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 re-ceptor 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 in-hibited 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 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 infor-mation on the health policies was from official governmental websites. According to the main health poli-cies, 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 in-creasing 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 pro-vinces 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 underdeve-loped 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 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 strati-fied 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 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 su-pervising the behaviors of children are indispensable for preventing and controlling childhood obesity.

SUMMARY Traffic noise pollution problem is increasingly emerging with the rapid developmentof 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 ad-verse health effects, and most of them are extra-auditory effects. The main aspects include that traffic noise can af-fect 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.

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 pa-tients 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 Pseudo-monas 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, ami-kacin 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 evaluate the safety and efficacy of antiplatelet therapy of ticagrelor on patients suffering from acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary in-tervention. 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. Re-sults:The differences between the two groups of patients with their baseline data, the features of coronary ar-tery 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 sig-nificantly 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 ca-ses 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 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 Chi-nese Biomedical Literature Database (January to November, 2014). Details in models and data for four-fold 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 re-sults 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 estimate the prevalence of antiretroviral drug resistance in treatment-naive in-dividuals 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%), respective-ly. 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 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 de-clined, 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.