Objective To monitor the concentrations of six disinfection byproducts including trichloromethane,dibromochloromethane,bromodichloromethane, tribromomethane, dichloroacetic acid and trichloroacetic acid in drinking water in the main urban area of Wuhan, and to assess the potential health risks. Methods A total of 373 samples were collected from the central urban area during 2023 to 2024. The concentrations of the substances were tested according to the national Standard Examination Methods for Drinking Water. The detection rates of the six disinfection byproducts were statistically analyzed, and the concentration differences of the six disinfection byproducts in different time periods and different types of water samples were compared. The health risk assessment model recommended by the United States Environmental Protection Agency was used for risk assessment. Results Trichloromethane was the most common substance found in drinking water, followed by dichlorobromomethane, chlorodibromomethane, trichloroacetic acid, tribromomethane, and finally dichloroacetic acid. The concentration of dichlorobromomethane in treated water was higher than that in tap water, while the concentration of dichloroacetic acid was lower than the tap water, both with significant differences. The concentrations of the six chlorination disinfection by-products in the dry season were all significantly higher than those in the wet season. The carcinogenic risks of the disinfection byproducts were trichloroacetic acid > dichloroacetic acid > dichlorobromomethane > chlorodibromomethane > tribromomethane, and the non-carcinogenic risks were trichloromethane > trichloroacetic acid > dichlorobromomethane > chlorodibromomethane > dichloroacetic acid > tribromomethane. Conclusion Trichloroacetic acid is the substance with the highest carcinogenic risk, while trichloromethane is the non-carcinogenic substance with the highest risk, which requires special attention.

Objective:To assess the effects of allergens on interleukin-18 (IL-18), IL-18 binding protein a (IL-18BPa), and IL-18 receptor α (IL-18Rα) expression levels in different monocyte subtypes of the peripheral blood samples of allergic asthma (AA) patients, and the correlations between the percentage of IL-18 +classical monocytes and plasma levels of pro-inflammatory cytokines. Methods:A cross-sectional study. Blood samples were collected from 28 healthy controls and 33 patients experiencing acute attack of AA based on a positive skin prick test of Henan Provincial People′s Hospital from February 2023 to April 2024. Flow cytometry was used to assess the effects of allergens on IL-18, IL-18BPa, and IL-18Rα expression levels in the classical, intermediate, and non-classical monocytes of the peripheral blood samples of AA patients. Kruskal-Wallis test and Pairwise test were used to analyze statistical significance between groups. Plasma tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) levels were estimated using Bioplex assays. Pearson correlation test was used to determine the association between the percentage of IL-18 +classical monocytes and the plasma levels of IL-1β and TNF-α. Results:Compared with healthy controls, the percentages of classical and non-classical monocytes in the peripheral blood of AA patients were reduced by 20.2% ( Z=-3.89, P<0.001) and 45.8% ( Z=-4.01, P<0.001), respectively. Allergens increased the percentages of classical, intermediate, and non-classical monocytes in AA patients in vitro by 13.1%-61.5% (all P<0.05). Compared with healthy controls, the percentages of IL-18 expression in classical monocytes of AA patients was elevated by 1.08-fold ( Z=-6.40, P<0.001), whereas the percentages of IL-18 expression in intermediate and non-classical monocytes were reduced by 52.7% ( Z=-6.40, P<0.001) and 3.23% ( Z=-3.13, P=0.001), respectively. Allergens upregulated IL-18 expression by 16.4%-67.8% in the classical and intermediate monocytes of AA patients (all P<0.05). Compared with healthy controls, IL-18BPa expression level was lower in the three monocyte subtypes of AA patients (all P<0.05). However, allergens upregulated IL-18BPa expression by 8.9% and 13.3% in the classical monocytes (both P<0.05). Compared with healthy controls, IL-18Rα expression was elevated by 1.29-fold in the classical monocytes of AA patients ( Z=-6.40, P<0.001). Allergens upregulated IL-18Rα expression by 17.6%-39.2% in the three monocyte subtypes of AA patients (all P<0.05). Plasma levels of IL-1β and TNF-α in the AA patients were increased compared to those in healthy controls (all P<0.001), and correlated with the percentage of IL-18 +classical monocytes ( r=0.451, 0.714; both P<0.05). Conclusions:Allergens may participate in the inflammatory response of AA by inducing the differentiation of monocytes and the expression levels of IL-18, IL-18BPa and IL-18Rα in different blood monocytes subtypes. Classical monocytes are the potential source of elevated plasma IL-18 level in AA patients.

Objective:To investigate the effect of Euphorbia Lathyrol on expressions of IL-7,IL-10 and VEGF in renal clear cell neoplasias(RCCN)mice by regulating TGF-β/Smad signaling pathway.Methods:RCCN xenograft mice were established and divided into model group,Euphorbia Lathyrol group and Cisplatin group.Euphorbia Lathyrol group were given 20 mg/kg Euphorbia Lathyrol solution intragastric administration,model group were given 0.9%NaCl gastric feeding,Cisplatin group were given intraperito-neal injection of 4 mg/kg cisplatin solution,then mice weight and tumor volume were recorded.Expressions of TGF-β1,Smad2 and Smad4 were tracked down through Western blot.Expressions of immune factors IL-7 and IL-10 in serum of xenograft mice were detected by ELISA.Expression of VEGF in tumor mass was detected by IHC.Results:After 14 days of administration,compared with model group,the proliferation of tumor grafts in Cisplatin group and Euphorbia Lathyrol group was inhibited(P<0.05),and the expressions of TGF-β1,Smad2,Smad4 protein and VEGF were observably decreased(P<0.05),expressions of IL-7 in serum was increased,while level of IL-10 in serum was decreased(P<0.05).Conclusion:Euphorbia Lathyrol is able to reduce expressions of IL-7,IL-10,as well as VEGF in RCCN xenograft mice by impeding TGF-β1/Smad signaling transduction system.

Objective:To investigate the effect of Euphorbia Lathyrol on expressions of IL-7,IL-10 and VEGF in renal clear cell neoplasias(RCCN)mice by regulating TGF-β/Smad signaling pathway.Methods:RCCN xenograft mice were established and divided into model group,Euphorbia Lathyrol group and Cisplatin group.Euphorbia Lathyrol group were given 20 mg/kg Euphorbia Lathyrol solution intragastric administration,model group were given 0.9%NaCl gastric feeding,Cisplatin group were given intraperito-neal injection of 4 mg/kg cisplatin solution,then mice weight and tumor volume were recorded.Expressions of TGF-β1,Smad2 and Smad4 were tracked down through Western blot.Expressions of immune factors IL-7 and IL-10 in serum of xenograft mice were detected by ELISA.Expression of VEGF in tumor mass was detected by IHC.Results:After 14 days of administration,compared with model group,the proliferation of tumor grafts in Cisplatin group and Euphorbia Lathyrol group was inhibited(P<0.05),and the expressions of TGF-β1,Smad2,Smad4 protein and VEGF were observably decreased(P<0.05),expressions of IL-7 in serum was increased,while level of IL-10 in serum was decreased(P<0.05).Conclusion:Euphorbia Lathyrol is able to reduce expressions of IL-7,IL-10,as well as VEGF in RCCN xenograft mice by impeding TGF-β1/Smad signaling transduction system.

Objective:To assess the effects of allergens on interleukin-18 (IL-18), IL-18 binding protein a (IL-18BPa), and IL-18 receptor α (IL-18Rα) expression levels in different monocyte subtypes of the peripheral blood samples of allergic asthma (AA) patients, and the correlations between the percentage of IL-18 +classical monocytes and plasma levels of pro-inflammatory cytokines. Methods:A cross-sectional study. Blood samples were collected from 28 healthy controls and 33 patients experiencing acute attack of AA based on a positive skin prick test of Henan Provincial People′s Hospital from February 2023 to April 2024. Flow cytometry was used to assess the effects of allergens on IL-18, IL-18BPa, and IL-18Rα expression levels in the classical, intermediate, and non-classical monocytes of the peripheral blood samples of AA patients. Kruskal-Wallis test and Pairwise test were used to analyze statistical significance between groups. Plasma tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) levels were estimated using Bioplex assays. Pearson correlation test was used to determine the association between the percentage of IL-18 +classical monocytes and the plasma levels of IL-1β and TNF-α. Results:Compared with healthy controls, the percentages of classical and non-classical monocytes in the peripheral blood of AA patients were reduced by 20.2% ( Z=-3.89, P<0.001) and 45.8% ( Z=-4.01, P<0.001), respectively. Allergens increased the percentages of classical, intermediate, and non-classical monocytes in AA patients in vitro by 13.1%-61.5% (all P<0.05). Compared with healthy controls, the percentages of IL-18 expression in classical monocytes of AA patients was elevated by 1.08-fold ( Z=-6.40, P<0.001), whereas the percentages of IL-18 expression in intermediate and non-classical monocytes were reduced by 52.7% ( Z=-6.40, P<0.001) and 3.23% ( Z=-3.13, P=0.001), respectively. Allergens upregulated IL-18 expression by 16.4%-67.8% in the classical and intermediate monocytes of AA patients (all P<0.05). Compared with healthy controls, IL-18BPa expression level was lower in the three monocyte subtypes of AA patients (all P<0.05). However, allergens upregulated IL-18BPa expression by 8.9% and 13.3% in the classical monocytes (both P<0.05). Compared with healthy controls, IL-18Rα expression was elevated by 1.29-fold in the classical monocytes of AA patients ( Z=-6.40, P<0.001). Allergens upregulated IL-18Rα expression by 17.6%-39.2% in the three monocyte subtypes of AA patients (all P<0.05). Plasma levels of IL-1β and TNF-α in the AA patients were increased compared to those in healthy controls (all P<0.001), and correlated with the percentage of IL-18 +classical monocytes ( r=0.451, 0.714; both P<0.05). Conclusions:Allergens may participate in the inflammatory response of AA by inducing the differentiation of monocytes and the expression levels of IL-18, IL-18BPa and IL-18Rα in different blood monocytes subtypes. Classical monocytes are the potential source of elevated plasma IL-18 level in AA patients.

Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.

Objective:To investigate the clinical effects of intermittent oro-esophageal tube feeding (IOE) combined with Xuanqiaoliyan decotion in stroke patients with dysphagia.Methods:A prospective study was conducted. Stroke patients with dysphagia admitted to Yidu Central Hospital Affiliated Hospital of Weifang Medical University from January 2018 to December 2019 were enrolled. According to the simple random sampling method, the patients were divided into control group and observation group, with 50 cases in each group. The control group was given routine swallowing function training, including low-frequency pulse electrical stimulation, swallowing function training and acupuncture treatment. The observation group was given IOE and Xuanqiaoliyan decoction (prescription composition: Rhizoma acori tatarinowii 15 g, Radix polygalae 10 g, Rhizoma gastrodiae 15 g, Arisaema cum bile 6 g, Rhizoma typhonii 6 g, Scorpio 6 g, Bombyx batryticatus 6 g, Perilla frutescens 10 g, Rhizoma pinelliae 10 g, Pericarpium citri reticulatae 10 g, Rhizoma zingiberis recens 3 tablets, decoction 200 mL, twice in the morning and evening by oral or nasal feeding) on the basis of the control group. Both groups were treated for 14 days. The standard swallowing function assessment (SSA) and water swallow test were used to evaluate the swallowing function before and after treatment. The time required for the improvement of swallowing function, total hospitalization time and the therapeutic effects were observed and the safety assessment was conducted. Results:There were no significant differences in the gender, age, course of disease, and location and frequency of stroke between the two groups. After treatment, both the SSA scores in the two groups were decreased, and the grading of water swallow test was improved. The SSA scores in the observation group were significantly lower than that in the control group (19.8±1.8 vs. 23.2±3.2, P < 0.05), the recovery degree of water swallow test was higher than that in the control group [complete recovery (cases): 18 vs. 13, basic recovery (cases): 23 vs. 18, effective (cases): 9 vs. 19, χ 2 = -2.107, P = 0.008]. The total effective rate of swallowing function in the observation group was higher than that in the control group (94.0% vs. 80.0%, Z = 4.684, P = 0.012), the time for improvement (days: 12.8±2.6 vs. 16.9±4.3, t = 11.628, P = 0.008) and total hospitalization time (days: 20.8±4.2 vs. 33.5±5.6, t = 10.924, P = 0.015) were shorter than those in the control group. In the observation group, there was 1 case of throat discomfort during the operation of IOE, and the symptoms disappeared after the operation; there was 1 case of mild elevation of alanine aminotransferase (ALT) and blood urea nitrogen (BUN) respectively, which returned to normal after the treatment. No adverse symptoms and damage to the liver and kidney were observed in the control group. Conclusion:IOE combined with Xuanqiaoliyan decotion could significantly improve the swallowing function of stroke patients with dysphagia, shorten the hospitalization time, and improve the curative effects and lifequality.

Objective:To investigate the risk factors of low anterior resection syndrome (LARS)after low anterior resection of rectal cancer (Dixon).Methods:This retrospective study was conducted in Peking University First Hospital and Traditional Chinese Medicine Hospital of Shanxi Provice from Jan 2012 to Jun 2019. A cohort of 504 patients with rectal cancer was enrolled in the study. All the patients underwent anterior resection. The relationship between clinical-pathological data were analyzed retrospectively. Univariate analysis using χ 2 test. Logistic regression analysis was used to screen the influencing factors of LARS, and the Nomogram method was used to score each factors. Results:Univariate analysis showed that BMI≥28 kg/m 2(χ 2=9.450, P=0.002), the distance from the lower edge of the tumors to the anus <6 cm (χ 2=12.070, P=0.001), high ligation of the inferior mesenteric artery (IMA) (χ 2=8.279, P=0.004), preoperative neoadjuvant therapy (χ 2=11.230, P=0.001), postoperative anastomotic leakage (χ 2=11.840, P=0.001) were associated with severe LARS.Multivariate analysis showed that the distance from the lower edge of the tumors to the anus <6 cm ( OR=1.861, 95% CI: 1.289-2.688, P=0.001), BMI≥28 kg/m 2 ( OR=1.747, 95% CI: 1.022-2.987, P=0.041), high IMA ligation ( OR=1.688, 95% CI: 1.157-2.463, P=0.007), preoperative neoadjuvant therapy ( OR=2.719, 95% CI: 1.343-5.505, P=0.005) were independent risk factors for LARS. Nomogram model showed that the total factor ranged from 2 to 212, and the corresponding risk rate ranged from 30% to 80%. The patients with higher score have greater risk for severe LARS. The area under the predictive power curve of Nomogram model (AUC) was 0.749 (95% CI: 0.705-0.793, P<0.001). Conclusion:Lower tumor location, obesity, preoperative neoadjuvant therapy, high IMA ligation and postoperative anastomotic leakage increase the risk of severe LARS.

Objective: To investigate the effect of fractionated radiotherapy on the immune system of mice with subcutaneously transplanted hepatocellular carcinoma. Methods: Logarithmic growth of mouse hepatocellular carcinoma cells Hepa 1-6 were inoculated subcutaneously on the right side of C57BL/6 J mice (1×10⁷ cells /mice). The tumor-bearing mice were randomly divided into control group (Ctrl) and irradiation group (IR), 20 mice in each group. Additionally, 10 healthy mice were set as normal control group. Local fractionated X-ray irradiation of 8 Gy×3 fraction was given to the subcutaneous tumors, and the dose rate was 0.883 Gy/min. At 7 and 14 d after irradiation, the tumor organ index, spleen organ index, spleen pathological changes, and splenic T lymphocyte subsets, B lymphocyte subsets, and NK cells were detected. Results: Compared with Ctrl, at 7 and 14 d after irradiation, the tumor organ index decreased (t=4.649, 26.34, P<0.05), and the percentage of NK cells increased significantly (t=3.952, 3.633, P<0.05). The percentages of CD3+ , CD4+ , CD3+ CD4+ lymphocytes and the ratio of CD4+ /CD8+ lymphocyte decreased at 7 d after irradiation (t=3.193, 3.656, 3.219, 2.641, P<0.05), and the percentage of CD3+ lymphocyte decreased at 14 d after irradiation (t=3.031, P<0.05). But after irradiation, there were no significant changes in spleen organ index, B lymphocyte, CD3+ CD4+ lymphocyte and CD8+ lymphocyte. Conclusions Local hepatoma radiotherapy causes imbalance of lymphocytes in distal spleen of mice and hence reduces immunity, which provides a novel mechanism of radiological immunity damage.

Objective:To evaluate the factors affecting the degree of radical resection and the prognosis of patients with locally recurrent rectal cancer (LRRC).Methods:A retrospective case-control study was performed. Clinical data of 111 patients with LRRC undergoing operation at the General Surgery Department of Peking University First Hospital from January 2009 to August 2019 were analyzed retrospectively. The "Peking University First Hospital F typing" was performed according to the preoperative images of the pelvic involvement. The pelvis was assigned into four directions: the front wall, lateral sides of the pelvic wall and the sacrum. According to the degree of pelvic wall involvement, F typing included F0 type (no involvement of the pelvic wall, the cancer only involved the adjacent organs or invaded conteriorly the urinary tract, genital organs or small intestine), F1 type (cancer involved the pelvic wall in one direction, such as the sacrum, or one side of the pelvic wall), F2 type (cancer involved the pelvic wall in two directions) and F3 type (cancer involved the pelvic wall in three directions). Case inclusion criteria: (1) LRRC was confirmed by imaging and pathological examination of samples (puncture or endoscopic biopsy); (2) complete clinical and follow-up data; (3) informed consent of patient. Those with dysfunction of heart, lung, etc., intolerance of operation, F3 type indicated by image, and distant metastasis were excluded. The degree of radical resection was evaluated according to the postoperative pathological results. Patients were followed up every 12 months and related examinations were arranged. The univariate analysis of radical resection was performed by χ 2 test, and the multivariate analysis was performed by logistic methods. The survival rate was calculated by Kaplan-Meier method and the survival curve was drawn. The survival rate was compared by log-rank test. Cox proportional hazards model was used to analyze the factors affecting the prognosis of patients with LRRC. Results:A total of 111 patients were included in this study. Of 111 patients, 59 were male and 52 were female; recurrent age of 36 cases was ≥ 65 years old; CEA level of 48 cases was ≥15 μg/L. According to the "Peking University First Hospital F typing", 70 cases were F0 type, 38 F1 type and 3 F2 type. Surgical procedures were abdominoperineal resection ( n=28), posterior pelvic exenteration ( n=32), and total pelvic exenteration ( n=51, including 1 case of TPE combined with sacrectomy). According to the postoperative pathological results, R0, R1 and R2 resections were 83, 20 and 8 cases, respectively. Univariate analysis showed that the degree of radical resection was associated with the secondary surgical procedure, F typing and lymph node metastasis (all P<0.05). Multivariate analysis showed that F typing (F1-F2) was an independent risk factor for non- R0 resection (OR=37.256, 95%CI:8.572 to 161.912, P<0.001). The morbidity of operative complications was 22.5% (25/111); the perioperative mortality was 1.8% (2/111); the local recurrence rate after the second operation was 37.8% (42/111). The 3- and 5-year overall survival rates were 41.2% and 21.9% respectively. The 3-year survival rates of patients with and without postoperative chemotherapy were 52.7% and 32.4% respectively ( P=0.005). The 3-year survival rates of patients with lower (<15 μg/L) and higher CEA level (≥15 μg/L) were 52.9% and 24.3% respectively ( P<0.001). The 3-year survival rates of patients with R0, R1 and R2 resection were 49.8%, 21.3% and 8.5% respectively ( P=0.002). The 3-year survival rates of patients with F0, F1 and F2 type were 52.7%, 22.0% and 0 respectively ( P<0.001). Cox analysis confirmed that the degree of radical resection (HR=2.088, 95%CI:1.095 to 3.979, P=0.025), the CEA level before the secondary operation (HR=1.857, 95%CI:1.157 to 2.980, P=0.010) and postoperative chemotherapy (HR=1.826, 95%CI:1.137 to 2.934, P=0.013) were independent factors affecting the prognosis. Conclusions:The indication of LRRC surgical treatments must be strictly limited. Evaluation of the fixation site to the pelvic wall is helpful for improving the rate of R0 resection. Lower preoperative CEA level, radical resection and postoperative chemotherapy are protective factors of prolonged overall survival time of patients with LRRC.