Specific detection of amatoxins and phallotoxins in body fluids is necessary for an early diagnosis of an intoxication with mushrooms.In this study, a rapid method for the simultaneous determination of α-, (β-and γ-amanitin, phalloidin and phallacidin in human urine and plasma was first developed by ultra-perform ance liquid chromatography-tandem mass spectrometry.Urine sample was directly injected into the separation system and plasma sample was initially prepared by precipitation of proteins with 1% acetic acid in acetoni trile.The toxin was analyzed on an ACQUITY UPLC HSS T3 column using a gradient program with a cycle time of 9 min, and detected by positive electrospray ionization tandem mass spectrometry in the MRM mode, and quantified by matrix-match standard solution.The detection limits (S/N = 3) of the toxins were within 0.2-1 μg/L and 0.1-0.5 μg/L for urine and plasma, respectively.The standard curves were linear in the range of 2-100 μg/L for urine and 1-100 μg/L for plasma.The average recoveries were 92.0%-108.0% and 85.0%-100.0% for the toxins spiked in urine and plasma, with RSDs of 1.0%-22.0% and 2.0%-22.0% (n = 6), respectively.The method was simple, selective and sensitive to detect the amatoxins and phallotoxins in urine and plasma for both clinical and forensic purposes.

A rapid method for the detection of tetrodotoxin(TTX) in human plasma and urine was developed by hydrophilic interaction liquid chromatography-tandem mass spectrometry. After a simple protein precipitation step was undertaken, the subsequent analysis of TTX was achieved on a TSK-gel amide-80 column using an ammonium formate-methanol-acetonitrile gradient with a cycle time of 13 min, and detected by positive electrospray ionization tandem mass spectrometry in the MRM mode, and quantified by matrix-match standard solution. It was found that linearity in urine was observed within concentration ranged from 3 μg/L to 500 μg/L, that in plasma 1 μg/L to 200 μg/L and that limits of detection(S/N=3) for urine and plasma were 1 and 0.3 μg/L, respectively. The average recoveries were 96%-108% and 100%-105% for TTX spiked in urine and plasma, respectively, with relative standard deviations of 1.7%-8.6% and 8.9%-16%(n=6). This method was simple, selective and sensitive to detect TTX in urine and plasma for both clinical and forensic purposes.

A method for the determination of methylmercury ( MeHg ) and ethylmercury ( EtHg ) in aquatic products was developed using gas chromatography-mass spectrometry with stable isotope-labelled internal standard. After ultrasonication assisted hydrochloric acid extraction, MeHg and EtHg in samples were extracted into toluene under the presence of sodium chloride and then back-extracted into cysteine aqueous solution. The MeHg and EtHg were released from their complexes with cysteine by adding cupric ions, and then derived with sodium tetraphenylborate. Under the optimal chromatographic conditions, MeHgPh and EtHgPh, the resulting derivatives, were separated completely on a DB-5MS capillary column and detected by electron impact ionization mass spectrometry in the selective ion monitoring ( SIM) mode, and quantified by a stable isotope dilution method using the d3-methylmercury as internal standard. The calibration curves were linear in the range of 1-500 μg/L of MeHg and EtHg. Concentration of 0. 828 mg Hg/kg with relative standard deviation ( RSD ) of 3 . 2% ( n=6 ) was obtained for MeHg in GBW 10029 . This was in good agreement with the certified values of (0. 84±0. 03) mg Hg/kg. The average recoveries were 94%-101% and 81%-104% for MeHg and EtHg spiked in aquatic samples, with RSDs of 1. 9%-4. 7% and 3. 1%-8. 2%(n=6), respectively. The limits of detection (S/N=3) of the two targets were 0. 1-0. 3μg/kg. This method was sensitive, accurate and could meet the demand of the determination of methylmercury and ethylmercury in aquatic products.

Anultra-performancehydrophilicinteractionliquidchromatography-triplequadrupolemass spectrometric ( UPLC-MS/MS) method was developed for the determination of tetrodotoxin ( TTX) in human urine and plasma. After the sample was cleaned-up and concentrated by immunoaffinity column, the separation of the TTX was carried out on an Acquity UPLC BEH amide column (100 mm×2. 1 mm, 1. 7 μm) with gradient elution using mobile phases of 0. 1% ( V/V) formic acid in water and acetonitrile. The analyte was detected by positive electrospray ionization mass spectrometry in the multiple reaction monitoring ( MRM) mode, and quantified by external solvent standard calibration. The measuring ranges of TTX in urine and plasma were 0. 05-400 μg/L. The average recoveries were 92%-95% and 91%-96% for TTX respectively spiked in urine and plasma with relative standard deviations of 3 . 3%-7 . 2% and 3 . 9%-7 . 8% ( n=5 ) . The limits of detection (LOD, S/N=3) and limits of quantitation (LOQ, S/N=10) of TTX were 0. 02 μg/L and 0. 05μg/L for urine and plasma, respectively. This method is suitable for the detection of TTX in urine and plasma for both forensic and clinical purposes.

Objective To compare the energy expenditure of a hemicorporectomy amputee moving with different mobility devices. Methods A middle-aged male hemicorporectomy amputee was measured with cardiopulmonary exercise test when moving with 4 kinds of transport: socket, cart, wheelchair, and prosthesis. Results The patient moved the slowest with prosthesis, fastest with wheelchair. The heart rate was the highest with prosthesis and lowest with cart. The absolute oxygen consumption, the relative volume of oxygen consumption and metabolic (Mets) were the most when hand walking with socket, and lowest with cart. Conclusion Hand walking with socket costs the largest energy when walking, and the rest are prosthesis, wheelchair, and cart.

Objective:Preparation and immune characteristic analysis of polyclonal antibody against hypervariable region protein of Taura syndrome virus major capsid protein VP 1 as a reference for studies on immunological diagnosis reagent.Methods:The recombinant vector pET-VP1 was transformed into E.coli BL21 for protein expression.Immunizing a New Zealand rabbit with purified VP1 protein,the titer of anti-VP1 serum was determined by Agar diffusion test and ELISA.Monoclonal phage specific binding to the purified VP1 protein was used for competitive inhibition test.Results: The VP1 protein was soluble and high expression in E.coli BL21.The biological activity titer of anti-VP1 serum reached 1∶26 ,1∶217 determined by Agar diffusion test and ELISA respectively.A litter binding activity of antiserum and VP 1 protein could be blocked by monoclonal phage , but would not affect the final positive result.Conclusion:High titer antibody Preparation of the VP 1 hypervariable region protein.The binding activity of the polyclonal antibody with VP1 protein was not affected by the mutations of VP 1 protein in minority areas ,so the antiserum could be used as immu-nological detection diagnosis agent.

Public health education is the core and foundation of the development of public health.Therefore,it is an urgent problem to explore the effective ways to improve public health education and to enhance the service abilities of public health,which meets the needs of development of modern public health.On the basis of analyzing the present situation of public health education in our country,this paper discusses the necessity of introducing the concept of integrated medicine in public health education,and then puts forward the corresponding settlement measures to solve the specific problems by utilizing the concept,thinking and method of integrated medicine,which aim to provide a certain theoretical basis for cultivating high-quality public health talents and accelerating the development of public health disciplines in China.

Objective:To systematically review parents ′ experience of caring for children with chronic kidney disease (CKD) to fully understand care needs and improve the psychological state and caregiving quality of parents. Methods:The qualitative studies on parents ′ experience of caring for children with CKD were retrieved from following databases, including PubMed, Web of Science, CNKI, VIP, CBM, and WanFang Data from inception to March 2020. The quality of included researches was evaluated according to the JBI Critical Appraisal Tool for qualitative studies in Australia. The results were integrated by pooled integration methods. Results:A total of 14 studies were included. 69 results were summarized and integrated to form 10 categories. These categories extracted 4 integrated results: parents' physical and mental condition are affected, relationship between parents and their support system has changed, reconstruction of parents ′ life, unmet care needs and problems. Conclusions:Parents are crucial to the disease management of children with CKD, so clinical medical staff should not only provide medical services for children, but also pay more attention to the psychological status and needs of parents, so as to provide guidance and support to promote parents to better implement care and disease management for children.

Objective: To explore the clinical characteristics, treatment and prognosis in 17 patients with primary cold agglutinin disease (CAD) . Methods: Clinical data, treatment and survival status of 17 patients diagnosed with primary cold agglutinin disease in Peking Union Medical College Hospital during April 2007 to October 2016 were retrospectively analyzed. The MYD88^L265P mutation was tested in 4 patients. Results: The median age of 17 patients was 67 years (range, 51-86 years) , and male- to female ratio was 1.1∶1. Seven patients were diagnosed with indolent lymphoma, including 3 Waldenstrom macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) , 2 small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) , and 2 splenic marginal zone lymphoma (SMZL) . 15 patients experienced anemia. The median HGB level was 67 (35-127) g/L. 11 patients had cold agglutinin (CA) titers ≥1∶64, with median CA of 1∶1 024. MYD88^L265P mutation was detected in 1 patient. 12 patients received drug therapy: 7 were treated with glucocorticoid-based therapy and 1 patient responded to treatment; 5 received rituximab-based therapy and 3 patients responded to treatment. With a median follow-up of 14 (0.5-96) months, the median overall survival was not reached. Conclusion Clinical manifestations of CAD are various, and diagnosis is dependent on CA testing. The efficacy of glucocorticoid-based therapy is limited, and rituximab is recommended for CAD treatment.

Objective: To evaluate the clinical characteristics, diagnosis criteria, treatment and prognosis in patients with Bing-Neel Syndrome (BNS) . Methods: The clinical characteristics, lab data, treatment and outcomes of 3 Bing-Neel syndrome patients diagnosed at Peking Union Medical College Hospital were collected. Results: The clinical presentation was heterogeneous without any specific common signs or symptoms. One patient was diagnosed with BNS 42 months after diagnosis of Waldenström macroglobulinemia (WM) by cerebrospinal fluid (CSF) cytology and flow cytometry, but dead of infection during the first course of chemotherapy. BNS was the first manifestation of WM in the other 2 cases. They were diagnosed by flow cytometry and cytology of CSF. The detection of MYD88^L265P mutation in CSF contributed to diagnosis and to sequential monitoring of minimal residual disease. They received systemic chemotherapy of FC (fludarabine + cyclophosphamide) ± rituximab and intrathecal therapy, followed by maintenance therapy of chlorambucil or R2 (rituximab + lenalidomide) . They were followed 17 and 20 months respectively without progression of disease. Conclusion The diagnosis approach of BNS should be based on a combination of CSF cytology, flow cytometry and detection of the MYD88^L265P mutation. The detection of MYD88^L265P mutation may be useful in the monitoring of minimal residual disease.