Objective:To investigate the effects of urinary nickel exposure on insulin resistance, islet function and diabetes risk in adults aged 18 years and above in China.Methods:Based on the China National Human Biomonitoring from 2017 to 2018, a total of 500 diabetes patients were randomly selected as the case group, and the matched euglycemic control were selected by 1∶1 matching ratio. The urinary and venous blood samples of the subjects were collected, and the urinary nickel levels and serum glucose metabolism indexes such as fasting blood glucose and fasting insulin were detected, and the insulin resistance index (HOMA-IR), β cell function index (HOMA-β), and adjusted HOMA-β were calculated by using homeostasis model assessment. A multivariate logistic regression model was used to analyze the association between urinary nickel level and diabetes risk. Multiple linear regression models were used to evaluate the association of urinary nickel level with HOMA-IR, HOMA-β and adjusted HOMA-β.Results:The sex ratio of controls and cases was 1∶1. The multivariate logistic regression model showed that after adjusting for factors such as education level, smoking status, alcohol consumption, rice and meat intakes, family history of diabetes, BMI, total cholesterol level, hypertension, and urinary creatinine, compared with T1 group, the ORs of diabetes risk in the T2 and T3 groups were 1.36 (95% CI: 0.98-1.89) and 1.60 (95% CI: 1.14-2.24), respectively. The multiple linear regression model showed a positive association between urinary nickel levels and the elevated HOMA-IR, the β value of HOMA-IR in the T3 group was 0.12 (95% CI: 0.01-0.25) compared with the T1 group and each one-unit increase in the log-transformed urinary nickel level (2.71 μg/L) was associated with a 0.06 elevation in HOMA-IR (95% CI: 0.02-0.10). Meanwhile, the urinary nickel levels were negative associated with the adjusted HOMA-β, the β value of adjusted HOMA-β in the T3 group were -0.26 compared with the T1 group (95% CI: -0.41- -0.11), and each one-unit increase in the log-transformed urinary nickel level (2.71 μg/L) was associated with a -0.09 decrease in adjusted HOMA-β(95% CI: -0.14- -0.04). Conclusion:Higher urinary nickel level is positively correlated with elevated insulin resistance and diabetes risk while negatively correlated with the function of pancreatic islet β cells in adults in China.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

Objective:To investigate the efficacy of Bailing capsule combined with conventional western medicine on diabetic nephropathy patientswith maintenance peritoneal dialysis. Methods:Eighty-six type 2 diabetic nephropathy patients receiving peritoneal dialysis in our hospital from February of 2016 to February of 2019 were selected and were divided into control group and observation group according to the random number table method with 43 cases in each group. All patients received continuous ambulatory peritoneal dialysis. Patients in the control group received routine treatment. In the observation group, patients took Bailing capsules based on the treatment of the control group. The two groups were treated continuously for 3 months. Insulin resistance (IR), fasting blood glucose (FPG), fasting insulin (FINS), renal function, and serum levels of microinflammatory factors high sensitivity c-reactive protein (hs-CRP), interleukin (IL)-6, IL-17, and tumor necrosis factor (TNF)-α were compared in the two groups. Results:After the treatment, FPG, FINS, HOMA-IR, blood creatinine, urea nitrogen, and 24 h urinary protein in the observation group were significantly less than those of the control group ( t value were 5.204, 8.227, 14.070, 5.022, 5.900, 5.246, respectively, all Ps<0.01). After thetreatment, serum levels of hs-CRP, IL-6, IL-17, TNF-α in the observation group were significantly lower than those of the control group ( t value were 12.871, 7.021, 7.733, 8.165, respectively, all Ps<0.01). Conclusions:Bailing capsule can effectively improve the insulin resistance and renal function of diabetic nephropathy patients during maintenance peritoneal dialysis and relieve the state of micro-inflammation.

Objective: To understand the relationship between visual impairment and risk of all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China. Methods: The data of the elderly aged 65 years and older in the project in 2012 were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, including physical measurement and survival status, and a follow-up for survival outcomes were conducted in 2014 and 2017 respectively. Cox proportional hazard regression model was used to analyze the influence of visual impairment on mortality. Gender and age specific analysis was conducted. Results: A total of 1 736 elderly adults were included. A total of 943 deaths occurred during the 5-year follow-up period with a 5-year mortality rate of 54.3%. The 5-year mortality rate was 76.7% in the group with visual impairment, and 47.6% in the group without visual impairment (P<0.001). After adjusting for demographic information, life style and some disease factors, the risk of 5-year mortality in the group with visual impairment group was 1.30 times higher than that in the group without visual impairment (HR=1.30, 95%CI: 1.09-1.55). In the females, the risk for mortality in the group with visual impairment was 1.48 times higher than that in the group without visual impairment (HR=1.48, 95%CI:1.20-1.84). However, vision status was not associated with the risk for mortality in males (HR=1.02, 95%CI: 0.72-1.43). The risk for mortality in the group with visual impairment was 1.39 times higher than that in the group without visual impairment in the elderly aged over 90 years (HR=1.39, 95%CI: 1.13-1.70). Vision status was not associated with mortality risk in the elderly aged 65-79 years and 80-89 years (HR=1.37, 95%CI: 0.61-3.07; HR=0.95, 95%CI: 0.61-1.48). Conclusion In the elderly people in China, visual impairment is a risk factor for mortality.

Objective:To investigate the association of cadmium exposure with liver function among adults in a non-ferrous metal mining area in Guangxi.Methods:A total of 310 residents aged 18 and above were recruited from 5 heavy metals polluted villages in a non-ferrous metal mining area in Guangxi from 2013 to 2014. The general demographic characteristics, blood cadmium levels and indicators of liver function index [Total bilirubin (TBIL), Glutamic oxaloacetic transaminase (AST), Alanine transaminase (ALT) and Glutamine transaminase (GGT)] were obtained by using questionnaire, physical examination and laboratory test. The blood cadmium levels were divided into quartiles as Q1- Q4 groups (using Q1 group as the reference).Multivariate logistic regression model was used to analyze the correlation between the blood cadmium level and functional liver index. Results:The age of subjects was (49.2±15.4) years, and 112 (36.1%) subjects were male residents. The prevalence of abnormal rates of TBIL,AST,ALT and GGT were 17.4% (54), 19.7% (61), 10.7% (33) and 11.9% (37), respectively. The geometric mean value of cadmium levels in adults was 3.72(95% CI: 3.43-4.02) μg/L. After adjusting for age, gender, body mass index (BMI), smoking, drinking, total cholesterol, hypertriglyceridemia and other factors, the risk of abnormal AST index in the highest concentration of blood cadmium group ( Q4) was higher than that in the lowest concentration of blood cadmium group ( Q1) ( OR=2.92, 95%CI:1.07-7.98). Conclusion:The level of blood cadmium exposure is higher than the reference value of general population in China, and the elevated cadmium exposure is related to the increasing risk of AST abnormality.

Objective:To investigate the association of cadmium exposure with liver function among adults in a non-ferrous metal mining area in Guangxi.Methods:A total of 310 residents aged 18 and above were recruited from 5 heavy metals polluted villages in a non-ferrous metal mining area in Guangxi from 2013 to 2014. The general demographic characteristics, blood cadmium levels and indicators of liver function index [Total bilirubin (TBIL), Glutamic oxaloacetic transaminase (AST), Alanine transaminase (ALT) and Glutamine transaminase (GGT)] were obtained by using questionnaire, physical examination and laboratory test. The blood cadmium levels were divided into quartiles as Q1- Q4 groups (using Q1 group as the reference).Multivariate logistic regression model was used to analyze the correlation between the blood cadmium level and functional liver index. Results:The age of subjects was (49.2±15.4) years, and 112 (36.1%) subjects were male residents. The prevalence of abnormal rates of TBIL,AST,ALT and GGT were 17.4% (54), 19.7% (61), 10.7% (33) and 11.9% (37), respectively. The geometric mean value of cadmium levels in adults was 3.72(95% CI: 3.43-4.02) μg/L. After adjusting for age, gender, body mass index (BMI), smoking, drinking, total cholesterol, hypertriglyceridemia and other factors, the risk of abnormal AST index in the highest concentration of blood cadmium group ( Q4) was higher than that in the lowest concentration of blood cadmium group ( Q1) ( OR=2.92, 95%CI:1.07-7.98). Conclusion:The level of blood cadmium exposure is higher than the reference value of general population in China, and the elevated cadmium exposure is related to the increasing risk of AST abnormality.

Objective: To explore the association of arsenic with unexplained recurrent spontaneous abortion (URSA). Methods: A case-control study was conducted to select URSA patients who were admitted to the Beijing Maternal and Child Health Care Hospital affiliated to Capital Medical University from April to October 2018 as a case group. Women who had a normal pregnancy in the Family Planning Department of the hospital but volunteered to have an abortion were selected as a control group. The case and control group were paired in a 1: 1 ratio. The inclusion criteria of the case group were patients with newly diagnosed recurrent spontaneous abortion who had clinically confirmed more than 2 spontaneous abortions and had 20 weeks prior to pregnancy, excluding patients with recurrent spontaneous abortion caused by abnormal blood coagulation (anti-phospholipid antibody positive), abnormal physiological anatomy (B-ultrasound), abnormal immune factors (anti-nuclear antibody positive, anti-cardiolipin antibody, etc.), genetic chromosomal abnormalities (karyotype analysis) and pathogenic microbial infection. The control group was matched according to the age of the case group (±3 years old) and the gestational age (±2 weeks) to exclude adverse pregnancy outcomes such as stillbirth, congenital malformation, premature delivery and low birth weight infants. A total of 192 subjects were included. Questionnaires were used to collect information of all subjects, and 12 ml of peripheral venous blood was collected to detect blood arsenic levels. Blood arsenic levels were divided into low concentration group (<1.00 μg/L), medium concentration group (1.00-1.50 μg/L) and high concentration group (>1.50 μg/L). The multivariate conditional logistic regression was performed to analyze the relationship between blood arsenic exposure and URSA and explore the influencing factors of blood Arsenic. Results: The geometric mean values of blood arsenic level in the cases group and control group were 1.68 (1.50-1.86) μg/L and 1.26 (1.17-1.37) μg/L, respectively. The blood arsenic level in the case group was significantly higher than that in the control group (P<0.05). The results of multivariate conditional logistic regression analysis showed that after adjusting for tobacco exposure during pregnancy, pre-pregnancy body mass index and the effects of residential decoration in past five years, the risk of URSA was higher in the high-concentration group compared with the low-concentration group (OR=2.56, 95%CI:1.06-6.24). Conclusion Blood arsenic may increase the risk of URSA in women of childbearing age.

The size of the non-sampling error is directly related to the accuracy and reliability of the sampling survey result. This paper studied the non-sampling errors generated during the sampling process of the China National Human Biomonitoring Program(CNBP), mainly including the sampling frame error, non-response error and measurement error. The program reduced the influence of the non-sampling error on the quality of the survey effectively by scientifically designing the sampling scheme and questionnaire, strengthening investigator trainings and standardizing the data review, which could be used to provide reference for the control of non-sampling errors in public health monitoring projects in China.

Objective To explore the association of arsenic with unexplained recurrent spontaneous abortion (URSA). Methods A case?control study was conducted to select URSA patients who were admitted to the Beijing Maternal and Child Health Care Hospital affiliated to Capital Medical University from April to October 2018 as a case group. Women who had a normal pregnancy in the Family Planning Department of the hospital but volunteered to have an abortion were selected as a control group. The case and control group were paired in a 1:1 ratio. The inclusion criteria of the case group were patients with newly diagnosed recurrent spontaneous abortion who had clinically confirmed more than 2 spontaneous abortions and had 20 weeks prior to pregnancy, excluding patients with recurrent spontaneous abortion caused by abnormal blood coagulation (anti?phospholipid antibody positive), abnormal physiological anatomy (B?ultrasound), abnormal immune factors (anti?nuclear antibody positive, anti?cardiolipin antibody, etc.), genetic chromosomal abnormalities (karyotype analysis) and pathogenic microbial infection. The control group was matched according to the age of the case group (±3 years old) and the gestational age (±2 weeks) to exclude adverse pregnancy outcomes such as stillbirth, congenital malformation, premature delivery and low birth weight infants. A total of 192 subjects were included. Questionnaires were used to collect information of all subjects, and 12 ml of peripheral venous blood was collected to detect blood arsenic levels. Blood arsenic levels were divided into low concentration group (<1.00 μg/L), medium concentration group (1.00-1.50 μg/L) and high concentration group (>1.50 μg/L). The multivariate conditional logistic regression was performed to analyze the relationship between blood arsenic exposure and URSA and explore the influencing factors of blood Arsenic. Results The geometric mean values of blood arsenic level in the cases group and control group were 1.68 (1.50-1.86) μg/L and 1.26 (1.17-1.37) μg/L, respectively. The blood arsenic level in the case group was significantly higher than that in the control group (P<0.05). The results of multivariate conditional logistic regression analysis showed that after adjusting for tobacco exposure during pregnancy, pre?pregnancy body mass index and the effects of residential decoration in past five years, the risk of URSA was higher in the high?concentration group compared with the low?concentration group ( OR=2.56, 95%CI :1.06-6.24). Conclusion Blood arsenic may increase the risk of URSA in women of childbearing age.

Objective To explore the association of arsenic with unexplained recurrent spontaneous abortion (URSA). Methods A case?control study was conducted to select URSA patients who were admitted to the Beijing Maternal and Child Health Care Hospital affiliated to Capital Medical University from April to October 2018 as a case group. Women who had a normal pregnancy in the Family Planning Department of the hospital but volunteered to have an abortion were selected as a control group. The case and control group were paired in a 1:1 ratio. The inclusion criteria of the case group were patients with newly diagnosed recurrent spontaneous abortion who had clinically confirmed more than 2 spontaneous abortions and had 20 weeks prior to pregnancy, excluding patients with recurrent spontaneous abortion caused by abnormal blood coagulation (anti?phospholipid antibody positive), abnormal physiological anatomy (B?ultrasound), abnormal immune factors (anti?nuclear antibody positive, anti?cardiolipin antibody, etc.), genetic chromosomal abnormalities (karyotype analysis) and pathogenic microbial infection. The control group was matched according to the age of the case group (±3 years old) and the gestational age (±2 weeks) to exclude adverse pregnancy outcomes such as stillbirth, congenital malformation, premature delivery and low birth weight infants. A total of 192 subjects were included. Questionnaires were used to collect information of all subjects, and 12 ml of peripheral venous blood was collected to detect blood arsenic levels. Blood arsenic levels were divided into low concentration group (<1.00 μg/L), medium concentration group (1.00-1.50 μg/L) and high concentration group (>1.50 μg/L). The multivariate conditional logistic regression was performed to analyze the relationship between blood arsenic exposure and URSA and explore the influencing factors of blood Arsenic. Results The geometric mean values of blood arsenic level in the cases group and control group were 1.68 (1.50-1.86) μg/L and 1.26 (1.17-1.37) μg/L, respectively. The blood arsenic level in the case group was significantly higher than that in the control group (P<0.05). The results of multivariate conditional logistic regression analysis showed that after adjusting for tobacco exposure during pregnancy, pre?pregnancy body mass index and the effects of residential decoration in past five years, the risk of URSA was higher in the high?concentration group compared with the low?concentration group ( OR=2.56, 95%CI :1.06-6.24). Conclusion Blood arsenic may increase the risk of URSA in women of childbearing age.