Objective: To quantitatively assess the health risk of preservatives from beverages around primary schools in Anshun City, and to provide scientific basis for precise food safety supervision. Methods: From December 2023 to July 2024, 602 beverage samples were randomly collected from within 100 meters of 19 primary schools in Anshun City. The content of benzoic acid, sorbic acid, and dehydroacetic acid was detected according to GB 5009 series standards. Combined with children s physiological parameters (body weight 30 kg, daily intake 0.15 L), the Hazard Quotient (HQ) and Hazard Index (HI) models were used to evaluate health risks. Results: The total detection rate of preservatives from beverages around primary schools was 63.0%, and the total over limit rate was 9.0%. The detection rate of preservatives in flavored beverages was the highest (72.6%), and the highest over limit rate of preservatives in special purpose beverages was the highest (17.2%). The single preservative HQ (benzoic acid up to 0.47 ) and mixed HI (up to 0.55) of all samples were below 1(safety threshold). However, the HQ value of benzoic acid in flavored beverages (0.47) was 2.9 times that of sorbic acid (0.16), contributing significantly to health risk. Sensitivity analysis showed that if the daily consumption increased to 0.3 L, the HI value of flavored beverages would rise to 1.11, exceeding the safety threshold. Enterprise scale analysis showed that the exceedance rate of special purpose beverages in large enterprises reached 30.0%, while micro enterprises, accounting for a dominant market share (52.2%), constituted the main source of children s daily exposure to their products. Conclusions The overall health risk of perservatives in beverages sold near primary schools in Anshun City is controllable, but there is a noticeable risk of gradient. The risk of children’s exposure to preservatives through beverage consumption should not be ignored.

Objective To explore the efficacy of arthroscopic reduction combined with percutaneous screw fixation in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures.Methods Forty-eight patients with Sanders types Ⅱ and Ⅲcalcaneal fractures were divided into the arthroscopic reduction combined with percutaneous screw fixation(arthroscopy)group(n=23)and the tarsal sinus approach open reduction combined with screw internal fixation(tarsal sinus approach)group(n=25)according to different surgical methods and plans.The operative time,incision length,postoperative complications and secondary removal of internal fixation were compared between the two groups.Changes in B?hler's angle and Gissane's angle were evaluated and compared between the two groups at 3 months,6 months after operation and at the last follow-up.Additionally,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score and the visual analog scale(VAS)for pain were used to assess outcomes at the last follow-up.Results Compared with the tarsal sinus approach group,the incision length was reduced,the operation time was prolonged and the incidence of complications was decreased in the arthroscopic group(P＜0.05).At 3 months,6 months after the operation and the last follow-up,there were no significant differences in the B?hler Angle,Gissanes Angle,AOFAS and VAS scores between the arthroscopic group and the tarsal sinus approach group(P＞0.05).Conclusion Both groups of regimens can enable patients to achieve good postoperative therapeutic efficacy.However,under arthroscopic assistance,surgical incisions inherently possess minimally invasive advantages,while the incidence of postoperative complications is lower compared to the sinus tarsi approach.

Objective To develop a nomogram diagnostic model to differentiate peripheral small cell lung cancer(PSCLC)from peripheral lung adenocarcinoma(PADC)using clinical and multi spiral computed tomography features.Methods A retrospective analysis was conducted on the CT characteristics and clinical presentations of 50 PSCLC and 100 PADC.Univariate and multivariate logistic regression analyses were employed to identify significant features.A nomogram was constructed to quantify the influencing factors.The efficacy and clinical applicability of the model were assessed using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results Smoking,neuron-specific enolase(NSE),smooth margin,spindle/branching shape,and lymphadenopathy were independent risk factors for PSCLC(P＜0.05),whereas rough margin and lobulation sign were independent risk factors for PADC(P＜0.05).The nomogram model demonstrated high diagnostic efficacy,and the calibration curve exhibited a good degree of calibration(Brier=0.079).The DCA indicated that the nomogram model possesses substantial clinical utility.Conclusion The nomogram model developed based on six indicators,including smoking,NSE≥17 ng/mL,margin characteristics,spindle/branching shape,lobulation sign,and lymphadenopathy can well distinguish PSCLC from PADC.

Objective To mine and analyze signals of acute kidney injury(AKI)related to drugs,comprehensively summarize the potential risk drugs,and provide a reference for clinically safe medication.Methods The AKI reports from January 2004 to September 2023 in the US FDA Adverse Event Reporting System(FAERS)were retrieved.Disproportionality methods were used to explore the relationship between drugs and AKI,and demographic information,time to onset,and patient outcomes were analyzed.Results Out of 1 253 drugs,159 were identified as AKI signal drugs.Among these,there were 49 antimicrobial agents(30.82%),including 35 antibiotics and 14 antiviral agents;33 antineoplastic agents(20.75%);and 25 hypotensive agents(15.72%).Drug-related AKI occurred mostly in the elderly,and the male-to-female ratio was 124∶100.The median time to onset for AKI related to antibiotics was≤8 d,with the third quartile≤21 d.Rivaroxaban and aspirin had higher proportions of death reports,with 33.03%and 31.44%respectively.Conclusions A multitude of drugs pose a risk for acute kidney injury,necessitating caution in their clinical application and the implementation of monitoring of renal function.The elderly are a high-risk group for drug-related AKI,and there are more males than females.For antibiotics,the first 21 days are the key monitoring period.For drugs that require long-term use,regular monitoring is necessary.

Objective To explore the efficacy of arthroscopic reduction combined with percutaneous screw fixation in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures.Methods Forty-eight patients with Sanders types Ⅱ and Ⅲcalcaneal fractures were divided into the arthroscopic reduction combined with percutaneous screw fixation(arthroscopy)group(n=23)and the tarsal sinus approach open reduction combined with screw internal fixation(tarsal sinus approach)group(n=25)according to different surgical methods and plans.The operative time,incision length,postoperative complications and secondary removal of internal fixation were compared between the two groups.Changes in B?hler's angle and Gissane's angle were evaluated and compared between the two groups at 3 months,6 months after operation and at the last follow-up.Additionally,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score and the visual analog scale(VAS)for pain were used to assess outcomes at the last follow-up.Results Compared with the tarsal sinus approach group,the incision length was reduced,the operation time was prolonged and the incidence of complications was decreased in the arthroscopic group(P＜0.05).At 3 months,6 months after the operation and the last follow-up,there were no significant differences in the B?hler Angle,Gissanes Angle,AOFAS and VAS scores between the arthroscopic group and the tarsal sinus approach group(P＞0.05).Conclusion Both groups of regimens can enable patients to achieve good postoperative therapeutic efficacy.However,under arthroscopic assistance,surgical incisions inherently possess minimally invasive advantages,while the incidence of postoperative complications is lower compared to the sinus tarsi approach.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective:To explore the effects of a tiered-categorized-integrated training model in standardized neurology residency training.Methods:This controlled before-and-after study enrolled 109 residents who rotated in the Department of Neurology of Renji Hospital of Shanghai Jiao Tong University School of Medicine from January 2023 to June 2024. Among them, 43 residents from January to July 2023 were assigned to control group to receive the traditional training model, while 66 residents from August 2023 to June 2024 were assigned to observation group to follow the competency-oriented tiered-categorized-integrated training protocol. In the observation group, the residents were categorized into neurology specialty and non-neurology specialty groups to follow a competency-based hierarchical and progressive training approach with systematical optimization and resource integration in terms of faculty allocation, training activities, and assessment evaluations. The effectiveness of the models was evaluated through semi-annual assessments (for neurology specialty), routine assessments and end-of-rotation assessments (for non-neurology specialty), and 360-degree evaluations. SPSS 26.0 was used to perform chi-square tests and t-tests. Results:The non-neurology specialty residents in the observation group significantly outperformed the control group in the total score of end-of-rotation assessments [(90.93±4.21) vs. (86.08±8.98), P=0.004], theoretical examinations [(16.47±2.47) vs. (13.55±5.34), P=0.003], clinical skills [(9.32±0.47) vs. (9.00±0.58), P=0.004], and case analysis [(86.75±5.95) vs. (82.64±11.20), P=0.047]. The neurology specialty residents in the observation group showed a significantly higher physical examination score than the control group [(87.50±8.66) vs. (75.00±8.17), P=0.040]. Furthermore, in the 360-degree evaluation, the observation group exhibited better performance in certain assessment indicators of core competencies, including professional ability, patient management, professionalism, and communication and cooperation ( P<0.05). Conclusions:The tiered-categorized-integrated training model helps residents to better grasp basic knowledge and skills in rotations, and also enhances their core competencies such as professional ability, patient management, and communication and cooperation. This model provides a replicable practical solution for clinical departments to achieve efficient and precise rotation management within the constraints of limited resources.

Objective To mine and analyze signals of acute kidney injury(AKI)related to drugs,comprehensively summarize the potential risk drugs,and provide a reference for clinically safe medication.Methods The AKI reports from January 2004 to September 2023 in the US FDA Adverse Event Reporting System(FAERS)were retrieved.Disproportionality methods were used to explore the relationship between drugs and AKI,and demographic information,time to onset,and patient outcomes were analyzed.Results Out of 1 253 drugs,159 were identified as AKI signal drugs.Among these,there were 49 antimicrobial agents(30.82%),including 35 antibiotics and 14 antiviral agents;33 antineoplastic agents(20.75%);and 25 hypotensive agents(15.72%).Drug-related AKI occurred mostly in the elderly,and the male-to-female ratio was 124∶100.The median time to onset for AKI related to antibiotics was≤8 d,with the third quartile≤21 d.Rivaroxaban and aspirin had higher proportions of death reports,with 33.03%and 31.44%respectively.Conclusions A multitude of drugs pose a risk for acute kidney injury,necessitating caution in their clinical application and the implementation of monitoring of renal function.The elderly are a high-risk group for drug-related AKI,and there are more males than females.For antibiotics,the first 21 days are the key monitoring period.For drugs that require long-term use,regular monitoring is necessary.

Natural human leukocyte antigen (HLA) antibodies refer to preformed antibodies present in the body that are not induced by prior exposure to allogeneic HLA antigens. In healthy individuals without a sensitization history, the detection rate of natural HLA antibodies is approximately 20%-29% when using screening assays with low sensitivity, and can reach up to 63% when more sensitive HLA-specific detection methods are employed. It is therefore inferred that natural HLA antibodies may also be present in transplant candidates with a similar prevalence. This review comprehensively discusses the potential mechanisms of natural HLA antibody generation, the characteristics of the recognized epitopes, detection techniques, clinical relevance in transplantation, their potential to confound therapeutic decisions, and approaches to distinguish and mitigate their impact. The goal is to raise clinician awareness of the objective existence of natural HLA antibodies, provide guidance on evaluating their association with allograft rejection, and inform appropriate clinical management strategies when encountering natural HLA antibody-positive transplant candidates.

Objective:To evaluate the clinical efficacy and safety of sulodexide soft capsules in treating proteinuria after renal transplantation, as well as its impact on graft function.Methods:The clinical data from 80 recipients who developed proteinuria after renal transplantation and were treated with sulodexide soft capsules during regular follow-up at the outpatient department of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 1, 2019, to March 1, 2023, were retrospectively analyzed. Proteinuria levels, graft function, safety-related indicators (coagulation function), and adverse events were compared before treatment and at 1, 2, 3, 6, and 12 months after treatment. Based on efficacy, recipients were divided into a satisfactory efficacy group (67 cases) and a general efficacy group (13 cases). Univariate and multivariate logistic regression analyses were conducted to stratify baseline data and explore factors influencing efficacy.Results:Among the 80 recipients, 63 (78.75%) had mild proteinuria and 17 (21.25%) had moderate proteinuria. The overall treatment response rate was 91.25% (73/80). Drug-related adverse events occurred in 12 patients (15.0%). Median urinary protein excretion at 1, 2, 3, 6, and 12 months post-treatment was 0.35 (0.20, 0.55) g/24 h, 0.30 (0.17, 0.44) g/24 h, 0.23 (0.15, 0.39) g/24 h, 0.21 (0.13, 0.32) g/24 h, and 0.15 (0.10, 0.23) g/24 h, respectively, all significantly lower than the pre-treatment level of 0.52 (0.43, 0.90) g/24 h (all P<0.001). The median urinary albumin-to-creatinine ratios at the corresponding time points were 99.15 (45.33, 201.13) μg/mg, 77.20 (43.30, 176.20) μg/mg, 57.50 (31.35, 173.75) μg/mg, 53.55 (25.90, 142.00) μg/mg, and 39.05 (20.53, 103.60) μg/mg, also significantly reduced compared to the pre-treatment value of 152.05 (71.90, 271.23) μg/mg ( P=0.012, P=0.003, P<0.001, P<0.001, P<0.001, respectively). At 12 months post-treatment, the serum creatinine level (132.86±36.86 μmol/L) showed a statistically significant improvement compared to the pre-treatment level (146.60±48.42 μmol/L) ( P=0.045). Univariate analysis indicated that satisfactory efficacy was associated with the time of proteinuria onset post-transplantation, the interval between proteinuria onset and treatment initiation, and recipient age ( HR= 1.001, 95% CI: 1.001-1.020, P=0.043; HR = 1.034, 95% CI: 1.009-1.058, P=0.006; HR=1.058, 95% CI: 1.003-1.116, P=0.040). Stratified univariate analysis revealed that proteinuria onset within 2 years post-transplantation, treatment initiation within 2 years of proteinuria onset, and age younger than 45 years were significantly associated with satisfactory efficacy ( HR=5.524, 95% CI: 1.510-20.207, P=0.010; HR= 7.800, 95% CI: 2.104-28.920, P=0.002; HR=5.972, 95% CI: 1.497-23.822, P=0.011). Multivariate analysis identified the interval between proteinuria onset and treatment initiation as an independent factor influencing satisfactory efficacy ( HR=1.025, 95% CI: 1.010-1.093, P=0.015). Conclusions:Sulodexide effectively reduces proteinuria after renal transplantation, particularly in mild-to-moderate or early-onset cases, while maintaining stable allograft function without significant adverse effects