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In order to investigate the effects of biochar on soil cadmium (Cd) content in northwestern China, we used cotton (Gossypium hirsutum L.) straw charcoal in a 2-year experiment involving different doses of both biochars (1.5% (C1) and 3% (C2)) and Cd (1 mg·kg-1 (H1), 2 mg·kg-1 (H2), and 4 mg·kg-1 (H3)) in addition to the treatments, control plots were set up with no biochar application. We grew cotton (Gossypium hirsutum L.) in pots for each treatment and examined soil pH, Cd forms, and Cd accumulations in aboveground plant organs. Compared to no added biochar, the addition of biochar significantly increased soil pH, but there was no notable difference in soil pH between the C1 and C2 treatments. Biochar significantly decreased soil-available Cd with this effect increasing with higher biochar doses. The lowest amounts of soil-available Cd in all Cd treatments (H0–H3), including the control, occurred later in the study, typically at 90 to 150 days post treatment. In the cotton (Gossypium hirsutum L.), Cd preferentially accumulated the most in leaves, then in stems, and then in bolls and the amount of Cd in cotton and soil-available Cd significantly correlated. The addition of biochar promoted the transformation of exchangeable and carbonate-bound Cd to organic matter-bound Cd at 30, 60, and 90 days, and the exchangeable and carbonate-bound Cd to Fe-Mn oxide-bound Cd at 120 and 150 days. In conclusion, biochar addition decreases both Cd bioavailability and the accumulation of Cd in cotton (Gossypium hirsutum L.) aboveground organs. [ABSTRACT FROM AUTHOR]

Rapid development of China’s economy demands for more mineral resources. At the same time, a vast quantity of mine tailings, as the waste byproduct of mining and mineral processing, is being produced in huge proportions. Tailings impoundments play an important role in the practical surface disposal of these large quantities of mining waste. Historically, tailings were relatively small in quantity and had no commercial value, thus little attention was paid to their disposal. The tailings were preferably discharged near the mines and few tailings storage facilities were constructed in mainland China. This situation has significantly changed since 2000, because the Chinese economy is growing rapidly and Chinese regulations and legislation require that tailings disposal systems must be ready before the mining operation begins. Consequently, data up to 2008 shows that more than 12 000 tailings storage facilities have been built in China. This paper reviews the history of tailings disposal in China, discusses three cases of tailings dam failures and explores failure mechanisms, and the procedures commonly used in China for planning, design, construction and management of tailings impoundments. This paper also discusses the current situation, shortcomings and key weaknesses, as well as future development trends for tailings storage facilities in China. [ABSTRACT FROM AUTHOR]

Infection of a Myxobolus species, previously identified as Myxobolus rotundus, was detected in 182 of 7892 (2.31%) allogynogenetic gibel carp, Carassius auratus gibelio, in a closed pond culture system in China. Morphological and molecular data showed that this myxosporean is a different species from M. rotundus parasitizing Abramis brama in Europe and is thus designated as a new species, Myxobolus turpisrotundus. M. rotundus (s.l.) ex C. auratus auratus is a synonym of M. turpisrotundus. Plasmodia of M. turpisrotundus develop in the subepidermal tissues of the body surface resulting in an unaesthetic appearance and causing severe economic losses. Prevalence of infection with the myxosporean plasmodia varied seasonally, increasing in winter and decreasing in spring. Prevalence was positively correlated to host size, but no host sex-specificity was found. No infection was observed in other fish species (grass carp, bighead carp and yellow catfish) reared in the same pond, suggesting that the parasite has a relatively strict host specificity. Plasmodia grew gradually as the parasite developed, and reached up to a maximum 5.6 mm in diameter. Plasmodia ruptured naturally to release the mature spores and host fish completely recovered with no mortality. Release of spores and regeneration of lesions were not correlated with water temperature. Histology showed that plasmodia developed sub-epidermally, and that the wall of the plasmodia was composed of a multiple complex structure, including layers of fibroblasts, a collagenous membrane, melanophores and a layer of cup-like cells of unknown derivation and function. The cup-like cells are in direct contact with pre-sporogonic stages located in the peripheral parts of the large plasmodia. No severe host inflammatory response was seen. [ABSTRACT FROM AUTHOR]

BACKGROUND Pulse wave analysis using the SphygmoCor system allows the estimation of central pulse pressure (PP) and peripheral and central augmentation indexes (AIxs). We studied the limits of normality of these measurements in Chinese. METHODS We computed limits of normality as the 95% confidence boundaries from regression models relating the arterial indexes to age. RESULTS The reference population included 924 subjects (50.7% men, mean age 40.7 years) without overt cardiovascular disease. Men, compared to women, had higher peripheral (43.3 vs. 41.7 mm Hg; P = 0.01) and central (32.9 vs. 30.9 mm Hg; P < 0.0001) PPs, but lower peripheral (69.0 vs. 74.2%; P < 0.0001) and central (16.6 vs. 21.0%; P < 0.0001) AIxs. All arterial measurements showed a curvilinear relation with age. Both before and after adjustment for confounding factors, peripheral and central PPs increased less (P ≤ 0.01) with age in men than in women, whereas the relation of peripheral and central AIxs with age was similar (P ≥ 0.13) in both sexes. In 40-year-old Chinese, approximate thresholds for peripheral and central PPs, peripheral and central AIxs were 58 mm Hg, 48 mm Hg, 105% and 45%, respectively. Considering the age range from 20 to 60 years, thresholds varied within ∼5 mm Hg, ∼10 mm Hg, ∼20%, and ∼15% of the aforementioned thresholds for peripheral and central PPs, peripheral and central AIxs, respectively. CONCLUSIONS Pending further validation in prospective studies, our present study provides preliminary diagnostic thresholds for PP and AIxs in Chinese. [ABSTRACT FROM AUTHOR]

Immunological methods have been developed for the diagnosis of Myxobolus rotundus but their use has been limited for the prevention and therapy of this serious parasitic pathogen. Phage display antibody libraries are a powerful technique for the development of antibodies to molecules of interest and have advantages over traditional hybridroma approaches. In the present study, four antigen fractions related to M. rotundus were prepared and a combined phage display single-chain antibody fragments (ScFv) library was constructed against this parasite. Preliminary analysis indicated that a combined antibody library of about 2.08 x 105 individual clones and high diversity was generated. After four rounds of screening (bio-panning) against soluble spore protein prepared from lysed, intact, mature M. rotundus spores, a strain monoclonal phage display ScFv, termed pCAN-6H9, with better affinity, was isolated. The pCAN-6H9 gene fragment was sequenced and analysed. The specificity of pCAN-6H9 was further demonstrated by dot-blot. In competition enzyme-linked immunosorbent assay, both the original and enriched phage-displayed ScFv repertoire showed significant inhibition of mouse anti-M. rotundus serum binding to coated antigen, while the inhibition rate of monoclonal pCAN-6H9 phage particles was only 11.83%. [ABSTRACT FROM AUTHOR]

There is growing evidence that low-grade chronic inflammation, as reflected by the raised serum concentration of C-reactive protein, might be a risk factor for hypertension, in particular in women. We therefore investigated gender-specific associations of systolic and diastolic blood pressure and pulse pressure with serum C-reactive protein concentration in a Chinese population sample. In 463 participants, we measured serum C-reactive protein concentration using a high-sensitivity immunonephelometric latex-enhanced assay. We performed single and multiple linear regression analyses. The 224 male and 239 female subjects were of similar age (51.0 years) and had similar levels of systolic blood pressure (124.7?mmHg) and pulse pressure (47.1?mmHg), but men, compared with women, had higher diastolic blood pressure (79.6 vs 75.8?mmHg; P<0.0001) and body mass index (24.3 vs 23.4?kg/m2; P=0.003). Both before and after adjustment for age, age2, body mass index, current smoking, alcohol intake, and use of antihypertensive drugs, pulse pressure was significantly associated with serum C-reactive protein concentration in women (P?0.002) but not in men (P>0.10; P=0.02 for interaction between gender and serum C-reactive protein). In women, with one-fold increase in serum C-reactive protein concentration, pulse pressure was 1.94?mmHg higher. The categorical analyses confirmed our findings. With similar adjustments applied, women in the fourth quartile, compared with those in the lowest quartile, had a 7.6?mmHg higher pulse pressure (95%confidence interval 3.5-11.7?mmHg; P=0.0003). Furthermore, when women were analysed according to menopausal status, the association between pulse pressure and C-reactive protein was only significant in postmenopausal (P?0.04), but not in premenopausal, subjects (P?0.21). In conclusion, taken together with the previous gender-specific observations on carotid lesions and hypertension, our finding suggests that chronic low-grade inflammation might play a role in the widening of pulse pressure in Chinese women. This cross-sectional observation warrants further investigation in prospective studies.Journal of Human Hypertension (2005) 19, 293-299. doi:10.1038/sj.jhh.1001818 Published online 27 January 2005 [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and associated risk of cardiovascular event of resistant hypertension in treated outpatients. Methods: This study was a nationwide multi-center prospective cohort study. The participants were treated outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry study of 42 hospitals in 19 provinces across the country from August 2009 to October 2017. Apparent resistant hypertension was defined as uncontrolled office blood pressure (≥140/90 mmHg, 1 mmHg=0.133 kPa) in spite of the use of three antihypertensive drugs or controlled office blood pressure (<140/90 mmHg) with four antihypertensive drugs or more. Subjects diagnosed with uncontrolled office blood pressure were further subdivided as pseudo-resistant hypertension and true resistant hypertension based on 24 h ambulatory blood pressure monitoring. The primary endpoint was fatal and non-fatal cardiovascular and cerebrovascular events, which was a composite endpoint consisting of cardiovascular and cerebrovascular death, ischemic and hemorrhagic stroke, myocardial infarction, coronary artery revascularization, unstable angina, heart failure, and coronary artery stenosis≥50% confirmed by coronary angiography. Secondary outcomes included fatal and non-fatal stroke or cardiac events. Patients with controlled office blood pressure after taking only 1 or 2 antihypertensive drugs were included as control. Kaplan-Meier survival curves, log-rank test, and Cox proportional risk model were used to evaluate the risk of apparent refractory hypertension in relation to cardiovascular and cerebrovascular prognosis. Results: A total of 2 782 treated hypertensive patients, aged (58.1±12.3) years were enrolled, including 1 403 (50.4%) men. The prevalence of apparent and true resistant hypertension was 15.1% (420/2 782) and 10.5% (293/2 782), respectively. Among patients with apparent resistant hypertension, during a median of 5 years follow-up, the cumulative incidence rate was 28.2, 11.2 and 19.1 per 1 000 person-years for fatal and non-fatal cardiovascular events ( n =58), stroke ( n =24) and cardiac events ( n =40), respectively. The Kaplan-Meier curve and log-rank test showed that those patients with true resistant hypertension, had the highest cumulative incidence rate of fatal and non-fatal cardiovascular events, stroke, and cardiac events. Multivariable Cox regression analyses showed that true resistant hypertension was associated with a significantly higher risk of fatal and non-fatal cardiovascular events ( HR =1.73, 95% CI 1.17-2.56, P =0.006) and stroke ( HR= 2.81, 95% CI 1.53-5.17, P =0.001). Conclusion: Resistant hypertension, especially true resistant hypertension, is associated with a higher risk of fatal and non-fatal cardiac and cerebrovascular events.

The study focused on individuals with influenza-like symptoms (fever, cough, sore throat, runny nose, and other respiratory symptoms) in three kindergartens in Tongzhou District, Beijing City, in April 2023. Nasopharyngeal swab specimens were collected, and real-time fluorescent quantitative PCR was used to detect common respiratory pathogens in the collected specimens. Positive specimens were subjected to sequencing analysis of the highly variable region of human respiratory syncytial virus (HRSV) G protein, homology analysis and phylogenetic tree analysis. A total of 25 fever cases were collected from 3 kindergartens, aged 3-8 years old, with an age M ( Q 1 , Q 3 ) of 4 (3.5, 5) years old. Ten confirmed cases of HRSV positive were screened and detected using the fluorescent quantitative PCR method, with a total detection rate of 40% (10/25). Typing identification and sequencing analysis confirmed that the main epidemic type was HRSV subtype B, which was highly homologous and closely related to previous epidemic strains in the region. Through pathogen investigation and analysis, it was preliminarily determined that this epidemic was dominated by HRSV subtype B.

Objective: To understand the etiological characteristics of an acute gastroenteritis outbreak. Methods: Real-time polymerase chain reaction (PCR) and bacteria cultures were performed for the samples, including stool samples from patients and cooks, environmental swabs, raw food material (chicken meat), collected during the outbreak. Pulsed-field gel electrophoresis, antibiotics susceptibility test and whole-genome sequencing were performed for the Campylobacter jejuni isolates. Results: Four stool samples from patients were positive for Campylobacter jejuni by real-time PCR, in which 1 Campylobacter jejuni strain was isolated from a case who had no antibiotic treatment. Twelve Campylobacter jejuni and 7 Campylobacter coli isolates were obtained from 4 raw chicken meat samples. The Campylobacter jejuni strain isolated from the case was resistant to nalidixic acid, ciprofloxacin, chloramphenicol, florfenicol and tetracycline. The MLST analysis with the whole-genome sequences confirmed that the Campylobacter jejuni isolate from the case belonged to ST10075. Antimicrobial resistance genes cmeABCR, tetO/M and blaOXA-61 were found in the genome of the isolate from the patient by the whole-genome sequencing. No mutation in 23S rRNA was found and the C257T mutation in gyrA was identified in this isolate. Conclusion: Laboratory analysis indicated that Campylobacter jejuni infection might be the major cause of this gastroenteritis outbreak.

Signal transducer and activator of transcription protein 3 (STAT3) has been implicated in cancer development and is recognized as a type of oncogene. However, association studies of single nucleotide polymorphisms (SNPs) in the STAT3 gene with cancer risk are rare and not available for lung cancer. We examined whether STAT3 polymorphisms are associated with the risk of non-small cell lung cancer (NSCLC). Eight SNPs in the STAT3 gene were genotyped by TaqMan assays in 326 NSCLC cases and 432 controls in a Chinese population. Significant decreased risk of NSCLC was observed for carriers of minor alleles rs4796793 (odds ratio (OR) = 0.68, 95% confidence interval (CI) = 0.51-0.92), rs7211777 (OR = 0.67, 95%CI = 0.50-0.90), rs12949918 (OR = 0.73, 95%CI = 0.54-0.97), rs744166 (OR = 0.69, 95%CI = 0.51-0.92), rs9912773 (OR = 0.75, 95%CI = 0.55-0.98), and rs3869550 (OR = 0.70, 95%CI = 0.53-0.94). The GGCGGC haplotype, comprised of minor alleles of the six NSCLC-associated SNPs, had a 0.78-fold (95%CI = 0.62-0.97) significantly decreased risk of NSCLC, as compared to the most common haplotype of CATACT. Stratification analyses by clinical stage showed that the trend for the association between STAT3 polymorphisms and NSCLC risk was present both for stage I/II and stage III/IV, and appeared moderately stronger for stage III/IV. We conclude that polymorphisms in the STAT3 gene may have a protective role in the development of NSCLC, particular of stage III/IV NSCLC.

Aims/hypothesis: Increased retinol-binding protein 4 (RBP4) has been reported in association with insulin resistance and type 2 diabetes. We aimed to investigate the association of serum RBP4 with impaired glucose regulation and microalbuminuria in Chinese adults aged 40 years or older., Methods: Serum RBP4 was measured in 763 individuals with normal glucose regulation, 508 with impaired glucose regulation and 524 newly diagnosed diabetic patients. Serum RBP4 was measured using ELISA and urine albumin/creatinine ratio was used to determine the urinary albumin excretion., Results: Serum RBP4 concentrations were significantly higher in participants with isolated impaired fasting glucose, isolated impaired glucose tolerance, combined impaired fasting glucose/impaired glucose tolerance and diabetes than in those with normal glucose regulation, whereas serum RBP4 levels were not different in the four groups with dysregulation of glucose metabolism. RBP4 was associated with a higher risk for impaired glucose regulation (OR 1.011 for each 1 microg/ml increase in RBP4, 95% CI 1.000-1.022, p = 0.04) after adjustment for sex, age, BMI, current smoking and alcohol intake, family history of diabetes, insulin resistance, triacylglycerol, total cholesterol, and HDL- and LDL-cholesterol; the corresponding OR of combined impaired glucose regulation and type 2 diabetes was 1.022 (95% CI 1.009-1.035, p = 0.0009). RBP4 was associated with the risk of microalbuminuria (OR 1.023, 95% CI 1.004-1.042, p = 0.01) after adjustment for sex, age, smoking habit and alcohol intake, BMI, waist/hip ratio, homeostasis model assessment of insulin resistance, GFR, triacylglycerol, total cholesterol, and HDL- and LDL-cholesterol., Conclusions/interpretation: Serum RBP4 level is closely associated with impaired glucose regulation and is an independent risk factor for microalbuminuria.

Background: Pulse wave analysis using the SphygmoCor system allows the estimation of central pulse pressure (PP) and peripheral and central augmentation indexes (AIxs). We studied the limits of normality of these measurements in Chinese., Methods: We computed limits of normality as the 95% confidence boundaries from regression models relating the arterial indexes to age., Results: The reference population included 924 subjects (50.7% men, mean age 40.7 years) without overt cardiovascular disease. Men, compared to women, had higher peripheral (43.3 vs. 41.7 mm Hg; P = 0.01) and central (32.9 vs. 30.9 mm Hg; P < 0.0001) PPs, but lower peripheral (69.0 vs. 74.2%; P < 0.0001) and central (16.6 vs. 21.0%; P < 0.0001) AIxs. All arterial measurements showed a curvilinear relation with age. Both before and after adjustment for confounding factors, peripheral and central PPs increased less (P < or = 0.01) with age in men than in women, whereas the relation of peripheral and central AIxs with age was similar (P > or = 0.13) in both sexes. In 40-year-old Chinese, approximate thresholds for peripheral and central PPs, peripheral and central AIxs were 58 mm Hg, 48 mm Hg, 105% and 45%, respectively. Considering the age range from 20 to 60 years, thresholds varied within approximately 5 mm Hg, approximately 10 mm Hg, approximately 20%, and approximately 15% of the aforementioned thresholds for peripheral and central PPs, peripheral and central AIxs, respectively., Conclusions: Pending further validation in prospective studies, our present study provides preliminary diagnostic thresholds for PP and AIxs in Chinese.

Redescription of Myxobolus pyramidis Chen, 1958, from gill lamellae of allogynogenetic gibel carp, Carassius auratus gibelio (Bloch), is presented in this paper to complete Chen's description. The diagnostic characters of the myxosporidia are: ovoid round, greyish-white polysporous plasmodia, averaging (159+/-21)x(72+/-6.5) mum in size; spore pyriform in front view with smooth surface and symmetrical valves, convex-shaped in sutural view with straight and thick sutural line, averaging (10.5+/-1.1)x(10.3+/-0.9)x(6.1+/-0.2) mum in size; two equal pyriform polar capsules averaging (5.5+/-0.7)x(3.5+/-0.2) mum in size with distinct intercapsular process and polar filament wounded in five to six coils. The histological effects of the pathogen were observed by light microscopy, and the parasite-host relationship was discussed.

Adrenomedullin (ADM) is a vasodilator and inhibits salt appetite. An A-to-G substitution at position -1984 in the promoter region of the ADM gene likely increases transcription. We therefore investigated this polymorphism in relation to blood pressure and urinary sodium in a Chinese population. We genotyped 427 Chinese enrolled in a family-based population study. We measured blood pressure by conventional sphygmomanometry and ambulatory monitoring. The frequencies of the ADM AA, AG, and GG genotypes were 50.6, 38.2, and 11.2%, respectively. In adjusted analyses, G allele carriers, compared to AA homozygotes, had significantly lower conventional (45.3 versus 48.5 mm Hg, P = 0.004) and 24-h (42.6 versus 44.3 mm Hg, P = 0.03) pulse pressures and urinary sodium excretion (143.8 versus 159.4 mmol/day, P = 0.03). In parents, but not offspring, both systolic pressure and pulse pressure were significantly (P<0.01) lower in G allele carriers. The genotypic difference in sodium excretion was consistent across the age range. In 68 informative offspring, transmission of the G allele was associated with lower urinary sodium excretion (effect size, 40.1 mmol/day, P = 0.01). In 81 healthy volunteers, the plasma ADM concentration was 15.2% higher in GG homozygotes than in sex- and age-matched AA subjects (11.4 versus 9.9 pmol/l, P = 0.10). In conclusion, in Chinese, the ADM -1984G allele is associated with lower sodium excretion and in older subjects also with lower systolic pressure and narrower pulse pressure.

We examined the relation of serum creatinine and uric acid to mortality and cardiovascular disease in older (aged >/=60 years) Chinese patients with isolated systolic hypertension (systolic/diastolic blood pressure >/=160/<95 mm Hg). We used Cox regression to correlate outcome with baseline serum creatinine and uric acid measured in 1880 and 1873, respectively, of the 2394 patients enrolled in the placebo-controlled Systolic Hypertension in China (Syst-China), Trial: Median follow-up was 3 years. In multiple Cox regression analysis with adjustment for gender, age, active treatment, and other significant covariates, serum creatinine was significantly associated with a worse prognosis. The relative hazard rates (95% CIs) associated with a 20-micromol/L increase in serum creatinine for all-cause, cardiovascular, and stroke mortality were 1.16 (1.05 to 1.27, P=0.003), 1.15 (1.01 to 1.31, P=0.03), and 1.37 (1.13 to 1.65, P=0.001), respectively. In a similar analysis, which also accounted for serum creatinine, serum uric acid was also significantly and independently associated with excess mortality of cardiovascular disease and stroke. The relative hazard rates associated with a 50-micromol/L increase of serum uric acid were 1.14 (1.02 to 1.27, P=0.02) for cardiovascular mortality and 1.34 (1.14 to 1.57, P<0.001) for fatal stroke. In conclusion, in older Chinese patients with isolated systolic hypertension, serum creatinine and serum uric acid were predictors of mortality.

Isolated systolic hypertension affects over 15% of all individuals aged >60 years. In the elderly, systolic hypertension is a major modifiable cardiovascular risk factor. Systolic blood pressure (SBP) is associated with higher risk of an adverse outcome, whereas diastolic blood pressure (DBP) is inversely correlated with total mortality, independent of SBP, highlighting the role of pulse pressure as a risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment in older patients with isolated systolic hypertension have been published: the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur) Trial and the Systolic Hypertension in China (Syst-China) Trial. These 3 trials demonstrated the benefit of antihypertensive drug treatment. A meta-analysis was performed by pooling the patients from these 3 trials with a subset of patients with isolated systolic hypertension from 5 other trials in the elderly. The pooled results of 15,693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment isjustified if on repeated clinic measurements SBP is 160 mm Hg or higher.

Background: In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Group initiated the placebo-controlled Syst-China trial to investigate whether antihypertensive drug treatment could reduce the incidence of fatal and nonfatal stroke in older Chinese patients with isolated systolic hypertension., Objectives: To explore (1) whether the benefits of active treatment were evenly distributed across 4 strata, prospectively defined according to sex and previous cardiovascular complications, and (2) whether the morbidity and mortality results were influenced by age, level of systolic or diastolic blood pressure (BP), smoking or drinking habits, or diabetes mellitus at enrollment., Methods: Eligible patients had to be 60 years or older with a sitting systolic BP of 160 to 219 mm Hg and diastolic BP less than 95 mm Hg. After stratification for center, sex, and previous cardiovascular complications, 1253 patients were assigned to active treatment starting with nitrendipine (10-40 mg/d), with the possible addition of captopril (12.5-50.0 mg/d), and/or hydrochlorothiazide (12.5-50 mg/d). In the 1141 control patients, matching placebos were used similarly., Results: Male sex, previous cardiovascular complications, older age, higher systolic BP or lower diastolic BP, living in northern China, smoking, and diabetes mellitus significantly and independently increased the risk of 1 or more of the following end points: total or cardiovascular mortality, all fatal and nonfatal cardiovascular end points, all strokes, and all cardiac end points. In the placebo-control group diabetes raised the risk of all end points 2- to 3-fold (P< or =.05). However, active treatment reduced the excess risk associated with diabetes to a nonsignificant level (P values ranging from .12-.86) except for cardiovascular mortality (P = .04). Cox regression with adjustments applied for significant covariates suggested that active treatment may reduce total mortality more (P = .06) in women and stroke more (P = .07) in men and that it may provide better protection against cardiac end points in nonsmokers than smokers (P = .04). Otherwise, the benefits of active treatment were equally manifest, regardless of the enrollment characteristics of the patients, and regardless of whether active treatment consisted of only nitrendipine or of nitrendipine associated with other active drugs., Conclusions: In elderly Chinese patients with isolated systolic hypertension, stepwise antihypertensive drug treatment, starting with the dihydropyridine calcium channel blocker nitrendipine, improved prognosis. The benefit was particularly evident in diabetic patients; for cardiac end points it tended to be larger in nonsmokers. Otherwise, the benefit of active treatment was not significantly influenced by the characteristics of the patients at enrollment in the trial.

Isolated systolic hypertension affects 8% to 15% of all people older than 60 years of age. In the elderly, systolic hypertension is the major modifiable cardiovascular risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment of this disorder have been published. This article briefly reviews the main findings of each of these three trials and presents pooled estimates of the benefit of antihypertensive drug treatment for elderly patients with isolated systolic hypertension. A total of 11, 825 patients were enrolled in the Systolic Hypertension in the Elderly Program (SHEP, n = 4736), the Systolic Hypertension in Europe (Syst-Eur, n = 4695), and the Systolic Hypertension in China (Syst-China, n = 2394) trials. The outcome results of these trials were pooled by calculating the common odds ratio for active versus placebo treatment. The pooled results of the outcome trials in older patients with isolated systolic hypertension prove that antihypertensive drug treatment must be prescribed if, on repeated measurement, systolic blood pressure is 160 mm Hg or higher.

In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Group started to investigate whether active treatment could reduce the incidence of stroke and other cardiovascular complications of isolated systolic hypertension. After stratification for center, sex and previous cardiovascular complications, alternate patients (n = 1253) were assigned nitrendipine 10-40 mg daily, with the possible addition of captopril 12.5-50.0 mg daily, or hydrochlorothiazide 12.5-50.0 mg daily, or both drugs. In 1141 control patients, matching placebos were employed similarly. At entry, sitting blood pressure averaged 170 mm Hg systolic and 86 mm Hg diastolic, age averaged 66 years, and total serum cholesterol was 5.1 mmol/L. At 2 years, the between-group differences were 9.1 mm Hg systolic (95% confidence interval: 7.6-10.7 mm Hg) and 3.2 mm Hg diastolic (2.4-4.0). Active treatment reduced total stroke by 38% (p=0.01), all-cause mortality by 39% (p=0.003), cardiovascular mortality by 39% (p=0.03), stroke mortality by 58% (p=0.02) and all fatal and nonfatal cardiovascular endpoints by 37% (p=0.004). In conclusion, antihypertensive treatment prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension. Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes, or 59 major cardiovascular endpoints.

Background: Isolated systolic hypertension occurs in around 8% of Chinese people aged 60 years or older. In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Group started to investigate whether active treatment could reduce the incidence of stroke and other cardiovascular complications in older patients with isolated systolic hypertension., Methods: All patients were initially started on masked placebo. After stratification for centre, sex and previous cardiovascular complications, alternate patients (n=1253) were assigned nitrendipine at 10-40 mg daily, with the addition of captopril at 12.5-50.0 mg daily or hydrochlorothiazide at 12.5-50.0 mg daily, or both, if a sufficient blood pressure fall was not obtained. In the remaining 1141 control patients, matching placebos were administered similarly., Results: At entry, sitting blood pressure averaged 170.5 mmHg systolic and 86.0 mmHg diastolic, age averaged 66.5 years and total serum cholesterol was 5.1 mmol/l. After 2 years of follow-up, sitting systolic and diastolic blood pressures had fallen by 10.9 mmHg and 1.9 mmHg in the placebo group and by 20.0 mmHg and 5.0 mmHg in the active treatment group. The intergroup differences were 9.1 mmHg systolic (95% confidence interval 7.6-10.7 mmHg ) and 3.2 mmHg diastolic (95% confidence interval 2.4-4.0). Active treatment reduced total strokes by 38% (from 20.8 to 13.0 endpoints per 1000 patient-years, P=0.01), all-cause mortality by 39% (from 28.4 to 17.4 endpoints per 1000 patient-years, P=0.003), cardiovascular mortality by 39% (from 15.2 to 9.4 endpoints per 1000 patient-years, P=0.03), stroke mortality by 58% (from 6.9 to 2.9 endpoints per 1000 patient-years, P=0.02), and ail fatal and nonfatal cardiovascular endpoints by 37% (from 33.3 to 21.4 endpoints per 1000 patient-years, P=0.004)., Conclusions: Antihypertensive treatment prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension. Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes or 59 major cardiovascular endpoints.

This report on the ongoing double-blind placebo-controlled Syst-China trial investigated whether antihypertensive drug treatment based mainly on a calcium entry blocker and a converting enzyme inhibitor, would be suitable for maintaining long-term blood pressure (BP) control in older Chinese patients (average age: 67 years) with isolated systolic hypertension (systolic pressure 160-219 mm Hg and diastolic pressure < 95 mm Hg). Active treatment consisted of nitrendipine (10- 40 mg/day) with the possible addition of captopril (12.5- 50 mg/day) and hydrochlorothiazide (12.5-50 mg/day), as necessary to reduce systolic pressure to a level of 150 mm Hg or lower and by at least 20 mm Hg. Matching placebos were used in the control group. This progress analysis was restricted to BP control up to 3 years of follow-up. The placebo (n = 1134) and active treatment n = 1245) groups had similar characteristics at enrolment. The sitting BP averaged 170/86 mm Hg. Systolic pressure fell (P < 0.001) on average 8 mm Hg more on active treatment than on placebo and diastolic pressure 3 mm Hg more. Fewer patients remained on monotherapy in the placebo than in the active treatment group (P < 0.001); on placebo the second and third line medications were started more frequently (P < 0.001). This progress report showed that significant BP reduction can be achieved and maintained in older Chinese patients treated with a calcium antagonist, associated with a converting-enzyme inhibitor and a thiazide, as necessary. Whether this BP reduction would result in a clinically meaningful decrease of cardiovascular complications is still under investigation.

Investigation of patients, healthy persons, and ticks in Jinghe County, Xinjiang Uygur Autonomous Region, People's Republic of China, for evidence of spotted fever group (SFG) rickettsiosis demonstrated strong evidence for a high prevalence of pathogenic SFG rickettsiae. Antibodies to SFG rickettsiae were detected in 62.5% of healthy subjects tested by enzyme-linked immunosorbent assay and 20% tested by complement fixation test. Two febrile patients were documented as having acute spotted fever rickettsiosis by complement fixation seroconversion. One, and 11-year-old Kazakh boy with eschar and regional lymphadenopathy, had an SFG rickettsia (An strain) isolated from his blood. A hemolymph test revealed that 20% of ticks contained rickettsiae. Two strains of SFG rickettsiae were isolated from male and female Dermacentor nuttalli ticks. The human SFG rickettsial isolate is the first to be obtained in the People's Republic of China.