Objective To evaluate the risk of occupational noise-induced hearing loss in workers in a metal tool manufacturing enterprise, and to carry out risk classification and risk management. Methods A total of 91 male noise-exposed workers from a metal tool manufacturing enterprise in Hebei Province were selected as the research subjects using the convenience sampling method. The work site survey on occupational health and the measurement on individual noise exposure level were carried out. The ISO 1999：2013 (E) Acoustics-Estimation of Noise-Induced Hearing Loss was used to predict the risk of high frequency hearing loss (HFHL) and occupational noise-induced deafness (ONID). The risk classification and risk management were conducted using the WS/T 754-2016 Guideline for Risk Management of Occupational Noise Hazard (hereinafter referred to as WS/T 754-2016). Results The individual noise exposure intensity of workers in the six work sites of the enterprise, including blade workers, sheet punching workers, roller forging workers (hoe), hole punching workers, roller forging workers(shovels), and carpenters, exceeded the national occupational exposure limit, with the maximum volume of 91.2-104.1 dB(A). Among these workers, the positions of blade workers, sheet punching workers, and roller forging workers (hoe) were identified as critical control points for noise hazards in the enterprise. The detection rates of HFHL and ONID were 24.2% and 8.8%, respectively. The risk prediction results showed that, based on the actual noise exposure time and age of the study subjects, the risk of HFHL and ONID ranged from 1.7%-48.8% and 0.0%-29.5%, respectively. The risks of HFHL caused solely by occupational noise exposure when working up to 50.0, 55.0, and 60.0 years of age were 11.4% to 64.7%, 16.4% to 65.1%, and 17.2% to 59.4%, respectively. The risks of ONID caused solely by occupational noise exposure were 0.0% to 45.5%, 4.2% to 51.7%, and 5.9% to 57.4%, respectively. Except for the blade workers, the predicted median of potential noise-induced permanent threshold shifts (NIPTS) in the other five positions were lower than the actual values of NIPTS, with the difference ranging from 3.0-28.3 dB, and 73.3% of them underestimated by 10.0 dB or more. Conclusion The outcome of noise exposure on the hearing of workers in this enterprise are severe. Risk management should be conducted according to the WS/T 755-2016.

OBJECTIVE: To assess the efficacy of letrozole in treatment of children with congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency (21-OHD). METHODS: Twenty eight children, including 19 boys and 9 girls aged 4-10y, with CAH due to 21-OHD were enrolled in the study. At the first six months of study, all children received conventional treatment with hydrocortisone or fludrocortisone, then letrozole was added to original regimen. The height velocity (HV), difference between bone age and chronological age (BA-CA), height standard diviation score based on bone age (HtSDS ), predicted adult height (PAH), Tanner phase, sex hormone, and possible adverse reaction were evaluated and compared between those before and after letrozole treatment. RESULTS: After 6 months of letrozole treatment, there was significant deceleration of HV, but it would recover soon. There was significant increase of HtSDS after 12 months of letrozole treatment ( < 0.05 or < 0.01), and significant changes in BA-CA after 18 months of letrozole treatment ( < 0.05). PAH of female children was significantly increased during letrozole treatment ( < 0.05), whereas PAH of male children was significantly increased 18 months after letrozole treatment ( < 0.05). Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were significantly increased, but did not meet the diagnostic criteria of central precocious puberty. Estradiol was significantly decreased ( < 0.01), but no changes in testosterone level was observed. During 24 months letrozole treatment, no hirsutism, severe acne, headache, bone pain, obesity, hypertension, rash and other adverse reactions were observed. CONCLUSIONS Letrozole can delay bone maturation and improve PAH, which can be used with conventional treatment for children with CAH due to 21-OHD, especially for those with high BA and low PAH.
Adrenal Hyperplasia, Congenital ; drug therapy ; Body Height ; Child ; Child, Preschool ; Female ; Humans ; Letrozole ; therapeutic use ; Male ; Puberty, Precocious

ObjectiveTo explore the effects of applying multidisciplinary team based action study method in quality control of blood samples before test in order to improve the quality of inpatients' blood samples before test. MethodsA multidisciplinary team which was mainly led by the Nursing Department, professionally guided by the department of Clinical Laboratory and assisted by the Service Center as well as the Information Center was established. We analyzed the quality of the blood samples before examination in August 2017 in a Class Ⅲ Grade A hospital, and used the action study method of planning, action, observation and reflection as the axis to intervene. After 3 cycles, the number of unqualified blood samples of inpatients from August 2017 to August 2018 were compared. ResultsThe unqualified rate of blood samples had an overall downward trend during the period from August 2017 to August 2018,and there was statistical difference before and after intervention(P＜0.01). ConclusionsMultidisciplinary team collaboration provides guarantee for the improvement of blood samples quality before examination, and the application of action study method regulate the quality of blood samples in each procedure before examination and effectively reduce the unqualified rate of the blood samples.

Objective To evaluate the morbidity and the influence factors of the geriatric syndrome in the elderly inpatients. Methods The characteristics of comprehensive geriatric assessment of180 elderly inpatients (83 male and 97 female) with age older than 65 in geriatric department from November 2014 to November 2015 were analyzed. Results Of 180 elderly patients, the incidences of visual loss, multiple co-morbidity, polypharmacy, impairment in activities of daily living, urinary incontinence, chronic constipation and chronic pain were 86.11%(155/180), 85.56%(154/180), 82.78%(149/180), 56.11%(101/180), 49.44%(89/180), 46.67%(75/180) and 42.22%(76/180). Female patients had more incidences compared with male in urinary incontinence [56.70%(55/97) vs. 40.96%(34/83)], chronic pain [56.70% (55/97) vs. 25.30%(21/83)] , impairment in activities of daily living [64.95%(63/97) vs. 45.78%(38/83)] and high risk of falling [43.30%(42/97) vs. 21.69%(18/83)], and there were significant differences (P<0.05). In addition, it was found that with the increasing of age, the incidences of hearing loss and chronic constipation, as well as medications were accordingly higher. When the patients′education level was higher, the incidences of urinary incontinence and impairment in activities of daily living were generally declined. Compared with non-diabetes mellitus group, diabetes mellitus group had higher incidences of comorbidities, multiple co-morbidity, medications, polypharmacy and impairment in activities of daily living:(10.59 ± 3.72) kinds vs. (8.29 ± 4.03) kinds, 94.59%(105/111) vs. 71.01%(49/69), (10.07 ± 3.77) kinds vs. (6.87 ± 3.07) kinds, 89.19%(99/111) vs. 72.46%(50/69), 62.16%(69/111) vs. 46.38% (32/69). With the increasing of the numbers of diabetes- related chronic complications, the incidences of visual loss, chronic constipation and multiple co- morbidity, comorbidities and medications were higher (P<0.05). Conclusions Geriatric syndrome such as visual loss, multiple co- morbidity, polypharmacy, impairment in activities of daily living and urinary incontinence are very common in the elderly inpatients. Elderly patients with diabetes mellitus are much easier to suffer from geriatric syndrome such as multiple co-morbidity, polypharmacy and impairment in activities of daily living.

OBJECTIVETo verify the feasibility and safety of the vascular interventional vascular interventional surgical robot system applied to vascular interventional operation.

METHODSFrom March to September 2013, 10 patients had undergone robot-assisted cerebral angiography. There were 6 male and 4 female patients; aged from 19 to 58 years, with an average age of 38.4 years. The operation were carried out by neurosurgeons and vascular interventional robot. After successfully implanted of femoral artery sheath by hand, the catheter was fixed on the robot, under the guidance of navigation image the surgeon manipulate the master part and control the slave part of robot by sending command through network transmission, finally finished the whole cerebral angiography. The operation time was recorded from placing the sheath into femoral artery to finishing cerebrovascular selective angiography, simultaneously the time of staff under exposure of X ray was recorded, and the position difference between the setted targets and the actual position(positioning accuracy).

RESULTSIt took 25-41 minutes to finish the cerebral angiography, the average time was (31 ± 5) minutes, and the robot-assisted angiography went quickly and smoothly without surgical complications. The remote positioning accuracy was (1.03 ± 0.23) mm. The time of staff under exposure of X ray was 0 minute, the entire experimental process was basically implemented mechanization and automation.

CONCLUSIONThis system basically achieves initial medical purposes, such as reducing the radiation, facilitating interventional procedures on the basis of enhancing the image navigation, shorting the operation time, and improve the quality of operation.

Objective To retrospectively analyze the effect and safety of bilateral stereotactic radiofrequency amygdalohippocampectomy (SAHE) for treatment of bilateral medial temporal lobe epilepsy (BMTLE). Methods Twelve BMTLE patients were treated with bilateral SAHE under limited coagulations. Clinical parameters were evaluated with the programs of Engel′s classification, Liverpool Seizure Severity Scale (LSSS) 2.0, Wechsler Adult Intelligence Scale-Revised (WAIS-R) and Wechsler Memory Scale-Revised (WMS-R), respectively. Results Five patients (42%) were assessed as EngelⅠwith 12 ~ 62-month follow-up. Seizure severity scores were declined sharply compared with the baseline of the patients with out seizure free. Function of memory and intelligence was transiently declined without statistical significance immediately after operation (P >0.05), but was significantly increasedat 6 months after operation (P < 0.05). Conclusion Bilateral SAHE could terminate seizures or reduce seizure severity in patients with BMTLE. Under the circumstance of limited coagulations, neuropsychological function was improved along with seizure control.

Objective:This study aimed to investigate the possible mechanism of 32P colloid induced apoptosis of craniopharyngi-oma (CP) cells in vitro and the relationship between dose effect and time effect. Methods:This study established a primary cell culture of CP limited subculture cell line. Methyl thiazolyl tetrazolium (MTT) assay was performed to plot the cell survival curve after the CP cells were treated with 32P colloid at different concentrations and time. Apoptotic rate was detected by flow cytometry(FCM). Apoptosis related DNA was investigated by TUNEL fluorescent staining. The morphological characteristics of apoptotic cells were determined by Hoechst33342 fluorescence staining. The ultrastructure of apoptotic cells was investigated by transmission electron microscopy (TEM). Results:Hoechst33342 fluorescence staining, TUNEL fluorescence staining, and TEM revealed that 32P colloid induced the apoptosis of CP cells. 32P colloid reduced the survival rate and increased the apoptotic rate of CP cells as concentration (0 MBq/mL to 14.80 MBq/mL) and time (1 d to 14 d) were increased. Conclusion: 32P colloid could effectively inhibit the growth of CP cells and induce apoptosis in vitro. High concentrations and prolonged time could induce a remarkable effect.

Objective To explore the effect of nurse grading supervision system for pressure ulcer prevention in neurosurgery department .Methods A total of 148 neurosurgery patients , enrolled from February 2012 to February 2013 , were taken as intervention group .The other 136 neurosurgery patients , enrolled from January 2011 to January 2012 , were taken as routine group .Two groups were given routine nursing care .The nurse grading supervision system was constructed in the intervention group .The nurse grading supervision system was for pressure ulcer prevention , which was established charge nurse-team leader-duty nurse.Results Three patients in the intervention group occurred pressure ulcer with an incidence of 2.03%.And 12 patients in the routine group occurred pressure ulcer with an incidence of 8.82%, and the difference was statistically significant (χ2 =4.308, P<0.05).Patient’s satisfaction rate was 98.0% in the intervention group and 91.2% in the routine group, and the difference was statistically significant (χ2 =4.308, P<0.05).The scores of operating skill and master of patient ’ s condition were (97.1 ±4.9) and (98.2 ±1.3), respectively, after the implementation of classification management , which were higher than (89.1 ±8.2) and (88.9 ±7.2), respectively, before the implementation,and the differences were statistically significant (t=9.873,14.843;P<0.01).Conclusions It is advisable to adopt nurse grading supervision system for pressure ulcer prevention in neurosurgery department .It can improve the nurse ’ s abilities of observation and nursing management , and decrease the incidence of pressure ulcer among neurosurgical patients .

Objective To investigate the technical feasibility of medical robot in application to vascular intervention. Methods The independent-developed medical robot was used in the glass vessel model and vascular intervention experiments in a dog. Results The process of experiments were smooth,the system movement did not have any malfunction,and the animal experiments did not have any operative complications. The operative time was 50 minutes.Conclusions The medical robot can basically meet the requirements of cerebral angiography. It has laid a foundation for further development of intracranial vascular interventional procedures and clinical application.

Objective To explore the value of brain CT scanning for distinguishing tumor-like inflammatory demyelinating diseases (TIDD) from glioma or primary central nervous system lymphoma.Methods The brain CT features in 20 patients with TIDD(10 female,10 male;mean age (35.6±14.0)years;range,6-51 years)and 32 gliomas(16 female,16 male;mean age(42.0±19.8)years;range,12-75 years)and 6 lymphomas(3 female,3 male;mean age(53.8±11.8)years;range,32-68 years)were retrospectively reviewed and compared between brain tumors and TIDD.Results (1)Among the 38 primary brain tumors,there were 19 cases(50%,14 gliomas,5 lymphomas)with hyperdense lesions,10 cases(26.3%,9 gliomas,1 lymphomas)with isodense lesions,and 9 glionms (23.7%)with hypodense lesions.In contrast,the brain unenhanced CT manifestation of 20 TIDD all showed with hypodense lesions.(2)On unenhanced CT the lesions of 6 lymphomas all were hyperdense or isodense,like 90% of 20 high grade gliomas(WHO grade Ⅲ and Ⅳ),but this rate for grade Ⅱ was only 41.7%.(3)According to the shape of hyperdense lesions of the 19 primary brain tumors with,7 cages(6 gliomas,1 lymphomas)manifested with asymmetric hyperdense small-patches,4 cases(1 gliomas,3 lymphomas)with symmetric hyperdense large-patches,4 cases(3 gliomas,1 lymphomas)with diffused hyperdensed lesions,and 4 cases(4 gliomas)with ring-shaped hyperdensed lesions.Furthermore,4 primary brain tumors(4 lymphomas)underwent CT enhanced scanning and all the cases showed strong enhancement(3 cases with hyperdense lesions and 1 with isodense lesions on unenhanced CT),but only 3 cases of 7 TIDD showed mild enhancement in contrast.(4)By Spearman's relevant analysis,hyperdense and isodense on unenhanced CT was proved to have significant positive correlation between the grade of gliomas(r=0.435,P=0.013).Therefore,the frequency of hyperdense and isodense lesions in lymphomas and WHO grade Ⅲ and Ⅳ astrocytoma was higher in contrast with low grade astrocytoma.Conclusions Brain CT as a simple,economical and practical examination method has significant meaning for differentiating TIDD from glioma or PCNSL and could be used as an adjuvant method for MRI and magnetic resonance spectroscopy.Patients with hyperdense or isodense on unenhanced CT or strong enhancement could be excluded from TIDD.