Objective To investigate the therapeutic effect of a new surgical procudure for intractable pnumothorax.Methods Subaxillary mini-incision and folding ligation of bullae of lung were conducted without suture if possible.Parietal pleura was rubbed with a dry gauze roll and irrigated with hydrogen peroxide solution.The corresponding pulmonary segments were suspended on the parietal pleura to keep the lung tissues in inflation state and to avoid over compression of the lungs.Pleural cavity was irrigated with 5-10 ml lidocaine for 3 days after the surgery.Results The operation was successfully conducted in 21 cases(including 1 case of bilateral surgery).The average operation time was 45 min(range:30-60 min);and the average blood loss was 70 ml(range:50-100 ml).No complications occurred.The follow-up time was 6-72 months,25 months in average,and no recurrence of pneumothorax occurred.Conclusions This therapeutic method combining subaxillary mini-incision,suspension of pulmonary lobe,folding ligation and general adhesion is effective,minimally invasive,safe and inexpensive for treating intractable pnumothorax.

Objective To evaluate the effect of mechanical dilation on cardia achalasia under an endoscope.Methods A total of 62 patients with cardia achalasia were treated with mechanical dilation by using a self-designed dilator under a gastroscope.Of the cases,one had experienced a failure of heller surgery,and four had received ballon dilation before the gastroscopy.Results Among the cases,2 were convered to open thoracic surgery becaues of rupture of the esophagus,1 patient could not tolerate the operation,1 received a second dilation because of unsatisfied outcome of the first attempt.In the other 58 patients,the surgery was completed in the first attempt.The mean dilation time was 3.5 minutes(ranged from 2 to 5 minutes).Slight mucosal hemorrhage was observed during the operation,while no continuous bleeding occurred.Cold liquid diet was given to the patients 2 hours after the dilation,and then semiliquid diet was prescribed in 6 hours,after that the patients began to take normal diet gradually.The patients were followed up for 2 to 11 years with a mean of 7.5.All of them were cured without recurrence.Conclusions Endoscopic mechanical dilation is microinvasive,safe,and effective for cardia achalasia.It is worth being widely used because of a low cost and reliable long-term outcomes.

Objective:To obtain the high-efficiency expression of the biological active rabies virus nucleoprotein in the prokaryotic expression system.Methods:This experiment uses codon optimization technology to re-encode the nucleoprotein gene of rabies virus CTN-1 strain, artificially synthesize the full-length gene and clone it into pET-43.1a prokaryotic expression vector, induced expression in BL21 (DE3) strain of Escherichia coli( E. coli), and used Western blot to detect its reactogenicity. Results:The results showed that after induction, SDS-PAGE electrophoresis analysis showed that an obvious expression band appeared at a molecular weight of 50×10 3, which was consistent with the expected protein band size. Among them, the E. coli concentration A600 is about 0.5, and the expression yield is the highest (about 32.3%) when induced at 37℃ for 5 h. Nucleoprotein expression product is mainly inclusion body when it is expressed in large quantities. After purification by Ni 2+ chelating chromatography, the purity of the target protein can reach over 95%. The purified product was identified by Western blot and positively reacted with the sera of mice immunized with rabies vaccine, indicating that the prokaryotic expression of the CTN-1 strain nucleoprotein has biological activity. Conclusions:This experiment successfully established a high-efficiency expression method for the nucleoprotein of the CTN-1 strain in the prokaryotic expression system, and obtained high-purity target protein, which provides a basis for further clinical diagnosis and preparation of new vaccines.

Objective To investigate the effects of ketamine combined with moderate hypothermia on brain ischemia-reperfusion (I/R) injury in a rat model of asphyxial cardiac arrest. Methods Fifty healthy Wistar rats of both sexes aged 4.0-4.5 months, weighing 410-510 g were randomly allocated into 5 groups (n = 10each): group Ⅰ sham operation (group S), group Ⅱ asphyxial cardiac arrest (group ACA), group Ⅲ ketamine (group K), group Ⅳ moderate hypothermia (group MH) and group Ⅴ K + MH. The animals were anesthetized with intraperitoneal (IP) phenobarbital 20 mg/100 g, tracheostomized and mechanically ventilated (RR 60 bpm,FiO2 50%), PaCO2 was maintained at 35-45 mm Hg. Cardiac arrest was induced by clamping tracheal tube until ECG activity disappeared and MAP ＜ 15 mm Hg. Resuscitated was started 5 min later. MAP ＞ 60 mm Hg and HR ＞ 250 bpm were considered to be signs of successful resuscitation. Dead animals and animals in which resuscitation time was longer than 5 min were excluded from the study. In group K ketamine 100 mg/kg was administered IP at 5 min before asphyxia. In group MH hypothermia was started as soon as asphyxia was started and body temperature was maintained at 30-35 ℃. After successful resuscitation, the animals were sacrificed. Their brains were removed for determination of brain water content and p-caspase-3 expression in hippocampus. Results Brain I/Rsignificantly increased brain water content and p-caspase-3 expression in group ACA. MH alone significantly attenuated 1/R-induced brain edema and decreased p-caspase-3 expression, while ketamine alone only significantly decreased p-caspase-3 expression but did not decrease I/R-induced brain edema. MH + K decreased p-caspase-3expression further but did not reduce brain edema further as compared with MH alone. Conclusion Ketamine combined with moderate hypothermia provides better protection against brain I/R injury.

Objective:To study the distribution of CT doses to paediatric patients in Shanghai by investigating the CT dose parameters availiable in Shanghai′s children′s hospticals, and to provide the basis for establishing the diagnostic reference level for the paediatic patients subjected to CT scanning in Shanghai.Methods:In 2021, a general survey was carried out of the CT doses to the head, chest and abdomen of the scanned paediatric patients in four children′s hospitals in the municipality. The scanned paediatic patients were divided into four age groups of 0-, 1-, 5- and 10-15 years old, each with 30 subjects. The basic information were collected on the subjects, CT scanning parameters, volume CT dose index (CTDI vol) and dose length product (DLP). SPSS 16.0 was used to carry out statistical analysis of the differences in CTDI vol and DLP between different age groups at the same site and between different hospitals for the same age group at the same site. Results:The 75 th percentile values of CTDI vol and DLP for 0-, 1-, 5- and 10-15 age groups were 25, 25, 28, 43 mGy and 402, 477, 504, 752 mGy·cm, respectively, for head scanning; 2.7, 2.2, 2.8, 5.4 mGy and 40, 48, 75 and 176 mGy·cm for chest; and 4.9, 4.4, 8.2, 12 mGy and 106, 131, 273, 471 mGy·cm for abdomen. There were significant differences in CTDI vol and DLP between different age groups at the same site and between different hospitals for the same age group at the same site (head, chest and abdomen CTDI vol:χ2=221.68, 167.27, 127.07, DLP: χ2=220.63, 261.46, 216.61; for four age groups, CTDI vol: head χ2=30.46, 38.39, 25.21, 73.04, chest χ2=30.46, 35.69, 58.92, and 48.03, abdomen χ2=66.58, 41.62, 48.93, and 67.38; DLP: head χ2=28.82, 72.49, 47.72, 52.34, chest χ2=28.82, 35.95, 50.66, 41.64, abdomen χ2=45.53, 26.02 39.34, 44.24, P <0.05 ). Conclusions:The 75 th percentile values of CTDI vol and DLP for head, chest and abdomen in 4 children′s hospitals in Shanghai are lower or close to the values given in the relevant national standards and the diagnostic reference levels in some European countries, with higher DLP values on some scanning sites. The CT scanning procedures for paediatric patients needs to be further optimized.

ObjectiveTo determine the individual dose level and changing trend in the occupational external exposure of radiation workers in Shanghai， and provide scientific evidence for health risk assessment for radiation workers. MethodsIn the Occupational Health Management System for Radiation Workers of the National Health Commission-External Exposure Personal Monitoring and Management Subsystem， we retrieved the monitoring data of 38 077 external exposure individual dose of all medical radiation workers in Shanghai from 2015 to 2019. Using clustered sampling method， a total of 11 370 radiation workers in medical institutions （including tertiary， secondary， and primary hospitals） were selected in the study. Statistical analyses were conducted using SPSS 22.0. ResultsThe collective annual effective dose of 11 370 radiation workers was determined to be 4.340 person Sv， including 2.270 man·mSv in diagnostic radiology， 1.112 man·mSv in interventional radiology， and <0.5 man·mSv in other categories. The average annual effective dose was 0.382 mSv， which was 0.482 mSv in nuclear medicine， 0.431 mSv in radiotherapy， and <0.5 mSv in other categories. Moreover， the average annual effective dose of 6 workers （0.05%） was higher than 5 mSv， whereas that of 10 453 workers （92%） were less than 1 mSv； in addition， the annual dose of 911 workers （8.0%） was between 1‒5 mSv. All workers had average annual effctive dose lower than 20 mSv. The annual effective dose differed significantly by years （F=161.1， P<0.01）， by occupational groups （F=13.5， P<0.01）， and by hospital levels （F=264.5， P<0.01）. ConclusionThe average annual effective dose of radiation workers in medical institutions in Shanghai is lower than the national standard limit， suggesting proper and adequate radiation protection system and measures in medical institutions.

Objective To investigate dose parameters in computed tomography (CT) scanning of common body parts inall public medical institutions in Shanghai, China, and analyze the dose distribution of CT scanning among adult subjects in Shanghai, and to provide a basis for establishing the diagnostic reference levels of CT scanning in Shanghai. Methods We selected at least one medical institution with CT services each from all 16 districts of Shanghai. In each medical institution, a piece of CT equipment with qualified annual inspection was sampled to investigate the doses to subjects in head, chest, abdomen, and lumbar spine scanning. We collected the basic information of the subjects, CT scanning parameters, volumetric CT dose index (CTDI_vol), and dose length product (DLP). Results The scanning data of 1475 subjects were obtained. The 75th percentiles of the CTDI_vol of the head, chest, abdomen, and lumbar spine were 57 mGy, 11 mGy, 16 mGy, and 23 mGy, respectively. The 75th percentiles of the DLP were 862 mGy·cm, 361 mGy·cm, 593 mGy·cm, and 550 mGy·cm, respectively. Conclusion CTDI_vol and DLP differed significantly at different body parts, and also differed greatly at the same body parts. The DLP of men was slightly higher than that of women.

Background The monitoring of external radiation individual doses for radiation workers is a statutory task and serves as an important basis for the diagnosis of occupational diseases in this occupational group. Ensuring the accuracy and reliability of monitoring data is crucial for safeguarding the health of radiation workers. Objective To evaluate and compare the capabilities and levels of external radiation individual dose monitoring conducted by radiation hygiene service institutions in Shanghai, to standardize relevant workflows, and to improve the accuracy and reliability of the monitoring service. Methods From 2021 to 2023, annual intercomparisons of external radiation individual dose monitoring capabilities were organized for radiation hygiene service institutions in Shanghai. The study subjects were 19 to 21 radiation hygiene service institutions registered in Shanghai for each year and they all participated in the intercomparisons. The monitoring subjects included 16 district-level centers for disease control and prevention (CDCs) and 13 third-party testing agencies. Monitoring capabilities were analyzed based on single-group performance, comprehensive performance, and Q-value. In the intercomparison, a thermoluminescent dosimetry system was used to perform irradiation tests on thermoluminescence dosimeter [made of lithium fluoride (magnesium, copper, phosphorus), LiF (Mg, Cu, P)], and monitoring data for X-rays and γ-rays at different doses and radiation conditions were analyzed following a standard procedure specified by GBZ 207−2016. Statistical methods included t-test and Kolmogorov-Smirnov test, with statistical significance set at P<0.05. Results From 2021 to 2023, the number of participating institutions was 19, 21, and 19, respectively, with an overall pass rate of 94.9% (56/59). Two institutions failed in 2022 and one in 2023. The number of institutions meeting the excellent standard in single-group and comprehensive performance was 9, 12, and 13, respectively, and the number of institutions ultimately rated as excellent was 3, 7, and 8,respectively, with an overall excellence rate of 30.5% (18/59) and an excellence conversion rate of 52.9%. The pass rates for single-group and comprehensive performance were both 98.3%. The number of groups with negative deviation was 1.86 times that of groups with positive deviation for X-rays, and 1.10 times for γ-rays. For X-rays, there was a statistically significant deviation between doses of less than 1.0 mSv and more than 1.0 mSv (P=0.01), while there was no significant difference in the single-group performance deviation between X-rays and γ-rays at the same dose. There was a statistically significant difference between the reported and reference values for X-rays in 2021 and 2022 (P<0.05), but no significant difference in 2023 (P>0.05); there was no significant difference between the reported and reference values for γ-rays over the three years (P>0.05). Conclusion Over the past three years, the external radiation individual dose monitoring capability intercomparison results of radiation hygiene service institutions in Shanghai have shown that the pass rate remains at a high level, with the excellence rate increasing year by year. However, some institutions still need to improve their monitoring capabilities, and further cooperation among institutions and training for technical staff are needed to enhance the capabilities and standardization of external radiation individual dose monitoring in Shanghai.

Microneedle percutaneous immunization is achieved by puncturing the stratum corneum of the skin with microneedles so that the vaccine is efficiently recognized by antigen-presenting cells to induce a specific immune response. Due to the advantages of efficient induction of immune response, low pain and easy storage, transdermal immunization by microneedles has been widely used for immunization of various vaccines in recent years. This review summarizes the materials of microneedles, application for transcutaneous immunization, as well as the challenges that need to be addressed.
Administration, Cutaneous ; Drug Delivery Systems ; Needles ; Vaccination ; Vaccines