[Effect of exercise intervention on musculoskeletal disorders in nursing staff].

Objective: To evaluate the effects of exercise intervention on musculoskeletal disorders (MSD) in nursing staff. Methods: In september 2021, we searched the articles on exercise intervention for nurses with musculoskeletal diseases in Embase, PubMed, ClinicalTrails, Wanfang, CNKI and other databases in September 2021, and the search period was from database creation to August 2021. The quality of article was evaluated by Cochrane bias risk assessment tool and MINORS. The systematic review method with narrative synthesis was used to analyze the research results. Results: A total of 7 studies were included, including 6 randomized controlled trials and 1 quasi-experiment. The sample size of the experimental group was 276, and the control group was 273. Depending on the type of exercise intervention, muscle strength training, muscle strength training+stretch/flexibility training, Back School program can reduce the local pain of nursing staff. Among them, muscle strength training can improve the nursing staff's muscle function and quality of life, muscle strength training+stretching/flexibility training can increase muscle strength, range of physical activity and self-efficacy, the Back School program is effective for improving poor posture. Conclusion: Exercise intervention is effective on controlling musculoskeletal disorder symptoms in nursing staff, managers can develop exercise strategies for different MSD symptoms.

[Clinicopathological features of de novo CD5-positive diffuse large B-cell lymphoma].

Objective: To investigate the relationship between the protein expression of C-MYC, bcl-2 and bcl-6 and the clinicopathological characteristics in patients with de novo CD5-positive diffuse large B cell lymphoma (CD5(+)DLBCL). Methods: Fifty seven cases of de novo CD5(+)DLBCL were collected at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from February 2013 to September 2018. The hematoxylin-eosin stained slides were reviewed, and immunohistochemical (IHC) staining and FISH were used to analyze the relationship between C-MYC, bcl-2, bcl-6 expression and the clinicopathologic characteristics of patients. Results: Among these 57 cases, 27 were male and 30 were female. The age of onset was 35-99 years old. The IHC expression rates of C-MYC, bcl-2 and bcl-6 were 50.9% (29/57), 84.2% (48/57), and 75.4% (43/57) respectively; and co-expression rate of C-MYC and bcl-2 proteins was 40.4 (23/57). There was no significant correlation between protein expression and patients' genders, clinical stage, the level of serum LDH,ß2 microglobulin, IPI,B symptoms, bone marrow involvement and central nervous system recurrence (P>0.05). Univariate analysis showed that the median OS of C-MYC negative patients was significantly longer than C-MYC positive patients (P<0.05); and the median OS of patients without double expression was significantly longer than that of patients with positive expression (P<0.05), and bcl-6 positive patients had longer median OS than bcl-6 negative patients (P<0.05). There was no significant correlation between prognosis and bcl-2 protein expression (P>0.05) . Cox multivariate analysis showed C-MYC protein expression was an independent predictor of OS in de novo CD5(+)DLBCL (P<0.05). Conclusions: Bcl-2 protein expression has no effect on the prognosis in de novo CD5(+)DLBCL whereas bcl-6 expression is correlated with good prognosis. C-MYC protein expression could be used as an independent and effective index to predict the prognosis of patients with de novo CD5(+)DLBCL.However, the relationship between protein expression and gene rearrangement of C-MYC, bcl-2 and bcl-6 needs to be further explored.

[Monitoring and research on pathogen spectrum in patients with acute diarrhea from sentinel hospital of Zhejiang Province during 2009 to 2014].

Objective: To explore pathogen spectrum constitution of acute diarrhea in outpatient and emergency of Zhejiang Province, and provide basis for treatment, prevention and control of the disease. Methods: During January 2009 to December 2014, we selected seven sentinel hospitals in different regions of Zhejiang, monitored and researched on pathogen spectrum in patients with acute diarrhea from outpatient and emergency. We recorded patients' personal basic information, the main symptoms and signs, and collected stool samples (5 g). Eight kinds of bacteria (Vibrio cholerae, Shigella spp., Salmonella spp., Diarrheagenic E. coli, Vibrio parahaemolyticus, Aeromonas hydrophila, Yersinia enterocolitica and Plesiomonas shigelloides) and five kinds of viruses (Rotavirus, Norovirus, Sappovirus, Astrovirus and Adenovirus) were detected. Chi-square test and Fisher's exact probability method were used to compare different characteristics of patients with single bacterial infection, single virus infection and multiple infection (bacteria-bacteria, bacteria-viruses, virus-virus). Results: During 2009 to 2014, 9 364 fecal samples from acute diarrhea patients were collected and tested, among which 3 500 cases were tested positive, with total positive rate of 37.38%. Positive rates of bacteria and viruses were 13.14% (1 230 cases) and 20.75% (1 943 cases), respectively. Mixed infection positive rate of multiple pathogens was 3.49% (327 cases). Positive rate of Vibrio parahaemolyticus (5.96% , 558 cases) was the highest among bacterial pathogens, followed by pathogenic Escherichia coli (3.86%, 361 cases). Viruses were mainly Norovirus (10.73%, 1 005 cases) and rotavirus (8.35%, 782 cases). A big difference existed in diarrheogenic pathogen spectrum between patients less than 15 years old and patients equal or older than 15 years old. Pathogens for patients less than 15 years old were mainly virus, with the positive rate of 32.69% (1 014 cases). However, the positive rate of bacteria was 16.86% (1 056 cases) in patients equal or older than 15 years old. Single bacterial infection was highest in age group of 25-34 years old (18.62%, 302 cases) , single virus infection was highest in age group of 1-4 years old (41.12%, 435 cases) , and mixed infections of multiple pathogens were mainly existed in age group of 1-4 years old (7.37%, 78 cases) . Pathogen positive rate were increasing year by year. Pathogen positive rate of patients with acute diarrhea has obvious seasonality, with single bacterial infection being highest during July to September and single virus infection being highest during December to March. Pathogen spectrum of outpatient and emergency patients with acute diarrhea in Zhejiang Province changed a little from 2009 to 2014, mainly rotavirus (22.34% (782/3 500)), norovirus (28.71% (1 005/3 500)), vibrio parahaemolyticus (15.92% (558/3 500)) and Escherichia coli (10.31% (361/3 500)). However, pathogen spectrums in different years owned different features. Conclusion: Common pathogens in outpatient and emergency patients with acute diarrhea in Zhejiang Province were tested with significant seasonal epidemic law. The composition of pathogenic spectrum was variant in different age group. Constitutes of major pathogen spectrum in different years differed a little.

PI3K-AKT pathway polymerase chain reaction (PCR) array analysis of epilepsy induced by type II focal cortical dysplasia.

The aims of this study were to observe the differential expression of PI3K-AKT pathway-related genes in seizure-inducing brain lesions in type II focal cortical dysplasia, and to explore the relationship between gene expression and histological changes in dysplastic foci and their epileptogenic mechanism. Typical lesions in brain tissue from three patients with epilepsy induced by type II focal cortical dysplasia were selected for analysis, along with normal brain tissue from two control group individuals. Following quantitative expression analysis using the RT2 Profiler(TM) PI3K-AKT PCR Array, differential expression of the pathway related genes was detected in the focal brain tissue lesions, and gene function queries were performed. Compared with the control group, thirteen related genes appeared to exhibit marked differences in expression in epileptic lesions from patients with type II focal cortical dysplasia; those genes were found to be involved in regulation of cell size, morphology, adhesion, migration, and apoptosis, and in immunity, inflammation, and many other domains. The differential expression of multiple genes in the PI3K-AKT signaling pathway in type II focal cortical dysplasia may be an important molecular mechanism underlying histological changes and recurrent seizures.

Autophagy in pulmonary macrophages mediates lung inflammatory injury via c-Src tyrosine kinase pathway activation during mechanical ventilation.

OBJECTIVE: It has been clearly demonstrated that autophagy plays a critical role in mechanical ventilation-Induced lung injury (VILI). Herein, we first evaluated the mutual effects of autophagy and c-Src signaling on the lung inflammatory response to mechanical ventilation. MATERIALS AND METHODS: Mice were respectively subjected to a lower or higher lung stretch induced by mechanical ventilation with low (7 mL/kg) or high (28 mL/kg) tidal volume, before measuring the activation of autophagy and c-Src signaling through LC3 lipidation and c-Src phosphorylation, respectively. Bone marrow-derived macrophages (BMDMs) were transfected with Atg5 siRNA and administered to AM-depleted mice to generate an autophagy-deficient phenotype, and c-Src signaling was evaluated by Western blot assay to determine the impact of autophagy on c-Src activation during VILI. Afterwards, the c-Src pathway was then blocked using PP2, prior to the evaluation of polymorphonuclear neutrophils (PMN), total cell counts in BAL fluid, and lung injury scores, in order to elucidate the role of the c-Src pathway in autophagy-mediated VILI. RESULTS: Both LC3-II and p-c-Src were remarkably increased after mechanical ventilation, in a time-dependent and tidal volume-dependent manner. Moreover, c-Src phosphorylation induced by ventilation was significantly compromised in autophagy-deficient mice. On the other hand, LC3-II expression did not change due to c-Src signaling abolishment. But the inflammatory response induced by injurious ventilation was markedly attenuated by PP2 or AM-abolishment, shown by PMN and total cell counts in BAL fluid, as well as lung injury scores. CONCLUSIONS: Our results suggested that autophagy caused VILI via regulating c-Src activation, which implies that c-Src may serve as a promising therapeutic target in VILI.

Correlations between claudin-1 and PIGF expressions in retinoblastoma.

OBJECTIVE: To investigate the expressions of claudin-1 and placental growth factor (PlGF) proteins in retinoblastoma (RB) and their relationships with the differentiation of RB, the infiltration of optic nerve and choroid and clinical stages. PATIENTS AND METHODS: Immunohistochemical (IHC) method was used to detect the expressions of claudin-1 and PlGF proteins in 56 cases of RB paraffin-embedded tissue samples. The x2-test and Fisher exact test were used to compare the qualitative variables. The Pearson correlation coefficient was used to detect the correlation of the expression of claudin-1 with that of PlGF in RB tissues. RESULTS: 1) Among RB tissues, the positive expression rates of claudin-1 in clinical stage I tumors and clinical stage III tumors were 69.2% and 38.9%, respectively, and claudin-1 was not expressed in all clinical stage II tumors (p=0.002). In case of optic nerve invasion, the lowly positive expression of claudin-1 was detected, and the difference was significant (p=0.001). 2) The positive expression rate of PlGF proteins in RB was 73.8%, which was higher in tumors with optic nerve invasion than in tumors without the invasion; the expression was significantly different (p=0.001). In addition, the positive expression rate of PlGF in tumors with choroidal invasion was 74.1%. 3) The expression of claudin-1 in RB was negatively correlated with the presence of choroidal invasion (r=0.52, p≤0.0001) and optic nerve infiltration (r=0.49, p=0.0003). There was a significant positive correlation between the expression of PlGF and the presence of optic nerve invasion (r=0.30, p=0.009). In addition, there was a significant positive correlation between the expression of claudin-1 and that of PlGF (r=0.41, p=0.006). CONCLUSIONS: The expression level of claudin-1 is negatively correlated with the differentiation of RB cells, optic nerve infiltration and clinical stages, while the expression of PlGF was positively correlated with the optic nerve infiltration and clinical stages of RB. The role of claudin-1 may be opposite to that of matrix metalloproteinase-2 (MMP-2) in the development of RB.

[Studies on the serum types and identification efficiency on Diarrheagenic Escherichia coli isolated from diarrhea patients, in Zhejiang province].

Objective: To investigate the serotypes of Diarrheagenic Escherichia coli (DEC) isolated from diarrheal patients in Zhejiang province and to explore the identification efficiency of serological screening methods. Methods: Serological agglutination tests were carried out in 696 strains of DEC (through the identification of virulence genes) which were selected from the Infectious Diarrhea Pathogen Monitoring Network Strain Bank of Zhejiang province, from July 2009 to June 2013. Results of virulence genes, serological identification and classification were compared. Results: Among the 696 isolates of DEC, O antigen type was identified in 288 (41.4%) isolates which belonging to 35 different 'O' serum types. H antigen was seen in 171 (24.6%) isolates and determined as having 21 types. The agglutination rates of EAEC, ETEC, EPEC and EHEC isolates were 31.9% (130/408), 70.6% (127/180), 31.5% (29/92) and 14.3% (2/14), respectively and belonged to 30, 18, 15 kinds of 'O' sero-groups, respectively. One EHEC isolate was identified as O157∶H7. Serum groups were diverse for EAEC and EPEC, while relatively concentrated on ETEC. Different types of DEC might belong to the same sero-group or type. Among the 74 strains of DEC available for classification serologically, 41 isolates were in consistent with virulence gene identification and another 33 strains were not. Conclusions: The sero-group/type of DEC strains in Zhejiang were varied. Based on the serological screening method alone, DEC classification might end in getting the wrong answer, thus we would recommend the use of virulence gene for the purpose of identification.

Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population.

BACKGROUND: Epidemiologic evidence indicates that diets high in fruits and vegetables are associated with a reduced risk of several cancers, including cancers of the esophagus and stomach. Vitamins and minerals in these foods may contribute to the reduced cancer risk. The people of Linxian County, China, have one of the world's highest rates of esophageal/gastric cardia cancer and a persistently low intake of several micronutrients. PURPOSE: We sought to determine if dietary supplementation with specific vitamins and minerals can lower mortality from or incidence of cancer as well as mortality from other diseases in Linxian. METHODS: Individuals of ages 40-69 were recruited in 1985 from four Linxian communes. Mortality and cancer incidence during March 1986-May 1991 were ascertained for 29,584 adults who received daily vitamin and mineral supplementation throughout this period. The subjects were randomly assigned to intervention groups according to a one-half replicate of a 2(4) factorial experimental design. This design enabled testing for the effects of four combinations of nutrients: (A) retinol and zinc; (B) riboflavin and niacin; (C) vitamin C and molybdenum; and (D) beta carotene, vitamin E, and selenium. Doses ranged from one to two times U.S. Recommended Daily Allowances. RESULTS: A total of 2127 deaths occurred among trial participants during the intervention period. Cancer was the leading cause of death, with 32% of all deaths due to esophageal or stomach cancer, followed by cerebrovascular disease (25%). Significantly (P = .03) lower total mortality (relative risk [RR] = 0.91; 95% confidence interval [CI] = 0.84-0.99) occurred among those receiving supplementation with beta carotene, vitamin E, and selenium. The reduction was mainly due to lower cancer rates (RR = 0.87; 95% CI = 0.75-1.00), especially stomach cancer (RR = 0.79; 95% CI = 0.64-0.99), with the reduced risk beginning to arise about 1-2 years after the start of supplementation with these vitamins and minerals. No significant effects on mortality rates from all causes were found for supplementation with retinol and zinc, riboflavin and niacin, or vitamin C and molybdenum. Patterns of cancer incidence, on the basis of 1298 cases, generally resembled those for cancer mortality. CONCLUSIONS: The findings indicate that vitamin and mineral supplementation of the diet of Linxian adults, particularly with the combination of beta carotene, vitamin E, and selenium, may effect a reduction in cancer risk in this population. IMPLICATIONS: The results on their own are not definitive, but the promising findings should stimulate further research to clarify the potential benefits of micronutrient supplements.

Vitamin A and other deficiencies in Linxian, a high esophageal cancer incidence area in northern China.

Biochemical analyses were conducted to evaluate the nutritional status of a high esophageal cancer risk population in Linxian, People's Republic of China. A study was conducted in September 1980 in which plasma levels of vitamins A, B2, and C were analyzed. In a second study in 1983, the plasma fat-soluble vitamins were analyzed with a newly developed high-performance liquid chromatography method that allowed the simultaneous determination of retinol, alpha-tocopherol, beta-carotene, alpha-carotene, and lycopene in 0.1 ml of plasma sample. The average plasma retinol levels ranged from 24 to 27 micrograms/dl among the population groups, with 20-35% of the individuals having levels under 20 micrograms/dl. Low plasma beta-carotene levels averaging 8-12 micrograms/dl were observed among the population groups. Low plasma alpha-tocopherol levels with average values around 700 micrograms/dl were also observed; about half the individuals were either low or deficient in vitamin E. After 4 months of supplementation with daily multivitamin tablets, the plasma contents of retinol and alpha-tocopherol were significantly increased. The plasma alpha-carotene and beta-carotene were also increased, possibly as a reflection of seasonal changes in the diet or a sparing effect of vitamins A and E on these carotenes. Low plasma ascorbate levels with an average of 567 micrograms/dl were observed, and about 23% of the individuals had values under 200 micrograms/dl. Riboflavin deficiency was prevalent, with about 90% of the subjects having an erythrocyte glutathione activation coefficient over 1.2. The study establishes the low nutritional status in vitamins of the population in Linxian and provides the background for further studies on the effects of nutritional deficiency on carcinogenesis.

Compliance and nutritional status during feasibility study for an intervention trial in China.

As part of a pilot study to assess the feasibility of a long-term intervention trial to be done in Linxian, People's Republic of China, nutritional status and compliance were assessed in villagers taking daily multivitamin pills containing the U.S. Recommended Dietary Allowances (RDA). Before the start of the trial and again during its 4th month, nutritional status was assessed by laboratory tests and a dietary interview. Compliance was assessed in all subjects by pill counts and in a subset by urinary riboflavin loading-dose tests. At the outset of the trial, the study population had widespread biochemical and dietary deficiencies of ascorbic acid and riboflavin. As expected, subjects taking a daily pill had significantly improved status for these vitamins during the study. Compliance as measured by pill counts was excellent, with over 90% of the subjects taking at least 80% of their daily pills. Mean urinary excretion of a riboflavin loading dose entered and remained in the normal range after 3 weeks of supplementation, indicating that compliance did not fall off over time. Compliance was similar in normal subjects and in those with a prior diagnosis of esophageal dysplasia. Compliance also was nearly as good in subjects receiving monthly home visits as in those receiving weekly home visits from the barefoot doctor (village paramedical worker). The results of this pilot study indicated that a long-term intervention trial was feasible in Linxian and that the RDA dose level of vitamins was effective in ameliorating certain nutritional deficiencies prevalent in the study population.

[Epidemiologic characteristics of noroviruses isolated in outpatients with acute gastroenteritis in Hangzhou area, from 2014 to 2015].

OBJECTIVE: To explore the epidemiologic characteristics of noroviruses isolated in patients with acute gastroenteritis in Hangzhou between March 2014 and April 2015. METHODS: Stool specimens and clinical data were collected from 1 109 patients with acute gastroenteritis. Specimens were detected for noroviruses with GⅠand GⅡsubtypes by one-step double real-time RT-PCR. Some of the positive specimens were then randomly selected and amplified by multiplex RT-PCR. Those positive PCR products were sequenced and analyzed phylogenetically for testing the partial capsids of noroviruses. RESULTS: Of the 1 109 stool specimens, positive rate of noroviruses was 26.87% (298/1 109). GⅡgenotype was the major viruses with the proportion as 25.52% (283/1 109), while 1.35% (15/1 109) belonged to GⅠgenotypes. There was no significant difference in the noroviruses detection rate of the different genders (P>0.05). However, in different age groups, GⅡgenotypes were predominant types of noroviruses, and the positive rates of GⅡgenotypes were 16.94% (<5 years-old), 19.45% (5-18 years-old) and 32.26% (≥18 years-old), respectively. In different seasons, noroviruses could be detected all year round, with positive rate as 29.67%-37.08% in the highly epidemic seasons (between December and March of the following year). The distribution trends were seen certain difference between noroviruses-GⅡand GⅠtypes. Additionally, results from the sequence analysis demonstrated that GⅡ-4 genotype was the prevalent strain of GⅡ genotypes, clustered into GⅡ-4/Sydney (46.43%, 13/28) and GⅡ-4/2006b (25.0%, 7/28), while GⅠstrains clustered into GⅠ-1. CONCLUSION: Noroviruses appeared one of the major pathogens, leading to acute gastroenteritis. G Ⅱgenotypes of noroviruses, especially the G Ⅱ-4/Sydney variant strains and GⅡ-4/2006b variant strains, were considered to be the prevalent strains prevailed in Hangzhou areas from 2014 to 2015.

Linxian nutrition intervention trials. Design, methods, participant characteristics, and compliance.

Two nutrition intervention trials were conducted in Linxian, China, where the esophageal/gastric cardia cancer mortality rates are among the highest in the world and there is suspicion that the population's chronic deficiencies of multiple nutrients are etiologically involved. Both trials were randomized, double-blind, and placebo-controlled, and tested the effect of multiple-vitamin and multiple-mineral supplements in lowering the rates of cancer. In the first trial, the Dysplasia Trial, 3318 individuals with a cytologic diagnosis of esophageal dysplasia received daily vitamin and mineral supplements or placebos for 6 years. The second trial, the General Population Trial, involved 29,584 individuals and used a one-half replicate of a 2(4) fractional factorial design, which enabled the testing of daily supplementation of four different vitamin and mineral combinations and placebo for a period 5 1/4 years. This article describes the design and methods of these studies as well as the baseline characteristics and compliance behavior of the participants in these two trials, the largest cancer chemoprevention studies reported to date.

Nutritional and haematological status of Chinese farmers: the influence of 13.5 months treatment with riboflavin, retinol and zinc.

A retinol (15 mg), riboflavin (200 mg) and zinc (50 mg) supplement or a placebo (D-mannitol) was given to 610 Chinese farmers weekly for 13.5 months. Riboflavin, retinol, beta-carotene, tocopherol and zinc status were measured in all subjects at the start and end of the intervention and in a subsample at 2 months. Plasma vitamin C, haemoglobin and haematocrits were measured on other subsamples at the end of the supplementation period. At the start vitamin A, zinc and riboflavin status were poor. Plasma retinol and zinc concentrations were higher in men than women but the opposite was observed with respect to beta-carotene. There was no difference between the sexes for tocopherol and riboflavin. Tocopherol:cholesterol ratios suggested vitamin E status was good and vitamin C status also appeared adequate. The supplement increased plasma retinol throughout the whole period but riboflavin status improved only over the first 2 months and then remained constant. Plasma zinc increased in both treatment and placebo groups by approximately 15 to 20 per cent in men and women. Mean concentrations of retinol and tocopherol and beta-carotene (in women only) increased by approximately 20 per cent in the placebo group. It is argued that seasonal factors and/or the placebo may have been responsible for the increase in retinol and beta-carotene in the placebo group. The lack of an increase in beta-carotene in the men may have been due to their higher retinol requirements. Lastly, the increase in retinol may have been responsible for the increase in tocopherol and zinc in plasma since these nutrients increased in those whose plasma retinol increased, irrespective of treatment.

Cytologic diagnosis by transthoracic fine needle sampling without aspiration.

The cytologic findings of transthoracic fine needle sampling without aspiration (fine needle capillary [FNC] sampling) are reported. Eleven patients were examined by FNC sampling while four were examined by the classic fine needle aspiration (FNA) method. In contrast to FNA sampling, FNC sampling produced less patient trauma and admixture of the sample with blood, while giving a better perception of the tumor and its consistency. The quality of the samples obtained by the FNC technique was equal to that of the FNA samples. The results demonstrate that fine needle sampling without aspiration may be used in the study of deep-seated as well as of superficial organs.

Nutritional status in Linxian, China: effects of season and supplementation.

The ability of a supplement to counteract seasonal alterations in nutritional status for certain vitamins was studied in Linxian, an area in northern China with high rates of esophageal cancer. 150 subjects took one daily pill from April to August (16 weeks), whereas 50 subjects did not take any supplement. Deficiencies of ascorbic acid, riboflavin, folic acid, retinol and tocopherol were prevalent at the outset of the study. The changes in diet occurring between the end of the winter (April) and the start of the autumn vegetable harvest (August) were reflected in greatly improved ascorbic acid status and slightly improved riboflavin status. Plasma retinol, tocopherol, alpha-carotene and beta-carotene were little affected by season, whereas erythrocyte folate levels declined. The ascorbic acid, riboflavin, folate, retinol and tocopherol status of the supplemented subjects was significantly improved. After 16 weeks of supplementation, erythrocyte folate levels of subjects with esophageal dysplasia were improved but remained significantly lower than those of normal supplemented subjects, targeting folic acid as a nutrient of particular interest in this precancerous condition.

Comparison of riboflavin, vitamin A, and zinc status of Chinese populations at high and low risk for esophageal cancer.

In two surveys in The Peoples Republic of China, blood samples were collected for nutritional studies in two counties where the risks of esophageal cancer are very different. The first survey was done in May 1980 in Linxian County (Henan Province) where the risk of esophageal cancer is very high. Blood samples were obtained from 111 persons (58 men, 53 women) who were selected randomly from 528 subjects that underwent endoscopical examination. The second survey was done in May 1981 in Jiaoxian County (Shandong Province) where the risk of esophageal cancer is reported to be relatively low. Blood samples were obtained from 120 persons (66 men, 54 women) who were selected randomly from 252 subjects that had also had undergone endoscopy. The blood samples were used to measure the nutritional status of riboflavin (erythrocyte glutathione reductase activation coefficient), vitamin A (retinol and carotene concentrations), and zinc (plasma and hair zinc concentrations). Only riboflavin status was significantly different in the two communities. The distribution of erythrocyte glutathione reductase activation coefficient values suggested that riboflavin status was much better in the low-risk community. Also in May 1981, a few more blood samples were obtained from some of the participants of the previous year's study in Linxian. A slight improvement in riboflavin and zinc status was detected. We considered the possibility that these changes may have been linked to the socioeconomic changes currently taking place in rural areas. Data were also collected from food allocation records in 15 production brigades in Linxian and 13 production brigades in Jiaoxian in the same years. The records used represented the food consumption of 3,491 and 2,552 persons, respectively, and were used to calculate daily food and nutrient intakes in the two communities. Dietary analyses highlighted the vegetarian nature of the diet, the low consumption of riboflavin, and the virtual dependence on carotene for vitamin A. Both communities consumed very little in the way of animal products or fruit, but intake of these items was higher in Jiaoxian.

Nutritional status of the high esophageal cancer risk population in Linxian, People's Republic of China: effects of vitamin supplementation.

Plasma levels of nutrients in 196 individuals were assayed as part of a study of the feasibility of a nutrition intervention trial in Linxian, a county in North Central China with exceptionally high rates of esophageal cancer. High-performance liquid chromatography analyses of samples collected in April 1983 showed low (relative to United States standards) base-line levels for retinol, alpha-tocopherol, and beta- and alpha-carotene. Repeat sampling in August 1983 revealed significantly increased plasma levels of retinol and alpha-tocopherol among those who had in the interim received daily supplementation with multivitamin pills containing the Recommended Dietary Allowance levels of those nutrients but not among those without supplementation. Levels of carotenes, which were not included in the pills, tended to increase regardless of supplementation, consistent with seasonal variations in availability of carotenoid-containing foods. Atomic absorption spectrophotometry analyses showed essentially normal levels of copper and zinc in plasma. Neither was affected by vitamin supplementation (the pills did not contain minerals) nor seasonal variation. The data are generally consistent with prior biochemical surveys in indicating marginal or low status of several nutrients in Linxian and in showing that supplementation with vitamins can effectively raise blood nutrient levels.

A pilot vitamin intervention trial in Linxian, People's Republic of China.

A 24-week pilot study of daily or weekly multiple vitamin supplementation among 852 adults in Linxian, where the rate of esophageal cancer is exceptionally high, demonstrated the feasibility of an intervention trial in this population. Compliance, when judged by pill count, was high for both frequencies of pill use. Only 2% of the subjects refused to take any pills, and, among pill takers, over 95% were reported to be taking most of their pills at the end of the study. Biochemical confirmation of high compliance was demonstrated in urine and blood tests, which showed markedly improved vitamin levels after supplementation. Results of the pilot study indicated that a system in which barefoot doctors were used in pill distribution was effective and that established field operating procedures for a full-scale intervention trial in this area were acceptable.