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Objective@#To explore the influence of heat and noise exposure on the risk of hypertension in workers,and to provide evidence for prevention of hypertension in occupational population.@*Methods@#Cluster sampling method was used to recruit 2 130 steel workers from four factories（north iron-making,long steel,cold steel and power department）of some steel company. A cross-sectional study was conducted to collect physical examination results,heat and noise exposure. Logistic regression models were used to analyze the effects of noise,heat and their interaction on hypertension. @*Results@#Totally 1 971 valid questionnaires were collected,and the response rate was 92.54%. There were 654 workers suffering from hypertension,with a prevalence rate of 33.18%. There were 1 006 workers exposed to noise,accounting for 51.04%;and 853 workers exposed to heat,accounting for 43.28%. The prevalence rates of hypertension in workers exposed to noise and heat were higher than those in workers without the above exposure（P<0.05）. The prevalence rates of hypertension increased with the increase of age and working years（P<0.05）. The results of multivariate logistic regression analysis showed that noise（OR=1.711,95%CI：1.380-2.121）,heat（OR=1.721,95%CI：1.394-2.125）were risk factors for hypertension;the interaction between noise and heat on hypertension was not statistically significant（P>0.05）,while the interaction between noise and age（OR=1.086,95%CI：1.057-1.115）,between heat and age（OR=1.087,95%CI：1.059-1.115）both increased the risk of hypertension.@*Conclusion@#Occupational exposure to heat and noise are risk factors for hypertension. These two occupational hazards also interact with age,which can increase the risk of hypertension in workers.
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Objective To explore the efficacy of the single versus combination drug therapies for benign prostatic hyperplasia(BPH) combined with overactive bladder(OAB).Methods A total of 471 outpatients with BPH and OAB meeting the inclusion/exclusion criteria were enrolled in this prospective cohort study from March 2012 to October 2015.Patients were divided into two groups:(1) the single alpha-blocker treatment group (prostate volume ＜ 30 ml),and (2) the 5 alpha reductase inhibitors(5-ARIs) plus alpha-blocker combination treatment group(prostate volume ≥ 30 ml).The 318 patients were treated with alpha blockers for 4 weeks,and then received a continuing alpha-blocker treatment for 8 weeks if IPSS score changes were less than 30％ (i.e.single alpha-blocker treatment group).And 153 patients were treated with 5-ARIs for 12 weeks,then received 5-ARIs plus alpha-blocker combination treatment for another 4 weeks(a total of 16 weeks)if IPSS score changes were less than 30 ％ (i.e.combination treatment group).The improvements of post-voiding residual(PVR),PV,maximum urinary flow rate(Qmax),international prostate symptom score(IPSS),overactive bladder symptom score (OABSS),quality of life (QOL),urine storage period symptom score (USPSS) and voiding symptom score(VSS)were compared between the two groups.Results The values of IPSS,OABSS,QOL,USPSS and VSS index in the two groups were improved after treatment as compared with pre-treatment(all P≤0.05).Patients in combination treatment group had little improvement in PVR and Qmax after treatment.The OAB symptom remission rates of BPH patients with OAB in single alpha-blocker treatment group were 70.5％ (206/292)and 78.6％ (165/210)after 4 and 12 weeks of treatment respectively.The OAB symptoms remission rates of BPH patients with OAB in combination treatment group were 54.5 ％ (64/122) and 67.1％ (53/79) after 12 and 16 weeks of treatment respectively.Conclusions Both single alpha-blocker treatment and alpha-blocker plus 5ARIs combination treatment,which identification was based on prostate volume,have good effects on BPH patients with OAB.The single alpha-blocker treatment can improve PVR and Qmax,and the alpha-blockers plus 5ARIs combination treatment can improve the prostate volume in BPH patients with OAB.
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ObjectiveTo investigate the effects of prenatal taurine supplementation on the Rho-ROCK signaling pathway activity and synaptophysin (Syp) expression in brain tissues of rats with intrauterine growth restriction.MethodsEighteen pregnant Sprague-Dawley rats were randomly divided into control group, fetal growth restriction (FGR) group and taurine group, with six rats in each group. Low-protein diet was given in FGR and taurine groups to establish an FGR model. Taurine 300 mg/(kg·d) was supplemented from gestational day 12 until delivery in taurine group. The mRNA expression levels of neurite growth inhibitor-A(Nogo-A), neurite growth inhibitor receptor (NgR), Rho-A and ROCKⅡin fetal rat brain were detected using reverse transcriptase polymerase chain reaction (n=24), which are the key signaling molecules of the Rho-ROCK signal pathway. The protein expression levels of Nogo-A and NgR were detected by Western blot (n=12). The mean optical density in Nogo-A, NgR and Syp was determined by immunohistochemistry (n=18). One-way analysis of variance and LSD-t test were used for statistical analysis.Results(1) Expression of mRNA: the expression levels of Nogo-A, NgR, Rho-A and ROCKⅡ mRNA in fetal rat brain were 4.09±1.34, 3.01±0.77, 39.89±7.71 and 7.82±1.83, respectively in FGR group, and were significantly higher than in control group (1.00±0.13, 1.00±0.10, 1.02±0.30 and 1.00±0.10) (t=4.735, 5.204, 7.682 and 10.675, allP0.05). (2) Expression of protein by Western blot: the expressions of Nogo-A and NgR protein in fetal rat brain were 1.51±0.09 and 0.31±0.05 in FGR group, 0.82±0.06 and 0.06±0.01 in taurine group, and 1.04±0.10 and 0.09±0.12 in control group. The expression was significantly higher in FGR group than in control group (t=9.644 and 5.285, bothP0.05). (3) Positive expression of protein: the positive expressions of Nogo-A and NgR protein in fetal rat brain were 0.28±0.06 and 0.11±0.02 in FGR group, 0.10±0.02 and 0.04±0.01 in taurine group, and 0.07±0.01 and 0.04±0.01 in control group. The expression was significantly higher in FGR group than in control group (t=9.778 and 7.645, bothP0.05). The positive expression of Syp protein in fetal rat brain was 0.08±0.01 in FGR group, and was significantly lower than in control group (0.16±0.04,t=4.600,P0.05).ConclusionsPrenatal taurine supplementation can improve neural axon development via down-regulating the expressions of the key molecules of Rho-ROCK signal pathway in fetal rat brain tissue.
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Objective To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schis?tosomiasis patients with portal hypertension. Methods Thirty?six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction(a portal hypertension group),as well as 10 patients treated with modified Sugiura operation(a modified Sugiura operation group)in the Third People’s Hospital of Yangxin County since 2006 were chosen as the observation objects,and the clinical effects of the two groups were observed and compared. Results The op?eration time,indwelling time of stomach tube,time to taking food after operation,drainage tube removal time of the portal hy?pertension group were all shorten than those of the modified Sugiura operation group(all P0.05). In addition,1 case with delayed gastric emptying and 1 case with stomal leak of esopha?gus happened in the modified Sugiura operation group,while no corresponding complications happened in the portal hyperten?sion group. Conclusions Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short?term clinical effect,and therefore it is suitable for application in primary hospitals. However,its long?term effect still needs fur?ther observation.
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Objective To compare the differences in metabolites between newborns with intrauterine growth restriction (IUGR) and appropriate for gestational age (AGA) in order to understand the changes in metabolites of newborns with IUGR and explore the possible metabolic mechanism of tissue and organ damages in patients with IUGR,with the ultimate goal of providing the basis for clinical intervention.Methods A total of 45 newborns with IUGR and 56 AGA newborns who were hospitalized in the Neonatal Intensive Care Unit of Bayi Children's Hospital,the General Hospital of the Chinese People's Liberation Army between July 2009 and June 2015 and who underwent metabolic disease screening were enrolled in this study.The differences in of 21 amino acids and 55 carnitines in peripheral blood,as well as the changes in the ratios of free carnitine and acylcarnitine to total carnitine,were compared.Results (1)According to the comparison of birth weights (＜ 3rd percentile,3rd-＜ 5th percentile,5th-＜ 10th percentile,and 10th-90th percentile),peripheral blood of the IUGR newborns with birth weight ＜ 3rd percentile contained lower concentrations of alanine (F =2.94,P =0.03),homocysteine (F =3.83,P =0.01),methionine (F =2.88,P =0.04),ornithine(F =3.32,P =0.02),serine (F =3.09,P =0.03) and tyrosine (F =4.76,P =0.00) than those of the AGA newborns.In the peripheral blood of the IUGR newborns with birth weight of 3rd-＜ 5th percentile,the diversity of alanine concentrations showed compensatory increase,and their alanine concentrations were higher than those of the AGA newborns.(2) Metabolites also had significant differences in different gestational age groups:the concentrations of alanine (t =2.423,P =0.026),proline (t =2.470,P =0.023),and 14-carbon acylcarnitine (t =-2.870,P =0.010) in premature was higher than those in full-term newborns,but the concentration of 26-carbon acylcarnitine (t =-2.189,P =0.041) was lower than full-term ones;the concentrations of alanine (t =2.354,P =0.022),glutamine (t =2.520,P =0.015),pipecolic acid (t =2.017,P =0.049),proline (t =2.204,P =0.032) in premature AGA newborns were higher than those in full-term ones,but the concentrations of homocysteine (t =-2.624,P =0.011),seven carbon acylcarnitine(t =-2.403,P =0.020),and ten carbon acylcarnitine (t =-5.739,P =0.000) were lower than those of full-term AGA newborns;the concentrations of homocysteine (t =-2.421,P =0.020),decanogl carnitine(t =-2.181,P =0.035),methyl propylene acyl carnitine (t =-2.373,P =0.022),pentyl acyl carnitine (t =-2.165,P =0.036),decyl acyl carnitine (t =-4.148,P =0.000),hydroxyl acetyl carnitine (t =-2.097,P =0.042),hydroxyl cetyl acylcarnitine (t =-2.446,P =0.019) in premature IUGR were higher than those in fullterm IUGR newborns;but the concentrations of arginine (t =2.167,P =0.036),glutamic acid (t =2.469,P =0.018),histidine (t =2.718,P =0.009),leucine/isoleucine (t =3.938,P =0.000),ornithine (t =4.264,P =0.000),serine (t =2.647,P =0.011),threonine (t =2.311,P =0.026),tryptophan (t =4.040,P =0.000),valine (t =2.700,P =0.01),7-carbon acylcarnitine (t =-2.44 1,P =0.019),18-carbon diene carnitine (t =2.449,P =0.018),capric acylcarnitine(t =-4.148,P =0.000) and hydroxyl acetyl carnitine (t =-2.097,P =0.042) were lower than those in full-term IUGR newborns.(3) For AGA newborns,metabolites had no differences between male and female (P ＞ 0.05);however,for newborns with IUGR,metabolites significantly differed between male and female,and the concentrations of aspartic acid(t=2.521,P =0.016),glutamate(t =-2.175,P =0.035) in male IUGR were lower than those in female newborns with IUGR,but the concentration of 26-carbon carnitine (t =2.231,P =0.031) was higher than that in female group.(4) Birth weight had no significant effect on free carnitine concentration or on the ratios of free carnitine and acylcarnitine to total carnitine(all P ＞ 0.05).Conclusions IUGR infants exhibit significant abnormalities in amino acid and acylcarnitine metabolism,especially those with birth weight ＜ 3rd percentile.With the increase of birth weight,amino acids and acylcarnitines showed compensatory increases or decrease,and when birth weight reached the 10th percentile,the newborns with IUGR were close to the AGA newborns.
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Objective To construct and assess the competency scale for emergency physicians in our country. Methods Learning from the milestone project in America, we developed the scale through Delphi method . The application effect was evaluated among 81 emergency physicians by questionnaire survey. Excel was used to do data entry. SPSS 20.0 was adopted to do data analysis. Factor analysis method was employed to verify the structure validity of the scale. Results The competency scale comprises six dimensions and 13 items. The scale of total Cronbach's alpha coefficient was 0.98 and the split half reliability was 0.95. Two factors were extracted by principal component analysis with cumulative contribution rate of 86.5%. The differ-ences of competency score on six aspects of different ages, titles, working years and training situation were tested and all had statistically significant differ-ence (P<0.01). Conclusion The scale developed in our study can reflect the growth stage of the emergency physicians and serve the purpose as an evaluation tool for the competency of emergency physicians in our country.
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Competency-based medical education and personnel training isbecoming a global trend, and the United States has developed a set of competence evaluation system to evaluate a pack-age of emergency, orthopedics, thoracic surgery physicians etc. in 26 specialties. This paper introduces the development background of the evaluation system, the structure of specialist competency evaluation form, content and methodologies , and uses emergency physicians for further evaluation to illustrate this. American physician competency evaluation system provides a unified framework for the country's medical graduates after graduating from medical education training. It helps tocombine process control withthe results ofthe evaluation, self-evaluation with the evaluation of others to makethe evaluation more objective and comprehensive . It can provide new reference to the evaluation and training of physicians in our country.