Objective To evaluate the role of distortion product otoacoustic emissions (DPOAE) testing in evaluating early hearing loss among noise-exposed workers. Methods A total of 174 noise-exposed workers in a metal shipbuilding enterprise were selected as the research subjects by the convenience sampling method. Pure tone audiometry (PTA), DPOAE and the level of noise exposure were conducted on the workers. The rank correlation analysis was used to analyze the correlation between DPOAE amplitude and PTA threshold. The multilevel model was used to analyze the effects of gender, age, noise exposure intensity, cumulative noise exposure (CNE), hearing loss classification and PTA threshold on DPOAE results. Results At the frequencies of 0.50, 1.00, 2.00, 3.00, 4.00, 6.00 and 8.00 kHz, the DPOAE amplitude was negatively correlated with the PTA threshold (rank correlation coefficients were -0.12, -0.48, -0.47, -0.18, -0.23, -0.44, -0.19, respectively, all P<0.01). At the most frequencies, DPOAE amplitude was negatively correlated with age and CNE (all P<0.05). The results of multilevel model analysis showed that there were significant differences in DPOAE amplitudes at certain frequencies across gender, age, noise intensity, CNE, and hearing loss classification (all P<0.05). Significant differences in DPOAE responses were found among different CNE and hearing loss groups (all P<0.01). Conclusion DPOAE testing can objectively reflect the hearing status of noise-exposed workers and could be considered for inclusion in routine hearing monitoring to facilitate early detection of noise-induced hearing loss.

Objective:To investigate the effect of puerarin on myocardial inflammation in rats with heart failure from the Toll-like receptor 4(TLR4)/nuclear transcription factor-κB(NF-κB)inflammatory pathway.Methods:The rat model of heart failure was established by subcutaneous injection of isoproterenol(5 mg/kg for 7 days),and was divided into model group,puerarin group,TLR4 activator group(RS09,25 μg/kg),TLR4 inhibitor group(TAK-242,0.5 mg/kg),puerarin+TLR4 activator group,with 20 rats in each group.Another 20 rats were selected as normal control group.Echocardiography was used to detect heart function;HE staining was used to observe pathological damage of myocardial tissue;TUNEL method was used to detect apoptosis of myocardial tissue cells;ELISA method was used to detect the levels of inflammatory factors IL-6,IL-1β and tumor necrosis factor-α(TNF-α)in myocardial tissue;immunohistochemical method was used to detect the expression of TLR4 and macrophage activation marker-F4/80;Western blot was used to detect the protein expressions of TLR4/NF-κB pathway,MyD88,IL-1 receptor-associated kinase(IRAK)and Galec-tin-3.Results:Compared with the normal control group,the necrosis,inflammatory infiltration and apoptosis of rat myocardial cells were severe in the model group,the heart function was decreased,the inflammatory factor release,macrophage activation,and TLR4/NF-κB pathway protein expression were increased(P<0.05).Puerarin and TLR4 inhibitors could improve the pathological damage of heart failure rats such as myocardial cell necrosis,inflammatory infiltration and apoptosis to the same extent,improve heart function,reduce inflammatory response,inhibit macrophage activation and reduce TLR4/NF-κB pathway activation(P<0.05).TLR4 activator could promote the activation of TLR4/NF-κB pathway,aggravate myocardial cell damage,apoptosis and cardiac function damage in rats with heart failure,and weaken the above-mentioned effects of puerarin(P<0.05).Conclusion:Puerarin may inhibit the activation of TLR4/NF-κB pathway,reduce myocardial inflammation,and play an anti-heart failure effect.

{L-End}Objective To analyze the characteristics of hearing loss and the influencing factors of high-frequency hearing loss (HFHL) among noise-exposed workers in an urban rail transit enterprise over five consecutive years. {L-End}Methods A total of 1 268 noise-exposed workers, who exposed to the average noise intensity of <85.0 dB(A), in an urban rail transit enterprise was selected as the research subjects using a judgment sampling method. The pure-tone audiometry results from 2019 to 2023 were collected to analyze the result of hearing loss. The influencing factors of HFHL (average hearing threshold ≥40.0 dB at high frequencies in both ears) were analyzed using the generalized estimating equations (GEE). {L-End}Results The detection rates of threshold elevations at frequencies of 0.5-6.0 kHz increased with increasing frequency from 2019 to 2023 (all P<0.01), with the highest detection rate at 6.0 kHz. The detection rate of speech frequency hearing loss (hearing threshold weighted value≥26.0 dB in the better ear) was 0.1%, 0.0%, 0.4%, 0.2%, and 0.2%, respectively. The detection rate of HFHL from 2019 to 2023 was 2.4%, 2.8%, 2.8%, 2.1%, and 2.8%, respectively. The GEE analysis results showed that the risk of HFHL of the workers in 2022 and 2023 was lower than that in 2019 (all P<0.01), with the odds ratios and 95% confidence intervals ［OR (95%CI)］ of 0.57 (0.41-0.81) and 0.65 (0.48-0.87), respectively. The risk of HFHL was higher among vehicle maintenance worker than train drivers (P<0.05), with OR (95%CI) of 2.37 (1.18-4.77). The risk of HFHL increased with age and length of service among the workers (all P<0.05), with the OR (95%CI) of 2.05 (1.22-3.46) and 1.69 (1.12-2.54), respectively. No interaction was found between type of job and age, type of job and length of service, or age and length of service in the risk of HFHL among the research subjects(all P<0.05). {L-End}Conclusion Noise exposure below the national occupational exposure limits can lead to hearing loss in noise-exposed workers of urban rail transit enterprises, possibly affecting the hearing threshold at 6.0 kHz first. The influencing factors for HFHL in workers of rail transit are age, length of service, and type of job. There is a dose-effect relationship with age and length of service.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Objective: To identify high risk behaviors and infection related factors among young adult males diagnosed with HIV/AIDS in Shandong Province, to provide evidence for targeted AIDS prevention and control strategies. Methods: By using convient sampling method, an face to face in depth interview on HIV related behaviors was conducted among young adult males newly diagnosed with HIV/AIDS in Shandong Province in July 2021. Results: A total of 31 young adult males diagnosed with HIV/AIDS were interviewed. All were male and infected through homosexuality behavior. Average age was (20.6±1.8) years. Totally 90.3% (28/31) were enrolled in tertiary education at the time of diagnosis. The findings revealed that 93.5% (29/31) of participants got infection due to unprotected homosexual behavior with the temporary partner whose HIV infection status was unknown, and 86.2% (25/29) got in touch with these temporary partner by social software. The awareness rate of knowledge about AIDS among all the participants was 100%, however, 83.9% (26/31) reported occasion condom usage while having homosexual behavior, and 16.1% (5/31) never did. Totally 74.2% (23/31) of the young adult males diagnosed with HIV/AIDS had a history of HIV testing before diagnosis. Conclusion The primary high risk behavior of HIV infection in young adult students are unawareness of HIV infection status for temporary sexual partner and the separation of knowing and doing. A targeted strategy should be developed to control the spread of HIV in young adult students.

Objective:To investigate genetic characteristics of human rhinovirus (HRV) in adult inpatients with pneumonia in autumn and winter in Bengbu, Anhui province, 2021.Methods:The pharyngeal swabs of inpatients with pneumonia in Bengbu were collected for the detection of 14 common respiratory pathogens by Real-time PCR during September to December 2021. VP4/VP2 coding regions of HRV positive samples were amplified by nested PCR and phylogenetic tree was constructed using MEGA7.0.Results:A total of 146 samples were collected from inpatients with pneumonia; 35.62% (52/146) samples were positive with at least one pathogen. The four viruses with high detection rate were HRV, adenovirus, human coronavirus OC43 and influenza B virus. HRV positive samples accounted for 44.23% (23/52) of the positive samples, among which 9 cases (39.13%, 9/23) co-infected with HRV. Phylogenetic analysis found that HRV infection were dominated by HRV-A and HRV-B groups. The analysis based on clinical syndrome found that the white blood cells count and the proportion neutrophils of patients with HRV co-infection were higher that of HRV single infection. The proportion of patients with hypertension, diabetes, mechanical ventilation and poor prognosis in the HRV co-infection group were higher than that of HRV single infection group ( P<0.05). Conclusions:HRV is the predominant pathogen among the adult inpatients with pneumonia in Bengbu. HRV-A and HRV-B groups are common. Patients accompanied by hypertension, diabetes were easily co-infected with HRV. Patients coinfeted with HRV are more likely to be mechanical ventilation and poor prognosis.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective:To analyze the status of first viral load (VL) suppression for newly diagnosed HIV/AIDS on antiretroviral therapy (ART) from 2014 to 2016 in Shandong province, to provide theoretical evidence for improvement of ART effectiveness.Methods:Based on a retrospective cohort study, logistic regression model was used to identify influencing factors about VL suppression.Results:There were 4 833 newly diagnosed HIV/AIDS cases who received ART from 2014 to 2016 in Shandong province, and 3 449 cases achieved VL suppression at the first VL testing. The rate of first VL suppression was 71.36%. The possibilities of first VL suppression among patients on ART with education at junior high school, junior college and above were higher than those with education at primary school and below, with OR values at 1.75 and 2.00, separately. The possibilities of first VL suppression for patients treated at medical institutions was higher than those by CDC, with OR value 1.29. The possibilities of first VL suppression among patients whose CD4 count level at 201-350, 351-500 and ≥501 cells/μl were higher than that of the patients whose CD4 count level at ≤200 cells/μl, with OR values at 2.36, 2.11 and 2.66, respectively. The possibilities of first VL suppression among patients who missed doses was lower than those who did not miss doses, with OR value at 0.55. All the Pvalues for the above comparisons was <0.05. Conclusions:The suppression of viral load for HIV/AIDS on ART was influenced by culture level, CD4 count level at the entry of ART, treatment institutions and adherence to the therapy. Earlier diagnosis, treatment services provided by medical institutions and improvement of drug adherence can enhance ART effectiveness.

Objective: To analyze the epidemiological characteristics of HIV/AIDS infected students in Shandong Province, to provide a basis for the prevention and control of AIDS transmission in the student population. Methods: All 863 HIV/AIDS students cases during 2010-2019 were collected in Shandong Province. Epidemiological characteristics was described and the trends in the 10 years since 2010 was analyzed. Results: These 863 HIV/AIDS students were mainly transmitted through homosexual sex (763 cases, 88.41%), and the samples were mainly from voluntary consultation testing (433 cases, 50.17%). From 2010 to 2019, the proportion of student cases in the total number of cases showed an increasing trend ( χ 2 trend =30.21, P <0.01). Among them, the proportion of homosexual transmission cases increased year by year ( χ 2 trend =6.35, P =0.01), the proportion of cases aged 18-22 years increased year by year ( χ 2 trend =6.10, P =0.01), the proportion of cases with college degree or above increased year by year ( χ 2 trend =4.26, P =0.04). At present, voluntary consultation testing were the main source.There was no significant difference between the years of sample sources ( χ 2 trend =2.97, P =0.09). Conclusion The report number of students in Shandong Province are on the rise in recent years, especially those infected by same sex transmission, mainly with high education background, which calls for targeted strategies and intervention measures.

Objective:To analyze the timeliness and influencing factors of antiretroviral treatment (ART) among HIV/AIDS patients from 2017 to 2019 in Shandong province.Methods:Data were collected from the Chinese HIV/AIDS Comprehensive Response Information Management System, HIV/AIDS cases enrolled in antiretroviral therapy, from January 1, 2017 to December 31, 2019, ≥15 years of age and from the mainland of China were the subjects of the study. The general demographic characteristics (gender, age, ethnicity, education level, marital status, etc), infection routes, sample sources, date of diagnosis, baseline CD4+ T cell level, and clinical stage and other information were collected from the database. Univariate analysis was conducted for the timeliness of ART of the subjects by Chi square test, and the influencing factors associated with timeliness of ART were analyzed by binary non-conditional Logistic regression.Results:Among the 7 425 cases of HIV/AIDS, 6 813(91.8%) were male, 5 236(70.5%) had homosexual transmission, the age at the ART initiation was(36.05±12.51)years. The proportion of timeliness of ART within 30 d increased from 55.9% (1145/2050) in 2017 to 65.3% (1821/2789) in 2019. The possibility of timeliness of ART among HIV/AIDS who were married or cohabiting, education of high school and above were higher, with OR values at 1.136, 1.299. The possibility of timeliness of ART among HIV/AIDS cases whose domicile place is outside Shandong province were lower, with OR values at 0.664. The possibility of timeliness of ART in group of HIV/AIDS aging≥55, 45~54 and 35~44 years old were higher than that in 15~24 years old, with OR values at 1.530, 1.505 and 1.394. The possibility of timeliness of ART among the heterosexuals were lower than that of homosexuals, with OR values at 0.803. The possibility of timeliness of ART is lower for cases in places of detention centers than cases from volunteer testing and counseling, with OR values at 0.204. The possibility of timeliness of ART among HIV/AIDS cases whose CD4+ T lymphocyte at >500 cells/μL were lower than that of the cases whose CD4+ T lymphocyte at≤500 cells/μl, with OR values at 0.545. Patients without symptoms at baseline were less likely to receive prompt treatment than those with clinical symptoms, with OR values at 0.727. Patients with baseline clinical staging of stage Ⅳ, period of HIV/AIDS treatment with timeliness was longer than the cases with baseline clinical stages ofⅠ, Ⅱ, Ⅲ, with OR values at 1.307. Conclusions:The proportion of timeliness of ART increased from 2017 to 2019. Marital status, educational level, age, sample source, infection routes, baseline clinical stage, and CD4+ T lymphocyte levels were associated with the timeliness of ART.