ObjectiveTo conduct comprehensive assessment of internal and external cadmium exposure and health risks for Shanghai residents. MethodsCadmium levels in food samples were calculated by employing two dietary exposure assessment methods， total diet study （TDS） and food frequency questionnaire （FFQ）， to estimate the daily dietary cadmium exposure of Shanghai residents. The provisional tolerable monthly intake （PTMI） of cadmium set by joint food and agriculture organization/WHO expert committee on food additives （JECFA） was applied to evaluate the health risk. Differences in dietary and urinary cadmium were compared by rank-sum test among different regions， age， gender， smoking status， and BMI groups， and the association between internal and external cadmium exposure was investigated by correlation analysis. ResultsThe mean value of urinary cadmium for 1 300 respondents was 0.542 μg·L^-1. Urinary cadmium was higher in the population in central urban and urban-rural fringe areas than in the suburban area， higher in the older age group than in the younger age group， and higher in the smoking group than in the non-smoking group （all P<0.01）. The two assessment methods showed that the mean values of daily dietary cadmium exposure for Shanghai residents were 0.306 and 0.090 μg·kg^-1， with 3.69% and 0.85% of Shanghai residents exceeding the PTMI， respectively. Correlation analyses showed that dietary exposure to cadmium based on the FFQ method was positively correlated with the urinary cadmium level when smoking status， age， gender， and BMI were adjusted. ConclusionDietary exposure to cadmium of Shanghai residents is mainly derived from vegetables， aquatic products， cereals and potatoes， and is overall at a low-risk level. Dietary exposure assessment based on FFQ and risk monitoring data can effectively estimate long-term cadmium exposure.

ObjectiveTo explore the impact of the interaction between occupational and non-occupational noise exposure on the risk of high-frequency hearing loss (HFHL) in noise-exposed workers. Methods A total of 602 male workers with normal hearing, engaged in an automobile manufacturing company between 2016 and 2018, were selected as the study subjects using the retrospective cohort study method. Pure-tone audiometry and questionnaire surveys were conducted on the workers. The Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression model were used to analyze the interaction between occupational and non-occupational noise exposure and the risk of HFHL in these workers. Results The prevalence of HFHL of the workers was 34.1% in 2020, without any cases of speech frequency hearing loss. Kaplan-Meier survival analysis result showed that the risk of HFHL increased in workers with excessive national occupational noise exposure intensity, self-reported noisy living environments, and both excessive national occupational noise exposure intensity and self-reported noisy living environments (all P<0.01). The results of the Cox proportional hazards model showed that the combined effect of excessive national occupational noise exposure intensity and self-reported noisy living environments [relative risk (RR)=2.40, P<0.01] was higher than the individual effects of excessive national occupational noise exposure intensity (RR=2.09, P<0.01) and self-reported noisy living environments (RR=2.39, P<0.01). There was an antagonistic effect between excessive national occupational noise exposure intensity and self-reported noisy living environments (interaction index <1.00). Conclusion Both occupational and non-occupational noise exposure can increase the risk of HFHL in noise-exposed workers, and there is an interaction between them.

ObjectiveTo analyze the research status and trends in low-level occupational benzene exposure. Methods Articles on low-level occupational benzene exposure from Chinese and English journals from January 1st, 2000, to December 31th, 2022 were retrieved using the Web of Science and the China National Knowledge Infrastructure, and a bibliometric analysis was conducted. Results A total of 327 articles were included in the analysis, comprising 216 English articles and 111 Chinese articles. i) The number of articles published in English fluctuates greatly over the years, without a trend of continuous growth or decline. Authors from 359 research institutions in 45 countries and regions have published relevant English articles in 97 kinds of journals, involving 281 grants from 226 foundations. The top three countries in terms of articles amount were the United States, Italy, and China, with 81, 46, and 43 papers, respectively. The English articles mainly focused on mechanistic research at the genetic level, such as hematotoxicity, oxidative stress, and DNA damage. ii) The number of Chinese articles increased gradually after 2012, with the growth peak in 2017. Authors from 127 research institutions in 26 provinces, autonomous regions, and municipalities published Chinese articles in 51 kinds of journals, involving 154 grants from 78 foundations. Chinese articles tended to focus on benzene-induced hematotoxicity and occupational health damage. Conclusion Most studies on low-level occupational benzene exposure were conducted in China, the United States and Italy, focused on hematotoxicity. Monitoring international research topics and hotspots of the field has certain reference value for related research in China.

Objective To analyze result of the external quality assessment for laboratories of toxicological pathology diagnosis in organizations in China. Methods A total of 86 organizations that participated in the 2020-2021 external quality assessment in laboratory of toxicological pathology diagnosis (hereinafter referred to as "reference units") were selected as research subjects using convenient sampling method, and the assessment results were analyzed. Results The median of total score was 92, and the 0-100 percentiles were 64-100 in these 86 reference units. Among these reference units, 76 were rated as excellent, 10 as qualified, with the excellent and the qualified rate of 88.4% and 11.6%, respectively. No reference unit was rated as unqualified. The rates of excellence of the reference units in public health institutions, pharmaceutical research institutions, drug safety evaluation centers and testing companies were 95.7%, 84.2%, 85.7% and 86.7%, and the qualified rates were 4.3%, 15.8%, 14.3% and 13.3%, respectively. The distribution of excellence and qualification among the four types of reference units showed no statistical difference (P>0.05). The distribution of sample scores according to the three grades of poor, good, and excellent were 4.9%, 20.7%, and 74.5% in public health institutions, 8.6%, 23.7%, and 67.8% in pharmaceutical research institutions, 12.5%, 25.0%, and 62.5% in drug safety evaluation centers, and 5.4%, 17.5%, and 77.1% in testing companies. The proportion of excellence unit in public health institutions was higher than that in pharmaceutical research institutions (P<0.05). Conclusion The overall toxicological pathology diagnostic capabilities in China are good, and various types of reference units demonstrate comparable technical capabilities. However, there is a need for standardization of diagnostic terminology.

Objective:To explore the effect of different surgical procedures on early postoperative symptomatic thrombosis in patients undergoing pancreaticoduodenectomy.Methods:From September 2016 to June 2018, 111 patients undergoing pancreaticoduodenectomy in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences were selected as the research objects by convenience sampling method, and were divided into the laparoscopic group ( n=47) and the laparotomic group ( n=64). The levels of D-dimer immediately after surgery and on the first, second, third, and seventh day after surgery and the occurrence of early postoperative symptomatic thrombus were compared between the two groups. Results:Repeated measures analysis of variance showed that there were between-group and time effects in the comparison of D-dimer immediately after surgery and on the first, second, third, and seventh day after surgery between the two groups, and the differences were statistically significant ( P<0.05). There was no significant difference in the occurrence of symptomatic thrombosis between the two groups ( P=0.62) . Conclusions:The risk of early symptomatic thrombosis after pancreaticoduodenectomy gradually increases, and laparoscopy had no significant advantage in reducing the risk of early symptomatic thrombosis after pancreaticoduodenectomy.

OBJECTIVE: To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in the treatment of patients with moderate coronavirus disease 2019 (COVID-19). METHODS: We prospectively enrolled 30 treatment-naïve patients with confirmed COVID-19 after informed consent at Shanghai Public Health Clinical Center. The patients were randomized 1：1 to HCQ group and the control group. Patients in HCQ group were given HCQ 400 mg per day for 5 days plus conventional treatments, while those in the control group were given conventional treatment only. The primary endpoint was negative conversion rate of SARS-CoV-2 nucleic acid in respiratory pharyngeal swab on days 7 after randomization. This study has been approved by the Ethics Committee of Shanghai Public Health Clinical Center and registered online (NCT04261517). RESULTS: One patient in HCQ group developed to severe during the treatment. On day 7, nucleic acid of throat swabs was negative in 13 (86.7%) cases in the HCQ group and 14 (93.3%) cases in the control group (>0.05). The median duration from hospitalization to virus nucleic acid negative conservation was 4 (1,9) days in HCQ group, which is comparable to that in the control group [2 (1,4) days, Z=1.27, >0.05]. The median time for body temperature normalization in HCQ group was 1 (0,2) day after hospitalization, which was also comparable to that in the control group [1 (0,3) day]. Radiological progression was shown on CT images in 5 cases (33.3%) of the HCQ group and 7 cases (46.7%) of the control group, and all patients showed improvement in follow-up examinations. Four cases (26.7%) of the HCQ group and 3 cases (20%) of the control group had transient diarrhea and abnormal liver function (>0.05). CONCLUSIONS The prognosis of COVID-19 moderate patients is good. Larger sample size study are needed to investigate the effects of HCQ in the treatment of COVID-19. Subsequent research should determine better endpoint and fully consider the feasibility of experiments such as sample size.
Betacoronavirus ; isolation & purification ; China ; Coronavirus Infections ; diagnostic imaging ; drug therapy ; Humans ; Hydroxychloroquine ; therapeutic use ; Pandemics ; Pilot Projects ; Pneumonia, Viral ; diagnostic imaging ; drug therapy ; RNA, Viral ; isolation & purification ; Treatment Outcome

OBJECTIVE: To observe the sub-acute toxicity of 1-bromopropane(1-BP) oral exposure for 28 days in SD rats. METHODS: Specific pathogen free adult female SD rats were randomly assigned to the control and exposed group, 8 rats in each group. The 1-BP was suspended in corn oil and administered by gavages in a dose of 800 mg/kg body weight to rats in the exposed group, once a day, 5 days per week for 4 weeks. The rats in the control group were given equal volume of corn oil. After the last exposure, blood and urine of rats were collected for 1-BP level detection and hematological examination. Brain, heart, lung, liver, kidney and spleen of rats were collected for gross pathological examination and histopathological examination. RESULTS: The rats of exposed group showed unstable standing, weakness of hind limbs, limping and lying down from the 3 rd week of exposure. From the 1 st to 4 th week of exposure, mean body weight of rats in the exposed group were significantly lower than those of the control group(P<0.05). In the exposed group, the level of 1-BP in urine was higher than that in blood(P<0.05), and that there was positive correlation between them(Spearman correlation coefficient=0.954, P<0.01). In the control group, 1-BP was not detected. The absolute weights of brain and lung tissue in the exposure group decreased(P<0.05), meanwhile the organ coefficients of heart, liver, spleen and kidney were significantly increased compared with the control group(P<0.05). The number of red blood cells, hemoglobin concentration, hematocrit, the mean hemoglobin concentration, the total serum cholesterol and triglycerides were decreased(P<0.05). No pathological change related to 1-BP exposure was observed in the main organs of the rats in the exposed group. CONCLUSION: The sub-acute oral toxicity of 1-BP is mainly neurotoxicity and hematotoxicity. The 1-BP level in urine may reflect its exposure.

OBJECTIVE: To evaluate the diagnostic ability of toxicity pathology in patho-toxicological testing institutions in China. METHODS: The institutions participated in the 2018 Interlaboratory Comparison Activity of Toxicity Pathology Testing(hereinafter referred to as reference unit) were selected as the research subjects. The heart, spleen, skin, soft tissue, liver and mammary gland of SD rats of different groups in the 2-year carcinogenesis test were selected. The femur, knee joint and nose of Beagle dogs in the 4-week toxicity test and a total of 10 pathological tissues were selected as the comparison samples. The pathological diagnosis was carried out by the pathological diagnostic personnel of the reference unit, and the diagnostic results were reported. The expert appointed by the Toxicology and Pathology Committee of Chinese Toxicology Association compared the diagnostic results with the appointed value. RESULTS: A total of 167 pathological diagnostic personnel from 75 reference units in 24 provinces and municipalities participated in the comparison activity. The reference units were mainly distributed in East China, South China and North China, accounting for 77.3%(58/75). Totally 75 reference units fed back 750 effective diagnostic results. The qualified rates of diagnosis on heart, spleen, skin, soft tissue and breast samples were higher than 60.0%. The qualified rates of diagnosis on femur and knee joint, and nose samples were low(30.7% and 6.7%, respectively). There were 1(1.3%), 46(61.4%) and 28(37.3%) reference units rated as unqualified, qualified and excellent, respectively. CONCLUSION: Most of the testing institutions in China have a high level of patho-toxicological diagnostic ability, that can provide reliable diagnostic results for toxicology safety evaluation tests.

Objective? To explore the effects of enhanced recovery nursing on early postoperative vein thromboembolism (VTE) risk after pancreaticoduodenectomy (PD). Methods? Using convenience sampling method, the 45 cases of PD patients with traditional nursing methods from September 2016 to March 2017 were assigned as the control group, and the 66 cases of PD patients with enhanced recovery nursing from March 2017 to June 2018 were assigned as intervention group. The plasma D-dimer level before operation, immediately after operation, and in different postoperative days (POD): POD1, POD2, POD3 and POD7 were collected. The D-dimer level and the incidence rates of symptomatic VTE were compared between two groups. Results? The D-dimer values of the intervention group immediately after surgery, POD1, POD2, POD3 and POD7 were (2.74±2.31), (3.31±2.03), (3.98±3.10), (4.30±2.89) and (7.46±3.90) mg/L·FEU. The D-dimer of the control group at each postoperative time point were (2.88±1.92), (3.77±2.72), (4.37±2.70), (4.08±1.81) and (6.85±4.07) mg/L·FEU. The overall D-dimer value of the two groups showed an upward trend after operation,but there was no significant difference between two groups (P＞0.05). Repeated measures analysis of variance showed that there were no differences in between-group effect (F=0.03, P=0.87) or interaction effect (F=1.01,P=0.38) of D-Dimer, while the difference in intra-group effect was statistically significant (F=108.28, P＜ 0.05). There was no statistical significance in the difference of the incidence rates of symptomatic VTE between two groups (χ2=0.87, P＞ 0.05). Conclusions? The early postoperative VTE risk after PD gradually increased, and the enhanced recovery nursing show no significantly advantage in VTE risk reduction after PD compared to traditional methods.

Objective To produce a plastic ampoule with an opening that fits syringe adapters to allow solutions to be drawn up without needles (to avoid needle stick and sharps injuries) and to test the effectiveness of the new design in terms of residual fluid volume and risk of microorganism contamination. Methods Evaluation study based on laboratory research was adopted. For the experimental group, 30 ampoules based on the new design were produced by 3D printing. The ampoules were sterilized and filled with 2 ml sterile water. The sterile water was drawn up without the use of needles, and the wastage fluid (i.e., 2 ml minus the quantity drawn up) was calculated. A 1 ml aliquot of sterile water from each ampoule was dropped onto a nutrient agar plate, and the number of colony-forming units was assessed after 48 h. For each ampoule, the experiment was performed twice. Sixty 2 ml glass-packaged sterile water injections constituted the control group. The fluid was drawn up with a needle, and the superfluous fluid and number of colony-forming units were assessed, as in the experimental group. Results The mean wastage fluid was 0.06 ml, 95% CI was 0.05-0.07 ml in the experimental group and the superfluous fluid was 0.06 ml, 95% CI was 0.06-0.07 ml in the control group, there was no significant difference between the two groups (Z=-1.194, P=0.233). The number of colony-forming units was 8 in the experimental group and 4 in the control group, there was no significant difference between the two groups (P=0.224). Conclusions The newly designed plastic ampoule opening could help health workers to avoid needle stick and sharps injuries when drawing up solution. The wastage fluid and microorganism contamination levels met the required standards, indicating that the new design is suitable for clinical application.