Objective:To investigate the correlation between occupational ionizing radiation exposure and abnormal metabolic indicators, providing a basis for assessing the health risks of occupational ionizing radiation workers and establishing a risk prediction model for chronic metabolic diseases.Methods:In January 2023, 7708 individuals were randomly selected from the occupational health examination data in Zhejiang Province. After excluding 16 individuals due to record errors, 2698 on-the-job workers exposed to ionizing radiation from 2020 to 2021 were selected as the exposure group, 2027 pre-employment workers exposed to ionizing radiation from 2016 to 2022 were selected as the pre-employment control group, and 2967 non-ionizing radiation workers from 2016 to 2022 were selected as the control group. Demographic data, blood routine, urine routine, biochemical indicators, and peripheral blood lymphocyte micronucleus rate of each group were collected. One-way ANOVA and rank sum test were used for comparison of indicators. The exposure group was divided into different groups based on age, exposure duration, and body mass index (BMI), and the correlation between indicators and occupational ionizing radiation was analyzed. Lasso variable selection was conducted by constructing a penalty coefficient (λ), and a complete regression model was established.Results:There were statistically significant differences in indicators such as blood pressure, heart rate, and average hemoglobin concentration between the exposure group and the control group, as well as the pre-employment control group ( P<0.05). Through Lasso variable selection, 19 indicators including exposure length, systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight, body mass index (BMI), urine pH value, red blood cell count, microscopic white blood cells, casts, absolute value of monocytes, mean corpuscular volume of red blood cells, mean hemoglobin concentration, alkaline phosphatase, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, and low-density lipoprotein cholesterol (LDL-C). There were statistically significant differences in exposure length, SBP, DBP, body weight, BMI, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, and mean corpuscular volume of red blood cells among workers of different ages in the exposure group ( P<0.05) ; there were statistically significant differences in SBP, DBP, body weight, BMI, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, and mean corpuscular volume of red blood cells among workers with different exposure durations ( P<0.05) ; there were statistically significant differences in exposure length, SBP, DBP, body weight, BMI, red blood cells, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, absolute value of monocytes, mean corpuscular volume of red blood cells, and mean hemoglobin concentration among workers with different BMIs ( P<0.05) . Conclusion:Occupational ionizing radiation is associated with abnormal metabolic indicators such as blood pressure, heart rate, total bile acid, α-L-fucosidase, urea, and creatinine in the human body. More attention should be paid to the risk of chronic metabolic diseases among workers exposed to ionizing radiation.

Objective:To investigate the correlation between occupational ionizing radiation exposure and abnormal metabolic indicators, providing a basis for assessing the health risks of occupational ionizing radiation workers and establishing a risk prediction model for chronic metabolic diseases.Methods:In January 2023, 7708 individuals were randomly selected from the occupational health examination data in Zhejiang Province. After excluding 16 individuals due to record errors, 2698 on-the-job workers exposed to ionizing radiation from 2020 to 2021 were selected as the exposure group, 2027 pre-employment workers exposed to ionizing radiation from 2016 to 2022 were selected as the pre-employment control group, and 2967 non-ionizing radiation workers from 2016 to 2022 were selected as the control group. Demographic data, blood routine, urine routine, biochemical indicators, and peripheral blood lymphocyte micronucleus rate of each group were collected. One-way ANOVA and rank sum test were used for comparison of indicators. The exposure group was divided into different groups based on age, exposure duration, and body mass index (BMI), and the correlation between indicators and occupational ionizing radiation was analyzed. Lasso variable selection was conducted by constructing a penalty coefficient (λ), and a complete regression model was established.Results:There were statistically significant differences in indicators such as blood pressure, heart rate, and average hemoglobin concentration between the exposure group and the control group, as well as the pre-employment control group ( P<0.05). Through Lasso variable selection, 19 indicators including exposure length, systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight, body mass index (BMI), urine pH value, red blood cell count, microscopic white blood cells, casts, absolute value of monocytes, mean corpuscular volume of red blood cells, mean hemoglobin concentration, alkaline phosphatase, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, and low-density lipoprotein cholesterol (LDL-C). There were statistically significant differences in exposure length, SBP, DBP, body weight, BMI, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, and mean corpuscular volume of red blood cells among workers of different ages in the exposure group ( P<0.05) ; there were statistically significant differences in SBP, DBP, body weight, BMI, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, and mean corpuscular volume of red blood cells among workers with different exposure durations ( P<0.05) ; there were statistically significant differences in exposure length, SBP, DBP, body weight, BMI, red blood cells, microscopic white blood cells, casts, albumin-to-globulin ratio, total bile acid, α-L-fucosidase, urea, creatinine, LDL-C, absolute value of monocytes, mean corpuscular volume of red blood cells, and mean hemoglobin concentration among workers with different BMIs ( P<0.05) . Conclusion:Occupational ionizing radiation is associated with abnormal metabolic indicators such as blood pressure, heart rate, total bile acid, α-L-fucosidase, urea, and creatinine in the human body. More attention should be paid to the risk of chronic metabolic diseases among workers exposed to ionizing radiation.

Adhering to the guidance of party building is an essential requirement for comprehensively promoting the high-quality development of public hospitals.How to solve the problem of"two skins"of party building and business,further promote the deep integration of the party and business has become an important topic for the party building of public hospitals in the new era.Taking Jieyang People's Hospital as an example,this paper introduces the innovation and exploration experience on the par-ty building work round in the hospital,the working mechanism of which is"1+5+5+4"of"Party building leading,five re-sponsibility coordination,five-step linkage and four-type integration".This approach effectively promotes the deep integration and promotion of the party and business,which further lead the high-quality development of various work in the hospital.It can pro-vide reference for exploring and improving the system and mechanism of the integration of party and business,and further promote party leadership in promoting high-quality development in public hospitals.

Adhering to the guidance of party building is an essential requirement for comprehensively promoting the high-quality development of public hospitals.How to solve the problem of"two skins"of party building and business,further promote the deep integration of the party and business has become an important topic for the party building of public hospitals in the new era.Taking Jieyang People's Hospital as an example,this paper introduces the innovation and exploration experience on the par-ty building work round in the hospital,the working mechanism of which is"1+5+5+4"of"Party building leading,five re-sponsibility coordination,five-step linkage and four-type integration".This approach effectively promotes the deep integration and promotion of the party and business,which further lead the high-quality development of various work in the hospital.It can pro-vide reference for exploring and improving the system and mechanism of the integration of party and business,and further promote party leadership in promoting high-quality development in public hospitals.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To systematically observe the location and severity of perineal lacerations during childbirth and explore the relationship between the length/depth and the degrees of perineal lacerations.Methods:This prospective study recruited full-term singleton cephalic pregnant women planning vaginal delivery at the Fourth Hospital of Shijiazhuang from March 2023 to July 2023. Before the second stage of labor, the perineal body length (PBL) was measured. After delivery, the locations of all birth canal lacerations, the perineal skin lacerations length (PSLL), and the perineal lacerations depth (PLD) were measured and recorded. A magnifying glass was used to identify the layers of the skin and photographs were taken if necessary. Statistical methods such as t-test, rank-sum test, and Chi-square test (or Fisher's exact test) were used to compare the basic conditions and birth canal lacerations between primiparous and multiparous women. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of PSLL, PLD, and the PSLL/PBL ratio. Results:During the study period, 200 women were included, of which 189 had vaginal deliveries (173 primiparous and 16 multiparous) and 11 had emergency cesarean sections (10 primiparous and one multiparous). Among the 173 primiparous women with vaginal deliveries, 33 (19.1%) underwent episiotomy, and the other 140 (80.9%) had perineal lacerations. Among these cases of perineal lacerations, nine were complicated by vaginal wall lacerations, 20 by labial lacerations, and four by clitoral and urethral lacerations. There were 32 (22.9%) primiparous women with first-degree perineal lacerations and 108 (77.1%) with second-degree perineal lacerations. Among the 16 multiparous women who delivered vaginally, two had intact birth canals without lacerations, and 14 had perineal lacerations (eight with first-degree and six with second-degree perineal lacerations). Besides, none of them underwent episiotomy or assisted vaginal delivery. The rates of episiotomy and second-degree perineal lacerations were higher in primiparous women than in multiparous women [19.1% (33/173) vs. 0/16, 77.1% (108/173) vs. 6/14, Fisher's exact test, both P<0.05). The PSLL, PLD, and PSLL/PBL ratio were significantly lower in the primiparous women with first-degree perineal lacerations than in the primiparous women with second-degree perineal lacerations [0.0 mm (0.0-10.0 mm) vs. 30.0 mm (25.5-40.0 mm), 5.0 mm (1.5-10.0 mm) vs. 14.0 mm (10.0-15.0 mm), 0.0 mm (0.0-21.1 mm) vs. 63.6 mm (50.0-77.3 mm); Z values were－8.04,－6.46, and－7.75, respectively, all P<0.05]. The optimal cut-off values of PSLL, PLD, and PSLL/PBL ratio for differentiating between first-degree and second-degree perineal lacerations were 15 mm, 9 mm, and 33.33%, with the area under the ROC curve (AUC) of 0.965, 0.869, and 0.951 and the sensitivity of 91.67%, 91.67%, and 89.81%, respectively. The AUC of PSLL was significantly greater than that of PLD ( Z=2.55, P=0.011), but the AUC of PSLL/PBL ratio showed no significant difference with that of PSLL or PLD ( Z=1.18 and 1.89, both P>0.05). Conclusions:It is difficult for full-term primiparas to maintain perineal integrity during vaginal delivery. Measuring the PSLL, PLD, and PSLL/PBL ratio of primiparous women will be useful for distinction between first- and second-degree perineal lacerations.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective: To explore the effect of dapagliflozin(DAPA) on the function of rat endothelial progenitor cells(EPCs) culturedin vitroin a high glucose environment. Methods: Bone marrow derived EPCs from sprague-dawley(SD) rats were identified by fluorescence staining. EPCs were divided into control group(CG group), high glucose group(HG group), high glucose + DAPA group(GD group) and high glucose + DAPA + LY294002 group(GDL group). MTT assay, flow cytometry, tubule formation assay were used to detect the viability, apoptosis, tubule formation ability of EPCs, respectively. Western blot was used to detect the protein expression of AKT/eNOS signaling pathway. Results: Compared with CG group, cell viability, the ability to form tubules, the protein expression of p-AKT and p-eNOS, and the ratio of p-AKT/AKT and p-eNOS/eNOS in HG group significantly decreased(P<0.05), while the apoptosis rate of EPCs significantly increased(P<0.05). Compared with HG group, cell viability, the ability to form tubules, the protein expression of p-AKT and p-eNOS, and the ratio of p-AKT/AKT and p-eNOS/eNOS in GD group significantly increased(P<0.05), while the apoptosis rate of EPCs was significantly reduced(P<0.05). Compared with GD group, cell viability, the ability to form tubules, the protein expression of p-AKT and p-eNOS, and the ratio of p-AKT/AKT and p-eNOS/eNOS in GDL group significantly decreased(P<0.05), while the apoptosis rate of EPCs significantly increased(P<0.05). Conclusion DAPA can protect EPCs from high glucose induced functional damage through AKT/eNOS pathway.

Objective:Partial stereotactic ablative boost radiotherapy(P-SABR)is a method to deliver SABR boost to the gross tumor boost volume(GTVb), followed by conventionally fractionated radiotherapy to the whole tumor area(GTV). GTVb is the max volume receiving SABR while ensuring the critical organ-at-risk(OAR)falloff to 3 GyE/f. We investigated the potential advantage of proton therapy in treating bulky non-small cell lung cancer(the tumor length greater than 8 cm).Methods:Nine patients with bulky NSCLC treated with photon P-SABR in our institute were selected. For the treatment planning of proton therapy, the GTVb target area was gradually outwardly expanded based on the photon GTVb target area until the dose to critical OARs reached 3 GyE/f. The GTV and CTV areas remained the same as photon plan. A proton intensity-modulated radiation treatment plan(proton-IMPT), a photon intensity-modulated radiation treatment plan(photon-IMRT)and a photon volumetric modulated arc therapy(photon-VMAT)were created for each patient, respectively. The dosimetric parameters of different treatment plans were compared.Results:The volume ratio of GTVb-photon and GTVb-proton to GTV was(25.4±13.4)% and(69.7±30.0)%,respectively( P<0.001). In photon-IMRT, photon-VMAT, and proton-IMPT plan groups, the mean dose of CTV was(76.1±4.9)Gy, (78.2±3.6)Gy, and(84.7±4.9)Gy, respectively; the ratio of tumor volume with Biologic Effective Dose(BED)≥ 90 Gy to GTV volume was(70.7±21.7)%, (76.8±22.1)%,and(97.9±4.0)%,respectively. The actual dose and BED to the tumor area of the proton-IMPT plan group were significantly higher than those of the photon plan group(both P<0.05). Besides, the OARs dose was significantly decreased in the proton-IMPT group, with(49.2±22.0)%, (56.8±19.0)% and(16.1±6.3)% of the whole lung V5 for photon-IMRT, photon-VMAT and proton-IMPT, respectively(all P<0.001). Conclusions:Larger GTV boost target volume, higher BED and reduced OARs dose can be achieved in proton plans compared with photon plans. Proton P-SABR is expected to further improve the local control rate of bulky NSCLC with fewer adverse effects.

Fang's scalp acupuncture is mainly used in the treatment of nervous system diseases, bone and joint pain and mental diseases. It has significant effect on the early stage recovery stage and complications of post-stroke hemiplegia. The selection of acupoint is basically the same in improving patients with neurological impairment and dyskinesia, but differenct in the selection of acupoints in the treatment of complications. In recent years, it has been widely used in the treatment of children with attention deficit hyperactivity disorder and Tourette's syndrome. Fang's scalp acupuncture method was formed quite early with relatively complete theoretical system, but its clinical application is relatively insufficient. There exist some problems such as failing to reflect the theory of viscera and meridians in acupoint selection, the theory of acupoint selection by projection of cerebral cortex function, which needs to be proved further, the operation requirements are strict while the methods and practice of researchers are are differenct, and some clinical research design is not rigorous,etc.