The multiple lifestyle modification for patients with prehypertension and hypertension patients: a systematic review protocol.

INTRODUCTION: The objective of this systematic review is to investigate the effectiveness, efficacy and safety of multiple concomitant lifestyle modification therapies for patients with hypertension or prehypertension. METHODS AND ANALYSIS: Electronic searches will be performed in the Cochrane Library, OVID, EMBASE, etc, along with manual searches in the reference lists of relevant papers found during electronic search. We will identify eligible randomised controlled trials utilising multiple lifestyle modifications to lower blood pressure. The control could be drug therapy, single lifestyle change or no intervention. Changes in systolic blood pressure and diastolic blood pressure constitute primary end points, and secondary end points include the number of patients meeting the office target blood pressure, the number of patients reporting microvascular or macrovascular complications, etc. We will extract descriptive, methodological and efficacy data from identified randomised controlled trials (RCTs). We will calculate the relative risk for proportion of patients with a normal blood pressure in the experimental group. Dichotomous data will be analysed using risk difference and continuous data using weighted mean differences, both with 95% CI. We will use the χ(2) test and the I(2) statistic to assess heterogeneity. We will use the fixed effects model to compute the efficacy unless there is evidence of heterogeneity. If heterogeneity of effect size persists with respect to blood pressure change, further metaregression will be performed within groups. We will examine the potential for publication bias by using a funnel plot. DISSEMINATION: We will synthesise results from RCTs which provide more precise and accurate information on the effect of multiple lifestyle changes on blood pressure. The results of this review will increase the understanding of multiple lifestyle modifications for patients with hypertension or prehypertension. TRAIL REGISTRATION NUMBER: Our protocol is registered on PROSPERO (CRD42013006476), http://www.crd.your.ac.uk/PROSPERO.

[Effects of Mn2+, Mo6+ and Zn2+ on the components change of extracellular polymeric substances in activated sludge].

By specific oxygen uptake rate, (SOUR) measurements of activated sludge with different metal ion concentration, the optimal stimulation concentrations of Mn2+, Mo6+ and Zn2+ were determined. Then within each metal ion stimulation concentration range, extracellular polymeric substances (EPS) were extracted from activated sludge and its components (protein, polysaccharide and nucleic acid) contents changes were investigated. The results showed that the optimal stimulation concentration of each metal ion is 1mg x L(-1). EPS components of activated sludge vary obviously with Mn2+ and Zn2+ concentration change but not with Mo6+. After storage at low temperature, EPS quantities in activated sludge are reduced with polysaccharide reduction is the most.