Residential elevation and its effects on hypertension incidence among older adults living at low altitudes: a prospective cohort study

BACKGROUND@#Research on the relationship between residential altitude and hypertension incidence has been inconclusive. Evidence at low altitudes (i.e., <1,500 m) is scarce, let alone in older adults, a population segment with the highest hypertension prevalence. Thus, the objective of this study is to determine whether hypertension risk may be affected by altitude in older adults living at low altitudes.@*METHODS@#This prospective cohort study collected data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We selected 6,548 older adults (≥65 years) without hypertension at baseline (2008) and assessed events by the follow-up surveys done in 2011, 2014, and 2018 waves. The mean altitude of 613 residential units (county or district) in which the participants resided was extracted from the Digital Elevation Model (DEM) of the National Aeronautics and Space Administration (NASA) and was accurate to within 30 m. The Cox regression model with penalized splines examined the linear or nonlinear link between altitude and hypertension. A random-effects Cox regression model was used to explore the linear association between altitude and hypertension.@*RESULTS@#The overall rate of incident hypertension was 8.6 per 100-person years. The median altitude was 130.0 m (interquartile range [IQR] = 315.5 m). We observed that the exposure-response association between altitude and hypertension incidence was not linear. The shape of the exposure-response curve showed that three change points existed. Hypertension risk increased from the lowest to the first change point (247.1 m) and slightly fluctuated until the last change point (633.9 m). The risk decreased above the last change point. According to the categories stratified by the change points, altitude was only significantly associated with hypertension risk (hazard ratio [HR] = 1.003; 95% confidence interval [CI] = 1.002-1.005) under the first change point (247.1 m) after adjusting for related covariates.@*CONCLUSION@#Our study found that the association between altitude and hypertension risk might not be linear. We hope the further study can be conducted to confirm the generality of our findings.

Effects of basic diseases on clinical characteristics and prognosis of septic shock in children / 中国小儿急救医学

Objective:To investigate the clinical features and prognosis of septic shock(SS) children with different basic diseases in pediatric intensive care unit (PICU).Methods:The medical records of SS children admitted to PICU at Beijing Children′s Hospital from January 1, 2017 to December 31, 2019 were collected retrospectively.They were grouped according to the presence or absence of basic diseases and types of basic diseases.The clinical characteristics, prognosis and pathogens of SS under different basic diseases were summarized.Results:A total of 218 children with SS were included during the study period, and the overall case fatality rate was 21.6%(47/218). There were 141 cases with basic diseases, accounting for 64.7%(141/218) and 24.1%(34/141) case fatality rate.The mortality rate was highest(37.5%, 17/45) in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression, and lowest(16.9%, 13/77) in patients with no underlying diseases.Gram-negative bacterial infection was more common in SS children with underlying diseases(63.1%, 41/65), and was highest in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression(80.0%, 20/25). Gram-positive bacteria accounted for the highest proportion in the group without underlying disease(52.1%, 25/48). The incidence of multiple organ dysfunction syndrome(MODS) was the highest(95.6%, 43/45) in the malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression, and the lowest(59.7%, 46/77) in the group without underlying disease.Conclusion:Gram-negative bacteria is the most common pathogen in SS children with underlying diseases, especially in malignant hematologic diseases and tumors patients with post-chemotherapy bone marrow suppression, and with high mortality and incidence of MODS.Gram-positive bacteria is the most common pathogen for those without underlying diseases, with a relatively low mortality and incidence of MODS.

Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China

BACKGROUND@#Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective.@*METHODS@#We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations.@*RESULTS@#We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations.@*CONCLUSION@#Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD.

Beneficial effects of n-3 polyunsaturated fatty acids on child development and health / 中华实用儿科临床杂志

n -3 polyunsaturated fatty acids (n -3 PUFAs),essential fatty acids for human body,have varied biological activities.They are absolutely or relatively deficient in modern human diets.Supplementation of n -3 PUFAs in early life is important for the optimal growth and development in fetus,infants and children,and well as for prevention of chronic non -communicable diseases in later life,such as attention deficient hyperactivity disorder,allergic diseases, asthma,hyperlipidemia and non -alcoholic fatty liver disease.The human body can synthesize eicosapentaenoic acid (EPA)and docosahexaenoic acid (DHA)with linolenic acid,but the ability is limited.Therefore,intake of pre -formed EPA and DHA is needed for body requirement.For pregnant women and infants,supplementation of DHA and EPA with a ratio above 51 is suggested.In clinic,n -3 PUFAs have been applied for treatment of chronic non -com-municable diseases and proved to be beneficial in relief of symptoms.

Role of dextran sulfate in the catabolism of lipid emulsions / 中华临床营养杂志

ObjectiveTo investigate the effects of scavenger receptor A on the catabolism of lipid emulsions and further to see if it differently affects long-chain triglyceride (LCT) and fish oil (FO) emulsions. MethodsA total of 24 C57BL/6J female mice, 10 to 12 weeks old, were randomly divided into 4 groups with 6 mice in each group. Two groups of mice were intravenously injected with dextran sulfate ( DexSO4 ) ( 1 mg/mouse) followed by intravenous injection of [1α, 2α(n)-3H] cholesteryl oleoyl ether [(3H)CEt] labelled LCT or FO emulsions (0.4mg triglycerde/mouse) at 2 minutes respectively, and other two groups were injected by saline as controls before injection of (3H)CEt labelled LCT and FO emulsions. Then, blood was drawn at fixed intervals to measure the radioactivities and the emulsion's fractional catabolic rates (FCR) were calculated. With the same procedures above mentioned, non-radiolabelled LCT and FO emulsions were intravenously injected to mice to determine liver uptake of lipid emulsions under electromicroscopy. Finally, THP1 cell line was used to examine the effects of DexSO4 on cell uptake of LCT and FO emulsions in vitro. ResultsPre-injection of DexSO4 to mice decreased the FCR of both LCT and FO emulsions at 72.38％ and 47.38％ respectively, as compared to controls ( P =0.020 ). Electromicroscopy showed that pre-injection of DexS04 decreased the uptakes of LCT and FO emulsions by Kupffer cells and sinusoidal endothelial cells similarly. In hepatocytes, no lipid droplets existed in mice with LCT emulsion injection, whereas some lipid droplets were still shown in mice with FO emulsions but with less quantities compared to control mice.In vitro, addition of DexSO4 to medium decreased THP1 cell uptakes of LCT and FO emulsions ( P =0.003 and 0.008) by 30.74％ and 41.60％ respectively. However, no differences were found in the effects of DexS04 on cell uptakes between LCT and FO emulsions ( P =0.080). ConclusionScavenger receptor A plays important roles in catabolism of lipid emulsions to some extent, and it's effects on FO emulsions may be less than LCT emulsions.