Background The quality of occupational health technical services is directly linked to the protection of workers' health rights and the efficacy of occupational disease prevention and control. However, the industry still faces critical challenges: sporadic instances of institutional non-compliance and persistent irregularities in professional practice continue to undermine overall service performance. Objective To assess the current quality status of occupational health technical services in Zhejiang Province and propose countermeasures for quality improvement, providing a scientific basis for policy optimization and service delivery quality enhancement. Methods A total of 69 occupational health technical service institutions in Zhejiang Province that obtained formal accreditation as of April 30, 2024, were sampled, including 3 public institutions and 66 private institutions (comprising 3 formerly Class-A, 28 formerly Class-B, 11 formerly Class-C, and 24 newly certified institutions). Following the Technical Protocol for Quality Monitoring of Occupational Health Technical Service in Zhejiang Province and the Technical Protocol for Proficiency Testing of Occupational Health Detection in Zhejiang Province, a quality assessment task force comprising national and provincial experts was established. Evaluation was conducted across four dimensions: qualification maintenance and compliance, standardization of technical services, authenticity of technical services, and proficiency testing, utilizing a combination of document review, on-site inspections, and technical skill assessments. Results The occupational health technical service institutions in Zhejiang Province were predominantly private entities (82.5%), with significant disparities in overall service quality. The pass rates for qualification maintenance and compliance, technical service standardization, technical service authenticity, and the excellence rate for laboratory proficiency testing were 81.5%, 80.7%, 97.3%, and 90.4%, respectively. Regarding qualification maintenance, the pass rates for "environmental conditions" (49.8%, 56.7%) and "instrumentation and equipment" (58.2%、65.6%) were significantly lower for formerly Class-C and newly certified institutions compared to other categories. In terms of technical standardization, "standardized on-site inspections" recorded the lowest pass rate (67.4%), with newly certified institutions at only 48.0%. Regarding technical service authenticity, formerly Class-C institutions exhibited issues such as missing raw chromatograms for blank samples (85.7% pass rate). In laboratory proficiency testing, public and formerly Class-A institutions achieved 100% excellence rates, but the performance of formerly Class-C and newly certified institutions was comparatively weak; specifically, the failure rate for organic analysis in formerly Class-C institutions reached 20%; the failure rate for dust testing items in newly certified institutions was 10.3%. Conclusion The overall quality of occupational health technical services in Zhejiang Province still requires significant improvement, particularly in basic institutional conditions, the standardization of on-site inspections, and laboratory proficiency in organic and dust analysis. Formerly Class-C and newly certified institutions should be the primary focus of quality management efforts. Differentiated regulatory strategies are recommended, alongside strengthening interim and ex-post supervision to gradually enhance the quality of occupational health technical services across all institutions.

ObjectiveTo investigate the mechanism of action of remifentanil （RMZL） in alleviating lung ischemia-reperfusion injury （LIRI） in rats by inhibiting pyroptosis through modulating hypoxia inducible factor-1α （HIF-1α）/NOD-like receptor thermal protein domain associated protein 3 （NLRP3） pathway. MethodsRats were stochastically assigned into Control group， LIRI group， RMZL low-dose group， RMZL medium-dose group， RMZL high-dose group， and RMZL high-dose+HIF-1α activator dimethyloxallyl glycine （DMOG） group， with 18 rats in each group. Rats in Control group only had their left pulmonary hilum free and did not undergo ischemia-reperfusion treatment. Except for the Control group， LIRI models were constructed in all other groups. Rats in LIRI group were intraperitoneally injected with an equal amount of physiological saline 15 minutes before constructing LIRI model； rats in Control group were intraperitoneally injected with an equal amount of physiological saline 15 minutes before freeing left pulmonary hilum； rats in other groups were intraperitoneally injected with corresponding dose of drug 15 minutes before constructing LIRI model. The wet/dry weight ratio of lungs was calculated. HE staining was used to study lung tissue pathology. Immunofluorescence staining was used to detect the relative fluorescence intensity of gasdermin D （GSDMD） and NLRP3 double positive cells in lung tissue. ELISA was used to detect interleukin-1β and IL-18 in lung tissue. Western blot was used to detect HIF-1α， NLRP3， cysteine-aspartic protease-1 （Cleaved caspase-1）， and gasdermin D-N （GSDMD-N） proteins in lung tissue. ResultsCompared to the Control group， the LIRI group showed disordered alveolar structure， thickened alveolar septa， and abundant inflammatory cell infiltration in rats. The lung wet/dry weight ratio， relative fluorescence intensity of GSDMD and NLRP3 double positive cells in lung tissue， IL-1β， IL-18 levels， and HIF-1α， NLRP3， Cleaved caspase-1， and GSDMD-N proteins increased （P0.05）. For the LIRI group， rats in the RMZL low， medium， and high-dose groups displayed attenuated alveolar septal thickening and reduced inflammatory cell infiltration. The lung wet/dry weight ratio， relative fluorescence intensity of GSDMD and NLRP3 double positive cells in lung tissue， IL-1β， IL-18 levels， and HIF-1α， NLRP3， Cleaved caspase-1， and GSDMD-N proteins declined， and the RMZL high-dose group showed the most prominent trend （P0.05）. Compared with the RMZL high-dose group， rats in the RMZL high-dose+DMOG group exhibited thickened alveolar septa and more inflammatory cell infiltration， along with increased lung wet/dry weight ratio， relative fluorescence intensity of GSDMD and NLRP3 double positive cells in lung tissue， levels of IL-1β and IL-18， and protein expression of HIF-1α， NLRP3， Cleaved caspase-1， and GSDMD-N （P0.05）. ConclusionRMZL may inhibit pyroptosis in LIRI rats by suppressing HIF-1α/NLRP3 pathway.

Objective: To analyze the association between poor sleep characteristics and the coexistence of negative emotions and overweight/obesity among college students, so as to provide a scientific basis for improving their physical and mental health. Methods: From November to December 2023, a convenience sampling method was used to survey 6 600 college students from nine universities in Jiangxi, Hunan, and Hubei provinces. The Depression Anxiety and Stress Scale-21 (DASS-21), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and physical examinations were employed to assess negative emotions, poor sleep characteristics, and overweight/obesity. Chi square test and Logistic regression were used to analyze the impact of poor sleep characteristics on the coexistence of negative emotions and overweight/obesity. Results: The coexistence rates of different categories of negative emotions (depression, anxiety, stress) and overweight/obesity were 6.1% ( n= 405), 8.0% ( n =529), and 3.3% ( n =217), respectively. Gender, grade level, major, maternal education level, annual family income, physical activity level, only child status, and carbonated beverage consumption were statistically associated with the coexistence rates of different categories of negative emotions and overweight/obesity ( χ 2=4.01-35.18, all P <0.05). Logistic regression analysis showed that after adjusting for gender, grade level, major, only child status, maternal education level, annual family income, physical activity level, and carbonated beverage consumption, poor sleep characteristics were significantly associated with an increased risk of the coexistence of negative emotions and overweight/obesity ( OR =1.41-6.65); moderate and poor sleep quality levels were significantly associated with an increased risk of the coexistence of different categories of negative emotions and overweight/obesity among female students ( OR =1.99-4.71) (all P <0.05). Conclusions Poor sleep characteristics are associated with the coexistence of negative emotions and overweight/obesity among college students. Greater attention should be paid to sleep issues in this population, and sleep education should be actively promoted to reduce the risk of comorbid negative emotions and overweight/obesity.

Objective:To explore the correlation of different HBV DNA loads with peripheral blood lymphocyte subsets and interleukin-6 (IL-6) in patients with chronic hepatitis B.Methods:A cross-sectional study was conducted. A total of 519 patients with chronic hepatitis B admitted to the Fifth Medical Center of the General Hospital of the People′s Liberation Army from April 2019 to June 2024 were included. The patients were divided into high, medium, and low viral load groups and a negative group based on HBV DNA load. Another 100 healthy individuals who underwent physical examinations during the same period were recruited as the control group. The quantities of peripheral blood lymphocyte subsets and IL-6 levels were compared among the groups. Meanwhile, alanine aminotransferase (ALT) levels were recorded and compared among the groups. The correlation of HBV DNA levels with lymphocyte subsets and IL-6 was analyzed using Pearson correlation analysis.Results:HBV DNA loads were negatively correlated with the counts of CD3 +, CD4 +, CD8 +, CD19 +, and CD56 + lymphocyte subsets (correlation coefficients r were -0.483, -0.508, -0.524, -0.573, and -0.561, respectively; all P<0.001) and positively correlated with IL-6 levels ( r=0.862, P<0.05). Compared with the control group, the counts of each lymphocyte subset were higher in the high, medium, and low viral load groups ( P<0.05). In the HBV DNA-negative chronic hepatitis B group, the counts of CD8 + and CD19 + lymphocyte subsets were significantly higher [712.32(526.00,898.64) and 495.62(345.74,645.50) cells/μl] than those in the control group [612.10(479.89,744.31) and 470.32 (396.00,544.64) cells/μl] ( P<0.05). Conclusion:The degree of HBV replication activity in patients with chronic hepatitis B is associated with the immune status of the body, and negatively correlated with the quantities of lymphocyte subsets and positively correlated with IL-6 levels.

Objective:To investigate the clinical characteristics and genetic etiology of Duchenne muscular dystrophy (DMD) with myogenic tumors.Methods:The clinical data of 2 children with DMD combined with myogenic tumors diagnosed in Children′s Hospital Affiliated to Zhengzhou University in July 2021 and February 2022 were collected. The relevant literature was reviewed to summarize the clinical characteristics and explore the mechanism of the dystrophin ( DMD) gene in myogenic tumors. Results:A 6-year and 10-month-old boy with DMD (deletion of exon 45) and a 12-year-old boy with DMD (deletion of exon 51) were diagnosed with tumors. They were diagnosed with DMD for delayed motor development in the Department of Neurology of Children′s Hospital Affiliated to Zhengzhou University. They presented with painless masses in the waist. Postoperative pathological diagnosis: the pathology and immunohistochemistry of case 1 showed an alveolar rhabdomyosarcoma (ARMS) and both myogenin and myogenic differentiation 1 positive; the pathology and immunohistochemistry of case 2 showed an alveolar soft part sarcoma(ASPS) and transcription factor enhancer 3 positive; both cases were myogenic tumors. Literature review (including this paper) showed that there were in total 14 cases with DMD combined with myogenic tumors including 13 cases of rhabdomyosarcoma (RMS) and 1 case of ASPS. All of them are male, and the age of onset of the tumors was 4-17 years. Pathological subtypes were described in 6 cases of ARMS and 5 cases of embryonal RMS, and were not described in 2 cases. The 9 cases described all had large deletions in the DMD gene which can change the reading frame of the DMD gene, and all gene mutations did not exceed exon 62. Conclusions:DMD gene with deletion may increase the risk of having myogenic tumors, and RMS is more common, which is manifested as painless mass in early stage. All DMD gene deletions do not exceed exon 62 and lead to change of the gene reading frame with severe clinical phenotype and degenerative changes in muscle function.

Objective:To investigate the clinical characteristics of encephalocraniocutaneous lipomatosis (ECCL) in pediatric patients.Methods:A retrospective analysis was conducted on the clinical data of 2 ECCL cases admitted to Children′s Hospital Affiliated to Zhengzhou University between January 2024 and December 2024. Additionally, a review of relevant literature was performed to summarize the clinical features of this condition.Results:Case 1 is a male patient aged 2 years and 10 months, while case 2 is a female patient aged 8 months. Both patients presented with seizures and exhibited nevus psiloliparus on the scalp, non-scarring alopecia, nodular skin tags around the eyes, and ocular choristomas. Brain magnetic resonance imaging revealed leptomeningeal angiomatosis in both cases, with case 1 also demonstrating an intracranial lipoma and case 2 showing localized cerebral atrophy and an arachnoid cyst. Whole-exome sequencing of peripheral blood and copy number variation analysis in both cases did not identify any pathogenic variants. Additionally, no relevant pathogenic variants were detected in the scalp lesion tissue of case 2. A review of the literature revealed that, to date, there have been 5 reported domestic cases, 132 reported foreign cases in pediatric populations, totally 139 cases including 2 cases described in this article. Among these patients, 86 are male, 49 are female, and the gender of 4 cases remains unspecified. Clinical manifestations observed included seizures in 79.0% (64/81) of cases and developmental delay in 64.7% (57/88). Cutaneous lesions were characterized by non-scarring alopecia in 100% (97/97) of cases,non-hair-bearing fatty tissue nevi in 98.3% (58/59), nodular skin tags in 96.5% (56/58), and subcutaneous lipomas in 94.8% (73/77). Ocular lesions predominantly involved choristomas, occurring in 91.8% (90/98) of cases. Central nervous system abnormalities were identified as ventricular dilatation or hydrocephalus in 85.0% (68/80) of cases, intracranial lipomas in 82.1% (69/84), localized cerebral atrophy in 80.9% (34/42), intracranial vascular anomalies in 74.1% (23/31), and spinal lipomas in 66.6% (30/45).Conclusions:ECCL is an uncommon neurocutaneous disorder with the potential to impact various organ systems, notably the integumentary, ocular, and central nervous systems. Pediatric patients may exhibit symptoms such as seizures, developmental delays, and additional clinical manifestations, necessitating vigilant monitoring and management.

Objective:To explore the clinical efficacy of pelvic floor biofeedback combined with electroacupuncture therapy in the treatment of chronic pelvic floor pain syndrome (CPPS).Methods:Ninety CPPS patients admitted to the Dongguan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine from August 2022 to July 2023 were selected prospectively, and they were divided into two groups by random number table method, each group with 45 cases. The control group received pelvic floor biofeedback treatment alone, while the observation group received pelvic floor biofeedback combined with electroacupuncture treatment. The two groups were treated once a day, 10 times as a course of treatment. After two courses of treatment, the clinical efficacy, pain degree before and after treatment, inflammatory factor levels, SF-36 health questionnaire (SF-36) scores, pelvic floor surface myoelectric parameters, and incidence of adverse reactions were compared between the two groups.Results:The total effective rate in the observation group after treatment was higher than that in the control group: 95.56% (43/45) vs. 75.56% (34/45), there was statistical difference ( χ2 = 7.28, P<0.05). After treatment, the visual analogue scale (VAS) scores, levels of procalcitonin (PCT), interleukin-6 (IL-6) and C-reactive protein (CRP) in the two groups were decreased, and SF-36 scores were increased, there were statistical differences ( P<0.05); the VAS scores, PCT, IL-6 and CRP levels in the observation group were lower than those in the control group, and SF-36 scores was higher than that in the control group: (2.11 ± 0.24) scores vs. (2.87 ± 0.34) scores, (0.92 ± 0.08) ng/L vs. (1.26 ± 0.09) ng/L, (24.08 ± 2.52) μg/L vs. (28.49 ± 3.10) μg/L, (4.55 ± 0.51) mg/L vs. (6.06 ± 0.63) mg/L, (74.55 ± 7.29) scores vs. (70.18 ± 7.80) scores, there were statistical differences ( P<0.05). After treatment, the surface muscle potential of pelvic floor muscle were increased in the front resting stage, rapid contraction stage, tension contraction stage, endurance contraction stage and post-resting stage, and the above parameters in the observation group were higher than those in the control group: (3.56 ± 0.34)μV vs.(3.20 ± 0.37) μV, (35.26 ± 3.05) μV vs. (31.47 ± 3.08) μV, (34.22 ± 3.25) μV vs. (31.15 ± 3.01)μV, (29.77 ± 3.17) μV vs. (27.04 ± 2.68) μV, (3.21 ± 0.27) μV vs. (3.00 ± 0.34) μV, there were statistical differences ( P<0.05). The incidence rate of adverse reactions in the two groups had no statistical difference ( P>0.05). Conclusions:Pelvic floor biofeedback combined with electroacupuncture in the treatment of CPPS has good clinical effect, and can relief pain response, regulate the inflammatory response and pelvic floor function, and have high safety.

Tunnel peripherally inserted central catheter (TPICC) catheterization technology is a new type of PICC catheterization that applies subcutaneous tunnel technology to traditional PICC catheterization. It has significant advantages in reducing catheter-related complications and improving patient comfort. According to the different methods of creating subcutaneous tunnels, it can be divided into one-needle TPICC catheterization technology and two-needle TPICC catheterization technology. This article reviews the overview, clinical application status and application effects of two TPICC catheterization techniques, and puts forward existing problems and prospects, in order to provide reference for clinical practice and related research of the two.

Objective:By analyzing the concentration distribution and hydrophilic/hydrophobic proportion differences of 15 bile acid subtypes in the serum of patients with hepatitis B virus（HBV）infection complicated with liver cirrhosis and primary biliary cholangitis（PBC）complicated with liver cirrhosis，this study aims to explore the potential associations between bile acid metabolism and these diseases，providing a reference basis for identifying disease-specific metabolic fingerprints in the diagnosis，treatment，and prognosis of liver diseases. Furthermore，building on the pharmacological mechanisms of ursodeoxycholic acid（UDCA）in the treatment of PBC，this research investigates potential therapeutic applications of bile acid drugs in HBV infection.Methods:A retrospective analysis method was adopted. We enrolled 27 HBV infection complicated with liver cirrhosis patients and 59 PBC complicated with liver cirrhosis patients who received outpatient or inpatient treatment at the Fifth Medical Center of PLA General Hospital from November 2024 to April 2025. The general data and routine clinical laboratory data of the two groups of patients were collected and analyzed. Using the ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry（UHPLC-QqQ-MS/MS）platform，precise quantification and differential analysis of 15 bile acid subtypes were performed in serum samples. Partial least squares discriminant analysis（PLS-DA）was employed to perform discriminant analysis on serum bile acid profiles data between the two groups，and variable importance in projection（VIP）values were calculated to identify key bile acid subtypes that could differentiate the two diseases. Box plots were constructed to analyze proportion differences in serum hydrophilic and hydrophobic bile acids between the two groups，aiming to explore potential associations between bile acid metabolism and the diseases.Results:The HBV infection group and the PBC group exhibited similar impairment of routine liver function parameters. The HBV infection group had higher serum concentrations of cholic acid（CA），chenodeoxycholic acid（CDCA）and deoxycholic acid（DCA），but lower concentrations of UDCA，glycoursodeoxycholic acid（GUDCA）and tauroursodeoxycholic acid（TUDCA）. The score plot generated by the PLS-DA model demonstrated significant differences in bile acid profile characteristics between the two diseases，with VIP values for UDCA，CDCA，GUDCA，TUDCA，and DCA all greater than 1. Box plots demonstrated a higher proportion of hydrophobic bile acids in the bile acid profile of the HBV infection group compared to the PBC group.Conclusion:This study found significant differences in serum bile acid profile characteristics between patients with HBV infection complicated with liver cirrhosis and those with PBC complicated with liver cirrhosis，specific bile acid subtypes such as CDCA and DCA have the potential to become specific metabolic fingerprints for these two diseases. HBV infection group exhibited higher proportion of hydrophobic bile acids in their bile acid profiles compared to PBC group. The characteristic changes in bile acid profiles can reflect the pathological characteristics of liver diseases，and their differences in hydrophilic/hydrophobic bile acids proportion represents a novel dimension independent of traditional liver function indicators，with potential value for disease prognosis assessment. UDCA or its derivatives may hold therapeutic potential for HBV infection patients with liver cirrhosis who exhibit accumulation of hydrophobic bile acids.

Objective:To summarize the clinical characteristics of focal cerebral arteriopathy (FCA) in children, and to analyze its influencing factor of prognosis.Methods:A retrospective cohort study was conducted. Clinical data from 40 children with FCA who were hospitalized at the Department of Neurology, Beijing Children′s Hospital, Capital Medical University, from September 2015 to August 2024 were collected. A centralized follow-up was conducted in October 2024 via outpatient clinics or the internet. The pediatric stroke outcome measure (PSOM) was used to evaluate their outcomes. Based on the PSOM, the children were further divided into a group with normal neurological function and another group with abnormal neurological function. Differences between groups were analyzed using the Mann-Whitney U test and Fisher exact test. Univariate Logistic regression analysis was performed to identify the influencing factors for neurological outcomes in children with FCA. Results:A total of 40 children were included, with 20 males and 20 females, and the onset age of 9.2 (6.8, 12.5) years. Among them, 12 cases (30%) had a history of varicella within 1 year before onset. There were 23 cases (58%) presenting with transient ischemic attack (TIA) or recurrent fluctuating symptoms of onset, while 3 cases (8%) developed progressive stroke within the first month of onset. The M1 segment of the middle cerebral artery was the most commonly affected vascular site, with a total of 16 cases (40%). Arterial occlusion occurred in 8 cases (20%). Lumbar puncture was completed in 36 children, and white blood cell counts in cerebrospinal fluid was increased in 6 cases. All 23 patients who completed magnetic resonance vessel wall imaging (VWI) showed circular enhancement of the arterial wall. A total of 28 patients (70%) received antiplatelet or anticoagulation therapy, and 16 patients (40%) received hormone therapy. At admission, the pediatric National Institute of Health Stroke Scale (PedNIHSS) score was 6.0 (2.0, 8.8) points, which decreased to 0.5 (0, 3.0) points at discharge. The follow-up duration was 1.6 (0.8, 4.9) years, with 1 case lost to follow-up. There was 1 case presenting with recurrence course manifesting as TIA. Among the 39 cases who completed the follow-up, 23 cases (59%) were assessed as neurologically normal by PSOM, while 16 cases (41%) were assessed as neurologically abnormal. Among the 29 cases who completed the imaging review, magnetic resonance angiography (MRA) review in 23 cases indicated stability or improvement in the original arterial stenosis, with 6 cases experiencing transient worsening of arterial stenosis early in the disease course (within 2 months), which later improved. Arterial stenosis progression occurred in 6 cases at the final review of 29 cases who completed the imaging review, with 1 case developing progressive cerebral arteriopathy. The proportion of patients with headache, altered consciousness, and aphasia in the abnormal neurological function group, as well as the PedNISS scores at admission and discharge, were all higher than those in the normal neurological function group (all P<0.05). Univariate Logistic regression analysis revealed that only a PedNISS score>6 points at onset was an influencing factor for abnormal neurological function ( OR=20.58, 95% CI 3.93-107.70, P<0.001). Conclusions:Childhood FCA often presents with fluctuating onset, and the proximal segment of the middle cerebral artery is frequently affected. Progression of arterial stenosis is common within 2 months of the disease course, but clinical progression and new ischemic lesions are uncommon. Most patients have a favorable long-term prognosis. PedNIHSS score>6 points at admission is related to abnormal neurological function outcomes.