Human exposure factor is one of the important parameters in environmental health risk assessment models. Proper selection of the exposure factors will contribute significantly to improve the accuracy of health risk assessment. This paper reviewed recent application of some key exposure factors for environmental health risk assessment in the USA, EU, Japan, etc. Some suggestions were proposed on focuses and trends of the related research in near future in China, based on the further analysis for the exposure factors of Chinese population.

ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

Objective To investigate the changes of traditional Chinese medical constitution types with menstrual cycle of sub-health state women, thus to explore the affectability of diseases during menstrual cycle. Methods Sub-health State Questionnaire and Menstruation State Questionnaire established in our previous study were used for the epidemiological survey of 330 women outpatients aged 20-45 years admitted by the disease-preventive department of Tianhe District Hospital of Traditional Chinese Medicine. Results In 330 cases, the cases of sub-health state accounted for 64.5%, in which 21.5%had pure sub-health state without any chronic diseases, and 43.0% had sub-health state together with some diseases. The diseases of hyperplasia of mammary glands, vaginitis, cervical spondylosis, hyperlipemia, chronic appendagitis, and uterus myoma had higher morbidity rate in order. At premenstrual phase, constitution types of Qi stagnation, damp heat, and blood stasis had the higher incidences; at menstruation phase, Qi stagnation, blood stasis, and damp heat had the higher incidences; at postmenstrual phase, yang deficiency, Qi deficiency, and damp heat had the higher incidences. Most of the sub-health state women had the complex constitution types, accounting for 93%. Conclusion Traditional Chinese medical constitution types are correlated with menstral cycle of sub-health state women, and show some effects on the affectability and progress of diseases. The investigation results of dynamic changes and the distribution of traditional Chinese medical constitution types during menstrual cycle will supply some evidence for the prevention and treatment of irregular menstruation and sub-health state of the women with Chinese medine.

Objective To investigate the occurrence of central venous catheter-related bloodstream infection(CRB-SI)in mass severe burn patients,evaluate related risk factors for infection,and effectiveness of prevention and con-trol measures.Methods In August 2014,9 cases of severe burn patients were rescued in a hospital,all patients re-ceived CVC,infection prevention and control intervention measures were performed during the whole process of catheterization.Results All patients received 30 episodes of CVC,total CVC-days were 227 days,bacterial culture for three-cavity catheters of femoral veins in 2 patients were positive,incidence of CRBSI was 8.81 ‰;1 patient was isolated Enterococcus faecium ,1 isolated both Acinetobacter baumannii and Stenotrophomonas maltophilia .2 CRB-SI patients received femoral vein catheterization,catheterization site was trauma surface,duration of catheterization were both ≥7 days,both used three-cavity catheters,and third degree burns were ≥60%,both patients were cured after timely removal of catheters and receiving of antimicrobial agents.Conclusion CVC is helpful for long term, safe and effective fluid infusion,but it can cause CRBSI;infection prevention and control intervention for patients receiving CVC during the whole process of catheterization can reduce the occurrence of CRBSI.

Objective To explore the change trend and antimicrobial resistance of pathogens causing infection in extensive burn patients,and provide reference for clinical prevention and treatment.Methods Specimens from 9 extensive burn patients who were admitted to a hospital at the same time were performed pathogenic culture and an-timicrobial susceptibility testing, change trend and antimicrobial susceptibility of pathogens were observed. Results The main specimen was wound secretion,accounting for 93.81 %.The major pathogens causing infection were Acinetobacter baumannii (44.85%),Staphylococcus aureus (32.47%),Pseudomonas aeruginosa (12.37%), and Klebsiella pneumoniae (5.15%).With the prolongation of hospital stay,pathogens changed from one kind to multiple strains, and from susceptibility to resistance,multidrug resistance,and extensive drug resistance. Conclusion Itis difficult to avoid infection in burn patients,timely realizing the changes of pathogens causing infec-tion and antimicrobial resistance play an important role in the control of infection.

Objective To investigate the incidence of sub-health fatigue among medical workers exposing to radioactive rays, and to observe the therapeutic effect of Bushen Jianpi recipe on sub-health fatigue. Methods An investigation was carried out among 1 056 medical workers exposing to radioactive rays which were from the medical and sanitary institutions of Guangzhou city. Sixty cases subjecting to the inclusion criteria were sampled from the investigated population by epidemiological methods for the randomized controlled trial. The subjects were evenly randomized into treatment group and control group. Both groups received health education and health-promoting lifestyle, and the treatment group was given self-prescribed Bushen Jianpi recipe additionally. The treatment lasted for 4 weeks. The scores of Multidimensional Fatigue Inventory ( MFI-20) and Sub-health Measurement Scale Version 1.0 ( SHMS V1.0) were observed before and after treatment, and the therapeutic effect was evaluated after treatment. Results ( 1) We got 976 effective questionnaires, and the effective response rate was 92.4%. Among the admitted 976 workers, the incidence of sub-health state was 66.8% (652/976) and that of sub-health fatigue is 31.4% ( 205/976). ( 2) The total effective rate was 80.0% in the treatment group and was 36.7% in the control group, the difference being significant ( P<0.01). ( 3) After treatment, the scores of MFI-20 and SHMS V1.0 were decreased in the treatmeat group, and fatigue symptom scores were decreased in the control group ( P<0.05 or P<0.01) , the decrease in the treatment group being superior to that in the control group ( P<0.05 or P<0.01). Conclusion The incidence of sub-health fatigue is popular in the medical workers exposing to radioactive rays, and Bushen Jianpi recipe has an effect on improving the sub-health fatigue.

Objective To seek for the differentially-expressed proteins in patients with kidney-yin deficiency syndrome and to screen out the specific proteins,so as to provide evidence for the establishment of objective standard of kidney deficiency syndrome of traditional Chinese medicine (TCM).Methods Five patients with typical kidney-yin deficiency syndrome and 6 normal healthy volunteers were enrolled into the study.Plasma proteins in both groups were detected by antibody chip,and then the plasma proteins profile was compared and analyzed.Results A total of 25 differentially-expressed proteins between kidney-yin deficiency group and normal control group were found,of which 2 were up-regulated and 23 were down-regulated.Conclusion The differentially-expressed proteins in patients with kidney-yin deficiency syndrome are mainly related to immune disorder,protein biosynthesis,metabolism,oxidative stress,cell apoptosis,signal transduction,and so on.

Objective To investigate the expression of the mRNA of muscle fibre types in the denervated post cricoarytenoid(PCA)muscle of rat.Methods Unilateral recurrent laryngeal nerve of eight rats were removed.Eight rats were used as controls.The mRNA expression of heavy chain myosin of PCA muscle fibre subtypes was measured with real-time quantitative RT-PCR in control rats and denervated rats 40 days after denervation.Results Compared to the control group,there were no significantly differences in mRNA expression of each muscle subtype between two groups.The ratio of MyHC type I to IIB was increased significantly(P=0.018).Conclusion The increased ratio of MyHC subtype I to IIB suggests the decreased contraction power of denervated PCA muscle.

Objective: To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China. Methods: Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation. Predictors were screened and used to develop the risk score model by logistic regression analysis in a retrospective cohort. Then, the risk score model was evaluated in a prospective validation cohort. Results: The study population of derivation cohort included 1 735 consecutive chest pain patients. Finally, 1 030 eligible patients were enrolled. Multivariate regression analysis defined five independent predictors: male gender (β=0.88); history of chest pain (β value of moderate and high suspicion of coronary heart artery was 2.70 and 3.51 respectively); electrocardiogram (β=0.84); ≥60 years old (β=0.51) and ≥3 risk factors (β=0.85).The range of weighted score was set as 0-13. The area under a receiver operating characteristic (ROC) curve was 0.75 (95%CI 0.72-0.78) in the final model. Major adverse cardiovascular events rates increased in proportion to score increase (P<0.01). The internal validity used bootstrap technique showed the same predictor factors as the final model, and its area under a ROC curve was 0.75(95%CI 0.72-0.78).MACE rates in the low risk group (score 0-3), intermediate risk group (score 4-7), and high risk group (score 8-13) were 1.3% (1/77) ,19.0% (22/116) ,and 42.2% (122/289) in the prospective validation cohort, respectively (P<0.01). Conclusion The developed ischemic risk score is feasible for risk stratification of acute chest pain patients with normal hs-TnI and without obvious ST-segment deviation, this score might be helpful to the decision making of treatment and management strategies for these patients.

Objective:To evaluate the effect of preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy on atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.Methods:In the prospective study, a total of 45 patients aged 65-80 years undergoing scheduled robot-assisted radical prostatectomy in First Hospital of Shanxi Medical University from August 2020 to November 2020 were divided into three groups( N=15, each): respiratory muscle exercise combined with lung protective ventilation strategy group(combined group), lung protective ventilation strategy group(pulmonary protective group)and conventional ventilation strategy(control group). Heart rate, systolic blood pressure, diastolic pressure, and pulse oxygen saturation as well as blood gas analysis of arterial blood and the calculated oxygenation index were measured and recorded immediately after establishing invasive artery monitoring in operating room, 10 min after endotracheal intubation, 1 h after the flexitic position, 30 min after tracheal extubation, 24 h after operation in all three groups of patients.The lung compliance values, peak airway pressure, and end-tidal carbon dioxide were recorded at 10 minutes after tracheal intubation, 30 minutes after tracheal extubation, 1 hour after succession position.A single-slice chest CT scan was performed at 1 h after surgery while satisfying the anesthesia recovery steward score ≥ 5.And the percentage of atelectasis area was calculated. Results:The American Society of Anesthesiologisits(ASA)classification of patients was 11/4, 12/3, and 11/4 in the combination group, lung protection group and control group respectively, and the difference was not statistically significant( χ2=0.127, P>0.05). Oxygenation index(mmHg)(1 mmHg=0.133 kPa)at 24 h after surgery was significantly higher in the combined group(351.1±11.2)than in lung protection group(337.0±13.4)( t=3.287, P<0.05). Atelectasis area(Median, Interquartile range)assessed by CT imaging at 30 min after tracheal extubation was 1.92(0.77)% in the combination group, 2.09(1.13)% in lung protection group, and 3.01(1.01)% in control group, with statistically significant difference( χ2 values, 26.036, 12.313, both P<0.05). Atelectasis area at 30 minutes after tracheal extubation was statistically significant smaller in the combination group than in lung protection group( χ2=6.240, P<0.05). Conclusions:Preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy can achieve the better effect of lung protection, reduce the degree of perioperative atelectasis in elderly patients, and improve oxygenation function.