ObjectiveTo investigate the association between single and combined exposure to arsenic （As）， mercury （Hg）， and cadmium （Cd） in urine and hearing loss in adults. MethodsA total of 400 adult patients were recruited for the study， comprising 200 participants in the normal hearing group and 200 in the hearing loss group. General demographic information of the study subjects was collected by a self-administered questionnaire， morning urine samples were tested for As， Hg， and Cd concentrations， and hearing status was assessed by Pure Tone Audiometry. A binary Logistic regression model was used to explore the association between the concentrations of the three metals in urine and hearing loss， and a Bayesian kernel-machine regression （BKMR） model was used to further explore the association between the concentrations of the three metal mixtures and hearing loss. ResultsAfter correction for urinary creatinine， As， Hg， and Cd concentrations were higher in the hearing loss group than those in the normal hearing group （P<0.05）. Binary Logistic regression indicated that concentrations of As， Hg， and Cd were positively associated with hearing loss， and the risk of hearing loss was significantly higher in the second quartile of Cd concentration compared to the first quartile （OR=2.000， 95%CI： 1.009-3.964）. BKMR modeling analysis showed that the combined exposure levels of As， Hg， and Cd significantly increased the risk of hearing loss， with Cd being the most important contributor （posterior inclusion probability=0.412）， and that there were potential interactions between As and Cd， and Cd and Hg. ConclusionCombined exposure to As， Hg， and Cd in urine is significantly associated with adult hearing loss， with Cd being the primary contributor in the exposure combination. The interactions between As and Cd， as well as Cd and Hg， may have adverse effects on hearing loss.

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 investigate the spatial and temporal distribution characteristics of brucellosis in Heilongjiang Province, Jilin Province and Inner Mongolia Autonomous Region (hereafter referred to as the Hei-Ji-Meng province and region), and study the influencing factors of brucellosis incidence.Methods:Using a retrospective analysis method, the data of brucellosis incidence in 22 prefecture-level cities in the Hei-Ji-Meng province and region from 2014 to 2018, as well as the data of natural environmental factors (precipitation, temperature, relative humidity, solar radiation, wind speed, vegetation index) and social environmental factors (livestock breeding, livestock and poultry meat production, cultivated land area) were collected and integrated. The spatial autocorrelation model and spatial Dubin model were used to analyze the spatial and temporal distribution rule of brucellosis and the impact of environmental factors on the incidence of brucellosis in prefecture-level cities.Results:From 2014 to 2018, the incidence of brucellosis in the Hei-Ji-Meng province and region was 18.77/100 000, among which the incidence in Inner Mongolia Autonomous Region was 33.45/100 000, followed by Heilongjiang Province (13.67/100 000) and Jilin Province (6.57/100 000). Among all prefecture-level cities, the brucellosis incidence was relatively higher in Hinggan League of Inner Mongolia Autonomous Region (69.10/100 000). Except 2016, the brucellosis incidence in other years had a positive spatial correlation (global Moran's I > 0, P < 0.05). The high-high concentration aggregation pattern was mainly concentrated in Ulanqab City, Xilingol League, Chifeng City, Tongliao City, Hinggan League, Hohhot City, and Hulunbuir City of Inner Mongolia Autonomous Region. Among the environmental factors related to brucellosis, cultivated land area and sheep breeding density had a positive effect on brucellosis incidence in the local area, with the effect intensity of 0.39 and 0.32, respectively ( P < 0.001). The average humidity from April to July had a negative effect on the brucellosis incidence in the local area, with the effect intensity of - 0.22 ( P = 0.023). The indirect effect of the number of pigs slaughtered on the brucellosis incidence in adjacent areas was the most significant, and the effect intensity was 2.15 ( P < 0.001). Conclusions:Among the Hei-Ji-Meng province and region, the annual average incidence rate of brucellosis in Inner Mongolia Autonomous Region is relatively higher, and the high-high concentration areas are mainly concentrated in this region. Among the environmental factors, the cultivated land area, sheep breeding density, the average humidity from April to July and the number of pigs slaughtered have an impact on brucellosis incidence.

Objective:To investigate the spatial and temporal distribution characteristics of brucellosis in Heilongjiang Province, Jilin Province and Inner Mongolia Autonomous Region (hereafter referred to as the Hei-Ji-Meng province and region), and study the influencing factors of brucellosis incidence.Methods:Using a retrospective analysis method, the data of brucellosis incidence in 22 prefecture-level cities in the Hei-Ji-Meng province and region from 2014 to 2018, as well as the data of natural environmental factors (precipitation, temperature, relative humidity, solar radiation, wind speed, vegetation index) and social environmental factors (livestock breeding, livestock and poultry meat production, cultivated land area) were collected and integrated. The spatial autocorrelation model and spatial Dubin model were used to analyze the spatial and temporal distribution rule of brucellosis and the impact of environmental factors on the incidence of brucellosis in prefecture-level cities.Results:From 2014 to 2018, the incidence of brucellosis in the Hei-Ji-Meng province and region was 18.77/100 000, among which the incidence in Inner Mongolia Autonomous Region was 33.45/100 000, followed by Heilongjiang Province (13.67/100 000) and Jilin Province (6.57/100 000). Among all prefecture-level cities, the brucellosis incidence was relatively higher in Hinggan League of Inner Mongolia Autonomous Region (69.10/100 000). Except 2016, the brucellosis incidence in other years had a positive spatial correlation (global Moran's I > 0, P < 0.05). The high-high concentration aggregation pattern was mainly concentrated in Ulanqab City, Xilingol League, Chifeng City, Tongliao City, Hinggan League, Hohhot City, and Hulunbuir City of Inner Mongolia Autonomous Region. Among the environmental factors related to brucellosis, cultivated land area and sheep breeding density had a positive effect on brucellosis incidence in the local area, with the effect intensity of 0.39 and 0.32, respectively ( P < 0.001). The average humidity from April to July had a negative effect on the brucellosis incidence in the local area, with the effect intensity of - 0.22 ( P = 0.023). The indirect effect of the number of pigs slaughtered on the brucellosis incidence in adjacent areas was the most significant, and the effect intensity was 2.15 ( P < 0.001). Conclusions:Among the Hei-Ji-Meng province and region, the annual average incidence rate of brucellosis in Inner Mongolia Autonomous Region is relatively higher, and the high-high concentration areas are mainly concentrated in this region. Among the environmental factors, the cultivated land area, sheep breeding density, the average humidity from April to July and the number of pigs slaughtered have an impact on brucellosis incidence.

Objective    To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery. Methods    A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared. Results    No massive bleeding, conversion to thoracotomy, postoperative pneumo-thorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05). Conclusion    Based on the optimized diagnosis and treatment model, thoraco-scopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.

Objective:To analyze the spatiotemporal characteristics and spatial aggregation of the incidence of hemorrhagic fever with renal syndrome (HFRS) in China from 2004 to 2020, and to provide a scientific basis for prevention and control of HFRS.Methods:The epidemic information of HFRS in China from 2004 to 2020 was collected from the Public Health Science Data Center, the China Health Statistics Yearbook, and the National Statutory Infectious Disease Epidemic Profile Report. The Joinpoint model was used to analyze the annual average incidence rate change trend, ArcGIS 10.5 software was used for spatial visualization analysis, and global spatial autocorrelation, local spatial autocorrelation and spatiotemporal scan analysis were applied to detect hot spots and aggregation areas.Results:From 2004 to 2020, a total of 208 441 cases of HFRS were reported in China, with an average annual incidence rate of 0.91/100 000. Joinpoint model analysis showed that the average annual incidence rate of HFRS in China showed a decreasing trend from 2004 to 2020. In the provinces with high incidence, the disease was mostly distributed with multimodal distribution in spring, autumn and winter, especially in autumn and winter. The results of global spatial autocorrelation analysis showed that the global Moran's I of HFRS incidence rate in China from 2004 to 2019 were all positive. Except 2012 and 2020, the random distribution pattern was not excluded, other years showed spatial clustering ( Z > 1.65, P < 0.05). The results of phased local spatial autocorrelation analysis indicated that Heilongjiang, Jilin and Liaoning provinces were high-high aggregation regions. A total of five aggregation regions were detected in the month-by-month spatiotemporal scan analysis, and the differences of each aggregation region were statistically significant ( P < 0.001). Conclusions:From 2004 to 2020, the overall incidence of HFRS in China shows a downward trend, and the incidence rate has obvious spatial aggregation. High-risk areas still exist, and it is necessary to focus on and take targeted prevention and control measures.

Objective:To assess the changes of selenium nutrition of school-age children in Kashin-Beck disease (KBD) areas of Linzhou County, Lhasa City and Xietongmen County, Shigatse City in Tibet Autonomous Region (referred to as Tibet), and provide a scientific basis for evaluating the effectiveness of prevention and control measures.Methods:According to the historical condition of KBD, a total of 344 children's hair samples were collected to determine the content of selenium in Kazi (KBD area) and Jiangxia townships (non-KBD area) of Linzhou County in 2013 and 2021, Renqinze (KBD area) and Tongmen townships (non-KBD area) of Xietongmen County in 2015 and 2021.Results:Compared to 2013/2015, in 2021, the hair selenium level of children in the four townships increased ( P < 0.001). The selenium nutritional level of more than 90% of the children reached medium or above (hair selenium > 0.25 μg/g) in 2021. The hair selenium levels of girls in the two KBD areas (Kazi and Renqinze townships) were lower than those of boys ( Z = - 2.83, - 2.83, P < 0.05). Conclusions:The selenium nutrition level of school-age children in KBD areas in Linzhou and Xietongmen counties has increased rapidly in recent years. However, the selenium nutrition level of girls is significantly lower than that of boys. It is necessary to strengthen prevention, controlling and monitoring, and to further improve the dietary structure of school-age children through the joint efforts of families and schools, to increase the proportion of exogenous high selenium food intake.

Objective    To investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery. Methods    From September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared. Results    There was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05). Conclusion    The non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.

Objective:To investigate the levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions.Methods:A cluster sampling method was used to select people with different degrees of skin lesions in the drinking water arsenic poisoning area of Bayannaoer City, Inner Mongolia Autonomous Region. According to the "Standard of Diagnosis for Endemic Arsenism" (WS/T 211-2001), the research subjects were divided into four clinical grading: normal, suspicious, mild, moderate and above on the basis of the degrees of skin lesions. Urine samples from any 1 middle section were collected, and the levels of urinary arsenic metabolites of different forms in different clinically graded people were detected by inductively coupled plasma mass spectrometry (ICP-MS).Results:A total of 522 people were included, including 309 males and 213 females; the age was (39.11 ± 12.38) years old, ranging from 11 to 65 years old. There were 337, 80, 31, 74 people in normal, suspicious, mild, moderate and above clinical grading, the levels of inorganic arsenic (iAs, medians: 15.46, 37.16, 104.46, 163.06 μg/L), monomethylarsonic acid (MMA, medians: 15.95, 33.27, 82.80, 123.84 μg/L), dimethylarsenic acid (DMA, medians: 78.16, 147.86, 301.28, 371.30 μg/L), total arsenic (tAs, medians: 113.90, 220.94, 501.25, 684.46 μg/L), iAs percentage (iAs%, medians: 15.66%, 15.53%, 21.67%, 21.65%), MMA percentage (MMA%, medians: 13.51%, 15.40%, 17.14%, 16.43%), DMA percentage (DMA%, medians: 70.37%, 67.98%, 63.25%, 61.23%), monomethylation rate (PMI, medians: 0.84, 0.84, 0.78, 0.78), dimethylation rate (SMI, medians: 0.84, 0.81, 0.79, 0.79), and ratio of MMA to DMA (MMA/DMA, medians: 0.20, 0.23, 0.27, 0.27) were compared in different clinically graded people, the differences were statistically significant ( H = 97.98, 96.44, 85.50, 95.08, 38.58, 29.94, 51.98, 38.58, 43.20, 43.20, P < 0.01). Compared with normal people, iAs, MMA, DMA, tAs, MMA%, and MMA/DMA levels significantly increased, and SMI level significantly decreased in suspicious, mild, moderate and above people ( P < 0.017); compared with normal people, iAs% level significantly increased, and DMA% and PMI levels significantly decreased in mild, moderate and above people ( P < 0.017). Conclusion:The levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions are different, showing a dose-response relationship.

Objective:To assess the present situation of selenium nutrition in adults and school-age children in Kaschin-Beck disease area of Binxian, Shaanxi Province, and provide the basis for taking targeted measures.Methods:Binxian was divided into five grades according to the condition of Kaschin-Beck disease, and 11 representative villages were selected as the survey villages in 2018. Each survey village was located in five directions: east, west, south, north, and middle. Two household villagers were selected from each location, and adult hair samples were collected for hair selenium content determination. And school-age children hair samples were collected at the township central primary schools and 1 village primary school corresponding to the five ward levels, and the selenium content was determined.Results:A total of 85 adult hair samples were collected, the average selenium content was 237.1 μg/kg, generally at the marginal selenium deficiency level (200 - < 250 μg/kg), and there was no significant difference among different grades of disease areas (χ 2 = 5.616, P > 0.05) . A total of 162 children hair samples were collected, the average selenium content was 301.3 μg/kg, generally at the middle selenium nutrition level (250 - < 500 μg/kg), and there was significant difference among different grades of disease areas (χ 2 = 13.627, P < 0.05) . Conclusion:Although Binxian has got rid of the risk of Kaschin-Beck disease as a whole, the selenium nutrition levels of some adults and children are still low, so it is still necessary to strengthen the prevention and control measures, especially for school-age children living in a relatively serious historical disease villages.