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Background Strokes significantly impair quality of life and incur high economic and societal burdens. The triglyceride and glucose (TyG) index is a biochemical marker of insulin resistance (IR) and may have important value in the prediction of strokes, especially ischemic stroke (IS). Our study aims to investigate the relationship between TyG index and IS and ascertain whether TyG index is independently associated with IS adverse outcomes. Methods The Cochrane, Embase, Medline, Web of Science, PubMed, and other relevant English databases and related websites were systematically searched for articles on ‘‘TyG index’’ and \"stroke\" published from inception to April 4, 2022. We reviewed the available literature on the TyG index and its relation to predicting IS occurrence in the general population and adverse clinical outcomes. We calculated odds ratios (OR) of TyG index and its predictability of IS occurrence and adverse outcomes. Statistical analyses were performed using the Meta Package in STATA, version 12.0. Results A total of 18 studies and 592,635 patients were included in our analysis. The pooled effect values of all stroke types showed that higher TyG index was associated with increased the risk of IS in the general population (OR 1.37; 95% CI 1.22–1.54) in a total sample of 554,334 cases with a high level of heterogeneity (P = 0.000, I 2  = 74.10%). In addition, compared to IS patients with a lower TyG index, IS patients with a higher TyG index was associated with higher risk of stroke recurrence (OR: 1.50; 95% CI 1.19–1.89) and increased risk of mortality (OR 1.40 95% CI 1.14–1.71). No correlation was found in the effect value combinations of poor functional outcomes (OR 1.12; 95% CI 0.88–1.43) and neurological worsening (OR: 1.76; 95% CI 0.79–3.95) in a total sample of 38,301 cases with a high level of heterogeneity (P = 0.000; I 2  = 77.20%). Conclusions TyG index has potential value in optimizing risk stratification for IS in the general population. Furthermore, there is a significant association between high TyG index and many adverse outcomes of stroke, especially stroke recurrence and high mortality. Future studies should focus on multi-center and multi-regional designs in order to further explore the relationship between IS and TyG index.

The prevalence of childhood hypertension is recognized as an important parameter of cardiovascular risk in adults. This retrospective study aimed to ascertain the prevalence and risk factors for hypertension from birth through childhood as of 2014. Stratified cluster sampling was used to select 17,007 participants (5971 with biochemical indexes available) aged 6–12 years on two avenues per region in urban, suburban, and rural areas. The prevalence of hypertension was 12.55%; children with obesity combined with rural residence, low family income, birth weight (<3000 g) (BWP25) or >10 months of breastfeeding had a significantly elevated prevalence of hypertension (37.06%, 30.41%, 30.04%, and 30.84%, respectively). Obesity and heart rate were the significant anthropometric determinants; gestational hypertension, BWP25 and >10 months of breastfeeding were the significant perinatal determinants; rural residence was the significant socioeconomic determinant; fasting blood glucose, triglycerides, and low-density lipoprotein cholesterol were the significant serum biochemical determinants; and red blood cell counts and platelet counts were the significant haematological determinants of childhood hypertension. The adjusted R2 values were 14.45% and 24.88% in the full models excluding and including serum indexes, respectively. We observed a notable prevalence of hypertension in a large paediatric sample. Obesity, high heart rate, BWP25, >10 months of breastfeeding, low family income, rural residence, abnormal lipid metabolism, and abnormal blood counts were associated with an increased risk of hypertension.

Objective. The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. Methods. Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6∼12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. Results. The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. Conclusions. The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension.

The standardized treatment of chronic obstructive pulmonary disease (COPD) in primary care settings in China remains suboptimal. This study aims to investigate the inhaled medication patterns among COPD patients with a history of acute exacerbations in primary care settings and to analyze the prescription adherence of inhaled medication for those COPD patients to the Global Strategy for Prevention, Diagnosis and Management of COPD (2023). A cross-sectional analysis of the baseline data from a multicenter, prospective cohort of COPD participants was performed. Patients diagnosed with COPD and had at least one mild, moderate or severe acute exacerbation in the previous 12 months were enrolled from 12 primary care clinics in two cities in China (Beijing and Chengdu). Sociodemographic information, symptoms and quality of life, pulmonary function results and inhaled therapy types were collected. Inhaled therapy distributions and adherence to GOLD recommendations were described and visualized, proportions were summarized descriptively. Six hundred and forty-six participants were included in the analysis. 82.7% of the patients were men, mean age 68.7 years. Group A, B, and E accounted for 12.1%, 13.7%, and 66.1%, respectively. 33.4% of the participants received No inhaled therapy. The most frequently used regimen was LABA/ICS (29.9%), followed by LABA/LAMA/ICS (26.0%). Adherence to GOLD strategy was the lowest in group B (4.2%), highest in group E (33.5%). Based on GOLD 2023 recommendation, 35.3% of the group A participants and 32.3% of the group B participants showed inhaled medication underuse, whereas 55.3% and 63.5% showed inhaled medication overuse in group A and B, respectively. Among the COPD patients with a history of acute exacerbations at primary care, prescribing frequently diverged from GOLD 2023 recommendations, characterized by high rates of No inhaled therapy and widespread use of ICS-containing regimens in groups A and B, necessitating improved prescription guideline adherence in the future to facilitate the implementation of standardized COPD management.

Chronic stress promotes the development of atherosclerosis, causing disruptions in the body's hormone levels and changes in the structural function of organs.BackgroundChronic stress promotes the development of atherosclerosis, causing disruptions in the body's hormone levels and changes in the structural function of organs.The purpose of this study was to investigate the pathological changes in the adrenal gland in a model of atherosclerosis under chronic stress and to verify the expression levels of Sodium-glucose cotransporter (SGLT) 1 and SGLT2 in the adrenal gland and their significance in the changes of adrenal gland.ObjectiveThe purpose of this study was to investigate the pathological changes in the adrenal gland in a model of atherosclerosis under chronic stress and to verify the expression levels of Sodium-glucose cotransporter (SGLT) 1 and SGLT2 in the adrenal gland and their significance in the changes of adrenal gland.The model mice were constructed by chronic unpredictable stress, high-fat diet, and Apoe-/- knockout, and they were tested behaviorally at 0, 4, 8 and 12 weeks. The state of the abdominal artery was examined by ultrasound, and the pathological changes of the aorta and adrenal glands were observed by histological methods, and the expression levels and distribution of SGLT1 and SGLT2 in the adrenal gland were observed and analyzed by immunofluorescence and immunohistochemistry. The predictive value of SGLT1 and SGLT2 expression levels on intima-media thickness, internal diameter and adrenal abnormalities were verified by receiver operating characteristic (ROC) curves, support vector machine (SVM) and back-propagation (BP) neural network.MethodsThe model mice were constructed by chronic unpredictable stress, high-fat diet, and Apoe-/- knockout, and they were tested behaviorally at 0, 4, 8 and 12 weeks. The state of the abdominal artery was examined by ultrasound, and the pathological changes of the aorta and adrenal glands were observed by histological methods, and the expression levels and distribution of SGLT1 and SGLT2 in the adrenal gland were observed and analyzed by immunofluorescence and immunohistochemistry. The predictive value of SGLT1 and SGLT2 expression levels on intima-media thickness, internal diameter and adrenal abnormalities were verified by receiver operating characteristic (ROC) curves, support vector machine (SVM) and back-propagation (BP) neural network.The results showed that chronic stress mice had elevated expression levels of SGLT1 and SGLT2. The model mice developed thickening intima-media and smaller internal diameter in the aorta, and edema, reticular fiber rupture, increased adrenal glycogen content in the adrenal glands. More importantly, analysis of ROC, SVM and BP showed that SGLT1 and SGLT2 expression levels in the adrenal glands could predict the above changes in the aorta and were also sensitive and specific predictors of adrenal abnormalities.ResultsThe results showed that chronic stress mice had elevated expression levels of SGLT1 and SGLT2. The model mice developed thickening intima-media and smaller internal diameter in the aorta, and edema, reticular fiber rupture, increased adrenal glycogen content in the adrenal glands. More importantly, analysis of ROC, SVM and BP showed that SGLT1 and SGLT2 expression levels in the adrenal glands could predict the above changes in the aorta and were also sensitive and specific predictors of adrenal abnormalities.SGLT1 and SGLT2 could be potential biomarkers of adrenal injury in atherosclerosis under chronic stress.ConclusionSGLT1 and SGLT2 could be potential biomarkers of adrenal injury in atherosclerosis under chronic stress.

BackgroundAging is an essential national condition throughout China in the 21st century. Cardio-cerebral vascular disease (CCVD) is a common chronic vascular disease in the elderly. Despite aging becoming an increasingly pressing issue, there has been no comprehensive national investigation into the risk factors, prevalence, and management of CCVD among the elderly population in China.Materials and methodsThrough the 4th Survey of the Aged Population in Urban and Rural China (SSAPUR), a nationally representative sample of 224,142 adults aged more than 60 years was surveyed using a multistage, stratified sampling method. The 4th SSAPUR was used to investigate CCVD in the elderly. Univariate and multivariate logistic proportional regression analyses explored the risk factors. These risk factors were then entered into a multivariate linear regression model to identify independent predictive factors for CCVD. Disease management was assessed from the self-reported history of physician diagnosis, treatments, and hospital visits among individuals with CCVD.ResultsAfter excluding samples with missing information, 215,041 individuals were included in the analysis. The overall prevalence of CCVD was 26%. Living in a rural area, being older, being female, having low literacy, smoking, getting little sleep, losing a spouse, being single, not getting enough exercise, having a bad financial situation, and not taking part in public welfare programs were the main risk factors for CCVD among the elderly in China ( P < 0.05). In the multivariate linear regression model, holding all other variables at any fixed value, CCVD remained associated with “urban and rural” (β = 0.012, P < 0.001), “age” (β = −0.003, P < 0.001), “sex” (β = −0.022, P < 0.001), “education level” (β = −0.017, P < 0.001), “marriage” (β = 0.004, P = 0.047), “smoking” (β = 0.012, P = 0.003), “drinking” (β = −0.015, P = 0.001), and “sleep” (β = 0.008, P = 0.005). There were no collinearity problems among these factors.ConclusionMajor risk factors for prevalent CCVD among the elderly in China include the following: rural residence, female, low literacy level, poor sleep quality, bereavement, non-marriage, living alone, lack of exercise, poor financial situation, and non-participation in public welfare activities. Chinese national policies for preventing, controlling, and managing risk factors for CCVD in the elderly must be urgently developed.

A series of model tests were conducted in this study to investigate the deformation characteristics of geosynthetic-reinforced pile-supported (GRPS) composite foundations under cyclic loading. The effects of the applied load, the number of geogrid layers, and types of piles on the performance of the GRPS composite foundation were studied through 1g physical models of composite foundation with well-planned instrumentation. Furthermore, a numerical fitting method was used to assess the relationship between the foundation settlement and the number of load cycles. The results show that with the increase in the magnitude of cyclic load and the number of load cycles, the settlement of GRPS composite foundations and the strain of the pile and geogrid increased accordingly. Adding rigid piles and increasing the number of geogrid layers both could reduce the settlement of GRPS composite foundations, while adding rigid piles was more effective. The relationship between the foundation settlement and the number of load cycles can be expressed by an exponential regression function. The pile strain varied from place to place that the strain of the upper part of the pile was greater than that of the lower part. The geogrid showed a significant impact on the load transfer mechanism of the composite foundation as the geogrid closer to piles endured larger strain. It is critical to consider the variation of the pile strain and the geogrid strain under cyclic loading in the geotechnical practice of composite foundation. The model test results also suggest that the use of GRPS system can effectively reduce the composite foundation settlement. This paper can provide useful references for developing the theoretical framework and design guides for GRPS composite foundations under cyclic loading.

* Eleven OPEs were detected in river sediment and lake sediment in Taihu Lake. * TnBP dominated in river sediment, while TBEP dominated in lake sediment. * A strong correlation existed between log K oc and log K ow of OPEs. * Vertical profiles of OPEs in sediment cores varied according to sampling location. Surface sediment samples from Taihu Lake in China and its inflow rivers, along with two lake sediment core samples, were collected and analyzed for organophosphate esters (OPEs). The concentrations of total OPEs varied from 28.60 ng/g to 158.72 ng/g (median: 54.25 ng/g) in river surface sediment and from 62.57 ng/g to 326.84 ng/g (median: 86.37 ng/g) in lake sediment. Tributyl phosphate (TnBP) was the predominant compound in river surface sediment, and tris(2-butoxyethyl) phosphate was predominant in lake sediment. High contamination occurred in the north-west region, which was related to the high level of urbanization and high usage of OPEs. The sediment-water partition coefficients of OPEs (log K oc ) were calculated, showing a significant correlation with log K ow ( p<0.05). The concentration and composition of OPEs in two sediment cores varied due to the different sampling locations, with more OPE species found in the northern region than in the southern one. Principal component analysis and positive matrix factorization indicated that sewage discharges, vehicle emissions, and atmospheric deposition were the possible sources of OPEs in Taihu Lake sediments. Tris(1-chloro-2-propyl) phosphate, tris(2-chloroethyl) phosphate, and TnBP were the main OPEs causing ecological risks.

The frequent and extensive use of insecticides has caused serious aquatic pollution, thus posing a great threat to ecosystems and public health. In this study, three classes of insecticides including 20 organochlorine pesticides (OCPs), 6 organophosphorus pesticides (OPs), and 8 pyrethroids were analyzed in 24 sediments from the Liaohe River basin. The results showed that all sediment samples were contaminated with insecticides, with the total concentrations ranging from 7.3 ng/g dry weight (dw) to 242.8 ng/g dw. Among them, pyrethroids (2.2–102.5 ng/g dw) contributed 55% of the total insecticide concentration, followed by OCPs (1.3–94.8 ng/g dw) and OPs (2.6–45.5 ng/g dw), representing 24% and 21% of the total concentrations, respectively. For OCPs, hexachlorocyclohexanes (HCHs) and dichlorodiphenyltrichloroethanes (DDTs) showed the highest concentrations of 0.37–37.5 ng/g dw and 0.05–23.2 ng/g dw, respectively. Historical inputs of lindane and technical DDT were the major sources of HCHs and DDTs, respectively, as indicated by isomer or metabolite ratios. Additionally, dichlorvos (0.26–17.1 ng/g dw) was the main OP, while cypermethrin dominated the pyrethroids with the concentrations of 1.6–32.6 ng/g dw. The spatial distribution revealed that significantly higher residues of insecticides were observed in sediments from the Daliao River system than those from the Liao River. This implied that these insecticides were most likely from the discharge of highly polluted sewage and industrial wastewater from adjacent industrial and populous cities as well as urban applications (e.g., landscape maintenance and household pest control). An ecological risk assessment based on risk quotients suggested that the three classes of insecticides analyzed here pose a low risk to aquatic organisms in the study area.

BackgroundPhthalates were detected in various environments due to their widespread application. In this study, indoor dust samples from 94 buildings, including 72 residences and 22 dormitories, were collected in seven geographical regions in China and analyzed for eight phthalate esters (PAEs). Investigation of contamination profiles, geographical distribution, sources, and risks of PAEs in indoor dusts was explored.ResultsThe highest Σ8PAEs concentration in residential buildings was found in Northeast China (median: 164.71 μg·g−1), which was 2.3 and 2.8 times higher than that in South China (median: 71.71 μg·g−1) and Southwest China (median: 58.53 μg·g−1), respectively. Di (2-ethylhexyl) phthalate (DEHP), di-iso-butyl phthalate (DIBP), and di-n-butyl phthalate (DBP) were the dominant compounds of Σ8PAEs in indoor dusts from residences and dormitories. The administrative levels revealed that the highly serious contamination occurred in the provincial capital, followed by nonprovincial cities and countries. Such an occurrence was related to the usage of PAE products and the level of urbanization. Principal component analysis (PCA) and positive matrix factorization (PMF) showed that the emission from cosmetics and personal care products, plasticizers, and household building materials were the possible PAE sources in indoor dusts. Among three routes of ingestion, dermal adsorption, and inhalation, dust ingestion was the main route of human exposure to PAEs. The health risk of PAE exposure for different populations in descending order of children > women > men. The hazard indexes of noncancer were higher than the threshold value of 10−6 during human exposure to DBP and DEHP. Children also faced potential noncancer risk due to benzyl butyl phthalate (BBzP) and di-n-octyl phthalate (DnOP) exposure. The carcinogenic risks via exposure to BBzP and DEHP were negligible.ConclusionOverall, PAEs were widely presented in indoor dusts. Obvious difference was observed in the distribution of PAEs concentration in indoor dusts due to the differences in economic development and usage of PAEs product. Plasticizers, household building materials, and cosmetics and personal care products were likely PAE sources in indoor dusts. The risk assessment suggested that carcinogenic risks of BBzP and DEHP were negligible, but DBP, DEHP, DnOP, and BBzP may pose noncancer risks to humans.