Objective: To assess the exposure levels of lead, cadmium, mercury, arsenic and aluminum in the diets of residents in Henan Province, so as to provide the basis for strengthening food safety supervision. Methods: Six sampling points were selected using stratified random sampling method in Henan Province, including Hebi City, Xiangfu District of Kaifeng City, Jianxi District of Luoyang City, Yuzhou City, Baofeng County and Tanghe County. Food samples were collected and processed into mixed samples of 12 major food categories. The levels of lead, cadmium, mercury, arsenic and aluminum in the samples were measured using inductively coupled plasma mass spectrometry (ICP-MS). Dietary consumption information in Henan Province was collected. The dietary exposure risks of lead, cadmium, mercury, arsenic and aluminum were analyzed using the point estimation method and distribution point estimation method, based on the health guidance values of the Joint FAO/WHO Expert Committee on Food Additives and the margin of exposure (MOE) as the assessment criteria. Results: The dietary exposure level of lead among residents in Henan Province was 41.89 μg/d, which was equivalent to 18.62% of its provisional tolerable weekly intake (PTWI), with cereals and vegetables being the main sources; the MOE values of lead among residents aged 2 to <7 years and 7 to <13 years were both less than 1. The dietary exposure level of cadmium was 10.79 μg/d, which was equivalent to 20.55% of the provisional monthly tolerable intake, with cereals and vegetables being the main sources. The dietary exposure level of total mercury was 0.45 μg/d, which was equivalent to 1.25% of its PTWI, with cereals, vegetables, and water and beverage categories being the main sources; the dietary exposure level of methylmercury was 0.04 μg/d, which was equivalent to 0.28% of its PTWI, and it was entirely derived from aquatic products. The dietary exposure level of total arsenic was 26.65 μg/d, which was equivalent to 0.89% of the daily allowable intake, with cereals and vegetables being the main sources; the dietary exposure level of inorganic arsenic was 8.41 μg/d, which was equivalent to 6.23% of its PTWI, with an MOE value of 22.47. The dietary exposure level of aluminum was 8.27 mg/d, which was equivalent to 45.94% of its PTWI, with cereals and tubers being the main sources; the P90 and P97.5 of dietary aluminum exposure among residents aged 2 to <7 years and 7 to <13 years were both greater than PTWI. Conclusion The overall dietary exposure risks of lead, cadmium, mercury, arsenic and aluminum among residents in Henan Province are relatively low.

Objective: To analyze the epidemiological characteristics of school foodborne disease outbreaks in Henan Province from 2011 to 2020 and to provide the basis for effective prevention and control of school foodborne disease outbreaks. Methods: The outbreaks of foodborne diseases in schools in Henan Province reported by the foodborne disease outbreak surveillance system from 2011 to 2020 were statistically analyzed. Results: A total of 47 outbreaks of school foodborne diseases were reported in Henan province in the past 10 years, with a total of 1 258 cases, 701 hospitalizations and 1 death. Zhengzhou, Zhumadian, Xinyang and Xinxiang were the top 4 cities in Henan Province in terms of the number of school foodborne disease outbreaks reported. The peak of foodborne illness incidents in schools was in June and September. The largest number of incidents occurred in middle school canteens and primary school canteens(all 12). The number of reported incidents (12) and the number of cases of foodborne diseases (371) in schools caused by cereals and their products were the largest. Pathogenic bacteria and their toxins were the main pathogenic factors that caused the outbreaks of foodborne diseases in schools, accounting for 78.26% of the identified causes. Bacillus cereus was the top pathogens causing foodborne diseases outbreaks in schools. The pathogenic factor that caused the largest number of cases was Diarrheogenic Escherichia Coli, and the pathogenic factor that caused the death cases was poisonous mushrooms. Apart from unexplained incidents, improper processing was the main link leading to foodborne diseases outbreaks in schools. Conclusion The primary and middle school students are the group with high incidence of foodborne diseases in schools. The supervision and management of school canteen should be strengthened in summer to prevent the outbreak of bacterial foodborne diseases caused by improper processing and storage of grain food.

Objective: Combining the aluminium content data of food in Henan Province with the data of children s food consumption, to evaluate probability of dietary aluminum exposure among primary school students. Methods: Database of nine types of aluminum containing food and their consumption among primary school students in Henan Province were established. The probability distribution of dietary aluminum exposure was calculated by Monte Carlo simulation using Crystal Ball 11.1.2.4 software, and the sensitivity analysis of exposure was conducted. Results: The average content of aluminum in fried bread stick was the highest, with the value of 150.89 mg/kg. The consumption of dietary aluminum was highest in steamed bun, with the value of 0.15 g. The average dietary aluminum exposure per kilogram of body weight was 1.99 mg per week of primary school students in Henan Province, accounting for 99.7% of the provisional tolerable weekly intake (PTWI). The 95th percentile of aluminum exposure per kilogram of body weight per week was 6.16 mg, which was three times of that of PTWI. Nearly 13.22% of primary school students had dietary aluminum exposure higher than PTWI. Among all kinds of food, the average aluminum exposure of fried bread stick per kilogram of body weight per week was the highest 1.19 mg. Aluminum content in fried bread stick accounted the highest proportion of average dietary aluminum exposure among primary school students. Conclusion The average dietary aluminum exposure level of primary school students in Henan Province is close to the PTWI established by JECFA, with the high consumption population exceeds the PTWI. Measures should be taken to reduce the dietary aluminum exposure risk of primary school students.

Objective: To assess the nutritional supply status of school meals for primary and secondary school students in Henan Province, so as to provide a basis for scientific guidance of school meals. Methods: During 2021-2023, 115 lunch and dinner samples were collected from 25 primary and secondary schools in Zhoukou, Anyang and Luoyang of Henan Province by a direct selection method, and 13 nutrients were determined for each sample. The nutrient supply was evaluated based on Nutrition Guidelines of School Meals and Reference Intake of Dietary Nutrients for Chinese Residents (2023 Edition). Mann-Whitney U test was used to compare the differences of nutritional supply between urban and rural schools. Results: The median values for energy (709.77 kcal,1 kcal=4.18 kJ), fat energy supply ratio (0.27) and carbohydrate energy supply ratio (0.55) in the 66 lunches and dinners from primary school were within the recommended range. The supply of protein (28.39 g) and sodium (1 464.59 mg) was excessive. The median values of zinc (2.62 mg) and dietary fiber (5.19 g) were lower than the reference values. No statistically significant differences were observed in the supply of 13 nutrients between urban and rural primary schools( U = 427.00 -633.00, P > 0.05 ). Among 49 samples from secondary schools, the median value of energy supply (930.02 kcal), carbohydrate energy ratio ( 0.54 ) and fat energy supply ratio(0.25) were within the recommended range; and the median values of protein (38.82 g) and sodium (2 556.80 mg) were higher than the standard; and the median values of calcium (250.32 mg) and vitamin B1 (0.16 mg) were lower than the standard. Additionally, the differences in the level of vitamin B2 ( U =372.00) and zinc ( U =375.00) between the urban and rural secondary schools were statistically significant ( P <0.05). Conclusion Nutrient supply of primary and secondary school meals in three cities of Henan Province is inadequate and imbalanced, and the recipe need to be further optimized and improved.

Objective:To investigate the specimen quality of intersphincteric resection with transabdominal transanal mixed approach for rectal cancer in the Chinese Transanal Total Mesorectal Excision Registry Collaborative (CTRC) database.Methods:The retrospective case-control study was conducted. Based on the concept of real-world research, the clinicopathological data of 281 pati-ents with rectal cancer in the CTRC database who underwent intersphincteric resection with trans-abdominal transanal mixed approach in 19 medical centers, including the Beijing Friendship Hospital of Capital Medical University et al, from November 15,2017 to December 31,2023 were collected. There were 196 males and 85 females, aged 61(range, 27-87)years. Observation indicators: (1) preoperative examinations; (2) neoadjuvant therapy; (3) postoperative examinations; (4) analysis of influencing factors for positive circumferential margin in surgical specimen of intersphincteric resec-tion for rectal cancer. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. The chi-square test was used for univariate analysis. Logistic regression model was used for multivariate analysis. Results:(1) Preoperative examinations. Of the 281 patients, 234 cases underwent preoperative pelvic magnetic resonance imaging (MRI) examina-tion. There were 2 cases in clinical stage T0, 3 cases in clinical stage T1, 58 cases in clinical stage T2, 137 cases in clinical stage T3, 24 cases in clinical stage T4, 3 cases in clinical stage Tx, 7 cases missing clinical T staging data. There were 87 cases in clinical stage N0, 68 cases in clinical stage N1, 60 cases in clinical stage N2, 9 cases in clinical stage Nx, 10 cases missing clinical N staging data. There were 30 cases with mesorectal fascia invasion, 53 cases with extramural venous invasion. The distance from lower margin of tumor to anal margin was 41.9(range, 1.0-80.0)mm. (2) Neoadjuvant therapy. Of the 281 patients, 125 cases underwent neoadjuvant therapy, including 39 cases receiving chemo-therapy alone, 6 cases receiving short-course simultaneous chemoradiotherapy, 5 cases receiving short-course simultaneous chemoradiotherapy and delayed surgery, 48 cases receiving long-course simultaneous chemoradiotherapy, 2 cases receiving other treatments, and 25 cases missing neoadju-vant therapy data. (3) Postoperative examinations. Of the 281 patients, 249 cases achieved R 0 resection, 9 cases achieved R 1 resection, and there were 23 cases missing surgical margin data. The maximum tumor diameter, the number of lymph nodes harvested and positive rate of vessel carcinoma embolus were 30.0(range, 0.5-200.0)mm, 13(range, 0-70) and 27.55%(73/265) in 281 patients. There were 252 patients with circumferential margin records, showing positive in 15 cases, with a positive rate as 5.95%(15/252). The minimum distance from deep part of tumor to circumferential margin was 7.0(range, 0-150.0)mm in 252 patients. There were 85 cases with distal margin records, showing positive in 1 case, and the distance from lower margin of tumor to distal margin was 10.0(range, 0-202.0)mm. There were 273 patients with specimen integrity records, which showed intact specimen in 208 cases, fair specimen in 58 cases, poor specimen in 4 cases, unevaluated specimen in 3 cases. There were 7 cases with rectal perforation. Of the 281 patients, cases in pathological stage T0, Tis, T1, T2, T3, T4 were 14, 5, 22, 107, 113, 12, respectively, and there were 8 cases missing pathological T staging data. Of the 281 patients, cases in pathological stage N0, N1a, N1b, N1c, N2a, N2b were 176, 27, 27, 11,20, 12, respectively, and there were 8 cases missing pathological N staging data. Of the 281 patients, there were 4 cases with distant metastasis, 262 cases without distant metastasis, 5 cases not evaluated, and 10 cases missing tumor metastasis data. Of the 125 patients undergoing neoadjuvant therapy, there were 85 cases with tumor regression grade records, including 16 cases as grade 1, 27 cases as grade 2, 19 cases as grade 3, 15 cases as grade 4, 8 cases as grade 5. (4) Analysis of influencing factors for positive circumferential margin in surgical specimen of intersphincteric resection for rectal cancer. Results of univariate analysis showed that preoperative T staging on preoperative pelvic MRI, mesorectal fascia invasion, extramural venous invasion, pathological T staging, and pathological N staging were related factors for positive circumferential margin in surgical specimen of intersphincteric resection for rectal cancer ( P<0.05). Conclusions:Intersph-incteric resection with transabdominal transanal mixed approach has good specimen quality and low positive rate of surgical margin. T staging on preoperative pelvic MRI may be related to positive circumferential margin after intersphincteric resection for rectal cancer.