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Background Mycophenolate has been shown to be effective in glomerular disease. However, the role of mycophenolate in the first-line treatment of adult - onset idiopathic minimal change disease (MCD) has not been systematically studied in a randomized fashion. Aim To evaluate the therapeutic efficacy of enteric-coated mycophenolate sodium combined with low-dose corticosteroid as first-line treatment for MCNS. Design A prospective, open-label, randomized clinical trial. Methods Twenty adult patients with biopsy proven MCD were recruited and randomly assigned to receive either enteric-coated Mycophenolate Sodium (EC-MPS) plus low-dose prednisolone (Group 1: Prednisolone 0.25 mg/kg/day, n = 10) or standard-dose prednisolone (Group 2: Prednisolone 1 mg/kg/day, n = 10). Results After 24 weeks of therapy, eight patients in Group 1 vs. seven of patients in Group 2 achieved complete remission (P = 0.606). Both groups showed a significant reduction of urine protein excretion (P < 0.05) and increased serum albumin (P < 0.001) vs. baseline levels. However, no significant between-group differences were demonstrated. The relapse rate was also similar in both groups. Both treatment regimens were well tolerated but there were more patient reported adverse effects in the standard-dose prednisolone group. Conclusion EC-MPS plus low-dose prednisolone is non-inferior to standard-dose prednisolone therapy in inducing clinical remission and preventing relapse in adult-onset idiopathic MCD and is associated with better tolerability and less adverse effects. This trial is registered with the ClinicalTrials.gov number NCT01185197. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To observe the curative effect of dl-3-n-Butylphthalide (NBP) on patients with acute cerebral infarction (ACI) and its effects on levels of serum vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). PATIENTS AND METHODS: A total of 160 ACI patients treated in our hospital who met the criteria were selected and randomly divided into treatment group (n=80, including 42 males and 38 females) and control group (n=80, including 40 males and 40 females). The control group was treated with routine drug therapy, while the treatment group was treated with butylphthalide on this basis. The curative effect was evaluated using the National Institute of Health Stroke Scale (NIHSS) and the Activity of Daily Life Scale (ADL Scale). The levels of the two factors in serum were measured using enzyme-linked immunosorbent assay (ELISA), and the changes in the levels of the two factors in serum at different time points before and after treatment were compared between the two groups. RESULTS: After treatment, the levels of the two factors in serum in both groups were significantly increased compared with those before treatment (p<0.05), and the increase in treatment group was more significant than that in control group (p<0.05). The scores of ADL scale in both groups were significantly increased after treatment compared with those before treatment, and the increase in treatment group was more significant than that in control group (p<0.05). The scores of NIHSS in both groups were significantly decreased compared with those before treatment, and the decrease in treatment group was more significant than that in control group (p<0.05). CONCLUSIONS: NBP can improve the expressions of VEGF and bFGF in serum of ACI patients, and its effect is superior to that of conventional drugs. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) imposes a significant burden on healthcare systems worldwide, and diabetes is a major risk factor for CKD. There is currently no consensus in Hong Kong regarding the prioritisation of early identification and intervention for CKD. A comprehensive and Hong Kong-specific diabetes and CKD treatment guideline is also lacking. A multidisciplinary group of experts discussed issues surrounding the current management of CKD and reviewed evidence in the context of local experience to support recommendations. The experts used a modified Delphi approach to finalise recommendations. Consensus was regarded as ≥75% acceptability among all expert panel members. The panel members finalised 14 CKD-focused consensus statements addressing disease definition, screening, disease monitoring, lifestyle management, and treatment strategies. The recommendations provided are relevant to the Hong Kong healthcare setting and can be used as a guide by physicians across various specialties to facilitate the appropriate management of CKD., Competing Interests: RCW Ma has received research funding from AstraZeneca, Bayer, Merck Sharp & Dohme, Novo Nordisk, Pfizer, Roche Diagnostics, and Tricida Inc for carrying out clinical trials or studies, and from AstraZeneca, Bayer, Boehringer Ingelheim, and Merck for speaker honoraria or consultancy on advisory boards. All proceeds have been donated to The Chinese University of Hong Kong to support diabetes research. CC Szeto receives research support from AstraZeneca, Boehringer Ingelheim, and Otsuka Pharmaceutical. KCB Tan has participated in advisory boards and speakers bureaus for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, and Sanofi. MCS Wong is an advisory committee member for Pfizer; an external expert for GlaxoSmithKline Limited, a member of the advisory board of AstraZeneca, and an honorary advisor of GenieBiome Limited. He was paid consultancy fees for providing research advice and delivering talks. Also, as an editor of the journal, he was not involved in the peer review process. Other authors have disclosed no conflicts of interest.

Competing Interests: All authors have disclosed no conflicts of interest.

To meet the requirement from the economy and society, China's emergency rescue has been developing towards specialization and professionalization. The working environment for emergency responders is special accompanying with tremendous challenges and uncertainties. To promote the research on occupational health and personal protection is an important guarantee for the workers in China to realize the goal of "decent work". This paper reviews the hazards that affect the occupational health of emergency rescue workers, the research progress of adverse outcomes caused from exposure to these hazards, and the related development issues of personal protection. In order to ensure the safety and health of emergency rescue workers, the direction of further research on occupational health of emergency rescue workers is put forward.

Objective: To explore the self-conscious health status and related influencing factors of greenhouse agricultural workers in Beijing suburb, so as to provide scientific basis for developing strategies to improve and promote the occupational health conditions of those workers. Methods: According to the production characteristics and scale of the main agricultural districts or counties in the suburb of Beijing, 182 agricultural production personnel were randomly selected to investigate the general situation, occupational situation and self-conscious health status during June 2018 to December 2019. The relevant factors which may affect the self-conscious health conditions were also analyzed by statistical methods. Results: The detection or reported rate of self-conscious health problems was 51.6% (94/182) , among which 29.1% (53/182) workers reported musculoskeletal disorder diseases and 21.4% (39/182) workers reported nervous system diseases. And the self-conscious health status of greenhouse agricultural workers were statistically different in household registration, gender, marital status, working years, mixing or spraying pesticides, smoking or eating in the greenhouse ( P <0.05) . Moreover, gender, mixing or spraying pesticide, eating and smoking behavior in the workplace all had an impact on the risk of self-conscious health status of greenhouse agricultural workers ( P < 0.05) . Specifically, male is the protective factor to reduce the occurrence of self-conscious symptoms of greenhouse agricultural workers ( OR =0.447, 95% CI : 0.234~0.852) , while mixing or spraying pesticides and smoking or eating behaviors in the workplace are the risk factors ( OR =1.055, 2.524; 95% CI : 0.503~2.210, 1.107~5.755) . Conclusion: Reducing pesticide use from the source thus minimize related exposure opportunities, strengthening occupational health education thus foster good hygienic habits and improve individual protection consciousness are of great significance for the health protection of greenhouse agricultural workers in Beijing suburb.

Background: Mycophenolate has been shown to be effective in glomerular disease. However, the role of mycophenolate in the first-line treatment of adult-onset idiopathic minimal change disease (MCD) has not been systematically studied in a randomized fashion., Aim: To evaluate the therapeutic efficacy of enteric-coated mycophenolate sodium combined with low-dose corticosteroid as first-line treatment for MCNS., Design: A prospective, open-label, randomized clinical trial., Methods: Twenty adult patients with biopsy proven MCD were recruited and randomly assigned to receive either enteric-coated Mycophenolate Sodium (EC-MPS) plus low-dose prednisolone (Group 1: Prednisolone 0.25 mg/kg/day, n = 10) or standard-dose prednisolone (Group 2: Prednisolone 1 mg/kg/day, n = 10)., Results: After 24 weeks of therapy, eight patients in Group 1 vs. seven of patients in Group 2 achieved complete remission (P = 0.606). Both groups showed a significant reduction of urine protein excretion (P < 0.05) and increased serum albumin (P < 0.001) vs. baseline levels. However, no significant between-group differences were demonstrated. The relapse rate was also similar in both groups. Both treatment regimens were well tolerated but there were more patient reported adverse effects in the standard-dose prednisolone group., Conclusion: EC-MPS plus low-dose prednisolone is non-inferior to standard-dose prednisolone therapy in inducing clinical remission and preventing relapse in adult-onset idiopathic MCD and is associated with better tolerability and less adverse effects. This trial is registered with the ClinicalTrials.gov number NCT01185197., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM). Methods: A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People's Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis. Results: ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ(2)=13.638, P <0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ(2)=4.074, P =0.044) and necrotizing fasciitis (χ(2)=4.457, P =0.035) in died cases were significantly higher than those in cured cases. Conclusion: DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.

Biomonitoring can be applied to assess internal exposure and environmental exposure by exposure markers with providing internal exposure to biological characterization and individual exposure information, which is a key tool to evaluate the risk exposure to disease by biological alternation information. With the development of high throughput, broad spectrum and high efficiency screening and detection technology, biomonitoring is defined as traditional biological monitoring (targeted monitoring) and non targeted monitoring analysis (exposomic approaches). An exposomic approach differs from traditional biomonitoring in that it can theoretically include all exposures of potential health significance, whether they are derived from exogenous sources. Both traditional and nontraditional biomonitoring methods should be used to understand the complexity of exposures faced throughout the lifespan. Through hybrid approaches, emerging techniques and the integration of bioinformatics, and developing the detection methods for low abundance chemicals, improving the differentiation ability between endogenous and exogenous chemical, the health outcomes and exposures can be widely recognized and characterized, which can finally contribute to improving the precise prevention and intervention for diseases under the new exposomic model.

Objective: To study the clinical outcome of transoral CO(2) laser surgery for glottic cancer involving the anterior commissure. Methods: Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO(2) laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bM0M0, 5 were T2N0M0. All cases were followed-up for more than 3 years. Results: All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa(13/32, 40.63%), loose incisors(3/32, 9.38%) and subcutaneous emphysema in the neck(2/32, 6.25%). During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO(2) laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90.6%. There was no significant difference in survival rate between T1bN0M0(92.6%) and T2N0M0(80.0%) ( Log Rank χ(2)=0.788, P =0.375). The overall 5-year local regional control rate was 84.4%. In T1bN0M0 lesions, the 5-year local regional control rate was 92.6%, which was significantly higher than that in T2N0M0 lesions(40.0%) ( Log Rank χ(2)=9.504, P =0.002). Conclusion: With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO(2) laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.

Objective: To explore and validate suitable risk assessment methods for titanium dioxide though applying three risk assessment tools for nanomaterials based on the control banding (CB) approach. Methods: A factory manufacturing titanium dioxide in Jinan city, Shandong province, was assessed using a quantitative exposure method and qualitative risk assessment methods in September, 2014. A condensation particle counter equipment was used to monitor the number concentration of particles at packaging workshop and jet milling workshop. We employed three control banding tools, including CB nanotool, Stoffenmanager nano and the Guidance on working safely with nanomaterials and nanoproducts (GWSNN) to evaluate the two workshops, then compared the evaluation results. Results: The increases of particle concentrations were generated directly by packaging and jet milling processes, the number concentration from (3.52±1.46) ×10(4)/cm(3) to (14.70±8.86) ×10(4)/cm(3) at packaging workshop and from (0.97±0.25) ×10(4)/cm(3) to (1.26±0.35) ×10(4)/cm(3) at milling workshop (both P <0.05) . The number concentrations at packaging workshop were higher than those at jet milling workshop during both manufacturing and break times (both P <0.05) . The results of CB nanotool showed that the risk level of the packaging workshop was classified as high and the risk level of the jet milling workshop was classified asmedium. The results of Stoffenmanager nano showed that the risk level of the packaging workshop was classified as medium and the risk level of the jet milling workshop was classified as low. The results of GWSNN showed that the risk level of packaging workshop was classified as high and the risk level of jet milling workshop was classified as low. Conclusion: The results of evaluation based on the three control banding tools are related and aligned with the results of quantitative monitoring, so they are all suitable to perform occupational health risk assessment on industrial scale production of titanium dioxideto some extent.

Objective: To characterize the health effects of nano-titanium dioxide exposure in an occupational cohort. Methods: Eighty-five male employees of a nano-titanium dioxide manufacturing enterprise in Shandong Province were evaluated in September 2014. Forty-four were exposed to nano-titanium dioxide (exposure group), and 41 were not exposed to nano-titanium dioxide (control group). We collected employees' basic information, smoking and drinking history, previous medical history, family history, and occupational history. Differences in blood pressure, hematological parameters, and blood biochemistry between the two groups were analyzed and compared. Multiple linear regression analysis was used to investigate the effect of nano-titanium dioxide exposure on blood pressure, hematological parameters, and blood biochemistry indices after controlling for age, smoking, drinking, and body mass index (BMI). Twenty-five employees from the exposure group and 25 employees from the control group were selected at random for measurement of genetic damage by cytokinesis-block micronucleus assay. Poisson regression analysis was used to investigate the effect of nano-titanium dioxide exposure on micronucleus frequency or micronucleus cell frequency after controlling for age, smoking, drinking, and BMI. Results: The median ( P 25 - P 75 ) surface area concentration of particles deposited in the tracheobronchial region, the surface area concentration of particles deposited in the alveolar region, and particle number concentration in the exposure group were 35.35(24.31-57.42) μ m 2 /cm 3 , 173.09(116.27-270.72) μ m 2 /cm 3 , and 40 244.00 (17 803.50-78 679.00) /cm 3 , respectively. These values were significantly higher than those in the control group 33.90 (27.44-43.29) μm 2 /cm 3 , 150.50(125.82-192.87)μm 2 /cm 3 , and 18 721.00 (12 721.00-51 898.50)/cm 3 <0.001 for all three values). Multiple linear regression analysis showed that exposure to nano-titanium dioxide contributed most to the alteration of mean corpuscular hemoglobin concentration, creatinine, and LDL-C, with standardized regression coefficients of 0.23, -0.51, and 0.30, respectively ( Z values were 15.47, 15.96, and 14.54, respectively ( P <0.001 for all three values). Multiple linear regression analysis showed that exposure to nano-titanium dioxide contributed most to the alteration of mean corpuscular hemoglobin concentration, creatinine, and LDL-C, with standardized regression coefficients of 0.23, -0.51, and 0.30, respectively ( P< 0.05 for all three values), after adjusting for age, smoking, drinking, and BMI. There were no significant differences in micronucleus frequency and micronucleus cell frequency between the exposure group (3.00‰ (1.50‰-5.00‰) and 3.00‰ (2.00‰-4.00‰), respectively) and control group (2.00‰ (1.00‰-4.50‰) and 2.00‰ (1.00‰-4.00‰), respectively); P> 0.05 for all comparisons. Poisson regression analysis showed that after adjusting for age, smoking, drinking, and BMI, there was still no statistically significant correlation between nano-titanium dioxide exposure and micronucleus frequency ( OR= 1.11, 95% CI: 0.81-1.54) or micronucleus cell frequency ( OR= 1.07, 95% CI: 0.75-1.51); P> 0.05 for all comparisons. Conclusion: Nano-titanium dioxide particles exerted some health effects on the occupationally-exposed cohort, whose hematological parameters and blood biochemistry were influenced to some degree. However, a potential link between occupational exposure to nano-titanium dioxide and blood pressure or induction of genetic damage or was not found.

Objective: To investigate the superiority of dynamic magnetic resonance imaging as an assessment method of pharyngeal constriction and cricopharyngeal muscle function, and introduce a new way to measure the pharyngeal constriction ratio, anteroposterior diameter of esophageal entrance and thickness of cricopharyngeal muscle in healthy volunteers., Methods: Twenty volunteers who were assessed as normal by fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study were included in this study. With the use of 3.0T magnetic resonance imaging, Fiesta sequence and Asset technique, the median sagittal plane and intervertebral transverse plane from C1 to C5 were scanned repeatedly. Pharyngeal constriction ratio in the median sagittal and intervertebral transverse plane, anteroposterior diameter of esophageal entrance and thickness of cricopharyngeal muscle were assessed and the data were analysed by SPSS13.0., Results: The intervertebral transverse plane between C1 and C2 was superior in observation of pharyngeal constriction ratio in the same way that the plane between C4 and C5 was superior in cricopharyngeal evaluation. The average of sagittal and intervertebral pharyngeal constriction ratio were estimated as 0.08±0.02, 0.09±0.04 respectively and the average of thickness of cricopharyngeal muscle and anteroposterior diameter of esophageal entrance were (6.50±1.69) mm, (1.99±0.76) mm respectively., Conclusion: Dynamic magnetic resonance imaging was superior in assessing the function of pharyngeal constriction and cricopharyngeal muscle by scanning the swallowing process in the median sagittal and intervertebral transverse plane.

Renal transplant recipients (RTRs) are subject to a variety of opportunistic infections. We present a rare case of varicella zoster virus-derived progressive outer retinal necrosis in an RTR, who presented with painless visual blurring. This clinical entity heralds an extremely poor visual prognosis and is an important condition to consider in any immunocompromised host. Early diagnosis by aqueous fluid sampling and immediate institution of combined systemic and intravitreal antiviral therapy was successful in this individual., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Alzheimer's disease (AD) is the most common type of dementia that leads to increasing death and mental disability among humans. Current therapy of AD mainly relies on the use of acetylcholinesterase inhibitors (AChEIs) or antagonists of N-methyl-D-aspartate receptors (NMDARs), which only relieve the symptoms of the disease but not halt its progression. Nevertheless, Traditional Chinese medicines (TCM) are highly prized as many bioactive components isolated from TCM are beneficial for treating AD. In this review, we summarize the latest information on TCM and the bioactive components according to their mechanistic role in alleviating AD. They act as modulators of α- and β-secretases, and inhibitors of betaamyloid (Aβ) aggregation. Some of them suppress Aβ-induced neuronal cytotoxicity and inflammation. Hence, this work has demonstrated the feasibility of applying TCM in AD therapy and the possibility of screening of constituents in TCM in the near future.