[The event of acute hepatitis of unknown etiology in children].

Recently, the cases of acute hepatitis of unknown etiology (AHUE) in children worldwide have been increasing continuously and rapidly, involving more than 396 cases in 26 countries, and global public health actions, including surveillance, health alerts, research, are being implemented. AHUE mainly affects immunocompetent children with typical acute hepatitis, which can be severe and require liver transplantation. There are few systematic studies at present; the risk factors are unknown, the etiology remains to be established, and the clinical features and pathogenesis remain elucidated. It is urgent to strengthen the monitoring and research of AHUE cases.

[Research progress of micronucleus visualization analysis and artificial intelligence detection strategy].

The micronucleomics test can comprehensively display a variety of harmful endpoints, such as DNA damage and repair, chromosome breakage or loss and cell growth inhibition, with fast, simple and economical feature. Micronucleomics is not only widely used in the comprehensive assessment of the types and modes of genetic action of exogenous chemicals (such as drugs, food additives, cosmetics, environmental pollutants, etc.), but also plays an important role in the screening and risk assessment of cancer population at high risk. However, the traditional micronucleomics image counting method has the characteristics of time-consuming, low accuracy, and high cost, which cannot meet the current analysis requirements of large-scale, multi-index, rapidity, high precision and visualization. In recent years, with the rapid development of the era of precision medicine based on big data, visualized analysis of new micronucleomics based on machine learning and detection strategies based on deep learning have shown a good application prospect. This review, based on the application value of micronucleomics, systematically compares the traditional and new artificial intelligence counting of micronucleus images, and discusses the future direction of micronucleus image detection.

[Influence of oxidative/antioxidative biomarkers and inflammatory cytokines on rats after sub-acute orally administration of titanium dioxide nanoparticles].

OBJECTIVE: To evaluate the sub-acute oral effect of titanium dioxide (TiO2) nanoparticles on the oxidation/antioxidation biomarkers and inflammatory cytokines in blood, liver, intestine, and colon in rats. METHODS: Twenty four 4-week-old clean-grade Sprague Dawley (SD) rats were randomly devided into 4 groups by body weight (n=6, control, low, middle, and high), in which the rats were orally exposed to TiO2 nanoparticles at doses of 0, 2, 10 and 50 mg/kg body weight/day for 28 consecutive days separately. Food intake, body weight and abnormal behaviors during the experiment were recorded. The rats were euthanized on the 29th day. The blood was collected via abdominal aortic method and centrifuged to collect the serum. Tissues from liver, intestine and colon were collected and homogenated. Then enzyme-linked immunosorbent assay (ELISA) and microwell plate methods were used to detect oxidation/antioxidation biomarkers including superoxide dismutase (SOD), glutathione (GSH), glutathione peroxidase (GSH-Px), total mercapto (T-SH), glutathione disulfide (GSSG), malomdialdehvde (MDA) and inflammatory cytokines including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in the serum, liver, intestine and colon in the rats. RESULTS: Compared with the control group, no significant differences in body weight, food intake and organ coefficients were observed in all the three groups after TiO2 gavage. No significant changes in GSH, GSH-Px, T-SH, and IL-6 were observed. Compared with the control group, significant increase of SOD activity in serum in high dose group, signi-ficant increase of GSSG concentration in intestine in middle and high dose group and significant increase of MDA concentration in liver in low and high dose group were observed. Compared with the control group, a significant increase of TNF-α in liver in middle and high dose group was observed. CONCLUSION: TiO2 nanoparticle can increase antioxidant enzymes activities in blood, increase oxidative biomarkers in liver and intestine, increase inflammatory cytokines in liver in rats after a 28-day sub-acute orally administration. Among blood, liver, intestine, and colon, liver is most sensitive to the toxicity induced by TiO2 nanoparticles, followed by intestine, blood, and colon in sequence.

Red blood cell distribution width is an independent predictor of mortality for an acute exacerbation of COPD.

BACKGROUND: The prognostic role of the red blood cell distribution width (RDW) on an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is incompletely understood.OBJECTIVE: To investigate the effect of the RDW on in-hospital and 1-year mortality after an AECOPD.DESIGN: For 442 AECOPD patients, the RDW was measured and clinical characteristics, comorbidities and laboratory measurements were recorded. The RDW that discriminated survivors and non-survivors was determined using a receiver operator characteristic (ROC) curve. The risk factors for in-hospital and 1-year mortality were identified through logistic regression analysis and Cox regression analysis, respectively.RESULTS: Of 442 study patients, 31 died, and 411 survived while in hospital. The area under the ROC curve for RDW for in-hospital death was 0.726 (95%CI 0.631-0.822), with sensitivity of 0.71 and specificity of 0.64 for a cut-off point of 13.75%. An RDW ≥13.75% was a risk factor for in-hospital mortality (relative risk 4.30, 95%CI 1.98-9.58; P < 0.001). Univariate and multivariate Cox regression analysis showed that an RDW ≥13.75% was an independent risk factor for death at 1 year (univariate analysis, hazard ration [HR] 2.33, 95%CI 1.55-3.51; multivariate analysis, HR 1.64, 95%CI 1.08-2.50).CONCLUSION: The RDW was a strong and independent risk factor for in-hospital and 1-year death for AECOPD patients.

[Early effects of low-level long-term occupational chromate exposure on workers'health].

OBJECTIVE: To explore the effects of low-level long-term occupational exposure to chromate on the health of workers, and the potential biomarkers of early health effects in terms of lung function, immune toxicity and genetic damage. METHODS: A total of 22 chromate contact workers and 44 non-chromate contact workers from an electroplating enterprise with long-term occupational environment monitoring in line with the national standards in Inner Mongolia were investigated. The questionnaire survey was conducted to collect the basic situation, the history of smoking, drinking, diseases and so on. The portable lung function instrument, inductively coupled plasma mass spectrometry and cytokinesis-blocked micronucleus test were performed to measure the chromate contact workers'lung function, whole blood Cr (WB-Cr) and micronuclei frequency (MNF) of peripheral blood lymphocytes respectively. The cytometric bead array was used to detect the levels of IL-1ß, IL-6, IL-8, IL-10, IL-12P70 and TNFα in the serum among the two groups. The effects of chromate exposure on the above-mentioned indexes involved biological exposure, lung function, immune response and genetic damage, and their correlation were analyzed with different statistical methods. RESULTS: (1) the average length of service for chromate contact workers was 31 years, and their concentration of WB-Cr was 1.11-4.19 µg/L. They were divided into high and low exposure groups according to the median of 1.72 µg/L. The WB-Cr in the high exposure group (2.17 µg/L) was higher than that in the low exposure group (1.58 µg/L) as well as the reference value of the healthy population (1.74 µg/L, P<0.05); (2) the lung function test showed 10 (45.45%) chromate exposure workers had single or multiple abnormal lung function indexes, among which large airway injury index PEF, and small airway injury indexes MVV and FEF25%-75% were all negatively correlated with WB-Cr (r=-0.53, P<0.05; r=-0.52, P<0.05; r=-0.44, P<0.05); (3) IL-1ß, IL-6, IL-8 and TNFα in the serum of chromate contact workers were higher than those in the control group (P<0.05), and there was a positive correlation between TNFα and WB-Cr, and among these cytokines (P<0.05); (4) the average lymphocyte MNF in chromate contact workers was 1.341%, higher than the reference value of the general population (0.436%, P<0.01). Poisson regression analysis showed MNF in thehigh exposure group was higher than that in the low exposure group, OR (95%CI) =1.323 (1.049, 1.669); (5) multiple linear regression analysis showed that the lung function index FEF25%-75% decreased with the increase of TNFα (P<0.05), no significant correlation was found between other cytokines, MNF and lung function indexes. CONCLUSION: Long-term low-level occupational exposure to chromate can cause the decline of lung function, immune inflammatory reaction and genetic damage in workers, in which local or systemic inflammatory response is associated with decreased lung function. Lung function indexes PEF, FEF25%-75% and MVV, serum cytokines IL-1ß, IL-6, IL-8, and TNFα, and peripheral blood lymphocyte MNF may be used as early health effects biomarkers of chromate exposure.

[The PRECIS-2 tool: designing trials that are fit for purpose].

To evaluate the intervention effects of randomized controlled trials (RCT) involved in theoretical efficacy and actual clinical outcome (effectiveness). Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) is a tool to help researchers make decisions in study design which is consistent with the intended purpose of their trial which can be used in the design of RCT to balance the internal validity and external validity. The role of PRECIS has been gradually recognized in the practice of designing clinical trials. To ensure that the design choices are concordant with the intention and the facilitation of use set by patients, clinicians and policy makers, a new PRECIS-2 tool has been developed by mangy international team experts under modification and upgrading the existing PRECIS. The PRECIS-2 tool mainly focuses on trial design choices which determining the applicability of a trial. PRECIS-2 has nine domains, with each of them intends to help the researchers consider the consequences of that design decision in terms of the applicability of the results under particular setting. The purpose of this paper is to introduce the development, basic principle, characteristics and application of PRECIS-2 for the designers and decision makers when working on clinical trials.

[Biomonitoring application in the exposome assessment].

Biomonitoring can be applied to assess internal exposure and environmental exposure by exposure markers with providing internal exposure to biological characterization and individual exposure information, which is a key tool to evaluate the risk exposure to disease by biological alternation information. With the development of high throughput, broad spectrum and high efficiency screening and detection technology, biomonitoring is defined as traditional biological monitoring (targeted monitoring) and non targeted monitoring analysis (exposomic approaches). An exposomic approach differs from traditional biomonitoring in that it can theoretically include all exposures of potential health significance, whether they are derived from exogenous sources. Both traditional and nontraditional biomonitoring methods should be used to understand the complexity of exposures faced throughout the lifespan. Through hybrid approaches, emerging techniques and the integration of bioinformatics, and developing the detection methods for low abundance chemicals, improving the differentiation ability between endogenous and exogenous chemical, the health outcomes and exposures can be widely recognized and characterized, which can finally contribute to improving the precise prevention and intervention for diseases under the new exposomic model.

[Effects on human peripheral erythrocytes of long-term occupational contact with chromate].

Objective: To investigate the effects on human peripheral blood erythrocytes of long-term occupational contact with chromate. Methods: A dynamic cohort study was conducted of chromate-exposed workers (343 cases) and non-chromate-exposed workers (73 cases) at a chromate production enterprise who were selected according to specific inclusion and exclusion criteria from 2010 to 2015. Personal information and chromate exposure information were obtained by questionnaire. A generalized estimating equation was employed to analyze the effects on human peripheral blood erythrocytes of long-term occupational contact with chromate, controlling for age, gender, smoking, alcohol consumption and body mass index. Results: The mean ages and working ages of those entering the cohort study were 36.67 ±6.78 and 38.47 ± 7.18, respectively, for the exposure group and 8.39 ± 6.02 and 12.86 ± 8.34, respectively, for the control group. The erythrocyte content [(4.73±0.46), (4.81±0.53), (4.41±0.45)]×1012/L in the peripheral blood in the chromate exposure group was lower than that [(4.76±0.42), (4.95±0.45), (4.47±0.39)]×1012/L in the control group for the years 2010, 2011, 2012 and 2014 (t values were 0.38, 1.96, 0.92 and 1.21; P values were 0.703, 0.051, 0.358 and 0.227, respectively). The correlations between the years 2010 and 2011, 2011 and 2012, 2012 and 2014, and 2014 and 2015 were 0.667, 0.464,-0.070 and 0.020, respectively (P<0.001). The RR for males and those that consumed alcohol were 0.661 (95% CI: 0.616-0.709) and 0.910 (95% CI: 0.811- 1.201), respectively. Compared with the control group, the risk of reduced erythrocyte levels in the peripheral blood was increased by 0.915 (95% CI: 0.852- 0.982) in the chromate-exposed group. Conclusions: The erythrocyte content of peripheral blood was reduced after long-term exposure to chromate. Maleness and alcohol consumption were factors that increased the risk of reduced peripheral blood erythrocytes in the chromate-exposed population.

[Hot research topics on cardiovascular diseases in occupational population: a bibliometric analysis].

Objective: To investigate the literature characteristics and research topics on cardiovascular diseases in the occupational population quantitatively via a bibliometric analysis, and to provide a reference for the selection of research directions. Methods: A search strategy was developed according to the words in Medical Subject Heading (MeSH) , and PubMed database was searched for articles on cardiovascular diseases in the occupational population published from 2006 to 2015. The information of published year, authors, journals, and MeSH words was extracted, frequently used MeSH words were screened out, and a cluster analysis was performed for frequently used MeSH words. Results: A total of 1 272 articles were found, and about 150 articles were published annually from 2011 to 2015. Most articles were published in Occupational and Environmental Medicine, and the author Tohr Nilsson had the highest number of published articles. The influencing factors mainly included occupational mental stress, smoking, and working system, and the health outcomes attracting the most attention were hypertension, hand-arm vibration, ischemic heart disease, and myocardial infarction. The articles were clustered into 5 types, and 5 hot topics were summarized. Conclusion: The bibliometric analysis of cardiovascular diseases in occupational population shows that hypertension and hand-arm vibration are hot research topics, which can provide a reference to researchers.

Development and validation of a chronic obstructive pulmonary disease screening questionnaire in China.

OBJECTIVE: To develop a brief, reliable screening questionnaire for chronic obstructive pulmonary disease (COPD) for use in primary care settings. METHODS: We developed a COPD Screening Questionnaire (COPD-SQ) using data collected from 19,800 subjects aged ≥40 years obtained from an epidemiological study of COPD in China in 2002 (Phase I). A stepwise logistic regression method was adopted for item reduction and scoring. We then assessed the COPD-SQ through a cross-sectional study (Phase II) among 3231 subjects aged ≥40 years. RESULTS: The final COPD-SQ consisted of seven items: age, smoking pack-years, body mass index, cough, dyspnoea, family history of respiratory diseases and exposure to biomass smoke from cooking. Using the questionnaire to screen for COPD in Phase II, we obtained high classification accuracy with an area under the curve of 0.812 (95%CI 0.786-0.838). The sensitivity, specificity and correct classification rates for COPD diagnosis were respectively 60.6%, 85.2% and 82.7% at a cut-off score of 16. CONCLUSIONS: The COPD-SQ can be used in first-level screening for COPD.

Chemical characterization of rainwater at Singapore.

A short term study of the chemical composition of rainwater was carried out from November 1999 to October 2000 in Singapore. The rainwater was typically acidic with a mean pH of 4.2. Sulfate was the most abundant ion and comparable to the results reported for other industrialized regions. The concentrations of major ions (NH(4)(+), Ca(2+), K(+), Na(+), Mg(2+), SO(4)(2+), NO(3)(2-), Cl(-), HCOO(-), CH(3)COO(-)) varied monthly. Results show that local meteorological conditions influence the chemical compositions to a significant extent. The pollutants in rainwater were derived from long range and local (industry and traffic) sources.