Objective This study aimed to assess the adherence to guideline-recommended therapies according to risk stratification in the management of acute coronary syndrome(ACS). Methods We analyzed 1,001 consecutive patients admitted with ACS. Patients were stratified using the GRACE risk score into low- and high-predicted risk of mortality at 6 months. We evaluated the use of hospital angiography,revascularization,and guideline-recommended medications between high and low-risk patients. Results High-risk compared to low-risk patients were less likely to underwent coronary angiography and/or revascularization during the hospitalization. The use of hospital-initiated pharmacotherapies was also lower in high-risk patients(P<0.05). Advanced age, increased creatinine level and higher GRACE score were independent predictors for failure to administer evidence-based therapies. Conclusion Patients with ACS at high risk of mortality were paradoxically less likely to undergo revascularization or receive medications according to guidelines. Better adherence to evidence-based therapies in high-risk patients may improve clinical outcome and quality of health care.

Objective : To investigate the status of occupational stress, burnout, and coping styles, and to explore the moderating effects of coping styles on the relationship between occupational stress and burnout among medical staff from one tertiary first-class hospital in Hubei Province, in order to provide the basis for mental health promotion of medical staff. Methods: From June to October in 2020, using stratified cluster sampling, doctors, nurses, and medical or pharmaceutical technicians on the ratio of 2∶2∶1 were selected from the tertiary first-class hospital. Chinese version of Burnout Questionnaire, Core Occupational Stress Scale (COSS) and Trait Coping Style Questionnaire were used to investigate the levels of burnout, occupational stress and coping styles. A linear stratified regression model was used to analyze the moderating effect of coping styles on the relationship between occupational stress and burnout. Results: Among 735 questionnaires issued, 679 valid ones were collected, with the response rate of 92.38%. The age of the respondents was ( 34.29±8.20 ) years old. There were 165 ( 24.30% ) males and 514 ( 75.70% ) females, including 241 ( 35.49% ) doctors, 358 ( 52.72% ) nurses and 80 (11.78%) medical or pharmaceutical technicians. The burnout score was 2.29±1.11 , and the positive rate of burnout was 44.33%; the COSS score was 47.32±8.31; the positive and negative coping style scores were 30.64±6.06 and 26.81±6.26, respectively. The linear stratified regression analysis suggested that the interactions between social support ( β=0.590, P<0.05 ), organization and reward ( β=0.523, P<0.05 ), and positive coping style were positively associated with burnout, and the interaction between organization and reward (β=-0.666, P<0.05) and negative coping style was negatively associated with burnout. Conclusions About 44.33% of medical staff investigated have burnout. Coping styles have a moderating effect on the relationship between occupational stress and burnout. Positive coping style helps to perceive social support and organizational support, to alleviate the adverse effects of occupational stress, and to reduce the risk of burnout.

Objective This study aims to explore the application value of tuberculosis T lymphocytes enzyme-linked immune SPOT test (T-SPOT.TB) on early diagnosis of tuberculosis.Methods The TB infection in 189 inpatients suspected tuberculosis in pneumology department of Shaanxi Provincial People's Hospital was detected with T-SPOT.TB,fluorescence RQPCR,tuberculosis (TB-Ab)protein chip and PPD methods.Results The sensitivity of four methods was 91.54％ (119/130),73.85％(96/130),63.08％(82/130) and 57.69％ (75/130) respectively and the specificity of those was 89.83％ (53/59),86.44％(51/59),67.79％(40/59) and 66.10％(39/59),respectively.The sensitivity of T-SPOT.TB method was statistically higher than those of other three tests,respectively (P＜0.05).The specificity of T-SPOT.TB was significantly higher than those of TB-AB and PPD (P＜0.05),but there was no statistical difference between RQ-PCR and T-SPOT.TB (P＞0.05).The positive predictive values of T-SPOT.TB,fluorescent quantitative PCR,TB-Ab and PPD assays were 95.2％ (119/1250),92.3％ (96/104),81.2％ (82/101) and 78.9％ (75/95) respectively while the negative predictive values of those were 82.8％ (53/64),60％ (51/85),45.5％ (40/88) and 41.5％ (39/94),respectively.The false-positive rates (misdiagnosis rate) of four assays were 10.2％ (6/59),13.6％ (8/59),32.2％ (19/59) and 33.9％ (20/59) respectively and the false-negative rates (rates of missed diagnosis) of those were 8.5％ (11/130),26.2％ (34/130),36.9％ (48/130)and 42.3 ％ (55/130),respectively.The negative likelihood ratios of T SPOT.TB,fluorescent quantitative PCR,TB-Ab and PPD assays were 0.11,0.16,0.48 and 0.51 respectively,meanwhile the positive likelihood ratios of T-SPOT.TB,fluorescent quantitative PCR,TB-Ab andPPD assays were 9.0,5.4,2.0 and 1.7,respectively.What' s more,the diagnostic accordance rates of the four assays were 91.0％ (172 189),77.8％ (147 189).64.6％ (122/189) and 60.3％ (114/189),respectively.Conclusion T-SPOT.TB test is a more sensitive and specific method and of great significance to the early diagnosis of TB,which has more clinical value in different stages of tuberculosis diagnosis.

Objective To evaluate the clinical efficacy of dragon-tiger contending needling at Xi-cleft points plus electroacupuncture in treating postherpetic neuralgia (PHN).Method Seventy PHN patients were randomized into a treatment group of 36 cases and a control group of 34 cases. The treatment group was intervened by dragon-tiger contending needling at Xi-cleft points plus electroacupuncture, while the control group was treated with electroacupuncture alone. In the 4-week treatment, the Visual Analogue Scale (VAS) scores right before and after the 1st, 2nd, 6th, 9th and 12th treatment sessions were recorded, “the maximum pain intensity since the last treatment session” and “real-time analgesic effect” were observed, and the total therapeutic efficacy was also evaluated.Result The real-time analgesic effects right after the 1st, 2nd and 6th treatments in the treatment group were significantly better than those in the control group (P<0.05). The “maximum pain intensities since the last treatment session” prior to the 2nd, 6th, 9th, and 12th treatment sessions were significantly different from the pain intensity before the intervention in the two groups (P<0.05). The “maximum pain intensities since the last treatment session” prior to the 6th, 9th, and 12th treatment sessions were significantly different from those in the control group (P<0.05). The total effective rate and recovery plus markedly-effective rate were respectively 97.2% and 77.8% in the treatment group, versus 91.2% and 59.2% in the control group. There was a statistically significant difference in the recovery plus markedly-effective rate between the two groups (P<0.05).Conclusion Dragon-tiger contending needling at Xi-cleft points plus electro- acupuncture is an effective approach in treating PHN; it acts efficiently and can produce a satisfactory real-time analgesic effect.

[Abstract ] Objective Cardiac shock wave therapy (CSWT) can promote arteriogenesis in ischemic myocardia , but the mo-lecular mechanism remains unclear .The study aimed to explore the effect of CSWT on arteriogenesis in human cardiac microvascular endothelial cells ( HCMEC ) and the role of focal adhesion kinase (FAK) and Calcium-activated potassium channels (KCa) in the sig-nal conduction pathway of CSWT arteriogenesis . Methods HC-MEC cells cultured in vitro were randomly divided into control group , CSWT group , CSWT +T ( FAK inhibitor PF-573228 ) group and CSWT+F( SCa inhibitor iberiotoxin ) group.Each group received one CSWT(0.09 mJ/mm2, 200Times) 48 h after added stimulant.24 hours'conventional culture later , tests were made on the levels of endothelial nitric oxide synthase ( eNOS ) and vascular endothelial growth factor ( VEGF) mRNA as well as the changes of related protein expression . Results ①QPCR test showed that eNOS , VEGF mRNA expressions increased in CSWT group compared with control group (4.61 ±0.19 vs 3.99 ±0.17, P<0.05), while compared with CSWT group, eNOS, VEGF mRNA expressions in CSWT +T group were decreased (0.62 ±0.10 vs 0.40 ±0.02, P<0.05), eNOS, VEGF mRNA expressions in CSWT +F group were also decreased (0.53 ±0.02 vs 0.64 ±0.02, P<0.05), all the differ-ences were of statistical significance .②Western blot showed that eNOS , VEGF protein expressions increased in CSWT group compared with control group(0.63 ±0.02 vs 0.43 ±0.02, P<0.05), while compared with CSWT group , eNOS, VEGF protein expressions in CSWT+T group were decreased (0.36 ±0.01 vs 0.29 ±0.02, P<0.05), eNOS, VEGF protein expressions in CSWT +F group were also decreased (0.37 ±0.02 vs 0.30 ±0.02, P<0.05), all the differences were of statistical significance . Conclusion CSWT can improve eNOS , VEGF mRNA and protein expressions in HCMEC cells and FAK and KCa may participate in the signal conduction pathway of CSWT arteriogenesis .

This study was aimed to reveal how the swelling properties and release behavior of a model drug from pectin gel beads were influenced by its crosslinking with different metal ions. Coomassie Brilliant Blue G-250 was chosen as the model drug. Pectinate beads were prepared by the dropping method and crosslinked with Ca2+, Fe3+, Zn2+, Ba2+, respectively. The release behavior and swelling properties were investigated. The results showed that there were significant differences between the pectinate beads that were crosslinked with different ions. Pectinate gel beads, as a potential cell microencapsulation and drug vehicle, could be acquired for different release profile by crosslinking with different ions.
Calcium ; chemistry ; pharmacology ; Cross-Linking Reagents ; Delayed-Action Preparations ; Drug Carriers ; chemistry ; Ferric Compounds ; chemistry ; pharmacology ; Gels ; chemistry ; Metals ; chemistry ; pharmacology ; Microspheres ; Pectins ; chemistry

Cross-Sectional Studies ; Dust ; Humans ; Occupational Exposure ; adverse effects ; Pneumoconiosis ; epidemiology ; Prevalence

INTRODUCTIONThe paediatric hearing impairment caregiver experience (PHICE) questionnaire is a 68-item instrument that assesses the stress experienced by caregivers of children with hearing impairment (HI). While the questionnaire has been validated in the United States, it may need to be modified for use in the Singapore context due to the differing healthcare system, costing and culture related to caregiving for children with HI. This study aims to modify and validate the PHICE questionnaire to increase its relevance and ease of use in Singapore.

MATERIALS AND METHODSThe original PHICE questionnaire was filled out by 127 caregivers of HI children managed at the otolaryngology clinic of the National University Hospital (NUH). An expert panel was convened to assess the questionnaire for its suitability for use in Singapore. Exploratory factor analysis was conducted to evaluate the underlying factor structure of the original PHICE questionnaire. Items with high cross-loadings were removed and a new factor structure was adopted which was further analysed using confirmatory factor analysis (CFA). Cronbach's alpha (α) was computed to determine the internal consistency of the new subscales.

RESULTSItems that are less relevant in Singapore and those with high cross-loadings were removed. A 5-factor structure with only 42 items remaining and corresponding to the factors: " Policy", "Healthcare", "Education", "Support" and "Adaptation" was adopted. CFA suggests a good model fit for the modified questionnaire, improved from the 8-factor structure of the original PHICE. Cronbach's α were high (>0.7) for each new subscale.

CONCLUSIONThe original PHICE questionnaire has been shortened and reorganised in terms of the subscales composition. The resulting instrument is structurally valid and internally consistent. It is a simple and useful tool for identifying factors related to caregiving that can negatively impact rehabilitation outcomes for children with HI in Singapore. Removal of some sign language items makes this modified version less useful for caregivers, places or countries where sign language is the main focus of rehabilitation for children with HI.

Adolescent ; Caregivers ; Child ; Child, Preschool ; Female ; Hearing Loss ; therapy ; Humans ; Infant ; Infant, Newborn ; Male ; Singapore ; Surveys and Questionnaires

OBJECTIVE: To explore the prevalence of neck pain in automobile manufacturing workers and to analyze its influencing factors. METHODS: A total of 1 566 workers with length of service over 1. 0 year from a automobile manufacturing factory were selected by using cluster random sampling method. The Musculoskeletal Disorders Standard Questionnaire was used to investigate the musculoskeletal disorders status of study subjects. The influencing factors that cause neck pain among the automobile manufacturing workers were analyzed. RESULTS: The annual prevalence of neck pain among workers was 57. 4%. The multivariate logistic regression analysis indicated that workers with older age,longer length of service and higher educational level had higher risk of neck pain( P < 0. 05). The female gender,neck forward,prolonged neck twisting,working with uncomfortable postures,driving,special operating conditions,regularly shifting work,and frequent overtime working promote the occurrence of neck pain( P < 0. 05). CONCLUSION: The gender,age,educational level,length of service,neck forward,prolonged neck twisting,working with uncomfortable postures,driving,special operating conditions,regularly shifting work,and frequent overtime working are influencing factors of neck pain.

Objective: To investigate the influencing factors and population attributable risk percent (PAR%) of low back pain in automobile assemblers. Methods: A total of 634 assemblers from 11 automobile manufacturers in Shiyan City, Hubei Province were chosen as research subjects using judgment sampling method. The prevalence of low back pain in the past one year was investigated using Musculoskeletal Disorders Questionnaire. PAR% was used to analyze the contribution of influencing factors to low back pain. Results: The annual prevalence of low back pain was 68.8%. The results of multivariate logistics regression showed that length of service>15 years, high school or secondary college education or above, standing most of the time, sitting most of the time, the proportion of cumulative time of poor posture in work shift time ≥1/8, and bending for insufficient height of working space were the risk factors for low back pain (all P<0.05). The PAR% of the proportion of cumulative time of poor posture in work shift time ≥1/8 was 43.0%, 37.8% for standing most of the time, and 12.8% for bending for insufficient height of working space. Conclusion: The annual prevalence of low back pain was higher in automobile assemblers. The influencing factors included individual factors and occupational factors. The proportion of cumulative time of poor posture in work shift time ≥1/8, standing most of the time and bending for insufficient height of working space should be taken as the priority intervention factors to reduce the prevalence of low back pain among assemblers in this enterprise.