Analysis of influencing factors of multi-site work-related musculoskeletal disorders in surgeons / 中国职业医学

@# Objective - - To analyze the prevalence and influencing factors of multi site work related musculoskeletal disorders （ ） Methods WMSDs in surgeons. A total of 102 surgeons from four hospitals were selected as study subjects by convenient sampling method. The Chinese version of Musculoskeletal Disorders Questionnaire was used to investigate the prevalence of ， Results WMSDs in the past one year the related individuals and occupational factors. The total prevalence of WMSDs among （ ）， （ ） （ ） surgeons was 54.9%. The top three sites were neck 48.0% lower back 35.3% and shoulder 32.4% . The prevalence of （ vs ，P ） WMSDs in multiple sites was higher than that in a single site 43.1% 11.8% <0.01 . Multivariate logistic regression ， ， analysis showed that surgeons who smoked were tired at work and had a bent back had a higher risk of developing WMSDs ［ （ - ）， （ - ）， （ - ）， P ］ odds ratios and 95% confidence intervals were 3.66 1.41 9.46 8.33 2.15 32.20 and 18.74 2.14 166.77 all <0.01 Conclusion - after excluding the influence of confounding factors. The prevalence rate of multi site WMSDs among surgeons is ， high and the influencing factors include bad living habits and occupational factors such as working load and working posture.

Five-year Clinical Outcomes of CAD Patients Complicated with Diabetes after StentBoost-optimized Percutaneous Coronary Intervention.

Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention (PCI). Methods From March 2009 to July 2010, 184 patients undergoing PCI at our hospital were found stent underexpansion or malapposition by StentBoost after stents implantation and were divided into the diabetic (n=73, 39.67%) and the non-diabetic group (n=111, 60.33%). All patients received StentBoost-guided post-dilatation after stent implantation. The instant procedural results were measured and clinical outcome after five-year follow-up was analyzed in each group. Between-group comparisons were performed using Chi-square test or Student's t test. Multivariate logistic regression analysis was carried out to reveal the independent predictors for long-term clinical outcomes of StentBoost-optimized PCI . Results After StentBoost-guided post-dilatation, the minimum diameter (MinLD), maximum diameter (MaxLD) and average diameter in both groups increased significantly than before (P<0.001), the (MaxLD-MinLD)/MaxLD ratio and the in-stent residual stenosis decreased accordingly (P<0.001). The five-year follow-up showed similar mortality rate (4.92% vs. 2.86%, P=0.67) and major adverse cardiac event rate (11.48% vs. 11.43%, P = 1.0) between the diabetic and the non-diabetic group, whereas the recurrence of angina pectoris was higher in the diabetic group compared to the non-diabetic group (47.54% vs. 29.52%; P=0.02). A multivariate logistic regression analysis revealed that age and left ventricular ejection fraction rather than diabetes mellitus were independent predictors for long-term clinical outcomes. Conclusions StentBoost could effectively improve instant PCI results; the long-term clinical outcomes of StentBoost-optimized PCI were similar between diabetic and non-diabetic patients. Age and left ventricular ejection fraction were the independent predictors for long-term clinical outcomes.

Fatal myocarditis and rhabdomyolysis induced by nivolumab during the treatment of type B3 thymoma.

Immune checkpoint inhibitors including programmed death-1 inhibitors are promising agents for many types of malignancies; however, it is still an off-label choice for type B3 thymoma. We reported for the first time a patient with type B3 thymoma developed fatal myocarditis and rhabdomyolysis after one dose of nivolumab administration. The results from myocardial and muscle biopsies revealed extensive myocyte damage, T-lymphocytic infiltration and strongly expression of PD-L1 which confirmed the nivolumab-related immune-related adverse events (irAEs). The blood tests showed elevated levels of serum AChR-binding antibody and inflammatory cytokines, in addition abnormal lymphocyte subsets were noted. Our report suggested that administration of nivolumab in type B3 thymoma could cause rare but fatal myocarditis and rhabdomyolysis, over-expressed AChR-binding antibody and inflammatory cytokines may be potential biomarkers for irAEs.

Association Between Serum Uric Acid Levels and Atrial Fibrillation Risk.

BACKGROUND: Several studies were published to assess the association between serum uric acid levels and atrial fibrillation risk, but no consistent results were reported. We performed a meta-analysis to evaluate the evidence of the association between hyperuricemia and atrial fibrillation risk. MATERIAL/METHODS: Pubmed and Embase databases were searched for prospective cohort studies assessing the association between hyperuricemia and atrial fibrillation risk. Relative risks (RRs) with corresponding 95% confidence intervals (95%CIs) were pooled using random-effect of meta-analysis to assess the risk of atrial fibrillation in individuals with hyperuricemia. RESULTS: Six cohort studies were finally included into the meta-analysis. Meta-analysis of those 6 studies showed that hyperuricemia was significantly associated with increased risk of atrial fibrillation (RR = 1.49, 95%CI 1.24-1.79, P < 0.001). Sensitivity analysis by omitting single study sequentially by turns did not have any obvious influence on the pooled risk estimates. There was no obvious risk of publication bias in the meta-analysis. CONCLUSIONS: Based on the currently available data, hyperuricemia is associated with increased risk of atrial fibrillation.

Leiomyosarcoma with coronary fistulae and ventricular septal perforation: A case study.

Coronary fistulae and ventricular septal perforation are very rare clinically, and even less caused by cardiac leiomyosarcoma. A case is reported that a 67-year-old female had cardiac leiomyosarcoma with progressive heart failure and coronary fistulae and ventricular septal perforation. This case was special since all ante-mortem examinations and cardiac surgery failed to detect the presence of any abnormal cardiac mass. Therefore, the malignant cardiac tumors could appear in an invasive form without mass and be one of the causes of the coronary fistulae and ventricular septal perforation.

[Glucometabolic abnormalities survey among outpatients without previous diabetes diagnosis and with coronary artery disease and hypertension].

OBJECTIVE: To explore the status of glucometabolic abnormalities in cardiological outpatients without previous diabetes diagnosis and with coronary artery disease (CAD) and hypertension. METHODS: Patients without previous diagnosis of diabetes but with hypertension and CAD aged 18 years or above were recruited from cardiology departments of 11 general hospitals in China. Demographic data, disease diagnosis and medical history were collected. Physical examination and questionnaire survey were performed after the random blood glucose test. Oral glucose tolerance test (OGTT) examination was made for patients with fasting blood glucose ≥ 6.1 mmol/L or postprandial random glucose ≥ 7.8 mmol/L. Adjusted prevalence rates were used in the study. RESULTS: A total of 7778 patients were included in 11 centers. After preliminary screening by fasting blood glucose and random blood glucose tests, 3861 patients were required to take OGTT, and 3019 (78.2%) patients actually took the test. 1287 out of 3019 patients screened with OGTT were diagnosed with diabetes, and the adjusted diabetes prevalence rate was 18.64% (1287/6904). The prevalence rate of diabetes was 19.87% (95/478), 9.22% (352/3819) and 14.81% (153/1033) in patients with CAD, hypertension, and CAD combined with hypertension, respectively. A total of 996 patients were diagnosed with impaired glucose tolerance (IGT) and its prevalence was 14.43% (996/6904). Of the enrolled population, 153 patients with random blood glucose lower than 7.8 mmol/L were also screened with OGTT test, 26.14% (40/153) patients met the diagnostic criteria of diabetes. CONCLUSION: A high prevalence of diabetes is found in patients without previous diagnosis of diabetes and with hypertension and CAD consulting at cardiology departments. We thus suggest to perform OGTT in this patient cohort to improve the early diagnosis of IGT and diabetes, and prevent missed detection of type 2 diabetes mellitus or IGT in cardiovascular patients with normal fasting blood glucose. Our results indicate that it was feasible to use OGTT as a screening tool for detecting diabetes in these patients and the patient compliance is satisfactory.

[Prognostic value of brain natriuretic peptide in people with viral myocarditis].

OBJECTIVE: To explore the brain natriuretic peptide (BNP) on prognostic value in patients with viral myocarditis. METHODS: A total of 48 patients with viral myocarditis and 42 healthy people were enrolled and followed up for two years. The NYHA class and LVEF were recorded and the concentration of BNP were measured. RESULTS: The concentration of BNP were higher and EF were lower in patients with viral myocarditis (P < 0.01) than contrast people. Higher levels of plasma BNP were related to higher mortality. CONCLUSION: Levels of brain natriuretic peptide measured in the plasma could be a useful biochemical marker for the myocarditis, and high concentration of BNP may correlate with poor prognosis in patients with myocarditis.

A novel angiographic technique, StentBoost, in comparison with intravascular ultrasound to assess stent expansion.

BACKGROUND: StentBoost (SB) is a novel angiographic technique which can enhance stent visualization and improve detection of inadequate stent expansion. Studies of SB that compare it with intravascular ultrasound (IVUS), which is the current gold standard for detection of stent underexpansion, remain inadequate. This study aimed to test the correlation of IVUS and SB, and to evaluate the effect of SB guiding the stent postdilatation. METHODS: From March 2009 to June 2010, 52 patients were analyzed using quantitative coronary angiography (QCA), IVUS, and SB. They included 37 patients (54 stents) with postdilatation and 15 patients (21 stents) without postdilatation. Correlations of stent diameter between the three modalities were determined. RESULTS: The minimum diameter, maximum diameter and average diameter of postdilatation obtained by QCA, IVUS, SB were significantly larger than that of poststenting, and the ratio (maximum stent diameter (MaxLD)-minimum stent diameter (MinLD))/MaxLD of postdilatation was smaller. Correlations of MinLD were the highest between IVUS and SB (r = 0.979, P < 0.0001) when compared with QCA and SB (r = 0.973, P < 0.0001), and QCA and IVUS (r = 0.964, P < 0.0001). CONCLUSIONS: SB has superior correlations for stent expansion measured by IVUS when compared with QCA. In addition, there is an important advantage for SB in guiding the stent postdilatation.