Objective To track and evaluate the implementation and application of the occupational health standard Radiation shielding requirements for radiotherapy room—Part 4: Radiotherapy room of ²⁵²Cf neutron afterloading (GBZ/T 201.4-2015) by radiation health technical service agencies, medical institutions, health supervision agencies, and radiotherapy facility design units, and to provide a scientific basis for the further revision and implementation of this standard. Methods Following the Guideline for health standards tracking evaluation (WS/T 536-2017) and the project implementation plan, relevant practitioners were randomly selected for a questionnaire survey. The survey primarily focused on their awareness, standard training, application, and revision suggestions of GBZ/T 201.4-2015. The results were summarized and analyzed. Results A total of 168 evaluation questionnaires were collected from relevant practitioners in 28 provinces. Only 31.6% of the respondents reported being “well familiar” or “ familiar” with the standard, 27.4% of the respondents believed that the standard was widely used, and 45.2% of the respondents believed that the standard could meet the needs of their work. Only 14.9% of the respondents had received relevant training on the standard, more than half of the respondents had not applied the standard within the past 10 years, and 45.2% of the respondents believed that the standard "needs to be revised". Conclusion Due to the small number of californium-252 neutron afterloading radiotherapy devices in operation on the market, the overall awareness of the standard is low, suggesting that relevant authorities need to strengthen training and publicity of the standard, and that certain sections of the standard need to be revised or merged.

Objective:To evaluate the effect of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) on regional cerebral oxygen saturation (rScO 2) during induction of general anesthesia in patients undergoing traumatic brain injury (TBI) emergency surgery. Methods:A prospective randomized controlled trial was conducted. The TBI emergency general anesthesia patients who underwent intracranial hematoma removal surgery at the Northern Jiangsu People's Hospital from January to July in 2023 were enrolled. The patients were divided into a conventional mask ventilation group and a THRIVE group using a random number table method. The patients in the conventional mask ventilation group were anesthetized and induced to pre oxygenate without positive pressure ventilation in the front mask for 10 minutes, with an oxygen flow rate of 8 L/min and an fraction of inspired oxygen (FiO 2) of 1.00. After anesthesia induction for about 90 s, tracheal intubation was performed after the muscle relaxant took effect (patient's jaw muscle was relaxed). The patients in the THRIVE group were pre oxygenated with THRIVE for 10 minutes, with an oxygen flow rate of 30 L/min and a FiO 2 of 1.00. During anesthesia induction, the oxygen flow rate was increased to 50 L/min, and anesthesia induction medication was used. The lower jaw of patient was supported with both hands to maintain airway patency, and the patient's mouth was kept closed throughout the process. After the muscle relaxant took effect (the patient's jaw muscle was relaxed), tracheal intubation was performed. At the time of patient entering the operating room, 10 minutes of pre oxygenation, and immediately after successful intubation, rScO 2 was measured on the surgical and non-surgical sides. At the same time, ultrasound was used to measure the cross-sectional area (CSA) of the gastric antrum and arterial blood gas analysis was performed. The partial pressure of end-tidal carbon dioxide (P ETCO 2) during the first mechanical ventilation after successful tracheal intubation, the incidence of hypoxemia [pulse oxygen saturation (SpO 2) < 0.95] during tracheal intubation, as well as prognostic indicators such as the length of intensive care unit (ICU) stay, total length of hospital stay, and Glasgow outcome scale (GOS) score at discharge were recorded. Results:During the study period, a total of 70 TBI patients underwent emergency general anesthesia surgery, of which 2 patients died postoperatively, 2 patients were unable to cooperate with closed mouth breathing, and 3 patients had poor ultrasound image acquisition in the gastric antrum, all of whom were excluded. A total of 63 patients were ultimately enrolled, including 32 in the conventional mask ventilation group and 31 in the THRIVE group. There were no statistically significant differences in gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, Glasgow coma scale (GCS) score, optic nerve sheath diameter (ONSD), baseline vital signs, fasting situation, anesthesia time, surgical time, and intraoperative blood loss between the patients in the two groups, indicating comparability. When entering the operating room, there was no statistically significant difference in rScO 2 on the surgical and non-surgical sides, and blood gas analysis indexes arterial partial pressure of oxygen (PaO 2) and arterial partial pressure of carbon dioxide (PaCO 2) between the patients in the two groups. When pre oxygenated for 10 minutes, both the surgical and non-surgical sides rScO 2 levels in the THRIVE group were significantly higher than those in the conventional mask ventilation group (surgical side: 0.709±0.036 vs. 0.636±0.028, non-surgical side: 0.791±0.016 vs. 0.712±0.027, both P < 0.01), and the PaO 2 was significantly increased [mmHg (1 mmHg≈0.133 kPa): 450.23±60.99 vs. 264.88±49.33, P < 0.01], PaCO 2 was significantly reduced (mmHg: 37.81±3.65 vs. 43.59±3.76, P < 0.01), and the advantage continues tilled immediately after successful intubation. There was no statistically significant difference in CSA at each time point of ultrasound examination between the two groups. Compared with the conventional mask ventilation group, the patients in the THRIVE group showed a significant decrease in P ETCO 2 during the first mechanical ventilation after successful tracheal intubation (mmHg: 43.10±2.66 vs. 49.22±3.31, P < 0.01), and the incidence of hypoxemia during tracheal intubation was also significantly reduced [0% (0/31) vs. 28.12% (9/32), P < 0.01]. In terms of prognostic indicators, there was no statistically significant difference in the length of ICU stay and total length of hospital stay between the patients in the conventional mask ventilation group and the THRIVE group [length of ICU stay (days): 10 (9, 10) vs. 10 (9, 11), total length of hospital stay (days): 28.00 (26.00, 28.75) vs. 28.00 (27.00, 29.00), both P > 0.05]. However, the proportion of patients in the THRIVE group with a good prognosis at discharge (GOS score > 3) was significantly higher than that in the conventional mask ventilation group [35.5% (11/31) vs. 12.5% (4/32), P < 0.05]. Conclusion:THRIVE can significantly increase rScO 2 during anesthesia induction in TBI emergency surgery patients and improve their neurological function prognosis.

Glioma is a primary aggressive brain tumor with high recurrence rate. The poor efficiency of chemotherapeutic drugs crossing the blood‒brain barrier (BBB) is well-known as one of the main challenges for anti-glioma therapy. Moreover, massive infiltrated tumor-associated macrophages (TAMs) in glioma further thwart the drug efficacy. Herein, a therapeutic nanosystem (SPP-ARV-825) is constructed by incorporating the BRD4-degrading proteolytic targeting chimera (PROTAC) ARV-825 into the complex micelle (SPP) composed of substance P (SP) peptide-modified poly(ethylene glycol)-poly(d,l-lactic acid)(SP-PEG-PDLLA) and methoxy poly(ethylene glycol)-poly(d,l-lactic acid) (mPEG-PDLLA, PP), which could penetrate BBB and target brain tumor. Subsequently, released drug engenders antitumor effect via attenuating cells proliferation, inducing cells apoptosis and suppressing M2 macrophages polarization through the inhibition of IRF4 promoter transcription and phosphorylation of STAT6, STAT3 and AKT. Taken together, our work demonstrates the versatile role and therapeutic efficacy of SPP-ARV-825 micelle against glioma, which may provide a novel strategy for glioma therapy in future.

Objective To explore the changes of related angles of knee joint in adults in recent 30 years according to the angle value of knee joint compiled by Qi Zhongzheng in 1984,to provide the basis for clinical individualized diagnosis and treatment.Methods 102 healthy volunteers underwent digital X-ray photography of lower limbs.The femoral angle,tibial angle and femoral tibial angle of bilateral knee joints were measured and compared with historical reference value.The correlation between height,weight,BMI and each angle was evaluated.The differences between different sides and different genders were also analyzed.Results There were statistical differences between the mean value and historical mean value of femoral angle,tibial angle and femoral tibial angle (P＜0.001).In female volunteers,the height was weakly correlated with tibial angle and femoral tibial angle (P＜0.05),the weight was weakly correlated with femoral angle (P＜0.01),and the weight was moderately correlated with femoral tibial angle (P＜0.0 1).BMI was weakly correlated with femoral angle or femoral tibial angle (P＜0.05).There were significant differences in femoral angle (right),tibial angle and femoral tibial angle between different genders (P＜ 0.05).Conclusion In the last 30 years,there is a statistical difference between the angle value of the knee joint and the historical reference value.There is also a statistical difference in knee joint angle value between both genders.And in female volunteers,height,weight and BMI show some correlations with the knee joint angle value.However,the cross-sectional survey data of multicenter,large sample size and the whole population are still necessarily needed for further study.

Objective To investigate the methods for prevention and treatment of unexpected hemorrhage during operation of biliary tract.Methods The clinical data of 28 patients with intraoptrative hemorrhage from Jan.2006 to Dec.2016 in our hospital were retrospectively analyzed.Results The cause of introoperative hemorrhage included:iatrogenic biliary injuries in 14 cases (50％),cholelithasis complicated biliary infection in 9 cases (32.1％),bleeding in gall bladder bed in 3 patients (10.7％),and other causes in 2 cases (7.1％).The intraoperative blood loss was 600 to 3000 ml.According to the specific location of bleeding,the amount of blood loss,the cause of bleeding and other conditions,the individual treatment was given.26 were cured and 2 died of hemorrhagic shock and MODS.Conclusions The major causes of hemorrhage during operation of biliary tract comprise iatrogenic biliary injuries,biliary infection,and biliary lithiasis.The reasonable treatment of intraoperative hemorrhage should be based on the concrete bleeding etiologies.

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

Objective To explore the outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries.Methods A retrospective review of clinical and radiographic data of 111 patients (113 procedures),admitted to our hospital from June 2010 to July 2014,was performed.The resection rate,clinical cured rate and complications in pituitary neoplasms of different Knosp classifications were compared.Results Gross total resection (GTR) rate for pituitary neoplasms according to Knosp classification was 97.4％ in grade 0,85.7％ in grade 1,88.7％ in grade 2,51.9％ in grade 3 and 0％ in grade 4,with significant differences (P＜0.05);GTR rate in pituitary neoplasms of grade 3 and 4 was significantly lower than that in pituitary neoplasms of grade 1 and 2 (P＜0.05).Clinical cured rate of the prolactin adenomas of different Knosp grades was significantly different,and that of grade 0 was statistically higher than that of grade 1-4 (P＜0.05).Clinical cured rate of growth hormone adenoma,adeno-corticotrophic stimulating hormone adenoma and mixed-functional adenomas of different grades showed no significant differences (P＞0.05).Chief complaints were improved in 75.0％-91.7％ non-functioning adenomas.Postoperative severe complications included 3 patients (2.7％) with cerebrospinal fluid rhinorrhea,4 (3.5％) intracranial hematoma,1 (0.9％);postoperative mild complications included 3 (2.7％) epistaxis,14 (12.4％) transient diabete insipidus,1 (0.9％) permanent diabetes insipidus and 3 (2.7％) hyponatremia.Mortality was observed in one patient with intracranial hematoma.Conclusions Neurendoscope provides a superior view of the sellar region,and improves the extent of resection of pituitary adenoma especially for those with cavernous sinus invasion;however,blind pursuit of GTR for tumor with Knosp classification greater than grade 3 will increase the risk of severe complications.Safety should always be the priority for a procedure with a long learning curve like neuroendoscopic surgery.Remission of residue tumor can be addressed by subsequent radiotherapy/stereotactic surgery.

Objective:To explore the clinical characteristics of patients with cholelithiasis in Jinshan district of Shanghai city. Methods:The clinical characteristics of 3455 patients with cholelithiasis treated in Jinshan Branch of Shanghai Sixth People′s Hospital from Jul 2010 to Dec 2012 were analyzed.Results:Among them,3127 patients (90.5%)had clinical symptoms,and 328 patients (9.5%)had no symptoms.The incidence rate of symptomatic cholelithiasis in male patients was lower than that in female patients,while the incidence rate of asymptomatic cholelithiasis in male patients was higher than that in female patients (P <0.05).The incidence rate of asymptomatic cholelithiasis in patients decreased with the increase of age,and the difference was statistically significant(P <0.05).The incidence of cholecystolithiasis was 54.5%.The appearance of symptoms in patients with cholelithiasis was not correlated with the body mass index(BMI)and the location of cholelithiasis(P >0.05).Conclusions:Jinshan district of Shanghai city has high incidence of cholelithiasis.The appearance of Symptoms in patients with cholelithiasis is correlated with gender and age,but not correlated with BMI and location of cholelithiasis.

ObjectiveTo compare the therapeutic result between ERCP and conventional treatment for bile leakage after cholecystectomy.MethodsData of 35 cases with bile leakage after cholecystectomy were retrospectively studied,in which 18 patients underwent conventional therapy and surgery ( conventional group),and 17 others underwent ERCP (endoscopy group).The time of bile leakage closure,complication rate,and re-operation rate of the 2 groups were compared.ResultsIn conventional group,leakage location was identified in 7 cases and mean bile leakage closure time was 23 days.A second operation was performed in 8 cases and complications occurred in 7.In endoscopy gnoup,leakage location was identified in 13 cases and mean bile leakage closure time was 13 days.A second operation was performed in 2 cases and complications occurred in 3.Significant differences were found between 2 groups in regarding of the above references.Conclusion ERCP is accurate and valuable for diagnosis and treatment for bile leakage after cholecystectomy.

Objective To investigate the efficacy of sequential ERCP and laparoscopy for acute biliary pancreatitis (ABP).Methods A total of 80 patients with ABP were randomly divided into 2 groups to receive sequential ERCP and laparoscopy (observation group,n=40) or traditional surgery (control group,n=40).Clinical data including abdominal pain relief time,recovery time of white blood cell,blood amylase and liver function,hospital stay,complication rate and mortality were analyzed.Results ERCP failed in 1 patient in observation group,and the remaining 39 patients (97.5％) were recruited into the study.There were significant differences between 2 groups in regarding of abdominal pain relief time (7.7±2.7 d vs.11.4±3.7 d),recovery time of white blood cell ( 9.7±2.6 d vs.13.3±3.9 d ),blood amylase ( 8.2±2.1 d vs.12.5±3.3 d ),liver function ( 12.5±5.1 d vs.21.3±6.5 d ),hospital stay ( 16.1±5.1 d vs.23.3±7.6 d ) and rate of complication ( 12.8％ vs.30.0％ ).There was no significant difference in morbidity between 2 groups (5.1％ vs.7.5％).Conclusion Sequential ERCP and laparoscopy is effective for ABP.