Objective To analyze a case of violations by an occupational medical examination (OME) institution and to explore the key control points for the supervision and management of OME institutions, as well as the core role of quality assessment in this context. Methods An OME institution suspected of illegal activities was used as the study subject. Retrospective analysis was conducted. Clues of suspected violations were identified by an on-site quality assessment. After investigation and verification by the local health authorities, legal action was taken against the institution for its violations. Results During an on-site quality assessment, the Guangdong Province OME quality control expert group discovered that the OME institution violated regulations, including unqualified personnel file, exceeding the scope of services category, issuing false reports, failing to report suspected occupational diseases on time, and failing to notify workers about suspected occupational diseases as required. The evidence was then submitted to the Guangdong Province OME Quality Control Center, which subsequently forwarded the case to local health administration department for filing and investigation. After the investigation, penalties were imposed on the OME institution for its illegal activities. Conclusion The key supervision and inspection points in the quality assessment of OME institutions include personnel file configuration, the quality control management system and its implementation, the quality of OME reports, and information reporting. Quality assessment plays a pivotal role in ensuring the legal and compliant practice of OME institutions, safeguarding the health rights and interests of workers, and enhancing the overall standard of the OME industry.

Objective To understand the instrument distribution and capacities of inter-laboratory comparisons among occupational medical examination (OME) institutions in Guangdong Province. Methods A total of 291 OME institutions in Guangdong Province that were within the validity period of filing in June 2024 and 101 OME institutions that participated in inter-laboratory comparisons in 2023 were selected as the study subjects. Their filing categories, instrument distribution and external quality assessment in laboratories were collected and analyzed. Results The location of 291 OME institutions distributed in 21 prefectural-level cities in the province, mainly in the Pearl River Delta (PRD) region, accounting for 68.4% of the total. The public hospitals, private medical institutions, the center for disease control and prevention and occupational disease prevention and treatment institutions (hereinafter referred to as "occupational prevention institutions") accounted for 61.2%, 28.5% and 10.3%, respectively. The filing rates for physical factors, chemical factors, and dust categories among OME institutions were 91.1%, 86.9%, and 86.6%, respectively. The average number of institutional instruments, from high to low, was 53.8, 38.8 and 38.2 per unit in occupational prevention institutions, private medical institutions and public hospitals, respectively. The passing rates of inter-laboratory comparisons among OME institutions of external quality assessment in laboratories among OME institutes in Guangdong Province, from high to low were occupational prevention institutions, public hospitals and private medical institutions (96.2% vs 86.8% vs 73.0%, P<0.05). Conclusion The regional distribution of OME institutes in Guangdong Province is unbalanced, mainly concentrated in the PRD region. Low overall level of OME capacity is found in public hospitals and private medical institutions. Leading by the occupational prevention institutions, public hospitals and private medical institutions should strengthen the development and investment in OME hardware, in order to improve the OME level.

Objective To analyze the abnormality of radiation damage sensitive indices in radiation workers after operation of a third-generation nuclear power plant in Guangdong Province, China, and to provide a basis for promoting the occupational health management of radiation workers. Methods A two-way cohort study (2019—2021) was conducted to compare the radiation sensitive indices of occupational health examination in the exposed group (453 subjects) and the control group (160 subjects). Results In 2021, the free triiodothyronine (FT3) level of the exposed group was significantly higher than that of the control group [(5.57 ± 0.56) pmol/L vs (5.42 ± 0.60) pmol/L, t = 0.59, P < 0.05]. From 2019 to 2021, the exposed group showed significant changes in the average levels of platelet, hemoglobin, FT3, free thyroxine (FT4), and thyroid-stimulating hormone (P < 0.05); FT3 and FT4 first increased and then decreased, while TSH decreased continuously. Conclusion Long-term exposure to low-dose ionizing radiation from nuclear power plants can affect the platelet, hemoglobin, FT3, FT4, and thyroid-stimulating hormone of radiation workers, and the effect is relatively prominent on thyroid function by causing a tendency to hypothyroidism.

Objective To investigate the clinical characteristics,diagnosis and treatment strategies of breast neuroendocrine carcinoma.Methods 20 cases with breast neuroendocrine carcinoma,who were admitted in Department of Breast Surgery,the Second Affiliated Hospital of Dalian Medical University from Mar.2005 to Dec.2017,were analyzed retrospectively.Results The average age of the 20 patients was(54.35±13.35) years.In aspect of surgery,18 patients received modified radical mastectomy,1 patient received total glandectomy and sentinel lymph node biopsy and stage I silicone implant breast reconstruction,and 1 patient received radical mastec tomy.In terms of pathological types,there were 5 cases (25.0％) of highly differentiated neuroendocrine carcinoma,4 cases (20.0％) of poorly differentiated neuroendocrine carcinoma (small cell carcinoma),and 11 cases (55.0％)of invasive breast cancer with neuroendocrine differentiation.In molecular typing,there were 7 cases (35.0％) of Luminal A,7 cases (35.0％) of Luminal B (HER2 negative),4 cases (20.0％) of Luminal B (HER2 positive),and one case(5.0％) of HER2 type and one case(5.0％) of Basal-like type.The positive rates of ER,PR and HER2 in this group were 90.0％,60.0％ and 25.0％ respectively.20 patients were followed up for 5 to 119 months,with an average follow-up of (59.85±24.51) months.One patient developed bone metastases in the 6th year after surgery and survived for 119 months.One patient developed pulmonary metastasis at the 20th month after surgery and died at the 28th month after surgery.So far,the remaining postoperative patients still survived and no sign of recurrence or metastasis was found.Conclusion The diagnosis of breast neuroendocrine carcinoma relies on histopathological and immunohistochemical detection.Its ER/PR positive rate is high,its molecular typing is mostly Luminal type,and neoadjuvant treatment can be performed when necessary.For specific patients whose ER or PR are positive,neoadjuvant endocrine therapy is also a well-established therapy,even the optimal results can be achieved.However,more cases are still needed for research.

Objective To evaluate the therapeutic efficacy and adverse reactions of raltitrexed plus oxaliplatin (RALOX project) and S1 in patients with advanced primary liver cancer.Methods Seventy-one patients with advanced primary liver cancer admitted to 6 cancer centers from July 2013 to July 2015 were divided into 2 groups according to the wishes of the patients and their families:RALOX group (34 patients) and S1 group (37 patients).The therapeutic efficacy such as objective remission rate (ORR),disease control rate (DCR),median overall survival (mOS),median progression free survival (mPFS),one year survival rate (SR),and adverse reactions in these patients were evaluated.Results Thirty-one patients could be evaluated in RALOX group,and 6 patients obtained partial response (PR),10 stable disease (SD) and 15 progressive disease (PD).Thirty-three patients could be evaluated in S1 group,and 3 patients obtained PR,8 patients SD and 22 PD.The ORR,DCR,and one year SR were 19.4％ vs.9.1％,51.6％ vs.33.3％,and 22.6％ vs.12.1％ respectively,and there were no statistically significant differences in the two groups (x2 =1.393,P =0.238;x2 =2.190,P =0.139;x2 =1.229,P =0.268).The mOS and mPFS were 7.2 months vs.6.1 months and 3.4 months vs.2.8 months,and there were statistically significant differences in the two groups (x2 =6.433,P =0.011;x2 =4.078,P =0.043).There was more serious peripheral nerve toxicity (29.0％ vs.3.0％,x2 =6.344,P =0.012) and lighter hand-foot syndrome (9.7％ vs.30.3％,x2 =4.201,P =0.040) in RALOX group than S1 group.But the incidences of other adverse effects were similar in the two groups.Condnsion RALOX project is safe and effective to the patients with advanced primary liver cancer.Compare with S1 project,RALOX project has better curative effects and the majority of adverse reactions are tolerable.The patients have good condition control and survival benefit.

Objective To explore the clinical efficacy and drug-toxic reactions of raltitrexed combined with oxaliplatin (RALOX protocol) and 5-fluorouracil + calciumfolinate + oxaliplatin (FOLFOX 4 protocol) in the treatment of patients with middle and advanced primary liver cancer (PLC).Methods A total of 72 patients with PLC were selected and randomly divided into RALOX group (n =34) and FOLFOX 4 group (n =38).The objective response rate (RR) was evaluated every 6 weeks after chemotherapy,while objective remission rate (OR),disease-control rate (DCR),median survival rate (mOS),median progression-free survival (mPFS),1-year survival rate (SR) as well as toxic and adverse reactions were observed.Results In RALOX group,31 patients were evaluable,with OR,DCR,mOS,mPFS,and 1-year SR being 19.4％,51.6％,7.2 months,3.4 months,and 22.6％,respectively.In FOLFOX 4 group,29 patients were evaluable,with OR,DCR,mOS,mPFS,and 1-year SR being 13.8％,48.3％,6.9 months,3.3 months and 20.7％,respectively.RALOX group was significantly lower than FOLFOX 4 group in the incidence rates of gastrointestinal reactions,liver toxicity,cardiac toxicity,peripheral nervous toxicity and hand-foot syndrome,but there were no significant differences in the incidence rates of renal toxicity and myelosuppression between two groups.Conclusion RALOX is safe and effective in the treatment of patients with middle and advanced PLC,and is superior to FOLFOX 4 protocol in clinical efficacy with mild adverse reactions.

Objective To explore the clinical efficacy and drug-toxic reactions of raltitrexed combined with oxaliplatin (RALOX protocol) and 5-fluorouracil + calciumfolinate + oxaliplatin (FOLFOX 4 protocol) in the treatment of patients with middle and advanced primary liver cancer (PLC).Methods A total of 72 patients with PLC were selected and randomly divided into RALOX group (n =34) and FOLFOX 4 group (n =38).The objective response rate (RR) was evaluated every 6 weeks after chemotherapy,while objective remission rate (OR),disease-control rate (DCR),median survival rate (mOS),median progression-free survival (mPFS),1-year survival rate (SR) as well as toxic and adverse reactions were observed.Results In RALOX group,31 patients were evaluable,with OR,DCR,mOS,mPFS,and 1-year SR being 19.4％,51.6％,7.2 months,3.4 months,and 22.6％,respectively.In FOLFOX 4 group,29 patients were evaluable,with OR,DCR,mOS,mPFS,and 1-year SR being 13.8％,48.3％,6.9 months,3.3 months and 20.7％,respectively.RALOX group was significantly lower than FOLFOX 4 group in the incidence rates of gastrointestinal reactions,liver toxicity,cardiac toxicity,peripheral nervous toxicity and hand-foot syndrome,but there were no significant differences in the incidence rates of renal toxicity and myelosuppression between two groups.Conclusion RALOX is safe and effective in the treatment of patients with middle and advanced PLC,and is superior to FOLFOX 4 protocol in clinical efficacy with mild adverse reactions.

Objective To explore changes in the capacity and working efficiency of divers performing deep saturation dives at various depths.Methods The divers completed the specified underwater operations at the depths of 70 m,255 m and 493 m,and changes in their working efficiency were assessed by working time and errors occurred during the underwater operations.Results The time consumed for the joining up of flanges,the binding and measurement of underwater objects at the depth of 255 m all significantly prolonged,when compared with the time used at 70 m(P <0.05).The time used for the joining up of flanges,the binding of underwa-ter objects at the depth of 493 m did not prolong significantly,when compared with the time spent at 255 m(P <0.05).However,the time used for underwater measurement prolonged significantly(P <0.01)and the rate of error both in the joining up of flanges and meas-urement of underwater objects increased significantly (P <0.05).Conclusion In deep saturation dives,the capability and working ef-ficiency of divers all considerably reduced.The greater the depths were,the more significantly their operating dexterity and short-term memory were affected.

Objective To explore changes in the capacity and working efficiency of divers performing deep saturation dives at various depths.Methods The divers completed the specified underwater operations at the depths of 70 m,255 m and 493 m,and changes in their working efficiency were assessed by working time and errors occurred during the underwater operations.Results The time consumed for the joining up of flanges,the binding and measurement of underwater objects at the depth of 255 m all significantly prolonged,when compared with the time used at 70 m(P <0.05).The time used for the joining up of flanges,the binding of underwa-ter objects at the depth of 493 m did not prolong significantly,when compared with the time spent at 255 m(P <0.05).However,the time used for underwater measurement prolonged significantly(P <0.01)and the rate of error both in the joining up of flanges and meas-urement of underwater objects increased significantly (P <0.05).Conclusion In deep saturation dives,the capability and working ef-ficiency of divers all considerably reduced.The greater the depths were,the more significantly their operating dexterity and short-term memory were affected.

Objective:To study the expression of CD40-CD40L system on rabbit aorta plaque and correlation with plaque stabil- ity during atherosclerotic process.Methods:50 healthy rabbits were derided into 10 groups in random:five controlled groups (C1～5 group)and five AS model groups(AS1-5 group).Rabbits in C1～5 group were fed on regular diets until 8 weeks,10 weeks.12weeks,14weeks and 16weeks to get the aorta specimen respectly.Correspondingly rabbits in AS1～5 groups were given high lipid diets continously until 8weeks,10weeks,12weeks,14weeks and 16weeks,during which each AS group was conducted balloon injury at the end of the first week to prumote the establishment of AS models.All the groups were detected serum CRP individually at beginning and before specimen obtained.Immunohistochemistry and special stain was used to detect the intima expression proportion of CD40,CD40L,MMP-1 as well as contant of collagen and lipid photographed under microscope and measured by computer.Then the collagen/lipid ratio were calculated.Finally correlation between CD40-CD40L expression and plaque stability were analyzed.Results:All atherosclerotic plaques were successfully established on all rabbits'abdominal aorta in the 5 AS groups.Compared with C1～5 groups correspondantly,the expression of CD40,CD40L,MMP-1 were significantly in- creased(P