To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Four putative knockdown resistance (kdr) mutations have been documented in the voltage-gated sodium channel (VGSC) gene of Cimex hemipterus from several countries. However, no information regarding kdr mutations in any Chinese tropical bed bug population is available to date. In this study, a double-mutation（M918I + L1014F）kdr allele was identified in six C. hemipterus populations across Guangxi Zhuang Autonomous Region of China. The frequency of this allele was 100% in all the six examined populations. In addition, only two cytochrome c oxidase I (COI) gene haplotypes, with one synonymous nucleotide variation, were identified in a total of 48 individuals from six locations. The fixation and broad geographic distribution of this resistant allele questions the continued use of pyrethroids in the treatment of tropical bed bug infestations. The very low genetic diversity within and among these populations indicates that these bed bugs may have a single origin.
This study attempts to figure out the seasonality of the transmissibility of hand, foot and mouth disease (HFMD). A mathematical model was established to calculate the transmissibility based on the reported data for HFMD in Xiamen City, China from 2014 to 2018. The transmissibility was measured by effective reproduction number (Reff) in order to evaluate the seasonal characteristics of HFMD. A total of 43 659 HFMD cases were reported in Xiamen, for the period 2014 to 2018. The median of annual incidence was 221.87 per 100 000 persons (range: 167.98/100,000–283.34/100 000). The reported data had a great fitting effect with the model (R2 = 0.9212, P < 0.0001), it has been shown that there are two epidemic peaks of HFMD in Xiamen every year. Both incidence and effective reproduction number had seasonal characteristics. The peak of incidence, 1–2 months later than the effective reproduction number, occurred in Summer and Autumn, that is, June and October each year. Both the incidence and transmissibility of HFMD have obvious seasonal characteristics, and two annual epidemic peaks as well. The peak of incidence is 1–2 months later than Reff.
In the livestock husbandry compensatory growth may be explored as a means to improve nutrient utilization, to reduce gut health problems due to excess protein intake, to simplify feeding strategies and thus to improve production efficiencies. This study investigated the effects of early protein restriction (EPR) and early antibiotic intervention (EAI) on growth performance, intestinal morphology, colonic bacteria, metabolites and mucosal gene expressions during the restriction phase and re-alimentation phase. A total of 64 piglets (10.04 ± 0.73 kg) were randomly divided into four treatment groups according to a 2 × 2 factorial arrangement with two levels of proteins (14% v. 20%) and two levels of antibiotics (0 v. 50 mg/kg kitasamycin and 20 mg/kg colistin sulphate). After a 30-day restriction phase with four kinds of diets, all groups were fed the same diets for another 74 days. The results showed that EPR decreased BW, average daily gain (ADG), average daily feed intake in the restriction phase (P < 0.01) and increased ADG on days 66 to 104 of the late re-alimentation phase. Early protein restriction could decrease the villus height in the jejunum (P < 0.05), while shifting to the same diets restored the villus height. Meanwhile, during the re-alimentation phase, pigs in the protein restriction groups had increased concentrations of total short chain fatty acids (P < 0.05), and modified the abundances of Firmicutes and Bacteroidetes in the colon. Furthermore, the lower microbial diversity caused by EPR was improved, and gene expression analysis indicated a better barrier function in the colon. During the whole trial, EAI had no interaction with EPR and played a dispensable role in compensatory growth. Collectively, the retardation of growth caused by EPR can be compensated for in the later stages of pig raising, and accompanied by altered intestinal morphology, microbial composition.
The experiment was conducted to investigate the effects of dietary threonine (Thr) on growth performance and muscle growth, protein synthesis and antioxidant-related signalling pathways of hybrid catfish Pelteobagrus vachelli♀ × Leiocassis longirostris♂. A total of 1200 fish (14·19 (se 0·13) g) were randomly distributed into six groups with four replicates each, fed six diets with graded level of Thr (9·5, 11·5, 13·5, 15·4, 17·4 and 19·3 g/kg diets) for 56 d. Results showed (P < 0·05) that dietary Thr (1) increased percentage weight gain, specific growth rate, feed efficiency and protein efficiency ratio; (2) up-regulated growth hormone (GH), insulin-like growth factor 1 (IGF-1), proliferating cell nuclear antigen, myogenic regulation factors (MyoD, Myf5, MyoG and Mrf4) and myosin heavy chain (MyHC) mRNA levels; (3) increased muscle protein content via regulating the protein kinase B/target of rapamycin signalling pathway and (4) decreased malondialdehyde and protein carbonyl contents, increased catalase, glutathione-S-transferase, glutathione reductase and GSH activities, up-regulated mRNA levels of antioxidant enzymes related to NFE2-related factor 2 and γ-glutamylcysteine ligase catalytic subunit. These results suggest that Thr has a potential role to improve muscle growth and protein synthesis, which might be due to the regulation of GH-IGF system, muscle growth-related gene, antioxidative capacity and protein synthesis-related signalling pathways. Based on the quadratic regression analysis of specific growth rate, the Thr requirement of hybrid catfish (14·19–25·77 g) was estimated to be 13·77 g/kg of the diet (33·40 g/kg of dietary protein).
Alzheimer’s Disease (AD), characterized by deficits in memory and cognition and by behavioral impairment, is a progressive neurodegenerative disorder that influences more than 47 million people worldwide. Currently, no available drug is able to stop AD progression. Therefore, novel therapeutic strategies need to be investigated.
We analyzed the RNA sequencing data (RNA-seq) derived from the Gene Expression Omnibus (GEO) database to identify the differentially expressed mRNAs in AD. The AD mouse model Tg2576 was used to verify the effects of IGF-2. The Morris Water Maze was administered to test the role of IGF-2 in memory consolidation. In addition, we quantified cell apoptosis by the TUNEL assay. The levels of amyloid plaques and the levels of Aβ40 and Aβ42 in the hippocampus were also determined by immunohistochemistry and ELISA, respectively.
RNA-seq analysis revealed that IGF-2 was remarkably reduced in AD. The expression of the upstream genes PI3K and AKT and the downstream gene CREB in the PI3K signaling pathway was significantly increased in the hippocampus of Tg2576 mice cells treated with IGF-2. The Morris water maze test showed that IGF-2 improved memory consolidation in Tg2576 mice. The activity of caspase-3 was decreased in Tg2576 mice treated with IGF-2. Amyloid plaques in the hippocampus were reduced, and the levels of Aβ40 and Aβ42 were decreased. The above effects of IGF-2 on AD were blocked when the PI3K signaling pathway inhibitor wortmannin was added.
IGF-2 attenuates memory decline, oxidative stress, cell apoptosis and amyloid plaques in the AD mouse model Tg2576 by activating the PI3K/AKT/CREB signaling pathway.
In this paper, it is shown that if a dynamical system is null and distal, then it is equicontinuous. It turns out that a null system with closed proximal relation is mean equicontinuous. As a direct application, it follows that a null dynamical system with dense minimal points is also mean equicontinuous. Meanwhile, a distal system with trivial
-pairs and a non-trivial regionally proximal relation of order
Nutrition therapy is considered an important treatment of burn patients. The aim of the study was to delineate the nutritional support in severe burn patients and to investigate association between nutritional practice and clinical outcomes. Severe burn patients were enrolled (n 100). In 90 % of the cases, the burn injury covered above 70 % of the total body surface area. Mean interval from injury to nutrition start was 2·4 (sd 1·1) d. Sixty-seven patients were initiated with enteral nutrition (EN) with a median time of 1 d from injury to first feed. Twenty-two patients began with parenteral nutrition (PN). During the study, thirty-two patients developed EN intolerance. Patients received an average of about 70 % of prescribed energy and protein. Patients with EN providing <30 % energy had significantly higher 28- d and in-hospital mortality than patients with EN providing more than 30 % of energy. Mortality at 28 d was 11 % and in-hospital mortality was 45 %. Multiple regression analysis demonstrated that EN providing <30 % energy and septic shock were independent risk factors for 28- d prognosis. EN could be initiated early in severe burn patients. Majority patients needed PN supplementation for energy requirement and EN feeding intolerance. Post-pyloric feeding is more efficient than gastric feeding in EN tolerance and energy supplement. It is difficult for severe burn patients to obtain enough feeding, especially in the early stage of the disease. More than 2 weeks of underfeeding is harmful to recovery.
Since 2009, China has initiated a national program on free provision of essential public health services. The national program has expanded both in terms of service categories and funding, showing China's great commitment to universal health coverage. However, with slowdown of public input in the health sector, the government decided to prioritize interventions and optimize reimbursement packages. Researchers in the China National Health Development Research Center (CNHDRC)—the Chinese national health technology assessment (HTA) agency were asked to design the tools to facilitate the decision process.
With multi-criteria decision analysis (MCDA) method, the researchers analyzed value dimensions in public health issues, and built an evidence matrix for the priority-setting decisions. Supported by HTA tools, they appraised interventions and services through literature review and field studies, and projected budget impact of potential adjustment decisions based on cost analysis results. A deliberative process of key stakeholder groups was taken, and their views were counted in making the final recommendations.
Based on evidence review and scores of stakeholders’ judgment, two public health service interventions were recommended for removal, and another two for adjustment (one for merger, one for optimizing care pathway). Cost estimation and potential budgetary impact were also analyzed to support financial decisions.
HTA and MCDA are key tools for defining the value criteria, evidence framework, and deliberative process for the essential public health program. However, lack of cost-effectiveness evidence hinders fine-tuned decisions on resource allocation. Continual health economic evaluation needs to be conducted in the near future.
Most of original studies indicated maternal violence experiences is associated with adverse obstetric outcomes, to date, but it is not clear that the association of maternal violence experiences and the risk of postpartum depression (PPD). We aimed to assess the association between maternal violence experiences and risk of developing PPD by performing a meta-analysis of cohort studies.
PubMed, Google Scholar, Cochrane Libraries and Chinese databases were searched through December 2017 to identify studies that assessed the association between violence and PPD. Meta-analysis was conducted by the RevMan software and Stata software. Potential heterogeneity source was explored by subgroup analysis and potential publication bias was assessed by Begg's funnel plots and Egger’s linear regression test.
Overall, women experiencing any violence events compared with the reference group were at a higher risk of developing PPD (odds ratio [OR] = 2.04; 95% confidence interval [CI]: 1.72–2.41). Additionally, different types of violence events such as sexual (OR = 1.56; 95%CI: 1.35–1.81), emotional (OR = 1.75; 95%CI: 1.61–1.89), and physical violence (OR = 1.90; 95%CI: 1.36–2.67), as well as domestic (OR = 2.05; 95%CI: 1.50–2.80) or childhood violence (OR = 1.59; 95%CI: 1.34–1.88) also increased the risk of developing PPD. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results.
Maternal violence experiences are significantly associated with risk of developing PPD. These finding highlight the necessary to protect women from any types of violence and formulate preventive strategies to promote the maternal mental health.
Chitooligosaccharides (COS) are multi-functional foods and nutrients and environmentally friendly biological abiotic-resistance inducing agents for plants. In the current study, the effects and possible mechanisms of COS on improving the cold resistance of rice (II YOU 1259) seedlings were investigated. Compared with the control, a COS pre-soaking treatment enhanced photosynthesis, reduced oxidation damage and led to accumulation of more osmotic regulation substances under chilling treatment. In addition, a novel Deg/HtrA family serine endopeptidase (DegQ) gene, related to COS enhanced rice cold resistance, was identified. Quantitative real-time polymerase chain reaction (qRT-PCR) analysis revealed that transcription of DegQ and psbA (D1 protein encoding gene) were up-regulated in a time-dependent manner by COS treatment under cold stress. With increasing expression of the D1 protein, chlorophyll b content was enhanced correspondingly. The current results suggest that COS could enhance cold stress tolerance of rice by repairing the photodamaged photosystem II, altering osmotic regulation and reducing oxidation damage.
A comprehensive geochronological and geochemical study was carried out on the gneissic monzogranites, porphyritic granodiorites and charnockites in the Gaozhou complex of the Yunkai massif in the southern part of the South China block to better understand the Early Palaeozoic tectonic regime of the South China block. Laser ablation – inductively coupled plasma – mass spectrometry (LA-ICP-MS) U–Pb dating of zircons indicates an age of 453.2 ± 5.1 Ma to the formation of the gneissic monzogranites, whereas the porphyritic granodiorites and charnockites were generated at 437.0 ± 1.5 Ma and 435.2 ± 2.2 Ma, respectively. The gneissic monzogranites show geochemical features consistent with the high-K, calc-alkaline rock series and are strongly peraluminous. They have SiO2 contents ranging from 67.75 to 69.65 wt. % and relatively low CaO contents (1.66–1.94 wt. %). Their REE patterns are fractionated with enriched LREEs and negative Eu anomalies. The samples also show enrichment in LILEs (e.g. Rb and K) and Pb, and depletion in Sr, Ba and HFSEs (e.g. Nb, Ta, Ti and P). They have εNd(t) values of −8.2 to −7.7. Conversely, the porphyritic granodiorites and charnockites are characterized as medium-K, calc-alkaline rock series and weakly to strongly peraluminous. They exhibit pronounced depletions in HFSEs and positive Pb anomalies. Compared to the earlier gneissic monzogranites, these rocks have relatively lower SiO2 (65.50–69.36 wt. %), but higher CaO contents (3.34–4.05 wt. %), and have slightly lower εNd(t) values (−9.1 to −8.4). Petrography and geochemical compositions of the gneissic monzogranites indicate that they are S-type granite and likely formed by partial melting of Neoproterozoic to Early Palaeozoic immature metagreywackes; whereas The porphyritic granodiorites and charnockites are A-type granite and likely derived from low degrees of partial melting of the dry, granulitic residue depleted by prior extraction of granitic melt. The new data for the Caledonian granitoids in the Yunkai massif suggest that they were formed in a post-collisional tectonic setting. They represent the earliest post-collisional alkaline magmatism reported so far in the Yunkai massif, and thus indicate a tectonic regime switch, from compression to extension, as early as the Late Ordovician to Early Silurian (~450–435 Ma).
Palaeoproterozic metasedimentary rocks, also referred to as khondalites, characterized by Al-rich minerals, are extensively exposed in the nucleus of the Yangtze craton, South China block. Samples of garnet–sillimanite gneiss in the khondalite suite were collected from the Kongling complex for Nd isotopic and elemental geochemical study. These rocks are characterized by variable SiO2 contents ranging from 35.71 to 58.07 wt%, and have low CaO (0.45–0.84 wt%) but high Al2O3 (18.56–29.04 wt%), Cr (174–334 ppm) and Ni (42.5–153 ppm) contents. They have high CIW (Chemical Index of Weathering) values (90.4–94.7), indicating intense chemical weathering of the source material. The samples display light rare earth elements (LREE) enrichment with negative Eu anomalies (Eu/Eu*=0.40–0.68), and have flat heavy rare earth elements (HREE) patterns. The high contents of transition elements (e.g. Cr, Ni, Sc, V) and moderately radiogenic Nd isotopic compositions suggest that the paragneisses might be those of first-cycle erosion products of predominantly mafic rocks mixing with small amounts of felsic moderately evolved Archaean crustal source. Geochemical and Nd isotopic compositions reveal that at least some of the protoliths of Kongling khondalite were sourced from local pre-existing mafic igneous rocks in a continental arc tectonic setting. Combined with documented zircon U–Pb geochronological data, we propose that the Palaeoproterozoic high-pressure granulite-facies metamorphism, rapid weathering, erosion and deposition of the khondalites in the interior of the Yangtze craton might be related to a Palaeoproterozoic collisional orogenic event during 2.1–1.9 Ga, consistent with the worldwide contemporary orogeny, implying that the Yangtze craton may have been an important component of the Palaeoprotorozoic Columbia supercontinent.
The Da Vinci surgical system is classified as a type “A” medical device in China; the procurement plan of which is regulated by the National Health and Family Planning Commission (NHFP). Between 2010 to 2015, there were thirty-four Da Vinci surgical robots purchased, and installed in thirty tertiary public hospitals across the country. In order to generate context-specific evidence and support further capital funding decisions, the NHFP commissioned a Health Technology Assessment (HTA) of Da Vinci surgical robots, with a focus on real use of the technology in those tertiary public hospitals.
Nine hospitals were selected to collect real word data between 2013 to 2015. Using a cross-sectional survey, data of all robotic surgical cases were collected and described. The unit costs of the robotic surgery were estimated from activity based costing. We also collected cases of prostatectomy (427 versus 421) and hysterectomy (247 versus 105) using the robotic system and laparoscope respectively, and then compared hospital fees and effectiveness during hospitalization. Simulation of the budget impact on health insurance in Shanghai City over the next 5 years was also performed.
A full HTA was conducted based on real data from nine public hospitals in the central and eastern region. Based on a systematic review methodology, we appraised evidence on safety, effectiveness and cost-effectiveness of the Da Vinci surgical robot. Data on technology use, clinical management, and pricing and payment were collected through a cross-sectional survey and interviews of hospital managers, surgeons and nurses. We designed a cohort study on cost-effectiveness of Da Vinci-assisted prostatectomy and hysterectomy, comparing Da Vinci-assisted and laparoscopic prostatectomy (427 vs 421) and Da Vinci-assisted and laparoscopic hysterectomy (247 versus 105). Ethics and inequity issues were discussed based on patient interviews. A budget impact analysis was performed based on scenario mapping of promoting Da Vinci-assisted prostatectomy in Shanghai City over a 5-year timeline.
Due to a lack of evidence on long-term clinical effectiveness and high impact on public finances, the Da Vinci robotic robot should not be procured in large numbers in China. For equipment purchasing the government should strengthen regulations and require the public hospitals to collect more evidence.
The objective of this study was to determine the protective effect of glutamate (Glu) in Cu-induced oxidative injury in fish intestine in vivo and enterocytes in vitro. The results indicated that exposure to 6 mg/l Cu for 72 h induced the production of reactive oxygen species, thereby increasing protein oxidation and lipid peroxidation in enterocytes of grass carp in vitro. Cells exposed to Cu alone resulted in a significant increase in lactate dehydrogenase release, which is accompanied by depletions of antioxidants, including total superoxide dismutase (T-SOD), glutathione S-transferase (GST), glutathione reductase (GR), anti-superoxide anion (ASA), anti-hydroxy radical (AHR) activities and GSH content. Pre-treatment with Glu remarkably prevented the toxic effects of Cu on the T-SOD, GST, GR, AHR, and ASA activities and GSH content in enterocytes. However, Cu induced an adaptive increase in the activities of catalase and glutathione peroxidase (GPx). Glu supplementation further increased GPx activity in enterocytes. Interestingly, the experiment in vivo showed that Glu pre-supplementation significantly elevated SOD, GPx, GST, GR, ASA and AHR activities, as well as GSH content. Further results showed that pre-treatment with Glu could alleviate Cu-induced oxidative injury by elevating antioxidant enzyme activities through regulating the expression of NF-E2-related nuclear factor 2 (Nrf2) mRNA. Together, these results indicated that Glu could attenuate Cu-induced cellular oxidative damage in fish intestine, likely mediated through Nrf2 signalling pathways regulating mRNA expressions of antioxidant enzyme genes and synthesis of GSH.
We present a scheme of electron beam radiography to dynamically diagnose the high energy density (HED) matter in three orthogonal directions simultaneously based on electron Linear Accelerator. The dynamic target information such as, its profile and density could be obtained through imaging the scattered electron beam passing through the target. Using an electron bunch train with flexible time structure, a very high temporal evolution could be achieved. In this proposed scheme, it is possible to obtain 1010 frames/second in one experimental event, and the temporal resolution can go up to 1 ps, spatial resolution to 1 µm. Successful demonstration of this concept will have a major impact for both future inertial confinement fusion science and HED physics research.
This study investigated the effects of glycinin on the growth, intestinal oxidative status, tight junction components, cytokines and apoptosis signalling factors of fish. The results showed that an 80 g/kg diet of glycinin exposure for 42 d caused poor growth performance and depressed intestinal growth and function of juvenile Jian carp (Cyprinus carpio var. Jian). Meanwhile, dietary glycinin exposure induced increases in lipid peroxidation and protein oxidation; it caused reductions in superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) activities; and it increased MnSOD, CuZnSOD, GPx1b and GPx4a mRNA levels, suggesting an adaptive mechanism against stress in the intestines of fish. However, dietary glycinin exposure decreased both the activity and mRNA levels of nine isoforms of glutathione-S-transferase (GST) (α, μ, π, ρ, θ, κ, mGST1, mGST2 and mGST3), indicating toxicity to this enzyme activity and corresponding isoform gene expressions. In addition, glycinin exposure caused partial disruption of intestinal cell–cell tight junction components, disturbances of cytokines and induced apoptosis signalling in the distal intestines>mid intestines>proximal intestines of fish. Glycinin exposure also disturbed the mRNA levels of intestinal-related signalling factors Nrf2, Keap1a, Keap1b, eleven isoforms of protein kinase C and target of rapamycin/4E-BP. Interestingly, glutamine was observed to partially block those negative influences. In conclusion, this study indicates that dietary glycinin exposure causes intestinal oxidative damage and disruption of intestinal physical barriers and functions and reduces fish growth, but glutamine can reverse those negative effects in fish. This study provides some information on the mechanism of glycinin-induced negative effects.
The present study was conducted to investigate the anti-inflammatory effect of vitamin D both in juvenile Jian carp (Cyprinus carpio var. Jian) in vivo and in enterocytes in vitro. In primary enterocytes, exposure to 10 mg lipopolysaccharide (LPS)/l increased lactate dehydrogenase activity in the culture medium (P<0·05) and resulted in a significant loss of cell viability (P<0·05). LPS exposure increased (P<0·05) the mRNA expression of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6 and IL-8), which was decreased by pre-treatment with 1,25-dihydroxyvitamin D (1,25D3) in a dose-dependent manner (P<0·05). Further results showed that pre-treatment with 1,25D3 down-regulated Toll-like receptor 4 (TLR4), myeloid differentiation primary response gene 88 (Myd88) and NF-κB p65 mRNA expression (P<0·05), suggesting potential mechanisms against LPS-induced inflammatory response. In vivo, intraperitoneal injection of LPS significantly increased TNF-α, IL-1β, IL-6 and IL-8 mRNA expression in the intestine of carp (P<0·05). Pre-treatment of fish with vitamin D3 protected the fish intestine from the LPS-induced increase of TNF-α, IL-1β, IL-6 and IL-8 mainly by downregulating TLR4, Myd88 and NF-κB p65 mRNA expression (P<0·05). These observations suggest that vitamin D could inhibit LPS-induced inflammatory response in juvenile Jian carp in vivo and in enterocytes in vitro. The anti-inflammatory effect of vitamin D is mediated at least in part by TLR4-Myd88 signalling pathways in the intestine and enterocytes of juvenile Jian carp.
The aim of the present study was to investigate the prevalence of hyperhomocysteinaemia (HHCY; total plasma homocysteine (tHcy) concentration >15 μmol/l) and its major determinants in healthy Chinese northerners. A descriptive and cross-sectional study was conducted in Shaanxi Province, China. The study sample included 2645 participants (1042 men and 1603 women) aged >20 years. Demographic characteristics and lifestyle factors were assessed via questionnaire interviews and physical examination. Plasma levels of homocysteine and folate and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism were determined according to standard methods. The prevalence of HHCY was 67·7 % (81·4 % in men and 58·8 % in women). The geometric mean of tHcy concentration was 19·1 μmol/l. The OR of HHCY were 0·44 (95 % CI 0·34, 0·57) for women v. men; 1·95 (95 % CI 1·41, 2·70), 1·41 (95 % CI 1·05, 1·88) and 0·76 (95 % CI 0·64, 0·89) for participants with smoking and alcohol drinking cessation and improved physical activity levels, respectively; 0·25 (95 % CI 0·17, 0·38), 0·33 (95 % CI 0·22, 0·49) and 0·56 (95 % CI 0·36, 0·88) for participants with an education level of elementary school, secondary school and university v. illiterate, respectively; 1·41 (95 % CI 1·13, 1·75) and 3·05 (95 % CI 2·35, 3·97) for participants with CT and TT v. CC genotype at MTHFR 677C → T polymorphism, respectively. These results demonstrate that the prevalence of HHCY is considerably high in Chinese northerners, especially in TT subjects, suggesting that implementation of tHcy-lowering strategies, such as lifestyle changes, is necessary.