Abstract: To investigate the main occupational hazards of sand casting process enterprises, so as to provide insights into occupational disease prevention and control. Methods: In 2021 and 2022, six typical ferrous metal casting enterprises using sand casting technology in Wenling City, Zhejiang Province were selected to investigate the production processes and equipment, the operation of occupational disease prevention facilities and personal protective equipment. Occupational hazards including silica dust, noise, high temperature and ultraviolet radiation were detected and analyzed. Results: Six sand casting enterprises had not effectively set up and use occupational disease prevention equipment, and some employees had not worn personal protective equipment as required. The participation rate of occupational health examination was 100.00%. Among the 54 silica dust sampling points at the sand mixing, molding, sand falling, shot blasting and mud core drilling positions, the overall dust concentration exceeding the standard rate was 100.00%, and the respiratory dust exceeding the standard rate was 44.44%. Among the 55 noise measurement points at the sand mixing, sand falling, shot blasting, mud core drilling, polishing and blowing positions, 51 exceeded the standard, with a rate of 92.73%. Among the 90 sampling points for melting, painting, polishing, blowing and welding positions, the concentrations of welding fumes, manganese and its compounds, ethyl acetate and other cahmical factors did not exceed the standard. Six ultraviolet radiation measurement points in the welding position and six heat stress measurement points in the melting position did not exceed the standard. Conclusion The main occupational hazards of sand casting process enterprises in Wenling City are silica dust and noise, and occupational disease prevention and control should be further strengthened.

Aim To further investigate the protective effect and mechanisms of total paeony glycoside (TPG) on apoptosis in experimental myocardial ischemic rats.Methods The myocardial ischemic model of rats was established by subcutaneous injection of isoprenaline (ISO), and early apoptosis rate of myocardial cells and the expression of apoptosis related genes Bax, Bcl-2 and proteins in myocardial tissues were analyzed and contrasted among five groups, including normal control, ISO injury, TPG prevention and treatment, TPG treatment and positive control.Results Compared with ISO injury group, all of indexes had improved in various degrees in TPG prevention and treatment group and TPG treatment group, such as the decrease of early apoptosis rate,expression of Bax gene and protein, the increase of Bcl-2 gene and protein and the ratio of Bcl-2 protein/Bax protein.Conclusion TPG has protective effect on apoptosis in ischemic myocardium induced by ISO.The pharmacological mechanism may relate to the activation of the Bcl-2 gene and protein expression, the inhibition of Bax gene and protein expression, as well as the increase of Bcl-2/Bax ratio.

Objective: To investigate the effects of glucagon-like peptide-1(GLP-1)on high glucose-induced apoptosis of human umbilical vein endothelial cells (HUVECs) and the mechanism involved. Methods: HUVECs were cultured under varying conditions for 48 h, and the cell viability was spectrophotometrically measured by MTT assay. Flow cytometry detected the ratio of cell apoptosis. Western blot detected the protein levels of p-Akt and p-eNOS, while NO assay kit detected the NO concentration.
Results: Treatment of high glucose (33 mmol/L) for 48 h signiifcantly decreased the HUVECs viability and induced the apoptosis of HUVECs, concomitant with decreased Akt and eNOS phosphorylation leves and subsequent NO production. Treatment with GLP-1 (3 nmol/L) for 48 h in the high glucose group increased the HUVECs viability (P<0.01), decreased the ratio of HUVECs early apoptosis (P<0.05), ameliorated the reduced protein levels of p-Akt and p-eNOS caused by high glucose, and increased the NO production (P<0.05). The anti-apoptotic effect and the increased NO production of GLP-1were inhibited by PI3K inhibitor wortmannine (100 nmol/L) or eNOS inhibitor L-NAME (100μmol/L). The effect on p-Akt, p-eNOS of GLP-1 was inhibited by wortmannine (100 nmol/L) while L-NAME (100μmol/L) did not have any influence on the expression of p-Akt.
Conclusion: GLP-1 can ameliorate high glucose-induced HUVECs apoptosis, which is probably related to the up-regulation of PI3K/Akt/eNOS pathway.

Objective To observe the fluctuations of blood glucose in type 2 diabetic patients treated by insulin hypodermic injection in different sites.Methods 30 patients with type 2 diabetes were randomly divided into three groups:abdominal,edltoid region and lateral femoral subcutaneous injection group.After half a year of insulin therapy,dynamic glucose monitoring for consecutive(71±10)hours was conducted,and(847±80)results of glucose Level were obtained.Results The average glucose had no difference in three group,but diurnal maximum and maximum fluctuation amplitude in patients of abdominal subcutaneous injection group were significantly lower than the Other groups(P＜0.05).The time percentage of glycemic fluctuations within 3.6～10.0mmol/L and diurnal minimum was higher compared to other groups(P＜0.05).Conclusion The site choice of insulin subcutaneous injection can influence the fluctuations of blood glucose in type 2 diabetes mellitus and abdominal subcutaneous tissue was the most ideal of the three subcutaneous injection sites.

Objective To compare the clinical efficacy of three kinds of replacement fluid for continuous hemofiltration in severe sepsis,and to develop a more rational composition.Methods Fifty severe sepsis patients with continuous hemofiltration were divided into four groups randomly.The configuration of the replacement fluid in accordance with the random number table,randomly selected from four different formulations:group A (13 cases):Ports composition provided by Nanjing general hospital;group B (12 cases):Zhongshan hospital composition; group C (11 cases):an improved composition; group D (14 cases):an improved composition by Donghua hospital affiliated to SUN Yat-sen university.Blood electrolytes,blood gas analysis,renal function,blood glucose(highest and lowest serum glucose in treatment period),high sensitive C-reactive protein(hs-CRP) concentration,calcium concentration in filter were tested before and after every treatment period.Results The concentration of blood electrolytes during treatment had no significant change (P ＞ 0.05).Renal function were improved significantly after treatment among four groups (P ＜ 0.05).The level of hs-CRP decreased significantly after treatment (P ＜ 0.05) and there was no significant difference among four groups (P ＞ 0.05).The change of serum glucose during treatment was the smallest in group D than that in group A,B,C [(3.0 + 0.9) mmol/L vs.(11.2 + 2.0),(3.8 + 1.1),(5.5 +1.3) mmol/L](P ＜ 0.05).Calcium concentration in filter was the lowest in group D than that in group A,B,C [(1.5 + 0.5) mmol/L vs.(2.0 + 0.7),(2.3 + 0.5),(2.1 + 0.4) mmol/L] (P ＜ 0.05).The dosage of heparin was the least during treatment in group D than that in group A,B,C[(6.5 ± 2.8) U/(kg·h) vs.(8.9 ± 3.4),(7.9 ± 3.0),(8.7 ± 3.1) U/ (kg· h)] (P ＜ 0.05).Conclusions Improved composition by Donghua hospital affiliated to SUN Yat-sen university hospital compared to other compositions can better maintain a stable blood glucose levels,have a better anticoagulant effect,reducing the application of heparin,maintain a stable homeostasis.It is worthy of using in clinic.

BACKGROUND: It is demonstrated in modern pharmacologic study that total paeony glycoside (TPG) provides extensive pharmacologic activities,such as inhibiting aggregation of platelets and erythrocytes, anticoagulation,antithrombsis, anti-arterial sclerosis, protecting heart and liver, anti-tumor,etc.OBJECTIVE: Neonatal rat cardiomyocytes were cultured in vitro and by the changes of superoxide dismutase (SOD) activity, malondialdehyde (MDA) and nitric oxide (NO) contents in cell culture solution, the protection of TPG on injured cardiomyocytes was analyzed.DESIGN: Controlled observation was designed.SETTING: Bioengineering Department in School of Life Science and Technology of Xi 'an Jiaotong University and Institute of Bone Diseases in Medical School of Xi'an Jiaotong University.MATERIALS: The experiment was performed in Bioengineering Department in School of Life Science and Technology of Xi 'an Jiaotong University from February to June in 2003, in which, 44 SD neonatal rats aged 1-3 days were employed. The 48-hour-cultured cardioryocytes were prepared in 42 bottles and randomized into 6 groups, named normal control (normal group), medicated-injury group (injury group), TPG 0.625 mg/L group,TPG 3.125 mg/L group, TPG 15.625 mg/L group and positive control, 7 bottles in each group.METHODS: Cardiomyocytic primary culture was performed under aseptic condition. No any drug was used in normal group, isoprenaline was added in injury group to terminate the concentration at 100 mg/L, in TPG 0.625, 3.125 and 15.625 mg/L groups, 30 minutes after isoprenaline added, RGP at dosages of 0.625, 3.125 and 15.625 mg/L were added respectively; in positive control, 30 minutes after isoprenaline added, coenzyme Q10 was used to terminate the concentration as 100 mg/L.Afterwards, the assay of every index was performed. Xanthine oxidase (XOD) method was used to assay SOD activity, thiobarbituric acid (TBA)method was to assay MDA content and nitrate reductase (NR) method was to assay NO content.cell culture solution in each group.Compared with normal group, the levels of total SOD, CuZn-SOD and MnSOD were reduced remarkably in injury group (P ＜ 0.05 or P ＜ 0.01).The above-indexes in every TPG group and positive control were improved to different extents (P ＜ 0.05 or ＜ 0.01), in which, the protection of TPG 15.625 mg/L group was near to or superior to positive control [(79.50±10.67), (80.30±13.50); (48.24±13.26), (49.73±10.23); (31.26±10.22),in cell culture solution in each group: Those in injury group were higher remarkably than normal group (P ＜ 0.01). MDA and NO contents were all reduced in every TPG group and positive control and dose dependence presented in TPG protection, the higher the dose was, the stronger the action of TPG on protection was, in which, in high-dose group, MDA content was near to normal group [(5.41±1.81), (4.48±0.94) μmol/L, P ＞ 0.05] and NO content was similar to positive control [(81.83± 9.08), (82.41±12.37) mol/L,P ＞ 0.05].CONCLUSION: TPG protects myocardial injury induced by isoprenaline,indicating dose-dependence relationship, which is probably associated with enhanced anti-oxidation of cell, reduced injury of cellular membrane induced by free radical and lipid oxidant.

As a heteronomy,the code of medical ethics plays an important role in sustaining the trust between physicians and patients.Based on a comparative analysis of the domestic and foreign codes of medical ethics,and field survey on such trust at tertiary hospitals in Beijing,as well as medical providers’moral characteristics,this article analyzed the causes that “goodwill”is insufficient in the trust in terms of internal and external factors;and then,in respect of heteronomy as a basis,it put forward suggestions to improve code of medical ethics in order to rebuild such trust.

Physician-patient trust is the basis of informed consent,and the informed consent institution is supposed to strengthen the trust.However,it affects trust in an opposite way in practice. This research aimed to analyze the relationship between informed consent and physician-patient trust,and provide with the advice,recommending on such rebuilding.

The study found that the physician-patient trust crisis results from overreliance on technology trust instead of interpersonal trust and institutional trust. The alleged “Paternalistic government innovation”in healthcare service has caused wastes of healthcare resources and gap below public expectancy due to its incompetence in resolving social problems,further eroding institutional legality and intensifying such crisis.This research aimed to identify government accountabilities in building such trust from three aspects.