Objective To determine the distribution of risk factors,the relationship between risk factors and chronic diseases and the order of intervention priorities of high-risk population,and to provide scientific evidence for the prevention and control of chronic diseases in different population within Xinjiang railway bureau.Methods A multi-stage stratified random sampling method was used to enroll 1 171 employees aged 18 and above from one region administered directly by the railway bureau and two other regions administered by the West Railway Station,on-site questionnaire interview and physical examination were conducted.Results The prevalence of dyslipidemia was the highest (380/1 171,32.45％),followed by hypertension (197/1 171,16.82％) and coronary atherosclerotic heart disease (75/1 171,6.40％).Age,family history,smoking,drinking,overweight and obesity,lack of physical exercise,unhealthy diet are major risk factors for chronic disease.Among the modifiable risk factors,percentage of subjects with smoking,drinking,overweight and unhealthy eating were 43.55％ (510/1 171),23.57％ (276/1 171),37.66％ (441/1 171) and 32.11％(376/1 171) respectively,the percentage of subjects with physical exercise was 38.60％(452/1 171).There were significant differences in smoking,drinking,obesity,physical exercise and unhealthy diets among different age groups (P＜0.05).In different education level,smoking rate of subjects at high school/ technical secondary school was significantly higher than those of college and above,High school/technical secondary school physical exercise rate is the lowest,36.87％ (212/575),junior college and above the lowest rate of poor diet,26.62％ (127/477).The smoking rate of diesel locomotive drivers,connecting workers are higher than other types of workers,the drinking rate of line workers,train inspection staff are higher than other types of workers,the obesity rate of diesel locomotive drivers,train inspection staff,station attendant are higher than other types of workers,the physical exercise rate of diesel locomotives drivers,conductor,truck inspection staff are lower than other types of workers.Conclusion intervention Priorities for chronic disease should be given to hypertension and dyslipidemia;production and frontline workers are a highcr risk.Intervention should focus on the top-five occupational groups ranked by the distribution of risk factors and prevalence of chronic diseases (diesel locomotive drivers,truck inspection staff,station attendants,train inspection staff and conductor).

Objective To observe the value of diffusion-weighted imaging (DWI)and ADC value in the differential diagnosis of benign and malignant lesions of the tongue.Methods 75 patients with lingual lesions,including 32 benign lesions and 43 malignant tumors,underwent conventional MRI,contrast-enhanced MRI and DWI with b values of 0 and 1 000 s/mm2 before therapy.ADC maps were reconstructed,and the ADC values of the lingual lesions were calculated.Diagnostic performance of ADC was compared using receiver operating characteristic curves (ROC).Results The mean ADC values of benign lesions and malignant tumors were (1.84±0.47)×10 -3 mm2/s and (1.12±0.21)×10 -3 mm2/s,respectively.Malignant tumors had lower ADCs than benign lesions (t=-8.038,P <0.000).The areas under the ROC curves of ADC diagnosing benign and malignant lesions of the tongue was 0.957±0.022.The optimal cutoff values of ADC for differentiating benign and malignant lesions of the tongue was 1.30 × 10 -3 mm2/s with sensitivity of 90.7%,specificity of 93.8% and accuracy of 92%.And ADC had a high consistency compared with pathological results (Kappa values were 0.813).Conclusion Different features between benign and malignant lesions of the tongue are able to be identified with DWI,which can be applied as a complementary tool in the detection of benign and malignant lesions of the tongue.

Objective To evaluate the utility of susceptibility weighted imaging (SWI)in the evaluation of traumatic brain injury (TBI)severities.Methods 20 mild TBI patients,20 moderate TBI patients and 20 severe TBI patients were collected.The involving brain regions,numbers and areas of hemorrhagic lesions detected by SWI were analyzed and the differences of each group were com-pared.The correlation analysis between Glasgow coma scale(GCS)scores and each above parameters were underwent.Results The differences of involving regions’number,lesions’number,lesions’area were statistically significant(P <0.05 ).Severe TBI group got the maximum number of involving regions,lesions,and the largest areas,followed by moderate group and mild group.The GCS were highly negatively correlated with the number of involving regions,number of lesions,areas of lesions detected by SWI.In descending order of relevance:GCS with areas detected by SWI(r=-0.982,P=0.000),the number of lesions detected by SWI(r=-0.941,P=0.000),the number of involving regions detected by SWI(r=-0.900,P=0.000).Conclusion The clinical applications of SWI in diagnosing TBI and evalua-ting the TBI severity is of great significance.

Objective To investigate the application value of apparent diffusion coefficient (ADC) in monitoring the response to chemotherapy of primary bone lymphoma(PBL). Methods Sixteen consecutive patients with PBL confirmed by pathology were enrolled in this retrospective study.All patients underwent a controlled MRI including a DWI sequence before chemotherapy and after the first chemotherapy session. The ADC values of PBL lesions were measured before and after the first chemotherapy session. All patients were divided into responders and non-responders groups according to the combined response assessment criteria. The difference in ADC values between the responders and non-responders groups before and after chemotherapy and the rate of change of ADC values were compared using Wilcoxon test. The paired t test was used to compare ADC values before and after chemotherapy in each group. Results Twenty-three cases of PBL lesions were diagnosed in 16 patients before the chemotherapy. After the first chemotherapy session, 10 patients (12 lesions) and 6 patients (11 lesions) were categorized into the responder and non-responder group, respectively. The mean pre-treatment ADC value of the responder group and non-responder group were 737.1(301.7,928.4)× 10-6mm2/s and 749.2(624.4, 1186.5)× 10-6mm2/s, which had no statistically significant difference (Z=1.51,P=0.132). The mean post-treatment ADC value of the responder group and non-responder group were 1843.0(721.5,2745.8)× 10-6mm2/s and 1026.3(382.8,2100.8)× 10-6mm2/s, which had no statistically significant difference (Z=-1.75,P=0.079). The post-treatment ADC value of the responder group significantly increased [156.7(60.9,227.5)%] while the post-treatment ADC value of the non-responder group slightly increased [31.7(-44.7,147.4)%]. The difference in the percentage changes of ADC values in the responder and non-responder groups before and after the treatment was statistically significant(Z=-3.66,P<0.001). Conclusion The measurement of the percentage changes of ADC values enable a good short-term response evaluation for PBL.

Objective This paper discusses the role of pre-audit management in the quality management of the first page of medical records,and studies the feasible measures to improve the quality of the first page of medical records and assist DRG payment.Methods This paper analyzes the new measures to improve the quality of the first page of medical records in an A-Class tertiary hospital in Suzhou,and analyzes the quality of 2 644 medical records discharged during 2023.Results In order to effectively respond to the DRG payment reform,an A-Class tertiary hospital in Suzhou innovatively established a pre-audit man-agement mechanism,and improved the quality of the first page of medical records to a certain extent,but there are still problems such as non-standard filling,inconsistent medical record data and untimely completion of medical record documents.Conclusion The hospital should build consensus,attach importance to the quality management;standardize the filling,ensure the accuracy and completeness;communicate and collaborate,improve the soft and hard power of the hospital;improve the assessment,and optimize the incentive mechanism for the management to improve the quality of the first page of medical records and assist DRG payment.

Objective To analyze the MRI features of endometrial stromal sarcoma(ESS)and to explore its value in clinical application. Methods Thirteen patients with histologically proven ESS were collected.All cases underwent non-contrast MRI scan and DWI,10 of which underwent contrast-enhanced MRI scan.The MRI features were discussed in combination with the pathological results after operation.Results In all lesions,6 lesions were located in endometrial cavity,4 in myometrium,1 in right wall of uterus and broad ligament,1 in cervical canals,and 1 in the top segment of vagina and pelvic.Plain MRI showed the lesions with hypointensity on T 1 WI and mixed hyperintensity on T 2 WI,which exhibited polypoid or multiple nodular masses.DWI showed the lesions with different hyperintensity.In 10 patients with post-enhanced scanning,moderate or marked heterogeneous enhancement of the masses were demonstrated,in which 6 presented plateau pattern of time-signal enhanced curve and 4 were persistent pattern.Conclusion ESS had some characteristic features on MRI,and DWI and dynamic contrast-enhanced examination can help to improve the diagnosis and differential diagnosis.

Objective To explore the effective measures to reduce the incidence of nosocomial infection through the implementation of continuous quality improvement measures in the neonatal intensive care unit (NICU). Methods One hundred and twenty-two premature infants hospitalized in NICU of the Affiliated Hospital of Inner Mongolia Medical University after continuous quality improvement from January 2018 to November 2018 were selected prospectively as the experimental group, and 125 premature infants using routine nursing management mode from March 2017 to December 2017 were selected as the control group. The occurrence of bloodstream infection in two groups was observed. Results The incidence of bloodstream infection in the experimental group [7.4%(9/122)] was significantly lower than that in the control group [17.6%(22/125)], and the difference was statistically significant (P＝0.015). Compared with the control group, the experimental group had statistically significant differences in implementation rate of hand hygiene, average days of peripherally insterted central catheter indwelling, and antibiotic use rate and average days (P < 0.01). Conclusions The incidence of bloodstream infections in NICU can be effectively controlled through strict continuous quality improvement measures.

Objective:To summarize the clinical and genetic features of 7 patients with a mild form of Geleophysic dysplasia type 2(GD2)/Acromicric dysplasia(AD) induced by fibrillin 1(FBN1) gene mutation from one Chinese family.Methods:A Chinese pedigree of mild GD2/AD treated at the Pediatric Endocrinology Department at the First Affiliated Hospital of Sun Yat-sen University between August 2017 and May 2022 was collected. Whole-exome genetic sequencing of the FBN1 gene were performed to establish the diagnosis. Additionally, a literature review was further conducted.Results:In this family, among 13 individuals spanning three generations, there were 7 affected cases, including 1 adult female, 1 adult male, and 5 children. All individuals exhibited postnatal growth failure, severe disproportionate short stature, and lacked typical facial features. Exome sequencing and Sanger sequencing confirmed the presence of a heterozygous missense mutation c. 5099A>G(p.Tyr1700Cys) in exon 42 of the FBNI gene in 6 affected individuals(Ⅱ-1, Ⅲ-1 to Ⅲ-5), which was identified as a pathogenic mutation. This mutation was previously reported in a Chinese classical achondroplasia(AD) family. Based on comprehensive genetic analysis, clinical features, and multisystem evaluation, 3 cases were diagnosed with mild type 2 growth hormone deficiency(GD2), and 4 cases were diagnosed with mild AD. Recombinant human growth hormone(rhGH; 1.1-1.4 IU·kg -1·week -1) was applied to all the 5 children, and additional gonadotropin releasing hormone analogue(GnRHa) was administered to the 2 girls in late puberty, resulting in certain growth-promoting effect. Conclusions:The c. 5099A>G(p.Tyr1700Cys) mutation not only leads to the classical type of achondroplasia(AD) as reported in the literature but also causes the non-classical GD2 or AD(mild GD2/AD). Further research is warranted to investigate the long-term therapeutic effects of rhGH treatment.

Objective? To explore the intervention effects of health education based on precede-proceed model on preventing recurrence in patients with upper urinary calculi. Methods? Totally 110 patients with upper urinary calculi admitted in Lanzhou Military Region General Hospital between January and June 2017 using convenient sampling and divided into the treatment group (n=55) and the control group (n=55) according to the random number table. Patients in the control group received conventional health education, while patients in the treatment group received health education based on precede-proceed model on this basis. Disease-related knowledge scores, health behavior scores and recurrence of disease 12 months after discharge were compared between the two groups. Results? The calculi-related knowledge score and the health behavior score of the treatment group 12 months after discharge were (13.0±1.7) and (127.5±14.8), higher than those of the control group, which were (11.9±1.9) and (120.7±14.3), and there were statistically significant differences (t=-4.940,-2.377; P＜0.05). The recurrence rate of calculi of the treatment group 12 months after discharge was 1.9%, while that of the control group was 12.0%, and there was statistically significant difference (χ2=4.050, P＜0.05). Conclusions? Health education based on precede-proceed model can improve the knowledge level of patients with upper urinary calculi, facilitate their health behavior, and reduce the recurrence rate of calculi.

Objective:To investigate the predictive value of albumin-to-fibrinogen ratio (AFR) for postoperative acute kidney injury (AKI) in infants with ventricular septal defect repair under cardiopulmonary bypass (CPB).Methods:A retrospective analysis was conducted on infants diagnosed with ventricular septal defect in Anhui Children's Hospital from January 2019 to July 2023. The infants were divided into AKI group and non-AKI group according to whether AKI occurred in hospital after operation. Demographic data, preoperative data, intraoperative data, postoperative data and laboratory results during CPB were collected. Multivariate Logistic regression analysis was used to find the factors of AKI after ventricular septal defect repair with CPB. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of AFR for postoperative AKI after ventricular septal defect repair with CPB.Results:A total of 215 children were collected, including 28 in AKI group and 187 in non-AKI group. There were no significant differences in age, gender, body weight, height, history of pneumonia and history of chronic heart failure between the two groups, but the left ventricular ejection fraction (LVEF) in the AKI group was significantly lower than that in the non-AKI group (0.526±0.028 vs. 0.538±0.030, P = 0.048). The duration of CPB (minutes: 74.1±12.1 vs. 65.8±11.3, P < 0.001), aortic cross-clamping (minutes: 41.7±9.7 vs. 37.2±9.4, P = 0.021) and hypothermic circulation arrest (21.4% vs. 8.6%, P = 0.047) in AKI group were significantly higher than those in non-AKI group, but there were no significant differences in the proportion of ultrafiltration and urine volume between the two groups. The length of intensive care unit (ICU) stay in AKI group was significantly longer than that in non-AKI group (days: 5.3±2.0 vs. 4.0±1.7, P < 0.001), but there were no significant differences in duration of mechanical ventilation and the proportion of postoperative hypotension between the two groups. During CPB, the levels of blood glucose (mmol/L: 9.4±1.3 vs. 8.8±0.8, P < 0.001), blood lactic acid (mmol/L: 2.2±0.3 vs. 2.0±0.3, P = 0.015) and serum creatinine (μmol/L: 79.7±11.5 vs. 74.4±10.9, P = 0.018) in AKI group were significantly higher than those in non-AKI group, while the AFR was significantly lower than that in non-AKI group (8.5±1.3 vs. 10.2±1.6, P < 0.001), but there were no significant differences in the levels of hemoglobin, blood urea nitrogen, alanine aminotransferase and aspartate aminotransferase between the two groups during CPB. Multivariate Logistic regression showed that AFR was a protective factor for AKI after ventricular septal defect repair with CPB [odds ratio ( OR) = 0.439, 95% confidence interval (95% CI) was 0.288-0.669, P < 0.001]. Blood glucose ( OR = 2.133, 95% CI was 1.239-3.672, P = 0.006) and blood lactic acid ( OR = 5.568, 95% CI was 1.102-28.149, P = 0.038) were risk factors for AKI after ventricular septal defect repair with CPB. ROC curve analysis showed that the area under the curve (AUC) of AFR in predicting AKI after ventricular septal defect repair with CPB was 0.804 (95% CI was 0.712-0.897, P < 0.001). When the optimal cut-off value was less than 9.05, the corresponding sensitivity was 75.0% and the specificity was 72.7%. Conclusions:Low AFR (≤9.05) during CPB is an independent risk factor for AKI after ventricular septal defect repair with CPB. AFR during CPB has a high predictive value for postoperative AKI after ventricular septal defect repair with CPB.