Comprehensive occupational hazard risk assessment in employers is a core component of the pilot program for occupational health classification supervision and law enforcement. The quality and effectiveness of classification-based supervision are directly affected by both the assessment process and its outcomes. However, several issues have emerged since the implementation of the pilot program on the comprehensive risk assessment, including an excessive number of self-assessment items, lack of implementation basis for certain self-assessment items, misinterpretation for certain self-assessment items, inconsistencies between evaluation criteria and existing standards, incomplete implementation of some items, omission of comprehensive risk assessment elements, unclear definitions of key industries and key occupational hazards, and inconvenient assessment procedures on comprehensive risk assessment. To enhance the applicability, accuracy, and objectivity of the comprehensive risk assessments conducted by employers, it is recommended to optimize self-assessment items, standardize risk assessment content, tailor comprehensive risk assessments to actual workplace conditions, refine the identification of key industries and key occupational hazards, improve comprehensive risk assessment methodologies, and establish clear grading rules for the comprehensive risk assessment.

Alzheimer's disease (AD) is regarded as a neurodegenerative disease, and it has been proposed that AD may be a systemic disease. Studies have reported associations between non-neurological diseases and AD. The correlations between AD pathology and systemic (non-neurological) pathological changes are intricate, and the mechanisms underlying these correlations and their causality are unclear. In this article, we review the association between AD and disorders of other systems. In addition, we summarize the possible mechanisms associated with AD and disorders of other systems, mainly from the perspective of AD pathology. Regarding the relationship between AD and systemic pathological changes, we aim to provide a new outlook on the early warning signs and treatment of AD, such as establishing a diagnostic and screening system based on more accessible peripheral samples.
Alzheimer Disease/therapy* ; Humans ; Brain/pathology*

Tumor immune microenvironment is a local external tumor environment composed of tumor immune cells and the cytokines secreted by these cells， and it plays a regulatory role in the development and progression of tumors. In the treatment of hepatocellular carcinoma， amino acid metabolism and its reprogramming of proliferating cell metabolism have attracted more and more attention， showing potential in regulating the tumor immune microenvironment. Although amino acid metabolic reprogramming is regarded as a novel approach for tumor therapy， its specific mechanism remains unclear in the regulation of tumor immunity in hepatocellular carcinoma. This article discusses the mechanism of action of amino acid metabolism in the tumor immune microenvironment of hepatocellular carcinoma and its application prospect in clinical practice， in order to provide new ideas for immunotherapy for liver cancer.

Objective　To analyze the sensitivity of carbapenem-resistant Enterobacteriaceae (CRE) producing different carbapenemases to antibacterial drugs, compare various detection methods of carbapenemases, and provide a technical basis for the clinical anti-infective treatment of CRE. Methods A total of 88 CRE strains isolated from clinical samples in a hospital in Nanchang, Jiangxi Province, from January 2021 to August 2022 were collected. MALDI-TOF MS was used for strain identification and Vitek 2-compact was used to detect their susceptibility to commonly used antibacterial drugs. The susceptibility of ceftazidime/avibactam and polymyxin B to CRE was detected by the broth microdilution method. The carbapenemase inhibitor enhancement test (EDTA-APB) was employed to screen for carbapenemase phenotypes, while polymerase chain reaction (PCR) method was used to detect five carbapenemase resistance genes: Klebsiella pneumoniae carbapenemases (blaKPC), New Delhi metallo-beta-lactamase-1 (blaNDM), Imipenem hydrolyzing β-lactamase (blaIMP), Metal β-lactamase of Verona integron (blaVIM), and Oxacillin-hydrolyzing carbapenemase (blaOXA-48-like). The consistency between carbapenemase phenotypes and gene results was compared. Results CRE infection was predominantly found in males (58 cases), with an average age of (63.4±14.2) years, mainly distributed in neurosurgery (26.1%, 23/88), the intensive care unit (17.0%, 15/88), and the rehabilitation department (15.9%, 14/88). The main sources of positive specimens were respiratory secretions (60.2%, 53/88), urine (21.6%, 19/88), and blood (5.7%, 5/88). The results of the drug susceptibility test showed that CRE had the highest resistance rate to cephalosporins and piperacillin/tazobactam, exceeding 95%, and the lowest resistance rate to tigecycline and polymyxin B, at 4.5% (4/88) and 1.1% (1/88), respectively. The results of the carbapenemase phenotype detection showed that the strains producing class A serine enzymes, class B metalloenzymes, and both class A and B carbapenemases accounted for 69.4% (61/88), 28.4% (25/88), and 1.1% (1/88), respectively. The results of PCR amplification of carbapenemase genes showed that the strains carrying class A resistance gene blaKPC, class B resistance gene blaNDM or blaIMP, and both blaKPC+NDM accounted for 70.5% (62/88), 28.4% (25/88), and 1.1% (1/88), respectively, with high consistency with enzyme phenotype results. The susceptibility rate of the strains carrying only blaKPC to ceftazidime/avibactam was 91.9% (57/62), while those carrying blaNDM or blaIMP were all highly resistant to ceftazidime/avibactam, accounting for 83.3% (25/30) of ceftazidime/avibactam-resistant strains. Conclusions The resistance mechanism of CRE strains to ceftazidime/avibactam is primarily due to the production of NDM-type metalloenzymes, while strains producing only KPC-type show higher sensitivity. Some ceftazidime/avibactam-resistant strains producing only KPC enzymes are caused by blaKPC-2 mutations. In addition, enzyme phenotype inhibition enhancement test and in vitro drug susceptibility test of ceftazidime/avibactam are recommended clinically to provide a basis for the rational selection of antibacterial drugs.

Objective To explore the effect of 153Sm-EDTMP combined ibandranate in treatment of osseous metastasis of lung cancer.Methods 100 patients with osseous metastasis of lung cancer were randomly divided into two groups.The patients received intervenous drop infusion of 153Sm-EDTMP and ibandranate in treatment group( n =52).The patients received therapy with 153Sm-EDTMP in control group( n =48).The differentces of effect of odynolysis,locomotor activity,improvement of quality of life,recovery of osteolysis,toxical and adverse reaction between two groups were compared.Results The overall response rate 94.2％ in treatment group was significantly higher than that 64.5 ％ in control group( x2 =4.78,P ＜ 0.0.5 ) ;The activity to improve situation 82.6％ in treatment group was significantly higher than that 64.5％ in control group( x2 =4.13,P ＜ 0.05 ) ;The total effective rate of quality of life improve the situation 84.6％ in treatment group was significantly higher than that 62.5％ in control group( x2 =4.58,P ＜0.05 ) ;The side effects had no significant difference between two groups ( x2 =0.345,P ＞ 0.05).Conclusion The treatment of 153Sm-EDTMP combined with ibandranate in the treatment of osseous-metastasis of lung cancer was effective for relieving pain,improvement locomotor activity,improvement of quality of life,recovery of osteolysis.

Objective To investigate the effect of iodine-131(131Ⅰ) therapy on patients with differentiated thyroid carcinoma concurrent metastases.Methods 50 cases with differentiated thyroid carcinoma after operation ac-cording to metastaticsites were given one of fractionated treatment,a total removal of dose(370～740)×107Bq,inter-val of 4 months.Results 35 of 50 patients(70.O%) had successful ablation of residual thyroid tissue after the first administration of radioiodine.Metastatic carcinoma in 18 cases,6 cases(33.3%) were cured,effective treatment was shown in 8 cases(44.4%)and treatment failure in 4 cases(22.2%);Thyroid metastasis before treatment were signifi-cantly higher than non-HTG thyroid metastasis(t=2.715,P<0.01),decreased significantly after treatment(t=2.844,all P<0.01);The contents of CD4+、CD8+、CD4+/CD8++ in treatment group after treatment[(26.5±4.7)%、(39.4±5.7)%、(0.6±0.4)%] were lower than before treatment[(38.3±5.6)%、(29.8±6.9)%、(1.4±0.5)%](t=2.345,t=2.244,t=2.451,all P<0.05).Conclusion Treatment with multiple hlsh doses of 131Ⅰ was safe and effective with little adverse side-effect.

In this paper , 2280 strains of suspicious Shigella c culture were detected by the diagnostic typing phage set for Enterobacteriaceae, the routine identification of them were carried oat at the same time . The results showed that 100% of shigella cultures were lysed with 10~3RTD and 99.9% lysed with 1RTD of phage Sh. 12.3% of 65 non-shigeUa cultures agglutinating with typing serum of shigeUa was lysed with 10~3RTD, 4.6% lysed with 1RTD of phage Sh. The determination of lytic-pattern of 2215 shigella culture indicated that only 3 strains of Boyd 5 of lytic-pattern 3 were not reported in literature, the rest strains were consistent to fomer studies. The nonshigella cultures lysed by Sh 10~3RTD could be excluded with 1RTD and its lytic-pattern. 20 strains of Enteroinvasive Escherichia coli possessing shigeUa-related antigens could be differentiated by Sh 10~3RTD. 1RTD and its lytic-pattern.