There is a bidirectional interactive relationship between heavy metals and intestinal microorganisms. Single exposure to common heavy metals (Cd, Cr, As, Pb, etc.) may cause intestinal microecological damage and related diseases by losing the diversity and relative abundance of intestinal microorganisms. However, heavy metals in the environment are usually mixed exposure and an overall toxic effect is presented. Published studies have suggested a synergistic effect between most heavy metals, so the impact of mixed exposure on intestinal microorganisms is expected to be more significant than that of single exposure. Intestinal microorganisms are the first line of defense against heavy metals entering the body, and can reduce inflammation and oxidation caused by heavy metals via changing protein synthesis, intestinal PH, enzyme activity, etc. At the same time, the colonization of oral probiotics in the intestinal tract has a significant detoxification effect on heavy metals entering the body through synergy with intestinal microorganisms, which can promote the elimination of heavy metals, reduce the production of oxides and inflammatory mediators, reverse the changes in the relative abundance of intestinal microorganisms, and then reduce the damage of heavy metals to intestinal microecology. Therefore, probiotics may have better prospects than traditional heavy metal antidotes. In the future, more in-depth research on the mechanism of bidirectional interactive relationship between heavy metals and intestinal microorganisms is needed to provide new ideas for clinical heavy metal detoxification.

With the widespread use of mobile phones, laptops, and WIFI, the effects of radio frequency radiation (RFR) on human health are of increasing concern, and there are particular concerns about its reproductive toxicity. Studies have shown that the reproductive system is a sensitive target for RFR. In males, RFR is associated with decreased sperm quality and serum testosterone levels, but there are few studies on the biological effects of RFR by altering physical parameters on the male reproductive system. This paper introduced common sources of RFR, reviewed the toxic effects and mechanisms of RFR targeting male reproductive system from the aspects of spermatogenic cells, sperm structure, blood-testicular barrier, and testicular function, and analyzed male reproductive system related toxic effects of RFR by varying physical parameters including frequency, treatment duration, and specific absorption rate, so as to provide a theoretical basis and scientific basis for the safe and reasonable use of radio frequency electromagnetic field by humans and subsequent in-depth research.

Objective To approach the significance of changes of percutaneous-arterial blood carbon dioxide partial pressure difference [P(tc-a)CO2] in liquid resuscitation of patients with septic shock. Methods One hundred and sixty-eight patients with septic shock admitted and treated in the Department of Intensive Care Unit (ICU) of Quzhou People's Hospital from January 2015 to January 2018 were enrolled, and after early goal-directed therapy (EGDT) for 6 hours, according to central venous oxygen saturation (ScvO2) and lactate clearance (LC), they were divided into ScvO2 and LC achievement group (ScvO2 ≥ 0.7 and LC≥10%), ScvO2 achievement group (ScvO2 ≥ 0.7 and LC < 10%), LC achievement group (ScvO2 < 0.7 and LC≥10%), and un-achievement group (ScvO2 < 0.7 and LC < 10%). The mechanical ventilation time, ICU hospitalization time, 28-day mortality, P(tc-a)CO2 etc. were compared among the four groups; the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of P(tc-a)CO2 for 28-day prognosis in patients with septic shock. Results The trends of mechanical ventilation time, ICU hospitalization time, and 28-day mortality were all ScvO2 and LC achievement group < LC achievement group < ScvO2 achievement group < un-achievement group [the mechanical ventilation times (days) were respectively 6.12±2.59, 8.43±3.24, 11.78±4.12, 13.03±4.75, ICU hospitalization times (days) were 10.31±2.32, 13.85±3.56, 16.41±3.83, 18.52±4.05, and 28-day mortality rates were 28.85% (15/52), 40.91% (18/44), 51.28% (20/39), 69.70% (23/33)] and the differences among the four groups were statistically significant (all P < 0.05). After 6 hours of EGDT, the heart rate (HR), lactate (Lac), and P(tc-a)CO2 were lower than those before fluid resuscitation, but the mean arterial pressure (MAP), central venous pressure (CVP), and ScvO2 were higher than those before fluid resuscitation among four groups. Except CVP, the differences of other indicators compared among the ScvO2 and LC achievement group, ScvO2 achievement group, LC achievement group and un-achievement group were statistically significant (all P < 0.05). After 6 hours of EGDT, HR, Lac, P(tc-a)CO2 in ScvO2 and LC achievement group, ScvO2 achievement group and LC achievement group were significantly lower than those in the un-achievement group [HR (bpm): 89.05±29.43, 98.82±30.21, 94.33±28.64 vs. 112.85±32.74, Lac (mmol/L): 2.97±1.95, 3.87±2.32, 2.69±1.52 vs. 4.17±2.44, P(tc-a)CO2 (mmHg, 1 mmHg = 0133 kPa): 7.18±4.61, 12.61±5.34, 9.71±4.11 vs. 16.56±10.19], MAP and ScvO2 were significantly higher than those of the un-achievement group [MAP (mmHg): 88.05±21.67, 77.33±18.56, 83.11±19.71 vs. 70.32±18.79, ScvO2: 0.76±0.14, 0.75±0.16, 0.67±0.14 vs. 0.63±0.18, all P < 0.05]. The P(tc-a)CO2 of 28 days survivors were significantly lower than that of the deaths among four groups (mmHg: 5.78±2.27 vs. 14.14±3.65, 7.07±2.81 vs. 15.06±4.11, 6.35±2.09 vs. 14.94±4.06, 7.93±3.81 vs. 18.34±4.63, all P < 0.05). When P(tc-a)CO2 > 7.24 mmHg predicted 28-day mortality in ScvO2 and LC achievement group, the sensitivity was 89.29%, specificity was 91.45%, and the area under ROC curve (AUC) was 0.86; when P(tc-a)CO2 > 9.46 mmHg predicted 28-day mortality in LC achievement group, the sensitivity was 88.72%, specificity was 85.83% and AUC was 0.91; when P(tc-a)CO2 >12.05 mmHg predicted 28-day mortality in ScvO2 achievement group, the sensitivity was 82.79%, specificity was 86.90% and AUC was 0.79; when P(tc-a)CO2 > 16.22 mmHg predicted 28-day mortality in un-achievement group, the sensitivity was 73.35%, specificity was 80.68% and AUC was 0.68. Conclusion P(tc-a)CO2 can be used as an indicator to evaluate fluid resuscitation effect and prognosis in patients with septic shock.

Objective: To analyze the mental health status of the Chinese Medical Team (CMT) members and its influencing factors. Methods: A total of 1 015 members of the CMT were recruited and surveyed by using a self-administered questionnaire and 12-item General Health Questionnaire (GHQ-12) from May 10 to June 10, 2018. Multivariable logistic regression models were used to identify risk factors for mental health problems. Results: A total of 808 subjects completed the questionnaire and an estimated 25.9% of them were suspected to have mental health problems (GHQ-12≥3). Logistic model analysis indicated that family life (OR=1.928, 95%CI: 1.162-3.197), domestic work status (OR=2.069, 95%CI: 1.210-3.538), father’s health status (OR=1.703, 95%CI: 1.060-2.736), disease symptoms (OR=2.087, 95%CI: 1.363-3.194), captain (OR=1.996, 95%CI: 1.128-3.532), cultural differences (OR=2.439, 95%CI: 1.621-3.671) were the risk factors for mental health. Age (OR=0.736, 95%CI: 0.571-0.949), leisure activities (OR=0.654, 95%CI: 0.490-0.872) were the protective factors. Drinking habits (OR=7.439, 95%CI: 1.290- 42.900), loneliness (OR=4.094, 95%CI: 2.438-6.875), and respect from the hospital (OR=0.783, 95%CI: 0.610-1.004) were relative to mental health problems. Conclusion CMT members have certain mental health problems, especially young members and captains. Therefore, interventions should be implemented to improve the mental health of CMT members and to promote the development of foreign aid work.

Objective To evaluate the effect of enteral immune nutrition on the occurrence of acute kidney injury(AKI) in sepsis patients. Methods A retrospective study was conducted, 80 patients with sepsis admitted and treated in the intensive care unit (ICU) of Quzhou People's Hospital from January 2015 to December 2016 were enrolled, and according to different treatment programs, they were divided into an immune nutrition group and a standard nutrition group, each group 40 cases. The two groups received an equal amount of calories and nitrogen in enteral nutrition (EN). After treatment, the changes of serum total protein (TP), albumin (Alb), prealbumin (PA), hemoglobin (Hb), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-10), infection site, length of stay in ICU, mortality in ICU, AKI incidence, AKI staging, etc in the two groups were observed. Results ① After treatment, the nutritional indicators TP, Alb, PA, Hb levels were significantly increased, the serum inflammatory factors CRP, TNF-α, IL-6 were obviously decreased and IL-10 was markedly increased in the two groups compared with those before treatment (all P < 0.05), the changes in the immune nutrition group were more obvious than those in the standard nutrition group [TP (g/L): 60.84±5.90 vs. 58.32±6.11, Alb (g/L): 33.95±3.83 vs. 31.79±3.44, PA (g/L): 0.24±0.04 vs. 0.21±0.03, Hb (g/L): 117.47±16.15 vs. 112.50±15.71, CRP (mg/L): 53.04±23.76 vs. 82.33±37.09, TNF-α (ng/L): 20.29±17.74 vs. 29.63±18.43, IL-6 (ng/L): 50.74±28.55 vs. 80.32±31.67, IL-10 (ng/L): 41.09±24.65 vs. 40.86±24.73]; ② The length of stay in ICU (days: 10.54±4.33 vs. 14.80±5.19), ICU mortality [15.00% (6/40) vs. 32.50% (13/40)] and the incidence of AKI [22.50% (9/40) vs. 47.50% (19/40)] of immune nutrition group were significantly lower than those of standard nutrition group (all P < 0.05); There were 9 cases of AKI mainly at stage I andⅡ (8 cases) in the immune nutrition group, while in the standard nutrition group there were 19 cases with AKI mainly at stageⅢ (11 cases). Conclusion The enteral immune nutrition can effectively reduce the incidence of AKI in sepsis patients, and the mechanism may be related to the immune nutritional preparation can inhibit the expressions of pro-inflammatory factors such as TNF-α, IL-6, etc.

Objective To apply hydride generation atomic fluorescence spectrophotometry (HG-AFS method) in urinary arsenic detection,and to provide a better,newer and more convenient detection method for quantitative analysis of urinary arsenic.Methods According to the Guide to Develop Biological Sample Inspection Method(WS/T 68-1996) and Guide for Establishing Occupational Health Standards-part 5:Determination Methods in Biological Materials (GB/T 210.5-2008),HG-AFS method was established to detect arsenic content in urine after modification of the method for sample pretreatment,and to verify the linear range of standard curve and linearity,detection limit,precision,accuracy,stability of the sample,and to compare the experimental results of HG-AFS method with those of standard methods of WS/T 28-1996 and Determination of Arsenic in Urine by Cyanide Generation Atomic Fluorescence Method (WS/T 474-2015).Results The HG-AFS method linear range was from 0-100 μg/L,the correlation coefficient r =0.999 9,the detection limit was 0.07 μg/L,the precision was 1.96％-3.97％,and the recovery rate was 95.1％-105.0％.There was no statistical significance between HG-AFS method,the standard of WS/T 28-1996 or WS/T 474-2015 methods (t =1.539,0.353,all P ＞ 0.05).Conclusion The new method is superior to the current detection method owing to its low detection limit,high precision,good accuracy,and wide linear range.

BACKGROUND AND PURPOSE: Encephalitis caused by Listeria monocytogenes (L. monocytogenes) is rare but sometimes fatal. Early diagnosis is difficult using routine cerebrospinal fluid (CSF) tests, while next-generation sequencing (NGS) is increasingly being used for the detection and characterization of pathogens. METHODS: This study set up and applied unbiased NGS to detect L. monocytogenes in CSF collected from three cases of clinically suspected listeria meningoencephalitis. RESULTS: Three cases of patients with acute/subacute meningoencephalitis are reported. Magnetic resonance imaging and blood cultures led to a suspected diagnosis of L. monocytogenes, while the CSF cultures were negative. Unbiased NGS of CSF identified and sequenced reads corresponding to L. monocytogenes in all three cases. CONCLUSIONS: This is the first report highlighting the feasibility of applying NGS of CSF as a diagnostic method for central nervous system (CNS) L. monocytogenes infection. Routine application of this technology in clinical microbiology will significantly improve diagnostic methods for CNS infectious diseases.
Central Nervous System ; Cerebrospinal Fluid ; Communicable Diseases ; Diagnosis ; Early Diagnosis ; Encephalitis ; Humans ; Listeria monocytogenes* ; Listeria* ; Magnetic Resonance Imaging ; Meningitis, Listeria ; Meningoencephalitis* ; Methods

OBJECTIVETo explore the effect of signal strength indictor (SSI) in improving sensitivity of China Infectious Diseases Automated-alert and Response System (CIDARS).

METHODSDiarrhea cases in 2007-2011 and early warning signals in 2010-2011 were selected by using random digital table method. Then, SSI and event-related ratio (ER) were calculated. The relationship between ER and SSI was analyzed, and the effect of SSI on ER was explored by using multiple logistic regression analysis.

RESULTS9 620 early warning signals in 2010-2011 were generated in two years. Of these, 74, or 0.77% were defined as suspected outbreak signal. The median of SSI related with suspected outbreak signal was 4.0, which was much higher than non-suspected outbreak signal (1.7). ER was significantly correlated with SSI (r=0.917). SSI classification has a good correlation between the ER, ER exceeded 20 after SSI reached 20. The multivariate logistic regression analysis showed OR of SSI related with suspected outbreak signal was 2.52 (95% CI 2.04-3.12). Compared with non-epidemic season, the relationship of SSI and ER in epidemic season was much higher.

CONCLUSIONSSI was closely related with ER. The relationship was much closer in large scale outbreak and epidemic season, and compared to non-epidemic,the effect of epidemic season is more obvious.

China ; Communicable Diseases ; diagnosis ; epidemiology ; Diarrhea ; diagnosis ; epidemiology ; Disease Outbreaks ; Humans ; Population Surveillance

OBJECTIVEProviding evidences for further modification of China Infectious Diseases Automated-alert and Response System (CIDARS) via analyzing the outbreak detection performance of Moving Percentile Method (MPM) by optimizing thresholds in different provinces.

METHODSWe collected the amount of MPM signals, response results of signals in CIDARS, cases data in nationwide Notifiable Infectious Diseases Reporting Information System, and outbreaks data in Public Health Emergency Reporting System of 16 infectious diseases in 31 provinces in Chinese mainland from January 2011 to October 2013. The threshold with the optimal sensitivity, the shortest time to detect outbreak and the least number of signals was considered as the best threshold of each disease in Chinese mainland and in each province.

RESULTSAmong all the 16 diseases, the optimal thresholds of 10 diseases, including dysentery, dengue, hepatitis A, typhoid and paratyphoid, meningococcal meningitis, Japanese encephalitis, scarlet fever, leptospirosis, hepatitis, typhus in country level were the 90(th) percentile (P90), which was the same as provincial level for those diseases.For the other 6 diseases, including other infectious diarrhea, influenza, acute hemorrhagic conjunctivitis, mumps, rubella and epidemic hemorrhagic fever, the nationwide optimal thresholds were the 80th percentile (P80), which was different from that by provinces for each disease. For these 6 diseases, the number of signals generated by MPM with the optimal threshold for each province was decreased by 23.71% (45 557), 15.59% (6 124), 14.07% (1 870), 9.44% (13 881), 8.65% (1 294) and 6.03% (313) respectively, comparing to the national optimal threshold, while the sensitivity and time to detection of CIDARS were still the same.

CONCLUSIONOptimizing the threshold by different diseases and provinces for MPM in CIDARS could reduce the number of signals while maintaining the same sensitivity and time to detection.

China ; Communicable Diseases ; Disease Notification ; Disease Outbreaks ; prevention & control ; Humans ; Population Surveillance ; methods

OBJECTIVEFor providing evidences for further modification of China Infectious Diseases Automated-alert and Response System (CIDARS) by comparing the early-warning performance of the temporal model and temporal-spatial model in CIDARS.

METHODSThe application performance for outbreak detection of temporal model and temporal-spatial model simultaneously running among 208 pilot counties in 20 provinces from 2011 to 2013 was compared; the 16 infectious diseases were divided into two classes according to the disease incidence level; cases data in nationwide Notifiable Infectious Diseases Reporting Information System was combined with outbreaks reported to Public Health Emergency Reporting System, by adopting the index of the number of signals, sensitivity, false alarm rate and time for detection.

RESULTSThe overall sensitivity of temporal model and temporal-spatial model for 16 diseases was 96.23% (153/159) and 90.57% (144/159) respectively, without significant difference (Z = -1.604, P = 0.109), and the false alarm rate of temporal model (1.57%, 57 068/3 643 279) was significantly higher than that of temporal-spatial model (0.64%, 23 341/3 643 279) (Z = -3.408, P = 0.001), while the median time for detection of these two models was not significantly different, which was 3.0 days and 1.0 day respectively (Z = -1.334, P = 0.182).For 6 diseases of type I which represent the lower incidence, including epidemic hemorrhagic fever,Japanese encephalitis, dengue, meningococcal meningitis, typhus, leptospirosis, the sensitivity was 100% for both models (8/8, 8/8), and the false alarm rate of both temporal model and temporal-spatial model was 0.07% (954/1 367 437, 900/1 367 437), with the median time for detection being 2.5 days and 3.0 days respectively. The number of signals generated by temporal-spatial model was reduced by 2.29% compared with that of temporal model.For 10 diseases of type II which represent the higher incidence, including mumps, dysentery, scarlet fever, influenza, rubella, hepatitis E, acute hemorrhagic conjunctivitis, hepatitis A, typhoid and paratyphoid, and other infectious diarrhea, the sensitivity of temporal model was 96.03% (145/151), and the sensitivity of temporal-spatial model was 90.07% (136/151), the number of signals generated by temporal-spatial model was reduced by 59.36% compared with that of temporal model. Compared to temporal model, temporal-spatial model reduced both the number of signals and the false alarm rate of all the type II diseases;and the median of outbreak detection time of temporal model and temporal-spatial model was 3.0 days and 1.0 day, respectively.

CONCLUSIONOverall, the temporal-spatial model had better outbreak detection performance, but the performance of two different models varies for infectious diseases with different incidence levels, and the adjustment and optimization of the temporal model and temporal-spatial model should be conducted according to specific infectious disease in CIDARS.

China ; Communicable Diseases ; Disease Notification ; Disease Outbreaks ; prevention & control ; Humans ; Models, Theoretical ; Population Surveillance ; methods ; Spatio-Temporal Analysis