Background Climate change has resulted in long-term impacts on human health. Implementing efficient adaptation strategies among primary healthcare facilities is well determined by whether staff of different genders recognize the health risks related to climate change and are willing to take active measures. Objective To investigate gender differences on perceptions of health risks and attitude towards adaptation strategies among primary healthcare workers in China, and provide relevant suggestions. Methods By adopting a multi-stage cluster sampling method, we selected 21 urban and 10 rural healthcare facilities in Guangdong Province to collect information with a questionnaire. Then chi-square test, Wilcoxon rank sum test, and logistic regression analysis were used to explore the gender differences in climate change-related health risk cognition, knowledge acquisition channels, attitudes towards adaptation strategies, main obstacles, and resource requirements among the healthcare workers. Results Of 733 participants, 38.47% (282 participants) were male and 61.53% (451 participants) were female. The percentages of male healthcare workers who agreed that climate change is happening and recognized the causes of climate change (70.21%, 60.99%) were higher than the percentages of female counterparts (59.87%, 49.00%) (both Ps＜0.05), but no obvious gender differences existed in recognizing health risks of heatwaves and infectious diseases as well as sensitive population identification (all Ps＞0.05). Most of the participants (92.50%) received climate change and health-related information from mass media like TV, radio, and newspapers. Meanwhile less men chose new media channels than women (OR=0.62, 95%CI∶ 0.41-0.94). Only 30.56% of the participants (33.69% of men and 28.60% of women) reported involvement of relevant training and lectures. Most of them (90.96%) agreed to take active measures to deal with the health threats associated with climate change without gender differences for various measures (all Ps＞0.05). The leading obstacles were hard to integrate health adaptation to climate change into main work of institutions (most female agreed, 72.28%) and the lack of funds (most male agreed, 77.66%). Increasing funding for primary health care was regarded as the most needed resource by male (86.88%) and female (89.14%). After controlling the influence of other social factors, more men agreed with the lack of funds than women (OR=1.57, 95%CI∶ 1.10-2.24). Conclusion There are some gender differences in the perceptions of health risks and adaptation strategies of climate change among primary healthcare workers: Male staff are more likely to agree with climate change and regard the lack of funds as the main obstacle, while women prefer to choose new media channels to obtain information. It’s suggested that the government and relevant institutions focus on the learning and training of climate change and health-related knowledge and expand diversified information access, and promote capacity building to cope with health threats at grass-root level, in the light of recognized gender differences among primary healthcare workers.

【Objective】 To explore the establishment methods of transgenic human umbilical cord mesenchymal stem cells (hUC-MSCs) overexpressing tumor necrosis factor(TNF)-related apoptosis-inducing ligand (TRAIL) based on the transposons, and attempt to apply it on the nude mice mode with glioma. 【Methods】 PiggyBac transposon system specially designed by us was used to prepare non-targeting and Her2-targeting hUC-MSCs that can stably express TRAIL through puromycin screening. The glioma cells expressing firefly luciferase (U87MG-LUC) were injected into the skull of the immunodeficient mice (BALB/c-nu/nu) with 1×10⁶ cells per mouse. After 7 days of injection, the mice transplanted with U87MG were detected with a small animal living imager to determine the size and location of the tumors in skull. Then we injected the glioma-transplantation nude mouse with two kinds of transgenic hUC-MSCs expressing TRAIL (named as untarget-TRAIL and target-TRAIL, respectively), or the non-transgenic hUC-MSCs (all 1×10⁶ cells per mouse) or PBS (named as WT-MSCs and PBS for negative control) respectively, and then monitored the changes of tumor signals by a small animal living imager every week for 3~4 weeks. 【Results】 After six passages to expand the cells, the both transgenic cell lines can stably express TRAIL gene. Their ratio of green fluorescent protein (GFP) positive cells can reach 93%-97%, and the positive ratio of their MSC-specific surface markers still maintained normal (CD34⁺, CD45⁺, and HLA-DR⁺ all <0.1%, CD90>99%, CD73>88%, and CD105 >60%). The median survival time (d) of U87MG-transplanted nude mice in the groups of untarget-TRAIL, target-TRAIL, WT-MSCs, and PBS was 41 vs 39 vs 24 vs 23(P<0.05). 【Conclusion】 The transgenic hUC-MSCs overexpressing TRAIL gene can significantly prolong the survival time of nude mice with brain glioma.

Objective: To explore the value of ultrasound in the differential diagnosis of neonatal upper and lower gastrointestinal tract(GIT)perforation. Methods: We retrospectively reviewed the ultrasound findings of 42 neonates of surgery-confirmed neonatal GIT perforation in our hospital from January 1, 2015 to December 31, 2018.The accuracy of ultrasound for detecting GIT perforation and the ultrasound features of upper and lower GIT perforation were evaluated. Results: (1)Of the 42 neonates with GIT perforation, 1 case didn′t undergo ultrasound, 2 cases were missed, and 1 case was misdiagnosed.Thirty-eight neonates were diagnosed of GIT perforation by ultrasound preoperatively, with a detection rate of 92.7%(38/41). The locations of GIT perforation were identified by ultrasound in 30 cases(78.9%, 30/38), including 11 cases of upper GIT perforation and 19 cases of lower GIT perforation.(2)A common sonographic finding of GIT perforation in 38 cases was pneumoperitoneum, which appeared as an echogenic line with posterior reverberation artifact under diaphragm or anterior to hepatic/splenic surface and a "stratosphere" sign in M-mode sonography.Free gas changed position when the patient′s position was changed, and didn′t change due to respiratory change.Besides, free gas dispersed with compression on abdomen, and gathered without compression.(3)Upper GIT perforation was showed that poor filling of the stomach cavity, and the abdominal free gas sharply increased.Lower GIT perforation was characterized by collapsed bowel, blurred and interrupted intestinal wall structure, and more accompanied with intestinal obstruction.(4)There was no significant difference of detection rate between ultrasound and X-ray in diagnosing GIT perforation[92.7%(38/41)vs.83.3%(35/42)](P>0.05), whereas ultrasound more sensitive for a very small amount of free gas in the early stage of perforation.(5)Helicobacter pylori infection was found in two cases of GIT perforation. Conclusion Ultrasound can be used for differential diagnosis of upper and lower GIT perforation, and could be recommended as the first choice for detecting GIT perforation in neonatal patients.

Objective To explore the mediating effect of health belief on the relationship between health knowledge and health behavior among hypertensive patients with stroke.Methods The questionnaire of Stroke Knowledge Questionnaire (SKQ),Short Form Health Belief Model Scale (SF-HBMS)and health behavior scale for stroke patients (HBS-SP) were used to investigate the health knowledge,health belief and health behavior among 151 hypertensive stroke patients.The structural equation model was established using SPSS 17.0 and Mplus7.0 software.Results The total score of SKQ,SF-HBMS and HBS-SP were (86.23±.14.67),(4.26±0.54) and (3.01 ± 0.46).The Pearson r value for SKQ and SF-HBMS,SF-HBMS and HBS-SP,SKQ and HBS-SP were 0.516,0.603 and 0.449,respectively,P＜0.01.Health knowledge had no direct effect on health behavior.but had an indirect effect through health belief=0.338 (P＜0.01).The health knowledge has direct and positive effect on the health belief including perceived susceptibility,health motivation,and perceived benefit to health behaviors;the health belief of perceived seriousness to stroke has direct and positive effect on the health behavior,while perceived barrier has direct and negative effect on the health behavior,all P＜0.05.Conclusion The health belief has mediator effect between health knowledge and health behavior among hypertensive stroke patients.Stroke education efforts should be targeted at not only health knowledge but also health belief in order to increase patients’health behavior so as to prevent secondary stroke.

Objective:To investigate the expression of CD56 antigen in leukemia cells of the patients with acute myeloid leukemia (AML)and its relationship with the prognosis of AML, and to clarify the role of CD5 6 antigen expression in predicting the prognosis of the AML patients.Methods:171 AML (non-M3)patients aged from 14 to 60 years old,who received a IA Regimen as the first time inducing chemotherapy were chosen.Flow cytometric analysis was used to evaluate the CD56 expression in leukemia cells.COX proportional regression analysis was used to select the prognostic factors,and bivariable analysis was used to study the relationship between the positive rate of CD56 and overall survival (OS).The CD56+ group (n=52),including CD56≥50% expression group (n=39) and CD56<50% expression group (n=13),and CD56- group (n=119)were identified by the expression of CD56 antigen.The complete remission rate (CRR), the relapse rate, the median OS, the median disease-free survival (DFS)and the survival rate of patients were compared.Results:The medium OS of the patients in CD56+ group (14.2 months)was shorter than that in CD56- group (39.4 months)(P<0.05).Moreover,the medium OS in CD56≥50% group was shorter than that in CD56<50% group (11.7 months vs 20.3 months,P<0.05).The 1-year and 2-year survival rates of the patients in CD56+ group (61.5%,46.2%)were lower than those in CD56-group (75.6%,63.9%)(P<0.05).The 1-year survival rate had no significant difference between CD56≥50%group and CD56<50% group (53.8%vs 84.6%,P>0.05),while the 2-year survival rate in CD56≥50% group was lower than that in CD56<50% group (41.0%vs 61.5%,P<0.05).There were no significant differences of the CRR between CD56+ group (76.9%)and CD56- group (68.9%)as well as CD56≥50% group (58.9%)and CD56<50% group (63.5%)(P>0.05).The relapse rate and first year relapse rate of patients in CD56+ group (64.3% and 37.5%)were significantly higher than those in CD56- group (34.3% and 17.9% )(P<0.05). However,there were no significant differences of the relapse rate and first year relapse rate between CD56≥50%group (75.0% and 42.9%)and CD56<50% group (37.5% and 16.7%)(P>0.05).The DFS in CD56+ group was shorter than that in CD56- group (P<0.05).The same DFS result was also found between CD56≥50%group and CD56<50% group (P<0.05).Conclusion:The expression of CD56 antigen in leukemia cells predicts a bad prognosis in the AML patients,and the higher expression of CD56 indicates the worse prognosis.

AIM:Increasing evidence indicates that inflammation contributes to the initiation and perpetuation of atrial fibrillation ( AF) .Al-though tumor necrosis factor ( TNF)-αlevels are increased in patients with AF , the role of TNF-αin the pathogenesis of AF remains unclear.Recent research has revealed that T-type Ca2+currents ( ICa,T ) play an important role in the pathogenesis of AF .METH-ODS:In this study , we used the whole-cell voltage-clamp technique and biochemical assays to explore the role of TNF-αin the regula-tion of ICa,T in atrial myocytes.RESULTS:We found that compared with sinus rhythm (SR) controls, T-type calcium channel (TCC) subunit mRNA levels were decreased , while TNF-αexpression levels were increased , in human atrial tissue from patients with AF .In murine atrial myocyte HL-1 cells, after cultured for 24 h, 12.5, 25 and 50 μg/L TNF-αsignificantly reduced the protein expression levels of the TCC α1G subunit in a concentration-dependent manner .The peak current was reduced by the application of 12.5 or 25μg/L TNF-αin a concentration-dependent manner [from ( -15.08 ±1.11) pA/pF in controls to ( -11.89 ±0.83) pA/pF and (-8.54 ±1.55) pA/pF in 12.5 and 25 μg/L TNF-αgroups, respectively].TNF-αapplication also inhibited voltage-dependent inactivation of ICa,T shifted the inactivation curve to the left .CONCLUSION:These results suggest that TNF-αis involved in the path-ogenesis of AF, probably via decreasing ICa,T function in atrium-derived myocytes through impaired channel function and down -regula-tion of channel protein expression .This pathway thus represents a potential pathogenic mechanism in AF .

Objective To assess the filtration efficiency of two N95 filtering-facepiece respirators(FFRs)for the decomposition products of sulfur hexafluoride (SF6).Methods Two types of N95 FFRs (the particulate and the acid-proof respirators) were selected in this study.The decomposition products of SF6,including particles,hydrogen fluoride (HF) and sulfur dioxide (SO2),were measured under experimental condition by using TSI PortaCount Plus,fluorine ion-selective electrodes and spectrophotometer separately.The filtration efficiency was then calculated and compared.Results Both two models of N95 respirators had lowest filtration efficiency larger than 95％ for particles under airflow ranged from 10 to 95 L/min.When exposed to different concentrations of HF (low:0.00～ 1.99 mg/m3,middle:2.00～3.99 mg/m3,high:＞4 mg/m3),the acid-proof N95respirator was more effective than the particulate respirator (P＜0.05) with a filtration efficiency of 98.83％,99.08％,and 99.03％ versus 48.44％,45.71％,and 47.31％.For four SO2 concentration ranges (0.00～2.49 mg/m3,2.50～4.99 mg/m3,5.00-9.99 mg/m3,and ＞10.00 mg/m3),the acid-proof respirator showed a high filtration efficiency within exposure to 1.5 hours:95.73％,98.67％,98.14％,and 97.78％,respectively,when exposure duration extended to 4 hours,the filtration efficiency of the acid-proof respirator decreased to 91.97％,82.28％,70.12％,and 58.56％,respectively.Conclusion Both the particulate and the acid-proof N95 FFRs met national standards on the particulate filtration efficiency.The acid-proof N95 respirator demonstrates to be more effective in filtering HF and SO2 than the particulate respirator.The filtration efficiency could decrease to an unsafe condition under longer exposure duration,timely replacement of respirator is recommended at the workplace.

Objective To assess the filtration efficiency of two N95 filtering-facepiece respirators(FFRs)for the decomposition products of sulfur hexafluoride (SF6).Methods Two types of N95 FFRs (the particulate and the acid-proof respirators) were selected in this study.The decomposition products of SF6,including particles,hydrogen fluoride (HF) and sulfur dioxide (SO2),were measured under experimental condition by using TSI PortaCount Plus,fluorine ion-selective electrodes and spectrophotometer separately.The filtration efficiency was then calculated and compared.Results Both two models of N95 respirators had lowest filtration efficiency larger than 95％ for particles under airflow ranged from 10 to 95 L/min.When exposed to different concentrations of HF (low:0.00～ 1.99 mg/m3,middle:2.00～3.99 mg/m3,high:＞4 mg/m3),the acid-proof N95respirator was more effective than the particulate respirator (P＜0.05) with a filtration efficiency of 98.83％,99.08％,and 99.03％ versus 48.44％,45.71％,and 47.31％.For four SO2 concentration ranges (0.00～2.49 mg/m3,2.50～4.99 mg/m3,5.00-9.99 mg/m3,and ＞10.00 mg/m3),the acid-proof respirator showed a high filtration efficiency within exposure to 1.5 hours:95.73％,98.67％,98.14％,and 97.78％,respectively,when exposure duration extended to 4 hours,the filtration efficiency of the acid-proof respirator decreased to 91.97％,82.28％,70.12％,and 58.56％,respectively.Conclusion Both the particulate and the acid-proof N95 FFRs met national standards on the particulate filtration efficiency.The acid-proof N95 respirator demonstrates to be more effective in filtering HF and SO2 than the particulate respirator.The filtration efficiency could decrease to an unsafe condition under longer exposure duration,timely replacement of respirator is recommended at the workplace.

OBJECTIVEThe objective of this study was to investigate the aspiratory resistance, filtration penetration and their influence factors of N95 filtering-facepiece respirators used widely in China.

METHODSThe total of 6 brands and 21 models of N95 filtering-facepiece respirators which are certified and big sales on the market. The aspiratory resistance and filtration efficiency filter penetration were measured while air pump ran from 10 L/min to 100 L/min using differential pressure gauge and the PortaCount, respectively.

RESULTSThe filtration penetrations for 2 of the 21 models were lower than 95%, and the qualified rate for all models was 90.47%. The filtration penetrations gradually decreased when ventilation flow of air pump increased. The negative correlation was observed between filtration penetration and ventilation flow (r(2) = 0.711, P < 0.05). The resistances of all 21 models of N95 respirators met the requirements of the national standard. The aspiratory resistance started to elevate with the increasing of ventilation flow, and a positive correlation between both (r(2) = 0.878, P < 0.05). Significant differences of filtration penetration and aspiratory resistance were observed among between different brands (P < 0.05) although no differences of filtration penetration existed among different models of one brand (P > 0.05). But the differences of the aspiratory resistance among different models of one brand were statistically significant (P < 0.05).

CONCLUSIONThe aspiratory resistances of all N95 filtering-facepiece respirators used in this study met the requirements of the national standard. And the qualified ratio of filtration penetration of all models was higher than 90%. The influencing factors of aspiratory resistance included materials, size and ventilation flow. And influencing factors for filtration penetration were materials and ventilation flow.

Air Pollutants, Occupational ; China ; Equipment Design ; Filtration ; instrumentation ; Masks ; standards ; Materials Testing ; Respiratory Protective Devices ; standards

Objective This article aimed to investigate the treatment adherence of patients with hypertension and examine determinants of adherence.Methods A longitudinal design was adopted to test the treatment adherence and correlated factors of patients with hypertension twice from 2009 to 2012.The influencing factors of treatment adherence in patients with hypertension were analyzed.Results A total of 520 patients finished the first investigation,and 331 patients completed the second investigation.The comparison of demographic characteristics between patients who participated the second investigation or not showed no significant difference except for the education degree (x2=9.38).The incidences of symptoms and complications,systolic blood pressure and diastolic blood pressure of hypertensive patients and the laboratory indexes such as serum creatinine (SCr),total cholesterol (TC),low density lipoprotein (LDL),high density lipoprotein (HDL),fasting blood-glucose and postprandial blood sugar in the second investigation were lower than those of the first investigation,but the difference showed no statistical significance.The scores of treatment adherence,self-efficacy,social support,quality of life were higher in the second investigation than those of the first investigation.The multiple regression analysis found that treatment adherence,social support,education degree and duration of disease course were significant predictors in the first investigation entered the equation,accounting for 26％ of the total variance,among which treatment adherence explained 15％ of the variance,social support 7％,education degree 3％ and duration of disease course 1％.Conclusions The treatment adherence of hypertensive patients improved over one year follow-up.Healthcare providers should pay attention to adherence behavior at initial phase of disease development,and effective strategies targeted patients at risk are suggested to be necessary and should be designed according to the factors affecting adherence.