The combined effects of polystyrene of different sizes and cadmium in mouse kidney tissues.

Environmental accumulation of nano- and microplastics pose serious risks to human health. Polystyrene (PS) is a polymer commonly used in the production of plastics. However, PS can adsorb cadmium (Cd), thereby influencing bioavailability and toxicity in vivo. Moreover, PS and Cd can accumulate in the mammalian kidney. Therefore, the aim of the present study was to assess the effects of combined exposure to PS and Cd in the kidney. Kidney damage was evaluated in male mice gavaged with PS (diameter, 100 nm and/or 1 µm) and Cd for 25 days.The results showed that PS at 100 nm caused more severe oxidative damage and cell apoptosis than PS at 1 µm. Combined exposure to PS at both 100 nm and 1 µm caused more severe kidney damage than the single administration groups. The extent of kidney toxicity caused by Cd differed with the combination of PS particles at 100 nm vs. 1 µm. The degree of damage to kidney function, pathological changes, and cell apoptosis induced by Cd+100 nm PS+1µm PS was the most severe. An increase in the Bax/Bcl2 ratio and overexpression of p53 and caspase-3 revealed that renal cell apoptosis might be induced via the mitochondrial pathway. Collectively, these findings demonstrate that the size of PS particles dictates the combined effects of PS and Cd in kidney tissues. Kidney damage caused by the combination of different sizes of PS particle and Cd is more complicated under actual environmental conditions.

Detection of microplastics in domestic and fetal pigs' lung tissue in natural environment: A preliminary study.

Microplastics (MPs) are ubiquitous in the environment. However, it is unclear whether MPs are present in mammalian lungs through inhalation, and if so, could be possibly found in fetal tissues. In this study, we aim to determine the presence and characteristics of particles in domestic and fetal pig lung tissue in the natural environment. Specimens from the lungs of domestic pigs (n = 10) and fetal pigs that already died in matrix during vaginal birth from the non-contaminated area (n = 10) were obtained from farmers' nearby sludge treatment plant. These specimens were compressed between two glass microscope slides, which were examined under polarized light microscopy. In addition, Agilent 8700 LDIR Chemical imaging system (LDIR) was used to determine the quantitative and qualitative characteristics of MPs. According to the polarized light microscope survey of domestic pig lungs, we observed an average of 12 particles/g, which was more than the 6 particles/g observed in fetal pig lungs, which ranged in size from 115.14 µm to 1370.43 µm. All the observed MP particles were fiber in shape. LDIR indicated an average of 180 particles/g of domestic pig lungs, ranging in size from 20.34 µm to 916.36 µm, which was twice as many MPs observed in fetal pig lungs. Furthermore, the compositions of MPs were different between them. LDIR indicated that polyamide (PA) was the most common polymer identified in domestic pig lungs (46.11%), while polycarbonate (PC) was the most common polymer in fetal pig lungs (32.99%). These findings confirmed the presence of MPs in the lung tissue of both domestic and fetal pigs in the natural environment, but the main characteristics differed. This fact indicated the increasing risk of MPs to human respiratory tract is increasing. Further research should be conducted to entirely estimate the specific exposure level on humans and offspring.

Exposure to microplastics in the upper respiratory tract of indoor and outdoor workers.

The aim of this study was to determine the presence of microplastics (MPs) in the upper respiratory tract of indoor and outdoor workers, to assess the type and the extent of contamination. Sputum and nasal lavage fluid were collected, and plastic particles were quantitatively analyzed by polarizing microscopy and a laser direct infrared chemical imaging system. The polarized light microscopy results showed that suspicious MPs were found in the nasal lavage and sputum of both couriers and office staff, and the abundance of MPs in the nasal lavage of office staff was significantly higher than in couriers (P < 0.0001). The chemical imaging results showed that polycarbonate (24.2%) and polyvinylchloride (PVC) (23.0%) were the predominant plastic materials in the sputum of couriers, while polyamide (PA) (25.3%) and polyethylene (22.9%) were dominant in the nasal lavage fluid. The sputum and nasal lavage fluid of office staff were both dominated by PVC (39.1% and 41.1%, respectively) and PA (24.8% and 31.6%, respectively). Therefore, this study revealed that microplastic pollution was found in the respiratory tract of both indoor and outdoor workers, but the distribution of MP particles differed between the two populations.

Blood uptake and urine excretion of nano- and micro-plastics after a single exposure.

Nano- and micro-plastic (NMP) pollution has emerged as a global issue; however, uptake in the blood is controversial. Also, there is no evidence that NMPs are excreted via urine. This study was designed to clarify the time course of NMPs absorption in blood and the excretion in urine. Male mice received a single administration of fluorescent polystyrene (PS) beads (100-nm and 3-µm) via tail vein injection, gavage, or pulmonary perfusion. Blood and urine samples were measured 0.5, 1, 2, and 4 h after exposure by confocal laser scanning microscope (CLSM). Transmission electron microscopy (TEM) was performed to corroborate the findings. Fluorescence particles were detected in both blood and urine from the 100-nm and 3-µm PS-treated groups after exposure. In the 3-µm PS treated group, particles with corresponding diameters were detected after intravenous injection and pulmonary perfusion, and particles with a diameter <3 µm were detected in blood samples after gavage. The fluorescent signal in urine was particularly weak and the size was <3 µm. Significant time course changes in fluorescence intensity were demonstrated in blood and urine (P < 0.05) after intravenous injection and pulmonary perfusion in the 100-nm PS-treated group. By contrast, significant changes were detected in the urine (P < 0.05), but not the blood, after gavage. TEM confirmed the presence of particles with corresponding diameters in blood samples; however, the excretion in urine was difficult to confirm for nano-plastics (NPs) and micro-plastics (MPs) because all particles with diameters of approximately 100 nm and 3 µm had irregular shapes and no clear boundaries. Our findings revealed that both NPs and MPs enter the blood circulation through digestive and respiratory pathways. Both 100-nm and 3-µm NMPs may be excreted through urine, but further evidence is needed. The physical and chemical properties of MPs may be impacted by digestive processes in vivo.

Incremental significance and sex discrepancies of neck circumference on the odds of ischaemic stroke: a multistage, population-based, cross-sectional study from Northeast China.

OBJECTIVES: Accumulated evidence suggests that neck circumference (NC) is associated with cardiometabolic risk factors. However, limited studies are available regarding the association between NC or height normalised NC (neck-to-height ratio (NHR)) and risk of ischaemic stroke (IS) in the Chinese population. Therefore, we aimed at examining the associations between NC or NHR and odds of IS and exploring the discrepancies between men and women. DESIGN: A multistage cluster cross-sectional study. SETTING: A population-based study carried out in Northeast China. METHODS: A cross-sectional study was undertaken in Northeast China between September 2017 and March 2019, involving 7236 men and 11 352 women, respectively. The median age of participants was 60.30 years, ranging from 40 to 97 years. The associations between NC or NHR and odds of IS were calculated using multiple logistic regression models. Dose-response relationships were depicted using restricted cubic spline functions. Reclassification analyses were carried out to determine the incremental significance of NC or NHR on the odds of IS. RESULTS: In women, NC and NHR were significantly associated with the odds of IS, independent of traditional risk factors and other anthropometric parameters for obesity. The highest quartile of NC and NHR had a 1.60 (95% CI 1.16 to 2.22)-and 1.72 (95% CI 1.23 to 2.41) times higher odds of IS compared with the lowest quartile. Furthermore, the odds of IS increased by 1.10 (95% CI 1.01 to 1.20) and 1.12 (95% CI 1.02 to 1.22) times per 1 SD increase in NC and NHR, respectively. Reclassification analyses showed that the proportion of correct classification increased by 11.5% (95% CI 2.2% to 20.7%) and 22.8% (95% CI 13.5% to 32.0%) after the addition of NC or NHR into established models, respectively. However, the findings could not be replicated in men. CONCLUSION: NC and NHR might be promising independent indicators for women IS. Their incremental value in the risk stratification of IS enables the individualised prevention of IS in women.

Etiological and epidemiological features of acute meningitis or encephalitis in China: a nationwide active surveillance study.

BACKGROUND: Acute meningitis or encephalitis (AME) results from a neurological infection causing high case fatality and severe sequelae. AME lacked comprehensive surveillance in China. METHODS: Nation-wide surveillance of all-age patients with AME syndromes was conducted in 144 sentinel hospitals of 29 provinces in China. Eleven AME-causative viral and bacterial pathogens were tested with multiple diagnostic methods. FINDINGS: Between 2009 and 2018, 20,454 AME patients were recruited for tests. Based on 9,079 patients with all-four-virus tested, 28.43% (95% CI: 27.50%‒29.36%) of them had at least one virus-positive detection. Enterovirus was the most frequently determined virus in children <18 years, herpes simplex virus and Japanese encephalitis virus were the most frequently determined in 18-59 and ≥60 years age groups, respectively. Based on 6,802 patients with all-seven-bacteria tested, 4.43% (95% CI: 3.94%‒4.91%) had at least one bacteria-positive detection, Streptococcus pneumoniae and Neisseria meningitidis were the leading bacterium in children aged <5 years and 5-17 years, respectively. Staphylococcus aureus was the most frequently detected in adults aged 18-59 and ≥60 years. The pathogen spectrum also differed statistically significantly between northern and southern China. Joinpoint analysis revealed age-specific positive rates, with enterovirus, herpes simplex virus and mumps virus peaking at 3-6 years old, while Japanese encephalitis virus peaked in the ≥60 years old. As age increased, the positive rate for Streptococcus pneumoniae and Escherichia coli statistically significantly decreased, while for Staphylococcus aureus and Streptococcus suis it increased. INTERPRETATION: The current findings allow enhanced identification of the predominant AME-related pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures in China, and a possible reassessment of vaccination strategy. FUNDING: China Mega-Project on Infectious Disease Prevention and the National Natural Science Funds.

Impact of microplastics on children s health / 中国学校卫生

Abstract@#As a new type of pollutant, microplastics have attracted extensive attention. Children in a critical stage of growth and development are vulnerable to microplastics. Summarzing the relevant laws and regulations and the source of microplastics, the paper demonstrates the ways of microplastics entering human body, some toxic effects of microplastics found in recent experimental studies and their potential hazards to children s health are introduced in detail.

Etiological and epidemiological features of acute respiratory infections in China.

Nationwide prospective surveillance of all-age patients with acute respiratory infections was conducted in China between 2009‒2019. Here we report the etiological and epidemiological features of the 231,107 eligible patients enrolled in this analysis. Children <5 years old and school-age children have the highest viral positivity rate (46.9%) and bacterial positivity rate (30.9%). Influenza virus, respiratory syncytial virus and human rhinovirus are the three leading viral pathogens with proportions of 28.5%, 16.8% and 16.7%, and Streptococcus pneumoniae, Mycoplasma pneumoniae and Klebsiella pneumoniae are the three leading bacterial pathogens (29.9%, 18.6% and 15.8%). Negative interactions between viruses and positive interactions between viral and bacterial pathogens are common. A Join-Point analysis reveals the age-specific positivity rate and how this varied for individual pathogens. These data indicate that differential priorities for diagnosis, prevention and control should be highlighted in terms of acute respiratory tract infection patients' demography, geographic locations and season of illness in China.

Etiological, epidemiological, and clinical features of acute diarrhea in China.

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018. Here we report the etiological, epidemiological, and clinical features of the 152,792 eligible patients enrolled in this analysis. Rotavirus A and norovirus are the two leading viral pathogens detected in the patients, followed by adenovirus and astrovirus. Diarrheagenic Escherichia coli and nontyphoidal Salmonella are the two leading bacterial pathogens, followed by Shigella and Vibrio parahaemolyticus. Patients aged <5 years had higher overall positive rate of viral pathogens, while bacterial pathogens were more common in patients aged 18‒45 years. A joinpoint analysis revealed the age-specific positivity rate and how this varied for individual pathogens. Our findings fill crucial gaps of how the distributions of enteropathogens change across China in patients with diarrhea. This allows enhanced identification of the predominant diarrheal pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures.

Status and disparities of diabetes among urban and rural residents aged 40 years and older: insight from a population-based study in northeast China, 2017-2019.

OBJECTIVES: To evaluate the up-to-date epidemiology of diabetes in northeast China. METHODS: The cross-sectional study was conducted between September 2017 and March 2019 using a multistage, stratified and cluster random sampling method. 18 796 participants (28.9% urban and 71.1% rural) aged ≥40 years were enrolled. Diabetes and pre-diabetes were diagnosed according to the history, fasting plasma glucose (FPG) and glycosylated haemoglobin A1c (HbA1c) levels. RESULTS: The prevalence of diabetes was 17.1%, higher in urban than in rural residents (20.2% vs 15.8%, p<0.001). Meanwhile, the prevalence of pre-diabetes was 44.3%, higher in rural than in urban areas (49.4% vs 31.8%, p<0.001). The overall FPG and HbA1c were 6.10±1.94 mmol/L and 5.59%±1.08%. The FPG level was higher in rural area than in urban areas (6.15±1.83 mmol/L vs 5.97±2.18 mmol/L, p<0.001). Among participants with diabetes, 47.5% were aware of their diabetes condition; 39.5% were taking antidiabetic medications and 36.8% of people had their diabetes controlled. The awareness and treatment rates in rural areas were lower than those in urban areas (47.3% vs 57.5%, 34.4% vs 49.5%, p<0.001). Patients with diabetic, especially those in rural areas, tended to have multiple risk factors including hypertension (71.7%), overweight or obesity (69.6%) and dyslipidaemia (52.8%). CONCLUSION: A considerable burden of diabetes was observed in northeast China, with high percentage of untreated diabetes, high prevalence of pre-diabetes, high overall FPG level and multiple uncontrolled risk factors in patients with diabetics. Therefore, region-specific strategies on prevention and management of diabetes should be emphasised.

Epidemiology of dyslipidemia and associated cardiovascular risk factors in northeast China: A cross-sectional study.

BACKGROUND AND AIMS: Management of dyslipidemia remains the cornerstone for prevention of cardiovascular diseases. We aimed to evaluate the epidemiology of dyslipidemia in northeast China. METHODS AND RESULTS: This cross-sectional survey was administered on 18,796 participants aged ≥40 years from September 2017 to March 2019 through a multistage, stratified, and cluster random sampling method. Lipid profiles were proposed by National Cholesterol Education Program Adult Treatment Panel III. The crude prevalence of dyslipidemia was 35.8%, higher in urban and women than their counterparts (49.5% vs 30.2%, 37.6% vs 33.0%, p < 0.001). The age-standardized prevalence of dyslipidemia was 34.0% (urban 47.9%, and rural 28.9%; men 36.2%, and women 33.4%). The prevalence of high total cholesterol (TC), high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) were 14.2%, 17.7%, 5.7% and 11.4% respectively. Noticeably, the prevalence of high LDL-C and low HDL-C in urban areas showed a 2.2-fold and 6.3-fold increase over the rural areas (9.3% vs 4.2% and 28.4% vs 4.5%, respectively). Among participants with dyslipidemia, 14.7% were aware of their condition; 5.9% were taking lipid-regulating medications; and only 2.9% had their dyslipidemia controlled. Comorbidities including hypertension (63.6%), and diabetes (25.2%) were highly prevalent in patients with dyslipidemia, however, the control rates of those comorbidities were only 40.0% and 6.6%. CONCLUSIONS: Patients with dyslipidemia showed high cardiovascular burden with low control rates of dyslipidemia, high prevalence of coexisting risk factors. Therefore, region- and sex-specific strategies to manage dyslipidemia and related risk factors should be highlighted.

Current heterosexual marriage is associated with significantly decreased levels of anxiety symptoms among Chinese men who have sex with men.

BACKGROUND: The high heterosexual marriage rate could be a 'double-edge' sword for the emotional health of Chinese men who have sex with men (MSM). The aim of this study was to determine if current marriage and breakdown of marriage (divorce) have different effects on the mental health of Chinese MSM. METHODS: Eight hundred seven MSM were recruited using respondent-driven sampling from four cities in northeastern China. Gay-related stressful events (GRSE) were measured using the Gay Related Stressful Life Events Scale; social support was measured by the Social Support Rating Scale (SSRS); and depressive and anxiety symptoms were assessed using the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), respectively. RESULTS: Of the study participants, 13.4% were married to women and 4.5% were divorced. The rates of marriage or divorce were 35.3 and 75.8% for participants 30-39 and > 40 years of age, respectively. The current married MSM had the highest SDS (50.0 ± 10.9) and SSRS (35.8 ± 8.6) levels, but the lowest SAS (38.7 ± 12.1) levels. Divorced MSM had the highest SAS (44.4 ± 9.6) and lowest SSRS (30.8 ± 8.1) levels. Age, GESE number, and HIV infection were predictors for SDS and SAS, and current marriage was associated with significantly decreased level of SAS (ß = - 0.136, P = 0.001) based on multiple linear analysis. CONCLUSIONS: Current marriage is associated with significantly decreased levels of anxiety symptoms among Chinese MSM. More studies are needed to understand the mechanisms underlying the effects of different marriage status on the emotional distress of Chinese MSM.

Prevalence of dyslipidemia and its influencing factors in rural residents aged 40 years and over in Liaoning Province / 预防医学

Objective@#To understand the prevalence and influencing factors of dyslipidemia in the residents aged 40 years and over in the rural areas of Liaoning Province,so as to provide basis for the development of targeted prevention and control measures.@*Methods@# From September 2017 to May 2018,by stratified cluster random sampling method,the residents aged 40 years or above from 19 villages in Liaoning Province were selected. Demographic features,height,weight,blood pressure and lipid level were collected. A logistic regression model was applied to explore the influencing factors for dyslipidemia.@*Results@#A total of 10 926 residents were recruited,with an average age of （59.97±10.08）years. The crude and standardized prevalence rate of dyslipidemia was 30.96% and 29.68%. The results of multivariate logistic regression analysis showed that women（OR=1.323,95%CI：1.189-1.473）,50-69 years old（OR：1.238-1.333,95%CI：1.075-1.523）,a high school education or below（OR：0.585-0.635,95%CI：0.439-0.842）,hypertension（OR=1.398,95%CI：1.273-1.534）,diabetes（OR=2.137,95%CI：1.918-2.381）,overweight or obesity（OR=2.101,95%CI：1.916-2.303）, meat-based meals（OR=1.306,95%CI：1.144-1.492）and vegetables intake less than 5 days a week（OR：1.169-1.387,95%CI：1.004-1.796） were associated with dyslipidemiais.@*Conclusions @# The prevalence rate of dyslipidemia was 30.96% in the rural residents aged 40 years and over in Liaoning Province. People who were females,who were 50-69 years old,and who suffered from hypertension,diabetes,overweight or obese,might take their lipid levels into consideration.

Direct detection from clinical sputum samples to differentiate live and dead Mycobacterium Tuberculosis.

BACKGROUND: In this study, we aimed to optimize the condition of propidium monoazide (PMA) treatment for direct detection of Mycobacterium tuberculosis (MTB) from clinical specimens. METHODS: The light exposure time, dark incubation time, bacterial load, and PMA concentration were varied to determine the optimal condition of PMA treatment. RESULTS: Overall, the maximum ΔCq value was observed in the group receiving a light exposure time of 20 minutes, which was significantly higher than the others (P < 0.05). The prolongation of dark incubation time seemed more likely to result in greater ΔCq value, and the ΔCq values were 2.0, 4.1, 6.5, 10.1, and 12.7 cycles under dark incubation time of 10, 20, 40, 60, and 120 minutes, respectively. Alternatively, the 4+ samples exhibited favorable detection results at the application of 104 -fold dilution by PMA assay with Cq values higher than 35 cycles. Further evaluation revealed that the PMA assay showed an accordance rate of 98.0% (98/100) among clinical sputa. CONCLUSIONS: we develop an acceptable method to directly identify the live bacteria from sputum samples. Our data demonstrate that the dark incubation plays a crucial role in the efficacy of PMA treatment for MTB.

Analysis of Requirements for Developing an mHealth-Based Health Management Platform.

BACKGROUND: Studies have consistently shown that mobile and Web-based apps have positive impacts on people's daily lifestyles, health management, and disease treatment. As the development of medical and health informatization in China has evolved, different kinds of mobile-based apps for individuals and hospitals have been developed by software vendors. However, doubts and challenges posed by the media have prevented these apps from having a stable and substantial user base. Analyses of user requirements have not typically been performed prior to the design of such mobile apps. The health information government authority in Liaoning Province, China, was planning to establish a mobile health (mHealth)-based health management platform, aiming to alleviate the difficulties citizens have in seeking hospital services. OBJECTIVE: The goal of this study was to determine the actual health and medical needs of citizens that may be addressed by medical information technologies. The results may contribute to the functional design and development of health management and appointed treatment-oriented mobile apps. METHODS: In this study, a semi-structured questionnaire on mHealth requirements was designed and tested, and 240 questionnaires were given to the outpatients of the First Hospital of the China Medical University in Shenyang, Liaoning Province, China; of these, 228 valid responses were collected, for a response rate of 95%. We discussed the current development of mHealth with 50 related experts and engineers from health authorities and a medical information company. SPSS 13.0 was used for statistical analyses. RESULTS: After detailed analyses of the questionnaire data, several findings were evident: first, most citizens and patients were unclear about their health conditions (64.5%, 147/228) and were interested in receiving a mobile app as a tool to manage their health and medical needs (71.1%, 162/228). Patients in different outpatient departments had different opinions regarding online registration. Conversely, the main problems for outpatients were long waiting times (66.4%, 148/223) and difficulties in making appointments (46.5%, 106/228), and they also worried about payments and Internet problems when using a mobile app for appointment reservations. Furthermore, as the main service target of mHealth is the health management of the general population, we first need to solve the associated interoperability and data security problems associated with such apps. CONCLUSIONS: This study provides insight into the health and medical requirements of smartphone apps, and draws attention to some of the challenges and opportunities of mHealth. We suggest several value-added features and characteristics that app developers should take into consideration when developing health and medical-related apps. The findings also highlight some major challenges that require further consideration and research to ensure that these apps meet the core needs of patients and aid the development of the health information system in Liaoning Province, China.