Background China has the largest elderly population in the world, and age-related cognitive impairment has become an increasingly important public health issue. Objective To investigate the associations of exposure to selected essential metals (EMs) and non-essential metals (NEMs) with cognitive function among rural older adults and to examine whether EMs modified the association between NEW exposure and cognitive functions. Methods A total of 1045 adults aged 60 years and above were enrolled using baseline survey data from a cohort study. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine urinary concentrations of five EMs (selenium, cobalt, vanadium, manganese, and boron) and five NEMs (arsenic, chromium, cadmium, lithium, and tin). The Mini-Mental State Examination (MMSE) scale was used to assess cognitive function. Generalized linear models (GLMs) and restricted cubic spline (RCS) models were used to examine the associations of individual EMs and NEMs with MMSE scores. Quantile g-calculation (QGC) and Bayesian kernel machine regression (BKMR) models were used to evaluate the associations of EM and NEM mixtures with MMSE scores. Results The mean age of the participants was (69.72±6.63) years, and 511 participants (48.90%) were male. The mean MMSE score was 21.06±5.79. After adjustment for covariates, GLM analysis showed that cobalt (β=0.575, 95%CI: 0.233, 0.918), selenium (β=0.440, 95%CI: 0.045, 0.836), and vanadium (β=0.633, 95%CI: 0.251, 1.016) were positively associated with MMSE scores, whereas tin (β=−0.379, 95%CI: −0.728, −0.029) was negatively associated with MMSE scores. After categorizing metal concentrations into quartiles and including them in the GLM, cobalt (β_{Q4 vs. Q1}=1.697, 95%CI: 0.806, 2.589) and vanadium (β_{Q4 vs. Q1}=1.598, 95%CI: 0.719, 2.477) remained positively associated with MMSE scores, whereas tin (β_{Q4 vs. Q1}=−0.890, 95%CI: −1.771, −0.008) and lithium (β_{Q4 vs. Q1}=−0.794, 95%CI: −1.689, −0.007) were negatively associated with MMSE scores. RCS model showed linear positive associations of cobalt and vanadium with MMSE scores, a linear negative association of tin with MMSE scores, and an inverted U-shaped association between lithium and MMSE scores. Both QGC and BKMR models indicated that the EMs mixture was positively associated with MMSE scores, with cobalt contributing the most. The NEM mixture showed a negative but nonsignificant association with MMSE scores, with lithium contributing the most. When EMs and NEMs were jointly modeled, no significant association was observed between the overall metal mixture and MMSE scores. Interaction analysis suggested a positive interaction between EMs and NEMs in relation to MMSE scores. Stratified analysis showed that, compared with participants with high cobalt or EMs exposure, those with low cobalt or EMs exposure had a more pronounced and statistically significant negative association between NEMs exposure and MMSE scores. Conclusion The EM mixture is significantly and positively associated with MMSE scores, whereas the NEMs mixture shows a negative but nonsignificant association. EMs and NEMs have a positive interaction on MMSE scores; EMs attenuate the association between NEMs and MMSE scores.

Objective: To evaluate the effect of total parathyroidectomy and autotransplantation (TPTX+AT) and total parathyroidectomy (TPTX) on secondary hyperparathyroidism (SHPT). Methods: PubMed, EMBASE and Cochrane library were searched from inception to June 2017 for relative studies, which were screened according to inclusion criteria. Meta-analysis of included study were conducted to compare the improvement of symptoms, persistent SHPT, recurrent SHPT, reoperation, hypoparathyroidism, duration of operation and hospitalization between TPTX+AT group and TPTX group. Results: A total of 11 studies with 1212 patients were included. Results of meta-analyses showed no difference between TPTX+AT and TPTX regarding improvement of symptoms and persistent SHPT (RR=1.03, P=0.70; RR=0.81, P=0.67, respectively), but TPTX was associated with lower risks of recurrent SHPT and reoperation (RR=0.25, P<0.01; RR=0.19, P<0.01). Patients with TPTX had higher rate of hypoparathyroidism (RR=2.68, P<0.01) but shorter time of operation (MD=-17.3, P=0.01). Durations of hospitalization were similar between the two groups (MD=-0.06, P=0.98). Conclusion Compared with TPTX+AT, TPTX reduces the risks of recurrent SHPT, reoperation and operation time, but has higher risk of hypoparathyroidism.

Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2 ± 16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI:1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P<0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.

OBJECTIVETo assess the prevalence of depressive symptoms, trends on its longitudinal development and related influencing factors among primary and middle school students in Changfeng county of Anhui province.

METHODSThrough cluster sampling methods, all students from 3 to 9 grades in 5 primary schools and 3 middle schools in Changfeng county of Anhui province were investigated through questionnaire as subjects of baseline survey in December 2009. Subjects of this longitudinal study were students in grades 3, 4 and 7 at the time of the baseline survey and were contacted once a year for two years. At last, a total of 816 students participated in all the three surveys. A structured questionnaire including Children's Depression Inventory, socio-demographic characteristics and some potential influential factors was employed for this study. A Generalized Estimating Equation (GEE) was used to evaluate the related influencing factors of children's depressive symptoms in the longitudinal study.

RESULTSPrevalence rates of depressive symptoms were 11.3% , 10.4% and 8.5% , respectively, at the baseline, 1-year and 2-year follow-up studies, among primary and middle school students. Scores on depressive symptoms of total subjects and children who had always been left at home in the follow-up process showed significant differences at the three surveys (F = 13.423, P < 0.001; F = 5.761, P = 0.003). 25 percent of the 92 students who showed depressive symptoms at the baseline survey remained those depressive symptoms at the 1-year follow-up study and 87 percent of the 23 students who had depressive symptoms at the baseline and 1-year follow-up surveys still showing depressive symptoms at the 2-year follow-up study. Results from the GEE program indicated that grade 3 students, having syblings, family with dysfunction or at low level of self-esteem etc., were prone to development while sex and parents' educational level were not correlated with depressive symptoms.

CONCLUSIONPrevalence of depressive symptoms among primary and middle school students in Changfeng county of Anhui province appeared a decreasing tendency during the follow-up process in our study. Through the longitudinal development, we noticed that the prevalence of depressive symptoms seemed to be related to the personal characteristics, education and family environment of the subjects under our study. Improving the level of family function as well as individual's self-esteem might positively contribute to mental health of those primary and middle school students.

Adolescent ; Child ; China ; epidemiology ; Depression ; epidemiology ; Female ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Male ; Students ; psychology

Objective To assess the prevalence of depressive symptoms,trends on its longitudinal development and related influencing factors among primary and middle school students in Changfeng county of Anhui province. Methods Through cluster sampling methods,all students from 3 to 9 grades in 5 primary schools and 3 middle schools in Changfeng county of Anhui province were investigated through questionnaire as subjects of baseline survey in December 2009. Subjects of this longitudinal study were students in grades 3,4 and 7 at the time of the baseline survey and were contacted once a year for two years. At last,a total of 816 students participated in all the three surveys. A structured questionnaire including Children’s Depression Inventory,socio-demographic characteristics and some potential influential factors was employed for this study. A Generalized Estimating Equation (GEE) was used to evaluate the related influencing factors of children’s depressive symptoms in the longitudinal study. Results Prevalence rates of depressive symptoms were 11.3%,10.4% and 8.5%,respectively,at the baseline,1-year and 2-year follow-up studies, among primary and middle school students. Scores on depressive symptoms of total subjects and children who had always been left at home in the follow-up process showed significant differences at the three surveys (F=13.423,P<0.001;F=5.761,P=0.003). 25 percent of the 92 students who showed depressive symptoms at the baseline survey remained those depressive symptoms at the 1-year follow-up study and 87 percent of the 23 students who had depressive symptoms at the baseline and 1-year follow-up surveys still showing depressive symptoms at the 2-year follow-up study. Results from the GEE program indicated that grade 3 students,having syblings,family with dysfunction or at low level of self-esteem etc.,were prone to development while sex and parents’ educational level were not correlated with depressive symptoms. Conclusion Prevalence of depressive symptoms among primary and middle school students in Changfeng county of Anhui province appeared a decreasing tendency during the follow-up process in our study. Through the longitudinal development,we noticed that the prevalence of depressive symptoms seemed to be related to the personal characteristics,education and family environment of the subjects under our study. Improving the level of family function as well as individual’s self-esteem might positively contribute to mental health of those primary and middle school students.