Benefits of cooperation among large-scale cohort studies and human biomonitoring projects in environmental health research: An exercise in blood lead analysis of the Environment and Child Health International Birth Cohort Group

A number of prospective cohort studies are ongoing worldwide to investigate the impact of foetal and neonatal exposures to chemical substances on child health. To assess multiple exposure (mixture) effects and low prevalence health outcomes it is useful to pool data from several studies and conduct mega-data-analysis. To discuss a path towards data harmonization, representatives from several large-scale birth cohort studies and a biomonitoring programme formed a collaborative group, the Environment and Child Health International Birth Cohort Group (ECHIBCG). In this study, an intra-laboratory trial was performed to harmonize existing blood lead measurements within the groups' studies. Then, decentralized analyses were conducted in individual countries' laboratories to evaluate blood lead levels (BLL) in each study. The measurements of pooled BLL samples in French, German and three Japanese laboratories resulted in an overall mean blood lead concentration of 8.66 μg l^?1 (95% confidence interval: 8.59–8.72 μg l^?1) with 3.0% relative standard deviation. Except for China's samples, BLL from each study were comparable with mean concentrations below or close to 10 μg l^?1. The decentralized multivariate analyses revealed that all models had coefficients of determination below 0.1. Determinants of BLL were current smoking, age >35 years and overweight or obese status. The three variables were associated with an increase in BLL in each of the five studies, most strongly in France by almost 80% and the weakest effect being in Norway with only 15%; for Japan, with the far largest sample (~18,000), the difference was 36%. This study successfully demonstrated that the laboratory analytical methods were sufficiently similar to allow direct comparison of data and showed that it is possible to harmonize the epidemiological data for joint analysis. This exercise showed the challenges in decentralized data analyses and reinforces the need for data harmonization among studies.     

Exposure assessment of Portuguese population to multiple mycotoxins: The human biomonitoring approach

Mycotoxins constitute a relevant group of food contaminants with several associated health outcomes such as estrogenic, immunotoxic, nephrotoxic and teratogenic effects. Although scarce data are available in Portugal, human biomonitoring studies have been globally developed to assess the exposure to mycotoxins at individual level. In order to overcome this lack of data, the present study concerned the analysis of mycotoxins in 24h urine and first-morning urine paired samples from 94 participants enrolled within the scope of the National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015–2016). Following a salt-assisted matrix extraction, urine samples were analysed by liquid chromatography–mass spectrometry for the simultaneous determination of 37 urinary mycotoxins’ biomarkers and data obtained used to estimate the probable daily intake as well as the risk characterization applying the Hazard Quotient approach. Results revealed the exposure of Portuguese population to zearalenone, deoxynivalenol, ochratoxin A, alternariol, citrinin and fumonisin B₁ through the quantification in 24h urine and first-morning urine paired samples. Risk characterization data revealed a potential concern to some reported mycotoxins since the reference intake values were exceeded by some of the considered participants. Alternariol was identified for the first time in urine samples from a European country; however, risk characterization was not performed due to lack of reference intake value. These results confirmed mycotoxins as part of the human exposome of the Portuguese population reinforcing the need for further studies regarding the determinants of exposure.     

Physical Performance Predictor Measures in Older Adults With Falls-Related Emergency Department Visits

ObjectivesIdentifying strong predictors for falls and mobility limitations in older adults with a falls-related emergency department visit is crucial. This study aimed to compare, in this clinical population, the incremental predictive value of the Short Physical Performance Battery (SPPB) component tests for incident falls, injurious falls, and mobility limitations.Design and measuresProspective cohort study.Setting and participantsA total of 323 community-dwelling older adults with a falls-related emergency department visit participated. Baseline physical performance was measured by the SPPB standing balance test, sit-to-stand test, and habitual gait speed test. Six-month prospective fall rate and self-reported mobility limitations at 6 months post baseline assessment were also measured. An injurious fall was defined as a fall for which the participant sought medical attention or that restricted his or her daily activities for at least 48 hours.ResultsIn multivariable proportional odds analyses adjusted for demographics and clinical covariates, higher levels of full-tandem balance and sit-to-stand performance were significantly associated with fewer incident falls (P = .04 and .02, respectively) and lower odds of mobility limitations (P = .05 and .03, respectively) and marginally associated with lower odds of injurious falls (P = .06 and .07, respectively). Habitual gait speed was the weakest predictor of falls but the strongest predictor (odds ratio 0.24, 95% confidence interval 0.08-0.70; P < .001) of mobility limitations.Conclusions/implicationsIn high-fall-risk older adults, the SPPB balance and sit-to-stand tests predicted falls whereas the SPPB gait speed test was adept at predicting mobility limitations. No one test is best across all situations, so the choice of test will depend on the goal of the assessment.     

我院2013年大肠埃希菌分布与耐药性分析

目的：了解南方医科大学附属郑州人民医院2013年大肠埃希菌分布及其对常用抗菌药物的耐药性,为临床选择抗菌药物提供参考。方法对2013年各科室标本中分离的630株大肠埃希菌进行抗菌药物敏感试验,依据2010年 CLSI 标准判读,并进行分析。结果630株大肠埃希菌中以中段尿、脓液及痰液检出最多,分别占50.00％、26.67％、17.94％。大肠埃希菌对一、二、三代头孢菌素,庆大霉素及喹诺酮类药物的耐药率较高,对阿米卡星、头孢西丁、碳青霉烯类抗菌药物、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的敏感性好,但出现了2株耐碳青霉烯类抗菌药物的大肠埃希菌。结论大肠埃希菌是泌尿道感染的常见致病菌,其对常用的抗菌药物耐药率较高。规范使用抗菌药物对防止和延缓细菌耐药具有重要意义。     

小牛血去蛋白提取物眼用凝胶在儿童干眼症患者中的应用效果观察

目的:评估小牛血去蛋白提取物眼用凝胶治疗儿童干眼症的效果。方法:100例(200眼)干眼症儿童被随机平均分为对照组和实验组,对照组用0.1%玻璃酸钠滴眼液,每日4次,实验组用小牛血去蛋白提取物眼用凝胶,每日4次;两组同时针对病因治疗。对比分析治疗前与治疗后30 d的症状评分、泪液分泌试验、泪膜破裂时间(BUT)、角膜荧光素染色评分。结果:两组治疗前、后各项评分比较差异有统计学意义(P<0.05);两组治疗后各项评分比较差异有统计学意义(P<0.05)。结论:小牛血去蛋白提取物眼用凝胶能有效治疗儿童干眼症。     

低分子肝素药理学机制及适应证研究进展

低分子肝素是由普通肝素经降解得到的分子量较小的肝素片断,与未分级肝素相比,具有较低的分子量、更好的抗Xa活性、低使用剂量时具有更好的效果、半衰期长、临床效应可预测性强。本文简要介绍了低分子肝素的药理学机制及适应证研究进展。     

大孔吸附树脂分离纯化淫羊藿EF5黄酮

目的：采用HPLC法和UV法监测AB-8大孔吸附树脂分离纯化以淫羊藿苷、朝藿定A、朝藿定B、朝藿定C和宝藿苷I这五种黄酮为主要成分的淫羊藿EF5黄酮并筛选出最佳分离纯化工艺参数。方法：采用UV法,以淫羊藿总黄酮洗脱率为指标,考察树脂对淫羊藿总黄酮的吸附容量、解吸附率、吸附动力学,以确定树脂分离纯化淫羊藿EF5黄酮的最佳吸附性能;采用HPLC法,以淫羊藿EF5黄酮中五种黄酮单体的洗脱率为指标,考察洗脱液浓度和洗脱液用量等参数,确定淫羊藿EF5黄酮的最佳洗脱参数。结果：AB-8大孔吸附树脂对淫羊藿总黄酮的吸附容量以湿树脂计为（58.37±2.36）mg·g-1,解吸附率为（86.77±2.32）%,最佳吸附时间为180min,最佳洗脱液为60%乙醇,最佳洗脱液用量为5BV,纯化后真空干燥所得棕褐色淫羊藿EF5黄酮粉末中朝藿定A、朝藿定B、朝藿定C、淫羊藿苷和宝藿苷I的含量分别为3.51%、4.87%、1.22%、33.05%、1.36%,淫羊藿EF5黄酮纯度为44%。结论：AB-8大孔吸附树脂分离纯化得到的淫羊藿EF5黄酮的纯度较高,适合工业生产。     

Mapping the Clinical Chronic Obstructive Pulmonary Disease Questionnaire onto Generic Preference-Based EQ-5D Values

ObjectivesTo develop a model to predict EuroQol five-dimensional questionnaire (EQ-5D) values from clinical chronic obstructive pulmonary disease (COPD) questionnaire (CCQ) scores.MethodsWe used data from three clinical trials (the Randomized Clinical Trial on Effectiveness of Integrated COPD Management in Primary Care [RECODE], the Assessment Of Going Home Under Early Assisted Discharge [GO-AHEAD], and the Health Status Guided COPD Care [MARCH]). Data were randomly split into an estimation sample and a validation sample. The conceptual similarity between patient-reported CCQ and preference-based EQ-5D scores was assessed using correlation and principal-component analysis. Different types of models were estimated with increasing complexity. We selected the final models on the basis of mean absolute error and root mean square error when comparing predicted and observed values from the same population (internal validity) and from different trial populations (external validity). We also developed models for different country-specific EQ-5D value sets.ResultsThe principal-component analysis showed that the CCQ domains functional state and mental state are associated with four dimensions of the EQ-5D. The EQ-5D dimension pain/discomfort formed a separate construct on which no CCQ item loaded. The mean observed EQ-5D values were not significantly different from the mean predicted EQ-5D values in internal validation samples but did significantly differ in external validation samples. The models underestimated EQ-5D values in milder health states and overestimated them in more severe health states. The predictive ability of the models was similar across different EQ-5D value sets.ConclusionsThe models can predict mean EQ-5D values that are similar to observed mean values in a similar population. The overestimating/underestimating of the low/high EQ-5D values, however, limits its use in Markov models. Therefore, mapping should be used cautiously.