Objectives To enhance occupational safety for medical practitioners involved in acupuncture procedures within the field of Chinese medicine,it is imperative to thoroughly investigate and analyze the current incidence of accidental punctures.Subsequently,effective strategies can be proposed to prevent such occurrences.Methods Through retrospective analysis,this study investigates the occupational exposure data of a tertiary hospital specializing in traditional Chinese medicine from 2020 to 2022.The demographic characteristics(age and gender),professional experience,occupational category,pre-service training,type of acupuncture tools used,puncture session details,and exposure sources of the individuals involved are collected and organized for analyzing the risk factors asso-ciated with accidental needlestick injuries.Corresponding preventive measures are proposed accordingly.Results In this survey,a total of 5 069 medical staff from 12 clinical departments were included,among whom 63 experienced accidental puncture with an incidence rate of 1.24%(63/5 069).The likelihood of puncture was found to be signifi-cantly higher in individuals aged between 25～30 years compared to those under the age of 25(OR=18.556,P＜0.05).Similarly,the probability of puncture was also higher in individuals aged over 30 years compared to those under the age of 25(OR=14.311,P＜0.05).Conversely,individuals with at least three years of experience had a lower probability of experiencing punctures compared to those with less than three years(OR=0.025,P＜0.05).Furthermore,interns exhibited a higher likelihood of puncture incidents compared to physicians(OR=2.212,P＜0.05).Regarding the puncture session,the highest probability of occurrence is 58.73%at the time of needle removal(χ2=106.222,P＜0.05).Regarding the type of acupuncture tools,acupuncture needles have the highest probability of occurrence at 41.27%(χ2=45.095,P＜0.05).Concerning the exposure source,"unknown exposure source"has the highest preva-lence at 42.86%(χ2=57.476,P＜0.05),while"exposure source is hepatitis B patient"accounts for 20.63%(χ2=57.476,P＜0.05).Regarding pre-service training,individuals who have received pre-service training exhibit a higher likelihood of puncture incidents(69.84%)(χ2=38.000,P＜0.05).Conclusions The serological status of patients should be obtained in advance,and strict adherence to infection prevention control measures such as"standard precau-tions"and"contact isolation"is necessary.Effective pre-service training must be implemented,with particular atten-tion given to the risk of puncture when using specialized acupuncture tools for occupational safety.

Objective:To investigate the influencing factors for splenomegaly secondary to acute pancreatitis (AP) and construction of a nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 180 patients with AP who were admitted to Xuanwu Hospital of Capital Medical University from December 2017 to December 2021 were collected. There were 124 males and 56 females, aged (49±15) years. Among them, 60 AP patients who developed secondary splenomegaly were taken as the case group, including 48 males and 12 females, aged (47±13)years, and the rest of 120 cases of AP without secondary splenomegaly were taken as the control group, including 76 males and 44 females, aged (50±16)years. Observation indicators: (1) occurrence and clinical characteristics of splenomegaly secondary to AP; (2) influencing factors for splenomegaly secondary to AP; (3) construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. The univariate analysis was performed using statistical methods appropriate to the data type. The optimal cut-off value was determined by the receiver operating characteristic curves. Multivariate analysis was conducted using the Logistic regression model with forward method. Based on the results of the multivariate analysis, a nomogram prediction model was constructed. The receiver operating characteristic curve was drawn, and the discrimination was evaluated using the area under curve. The consistency of the nomogram prediction model was evaluated using calibration curve, and its clinical benefit was evaluated using decision curve. Results:(1) Occurrence and clinical characteristics of splenomegaly secondary to AP. The first detection time of 60 patients with splenomegaly secondary to AP was 60(30,120)days after the onset of AP. Cases with persistent respiratory dysfunction, multiple organ failure, severity of illness as mild or moderately severe/severe, pancreatic and/or peripancreatic infection, surgery were 19, 17, 4, 56, 37, 32 for 60 patients with splenomegaly secondary to AP, versus 16, 19, 43, 77, 39, 29 for 120 patients without splenomegaly secondary to AP, respectively, showing significant differences in the above indicators between the two groups ( χ2=8.58, 3.91, 17.64, 13.95, 15.19, P<0.05). (2) Influencing factors for splenomegaly secondary to AP. Resuts of multivariate analysis showed that white blood cell count <5.775×10?/L within 24 hours of AP onset, revised computed tomography (CT) severity index >7 in 3-7 days after onset and the presence of local complications were independent risk factors influencing the splenomegaly secondary to AP ( odds ratio=3.85, 2.86, 6.40, 95% confidence interval as 1.68-8.85, 1.18-6.95, 1.56-26.35, P<0.05). (4) Construction and evaluation of a nomogram prediction model for splenomegaly secondary to AP. The nomogram prediction model was constructed based on white blood cell count within 24 hours of AP onset, revised CT severity index in 3-7 days after onset and local complications. The area under the receiver operating characteristic curve of the nomogram prediction model was 0.76 (95% confidence interval as 0.69-0.83, P<0.05), with a sensitivity of 0.87 and a specificity of 0.55. The calibration curve demonstrated consistency between the predicted rate from the nomogram prediction model and the actually observed rate. The decision curve analysis indicated that the nomogram prediction model had favorable clinical practicability. Conclusions:Patients with AP who develop secondary splenomegaly tend to have a higher severity of illness than those develop no secondary splenomegaly. White blood cell count <5.775×10?/L within 24 hours of AP onset, revised CT severity index >7 in 3-7 days after onset and presence of local complications are independent risk factors influencing splenomegaly secondary to AP, and its nomogram prediction model can predict incidence rate of splenomegaly secondary to AP.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Objective: miR-663a has been reported to be downregulated by X-ray irradiation and participates in radiation-induced bystander effect via TGF-β1. The goal of this study was to explore the role of miR-663a during radiation-induced Epithelium-to-mesenchymal transition (EMT). Methods: TGF-β1 or IR was used to induce EMT. After miR-663a transfection, cell migration and cell morphological changes were detected and the expression levels of miR-663a, TGF-β1, and EMT-related factors were quantified. Results: Enhancement of cell migration and promotion of mesenchymal changes induced by either TGF-β1 or radiation were suppressed by miR-663a. Furthermore, both X-ray and carbon ion irradiation resulted in the upregulation of TGF-β1 and downregulation of miR-663a, while the silencing of TGF-β1 by miR-663a reversed the EMT process after radiation. Conclusion Our findings demonstrate an EMT-suppressing effect by miR-663a via TGF-β1 in radiation-induced EMT.
Down-Regulation ; Epithelial-Mesenchymal Transition ; Epithelium/metabolism* ; MicroRNAs/metabolism* ; Transforming Growth Factor beta1/pharmacology*

Objectives:To evaluate the role of pancreas multidisciplinary team(MDT) clinic in the diagnosis of pancreatic diseases,patient compliance with MDT advice,and the impact of MDT on the postoperative survival of patients with pancreatic cancer.Methods:The study included 927 patients(554 males,373 females,aged (58.1±13.3)years (range: 15 to 89 years)) that had visited the pancreas MDT clinic of Zhongshan Hospital from May 2015 to December 2021,and 677 patients(396 males, 281 females, aged (63.6±8.9)years(range: 32 to 95 years)) who underwent radical surgery and with pathologically confirmed pancreatic adenocarcinoma from January 2012 to December 2020,of whom 79 patients had attended the pancreas MDT. The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate. The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model. Survival rates were compared using χ 2 test. Results:Among the 927 patients that had visited the MDT clinic,233 patients(25.1%) were referred due to undetermined diagnosis. A direct diagnosis was made in 109 cases (46.8%,109/233) by the MDT clinic, of which 98 were consistent with the final diagnosis,resulting in an accuracy of 89.9%(98/109). The direct diagnosis rate in the recent years(36.6%(41/112),from June 2019 to December 2021) decreased compared to that in the previous years(56.2%(68/121),from May 2015 to May 2019),yet the accuracy in the recent years(90.2%,37/41) was basically the same as before (89.7%,61/68). The rate of compliance of the entire cohort was 71.5%(663/927), with the compliance rate in the recent two and a half years(81.4%,338/415) remarkably higher than that in the previous four years(63.4%,325/512). Patients with pancreatic cancer that attended the MDT exhibited a trend toward longer median postoperative survival than patients that did not attend the MDT,but the difference was not statistically significant(35.2 months vs.30.2 months, P>0.05). The 1-year and 3-year survival rates of patients that attended the MDT were significanly higher than patients that did not attend the MDT(88.6% vs. 78.4%, P<0.05;32.9% vs. 21.9%, P<0.05,respectively),but the 5-year survival rate was not statistically different(7.6% vs. 4.8%, P>0.05). Conclusions:The pancreas MDT clinic is an accurate and convenient way to diagnose intractable pancreatic diseases,and in the recent years the patients′ compliance rate with MDT advice has increased. Pancreatic cancer patients that have attended the MDT have higher 1-year and 3-year postoperative survival rates,but the long-term survival benefits of MDT still needs to be proved by clinical studies on a larger scale.

Objectives:To evaluate the role of pancreas multidisciplinary team(MDT) clinic in the diagnosis of pancreatic diseases,patient compliance with MDT advice,and the impact of MDT on the postoperative survival of patients with pancreatic cancer.Methods:The study included 927 patients(554 males,373 females,aged (58.1±13.3)years (range: 15 to 89 years)) that had visited the pancreas MDT clinic of Zhongshan Hospital from May 2015 to December 2021,and 677 patients(396 males, 281 females, aged (63.6±8.9)years(range: 32 to 95 years)) who underwent radical surgery and with pathologically confirmed pancreatic adenocarcinoma from January 2012 to December 2020,of whom 79 patients had attended the pancreas MDT. The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate. The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model. Survival rates were compared using χ 2 test. Results:Among the 927 patients that had visited the MDT clinic,233 patients(25.1%) were referred due to undetermined diagnosis. A direct diagnosis was made in 109 cases (46.8%,109/233) by the MDT clinic, of which 98 were consistent with the final diagnosis,resulting in an accuracy of 89.9%(98/109). The direct diagnosis rate in the recent years(36.6%(41/112),from June 2019 to December 2021) decreased compared to that in the previous years(56.2%(68/121),from May 2015 to May 2019),yet the accuracy in the recent years(90.2%,37/41) was basically the same as before (89.7%,61/68). The rate of compliance of the entire cohort was 71.5%(663/927), with the compliance rate in the recent two and a half years(81.4%,338/415) remarkably higher than that in the previous four years(63.4%,325/512). Patients with pancreatic cancer that attended the MDT exhibited a trend toward longer median postoperative survival than patients that did not attend the MDT,but the difference was not statistically significant(35.2 months vs.30.2 months, P>0.05). The 1-year and 3-year survival rates of patients that attended the MDT were significanly higher than patients that did not attend the MDT(88.6% vs. 78.4%, P<0.05;32.9% vs. 21.9%, P<0.05,respectively),but the 5-year survival rate was not statistically different(7.6% vs. 4.8%, P>0.05). Conclusions:The pancreas MDT clinic is an accurate and convenient way to diagnose intractable pancreatic diseases,and in the recent years the patients′ compliance rate with MDT advice has increased. Pancreatic cancer patients that have attended the MDT have higher 1-year and 3-year postoperative survival rates,but the long-term survival benefits of MDT still needs to be proved by clinical studies on a larger scale.

OBJECTIVE：To syst ematically evaluate the effectiveness and safety of ticagrelor versus clopidogrel in the treatment of acute coronary syndrome （ACS）patients in East Asia ，and to provide evidence-based references for clinical drug use. METHODS：Retrieved from Cochrane Library ，PubMed，Embase，CNKI，Wanfang database ，etc.，randomized controlled trials （RCTs）about ticagrelor （trial group ）versus clopidogrel （control group ）in the treatment of ACS patients in east Asia were collected. After literature screening and data extraction ，the quality of included literatures was evaluated by using biasrisk evaluation tool recommended by Co chrane system evaluation manual 5.1.0，and Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS ：A total of 5 RCTs were included ，with a total of 4 511 cases. Meta-analysis showed that the incidence of major adverse cardiovascular events [OR ＝0.85，95％CI（0.68，1.04），P＝0.12]，the incidence of death from cardiovascular causes [OR ＝0.76，95％CI（0.57，1.03），P＝0.08] and the incidence of stroke [OR ＝0.77，95％CI（0.48，1.24），P＝0.28]， without statistical significance. The incidence of major bleeding events [OR ＝1.54，95％CI（1.19，1.99），P＝0.001] and minor bleeding events [OR ＝1.80，95％ CI（1.40，2.32），P＜0.000 01] in trial group were significantly higher than control group. CONCLUSIONS：Ticagrelor is comparable to clopidogrel in reduce the major adverse cardiovascular events，death from cardiovascular causes and stroke in ACS patients in East Asian ，but it can increase the risk of major and minor bleeding events.

OBJECTIVE: To explore the molecular basis for a Chinese family affected with neurofibromatosis type I. METHODS: Peripheral blood samples were collected from the proband and his parents. Potential mutations of NF1 gene were screened by PCR and Sanger sequencing. Pathogenicity of candidate mutations was analyzed using Polyphen-2 and Provean software. RESULTS: Two mutations of the NF1 gene, including c.702G>A (synonymous mutation) and c.1733T>G (missense mutation), were discovered in the proband. Neither mutation was found in his parents and 50 healthy controls. Bioinformatics analysis indicated that the c.1733T>G mutation (p.Leu578Arg) was probably damaging. The affected codon L578 is highly conserved across various species. CONCLUSION The c.1733T>C mutation of the NF1 gene probably underlies the neurofibromatosis type I in this family.
Asian Continental Ancestry Group ; Genes, Neurofibromatosis 1 ; Humans ; Mutation ; Neurofibromatosis 1 ; genetics ; Neurofibromin 1 ; genetics ; Pedigree

Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients.Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016.According to the treatment method,the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation.Group A consisted of 28 cases (28 vertebrae),including eight males and 20 females,aged 64-91 years [(78.1 ±8.5) years].In terms of the distribution of injured vertebrae,there were four cases of T10,six cases of Tu,eight cases of T12,four cases of L1,and six cases of L2 in Group A.Group B consisted of 30 cases (30 vertebrae),including 10 males and 20 females,aged 65-90 years [(77.8 ± 8.2) years].In terms of the distribution of injured vertebrae,there were three cases of T10,seven T11,nine T12,six L1,and five L2.The operation time,visual analogue scale (VAS) before operation,1 day after operation and at the last follow up,Japanese Orthopedic Association (JOA) score,anterior compression ratio of injured vertebrae,and cement leakage rate were compared between the two groups.Results All the operations were completed successfully.The patients were followed up for 14-26 months [(18.7 ± 3.4)months] in Group A and for 12-28 months [(20.0 ± 5.4) months] in Group B.The operation time was (28.0 ± 3.4) min in Group A and (30.9 ±5.3) min in Group B (P ＜ 0.05).Both the VAS 1 d after operation of Group A [(2.3 ± 1.0) points] and Group B [(2.0 ± 0.8) points] and the VAS at the last follow up of Group A [(0.7 ± 0.7) points] and Group B [(0.8 ± 0.7) points] were significantly lower than those before operation (P ＜ 0.05),but there was no significant difference between thetwo groups (P ＞ 0.05).Both the JOA at day 1 after operation of Group A [(21.3 ± 2.2) points] and Group B [(20.7 ± 2.1) points] and the JOA at the last follow up of Group A [(24.7 ± 2.3) points] and Group B [(24.1 ± 2.0) points] were significantly higher than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).The anterior compression ratio of injured vertebrae 1 d after operation of Group A (59.4 ± 7.9) ％ and Group B (59.1 ± 6.8) ％ and that at the last follow up of Group A (59.1 ± 7.8) ％ and Group B (58.7 ± 5.4) ％ were significantly improved than those before operation (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).There were three cases of bone cement leakage in Group A (11％) and 11 cases of bone cement leakage in Group B (37％) after PVP,and the difference was statistically significant (P ＜ 0.05).Conclusion Compared with conventional PVP,3D printingassisted PVP has lower leakage rate,shorter operation time,and better clinical effect in treating severe OVCF in the elderly.

Objective To study the clinical efficacy of micro-plasma radiofrequency with joint electron-beam radiation treatment for keloids.Methods A total of 15 patients with keloids over half a year were treated with single time micro-plasma radiofrequency technology by roller tip at 80-100 watts.The hypofractionated electron-beam was used,with 9 Gy dose per time covering the scar with a 1 cm margin,within 24 hours and 1 week after the micro-plasma treatment.The Vancouver Scar Scales (VSS) were assessed before and 6 months after the treatment.Patients' satisfaction and the adverse reactions were evaluated 6 months after the treatment.Results There was astatistically significant difference between the mean VSS of 15 patients pre-and 6 months posttreatment (from 11.73± 1.12 to 3.87±2.53,P＜0.05).The degree of improvement was:excellent in 1 case,good 10 cases,fair 3 cases,and poor 1 case.Patients' assessment was:extremely satisfied in 6 cases,satisfied 6 cases,approximately satisfied 2 cases and dissatisfied 1 case.The adverse reactions included hyperpigmentation within the radiation field on the anterior chest wall in 1 case and delayed healing of 1 patient 's scar wound.Conclusions Micro-plasma radiofrequency combined with electron-beam radiation therapy is highly effective and safe on keloids with good clinical application value.