Study on primary screening technique for children with autism spectrum disorder / 中华预防医学杂志

To explore screening tools for children with autism spectrum disorder (ASD), which are convenient for primary hospitals, it can provide basic data for formulating ASD prevention policies. This was a cross-sectional study by cluster sampling. Huyi District and Xincheng District were extracted for investigation in Xi'an City. From July 2021 to September 2022, all children aged from 3 months to 36 months who live in the two districts were subjected to primary screening. The child care physician used the routine screening tool "warning signs checklist for screening psychological, behavioral and developmental problems of children" and cartoon pictures of "early high-risk warning signs of autism", the children who were positive in the initial screening were referred to the district level maternal and child health hospital for re-screening, and those who were positive in the re-screening were referred to Xi 'an Children's Hospital for diagnosis. The results showed that a total of 17 905 children aged from 3 months to 36 months were initially screened in the two districts, including 10 588 children aged from 18 months to 36 months, 50 children who were positive in the initial screening and 50 children who were re-screened. 23 children (18 boys and 5 girls) were diagnosed with ASD. The prevalence rate of ASD in children was 2.17‰ (95% confidence interval:1.29‰-3.06‰). 42 children were positive for "warning signs checklist" at the preliminary screening, and 19 were confirmed as ASD. 27 children were positive for "cartoon pictures" in the preliminary screening, and 23 were confirmed with ASD. The "cartoon pictures" in the preliminary screening and diagnosis of consistent rate was higher than the "warning signs checklist", two kinds of screening methods comparison were statistically significant difference in the odds of consistent (χ2=11.01, P=0.001). In conclusion, relying on the three-level network of maternal and child health care, it is conducive to the whole process management of screening and diagnosis of children with ASD, and to guide the formulation of prevention policies. The cartoon pictures of "early high-risk warning signs of autism" can assist the identification of children with ASD based on the "warning signs checklist", which is simple, effective and suitable for promotion in the community health care.

Study on primary screening technique for children with autism spectrum disorder / 中华预防医学杂志

To explore screening tools for children with autism spectrum disorder (ASD), which are convenient for primary hospitals, it can provide basic data for formulating ASD prevention policies. This was a cross-sectional study by cluster sampling. Huyi District and Xincheng District were extracted for investigation in Xi'an City. From July 2021 to September 2022, all children aged from 3 months to 36 months who live in the two districts were subjected to primary screening. The child care physician used the routine screening tool "warning signs checklist for screening psychological, behavioral and developmental problems of children" and cartoon pictures of "early high-risk warning signs of autism", the children who were positive in the initial screening were referred to the district level maternal and child health hospital for re-screening, and those who were positive in the re-screening were referred to Xi 'an Children's Hospital for diagnosis. The results showed that a total of 17 905 children aged from 3 months to 36 months were initially screened in the two districts, including 10 588 children aged from 18 months to 36 months, 50 children who were positive in the initial screening and 50 children who were re-screened. 23 children (18 boys and 5 girls) were diagnosed with ASD. The prevalence rate of ASD in children was 2.17‰ (95% confidence interval:1.29‰-3.06‰). 42 children were positive for "warning signs checklist" at the preliminary screening, and 19 were confirmed as ASD. 27 children were positive for "cartoon pictures" in the preliminary screening, and 23 were confirmed with ASD. The "cartoon pictures" in the preliminary screening and diagnosis of consistent rate was higher than the "warning signs checklist", two kinds of screening methods comparison were statistically significant difference in the odds of consistent (χ2=11.01, P=0.001). In conclusion, relying on the three-level network of maternal and child health care, it is conducive to the whole process management of screening and diagnosis of children with ASD, and to guide the formulation of prevention policies. The cartoon pictures of "early high-risk warning signs of autism" can assist the identification of children with ASD based on the "warning signs checklist", which is simple, effective and suitable for promotion in the community health care.

Clinical application of magnetic resonance imaging-guided radiation therapy in the treatment of pancreatic cancer / 中华放射肿瘤学杂志

At present, pancreatic cancer is a solid tumor with the worst prognosis. Compared with surgery and chemotherapy, radiotherapy plays an auxiliary role in the treatment of pancreatic cancer. In recent years, significant advances have been achieved in radiotherapy technology, which have been gradually applied in the diagnosis and treatment of pancreatic cancer. In this article, the progress in radiation therapy in the treatment of pancreatic cancer was reviewed, especially the clinical application of magnetic resonance imaging-guided radiation therapy in the treatment of pancreatic cancer, aiming to deepen the understand of the progress in radiation therapy for pancreatic cancer, and providing reference for improving the survival rate of pancreatic cancer patients.

Analysis of the impact of patients ages on propofol dosage in painless gastroscopy / 中国内镜杂志

Objective To analyze the impact of patients ages on propofol dosage in painless gastroscopy.Methods A retrospective analysis was conducted on the clinical data of 158 painless gastroscopy patients from January 2017 to June 2020.They were divided into the young group(18～44 years old,n = 57),the middle-aged group(45～59 years old,n = 51),and the elderly group(≥60 years old,n = 50)based on their age.The anesthesia status and safety of each group were compared.Results The results showed that the dosage of propofol,average total dosage of propofol,MAP,HR,RR,SpO2 levels in the young group were higher than those in the middle-aged and elderly groups when consciousness disappeared,and the middle-aged group was higher than the elderly group;The onset time,anesthesia recovery time,orientation recovery time,and departure time in the young group of patients were shorter than those in the middle-aged and elderly groups,and the middle-aged group was shorter than the elderly group(P<0.05).The incidence of airway obstruction,hypoxemia,mandible support,mask ventilation,adverse cardiovascular events,sedation related adverse events,and incidence of obstructed endoscopy in the elderly group were higher than those in the young and middle-aged groups.The incidence of smooth endoscopy was lower than that in the young and middle-aged groups(P<0.05).Conclusion Aging may increase the dosage of propofol in patients underwent painless gastroscopy under anesthesia,prolong the onset time,anesthesia recovery time,orientation recovery time,and departure time,increase stress reactions and adverse reactions,and strengthen monitoring for elderly patients in clinical practice.

YANG Yu-Feng's Experience in Treating Seborrheic Alopecia Using the Method of Strengthening the Spleen,Dispelling Dampness,Controlling Oil and Removing Fat / 广州中医药大学学报

Based on the theory of traditional Chinese medicine(TCM)and clinical manifestations of seborrheic alopecia,Professor YANG Yu-Feng believes that the fundamental pathogenesis of seborrheic alopecia is due to spleen deficiency with dampness accumulation,and dampness and fat sharing the same origin.The internal accumulation of dampness and turbidity results from the deficiency of spleen,and then the dampness and turbidity blended with heat attack the head and face.For dampness and fat share the same origin,the turbid fat forms,and then overflows and blocks the hair roots,which causes the qi and blood being difficult to go upward and nourish the hair roots,and then induces hair loss.Among them,spleen deficiency with dampness accumulation is the core pathogenesis of the disease,heat activating the movement of dampness is the key pathogenesis to the disease,and the disharmony of qi and blood is the pivot of the pathogenesis.For the treatment of seborrheic alopecia,Professor YANG Yu-Feng suggested that the hair root should be unblocked and the hair quality should be nourished by blood essence,and emphasized the importance of the method of invigorating the spleen and removing dampness,controlling oil and removing fat in dredging the hair root and relieving seborrheic alopecia.It is proposed that invigorating the spleen and removing dampness is the key,expelling wind and clearing heat is for assistance,and harmonizing qi and blood serves as the pivot.

Discussion on the Pathogenesis of Osteonecrosis of the Femoral Head Under the System of Non-uniform Settlement During Bone Resorption and Multidimensional Composite Bowstring Working in Coordination with the Theory of Liver-Kidney and Muscle-Bone Based on the Concept of Liver and Kidney Sharing the Common Source / 广州中医药大学学报

From the perspective of the physiological basis of liver and kidney sharing the common source in traditional Chinese medicine(TCM),and by integrating the theory of kidney dominating bone,liver dominating tendon,and meridian sinew of TCM as well as the bone resorption and collapse theory,and non-uniform settlement theory and lower-limb musculoskeletal bowstring structure theory of modern orthopedics,the pathogenesis of osteonecrosis of the femoral head(ONFH)under the system of non-uniform settlement during bone resorption and multidimensional composite bowstring working in coordination with the theory of liver-kidney and muscle-bone was explored.The key to the TCM pathogenesis of ONFH lies in the deficiency of the liver and kidney,and then the imbalance of kidney yin-yang leads to the disruption of the dynamic balance of bone formation and bone resorption mediated by osteoblasts-osteoclasts,which manifests as the elevated level of bone metabolism and the enhancement of focal bone resorption in the femoral head,and then leads to the necrosis and collapse of the femoral head.It is considered that the kidney dominates bone,liver dominates tendon,and the tendon and bone together constitute the muscle-bone-joint dynamic and static system of the hip joint.The appearance of collapse destroys the originally balanced muscle-bone-joint system.Moreover,the failure of liver blood in the nourishment of muscles and tendons further exacerbates the imbalance of the soft tissues around the hip joint,accelerates the collapse of the muscle-bone-joint dynamic and static system,speeds up the process of femoral head collapse,and ultimately results in irreversible outcomes.Based on the above pathogenesis,the systematic integrative treatment of ONFH should be based on the TCM holistic concept,focuses on the focal improvement of internal and external blood circulation of the femoral head by various approaches,so as to rebuild the coordination of joint function.Moreover,attention should be paid to the physical constitution of the patients,and therapy of tonifying the kidney and regulating the liver can be used to restore the balance between osteogenesis and osteoblastogenesis,and to reconstruct the muscle-bone-joint system,so as to effectively delay or even prevent the occurrence of ONFH.

Associations of well-being and sleep quality with occupational stress among locomotive engineers in the Yangtze River Delta region / 环境与职业医学

Background Occupational stress is an important factor affecting the health of working population, wellness is a topic that has received much attention in recent years, and sleep quality and wellness have a certain impact on occupational stress. Objective To understand the current situation of occupational stress among locomotive engineers in in the Yangtze River Delta, explore the influence of well-being and sleep quality on occupational stress, and provide a theoretical basis for occupational stress intervention among locomotive engineers. Methods Sampling was conducted from October to December 2022 using stratified random sampling. The Chinese version of the Brief Occupational Tension Questionnaire based on the Job Demand-Control Model (JDC model), the World Health Organization 5-item Well-Being Index (WHO-5), and the Pittsburgh Sleep Quality Index (PSQI) scale were used to investigate the occupational stress, well-being, and sleep quality of locomotive engineers. Logistic regression was used to analyze the effects of sleep quality and well-being on occupational stress, and additive and multiplicative interaction models were applied to evaluate the interactive effects of well-being and sleep quality on occupational stress. Results A total of 8243 questionnaires were collected from five locomotive companies, and after excluding unqualified questionnaires, a total of 7976 questionnaires were included in the analysis. The number of locomotive engineers in the Yangtze River Delta reporting positive occupational stress was 4633 (58.09%), the number of low-level well-being was 4949 (62.05%), and the number of poor sleep quality was 4129 (51.77%). The distribution of occupational stress varied by age, length of service, region, technical level, nature of vehicle, education, per capita monthly family income, marital status, smoking, drinking, number of exercise sessions per week, quality of sleep, work shifts, and length of commute (P<0.01). The results of logistic regression showed that a lower level of occupational stress was associated with >11000 yuan per capita monthly household income (OR=0.795, 95%CI: 0.656, 0.964), high level of well-being (OR=0.477, 95%CI: 0.430, 0.528), and good sleep quality (OR=0.588, 95%CI: 0.531, 0.651); a higher level of occupational stress was associated with night shifts: 1 or fewer night shifts (OR=1.707, 95%CI: 1.312, 2.221), 2 to 3 night shifts (OR=2.649, 95%CI: 2.111, 3.325), and 4 or more night shifts (OR=2.804, 95%CI: 2.202, 3.571); a higher level of occupational stress was associated with 60 min or more commuting time (OR=1.353, 95%CI: 1.111, 1.646). Regarding interaction between poor sleep quality and low well-being on occupational stress, the relative excess risk ratio (RERI), attributable risk index (API), and synergy index (SI) were 1.451 (1.059, 1.844), 0.417 (0.327, 0.507), and 2.407 (1.787, 3.241), respectively, and the result of the multiplicative interaction was an OR of 1.546 (95%CI: 1.262, 1.893). Conclusion The prevalence of occupational stress among locomotive engineers in the Yangtze River Delta region is generally at a medium level compared with other industries. Good sleep quality reduces the risk of occupational stress to a greater extent than high well-being, and poor sleep quality and low well-being can interact and further increase the risk of occupational stress.

Communication disorders in children with autism spectrum disorder from speech language pathology perspective / 中国儿童保健杂志

Children with autism spectrum disorder (ASD) face varying degrees of difficulties in communication, language, and social interactions.This article analyzes the basic communication abilities, language development characteristics, and social pragmatic features of ASD children from the perspective of speech pathology, introduces corresponding assessment tools and proposes intervention strategies based on the International Classification of Functioning, Disability, and Health (ICF). Meanwhile, this article emphasizes the adoption of a comprehensive intervention model that involves medical, family, and school components to enhance the communication, language, and social skills of this group comprehensively, with the aim of effectively improving their overall quality of life.

Effect of acupuncture at neck-Jiaji (EX-B 2) and tuina on the cognitive function in the patients with subjective cognitive decline / 中国针灸

OBJECTIVES@#To observe the effects on cognitive function, sleep quality and hemodynamics in the patients with subjective cognitive decline (SCD) after treated with acupuncture at neck-Jiaji (EX-B 2) and tuina on the base of healthy lifestyle education and meta-memory training.@*METHODS@#Sixty SCD patients were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 3 cases dropped out). In the control group, the healthy lifestyle education and meta-memory training was performed, twice daily, 15 min each time; the 5-day intervention was delivered a week, lasting consecutively 4 weeks. On the base of the intervention as the control group, in the observation group, acupuncture at neck-Jiaji (EX-B 2) and tuina was conducted. First, one-finger pushing and plucking method of tuina was exerted on the neck region along the running courses of the bladder meridian of foot-taiyang and the governor vessel, for 10 min to 15 min; afterwards, acupuncture was delivered at bilateral neck-Jiaji (EX-B 2), from C1 to C7; and the needles were retained for 30 min. This intervention was given once daily, 5 times a week, for consecutive 4 weeks. Before and after treatment, the score of the mini-mental state examination (MMSE), the score of full scale memory quotient (FSMQ) were assessed by Wechsler memory scale-fourth edition (WMS-Ⅳ) and the score of the Pittsburgh sleep quality index (PSQI) was compared between the two groups. Using transcranial Doppler ultrasound, the hemodynamic indexes (the mean velocity [Vm] and pulsatility index [PI] of the left vertebral artery [LVA], the right vertebral artery [RVA] and the basilar artery [BA]) were determined in the two groups.@*RESULTS@#After treatment, the scores of MMSE and FSMQ increased compared with those before treatment in the two groups (P<0.05, P<0.001), PSQI score was lower (P<0.05) and Vm of BA was higher (P<0.001) in the observation group when compared with those before treatment. The scores of MMSE and FSMQ, as well as Vm of BA were higher (P<0.05, P<0.001), and PSQI score was decreased (P<0.05) in the observation group when compared with the control group.@*CONCLUSIONS@#The combined therapy of acupuncture at neck-Jiaji (EX-B 2) and tuina is more advantageous to improving cognitive function, relieving chronic emotional stress and ameliorating sleeping quality in the patients with subjective cognitive decline, which may be achieved by improving the blood supply of the basilar artery.

Influence of Gut Microbiota and its Metabolites on Progression of Metabolic Associated Fatty Liver Disease / 中国医学科学杂志(英文版)

Metabolic associated fatty liver disease (MAFLD) has become a prevalent chronic liver disease worldwide because of lifestyle and dietary changes. Gut microbiota and its metabolites have been shown to play a critical role in the pathogenesis of MAFLD. Understanding of the function of gut microbiota and its metabolites in MAFLD may help to elucidate pathological mechanisms, identify diagnostic markers, and develop drugs or probiotics for the treatment of MAFLD. Here we review the pathogenesis of MAFLD by gut microbiota and its metabolites and discuss the feasibility of treating MAFLD from the perspective of gut microbes.

Current status of public health system in Guangdong-Hong Kong-Macao Greater Bay Area and improvement suggestion / 中华流行病学杂志

Guangdong-Hong Kong-Macao Greater Bay Area (GBA) has three public health systems under different systems, which plays an important role in the construction of the public health system in China. Further strengthening the construction of the public health system in the GBA will play an important reference role in the optimization and upgrade of China's public health system in the future. Based on the key consulting project of "research on the strategy of the modern public health system and capacity building in China" by Chinese Academy of Engineering, this paper deeply analyzes the current status and existing problems of public health system construction in GBA and suggests to improve and innovate the mechanisms of collaborative prevention and control of public health risks, resource coordination and joint research and result sharing, information sharing and exchange, personnel training and team building in order to comprehensively improve the capacity of public health system in GBA, and promote the construction of Healthy China.

Aucubin combined with ADSCs-exos protects TBHP-induced nucleus pulposus cells via TLR4/NF-κB pathway / 中国中药杂志

This paper aims to investigate the effects and mechanisms of adipose-derived stem cells-exosomes(ADSCs-exos) toge-ther with aucubin in protecting human-derived nucleus pulposus cells(NPCs) from inflammatory injury, senescence, and apoptosis. The tert-butyl hydroperoxide(TBHP)-induced NPCs were assigned into normal, model, aucubin, ADSCs-exos, and aucubin+ADSCs-exos groups. The cell viability was examined by cell counting kit-8(CCK-8), cell proliferation by EdU staining, cell senescence by senescence-associated-β-galactosidase(SA-β-Gal), and cell cycle and apoptosis by flow cytometry. Enzyme-linked immunosorbent assay was employed to examine the expression of interleukin-1β(IL-1β), IL-10, and tumor necrosis factor-α(TNF-α). Real-time fluorescence quantitative PCR and Western blot were employed to determine the mRNA and protein levels of aggregated proteoglycan(aggrecan), type Ⅱ collagen alpha 1(COL2A1), Toll-like receptor 4(TLR4), and nuclear factor-kappa B(NF-κB). The results showed that compared with the model group, the aucubin or ADSCs-exos group showed enhanced viability and proliferation of NPCs, decreased proportion of G_0/G_1 phase cells, increased proportion of S phase cells, reduced apoptosis and proportion of cells in senescence, lowered IL-1β and TNF-α levels, elevated IL-10 level, down-regulated mRNA and protein levels of TLR4 and NF-κB, and up-regulated mRNA and protein levels of aggrecan and COL2A1. Compared with the aucubin or ADSCs-exos group, the aucubin+ADSCs-exos combination further increased the viability and proliferation of NPCs, decreased the proportion of G_0/G_1 phase cells, increased the proportion of S phase cells, reduced the apoptosis and proportion of cells in senescence, lowered the IL-1β and TNF-α levels, elevated the IL-10 level, down-regulated the mRNA and protein levels of TLR4 and NF-κB, and up-regulated the mRNA and protein levels of aggrecan and COL2A1. In summary, both aucubin and ADSCs-exos could exert protective effects by inhibiting inflammatory responses, reducing apoptosis and senescence of NPCs, improving cell viability and proliferation as well as extracellular matrix synthesis, which may be associated with the inhibition of TLR4/NF-κB signaling pathway activation. The combination of both plays a synergistic role in the protective effects.

The value of transcranial Doppler sonography and digital subtraction angiography in evaluating collateral circulation in ischemic stroke and its correlation with prognosis / 中国医师进修杂志

Objective:To explore the value of transcranial Doppler sonography (TCD) and digital subtraction angiography (DSA) in evaluating collateral circulation in ischemic stroke (IS) and its correlation with prognosis.Methods:The 350 IS patients admitted to Shaoxing People′s Hospital from January 2017 to December 2020 were selected as the research objects. According to the results of DSA, they were divided into collateral circulation group and non-collateral circulation group. According to the prognosis, they were divided into good prognosis group and poor prognosis group. The consistency between the evaluation results of collateral circulation on IS of TCD and DSA was analyzed, and its correlation with prognosis was analyzed.Results:The DSA results showed that among 350 patients, 118 had no collateral circulation and 232 had collateral circulation, including 130 cases of grade 1 collateral circulation and 102 cases of grade 2 collateral circulation. TCD results showed that there were 117 cases without collateral circulation and 233 cases with collateral circulation, including 131 cases with grade 1 collateral circulation and 102 cases with grade 2 collateral circulation. The consistency test showed that the evaluation results of TCD on collateral circulation was highly consistent with the gold standard DSA ( Kappa>0.9, P<0.05). Repeated measures analysis of variance showed that time-point effects, inter-group effects, time-point and inter-group interaction effects can significantly affect the changes in modified Rankin scale(mRS) scores ( P<0.05); and the mRS scores in the collateral circulation group were less than those in the non-collateral circulation group at admission the hospital, discharge of the hospital and 3 months after discharge the hospital: (1.89 ± 0.82) scores vs. (2.98 ± 0.98) scores, (1.13 ± 0.53) scores vs. (2.45 ± 0.80) scores, (0.50 ± 0.45) scores vs. (1.86 ± 0.80) scores, there were statistical differences ( P<0.05). The collateral circulation rate in the good prognosis group was higher than that in the poor prognosis group: 78.95%(150/190) vs. 47.50%(76/160), there was statistical difference ( P<0.05). Conclusions:The evaluation value of TCD for IS collateral circulation is high, and collateral circulation is closely related to prognosis.

The application of updated size-specific dose estimation method in children's head CT scans / 实用放射学杂志

Objective To analyze the value of the size-specific dose estimation(SSDE)and volume CT dose index(CTDIvol)on dose estimations of children's head CT scans and the correlations with the body size.Methods A retrospective study was conducted on plain children's head CT scans of 1 409 patients,they were divided into six groups according to age.The age,CTDI,the head perimeter(HP)of the initial plane of the images,the anterior-posterior length(AP),lateral length(LAT),region of interest area(ARoI)and CT value(CTROI)of the intermediate plane of the images were measured retrospectively.Effect diameter(De),water equivalent diameter(Dw)and SSDE based on Dw were calculated respectively.The differences between CTDI and SSDE in measuring radiation dose and the correlations between CTDIvol,SSDE and age,HP and De were analyzed.Results There were significant differences between CTDIvol and SSDE in all groups(P＜0.001).Compared with SSDE,CTDIvol overestimated the radiation dose by-10.17％,0.69％,7.96％,12.84％,17.99％,22.36％respectively.The bigger the age,the higher CTDIvol overestimated its radiation.CTDIvol and SSDE had strong correlations with age,HP and De,the correlation coefficients CTDIvol were stronger than SSDE.Conclusion SSDE takes body size into account in the calculation,so it can reflect the radiation dose of children's head CT more accurately,CTDIvol overestimates the radiation doses except in children younger than 6 months.CTDIvol is closely collected with age,HP and De and underestimated the radiation dose,so it is more beneficial to reduce the radiation.

Construction of an epileptic seizure prediction model using a semi-supervised method of generative adversarial and long short term memory network combined with Stockwell transform / 南方医科大学学报

OBJECTIVE@#To propose a semi-supervised epileptic seizure prediction model (ST-WGAN-GP-Bi-LSTM) to enhance the prediction performance by improving time-frequency analysis of electroencephalogram (EEG) signals, enhancing the stability of the unsupervised feature learning model and improving the design of back-end classifier.@*METHODS@#Stockwell transform (ST) of the epileptic EEG signals was performed to locate the time-frequency information by adaptive adjustment of the resolution and retaining the absolute phase to obtain the time-frequency inputs. When there was no overlap between the generated data distribution and the real EEG data distribution, to avoid failure of feature learning due to a constant JS divergence, Wasserstein GAN was used as a feature learning model, and the cost function based on EM distance and gradient penalty strategy was adopted to constrain the unsupervised training process to allow the generation of a high-order feature extractor. A temporal prediction model was finally constructed based on a bi-directional long short term memory network (Bi-LSTM), and the classification performance was improved by obtaining the temporal correlation between high-order time-frequency features. The CHB-MIT scalp EEG dataset was used to validate the proposed patient-specific seizure prediction method.@*RESULTS@#The AUC, sensitivity, and specificity of the proposed method reached 90.40%, 83.62%, and 86.69%, respectively. Compared with the existing semi-supervised methods, the propose method improved the original performance by 17.77%, 15.41%, and 53.66%. The performance of this method was comparable to that of a supervised prediction model based on CNN.@*CONCLUSION@#The utilization of ST, WGAN-GP, and Bi-LSTM effectively improves the prediction performance of the semi-supervised deep learning model, which can be used for optimization of unsupervised feature extraction in epileptic seizure prediction.

Association between long working hours and occupational stress/fatigue accumulation in medical staff of tertiary grade A hospitals in Shanghai / 环境与职业医学

Background Long working hours are a common occupational health risk factor. The problem of long working hours and its impact on health of medical staff cannot be ignored. Objective To investigate long working hours in medical staff of tertiary grade A hospitals in Shanghai, and evaluate the relationships of long working hours with occupational stress and fatigue accumulation. Methods A total of 1531 medical staff in departments of emergency, internal medicine, surgery, intensive care unit (ICU), anesthesiology, and obstetrics and gynecology from 6 hospitals in 6 districts of Shanghai were selected using stratified random sampling. A structured questionnaire was used to collect information on social demographics, occupational characteristics, andbehavior and lifestyle. The Core Occupational Stress Scale (COSS) and the Self-diagnostic Questionnaire on the Accumulation of Fatigue of Laborers were used to assess occupational stress and fatigue accumulation condition. Chi-square test and Kruskal-Wallis H test were used to analyze the distributions of long working hours, occupational stress, and fatigue accumulation, log-binomial models were used to analyze the relationships of long working hours with occupational stress and fatigue accumulation, and job title stratified models were also constructed. Results The average weekly working hours of the study subjects was (47.84±11.40) h, 65.90% of the medical staff worked more than 40 h every week. The percentages of the weekly working hours categories of 41-48 h, 49-54 h, and ≥55 h were 31.42%, 13.46%, and 21.03%, respectively. The positive rates of occupational stress and fatigue accumulation were 25.87% and 65.64% respectively, and the differences among different age, gender, job title, education, length of service, and shift system groups were statistically significant (P<0.05). The results of log-binomial regression showed that after adjusting for gender, age, monthly income, marital status, education, physical exercise, smoking, job position, length of service, and shift system, weekly working hours were an influencing factor of occupational stress and fatigue accumulation (P<0.05). Compared with weekly working hours≤40 h, the risk, PR(95%CI), of reporting occupational stress and fatigue accumulation increased to 2.595 (1.989, 3.385) and 1.578 (1.349, 1.845) times respectively for weekly working hours≥55 h (P<0.001). The results of job title stratification analysis showed that the risk of occupational stress among physicians, nurses, and medical technicians increased when weekly working hours≥55 h versus ≤40 h, and the PR (95%CI) values were 2.003 (1.383, 2.902), 1.971 (1.068, 3.636), and 2.770 (1.220, 6.288), respectively (P<0.05). The risk of fatigue accumulation was increased in physicians when weekly working hour≥55 h versus ≤40 h, with a PR (95%CI) value of 1.594 (1.208, 2.103) (P<0.001). Conclusion Long working hours are common among medical personnel and related to the occurrence of occupational stress and fatigue accumulation.

Treatment of four-part proximal humerus fractures with depressed humeral head collapse using strut allograft with locking plates / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcomes of allogeneic femoral head as strut allograft combined with proximal humeral internal locking system (PHILOS) in the treatment of proximal humeral Neer grade Ⅳ fracture with humeral head collapse.@*METHODS@#From January 2018 to November 2020, 18 patients with Neer grade Ⅳ fracture with humeral head collapse were treated with strut allograft with PHILOS, including 4 males and 14 females, aged from 55 to 78 years old, with an average of (68.11±7.20) years old. The operation time, intraoperative bleeding, postoperative drainage volume, fracture healing time, neck-shaft angle and the height of the humeral head, failure of internal fixation the shoulder function at the last follow-up was assessed using Neer's scoring system.@*RESULTS@#All 18 patients were followed up, and the duration ranged from 10 to 12 months, with an average of (11.08±0.65) months. The operation time was (66.44±5.06) min, the intraoperative bleeding volume was (206.67±36.14) ml, the postoperative drainage volume was (76.11±9.63) ml, and the fracture healing time was (17.28±3.92) weeks. At the last follow-up, the degree of loss of neck-shaft angle was (5.44±0.86) ° and the loss of the height of humeral head was (1.43±0.27) mm. All 18 patients had healing without complications such as fracture, withdrawal, penetration of internal fixation and necrosis of humeral head. According to Neer's evaluation standard, the total score was (89.61±5.60), 10 cases got an excellent result, 6 good, 2 fair.@*CONCLUSION@#Allogeneic femoral head combined with PHILOS is an appropriate treatment for the four-part proximal humerus fractures with humeral head collapse, exhibiting good clinic outcome.

The characteristics and clinical significance of ascites and peripheral blood lymphocyte subpopulations in decompensated liver cirrhosis patients with alcoholic liver disease / 中国医师杂志

Objective:To analyze the characteristics and clinical significance of ascites, peripheral blood lymph nodes, and cell subpopulations in patients with decompensated liver cirrhosis caused by alcoholic liver disease.Methods:Sixty decompensated liver cirrhosis patients with alcoholic liver disease admitted to the Affiliated Hospital of Jining Medical Unversity from July 2020 to July 2022 were selected as the observation group, and 40 healthy volunteers who underwent physical examinations in our hospital were randomly selected as the control group. The observation group was divided into A, B, and C grades based on the severity of the condition, according to the Child-Pugh grading of liver function. The differences in clinical data, peripheral blood lymphocyte subpopulation indicators, and ascites lymphocyte subpopulation indicators (CD3 + , CD4 + , CD8 + , CD20 + ) under different disease grades were analyzed, and the differences in peripheral blood lymphocyte subpopulation indicators between the two groups of people were compared. Resultsl:The levels of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in the observation group were significantly lower than those in the control group (all P<0.05). Compared with Child-Pugh A grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in peripheral blood of Child-Pugh B and C grade patients decreased significantly (all P<0.05); Compared with Child-Pugh B grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in peripheral blood of Child-Pugh C grade patients decreased significantly (all P<0.05). Compared with Child-Pugh A grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in ascites of Child-Pugh B and C grade patients decreased significantly (all P<0.05); Compared with Child-Pugh B grade patients, the expression of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + , and CD20 + in ascites of Child-Pugh C grade patients decreased significantly (all P<0.05). The peripheral blood and ascites lymphocyte subsets were negatively correlated with the Child-Pugh grading of decompensated liver cirrhosis in alcoholic liver disease (all P<0.05). Conclusions:Patients with decompensated liver cirrhosis caused by alcoholic liver disease are accompanied by varying degrees of immune dysfunction. Detection of lymphocyte subsets in the patient′s peripheral blood and ascites has significant clinical significance for the diagnosis and prognosis of this disease.

Progress on drug delivery of iontophoresis / 药学实践与服务

Iontophoresis is a non-invasive physical permeation technology, which has been widely applied in transdermal and transmucosal administration. Compared with other permeation technologies, iontophoresis have the advantages of high efficacy, high patient compliance and controllable delivery dose. With the development of microneedles and nano-carrier technology, the combination of iontophoresis and other penetration promotion technologies has gradually become a research hotspot. The penetration mechanism and influencing factors of iontophoresis, and the study on the combination of iontophoresis with hydrogel, microneedles or nano-carrier were reviewed in this paper.

Efficacy analysis of autologous facet joint bone block in lumbar interbody fusion of osteoporosis patients / 北京大学学报(医学版)

OBJECTIVE@#To compare and analyze the feasibility of autologous facet joint bone block as an alternative to polyetheretherketone (PEEK) cage in lumbar intervertebral fusion surgery for patients with osteoporosis.@*METHODS@#From December 2018 to June 2021, the case data of patients with osteoporosis (T value ≤ -2.5 on dual energy X-ray bone density) who underwent posterior lumbar interbody fusion in the Fourth Medical Center, Chinese PLA General Hospital were retrospectively reviewed. All the cases were followed up for no less than 12 months and were divided into two groups according to the differences of interbody fusion materials: the autologous facet joint bone block group (autogenous bone group) and the PEEK cage group (PEEK group). The general data [such as age, gender, body mass index (BMI), primary diagnosis, distribution of fusion segments, bone mineral density of lumbar (BMD), incidence of preoperative complications], the perioperative data (such as duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate), and the incidence of postoperative complications were compared between the two groups. Imaging parameters (disc height, lumbar lordosis angle, segment lordosis angle, segmental lordosis angle, disc height improvement rate, and fusion rate) and lumbar functional scores [visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedics Association (JOA) score for lower back pain] were compared to evaluate the clinical efficacy between the kinds of intervertebral fusion materials 1 week, 3 months and 6 months postoperative and at the last follow-up.@*RESULTS@#A total of 118 patients were enrolled, including 68 cases in the autogenous bone group and 50 cases in the PEEK group, there were no statistical differences in age, gender, BMI, primary diagnosis, distribution of fusion segments, BMD, incidence of preoperative complications, duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate, incidence of postoperative complications, all the preoperative imaging parameters and all the lumbar function scores between the two groups (P>0.05). Postoperative superficial surgical site infections occurred in 3 patients in the autogenous bone group and 2 patients in the PEEK group. At the last follow-up, 3 cases of intervertebral graft collapse occurred in the autogenous bone group and 5 cases in the PEEK group, 1 case of graft subsidence in the autogenous bone group and 1 case in the PEEK group. All the imaging parameters showed significant differences between postoperation and preoperation (P < 0.05), and all the imaging parameters showed significant differences between 1 week and 3 months postoperative in both groups (P < 0.05). The height, angle of fusion gap in the autogenous bone group were lower than those in the PEEK group 1 week postoperatively (P < 0.05), and the fusion gap height improvement rate in the autogenous bone group was lower than that in the PEEK group (P < 0.05). The cases in both groups started to show final fusion 3 months after surgery, and the fusion rate in the autogenous bone group was 75% 6 months postoperatively, which was significantly higher than the rate of 56% in the PEEK group (P < 0.05), and there was no statistically significant difference in the final fusion rate between the two groups (P>0.05). The ODI, the postoperative VAS score was significantly lower than that in preoperation, while the postoperative JOA score was significantly higher than that in preoperation (P < 0.05). The ODI was lower while the JOA score was higher of the autogenous bone group than that of the PEEK group 6 months postoperatively (P < 0.05).@*CONCLUSION@#In osteoporosis patients, good interbody fusion rate and improvement of lumbar vertebral function can be obtained by using autologous facet joint bone block or PEEK cage, while the fusion rate and the improvement of lumbar function with autologous facet joint bone block are better than those with PEEK cage 6 months post-operatively. PEEK cage is superior to autologous facet joint bone block in intervertebral distraction and improvement of lumbar lordosis. Significant disc space subsidence occurred in osteoporotic patients within 3 months after lumbar interbody fusion, and the subsidence of PEEK cage was more obvious than that of autologous facet joint bone block.