Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers(NSBBs) is recommended for patients with small varices that have not bled ...Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers(NSBBs) is recommended for patients with small varices that have not bled but with increased risk for bleeding. The recommended treatment strategies on primary prevention of variceal bleeding in patients with medium and largesized varices are NSBBs or endoscopic band ligation. Nitrates, shunt surgery and sclerotherapy are not recommended in this setting. In this review, the most recent data on prevention of esophageal variceal bleeding are presented. Available data derived from randomized-controlled trials suggest both treatment strategies, and according to Baveno V consensus in portal hypertension "the choice of treatment should be based on local resources and expertise, patient preference and characteristics, side-effects and contra-indications".展开更多
Colorectal cancer incidence has been rising strongly in parallel with economic development.In the past few decades,much has been learned about the lifestyle,dietary and medication risk factors for this malignancy.With...Colorectal cancer incidence has been rising strongly in parallel with economic development.In the past few decades,much has been learned about the lifestyle,dietary and medication risk factors for this malignancy.With respect to lifestyle,compelling evidence indicates that prevention of weight gain and maintenance of a reasonable level of physical activity can positively influence in lowering the risk.Although there is controversy about the role of specific nutritional factors,consideration of dietary pattern as a whole appears useful for formulating recommendations.Though quite often recommended,the role for many supplements,including omega-3,vitamin D,folate,and vitamin B6,remains unsettled.Only calcium and vitamin D supplementation appear to add a modest benefit,particularly in those with a low daily intake.With regard to chemoprevention,medications such as aspirin and nonsteroidal antiinflammatory drugs,and postmenopausal hormonal replacement for women might be associated with substantial reductions in colorectal cancer risk,though their utility is affected by their side effect profile.However,the role of agents such as statins,bisphosphonates and antioxidants have yet to be determined.Ultimately,primary prevention strategies focusing on modifying environmental,lifestyle risk factors,and chemopreventive drugs are options that have already been tested,and may impact on colon cancer incidence.展开更多
Unipolar depressive disorder(UDD)affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted...Unipolar depressive disorder(UDD)affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted life years lost in 2030.It is imperative for leading economies to implement preventive strategies targeted towards UDD,given consistent policies are currently lacking.Recently established similarities between the aetiological hypotheses of depression and cardiometabolic diseases are shifting paradigms within this field.It is believed that dietary practices could potentially reduce the incidence of depression;similar to their effects on metabolism.Thus,the aim of this review was to compile current evidence on healthy dietary patterns as suitable contributors towards primary prevention strategies against UDD.Most of the well-known biological mechanisms behind depression have been positively associated with healthful diets and dietary patterns to varying degrees.Interestingly,a common factor of UDD is the production and overall effects of inflammatory cytokines,such as interleukin-6,tumor necrosis factor-α,and Creactive protein.These compounds have been associated with depressive symptoms,disturbances in neuroendocrine function,leaky gut,monoamine activity and brain function,while also being key factors in the development of cardiometabolic diseases.The Mediterranean diet(MD)in particular,is well supported by first-level evidence regarding its preventive qualities against metabolic and cardiovascular diseases and thus considered a model for healthy eating by various organizations.In one of the few clinical trials investigating these associations,the PREDIMED trial,individuals with diabetes assigned to a MD supplemented with mixed tree nuts experienced a 41%relative risk reduction for developing depression.Lastly,there is a need to include health related quality of life as an indicator of physical and mental well-being,considering its putative associations with depression and suicide risk.Going forward,focusing on clinical trials,using precise nutritional assessments,and identifying nutritional biomarkers which may be related to depression are needed to fully support the implementation of dietary recommendations in the field of psychiatry.展开更多
Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incide...Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incidence of bleeding,their efficacy is limited due to side effects and related contraindications.With recent advances in precision medicine,precise drug treatment provides better treatment efficacy.Data sources:Literature search was conducted in PubMed,MEDLINE and Web of Science for relevant articles published up to May 2022.Information on clinical trials was obtained from https://clinicaltrials.gov/and http://www.chictr.org.cn/.Results:The in-depth understanding of the pathogenesis and advances of portal hypertension has enabled the discovery of multiple molecular targets for promising drugs.According to the site of action,these drugs could be classified into four classes:intrahepatic,extrahepatic,both intrahepatic and extrahepatic targets and others.All these classes of drugs offer advantages over traditional treatments in prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.Conclusions:This review classified and summarized the promising drugs,which prevent gastroesophageal variceal bleeding by targeting specific markers of pathogenesis of portal hypertension,demonstrating the significance of using the precision medicine strategy to discover and develop promising drugs for the primary prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.展开更多
Objective To investigate whether plasma big endothelin-1(ET-1) predicts ventricular arrythmias(VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator(ICD) indication patigents. Methods ...Objective To investigate whether plasma big endothelin-1(ET-1) predicts ventricular arrythmias(VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator(ICD) indication patigents. Methods In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1(< 0.38 pmol/L, n = 68), tertile 2(0.38–0.7 pmol/L, n = 69), and tertile 3(> 0.7 pmol/L, n = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation. Results During a mean follow-up period of 25.6 ± 13.9 months, 38(18.4%) VAs and 78(37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class(r = 0.165, P = 0.018), serum creatinine concentration(Scr;r = 0.147, P = 0.034), high-sensitivity C-reactive protein(hs-CRP;r = 0.217, P = 0.002), Lg NT-pro BNP(r = 0.463, P < 0.001), left ventricular end diastolic diameter(LVEDD;r = 0.234, P = 0.039) and negatively correlated with left ventricular ejection fraction(LVEF;r =-0.181, P = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events(P < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs(hazard ratio(HR) = 3.477, 95% confidence interval(CI): 1.352–8.940, P = 0.010, tertile 2 vs. tertile 1;HR = 4.112, 95% CI: 1.604–10.540, P = 0.003, tertile 3 vs. tertile 1) and end-stage events(HR = 2.804, 95% CI: 1.354–5.806, P = 0.005, tertile 2 vs. tertile 1;HR = 4.652, 95% CI: 2.288–9.459, P < 0.001, tertile 3 vs. tertile 1). Conclusions In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.展开更多
Type 2 diabetes is in epidemic proportion in Papua New Guinea. Although many people are at high-risk of developing diabetes, there is no diabetes prevention policy and services in Papua New Guinea to address this prob...Type 2 diabetes is in epidemic proportion in Papua New Guinea. Although many people are at high-risk of developing diabetes, there is no diabetes prevention policy and services in Papua New Guinea to address this problem. A literature search was carried out to assess the available evidence in the primary prevention of type 2 diabetes mellitus among the population with pre-diabetes. The result shows that the primary preventative studies conducted on lifestyle modification and the use of metformin in prediabetes patients reduced overt type 2 diabetes mellitus. The application of the evidence in the prevention of the type 2 diabetes epidemic in Papua New Guinea, driven by a policy is feasible to address the diabetes epidemic.展开更多
Individuals with unipolar depressive disorder(UDD)are having an increased risk of death and development of dementia in later life.It is widely expected that in a near future UDD would be the leading cause of death;the...Individuals with unipolar depressive disorder(UDD)are having an increased risk of death and development of dementia in later life.It is widely expected that in a near future UDD would be the leading cause of death;therefore,a primary inexpensive prevention of UDD will be of a great importance to the society.Several studies provide evidences supporting the positive effect of Mediterranean diet on a reduced risk for development of depression.展开更多
Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in r...Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.展开更多
Objective: This paper aims to evaluate the safety and efficacy of aspirin in primary stroke prevention by meta-analysis. Methods: By searching PubMed, Cochrane Library, Embase, MEDLINE, Web of Science, CNKI, China Bio...Objective: This paper aims to evaluate the safety and efficacy of aspirin in primary stroke prevention by meta-analysis. Methods: By searching PubMed, Cochrane Library, Embase, MEDLINE, Web of Science, CNKI, China Biomedical Literature Database, VIP Database and Wanfang Database, we collected randomized controlled trials on aspirin for primary prevention of stroke. The retrieval time limit is from the establishment of the database to December 2021. Two researchers independently conducted literature search, screening, data extraction and quality evaluation, and Meta-analysis was performed using RevMan 5.3. Results: A total of 19 articles were included, including 220,636 subjects. Meta-analysis results show that long-term preventive use of aspirin can reduce the incidence of stroke [RR = 0.91, 95% CI (0.85, 0.98), P = 0.009], and reduce the incidence of ischemic stroke [RR = 0.84, 95% CI] (0.77, 0.91), P RR = 0.80, 95% CI (0.72, 0.88), P RR = 0.85, 95% CI (0.75, 0.97), P RR = 1.23, 95% CI (1.04, 1.46), P = 0.01] and gastrointestinal bleeding [RR = 1.62, 95% CI (1.35, 1.93), P RR = 0.97, 95% CI (0.93, 1.02), P = 0.20]. Conclusion: Long-term prophylactic use of aspirin can reduce the overall incidence of stroke, but there is also a risk of bleeding. The advantages and disadvantages of aspirin should be fully evaluated and strict screening should be carried out before medication, which can minimize adverse reactions and improve the safety and effectiveness of aspirin in the primary prevention of stroke.展开更多
Introduction:This study aimed to quantify potentially inappropriate medication(PIM)use for primary cardiovascular disease(CVD)prevention in China and its attributable mortality and morbidity.Methods:Data from the 2015...Introduction:This study aimed to quantify potentially inappropriate medication(PIM)use for primary cardiovascular disease(CVD)prevention in China and its attributable mortality and morbidity.Methods:Data from the 2015,2018,and 2023 China Chronic Disease and Risk Factor Surveillance were analyzed for adults aged≥30 years without diagnosed CVD.PIM use was defined according to guideline adherence for aspirin,statins,antihypertensives,and glucose-lowering agents.Population attributable fractions(PAFs)were calculated using weighted prevalence and relative risks,and CVD outcomes were derived from the Global Burden of Disease 2023.Results:From 2015 to 2023,PIM prevalence for primary CVD prevention declined by half,with larger relative reductions observed among women and older adults.The number of PIM-attributable CVD deaths decreased by 39%,and its rank among CVD risk factors dropped from 17th to 21st after 2018.Before 2018,15 provinces showed increases in PIMattributable CVD mortality and morbidity,but subsequent declines occurred in 30 provinces for mortality and 28 for morbidity,with Inner Mongolia and Tianjin showing the largest improvements.Conclusion:Despite marked progress,disparities persist across regions and populations.Establishing population-based PIM surveillance and implementing targeted interventions in high-burden areas are essential to further reduce preventable CVD morbidity and mortality.展开更多
Background An implantable cardioverter-defibrillator （ICD） has been suggested for heart failure patients for primary prevention of sudden cardiac death. However, few data have been reported on the application of ICD...Background An implantable cardioverter-defibrillator （ICD） has been suggested for heart failure patients for primary prevention of sudden cardiac death. However, few data have been reported on the application of ICD as primary prevention of sudden cardiac death in China. We evaluated the value of primary prevention ICD therapy in Chinese patients with heart failure.Methods Thirty-four patients at an average age of （60.2±13.7） years seen in Peking Union Medical College Hospital were treated with ICD implantation for primary prevention of sudden cardiac death from November 2005 to July 2009. Single-chamber ICDs were implanted in 16 （47.0%） cases, and dual-chamber or cardiac resynchronization therapy defibrillators in 18 （53.0%） cases. The patients had an average left ventricular ejection fraction of （26.9±5.5）% （11% to 35%）, of which 18 （53.0%） patients had ischemic cardiomyopathy and 16 （47.0%） patients had non-ischemic cardiomyopathy. All patients were followed up at three months after the implantation and every six months thereafter or when prompted by an ICD event.Results There were five （14.7%） deaths, including two of heart failure and three with a non-cardiac course, during an average follow-up of （15.0±11.9） months. Forty-one ICD therapy events were recorded, including 19 （46.3%） appropriate ICD therapies in six patients and 22 （53.7%） inappropriate ICD therapies in four patients with single chamber leads. Inappropriate ICD therapies were mainly due to supraventricular tachyarrhythmias, especially atrial fibrillation. Patients with ischemic cardiomyopathy and non-ischemic cardiomyopathy did not differ in the incidence of either appropriate or inappropriate therapy.Conclusions ICD for primary prevention of sudden cardiac death in China prevents patients from arrhythmia death. Relatively high incidence of inappropriate therapies highlights the importance of an atrial lead.展开更多
Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries...Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.展开更多
Objective Pregnancy has been identified as a risk factor for pelvic floor dysfunction(PFD).The aim of this study was to establish primary prevention measures for PFD during pregnancy and reduce the overall incidence o...Objective Pregnancy has been identified as a risk factor for pelvic floor dysfunction(PFD).The aim of this study was to establish primary prevention measures for PFD during pregnancy and reduce the overall incidence of PFD.Methods We assembled a panel of 36 experts,including gynecologists,obstetricians,and physiotherapists.Through surveys and expert meetings,the panel reviewed and assessed the safety and effectiveness of various clinical interventions.Based on expert comments from Round 1,a revised list of 8 clinical interventions was developed and submitted for a second round of expert review.Results A consensus was reached on the importance of implementing prevention measures to protect pelvic floor function during pregnancy.Experts particularly emphasized the significance of health education,weight management,pelvic floor muscle training,respiratory training,overall exercise,physical activity,and perineal massage.Conclusion The expert consensus provides comprehensive clinical measures to safeguard pelvic floor function during pregnancy.This paper represents the initial step toward developing scientific recommendations for pregnant women regarding the primary prevention of PFD.Future research should focus on the implementation of these recommendations in clinical practice.展开更多
Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prev...Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events.To promote a healthy lifestyle and enhance the detection,diagnosis,and treatment of cardiovascular risk factors such as hypertension,dyslipidemia,and diabetes,and to improve the overall capacity of primary prevention of cardiovascular disease,the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults.The guideline consists of 10 sections:introduction,methodology for developing the guideline,epidemiology of cardiovascular disease in China and challenges in primary prevention,general recommendations for primary prevention,assessment of cardiovascular risk,lifestyle intervention,blood pressure control,lipid management,management of type 2 diabetes,and use of aspirin.The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.展开更多
The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortali...The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.展开更多
Objective To study the effect of primary prevention of implantable cardioverter defibrillator(ICD)on sudden cardiac death(SCD)in patients with dilated cardiomyopathy.Methods A total of 36 patients with dilated cardiom...Objective To study the effect of primary prevention of implantable cardioverter defibrillator(ICD)on sudden cardiac death(SCD)in patients with dilated cardiomyopathy.Methods A total of 36 patients with dilated cardiomyopathy treated in our hospital from 2013-12 to2014-12 were studied including 29(80.6%)male and 7(19.4%)female with the mean age of(63±11.8)展开更多
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with an extremely poor prognosis. The major etiologic risk factors for HCC development include hepatitis B virus (HB...Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with an extremely poor prognosis. The major etiologic risk factors for HCC development include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, toxins (alcohol, aflatoxin BI) and various inherited metabolic liver diseases, such as hemochromatosis and alpha-1-antitrypsin deficiency. Central to the molecular pathogenesis of HCC are mutations of various genes and genetic/chromosomal instability that result from chronic liver disease and the associated enhanced liver cell regeneration and mitotic activity. Alterations in the structure or expression of several tumor suppressor genes and oncogenes have been described. In addition, mechanisms leading to genetic instability due to mismatch repair deficiency or chromosomal instability and aneuploidy due to defective chromosomal segregation appear to be involved. The prognosis of HCC patients is generally very poor. Most studies have shown a five-year survival rate of less than 5% in symptomatic patients. HCC has been found to be quite resistant to radio- or chemotherapy. Investigations of the natural history and clinical course of HCC revealed a long-term survival of patients only with small asymptomatic HCC that could be treated surgically or nonsurgically. For patients with advanced symptomatic HCC, novel therapeutic strategies such as gene therapy are urgently needed. Apart from exploring and refining new HCC treatment strategies, the implementation of the existing measures or the development of novel measures to prevent HCC is most important. Primary HCC prevention could have a major impact on the incidence of HCC. Further, secondary prevention of a local recurrence or of new HCC lesions in patients after successful surgical or nonsurgical HCC treatment is of paramount importance and is expected to significantly improve disease-free and overall survival rates of patients. Based on rapid scientific advances, molecular diagnosis, gene therapy and molecular prevention are becoming increasingly part of our patient management and will eventually complement or in part replace the existing diagnostic, therapeutic and preventive strategies. Overall, this should result in a reduced HCC incidence and an improved clinical outcome for patients with HCC, one of the most devastating malignancies worldwide.展开更多
Diabetes is a devastating public health problem.Prediabetes is an intermediate stage in the disease processes leading to diabetes,including types 1 and 2 diabetes.In the article“Prediabetes in children and adolescent...Diabetes is a devastating public health problem.Prediabetes is an intermediate stage in the disease processes leading to diabetes,including types 1 and 2 diabetes.In the article“Prediabetes in children and adolescents:An updated review,”the authors presented current evidence.We simplify and systematically clearly present the evidence and rationale for a conceptual framework we term the‘3ASs’:(1)Awareness Sensible;(2)Algorithm Simple;and(3)Appealing Strategies.Policy makers and the public need to be alerted.The prevalence of prediabetes should send alarm bells ringing for parents,individuals,clinicians,and policy makers.Prediabetes is defined by the following criteria:impaired fasting glucose(100-125 mg/dL);impaired glucose tolerance(2 h postprandial glucose 140-199 mg/dL);or hemoglobin A1c values of 5.7%–6.4%.Any of the above positive test alerts for intervention.Clinical guidelines do not recommend prioritizing one test over the others for evaluation.Decisions should be made on the strengths and shortfalls of each test.Patient preferences and test accessibility should be taken into consideration.An algorithm based on age,physiological stage,health status,and risk factors is provided.Primordial prevention targeting populations aims to eliminate risk factors through public education and encouraging practices through environmental modifications.Access to healthy foods is provided.Primary prevention is for individuals with a prediabetes diagnosis and involves a structured program to reduce body weight and increase physical activity along with a healthy diet.An overall methodical move to a healthy lifestyle for lifelong health is urgently needed.Early energetic prediabetes action is necessary.展开更多
Objective: To study changes in lifestyle and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-yea...Objective: To study changes in lifestyle and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-year follow-up survey and register study of a cohort of men 33 - 42 years old, examined with a health profile at baseline. With the health profile based on lifestyle, biological risk markers, self-rated mental stress and mental health, the men were separated in different risk groups. Setting: Primary health care center of Habo in Sweden. Subjects: All 757 men, 33 - 42 years old, and living in the community of Habo in Sweden in 1985. Main Outcome Measures: Lifestyle, biological risk markers, morbidity from CVD and cancer, and total mortality. Results: Smoking and physical activity decreased during follow-up time while alcohol consumption increased. Biological risk markers, except diastolic blood pressure, deteriorated significantly with age. Based on three- lifestyle groups, 16 % of the men had a more favorable lifestyle and 19% had a less favorable life-style at follow-up compared with baseline. The men, who had been classified as high-risk, based on the health profile at baseline, had a significantly higher incidence of CVD and cancer in the register study compared to men in a low-risk group. The baseline non-participant group had a significantly higher incidence of CVD and a higher mortality compared to the low-risk group. Conclusion: A health profile with a combination of lifestyle factors and biological risk markers can already at the age of 33 - 42 years predict incidence of CVD and cancer on group level among men after 24 years.展开更多
Objective: To evaluate the efficacy of Genni-anchun (GNC) in preventing primary osteoporosis. Methods: Fifty female SD rats of 10 - 12 months old were randomly divided into five groups. Except those in the sham operat...Objective: To evaluate the efficacy of Genni-anchun (GNC) in preventing primary osteoporosis. Methods: Fifty female SD rats of 10 - 12 months old were randomly divided into five groups. Except those in the sham operation group, animals were ovariectomized bilaterally. The gastric perfusion was started immediately after operation, with normal saline to the sham operation group and model group; GNC to high dose (2 ml) and low dos (1 ml) GNC groups and Nilestriol to the NE group, every day for 3 months. Animals were sacrificed at the end of experiment, their vertebra and展开更多
文摘Variceal bleeding is a life threatening situation with mortality rates of at least 20%. Prophylactic treatment with non-selective beta blockers(NSBBs) is recommended for patients with small varices that have not bled but with increased risk for bleeding. The recommended treatment strategies on primary prevention of variceal bleeding in patients with medium and largesized varices are NSBBs or endoscopic band ligation. Nitrates, shunt surgery and sclerotherapy are not recommended in this setting. In this review, the most recent data on prevention of esophageal variceal bleeding are presented. Available data derived from randomized-controlled trials suggest both treatment strategies, and according to Baveno V consensus in portal hypertension "the choice of treatment should be based on local resources and expertise, patient preference and characteristics, side-effects and contra-indications".
文摘Colorectal cancer incidence has been rising strongly in parallel with economic development.In the past few decades,much has been learned about the lifestyle,dietary and medication risk factors for this malignancy.With respect to lifestyle,compelling evidence indicates that prevention of weight gain and maintenance of a reasonable level of physical activity can positively influence in lowering the risk.Although there is controversy about the role of specific nutritional factors,consideration of dietary pattern as a whole appears useful for formulating recommendations.Though quite often recommended,the role for many supplements,including omega-3,vitamin D,folate,and vitamin B6,remains unsettled.Only calcium and vitamin D supplementation appear to add a modest benefit,particularly in those with a low daily intake.With regard to chemoprevention,medications such as aspirin and nonsteroidal antiinflammatory drugs,and postmenopausal hormonal replacement for women might be associated with substantial reductions in colorectal cancer risk,though their utility is affected by their side effect profile.However,the role of agents such as statins,bisphosphonates and antioxidants have yet to be determined.Ultimately,primary prevention strategies focusing on modifying environmental,lifestyle risk factors,and chemopreventive drugs are options that have already been tested,and may impact on colon cancer incidence.
文摘Unipolar depressive disorder(UDD)affects more than 264 million people worldwide and was projected well before the severe acute respiratory syndrome coronavirus 2 pandemic to be the leading cause of disability-adjusted life years lost in 2030.It is imperative for leading economies to implement preventive strategies targeted towards UDD,given consistent policies are currently lacking.Recently established similarities between the aetiological hypotheses of depression and cardiometabolic diseases are shifting paradigms within this field.It is believed that dietary practices could potentially reduce the incidence of depression;similar to their effects on metabolism.Thus,the aim of this review was to compile current evidence on healthy dietary patterns as suitable contributors towards primary prevention strategies against UDD.Most of the well-known biological mechanisms behind depression have been positively associated with healthful diets and dietary patterns to varying degrees.Interestingly,a common factor of UDD is the production and overall effects of inflammatory cytokines,such as interleukin-6,tumor necrosis factor-α,and Creactive protein.These compounds have been associated with depressive symptoms,disturbances in neuroendocrine function,leaky gut,monoamine activity and brain function,while also being key factors in the development of cardiometabolic diseases.The Mediterranean diet(MD)in particular,is well supported by first-level evidence regarding its preventive qualities against metabolic and cardiovascular diseases and thus considered a model for healthy eating by various organizations.In one of the few clinical trials investigating these associations,the PREDIMED trial,individuals with diabetes assigned to a MD supplemented with mixed tree nuts experienced a 41%relative risk reduction for developing depression.Lastly,there is a need to include health related quality of life as an indicator of physical and mental well-being,considering its putative associations with depression and suicide risk.Going forward,focusing on clinical trials,using precise nutritional assessments,and identifying nutritional biomarkers which may be related to depression are needed to fully support the implementation of dietary recommendations in the field of psychiatry.
基金This work was supported by grants from the National Natural Science Foundation of China(81902484)China Postdoctoral Science Foundation(2020M670864)+2 种基金Youth Support Project of Jilin Association for Science and Technology(202028)Jilin Provincial Health Special Project(2020SCZT039)Jilin Health and Healthy Youth Science and Technology Training Plan(2020Q017).
文摘Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incidence of bleeding,their efficacy is limited due to side effects and related contraindications.With recent advances in precision medicine,precise drug treatment provides better treatment efficacy.Data sources:Literature search was conducted in PubMed,MEDLINE and Web of Science for relevant articles published up to May 2022.Information on clinical trials was obtained from https://clinicaltrials.gov/and http://www.chictr.org.cn/.Results:The in-depth understanding of the pathogenesis and advances of portal hypertension has enabled the discovery of multiple molecular targets for promising drugs.According to the site of action,these drugs could be classified into four classes:intrahepatic,extrahepatic,both intrahepatic and extrahepatic targets and others.All these classes of drugs offer advantages over traditional treatments in prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.Conclusions:This review classified and summarized the promising drugs,which prevent gastroesophageal variceal bleeding by targeting specific markers of pathogenesis of portal hypertension,demonstrating the significance of using the precision medicine strategy to discover and develop promising drugs for the primary prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.
基金supported by Natural Science Foundation of China(81470466)。
文摘Objective To investigate whether plasma big endothelin-1(ET-1) predicts ventricular arrythmias(VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator(ICD) indication patigents. Methods In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1(< 0.38 pmol/L, n = 68), tertile 2(0.38–0.7 pmol/L, n = 69), and tertile 3(> 0.7 pmol/L, n = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation. Results During a mean follow-up period of 25.6 ± 13.9 months, 38(18.4%) VAs and 78(37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class(r = 0.165, P = 0.018), serum creatinine concentration(Scr;r = 0.147, P = 0.034), high-sensitivity C-reactive protein(hs-CRP;r = 0.217, P = 0.002), Lg NT-pro BNP(r = 0.463, P < 0.001), left ventricular end diastolic diameter(LVEDD;r = 0.234, P = 0.039) and negatively correlated with left ventricular ejection fraction(LVEF;r =-0.181, P = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events(P < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs(hazard ratio(HR) = 3.477, 95% confidence interval(CI): 1.352–8.940, P = 0.010, tertile 2 vs. tertile 1;HR = 4.112, 95% CI: 1.604–10.540, P = 0.003, tertile 3 vs. tertile 1) and end-stage events(HR = 2.804, 95% CI: 1.354–5.806, P = 0.005, tertile 2 vs. tertile 1;HR = 4.652, 95% CI: 2.288–9.459, P < 0.001, tertile 3 vs. tertile 1). Conclusions In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.
文摘Type 2 diabetes is in epidemic proportion in Papua New Guinea. Although many people are at high-risk of developing diabetes, there is no diabetes prevention policy and services in Papua New Guinea to address this problem. A literature search was carried out to assess the available evidence in the primary prevention of type 2 diabetes mellitus among the population with pre-diabetes. The result shows that the primary preventative studies conducted on lifestyle modification and the use of metformin in prediabetes patients reduced overt type 2 diabetes mellitus. The application of the evidence in the prevention of the type 2 diabetes epidemic in Papua New Guinea, driven by a policy is feasible to address the diabetes epidemic.
文摘Individuals with unipolar depressive disorder(UDD)are having an increased risk of death and development of dementia in later life.It is widely expected that in a near future UDD would be the leading cause of death;therefore,a primary inexpensive prevention of UDD will be of a great importance to the society.Several studies provide evidences supporting the positive effect of Mediterranean diet on a reduced risk for development of depression.
文摘Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.
文摘Objective: This paper aims to evaluate the safety and efficacy of aspirin in primary stroke prevention by meta-analysis. Methods: By searching PubMed, Cochrane Library, Embase, MEDLINE, Web of Science, CNKI, China Biomedical Literature Database, VIP Database and Wanfang Database, we collected randomized controlled trials on aspirin for primary prevention of stroke. The retrieval time limit is from the establishment of the database to December 2021. Two researchers independently conducted literature search, screening, data extraction and quality evaluation, and Meta-analysis was performed using RevMan 5.3. Results: A total of 19 articles were included, including 220,636 subjects. Meta-analysis results show that long-term preventive use of aspirin can reduce the incidence of stroke [RR = 0.91, 95% CI (0.85, 0.98), P = 0.009], and reduce the incidence of ischemic stroke [RR = 0.84, 95% CI] (0.77, 0.91), P RR = 0.80, 95% CI (0.72, 0.88), P RR = 0.85, 95% CI (0.75, 0.97), P RR = 1.23, 95% CI (1.04, 1.46), P = 0.01] and gastrointestinal bleeding [RR = 1.62, 95% CI (1.35, 1.93), P RR = 0.97, 95% CI (0.93, 1.02), P = 0.20]. Conclusion: Long-term prophylactic use of aspirin can reduce the overall incidence of stroke, but there is also a risk of bleeding. The advantages and disadvantages of aspirin should be fully evaluated and strict screening should be carried out before medication, which can minimize adverse reactions and improve the safety and effectiveness of aspirin in the primary prevention of stroke.
基金provided by the Sci-Tech Innovation 2030 Agenda(2023ZD0503900,2023ZD0503901)Non-communicable Chronic Diseases-National Science and Technology Major Project(2024ZD0524100,2024ZD0524101)Xizang Autonomous Region Key Special Project for R&D and Transformation(XZ202501ZY0072).
文摘Introduction:This study aimed to quantify potentially inappropriate medication(PIM)use for primary cardiovascular disease(CVD)prevention in China and its attributable mortality and morbidity.Methods:Data from the 2015,2018,and 2023 China Chronic Disease and Risk Factor Surveillance were analyzed for adults aged≥30 years without diagnosed CVD.PIM use was defined according to guideline adherence for aspirin,statins,antihypertensives,and glucose-lowering agents.Population attributable fractions(PAFs)were calculated using weighted prevalence and relative risks,and CVD outcomes were derived from the Global Burden of Disease 2023.Results:From 2015 to 2023,PIM prevalence for primary CVD prevention declined by half,with larger relative reductions observed among women and older adults.The number of PIM-attributable CVD deaths decreased by 39%,and its rank among CVD risk factors dropped from 17th to 21st after 2018.Before 2018,15 provinces showed increases in PIMattributable CVD mortality and morbidity,but subsequent declines occurred in 30 provinces for mortality and 28 for morbidity,with Inner Mongolia and Tianjin showing the largest improvements.Conclusion:Despite marked progress,disparities persist across regions and populations.Establishing population-based PIM surveillance and implementing targeted interventions in high-burden areas are essential to further reduce preventable CVD morbidity and mortality.
文摘Background An implantable cardioverter-defibrillator （ICD） has been suggested for heart failure patients for primary prevention of sudden cardiac death. However, few data have been reported on the application of ICD as primary prevention of sudden cardiac death in China. We evaluated the value of primary prevention ICD therapy in Chinese patients with heart failure.Methods Thirty-four patients at an average age of （60.2±13.7） years seen in Peking Union Medical College Hospital were treated with ICD implantation for primary prevention of sudden cardiac death from November 2005 to July 2009. Single-chamber ICDs were implanted in 16 （47.0%） cases, and dual-chamber or cardiac resynchronization therapy defibrillators in 18 （53.0%） cases. The patients had an average left ventricular ejection fraction of （26.9±5.5）% （11% to 35%）, of which 18 （53.0%） patients had ischemic cardiomyopathy and 16 （47.0%） patients had non-ischemic cardiomyopathy. All patients were followed up at three months after the implantation and every six months thereafter or when prompted by an ICD event.Results There were five （14.7%） deaths, including two of heart failure and three with a non-cardiac course, during an average follow-up of （15.0±11.9） months. Forty-one ICD therapy events were recorded, including 19 （46.3%） appropriate ICD therapies in six patients and 22 （53.7%） inappropriate ICD therapies in four patients with single chamber leads. Inappropriate ICD therapies were mainly due to supraventricular tachyarrhythmias, especially atrial fibrillation. Patients with ischemic cardiomyopathy and non-ischemic cardiomyopathy did not differ in the incidence of either appropriate or inappropriate therapy.Conclusions ICD for primary prevention of sudden cardiac death in China prevents patients from arrhythmia death. Relatively high incidence of inappropriate therapies highlights the importance of an atrial lead.
基金supported by the Portuguese Foundation for Science and Technology,(UID/DTP/04045/2013)by the European Regional Develop-ment Fund,through COMPETE 2020(POCI--01--0145-FEDER--006969)+4 种基金funded by the European Regional Development Fund,through NORTE 2020(NORTE--01--0145--FEDER--000016)The European Regional Development Fund through the Operational Competitiveness Programthe Foun-dation for Science and Technology(FCT)of Portugal support the research unit CIAFEL within the projects FCOMP--01--0124--FEDER--020180(References FCT:PTDC/DES/122763/2010)and UID/DTP/00617/2013supported by the Portuguese Foundation for Science and Technology(REF:UID/BIM/04501/2013)FEDER/Compete2020 funds
文摘Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.
基金supported by the National Key Technology R&D Program of China(grant number:2018YFC2002204)National Natural Science Foundation of China(grant number:82171615 and 82101697)+1 种基金Chinese Association of Plastics and Aesthetics(grant number:2020-Z-27)Beijing Natural Science Foundation(grant number:7214263).
文摘Objective Pregnancy has been identified as a risk factor for pelvic floor dysfunction(PFD).The aim of this study was to establish primary prevention measures for PFD during pregnancy and reduce the overall incidence of PFD.Methods We assembled a panel of 36 experts,including gynecologists,obstetricians,and physiotherapists.Through surveys and expert meetings,the panel reviewed and assessed the safety and effectiveness of various clinical interventions.Based on expert comments from Round 1,a revised list of 8 clinical interventions was developed and submitted for a second round of expert review.Results A consensus was reached on the importance of implementing prevention measures to protect pelvic floor function during pregnancy.Experts particularly emphasized the significance of health education,weight management,pelvic floor muscle training,respiratory training,overall exercise,physical activity,and perineal massage.Conclusion The expert consensus provides comprehensive clinical measures to safeguard pelvic floor function during pregnancy.This paper represents the initial step toward developing scientific recommendations for pregnant women regarding the primary prevention of PFD.Future research should focus on the implementation of these recommendations in clinical practice.
文摘Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events.To promote a healthy lifestyle and enhance the detection,diagnosis,and treatment of cardiovascular risk factors such as hypertension,dyslipidemia,and diabetes,and to improve the overall capacity of primary prevention of cardiovascular disease,the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults.The guideline consists of 10 sections:introduction,methodology for developing the guideline,epidemiology of cardiovascular disease in China and challenges in primary prevention,general recommendations for primary prevention,assessment of cardiovascular risk,lifestyle intervention,blood pressure control,lipid management,management of type 2 diabetes,and use of aspirin.The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.
文摘The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.
文摘Objective To study the effect of primary prevention of implantable cardioverter defibrillator(ICD)on sudden cardiac death(SCD)in patients with dilated cardiomyopathy.Methods A total of 36 patients with dilated cardiomyopathy treated in our hospital from 2013-12 to2014-12 were studied including 29(80.6%)male and 7(19.4%)female with the mean age of(63±11.8)
文摘Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with an extremely poor prognosis. The major etiologic risk factors for HCC development include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, toxins (alcohol, aflatoxin BI) and various inherited metabolic liver diseases, such as hemochromatosis and alpha-1-antitrypsin deficiency. Central to the molecular pathogenesis of HCC are mutations of various genes and genetic/chromosomal instability that result from chronic liver disease and the associated enhanced liver cell regeneration and mitotic activity. Alterations in the structure or expression of several tumor suppressor genes and oncogenes have been described. In addition, mechanisms leading to genetic instability due to mismatch repair deficiency or chromosomal instability and aneuploidy due to defective chromosomal segregation appear to be involved. The prognosis of HCC patients is generally very poor. Most studies have shown a five-year survival rate of less than 5% in symptomatic patients. HCC has been found to be quite resistant to radio- or chemotherapy. Investigations of the natural history and clinical course of HCC revealed a long-term survival of patients only with small asymptomatic HCC that could be treated surgically or nonsurgically. For patients with advanced symptomatic HCC, novel therapeutic strategies such as gene therapy are urgently needed. Apart from exploring and refining new HCC treatment strategies, the implementation of the existing measures or the development of novel measures to prevent HCC is most important. Primary HCC prevention could have a major impact on the incidence of HCC. Further, secondary prevention of a local recurrence or of new HCC lesions in patients after successful surgical or nonsurgical HCC treatment is of paramount importance and is expected to significantly improve disease-free and overall survival rates of patients. Based on rapid scientific advances, molecular diagnosis, gene therapy and molecular prevention are becoming increasingly part of our patient management and will eventually complement or in part replace the existing diagnostic, therapeutic and preventive strategies. Overall, this should result in a reduced HCC incidence and an improved clinical outcome for patients with HCC, one of the most devastating malignancies worldwide.
文摘Diabetes is a devastating public health problem.Prediabetes is an intermediate stage in the disease processes leading to diabetes,including types 1 and 2 diabetes.In the article“Prediabetes in children and adolescents:An updated review,”the authors presented current evidence.We simplify and systematically clearly present the evidence and rationale for a conceptual framework we term the‘3ASs’:(1)Awareness Sensible;(2)Algorithm Simple;and(3)Appealing Strategies.Policy makers and the public need to be alerted.The prevalence of prediabetes should send alarm bells ringing for parents,individuals,clinicians,and policy makers.Prediabetes is defined by the following criteria:impaired fasting glucose(100-125 mg/dL);impaired glucose tolerance(2 h postprandial glucose 140-199 mg/dL);or hemoglobin A1c values of 5.7%–6.4%.Any of the above positive test alerts for intervention.Clinical guidelines do not recommend prioritizing one test over the others for evaluation.Decisions should be made on the strengths and shortfalls of each test.Patient preferences and test accessibility should be taken into consideration.An algorithm based on age,physiological stage,health status,and risk factors is provided.Primordial prevention targeting populations aims to eliminate risk factors through public education and encouraging practices through environmental modifications.Access to healthy foods is provided.Primary prevention is for individuals with a prediabetes diagnosis and involves a structured program to reduce body weight and increase physical activity along with a healthy diet.An overall methodical move to a healthy lifestyle for lifelong health is urgently needed.Early energetic prediabetes action is necessary.
基金grants from the Medical Research Council of Southeast Sweden (FORSS) Futurum County Council of Jönköping Sweden
文摘Objective: To study changes in lifestyle and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-year follow-up survey and register study of a cohort of men 33 - 42 years old, examined with a health profile at baseline. With the health profile based on lifestyle, biological risk markers, self-rated mental stress and mental health, the men were separated in different risk groups. Setting: Primary health care center of Habo in Sweden. Subjects: All 757 men, 33 - 42 years old, and living in the community of Habo in Sweden in 1985. Main Outcome Measures: Lifestyle, biological risk markers, morbidity from CVD and cancer, and total mortality. Results: Smoking and physical activity decreased during follow-up time while alcohol consumption increased. Biological risk markers, except diastolic blood pressure, deteriorated significantly with age. Based on three- lifestyle groups, 16 % of the men had a more favorable lifestyle and 19% had a less favorable life-style at follow-up compared with baseline. The men, who had been classified as high-risk, based on the health profile at baseline, had a significantly higher incidence of CVD and cancer in the register study compared to men in a low-risk group. The baseline non-participant group had a significantly higher incidence of CVD and a higher mortality compared to the low-risk group. Conclusion: A health profile with a combination of lifestyle factors and biological risk markers can already at the age of 33 - 42 years predict incidence of CVD and cancer on group level among men after 24 years.
文摘Objective: To evaluate the efficacy of Genni-anchun (GNC) in preventing primary osteoporosis. Methods: Fifty female SD rats of 10 - 12 months old were randomly divided into five groups. Except those in the sham operation group, animals were ovariectomized bilaterally. The gastric perfusion was started immediately after operation, with normal saline to the sham operation group and model group; GNC to high dose (2 ml) and low dos (1 ml) GNC groups and Nilestriol to the NE group, every day for 3 months. Animals were sacrificed at the end of experiment, their vertebra and
