Occupational Health Services

Objective To analyze the clinical characteristics and to evaluate prognosis of critically ill patients who developed acute renal failure(ARF).Methods A retrospective study was carried out in critically ill patients who developed ARF.APACHE Ⅱ,SAPSⅡ,SOFA and ATN-ISI were used to evaluate outcome of ARF.Results The incidence of ARF in critically ill patients was 19.1% with a high mortality(51.2%).The clinical characteristics of 41 patients with ARF were:mechanical ventilation 65.9%,vasopressor support 46.3%,oliguria 41.5%,number of insufficient organs 2.16,APACHEⅡscore 17.3,SAPSⅡ score 52.0,SOFA score 9.26 and ATN-ISI 0.54.By COX regression,number of insufficient organs(RR 2.54;95%CI 1.316 ~ 4.913)(P=0.006)and requirement of mechanical ventilation(RR 6.0;95%CI 1.102~32.6)(P=0.038)were independent risk factors for ICU mortality of ARF.APACHEⅡscore,SAPSⅡscore,SOFA score and ATN-ISI were demonstrated to predict mortality of ARF patients accurately as indicated by areas under the receiver operating characteristics(ROC)curves of 0.848(95% CI: 0.722~0.974;P

Objective To analysis the progress in prevention and control of iodine deficiency disorders (IDD) in Dalian and to provide a scientific basis for further prevention and control of the disease.Methods From 2006 to 2010,5 or 9 townships were randomly sampled from each county in Dalian,4 villages were sampled from each selected townships and 15 or 8 households were sampled from each selected villages for collecting salt samples and salt iodine level was determined by direct titration method.Sixty daytime urine samples from pregnant women,breast feeding women,infants and young children were collected,respectively,every year to detect urinary iodine level.From 2007 to 2009,2 to 11 counties were sampled and from each selected county one school was sampled to collect 100 daytime urine samples of children aged 8-10 and iodine content was determined.From 2006 to 2009,2 to 5 counties were sampled,from each selected county 2 to 5 schools were sampled and 100 children aged 8 to 10 in each selected school were sampled to detect intelligence quotient level and the thyroid volume.Results From 2006 to 2010,16 012 copies of households' edible salt samples were monitored; the average iodine content was ranged 29.68-31.51 mg/kg,the rate of qualified iodized salt in household ranged from 97.24％ to 98.42％.A total of 1398 copies of urine samples of pregnant women,486 breast feeding women,473 infants and 502 young children were monitored,and the median value of urinary iodine was 129.3-189.6,114.6-190.6,148.5-298.5 and 144.4-187.3 μg/L,respectively.A total of 1657 urine samples were monitored,1264 intelligence quotient level and 1197 thyroid volume of school-age children were determined,the median urinary iodine,thyroid goiter rate and intelligence quotient level was 217.9-266.7 μg/L,0-3.29％ and 110.4-117.2 μg/L,respectively.Conclusions From 2006 to 2010,the city's households qualified iodized salt coverage rate has reached the national standard for elimination of iodine deficiency disorders.The iodine nutrition of key population and school-age children has reached adequate level,the thyroid goiter rate is less than 5％,and the level of intelligence quotient has increased every year.But the iodine nutrition of breast feeding women in 2009 and 2010,pregnant women in 2010 is inadequate,so iodine nutrition surveillance and health education in pregnant and breast feeding women need to be strengthened in the future.

Objective To investigate the correlation between the olasma concentrations of angiotesin Ⅱ,aldosterone and the parameters that reflected the reconstruction of left ventricular in chronic heart failur(CHF)patients.Methods 61 CHF pmiems and 20 normal control subjects were enrolled.plasma concentration of angiotesin Ⅱ,aldosterone were measured by specific radioimmunoassays.Two dimensional,M-mode and Doppler ultrasound recording were obtalned to determine left vantricular mass index(LVMI),left ventricular ejection fraction(LVEF)and maximal early transmitral flow velocity in diastole(VE)and maximal late transmittal flow velocity(VA).Results Baseline plasma concemrations of angiotesin Ⅱ,aldostemne were increased significantly in CHF patients as compared with normal thme of control group and were paralleled to the increase of NYHA cardiac functional classification of CHF(P＜0.01).Plasma concentrations of angiotesin Ⅱ,aldostemne were positively correlated with LVMI but negatively correlated with VE/VA(P＜0.01).Conclusion Plasma concentrations of angiotesin Ⅱ,aldosterone were increased signifcantly in CHF patients and might be involved in and regulated the reconstruction of left ventricular in CHF patients.

OBJECTIVETo investigate the injury stress responses caused by ischemia reperfusion and its effects on the salivary secretory function of rat submandibular glands.

METHODSAn in situ ischemia reperfusion experimental model of rat submandibular glands was developed. The rat submandibular glands were subjected to 90 min of ischemia without denervation followed by reperfusion for 1, 12, 24, and 72 h. Salivary secretion, histological changes, reactive oxygen species (ROS) levels, and cellular apoptosis of the involved submandibular glands were detected after reperfusion.

RESULTSThe secretory function of the glands decreased at 1 and 12 h, and the saliva secretion gradually had the same value as that of the control sample 72 h after reperfusion. Increasing inflammatory cells infiltration, cellular atrophy, and tissue edema were observed especially after reperfusion for 12 h. The level of ROS and the number of apoptotic cells exhibited the same tendency, and higher ROS levels and more apoptosis cells 1 and 12 h after reperfusion were observed.

CONCLUSIONOur study suggests that ischemia reperfusion can cause a series of injury stress responses in submandibular glands, which might have an important function in the early phase dysfunction of transplanted submandibular glands.

Objective To evaluate imaging findings and treatment experience in central venous stenosis without a history of previous catheterization in hemodialysis patients. Methods Clinical data of 5 haemodialysis cases of central vein stenosis without a previous catheterization history in our hospital from July 2006 to July 2008 were analyzed retrospectively. Results Patients were three women and two men aged 43 to 65 years with mean age(53±8)years and all had arm swelling as the main complaint.The vascular accesses were located at the wrist in all the patients.The mean duration of the vascular accesses from the time of creation was(33.6±35.4)months.Venography showed occlusion in 2 cases and stenosis in 3 cages of central vein including 1 case of stenosis in brachiocephalic vein.1 case of stenosis beth in branchiocephalic vein and subclavian vein,1 case of stenosis in two segments of subclavian vein.The stenosis of branchiocephalic vein was fixed anterior to the tracheal and CT showed the compression of the vein by the aorta.Symptoms were resolved by the treatment of PTA.subclavian vein-contralateral subclavian vein bypass and ligation of the access. Conclusions Central venous stenosis in haemodialysis patients without a history of catheterization may be due to the intimal hyperplasia of the compression site or valve which is accelerated by the high flow of vascular access.Venography is the first choice for the diagnosis and the current management of central venous stenosis is far from being effective for the long term.

Objective:To investigate the efficacy of three different methods of digestive tract reconstruction after total gastrectomy.Methods:A total of 106 cases underwent the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch(group A,n=38) ,Roux-en-Y esophagojejunostomy with the J-type jejunal pouch(group B,n=31) ,and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch(group C,n=37) respectively.The clinical data were retrospectively studied.The digestive tract reconstruction time,the post-operative complication incidence rate,postprandial symptoms,food-intake quantity,weight,serum nutritional parameters and emptying time of the gastricsubstitute were compared respectively.Results:The reconstruction time was the shortest in group A,which was significantly shorter than that in group B(P0.05) ,Group A was significantly lower than group B and C in the incidence of roux stasis syndrome.The Visick score of group A were superior to those of group B and C in 6 and 12 months after operation.The food intake gain of group A and B were superior to that of group C 6 and 12 months after operation.There were no significant differences among 3 groups in the term of weight,Hb and ALB loss and prognosis nutritional index(PNI) 6 months postoperatively.Weight and ALB loss in group A and B were lower than those in group C 12 months postoperatively,but PNI was higher in group A and B than those in group C.Emptying time of the gastric substitute was prolonged both in group A and B 12 months postoperatively.Conclusion:The uncutted Roux-en-Y esophagojejunostomy may act as an adoptable method of digestive tract reconstruction after total gastrectomy for gastric cancer.

Objective To investigate the incidence and related risk factors of female stress urinary incontinence(SUI) in a county of Chengdu. Methods The women were interviewed with questionnaires,which were designed to the modified standard of the Advisory Committee of Urinary Incontinence of Asia-pacific Region. Results The total number of the women investigated was 563,while the number of the valid questionnaires was 512,with the efficient rate 98.5%.Of these women,46.1%(236/512) had urinary incontinence,21.9%(112/512) had simplex SUI,4.7%(24/512) had simplex urgent urinary incontinence and 19.5%(100/512) had complex urinary incontinence.The incidence of SUI(simplex SUI plus complex urinary incontinence) was 41.4%(212/512).The incidence of SUI was associated with factors such as age,pregnancies,drinking and education level,and the severity was associated with age,body mass index and education level.Conclusion The incidence of SUI in this county of Chengdu is relatively higher.Heath education is very important for the female health.

Objective To evaluate the value of the short-segment nerve conduction studies (SSCSs, inching test) in the diagnosis and localization of cubital tunnel syndrome (CubTS).Methods The clinical and electrophysiologic data of 46 patients (92 limbs from 32 men and 14 women, aged from 19 to 59 years, with average age of 41.2 years) with CubTS were collected.The symptoms occurred in unilateral arm in 41 patients and bilateral arms in 5 patients, involving 35 left arms and 16 right arms.SSCSs were performed in both arms in all the 46 patients.Sixty ulnar nerves were studied in 30 healthy control subjects using SSCSs.Results The 51 symptomatic arms with CubTS were abnormal in long segment motor nerve conduction studies.There were 68 abnormal arms ( 51 symptomatic arms, 17 asymptomatic arms ) in SSCSs.The lesions were located 2 cm proximal to the elbow-the elbow segment ( AE2-E ) in 41 arms (44.6%),the elbow-2 cm distal to the elbow segment (E-BE2) in 23 arms (25%), 4 cm proximal to the elbow-2 cm proximal to the elbow segment (AE4-AE2) in 18 arms (19.6%), 6 cm proximal to the elbow-4 cm proximal to the elbow segment (AE6-AE4) in 9 arms (9.8%), 2 cm distal to the elbow-4 cm distal to the elbow segment (BE2-BE4) in 8 arms(8.6%) and 4 cm distal to the elbow-6 cm distal to the elbow segment (BE4-BE6) in 6 arms(6.5%),respectively.Conclusions SSCSs are more sensitive in detecting CubTS than the conventional long segment motor conduction studies.SSCSs could precisely localize the entrapment lesions in patients with CubTS ,might be a useful tool for the detection of ulnar mononeuropathy at the elbow, especially for diagnosing the patients with CubTS who have no clinical features or have a normal long segmental nerve conduction findings.

Objective To investigate the risk factors of upper gastrointestinal injury induced by non-steroidal anti-inflammatory drugs (NSAIDs).Methods A total of 1032 patients which used NSAIDs was selected.Patients were divided into two groups based on the condition of dyspepsia,peptic ulcer or upper gastrointestinal bleeding:the adverse drug reaction group (331 cases) and the control group (701 cases).Data of two groups on clinical presentation,laboratory test,medication and treatment were analyzed.Risk factors for the adverse drug reaction were identified by multivariable Logistic regression.Results The two groups had significant difference in age ＞ 65 years old,Helicobacter pylori (Hp) infection,ulcer history,drug overdose,combination with glucocorticoid,addicted to tobacco and alcohol history,non-specific inhibitor of cyclooxygenase(COX)-2,combination with anticoagulant,concomitant chronic cardiopulmonary disease (P ＜ 0.05).Logistic regression analysis by backward elimination method revealed that following variables retained,such as combination with glucocorticoid (OR =3.104,95％ CI 1.936-4.695),Hp infection (OR =2.768,95％ CI 2.047-3.742),drug overdose (OR =2.411,95％ CI 1.683-3.453),ulcer history (OR =1.781,95％ CI 1.278-2.480),age ＞ 65 years old (OR =1.659,95％ CI 1.237-2.225),non-specific inhibitor of COX-2 (OR =1.470,95％ CI 1.103-2.133),addicted to tobacco and alcohol history (OR =1.459,95％ CI 1.032-2.064),concomitant chronic cardiopulmonary disease (OR =1.357,95％ CI 1.008-2.143),P＜0.05.Conclusion Combination with glucocorticoid,Hp infection,drug overdose,ulcer history,age ＞ 65 years old,non-specific inhibitor of COX-2,addicted to tobacco and alcohol history,concomitant chronic cardiopulmonary disease are risk factors of upper gastrointestinal injury induced bv NSAIDs.