Metformin use and risk of ischemic stroke in patients with type 2 diabetes: A cohort study / 北京大学学报(医学版)

OBJECTIVE@#To explore the association between the use of metformin and the risk of ischemic stroke in patients with type 2 diabetes.@*METHODS@#A prospective cohort study was designed from the Fangshan family cohort in Beijing. According to metformin use at baseline, 2 625 patients with type 2 diabetes in Fangshan, Beijing were divided into metformin group or non-metformin group and the incidence of ischemic stroke between the different groups during follow-up was estimated and compared by Cox proportional hazard regression model. The participants with metformin were first compared with all the parti-cipants who did not use metformin, and then were further compared with those who did not use hypoglycemic agents and those who used other hypoglycemic agents.@*RESULTS@#The patients with type 2 diabetes were with an average age of (59.5±8.7) years, and 41.9% of them were male. The median follow-up time was 4.5 years. A total of 84 patients developed ischemic stroke during follow-up, with a crude incidence of 6.4 (95%CI: 5.0-7.7) per 1 000 person-years. Among all the participants, 1 149 (43.8%) took metformin, 1 476 (56.2%) were metformin non-users, including 593 (22.6%) used other hypoglycemic agents, and 883 (33.6%) did not use any hypoglycemic agents. Compared with metformin non-users, the Hazard ratio (HR) for ischemic stroke in metformin users was 0.58 (95%CI: 0.36-0.93; P = 0.024). Compared with other hypoglycemic agents, HR was 0.48 (95%CI: 0.28-0.84; P < 0.01); Compared with the group without hypoglycemic agents, HR was 0.65 (95%CI: 0.37-1.13; P=0.13). The association between metformin and ischemic stroke was statistically significant in the patients ≥ 60 years old compared with all the metformin non-users and those who used other hypoglycemic agents (HR: 0.48, 95%CI: 0.25-0.92; P < 0.05). Metformin use was associated with a lower incidence of ischemic stroke in the patients with good glycemic control (0.32, 95%CI: 0.13-0.77; P < 0.05). In the patients with poor glycemic control, and the association was not statistically significant (HR: 0.97, 95%CI: 0.53-1.79; P>0.05). There was an interaction between glycemic control and metformin use on incidence of ischemic stroke (Pinteraction < 0.05). The results of the sensitivity analysis were consistent with the results in the main analysis.@*CONCLUSION@#Among patients with type 2 diabetic in rural areas of northern China, metformin use was associated with lower incidence of ischemic stroke, especially in patients older than 60 years. There was an interaction between glycemic control and metformin use in the incidence of ischemic stroke.

Genotype-environment interaction on arterial stiffness: A pedigree-based study / 北京大学学报(医学版)

OBJECTIVE@#To utilized the baseline data of the Beijing Fangshan Family Cohort Study, and to estimate whether the association between a healthy lifestyle and arterial stiffness might be modified by genetic effects.@*METHODS@#Probands and their relatives from 9 rural areas in Fangshan district, Beijing were included in this study. We developed a healthy lifestyle score based on five lifestyle behaviors: smoking, alcohol consumption, body mass index (BMI), dietary pattern, and physical activity. The measurements of arterial stiffness were brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI). A variance component model was used to determine the heritability of arterial stiffness. Genotype-environment interaction effects were performed by the maximum likelihood methods. Subsequently, 45 candidate single nucleotide polymorphisms (SNPs) located in the glycolipid metabolism pathway were selected, and generalized estimated equations were used to assess the gene-environment interaction effects between particular genetic loci and healthy lifestyles.@*RESULTS@#A total of 6 302 study subjects across 3 225 pedigrees were enrolled in this study, with a mean age of 56.9 years and 45.1% male. Heritability of baPWV and ABI was 0.360 (95%CI: 0.302-0.418) and 0.243 (95%CI: 0.175-0.311), respectively. Significant genotype-healthy diet interaction on baPWV and genotype-BMI interaction on ABI were observed. Following the findings of genotype-environment interaction analysis, we further identified two SNPs located in ADAMTS9-AS2 and CDH13 might modify the association between healthy dietary pattern and arterial stiffness, indicating that adherence to a healthy dietary pattern might attenuate the genetic risk on arterial stiffness. Three SNPs in CDKAL1, ATP8B2 and SLC30A8 were shown to interact with BMI, implying that maintaining BMI within a healthy range might decrease the genetic risk of arterial stiffness.@*CONCLUSION@#The current study discovered that genotype-healthy dietary pattern and genotype-BMI interactions might affect the risk of arterial stiffness. Furthermore, we identified five genetic loci that might modify the relationship between healthy dietary pattern and BMI with arterial stiffness. Our findings suggested that a healthy lifestyle may reduce the genetic risk of arterial stiffness. This study has laid the groundwork for future research exploring mechanisms of arterial stiffness.

Incidence and risk factors of ischemic stroke in patients with type 2 diabetes among urban workers in Beijing, China / 北京大学学报(医学版)

OBJECTIVE@#To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research.@*METHODS@#The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes.@*RESULTS@#A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P < 0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients < 80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes.@*CONCLUSION@#The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.

Exploring the association between de novo mutations and non-syndromic cleft lip with or without palate based on whole exome sequencing of case-parent trios / 北京大学学报(医学版)

OBJECTIVE@#To explore the association between de novo mutations (DNM) and non-syndromic cleft lip with or without palate (NSCL/P) using case-parent trio design.@*METHODS@#Whole-exome sequencing was conducted for twenty-two NSCL/P trios and Genome Analysis ToolKit (GATK) was used to identify DNM by comparing the alleles of the cases and their parents. Information of predictable functions was annotated to the locus with SnpEff. Enrichment analysis for DNM was conducted to test the difference between the actual number and the expected number of DNM, and to explore whether there were genes with more DNM than expected. NSCL/P-related genes indicated by previous studies with solid evidence were selected by literature reviewing. Protein-protein interactions analysis was conducted among the genes with protein-altering DNM and NSCL/P-related genes. R package "denovolyzeR" was used for the enrichment analysis (Bonferroni correction: P=0.05/n, n is the number of genes in the whole genome range). Protein-protein interactions among genes with DNM and genes with solid evidence on the risk factors of NSCL/P were predicted depending on the information provided by STRING database.@*RESULTS@#A total of 339 908 SNPs were qualified for the subsequent analysis after quality control. The number of high confident DNM identified by GATK was 345. Among those DNM, forty-four DNM were missense mutations, one DNM was nonsense mutation, two DNM were splicing site mutations, twenty DNM were synonymous mutations and others were located in intron or intergenic regions. The results of enrichment analysis showed that the number of protein-altering DNM on the exome regions was larger than expected (P < 0.05), and five genes (KRTCAP2, HMCN2, ANKRD36C, ADGRL2 and DIPK2A) had more DNM than expected (P < 0.05/(2×19 618)). Protein-protein interaction analysis was conducted among forty-six genes with protein-altering DNM and thirteen genes associated with NSCL/P selected by literature reviewing. Six pairs of interactions occurred between the genes with DNM and known NSCL/P-related genes. The score measuring the confidence level of the predicted interaction between RGPD4 and SUMO1 was 0.868, which was higher than the scores for other pairs of genes.@*CONCLUSION@#Our study provided novel insights into the development of NSCL/P and demonstrated that functional analyses of genes carrying DNM were warranted to understand the genetic architecture of complex diseases.

Prevalence and risk factors of osteoarthritis in patients with type 2 diabetes in Beijing, China from 2015 to 2017 / 北京大学学报(医学版)

OBJECTIVE@#To explore the prevalence and related factors of osteoarthritis in patients with type 2 diabetes mellitus, and provided a scientific basis for the prevention of the comorbidity.@*METHODS@#The data were obtained from the database of all designated medical institutions in Beijing from 2015 to 2017. Data of the adult patients with type 2 diabetes mellitus were collected for descriptive analysis, and a Logistic regression model was used to explore the related factors of osteoarthritis in the patients with type 2 diabetes mellitus.@*RESULTS@#A total of 1 046 264 diagnosed type 2 diabetes mellitus adult patients were included in our study, with an average age of 63.07 years, and 50.78% were males. Among the patients with type 2 diabetes mellitus, there were 341 561 cases with osteoarthritis, and the prevalence of osteoarthritis was 32.65%. The prevalence of females (38.05%) was higher than that of males (27.41%), and the difference was statistically significant (P < 0.05). Osteoarthritis occurred in all age groups among the patients with type 2 diabetes mellitus, with the highest prevalence of osteoarthritis in the age group of 65-69 years (36.76%), and the lowest prevalence in the age group ≤44 years (14.3%). Before the age of 70, the prevalence increased with age. Further analysis of related factors for osteoarthritis in the patients with type 2 diabetes mellitus showed that female (OR=1.62, 95%CI: 1.61-1.63), age (OR=1.01, 95%CI: 1.01-1.01), had other comorbidities (OR=1.19, 95%CI: 1.18-1.21), used hypoglycemic drugs (OR=0.79, 95%CI: 0.78-0.80), having the cardiovascular disease (OR=1.13, 95%CI: 1.11-1.15), having cerebrovascular disease (OR=1.25, 95%CI: 1.23-1.28), and having nephropathy (OR=1.61, 95%CI: 1.51-1.71) were associated with the osteoarthritis in the type 2 diabetic mellitus patients.@*CONCLUSION@#Our study revealed that the prevalence of osteoarthritis in patients with type 2 diabetes mellitus is high in Beijing area. Health education and disease monitoring should be strengthened in middle-aged and elderly patients. Screening for comorbidities should be carried out as soon as possible, with the focus on menopausal women.

CDH13 Genetic Polymorphisms, Adiponectin and Ischemic Stroke: a Chinese Family-based Sib-pair Study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To understand the relationships between CDH13 (T-cadherin) genetic polymorphisms, adiponectin levels and ischemic stroke, and possible interactions between CDH13 polymorphisms and other risk factors.</p><p><b>METHODS</b>We recruited 342 Chinese ischemic stroke sib pairs. We genotyped rs4783244 and rs7193788 on CDH13 using time-of-flight mass spectrometry genotyping technology and measured total and high-molecular weight (HMW) adiponectin levels. We investigated associations between SNPs and ischemic stroke, and interactions between SNPs and other risk factors using multi-level mixed-effects regression model.</p><p><b>RESULTS</b>In individuals without ischemic stroke, CDH13 rs4783244 was associated with total adiponectin levels (per T: Coef = -0.257, P = 0.001). CDH13 rs7193788 was associated with total adiponectin levels (per A: Coef = -0.221, P = 0.001) and HMW adiponectin levels (per A: Coef = -0.163, P = 0.003). rs7193788 was significantly associated with ischemic stroke (GA/AA vs. GG: OR = 1.55, 95% CI: 1.07 to 2.24, P = 0.020) after Bonferroni correction (α = 0.025). There was an interaction between rs7193788 and diabetes (P = 0.036). Compared to diabetes-free individuals with rs7193788 GG genotype, diabetes patients with rs7193788 GA/AA genotypes had higher risks for ischemic stroke (OR = 2.64, 95% CI: 1.58-4.40, P < 0.001).</p><p><b>CONCLUSION</b>CDH13 genetic polymorphisms are associated with adiponectin levels and ischemic stroke. An interaction is found between CDH13 SNP and diabetes for ischemic stroke.</p>

Profile and Correlates of Health-related Quality of Life in Chinese Patients with Coronary Heart Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although coronary heart disease (CHD) is one of the major cardiovascular diseases, risk factors associated with the health-related quality of life (HRQoL) of CHD patients remain unclear. The present study was designed to determine the profile and significant factors of the HRQoL in CHD patients.</p><p><b>METHODS</b>A cross-sectional study was conducted in rural communities of Fangshan District, Beijing, China. Socio-demographic, lifestyle, and comorbidity information of CHD patients were collected by a structured questionnaire and medical records. HRQoL was measured using European Quality of Life 5-dimensions (EQ-5D) scale and EQ Visual Analog Scale (EQ-VAS). Multiple linear and logistic regressions were performed to explore the association of potential risk factors with HRQoL scores and each EQ-5D, respectively.</p><p><b>RESULTS</b>Totally, 1928 CHD patients (mean age 61.64 ± 9.24 years; female:male = 2.4:1) were enrolled in the study. The mean score of EQ-5D index and EQ-VAS were 0.889 ± 0.172 and 71.56 ± 17.65, respectively. Multiple linear regression revealed that marital status, physical activity, moderate alcohol drinking, and family's population were positive independent correlates of EQ-VAS, whereas diabetes mellitus and stroke were negative independent correlates (all P < 0.05). Age and stroke were negatively while physical activity, moderate alcohol drinking, family's population and household income were positively correlated with EQ-5D index (all P < 0.05) independently. In addition, each of the five HRQoL dimensions had various specific determinants, including obesity, underweight, smoking or education.</p><p><b>CONCLUSIONS</b>Findings of the study highlight certain socio-demographic, lifestyle factors, and comorbid stroke or diabetes mellitus as correlates of HRQoL in Chinese CHD patients. Large-scale cohort studies should be carried out to confirm our results in the future.</p>

The impact of lipid-metabolizing genetic polymorphisms on body mass index and their interactions with soybean food intake: a study in a Chinese population / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To evaluate the association of known polymorphisms in the lipid metabolic pathway with body mass index (BMI), and estimate their interactions with soybean food intake.</p><p><b>METHODS</b>A community-based cross-sectional survey was conducted in a Chinese Han population. BMI, soybean food intake, and single nucleotide polymorphisms of rs599839, rs3846662, rs3846663, rs12916, rs174547, rs174570, rs4938303, and rs1558861 were measured in 944 subjects. A multivariate logistic regression was used to analyze the association of the studied polymorphisms with BMIs. The expectation-maximization algorithm was employed to evaluate the extent of linkage disequilibrium between pairwise polymorphisms. The gene-environment interaction was assessed in the general multifactor dimensionality reduction model.</p><p><b>RESULTS</b>The polymorphisms of rs3846662 and rs3846663 were associated with 10% highest BMIs when comparing to the 10% lowest values both in individuals and haplotype-based association tests. Although no statistically significant gene-environment interactions were found, people with the haplotype composed of C allele in rs3846662 and T allele in rs3846663 and low frequency of soybean intake had significantly higher risk to overweight and obesity as compared with those with the haplotype consisting of T allele in rs3846662 and C allele in rs3846663 and highly frequent soybean food intake, with an odds ratio of 1.64 (95% confidence interval: 1.15-2.34, P<0.01) after adjusting for the common confounders.</p><p><b>CONCLUSION</b>Our study has suggested that rs3846662 and rs3846663 may be the potential candidate polymorphisms for obesity, and their effect on the pathogenesis could be mediated by the frequency of soybean food intake.</p>

Influence of chronic diseases on health related quality of life in middle-aged and elderly people from rural communities: application of EQ-5D scale on a Health Survey in Fangshan, Beijing / 中华流行病学杂志

Objective To evaluate the health related quality of life (HRQoL) and to explore the influencing factors related to the prevalence of the essential hypertension,diabetes,coronary heart disease (CHD) and stroke in middle-aged and elderly people from rural communities.Methods A total of 5345 individuals were chosen from a 2010 Health Survey in Fangshan,Beijing.Self-designed questionnaire was applied to collect the information on general health-related behaviors,chronic conditions,self-rated health,blood pressure and HRQoL with the EuroQoL questionnaire (EQ-5D) were measured.Probit regression model was used to identify the influencing factors on HRQoL,adjusting age,marriage status,education level,smoking,alcohol intake,physical activity and control of blood pressure.Population Attributable Risk Proportion (PARP) for estimating the influence of chronic disease on HRQoL was also calculated.Results The average EQ-5D index was 0.923 ±0.145,with 72.1％ of the overall respondents in the status of having chronic diseases.Participants with chronic diseases had significantly lower EQ-5D index (0.907 ± 0.155 ) than those without (0.963 ±0.105 ) (t =15.082,P＜ 0.001 ).Significant relations were found between a lower HRQoL and chronic diseases.Relative risk (RR) and 95％ confidence interval (95％ CI) of poor HRQoL in populations with hypertension,diabetes,CHD and stroke were 1.686 (95％CI: 1.519-1.871),1.725 (95％CI:1.502-1.981 ),1.869 (95％CI: 1.663-2.099),and 1.759 (95％CI: 1.474-2.089) respectively.The most influential disease appeared to be stroke in male (RR=1.929,95％CI: 1.462-2.546),whereas CHD in female individuals (RR=1.926,95％CI: 1.671-2.220).Rates of PARP (PAR％) for poor HRQoL in chronic disease subgroups were as follow: hypertension 31.05％,CHD 23.39％,diabetes 4.84％ and stroke 4.44％,respectively.Conclusion This study suggested that stroke,at individual level,was the major influential factor to HRQoL.However,hypertension remained the leading preventable influential factor to HRQoL at the population level.

Application of pragmatic clinical trials in clinical evaluation of Chinese medicine / 中国中西医结合杂志

Since the evidence-based medicine (EBM) being evoked widely, to seek out the best evidence is becoming the pivotal step for the development of Chinese medicine (CM), and randomized controlled trial (RCT, at most times, it means explanatory clinical trial--ECT) has been accepted as the general golden standard for the evaluation of clinical intervention. However, it is noted that the traditional RCT (ECT) is unsuitable for the special characteristics of individual treatment in CM. The formation and development of CM theory is found on large amount of clinical experiences, and to evaluate its clinical efficacy and safety is the most primary task. Because the CM intervention measures are complex and individualized, the clinical effectiveness of CM is embodied as a complex system, which impacted greatly by the environment factors. It is deemed that the pragmatic clinical trial (PCT) has the character just fitting for the evaluation. The feasibility of PCT in CM clinical evaluation is discussed in this paper in order to raise a new issue for the evaluation of CM effectiveness.

Clinical outcome of dental implants placed in fibula-free flaps for orofacial reconstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors.</p><p><b>METHODS</b>We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed.</p><p><b>RESULTS</b>In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants placed into the fibula bone grafts were 95% and 87%, respectively. The main reasons for failure of the dental implants were infection, tumor recurrence and soft tissue proliferation. The fibula flap presents many advantages for implant placement, but its limited height sometimes makes implant-supported prosthetic rehabilitation difficult.</p><p><b>CONCLUSIONS</b>Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.</p>

Development of bovine blood lead component analysis standard reference materials / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop the first grade standard analytical reference material of bovine blood lead.</p><p><b>METHODS</b>According to standards and technology specification of primary standard reference material (JJG1006-1994), ISO 17511, and volume-effect relationship, a bovine blood lead model was developed by adding acetate lead in the feed in dose of 2-5 mg x kg(-1) x d(-1). Cow blood was collected when blood lead concentration went up to low, medium and high concentration range (90-100, 190-200, 280-300 microg/L). Blood sample was kept in tube and frozen after irradiation. The samples were tested for homogeneity and stability. ID-MS method was used to measure the lead concentration through comparison with two standard lead samples from the USA NIST SRM 955b.</p><p><b>RESULTS</b>Samples of the three lead concentrations showed uniformity by single factor analysis of variance (F = 0.61, 1.64, 0.28, respectively, P > 0.05) . After 14 months monitoring, the RSD was 0.85%, 1.05% and 0.49% (t = 0.787, 1.132, 0.854, respectively, P > 0.05). The characteristic and indefinite values were 102.4 +/- 5.5; 181.2 +/- 4.0; 304.5 +/- 3.9, respectively (unit: microg/L). The reproduction of the two USA NIST SRM 955b samples further showed our methods and procedures were correct. Our sample was stabile for four days at room temperature.</p><p><b>CONCLUSION</b>The standard reference material of bovine in our research had reached the national standard material requirements.</p>

Study on the long-term efficacy and safety of medicine named 'Beijing Hypertensive No. 0' in patients with primary hypertension / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the antihypertensive effect and safety on medicine named 'Beijing Hypertensive No. 0' in a three-year treatment of primary hypertension.</p><p><b>METHODS</b>A community-based intervention study was conducted. The antihypertensive effects and adverse events were observed.</p><p><b>RESULTS</b>4000 patients with primary hypertension were randomly divided into two groups with 1529 patients treated with 'Beijing Hypertensive No. 0' and 976 patients treated with other antihypertensive drugs, among which 946 and 853 patients in the two groups completed the three-year study. After treatment, the systolic blood pressure decreased 13 mm Hg and 7 mm Hg while diastolic blood pressure decreased 8 mm Hg and 4 mm Hg in the 'No. 0' group and controlled group respectively. After three years of treatment, 90.0% and 79.5% in the 'No.0' group and in the control group had reached the BP 'fulfillment criteria', which were much higher than the baseline data. Side effects occurred in 33/1274 (2.6%) cases during three years' treatment with most commonly seen as dizziness, headache, palpitation and weakness. No serious adverse reactions occurred. There were some positive effects after treated by 'No. 0', including 0.13 mmol/L decrease of TC, 0.70 mmol/L decrease of LDL-C and an average 0.12 mmol/L increase of HDL-C. All of these changes were statistically significant. There were also opposite effects as 0.13 mmol/L increase of TG, 0.24 mmol/L increase of K+, and 0.88 mmol/L increase of Na+ on average, which were also statistically significant.</p><p><b>CONCLUSION</b>Compared with the conventional treatment, this treatment of 'Beijing Hypertensive No.0' was more convenient, safe and effective in treating mild to moderate primary hypertension in the community.</p>

Cost-effectiveness analysis on compound anti-hypertensive tablets for primary hypertension / 中华流行病学杂志

Objective To compare the cost-effectiveness of two anti-hypertensive therapy regimens,Compound anti-hypertensive tablets and other common anti-hypertensive agents,in the treatment program of Primary Hypertension.Methods We conducted a cost-effectiveness analysis based on a community trial.Two communities'primary hypertensive patients were enrolled to receive different therapy drugs:Compound anti-hypertensive tablets(Group A)or other common anti-hypertensive agents(Group B).Blood pressure,medicine used,and adverse drug reactions were observed and recorded for one year,and then costeffectiveness ratio of the two groups and incremental ratio were calculated.We considered a 30%drug price fluctuating load to make the sensitivity analysis.Results 2505 cases were enrolled with 1529 cases in group A and 976 cases in group B.The cost-effectiveness ratios were 418.1 and 1057.7 for Group A and B respectively while the incremental cost-effectiveness of Group B vs.Group A was 19 202.2.The results were insensitive to variation in the costs of drugs over clinically reasonable ranges.Conclusion Compound anti-hypertensive tablets appeared to be relatively cost-effective when compared to common drugs for the treatment of primary hypertension.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions.</p><p><b>METHODS</b>Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12 approximately 15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS.</p><p><b>RESULTS</b>A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner's gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner's gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1 approximately 3 years. No related complications occurred among all patients that received EUS examinations.</p><p><b>CONCLUSION</b>EUS is an effective and reliable diagnostic method for duodenal protruding lesions.</p>

Buccal soft tissue augmentation using acellular dermal matrix in implant therapy / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the use of acellular dermal matrix (ADM) to improve esthetic effects of alveolar ridge in dental implantology.</p><p><b>METHODS</b>Fifty patients with similar single missing tooth in the anterior maxilla were randomly divided into two groups: the ADM group was treated with dental implant therapy plus ADM transplantation; the control group was treated with dental implant therapy alone. The periodontal parameters and the changes of horizontal width of alveolar crest at implant zones were evaluated before surgery and 12 weeks after surgery.</p><p><b>RESULTS</b>All operated sites healed uneventfully. Mean horizontal width of alveolar crest in ADM group increased by (3.10 +/- 0.64) mm at 12 weeks and the control group increased by (0.30 +/- 0.50) mm, The volume increase showed a significant difference groups (P < 0.05). Mean horizontal width of alveolar crest in ADM group was (11.50 +/- 1.48) mm and the contralateral alveolar crest was (11.60 +/- 1.60) mm (P > 0.05).</p><p><b>CONCLUSIONS</b>ADM is a suitable material for the treatment of soft tissue deformities due to its biocompatibility and horizontal gain of soft tissue.</p>

The installation of zygomatic implants and drilling guide / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To discuss the technique of installation of zygomatic implants in severely resorbed edentulous maxillae, and maxillary defect.</p><p><b>METHODS</b>Five patients received 8 zygoma implants and 11 dental implants. On the basis of an axial spiral CT data, anatomical models of natural size were manufactured using CAD/CAM system and before operation preoperative measurements of relevant parameters (length, areas, and volumes) carried out. Theses maxillary and zygomatic measurements obtained were referred for installing zygomatic implants.</p><p><b>RESULTS</b>The ideal direction and position of installation of the 8 zygomatic fixtures were obtained in 5 patients. The anatomical model and surgical plate were used for preoperative planning and intraoperative control of the insertion of zygomatic fixtures. The implants could be positioned precisely as preoperatively planned. The length of the zygomatic implants was between 40 mm and 50 mm.</p><p><b>CONCLUSIONS</b>The use of surgical drilling guides should be encouraged for zygomatic implant placement. 3-D image data and anatomical models improves preoperative planning and facilitates clinical procedure.</p>

Toxicokinetics of tetramethylene disulphotetramine / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore toxicokinetics of tetramethylene disulphotetramine (TETS) in rabbit and the effects on toxicokinetics of TETS after activated charcoal by gavage.</p><p><b>METHODS</b>Eight rabbits were exposed through gavage and vein respectively, the blood samples were collected from the center artery in ear of rabbit at an arranged time. Four rabbits were exposed after being intubated into urethra and common bile duct. The samples of bile and urine were collected at arranged times. After being exposed by gavage, activated charcoal (1 g/kg) was administrated in the activated charcoal group and the distilled water (1 g/kg) administrated to the controls. The samples of blood were collected from the center artery in ear of rabbit at arranged times. The contents of TETS in samples were determined by GC/NPD method. Analysed by the 3p87 soft, toxicokinetics parameters of TETS were acquired.</p><p><b>RESULTS</b>TETS was eliminated very slowly in rabbit. The plasma half time in elimination phase (Tke1/2) of TETS was 56.9 hours in vein exposure group and 262.5 hours in oral exposure group respectively. The plasma clearance (CL) of it was only 15.4 ml.kg(-1).h(-1) in oral exposure group and 24.1 ml.kg(-1).h(-1) in vein exposure group. TETS was eliminated from urine in rabbit. The eliminated amount of it from urine was more 5 times than from bile. All parameters of toxicokinetics of TETS were significantly different between the activated charcoal group and the control. Compared to the control, Tke1/2 of TETS in the activated charcoal group was equal to 55%, CL was increased over 3-fold, area under the curve was equal to 30%.</p><p><b>CONCLUSION</b>TETS was a poison eliminated very slowly in body. The eliminated amount of it from urine was more than from bile. The excretion of TETS could be quickened after activated charcoal by gavage.</p>

Study on injuries from emergency departments in 25 general hospitals / 中华流行病学杂志

<p><b>OBJECTIVE</b>This study aimed to study the characteristics of injuries in the Emergency Departments.</p><p><b>METHODS</b>Acute injuries of the Emergency Department attendants from Jury 1, 2001 to June 30, 2002 were selected.</p><p><b>RESULTS</b>25,019 cases were sampled. Results showed that injured persons accounted for 17.46% of all emergent cases attending the above hospitals. 81.67% of the injuries were accidental. Sex ratio was 2.0. Young people aged 15-34 years accounted for 50.63% of all the injuries. The leading cause was mechanical injury, followed by traffic accidents and accidental falls. The leading occupation would include workers, followed by farmers and students. The fatality rate was 5.12 per thousand. The number of deaths for young people accounted for 79.69% of all deaths. The number of deaths for motor vehicle accidents took the first place and accounted for 46.88%. The characteristics due to mechanical injury and 11,151 cases of acute poisoning were analyzed.</p><p><b>CONCLUSION</b>To develop a surveillance post on injuries in the Emergency Departments of general hospitals are not only necessary, urgent but feasible.</p>

The comparison on cause and treatment of injuries between two types of Emergency Department among 25 hospitals / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of injuries between two types of Emergency Department (ED) in China.</p><p><b>METHODS</b>We selected 25 hospital EDs in the whole country as spots for investigation, and designed one special questionnaire to collect information, from 1st July, 2001 to 30th June, 2002.</p><p><b>RESULTS</b>In city hospitals (CIH), the proportion of injury to all diseases were 19.65%, and in country hospital (COH) it was 29.88%. The fatality rate of injuries was 1.29% in COH, which was higher than that of CIH's (P < 0.001). In COH, ambulance was more frequently used to treat injury patients than in CIH, but the average rescue time was not different. In cities, machinery was the leading cause (about 32.88%), but in country it was due to transpert (35.34%). Traffic accidents, suicide/homicide and unintentional drowning were the main causes of death. In CIH, the number of unintentional poisoning was almost twice as intentional, but in COH the patients due to poisoning suicide act were more than unintentional poisoning, with 2/3 of the poisoning causes were women. Patients due to chemical, drug and food poisoning accounted for 86.13% in CIH, while in COH the main causes were pesticidal, chemical and druggery (89.80%). In all poisons, pesticide was the leading cause for death.</p><p><b>CONCLUSION</b>It's suggested that patients with injury be treated timely since the acute injury patients accounted for important part of ED's patients. The differences between CIH and COH were obvious, with better ability of treatment in CIH than in COH. More relevant measures were needed to improve the ability of acute treatment for injuries.</p>