Objective To analyze the health effects of long-term occupational exposure to ionizing radiation on radiation workers in a nuclear power plant, and to provide a scientific basis for their occupational health monitoring. Methods In 2023, 183 radiation workers in a nuclear power plant were subjected to the analysis of blood cell parameters such as mean red blood cell count, white blood cell count (WBC), lymphocyte count, and hemoglobin count, thyroid function indicators such as serum triiodothyronine, thyroxine, and thyrotropin, as well as the chromosomal aberration rate and micronucleus rate of the lymphocytes in the peripheral blood. Results The blood cell parameters, thyroid function indicators, chromosomal aberration rate, and micronucleus rate of these radiation workers in the nuclear power plant were within normal reference ranges. Comparison among radiation workers with different ages showed statistically significant differences in triiodothyronine (H = 6.98, P < 0.05) and micronucleus rate (H = 48.44, P < 0.05). Among the three groups of radiation workers with different working years, WBC was significantly different (χ² = 3.87, P < 0.05), with the lowest WBC observed in radiation workers with ≥ 20 years of service. Thyroxine (χ² = 4.01, P < 0.05) and micronucleus rate (H = 40.95, P < 0.05) also varied significantly among these three groups. Conclusion Thyroid triiodothyronine level and micronucleus rate were affected by age, while WBC, thyroid thyroxine level, and micronucleus rate were related to working years. Targeted health management should be carried out for radiation workers in nuclear power plants to improve the awareness of radiation protection and continuously enhance their health status.

Starting from the intrinsic relationship between the glymphatic system and the core pathogenesis of vascular cognitive impairment （VCI）， including internal dampness， phlegm turbidity， and blood stasis， this paper explores clinical approaches to the diagnosis and treatment of VCI. Dysfunction of the kidney's role in governing water leads to the accumulation of dampness， phlegm turbidity， and blood stasis， which are key pathological mechanisms underlying the onset and progression of VCI. The glymphatic system participates in the circulation of cerebrospinal fluid within the central nervous system， and its impairment can result in reduced clearance of soluble metabolic waste products in the brain， a crucial factor contributing to VCI. It is proposed that the "kidney governing water" function is related to the glymphatic system， and that the cerebral collaterals correspond structurally to the glymphatic pathways. Clinically， therapies aimed at tonifying the kidney， resolving phlegm， activating blood circulation， and unblocking collaterals， such as modified Kaixin Powder （开心散）， which eliminates dampness and turbidity， transforms phlegm， restores consciousness， enhances cognition， and strengthens the brain， are commonly employed. These treatments may improve VCI prognosis by regulating glymphatic system function， providing a theoretical basis for the prevention and treatment of VCI with traditional Chinese medicine.

Objective To compare the results obtained from an artificial intelligence (AI)-based chromosome image scanning and processing system, the Metafer 4 chromosome scanning and analysis system, and manual analysis of dicentric chromosomes, and to explore the feasibility of applying AI technology for dicentric chromosome detection and biological dose estimation. Methods Healthy human elbow vein blood was collected and subjected to ⁶⁰Co in vitro irradiation. Chromosome samples were prepared using conventional methods. The slides were scanned and automatically analyzed using the AI-based system and the Metafer 4 system. The results were manually analyzed and confirmed. Results The number of cells was comparable between the AI-based system and the Metafer 4 system. However, the scanning speed of the AI-based system was 4.5 seconds per image, which was significantly faster than the 7.3 seconds per image of the Metafer 4 system (t = −6.19, P < 0.05). At a confidence level of 0.7, the AI-based system demonstrated a true positive rate of 96.7% and a false positive rate of 6.5%, which were significantly better than the true positive rate (45.4%-54.5%) and false positive rate (22.2%-29.2%) of the Metafer 4 system (all P < 0.05). In the biological dose estimation, the deviation of the dose-response curve was ≤ ± 10% in the automatic analysis using the Metafer 4 system. Due to the use of the manual dose-response curve, the deviation of the AI-based System was ≤ ± 15%. However, there were no significant differences in the estimated doses when the two systems were compared with the manual analysis (P > 0.05). Conclusion Both the AI-based chromosome image scanning and processing system and the Metafer 4 chromosome scanning and analysis system greatly improved the analysis speed of chromosome aberrations. However, the scanning speed, true positive rate, and false positive rate of the AI-based system were superior to those of the Metafer 4 system. Therefore, the AI-based system is more suitable for rapid and high-throughput biological dose estimation in large-scale radiation accidents.

Annular pancreas is a rare congenital anomaly that is frequently misdiagnosed due to its nonspecific imaging characteristics. This article presented a case of annular pancreas with duodenal bulb stenosis causing upper gastrointestinal obstruction, which was initially misdiagnosed as ampullary tumor preoperatively and subsequently confirmed by surgical exploration. Through retrospective case analysis and literature review, we aimed to evaluate the potential clinical value of endoscopic retrograde cholangiopancreatography (ERCP) in the management of this condition.

Objective:To assess the real-world triage performance of a dual-marker strategy (DMS) combining copeptin and high-sensitivity cardiac troponin T (hs-cTnT) in patients presenting with chest pain and suspected non-ST-segment elevation myocardial infarction (NSTEMI).Methods:It was conducted a prospective study of 277 consecutive chest pain patients admitted to the Emergency Department of Zhongshan Hospital, Fudan University, between July and August 2023. Admission levels of copeptin and hs-cTnT were measured. The safety, efficacy, and triage efficiency of the DMS (defined as copeptin <10 pmol/L and hs-cTnT <0.014 ng/mL) for excluding NSTEMI were evaluated based on final diagnoses and clinical outcomes.Results:Among 277 patients, 141 (50.9%) had cardiogenic diseases (51 NSTEMI, 37 unstable angina pectoris [UAP], 11 myocardial bridges, and 42 non-coronary artery disease), 29 (10.5%) had non-cardiac conditions, and 107 (38.6%) had low-risk chest pain of unknown etiology. A total of 103 patients (37.2%) were DMS-negative (copeptin and hs-cTnT both below cutoff), including 0 NSTEMI cases, 2 UAP cases, 1 myocardial bridge, 6 non-coronary artery diseases, 4 non-cardiac conditions, and 90 low-risk cases. The DMS demonstrated a negative predictive value (NPV) of 100% for excluding NSTEMI, with no major adverse cardiac events (MACE) observed in DMS-negative patients during 30-day follow-up. Real-world data revealed that only 42.2% of suspected NSTEMI patients received a second troponin test (timing: 1 hour—5.9%, 2 hours—23.9%, ≥3 hours—70.1%). The DMS enabled safe and efficient triage of 37.2% of chest pain patients at 0-hour, outperforming other strategies in applicability and feasibility ( P < 0.05). Conclusions:In real-world clinical practice, the DMS (copeptin combined with hs-cTnT) optimally complements guideline-recommended hs-cTnT algorithms. It provides a simple, rapid, and safe approach to managing acute chest pain, demonstrating superior applicability for improving emergency triage efficiency.

Public health and social measures (PHSMs) are one of the most important measures in the prevention and control of COVID-19 and have also been effective in suppressing the spread of influenza viruses, but their effectiveness has not been fully investigated. This study aimed to review the progress of research on the impact of PHSMs on influenza during the COVID-19 pandemic based on the latest evidence of the effectiveness of various PHSMs in controlling transmission of influenza viruses, to provide scientific evidence for optimizing influenza prevention and control strategies.

Objective To explore the effects of sodium oligomannate combined with high-frequency repetitive transcranial magnetic stimulation on the activity of daily living and intelligence level of patients with Alzheimer's disease.Methods A total of 100 patients with Alzheimer's disease admitted to Henan Provincial Staff Hospital from September 2021 to September 2023 were selected as the research subjects.These patients were divided into an observation group and a control group according to the random number table method,with 50 patients in each group.Patients in the control group were given high-frequency repetitive transcranial magnetic stimulation,and patients in the observation group were given sodium oligomannate combined with high-fre-quency repetitive transcranial magnetic stimulation.Enzyme-linked immunosorbent assay was used to detect the levels of amyloid β-protein(Aβ)142,tumor necrosis factor-a(TNF-a)and interleukin-6(IL-6)in patients of the two groups before and after treatment.Chemiluminescence was used to detect the levels of neurotransmitters in patients of the two groups before and after treatment.The mental symptoms of patients in the two groups before and after treatment were evaluated by the behavioral pathology in Alzheimer's disease rating scale,the intelligence level of patients in the two groups before and after treatment was evaluated by the mini-mental state examination(MMSE)scale and the Montreal cognitive assessment(MoCA)scale,the activity of daily living of patients in the two groups before and after treatment was evaluated by Alzheimer's disease cooperative study-activity of daily living(ADCS-ADL),and the quality of life of patients in the two groups before and after treatment was evaluated by the quality of life-Alzheimer's disease scale.Results Before treatment,the two groups showed no significant difference in the levels of Aβ1-42,TNF-α and IL-6(P＞0.05);after treatment,the levels of Aβ1-42,TNF-α and IL-6 in both groups were lower than those before treatment,and the levels of Aβ1-42,TNF-α and IL-6 in the observation group were lower than those in the control group(P＜0.05).Before treatment,there were no statistically significant differences in the levels of 5-hydroxytryptamine(5-HT),acetylcholine(ACh),γ-aminobutyric acid(GABA),and Alzheimer-associated neuronal thread protein(AD7c-NTP)between the two groups(P＞0.05);after treatment,the levels of 5-HT,ACh,and GABA in the two groups were higher than those before treatment,while the AD7c-NTP level was lower than that before treatment(P＜0.05);after treatment,the levels of 5-HT,ACh,and GABA in the observation group were higher than those in the control group,while the AD7c-NTP level was lower than that in the control group(P＜0.05).Before treatment,there were no significant differe-nces in the scores of paranoid and delusional ideas,hallucinations,behavioral disorders,aggressive behaviors,daily rhythm disorders,emotional disorders,anxiety and fear,and the total scores between the two groups(P＞0.05);after treatment,the scores of paranoid and delusional ideas,hallucinations,behavioral disorders,aggressive behaviors,daily rhythm disorders,emotional disorders,anxiety and fear,and the total scores of patients in the two groups were lower than those before treatment,and the scores of paranoid and delusional ideas,hallucinations,behavioral disorders,aggressive behaviors,daily rhythm disorders,emotional disorders,anxiety and fear,and the total scores of patients in the observation group were lower than those in the control group(P＜0.05).Before treatment,there were no significant differences in MMSE,MoCA and ADCS-ADL scores of patients between the two groups(P＞0.05);after treatment,the MMSE,MoCA and ADCS-ADL scores of patientsin the two groups were higher than those before treatment,and the MMSE,MoCA and ADCS-ADL scores of patientsin the observation group were higher than those in the control group(P＜0.05).Before treatment,there were no significant differences in the scores of physiological function,mental function,behavioral ability and interpersonal relationship,and the total scores of patients between the two groups(P＞0.05).After treatment,the scores of physiological function,mental function,behavioral ability and interpersonal relationship,and the total scores of patients in the two groups were higher than those before treatment,and the scores of physiological function,mental function,behavioral ability and interpersonal relationship,and the total scores of patients in the observation group were higher than those in the control group(P＜0.05).Conclusion Sodium oligomannate combined with high-frequency repetitive transcranial magnetic stimulation can improve the inflammatory state of patients with Alzheimer's disease,regulate neurotransmitter levels,alleviate psychiatric symptoms,enhance the intelligence level and the activity of daily living,and increase the quality of life.

In recent years,enhanced recovery after surgery(ERAS)has been widely used in clinical practice,aiming to optimize perioperative management measures through evidence-based medicine and reduce the physical and mental trauma,stress reactions,and complications of surgical patients through multidisciplinary collaboration.This paper examined the clinical practice of ERAS from the perspective of medical humanities,reviewed its development and characteristics,and first pointed out that the concept of"minimal harm"laid the medical humanities foundation for ERAS.However,the concept of"minimum harm"faced ethical and realistic challenges in practice,such as differentiated cognition between benefits and non-harm,the tension between generalization and personalization,and the gap between rehabilitation continuity and family care.This paper led into the caregiving perspective of social sciences,proposed"optimal care"as a supplement to the medical humanities concept of ERAS,and introduced its connotation and practice.The combination of"minimal harm"and"optimal care"can provide theoretical guidance for medical humanistic care in ERAS and innovate the practical path of medical humanities into clinical practice.