Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.
Male ; Female ; Humans ; Aged ; Natriuretic Peptide, Brain ; Simendan/therapeutic use* ; Non-ST Elevated Myocardial Infarction ; Heart Failure/drug therapy* ; Peptide Fragments ; Arrhythmias, Cardiac ; Biomarkers ; Prognosis

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
Chemotherapy, Adjuvant ; Female ; Gastrectomy ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/surgery*

Objective To explore the clinical effect of the transurethral ureteroscopic holmiumlaser lithotripsy in the treatment of ureteral calculi.Methods This study conducted a retrospective analysis of 205 patients with ureteral calculi from September 2015 to June 2017 in the affiliated hospital of Panzhihua university.According to the surgical method,all the patients were divided into control group (102 cases) who were treated with conventional pneumatic lithotripsy and observation group(103cases) who received transurethral ureteroscopic holmiumlaser lithotripsy.The surgical efficacy,renal function indexes and surgical indexes of the two groups were compared and analyzed respectively.Results The total effective rate of observation group was 97.06％,the control group was 85.00％,the difference between two groups was significantly(P ＜ 0.05).There was no significant difference in Cr and BUN level before surgery between two groups (P ＞ 0.05);after treatment,the Cr and BUN levels of two groups were improved significantly (P ＜ 0.05);while the renal function improved index of observation group was significantly better than that of control group,the difference was significant(P ＜ 0.05).The intraoperative blood loss,operative time and postoperative hospital stay of the observation group were significantly lower than those of control group (P ＜ 0.05).Conclusion The transurethral ureteroscopic holmiumlaser lithotripsy and normal air pressure ballistic were both well treatment for ureteral calculi,but patients with the holmium laser lithotripsy have better renal function indexes and operation index.

OBJECTIVETo study the biological exposure index of carbon disulfide in China.

METHODSHigh-performance liquid chromatography (HPLC) was used to detect the levels of 2-thiothiazolidine-4-carboxylic acid (TTCA) in the urine of the workers after working shift end, Gas chromatography was used to detect the concentrations of the carbon disulfide in the workplace air. The relationship between the urine TTCA levels and the concentrations of the carbon disulfide was analyzed, the biological exposure index and judgement result from PC-TWA were compared.

RESULTSThe levels of TTCA in urine of workers occupationally exposed to carbon disulfide were closely and positively related with the concentrations of the carbon disulfide in the workplace air. The regression equation was Y = 0.265X - 0.165, The biological exposure index of carbon disulfide were calculated by regression equation according to occupational exposure limits of carbon disulfide in China.

CONCLUSIONThe biological exposure index of CS(2) in China might be revised for 1.2 mg/g Cr.

Carbon Disulfide ; analysis ; Chromatography, Gas ; Environmental Monitoring ; Humans ; Occupational Exposure ; analysis ; Thiazolidines ; urine ; Threshold Limit Values ; Workplace

OBJECTIVEEstablishment of determination method of 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine with HPLC.

METHODSA volume of 0.5 ml hydrochloric acid (2 mol/L) and 0.5 ml pure water was added into 1 ml urine, and then extracted by 4 ml of diethyl ether by shaking for 2 min. Remove the water phase in a tube with plug and extract again, mix the two extraction diethyl ether together, take 4 ml by adding 2 ml borax-monopotassium phosphate buffer and shaking for 2 min to extract, then take the water phase to detect. A C(18) column and UV detector were used for separating and detecting. The wavelength was 273 nm, the flow rate was 1.0 ml/min, and the injection volume was 20 µl.

RESULTSTTCA has a good linearity (r = 0.9995) over the concentration of1 1 ∼ 10 µg and the minimum detectable concentration of TTCA in urine was 0.1 µg/ml. The within-day precision (RSD) were 8.4%, 3.0% and 1.7%, the between-day precision (RSD) were 11%, 3.8%, 1.9%, respectively. The extraction recovery were between 80% ∼ 102%.

CONCLUSIONThe method was accurate and sensitive to detect TTCA in urine.

Carbon Disulfide ; urine ; Chromatography, High Pressure Liquid ; methods ; Humans ; Thiazolidines ; urine

OBJECTIVETo explore the relationship between occupational stress and serum glycosylated hemoglobin A1c (HbA1c) level.

METHODSA cross-sectional epidemiological study was conducted in 115 dispatchers. The occupational stressors, personality, occupational strain and coping with stress were measured using Occupational Stress Instrument. Serum HbA1c levels were measured by stratigraphic analysis of cation exchange resin.

RESULTSSerum HbA1c level (6.63% ± 1.93%) in the shiftwork group was significantly higher than that (5.73% ± 1.57%) in the daily relay work group (P < 0.05). Spearman correlation analyses showed the positive correlation between type A behavior and serum HbA1c level (r = 0.221), the negative correlation between organizational commitment and serum HbA1c level (r = -0.218). Variance analyses revealed that serum HbA1c levels among high, middle and low job requirement groups and job control groups were significantly different (P < 0.05). There were significant differences of serum HbA1c levels among different type A behavior, internal control, susceptibility of stress and organizational commitment groups (P < 0.05). Stepwise regression analyses indicated that shiftwork affects obviously serum HbAlc level, internal control and job future were the predictors of serum HbA1c level (R2 = 0.082).

CONCLUSIONSerum HbA1c may be a potential biomarker in field investigation of the effects of occupational stress.

Adult ; Cross-Sectional Studies ; Glycated Hemoglobin A ; metabolism ; Humans ; Male ; Middle Aged ; Occupational Diseases ; blood ; Serum ; chemistry ; Stress, Psychological ; blood ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo explore the effect of occupational stress on serum tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-2 and IL-4.

METHODSA cross-sectional epidemiological study was conducted in 200 workers from the refrigerator assembly line in Henan province in China. Psychosocial work conditions were measured by using the job demand-control model, the effort-reward imbalance model questionnaires and occupational stress measurement scale. Serum TNF-α, IL-1β, IL-2, and IL-4 concentrations were measured by radioimmunoassay or immunoradiometric assay method respectively.

RESULTSSerum TNF-α concentration was statistically significantly different between workers with higher affective balance level and control groups [(1.947 ± 0.173) and (2.029 ± 0.240) fmol/ml] (P < 0.05). Serum IL-1β concentration was statistically significantly different between workers with higher effort level and control groups [(0.133 ± 0.034) and (0.118 ± 0.031) ng/ml] (P < 0.05). Serum IL-2 concentration was statistically significantly different between workers with higher role ambiguity level [(1.658 ± 0.376) and (1.491 ± 0.033) ng/ml] and control groups (P < 0.05), as well as between workers with higher role conflict level and control groups [(1.774 ± 0.311) and (1.589 ± 0.380) ng/ml] (P < 0.05), between workers with higher daily life stress level and control groups [(1.759 ± 0.361) and (1.606 ± 0.381) ng/ml] (P < 0.05). Serum IL-4 concentration was statistically significantly different between workers with higher reward level and control groups [(1.449 ± 0.025) and (1.466 ± 0.041) pg/ml] (P < 0.05). Stepwise regression analysis indicated that affective balance was the predictor of serum TNF-α (R(2) = 0.029). Effort and mental health were the predictors of serum IL-1β (R(2) was 0.029 and 0.055, respectively). Role conflict, daily life stress and role ambiguity were the predictors of serum IL-2 (R(2) was 0.040, 0.078 and 0.104, respectively). Reward was the predictor of serum IL-4 (R(2) = 0.030).

CONCLUSIONUnhealthy psychological stress factor might be induce a marked increase in the concentrations of serum TNF-α, IL-1β, IL-2, as well as IL-4.

Adolescent ; Adult ; Cross-Sectional Studies ; Female ; Humans ; Interleukin-1beta ; blood ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Male ; Occupational Exposure ; Stress, Psychological ; blood ; Surveys and Questionnaires ; Tumor Necrosis Factor-alpha ; blood ; Young Adult

OBJECTIVETo analyse the relationship between coping strategy and occupational stress in rail freight dispatchers.

METHODS115 rail freight dispatchers were investigated by using group sampling method, investigation contents included coping strategies, occupational stressors, strains and personalities.

RESULTSThe proportion of using coping strategy in rail freight dispatchers is lower. The scores of job future ambiguity, type A behavior and work locus of control in workers with insufficient coping strategy were higher than those in workers with sufficient strategy (P < 0.05 or P < 0.01), but the score of organization commitment score in workers with insufficient coping strategy was lower than those in workers with sufficient strategy (P < 0.05), the differences of scores of some occupational stressor, strain and personality variables between workers with insufficient and those with sufficient in social support, job-family balance, job involvement coping factors of coping strategy were remarkable significant (P < 0.05 or P < 0.01), the differences of scores of occupational stressor, strain and personality variables between workers with insufficient and those with sufficient in ask, logic and time management factors of coping strategy weren't significant (P > 0.05). Logistic regression analysis showed that risk of being job dissatisfaction and daily life stress in workers with insufficient social support coping was three or four times than those with sufficient coping (OR = 3.06 or 4.38, respectively), risk of being daily life stress in workers with insufficient job involvement coping was three times than those with sufficient coping (OR = 3.26).

CONCLUSIONThe proportion of using coping strategy in rail freight dispatchers is lower. Coping strategy has influence on the individual's perception of occuaptional stressors, strains and personalities.

Adaptation, Psychological ; Adult ; Burnout, Professional ; psychology ; China ; Humans ; Middle Aged ; Occupational Diseases ; psychology ; Occupational Health ; Personality ; Railroads ; Social Support ; Stress, Psychological ; psychology

OBJECTIVETo discuss the clinical effectiveness in treating thoracolumbar fractures adopting the rehabilitation exercise utilizing knee pads on the orthopedic traction bed.

METHODSFrom June 1996 to June 2006, we studied the clinical effectiveness of thoracolumbar fractures utilizing knee pads on the orthopedic traction bed for rehabilitation exercise. The cases surveyed total 209, 163 of which had full data. There were 98 males and 65 females with the age from 17 to 74 years (mean, 14.5 years). Consulting time after injury from 30 min to 7 days. Fracture site in T11 had 8 cases, in T12 24 cases, in L1 73 cases, in L2 33 cases, in L3 8 cases, in L4 3 cases, in T12 and L1 14 cases. Compression degree of vertebral anterior border: full compression had 1 case,more than 4/5 had 23, more than 2/3 had 67, more than 1/2 had 40, in 1/3 had 46.

RESULTSAmong them, 8 cases with legs paresis no recovery in nerval function or stopping recovery changed methods, and underwent surgical treatment. Others 155 cases were followed up from 2 to 12 years with an average of 3 years and 4 months. The average height of vertebral anterior borders of the 169 injured compressed had increased from 1.55 cm before treatment to 2.70 cm after treatment with an average of 1.15 cm. The height of the injured vertebral anterior borders had recovered from 50.5% (1.55/3.07) before treatment to 89.4% (2.70/3.02) after treatment. Kyphosis angle of the injured vertebral bodies had recovered from 13.25 degrees to -1.6 degrees in average. Twenty-three cases associated with dislocation basic reduction.

CONCLUSIONRehabilitation exercise using knee pads on the orthopedic traction bed can obtain satisfactory clinical effect in treating thoracolumbar fractures, the method is easy. At 3, 7, 10 days after treatment, the height of bed should be adjusted according X-ray.

Adolescent ; Adult ; Aged ; Exercise Therapy ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Orthopedic Equipment ; Recovery of Function ; Spinal Fractures ; physiopathology ; rehabilitation ; surgery ; Thoracic Vertebrae ; injuries ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the effect of occupational stress on ambulatory blood pressure.

METHODS30 male healthy workers from the refrigerator assembly line in Henan province in China were investigated. Psychosocial work conditions were measured by using the Job Demand-control Model, the Effort-reward Imbalance Model questionnaires and Occupational Stress Measurement Scale. Ambulatory blood pressure(ABP) was measured by using mobile ABP monitor. The t test was utilized to analyze the difference of parameters of ABP monitoring between different groups of occupational stress and other variables scores. The stepwise regression analysis was used to analyse the effect of occupational stress factors on parameters of ABP.

RESULTS(1) As to stressors, systolic blood pressure variability (SBPV), mean arterial blood pressure variability (MABPV) and heart rate at 30 minute after work in workers with high role conflict score were significantly higher than those in workers with low score (P < 0.05). Workers with high skill utilization score had significantly lower mean systolic blood pressure (SBP) at 30 minute after work than workers with low score (P < 0.05). Diastolic blood pressure variability (DBPV) and heart rate variability (HRV) in workers with high decision latitude score were significantly higher than those in workers with low score (P < 0.05). Workers with high job psychological demands score had significantly higher SBPV, DBPV and MABPV than workers with low score (P < 0.05). Heart rate-pressure product(RPP) and SBPV in workers with high effort score were significantly higher than those in workers with low score (P < 0.05). Workers with low rewards score had higher mean heart rate and heart rate at 30 minute after work than workers with high score (P < 0.05). (2) For personalities, workers with high work locus of control score had significantly higher mean diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) than workers with low score (P < 0.05). Workers with high patience score had significantly lower mean SBP at 30 minute after work than workers with low score (P < 0.05). Heart rate at 30 minute after work in workers with high organization commitment score was significantly lower than that in workers with low score (P < 0.05). (3) Concerning buffer factors, HRV in workers with high control strategies score were significantly lower than that in workers with low score (P < 0.05). Workers with low supervisor support score had higher RPP and MABPV than workers with high score (P < 0.05). (4) In the multiple stepwise regression, daily life stress affected SBPV (R2 = 0.12) and MABPV (R2 = 0.05), depression was related to DBPV at 30 minute after work (R2 = 0.15) and SBPV (R = 0.03), mental health was predictor of MABPV (R2 = 0.07) and negative affection was predictor of heart rate at 30 minute after work (R2 = 0.24).

CONCLUSIONSOccupational stressors, personality and social support have effect on parameters of ABP. Parameters of ABP monitoring could be used to evaluate occupational stress in the field research.

Adult ; Blood Pressure ; physiology ; Blood Pressure Monitoring, Ambulatory ; Burnout, Professional ; physiopathology ; Humans ; Male ; Multivariate Analysis ; Regression Analysis ; Surveys and Questionnaires ; Young Adult