[Epidemiological characteristics of hemorrhagic stroke among residents in Tianjin from 1999 to 2018].

Objective: To explore the incidence characteristics of hemorrhagic stroke among residents in Tianjin from 1999 to 2018, to provide data for formulating accurate prevention and control strategies. Methods: The incidence rate of hemorrhagic stroke and its distribution in different ages, gender, urban and rural areas were analyzed by monitoring new hemorrhagic stroke cases in Tianjin from 1999 to 2018. The standardized incidence rate was calculated based on the sixth national population census in 2010. χ2 test was used to compare the incidence rate. The trend of age and trend of age were analyzed by trend χ2 test. Joinpoint software was used to analyze the change in the annual incidence rate. Results: During the study period, hemorrhagic stroke accounted for 13.08% of all stroke cases. The incidence rate of a hemorrhagic stroke in Tianjin residents was 75.38/100 000-46.70/100 000, showing a downward trend (Z=-28.63, P<0.01, APC=-1.45%). After adjustment of age and gender, the standardized rate was 57.93/100 000-27.55/100 000, still showing a downward trend (Z=-54.72, P<0.01, APC=-3.38%). The incidence rate of male and female hemorrhagic stroke decreased, and the incidence rate of males in all ages and age groups was higher than that in females (P<0.01). The age of onset is younger, and the standardized incidence rate of an urban hemorrhagic stroke in the city decreases (P<0.01), and the city descends faster. Conclusions: The characteristics of hemorrhagic stroke in Tianjin are similar to those in developed countries. The lower age group and rural population are the key groups of intervention. The study of incidence characteristics and trends is of great significance for accurate prevention and control of stroke, reducing disease and medical costs.

[Epidemiological characteristics of pre-hospital mortality due to acute myocardial infarction from 1999 to 2016 in Tianjin city].

To explore the epidemiological characteristics, trends and relevant factors of pre-hospital mortality due to acute myocardial infarction (AMI) from 1999 to 2016 in Tianjin city, based on mortality surveillance information and household registration population information. Standardized mortality rates were calculated using the year 2000 world standard population. From 1999 to 2016, the research result showed that the pre-hospital crude mortality rates of AMI were 39.47/100 000 to 90.64/100 000 and the standardized mortality rates were 30.92/100 000 to 53.90/100 000. The proportion of pre-hospital AMI deaths was 73.96%-81.92% (t=1.09, P>0.05) within the same period. Aged, female, rural residents, unmarried, divorced, widowed, low education level, and outdoor workers have a relative higher proportion of pre-hospital AMI mortality.

[Status quo on smoking and related change pattern of smoking related behavior in past 20 years in urban residents in Tianjin].

Objective: To understand the status quo of smoking and change pattern of smoking related behaviors in the past 20 years in the urban adults in Tianjin. Methods: Data was from the study of Chinese Chronic Disease and Risk Factors (2015). Multi stage stratified random sampling method was used to conduct a questionnaire survey in 7 surveillance sites in Tianjin. Results: in the urban residents aged>20 years were compared with those in surveys in 1996 and 2010. Results In 2015, the smoking rate in men and women aged>20 years in Tianjin were 41.1% and 4.5% respectively. The average age of starting smoking was (19.2±4.7) years for men and (24.8±10.9) years for women, showing a younger age trend. Compared with the data from 1996 and 2010, the smoking rate in the urban residents was in decrease, but the rate of successful smoking cessation was in increase in 2015, the differences were significant. Conclusions: Since 1996, the rate of smoking in the urban residents of Tianjin has been in decline, however it is still at a high level, especially in women. The average age of starting smoking remains to be younger. It is necessary to strengthen the health education about harm of smoking in adolescents.

Propranolol regulates ERK1/2 signaling pathway and promotes chronic wound healing in diabetic rats.

OBJECTIVE: This study aimed to investigate if propranolol could regulate ERK1/2 signaling pathway and promote chronic wound healing in diabetic rats. MATERIALS AND METHODS: Twenty-two rats were used to establish a diabetic chronic wound animal model. They were randomly separated into two groups: the propranolol group and the control group. The propranolol group was treated with propranolol ointment and the control group was treated with propranolol matrix cream to cover the wound surface. The expression of the p-ERK1/2 protein was detected by the Western Blot. RT-qPCR was used to detect the expression of VEGF. The concentrations of IL-6 and TNF-α were detected by ELISA. RESULTS: The body weight of rats was significantly reduced after type 2 diabetes mellitus modeling. The healing rate of rats in the control group was significantly lower than that in the propranolol group (p<0.05). There was a significant increase in the expression of the p-ERK1/2 protein in the wound tissue of the propranolol group compared with that in the control group, except for the 11th day (p<0.05). The relative expression of Vascular Endothelial Growth Factor (VEGF) in the propranolol group was significantly higher than that in the control group on the 2nd day (p<0.05), while the relative expression of VEGF in the propranolol group was significantly increased on the 11th day after modeling (p<0.05). On the 20th day, the expressions of IL-6 and TNF-α in the propranolol group were significantly higher than those in the control group, and there were significant differences (p<0.05). It was found that the IL-6 and TNF-α expressions in the propranolol group reached the peak on the 11th day and then gradually decreased (p<0.05). CONCLUSIONS: The results indicated that propranolol can accelerate the healing of diabetic wounds by regulating the expression of VEGF by phosphorylation of ERK1/2 protein, thus promoting chronic wound healing in diabetes.

[The trend of chronic lower respiratory disease mortality of the residents in Tianjin, China, 2000-2016].

Objective: To explore the trends and distribution of chronic obstructive pulmonary disease (COPD) mortality of the residents with different characteristics from 2000 to 2016 in Tianjin. Methods: COPD mortality data in 2000-2016 were from Tianjin population based mortality surveillance system. The mortality rate of COPD, difference in the rate by gender, age, and geographic distribution, and the trend over years were analyzed. Age-sex-standardized mortality rates of COPD were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend analysis were used to examine the trend of mortality. Results: The crude COPD mortality rate in Tianjin decreased from 57.57/100 000 in 2000 to 28.23/100 000 in 2016 (annual percent change (APC)=-5.01%, Z=-64.76, P<0.001), and the standardized mortality rate decreased from 56.53/100 000 in 2000 to13.88/100 000 in 2016 (APC=-9.17%, Z=-100.83, P<0.001). The crude COPD mortality rate of males decreased from 54.57/100 000 to 27.77/100 000 (APC=-4.89%, Z=-43.63, P<0.001) and the standardized mortality rate decreased from 57.52/100 000 to 14.63/100 000 (APC=-9.07%, Z=-71.48, P<0.001). The crude COPD mortality rate of females decreased from 60.63/100 000 to 28.68/100 000 (APC=-5.12%, Z=-47.92, P<0.001) and the standardized mortality rate decreased from 55.53/100 000 to 13 13/100 000 (APC=-9.27%, Z=-71.13, P<0.001). The crude mortality rate of COPD in urban areas decreased from 45.07/100 000 to 19.54/100 000 (APC=-5.35%, Z=-42.38, P<0.001) and the standardized mortality rate decreased from 39.24/100 000 to 7.45/100 000 (Z=-63.97, P<0.001, APC=-10.22%). The crude mortality rate of COPD in rural areas decreased from 70.20/100 000 to 37.24/100 000 (APC=-4.77%, Z=-48.77, P<0.001) and the standardized mortality rate decreased from 78.88/100 000 to 25.70/100 000 (APC=-7.59%, Z=-72.43, P<0.001). The COPD mortality rate in rural areas was higher than that in urban areas (P<0.001). The COPD mortality rate in 35 years old and over decreased from 2000 to 2016 (P<0.001). Conclusion: The COPD mortality in Tianjin decreased from 2000 to 2016. More efforts are need to reduce COPD mortality in Tianjin, in particular people in rural areas.

[Clinical application of CT-guided radiofrequency ablation combined with biopsy synchronously to multiple small nodules of lung metastatic tumors].

Objective: To investigate the therapeutic efficacy and safety of CT-guided radiofrequency ablation(RFA)combined with biopsy synchronously to multiple small nodules of metastatic tumors in lung. Method: From January 2016 to December 2016, a total of 86 patients in the General Hospital of People's Liberation Army with 144 lesions were divide into two groups(all the lesions were less than 1 cm). Group A with 51 cases located in the lung periphery underwent biopsy prior to RFA.Group B with 35 cases located in the middle and inner side of lung adjacent to the vasculatures contrarily underwent RFA first.The changes of these lesions during the 1 to 12-month were followed up. Results: All the procedures were completed successfully.The intra operative CT scanning showed the ablation zones were completely covered by the indicative "halo sign" respectively.The P value was 0.818, 0.155 and 0.452 respectively, in the number of nodules, pathological results positive rate and complications in the rank and inspection for A, B two groups, which were all higher than 0.05.Though different strategies according to different location of the nodes, the two groups can achieve safe and effective treatments.All patients in two groups had high density ablation zones on their 1-month post operative CT without enhancement.3-and 6-post operative CT illustrated a decrease of lesions, 12-month post operative CT showed the lesions turned to fibrous stripes. Conclusion: The CT-guided RFA combined with biopsy synchronously to multiple small nodules of metastatic tumors in lung is safe and effective, for the lesions located in the middle or inner side of lung, RFA prior to the biopsy can avoid the massive hemoptysis.

[The trend of intracerebral hemorrhage mortality of the residents with different characteristics in Tianjin, China, 1999-2015].

Objective: To explore the trends and distribution of intracerebral hemorrhage (ICH) mortality of the residents with different characteristics from 1999 to 2015 in Tianjin. Methods: ICH mortality data in 1999-2015 were from Tianjin population based mortality surveillance system. The mortality rate of ICH, difference in the rate by gender, age, and geographic distribution, and trends over the years were analyzed. Standardized mortality rates of ICH were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to examine the trends in mortality. Results: A total of 102 279 ICH death cases were observed in Tianjin from year 1999 to 2015. The crude ICH mortality rate in Tianjin decreased from 76.35/100 000 in 1999 to 51.46/100 000 in 2015 (annual percent change (APC)=-1.96%, Z=-31.08, P<0.001) , and the standardized mortality rate decreased from 72.41/100 000 to 29.00/100 000 (APC=-5.20%, Z=-70.91, P<0.001). The crude mortality rate of ICH mortality in males decreased from 87.26/100 000 to 59.89/100 000 (APC=-1.79%, Z=-21.71, P<0.001) and the standardized mortality rate decreased from 85.65/100 000 to 35.75/100 000 (APC=-4.93%, Z=-52.32, P<0.001). The crude mortality rate of ICH mortality in females decreased from 65.21/100 000 to 42.98/100 000 (APC=-2.18%, Z=-22.28, P<0.001) and the standardized mortality rate decreased from 59.17/100 000 to 22.26/100 000 (APC=-5.63%, Z=-48.15, P<0.001). The ICH mortality rate under 35 years old increased from 0.78/100 000 to 0.92/100 000 (APC=4.41%, Z=5.07, P<0.001), especially in males increasing from 0.90/100 000 to 1.54/100 000 (APC=6.59%, Z=6.52, P<0.001). The crude mortality rate of ICH in urban areas decreased from 69.74/100 000 to 41.79/100 000 (APC=-3.18%, Z=-31.43, P<0.001) and the standardized mortality rate decreased from 57.56/100 000 to 20.42/100 000 (APC=-6.59%, Z=-53.43, P<0.001). The crude mortality rate of ICH in rural areas decreased from 82.99/100 000 to 61.49/100 000 (APC=-1.10%, Z=-14.06, P<0.001) and the standardized mortality rate decreased from 91.55/100 000 to 43.14/100 000 (APC=-3.78%, Z=-43.21, P<0.001). The ICH mortality rate in rural areas was higher than that in urban areas (P<0.05). Conclusion: ICH mortality rate in Tianjin decreased from 1999 to 2015. Further efforts to reduce ICH mortality in Tianjin is needed, in particular males, under 35 years old, and people in rural areas.

[Analysis on trend of cerebral infarction mortality from 1999 to 2015 in Tianjin of China].

Objective: To explore the trends and distribution of cerebral infarction between sexes, ages and urban-rural areas from 1999 to 2015 in Tianjin, China, and provide data for targeted prevention and control strategies of cerebral infarction in Tianjin. Methods: Cerebral infarction mortality data from January 1, 1999 to December 31, 2015 were obtained from Tianjin population based mortality surveillance system established by the Tianjin Centers for Disease Control and Prevention, and population data of permanent residents were obtained from Tianjin Municipal Public Security Bureau. The trends change and affecting factors including gender, age, and geographic distribution on mortality following cerebral infarction were analyzed. Results: (1) Cerebral infarction mortality rate in Tianjin increased from 1999 to 2015 with the crude mortality rate of 57.06/100 000 to 105.22/100 000 (Z=59.65, P<0.01, annual percent change(APC)=3.39%) and decreased with the standardized mortality rate from 55.59/100 000 to 56.12/100 000 (Z=-5.47, P<0.01, APC=-0.35%). (2) The crude mortality rate (64.23/100 000 to 118.72/100 000) and standardized mortality rate (65.44/100 000 to 67.23/100 000) of male cerebral infarction was higher than that of female (crude: 49.73/100 000 to 91.64/1/100 000, standardized: 45.73/100 000 to 45.01/100 000) from 1999 to 2015. (3) With the increase of age, the mortality of cerebral infarction increased gradually from 1999 to 2015 (all Z>0.00,all P<0.01). (4) The mortality rate of cerebral infarction in urban areas increased with the crude mortality rate from 71.43/100 000 to 103.20/100 000 (Z=17.34, P<0.01, APC=1.30%) and decreased with the standardized mortality rate from 61.04/100 000 to 43.77/100 000 (Z=-32.49, P<0.01, APC=-3.06%) from 1999 to 2015. The mortality rate of cerebral infarction in rural areas increased with the crude mortality rate from 42.63/100 000 to 107.32/100 000 (Z=69.14, P<0.01, APC=5.95%) and with the standardized mortality rate from 48.34/100 000 to 77.09/100 000 (Z=36.88, P<0.01, APC=5.95%) from 1999 to 2015. Conclusions: Cerebral infarction crude mortality increased and standardized mortality decreased from 1999 to 2015 in Tianjin. Further efforts to reduce cerebral infarction mortality in Tianjin are needed, special attention should be focused on the elderly, male and rural residents.

[Analysis on the trends in mortality following acute myocardial infarction from 1999 to 2015 in Tianjin of China].

Objective: To explore the trends change in mortality following acute myocardial infarction (AMI) from 1999 to 2015 in Tianjin, China. Methods: AMI mortality data from 1999 to 2015 were obtained from Tianjin population based mortality surveillance system operated by the Tianjin Centers for Disease Control and Prevention (CDC), and population data of permanent residents were obtained from Tianjin Municipal Public Security Bureau. The trends change and affecting factors including gender, age, and geographic distribution on mortality following AMI were analyzed. Results: (1)The standardized mortality rate of AMI in Tianjin from 1999 to 2015 was 52.32/100 000 to 48.62/100 000. Adjusted AMI mortality rate from 1999 to 2013 was 52.32/100 000 to 73.72/100 000, indicating an increased trend(Z=32.15, P<0.001)with an annual percent change (APC) of 2.53%. Adjusted AMI mortality rate was decreased from 2013 to 2015: 73.72/100 000 to 48.62/100 000 (Z=-22.80, P<0.001), and APC was -19.07%. Above trends change was similar for male and female residents (all P<0.001). (2)The AMI standardized mortality rate of male was significantly higher than that of female during the 17 years. The AMI standardized mortality of male was significantly higher than that of female in<35, 35-44, 45-54, 55-64 and ≥65 years old group, respectively. AMI mortality rate increased with age. (3)Except in the year of 2002 and 2003, the AMI mortality rate were significantly higher in rural residents than in urban residents during this study period (P<0.001). Adjusted AMI mortality in urban residents increased from 1999 to 2009(Z=8.05, P<0.001, APC=1.43%), and decreased in the year from 2009 to 2015 (Z=-18.71, P<0.001, APC=-6.32%). Adjusted AMI mortality in rural residents increased in the year of 1999 to 2013(Z=56.05, P<0.001, APC=5.84%), and decreased in the year of 2013 to 2015 (Z=-24.40, P<0.001, APC=-21.35%). Conclusions: Our results suggest that AMI mortality in Tianjin increased from 1999 to 2013, and decreased from 2013 to 2015, and male and rural residents have higher AMI mortality. Related prevention and intervention measures should be taken to decrease AMI mortality, especially for male and rural residents.

[Study on smoking attributed death and effects of smoking cessation in residents aged 35-79 years in Tianjin, 2016].

Objective: To analyze the influence of smoking on deaths in residents aged 35-79 years and the effects of smoking cessation in Tianjin. Methods: The data of 39 499 death cases aged 35-79 years in 2016 in Tianjin were collected, the risks for deaths caused by smoking related diseases and excess deaths as well as effects of smoking cessation were analyzed after adjusting 5 year old age group, education level and marital status. Results: Among the 39 499 deaths cases, 1 589 (13.56%) were caused by smoking, the percentage of the excess mortality of lung cancer caused by smoking was highest (47.60%); the risk of death due to lung cancer in smokers was 2.75 times higher than that in non-smokers (95%CI: 2.47-3.06). Among the female deaths, 183 (7.29%) were caused by smoking, the percentage of the excess mortality of lung cancer was highest (28.90%); and the risk of death of lung cancer in smokers was 4.04 times higher than that in non-smokers (95%CI: 3.49-4.68). The OR for disease in ex-smokers was 0.80 compared with 1.00 in smokers (95%CI: 0.72-0.90). The OR in males who had quitted smoking for ≥10 years was lower (0.74, 95%CI: 0.63-0.86) than that in those who had quitted smoking for 1-9 years (0.85, 95%CI: 0.74-0.98), but the difference was not significant. Conclusion: Smoking is one of the most important risk factors for deaths in residents in Tianjin. Smoking cessation can benefit people's health.

[Comparison of application of Cochran-Armitage trend test and linear regression analysis for rate trend analysis in epidemiology study].

We described the time trend of acute myocardial infarction (AMI) from 1999 to 2013 in Tianjin incidence rate with Cochran-Armitage trend (CAT) test and linear regression analysis, and the results were compared. Based on actual population, CAT test had much stronger statistical power than linear regression analysis for both overall incidence trend and age specific incidence trend (Cochran-Armitage trend P value

[Fifteen-year trend in incidence of acute myocardial infarction in Tianjin of China].

Objective: To observe the incidence of acute myocardial infarction (AMI) between 1999 and 2013 in Tianjin residents and analyze the incidence differences on residents with various age, gender and living in urban or rural areas. The data might help for targeted prevention strategies among Tianjin residents. Methods: AMI incidence data between 1999 and 2013 were obtained based on Tianjin cardiovascular disease incidence surveillance registry established by the Tianjin Centers for Disease Control and Prevention (CDC). Related information such as permanent residents' population data were obtained from Tianjin Municipal Public Security Bureau. The Chinese population data in 2000 were used for age-sex-standardized rates estimation. Difference between two (or more) independent groups was compared by the Chi Square statistics. The Chi-square test for trend was used for computing the incidence trend in years and ages. Results: AMI incidence rate in Tianjin declined from the year 1999 to 2013 with the rude incidence rate of 80.46/100 000 to 81.29/100 000, and with the standardized incidence rate of 64.85/100 000 to 44.57/100 000 (Z=-35.767, P<0.001). AMI incidence decreased gradually in residents aged over 45 years old (P<0.01), but increased in residents younger than 45 years old (P<0.001) from 1999 to 2013. The AMI incidence rate is consistently higher in male residents (rude incidence 99.89/100 000-102.98/100 000, standardized incidence rate 78.53/100 000-56.61/100 000) than in female residents (rude incidence 61.18/100 000-59.44/100 000, standardized incidence rate 50.31/100 000-31.76/100 000, both P<0.001) and higher in urban residents (rude incidence rate 133.98/100 000-98.02/100 000, standardized incidence rate 99.89/100 000-50.12/100 000) than in rural residents (rude incidence rate 35.57/100 000-66.19/100 000, standardized incidence rate 32.68/100 000-43.51/100 000, Z=6.217, P<0.001). AMI incidence decreased significantly in the urban residents (rude incidence rate 133.98/100 000-98.02/100 000, standardized incidence rate 99.89/100 000-50.12/100 000, Z=-46.968, P<0.001), while significantly increased in rural residents (rude incidence rate 35.57/100 000-66.19/100 000, standardized incidence rate 32.68/100 000-43.51/100 000, Z=6.217, P<0.001) during the study period. Conclusions: The general incidence of AMI decreased during the study period in Tianjin residents. However, AMI incidence significantly increased in young male residents and rural residents. It is necessary to develop corresponding strategies for AMI control for Tianjin residents with different age/gender and living in different areas.

[Trend of premature mortality from chronic and non-communicable diseases in Tianjin, 1999-2015].

Objective: To explore the trends and distribution of premature mortality caused by four main non-communicable diseases (NCDs) including cardiovascular and cerebrovascular diseases, cancer, chronic respiratory disease and diabetes in different sex and residential areas in Tianjin so as to provide basis for setting up prevention and control programs on premature mortality. Methods: Population data on premature mortality in 1999-2015 were from the 'Tianjin population based mortality surveillance system' maintained by Tianjin Centers for Disease Control and Prevention (CDC). Data related to permanent residents was from the Tianjin Municipal Public Security Bureau. Standardized premature mortality rates were calculated and adjusted for age and gender according to the '2000 world standard population'. Premature mortality probabilities were analyzed according to the methods recommended by WHO. Joinpoint regression and Cochran-Armitage trend methods were used to determine the significance of differences on the trends of mortality. Results: From 1999 to 2015, the premature mortality appeared consistent (P<0.001) declining in the above-said four diseases with the APC of probabilities as-2.92%, -1.13%, -9.51% and -3.39%, respectively. The probabilities of premature mortality were all declining consistently in both men and women and in both urban and rural areas in Tianjin. From 1999 to 2015, the probabilities of the four main NCDs were between 19.67% and 12.85% (APC=-2.49%, P<0.001), higher in women (from 17.02% to 9.17%, APC=-3.84%, P<0.001) than that in men (from 22.27% to 16.47%, APC=-1.59%, P<0.001), in urban (from 21.04% to 12.34%, APC=-3.26%, P<0.001) than that in rural areas (from 17.80% to 13.54%, APC=-1.54%, P<0.001). Conclusion: Our findings suggested that premature mortality in Tianjin was decreasing during 1999-2015 but attention should still be called for on males and people living in the rural areas to further reducing the premature mortality.