To summarize the problems and improvement suggestions in the implementation of GBZ158, the focus groups interview was used to interview industry experts from CDC, Occupational disease prevention and control hospital institutes, employers, third d dd鄄party technical service institutions and universities, and extract their opinions on the problems and improvement suggestions in the implementation of the standard. The operability of GBZ 158 is not strong, and there is a certain overlap with the signs in the fields of firefighting, safety and other fields. It urgently needs to be modified to comply with the reality of occupational health management in China. There are many and concentrated revision opinions on "6. Notification Cards for Occupational Hazards of Toxic Substance in Workplaces" and "7. Setting of Warning Signs in Workplaces with Toxic Substances". It is concluded that Some technical indicators of GBZ 158 have not been according with the current actual work of occupational health, and need to be revised and improved urgently, which includes enhancing the coordination with standards in the fields of firefighting and safety, supplementing normative reference documents, clarifying the setting conditions, scope of use, and application examples of warning signs of occupational hazards.

Objective:By systematically evaluate the implementation of GBZ 2.1, so as to provide technical basis for the future revisions of this standard.Methods:From May to October 2023, Based on the pre survey questionnaire, the semi-structured interview method was used to interviews with experts from CDC, Occupational disease prevention and control hospital institutes, employers, occupational hygiene technical service intermediaries and universities, and the inductive method was used to extract the topics and relevant suggestions.Results:Generally, GBZ 2.1 is scientific, practical, progressiveness and operable. There are still some issues such as OELs overlapping and the correspondence between Chinese and English names. The outstanding problem is the coordination with other standard contents.Conclusion:The technical indicators in GBZ 2.1 could adapt to the needs of current practical work. The coordination between standards needs to be clarified, and the new recommended content needs further promotion and exploration on how to implement it.

Objective:To analyze the characteristics of toxic substances determination standards in workplaces in China, in order to provide basis for further development of national occupational health standards.Methods:In November 2023, Used descriptive analysis methods, conduct a characteristic analysis of the toxic substance determination standards for workplaces in China issued between 2004 and 2024, including the first drafting situation, standard formulation/revision situation, standard determination methods types, and method performance indicators.Results:The The first drafting unit in the GBZ/T 160 and GBZ/T 300 standards that have been issued is mainly composed of disease prevention and control centers (154, accounting for 60.6%) and the hospital of Occupational disease prevention and control (154, accounting for 60.6%). The regional distribution is North China (65 items, accounting for 25.6%), East China (60 items, accounting for 23.7%), and South China (51 items, accounting for 20.2%). 93.1% of the standards were published between 2004 and 2017; Covering 671 measurement methods.The method types are gas chromatography (367, 54.7%), spectrophotometry (98, 14.6%), inductively coupled plasma mass spectrometry (54, 8.0%), etc. The missing items of standard performance indexes mainly focus on penetration capacity, recovery rate and detection limit. The missing items of penetration capacity and recovery rate are mainly distributed in gas chromatography methods; The missing detection limits and minimum detection concentrations are mainly distributed in spectrophotometry and gas chromatography method.Conclusion:Suggest accelerating the update speed of toxic substance determination standards in the workplace, supplementing the supporting determination methods in GBZ 2.1 standard, focusing on solving common problems in existing standards, gradually improving the standards for missing performance indicators, and gradually carrying out national standard transformation in a hierarchical and phased manner for local or group standards with good practical applications.

Objective:To analyze the molecular characteristics of prevalent Bordetella pertussis (Bp) isolates in Liaocheng City, Shandong Province in 2024. Methods:From March to August 2024, oropharyngeal swabs were collected from suspected pertussis cases at Liaocheng People′s Hospital in Shandong Province for Bp isolation. A total of 99 Bp isolates were obtained. Whole-genome sequencing was performed on all isolates, followed by Multilocus Sequence Typing (MLST), vaccine antigen-related gene typing (including ptxP, ptxA, ptxB, ptxC, ptxD, ptxE, fhaB, fim2, fim3, and prn), 23S rRNA gene typing, and phylogenetic analysis. To capture the differences between Bp isolates and vaccine strains in Liaocheng City, the international vaccine strain Tohama I and the Chinese vaccine strain CS were included in the analysis. Antimicrobial resistance testing against 11 agents was performed on 52 isolates. Results:The throat swabs of 99 Bp isolates were collected from patients aged 44 days to 42 years, and the median age of the patients was 7 (5, 8) years. All isolates ptxP were ptxP3 type. 74 isolates (74.75%) carried the prn150, while 21 isolates (21.21%) were prn-deficient. The predominant antigenic profile was ptxP3/ ptxA1/ ptxB1/ ptxC4/ ptxD1/ ptxE4/ fhaB1/ fim2-1/ fim3-1/ prn150, found in 72 isolates (72.73%). All 99 isolates carried the A2047G mutation in the 23S rRNA gene. Antimicrobial susceptibility testing showed that the MICs of macrolides and clindamycin for all 52 Bp isolates were all >256 mg/L. However, the isolates showed low MIC for seven other antimicrobials tested, including trimethoprim-sulfamethoxazole, amoxicillin, and levofloxacin. MLST typing revealed that 94 isolates (94.95%) were identified as ST-2, while 5 isolates (5.05%) belonged to a novel sequence type (ST-118). Phylogenetic analysis demonstrated that all 99 Bp isolates were highly homologous but clustered in evolutionary branches distinct from vaccine strains. Conclusion:In 2024, Bordetella pertussis isolates in Liaocheng City exhibit distinct clonal epidemic characteristics, with the predominant antigenic genotype being ptxP3/ ptxA1/ ptxB1/ ptxC4/ ptxD1/ ptxE4/ fhaB1/ fim2-1/ fim3-1/ prn150. All isolates are resistant to macrolide antibiotics.

Objective:To analyze the characteristics of toxic substances determination standards in workplaces in China, in order to provide basis for further development of national occupational health standards.Methods:In November 2023, Used descriptive analysis methods, conduct a characteristic analysis of the toxic substance determination standards for workplaces in China issued between 2004 and 2024, including the first drafting situation, standard formulation/revision situation, standard determination methods types, and method performance indicators.Results:The The first drafting unit in the GBZ/T 160 and GBZ/T 300 standards that have been issued is mainly composed of disease prevention and control centers (154, accounting for 60.6%) and the hospital of Occupational disease prevention and control (154, accounting for 60.6%). The regional distribution is North China (65 items, accounting for 25.6%), East China (60 items, accounting for 23.7%), and South China (51 items, accounting for 20.2%). 93.1% of the standards were published between 2004 and 2017; Covering 671 measurement methods.The method types are gas chromatography (367, 54.7%), spectrophotometry (98, 14.6%), inductively coupled plasma mass spectrometry (54, 8.0%), etc. The missing items of standard performance indexes mainly focus on penetration capacity, recovery rate and detection limit. The missing items of penetration capacity and recovery rate are mainly distributed in gas chromatography methods; The missing detection limits and minimum detection concentrations are mainly distributed in spectrophotometry and gas chromatography method.Conclusion:Suggest accelerating the update speed of toxic substance determination standards in the workplace, supplementing the supporting determination methods in GBZ 2.1 standard, focusing on solving common problems in existing standards, gradually improving the standards for missing performance indicators, and gradually carrying out national standard transformation in a hierarchical and phased manner for local or group standards with good practical applications.

Objective:To analyze the molecular characteristics of prevalent Bordetella pertussis (Bp) isolates in Liaocheng City, Shandong Province in 2024. Methods:From March to August 2024, oropharyngeal swabs were collected from suspected pertussis cases at Liaocheng People′s Hospital in Shandong Province for Bp isolation. A total of 99 Bp isolates were obtained. Whole-genome sequencing was performed on all isolates, followed by Multilocus Sequence Typing (MLST), vaccine antigen-related gene typing (including ptxP, ptxA, ptxB, ptxC, ptxD, ptxE, fhaB, fim2, fim3, and prn), 23S rRNA gene typing, and phylogenetic analysis. To capture the differences between Bp isolates and vaccine strains in Liaocheng City, the international vaccine strain Tohama I and the Chinese vaccine strain CS were included in the analysis. Antimicrobial resistance testing against 11 agents was performed on 52 isolates. Results:The throat swabs of 99 Bp isolates were collected from patients aged 44 days to 42 years, and the median age of the patients was 7 (5, 8) years. All isolates ptxP were ptxP3 type. 74 isolates (74.75%) carried the prn150, while 21 isolates (21.21%) were prn-deficient. The predominant antigenic profile was ptxP3/ ptxA1/ ptxB1/ ptxC4/ ptxD1/ ptxE4/ fhaB1/ fim2-1/ fim3-1/ prn150, found in 72 isolates (72.73%). All 99 isolates carried the A2047G mutation in the 23S rRNA gene. Antimicrobial susceptibility testing showed that the MICs of macrolides and clindamycin for all 52 Bp isolates were all >256 mg/L. However, the isolates showed low MIC for seven other antimicrobials tested, including trimethoprim-sulfamethoxazole, amoxicillin, and levofloxacin. MLST typing revealed that 94 isolates (94.95%) were identified as ST-2, while 5 isolates (5.05%) belonged to a novel sequence type (ST-118). Phylogenetic analysis demonstrated that all 99 Bp isolates were highly homologous but clustered in evolutionary branches distinct from vaccine strains. Conclusion:In 2024, Bordetella pertussis isolates in Liaocheng City exhibit distinct clonal epidemic characteristics, with the predominant antigenic genotype being ptxP3/ ptxA1/ ptxB1/ ptxC4/ ptxD1/ ptxE4/ fhaB1/ fim2-1/ fim3-1/ prn150. All isolates are resistant to macrolide antibiotics.

To summarize the problems and improvement suggestions in the implementation of GBZ158, the focus groups interview was used to interview industry experts from CDC, Occupational disease prevention and control hospital institutes, employers, third d dd鄄party technical service institutions and universities, and extract their opinions on the problems and improvement suggestions in the implementation of the standard. The operability of GBZ 158 is not strong, and there is a certain overlap with the signs in the fields of firefighting, safety and other fields. It urgently needs to be modified to comply with the reality of occupational health management in China. There are many and concentrated revision opinions on "6. Notification Cards for Occupational Hazards of Toxic Substance in Workplaces" and "7. Setting of Warning Signs in Workplaces with Toxic Substances". It is concluded that Some technical indicators of GBZ 158 have not been according with the current actual work of occupational health, and need to be revised and improved urgently, which includes enhancing the coordination with standards in the fields of firefighting and safety, supplementing normative reference documents, clarifying the setting conditions, scope of use, and application examples of warning signs of occupational hazards.

Objective:By systematically evaluate the implementation of GBZ 2.1, so as to provide technical basis for the future revisions of this standard.Methods:From May to October 2023, Based on the pre survey questionnaire, the semi-structured interview method was used to interviews with experts from CDC, Occupational disease prevention and control hospital institutes, employers, occupational hygiene technical service intermediaries and universities, and the inductive method was used to extract the topics and relevant suggestions.Results:Generally, GBZ 2.1 is scientific, practical, progressiveness and operable. There are still some issues such as OELs overlapping and the correspondence between Chinese and English names. The outstanding problem is the coordination with other standard contents.Conclusion:The technical indicators in GBZ 2.1 could adapt to the needs of current practical work. The coordination between standards needs to be clarified, and the new recommended content needs further promotion and exploration on how to implement it.

Objective To investigate the effects of transcutaneous electrical acupoint stimulation at Neiguan combined with Danzhong on intraoperative remifentanil dosage and early postoperative pain in pa-tients undergoing radical mastectomy.Methods A total of 153 female patients undergoing radical mastecto-my under general anaesthesia aged 18-64 years,BMI 18.5-30.0 kg/m2 and ASA physical status Ⅰ or Ⅱwere enrolled.The patients were randomly assigned into three groups:single-acupoint(Neiguan)group,dual-acupoint(Neiguan and Danzhong)group and control group,51 patients in each group.TEAS for 30 minutes at different points(Neiguan combined with Danzhong for the dual-acupoint group,Neiguan for the single-acupoint group,no stimulation for the sham group)were given before anaesthesia induction.30 mi-nutes of disperse/dense stimulation of 2/10 Hz with an intensity of 4-11 mA was used.The consumption of remifentanil,time to recall and to extubation were recorded.The visual analogue scale(VAS)pain score in PACU and 24 hours after surgery,and patient satisfaction scores was recorded.Results The intra-operative remifentanil consumption in the dual-acupoint group was significantly less than groups single-acupoint and sham(P＜0.05).Patient satisfaction score 24 hours after surgery was significantly higher in the dual-acu-point group than those in groups single-acupoint and sham(P＜0.05).The VAS scores in PACU and 24 hours after surgery had no significantly differences among the three groups.Conclusion Compared with single-acupoint,stimulation at Neiguan combined with Danzhong in patients undergoing radical mastectomy induced stronger remifentanil-sparing effect and higher patients'satisfaction after radical mastectomy.

Objective:To investigate the association of urinary cadmium levels with peripheral leukocyte classification counts among middle-aged and older adults aged 40 to 89 years in selected areas of China.Methods:The research was based on the survey of the impact of soil quality of agricultural land on human health in typical areas conducted in 2019-2020. A total of 5 600 middle-aged and older adults aged 40 to 89 years were included by using a multi-stage stratified random sampling method. Baseline characteristics of the subjects were collected and physical examinations were performed. Random midstream urine was collected to measure urinary cadmium and urinary creatinine and fasting venous blood was collected to measure the leukocyte count, neutrophil count, lymphocyte count, monocyte count and eosinophil count. The linear mixed effect model was used to analyse the association of urinary cadmium levels with leukocyte classification counts, and the dose-response relationship between them was analyzed by using the restricted cubic spline (RCS) function.Results:The age of the subjects was (63.17±12.02) years; 2 851 (50.91%) were males; and the M ( Q 1, Q 3) of urinary creatinine-corrected urinary cadmium levels was 2.69 (1.52, 4.69) μg/g·creatinine. After adjusting for confounding factors, the results of linear mixed effects model analysis showed that for each 1-unit increase in urinary creatinine-corrected urinary cadmium level, the percentage change [% (95% CI)] of leukocyte count and lymphocyte count was -1.70% (-2.61%, -0.79%) and -1.57% (-2.86%, -0.26%), respectively. RCS function showed a negative linear relationship between urinary creatinine-corrected urinary cadmium levels and leukocyte counts and lymphocyte counts, respectively (all Pnon-linear>0.05). Conclusion:Urinary cadmium levels are negatively associated with leukocyte count and lymphocyte count among middle-aged and older adults aged 40 to 89 years in selected areas of China.