This article introduces the occupational disease diagnosis of work-related musculoskeletal disorders such as lumbar and spinal injuries in Germany, and focuses on the research and standard values of the maximum pressure tolerance of intervertebral discs. This article mainly introduces the dose model limits and their applications proposed by the Mainz Dortmund Dosis model (MDD), the judgment of the German Social Court (Bundessozialgericht, BSG), and the German Spinal Research Re evaluation (Deutsche Wirbels ulentudieⅡ, DWSⅡ) ; X-ray manifestations and measurements of intervertebral disc injury; Problems in actual cases and diagnosis. In order to provide reference and inspiration for the occupational diseases diagnosis of work related musculoskeletal disorders in China.

Objective:To analyze the effects of rehabilitation nursing under the guidance of electrical impedance tomography (EIT) on mechanical ventilation time and complications in ICU patients with respiratory failure so as to promote the systematic improvement of pulmonary rehabilitation nursing exercise measures.Methods:In the randomized controlled trial, 80 patients with respiratory failure admitted to ICU of Quzhou People′s Hospital were enrolled between July 2021 and July 2022 by convenience sampling method. According to different admission time, patients were divided into control group (40 cases, July-December 2021, routine rehabilitation nursing) and observation group (40 cases, February-July 2022, EIT-guided rehabilitation nursing). The lung function indexes, stay time in ICU, mechanical ventilation time, blood gas indexes and incidence of complications were compared between the two groups.Results:There were 22 males and 18 females in the control group, with an age of (53.54 ± 5.17) years; there were 21 males and 19 females in the observation group, with an age of (52.82 ± 5.21) years.After intervention, forced expiratory volume in the first second (2.82 ± 0.67) L, forced expiratory volume/forced vital capacity in the first second (78.87 ± 4.82) % and forced expiratory volume in the first second as a percentage of the predicted value (74.24 ± 9.65) % in observation group were higher than those in control group [(2.10 ± 0.66) L, (65.59 ± 3.67) %, (60.87 ± 9.66) %], and the differences were statistically significant ( t=4.84, 13.86, 6.19, all P<0.05). The stay time in ICU (10.37 ± 1.34)h and mechanical ventilation time (9.82 ± 1.24) h in observation group were shorter than those in control group (12.19 ± 1.22) h, (11.54 ± 1.37) h, and the differences were statistically significant ( t=6.35, 5.89, both P<0.05). After intervention, arterial oxygen partial pressure (90.76 ± 12.46) mmHg (1mmHg=0.133kPa) and oxygenation index (377.36 ± 54.38) in observation group were higher than those in control group (72.65 ± 11.65), (329.15 ± 42.26) mmHg, and the differences were statistically significant ( t=6.72, 4.43, both P<0.05), while arterial carbon dioxide partial pressure (45.32 ± 4.87) mmHg was lower than that in the control group (52.73 ± 4.27) mmHg, the differences was statistically significant ( t=7.24, P<0.05). The incidence of complications 7.50% (3/40) in observation group was lower than that in control group 25.00% (10/40), the differences was statistically significant ( χ2=4.50, P<0.05). Conclusions:EIT-guided rehabilitation nursing is beneficial to improve blood gas indexes and lung ventilation function, effectively shorten tracheal intubation time and stay time in ICU, and reduce the incidence of related complications in ICU patients with respiratory failure.

This article introduces the occupational disease diagnosis of work-related musculoskeletal disorders such as lumbar and spinal injuries in Germany, and focuses on the research and standard values of the maximum pressure tolerance of intervertebral discs. This article mainly introduces the dose model limits and their applications proposed by the Mainz Dortmund Dosis model (MDD), the judgment of the German Social Court (Bundessozialgericht, BSG), and the German Spinal Research Re evaluation (Deutsche Wirbels ulentudieⅡ, DWSⅡ) ; X-ray manifestations and measurements of intervertebral disc injury; Problems in actual cases and diagnosis. In order to provide reference and inspiration for the occupational diseases diagnosis of work related musculoskeletal disorders in China.

Objective:To study the effects of early essential newborn care (EENC) on breastfeeding and health outcomes of infants within 3 months of age.Methods:From September 2017 to September 2018, a prospective non-randomized controlled experimental study were carried out in 8 Women & Children's Hospital in Sichuan Province, including 1 municipal hospital and 3 county (district) hospitals as the intervention group and the other 1 municipal hospital and 3 county (district) hospitals as the control group. The intervention group received EENC and the control group received routine newborn care. Clinical data were collected after delivery and at the age of 1- and 3-month, including breastfeeding method, umbilical cord separation time, pneumonia, sepsis and diarrhea. Health outcome of the two groups were compared. The data were analyzed using SPSS 22.0.Results:There are 91.1% (278/305) of the newborns in the intervention group completed their first breastfeeding before their first mother-baby skin contact, compared with 33.3% (36/108) in the control group ( P<0.001). Exclusive breastfeeding rate before discharge in the intervention group was higher than the control group [(74.5% (228/306) vs. 55.0% (177/322), P<0.001]. The incidences of re-hospitalization and referred to other hospitals due to illness was lower in intervention group than the control group within 1 month of age [7.0% (19/272) vs. 13.3% (37/278), P=0.014]; Umbilical cord separation time in the intervention group was earlier than the control group [(8.3±2.9) d vs. (10.5±3.3) d, P<0.001]; No significant differences existed in the incidences of umbilical cord infection, pneumonia and diarrhea between the two groups ( P>0.05). The incidence of diarrhea in intervention group was higher than that the control group at 3 months of age ( P<0.05); No significant differences existed in the incidences of pneumonia and re-hospitalization and referred to other hospitals due to illness between the two groups ( P>0.05). There was no sepsis case in the two groups. Conclusions:EENC may improve exclusive breastfeeding rate before discharge, reduce the incidences of referral/hospitalization within 1 month and shorten the umbilical cord separation time without causing more infections.

Objective:To systematically review risk factors for prolonged postoperative ileus (PPOI) in colorectal surgery patients.Methods:Researches related to the influencing factors of PPOI in patients undergoing elective colorectal surgery were retrieved by computer in PubMed, Web of Science, Embase, Cochrane Library, Medline, China Biomedical Literature Database, China National Knowledge Infrastructure, WanFang Data and VIP. The retrieval time limit was from the establishment of the database to August 1, 2021. Two researchers screened article, extracted data, and evaluated the quality of the article. Meta-analysis was performed using RevMan 5.3 software.Results:A total of 21 articles were included. Meta-analysis results showed that the influence factors for PPOI in patients with colorectal surgery included gender [ OR=1.70, 95% confidence interval ( CI) : (1.55, 1.87) , P<0.001], smoking history [ OR=1.56, 95% CI: (1.30, 1.86) , P<0.001], chronic obstructive pulmonary disease [ OR=1.60, 95% CI: (1.52, 1.68) , P<0.001], hypertension [ OR=1.64, 95% CI: (1.03, 2.62) , P=0.04], diabetes [ OR=1.27, 95% CI: (1.09, 1.48) , P=0.002], history of abdominal surgery [ OR=2.15, 95% CI: (1.55, 2.98) , P<0.001], surgical site [ OR=1.40, 95% CI: (1.09, 1.81) , P=0.009], surgical method [ OR=0.43, 95% CI: (0.29, 0.62) , P<0.001], surgery time [ OR=1.18, 95% CI: (1.15, 1.22) , P<0.001] and intraoperative blood loss [ OR=1.77, 95% CI: (1.15, 2.71) , P=0.009]. Conclusions:The occurrence of PPOI in patients with colorectal surgery is affected by multiple factors. It is recommended that medical and nursing staff identify the risk factors of PPOI in a timely and accurate manner, and actively take measures to prevent the occurrence of PPOI and reduce the incidence of PPOI in patients.

Objective:To investigation the situation of occupational noise exposure and hearing loss among workers in automobile manufacturing enterprise during 2017-2019 in Wuhan.Methods:Workers in automobile manufacturing who underwent physical examination in Wuhan Hospital for the Prevention and Treatment of Occupational Diseases from 2017 to 2019 were included as subjects in the cross-sectional survey. Questionnaire survey, noise detection and pure tone threshold test were used. Excluding individuals with working time less than 3 years and information deficiency, 3 948 individuals were finally included in the study.Results:Among 3 948 workers, 128 workers had hearing loss and the rate of hearing loss was 3.24%, among which 101 workers had high-frequency hearing loss and 27 workers were diagnosed as occupational noise deafness. The prevalence of hearing loss among workers previously exposed to noise was significantly higher than that without prior exposure (12.10%, 0.96%, P<0.05) . The prevalence of hearing loss among workers with occupational noise exposure <80 dB (A) , 80~<85 dB (A) and ≥85 dB (A) was 1.83%, 2.69% and 5.09%, respectively. The prevalence of high frequency hearing loss was 1.60%, 2.05% and 3.71%, respectively. The prevalence of occupational noise deafness was 0.23%, 0.64% and 1.38%, respectively. The prevalence of hearing loss and high frequency hearing loss among workers exposed to different occupational noise was statistically significant ( P<0.05) , while the prevalence of occupational noise deafness was not statistically significant ( P>0.05) . There were statistically significant differences in the prevalence of hearing loss (2.88%, 4.45%) and occupational noise deafness (0.46%, 1.41%) between those who used protective equipment and those who did not ( P<0.05) . Compared with workers exposed to occupational noise <80 dB (A) , workers exposed to occupational noise ≥85 dB (A) had A 3.16-fold increased risk of hearing loss ( OR=3.16, 95% CI: 1.44~6.95, P<0.05) . Compared to workers using hearing protective equipment, the risk of hearing loss ( OR=1.96, 95% CI: 1.25~3.06, P<0.05) and occupational noise deafness ( OR=3.46, 95% CI: 1.51-7.96, P<0.05) significantly increased among those without using hearing protective equipment. Conclusion:The risk of hearing loss in automobile manufacturing workers is significantly associated with occupational noise exposure and the use of hearing protective equipment. Good hearing protection may reduce the risk of occupational noise-induced hearing loss and occupational noise deafness.

Objective:To investigation the situation of occupational noise exposure and hearing loss among workers in automobile manufacturing enterprise during 2017-2019 in Wuhan.Methods:Workers in automobile manufacturing who underwent physical examination in Wuhan Hospital for the Prevention and Treatment of Occupational Diseases from 2017 to 2019 were included as subjects in the cross-sectional survey. Questionnaire survey, noise detection and pure tone threshold test were used. Excluding individuals with working time less than 3 years and information deficiency, 3 948 individuals were finally included in the study.Results:Among 3 948 workers, 128 workers had hearing loss and the rate of hearing loss was 3.24%, among which 101 workers had high-frequency hearing loss and 27 workers were diagnosed as occupational noise deafness. The prevalence of hearing loss among workers previously exposed to noise was significantly higher than that without prior exposure (12.10%, 0.96%, P<0.05) . The prevalence of hearing loss among workers with occupational noise exposure <80 dB (A) , 80~<85 dB (A) and ≥85 dB (A) was 1.83%, 2.69% and 5.09%, respectively. The prevalence of high frequency hearing loss was 1.60%, 2.05% and 3.71%, respectively. The prevalence of occupational noise deafness was 0.23%, 0.64% and 1.38%, respectively. The prevalence of hearing loss and high frequency hearing loss among workers exposed to different occupational noise was statistically significant ( P<0.05) , while the prevalence of occupational noise deafness was not statistically significant ( P>0.05) . There were statistically significant differences in the prevalence of hearing loss (2.88%, 4.45%) and occupational noise deafness (0.46%, 1.41%) between those who used protective equipment and those who did not ( P<0.05) . Compared with workers exposed to occupational noise <80 dB (A) , workers exposed to occupational noise ≥85 dB (A) had A 3.16-fold increased risk of hearing loss ( OR=3.16, 95% CI: 1.44~6.95, P<0.05) . Compared to workers using hearing protective equipment, the risk of hearing loss ( OR=1.96, 95% CI: 1.25~3.06, P<0.05) and occupational noise deafness ( OR=3.46, 95% CI: 1.51-7.96, P<0.05) significantly increased among those without using hearing protective equipment. Conclusion:The risk of hearing loss in automobile manufacturing workers is significantly associated with occupational noise exposure and the use of hearing protective equipment. Good hearing protection may reduce the risk of occupational noise-induced hearing loss and occupational noise deafness.

Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in Xiangya Hospital,and provide reference for preventing and controlling HAI.Methods The cross sectional surveys on preva-lence rates of HAI,cross-sectional antimicrobial use,and bacterial detection among all hospitalized patients on the given days in 2000-2014 (except 2006)were carried out by combination of bedside investigation and medical record reviewing.Results The prevalence rates of HAI in 2000-2014 decreased from 6.30% to 3.91%,difference was statistically significant (χ2 = 35.14,P < 0.001 );prevalence rates of community-associated infection(CAI)were 15.61%-15.76%,there was no significant difference among each year.General intensive care unit (ICU)had the highest prevalence rate;respiratory tract was the most common site of both HAI and CAI;urinary catheterization rate showed a decreased tendency,arteriovenous catheterization rate showed a increased tendency,difference were both significant(χ2 = 5.21,96.24,respectively,both P <0.001).In 2008 - 2014,pathogenic detection rates for specimens from patients receiving therapeutic antimicrobial agents were 36.37%-44.51%,from patients with HAI were 34.00%-44.99%,detection rate of pathogens causing HAI were 41.57%-68.48%,all showed a increased tendency,difference was significant (χ2 = 22.78,10.03,26.49,respectively,all P < 0.001 ).Gram-negative bacteria were the main pathogens causing infection;both cross sectional and combination antimicrobial usage rates declined (P < 0.05 ).Conclusion Prevention and control of HAI,and antimicrobial management has achieved preliminary success,prevalence rate of HAI and cross sectional antimicrobial usage rate declined obviously,the main pathogen is gram-negative bacteria,and the major infection site is lower respiratory tract.

OBJECTIVETo investigate the effects of rs10916581, a common single nucleotide polymorphism (SNP) located in the promoter region of pre-miR-320b-2, on coronary heart disease (CHD) risk and circulating microRNA-320b (miR-320b) level. To explore potential factors influencing circulating miR-320b level.

METHODSRs10916581 was genotyped in a case-control study with 1 507 CHD cases and 1 379 age- and sex-frequency-matched controls. The cases were consecutively recruited from 3 hospitals (Tongji Hospital, Union Hospital, and Wugang Hospital) in Wuhan city (Hubei, China) between May 2004 and October 2009 and all the controls resided in Wuhan communities. A subgroup of 174 CHD cases and 181 non-diabetes controls without acute infection were randomly selected and their circulating miR-320b levels were detected using quantitative reverse transcriptase polymerase chain reaction assays. The association of rs10916581 with CHD susceptibility was analyzed with multivariable logistic regression model. Generalized linear regression model was used to explore the associations of rs10916581 and some other factors with circulating miR-320b level.

RESULTSIn single-factor logistic regression analysis, no association was found between rs10916581 and CHD risk. After adjustment for age, sex, BMI, smoking status, hypertension, diabetes, total triglyceride, total cholesterol/high density lipoprotein (TC/HDL-C), the result did not materially alter(compared with CC genotype, the OR (95%CI) of CHR in the subjects carried CT, TT, CT+TT genotypes were 0.94 (0.76-1.15), 0.99 (0.74-1.33) and 0.95 (0.78-1.16) ). No significant interactions were observed between the conventional risk factors of CHD (age, gender, smoking status, BMI, hypertension, diabetes, CHD family history) and rs10916581 on CHD risk (P > 0.05). Rs10916581 showed no significant association with circulating miR-320b level in cases, controls or total population (β(95%CI) was -0.028 (-0.495-0.440), 0.250 (-0.226-0.727) and 0.134 (-0.218-0.486) respectively, P > 0.05). However, circulating miR-320b level was negatively associated with BMI (β (95%CI) was -0.140 (-0.261--0.020), P = 0.022) while positively associated with TC/HDL(β (95%CI) was 0.620 (0.261-0.979), P = 0.001) in cases, and in total population, its circulating level tended to be lower in diabetes or hypertension patients (β(95%CI) was -1.025 (-1.696--0.354) and -0.594 (-1.138--0.049) respectively, P = 0.003, 0.033 respectively) and was positively associated with TC/HDL-C (β(95%CI) was 0.108 (0.027-0.190), P = 0.009).

CONCLUSIONThe common SNP (rs10916581) in the promoter region of pre-miR-320b-2 might have little contribution to the CHD predisposition in Chinese Han population, and it might not affect circulating miR-320b level. Conventional CHD risk factors (BMI, TC/HDL-C, hypertension and diabetes) might have effects on its circulating level.

Aged ; Case-Control Studies ; China ; ethnology ; Coronary Disease ; genetics ; Diabetes Mellitus ; Genotype ; Humans ; Hypertension ; Logistic Models ; MicroRNAs ; adverse effects ; blood ; genetics ; Polymorphism, Single Nucleotide ; genetics ; Promoter Regions, Genetic ; Risk Factors ; Triglycerides

Objective Nasopharyngeal carcinoma patients with stage N3 disease are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy(CRT).The aim of this study is to compare the ettlcacy of difierent chemotherapy sequences in these patients.Methotis All patients with histologically proven,carcinoma of the nasopharynx treated between July 1999 and November 2003 were restaged according to the AJCC 2002 stage classification system.A total of 114 patients had AJCC N3 diseases were analyzed retrospectively.Patients were treated by conventional RT technique using 6 MV photons or 60 Coγ-ray with 1.8-2.0 Gy per fraction,5 fractions a week,to a planned dose of 70 Gy.The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients received RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The median follow up time was 54 months(3-117months).The 5-year overall survival rate was 59.1%in whole groups,and with 17%,51%,68%and 71%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=15.44,P=0.001).The 5-year relapse-free survival rates were 83%,77%,88%and 93%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=2.34,P=0.505).The 5-year metastasis-free survival rates were 17%,54%,72%and 80%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=19.28,P=0.000).Conclusions The NACT+CRT and CRT+AC regimens were more effective than CRT alone for N3 disease in the current study.Large prospective,randomized clinieal studies are warranted.