Association of endemic arsenic poisoning and abnormal electrocardiogram: Meta-analysis / 中华地方病学杂志

Objective:To evaluate the correlation between endemic arsenic poisoning and abnormal electrocardiogram (ECG).Methods:PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang data, VIP and other databases were used for literature retrieval, and epidemiological literatures related to abnormal ECG of endemic arsenic poisoning published in domestic and abroad were included in the study. The time limit was from the establishment of the database to December 1, 2020. RevMan 5.3 was used for Meta-analysis of binary variables. Random effect model was selected according to the results of heterogeneity, and odds ratio ( OR) was used as the effect index. Characteristic changes were found by subgroup analysis. Bias was published by funnel plot. Results:Nine articles were included in this Meta-analysis, with 6 articles in Chinese and 3 articles in English, respectively. The abnormal ECG changes included QTc prolongation, ST-T segment change, left axis deviation and arrhythmia. Finally, 1 975 cases were included in the exposure group, including 575 cases of abnormal ECG; 750 cases of control group, including 145 cases of abnormal ECG. Meta-analysis showed that the combined OR value [95% confidence interval ( CI)] of abnormal ECG changes was 4.41 (2.83 - 6.87), with statistical significance between the two groups ( Z = 6.56, P < 0.05); the results of subgroup analysis showed that the combined OR values (95% CI) of QTc prolongation, ST-T segment change, left axis deviation and arrhythmia were 12.30 (5.91 - 25.59), 2.74 (1.39 - 5.41), 2.93 (0.89 - 9.62) and 4.13 (2.38 - 7.17), respectively. Conclusions:Endemic arsenic poisoning may cause abnormal ECG. Prolongation of QTc caused by arsenic exposure may be the characteristic change of abnormal ECG.

Noise exposure and its impact on health in an auto parts manufacturing enterprise / 中华劳动卫生职业病杂志

Objective: To learn about the noise exposure and health status of workers and analyze factors that may affect the health outcomes of workers in an auto manufacturing enterprise in Tianjin City. Methods: In September 2020, occupational hygiene survey, noise exposure level detection and occupational health examination data collection were carried out in an auto parts manufacturing enterprise. Chi square test and unconditional logistic regression analysis were used to analyze the health effects of noise exposure and hearing loss of 361 noise exposure workers. Results: The rates of over-standard noise exposure, hearing loss and hypertension were 69.39% (34/49) , 33.24% (120/361) and 11.36% (41/361) , respectively. There were upward trends on age and noise-working years for hearing loss and hypertension rates (χ(2)=-5.95, -6.16, -2.81, -2.74, P<0.05) . Unconditional logistic regression analysis showed that age>35 years old, noise exposure length of service >10 years and noise L(EX, 8 h)>85 dB (A) were risk factors for hearing loss (OR=3.57, 95%CI: 1.09, 11.75; OR=4.05, 95%CI: 1.97, 8.25; OR=1.75, 95%CI: 1.00, 3.05; P=0.036, 0.001, 0.047) . Conclusion: This company has a high rate of job noise exceeding the standard, and noise-exposed workers have more serious hearing loss. Age, noise exposure and high noise exposure are risk factors for hearing loss.

Clinical analysis of children with cardiac syncope caused by anomalous origin of the left coronary artery from the right sinus / 中华心血管病杂志

Objective: To analysis the clinical characteristics and to summarize therapy experience of pediatric patients with cardiac syncope caused by anomalous origin of the left coronary artery from the right sinus (ALCA-R). Methods: We retrospectively analyzed the clinical data including clinical manifestations, myocardial injury biomarkers, radiological features, treatments and prognoses of pediatric patients with ALCA-R who were admitted to Beijing Children's Hospital from November 2015 to June 2018. Results: Four female patients were included in this analysis, age of onset was 7 to 14 years. All the patients presented with exercise-induced syncope and acute myocardial infarction. During the course, three patients presented with acute left heart failure, and one patient had history of sudden cardiac arrest. Laboratory data showed significant elevation of both the creatine kinase and troponin levels in four patients. All electrocardiogram (ECG) showed left main coronary artery occlusion, echocardiography suggested the possible anomalous origin of the left coronary artery in one child. Coronary CT angiography (CTA) revealed there was no coronary ostium in the left coronary sinus, and the left coronary artery had an anomalous origin from the right sinus. The left main coronary artery passed between the ascending artery and the root of the main pulmonary artery, which was compressed by these two large vessels. Two patients underwent cardiac magnetic resonance examination, which detected late gadolinium enhancement in ALCA-R with an interarterial course. Unroofing of the left coronary ostium (cut-back procedure) was performed in two patients, and the other two patients who were not operated were recommended to restrict their physical activities. During a regular follow-up period of 12-43 months, all the children survived without recurrent cardiovascular event. Conclusion: If an adolescent presents with exercise-induced syncope, acute myocardial infarction and even sudden death, and ECG shows left main coronary artery occlusion characteristics, we should consider the possibility of developmental abnormality of coronary artery, particularly the ALCA-R. Once diagnosed as ALCA-R, patients should be recommended to avoid strenuous activities，early recognition and surgical treatment are imperative for these patients.

Analysis of abnormal electrocardiogram index among residents in Keshan disease areas / 中华地方病学杂志

Objective To investigate the relevance ratio of abnormal electrocardiogram (ECG) and describe the abnormal ECG index among the residents in Keshan disease (KD) area.To assess the KD illness severity and provide comparable quantitative indicators,provide the scientific basis for elimination of KD.Methods Non probability sampling method was used,and monitoring stations with the highest incidence of KD at the county level were selected in 2012.Clinical examination and 12 lead ECG was carried out.According to The KD Diagnosis Standard (WS/T 210-2011),eight common changes in ECG of KD were scored.According to age and sex group,check the abnormal rate of ECG detection of Keshan disease,while analysed the changes of abnormal ECG index score in latent KD patients and chronic KD patients.Abnormal ECG index to determine:If there was one change,the score was 1 and the abnormal ECG index was 1.And so on,the highest score was 8.Results Totally 61 831 residents were surveyed and 9 634 were found with abnormal ECG,and the relevance ratio of abnormal ECG was 15.58％;totally 3 862 residents had eight ECG changes of KD and the relevance ratio was 6.25％;totally 508 residents were diagnosed with KD and the relevance ratio was 0.82％.The relevance ratio of abnormal ECG among all age groups was statistically different (x2 =3 065.64,P ＜ 0.05).The relevance ratio of abnormal ECG in women was higher than that of men [3.91％ (2 419/61 831) vs 2.33％ (1 443/61 831),x2 =86.30,P＜ 0.05].Abnormal ECG index score was (1.06 ± 0.25) which was not statistically different between gender [men:(1.07 ± 0.27) vs women:(1.06 ± 0.24),t =1.41,P ＞ 0.05].The abnormal ECG index score in latent KD patients was lower than that of chronic KD patients [(1.09 ± 0.30) vs (1.60 ± 0.69),t =-4.87,P ＜ 0.05].In eight ECG changes,the most check out items were T wave and/or ST segment changes (2 816).Conclusions The relevance ratio of abnormal ECG in KD area is at a higher level.The abnormal ECG index can be used to assess the KD illness severity and provide comparable quantitative indicators,in order to provide a new train of thought for the evaluation of KD elimination.

Epidemiological characteristics of major abnormal electrocardiogram in adults from Shanghai / 中华流行病学杂志

Objective To understand the prevalence,characteristics and risk factors of major abnormal electrocardiogram (MA-ECG) in adults living in Shanghai.Methods The cross-sectional dataset of prevalence survey on diabetes and metabolic syndrome in adults,aged 20-74 years,from Shanghai,in 2007-2008,was analyzed.Demographic information,personal and,family histories of diseases were collected.Physical examination and laboratory tests were done.Subjects underwent examination on resting 12-leads electrocardiogram (ECG),ECG records were coded according to the Minnesota criteria and classified as MA-ECG or non-MA-ECG.Results A total number of 5364 subjects (2003 men,3361 women) were finally included in this analysis.(1) The standardized prevalence of MA-ECG was 7.3％ (7.0％ in men,7.7％ in women).In both genders,the age-specific prevalence of MA-ECG significantly increased with age (Ptrend＜0.01).The age-specific prevalence of MA-ECG in youths,middle aged and the elderly were 2.3％,7.7％,and 17.3％ in men,and 3.3％,8.8％ and 16.4％ in women,respectively (both Ptren＜0.01).(2) The three most common MA-ECG forms were arrhythmia (28.8％),bundle branch block (26.5％) and ST segment depression (20.0％) in men,while there appeared ST segment depression (44.6％),arrhythmia (23.0％) and combined MA-ECG (11.8％) in women.(3) Data from multivariate logistic regression analysis showed that other than age,coronary heart disease (CHD) was the only independent risk factor of MA-ECG in men,with its corresponding OR being 2.33-2.39; while in women,menopause (OR value:1.72-1.85) and hypertension (OR value:1.33-1.34) were main factors related to MA-ECG.Conclusion MA-ECG was prevalent in the middle aged and the elderly,with,arrhythmia and ST segment depression the most frequent forms of MA-ECG.Age,CHD and hypertension were the main risk factors of MA-ECG in the adults from Shanghai.

Incidence of abnormal electrocardiograms which affected the changes of exercise programs at outpatient cardiac rehabilitation clinic.

Objective: the primary purpose of the study was to determine the incidence of abnormal electrocardiograms (ECGs) which affected the changes of exercise programs. The secondary purpose was to study types of ECG abnormality and the time of detecting the abnormality. Methods: The study was retrospective design. The studied population was selected from the followed up patients at our outpatient cardiac rehabilitation clinic from October 1, 2008 to May 31, 2009. The inclusion criteria were patients who had to follow up at our outpatient cardiac rehabilitation clinic and were monitored for ECG telemetry. The medical and ECG telemetry records of the patients were reviewed. The incidence of abnormal ECGs was reported as the percentage of patients with abnormal ECGs. The patients with abnormal ECGs were classified as the ECG changing group and those without abnormal ECGs were classified as the non-ECG changing group. The comparison of both groups was performed by Chi-square test for categorical data and the independent samples t-test for the quantitative data. The median survival time was carefully estimated by Kaplan-Meier method of Survival Analysis. The factors associated with time of detecting abnormal ECGs were analyzed by using Cox proportional hazards model. The data analysis was performed with statistical significant difference of the p-value < 0.05. Results: Five hundred and forty patients, 378 males and 162 females, were enrolled. There were 151 from 540 patients (28%) in the ECG changing group and 389 patients (72%) in the non-ECG changing group. The comparison between two groups indicated that there were no significant differences regarding gender, age, body mass index, diseases and co-morbidities (such as coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, dyslipidemia and chronic obstructive lung disease), left ventricular ejection fraction and status of cardiac surgery. The two most common types of ECG abnormality in the ECG changing group were tachyarrhythmia and bradyarrhythmia, respectively. The Cox proportional hazards model revealed that there was no factor associated with time of detecting abnormal ECGs. From the Kaplan-Meier method of Survival Analysis, the median survival time of detecting abnormal ECGs was 61 months (95%CI: 47.6, 74.9). Conclusion: The incidence of abnormal ECGs which affected the changes of exercise programs in our outpatient cardiac rehabilitation clinic was 28%. The most common type of abnormality was tachyarrhythmia. The median survival time for detecting abnormal ECGs was 61 months after cardiac hospital discharge. There was no associated factor with the time of detecting abnormal ECGs.