Objective To learn the exposure levels and health hazards of long-term exposure to hexavalent chromium (Cr6+) through drinking water in a west county,and to provide a scientific basis for making preventive measures.Methods Five water points were selected to test the Cr6+ concentration of drinking water in the county in 2015,data of 3 water points with water Cr6+ concentrations exceeded the standard (Cr6+ ＞ 0.05 mg/L) were selected from 12 drinking water points in some west counties in the recent six years (2009-2014) as the exposed group,2water points that drinking water Cr6+ concentrations not exceeded the standard (Cr6+ ≤0.05 mg/L) in the county and adjacent to the exposed group were selected as the control group.Sixty villagers were selected as the investigation objects in each water point to conduct internal medicine,ears,nose,throat (ENT),dermatology and health examination,urinary chromium content,routine blood and urine test were done.Determination of hexavalent chromium concentration in drinking water was done according to The Drinking Water Standard Examination Method 1,5-diphenylcarbazide Spectrophotometry (GB/T 5750-2006);routine urine was tested using the 10 urine analyzer test;urinary chromium was tested using graphite furnace atomic absorption spectrometer;routine blood five classification was tested using automatic blood analyzer;determination of drinking water hexavalent chromium concentration was done according to The Hygienic Standard for Drinking Water (GB 5749-2006).Higher than 0.05 mg/L was judged as exceeded the standard;physical examination was done according to The Diagnostic Criteria of Occupational Chromium Nasal Disease (GB Z12-2002) and The Diagnostic Standard of Occupational Contact Dermatitis (GB Z20-2002).Results There were 184 and 109 people in the exposed group and the control group,respectively.The average concentration of Cr6+ exceeding the standard ratio was 2.82-3.22 in drinking water,the nasal septum nucosa perforation,skin erythema edema,skin ulcers were 4.9％ (9/184),4.3％ (8/184) and 4.3％ (8/184) in the exposed group,and the urinary chromium level (0.31 μg/L) in the exposed group was significantly higher than that of the control group (0.27 μg/L,Z =-4.078,P ＜ 0.05).Routine blood test result of mean corpuscular haemaglobin (MCH) was (29.56 ± 2.07) pg,platelet counts (PLT) was (222.38 ± 47.53) × 109/L and plateletcrit (PCT) was (0.25 ± 0.05)％ in the exposed group,it was all higher than those of the control group [(29.03 ±2.95) pg,(211.74 ±75.27)× 109/L,(0.24 ± 0.08)％,t =1,940,2.318,2.079,all P ＜ 0.05];standard difference coefficient of variation of red blood cell distribution width (RDW-CV) was (13.14 ± 1.05)％,lymphocyte number (LYMPH) was (2.01 ± 0.64) × 109/L in the exposed group,it was all lower than those of the control group [(13.38 ±1.54)％,(2.21 ± 1.02) × 109/L,t =-1.989,-1.956,all P ＜ 0.05].The positive rate of glycosuria,uric bravery red,and urine nitrite in routine urine test of exposed group was 17.39％ (32/184),23.36％ (43/184),7.61％ (14/184);it was all higher than those of the control group [(8.25％ (9/109),11.93％ (13/109),0.91％ (1/109),x2 =4.746,5.798,6.309,all P ＜ 0.05].Conclusions Urine chromium accumulation has been found in populations long-term exposed to 2.82-3.22 times excessive Cr6+ through drinking water,which has affected the population's health to some extent.Therefore,it is necessary to speed up the local drinking water improvement project.

Objective To investigate de-escalation of empiric broad-spectrum antibiotics treatment for patients in intensive care unit (ICU).Methods Data of the patients discharged from ICU in the Second Affiliated Hospital of Zhejiang University from July 1 to December 31 of 2012 and from July 1 to December 31 of 2013 were retrospectively reviewed.Patients with initial use of empirical broad-spectrum antibiotics within 3 d after ICU admission were included in the study.Clinical data including status of infection,the initial empiric antimicrobial therapy,pathogens culture and adjustment of antibiotics in 5 days were analyzed.Results A total of 841 patients were discharged from ICU during the study periods and antibiotics were used in 786 (93.5％) patients.Among 786 patients,389 (49.5％) were treated empirically with broad-spectrum antibiotics,but only 269 (69.2％) had evidences of bacterial infections.Of the 389 patients with empiric antibiotics use,de-escalation of antibiotics was applied only in 6 (1.54％) patients within 5 days after the initiation of treatment.In 269 patients with evidence of infection,specimen sampling and culture were performed in 248 (92.2％) patients within 3 days,among which 165 samples were positive,and the clinical isolates were mainly multi-drug resistant gram negative bacilli and colonized bacteria in oropharyngeal cavity.De-escalation was applied only in 4 (1.49％,4/269) patients with evidences of bacterial infections.Conclusion Broad-spectrum antibiotics as initial empiric therapy is common for patients in ICU,however de-escalation of empiric therapy is rarely applied even in patients with positive results in pathogen isolation and culture.

Objective To explore specimen sampling for microbial culture in ICU patients with documented infections in order to offer clinical evidence for improving the rational use of antibiotics.Methods Patients with documented infection on the first day after admission into ICU and discharged from ICU from July to December 2012 and from July to December 2013 were enrolled in the study.Clinical data including presence or absence of infection,initial antimicrobial therapy,microorganism specimen sampling and culture were retrospectively analyzed.Results Of 841 patients discharged from ICU,443 had evidence of infections and received antimicrobial therapy on the admission day,and only 30 (6.8％) of them had microbiological detection results prior to treatment.There were microbial specimens available at infection sites on the admission day in 369 cases,and 360 cases (97.6％) of them were sampled in the first three days after ICU admission,while only 119 cases (33.1％) were sampled before the first dose of antimicrobial therapy.Specimens sampled were sputum (56.4％) in the majority,followed by the blood (17.4％).Further analysis of 269 infected patients receiving initial broad-spectrum antimicrobial therapy also showed that only 33.5％ cases were sampled before the first dose of broad-spectrum antimicrobial administration.The positive isolation rate of multi-drug resistant isolates including A.baumannii,S.maltophilia and B.cepacia from specimens sampled after first dose of initial broad-spectrum antimicrobial therapy were significantly higher than those sampled before antimicrobial therapy,P ＜ 0.05.There was no significant difference in isolation rate of Staph.aureus and Enterobacteriaceae between samples obtained before and after first dose of initial broad-spectrum antimicrobial therapy.Conclusions Few evidence of pathogenic microorganisms was available before initial antimicrobial therapy in ICU patients.Although sampling rate of microbial specimens is high,the most of them are sampled after the first dose of antimicrobial administration,and the patentially contaminated specimens such as sputum in predominance,obviously decrease the reliability of authentic results obtained from microorganism culture.

Objective To observe the effects of electro-acupuncture on the E-selectin and resistin protein expression in the hippocampus of rats of chronic stress depression;To explore the role and mechanism of electro-acupuncture in the micro-environment of brain with depression. Methods 40 Fourty rats were randomly divided into four groups:blank group, model group, model+EA group, and model+fluoxetine group by using chronic stress combined with solitary raising methods, 10 rats in each group. Electro-acupuncture intervention was used 1 hour before the modeling. Electro-acupuncture was given at points Baihui (Du 20) and Yintang (Extra) for twenty minutes (2 Hz, 0.6 mA) every day. Fluoxetine was given at the volume of 5 mL/kg, dosage of 10 mg/kg. E-selectin and resistin protein expression in hippocampus were determined by biotin label-based antibody array. Results Compared with the blank group, the protein expression of E-selectin and resistin in the model group increased (fold change=1.23, 1.22). Compared with the model group, E-selectin and resistin expression decreased (fold change=0.65, 0.62;fold change=0.76, 0.65). Conclusion Electro-acupuncture intervention could down-regulate E-selectin and resistin expression in the hippocampus of chronic stress depression model.