (HRs (95%CIs) were 2.394(1.130-5.073), 3.341(1.454-7.674), 6.047(2.978-12.279), 5.808(2.924-11.539) and 8.716(4.391-17.302), respectively, all P<0.05), after adjusting for other confounders. Conclusions The incidence of overweight, obesity, and hypertension is high in middle-aged people in China. Overweight, obesity and hypertension are associated with significantly increased risk of cardiovascular events during the 6 years follow up.

Objective:To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF).Methods:Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients.Results:Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs( P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion:HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.