Objective：To explore the association between 10 candidate genes on transforming growth factor-β (TGFB) signaling pathway and non-syndromic cleft lip with or without cleft palate (NSCL/P) among Chinese populations, and to study the gene-environment interaction. Methods: A total of 806 Chinese Han NSCL/P trios were ascertained from an international consortium, which conducted a genome-wide association study using a case-parent trio design to investigate the genes affecting risk to NSCL/P. The transmission disequilibrium test (TDT) was used to test for effects of 343 single nucleotide polymorphisms (SNPs) in 10 genes on TGFB signaling pathway including DCN, TGFB1, TGFB2, TGFB3, TGFBR1, TGFBR2, BAMBI, SMAD2, SMAD3 and SMAD4. The conditional regression models were used to test for gene-environment interaction. Results: For TDT, although 19 SNPs showed nominal significant association with NSCL/P, no significant evidence of association was seen for all SNPs in 806 NSCL/P trios after Bonferroni correction. The interactions between genes and maternal smoking, environmental tobacco smoke, alcohol consumption and multi-vitamin supplementation during pregnancy did not attain statistical significance after correction for multiple comparisons. Conclusion: No evidence for SNP effect of genes on TGFB signaling pathway and significant gene-environment interaction was seen in our data.

Objective：To explore the relations among screen-based sedentary behaviors (SSB), family factors and body mass index (BMI) of children, and to study how family factors have effect on BMI through influencing SSB. Methods: A total of 1 846 students aged 7-11 years from 12 primary schools in one district of Beijing were included. Their body weight and height  were measured to calculate the BMI. The time of SSB and family factors were investigated by using questionnaires. The time of SSB was the total time of watching TV and videos, playing computer games and iPad each day during the past 7 days recalled by children. The family factors included the parents’ education, occupation, the parents’time of SSB, whether the parents told their child the harm of SSB, the parents’time limit for the children’s SSB. The parents’education and occupation were used for calculating the family socioeconomic score. Results: The median time of SSB for children was 1 hour/day, and the interquartile range was 1 hour/day. The BMI of the children with the parents’time limit for the children’s SSB less than 120 min/day were smaller than the children with the parents’time limit not less than 120 min/day, in both the boys(1.63 kg/m²，P<0.001) and the girls (0.85 kg/m², P=0.004). The family socioeconomic score, the parents’SSB time, whether the parents told their children the harm of SSB were not related to the children’s BMI . The mediation effects of SSB time for children on the association between the parents’time limit for the children’s SSB and  BMI  were-0.222 kg/m²(95%CI:-0.432, -0.095) for boys and -0.187 kg/m² (95%CI: -0.507, -0.049) for girls , which accounted for 13.67% of the total effects for boys and 22.11% for girls.  Conclusion:The parents’ time limit for the children’s SSB has effect on their BMI  through influencing their SSB time. Parents’ supervision on the behaviors of children produces larger benefit for BMI than health education conveyed by parents. Therefore, parents’ participation in supervising the behaviors of children are indispensable for preventing and controlling childhood obesity.

Objective：To compare the differences of children’s health in different area, and to confirm if the prevalence of respiratory diseases and symptoms among children are closely associated with the air pollution.Methods: A cross-sectional study was conducted in an urban area A and a suburban area B with different levels of air pollution in Beijing. Using a cluster sampling method, we recruited 4 564 children from 3 primary schools in urban A and 4 primary schools in suburban B. Respiratory symptoms were investigated using an international standardized questionnaire including characteristics of children, living conditions, respiratory diseases and symptoms and situation of parents. The concentrations of air pollutants for recent five years were obtained from Reports on the Quality of the Beijing Environment. SPSS 16.0 was used to analyze data.Results: The prevalence of cough, persistent cough, phlegm, persistent phlegm, wheeze and asthma in A area were higher than those in B area［（62.2% vs. 59.9%）, (6.3% vs. 3.1%）, （42.4% vs. 37.4%）,（3.6% vs. 2.4%）,（13.3% vs. 9.9%）and（9.5% vs. 5.4%）］. Except for cough, cough with cold, cough without cold, the prevalence of respiratory diseases and symptoms in A area were significantly higher than those in B area (P<0.05). Logistic regression analysis showed the prevalence of persistent cough, phlegm without cold, asthma in A area were significantly higher than those in B area (P<0.05). Conclusion: Respiratory diseases and symptoms among schoolage children were closely associated with the level of air pollution.

Objective： To study whether the socio-ecological model based on “student-school-family” three-level strategy is effective in obesity prevention.Methods: A total of 3 175 students aged 7 to 18 from 16 schools (4 urban primary schools, 4 rural primary schools, 4 urban secondary schools and 4 rural secondary schools, of which 2 intervention schools were selected, respectively ) were recruited by stratified cluster sampling method. A threemonth intervention using “student-school-family” socio-ecological model was conducted through health education and environment improvement. The intervention contents included knowledge on obesity, healthy diet and physical activities. Their anthropometric indexes were recorded. Results: The intervention prevented obesity(OR=1.12, P<0.05), and was effective in waist circumference (WC) and waist-hip ratio (WHR) (adjusted difference=0.63, 0.02, P<0.05). WC and WHR were reduced in girls (adjusted difference=0.52 & 0.02, P<0.05), and obesity was prevented in girls (OR=1.18, P<0.05). WC and WHR were reduced in boys (adjusted difference=0.73, 0.01, P<0.05). WHR were reduced in urban areas (adjusted difference=0.01, P<0.05). WC and WHR were reduced (adjusted difference=1.05, 0.02,P<0.05) and obesity was prevented (OR=1.18, P<0.05) in rural areas. WHR were reduced (adjusted difference=0.01, P<0.05) and obesity was prevented (OR=1.21, P<0.05) in primary schools. WHR were reduced in secondary schools (adjusted difference=0.02, P<0.05).The intervention effect was better in girls than in boys, in rural areas than in urban areas, and in primary schools than in secondary schools. The overweight and obesity prevalence went down after the intervention (χ2=11.01，P<0.01).   Conclusion:Intervention strategy is effective in central obesity indexes such as WC and WHR, and it can be used widely.

Objective：To analyze the association between obesity and age at spermarche among Chinese Han boys aged 11-18 years . Methods：The height, weight and status of the spermarche of Chinese Han boys aged 11-18 years were selected from the data of 2010 National Physical Fitness and Health Surveillance．The body mass index (BMI), prevalence of spermarche in each age group and ages at spermarche by BMI groups were calculated. Chi square test was used to analyze the differences of prevalences of spermarche among the boys with different BMIs across ages. U-test was used to compare the differences of age at spermarche between the boys who were obese and not. Results: In the boys aged 12 and 17 years in urban areas and boys aged 13 years in rural areas, the differences of prevalences of spermarche among the normal weight, overweight and obesity groups were significant (P<0.05). The age at spermarche in the obesity group (13.90 years) was 0.1 years earlier than that in the nonobesity group (14.00 years) (P<0.05).Conclusion:Obesity may make the age at spermarche ahead of time.

Objective：To analyze the awareness rate of obesity risk factors among children and adolescents, and to provide the basis for preventing their obesity. Methods: The students selected by using stratified cluster sampling method, were measured for the body height, weight, and waist circumference, and were surveyed for the awareness rate of obesity risk factors by using the questionnaire. The distribution characteristics of awareness on obesity risk factors were analyzed. Results: The awareness rate of obesity risk factors was 74.1%, and there was no significant difference on the awareness rate of obesity risk factors between the males ［71.2% (247/347)］ and females ［77.2% (257/333)］, the abdominal obesity students ［73.5% (202/275)］ and nonabdominal obesity students ［74.6% (302/405)］, the overall obesity students ［74.3% (185/249)］ and nonoverall obesity students ［74.0% (319/431)］, respectively. However, the awareness rate of obesity risk factors among the primary school students was 81.9% (272/332) that was higher than that of the middle school students ［66.7% (232/348)］ (P＜0.05). Compared with the primary school students, the nonawareness risk of obesity risk factors would increase among the middle school students (OR=2.23, P＜0.05). Conclusion:The overall awareness rate of obesity risk factors is not high among children and adolescents, especially among middle school students.

Objective： To analyze the secular trends of height among Chinese students aged 17 in different ethnic minorities from 1985 to 2010. Methods: A total of 18 Chinese ethnic minorities’ students, including Mongolian, Hui, Uygur, Zhuang, Korean, Tibetan, Miao, Buyi, Dong, Bai, Tujia, Hani, Dai, Lisu, Wa, Nakhi, Tu and Qiang as subjects were sampled from the 1985, 1995, 2000, 2005 and 2010 Chinese National Surveys on Students’ Constitution and Health. The heights of 17 years old people by gender in various ethnic minorities were analyzed and compared. Results: From 1985 to 2010, the increments of adult heights increased significantly in many ethnic minorities’ boys. In 2010, the average height of boys aged 17 years in each minority group was higher than 162 cm and was higher than 170 cm among boys from Hui, Mongolian and Korean groups. The ethnics with height growth rates of more than 2 cm per decade in boys were Hui (2.64 cm/decade) and Dong (2.05 cm/decade) and the ethnics with height growth rates of more than 1 cm per decade were Korean (1.99 cm/decade), Tibetan (1.90 cm/decade), Hani (1.80 cm/decade) and the other 9 minority groups. The average height of girls aged 17 years in each minority group was higher than 150 cm in 2010. The heights showed an upward trend in 15 minority groups, but with different degrees. The ethnics with height growth rates of more than 1 cm per decade were Hui (1.56 cm/decade) and Korean (1.29 cm/decade). The increments that were significant between 1985 and 2010 were Hui (3.89 cm), Korean (3.23 cm), Dong (2.35cm) and the other 6 minority groups (P<0.05). Conclusion: Our data suggest that the increments of adult heights may reflect the secular growth change in the major minority groups during the past 25 years, but there was an obvious disequilibrium among various ethnic minorities. We should pay more attention to the minority groups with poor growth and give them more help. Meanwhile, we should also pay attention to the negative effects of the secular growth trend on those minority groups with fast increasing adult height.

Objective：To explore the environmental risk factors of different categories of congenital heart defects (CHD) and provide evidence for further risk factors and prevention research of CHD phenotypes. Methods: Data of Guangdong CHD Register Study from 2004 to 2012 were used. In the study, 3 038 CHD cases and 3 038 paired controls from 34 hospitals distributed in 17 cities were registered and related information were collected using uniform, and structured questionnaires. All the CHD phenotypes were coded according to the International Classification of Diseases 10^th Revision (ICD-10) and classified into 6 categories according to their pathological features. Univariate analyses were adopted to filter potential risk factors for each category of CHD. Then multivariate conditional Logistic regression was used to calculate the odds ratios of the risk factors for each category of CHD. Results: The risk factors for left-to-right shunt CHD included low (OR=2.63, 95%CI：2.04-3.39) or over birth weight (OR=2.21, 95%CI： 1.47-3.32), premature delivery (OR=1.95, 95%CI： 1.53-2.49), polyembryony (OR=1.99, 95%CI： 1.22-3.26), maternal low education, mother as factory worker (OR=1.62, 95%CI： 1.32-1.98), parity≥2 (OR=1.38, 95%CI： 1.13-1.69), maternal abnormal reproduction history (OR=2.29, 95%CI： 1.75-3.01), fever (OR=2.38, 95%CI： 1.26-4.48), virus infection (OR=1.80, 95%CI： 1.29-2.51), medicine usage (OR=1.73, 95%CI： 1.11-2.69), passive smoking (OR=1.69, 95%CI： 1.26-2.29), chemical agent contact (OR=8.71, 95%CI： 2.33-32.58), living in newly decorated houses (OR=2.56, 95%CI： 1.60-4.09) or room close to the main road (OR=1.40, 95%CI： 1.14-1.72) in the first 3 months of pregnancy and father as factory worker (OR=1.46, 95%CI： 1.23-1.73). The risk factors for pulmonary outflow tract obstruction CHD included low (OR=5.98, 95%CI： 2.88-12.44) or over birth weight (OR=6.56, 95%CI：1.19-36.26), maternal low education, parity≥2 (OR=2.08, 95%CI： 1.03-4.22), virus infection in the first 3 months of pregnancy (OR=4.30, 95%CI： 1.27-13.45). The risk factors for left ventricular outflow tract obstruction CHD included father as factory worker (OR=6.01, 95%CI：1.05-34.59). The risk factors for transposition of the great arteries included low birth weight (OR=12.93, 95%CI:1.14-146.26), maternal low education, mother as factory worker (OR=3.69, 95%CI:1.53-8.91). The risk factors for conditions with intra cardiac mixing of oxygenated and deoxygenated blood included parity=2 (OR=3.45, 95%CI： 1.42-8.38). The risk factors for other CHD included over birth weight (OR=4.87, 95%CI： 1.19-19.94), maternal abnormal reproduction history (OR=2.96, 95%CI： 1.14-7.68), virus infection (OR=4.92, 95%CI： 1.56-15.47), medicine usage (OR=4.90, 95%CI： 1.22-19.77) or passive smoking (OR=10.31, 95%CI： 1.25-85.05) in the first 3 months of pregnancy. Conclusion：The environmental risk factors were discrepant among different categories of CHD. Further risk factors study of CHD phenotypes should be performed specially. To prevent CHD, attention should be paid to the risk factors which are related to multi or complex categories of CHD.

Objective：To explore the correlation between glycemic control of type 2 diabetes mellitus (T2DM) patients and brachial-ankle pulse velocity (baPWV). Methods: A community-based cross-sectional study was conducted in Beijing, China. Every subject underwent physical examinations, glycated hemoglobin (HbA1c), blood lipid and baPWV measurements and completed a standardized questionnaire. T2DM patients were divided into well controlled and poorly controlled groups according to HbA1c levels. The correlation between glycemic control of T2DM patients and baPWV was analyzed. Results: In this study, 1 341 subjects were recruited, including 733 T2DM patients and 608 non-diabetes subjects. Compared with non-diabetes subjects, abnormal baPWV (baPWV≥1 700 cm/s) rate for T2DM patients was higher (40.8% vs. 26.8%, P<0.001). With HbA1c<6.5% or <7.0% as the aim of glycemic control in T2DM patients, the abnormal baPWV rates for non-diabetes subjects, well controlled and poorly controlled T2DM patients were significantly different (non-diabetes vs. HbA1c<6.5% T2DM vs. HbA1c≥6.5% T2DM: 26.8% vs. 32.8% vs. 42.6%, P<0.001; non-diabetes vs. HbA1c<7.0% T2DM vs. HbA1c≥7.0% T2DM: 26.8% vs. 36.1% vs. 43.4%, P<0.001). After being adjusted for gender, age, smoking status, diabetes mellitus family history, T2DM duration, cardiovascular diseases (CVD), waist hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), total triglycerides (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C), the Logistic regression models suggested that glycemic control status of T2DM patients was associated with abnormal baPWV. Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1c<6.5% T2DM patients and HbA1c≥6.5% T2DM patients were 0.927(95%CI 0.560-1.537) and 1.826 (95%CI 1.287-2.591). Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1c<7.0% T2DM patients and HbA1c≥7.0% T2DM patients were 1.210 (95%CI 0.808-1.811) and 1.898 (95%CI 1.313-2.745). Conclusion:The glycemic control status of T2DM patients from communities is significantly associated with baPWV. Poor glycemic control is a risk factor for abnormal baPWV. Keeping HbA1c under control might lower the risk of cardiovascular diseases in T2DM patients.

Objective：To describe the secular trends of premarital medical examination (PME) in China during 1996 and 2013 and to assess the impacts of national health policies on the PME rate. Methods: The information on marriage and PME for districts and counties in 31 provinces of China was annually collected by the Office for National Maternal & Child Health Statistics of China, and the information on the health policies was from official governmental websites. According to the main health policies, the calendar years were categorized into 3 periods: 1996 to 2003 was mandatory PME period; 2004 to 2008 was encouraged voluntary PME period; and 2009 to 2013 was free-paid voluntary PME period. Results: During the 18-year period, 284 242 719 people were registered for a marriage in which 107 198 795 were examined, giving the PME rate of 37.7%. During the mandatory PME period, the rate ranged 52.7%-67.7% with an average of 60.9% (urban 71.5%, and rural 51.7%). In 2004, the first year when the PME became voluntary, the rate was abruptly dropped to 2.6%, and thereafter gradually increased to 11.5% in 2008. As the policies of the free-paid voluntary PME were subsequently issued, the rate was quickly increased to 52.3% (urban 49.8%, and rural 54.6%) in 2013. The increasing trend was consistently observed both in urban and rural areas, and across East, Middle, West, and Northeast economical regions. However, the rates differed greatly among provinces. In 2013, 5 provinces had rates of >90% (Guangxi 97.5%, Fujian 96.0%, Ningxia 95.4%, Zhejiang 93.4% and Anhui 90.1%), whereas some provinces were stuck at a low rate, including developed and underdeveloped provinces/cities. The PME rate in 2013 was 27.4% for Shanghai, 25.5% for Guangdong, 12.4% for Chongqing, 5.8% for Beijing and 4.6% for Tianjin. Underdeveloped provinces were Guizhou (6.4%) and Qinghai (1.8%). Conclusion: As various national policies to promote voluntary PME were issued, the PME rate was significantly increased after a sharp decline, though it varied greatly by provinces. For provinces with high PME rate, PME-related health benefits need to be evaluated; for provinces with low rate, it is of important practical significance to explore a costeffective health service model that is likely incorporated with pre-pregnancy examination.

Objective：To examine factors that may have impact on the Mini-Mental State Examination (MMSE) screening validity, which could lead to further establishing the general model of the MMSE score in Chinese health elderly and to improve the screening accuracy of the existing MMSE reference. Methods: Based on the data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the MMSE scores of 19 117 normal elderly and 137 dementia patients who met the inclusion criteria were used for the analysis. The area under the curve (AUC) and validity indexes were used to compare the screening accuracy of various criteria. Multiple linear regression was used to identify factors that had impact on the MMSE score for both the normal and dementia elderly. Descriptive analysis was performed for differences in the MMSE scores by age trends and gender between the normal and dementia elderly. Results: The AUC of MMSE was≥0.75（P＜0.05). The MMSE score of the normal elderly declined nonlinearly as the age grew older（male: R²=0.924, P＜0.05; female: R²=0.951, P＜0.05）, and increased nonlinearly as the education level rose（male: R²=0.948, P＜0.05; female: R²=0.859, P＜0.05）. The females had significantly lower MMSE scores than the males, with a faster decline trend with age than the males (95%CI of female partial regression coefficient was not overlapped with 95%CI of male partial regression coefficient). The dementia elderly showed a much lower MMSE score (male: difference of Z score:-1.573, P＜0.05; female: difference of Z score:-1.222, P＜0.05) and tended to with a faster decline speed than that of the normal elderly (95%CI of dementia partial regression coefficient included 95%CI of normal  partial regression coefficient). Conclusion:The screening validity of MMSE in CLHLS is not affected by educational level. The analysis of factors that may impact on the MMSE screening validity are gender, age, vision and residence which with validity identification. These four factors can be used as assist tool of MMSE in the screening of dementia to improve the screening accuracy.

Objective：To evaluate the preventive effects of sound insulation windows on traffic noise. Methods: Indoor noise levels of the residential rooms (on both the North 4th ring road side and the campus side) with closed sound insulation windows were measured using the sound level meter, and comparisons with the simultaneously measured outdoor noise levels were made. In addition, differences of indoor noise levels between rooms with closed sound insulation windows and open sound insulation windows were also compared. Results: The average outdoor noise levels of the North 4th ring road was higher than 70 dB(A), which exceeded the limitation stated in the “Environmental Quality Standard for Noise” (GB 3096-2008) in our country. However, with the sound insulation windows closed, the indoor noise levels reduced significantly to the level under 35 dB(A) (P<0.05), which complied with the indoor noise level standards in our country. The closed or open states of the sound insulation windows had significant influence on the indoor noise levels (P<0.05). Compared with the open state of the sound insulation window, when the sound insulation windows were closed, the indoor noise levels reduced 18.8 dB(A) and 8.3 dB(A) in residential rooms facing North 4th ring road side and campus side, respectively. The results indicated that installation of insulation windows had significant noise reduction effects on street residential buildings especially on the rooms facing major traffic roads. Conclusion:Installation of the sound insulation windows has significant preventive effects on indoor noise in the street residential building.

Objective：To understand the status and identify the determinants of self-treatment of rural floating population in Beijing. Methods: The data were derived from the Fourth National Health Service Investigation of China, part of which was about rural floating population in Beijing. According to Andersen health services utilization model, Binary Logistic Regression model was used to analyze the influencing factors. Results: In the study, 51.7% of the research objects were inclined to self-treatment when they ever felt uncomfortable or sick in Beijing. The Binary Logistic Regression model suggested that, some factors from predisposing, enabling and need, were statistically significant determinants of utilization of self-treatment. Conclusion: There exists a certain percentage of self-treatment behavior for rural floating population in Beijing, and we should take some measures to promote the efficacy and safety of self-treatment.

Objective： To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. Methods: The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study employed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and reimbursements on inpatient services.Results: One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10 000 Yuan outpatient reimbursements saved 9 700 Yuan inpatient expenses. An increase of 10 000 Yuan outpatient expenses led to a decrease of 3 000 Yuan inpatient reimbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/county levels, and no significant impacts on the outpatient services at the city levels. Conclusion: There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design outpatient and inpatient reimbursement policies.

Objective： To examine the utilization and cost of outpatient care and their influencing factors among middle and aged peasant-workers in China. Methods: The data of China Health and Retirement Longitudinal Study (CHARLS) collected in 2011-2012 were used and the data on peasant-workers aged 45 years and older were analyzed with Two-part Model. Results: The four-week outpatient rate of middle and aged peasant-workers was 13.7% (407/2 974). The determinants of the rate included gender, marital status, economic level, household size, the place of insurance enrollment, self-assessed health and having or having no chronic diseases. The average outpatient cost was (400.3±56.7) yuan (RMB) and the median was 138.0 yuan. Multivariate analyses showed that outpatient costs were higher for those males who lived in Eastern China and worked at the same place with insurance enrollment, with fair to bad self-assessed health and chronic diseases. Conclusion: Allowing higher flexibility for migrants to transfer the new rural cooperative medical system(NCMS) between rural and urban areas and thus making reimbursement for medical services provided by undesignated providers received immediately could increase the use of outpatient services.

Objective： To study the influence of contractual medical association on inpatient service performance. Methods: The data came from “Database of Inpatient Record” administered by Department of Medical Insurance. Using diagnosis related groups (DRG) as the tool of risk-adjustment, the third-tier general hospitals and second-tier general hospitals in medical alliance as the intervention group, and the average level of the same grade local hospitals as the control group, the influence of medical alliance on inpatient service performance was evaluated. The difference in difference (DID) method was used for the data analysis. The assessing indicators included the number of DRG group, case mix index (CMI), the total weight, cost efficiency index and time efficiency index. Results: After the establishment of medical association, compared with the average level of the same grade local hospitals, in the third-tier general hospitals of medical alliance, the growth rate of the total weight had declined, and cost efficiency index had increased, while in the second-tier general hospitals of medical alliance, the CMI value had declined, and the cost efficiency index had increased. Conclusion: Contractual medical association played a role of triage patients, and improved the service levels and management efficiency of the second-tier general hospitals.

Objective：To estimate the prevalence of antiretroviral drug resistance in treatment-naive individuals with human immunodeficiency virus (HIV) in China. Methods: Five electronic databases ［Chinese BioMedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese ScienceTechnology Journal Database (VIP), Wanfang Data, and PubMed］ were searched for studies of HIV drug resistance in untreated individuals. Drug resistance data were abstracted then pooled using the random effect model. Subgroup analysis was done across sampling time, location, study population (mean age and infection status), and sample size. Results: Seventy-six studies were included for our meta-analysis (46 in Chinese, 30 in English). The pooled rates of drug resistance to total, to non-nucleoside reverse transcriptase inhibitor (NNRTI), to nucleoside reverse transcriptase inhibitor (NRTI), and to protease inhibitor (PI) were 4.7% (95%CI：4.0%-5.4%), 2.3% (95%CI：1.8%-2.8%), 1.8% (95%CI：1.3%-2.3%), and 1.4% (95%CI：1.1%-1.8%), respectively. All the rates before 2007 were higher than those for 2008 or later. Meanwhile, significant differences were found in the sample areas (P<0.05), in which, the rates in South-central and Southwest were both higher than 5%. The difference was complex between mean age and infection status subgroup, and we found the total prevalence in the group under 25 years and the newly infected, and confirmed group was lower than in the others. For sample size, all the rates in the group under 100 samples were higher than in the others, and the difference was significant (P<0.05). Conclusion: The prevalence of HIV primary drug resistance in China was 4.7%, which stayed low, but was also close to the line set by WHO. Enhanced surveillance for drug resistance is necessary in high epidemic areas including the South-central and Southwest China whose prevalence has crossed the line.

Objective：To investigate the use of simple pooling and bivariate model in meta-analyses of diagnostic test accuracy (DTA) published in Chinese journals (January to November, 2014), compare the differences of results from these two models, and explore the impact of between-study variability of sensitivity and specificity on the differences. Methods:DTA meta-analyses were searched through Chinese Biomedical Literature Database (January to November, 2014). Details in models and data for fourfold table were extracted. Descriptive analysis was conducted to investigate the prevalence of the use of simple pooling method and bivariate model in the included literature. Data were re-analyzed with the two models respectively. Differences in the results were examined by Wilcoxon signed rank test. How the results differences were affected by between-study variability of sensitivity and specificity, expressed by I², was explored. Results:The 55 systematic reviews, containing 58 DTA meta-analyses, were included and 25 DTA meta-analyses were eligible for re-analysis. Simple pooling was used in 50 （90.9%）systematic reviews and bivariate model in 1 (1.8%). The remaining 4 (7.3%) articles used other models pooling sensitivity and specificity or pooled neither of them. Of the reviews simply pooling sensitivity and specificity, 41(82.0%) were at the risk of wrongly using Meta-disc software. The differences in medians of sensitivity and specificity between two models were both 0.011( P<0.001, P=0.031 respectively). Greater differences could be found as I2 of sensitivity or specificity became larger, especially when I²＞75%.Conclusion: Most DTA meta-analyses published in Chinese journals(January to November, 2014) combine the sensitivity and specificity by simple pooling. Meta-disc software can pool the sensitivity and specificity only through fixed-effect model, but a high proportion of authors think it can implement random-effect model. Simple pooling tends to underestimate the results compared with bivariate model. The greater the between-study variance is, the more likely the simple pooling has larger deviation. It is necessary to increase the knowledge level of statistical methods and software for meta-analyses of DTA data.

Objective：To study the mechanism on extracellular signal-regulate kinases (ERK) signal transduction by calcium influx initiated by combination of  estrogen with calcium channels or estrogen receptor in endometrial cancer cell Ishikawa. Methods: Confocal test was used to determine the relative calcium mobilization by stimulation of estrodiol together with and without the inhibition of ICI182780 and nifedipine. Western-blotting was used to detect the protein expression of phosphorylated ERK1/2(P-ERK1/2) in the same condition. Results: The transient calcium flux initiated by 17β-estrodiol (E2) and a membrane-impermeable conjugate of estrogen and bovine serum albumin (E2-BSA), and the calcium mobilization could be inhibited by ICI182780 and nifedipine in 1 min. In Ishikawa cells, phosphorylation of ERK1/2 was stimulated by E2, and the phosphorylation could not be inhibited by E2 after the combination with ICI182780 in 5 min and in 30 min. The phosphorylation also could not be inhibited by E2-BSA after the combination with nifedipine in 5 min, but in 30 min the phosphorylation was decreased. The phosphorylation of ERK by E2-BSA was decreased by the combination with nifedipine in 30 min. Conclusion: The transient calcium flux initiated by estrogen has an effect on the activation of ERK signal pathway in endometrial carcinoma cells.

Objective： To evaluate the safety and efficacy of antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.Methods: In the study, 96 patients suffering from acute ST segment elevation myocardial infarction onset within 12 h undergoing primary percutaneous coronary intervention from May to October in 2013 were randomly divided into ticagrelor group (n=48) and clopidogrel group (n=48) by using the method of random number table. Ticagrelor and clopidogrel antiplatelet treatment were used before and after operation. Their baseline data, coronary artery disease characteristics, platelet count, adenosine diphosphate(ADP)-induced platelet inhibition rate by thrombelastograph after 5 days of treatment, the major adverse cardiovascular events of the follow up for 6 months and bleeding complications were observed and compared in the two groups. Results:  The differences between the two groups of patients with their baseline data, the features of coronary artery lesions, platelet count before and after 5 days of treatment had no statistical significance (P>0.05). ADP induced platelet inhibition rate ［(80.2±10.7)%］ after 5 days of treatment in ticagrelor group was significantly higher than that in clopidogrel group ［(75.3±12.1)%, P<0.05］. The two groups of patients were followed up for 6 months, 8 cases of major adverse cardiovascular events occurred in clopidogrel group, 2 cases of major adverse cardiovascular events occurred in ticagrelor group, and there was significant difference between the two groups (P<0.05). The two groups (7 cases of 48 patients in ticagrelor group vs. 3 cases of 48 patients in clopidogrel group) had no statistically significant difference in bleeding complications (P>0.05).Conclusion: Antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing emergency PCI has good efficacy and safety.

Objective：To analyze the characteristics of hospital infection of hematological disease, so as to provide reference for clinical therapy．Methods: Bacterial strains and antimicrobial resistance of patients with hospital infection in Department of Hematology, Peking University Third Hospital from Jan. 2011 to Dec. 2013 were identified and analyzed retrospectively. The specimens were from their blood, urine, sputum, throat swabs and etc.Results: Among the total of 168 isolates of bacteria，the majority of the bacteria strains were from sputum (42.9%);114(67.9%) bacteria strains were gram negative and 54(32. 1%) bacteria strains were gram positive; the pathogen testing showed that 20.8% were Pseudomonas aeruginosa,18.5% Escherichia coli,17.9% Staphylococcus aureus, 9.5% Klebsiellar pneumonia, 5.9% Staphylococcus epidermis and 27.4% other bacteria ; The gram negative bacilli to cefepime, amikacin and carbapenems showed the lowest antimicrobial resistance rates, and S. aureus showed the lowest antimicrobial resistance rates to vancomycin and linezolid. Conclusion: Patients with hemopathy are the main population of hospital infections, the gram negative bacteria are the most common pathogens．It is very important to promptly know the change in distribution of the pathogens in order to rationally select antibiotics and reduce the incidence of bacterial infections．

Objective：To investigate clinical features of distant metastases (DM)and analyze clinicopathologic risk factors associated with DM from salivary gland carcinomas after being treated by surgery combined with ¹²⁵I internal brachytherapy. Methods: Between October 2001 and March 2010, 197 patients with salivary gland carcinoma were treated by surgery combined with ¹²⁵I internal brachytherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate clinicopathologic risk factors that might influence the risk of distant metastases.Results:  DM occurred in 28 of 197 patients (14.2%). The commonest site of distant metastases overall was the lung 89.3% (25/28), followed by bones 17.9% (5/28) and liver (4/28). DM developed after an average interval of (44.2±45.8) months from the time of initial diagnosis, and the mean interval was 64 months. The average time to death after the diagnosis of DM was only (9.7±13.4) months, and the mean time was 12 months. The 3-year locoregional control rate and survival rate were 90.8%, and 87.8% respectively，and the 5-year ones  84.0% and 81.0%, respectively. Univariate analyses revealed that the risk of distant metastases was significantly influenced by locoregional tumor failure (F=26.997，P<0.01) and histologic differentiation (F=1.592，P<0.01). Multivariate analysis of freedom from distant metastases revealed that locoregional control (F=29.332，P<0.01) significantly influenced this end point. Conclusion: Salivary gland carcinoma could achieve high local control rate after being treated by surgery combined with 125I internal brachytherapy, and the average interval from diagnosis to DM was prolonged, DM was significantly influenced bylocoregional control.

Objective： To investigate the defect types and reconstruction methods of maxillary defects.Methods: The database of 1 107 cases with maxillary defects in Peking University School and Hospital of Stomatology from January 1985 to December 2010 was established. There construction methods were reviewed. The defect types were classified according to Brown classification system.Results: In the 1 107 cases, 1 104 cases could be classified according to Brown classification system. The most common type was 2a with 559 cases (50.6%). Among all the 1 107 cases, 349 cases were reconstructed with autotransplantation, 443 cases with prosthesis, 107 cases untreated, and 208 patients lost to the followup. There was a significant growing trend over time for the application of free flaps and a downward trend of prosthesis. The most popular free flaps were fibular flap (88 cases) and radial forearm flap (75 cases). Rectus abdominis flap and anterolatreal thigh flap were fit for extensive maxillary defects.Conclusion:The most common defect type is 2a. Free flap has become the dominant option for maxillary reconstruction. Free flaps could be selected according to the maxillary defect types.

Objective： To investigate the alveolar bone defects of anterior alveolar bone in patients with bimaxillary protrusion by using cone-beam computed tomography (CBCT). Methods: The samples consisted of 50 patients with bimaxillary protrusion, who were assigned to the teenage group［20 cases, （13.1±1.0） years］ and adult group［30 cases, (22.9±4.2) years］ . The adult group included 9 hypo-divergent, 11 normo-divergent and 10 hyperdivergent patients. The images were obtained by using NewTom VG CBCT and the alveolar defects were evaluated. Results: The ratio of the patients had alveolar bone defects was 94.00%. Meanwhile, the defects were associated with 38.60% of all the teeth. Most defects occurred on labial alveolar bone (98.66%); fenestration was found more in the maxillary alveolar region and dehiscence occurred more in the mandible. The dehiscences (3.06%) and defects prevalence (30.13%) of the teenage group were significant lower than those of the adult group (11.73% vs. 42.46%), P<0.05; while there was no significance of the fenestrations prevalence between the two group (P>0.05). The hypo-divergent group had lower fenestrations prevalence (22.22%) than the normo-divergent (33.84%) and hyper-divergent groups (37.50%), P<0.05. The upper central incisor had the lowest alveolar bone defect prevalence. Conclusion: Alveolar bone defects are common findings in patients with bimaxillary protrusion before orthodontic treatment. The prevalence of defects is affected by age and vertical-growth type.

Objective： To establish the preliminary somatosensory data stratified by gender, age group, and sites in the trigeminal region through standardized quantitative sensory testing on healthy individuals, and to evaluate the effects of gender, age, and sites on somatosensory functions. Methods: The standardised QST battery developed by the German Research Network on Neuropathic Pain consists totally of 13 different parameters. A total of 70 healthy individuals participated. The subjects were stratified into two groups according to age: younger group (16 female, 16 male, age 24-40 years old) and elder group (20 female, 18 male, age 41-69 years old). The test was performed bilaterally over the infraorbital, mental, and hand regions. Results: The preliminary orofacial somatosensory data stratified by gender, age group, and sites were presented. Female were more sensitive than male for most of the parameters (P<0.05). Age had a significant effect on most of the parameters (P<0.05), the younger group was more sensitive compared with the elder group (P<0.01) for heat pain threshold (HPT): younger group (38.07±2.94) ℃, elder group (39.85±3.52) ℃; warmth detection threshold (WDT): younger group (1.40±0.74) ℃, elder group (1.89±1.14) ℃; mechanical detection threshold (MDT): younger group (0.73±1.66) mN, elder group (1.41±2.82) mN; pressure pain threshold (PPT): younger group (171.71±92.51) kPa, elder group (196.36±73.73) kPa; cold pain threshold (CPT): younger group (25.90±5.38) ℃, elder group (21.64±6.78) ℃; cold detection threshold (CDT): younger group (-0.97±0.55) ℃, elder group (-1.36±0.90) ℃, and windup ratio (WUR): younger group (3.33±2.20), elder group (2.67±1.68). The inverse results were demonstrated for mechanical pain threshold (MPT): younger group (111.50±88.93) mN, elder group (104.49±94.94) mN; mechanical pain sensitivity (MPS): younger group (6.96±5.61), elder group (8.93±6.53), and vibration detection threshold (VDT): younger group (7.44±0.52) scale, elder group (7.55±0.48) scale (P<0.05). Somatosensory function was site dependent (P<0.001), the two trigeminal sites (infraorbital and mental) were more sensitive than the hand for CDT, HPT, WDT, thermal sensory limen (TSL), MDT, MPT, MPS, and PPT (P<0.001), but the inverse result was observed for VDT (P<0.001). Conclusion: The preliminary orofacial somatosensory data of Han Ethnicity stratified by gender, age group, and sites were established. The study evaluated the effects of gender, age and sites on orofacial somatosensory functions by employment standardized quantitative sensory testing.

Objective：To compare clinical and radiographic success rates of a modified primary root canal filling (ingredients: zinc oxide-eugenol, iodoform and calcium hydroxide, MPRCF) vs. zinc oxide-eugenol cement (ZOE) and calcium hydroxide/iodoform paste (Vitapex) in pulpectomized primary molars at the end of 6 and 12 months, and to evaluate the degradation of materials in the root canals and in apical area. Methods: In the study, 160 primary molars from 155 children ( the average age: 5.88±1.27 years) that met the inclusion criteria were allocated to one of the three materials via block randomization. A two-visit pulpectomy was performed by an investigator. The clinical and radiographic diagnoses were blindly assessed by other two investigators. Results: At the end of 6 and 12 months, the ZOE and MPRCF success rates were 100% both in clinical and radiographic evaluation. The Vitapex group showed the clinical success of 100% at the end of 6 months and 94.5% at the end of 12 months. Radiographic evaluation for the Vitapex group showed 80.4% success at the end of 6 months and 60.7% at the end of 12 months. No statistically significant differences were noted at the end of 6 months in the three groups both in clinical and radiographic evaluation. The success rates in clinical and radiographic evaluation at the end of 12 months for ZOE and MPRCF groups were not significantly different, and better than those for Vitapex group with statistically significant difference. The completely resorb rate of excess extruded extraradicularly were 14.3%, 100% and 71.4% for ZOE, Vitapex and MPRCF at the end of 12 months. The rates of resorption of material at the same rate of the root were 5.8%, 7.2% and 40.9% for ZOE, Vitapex and MPRCF at the end of 12 months. Conclusion: MPRCF, a mixture of zinc oxide eugenol and iodoform with calcium hydroxide can be used as a root canal filling material in primary teeth, taking account of the success rate and resorbing at a similar rate with the roots of the primary teeth.

Objective：To assess the repeatability（intraobserver comparison）and reproducibility（interobserver comparison）of two different methods for establishing the occlusal plane on digital dental models．Methods:With Angle’s classification as a stratification factor，48 cases were randomly extracted from 806 ones which had integrated clinical data and had their orthodontic treatment from July 2004 to August 2008 in Department of Orthodontics，Peking University School and Hospital of Stomatology．Post-treatment plaster casts of 48 cases were scanned by Roland LPX-1200 3D laser scanner to generate geometry data as research subjects．In a locally developed software package，one observer repeated 5 times at intervals of at least one week to localize prescriptive landmarks on each digital model to establish a group of functional occlusal planes and a group of anatomic occlusal planes, while 6 observers established two other groups of functional and anatomic occlusal planes independently．Standard deviations of dihedral angles of each group on each model were calculated and compared between the related groups．The models with the five largest standard deviations of each group were studied to explore possible factors that might influence the identification of the landmarks on the digital models．Results: Significant difference of intraobserver variability was not detected between the functional occlusal plane and the anatomic occlusal plane （P＞0.1），while that of interobserver variability was detected （P＜0.001）．The pooled experimental standard deviation the 6 observers established for the functional occlusal plane was 0.2° smaller than that of the anatomic occlusal plane．The functional occlusal plane’s variability of intraobserver and interobsever did not differ significantly （P＞0.1），while the anatomic occlusal plane’s variability of the intraobserver was significantly smaller than that of the interobserver （P＜0.001），with a 0.12° difference value of the pooled experimental standard deviation．Conclusion: When one observer measures a number of digital models，both the functional and the anatomic occlusal planes are suitable as a conference plane with equal repeatability. When several observers measure a large number of digital models，the functional occlusal plane is more reproducible than the anatomic occlusal plane，but the difference is small．

Objective：To optimize and establish the experimental methods for the determination of 2,4-dihydroxybenzophenone (BP-1) in mouse brain. Methods: BP-1 was determined by high performance liquid chromatography (HPLC) and separated by Waters Symmetry^® C18 (4.6 mm×250 mm, 5 μm) using isocratic elution, and the sample preparation conditions were optimized by orthogonal experiment design. The mobile phase was methanolwater (volume ratio 3∶1) containing 3% (volume fraction) acetic acid (pH 3.40) at a flow rate of 1.0 mL/min, and ultraviolet (UV) detection wavelength was set at 290 nm. Retention time was used for qualitative analysis and internal standard method for quantitative analysis. Results: Under the optimized experimental conditions, the calibration curve was linear with a correlation coefficient of 0.999 8 over the concentration range of 0.2-10.0 mg/L. The recoveries of BP-1 were between 96.8% and 104.5%. The intra-day and inter-day precision of BP-1 were 3.5%-5.7% and 4.5%-6.4%, respectively. The extraction recoveries of BP-1 at three concentrations (0.5, 2.0, 8.0 mg/L) in the mouse brain were 90.5%, 89.5%, and 97.7%, and the matrix effect of BP-1 at these three concentrations were 102.9%, 102.7%, and 90.9%, respectively. Conclusion:The method is simple, accurate, and suitable for determination of the contents of BP-1 in mouse brain.

Objective：To report a rare type of aortic arch aneurysm. Methods: Three cases of aortic arch aneurysm derived from the fourth aortic arch were retrospectively analyzed. The pathogenesis and treatment of this type of aortic arch aneurysm were investigated. Results: Most of the aneurysm body was located in the Z2 zone, which was the stem from the fourth aortic arch in the embryonic development period. All of the 3 cases could not be explained by common etiology. We speculated that the cause might be developmental anomaly of the fourth aortic arch. All the 3 aortic arch aneurysms were totally excluded with a covered stent. The technical success rate was 100%. Endoleak of type Ⅰ was seen in one case, which was resolved in a later open surgery. During the follow-up, no type of complications was found. Conclusion:To the best of our knowledge, this is the first report of this type of aortic arch aneurysm. The cause may be developmental anomaly of the fourth aortic arch. Endovascular treatment of this type of aortic arch aneurysm is feasible.

Traffic noise pollution problem is increasingly emerging with the rapid development of urban traffic. Researchers have paid close attention to the health effects of traffic noise. This review has summarized the recent research progress in the health effects of traffic noise both at home and abroad. Traffic noise can have various adverse health effects, and most of them are extra-auditory effects. The main aspects include that traffic noise can affect the cardiovascular system, which is verified by the evidence that exposure to traffic noise significantly increases the risk for cardiovascular diseases, such as high blood pressure, myocardial infarction, coronary heart disease, and so on. In addition, traffic noise can induce adverse effects on nervous system, leading to the increasing levels of anxiety, noise annoyance, and occurrence of insomnia. Furthermore, traffic noise is significantly associated with adverse pregnant outcomes, and can affect the endocrine system and digestive system. As traffic noise and traffic related air pollutants co-exist in the traffic environment, whether there are joint effects between these two factors have become areas of research focus nowadays. Although there is sufficient evidence that traffic noise has adverse health effects, inadequacies still existe. Analysis of the shortages of current studies and the prospects of the future studies are pointed out in this review.