China ; Humans ; Occupational Health ; statistics & numerical data ; Physical Examination ; trends

Objective To establish a new and convenient assay for whole blood lead concentration. Methods Whole blood sample was digested by nitric acid-perchloric. Under the condition of pH 0.8～1.0, lead concentration was examined by Hydridegeneration Atomic Fluorescence Spectrometry.Results The method had good linearity when lead concentration were between 0 to 600 ?g/L, r =0.999. The within-run CV of the method for high, middle and low lead level were 4.1%, 3.6% and 3.5% respectively. The between-run CV were 4.9%, 4.6% and 4.7% respectively. The recovery rates were 105.4%, 98.5% and 94.8% respectively. The single-blind test result of series standard lead samples provided by Chinese Academy of Preventive Medicine were within the acceptable range. The detecting Limit of this method was 0.3 ng. There was no significant interference from main two-valence positiveion. The sample can be storage at lest for 1 months at 4℃. Samples of 869 children from Tianjin were tested by this method. The mean value was 91.9 ?g/L, median was 83.8 ?g/L, all data were within 23.1～386.3 ?g/L. The result showed out positive skewness distribution.Conclusion This method were sensitive, accurate, precise, quick and low-cost. It was suitable for use in clinical laboratories.

Objective To investigate the clinical value of serum soluble intercellular adhesion molecule-1 (sICAM-1 )in patients with primary biliary cirrhosis (PBC)and autoimmune hepatitis (AIH).Methods Sixty-one PBC patients and 59 AIH patients,who were hos-pitalized or visited the outpatient department from June 2012 to September 2013,as well as 50 healthy controls,were included in the study. The PBC patients included 29 incipient cases,21 cases in remission,and 11 recurrent cases;the AIH patients included 26 incipient cases, 20 cases in remission,and 13 recurrent cases.Serum sICAM-1 level was measured by double-antibody sandwich enzyme-linked immu-nosorbent assay,and serum levels of alanine aminotransferase (ALT)and total bilirubin (TBil)were determined by biochemical enzyme as-say.Comparison between groups was made by analysis of variance;Pearson correlation analysis was performed.Results Among PBC pa-tients,the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.484);the remission group had a significantly higher serum sICAM-1 level than the control group (P=0.000).Among AIH patients, the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.802);no significant difference in serum sICAM-1 level was seen between the remission group and control group (P=0.281).For patients with PBC and AIH,serum sICAM-1 level was positively correlated with serum levels of ALT (r=0.664,P=0.000;r=0.784,P=0.000) and TBil (r=0.715,P=0.000;r=0.580,P=0.000).Conclusion Serum sICAM-1 may be involved in the immunologic injury in PBC and AIH.In patients with PBC and AIH,the elevation of serum sICAM-1 level is closely correlated with the severity of liver damage. Clinical monitoring of serum sICAM-1 level may play an important role in severity assessment,prognostic evaluation,and therapy guidance among patients with autoimmune liver diseases.

Humans ; Occupational Exposure ; Occupational Health

Teaching of clinical skills is an important bridging phase from preclinical medicine to clinical practice.It is also an important element of medical students'clinical skills training.According to the character of internal medical cardiology,we should enhance the training of their clinical thinking ability,medical communication competence,and clinical operating ability to get satisfactory teaching effect.

Objective To investigate the changes and significance of plasma level of homocysteine (Hcy) in Parkinson disease (PD) patients with cognitive dysfunction. Methods Ninety-two PD patients were enrolled. Among them, 51 patients had mild cognitive impairment (CI), and the other 41 had not CI. Forty healthy subjects were enrolled as control group. The information including gender, age, illness duration, years of education and Hoehn and Yahr (H-Y) stage were recorded. Cognitive function of all the patients with PD and the controls were measured by using Montreal Cognitive Assessment (MoCA) scale. Plasma levels of Hcy, folic acid and vitamin B12 were measured by high performance liquid chromatography or radioimmunoassay. Results The plasma level of Hcy in PD group was significantly higher than that in control group: (16.72 ± 5.52) μmol/L vs. (13.65 ± 5.16) μmol/L, there was statistical difference (P<0.05). The plasma level of Hcy in patients with CI was (18.13 ± 4.67)μmol/L, and the patients without CI was (15.44 ± 3.71) μmol/L, the plasma levels of Hcy in patients with CI and without CI were significantly higher than that in control group, furthermore the plasma level of Hcy in patients with CI was significantly higher than that in patients without CI, there were statistical differences (P<0.05). The plasma level of folic acid in PD group was significantly lower than that in control group:(7.15 ± 3.54) μg/L vs. (8.73 ± 3.78) μg/L, there was statistical difference (P<0.05). The plasma level of folic acid in patients with CI was (7.11 ± 3.95) μg/L, and the patients without CI was (7.36 ± 3.84) μg/L, the plasma levels of folic acid in patients with CI and without CI were significantly lower than that in control group, there were statistical differences (P<0.05). But there was no statistical difference in the plasma of folic acid between patients with CI and patients without CI (P>0.05). There was no statistical difference in the plasma of vitamin B12 between the 2 groups (P>0.05). There was a negative relationship between plasma levels of Hcy and folic acid (r =-0.576, P<0.01). The plasma level of Hcy in early PD patients was significantly lower than that in middle-late patients:(15.14 ± 5.31)μmol/L vs. (17.75 ± 5.87) μmol/L, there was statistical difference (P<0.05), and there were no statistical differences in the plasma levels of folic acid and vitamin B12 between early PD patients and middle-late patients (P>0.05). The correlation analysis results showed that MoCA score was positive correlation with years of education (β = 0.541, P = 0.000), MoCA score was negative correlation with illness duration, H-Y stag and plasma level of Hcy (β=-0.417, -0.367 and-0.515;P=0.026, 0.037 and 0.000), but MoCA score was not correlation with age, plasma levels of folic acid and vitamin B12 (P>0.05). Conclusions The changes of plasma level of Hcy may be involved in the pathogenesis of patients with PD. The elevated plasma level of Hcy is significantly correlated with CI, it is an important risk factors of CI in patients with PD.

BACKGROUND: Thermosensitive hydrogel has made great progresses in drug carrier and tissue engineering. However, its phase-transition temperature is lower than human body temperature, so it has not been used as implants. OBJECTIVE: To prepare and evaluate the biocompatibility of a thermosensitive hydrogel poly-(N-isopropylacrylamide-co-N-hydroxymethylacrylamide)[P(NIPAAm-co-NHMPA)] In vitro so as to assess its safety as a medical implant.DESIGN, TIME AND SETTING: Material experiment was performed at the Central Laboratory of Union Hospital of Tongji Medical College, Huazhong University of Science & Technology and Key Laboratory of Biomedical Polymers, Ministry of Education, Wuhan University Chemical Department from January to October 2007.MATERIALS: L929 mice fibroblast line was provided by Professor Chen, Stomatology Hospital of Wuhan University. N-isopropylacrylamide and N-hydroxymethylacrylamide were purchased from Aldrich.METHODS: Using ammonium persulfate and tetramethylethylenediamine as oxidateion-reduction initiation system and N, N'-methylene bisacrylamide as crosslinking agent, mass fraction 8.5% N-hydroxymethylacrylamide was added to the reaction system. The N-isopropylacrylamide and N-hydroxymethylacrylamide were dissolved in deionized water and reacted with N, N'-methylene bisacrylamide, ammonium persulfate and tetramethylethylenediamine at room temperature for 3 hours. The colorless transparent cylinder gel was obtained, soaked in deionized water and dried.MAIN OUTCOME MEASURES: Biocompatibility in vitro of the material was validated by cytotoxicity test, cells/scaffolds interaction test, hemolysis test and pyrogen test in vitro.RESULTS: Synthesized hydrogel showed thermosensitive character as expected and the lower critical solution temperature was 38 ℃. The toxicity rate was grade 0-1. Through the scanning electron microscopy, cells and scaffolds were tightly attached, producing a perfect interface, and the shape of cells was all right. Hemolysis rate was 2.54%. No pyrogen reaction was found. CONCLUSION: P(NIPAAm-co-NHMPA) has been successfully prepared with good biocompatibility in vitro and might become a good medical implant for clinical use.

Objective To investigate haemodynamic change during hemodialysis and analyze effects of cardiac index (CI) on hemodynamic parameters and associated influencing factors in maintenance hemodialysis (MHD) patients.Methods Seventy-five patients bearing an arteriovenous fistula (AVF) entered the study.Cardiac output (CO),cardiac index (CI),central blood volume (CBV) and peripheral vascular resistance (PR) were determined by ultrasound dilution technique at the end of 1 hour,2 hours and 3 hours of dialysis.AVF blood flow (Qa) was also measured with the same device before haemodynamic parameters investigation.Results Mean age of patients was (55.84 ±12.39) years old (range 21-81 years) and 43 patients (57.3％) were female.Systolic arterial pressure,SV,CO,CI and CBV were significantly declined and no significant change for diastolic arterial pressure and heart rates at the end of 2 hour and 3 hour hemodialysis,whereas PR was increased gradually during hemodialysis.Patients were divided into there groups with CI less than 2.5 L·min 1·(m2)-1,2.5-4.2 L·min-1·(m2)-1 and more than 4.2 L·min-1 ·(m2)-1 at the end of 1 hour dialysis.Statistically significant decreasing SV,CO and increasing PR were detected in patients with CI＜2.5 L·min-1· (m2)-1 and 2.5-4.2 L· min-1· (m2)-1,compared with CI＞4.2 L·min-1· (m2)-1 group (P＜0.01).The hemodynamic change was the most obvious in the group of CI less than 2.5 L· min-1· (m2) 1,and no significant changes happened in CI＞4.2 L·min-1 ·(m2)-1 group.Some factors were found to be associated to CI values.Qa and systolic arterial pressure had positive relationship with CI,while age and diabetes had negative relationship with CI.Conclusions Systolic arterial pressure,CO,CI and CBV decrease and PR increases during hemodialysis.Obvious change occurs when CI is less than 2.5 L·min-1· (m2)-1.CI is associated with Qa,systolic arterial pressure,age and diabetes.

Objective To establish mathematical model for the differential diagnosis of endoscopic gastric ulcerative lesions with the help of image processing software and statistical analysis method. Methods The microscopic images of 25 gastric ulcers and 25 gastric peptic cancers were collected from January 2013 to December 2013.Then the Photoshop CS4 software was used for image processing and representative measurements gathering(area,perimeter,roundness,height,width,gray scale,involving the density,color,lightness,pixels).Then the principal component analysis,the scatter plot and cluster analysis were performed by SPSS 16.0.Results According to the results of principal component analysis, Z1 showed a strong positive correlation with area,perimeter,height,width,cumulative density,pixel,which represented the shape statistics of ulcer.And Z2 showed a strong positive correlation with gray scale,color, lightness,which represented the color statistics of ulcer.On the Scatter plot,gastric peptic cancer images showed a stronger positive correlation with the principal component Z1 and Z2 .Clustering analysis results showed that for the majority of patients,there was a pattern in its incidence.In the gastric ulcer diagnostic models,the effective information should include area≤10 000;perimeter≤250;height≤90;width≤60;gray scale≥90;cumulative density≤190 000;color≥110;and lightness≥110(unit:pixel).In the gastric ulcera-tive cancers,the effective information should include area≥38 000,perimeter≥690,height≥300,width ≥ 426,gray scale ≤ 100,cumulative density ≥ 14 000 000,color ≤ 125,and lightness ≤ 130 (unit:pixel). Conclusion Among the endoscopic image data,area,perimeter,roundness,height,width,gray scale, cumulative density,color,brightness,pixels are important indices,which can contribute to the differential diagnosis of gastric ulcerative lesions.The established mathematical model based on the ten indices can be applied to predict and diagnose gastric ulcerative lesions.

Objective To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating benign and malignant solid breast lesions. Methods From January 2015 to December 2015, 150 patients with 155 lesions were examined with SE and SWE respectively in the First Affiliated Hospital with Nanjing Medical University. Elasticity scores on a improved 5-point scale,strain ratio (SR), maximum elasticity (Emax), mean elasticity (Emean), standard deviation of the elasticity (Esd) and the lesion-to-fat elasticity ratio (Eratio) were assessed. The receiver operating characteristic (ROC) curve of SE and SWE parameters were plotted to assess the value in distinguishing benign and malignant breast lesions. The results were compared using the area under the ROC curve (AUC). The accuracy of the parameters with the largest AUC were compared between SE and SWE by McNemar test in different breast imaging reporting and data system (BI-RADS) categories. Results The AUC of elasticity scores, SR, Emax,Emean, Esd and Eratio were 0.823, 0.810, 0.877, 0.835, 0.881 and 0.853, respectively. The SE and SWE parameter with the largest AUC were elasticity scores and Esd respectively. The accuracy of Esd was higher than that of elasticity scores(86.3% vs 64.7%)in 4A lesions (2=4.639, P < 0.05). There were no significant differences in accuracy in other BI-RADS categories. Conclusions Both SE and SWE were helpful for the differentiation of benign and malignant solid breast lesions, and the diagnostic performance of SE and SWE was similar. The optimization of elastography can be achieved by combination with BI-RADS.