Transrectal ultrasound-guided biopsy for prostate cancer: an update / 中华男科学杂志

The prostate-specific antigen (PSA) test contributes a lot to the diagnosis and treatment of prostate cancer (PCa) and, along with imaging-guided prostate biopsy, has improved the diagnosis rate of lower-risk PCa and the accuracy of its clinical staging. However, many questions and controversies remain as to the choice of optimal biopsy strategies. Scholars differ in views about how to utilize PCa-related biomarkers to optimize the detection of initial and repeat biopsies. This review focuses on the present status of and advances in transrectal ultrasound-guided biopsy for PCa.

Effect of elevated total cholesterol level and hypertension on the risk of fatal cardiovascular disease: a cohort study of Chinese steelworkers / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Increased blood pressure and elevated total cholesterol (TC) level are the two most important modifiable risk factors of cardiovascular disease (CVD) in the world. Hypertension and hypercholesterolemia co-exist more often than would be expected and whether there is a synergistic impact on fatal CVD between elevated TC and hypertension need to be further examined in Chinese population.</p><p><b>METHODS</b>We conducted a cohort study which recruited 5092 Chinese male steelworkers aged 18 - 74 years in 1974 - 1980 and followed up for an average of 20.84 years. Totally 302 fatal CVD events were documented by the year of 2001. Cox proportional hazards regression models were undertaken to adjust for baseline variables with fatal CVD events as the outcome variable. Additive interaction model was used to evaluate the interaction between elevated TC and hypertension.</p><p><b>RESULTS</b>Hypercholesterolemia and hypertension were significantly associated with an increased hazard ratio (HR) of fatal CVD (1.67 (95%CI 1.18 - 2.38) and 2.91 (95%CI 2.23 - 3.80) respectively. Compared to participants with normotension and TC < 240 mg/dl, the HRs were 1.11 (95%CI 0.56 - 2.21), 2.74 (95%CI 2.07 - 3.64) for hypercholesterolemia and hypertension respectively, and 5.51 (95%CI 3.58 - 8.46) for participants with both risk factors. There was an additive interaction with a 2.65 (95%CI 0.45 - 4.85) relative excess risk (RERI) between hypercholesterolemia and hypertension on CVD.</p><p><b>CONCLUSION</b>We found that the risk of fatal CVD was significantly associated with an additive interaction due to hypercholesterolemia and hypertension besides a conventional main effect derived from either of them, which highlights that the prevention and treatment of both risk factors might improve the individual risk profile thus reduce the CVD mortality.</p>

The effect of total cholesterol on myocardial infarction in Chinese male hypertension population / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Total cholesterol (TC) is an important risk factor for myocardial infarction (MI), but the effect of TC on MI in Chinese male hypertension population has not been well documented. We conducted a prospective cohort study to determine the incidence and relative risk for MI across a wide range of TC levels in Chinese male hypertension population.</p><p><b>METHODS</b>A cohort of 5298 male employees aged 18-74 years recruited from Capital Steel and Iron Company in Beijing of China in 1974-1980 was followed up for an average of 20.84 years. A total of 122 incident MI cases were identified during the period of follow-up.</p><p><b>RESULTS</b>The incidence of MI among participants with elevated TC and those with desirable TC in male non-hypertension population was 137.20 and 63.81 per 100,000 person-years, respectively; and the corresponding incidence in male hypertension population was 279.80 and 130.96 per 100,000 person-years, respectively. After adjustment for important covariables, 10.38%, 16.71%, and 23.80% of MI cases were attributable to hypertension, elevated TC, and hypertension plus elevated TC, respectively. In male hypertension population, the multivariate adjusted hazard ratios of MI were 1.21, 2.39, 3.38, and 3.95 for participants with TC level of 5.17-5.68, 5.69-6.20, 6.21-6.71, and > or = 6.72 mmol/L, compared with those with TC < 5.17 mmol/L. The corresponding population attributable risks were 2.92%, 9.20%, 8.87%, and 9.84%, respectively.</p><p><b>CONCLUSION</b>Elevated TC is an important independent risk factor of MI both in male non-hypertension and hypertension populations. There is a linear association between TC level and MI incidence in Chinese male hypertension population.</p>

Major causes of death among male steelworkers in Beijing: a prospective study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the major causes of death and risk factors among male steelworkers in Beijing.</p><p><b>METHODS</b>The study included 5137 men from the cohort of Beijing Capital Steel and Iron Company. The baseline survey was performed in 1974, 1979 and 1980 and the final follow-up evaluation was made in 2001 with a mean follow-up of 20.8 years. Causes of death were coded according to the Ninth Revision of International Classification of Diseases (ICD-9). The mortality was calculated by person-years of follow-up and age-standardized according to the 2000 census data in China. Cox proportional-hazards models adjusting for risk factors were used to estimate the relative risk of death.</p><p><b>RESULTS</b>There is 760 deaths during follow-up. Age-standardized mortality from all causes was 643.0 per 100,000 person-years. The three leading causes of death were malignant neoplasms (mortality, 231.3 per 100,000 person-years), cerebrovascular diseases (mortality, 139.3 per 100,000 person-years) and heart diseases (mortality, 96.4 per 100,000 person-years). The multivariate-adjusted relative risk of death and the population attributable risk proportion for risk factors were as follow: cigarette smoking (95% CI, 1.174 to 1.765); hypertension (95% CI, 1.370 to 1.904) and hypercholesterolemia (95% CI, 1.057 to 1.537).</p><p><b>CONCLUSIONS</b>Our study indicates that malignant neoplasms, cerebrovascular diseases and heart diseases were major causes of death among male steelworkers. Furthermore, cigarette smoking, hypertension and hypercholesterolemia are leading preventable risk factors for death.</p>

Clinical study on effect of tuihuan decoction rectoclysis in hyperbilirubinemia of newborn / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the therapeutic effect and feasibility of rectoclysis with Tuihuang decoction (RTD) in treating hyperbilirubinemia of newborns.</p><p><b>METHODS</b>One hundred and seventy-five newborns with hyperbilirubinemia were randomly divided into the treated group and the control group. They were treated with western medicine plus double faced blue treatment while the treated group were given RTD additionally. Blood bilirubin was detected by micro-bilirubin detector daily during the treatment course. The time of jaundice regression, the speed of blood bilirubin reducing, liver function, and condition of rebounding were observed.</p><p><b>RESULTS</b>The 7-day curative rate of jaundice in the treated group was superior to that in the control group, showing significant difference (P < 0.05). The average speed of blood bilirubin reducing daily in the treated group was quicker than that in the control group (P < 0.01). The improvement of liver function, such as AST, ALT and gamma-GT in the treated group was superior to that in the control group (P < 0.01). Rebound rate of blood bilirubin in the control group was significantly higher than that in the treated group (P < 0.05).</p><p><b>CONCLUSION</b>RTD is an ideal therapy for treatment of hyperbilirubinemia of newborn, it shows obvious clinical efficacy and can effectively prevent the rebound of blood bilirubin.</p>

Pulse pressure and prevalence of stroke and myocardial infarction in Chinese population / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the characteristics of distribution of pulse pressure (PP) in Chinese population and its relationship to major cardiovascular diseases in them.</p><p><b>METHODS</b>Data from the Third National Blood Pressure Survey involved 882,681 subjects aged over 18 in 1991 were reanalysed for the relationship between PP and risks of major cardiovascular diseases, with t-test, chi2 test and logistic regression model. PP is defined as the difference between systolic and diastolic blood pressure.</p><p><b>RESULTS</b>(1) Overall mean PP was (44.61 +/- 13.59) mm Hg for the subjects aged over 18, higher in men [(44.92 +/- 12.72) mmHg] than that in women [(44.34 +/- 14.32) mmHg]. PP increased progressively with age, and its increase accelerated significantly at age over 50 but higher in women than in men. Proportion of the subjects with PP equal to or greater than 60 mmHg was more in those aged 60 or over than that in younger ones. (2) Prevalence of stroke and myocardial infarction (MI) increased with PP and age, whether in the normotensives, or in the hypertensives or in the isolated systolic hypertensives. (3) Results of multivariate logistic regression analysis revealed that risks of stroke in the subjects with PP of (45-59) mmHg, (60-74) mmHg and over 75 mmHg were 1.9, 3.5 and 5 times as in those with PP less than 45 mm Hg, respectively, adjusted for other risk factors, and their risks of myocardial infarction (MI) were 1.2, 1.5 and 1.7 times, respectively. Furthermore, PP was significantly and independently related to the risks of stroke and MI, even adjusted for systolic and diastolic pressures.</p><p><b>CONCLUSIONS</b>Prevalence of stroke and MI increased with the breadth of PP and age. Broader PP may be an important and independent predictor of risks of stroke and MI, especially in the aged people.</p>

A 20-year prospective study on risk factors for myocardial infarction of 5,137 men in Capital Steel and Iron Company / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify independent risk factors for myocardial infarction (MI) in Chinese men and to develop a model to predict risk profile of an individual suffering MI.</p><p><b>METHODS</b>Study sample included 5 137 men aged 45.2 +/- 7.8 years who came from a cohort in Beijing Capital Steel and Iron Company, based on the three surveys on coronary heart disease conducted in 1974, 1979 and 1980, respectively. Demographic data and other risk factors, such as life style, medical history, blood pressure, total serum cholesterol level (TC), etc. were collected according to the same protocol in 1980. All the participants were followed up for MI in an average period of 20.84 years until 2001.</p><p><b>RESULTS</b>(1) There were 122 cases with MI identified during the period of follow-up, with an incidence of MI 117.4 per 100 000 person-years. Age of more than 50, smoking, higher systolic and diastolic blood pressure (SBP and DBP) levels, higher TC all were identified as important risk factors of MI. (2) Incidence of MI increased with TC. An increment of 0.52 mmol/L of TC significantly increased relative risk of MI by approximately 40% after adjusted for age, blood pressure and smoking. (3) An increment of 20 mm Hg in SBP or 10 mm Hg in DBP associated with a 40% increase in incidence of MI, adjusting for age, TC and smoking. (4) Smoking was the most risky factors for MI. Smokers had 2.3 times risk of MI, after as compared to non-smokers (or its incidence increased by 137%), after adjusting for blood pressure, TC and age, etc. (5) Incidence of MI increased by 20% with increment of five-year of age in those aged over 50 (P < 0.05), after adjusting for blood pressure, TC and smoking. And, (6) finally, based on multivariate logistic and Cox regression analyses, a model containing several risk factors, such as age, blood pressure, TC and smoking, was developed to predict individual's risk for afflicting MI.</p><p><b>CONCLUSIONS</b>Results of this prospective study showed several established risk factors for MI, including age, blood pressure, TC and smoking all as independent predictors of MI in Chinese men. It is clear and rational that intervention and modification of those traditional risk factors can lead to a decrease in coronary events in Chinese population.</p>

Prevalence, awareness, treatment and control of hypertension in Chinese adults / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify the prevalence, distribution, current status of awareness and control of hypertension in Chinese adult population.</p><p><b>METHODS</b>A cross-sectional survey was conducted in mainland of China in 2000 - 2001 as a part of work coordinated with InterASIA Program. A total of 15,838 nationally representative subjects aged 35 to 74 were selected with multistage cluster sampling. Measurement of blood pressure was taken for all of them with three readings in a mercuric-column sphygmomanometer after resting for five minutes. Standard structured questionnaire was used to collect their histories and treatment and prevention for hypertension. A case of hypertension was defined as any person with systolic blood pressure equal to or greater than 140 mmHg, or with diastolic blood pressure equal to or greater than 90 mmHg, or being administered with antihypertensive agents.</p><p><b>RESULTS</b>A total of 15,838 adults aged 35 - 74 years were included in this survey. Overall, the prevalence of hypertension was 27.2%, representing 130 million persons with hypertension nationwide as estimated. Age-specific prevalence of hypertension was 10.7%, 26.8%, 38.9% and 50.2% for women and 17.4%, 28.2%, 40.7% and 47.3% for men aged 35 - 44, 45 - 54, 55 - 64 and 65 - 74 years, respectively. Among hypertensive patients, 44.7% were aware of their high blood pressure, 28.2% were taking antihypertensive medication, and 8.1% achieved their blood pressure under control (< 140/90 mm Hg). All these data indicated that percentages of awareness, treatment and control of hypertension increased by 86.2%, 92.6% and 145.4%, respectively in the past ten years, as compared with the data in 1991.</p><p><b>CONCLUSIONS</b>In the past ten years, percentages of awareness, treatment and control of hypertension in Chinese adults increased significantly, who had a relatively high prevalence of hypertension, but lower awareness and much lower percentages of treatment and control of hypertension. It is urgently needed to improve prevention, detection and treatment for hypertension in adults.</p>

An evaluation on effectiveness of worksite-based intervention for cardiovascular disease during 1974 - 1998 in capital iron and steel company of Beijing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the feasibility and effectiveness of worksite-based cardiovascular disease (CVD) prevention and control program in urban population of China.</p><p><b>METHODS</b>Worksite-based intervention program was implemented 110 000 employees at Capital Iron and Steel Company of Beijing (CISC) focusing on primary prevention for CVD and control of hypertension. Intervention components comprised of infrastructure setting-up, health education and health promotion, professional training, detection and management of hypertensive patients, and reasonably readjusting their diet structure focusing on salt intake reduction, reducing their overweight, quitting smoking, and restricting alcohol consumption in high-risk population. Changes in level of risk factors, incidence and mortality of stroke and coronary events and their trend were evaluated between the intervention group at CISC and eight simultaneously parallel reference groups in other provinces outside Beijing with population surveillance data.</p><p><b>RESULTS</b>Major risk factors for CVD, including blood pressure, body mass index and serum cholesterol level, decreased relatively in intervention population at CISC during 1974 to 1998, while those in majority of eight parallel reference groups at different provinces of China significantly increased at the same time. Systolic blood pressure (SBP) decreased by 0.8 mm Hg and 4 mm Hg in average for men and women, respectively, and their diastolic blood pressure (DBP) remained the same as baseline for both men and women at CISC, while SBP increased by (2 - 11) mm Hg and (6 - 8) mm Hg in average for men and women, respectively in reference groups, and DBP increased by (2 - 6) mm Hg in average for men in five of eight reference groups, and by (3 - 6) mm Hg for women in four of eight reference groups. Serum level of cholesterol decreased by 0.26 mmol/L in women and slightly increased for men at CISC, and increased by (0.35 - 0.97) mmol/L for men and (0.29 - 1.05) mmol/L for women in all reference groups. Prevalence of overweight increased by 58.7% for men and 11.3% for women at CISC and increased by one to 22 folds in eight reference groups. Awareness of health knowledge improved significantly with an average net reduction of SBP/DBP of (2.5/2.2) mm Hg in the enforced intervention group at CISC than that in general intervention groups. Incidence and mortality rates of stroke decreased by 54.7% and 74.3%, respectively in intervention group at CSIC, but those of coronary events slowly increased with fluctuation.</p><p><b>CONCLUSION</b>Worksite-based comprehensive intervention for CVD prevention and control was feasible and cost-effective in decreasing risk factors for CVD, incidence and mortality rate of stroke in population of urban areas of China.</p>