Objective To investigate the effects of low-dose ionizing radiation on the thyroid status and hormone levels of radiation workers. Methods Radiation workers who underwent occupational health examinations at a hospital in Guangzhou from 2015 to 2022 were selected as the subjects of this study. The levels of FT3, FT4 and TSH were analyzed, and the thyroid abnormality status of radiation workers in different groups were compared. Results A total of 1152 participants were included in this study, consisting of 885 (76.82%) males and 267 (23.18%) females, with an average age of (35.26 ± 10.16) years. The prevalence of thyroid abnormalities was 9.38%, which was significantly higher in females (13.86%) than in males (8.02%) (P < 0.05). The TSH level of females [(2.15 ± 1.29) mIU/L] was higher than that of males [(1.85 ± 1.20) mIU/L], while the levels of FT3 [(5.10 ± 0.64) pmol/L] and FT4 [(15.84 ± 2.32) pmol/L] in females were lower than those in males [(5.23 ± 0.63) pmol/L and (16.61 ± 2.75) pmol/L, P < 0.05]. The FT3 of industrial workers [(5.25 ± 0.63) pmol/L] was higher than that of medical workers [(5.10 ± 0.63) pmol/L], while the TSH of industrial workers [(1.80 ± 1.12) mIU/L] was lower than that of medical workers [(2.15 ± 1.37) mIU/L]. FT4 levels decreased with increasing age and duration of occupational exposure. Multivariable logistic regression analysis revealed that sex was a significant independent predictor of thyroid abnormalities among radiation workers. Female workers were more likely to experience thyroid abnormalities (β = −0.62, P < 0.05). Conclusion Low-dose ionizing radiation may have a certain impact on the thyroid status of radiation workers, especially for female workers, which requires further attention and research.

Objective:To develop a quality control model for anal sphincter ultrasound images and validate its diagnostic performance across multiple centers.Methods:A retrospective analysis was conducted on anal sphincter ultrasound images from seven medical centers in China between May 2019 and June 2022. A total of 7 040 images from 3 116 patients were included and divided into a training set（4 912 images）and a validation set（2 128 images）. The images were classified as standard or non-standard images by three experts. Three models were developed based on different image feature extraction methods：a single-branch model，a multi-branch weighted model，and a multi-branch ensemble model. The diagnostic performance of each model was evaluated using the area under the ROC curve（AUC），sensitivity，specificity，accuracy，positive predictive value，and negative predictive value，respectively. The optimal model was selected and compared with the performance of 4 doctors with varying experience levels. Sixty days later，the images with the assistance of the model's output were reassessed by the doctors to evaluate its impact on manual quality control.Results:① Among the 3 models，the multi-branch ensemble model demonstrated the highest AUC and sensitivity，with an AUC of 0.966（95% CI=0.958 - 0.974），a sensitivity of 91.83%，and a specificity of 91.41%. This model was named M quality. ② M quality's AUC was slightly lower than that of Senior A and B（0.966 vs. 0.976，0.976，and P<0.05），its sensitivity was slightly lower than that of Senior A（91.83% vs. 95.61%， P<0.001）but comparable to Senior B（91.83% vs. 92.89%， P=0.315），its specificity was slightly lower than Senior A and B（91.41% vs. 94.44%，98.18%，and P<0.05）. However，M quality significantly outperformed Junior A and B in AUC and sensitivity（AUC：0.966 vs. 0.850，0.818；sensitivity：91.83% vs. 84.90%，61.46%；all P<0.001），its specificity was higher than that of Junior A（91.41% vs. 80.28%， P<0.001）but lower than that of Junior B（91.41% vs. 95.96%， P<0.001）. ③ With model assistance，Senior B's sensitivity（92.89% vs. 94.20%， P=0.001）and Senior A's specificity（94.44% vs. 96.56%， P<0.001）improved significantly. Junior A and B showed significant improvements in AUC and sensitivity（AUC：0.931 vs. 0.850，0.914 vs. 0.818；sensitivity：91.83% vs. 84.90%，89.53% vs. 61.46%；all P<0.001）. After model assistance，Junior A's specificity increased（93.62% vs. 80.28%， P<0.001），while Junior B's specificity decreased（91.60% vs. 95.96%， P=0.013）. Conclusions:This study develops a quality control model for anal sphincter ultrasound images with robust diagnostic performance，approaching the level of seniors. The model significantly enhances the image quality assessment capabilities of juniors，demonstrating promising clinical application potential.

Objective:To explore the facilitators and barriers of home-based pulmonary rehabilitation in patients with pulmonary hypertension, in order to provide a basis for medical staff to formulate precise pulmonary rehabilitation interventions.Methods:The maximum variation purposive sampling method was used. From October to December 2023, a total of 12 patients with pulmonary hypertension attending the Department of Cardiology, Tianjin Medical University General Hospital, were selected as study participants and underwent semi-structured interviews. Colaizzi's phenomenological method was applied to analyze the data.Results:The facilitators of home-based pulmonary rehabilitation among patients with pulmonary hypertension included: capability factor (good exercise habits) ; opportunity factors (supervision and support from family members, professional guidance from medical staff) ; motivation factors (rehabilitation enthusiasm, perceived benefits of exercise). The barriers included: capability factors (obvious perception of physical symptoms, lack of knowledge about pulmonary rehabilitation, low level of e-health literacy) ; opportunity factors (unfavorable health environment, limited time) ; motivation factors (fear of exercise, lack of rehabilitation self-discipline) .Conclusions:Home-based pulmonary rehabilitation in patients with pulmonary hypertension is affected by multiple factors. Medical staff should adopt targeted interventions to promote patients' engagement in home-based pulmonary rehabilitation, with the aim of improving cardiopulmonary health, exercise endurance, and quality of life, thereby enhancing clinical prognosis.

Objective:To analyze the research status and emerging hotspots in the field of cardiac telerehabilitation (CTR) and provide references for the development of CTR in China.Methods:A systematic search was conducted for relevant literature on CTR in the databases of China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine disc, Web of Science Core Collection, PubMed, CINAHL, Cochrane Library, and Embase, with a search timeframe from the establishment of the databases to February 28, 2024. EndNote and CiteSpace software were used for visual analysis of the search results.Results:A total of 889 papers were included, of which 269 were in Chinese and 620 were in English, showing an overall increasing trend in publication volume. The Chinese database revealed 12 clustering groups and 9 emerging keywords, while the English database identified 10 clustering groups and 16 emerging keywords.Conclusions:The publication volume of CTR is generally on the rise, but cooperation between countries and institutions still needs strengthening. Current research hotspots and frontiers include the demand for CTR, target populations, exercise program design, and the application of electronic information technology. Researchers in China should fully refer to these hotspots and frontiers and explore CTR models that are suitable for the Chinese patient population.

Objective:To explore the facilitators and barriers of home-based pulmonary rehabilitation in patients with pulmonary hypertension, in order to provide a basis for medical staff to formulate precise pulmonary rehabilitation interventions.Methods:The maximum variation purposive sampling method was used. From October to December 2023, a total of 12 patients with pulmonary hypertension attending the Department of Cardiology, Tianjin Medical University General Hospital, were selected as study participants and underwent semi-structured interviews. Colaizzi's phenomenological method was applied to analyze the data.Results:The facilitators of home-based pulmonary rehabilitation among patients with pulmonary hypertension included: capability factor (good exercise habits) ; opportunity factors (supervision and support from family members, professional guidance from medical staff) ; motivation factors (rehabilitation enthusiasm, perceived benefits of exercise). The barriers included: capability factors (obvious perception of physical symptoms, lack of knowledge about pulmonary rehabilitation, low level of e-health literacy) ; opportunity factors (unfavorable health environment, limited time) ; motivation factors (fear of exercise, lack of rehabilitation self-discipline) .Conclusions:Home-based pulmonary rehabilitation in patients with pulmonary hypertension is affected by multiple factors. Medical staff should adopt targeted interventions to promote patients' engagement in home-based pulmonary rehabilitation, with the aim of improving cardiopulmonary health, exercise endurance, and quality of life, thereby enhancing clinical prognosis.

Objective:To analyze the research status and emerging hotspots in the field of cardiac telerehabilitation (CTR) and provide references for the development of CTR in China.Methods:A systematic search was conducted for relevant literature on CTR in the databases of China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine disc, Web of Science Core Collection, PubMed, CINAHL, Cochrane Library, and Embase, with a search timeframe from the establishment of the databases to February 28, 2024. EndNote and CiteSpace software were used for visual analysis of the search results.Results:A total of 889 papers were included, of which 269 were in Chinese and 620 were in English, showing an overall increasing trend in publication volume. The Chinese database revealed 12 clustering groups and 9 emerging keywords, while the English database identified 10 clustering groups and 16 emerging keywords.Conclusions:The publication volume of CTR is generally on the rise, but cooperation between countries and institutions still needs strengthening. Current research hotspots and frontiers include the demand for CTR, target populations, exercise program design, and the application of electronic information technology. Researchers in China should fully refer to these hotspots and frontiers and explore CTR models that are suitable for the Chinese patient population.

Objective:To develop a quality control model for anal sphincter ultrasound images and validate its diagnostic performance across multiple centers.Methods:A retrospective analysis was conducted on anal sphincter ultrasound images from seven medical centers in China between May 2019 and June 2022. A total of 7 040 images from 3 116 patients were included and divided into a training set（4 912 images）and a validation set（2 128 images）. The images were classified as standard or non-standard images by three experts. Three models were developed based on different image feature extraction methods：a single-branch model，a multi-branch weighted model，and a multi-branch ensemble model. The diagnostic performance of each model was evaluated using the area under the ROC curve（AUC），sensitivity，specificity，accuracy，positive predictive value，and negative predictive value，respectively. The optimal model was selected and compared with the performance of 4 doctors with varying experience levels. Sixty days later，the images with the assistance of the model's output were reassessed by the doctors to evaluate its impact on manual quality control.Results:① Among the 3 models，the multi-branch ensemble model demonstrated the highest AUC and sensitivity，with an AUC of 0.966（95% CI=0.958 - 0.974），a sensitivity of 91.83%，and a specificity of 91.41%. This model was named M quality. ② M quality's AUC was slightly lower than that of Senior A and B（0.966 vs. 0.976，0.976，and P<0.05），its sensitivity was slightly lower than that of Senior A（91.83% vs. 95.61%， P<0.001）but comparable to Senior B（91.83% vs. 92.89%， P=0.315），its specificity was slightly lower than Senior A and B（91.41% vs. 94.44%，98.18%，and P<0.05）. However，M quality significantly outperformed Junior A and B in AUC and sensitivity（AUC：0.966 vs. 0.850，0.818；sensitivity：91.83% vs. 84.90%，61.46%；all P<0.001），its specificity was higher than that of Junior A（91.41% vs. 80.28%， P<0.001）but lower than that of Junior B（91.41% vs. 95.96%， P<0.001）. ③ With model assistance，Senior B's sensitivity（92.89% vs. 94.20%， P=0.001）and Senior A's specificity（94.44% vs. 96.56%， P<0.001）improved significantly. Junior A and B showed significant improvements in AUC and sensitivity（AUC：0.931 vs. 0.850，0.914 vs. 0.818；sensitivity：91.83% vs. 84.90%，89.53% vs. 61.46%；all P<0.001）. After model assistance，Junior A's specificity increased（93.62% vs. 80.28%， P<0.001），while Junior B's specificity decreased（91.60% vs. 95.96%， P=0.013）. Conclusions:This study develops a quality control model for anal sphincter ultrasound images with robust diagnostic performance，approaching the level of seniors. The model significantly enhances the image quality assessment capabilities of juniors，demonstrating promising clinical application potential.

Objective To discuss the feasibility and safety of simultaneous bilateral adrenal vein sampling(AVS)using two 4F-MPA1 catheters via right elbow vein access.Methods A total of 51 consecutive patients with primary aldosteronism,who received simultaneous bilateral AVS using two 4F-MPA1 catheters(one of the two catheters was shaped into pig tail figure)via right elbow vein access at Xiangyang Municipal Central Hospital between October 2021 and October 2022,were enrolled in this study.The used catheter,the success rate of simultaneous bilateral AVS,and the incidence of complications rate were calculated.Results The 4F-MPA1 catheter was used for all of the right AVS,while a specially shaped 4F-MPA1 catheter was used for the main trunk vein AVS of the left adrenal gland and the central vein AVS of the left adrenal gland.The success rate of simultaneous bilateral AVS was 92.2%(47/51).Adrenal hematoma occurred in one patient(1.96%).Conclusion The technique of simultaneous bilateral AVS using two 4F-MPA1 catheters via right elbow vein access is simple to operate,less traumatic,and clinically safe and feasible.However,due to the small sample used in this study,the clinical value of this technique still needs further investigation and verification.

Objective:To explore the application effect of case-based learning (CBL) combined with problem-based learning (PBL) interactive teaching mode on the teaching of rehabilitation nursing.Methods:The research objects were 89 nursing interns of Batch 2019 and Batch 2020 from the Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, and they were divided into experimental group ( n=44) and control group ( n=45). The experimental group adopted CBL+PBL interactive teaching mode, and the control group adopted traditional teaching mode. Teaching period lasted 5 months. SPSS 17.0 statistical software was used for t test. Results:Compared with the control group, the academic and specialized operation performances of experimental group were significantly improved [(84.55±6.35) vs. (89.51±4.87) and (94.74±1.58) vs. (95.93±1.19), P<0.05]. In the comprehensive quality evaluation, the interns' work performance was also significantly improved in experimental group [(9.69±0.51) vs. (9.23±0.99), P<0.05]. Conclusion:CBL+PBL teaching method has better teaching effect than traditional teaching mode in the teaching of rehabilitation nursing interns.

【Objective】 To investigate the HBV infection of TMA initially reactive but discriminatory test non-reactive samples(NDR) after the individual donation nucleic acid detection(ID-NAT)of TMA, and analyze its serological and molecular biological characteristics, so as to improve the safety of blood transfusion. 【Methods】 121 970 samples of blood donors in the center from January 1, 2021 to December 31, 2021 were routinely tested by serology and nucleic acid of ID NAT, and 21 HBsAg(-)/ NDR samples were random collected. After the plasma samples were concentrated by ultra-high speed centrifugation, the gene sequences of BCP/PC, pre-S/S and S region were amplified by Nested PCR. The S region sequence was also sequenced to analyze the viral genotype and amino acid variation. At the same time, the original TMA retest discriminatory test was adopted, and Roche MPX 2.0 was used for ID-NAT, and the samples was not virus-concentrated.NDR samples were supplemented with electrochemiluminescence for anti-HBc and anti-HBs quantitative detection. 【Results】 Of the 121 970 samples screened, 117(0.096%) were found to be HBsAg(-)/NDR samples, of which 21 samples underwent a confirmation test. Sixteen(76.2%) cases were positive for HBV DNA by TMA retest, 7(33.3%) positive for HBV DNA by Roche MPX 2.0 ID-NAT, 9(42.9%) confirmed by Nested PCR, and 8(38.1%) positive by any two methods. Test results of serological markers were as follows: 17(80.9%) positive anti-HBc and 8(38.1%) positive anti-HBs. Eight infected cases were confirmed to have occult hepatitis B infection(OBI). The gene sequence of S region was successfully amplified and sequenced in 3 cases, all of which belonged to C type. Two mutations occurred in specimen S-2, all of which were outside MHR. There were 13 mutations in sample S-6, 6 mutations outside MHR and 7 mutations inside MHR. 【Conclusion】 Nearly 40% of NDR samples can still be detected as HBV DNA positive after virus concentration. Anti-HBc has a high detection rate, and there may be a potential risk of HBV transmission. The current NAT detection sensitivity should be improved. The amino acid mutation of S gene sequence may be related to OBI formation.