OBJECTIVE To provide references for the accurate identification and management of immune-related cutaneous adverse events （irCAEs） caused by durvalumab， and ensuring safe clinical drug use. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with gallbladder cancer who developed irCAEs caused by durvalumab. The clinical pharmacists systematically reviewed the patient’s past medical history and medication history， and assisted physicians in assessing the association between adverse drug reactions and administered drugs. Meanwhile， the clinical pharmacists conducted a graded assessment of the adverse reaction， proposed recommendations such as discontinuing durvalumab and adjusting the administration regimen of glucocorticoids， assisted physicians in restarting immunotherapy， and carried out medication education and other pharmaceutical care. RESULTS The occurrence of irCAEs in this patient was “highly likely” related to durvalumab and was classified as severe. The physicians adopted the clinical pharmacist’s opinion， and after symptomatic treatment， the patient’s skin symptoms improved， and discharged with medication. After the completion of glucocorticoid therapy for the patient， the physician restarted immunotherapy with tislelizumab， and no related adverse reactions occurred again in the patient. CONCLUSIONS Durvalumab can cause irCAEs such as severe skin maculopapular rash. In clinical practice， it is crucial to promptly identify and discontinue suspicious drugs， immediately implement effective symptomatic treatment measures， and actively resume immunotherapy to ensure the continuity and safety of the patient’s treatment.

Objective To understand the distribution of M protein gene (emm) of group A streptococcus (GAS) infections among children in Xicheng District of Beijing. Methods Throat swab samples from scarlet fever and pharyngeal infection cases were collected in sentinel hospitals of Xicheng District, Beijing from 2011 to 2024. GAS strains were isolated and identified, and emm gene was amplified and sequenced by PCR to determine the genotype. The differences in emm genotype between different groups were compared. Results A total of 3 130 throat swab samples were collected, and 400 GAS strains were isolated, with a positive rate of 12.78%. The highest positive rate was 19.93% in 2011. The positive rate of scarlet fever (45.71%) was higher than that of pharyngeal infection (6.14%) (P<0.001). There were 391 emm gene positive strains, and the differences in the positive rate of emm gene among different cases were statistically significant (P<0.001). A total of 7 genotypes and 27 gene subtypes were detected. Among different groups, the emm genotypes were mainly emm12 and emm1. The emm gene subtypes were mainly emm12.00 and emm1.00. Except for some years, the genotypes and their subtypes were dominated by emm12 and emm12.00, and the distribution differences of the two major genotypes and their subtypes were statistically significant from 2011 to 2019 (P<0.001). There were differences in genotypes and subtypes among different age groups (P=0.002). Conclusion The dominant types of emm genes in group A streptococcus infections among children were emm12 and emm1 in Xicheng District of Beijing from 2011 to 2024, and the dominant gene subtypes were emm12.00 and emm1.00. It is necessary to comprehensively strengthen the monitoring of the epidemic situation and genotype, timely grasp the distribution and variation of emm gene.

ObjectiveTo tentatively understand the status of radioactive contamination in nuclear medicine personnel. MethodsA total of 34 radiation staff engaged in nuclear medicine diagnosis and treatment were selected from two hospitals in Shanghai as the survey subjects.Among the 34 medical staff， 8 were nuclear medicine doctors， 14 were nuclear medicine technicians and 12 were nuclear medicine nurses. After surface contamination monitoring was first carried out to confirm that they had no surface radioactivity contamination， whole body scanning was performed with a whole body counter to determine whether they were internally contaminated with artificial radionuclides. ResultsThe α surface contamination was not detected in the nuclear medical staff. The β surface contamination of the nuclear medicine doctors， technicians and nurses was （13.8±0.8）， （14.1±0.8） and （14.0±0.7） times per second， respectively. There were 2， 2， and 4 nuclear medicine doctors who were contaminated with ¹⁸F， ^99mTc and ¹³¹I， 3， 5， and 2 nuclear medicine technicians who were contaminated with ¹⁸F， ^99mTc and ¹³¹I， and 6， 8， and 5 nuclear medicine nurses who were contaminated with ¹⁸F， ^99mTc and ¹³¹I， respectively. The ¹⁸F activity of nuclear medicine technicians was 1 997‒9 401 Bq， and the ^99mTc activity of nuclear medicine technicians and nurses was 3 699‒18 692 and 652‒388 22 Bq， respectively. One nuclear medicine nurse had a ^99mTc activity of 35 389 Bq. According to the preliminary estimation of ¹³¹I internal irradiation dose， the maximum committed effective dose of nuclear medicine doctors， technicians and nurses could reach 0.370， 0.018 and 0.584 mSv， respectively. ConclusionThe nuclear medicine staff are exposed to radioactive contamination， and it is important to monitor and evaluate their internal radiation doses.

Background Based on numerous epidemiological studies, radionuclide ¹³¹I can result in thyroid disease. Objective To study the contamination level of thyroid ¹³¹I in ¹³¹I treatment associated radiation workers in nuclear medicine departments in Shanghai. Methods Based on a general survey on basic situation of nuclear medicine in Shanghai, the level of internal exposure of radiation workers involved in ¹³¹I treatment was assessed with questionnaires and on-site monitoring. A portable γ spectrometer was used for on-site detection, the intake and annual effective dose were estimated according to the measurement results. Physical examination reports were collected for radionuclide positive workers, and chromosome testing was performed. Results There were 579 nuclear medicine workers and 175 were engaged in ¹³¹I treatment in Shanghai. ¹³¹I was detected in thyroid of 18 workers, with a detection rate of 10.3%. Among them, the detection rates of thyroid ¹³¹I in nurses and cleaners were 23% and 25% respectively. The mean measured activity of thyroid ¹³¹I was 306.1 Bq and the maximum measured activity was 3716.9 Bq (nurse). The maximum intake was estimated at 37544 Bq and the median was 786.4 Bq. The average annual committed effective dose was 1.22 mSv and the maximum value was 14.87mSv. The chromosomal aberration rates of all detected workers were negative, and all blood indicators were normal except one with low hemoglobin. Conclusion The annual dose of nuclear medical staff engaged in ¹³¹I treatment does not exceed the national standard limit, but the internal exposure of nurses and cleaners should not be ignored. On the basis of strengthening protection and decontamination, routine internal exposure monitoring should be carried out.

Objective:To explore the association between the frequency of using smoking cessation application (APP) and the effect of smoking cessation in smoking cessation clinic.Methods:A clinical trial with a non-randomized controlled design was conducted in the smoking cessation clinic of China-Japan Friendship Hospital from July 2019 to June 2021. Participants were given a comprehensive smoking cessation intervention of mobile APP combined with bupropion. The primary outcome measures were carbon monoxide validated sustained abstinence at 9-12 weeks.Results:A total of 187 participants were included in the final analysis. After 12-week intervention, the sustained abstinence at 9-12 weeks was 42.2%. For the frequency of APP use, 20.9% (39/187) of the participants used it≥6 days per week, 62.0% (116/187) used it 2-5 days per week, and 17.1% (32/187) used it≤1 day per week. Multivariate analysis showed that smoking cessation rate was associated with smoking duration, cigarettes smoked per day and frequency of APP use. Participants with higher frequency of APP use had a higher likelihood of quitting smoking ( OR=4.95, 95% CI: 1.32-18.63). Conclusion:The increased frequency of mobile smoking cessation APP use is associated with higher probability of quitting smoking in smoking cessation clinic.

Objective:To describe the study methods and baseline characteristics of participants enrolled in mCessation program.Methods:This is a longitudinal, real-world study with non-randomized controlled design. The mCessation program consisted of a WeChat official account, an applet and a website using the same name ‘mCessation Online’. After users followed the WeChat account, filled in baseline information online and set a quit date, they would receive 162 short text messages in the next six and a half months as scheduled. This study collected the information of participants enrolled from May 26, 2021 to September 30, 2022, and analyzed baseline data including demographic characteristics, smoking characteristics, degree of tobacco dependence, reasons for smoking cessation and other related factors.Results:During the study period, a total of 16 746 participants registered, and 13 887 participants (82.9%) were enrolled in final analysis after screening the inclusion and exclusion criteria and completion of main indicators. Each year the number of enrolled participants in May or June was 1 381 to 2 707 per month, higher than the number of enrolled participants in other months (233 to 569 per month). Participants from North China accounted for the largest proportion (29.3%). There were 13 316 men (95.9%) in enrolled participants and the mean age was (36±10) years. Most participants were 25-34 (38.8%) or 35-44 (30.8%) years old. In terms of smoking characteristics, there were 12 564 (90.5%) daily smokers. The starting age of smoking was 18 (15, 20) years old. 11 866 participants (85.4%) were tobacco dependent, mostly with degree of mild (76.4%) or moderate (20.2%). In terms of reasons for quitting, 9 315 participants′ (67.1%) reasons were to prevent disease, 6 742 participants (48.5%) were concerned about impact of smoking on family members, and 6 731 participants (48.5%) were under requested by families.Conclusion:mCessation program can effectively recruit smokers with intention to quit in short time, especially those who were male, young and tobacco dependent.

Objective:To conduct an MRI observation on the incidences of ligamentous injuries and fracture morphology in Schatzker type Ⅳ tibial plateau fracture (TPF) and investigate their influence on knee stability.Methods:A retrospective analysis was conducted of the 30 patients with Schatzker type Ⅳ TPF who had undergone surgery at Department of Orthopaedic Trauma, Jiangsu Provincial People's Hospital from January 2010 to December 2019 and whose preoperative X-ray, CT and MRI were available. They were 18 males and 12 females, aged from 22 to 75 years (mean, 45.4 years). They were divided into a dislocation-free group and a dislocation group according to the absence or presence of knee dislocation on their anteroposterior X-ray films. The fracture morphology was assessed on CT according to the modified three-column classification. The incidences of ligamentous injuries [involving anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), posterolateral complex (PLC) and anterolateral ligament (ALL)] were investigated on MRI. The 2 groups were compared in fracture morphology and incidences of ligamentous injuries. Multiple linear regression (MLR) analysis was used to identify the main factor contributing to preoperative knee dislocation.Results:The dislocation group had 12 patients and the dislocation-free group 18. The fracture involving medial+posteromedial+posterolateral columns was found in 66.7% of the patients (20 cases), and accounted for 83.3% (10 cases) in the dislocation group. The incidence was 96.7% (29 cases) for ACL injury, 43.3% (13 cases) for PCL injury, 70.0% (21 cases) for MCL injury, 90% (27 cases) for PLC injury, 73.3% (22 cases) for ALL injury and 90% (27 cases) for the multiple-ligament disruption. There was a significant difference in the posterolateral column injury between the dislocation-free group [55.6% (10/18)] and the dislocation group [91.7% (11/12)] ( P < 0.05), but there were no significant differences between the 2 group in the injury to any other single ligament or multiple ligaments ( P>0.05). The MLR analysis confirmed that the posterolateral column injury was a risk factor for coronary plane dislocation in Schatzker type Ⅳ TPF( P<0.05). Conclusions:In Schatzker type Ⅳ TPF, the incidences of ligamentous injuries are very high but the fracture of posterolateral column may be the main cause for preoperative knee dislocation in some patients.

To investigate the current status of postgraduates training in public health and preventive medicine in China. In this study, a questionnaire survey was conducted among directors of enrollment and teaching in 22 universities with postgraduate admission qualifications in corresponding disciplines nationwide. In 2016, full-time postgraduates were mainly academic masters. In addition to the graduate entrance examination, the common enrollment mode in colleges was to enroll a high qualified student with recommendations from relevant experts or institutions and an exemption from entrance examination (20/22). The emphasis on training contents between academic and public health master was different. Currently, the scale of public health postgraduate enrollment in public health and preventive medicine in China is stable, and the training program is reasonable, but there is an issue of monotonous model and uneven distribution of enrollment.

In order to understand the status of the cultivation of the masters of public health (MPH) in colleges in China and improve the cultivation model, an electronic questionnaire survey were conducted among 22 schools of public health in colleges. The result showed that the size and the enrolment scale of Chinese MPH students were relatively small, and the training objectives were still unclear. There was no obvious difference between the curriculum setting for MPH and academic master degree. The practical skill-oriented courses and emergency response ability of public health practice were insufficient. The cultivation model of MPH should be improved in future.

In order to underst and the status of health emergency personnel training development and raising coping measures, electronic questionnaire surveys were conducted among 22 colleges and universities in different region of China. The result showed that colleges universities in China invested less in the training of emergency personnel. It is different and emphasized particularly for the cultivation of emergency professional ability among different types of public health students. Universities and employer hold relative evaluation of students′ emergency professional ability with distinct regional differences.