OBJECTIVE Explore the influencing factors of hearing loss among workers exposed to noise.METHODS A total of 167 noise exposure practitioners undergoing hearing testing in Hangzhou Occupational Disease Prevention and Treatment Center from January 2022 to December 2023 were selected to perform hearing testing on the left and right ears of the patients.Based on the test results,the patients were divided into 123 hearing loss patients(loss group)and 44 non hearing loss patients(control group).The population characteristics,laboratory indicators,noise exposure,and other indicators of the two groups were compared.Logistic regression models were used to analyze the risk factors for hearing loss in noise exposed workers.RESULTS In the 2 000,3 000,4 000,and 6 000 Hz air conduction hearing threshold tests,the hearing threshold of the right side of the loss group patients was higher than that of the control group.In the 500,1 000,2 000,3 000,4 000,and 6 000 Hz air conduction hearing threshold tests,the hearing threshold of the left side of the loss group patients was higher than that of the control group,and the differences were statistically significant(P<0.05).The age of patients in the loss group,the proportion of patients with concurrent chronic diseases,and the proportion of patients with junior high school education or below were all significantly different from those in the control group,and the differences were statistically significant(P<0.05).The length of service and the proportion of patients with liver function loss in the loss group were significantly higher than those in the control group.The proportion of noise protection patients and those who frequently use noise protection equipment in the loss group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The results of the Logistic regression model showed that older age,comorbidities with chronic diseases,longer working experience,lack of noise protection,and occasional or never use of noise protection equipment were independent risk factors for hearing loss in noise exposed workers(P<0.05).CONCLUSION There are many factors that can affect the occurrence of hearing loss among workers exposed to noise.Targeted preventive interventions based on high-risk factors can reduce the risk of hearing loss in the population.

Objective:To explore the clinical characteristics and prognoses of severe autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).Methods:A retrospective analysis was performed. The clinical data of 12 patients with severe GFAP-A admitted to Department of Neurology, Guangdong 999 Brain Hospital from January 2018 to June 2023 were collected, including demography, clinical manifestations, MRI features, laboratory examination results (such as antibodies), treatments and prognoses.Results:Among the 12 patients, 9 were male and 3 were female, with an average onset age of (46.58±17.53) years. Primary symptoms included headache, limb weakness, limb numbness, mental disorder, epileptic seizure, and urinary and defecation disorder; 9 patients had fever before onset. With aggravated severe GFAP-A, 12 patients had impaired consciousness, 12 had respiratory failure, 6 had unstable blood pressure and heart rate, and 2 had status epilepticus. Cranial MRI indicated abnormal lesions in all 12 patients, including 10 with brainstem involvement (7 had involved medulla oblongata); 10 showed soft meningeal enhancement. In 8 patients received MRI of the whole spinal cord, 7 had abnormal spinal cord lesions; point-like enhancement of the whole spinal meninges was observed in 6 of the 7 patients. All 12 patients had positive cerebrospinal fluid GFAP-IgG, and 3 patients also had positive serum GFAP-IgG. All patients accepted glucocorticoids and immunoglobulin immunotherapy, and 1 patient was supplemented with mycophenolate mofetil; 8 patients had good prognosis, and 4 patients died. Pulmonary infection, hyponatremia, hypoproteinemia, and deep vein thrombosis were the common complications.Conclusion:Patients with severe GFAP-A mainly manifest as meningoencephalitis and meningoencephalomyelitis, and are likely involved medulla oblongata, enjoying rapid clinical progression; even with early immunotherapy, high mortality rate is still noted.

OBJECTIVE To investigate the impact of noise exposure in metallurgical manufacturing on hearing.METHODS 245 workers exposed to noise in an enterprise and 51 administrative staff were tested for air conduction hearing threshold of pure tones at 0.5-8 kHz in both ears,and the equivalent sound level of workplace noise was measured for 8 hours.The hearing threshold of workers in different jobs was statistically analyzed.RESULTS The hearing threshold of workers exposed to noise at 0.5-8 kHz was significantly higher than that of administrative staff;hearing loss mainly occurred at 4 kHz and 6 kHz;the hearing threshold was positively correlated with working age and age,and the hearing threshold of workers over 40 years old and with working age of more than 6 years were higher than 40 dB HL at both ears at 4 kHz and 6 kHz.CONCLUSION The hearing loss of 4 kHz and 6 kHz is most obvious in noise-exposed workers,and age,working age,and noise exposure intensity were risk factors for hearing loss.It is necessary to strengthen the control of noise sources,attach importance to protective measures such as earplugs,and reduce noise exposure time.

OBJECTIVE To explore the clinical practice differences based on GBZ 49-2007 and GBZ 49-2014 diagnostic criteria for occupational noise induced hearing loss.METHODS Two hundred and sixty-five noise workers who applied for occupational noise induced hearing loss diagnosis in Hangzhou Occupational Disease Prevention and Treatment Center from January 2016 to November 2023 were selected and diagnosed according to the diagnostic criteria of GBZ 49-2007 and GBZ 49-2014 for noise induced hearing loss.RESULTS The diagnostic rate of occupational noise induced hearing loss in GBZ 49-2014 standard was 53.58%,which was significantly higher than the 42.64%in GBZ 49-2007 standard(P<0.05).The κ value of the diagnostic consistency between the GBZ 49-2014 standard and the GBZ 49-2007 standard for occupational noise induced hearing loss was 0.761,P<0.05,indicating good diagnostic consistency with a diagnostic consistency rate was 86.04%.The diagnostic rate of occupational noise induced hearing loss(GBZ 49-2007)among workers with work experience≥10 years was 59.05%,which was higher than that of workers with work experience<10 years(P<0.05).The diagnostic rate of occupational noise induced deafness in workers with work experience≥10 years(GBZ 49-2014)was 72.38%,which is higher than that of workers with work experience<10 years(P<0.05).According to the diagnosis of occupational noise induced hearing loss in GBZ 49-2007 and GBZ 49-2014,patients with work experience≥10 years had a higher severity of occupational noise induced hearing loss than those with work experience<10 years(P<0.05).CONCLUSION Compared to the GBZ 49-2007 standard,the GBZ 49-2014 standard will increase the diagnostic cases of occupational noise induced hearing loss;Under the GBZ 49-2007 and GBZ 49-2014 standards,the diagnosis and severity of occupational noise induced hearing loss are related to length of service.

This article analyzed the clinical data and on-site occupational health survey results of a patient with occupational acute methyl acetate poisoning in Zhejiang. Based on the pathways of methyl acetate poisoning and the characteristics of target organ damage, diagnosis and treatment experience were summarized, providing reference for the diagnosis and treatment of occupational acute methyl acetate poisoning and occupational health monitoring of methyl acetate.

This article analyzed the clinical data and on-site occupational health survey results of a patient with occupational acute methyl acetate poisoning in Zhejiang. Based on the pathways of methyl acetate poisoning and the characteristics of target organ damage, diagnosis and treatment experience were summarized, providing reference for the diagnosis and treatment of occupational acute methyl acetate poisoning and occupational health monitoring of methyl acetate.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.

Objective:To analyze the clinical characteristics of hereditary diffuse leukoencephalopathy with spheroids (HDLS).Methods:A retrospective analysis was performed. The clinical data of 2 patients with genetically conformed HDLS, admitted to our hospital in August 2020 and October 2021, were collected; and a literature search was conducted in domestic and foreign databases from January 2012 to January 2022 (enrolling a total of 48 patients with HDLS caused by colony-stimulating factor-1 receptor [ CSF1R] gene mutation). The population, clinical, imaging and gene mutation characteristics of these patients were summarized and analyzed. Results:(1) In these 50 patients, 20 were male and 30 were female, with onset age of (40.72±11.27) years; 40 patients (80.0%) had been misdiagnosed. (2) The most common first symptom and sign were progressive cognitive impairment (74.0%) and progressive dementia (80.0%). The patients in the middle and old aged group (≥40 years old, n=31) had significantly higher incidences of progressive cognitive impairment and Parkinson's-like symptom, and statistically lower incidence of muscle weakness as compared with those in the youth group (<40 years old, n=19, P<0.05). (3) The highest incidence of abnormal imaging findings was white matter lesions (100.0%), followed by cerebral atrophy (84.0%), ventricular enlargement (84.0%) and corpus callosum atrophy (60.0%). DWI examination was completed in 28 patients, and all patients showed persistent limitation of diffusion (100.0%). The most affected areas of white matter lesions were around the lateral ventricles, followed by the frontal-parietal occipital lobe, and corpus callosum. The incidence of abnormal signal of central semiovale in youth group was statistically higher than that in middle and old aged group ( P<0.05). (4) A total of 36 CSF1R gene mutations or possibly pathogenic mutations were identified in 50 patients, 21 of which were novel mutations reported for the first time. Of the 47 patients whose mutations were described in detail, 8 (17.0%) and 5 (10.6%) probands carried c. 2381T>C/p. I794T and c.2345G>A/p.R782H, respectively. Conclusions:The clinical manifestations of HDLS are diverse and lack of specificity. The most common first symptom and sign are progressive cognitive impairment and progressive dementia; however, the symptom spectrum and MRI imaging changes of white matter damage are related to age. MRI follow-up and targeted gene testing help reduce misdiagnosis and missed diagnosis of HDLS.

OBJECTIVE To identify an d analyze chemical cons tituents of Pleione yunnanensis with origin of Pleione yunnanensis. METHODS UPLC-Q-Exactive-Plus-Orbitrap-MS was adopted. The determination was performed on Hyperdil GOLD column with mobile phase consisted of 0.1％ formic acid solution-0.1％ formic acid acetonitrile solution （gradient elution ）at the flow rate of 0.3 mL/min. The column temperature was set at 40 ℃，and sample size was 2 µL. The electrospray ion source was adopted，and the scanning range was m/z 100-1 500，and the scanning mode was positive and negative ion exchange mode of full scan+ddMS2. The structure of chemical constituents were determined by using Compound Discoverer 3.1 software，comparing with mzCloud，PubChem network database and OTCML ，on the basis of reference substance and published literatures. RESULTS & CONCLUSIONS A total of 42 chemical constituents were identified （positive ion mode has 24，negative ion mode has 27）， including 13 benzyl succinate glycosides （such as dactylorhin C ，coelovirin A ，militarine），4 phenol glycosides （such as adenosine ， guanosine，gastrodin），3 alkaloids（choline，betaine，berberine），and one flavonoid （nobiletin），7 aromatics（such as DL-lysine ， DL-arginine，DL-glutamine），one sugar （sucrose），3 benzenes（shancigusin H ，shancigusin H isomer ，batatasin Ⅲ）and 10 others （such as p-methoxybenzoic acid ，monomethyl dodecanedioate ，diphenylamine）. Glucose oxybenzyl and some small mole cules are easy to be lost in the cleavage of benzyl succinate glycosides；glycosyl is easy to be lost in the cleavage of phenol glycosides；the cleavage of alkaloids mainly manifest as the cleavage and loss of small molecular substituents ；demethyla- tion reaction is occurred in most flavonoids.

Objective:To investigate and analyze the quality of life of occupational patients in Hangzhou and its influencing factors, so as to improve their qol.Methods:From January 2007 to June 2018, patients with diagnosed occupational diseases in Hangzhou City were randomly sampled in October 2019. The patients＇basic condition and quality of life were investigated by self-made questionnaire and SF-36, a total of 303 valid questionnaires were collected and the influencing factors were analyzed by correlation analysis and multiple linear regression.Results:The scores of physiological function, physiological function, physical pain, general health status, energy, social function, emotional function and mental health of the patients with occupational diseases in Hangzhou were lower than those of the general population in China, the differences were statistically significant ( P<0.01) . The main factors affecting the score of quality of life of occupational patients are the types of occupational diseases, the level of disability and the duration of illness, the condition of suffering from other diseases, age, educational level, whether they are entitled to Work Injury Insurance, economic income, medical security and social support, the difference was statistically significant ( P<0.05) . Conclusion:The quality of life of the patients with occupational diseases in Hangzhou City is poor, and the corresponding measures should be established to improve the qulity of life.