Simulation analysis on the distribution characteristics and movement rules of particulate matter in a convenience store / 中国职业医学

Objective: The spatial distribution model of particulate matter based on time change in a specific place was established to analyze the spatial and temporal distribution characteristics and movement of particulate matter. Methods: A convenience store was selected as the research subject. The micro-climate and particle number concentration (PNC) of the site were detected, and numerical simulation was carried out by computational fluid dynamics (CFD) simulation method. Based on the discrete phase model, the temporal and spatial distribution characteristics and movement rules of simulated particles were analyzed. Results: The wind speed at the entrance of the convenience store was low and almost unchanged during the detection, while the wind speeds outside and inside outlets were high and changed sharply. The PNC of particle size of 0.02-1.00 μm was higher than that of particle size >1.00 μm (all P<0.05). The PNC with particle size of 0.02-1.00 μm from high to low were checkout counter, entrance, outer outlet and inner outlet (all P<0.05). The PNC of the checkout counter and entrance varies greatly, while the PNC of the outer outlet and inner outlet was relatively steady. The CFD simulation results showed that particles exhaled by individuals near the entrance of the checkout counter of the convenience store could be expelled outdoors more quickly with the influence of airflow. However, particles exhaled by individuals in the middle of the shelves remained suspended indoors for a longer period of time compared to those near the checkout counter. Particles emitted from the air conditioning outlet diffuse throughout the entire store and reach a steady state in 300 seconds. Conclusion: The particulate matter in the convenience store was mainly small particle with the size less than 1.00 μm. The residence time, downward trend and number of suspended particulates of human exhaled particles were related to air flow. The particulates escaped from the air conditioner could quickly spread to almost the entire convenience store.

Molecular mechanism of high altitude hypoxia induced intestinal homeostasis imbalance and research progress of traditional Chinese medicine / 中国临床药理学与治疗学

Hypoxia is one of the factors restricting the survival of people at high altitudes, which can cause various symptoms such as vomiting, diarrhea, palpitations, shortness of breath and acute coma. About 80% of patients with acute mountain sickness have at least one symptom of a gastrointestinal distress (e. g., anorexia, nausea, diarrhea, vomiting, etc.). The pathological characteristics, pathogenesis and drug treatment of intestinal injury caused by high-altitude hypoxia were studied, which is conducive to the diagnosis and treatment of plateau gastrointestinal diseases. Therefore, by summarized relevant literature and systematically expounds the related researches on intestinal damage caused by high altitude hypoxia. We summarized the changes of intestinal morphology, intestinal cells, intestinal flora and other intestinal homeostasis caused by high altitude hypoxia, the mechanism of intestinal inflammation and oxidative damage, and the treatment of traditional Chinese medicine, which provide reference and information for reference for scientific research workers and clinicians.

Effects of motorcycle exhaust on oxidative stress levels in cells of human respiratory tract / 中国职业医学

{L-End}Objective To investigate the effect of motorcycle exhaust (ME) on the level of oxidative stress in different parts of respiratory tract epithelial cells. {L-End}Methods BEAS-2B and A549 cells in logarithmic growth phase were randomly divided into control group, low- and high-dose groups. The two kinds of cells growing on the membrane of Transwell inserts were treated with air-liquid interface (ALI) exposure technique for 60 minutes. The cells in the low- and high- dose groups were treated with diluted gas with the volume ratio of ME to clean air of 1∶20 and 1∶10, respectively, while the cells in the control group were treated with clean air. Cells were collected to detect their relative survival rate using CCK-8 method after exposure. And the levels of malondialdehyde, glutathione and the activity of superoxide dismutase (SOD) of the cells were detected using colorimetry. {L-End}Results The ME exposure dose affected the relative survival rate of cells (P<0.01), which showed a downward trend with the increasing ME exposure doses (all P<0.05). However, there was no significant difference in the main effect of cell types and the interaction effect of ME exposure dose and cell type (all P>0.05). There was a significant interaction between ME exposure dose and cell type in the level of glutathione and the activity of SOD (all P<0.01), and the level of malondialdehyde was a significant main effect of cell type (P<0.01). There was no significant difference in the glutathione level and SOD activity between the low-dose group and the control group (all P>0.05), while the glutathione level and SOD activity in high-dose group were higher than those in the control group and low-dose group in BEAS-2B cells (all P<0.05). The glutathione level decreased with increasing ME exposure dose in A549 cells (all P<0.05). Compared with the control group, the low-dose group had a significantly higher activity of SOD (P<0.05) in A549 cells. The SOD activity of A549 cells in high-dose group was lower than those in control group and low-dose group (all P<0.05). The level of malondialdehyde in A549 cells was higher than those in BEAS-2B cells(P<0.05). {L-End}Conclusion ME exposure can lead to changes in the production of oxidative stress biomarkers in respiratory tract epithelial cells. The oxidative stress response induced by ME exposure varies among respiratory tract epithelial cells from different regions.

Study on the relationship between local muscle fatigue and related metabolic biomarkers in simulated manual lifting / 中国职业医学

{L-End}Objective To analyze the local muscle response under continuous ergonomic workload by simulating manual lifting, and to screen the sensitive metabolic biomarkers during fatigue process. {L-End}Methods A total of 13 healthy male volunteers were selected as the study subjects using simple random sampling method. Study subjects underwent repetitive simulated manual lifting for four periods (T1 to T4), each lasting 12 minutes. The degree of work-related fatigue in the forearm, upper arm, shoulder, back, and leg muscles, and the whole body was accessed using Borg 6-20 Rating of Perceived Exertion (RPE) Scale. The venous blood samples were collected from elbow between each two periods to detect the levels of eight metabolic biomarkers: ammonia, lactate, creatine kinase, lactate dehydrogenase (LDH), C-terminal telopeptide of type Ⅰ collagen (CTX-Ⅰ), C-terminal telopeptide of type Ⅱ collagen (CTX-Ⅱ), cartilage oligomeric matrix protein (COMP), and calcium ions. {L-End}Results The RPE scores of the study subjects for the muscles of five body parts and the whole body increased with the increasing lifting periods (all P<0.01). Fatigue was observed in all target muscles, with overall body fatigue occurring in the T2 period. The levels of ammonia, lactate, creatine kinase, LDH, COMP, and calcium ions in the serum of study subjects were higher in the T1 to T4 periods than in the T0 period (all P<0.05). The serum CTX-Ⅰ level was higher in the T1 and T3 periods than that in the T0 period (all P<0.05) , and the serum CTX-Ⅱ level was higher in the T1, T2 and T4 periods than that in the T0 period (all P<0.05). The level of these eight serum metabolic biomarkers fluctuated during the T1 to T4 periods. The serum creatine kinase level increased with the period of lifting (all P<0.05). The serum lactate level was higher in the T3 period than those in the T1 and T2 periods (all P<0.05). The serum LDH and calcium ion levels were higher in the T2 to T4 periods than that in the T1 period (all P<0.05). The serum COMP level was higher in the T2 and T3 periods than that in the T1 period (all P<0.05). Except for CTX-Ⅰ, the levels of other seven metabolic markers in serum were higher in individuals after fatigue than before fatigue (all P<0.05). {L-End}Conclusion Serum metabolic biomarkers such as ammonia, lactate, creatine kinase, calcium ions, LDH, CTX-Ⅱ, and COMP exhibit significant changes before and after fatigue. These metabolic biomarkers could be used as sensitive biomarkers for evaluating muscle fatigue during repetitive works.

Melatonin Attenuates Mitochondrial Damage in Aristolochic AcidInduced Acute Kidney Injury

Aristolochic acid (AA), extracted from Aristolochiaceae plants, plays an essential role in traditional herbal medicines and is used for different diseases. However, AA has been found to be nephrotoxic and is known to cause aristolochic acid nephropathy (AAN).AA-induced acute kidney injury (AKI) is a syndrome in AAN with a high morbidity that manifests mitochondrial damage as a key part of its pathological progression. Melatonin primarily serves as a mitochondria-targeted antioxidant. However, its mitochondrial protective role in AA-induced AKI is barely reported. In this study, mice were administrated 2.5 mg/kg AA to induce AKI. Melatonin reduced the increase in Upro and Scr and attenuated the necrosis and atrophy of renal proximal tubules in mice exposed to AA. Melatonin suppressed ROS generation, MDA levels and iNOS expression and increased SOD activities in vivo and in vitro. Intriguingly, the in vivo study revealed that melatonin decreased mitochondrial fragmentation in renal proximal tubular cells and increased ATP levels in kidney tissues in response to AA. In vitro, melatonin restored the mitochondrial membrane potential (MMP) in NRK-52E and HK-2 cells and led to an elevation in ATP levels. Confocal immunofluorescence data showed that puncta containing Mito-tracker and GFP-LC3A/B were reduced, thereby impeding the mitophagy of tubular epithelial cells. Furthermore, melatonin decreased LC3A/B-II expression and increased p62 expression. The apoptosis of tubular epithelial cells induced by AA was decreased. Therefore, our findings revealed that melatonin could prevent AA-induced AKI by attenuating mitochondrial damage, which may provide a potential therapeutic method for renal AA toxicity.

Historical Evolution and Textual Research on Classic Prescription Danggui Buxuetang / 中国实验方剂学杂志

Danggui Buxuetang， derived from Clarifying Doubts about Damage from Internal and External Causes （Volume 2）： Treatise on Heat Injury to Stomach Qi（《内外伤辨惑论卷中·暑伤胃气论》） by LI Dongyuan in the Jin and Yuan dynasties， is a classic and famous formula for tonifying qi and generating blood that has been inherited and promoted by successive generations of medical practitioners and has been included in the "Catalogue of Ancient Classical Prescriptions （First Batch）" published by the National Administration of Traditional Chinese Medicine in 2018. The paper analyzed the historical origin， composition， dosage， processing， preparation， decocting， and taking methods， efficacy， and application of the classic formula Danggui Buxuetang by consulting ancient and modern literature and combining the key information examination principles of ancient classic prescriptions. A total of 604 pieces of information on relevant ancient literature were collected， including 186 ancient Chinese medical books， of which 40 （five in the Jin and Yuan dynasties， 19 in the Ming Dynasty， and 16 in the Qing Dynasty） had detailed records of composition， processing， and dosage. Danggui Buxuetang is mainly comprised of Astragali Radix and Angelicae Sinensis Radix. According to the ancient and modern dose conversion， there are 37.3-38.1 g of Astragali Radix and 7.5-7.6 g of Angelicae Sinensis Radix in the formula. Astragali Radix is preferably fried with honey and Angelicae Sinensis Radix with wine. Astragali Radix and Angelicae Sinensis Radix are decocted with 600 mL of water to 300 mL， and taken warm before meals. The main effect of this formula are described in ancient books as blood deficiency and fever， with symptoms of muscle fever， dryness and heat， irritability and thirst， red eyes and face， sleeplessness in daytime and night， and surging and feeble pulse which is weak under hard pressing， and it is a famous formula for replenishing qi and generating blood. Modern research shows that Danggui Buxuetang is commonly used in the treatment of various kinds of anemia， diabetic nephropathy， tumors， and cardiovascular and cerebrovascular diseases. The above research results can provide a reference for the subsequent development and research on the classic formula Danggui Buxuetang.

Evaluating value of modified critical care ultrasonic examination scheme for the etiological diagnosis of various shock in ICU patients / 中华急诊医学杂志

Objective:The purpose of this study was to investigate the evaluating value of modified critical care ultrasonic examination(M-CCUE) scheme for the etiological diagnosis of shock in ICU patients.Methods:The prospective study collected relevant clinical data of various shock patients admitted to the Department of Intensive Care Medicine, Henan Provincial People's Hospital from May 2020 to July 2021, including hemodynamic、blood indicators、organ/tissue perfusion and prognostic evaluation indicators.All selected patients completed the initial M-CCUE assessment within 30 minutes, were scored according to the M-CCUE score system and related data results were analyzed.Results:Ninety-three patients were included in this study,Two of them were not completed the M-CCUE assessment due to emergency treatment immediately after entering our department, and five were excluded due to inconsistent ultrasound judgments by the two physicians. In the end, a total of 86 patients were enrolled in the group. In patients applied with M-CCUE scheme,time to preliminary diagnosis and final diagnosis were (13.02±3.15)min and (67.70±20.20)min respectively, the accuracy of diagnosis was 83.7%. Among them, distributed shock accounted for 60.4%, hypovolemic shock accounted for 25.6%, cardiogenic shock and obstructive shock accounted for 3.5%, and mixed shock accounted for 7%; MCS is (13.27±4.91), M-CCUE scheme had the high sensitivity and specificity for the diagnosis of distributed shock (sensitivity 91.2%, specificity 93.9%), hypovolemic shock (sensitivity 96.0%, specificity 96.7%), cardiogenic shock (sensitivity 85.7%, specificity 98.7%) and obstructive shock (sensitivity 60.0%, specificity 100%); MCS has a good positive correlation with APACHEⅡ score ( r=0.861, P<0.001), and has no correlation with ICU cost ( r=0.012, P=0.915). There is no significant difference in MCS between the 28d death group and the recovery group ( P=0.391). Conclusions:For shock patients admitted to ICU with unknown etiology, the initial diagnosis of the cause of the M-CCUE program takes less time, has a higher correct diagnosis rate, sensitivity and specificity, and its quantitative evaluation results can predict the patient's criticality.

Construction of exercise rehabilitation index system for cardiac surgery patients after cardiopulmonary bypass based on Delphi method / 中国实用护理杂志

Objective:To construct the exercise rehabilitation index system and exercise program for cardiac surgery patients after cardiopulmonary bypass, in order to provide basis for exercise rehabilitation.Methods:By literature analysis and group discussion, initial expert consultation letters were drawn up, and the Delphi method was used to conduct two rounds of consultation with 20 experts in the field of cardiac rehabilitation, and the exercise rehabilitation program was constructed on the basis of index system.Results:Response rate of two rounds of consultation was 100%, respectively. Experts ′ authority coefficients of the two rounds of consultation were 0.882 5 and 0.935 0 respectively. The Kendall coordination coefficients of the first and second level indexes were all statistically significant. The index system included 10 first-class indicators and 48 second-class indicators, forming a three-level exercise rehabilitation program. Conclusions:The index system and exercise rehabilitation program are scientific and practical, which provide reference for the implementation of exercise rehabilitation.

Clinical value of point of care ultrasound on cardiac output and volume responsiveness in patients with septic shock / 中华危重病急救医学

Objective:To assess the value of point of care ultrasound on cardiac output (CO) and volume responsiveness in patients with septic shock.Methods:A prospective investigation study was conducted. Twenty-four mechanical ventilation patients with septic shock who needed pulse-indicated continuous cardiac output (PiCCO) monitoring in the department of critical care medicine of Zhengzhou University People's Hospital, Henan Provincial People's Hospital from November 25, 2020 to April 30, 2021 were selected as the subjects, the patient's basic information and laboratory test results were recorded. PiCCO was used as standard to monitor CO and stroke volume variability (SVV) at 0, 2, 6, 12, 24 and 48 hours. At the same time, point of care transthoracic echocardiography (TTE) was used to measure velocity time integral (VTI) and inferior vena cava diameter (dIVC), the CO, VTI variation rate (△VTI) and dIVC variation rate (△dIVC) were calculated. Then, using the value monitored by PiCCO as the standard, the consistency and correlation analysis were carried out between point of care ultrasound with PiCCO.Results:Twenty-two out of 24 patients obtained satisfactory ultrasound Doppler images, the heart rate (HR), mean arterial pressure (MAP) and body temperature of the enrolled patients were consistent with the pathophysiological characteristics of septic shock. With the extension of treatment time, HR and CO both gradually decreased, and MAP gradually increased, reaching a peak or trough at 48 hours after admission. The difference were statistically significant compared with the time of admission [HR (bpm): 90.36±15.35 vs. 116.82±19.82, MAP (mmHg, 1 mmHg = 0.133 kPa): 87.82±11.06 vs. 58.82±9.85, CO (L/min): 4.80±0.56 vs. 6.78±1.31, all P < 0.05]. The CO obtained by PiCCO and point of care ultrasound had good agreement [5.36 (4.78, 6.33) L/min and 5.21 (4.88, 6.35) L/min, respectively], the average difference value at each time point was (-0.02±0.69) L/min, the 95% agreement limit range was -1.35-1.34, and there was a high degree of correlation ( rs = 0.800, P < 0.001); The SVV by PiCCO and the △dIVC by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 21.00% (14.00%, 25.75%), respectively], the average difference value at the time point was (-3.16±6.89)%, the 95% agreement limit range was -16.89-10.54, and there was a moderate correlation ( rs = 0.702, P < 0.001); The SVV by PiCCO and the △VTI by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 16.00% (11.25%, 20.75%), respectively], the average difference value at each time point was (13.03±14.75)%, and the 95% agreement limit range was 1.72-27.78, and there was a high correlation ( rs = 0.918, P < 0.001). Conclusion:Point of care ultrasound can accurately assess CO and volume responsiveness of patients with septic shock, and the △VTI is better than the △dIVC in assessing volume responsiveness.

Analysis of prenatal phenotype and pathogenetic variant in a fetus with Papillorenal syndrome / 中华医学遗传学杂志

OBJECTIVE@#To determine the carrier rate of deafness-related genetic variants among 53 873 newborns from Zhengzhou.@*METHODS@#Heel blood samples of the newborns were collected with informed consent from the parents, and 15 loci of 4 genes related to congenital deafness were detected by microarray.@*RESULTS@#In total 2770 newborns were found to carry deafness-related variants, with a carrier rate of 5.142%. 1325 newborns (2.459%) were found to carry heterozygous variants of the GJB2 gene, 1071 (1.988%) were found with SLC26A4 gene variants, 205 were found with GJB3 gene variants (0.381%), and 120 were found with 12S rRNA variants (0.223%). Five newborns have carried homozygous GJB2 variants, two have carried homozygous SLC26A4 variants, five have carried compound heterozygous GJB2 variants, and four have carried compound heterozygous SLC26A4 variants. 33 neonates have carried heterozygous variants of two genes at the same time.@*CONCLUSION@#The carrier rate of deafness-related variants in Zhengzhou, in a declining order, is for GJB2, SLC26A4, GJB3 and 12S rRNA. The common variants included GJB2 235delC and SLC26A4 IVS7-2A>G, which are similar to other regions in China. To carry out genetic screening of neonatal deafness can help to identify congenital, delayed and drug-induced deafness, and initiate treatment and follow-up as early as possible.

Nurse-led evidence-based nursing practice of reducing pulmonary complications among patients after thoracic surgery / 中国实用护理杂志

Objective:To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery.Methods:A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients ′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results:After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 ( χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant ( t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff ′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence ( χ2 value was 16.834-64.000, P<0.01). Patients ′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant ( χ2 value was 22.823, P<0.01). Patients ′ satisfaction improved. Conclusions:By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery.

Nurse-led evidence-based nursing practice of reducing pulmonary complications among patients after thoracic surgery / 中国实用护理杂志

Objective:To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery.Methods:A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients ′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results:After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 ( χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant ( t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff ′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence ( χ2 value was 16.834-64.000, P<0.01). Patients ′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant ( χ2 value was 22.823, P<0.01). Patients ′ satisfaction improved. Conclusions:By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery.

Relationship between work-related musculoskeletal disorders and ergonomic factor load in shipyard workers / 中国职业医学

OBJECTIVE: To assess the effect of ergonomic factor load on work-related musculoskeletal disorders(WMSDs) in shipyard workers. METHODS: A total of 751 shipyard workers were selected as the research subjects using judgment sampling method. The exposure level of adverse ergonomic factors was assessed using the Quick Exposure Check method. The prevalence of WMSDs was investigated using the revised Musculoskeletal Disorders Investigating Questionnaire of our research group, and the relationship between them was analyzed. RESULTS: The proportions of high or very high level of work load exposure to the neck, back, shoulder and hand in shipyard workers from high to low were 66.4%, 63.5%, 59.8% and 43.7%(P<0.01) respectively. The proportions of occupational stress, driving, vibration and working rhythm at high or very high exposure level were 20.0%, 4.1%, 22.9% and 3.2%, respectively. The prevalence of WMSDs in four body parts of shipyard workers from high to low was the back, neck, hand and shoulder(the prevalence were 44.2%, 31.2%, 26.9% and 26.6%, respectively, P<0.01). After excluding the influence of confounding factors, multiple logistic regression analysis showed that the higher the labor load exposure level and longer of the vibration tool using, the higher the risk of shoulder WMSDs [odds ratio(OR) and 95% confidence interval(CI) were 1.25(1.04-1.51) and 1.33(1.05-1.69), respectively, P<0.05]. The higher the level of occupational stress, the higher the risk of back and neck WMSDs [OR(95%CI) was 1.29(1.05-1.58) and 1.42(1.15-1.77), respectively, P<0.05]. CONCLUSION: There was a dose-effect relationship between the exposure level of shoulder load, the time of using vibration tools and the shoulder WMSDs, and there was a dose-effect relationship between the occupational stress level and the WMSDs in the back and neck.

Cognition of remote consultation of pneumoconiosis and analysis of influencing factors on its use intention / 中国职业医学

OBJECTIVE: To investigate the cognition of remote consultation of pneumoconiosis and analysis of influencing factors on its use intention. METHODS: A total of 282 physicians from 216 hospitals were selected using a convenient sampling method. The cognition of remote consultation of pneumoconiosis was investigated using the Questionnaire of Use Intention of Remote Consultation Mode in the Diagnosis of Pneumoconiosis. A structural equation model was used to analyze the influencing factors of the willingness to use remote consultation. RESULTS: The average scores in the dimensions of subjective norms, attitude, trust, uncertainty, compatibility, comparative advantage, complexity, perceived risk and use intention of remote consultation for pneumoconiosis were(3.7±0.9),(3.7±0.8),(3.5±0.8),(3.7±0.9),(3.7±0.9),(3.8±0.9),(3.0±0.8) and(3.5±0.8), respectively. Structural equation model analysis results showed that, on use intention of remote consultation, the perceived risk and uncertainty had significant negative impact(standardized path coefficient=-0.148 and-0.828, respectively, P<0.01), and compatibility had a significant positive impact(standardized path coefficient=2.053, P<0.01). There was no significant effect of dimensions of subjective norms, attitude, trust, comparative advantage and complexity on use intention(P>0.05). CONCLUSION: Perceived risk, uncertainty and compatibility are the main factors affecting the willingness to use remote consultation for pneumoconiosis. Remote consultation for pneumoconiosis is helpful to meet the needs of pneumoconiosis diagnosis in all hospitals.

Effects of dexmedetomidine on content of glutamate and expression of NR1 in hippocampus of mice with endotoxemia and the role of cholinergic anti-inflammatory pathway / 中华麻醉学杂志

Objective:To evaluate the effects of dexmedetomidine on the content of glutamate and expression of NR1 in hippocampus of mice with endotoxemia and the role of cholinergic anti-inflammatory pathway.Methods:Eighty clean-grade male C57BL/6 mice, aged 8 weeks, weighing 24-28 g, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C), endotoxemia group (group LPS), dexmedetomidine group (group DEX) and alpha-bungarotoxin (α-BGT) group.Lipopolysaccharide 20 mg/kg was intraperitoneally injected to establish the model of endotoxemia in LPS, DEX and α-BGT groups. Dexmedetomidine 40 μg/kg was intraperitoneally at 15 min before establishing the model in DEX and α-BGT groups.In group α-BGT, alpha-7 nicotinic acetylcholine receptors specific agonist α-BGT 1 μg/kg was intraperitoneally injected at 15 min before injecting dexmedetomidine.Ten mice taken in each group were selected to collect the blood samples from the eyeball and then sacrificed, and hippocampi were isolated.Enzyme-linked immunosorbent assay was used to measure the concentration of serum S100β protein and NSE, and high-performance liquid chromatography was used to determine the content of glutamate in hippocampus.Ten mice in each group were sacrificed at 6 h after establishing the model to detect the expression of NR1 in hippocampus by immumofluorescence method. Results:Compared with group C, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly increased, and NR1 expression was up-regulated in LPS, DEX and α-BGT groups ( P<0.01). Compared with group LPS, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly decreased, and NR1 expression was down-regulated in DEX and α-BGT groups ( P<0.01). Compared with group DEX, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly increased, and NR1 expression was up-regulated in group α-BGT ( P<0.01). Conclusion:The mechanism by which dexmedetomidine alleviates cerebral injury is associated with activating cholinergic anti-inflammatory pathway, decreasing glutamate content and down-regulating NR1 expression in mice with endotoxemia.

The cognitive level and practice status of nursing ethics of clinical nurses and related factors in Shandong Province / 中国实用护理杂志

Objective@#To investigate the cognitive level and practice status of nursing ethics of clinical nurses in Shandong Province.@*Methods@#3 205 nurses from 20 tertiary hospitals and 10 secondary hospitals were investigated using clinical nursing ethics cognition and practice questionnaire, with the aid of the special committee of nursing ethics in Shandong province. All data were analyzed by SPSS 17.0 software.@*Results@#The total score of nursing ethics in Shandong Province was (16.65±3.25), and the total score of ethical practice was(40.10±6.72). Univariate analysis showed that there were differences in ethical cognitive level among nurses of different age, education, working years, professional title, marital status, income and working department (t=49.880, F=5.470-65.006, P<0.01); and there were differences in ethical practice level among nurses of different gender, age, education, working years, professional title, marital status, income and working department (t=36.037, 103.510, F=37.267-132.710, P<0.01). Multiple linear regression analysis showed that different age, working years and professional title have statistically significant influence on the nursing ethical cognitive level; and different gender, working years, professional title, education, income and marital status have statistically significant influence on the nursing ethical practice level.@*Conclusion@#The ethical cognition of clinical nurses in Shandong province was in the middle level. Although nurses were aware of the importance of ethics, there were some weak points in ethical practice. The influencing factors include hospital management, society, patients, nurses 'own factors, and national policies. It is recommended to improve ethical cognition and practice status by carrying out continuing education, reducing nurses′ workload, strengthening positive publicity, and strengthening management learning, etc, thus improving nursing quality.

Central venous catheter-related thrombosis in critically ill patients: a prospective observational study by ultrasonography / 中国中西医结合急救杂志

Objective Doppler ultrasonography was used to screen the incidence of central venous catheter (CVC) thrombosis in severe patients to observe the incidences of catheter-related thrombosis (CRT) at subclavian (SC) and internal jugular (IJ) venous insertion sites, and to analyze the factors affecting the thrombosis. Methods One hundred and twenty three adult patients with IJ or SC CVC admitted to the Department of Intensive Care Unit (ICU) of Zhongnan Hospital of Wuhan University from May to December 2015 were enrolled to be the research objects, they were divided into an IJCVC group (35 cases) and a SCCVC group (88 cases) according to different catheterization sites; they were divided into an operation group (85 cases) and a non-operation group (38 cases) according to whether operation was performed or not; and they were also divided into an anticoagulation group (25 cases) and a non-anticoagulation group (98 cases) according to whether anticoagulation therapy was used or not. Doppler ultrasonography was performed every day to observe the incidences of CRT during ICU stay. Results One hundred and twenty-three patients were included in this study. CRT was detected in 11 (8.9%) patients, with an incidence of 22.1 per 1 000 catheter-days. All the 11 cases with CRT were presented within 3 days after the insertion, with 9 cases (81.8%) on the first day and 2 cases (18.2%) on the third day. The incidence of CRT in SCCVC group was significantly lower than that in IJCVC group [5.7% (5/88) vs. 17.1% (6/35), P < 0.05], with the rates of 12.6 and 59.4 per 1 000 catheter-days, respectively. There were no statistical significant differences in the incidences of CRT between operation group and non-operation group [11.8% (10/85) vs. 2.6% (1/38)], and between anticoagulation group and non-anticoagulation group [8.0% (1/25) vs. 9.2% (2/98), both P > 0.05]. Conclusions The incidence of CRT at IJCVC site is estimated to be 3-times higher than that at SCCVC site, anticoagulants or surgical operation may have impacts on the incidence of CRT, although there were no statistically significant differences. The CRT usually occurs within 3 days after the catheter insertion. Frequent bedside ultrasonography in the first 3 days after catheterization can confirm the diagnosis and guide clinical treatment.

Investigation and Analysis of the Current Operation Situation o f Online Drugstores in China / 中国药房

OBJECTIVE： To investigate the current situation and existing problems of online drugstores in China and put forward corresponding countermeasures and suggestions， so as to provide a basis for promoting and improving the standardization of online drugstores in China. METHODS： The number of online drugstores was counted by inquiring about the online drugstores in all provinces， autonomous regions and municipalities directly under the central government published by the “Public inquiry” column on the official website of the previous China Food and Drug Administration （CFDA）. According to the administrative division， stratified sampling of online drugstores was conducted. The website domain names of sampled online drugstores and their Taobao stores， Jingdong stores， Wechat public accounts， Wechat small programs and other platforms were retrieved to analyze their operation methods. At the same time， the online drugstores which actually had online trading behavior were investigated and analyzed from three aspects， including business scope， propaganda behavior and service behavior. RESULTS & CONCLUSIONS： A total of 693 online drugstores were obtained from the official website of CFDA， and the domain names of only 14 （41.2％） of 34 online drugstores selected by stratified sampling were their corresponding online drugstores. Other online drugstores had some problems， such as domain name could not be opened or was not related websites. There were 14 online drugstores dealing in drugs through their own websites， of which 12 also operated on third-party platforms such as Taobao， Jingdong and Wechat. The problems of 27 drugstores with online online trading behavior mainly included non-standard operating varieties， illegal sale of prescription drugs， disunity of qualification mark，false propaganda，untimely online customer service response and imperfect drug distribution system， etc. It is suggested that relevant supervisory and administrative departments strengthen supervision， standardize the management of domain names and trading platforms of online drugstores， and vigorously crack down on and control illegal online transactions. Online drugstores should improve their service levels， standardize their own website construction， improve the level of real-time customer service and drug distribution services， so as to improve the current operation situation of online drugstores in China.

Research on metabolic and inflammatory biomarkers related to local muscle fatigue in workers with simulated manual lifting / 中国职业医学

OBJECTIVE: To analyze the relationship between the blood biochemical indexes and the local muscle fatigue of operators with local muscle fatigue caused by moderate-load repetitive manual lifting. METHODS: Five healthy male volunteers were selected as the research subjects. They repeatedly performed simulated manual lifting operation for four periods(T1-T4), 10 minutes per period. Each period was suspended for 3 minutes to be accessed for the rating of perceived exertion(RPE) score of local muscle. Meanwhile, their venous blood was collected to be detected for serum calcium ion, creatine kinase, cartilage oligomeric matrix protein(COMP), ammonia, lactic acid, lactate dehydrogenase(LDH), C-reactive protein(CRP), and collagen type Ⅱ C terminal telopeptide(CTX-Ⅱ). RESULTS: The RPE score and serum creatine kinase level of the subjects increased with the increasing of lifting time(P<0.05). Serum calcium ion levels in time periods T2, T3 and T4 were higher than that in T1(P<0.05). Serum COMP levels in T3 and T4 were higher than that in T1(P<0.05). The levels of ammonia,lactic acid, LDH, CRP and CTX-Ⅱ in each time period showed no statistical significance(P>0.05). Serum creatine kinase, calcium ion and LDH levels were positively correlated with RPE score(correlation coefficient were 0.840, 0.512, 0.741, respectively, P<0.01). CONCLUSION: Serum creatine kinase is a sensitive, effective and objective index reflecting muscle fatigue, which is suitable for evaluating the fatigue process of moderate-load repetitive activities. Serum calcium ion has a good correlation with muscle fatigue, and serum COMP can reflect muscle fatigue to some extent.

Effect of axitinib on the proliferation and apoptosis of human lung adenocarcinoma PC9 cells and its mechanism / 肿瘤研究与临床

Objective To study the effect of axitinib on the proliferation and apoptosis of human lung adenocarcinoma PC9 cells and its mechanism. Methods PC90 cells were treated with different concentrations (0, 0.125, 0.25, 0.5, 1, 2, 4, 8, 16, 32, and 64 μmol/L) of axitinib for 72 h, and half-inhibitory concentration (IC50) was calculated. The cell proliferation ability was detected by CCK-8 method. Plate cloning experiments were performed to observe the effect of axitinib on the formation of PC9 cell clones. The mitochondrial membrane potential and apoptosis of PC9 cells were detected by flow cytometry. The expression of cleaved-Caspase-3 protein in PC9 cells was detected by Western blot. Results Asitinib inhibited the proliferation of PC9 cells in a concentration-dependent manner. The IC50 at 72 h was 10.18μmol/L. The clone formation rates of PC9 cells were (100.0±3.2)％, (58.6±2.7)％, (29.3±3.3)％, and (10.9±3.0)％10 d after treatment with 0, 1, 2 and 4 μmol/L axitinib, and the difference was statistically significant (F= 316.922, P< 0.01). The apoptotic rate of PC9 cells at early and late stages increased after treatment with different concentrations of axitinib for 48 h, and the differences were statistically significant (both P< 0.01). After treatment with 0, 4, 8 and 16 μmol/L axitinib for 24 h, the percentage of PC9 cells with low mitochondrial membrane potential was (11.9±1.9)％, (38.5±2.3)％, (56.3±2.7)％, and (76.9±3.1)％, and the difference was statistically significant (F=234.320, P<0.01). The expression level of cleaved-Caspase-3 protein in PC9 cells increased, and the relative expression levels were 1.00±0.04, 1.26±0.09, 1.78±0.12, and 2.10±0.11, respectively, and the difference was statistically significant (F=55.670, P<0.01). Conclusions Axitinib could inhibit the proliferation of human lung adenocarcinoma PC9 cells. Axitinib induces the apoptosis of PC9 cells possibly through decreasing the mitochondrial membrane potential of PC9 cells.