Objective To evaluate the role of distortion product otoacoustic emissions (DPOAE) testing in evaluating early hearing loss among noise-exposed workers. Methods A total of 174 noise-exposed workers in a metal shipbuilding enterprise were selected as the research subjects by the convenience sampling method. Pure tone audiometry (PTA), DPOAE and the level of noise exposure were conducted on the workers. The rank correlation analysis was used to analyze the correlation between DPOAE amplitude and PTA threshold. The multilevel model was used to analyze the effects of gender, age, noise exposure intensity, cumulative noise exposure (CNE), hearing loss classification and PTA threshold on DPOAE results. Results At the frequencies of 0.50, 1.00, 2.00, 3.00, 4.00, 6.00 and 8.00 kHz, the DPOAE amplitude was negatively correlated with the PTA threshold (rank correlation coefficients were -0.12, -0.48, -0.47, -0.18, -0.23, -0.44, -0.19, respectively, all P<0.01). At the most frequencies, DPOAE amplitude was negatively correlated with age and CNE (all P<0.05). The results of multilevel model analysis showed that there were significant differences in DPOAE amplitudes at certain frequencies across gender, age, noise intensity, CNE, and hearing loss classification (all P<0.05). Significant differences in DPOAE responses were found among different CNE and hearing loss groups (all P<0.01). Conclusion DPOAE testing can objectively reflect the hearing status of noise-exposed workers and could be considered for inclusion in routine hearing monitoring to facilitate early detection of noise-induced hearing loss.

Objective To investigate the association of sleep disorders with the development and progression of nonalcoholic fatty liver disease(NAFLD).Methods A total of 1 868 participants from the health examination cohort and fatty liver cohort of Beijing Friendship Hospital from June 2022 to June 2023 were enrolled as subjects.Related data were collected from all subjects,including age,sex,education level,chronic medical history,and biochemical parameters,and all subjects completed Pittsburgh Sleep Quality Index(PSQI)scale independently.According to the diagnostic criteria,the subjects were divided into non-NAFLD group with 1 122 subjects and NAFLD group with 746 subjects,and according to the stage of progression,the patients in the NAFLD group were further divided into simple fatty liver group(SFL group with 624 subjects)and nonalcoholic steatohepatitis(NASH)group with 122 subjects.A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between three groups.The chi-square test was used for comparison of categorical data between the three groups.The binary Logistic regression analysis was used to investigate the association between sleep factors and NAFLD,and the multinomial Logistic regression analysis was used to investigate the association between sleep factors and the different stages of NAFLD;two multivariate models were constructed for adjustment of potential confounding factors,i.e.,an age-sex adjustment model and a multivariate adjustment model,and the multivariate adjustment model adjusted the factors of age,sex,education level,smoking,diabetes,hypertension,body mass index(BMI),triglyceride(TG),and high-density lipoprotein cholesterol(HDL-C).Results There were significant differences in age,sex,BMI,education level,smoking,diabetes,hypertension,alanine aminotransferase,TG,and HDL-C between the non-NAFLD,SFL,and NASH groups(all P<0.05).There were also significant differences between the three groups in the total score of PSQI scale and the proportion of subjects with a score of 0—3 points for the 7 sleep components(all P<0.05).The multivariate adjustment model showed no significant association between sleep disorders and SFL,while long sleep latency(odds ratio[OR]=4.04,95%confidence interval[CI]:2.33—7.03,P<0.001),short sleep duration(OR=3.53,95%CI:1.83—6.82,P<0.001),and severe sleep disorders(OR=2.96,95%CI:1.48—5.93,P=0.002)were closely associated with the risk of NASH.Conclusion Overall sleep condition and its components of sleep disorders are not significantly associated with the simple fatty liver;however,long sleep latency,short sleep duration,and severe sleep disorders can increase the risk of NASH,which should be taken seriously in clinical practice.

Objective:To analyze the correlation between phonographic cardiac function and uterine artery resistance index (RI) in pregnant women with hypertension of different conditions during pregnancy by color Doppler ultrasonically.Methods:A total of 100 pregnant women with gestational hypertension admitted to Lishui People′s Hospital from January 2020 to February 2021 were selected and divided into gestational hypertension group (40 cases), mild pre-eclampsia group (30 cases) and severe pre-eclampsia group (30 cases) according to the severity of their disease. Another 30 normal pregnant women who underwent physical examination during the same period were selected as the control group. The left ventricular function parameters isovolumetric relaxation time (IVRT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume(LVESV), left atrial volume index (LAVI) and uterine arter RI in 4 groups were quantitatively analyzed by ultrasound during 28 to 38 weeks of gestation. The correlation between cardiac ultrasound parameters and of pregnant women RI were analyzed.Results:As the severity of the disease, the levels of IVRT, LVEDV, LVESV, LAVI were gradually rised, and the level of LVEF was gradually decreased, there were significant differences among the 4 groups ( P<0.05). The uterine arter RI in the control group, gestational hypertension group, mild pre-eclampsia group and severe pre-eclampsia group was 0.42 ± 0.04, 0.50 ± 0.05, 0.54 ± 0.11, 0.58 ± 0.06, there was significant difference ( F = 34.11, P<0.001), and as the severity of the disease , the level of uterine arter RI was gradually rised, there were significant differences among the 4 groups ( P<0.05). Pearson correlation analysis showed that IVRT had certain correlation with RI in the 4 groups ( r = 0.331, 0.450, 0.531, 0.582; P<0.05). In mild and severe pre-eclampsia group, there were a certain correlation between LVEDV, LVESV and RI (in mild pre-eclampsia group: r = 0.360 and 0.411, P<0.05; in severe pre-eclampsia group: r = 0.383 and 0.451, P<0.05). Conclusions:The left heart function of pregnant women with different conditions evaluated by ultrasound showed a downward trend, and the uterine artery RI increased gradually in pregnant women with severe pre-eclampsia, and RI was closely related to the cardiac ultrasound parameter IVRT.

Objective:Factors influencing the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults were analyzed based on multicentric data.Methods:Clinical data of 124 adult patients with HLH diagnosed in eight medical centers in the Huaihai Lymphoma Working Group from March 2014 to July 2020 were collected. The optimal truncation value of continuous variables was obtained based on the Maxstat algorithm, X-Tile software, and restricted cubic spline. Cox proportional risk regression model was used to construct the adult HLH risk prediction model, and the visualization of the model was realized through the histogram. The bootstrap resampling method was used to verify the model, C-index and calibration curve was used to verify the histogram, and the prediction accuracy was checked. Kaplan-Meier analysis was used to calculate the survival rate and draw the survival curve. Furthermore, the differences between groups were tested by log-rank.Results:The median age of the 124 patients was 55 (18-84) years, including 61 (49.19%) males. The most common etiology was infection. Serum ferritin increased in 110 cases (88.71%) , hepatosplenomegaly in 57 cases (45.97%) . Of the 124 patients, 77 (62.10%) died, and the median survival time of the patients was 7.07 months. Univariate results showed that the prognosis of adult HLH was influenced by sex, age, fibrinogen, serum creatinine, alanine aminotransferase, and albumin ( P<0.05) . The results of multivariate analysis showed that gender, platelet, albumin, alanine aminotransferase, and treatment regimens were independent influencing factors for prognosis. Based on the above five risk factors, the prediction model of the histogram was established, and the C-index of the model was 0.739. Finally, the calibration chart showed good consistency between the observed and predicted values of HLH. Conclusion:The prognosis of the adult hemophagocytic syndrome is influenced by many factors. Gender, platelet, albumin, alanine aminotransferase, and treatment regimens are independent risk factors. Therefore, the established histogram provides a visual tool for clinicians to evaluate the prognosis of adult HLH.

Objective:To investigate the effect of L-asparaginase on the proliferation, cell cycle, and apoptosis of Burkitt lymphoma cell lines and explore the molecular mechanism.Methods:The effect of L-asparaginase on the cell proliferation of Burkitt lymphoma cell lines was detected using the CCK-8 method. The apoptosis rate and cell cycle were detected using flow cytometry. The expression of related molecules in cell cycle, apoptosis, autophagy, and PI3K/Akt/mTOR signaling pathway was detected and analyzed using qPCR and Western blot assay.Results:L-asparaginase significantly inhibited the proliferation of Burkitt lymphoma cell lines and caused cell cycle arrest at G 0/G 1 phage. L-asparaginase induced cell apoptosis and autophagy in Burkitt lymphoma cell lines. Further results showed that L-asparaginase inhibited the expression of c-Myc and also inhibited the expression of p-PI3K, p-Akt-S473, p-mTOR, p-70S6K, and p-4E-BP1. Combining PI3K inhibitor LY294002 with L-asparaginase further induced apoptosis. Additionally, L-Asp inhibited STAT and ERK signaling pathways. Conclusion:L-asparaginase inhibited Burkitt lymphoma cell proliferation, arrested cell cycle, activated autophagy, and induced apoptosis by inhibiting the PI3K/Akt/mTOR signaling pathway.

Objective: To explore hepatitis B virus (HBV) infection rate of breast feeding to newborn babies of HBV carrying parturient women with hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) double positive. Methods: A prospective cohort study was conducted to include HBsAg and HBeAg double-positive HBV carrying parturient women and their babies born from February 2016 to May 2018 at the Women′s Hospital, Zhejiang University School of Medicine, and 323 parturient women and 323 babies were enrolled. The babies were divided into breast feeding group and artificial feeding group. Chemiluminescence immunoassay and polymerase chain reaction-fluorescent probe method were used to detect the positive rates of serum HBV markers and HBV DNA levels in the newborns <24 h and seven-month-old age, respectively. The statistical method was performed using χ² test. Results: A total of 297 parturient women were finally included for the analysis, including 149 in the breast feeding group and 148 in the artificial feeding group. There were no significant differences in the positive rates of HBsAg, hepatitis B surface antibody (anti-HBs), HBeAg and HBV DNA>100 IU/mL between the two groups at birth <24 h and seven months of age (all P>0.05). The positive rate of anti-HBs in newborns in the breast feeding group at birth <24 h was 58.39%(87/149), which was lower than 95.97%(143/149) at seven months of age. The HBeAg-positive group was 65.10%(97/149) at birth <24 h in the breast feeding group, which was higher than 13.42%(20/149) at seven months of age. The differences were both statistically significant (χ²=59.75 and 40.49, respectively, both P<0.01). The positive rates of HBsAg and HBV DNA>100 IU/mL in newborns in the breast feeding group were 2.01%(3/149) and 2.68%(4/149) at birth <24 h, respectively, and those at seven months were 2.68%(4/149) and 2.68%(4/149), respectively. There were no significant differences between the two time points (both P>0.05). In the artificial feeding group, the positive rate of anti-HBs in newborns was 47.97%(71/148) at birth <24 h, which was lower than 95.94% (142/148) at seven months of age. The positive rate of HBeAg in the artificial feeding group was 55.41%(82/148) in newborns at birth <24 h, which was higher than 19.59%(29/148) at seven months of age. The differences were statistically significant (χ²=85.37 and 39.84, respectively, both P<0.01). The positive rates of HBsAg and HBV DNA>100 IU/mL in newborns in the artificial feeding group at birth <24 h were 4.73%(7/148) and 1.35%(2/148), respectively, and those at seven months were 1.35%(2/148) and 1.35%(2/148), respectively. There were no significant differences between the two time points (both P>0.05). Conclusions Breast feeding is not a decisive factor for the risk of vertical transmission in HBsAg and HBeAg double-positive HBV carriers. It is recommended that such women could breastfeed under formal precautions.

A training cause for management of complex perineal tearing with bionic simulators were conducted from March 2018 to March 2019 among 223 midwives in Beijing Luohe Hospital affiliated to Capital Medical University and Shanghai First Maternal and Infant Health Hospital. The clinical comprehensive ability of normal delivery was assessed before and after training; and the effect of training with the complex perineal tearing simulator was evaluated after the training. There were significant differences in examination scores of theoretical knowledge and practical ability between senior (working years>5 year, n=85) and junior (working years 3-5 year, n=138) midwives both before and after training ( P<0.05); however the assessment results were all improved in both groups after training. All midwives gives high evaluation scores and feedback for the training of complex perineal tear with bionic simulator (5 points), indicating that the simulation training deserves promotion in clinical skill training for midwives.

Due to the decline of motor ability and the impact of the diseases, abnormalities in gait is common in the elderly population, which will raise the risk of fall and cause serious injury. This study focuses on the analysis of the gait kinematics parameters of normal adults' gait, aiming to investigate the characteristics of gait parameters in different age groups and to explore the role of gait parameters in motor function assessment and clinical diagnosis. Based on the gait data gained by electronic walkway, the relationship among the toe out angles and their correlation with age and gender etc. were quantitatively analyzed. The results show that most normal subjects walk with positive toe out angles, and the angles increase with age. Such changes are slow in the young and middle age groups. However, the elevations of the left out toe angle and the angles between the feet are statistically significant after entering elder age ( >60 years). The results also suggest that the angle between the feet is a kind of practical gait parameter for varying applications. This study concludes that feet angle analysis is potential to provide a convenient and quantitative tool for the assessment of lower limb motor ability and the diagnosis of knee joint diseases.

Objective To provide reference and ideas for information service in hospital library by analyzing the influencing factors for its service satisfaction.Methods The satisfaction of hospitalized patients for information service was investigated.The characteristics of patients,their requirements for information service and the influencing factors for their satisfaction were analyzed by logistic regression analysis.Their satisfaction for information service was assessed according to the IPA method and analyzed using the SPSS19.0.P<0.05 was considered statistically significant.Results Health information was provided for 221 patients.No significant difference was found in sex,age,education level between the importance of information service and the influence of satisfaction for information service (P>0.05).The importance of information service and the satisfaction of patients for information service were rather high.IPA analysis showed that the patients considered high the importance of library-provided personal bibliography and departments-provided health pamphlets with a low satisfaction,which should thus be solved.Conclusion The satisfaction of patients for information service is good.However,the importance of library-provided personal bibliography and departments-provided health pamphlets is high and the satisfaction for them is low.It is thus necessary for librarians to improve their service and encourage more medical staff to participate in information service for patients.

Objective To analysis the difference of lymph node cleaning and operative complication rate between thoracoscope surgery and routine thoracotomy on patients with thoracic segment esophageal cancer.Methods A summary of 62 patients with thoracic segment esophageal cancer in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from August 2012 to August 2014,who were carried with thoracoscope surgery,were randomly chosed and designed as the thoracosc0Pe group,and 62 patients with thoracic segment esophageal cancer over the same period,carried out with routine thoracotomy,were designed as the control group.All the clinical data of the two groups were collected.The total of thoracic lymph node cleaned and the group of thoracic lymph node cleaned were compared between the two groups.The operation time,intraoperative blood loss,chest tube placement time and postoperative hospital duration were collected and compared.All the patients were followed up at least for one year.The incidence of postoperative complications such as pulmonary infection,pneumothorax,atelectasis,recurrent laryngeal nerve injury and anastomotic leakage in the follow-up period were compared.The follow-up time,mortality and recurrence rate were compared.Results The total of thoracic lymph node cleaned(13.36±3.28) and the group of thoracic lymph node cleaned(3.35±0.84) in the thoracoscope group were lower then these of the control group ((14.22± 2.78) and (3.58±0.75)),but with no statistical difference (t =1.57,1.61,P＞ 0.05).The operation time of the thoracoscope group((314.63±38.72) min) were higher then that of the control((217.46±41.54) min),and the intraoperative blood loss ((205.73 ± 114.38) ml),chest tube placement time ((6.83 ± 1.92) d) and postoperative hospital duration((18.47±5.36) d) of the thoracoscope group were remarkably lower then these of the control ((345.72 ±175.62) m1,(10.04±2.41) d,(22.65±6.84) d,t=13.47,5.26,8.20,3.79,P＜0.05).The incidence of pulmonary infection (4.8％ (3/62)) and atelectasis (1.6％ (1/62)) of the thoracoscope group,were evidently lower then these of the control (17.7％ (11/62),1.3％ (7/62),x2 =5.15,4.81,P＜0.05).There was no significant difference in mortality and recurrence ratebetween the two groups during the follow-up period (3.2％ (2/62) vs.8.1％ (5/62),11.3％ (7/62) vs.14.5％ (9/62),x2 =1.36,0.29,P＞0.05).Conclusion There are no significant difference inlymph node cleaning between thoracoscope surgery and routine thoracotomy on patients with thoracic segment esophageal cancer,but thoracoscope surgery can shorten the length of hospital duration,reduce the intraoperative blood loss,chest tube placement time and postoperative complications.So the thoracoscope surgery is a safe and feasible operation for patients with thoracic segment esophageal cancer.