Objective Chlorination is often used to disinfect recreational water in large amusement parks;however,the health hazards of chlorination disinfection by-products(DBPs)to occupational populations are unknown.This study aimed to assess the exposure status of chlorinated DBPs in recreational water and the health risks to employees of large amusement parks. Methods Exposure parameters of employees of three large amusement parks in Shanghai were investigated using a questionnaire.Seven typical chlorinated DBPs in recreational water and spray samples were quantified by gas chromatography,and the health risks to amusement park employees exposed to chlorinated DBPs were evaluated according to the WHO's risk assessment framework. Results Trichloroacetic acid,dibromochloromethane,bromodichloromethane,and dichloroacetic acid were detected predominantly in recreational water.The carcinogenic and non-carcinogenic risks of the five DBPs did not exceed the risk thresholds.In addition,the carcinogenic and non-carcinogenic risks of mixed exposure to DBPs were within the acceptable risk limits. Conclusion Typical DBPs were widely detected in recreational water collected from three large amusement parks in Shanghai;however,the health risks of DBPs and their mixtures were within acceptable limits.

This study utilized the CCK-8 assay to examine the effects of various concentrations of CoCl2(0,50,100,200,300,400 μmol/L)and different treatment durations(0,6,12,24,48 h)on the viability of adipocytes,in order to determine the most suitable treatment conditions.Western blot analysis was employed to investigate the impact of different concentrations of CoCl2(0,50,100,200,400 μmol/L)on the expression of hypoxia and its downstream key proteins in adipocytes.The results indicated that higher concentrations of CoCl2 led to lower adipocyte viability,with sig-nificant decreases in cell viability observed in the 300,400 μmol/L treatment groups(P＜0.01),while the 200 μmol/L group exhibited the highest cell viability.Compared to the control group,the 200 μmol/L CoCl2 treatment group showed a significant upregulation in the expression of hypoxia and its downstream signaling pathway key molecules:hypoxia-inducible factor 1-alpha(HIF-1α),glucose transporter type 4(GLUT4),vascular endothelial growth factor receptor 1(FLT-1),prolyl hydroxylase 2(PHD2),and vascular endothelial growth factor(VEGF)(P＜0.01).Addi-tionally,the 200 μmol/L CoCl2 treatment group exhibited higher levels of key lipolytic enzymes,including adipose triglyceride lipase(ATGL),perilipin 1(PLIN1),protein kinase A(PKA),and increased phosphorylation levels of hormone-sensitive lipase(HSL)in the 300 and 400 μmol/L groui ps(P＜0.01).CoCl2-mediated hypoxia in the 200 μmol/L treatment group also in-creased the protein expression of phosphatidylinositol 3-kinase(PI3K)and the phosphorylation level of protein kinase B(Akt).These findings suggest that adding 200 μmol/L CoCl2 can enhance the expression of hypoxia-related proteins,lipolytic enzymes,and insulin-related signaling proteins in primary bovine adipocytes.

Objective:To explore the influencing factors of HIV-1 DNA and its clinical value.Methods:The relationship between HIV-1 DNA and CD4 + T cell count, CD4/CD8, HIV viral load and subtype was analyzed in 304 patients with HIV/AIDS in order to explore the factors affecting HIV-1 DNA and the value of clinical application. Results:There was no statistically significant difference in HIV-1 DNA levels between the different CD4 + T cell level groups (Z=1.194, P>0.05). HIV-1 DNA levels were higher in the CD4/CD8≤0.5 group than in the CD4/CD8>0.5 group (Z=-2.788, P<0.01). HIV-1 DNA levels were higher in the HIV viral load >100 copies/ml group than in the ≤100 copies/ml group (Z=-2.953, P<0.01). HIV-1 DNA levels were higher in those with CD4 + T cell counts ≤200 at diagnosis than in those with CD4 + T cell counts >200 at diagnosis (Z=-2.175, P<0.05). HIV-1 DNA levels were higher in patients with CD4/CD8 ≤0.2 at diagnosis than in those with CD4/CD8 between 0.2 and 0.5, but there was no significant difference between the two groups (Z=-0.893, P>0.05). HIV-1 DNA levels were higher in both groups than in the CD4/CD8≥0.5 group (Z=-2.568, Z=-1.960, P<0.05). Higher HIV-1 DNA levels were found in people with an HIV viral load >100, 000 copies/ml at diagnosis than in people with an HIV viral load ≤100, 000 copies/ml at diagnosis (Z=-3.520, P<0.001). The level of HIV-1 DNA was higher in the CRF01_AE group than in the non-CRF01_AE group, and the difference was statistically significant (Z=-2.848, P<0.01). CD4/CD8 seemed to be a protective factor for HIV-1 DNA>500 copies/ml. (OR=0.214(95%CI: 0.056~0.822, P<0.05) Conclusion:CD4 + T lymphocyte count, CD4/CD8, viral load and subtype are factors that influence HIV-1 DNA levels, while HIV-1 DNA may be informative for immune status assessment and disease progression determination.

Objective To investigate the association of biliary, pancreatic, and ampullary tumors with the onset of acute pancreatitis (AP) and the clinical features of tumor-induced AP by retrospectively analyzing the clinical data of patients with tumor-induced AP. Methods Related clinical data were collected from the patients with AP who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to August 2021. The etiological composition of AP was analyzed, as well as the change in the incidence rate of tumor-induced AP; the clinical features of AP were compared between tumor-induced and non-tumor-induced AP and between the tumors at different locations to explore the pathogenesis of tumor-induced AP. For normally distributed continuous data, the t -test was used for comparison between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK- q test was used for further comparison between two groups. For non-normally distributed continuous data, the Mann-Whitney U test was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test or the Fisher's exact test was used for comparison of dichotomous categorical data between groups, and the goodness-of-fit test was used for comparison of polytomous categorical data between groups. The receiver operating characteristic (ROC) curve was used to evaluate the differential factors for pancreatic tumor-induced AP, and a multivariate logistic regression analysis was used to investigate the independent predictive factors for tumor-induced AP. Results A total of 8106 patients with AP were enrolled, among whom 84 patients (1.04%) had tumor-induced AP (tumor group). The tumor group had a significantly higher mean age than the non-tumor group ( t =6.050, P < 0.001). The mean time from initial onset of AP to tumor diagnosis was 7.38 months. Among the 84 patients with tumor-induced AP, 75 (89.2%) had mild AP (MAP), 8 (9.5%) had moderate severe AP, and 1(1.2%) had severe AP; as for the origin of tumor, 11(13.1%) had tumor originating from the lower biliary tract, 13(15.5%) had tumor originating from the ampulla, and 60(71.4%) had tumor originating from the pancreas. Recurrence of AP (risk ratio [ RR ]=8.362, 95% confidence interval [ CI ]: 3.162-22.115, P < 0.001), pancreatic duct dilatation ( RR =10.996, 95% CI : 3.871-31.236, P < 0.001), bile duct dilatation ( RR =7.738, 95% CI : 2.521-23.752, P < 0.001), and leukocyte count ( RR =0.766, 95% CI : 0.666-0.881, P < 0.001) were independent predictive factors for tumor-induced AP. Conclusion Tumor-induced AP is common in middle-aged and elderly men, with the clinical manifestations of MAP, easy recurrence, pancreatic duct dilatation/bile duct dilatation, and a persistent increase in the tumor marker CA19-9. Imaging examination of the biliary, pancreatic, and ampullary regions should be enhanced for AP with the above characteristics and no apparent trigger, and follow-up should be strengthened to avoid the missed diagnosis of tumor and the influence on prognosis.

Objective:To investigate the relationship between medical students' employment intention in primary healthcare unit and their learning and psychological state through a questionnaire survey among clinical undergraduates.Methods:A cross-sectional survey was conducted among 821 graduates of a Medical University in 2017 to investigate their employment intention, learning and psychological status and employment plan. The learning and psychological status was evaluated by a self-designed questionnaire. Independent-sample t test, variance analysis and multiple linear regression analysis were used to examine the relevant factors affecting medical students' employment intention in primary healthcare by SPSS 21.0 version. Results:A total of 810 questionnaires were distributed and 753 questionnaires were included in the analysis. The employment intention of working in primary healthcare units of medical students was (4.61±2.24). Students in the advanced class had lower willingness to work in primary healthcare unit (the group of students with higher entrance examination scores) ( P<0.05), and students with higher learning pressure and greater pressure of doctor-patient relationship were more reluctant to work in primary healthcare units ( P<0.05). In terms of the employment plan, students who focus on their professional counterparts are more willing to work in primary healthcare unit, while those who pay more attention to salary are less willing to work in primary healthcare unit ( P<0.05). Conclusion:Improving the incentive policies for working in primary healthcare unit, actively relieving psychological pressure of medical students, and increasing the training of doctor-patient communication can have a positive effect on improving the willingness of medical students to have an employment intention in primary healthcare unit.

Object the current radiological health situation of different ranks medical institutions of interventional radiology in a city of Pearl Delta. Methods all the medical institutions in the city, which had carried out interventional radiology before December 31, 2019 as the research objects by survey. By using the method of field epidemiological investigation, the basic situation of general messages, the status of protective facilities, environmental radiation does, personal protective equipment, occupational health monitoring were investigated. Results There were 12 interventional radiology equipment and 180 employees in 7 medical institutions in the city, before December 31, 2019. There was no statistical significance in the composition of employees of different ranks medical institutions (P > 0.05). There was no statistical significance in the composition of protective facilities for interventional treatment in different ranks hospitals (P > 0.05). The environmental radiation dose in interventional radiology devices room of grade A class 3 hospital was higher than that of grade A class 2 hospital (P < 0.05). There was no statistical significance in the composition of individual protective equipment for interventional therapy in different ranks medical institutions (P > 0.05). The proportion of occupational health examination before work and during work in grade A class 2 hospital was higher than A class 3 hospital (P < 0.01). Conclusion The current situation of radiological health of different ranks medical institutions of interventional radiology in a city of Pearl Delta was good momentum. It may be helpful to improve the radiological health protection level of interventional therapy in this city by strengthening the radiological protection management of applying for interventional therapy, actively carrying out the evaluation of radiological protection against occupational disease hazards in construction projects, and urging the employee to carry out the occupational health monitoring inspection as required.

Objective:To evaluate the effect of transfusion-free techniques on the prognosis of liver transplant patients.Methods:The recipients of adult liver transplantation at Tianjin First Central Hospital from August to December 2019 were included in the clinical observation. Liver transplantation without allogeneic blood transfusion was performed through anesthesia management techniques such as acute hemodilution or phlebotomy without volume replacement,maintaining decreased baseline central venous pressure and cell saver. According to the actual results,the patients were divided into two groups: transfusion-free group( n=21) and allogeneic transfusion group( n=28). There were 13 males and 8 females aged of (56.3±11.6) years in the transfusion-free group;and there were 16 males and 12 females aged (54.3±14.2)years in the allogeneic transfusion group. The transplant recipients who had not adopted transfusion management strategy from January to July 2019 were included as control group(27 males and 13 females,aged of (58.9±14.1)years). The clinical data of patients in perioperative period were collected to compare whether there were differences in the recovery of liver function and early complications among the three groups, one-way ANOVA test, rank-sum test, and χ 2 test were used for data analysis. Results:The amount of intraoperative blood loss in both the transfusion-free group and the transfusion group was less than that in the control group((454.2±271.3)ml vs.(673.6±333.4)ml vs.(890.3±346.7)ml; q=-6.342,-5.286,both P<0.05).The duration of stay in ICU of the transfusion-free group was less than that of the transfusion group and control group((36.4±9.1)hours vs.(44.3±14.9)hours vs.(58.2±21.1)hours; q=-4.432,-3.824,both P<0.05).The mean ALT level at 7 days after operation was significantly lower in the transfusion-free group than in the control group((56.8±32.1)U/L vs.(89.6±45.6)U/L; q=-3.358, P<0.05). Conclusions:The improvement of multi-disciplinary transfusion management technology aimed at transfusion-free liver transplantation can effectively reduce intraoperative hemorrhage and help to avoid surgical transfusion. Transfusion-free liver transplantation is beneficial to the early postoperative recovery,and its long-term clinical significance is worthy of further clinical research.

Based on domestic and foreign literature, this article systematically elaborates the frailty assessment tools for the aged, and summarizes effective intervention measures to prevent and improve frailty, such as exercise, nutrition and social support, so as to provide a reference for clinical nurses or researchers to compile a frailty assessment scale suitable for the aged in my country and to formulate a comprehensive frailty intervention model.

Objective:To evaluate the effect of transfusion-free techniques on the prognosis of liver transplant patients.Methods:The recipients of adult liver transplantation at Tianjin First Central Hospital from August to December 2019 were included in the clinical observation. Liver transplantation without allogeneic blood transfusion was performed through anesthesia management techniques such as acute hemodilution or phlebotomy without volume replacement,maintaining decreased baseline central venous pressure and cell saver. According to the actual results,the patients were divided into two groups: transfusion-free group( n=21) and allogeneic transfusion group( n=28). There were 13 males and 8 females aged of (56.3±11.6) years in the transfusion-free group;and there were 16 males and 12 females aged (54.3±14.2)years in the allogeneic transfusion group. The transplant recipients who had not adopted transfusion management strategy from January to July 2019 were included as control group(27 males and 13 females,aged of (58.9±14.1)years). The clinical data of patients in perioperative period were collected to compare whether there were differences in the recovery of liver function and early complications among the three groups, one-way ANOVA test, rank-sum test, and χ 2 test were used for data analysis. Results:The amount of intraoperative blood loss in both the transfusion-free group and the transfusion group was less than that in the control group((454.2±271.3)ml vs.(673.6±333.4)ml vs.(890.3±346.7)ml; q=-6.342,-5.286,both P<0.05).The duration of stay in ICU of the transfusion-free group was less than that of the transfusion group and control group((36.4±9.1)hours vs.(44.3±14.9)hours vs.(58.2±21.1)hours; q=-4.432,-3.824,both P<0.05).The mean ALT level at 7 days after operation was significantly lower in the transfusion-free group than in the control group((56.8±32.1)U/L vs.(89.6±45.6)U/L; q=-3.358, P<0.05). Conclusions:The improvement of multi-disciplinary transfusion management technology aimed at transfusion-free liver transplantation can effectively reduce intraoperative hemorrhage and help to avoid surgical transfusion. Transfusion-free liver transplantation is beneficial to the early postoperative recovery,and its long-term clinical significance is worthy of further clinical research.

Objective:To investigate the relationship between medical students' employment intention in primary healthcare unit and their learning and psychological state through a questionnaire survey among clinical undergraduates.Methods:A cross-sectional survey was conducted among 821 graduates of a Medical University in 2017 to investigate their employment intention, learning and psychological status and employment plan. The learning and psychological status was evaluated by a self-designed questionnaire. Independent sample t-test, variance analysis and multiple linear regression analysis were used to examine the relevant factors affecting medical students' employment intention in primary healthcare by SPSS 21.0 version.Results:A total of 810 questionnaires were distributed and 753 questionnaires were included in the analysis. The employment intention of working in primary healthcare units of medical students was 4.61±2.24. Students in the advanced class had lower willingness to work in primary healthcare unit (the group of students with higher entrance examination scores) ( P<0.05), and students with higher learning pressure and greater pressure of doctor-patient relationship were more reluctant to work in primary healthcare units ( P<0.05). In terms of the employment plan, students who focus on their professional counterparts are more willing to work in primary healthcare unit, while those who pay more attention to salary are less willing to work in primary healthcare unit ( P<0.05). Conclusion:Improving the incentive policies for working in primary healthcare unit, actively relieving psychological pressure of medical students, and increasing the training of doctor-patient communication can have a positive effect on improving the willingness of medical students to have an employment intention in primary healthcare unit.