ObjectiveTo analyze the spectrum distribution characteristics of high-intensity productive noise in key industries in Guangdong Province. Methods A total of 2 806 enterprises in 21 prefecture-level cities in Guangdong Province were selected as the study subjects using the stratified sampling method. On-site investigations were conducted in workplaces. Noise in workplaces and work-sites, and the noise spectrum of the workplaces with sound pressure level ≥85.0 dB(A) were detected. Results The noise of a total of 23 076 workplaces and 20 969 work sites from 30 key industries were monitored. The median (M) and 25th and 75th percentiles (P₂₅, P₇₅) of workplace sound pressure level were 82.3 (78.6, 86.5) dB(A). The rate of the noise exceeded national standard was 30.4%. The sound pressure level M (P₂₅, P₇₅) of work-site was 78.6 (70.0, 83.5) dB(A). The rate of the noise exceeded national standard was 18.0%. Workplace noise and work site noise were positively correlated (Spearman correlation coefficient=0.86, P<0.01). The rate of the noise exceeded national standard was 46.5% in key work sites where the rate of noise exceeded the national standard was ≥25.0%, and corresponding rate of the workplace noise exceeded national standard was 58.1%. The noise spectrum result of 5 636 workplaces sound pressure level>85.0 dB(A) showed that most of the noise source was from grinding machines (441 cases), and the highest average sound pressure level of noise source was from screening machines [93.0 dB(A)]. Cluster analysis results showed that the main noise sources could be divided into three categories, including wideband noise with levels >80.0 dB in all frequency bands except 8 000.0 Hz, medium-high-frequency noise with the highest sound pressure level at 1 000.0, 2 000.0, and 4 000.0 Hz and low frequencies <75.0 dB, and medium-low-frequency noise below 500.0 Hz with sound pressure level >85.0 dB. Conclusion The rate of the noise exceeded national standard in workplace of key industries in Guangdong Province is high, involving a wide range of industries, with high sound pressure levels and obvious spectrum characteristics of corresponding noise sources. Corresponding noise control strategies can be formulated based on different spectrum characteristics and magnitudes.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Objective To explore the value of shear wave elastography(SWE)in the early assessment of hepatic and renal fibrosis in patients with metabolic associated fatty liver disease(MAFLD).Methods A total of 52 MAFLD patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from July 2023 to May 2024 were selected as MAFLD group,and 40 non-MAFLD patients treated during the same period were served as control group.General information,laboratory data and ultrasound data were collected and compared between two groups.The differences as well as the correlation of the indicators between two groups were compared.The value of SWE in hepatic fibrosis and renal fibrosis in MAFLD patients was assessed.Results Liver function indicators,uric acid and aspartate aminotransferase-to-platelet ratio index(APRI)in MAFLD group were higher than those in control group(P＜0.01);There were no statistically significant differences between two groups in fibrosis 4 index,estimated glomerular filtration rate,serum creatinine and blood urea nitrogen(P＞0.05).The brightness of the liver,liver-kidney ratio,and liver elasticity value were higher in MAFLD group than those in control group(P＜0.05);There was no significant difference in the elasticity value of the right renal cortex between two groups(P＞0.05).Liver elasticity values was positively correlated with alanine aminotransferase(ALT);The liver-kidney ratio was positively correlated with body mass index(BMI),ALT,aspartate aminotransferase,alkaline phosphatase,y-glutamyl transferase and APRI.No significant correlation was found between the right renal cortex elasticity and BMI,estimated glomerular filtration rate,serum creatinine,blood urea nitrogen,or serum uric acid.Conclusion SWE helps in early identification of liver hardness in the MAFLD patients.But the application of SWE in early renal fibrosis in the MAFLD patients needs further evaluation.

Intestinal dysbiosis and disrupted bile acid(BA)homeostasis are associated with obesity,but the precise mechanisms remain insufficiently explored.Hepatic protein phosphatase 1 regulatory subunit 3G(PPP1R3G)plays a pivotal role in regulating glycolipid metabolism;nevertheless,its obesity-combatting potency remains unclear.In this study,a substantial reduction was observed in serum PPP1R3G levels in high-body mass index(BMI)and high-fat diet(HFD)-exposed mice,establishing a positive correlation between PPP1R3G and non-12α-hydroxylated(non-12-OH)BA content.Additionally,hepatocyte-specific overexpression of Ppp1r3g(PPP1R3G HOE)mitigated HFD-induced obesity as evidenced by reduced weight,fat mass,and an improved serum lipid profile;hepatic steatosis alleviation was confirmed by normalized liver enzymes and histology.PPP1R3G HOE considerably impacted systemic BA homeostasis,which notably increased the non-12-OH BAs ratio,particularly lithocholic acid(LCA).16S ribosomal DNA(16S rDNA)sequencing assay indicated that PPP1R3G HOE reversed HFD-induced gut dysbiosis by reducing the Firmicutes/Bacteroidetes ratio and Lactobacillus population,and elevating the relative abundance of Blautia,which exhibited a positive correlation with serum LCA levels.A fecal microbiome transplantation test confirmed that the anti-obesity effect of hepatic PPP1R3G was gut microbiota-dependent.Mechanistically,PPP1R3G HOE markedly suppressed hepatic cholesterol 7α-hydroxylase(CYP7A1)and sterol-12α-hydroxylase(CYP8B1),and concurrently upregulated oxysterol 7-α hydroxylase and Takeda G protein-coupled BA receptor 5(TGR5)expression under HFD conditions.Furthermore,LCA administration significantly mitigated the HFD-induced obesity phenotype and elevated non-12-OH BA levels.These findings emphasize the significance of hepatic PPP1R3G in ameliorating diet-induced adiposity and hepatic steatosis through the gut microbiota-BA axis,which may serve as potential ther-apeutic targets for obesity-related disorders.

Objective: To analyze the status of noise hazard in workplace of key industries in Guangdong Province. Methods: A total of 1 061 enterprises from 14 key industries in 21 prefecture-level cities in Guangdong Province were selected as the research subjects using stratified sampling method. The occupational health survey was carried out, and the noise intensity in the workplace was detected. Results: There were 12 606 workplaces and 5 570 work sites involved among 1 061 enterprises. The median and the 0-100th percentile value ［M (P₀-P₁₀₀)］ of noise intensity in workplace were 82.6 (46.5-112.6) dB(A), and 35.03% of the workplace exceeded the national noise intensity standard. The regions and industry with the highest rate of noise exceeded the national noise intensity standard in workplace were in the northern part of Guangdong and the stone processing industry respectively. The M (P₀-P₁₀₀) of noise intensity in the work sites was 83.7 (47.5-106.2) dB(A), and 36.00% of the work sites exceeded the national noise intensity standard. The regions and industry with the highest rate of noise exceeded the national noise intensity standard in work sites were in the Pearl River Delta region and the ferrous metal mining and dressing industry respectively. The rate of noise protection facilities setting was 66.45%, and the validity of personal protection was 61.73%. The occupational medical examination was performed in 73.24% of the research subjects, and 3.25% of the result was abnormal. The industry with the highest occupational medical examination rate was nonferrous metal smelting and rolling processing, and the industry with the highest abnormal rate of occupational medical examination was stone processing industry. Conclusion: Noise hazards in workplaces of key industries in Guangdong Province are relatively severe, necessitating strengthened supervision and management, noise control measures, and efforts to reduce noise exposure levels in workplaces and work sites.

Background Wearing anti-vibration gloves is a simple and effective way to prevent hand-arm vibration disease. The requirements for vibration damping gloves are varied by types of operations exposed to vibration. Objective To study the vibration attenuation and dexterity of different types of protective gloves, and to provide reference for scientific wearing of vibration damping gloves for people working with vibration exposure. Methods Nine kinds of common protective gloves (A and B were dipping gloves; C, D, and E were rubber gloves; F and G were textile and fabric gloves; H was cotton gloves; I was leather gloves) used by workers exposed to vibration in 28 factories in Guangdong Province were selected as research objects by typical case sampling method, and the basic parameters of included protective gloves were investigated and measured. According to ISO 10819:2013, a glove vibration transmissibility (GVT) test system was used to detect the vibration transmissibility values and analyze vibration attenuation characteristics of the subjects wearing different protective gloves. The dexterity was tested by Minnesota Manual Dexterity Test. Pearson test was used to analyze the correlations among glove thickness, vibration transmissibility, dexterity score, and grip strength score. Results For rubber gloves (C, D, and E), the associated average adjusted vibration transmissibility at middle and low frequencies \begin{document}$ {\overline T _{\text{M}}} $\end{document} and average adjusted vibration transmissibility at high frequency \begin{document}$ {\overline T _{\text{H}}} $\end{document} were lower than those of other gloves (0.89-0.91 and 0.59-0.80 respectively), the vibration transmissibility values of 50-200 Hz frequency band was 0.81-0.97, and the vibration transmissibility values of 315-1250 Hz frequency band decreased with the increase of frequency (the minimum value was 0.13). For other types of gloves (A, B, F, G, H, and I), the \begin{document}$ {\overline T _{\text{M}}} $\end{document} and \begin{document}$ {\overline T _{\text{H}}} $\end{document} were 0.95-0.98 and 1.03-1.11 respectively, the vibration transmissibility values of 50-200 Hz frequency band was 0.96-1.02, and the vibration transmissibility values of 400-1250 Hz frequency band increased (the maximum value was 1.29). The \begin{document}$ {\overline T _{\text{M}}} $\end{document}, \begin{document}$ {\overline T _{\text{H}}} $\end{document}, and vibration transmissibility values of 40-1250 Hz frequency band of rubber gloves with double-layer protective materials (C, D, and E) were significantly lower than those of gloves with single-layer protective materials. But the \begin{document}$ {\overline T _{\text{M}}} $\end{document} and \begin{document}$ {\overline T _{\text{H}}} $\end{document} of gloves of other types with double-layer materials (F, H, and I) were still greater than 0.9 and 1.0 respectively. Compared with single-layer protective materials, the gloves of other types with double-layer materials showed no significant changes in the vibration transmissibility values of 25-200 frequency band (0.91-1.06), and an increase in the vibration transmissibility values of 250-630 Hz frequency band (the maximum value was 1.22). The dexterity scores and grip strength scores of dipping gloves (A and B) were the lowest. Rubber gloves C had the highest dexterity score and grip strength score. The thickness of protective gloves was negatively correlated with the vibration transmissibility values, and positively correlated with the dexterity score and the grip strength score (P < 0.05). The vibration transmissibility value was negatively correlated with the dexterity score and the grip strength score (P < 0.05). Conclusion Among the 9 kinds of gloves, cotton gloves and leather gloves have no damping effect. Rubber gloves have certain vibration reduction effect, and the vibration reduction effect on high frequency band is better than that on low frequency band. The thicker the damping material is, the better the damping effect is, but the less the dexterity is. Appropriate damping gloves should be selected according to actual vibration operations.

Objective:To study the clinical features and genetic characteristics of isobutyryl-CoA dehydrogenase deficiency (IBDD) of neonates in Xuzhou area.Methods:From October 2016 to October 2021, neonates diagnosed with IBDD using tandem mass spectrometry in Xuzhou area were retrospectively studied. Their clinical phenotypes and genotypes, clinical diagnosis, treatment and follow-up were analyzed.Results:A total of 510 057 neonates were screened and 10 cases of IBDD were diagnosed. The 10 IBDD cases showed increased butyryl carnitine (C4), C4/C2 and C4/C3 during screening and follow-up tests. One case had transient elevated transaminase and one case showed delayed language development. The other 8 cases were otherwise normal. A total of 16 mutation loci of acyl-CoA dehydrogenase 8 (ACAD8) gene were found, including 10 unreported loci: c.567+8C>T, c.213G>T, c.553C>T, c.1190T>C, c.1060G>A, c.494G>A, c.771C>A, c.962A>T, c.715A>G and c.731G>A. Genetic mutations were found in Exon 3, Exon 4, Exon 5, Intron 5, Exon 7, Exon 9 and Exon 10. The hot spots of mutations were c.1176G>T, c. 286G>A and c.1000C>T.Conclusions:IBDD is a rare disease without specific clinical manifestations. Neonatal metabolic disease screening combined with urinary organic acid tests and genetic sequencing can be used for early detection and diagnosis of IBDD. No serious adverse outcome is found in IBDD patients during short-term follow-up, however, long-term follow-up is recommended.

Objective:To study the incidence, clinical features and genetic mutation profiles of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) using screening strategy.Methods:From September 2015 to September 2020, neonates in Xuzhou area were prospectively screened for genetic metabolic diseases using tandem mass spectrometry. Suspected infants were further confirmed using urinary organic acid test and SLC25A13 gene mutation analysis. The clinical manifestations, biochemical and gene mutation results, treatment and prognosis of the confirmed cases were analyzed.Results:A total of 468,494 live-birth newborns were screened with 112 cases suspected and 95 cases received urinary organic acid test and SLC25A13 gene mutation analysis. 13 cases of NICCD were diagnosed with a prevalence of 1/36,038. Most confirmed cases presented with delayed disappearance of neonatal jaundice, feeding difficulties and poor weight gain. Biochemical changes included increased bile acid, abnormal liver enzymes, increased alpha-fetoprotein, hypoglycemia, decreased hemoglobin, abnormal coagulation function and increased blood ammonia. Tandem mass spectrometry showed increased citrulline, methionine, arginine, tyrosine and phenylalanine, and in some cases with slightly increased acylcarnitine. Urine organic acid analysis mainly showed increased 4-hydroxyphenyllactic acid and 4-hydroxyphenylpyruvate. All confirmed cases received genetic mutation tests and a total of 13 mutation loci were detected, including c.852_855delTATG, c.511dupG, c.1638_1660dup, IVS16ins3kb, c.1078C>T, c. 615+5G>A, c.742G>A, c.44G>A, c.1311+1G>A, c.1399C>T, c.889G>T, c.1177+1G>A, c.1841+3_1841+4del, among which, c.852_855delTATG was the most common one. A total of 5 novel mutation loci were discovered in this study with c.1841+3_1841+4del, c.511dupG and c.889G>T predicted as pathogenic variants. Special formula of lactose-free and fortified medium-chain triglyceride (MCT) were used in confirmed cases and most of the symptoms were relieved within 1 year and abnormal indicators significantly improved.Conclusions:The prevalence of NICCD in Xuzhou was 1/36,038. c.852_855delTATG mutation is the most frequent one. Five novel mutation loci are discovered, expanding the SLC25A13 gene mutation spectrum. Most infants with NICCD have a good prognosis, requiring early diagnosis, treatment and life-long follow-up.

Objective:To investigate the protective effect of adeno-associated virus (AAV) vector-mediated heme oxygenase-1 ( HO-1) gene overexpression on retinitis pigmentosa (RP) models in rats. Methods:Eighty healthy male SD rats were selected and randomized into the blank control group, RP model group, AAV-GFP group and AAV-HO-1-GFP group, with 20 rats in each group.The RP model was established via tail vein injection of 1% sodium iodate solution at the dose of 50 mg/kg.Rats in the RP model group, AAV-GFP group and AAV-HO-1-GFP group were subretinally injected with normal saline, AAV-GFP virus and AAV-HO-1-GFP virus according to grouping.Rats in the blank control group were administrated with subretinal injection of equal volume of normal saline.The eyeballs of rats were enucleated on 14th day after molding.The retinal structure and thickness were detected by hematoxylin-eosin staining; apoptosis in retinal tissue was detected by TUNEL assay; the expression levels of cysteinyl aspartate specific proteinase 3 (caspase 3), B-lymphoma-2 (bcl-2) and HO-1 protein in rats retina was identified by Western blot.The use and care of the animals complied with the Statement of the Association for Research in Vision and Ophthalmology (ARVO). The study protocol was approved by an Ethics Committee of The Second Affiliated Hospital of Fujian Medical University (No.202188).Results:Hematoxylin-eosin staining results showed normal retinal structure in the blank control group, obvious retinal structure damage with thinned and wavy outer nuclear layer in the RP model group and AAV-GFP group, and mild retinal structure damage with slightly thinned outer nuclear layer in the AAV-HO-1-GFP group.Compared with the blank control group, the outer nuclear layer was significantly thinner in the RP model group and AAV-GFP group (both at P<0.05). Relative expression level of HO-1 protein in the RP model group, AAV-GFP group, and AAV-HO-1-GFP group was 0.76±0.21, 0.76±0.16, 0.92±0.05, respectively, which were all significantly higher than 0.48±0.25 in the blank control group (all at P<0.05). The relative expression level of HO-1 protein in the AAV-HO-1-GFP group was significantly higher than that in the RP model group and the AAV-GFP group (both at P<0.05). There were significant differences in apoptosis rate, the relative expression levels of bcl-2 and caspase 3 protein among the four groups ( F=1 596.333, 1 043.806, 364.331; all at P<0.01). The apoptosis rate and the relative expression level of caspase 3 were significantly higher, and the relative expression level of bcl-2 was lower in the RP model group and AAV-GFP group than those in the AAV-HO-1-GFP group (all at P<0.05). Conclusions:AAV-mediated overexpression of HO-1 gene can protect the retina of RP rats.

Objective:To evaluate the efficacy and safety of Tyrosine Kinase Inhibitors (TKIs) combined with stereotactic body radiation therapy(SBRT) in the treatment of renal cell carcinoma (RCC) patients with bone metastasis.Methods:The clinical data of 80 RCC patients with bone metastasis in Sun Yat-sen University Cancer Center from April 2010 to April 2020 were analyzed retrospectively. Among them, 64 patients were medium or high risk according to the International Metastatic Renal Cell Carcinoma Database Consortium(IMDC) score. Twenty-four patients received TKI therapy alone(Group A), and the other 56 cases received TKIs combined with SBRT to bone metastastic lesions (Group B).Results:The median follow-up period was 20.7 months (4.8-115.6 months), 70 patients received second or third-line targeted drug therapy, and 4 patients in group A and 15 patients in group B received TKI plus immunotherapy. Fifty-four patients had symptoms of bone pain before radiotherapy, 46 patients were satisfied with the analgesic effect after SBRT treatment. Twelve patients got complete response (CR) after bone lesions, and 32 patients achieved partial response (PR). Forty patients died of disease progression during follow-up. The median OS was: 20.7 months vs not reached(Group A vs. Group B), and the 2-y OS and 5-y OS were 50% vs. 62%, and 19% vs. 56%, respectively ( P=0.006). There were only 2 patients (3.6%) had grade 3 SBRT related adverse events. Conclusions:SBRT combined with TKIs improved the quality of life and prolonged the overall survival of RCC patients with bone metastasis.