Volume 95  ·  Issue 08  ·  2015

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow restriction. Conditions have previously been assessed based on forced expiratory volume at the first second (FEV₁) as a percentage of estimated value (FEV₁% predicted value) and classified patients into the Global Initiative for COPD (GOLD)^[1]Grades I ~ IV. With similar FEV due to heterogeneity in patients with COPD₁Patients with % predicted values may have different clinical conditions. In 2011, GOLD recommended a new comprehensive assessment method covering the degree of airflow restriction, symptoms, acute exacerbations, and comorbidities, and divided patients into groups A, B, C, and D according to the first three. Symptom scores were assessed using the modified British Medical Research Council Dyspnea Scale (mMRC) score and the Chronic Obstructive Pulmonary Assessment Test (CAT) score, mMRC score 0 to 1 or CAT<10 were divided into the group with few symptoms, mMRC score ≥2 or CAT ≥10 were divided into the group with multiple symptoms; Acute exacerbation Acute exacerbation in the past year<2 times or hospitalization for acute exacerbation<Once was the low-risk group, and ≥2 acute exacerbations in the past year or ≥1 hospitalization due to acute exacerbations were the high-risk group; The pulmonary function was classified as GOLD, and Grade I and II were low-risk groups, and Grade III and IV were high-risk groups. If the two risk assessments are inconsistent, the higher risk method will prevail. Group A with fewer symptoms and low risk, Group B with more symptoms and low risk, Group C with fewer symptoms and high risk, and Group D with more symptoms and high risk. Comprehensive assessment method compared with FEV alone₁The % predicted value can better reflect the complexity of COPD.

Lung cancer is a malignant tumor with the highest morbidity and mortality rate in the world, and the 5-year survival rate is only 16.8%^[1]In 2010, the incidence and mortality of lung cancer ranked first among all malignant tumors in China^[2]。 Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all pathological types of lung cancer, and>70% of them are diagnosed at advanced stage^[3]Systemic chemotherapy has been the main treatment option for this group of patients. At the beginning of the 21st century, with the continuous deepening of molecular biology research, NSCLC can be classified by molecular phenotype according to the different expression of various molecular markers, and new drugs can be developed targeting driving genes related to tumorigenesis and development., and carry out targeted individualized molecular targeted therapy. At present, individualized treatment based on molecular markers has moved from laboratory to clinical, and has made significant clinical progress in the treatment of patients with advanced NSCLC, which also includes clinical trials involving many Chinese doctors and Chinese patients. Gefitinib (trade name: Iressa) is a selective epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). It is the world's first small molecule targeted drug for the treatment of NSCLC. It was launched in my country in February 2005. Due to the launch of gefitinib and the development of molecular targeted therapy, the research of lung cancer in China has made leap-forward progress, and the treatment effect of patients has been significantly improved. This article will systematically review the course of molecular targeted therapy for NSCLC in China in the past ten years from four aspects: clinical research and application of targeted drugs for advanced NSCLC, detection methods and quality control of molecular targets, clinical molecular epidemiology and development of molecular diagnostic reagents.

To survey the present status of medical treatment for Chinese outpatients with chronic obstructive pulmonary disease (COPD) based upon the guidelines for diagnosing and treating COPD (2007 Revised Edition and 2013 Revised Edition) and explore the impact of new guideline on treatment regimens.

A retrospective study was conducted at 11 participating hospitals. Stable COPD patients were consecutively recruited from outpatient clinics in China between September 2007 and December 2008 and categorized into the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I-IV classification and A-D groups according to the Chinese guidelines for diagnosing and treating COPD (2007 Revised Edition and 2013 Revised Edition). The authors compared the present status of medical treatment of two guidelines and analyze the impact of new guideline on treatment regimens.

Among a total of 749 patients, 79.2% (593/749) patients received medical treatment. The distribution of classification GOLD I-IV was 34 (4.5%), 211 (28.2%), 309 (41.3%) and 195 (26.0%). According to the guideline 2007, the patients on medical under-treatment based upon the guidelines in GOLD I-IV classification were 32.4% (11/34), 53.6% (113/211), 57.6% (178/309) and 55.4% (108/195); those on medical treatment: 23.5% (8/34), 3.8% (8/211), 28.8% (89/309) and 33.3% (65/195); those on medical over-treatment: 44.1% (15/34), 42.7% (90/211), 13.6% (42/309), 11.3% (22/195). The distribution of categories A-D was 93 (12.4%), 45 (6.0%), 196 (26.2%), and 415 (55.4%). According to guideline 2013, the patients on medical under-treatment were 34.4% (32/93), 62.2% (28/45), 67.9% (133/196) and 60.7% (252/415); those on medical treatment: 24.7% (23/93), 4.4% (2/45), 32.1% (63 /196) and 39.3% (163/415); those on medical over-treatment: 40.9% (38/93), 33.3% (15/45), 0 and 0. The concordance analysis comparing the judgments of treatment regimens by these two guideline yielded a weighted Kappa coefficient of 0.534 (P<0.001), indicating that there was a moderate degree of judgments between two guidelines. Medical treatment regimens recommended by new guideline was different from old guideline in 143 COPD patients. Among them, 24 patients (16.8%) required a step-down therapy while 119 patients (83.2%) a step-up therapy.

There are more outpatients with COPD on medical treatment, but few of them have received standardized treatment. Compared with the old GOLD classification, more patients are recommended for a step-up therapy by new stratification.

To explore the relationship between desmosine plasma levels and exacerbation risk in patients with chronic obstructive pulmonary disease (COPD).

COPD patients and normal subjects were recruited from Beijing Hospital during March 2013 to March 2014. COPD patients were divided into COPD low risk and COPD high risk groups according to the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy. The plasma concentrations of desmosine were measured by enzyme-linked immunosorbent assay (ELISA) for exploring the inter-group difference in desmosine levels.

Sixty-three COPD patients (COPD low risk group, n=30; COPD high risk group, n=33) and 50 normal subjects (24 healthy non-smokers, 26 healthy smokers) were recruited. The plasma desmosine concentrations in healthy non-smokers, healthy smokers, low risk and high risk COPD patients were (200±159), (191±105), (197±118) and (131±47) ng/L respectively. The plasma concentration of desmosine was significantly lower in COPD high risk group than healthy non-smokers (mean difference -70, 95% CI: -128--11, P=0.021), healthy smokers (mean difference -60, 95% CI: -118--3, P=0.039) and COPD low risk group (mean difference -67, 95% CI: -122--12, P=0.018). The plasma concentration of desmosine was negatively correlated with exacerbation frequency (r=-0.409, P=0.002), mMRC scores (r=-0.447, P=0.010) and emphysema severity (r=-0.386, P=0.047) in COPD patients. No significant correlation existed between desmosine plasma levels and forced expiratory volume in one second (FEV₁% pred) in COPD patients (r=0.225, P=0.084).

The plasma levels of desmosine are lower in high risk COPD patients than those in normal subjects or low risk COPD patients. And it is negatively correlated with exacerbation frequency in COPD patients.

To explore the role and mechanism of heat shock protein 70 (HSP70) in airway hypersecretion.

After a stimulation of 8% cigarette smoke extract (CSE), airway cells A549 were treated with HSP70 antibody and c-Jun N-terminal kinase (JNK) specific inhibitor SP600125 respectively. And the cells were divided into 4 groups of blank contrast (serum-free medium), CSE stimulation (8% CSE for 24 h), HSP70 antibody (30-min pre-treatment of HSP70 antibody and culturing in 8% CSE for 24 h) and SP600125 (30-min pre-treatment of SP600125 30μmol/L and culturing in 8% CSE for 24 h). The relative expression levels of MUC5AC protein in various groups were determined by enzyme-linked immunosorbent assay (ELISA). And the relative transcription level of MUC5AC mRNA was detected by reverse transcription-polymerase chain reaction (PCR) while the synthesized levels of HS70 as well as the phosphorylation levels of JNK and activated protein-1 (mostly c-Jun) were measured by Western blot.

As compared with those in blank contrast group (0.26±0.10, 0.28±0.06, 0.30±0.05, 0.30±0.08, 0.36±0.08), HSP70 antibody group (0.30±0.12, 0.29±0.09, 0.34±0.06, 0.47±0.19, 0.39±0.13) and SP600125 group (0.38±0.06, 0.31±0.14, 0.39±0.04, 0.44±0.12, 0.48±0.11), the relative expression levels of MUC5AC protein and mRNA, phosphorylation JNK (p-JNK), c-Jun and p-c-Jun (0.52±0.07, 0.64±0.11, 0.73±0.06, 0.67±0.10, 0.67±0.09) significantly increased in CSE stimulation group (all P<0.05). And the synthesis levels of HSP70 (0.75±0.09) in CSE stimulation group increased than blank contrast group (0.29±0.03) and HSP70 antibody group (0.40±0.11) (allP<0.05).

HSP70 may enhance the expression of MUC5AC in bronchial epithelial A549 cells via a signaling pathway of JNK/AP-1.

To investigate the clinical features, mechanism of resistance and molecular epidemiology of carbapenem-resistant Acinetobacter baumannii (CRAB) infections at Shenzhen People's Hospital during an 8-year period.

A. baumannii isolates were recovered from nosocomial infections patients at this hospital from 2002 to 2009. The minimum inhibitory concentrations (MICs) of antimicrobial agents against A. baumannii isolates were detected by agar dilution method. Polymerase chain reaction (PCR) and DNA sequencing were used to examine the carbapenemase genotype among CRAB. All isolates were typed by pulse field gel electrophoresis (PFGE). Clinical cases of CRAB infections were retrospectively analyzed according to Chinese experts' consensus on diagnosis, treatments, preventions and controls ofAcinetobacter baumannii infections in China.

A total of 87 cases of CRAB nosocomial infections were diagnosed in this study. The most prominent infections caused by CRAB was lung infections, followed by bloodstream infections, wound infections and abdominal infections, accounting for 69.0%, 8.0%, 8.0% and 6.9% of 87 cases, respectively. Approximately 80.5% (70/87) of CRAB isolated from intensive care unit (ICU). A sharp increase of CRAB infections (42/87) occurred in 2009, with the majority of pulmonary infections (34/42). Genotyping by PFGE found eight distinct PFGE patterns among 87 isolates of CRAB. The prominent CRAB clone A, carrying a bla_OXA-58-like carbapenemase gene, had been prevalent from 2002 to 2006 at this hospital. The CRAB clone C, harboring a bla_OXA-23-like carbapenemase gene, as well as clone A became the prominent clones during 2007 to 2008. The CRAB clone D, carrying a bla_OXA-23-like carbapenemase gene, replaced clone A and C, and became the dominant clone in 2009.

The spread of the CRAB clone D harboring a bla_OXA-23-like gene causes a rapid increase of CRAB infections at this hospital during 2009.

To retrospectively explore the status of primary patency after subintimal angioplasty (SIA) and identify the risk factors affecting for primary patency of occlusive lesions in femoral arteries after SIA in patients with diabeticses mellitus.

From January 2009 to May 2011, 43 diabetics patients with 43 occlusive femoral arteries were successfully underwent subintimal angioplasty successfully with or without stenting. Recurrent stenosis was defined as an arterial diameter reduction of over 50%. And arterial occlusion was confirmed by an absence of color or power signal in the arterial lumen measured on color Doppler. The Kaplan-Meier method was employed to determine the primary patency. A multivariate analysis was performed with Cox's proportional hazard regression model to determine the independent factors for effects on primary patency.

A total of 17 morphologic abnormalities occurred during a median follow-up period of 21 (14-32) months. The median follow time of the successful 43 patients was 21 months (from 14 to 32 month). Minor complications occurred in 4 patents. There was no early mortality. A total of 17 morphologic abnormalities occurred during follow-up. The cumulative primary patency at 6、12, 12 and 24 months were (86±5)%, (75%±7)% and (43±12)% respectively. Primary patency was affected negatively by the number of occlusive run-off vessels (B=-4.417, S=1.627, P=0.007) and the severity degree according to the Inter-society consensus for the management of peripheral arterial disease (TASC II) classification (B=-2.502, S=0.955, P=0.009), and positively by the a history of smoking (B=3.115, S=1.523, P=0.041).

Subintimal angioplasty is a less invasive procedure with a lower rate of morbidity and adequate cceptable patency. And the number of occlusive run-off vessels, lesion typing degree of severity according to the TASCIIclassification negatively and smoking positively have significant influence effects on the primary patency in diabetics patients.

To explore the predictive significance of FOXP3 Tregs in patients with breast cancer on neoadjuvant chemotherapy (NACT).

A total of 78 newly diagnosed and untreated patients with invasive breast cancer were recruited for this retrospective study. FOXP3 Tregs were assessed by immunohistochemistry. The relationship between clinicopathological factors, FOXP3+ Tregs and pathological complete response (pCR) rate was analyzed.

Among 78 patients with TAC neoadjuvant chemotherapy, the pCR rate was 19.2%. The pCR rate of patients with high expressions of FOXP3+ Tregs was significantly lower than that of those with low expressions of FOXP3+ Tregs (9.5% vs 30.5%, P=0.023). FOXP3+ Tregs expression in breast cancer and efficacy of NACT were negatively correlated.

FOXP3+ Tregs may serve as a predictor for assessing the efficacy of NACT.

To explore the functions of inflammatory cytokine, tissue factor (TF) and cancer procoagulant (CP) in non-tumor deep venous thrombosis (NT-DVT).

A total of 17 NT-DVT patients (5 males and 12 females) were selected for NT-DVT group while 20 voluntary (10 males and 10 females) blood donors for control group from May 2012 to March 2013. The levels of inflammatory cytokines interleukin 1β (IL-1 β), IL-18, tumor necrosis factor alpha (TNF-α), TF and CP were tested by enzyme-linked immunosorbent assay (ELISA) before and after treatment. Also the correlations of inflammatory cytokines and TF were determined.

The levels of inflammatory cytokines and TF were higher in NT-DVT than those in control group pre-treatment ((153.13±2.30) vs (59.26±1.57) ng/L, (364.27±1.46) vs (67.46±1.48) ng/L, (363.51±1.85) vs (216.42 ±1.55)μg/L, (66.90±1.44) vs (14.55±1.52) ng/L, allP<0.05). And after anticoagulant therapy, the levels decreased (allP<0.05). Also the levels of IL-1β, IL-18 and TNF-α were positively correlated with TF pre-treatment. And the correlation coefficients were 0.492 (P=0.045), 0.652 (P=0.005) and 0.511 (P=0.036) respectively. Compared with control group, the plasma level of CP had no obvious change before and after treatment (both P>0.05).

A high level of inflammatory cytokines is an important risk factor for NT-DVT.

To establish a murine model of hindlimb ischemia and denervation and evaluate the effects of neural factors on angiogenesis and skeletal muscle fiber remodeling.

A total of 54 mice were randomly allocated into three groups of control (n=6), hindlimb ischemia (n=24), hindlimb ischemia and denervation (n=24). The model of hindlimb ischemia was established by ligating femoral artery. And the model of hindlimb ischemia and denervation was established by transecting sciatic nerve on the basis of hindlimb ischemia modeling. Gastrocnemius of ischemic hindlimbs were harvested under the condition of peritoneal cavity anesthesia at Days 7, 14, 21 and 28 postoperation. And then the mice were sacrificed. The gastrocnemius of three groups were tested by hematoxylin-eosin staining, CD31 and PCNA immunohistochemical staining and myosin ATPase staining. The protein expressions of nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) were detected by enzyme-linked immunosorbent assay.

At Day 7 postoperation, hindlimbs of two intervention groups showed ischemic manifestations as compared with controls. And semiquantitative assessment of ischemic damage showed the proportion level I-IV of hindlimb ischemia and denervation group was significantly higher than that of hindlimb ischemia group (33.4% vs. 16.6%, χ ²=7.94, P=0.047). At Day 28 postoperation, the values of endothelial cell proliferation index [(2.4±0.4)% vs. (5.7±1.0)%, P=0.000], capillary density [(0.44±0.05) vs. (0.61±0.07), P=0.000], NGF protein expression [(6.71±0.94) vs. (8.36±0.77) pg/ml, P=0.008] and VEGF protein expression [(11.32±1.56) vs. (15.13±2.93) pg/ml, P=0.018] of hindlimb ischemia and denervation group significantly decreased as compared with hindlimb ischemia group. At Day 28 postoperation, the proportion of typeII muscle fiber in gastrocnemius was significantly higher than that of hindlimb ischemia group [(84.9±3.8)% vs. (78.8±1.8)%, P=0.008].

Neural factors play important roles in promoting angiogenesis and maintaining muscle fiber types in ischemic limbs. But its molecular regulatory mechanism requires further studies.

To explore the effects of somatostatin (SST) on macaque intestinal Peyer's patches (PP) in immune B cells and explore its mechanism.

A total of 15 healthy adult macaques were randomized into control, MODS and MODS+ SST groups. Surgical procedures of MODS in macaques: For MODS group, anesthesia was maintained with diazepam (0.16±0.09) mg·kg^-1·h^-1, i.v.). A catheter was inserted into a peripheral vein for infusing 0.9% saline and 20 g glucose (0.1-0.2 ml·kg^-1·min^-1, i.v.gtt) for 24 h. Midline laparotomy was performed. Then superior mesenteric artery (SMA) was isolated and occluded with a microsurgical clip. After a 1-hour occlusion, clip was removed and intestinal perfusion reestablished. In MODS+ SST group, SST was infused intravenously with a syringe pump at a dosage of 5 μg·kg ^-1·h^-1 for 5 min before an occlusion of SMA until the end of experiment. Venous blood samples were redrawn and the animals sacrificed at 24 h post-IIR for harvesting vital organs. The changes of organs and the morphological changes of PP were detected by hematoxylin and eosin. And the expressions of TLR4, TLR2, CD20, CD5, α4β7 and MadCAM-1 were evaluated by immunohistochemical staining. Semiquantitative immunohistochemical analysis of raw data was performed with Image Pro Plus 4.0 software.

All animals in MODS group presented with small intestines PP increased both in number and size compared with control group (4.8±2.3 vs 1.2±0.9, P<0.05). After prophylactic to SST, compared with MODS group, the number of PP in small intestines in MODS+ SST group decreased (2.7±1.5 vs 4.8±2.3,P< 0.05), but there was no significant difference in morphological of PP. The expression of CD20⁺ of B-cells in MODS group was significantly lower than in normal group (integrated optical density (IOD), 64.22±42.45 vs 100.00±86.67, P< 0.05). Interestingly, after prophylactic dosing of SST, the expression level of CD20⁺ of B-cells elevated significantly in MODS+ SST group compared with that in MODS group (129.02±75.04 vs 64.22±42.45, P< 0.05). There was no α4β7 expression of B-cells in PP of macaques in three groups. And the expression level of MadCAM-1 was strongly up-regulated after prophylactic dosing of STT compared with MODS. After prophylactic dosing of STT, the expressions of TLR4 and TLR2 declined significantly compared with MODS (56.60±6.83 vs 93.26±10.40, 35.56±4.71 vs 62.06±9.90,P< 0.05). Plasma cells within normal intestinal mucosa were predominantly located in lamina propria. During MODS, plasma cells almost disappeared. After prophylactic dosing of STT, compared to MODS group, there was a rebound of plasma cells.

Endogenous SST controls the switch of B-cells in PP between natural and acquired immunities. The prophylactic dosing of SST could convert excessive natural immunity into beneficial acquired humoral immunity. And SST may facilitate the prevention of multiple organ dysfunction syndromes.

Sterol regulatory element binding protein-1c (SREBP-1c) is a master regulator of fatty acid synthase and controls lipogenesis. And insulin receptor substrate-1 (IRS-1) is a key insulin signaling mediator in skeletal muscle. The present study was conducted to explore the mechanism of SREBP-1c in the regulation of IRS-1 in skeletal muscle cells and elucidate the role of SREBP-1c in high fat-induced skeletal muscle insulin resistance.

L6 cells differentiated into myotubes in differentiation medium with 2%FBS. An in vitro insulin resistant model in L6 myotubes was established by 500 μmol/L of palmitate acid (PA). SREBP-1c, p-IRS-1 (Tyr608/612), IRS-1, p-AKT (Ser473) and AKT were detected by Western blot after incubating L6 myobutes with 500 μmol/L of PA for 0.5, 1, 3, 6, 12, 18 or 24 h. SREBP-1c, FAS and molecules related to insulin signaling pathway were detected by Western blot when L6 myotubes over-expressed SREBP-1c or after a treatment of liver X receptor (LXR) agonist (TO901317, 5 μmol/L). The regulatory effects of transcription factor SREBP-1c on promoter region of IRS-1 were assessed by dual-luciferase reporter assay.

SREBP-1c protein expression increased significantly after 1-hour exposure to PA. The protein levels of p-IRS-1 (Tyr608/612), IRS-1 and p-AKT (Ser473) decreased significantly after a 6-hour incubation of PA. However AKT protein levels were unaffected. The protein expressions of SREBP-1c and FAS were up-regulated by LXR agonist treatment versus controls. By contrast, LXR agonist treatment led to decreased expressions of IRS-1, p-IRS-1 (Tyr608/612) and p-AKT (Ser473)/AKT proteins versus controls. The expressions of related proteins were similar to the observations made with LXR agonist intervention. The results of dual-luciferase reporter assay indicated that IRS-1 promoter activity was repressed significantly by SREBP-1c over-expression or TO901317 treatment whereas the dominant negative form of SREBP-1c (a mutant of Tyr320Ala lacking the ability of binding DNA) had no effect.

SREBP-1c may suppress IRS-1 expression and the subsequent insulin signaling pathway. And it plays a key role in PA-induced insulin resistance of skeletal muscle.

Chronic obstructive pulmonary disease (COPD) often coexists with other diseases and has a significant impact on prognosis. Including cardiovascular disease, osteoporosis, skeletal muscle weakness, metabolic disease, bronchiectasis, depression, etc. Among them, cardiovascular disease is the main complication of COPD and is the most common and important disease coexisting with COPD^[1]。 The most important risk factors for COPD patients include smoking, age and environmental pollution. However, studies have shown that the effect of COPD on cardiovascular disease is independent of these risk factors^[2]。 According to epidemiological statistics, the probability of COPD complicated with heart failure is very high, estimated to be 11% ~55%^[3]。 In a small case-control study, COPD patients had a 70.9% probability of developing diastolic dysfunction, compared with a 27.5% probability in age-matched healthy controls^[4]。 Recent studies have shown that emphysema (including static and ambulatory emphysema), pulmonary hypertension, skeletal muscle weakness and coronary ischemia caused by COPD are closely related to the effects on cardiac function^[5]。

Chronic heart failure (CHF) is the terminal stage of many cardiovascular diseases. Because of its high hospitalization and mortality rate, it has been a difficult problem in the treatment of cardiovascular diseases. In recent years, cardiac resynchronization therapy (CRT) has received extensive attention in the industry as a new technology for the treatment of CHF. However, according to the current guideline inclusion criteria, about 30% to 40% of patients are still unresponsive to CRT^[1]。 According to statistics, about 5.1 million people in the United States suffer from CHF. If calculated according to this ratio, about 2 million patients in the United States alone do not respond to CRT. The high non-response rate has greatly limited the development and popularization of CRT technology^[2]。 Therefore, how to improve CRT reactivity has become an urgent problem today. As an important surgical inclusion index at present, QRS wave time limit has become the focus of widespread attention. The effect of QRS wave time limit on CRT responsiveness is summarized below.

Babesiosis is a species of Babesiosis parasitic in red blood cells (Babesia) zoonosis transmitted by the bite of an Ixodes tick, which can be transmitted from person to person by placental, perinatal and blood transfusion routes^[1,2]。 The disease is not uncommon in clinic and has great potential risk. The clinical manifestations of patients vary in severity, from asymptomatic or subclinical manifestations to acute fulminant infection, and even lead to death in special populations (such as the elderly, immunosuppressant therapy and HIV infected people, etc.)^[3]。 According to statistics, the mortality rate among hospitalized patients is 6% ~9%, and the mortality rate of those with a history of immunosuppressive therapy or blood transfusion is about 20%^[4,5,6,7]。 Some patients have a history of outdoor camping, such as mountaineering, hunting, boating, etc., which increases the chance of contact with ticks, resulting in an increase in tick-borne diseases, and babesiosis infection is particularly prominent. Between 2005 and 2007, 600 cases of human babesiosis were reported in the United States; 632 cases were reported in 2011^[8]。 In recent years, a few cases have also been reported in China. This article reviews the new research progress of human babesiosis as follows.

irritable bowel syndrome (IBS) is a common functional bowel disease, with abdominal pain or abdominal discomfort as the main symptom, which can improve after defecation, often accompanied by changes in defecation habits, but no structural or biochemical abnormalities that can explain the symptoms of the disease were found in relevant routine examinations^[1]。 According to the Rome III diagnostic criteria of functional gastrointestinal diseases, IBS can be divided into constipation-predominant irritable bowel syndrome (IBS-C), diarrhea-predominant irritable bowel syndrome (IBS-D), Four subtypes: mixed (IBS-M) and amorphous (IBS-U). The prevalence of IBS worldwide is 2% to 15%^[2]The prevalence of IBS in China is relatively low. According to Manning diagnostic criteria and Rome II criteria, the prevalence of IBS in Beijing is 7.26% and 0.82%, respectively^[3]Using Rome II as the diagnostic criterion, the prevalence of IBS in Guangzhou population was 5.6%^[4]。 A meta-analysis showed a global prevalence of 11.2% and 8.8% and 9.4% according to the Rome I and Rome II diagnostic criteria, respectively^[5]。

To assess qualities on methodologies and reporting on Meta-analysis used in papers being published in National Medical Journal of China.

Computerized literature searching was performed in Wangfang Medical Online to collect articles that Meta-analysis was used in the National Medical Journal of China since January 1998 until October 2014. Manual retrieval was also conducted. Qualities on methodologies and reporting were evaluated by both Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scales.

A total of 74 papers were included. The results on the qualities of methodology evaluation in these papers were 3 to 10 (median 7) scores, 10 articles (13.5%) were rated as high, 61 articles (82.4%) as moderate and 3 articles (4.1%) as low. No statistically significant difference existed in each year of AMSTAR score (χ²=10.205, P=0.423). The titles of AMSTAR scales with a lower coincidence rate were "Was a list of studies (included and excluded) provided? ", "Was the conflict of interest stated? ", "Was the status of publication (i.e.grey literature) used as an inclusion criterion? " and "Was the likelihood of publication bias assessed? ". The results on the qualities of reporting evaluation in these papers were 5.5 to 26 (median 20) scores, 9 articles (12.2%) scored <15 points, 39 articles (52.7%) 15.5-21 points and 26 articles (35.1%) 21.5-27 points. There was statistically significant difference in each year of PRISMA score ( F=4.301, P=0.000). And the year 2010 was the highest one. The titles of PRISMA scales with a lack of comprehensive reports were "Structured summary", "Objectives of introduction", "Protocol & registration", "Data collection process", "Data items", "Risk of bias in individual studies", "Risk of bias across studies", "Additional analyses", "Study selection", "Risk of bias within studies", "Conclusion limitations", "Conclusions" and "Funding support" etc.

Articles of Meta-analysis published in National Medical Journal of China have a high quality so as to provide rationales for clinical decision-making. However, both of qualities on methodology and reports sill call for continual improvements.

To investigate the percentages of awareness, treatment and control and the prevalence of hypertension in north rural China.

An epidemiological study was conducted by stratified cluster random sampling in March 2013 within 4 out of 20 regions in north China. At least 1 250 residents aged over 35 years were recruited and there were 625 males and 625 females from 4 villages randomly selected from each region. The risk factors for hypertension such as blood pressure (BP), height, weight and past history of illness were collected. From 4 575 valid samples, there were 2 062 males and 2 513 females. Hypertension was defined as any subject with mean systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or use of antihypertensive medication. All the relevant rates were standardized by gender and age group according to the figures of Third National Population Census.

The standardized rates of hypertension in population aged over 35 years were 41.2% in Shunyi District, Beijing, 26.0% in Yuzhong County, Gansu Province, 25.2% in Jingyu County, Jilin Province and 22.8% in Dongfeng County, Jilin Province respectively. And significant differences existed among different regions (P<0.001). The prevalence of hypertension in males was higher than that in females. The overall rates of awareness, treatment, control and control under treatment were 46.9%, 30.5%, 12.8% and 41.5% respectively in males versus 64.2%, 48.9%, 20.4% and 38.4% respectively in females. These rates were significantly higher in people with a family history of hypertension than those without one (P<0.05). The prevalence of hypertension and the rates of awareness, treatment increased with the increase of BMI (P<0.05) other than the rates of control and control with drugs.

The prevalence of hypertension was of great difference between different rural areas in north China. The rates of awareness, treatment and control have remained at a low level.