Background Work-related musculoskeletal disorders (WMSDs) are one of the major occupational health problems faced by bus drivers and should receive special attention. Objective To explore the associations of weekly working hours and sleep quality with neck and lower back WMSDs among bus drivers, as well as assess the potential mediating role of sleep quality. Methods From June to December 2022, we recruited bus drivers from 5 subsidiaries of the Shenzhen Bus Group by convenient sampling method. Demographic characteristics, lifestyles, and work-related features of the bus drivers were collected through a questionnaire survey. The Pittsburgh Sleep Quality Index (PSQI) scale and the Musculoskeletal Disorders Survey Questionnaire were used to assess sleep quality and WMSDs respectively. Logistic regression models were applied to analyze the associations of weekly working hours and sleep quality with WMSDs in neck and lower back. Furthermore, mediation analysis was performed to investigate the role of sleep quality in the associations between weekly work hours and neck and lower back WMSDs. Results A total of 1792 valid questionnaires were collected, with a response rate of 95.07%. Among these, 89.3% of the bus drivers worked more than 40 h per week, and the positive rate of poor sleep quality was 28.2%. The overall positive rate of WMSDs within one year before the survey was 69.12%. Among different body regions, the leading positive rates were identified in neck and lower back regions, at 55.92% and 53.68%, respectively. The logistic regression model showed that compared to the bus drivers with weekly work hours ≤40 h, those weekly worked (40~48] h (OR=1.43, 95%CI: 1.02, 2.01; OR=1.65, 95%CI: 1.17, 2.34), (48~56] h (OR=2.69, 95%CI: 1.89, 3.83; OR=2.30, 95%CI: 1.62, 3.29) and ＞56 h (OR=2.63, 95%CI: 1.86, 3.74; OR=3.23, 95%CI: 2.27, 4.62) had significantly increased risk of WMSDs in neck and lower back. Additionally, when compared to those with good sleep quality, bus drivers with poor sleep quality had higher risks of both neck and lower back WMSDs (OR=4.08, 95%CI: 3.20, 5.23; OR=4.15, 95%CI: 3.26, 5.30, respectively). Further mediation analysis indicated that sleep quality partially mediated the associations between weekly working hours and both neck and lower back WMSDs, with 36.15% and 33.68% as the respective proportion of mediation. Conclusion The positive rate of WMSDs is high among bus drivers, and the most common WMSDs occur in neck and lower back. Long working hours and poor sleep quality are significantly associated with increased risks of neck and lower back WMSDs. Sleep quality may mediate the associations of weekly working hours with neck and lower back WMSDs.

OBJECTIVE To evaluate the cost-effectiveness of iruplinalkib for ALK-positive non-small cell lung cancer （NSCLC） patients who had not previously received ALK-tyrosine kinase inhibitors （TKIs） from the perspective of the Chinese healthcare system. METHODS Based on the INSPIRE clinical trial， a three-health state partitioned survival model was developed to simulate the progression of disease， with model cycle of 3 weeks and a life-year time range of 15 years； the discount rate was 5%. For the treatment of ALK-positive advanced NSCLC， total cost， quality-adjusted life year （QALY）， and incremental cost- effectiveness ratio （ICER） were compared between iruplinalkib and crizotinib； using 1-3 times China’s per capita gross domestic product （GDP） （89 358-268 074 yuan） in 2023 as the willingness-to-pay （WTP） threshold， the cost-effectiveness of two regimens were compared. The sensitivity analysis and scenario analysis （altering the distribution of survival curves， utility values） were conducted to assess model robustness. RESULTS Compared with the crizotinib regimen， the ICER for the iruplinalkib regimen was 194 412.74 yuan/QALY， which was below the WTP threshold of three times China’s per capita GDP in 2023 yuan）. The results under the scenario of altering the survival curve distribution were consistent with the base case analysis. However， after increasing the utility value of the disease progression state， the ICER exceeded the WTP threshold， and iruplinalkib no longer had a cost-effective advantage. The results of the one-way sensitivity analysis indicated that the cost of iruplinalkib and the utility values of disease progression states had a significant impact on the ICER. The probabilistic sensitivity analysis confirmed the robustness of the base case analysis results. CONCLUSIONS From the perspective of China’s healthcare system， compared with crizotinib regimen， the therapy with iruplinalkib is cost-effective for ALK-positive NSCLC patients who have not previously received ALK-TKIs.

Objective: To investigate the characteristics and risk factors of an outbreak of acute hemorrhagic conjunctivitis (AHC) in a boarding middle school in Guangdong Province, in order to provide a scientific evidence for effective prevention and control of campus AHC outbreaks. Methods: From September 1st to 28th 2023, case identification was conducted among 559 students and 60 faculty members using standardized definition. Descriptive analysis was conducted on the three distrubution patterns of the outbreak. Questionnaires were designed, and a case-control study was adopted to analyze the possible risk factors of the disease transmission. The propensity score matching (PSM) method was used to control the difference of baseline data. Results: A total of 269 cases of AHC were identified, with an attack rate of 43.46%. The pathogen was confirmed as Coxsackie virus A24 variant (CA24v). Among these, 264 cases were students (attack rate of 47.23%) and 5 were staff (attack rate of 8.33%). A total of 153 pairs of PSM were successfully matched. After PSM matching, there were no statistically significant differences in gender, grade and class between the case group and the control group ( χ 2=0.12, 5.41, 11.24, P >0.05). The results of multivariate Logistic regression analysis showed that middle school students whose towels contacted with others ( OR =1.81), and direct contact with other AHC cases recently ( OR =4.89) were more likely to have AHC; while wearing glasses ( OR =0.43) and frequent use of hand sanitizer ( OR = 0.37 ) were less likely to have AHC ( P <0.05). Conclusion The outbreak of AHC is caused by CA24v, demonstrating rapid spread and extensive impact within the school setting.

Objective To investigate the feasibility and early efficacy of transapical transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve edge-to-edge repair (TEER) in patients with high-risk aortic valve lesions combined with severe mitral regurgitation. Methods The clinical data of patients who underwent "one-stop" transapical TAVR+TEER in our hospital from August 2022 to October 2023 were retrospectively analyzed. Results Five patients were collected, including 3 males and 2 females with a mean age of 66.6±1.8 years. Four patients had aortic valve insufficiency combined with mitral regurgitation and one had aortic valve stenosis and insufficiency combined with mitral regurgitation. All patients successfully completed transapical TAVR+TEER, and the immediate postoperative echocardiographic results revealed that none of them had more than mild perivalvular leakage and mitral regurgitation, and the prosthetic valves were in good position and function. At 1 week postoperatively, echocardiographic results showed 5 patients with no displacement of the prosthetic valve, detachment of the mitral clip, or damage to the leaflets. At 1 month postoperatively, cardiac function was improved to varying degrees in 4 patients, and 1 patient died of multiorgan failure. At 2 months postoperatively, 1 patient died of cerebrovascular accident, and at 3 months postoperatively the echocardiographic results of the remaining 3 patients revealed that there was no more than mild perivalvular leakage or mitral regurgitation, and the patients' postoperative cardiac function and daily life ability were significantly improved. Conclusion In high-risk aortic valve lesions combined with severe mitral regurgitation, "one-stop" transapical TAVR+TEER is feasible with favorable early efficacy and safety.

OBJECTIVE To investigate the improvement effects of sinomenine （Sin） on non-alcoholic steatohepatitis （NASH） and its potential mechanism. METHODS Male C57BL/6J mice were randomly divided into standard chow diet （SCD） group， high- fat diet （HFD） group， Sin low-dose group （Sin-L group， 50 mg/kg）， and Sin high-dose group （Sin-H group， 100 mg/kg）， with 6 mice in each group. The mice of SCD groups were fed with SCD， and other groups were given HFD for consecutive 24 weeks to establish NASH model. Since 17th week， the mice in each drug group were given corresponding drug solutions intragastrically， once a day， for 8 consecutive weeks. After the last medication， the body weight and liver weight of mice were determined， and liver indexes were calculated. The contents of total cholesterol （TC） and triglyceride （TG） in liver tissue， the serum contents of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， interleukin-1β （IL-1β） and IL-18 were all determined. Hepatic steatosis and fibrosis were observed， and hepatic lipid droplets were located. The expressions of IL-18 and IL-1β mRNA， inflammation-related proteins （IL-1β， cleaved-IL-1β）， fibrosis-related proteins [collagen Ⅰ （Col-Ⅰ）， α-smooth muscle actin （α-SMA）， connective tissue growth factor （CTGF）]， and pathway-related protein [adenosine monophosphate-activated protein kinase （AMPK）， phosphorylated AMPK （p-AMPK）， Yes-associated protein （YAP）， phosphorylated YAP （p-YAP）] were all determined. HepG2 human liver cancer cells were selected as subjects and divided into control group， oleic acid （OA） group， Sin 50 μmol/L group， Sin 100 μmol/L group， OA+Sin 50 μmol/L group and OA+Sin 100 μmol/L group. After 24 hours of treatment， the accumulation of lipid droplets was observed， and the expressions of pathway-related proteins were detected.RESULTS Compared to HFD group， hepatic steatosis， zengcheng@gdpu.edu.cn fibrotic lesions and lipid droplet accumulation were all alleviated in Sin groups； body weight， liver weight， liver indexes， the contents of AST， ALT， IL-1β， IL-18 in serum and TG， TC in liver tissue， the mRNA expressions of IL-1β and IL-18， and the expressions of cleaved-IL-1β and fibrosis-related proteins all decreased significantly （P＜0.01）； the protein expression of IL-1β， and the phosphorylation levels of AMPK and YAP proteins significantly increased （P＜0.01）. Compared with OA group， the lipid droplet accumulation of cells in OA+Sin groups significantly decreased， while the phosphorylation levels of AMPK and YAP proteins significantly increased （P＜0.05）. CONCLUSIONS Sin can ameliorate the inflammation， lipid deposition and fibrosis of liver tissue in mice， the mechanism of which may be associated with activating the AMPK signaling pathway and promoting YAP phosphorylation.

Gingival recessions (GRs) result in root hypersensitivity, root surface caries, and esthetic problems. Various root coverage surgeries are being developed for periodontal plastic therapy. The tunnel technique (TUN) is one of the most widely applied surgeries due to its features of being minimally invasive, practical, excellent outcomes and long-term stability; however, there are still some limitations of this technique. The history and evolution from the envelope flap to TUN, including its efficiency when compared with coronally advanced flaps with a connective tissue graft (CTG), are reviewed in this paper. The limitations of TUN are discussed in consideration of our clinical experience; for example, there is high technique sensitivity when TUN is applied in GR>5 mm because of the great difficulty in covering the grafts. The advantages of surgical access, including vertical incisions in the vestibule, “W” type and pinhole access, are discussed for different situations. Mattress sutures and sling sutures in a single tooth or multiple teeth are applied in TUN. The different types of grafts, such as CTG, platelet-rich plasma, articular dermal matrix and xenogeneic collagen matrix, are described. Mechanical, chemical and biological conditioning of the root surface are recommended during surgery. Protecting the surgical area and taking antibiotics postoperatively are also very important. Finally, the modifications when TUN is applied with other kinds of techniques are discussed, including lateral closed TUN, laterally positioned flaps, double papilla flaps and frenuloplasty. Minimally invasive, esthetic, long-term stability and simplified techniques are the development trends of TUN in the future.

{L-End}Objective To understand the prevalence of work-related musculoskeletal disorders (WMSDs) and sickness absence due to WMSDs among key industry workers in Shenzhen City. {L-End}Methods A total of 14 949 workers exposed to dust, noise, chemical and radiation (hereinafter referred to as "traditional occupational groups") in some key industries in Shenzhen City, as well as bus drivers, teachers, medical staff, policemen, courier, sanitation workers and video operators were selected as the research subjects using stratified cluster sampling. The Musculoskeletal Disorders Questionnaire was used to investigate the prevalence of WMSDs and sickness absence due to WMSDs in the past year. {L-End}Results The overall prevalence of WMSDs among the study subjects was 56.3% (8 423/14 949). The prevalence of WMSDs in different body parts from high to low was neck, waist, shoulder, back, knee, wrist, ankle, hip, and elbow, which was 37.6%, 35.7%, 31.7%, 25.2%, 18.3%, 15.4%, 14.9%, 12.4%, and 11.6%, respectively (P<0.01). The overall prevalence of WMSDs among different occupational groups from high to low was teachers, video operators, bus drivers, couriers, medical staff, policemen, traditional occupational groups, and sanitation workers, which was 82.2%, 75.7%, 74.9%, 73.9%, 67.9%, 64.3%, 43.3%, and 31.9%, respectively (P<0.01). The overall rate of sickness absence due to WMSDs was 18.3% (2 736/14 949). The overall rate of sickness absence among different occupational groups from high to low was bus drivers, couriers, teachers, traditional occupational groups, policemen, video operators, medical staff, and sanitation workers, which was 31.6%, 24.5%, 20.9%, 20.2%, 15.2%, 12.4%, 9.3%, and 6.7%, respectively (P<0.01). Among different parts of the body, the highest correlation coefficient of WMSDs was found between neck and shoulder ［correlatioon cofficient (r)=0.648, P<0.01］, while the lowest was between neck and ankle (r=0.303, P<0.01). {L-End}Conclusion The prevalence of WMSDs and sickness absence due to WMSDs among key industry workers in Shenzhen City is relatively high. Comprehensive prevention and control measures should be taken according to the characteristics of occupational population to reduce the impact of WMSDs on the health of occupational population.

{L-End}Objective To investigate the prevalence of neck and waist work-related musculoskeletal disorders (WMSDs) and its relationship with occupational stress among express delivery workers. {L-End}Methods A total of 437 express delivery workers in Shenzhen City were selected as the research subjects using convenient sampling method. The prevalence of neck and waist WMSDs and the level of occupational stress were investigated by the Musculoskeletal Disorder Questionnaire and Work Content Questionnaire. {L-End}Results The prevalences of neck and waist WMSDs among the workers in the past year were 47.6% (208/437) and 60.2% (263/437), respectively. The detection rate of occupatioonal stress was 51.5%(225/437). The prevalences of neck and waist WMSDs among the workers of the occupational stress group were higher than that in the non-occupational stress group (51.9% vs 42.6%, 66.4% vs 53.0%, both P<0.01). The results of multivariate logistic regression analysis showed that the risk of neck WMSDs was higher in workers with weekly working hours >40 hours, workers with poor working posture, and workers with occupational stress compared with workers with weekly working hours ≤40 hours, workers without poor working posture, and workers without occupational stress, respectively (all P<0.05). The risk of waist WMSDs was higher in workers without weekly exercise, workers with poor working posture, and workers with occupational stress compared with workers with weekly exercise, workers without poor working posture, and workers without occupational stress, respectively (all P<0.05). {L-End}Conclusion The prevalence of neck and waist WMSDs, which may be influenced by occupational stress and poor working postures, is relatively high among express delivery workers.

OBJECTIVE: To detect the expression of plasma exosomal microRNA (miRNA) in systemic sclerosis (SSc), and to investigate its clinical significance. METHODS: A total of 20 patients who were initially diagnosed with SSc and did not receive medication in Department of Rheumatology and Immunology of Meizhou People' s Hospital from January 2020 to January 2022 were recruited, as well as 15 healthy individuals whose gender and age matched with those of the SSc patients. Plasma exosomes were isolated using ultracentrifugation method. The expression levels of exosomal miR-34-5p, miR-92-3p and miR-142-3p were detected by quantative real-time polymerase chain reaction (qRT-PCR). Correlations between the expression levels of exosomal miRNAs and clinical characteristic were analyzed by Spearman's rank correlation coefficient test. RESULTS: The mean age of 20 patients with SSc was (52.6±12.6) years, including 7 males and 13 females. Among the 20 SSc patients, 13 cases were diagnosed as limited cutaneous systemic sclerosis (lcSSc) and 7 cases were diagnosed as diffuse cutaneous systemic sclerosis (dcSSc) according to the extent of skin involvement. According to the findings of high resolution chest CT, 7 of 20 SSc patients were diagnosed with interstitial lung disease (ILD) and 13 SSc patients were diagnosed with non-ILD. The expression levels of exosomal miR-34-5p, miR-92-3p and miR-142-3p were significantly elevated in the SSc patients compared with those in the healthy controls group (P=0.003, P=0.000 1, and P=0.016, respectively). Compared with the SSc patients without ILD, the expression levels of miR-34-5p and miR-142-3p were significantly lower in the SSc patients with ILD (P=0.037 and P=0.015, respectively). The expression levels of exosomal miR-34-5p and miR-142-3p showed negative correlation with ILD (r=-0.48, P=0.031 and r=-0.55, P=0.011, respectively), and arthritis (r=-0.46, P=0.040 and r=-0.48, P=0.032, respectively). The expression levels of exosomal miR-142-3p showed a negative correlation with erythrocyte sedimentation rate (ESR) (r=-0.55, P=0.012). CONCLUSION Plasma exosomal miR-34-5p, miR-92-3p and miR-142-3p were dysregulated in SSc. The dyregulation of exosomal miR-34-5p and miR-142-3p showed correlation with SSc associated ILD (SSc-ILD).
Male ; Female ; Humans ; Young Adult ; Adult ; Clinical Relevance ; MicroRNAs/genetics* ; Scleroderma, Systemic/genetics* ; Lung Diseases, Interstitial

OBJECTIVE: To explore the efficacy of venetoclax (VEN) plus azacitidine (AZA) in patients with FLT3-ITD mutated relapsed/refractory acute myeloid leukemia (FLT3-ITD^mut R/R AML) and analyze the molecular genetic characteristics of the patients. METHODS: Clinical baseline characteristics and follow-up data of 16 R/R AML patients treatd with VEN plus AZA in the hematology department of Shenzhen Second People's Hospital from November 2018 to April 2021 were collected. Leukemia related genes were detected by next-generation sequencing(NGS) or PCR. The relationship between the efficacy of VEN plus AZA and molecular genetics characteristics of patients with FLT3-ITD^mut R/R AML were analyzed. RESULTS: 14.3% (1/7) of the patients in FLT3-ITD^mut group and 22.2% (2/9) of the patients in FLT3-ITD^wt group achieved complete remission (CR)/CR with incomplete blood count recovery (CRi), respectively, with no significant difference (P=0.69). There was no significant difference in overall response rate (ORR) (CR/CRi+PR) between FLT3-ITD^mut group and FLT3-ITD^wt group [42.9%(3/7) vs 44.4%(4/9), P=0.95], too. The median overall survival (OS) time of FLT3-ITD^mut patients was significantly shorter than that of FLT3-ITD^wt patients (130 vs 300 days, respectively) (P =0.02). Co-existing mutations of FLT3-ITD and IDH1 were detected in one patient who achieved CR. Co-existing mutations of FLT3-ITD and SF3B1 were found in one patient who achieved PR. Three FLT3-ITD^mut R/R AML patients accompanied with NPM1 mutation had no response to VEN plus AZA. CONCLUSION VEN plus AZA showed a certain effect on patients with FLT3-ITD^mut R/R AML. To improve OS of the patients, bridging transplantation is need. IDH1 and SF3B1 mutations might predict that patients with FLT3-ITD^mut R/R AML have treatment response to VEN plus AZA, while the combination of NPM1 mutation may indicate poor response.
Humans ; Nucleophosmin ; Prognosis ; Leukemia, Myeloid, Acute/genetics* ; Mutation ; Azacitidine/therapeutic use* ; fms-Like Tyrosine Kinase 3/genetics*