Objective: To establish a prediction model for the risk of peripheral arterial disease (PAD) among patients with type 2 diabetes mellitus (T2DM), so as to provide a basis for risk assessment and early screening of PAD. Methods: Patients with T2DM hospitalized at the First Affiliated Hospital of Jinan University from December 2018 to December 2020 were selected as study subjects. Basic information, including gender and age, laboratory indicators, including fasting blood glucose and glycated hemoglobin, and foot screening indicators, including foot calluses, abnormal foot sensations and current perception threshold (CPT), were collected through the electronic medical record system. The study subjects were randomly divided into a training set and a validation set at a ratio of 7∶3. Predictors were screened using LASSO regression and multivariable logistic regression, and a nomogram prediction model was established. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test and decision curve analysis. Results: A total of 972 patients with T2DM were collected, including 535 (55.04%) males and 437 (44.96%) females. The median age was 59.00 (interquartile range, 18.00) years. PAD was detected in 84 patients, with a detection rate of 8.64%. The training set included 681 patients, with 59 PAD cases, while the validation set included 291 patients, with 25 PAD cases. Multivariable logistic regression analysis showed that age (OR=1.053, 95%CI: 1.027-1.080), abnormal foot sensation (pain, OR=4.517, 95%CI: 1.610-12.667) and CPT (OR=1.094, 95%CI: 1.022-1.171) were predictors of PAD among patients with T2DM. In the training set, the AUC, sensitivity and specificity were 0.771, 0.780 and 0.701, with a higher net clinical benefit at risk threshold probabilities of 1%-26%. In the validation set, the AUC, sensitivity and specificity were 0.752, 0.800 and 0.628, respectively, with a higher net clinical benefit at risk threshold probabilities of 1%-43%. The Hosmer-Lemeshow test showed good model calibration in both the training and validation sets (both P>0.05). Conclusion The nomogram prediction model constructed using three predictors, including age, abnormal foot sensation and CPT, showed good discrimination, calibration and net clinical benefit, and can be used to predict the risk of PAD in patients with T2DM.

Objective To investigate the protective effect and mechanism of astragaloside Ⅳ(AS-Ⅳ)on the pulmonary arterial hypertension(PAH)model induced by monocrotaline(MCT)/monocrotaline pyrrole(MCTP)in SD rats/human pulmonary artery endothelial cell(HPAEC).Methods In vivo experiment,60 male SD rats were randomly assigned to control group,PAH model group,AS-Ⅳ low-dose(20 mg/kg)group,AS-Ⅳ medium-dose(40 mg/kg)group,AS-Ⅳ high-dose(80 mg/kg)group,or sildenafil(Sil,100 mg/kg)group,with 10 rats in each group;except for the control group,PAH rat models were established by single intraperitoneal injection of MCT(60 mg/kg)in other groups.In vitro experiment,HPAECs were randomly assigned to control group,PAH model group,AS-Ⅳ low-dose(10 μmol/L)group,AS-Ⅳ medium-dose(20 μmol/L)group,MCTP+AS-Ⅳ high-dose(40 μmnol/L)group,or p38 mitogen-activated protein kinase(MAPK)signaling pathway inhibitor(SB203580,5 μmol/L)group;except for the control group,in vitro PAH cell models were established by MCTP(60 μg/mL)induction for 24 h in other groups.In vivo experiments,after 4 weeks of drug intervention,the right ventricular systolic pressure(RVSP)and mean pulmonary artery pressure(mPAP)of rats were measured by hemodynamic methods,the right ventricle hypertrophy index was measured by weighing methods,the percentage of pulmonary arteriole wall thickness to outer diameter(WT％)and percentage of the wall area to total vascular area(WA％)were observed by hematoxylin-eosin staining,the expression of cysteine aspartic acid specific protease 3(caspase 3)protein in lung tissue was observed by immunohistochemistry(IHC),and the apoptosis of lung tissue cells was detected by TUNEL assay.In vitro experiments,JC-1 staining was used to detect the mitochondrial membrane potential in cells,and immunofluorescence was used to detect caspase 3 protein expression.In vitro and in vivo experiments,Western blotting was used to detect the expression of caspase 3,B-cell lymphoma gene 2(Bcl-2),Bcl-2 associated X protein(Bax),p38 MAPK,and phosphorylated p38 MAPK proteins in lung tissue and HPAECs.Results In vivo experiments,the RVSP,mPAP,and right ventricle hypertrophy index were decreased in the Sil group and each dose group of AS-Ⅳ(all P＜0.01);the WA％and WT％of each dose group of AS-Ⅳ were decreased(all P＜0.01),the expression of caspase 3 protein in lung tissue was decreased(all P＜0.01),and the apoptosis of lung tissue cells was decreased(all P＜0.01).In vitro experiments showed that after intervention with each dose of AS-Ⅳ and SB203580,the mitochondrial membrane potential of HPAEC was increased(all P＜0.01)and the expression of caspase 3 was decreased(all P＜0.01).In vivo and in vitro experiments,each dose of AS-Ⅳand SB203580 reduced the expression of Bax and phosphorylated p38 MAPK proteins,and increased the expression of Bcl-2 protein(all P＜0.01).Conclusion AS-Ⅳ reduces apoptosis by inhibiting p38 MAPK signaling pathway,improving PAH in SD rats.

Objective: To provide scientific evidence for the prevention and control measures of silicosis by analyzing the epidemiological characteristics of silicosis cases reported in Tianjin city during 2001-2015. Methods: The database of silicosis cases reported in Tianjin from 2001 to 2015 was established and analyzed by SPSS 24.0 software. Results: 2 213 cases of silicosis were reported during 2001~2015 in Tianjin, 2015 of them were new cases, and fewer reports of promoting stage cases and death cases, which were129 and 69 cases. The new cases were increasing by years, mainly stage I silicosis accounting for 99.2%, the years of dust exposure were concentrated from 1970 to 1989, accounting for 69.58%. From 2001 to 2015, the median length of service at the onset of silicosis was 19.30 years, the age of the onset of silicosis is decreasing. The median of onset age in new cases of silicosis was 53.28 years, and increased year by year. There were significant differences in indirect dust working age and diagnostic age in different reporting years. Most cases were distributed in non-mental mineral product industry, and ferrous metal smelting and rolling processing industry. The work types of these cases are various. Conclusion The increasing incidence of silicosis and the shortening of dust-exposed working years suggest that the form of silicosis hazards is still severe in Tianjin. According to the epidemic characteristics of silicosis, we should strengthen the supervision and management of key industries and special investigation, carry out silicosis census and silicosis screening of dust-removal workers, and take pertinent measures to prevent and control the occurrence of silicosis.

Objective? To explore the application effect of online learning platform on the training of family caregivers of disabled elderly people. Methods? From September 2017 to March 2018, the family caregivers of 90 disabled elderly people in a district of Changsha were selected by convenience sampling method, and divided into control group and observation group by random number table method, with 45 cases in each group. During the study period, the caregivers of the control group received general health education. The caregivers in the intervention group received online training on the self-developed online learning platform under the guidance of the researchers for months. Before and after the training, the family caregivers were investigated using the Family Caregivers Care Ability Scale and the Care Knowledge Assessment Questionnaire. Results? Before the training, there was no statistically significant difference in average score of care knowledge, and the total score and the five dimensions' scores of the Family Caregivers Care Ability Scale between the two groups (P ＞ 0.05). After training, the score of the care knowledge in the intervention group was (82.2±15.2), which was higher than that in the control group (64.2±17.2), and the difference was statistically significant (t=5.260,P＜ 0.01). After training, the score of Family Caregivers Care Ability Scale in the intervention group was (13.90±4.52), which was lower than that in the control group (16.57±3.25), and the difference was statistically significant (t=3.217,P＜ 0.01). The scores of the four dimension of the scale, including adjusting the role of caregiver, meeting need and providing assistance, dealing with personal mood, adjusting life in order to meet the needs to take care of elderly in the intervention gorup were lower than those in the control group, and the differences were statistically significant (P＜ 0.05). Conclusions? The training based on the online care knowledge and skill system for disability elderly can improve the family caregivers of nursing knowledge level and ability to take care of the elderly.

Objective: To understand the status of occupational health surveillance to workers exposed to toxic environment in a city, so as to provide scientific basis for strategy of occupational diseases prevention. Methods: In January 2017, collecting the data of on-the-job poisonous and harmful workers occupational health surveillance in the city from January 1, 2010 to December 31, 2016 in China Information System for Disease Control and Prevention, the trend of occupational health monitoring in the city was analyzed, and the differences between diverseeconomic types, enterprise scale, industry nature and hazard factors were analyzed and compared. Results: The occupational health examination rate showed an overall upward trend in workers exposed to dust in the city from 2010-2016 (t=3.607, P<0.05) , and the detection rate of occupational contraindications was on the rise in workers exposed to chemical factors (t=3.071, P<0.05). The detection rate of occupational contraindications and suspected occupational diseaseswere significant in different economic types, enterprise scale, industry nature and hazard factors (P<0.05). The detection rate of occupational contraindications was the highest among the large enterprises (1.24%) , the manufacturing industry (0.84%) and the state-owned economy (1.49%). The detection rate of suspected occupational diseases (0.04%) and occupational contraindications (1.15%) were the highest in the physical factors. Conclusion Occupational health monitoring in the city is not optimistic. It is necessary to focuson the occupational health care of manufacturing practitioners, raise the detection rate of suspected occupational diseases, and standard the occupational health check work to protect the occupational health.

Objective To study the liver protection of total celosins (CES) in different liver damage models .Method A-cute liver damage mouse model ,chronic liver damage rat model and immune liver damage mouse model were established for this study .Liver function tests ,liver lipid peroxidation indicators and liver pathology were observed .Results CES of each dose group can lower serum ALT and AST in different degrees ,can significantly reduce the content of MDA in liver homogenate , while can increase SOD activity .Pathological examination showed that animals administered significantly reduced the degree of liver cell damage .Conclusion CES have protective effects on acute liver damage induced by CCl 4 ,chronic liver damage induced by CCl4 and immunological liver damage induced by concanavalin A .Its hepatoprotective effect may be related to its antioxidant effects .

Objective To study the value of diffusion tensor imaging(DTI) in early assessment of prognosis of hypoxic-ischemicencephalopathy(HIE) in new infants. Methods 96 cases of full term infants with HIE underwent DTI examinations at 0～12 days and 6～36 months. Based on clinical diagnostic criteria, 96 cases were divided into three groups: mild, moderate and severe HIE groups. Fractional anisotropy(FA) values in the corpus callosum splenium and the posterior limb of internal capsules were measured. Results (1) Varying degrees of FA groups was significantly different from the same site, increased linearly with time,but the magni-tude of change was different;(2)When FA value of corpus callosum splenium in the cut-off point was ≥0.437,the sensitivity(SE) was 83.8% , the specificity(SP) was 18.6% , ROC area under the curve was 0.903 , 95% confidence interval was from 0.846 to 0.961,standard error was 0.029;when FA value of posterior limb of internal capsule in the cut-off point ≥0.391,SE was 86.5%, SP was 11.9% ,ROC area under the curve was 0.940,95% confidence interval was from 0.898 to 0.984,standard error was 0.022. Conclusion MR DTI examination is of significant value in evaluating early the prognosis of HIE in infants.

Objective To study the follow-up value of MRI in the sequela hypoxic-ischemic encephalopathy(HIE).Methods MRI features of HIE in 81 neonates were analyzed retrospectively,every child had two cranial MRI scans,the first scan at the end of the newborn stage,the second scan at 4 months to 4 years.There were 66 full-term neonates and 15 preterm neonates.Results Of 81 cases,79 cases were abnormal on second MRI examination,including myelinogenetic abnormal in 59 cases(72.8%),external hydrocephalus(EH) in 53 cases(65.4%),brain malacia in 26 cases(32.1%),cerebaral atrophy in 25 cases(30.1%),white matter decrease in 24 cases(29.6%) and dysplasia of corpus callosum in 9 cases(11.1%).EH(26/35cases) and myelinogenetic abnormal(16/35 cases) in mild HIE group,brain malacia(12/29 cases) in moderate HIE group,cerebaral atrophy(16/17 cases) and white matter decrease(15 /17 cases)in severe HIE group were often seen.Conclusion MRI findings can reflect the pathological changes of sequela of HIE,and provide objective basis for diagnosis and assessment of prognosis.