Objective:Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures.Methods:According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized.Results:Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness.Conclusion:Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.

Objective:Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures.Methods:According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized.Results:Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness.Conclusion:Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.

Background/Aims: Epstein-Barr virus-associated gastric cancers (EBVaGCs) have unique molecular and clinicopathological characteristics. The cyclic GMP-AMP synthase-stimulator of interferon genes (STING) pathway is recently recognized as the critical innate immunity against pathogens and tumors. STING is also a master regulator in the cancer-immunity cycle and targeting STING could synergize with existing immune-checkpoint therapies. However, the role of STING in GC, especially in EBVaGC, and its correlation with programmed death-ligand 1 (PD-L1) remain largely unclear. Methods: We collected 78 cases of EBVaGCs and 210 cases of EBV-negative GC (EBVnGC) from a total of 1,443 cases of GC analyzed by EBV-encoded small RNA in situ hybridization. We investigated STING and PD-L1 expression and their concomitant prognostic value in EBVaGCs and EBVnGCs using tissue microarray and immunohistochemistry. The effects of STING and PD-L1 expression on the overall survival of patients with EBVaGC or EBVnGC were assessed by univariate and multivariate analysis. Results: We found that both STING and PD-L1 exhibited significantly higher expression in the EBVaGCs than that in the EBVnGCs. The expression of STING was positively correlated with that of PD-L1 in EBVaGCs. Simultaneous negative expression of STING and PD-L1, and positive expression of STING were independent prognostic risk factors for EBVaGC and EBVnGC, respectively. Conclusions This is the first prognostic retrospective study of STING and PD-L1 expression and the prognosis among EBVaGC and EBVnGC. The expression and prognostic value of STING and PD-L1 are different in the two types of GCs. STING and PD-L1 are promising prognostic biomarkers and therapeutic targets for EBVaGC and EBVnGC.

Objective:To evaluate the effectiveness and safety of 3.5% lidocaine hydrochloride ophthalmic gel for eye surface anesthesia.Methods:A multicenter, randomized, double-blind, placebo controlled clinical trial was conducted in 10 hospitals in China from August 2018 to April 2019 under the approval of an Ethics Committee of Beijing Hospital (No.2018BJYYEC-014-02). A total of 220 fellow eyes of 220 subjects who received ocular surgery in one eye were actually enrolled according to a same included criteria in different institutes.The 220 eyes were randomly divided into control group and trail group.Two drops of lidocaine hydrochloride gel were dropped at about 5 mm away from corneal limbus at 6 o'clock direction of experimental eye of the trail group, and the blank gel was used in the eyes of the control group in the same way.The pain sensation was assessed with a 0.3 mm toothless micro forceps on conjunctiva within a specified time, and ''pain'' or ''no pain'' was answered by the subjects.The primary effective indexes, namely the number of eyes and percentage of ''no pain'' within 5 minutes following dropping, as well as the secondary indexes including the onset time point of the drug and the duration of anesthesia were recorded and evaluated.Safety evaluation took ocular and system adverse events into account.Results:Within 5 minutes after dropping, ''no pain'' occurred in 104 eyes (94.55%) and 29 eyes (26.36%) in the trail group and control group, respectively, showing a significant difference between the two groups ( χ2=106.948, P<0.001). And there was a significant difference in anesthesia onset time between the trail group and control group (40.0 seconds vs. 300.0 seconds) ( Z=-15.17, P<0.001). The duration of anesthesia was 860.5 (577.5, 1 180.0) seconds in the trail group and 676.0 (280.0, 1 401.0) seconds in the control group, with no statistically significant difference between the two groups ( Z=0.898, P>0.05). The incidence of adverse events in the trail group and control group were 5.45% (6/110) and 4.55% (5/110), respectively, without statistical significance between them ( P=1.000). Conclusions:The 3.5% lidocaine hydrochloride is a safe, effective, easy to use and high-quality surface anesthesia drug for eye surgery.

OBJECTIVE： To investigate the pratice of pharmaceutical care provided by clinical pharmacists in orthopedics department. METHODS： Based on the characteristics of orthopedic diseases and clinical drug use， combined with case analysis， the content， work focus and working methods of pharmaceutical care provided by clinical pharmacists were summarized in orthopedics department of our hospital. RESULTS： Clinical pharmacists of our hospital provided basal pharmaceutical care， such as pharmacy consultation， drug reforming， medication education. Focusing on the application standardization of antibiotics in perioperative period， pain evaluation， analgesic regimen optimization， hemostasis and anticoagulation medication safety monitoring of patients undergoing orthopaedic surgery， clinical pharmacists went deep into ward work to assist physicians in formulating treatment plans. Results of case analysis showed that the work of clinical pharmacists was recognized by doctors and promoted rational drug use in clinic. CONCLUSIONS： Clinical pharmacists should combine different specialty characteristics to carry out pharmacy services for specific groups， continuously improve the professional level and their ability to work， and improve the level of pharmaceutical care.

Objective? To provide guidance for the future nursing for patients undergoing cholecystectomy and reduce the incidence of complications by summarizing the nursing experiences for patients who develop deep vein thrombosis(DVT) and infection after cholecystectomy. Methods? By retrospective analysis, a total of 22 patients with DVT and infection after laparoscopy cholecystectomy in Hepatobiliary Surgery Department in Ruian People's Hospital from January to December 2018 were selected and studied. All of them had surgeries under general anaesthesia. Among them, those who developed DVT and infection were analyzed in terms of the nursing care they received. Results? There were 22 patients who had cholecystectomy and the surgeries lasted for 2 to 5 hours. After surgery, 3 patients developed lung infection, and 1 developed DVT on the right leg. They got discharged after recovery through anti-infection and anticoagulant treatment. The rest patients didn't develop any complications, and got discharged when they were stable. Conclusions? To avoid postoperative complications including DVT and infection, it is essential to actively prevent, timely discover,and actively treating the complications.

Objective To study the MRI features of primary central nervous system lymphoma (PCNSL)to improve its diagnosis. Methods The MRI data of 1 3 patients with PCNSL confirmed by biopsy or surgical pathology were analyzed retrospectively.All patients underwent nonenhanced and contrast-enhanced MRI examinations.Results Multiple lesions in 8 cases and solitary one in 5 cases were found.Five leisons (38.5%)were located in the cerebral hemispheres.Eight(61.5%)were located in deep structures of the brain including periventricular white matter,basal ganglia,thalami and corpus callosum,6 (46.2%)of whom involved in the ependyma including 1 involved in the ependyma of the 4 th ventricle.One leison(7.7%)was located in the cerebellar hemisphere.The tumor showed isointense or mildly hypointense signal on T1WI,mildly hyperintense signal on T2WI and hyperintense signal on DWI.Mild to moderate perilesional edema was noted.The tumors in 13 cases showed remarkable homogeneous enhancement after the contrast agent was injected with the signs of characteristic notch,butterfly and satellite.Focal necrosis occurred in 1 lesions.Conclusion PCNSL shouldbe first considered when a lesion located in the deep central structeres of the brain,multiple and involve ependymal membrane,showed isointensity on T1WI and T2WI,highintensity on DWI in tumoral parenchyma demonstrated,significantly enhancement in the solid part of the tumor.

Objective To evaluate the feasibility of PerkinElmer Genetic Screening Processor(GSP) in the application of newborn screening for congenital hypothyroidism (CH) and congenital adrenal hyperplasia (CAH) by detecting thyroid-stimulating hormone (TSH) and 17-OH-progesterone(17-OHP).Methods The dried-blood spots specimens from Centers for Disease Control and Prevention(CDC) and the quality control in the reagent kit were detected and the accuracy,precision and linearity were calculated.A total of 1 012 samples of TSH(60 of positive and 952 negative samples) and 991 samples of 17-0HP(34 positive and 957 negative samples)were detected.The initial cut-off value was determined by ROC curve determined.The consistency between the results from GSP and clinical diagnosis was analyzed.Results The average of within-run coefficient of variation(CV) of TSH and 17-OHP were 6.69％ to 12.6％ and 7.52％ to 9.29％,and the average of between-run CV were 6.91％ to 10.96％ and 6.86％ to 12.36％,respectively.The average of bias of TSH and 170HP were-14.28％ to-0.74％ and-0.45％ to 12.54％.The linearity of GSP detection was fine.The initial cut-off values were 23.43 U/mL(TSH) and 21.42 ng/mL(17-OHP).The sensitivity of GSP detection was 100％ and the specificity of TSH and 17-OHP were 98.11％ and 99.58 ％ respectively.The results of GSP detection showed good consistency with clinical diagnosis.Conclusion As the first real automatic fluorescence immunoassay analyzer,GSP could be used in routine clinical diagnosis for CH and CAH.

Objective To evaluate the left ventricular systolic circumferential strain by layer specific speckle tracking imaging in healthy volunteers and patients with left bundle branch block (LBBB).Methods Forty patients with LBBB were divided into two groups,LBBB1 group [left ventricular ejection fraction (LVEF≥50％] and LBBB2 group (LVEF＜50％),and 25 healthy subjects were selected as the control group.High frame rate two dimensional images were recorded from the left ventricular short-axis views at the levels of the mitral annulus,papillary muscle and apex respectively.The peak systolic circumferential strain of the endocardium,myocardium and epicardium were measured using layer-specific strain software.Results The circumferential strain of the epicardium and myocardium at the level of the apex showed a statistically significant difference between the LBBB1 group and the control group (P =0.004),while there was no statistically significant difference demonstrated at the levels of the mitral annulus and papillary muscle(P ＞0.01).The circumferential strain of the endocardium at the levels of the papillary muscle and apex showed a statistically significant difference between the LBBB1 group and the control group (P =0.000),while there was no statistically significant difference demonstrated at the level of the mitral annulus (P ＞0.01).The circumferential strain of the endocardium,myocardium and epicardium at the three short axis view levels showed statistically significant differences between the LBBB2 group and the control or LBBB1 groups respectively(P =0.000).Conclusions The circumferential strain of the endocardium at the level of the apex can provide more information about disease prognosis,especially in LBBB patients with a LVEF of ≥50％.

Objective To compare patients'satisfaction and comfort associated with automated breast volume scanner(ABVS),handheld ultrasound(HHUS)and mammography(MMG).Methods Five hundred and twenty-eight women who performed ABVS examination and previously had undergone MMG and HHUS were enrolled.BMI,bra size,with or without lesion,lesion size,pain score of MMG,ABVS and HHUS were documented and analyzed.Results The pain score of MMG was significantly higher than that of ABVS[4.0(2.0,6.0)vs 2.0(1.0,4.0)](P <0.05).92.4% of the cases were preferred for the ABVS examination,which was higher than that for the MMG(45.5%),and was similar to HHUS(94.7%).Bra size,BMI,with or without lesion and lesion size could affect the pain degree of ABVS.Conclusions Routine use of ABVS will be well tolerated by patients than MMG.