Interpretation of Consolidated Health Economic Evaluation Reporting Standards 2022 / 中华流行病学杂志

The number of studies related to health economics evaluation is increasing. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) contains 28 items. Based on CHEERS 2013, CHEERS 2022 adds a health economic analysis plan, model sharing, and community, patient, public, and other relevant stakeholders' participation in the statement, taking into account the future development direction of health economics evaluation. It provides a useful review tool for peer reviewers, editors, and readers and supports health technology assessment agencies in establishing standard reporting standards for health economics evaluations. In this study, we briefly introduced and interpreted the CHEERS 2022 statement and analyzed an example of health economics evaluation in infectious disease epidemiology to provide a reference for researchers to report studies regarding health economics evaluation standardly.

Nomogram to predict pregnancy outcomes of emergency oocyte freeze-thaw cycles / 中华医学杂志(英文版)

BACKGROUND@#Existing clinical prediction models for in vitro fertilization are based on the fresh oocyte cycle, and there is no prediction model to evaluate the probability of successful thawing of cryopreserved mature oocytes. This research aims to identify and study the characteristics of pre-oocyte-retrieval patients that can affect the pregnancy outcomes of emergency oocyte freeze-thaw cycles.@*METHODS@#Data were collected from the Reproductive Center, Peking University Third Hospital of China. Multivariable logistic regression model was used to derive the nomogram. Nomogram model performance was assessed by examining the discrimination and calibration in the development and validation cohorts. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration plots.@*RESULTS@#The predictors in the model of "no transferable embryo cycles" are female age (odds ratio [OR] = 1.099, 95% confidence interval [CI] = 1.003-1.205, P = 0.0440), duration of infertility (OR = 1.140, 95% CI = 1.018-1.276, P = 0.0240), basal follicle-stimulating hormone (FSH) level (OR = 1.205, 95% CI = 1.051-1.382, P = 0.0084), basal estradiol (E2) level (OR = 1.006, 95% CI = 1.001-1.010, P = 0.0120), and sperm from microdissection testicular sperm extraction (MESA) (OR = 7.741, 95% CI = 2.905-20.632, P 10 mm on the day of hCG administration.

Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China / 中华医学杂志(英文版)

BACKGROUND@#Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs.@*METHODS@#In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs.@*RESULTS@#There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was -7.9 mmHg (95% CI, -9.9 to -5.9) in the brand-name drug group and -7.1 mmHg (95% CI, -9.1 to -5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2-2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment.@*CONCLUSIONS@#Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.

Effect of different shunt strategies on cerebral infarction after carotid endarterectomy / 北京大学学报(医学版)

OBJECTIVE@#The key point of anesthesia management in carotid endarterectomy (CEA) is to maintain adequate cerebral perfusion during carotid artery occlusion. Placement of shunt is one of the common surgical methods. This study analyzed the effects of different shunt strategies on cerebral infarction after carotid endarterectomy.@*METHODS@#A total of 443 patients who underwent CEA under general anesthesia within 2 years were divided into imaging group (based on preoperative imaging data as the basis for shunt) and stump pressure group (based on intraoperative stump pressure as the basis for shunt). The preoperative demographic data, past medical history, degree of cervical vascular stenosis, blood pressure at each time point during the perioperative period, vascular blocking time, whether to place the shunt, postoperative hospital stay, cerebral infarction during hospitalization, and other adverse events were collected and compared between the two groups. On this basis, the preoperative and intraoperative conditions with significant differences were matched with propensity scores, and the influence of different shunt strategies on postoperative cerebral infarction was analyzed.@*RESULTS@#In the study, 268 patients in the imaging group and 175 patients in the stump pressure group underwent CEA under general anesthesia. There were statistically significant differences in basic conditions and blood pressure at each time point between the two groups. After matching the propensity scores, 105 patients in each of the two groups were matched. The basic conditions of the patients before surgery and the difference in blood pressure of the two groups at each time point were not statistically significant. There was no significant diffe-rence in the incidence of postoperative cerebral infarction between the two groups (1.9% vs. 1.0%, P>0.999). The intraoperative shunt rate in the imaging group was lower than that in the stump pressure group (0 vs. 22.9%, P < 0.001). The postoperative hospital stay in the imaging group was 8 (7, 8) days, which was longer than the stump pressure group 5 (4, 6) days (P < 0.001).@*CONCLUSION@#The rate of the shunt was lower according to preoperative imaging examination than that according to the residual pressure in our hospital. There is no significant difference in the incidence of cerebral infarction during the postoperative hospital stay. The effect of different shunt strategies on cerebral infarction needs further study.

Usefulness of the indocyanine green fluorescence imaging technique in laparoscopic partial nephrectomy / 北京大学学报(医学版)

OBJECTIVE@#To detail a novel technique for marking renal tumors with intravenous indocyanine green (ICG) during laparoscopic partial nephrectomy, and to investigate the feasibility and safety of this technique with the use of near-infrared fluorescence imaging.@*METHODS@#Between July 2019 and January 2020, 25 consecutive cases with renal masses underwent intraoperative ICG tumor marking laparoscopic partial nephrectomy, at the department of urology in Peking University Third Hospital by the same surgeon. The key benefits included quick intraoperative identification of the mass with improved visualization and real-time control of resection margins by the ICG Immunofluorescence imaging technique. Clinical data were prospectively collected in our institutional database. Perioperative, pathological, and clinical outcomes of the partial nephrectomy were assessed. Measurement data with normal distribution and count data were respectively described as M(range) and percentage. Among these cases, 16 cases were male and 9 cases female, The median body mass index was 25.4 (20.0-35.4) kg/m2. The average age was 54 (29-77) years. The maximum tumor diameter was 2.75(1.30-5.20) cm. The R.E.N.A.L score was 7.5 (5.0-10.0).The tumor locations were distributed with upper pole (11, 42%), middle (6, 23%), and lower pole (9, 35%).The clinical stages of the tumor were described as follows: T1aN0M0 (23, 88.5%), T1bN0M0(2, 7.7%), T2aN0M0 (1, 3.8%).@*RESULTS@#All the 25 cases were performed 26 times with intraoperative ICG tumor marking laparoscopic partial nephrectomy. There were no allergy, infection and other complications with intravenous indocyanine green. The surgical procedure was successful in all the patients. No conversion and blood transfusion were needed. All the cases of the surgical margin were negative. Overall the operative time was 136 (50-247) min and warm ischemia time was 14 (7-30) min.The estimated blood loss was 50 (10-400) mL and the hospital stay was 5.5 (3.0-31.0) days. One case with perirenal hematoma, one case with urine leak, one with respiratory failure and deep venous thrombosis. All of these cases were cured by the corresponding treatment. The others had no severe complications. There was no tumor recurrence and metastasis during the follow up with 4 to 10 months.@*CONCLUSION@#ICG marking and near-infrared fluorescence imaging technology has now emerged as a safe, feasible and useful tool that may facilitate laparoscopic partial nephrectomy.

Protective effect of cardiopulmonary fitness on patients with high risk of atherosclerotic cardiovascular disease / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effects of cardiopulmonary fitness on arteriosclerotic cardiovascular disease (ASCVD) events in patients with different risks of ASCVD.@*METHODS@#This study enrolled 544 non ASCVD patients who underwent cardiopulmonary exercise testing in Peking University Third Hospital from September 2016 to April 2018. ASCVD overall risk assessment was conducted according to "Chinese Guidelines for the Prevention and Treatment of Adult Dyslipidemia". Peak oxygen uptake (VO2peak), the classic indicator of cardiopulmonary fitness, was accurately determined by cardiopulmonary exercise testing in all the patients. All of the patients were followed up clinically.@*RESULTS@#In the study, 506 patients completed the follow-up (250 lowrisk patients, 93 moderaterisk patients and 163 highrisk patients). The median follow-up period was 19 months (9-28 months), and 51 patients developed ASCVD events during the follow-up period, of whom, 33 cases developed myocardial infarction, unstable angina or coronary revascularization, and 18 cases ischemic stroke, transient ischemic attack or carotid vascular revascularization. The patients were divided into the ASCVD group (n=51) and the non ASCVD group (n=455) based on the presence or absence of ASCVD events. VO2peak [16.3 (3.6) mL/(kg·min) vs. 19.1 (3.2) mL/(kg·min), P<0.001] in the ASCVD group were significantly lower than that in the non ASCVD group. Logistic regression analysis found VO2peak [OR 0.893 (95%CI: 0.831-0.959), P=0.002] and ASCVD risk stratification [OR 1.428 (95%CI:1.028-1.878), P=0.031] were both independently associated with the occurrence of ASCVD events, which meant that every 1 mL/(kg·min) of increase in VO2peak, the risk of ASCVD events was reduced by 11%. The patients were divided into low, moderate, and high VO2peak according to the tertiles of their VO2peak [14.4 mL/(kg·min), and 23.0 mL/(kg·min)]. Logistic regression analyses were performed using ASCVD events as a dependent variable in the patients with highrisk and low/moderate-risk of ASCVD respectively. In the patients with highrisk of ASCVD, the results suggested that the incidence of ASCVD events was significantly decreased in the patients with moderate VO2 peak [OR 0.210 (95%CI: 0.054-0.814), P=0.024] and high VO2 peak [OR 0.146 (95%CI:0.025-0.870), P=0.035], but no significant effect of VO2 peak elevation on the incidence of ASCVD events was found in the low/moderate-risk ASCVD patients.@*CONCLUSION@#High cardiopulmonary fitness can significantly reduce the occurrence of ASCVD events in patients with high-risk of ASCVD.

Effects of ticagrelor on cardiorespiratory fitness in patients after percutaneous coronary intervention / 中华心血管病杂志

Objective: To investigate the effects of ticagrelor on cardiorespiratory fitness in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods: A total of 1 073 patients, who were diagnosed as coronary heart disease and underwent cardiopulmonary exercise testing (CPET) within 1 year after PCI, were enrolled from September 2017 to September 2019 in Peking University Third Hospital, including 309 patients in ticagrelor group and 764 patients in clopidogrel group. Clinical information, blood test results, echocardiographic parameters, cardiorespiratory fitness related parameters (including peak oxygen uptake (VO(2)), anaerobic threshold VO(2), peak oxygen pulse (VO(2)/HR) and carbon dioxide ventilation equivalent (VE/VCO(2)) slope), coronary lesions and intervention information were obtained. Cardiopulmonary fitness related indexes were compared between the two groups, and the correlation between ticagrelor use and cardiopulmonary fitness related indexes was analyzed by multivariate logistic regression. Patients who underwent CPET within 1 month after PCI were included in the subgroup analysis. Results: In ticagrelor group, the age was (60.3±10.3) years, and 253(81.9%) cases were male. The age of clopidogrel group was (60.6±10.0) years, and there were 608(79.6%) males. No significant differences were observed in peak VO(2), anaerobic threshold VO(2), and peak VO(2)/HR between the two groups (all P>0.05), but the VE/VCO(2) slope was significantly higher in the ticagrelor group than in the clopidogrel group (30.075 (27.207, 33.603) vs. 28.853 (25.970, 32.336), P<0.001). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with the ticagrelor use (all P>0.05), while the VE/VCO(2) slope was independently correlated with ticagrelor use (OR=1.098, 95%CI 1.032-1.168, P=0.003). Subgroup analysis of patients who underwent CPET within 1 month after PCI also indicated that no significant difference were observed in peak VO(2), anaerobic threshold VO(2), peak VO(2)/HR and VE/VCO(2) slope between the two groups (all P>0.05). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with ticagrelor use (all P>0.05), while the VE/VCO(2) slope was significantly correlated with ticagrelor use (OR=1.132, 95%CI 1.030-1.244, P=0.010). Conclusion: Among coronary heart disease patients after PCI, treatment with clopidogrel does not result in significant decrease in exercise endurance as compared with patients treated with ticagrelor.

Efficacy and safety of antifibrinolytic agents in spinal surgery: a network meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-associated blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method.@*METHODS@#Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1, 2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0.@*RESULTS@#Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=-0.65, 95% credibility intervals [CrI;-1.25, -0.06]), low-dose TXA (SMD = -0.58, 95% CrI [-0.92, -0.25]), and high-dose TXA (SMD = -0.70, 95% CrI [-1.04, -0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD = -1.90, 95% CrI [-3.32, -0.48]) and high-dose TXA (SMD = -2.31, 95% CrI [-3.75, -0.87]) had less postoperative blood loss. Low-dose TXA (SMD = -1.07, 95% CrI [-1.82, -0.31]) and high-dose TXA (SMD = -1.07, 95% CrI [-1.82, -0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD = -2.07, 95% CrI [-3.26, -0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD = -1.67, 95% CrI [-3.20, -0.13]). Furthermore, aprotinin (odds ratio [OR] = 0.16, 95% CrI [0.05, 0.54]), EACA (OR = 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR = 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. Antifibrinolytics did not show a significantly increased risk of postoperative thrombosis. Results of ranking probabilities indicated that high-dose TXA had the greatest efficacy and a relatively high safety level.@*CONCLUSIONS@#The antifibrinolytic agents are able to reduce perioperative blood loss and transfusion requirement during spine surgery. And the high-dose TXA administration might be used as the optimal treatment to reduce blood loss and transfusion.

Evaluation of screening accuracy on osteoporosis self-assessment tool for Asians and its cut-off value in healthy physical examination population / 北京大学学报(医学版)

OBJECTIVE@#To explore the screening value of osteoporosis self-assessment tool for Asians (OSTA) and the optimal cut-off value in Chinese healthy physical examination population.@*METHODS@#We selected a healthy physical examination population for bone mineral density screening at the Health Examination Center in Peking University Third Hospital from 2013 to 2016. Quantitative ultrasound (QUS) results were used as the gold standard, and T value ≤-2.5 was defined as osteoporosis patients. Diagnostic test methods were used to analyze the sensitivity, specificity, likelihood ratio and area under curve (AUC) of different cut points of OSTA. The screening accuracy of OSTA at different cut points was compared and the optimal cut-point value determined.@*RESULTS@#A total of 5 833 subjects were included in the study, with an average age of (48.3±17.5) years and 2 594 women (44.5%). The QUS test showed 403 patients with osteoporosis (6.9% of the total population), 343 female osteoporosis patients (13.22% of the female population). In the whole age group, AUC at the international routine cut-off value (OSTA ≤-1) screening for osteoporosis was 0.815 (95%CI: 0.804-0.825), and screening accuracy was higher in the women (AUC=0.837, 95%CI: 0.823-0.851) than that in the men (AUC=0.767, 95%CI: 0.752-0.781; P<0.05). In the whole age group, when the optimal cut-off value was 0, its AUC 0.842 (95%CI: 0.832-0.851) was significantly higher than that when the cut-off value was -1 (P<0.01), and net reclassification improvement (NRI) increased by 5.5%. In the 40 to 65-year-old group, when OSTA cut-off value ≤0, the screening accuracy was significantly higher (NRI=19.5%, P=0.003) than that when it was -1.@*CONCLUSION@#The OSTA screening tool had good osteoporosis screening value in healthy people, and the screening accuracy in women is higher than that in men. Increasing the screening cut-off value of OSTA would be helpful to improve the screening accuracy in the whole and 40 to 65-year-old population. There may be different optimal cut-off values for different age group population.

Comparison of Vaginal Gel and Intramuscular Progesterone for Fertilization and Embryo Transfer with Gonadotropin-Releasing Hormone Antagonist Protocol / 中华医学杂志(英文版)

<p><b>Background</b>Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer (IVF-ET) with gonadotropin-releasing hormone (GnRH)-antagonist protocol. This study aimed to compare the effect between vaginal progesterone (VP) and intramuscular progesterone (IMP) with GnRH-antagonist protocol after IVF-ET.</p><p><b>Methods</b>A total of 1760 patients (18 years ≤ age ≤35 years) undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP (VP group) and 419 patients received IMP (IMP group) as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median (p25 and p75) and were compared using nonparametric Mann-Whitney U-test.</p><p><b>Results</b>Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% (χ = 8.287, P = 0.004). The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group (clinical intrauterine pregnancy rate 47.35% vs. 41.29%, χ = 4.727, P = 0.030; implantation rate 30.99% vs. 25.26%, χ = 14.546, P < 0.001). Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed.</p><p><b>Conclusion</b>: Luteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.</p>

Efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty / 北京大学学报(医学版)

OBJECTIVE@#To investigate the safety and efficacy of applying ultrasonic osteotome in patients undergoning cervical expansive open-door laminoplasty (CEOL).@*METHODS@#In the study, 94 consecutive patients who were administrated in the spine group of Orthopedic Department of Peking University Third Hospital from March 2015 to March 2016 were reviewed retrospectively. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and underwent CEOL. These patients were divided into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. The parameters we studied were as follows: the duration of operation, blood loss in operation, volume of drainage on the first postoperative day, days of remaining the drainage tube, preoperative and postoperative Japanese Orthopedic Association (JOA) scores, complications of cerebrospinal fluid leak and hinge bone nonunion.@*RESULTS@#Compared with the traditional group, the duration of operation of the ultrasonic osteotome group was increased, but the blood loss in operation, volume of drainage on the 1st postoperative day and days of remaining the drainage tube of the ultrasonic osteotome group were all reduced. There was no obvious difference between the two groups when considering the cerebrospinal fluid leak. At the end of the 3-month follow-up, the JOA score and improvement rate of the JOA score were of no obvious difference between the two groups. But the hinge bone union of the traditional group was better than the ultrasonic osteotome group. At the end of the 12-month follow-up, all the JOA score, the improvement rate of the JOA score and the hinge bone union were not obviously different between the two groups.@*CONCLUSION@#Applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty is both safe and effective. Compared with the rongeur, ultrasonic osteotome can cause the delayed union of the hinge bone, but it reduces the blood loss in operation, volume of postoperative drainage and days of remaining the drainage tube.

Efficacy of Different Treatment Regimens for Antiphospholipid Syndrome-related Recurrent Spontaneous Abortion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Antiphospholipid syndrome (APS)-related immune factors are considered as an important cause of recurrent spontaneous abortion (RSA). Anticoagulant and anti-inflammatory treatments are believed to effectively improve adverse pregnancy outcomes by affecting the abnormal autoimmune response of the maternal-fetal interface. The aim of this study was to observe the clinical characteristics and treatment outcomes of anticoagulant regimens and anti-inflammatory plus anticoagulation regimens for APS-related RSA.</p><p><b>METHODS</b>APS-related RSA cases from September 2011 to September 2016 at Peking University Third Hospital were retrospectively analyzed. The patients were assigned to study group (anti-inflammation plus anticoagulation) and control group (simple anticoagulation). The incidence of repeat abortion, the incidence of placental dysfunction, the gestational weeks of pregnancy, and the mean weight of the fetus were observed.</p><p><b>RESULTS</b>The pregnancy and neonatal outcome indicators of the repeat pregnancy loss rate (11.11% vs. 22.70%), placental dysfunction-related diseases (6.35% vs. 15.60%), the mean birth weight of infants born after 24 weeks gestation (3152.41 ± 844.67 g vs. 2765.76 ± 816.40 g), full-term delivery weight (3456.28 ± 419.79 g vs. 3076.18 ± 518.79 g), the proportions of low birth weight infants (12.70% vs. 21.98%), and small for gestational age (6.35% vs. 14.18%) differed significantly between the study and control groups (all P< 0.05). The incidence of preterm delivery, term delivery, and stillbirth was not significantly different between the two groups, and there was no significant difference between the study and control groups in gestational age at birth (37.6 ± 3.3 weeks vs. 36.9 ± 3.2 weeks; P > 0.05).</p><p><b>CONCLUSION</b>The anti-inflammatory and anticoagulation regimen is more effective than the simple anticoagulation regimen in the treatment of APS recurrent abortion.</p>

Comparison of two dose-response relationship of noise exposure evaluation results with high frequency hearing loss / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Complex noise and its relation to hearing loss are difficult to measure and evaluate. In complex noise measurement, individual exposure results may not accurately represent lifetime noise exposure. Thus, the mean L Aeq,8 h values of individuals in the same workgroup were also used to represent L Aeq,8 h in our study. Our study aimed to explore whether the mean exposure levels of workers in the same workgroup represented real noise exposure better than individual exposure levels did.</p><p><b>METHODS</b>A cross-sectional study was conducted to establish a model for cumulative noise exposure (CNE) and hearing loss in 205 occupational noise-exposed workers who were recruited from two large automobile manufacturers in China. We used a personal noise dosimeter and a questionnaire to determine the workers' occupational noise exposure levels and exposure times, respectively. A qualified audiologist used standardized audiometric procedures to assess hearing acuity after at least 16 h of noise avoidance.</p><p><b>RESULTS</b>We observed that 88.3% of workers were exposed to more than 85 dB(A) of occupational noise (mean: 89.3 ± 4.2 dB(A)). The personal CNE (CNEp) and workgroup CNE (CNEg) were 100.5 ± 4.7 dB(A) and 100.5 ± 2.9 dB(A), respectively. In the binary logistic regression analysis, we established a regression model with high-frequency hearing loss as the dependent variable and CNE as the independent variable. The Wald value was 5.014 with CNEp as the independent variable and 8.653 with CNEg as the independent variable. Furthermore, we found that the figure for CNEg was more similar to the stationary noise reference than CNEp was. The CNEg model was better than the CNEp model. In this circumstance, we can measure some subjects instead of the whole workgroup and save manpower.</p><p><b>CONCLUSIONS</b>In a complex noise environment, the measurements of average noise exposure level of the workgroup can improve the accuracy and save manpower.</p>

Effect of tongxie yaofang on intestinal mast cells and cytokine expression of rats with visceral hypersensitivity / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Tongxie Yaofang (TY) on the number of mast cells (MCs) and the expression of cytokines in rats with visceral hypersensitivity, and to explore roles of TY in treating visceral hypersensitivity and its possible mechanism.</p><p><b>METHODS</b>Totally 30 male adult Sprague Dawley (SD) rats were randomly divided into the blank control group, the model group, and the TY treatment group, 10 in each group. The irritable bowel syndrome (IBS) rat model was established by combining colorectal distention with restraint stress in the TY treatment group and the model group. The visceral hypersensitivity was assessed by abdominal withdrawal reflex (AWR). From the 2nd day of successful modeling, rats in the treatment group were admiministered with TY at the daily dose of 4 g/kg for 4 successive weeks. Equal volume of normal saline was given to rats in the model group for 4 successive weeks. No treatment was given to rats in the blank control group. Four weeks later the number of MCs was counted by using toluidine blue staining. The expression of interleukin-4 (IL-4) and interleukin-9 (IL-9) both in colonic mucosa and serum were measured by enzyme linked immunosorbent assay (ELISA), and the expression of protease-activated receptor type 2 (PAR-2) was detected by Western blot.</p><p><b>RESULTS</b>Compared with the blank control group, the visceral sensitivity was significantly elevated, the number of MCs in the ileocecal junction increased, and the expression of IL-4, IL-9, and PAR-2 in serum and the colonic mucosa significantly increased (P < 0.05). Compared with the model group, the visceral sensitivity significantly decreased, the number of MCs reduced, and the expression of PAR-2 in the colonic mucosa significantly reduced (all P < 0.05), and the expression of IL-4 in colonic mucosa and IL-9 in serum were obviously reduced in the TY treatment group (P < 0.05).</p><p><b>CONCLUSION</b>TY might improve the visceral hypersensitivity by acting on MCs related cytokines and reducing degranulation of MCs.</p>

Assessment comparison between area sampling and personal sampling noise measurement in new thermal power plant / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To compare the results of noise hazard evaluations based on area sampling and personal sampling in a new thermal power plant and to analyze the similarities and differences between the two measurement methods.</p><p><b>METHODS</b>According to Measurement of Physical agents in Workplace Part 8: Noise(GBZff 189.8-2007), area sampling was performed at various operating points for noise measurement, and meanwhile the workers under different types of work wore noise dosimeters for personal noise exposure measurement. The two measurement methods were used to evaluate the level of noise hazards in the enterprise according to the corresponding occupational health standards, and the evaluation results were compared.</p><p><b>RESULTS</b>Area sampling was performed at 99 operating points, the mean noise level was 88.9 ± 11.1 dB (A)(range, 51.3-107.0 dB (A)), with an over-standard rate of 75.8%. Personal sampling was performed (73 person times),and the mean noise level was 79.3 ± 6.3 dB (A), with an over-standard rate of 6.6% ( 16/241 ). There was a statistically significant difference in the over-standard rate between the evaluation results of the two measurement methods ( x2=53.869, ?<0.001 ).</p><p><b>CONCLUSION</b>Because of the characteristics of the work in new thermal power plants, the noise hazard evaluation based on area sampling cannot be used instead of personal noise exposure measurement among workers. Personal sampling should be used in the noise measurement in new thermal power plant.</p>

Noise exposure assessment with task-based measurement in complex noise environment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Task-based measurement (TBM) is a method to assess the eight-hour A-weighted equivalent noise exposure level (L(Aeq.8h)) besides dosimeter. TBM can be better used in factories by non-professional workers and staffs. However, it is still not clear if TBM is equal or similar with dosimeter for L(Aeq.8h) measurement in general. This study considered the measurement with dosimeter as real personal noise exposure level (PNEL) and assessed the accuracy of TBM by comparing the consistencies of TBM and dosimeter in L(Aeq.8h) measurement.</p><p><b>METHODS</b>The study was conducted in one automobile firm among 387 workers who are exposed to unstable noise. Dosimeters and TBM were used to compare the two strategies and assess the degree of agreement and causes of disagreement. Worker's PNEL was measured via TBM for noise; the real PNEL was also recorded. The TBM for noise was computed with task/position noise levels measured via sound level meter and workers' exposure information collected via working diary forms (WDF) filled by participants themselves. Full-shift noise exposure measurement via personal noise dosimeters were taken as the real PNEL. General linear model (GLM) was built to analyze the accuracy of TBM for noise and the source of difference between TBM for noise and real PNEL.</p><p><b>RESULTS</b>The L(Aeq.8h) with TBM were slightly higher than the real PNELs, except the electricians. Differences of the two values had statistical significance in stamping workers (P < 0.001), assembly workers (P = 0.015) and welding workers (P = 0.001). The correlation coefficient of L(Aeq.8h) with TBM and real PNELs was 0.841. Differences of the two results were mainly affected by real PNEL (F = 11.27, P = 0.001); and work groups (F = 3.11, P < 0.001) divided by jobs and workshops were also independent factors. PNEL of workers with fixed task/position ((86.53 ± 8.82) dB(A)) was higher than those without ((75.76 ± 9.92) dB(A)) (t = 8.84, P < 0.01). Whether workers had fixed task/position was another factor on the accuracy of TBM for noise (F = 4.36, P = 0.038).</p><p><b>CONCLUSION</b>TBM for noise has acceptable accuracy on workers' PNEL measurement. The accuracy is affected by job categories, workshops and variability of task/position. TBM for noise can yield a relatively conservative result of worker's PNEL in most cases, so it can be used to measure and assess workers' real PNEL.</p>