1.Endovascular Treatment for Acute Posterior Circulation Tandem Lesions: Insights From the BASILAR and PERSIST Registries
Wei LI ; Mohamed F. DOHEIM ; Zhongming QIU ; Tan WANG ; Zhibin CHEN ; Wenjie ZI ; Qingwu YANG ; Haitao GUAN ; Hongyu QIAO ; Wenhua LIU ; Wei HU ; Xinfeng LIU ; Jinbo HUANG ; Zhongkui HAN ; Zhonglun CHEN ; Zhenqiang ZHAO ; Wen SUN ; Raul G. NOGUEIRA
Journal of Stroke 2025;27(1):75-84
Background:
and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT.
Methods:
Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery.
Results:
A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24).
Conclusion
Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.
2.Endovascular Treatment for Acute Posterior Circulation Tandem Lesions: Insights From the BASILAR and PERSIST Registries
Wei LI ; Mohamed F. DOHEIM ; Zhongming QIU ; Tan WANG ; Zhibin CHEN ; Wenjie ZI ; Qingwu YANG ; Haitao GUAN ; Hongyu QIAO ; Wenhua LIU ; Wei HU ; Xinfeng LIU ; Jinbo HUANG ; Zhongkui HAN ; Zhonglun CHEN ; Zhenqiang ZHAO ; Wen SUN ; Raul G. NOGUEIRA
Journal of Stroke 2025;27(1):75-84
Background:
and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT.
Methods:
Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery.
Results:
A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24).
Conclusion
Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.
3.Endovascular Treatment for Acute Posterior Circulation Tandem Lesions: Insights From the BASILAR and PERSIST Registries
Wei LI ; Mohamed F. DOHEIM ; Zhongming QIU ; Tan WANG ; Zhibin CHEN ; Wenjie ZI ; Qingwu YANG ; Haitao GUAN ; Hongyu QIAO ; Wenhua LIU ; Wei HU ; Xinfeng LIU ; Jinbo HUANG ; Zhongkui HAN ; Zhonglun CHEN ; Zhenqiang ZHAO ; Wen SUN ; Raul G. NOGUEIRA
Journal of Stroke 2025;27(1):75-84
Background:
and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT.
Methods:
Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery.
Results:
A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24).
Conclusion
Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.
4.Survey of awareness of influenza and influenza vaccine, influenza incidence, influenza vaccination status, related factors in primary and secondary school teachers in a district of Beijing
Xiaokun YANG ; Wenzeng ZHANG ; Fanglei ZHANG ; Songqi FENG ; Tian QIU ; Hui WU ; Zhibin PENG ; Yingxin PEI ; Lijie ZHANG ; Kaiju LIAO ; Huilai MA
Chinese Journal of Epidemiology 2025;46(5):826-832
Objective:To understand the awareness of influenza and influenza vaccine, influenza incidence, influenza vaccination status and intention and related factors in primary and secondary school teachers.Methods:Cross-sectional study design and stratified random sampling method were used to select 5 teachers from each of 51 primary schools and 40 middle schools in a district of Beijing from April 17 to 21, 2024. A questionnaire survey was conducted in the selected teachers with an estimated sample size of 1 040. The survey collected the information about their demographic characteristics, awareness of influenza and influenza vaccine, influenza incidence, influenza vaccination status and intention. Multivariate logistic regression model was used to analyze the factors related to influenza vaccination status and intention.Results:In the 975 primary and secondary school teachers, the awareness of susceptibility and severity of influenza and the benefits of influenza vaccination were high. In terms of safety of influenza vaccine, 48.00% (468/975) of the teachers believed that adverse reaction would occur after the vaccination. Influenza like illness occurred in 41.13% (401/975) of the teachers during 2023-2024, and in these teachers, 40.15% (161/401) asked for leave from work due to illness, 40.90% (164/401) sought medical care and 32.93% (54/164) were influenza virus positive. In the 975 teachers, 13.95% (136/975) were vaccinated against influenza during 2023-2024 and 34.46% (336/975) were willing to be vaccinated against influenza during 2024-2025. Multivariate logistic regression analysis showed that being teacher in charge of a class (a OR=1.58, 95% CI: 1.06-2.35), believing that influenza vaccination could effectively prevent influenza (a OR=1.99, 95% CI: 1.05-3.80), believing that teachers' vaccination could improve students' willingness to be vaccinated (a OR=1.98, 95% CI: 1.12-3.50) were the positive factors for teachers' vaccination, and worrying about adverse reactions after the vaccination (a OR=0.52, 95% CI: 0.34-0.80) was the negative factor. Doctors' recommendation (a OR=2.62, 95% CI: 1.41-4.86) and free influenza vaccination (a OR=10.26, 95% CI: 5.17-20.39) were positively correlated with teachers' intention to influenza vaccination. Conclusions:Primary and secondary school teachers in a district of Beijing had high awareness of influenza and influenza vaccine, but their awareness of influenza vaccine safety should be improved. The incidence of influenza-related infection was high in the primary and secondary school teachers. The influenza vaccination rate was low and the willingness to receive influenza vaccination in following year was not strong. For the better prevention and control of influenza in schools, it is necessary to strengthen the health education in primary and secondary school teachers to improve their awareness of influenza vaccine safety and vaccination rate.
5.Effect of intraoperative optimization of regional cerebral oxygen saturation intervention on postoperative delirium in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass
Shuhui HOU ; Wei ZHONG ; Lin QIU ; Bo ZHAO ; Taibing FAN ; Junhui ZHOU ; Yibao ZHANG ; Hongqi LIN ; Zhibin LANG
Chinese Journal of Anesthesiology 2025;45(4):410-414
Objective:To evaluate the effect of intraoperative optimization of regional cerebral oxygen saturation(rSO 2C) intervention on postoperative delirium(POD) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass(CPB). Methods:Two hundred and seventy-three pediatric patients of both sexes, aged 28 days-6 yr, with American Society of Anesthesiologists Physical Status classification ≤Ⅳ, scheduled for elective cardiac surgery under CPB, were divided into intervention group( n=136) and control group( n=137) based on the computer random coding. In intervention group, optimized intervention measures were given when rSO 2C was below 75% of the baseline value for more than 1 min. In control group, rSO 2C was not monitored during operation, and intraoperative management was performed according to the routine monitoring indicators of pediatric cardiac surgery under CPB. The occurrence of POD within 7 days after operation was evaluated, and the duration and first occurrence time of POD were recorded. Results:Compared with control group, no significant change was found in the incidence of POD( P>0.05), the first occurrence time of POD was significantly prolonged, and the duration of POD was shortened in intervention group( P<0.05). Conclusions:Intraoperative optimization of rSO 2C intervention can delay the time to the first occurrence of POD and shorten the duration in pediatric patients undergoing cardiac surgery under CPB.
6.Survey of awareness of influenza and influenza vaccine, influenza incidence, influenza vaccination status, related factors in primary and secondary school teachers in a district of Beijing
Xiaokun YANG ; Wenzeng ZHANG ; Fanglei ZHANG ; Songqi FENG ; Tian QIU ; Hui WU ; Zhibin PENG ; Yingxin PEI ; Lijie ZHANG ; Kaiju LIAO ; Huilai MA
Chinese Journal of Epidemiology 2025;46(5):826-832
Objective:To understand the awareness of influenza and influenza vaccine, influenza incidence, influenza vaccination status and intention and related factors in primary and secondary school teachers.Methods:Cross-sectional study design and stratified random sampling method were used to select 5 teachers from each of 51 primary schools and 40 middle schools in a district of Beijing from April 17 to 21, 2024. A questionnaire survey was conducted in the selected teachers with an estimated sample size of 1 040. The survey collected the information about their demographic characteristics, awareness of influenza and influenza vaccine, influenza incidence, influenza vaccination status and intention. Multivariate logistic regression model was used to analyze the factors related to influenza vaccination status and intention.Results:In the 975 primary and secondary school teachers, the awareness of susceptibility and severity of influenza and the benefits of influenza vaccination were high. In terms of safety of influenza vaccine, 48.00% (468/975) of the teachers believed that adverse reaction would occur after the vaccination. Influenza like illness occurred in 41.13% (401/975) of the teachers during 2023-2024, and in these teachers, 40.15% (161/401) asked for leave from work due to illness, 40.90% (164/401) sought medical care and 32.93% (54/164) were influenza virus positive. In the 975 teachers, 13.95% (136/975) were vaccinated against influenza during 2023-2024 and 34.46% (336/975) were willing to be vaccinated against influenza during 2024-2025. Multivariate logistic regression analysis showed that being teacher in charge of a class (a OR=1.58, 95% CI: 1.06-2.35), believing that influenza vaccination could effectively prevent influenza (a OR=1.99, 95% CI: 1.05-3.80), believing that teachers' vaccination could improve students' willingness to be vaccinated (a OR=1.98, 95% CI: 1.12-3.50) were the positive factors for teachers' vaccination, and worrying about adverse reactions after the vaccination (a OR=0.52, 95% CI: 0.34-0.80) was the negative factor. Doctors' recommendation (a OR=2.62, 95% CI: 1.41-4.86) and free influenza vaccination (a OR=10.26, 95% CI: 5.17-20.39) were positively correlated with teachers' intention to influenza vaccination. Conclusions:Primary and secondary school teachers in a district of Beijing had high awareness of influenza and influenza vaccine, but their awareness of influenza vaccine safety should be improved. The incidence of influenza-related infection was high in the primary and secondary school teachers. The influenza vaccination rate was low and the willingness to receive influenza vaccination in following year was not strong. For the better prevention and control of influenza in schools, it is necessary to strengthen the health education in primary and secondary school teachers to improve their awareness of influenza vaccine safety and vaccination rate.
7.Effect of intraoperative optimization of regional cerebral oxygen saturation intervention on postoperative delirium in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass
Shuhui HOU ; Wei ZHONG ; Lin QIU ; Bo ZHAO ; Taibing FAN ; Junhui ZHOU ; Yibao ZHANG ; Hongqi LIN ; Zhibin LANG
Chinese Journal of Anesthesiology 2025;45(4):410-414
Objective:To evaluate the effect of intraoperative optimization of regional cerebral oxygen saturation(rSO 2C) intervention on postoperative delirium(POD) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass(CPB). Methods:Two hundred and seventy-three pediatric patients of both sexes, aged 28 days-6 yr, with American Society of Anesthesiologists Physical Status classification ≤Ⅳ, scheduled for elective cardiac surgery under CPB, were divided into intervention group( n=136) and control group( n=137) based on the computer random coding. In intervention group, optimized intervention measures were given when rSO 2C was below 75% of the baseline value for more than 1 min. In control group, rSO 2C was not monitored during operation, and intraoperative management was performed according to the routine monitoring indicators of pediatric cardiac surgery under CPB. The occurrence of POD within 7 days after operation was evaluated, and the duration and first occurrence time of POD were recorded. Results:Compared with control group, no significant change was found in the incidence of POD( P>0.05), the first occurrence time of POD was significantly prolonged, and the duration of POD was shortened in intervention group( P<0.05). Conclusions:Intraoperative optimization of rSO 2C intervention can delay the time to the first occurrence of POD and shorten the duration in pediatric patients undergoing cardiac surgery under CPB.
8.Expression of long non-coding RNA TCF7 and LSINCT5 in non-small cell lung cancer tissues and the relationship with prognosis
Qi QIU ; Jun LIU ; Zhibin XIE ; Kelan DENG ; Mengmeng WANG
Journal of International Oncology 2024;51(11):684-689
Objective:To investigate the expression levels of long non-coding RNA (lncRNA) TCF7 and LSINCT5 in non-small cell lung cancer (NSCLC) tissues and the relationship with clinical pathological characteristics and prognosis of patients.Methods:NSCLC tissues and para-carcinoma tissues specimens of 108 NSCLC patients who underwent single-port thoracoscopic radical resection at Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from June 2020 to October 2021 were collected. Real-time fluorescence quantitative PCR was applied to detect the expression of lncRNA TCF7 and LSINCT5 in NSCLC tissues and para-carcinoma tissues. The relationship between the expression of both and the clinical and pathological characteristics of patients was analyzed. Pearson correlation analysis was used to explore the correlation between the expression of lncRNA TCF7 and LSINCT5 in NSCLC tissues. Kaplan-Meier method was used for survival analysis. Cox proportional hazard regression model was applied to analyze the influencing factors of prognosis of NSCLC patients.Results:The relative expression of lncRNA TCF7 in NSCLC tissues was 1.62±0.53, which was significantly higher than that in para-carcinoma tissues (1.08±0.34, t=8.91, P<0.001). The relative expression of lncRNA LSINCT5 in NSCLC tissues was 1.54±0.48, which was significantly higher than that in para-carcinoma tissues (1.07±0.33, t=8.39, P<0.001). Pearson correlation analysis showed that the expression of lncRNA TCF7 and LSINCT5 in NSCLC tissues was positively correlated ( r=0.41, P<0.001). There were statistically significant differences in the expression of lncRNA TCF7 and LSINCT5 in NSCLC tissues among patients with different TNM stages ( χ2=6.28, P=0.012; χ2=5.40, P=0.020) and histological grades ( χ2=6.31, P=0.012; χ2=7.23, P=0.007). The 2-year survival rate of NSCLC patients with high expression of lncRNA TCF7 ( n=54) was 48.15%, which was significantly lower than that of patients with low expression ( n=54) (72.22%, χ2=6.53, P=0.011). The 2-year survival rate of NSCLC patients with high expression of lncRNA LSINCT5 ( n=55) was 47.23%, which was significantly lower than that of patients with low expression ( n=53) (73.58%, χ2=7.80, P=0.005). Univariate analysis showed that lymph node metastasis ( HR=1.55, 95% CI: 1.11-2.17, P=0.011), TNM stage Ⅲ ( HR=2.15, 95% CI: 1.32-3.48, P=0.002), poorly differentiated histologically grade ( HR=1.39, 95% CI: 1.11-1.73, P=0.004), positive lymph node status ( HR=1.75, 95% CI: 1.37-2.23, P<0.001), maximum diameter of tumor >2 cm ( HR=1.93, 95% CI: 1.09-3.43, P=0.024), high expression of lncRNA TCF7 (≥1.62) ( HR=1.77, 95% CI: 1.41-2.21, P<0.001), high expression of lncRNA LSINCT5 (≥1.54) ( HR=1.54, 95% CI: 1.21-1.97, P<0.001) were associated with prognosis of NSCLC patients who underwent single-port thoracoscopic radical resection. Multivariate analysis showed that TNM stage Ⅲ ( HR=1.25, 95% CI: 1.03-1.53, P=0.026), poor differentiated histologically grade ( HR=1.63, 95% CI: 1.07-2.48, P=0.023), high expression of lncRNA TCF7 ( HR=1.29, 95% CI: 1.03-1.62, P=0.025), high expression of lncRNA LSINCT5 ( HR=1.48, 95% CI: 1.14-1.93, P=0.004) were independent risk factors for prognosis of NSCLC patients. Conclusion:The expressions of lncRNA TCF7 and LSINCT5 are up-regulated in NSCLC tissues, and their expressions are positively correlated. Patients with high expression of lncRNA TCF7 and LSINCT5, patients in TNM stage Ⅲ, and patients with poorly differentiated histologically grade have a high risk of poor prognosis.
9.Evaluation of current status in implementation of WS 582-2017 Specifications for testing of quality control in X and γ ray stereotactic radiotherapy system
Wei CHEN ; Jinxin JU ; Zhibin ZHANG ; Qiao MA ; Xingjiang CAO ; Xiangyong FAN ; Xindi WEI ; Zihao ZHANG ; Lanlan TIAN ; Tianyuan QIU ; Jin WANG
Chinese Journal of Radiological Medicine and Protection 2024;44(12):1043-1048
Objective:To investigate WS 582-2017 Specifications for testing of quality control in X and γ ray stereotactic radiotherapy system (hereinafter referred to as WS 582-2017) with respect to its current status, existing problems and evaluation since its implementation in Beijing, Chongqing, Jiangsu and Sichuan. Methods:The evaluation of this standard was carried out by means of field survey, questionnaire survey and expert seminar. In accordance with the WS 582-2017 implementation assessment programme, a total of 153 professionals involved in the implementation of WS 582-2017 from 80 radiological health technical service institutions, health supervision institutions and medical institutions of two municipalities and two provinces were surveyed in 2023. The investigation was carried out by using a combination of cluster sampling and stratified sampling and through sampling professionals with of different institution characteristics and different technical titles. The general survey method was used for Jiangsu province, while the cluster sampling method was used for others, with 153 individulas from 80 institutions being sampled for the investigation.Results:The awareness rate of WS 582-2017 was 80.39%, of which 90.85% considered it to be scientific and rigorous, 81.05% considered it to be operational and 97.39% considered it to be in consistency with the relevant regulatory standards, 90.20% considerd it to have played an important role in promoting radiological protection optimization for radiotherapy, 90.85% considered the implementation of it to have played a significant role in the quality control of standarded testing of radiotherapy equipment, and 86.93% considered the implementation of it to have played a significant role in enhancing the professional competence of relevant technicians.Conclusions:The overall implementation of WS 582-2017 in two municipalities and two provinces is good, with scientific and operable technical contents and the remarkable effect achieved in its implementation. However, the WS 582-2017 needs to be further improved in some areas, and training on the standard needs to be strengthened to improve the awareness rate of it.
10.Evaluation of current status in implementation of WS 582-2017 Specifications for testing of quality control in X and γ ray stereotactic radiotherapy system
Wei CHEN ; Jinxin JU ; Zhibin ZHANG ; Qiao MA ; Xingjiang CAO ; Xiangyong FAN ; Xindi WEI ; Zihao ZHANG ; Lanlan TIAN ; Tianyuan QIU ; Jin WANG
Chinese Journal of Radiological Medicine and Protection 2024;44(12):1043-1048
Objective:To investigate WS 582-2017 Specifications for testing of quality control in X and γ ray stereotactic radiotherapy system (hereinafter referred to as WS 582-2017) with respect to its current status, existing problems and evaluation since its implementation in Beijing, Chongqing, Jiangsu and Sichuan. Methods:The evaluation of this standard was carried out by means of field survey, questionnaire survey and expert seminar. In accordance with the WS 582-2017 implementation assessment programme, a total of 153 professionals involved in the implementation of WS 582-2017 from 80 radiological health technical service institutions, health supervision institutions and medical institutions of two municipalities and two provinces were surveyed in 2023. The investigation was carried out by using a combination of cluster sampling and stratified sampling and through sampling professionals with of different institution characteristics and different technical titles. The general survey method was used for Jiangsu province, while the cluster sampling method was used for others, with 153 individulas from 80 institutions being sampled for the investigation.Results:The awareness rate of WS 582-2017 was 80.39%, of which 90.85% considered it to be scientific and rigorous, 81.05% considered it to be operational and 97.39% considered it to be in consistency with the relevant regulatory standards, 90.20% considerd it to have played an important role in promoting radiological protection optimization for radiotherapy, 90.85% considered the implementation of it to have played a significant role in the quality control of standarded testing of radiotherapy equipment, and 86.93% considered the implementation of it to have played a significant role in enhancing the professional competence of relevant technicians.Conclusions:The overall implementation of WS 582-2017 in two municipalities and two provinces is good, with scientific and operable technical contents and the remarkable effect achieved in its implementation. However, the WS 582-2017 needs to be further improved in some areas, and training on the standard needs to be strengthened to improve the awareness rate of it.

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