Development and validation of a prediction model for suboptimal ovarian response in polycystic ovary syndrome (PCOS) patients undergoing GnRH-antagonist protocol in IVF/ICSI cycles.

BACKGROUND: PCOS patients with unexpectedly low oocyte yield following conventional ovarian stimulation are referred to as suboptimal responders. However, identifying suboptimal responders presents a significant challenge within reproductive medicine and limited research exists on the occurrence of suboptimal response. This analysis aimed to develop a predictive model of suboptimal response during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments in PCOS patients. METHODS: This retrospective study involved a cohort of 313 PCOS patients undergoing their first IVF/ICSI cycle from 2019 to 2022. Univariate logistic regression analyses, least absolute shrinkage, selection operator regression analysis, and recursive feature elimination were employed to identify relevant characteristics and construct predictive models. Moreover, a nomogram was constructed based on the best model. Receiver operating characteristic curves, decision curve analysis (DCA), and calibration curves were used to evaluate the model. RESULTS: The predictors included in the model were age, Anti-Mullerian hormone, antral follicle count, and basal follicle-stimulating hormone. The area under the receiver operating characteristic curve (AUC) was 0.7702 (95% confidence interval 0.7157-0.8191). The AUC, along with the DCA curve and calibration curve, demonstrated a satisfactory level of congruence and discrimination ability. CONCLUSION: The nomogram effectively predicted the probability of suboptimal response in PCOS patients undergoing gonadotropin-releasing hormone antagonist protocol during IVF/ICSI treatment.

A multi-ancestry cerebral cortex transcriptome-wide association study identifies genes associated with smoking behaviors.

Transcriptome-wide association studies (TWAS) have provided valuable insight in identifying genes that may impact cigarette smoking. Most of previous studies, however, mainly focused on European ancestry. Limited TWAS studies have been conducted across multiple ancestries to explore genes that may impact smoking behaviors. In this study, we used cis-eQTL data of cerebral cortex from multiple ancestries in MetaBrain, including European, East Asian, and African samples, as reference panels to perform multi-ancestry TWAS analyses on ancestry-matched GWASs of four smoking behaviors including smoking initiation, smoking cessation, age of smoking initiation, and number of cigarettes per day in GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN). Multiple-ancestry fine-mapping approach was conducted to identify credible gene sets associated with these four traits. Enrichment and module network analyses were further performed to explore the potential roles of these identified gene sets. A total of 719 unique genes were identified to be associated with at least one of the four smoking traits across ancestries. Among those, 249 genes were further prioritized as putative causal genes in multiple ancestry-based fine-mapping approach. Several well-known smoking-related genes, including PSMA4, IREB2, and CHRNA3, showed high confidence across ancestries. Some novel genes, e.g., TSPAN3 and ANK2, were also identified in the credible sets. The enrichment analysis identified a series of critical pathways related to smoking such as synaptic transmission and glutamate receptor activity. Leveraging the power of the latest multi-ancestry GWAS and eQTL data sources, this study revealed hundreds of genes and relevant biological processes related to smoking behaviors. These findings provide new insights for future functional studies on smoking behaviors.

Combining Classic and Novel Neutrophil-Related Biomarkers to Identify Non-Small-Cell Lung Cancer.

BACKGROUND: Recent studies have revealed that neutrophils play a crucial role in cancer progression. This study aimed to explore the diagnostic value of neutrophil-related biomarkers for non-small-cell lung cancer (NSCLC). METHODS: We initially assessed the associations between classic neutrophil-related biomarkers (neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil counts (NEU), absolute lymphocyte counts (LYM)) and NSCLC in 3942 cases and 6791 controls. Then, we measured 11 novel neutrophil-related biomarkers via Luminex Assays in 132 cases and 66 controls, individually matching on sex and age (±5 years), and evaluated their associations with NSCLC risk. We also developed the predictive models by sequentially adding variables of interest and assessed model improvement. RESULTS: Interleukin-6 (IL-6) (odds ratio (OR) = 10.687, 95% confidence interval (CI): 3.875, 29.473) and Interleukin 1 Receptor Antagonist (IL-1RA) (OR = 8.113, 95% CI: 3.182, 20.689) shows strong associations with NSCLC risk after adjusting for body mass index, smoking status, NLR, and carcinoembryonic antigen. Adding the two identified biomarkers to the predictive model significantly elevated the model performance from an area under the receiver operating characteristic curve of 0.716 to 0.851 with a net reclassification improvement of 97.73%. CONCLUSIONS: IL-6 and IL-1RA were recognized as independent risk factors for NSCLC, improving the predictive performance of the model in identifying disease.

Multi-omics analysis of lung tissue metabolome and proteome reveals the therapeutic effect of Shegan Mahuang Decoction against asthma in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Shegan Mahuang Decoction (SMD) is a classic traditional Chinese medicine (TCM) formula for asthma treatment, but the anti-asthma mechanism of SMD is still not fully studied. AIMS OF THE STUDY: In this study, we established an ovalbumin (OVA)-induced asthma rat model and treated it with SMD to observe its anti-asthma effect and explore the related mechanism. MATERIALS AND METHODS: We evaluated the anti-inflammatory effect of SMD via testing the levels of immunoglobulin E (IgE), C-reactive protein (CRP), interleukin-4 (IL-4), interleukin-6 (IL-6) in serum and performing the hematoxylin-eosin (H&E) staining of lung tissue slices. We analyzed the variations of metabolites and proteins in the lung tissue of different groups using liquid chromatography-mass spectrometry (LC-MS)-based untargeted metabolomics and TMT-based proteomics approaches. The metabolic biomarkers and differentially expressed proteins (DEPs) were picked, and the related signal transduction pathways were also investigated. In addition, the key proteins on the signaling pathway were validated through western blotting (WB) experiment to reveal the anti-asthma mechanism of SMD. RESULTS: The results showed that the SMD could significantly reduce the serum levels of IgE, CRP, IL-4, and IL-6 and attenuate the OVA-induced pathological changes in lung tissue. A total of 34 metabolic biomarkers and 84 DEPs were screened from rat lung tissue, which were mainly associated with lipid metabolism, nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation, the excessive production of reactive oxygen species (ROS), and lysosome pathway. Besides, SMD could inhibit the myeloid differentiation factor 88 (MyD88)/inhibitor of kappa B kinase (IKK)/nuclear factor-kappa B (NF-κB) signaling pathway to exhibit anti-inflammatory activities. CONCLUSIONS: SMD exhibited a therapeutic effect on asthma, which possibly be exerted by inhibiting the MyD88/IKK/NF-κB signaling pathway.

Exploring the in vitro anti-inflammatory activity of gross saponins of Tribulus terrestris L. fruit by using liquid chromatography-mass spectrometry-based cell metabolomics approach.

Our previous studies confirmed the efficacy of gross saponins of Tribulus terrestris L. fruit in treating cerebral ischemia. This study aimed to investigate the related mechanisms in vitro. The lipopolysaccharide-induced BV2 cells model was constructed and treated with gross saponins at different concentrations to explore its anti-inflammatory activity. The cell metabolite changes were tracked by liquid chromatography-mass spectrometry (LC-MS)-based metabolomics, and the metabolic biomarkers and related metabolic pathways were analyzed. Molecular biochemistry analysis was further used to verify the relevant inflammatory pathways. The results showed that the saponins reduced nitric oxide release and the secretion of tumor necrosis factor-alpha, interleukin-1ß, and interleukin-6 from lipopolysaccharide-induced BV2 cells. Metabolic perturbations occurred in lipopolysaccharide-treated BV2 cells, which could be reversed by drug treatment via mainly regulating glycerophospholipid metabolism, tryptophan metabolism, purine metabolism pathways, etc. The western blot analysis demonstrated that saponin could suppress the activation of the inflammatory-related signaling pathway. The present study explored the in vitro anti-inflammatory mechanism of gross saponins of Tribulus terrestris L. fruit using an LC-MS-based cell metabolomics approach, which confirms the great potential of LC-MS for drug efficacy evaluation and can be applied in other herbal medicine-related analyses.

Assessment of source-oriented health risk associated with the oral ingestion of heavy metals in dust within an iron/steel smelting-affected area of the North China Plain.

Heavy metals (HMs) from iron/steel smelting activities pose notable risks to human health, especially to those living around industrial facilities of North China Plain, the base of China's steel production. In this study, 78 outdoor windowsill dust samples were collected around a large-scale iron/steel smelter with more than 65 years of production history in the western North China Plain. Nine HMs were analysed to comprehensively assess the health risks by integrating Monte Carlo simulation, oral bioaccessibility, and source apportionment. Results showed serious pollution with Cd, Pb, and Zn based on their geo-accumulation index values and concentrations. Four potential sources including industrial sources (49.85%), traffic sources (21.78%), natural sources (20.58%), and coal combustion (7.79%) were quantitatively identified by multivariate statistical analysis. The oral bioaccessibilities of HMs determined by the physiologically based extraction test ranged from 0.02% to 65.16%. Zn, Mn, Cd, and Pb had higher bioaccessibilities than other HMs. After incorporating oral bioavailability adjustments, noncarcinogenic and carcinogenic risks were significantly reduced, especially for adults. The mean hazard index (HI) for children and adults was below the safety threshold (1.0), whereas the mean of the total carcinogenic risk (TCR) based on HM bioaccessibilities in the gastric phase remained above the acceptable level (1.0E-06) (children: 5.20E-06; adults: 1.16E-06). Traffic sources warranted increased concern as it substantially increased TCR. Cd was identified as the priority pollution in iron/steel smelting areas. Assessing source-oriented health risks associated with oral ingestion exposure can guide the management and control of HM contamination within iron/steel smelting-affected areas.

A practical method for the retrieval of tulip-head polyaxial pedicle screw by reusing the rod in revision and implants removal surgery: introduction of technique and evaluation of clinical outcomes.

BACKGROUND: The removal of spinal implants is needed in revision surgery or in some cases whose fracture had healed or fusion had occurred. The slip of polyaxial screw or mismatch of instruments would make this simple procedure intractable. Here we introduce a simple and practical method to address this clinical dilemma. METHODS: This is a retrospective study. The patients underwent new technique for retrieving the implants from July 2019 to July 2022 were labeled as group A, while the patients underwent traditional implants retrieval technique from January 2017 to January 2020 were labeled as group B. Patients in each group were subdivided into revision surgery group (r group) and simple implants removal group (s group) according to the surgery fashion. For the new technique, the retrieved rod was cut off to a proper length which was matched with the size of tulip head, and was replaced into the tulip head. After tightened with nut, a monoaxial screw-rod "construct" was formed. Then the "construct" can be retrieved by a counter torque. The operation duration, intraoperative blood loss, post-operative bacteria culture, hospital stay and costs were analyzed. RESULTS: A total of 116 polyaxial screws with difficult retrieval (43 screws in group A, 73 screws in group B) in 78 patients were recorded, in which 115 screws were successfully retrieved. Significant differences were found in the mean operation duration, intraoperative blood loss when comparing the r group in group A and B, as well as the s group in group A and B (P < 0.05). There were no significant differences in hospital stay and costs between group A and B. Three patients were found positive bacteria culture of drainage tube/tape in group A (3/30), while 7 patients in group B (7/48). The most prevalent bacteria was Propionibacterium acnes. CONCLUSION: This technique is practical and safe in retrieving tulip head poly-axial screw. Reduced operation duration and intraoperative bloods loss may potentially alleviate the hospitalization burden of patients. Positive bacterial cultivation results are common after implants removal surgery, but they rarely represent an organized infection. A positive culture with P. acnes or S. epidermidis should be interpreted with caution.

Human Dietary Exposure to Heavy Metals via Rice in Nepal.

The effects of exposure to heavy metals (HMs) in rice on human health have become a global public health concern, particularly in countries where rice is consumed as a staple food. The concentrations of HMs, including cadmium (Cd), arsenic (As), lead (Pb), and copper (Cu), in commercial rice samples (n = 170) were analyzed to estimate the HM exposure of consumers in Nepal. The geometric mean concentrations of Cd, As, Pb, and Cu in commercial rice were 15.5 ± 16.0, 43.4 ± 19.6, 16.0 ± 14.0, and 1066 ± 1210 µg/kg, respectively, all below the maximum allowable concentrations (MACs) recommended by FAO/WHO. Generally, the average estimated daily intakes (EDIs) of Cd, As, Pb, and Cu were all below the oral reference doses (RfDs). However, young age groups were exposed to high levels of HMs, and the average EDI of As and the P99.9 EDIs of Cu and Cd were above the corresponding RfDs. The mean hazard index and total carcinogenic risk were 1.13 and 1.04 × 10-3 respectively, suggesting a potential non-carcinogenic risk (NCR) and a carcinogenic risk (CR) via rice consumption. Arsenic contributed the most strongly to NCR and Cd to CR. Overall, although the HM levels in rice were generally safe, the Nepalese population may be exposed to an elevated health risk from rice consumption.

Health risk assessment of heavy metals in road dust from the fourth-tier industrial city in central China based on Monte Carlo simulation and bioaccessibility.

Health risks caused by heavy metal (HM) exposure in road dust has attracted extensive attention, but few studies have focused on the health risks of residents living in small- and medium-sized cities with rapid industrialization and urbanization. Thus, 140 road dust samples were collected across Anyang, a typical fourth-tier industrial city in central China, which were analysed for 10 different HMs (Mn, Zn, Pb, V, Cr, As, Cd, Ni, Cu and Co). Monte Carlo simulation and bioaccessibility were used to quantify the health risks of heavy metals comprehensively in road dust. Results revealed a remarkable accumulation of Mn, Zn, Pb, Cd and Cu. According to the Geo-accumulation index and potential ecological risk index, Cd was priority control pollutant. Moreover, 55.0% of the road dust samples reached heavily polluted level, and 52.86% of the samples were at high ecological risk levels. These results illustrated that HM contamination was serious and universal in the road dust of Anyang. The occurrences of HMs were allocated to traffic emissions, natural sources, industrial activities and agricultural activities with contribution rates of 35.4%, 6.0%, 41.6% and 17.0%, respectively. Except for Zn in the gastric phase, all other HMs had relatively low bioaccessibilities in the gastrointestinal system, usually less than 20%. The bioaccessibilities of most HMs were higher in the gastric phase, except for Cr, Ni and Cu, which remained higher in the intestinal phase. The non-carcinogenic risk and carcinogenic risk were remarkably reduced when considering the HM bioaccessibilities in the gastrointestinal system, especially for adults. The outcomes of this paper are valuable for understanding HM contamination in road dust and highlight the importance of risk assessment for populations living in the fourth- and fifth-tier cities.

Integrated Insights into Source Apportionment and Source-Specific Health Risks of Potential Pollutants in Urban Park Soils on the Karst Plateau, SW China.

Polycyclic aromatic hydrocarbons (PAHs) and heavy metal(loid)s (HMs) pose risks to environmental and human health. Identification of priority control contaminants is important in guiding the management and control of these synchronous pollutants. A total of 247 soil samples were collected from 64 urban parks in the karst plateau city of Guiyang in SW China to determine the concentrations, spatial distributions, and health risks of PAHs and HMs. The results indicate that dibenz(ah)anthracene and benzo(a)pyrene are the main PAHs species of high ecological risk, and Cr, Mn, and Ni pose elevated ecological risk among the HMs. Four sources were identified for PAHs (biomass burning, coke oven, traffic sources, and coal burning) and HMs (traffic sources, coal burning, industrial sources, and natural sources). The non-carcinogenic risk (NCR) and total carcinogenic risk (TCR) of PAHs were all determined to be negligible and at acceptable levels, several orders of magnitude below those of HMs. The NCR and TCR values of HMs were relatively high, especially for children (11.9% of NCR > 1; 79.1% of TCR > 10-4). Coal burning and natural sources make the greatest contributions to the NCR and TCR values from karst park soils in Guiyang. Considering HMs bioavailability, NCR and TCR values were rather low, due to the high residual HM fractions. Integrated insights into source specific ecological and human health risk indicate future directions for management and control of synchronous PAH and HM pollution, particularly for karst plateau areas. Supplementary Information: The online version contains supplementary material available at 10.1007/s12403-023-00534-3.

Soluble Immune Checkpoint-Related Proteins in Blood Are Associated With Invasion and Progression in Non-Small Cell Lung Cancer.

Background: Immune checkpoint inhibition therapy has been achieved significant success in the treatment of non-small cell lung cancer (NSCLC). However, the role of soluble immune checkpoint- related proteins in NSCLC remains obscure. Methods: We evaluated the circulating levels of 14 immune checkpoint-related proteins panel (BTLA, LAG-3, GITR, IDO, PD-L2, PD-L1, PD-1, HVEM, Tim-3, CD28, CD27, CD80, CD137 and CTLA-4) and their associations with the risk of invasive disease and the risk of NSCLC in 43 pre-invasive (AIS), 81 invasive NSCLC (IAC) patients and matched 35 healthy donors using a multiplex Luminex assay. Gene expression in tumors from TCGA were analyzed to elucidate potential mechanisms. The multivariate logistic regression model was applied in the study. ROC(receiver operator characteristic) curve and calibration curve were used in the performance evaluation. Results: We found that sCD27, sCD80, CD137 and sPDL2 levels were significantly increased in IAC cases compared to AIS cases (P= 1.05E-06, 4.44E-05, 2.30E-05 and 1.16E-06, respectively), whereas sPDL1 and sPDL2 levels were significantly increased in NSCLC cases compared to healthy controls (P=3.25E-05 and 1.49E-05, respectively). Unconditional univariate logistic regression analysis indicated that increased sCD27, sCD80, sCD137, and sPDL2 were significantly correlated with the risk of invasive diseases. The model with clinical variables, sCD27 and sPDL2 demonstrated the best performance (AUC=0.845) in predicting the risk of IAC. CD27 and PDCD1LG2 (PDL2) showed significant association with cancer invasion signature in TCGA dataset. Conclusion: Our study provides evidence that soluble immune checkpoint-related proteins may associate with the risk of IAC, and we further established an optimized multivariate predictive model, which highlights their potential application in the treatment of NSCLC patients. Future studies may apply these biomarkers to test their predictive value of survival and treatment outcome during immunotherapy in NSCLC patients.

Discovery and Characterization of a New Crustin Antimicrobial Peptide from Amphibalanus amphitrite.

Crustins are an antimicrobial peptide (AMP) family that plays an important role in innate immunity in crustaceans. It is important to discover new AMPs from natural sources to expand the current database. Here, we identified and characterized a new crustin family member, named AaCrus1, from Amphibalanus amphitrite. AaCrus1 shares high identity (48.10%) with PvCrus, a Type I crustin of Penaeus vannamei that possesses a whey acidic protein (WAP) domain. AaCrus1 contains 237 amino acids and eight cysteine residues forming conserved 'four-disulfide core' structure. Our recombinant AaCrus1 (rAaCrus 1) could inhibit the growth of two Gram-positive bacteria (Staphylococcus aureus, Bacillus sp. T2) and four Gram-negative bacteria (Vibrio parahaemolyticus, Vibrio harveyi, Vibrio anguillarum, Vibrio alginolyticus) with a minimum inhibitory concentration of 3.5-28 µM. It can further induce agglutination of both Gram-positive and Gram-negative bacteria. rAaCrus1 can bind to bacteria and damage bacterial cell membranes. Furthermore, rAaCrus1 disrupted biofilm development of S. aureus and V. parahaemolyticus. Our discovery and characterization of this new crustin can be further optimized as a good alternative to antibiotics.

Prevalence and associated factors of infertility among 20-49 year old women in Henan Province, China.

BACKGROUND: Infertility is a reproductive health problem which affects not only individuals, families and social populations. Recently, the infertility rate in China has a trend of increase year by year, and few studies have reported the infertility rate in Henan Province, China. The aim of this study was to investigate the current prevalence and associated factors of infertility among women of childbearing age in Henan Province, China. METHODS: This cross-sectional study was conducted from March 2019 to October 2019. We sampled 765 women who were 20-49 years old in eight hospitals of four cities in Henan Province, China. This survey included a questionnaire, physical examination, vaginal ultrasound examinations, and serum anti-Mullerian hormone (AMH) assessment, all of which were conducted under uniform standards by trained personnel. According to the data collected from questionnaire, participants were divided into infertile and fertile groups and analyzed associated factors. RESULTS: Among all the 765 participants in this study, the prevalence of infertility was 24.58%. The prevalence of primary infertility was 6.54%, and the prevalence of secondary infertility was 18.04%. In logistic multivariate regression analyses, infertility was associated with age (p < 0.001), history of gynecological surgery (p < 0.001), sweet food (p = 0.003) and decreased ovarian reserve (DOR) (p < 0.001). After further analyses, factors associated with primary infertility were age of marriage (p = 0.006), age of first sexual intercourse (p = 0.003), long-term air-conditioning environment (p < 0.001), decreased ovarian reserve (p = 0.005) and age (p = 0.002). And factors associated with secondary infertility were history of gynecological surgery (p < 0.001), decreased ovarian reserve (p = 0.002), waist-to-hip ratio (WHR) above 0.85 (p = 0.043), delivery times (p = 0.001) and ages (p < 0.001). CONCLUSION: The prevalence of infertility among women aged 20-49 was 24.58% and only 61.17% infertile women sought medical help in Henan Province, China. Age, history of gynecological surgeries and DOR may increase the risk of infertility. Local public health departments and medical professionals need to discharge their duty of reducing the high incidence of infertility and protecting women's reproductive health.

Infertility prevalence rate has increased in the past 30 years. Infertility plagues thousands of women of childbearing age. Although not life-threatening, the detrimental influence of infertility to patients, their families, and society should not be underestimated, especially in China. In order to investigate the prevalence of infertility, determine the associated factors, and promote disease prevention and treatment, we conducted a cross-sectional study among 20­49 year old women in Henan, one of the central provinces of China.This study distributed 920 questionnaires and collected 803 completed questionnaires. Interviews, questionnaires, and physical and ultrasound examinations were done.Among all the 765 participants in this study, the prevalence of infertility was 24.58%. The prevalence of primary infertility was 6.54%, and the secondary infertility was 18.04%. Age, history of gynecological surgeries and DOR may increase the risk of infertility.In conclusion, among women aged 20­49 years in Henan Province, China, the prevalence of infertility in 2019 was 24.58% and 61.17% of infertile women sought medical help.

Wound infiltration of dexmedetomidine as an adjunct to local anesthesia in postoperative analgesia for lumbar surgery.

INTRODUCTION: Most patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery. EVIDENCE ACQUISITION: Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms "dexmedetomidine," "infiltration," and "lumbar." The random-effect model was used to perform the meta-analysis based on deviance information criteria. EVIDENCE SYNTHESIS: Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with dexmedetomidine significantly reduced the postoperative VAS scores (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; P=0.0003); 24th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; P<0.00001); 6th hour dynamic VAS scores (MD=-1.84; 95% CI: -2.23 to -1.45; P<0.00001) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; P<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95% CI:2.31 to 4.76; P<0.00001), and reduced the incidence of nausea or vomiting (RR=0.40; 95% CI: 0.17 to 0.93; P<0.05). CONCLUSIONS: Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.

Cadmium exposure as a key risk factor for residents in a world large-scale barite mining district, southwestern China.

Cadmium (Cd) contamination is easily generated during the mining and manufacturing of barium (Ba). In this study, concentrations of both Ba and Cd in rice, vegetables, pork, fish, drinking water, and soil samples from an active barite mining district were determined. Daily intakes of Ba and Cd, as well as corresponding health risks, were evaluated. The average total daily exposure doses of Cd were 0.0035 and 0.0012 mg/kg BW/day (geometric mean) in the mining zone (MZ) and the chemical plant zone (PZ), respectively. These values significantly exceed the provisional tolerable monthly intake (25 µg/kg BW/month, equal to 0.00083 mg/kg BW/day). Based on the daily exposure doses, vegetable consumption was the most significant Ba exposure route for residents, contributing around 66.1% of the total exposure. In contrast, rice consumption was the major Cd exposure pathway, accounting for about 85.6% of the total exposure. Although the geometric mean (0.17) and 95th percentile (P95, 0.75) of the total hazard quotient (HQ) for Ba were below the acceptable level (1), suggesting that there were no significant health effects caused by Ba exposure, Cd exposure was associated with significant health risks, with the geometric mean of the HQ (1.7) and the P95 (21) well above the acceptable limit (1), indicating the unacceptable non-carcinogenic risk of Cd exposure. In summary, high Cd exposure risk, rather than Ba, was observed for populations living in a large-scale active Ba mining area.

Clinical Effect of Suture Anchor and Double-Pulley Technique in the Treatment of Inferior Patellar Fracture.

OBJECTIVE: To evaluate the efficacy of suture anchor combined with double-pulley technique for subpatellar comminuted fractures compared with wire vertical suture and Krachow in the treatment of subpatellar fractures. METHODS: Retrospectively selected 48 patients with subpatellar pole comminuted fracture admitted in our hospital from February 2013 to July 2019, 25 patients with double-pulley technique (group A), and 23 patients with vertical wire suture with Krachow suture. Patient age, gender, AT/OTA typing, injury mechanism, follow-up time, surgical time, bleeding volume, mean fracture healing time, and postoperative complications were recorded. The Insall-Salvati index immediately and 6 weeks after surgery. Bostman scores and knee activity were recorded at each follow-up, and month 12 was taken as the final result. RESULTS: Time of surgery in group A (46.52 min) was significantly shorter than in group B (76.30 min). Intraoperative bleeding in group 15.1 ml, B, group 15.9 ml. Both incisions healed in stage I, averaging clinical healing of patella fracture within 10 weeks. There was no significant difference in mean Bostman score and knee activity at month 12 (group A: 28.4, 124.8°; group B: 28.1, 125.7°). There was no significant statistical difference in the Insall-Salvati index immediately or 6 weeks between the two groups. Group B patients had two wire fractures, fracture healing and the wire removed one year after surgery, and the remaining patients had no complications such as internal fixation loosening, fracture, delayed healing, or nonhealing of fracture. CONCLUSION: Compared with the treatment of subpatellar fracture with wire vertical suture and Krachow method, suture anchor with double-pulley technique has short operation time, reliable fixation, and less complications. Patients can have early functional exercise and good knee function recovery without secondary surgery. It can be considered as an alternative therapy for this fracture and deserves clinical adoption and promotion.

Intraoperative Use of Topical Retropharyngeal Steroids for Dysphagia after Anterior Cervical Fusion: A Systematic Review and Meta-Analysis.

PURPOSE: The anterior cervical approach is commonly used clinically for cervical spondylosis, but it also results in frequent postoperative dysphagia, which can increase the risk of complications and poor treatment satisfaction in severe cases. Intraoperative local application of retropharyngeal steroids has an impact on reducing the occurrence and severity of dysphagia; however, the results of current studies vary. The meta-analysis of this randomized trial was to evaluate the effectiveness and safety of intraoperative topical retropharyngeal steroids for the control of dysphagia after anterior cervical spine surgery. METHODS: Two authors searched electronic databases such as PubMed, MEDLINE, EMBASE, Cochrane Library, and Google Scholar, respectively. The search terms were "Dysphagia," "Steroids," "Anterior Cervical Discectomy and Fusion," etc. A random effects model was used to conduct a meta-analysis based on deviance information criteria. RESULTS: A total of 8 studies were included in this meta-analysis after screening of 792 studies. Bazaz scores were not significantly different in the steroid group at one day postoperatively (P = 0.38), and dysphagia was significantly improved at 14 days postoperatively (95% CI: 0.15 to 0.64; P = 0.002). PSTSI was significantly improved one day (P = 0.03) and 14 days after surgery (P < 0.0001). VAS scores were all lower versus controls (P < 0.001). CONCLUSION: Perioperative local retropharyngeal steroid administration as an adjunct to anterior cervical spine surgery reduces the incidence and severity of dysphagia compared with placebo control. However, future high-quality randomized controlled studies could incorporate nonsubjective dysphagia measures and long-term follow-up on the occurrence of associated complications or other side effects.

Dietary exposure assessment of cadmium, arsenic, and lead in market rice from Sri Lanka.

Rice is frequently reported to be contaminated with heavy metals (HMs); thus, the human health risks from its consumption have received increasing attention. A total of 165 commercial rice samples from Sri Lanka were collected to determine their cadmium (Cd), arsenic (As), and lead (Pb) concentrations. The exposure risk for Sri Lankans from the estimated daily intakes (EDIs) of these toxicants was assessed. Simultaneously, non-carcinogenic and carcinogenic risks were evaluated using hazard quotients (HQs) and the hazard index (HI). The results revealed that the average levels of Cd, As, and Pb in commercial rice were 0.080 ± 0.130, 0.077 ± 0.040, and 0.031 ± 0.050 mg/kg, respectively, with ranges of 0.003-0.727, 0.019-0.217, and 0.001-0.345 mg/kg (expressed on a dry weight basis), respectively. The average EDIs of Cd, inorganic As (iAs), and Pb were 0.772, 0.490, and 0.306 µg/kg body weight (bw)/day, respectively; these were below provisional tolerable weekly intake (PTWI) values recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA), but iAs was above the recommended reference doses (RfDs) recommended by the United States Environmental Protection Agency (USEPA). However, approximately 25% and 75% of the Cd and iAs HQs for the Sri Lankan population, respectively, were greater than 1, suggesting a potential health risk, whereas the HQs for Pb was less than 1. Considering the additive effect, HI values of the P90, P95, P97.5, and P99 percentiles would reach 4.773, 6.458, 8.392, and 11.614, implying that intake of the combined metals might result in potential health risks.

Cadmium contamination in a soil-rice system and the associated health risk: An addressing concern caused by barium mining.

Cadmium (Cd) is associated with barite; however, its biogeochemical characteristics in environments impacted by barium (Ba) mining are not known. Here, we first revealed the characteristics of Cd concentrations, distributions, and chemical forms in the soil-rice system in Ba mining areas. The associated exposure and risk assessments of Cd via rice consumption were also conducted. Elevated levels of Cd with a wide range of 0.054-91 mg/kg were found in paddy soils, approximately 63% of which exceeded the national Grade II value for soil Cd levels in China (0.3 mg/kg). A significant positive correlation between the soil Cd and soil Ba demonstrated that large amounts of Cd were released into the environment from Ba mining. Cadmium accumulated remarkably in the rice grains (0.007-3.5 mg/kg). The chemical forms in the rice plants indicated that most of the Cd was in the pectate/protein fraction (F2, 92% in the grains and 61-71% in the other tissues), followed by the residual fraction (F3, 7.1% in the grains, 27-38% in the other tissues). A minor portion of Cd was in the soluble and aminophenol fraction (F1, 0.44% in the grains, 0.26-1.4% in the other tissues). The positive correlations observed between the grain Cd and F2 in the roots, stems and leaves suggested that Cd in the rice grain was mainly from F2. Similarly, the root F2 was also positively correlated with that in the stems/leaves, indicating the critical role of F2 in Cd2+ migration in rice tissues. The estimated average hazard quotient (2.5) and annual excess lifetime cancer risk (21 × 10-5 a-1) were higher than the safety levels of 1 and 5.0 × 10-5 a-1, respectively, showing that the dietary intake of Cd via rice consumption posed high health risks to residents. Our study demonstrated that more concerns should be paid to Cd contamination in Ba mining areas.

New insights into the chemical forms of extremely high methylmercury in songbird feathers from a contaminated site.

The chemical forms of mercury (Hg), particularly methylmercury (MeHg), in songbird feathers from an abandoned mining region were analyzed via X-ray absorption near-edge structure analysis (XANES). In feathers, proportions of MeHg as total mercury (75.6-100%) quantified by the XANES were directly comparable to the chemical extraction values (74.1-95.9%). Most of MeHg were bound with cysteine (Cys) and reduced glutathione (GSH), whereas inorganic mercury (IHg) was mainly bound with GSH. These results were consistent with those found in fish muscles and human hairs of both fish consumers and occupational Hg exposure populations. Our study suggested that chemical forms and speciation of Hg were highly dependent on the exposure sources and food consumption, respectively. Bird feathers were able to selectively accumulate MeHg due to their special binding ways. However, detailed mechanisms of Hg accumulation in bird feathers remain to be further elucidated.