Background The human body is usually exposed to a variety of heavy metals at the same time, and different types and concentrations of heavy metals may have complex interactions during their absorption and metabolism in the human body. Seminal fructose is an important energy source for sperm movement. A large number of studies have shown that metal exposure may impair semen quality, and seminal fructose is an important factor affecting male reproduction, so it is necessary to investigate the relationship between mixed heavy metal exposure and seminal fructose to explore the mechanism of semen quality damage caused by metal exposure. Objective To understand the status of common heavy metal exposure in men of childbearing age in Puyang City, Henan Province, and to study the relationship between mixed exposure to heavy metals and seminal fructose, as well as potential interactions among heavy metals. Methods Volunteers were recruited from the Puyang Maternal and Child Health Hospital Reproductive Center for a cross-sectional survey on general demographic characteristics, smoking, alcohol consumption, and other information. Semen samples were collected to detect 12 metals such as vanadium (V), manganese (Mn), cobalt (Co), nickel (Ni), zinc (Zn), selenium (Se), silver (Ag), cadmium (Cd), barium (Ba), thallium (Tl), iron (Fe), and lead (Pb) in seminal plasma and seminal fructose. After correcting for selected confounding factors, a Bayesian kernel machine regression (BKMR) model was used to evaluate the impact of seminal plasma heavy metal mixed exposure and its interactions on seminal fructose. Results A total of 825 adult males were enrolled. The concentrations in M (P₂₅, P₇₅) of V, Mn, Co, Ni, Zn, Se, Ag, Cd, Ba, Tl, Fe, and Pb in seminal plasma were 0.39 (0.28, 0.54), 12.31 (8.92, 17.52), 0.26 (0.18, 0.38), 5.15 (3.32, 8.64), 182159.80 (121847.80, 199144.50), 13.61 (10.55, 17.68), 0.03 (0.02, 0.04), 0.34 (0.27, 0.46), 8.64 (5.94, 13.43), 0.06 (0.05, 0.08), 168.74 (114.17, 259.45), and 1.69 (1.15, 2.36) μg·L⁻¹ respectively. The Spearman correlation results indicated that there was a negative correlation between V, Mn, Co, Zn, Se, Ba, Tl, or Fe in seminal plasma and seminal fructose (P<0.05), and the values of r (95%CI) were −0.044 (−0.087, −0.001), −0.129 (−0.171, −0.087), −0.055 (−0.099, −0.012), −0.099 (−0.143, −0.056), −0.053 (−0.097, −0.010), −0.068 (−0.111, −0.025), −0.095 (−0.138, −0.052), and −0.082 (−0.125, −0.039), respectively. The results of multiple linear regression indicated that there was a negative correlation between the exposure level of Cd, Mn, Zn, Ag, Ba, Tl, or Fe in seminal plasma and seminal fructose (P<0.05), the values of associated β (95%CI) were −0.551 (−0.956, −0.147), −0.315 (−0.419, −0.212), −0.187 (−0.272, −0.103), −0.161 (−0.301, −0.021), −0.188 (−0.314, −0.062), −1.159 (−2.170, −0.147), and −0.153 (−0.230, −0.076), respectively. The BKMR model analysis showed that seminal fructose level decreased with the increase of plasma metal mixed exposure concentration. Compared with all metal exposure at P₅₀, the seminal fructose level decreased by 0.2374 units when all metal exposure was at P₇₅. Seminal plasma Zn [posterior inclusion probabilities (PIPs)=1.0000] had the strongest effect on seminal fructose, followed by Mn (PIPs=0.5872), Se (PIPs=0.5656), and Ba (PIPs=0.5398). The univariate exposure-response curve showed a negative approximate linear correlations between Ba or Mn and seminal fructose, a positive linear correlation between Se and seminal fructose, and an approximate inverted U-shaped association between Zn and seminal fructose. No significant interaction between studied metals was found. Conclusion Mixed metal exposure may lead to decrease of seminal fructose, in which Zn, Mn, Se, and Ba may play an important role. Mn and Zn exposure may reduce the level of seminal fructose, Se may increase the level of seminal fructose, and there may be a threshold effect between Zn exposure and seminal fructose level. No interaction between different metals on seminal fructose is found.

Objective:With the development of perinatal and neonatal intensive care medicine,the survival rate of very premature infants increases year by year.However,the incidence of bronchopulmonary dysplasia(BPD)increases year by year,which seriously affects the survival prognosis of very premature infants.How to prevent and treat BPD effectively has become the focus of neonatologists.This study aims to provide ideas for the prevention and treatment of BPD in very preterm infants via analyzing the clinical characteristics of BPD. Methods:A total of 472 cases of very premature infants admitted to the Divison of Neonatology,Department of Pediatrics at the Second Xiangya Hospital of Central South University were retrospectively selected and assigned into a BPD group(n=147)and a non-BPD group(n=325)according to the diagnosis of BPD.Clinical data of each group were collected to find out the clinical characteristics of BPD in very preterm infants.Basic information,maternal pregnancy data,laboratory findings,nutritional support,respiratory support patterns and duration,and systemic complications were included. Results:Compared with the non-BPD group,gestational age,birth weight,head circumference and body length in the BPD group were lower,the Apgar score in 1st min and 5th min and average body weight growth rate were lower(all P<0.05);the ratios of male,very low birth weight(VLBW),and extremely low birth weight(ELBW)in the BPD group were higher than those in the non-BPD group(all P<0.5);the incidence of maternal cervical insufficiency and the rate of using embryo transfer technology in the BPD group were higher than those in the non-BPD group,and the rate of using prenatal hormone in the BPD group was lower than that in the non-BPD group(all P<0.05).The positive rate of sputum culture in the BPD group was higher than that in the non-BPD group(P<0.05),and the white blood cell count,neutrophil ratio,and procalcitonin in the BPD group were higher than those in the non-BPD group(all P<0.05).The period of fasting,minimal feeding,total parenteral nutrition(TPN),and partial parenteral nutrition(PPN)in the BPD group were longer than those in the non-BPD group(all P<0.05).The duration of nasal catheter oxygen inhalation and mechanical ventilation in the BPD group was longer than that in the non-BPD group,and the rates of mechanical ventilation at Day 1,3,7,14,21 and 28 after birth were higher than those in the non-BPD group(all P<0.05).The incidence of respiratory distress syndrome,apnea of prematurity,respiratory failure,pneumonia,pulmonary hemorrhage,pleural effusion,persistent pulmonary hypertension,hemodynamic patent ductus arteriosus,cytomegalovirus infection,neonatal necrotic enterocolitis,cholestasis,anemia,abnormal blood system,hypothyroidism,retinopathy of prematurity,and internal environment disorders in the BPD group were significantly higher than those in non-BPD group(all P<0.05). Conclusion:There are significant differences between very premature infants with BPD and those without BPD in general information,maternal history,inflammatory indicators,nutritional support,respiratory support,comorbidities and complication rates.To ensure normal fetal development,reducing the inflammatory reaction of very premature infants,establishing enteral nutrition as early as possible,shortening the time of mechanical ventilation,and reducing the occurrence of complications are beneficial to decrease the incidence of BPD in very premature infants and improve the long-term prognosis of BPD.

Objective:To analyze the accuracy of lung ultrasound and chest X-ray in the diagnosis of neonatal pulmonary disease.Methods:We prospectively collected newborns that needed chest X-ray examination to diagnose pulmonary disease from twelve neonatal intensive care units across the country between June 2019 and April 2020.Each newborn was examined by lung ultrasound within two hours after chest X-ray examination.All chest X-ray and lung ultrasound images were independently read by a radiologist and a sonographer.When there was a disagreement, a panel of two experienced physicians made a final diagnosis based on the clinical history, chest X-ray and lung ultrasound images.Results:A total of 1 100 newborns were enrolled in our study.The diagnostic agreement between chest X-ray and lung ultrasound(Cohen′s kappa coefficient=0.347) was fair.Lung ultrasound(area under the curve=0.778; 95% CI 0.753-0.803) performed significantly better than chest X-ray(area under the curve=0.513; 95% CI 0.483-0.543) in the diagnosis of transient tachypnea of the newborn( P<0.001). The accuracy of lung ultrasound in diagnosing neonatal respiratory distress syndrome, meconium aspiration syndrome, pneumonia and neonatal pulmonary atelectasis was similar to that of chest X-ray. Conclusion:Lung ultrasound, as a low-cost, simple and radiation-free auxiliary examination method, has a diagnostic accuracy close to or even better than that of chest X-ray, which may replace chest X-ray in the diagnosis of some neonatal lung diseases.It should be noted that both chest X-ray and lung ultrasound can only be used as auxiliary means for the diagnosis of lung diseases, and it is necessary to combine imaging with the clinical history and presentation.

Objective : To investigate a cluster of coronavirus disease 2019 (COVID-19) in Pingyang County,and to put forward targeted prevention and control suggestions. Methods: According to the Prevention and Control Plan of COVID-19 (Third Edition),we carried out epidemiological investigation to collect the information of demographic features,diagnosis and treatment,clinical manifestations,laboratory examination,exposure history and close contact. We analyzed the mode and frequency of exposure,so as to figure out the route of transmission. Results: This epidemic resulted in 6 confirmed cases of COVID-19 and 3 asymptomatic cases,with an attack rate of 6.52% (9/138). The median age of the cases was 48 years old. The confirmed cases mainly had imaging features of pneumonia, fever and cough. Their incubation period ranged from 4 to 9 days,and the median was 6 days. The first case,Wang,returned for the funeral of her grandmother from Wuhan with his husband and son on January 18 and lived with her mother. She had cough on January 19,and went to see her grandmother during January 19 to 23. She had contact with 6 cases,and the other 2 cases were Wang's mother and husband,who lived with Wang. All the cases except Wang had no COVID-19 related symptoms before the funeral,no contact history of COVID-19 cases or no other common exposure history except during the funeral. Therefore,Wang was determined as the source of the epidemic,staying in the same room and eating at the same table with her were risk factors for the infection of COVID-19 in this epidemic (P<0.05). Conclusions This was a local clustering epidemic caused by COVID-19 imported cases from Wuhan. It spread mainly by close contacts like staying in the same room and eating at the same table.

Objective: To compare the application of dynamic contrast-enhanced magnetic resonance imaging (MRI) and conventional MRI in the detection of hepatocellular carcinoma (HCC) lesions before and after transcatheter arterial chemoembolization (TACE) treatment and evaluation of the effect of TACE treatment, thus to judge its application value, and to provide guidance for early clinical diagnosis. Methods: Seventy-six patients with HCC who underwent TACE in Pingyang Hospital Affiliated to Wenzhou Medical University from January 2018 to December 2018 were selected in the research.According to the random number table method, 76 patients were randomly divided into control group and study group, with 38 cases in each group.The control group was examined by conventional MRI, while the study group was examined by dynamic enhancement of MRI.The lesions were observed before and after treatment, and Ktrans, Kep and ve of the two groups were recorded before and after treatment.The accuracy, sensitivity and specificity of the two groups were compared. Results: Before and after treatment, the total detection rates of the study group (92.05%, 100.00%) were significantly higher than those of the control group (80.85%, 71.43%) (χ²=16.489, 15.246, all P<0.05). Before treatment, the Ktrans, Kep, ve equivalents between the two groups had no statistically significant differences (t=0.915, 0.448, 0.354, all P>0.05). After treatment, the Ktrans and Kep values of the two groups were significantly decreased, and the Ktrans[(0.419±0.101)min] and Kep[(1.073±0.237)min] values of the study group were significantly lower than those of the control group [(0.647±0.128)min, (1.158±0.221)min], the differences were statistically significant (t=9.485, 5.642, all P>0.05). There was no statistically significant difference in ve value between the two groups (t=1.025, P>0.05). The accuracy and sensitivity of detection in the study group (92.11%, 97.37%) were significantly higher than those in the control group (81.58%, 84.21%), and the specificity (94.74%) of the study group was significantly lower than that of the control group (97.37%) (χ²=17.186, 14.453, 6.489, all P<0.05). Conclusion Dynamic contrast-enhanced MRI is more effective in the detection of HCC patients before and after TACE treatment.It is convenient to provide guidance for treatment and has higher clinical application value.It is worthy of popularizing.

Objective To evaluate left ventricular myocardial function altemation by three-dimensional speckle tracking imaging (3D-STI) after surgical aortic valve replacement (AVR) in severe aortic stenosis (AS) patients with preserved left ventricular ejection fraction (LVEF),and discuss its clinical value.Methods Forty patients with severe aortic stenosis who were hospitalized or outpatient in Nanjing First Hospital Affiliated to Nanjing Medical University during the period of October 2014 to October 2016 (AS group),and forty healthy volunteers (normal control group) were enrolled in this study.Normal control group underwent conventional echocardiography and 3D-STI measurement,while the AS group underwent conventional echocardiography and 3D-STI measurement at preoperative,1 week postoperative and 3 months postoperative,then we obtained left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),interventricular septum thickness diameter (IVSd),left ventricular posterior wall thickness diameter (LVPWd),left ventricular ejection fraction (LVEF),global longitudinal strain (GLS),global circumferential strain (GCS),global radial strain (GRS),global area strain (GAS) strain and 3D-strain.The independent sample t test was used to compare the difference of conventional ultrasound parameters and 3D-STI parameters between AS preoperative patients and healthy controls,AS patients at 3 months postoperative and healthy controls.The single factor analysis of variance was used to compare the difference of conventional ultrasound parameters and 3D-STI parameters in severe patients at preoperative,1 week postoperative and 3 months postoperative.LSD-t test was used to compare in different AS groups.Results Compared with normal control group,IVSD,LVPWD and GCS of severe AS patients increased significantly (t=13.824,11.298 and-6.584,all P ＜ 0.001),GLS,GRS and 3D-Strain decreased significantly (t=10.221,-6.237 and-5.674,all P ＜ 0.001),LVEDD,LVESDand GAS had no significant difference.Compared with preoperative AS patients,LVEF,GLS,GAS and GCS decreased significantly (t=-2.205,-2.093,-2.034 and-3.152,all P ＜ 0.05 or 0.01) at 1 week postoperative,LVEDD,LVESD,IVSD,LVPWD,GRS and 3D-strain had no significant difference at 1 week postoperative;GLS,GRS and 3D-strain increased significantly (t=5.446,-4.923 and-4.388,all P ＜ 0.05 or 0.01) at 3 months postoperative,GCS,IVSD and LVPWD decreased significantly (t=-3.988,4.794 and 4.211,all P ＜ 0.05 or 0.01) at 3 months postoperative,LVEDD,LVESD,LVEF and GAS had no significant difference at 3 months postoperative.Compared with AS patients at 1 week postoperative,LVEF,GLS,GRS,GAS and 3D-strain increased significantly (t=-2.631,7.383,-4.719,2.923 and-4.154,all P ＜ 0.05 or 0.01) at 3 months postoperative,GCS,IVSD and LVPWD decreased significantly (t=-2.109,4.747 and 4.323,all P ＜ 0.05 or0.01) at 3 months postoperative.But in AS patients at 3 months postoperative,IVSD,LVPWD,GLS and GCS were still higher than those of normal control group (t=9.809,7.066,4.752 and-2.553,all P ＜ 0.001 or ＜ 0.05),LVEDD,LVESD,LVEF,GRS,GAS and 3D-strain had no significant difference.Conclusion The alternation of left ventricular myocardial function have a certain characteristic before and after aortic valve replacement in severe aortic stenosis patients with preserved LVEF,and 3D-STI can evaluate it more accurately.

OBJECTIVETo analyze the clinical characteristics and imaging features of sternum tumor, in order to improve the knowledge of the diseases.

METHODSThe clinical data and imaging data of 18 patients with sternum tumor were retrospectively analyzed. There were 13 males and 5 females, aged from 24 to 73 years old with an average of 58.3 years. Eleven patients were treated by conservative treatment and 7 patients were treated by surgery. The course of disease ranged from 2 months to 6 years. One patient had no obvious symptoms and 1 patient had a history of chest trauma. Lesion location, pattern of bone destruction, cortical bone abnormality, MRI signal characteristics and contrast enhancement were observed in the patients.

RESULTSEighteen cases included malignant bone tumor in 16 cases and benign tumor in 2 cases;and 7 cases located in sternal manubrium, 9 cases located in sternal body, and 2 cases located in both. On the imaging, sternal tumor had expansively developing tendency, and the bone destruction zone boundary continuity or partial disruption occurred in 15 cases, the border of cortical bone thinning in 2 cases, the cortical bone increased thickness in 1 case. No bone marrow edema around tumor was found in 7 cases by MRI and soft tissues was encroached in 2 cases; in T1WI of MRI, 4 cases showed the hypointense signal and 3 cases showed the iso or hyper intensity signal; in T2WI of MRI, 6 cases showed the iso or hyper intensity signal and 1 case showed confounding signal. Enhancement scanning in MRI, premodinantly tumors showed obviously strengthening.

CONCLUSIONSThe types of the sternum tumors are various and the most tumors are malignant. The images of the mostly sternum tumor absented same charactiristic, and it must combine with clinical manifestation to analyze the X rays, CT scanning and MRI, it will conduce to improve the diagonstic accuracy of the sternum tumors.

AIM:To investigate the role of damaged mitochondria in dendritic cell ( DC) apoptosis induced by Vibrio vulnificus (Vv) and its possible mechanism.METHODS: DC2.4 cells were co-cultured with Vv 1.1758 strain. Fluorescent probes DCFH-DA and Fluo-8-AM were used to detect reactive oxygen species ( ROS) and intracellular Ca 2+concentration in the invaded cells , respectively .The cellular apoptotic rates and mitochondrial membrane potential (Δψm ) were measured by flow cytometry.The expression of nuclear factor-kappa B p65 (NF-κB p65) and tumor necrosis factor-al-pha (TNF-α) was detected by Western blotting.RESULTS:Vv 1.1758 induced DC2.4 cell apoptosis.Vv 1.1758 bacte-ria invaded into the DC2.4 cells by binding with cellular membrane though the end of the body .In the invaded DC2.4 cells, the visible mitochondrial damage, elevated ROS and intracellular Ca2+levels, and declinedΔψm were presented.Af-ter 1 h of co-culture, NF-κB p65 began to rise and reached the peak at 5 h, and then slightly decreased at 6 h.The TNF-αlevel increased after 2 h of co-culture and reached the peak at 6 h.CONCLUSION:The damaged mitochondria play an important role in DC apoptosis induced by Vv , and its possible mechanism may associate with the elevation of ROS and in-tracellular Ca2+level, and the declined Δψm.Meanwhile, NF-κB p65 and TNF-αare potential critical signaling molecules in the process of apoptosis .

Objective To investigate the role of three-dimensional speckle tracking echocardiography (3D-STE) in providing a novel approach to assessing myocardial viability in patients with myocardial infarction (MI).Methods The subjects from the Department of Cardiology and the Department of Cardiac Surgery admitted from April 2010 through December 2012 were diagnosed as MI by electrocardiogram,myocardial enzymes and angiography.The clear imaging of angiography was selected out and collected.All patients had different degrees of segmental wall motion abnormalities,and some already had percutaneous transluminal coronary angioplasty and coronary stenting or coronary artery bypass grafting.Patients with diabetes,heart disease and severe valvular disease of heart were excluded.A total of 45 MI patients were checked with routine echocardiography,two-dimensional speckle tracking echocardiography (2D-STE) and 3D-STE.Then,radionuclide myocardial perfusion/metabolic imaging was served as a golden standard to distinguish the viable from nonviable myocardium in each patient within a day.In order to determine the most sensitivity and specificity threshold values of circumferential peak-systolic strain (Cs),longitudinal peak-systolic strain (Ls),radial peak-systolic strain (Rs),3D strain and area strain for viability detection from 3D-STE,the receiver operating characteristic curve was used to investigate the sensitivity and specificity of the detection of viable myocardium with strain parameters in the study.Comparisons between viable and non-viable groups were carried out with t test.Data were expressed as the mean value ± standard deviation (-x ± s).Results The ventricular wall motion abnormality by visual assessment was observed in 368 segments from 720 segments in 45 patients.Furthermore,204 segments were confirmed to be viable by radionuclide myocardial perfusion/metabolic imaging whereas the rest 164 segments were identified as nonviable among 368 abnormal segments.There were no significant differences in circumferential peaksystolic strain (Cs),longitudinal peak-systolic strain (Ls) and radial peak-systolic strain (Rs) by 2D-STE between viable and nonviable group.Compared with those in viable group,there wasn' t any difference in Cs,but Rs and Ls decreased significantly by 3D-STE in nonviable group.The 3D strain and area strain in absolute value decreased in nonviable group compared with viable group.According to 3D-STE,when Rs higher than 11.1％,the sensitivity was 95.1％ and the specificity was 53.4％ for identification of viable myocardium,whereas Ls higher than 14.3％ resulted in sensitivity of 65.2％ and a specificity of 65.7％.Besides,3D strain higher than 17.4％ had a sensitivity of 70.6％ and a specificity of 77.2％ for detection of viable myocardium,while area strain higher than 23.2％ allowed a sensitivity of 91.5％ and a specificity of 78.8％.Conclusions The 3D-STE might have potential reliability of myocardial viability detection in the patients with left ventricular dysfunction after MI.

Objective To study the uncertainty and traceability of HBV DNA assays and discuss the comparability of results among different detection systems. Methods Different detecting systems were used to detect HBV DNA using the national standard substance as "quality control substance". The uncertainty of the results was evaluated referring "Guidelines for estimating and reporting measurement uncerTAinty of chemical test results" of NATA The results were traced back to the national standard substance. According to the CLSI document EP9-A2, the results were analyzed and subjected to bias estimation with the t(0.05sv) √u2b1+ u2b2 as the criterion clinically accepted to investigate the comparability of different detecting systems. Results The means (-y) measured by 3 HBV DNA assay systems were 6.15,5.88,and 6.31 lg(kIU/L) respectively. Except system A,both the biases of system B and C had statistical significance (all P ＜ 0. 05) and expanded uncertainty of three detection systems was varied, but the difference was within the maximum acceptable range (± 0. 5) of the external quality assessment by National Center for Clinical Laboratory. Being traceable to national standard substance, the results of HBV DNA of the three detecting systems were (5.45 ± 1.23), (5.55 ± 1.32) and (5.42 ± 1.25) lg(kIU/L), respectively.There was significant difference among three systems (F = 5.63, P ＜ 0. 05). Comparing system A and B,there was significant difference in statistic (q = 5. 12, P ＜ 0. 05) and the difference between system B and C also had statistically significant (q = 6. 85, P ＜ 0. 05), but the results between system A and C had no statistical difference (q = 1.85,P ＞ 0. 05). Among these three systems, the difference of any two detection systems had no statistical significance (all P ＞ 0. 05). It showed that system bias was acceptable in clinical application and the results between different systems were comparable. Conclusions It is necessary to estimate the uncertainty and traceability when comparing the HBV DNA assay among the different labs. It also needs to estimate the bias of different systems and evaluate the clinical acceptability to ensure the accuracy and comparability of the results.