Arsenic is a widely occurring metalloid element in the natural environment and is one of the primary carcinogens identified by the World Health Organization (WHO), but the specific carcinogenic mechanism is currently unclear. In recent years, through toxicological studies on arsenic, it has been found that exposure to arsenic can affect cellular metabolism in the body, which may be closely related to the carcinogenic mechanism of arsenic. Therefore, the authors review the research progress on arsenic exposure-induced effects on glucose metabolism, lipid metabolism, and amino acid metabolism, with a view to providing a theoretical basis for the study of the mechanism of arsenic carcinogenesis.

Abstract: Objective To investigate the clinical features and risk factors for severe tsutsugamushi disease, so as to provide reference for diagnosis and differentiation of severe tsutsugamushi disease as soon as possible. Methods The clinical data of 178 cases of inpatients with tsutsugamushi disease admitted to the Guangzhou Eighth People's Hospital, Guangzhou Medical University from January 2016 to September 2021 were collected and analyzed according to their gender, age, underlying diseases, clinical characteristics at admission, laboratory examination results within 24 hours of admission and epidemiological history. The patients were divided into the severe group and the non-severe group according to the diagnostic criteria. The data of clinical characteristics, laboratory examination and prognosis of the two groups were compared. Multivariate logistic regression analysis was performed on the variables with statistical significance and the receiver operating characteristic curve (ROC) was drawn. Results A total of 178 patients were included in this study, with 37 in the severe group and 141 in the non-severe group. Compared with the non-severe group, the age of the severe group was older, the underlying diseases were more, the incidence of dyspnea and the levels of white blood cell, total bilirubin, aspartate aminotransferase, lactate dehydrogenase, cystatin C, uric acid and serum creatinine were significantly increased, the levels of platelet and albumin were significantly decreased (all P<0.05). The dyspnea [odds ratio (OR value)=8.93, 95% confidence interval (CI): 1.200-66.424; P=0.032], total bilirubin (OR=1.091, 95%CI: 1.028-1.159; P=0.004) and serum creatinine (OR=1.052, 95%CI: 1.004-1.102; P=0.033) were independent risk factors for severe tsutsugamushi disease. The area under ROC curve of total bilirubin and serum creatinine were 0.777 and 0.764, respectively (both P<0.01), indicating high predictive value for severe tsutsugamushi disease. The optimal cut-off value for total bilirubin was 23.01 µmol/L, with a sensitivity of 54.10% and a specificity of 90.60%; the optimal cut-off value for creatinine was 126.45 µmol/L, with a sensitivity of 43.20% and a specificity of 100.00%. The case fatality rate of severe tsutsugamushi disease was 2.70%. Conclusions The patients with severe tsutsugamushi disease are older, and have more underlying diseases. Dyspnea, increased total bilirubin and elevated serum creatinine are independent risk factors for severe tsutsugamushi disease, which can help in the early identification of severe tsutsugamushi disease early.

Objective:To analyze the epidemiological and clinical characteristics of patients with tsutsugamushi disease in Guangdong Province from 2016 to 2021, and to provide a reference for clinical diagnosis, treatment, scientific prevention and control of tsutsugamushi disease.Methods:A retrospective analysis was conducted to collect the information of patients with tsutsugamushi disease admitted to Guangzhou Eighth Hospital Affiliated to Guangzhou Medical University from 2016 to 2021, including the basic information, epidemiological characteristics, clinical manifestations, auxiliary examinations, complications, misdiagnosis at first diagnosis and treatment outcomes.Results:Among 155 patients with tsutsugamushi disease, there were 75 males (48.39%) and 80 females (51.61%), with an e age of (54.41 ± 13.78) years old, and 30 cases (19.35%) had other underlying diseases. The peak time of onset was from June to September. There were 97 local patients (62.58%) in Guangzhou, and 58 cases (37.42%) in other prefecture-level cities; 76.77% (119/155) had a history of field activities before the onset of the disease. 36.13% (56/155) were farmers. The most common clinical manifestations were fever (100.00%, 155/155), chills and/or shivering (77.42%, 120/155), headache and/or dizziness (74.19%, 115/155), fatigue (65.81%, 102/155), eschar or ulcer (92.90%, 144/155), and lymphadenopathy (49.68%, 77/155). The laboratory test results mainly showed a decrease in eosinophils (81.94%, 127/155), a decrease in hematocrit (78.71%, 122/155), a decrease in hemoglobin (52.26%, 81/155), a decrease in platelet count (50.97%, 79/155), a decrease in albumin (92.26%, 143/155), an increase in lactate dehydrogenase (90.32%, 140/155), an increase in adenosine deaminase (88.39%, 137/155), and an increase in alanine aminotransferase (85.16%, 132/155), elevated aspartate aminotransferase (85.16%, 132/155), and elevated procalcitonin (52.90%, 82/155); 30 cases (19.35%) were positive for the Weil-Felix Test. There were 95 cases (61.29%) with abnormal chest imaging results, and 34 cases (21.94%) with abnormal abdominal ultrasound or CT results. Common complications were toxic hepatitis, pulmonary infection, organ failure, and acute kidney injury, etc. The misdiagnosis rate of the initial diagnosis of this disease was 75.48% (117/155). Doxycycline and symptomatic and supportive therapy were given, 154 patients (99.35%) were cured or improved and discharged from hospital.Conclusions:Tsutsugamushi disease is prevalent in summer and autumn in Guangdong Province. Before the onset, most of the patients have a history of field activities. Farmers are susceptible people. Its clinical manifestations are diverse, and can affect multiple systems and organs. There are many complications, and doxycycline can be used for anti-infection treatment, with a high cure rate.

Objective:To explore the difference of clinical characteristics between senile Parkinson's disease(PD)with depression and unipolar depression.Methods:From March 2019 to March 2020, 53 patients with Parkinson's disease depression and 57 patients with unipolar depression who were admitted to the neurology department of Beijing Hospital were continuously collected.The gender, age and education level of the patients were recorded.The course of disease and other general data of the patients with Parkinson's disease were also recorded.Depression and anxiety of the patients were evaluated by Beck Depression Inventory(BDI)and Generalized Anxiety Disorder Scale(GAD-7). Quality of life of patients with Parkinson's disease was evaluated by 8-item Parkinson's disease questionnaire(PDQ-8). Differences in the assessment results and quality of life scores between the two groups were analyzed.Results:The incidence of depression comorbid with anxiety in elderly PD patients was 52.8%(28/53), lower than that in elderly unipolar depression patients comorbid with anxiety [84.2%(48/57)]( χ2=12.664, P<0.001). The scores of activity inhibition [(1.8±0.8)points]and hyposexuality [(0.4±1.0)points]in elderly PD patients with comorbid depression were higher than that in patients with unipolar depression [(1.1±0.8)points, (0.0±0.0)points]( t=4.399, 2.942, P<0.001, =0.005). Moreover, the incidence of activity inhibition(98.1%)and hyposexuality(15.1%)in PD patients with comorbid depression was higher than that in patients with unipolar depression(78.9%, 0.0%)( χ2=9.680, 9.279, both P=0.002). The scores of self-blame [(1.0±0.8)points]and pain [(1.0±0.8)points]in elderly patients with unipolar depression were higher than those in PD patients with comorbid depression [(0.5±0.7)points, (0.9±0.7)points]( t=-3.902, -2.486, P<0.001, =0.014). Moreover, the incidence of self-blame(66.7%), irritability(78.9%)and image distortion(56.1%)in elderly patients with unipolar depression was higher than that in PD patients(35.8%, 56.6%, 35.8%)( χ2=10.447, 6.320, 4.547, P=0.001, 0.012, 0.033). The scores of PDQ-8 in PD patients with comorbid depression and anxiety [14.8(10.8, 19.0)points]( Z=-3.544, P<0.001)were higher than those in PD patients with depression only [7.0(4.8, 11.0)points]. Conclusions:The focus of depression in elderly PD patients is different from that in elderly unipolar depression patients.Elderly patients with unipolar depression are more likely to be comorbid with anxiety.Depression reduces the quality of life in PD patients, and the comorbidity of anxiety further reduces the overall quality of life in PD patients with depression.

Objective:To explore the clinical characteristics of imported malaria from Africa, and the correlation between blood lipids and disease severity.Methods:The clinical data of 172 imported malaria patients from Africa were collected from January 1, 2018 to January 31, 2021 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment and prognosis of the patients were analyzed retrospectively. The independent samples t-test, Mann-Whitney U test and binary multivariate logistic regression analysis were used for statistical analysis when appropriate. Results:A total of 172 patients were divided into 39 severe cases and 133 non-severe cases in this study. The main infection species was Plasmodium falciparum, with a total of 153 cases (89.0%), and the severe cases were all falciparum malarias. Compared with the non-severe group, the white blood cell count and triacylglycerol level were increased in the severe group.The differences were both statistically significant ( Z=2.397 and 4.368, respectively; both P<0.05). The hemoglobin, hematocrit, platelet count, high-density lipoprotein cholesterol, apolipoprotein A (ApoA)Ⅰ and ApoAⅠ/apolipoprotein B (ApoB) were significantly decreased in the severe group. The differences were all statistically significant ( Z=-4.473, -4.464, -4.750, -4.826, -5.488 and -4.419, respectively; all P<0.01). The total cholesterol and low-density lipoprotein cholesterol were also reduced in the severe group. The differences were both statistically significant ( t=3.817 and 5.285, respectively; both P<0.01). The area under receiver operator characteristic curve of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, and ApoAⅠ/ApoB were 0.754, 0.727, 0.730, 0.789 and 0.733, respectively (all P<0.01). When the Youden index was at its maximum, the best cut-off value of ApoAⅠ was 0.535 g/L with sensitivity of the prediction for severe malaria of 79.5% and the specificity of 68.4%. ApoAⅠ had independent predictive value for severe malaria (odds ratio ( OR)=0.013, 95% confidence interval ( CI) 0.002 to 0.086, P<0.01), and stratified according to the best cut-off value, the risk of severe malaria when ApoA Ⅰ<0.535 g/L was 8.396 times of ApoA Ⅰ≥0.535 g/L ( OR=8.396, 95% CI 3.557 to 19.820, P<0.01). The case fatality rate of severe malaria was 2.6%(1/39). Conclusions:The imported malaria patients from Africa are mainly infected with Plasmodium falciparum and the case fatality rate of severe malaria is high. The high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, ApoAⅠ/ApoB of blood lipids show higher predictive value for severe malaria, among which, ApoAⅠ has independent predictive value for severe malaria. Changes in blood lipids will help to identify severe malaria as early as possible, improve the cure rate, and reduce the risk of death.

Objective:To investigate the accurrence and related factors of depression in patients with parkinson's disease (PD).Methods:One hundred PD patients with Parkinson′s disease (PD) were enrolled in Department of Neurology in Beijing Hospital from March to June 2019. The depressive mood, sleep status and health-related quality of life of PD patients were evaluated by Beck Depression Scale (BDI), Parkinson′s Disease Sleep Scale 2 (PDSS-2), and 8 items of Parkinson′s Disease Questionnaire (PDQ-8). Spearman correlation analysis and multivariate regression analysis were used to analyze the related factors of PD depression. Nonparametric test was used to analyze the differences between different sleep disorder domains in PD patients with depression.Results:The total score of BDI in 100 PD patients ranged from 0 to 44, with an average of 9.9±8.6 points; the total score of PDSS-2 ranged from 0 to 43, with an average of 12.0±9.2; the total scores of PDQ-8 ranged from 0 to 24, with an average of 6.4±6.0 points. The detection rate of depression in 100 PD patients was 42.0% (42/100), and the total BDI score of 22 patients with mild depression ranged from 10 to 15 with an average of 13.0±1.9; the total BDI score of 14 patients with moderate depression ranged from 16 to 25, with an average of 19.1±3.0; the total BDI score of 6 patients with major depression ranged from 28 to 44 points, with an average of 33.3±6.4. The depression in PD patients was positively correlated with PDQ-8 score ( t=8.908, P<0.01) and PDSS-2 score ( t=2.286, P=0.02); and 85.7% (36/42) of PD patients with depression had sleep disturbance. The score of sleep disturbance domain of PD patients with depression (9.8±3.9) was higher than that of nocturnal motor symptom domain (4.8±4.5) and nocturnal PD non-motor symptom domain (4.1±3.3) ( P<0.01). The scores of emotional health, relationship with loved ones, attention, communication ability dimensions of PDQ-8 were positively correlated with PD depression ( P<0.05). Conclusion:Depression is a common non-motor symptom of PD patients; and PD patients with depression suffer from reduced quality of life and are more prone to sleep disorders.

Objective:To find out the occurrence of anxiety and depressive symptoms, and the major risk factors, and the participation rate, as well as the experience of medical personnel who are involved in the intervention.Methods:Since January 2018, a pilot intervention had been carried out on pregnant women registered in the antenatal clinic. The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms, and risk factors were screened too. Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel. A qualitative interview was conducted on the intervention providers.Results:A total of 9 488 pregnant women were included, and the positive rate of moderate anxiety symptoms was 3.0%, the positive rate of severe anxiety symptoms was 1.4%; the positive rate of moderate depression symptoms was 18.1%, and the positive rate of severe depressive symptoms was 5.2%; the comorbidity rate of anxiety and depression symptoms was 3.4%. The first three risk factors for pregnant women with anxiety symptoms were: once had premenstrual stress symptom, excessive fear of fetal growth, previous abnormal maternal history; the first three risk factors for pregnant women with depressive symptoms: once had premenstrual stress symptom, previous abnormal maternal history, this pregnancy was cherished; the first three risk factors for pregnant women with moderate and above anxiety combined with depression were: once had premenstrual stress symptom, excessive fear of fetal growth, and fear the delivery process is not successful. Among the psychological moderate risk pregnant women, 19.1% participated in the midwife joint counselor clinic, and 1.7% participated in the obstetrician joint psychological specialist nurse clinic, 2.2% of the pregnant women with high risk participated in the psychological multidisciplinary consultation, and 1.7% referred to the psychiatric department. From the interviews, providers believed that it was necessary to further strengthen the ability of psychological intervention capacity, and the psychological screening tools needed to be improved, and the problems sought by pregnant women involved in physical, psychological and social aspects, and the influence of pregnant women's treatment compliance included multiple factors.Conclusions:The psychological health care service during pregnancy was feasible, but the screening scales needed further examination. The mental health care ability of obstetric medical staff needed to be strengthened, and the compliance of pregnant women with mental health services needed to be improved.

Objective:To assess the feasibility and efficacy of radiofrequency catheter ablation (RFCA) of arrhythmias with low dose X-ray in children guided by three-dimensional mapping system.Methods:Fourteen children with tachyarrhythmia who were transferred to Tianjin Medical University General Hospital after being hospitalized in Tianjin Children′s Hospital and underwent RFCA from April 2017 to May 2018 were included.The results of intraoperative electrophysiological examination, intraoperative X-ray dosage,the immediate success rateand complications of RFCA,and the recurrence during the follow-up for at least 6 months were recorded.Results:Among the 14 children, 11 cases were diagnosed with supraventricular tachycardia.Five cases had atrioventricular reentrant tachycardia (AVRT) which included two cases with left accessory pathway and three cases with right accessory pathway, and four cases had atrioventricular nodular reentrant tachycardia (AVNRT), one case had atrial flutter (AFL), one case had both AFL and AVNRT. One case had focal atrial tachycardia, one case had ventricular tachycardia, and one case had premature ventricular contraction. Eleven cases underwent RFCA with zero radiation, and 3 cases underwent atrial septal puncture with low dose X-ray. The exposure amounts were 3.85, 3.23 and 4.67 mGy, respectively. No complications occurred except for one case with AVRT had atrioventricular block and recovered to normal in 25 days after operation.During the follow-up of 7 to 20 months, no arrhythmias had been found in 13 cases, and one case with AVRT and AFL recurred.Conclusion:Under the guidance of three-dimensional mapping system, RFCA of tachyarrhythmia with low dose X-ray in children is feasible.

Objective To investigate the prevalence of depression in Parkinson's disease ( PD) patients, analyze the clinical features of depression in PD patients , and evaluate its impact on quality of life. Methods One hundred and ninety-five PD patients and 63 normol controls were recruited in this study.The detailed clinical information was documented.Unified Parkinson's Disease Rating Scale and Hoehn-Yahr stage were used to evaluate the severity of motor function impairment in PD patients.Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale were employed to assess the severity of depression and anxiety in PD patients.The 39-item Parkinson's Disease Questionnaire was applied to assess the quality of life.The cross-sectional data were calculated with SPSS 21.0 statistic software, and P ＜0.05 was considered statistically significant.Results The average score of HAMD was 8.74 ±5.51 in 195 PD patients.Depressive symptoms were found in 54.4%of the PD patients ( mild depression 48.7% and moderate depression 5.6%).Depression significantly impaired the quality of life in PD.Compared with PD without depression, PD with depression earned more scores in anxiety factor (4 (2, 5) vs 1(0, 2), Z＝ -8.69, P＝0.00), blocker factor (2 (1, 3) vs 0(0, 1), Z＝-7.95, P＝0.00), cognitive factor (1 (0, 2) vs 0(0, 0), Z＝-7.01, P＝0.00), sleep factor (2(1, 3) vs 0(0, 1), Z＝-6.42, P＝0.00) and despair factor (2 (1, 3) vs 1 (0, 1), Z＝-7.16, P＝0.00).There was no significant difference in day and night change (0(0, 0) vs 0(0, 0), Z＝-0.19, P＝0.85) and body weight (0(0, 0) vs 0(0, 0), Z＝-1.28, P＝0.20) between these two groups.The PD with depression obtained higher scores in total quality of life (30(22, 44) vs 14 (5, 24), Z＝-7.03, P＝0.00), motor function (6 (2, 13) vs 1 (0, 5), Z＝-3.67, P＝0.00), daily life ability (4 (1, 8) vs 1 (0, 4), Z＝-2.81, P＝0.01) , emotional health (5 (2, 11) vs 0 (0, 2), Z＝-5.82, P＝0.00), humiliation (2 (0, 5) vs 0 (0, 1), Z＝-3.10, P＝0.00), social support (0 (0, 1) vs 0 (0, 0), Z＝-2.86, P＝0.00), recognition function (4 (2, 6) vs 2 (0, 4), Z＝-2.87, P＝0.00), sociability(1(0, 3) vs 0(0, 1), Z＝-3.25, P＝0.00), and body pain (3 (1, 6) vs 1 (0, 2), Z＝-3.91, P＝0.00) than patients without depression.Conclusions Incidence of depression ( mainly mild ) in PD patients is high. Depressive symptoms significantly affect the quality of life of PD patients.

Objective To analyze the clinical characteristics and related factors associated with impulse compulsive behaviors (ICBs) in Parkinson's disease (PD).Methods Two hundred and thirty-one PD outpatients were recruited from Beijing Hospital and Chinese Medicine Hospital of Pinggu District of Beijing from November 2012 to November 2015.Questionnaire for Impulse Compulsive Disorders in Parkinson's Disease (QUIP) was used to assess all subjects if they have ICBs or not.The general materials, medication utilized were recorded , and the related scales were used to evaluate PD patients.Intergroup analysis was made according to with or without ICBs.The Logistic regression analysis was adopted to analyze the relevance between incidence of ICBs and on-set age of PD, drinking tea or not, the 39-item Parkinson's Disease Questionnaire score, dosage of amantadine and dopamine agonist levodopa equivalent daily doses (DA-LEDD).Results Twenty-four cases of 231 outpatients were QUIP screening positive , and only 13 cases ( 5.63%) were diagnosed with ICBs as follows : hypersexuality in four ( 1.73%), compulsive shopping in two (0.87%), pathological gambling in one (0.43%), punding in eight(3.46%), dopamine dysregulation syndrome in two (0.87%) and with two or more ICBs in three (1.30%).Compared with non-ICBs group, ICBs group took more dopamine agonists (137.5(37.5, 175.0) mg/d vs 50.0(0, 125.0) mg/d, Z＝-2.175,P＝0.030), and had higher percentage of drinking tea (2/13 vs 3/218(1.4%),χ2＝11.369,P＝0.027).Logistic regression showed that higher dosage of dopamine agonist ( DA-LEDD≥100 mg/d,OR＝4.404, 95%CI 1.191-16.284,P＝0.026) was a risk factor for ICBs.Conclusions ICBs are not rare in Parkinson's disease, and punding is more common among the clinical phenotypes of ICBs. More dopamine agonists in PD (more than 100 mg/d) may be associated with about 4-fold increased odds of having ICBs.