Objective To investigate the microbial disinfection and sterilization effectiveness of an electron linear accelerator on the surface and interior of postal packages, and to design and conduct a penetrating radiation disinfection and sterilization experiment. Methods This experiment selected Bacillus pumilus E601 (ATCC 27142) as the indicator microbial strain for radiation. An experimental model of postal package was subjected to penetrating radiation with different dose gradients using high-energy electron beams generated by an S-band 10 MeV electron linear accelerator. The disinfection and sterilization effectiveness was assessed by culturing and counting B. pumilus after high-energy electron beam radiation treatment. A control group was established to analyze the influence of actual absorbed doses at different gradients on the disinfection and sterilization effectiveness of the electron linear accelerator. Results The actual absorbed doses of high-energy electron-beam radiation required to achieve 1-, 3-, and 6-log reductions of B. pumilus were 1.63, 5.07, and 10.22 kGy, respectively. Complete inactivation was achieved at an absorbed dose of 10.92 kGy, which met the processing requirements specified in the technical standard for ionizing-radiation disinfection. Conclusion The experimental data indicated that the actual absorbed dose for B. pumilus is linearly positively correlated with the log reduction of bacterial colonies killed by electron beam radiation. For disinfection and sterilization requirements in different scenarios, the required actual absorbed dose can be achieved by dynamically adjusting the operating speed of the under-beam transmission system.

Objective:To explore the relationship between serum triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, interleukin-17C (IL-17C), and C-C motif chemokine ligand-26 (CCL-26) with clinical symptoms and suicide ideation in patients with major depressive disorder.Methods:A total of 186 patients with major depressive disorder (major depressive disorder group) admitted to the Heze Third People′s Hospital from January 2021 to December 2024 were prospectively selected, including 66 males and 120 females, aged 19-68 (36.5±11.9) years old. In addition, 93 healthy and mentally healthy volunteers (control group) with matched gender and age were selected, including 38 males and 55 females, aged 19-65 (35.6±9.5) years old. According to the presence of suicidal ideation, patients with major depressive disorder were divided into a suicidal ideation group ( n=80) and a non-suicidal ideation group ( n=106). Serum TG/HDL-C ratio, IL-17C and CCL-26 levels of all participants were measured. Clinical symptoms were assessed using the 17-Item Hamilton Depression Rating Scale (HAMD 17), 14-Item Hamilton Anxiety Rating Scale (HAMA), and Pittsburgh Sleep Quality Index (PSQI). Spearman's rank correlation analysis was performed to evaluate associations between serum markers and clinical scores. Generalized additive models were used to assess nonlinear correlations. Multivariate unconditional logistic regression was conducted to identify independent risk factors for suicidal ideation. A nomogram prediction model was constructed. Model fit was evaluated with the H-L test, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve assessed predictive ability, the C-index evaluated discrimination, calibration curves assessed agreement, and decision curve analysis assessed clinical utility. Results:Compared with the control group, the serum TG/HDL-C ratio, IL-17C level, HAMD 17 score, HAMA score and PSQI score increased in the severe depression group, while CCL-26 level decreased ( P<0.001). Serum TG/HDL-C ratio and IL-17C levels were positively correlated with HAMD 17, HAMA and PSQI scores ( r s=0.74, 0.74, 0.75, 0.78, 0.78, 0.79; all P<0.001), while CCL-26 levels were negatively correlated with these scores ( r s=-0.62, -0.63, -0.65, all P<0.001). There were nonlinear relationships between serum TG/HDL-C ratio, IL-17C, CCL-26 levels and the clinical symptom scores ( P<0.001). Among the 186 major depressive disorder patients, the incidence of suicidal ideation was 43.01% (80/186). History of attempted suicide, increased HAMD 17 score, increased HAMA score, increased PSQI score, elevated TG/HDL-C ratio and elevated IL-17C were independent risk factors for suicidal ideation in patients with severe depression ( OR (95% CI)=10.89 (2.27-52.25), 1.81 (1.19-2.74), 1.23 (1.08-1.40), 1.53 (1.15-2.02), 6.64 (2.71-16.24), 1.46 (1.18-1.81) respectively), elevated CCL-26 were independent protective factor( OR (95% CI)=0.22 (0.11-0.43)). Constructing a column chart prediction model for suicidal ideation in patients with severe depression based on the independent factors affecting suicidal ideation in patients with severe depression mentioned above, the AUC for predicting suicidal ideation in patients with severe depression is 0.93 (95% CI:0.88-0.96), and the C-index is 0.93 (95% CI:0.92-0.93). The decision curve showed that the predicted probability was consistent with the ideal curve, and when the threshold probability was greater than 0.10, the clinical net benefit was greater than 0. Conclusion:Elevated serum TG/HDL-C ratio and IL-17C levels, as well as decreased CCL-26 levels, are associated with depression, anxiety, sleep disorders, and suicidal ideation in patients with severe depression. The column chart prediction model based on serum TG/HDL-C ratio, IL-17C and CCL-26 levels has high predictive value for suicidal ideation.

Objective To explore the influencing factors of immune-associated thyroid dysfunction caused by sintilimab treatment in solid tumors and construct a prediction model.Methods Medical records of patients diagnosed with solid tumors and treated with sintilimab at Peking University People's Hospital(Xizhimen Campus,Tongzhou Campus,Shijiazhuang Campus)from January 2023 to September 2024 were collected to explore the influencing factors that caused immune-related thyroid dysfunction using univariate and multifactorial binary logistic regression analyses and to establish a prediction model.The predictive effect of the model was assessed using the receiver operating characteristic(ROC)curve.Results A total of 120 patients were included,and 33 presented with immune-related thyroid dysfunction.Multifactorial logistic regression analysis revealed that thyroid-stimulating hormone(TSH)[OR=2.470,95%CI=(1.279,4.771)]and treatment cycles[OR=1.298,95%CI=(1.117,1.509)]were independent risk factors for the occurrence of immune-associated thyroid dysfunction,and the difference was statistically significant(P＜0.05).The area under the ROC curve was(0.897±0.043)[95%CI=(0.813,0.981)],the Yoden index was 0.703,and the model prediction accuracy was 86.5%.Conclusion The risk of immune-related thyroid dysfunction caused by sintilimab is high,and TSH and treatment cycle are the influencing factors,and the constructed model has certain predictive value and is of reference significance.

Objective To explore the influencing factors of immune-associated thyroid dysfunction caused by sintilimab treatment in solid tumors and construct a prediction model.Methods Medical records of patients diagnosed with solid tumors and treated with sintilimab at Peking University People's Hospital(Xizhimen Campus,Tongzhou Campus,Shijiazhuang Campus)from January 2023 to September 2024 were collected to explore the influencing factors that caused immune-related thyroid dysfunction using univariate and multifactorial binary logistic regression analyses and to establish a prediction model.The predictive effect of the model was assessed using the receiver operating characteristic(ROC)curve.Results A total of 120 patients were included,and 33 presented with immune-related thyroid dysfunction.Multifactorial logistic regression analysis revealed that thyroid-stimulating hormone(TSH)[OR=2.470,95%CI=(1.279,4.771)]and treatment cycles[OR=1.298,95%CI=(1.117,1.509)]were independent risk factors for the occurrence of immune-associated thyroid dysfunction,and the difference was statistically significant(P＜0.05).The area under the ROC curve was(0.897±0.043)[95%CI=(0.813,0.981)],the Yoden index was 0.703,and the model prediction accuracy was 86.5%.Conclusion The risk of immune-related thyroid dysfunction caused by sintilimab is high,and TSH and treatment cycle are the influencing factors,and the constructed model has certain predictive value and is of reference significance.

Objective:To explore the relationship between serum triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, interleukin-17C (IL-17C), and C-C motif chemokine ligand-26 (CCL-26) with clinical symptoms and suicide ideation in patients with major depressive disorder.Methods:A total of 186 patients with major depressive disorder (major depressive disorder group) admitted to the Heze Third People′s Hospital from January 2021 to December 2024 were prospectively selected, including 66 males and 120 females, aged 19-68 (36.5±11.9) years old. In addition, 93 healthy and mentally healthy volunteers (control group) with matched gender and age were selected, including 38 males and 55 females, aged 19-65 (35.6±9.5) years old. According to the presence of suicidal ideation, patients with major depressive disorder were divided into a suicidal ideation group ( n=80) and a non-suicidal ideation group ( n=106). Serum TG/HDL-C ratio, IL-17C and CCL-26 levels of all participants were measured. Clinical symptoms were assessed using the 17-Item Hamilton Depression Rating Scale (HAMD 17), 14-Item Hamilton Anxiety Rating Scale (HAMA), and Pittsburgh Sleep Quality Index (PSQI). Spearman's rank correlation analysis was performed to evaluate associations between serum markers and clinical scores. Generalized additive models were used to assess nonlinear correlations. Multivariate unconditional logistic regression was conducted to identify independent risk factors for suicidal ideation. A nomogram prediction model was constructed. Model fit was evaluated with the H-L test, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve assessed predictive ability, the C-index evaluated discrimination, calibration curves assessed agreement, and decision curve analysis assessed clinical utility. Results:Compared with the control group, the serum TG/HDL-C ratio, IL-17C level, HAMD 17 score, HAMA score and PSQI score increased in the severe depression group, while CCL-26 level decreased ( P<0.001). Serum TG/HDL-C ratio and IL-17C levels were positively correlated with HAMD 17, HAMA and PSQI scores ( r s=0.74, 0.74, 0.75, 0.78, 0.78, 0.79; all P<0.001), while CCL-26 levels were negatively correlated with these scores ( r s=-0.62, -0.63, -0.65, all P<0.001). There were nonlinear relationships between serum TG/HDL-C ratio, IL-17C, CCL-26 levels and the clinical symptom scores ( P<0.001). Among the 186 major depressive disorder patients, the incidence of suicidal ideation was 43.01% (80/186). History of attempted suicide, increased HAMD 17 score, increased HAMA score, increased PSQI score, elevated TG/HDL-C ratio and elevated IL-17C were independent risk factors for suicidal ideation in patients with severe depression ( OR (95% CI)=10.89 (2.27-52.25), 1.81 (1.19-2.74), 1.23 (1.08-1.40), 1.53 (1.15-2.02), 6.64 (2.71-16.24), 1.46 (1.18-1.81) respectively), elevated CCL-26 were independent protective factor( OR (95% CI)=0.22 (0.11-0.43)). Constructing a column chart prediction model for suicidal ideation in patients with severe depression based on the independent factors affecting suicidal ideation in patients with severe depression mentioned above, the AUC for predicting suicidal ideation in patients with severe depression is 0.93 (95% CI:0.88-0.96), and the C-index is 0.93 (95% CI:0.92-0.93). The decision curve showed that the predicted probability was consistent with the ideal curve, and when the threshold probability was greater than 0.10, the clinical net benefit was greater than 0. Conclusion:Elevated serum TG/HDL-C ratio and IL-17C levels, as well as decreased CCL-26 levels, are associated with depression, anxiety, sleep disorders, and suicidal ideation in patients with severe depression. The column chart prediction model based on serum TG/HDL-C ratio, IL-17C and CCL-26 levels has high predictive value for suicidal ideation.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

AIM:To evaluate the efficacy,safety,and economy of camrelizumab(CAM)combined with platinum-containing chemotherapy(CT)for the first-line treatment of locally advanced/meta-static non-small cell lung cancer(NSCLC).METH-ODS:Chinese and English databases such as Pubmed,the Cochrane Library,China Knowledge Network,Wanfang Data,and other related web-sites were systematically searched.After literature screening,quality assessment,and data extraction of the literature according to the inclusion and ex-clusion criteria,two researchers conducted a rapid health technology assessment(HTA).RESULTS:A total of 7 systematic evaluations/Meta-analyses and 17 economics evaluations were included.In terms of effectiveness,compared to docetaxel che-motherapy,CAM+CT significantly prolonged the overall survival(OS),progression-free survival(PFS),and improved the objective remission rate(ORR)of mutation-negative patients with locally ad-vanced/metastatic NSCLC.Compared with CT and pembrolizumab(PEM),CAM+CT significantly pro-longed the PFS,and improved the ORR of mutation-negative patients with locally advanced/metastatic NSCLC.Subgroup analysis showed that CAM+CT significantly prolonged PFS in patients with PD-L1 ≥1％and PD-L1 ≥ 50％compared with CT.Compared with CT,CAM+CT significantly prolonged the OS and PFS of mutation-negative patients with locally advanced/metastatic squamous NSCLC.Compared with sintilimab(SIN),CAM+CT significantly pro-longed the PFS of mutation-negative patients with locally advanced/metastatic squamous NSCLC.Sub-group analysis showed that CAM+CT significantly prolonged OS in patients with PD-L1＜1％com-pared with CT.In terms of safety,CAM+CT was comparable in terms of the occurrence of all grades of adverse events,but the incidence of grade 3 or higher treatment-related adverse events was significantly increased compared with CT and PEM for mutation-negative locally advanced/meta-static NSCLC patients.CAM+CT was significantly in-creased the occurrence of all grades of adverse events compared with CT,but was comparable in terms of the occurrence of grade 3 or higher treat-ment-related adverse events.In terms of economy,CAM+CT has a cost-effectiveness advantage over CT for patients with mutation-negative advanced/metastatic squamous NSCLC.CAM+CT has a cost-effectiveness advantage over CT and PEM+CT;and CAM+CT does not have a cost-effectiveness ad-vantage over SIN+CT for patients with mutation-negative locally advanced/metastatic non-squa-mous NSCLC.CONCLUSION:CAM+CT has good ef-ficacy and cost-effectiveness for the first-line treat-ment of locally advanced/metastatic NSCLC,and the safety aspect is compared with CT,PEM or slightly worse.

Objective:To explore the value of high frequency ultrasound elastography in the differential diagnosis of Hashimoto’s thyroiditis (HT) with thyroid nodules.Methods:112 HT patients complicated with thyroid nodule disease in Department of Ultrasound in Yantai Yantaishan Hospital from Jan. 2017 to Jan. 2020 were randomly selected for prospective study. All patients were diagnosed by routine ultrasound and high-frequency ultrasound elastography, and underwent surgical exploration and pathological diagnosis. Taking the postoperative pathological results as the gold standard, the specificity, sensitivity, negative-positive predictive value of conventional ultrasound and high-frequency ultrasound elastography in HT complicated with thyroid nodular disease were compared and analyzed, and the diagnostic efficacy was evaluated.Results:There were 138 nodules in 112 cases, including 47 benign nodules and 91 malignant nodules. The specificity and sensitivity of routine ultrasonography were 80.85% and 78.02%, respectively; The specificity and sensitivity of high frequency ultrasound elastography were 87.23% and 90.11%. Compared with conventional ultrasound, high frequency ultrasound elastography had higher specificity and sensitivity in detecting lesions ( χ2=4.54, 4.25, P=0.026, 0.039) . The negative predictive value of routine ultrasonography was 65.52%, the positive predictive value was 88.75%, and the ROC was 0.775. The best diagnostic cut-off point was 3.04. The negative predictive value of high frequency ultrasound elastography was 82.00%, the positive predictive value was 93.18%, the ROC was 0.812, and the best diagnostic cut-off point was 32.89 kpa. Compared with conventional ultrasound, high frequency ultrasound elastography had higher negative and positive predictive values ( χ2=4.35, 4.48, P=0.031, 0.027) . Conclusion:High frequency ultrasound elastography can improve the negative predictive value and sensitivity in the diagnosis of Hashimoto’s thyroiditis and thyroid cancer, judge the benign and malignant lesions, and provide more accurate data for early surgical treatment.

Objective:To analyze the change trend of survival rate after hip fragility fracture in Tianjin Hospital from 2015 to 2021, and the influence of gender, marital status, age and number of complications on survival rate.Methods:From January 1, 2015 to December 31, 2021, a total of 12,570 patients with fragility fracture of hip were retrieved, including 3,934 males and 8,636 females. The age at admission was 74.11±9.50 years and 74.62±8.99 years respectively. By comparing the ID number with the Tianjin population information database, 2,054 cases died, including 804 males and 1,250 females, aged 81.34±7.88 years and 81.92±7.42 years respectively at the time of death. Acquire the patient's survival status, calculate the cumulative survival rate at 3 month intervals, study the change rule of the cumulative survival rate over time, and use Kaplan-Meier method to calculate the cumulative survival rate of the whole population and the impact of gender, marital status, age, and number of complications on the survival rate.Results:The median survival time of all the dead people after fracture was 13(3, 31) months, including 11(2, 27) months for males and 15(4, 32) months for females. Joinpoint regression showed that 9 months after the hip fragility fracture was the break point of the survival rate. The mortality rate changed significantly within 9 months after fracture (the annual change rate was 47%), and slowed down 9 months later (the annual change rate was 1%). There was a statistically significant difference in trend detection before and after the break point ( P<0.05). The age at admission was 80.11±7.71 years for the dead and 73.36±9.01 years for the non dead, with a statistically significant difference ( t=31.80, P<0.001). After normalization, the number of complications was 0.20±0.93 among the dead and 0.00±0.87 among the non dead, with a statistically significant difference ( t=88.81, P<0.001). The survival rate of men after hip fracture is lower than that of women, the number of people without spouse is lower than that of people with spouse, the number of people with more than 70 years old is lower than that of people with less than 70 years old, and the number of complications ≥2 people is lower than that of people with less than 1 complication, all of which are statistically significant ( P<0.05). Conclusion:The survival rate within 9 months after the occurrence of hip fragility fracture decreased significantly, and it needs to be tracked and managed for at least 9 months to effectively reduce the risk of death; Male, no spouse, age>70 years old, number of complications ≥2 will increase the risk of death after hip fragility fracture, leading to reduced survival rate of patients.

Objective To investigate the application of diffusion tensor imaging (DTI) in evaluating prognosis of patients with moderate and severe diffuse axonal injury (DAI).Methods A prospective cohort study was made on 35 patients with moderate and severe DAI,who were enrolled from June 2013 to December 2015 as study group.There were 21 males and 14 females,with age of (55.1 ± 11.6) years.The Glasgow coma scale (GCS) was (8.2 ± 2.9)points on admission.Moderate DAI was seen in 20 patients and severe DAI in 15 patients.Other 15 healthy volunteers were selected as control group.Fractional anisotropy (FA) was measured by DTI in three areas of interests as follows:the corpus callosum,thalamus,and brainstem areas.Glasgow outcome scale (GOS) was adopted to assess the prognosis of DAI patients at 6 months after the injury.The FA values of the three areas between study group and control group as well as FA values of patients when they were admitted to hospital and 6 months after injury were measured.In this way,the relationship between the FA values of different areas of interests in DAI patients on admission and the prognosis 6 months after injury was analyzed.Results The FA values of the corpus callosum,thalamus and brainstem area in study group were all lower than those in control group (P ＜ 0.05).Further,FA values of the corpus callosum,thalamus,brainstem area in severe DAI patients were lower than those of moderate DAI patients (P ＜ 0.05).FA values of the corpus callosum,thalamus,brain stem areas in DAI patients at 6 months after injury were lower than those of corresponding areas when DAI patients were admitted to hospital (P ＜ 0.05).FA values of the corpus callosum,thalamus and brain stem on admission were significantly positively correlated with GOS at 6 months after injury (P ＜ O.05).Conclusions Lower FA values of the corpus callosum,thalamus and brainstem area in patients with moderate and severe DAI are associated with more severe injury and worse prognosis.DTI scans can be used as a valuable tool to evaluate the prognosis of DAI patients.