[High-grade Fetal Adenocarcinoma of the Lung with Scalp Metastasis: A Case Report].

Fetal adenocarcinoma of the lung (FLAC) is a rare tumor. Due to its different clinicopathological features, biological behavior and clinical outcome, FLAC is classified into low-grade FLAC (L-FLAC) and high-grade FLAC (H-FLAC). Most patients with H-FLAC are middle-aged heavy smokers. Here, we describe an extremely rare case of a young male patient who denies smoking and initially presents with a mass on the top of the head and is eventually diagnosed with H-FLAC. The aim of this article is to improve the understanding and awareness of FLAC, and increase the attention to the disease, so as to prevent the underdiagnosis and misdiagnosis of the disease, strengthen early identification and accurate diagnosis, and promote subsequent effective treatment and improve prognosis.
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Hotspot mapping and risk prediction of fluoride in natural waters across the Tibetan Plateau.

Intake of high fluoride concentrations through water affects up to 1 billion people worldwide, and the Tibetan Plateau (TP) is one of the most severely affected areas. Knowledge regarding the high fluoride risk areas, the driving factors, and at-risk populations on the TP remains fragmented. We collected 1581 natural water samples from the TP to model surface water and groundwater fluoride hazard maps using machine learning. The geomean concentrations of surface water and groundwater were 0.26 mg/L and 0.92 mg/L, respectively. Surface water fluoride hazard hotspots were concentrated in the north-central region; high fluoride risk areas of groundwater were mainly concentrated in the southern TP. Hazard maps showed a maximum estimate of 15% of the total population in the TP (approximately 1.47 million people) at risk, and 500,000 people considered the most reasonable estimate. Critical environment driving factors were identified, in which climate condition was taken for the vital one. Under the moderate climate change scenario (SSP2.45) for 2089-2099, the high fluoride risk change rate differed inside the TP (surface water -24%-55% and groundwater -56%-50%), and the overall risk increased in natural waters throughout the TP, particularly in the southeastern TP.

Selenium and Zinc Intakes of Staple Grains and Their Correlation with Urine Selenium and Zinc in the Tibetan Rural Residents along the Yarlung Zangbo River.

Grains account for a large proportion of the diet of rural residents in Tibet. The lack of selenium (Se) and zinc (Zn) threatens the population's nutrition and health. However, the intakes of selenium and zinc in grains remains unclear. To clarify the nutritional status of selenium and zinc consumed from staple grains of residents along the Yarlung Zangbo River in Tibet, 341 grain samples and 242 urine samples were collected, and 244 food frequency questionnaires were completed along the Yarlung Zangbo River in 2020-2021. The results showed that the selenium concentrations of 88.5% of self-produced tsampa and 80.8% of self-produced flour were lower than the grain selenium threshold (<25 µg·kg-1). The intake of selenium and zinc from staple grains (tsampa, flour, and rice) contributed 15.0% and 43.5% to the recommended nutrient intake (RNI) on average, respectively. A geographical detector model analyzed factors affecting urinary selenium and zinc levels. Selenium and zinc intakes in rice and flour, and dietary diversity score (DDS) were the main factors affecting urinary selenium and zinc (p < 0.01). Their interaction effects on urinary selenium and zinc were greater than those of a single factor. The staple grains of rural residents along the Yarlung Zangbo River were in a state of selenium deficiency. The zinc content of the staple grain purchased was lower than that of the main grain produced by rural residents. Changing the grain consumption pattern and adjusting the proportion of exogenous grains can improve selenium and zinc nutrition in residents.

Bifidobacterium as a Potential Biomarker of Sarcopenia in Elderly Women.

Gut microbial dysbiosis influences the development of sarcopenia. This case-control study explored the gut microbiota composition in elderly Chinese women with sarcopenia. The information from 50 cases and 50 controls was collected. Grip strength, body weight, body mass index, skeletal muscle mass, energy intake, and total and high-quality protein intake were lower in cases than in controls (p < 0.05). Gut microbiota metagenomic sequencing showed that phylum Bacteroides was significantly reduced in the case group, whereas genus Prevotella was more abundant (p < 0.05). Linear discriminant analysis (LDA) effect size showed that 9 and 13 distinct microbial taxa were enriched in the case and control groups, respectively (LDA > 2, p < 0.05), among which Prevotella copri and Bifidobacterium longum were significantly different (LDA > 4, p < 0.05). The AUC of Bifidobacterium longum was 0.674 (95% CI: 0.539-0.756). Elderly women with sarcopenia exhibited significantly different gut microbiota compositions than healthy controls.

Factors influencing the spatial distribution and individual variation in urinary fluoride levels in Tibet, China.

Nowadays, fluorosis is the most prevalent endemic disease in Tibet and one of the most concerned public health problems in China; urinary fluoride is a common diagnostic indicator of endemic fluorosis. However, the spatial distribution and influencing factors of urinary fluoride content in Tibet remain unclear. This study aims to bridge this gap by geographically weighted regression (GWR), analyses of variance (ANOVAs), Geodetector, and stepwise multiple linear regression (MLR). To achieve this goal, this study first investigated fluoride levels in the fasting urine among 637 Tibetan residents from 73 counties in Tibet, the urinary fluoride level was chosen as an indicator of fluorosis, which can reflect the health impairment. Then we identified the potential factors that could influence the spatial distribution and individual variation of urinary fluoride levels from physical environmental and socioeconomic perspective, respectively. The results showed that urinary fluoride levels in Tibet were slightly exceeding the average value for adult urinary fluoride in China, and that residents with high urinary fluoride were mainly found in the west and east; those with low urinary fluoride were mainly found in the central-southern regions. And the urinary fluoride levels had a significantly positive correlation with water fluoride and a significantly negative correlation with average annual temperature. Urinary fluoride levels increased until age 60 and followed an inverted "U"-shaped trajectory according to annual household income (80,000 renminbi (RMB) was the inflection point); pastoralists had greater exposure to fluoride than farmers. Furthermore, the Geodetector and MLR showed that the urinary fluoride level was influenced by both physical environmental and socioeconomic factors. The socioeconomic factors such as age, annual household income and occupation had a greater impact than the physical environment on urinary fluoride concentration. These findings can provide scientific basis for preventing and controlling endemic fluorosis in the Tibetan Plateau and adjacent areas.

Bioaccumulation characteristics, transfer model of heavy metals in soil-crop system and health assessment in plateau region, China.

This study investigated the bioaccumulation and transfer of heavy metals including Cd, Cr, Cu, Mn, Ni, Pb and Zn in soil-crop system in Lhasa, and assessed the health risks of the edible part of the crops. The results showed that the average values of Cd, Cr, Cu, Mn, Ni, Pb and Zn were 0.15, 44.55, 24.68, 532.40, 22.47, 38.18 and 73.99 mg kg-1 in natural soil, and 0.16, 46.93, 38.45, 559.13, 23.23, 40.03 and 83.29 mg kg-1 in cultivated soil, respectively. Highland barley and wheat had the strongest ability to accumulate Zn in grain, the BCF values were 0.24 and 0.27, respectively, significant differences in the distribution of metal contents in crop root, stem, leaf and grain were observed. Root presented larger accumulation capacity in most metals, Zn and Cu was easily transferred in the plant organs, most metals in this study presented difficult to migrate from root to grain. The transfer peak of most metals in soil-crop system appeared from stem to leaf. The concentrations of Cr and Mn in crop grains could be predicted according to the multiple linear regression models. THQ and HI values of heavy metals in edible parts of both highland barley and wheat were below the safety threshold of 1, indicating no detrimental effects posed to adults health. This study helps to understand the accumulation and transfer of heavy metals in soil-crop system in plateau region.

Dietary and Food Consumption Patterns and Their Associated Factors in the Tibetan Plateau Population: Results from 73 Counties with Agriculture and Animal Husbandry in Tibet, China.

Dietary imbalances are an important cause of morbidity and mortality, both in China and globally. Abnormal element content in the natural environment and the unbalanced dietary structure of populations coexist in the Tibetan Plateau. This study analyzed the dietary and food consumption patterns of 617 Tibetan residents and their associated factors. Cluster analysis revealed three modes of dietary pattern; the food consumption scores (FCSs) of subjects in modes with relatively high consumption frequency of staple food and relatively singular dietary structure were the lowest. Although the FCSs of most subjects were acceptable (FCS > 35), subjects with relatively low FCSs were more dependent on locally cultivated highland barley that is probably low in selenium. Hierarchical linear models revealed both individual−family and regional factors were significantly related (p values < 0.05) with the food consumption of subjects as follows: age, travel time from township to county, and cultivation area of highland barley were negatively related; numbers of individuals aged 40−60 years and pork, beef, and mutton production were positively related. Individuals with secondary or higher education had higher FCSs. A single indicator may be incomprehensive in dietary and food consumption studies. For people with a relatively unbalanced diet, an analysis of the main foods they consume is critical. Dietary and food consumption patterns might have relatively large inter-regional and intra-regional variations; therefore, factors that influence it might be multi-level and multi-scale.

Association of selenium, arsenic, and other trace elements in drinking water and urine in residents of the plateau region in China.

Drinking water is considered to be an important exposure pathway for humans to ingest trace elements; human urine samples are widely accepted as biometric substrates that can reflect human exposure to trace elements. The current study aimed at investigating the concentrations of trace elements including selenium (Se), arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn) in drinking water and human urine in plateau region of China, determining the association among trace elements in drinking water and urine, and analyzing their associations with age and gender. The results showed that the majority of trace element concentrations were in the range of the World Health Organization (WHO 2011) guideline values, in both urine samples of male and female, and the median values were descending in the order: Zn > Cu > As > Se > Cr > Ni > Mn > Pb > Cd > Co. Selenium contributed to the excretion of As, Cr, Cu, Cd, and Zn in human body, group of 31-40 years appeared to present the greatest excretion ability in most of the trace elements. Weak positive correlations were observed between age and Mn in female urine samples, and negative correlations were observed between age and Se, As, Co, and Cu in male urine samples and between age and Co in female urine samples, respectively. Significant positive correlation was observed in As between drinking water and the whole human urine. In the same family, female seemed to show higher proportions of urinary As levels than male. This study will provide elementary information regarding trace element levels in drinking water and human urine in residents in plateau region of China and is helpful to provide reference for dietary nutrient trace element intake and effective control for local resident.

Translation and validation of the Tibetan confusion assessment method for the intensive care unit.

BACKGROUND: At present, there is no available delirium translated assessment method for 3.3 million Tibetans. This study aimed to provide a method for delirium assessment for Tibetan patients speaking this language by validating a translation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). METHODS: The study was conducted between July 2018 and November 2018. Patients were screened for delirium by a neurologist using the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). Patients were subsequently screened by two nurses using Tibetan translations of the CAM-ICU. With DSM-IV criterion as the reference standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the validity of the CAM-ICU criterion. Interrater reliability was determined by comparing the CAM-ICU ratings of nurse 1 vs. nurse 2 using the κ coefficient. RESULTS: Ninety-six patients were assessed independently by two nurses and one neurologist. According to DSM-IV standard, 42 out of 96 (43.8%) patients developed delirium. The sensitivities of Tibetan CAM-ICU were 90.5% for nurse 1 and 92.9% for nurse 2, respectively. Their specificities were 85.2% and 90.7%, respectively. The PPV were 82.6% for nurse 1 and 88.6% for nurse 2. Their NPV were 92.0% and 94.2%, respectively. The Tibetan CAM-ICU was done with good interrater reliability between nurse 1 and nurse 2 (κ = 0.91, P < 0.001). CONCLUSION: The Tibetan CAM-ICU shows good validity and might be incorporated into clinical practice in Tibetan Intensive Care Units. CLINICAL TRAIL REGISTRY:: www.chictr.org.cn (No. ChiCTR1800018231).

Hair Selenium Levels of School Children in Kashin-Beck Disease Endemic Areas in Tibet, China.

Previous studies have shown that the selenium (Se) deficiency is an important factor for the etiology of Kashin-Beck disease (KBD). Although KBD is presently controlled in most regions of China, it is still active in the Tibetan Plateau. The present study aimed to assess the nutritional status of selenium in school children by using the Se level in hair as a biomarker in KBD endemic areas of Lhasa in Tibet, China. Hair samples of 155 school children aged 6-15 years were collected in both KBD areas and non-KBD areas of Lhasa in 2013. The Se level in the hair samples was determined by inductive coupled plasma mass spectrometry (ICP-MS). The average concentration of Se in children's hair was 0.232 µg/g in KBD areas of Lhasa, which was significantly higher than the data reported decades ago. A significant difference in hair Se was observed between the boys (0.255 µg/g) and the girls (0.222 µg/g) in the studied KBD areas (P < 0.01, Mann-Whitney U test), but hair Se did not vary by age or region. School children in KBD endemic areas in Lhasa likely have improved Se status as a result of high Se content staple food substitution with the enforcement of Free Education Policy and Nutrition Improvement Plan in Tibet. Nevertheless, there were still 20.3 % of students with low Se status (hair Se <0.20 µg/g), which showed that Se status of school children was also partly affected by low Se environment in KBD endemic areas of Lhasa.