Tsung O. Cheng

Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005

This study tracks the temporal changes in prevalence of childhood and adolescent overweight and obesity in different regions of China from 1985 to 2005. Using a series data of the Chinese National Survey on Students Constitution and Health, we compared the temporal changes over a 20-year period of the prevalence of overweight and obesity among ten regions in China for school-aged children between 7 and 18 years of age. Large disparities in the temporal changes of obesity prevalence exist in different regions of China. North coastal residents, especially those of the upper socioeconomic status, had the earliest and largest increase in prevalence. Similar increases then followed successively in other regions of upper, moderate and low socioeconomic status, and finally in the affluent rural regions. No significant increase was found in the developing rural areas. Regions where the obesity epidemic occurred late also began to show rather rapid increases in prevalence in recent years. In 2005, the national estimates indicated that 7.73% of Chinese youth are overweight and 3.71% of them are obese, representing an estimated 21.37 million Chinese children (13.43 million boys and 7.94 million girls).

Prevalence and geographic distribution of childhood obesity in China in 2005

China now joins the world epidemic of childhood obesity. Because of the large disparity of environmental conditions across various sub-populations, accurate prevalence of obesity/overweight cannot be estimated by population-based approaches. Using a resident-based targeted approach, we determined the geographical distribution of childhood obesity in China and analyzed the specific factors related to the increasing prevalence of obesity in each of its ten regions. An alarming increase in the prevalence of obesity has spread all over China, except for the poverty western rural areas. In 2005, the prevalence of combined childhood overweight and obesity in China reached 32.5% for males and 17.6% for females in the northern coastal big cities, suggesting that the obesity prevalence in some urban Chinese populations has approached that of the developed countries. The prevalence of obesity in the affluent rural sub-populations first exceeded that in some urban populations; then, as they learned their lessons and revised their lifestyles, the prevalence declined to a lower level approaching that of the transitional societies of other countries. The geographical distribution of obesity prevalence in China is mainly caused by the large disparity in the socioeconomic status related to dietary and lifestyle changes in modern China. Multiple and integrated interventions are urgently needed to halt the epidemic of childhood obesity by tackling its basic causes such as fast food, automobiles, television and lack of exercise. The differing prevalences in different regions of China offer an opportunity to reverse this alarming, growing epidemic of childhood obesity in the worlds most populous country.

Standing position alone or in combination with exercise as a stress test to provoke left ventricular outflow tract gradient in hypertrophic cardiomyopathy and other conditions

Measuring left ventricular outflow tract (LVOT) gradient by echocardiography in decubitus position, which is used in routine clinical practice, does not reflect the pathophysiology of this dynamic abnormality during daily activities, which trigger the symptoms. LVOT obstruction is dynamic and greatly dependent upon the left ventricular cavity size, geometric configuration of hypertrophy, load, contractility and mitral apparatus abnormalities, including systolic anterior motion of mitral leaflet. Importantly, LVOT gradient may develop not only in hypertrophic cardiomyopathy, but also in other heart diseases. Recent studies show that LVOT gradient should be measured both in a standing position and during exercise.

Experimental study of relationship between intracoronary alcohol injection and the size of resultant myocardial infarct

BACKGROUNDnHypertrophic obstructive cardiomyopathy (HOCM) is a complex disease with unique pathophysiologic characteristics and a great diversity of morphologic,functional and clinical features. Percutaneous transluminal septal myocardial ablation (PTSMA) using alcohol injection via a catheter into the septal branch of the left anterior descending coronary artery has been recently introduced as a promising nonsurgical therapy for HOCM. However, the relationship between the volume and velocity of intracoronary injection of absolute alcohol and the size of the resultant myocardial infarct has not been investigated. We therefore studied such a relationship in piglets.nnnOBJECTIVESnTo investigate the relationship between the volume and velocity of selective intracoronary alcohol injection by means of a catheter and the size of the resultant myocardial infarction.nnnMETHODSnTwenty piglets were equally divided at random into four groups (n=5 in each) according to the volume and the velocity of intracoronary absolute alcohol injection and the coronary arteries injected. Group I: the volume and velocity of injection of alcohol into the left circumflex coronary artery (LCX) were 0.5 ml and 0.2 ml/s, respectively. Group II: the volume and velocity of injection into LCX were 2.0 ml and 0.2 ml/s, respectively. Group III: the volume and velocity of injection of alcohol into the left anterior descending coronary artery (LAD) were 1.2 ml and 0.06 ml/s, respectively. Group IV: the volume and velocity of injection into the LAD were 1.2 ml and 1.2 ml/s, respectively. The resultant myocardial infarcts were then quantitatively measured 6 h after myocardial ablation.nnnRESULTSnThe myocardial infarct size for group I was 4.26+/-2.71(%), for group II was 10.12+/-4.55(%), for group III was 5.84+/-1.21(%) and for group IV was 7.11+/-1.63(%). There were significant differences in myocardial infarct size with different volumes of intracoronary absolute alcohol injection (0.02<P<0.05). but there were no apparent differences found in myocardial infarct size with different velocities of intracoronary alcohol injection (0.05<P<0.2).nnnCONCLUSIONSnThe myocardial infarct size is directly related to the volume of intracoronary absolute alcohol injection during myocardial ablation by a catheter, but has no relation to the injection velocity.

Cardiovascular health, risks and diseases in contemporary China.

Whereas China in recent years is rapidly prospering economically to become the worlds second-largest economy after the United States, the cardiovascular health of the Chinese people has deteriorated significantly over the past several decades [1–3]. The China Multicenter Collaboration Study of Cardiovascular Epidemiology indicated in 2007 that cardiovascular disease was the major cause of death for both men and women [2]. At present, cardiovascular disease remains the leading cause of death in China [4]. Because China contributes to one fifth of the world population, this alarming situation becomes a major issue of global concern, to which this article is addressed.

Hippocrates, cardiology, Confucius and the Yellow Emperor

Although Hippocrates (460-c.375 BC) has been traditionally recognized as the Father of Medicine, the fact that he was seminal in the development of cardiology is much less well known. Evidence is presented to support the notion that Hippocrates could also be considered the Father of Cardiology. Hippocrates also had many of the teachings and practices in common with Confucius (c.551-c.479 BC) and the Yellow Emperor of China (2695-2589 BC). Whereas Confucius was not a physician, the Yellow Emperor was an ancient Chinese physician whose Huang Di Neijing, the Yellow Emperors Canon of Internal Medicine, is the oldest known treatise of medicine in existence.

How much of the recent decline in rheumatic heart disease in China can be explained by changes in cardiovascular risk factors

Rheumatic heart disease (RHD) used to be the most common heart disease in China [1]. Indeed, when I was an intern in a Shanghai hospital in the late 1940s, children with rheumatic fever (RF) occupiedmany of the beds in the pediatric wards, and adults with RHD occupied many of the beds in the adult medical wards. But both RF and RHD have declined progressively over the past 6 decades from 50% of the total hospital cardiac admissions in Shanghai, China in 1948–1957, to 44% in 1958–1968, 30% in 1969–1979, 24% in 1980– 1989, 10% in 1990–1999 [2], and finally to 2% in 2000–2005 (Fig. 1). As amatter of fact, during several ofmy recent visits to China, I discovered that many of the young Chinese physicians have never seen a patient with RF. None could tell me what the Jones criteria [3] for the diagnosis of RFwere.What happened? Just as RF has virtually disappeared in the United States [4], so it almost did in China. Although the reason for the declining incidence of RHD in developing countries – changing virulence of group A streptococci versus changing living conditions – was debated recently in the New England Journal of Medicine [5,6], the explanation is obvious in China. In China, the most populous country in the world and also the most advanced developing country in the world, the striking decline in rheumatic heart disease in recent years is definitely due to improvement in living conditions. Although improved medical care and widespread use of penicillin prophylaxis of streptococcal infections play a role, the decline in RF morbidity and mortality in the developed world began before anti-streptococcal agents became available [4]. Rheumatic fever is a disease of poverty [7]. With

Is China finally going to ban cigarette smoking

Article history: Received 26 May 2010 Accepted 26 May 2010 Available online 30 June 2010 farming and 13 million in retail trade. Tobacco taxes are source of revenue for the government and accounted for abo dollars in 1992, or about 10% of all revenue [4]. The tobacc is the biggest source of tax revenues in China. Thus the go that needs money to raise living standards in China is as a tobacco revenue as smokers are to nicotine. It is a dilemma

What is the ZAHARA study? Acronymania is an incurable Disease Afflicting MAiNly the cardiologisTs (ADAMANT).

There is a persistent problem in the use of trial acronyms, especially unexplained acronyms, in the medical literature, especially in the cardiological literature [1,2]. When I saw the title of the interesting article on risk of complications during pregnancy in women with congenital aortic stenosis [3], I was especially fascinated by the multiple authorship on behalf of the ZAHARA investigators. I read and reread the entire text several times in an attempt to find out what the acronym ZAHARA stood for. But I failed miserably, because there was no explanation anywhere in the text. Then I did a search of PubMed for other articles by the ZAHARA investigators. There were nine such articles, but none contained an explanation of the acronym ZAHARA either. According to the International Committee of Medical Journal Editors [4], every abbreviation or acronym should be defined when first used. In the medical world of acronymania [5], we should encourage acronymophobia rather than acronymophilia [6]. The latter may be habit-forming [7]. I write this letter to the editor, not only to draw your attention to this serious problem but also on the behalf of those readers who get aggravated by unexplained acronyms [8]. Please have the authors spell out every acronym when first used and never use the acronym in the title. You can

Acupuncture anesthesia for open heart surgery: past, present and future.

Fig. 1. A child, fully awake and comfortable, undergoing open heart surgery for repair of a congenital ventricular septal defect under acupuncture anesthesia in a hospital in Shanghai, photographed by the author during his 1972 visit to China. The word acupuncture combines the Latin acus (needle) and punctum (a prick) [1,2]. From the historical record of Huangdi Neijin (the Yellow Emperors Classic), acupuncture has been used in China as a therapeutic tool for at least 2000 years [3]. Soldiers noted, after being wounded by arrows, that their pain often eased for quite a while. Therefore, a cause-and-effect relationship was assumed between the arrow wound and the unexpected diminution of pain. However, it has been little known in theWestern world until the early 1970s following U.S. President Nixons historic visit to China in 1972 [4]. Acupuncture becomes one of the most popular treatments in alternative medicine and accounts for more than 10 million treatments given annually in the United States [5]. Much interest was further engendered by tales by subsequent visitors to China who witnessed surgical operations being successfully performed on conscious patients under acupuncture anesthesia [6–15]. Skeptics who deny that acupuncture anesthesia can work have suggested that acupuncture is nothing more than an effective use of hypnosis or autosuggestion. I was also a skeptic until I witnessed with myowneyes several operative procedures performedonpatients under acupuncture anesthesia including those with congenital (Fig. 1) and acquired valvular (Fig. 2) heart diseases. Being a native-born Chinese, I was able to communicate directly with the patients, without going through any interpreters, to find out what discomfort and if any pain they actually might experience during the procedures. Of course, I was not the only physician who was impressed by cardiac surgery under acupuncture anesthesia. Other well-known surgeons around theworld, such as DeBakey from the United States [16], Hollinger et al. [17] from Germany, and Caracausi from Italy [18] were too.