Objective To evaluate on novitiate of medical students in center of disease control and prevention(CDC).Methods Junior medical students of Grade 2007 were selected randomly by Cluster sampling method and classified into teaching reform group(novitiate in CDC,n=79) and control group.Traditional lecture and discussion were used in the laboratory of the school to 98 students of the control group,while 79 students of the teaching reform group became CDC trainees.Questionnaire and qualitative interviews were used to evaluate the trainees' preventive medicine cognition,their interest and employment intention.Questionnaire data was proofread and entered in EPIdata (version 3.1),and was analyzed by using Statistical Package for Social Sciences(SPSS version 17.0),and ratio or rate between groups were compared by x2 test,and scores of two groups were compared by using Wilcoxon test.Results In teaching reform group,rate of H1N1 correctly classified as category B was 76.0％,score of knowledge of Programme on Immunization,knowledge of H 1N 1 reporting procedures,knowledge of DOTs strategy,knowledge of chronic non-communicable disease management,and self-interest in preventive medicine was 4.0,4.0,3.0,5.0 and 4.0(points) respectively,and the proportion of regarding CDC as an employment options was 73.3％,respectively higher than 40.4％,2.9,2.9,2.0,4.0,3.8 points and 28.7％ in control group(all P＜0.05).Conclusion Novitiate in CDC is helpful to increasing students' interest in learning preventive medicine,learning knowledge of preventive medicine,and changing employment concept.

Objective:To investigate the risk factors of bleeding events in patients with high international normalized ratio (INR) values (INR>3.5) in warfarin therapy.Methods:Two hundred and one patients with high INR values (INR>3.5) during warfarin therapy admitted in Beijing Tongren Hospital from August 2013 to August 2019 were enrolled. The bleeding occurred in 75 patients (bleeding group) and did not occur in 126 cases (non-bleeding group) during hospitalization. The bleeding group included 12 major bleeding patients and 63 minor bleeding patients. The baseline information, laboratory results and medication of other drugs were recorded.Results:There were no significant differences in age, sex, smoking history, drinking history, previous bleeding history and the proportion of first application of warfarin between the two groups ( P>0.05).The proportion of patients with liver dysfunction [7.14%(9/126)], renal dysfunction [11.90%(15/126)], anemia [4.76%(6/126)], hypoproteinemia [4.76%(6/126)], infectious diseases [20.63%(26/126)] in non-bleeding group were significantly lower than that in bleeding group [16.00% (12/75), 32.00% (24/75), 29.33%(22/75), 16.00%(12/75), 44.00%(33/75); χ 2=3.942, 12.140, 23.675, 7.283, 12.377, respectively; all P<0.05]. A total of 54 kinds of drugs were associated with the INR elevation. The most commonly used drugs were cardiovascular system drugs ( n=162, 80.60%), blood system drugs ( n=155, 77.11%), anti-infective drugs ( n=112, 55.72%), digestive system drugs ( n=82, 40.80%), and endocrine system drugs ( n=56, 27.86%). The INR values [4.58(3.94, 5.90), 4.96(4.03, 8.27)] and the HAS-BLED scores [3.00 (2.00,3.00), 3.00(2.25,3.00)] in minor bleeding group ( n=63) and major bleeding group ( n=12) were higher than those in non-bleeding group [4.00(3.74, 4.35), 2.00 (1.00,3.00), P<0.01), but there was no significant difference in INR values and HAS-BLED scores between minor bleeding group and major bleeding group ( P>0.05). Conclusion:There are many factors leading to the increase of INR in patients taking warfarin, such as abnormal liver and kidney function, anemia, hypoproteinemia, and the use of antibacterial drugs. It is necessary to be cautious about co-administration in these patients.

Preeclampsia is a kind of idiopathic disease during pregnancy. Its pathogenesis may involve many factors, such as mother, placenta and fetus. The study found that the abnormal metabolism of blood glucose and blood lipid during pregnancy may be closely related to the onset of preeclampsia. This paper reviews the research progress of abnormal glycolipid metabolism in preeclampsia at home and abroad in order to better guide the management of related aspects during pregnancy.

Secondary lymphedema is a chronic progressive disease caused by the obstruction of lymphatic reflux, which leads to a series of secondary affection. There is no cure at present. Exploring the pathogenesis and treatment of lymphedema is based on animal models that mimic the pathophysiology of chronic lymphedema in humans. Currently, there are many known animal models of lymphedema, such as the limb lymphedema model of mice, dogs and other animals, and the rabbit ear lymphedema model. But most of them cannot induce the persistent and stable lymphedema temporarily, which lead to a deadlock in the related research progress. Therefore, it is necessary to improve and even create new animal models of lymphedema. This paper summarises the progress of relevant literature and provides references for further improving the establishment of a lymphedema animal model. It also summarise existing methods for evaluating lymphedema or lymphatic vessel function to provide an evaluation tool for modified or new animal models.

Objective To explore the relationship between obesity and serum testosterone level among community adult males.Methods The stratified cluster sampling method was adopted to extract 1 166 male residents aged 20 years old and over in Zunyi City and conduct the questionnaire survey and physical examination.Fasting venous blood samples were collected for detecting the serum total testosterone(TT),sex hormone binding globulin(SHBG) and luteinizing hormone(LH).Then free testosterone index(cFT),free testosterone index(FTI) and testosterone secreting index(TSI) were calculated.Results The average levels of serum TT,SHBG,cFT,FTI,TSI and LH in 1 166 adult males were(16.83±4.90)nmol/L,(42.15 ± 20.21)nmol/L,(0.31 ±0.10)nmol/L,(0.46 ± 0.19) IU/L,(3.40 ± 2.04) IU/L and(6.77 ± 5.14) IU/L respectively;the Pearson correlation analysis showed that WHtR,BMI and WC were negatively correlated with TT,SHBG,TSI and LH,and were positively correlated with FTI,WHtR was negatively correlated with cFT,BMI and WC were negatively correlated with LH,the differences were statistically significant(P＜0.05).The multivariate linear regression analysis shown that WHtR was negatively correlated with TT,SHBG,TSI and LH;and was positively correlated with FTI,the differences were statistically significant(P＜0.01).Conclusion Adult male central obesity may be associated with the decrease of serum TT,SHBG,TSI and LH levels,and increase of FTI level.

ObjectiveTo investigate the mechanism of Xiaonang Tiaojing decoction（XNTJD）in improving polycystic ovary syndrome with insulin resistance（PCOS-IR）model rats based on anti-Müllerian hormone（AMH）/AMH type Ⅱ receptor（AMHRⅡ）signaling pathway. MethodForty-eight adult female SD rats were randomly divided into the blank group， model group， XNTJD group（11.4 g·kg^-1·d^-1） and Diane-35 group（0.21 g·kg^-1·d^-1）， PCOS-IR model was established by high-fat and high-sugar diet combined with letrozole in rats of all groups except the blank group， rats in the administration groups were given the corresponding dose of drugs by gavage for 15 days with an interval of 1 d every 4 d， normal saline of the same volume was given to the blank group and the model group. Estrous cycle was recorded daily during treatment. At the end of treatment， body weight and Lee's index were recorded， AMH， luteinizing hormone（LH）， LH/follicle stimulating hormone（FSH）， testosterone（T）and estradiol（E₂）levels were measured by enzyme-linked immunosorbent assay（ELISA）， fasting plasma glucose（FPG）was measured by glucometer， fasting insulin（FINS） level was measured by radioimmunoassay（RIA）， and the insulin resistance index（HOMA-IR） and insulin sensitivity index（QUICKI）were calculated， triglyceride（TG）and total cholesterol（TC）levels were measured by automatic biochemical analyzer， hematoxylin-eosin（HE）staining was used to observe the morphological changes of the ovary， the levels of AMHRⅡ， bone morphogenetic protein-15（BMP-15）and Smad5 in ovarian tissues were detected by immunohistochemistry（IHC），Western blot was used to analyze the protein expression levels of AMHRⅡ， BMP-15 and Smad5. ResultCompared with the blank group， a large number of leukocytes were observed in the vaginal exfoliated cells of rats in the model group， mainly in diestrus， the levels of body weight， Lee's index， glucose-lipid metabolism indexes（FPG， FINS， HOMA-IR， TG， TC）， AMH and sex hormones（LH， LH/FSH， T）were significantly increased（P<0.01）， and QUICKI and E₂ levels were significantly decreased（P<0.01）， there were more cystic bulges on the ovarian surface， more wet weight， more atretic and cystic dilated follicles in the ovarian tissues， and the thickness of granulosa cell layer was reduced without oocytes， the expression level of AMHRⅡ protein in ovarian tissues was significantly increased（P<0.01）， and the expression levels of BMP-15 and Smad5 proteins were significantly decreased（P<0.01）. Compared with the model group， the exfoliated cells in the vagina of rats treated with XNTJD group showed keratinocytes from the 5^th to 6^th day of treatment， and a stable estrous cycle gradually appeared， body weight， Lee's index， glucose-lipid metabolism indexes（FPG， FINS， HOMA-IR， TG， TC）， AMH and sex hormones（LH， LH/FSH， T）levels were significantly decreased（P<0.05， P<0.01）， QUICKI and E₂ levels were significantly increased（P<0.01）， ovarian surface was smoother and lighter in wet weight， oocytes and mature follicles were observed in ovarian tissues， the thickness of granulosa cell layer increased and the morphology was intact， the expression levels of BMP-15 and Smad5 proteins were significantly increased（P<0.01）and the expression level of AMHRⅡ protein was significantly decreased（P<0.01）in ovarian tissues. ConclusionXNTJD may mediate the up-regulation of BMP-15 and Smad5 in ovarian tissues of PCOS-IR rats by down-regulating AMH/AMHRⅡ， thereby improving ovarian function， sex hormones and glucose-lipid metabolism levels in PCOS-IR rats.

Background Noise is the most common occupational hazard in the automobile manufacturing industry with the most workers exposed. Automobile manufacturing industry is a high-risk industry for noise-induced hearing loss. Objective To understand the epidemiological characteristics of noise-induced hearing loss among workers in automobile manufacturing industry and explore related influencing factors. Methods A questionnaire survey, individual noise recording, and pure tone audiometry were conducted among workers (n=656) exposed to noise from five automobile manufacturing enterprises. The data on age, sex, exposure duration, noise intensity, kurtosis, and hearing loss were obtained. The positive rates of high-frequency noise-induced hearing loss (HFNIHL) and speech-frequency noise-induced hearing loss (SFNIHL) were calculated, and each factor was compared between workers with and without HFNIHL. Chi-square test and analysis of trend were conducted among different groups of age, sex, exposure duration, A-weighted equivalent continuous sound pressure level normalized to a nominal 8-hour working day (L_Aeq,8h), and kurtosis. Logistic regression analysis was conducted to analyze the factors influencing the positive rates of HFNIHL and SFNIHL. Results The exposure rates of non-Gaussian noise was 73.6%. The positive rates of HFNIHL and SFNIHL were 32.6% (214 workers) and 6.7% (44 workers), respectively. The HFNIHL workers showed older age, higher proportion of male, longer exposure duration, higher noise intensity (L_{Aeq,8 h}), and increased kurtosis than those without HFNIHL (P<0.05). The positive rates of HFNIHL increased with the increase of age, exposure duration, L_{Aeq,8 h}, and kurtosis (\begin{document}$ {\chi ^2} $\end{document}_trend-age=49.25, P<0.001; \begin{document}$ {\chi ^2} $\end{document}_{trend-duration}=22.19, P<0.001; \begin{document}$ {\chi ^2} $\end{document}_trend-LAeq=6.91, P=0.009; \begin{document}$ {\chi ^2} $\end{document}_{trend-kurtosis}=8.56, P=0.003). The results of logistic regression showed that age (OR=2.13, 95%CI: 1.67-2.71, P<0.001), sex (OR=2.29, 95%CI: 1.44-3.62, P<0.001), exposure duration (OR=1.43, 95%CI: 1.11-1.85, P=0.006), L_Aeq,8h (OR=1.37, 95%CI: 1.08~1.76, P=0.011), and kurtosis (OR=1.37, 95%CI: 1.14-1.63, P=0.001) were factors associated with the risk of HFNIHL, while only age was associated with the risk of SFNIHL (OR=2.15, 95%CI: 1.33-3.33, P=0.001). Conclusion Workers exposed to noise in automobile manufacturing industry are at a high risk of hearing loss. Age, sex, exposure duration, L_{Aeq,8 h}, and kurtosis are key influencing factors of hearing loss.