The occurrence of eosinophilic leukemia complicated with cardiogenic embolism and L?ffler endocarditis are relatively rare.Early accurate diagnosis and prompt treatment can improve the its prognosis.When patients have symptoms of neurological impairment accompanied by increased eosinophils,the rare etiological type of cerebral infarction should be actively screened.Further improvements are needed in the examination of bone marrow smears,detection of fusion genes associated with leukemia,screening for L?ffler endocarditis,and identification of intraventricular thrombi.In this case,the main manifestations of eosinophilic leukemia were cardiogenic embolism and L?ffler endocarditis.After active treatment,the symptoms improved,and the eosinophil count returned to normal.This study summarizes the case data of this patient and combines it with a literature review,with the hope of raising clinicians'understanding of this rare disease.

Objective:To investigate the association between pulse pressure(PP) and new-onset diabetes in overweight and obese people.Methods:A prospective cohort study was conducted in overweight or obese participants selected from Kailuan Study who underwent 2006-2007 annual checkup and met the inclusion and exclusion criteria. PP was calculated by blood pressure and participants were divided into 4 groups according to PP quartile. The cumulative incidence of new-onset diabetes of different PP groups was calculated by Kaplan- Meier method and compare by Log- Rank test. The multivariate Cox proportional hazards model was used to analyze the association between different PP groups and new-onset diabetes. Results:During an average follow-up of 8.45 years, 8 922 diabetes was identified. The cumulative incidence rate of the Q1, Q2, Q3, and Q4 groups were 22.12%, 24.48%, 27.97%, and 33.44% respectively, which were statistically different( χ2=368.16, P<0.01). Cox proportional hazards regression analysis showed that after adjusting for multiple confounding factors, compared with Q1 group, the hazard ratio for diabetes in Q2, Q3, and Q4 groups were 1.07(1.00-1.14), 1.13(1.05-1.21), and 1.17(1.09-1.27) respectively. And the HR of diabetes event in pulse pressure(per 1 SD increase) was 1.04(1.02-1.07). Similar results were found in participants who were over-weight, obese, with normal blood pressure or hypertensive without drugs use. Conclusion:PP is positively correlated with the new-onset diabetes. High PP is one of the risk factors for developing diabetes in overweight and obese people.

Objective: To investigate the characteristics of asymmetric hearing loss in automobile manufacturing workers and the effect of occupational noise exposure on asymmetric hearing loss. Methods: A cross-sectional approach was used in this study. From March 2017 to February 2018, Subjects (7066) from four complete vehicle factories were given a pure tone audiometry (Hearing thresholds were measured at frequencies of 0.5, 1, 2, 3, 4 and 6 kHz in each ear) and were required to complete a health-related information questionnaire. According to the inclusion criteria, a total of 6339 workers were selected. The mean hearing thresholds for the left and right ears at overall frequencies were compared using the repeated means analysis of variance (ANOVA) test. The threshold differences at each frequency were compared using paired t tests. Results: The overall mean left minus right threshold difference across all frequencies was determined to be 0.58 dB, which met statistical significance (P<0.01) . Hearing threshold in the left ear was statistically significantly higher compared with the right ear at each frequency. The differences between binaural threshold shifts at each frequency among subjects with a asymmetry in terms of worse left ear and worse right ear were at the range of 6.17-9.87 dB and 6.39-10.92 dB, respectively. Hearing threshold in the left ear was statistically significantly higher compared with the right ear at only 2, 3 kHz of subjects with high-frequency hearing threshold shifts (HFHTs) more than 25 dB. Hearing threshold in the left ear was statistically significantly higher compared with the right ear at only 3 kHz of subjects with high-frequency hearing threshold shifts (HFHTs) more than 30 dB. With the increase of HFHTs, the proportion of subjects with a asymmetry at 2 and 3 kHz of more than 10 dB in terms of worse left ear and worse right ear increased. Conclusion The average hearing threshold of the left ear across overall frequencies is higher compared with the right ear, the proportion of the cases with a higher left ear hearing threshold is higher that that of the cases with a higher right ear hearing threshold. As hearing loss caused by occupational noise exposure getting worse, the proportion of the cases with a higher left ear hearing threshold and the cases with a higher right ear hearing threshold may tent to be the same.

OBJECTIVE: To compare the applicability of three risk assessment methods on occupational health risk assessment of chemical harmful factors in lead-acid battery manufacturers. METHODS: The convenient sampling method was used to select six lead-acid battery enterprises as research subjects. The occupational health risks of jobs with lead smoke,lead dust and sulfuric acid were determined by contact ratio method,comprehensive index method( both are semiquantitative evaluation method) and qualitative risk assessment method. The assessment was carried out,and the obtained risk level was standardized as the risk ratio. The evaluation results of these three methods were compared. RESULTS: For occupational health risk levels of lead smoke,lead dust and sulfuric acid,the contact ratio assessment method were 2-4,and the comprehensive index method were 2-3. The risk ratios after standardization were consistent with the risk level of that before standardization. The result of the qualitative risk assessment method was 2-3,and the standardized risk ratio was 3-4. The risk ratio of each post after standardization increased by one level compared with the risk level before standardization. When( Exposure limit concentration,E)/( Occupational exposure limit,OEL) ≥ 2,the occupational health risk levels of lead smoke,lead dust of qualitative risk assessment method and the contact ratio method were completely consistent,both of which were high risk,which were higher than the medium risk result of the comprehensive index method. When E/OEL < 2,Kappa analysis results showed that the contact ratio method and the comprehensive index method were in good agreement( Kappa = 0. 84,P < 0. 01). The qualitative risk assessment method were inconsistent with the contact ratio method and the comprehensive index method( Kappa value were -0. 22 and -0. 24). CONCLUSION: For occupational health risk assessment of chemical harmful factors in lead-acid battery manufacturers,the comprehensive index method could be used to evaluate the comprehensive results of occupational disease hazard factors and OEL in workplace. A qualitative risk assessment method can be used for assessment without test method or OEL of occupational hazard factor.

Objective: ICMM occupational health risk assessment model was be used to evaluate the risk of a lead-acid battery enterprise. Methods: In November 2016, a lead-acid battery company in Jiangsu Province was selected as the research object. Based on the occupational health survey data and occupational hazard assessment reports, the ICMM risk assessment model was used to conduct occupational health risks in eight key positions of a lead-acid battery enterprise. The risk assessment results was verified by actual test results. Results: In the quantitative assessment model, the occupational health risk assessment results for the castings and welding positions exposed to lead smoke, and the occupational health risk assessment results for the grinding and dividing positions exposed to lead dust existed unacceptable risks. The occupational health risk assessment results for the ball-milled and plated positions exposed to lead dust existed tolerable risks. The occupational health risk assessment results for the lead-plated and soldered positions exposed to sulphuric acid pastes and acids existed potential risks. In qualitative evaluation matrix method, the occupational health risk assessment results for the castings and welding positions exposed to lead smoke, and the occupational health risk assessment results for the grinding and dividing positions exposed to lead dust existed high risks, the occupational health risk assessment results for other four key positions were considered to be with low risks. Conclusion The key control points for lead smoke in this enterprise were castings and welding positions; The key control points for lead dust were the grinding and separating brush positions. The quantitative assessment model and the qualitative assessment matrix method in the ICMM model were consistent with the actual test results in the eight health risk assessments of occupational hazards in key positions. Therefore, the method could be applied to the assessment of occupational health risks of the lead-acid battery enterprise. According to the results of the assessment, improvements could be made to high-risk positions and the concentration of occupational hazards in high-risk posts could be reduced to better protect the health of workers.

Objective To investigate the changes and clinical significance of neck-shaft angle in the treatment of proximal humerus fractures with locking plate.Methods A retrospective case-control study was done on 214 cases of proximal humerus fractures treated with locking plate in our hospital from January 2008 to June 2016.According to the presence of medial bone defects,the cases were divided into medial bone defect group (85 cases) and non-medial bone defect group (129 cases).In medial bone defect group,there were 35 males and 50 females,with an average age of 63.3 years old.In this group,the cases of Neer three-part fractures and Neer four-part fractures were 47 and 38,respectively.In non-medial bone defect group,there were 51 males and 78 females,with an average age of 65.9 years old.In this group,the cases of Neer three-part fractures and Neer four-part fractures were 57 and 72,respectively.The preoperative humeral neck-shaft angle of contralateral humerus,and the humeral neck-shaft angle with its changes on the second postoperative day as well as 1,3,6 and 12 months after surgery were evaluated by the X-ray film.The Constant scores of the shoulder function were also assessed.Results The follow-up time for the patients ranged from 12 to 42 months (mean 24.2 months).In medial bone defect group,the preoperative neck-shaft angle of contralateral humerus,as well as neck-shaft angles of fractured side at five follow-up visits were (133.4±4.0) °,(134.7 ±11.5) °,(120.8±4.0) °,(118.5 ±3.5) °,(117.9 ±10.4) °and (114.7 ±4.4)°,respectively.While in the other group,the corresponding parameters were (134.0±2.4)°,(133.8± 17.1)°,(135.6± 2.9)°,(132.7± 2.8) °,(131.5 ± 13.5) °,(135.2 ± 2.8) °,respectively.There were significant differences between the two groups of the neck-shaft angle at 1,3,6 and 12 months (P ＜ 0.05).In the medial bone defect group,there were no significant differences between neck-shaft angle of contralateral humerus and the second postoperative day (P ＞0.05),but both of them are significantly greater than others(P ＜0.05).In the other group,except for the neck-shaft angles of postoperative 1 month and 6 months (P ＜ 0.05),there was no statistically significant difference between the angles in different time points(P ＞ 0.05).The mean Constant scores of medial bone defect group and no medial bone defect group were (69.3 ± 14.6) and (75.2 ± 12.6),respectively.Conclusions After the recovery of neck shaft angle,there is still a need of attention to the losses of neck shaft angle after surgery.Neck-shaft angle could be a reference for the treatment strategy of proximal humerus fractures with locking plate,which could guide the anatomical reduction as well as be used to evaluate the effects after surgery.It could also be a reference for function exercise.Moreover,the losses of neck shaft angle will be influenced by supporting from internal side,which could have effects on the function recovery after surgery.

Objective To observe the effect of Sirt1 on the phosphorylation of Tau protein in neuroblastoma SK-N-SH cell line.Methods We cultured SK-N-SH cells in vitro with adenovirus packaging of Sirt1 and SirtM (Sirt mutant),and then observed the expression of Sirt1 under an inverted fluorescence microscope.The expressions of Sirt1and SirtM were detected by Western blot;t-Tau protein and phosphorylation of Tau protein were detected by Western blot,Real-time PCR,immunohistochemistry and immunofluorescence;and the effect of Sirt1 on SK-N-SH apoptosis was investigated by flow cytometry.Results The t-Tau protein level and its phosphorylation were significantly decreased in Sirt1 and SirtM groups compared with those in control group,and Sirt1 group showed more significantly decreased ser404,thr231 phosphorylation of tau protein and the mRNA level of Tau.Flow cytometry showed that Sirt1 could significantly reduce the apoptosis of SK-N-SH cells compared with the control group.Conclusion Sirt1 can decrease the phosphorylation of Tau protein and reduce the apoptosis of SK-N-SH,which provides an important laboratory basis for studies on Tau protein disease and other neurodegenerative diseases.

Objective To investigate the effect of measuring value transfer for human serum samples assigned by the reference laboratory network on improving the trueness of seven enzyme activities in clinical laboratories,such as ALT,AST,GGT,LDH,CK,AMY and ALP.Methods Depending on the medical imtitutions at all levels contacted by 5 reference laboratories in North China,South China,East China and Southwest China,the corresponding clinical laboratory measuring value transfer/traceability network was established.The frozen human serum samples with good interehangeability and standard material characteristics,including calibrator,sample 1 and sample 2,were provided by Beijing Aerospace General Hospital,and were assigned by 5 reference labotatories in four regiom.These samples were sent to 48 clinical laboratories.These clinical laboratories measured sample 1 and sample 2 according to their standard operating procedures,and then measured.the two samples again after adjusting their measurement system by using the supplied calibrator.The changes of trueness of detection results in these laboratories were evaluated according to the WS/T 403-2012 standard,and the changes of consistency for ALT and AST before and after measuring value tramfer were investigated.Results The results of AMY,ALP,GGT,CK and LDH calibrator,sample 1 and sample 2 assigned by the established network were 138.7 U/L,278.5 U/L and 68.3 U/L,265.3 U/L,94.5 U/L and 134.4 U/L,195.8 U/L,89.0 U/L and 158.9 U/L,393.7 U/L,260.0 U/L and 645.3 U/L,and 302.0 U/L,250.0 U/L and 452.7 U/L,respectively.The percentages of sample 1 and sample 2 which met the bias requirements of the WS/T 403-2012 standard before measuring value transfer for AMY,ALP and GGT were 65.9％ and 61.0％,76.6％ and 78.7％,and 66.7％ and 70.8％,respectively,while after measuring value transfer,they were 89.2％ and 83.8％,86.7％ and 80.0％,and 85.4％ and 91.7％,respectively.The percentages of sample 2 which met the bias requirements of the WS/T 403-2012 standard before measuring value transfer for CK and LDH were 64.6％ and 58.3％,respectively,while after measuring value trander,they were 93.5％ and 84.8％,respectively.The coefficients of variation (consistency) of sample 1 and sample 2 for ALT and AST before measuring value tramfer were 12.9％ and 11.3％,and 10.2％ and 8.9％,respectively,while after measuring value transfer,they were 9.3％ and 8.2％,and 5.6％ and 5.9％,respectively.Conclusion The calibration of routine measurement systems based on the measuring value transfer for human serum samples assigned by the reference laboratory network may improve the comparability of 7 enzyme actvities measurement results in chnical laboratories at all levels obviously,which deserves to be further spread.

A molecularly imprinted two-dimensional photonic crystal hydrogel sensor was developed with erythromycin as imprinted molecule, polystyrene two-dimensional photonic crystal as templates, methanol as solvent, methacrylic acid as monomers and ethylene glycol dimethylacrylate as cross-linkers.The imprinted molecule was removed by methanol/acetic acid (9∶1, V/V).The results showed that the diameter of Debye ring increased 6 mm when the concentration of EM changed from 0 to 1×10-6 mol/L.Namely the lattice spacing decreased 30 nm.In addition, the diameter of Debye ring only increased 1.5 and 2.0 mm when the hydrogel immersed in 1×10-6 mol/L roxithromycin (RM) or erythromycin ethylsuccinate (EEs) solution.The result indicated that the sensor had high selectivity and could be used in determination of erythromycin with low cost and easy operation.

Objective Repetitive transcranial magnetic stimulation (rTMS) has gradually been used in the treatment of generalized anxiety disorder (GAD).The efficacy and adverse reactions of repetitive transcranial magnetic stimulation on general anxiety disorder are assessed in the review.Methods Searched databases such as Pubmed,Cochrane library,OVID,CNKI,VIP by computer,and researched published randomized controlled trials (RCTs) focused on repetitive transcranial magnetic stimulation on general anxiety disorder.Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs were included,involving 732 general anxiety disorder patients.The were divided into two subgroups,one group is effect observation,the other group is the improvement of curative effect in the treatment process.The effectiveness of intervention of rTMS follow up is better than that of the control group (WMD =-5.02,95％ CI=-6.84--3.20,P＜0.01).The intervention of rTMS group can early ameliorate the symptom of anxiety.The results of low frequency and high frequency rTMS intervention is (WMD =-1.34,95％ CI=-1.97--0.71,P＜0.01;WMD =-2.65,95％ CI=-3.51--1.79,P＜0.01).The adverse reactious of the intervention of rTMS group is less than that of the control group(WMD =-7.04,95％ CI=-11.64--2.43,P＜0.01).Conclusion rTMS intervention in the treatment of GAD patients at the end of the treatment and short-term follow-up efficacy is better,rTMS intervention after the onset of rapid intervention,the intervention group adverse reactions are rare.