[Pollution Characteristics and Health Risk Assessment of Heavy Metals in the Water of Lijiang River Basin].

In order to clarify the pollution levels of heavy metals in the drinking water sources of the Lijiang River Basin, surface water samples were collected from 62 sites throughout the Lijiang River during May 2019. Heavy metals, including As, Cd, Cr, Mn, Cu, Zn, Hg, Co, and Sb, in the water samples were analysed. Health risk assessments associated with these nine heavy metals were conducted using the health risk assessment model from the US EPA. The results indicated that the order of the average concentrations of heavy metals in the water samples were Mn > Zn > As > Cr > Cu > Sb > Co > Cd > Hg. No heavy metals exceeded the limit values of the drinking water health standards in China (GB 5749-2006), and the concentrations were lower than the limitations of Grade Ⅰ level in the environmental quality standards for surface water (GB 3838-2002). According to the spatial distribution, the high contents areas of As, Cr, Zn, and Sb were predominantly distributed downstream of the Lijiang River, while the high contents areas of Cd, Cu, Hg, Co, and Mn were mostly distributed in the upper reaches. Multivariate analysis indicated that Cd, Mn, Cu, and Co were primarily from agricultural production; Cr, Zn, and Sb were mainly from tourism transportation; As was predominantly from the weathering of rock parent material and soil erosion; Hg was mainly from the improper disposal of domestic garbage and atmospheric deposition. The results of the health risk assessment indicated that children were more susceptible to the threat of heavy metal pollution than adults, and the average annual risk of carcinogenic heavy metals to human health through drinking water ingestion were higher than those of non-carcinogenic metals. The maximum personal average annual health risk of Cr was higher than the maximum allowance levels recommended by the International Commission on Radiological Protection (5×10-5 a-1). The average annual risk of non-carcinogenic heavy metals (10-14-10-9 a-1) decreased in the order of Co > Cu > Hg > Zn > Sb > Mn, which were far below the maximum allowance levels recommended by the ICRP.

Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non-inferiority, phase III trial.

BACKGROUND AND AIM: Remimazolam tosilate (RT) is a new short-acting GABA(A) receptor agonist, having potential to be an effective option for procedural sedation. Here, we aimed to compare the efficacy and safety of RT with propofol in patients undergoing upper gastrointestinal endoscopy. METHODS: This positive-controlled, non-inferiority, phase III trial recruited patients at 17 centers, between September 2017 and November 2017. A total of 384 patients scheduled to undergo upper gastrointestinal endoscopy were randomly assigned to receive RT or propofol. Primary endpoint was the success rate of sedation. Adverse events (AEs) were recorded to evaluate safety. RESULTS: The success rate of sedation in the RT group was non-inferior to that in the propofol group (97.34% vs 100.00%; difference in rate -2.66%, 95% CI -4.96 to -0.36, meeting criteria for non-inferiority). Patients in the RT group had longer time to adequate sedation (P < 0.0001) but shorter time to fully alert (P < 0.0001) than that in the propofol group. The incidences of hypotension (13.04% vs 42.86%, P < 0.0001), treatment-related hypotension (0.54% vs 5.82%, P < 0.0001), and respiratory depression (1.09% vs 6.88%, P = 0.0064) were significantly lower in the RT group. AEs were reported in 74 (39.15%) patients in the RT group and 114 (60.32%) patients in the propofol group, with significant difference (P < 0.0001). CONCLUSION: This trial established non-inferior sedation success rate of RT compared with propofol. RT allows faster recovery from sedation compared with propofol. The safety profile is favorable and appears to be superior to propofol, indicating that it was feasible and well tolerated for patients.

D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study.

Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission (within 48 hours after initial hemorrhage) and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.

Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta-analysis.

OBJECTIVE: Previous systematical reviews showed that systemic magnesium decreased postoperative pain and reduced morphine use without any reported serious adverse effects in adults. However, studies in children yielded different results. So we conducted a systematic review to evaluate the impact of magnesium sulfate on postoperative complications in children undergoing tonsillectomies. METHODS: The PubMed, EMbase via OVID, CENTRAL, and WHO ICTRP were searched to identify randomized controlled trials that addressed the effect of magnesium for postoperative pain, agitation, and complications in children undergoing tonsillectomies. Two reviewers screened titles and abstracts for eligibility and assessed the quality of the included studies. The meta-analysis was performed using RevMan 5.3. RESULTS: Ten randomized controlled trials involving 665 participates published between 2003 and 2015 were included. Eight studies showed no different effect on pain scores between MgSO4 and control groups. Two studies showed significant lower emergence agitation incidence in MgSO4 group (pooled OR = 0.18, 95% CI 0.07 to 0.48, P = 0.0006). Five studies showed rescue analgesia was reduced in MgSO4 group (RR = 0.53, 95% CI 0.31 to 0.91, P = 0.02). Laryngospasm was founded lower in MgSO4 group (OR = 0.36, 95% CI 0.13 to 0.96, P = 0.04). Postoperative nausea and vomiting was found no difference between two groups (OR = 1.23, 95% CI 0.70 to 2.18, P = 0.47). CONCLUSION: Unlike the studies in adults, this review shows there is no statistically significant effect of perioperative use of magnesium in the postoperative pain control in children undergoing tonsillectomies. But it seems has benefits in reducing rescue analgesia, emergence agitation incidence, and laryngospasm.

[Effect of magnesium sulphate infusion on emergence agitation in patients undergoing esophageal carcinoma with general anesthesia: a randomized, double-blind, controlled trial].

OBJECTIVE: To evaluate the safety and effectiveness of magnesium sulphate for reducing the incidence of the emergence agitation in patients undergoing surgery for esophageal carcinoma with general anesthesia. METHODS: This randomized, double-blind, controlled clinical trial was conducted in patients undergoing elective radical resection of esophageal carcinoma in Sichuan Provincial People's Hospital between October, 2015 and March, 2016. The patients underwent surgeries under general intravenous anesthesia, and after anesthesia induction, the patients were infused with magnesium sulphate at the rate of 0.1 mL·kg-1·h-1 (2.5 g magnesium sulphate in 50 ml saline pumped at 5 mg·kg-1·h-1) or saline (control group) at the same speed until the end of the surgery. The Riker's sedation agitation scale, pain score, muscle tension score, extubation time, residence time in the postanesthesia care unit (PACU), and adverse reactions were recorded. RESULTS: A total of 108 patients were enrolled including 57 in magnesium sulphate group and 51 in the control group. Riker's sedation agitation scale in the PACU, pain score, and muscle tension score were all significantly lower but the extubation time was longer in magnesium sulphate group than in the control group (P<0.05). In all the patients, blood Ca2+ level was reduced significantly after the operation; blood Mg2+ level was significantly lowered postoperatively in the control group, and the postoperative Mg2+ level was significantly higher in magnesium sulphate group than in the control group (P<0.05). Mg2+ level underwent no significant variations in magnesium sulphate group after the operation (P>0.05). The residence time in the PACU, postoperative Riker's sedation agitation scale score, and blood K+ level were all similar between the two groups(P>0.05). CONCLUSION: Infusion of magnesium sulphate at 5 mg·kg-1·h-1 can significantly reduce the incidence of emergence agitation in patients undergoing esophageal carcinoma under general anesthesia without causing such complications such as muscle recovery delay or electrolyte disorder.