Objective To explore predictive diagnosis value of serum interleukin-33 (IL-33) for non-alcoholic fatty liver disease (NAFLD) and its relative influencing factors.Methods Participants were recruited from check up crowd in physical examination center of the Third Affiliated Hospital, Sun Yat-sen University from October 2012 to January 2013.One hundred and forty subjects meeting the diagnostic criteria of NAFLD were selected as the case group and 140 healthy individuals who were non-drinkers, without cardiovascular disease or other chronic diseases, explicitly excluded from NAFLD, and matched to cases on gender and age, were taken as the control group.Height, weight, waist circumference, hip circumference, and blood pressure were measured and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in fasting venous blood, fasting blood glucose, total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood uric acid, and serum IL-33 were tested in both groups.Multivariate unconditional logistic regression and receiver operating characteristic (ROC) curve were employed to determine the association between IL-33 and NAFLD.ResultsThe average age of the 140 NAFLD cases (87 males and 53 females) was (54.51±9.08) years (mean±SD) and that of the 140 controls (76 males and 64 females), (52.69±9.22) years.There were no statistically significant differences in age and gender between the two groups (P＞0.05 for both).Compared with controls, the NAFLD cases had significantly higher levels of SBP, DBP, BMI, waist circumference, hip circumference, waist-to-hip ratio, ALT, TG, and UA, but lower HDL-C (P＜0.01 for all).The prevalence rates of obesity, hypertension, dyslipidemia, metabolic syndrome, and hyperuricemia were significantly higher in the NAFLD case group than those in the control group (P＜0.01 for all).The serum IL-33 level in NAFLD case group (［3.92±1.96］ pg/mL） was higher than that in the control group (［1.92±1.31］ pg/mL），P＜0.01.High levels of IL-33 (OR= 3.678)，ALT (OR=1.091), TG (OR=2.557)，obesity (OR=6.437), and hypertension (OR=2 383) might be the risk factors of NAFLD, while high level of HDL-C (OR=0 069)might be the beneficial factor.The areas under ROC curve of IL-33，ALT，TG，HDL-C，and BMI for predictive diagnosis of NAFLD were 0.819，0.665，0.749，0.720，and 0.776, respectively (P＜0.01 for all).Conclusion As an independent risk factor for NAFLD, IL-33 played an important role in the development of NAFLD and has a high diagnosis value for it.

Objective To study the intervention effect of folic acid on inflammatory cytokines in athletes.

Methods Athletes in a sports training base in Guangdong Province were recruited.All subjects were orally administrated folic acid supplement (1.0 mg/d) for 3 months.Balanced diet was required during the period.Before and after the folic acid intervention for three months, questionnaire survey was conducted to collect information including age, gender, height, weight, education level, disease history, and dietary supplement intake.Dietary survey was conducted over three consecutive days by 24-hour recall method.Average daily intake of energy, carbohydrate, protein, fat, and dietary folic acid were calculated by the obtained dietary data using nutritional calculation software 2,1 designed by Chinese CDC.Plasma levels of inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and interleukin-1β(IL-1β) were evaluated before and after 3-month folic acid intervention.ResultsA total of 114 athletes were recruited, including 56 males (49.1%) and 58 females (50.9%).Their age was（22.24±4.16）years (mean±SD ) and BMI was 22 70±4 19 After folic acid intervention for three months, the plasma levels of TNF-α(47.92 pg/mL), IL-8 (1.89 pg/mL), and IL-1β(12.3954 (P<0.01).Conclusion Folic acid supplement can decrease the plasma levels of pro-inflammatory cytokines TNF-α, and IL-8, increase the IL-10/TNF-αratio, thus reduce inflammatory levels in athletes undergoing long-term intensive exercise training.

Objective To assess the association of physical activity with the risk of hip fractures.

Methods 1:1 matched case-control study was conducted.Cases of incident hip fractures from four hospitals and controls matched by age (3 years) and sex from hospitals or communities were enrolled between January 2008 and July 2013 in Guangdong Province.Study participants were face-to-face interviewed for general demography, daily activities in recent two years, health related behaviors, and parental history of fractures.Univariate and multivariate conditional logistic regressions were used to test the association between physical activity and risks of hip fracture.Age, BMI，education levels, parental history of fractures, smoking and alcohol drinking, vitamins and calcium supplements, and years since menopause (women) were adjusted for multivariate model.Results There were 726 pairs of cases and controls (177 pairs of males and 549 pairs of females).Ages of cases and controls were (71.0±7.0) and (70.9±6 9) years, respectively (P>0.05).Energy consumption in total physical activity and exercise in recent two years of cases (39.5 and 0.91 MET×h/d) were lower than those of controls (53 4 and 1.60 MET×h/d)，P<0.01 for all.Multivariate analyses showed the risks of hip fractures were lower in the highest energy consumption group for total energy consumption of daily average physical activity (OR=0.38) and energy consumption of exercise (OR=0.47), compared with the lowest group; the risk of fracture in group taking part in physical exercise was lower than that in group without physical exercise (OR=0.53).Stratified analyses revealed that high physical activity showed a protective effect only for women; the risks of hip fractures were lower in the highest energy consumption group for total energy consumption of daily average physical activity (OR=0.40) and energy consumption of exercise (OR=0.47) compared with the lowest group; the group who participated regular physical exercise had a lower risk of hip fractures than those who did not (OR=0.51).Conclusion Greater levels of total physical activity and exercise were associated with lower risk of hip fractures in the elderly females in Guangdong Province.

Objective To investigate the effect of genistein on cholesterol metabolism and SREBP-2 pathway in HepG2 cell.Methods HepG2 cells were cultured with 0, 0.01, 0.10, 1.00, 10.00, 50.00, and 100.00 μmol/L of genistein for 24, 48, and 72 hours, respectively.Then, the cell proliferative activity was detected by MTT.HepG2 cells were incubated with 0, 0.01, 1.00, 10.00, and 50.00 l/L genistein for 24 hours and then collected for the cholesterol determination.The gene expression levels of ldlr and hmgcr were measured by real-time quantitative PCR.The expression of nuclear transcription factor SREBP-2 was determined by Western blotting.ResultsAfter incubation with genistein for 24 hours, the proliferative rates of cells treated with 0.01, 0.10, and 1.00 μmol/L genistein were higher than that of the control (P<0.05 for all).However, after incubation with genistein for 48 or 72 hours, the proliferative rates of cells treated with 1.00, 10.00, 50.00, and 100.00 μmol/L genistein were lower than that of the control (P<0.05 for all).Cholesterol levels in HepG2 cells incubated with 1.00, 10.00, and 50.00 μmol/L genistein for 24 hours were［1.81±0.15］,［2.29±0.17］, and［2.88±0.08］mmol/L, respectively, which were higher than that of the control cells (［1.44±0.17］mmol/L).There was a rising trend as the genistein concentration increased (R2=0.48，P<0.01).Meanwhile, mRNA levels of hmgcr and ldlr were also increased as the genistein concentration increased (R2=0.53 or 0.79,P<0.01 for all).SREBP-2 protein levels in HepG2 cells incubated with 1.00, 10.00, and 50.00 μmol/L genistein were much higher than that in control cells (P<0.01 for all).Conclusion Genistein could regulate the cholesterol metabolism in HepG2 cells and its mechanism may be related to regulating gene or protein expressions involved in the SREBP-2 pathway.

Objective To understand the pathogen characters and change variation trend of viral diarrhea in Guangdong Province and to provide reference for prevention and control of viral diarrhea.Methods Twenty-three sentinel hospitals were collected from 11 cities in Guangdong Province.Every sentinel hospital collected at least 3 stool samples of diarrhea outpatients aged 5 and below and above 5 years, respectively, for rotavirus and norovirus detection.Results A total of 4 644 specimens of diarrhea cases were collected from 23 sentinel hospitals in 2012 in Guangdong Province.Positive rates of rotavirus and norovirus were 13.94% (645/4627) and 22.14% (1028/4644), respectively.The rotavirus-positive rate of cases aged 5 and below (18.60%）was significantly higher than that above 5 years (8.95%) (P<0.01).The norovirus-positive rates had no significant difference between cases aged 5 and below (21.88%) and those above 5 years (22 41%) (P>0.05).The highest rotavirus-positive rate (41 50%, 105/253) presented in January The highest norovirus-positive rate (40.15%, 218/543) was in October.Of 226 specimens randomly selected from 1 028 norovirus-positive ones for gene sequenced, 203 belonged to GII genotype and 23 belong to GI genotype.Among 203 GII genotype strains, 172 were GII-4 genotype (87 as GII.4 Sydney 2012 genotype, 78 as GII.4 2006 b genotype, 4 as GII.4 2010 gonotype, and 3 as unsubtyped).Conclusion The dominant virus of viral diarrhea was norovirus in Guangdong Province in 2012 and relevant to the emergence of GII-4 Sydney 2012 strain.

Objective To investigate the cognitive level, drinking habits, and their influential factors of herbal tea among Guangdong (residents), thus to provide scientific guidance on herbal tea consuming.

Methods Residents in cities of Guangzhou and Zhaoqing were selected by stratified random sampling method.Intercept on street and face to face household questionnaire surveys were conducted to investigate the participants' demographic characteristics, such as gender, age, birthplace, education, and their understanding on property and ingredients of herbal tea, the drinking status and habits.Descriptive epidemiological analysis was applied, and univariate and multivariate logistic regressions were used to determine the factors influencing herbal tea drinking habit.Results A total of 2 154 residents were recruited.Of them, 1005 (46.7%) were from Guangzhou and 1149 (53.3%) from Zhaoqing; 957 (44.4%) were males and 1 197 (55.6%) females; 522 (24.2%) were aged 12-19 years.Birth place of 1.781 (82.7%) participants was Guangdong.Among all the participants, 98.7% knew one or more kinds of herbal tea, 43.7% knew six or more components of the herbal tea, 49.2% considered the herbal tea to be Chinese herbal medicine, 99.1% once drank herbal tea, and 37.6% had a habit of drinking herbal tea.Multivariate logistic regression showed that those aged 30-39(OR=1.47),40-49(OR=1.58),and aged 50 and above(OR=1.78), birth place of Guangdong (OR=2.92), currently living in Guangzhou (OR=2.97), knowing 1 to 5 kinds of herbal tea (OR=2.28), knowing 6 or more ingredients of herbal tea tended to have a habit of drinking herbal tea (P＜0.05 or P＜0.01).Conclusion Acceptance of herbal tea was high in residents of Guangzhou and Zhaoqing cities.Age, birthplace, living place, and understanding of herbal tea ingredients were factors that would influence the behavior of drinking herbal tea.

Objective To investigate prevalence, knowledge, attitudes, and practices (KAP) of chronic diseases among residents in Liurong Community, and to provide scientific basis for developing effective community prevention and control measures of chronic diseases. Methods The data of household survey of Liurong Community were sourced from the Guangzhou Community Health Diagnosis in 2009.One hundred households per resident committee from 8 resident committees in all resident committees of Liurong Community were randomly selected.Residents were interviewed with a standardized questionnaire including demographic characteristics, family status, chronic diseases and behavioral risk factors, and other related diseases.The KAP contents were answered by subjects aged 15 years and over.Results A total of 2 252 people (1 090 males and 1 162 females) aged from 12 to 85 years were investigated.The overall chronic diseases prevalence was 30.91% (696/2 252) and the standardized prevalence was 22.83%.Among residents aged 65 and over, the prevalence and standardized prevalence were 71.95% (413/574) and 54.08%, respectively.The trend in the prevalence of chronic diseases was strongly associated with the increasing of age (P＜0.01).The top five chronic diseases with high prevalence were: hypertension (19.63%，442/2 252), diabetes (6.08%, 137/2 252), coronary heart disease (2.40%, 54/2 252), hyperlipidemia (1.82%, 41/2 252), and stroke (1.55%, 35/2 252).The KAP survey results showed that the rates of behavior for patients with chronic diseases and non-chronic diseases to participating in health knowledge lectures in community were 16.67% (115/690) and 8.84% (118/1 335), respectively, (P<0.01); the awareness rate of hypertension related knowledge of patients with chronic diseases was higher than that of patients with non-chronic diseases (P＜0.01); the rates of self-awareness of hypertension, self-monitoring, and behavior often taking the initiative to acquire health knowledge in patients with chronic diseases were higher than those in non-chronic diseases patients (P＜0.01 for all).The rates of behaviors of unhealthy lifestyle such as smoking and lack of physical exercise among patients with non-chronic diseases were higher than those among patients chronic ones, while the smoking quit rate was significantly higher in patients with chronic diseases than that in those with non-chronic diseases (P＜0.01 for all).Conclusion There was a high prevalence rate of chronic diseases among residents in Liurong Community.Residents would tend to pay attention to control risk factors after suffering from chronic diseases.The chronic disease prevention and control strategies should be extended to healthy population, and the awareness of whole population should be improved.

Objective To observe the occurrence of school violence in elementary schools and explore its influencing factors at individual and school levels.Methods Pupils of grades 4 to 6 were selected from 14 public elementary schools and 6 elementary schools for children of peasant-workers in Baoan District, Shenzhen City with stratified-cluster sampling method for investigation of the school violence incidents within one year and the related influential factors.Multilevel logistic regression model was used to determine the influencing factors at pupil level and school level.Results A total of 5 834 pupils were surveyed (3 281 boys and 2 553 girls).Their age was(11.49±1.17)yeas (mean±SD ).Numbers of pupils from the public schools and schools for children of peasant-workers were 4 234 (72.60%) and 1 600 (27.40%), respectively.The incidence rate of school violence was 72.51%(4 230/5 834).Of the violence types, the incidence rates of psychological violence and physical violence were 71.94% (4 197/5 834) and 44.31% (2 585/5 834), respectively.The incidence rates of violence occurred in public schools, schools for children of peasant-workers, boys, and girls were 76.10%（3 220/4 234）, 63.10%（1 010/1 600），75.59%（2 480/3 281), and 68.55%（1 750/2 553), respectively.Risk factors of violence behavior were associated with public schools (OR=2.20), lack of health education (OR=1.73), male (OR=1.27), ordinary academic records (OR=1.29), playing network games (OR=1.93), parents quarreling in front of children (OR=1.56), and child maltreatment (OR=1 60). Conclusion Violence in elementary school pupils was widespread in Baoan District, Shenzhen; relevant departments of the schools should take measures to prevent the occurrence of school violence by minimizing some risk factors.

Objective To analyze occurrence features of adverse events following immunization (AEFI) and evaluate the operating quality of AEFI information management system and the immunization safety in Guangdong Province during 2011—2012. Methods AEFI data reported from January 1, 2011 to December 31, 2012 were collected through the National AEFI Information Management System.Records of vaccination in the same period were sourced from the monthly vaccination reporting system of Guangdong Province.The descriptive method was used to analyze the AEFI occurrence features.Results A total of 9 753 AEFI cases were reported (reported incidence rate, 89.77 per million doses)，of which 60.96% 5 945/9 753）were males and 39.04%（3 808/9 753）were females, 65.75% (6 413/9 753) were aged one year and under and 32.29% (3 149/9 753) were aged 2-7 years.Of all the AEFIs, 63.68% (6 211/9 753) were general reactions (mean reported incidence rate, 57.17 per million doses), 30.44% (2 969/9 753) were abnormal reactions (mean reported incidence rate, 2 733 per million doses), and 1.98% (193/9 753) were serious abnormal reactions (mean reported incidence rate, 1.79 per million doses).Symptoms of general reactions were mainly fever, redness and swelling, or indurations.Anaphylactic rash (2 399 cases), angioedema (125 cases), and lymphadenitis of Bacilli Calmette-Guerin vaccine (BCG) (137 cases) accounted for 89.63% (2 661/2 969) of all the abnormal reactions.Anaphylactic shock (57 cases), thrombocytopenic purpura (20 cases), and allergic purpura (16 cases) accounted for 48.19%(93/193) of serious abnormal reactions.Of all the AEFIs, 87.41% (8 525/9 753) occurred within 1 day after vaccination, and 97.75% (9 534/9 753) were cured or improved.Of all the diagnostic conclusions of abnormal reactions, 92.49% (2 746/2 969) were provided by investigation teams of institutions for disease control and prevention, 89.59% were provided by institutions for disease control and prevention at county level.Conclusion The sensitivity of AEFI surveillance in Guangdong was high.AEFIs often occurred among young group, within 1 day after vaccination, and with favourable prognosis.

Objective To investigate direct medical expenses and their constitutions of tuberculosis (TB) patients in Baoan District, Shenzhen City, to provide a basis for establishing and perfecting tuberculosis control strategy and optimizing the allocation of medical resources.Methods All TB patients who were registered and completed the treatment in the Chronic Diseases Prevention and Treatment Hospital of Baoan District from 2008 to 2012 were investigated.The data such as demographic characteristics, therapy and classification, diagnosis, and therapy management were collected from TB management information system and expense information system.A multiple linear regression model was employed to analyze influential factors of TB treatment expenses.

Results A total of 5 985 TB patients aged（31.05±10.88）years (mean±SD) were included in the study.Of them, 63.86% (3 822/5 985) were males, 36.14% (2 163/5 985) were females, and 94.72% (5 669/5 985) were floating population.The median of outpatient medical expenses was RMB 2 596.10 Yuan, in which the mean expenses of examination, supportive drugs, other drugs, and other fees were 1 512.14 (56.81%), 627.50 (24.33%), 348.80 (17.02%), and 43.75(1.84%）Yuan, respectively.Nonlocal, retreatment, and smear-negative patients had higher medical expenses than local, initial treatment, and smear-positive patients, respectively (P<0.01 for all).Multiple linear regression showed that nonlocal patients had ligher medical expenses than local patients (β=0.017, P<0.01), retreatment patients had higher expenses than initial treatment ones (β=0 093,P<0.01), smear-positive patients at the end of two months had higher expenses than smear-negative ones (β=0.048,P<0.01), and patients with pulmonary cavity had higher expenses than those without pulmonary cavity (β=0.043,P<0.01).Conclusion Examination expenses largely accounted for the total outpatient medical expenses of TB patients in Baoan District, Shenzhen.The medical expenses varied in different types of TB patients.

Objective To investigate the cause of an outbreak of infectious diarrhea in a town of Meizhou City and propose countermeasures for control of the outbreak.Methods We screened the cases according to the case definition, described the epidemiological characteristics, investigated the habits of drinking water and eating meals, and analyzed the possible exposure factors by carrying out retrospective cohort study.Then we collected clinical specimens, including stool specimens, rectal swabs, and vomitus of part patients, and water samples from waterworks including source water, finished water and tap water, mountain spring, and wells for microbiological and etiological detection.Results From October 20 to 28 in 2012, a total of 131 patients with infectious diarrhea were found in the town, with an attack rate of 0.7%（131/18 597）.The initial case occurred at 23∶00 pm on October 20, and the peak occurred from October 21 to 22, accounting for 80.2% (105/131) of total cases .The main clinical symptoms were vomiting and diarrhea.The gender ratio was 0.7∶1, and the main occupations were farmers (38.9%), students (23.7%), and scattered children (14.5%).13 villages were involved, and the top five villages in incidence were A (30 cases, attack rate 2.7%), B (24, 0.8%), C (21, 1.3%), D (18, 1.4%), and E (10, 1.5%).88.5% (116/131) cases used centralized water supply.The attack rate in eight villages with centralized water supply (1.0%, 116/11 135) was higher than that in villages only using decentralized water supply (0.2%,15/7 462), and the relative risk (RR) was 5.2 (95%CI: 3.0-8.9).There were three waterworks in the town.The X waterworks provided water supply for 6 villages of A, B, C, D, E, and H, where the attack rate was 1.3%（106/8 166）.Y and Z waterworks only supplied their own villages, where the attack rates were 0.4%（9/2 149） and 0.1%（1/820）, respectively.The results of retrospective cohort study indicated that using water from the X waterworks was a risk factor (RR=6.5, 95%CI:3.8-11.1).A total of 12 clinical specimens and 15 water samples were tested.8 clinical specimens, including 2 stool specimens, 5 rectal swabs, and 1 vomitus were positive for Norovirus nucleic acid, 8 water samples from X waterworks, including 1 source water,2 finished water and 5 tap water from pipe network were positive for total coliform group and thermotolerant coliform bacteria, and 7 water samples from X waterworks, including 1 finished water, 3 tap water from pipe network and 3 source water, and 1 well water were negative for Norovirus nucleic acid.