Radiation-associated sarcomas of bone and soft tissue: a clinicopathological analysis of 46 cases / 中华病理学杂志

Objective: To investigate the clinical, imaging, histological, and molecular features and the differential diagnosis of radiation-associated sarcomas of bone and soft tissue. Methods: Forty-six cases of radiation-associated sarcomas of the bone and soft tissue in Beijing Jishuitan Hospital from January 2010 to January 2022 were retrospectively analyzed; and the imaging, histological features and immunophenotype were examined. Results: There were 33 females and 13 males, aged from 18 to 74 years, with a mean of 52 years. The most common site of radiation-associated sarcomas were the limbs and spine (15 cases), followed by the chest (9 cases). The primary diseases included epithelial tumors (15 breast cancer, 6 cervical cancer, and 5 bowel cancer), hematolymphoid tumors, bone and soft tissue tumors and infectious lesions. The latent period of radiation-associated sarcomas ranged from 2-22 years, with an average of 11.6 years. Histopathologically, the morphology was divergent from the primary tumor. The most common malignant tumor type was undifferentiated sarcoma (22 cases), followed by osteosarcoma (16 cases). The immunophenotype of radiation-related sarcoma was almost the same as the corresponding soft tissue sarcoma. Conclusions: Radiation-induced sarcoma has a wide range of primary tumor types and its imaging, morphology and immunohistochemical features are similar to those of the primary sarcoma of bone and soft tissue. Clinical correlation is often recommended for the differential diagnosis.

Characteristics related to maternal and child cohort studies in China: A review / 中华流行病学杂志

Cohort study is an irreplaceable method for studies related to maternal and child health. Compared with other countries, China's maternal and child cohort studies started relatively later but has its unique developing track. This paper summarizes the basic information and characteristics of the maternal and child cohorts with wide and great influence in China in the past 25 years.

Frailty progress and related factors in the elderly living in community: a prospective study / 中华流行病学杂志

Objective: To investigate frailty progress status and related factors in the elderly living in communities. Methods: A cohort of elderly people aged 65 and over in Pingyi community of Dujiangyan, Sichuan province, was established. Face-to-face questionnaire survey was conducted by trained interviewers. The frailty status, cognitive function, nutrition status and other functions of the subjects surveyed were evaluated at baseline survey and during follow-up. The socio-demographic and clinical characteristics of the subjects surveyed were assessed at baseline survey. Binary logistic regressions were used to identify factors associated with frailty progress. Results: A total of 653 elderly people were surveyed in January 2014, and 507 elderly people were followed up while 146 elderly people terminated further follow-up in January 2017. The prevalence rates of frailty and pre-frailty at baseline survey were 11.2% (n=57) and 26.2% (n=133), respectively. After 3 years, 205 subjects (40.4%) surveyed experienced frailty progress, 276 (54.5%) remained to be in frailty state at baseline survey, and 26 (5.1%) had improvement. Disability (OR=8.27, 95%CI: 1.62-42.26), visual problem (OR=2.02, 95%CI: 1.27-3.22), cognitive impairment (OR=1.94, 95%CI: 1.08-3.48), poor self-rated health (OR=1.89, 95%CI: 1.07-3.31), chronic pain (OR=1.57, 95%CI: 1.03-2.40) and older age (OR=1.12, 95%CI: 1.08-1.17) were independently associated with the progress of frailty. In contract, overweight was a protective factor (OR=0.54, 95%CI: 0.34-0.85). Conclusions: Frailty is a dynamic syndrome affected by several socio-demographic factors and geriatric factors. The results of the study can be used in the prevention of frailty progress in the elderly in communities.

Study on the coverage of cervical and breast cancer screening among women aged 35-69 years and related impact of socioeconomic factors in China, 2013 / 中华流行病学杂志

Objective: To estimate the cervical and breast cancer screening coverage and related factors among women aged 35-69 years who were in the National Cervical and Breast Screening Program, to provide evidence for improving cervical and breast cancer control and prevention strategy. Methods: Data used in this study were abstracted from the 2013 Chinese Chronic Diseases and Risk Factors Surveillance Program. A total of 66 130 women aged 35-64 years and 72 511 women aged 35-69 years were included for this study. Weighted prevalence, (with 95% confidence interval, CI) was calculated for complex sampling design. Rao-Scott χ(2) method was used to compare the screening coverage among subgroups. A random intercept equation which involved the logit-link function, was fitted under the following five levels: provincial, county, township, village and individual. Fix effects of all explanatory variables were converted into OR with 95%CI. Results: In 2013, 26.7% (95%CI: 24.6%-28.9%) of the 35-64 year-old women reported that they ever had been screened for cervical cancer and 22.5% (95% CI: 20.4%-24.6%) of the 35-69 year-olds had ever undergone breast cancer screening. Lower coverage was observed among women residing in rural and central or western China than those in urban or eastern China (P<0.000 1). The coverage among women aged 50 years or older was substantially lower than those aged 35-49 years. Those who were with low education level, unemployed, low household income and not covered by insurance, appeared fewer number on this cervical or breast cancer screening program (P<0.000 1). Women living in rural and western China were having less chance of receiving the breast cancer screening (P<0.05), but the difference was not statistically significant. Conclusion: It is essential to strengthen the community-based cervical and breast cancer screening programs, in order to increase the coverage. More attention should be paid to women aged 50 years or older, especially those socioeconomically disadvantaged ones.

Relations between cigarette smoking and chronic diseases of Chinese adults in 2013 / 中华流行病学杂志

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.

Current status of falls and related injuries among Chinese elderly in 2013 / 中华流行病学杂志

Objective: To investigate the demographic characteristics of falls and fall-related injuries in Chinese elderly population. Methods: In 2013, the 4(th) round Chronic Non-communicable Disease and Risk Factor Surveillance in China was conducted in 31 provinces. A stratified multi-stage cluster sampling was used to select the samples. A total number of 98 629 community-based adults aged 60 years and older received a set of standardized questionnaires with a face to face interview. The prevalence rates of falls and consequent injuries were compared between different genders, age groups, levels of education and areas of residency. Results: The overall prevalence of falls among elderly in the previous 6 months was 8.0%(95%CI: 7.5%-8.5%). The prevalence was increasing with age and decreasing with the levels of education, and higher in females (9.1%) than in males (6.8%), with differences statistically significant (χ(2)=74.1, P<0.01). Prevalence rates were also seen higher in rural (8.6%), in widowed (11.0%) residents and in farmers or house workers than those in urban areas (7.2%), in non-widowed (7.0%), or having other jobs, with differences all statistically significant (χ(2)=7.7, P<0.01, χ(2)=128.0, P<0.01). 52.6% of the elderly got injured when fell. The proportion of injury was greater in females (54.8%) than that in males (49.6%), with differences statistically significant (χ(2)=10.2, P<0.01). Proportion of most frequent types of injuries were hip fractures (7.3%), hand/arm fractures (12.5%), head injury (8.0%) and bruise (53.6%) respectively. The proportion of hip fractures was 12.4% in elderly over 80 year of age, also was the highest. Conclusions: Results from the present study showed that elderly suffered high prevalence of falls.Statistically significant differences were seen in residents with different groups as genders, age, education levels, marital status, urban/rural areas or jobs. Group-based comprehensive prevention and intervention on falls should be strengthened.

Study on relationship between prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure level in adults in China / 中华流行病学杂志

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.

Age-related modification effect on the association between body mass index and the risk of hypertension: A Cohort Study on Chinese people living in the rural areas / 中华流行病学杂志

Objective: To study the modification effect of age on the association between body mass index and the risk of hypertension. Methods: People age ≥18 years old were selected by clusters, from a rural area of Henan province. In total, 20 194 people were recruited at baseline during 2007 and 2008, and the follow-up study was completed from 2013 to 2014. Logistic regression model was used to assess the risk of incident hypertension by baseline BMI and age-specific BMI. Results: During the 6-year follow-up period, 1 950 hypertensive persons were detected, including 784 men and 1 166 women, with cumulative incidence rates as 19.96%, 20.51%, and 19.61%, respectively. Compared with those whose BMI<22 kg/m(2), the RRs of hypertension were 1.09 (0.93-1.27), 1.17 (1.01-1.37), 1.34 (1.14-1.58) and 1.31 (1.09-1.56) for participants with BMI as 22-, 24-, 26- and ≥28 kg/m(2), respectively. In young and middle-aged populations, the risk of hypertension gradually increased with the rise of BMI (trend P<0.05). However, in the elderly, the increasing trend on the risk of hypertension risk was not as significantly obvious (trend P>0.05). Conclusion: The effect of BMI on the incidence of hypertension seemed to depend on age. Our findings suggested that a weight reduction program would be more effective on young or middle-aged populations, to prevent the development of hypertension.

Effect of frailty syndrome on falls in Chinese elderly diabetics in the communities: a prospective cohort study / 中华流行病学杂志

Objective: To explore the relationship between frailty syndrome and falls in the elderly diabetics, in the communities. Methods: A three-year cohort study involving 653 community-dwelling adults who were over 65 years of age and participated in the Survey of Disease, Psychological and Social Needs in Dujiangyan Pingyi Community. Diabetic patients would include those who self-reported as having histories of diabetes or on anti-hyperglycemic therapies. Frailty, functional and other geriatric status were assessed respectively. Falls was defined as having had multiple falls or at least one event but with injury. Results: The highest prevalence of falls was found in the group of frail diabetic group (62.5%). Data showed that baseline frailty was associated with falls in both diabetic and non-diabetic groups but the odds ratio in the diabetic group was higher than that of the non-diabetic group (OR=3.87, 95%CI: 1.45-10.28 vs. OR=6.68, 95%CI: 1.14-38.99). Conclusion: Frailty could be used as a strong clinical predictor to prevent falls, for the elderly diabetic Chinese living in the communities.

Association between blood pressure related dietary patterns and identified cognitive performance in the elderly Chinese-a study by reduced rank regression method / 中华流行病学杂志

Objective: To study the association between blood pressure related dietary pattern and cognitive impairment in the elderly. Methods: In 2015, all participants who were aged ≥60 and participated in the Nutrition and Chronic disease family cohort were involved in the study. Information on demographic variables, lifestyle and health status was collected. Cognitive performance was assessed by the Mini Mental State Evaluation (MMSE) scale. Blood pressure, height and weight were measured by trained medical personnel and fasting venous blood samples were collected for testing on serum level of triglycerides and total cholesterol. Both SBP and DBP were used as response variables when dietary patterns were identified by reduced rank regression method. Logistic regression models were fit to explore the associations of scores on blood pressure-related dietary pattern and cognitive impairment. Results: Two blood related dietary patterns were identified. The first one was characterized by high consumption of vegetables and less meat, eggs and dessert (Pattern 1), while the second one was with high consumption of meat, soy products, wine and fried foods and less intake of dairy (Pattern 2). Data showed that the Pattern 1 was associated with the risk of cognitive impairment. Comparing with the lowest quartile of score of this dietary pattern, the risk of cognitive impairment in the highest quartile group showed a significant (P<0.01) increase, with OR=1.94 (1.21-3.11) and showing significant (P=0.002) linear trend. However, no significant association was observed (P>0.05) with cognitive impairment in the second dietary pattern. Conclusion: Blood pressure-related dietary pattern was positively associated with cognitive impairment.

Prevalence and influencing factors of respiratory symptoms among people aged 40 years and above in China / 中华流行病学杂志

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.

A cohort study on body mass index and risk of all-cause mortality among hypertensive population / 中华流行病学杂志

Objective: To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population. Methods: All participants were selected from a prospective cohort study based on a rural population from Henan province, China. Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality. Restricted cubic spline models were used to detect the dose-response relation. Results: Among the 5 461 hypertensive patients, a total of 31 048.38 person-years follow-up was conducted. The median of follow-up time was 6 years, and 589 deaths occurred during the follow-up period. Compared to normal weight group (18.5 kg/m(2)<BMI<24.0 kg/m(2)) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (<18.5 kg/m(2), 24-28 kg/m(2), and ≥28 kg/m(2)) were 0.83 (95%CI: 0.37-1.87), 0.81 (95%CI: 0.67-0.97), and 0.72 (95%CI: 0.56-0.91), respectively. The dose-response analysis showed a nonlinear, reverse "S" shaped relationship (non-linearity P<0.001). Conclusion: Overweight or obese might have a protective effect on all-cause mortality in hypertensive population, which supports the "obesity paradox" phenomenon.

Antibiotic use in emergency departments of class Ⅲ general hospitals in China / 中华流行病学杂志

Objective: To investigate the utilization of antibiotics in emergency departments (EDs) of class Ⅲ general hospitals in China. Methods: Data from a national monitoring network for rational use of drugs was used. The data included prescriptions of EDs from 114 class Ⅲ general hospitals in 30 provinces (autonomous regions, municipalities) of China. A total of 10 260 595 prescriptions from October 1, 2014 to December 31, 2016 were extracted. The Anatomical Therapeutic Chemical Classification/Defined Daily Dose (DDD) system was used for the classification of antibiotics and calculation of antibiotic use intensity. An auto-regression model was used to analyze the trend over time and seasonal variation of antibiotic use in EDs. Results: The rate of antibiotic prescriptions was 27.82% in EDs, among the antibiotics prescribed, 25.58% were for the combination therapy with 2 or more antibiotic agents, and injectable antibiotic prescriptions accounted for 60.59%. Besides, the number of DDDs per 100 patient visits was 81.84. Broad-spectrum agents were the most commonly used antibiotics, among which the second and third generation cephalosporins, quinolones and macrolides accounted for 23.83%, 21.68%, 19.17% and 7.89% of all prescribed antibiotics, respectively. The use of antibiotics, including prescription frequency and use intensity, in EDs had a slight but significant increase tendency (P<0.05), and the seasonal variation of antibiotic use in EDs was obvious, characterized by the highest frequency and intensity of antibiotic use in winter, the differences were significant (P<0.05). Conclusion: The antibiotic prescription rate in EDs of classⅢ general hospitals in China was controlled at a low level, but the proportions of broad-spectrum antibiotics and injectable antibiotics were high, and a significant increase trend in antibiotic use in EDs was found.

Establishment of the classified evaluation system on the levels of influenza epidemics through a synthetic index method, in Beijing / 中华流行病学杂志

Objective: To establish a classified evaluation system for recognizing the levels of influenza epidemics and to explore the new reporting system on influenza epidemics. Methods: The following 3 indicators, including 1) the number of influenza-like illness, 2) positive rate of detection on influenza virus nucleic acids, and 3) the number of influenza outbreaks were chosen to calculate the synthetic index and to classify the grades of evaluation. Results: 209 weeks during 2013-2017 were classified into 5 grades: Grade 1 were 110 weeks (52.63%), Grade 2 were 47 weeks (22.49%), Grade 3 were 44 weeks (21.05%), Grade 4 were 8 weeks (3.83%), and Grade 5 were 0 week. Conclusion: This classified evaluation system provided simple, comprehensive and comparable reference indicators and used for the evaluation on influenza epidemics, also providing suggestions for influenza prevention and control accordingly.

Epidemiological characteristics of outbreaks of norovirus-GⅡ.2, GⅡ.17 and GⅡ.4/Sydney in Guangdong province, 2013-2017 / 中华流行病学杂志

Objective: To understand the epidemiologic characteristics of outbreaks, caused by norovirus-GⅡ.2、GⅡ.17 and GⅡ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control. Methods: Incidence data of norovirus outbreaks in Guangdong from January 1(st) 2013 to November 30(th) 2017 were collected from Public Health Emergency Management Information System. RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus. Characteristics of norovirus GⅡ.2, GⅡ.17 and GⅡ.4/Sydney outbreaks were analyzed. Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting. Results: From January 1(st) 2013 to November 30(th) 2017, a total of 167 norovirus outbreaks were reported in Guangdong, and 115 outbreaks were caused by norovirus GⅡ.2, GⅡ.17 and GⅡ.4/Sydney respectively. The outbreaks caused by norovirus GⅡ.2 accounted for 39.68% (25/63) in primary schools, 28.57% (18/63) in child care settings, 25.40% (16/63) in middle schools and 6.35% (4/63) in universities. Outbreaks caused by norovirus GⅡ.17 accounted for 41.03% (16/39) in middle schools, 20.51% (8/39) at workplaces, 15.38% (6/39) in primary schools, 12.82% (5/39) in universities, 5.13% (2/39) in communities and child care settings respectively. The outbreaks caused by norovirus GⅡ.4/Sydney accounted for 53.85% (7/13) in universities, 15.38% (2/13) in child care settings and at workplaces respectively, 7.69%(1/13) in primary schools and middle schools respectively. The outbreaks caused by norovirus GⅡ.2 had 77.78% (49/63) of contact transmission, 17.46% (11/63) of food-borne transmission. The outbreaks caused by norovirus GⅡ.17 showed 53.85% (21/39) of food-borne transmission, 15.38% (6/39) of contract transmission, 12.82% (5/39) of water-borne transmission. The outbreaks caused by norovirus GⅡ.4/Sydney had 53.85% (7/13) of food-borne transmission, 38.46% (5/13) of the contact transmission. In terms of the clinical manifestations, the standardized proportion of vomit was 73.76% and the proportion of diarrhea was 42.85% in cases infected with norovirus GⅡ.2, the proportion of standardized of vomit was 76.37% and the proportion of diarrhea was 51.40% in cases infected with norovirus GⅡ.17, with the standardized proportion of vomit was 54.10% and the proportion of diarrhea was 55.95% in cases infected with norovirus GⅡ.4/Sydney. Conclusions: The outbreaks caused by norovirus GⅡ.2 through contact transmission mainly occurred in primary schools, child care settings and middle schools. The outbreaks caused by norovirus GⅡ.17 through food-borne transmission mainly occurred in middle schools and at workplaces. The outbreaks caused by norovirus GⅡ.4/Sydney food-borne transmission and contact mainly occurred in universities.

Estimation on the incidence and mortality of kidney cancer in China, in 2014 / 中华流行病学杂志

Objective: To estimate the incidence and mortality of kidney cancer in China in 2014, based on the cancer registration data. Data was collected through the National Central Cancer Registry (NCCR). Methods: All together, 449 cancer registries submitted required data on incidence and deaths of kidney cancer occurred in 2014, to the NCCR. After evaluation on the quality of data,339 registries were accepted for analysis and stratified by areas (urban/rural) and age groups. Combined with data from the National population in 2014, the nationwide incidence and mortality of kidney cancer were estimated. Data from the 2000 National census was used, and with Segi's population used for the rates of age-standardized incidence/mortality. Results: The qualified 339 cancer registries covered a total population of 288 243 347, with 144 061 915 in urban and 144 181 432 in rural areas. The percentage of morphologically verified cases and cases with only available death certificates were 72.70% and 1.27%, respectively. The mortality to incidence ratio was 0.37. The estimates of new cases were around 68 300 in whole China, in 2014, with a crude incidence rate as 4.99/100 000 (95%CI: 4.95/100 000-5.03/100 000). The age-standardized incidence rates of kidney cancer, estimated by China standard population (ASR China) and world standard population (ASR world) were 3.43/100 000 (95%CI: 3.40/100 000-3.46/100 000) and 3.40/100 000 (95%CI: 3.37/100 000- 3.43/100 000), respectively. The cumulative incidence rate of kidney cancer was 0.40% in China. The crude and ASR China incidence rates for males appeared as 6.09/100 000 (6.03/100 000-6.15/100 000) and 4.32/100 000 (4.28/100 000-4.36/100 000), respectively, whereas those were 3.84/100 000 (3.79/100 000-3.89/100 000) and 2.54/100 000 (2.50/100 000-2.58/100 000) for females. The crude and ASR China incidence rates in urban areas appeared as 6.60/100 000 (95%CI: 6.54/100 000-6.66/100 000) and 4.25/100 000 (95%CI: 4.21/100 000-4.29/100 000), respectively, whereas those were 3.05/100 000 (95%CI: 3.01/100 000-3.09/100 000) and 2.29/100 000 (95%CI: 2.25/100 000-2.33/100 000) in rural areas. The estimates of kidney cancer deaths were around 25 600 in the country, in 2014, with a crude mortality rate of 1.87/100 000 (95%CI: 1.85/100 000-1.89/100 000). The ASR China and ASR world mortality rates appeared as 1.16/100 000 (95%CI: 1.14/100 000-1.18/100 000) and 1.16/100 000(95%CI: 1.14/100 000-1.18/100 000), respectively, with a cumulative mortality rate (0-74 years old) of 0.12%. The crude and ASR China mortality rates were 2.31/100 000 (95%CI: 2.27/100 000- 2.35/100 000) and 1.52/100 000 (95%CI: 1.50/100 000-1.54/100 000) for males, respectively, whereas those were 1.41/100 000 (95%CI: 1.38/100 000-1.44/100 000) and 0.81/100 000 (95%CI: 0.79/100 000- 0.83/100 000) for females. The crude and ASR China mortality rates were 2.49/100 000 (95%CI: 2.45/100 000-2.53/100 000) and 1.42/100 000 (95%CI: 1.40/100 000-1.44/100 000) in urban areas, respectively, whereas those were 1.12/100 000 (95%CI: 1.09/100 000-1.15/100 000) and 0.78/100 000 (95%CI: 0.76/100 000-0.80/100 000) in the rural areas. Conclusions: Both the incidence and mortality of kidney cancer seemed low, in China. However, the incidence of kidney cancer had greatly increased. Our findings suggested that prevention and control strategies for kidney cancer should be focused on males in the urban areas.

Epidemiological characteristics of hepatitis A and hepatitis E in different periods of vaccination in China, 2004-2015 / 中华流行病学杂志

Objective: Through analyzing the epidemiological characteristics of hepatitis A and E and the situation of vaccination, to promote the recommendation profile on Hepatitis E vaccination program, in China. Methods: Three phases of time span were divided as 2004-2007, 2008-2011 and 2012-2015, with age groups divided as <20, 20-29, 30-39 and ≥40. Incidence rates in both different phases and age groups were compared. Numbers of Hepatitis A and E vaccines released and used, were described. Results: Between 2004 and 2015, a declining trend in the reported incidence of hepatitis A (t=-12.15, P<0.001), but an increasing trend in hepatitis E (t=6.63, P<0.001) were noticed. The mean number of hepatitis A cases declined from 6 515 to 1 986 between 2004 and 2007 while the number of hepatitis E cases increased from 1 491 to 2 277 between 2012 and 2015. The peaks of hepatitis E appeared persistent annually, in March. The incidence of hepatitis A declined in three regions, with the western region (3.46/100 000) much higher than the eastern (1.13/100 000) or central regions (1.14/100 000) (χ(2)=32 630, P<0.01). The incidence of hepatitis E increased both in the central (1.74/100 000) and western regions (1.58/100 000), but more in the eastern region (2.66/100 000) (χ(2)=6 009, P<0.01). Incidence of hepatitis A declined in all age groups and declined by 84.36% among the 0-19 group. However, the incidence of hepatitis E showed an increasing trend among the ≥20 group. Incidence rates appeared higher in the older age groups. The coverage of hepatitis A vaccine increased from 62.05% to 93.54%, but with a negative association seen between the coverage of Hepatitis A vaccine and the incidence (F=10.69, χ(2)<0.05). Conclusion: The incidence of Hepatitis A declined sharply in China while hepatitis E was still increasing from 2004 to 2015, calling for the expansion on the coverage of Hepatitis E vaccine in the whole population.

Study on the super-antigen genes of group A Streptococcus pyogenes strains isolated from patients with scarlet fever and pharyngeal infection, in Beijing, 2015-2017 / 中华流行病学杂志

Objective: To analyze the characteristics of super-antigen (SAg) of group A Streptococcus pyogenes (GAS), isolated from patients with scarlet fever or pharyngeal infections in Beijing between 2015-2017. Methods: Throat swab specimens from patients with scarlet fever or pharyngeal infections were collected and tested for GAS. Eleven currently known SAg genes including SpeA, speC, speG, speH, speI, speJ, speK, speL, speM, smeZ and ssa were tested by real-time PCR while M protein genes (emm genes) were amplified and sequenced by PCR. Results: A total of 377 GAS were isolated from 6 801 throat swab specimens, with the positive rate as 5.5%. There were obvious changes noticed among speC, speG, speH and speK in three years. A total of 45 SAg genes profiles were observed, according to the SAgs inclusion. There were significant differences appeared in the frequencies among two of the highest SAg genes profiles between emm1 and emm12 strains (χ(2)=38.196, P<0.001; χ(2)=72.310, P<0.001). There also appeared significant differences in the frequencies of speA, speH, speI and speJ between emm1 and emm12 strains (χ(2)=146.154, P<0.001; χ(2)=52.31, P<0.001; χ(2)=58.43, P<0.001; χ(2)=144.70, P<0.001). Conclusions: Obvious changes were noticed among SAg genes including speC, speG, speH and speK from patients with scarlet fever or pharyngeal infections in Beijing between 2015-2017. SAg genes including speA, speH, speI and speJ appeared to be associated with the emm 1 and emm 12 strains. More kinds of SAg genes profiles were isolated form GAS but with no significant differences seen in the main SAg genes profiles, during the epidemic period.

Research of influence and mechanism of combining exercise with diet control on a model of lipid metabolism rat induced by high fat diet.

OBJECTIVE: To investigate the influence and mechanism of combining exercise with diet control on a model of lipid metabolism rat induced by high fat diet. METHODS: Twenty-four male Wistar rats were randomly divided into 3 groups of 8: normal, model and intervention. The model group and intervention group were fed with high fat diet, while the normal group received basal feed. From day 1, the intervention group was randomly given interventions such as swimming exercise and dietary restriction. The interventions duration were 28 days. At the end of the experiment, the levels of rats' body weight and liver weight were detected, the serum levels of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and hepatic triglyceride content (TG) were detected by using biochemical assay, serum level of gastrin (GAS), motilin (MTL) were assayed by the enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with the level of body weight and liver weight in the normal rats, body weight and liver weight in the rat of the model group were significantly increase (P<0.05 or P<0.01). Plasma concentrations of TC, LDL-C and hepatic TG in the model group were significantly increased compared with those in the normal group (P<0.05 or P<0.01). The contents of GAS, MTL, HDL-C in the model rats'plasma were significantly reduced compared with those of the normal group (P<0.05 or P<0.01). Compared with those in the model group, rats' body weight, liver weight, serum TC, LDL-C, and TG content of liver in the intervention group decreased significantly (P<0.05 or P<0.01). Meanwhile, serum content of GAS, MTL, HDL-C were significantly improved in the intervention rats compared to the model group. CONCLUSION: The action of combining exercise with diet control for lipid metabolism disorder might be related to regulation of GAS, MTL and other gastrointestinal hormones.