Background The quality of occupational health technical services is directly linked to the protection of workers' health rights and the efficacy of occupational disease prevention and control. However, the industry still faces critical challenges: sporadic instances of institutional non-compliance and persistent irregularities in professional practice continue to undermine overall service performance. Objective To assess the current quality status of occupational health technical services in Zhejiang Province and propose countermeasures for quality improvement, providing a scientific basis for policy optimization and service delivery quality enhancement. Methods A total of 69 occupational health technical service institutions in Zhejiang Province that obtained formal accreditation as of April 30, 2024, were sampled, including 3 public institutions and 66 private institutions (comprising 3 formerly Class-A, 28 formerly Class-B, 11 formerly Class-C, and 24 newly certified institutions). Following the Technical Protocol for Quality Monitoring of Occupational Health Technical Service in Zhejiang Province and the Technical Protocol for Proficiency Testing of Occupational Health Detection in Zhejiang Province, a quality assessment task force comprising national and provincial experts was established. Evaluation was conducted across four dimensions: qualification maintenance and compliance, standardization of technical services, authenticity of technical services, and proficiency testing, utilizing a combination of document review, on-site inspections, and technical skill assessments. Results The occupational health technical service institutions in Zhejiang Province were predominantly private entities (82.5%), with significant disparities in overall service quality. The pass rates for qualification maintenance and compliance, technical service standardization, technical service authenticity, and the excellence rate for laboratory proficiency testing were 81.5%, 80.7%, 97.3%, and 90.4%, respectively. Regarding qualification maintenance, the pass rates for "environmental conditions" (49.8%, 56.7%) and "instrumentation and equipment" (58.2%、65.6%) were significantly lower for formerly Class-C and newly certified institutions compared to other categories. In terms of technical standardization, "standardized on-site inspections" recorded the lowest pass rate (67.4%), with newly certified institutions at only 48.0%. Regarding technical service authenticity, formerly Class-C institutions exhibited issues such as missing raw chromatograms for blank samples (85.7% pass rate). In laboratory proficiency testing, public and formerly Class-A institutions achieved 100% excellence rates, but the performance of formerly Class-C and newly certified institutions was comparatively weak; specifically, the failure rate for organic analysis in formerly Class-C institutions reached 20%; the failure rate for dust testing items in newly certified institutions was 10.3%. Conclusion The overall quality of occupational health technical services in Zhejiang Province still requires significant improvement, particularly in basic institutional conditions, the standardization of on-site inspections, and laboratory proficiency in organic and dust analysis. Formerly Class-C and newly certified institutions should be the primary focus of quality management efforts. Differentiated regulatory strategies are recommended, alongside strengthening interim and ex-post supervision to gradually enhance the quality of occupational health technical services across all institutions.

To investigate the efficacy and safety of glucocorticoids combined with cyclophosphamide (CTX) and rituximab (RTX) in elderly patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with renal involvement.

This article reports a case of an elderly male patient presenting with nephrotic syndrome. Renal biopsy pathology indicated membranous nephropathy, with both renal tissue staining for M-type phospholipase A2 receptor (PLA2R) and serum anti-PLA2R antibodies being negative. Nephrotic syndrome achieved remission following treatment with prednisone combined with tacrolimus; however, the patient relapsed during tacrolimus maintenance therapy. Subsequent laboratory evaluation revealed positive anti-nuclear antibodies and anti-double-stranded DNA antibodies, accompanied by decreased complement levels. Exostosin 1 and Exostosin 2 staining performed on the initial renal biopsy specimen yielded positive results, leading to a diagnosis of lupus nephritis. Due to the patient's history of rituximab-related allergic reactions, pulmonary infection, and acute kidney injury, the subsequent treatment regimen consisted of obinutuzumab sequentially combined with belimumab, in addition to prednisone 10 mg/d. During the two-year follow-up period, the patient's anti-double-stranded DNA antibodies converted to negative, complement levels normalized, proteinuria achieved complete remission, and no adverse events such as severe infection occurred. This article reviews the diagnosis, treatment, and relevant literature for this case, aiming to provide clinical insights for the early diagnosis and selection of therapeutic strategies for similar patients.

A convenience sampling method was employed to recruit 445 food service employees from 67 Chinese restaurants across all 16 administrative districts of Beijing City from August to December in 2022. A questionnaire survey was conducted to assess their knowledge, attitudes, and behaviors regarding salt reduction and hypertension. The results revealed that awareness was highest for the statement "Hypertensive patients should reduce salt intake" (88.3%), while awareness of "China′s diagnostic criteria for hypertension" was the lowest (23.8%). Positive attitude endorsement rates were 96.0% for willingness to reduce salt, 95.3% for perceived self-efficacy in salt reduction, and 93.0% for agreement with a low-salt diet. Regarding behaviors, the rates of actively reducing salt when ordering takeout or dining out, using low-sodium salt, and using salt-reducing spoons were 73.7%, 45.4%, and 55.5%, respectively. The overall compliance rate for salt-reduction related behaviors was 73.9%. Multivariable logistic regression analysis demonstrated that: compared to the 18-29 age group, employees aged 30-39 ( OR=2.19, 95% CI: 1.16-4.14), 40-49 ( OR=3.36, 95% CI: 1.52-7.42), and 50-59 ( OR=3.25, 95% CI: 1.25-8.50) were significantly more likely to achieve compliance with salt-reduction behaviors; chefs were significantly more likely to achieve behavioral compliance compared to managerial staff ( OR=2.08, 95% CI: 1.08-3.98); employees in catering with adequate knowledge about salt reduction and hypertension were significantly more likely to exhibit behavioral compliance compared to those with inadequate knowledge ( OR=3.32, 95% CI: 1.83-5.92); employees in catering with positive attitudes towards salt reduction were significantly more likely to achieve behavioral compliance compared to those with negative attitudes ( OR=5.81, 95% CI: 2.05-16.43). In conclusion, food service employees in Beijing exhibit insufficient knowledge about salt intake and hypertension. While they demonstrate strong willingness to reduce salt, this does not consistently translate into action. Compliance with salt-reduction behaviors is influenced by age, education level, and job position. There is an urgent need to strengthen the dissemination of knowledge regarding high salt intake and hypertension and to implement personalized interventions targeting salt-reduction behaviors and skills.

Objective:Analyze the imaging and clinical data of cases undergoing thoracoscopic subsegmental resection for non-small cell lung cancer(NSCLC) with a diameter≤2 cm, and explore the clinical outcomes of subsegmental resection.Methods:A retrospective analysis was conducted on the clinical data of 58 patients who underwent thoracoscopic subsegmentectomy in China-Japan Friendship Hospital from January 2020 to July 2024. Three-dimensional reconstruction technology was used for surgical planning before the operation, and thoracoscopic subsegmentectomy was performed, including single lung subsegmentectomy(Group 1), multiple lung subsegmentectomy(Group 2), and combined segmentectomy and subsegmentectomy(Group 3).Results:All patients successfully completed the surgery, with 23 cases of single lung subsegmentectomy, 6 cases of multiple lung subsegmentectomy, and 29 cases of combined segmentectomy and subsegmentectomy. The median intraoperative blood loss was 30.0(20.0, 30.0)ml, the average operation time was(2.03±0.68) h, the average pathological size of the nodules was(10.53±4.45) mm, and the average postoperative tube retention was(2.55±0.92) days. There were 6 cases of postoperative complications, including pulmonary air leakage in 2 cases, cerebral embolism in 1 case, pulmonary embolism in 1 case, pulmonary infection in 1 case, and atrial fibrillation in 1 case. All patients had negative surgical margins in the postoperative pathology. Group 1 had less average intraoperative blood loss than Group 2, with statistically significant differences( P=0.027). Surgical procedures for the upper lobe of the lung mainly involve the resection of combined segments and subsegments, while those for the lower lobe primarily consist of single segmentectomy. Conclusion:Subsegmentectomy is an effective surgical approach when the nodule is small and a clear margin can be ensured, allowing for better preservation of remaining lung tissue. Bleeding during multiple subsegmentectomies is greater than that in single subsegmentectomy and combined segmentectomy with subsegmentectomy, which may be related to the more complex vascular variations in multiple subsegmentectomies.

Objective:To improve the risk management process for clinical trial projects using healthcare failure mode and effect analysis(HFMEA), for references for enhancing the risk identification and preventing capabilities of drug clinical trial institutions.Methods:From June to December 2022, this study focused on the project management process of a clinical trial centre in a tertiary public hospital. Following HFMEA procedures, a research team was established. Core processes prone to failure modes in the drug clinical trial project management and their potential failure modes were identified through group discussions, literature analysis, the Delphi method, and decision tree analysis. High-risk failure modes were screened via risk assessment, corresponding improvement measures were formulated and performed, and their effectiveness was validated.Results:The study identified 6 main processes, 17 sub-processes, and 102 potential failure modes. Delphi analysis confirmed 88 failure modes, with 19 having a failure risk priority number(RPN)≥8.00. Decision tree analysis identified 16 high-risk failure modes, involving 5 main processes and 10 sub-processes. Targeted improvements, such as adopting standardized hospital contract templates and setting deadlines for final payment settlement, etc., were implemented. One year post-implementation(January 2024), the RPN for all 16 high-risk failure modes were<8.00.Conclusions:HFMEA could help hospital clinical trial institutions comprehensively and systematically identify high-risk failure modes in the project management process, develop targeted improvement measures, and improve the level of drug clinical trial project management.

Objective:To systematically evaluate the fairness of traditional Chinese medicine (TCM) healthcare resource allocation at the prefecture-level in China using the healthcare resource agglomeration degree (HRAD) method, so as to provide empirical evidence for optimizing resource distribution.Methods:Data on TCM healthcare resources (including the number of TCM institutions, public TCM hospitals, TCM hospital beds, and TCM healthcare technicians) were collected from 333 prefecture-level regions in 2023. The HRAD method was employed to assess fairness in geographic allocation (HRAD i) and population-based allocation (HRAD i/PAD i). A multi-indicator comprehensive evaluation was conducted using the entropy weight method to determine weighting coefficients. Results:Significant disparities were observed in the geographic agglomeration of TCM resources (HRAD i) in China. Resource-rich regions (HRAD i>5) were primarily concentrated in eastern and some central-western provinces, while resource-scarce regions (HRAD i<1) were mainly distributed in western, northeastern, and parts of central and eastern provinces. Analysis of population-based fairness (HRAD i/PAD i) revealed that most prefecture-level cities nationwide had ratios<1, with only 8 provinces having more cities with ratios>1 than<1. The comprehensive evaluation showed that top-ranked cities in the east (e.g., Hangzhou, Dongying, Shenzhen), central region (e.g., Taiyuan, Zhengzhou), and west (e.g., Hainan Prefecture, Alxa League) were predominantly core cities or sparsely populated areas. Conclusions:China′s prefecture-level TCM healthcare resource allocation exhibits significant geographic and population-based inequities, with excessive concentration in provincial capitals and developed cities. Urgent strategies are needed to optimize resource allocation, enhance fairness and accessibility, including promoting the decentralization of high-quality resources, strengthening regional collaborative support, enhancing talent attraction in underdeveloped areas, and leveraging information technology to improve efficiency.

OBJECTIVE: To block family transmission of a small fragment copy number variation (CNV) with combined 1 Mb resolution preimplantation genetic testing for aneuploidy (PGT-A) and target region preimplantation genetic testing for monogenic disease (PGT-M) strategies. METHODS: A couple who attended the Reproductive and Genetic Medicine Center of Dalian Women and Children's Medical Center (Group) in 2024 were selected as the study subject. Upon the woman's two pregnancies, ultrasound examination revealed fetal abnormalities, and CNV-seq based on low-depth whole genome sequencing revealed that both fetuses had carried a maternal 17p12 microduplication of approximately 1.43 Mb. Microduplication in this region has been associated with Charcot-Marie-Tooth disease type 1A. In view of the fact that the resolution of conventional PGT-A detection cannot meet the requirement of small fragment CNV analysis, and conventional PGT-M assay cannot directly determine the CNV, two detection schemes were adopted. On the one hand, PGT-A testing with 1 Mb resolution was performed on the embryo to directly determine whether it carries the above microduplication. At the same time, the couple and their fetus were subjected to chromosomal typing scheme for the 17p12 region to indirectly identify embryos carrying the risk chromosome for microduplication. This study has been approved by the Medical Ethics Committee of the Hospital (Ethics No: FEJT-KY-2025-51). RESULTS: Three embryos were tested after the first PGT cycle, of which 1 was not carrying the pathogenic variant and was euploid, whilst the other 2 embryos were carrying the 17p12 microduplication, and 1 of them was aneuploid. After genetic counseling, the euploid embryo without the 17p12 microduplication was selected for transfer, and prenatal diagnosis based on amniotic fluid sample showed that the fetal chromosomal karyotype was normal and did not carry the 17p12 microduplication. CONCLUSION The combined application of high-resolution PGT-A and PGT-M typing detection of the target region can effectively block family transmission of the CNVs of small fragments.
Humans ; Female ; DNA Copy Number Variations/genetics* ; Preimplantation Diagnosis/methods* ; Pregnancy ; Pedigree ; Genetic Testing/methods* ; Male ; Adult ; Aneuploidy ; Chromosomes, Human, Pair 17/genetics* ; China ; East Asian People

Autism spectrum disorder in children (hereinafter called "childhood autism") is a prevalent neurodevelopmental condition; however, ancient Chinese medical texts did not provide detailed accounts of it. The concept of "the sovereign fire illuminates, while the ministerial fire occupies its position" was first introduced in the Plain Questions: The Great Treatise on the Origin of Heavenly Influences chapter. Subsequent medical practitioners have elaborated on this idea, identifying the sovereign fire as the master of the spirit and governing life activities, while the ministerial fire is the assisting minister that supports the functions of the zang-fu organs. When these two are in harmony, they complement each other, collectively sustaining the body′s normal physiological functions. In the context of this theory, the pathogenesis of childhood autism is attributed to the imbalance between the sovereign and ministerial fires. The root cause lies in the mutual antagonism of these two fires, resulting in the dysfunction of the spirit. Central to childhood autism onset is the dimming of the sovereign fire and a deficiency in the spirit, while the displacement of the ministerial fire and the impaired function of the five viscera contribute significantly to the progression of the condition. Effective treatment for childhood autism involves restoring these imbalances: dispelling yin-related obstructions to illuminate the sovereign fire, nourishing the spleen and kidney to nourish the ministerial fire, and regulating the liver and lung to harmonize the sovereign and ministerial fires. The ultimate goal is to integrate body and spirit, harmonize the sovereign and ministerial fires, and restore the interconnectedness between spirit and the function of the five zang viscera. This article, based on the "the sovereign fire illuminates, while the ministerial fire occupies its position" theory, provides a novel perspective and insights for understanding and treating childhood autism through the holistic principles of traditional Chinese medicine. Emphasizing the integration of body and spirit offers new insights and approaches for the clinical management of childhood autism in traditional Chinese medicine.