Background Previous studies have focused on the respiratory system and skin damage caused by refractory ceramic fibers (RCFs). However, investigations into cardiovascular health of workers exposed to RCFs are insufficient. There is limited research on the association between occupational RCFs exposure and abnormal blood pressure, as well as the potential underlying mechanisms. Objective To explore the association between occupational exposure to RCFs and abnormal blood pressure, and to analyze the role of serum 8-hydroxy-2’-deoxyguanosine (8-OHdG) in this relationship, providing a reference for comprehensive health protection strategies for RCFs-exposed workers. Methods Using a cluster sampling method, 311 workers engaged in the production and processing of RCFs at a large RCFs enterprise were selected as the study population. A questionnaire survey was conducted to collect demographic information and other relevant data. The workers’ total dust, respirable fiber, and noise exposure levels were measured. Blood pressure was measured during occupational health examinations, and blood samples were collected. Based on blood pressure levels, the participants were divided into three groups: normotension, prehypertension, and hypertension. Serum 8-OHdG concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Ordinal logistic regression and multiple linear regression models were applied to evaluate the associations of exposures to noise and RCFs with abnormal blood pressure and serum 8-OHdG levels. The mediating effect of serum 8-OHdG on the relationship between occupational RCFs exposure and abnormal blood pressure was analyzed using the PROCESS 4.1 macro. Results All 311 RCFs workers had varying levels of occupational exposure to RCFs, among whom 113 were also exposed to noise. The overall prevalences of prehypertension and hypertension among the participants were 49.84% and 11.25%, respectively. In the noise-exposed group, the prevalences of normotension, prehypertension, and hypertension were 44.2%, 43.4%, and 12.4%, respectively, which showed no statistically significant difference compared to the non-noise-exposed group (35.9%, 53.5%, and 10.6%, respectively; P=0.652). Significant differences were observed in the prevalences of normotension, prehypertension, and hypertension among workers with different levels of total dust exposure (P=0.033) and respirable fiber exposure (P=0.034). The differences in serum 8-OHdG concentrations across these groups were also statistically significant (P<0.05). Multiple regression analyses showed that both total dust exposure level (OR=1.83, 95%CI: 1.34, 2.51) and respirable fiber exposure level (OR=1.85, 95%CI: 1.31, 2.62) were positively associated with the detection of abnormal blood pressure. Furthermore, total dust exposure level (β=5.85, 95%CI: 0.53, 11.17) and respirable fiber exposure level (β=6.04, 95%CI: 0.14, 11.94) were positively associated with serum 8-OHdG concentrations. Further analysis indicated that the severity of abnormal blood pressure was positively associated with serum 8-OHdG concentrations (β=10.54, 95%CI: 3.62, 17.46). Mediation analysis demonstrated that serum 8-OHdG mediated the relationship between RCFs total dust exposure levels and the risk of abnormal blood pressure (P<0.05), accounting for 8.63% of the total effect. However, no mediating effect of serum 8-OHdG was observed in the association between RCFs respirable fiber exposure levels and the risk of abnormal blood pressure (P>0.05). Conclusion Occupational exposure to RCFs is closely associated with an increased risk of abnormal blood pressure and elevated serum 8-OHdG levels. Oxidative stress may play a mediating role in the relationship between RCF exposure and abnormal blood pressure.

Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

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 investigate the clinical features, treatment strategies, and prognosis of pediatric Castleman disease (CD), with the aim of enhancing disease recognition and improving diagnostic and therapeutic approaches.Methods:A retrospective analysis was conducted on the clinical data of 29 children diagnosed with CD at the Children′s Hospital, Zhejiang University School of Medicine, between January 2016 and January 2024. Age, sex, initial presentations, routine blood test, inflammatory indicators, coagulation function test, immunoglobulin level, histopathological examination, imaging examination, treatment and follow-ups were recorded. Patients were classified into two groups based on the presence or absence of symptoms: the symptomatic Castleman disease group (SC) and the asymptomatic Castleman disease group (AC). All patients were followed for a minimum of six months. Clinical characteristics, therapeutic regimens, and outcomes were compared between the two groups.For the measurement information, the independent samples t test was used for comparison between groups of data that conformed to normal distribution; the Mann-Whitney U test was used for comparison between groups of data that did not conform to normal distribution. The Chi-square test or Fisher′s exact probability method was used for comparison between groups of count data. Results:A total of 29 pediatric CD cases were included, comprising 15 males and 14 females. The number of patients diagnosed as unicentric Castleman disease (UCD) was 21, with the rest 8 as multicentric Castleman disease (MCD). There were 11 patients (37.9%) in the SC group and 18 patients (62.1%) in the AC group. The median age at onset was 10.0 years (interquartile range: 6.5-12.2 years). The most common initial presentation was mass ( n=20), followed by fever ( n=2), amaemia ( n=2), fever with fatigue ( n=2), rash ( n=1), abdominal pain ( n=1), and cough ( n=1). The frequently involved sites were neck ( n=8), abdominal cavity ( n=5), mediastinum ( n=3), retroperitoneum ( n=2), and one case each in the back, upper arm, and pelvis. The maximum lesion volume reached 1 040 cm 3. Compared to the AC group, the SC group had significantly lower hemoglobin levels [108.0(92.0, 123.0)g/L vs. 127.0(117.5, 139.0)g/L, Z=-2.35, P=0.019] and significantly higher levels of C-reactive protein (CRP) [38.0(3.0, 87.0)mg/L vs. 0.6(0.5, 3.8)mg/L, Z=-2.19, P=0.029], prothrombin time[12.6(11.4, 13.3)s vs. 11.3(10.5, 11.7)s, Z=-2.64, P=0.008], and fibrinogen [4.5(3.5, 5.4)g/L vs. 2.1(1.9, 2.6)g/L, Z=-3.04, P=0.002]. All patients underwent MRI/CT and ultrasonography; however, only 2 cases were diagnosed as CD by ultrasound. All patients underwent surgical excision of the mass, and diagnoses were confirmed by histopathological examination. Among the SC group, 4 patients (4/11, 36.4%) required postoperative treatment with glucocorticoids alone or in combination with immunosuppressants and biologics. The overall prognosis was favorable, with follow-up ranging from 6 months to 7 years and no reported mortality. One case, initially misdiagnosed as systemic lupus erythematosus, was later confirmed to be CD complicated with paraneoplastic pemphigus (PNP); this patient experienced recurrent fever, rash, and elevated CRP, and continued to require low-dose glucocorticoids and tacrolimus during the 4-year follow-up. Conclusion:In chileren, CD is most common in the neck and surgical resection yields favorable outcomes. Approximately 37.9% of patients present with systemic symptoms, of which about 36.4% require postoperative systemic therapy such as glucocorticosteroids. CD complicated with PNP may be misdiagnosed. Symptomatic cases are often associated with anemia, elevated CRP levels, and coagulation abnormalities. UCD pediatric patients without complications have a good prognosis and there′s no need for long-term medications after surgery. About 37.5% of MCD pediatric patients require glucocorticoids, immunosuppressants, biotherapy or chemotherapy to control symptoms in the postoperative period. Imaging modalities have limited diagnostic value, and histopathological examination remains the gold standard for diagnosis.

Objective To investigate the influencing factors of pulmonary and extrapulmonary acute re-spiratory distress syndrome(ARDS)caused by sepsis.Methods A total of 126 patients with ARDS admitted to the Department of Critical Care Medicine,General Hospital of Ningxia Medical University,from January 2022 to June 2024 were selected.Patients were divided into pulmonary ARDS and extrapulmonary ARDS groups based on the etiology of ARDS.General data,inflammatory indicators,and prognostic outcomes were compared between the two groups.COX regression analysis was used to identify prognostic factors.Results A-mong the 126 patients,72 were diagnosed with pulmonary ARDS and 54 with extrapulmonary ARDS.The pulmonary ARDS group had significantly lower SOFA scores,fewer organ dysfunctions,a lower incidence of arrhythmia,shorter mechanical ventilation duration,higher Murray scores,and higher Charlson Comorbidity Index(CCI)compared to the extrapulmonary ARDS group(P<0.05).Inflammatory markers,including pro-calcitonin(PCT),C-reactive protein(CRP),interleukin(IL)-4,IL-6,IL-10,and tumor necrosis factor-α(TNF-α),were significantly lower in the pulmonary ARDS group,while interferon-γ(INF-γ)levels were higher(P<0.05).For pulmonary ARDS,CCI and TNF-α were identified as independent risk factors for prog-nosis(P<0.05),with the combination of CCI and TNF-α yielding the highest predictive accuracy(AUC=0.81,95%CI:0.71-0.91).For extrapulmonary ARDS,CCI and CRP were independent risk factors(P<0.05),and their combination achieved the highest predictive performance(AUC=0.91,95%CI:0.84-0.98).Conclusion Inflammatory profiles between pulmonary and extrapulmonary ARDS caused by sepsis are different.CCI and TNF-α are independent risk factors for mortality in pulmonary ARDS,while CCI and CRP are independent risk factors in extrapulmonary ARDS.

During the career life cycle, workers may face various health problems such as occupational injuries, occupational diseases, and work-related diseases. How to comprehensively protect the health of workers is a crucial scientific issue that needs to be solved urgently. Workers show the characteristics of co-exposure to multiple occupational risks or co-existence of multiple health conditions in their occupational activities. Occupational injuries are closely related to occupational diseases and work-related diseases. To carry out prevention and control of occupational injuries in the context of "big health", we should further strengthen the systematic approach and highlight the concept of "overall process" and "all-round". That is to establish an occupational injury surveillance system covering the whole process of surveillance-assessment-intervention and the evaluation of intervention effects, and to set up the joint prevention and control strategy of occupational injuries, occupational diseases, and work-related diseases. This will promote the implementation of efficient and intensive health management at government, society, employers, workers and other levels to achieve all-round protection of workers' health. When exploring the possible effects of job burnout, occupational stress, comorbidity, and other factors on occupational injuries, the introduction of machine learning methods provides a new approach to identifying and analyzing the influencing factors of occupational injuries and to exploring potential underlying mechanisms.

Background As a pillar industry in China, the manufacturing sector has a high incidence of non-fatal occupational injuries. The factors influencing non-fatal occupational injuries in this industry are closely related at various levels, including individual, equipment, environment, and management, making the analysis of these influencing factors complex. Objective To identify influencing factors of non-fatal occupational injuries among manufacturing workers, providing a basis for targeted interventions and surveillance. Methods A total of 2243 frontline workers from cable and shipbuilding enterprises were selected as study subjects to investigate the incidence of non-fatal occupational injuries and collect information at four levels: individual, equipment, management, and environment in past 12 months. Data balancing was performed using resampling, and LASSO regression was used to select factors of non-fatal occupational injuries. The influence degree and type of variables were judged based on the magnitude of the estimated coefficients of each variable, where variables with estimated coefficients > 0 are risk factors, and those <0 are protective factors. The area under the receiver operating characteristic (ROC)curve (AUC) was used to test the performance of the model, with an AUC value > 0.7 indicating good model performance. Results Among the 2243 frontline workers, males accounted for 77.7% (1742 out of 2243), with the main age range being 40-49 years old, representing 29.5% (661 out of 2243), 82.7% of the workers (1854 out of 2243) were married, and 55.6% (1248 out of 2243) had a junior middle school education level. The average monthly income for 51.0% (1144 out of 2243) of the workers was between 5000 and 6999 Chinese Yuan. The incidence of non-fatal occupational injuries among the manufacturing workers was 8.4% (189/2243) in the past 12 months. Among the 22 factors associated with the occurrence of non-fatal occupational injuries (P<0.05), 10 were individual-level factors, including gender, smoking, alcohol consumption, colleague relationships, average exercise duration, job burnout, work fatigue, musculoskeletal disorders, cardiovascular diseases, and neurological and sensory organ diseases; 3 were equipment-level factors, including equipment operability, hazardous workpieces, and safety hazards; 5 were environmental-level factors, including low temperatures, special operations, noise, workspace size, and dirty and disorderly environment; and 4 were management-level factors, including daily working hours, weekly working days, overtime, and pre-job technical training. The AUC value of the LASSO regression model was 0.704 and the final model retained a total of 10 variables. Among them, there were 7 risk factors for non-fatal occupational injuries (coefficient > 0), including safety hazards, musculoskeletal disorders, dangerous workpieces, job burnout, dirty and disorderly environment, smoking, and male gender; and 3 protective factors (coefficient < 0), including pre-job technical training, good colleague relationship, and long working days per week. Conclusion Manufacturing enterprises need to focus on the incidence of non-fatal occupational injuries and conduct targeted interventions for non-fatal occupational injuries by controlling potential safety hazards, providing pre-job technical training, reducing dangerous workpieces, rectifying working environment, and reasonably arranging working hours.

Background Workers in the cable manufacturing industry are exposed to high-speed machinery and equipment for a long time, coupled with heavy workload, which poses significant risks to their physical health. However, the issue of occupational injuries in this industry has not received enough attention yet. Objective To understand the incidence of occupational injury of workers in cable manufacturing industry and to analyze the influencing factors. Method A basic information questionnaire and an occupational injury questionnaire were developed to investigate the occupational injuries of 1 343 workers in a cable manufacturing enterprise in the past year, and a total of 1 225 valid questionnaires were recovered, with an effective rate of 91.2%. Descriptive statistics were used to characterize the causes, injury locations, injury types, and other characteristics of employees’ occupational injuries. Chi-square test was used to analyze the occupational injury status of groups with different demographic characteristics, occupational characteristics, lifestyles, and interpersonal relationships. Logistic regression was used to analyze the influencing factors of occupational injuries. Result The incidence of occupational injuries among workers in a cable manufacturing enterprise in the past year was 8.6%, which mainly happened in male workers (80.0%) and occurred from May to July in summer (45.7%). The main causes were mechanical injuries (32.4%) and object blows (27.6%). The main sources of damage were machinery and equipment (36.2%) as well as raw materials and products (15.2%). The main injuries were located in upper limbs (53.3%) and lower limbs (22.9%). The main types of injuries were fractures (33.3%) and abrasions/contusions/puncture wounds (19.0%). The results of univariate analysis showed that there were statistically significant variations in the incidence of occupational injuries by gender, overtime, pre-job training, years of service in current position, alcohol consumption, physical exercise per week, and co-worker relationship (P<0.05). The logistic regression model showed that workers who exercised less than twice a week, did not participate in pre-job training, worked overtime, and had fair/poor/very poor colleague relationship had a higher risk of occupational injury, while women had a lower risk of occupational injury. Conclusion The distribution of occupational injury population is mainly male, and the time distribution is mainly from May to July. Gender, physical exercise, pre-job training, overtime, and colleague relationship are the influencing factors of occupational injuries. We should strengthen pre-job training, arrange work hours reasonably, and create a good working atmosphere to reduce the occurrence of occupational injuries.

Background Social psychological factors have emerged as a key area of research in occupational injury prevention. Occupational stress, a significant component of social psychology, has garnered widespread attention due to its potential impact on occupational injury. Objective To analyze the factors influencing occupational stress among cable manufacturing workers and explore the relationship between occupational stress and occupational injury, and to provide scientific evidence for reducing occupational stress and injury. Methods A questionnaire on basic demographics, occupational injury, and occupational stress (Effort-Reward Imbalance, ERI) was used to investigate 1343 workers in a cable enterprise. Chi-square test was employed to analyze the distribution of occupational stress across different worker characteristics. Logistic regression was used to identify factors influencing occupational stress, and a decision tree model was applied to assess the impact of occupational stress on injury risk. Results A total of 1225 valid questionnaires were collected, yielding a response rate of 91.2%. The positive rate of occupational stress was 28.7%, while the incidence of occupational injury in the past year was 8.6%. The results of univariate analysis revealed that workers who had experienced occupational injuries had a higher positive rate of occupational stress compared to those without injuries (P<0.05), and there were significant differences in the distribution of occupational stress by genders, overtime work, shift work, daily working hours, fatigue levels, sleep duration, family relationships, and colleague relationships (P<0.05). The logistic regression results showed that individuals who worked shifts, had fair/poor/very colleague relationships, and frequently worked overtime had a higher risk of occupational stress (P<0.05). The final decision tree model confirmed that occupational stress was a risk factor for occupational injury. Additional factors influencing occupational injury included physical exercise, colleague relationships, pre-job training participation, and gender. Workers who exercised less than twice per week and experienced occupational stress had a significantly higher risk of injury (23.6%) compared to those without occupational stress (10.9%). Conclusion Shift work, colleague relationships, and overtime work are correlated with the positive rate of occupational stress among cable manufacturing workers. Implementing a reasonable work schedule and fostering a positive work environment are recommended. Reducing occupational stress may help lower the risk of occupational injuries in this industry.

Background Construction workers represent a high risk group for occupational injuries. Currently, domestic and international studies examining the factors affecting occupational injuries among construction workers focus on demographic and behavioural characteristics. However, there is limited attention to psychosocial, use of digital technology, and health status of workers. Objective To analyze the occurrence of occupational injuries among workers in the construction industry, explore impacts of psychosocial risk, use of digital technology, health status, and preventive measures at the workplace on occupational injuries, and provide a basis for the development of preventive measures. Methods Publicly available data from the European Union Occupational Safety and Health Administration were retrieved, comprising a sample of 2167 construction workers. The outcome indicator was the presence of occupational injuries among workers. A total of 25 variables in the dimensions of psychosocial risk, use of digital technology, health status, and preventive measures at the workplace were extracted after Chi-square test, and then a combination of Boruta's algorithm and logistic regression was applied to identify the key factors affecting occupational injuries. Results Among the 2167 construction workers surveyed, 182 (8.6%) reported experiencing occupational injuries. The Boruta algorithm identified eight characteristics which in descending order of importance were musculoskeletal disorders, job type, depression and anxiety, level of completed education, use of electronic smart products, timely solution of safety problems, overall fatigue, and age. The logistic regression results indicated that six variables had statistically significant effects on occupational injuries: age, job type, level of completed education, musculoskeletal disorders, overall fatigue, and timely solution of safety problems (P<0.05). Conclusion Occupational injuries in construction workers are influenced by a variety of factors, including age, job type, level of completed education, musculoskeletal disorders, overall fatigue, and timely solution of safety problems. Companies and workers should take targeted measures to reduce the incidence of occupational injuries.