Association of Glasgow Coma Scale with Total Homocysteine Levels in Patients with Hemorrhagic Stroke.

OBJECTIVES: We aimed to evaluate the association between Glasgow Coma Scale (GCS) and total homocysteine (tHcy) levels and examine the possible effect modifiers in patients with hemorrhagic stroke. METHODS: A total of 1,516 participants with hemorrhagic stroke and having the complete data on baseline GCS and tHcy measurements were included in the final analysis. RESULTS: The mean (SD) of age, tHcy, and GCS levels were 61.5 (11.3) years, 17.0 (10.3) µmol/L, and 13.9 (2.2), respectively. Compared with participants with severe damage (GCS <9), those with mild damage (GCS ≥13) had significantly lower transformed tHcy levels (ß = -2.46; 95% CI -4.80 to -0.12). Consistently, a significantly lower transformed tHcy levels were found in participants with mild damage (GCS ≥13; ß = -1.37; 95% CI -2.66 to -0.08) compared with those with moderate to severe damage (GCS <13). In the stratified analysis, a stronger inverse association between GCS categories (≥13 vs. <13) and tHcy concentrations was observed in ever smokers (vs. never; p for interaction = 0.045), and in participants with systolic blood pressure (SBP) ≥160 mm Hg (vs. <160 mm Hg; p for interaction = 0.031), or total cholesterol (TC) ≥5.2 mmol/L (vs. <5.2 mmol/L; p for interaction = 0.025). CONCLUSION: There was an inverse association between GCS level and tHcy concentration among patients with hemorrhagic stroke, especially in ever smokers or in participants with higher SBP or TC levels.

Strategy for early identification of prediabetes in lean populations: New insight from a prospective Chinese twin cohort of children and young adults.

AIMS: To identify certain subgroups in young and lean populations, who may be at a high risk of developing prediabetes/diabetes, which is not captured by current BMI-based screening algorithms. METHODS: Incidence of prediabetes/diabetes was assessed using oral glucose tolerance tests among 1859 children and 1073 young adults from a prospective Chinese twin cohort. RESULTS: Over a 6-year follow-up, 507 (27.3%) children and 293 (27.3%) adults developed prediabetes/diabetes. Of the 800 incidents, 737(92.1%) and 644(80.5%) were lean at baseline and follow-up, respectively. Baseline fasting glucose in the top tertile of the normal range was associated with an increased risk of prediabetes/diabetes: odds ratio, 1.85 (95% CI 1.32-2.59) and 3.29 (95%CI 2.10-5.17) among normal weight and underweight children, respectively, and 2.74 (95% CI 1.78-4.23) and 3.08 (95% CI 1.69-5.58) among normal weight and overweight/obese adults, respectively, compared with the low tertile of fasting glucose. CONCLUSIONS: We showed that majority incident cases of prediabetes/diabetes were not overweight/obese (at baseline), who would have been missed by traditional screening algorithm emphasizing overweight/obesity. Our findings revealed that an upper end of normal fasting glucose was a simple and robust predictor of future higher risk of prediabetes/diabetes in this young and lean population.

Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT).

The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45-75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m²), overweight (24.0-27.9 kg/m²), and obesity (≥28.0 kg/m²) were calculated relative to normal weight (18.5-23.9 kg/m²). The summary HRs were 1.56 (95% CI, 1.11-2.18) for underweight, 0.78 (95% CI 0.64-0.95) for overweight and 0.64 (95% CI, 0.48-0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity.

Interactive Effect of the KCNJ11 Ile337Val Polymorphism and Cigarette Smoking on the Antihypertensive Response to Irbesartan in Chinese Hypertensive Patients.

OBJECTIVE: This study was designed to detect the association of the potassium inwardly rectifying channel, subfamily J, member 11 (KCNJ11) gene polymorphism with antihypertensive therapeutic response to irbesartan in a large-scale Chinese hypertensive population. METHODS: A total of 1,099 patients with essential hypertension were enrolled to receive a daily dose of 150 mg irbesartan for 27 days. Pretreatment baseline blood pressure (BP) and posttreatment BP on the 28th day were measured. Plasma irbesartan concentrations were measured by high-performance liquid chromatography-fluorescence. The KCNJ11 I337V gene polymorphism was determined using high-throughput TaqMan technology. RESULTS: The HapMap data in the Han Chinese population showed that the I337V was used as a representative for 4 common functional polymorphisms. Our results showed that the association of antihypertensive response to irbesartan and the KCNJ11 genetic variant in the total sample was not significant. However, in nonsmokers, relative to the GG genotype, subjects with the homozygous AA genotype had a significantly higher therapeutic response to irbesartan (adjusted beta ± SE: 4.7±1.9 mm Hg, P = 0.015). In smokers, the subjects with the homozygous AA genotype had a significantly lower therapeutic response to irbesartan (adjusted beta ± SE: -5.6±2.5 mm Hg, P = 0.026). A multivariate linear regression model confirmed that there was a significant interactive effect between the KCNJ11 gene and smoking on irbesartan treatment (interaction P = 0.001). CONCLUSION: The interactive effect of smoking status and the KCNJ11 genotype may influence the antihypertensive effects of irbesartan, which indicates a consideration for future individualized antihypertensive drug treatment.

A prospective study on pulse wave velocity (PWV) and response to anti-hypertensive treatments: PWV determines BP control.

OBJECTIVES: Recent data indicate that hypertension is not well controlled in many populations throughout the world. The factors that influence individual response to anti-hypertensive treatment need to be clarified. Pulse wave velocity (PWV), as a marker of arterial stiffness, has been demonstrated to have important relationships with BP progression; however, little information is available on the role of PWV in blood pressure (BP) control. We aimed to assess BP control during the run-in treatment period in the China Stroke Primary Prevention Trial (CSPPT). METHODS AND RESULTS: These analyses included a total of 3056 treated hypertensive subjects (age: 59.6±7.5years, male/female 1339/1717) with PWV measured at baseline. The average BP at enrollment was 166/95mmHg, and declined to 141/85mmHg after short-term antihypertensive treatment (a median follow-up of 20days). There was an inverse relationship between PWV level and BP reduction during the treatment, most notably for systolic BP (with estimated coefficients of -9.01 (P<0.001) for the top quartile, as compared to the bottom quartile). The association did not differ significantly by gender or types of antihypertensive drugs. Factors related to smaller BP decline were low baseline BP, high baseline PWV, high body mass index, high creatinine, use of fewer types of antihypertensive drug, high heart rate (only for SBP), high homocysteine and low age (only for DBP). CONCLUSION: PWV appears to be an independent determinant of individual response to anti-hypertensive treatment.

Metabolic syndrome, but not insulin resistance, is associated with an increased risk of renal function decline.

BACKGROUND & AIMS: The purpose of this study was to evaluate the effect of metabolic syndrome (Mets) and insulin resistance (IR) on the risk of renal function decline (RFD) in a rural Chinese cohort. METHODS: A total of 2696 subjects aged 40-71 years with normal renal function were followed-up for 7 years. RFD was defined using the Kidney Disease: Improving Global Outcome definition, i.e., a drop in estimated glomerular filtration rate (eGFR) category accompanied by a 25% or greater drop in eGFR from baseline or a sustained decline in eGFR of more than 5 mL/min/1.73 m(2)/year. RESULTS: During the 7-year follow-up, 9.0% of the subjects developed RFD. Subjects with Mets at baseline had an increased risk of RFD with an adjusted odds ratio (OR) of 1.77 (95%CI: 1.25-2.52), and there was a graded relationship between the numbers of Mets components and the risk for RFD. Exclusion of the subjects with hypertension (1.65; 0.99-2.75) or diabetes (1.86; 1.30-2.67) at baseline or further adjustment for IR (1.72; 1.15-2.57) did not substantially change the association between Mets and the risk of RFD. Moreover, the ORs of Mets status for RFD in the older group (≥55 years) were 2.14 (1.06-4.33) times of that in the younger group (<55 years) and 2.26 (1.07-4.78) times in hypercholesterolemia group (≥5.2 mmol/L) of that in the normal (<5.2 mmol/L) group. The baseline IR was not associated with the risk for RFD. CONCLUSIONS: Mets, but not IR, was associated with an increased risk for RFD. And there was a detrimental interaction of Mets with older age and hypercholesterolemia on the risk of RFD.

Age, arterial stiffness, and components of blood pressure in Chinese adults.

Blood pressure (BP) changes with age. We conducted a cross-sectional study in rural Chinese adults to investigate: (1) what is the relationship between age, arterial stiffness, and BP in Chinese men and women; and (2) to what degree can the age-BP relationship be explained by arterial stiffness, controlling for other covariables. These analyses included a total of 1688 subjects (males/females: 623/1065), aged 40 to 88 years. Among them, 353 (20.9%) had hypertension (defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg). Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). baPWV appeared to be more strongly correlated with BP (including SBP, DBP, mean arterial pressure [MAP], pulse pressure [PP]) than age (P < 0.001 for comparisons between Spearman correlation coefficients). Furthermore, baPWV was associated with BP (including SBP, DBP, MAP, and PP) and risk of hypertension in a dose-response fashion, independent of age; in contrast, the age-BP associations were either attenuated or became negative after adjusting for baPWV. Arterial stiffness appears to be an independent contributor to hypertension, even after adjusting for age and other covariables. In contrast, age-BP associations became attenuated or negative after adjusting for baPWV. The utility of baPWV as a diagnostic, prognostic, and therapeutic indicator for hypertension warrants further investigation.

Community-based stroke system of care for Chinese rural areas.

BACKGROUND AND PURPOSE: Stroke system of care plays key roles both in providing effective therapies and in improving the overall outcome of patients with stroke. Our purpose was to develop and evaluate the system in Chinese rural areas. METHODS: A stroke system of care was developed from November 2009 to November 2010 in 3 townships in Ganyu County. An additional 3 matched townships were invited as controls. We first investigated stroke management in these townships and then implemented stroke system of care and an education campaign in the 3 intervention townships. The effectiveness of the system was then evaluated. RESULTS: There were 1036 patients with new stroke among 344 345 subjects in the 6 rural communities. The incidence of stroke in the rural areas was 301/100 000, and the mortality rate was 55/100 000. The proportions significantly increased in the intervention communities after the implementation of the stroke system of care and education campaign when compared with the control communities, including patients presenting at rural hospitals within 3 hours of symptom onset (13.6% versus 8.7%; P=0.017), diagnosed by computed tomographic scanning within 24 hours of admission (65.3% versus 58.5%; P=0.034), and received thrombolytic treatment (3.9% versus 1.7%; P=0.038). During the 1-year follow-up, 32 (6.5%) patients with stroke in the intervention communities and 48 (10.1%) in the control communities died. The disability rate of stroke was significantly reduced in the intervention communities at postintervention (38.4% versus 48.1%; P=0.001). CONCLUSIONS: A stroke system of care would be reliable and practical in Chinese rural areas. CLINICAL TRIAL REGISTRATION URL: http://www.chictr.org. Unique identifier: ChiCTR-RCH-13003408.

Do static and dynamic insulin resistance indices perform similarly in predicting pre-diabetes and type 2 diabetes?

AIMS: We designed a study to compare the predictive power of static and dynamic insulin resistance indices for categorized pre-diabetes (PDM)/type 2 diabetes (DM). METHODS: Participants included 1134 adults aged 18-60 years old with normal glucose at baseline who completed both baseline and 6-years later follow-up surveys. Insulin resistance indices from baseline data were used to predict risk of PDM or DM at follow-up. Two static indices and two dynamic indices were calculated from oral glucose tolerance test results (OGTT) at baseline. Area under the receiver operating characteristic curve (AROC) analysis was used to estimate the predictive ability of candidate indices to predict PDM/DM. A general estimation equation (GEE) model was applied to assess the magnitude of association of each index at baseline with the risk of PDM/DM at follow-up. RESULTS: The dynamic indices displayed the largest and statistically predictive AROC for PDM/DM diagnosed either by fasting glucose or by postprandial glucose. The bottom quartiles of the dynamic indices were associated with an elevated risk of PDM/DM vs. the top three quartiles. However, the static indices only performed significantly to PDM/DM diagnosed by fasting glucose. CONCLUSIONS: Dynamic insulin resistance indices are stronger predictors of future PDM/DM than static indices. This may be because dynamic indices better reflect the full range of physiologic disturbances in PDM/DM.

Effect of simvastatin on plasma homocysteine levels and its modification by MTHFR C677T polymorphism in Chinese patients with primary hyperlipidemia.

OBJECTIVE: We investigate the effect of simvastatin on plasma homocysteine (Hcy) levels and whether genetic factor affects the effect of simvastatin. METHODS: A total of 338 patients with hyperlipidemia were enrolled. Simvastatin was orally administered at a dose of 20 mg/day for 8 weeks. Plasma Hcy levels were measured by high-performance liquid chromatography at baseline and after 8 weeks of treatment. Genotyping of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism was performed by TaqMan probe technique. RESULTS: Serum total Hcy levels were positively correlated with serum creatinine (r = 0.332, P < 0.001). Among total subjects, simvastatin treatment resulted in a significant reduction in serum Hcy levels after 8 weeks (-0.37 ± 2.21 µmol/L, P = 0.003), and this effect was dependent on the initial levels of serum Hcy. The individuals with 677TT genotype had a significantly higher baseline Hcy level and a greater change in Hcy levels. After stratification by body mass index (BMI), we observed a significant increase in Hcy levels among the TT genotype group in adjusted model (beta±SE: 2.64 ± 0.84 µmol/L; P = 0.002) among patients with BMI ≥ 25 (kg/m(2) ). CONCLUSIONS: Simvastatin can cause a marked decrease in plasma Hcy levels. MTHFR C677T genetic variant contributes to simvastatin's effects among Chinese subjects with primary hyperlipidemia.

Prevalence of obesity, abdominal obesity and associated factors in hypertensive adults aged 45-75 years.

BACKGROUND & AIMS: We aimed to examine the prevalence of obesity, abdominal obesity and associated factors in 17,656 Chinese hypertensive adults aged 45-75 years. METHODS: A cross-sectional investigation was carried out in Lianyungang, China. Overweight or obesity was defined as a body mass index of ≥25 kg/m(2). Abdominal obesity was defined as a waist circumference ≥90 cm for men and ≥80 cm for women. RESULTS: The prevalence of overweight or obesity and abdominal obesity was 54.4% (women 59.3% and men 46.0%) and 59.4% (women 73.8% and men 35.1%), respectively. In the multivariable logistic-regression models, higher hypertension grades and standard of living, greater red meat consumption, lower physical activity levels, and antihypertensive treatment were independently associated with overweight or obesity and abdominal obesity in both sexes. Inland residence (versus coastal) was an independent associated factor for abdominal obesity in both sexes. Furthermore, a positive family history of diabetes in both sexes, a positive family history of hypertension, men with a positive family history of coronary heart disease, and men with inland residence were all independently associated with overweight or obesity. CONCLUSIONS: We found a high prevalence of overweight or obesity and abdominal obesity in Chinese hypertensive adults, particularly in inland areas.

Prevalence of unrecognized lower extremity peripheral arterial disease and the associated factors in chinese hypertensive adults.

We aimed to examine the prevalence of lower-extremity peripheral artery disease (LE-PAD) and its associated factors in 3,128 Chinese hypertensive adults 45 to 75 years old without known cardiovascular disease, PAD, chronic kidney disease, diabetes, and dyslipidemia. A cross-sectional investigation was carried out in a rural area of Lianyungang, China. An ankle-brachial index ≤0.90 in either leg was used to define LE-PAD. Prevalence of LE-PAD was 9.0% (10.0% in women and 7.4% in men). In the multivariable logistic regression model, odds ratios (95% confidence interval) of having LE-PAD, were 1.82 (1.27 to 2.61) for participants 65 to 75 versus 45 to 55 years old, 1.48 (1.00 to 1.20) for participants with a waist circumference ≥90 versus <90 cm, 1.47 (1.05 to 2.04) and 1.62 (1.15 to 2.27) for participants with grade 2 and 3 hypertension versus controlled blood pressure or grade 1 hypertension, 1.35 (1.00 to 1.83) and 1.61 (1.16 to 2.23) for participants with heart rate at rest 70 to 80 and ≥80 versus <70 beats/min, and 1.41 (1.00 to 1.97) for participants with poor versus good sleeping quality. For other risk factors, gender-related differences were observed. Adjusted odds ratios of having LE-PAD for men and women were 1.07 (0.66 to 1.74) and 0.65 (0.47 to 0.90) for inland versus coastal residents and 1.03 (0.57 to 1.86) and 1.62 (1.09 to 2.41) for participants with body mass index ≥25 versus <25 kg/m(2). In conclusion, there was a high prevalence of LE-PAD in Chinese hypertensive adults without known cardiovascular disease, PAD, chronic kidney disease, diabetes, and dyslipidemia, particularly in women in coastal areas and in participants with higher heart rate and poor sleeping quality. Therefore, ankle-brachial index determinations should be encouraged in clinical practice in Chinese hypertensive adults.

Methylenetetrahydrofolate reductase C677T polymorphism is associated with estimated glomerular filtration rate in hypertensive Chinese males.

BACKGROUND: Plasma level of total homocysteine (tHcy) is negatively correlated with kidney function in general population. However, the causal mechanism of this correlation is poorly understood. The purpose of this study is to investigate the association of methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, which is a major genetic determinant of the plasma tHcy level, with estimated glomerular filtration rate (eGFR) in Chinese. METHODS: A total of 18 814 hypertensive patients (6,914 males, 11,900 females) were included in the study. RESULTS: Association between the eGFR and MTHFR C677T genotype was examined by sex-specific regression analyses. In males, TT genotype was associated with 1.37 ml/min/1.73 m(2) decrease in eGFR (p = 0.004) and with an increased risk (OR = 1.32, p = 0.008) for the lowest quintile of eGFR after adjusting for age, BMI, and blood pressures. However, such association was not observed in females (p > 0.05). This association suggests MTHFR C677T polymorphism may play a role in the regulation of eGFR in males. CONCLUSIONS: MTHFR 677 T is a risk allele for decreased kidney function in Chinese males, implicating this gene in the pathogenesis of chronic kidney disease (CKD).

Prevalence and associated factors of diabetes and impaired fasting glucose in Chinese hypertensive adults aged 45 to 75 years.

OBJECTIVE: This study examined the prevalence of impaired fasting glucose (IFG) and diabetes and their associated factors in 17,184 Chinese hypertensive adults aged 45-75 years. METHODS: A cross-sectional investigation was carried out in a rural area of Lianyungang, China. Previously undiagnosed diabetes [fasting plasma glucose (FPG) ≥ 7.0 mmol/l] and IFG (6.1-6.9 mmol/l) were defined based on FPG concentration. Previously diagnosed diabetes was determined on the basis of self-report. Total diabetes included both previously diagnosed diabetes and previously undiagnosed diabetes. RESULTS: The prevalence of previously diagnosed diabetes, undiagnosed diabetes, and IFG were 3.4%, 9.8%, and 14.1%, respectively. About 74.2% of the participants with diabetes had not previously been diagnosed. In the multivariable logistic-regression model, older age, men, antihypertensive treatment, obesity (BMI ≥ 25 kg/m(2)), abdominal obesity (waist circumference ≥ 90 cm for men and ≥ 80 cm for women), non-current smoking, a family history of diabetes, higher heart rate, lower physical activity levels, and inland residence (versus coastal) were significantly associated with both total diabetes and previously undiagnosed diabetes. Furthermore, methylene- tetrahydrofolate reductase (MTHFR) 677 TT genotype was an independent associated factor for total diabetes, and current alcohol drinking was an independent associated factor for previously undiagnosed diabetes. At the same time, older age, men, abdominal obesity, non-current smoking, current alcohol drinking, a family history of diabetes, higher heart rate, and inland residence (versus coastal) were important independent associated factors for IFG. CONCLUSION: In conclusion, we found a high prevalence of diabetes in Chinese hypertensive adults. Furthermore, about three out of every four diabetic adults were undiagnosed. Our results suggest that population-level measures aimed at the prevention, identification (even if only based on the FPG evaluation), and treatment of diabetes should be urgently taken to overcome the diabetes epidemic in Chinese hypertensive adults.

Association of adiposity trajectories with insulin sensitivity and glycemic deterioration: a longitudinal study of rural Chinese twin adults.

OBJECTIVE: To evaluate associations between adiposity trajectories over time and insulin sensitivity and glucose deterioration in a Chinese twin cohort. RESEARCH DESIGN AND METHODS: This study focused on 341 males and 292 females aged 20-50 years at baseline who had physical clinical examinations and oral glucose tolerance test at two time points with an average of 6 years apart. BMI, waist circumference, percent body fat (PBF), and percent trunk fat (PTF) trajectories were classified into five track groups based on age- and sex-specific tertiles at each visit. We calculated the odds of the insulin sensitivity index((0,120)) [ISI((0,120))] or glycemic deterioration at follow-up among five defined trajectories (tertile(baseline) → tertile(follow-up)) using generalized estimate equation models. Additionally, we applied structural equation models to examine genetic and environmental influences on adiposity, adiposity change over time (ACO), ISI((0,120)), and the interrelationships among them. RESULTS: Participants with stable adiposity (BMI, waist circumference, PBF, and PTF) in the highest tertile or shifting to the highest tertile tended to have the lowest ISI((0,120)) at follow-up or experience glycemic deterioration. Genetic factors exerted the major influence on adiposity, but environmental factors unique to each twin contributed more strongly to ISI and ACO. Correlations between adiposity/ACO and insulin sensitivity were mainly due to environmental influences. CONCLUSIONS: When adiposity stays or becomes high, insulin sensitivity falls and risk of glycemic deterioration rises. Additionally, we found that genetic factors exerted the major influence on adiposity, while environmental factors played the principal role for ACO and insulin sensitivity.

Tracking blood glucose and predicting prediabetes in Chinese children and adolescents: a prospective twin study.

We examined the tracking of blood glucose, the development of prediabetes, and estimated their genetic contributions in a prospective, healthy, rural Chinese twin cohort. This report includes 1,766 subjects (998 males, 768 females) aged 6-21 years at baseline who completed a 6-year follow-up study. Oral glucose tolerance test was performed for all subjects at both baseline and follow-up. We found that subjects with low fasting plasma glucose (FPG) or 2 h post-load glucose (PG) levels at baseline tended to remain at the low level at follow-up. Subjects in the top tertile of baseline plasma glucose tended to have a higher risk of developing prediabetes at follow-up compared to the low tertile: in males, 37.6% vs. 27.6% for FPG and 37.2% vs. 25.7% for 2hPG, respectively; in females, 31.0% vs. 15.4% for FPG and 28.9% vs. 15.1% for 2 h PG, respectively. Genetic factors explained 43% and 41% of the variance of FPG, and 72% and 47% for impaired fasting glucose for males and females, respectively; environmental factors substantially contribute to 2hPG status and impaired glucose tolerance. In conclusion, in this cohort of healthy rural Chinese children and adolescents, we demonstrated that both FPG and 2hPG tracked well and was a strong predictor of prediabetes. The high proportion of children with top tertile of blood glucose progressed to prediabetes, and the incidence of prediabetes has a male predominance. Genetic factors play more important role in fasting than postload status, most of which was explained by unique environmental factors.

Prevalence estimates for primary brain tumors in China: a multi-center cross-sectional study.

BACKGROUND: Although the first leading cause of death in China was malignant neoplasms (mortality, 374.1 per 100,000 person-years), the full impact of primary brain tumors (PBT) on the healthcare system is not completely described because there are a few well documented reports about the epidemiologic features of brain tumors. This study aimed to report a comprehensive assessment on the prevalence of PBT. METHODS: A multicenter cross-sectional study on brain tumor (MCSBT) in China was initiated in five regional centers: Daqing (northeast), Puyang (north of China), Shiyan (center of China), Ma'anshan (center of China) and Shanghai (southeast). Prevalence rate was calculated by counting the number of people living with a PBT between October 1, 2005 and September 30, 2006 and dividing by the total population of the five communities at January 1, 2006. Estimates of prevalence were expressed as percentages and grouped according to gender and to age in fifteen-year categories. Within these strata, the rates were estimated with 95% confidence intervals (CI) using the accurate calculation of CI for Poisson distribution. A chi-square test was used to compare the various frequencies with α < 0.05. Age-standardized prevalence with the direct method was calculated with the ten-year age-specific prevalence and the age distribution of the Chinese population in 2010, obtained from World population prospects: the 2008 revision. RESULTS: We estimated that the overall prevalence of PBT was 24.56 per 100,000 (95%CI, 14.85 to 34.27), and the overall prevalence of PBT in female population (30.57 per 100,000 and its 95%CI ranged from 19.73 to 41.41) was higher than that in male population (18.84 per 100,000 and its 95%CI ranged from 10.33 to 27.35). However, the discrepancy between genders was not statistically significant because the 95%CI overlapped. Of 272 cases of newly diagnosed PBT, the proportion of histological subtypes by age groups, gender was statistically different (χ(2) = 52.6510, P < 0.0001). More than half of all reported tumors (52.57%) were either gliomas or meningiomas. For the youngest (aged from 0 - 19) strata of the population, glioma appeared to occur more than other subtypes, accounting for 55.56% of all of cases. The majority of brain tumors presented in those aged from 20 to 59 years was pituitary adenomas (45.12%) and gliomas (31.10%). Opposed to brain tumors in adults and teenage, gliomas only accounted for 22.22%. Meanwhile, the median ages at diagnosis of the patients with PBT were similar between males and females except for pituitary adenomas (male: 59 years old; female: 45 years old). CONCLUSIONS: Age standardized prevalence of PBT is 22.52 per 100,000 (95%CI, 13.22 to 31.82) for all populations, 17.64 per 100,000 (95%CI, 9.41 to 25.87) for men, and 27.94 per 100,000 (95%CI, 17.58 to 38.30) for women. Age standardization to China's 2010 population yielded an estimated population of 304 954 cases with PBT. Our prevalence estimates provide a conservative basis on which to plan health care services and to develop programmatic strategies for surviving. In the future, it would be helpful to have long-term observed survival rates that would make the assumptions and the resulting imprecision in the current estimates unnecessary.

C-reactive protein in adolescent twins: patterns and relationship to adiposity.

CONTEXT: Elevated C-reactive protein (CRP) is a marker of cardiovascular risk in adults. Patterns and determinants of CRP in adolescents have not been well described. OBJECTIVE: This study aimed to determine how CRP varies by age, gender, Tanner stage, and body fat composition in rural Chinese adolescents and to what degree adiposity-CRP associations are attributable to shared genetic and environmental factors. DESIGN AND SETTING: Data were derived from an ongoing study of metabolic syndrome in a large community-based twin cohort enrolled in Anqing, China. PARTICIPANTS: The study sample included 1180 adolescent twins aged 13-21 yr. MAIN OUTCOME MEASURES: Plasma CRP concentrations were measured by sandwich immunoassay using flow metric xMAP technology. Body fat composition was assessed by dual-energy x-ray absorptiometry. RESULTS: CRP levels linearly increased across age and Tanner stage in males (P ≤ 0.0001), but in females, CRP exhibited no trend after adjusting for fat mass (P > 0.05). For males, the most explanatory measure was body mass index (partial r(2) = 5.2%), whereas percent body fat (partial r(2) = 8.8%) was more explanatory in females. Of the phenotypic correlations between adiposity measures and CRP (0.25-0.28), 86-89% were attributed to shared genetic factors and 11-14% to common unique environmental factors in both sexes. CONCLUSIONS: Adiposity is a strong determinant of CRP even in this relatively lean Chinese population. There is notable gender difference for the CRP pattern and the relationship of CRP with adiposity during adolescence. To a large degree, common genetic factors may underlie the observed adiposity-CRP-phenotypic correlations.

A common mutation in the defensin DEFB126 causes impaired sperm function and subfertility.

A glycosylated polypeptide, ß-defensin 126 (DEFB126), derived from the epididymis and adsorbed onto the sperm surface, has been implicated in immunoprotection and efficient movement of sperm in mucosal fluids of the female reproductive tract. Here, we report a sequence variant in DEFB126 that has a two-nucleotide deletion in the open reading frame, which generates an abnormal mRNA. The allele frequency of this variant sequence was high in both a European (0.47) and a Chinese (0.45) population cohort. Binding of the Agaricus bisporus lectin to the sperm surface glycocalyx was significantly lower in men with the homozygous variant (del/del) genotype than in those with either a del/wt or a wt/wt genotype, suggesting an altered sperm glycocalyx with fewer O-linked oligosaccharides in del/del men. Moreover, sperm from del/del carriers exhibited an 84% reduction in the rate of penetration of a hyaluronic acid gel, a surrogate for cervical mucus, compared to the other genotypes. This reduction in sperm performance in hyaluronic acid gels was not a result of decreased progressive motility (average curvilinear velocity) or morphological deficits. Nevertheless, DEFB126 genotype and lectin binding were correlated with sperm performance in the penetration assays. In a prospective cohort study of newly married couples who were trying to conceive by natural means, couples were less likely to become pregnant and took longer to achieve a live birth if the male partner was homozygous for the variant sequence. This common sequence variation in DEFB126, and its apparent effect of impaired reproductive function, will allow a better understanding, clinical evaluation, and possibly treatment of human infertility.

Interactive effect of angiotensin II type 1 receptor (AGT1R) polymorphisms and plasma irbesartan concentration on antihypertensive therapeutic responses to irbesartan.

BACKGROUND: To investigate the interactive effect of plasma irbesartan concentration and angiotensin II type 1 receptor (AGT1R) gene polymorphisms on blood pressure (BP) response to irbesartan treatment. METHODS: This study included 1049 Chinese hypertensive patients who were treated with daily oral 150 mg irbesartan for 4 weeks. BP at predose and 28th day of treatment and trough plasma irbesartan concentration (on 28th day of treatment) were measured. Four AGT1R gene polymorphisms (rs2640539, rs1492097, rs388915, rs5186) were genotyped. Multiple linear regression models were used to assess interactive effect of plasma irbesartan concentration and gene polymorphisms on BP response, with adjustment for covariates. RESULTS: When stratified by genotypes, patients carrying allele C of single-neucleotide polymorphism (SNP) rs5186 showed positive association between irbesartan concentration and BP response [SBP: ß ± SE=6.1 ± 2.3 with false discovery rate (FDR) P=0.029; DBP: ß ± SE=2.7 ± 1.0 with FDR P=0.029], but this was not seen in patients with AA genotype. There was a significant interaction between plasma irbesartan concentration and SNP rs5186 on SBP response (interaction P=0.0335) and DBP response (interaction P=0.0190). There also were significant interactions between plasma irbesartan concentration and hap3, hap5 and hap6 (constructed by four genotyped SNPs) on SBP response (FDR P<0.001), but not on DBP response. CONCLUSION: Our data suggest that AGT1R gene polymorphisms and plasma concentration of irbesartan can act interactively to modulate individual response to antihypertensive therapy using irbesartan.