Objective:To assess the risk of noise-induced hearing loss in workers from a petrochemical plant.Methods:In October 2020, 488 male workers exposed to noise in a petrochemical plant in Guangdong Province were selected by cluster sampling. Acoustics-Estimation of Noise-Induced Hearing Loss (ISO 1999: 2013) was used to assess the risk of noise-induced hearing loss of workers, and individual fit testing was used to evaluate the sound attenuation obtained by the workers. The risk assessment results and fitness test results of workers with different hearing levels were compared.Results:The average noise exposure equivalent sound level of the workers in the petrochemical plant was 86.7 dB (A) . The median of PARs (personal attenuation ratings) was 16 (4, 23) dB. There were statistically significant differences in age and service years among workers with different hearing results ( P<0.05) , but no statistically significant differences in noise intensity and PARs ( P>0.05) . According to risk assessment results of ISO 1999: 2013, the current risk of high-frequency hearing loss in 488 workers were negligible risk and acceptable risk. The risk of noise-induced deafness weredivided into three levels: negligible risk in 452 workers (92.7%) , medium risk in 27 workers (5.5%) and high risk in 9 workers (1.8%) . The risk of high-frequency hearing loss in next 5 to 15 years for workers with noise exposure level of >94 to 97 dB and >97 dB or above would be medium risk or above. The risk of noise-induced deafness in next 5 to 15 years for workers exposed to noise withlevel of 91 to 94 dB would be medium risk or above. Conclusion:The risk of noise-induced hearing loss in workers from the petrochemical plant is high in next 5 to 15 years, and noise prevention and control measures need to be strengthened. ISO1999: 2013 assessment method may underestimate the risk of hearing loss among workers.

Objective:To establish a risk prediction model for hospital acute heart failure in elderly patients with chronic heart failure (CHF) .Methods:From January 2018 to December 2020, 619 elderly CHF patients admitted to the Cardiovascular Department of Peking University Third Hospital were selected as the research object by convenience sampling. The patients were divided into the occurrence group ( n=55) and the non-occurrence group ( n=564) according to whether the patients had acute heart failure in hospital. Binomial Logistic regression was used to explore the independent risk factors of acute heart failure in elderly CHF patients. The nomogram model was constructed by R software, and its prediction effect was verified. Results:Binomial Logistic regression showed that high heart rate at admission [ OR=1.021, 95% CI (1.003, 1.039) ], history of cerebrovascular disease [ OR=2.253, 95% CI (1.197, 4.240) ], constipation [ OR=10.382, 95% CI (1.376, 78.308) ], arrhythmia [ OR=2.051, 95% CI (1.079, 3.898) , taking aspirin [ OR=2.741, 95% CI (1.447, 5.193) ], intravenous diuretics [ OR=6.326, 95% CI (2.629, 15.220) ]and high level of N-terminal forebrain natriuretic peptide [ OR=3.511, 95% CI (1.890, 6.521) ]were independent risk factors for hospital onset of acute heart failure in elderly patients with CHF, and the use of vasodilator was a protective factor. The nomogram model was validated. The area under the receiver operating characteristic curve ( AUC) of the subject was 0.808 [95% CI (0.753, 0.864) ], the AUC of internal validation was 0.821 [95% CI (0.764, 0.871) ], and the calibration curve was a straight line with a slope close to 1. Conclusions:There are many risk factors of hospital acute heart failure in elderly CHF patients. The prediction model based on risk factors has good discrimination and calibration, and can predict the risk of acute heart failure in elderly CHF patients in hospital.

Objective:To assess the risk of noise-induced hearing loss in workers from a petrochemical plant.Methods:In October 2020, 488 male workers exposed to noise in a petrochemical plant in Guangdong Province were selected by cluster sampling. Acoustics-Estimation of Noise-Induced Hearing Loss (ISO 1999: 2013) was used to assess the risk of noise-induced hearing loss of workers, and individual fit testing was used to evaluate the sound attenuation obtained by the workers. The risk assessment results and fitness test results of workers with different hearing levels were compared.Results:The average noise exposure equivalent sound level of the workers in the petrochemical plant was 86.7 dB (A) . The median of PARs (personal attenuation ratings) was 16 (4, 23) dB. There were statistically significant differences in age and service years among workers with different hearing results ( P<0.05) , but no statistically significant differences in noise intensity and PARs ( P>0.05) . According to risk assessment results of ISO 1999: 2013, the current risk of high-frequency hearing loss in 488 workers were negligible risk and acceptable risk. The risk of noise-induced deafness weredivided into three levels: negligible risk in 452 workers (92.7%) , medium risk in 27 workers (5.5%) and high risk in 9 workers (1.8%) . The risk of high-frequency hearing loss in next 5 to 15 years for workers with noise exposure level of >94 to 97 dB and >97 dB or above would be medium risk or above. The risk of noise-induced deafness in next 5 to 15 years for workers exposed to noise withlevel of 91 to 94 dB would be medium risk or above. Conclusion:The risk of noise-induced hearing loss in workers from the petrochemical plant is high in next 5 to 15 years, and noise prevention and control measures need to be strengthened. ISO1999: 2013 assessment method may underestimate the risk of hearing loss among workers.

Cardiopulmonary resuscitation (CPR) guidelines emphasize that external chest compressions should be started as soon as possible when CPR is performed in patients with cardiac arrest. Moreover, those guidelines stress on fast and hard compressions to make the chest fully rebound and minimize non-pressing time. Current mechanical recovery device has several problems such as displacement of the pressing position, high price, difficult to move, and easy dislocation of piston. Because of the physical loss of high-intensity unarmed CPR, the depth and frequency of external chest compression will decrease with the extension of CPR time, leading to CPR failure. Besides, there are other problems caused by non-professional staff, such as the deviation of compression position, the inaccuracy of compression depth and the unsatisfactory rebound of the chest wall. Based on the above factors, the medical staff from the intensive care unit of the Eighth Medical Center of the Chinese People's Liberation Army General Hospital designed a portable external chest cardiac compressor based on international CPR guidelines which obtained the National Utility Model Patent of China (ZL 2018 2 1173254.3). The portable external chest cardiac compressor is composed of a positioning sucker, elastic body, mounting shell, and pressing components. Rapid and accurate compression positioning, visible compression depth and full chest rebound can be achieved. This device is mobile, easy to operate, and suitable for a broad crowd and various occasions.

Chronic?obstructive?pulmonary?disease?(COPD)?is?a?severe?respiratory?disease?characterized?by?airway?obstruction?with?high?mortality?and?rate?of?recurrence.?Rehabilitation?exercise?can?lessen?the?possibility?of?the?progressive?exacerbation?of?the?patient's?condition,?exerting?an?active?role?in?improving?their?lung?function?and?the?quality?of?the?patients'?life.?Therefore,?we?have?designed?a?lung?function?exercise?bottle,?which?is?capable?of?adjusting?the?pressure?according?to?the?patient's?needs.?It?is?easy?to?operate?and?apply?in?practice.?The?exercise?bottle?is?composed?of?three?components,?including?bottle?body,?threaded?round?cap?and?air?blow?pipe.?The?bottle?body?is?formed?in?rectangle?shape,?and?utilized?to?contain?liquid.?The?filling?opening?is?designed?on?the?top?of?the?bottle.?Outside?of?the?filling?opening,?there?is?a?screw?thread?round?cap,?which?can?adjust?the?pressure?according?to?the?patient's?tolerance,?gradually?increasing?the?training?intensity,and?improving?the?training?effect?thereby.?The?blowpipe?can?be?inserted?into?the?bottle?body?and?the?patient?can?blow?the?air?through?the?tube.?Compared?with?the?traditional?rehabilitation?training,?when?the?newly?invented?lung?function?exercise?bottle?has?been?used?for?rehabilitation?exercise,?the?air?pressure?in?the?bottle?can?be?adjusted,?with?the?advantage?of?wider?range?of?application,?lower?cost?and?more?convenient.?It?provides?a?good?solution?for?clinical?and?home-based?rehabilitation?and?is?worth?of?popularizing.

Patient position management is an important work in clinical treatment. In clinic, it is necessary to adjust the corresponding patient's position according to the characteristics of the patient's condition. The appropriate patient's position plays an important role in treating the disease, alleviating the severity of symptoms and preventing the complications in the critical patients. A medical bedside angle measuring device and medical bed was designed. The measuring device was convenient for the clinicians to read the raised angle in time, improving the working efficiency, and the structure was simple and the operation was convenient. The whole device mainly included panel, unfolding device and medical bed with bed angle measuring device on the panel. There was an angle display area, with the range of display angle was 0°to 75°, which was adjusted to the corresponding angle according to the needs of the patient's condition under usage. The angle corresponding to the horizontal measurement line was the angle of elevating the head of the bed. The newly invented medical bedside angle measuring device and the medical bed could help the clinical medical staff know the patient's position at a glance, raising the bed head accurately, and making it convenient to use. It provided a good solution for clinical application and it was worth to popularize.

OBJECTIVE： To study the chemical constituents of ethyl acetate fraction of Panax ginseng fungal substance obtained by biotransformation， in order to obtain compounds with better activity and lower toxicity， and to provide reference for new drug R&D and the second development and utilization of P. ginseng. METHODS： Fungus of Code Name C-1 seed solution was added into the culture medium containing P. ginseng， and P. ginseng fungal substance was obtained by biotransformation； the dried P. ginseng fungal substance were weighed， extracting with 70％ ethanol solvent and concentrating to obtain thick paste. The thick paste was added with water suspension and extracted with ethyl acetate to obtain ethyl acetate fraction. TLC， silica gel column chromatography， ODS column chromatography and semi-prepared liquid phase were used to isolate and purify above ethyl acetate fraction， and the compound structure was identified according to physicochemical properties， hydrogen spectrum （1H-NMR） and carbon spectrum （13C-NMR） data. RESULTS： Eight compounds were isolated and identified from the ethyl acetate fraction of P. ginseng fungal substance and identified as ginsenoside Rs7 （1）， ginsenoside Rk3 （2）， oleanolic acid-28-O-β-D-glucopyranoside （3）， ginsenoside Rs6 （4）， 20（R）-ginsenoside Rh1 （5）， ginsenoside F1 （6）， notoginsenoside R2 （7） and ginsenoside F4 （8）. CONCLUSIONS： All the above compounds were found in P. ginseng fungal substance， which compounds 3， 5， 6， 7 and 8 were obtained after biotransformation， proving that biotransformation technology can change the chemical composition of ginseng.

Chronic obstructive pulmonary disease (COPD) is a severe respiratory disease characterized by airway obstruction with high mortality and rate of recurrence. Rehabilitation exercise can lessen the possibility of the progressive exacerbation of the patient's condition, exerting an active role in improving their lung function and the quality of the patients' life. Therefore, we have designed a lung function exercise bottle, which is capable of adjusting the pressure according to the patient's needs. It is easy to operate and apply in practice. The exercise bottle is composed of three components, including bottle body, threaded round cap and air blow pipe. The bottle body is formed in rectangle shape, and utilized to contain liquid. The filling opening is designed on the top of the bottle. Outside of the filling opening, there is a screw thread round cap, which can adjust the pressure according to the patient's tolerance, gradually increasing the training intensity,and improving the training effect thereby. The blowpipe can be inserted into the bottle body and the patient can blow the air through the tube. Compared with the traditional rehabilitation training, when the newly invented lung function exercise bottle has been used for rehabilitation exercise, the air pressure in the bottle can be adjusted, with the advantage of wider range of application, lower cost and more convenient. It provides a good solution for clinical and home-based rehabilitation and is worth of popularizing.
Equipment Design ; Exercise Therapy/instrumentation* ; Humans ; Lung/physiology* ; Pulmonary Disease, Chronic Obstructive/rehabilitation*

Warfarin is widely used as an oral anticoagulant in clinic in China. It has narrow therapeutic index, large individual differences on dosage and the variability in warfarin dosage depends on many factors, including gene polymorphism, age, diet habits and so on. For clinicians, how to optimize the individual therapeutic regimen of warfarin is becoming a significant part of their work. In recent years, studies on genetic pharmacogenomics of warfarin are reported frequently. It is found that multiple gene polymorphisms can affect the efficacy of warfarin. We will introduce the gene polymorphism of some warfarin related genes and their effects on warfarin, and the advances of warfarin individual therapeutic regimen will also be discussed here.

Objective To analyze and summarize the sonographic features of immunoglobulin G4(IgG4)-related submandibular gland disease.Methods The retrospective analysis on the sonographic results of 22 lesions in 19 patients with IgG4-related submandibular gland disease were conducted,including submandibular gland size,shape,lesion range,internal echo,blood flow,and peripheral lymph nodes.Results The sonographic features of 22 lesions of IgG4-related submandibular gland disease were classified into localized nodule changes,diffuse nodule changes,and tumor-forming changes.The localized nodule appearance,includes 2 lesions in 2 patients,shows a hypo-echoic area with a coarse echotexture in the superficial site of the gland and rich blood flow.In the diffuse nodule appearance,includes 12 lesions in 11 patients,the gland shows an irregular net or honeycomb structure.Further,the gland shows echo enhancement,thickening,uneven,and rich blood flow with the features of multiple,variously sized hypoechoic foci and surrounding parallel echogenic foci.The tumor-forming appearance,includes 8 lesions in 7 patients,shows the decrease of echogenic heterogeneity,coarse gland texture,multiple parallel echogenicity,and rich blood flow.Conclusions Ultrasonography can be used as the preferred diagnostic method for IgG4-related submandibular gland disease.When a patient is suspected of having IgG4-related submandibular gland disease,the tissues and organs often involved in IgG4 related diseases should be further examined,meanwhile conducting ultrasound-guided biopsy.