Background Individual lead or cadmium exposure can cause abnormal blood glucose level and changes in telomere length, and the role of telomere length in the relationship between heavy metal joint exposure and blood glucose level is still unclear. Objective To explore the role of telomere length in the relationship between lead and cadmium coexposure and blood glucose. Methods A cross-sectional study was conducted. By convenient sampling method, 600 residents living in two communities in a city in North China were selected as participants from April to June 2016. Face-to-face interviews were performed to collect general demographics and lifestyles of the participants. The peripheral blood samples of the participants were collected for blood glucose and telomere length detection, the urine samples were collected for urinary cadmium, urinary lead, and urinary creatinine measurement, and both urinary cadmium and urinary lead were corrected by urinary creatinine. The included participants were divided into a control group, a high-cadmium and low-lead group, a high-lead and low-cadmium group, and a high-lead and high-cadmium group, according to the median levels of urinary cadmium and urinary lead. A restricted cubic spline model was constructed to analyze the relationship between urinary lead/cadmium levels and blood glucose concentrations in the four groups and the relationship between cadmium exposure and telomere length in the high-lead and high-cadmium group. Intermediary model test was conducted to analyze the effect of telomere length on the relationship between exposures to lead and cadmium and blood glucose. Results The included participants were divided into the control group (n=99), the high-cadmium and low-lead group (n=91), the high-lead and low-cadmium group (n=145), and the high-lead and high-cadmium group (n=265). The differences in age, education level, per capita monthly household income, smoking, blood glucose, and telomere length were statistically significant among the four groups (P＜0.05). The high-lead and high-cadmium group had the highest blood glucose concentration, (5.63±1.68) mmol·L⁻¹, and the shortest telomere length, (2.63±1.05) Kb. The restricted cubic spline results showed that urinary cadmium level was correlated with blood glucose concentration in the high-lead and high-cadmium group (F=3.45, P=0.037), and there was a non-linear association (F=6.91, P=0.002); the association between urinary cadmium level and telomere length was also non-linear (F=5.93, P=0.043). The intermediary model test results showed that telomere length was a mediating variable between urinary cadmium level and blood glucose concentration, and the mediating effect size was 0.0192 (95%CI: 0.0007-0.0563), with a mediation ratio of 15.57%. Conclusion Correlations between urinary cadmium and blood glucose and between urinary cadmium and telomere length were observed in the high-lead and high-cadmium coexposure group, and telomere length may play a mediating role in the relationship between them.

Abstract: Objective To investigate the feasibility of kurtosis in evaluating high frequency hearing loss (HFHL) caused by Methods - complex noise. A total of 273 noise exposed workers in three metal tool manufacturing enterprises were chosen as studysubjectsusingajudgementsamplingmethod.Thenoiseintensityandkurtosisintheworkplacewasmeasured.Cumulative noiseexposure(CNE)wascalculatedfromnoiseintensityandworkingageandtheCNEwasadjustedusingkurtosis(CNE′).CNEResultsandCNE′wereusedtoevaluatetheriskofHFHL,andtheeffectsofthetwomethodswerecompared.ThemedianandMPP25,75percentiles[(25,75)]ofnoiseexposedintensityinthestudysubjectswas91.9(88.3,97.3)dB(A),andtheincidenceofMPPnoiseexposureexceededthenationaloccupationalexposurelimitaccountedfor81.0%.The(25,75)ofthekurtosiswas8.3 (7.9, 27.3), and kurtosis>4.0 accounted for 100.0%. The detection rate of HFHL was 39.6% (108/273). The detection rate of P - - HFHL increased with the increase of CNE and CNE′ (all <0.01). The goodness of fit of CNE′ in assessing the risk of HFHL Conclusion detectionwasbetterthanthatofCNE(coefficientsofdeterminationwere0.91and0.83,respectively). Kurtosiscan beusedasanauxiliaryparametertoadjusttheCNEandthenappliedtoevaluatetheriskofHFHLcausedbycomplexnoise.Keywords:Hearingloss;Noise;Strength;Kurtosis;Cumulativenoiseexposure;Riskassessment

Background Exposure to environmental lead can cause kidney damage and telomere wear. However, the relationship among lead, peripheral blood telomere length, and glomerular filtration rate (eGFR) are unclear. Objective This study is conducted to investigate the relationships of urinary lead level with peripheral blood telomere length and renal function index eGFR, and further explore whether peripheral blood telomere length plays an intermediary role in the relationship between urinary lead level and eGFR. Methods A case-control study was conducted to select 497 residents from two communities in a city, including 230 in the control group (eGFR≥80 mL·min⁻¹) and 267 in the abnormal eGFR group (eGFR<80 mL·min⁻¹). Basic information and health information of the subjects were collected through a face-to-face questionnaire survey. Fasting morning urine was collected, and urinary lead and urinary creatinine (UCr) were detected. Fasting peripheral venous blood was collected to detect telomere length and serum creatinine (SCr) in peripheral blood leukocytes. eGFR was estimated by the Levey formula. After further adjusting for age, gender, education level, family per capita monthly income, smoking, and drinking the relationship among urinary lead level, peripheral blood telomere length, and renal function index eGFR was evaluated by mediating effect analysis. Results The overall level of creatinine-adjusted urinary lead [M (P₂₅, P₇₅)] in the abnormal eGFR group was 3.85 (1.56, 7.34) μg·g⁻¹ which was higher than that in the control group, 1.57 (0.60, 3.62) μg·g⁻¹(P<0.001). In addition, the overall level of peripheral blood telomere length in the abnormal eGFR group was 2.42 (1.89, 3.10) Kb, lower than that in the control group, 2.69 (2.09, 3.64) Kb (P<0.001). The results of mediating effect analysis showed that the magnitude of mediating effect by peripheral blood telomere length was −0.276 (95%CI: −0.708-−0.001) and it contributed 3.35% to the relationship between urinary lead level and eGFR. In women, the magnitude of mediating effect by peripheral blood telomere length was −0.484 (95%CI: −1.160-−0.023) between urinary lead level and eGFR, and the proportion of the mediating effect was 5.34%. In men, no mediating role of peripheral blood telomere length was found between urinary lead and eGFR. Conclusion Urinary lead level is closely related to renal function index eGFR and telomere length in peripheral blood. Peripheral blood telomere length plays a mediating role in the relationship between female urinary lead and eGFR in women.

Objective:To investigate the evaluation of disease perception, treatment compliance and community follow-up services of community schizophrenia patients, family members and personnel in Shantou City, and to provide a reference basis for improving the quality of management treatment.Methods:With the method of stratified sampling qualitative research, a community sample of 17 198 patients with schizophrenia in seven districts or county in Shantou City were sampled from February to August 2019, with 2 towns being drawn from each district or county, and 10 patients, 10 family members and 3 personnel were selected in each town. The evaluation of disease perception, treatment compliance and community follow-up services were investigated and analyzed. Respondents were eventually included in 137 patients, 138 family members and 41 personnel.The interviewees were conducted with semi-structured interviews, the data were collected according to traditional methods, and the descriptive statistical analysis was carried out with SPSS 12.0.Results:(1)34.3% of patients and 32.6% of the family members were not fully aware of the disease.22.6% of the patients and 23.2% of the family members had a sense of ill shame. (2)26.3% of patients did not comply with treatment, 29.9% of patients had not insight, 53.3% of patients and 24.6% of family members on the side effects of drugs and addiction understood improperly, and, 35.0% of patients and 13.0% of the family had a misunderstanding of illness and using drugs. (3)29.2% of patients and 31.2% of their families were tired of taking long-term medication, 24.8% of patients and 21.0% of their families felt socially isolated, and, 17.5% felt unsupported and 18.8% of their families admitted that they did not care enough about patients. (4)31.4% of patients did not actively receive follow-up services, 37.2% of patients and 20.3% of family members did not cooperate with follow-up doctors, and, 21.2% of patients and 10.1% of family members were not satisfied with follow-up services. (5)The personnel of psychiatric care could basically grasp the conditions of patients in the jurisdiction and carried out follow-up services on a regular basis (90.2%), master emergency disposal methods (92.7%), and have carried out training (97.6%). However, the psychiatric practice of the personnel were lower than (58.5%) and most lying part-time (78.0%), the average length of service was 5.7±1.4 years. The personnel satisfaction with the community follow-up service was higher (95.1%), but most of them thought that the psychiatric care was more difficult (36.6%), and were dissatisfied with the multi-functional staff to undertake a number of public services (31.7%).Conclusion:The management treatment project of mental disorders services in Shantou City show initial results.The patients were satisfied with the community follow-up service, but the patients and their families still have low level of cognition, poor compliance, obvious negative emotions, and have concerns about drug treatment.It is necessary to strengthen the professionalization of personnel, to carry out early mental health education and rational emotional behavior training for patients and their families.

Objective:To explore the relationship of telomere length, mitochondrial DNA copy number of peripheral blood with hypertension and the interaction between telomere length and mtDNA-CN on hypertension in coal miners.Methods:A case control study was conducted in a coal mine of Shanxi province from July to December of 2013, in which 325 healthy workers were selected as the control group and 378 workers with hypertension as the case group. The information about general demographic characteristics and life behavior habits of the subjects were collected through questionnaire. Levels of telomere length and mtDNA-CN in peripheral blood were detected by real-time PCR. Unconditional logistic regression was used to examine the association between hypertension and telomere length, mtDNA-CN. The interaction test between telomere length and mtDNA-CN on hypertension was performed by adding the interaction term in the corresponding model.Results:The mean telomere length of the workers in the case group was (1.50±0.55) kb, and that of the control group was (2.01±0.62) kb, the difference between two groups was significant ( t=11.68, P<0.001). The correlation analysis showed that telomere length was positively correlated with mtDNA-CN ( r=0.157, P=0.002) in the case group. Multivariate analysis showed that telomere length ( OR=4.408, 95% CI: 3.012-6.452), age ( OR=0.417, 95% CI: 0.284-0.613), BMI ( OR=1.357, 95% CI: 1.162-1.584), monthly household income level ( OR=0.656, 95% CI: 0.553-0.778) and work duration ( OR=1.249, 95% CI: 1.100-1.417) were influencing factors of hypertension. The multiply interaction between telomere length and mtDNA-CN was significant on hypertension ( OR=1.267, 95% CI: 1.094-1.468). Conclusions:The results suggest shorter telomere length is a risk factor of hypertension. There is a multiply interaction between telomere length and mtDNA-CN on hypertension. However, the association between mtDNA-CN and hypertension was not found.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.

Objective To explore the application of video laryngoscope in patients with pituitary adenoma during endotracheal intubation.Methods Fifty-one patients (19 males, 32 females, aged 18-71 years, ASA physical status I or II) scheduled for resection of pituitary adenoma under general anesthesia were enrolled.These patients were randomly divided into two groups: Macintosh laryngoscope Group (group M, n=25) and Video laryngoscope Group (group VL, n=26).When performing endotracheal intubation, Macintosh laryngoscope was used to expose the glottis in group M, and video laryngoscope was used in group VL.Head tilted backward angle, mouth opening, thyromental distance, neck circumference, mandibular ramus length, modified Mallampati classification and the difficulty classification of mask ventilation of the patients in two groups were recorded during peri-operation period.The Cormark-Lehane grade, needed pressing of the cricoids cartilage, the ratio of a second attempt during intubation and the intubation time consumed were recorded.Results Less patients in group VL needed cricoids cartilage press (7.7% vs 48.0%) during the intubation than that in group M (P<0.01).Compared with group M, the Cormack-Lehane grade was significantly lower (P<0.01) and the intubation time consumed was significantly shorter in group VL [(32.4±11.7)s vs (45.8±12.6)s] (P<0.01).Conclusion In patients with pituitary adenoma,video laryngoscope may improve the glottis exposure and the success rate of intubation, as well as shorten the intubation time.

Objective To investigate the effects of mitochondrial DNA (mtDNA) copy number in peripheral blood and related factors on the risk of hypertension in coal miners.Methods A case-control study was conducted in 378 coal miners with hypertension and 325 healthy coal miners recruited from Datong Coal Mine Group.A standard questionnaire was used to collect their general information,such as demographic characteristics,habits and occupational history.Fluorescence quantitative PCR was performed to detect the copy number of mtDNA.Logistic regression model was applied for identifying the related risk factors of hypertension and analyzing the interaction between mtDNA copy number and risk factors.Results The prevalence of hypertension of high mtDNA copy number was lower than mtDNA copy numberin 0-5.67 group,but the difference was not statistically significant (P=0.414).Alcohol drinking (OR=1.80,95％CI:1.26-2.56),family history of hypertension (OR=1.74,95％ CI:1.20-2.50),work shifts (OR=0.69,95％ CI:0.48-0.99),education level (P=0.012) and family monthly income level (P=0.001) were related to the prevalence of hypertension.There were potential interactions between mtDNA copy number and alcohol drinking,family monthly income level,family history of hypertension,respectively.Alcohol drinking was a risk factor for hypertension [1.77(1.25-2.50)].Potential interactions between mtDNA copy number and alcohol drinking reduced the risk of hypertension (OR=1.20,95％CI:1.07-1.35).Family history of hypertension was a risk factor for hypertension [1.81(1.26-2.59)].Potential interactions between mtDNA copy number and family history of hypertension reduced the risk of hypertension (OR=1.24,95％ CI:1.09-1.41).Family monthly income level was a protect factor for hypertension [0.55(0.46-0.66)].Potential interactions between mtDNA copy number and family monthly income level increased the protection role of hypertension (OR=0.90,95％CI:0.86-0.94).Conclusion mtDNA copy number variation was not significantly associated with the prevalence of hypertension in coal miners,but mtDNA copy number shewed multiplication interaction on the prevalence of hypertension with alcohol drinking,family monthly income level as well as family history of hypertension and made their influences weaken.

Objective:To investigate the correlation among prognostic nutritional index (PNI), clinical features, and adverse reac-tions after adjuvant chemotherapy of gastric cancer patients who underwent radical gastrectomy. Furthermore, this study aimed to clari-fy the predictive and prognostic significance of PNI in patients who underwent gastrectomy for gastric cancer. Methods:This study re-viewed the medical records of 148 patients with gastric cancer who underwent gastrectomy. The PNI value was calculated by serum al-bumin concentration (g/L)+5 × lymphocyte count (×109/L). The receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off value of the PNI. Survival curves were described by Kaplan-Meier method and compared by Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors. Re-sults:The mean values of the PNI in<65 years old patients (P<0.01), T1 and T2 stages of tumor (P<0.01), and negative lymph node (P=0.013) were significantly higher than those without such factors. Patients with higher PNI had significantly lower rates of postoperative complication and adjuvant chemotherapy adverse reactions than those with lower PNI (P<0.01). When the PNI value was 52.08, the Youden index was maximal, with a sensitivity of 66.7%and a specificity of 34.3%. The overall survival rate in the high PNI group was higher than that in the low PNI group (P<0.01). The univariate and multivariate analyses showed that preoperative carcinoembryonic antigen level (P=0.018), tumor depth (P=0.010), intravascular cancer embolus (P=0.010), time to initiation of chemotherapy after sur-gery (P=0.034), and the PNI value (P=0.015) were independent factors in predicting overall survival rate. Conclusion:The PNI value was a simple and useful tool to predict the prognosis and the incidence of adjuvant chemotherapy adverse reactions of gastric cancer pa-tients after radical gastrectomy.

Objective To discuss the timing and procedures of reoperations on the residual aortic dissection after initial ascending aortic operations on Stanford type A aortic dissection.Methods From March 2009 to November 2011,16 consecutive patients(13 males,3 females) underwent reoperations on the residual aortic dissection.The mean age was 44 years(23-61 years),8 cases was associated with Marfan syndrome.The right axillary artery or femoral artery cannulation was used for cardiopulmonary bypass,cerebral protection was achieved by unilateral antegrade brain perfusion and nasopharyngeal temperature was dropped to 20℃-25℃.The Sun's procedure (total arch replacement with stented elephant trunk implantation) was performed in all patients,concomitant procedure include aortic root replacement (Bentall procedune) in 3 patients,aortic root replacement and coronary artery bypass grafting (Bentall + CABG) in 1 patient,the coronary artery anastomotic leakage repair in 1 patient,mitral valve replacement (MVR) in 1 patient.Results The interval between two operations averaged(66 ±40)months.The means of cardiopulmonary bypass,cross clamp and selective cerebral perfusion times were(193 ± 49)minutes,(90 ±28) minutes and(22 ± 10) minutes,respectively.The mean time to tracheal extubation was(17 ± 10) hours.All patients survived from the operation.One patient suffered from temporary left lower limb paralysis and recovered after treatment during follow-up.Computed tomography angiography (CTA)of aorta was performed on each patient before discharged from the hospital:descending aortic true lumen was significantly expanded,thrombosis of false lumen was found near stent graft.The average follow-up time was 17 (3-42) months,one patient died of aortic rupture 3 months later,one patient underwent total thoracoabdominal aorta replacement 6 months later,one patient with descending thoracic aortic dilatation combined with endometrial tear underwent thoracic endovascular aortic repair.Conclusion Reoperation should be performed as the following condition:the annual growth rate of residual aortic diameter exceeds 0.5 cm/year,the maximal aortic diameter exceeds 5 cm.The Sun's procedure (total arch replacement with the elephant trunk implantation) is safe and effective in the treatment of residual aortic dissection,low mortality and complications was achieved by it,the mid-and long-term results need the further follow-up.