Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes.Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder.However,its therapeutic dosage closely approaches toxic levels.Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L,typically giving rise to gastrointestinal and central nervous system reactions.Cardiac toxicity is rare but serious in cases of lithium poisoning.The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers.This resulted in symptoms such as arrhythmia,shock,impaired consciousness,and coarse tremors.Following symptomatic supportive treatment,including blood dialysis,the patient's physical symptoms gradually improved.It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.

Objective:To learn about the monitoring indicators and patient management in coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province, and provide a basis for consolidating and improving the prevention and control achievements.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing of the Monitoring Plan for Key Endemic Diseases Such as Kashin-Beck Disease" and "The Monitoring Plan for Endemic Fluorosis and Arsenic Poisoning in Shaanxi Province", a basic situation investigation was conducted in the affected villages of all counties (districts) with coal-burning-borne endemic arsenic poisoning in Shaanxi Province, and on-site visits were conducted to check the management of high arsenic coal mines. Using the simple random sampling method, 30 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors. A survey on arsenic poisoning was carried out among all populations in the affected villages. According to the requirements of the provincial monitoring program, 720 people were randomly selected from 12 affected villages in 3 monitoring counties to measure their urinary arsenic level. The determination was based on the "Guidelines for the Safety of Urinary Arsenic in Population" (WS/T 665-2019). The evaluation for elimination of disease areas was carried out in accordance with the "National Health Commission Issued the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition)".Results:A total of 2 cities, 8 counties (districts), 99 townships, and 1 414 affected villages were monitored. All 53 high arsenic coal mines had stopped mining. The rate of qualified improved stoves was 99.97%; the correct utilization rate of qualified improved stoves, and the correct drying rate of corn and chili peppers provided for human consumption in the affected villages were 100.00%. A total of 2 064 138 people were examined, and 2 682 cases of arsenic poisoning were detected, all of whom were historical patients. There were no new cases of arsenic poisoning or skin cancer. There were currently 2 682 arsenic poisoning patients who had received family doctor contract services and implemented follow-up management. The geometric mean of urinary arsenic was 0.016 7 mg/L, which was lower than the safety guideline value for human urinary arsenic (0.032 mg/L).Conclusions:The monitoring indicators in the coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province have reached the elimination standards. In the future, we should continue to strengthen the management of high arsenic coal mines, implement comprehensive prevention and control measures mainly focused on furnace and stove renovation and health promotion, and do a good job in patient management to continuously consolidate and improve the prevention and control achievements.

Objective:To evaluate the prevention and control effect of coal-burning-borne endemic fluorosis in Ankang City of Shaanxi Province, so as to provide a scientific basis for formulating precise prevention and control strategies in the future.Methods:From 2019 to 2023, according to the requirements of the "Monitoring Program of Shaanxi Province for Coal-burning-borne Endemic Fluorosis (2019 Edition)", full coverage monitoring was carried out in all affected villages in seven affected counties under the jurisdiction of Ankang City. Using the simple random sampling method, 30 households in each affected village were selected to investigate the use of improved stoves and the formation of health-related behaviors. All children aged from 8 to 12 in the village were examined for the prevalence of dental fluorosis. At the same time, 6 monitoring villages were selected in 2019, and 8 monitoring villages were selected in 2023 to collect real-time urine samples from children aged 8 - 12 for determination of urinary fluoride level. The evaluation for control and elimination of disease areas was carried out in accordance with the "Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 Edition)".Results:From 2019 to 2023, a total of 203 880 households were monitored, the rate of qualified improved stoves and the correct use rate of qualified improved stoves were more than 95.00%. The utilization rate of improved stoves decreased from 16.34% (6 584/40 290) in 2019 to 8.89% (3 706/41 700) in 2023, showing a decreasing trend year by year (χ 2trend = 3 400.37, P < 0.001). The utilization rate of clean energy increased from 82.52% (33 247/40 290) in 2019 to 94.36% (39 350/41 700) in 2023, showing an upward trend year by year (χ 2trend = 7 506.09, P < 0.001). The correct drying rate of corn and pepper for human consumption were 100.00%. A total of 455 327 children aged 8 - 12 were examined, and 2 301 cases of dental fluorosis were diagnosed, with a detection rate of 0.51%. Children with dental fluorosis were mainly extremely mild and mild, accounting for 94.87% (2 183/2 301). The dental fluorosis index was 0.012, indicating no trend of fluorosis prevalence. The detection rate of dental fluorosis in children decreased from 0.81% (765/94 537) in 2019 to 0.24% (204/86 066) in 2023, showing a declining trend year by year (χ 2trend = 375.45, P < 0.001). The geometric mean urinary fluoride levels of children aged 8 to 12 in 2019 and 2023 were 0.48 and 0.42 mg/L, respectively, with statistically significant differences between groups ( Z = - 3.05, P = 0.002). As of 2023, 1 390 affected villages had met the elimination criteria. Conclusions:The prevention and control of coal-burning-borne endemic fluorosis in Ankang City has achieved remarkable results, with all seven affected counties reaching the elimination standard. In the future, we should strengthen the management of high fluoride coal mines, continue to promote the use of clean energy, strengthen health promotion and disease monitoring, and continuously consolidate and improve the results of prevention and control.

OBJECTIVE: To investigate the prevalence, risk factors, duration and outcome of delirium in intensive care unit (ICU) patients. METHODS: A prospective observational study was conducted for critically ill patients admitted to the department of critical care medicine, the Affiliated Hospital of Guizhou Medical University from September to November 2021. Delirium assessments were performed twice daily using the Richmond agitation-sedation scale (RASS) and confusion assessment method of ICU (CAM-ICU) for patients who met the inclusions and exclusion criteria. Patient's age, gender, body mass index (BMI), underlying disease, acute physiologic assessment and chronic health evaluation (APACHE) at ICU admission, sequential organ failure assessment (SOFA) at ICU admission, oxygenation index (PaO₂/FiO₂), diagnosis, type of delirium, duration of delirium, outcome, etc. were recorded. Patients were divided into delirium and non-delirium groups according to whether delirium occurred during the study period. The clinical characteristics of the patients in the two groups were compared, and risk factors for the development of delirium were screened using univariate analysis and multivariate Logistic regression analysis. RESULTS: A total of 347 ICU patients were included, and delirium occurred in 57.6% (200/347) patients. The most common type was hypoactive delirium (73.0% of the total). Univariate analysis showed statistically significant differences in age, APACHE score and SOFA score at ICU admission, history of smoking, hypertension, history of cerebral infarction, immunosuppression, neurological disease, sepsis, shock, glucose (Glu), PaO₂/FiO₂ at ICU admission, length of ICU stay, and duration of mechanical ventilation between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.045, 95% confidence interval (95%CI) was 1.027-1.063, P < 0.001], APACHE score at ICU admission (OR = 1.049, 95%CI was 1.008-1.091, P = 0.018), neurological disease (OR = 5.275, 95%CI was 1.825-15.248, P = 0.002), sepsis (OR = 1.941, 95%CI was 1.117-3.374, P = 0.019), and duration of mechanical ventilation (OR = 1.005, 95%CI was 1.001-1.009, P = 0.012) were all independent risk factors for the development of delirium in ICU patients. The median duration of delirium in ICU patients was 2 (1, 3) days. Delirium was still present in 52% patients when they discharged from the ICU. CONCLUSIONS The prevalence of delirium in ICU patients is over 50%, with hypoactive delirium being the most common. Age, APACHE score at ICU admission, neurological disease, sepsis and duration of mechanical ventilation were all independent risk factors for the development of delirium in ICU patients. More than half of patients with delirium were still delirious when they discharged from the ICU.
Humans ; Prevalence ; Critical Care ; Risk Factors ; Sepsis ; Intensive Care Units

Objective:To learn about the changes of the condition of coal-burning-borne endemic arsenism, the use of improved stoves and the formation of health-related behaviors in Shaanxi Province, and evaluate the effect of prevention and control measures.Methods:From 2015 to 2020, according to the "Implementation Plan for Monitoring Coal-burning-borne Endemic Arsenism in Shaanxi Province", regular field surveys were carried out in 4 natural villages, 2 counties in Ankang City and Hanzhong City, Shaanxi Province, to learn about the basic prevention and control situation in the monitoring village. Using the simple random sampling method, 10 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors, and 5 of these families were selected to collect coal samples for arsenic content determination in accordance with the "Determination of Arsenic in Coal" (GB/T 3058-2008). According to the "Diagnosis of Endemic Arsenicosis" (WS/T 211-2015), the condition of the people exposed to high arsenic coal in the monitoring village was investigated. Urine samples of 30 adult patients (half males and half females) with arsenic poisoning were collected, the content of arsenic in urine was determined by the "Urine-Determination of Arsenic-Silver Diethyldithiocarbamate-Triethanolamine-Spectrophotometric Method" (WS/T 28-1996).Results:A total of 240 households were monitored in the past 6 years, and the quality conformance and correct utilization rates of improved stoves in the households monitored in the disease areas remained at 100.00% in 2018 - 2020. The utilization rate of clean energy increased from 75.00% (30/40) in 2015 to 100.00% (40/40) in 2018 - 2020 (χ 2trend = 25.5, P < 0.001). The 73.75% (177/240) of households using a variety of clean energy. From 2018 to 2020, the correct drying, storage and pre-processing washing rates of corn and pepper continued to reach 100.00% (40/40). The arsenic content of coal ( n = 120) in the disease areas was (118.09 ± 57.91) mg/kg, ranging from 16.70 to 280.94 mg/kg. The detection rate of arsenic poisoning decreased from 6.34% (231/3 646) in 2015 to 2.90% (109/3 754) in 2020 (χ 2trend = 121.8, P < 0.001), and no skin cancer or Bowen's disease was detected. The geometric mean of arsenic content in urine ( n = 720) was 0.038 1 mg/L, ranging from 0.000 5 to 0.312 9 mg/L. Conclusions:The condition of coal-burning-borne endemic arsenism areas in Shaanxi Province has reached the national elimination standard. The quality and correct utilization rate of improved stoves and the rate of using clean energy have increased. The healthy-related behaviors the people in the endemic areas have been basically formed. The prevention and control work has achieved good results.

A group of compounds structurally related to tetrahydrocannabinol or capable of binding to cannabinoid receptors are collectively referred to as cannabinoids. Cannabinoids can be divided into plant derived cannabinoids， synthetic cannabinoids， and endogenous cannabinoids. Δ-9-THC is the only psychoactive compound in plant cannabinoids. Cannabis with Δ-9-THC>0.3% is internationally listed as a prohibited drug， while cannabis with Δ-9-THC<0.3% is industrial cannabis. Due to its low addiction and high commercial value， it is allowed to be added to food in many countries. More and more industrial cannabis foods become popular， and the detection/analysis of cannabinoid compounds in cannabis foods is particularly important； In addition to industrial cannabis， which is widely used in food， there are also various new drugs， synthetic cannabinoids， disguised as conventional food， which can cause the social problems and increase the food safety risks. This article will elaborate on the regulatory status of cannabinoid compounds in food， In order to promote the safety supervision of the domestic cannabis food.

Objective To analyze the influencing factors of recurrence within one year after dis-continuation of regular treatment of children's cough variant asthma(CVA)and to construct a predic-tive model,in order to provide guidance for doctors to evaluate the risk of recurrence after CVA treat-ment in children and develop prevention strategies.Methods A total of 215 children with CVA were selected as the study objects.According to whether recurrence occurred within one year after discontin-uation of regular treatment,the patients were divided into recurrence group(n=89)and non-recur-rence group(n=126).Data of two groups were collected for univariate and multivariate Logistic re-gression analysis to screen out the influencing factors of recurrence in children with CVA.The GBM prediction model was constructed by using R software to run the gradient boosting model(GBM)algo-rithm.Receiver operating characteristic(ROC)curve was used to analyze and compare the predictive efficiency of GBM model and Logistic regression model.Results The recurrence rate of 215 children with CVA within one year after regular treatment was 41.40％(89/215).Allergy history(OR=2.870,95％CI,1.442 to 5.714),repeated respiratory infection history(OR=4.132,95％CI,2.045 to 8.348),parents'cognitive level of CVA prevention and control(OR=1.063,95％CI,1.011 to 1.118),eosinophils(OR=0.801,95％CI,0.674 to 0.952),forced expiratory flow at 50％of vi-tal capacity(FEF50)(OR=1.055,95％CI,1.012 to 1.099),maximal midexpiratory flow rate 75/25(MMEF75/25)(OR=1.054,95％CI,1.009 to 1.102),and fractional exhaled nitric oxide(FeNO)(OR=0.883,95％CI,0.834 to 0.935)were influencing factors for recurrence within one year after regular treatment of children's CVA(P＜0.05).According to ROC curve analysis,the area under the curve of GBM model was 0.872,which was larger than 0.827 of Logistic regression model.Conclusion GBM prediction model is established based on the influencing factors of recur-rence within one year after regular treatment of CVA in children,which can be used as a reference for clinical measures to prevent recurrence in children after treatment of CVA.

Objective To analyze the influencing factors of recurrence within one year after dis-continuation of regular treatment of children's cough variant asthma(CVA)and to construct a predic-tive model,in order to provide guidance for doctors to evaluate the risk of recurrence after CVA treat-ment in children and develop prevention strategies.Methods A total of 215 children with CVA were selected as the study objects.According to whether recurrence occurred within one year after discontin-uation of regular treatment,the patients were divided into recurrence group(n=89)and non-recur-rence group(n=126).Data of two groups were collected for univariate and multivariate Logistic re-gression analysis to screen out the influencing factors of recurrence in children with CVA.The GBM prediction model was constructed by using R software to run the gradient boosting model(GBM)algo-rithm.Receiver operating characteristic(ROC)curve was used to analyze and compare the predictive efficiency of GBM model and Logistic regression model.Results The recurrence rate of 215 children with CVA within one year after regular treatment was 41.40％(89/215).Allergy history(OR=2.870,95％CI,1.442 to 5.714),repeated respiratory infection history(OR=4.132,95％CI,2.045 to 8.348),parents'cognitive level of CVA prevention and control(OR=1.063,95％CI,1.011 to 1.118),eosinophils(OR=0.801,95％CI,0.674 to 0.952),forced expiratory flow at 50％of vi-tal capacity(FEF50)(OR=1.055,95％CI,1.012 to 1.099),maximal midexpiratory flow rate 75/25(MMEF75/25)(OR=1.054,95％CI,1.009 to 1.102),and fractional exhaled nitric oxide(FeNO)(OR=0.883,95％CI,0.834 to 0.935)were influencing factors for recurrence within one year after regular treatment of children's CVA(P＜0.05).According to ROC curve analysis,the area under the curve of GBM model was 0.872,which was larger than 0.827 of Logistic regression model.Conclusion GBM prediction model is established based on the influencing factors of recur-rence within one year after regular treatment of CVA in children,which can be used as a reference for clinical measures to prevent recurrence in children after treatment of CVA.

【Objective】 To construct the eukaryotic expression vector carrying the human wild-type p27 and lacking nuclear localization signal p27△NLS coding sequences， and the express them in HEK293T cells， which may contribute to investigating the different locations and roles of p27 in the cytoplasm and nucleus. 【Methods】 Total RNA was prepared from human breast cancer MCF7 cells， and cDNA was obtained by reverse transcription-polymerase chain reaction （RT-PCR）. After amplification of the p27 CDs and non-NLS fragments by PCR， full length p27WT （CDKN1B， NM_004064.5） and p27△NLS coding regions were obtained. PCR products were then subcloned into the eukaryotic expression vector pCMV-Blank. After identification with bacterial PCR， double restriction enzyme digestion and sequencing， they were defined officially as pCMV-p27WT and pCMV-p27△NLS， respectively. The recombinant plasmids were transfected into HEK293T cells by electroporation. After 48 h， the levels of p27 protein in the cytoplasm and nucleus were detected by Western blotting. 【Results】 The sequencing results showed that the sequences of p27WT and p27△NLS inserted into the plasmids were both correctly consistent with that of NM_004064.5. After transfection with pCMV-p27WT， total p27 protein expression was increased and distributed in both the cytoplasm and nucleus of HEK293T cells. After transfection with pCMV-p27△NLS， p27 protein was significantly increased and almost entirely localized in the cytoplasm of HEK293T cells. 【Conclusion】 The eukaryotic expression plasmids of human p27WT and p27△NLS coding sequences were successfully constructed and overexpressed in HEK293T cells. This research may lay a foundation for investigating the biological function of p27 in the cell cycle progression of tumor cells.

Objective:To explore the value of spectral CT in the preoperative evaluation of solid lung adenocarcinoma with different pathological grades based on the 2011 and 2020 version of the pathological grading system.Methods:A total of 76 cases of solid lung adenocarcinoma confirmed by surgery in Renji Hospital, School of Medicine, Shanghai Jiao Tong University, from January 2019 to September 2021 were analyzed retrospectively. All cases were divided into groups according to the grading system for invasive adenocarcinoma proposed by the International Association for the Study of Lung Cancer (IASLC) in 2011 and 2020 (G low group included G1 and G2 adenocarcinoma, G high group included G3 adenocarcinoma). The tumors with stage Ⅰ and Ⅱ were non-advanced and the tumors with stage Ⅲ and Ⅳ were advanced. The clinical manifestations (gender, age, smoking history and stage), routine CT parameters (tumor size, morphological characteristics, plain CT value and enhancement degree) and spectral parameters [iodine concentration, effective atomic number, enhanced monochromatic CT attenuation values of 40-200 keV (CT 40 keV-CT 200 keV), and the slope of spectral curve (k value)] were compared between G low group and G high group using independent sample t-test or Mann-Whitney U test. And the efficacy of each parameter for indicating G high adenocarcinoma was analyzed using receiver operating characteristic curve analysis and area under the curve (AUC), and the Z test was used to compare the AUC. Results:Seventy-six cases were included (59 cases of G low group and 17 cases of G high group in 2011 version; 46 cases of G low group and 30 cases of G high group in 2020 version). Among the 76 cases, 62 cases were non-advanced stage (50 cases of G low group and 12 cases of G high group in 2011 version; 37 cases of G low group and 25 cases of G high group in 2020 version) and 14 cases were advanced stage (9 cases of G low group and 5 cases in G high group in both 2011 and 2020 version). Among the non-advanced adenocarcinomas, the CT parameters of enhancement degree, k value and CT 40 keV-CT 60 keV in arterial phase and enhancement degree, k value and CT 40 keV-CT 70 keV in venous phase of G high group in 2011 grading system were significantly lower than those of G low group ( P<0.05), while other parameters were similar between G low and G high group in 2011 grading system ( P>0.05); and the CT parameters of CT 60 keV in arterial phase and CT 50 keV-CT 70 keV in venous phase of G high group in 2020 grading system were significantly lower than those of G low group ( P<0.05). Among the advanced adenocarcinomas, all of the clinical and CT parameters were similar between G low and G high group in both 2020 and 2011 grading systems ( P>0.05). For the non-advanced adenocarcinomas, there was medium to good efficacy of the CT parameters of enhancement degree, k value and CT 40 keV-CT 60 keV in arterial phase and enhancement degree, k value and CT 40 keV-CT 70 keV in venous phase for diagnosing 2011 grading system G high adenocarcinoma (AUC=0.700-0.853), with CT 50 keV in venous phase as the best; while the diagnosis efficacy of CT parameters of CT 60 keV in arterial phase and CT 50 keV-CT 70 keV in venous phase was poor for 2020 grading system G high adenocarcinoma (AUC=0.652-0.688), with CT 60 keV in venous phase as the best. After combining smoking history and CT 60 keV in venous phase, the diagnosis efficacy for 2020 grading system G high adenocarcinoma was slightly improved (AUC=0.772), but the difference had no significance ( Z=0.93, P=0.176). Conclusion:The spectral parameters are useful for distinguishing the pathological grades of solid lung adenocarcinoma. And the detecting efficacy for G high adenocarcinoma of IASLC 2011 version is slightly better than that of 2020 version.