ObjectiveTo explore the influencing factors of occupational hand-arm vibration disease (OHAVD) caused by handheld workpiece polishing. Methods A total of 222 OHAVD patients (case group), 275 hand-transmitted vibration-exposed workers (exposed group) and 243 healthy workers without hand-transmitted vibration exposure (control group) in a sports equipment manufacturing enterprise were selected as the study subjects using the convenience sampling method. Worksite survey of occupational health was conducted on these three groups, and the human vibration measurement equipment was used to measure the vibration exposure level of handheld vibration among the study subjects. The 8-hour energy equivalent frequency-weighted vibrating acceleration ［A(8)］ and cumulative vibration exposure level (CVEL) were calculated. Results The prevalence of coldness, numbness, tingling fingers, and vibration-induced white finger was higher in the exposed group and the case group compared with the control group (all P<0.05). The prevalence of the above-mentioned hand symptoms was higher in the case group compared with the exposed group (all P<0.05). The A(8) and CVEL levels of the study subjects in the case group were higher than those in the exposed group (all P<0.05). Binary logistic analysis result showed that age and CVEL were both influencing factors of OHAVD (all P<0.05). According to the restricted cubic spline models, CVEL of the study subjects in the exposed group had a positive nonlinear dose-response relationship with the risk of OHAVD (overall trend P<0.01, nonlinear P<0.01), indicating an increasing risk of OHAVD with increasing CVEL. Conclusion Hand-transmitted vibration exposure is a risk factor for OHAVD. Early intervention should be carried out for hand-transmitted vibration-exposed individuals to reduce vibration-exposed levels and control vibration exposure time.

ObjectiveTo analyze the spectrum distribution characteristics of high-intensity productive noise in key industries in Guangdong Province. Methods A total of 2 806 enterprises in 21 prefecture-level cities in Guangdong Province were selected as the study subjects using the stratified sampling method. On-site investigations were conducted in workplaces. Noise in workplaces and work-sites, and the noise spectrum of the workplaces with sound pressure level ≥85.0 dB(A) were detected. Results The noise of a total of 23 076 workplaces and 20 969 work sites from 30 key industries were monitored. The median (M) and 25th and 75th percentiles (P₂₅, P₇₅) of workplace sound pressure level were 82.3 (78.6, 86.5) dB(A). The rate of the noise exceeded national standard was 30.4%. The sound pressure level M (P₂₅, P₇₅) of work-site was 78.6 (70.0, 83.5) dB(A). The rate of the noise exceeded national standard was 18.0%. Workplace noise and work site noise were positively correlated (Spearman correlation coefficient=0.86, P<0.01). The rate of the noise exceeded national standard was 46.5% in key work sites where the rate of noise exceeded the national standard was ≥25.0%, and corresponding rate of the workplace noise exceeded national standard was 58.1%. The noise spectrum result of 5 636 workplaces sound pressure level>85.0 dB(A) showed that most of the noise source was from grinding machines (441 cases), and the highest average sound pressure level of noise source was from screening machines [93.0 dB(A)]. Cluster analysis results showed that the main noise sources could be divided into three categories, including wideband noise with levels >80.0 dB in all frequency bands except 8 000.0 Hz, medium-high-frequency noise with the highest sound pressure level at 1 000.0, 2 000.0, and 4 000.0 Hz and low frequencies <75.0 dB, and medium-low-frequency noise below 500.0 Hz with sound pressure level >85.0 dB. Conclusion The rate of the noise exceeded national standard in workplace of key industries in Guangdong Province is high, involving a wide range of industries, with high sound pressure levels and obvious spectrum characteristics of corresponding noise sources. Corresponding noise control strategies can be formulated based on different spectrum characteristics and magnitudes.

To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.

Background Wearing anti-vibration gloves is a simple and effective way to prevent hand-arm vibration disease. The requirements for vibration damping gloves are varied by types of operations exposed to vibration. Objective To study the vibration attenuation and dexterity of different types of protective gloves, and to provide reference for scientific wearing of vibration damping gloves for people working with vibration exposure. Methods Nine kinds of common protective gloves (A and B were dipping gloves; C, D, and E were rubber gloves; F and G were textile and fabric gloves; H was cotton gloves; I was leather gloves) used by workers exposed to vibration in 28 factories in Guangdong Province were selected as research objects by typical case sampling method, and the basic parameters of included protective gloves were investigated and measured. According to ISO 10819:2013, a glove vibration transmissibility (GVT) test system was used to detect the vibration transmissibility values and analyze vibration attenuation characteristics of the subjects wearing different protective gloves. The dexterity was tested by Minnesota Manual Dexterity Test. Pearson test was used to analyze the correlations among glove thickness, vibration transmissibility, dexterity score, and grip strength score. Results For rubber gloves (C, D, and E), the associated average adjusted vibration transmissibility at middle and low frequencies \begin{document}$ {\overline T _{\text{M}}} $\end{document} and average adjusted vibration transmissibility at high frequency \begin{document}$ {\overline T _{\text{H}}} $\end{document} were lower than those of other gloves (0.89-0.91 and 0.59-0.80 respectively), the vibration transmissibility values of 50-200 Hz frequency band was 0.81-0.97, and the vibration transmissibility values of 315-1250 Hz frequency band decreased with the increase of frequency (the minimum value was 0.13). For other types of gloves (A, B, F, G, H, and I), the \begin{document}$ {\overline T _{\text{M}}} $\end{document} and \begin{document}$ {\overline T _{\text{H}}} $\end{document} were 0.95-0.98 and 1.03-1.11 respectively, the vibration transmissibility values of 50-200 Hz frequency band was 0.96-1.02, and the vibration transmissibility values of 400-1250 Hz frequency band increased (the maximum value was 1.29). The \begin{document}$ {\overline T _{\text{M}}} $\end{document}, \begin{document}$ {\overline T _{\text{H}}} $\end{document}, and vibration transmissibility values of 40-1250 Hz frequency band of rubber gloves with double-layer protective materials (C, D, and E) were significantly lower than those of gloves with single-layer protective materials. But the \begin{document}$ {\overline T _{\text{M}}} $\end{document} and \begin{document}$ {\overline T _{\text{H}}} $\end{document} of gloves of other types with double-layer materials (F, H, and I) were still greater than 0.9 and 1.0 respectively. Compared with single-layer protective materials, the gloves of other types with double-layer materials showed no significant changes in the vibration transmissibility values of 25-200 frequency band (0.91-1.06), and an increase in the vibration transmissibility values of 250-630 Hz frequency band (the maximum value was 1.22). The dexterity scores and grip strength scores of dipping gloves (A and B) were the lowest. Rubber gloves C had the highest dexterity score and grip strength score. The thickness of protective gloves was negatively correlated with the vibration transmissibility values, and positively correlated with the dexterity score and the grip strength score (P < 0.05). The vibration transmissibility value was negatively correlated with the dexterity score and the grip strength score (P < 0.05). Conclusion Among the 9 kinds of gloves, cotton gloves and leather gloves have no damping effect. Rubber gloves have certain vibration reduction effect, and the vibration reduction effect on high frequency band is better than that on low frequency band. The thicker the damping material is, the better the damping effect is, but the less the dexterity is. Appropriate damping gloves should be selected according to actual vibration operations.

Objective:To construct a Traditional Chinese Medicine (TCM) nursing training system for nurses with medium-grade professional title in TCM hospitals based on Kirkpatrick model, so as to provide a reference for the training of nurses with medium-grade professional title in TCM hospitals.Methods:Based on the Kirkpatrick model, combined with the results of literature review, questionnaire survey and semi-structured interviews, the first draft of the training system was formulated and the expert consultation questionnaire was prepared. A total of 21 experts from Zhejiang Province were selected for 2 rounds of expert correspondence.Results:The questionnaire recovery rate of the two rounds of expert correspondence was 100%. The expert authority coefficients were 0.89 and 0.91, and the Kendall's W were 0.239 and 0.176 ( P<0.001) . The final training system included 3 first-level indicators, 11 second-level indicators, 37 third-level indicators and 145 fourth-level indicators. Conclusions:The construction method of the TCM nursing training system for nurses with medium-grade professional title is scientific and the content is reasonable and comprehensive, which can provide a scientific reference for the training of nurses with medium-grade professional title in TCM hospitals.

BACKGROUND: Low dose computed tomography (LDCT) for lung cancer screening is widely employed in China as a result of increasing cancer screening awareness. Although some pulmonary lesions detected by LDCT are cancerous, most of the pulmonary nodules are benign. It is important to make effective preoperative differentiation of pulmonary lesions and to obviate the need for surgery in some patients with benign disease. METHODS: From January 1, 2017 to December 31, 2018, patients in our institution with surgical pathology confirmed benign pulmonary lesions in which malignancy could not be excluded in preoperative assessment were enrolled in this study. Retrospective analysis of clinical data was conducted. RESULTS: 297 cases were collected in this study. Prevalence of benign disease in patients underwent resection for focal pulmonary lesions is 9.8% in our institution. In 197 patients (66.3%), pulmonary lesions were detected by LDCT screening. A total of 323 assessable pulmonary lesions were detected by chest CT. The average diameter of pulmonary lesions was (17.9±12.1) mm, and 91.0% of which were greater than or equal to 8 mm. Solid nodules accounted for 65.6% of these lesions. Imaging characteristics suggesting malignancy were common, including spicule sign (71/323, 22.0%), lobulation (94/323, 29.1%), pleural indentation (81/323, 25.1%), vascular convergence sign (130/323, 40.2%) and vacuole sign (23/323, 7.1%). 292 patients (98.3%) underwent video-assisted thoracoscopic surgery (VATS). Pulmonary wedge resection was performed in 232 cases (78.1%), segmental resection in 13 cases (4.4%) and lobotomy in 51 cases (17.2%). Surgical complications occurred in 4 patients (1.3%). The most frequent findings on surgical pathology analysis were: infectious lesions in 98 cases (33.0%), inflammatory nodules in 96 cases (32.3%), and hamartoma in 64 cases (21.5%). CONCLUSIONS Solid nodules accounted for most of these benign pulmonary lesions in which malignancy could not be excluded preoperatively, and imaging characteristics suggesting malignancy were common. VATS is an important biopsy method to identify etiology and pathology for lesions. The most frequent benign pulmonary diseases that are suspected to be malignant and underwent surgical resection are: infectious lesions, inflammatory nodules and hamartoma.

BACKGROUND: Pneumonic-type lung carcinoma is a special type of lung cancer both clinically and radiologically. Here we present our experience on pneumonic-type lung carcinoma in an attempt to investigate the clinical, radiological and pathological features, diagnostic procedures, treatment, and prognosis of this type of tumor. METHODS: Pathologically confirmed lung cancer with a chest CT characterized by ground glass opacity or consolidation was defined as pneumonic-type lung carcinoma. Cases with advanced pneumonic-type lung carcinoma admitted to Peking Union Medical College Hospital (PUMCH) from January 1, 2013 to August 30, 2018 were enrolled. Retrospective analysis of clinical data and survival follow-up of these patients was conducted. RESULTS: A total of 46 cases were enrolled, all of which were adenocarcinoma. Cough (41/46, 89.1%) and expectoration (35/46, 76.1%) were the most prominent symptoms. The most frequent chest CT findings were ground glass attenuation (87.0%), patchy consolidation (84.8%), and multiple ground-glass nodules (84.8%). Multiple cystic changes (40%) and cavitation (13%) were also quite frequent. Ipsilateral and contralateral intrapulmonary metastasis were noted in 95.3% and 84.8% of cases respectively. The median duration from symptom onset to diagnosis was 214 days (95%CI: 129-298). Both surgical lung biopsy and CT-guided percutaneous lung biopsy had a diagnostic yield of 100%. Transbronchial lung biopsy (TBLB) combined with bronchoalveolar lavage (BAL) had a diagnostic yield of 80.9% (17/21). Sputum cytology had a diagnostic yield of 45% (9/20). Twenty-six cases were invasive mucinous adenocarcinoma (26/46, 56.5%) and the remainder were unable to identify pathological subtypes due to lack of adequate biopsy sample size. EGFR mutation was detected in 15.8% (6/38) of patients and ALK rearrangement was detected in 3.0% (1/33) of patients. The median overall survival for these patients was 522 d (95%CI: 424-619). In patients without EGFR mutation or ALK rearrangement, chemotherapy significantly improved survival (HR=0.155, P=0.002,2). The median overall survival was 547 d (95%CI: 492-602 d) with chemotherapy and 331 d (95%CI: 22-919) without chemotherapy. CONCLUSIONS Diagnosis of pneumonic-type carcinoma is usually delayed due to clinical and radiological features mimicking pulmonary infection. TBLB combined with BAL has a quite high diagnostic yield. The most frequent histological type is invasive mucinous adenocarcinoma. The incidence of EGFR mutation or ALK rearrangement is low in pneumonic-type carcinoma. For patients without cancer driver genes, chemotherapy is recommended to improve overall survival.
Aged ; Anaplastic Lymphoma Kinase ; genetics ; metabolism ; Antineoplastic Agents ; therapeutic use ; Carcinoma ; diagnostic imaging ; drug therapy ; genetics ; pathology ; ErbB Receptors ; genetics ; metabolism ; Female ; Gene Rearrangement ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; genetics ; pathology ; Male ; Middle Aged ; Mutation ; Neoplasm Staging ; Retrospective Studies ; Survival Analysis ; Tomography, X-Ray Computed

Objective: To investigate the current situation of exposure of solid particles in medical staff and the occurrence of related diseases, and to understand the distribution characteristics of occupational exposure and the influencing factors. Methods: In August 2016, the stratified cluster sampling method was adopted to select three tertiary general hospitals with different regions, different administrative levels and departments in Shandong Province. A face-to-face questionnaire survey was conducted on the basic situation of the staff of the hospital, the status of exposure to occupational hazards and the health effects. Two-class logistic regression analysis was used to analyze the relationship between medical staff's solid particle contact and occupational health effects. In August 2016, the stratified cluster sampling method was adopted to select three tertiary general hospitals with different regions, different administrative levels and departments in Shandong Province, which were in contact with the basic conditions and occupational hazards of the staff of the hospital. Current situation and health impacts were conducted face-to-face questionnaires. Two-class logistic regression analysis was used to analyze the relationship between medical staff's solid particle contact and occupational health effects. Results: The overall contact rate of solid particles of medical staff was 41.5% (1843/4 446) , and the solid particles with the highest contact rate were 28.2% (1254/4 446) of talc dust. There was a statistically significant difference in the contact rate of solid particles between medical staff of different occupations, current working age, education and hospital type (χ²=76.30, 41.26, 26.16, 188.97, P<0.05) . There were significant differences in the conditions and types of solid particles in different departments (χ²=740.23, P<0.05) . Compared with the control group, the incidence of allergic asthma, chronic tracheobronchitis and dermatitis was higher in the contact group medical staff (P<0.05) . Contact with zirconia dust, talc dust, cotton dust is a risk factor for dermatitis in medical staff (OR=2.09, 1.45, 1.34) ; exposure to zirconia dust and cotton dust is a risk factor for chronic tracheobronchitis in medical staff (OR=2.38, 1.66) ; exposure to zirconia dust, gypsum dust is a risk factor for allergic asthma in medical staff (OR=3.90, 1.52) . Conclusion The contact rate of solid particles in medical staff is high, and there are many types of contact. Frequent contacted with solid particles is a dangerous cause of related diseases. The working environment of medical staff should be further monitored and be strengthen the targeted protective measures and regulatory systems for the exposure of medical personnel to solid particles.

Objective: To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer. Methods: Sixty-five patients with locally advanced gastric cancer (LAGC) confirmed by gastroscopy and received neoadjuvant chemotherapy (NCT) were enrolled in this study. Quantitative DCE-MRI was performed before NCT, and the quantitative parameters were measured, including volume transfer constant (K^trans), rate constant (K_ep), volume fraction of extravascular extracellular space (V_e) and volume fraction of plasma (V_p). After NCT, all patients received radical gastrectomy. According to postoperative pathological tumor regression grade, patients were divided into response group and non-response group, and the differences of DCE quantitative parameters between the two groups were compared. ROC curve was utilized to analyze the predictive efficacy of DCE quantitative parameters for NCT response of LAGC, and multivariate logistic regression analysis was performed to analyze the predictive efficacy of combined parameters. Results: Thirty-seven patients were in response group and 28 patients were in non-response group. The pretreatment K^trans in the response group were [0.216 min^-1 (0.130 min^-1, 0.252 min^-1)], significantly higher than [0.091 min^-1 (0.069 min^-1, 0.146 min^-1)] of non-response group (P<0.001), and V_e in the response group were [0.354(0.228, 0.463)], significantly higher than [0.200(0.177, 0.253)]of non-response group (P<0.001). ROC analysis showed the AUCS of K^trans and V_e in predicting NCT efficacy were 0.881 and 0.756, respectively. Multiple logistic regression analysis showed that the combination of the two parameters could improve the AUC to 0.921, with the sensitivity and specificity of 86.5% and 89.3%, respectively. Conclusion DCE-MRI quantitative parameters could help to predict the NCT response of LAGC, and the combination of parameters could improve the predictive efficacy.

Objective To investigate the predictive value of dynamic contrast?enhanced magnetic resonance imaging ( DCE?MRI) quantitative parameters for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer. Methods Sixty?five patients with locally advanced gastric cancer (LAGC) confirmed by gastroscopy and received neoadjuvant chemotherapy ( NCT ) were enrolled in this study. Quantitative DCE?MRI was performed before NCT, and the quantitative parameters were measured, including volume transfer constant (Ktrans ), rate constant ( Kep ), volume fraction of extravascular extracellular space (Ve) and volume fraction of plasma (Vp). After NCT, all patients received radical gastrectomy. According to postoperative pathological tumor regression grade, patients were divided into response group and non? response group, and the differences of DCE quantitative parameters between the two groups were compared. ROC curve was utilized to analyze the predictive efficacy of DCE quantitative parameters for NCT response of LAGC, and multivariate logistic regression analysis was performed to analyze the predictive efficacy of combined parameters. Results Thirty?seven patients were in response group and 28 patients were in non?response group. The pretreatment Ktrans in the response group were [ 0.216 min－1 ( 0.130 min－1, 0.252 min－1)], significantly higher than [0.091 min－1(0.069 min－1, 0.146 min－1 )] of non?response group (P＜0.001), and Ve in the response group were [0.354 ( 0.228, 0.463)], significantly higher than [ 0.200 (0.177, 0.253)] of non?response group (P＜0.001). ROC analysis showed the AUCS of Ktrans and Ve in predicting NCT efficacy were 0.881 and 0.756, respectively. Multiple logistic regression analysis showed that the combination of the two parameters could improve the AUC to 0.921, with the sensitivity and specificity of 86.5% and 89.3%, respectively. Conclusion DCE?MRI quantitative parameters could help to predict the NCT response of LAGC, and the combination of parameters could improve the predictive efficacy.