[Analyses of clinical and radiological characteristics of IgG4-related rhinosinusitis]

Objectives: To discuss the clinical and radiological features of IgG4-related rhinosinusitis. Methods: In this retrospective research, the clinical data of 16 patients diagnosed with IgG4 related rhinosinusitis, who were enrolled in Beijing Tongren Hospital from November 2013 to September 2017, were collected. The clinical features, laboratory findings, radiological findings, histological features, treatment and prognosis were all summarized. Results: There were 12 males and 4 females among 16 patients, and male-to-female ratio was 3︰1. The age was between 30 to 70 years old, with median age of 52 years old. The chief nasal complaints were nasal obstruction and hyposmia, complicated with proptosis and eyelid swelling in 11 patients (11/16). Serum IgG4 levels were elevated in all patients and the value was over 1.44 g/L, and one patient serum IgG4 level was up to 49.70 g/L. Computed tomography (CT) showed the mainly affected sinuses were bilateral ethmoid sinus and olfactory cleft. The classic feature of CT scans was thickening of the involved bilateral ethmoid sinus mucous membrane with ethmoid bone absorption, which was mainly at midline. Histological features were severe inflammation of the mucosal tissue with mass of neutrophils and plasma cell infiltration. All patients were treated by methylprednisolone combined with cyclophosphamide or methotrexate. Remission of symptoms was detected in all patients. Conclusion: The clinical features of IgG4-related rhinosinusitis are often accompanied by orbital tissue involvement, elevated IgG4 serum concentration, associated sinus imaging changes, and sensitive glucocorticoid and immunosuppressive therapy.

[Number of deaths that attributable to high fasting plasma glucose among population aged 25 and above and its impact on life expectancy in China, 2013]

Objective: To analyze deaths that attributable to high fasting plasma glucose and its impact on life expectancy among Chinese residents in 2013. Methods: Data from the Mortality Surveillance Programs in National Disease Surveillance Points System and the China Chronic Disease Surveillance (2013) were used. Death attributed to high fasting plasma glucose and its impact on the life expectancy of Chinese residents were estimated, based on the principle of population attributable fraction. Results: In 2013, the total number of deaths attributed to high fasting plasma glucose among aged ≥25 years old was 621 thousand, with 333 thousand males and 288 thousand females. Diseases related to the number of deaths caused by high fasting plasma glucose would include ischemic heart disease (212 thousand) as the most important one. Cerebrovascular disease appeared the 2(nd) place, with around 181 thousand cases and then followed by diabetes (145 thousand), chronic kidney disease (52 thousand) and tuberculosis (31 thousand). After removal of the effects on high blood glucose exposure, the life expectancy of Chinese residents in 2013 would have reached 76.5 years old, an average increase of 0.7 years, compared to the average life expectancy of all deaths, with men having an increase of 0.7 years and women of 0.8 years, respectively. Conclusions: High fasting plasma glucose appeared an important risk factor for mortality and life expectancy on the Chinese residents. Programs related to prevention and control of high fasting plasma glucose and related diseases should be strengthened.

Temporal patterns of driving fatigue and driving performance among male taxi drivers in Hong Kong: A driving simulator approach

This study uses a questionnaire survey and a driving simulator test to investigate the temporal patterns of variations in driving fatigue and driving performance in 50 male taxi drivers in Hong Kong. Each driver visited the laboratory three times: before, during, and after a working shift. The survey contained a demographic questionnaire and the Brief Fatigue Inventory. A following-braking simulator test session was conducted at two speeds (50 and 80 km/h) by each driver at each of his three visits, and the driver's performance in brake reaction, lane control, speed control, and steering control were recorded. A random-effects modeling approach was incorporated to address the unobserved heterogeneity caused by the repeated measures. In the results, a recovery effect and a lagging effect were defined for the driving fatigue and performance measures because their temporal patterns were concavely quadratic and had a 1-hour delay compared to the temporal patterns of occupied taxi trips and taxi crash risk in Hong Kong. Demographic variables, such as net income and driver age, also had significant effects on the measured driving fatigue and performance. Policies regarding taxi management and operation based on the modeling results are proposed to alleviate the taxi safety situation in Hong Kong and worldwide.

Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy

Background

There are inconsistencies in the literature regarding the prevalence and assessment of chemotherapy-induced peripheral neuropathy (CIPN). This study explored CIPN natural history and its characteristics in patients receiving taxane- and platinum-based chemotherapy.

Patients and methods

Multi-country multisite prospective longitudinal observational study. Patients were assessed before commencing and three weekly during chemotherapy for up to six cycles, and at 6,9, and 12 months using clinician-based scales (NCI-CTCAE; WHO-CIPN criterion), objective assessments (cotton wool test;10 g monofilament); patient-reported outcome measures (FACT/GOG-Ntx; EORTC-CIPN20), and Nerve Conduction Studies.

Results

In total, 343 patients were recruited in the cohort, providing 2399 observations. There was wide variation in CIPN prevalence rates using different assessments (14.2–53.4%). Prevalence of sensory neuropathy (and associated symptom profile) was also different in each type of chemotherapy, with paclitaxel (up to 63%) and oxaliplatin (up to 71.4%) showing the highest CIPN rates in most assessments and a more complex symptom profile. Peak prevalence was around the 6-month assessment (up to 71.4%). Motor neurotoxicity was common, particularly in the docetaxel subgroup (up to 22.1%; detected by NCI-CTCAE). There were relatively moderately-to-low correlations between scales (r_s = 0.15,p < 0.05-r_s = 0.48 p < 0.001), suggesting that they measure different neurotoxicity aspects from each other. Cumulative chemotherapy dose was not associated with onset and course of CIPN.

Conclusion

The historical variation reported in CIPN incidence and prevalence is possibly confounded by disagreement between assessment modalities. Clinical practice should consider assessment of motor neuropathy for neurotoxic chemotherapy. Current scales may not be all appropriate to measure CIPN in a valid way, and a combination of scales are needed.

[The role of Smad signaling pathway in the repair of mucosal epithelium in chronic sinusitis with nasal polyps and without nasal polyps]

Objective:To evaluate the differences in CRS and normal subjects between chronic rhinosinusitis without nasal polys (CRSsNP) and chronic rhinosinusitis with nasal polys (CRSwNP) in the role of TGF-β-Smad pathways in the repair of mucosal epithelium.Method:Ethmoidal mucosal samples collected from CRS and healthy control patients were analyzed for TGF-β1, TGF-β receptorⅠ,TGF-β receptor Ⅱ, Smad3, phospho-Smad3, Smad7, and Smad anchor for receptor activation by Western blot. The proliferation of sinonasal epithelial cells at baseline after TGF-β1 and/or EGF stimulation was evaluated by the MTT assay.Result:In CRSsNP,TGF-β1,TGF-β receptorⅠ,TGF-β receptor Ⅱ and Smad3 protein levels were significantly higher than controls. In CRSwNP, TGF-β1, Smad3 and pSmad3 protein levels were significantly lower than controls. Smad7 protein was significantly higher in CRS than controls. In vitro experiments demonstrated that the baseline proliferation levels of sinonasal epithelial cells were lower in CRS than controls.Conclusion:CRSwNP is characterized by a lower level of TGF-signaling compared with the control. In CRSsNP, although the upstream signaling of TGF-β was enhanced, over expression of Smad7 protein may restrain the downstream signaling components (e.g., pSmad3) and the TGF-β antiproliferative effect on sinonasal epithelium. The difference in the local tissue concentration of TGF-β1 between CRSsNP and CRSwNP patients did not show significant differences in epithelial proliferation.

[Prevalence and influencing factors of respiratory symptoms among people aged 40 years and above in China]

Objective: To investigate the prevalence and influencing factors on respiratory disease related symptoms (coughing, expectoration, persistent coughing and persistent expectoration) in Chinese people ≥40 years old. Methods: Data was collected from 162 surveillance points in the China Non-communicable and Chronic Disease Surveillance Project in 2010. A total number of 56 066 people, aged ≥40 years, were selected by multi-stage cluster random sampling method in this study. The prevalence rates of coughing, expectoration, persistent coughing and persistent expectoration were calculated according to gender by χ(2) test. Multivariate logistic regression model was used to analyze the related influencing factors. Results: The prevalence rates of coughing, persistent coughing, expectoration and persistent expectoration in men were significantly higher than that in women (P<0.01). The prevalence rate of respiratory symptoms was positively correlated with age and duration and amount of cigarette smoking (P<0.01), while negatively correlated with participants'education level (P<0.01). Results from multivariate logistic regression analysis showed that gender, age, education level, smoking-related parameters, areas of residency (in urban or rural areas), etc. were appeared as influencing factors on the prevalence of respiratory symptoms. Conclusion: The symptoms of chronic respiratory diseases appeared prevalent in Chinese population aged ≥40 years. Factors as older age, living in the central/western regions and smoking-related parameters were identified as of higher risks.

[Study on relationship between prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure level in adults in China]

Objective: To study the relationship between blood pressure level and major risk factors for cardiovascular diseases in adults in China. Methods: A total of 179 347 adults aged ≥18 years were recruited from 298 surveillance points in 31 provinces in China in 2013 through complex multistage stratified sampling. The survey included face to face interview and physical examination to collect information about risk factors, such as smoking, drinking, diet pattern, physical activity, overweight or obesity, and the prevalence of hypertension. The blood pressure was classified into 6 levels (ideal blood pressure, normal blood pressure, normal high blood pressure and hypertension phase Ⅰ, Ⅱ and Ⅲ). The relationship between the prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure was analyzed. Results: The adults with ideal blood pressure, normal blood pressure, normal high pressure, hypertension phase Ⅰ, Ⅱ and Ⅲ accounted for 36.14%, 22.77%, 16.22%, 16.43%, 5.97% and 2.48%, respectively. Among them, the blood pressure was higher in men, people in Han ethnic group and those married, and the blood pressure was higher in those with older age, lower income level and lower education level, the differences were all significant (P<0.05). Whether taking antihypertensive drug or not, co-prevalence of risk factors influenced the blood pressure levels of both sexes (P<0.05), and the blood pressure levels of those taking no antihypertensive drug was influenced more by the co-prevalence of risk factors. Finally, multiple logistic analysis showed that the risks for high blood pressure in adults with 1, 2 and ≥3 risk factors were 1.36, 1.79 and 2.38 times higher, respectively, than that of the adults without risk factor. Conclusion: The more the risk factors for cardiovascular disease in adults, the higher their blood pressure were. It is necessary to conduct comprehensive behavior intervention targeting ≥ 2 risk factors for the better control of blood pressure in general population.

[Clinical research on surgical treatment of benign lesions in maxillary sinus by modified prelacrimal duct recess approach]

Objective:To explore the clinical effects, surgical procedure and indications of surgical treatment for benign lesions in maxillary sinus through modified prelacrimal duct recess approach. Method:All 21 patients in this study who diagnosed with benign lesions in maxillary sinus, received routine preoperational exam and underwent endoscopic maxillary sinus surgery through modified prelacrimal duct recess approach. Postoperatively patients received routine medical treatment, and regular follow-up for average 11.3 months(from 3 months to 16 months). Result:Among 21 patients, there were 9 cases diagnosed with maxillary sinus cyst, 6 cases diagnosed with maxillary sinus choanal polyps, and 5 cases diagnosed with maxillary sinus hemorrhagic and necrotic polyps, 1 case of maxillary sinus root cyst. During the operation, the roots of maxillary sinus cyst or polyps were found in anterior or inferior wall of maxillary sinus. All patients recovered very well without recurrence. Conclusion:Modified prelacrimal duct recess approach appears to be a safe and effective method to resect benign lesions in the maxillary sinus, especially when lesions involved in anterior and inferior wall of the maxillary sinus.

[Analysis of imaging features and treatment strategies of unilateral maxillary sinus and nasal diseases]

Objective: To analyze the imaging features of unilateral maxillary sinus nasal lesions and the selection of treatment strategies based on imaging findings for these lesions. Method: The CT and enhanced MRI data of 64 cases of unilateral maxillary sinus and nasal lesions were selected. The imaging findings and surgery approach were observed and recorded. To summarize the imaging characteristics and analyze the choice of treatment strategy. Result: All 64 Unilateral maxillary sinus nasal lesions presented a roughly uniform soft tissue density shadow on CT. In all benign lesions, there were 9 cases manifested maxillary sinus wall bone destruction and bone discontinuity(18.4%,9/49); There were 17 cases of bone hyperplasia (34.7%,17/49).Bone destruction was observed in 14 cases of all malignant lesions (93.3%, 14/15). The appearance is approximately uniform signal shadow on MRI T1WI images. The lesions with different properties of the enhanced T1 images showed the imaging manifestations with their own characteristics. According to the CT and enhanced MRI images, the designed treatment plan was divided into 5 types. The coincidence rate of operation and plan was 90.5%,there were 4 cases of temporary modification in operation. Conclusion: For unilateral lesions, preoperative enhanced MRI and CT scan should be included as routine examination. CT is clear for bone observation, and can be the nature of tumor and germinal center. Enhanced MRI can provide more accurate information on the lesion scope, blood supply and the relationship between mass and surrounding tissues. Combined with the preoperative imaging data, it can provide the basis for the operation plan and treatment strategy of unilateral lesions.

[Functional rhinoplasty under nasal endoscope]

Objective:At different times and cultural background,people have different definition of beauty.With the improvement of economic level and culture quality,people are becoming more and more recognition of nasal appearance and function are equally important.Even the importance of the function of the nasal is higher than the importance of shape of the nose. Concurrent rhinoplasty (nasal dorsum and lateral nasal wall reduction) and functional sinus surgery (nasal septum reconstructory, middle turbinate,inferior turbinate surgery even extended to the nasal cavity expansion tecunhnique, sinusitis surgery) with endoscopic surgical surgical methods were discussed.Method:The study included 20 patients with deformed functional endoscopic rhinoplasty, 2010-2015 in Beijing Tongren Hospital,of ages 16-53, male 14 cases,female 6 cases, 11cases had history of trauma, all of 20 patients have unilateral nasal plugging. Operating methods, 17 patients were performed nasal endoscopic septoplasty and rhinoplasty at the same time. One case cocurrent endoscopic rhinodacryocystostomy.Two cases were performed Nasal endoscopic sinus operation. Only 5 cases use silica gel prosthesis, 15 cases use autologous cartilage in functional rhinoplasty.Result:Twenty patients compared with performed rhinoplasty,nasal septum reconstructory,middle turbinate,inferior turbinate surgery,nasal cavity expansion,sinusitis surgery separately,surgery is better,no other complicationgs occurred.Actually decredsed the number of surgical treatment and hospitalization expenses.Conclusion:Functional endoscopic rhinoplasty,over the same period it solved the nasal shape and nasal ventilation function.To avoid impact on ventilation function in the process of the rhinoplasty.Implements the unification of beauty and function.Reduce the surgical treatment of times and cost.No other complication compared to convertional surgery,high feasibility.

Discrete Superconducting Phases in FeSe-Derived Superconductors

A general feature of unconventional superconductors is the existence of a superconducting dome in the phase diagram. Here we report a series of discrete superconducting phases in the simplest iron-based superconductor, FeSe thin flakes, by continuously tuning the carrier concentration through the intercalation of Li and Na ions with a solid ionic gating technique. Such discrete superconducting phases are robust against the substitution of 20% S for Se, but they are vulnerable to the substitution of 2% Cu for Fe, highlighting the importance of the iron site being intact. The superconducting phase diagram for FeSe derivatives is given, which is distinct from that of other unconventional superconductors.

[The role of MAPK signaling pathway in the repair of mucosal epithelium in chronic sinusitis with nasal polyps and without nasal polyps]

Objective:To evaluate the differences between CRS and normal subjects and between chronic rhinosinusitis without nasal polys(CRSsNP) and chronic rhinosinusitis with nasal polys(CRSwNP) in the regulation of EGF pathways and the regulating proliferative position of MAPK pathways.Method: We evaluated the proliferation rates of ethmoidal mucosal cells before and after stimulation with EGF,epidermal growth factor receptor(EGFR) kinase inhibitor AG1478, and extracellular signalregulated kinase1/2(ERK1/2) inhibitorPD98059 using MTT assays.We also analyzed the sinonasal epithelial cells collected from control subjects and patients with CRS subtypes CRSsNP and CRSwNP for the expression of ERK1/2,phosphorylated ERK1/2 using western blot analyses.Result:The proliferation rates of sinonasal epithelial cells before and after EGF stimulation were lower in CRS patients than in the controls.AG1478 or PD98059 inhibitor treatment of control epithelial cells did not result in a significant difference in proliferation.Although,AG1478 and PD98059 inhibited the proliferation of CRS cells, the level of proliferation inhibition was markedly different in CRSsNP.AG1478 suppressed the proliferation of CRSwNP epithelial cells, whereas PD98059 had no effect.The ratio of ERK1/2 phosphorylation in CRS cells was lower than that of the control cells.Conclusion:MAPK classical pathway and other pathways might be active at the same time to stimulate epithelial cell proliferation in CRSsNP. When the classical pathway was blocked in CRSwNP, some other pathway could have completely compensated the proliferation.

Role and influence of p75NTR receptor on antioxidative damage of retinal pigment epithelial cells

The study aimed to investigate the role and mechanism of the p75 NTR receptor in the oxidative damage of retinal pigment epithelial cells (RPE). RPE cells transfected with the p75 NTR receptor were used as the experimental group, and the untransfected RPE cells as the control group. BrdU (5-Bromo-2-deoxyUridine) was used to detect cell proliferation activity; PI/Annexin V-FITC (fluorescein isothiocyanate, FITC) double staining was used to detect the apoptosis rate of the cells. The expression of reactive oxygen species (ROS) in cells was observed by laser microscope, and the expression of ROS, mitochondrial markers, and C expression of cytochrome in cells was detected by flow cytometry. Western blot was used to detect the Fas protein, pyrolysis Caspase-3, and expression level of the vascular endothelial growth factor 165 (VEGF165) protein. The results showed that the proliferation activity of RPE cells in the experimental group decreased gradually with the increase of transfection time, and the apoptosis rate of RPE cells in the experimental group increased gradually with the increase of transfection time, and the apoptosis rate of RPE cells at each time point was significantly higher than that of the control group. The fluorescence intensity of ROS in the experimental group was significantly stronger than that in the control group (P less than 0.01). The fluorescence intensity of cytochrome C in the RPE cells in the experimental group was significantly higher than that in the control group, while the number of positive mitochondria markers in the experimental group was less than that of the control group and the fluorescence intensity was weakened. The expression of Fas protein, Caspase-3 and VEGF165 protein in the experimental group was significantly higher than that in the control group (P less than 0.01). In conclusion, p75 NTR receptor may be a cause of oxidative damage in RPE cells. .

[Imaging charateristics of bony erosion and fungal culture analysis in allergic fungal rhinosinusitis]

Objective:To investigate the imaging characteristics of bony erosion, fungal culture and related factors in allergic fungal rhinosinusitis (AFRS). Method:Sixty cases of AFRS were reviewed in this study. The characteristics of Computed Tomography and Magnetic Resonance Imaging including positive rate of bony erosion, eroded sites, disease extension and sinus expansion were summarized. Fungal culture and identification of nasal secretion were done. The correlation between the degree of sinus expansion, species of fungi and bony erosion was evaluated by statistical analysis. Result:Of the 60 patients, 18 (30%) had bony erosion. There was a significant difference in the proportion of bone erosion among the sinuses (P<0.05). The most commonly eroded site was the ethmoid sinus. The orbit were the most common adjacent anatomic spaces to exhibit disease extension, and anterior cranial fossa is the second most common. Statistical analysis revealed a significant association(P<0.05)of bone erosion with sinus expansion. The positive rate of fungal culture was 51.3%, among which the most common is Aspergillus. Statistical analysis shows no association(P>0.05)of bone erosion with specific fungi. Conclusion:Bone erosion is an important imaging feature of AFRS. Bone erosion may cause by sinus expansion. Extension of disease into the orbit or intracranial cavity results from a natural progression of disease after erosion occurs. Specific fungal species that can cause bone erosion was found.

[Analysis of surgical outcomes of functional endoscopic sinus surgery and radical sinus surgery for refractory rhinosinusitis]

Objective:To study the surgical outcomes of functional endoscopic sinus surgery and radical sinus surgery for refractory rhinosinusitis.Method:A retrospective analysis of 56 cases with refractory rhinosinusitis was performed, who were enrolled in Beijing Tongren hospital from January 2011 to April 2013. According to different surgical methods, all patients were classified into functional endoscopic surgery group (FESS group) and radical sinus surgery group (RSS group). All patients were followed up for more than one year after surgery. Symptom visual analog scale (VAS), peripheral blood eosinophil percentage, serum total IgE, skin prick test (SPT), olfactory function, Lund-Kennedy score and Lund-Mackay score were all examined and analyzed in two groups before and after surgery. SPSS 17.0 was used to do data statistic analysis.Result:There was no significant difference between two groups in age, gender, complicated with allergic rhinitis and asthma (P> 0.05). However, there was significant difference between two groups in the number of patients with previous surgery (P< 0.05). Pre-operative VAS symptom score, Lund-Kennedy score and Lund-Mackay score were higher in RSS group than in FESS group. All patients were followed up for at least one year. VAS symptom score, Lund-Kennedy score and Lund-Mackay score in two groups were compared before and after surgery respectively. VAS symptom score (P< 0.01; P< 0.01), Lund-Kennedy score (P< 0.01; P< 0.01), Lund-Mackay score (P< 0.01; P< 0.01) were significantly lower after surgery. There was no significant difference in VAS symptom scores between two groups postoperatively (P> 0.05). However, Lund-Kennedy score (P< 0.01) and Lund-Mackay score (P< 0.01) were lower in RSS group postoperatively. Among patients with surgery history, Lund-Kennedy score (P< 0.01) and Lund-Mackay score (P< 0.01) were also lower in RSS group at one year follow-up. Conclusion:Radical sinus surgery was more effective in relieving symptoms and reducing inflammation of sinus, compared with functional sinus surgery, especially in refractory sinusitis patients with previous surgery.

Seroprevalence of Toxoplasma gondii infection in sheep from northern China

Toxoplasma gondii is an important zoonotic parasite causing significant health problems to humans and animals. In recent years, a number of investigations about the seroprevalence of T. gondii in China have been reported, but little is known on the prevalence of toxoplasmosis in sheep in northern China. In the present study, a total of 288 sheep serum samples were collected from Inner Mongolia, Heilongjiang, Jilin and Hebei provinces of northern China for T. gondii antibody survey using a latex agglutination test (LAT). Of these, 87 (30.2%) serum samples were positive for antibodies to T. gondii, and the antibody titres ranged from 1:64 to 1:1,024. Seroprevalence of T. gondii infection in sheep was 17.1% in Inner Mongolia, 33.8% in Heilongjiang, 24.6% in Jilin and 46.3% in Hebei. Age and rearing system significantly affected seropositivity. The present survey indicates antibodies to T. gondii are widely prevalent in sheep in northern China, which may cause public health problems in these provinces.

[One case of severely burned patient complicated by acute hemorrhagic necrotizing enteritis and fungal infection]

One severely burned patient, caused by heat lead slag and combined with shock, was hospitalized in our burn unit on 2nd June, 2016. The patient received treatments including anti-shock, intensive care, anti-infection, and organ protection. On post injury day 16, the patient suffered outbreak of acute hemorrhagic necrotizing enteritis after eating dumplings. Plasma and albumin were given, octreotide was intravenously infused to inhibit the secretion of intestinal fluid, the broad-spectrum antibiotics were used for anti-infection, abdominal puncture and drainage were performed, sodium tanshinone ⅡA sulfonate was applied to improve the intestinal microcirculation, ulinastatin was applied to alleviate inflammatory reaction, somatostatin was given to reduce intestinal bleeding, and voriconazole was given for antifungal treatment. The patient gradually recovered and was finally cured and discharged. Among critically ill patients, gastrointestinal tract is not only the initiating organ of sepsis, but also one of the target organs which can be easily damaged during sepsis. This case reminds us the importance of gastrointestinal management in severely burned patients.

[Multilevel logistic regression analysis on hypercholesterolemia related risk factors among adults in China]

Objective: To investigate the prevalence of hypercholesterolemia among Chinese adults in different geographic areas, and to analyze the related factors. Methods: China Chronic and Non-Communicable Disease and Risk Factor Surveillance was conducted in 2013, based on 298 counties/districts in 31 provinces of Chinese mainland. The adults aged 18 years old were randomly selected using multi-stage stratified clustering sampling method. Information on chronic disease and risk factors was collected using face-to-face questionnaire interview and physical measurement. Blood samples were collected by local staffs. Serum total cholesterol (TC) was determined using standard method in a central laboratory. After excluding 565 participants missing key variables and 1 558 participants with abnormal TC values, a total of 174 976 participants were included. Weighted prevalence of hypercholesterolemia was calculated. Hypercholesterolemia related individual or geographic determinants were defined using multilevel logistic regression. Results: The prevalence of hypercholesterolemia in Chinese adults age 18 years old and above was 6.9% (95%CI: 6.4%-7.3%), ranged from 3.0% (95%CI: 2.5%-3.4%) in the northwest of China to 14.2% (95%CI: 12.9%-15.5%) in the south (χ(2)=183.42, P<0.001). The prevalence of hypercholesterolemia was higher in 6 provinces including Tianjin, Liaoning, Fujian, Guangdong, Guangxi, and Hainan (≥9.0%), but lower in 7 provinces including Shanxi, Shannxi, Gansu, Qinghai, Ningxia, Xinjiang, and Tibet (<3.9%). There was a 1.27 fold variation in hypercholesterolemia prevalence by provincial level, and 72.5% of the geographical variation in hypercholesterolemia prevalence was account for by area-level determinants. With multilevel logistic analysis, the individual risk factors associated with hypercholesterolemia included aging, higher education level or annual household income per capita, regular drinking, too much red meal intake, inactivity, overweight or obesity. For geographic factors, residents living at south China, counties/districts with higher urbanization rates, higher education level or lower standardized death rates were more likely to have hypercholesterolemia (all P<0.05). Conclusion: The prevalence of hypercholesterolemia was high in Chinese adults, it was different between regions and related with characteristics of population, individual behaviors and geographical regions.

[Effects and the associated factors of the 2016 China Motivational Healthy Walking Program among occupational population]

Objective: To examine the effects and associated factors of the China Motivational Healthy Walking Program among occupational population. Methods: The 2016 China Motivational Healthy Walking Program recruited 29 224 participants from 139 demonstration areas for comprehensive prevention and control of chronic and non-communicable disease at national level and 70 at provincial level. Intervention on walking was carried out by adopting group and individual motivating measures. Walking steps were recorded by electronic pedometer. We used percent of days achieving 10 000 steps (P10 000), percent of days fulfilling continuous walking (PCW), and proportion of valid walking (PVW) steps to reflect walking quantity, pattern and quality of participants. Motivation intensity was measured by summing up scores of each motivating activity. Questionnaire-based online survey collected information about demographic characteristics, lifestyle risk factors and chronic diseases. This study finally included 12 368 individuals in the analysis. Multilevel logistic regression model was used to assess the effect of group and individual motivating measures on walking activity and corresponding associated factors. Results: Age of the study sample was (41.2±8.99) years, and 58.17% (7 194) of them were female. After 100-day intervention, the P10 000, PCW and PVW of all participants were 93.89%±14.42%,92.01%±15.97% and 81.00%±7.45%, respectively. The mean P10 000 and PCW increased with rising group-motivated scores, self-motivated scores and individual-activity scores (P<0.001 for all). The mean PVW decreased with both higher group-motivated scores and self-motivated scores (both P<0.05), and varied little among groups with different level individual-activity scores (P=0.525). According to the results from the multilevel model, those who had greater group-motivated scores and self-motivated scores tended to have more likelihood of high-level of P10 000 and PCW. Age, sex, smoking status, education attainment and alcohol drinking were associated with P10 000 and PCW (P<0.05 for all). Conclusion: The Motivational Healthy Walking Program had positive effect on promoting healthy walking among occupational population. Group-motivated and self-motivated activities were associated with healthy walking.

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030]

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

[Relations between cigarette smoking and chronic diseases of Chinese adults in 2013]

Objective: To explore the relations between the prevalence of multiple chronic diseases and cigarette smoking behavior in the Chinese adults. Methods: Based on the results: from the 2013 Chronic Disease Risk Factor Surveillance (NCD Surveillance), 176 534 Chinese residents aged 18 years and above, covering 298 counties (districts) in 31 provinces, was randomly recruited, using the multi-stage stratified clustering sampling method. Information on demographics, cigarette smoking (status, quantity and period) was obtained through face-to-face interviews and questionnaires. Anthropometric data and blood samples were collected and properly stored for analysis. Results In total, 175 386 adults were included for statistical analyses, with 42.7% as males and 57.3% as females. The prevalence rates of hypertension, high total cholesterol and high triglycerides were 30.4%, 7.2% and 18.0% in male smokers, 35.6%, 14.0%, 10.3% and 15.9% in female smokers respectively, which were all higher than those in the respective non-smokers. Male smokers were found under lower risk on hypertension, but 19% higher on total glycerides when compared with non-smokers of the same sex(OR=1.19, 95%CI:1.10-1.30), when multiple risk factors were under control. Male current smokers with more than 20 cigarettes per day have 41% (OR=1.41, 95%CI: 1.28-1.55) higher risk of high TG than non-smokers. Female smokers presented 40% (OR=1.40, 95%CI: 1.15-1.70) higher risk in high glycerides than the non-smokers. Specifically, women smoking longer than 20 years have 60% (OR=1.60, 95%CI: 1.31-1.95) higher risk of high TG than women smoking less than 20 years. Conclusions: Prevalence rates of certain chronic diseases were seen higher in smokers of both genders. People with longer history of smoking or being heavier smokers, appeared at advanced risk on developing chronic diseases.

[Clinical research of different characteristics of fungal ball sinusitis]

Objective:The aim of this study is to investigate the clinical features of different subtypes of fungal ball sinusitis. Method:Four hundred and forty-nine cases with fungal ball rhinosinusitis (FBS) were involved in this retrospective analysis. The clinical features including symptoms, signs, and imaging scans, pathological results were all collected for each patient and the patients were classified into different subtypes according to these clinical features and the follow-up treatment. Result:In this retrospective study, 449 patients who diagnosed with fungal ball sinusitis were involved. According to clinical features, these patients were divided into 5 subtypes respectively: ①Subtype 1 simple FBS: there were 299 patients in this subtype. Main symptoms were one side headache, purulent rhinorrhea, nasal obstruction. CT scans showed the classical features of FBS. ②Subtype 2 FBS with nasal polyps: there were 78 patients in this subtype. Main symptoms were bilateral or unilateral nasal obstruction, purulent rhinorrhea. Histopathologic results showed nasal polyps with acute or chronic inflammation by inflammatory cell infiltration. Eosinophils infiltration was the most common phenomenon. Postoperative therapy was as same as the treatment to chronic rhinosinusitis. ③Subtype 3 FBS with allergic rhinitis:there were 51 patients in this subtype. During the operation, infected nasal sinus mucosa with serious edema could be found, often with asubmucosa cyst. Postoperative medical therapy with antihistamines during follow-up. ④Subtype 4 FBS with purulent cyst: there were 6 cases. Main symptoms were nasal obstruction, purulent rhinorrhea and facial pain. Sinus CT scans showed that the typical features of both fungal ball sinusitis and mucous cyst. Antibiotic saline nasal irrigation should be used intraoperatively and postoperatively, other than systemic antibiotic treatment. ⑤Subtype 5 mixed type: there were 15 cases. All of these patients were diagnosed with fungal ball sinusitis with nasal polyps combined with allergic rhinitis. The clinical features of diagnosis and treatment were combination of the two types. Conclusion:According to the different clinical features, fungal ball sinusitis could be classified with five different clinical features. This classification would help to standardize the treatment, reduce the postoperative recurrence rate, and improve the prognosis.

[Geographical variation and related factors in prediabetes prevalence in Chinese adults in 2013]

Objective: To investigate the geographical variation of prediabetes in adults in different regions of China, and to analyze the related factors of prediabetes. Methods: Data was obtained from China Chronic Disease and Related Risk Factor Surveillance in 2013. The surveillance adopted multiple-stage stratified cluster random sampling method, which sampled 177 099 residents aged above 18 years old among 298 surveillance points in 31 provinces of Chinese Mainland. Questionnaire interview was used to obtain demographic variables, personal living style, and socio-economical information. Physical examination was conducted and fasting venous blood sample and (oral glucose tolerance test-2 hours, OGTT-2 h) venous blood sample were obtained from the participants. A total of 171 567 residents aged 18 and above were included in the analysis. The prevalence of prediabetes was analyzed by provinces and by China's geographical regions, after complex weighting. Multilevel logistic models were established to explore the related factors of prediabetes on the area level and individual level. Results: The prevalence of prediabetes among residents aged 18 and above was 16.6% (95%CI: 15.6%-17.6%) in China. The prevalence of prediabetes was the highest (18.3%) in the south China and lowest (13.1%) in the northwest area. The difference of the prevalence in different areas were not statistically significant (P=0.510). If categorized the prevalence of prediabetes into 5 groups by quintile, Hainan, Jilin, Shandong, Anhui, Hunan and Chongqing were in the highest group of prevalence of prediabetes (18.6%-22.7%), and Tibet, Qinghai, Gansu, Ningxia, Guizhou, and Jiangxi were in the lowest group (7.6%-12.6%). The variance of prevalence of prediabetes on the county level (MOR: 1.60 (95%CI:1.53-1.67)) was more diverse than the province level (MOR: 1.21(95%CI:1.08-1.29)) and higher than the street level (1.23 (95%CI:1.14-1.30)). Several factors increased risk of pre-diabetes, including smoking, hazardous drinking and harmful drinking, drinking in the past 30 days, overweight, obesity, central obesity, sugary drink intake, hypertension, high total cholesterol, high triglycerides, high blood low-density lipoprotein cholesterol, low blood high-density lipoprotein cholesterol (all P<0.05). After adjusted the above variables, 92.5% of variance of prediabetes prevalence conld be explained on the provincial level. Conclusion: The geographical distribution of prediabetes in adults in China differed by geographic areas, and it significantly varied on the county level. The related variables included demographic variables, personal behavior, and geographic related variables.

[Deaths attributable to alcohol use and its impact on life expectancy in China, 2013]

Objective: To analyze the deaths attributable to alcohol use and its impact on people's life expectancy in China in 2013. Methods: The mortality data from the Disease Surveillance Points System and alcohol use data from China Chronic Disease Surveillance (2013) were used. The deaths attributed to alcohol use and its impact on the life expectancy of Chinese residents were estimated based on the principle of comparative risk assessment by calculating population attributable fraction. Results: In 2013, alcohol use resulted in 381 200 deaths, including 97 100 hemorrhagic stroke deaths, 88 200 liver cancer deaths, 61 400 liver cirrhosis deaths and 48 700 esophageal cancer deaths, and prevented 76 500 deaths, including 68 500, 4 900 and 3 100 deaths which might be caused by ischemic heart disease, hemorrhagic stroke and diabetes respectively. If risk factor of alcohol use is removed, the people's life expectancy would rise by an average of 0.43 years, especially in western China by 0.52 years, which was 0.12 years higher than that in eastern and central China, and the life expectancy of the population in rural and urban areas would rise by 0.48 years and 0.31 years respectively. Conclusions: Although alcohol has a protective effect on reducing ischemic heart disease, stroke and diabetes deaths, alcohol use is still a risk factor influencing the mortality and life expectancy of residents in China. It is necessary to take targeted measures to reduce the health problems caused by harmful use of alcohol.

[Effects of non-muscle myosin ⅡA silenced bone marrow mesenchymal stem cells on lung damage of rats at early stage of smoke inhalation injury]

Objective: To investigate the effects of non-muscle myosin ⅡA (NMⅡA) silenced bone marrow mesenchymal stem cells (BMSCs) on the lung damage of rats at early stage of smoke inhalation injury. Methods: Forty Sprague-Dawley rats were divided into control, simple injury, NMⅡA-BMSCs, and BMSCs groups according to the completely random method, with 10 rats in each group. Rats in control group inhaled air normally, while rats in the latter 3 groups inhaled smoke to reproduce model of smoke inhalation injury. At 30 min post injury, rats in simple injury group were injected with 1 mL normal saline via caudal vein, and rats in group BMSCs were injected with 1 mL the fifth passage of BMSCs (1×10(7)/mL), and rats in group NMⅡA-BMSCs were injected with 1 mL NMⅡA silenced BMSCs (1×10(7)/mL). At post injury hour (PIH) 24, abdominal aorta blood and right lung of rats in each group were harvested, and then arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), and pH value were detected by blood gas analyzer. Ratio of wet to dry weight of lung was determined by dry-wet weight method. Pathological changes of lung were observed with HE staining. Bronchoalveolar lavage fluid (BALF) were collected, and then tumor necrotic factor-α (TNF-α) and interleukin-10 (IL-10) content of BALF was determined by enzyme-linked immunosorbent assay. Data were processed with one-way analysis of variance, Kruskal-Wallis H test, and least-significant difference test. Results: (1) At PIH 24, compared with those in control group, PaO(2) values of rats in simple injury, BMSCs, and NMⅡA-BMSCs groups were obviously decreased (with P values below 0.05), and PaCO(2) values were obviously increased (with P values below 0.05). Compared with those in simple injury group, PaO(2) values of rats in groups NMⅡA-BMSCs and BMSCs were obviously increased (with P values below 0.05), while PaCO(2) values were obviously decreased (with P values below 0.05). PaO(2) value of rats in group NMⅡA-BMSCs was obviously increased as compared with that in group BMSCs (P<0.05). The pH value of arterial blood of rats in simple injury group was obviously lower than that in control group (P<0.05). (2) At PIH 24, ratios of wet to dry weight of lung of rats in control, simple injury, BMSCs, and NMⅡA-BMSCs groups were 4.36±0.15, 7.79±0.42, 5.77±0.18, and 5.11±0.20, respectively. Compared with that in control group, ratio of wet to dry weight of lung of rats was obviously increased in the other 3 groups (with P values below 0.05). Compared with that in simple injury group, ratio of wet to dry weight of lung of rats was obviously decreased in groups BMSCs and NMⅡA-BMSCs (with P values below 0.05). Compared with that in group BMSCs, ratio of wet to dry weight of lung of rats in group NMⅡA-BMSCs was obviously decreased (P<0.05). (3) At PIH 24, alveolar structure of rats in control group was complete without abnormality. Compared with those in simple injury group, lung injury and infiltration of inflammatory cells of rats in groups BMSCs and NMⅡA-BMSCs were obviously alleviated, and alveolar structure was relatively complete with no thickening of alveolar wall. (4) At PIH 24, compared with that in control group, TNF-α content of BALF of rats in simple injury and BMSCs groups was obviously increased (with P values below 0.05). Compared with that in simple injury group, TNF-α content of BALF in groups BMSCs and NMⅡA-BMSCs was obviously decreased (with P values below 0.05). Compared with that in control group, IL-10 content of BALF in simple injury, NMⅡA-BMSCs and BMSCs groups were obviously increased (with P values below 0.05). Compared with that in simple injury group, IL-10 content of BALF in groups BMSCs and NMⅡA-BMSCs was obviously increased (with P values below 0.05). Compared with that in group BMSCs, IL-10 content of BALF in group NMⅡA-BMSCs was obviously increased (P<0.05). Conclusions: NMⅡA silenced BMSCs can alleviate lung damage of rats at early stage of smoke inhalation injury, showing better effectiveness than using BMSCs only.

Effects of Drink Driving on Crash Risk Based on Random Breath Test Data

Introduction

Driving under the influence of alcohol (DUIA) is an important contributor to road crashes, injuries, and fatalities. Legal limits on drivers' breath alcohol concentration (BrAC) were first introduced in Hong Kong during the 1990s. Since then, the number of alcohol-related crashes has decreased. In 2009, police were empowered to conduct random breath tests (RBT) at roadblocks at any time. The availability of comprehensive RBT data allows us to determine the relationship between crash risk and BrAC, while controlling for confounding factors such as temporal distribution, road environment, and traffic conditions.

Method

In this study, we established two negative binomial regression models to analyse the risk of crashes in which people are killed or seriously injured (KSI crashes) and those involving only slight injuries on 182 urban road segments.

Results

Our results indicated that a higher mean BrAC markedly increases the risk of KSI crashes. However, there was no relationship between the risk of crashes involving slight injury and mean BrAC, although the absence of a hard shoulder, the presence of roadside parking bays, the dawn period, and the location noticeably increase the risk of these crashes.

Conclusion

It is worth exploring the benefits of remedial measures if comprehensive information on demographics and the driving habits of individual drivers become available in the future.

Occupant-level injury severity analyses for taxis in Hong Kong: A Bayesian space-time logistic model

This study aimed to identify the factors affecting the crash-related severity level of injuries in taxis and quantify the associations between these factors and taxi occupant injury severity. Casualties resulting from taxi crashes from 2004 to 2013 in Hong Kong were divided into four categories: taxi drivers, taxi passengers, private car drivers and private car passengers. To avoid any biased interpretation caused by unobserved spatial and temporal effects, a Bayesian hierarchical logistic modeling approach with conditional autoregressive priors was applied, and four different model forms were tested. For taxi drivers and passengers, the model with space-time interaction was proven to most properly address the unobserved heterogeneity effects. The results indicated that time of week, number of vehicles involved, weather, point of impact and driver age were closely associated with taxi drivers' injury severity level in a crash. For taxi passengers' injury severity an additional factor, taxi service area, was influential. To investigate the differences between taxis and other traffic, similar models were established for private car drivers and passengers. The results revealed that although location in the network and driver gender significantly influenced private car drivers' injury severity, they did not influence taxi drivers' injury severity. Compared with taxi passengers, the injury severity of private car passengers was more sensitive to average speed and whether seat belts were worn. Older drivers, urban taxis and fatigued driving were identified as factors that increased taxi occupant injury severity in Hong Kong.

[Subnational analysis of probability of premature mortality caused by four main non-communicable diseases in China during 1990-2015 and " Health China 2030" reduction target]

Objective: To investigate the current status, temporal trend and achieving Health China 2030 reduction target of probability of premature mortality caused by four main non-communicable diseases (NCDs) including cardiovascular and cerebrovascular diseases, tumour, diabetes, and chronic respiratory disease in China both at national and provincial level during 1990 to 2015. Methods: Using the results of Global Burden of Disease study 2015 (GBD 2015), according to the method of calculating premature mortality probability recommended by WHO, the current status and temporal trend by different gender from 1990 to 2015 were calculated, analyzed, and compared. Referring to " Health China 2030" target of reduction 30% of probability of premature mortality caused by major NCDs, we evaluated the difficulty of achieving the reduction target among provinces (not including Taiwan). Results: From 1990 to 2015, the probabilities of premature mortality in cardiovascular and cerebrovascular diseases, tumour, and chronic respiratory disease were all declined consistently for both men and women in China, the total of four main NCDs decreased from 30.69% to 18.54% with higher decreasing in women (from 25.97% to 12.40%) than that in men (from 34.94% to 24.19%). In 2015, the top five provinces in terms of probability of premature mortality caused by four main NCDs were Qinghai (28.81%), Tibet (25.88%), Guizhou (24.67%), Guangxi (23.56%), and Xinjiang (23.21%) in turn, while the top five provinces with the lowest probability were Shanghai (8.40%), Beijing (9.39%), Hong Kong (10.10%), Macao (10.31%), and Zhejiang (11.70%). If achieving the " Health China 2030" target, the probabilities of premature mortality in Qinghai and Tibet with the highest probability should decline to about 20.17%, and 18.12%, respectively in 2030, while 5.88%, and 6.57% in Shanghai and Beijing, respectively. From 1990 to 2015, the probability of premature mortality of four main NCDs declined by 2.00% a year on average, the top five provinces with the fastest decline were Beijing (3.48%), Shanghai (3.24%), Zhejiang (2.81%), Fujian (2.75%), and Guangdong (2.67%), and 11 provinces including these five provinces could achieve the " Health China 2030" target by the usual rate of decline, while other 22 provinces could not achieve the target, they need greater rate of decline in order to achieve the target. Conclusion: From 1990 to 2015, the probabilities of premature mortality of four main NCDs were declined consistently in China both at national and provincial level, compared with women, the men had higher probabilities and declined slower, there were significant different in probabilities of premature mortality and their change speed among provinces. Based on the results from 1990 to 2015, there were about two thirds of the provinces, which the task of achieving the Health China 2030 target will be daunting.

[Research on Mogan Mt. Sanatorium for pulmonary tuberculosis in modern time]

The Mogan Mt.Sanatorium for Pulmonary Tuberculosis, founded in 1927, was the first tuberculosis sanatorium in modern China, with an initial intention of "treating and caring the diseased, not seeking profits" , and its name was then changed to Mogan Mountain Sanatorium in 1931. During the early period of Anti-Japanese War, it became an asylum for refugees and carrying out charitable rehabilitation activity.In May 1939, the Sanatorium was compelled to close because of the bombardment of Japanese aircraft, andonly formally opened in 1948 until today. The patients in the Sanatorium included politicians, wealthy businessmen and academic elites. It laid equal stress on natural convalesce and medication, together with moral solicitude. The funds of the Sanatorium came from convalesce charges, patients' grant-in-aid, Boxer Indemnity and exhibition of calligraphy and painting of celebrity, etc.By means of advertisements, Sanatorium noticedits expansion of medical works, and changes of doctor, announcements of the curative effects to absorb patients. As a novel thingin the early 20(th) century, the appearance of sanatorium was a product of development of health sense, enhancement of health idea and awakening the consciousness of sovereignty of the people.

Structural analyses of the bacterial primosomal protein DnaB reveal that it is a tetramer and forms a complex with a primosomal re-initiation protein

The DnaB primosomal protein from Gram-positive bacteria plays a key role in DNA replication and restart as a loader protein for the recruitment of replisome cascade proteins. Previous investigations have established that DnaB is composed of an N-terminal domain, a middle domain, and a C-terminal domain. However, structural evidence for how DnaB functions at the atomic level is lacking. Here, we report the crystal structure of DnaB, encompassing the N-terminal and middle domains (residues 1-300), from Geobacillus stearothermophilus (GstDnaB1-300) at 2.8 Å resolution. Our structure revealed that GstDnaB1-300 forms a tetramer with two basket-like architectures, a finding consistent with those from solution studies using analytical ultracentrifugation. Furthermore, our results from both GST pulldown assays and analytical ultracentrifugation show that GstDnaB1-300 is sufficient to form a complex with PriA, the primosomal reinitiation protein. Moreover, with the aid of small angle X-ray scattering experiments, we also determined the structural envelope of full-length DnaB (GstDnaBFL) in solution. These small angle X-ray scattering studies indicated that GstDnaBFL has an elongated conformation and that the protruding density envelopes originating from GstDnaB1-300 could completely accommodate the GstDnaB C-terminal domain (residues 301-461). Taken together with biochemical assays, our results suggest that GstDnaB uses different domains to distinguish the PriA interaction and single-stranded DNA binding. These findings can further extend our understanding of primosomal assembly in replication restart.

[Diagnostic value of p16/mcm2 dual staining in cervical intraepithelial neoplasia and its association with high-risk HPV infection]

Objective: To study the expression of p16/mcm2 immunocytochemical dual staining in cervical lesions and its association with high-risk HPV infection, and discuss its clinical value in cervical cancer screening. Methods: From May to December 2015, a total of 1 127 women receiving cervical cancer screening, high-risk HPV (HR-HPV) test and liquid-based cytology test were included in the study. p16/mcm2 immunocytochemical dual staining was performed on residual cytology specimens and the results were compared with histopathology results. Results: p16/mcm2 had a higher expression risk in HPV16/18 group and other HR-HPV group compared with HPV negative group, with OR of 15.95 (95%CI: 9.59-26.51) and 10.53 (95%CI: 7.41-14.98), respectively. The positive rate of p16/mcm2 increased with cervical intraepithelial neoplasia (CIN) severity, and was higher in both CIN2 group and CIN3 group than in benign lesion group (P<0.05). The overall sensitivity of p16/mcm2 to detect CIN2+and CIN3+lesions were 86.1% and 92.0%, respectively, and the overall specificity were 46.1% and 44.4%, respectively. In group with cytologic diagnoses of atypical squamous cells (ASC) and low-grade squamous intraepithelial lesion (LSIL), the sensitivity to detect CIN2+and CIN3+lesions were 85.7% and 87.5%, respectively, and the specificity were 45.5% and 44.1%, respectively. Conclusions: p16/mcm2 dual staining has higher sensitivity than cytology test and better specificity than HPV test. It can identify high-grade cervical lesions and guide the classification of CIN. p16/mcm2 might be used as an innovative biomarker for cervical cancer screening.

[Acute effect of fine particulate matters on daily cardiovascular disease mortality in seven cities of China]

Objective: To explore the effect of fine particulate matters with an aerodynamic diameter less than 2.5 μm (PM(2.5)) on daily cardiovascular disease mortality in seven cities of China. Methods: Daily average concentrations of PM(2.5), cardiovascular disease mortality data and environmental data were collected from January 1, 2013 to December 31, 2015 in seven cities of China, including Shijiazhuang, Haerbin, Shanghai, Wuhan, Guangzhou, Chengdu and Xi' an. We linked generalized additive model with Quasi-Poisson distribution to evaluate the association between daily concentrations of PM(2.5) and cardiovascular disease mortality at single-city level and multi-city level, after adjusting for the long-term and seasonal trend, as well as meteorological factors and the effect of " days of week" . Results: The single-pollutant model indicated that there were marked differences in association strength in these cities, among which the effect in Guangzhou was strongest. At multi-city level, a 10 μg/m(3) increase of PM(2.5) was associated with an increase of 0.315% (95%CI: 0.133%-0.497%) of daily cardiovascular disease mortality. From lag0 to lag2, the effect of PM(2.5) on cardiovascular disease mortality decreased, while it was strongest on lag01. In the two-pollutant model, the estimated effect decreased in all the cities with the adjustments of SO(2) or NO(2). The insignificant combined results suggested that PM(2.5) might have combined effect with other pollutants. Each 10 μg/m(3) increase of PM(2.5) was associated with increases of 0.371% (95%CI: 0.141%-0.600%) and 0.199% (95% CI: 0.077%-0.321%) of cardiovascular disease mortality in males and females, respectively. The effect of PM(2.5) on cardiovascular disease mortality increased with age and decreased with educational level, although the differences between different subgroups were insignificant. The dose-response relationship between PM(2.5) and cardiovascular disease mortality was non-linear and non-threshold, with a steeper curve at lower concentrations. Conclusion: The increases of PM(2.5) concentration can result in the increase of daily cardiovascular mortality.

[Analysis on life expectancy and healthy life expectancy in China, 1990-2015]

Objective: To understand the life expectancy (LE) and health life expectancy (HALE) of Chinese during 1990-2015. Methods: Using the results of global burden of disease study 2015 (GBD 2015), we compared the Chinese LE and HALE in 2015 with those of other countries and analyzed the differences between LE and HALE in Chinese and the changes of LE and HALE during 1990-2015 at both national level and provincial level. Results: In 2015, the LE and the HALE of Chinese were 76.2 and 68.0 years, 4.4 and 5.2 years higher than the global averages, respectively. The LE and HALE were higher in women than in men. The high LE and HALE were observed in developed provinces or areas, such as Shanghai, Beijing, Hong Kong, Macau, Zhejiang, Jiangsu, Tianjin and Guangdong, while the low LE and HALE were found in underdeveloped provinces, such as Tibet, Qinghai, Guizhou, Xinjiang and Yunnan. Between 1990 and 2015, the LE and HALE of Chinese increased substantially by 9.5 and 8.4 years, respectively. The increase of LE was greater than that of HALE at both national level and provincial level. Conclusion: LE and HALE of Chinese increased substantially from 1990 to 2015, but the differences among provinces were obvious.

[Burden of disease attributable to high fasting plasma glucose in 1990 and 2013 in China]

Objective: To analyze the burden of disease attributed to high fasting plasma glucose(FPG)in China in 1990 and 2013. Methods: The analysis used data obtained from the 2013 Global Burden of Diseases Study and examined deaths, death rate, disability-adjusted life years(DALY), years lived with disability(YLD)and years of life lost(YLL)attributed to high FPG in 1990 and 2013 in China(not including Taiwan, China). An average world population age-structure for the period 2000- 2025 was adopted to calculate age-standardized rates. Results: In 2013, the number of deaths attributed to high FPG in China increased to 621.9 thousand from 320.3 thousand in 1990. From 1990- 2013, the age-standardized death rate attributable to high FPG increased from 45.69/100 000 to 48.64/100 000. DALYs caused by high FPG increased to 20.389 1 million in 2013 from 10.648 3 million in 1990. In 2013, high FPG caused 8.751 5 million YLD and 11.637 6 million YLL, and the percentage of YLL in DALY decreased to 57.1% in 2013 from 68.7% in 1990. Compared with 1990, the age-standardized DALY rate attributed to high FPG increased by 10.81%. In 2013, the top three provinces with the highest burden of disease attributed to high FPG were Xinjiang, Jilin and Liaoning provinces, with standardized death rates of 83.38, 74.01 and 68.64/100 000, respectively, and the standardized DALY rate was 2 217.96, 2 001.84 and 1 837.79/100 000 in the three provinces, respectively. Conclusion: Compared with 1990, the burden of disease attributed to high FPG in 2013 increased substantially in China, in particular the burden of attributed YLD. However, the burden of YLL attributed to high FPG has decreased modestly. The burden of disease caused by high FPG shows variation among different provinces in China.

[Burden of disease attributable to high- sodium diets in China, 2013]

Objective: To examine the burden of disease(BOD)attributable to high-sodium diets in China in 2013. Methods: Data were extracted from the 2013 Global Burden of Disease Study for China to examine the BOD attributable to high-sodium diets in 2013, gender, and disease composition. Measurements for attributable BOD were population attributable fraction(PAF), deaths, standardized mortality and disability-adjusted life years(DALY)(not including Taiwan, China). An average world population age-structure for the period 2000-2025 was adopted to calculate age-standardized rates. Results: In 2013, deaths attributable to high-sodium diets accounted for 12.6% of all deaths and 14.5% of chronic disease deaths. Overall, 7.8% of deaths because of neoplasms, 25.2% of cardiovascular disease deaths, and 22.9% of chronic kidney disease deaths were attributable to high-sodium diets. A total of 1 176 553 deaths were attributable to high-sodium diets and the standardized mortality was 91.5/100 000, which was higher in men than in women(121.7/100 000 and 63.0/100 000, respectively). Overall, 22.759 million DALYs were attributable to high-sodium diets. The DALY standardized rate was 1 588.0/100 000, which was higher in men than in women(2 189.7/100 000 and 993.2/100 000, respectively). When compared by province, PAF in Xinjiang(25.0%), Qinghai(23.7%), Shanxi(23.2%), Tibet(22.1%)and Shandong(20.5%)was higher than other provinces. The standardized mortality in Xinjiang(239.4/100 000), Qinghai(238.9/100 000), Tibet(221.7/100 000), Shanxi(166.2/100 000)and Hebei(149.9/100 000)were higher than other provinces. The DALY standardized rate attributable to high-sodium diets was highest in Xinjiang(4 430.8/100 000), Qinghai(4 422.5/100 000), Tibet(4 021.4/100 000), Shanxi(2 816.6/100 000), and Hebei(2 624.9/100 000). Conclusion: The BOD attributable to high-sodium diets is a serious issue in China, particularly in men and in the northern provinces. Effective measures should be taken in northern provinces to reduce sodium intake.

Zerumbone reduced the inflammatory response of acute lung injury in endotoxin-treated mice via Akt-NFκB pathway

Zerumbone, a cyclic eleven-membered sesquiterpene, is the major component of the essential oil isolated from the wild ginger, Zingiber zerumbet. There are several beneficial pharmacological activities of zerumbone including anti-inflammatory, antioxidant, and anticancer activities. Acute lung injury (ALI) is an acute pulmonary inflammatory disorder with high morbidity and mortality rate. In present study, we aimed to investigate the protective effects and mechanisms of zerumbone on endotoxin, lipopolysaccharide (LPS)-induced ALI. Mice were pretreated with zerumbone at various concentrations for 30 min followed by intratracheal administration of LPS for 6 h. Pretreatment with zerumbone not only reduced leukocytes infiltration into the alveolar space but also inhibited lung edema in LPS-induced ALI. Decreased secretion of proinflammatory cytokines such as TNFα and IL-6 caused by LPS were reversed by zerumbone. LPS-induced expressions of proinflammatory mediators, iNOS and COX-2, were inhibited by zerumbone. In addition, NFκB activation and Akt phosphorylation were inhibited by zerumbone in LPS-induced ALI. All these results suggested that the protective mechanisms of zerumbone on endotoxin-induced ALI were via inhibition of Akt-NFκB activation.

[Disease burden of thyroid cancer in the Chinese population, in 1990 and 2013]

OBJECTIVE

To analyze the disease burden of thyroid cancer in the Chinese population, in 1990 and 2013.

METHODS

Data on China from the Global Burden of Disease 2013 (GBD2013) was used to analyze the related parameters as mortality, prevalence,years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) of thyroid cancer in China in 1990 and 2013 among all the Chinese population.

RESULTS

There were 33 939 thyroid cancer patients identified in 2013 (7 146 men and 26 793 women), with an increase of 21 898 patients than the number in 1990. The incidence rate of thyroid cancer increased by 181.86%. The incidence rates of thyroid cancer showed an increase in females but a decrease in males. In 2013, 4 974 people (2 292 men and 2 682 women) died of thyroid cancer, with an increase of 1 810 patients, compared with the figures in 1990. The mortality rate of thyroid cancer in 2013 decreased by 14.29%, compared with the figures in 1990. The mortality rate of thyroid cancer decreased in females while the incidence rate in males showed an increase. The incidence rates increased with age in females, reaching a peak at the 50-54 years old group. The mortality rate of thyroid cancer increased with age. The DALY, YLL and YLD due to thyroid cancer appeared as 13.35, 11.42 and 1.93 ten thousand person years, respectively, in 2013. Between 1990 to 2013, the age-standardized rates on DALY, YLL and YLD decreased from 10.33/100 000 to 8.84/100 000, from 9.60/100 000 to 7.61/100 000 and increased from 0.72/100 000 to 1.23/100 000, respectively. In 2013 the top three incidence rates were recorded in Qinghai, Xinjiang and Fujian provinces while the lowest was in Tibet. Compared with those in 1990, the incidence rates increased in all the provinces except for Tianjin. The top three high mortality rates were recorded in Qinghai, Hong Kong and Fujian and the lowest was also in Tibet. The mortality rates increased in five provinces.

CONCLUSIONS

Compared with those in 1990, the incidence of thyroid cancer increased, but the mortality decreased in 2013. Although significant decrease of DALY due to thyroid cancer was seen in 2013, the YLD burden was still increasing.

[Electrocardiogram characteristics of patients with ventricular arrhythmia originating from the distal great cardiac vein]

Objective: To explore the electrocardiographic characteristics of patients with idiopathic ventricular arrhythmias (VAs) originating from different portions of distal great cardiac veins (DGCV). Methods: The study included 49 patients underwent successful RFCA of premature ventricular complex(PVCs)/ventricular tachycardia(VT) from different portions of the DGCV in our department from July 2009 to March 2016. The surface 12-lead electrocardiogram (ECG) and intraventricular ablation mapping features were analyzed. Patients were divided into four groups according to the mapping and ablation results: DGCV1(10 patients), DGCV2 (13 patients), proximalanterior interventricular vein (PAIV, 17 patients)and extend distal great cardiac vein (EDGCV, 9 patients). We analyzed the similarities and differences between surface 12-lead ECG of patients with PVCs/VT from different portions of DGCV, and compared with random chosen 290 patients with PVCs/VT from ventricular outflow tract and adjacent structure. Results: A positive R wave in inferior leads, a negative QS morphology in lead aVL and aVR were found among all groups. The different characteristics of surface 12-lead ECG of VAs originating from DGCV were as follows: (1)EDGCV patients demonstrated a positive R or r wave on lead Ⅰ(6/9) while a negative rS or qr wave was evidenced in other three groups (39/40). (2)A positive R pattern on lead V(1), V(5)-V(6) (11/13) was presented in patients of DGCV2 group; R (without S or s) wave on V(1) (9/10), RS or Rs wave on V(5)-V(6) were found in DGCV1 group; RS or rS wave was seen on lead V(1), R(without S)wave in lead V(5)-V(6) (25/26) were found in EDGCV and PAIV group and the amplification of R wave in EDGCV was higher than V(1) of PAIV group.(3)Precordial lead transition zone was in front of V(1) for DGCV1 and DGCV2 groups (23/23), within V(1)-V(3) for EDGCV group, but on V(2) or within V(2)-V(3) for PAIV group.(4)Patients of DGCV1 and DGCV2 demonstrated a longer Pseudo delta wave time(PdW), intrinsicoid deflection time (IDT), significantly larger maximum deflection index (MDI) than those in PAIV and EDGCV groups (P<0.001). (5)The different characteristics of surface 12-lead ECG between VAs originating from DGCV and those from ventricular outflow tract and adjacent structure were as follows: ① The ECG features were similar between PVIA and LCC group, both demonstrated a rs wave on the lead Ⅰ, rS wave on V(1)-V(2) and R wave on V(5)-V(6); ②The ECG features were similar betweenEDGCV and RCC group, both presented with R or r wave on the lead Ⅰ, the QRS wave of precordial leads was similar as PAIV and LCC groups; ③A R wave on the lead V(1), V(5)-V(6) was found in group DGCV2, and ILCC; ④Similar to the group Endo-MAA, patients in DGCV1 group also demonstrated a R wave on the lead V(1) and a Rs wave on V(5)-V(6). Conclusion: A positive R wave in inferior leads, a negative QS morphology in lead aVL and aVR are seen in all patients, but different electrocardiographic characteristics of PVC/VT originating from the different portions of the DGCV are presented on lead Ⅰ and V(1)-V(6).

[The microbiology of chronic rhinosinusitis with nasal polyps in different phenotype of peripheral blood eosinophils]

Objective:To investigate the association between immune status and microbial community in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) in different phenotype of peripheral blood eosinophils (PBEOS).Method:Retrospective analysis of clinical data of 125 patients with CRSwNP and and 49 control subjects was performed. According to the proportion of peripheral blood eosinophils, the patients with CRSwNP were divided into PBEOS normal group and PBEOS elevated group. The samples of nasal secretions in middle meatus were collected, and then isolated and identified by microbial culture. Differences of microbial colonization rate between the groups were analyzed. SPSS 19.0 software was used to analyze the data.Result:There were 61 cases in PBEOS normal group (0<PBEOS≤ 5%), 64 cases in PBEOS elevated group (PBEOS> 5%) and 49 control subjects.In patient with CRSwNP, the positive rate of microbial culture was 84.4%, and the main microorganisms were Gram positive Aerobic and facultative anaerobic bacteria. The most common bacteria were coagulase negative staphylococci, Staphylococcus epidermidis (S. epidermidis) and Corynebacterium. The average positive rate of Staphylococcus aureus (S.aureus) was 10.4%, and S. epidermidis was 20.0%. The positive rate of S. aureus in the elevated group was higher than that in the normal group (17.2%, 3.3%), and the rate of S. epidermidis was lower (10.9%, 29.5%). The positive rate of S. epidermidis in the elevated group was also lower than that in control subjects (10.9%, 30.6%).Conclusion:In different PBEOS phenotypes, the colonization rate of S. aureus and S. epidermidis showed the opposite trend. In contrast to the normal goup, the colonization rate of S. aureus in the elevated group increased, and the rate of S. epidermidis decreased. At the same time, the colonization rate of S.epidermidis decreased in elevate group in contrast to the control subjests. This suggests that S. aureus may promote eosinophilic inflammatory response and S. epidermidis may promote noneosinophilic inflammatory response, which plays protective role.

Protective effect of wogonin on endotoxin-induced acute lung injury via reduction of p38 MAPK and JNK phosphorylation

Acute lung injury (ALI) is a serious inflammatory disorder which remains the primary cause of incidence and mortality in patients with acute pulmonary inflammation. However, there is still no effective medical strategy available clinically for the improvement of ALI. Wogonin, isolated from roots of Scutellaria baicalensis Georgi, is a common medicinal herb which presents biological and pharmacological effects, including antioxidation, anti-inflammation, and anticancer. Preadministration of wogonin inhibited not only lung edema but also protein leakage into the alveolar space in murine model of lipopolysaccharide (LPS)-induced ALI. Moreover, wogonin not only reduced the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2 but also inhibited the phosphorylation of mitogen-activated protein kinase (MAPK) induced by LPS. We further found wogonin inhibited the phosphorylation of p38 MAPK and JNK at a concentration lower than ERK. In addition, inhibition of lung edema, protein leakage, expression of iNOS and COX-2, and phosphorylation of p38 MAPK and JNK were all observed in a parallel concentration-dependent manner. These results suggest that wogonin possesses potential protective effect against LPS-induced ALI via downregulation of iNOS and COX-2 expression by blocking phosphorylation of p38 MAPK and JNK. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 397-403, 2017.

[Study on Li Ting'an's contribution to military medicine during 1932-1943]

From 1920, Li Ting'an started to pay attention to military medicine. At the beginning of the Anti-Japanese War, Li Ting'an compiled books of military medicine, restored the health office, participated in the compilation of first aid measures, rehabilitation outlines, and methods of protection practice, and preparing the establishment of hospitals for wounded soldiers in order to support the Anti-Japanese War. At that time, he was appointed as the anti-epidemic commissioner of South China to organize and conduct the epidemic prevention works in the War. During the stalemate period, he kept an eye on the long-term War and devoted himself to the research of national diet and soldier's nutrition. At the same time, Li also recognized the public health at an advanced level so as to save the country.

[Study on effects of community-based management of hypertension patients aged ≥35 years and influencing factors in urban and rural areas of China, 2010]

OBJECTIVE

To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors.

METHODS

The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project. The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project. By face-to-face questionnaire survey and health examination, the information of the subjects' demographic characteristics, risk factors, complications, involvement in community-based management of hypertension, anti-hypertension treatment, blood pressure, body height, waistline and body weight were collected. In this study, Rao-Scott χ(2) test was used to compare the variations among sub-groups. Taylor series linearization method was used to estimate the prevalence rate. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension.

RESULTS

A total of 5 120 subjects were recruited in the analysis. The proportion of those receiving management for more than two years was 36.57%, and it was higher in urban area(44.56%)than in rural area(31.79%, P<0.05); In the past 12 months, 6.17% and 14.46% of the patients received no blood pressure measurement and drug therapy advice respectively, but there were no significant differences between urban group and rural group(P>0.05); In the past 12 months, the proportions of the patients receiving diet and physical activity advice were 84.25% and 84.90% respectively, and the proportions were higher in urban group than in rural group(P<0.05); In the past 12 months, the proportions of the subjects receiving tobacco and alcohol use advice were 78.41% and 77.80% respectively, and the proportions were higher in rural group than in urban group(P<0.05). In urban area, the subjects receiving standardized management had lower SBP(142.79±17.39)mmHg, lower DBP(84.26±9.49)mmHg and higher blood pressure control rate(49.77%)than those receiving no standardized management(P<0.05); while in rural area, no difference was found in BP control between the patients receiving and receiving no standardized management(P>0.05). In urban area, the influencing factors for BP control among the subjects receiving community based management were educational level, annual income, body weight, hypertension management mode, times of receiving BP measurement, times of receiving antihypertensive medicine advice and receiving physical activity advice; while in rural area, the influencing factors for BP control among the subjects receiving community based management were annual income, body weight, family history of hypertension, antihypertensive medicine awareness, times of receiving antihypertensive medicine advice and receiving diet advice.

CONCLUSION

The effects of community-based standardized management of hypertension were better in urban area than in rural area, and the quality of the services of community-based hypertension management was lower in rural area than in urban area.

A simulation study of the effects of alcohol on driving performance in a Chinese population

Driving under the influence of alcohol (DUIA) is a significant factor contributing to road traffic crashes, injuries, and fatalities. Although the effects of alcohol on driving performance are widely acknowledged, studies of the effects of alcohol impairment on driving performance and particularly on the control system of Chinese adults are rare. This study attempts to evaluate the effects of alcohol on the driving performance of Chinese adults using a driving simulator.

METHOD

A double-blind experimental study was conducted to evaluate the effects of alcohol impairment on the driving performance of 52 Chinese participants using a driving simulator. A series of simulated driving tests covering two driving modules, including emergency braking (EB) and following braking (FB), at 50km/h and 80km/h were performed. Linear mixed models were established to evaluate driving performance in terms of braking reaction time (BRT), the standard deviation of lateral position (SD-LANE), and the standard deviation of speed (SD-SPEED).

RESULTS

Driving performance in terms of BRT and SD-LANE was highly correlated with the level of alcohol consumption, with a one-unit increase in breath alcohol concentration (BrAC) degrading BRT and SD-LANE by 0.3% and 0.2%, respectively. Frequent drinkers generally reacted faster in their BRT than less-frequent drinkers and non-drinkers by 10.2% and 30.6%, respectively. Moreover, alcohol impairment had varying effects on certain aspects of the human control system, and automatic action was less likely to be affected than voluntary action from a psychological viewpoint.

CONCLUSION

The findings should be useful for planning and developing effective measures to combat drink driving in Chinese communities.

[Progress in research of health-related quality of life]

Health-related quality of life (HRQoL) is a multidimensional concept for the comprehensive assessment of people's physical and mental health status, which plays an irreplaceable role in clinical treatment, pharmaceutics research, prevention and health care, health policy decision and health economy evaluation, etc. This paper summarizes the connotation, research status, assessment scales and influencing factors of health-related quality of life in order to provide reference to improve the research of health-related quality of life in the future.

[Management of diabetes patients aged ≥35 years in disease surveillance areas in China]

Objective: To investigate the community-based management of diabetes patients aged ≥35 years in China. Methods: The subjects from 2013-2014 Chronic Non-communicable Disease and Risk Factor Surveillance in China were used in this study, those who were aged ≥35 years and diagnosed by doctors in hospitals at community level or above were selected through clustering sampling. Questionnaire was used to collect the data of subjects' general information, health status, the treatment and the control of blood glucose. Blood samples were taken from the subjects to detect the fasting blood glucose level and blood glucose level at 2 hours after oral administration of glucosum anhydricum. The subjects were weighted according to complex sampling scheme to calculated the different rates and 95%CI. The Rao-scott χ² test was performed to test the differences in rates between the subgroups. Results: The survey indicated that among the 10 056 diabetes patients aged ≥35 years and diagnosed with diabetes, 4 609 received management service in communities. After being weighted, the management rate of diabetes patients was 45.0% (95% CI: 40.8%-49.2%). Females (46.9%, 95% CI: 42.8%-51.0%) had higher management rate than males (43.0%, 95% CI: 38.1%-47.9%). The management rate was higher in rural area (50.4%, 95%CI: 46.3%-54.5%) than in urban area (41.6%, 95%CI: 35.5%-47.6%). There was a significant age specific difference in the proportion of patients receiving management services (χ²=21.0, P<0.01), the rate of management was highest in the patients aged ≥65 years (49.2%, 95%CI: 43.6%-54.7%), but lowest in the patients aged 35-44 years (35.2%, 95% CI: 27.9%-42.4%). The overall standardized management rate of diabetes patients in communities was 16.7% (95% CI: 13.7%-19.7%). The proportion of urban patients receiving standardized management service (19.7%, 95% CI: 15.3%-24.1%) was higher than that of rural patients (12.8%, 95% CI: 9.8%-15.8%). The overall treatment rate of diabetes patients in communities was 95.8% (95%CI: 94.8%-96.9%). The treatment rate was higher in females (97.0%, 95%CI: 96.0%-98.0%) than that in males (94.5%, 95%CI: 92.7%-96.4%). The control rate of blood glucose in diabetes patients receiving management in communities was 34.6% (95%CI: 31.5%-37.6%), and the highest blood glucose control rate was in the patients aged ≥65 years (38.2%, 95%CI: 33.4%-43.0%), while the lowest blood glucose control rate was in the patients aged 45-54 years (34.4%, 95% CI: 26.7%-42.0%). Conclusions: Both the standardized management rate and blood glucose control rate were low in the diabetes patients aged ≥35 years in China. It is necessary to strengthen the allocation of medical resources in communities and standardized diabetes management.

[Burden of disease attributed to high total cholesterol in 2013 in China]

Objective: To analyze the burden of disease attributed to high total cholesterol(TC)in 2013 in China. Methods: We used data from the 2013 Global Burden of Disease Study. The population attributable fraction was calculated to estimate the deaths and disability-adjusted life years(DALY)attributed to high TC. Disease burden was compared by age, gender, diseases and province(not including Taiwan, China). An average world population age structure for the period 2000- 2025 was adopted to calculate age-standardized rates. Results: In 2013, high TC caused 298 952 deaths in China, accounting for 3.3% of total deaths, and caused 6 332 thousand DALYs. DALYs attributed to high TC were highest among the 50-69 years age group(3 165 thousand person years), accounting for 50.0% of the total attributed DALYs. The DALY rate in the ≥70 years age group was 2 053.3/100 000, which was 10.3 times that of 15-49 age group(198.6/100 000). DALYs among men were 4 431 thousand person years, which was 2.3 times higher than in women(1 900 thousand person years), and the age-standardized DALY rate among men was 590.6/100 000, which was 2.3 times higher than in women(257.1/100 000). DALYs attributed to high TC were mainly caused by ischemic heart disease(IHD; 5 572 thousand person years), accounting for 88.0% of the total attributed DALYs. Deaths and DALYs attributed to high TC were highest in Shandong(31 002 and 628 thousand person years for deaths and DALYs, respectively), Henan(27 398 deaths and 587 thousand person years, respectively), Hebei(25 744 deaths and 589 thousand person years, respectively), accounting for 28.1% of total attributed deaths and 28.5% of total attributed DALYs. The number of deaths and DALY were lowest in Macao(75 deaths and 1 thousand person years, respectively)and Tibet(385 deaths and 10 thousand person years, respectively). The age standardized DALY rates were highest in Beijing(794.8/100 000), Hebei(732.7/100 000), and Jilin(709.1/100 000), and lowest in Shanghai(151.4/100 000), Zhejiang(168.1/100 000), and Hong Kong(182.0/100 000). Conclusion: The burden of disease attributed to high TC in 2013 in China was mainly the result of the IHD it causes, with greater influence among males and those aged ≥50 years, and variation among provinces.