Objective To improve outpatient medical care. Methods A sample survey was conducted into 1716 outpatients during 6 days in October of 2004 using questionnaires that covered such items as the patients' choice of hospitals, their choice of doctors, their medical needs and their needs for continuous services. Results The medical needs of the patients, regardless of gender, age, and form of payment (personal payment, medical insurance or treatment at public expenses), are, in terms of urgency, disease relief, safety, respect, service, and the right to be informed. Ranking first in the needs for continuous medical services is medical appointments, with telephone follow-ups coming next. Conclusion Outpatients have diversified medical needs and hospitals ought to attach importance to relieving patients from disease, ensuring medical safety, respecting patients, improving services, bettering continuous medical services, and satisfying the needs of patients at different levels.

Objective To summarize the clinical data and laboratory features of vera polycythemia incorporated with hemolysis in one case. Methods The treatment and diagnosis of series of laboratory detection with conventional cytogenetics,mutation detection in JAK2V617F,BCR/ABL fusion gene were investigated with literature. Results JAK2V617F point mutation was detected positively,BCR/ABL fusion gene was negative and trisomic chromosome 8. The case was mend and discharged after successively treated with conventional treatment of dexamethasone,antiinfective,hepatoprotective and follow-up treatment of bloodletting,hydroxyurea and interferon.Conclusions The onset of vera polycythemia is latent which is difficult to find in the early phase.Allele-specific PCR (AS-PCR) of JAK2V617F mutation will be helpful to the diagnosis.

Purpose To investigate the pathological characteristics of loco-regional recurrent nasopharyngeal carcinoma ( rNPC ) . Methods Nasopharyngeal biopsy specimens of 46 rNPCs and 63 primary NPCs were collected. HE staining, immunohistochemistry and EBV small RNAs ( EBERs) in-situ hybridization were performed. Results The over-expression rates of both p63 and CK5/6 in rNPC were significantly higher than those of primary NPCs (P=0. 005, P=0. 026), while no statistical significance of Ki-67 over-ex-pression existed between the two groups ( P=0. 387 ) . More necrotic tissues, inflammatory exudates, giant bizarre carcinoma cells, desmoplastic stroma, giant bizarre tumor cells and higher degree of squamous differentiation were found in rNPCs. The carcinoma cells of 5 rNPCs were negative for both EBERs in-situ hybridization and LMP-1 immunohistochemical staining. Conclusion The loco-re-gional rNPC has two peaks of latency interval:2~5 and 9~11 years. The loco-regional rNPC cells have higher degree of squamous differentiation with higher expression of p63 and CK5/6, as well as more invasive ability. In addition, both EBERs in-situ hybridization and LMP-1 immunostaining are negative in 10. 87% (5/46) of loco-regional rNPC.

Objective To investigate the clinical data and laboratory features of acute megakaryocytic leukemia transformed from idiopathic myelofibrosis after 26 years in one case and the prognostic factors of myelofibrosis.Methods A case of acute megakaryocytic leukemia (M7) transformed from idiopathic myelofibrosis after 26 years was reported,and the clinical data was analyzed.Bone marrow cytology,cytogenetic and mutation detection in JAK2V617F were detected before and after transformation.Standard chemotherapeutic protocols including idarubicin plus cytarabine (IDA),homoharringtonine and cytarabine (HA),mitoxantrone and cytarabine (MA),pirarubicin plus cytarabine (TA) sequential therapies were performed.Results JAK2V617F mutation and normal karyotype were found before and after the transformation.This patient was treated with standard chemotherapeutic protocols of IDA,HA,MA and TA sequential therapies until getting complete remission,and he lived well till now.Conclusions Chromosome karyotype is related to the prognosis of IMF.Acute megakaryocytic leukemia (M7) with the normal karyotype transformed from the IMF can achieve complete remission by rational consecutive chemotherapy.

Background The operation mode of automobile manufacturing industry (AMI) makes workers have different degrees of occupational stress and burnout, which may lead to negative emotions and depressive symptoms. Objective To study the relationship between occupational stress, job burnout, and depressive symptoms in AMI workers. Methods In this study, 1300 workers from a Guangzhou AMI company were selected as subjects by cluster random sampling method. Occupational stress, job burnout, and depressive symptoms of the workers were assessed by using the Effort-Reward Imbalance (ERI) questionnaire, the Maslach Burnout Inventory general survey questionnaire, and the Patient Health Questionnaire-9, respectively. Hierarchical regression was used to analyze the effects of occupational stress and job burnout on depressive symptoms in AMI workers. Mediating effect model was used to analyze the mediating effect of job burnout on the relationship between occupational stress and depressive symptoms. Results There were 1300 questionnaires distributed, 1228 valid questionnaires collected, with a 94.5% recovery rate. The ERI ratio of 1228 AMI workers was 1.06±0.72, and the positive rate of occupational stress was 37.3% (458/1228). The score of job burnout was 2.18±1.37, and the positive rate of job burnout was 62.6% (769/1228). The score of depressive symptoms was 10.27±6.42, and the positive rate of depressive symptoms was 47.1% (578/1228). The dimensional scores of effort and over-commitment in occupational stress as well as emotional exhaustion and depersonalization in job burnout of AMI workers were positively correlated with the depressive symptom scores (r_s=0.415, 0.571, 0.573, 0.593, P＜0.05). The dimensional scores of reward and personal achievement were negatively correlated (r_s=−0.454, −0.339, P＜0.05). The percentages of variance in depressive symptoms score explained by occupational stress and job burnout were 26.7% and 16.6%, respectively. Job burnout had a partial mediating effect between the three dimensions of occupational stress and depressive symptoms, and the mediating effect values were −0.2832 (95%CI: −0.3250– −0.2434), 0.3553 (95%CI: 0.3071–0.4041), and 0.4193 (95%CI: 0.3681–0.4725), respectively. Conclusion AMI workers' occupational stress affects job burnout, but also indirectly affects depressive symptoms. Job burnout partially mediates the association between occupational stress and depressive symptoms. Reducing occupational stress and burnout levels of AMI workers may alleviate depressive symptoms.

Objective To explore the safety and feasibility of application of nalbuphine in uterine artery embolization. Methods We selected 70 cases of gynecologic fibroids receiving interventional surgery from January 2015 to October 2016 in our hospital.According to random number table,they were divided into either experimental group or control group,with 35 cases in each group.After selective uterine artery embolization,conventional intravenous analgesia pump was used to relieve pain.The experimental group was given nalbuphine 1 mg/kg and flurbiprofen 100 mg,and the control group was given sufentanil 2 μg/kg and flurbiprofen 100 mg.The visual analogue scale(VAS), nausea and vomiting, respiratory depression and other complications were observed in both groups after operation at 2,6,12,24 and 48 h. Results There were no significant differences between two groups at each time point after surgery in VAS scores[2 h:(4.2 ±0.7)points vs.(4.0 ±0.5)points,t=1.375,P=0.174;6 h:(3.5 ±0.4)points vs.(3.3 ±0.6)points,t=1.641,P=0.105;12 h:(3.0 ±0.7)points vs.(2.8 ±0.5)points, t=1.375, P=0.174;24 h:(2.8 ±0.5)points vs.(2.6 ±0.6)points,t=1.515,P=0.134].At 48 h after operation,the VAS score was significantly higher in the control group than that in the experimental group[(2.3 ±0.3)points vs.(2.1 ±0.4)points, t=2.366, P=0.021].The incidence of nausea in the experimental group was lower than that in the control group(22.9%vs.2.9%,χ2=4.590,P=0.032). Conclusion Use of nalbuphine for analgesia after uterine artery embolization has good analgesic results and reduces the incidence of nausea and vomiting after operation.

OBJECTIVETo investigate noise hazard and its influence on hearing loss in workers in the automotive component manufacturing industry.

METHODSNoise level in the workplace of automotive component manufacturing enterprises was measured and hearing examination was performed for workers to analyze the features and exposure levels of noise in each process, as well as the influence on hearing loss in workers.

RESULTSIn the manufacturing processes for different products in this industry, the manufacturing processes of automobile hub and suspension and steering systems had the highest degrees of noise hazard, with over-standard rates of 79.8% and 57.1%, respectively. In the different technical processes for automotive component manufacturing, punching and casting had the highest degrees of noise hazard, with over-standard rates of 65.0% and 50%, respectively. The workers engaged in the automotive air conditioning system had the highest rate of abnormal hearing ability (up to 3.1%).

CONCLUSIONIn the automotive component manufacturing industry, noise hazard exceeds the standard seriously. Although the rate of abnormal hearing is lower than the average value of the automobile manufacturing industry in China, this rate tends to increase gradually. Enough emphasis should be placed on the noise hazard in this industry.

Automobiles ; China ; Hearing Loss, Noise-Induced ; epidemiology ; Hearing Tests ; Humans ; Manufacturing Industry ; Noise, Occupational ; adverse effects ; Occupational Exposure ; Occupations ; Workplace

Objective To explore the correlation of metabolic syndrome (MS ) with low triiodothyronine(T3)syndrome(LT3S ,or It is known as ESS :euthyroid sick syndrome) ,subclinical hypothyroidism (SCH )and a high serum total homocysteine (tHcy )level (hyperhomocysteinemia )in elderly patients. Methods We retrospectively analyzed thyroid function ,serum glucose ,lipids and homocysteine(Hcy)level in 83 MS patients(MS group) ,30 patients with low T3 syndrome(low T3 group) ,41 patients with SCH (SCH group)and 80 healthy individuals (control group)aged over 60 years from January 2015 to March 2017 in outpatient and inpatient departments of our hospital. The correlations of thyroid function and serum Hcy level with MS components were analyzed by multiple Logistic regression model. Results The incidence of low T3 syndrome and SCH in MS patients was 37.3％ (31/83)and 49.4％ (41/83) ,respectively.Low T3 group versus control group showed the lower levels in free triiodothyronine ,FT4 ,folic acid ,and Hcy ,with statistically significant differences (all P<0.05).SCH group versus control group showed a lower levels of FT 4 ,of Hcy and of folic acid ,but an increased TSH level ,with statistically significant differences (all P<0.05).Patients with TSH >5.5 mU/L had decreased FT3 which occurred later than the rise of TSH (P<0.05) .Univariate correlation analysis showed that FT3 was negatively correlated with Hcy (P< 0.01) ,and TSH was negatively correlated with high-density lipoprotein cholesterol(P<0.01).Multivariate linear regression analysis found linear correlations of TSH with triglyceride ,high-density lipoprotein cholesterol ,and Hcy(all P < 0.05).Logistic regression analysis showed that FT3 ,Hcy and TSH are highly associated with hypertension after adjustment for gender and body mass index (all P< 0.05).Decreased FT3(P<0.01) ,elevated Hcy(P<0.05) ,and increased TSH(P<0.05)were independent risk factors for MS in elderly patients. Conclusions The incidences of low T3 syndrome and SCH are increased with aging. FT3 ,TSH ,and Hcy are independent risk factors for MS in the elderly.

Exposure to occupational noise and heavy metals are common occupational hazards in workplaces. Occupational noise exposure not only leads to noise-induced hearing loss but also cognitive dysfunction. Exposure to common heavy metals such as lead, manganese, and cadmium during work is closely related to cognitive dysfunction in workers. Combined exposure to noise and heavy metals is common in workplaces. However, current research on the combined effects of exposure to occupational noise with lead or manganese on workers' cognitive function is not comprehensive or systematic. The method for cognitive dysfunction identification varies, leading to a lack of comparability. And the causality between occupational exposure and cognitive dysfunction in workers has not been clarified. Therefore, studying the cognitive dysfunction due to combined exposure to noise and common heavy metals is of great significance for workers' occupational health. In the future, it is necessary to unify the method for cognitive dysfunction identification and conduct systematic and comprehensive research on the effects, mechanisms, and combined effects of exposure to occupational noise with lead, manganese, cadmium, and other heavy metals on workers' cognitive dysfunction, to ensure the occupational health rights and interests of workers.