Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.

Objectives: To evaluate (1) the accuracy of the International Organization for Standardization (ISO) standard ISO 1999 [(2013), International Organization for Standardization, Geneva, Switzerland] predictions of noise-induced permanent threshold shift (NIPTS) in workers exposed to various types of high-intensity noise levels, and (2) the role of the kurtosis metric in assessing noise-induced hearing loss (NIHL). Design: Audiometric and shift-long noise exposure data were acquired from a population (N = 2,333) of screened workers from 34 industries in China. The entire cohort was exclusively divided into subgroups based on four noise exposure levels (85 ≤ LAeq.8h < 88, 88 ≤ LAeq.8h < 91, 91 ≤ LAeq.8h < 94, and 94 ≤ LAeq.8h ≤ 100 dBA), two exposure durations (D ≤ 10 years and D > 10 years), and four kurtosis categories (Gaussian, low-, medium-, and high-kurtosis). Predicted NIPTS was calculated using the ISO 1999 model for each participant and the actual measured NIPTS was corrected for age and sex also using ISO 1999. The prediction accuracy of the ISO 1999 model was evaluated by comparing the NIPTS predicted by ISO 1999 with the actual NIPTS. The relation between kurtosis and NIPTS was also investigated. Results: Overall, using the average NIPTS value across the four audiometric test frequencies (2, 3, 4, and 6 kHz), the ISO 1999 predictions significantly (p < 0.001) underestimated the NIPTS by 7.5 dB on average in participants exposed to Gaussian noise and by 13.6 dB on average in participants exposed to non-Gaussian noise with high kurtosis. The extent of the underestimation of NIPTS by ISO 1999 increased with an increase in noise kurtosis value. For a fixed range of noise exposure level and duration, the actual measured NIPTS increased as the kurtosis of the noise increased. The noise with kurtosis greater than 75 produced the highest NIPTS. Conclusions: The applicability of the ISO 1999 prediction model to different types of noise exposures needs to be carefully reexamined. A better understanding of the role of the kurtosis metric in NIHL may lead to its incorporation into a new and more accurate model of hearing loss due to noise exposure.

a b s t r a c tObjectives: To explore the variations in the mortality trends, especially death due to lung cancer, from 1990 to 2013 in Xuanwei City. Materials and methods: Mortality data were collected in Xuanwei during the 2nd and 3rd National Retrospective Sampling Survey on Mortality and Routine Death Registration System (DRS) during 2011-2013. According to the result of the survey on under-reported deaths, mortality data from DRS during 2011-2013 were adjusted. Disease specific mortality rate, age-standardized mortality rate (ASMR) and 45Q15 were calculated in Xuanwei and compared with those in rural areas of China. Results: During three periods, 1990-1992, 2004-2005 and 2011-2013, lung cancer contributed to 56.86%, 58.45% and 63.03% of deaths from all cancers respectively with a much higher proportion than rural areas nationally. The ASMR of lung cancer for males surged from 41.43/10 5 to 88.17/10 5 during 1990-2005 and it surged from 37.70/10 5 to 74.45/10 5 for females. Although they declined slightly during 2011-2013 (82.53/10 5 and 62.62/10 5 for males and females respectively), the ASMR of lung cancer among males in Xuanwei was three times of that in rural areas in China, and it was six times higher among females. The 45Q15 of lung cancer for males in Xuanwei was 3-5 times of that in rural areas of China and for females it was 7-9 times. The high-mortality areas of lung cancer were still located in Laibin, Longchang, Wanshui and Shuanglong Communities. High-mortality areas of lung cancer expanded to their surrounding areas and those in southeast. Conclusions: Although indoor air pollution caused by smoky coal has been fairly well controlled, patterns of death due to lung cancer have not obviously changed. The mortality rate of lung cancer among females was similar to that among males. Therefore, further studies should be conducted to comprehensively explore the risk factors of lung cancer in Xuanwei.

Objective Data on noise‐induced hearing loss (NIHL) in the automotive industry are rare. This pilot study aimed to investigate the prevalence and determinants of NIHL among workers in the automotive industry in China. Methods A cross‐sectional survey was conducted with 6557 participants from the automotive industry. The questionnaire survey was administered, and individual noise exposure level (LAeq.8h) and hearing loss level were measured. Results Of participants, 96.43% were male; the median age was 27.0 years and 28.82% had NIHL defined as adjusted high‐frequency noise‐induced hearing loss (AHFNIHL). Concerning individual noise levels (LAeq.8h), 62.53% exceeded 85 dB(A), which were mainly concentrated in various jobs, including metal cutting, surface treatment, stamping, welding, grinding, assembly, plastic molding, and forging. Each typical noise source generated its own unique temporal waveform shape with the type of non‐Gaussian noise. Of workers, 53.15% regularly used hearing protector devices (HPD), and the proportion of regular HPD use increased with LAeq.8h. The trend test showed that the prevalence of AHFNIHL in male workers significantly increased with an increase in LAeq.8h at <94 dB(A) and cumulative noise exposure (CNE) in each age group (P < 0.05 or P < 0.01). A logistic regression analysis showed that CNE and HPD usage frequency were important factors contributing to AHFNIHL. Conclusions CNE and HPD usage frequency were the determinants for NIHL. Much more human surveys are needed to understand the prevalence and determinants of NIHL in the automotive industry in China.

Objective: The association of occupational noise-induced hearing loss (NIHL) with noise energy was well documented, but the relationship between occupational noise and noise temporal structure is rarely reported. The objective of this study was to investigate the principal characteristics of the relationship between occupational NIHL and the temporal structure of noise. Methods: Audiometric and shift-long noise exposure data were collected from 3102 Chinese manufacturing workers from six typical industries through a cross-sectional survey. In data analysis, A-weighted 8-h equivalent SPL ( L Aeq.8h ), peak SPL, and cumulative noise exposure (CNE) were used as noise energy indicators, while kurtosis (β) was used as the indicator of noise temporal structure. Two NIHL were defined: (1) high-frequency noise-induced hearing loss (HFNIHL) and (2) noise-induced permanent threshold shift at test frequencies of 3, 4, and 6 kHz (noise-induced permanent threshold shift [NIPTS 346 ]). The noise characteristics of different types of work and the relationship between these characteristics and the prevalence of NIHL were analyzed. Results: The noise waveform shape, with a specific noise kurtosis, was unique to each type of work. Approximately 27.92% of manufacturing workers suffered from HFNIHL, with a mean NIPTS 346 of 24.16 ± 14.13 dB HL. The Spearman correlation analysis showed that the kurtosis value was significantly correlated with the difference of peak SPL minus its L Aeq.8h across different types of work ( p < 0.01). For a kurtosis-adjusted CNE, the linear regression equation between HFNIHL% and CNE for complex noise almost overlapped with Gaussian noise. Binary logistic regression analysis showed that L Aeq.8h , kurtosis, and exposure duration were the key factors influencing HFNIHL% ( p < 0.01). The notching extent in NIPTS at 4 kHz became deeper with the increase in L Aeq.8h and kurtosis. HFNIHL% increased most rapidly during the first 10 years of exposure. HFNIHL% with β ≥ 10 was significantly higher than that with β < 10 ( p < 0.05), and it increased with increasing kurtosis across different CNE or L Aeq.8h levels. When L Aeq.8h was 80 to 85 dB(A), the HFNIHL% at β ≥ 100 was significantly higher than that at 10 ≤ β < 100 or β < 10 ( p < 0.05 and p < 0.01, respectively). Conclusions: In the evaluation of hearing loss caused by complex noise, not only noise energy but also the temporal structure of noise must be considered. Kurtosis of noise is an indirect metric that is sensitive ...