Study on the Healthy Risk of the Workers: a survey in the Yangtse Rive Delta

Problems of occupational health and safety in small and medium size enterprises are severe in China. With this paucity of official statistics documenting work-related injuries, the auther undertook a project in the Yangtse Rive Delta last year in the hopes of injecting at least some preliminary data into the public discourse. The epidemic of work-related injuries, and the failure of local business and govennnent to address it either through prevention or adequate compensation stems from two functional dimensions: the technical and the institutional. The technical level includes the physical causes of work-related injuries, which are not unique to the Yangtse Rive Delta. The institutional problems, on the other hand, are rooted in China's unique developmental history, politics and growth. These include the absence of legal aid institutions, poor government oversight and official corruption on the local and provincial levels. Key words: healthy risk, workers, survey Résumé: Les problèmes de santé et de sécurité professionnelles dans les petites et moyennes entreprises s’avèrent graves en Chine. Avec l’insuffisance de statistiques officielles documentant l’accident du travail, l’auteur a effectué l’année dernière un projet dans le delta du Yangtsé dans l’espoir d’injecter au moins des données préliminaires dans la conversation du public. L’augmentation des accidents du travail, l’échec des entreprises locales et du gouvernement à résoudre le problème soit par la prévention soit par la compensation adéquate sur les plans technique et institutionnel. Le niveau technique inclut les causes physiques de l’accident du travail qui n’est pas unique dans le delta du Yangtsé. De l’autre côté, les problèmes institutionnels s’enracinent dans l’unique histoire de développement de la Chine, ses politiques et sa croissance, comme l’absence d’aide institutionnelle légale, la vue courte du gouvernement et la corruption des officiers à l’échelle locale et provinciale. Mots-Clés: risque de santé, travailleurs, enquêt

Association between dosing of spironolactone and outcomes in heart failure with preserved ejection fraction patients combined with chronic kidney disease------Balance of efficacy and risk

Aims: Few studies have compared the association between dosing of spironolactone and outcomes in patients with heart failure with preserved ejection fraction (HFpEF), and whether spironolactone dose could significantly affect the prognosis of HFpEF patients combined with chronic kidney disease (CKD) remains unclear. Our aim was to directly compare ‘high vs. low’ doses of spironolactone in an attempt to find a benefit-risk-balanced point, and infer an adequate dose for HFpEF with CKD patients.Methods: Overall, 4,321 symptomatic heart failure inpatients were initially screened from January 2013 to December 2019, and all enrolled patients were followed-up for 36 months; After including patients who meet the diagnostic criteria of HFpEF and CKD with ejection fraction > 45% and estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, a total of 387 patients was selected. Primary outcome was a composite of all-cause death, heart failure (HF) hospitalization and non-fatal stroke. The key safety outcome was hyperkalemia rates during the follow-up period.Results: The primary outcome event rates in patients with or without spironolactone were 12.74 and 21.45 per 100 person-years, respectively. Compared with patients not taking spironolactone, the adjusted hazard ratio (HR) [95% confidence interval (CI)] was 0.55 (0.38–0.79) with spironolactone group for primary outcomes. After grouped by the daily dose of spironolactone, low-dose group (≤ 40 mg) was associated with lower relative risk for the primary efficacy outcome [adjusted HR (95% CI) was 0.43 (0.23–0.81), 0.50 (0.33–0.76) and 0.74 (0.36–2.79) with < 40 mg, 40 mg and >40 mg, respectively]. During 3-year follow-up, the risk for hyperkalemia was amplified in the higher dose group (>40 mg) while showed no significant difference compared with low dose group (p = 0.425).Conclusion: HFpEF with CKD patients using spironolactone had lower risk of adverse cardiovascular outcomes. And the use of low-dose spironolactone (≤ 40 mg) showed the best efficacy and safety, therefore we may recommend ≤ 40 mg as the optimal initial dose for these patients. However, this was a relatively small sample size, retrospective study, and further adequately powered randomized trials are needed to verify these results

Malignant Melanoma of Unknown Primary Origin Presenting as Cardiac Metastasis

Malignant melanoma has a very high propensity to metastasize to the heart. However, melanoma may sometimes present as a metastatic lesion in the absence of a primary lesion, which are called melanomas of unknown primary origin. We report a case in which a patient presented with a metastatic maligant melanoma in the right atrium with pericardial effusion and without a primary origin

Immunoglobulin a vasculitis with testicular/epididymal involvement in children: A retrospective study of a ten-year period

The clinical characteristics and risk factors for testicular/epididymal involvement in 73 children with immunoglobulin A vasculitis (IgAV) who were admitted to our hospital between January 2012 and November 2022 were reviewed. The demographic data, laboratory parameters, and follow-up data of the patients were compared to those of 146 males without testicular/epididymal involvement. A logistic regression analysis was performed to determine the variables associated with testicular/epididymal involvement. The prevalence of testicular/epididymal involvement among male patients with IgAV was 1.3% (73/5,556). Increased blood flow in the testes and/or epididymis on ultrasound was found in 71 patients. The remaining two patients underwent surgical exploration for loss or reduction of testicular blood flow. One patient underwent orchiectomy for intraoperative confirmation of complete right testicular infarction. Pathological findings revealed IgA immune complex deposition in the testis. Patient age (odds ratio [OR] = 0.792; 95% confidence interval [CI]: 0.682–0.919, p = 0.002), platelet count (OR = 1.011; 95% CI: 1.002–1.020, p = 0.013), and immunoglobulin M (IgM) levels (OR = 0.236; 95% CI: 0.091–0.608, p = 0.003) were strongly associated with the occurrence of testicular/epididymal involvement in IgAV. Therefore, young age, increased platelet count, and low IgM levels in patients with IgAV are potential risk factors for testicular/epididymal involvement. Doppler ultrasound can help differentiate IgAV from acute scrotum. Most patients with testicular/epididymal involvement have good prognoses, although serious complications such as testicular infarction may occur