National Medical Journal of China
Volume 100 · Issue 44 · 2020
Natl Med J China
Compared with the rapid increase in the number of clinical research projects and their output in China, the innovation level and academic influence of clinical research still need to be improved. According to the experience of designing clinical research schemes, organizing clinical research implementation, participating in clinical research project evaluation and providing clinical research topic selection consultation for more than ten years, the author expounds the definition of innovation, basic characteristics of clinical research innovation, sources of innovative ideas or innovative problems, evaluation methods of clinical research innovation level, common "innovation misunderstandings" in clinical research, and introduces domestic and foreign projects on clinical research innovation training for everyone's reference. Improving the level of clinical research innovation is not something that can be achieved overnight, and requires long-term accumulation. This article focuses on the related issues of clinical research innovation, hoping to attract the attention of peers, urge everyone to think about how to improve the ability of clinical research innovation in China, and finally promote the practical improvement of clinical research level in China.
The World Health Organization (WHO) launched a global call to action to eliminate cervical cancer in May 2018. The Director-General of WHO led the development of a global strategy to accelerate the elimination of cervical cancer, clearly setting out the overall goal and the target value to be achieved by 2030. The strategy was approved for adoption by the 73rd World Health Assembly in 2020. China has invested hugely in the field of cervical cancer prevention and control, but there is still a big gap between the goal of eliminating cervical cancer. Under the historical background of the global elimination of cervical cancer, it is urgent to seize the opportunity to formulate an economic and effective strategic plan suitable for China's national conditions.
chronic kidney diseases (CKD) are major diseases that endanger human health. The global prevalence of CKD is 8% ~16%[
To investigate the clinical characteristics and related factors of acute tubular necrosis (ATN) in patients with minimal change disease (MCD).
Patients from Chinese PLA General Hospital who were pathologically diagnosed with MCD and had clinical manifestations of nephrotic syndrome from January 1, 2013 to December 31, 2019 were included. The clinical and pathological data of patients were retrospectively analyzed. Meanwhile, the incidence and clinical characteristics of ATN in different age groups were compared. The risk factors for ATN were assessed using binary logistic regression.
A total of 525 patients were included, with a gender ratio of 1.56∶1 (male: female), aged 33 (21, 48) years old. ATN occurred in 49 (9.3%) of 525 patients, of which 34 were male and 15 were female. The incidence of ATN increased with age in MCD patients of different age groups (χ2=31.442, P<0.001). The incidence of ATN in groups of age≤20 years, 21-40 years, 41-60 years, and >60 years was 2.4% (3/123), 5.2% (10/192), 13.2% (20/152) and 27.6% (16/58), respectively. Elevations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT) and serum IgE occurred in 92 patients (17.5%), 53 patients (10.1%), 99 patients (18.9%), and 303 patients (57.7%), respectively. There were significant differences in age, ALT, serum creatinine, serum urea nitrogen, history of diabetes and history of hypertension between non-ATN group and ATN group (all P<0.05). The results of logistic regression analysis showed that>40 years old (OR=6.283, 95% CI: 2.695-14.649, P<0.001) and serum albumin (OR=0.924, 95% CI: 0.857-0.997, P=0.040) was independently associated with ATN in MCD patients.
Age>40 years is an independent risk factor and serum albumin is a protective factor for ATN in MCD patients.
To investigate risk factors for hyperkalemia among chronic kidney disease (CKD) patients and establish a risk assessment model for predicting hyperkalemia events.
Clinical data of CKD patients (stage 3 to 5) hospitalized between May 2017 and June 2020 from 14 hospitals were retrospectively collected and divided into training dataset and validation dataset through balanced random sampling. Multivariate logistic regression analysis was used to analyze risk factors for hyperkalemia in CKD patients and the factors were scored. Receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Meanwhile, the cut-off value with the best sensitivity and specificity were used to verify the accuracy of the model in validation dataset.
A total of 847 CKD patients were enrolled and further divided into training dataset (n=675) and validation dataset (n=172). There were 555 males and 292 females, with a mean age of (57.2±15.6) years. Multivariate logistic regression analysis showed that age, CKD stage, history of heart failure, history of serum potassium ≥5.0 mmol/L, diabetes, metabolic acidosis, and use of medications that increase serum potassium levels were risk factors for causing hyperkalemia in patients with CKD. Risk assessment model was established based on these risk factors. The AUC of the ROC curve was 0.809. Using 4 as the cut-off value, the sensitivity and specificity for predicting hyperkalemia events reached 87.1% and 57.0%, respectively.
The model established in the current study can be used for predicting hyperkalemia events in clinical practices, which offers a new way to optimize serum potassium management in patients with CKD.
To analyze the relationship between matrix Gla protein(MGP) and clinical characteristics of patients with ulcerative colitis (UC).
Fifty-one UC patients who were admitted to the gastroenterology department of Peking union medical college hospital from July 1, 2015 to May 31, 2017 were included. Twenty-seven healthy subjects in the same period were included as normal controls. The expression of MGP mRNA in the colonic mucosa was detected by real-time fluorescence quantitative PCR. Clinical data of the patients were collected during a 2-year follow-up. The public data set containing MGP gene expression profile of UC patients was downloaded from the GEO database, and was divided into four groups according to the microscopic Mayo score. The differential expression of MGP in each group was analyzed.
All the fifty-one UC patients were followed up. The expression of MGP mRNA in the colonic mucosa of UC patients treated with hormone and immunosuppressive agents or biological agents or surgery was higher than that of patients treated with mesalazine. MGP mRNA expression was positively correlated with C-reactive protein level. It was also higher in the colonic mucosa of UC patients with clostridium difficilis or cytomegalovirus infection than that of patients without opportunistic infection. The difference of MGP mRNA expression between groups in GEO public data set was statistically significant(P<0.01), showing an up-regulation trend with the aggravation of inflammation. The expression level of MGP was moderately correlated with the microscopic Mayo score. The relationship between MGP mRNA expression and lifestyle, lesion range, erythrocyte sedimentation rate, parenteral manifestations and recurrence frequency of UC patients was not obvious.
MGP is associated with colonic inflammation and its abnormal expression can help to predict the disease activity of patients with UC.
To investigate the effect of direct antiglobulin test (DAT) positive strength on the clinical effect of red blood cell transfusion.
The clinical data was collected on blood transfusion compatibility test and clinical transfusion of patients who underwent DAT testing from January 2015 to March 2019 in the Department of Blood Transfusion, Beijing Shijitan Hospital affiliated to Capital Medical University. A retrospective cohort study method was used to analyze the correlation between the DAT positive strength and the blood match results, irregular antibody test results, bilirubin value after blood transfusion, and red blood cell transfusion effect.
According to the blood matching test results, the minor cross-matching results were significantly correlated with the DAT strength (r=0.58, P<0.01). The DAT strength of the antibody-screening positive patients was greater (χ2=126.810, P<0.01). DAT-positive strength influences the direct bilirubin, the higher the DAT-positive strength, the higher the direct bilirubin concentration of the patients (χ2=32.069, P<0.01). DAT-positive strength also had an effect on patients′ total bilirubin value (χ2=17.981, P=0.001). From the effect of red blood cell transfusion, patients with a DAT positive strength of 0.5 had a lower effective rate of transfusion (28.6%). The remaining DAT strength had no relation to the effect of red blood cell transfusion, and the efficiency of blood transfusion in patients with different DAT-positive strengths (1, 2, 3, 4) was 57.0%, 60.1%, 65.6% and 60.0%, respectively. With the same DAT strength, the patient′s transfusion efficiency was higher (χ2=41.071, P=0.009).
Different DAT-positive strengths are correlated with the patient′s minor cross-match results and bilirubin content, while the effect of red blood cell transfusion has no significant correlation with DAT-positive strength. However, with the increase of DAT positive strength, patients are more likely to have irregular antibodies.
To investigate the prognosis and risk factors of patients with anterior communicating aneurysm treated by aneurysm clipping or interventional embolization.
The clinical data of 730 patients with anterior communicating aneurysm who underwent aneurysm clipping or interventional embolization in the department of neurosurgery, the first affiliated hospital of Soochow University from January 1999 to December 2018 were retrospectively analyzed. The prognosis of patients in the clipping group from 1999 to 2008 and the clipping group from 2009 to 2018, the clipping group from 2009 to 2018 and the interventional group from 2009 to 2018 were compared respectively, and the risk factors affecting the prognosis of patients were statistically analyzed.
The rate of poor prognosis was 32.7% in the clipping group from 1999 to 2008, 21.3% in the clipping group from 2009 to 2018, and the rate of intraoperative aneurysm rupture and postoperative cerebral infarction was lower in the clipping group from 2009 to 2018 (P<0.05). There was no significant statistical difference in the prognosis between the clipping group and the interventional group from 2009 to 2018 (P>0.05). The results of multivariate analysis showed that preoperative Hunt-Hess grade, postoperative cerebral infarction and postoperative hemorrhage were the risk factors affecting the prognosis of patients (P<0.05).
The prognosis of patients treated by clipping from 2009 to 2018 was significantly improved compared with that from 1999 to 2008. There was no significant difference in the prognosis between the clipping group and the interventional group from 2009 to 2018. Preoperative Hunt-Hess grading, postoperative cerebral infarction and postoperative hemorrhage were independent risk factors affecting the prognosis.
To Evaluate the clinic effect of two-staged laparoscopic Fowler-Stephens orchiopexy in the treatment of high cryptorchidism, and compare it with laparoscopic orchiopexy treatment without disconnecting spermatic vessels.
A retrospective analysis was conducted on 20 cases of children with high cryptorchidism who were treated with two-staged Fowler-Stephens orchiopexy from January 2015 to April 2019 (F-S group). All the children in this group had unilateral cryptorchidism, age 6 to 18 months. The average age was 13.5 months. Seven cases were on the left side, and 13 cases were on the right side. There were 20 control children in the same age group who were treated with testicular fixation without disconnecting spermatic vessels, age 6 to 18 months. The average age was 12.5 months. Six cases were on the left side, and 14 cases were on the right side. Testicular ultrasonography and sex hormone examination were conducted before operation. F-S group met the indications for Fowler-Stephens surgical. In the first stage, the testicular vessels were doubly clipped at a site away from the testis in laparoscopic, and the second stage was scheduled about 6 months after the first stage. The children in the control group were treated with laparoscopic orchiopexy without disconnect spermatic vessels. The two groups were followed up to 6 months after the operation, and the testicular volume and sex hormone indexes of the two groups were measured. The testicular volume and sex hormones before and after the operation of the F-S group and the control group were respectively subjected to a self-control study, and a hormone comparison study was carried out between the two groups of children.
Both the F-S group and the control group successfully fixed the testes in the scrotum without tension during the operation. In both groups, 20 cases of testicular positions were reexamined 6 months after the operation without retraction. All the patients had a viable testis in scrotum after operation. Two of F-S group had an atrophic testis in the scrotum, and the others had a good vascularization detected on echo color doppler ultrasound. The average testicular volume of F-S group was (0.34±0.16) ml before operation and the postoperative one was (0.38±0.13) ml, P=0.089, P>0.05. In control group, the preoperative average testicular volume was (0.40±0.14) ml, and postoperative one was (0.40±0.15) ml, P=0.933, P>0.05. The testicular volume of two group had no significant difference. Sex hormone reexamination: Testosterone (T), estradiol (E2) and luteinizing hormone (LH) did not change after operation. Prolactin (PRL) in F-S group was 13.44 μg/L before operation and 12.3 μg/L after operation, PRL in control group was from 15.45 μg/L to 10.34 μg/L, P=0.732, the change of prolactin (PRL) has no significant difference. The median preoperative follicle stimulating hormone (FSH) in the F-S group was 1.18 U/L preoperatively and 1.61 U/L postoperatively; the median FSH of the control group was 1.21 U/L preoperatively and 1.1 U/L postoperatively. Compared between the two groups, the postoperative increase in the FS group was higher than that before the operation, P=0.032, P<0.05, the difference was statistically significant. The median of progesterone (PROG) in the F-S group was 0.25 nmol/L before operation and 0.17 nmol/L after operation; the median PROG of the control group was 0.56 nmol/L before operation and 0.24 nmol/L after operation. It was lower after the operation than before the operation, P=0.034, P<0.05, the difference was statistically significant.
(1) Laparoscopic Fowler-stephens staging operation is an effective method for the treatment of patients with high cryptorchidism, and it is worthy of further promotion. (2) Disruption of spermatic cord vessels does have an impact on hormones changes. The choice of this surgical procedure should be carefully and fully evaluated.
To investigate the clinical application of multimodality navigation for liver resection in the treatment of complicated alveolar echinococcosis (AE).
From October 2019 to February 2020, the clinical data and perioperative results of patients with AE treated by surgery in our department were retrospectively studied. Hepatic parenchyma disconnection plane and liver resection were navigated and performed with three-dimensional reconstruction and HITACHI real-time multi-image fusion interventional navigation system (RVS).
All of six patients were successful performed radical liver resection without mortality. The operation time was (301±106)min and the median blood loss was 200 ml. Two patients needed blood transfusion intraoperative (33.33%). The postoperative hospital stay was (10.8±2.8) day, and the cost of hospitalization was (82 584±995.61) yuan. Clavien-Dindo grade Ⅲ complication occurred in one patient.
Multimodality navigation might provide precise intraoperative navigation of the surgical plane and effectively assist liver resection for the treatment of complicated AE.
To investigate the effect of bone marrow mononuclear cell transplantation on the expression of miRNA-21 and miRNA-155 in mice with ulcerative colitis(UC).
Healthy and clean KM mice aged 6-8 weeks were randomly divided into transplantation group, model group and normal control group with 15 mice in each group. In the transplantation group and model group, dextran sodium sulfate (DSS) was used to establish the model for 24 h. The mice in the transplantation group were injected with 0.4 ml of 4 ′, 6-diaminol-2-phenylindole (DAPI) -labeled P3-BM-MNCs cell suspension (3.2×106 cells/ml), and the mice in the model group and the normal control group were injected with 0.4 ml phosphate buffer (PBS).UC disease activity index (DAI) was used to test the general condition of mice; HE staining was used to observe the pathological changes of colon tissue; Real-time quantitative PCR was used to detect the expression of miRNA-21 and miRNA-155 mRNA.
DAI scores of normal control group, model group and transplantation group were 0 (0,1), 3.1 (2.8,3.3) and 2.7 (2.4,3.1),respectively. Compared with normal control group, the DAI score of model group and transplantation group was higher (P<0.05), and the DAI score of transplantation group was lower than that of model group (P<0.05). The gross scores of tissue injury in normal control group, model group and transplantation group were 0 (0, 1), 3 (3, 4) and 1 (1, 2), respectively,and the pathological scores of tissue injury were 0 (0, 1), 16 (12, 16) and 6 (6, 8), respectively,compared with the normal control group. The tissue injury score of the model group and the transplantation group was higher (P<0.05), and the tissue injury score of the transplantation group was lower than that of the model group (P<0.05). The expression levels of miRNA-21 mRNA in normal control group, model group and transplantation group were 0.87±0.15, 2.38±0.29 and 1.59±0.32, respectively, and the expression levels of miRNA-155 mRNA were 1.87±0.46, 7.38±1.97 and 3.92±0.84, respectively, compared with the normal control group, the expression of miRNA-21 and miRNA-155 mRNA in the model group and transplantation group was higher (P<0.01), the expression of miRNA-21 and miRNA-155 mRNA in the transplantation group was lower than that of the model group (P<0.05).
Bone marrow mononuclear cell transplantation can improve the histopathological and DAI scores of mice with UC, which may be related to the down-regulation of miRNA-21 and miRNA-155 mRNA expression.
To observe the expression of NEK2 mRNA and protein in the cryptorchidism mice model, and to explore its role in apoptosis of testicular tissue.
A mouse cryptorchid model was constructed, and the spermatids in the spermatic tubules were observed by HE staining. Apoptosis was detected by Tunel test, and expression of NEK2 mRNA and protein was detected by RT-PCR and immunohistochemistry, respectively.
After the mouse cryptorchidism model was successfully constructed, the HE staining results showed that the damage of spermatogonia cells, primary spermatocytes and sperm cells in the seminiferous tubules became more severe with time. The results of Tunel test showed that the number of apoptotic cells first increased and then decreased, 1, 3, 6, 9 and 15 d apoptotic cells were 3.67±2.08 (t=2, P=0.0412), 7.67±1.53 (t=6.325, P=0.003), 17.67±3.51 (t=7.906, P=0.001), 30.67±3.51 (t=14.072, P<0.001) and 14.33±3.21 (t=6.860, P=0.002). The results of immunohistochemistry showed that NEK2 protein was expressed in the nucleus and cytoplasm in normal testis and cryptorchidism. RT-PCR and immunohistochemistry showed that expression of NEK2 mRNA and protein gradually increased after modeling. After reaching the peak, the expression gradually decreased with time, and was significantly lower than the normal control group.
The trend of NEK2 expression in cryptorchidism tissue is consistent with the trend of cell apoptosis in cryptorchidism tissue, suggesting that abnormal expression of NEK2 may affect the damage of sperm cells in the seminiferous tubules through apoptosis, leading to infertility in patients with cryptorchidism.
Diffuse large B-cell lymphoma (DLBCL) is a disease that can involve multiple organs in the whole body and has rich and diverse clinical manifestations. This paper reports a patient with lactic acidosis, hepatosplenomegaly, jaundice and pancytopenia as the main manifestations. Through the differential diagnosis of three main clinical manifestations of lactic acidosis, pancytopenia and hyperbilirubinemia, the diagnosis of DLBCL was confirmed by bone marrow puncture biopsy. The condition was significantly relieved after treatment with a regimen for lymphoma. It is hoped that this case will strengthen the differential diagnosis of lactic acidosis and the understanding of the diversity of clinical manifestations of DLBCL.
Hepatic portal pneumatosis is a rare cause of acute abdominal pain. Literature reports that the proportion of hepatic portal pneumatosis in maintenance hemodialysis patients is higher than that in healthy people, but the typical imaging features, treatment options and prognosis of this disease in clinic are still not completely clear. This paper reports the diagnosis and treatment of a patient on maintenance hemodialysis with acute hepatic portal pneumatosis and the typical abdominal CT changes.
Vaccination with Streptococcus pneumoniae conjugate vaccine (PCV) is an effective measure to prevent Streptococcus pneumoniae infection, but after vaccination, the body only gains immunity mainly against the vaccine serotype, so the pathogenesis of non-vaccine serotype (NVT) Streptococcus pneumoniae has aroused widespread concern. After the promotion and use of 13-valent PCV (PCV13), there may be an increased risk of non-PCV13 carrier and disease. This paper reviews the epidemic and pathogenic status of non-PCV13 Streptococcus pneumoniae before and after vaccine use at home and abroad, and summarizes the influencing factors of NVT epidemic, so as to provide ideas for future epidemiological surveillance of Streptococcus pneumoniae serotypes and vaccine development and optimization.
The epidemic of novel coronavirus (COVID-19) has an impact on all aspects of society, and also brings impacts and challenges to the prevention and control of chronic diseases. Patients with chronic diseases have a high risk of contracting COVID-19, and an increased risk of severe illness and death after infection. During the prevention and control period of COVID-19, patients with chronic diseases have some problems and face great challenges in routine diagnosis and treatment services of chronic diseases, self-management and medication, mental health and bad lifestyle related to chronic diseases. In order to ensure the medical service needs of patients with chronic diseases, China has introduced supporting policies in the adjustment of medical resources, Internet plus, primary medical and health services and "long prescription" measures, which provide effective help for the prevention, control and management of chronic diseases. In order to ensure the prevention and control effect of chronic diseases in the case of sudden public health, it is suggested that in the future, construction should be strengthened from the aspects of adjustment of medical resources, diversified development of medical service modes, promoting the implementation of medical policies conducive to the management of chronic diseases patients, strengthening grass-roots community medical services, strengthening self-management and health education of chronic diseases patients, promoting the popularization of healthy lifestyle for the whole population, and establishing monitoring of the impact of epidemic situation on chronic diseases.
Proteomics is a new comprehensive subject developed on the basis of proteins and proteomics. It is a great progress in biological system research after genomics and transcriptomics. Although it is not yet fully mature, it is widely used in biology, especially in medicine. This paper only introduces the background of proteomics and its research progress in glioma and brain metastatic cancer.
With the improvement of diagnosis and treatment methods, some patients are diagnosed with Gaucher's disease with mild or asymptomatic symptoms. Receiving enzyme replacement therapy as soon as possible can avoid irreversible complications. Therefore, which patients should receive enzyme replacement therapy, and when to start therapy, is worth exploring. Glucosphingosine (lyso-Gb1), a bypass metabolite of glucose ceramide, has been reported to be a sensitive and specific marker for diagnosis and therapeutic monitoring in adult patients with Gaucher disease. However, the role of lyso-Gb1 level monitoring in treated and untreated children with Gaucher disease has not been investigated. The study reviewed 81 children followed up at Shaare Zedek Medical Center from 2014 to 2018 (<18 years old), including 35 children with mild type I Gaucher's disease, 34 children with severe type I Gaucher's disease and 12 children with type III Gaucher's disease. The severity of disease in children with type I Gaucher disease is related to genotype. A total of 40 children with severe type I Gaucher disease and type III Gaucher disease received enzyme replacement therapy, and only 2 children with mild type I Gaucher disease received enzyme replacement therapy. Dried blood spot samples were collected at each visit and Lyso-Gb1 levels were measured. The level of lyso-Gb1 in children with mild type Ⅰ Gaucher disease was significantly lower than that in children with severe type Ⅰ Gaucher disease (P=0.009), there was no statistically significant difference between the level of lyso-Gb1 in children with severe type Ⅰ Gaucher disease and that in children with type Ⅲ Gaucher disease (P=0.81）。 In untreated children, lyso-Gb1 levels were inversely correlated with platelet counts. The study observed that nearly 50% of untreated children had elevated lyso-Gb1 levels during follow-up, and that elevated lyso-Gb1 levels were more prevalent in young children. lyso-Gb1 levels were inversely correlated with hemoglobin levels in treated children. Eight children treated with enzyme replacement therapy had increased lyso-Gb1 levels, and retrospective analysis found that this was partly related to medication adherence and lack of adjustment of drug dose based on weight gain. Studies suggest that lyso-Gb1 levels are related to disease severity, and can provide reference for drug efficacy and treatment compliance. The study recommends that lyso-Gb1 be monitored during routine follow-up. Gradual increases in lyso-Gb1 levels in untreated children suggest that enzyme replacement therapy should be started as soon as possible. Dose adjustment should be considered for increased lyso-Gb1 levels in treated children.
Hearing loss is an important public health problem, with an estimated 432 million adults and 1/3 of people aged 65 and over suffering from hearing loss worldwide. Hearing loss is not just a sensory disorder but can have a profound impact on people's quality of life. Therefore, there is a need for an effective and sustained hearing loss screening strategy for early detection and intervention of hearing loss in older adults. The study examined the consistency of self-reported hearing difficulties with objective hearing data and, in a representative sample of people aged 50 and over in the UK, the associated factors influencing potential contributing to inconsistencies between self-reported and objective measures through a cross-sectional analysis of survey data from the UK Longitudinal Study on Ageing Round 7. The researchers analyzed information from 8,529 adults between the ages of 50 and 89 who first completed a self-hearing assessment and agreed to an objective assessment by a nurse through a hearing screening device. The study investigated age, marital status, retirement status, socioeconomic status indicators, and lifestyle factors such as BMI, physical activity, smoking, and alcohol consumption, and analyzed associations with self-reported hearing problems and objective hearing measures in older adults. The results showed that 9,666 study participants, of whom 5,368 (55.5%) were women; Age (67.4 ± 14.4) years. The 684 (30.2%) respondents with objective measurements of hearing loss (more than 35 dB at 3.0 kHz) were not reflected in the self-reported hearing assessment. Factors associated with false positive hearing difficulties included: female (OR =1.97，95% CI: 1.18~3.28), low education (OR =1.37，95% CI: 1.26~2.55), daily or manual occupations (OR =1.43，95% CI: 1.28 to 2.61), smoking (OR =1.14，95% CI: 1.08~1.90), alcohol intake higher than the guideline low risk level (OR =1.13，95% CI: 1.11-2.34), and lack of moderate physical activity (OR =1.25，95% CI：1.03~1.42）。 Age was greatly associated with false positives for moderate to severe hearing loss; False positives of hearing impairment in people aged 65 to 74 compared with those aged 50 to 64ORThe value was 5.75 (95% CI: 1.17-8.13), 75-89 years oldORThe value was 7.08 (95% CI：1.41~9.30）。 In addition, socio-economic indicators, such as education level (OR =1.95，95% CI: 1.63~6.01) and occupation (OR =2.07，95% CI: 1.78 to 5.40), and lifestyle factors such as smoking (OR =1.46，95% CI: 1.25 to 2.48) and alcohol intake higher than the guideline low-risk level (OR =1.86，95% CI: 1.67~5.12) are factors related to false alarms of moderate and severe hearing loss.
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