Background Due to the unique working environment and numerous occupational disease hazards, workers in mining industry are particularly susceptible to psychological problems such as occupational stress. Objective To understand the current status of occupational stress, depressive symptoms, anxiety symptoms and sleep quality of workers in ferrous and non-ferrous metal mining industry in Gansu Province, and to explore the effects of occupational stress on depressive symptoms, anxiety symptoms, and sleep. Methods From April to December 2022, the workers of 25 large, medium, and small and micro enterprises were selected by stratified cluster random sampling and surveyed in ferrous and non-ferrous metal mining industry in Gansu Province. The Occupational Health Literacy Questionnaire of National Key Population, Core Occupational Stress Scale, Patient Health Questionnaire-q, Generalized Anxiety Disorder, and Self-administer Sleep Questionnaire were used to collect basic information, occupational stress, depressive symptoms, anxiety symptoms, and sleep quality of the workers. Chi-square test was used to compare occupational stress, depressive symptoms, anxiety symptoms and sleep disorders among different categories. Logistic regression model was used to study the effects of occupational stress on depressive symptoms, anxiety symptoms, and sleep quality. Results In this study, 2192 workers in mining industry were surveyed, of which 2087 returned valid questionnaires, and the recovery rate of valid questionnaires was 95.2%. Among them, 728 (38.4%) reported occupational stress. There were statistically significant differences in the positive rate of occupational stress among workers by gender, age, marital status, education level, average monthly income, length of service, enterprise size, and night shifts (P<0.001). The positive rates of depressive symptoms, anxiety symptoms, and sleep disorders in the mining industry workers were 85.6%, 49.8%, and 47.3%, respectively. The positive rates of depressive symptoms, anxiety symptoms, and sleep disorders among workers with higher occupational stress were higher than those among workers without occupational stress (P<0.001). The logistic regression analysis showed that occupational stress was a common risk factor for depressive symptoms (OR=3.29, 95%CI: 2.26, 4.79), anxiety symptoms (OR=2.87, 95%CI: 2.33, 3.53), and sleep disorder (OR=1.78, 95%CI: 1.46, 2.16). In addition, length of service and enterprise-scale were also risk factors for depressive symptoms, anxiety symptoms, and sleep disorders. In the 5−<10 and 10−<20 years of service groups, the risks of reporting depressive symptoms were 1.80 (95%CI: 1.18, 2.74) and 1.73 (95%CI: 1.10, 2.71) times higher than that of workers with less than 1 year of service, respectively; the risks of reporting anxiety symptoms were 1.98 (95%CI: 1.42, 2.76) and 2.11 (95%CI: 1.48, 3.01) times higher than that with less than 1 year of service, respectively; the risks of reporting sleep disorders were 1.58 (95%CI: 1.15, 2.16) and 1.78 (95%CI: 1.29, 2.45) times higher than that with less than 1 year of service, respectively. Workers in large enterprises were inclined to report more depressive symptoms, anxiety symptoms, and sleep disturbances than those in micro and small enterprises (OR=3.53, 95%CI: 2.41, 5.16; OR=2.49, 95%CI: 1.98, 3.13; OR=2.10, 95%CI: 1.67, 2.62). Conclusion The occupational stress level of mining industry workers in Gansu Province is high, and reporting occupational stress, 5−<10 and 10−<20 working age groups, and large enterprises are important risk factors affecting workers' mental health and sleep. It is necessary to increase the attention and develop intervention programs for mental health of miners in the working age group of 5−20 years old and in large enterprises.

OBJECTIVE: To investigate the effectiveness of digital three-dimensional (3D) printing osteotomy guide plate assisted total knee arthroplasty (TKA) in treatment of knee osteoarthritis (KOA) patients with femoral internal implants. METHODS: The clinical data of 55 KOA patients who met the selection criteria between July 2021 and October 2023 were retrospectively analyzed. Among them, 26 cases combined with femoral implants were treated with digital 3D printing osteotomy guide plate assisted TKA (guide plate group), and 29 cases were treated with conventional TKA (control group). There was no significant difference in gender, age, body mass index, side, Kellgren-Lawrence classification, preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, knee range of motion, and other baseline data between the two groups ( P>0.05). The operation time, intraoperative blood loss, incision length, postoperative first ambulation time, surgical complications; VAS score, knee HSS score, knee range of motion before operation, at 1 week and 3 months after operation, and at last follow-up; distal femoral lateral angle, proximal tibial medial angle, hip-knee-ankle angle and other imaging indicators at last follow-up were recorded and compared between the two groups. RESULTS: The operation time, incision length, intraoperative blood loss, and postoperative first ambulation time in the guide plate group were significantly lower than those in the control group ( P<0.05). In the control group, there were 1 case of incision rupture and bleeding and 1 case of lower limb intermuscular venous thrombosis, which was cured after symptomatic treatment. There was no complication such as neurovascular injury, incision infection, or knee prosthesis loosening in both groups. Patients in both groups were followed up 12-26 months, with an average of 16.25 months. The VAS score, HSS score, and knee range of motion improved at each time point after operation in both groups, and further improved with time after operation, the differences were significant ( P<0.05). The above indicators in the guide plate group were significantly better than those in the control group at 1 week and 3 months after operation ( P<0.05), and there was no significant difference between the two groups at last follow-up ( P>0.05). At last follow-up, the distal femoral lateral angle, the proximal tibial medial angle, and the hip-knee-ankle angle in the guide plate group were significantly better than those in the control group ( P<0.05). CONCLUSION The application of digital 3D printing osteotomy guide plate assisted TKA in the treatment of KOA patients with femoral implants can simplify the surgical procedures, overcome limitations of conventional osteotomy guides, reduce surgical trauma, achieve individualized and precise osteotomy, and effectively restore lower limb alignment and knee joint function.
Humans ; Arthroplasty, Replacement, Knee/instrumentation* ; Osteoarthritis, Knee/surgery* ; Osteotomy/instrumentation* ; Male ; Retrospective Studies ; Female ; Printing, Three-Dimensional ; Femur/surgery* ; Middle Aged ; Bone Plates ; Range of Motion, Articular ; Aged ; Treatment Outcome ; Surgery, Computer-Assisted/methods* ; Knee Prosthesis ; Knee Joint/surgery* ; Operative Time

Objective:To investigate the impact of proximal versus total gastrectomy on survival outcomes in patients with advanced upper gastric cancer following neoadjuvant therapy, aiming to provide evidence-based guidance for optimal surgical approach selection.Methods:A retrospective cohort study was conducted to collect clinical data from 114 patients with upper gastric cancer who underwent surgical treatment after neoadjuvant therapy in the PLA General Hospital between November 2014 and November 2023, consisting of 96 males and 18 females, with an age range of 41 to 78 years and a median age of 64 years. According to the extent of surgical resection, 44 patients underwent proximal gastrectomy (PG), and 70 patients underwent total gastrectomy (TG). Propensity score matching was used to match patients with advanced upper gastric cancer who received proximal gastrectomy or total gastrectomy after neoadjuvant therapy based on factors such as gender, age, surgical approach, BMI, ypT stage, ypN stage, tumor size, R0 resection status, neoadjuvant therapy cycles, and neoadjuvant therapy regimen, with a 1∶1 matching ratio. In the end, 44 patients in the PG group and 44 patients in the TG group were successfully matched and analyzed. The primary outcomes were overall survival (OS) and disease-free survival (DFS), while secondary outcomes included operative duration, R0 resection rate, complication rate, total number of lymph nodes dissected, number of lymph nodes dissected in each group, and lymph node metastasis rate. Data analysis was performed using SPSS 25.0, and survival curves were generated using the Kaplan-Meier (K-M) method.Results:After propensity score matching, the operative time in the TG group was significantly longer than that in the PG group [(222.0±42.5) min vs (257.0±62.0) min, χ2=3.07, P=0.003], while the differences in other baseline characteristics between the two groups were not statistically significant ( P>0.05). In terms of postoperative complications, the incidence of Clavien-Dindo grade II or higher complications was 29.5% in the PG group and 34.1% in the TG group ( P=0.819), indicating no significant difference. The 5-year overall survival (OS) rates were 55.8% for the PG group and 49.5% for the TG group ( P=0.592), showing no statistically significant difference. Lymph node metastasis rates in the TG group were 5.71% (4/70) in group 4d, 4.29% (3/70) in group 5, 2.86% (2/70) in group 6, and 2.86% (2/70) in group 12a. Conclusions:For patients with advanced upper gastric cancer who undergo proximal gastrectomy or total gastrectomy following neoadjuvant therapy, there is no significant difference in perioperative complications and long-term survival rates. Therefore, proximal gastrectomy is a safe and reliable option for these patients, allowing partial preservation of gastric function and potentially improving quality of life.

Based on the pathogenesis of “tendon off-position and joint subluxation”， combined with modern ana-tomy and biomechanics， the characteristic manifestations of “tendon off-position” and “joint subluxation” of the knee and the intrinsic connection between them are clarified. Through sorting out the relationship between “tendon off-position and joint subluxation” and knee osteoarthritis （KOA） in modern research， it is believed that “tendon off-position and joint subluxation” is the key mechanism for the occurrence and development of KOA， and accordingly， it is proposed to take the diet as the guide， use bone manipulation for external diagnosis and treatment， use traditional Chinese medicine decoction for internal treatment， and use Daoyin exercise throughout the whole process as the strategy for KOA's comprehensive traditional Chinese medicine treatment to improve the clinical effectiveness.

Objective:To explore the feasibility of deep learning-based restoration of obscured thyroid ultrasound images.Methods:A total of 358 images of thyroid nodules were retropectively collected from January 2020 to October 2021 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and the images were randomly masked and restored using DeepFillv2. The difference in grey values between the images before and after restoration was compared, and 6 sonographers (2 chief physicians, 2 attending physicians, 2 residents) were invited to compare the rate of correctness of judgement and detection of image discrepancies. The ultrasound features of thyroid nodules (solid composition, microcalcifications, markedly hypoechoic, ill-defined or irregular margins, or extrathyroidal extensions, vertical orientation and comet-tail artifact) were extracted according to the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS). The consistency of ultrasound features of thyroid nodules before and after restoration were compared.Results:The mean squared error of the images before and after restoration ranged from 0.274 to 0.522, and there were significant differences in the rate of correctness of judgement and detection of image discrepancies between physicians of different groups(all P<0.001). The overall accuracy rate was 51.95%, the overall detection rate was 1.79%, there were significant differences also within the chief physicians and resident groups (all P<0.001). The agreement rate of all ultrasound features of the nodules before and after image restoration was higher than 70%, over 90% agreement rate for features such as solid composition and comet-tail artifact. Conclusions:The algorithm can effectively repair obscured thyroid ultrasound images while preserving image features, which is expected to expand the deep learning image database, and promote the development of deep learning in the field of ultrasound images.

Objective:To investigate the relationship between glutathione peroxidases (GPXs) gene expression in colorectal cancer tissues and survival prognosis, and to construct and evaluate a nomogram prediction model of GPXs for survival prognosis of colorectal cancer patients.Methods:The GPXs gene expresion data and other clinical data of 620 patients with colorectal cancer (455 cases of colon cancer and 165 cases of rectal cancer) were downloaded from The Cancer Genome Atlas (TCGA) database, and the GPXs gene expression data of 820 normal people were downloaded as controls, preprocessed by R language, and the gene expression data were analyzed for differential expression. Spearman rank correlation was used to analyze the correlation between GPXs gene expression and tumor mutation burden (TMB) in colorectal cancer tissues. Cox risk regression model was used to analyze the influencing factors of survival and prognosis of colorectal cancer patients. Nomogram models were constructed to predict overall survival (OS) of colon cancer and rectal cancer patients, and its predictive performance was evaluated by calibration curve.Results:In the GPXs family, there were statistically significant differences in the mRNA expressions of GPX1, GPX2, GPX3, GPX4, GPX5, GPX7 and GPX8 between colon cancer patients and normal population, and the mRNA expressions of GPX1, GPX2, GPX4 and GPX8 in colon cancer patients were higher than those in normal population (all P<0.05) . There were statistically significant differences in the mRNA expressions of GPX1, GPX2, GPX3, GPX4, GPX7 and GPX8 between rectal cancer patients and normal population, and the mRNA expressions of GPX1, GPX2, GPX4, GPX7 and GPX8 in rectal cancer patients were higher than those in normal population (all P<0.05) . Spearman rank correlation analysis showed that GPX2 ( r s=-0.27, P<0.001) and GPX7 ( r s=-0.11, P=0.043) expressions were negatively correlated with TMB in colon cancer. There were no significant correlations between GPXs genes expressions and TMB in rectal cancer tissues (all P>0.05) . In colon cancer, univariate analysis showed that GPX3 ( HR=1.22, 95% CI: 1.05-1.43, P=0.012) , GPX4 ( HR=1.39, 95% CI: 1.01-1.92, P=0.045) , age ( HR=1.02, 95% CI: 1.01-1.04, P=0.010) and pTNM-stage ( HR=1.78, 95% CI: 1.43-2.21, P<0.001) were the influencing factors of OS. Multivariate analysis showed that GPX4 ( HR=1.96, 95% CI: 1.09-3.51, P=0.024) , age ( HR=1.02, 95% CI: 1.00-1.04, P=0.042) and pTNM-stage ( HR=1.61, 95% CI: 1.21-2.15, P=0.001) were the independent risk factors of OS. In rectal cancer, univariate analysis showed that age ( HR=1.08, 95% CI: 1.04-1.13, P<0.001) was the influencing factor of OS. Multivariate analysis showed that GPX7 ( HR=0.44, 95% CI: 0.22-0.88, P=0.020) , GPX8 ( HR=3.17, 95% CI: 1.63-6.17, P=0.001) and age ( HR=1.10, 95% CI: 1.04-1.16, P=0.001) were the independent influencing factors of OS. The consistency index (C-index) of the nomogram model for predicting OS in patients with colon cancer and rectal cancer were 0.71 (95% CI: 0.63-0.79) and 0.88 (95% CI: 0.82-0.94) respectively. The calibration curve showed that the prediction curve of the two models had a good fit with the real curve. Conclusion:GPX4 is an independent risk factor affecting the prognosis of colon cancer patients. Patients with high GPX4 expression have a poor prognosis. GPX7 and GPX8 are independent prognostic factors for rectal cancer patients, and the rectal cancer patients with low GPX7 expression and high GPX8 expression have poor prognosis. The nomogram constructed based on the above factors can better predict the prognosis of patients with colon cancer and rectal cancer.

Objective To evaluate the effective dose of dexmedetomidine (DEX) for prevention of emergence agitation (EA) after total intravenous anesthesia or sevoflurane anesthesia for preschool children undergoing a tonsillectomy.Methods 80 preschool children undergoing a selective tonsillectomy were randomly divided into 2 groups:intravenous group (total intravenous anesthesia,n =40) and inhalation group (sevoflurane inhaled anesthesias,n =40).According to the spot-slope method,intravenous group and inhalation group were randomly divided into 5 dose groups and given DEX in a geometric progression after induction.The EA,adverse effects,the pain score and the postoperative behavioral outcomes of each child in the two groups were recorded.Results The ED50s for prevention of EA were 0.28 μg/(kg · h) in intravenous group and 0.34 μg/(kg · h) in inhalation group.The duration of children's staying post-anesthesia care unit (PACU) and the incidence of pain were significantly greater in those with EA than those without (P ＜ 0.05),and the incidence of the postoperative behavioral outcomes were not statically different (P ＞ 0.05).No severe adverse reactions were observed in 95％ confidence limits.Conclusions 0.28 (0.22-0.35) μg/(kg · h) and 0.34 (0.27-0.43) μg/(kg · h) of DEX are safe and reliable for prevention of EA after intravenous anesthesia and sevoflurane anesthesia for preschool children undergoing a tonsillectomy.

Objective To explore the corelations between trace protein in urine and early kidney damage in gestational hypertension disease.Methods 126 patients with gestational hypertension disease were selected as the observation group,and 100 cases of healthy pregnant women over the same period were selected as the control group.The urinary albumin content of pregnant women in the two groups was detected and compared.Results In the observation group,the content of urinary albumin was (34.86 ± 18.41) mg/L,and positive patients in 56 cases,negative in 70 cases.In the control group,the content of urinary albumin was (18.64 ± 16.45)mg/L,and positive patients in 12cases,negative in 88 cases.The differences of the urinary albumin content and positive rates between the two groups were statistically significant(t =6.89,x2 =27.90,all P ＜ 0.05) ;The systolic blood pressure of urinary albumin-positive patients and negative patients in the observation groups were (155.6 ± 18.4) mm Hg,(146.3 ± 18.7)mm Hg,respectively,and the difference was statistically significant (t =2.79,P ＜ 0.05).Conclusion Urinary albumin testing during pregnancy can effectively determine the existence of early renal damage in patients with gestational hypertension disease,and it can help to judge the severity of gestational hypertension disease.

Objective To investigate the incidence and distribution of fetal discrepancy during the first trimester in dichorionic twins.Methods This was a prospective analysis of dichorionic twin pregnancies that underwent 11+0～ 13+6 week scan at a tertiary hospital from Sep 2008 to Oct 2010.Differences in crown-rump length (CRL),nuchal translucency ( NT),heart rate ( HR).deepest vertical pockets of amniotic fluid (DVP) for every pair of twin fetuses were calculated and expressed as absolute value and percentage of discordance.Results A total of 66 dichorionic twin pregnancies were included.The average CRL was significantly different between the larger fetus and the smaller one,which were (65.28 ±8.54)mm and (62.34 ± 8.49) mm respectively ( P ＜ 0.001).The average NT was significantly different between two fetuses,which were ( 1.56 ± 0.35) mm and (1.28 ± 0.30) mm respectively. HR and DVP were also statistically different between two fetuses ( P ＜0.001).Conclusions The growth of two fetuses in normal dichorionic twins is not uniform during the first trimester.