Objective To investigate the prevalence of work-related musculoskeletal disorders (WMSDs) in passenger drivers and its influencing factors. Methods A total of 951 passenger drivers in Guangdong Province were selected as the research subjects using the judgmental sampling method. A Musculoskeletal Injury Questionnaire was employed to assess the prevalence of WMSDs in the past year. Results The prevalence of WMSDs in passenger drivers was 41.11%. The result of multivariable logistic regression analysis showed that married drivers had a higher risk of WMSDs than single drivers (P<0.05). The lower the frequency of physical exercise, the longer the driving time per week, the longer the continuous driving time, the more restricted the driving working space, the poorer the foot comfort during driving, and the more affected the normal meal, the higher the risk of WMSDs (all P<0.05). The risk of WMSDs in drivers with sleep time ≤ 8.0 h/d was higher than that in drivers with sleep time > 8.0 h/d (P<0.01), and the risk of WMSDs in drivers with the same posture for a long time on the shoulder was higher than that in drivers without this poor working posture (P<0.01). Conclusion WMSDs were prevalent among passenger drivers, which was associated with demographic and adverse ergonomic factors. Intervention on lifestyle and adverse ergonomic factors could further reduce the risk of WMSDs of passenger drivers.

Objective:To investigate the effect of lower limb exoskeleton robots on balance function in children with spas-tic diplegia. Method:Twenty children with spastic diplegia who were admitted to the Department of Rehabilitation of the Children's Hospital of Zhejiang University School of Medicine from July 2022 to December 2022 were includ-ed in the treatment group.The other 20 children matched with age,gender and functional status were includ-ed in the control group.Both groups were given conventional rehabilitation training(exercise therapy,suspen-sion training,isokinetic muscle strength training),and the treatment group were received the 30-min lower limb exoskeleton robot training 5 times a week for 8 weeks.Before and after treatment,the two groups were tested with surface electromyography(sEMG)data,dynamic balance response displacement,static balance score,and Pediatric Balance Scale(PBS). Result:Before treatment,there was no statistically significant difference(P＞0.05)in sEMG values(gluteus maximus,gluteus medius,quadriceps femoris and tibialis anterior muscle),dynamic balance reaction displace-ment,static balance score,and PBS score between the two groups.There were significant improvements in the scores of these measurements(P＜0.05)in both group before and after treatment.Compared with the con-trol group,there were statistically significant differences in sEMG values(gluteus maximus P=0.021;gluteus medius P=0.016;quadriceps femoris P=0.004),dynamic balance reaction displacement(anterior P=0.014;left P=0.003;right P=0.003),static balance score(P=0.005),and PBS score(P=0.004)in the treatment group af-ter treatment. Conclusion:Lower limb exoskeleton robot gait training combined with conventional rehabilitation treatment can effectively improve the balance function of cerebral palsy children with spastic diplegia.

Objective:To investigate the effect of gene polymorphism of β1 adrenergic receptor (β1-AR) G1165C and A145G locus on myocardial hypertrophy and the efficacy in patients with hypertension.Methods:Two hundred and twenty-seven cases of patients with hypertension admitted to Binhai County People′s Hospital from January to December 2019 were enrolled. Among them, there were 113 cases of hypertension with myocardial hypertrophy and 114 cases of hypertension without myocardial hypertrophy. In addition, 115 patients with normal physical examination during the same period were selected as the control group. DNA in the peripheral blood leukocytes was extracted, polymerase chain reaction-restriction fragment length polymorphism method was used to detect β1-AR G1165C and A145G locus gene polymorphism, and the differences in the efficacy of β blockers in hypertensive patients with different genotypes were compared.Results:There was no statistically significant differences in the distribution of β1-AR A145G genotypes among the three groups ( P>0.05). Compared with the healthy control group, the frequency of Gly/Gly genotype carrying β1-AR G1165C locus was higher in hypertension with myocardial hypertrophy group, and the frequency of Gly/Arg and Arg/Arg gene were lower; compared with hypertension without myocardial hypertrophy group, the frequency of Gly/Arg+Gly/Gly gene in hypertension with myocardial hypertrophy group was higher; taking Arg/Arg genotype as the control group, carrying Gly/Gly genotype could increase the risk of cardiac hypertrophy in hypertensive patients by 3.159 times ( OR = 3.159, 95% CI 1.240 - 7.412, P<0.05).The frequency of G1165C allele Arg in the hypertension with myocardial hypertrophy group was significantly lower than that in the control group and the hypertension without myocardial hypertrophy group ( P<0.05); the frequency of G1165C allele Gly was significantly higher than that in the control group and the hypertension without myocardial hypertrophy group ( P<0.05); taking Arg/Arg genotype as the control, carrying Gly/Gly genotype could increase the risk of cardiac hypertrophy in hypertensive ( OR = 3.417, 95% CI 1.357 - 7.965, P<0.05). The left ventricular mass index of Gly/Gly genotype patients was (120.38 ± 28.41) g/m 2, which was significantly higher than (99.76 ± 25.16) g/m 2 and (90.30 ± 19.54) g/m 2 of Gly/Arg and Arg/Arg, with statistically significant differences ( F = 10.89, P<0.01). After the treatment, the resting heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure of patients with G1165C allele Arg hypertension with myocardial hypertrophy were lower than those with G1165C allele Gly, with statistically significant differences ( P<0.05). Conclusions:β1-AR G1165C gene polymorphism is related to the risk of myocardial hypertrophy in hypertensive patients. Carrying the G1165C allele Gly may increase the risk of susceptibility to cardiac hypertrophy, and β-blockers are more effective in hypertensive patients with myocardial hypertrophy who carry the G1165C allele Arg.

Objective:To evaluate the development of children 2-4 years old with autism spectrum disorders (ASDs) using the Chinese version of the Griffiths Development Scales (GDS-C).Methods:Eighty-eight children with ASD, 80 children with developmental language disorder (DLD) and 82 healthy children aged 2-4 were evaluated using the GDS-C. They were compared and their development in sports, personal and social relationships, language, hand-eye coordination and other performance were analyzed. The personal-social and language results of the ASD and DLD children were compared.Results:No significant differences were found between the ASD and DLD children in their language development. The development quotient of the ASD children was significantly lower, on average, than those of the DLD and healthy children in all fields except language. However, the ASD children′s development was not balanced. Their average developmental quotients in the language and the personal-social fields were significantly lower than in the sports, performance and hand-eye coordination fields. In the field of language, the entry loss rates of the two structural modes of receptive language and non-verbal expression of the ASD children were significantly higher than the DLD children′s averages. In the personal-social field the entry loss rates of communication and housework skills and of self-care skill were significantly higher than the DLD children′s averages. The command structure model of the ASD children was also superior, on average.Conclusions:The GDS-C can effectively assess the development of ASD children aged 2-4, especially in terms of language and personal and social skills. It can provide clinical evidence useful for early diagnosis and intervention for children with ASD.

Objective: To investigate the prevalence, awareness, treatment and control of hypertension in adult residents in Jiangsu province and provide evidence for the prevention and control of hypertension. Methods: A population-based cardiovascular disease screening project was conducted during 2015-2018 in Jiangsu, a total of 95 348 community-dwelling adults aged 35-75 years from 6 project areas were included in the study. The prevalence rate of hypertension and rates of awareness, treatment and control of hypertension in the adults with different characteristics were analyzed. Multilevel model was applied to identify the influencing factors. Results: Among 95 348 adults surveyed, 54 407 were hypertensive, the standardized prevalence rate was 48.1%. The prevalence rate was significantly higher in males than in females (62.1% vs. 54.0%, P<0.05). Among the hypertension patients, the rates of awareness, treatment and control of hypertension were 56.6%, 45.3% and 12.0% (standardized rates: 52.2%, 41.0% and 11.2%), respectively, and all the rates were positively associated with age (all P<0.05). Multilevel model analysis showed that those who were males, at older age, lived in rural area, suffered from diabetes, had frequent alcohol drinking and those who were overweight/obese had higher risk for hypertension (all P<0.05). Among people with hypertension, those who had younger age, lower education level, lower household income level and those who had frequent alcohol drinking had lower awareness, treatment and control rates of hypertension (all P<0.05). Conclusions The prevalence rate of hypertension was high, but related awareness, treatment and control rates were low in adult residents in Jiangsu province. Comprehensive measures should be taken to improve awareness, treatment and control of hypertension in whole population, especially in young adults, and those with low education or income levels.

OBJECTIVE: To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. METHODS: The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. RESULTS: The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. CONCLUSIONS The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
China ; Humans ; Liver Transplantation

Objective To evaluate the efficacy of surgical procedure for tibia-fibula fracture using a combination of internal fixation and vacuum sealing drainage(VSD).Methods Totally 108 patients were enrolled in this study and these patients were from January 2012 to December 2015 divided into two groups(54 per group) according to the surgical method.Patients in the observation group were treated with locking plates or intramedullary naiis fixation combined with VSD covered the wound for the following 6 to 10 days,and then the transplantation was performed.Patients in control group received external fixation with kirschner wire and screw fixation.When granulation tissue filled the wound,flap transplantation was performed to repair tissue defect and cover the exposed bone.The average hospital stay,operation time,local infection rate,fracture healing time were recorded and analyzed.Results In the observation group,the average hospital stay was (24.8 ± 4.2) d,wound closure time was (9.4 ± 1.7) d,rate of local infection was 5.6％,rate of bone nonunion was 7.4％,rate of osteomyelitis was 1.9％,fracture healing time was (17 ±4.7)weeks;the corresponding data in the control group was (32.2 ±8.7)d,(14.1 ±3.8)d,22.2％,9.3％,0 and (16 ± 6.5) weeks.The average hospital stay,wound closure time and infection rate of the two groups were of significant difference(P ＜0.05).There was no significant difference in terms of bone nonunion rate,osteomyelitis rate and union time (P ＞ 0.05).Conclusion Tibia-fibula fracture patients can be effectively treated with a combination of internal fixation and vacuum sealing drainage (VSD).This treatment may shorten the length of hospital stay,reduce the wound-close time and lower the infection rate.

Objective Through comparing ultrasound-guided microwave ablation (MWA) with surgical resection for the treatment of nodular goiter to evaluate the effect of RFA on the thyroid function.Methods A total of 50 patients with nodular goiter,who were admitted to authors' hospital during the period from January 2010 to January 2013 to receive ultrasound-guided MWA,were selected and used as the study group;and other 96 patients with nodular goiter,who were encountered at authors' hospital during the same period to receive partial thyroidectomy,were collected and used as the control group.Of the 50 patients in the study group,RFA of unilateral lobe nodules was performed in 8 and RFA of bilateral lobe nodules in 42.Among the 96 patients in the control group,unilateral lobe nodules were seen in 52 and bilateral lobe nodules in 44.Postoperative complications were recorded,the serum FT3,FT4,TSH levels were determined at one week,as well as one,3,6 and 12 months after the treatment.The results were statistically analyzed.Results All patients were followed up for 12 months.In the study group,no complications occurred;one week after RFA the serum FT3 and FT4 levels increased while the serum TSH level decreased when compared with preoperative ones,and the differences were statistically significant (P＜0.05).In the control group,bleeding asphyxia occurred in one patient,hoarseness in 5 patients and hypocalcemia convulsion in 3 patients.One week after partial thyroidectomy,the serum FT3 and FT4 levels increased while the serum TSH level decreased when compared with preoperative data,and the differences were statistically significant (P＜0.05).One week after surgery thyroxine replacement therapy was routinely given to 44 patients who had received bilateral subtotal thyroidectomy.Three patients who had received unilateral subtotal thyroidectomy developed hypothyroidism at 3,6 and 8 months after the surgery respectively.In other 49 patients receiving unilateral subtotal thyroidectomy the serum FT3,FT4,TSH levels determined at one,3,6 and 12 months after surgery were significantly different from those in the patients of the study group (P＜0.05).Conclusion For the treatment of nodular goiter,ultrasound-guided MWA is quite safe.MWA has very slight effect on thyroid function and is definitely superior to subtotal thyroidectomy.Therefore,MWA is a minimally invasive technique which is worthy of clinical promotion.

Objective To explore risk factors for healthcare-associated infection (HAI)in patients undergoing craniocerebral operation,and provide guidance for the prevention of HAI in patients in department of neurosurgery. Methods 200 patients who underwent craniocerebral operation in a department of neurosurgery from November 2013 to November 2014 were surveyed,risk factors for HAI were analyzed.Results Among 200 patients undergo-ing craniocerebral operation,81 patients developed 99 cases of HAI,HAI rate was 40.50%,HAI case rate was 49.50%;the top five HAI sites were lower respiratory tract,urinary tract,intracranial site,bloodstream,and in-testinal tract.Univariate analysis showed that patients’age ≥60,Glasgow Coma Scale (GCS)<15,intraoperative blood loss ≥800 mL,staying in intensive care unit(ICU),indwelling gastric tube,ventricular drainage,using ventilator,tracheotomy,and using H2 receptor antagonists were important risk factors for HAI in patients undergo-ing craniocerebral operation (all P <0.05).Multivariate logistic regression analysis showed that patients’age ≥60, GCS<15,staying in ICU,and using H2 receptor antagonists were independent risk factors for HAI in patients un-dergoing craniocerebral operation.Conclusion Strengthening the surveillance of HAI patients undergoing cranioce-rebral operation and realizing risk factors for HAI are helpful for taking comprehensive prevention measures and re-ducing the incidence of HAI.

Objective To establish the reference intervals of 20 dry biochemical items in different age periods among healthy population in Chengdu to providing better support and service for clinical diagnosis and treatment .Methods The stratified random‐ized cluster method was used to collect healthy children and adults in 4 age periods(1 month-3 years old ,>3-7 years old ,>7-18 years old and >18 years old) .Totally 1 495 healthy people (740 males and 755 female) were screened out as the research sub‐jects by the questionnaire ,physical examination and laboratory screening .Fasting venous blood samples were collected from these cases ,then the VITROS 5600 dry biochemistry analyzer was used to detect 20 biochemical items .The obtained results were statisti‐cally analyzed .Results In different groups according to sex and age ,except the conjugated bilirubin (BC) was constant 0 μmol/L , the other items had statistical differences (P<0 .05) .After merging the different groups without statistically significant difference , the obtained reference intervals had significant differences compared with the reference intervals provided by the manufacturer .Con‐clusion Laboratory should establish the different reference intervals aiming at different age and gender populations according to the special character of hospital visiting populations in order to meet the clinical requirements .