Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To study the predictive value of combining alpha-feto protein (AFP) with contrast-enhanced MRI imaging features in predicting incidence of microvascular invasion (MVI) in patients with hepatocellular carcinoma.Methods:The data of 206 patients with hepatocellular carcinoma treated at Tianjin Medical University Cancer Institute and Hospital from January 2017 to April 2019 were retrospectively analyzed. There were 179 males and 27 females, with an average age of 58.7 years. The roles of preoperative MRI imaging features and clinical data on predicting the incidence of MVI in patients with hepatocellular carcinoma were evaluated by univariate and multivariate logistic regression analyses. Multivariable regression analysis was then used to plot a nomogram.Results:There were 86 patients (41.7%) with MVI positivity and 120 patients (58.3%) with MVI negativity. Multivariate logistic regression analysis showed that AFP >400 μg/L ( OR=3.318, 95% CI: 1.243-8.855, P=0.017), two-trait predictor of venous invasion (TTPVI) ( OR=13.111, 95% CI: 6.797-28.119, P<0.001), diffusion weighted imaging/T 2 weighted imaging (DWI/T 2WI) mismatch ( OR=17.233, 95% CI: 4.731-44.490, P<0.001), and rim enhancement( OR=5.665, 95% CI: 2.579-18.152, P=0.013) predicted increased risks of MVI in patients with hepatocellular carcinoma. The constructed nomogram directly predicted the risk of MVI in these patients. Conclusions:AFP>400 μg/L, TTPVI, DWI/T 2WI mismatch and rim enhancement were independent risk factors in predicting MVI in patients with hepatocellular carcinoma. This predictive model of MVI which was based on multivariate logistic regression analysis was helpful to clinicians in making individualized treatment plans for patients with hepatocellular carcinoma.

Objective:To investigate the prevalence of pre-diabetes mellitus (PDM) and the impact of occupation-related factors on PDM, among workers from a steel company in Tangshan city, Hebei province.Methods:Clustering sampling method was used to select a steel company and to carry out occupational health-related physical checkup programs for eligible workers who had working in this company for longer than one year. The study began in February and ended up in June, 2017. Workers who were with FPG level as ≤6.9 mmol/L, and free from diabetes, were selected as the subjects for this study. Questionnaires were used and physical examinations and FPG testing conducted.Results:The total number of subjects in this study was 4 173, of which 2 648 appeared as pre-diabetic, with the prevalence rate as 63.4 %. Increase of the PDM prevalence was in parallel with the length of service, among the workers. The risk for the pre-diabetes in those who worked more than 8 hours per day was 1.696 times higher than those who worked less than or equal to 8 h/d (95 %CI:1.517-1.937). Compared with those workers without exposures to heat, noise or carbon monoxides, the proportion of pre-diabetes appeared higher in workers exposed to heat, noise or CO with OR=1.782 (95 %CI: 1.205-2.636), 1.815 (95 %CI: 1.209-2.794) and 1.653 (95 %CI: 1.158-2.361), respectively. Risks for those who were exposed to heat or noise were higher than those who were free from exposure to any occupational hazards ( OR=2.098, 95 %CI: 1.296-3.397). Prevalence rates of pre-diabetes in those who were exposed to heat, noise or CO, were higher than that those who were not. Conclusion:Working hours and exposures to heat, noise or CO appeared as influential factors on PDM.

Objective: To investigate the prognostic value of chest computed tomography (CT) characteristics in crizotinib-treated pa-tients with advanced non-small cell lung cancer (NSCLC). Methods: Forty-seven patients with advanced ALK-rearranged NSCLC who re-ceived crizotinib treatment from January 2014 to March 2017 were enrolled in this retrospective study. Pre-treatment CT characteris-tics were evaluated. Patients were followed up after crizotinib treatment, and the best overall response and progression-free survival (PFS) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). Results: The median PFS of all patients was 10 months. There was no association between CT characteristics and response. In univariate analysis, large tumor size (P=0.009), central type (P=0.002), consolidation of surrounding lung tissue (P=0.002), pleural effusion (P=0.001), and lymphangitic carcino-matosis (P=0.019) suggested a poor prognosis. Multivariate Cox regression analysis showed that location (hazard ratio, 3.219; 95% con-fidence interval: 1.517-6.833; P=0.002) was an independent prognostic predictor. Conclusions: Pre-treatment CT characteristics are useful in predicting the PFS of crizotinib-treated patients with advanced NSCLC harboring ALK rearrangement.

To investigate the correlation between magnetic resonance imaging (MRI) features and tumor risk grade of gas-trointestinal stromal tumors (GISTs). Methods: Between September 2007 to December 2017, 54 patients who underwent MRI and were pathologically diagnosed in Tianjin Medical University Cancer Institute and Hospital were retrospectively reviewed. We analyzed MRI features including the size, location, shape, boundary, and growth pattern of the tumor; cystic necrosis; metastasis; T1WI and T2WI signal intensities; enhancement signal intensity-time (SIT) curve pattern; and average apparent diffusion coefficient (ADC) val-ues. The MRI features were compared with the tumor risk grade. Results: Of the 54 cases, 16 were of low-risk grade, 13 were of inter-mediate-risk grade, and 25 were of high-risk grade. Statistical analysis showed that tumor size, location, shape, boundary, cystic necro-sis, signal intensity, and average ADC values were correlated with tumor risk grade (P<0.05). However, tumor growth pattern, metasta-sis, and enhancement SIT curve pattern were not correlated with tumor risk grade (P>0.05). GISTs with higher aggressive features were more likely to have larger size, irregular shape, unclear boundary, cystic necrosis, heterogeneous signal intensity, and lower ADC values on MRI. Conclusions: MRI has the potential to predict the risk grade of GISTs before surgery, thereby guiding clinical manage-ment, and evaluating prognosis.

OBJECTIVE: To explore the effect of occupational high temperature exposure on type 2 diabetes( T2 DM) in male steel workers. METHODS: A cluster random sampling method was used to select 684 male steel workers,who exposed to occupational high temperature in a steel enterprise in Tangshan City,as the high temperature group,and 1 153 male steel workers without occupational high temperature exposure as the control group. The high temperature level of workers in these two groups was measured. The cumulative exposure( CE) of high temperature was calculated,and occupational health exam was performed. The multivariate logistic regression analysis and restricted cubic splines were used to analyze the relationship between high temperature CE and T2 DM. RESULTS: The prevalence of T2 DM in high-temperature group was higher than that in the control group( 13. 0% vs 7. 9%,P < 0. 05). The multivariate logistic regression analysis results showed that the risk of T2 DM in the high temperature group was higher than that in the control group after adjusting for age,body mass index,smoking,drinking,physical exercise and parents with diabetes( P < 0. 05). The 95% confidence interval was 1. 65( 1. 17-2. 33). Restricted cubic spline analysis showed that the high temperature CE was correlated with the prevalence of T2 DM in workers( P < 0. 01) and showed a linear correlation( nonlinearity test,P > 0. 05). CONCLUSION: Occupational high temperature exposure is associated with the occurrence of T2 DM in male steel workers. The male steel workers with high temperature CE show high prevalence of T2 DM risk.

OBJECTIVE: To analyze the effect of occupational stress on abnormity of serum total cholesterol and triglyceride in male steel workers. METHODS: A total of 3 957 male steel workers from an iron and steel group company were selected as study objects by judgment sampling method. Occupational stress was measured by the Chinese version of Job Content Questionnaire. The serum total cholesterol and triglyceride levels were measured using fasting venous blood. RESULTS: Among the 3 957 workers,the detection rate of occupational stress was 56. 8%,and 55. 0% of them showed high social support. The abnormal rates of total cholesterol and triglyceride were 21. 8% and 40. 9%,respectively. The multivariate logistic regression analysis showed that workers with high social support had high risk of abnormal total cholesterol and abnormal triglyceride than workers with low social support( P < 0. 05) after adjusting for confounding factors such as age,education level,marital status,body mass index,smoking and drinking alcohol,tea. The odds ratio of abnormal total cholesterol in occupational stress workers was 1. 17 times of that of non-occupational stress workers. No association was found between occupational stress and abnormal triglyceride( P > 0. 05). CONCLUSION: Occupational stress may be associated with abnormity of total cholesterol in male steel workers. Social support is an important influences factor to the abnormity of total cholesterol and triglyceride in male steel workers.

Objective To discuss progress in Qinghai Tibetan Thymidylate synthase enhancer in patients with gastric cancer (TSER),ERCC1 polymorphism of genes,gene expression and mRNA studies.Methods 210 cases of advanced gastric cancer were enrolled as required to complete the treatment and follow-up.TSER,ERCC 1 gene polymorphism were tested using PCR-RFLP method.Analysis of gastric cancer is based on the results of gene polymorphism and clinical pathological factors in relations.The expression of ERCC1 mRNA was detected by RTPCR,and tracking access after treatment.Analyzing the relationship among ERCC1 mRNA expression,clinical treatment of overall survival,total response rates and gene polymorphism.Results In patients with advanced gastric C/C in Qinghai ERCC1 gene frequency was 54.2％,C/T frequency was 42.7％,T/T ERCC1 gene frequency was 5.6％.ERCC1 mRNA expression and clinical effect in the treatment of pathological factors were not related,ERCC1 mRNA and gene ERCC1 polymorphism had no relevance.Conclusions Progress in Qinghai Tibetan TSER gene is highly expressed type 3R/3R in patients with gastric cancer.ERCC 1 gene polymorphisms with type C/ C is overexpressed.ERCC1,TSER gene polymorphism and clinicopathologic parameters in advanced gastric is not related.Extension of Tibetan ERCC1 mRNA in gastric cancer patients expression has no association with ERCC1 gene polymorphism.

OBJECTIVE: To study the mechanism of tumor necrosis factor( TNF)-α and its receptor( TNFR) signal transduction pathways in regulating cell apoptosis of alveolar macrophage( AM) in coal workers' pneumoconiosis( CWP).METHODS: Twenty-four coal workers with pneumoconiosis at stage Ⅰ were selected as CWP group and four observation subjects exposed to coal were chosen as observation group by using simple random sampling method. The bronchoalveolar lavage fluids of whole-lung lavage of two groups were collected. AMs were separated and purified. Then they were divided into 6 groups: a control group,a superoxide dismutase( SOD) group,a TNF/TNFR group,an anti-TNF-α antibody group,a Caspase-8 suppression group and a nuclear factor-κB( NF-κB) suppression group. The AMs of 6 groups with corresponding treatment were cultivated. After 24 hours,the cells were harvested and proteins extracted. The relative expression of TNF-α,TNFR1,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 protein was detected by Western blotting. RESULTS: The protein relative expression of TNF-α,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 in CWP group was significantly higher than those in the observation group( P < 0. 05). The protein relative expression of TNF-α,TNFR1,Caspase-8,Caspase-3 and NF-κB P50 in the TNF/TNFR group and the anti-TNF-αantibody group was lower than that of the control group( P < 0. 05). The above indexes in the anti-TNF-α antibody group were lower than that of the NF-κB suppression group( P < 0. 05). The protein relative expression of TNFR1,Caspase-8and Caspase-3 in the TNF/TNFR group was higher than that of the SOD group and the Caspase-8 suppression group( P <0. 05). The protein relative expression of TNFR1,Caspase-8 and NF-κB P50 in the TNF/TNFR group was lower than that of the NF-κB suppression group( P < 0. 05). Among the CWP patients,the relative expression of TNFR2 and NF-κB P65 in the TNF/TNFR group was lower than that of the control group( P < 0. 05),and higher than that of the SOD group( P <0. 05). CONCLUSION: AM apoptosis mediated by TNF-α/TNFR/NF-κB signal transduction pathway plays an important role in the occurrence and development of CWP. The TNF-α/TNFR/NF-κB signal transduction pathways inhibited or blocked at different stages can affect the expression of proteins related to AM apoptosis.