Phthalate esters (PAEs)are by far the most widely used plasticisers and are categorized as high and low,depending on their molecular weight.Because of their extensive use,humans are most likely exposed to PAEs in the workplace and home environment through direct as well as indirect sources.Injection,inhalation,intravenous injection and skin absorption are potential pathways of expo-sure.With respect to health effects,phthalates are often classified as endocrine disruptors because of their ability to interfere with the endocrine syste m in the body.Furthermore,PAEs possess reproductive toxicity because of their influence on development of the reproductive system in infancy and development and differentiation of germ cells in adults.PAEs promote pathogenesis and development of liver cancer by activating peroxisome proliferator-activated receptor (PPAR)and DNA methylation.In addition, PAEs,which inhibit the i mmune functions of macrophages and pro mote hypersensitive response,pos-sess immunotoxicity.PAEs are also carcinogens that promote pathogenesis and development of cancers including breast,ovarian and so me other cancers.

Objective To develop recruits training burnout self-reported questionnaires, and test the reliability and validity.Methods 780 recruits(360 for first test ,420 for second test) in Xinjiang were randomly assesscd with training burnout self-reported questionnaires.Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to the data, and tested the reliability and validity of recruits training burnout self-reported questionnaires.Results The questionnaires consisted of 13 items and 3 dimensions.One of the dimensions (physically and psychologically exhausted situation, training-alienation, low accomplishment) , explained 61.599％ of the total variance.Cronbach's α coefficient of the whole questionnaire was 0.837, Cronbach's α coefficient of each partial scale were between 0.775 and 0.807.Split-half reliability of the whole scale reached to 0.817, split-half reliability of each partial were between 0.758 and 0.793.The correlation coefficient among each dimensions were 0.267 to 0.569 (P＜0.01) ,and the coefficient between each dimensions and the total score were between 0.671 and 0.857(P＜0.01).Confirmatory factor analysis showed that three factor model was optimal (GFI =0.935, AGFI =0.902, NFI =0.907, CFI =0.936, IFI =0.935, RMSEA =0.050).The three dimensions and the total questionnaire had significant positive correlations with mental stress (r=-0.215--0.313, P＜ 0.01) and significant negative correlations with depression(r=0.319-0.602, P＜0.01).Conclusion The recruits training burnout self-reported questionnaires meets the requirements of psychological surveying, and could be used to text recruits training burnout.

Objective:To explore the effects of body mass index (BMI) and gender on primary lung cancer 18F-FDG uptake param-eters, standardized uptake value (SUV), and standard uptake value of lean body mass (SUL). Methods:Data of 50 patients with prima-ry lung cancer confirmed by 18F-FDG positron emission tomography (PET)/computed tomography (CT) were retrospectively analyzed. AW4.6 workstation was employed to measure the SUVmean and SUVmax. Meanwhile, PETVCAR (PET Volume Computed Assisted Reading, GE Healthcare) software was used to automatically measure the SULmean, SULmax, and SULpeak. The SUVmean, SUV-max, SULmean, and SULmax of the liver (central region of the right lobe) were also measured automatically by PETVCAR. Afterward, T/N ratios (lesion SUVmax/liver SUVmean, lesion SULmax/liver SULmean, and lesion SULpeak/liver SULmean) of the lung cancer lesions were calculated. Correlations of the 18F-FDG metabolic parameters with BMI and gender of the patients were analyzed. Results:Liver SUVmean and SUVmax demonstrated significant positive correlations with BMI in all the patients (γ=0.38 and 0.36, P<0.05), and the SUVmean and SUVmax were positively correlated with BMI in male and female groups (γ=0.47 and 0.44, P<0.05), respective-ly. By contrast, no correlation existed between the liver SULmean and SULmax and BMI (P>0.05). No significant correlation was not-ed between the SUVmean, SUVmax, SULmean, SULmax, and SULpeak of the lung cancer lesions and BMI (P>0.05). The correlation trend is the same as that in different gender groups. Only the SUVmax T/N ratio of the lung cancer lesions showed a significant nega-tive correlation with BMI (γ=?0.29, P<0.05). The T/N ratios did not correlate with BMI in the different gender groups (P>0.05). Con-clusion:Patient BMI and gender mainly affect SUV values, particularly SUVmax, by contrast, patient BMI and gender did not signifi-cantly influence SUL and T/N ratio (SUL). Hence, SUL can be more suitable to quantitatively analyze and assess treatment response ob-jectively. This result will be helpful to the clinical application and promotion of PERCIST, which evaluates treatment response mainly by SUL.

Objective To explore the reason of colon cancer with appendicitis and reduce the rate of misdiagnosis. Methods We car-ried out analysis retrospectively to analyze 1 094 hospitalized patients with colon cancer in the First Affiliated Hospital of Harbin Medical Uni-versity from January 2006 to March 2013. Results Among 1 094 colon cancer patients,31 patients who firstly diagnosed with acute appendi-citis received appendectomy,1 patient with appendiceal abscess received non-surgical treatment. Among 31 patients with acute appendicitis,6 patients were found to be with ileocecal tumors during surgeries;24 patients were diagnosed with colon cancer within one year;incision of 1 patient did not heal, with continuous drainage of brown liquid;the appendicitis of 1 patient who received non-surgical treatment was recur-rent. Conclusion As lack of typical symptoms,colon cancer is prone to misdiagnose and diagnose incorrectly when the cancer co-exists with appendicitis and symptoms of appendicitis were showed firstly. Therefore,clinicians should be vigilant for patients with appendicitis. In order to induce the rate of misdiagnosis,it is essential that requesting disease history carefully,timely and relevant inspection and appropriate ex-ploratory surgery for the patients with appendicitis.

Objective:To observe whether there was a chronic light damage after the irradiation of 650 nm semiconductor laser (power 2 mW) in chicken cone-rich-retina and discuss the safety of this laser for retina.Methods:Sixty 1-month-old chicken reared under natural light were divided into a normal control group, an irradiation 3-min group, an irradiation 6-min group and an irradiation 30-min group by using a random number table and 15 for each group.The chicken eyes were irradiated with 650 nm laser for different duration according to a grouping.Relative retina area was measured with optical coherence tomography (OCT) at 1 month (2-month-old chicken), 3 months (4-month-old chicken) and 6 months (7-month-old chicken) after laser irradiation.Chickens were sacrificed by overdose anesthesia and the histopathology of chiken retina was examined by hematoxylin-eosin staining.The apoptosis of the retinal cells was evaluated by TUNEL staining.Chicken retinal homogenate was prepared, and the content of malondialdehyde and activity of superoxide dismutase (SOD) in the retina were detected by TBA method and NBT method, respectively.Western blot was employed to detect the expression of L/M opsin and rhodopsin in the retina.The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results:In 2-month-old chicken, the molar concentration of malondialdehyde in retina was significantly higher in the irradiation 30-min group compared with the normal control group ( P<0.05). In 4-month-old chicken, the molar concentration of malondialdehyde was statistically higher in the irradiation 6-min group and the irradiation 30-min group in comparison with the normal control group ( P=0.026, 0.003). In 7-month-old chicken, the concentrations of retinal malondialdehyde in the irradiation 3-min group, irradiation 6-min group and irradiation 30-min group were statistically higher than those of the normal control group( P=0.038, 0.032, <0.01). In 7-month-old chicken, the SOD activity and the relative expression of rhodopsin in the retina of the irradiation 30-min group were statistically reduced incomparison with the normal control group (SOD: [140.20±5.99][nmol/s·mg] vs.[160.57±3.13][nmol/s·mg]); Rhodopsin: 0.392±0.065 vs.0.566±0.072) (both at P<0.05). OCT showed that there was no significant difference in relative retinal area within 6 months among the four groups.Histopathological examination showed that the thickness of the retina in each irradiation group was close to the normal control group.TUNEL staining showed that the retinal cells were regularly arranged, and no TUNEL positive staining cells were found in all of the groups. Conclusions:Irradiation of a 650 nm semiconductor laser (2 mW) in chicken's eyes for 6 minutes is safe for retina within 6 months.The lasser irradiation 30 minutes for 6 months results in an increase of free radical content in the retina and a decrease in rhodopsin, suggesting the presence of photo damage.

Abstract Child abuse is a global public health problem, which has emerged as a neglected yet pressing issue in global development. Early and accurate identification of abuse at a lower-age group is of great significance for treatment, which might reduce the risk of re-maltreatment and promote children s physical and mental health development. Therefore, by reviewing the clinical characteristics, risk factors and existing abuse identification and screening tools of child abuse, the study aims at providing basic evidence for the development of child abuse risk identification tools and the establishment of child maltreatment system in China, so as to take timely intervention measures to prevent adverse outcomes or reduce their severity.

BackgroundMajor depressive disorder and insomnia often coexist， and the two may share a mechanism of pathogenesis and be affected by common underlying genes with strong pleiotropic effects. Previous genome-wide association studies （GWAS） mainly focused on single-gene morphological characters analysis， which impose limitations on showing possible pleiotropic effects. ObjectiveTo identify genetic loci related to insomnia and major depressive disorder， and to examine whether there are common genetic factors underlying both insomnia and depression. MethodsThe GWAS data for major depressive disorder originates from the Psychiatric Genomics Consortium （PGC）， which comprises a total of 246 363 depressive cases and 561 190 controls. The insomnia GWAS data was downloaded from Sleep Disorder Knowledge Portal， involving 1 331 010 participants. Then the conditional false discovery rate （cFDR） and conjunction cFDR （ccFDR） were utilized to identify the genetic loci associated with major depressive disorder and insomnia， and pathway enrichment analysis was performed to examine the biological functions of these loci. ResultsA significant pleiotropic effect was detected between major depressive disorder and insomnia. By leveraging pleiotropic enrichment， 21 susceptibility loci （17 novel loci） for major depressive disorder and 38 susceptibility loci （28 novel loci） for insomnia were identified with the threshold of cFDR<0.01. A total of 16 pleiotropic loci （15 novel loci） related to both major depressive disorder and insomnia were identified with the threshold of ccFDR<0.05. pathway enrichment analysis indicated that the susceptibility loci were mainly enriched in synaptic transmission pathway， such as postsynaptic density （GO：0014069， P=4.91E-04， FDR=4.84E-03）， asymmetric synapse （GO：0032279， P=5.09E-04， FDR=4.84E-03）， and regulation of postsynaptic membrane neurotransmitter receptor levels （GO：0099072， P=5.11E-04， FDR=1.69E-02）. ConclusionA significant pleiotropic enrichment is found between major depressive disorder and insomnia， and the comorbidity mechanism is related to synaptic transmission. ［Funded by Tianjin Health Science and Technology Project （number， TJWJ2021QN065）； Tianjin Key Medical Discipline （Specialty） Construction Project （number， TJYXZDXK-033A）］

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

Exposure to ionizing radiation intervenes in genomic stability and gene expression,resulting in the disruption of normal metabolic processes in cells and organs by causing complex biolog-ical responses.Altered genomic variations,gene expression and metabolite concentrations in blood or tissue samples reflect systemic radiation damage.With the application of new techniques and exten-sive study on the mechanisms for ionizing radiation damage,related indicators such as chromosomal variation,gene expression,lipid and metabolism are being recognized and promise to be the markers for early diagnosis and prognosis of radiation exposure.Therefore,this article reviews recent progress in and potential applications of biomarkers related to ionizing radiation injury.

BACKGROUND:The problem of intervertebral disc injury and degeneration has been studied in many ways.Many studies have shown that intervertebral disc injury and degeneration is driven by mechanical loading factors.However,the potential relationship between common phenotypes of intervertebral disc injury and degeneration and mechanical loading factors has been rarely summarized. OBJECTIVE:To summarize the types of common structural abnormalities exhibited by intervertebral disc injury and degeneration in the published literature,and sum up the potential links to the types of mechanical loading that lead to these structural abnormalities in in vitro and ex vivo experimental studies. METHODS:Using the terms"intervertebral disc failure,intervertebral disc injury,mechanical load,mechanical factor,load factor,biomechanics"as Chinese and English key words in PubMed,CNKI,and WanFang databases,articles related to intervertebral disc injury degeneration and mechanical load factors were retrieved.Literature screening was performed according to the inclusion and exclusion criteria,and 88 articles were finally included. RESULTS AND CONCLUSION:(1)Common structural abnormalities of intervertebral discs include decreased intervertebral disc height,disc bulge,osteophyte formation,annulus fibrosus tear,intervertebral disc herniation or disc prolapse,endplate damage,Schmorl nodes and intervertebral disc calcification.Intervertebral discs are susceptible to mechanical load types such as compression,bending,axial rotation,and compound loads.(2)The compressive load mainly causes the decrease of the proteoglycan content and the water-binding ability of the intervertebral disc,leading to the decrease or swelling of the intervertebral disc and further damage and degeneration of the intervertebral disc.In addition,the excessive compressive load causes greater damage to the endplate.(3)Bending load and axial rotation load damage the annulus fibrosus more than the endplate,and prolonged or repeated bending loads can cause tearing of the fibrous annulus and herniation or prolapse of the intervertebral disc,while pure axial rotation loads can induce less damage to the intervertebral disc and only cause the tear of the annulus fibrosus.(4)However,when different load types act in combination,it is more likely to result in high stress on the disc and a greater risk of disc injury.(5)Injury and degeneration of the intervertebral disc present progressive structural damage,and early prevention and protection are particularly important in clinical practice.Future tissue engineering research can start with early repair of the intervertebral disc.