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The order Agaricales was divided into eight suborders. However, the phylogenetic relationships among some suborders are largely unresolved, and the phylogenetic positions and delimitations of some taxa, such as Sarcomyxaceae and Tricholomopsis, remain unsettled. In this study, sequence data of 38 genomes were generated through genome skimming on an Illumina sequencing system. To anchor the systematic position of Sarcomyxaceae and Tricholomopsis, a phylogenetic analysis based on 555 single-copy orthologous genes from the aforementioned genomes and 126 publicly accessible genomes was performed. The results fully supported the clustering of Tricholomopsis with Phyllotopsis and Pleurocybella within Phyllotopsidaceae, which formed a divergent monophyletic major lineage together with Pterulaceae, Radulomycetaceae, and Macrotyphula in Agaricales. The analysis also revealed that Sarcomyxaceae formed a unique major clade. Therefore, two new suborders, Phyllotopsidineae and Sarcomyxineae, are proposed for the two major lineages. Analyses of 450 single-copy orthologous genes and four loci suggested that Tricholomopsis consisted of at least four clades. Tricholomopsis is subsequently subdivided into four distinct sections. Seventeen Tricholomopsis species in China, including six new species, are reported. Conoloma is established to accommodate T. mucronata. The substrate preference of Tricholomopsis species and the transitions of the pileate ornamentations among the species within the genus are discussed. [ABSTRACT FROM AUTHOR]

Background: A workplace-based primary prevention intervention be an effective approach to reducing the incidence of hypertension (HTN). However, few studies to date have addressed the effect among the Chinese working population. We assessed the effect of a workplace-based multicomponent prevention interventions program for cardiovascular disease on reducing the occurrence of HTN through encouraging employees to adopt a healthy lifestyle. Methods: In this post hoc analysis of cluster randomized controlled study, 60 workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20). All employees in each workplace were asked to complete a baseline survey after randomization for obtaining sociodemographic information, health status, lifestyle, etc. Employees in the intervention group were given a 2-year workplace-based primary prevention intervention program for improving their cardiovascular health, including (1) cardiovascular health education, (2) a reasonable diet, (3) tobacco cessation, (4) physical environment promotion, (5) physical activity, (6) stress management, and (7) health screening. The primary outcome was the incidence of HTN, and the secondary outcomes were improvements of blood pressure (BP) levels and lifestyle factors from baseline to 24 months. A mix effect model was used to assess the intervention effect at the end of the intervention in the two groups. Results: Overall, 24,396 participants (18,170 in the intervention group and 6,226 in the control group) were included (mean [standard deviation] age, 39.3 [9.1] years; 14,727 men [60.4%]). After 24 months of the intervention, the incidence of HTN was 8.0% in the intervention groups and 9.6% in the control groups [relative risk (RR) = 0.66, 95% CI, 0.58 ~ 0.76, P < 0.001]. The intervention effect was significant on systolic BP (SBP) level (β = − 0.7 mm Hg, 95% CI, − 1.06 ~ − 0.35; P < 0.001) and on diastolic BP (DBP) level (β = − 1.0 mm Hg, 95% CI, − 1.31 ~ − 0.76; P < 0.001). Moreover, greater improvements were reported in the rates of regular exercise [odd ratio (OR) = 1.39, 95% CI, 1.28 ~ 1.50; P < 0.001], excessive intake of fatty food (OR = 0.54, 95% CI, 0.50 ~ 0.59; P < 0.001), and restrictive use of salt (OR = 1.22, 95% CI, 1.09 ~ 1.36; P = 0.001) in intervention groups. People with a deteriorating lifestyle had higher rates of developing HTN than those with the same or improved lifestyle. Subgroup analysis showed that the intervention effect of BP on employees with educational attainment of high school above (SBP: β = − 1.38/ − 0.76 mm Hg, P < 0.05; DBP: β = − 2.26/ − 0.75 mm Hg, P < 0.001), manual labor workers and administrative worker (SBP: β = − 1.04/ − 1.66 mm Hg, P < 0.05; DBP: β = − 1.85/ − 0.40 mm Hg, P < 0.05), and employees from a workplace with an affiliated hospital (SBP: β = − 2.63 mm Hg, P < 0.001; DBP: β = − 1.93 mm Hg, P < 0.001) were significantly in the intervention group. Conclusions: This post hoc analysis found that workplace-based primary prevention interventions program for cardiovascular disease were effective in promoting healthy lifestyle and reducing the incidence of HTN among employees. Trial registration: Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641. [ABSTRACT FROM AUTHOR]

Background: The relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and physical frailty in elderly patients remains unclear. The study aims to investigate the association between the BUN/Cr ratio and physical frailty in the elderly Chinese population. Methods: In this cross-sectional analysis, the clinical data of 5213 participants from 2015 were selected from the China Health and Retirement Longitudinal Study (CHARLS). The demographic variables (including age and gender) and health behavior (including smoking and drinking history), anthropometric (including systolic and diastolic blood pressure, waist circumference (WC), etc.), physical performances (i.e., grip strength, repeated chair stands, etc.), and biochemical indicators (i.e., blood urea nitrogen (BUN), creatinine(Cr), total cholesterol (TC), triglycerides (TG), etc.) were measured. The association between the BUN/Cr ratio and physical frailty was analyzed. Results: After adjusting for potential confounding factors, smooth curve fitting showed a linear relationship between the BUN/Cr ratio and grip strength, a non-linear relationship between the BUN/Cr ratio, and repeated chair-rising time. The fully adjusted linear regression results showed a negative association between the BUN/Cr ratio and grip strength. In the multivariate, piecewise linear regression, when the BUN/Cr ratio was greater than 18.60, the repeated chair-rising time increased with the increase in BUN/Cr ratio (β = 0.046, 95%CI 0.025, 0.066; p < 0.001). However, we did not observe a significant correlation when the BUN/Cr ratio was less than 18.60 (β = −0.007, 95%CI −0.046, 0.032; p = 0.717). Conclusion: This study demonstrated that the BUN/Cr ratio might be associated with physical frailty in older-aged Chinese, and this association requires further investigation. [ABSTRACT FROM AUTHOR]

Hypertension is a common and costly public health burden in China, while the interaction effects of individual and contextual level factors on the risk of hypertension remain unclear. This study aimed to investigate whether the interaction effects between individual education and regional chemical fertilizer consumption are associated with the risk of hypertension based on a cross-level interaction perspective. Data was from the China Hypertension Survey (CHS) study, which used a nationally representative sample, and was conducted between 2012 and 2015. A total of 379 467 participants aged over 18 years from 221 counties in 31 provinces were included. A cross-sectional study design and two-level logistic models were conducted to investigate the cross-level interaction between individual education and regional chemical fertilizer consumption on the risk of hypertension after adjusting for potential confounding variables. Compared to individuals with high education (college or more), the adjusted OR (95%CI) for hypertension among those in the high school, middle school, and elementary school or less was 1.16 (1.12–1.21), 1.25 (1.20–1.30), and 1.49 (1.43–1.55), respectively. The association between regional chemical fertilizer consumption and hypertension was not significant. Interaction analysis showed that regional chemical fertilizer consumption was associated with an increased risk of hypertension for individuals with lower education. These patterns were consistent after stratified by sex. This study provided evidence from the Chinese population that interaction between individual education and regional chemical fertilizer was associated with risk of hypertension. Future research and policy aimed to improve population health and reduce hypertension could address the regional context of population as well as individual factors. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) is associated with cardiovascular risk, and there are various definitions, but which is most predictive of future cardiovascular disease (CVD) in the Chinese population is still unclear. MetS was defined with the revised ATP III (Third Adult Treatment Panel Report), International Diabetes Federation (IDF), and the Joint Committee for Developing Chinese Guidelines (JCDCG) definitions. Cox regression was used to estimate the hazard risk of cardiovascular disease among 20,888 participants using the Chinese Hypertension Survey (CHS) data. Sensitivity, specificity, and receiver operating characteristic (ROC) curve distance were used to test the ability of three MetS criteria to identify CVD. During an average follow-up of 4.89 years of 20,888 participants, 925 CVD events occurred (stroke, 560; coronary heart disease, 275; and other cardiovascular events, 119). The revised ATP III criteria identified the most individuals with MetS and had the highest prevalence of MetS. In addition, MetS was associated with a high risk of CVD in both men and women, according to three criteria. The highest diagnostic specificity was for IDF in men and JCDCG in women. The revised ATP III criteria had the highest sensitivity and shortest ROC curve distance in both men and women. Although the MetS definitions, including the revised ATP III, IDF, and JCDCG, are all related to the increased risks of CVD, overall, the revised ATP III performs best and is the most recommended for the Chinese population. [ABSTRACT FROM AUTHOR]

Previous studies have documented the associations between short-term diurnal temperature range (DTR) exposure and cardiovascular disease (CVD) via time-series analyses. However, the long-term impacts of DTR through a population-based prospective cohort have not been elucidated thoroughly. This study aimed to quantify the longitudinal association of DTR exposure with all-cause mortality and CVD in a nationwide prospective cohort and, by extension, project future DTR changes across China under climate change. We included 22,702 adults (median age 56.1 years, 53.7% women) free of CVD at baseline from a nationwide cross-sectional study in China during 2012–2015, and examined three health outcomes during a follow-up survey in 2018–2019. We estimated the chronic DTR exposure as baseline annual mean daily maximum minus minimum temperature. The Cox proportional hazards regression was adopted to assess the multivariable-adjusted hazard ratio and its corresponding 95% confidence interval (95% CI). We employed 31 downscaled global climate models under two shared socioeconomic pathways for future projection. During the median follow-up period of ~5 years, 1096 subjects died due to all causes while 993 and 597 individuals developed fatal or nonfatal CVD and fatal or nonfatal stroke, respectively. The cumulative incidence rates of all-cause mortality, CVD, and stroke were 10.49, 9.45, and 5.64 per 1000 person-years, respectively. In the fully adjusted models, the risks for all-cause mortality, CVD, and stroke would increase by 13% (95% CI: 8–18%), 12% (95% CI: 7–18%), and 9% (95% CI: 2–16%) per 1 °C increment in DTR, respectively. Moreover, linear positive associations for the concentration–response curves between DTR and mortality and CVD were observed. We also found significantly greater DTR-related mortality risks among rural residents than their urban counterparts. The DTR changes featured a dipole pattern across China under a warming climate. The southern (northern) China would experience increased (decreased) DTR exposure by the end of 21st century. The present study indicates that chronic DTR exposure can exert long-term impacts on mortality and CVD risks, which may inform future public health policies on DTR-related susceptible population and regions. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is characterized by a cluster of signs of metabolic disturbance and has caused a huge burden on the health system. The study aims to explore the prevalence and characteristics of MetS defined by different criteria in the Chinese population.Methods: Using the data of the China Hypertension Survey (CHS), a nationally representative cross-sectional study from October 2012 to December 2015, a total of 28,717 participants aged 35 years and above were included in the analysis. The MetS definitions of the International Diabetes Federation (IDF), the updated US National Cholesterol Education Program Adult Treatment Panel III (the revised ATP III), and the Joint Committee for Developing Chinese Guidelines (JCDCG) on Prevention and Treatment of Dyslipidemia in Adults were used. Multivariable logistic regression was used to identify factors associated with MetS.Results: The prevalence of MetS diagnosed according to the definitions of IDF, the revised ATP III, and JCCDS was 26.4%, 32.3%, and 21.5%, respectively. The MetS prevalence in men was lower than in women by IDF definition (22.2% vs. 30.3%) and by the revised ATP III definition (29.2% vs. 35.4%), but the opposite was true by JCDCG (24.4%vs 18.5%) definition. The consistency between the three definitions for men and the revised ATP III definition and IDF definition for women was relatively good, with kappa values ranging from 0.77 to 0.89, but the consistency between the JCDCG definition and IDF definition (kappa = 0.58) and revised ATP III definition (kappa = 0.58) was poor. Multivariable logistic regression showed that although the impact and correlation intensity varied with gender and definition, area, age, education, smoking, alcohol use, and family history of cardiovascular disease were factors related to MetS.Conclusions: The prevalence and characteristics of the MetS vary with the definition used in the Chinese population. The three MetS definitions are more consistent in men but relatively poor in women. On the other hand, even if estimated according to the definition of the lowest prevalence, MetS is common in China. [ABSTRACT FROM AUTHOR]

Species of Cantharellus subgenus Cantharellus are interesting and important for their mycorrhizal properties, medicinal values, and edibility. In China, there are many undescribed species of the subgenus. In this study, four new species of subg. Cantharellus , viz. Cantharellus albopileatus , Cantharellus chuiweifanii , Cantharellus pinetorus , and Cantharellus ravus from Hainan and Hunan Provinces, respectively, were described based on morphological and phylogenetic evidence as a contribution to the knowledge of the species diversity in China. Detailed descriptions, color photographs of fresh basidiomata, and line drawings of microstructures of these four new species are presented as well as comparisons with related species. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of valvular heart disease (VHD) has changed markedly over the last 50 years worldwide, and the prevalence and features of VHD in China are unknown. The objective of this study was to investigate the current status and etiology of VHD in China.Methods: We used a cross-sectional national survey with stratified multistage random sampling from the general Chinese population to estimate the VHD burden. Data on demographic characteristics, medical history, physical examination, blood tests, and potential etiology were collected. Echocardiography was used to detect VHD.Results: The national survey enrolled 34,994 people aged 35 years or older across China. Overall, 31,499 people were included in the final analysis, and 1309 participants were diagnosed with VHD. The weighted prevalence was 3.8%, with an estimated 25 million patients in China. The prevalence of VHD increased with age and was higher in participants with hypertension or chronic kidney disease than in their counterparts. Among participants with VHD, 55.1% were rheumatic and 21.3% were degenerative. The proportion of rheumatic decreased with age, and the proportion of degenerative rose with age. However, the prevalence of rheumatic disease was still higher in the elderly population than in the younger population. Logistic regression revealed that age and hypertension were correlated with VHD.Conclusions: In China, rheumatic heart disease was still the major cause of the VHD, with a significant increase in degenerative heart disease. Age and hypertension are important and easily identifiable markers of VHD. [ABSTRACT FROM AUTHOR]

Copyright of Mycosystema is the property of Mycosystema Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mycosystema is the property of Mycosystema Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Obesity has become a global health public problem. The study aims to examine the latest prevalence of overweight and obesity in China. Data came from the China Hypertension Survey (CHS), a nationally representative cross-sectional study among residents aged ≥18 years from October 2012 to December 2015. Overweight and obesity were defined as 25 ≤ BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 according to the WHO classifications, respectively. The data of 441 306 participants were analyzed. The prevalence of overweight and obesity was 28.1% and 5.2% respectively. The prevalence of overweight and obesity varied considerably across provinces. The prevalence of overweight was the highest in Beijing, which was 2.8 fold of the lowest in Guangxi (40.9% vs. 14.6%). The prevalence of obesity was the highest in Tianjin, which was 9.4 fold of the lowest in Hainan (12.2% vs. 1.3%). There was a striking north-south gradient with the prevalence higher in Northeast and Northwest China and lower in Southeast China. Multivariate logistic regression analysis indicated that sex, age, education, smoking, marital status and family history of cardiovascular disease were significantly associated with overweight and obesity. Overweight and obesity are highly prevalent among Chinese adults, and their prevalence varies greatly among different population subgroups and provinces. National and provincial obesity control and prevention strategies should be public health priorities in China. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the latest prevalence of abdominal obesity in China based on nationally representative data.Methods: A stratified, multistage, random sampling method was used to obtain a nationally representative sample of residents aged ≥ 18 years from 31 provinces in mainland China from October 2012 to December 2015. Abdominal obesity was defined as a waist circumference ≥ 90 cm for men and a waist circumference ≥ 85 cm for women.Results: The data of 441,306 participants were analyzed. The prevalence of abdominal obesity was 29.1% (28.6% in men and 29.6% in women); the number of adults with abdominal obesity was estimated to be 277.8 million (approximately 140.1 million in men and 137.7 million in women). The prevalence of abdominal obesity varied considerably among provinces. In general, the prevalence of abdominal obesity was higher in the northern, lower in the southern, higher in the western, and lower in the eastern areas of China. Besides the regional disparities, the prevalence of abdominal obesity varied greatly among different population subgroups.Conclusions: Abdominal obesity is highly prevalent among Chinese adults. National and provincial obesity control and prevention strategies should be public health priorities in China. To better control obesity, the underlying reasons for the regional disparities need to be addressed. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a major health burden worldwide. However, there is no nationwide epidemiological data on HF in China after 2000. The aims of this study are (i) to determine the prevalence of left ventricular (LV) dysfunction and HF (with reduced, mid-range, and preserved ejection fraction) in a nationally representative Chinese population, and (ii) to investigate the treatment and control of hypertension in HF patients.Methods and Results: Data from the China Hypertension Survey (CHS) and 22 158 participants were eligible for analysis in this study. For each participant, a self-reported history of HF and any other cardiovascular diseases was acquired. Two-dimensional and Doppler echocardiography was used to assess LV dysfunction. Overall, 1.3% (estimated 13.7 million) of the Chinese adult population aged ≥35 years had HF, 1.4% of participants had LV systolic dysfunction (ejection fraction <50%), and 2.7% were graded as having 'moderate' or 'severe' LV diastolic dysfunction. The weighted prevalence of HF was similar between urban and rural residents (1.6% vs. 1.1%, P = 0.266), and between men and women (1.4% vs. 1.2%, P = 0.632). In addition, among HF patients with hypertension, 57.7% received antihypertensive medication, and 14.5% had their blood pressure controlled <140/90 mmHg.Conclusions: In summary, there was an increase in the prevalence of HF, and LV dysfunction was very common in China. However, treatment and control of hypertension in participants with HF were low.Clinical Trial Registration Number: ChiCTR-ECS-14004641. [ABSTRACT FROM AUTHOR]

We estimated the prevalence of ideal cardiovascular health (CVH), and its relationship with cardiovascular disease (CVD) and all-cause mortality in a Chinese population. A cross-sectional survey of CVD risk factors was conducted among Chinese participants aged 35 to 64 years in 2009 to 2010. In 2017, 8965 participants completed follow-up assessments in which CVD and all-cause mortality were collected; 8754 participants were eligible for analysis. The percentage of meeting all 7 ideal CVH metrics was 0.10%. During a median follow-up of 6.3 years, the incidence of CVD and all-cause mortality were 6.02% and 4.85% per 1000 person-year in participants with 0 to 1 ideal CVH metrics, 3.33% and 3.57% in those with 2 to 5, 0.40% and 0.79% in those with 6 to 7, respectively. After adjusting for covariates, the risk of CVD was significantly lower in participants with 2 to 5 (hazard ratio [HR]: 0.67, 95% confidence interval [CI]: 0.45-0.98) and 6 to 7 (HR: 0.12, 95%CI: 0.02-0.87) ideal CVH metrics compared to those with 0 to 1 ideal CVH metrics. The risk of all-cause mortality was decreased as ideal CVH metrics increased (HR: 0.78, 95%CI: 0.70-0.88). A greater number of ideal CVH metrics was associated with a lower risk of CVD and all-cause mortality, but the prevalence of all 7 ideal CVH metrics was low in a Chinese population. [ABSTRACT FROM AUTHOR]

Background To investigate the detection of the increase of interarm systolic pressure difference (IASBPD) in people aged ≥35 years in our country and its related factors. Methods Stratified multistage sampling method was used to randomly select 262 urban and rural residents from 31 provinces from 2012 to 2015. Further, simple random sampling method was used to select 16 cities and 17 rural residents from eastern, central, and western regions. A total of 34,121 subjects aged ≥35 years were analyzed after removing the missing information. Data were collected by questionnaire, and blood pressure in both arms was measured by ankle–brachial index meter. All data were analyzed by SPSS 23.0 software. Continuous data were expressed as mean ± SD. Comparison between groups was performed using t -test if it was normal distribution, and rank-sum test if it was not. Categorical data were expressed as frequency sum rate or constituent ratio, χ 2 test was used for comparison of various rates and constituent ratio, and rank-sum test was used for rank data. Multivariate logistic regression was used to analyze the influencing factors of IASBPD increase. Results The detection rates of IASBPD ≥10 and ≥15 mm Hg were 16.31% and 7.55%, respectively. The detection rate of IASBPD ≥10 mm Hg in males was higher than that in females (P < 0.05). Multivariate logistic regression showed that age, family history of hypertension, low HDL-C, hypertension, and abdominal obesity were risk factors for IASBPD ≥10 and 15 mm Hg (all P < 0.05). Conclusions The detection rates of IASBPD ≥10 and 15 mm Hg are 16.31% and 7.55%, respectively, in Chinese ≥35 years old people, and age, low HDL-C emia, family history of hypertension, hypertension, and abdominal obesity are the influencing factors of large differences in interarm blood pressure. [ABSTRACT FROM AUTHOR]

In December 2019, the New Crown Pneumonia (the COVID-19) outbroke around the globe, and China imposed a nationwide lockdown starting as early as January 23, 2020. This decision has significantly impacted China's air quality, especially the sharp decrease in PM 2.5 (aerodynamic equivalent diameter of particulate matter less than or equal to 2.5 μm) pollution. Hunan Province is located in the central and eastern part of China, with a "horseshoe basin" topography. The reduction rate of PM 2.5 concentrations in Hunan province during the COVID-19 (24.8%) was significantly higher than the national average (20.3%). Through the analysis of the changing character and pollution sources of haze pollution events in Hunan Province, more scientific countermeasures can be provided for the government. We use the Weather Research and Forecasting with Chemistry (WRF-Chem, V4.0) model to predict and simulate the PM 2.5 concentrations under seven scenarios before the lockdown (2020.1.1–2020.1.22) and during the lockdown (2020.1.23–2020.2.14). Then, the PM 2.5 concentrations under different conditions is compared to differentiate the contribution of meteorological conditions and local human activities to PM 2.5 pollution. The results indicate the most important cause of PM 2.5 pollution reduction is anthropogenic emissions from the residential sector, followed by the industrial sector, while the influence of meteorological factors contribute only 0.5% to PM 2.5. The explanation is that emission reductions from the residential sector contribute the most to the reduction of seven primary contaminants. Finally, we trace the source and transport path of the air mass in Hunan Province through the Concentration Weight Trajectory Analysis (CWT). We found that the external input of PM 2.5 in Hunan Province is mainly from the air mass transported from the northeast, accounting for 28.6%–30.0%. To improve future air quality, there is an urgent need to burn clean energy, improve the industrial structure, rationalize energy use, and strengthen cross-regional air pollution synergy control. [Display omitted] • First study of air quality impacts during COVID-19 in Hunan Province, central China. • The changing meteorological conditions contributed 0.5% to PM 2.5. • The residential sector was the main anthropogenic source. • The sharply reduced NO x and VOCs emissions directly led to the decreased PM 2.5. • The regional transport came from the northeast, accounting for 28.6%∼30.0%. [ABSTRACT FROM AUTHOR]

Many localities in China are faced with an outdated, segmented infrastructure system and a shrinking budget. However, the state‐led promotion of Public–Private Partnerships (PPPs) in China is providing an innovative solution. This paper looks at financing innovations in China such as industrial funds and asset‐backed securitisation for PPP projects. Particularly, this paper empirically studies the characteristics of project revenue bonds and PPP asset‐backed securities (PPP–ABS) in China. The study finds that the majority of social investors remain state‐owned enterprises (SOEs) and returns on whole business securitisation (WBS) of projects could vary with the volume issued and the credit of the company. Securitisation not only solves the problem of limited source of financing, but also improves the efficiency of management. While securitisation of PPP projects can succeed in tapping social capital to invest infrastructures, the banking system should handle with caution the credit risk and default risk caused by rising leverage of PPP special purpose vehicles (SPVs). [ABSTRACT FROM AUTHOR]

Toughest-ever clean air actions in China have been implemented nationwide to improve air quality. However, it was unexpected that from 2014 to 2018, the observed wintertime PM 2.5 (particulate matter with an aerodynamic diameter of less than 2.5 μm) concentrations showed an insignificant decrease in Henan Province (HNP), a region in the west of the North China Plain. Emission controls seem to have failed to improve winter air quality in HNP, which has caused great confusion in formulating the next air improvement strategy. We employed a deweathering technique to decouple the impact of meteorological conditions. The results showed that the deweathered PM 2.5 trend was −3.3%/yr in winter from 2014 to 2018, which had a larger decrease than the observed concentrations (−0.9%/yr), demonstrating that emission reduction was effective at improving air quality. However, compared with the other two megacity clusters, Beijing-Tianjin-Hebei (BTH) (−8.4%/yr) and Yangtze River Delta (YRD) (−7.4%/yr), the deweathered decreasing trend of PM 2.5 for HNP remained slow. The underlying mechanism driving the changes in PM 2.5 and its chemical components was further explored, using the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem). Model simulations indicated that nitrate dominated the increase of PM 2.5 components in HNP and the proportions of nitrate to total PM 2.5 increased from 22.4% in January 2015 to 39.7% in January 2019. There are two primary reasons for this phenomenon. One is the limited control of nitrogen oxide emissions, which facilitates the conversion of nitric acid to particulate nitrate by ammonia. The other is unfavourable meteorological conditions, particularly increasing humidity, further enhancing nitrate formation through multiphase reactions. This study highly emphasizes the importance of reducing nitrogen oxide emissions owing to their impact on the formation of particulate nitrate in China, especially in the HNP region. [Display omitted] • Wintertime PM 2.5 in Henan Province showed a slow decrease for 2014–2018. • The causes were explored by combined statistical and air quality models. • Relative humidity was the most important variable affecting the PM 2.5 trend. • Nitrate dominated the increase in PM 2.5 components during the study period. [ABSTRACT FROM AUTHOR]

An increasing body of evidence has emerged showing that the central systolic blood pressure (CSBP) is more relevant to the risk of cardiovascular (CV) diseases than brachial blood pressure. However, there are no agreed CSBP threshold values above which the risk of CV disease is increased. The aim of our study was to define the threshold values of the CSBP in a normotensive Chinese population; 10 012 adults 35 to 65 years of age were eligible for analysis. We excluded 3765 participants with hypertension, and the final normotensive reference sample consisted of 6247 participants. We defined abnormally high CSBP as exceeding the 90th percentile age- and sex-specific values in the normotensive population. The 90th percentile cutoff value for CSBP in the reference sample was 125 mm Hg in men and 126 mm Hg in women. The CSBP was significantly higher in participants with diabetes, history of CV disease, and hyperlipidemia (P < .001). The CSBP values increased with age (P < .001). We established that the 90th percentile of the CSBP threshold value in normotensive Chinese middle-aged population is 125 mm Hg for men and 126 mm Hg for women. [ABSTRACT FROM AUTHOR]

We assessed the relationship between alcohol consumption and serum lipids in a middle-aged Chinese population. The overall prevalence of drinking among 10 154 participants was 34.07% in males and 3.61% in females. Heavy alcohol drinkers (≥ 30 g/d) tended to be older, smokers, hypertensive, do heavy physical activity, and have a lower body mass index. Levels of high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A1, low-density lipoprotein cholesterol–HDL-C ratio, and apo B–apo A1 ratio rose with increase in alcohol intake in males. An increase of 0.27 mmol/L in triglycerides and a decrease of 2.10 mg/dL in lipoprotein(a), Lp(a), were observed in male alcohol drinkers who consumed ≥30 g alcohol/d compared with abstainers after controlling for all confounders. Levels of total cholesterol, HDL-C, and apo A1 increased with increase in alcohol intake in both genders and Lp(a) decreased with the increase in alcohol intake in males. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of microalbuminuria (MAU) and the relationships with other cardiovascular (CV) risk factors among a middle-aged Chinese population. Data from 10 313 participants were included in our cross-sectional survey. Microalbuminuria was defined as the urine albumin to creatinine ratio of 30:300 mg/g from a single-spot morning urine sample. Microalbuminuria was found to be common in males and females (15.04% vs 10.09%) aged 35 to 64 years in this Chinese general population, especially in those with obesity, hypertension, and diabetes. Multivariate analysis found that body mass index, triglyceride, high-sensitivity C-reactive protein, alcohol consumption, hypertension, and diabetes were independently associated with MAU. Microalbuminuria may be a useful indicator for risk of CV disease in general populations. [ABSTRACT FROM AUTHOR]

BACKGROUND Blood pressure (BP) control in China is generally poor. It is assumed that an important cause of this unsatisfactory situation is the present standard of care provided by primary care physicians. METHODS One thousand community health centers (CHCs) were selected across China based on geographical location, previous cooperative experience, and acceptance of an invitation to implement a standardized protocol of community-based BP management. Baseline information for each hypertensive patient under the care of these CHCs was collected, and the present pattern of hypertensive drug treatment was analyzed. RESULTS Of all identified hypertensive patients (n = 249,830), 37% were treated with drugs. Characteristics linked with hypertension treatment included systolic BP, age, sex, region, smoking and alcohol consumption status, body mass index, comorbidities, and family history. The most frequently prescribed classes of antihypertensive drugs were diuretics (56.0%), followed by centrally active drugs (CADs) (38.3%), calcium channel blockers (CCBs) (36.8%), vasodilators (26.5%), and angiotensin-converting enzyme inhibitors (ACEIs) (23.3%). In regards to drug combination patterns, diuretics plus CADs was the most frequently used 2-drug combination (61.4%) and vasodilators plus CADs plus diuretics was the most frequently used 3-drug therapy (69.2%). Seventy-seven percent of patients on combination therapy were prescribed single pill combinations, 87.2% of which were composed of CADs and vasodilators and 12.8% of which were composed of ACEIs and diuretics. The control rates of patients on monotherapy and combination therapy were 27.7% and 24.1% (P < 0.05), respectively. CONCLUSIONS Our study identified major shortcomings in the present status of antihypertensive pharmacotherapy in routine medical practice in China. It is essential to implement a program of professional education regarding the appropriate use of antihypertensive drugs. [ABSTRACT FROM PUBLISHER]

Introduction This study examined the validity and reliability of the Patient Health Questionnaire-9 ( PHQ-9) and Patient Health Questionnaire-2 ( PHQ-2). The optimal cutoff score when screening for depression among Chinese college students was also determined. Methods A total of 959 participants completed the PHQ-9 and the Beck Depression Inventory ( BDI) questionnaire. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders was used to diagnose depression. Statistical tests were performed to determine the reliability, validity, and receiver operating characteristic curve of the data. The concurrent validity was tested by examining associations between PHQ-9 and BDI. The sensitivity and specificity, as well as the positive and negative predictive values, were calculated for different cutoff scores of PHQ-9 and PHQ-2. Results The internal consistency values of PHQ-9 and PHQ-2 were 0.854 and 0.727, respectively. The test-retest reliability values of PHQ-9 and PHQ-2 were 0.873 and 0.829, respectively. The scores of PHQ-9 ( r = 0.790) and PHQ-2 ( r = 0.651) were significantly associated with that of BDI. PHQ-9 had an optimal cutoff score of 11, which indicated a sensitivity of 0.89 and a specificity of 0.97, with an area under the curve of 0.977 (95% confidence interval: 0.966-0.988). The PHQ-2 demonstrated satisfactory sensitivity (0.81) and specificity (0.96) at the cutoff score of 3, and its area under the curve was 0.939. Discussion The PHQ-9 and the PHQ-2 are valid and reliable tools to screen depression in Chinese college students. For screening purposes, cutoff scores of 11 and 3 are recommended for PHQ-9 and PHQ-2, respectively. [ABSTRACT FROM AUTHOR]

Only a few prospective studies have investigated the relationship between solid fuel use and cardiovascular disease (CVD) and mortality, and they have reported inconsistent conclusions. This study aimed to investigate the effect of solid fuel heating on the risk of CVD events and all-cause mortality among non-smokers. Data of this sub-study were obtained from the China Hypertension Survey (CHS), and 13,528 non-smoking participants aged 35 or above without self-reported medical history of CVD were enrolled between October 2012 and December 2015. CVD events and all-cause mortality were followed up in 2018 and 2019. The type of primary heating fuel was categorized as clean fuel (natural gas and electricity) and solid fuel (coal, wood, and straw). Cox regression was applied to evaluate the relationship between solid fuel use and CVD events and all-cause mortality. Of the 13,528 non-smoking participants, the mean age was 55.4 ± 13.1 years. During the median follow-up of 4.93 years, 424 participants developed fatal or nonfatal CVD (stroke, 273; coronary heart disease, 119; and other cardiovascular events, 32) and 288 died from all causes. The cumulative incidence of fatal and nonfatal CVD and all-cause mortality were 6.78 and 4.62 per 1000 person-years, respectively. Solid fuel heating was independently associated with an increased risk of fatal or nonfatal stroke and all-cause mortality compared with the use of clean fuels, the fully adjusted hazard ratios (HRs), and 95% confidence intervals (CI) were 1.44 (1.00–2.08) and 1.55 (1.10–2.17), respectively. The relationship between solid fuel heating and fatal and nonfatal CVD events was non-significant (HR = 1.19; 95% CI: 0.89–1.59). Solid fuel heating is longitudinally associated with a higher risk of stroke and all-cause mortality in non-smoking Chinese. Switching to cleaner energy sources for heating may be important for reducing the risk of CVD and mortality. • Findings of effect of solid fuel use on CVD event and mortality were inconsistent. • Solid fuel for heating was significantly associated with stroke in non-smokers. • Solid fuel for heating was significantly associated with all-cause mortality. • Switching to cleaner energy sources may reduce risk of CVD and all-cause mortality. [ABSTRACT FROM AUTHOR]

In the context of global climate change, far less is known about the impact of long-term temperature variability (TV), especially in developing countries. The current study aimed to estimate the effect of long-term TV on the incidence of cardiovascular disease (CVD) in China. A total of 23,721 individuals with a mean age of 56.15 years were enrolled at baseline from 2012 to 2016 and followed up during 2017–2019. TV was defined as the standard deviation of daily temperatures during survey years and was categorized into tertiles (lowest≤ 8.78 °C, middle = 8.78–10.07 °C, highest ≥ 10.07 °C). The Cox proportional hazards regression was used to estimate the multivariable-adjusted hazard ratio (HR) between TV and CVD. During the median follow-up of 4.65 years, we ascertained 836 cases of incident CVD. For per 1 °C increase in TV, there was a 6% increase of CVD (HR = 1.06 [95% confidence interval (CI): 1.01–1.11]). A significant positive trend was observed between CVD risk and increasing levels of TV compared to the lowest tertile [HR = 1.34 (95% CI: 1.13–1.59) for the medium tertile, HR = 1.72 (95% CI: 1.35–2.19) for the highest tertile, P trend < 0.001]. Exposure to high TV would lose 2.11 disease-free years for the population aged 35–65 years and 66 CVD cases (or 7.95% cases) could been attributable to TV higher than 8.11 °C in the current study. The current findings suggested that long-term TV was associated with a higher risk of CVD incidence, it is needed to reduce the TV-related adverse health effect. [Display omitted] • Temperature variability (TV) was defined as the standard deviation of daily temperatures during survey years. • The cohort study was to explore the association between long-term TV and the incidence of cardiovascular diseases (CVD). • Per 1 °C increase in TV, the HR was 1.06 (95% CI: 1.01–1.11) for CVD incidence. • Exposure to high TV would lose 2.11 years disease-free years for population. • More attention should be paid to unstable weather. [ABSTRACT FROM AUTHOR]

Wild fish faeces play an important role in mediating marine organic carbon cycle, but the faeces released dissolved organic matter (DOM) and its potentials in contribution to refractory DOM is unclear. The mixed wild fish (including mesopelagic fish) faecal samples from the northern South China Sea were collected and incubated up to 75 days using the waters collected at 800 m depth of the same site, to reveal the stability of the faeces released DOM. Our result showed that the faeces had a good DOM-release potential and dissolved organic carbon (DOC) was up to 150 μM in the first day and reached its maximum (172 μM) on day 3, which was in comparison with the control group (DOC <70 μM). In our incubations, the faecal samples contributed net DOC of 110 μM, in which 42 μM persisted till the end of the 75 days dark incubation. This meant the faeces-released DOC had a refractory fraction of 38% over the incubation. Total hydrolysable amino acids concentration significantly dropped, and amino acids molecular indicator (DI, AA C yield and D/L ratio) changes over the incubation indicated the fast transformation of DOM from labile to degraded stage. Network analysis was applied to the amino acids and our result showed that D-form amino acids were almost positively coupled with L-form amino acids. Glycine (in mol%) showed consistent accumulation along with DOM degradation. Also, glycine was at the key node position of the amino acids network, showing negative relation with all other amino acids enantiomers in both faeces group and control group. Our results proved that glycine had the potential in tracing the refractory fraction over the DOM degradation. • Wild fish faeces showed high DOM release potential. • Persisted-to-end fraction of the faeces released DOC is 38%. • Glycine showed relative accumulation over DOM degradation. [ABSTRACT FROM AUTHOR]

The genus Amanita sect. Amanita harbors approximately 150 species in the world, and 27 species have been recognized in China. Some of the species in China have continuously caused poisoning. The responsible toxins should be ibotenic acid (IBO) and muscimol (MUS). However, species of the section Amanita containing IBO and MUS and their systematic positions are unclear. In this study, the contents of IBO and MUS in 84 samples of 24 species in section Amanita were detected using UPLC‒MS/MS, and the distribution of toxin-containing species in the molecular phylogeny was analyzed by the combined (ITS, nrLSU, RPB2 , TUB2 and TEF1-α) dataset using maximum likelihood (ML) analysis and Bayesian inference (BI). Our results indicated that 10 of the 24 species contained IBO and MUS ranging from 0.6125 to 32.0932 and 0.0056–5.8685 g/kg dry weight, respectively. Among these 10 species, the toxins of eight species, including Amanita altipes , A. concentrica , A. flavopantherina , A. griseopantherina , A. pseudopantherina , A. rubrovolvata , A. subglobosa and A. sychnopyramis, were detected for the first time. In addition, the IBO and MUS contents of A. s ubglobosa in different growth stages showed that both toxins decreased in the mature stage. The phylogenetic analysis showed that all species of sect. Amanita from China were divided into 5 groups. And IBO- and MUS-containing species were gathered in clades Ⅰ and Ⅳ, but not all of the species in the two clades contain the toxins. No presence of IBO and MUS in the species of clades Ⅱ, Ⅲ and Ⅴ were confirmed. [Display omitted] • Ibotenic acid (IBO) and muscimol (MUS) were detected in 10 species of the genus Amanita section Amanita from China. • The IBO and MUS contents of A. subglobosa in different growth stages showed that both toxins decreased in the mature stage. • The phylogenetic analysis showed that IBO- and MUS-containing species were mainly gathered in two clades. [ABSTRACT FROM AUTHOR]

Under the "Double Carbon" target, the development of low-carbon agriculture requires a holistic comprehension of spatially and temporally explicit greenhouse gas (GHG) emissions associated with agricultural products. However, the lack of systematic evaluation at a fine scale presents considerable challenges in guiding localized strategies for mitigating GHG emissions from crop production. Here, we analyzed the county-level carbon footprint (CF) of China's rice production from 2007 to 2018 by coupling life cycle assessment and the DNDC model. Results revealed a significant annual increase of 74.3 kg CO 2 -eq ha -1 in the average farm-based CF (FCF), while it remained stable for the product-based CF (PCF). The CF exhibited considerable variations among counties, ranging from 2324 to 20,768 kg CO 2 -eq ha -1 for FCF and from 0.36 to 3.81 kg CO 2 -eq kg -1 for PCF in 2018. The spatiotemporal heterogeneities of FCF were predominantly influenced by field CH 4 emissions, followed by diesel consumption and soil organic carbon sequestration. Scenario analysis elucidates that the national total GHG emissions from rice production could be significantly reduced through optimized irrigation (48.5%) and straw-based biogas production (18.0%). Moreover, integrating additional strategies (e.g., advanced crop management, optimized fertilization, and biodiesel application) could amplify the overall emission reduction to 76.7% while concurrently boosting the rice yield by 11.8%. Our county-level research provides valuable insights for the formulation of targeted GHG mitigation policies in rice production, thereby advancing the pursuit of carbon-neutral agricultural practices.

This paper examines the impact of air pollution control policies targeting key polluting enterprises, highlighting a strategic shift towards precision pollution control that concentrates on high-emission, high-risk businesses. The paper explores the efficacy of these policies and their potential spatial spillover effects, utilizing panel data from 259 Chinese cities from 2013 to 2021. Employing the difference-in-differences (DID) model and spatial Durbin model, the study analyzes both the direct local effects and the broader spatial consequences of these regulatory measures on air quality. The findings indicate a significant reduction in air pollutant concentrations in urban areas, attributing this improvement to factors such as industrial restructuring, increased investment in science and technology, and economic growth. Spatial econometric analysis further reveals a substantial positive correlation in air quality among Chinese cities. However, estimates of the spillover effect indicate that while such policies successfully reduce pollution locally, they could unintentionally degrade air quality in adjacent areas. The study highlights the need for nuanced policy strategies to mitigate unintended spatial spillovers and enhance overall effectiveness. It recommends tailored policies that integrate environmental and socioeconomic objectives, national and regional coordination for consistent enforcement, technology-driven compliance strategies, and incentives for sustainable enterprise practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to examine the dose-response associations of physical activity with blood pressure (BP) and hypertension risk among Chinese adults., Methods: Derived from the national community-based China Hypertension Survey database during 2012--2015, a total of 203 108 residents aged at least 18 years were included. Individual-level physical activity was evaluated using a standardized questionnaire, and minutes of metabolic equivalent tasks per week (MET-min/week) were calculated, integrating domain, intensity, frequency, and duration. Multivariable linear and logistic regressions were used to estimate associations of physical activity with BP and hypertension risk, and restricted cubic spline regressions were performed for their nonlinear dose-response relationships., Results: Overall, the median total physical activity (TPA) was 3213.0 MET-min/week and the prevalence of physical inactivity was 14.8%. TPA was negatively associated with BP. Increasing TPA levels was related to a steep decrease in systolic BP, up to approximately 2500 MET-min/week, with more modest benefits above that level of TPA. Higher levels of domain-specific and intensity-specific physical activity were found to be associated with lower BP levels and hypertension risk, except for the association between vigorous-intensity physical activity and systolic BP. We found that TPA within the range of 2000--4000 MET-min/week, a higher frequency and shorter duration were inversely associated with diastolic BP levels., Conclusion: Total, domain-specific, and intensity-specific physical activity were inversely related to BP levels, respectively, in a dose-response fashion. Of a given amount, higher-frequency, shorter-duration, and lower-intensity physical activity produced more beneficial effects., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

In December 2019, the New Crown Pneumonia (the COVID-19) outbroke around the globe, and China imposed a nationwide lockdown starting as early as January 23, 2020. This decision has significantly impacted China's air quality, especially the sharp decrease in PM 2.5 (aerodynamic equivalent diameter of particulate matter less than or equal to 2.5 μm) pollution. Hunan Province is located in the central and eastern part of China, with a "horseshoe basin" topography. The reduction rate of PM 2.5 concentrations in Hunan province during the COVID-19 (24.8%) was significantly higher than the national average (20.3%). Through the analysis of the changing character and pollution sources of haze pollution events in Hunan Province, more scientific countermeasures can be provided for the government. We use the Weather Research and Forecasting with Chemistry (WRF-Chem, V4.0) model to predict and simulate the PM 2.5 concentrations under seven scenarios before the lockdown (2020.1.1-2020.1.22) and during the lockdown (2020.1.23-2020.2.14). Then, the PM 2.5 concentrations under different conditions is compared to differentiate the contribution of meteorological conditions and local human activities to PM 2.5 pollution. The results indicate the most important cause of PM 2.5 pollution reduction is anthropogenic emissions from the residential sector, followed by the industrial sector, while the influence of meteorological factors contribute only 0.5% to PM 2.5 . The explanation is that emission reductions from the residential sector contribute the most to the reduction of seven primary contaminants. Finally, we trace the source and transport path of the air mass in Hunan Province through the Concentration Weight Trajectory Analysis (CWT). We found that the external input of PM 2.5 in Hunan Province is mainly from the air mass transported from the northeast, accounting for 28.6%-30.0%. To improve future air quality, there is an urgent need to burn clean energy, improve the industrial structure, rationalize energy use, and strengthen cross-regional air pollution synergy control., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Air pollution is a growing public health concern of global significance. Till date, few studies have explored the associations between air pollutants and cardiac imaging phenotypes. In this study, we aim to explore the association of ambient air pollution and abnormal left ventricular diastolic function (ALVDF) among a large-scale free-living population., Methods: The participants were from a national representative large-scale cross-sectional study, i.e., the China Hypertension Survey (CHS), 2012-15. After exclusion, 25,983 participants from 14 provinces and 30 districts in China were included for the final analysis. The annual average ambient PM 2.5 , PM 10 and NO 2 concentrations were obtained from the chemical data assimilation system (ChemDAS). The clinical evaluation of left ventricular function was conducted in the survey field which was based on echocardiography. Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009)., Results: The mean age of 25,983 participants was 56.8 years, 46.5% were male, and the crude prevalence of GradeI-III ALVDF were 48.1%, 1.6% and 1.1%, respectively. The ORs (95% CI) for ALVDF in the fully adjusted model were 1.31 (1.11-1.56), 1.11 (1.01-1.21) and 1.18 (0.90-1.54) for an increase of 10 μg/m 3 of PM 2.5 , PM 10 and NO 2 , respectively. And for different grades of ALVDF, elevated concentration of PM 2.5 and PM 10 exposures significantly increased the risk of gradeIinstead of gradeII ~ III ALVDF. There was a positive linear and "J" shape concentration-response association between annual average ambient PM 2.5 and NO 2 and the ALVDF risk assessed by the restricted cubic spline. The exposure level of most participants to PM 10 was less than 130 μg/m 3 , and the risk of ALVDF increased significantly with the concentration rise., Conclusions: This large-scale nationwide population study demonstrated a significantly positive association between ambient PM 2.5 , PM 10 and NO 2 with ALVDF, especially for mild ALVDF. The functional abnormality may partially explain the enhanced cardiovascular morbidity and mortality associated with air pollution, which highlights the importance of appropriate interventions to reduce ambient air pollution in China., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Toughest-ever clean air actions in China have been implemented nationwide to improve air quality. However, it was unexpected that from 2014 to 2018, the observed wintertime PM 2.5 (particulate matter with an aerodynamic diameter of less than 2.5 μm) concentrations showed an insignificant decrease in Henan Province (HNP), a region in the west of the North China Plain. Emission controls seem to have failed to improve winter air quality in HNP, which has caused great confusion in formulating the next air improvement strategy. We employed a deweathering technique to decouple the impact of meteorological conditions. The results showed that the deweathered PM 2.5 trend was -3.3%/yr in winter from 2014 to 2018, which had a larger decrease than the observed concentrations (-0.9%/yr), demonstrating that emission reduction was effective at improving air quality. However, compared with the other two megacity clusters, Beijing-Tianjin-Hebei (BTH) (-8.4%/yr) and Yangtze River Delta (YRD) (-7.4%/yr), the deweathered decreasing trend of PM 2.5 for HNP remained slow. The underlying mechanism driving the changes in PM 2.5 and its chemical components was further explored, using the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem). Model simulations indicated that nitrate dominated the increase of PM 2.5 components in HNP and the proportions of nitrate to total PM 2.5 increased from 22.4% in January 2015 to 39.7% in January 2019. There are two primary reasons for this phenomenon. One is the limited control of nitrogen oxide emissions, which facilitates the conversion of nitric acid to particulate nitrate by ammonia. The other is unfavourable meteorological conditions, particularly increasing humidity, further enhancing nitrate formation through multiphase reactions. This study highly emphasizes the importance of reducing nitrogen oxide emissions owing to their impact on the formation of particulate nitrate in China, especially in the HNP region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Temporal trends and geographical variations in cardiovascular disease attributable to high systolic blood pressure in China are not yet fully understood. The aim of this study was to quantify the cardiovascular disease burden attributable to high systolic blood pressure at national and provincial levels in China., Methods: In this population-based study, we evaluated systolic blood pressure and estimated the number of deaths, age-standardised mortality rates, and years of life lost (YLLs) due to cardiovascular disease and its subcategories (including ischaemic heart disease, ischaemic stroke, haemorrhagic stroke, and other cardiovascular diseases) attributable to high systolic blood pressure, at the national level and by 31 provincial levels, in China, from 2005 to 2018. We pooled blood pressure data of 1·30 million adults aged 25 years and older from the China Chronic Disease and Risk Factor Surveillance project, the China National Nutrition Survey, and the China Hypertension Survey. We applied a temporal-spatial Bayesian hierarchical model to estimate age-specific, sex-specific, province-specific, and year-specific average systolic blood pressure, and a comparative risk assessment method to compute the cardiovascular disease burden attributable to high systolic blood pressure by age, sex, year, and province., Findings: Nationally, age-standardised mean systolic blood pressure was 132·5 mm Hg (95% uncertainty interval [UI] 124·6-140·3) in men and 129·4 mm Hg (121·7 to 137·2) in women. 2·67 million (95% UI 2·61 to 2·72) cardiovascular disease deaths in China were attributable to high systolic blood pressure, including 1·12 million deaths (1·07 to 1·16) due to ischaemic heart disease, 0·63 million deaths (0·60 to 0·65) due to ischaemic stroke, 0·58 million deaths (0·57 to 0·60) due to haemorrhagic stroke, and 0·34 million deaths (0·32 to 0·36) due to other cardiovascular disease. The age-standardised cardiovascular disease mortality rates associated with high systolic blood pressure were 268·99 per 100 000 people (95% UI 264·11 to 273·51) in 2005 and 220·84 per 100 000 people (216·30 to 224·76) in 2018, a percentage change of -17·90%; the rate changed by an average of -1·50% (95% UI -1·55% to -1·45%) per year from 2005 to 2018 nationally. YLL rates for total cardiovascular disease caused by high systolic blood pressure varied substantially across provinces, ranging from 3078·33 (95% UI 2807·40 to 3303·57) per 100 000 people in Beijing to 7189·98 (95% UI 6817·18 to 7507·99) per 100 000 people in Heilongjiang in 2018. Age-standardised YLL rates for ischaemic heart disease and ischaemic stroke attributable to high systolic blood pressure were particularly high in northeastern provinces, including Heilongjiang, Liaoning, and Jilin., Interpretation: The deaths and YLLs for cardiovascular disease attributable to high systolic blood pressure in China increased between 2005 and 2018, and age-standardised cardiovascular disease mortality rates decreased in the same timeframe. Our findings could help policy makers in promoting blood pressure control measures and implementing effective and locally adapted preventive interventions to reduce the prevalence of high systolic blood pressure and reduce the burden of systolic blood pressure-related cardiovascular disease in China., Funding: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China., Translation: For the Chinese translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Importance: The prevalence of hypertension is high and still increasing across the world, while the control rate remains low in many countries. Emerging technology, such as telemedicine, may offer additional support to change the unsatisfactory situation., Objective: To establish a multicomponent intervention delivered on a web-based telemedicine platform and oriented with the Chinese hypertension management guidelines and to evaluate the effect of the intervention on blood pressure (BP) control for patients with hypertension., Design, Setting, and Participants: This cluster randomized clinical trial of a hypertension management program was conducted at 66 community health centers in China from October 1, 2018, to May 31, 2020, with a 12-month follow-up. Patients with hypertension were blinded to randomization and were randomized to either the intervention group or control group. Hypertension was diagnosed at mean systolic BP (SBP) and diastolic BP (DBP) readings higher than 140 and 90 mm Hg or with use of antihypertensive medication. Evaluation of the intervention effect was based on the principle of modified intention to treat., Interventions: Multicomponent intervention was delivered on a web-based platform and consisted of a primary prevention program for cardiovascular disease and standardized management for hypertension., Main Outcomes and Measures: The primary outcome was the change in BP control rate (SBP and DBP levels <140 and 90 mm Hg, or <130 and 80 mm Hg for patients with diabetes) from baseline to the 12-month follow-up among patients with hypertension in the intervention and control groups., Results: A total of 4118 patients (mean [SD] age, 61.6 [9.4] years; 2265 women [55.0%]) were included in the analysis, with 2985 in the intervention group and 1133 in the control group. The BP control rate at baseline was 22.8% in the intervention group and 22.5% in the control group. After 12 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (47.4% vs 30.2%; odds ratio, 1.18; 95% CI, 1.13-1.24; P < .001). The intervention effect on SBP level was -10.1 mm Hg (95% CI, -11.7 to -8.5 mm Hg; P < .001) and on DBP level was -1.8 mm Hg (95% CI, -2.8 to -0.8 mm Hg; P < .001)., Conclusions and Relevance: Results of this trial showed that a multicomponent intervention delivered on a web-based platform improved BP control rate and lowered BP level more than usual care alone. Such a telemedicine program may provide a new, effective way to treat patients with hypertension in the community and may generate public health benefits across diverse populations., Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR1800017791.

Purpose: The National Essential Public Health Services Package (NEPHSP), a set of community-based hypertension management programs, was launched by the Chinese government in 2009. However, the data are limited for the comprehensive evaluation of NEPHSP on hypertension management. This study was to estimate the effect of NEPHSP on hypertension control nationwide in China., Methods: Data were from China Hypertension Survey (CHS). The participants ( n = 119,412) aged ≥35 years with hypertension were included in the analysis. Further, a subset of 64,188 diagnosed hypertensive patients were analyzed to evaluate the effect of NEPHSP by comparing the ones covered and not covered by NEPHSP. Blood pressure (BP) was measured by trained staff using a validated digital portable monitor in local communities or clinics., Results: Among adults aged ≥35 years with hypertension, the coverage of NEPHSP was 25.6% and increased with age. The coverage was significantly higher in women than in men ( P < 0.001). Among the 64, 188 diagnosed hypertensive patients, compared to the control group (not covered by NEPHSP), the mean systolic and diastolic BPs were 2 mmHg and 1.6 mmHg lower in NEPHSP group, respectively. The rate of treatment for hypertension was significantly higher in NEPHSP group than the control group (93.0% vs. 81.4%, P < 0.001), and the rate of BP control was also significantly higher in NEPHSP group than the control group (35.9% vs. 29.6%, P < 0.001). Furthermore, similar trends were found in rural and urban, as well as in men and women., Conclusions: Our results showed that NEPHSP is effective in improving hypertension treatment and control in hypertensive patients in China. However, the coverage of NEPHSP was still low., Competing Interests: OMRON Corporation, Kyoto, Japan supported Blood Pressure Monitor (HBP-1300) and body fat and weight measurement device (V-body HBF-371); Henan Huanan Medical Science & Technology Co., Ltd, China supported Digital ECG device (GY-5000); and Microlife, Taibei, China supported for Automated ABI device (WatchBP Office device). And, this study received funding from BUCHANG PHARMA, Xian, China, Pfizer China, and Essen Technology (Beijing) Company Limited. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hao, Chen, Wang, Zhang, Kang, Zheng, Chen, Wang and Gao.)

This study intended to compare the prevalence of hypertension in adolescents aged 15-17 years in China according to different criteria defined by various guidelines. We included 28 715 adolescents aged 15-17 years from the China Hypertension Survey study (CHS) 2012-2015, and the 2017 American Association of Pediatrics (AAP) Clinical Practice Guideline and 2018 Chinese guidelines for children and adults were used to define hypertension. The prevalence of hypertension among Chinese adolescents aged 15-17 years was 24.4% according to the 2018 Chinese guidelines for children; the corresponding values were 18.6% according to the 2017 AAP Guidelines, and 3.5% according to 2018 Chinese guidelines for adults. The age-specific prevalence of hypertension in the age of 15, 16, and 17 years in the same population was 26.2%, 24.4%, and 23.3% according to 2018 Chinese guidelines for children; 18.8%, 17.9%, and 19.2% as per the 2017 AAP Guidelines; 3.4%, 3.4%, and 3.6% as per the 2018 Chinese guidelines for adults. A highest prevalence of hypertension was observed according to 2018 Chinese guidelines for children than the other two guidelines. Compared with the 2018 Chinese guidelines for children, a higher 95 th percentile BP (systolic and diastolic) was also observed in the present study in each gender-age-height-specific group. And the height, which was key factor to influence blood pressure, was similar between adolescents aged 15-17 and adults, and a paralleled result was seen in the present study. Therefore, the 2018 Chinese guidelines for adults may also be appropriate for adolescents aged 15-17 years., (© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background: The epidemiological data on the use of aspirin in diabetic patients is very limited. The main purpose of this study is to examine the current status of aspirin use in the United States (US) and China in large representative populations., Methods: Data came from the National Health and Nutrition Examination Survey (NHANES) and China Hypertension Survey (CHS), two nationally representative cross-sectional studies., Results: The percentage of aspirin use was 73.8% in US diabetic patients with ASCVD, and the percentage of aspirin use in diabetic patients with high ASCVD risk was marginally higher in men ( p = .052), 54.5% in men and 37.1% in women. The percentages of aspirin use in diabetic patients with intermediate and low ASCVD risk were 55.1% and 35.0%, respectively. In China, the percentage of aspirin use in diabetic patients with ASCVD was 53.5%, and were 14.3%, 9.7%, and 3.2% among diabetic patients with high, intermediate, and low ASCVD risk, respectively., Conclusions: In summary, the percentage of aspirin use in primary prevention in US diabetic patients in men was higher than in women, and this percentage for primary and secondary prevention in US patients was higher than that in Chinese patients.

This study explored the association between age at menarche and the risk of hypertension in Chinese women. A total of 234 867 women aged ≥18 years from the China Hypertension Survey were included in this study. Participants were required to complete a standard questionnaire. Blood pressure and physical examination of the participants were performed by trained medical staff. Spearman correlation analysis was used to explore the correlation between age at menarche and other individual characteristics. Logistic regression was used to estimate the odds ratios for hypertension by age in years at menarche. The average age at menarche in Chinese women was 14.8 years. Women who were older at menarche were more likely to have a higher body mass index, larger waist circumference, smoke, and have a primary education (p < .05). After adjustments, odds ratios (95% confidence interval) for hypertension across age at menarche groups were 0.912 (0.877-0.948), 0.927 (0.893-0.963), 1.00 (reference), 1.061 (1.020-1.102), and 1.129 (1.090-1.169) for those aged ≤13, 14, 15 (reference), 16, and ≥17 years at menarche, respectively. Each 1-year delay in menarche was associated with a 6.2% increase in the prevalence of hypertension (odds ratio, 1.062; 95% confidence interval, 1.053-1.071). The positive association between age at menarche and hypertension was evident among age at recruitment groups, BMI categories, and education levels. This association was stronger in urban women and postmenopausal women. Our findings suggest that late menarche is related to a higher risk of hypertension among Chinese adult women, and this association appeared similar among different subgroups., (© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background Although numerous studies have been published evaluating the positive or negative effects of altitude on cardiovascular disease, many of them are conflicting. Methods and Results Data come from 2 cross-sectional surveys using a similar method in China; and a total of 34 215 residents, aged ≥35 years, were eligible and recruited in the study. Left ventricular diastolic dysfunction (LVDD), according to the 2009 American Society of Echocardiography guidelines, was defined and evaluated. Altitude was divided into low (<1500 m), middle (1500-3500 m), and high (≥3500 m) level groups. Among the 34 215 participants (aged 55.87 years; men, 45.92%; altitude ranging from 3.1 ~ 4507 m), 15 099 (crude prevalence, 44.13%), 517 (crude prevalence, 1.51%), and 272 (crude prevalence, 0.79%) were diagnosed as having grades I, II, and LVDD, respectively. Compared with low-level group, the odds ratios (ORs) (95% CIs) of LVDD for middle- and high-level groups were 1.65 (1.49-1.82) and 1.89 (1.63-2.19), respectively ( P trend <0.001). The ORs (95% CI) were 1.43 (1.31-1.56) and 2.03 (1.67-2.47) per 500-m increment for middle- and high-level groups. There was a nonlinear relationship (upward-sloping "W" shape) between altitude and the risk of LVDD, assessed by the restricted cubic spline. For each LVDD grade, ORs (95% CIs) of grade I LVDD for middle- and high-level groups were 1.75 (1.59-1.92) and 1.95 (1.69-2.25), respectively; for grade II, ORs (95% CIs) for middle- and high-level groups were 6.19 (3.67-10.42) and 5.27 (2.18-12.74), respectively. The stratified analyses indicated that LVDD was much more remarkably influenced by elevated altitude in men ( P interaction =0.0019). Conclusions Higher altitude is associated with increased risk of LVDD among people living over 1500 m, especially for men.

Background: Along with global climate change, the relationship between temperature variability (TV) and cardiovascular hospitalization and deaths have been well established. However, limited studies were conducted to reveal the underlying mechanism for TV-related cardiovascular diseases., Objectives: In the current study, a novel TV calculation, taking account for both interday and intraday TV as well as lag effects, was used to investigate the effect of short-term TV on the level of high-sensitivity C reactive protein (hs-CRP), which is a crucial preclinical predictor for cardiovascular disease (CVD)., Results: Among the 11,623 Chinese population (46.0% male; mean age 49.8 years), the average hs-CRP was 1.4 mg/ L (standard deviation 1.6 mg/L). Statistical significance between TV and hs-CRP was observed for different TV exposure days (TV01-TV07) in adjusted model, with highest effect for TV06. Specifically, per 1 °C increase in TV06 led to 2.241% (95%CI: 1.552%-2.935%) increase in hs-CRP. Female, obesity and elderly population were more susceptible to TV. The largest mediator for the association of TV and hs-CRP was lipoprotein(a), accounting for 8.68%, followed by smoking status (4.78%), alcohol use (3.95%) and systolic BP (3.20%)., Conclusion: Short-term TV will significantly increase the level of hs-CRP, suggesting hs-CRP to be the potential biologic mechanisms underlying the cardiovascular effects of TV. And more attention should be paid to unstable weather in the global climate change context. Further developing efficient public health policies on climate change may benefit for global heath., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

To explore the association between unbalanced social determinants status and hypertension (HTN) in China, we conducted a cross-sectional survey in a sample of 299 220 Chinese in 2012 to 2015. Social determinants status were measured with: (a) district-level:Per capita GDP (Per&#95;GDP), the number of hospital beds per 1000 residents (Per 1000&#95;bed) and tertiary industry added value (TIAV); (b) individual-level: education and employment conditions. Compared with the poorest level of Per&#95;GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12 (1.09-1.14) and 0.99 (0.96-1.02)] and higher possibility of HTN awareness, treatment, and control. Higher risk of HTN and lower possibility of awareness, treatment, and control were associated with elevated Per 1000&#95;bed in rural area. Higher possibility of HTN control was associated with the higher TIAV (P trend  < .001). Those with middle (OR, 95%CI: 0.86, 0.84-0.88) and senior (OR, 95%CI: 0.72, 0.69-0.76) education had a decreased risk of HTN and higher HTN control possibility compared to primary. And participants in retirement/unemployment conditions had a higher risk of HTN and higher possibility of HTN awareness, treatment, and control compared with the job-holders. This study provides evidence from China that social determinants status has a detectable association with HTN. People with a higher economic area living, lower level of education, or retirement/ unemployment conditions has a higher risk of HTN, especially for male or rural residents. And lower possibility of HTN awareness, treatment, and control were associated with worse economic development and social circumstances environment, lower education level, and employment/student conditions., (© 2020 Wiley Periodicals LLC.)

To understand the relationships among dominant species of cephalopods in offshore nor-thern South China Sea, we examined the niche characteristics of these dominant species from both spatial and temporal dimensions using the index of relative importance ( IRI ), the niche breadth and overlap indices based on fishery resources data from the bottom-trawl survey for four seasons during 2014-2015. The results showed that five dominant species of cephalopods were recorded for four seasons, including Loligo edulis , L. chinensis , L. beka , Sepia esculenta , and L. duvaucelii . The first two species were shared by all seasons. Compared with historical data, the composition of dominant cephalopods species had changed. The cephalopods resource exhibited obvious temporal and spatial variations. Stock density was higher in the sea area extending from the southern Hainan Island to eastern Guangdong Province than that in Beibu Gulf. The seasonal variation was characte-rized by the largest in summer but the smallest in winter. The temporal and spatial niche analysis showed that there was inconsistent in the order between temporal and spatial niche breadths for domi-nant species. L. edulis (1.32) and L. chinensis (3.90) occupied the largest temporal and spatial niche breadths, respectively. The smallest of temporal and spatial niche breadths were shown for S. esculenta (0.98) and L. duvaucelii (2.04), respectively. Though the temporal niche overlap was numerically larger than the spatial niche overlap, both of them had higher values in interspecies among L. edulis , L. chinensis , L. beka , and the lower overlap for the species pairs between L. duvaucelii and other species. The result of correlation analysis suggested that niche breadth exhibited a significant negative correlation with variation in abundance on both temporal and spatial scales. The ecological niche could reflect the tempo-spatial changes of species resource, which enriched the traditional methods of fishery communities.

Results from recent studies on associations between blood pressure (BP) and short-term exposure to fine particulate matter (PM 2.5 ) have been inconsistent. Most studies have been evaluations of small geographic areas, with no national study in China. This study aimed to examine the acute BP responses to ambient PM 2.5 among the general population of Chinese adults. During 2012-2015, systolic and diastolic BP levels were obtained from a large national representative sample, the China Hypertension Survey database (n = 479,842). Daily PM 2.5 average exposures with a spatial resolution of 0.1° were estimated using a data assimilation that combines satellite measurements, air model simulations, and monitoring values. Overall, a 10-μg/m 3 increase in daily PM 2.5 was associated with a 0.035 (95% confidence interval: 0.020, 0.049) mmHg change in systolic BP and 0.001 (-0.008, 0.011) mmHg in diastolic BP after adjustments. Stratified by geographic regions, the systolic and diastolic BP levels varied from -0.050 (-0.109, 0.010) to 0.242 (0.176, 0.307) mmHg, and from -0.026 (-0.053, 0.001) to 0.051 (0.020, 0.082) mmHg, respectively. Statistically significant positive BP-PM 2.5 associations were only found in South and North China for systolic levels and in Southwest China for diastolic levels. We further explored the regional study population characteristics and exposure-response curves, and found that the geographic variations in BP-PM 2.5 associations were probably due to different population compositions or different PM 2.5 exposure levels. Our study provided national-level evidence on the associations between ambient PM 2.5 exposure and elevated BP levels. The magnitude of the estimated associations varied substantially by geographic location in China. CLINICAL TRIAL REGISTRATION: The Clinical trial registration name was Survey on prevalence of hypertension in China; the registration number was ChiCTR-ECS-14004641. http://www.chictr.org.cn/showproj.aspx?proj=4932., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: The study aimed to investigate the spatial variation of hypertension (HTN) and the associations between the risk of HTN and altitude, longitude, latitude in Chinese population., Methods: The newest China Hypertension Survey (CHS) study, which used a nationally representative sample, was conducted between 2012 and 2015. A total of 451 755 participants aged at least 18 years from 262 county-level regions in 31 provinces were analyzed to explore the geographical variations of HTN prevalence at county-level. A total of 444 375 participants were included in two-level logistic regression model to examine the association between HTN risk and exposure to altitude, longitude, and latitude after adjusting for potential confounding variables at individual level., Results: The findings of spatial analysis indicated that there were remarkably high and low HTN prevalence zones. High HTN prevalence zones extended from parts of the southeast to northern China and the northeast. The risk of HTN increased with increasing longitude, with adjusted odds ratios (aORs, 95% confidence interval [CI]) of 2.08 (1.04--4.18), 2.21 (1.15--4.22), 2.54 (1.31--4.93), 2.59 (1.32--5.08), and 2.81 (1.12--7.08) for longitudes of 90-100°E, 100-110°E, 110-120°E, 120-130°E, and at least 130°E, respectively, with a significant dose--response relationship that HTN risks increase as longitude rises from 90°E to ≥130°E(Ptrend <0.001), compared with the longitude group of less than 80°E, consistent with the conclusion that geographical variations of high HTN prevalence zones by spatial analysis., Conclusion: The findings of remarkably high HTN prevalence zones modified previous understandings about the regional difference of HTN distribution, and provide an important basis for future efforts to prevent and control HTN in different regions of China.

The purpose of this study was to assess the association of blood pressure (BP) measurements with the risk of cardiovascular disease (CVD) and examine whether central systolic BP (CSBP) predicts CVD better than brachial BP measurements (SBP and pulse pressure [PP]). Based on a cross-sectional study conducted in 2009-2010 with follow-up in 2016-2017 among 35- to 64-year-old subjects in China, we evaluated the performance of non-invasively predicted CSBP over brachial BP measurements on the first CVD events. Each BP measurement, individually and jointly with another BP measurement, was entered into the multivariate Cox proportional-hazards models, to examine the predictability of central and brachial BP measurements. Mean age of participants (n = 8710) was 50.1 years at baseline. After a median follow-up of 6.36 years, 187 CVD events occurred. CSBP was a stronger predictor for CVD than brachial BP measurements (CSBP, 1-standard deviation increment HR = 1.49, 95%CI: 1.31-1.70). With CSBP and SBP entering into models jointly, the HR for CSBP and SBP was 1.28 (1.04-1.58) and 1.22 (0.98-1.50), respectively. With CSBP and PP entering into models jointly, the HR for CSBP and PP was 1.51 (1.28-1.78) and 0.98 (0.83-1.15), respectively. For subgroup analysis, the association of CSBP with CVD was stronger than brachial BP measurements in women, those with hypertension and obesity. In the middle-aged Chinese population, noninvasively estimated CSBP may offer advantages over brachial BP measurements to predict CVD events, especially for participants with higher risk. These findings suggest prospective assessment of CSBP as a prevention and treatment target in further trials., (© 2020 Wiley Periodicals, Inc.)

Background: To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage., Methods: A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019., Results: A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH., Conclusions: This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Background: Limited evidence is available regarding the potential heterogeneity of ambient temperature on blood pressure (BP) in various climate zones., Objectives: To explore the effect of daily ambient temperature on BP in various climate zones across 31 provinces in China., Methods: A representative population sample (n = 451,770) were obtained from the China Hypertension Survey study (CHS) from October 2012 to December 2015. Survey seasons were divided into warm and cold seasons. Survey sites were divided into three climate zones as subtropical, temperate monsoon and temperate continental zones., Results: After adjustment for confounders, an overall 10 °C decrease in ambient temperature was statistically associated 0.74 mmHg (95% CI: 0.69, 0.79) and 0.60 mmHg (95% CI: -0.63, -0.57) rise for SBP and DBP, respectively. In the warm season, U-shaped exposure-response curves were observed between ambient temperature and BP in temperate monsoon and continental zones, and liner curves in other zones. A greater SBP change due to a lower temperature was observed in subtropical zones, so did DBP in temperate continental zones, especially for cold season. Female, rural and elderly populations were more susceptible to cold weather than their counterparts., Discussion: There is a geographical disparity between temperature and BP across different climate zones, which should been taken into consideration when maintaining stable blood pressure levels., (Copyright © 2018 Elsevier B.V. All rights reserved.)