Background Co-exposure to noise and microwave radiation occurs frequently. The central nervous system has been identified as a sensitive target organ for both noise and microwave exposure individually, and the underlying mechanisms remain poorly understood. The specific biological effects resulting from co-exposure to these two factors have yet to be fully elucidated. Objective To clarify the effects of co-exposure to noise and microwave on neurobehavior and hippocampal tissue structure, and to explore the underlying mechanism through the assessment of serum cytokines. Methods C57BL/6N mice were selected and randomly assigned to a blank control group, a noise group, a microwave group, and a combined noise & microwave exposure group. To establish the exposure models, the noise group was subjected to broadband noise at 100 dB for 2 h, while the microwave group received radiation at a central frequency of 9.375 GHz with an average power density of 12 mW·cm⁻² and a specific absorption rate of 2.58 W·kg⁻¹ for 15 min. Open field and tail suspension tests assessed anxiety-like emotional behaviour; novel object recognition and Y-maze tests evaluated cognitive function. Histological changes in hippocampal tissue were examined using haematoxylin and eosin (HE) staining, and Nissl staining under light microscopy. Serum cytokine levels were measured using radioimmunoassay and enzyme-linked immunosorbent assay (ELISA). Results After 3 d of exposure, the noise, microwave, and combined exposure groups showed significant reductions in exploration frequency, duration, and distance within the central zone of the open field test compared to the control group (P < 0.01); the combined exposure group exhibited increased ratios of peripheral-to-central exploration time and distance (P < 0.05). After 7 d of exposure, compared with the control group, the noise group maintained a decrease in central zone exploration time (P < 0.01), while the combined exposure group showed persistent decline across all central zone metrics (P < 0.05) and elevated peripheral-to-central ratios (P < 0.05); compared to the microwave group, the combined exposure group showed significant less time in the central zone (P < 0.05) and higher peripheral-to-central ratios (P < 0.05). Regarding behaviour and cognition, compared with the control group, the combined exposure group showed increased immobility time in the tail suspension test after 3 d of exposure (P < 0.01). At this interval, all exposure groups demonstrated reduced frequency and duration of novel object recognition (P < 0.05), with the combined exposure group showing a marked decrease in novel arm exploration time (P < 0.01). After 7 d of exposure, compared with the control group, the noise group showed reduced novel object recognition frequency (P < 0.05), and both the noise and microwave groups exhibited decreased novel arm exploration time (P < 0.05). Pathological alterations including an increased number of hyperchromatic nuclei and depleted Nissl bodies were observed in the CA3 and DG regions across all exposure groups with the most severe lesions observed in the combined exposure group. Serum levels of central nervous system-specific protein β (S-100β), glial fibrillary acidic protein (GFAP), and corticosterone (CORT) were significantly elevated in all exposure groups compared with the control group (P < 0.05). Aquaporin-4 (AQP4) levels increased in the combined exposure group (P < 0.05), while CXC chemokine ligand 10 (CXCL10) levels rose in both the noise and combined groups compared with the control group (P < 0.05). Specifically, S-100β and CXCL10 levels in the combined exposure group were higher than those in the microwave group (P < 0.05); moreover, levels of S-100β, GFAP, CORT, AQP4, and CXCL10 in the combined exposure group were significantly higher than those in the noise group (P < 0.05). Conclusion Combined exposure to noise and microwave radiation induces pathological changes in the hippocampus of mice, increases levels of serum stress hormones and neuro-specific biomarkers. These impairments are more severe than those observed following single-factor exposure. The underlaying mechanism may be related to systemic stress response, neuronal damage, astrocyte activation, and changes in blood-brain barrier permeability, leading to emotional behavioral abnormalities and cognitive decline.

Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

BACKGROUND:Post and core restoration is a common choice for tooth defects,but the repair effects of various post and core materials are different. OBJECTIVE:To evaluate the stress distribution at the post and core,tooth root,and bonding agent site of post and core models made of different elastic modulus post and core materials using finite element method. METHODS:A three-dimensional root canal treated maxillary central incisor model was built using three-dimensional modeling software,which was restored with a full ceramic crown.The post and core materials in the restoration used nanoceramic resin(elastic modulus=12.8 GPa),composite resin(elastic modulus=16 GPa),hybrid ceramic(elastic modulus=34.7 GPa),glass ceramic(elastic modulus=95 GPa),titanium alloy(elastic modulus=112 GPa),and zirconia(elastic modulus=209.3 GPa).The model was fixed in cortical bone.A 100 N concentrated force of 45° from the long axis of the tooth was applied to 1/3 of the crown and tongue side of the central incisor.The stress distribution of the post and core,dentin,and tooth-root bonding agent in the model was repaired by the maximum principal stress criterion. RESULTS AND CONCLUSION:(1)When the post and core materials with higher elastic modulus was used,the post-core stress in the repair model was more concentrated.When the elastic modulus of the post and core materials(nanoceramic resin and composite resin)was close to dentin,the stress distribution of the post and core was more uniform.The stress distribution of dentin in all restoration models was similar regardless of post and core materials.When the post and core with higher elastic modulus was used,more stress concentration was shown at the post and root bonding agent in the repair model.(2)The maximum stress values at the post and core,tooth root,and the bonding agent site of post and tooth root in the nanoceramic resin model were 31.00,33.21,and 0.51 MPa,respectively.The maximum stress values at the post and core,tooth root,and the bonding agent between the post and tooth root in the composite resin model were 36.84,33.14,and 0.59 MPa,respectively.In the mixed ceramic model,the maximum stress values at the post and core,tooth root,and the bonding agent between the post and tooth root were 64.05,32.83,and 1.00 MPa,respectively.In the glass ceramic model,the maximum stress values at the post and core,tooth root,and the bonding agent between the post and tooth root were 112.30,32.69,and 1.73 MPa,respectively.In the titanium alloy model,the maximum stress values of the post and core,tooth root,and the bonding agent between the post and tooth root were 120.00,32.17,and 1.86 MPa,respectively.In the zirconia model,the maximum stress values of the post and core,tooth root,and the bonding agent between the post and tooth root were 148.80,31.85,and 2.28 MPa,respectively.(3)The higher the elastic modulus of the post and core material,the higher the maximum stress at the post and core during restoration.The elastic modulus of the post and core material had no significant effect on the maximum stress of the dental bonding agent and dentin.

OBJECTIVE: To analyze the imaging and clinical features of diaphragm dysfunction in patients who underwent selective cardiac sternotomy with diaphragm ultrasound and chest CT. METHODS: A prospective cohort study was conducted. The patients undergoing selective cardiac sternotomy in the cardiac and vascular surgery department of Tianjin Medical University General Hospital from June to September 2023 were enrolled. Bedside ultrasound was performed on the day before surgery, within 24 hours of extubation, and on the 7th day after surgery to measure diaphragm excursion (DE) and diaphragm thickness (DT), and to calculate the diaphragm thickening fraction (DTF). The distance from the diaphragm's apex to the thorax's apex in the chest CT scout view was measured before and after the operation, and the diaphragm elevating fraction (DEF) was calculated. Patients were divided into two groups based on whether diaphragm dysfunction (DE < 1 cm) occurred on the 7th day after surgery. The change patterns of imaging indicators were analyzed in both groups. The clinical data of both groups before, during, and after surgery were compared. RESULTS: In total, 67 patients who underwent cardiac sternotomy were enrolled. Among them, 24 patients developed diaphragm dysfunction within 24 hours after extubation; on the 7th day after surgery, 19 patients (28.4%) still exhibited diaphragm dysfunction, while 48 patients (71.6%) did not. Ultrasonic examination of the diaphragm revealed that, compared with the non-diaphragm dysfunction group, patients in the diaphragm dysfunction group exhibited varying degrees of decrease in DE and DTF before and after surgery, with a more significant decrease on the left side, and the differences were statistically significant on the 7th day after surgery [DE (cm): 1.06±0.77 vs. 1.59±0.63, DTF: 19.3% (14.8%, 21.1%) vs. 21.3% (18.3%, 26.1%), both P < 0.05]. There was no statistically significant difference in DT between the two groups at each time point. Changes in bilateral DE and DTF revealed that the non-diaphragm dysfunction group experienced early transient postoperative weakening of diaphragm function, followed by rapid recovery to the preoperative level on the 7th day after surgery, unlike the diaphragm dysfunction group. There were no significant differences between bilateral DE in the two groups on the day before surgery, and the left DE was significantly lower than the right DE within 24 hours after extubation and on the 7th day after surgery in the diaphragm dysfunction group (cm: 0.93±0.72 vs. 1.45±0.70 within 24 hours after extubation, 1.06±0.77 vs. 1.70±0.92 on the 7th day after surgery, both P < 0.05) but no significant difference was found in bilateral DT or DTF. The chest CT scan showed that, the incidence of postoperative diaphragm elevation was 61.2% (41/67), and 38.8% (26/67) did not, while no statistically significant difference in DEF was found between the two groups, nor within each group on both sides. Analysis of the clinical data showed a higher proportion of atrial fibrillation and pulmonary hypertension before surgery [atrial fibrillation: 36.8% (7/19) vs. 10.4% (5/48), pulmonary hypertension: 15.8% (3/19) vs. 2.1% (1/48), both P < 0.05], a higher incidence of high-flow oxygenation and pneumonia during surgery [high-flow oxygenation: 52.6% (10/19) vs. 25.0% (12/48), pneumonia: 73.7% (14/19) vs. 45.8% (22/48), both P < 0.05], and a longer duration of mechanical ventilation and length of intensive care unit (ICU) stay [duration of mechanical ventilation (hours): 47.0 (38.0, 73.0) vs. 24.5 (20.0, 48.0), length of ICU stay (hours): 69.0 (65.0, 117.5) vs. 60.0 (42.3, 90.6), both P < 0.05] in the diaphragm dysfunction group as compared with those in the non-diaphragm dysfunction group. CONCLUSIONS There was a high incidence of diaphragm dysfunction after cardiac sternotomy, which reflected the early transient postoperative weakening of diaphragm function, followed by rapid recovery to the preoperative level in most patients, predominantly on the left side. Diaphragm dysfunction, which was associated with atrial fibrillation and pulmonary hypertension significantly increased the incidence of postoperative pneumonia and prolonged the duration of mechanical ventilation and length of ICU stay.
Humans ; Diaphragm/physiopathology* ; Prospective Studies ; Sternotomy/adverse effects* ; Ultrasonography ; Postoperative Complications/diagnostic imaging* ; Tomography, X-Ray Computed ; Male ; Female ; Middle Aged ; Aged ; Cardiac Surgical Procedures/adverse effects*

Objective To investigate the risk factors and intervention measures for surgical site infec-tion following posterolateral approach lumbar fusion surgery.Methods A total of 1 078 patients who under-went posterolateral approach lumbar fusion surgery in the department of spine surgery from January 1,2022 to December 31,2023 were included.Patient related information was collected through the real-time nosocomi-al infection monitoring system,while medical visit information was obtained via the outpatient electronic med-ical record system.Multivariate logistic regression analysis was performed to identify risk factors for surgical site infection.Results Among the 1 078 patients,34 cases(3.15%)developed surgical site infections,while 1 044 cases did not.Multivariate logistic regression analysis revealed that age,smoking,hypertension,diabetes,concurrent hospital stay,operative time,duration of postoperative antimicrobial use after initial surgery,and total antimicrobial use duration were significant risk factors for surgical site infection(P＜0.05).Among the 34 infected patients,the duration of antimicrobial use varied significantly across different infection sites(P＜0.05),with the longest duration observed in patients with deep space infections.Conclusion Targeted surveil-lance of surgical site infections should be reinforced based on these risk factors.Perioperative infection control measures must be strictly implemented to improve the scientific,precise,and standardized management of sur-gical-related nosocomial infections.

Objective To establish a quantifiable quality control index system for infection management in neonatal specialty hospitals for the comprehensive evaluation of neonatal healthcare-associated infection(HAI)management quality,and to promote the continuous enhancement and improvement of neonatal HAI management quality.Methods The framework of the index system was preliminarily established through literature research and focus group discussion,the indexes were repeatedly screened using Delphi expert consultation approach,and the weights of each index were determined using the analytic hierarchy process.The empirical study of the established index sys-tem was conducted using TOPSIS method and rank sum ratio method.Results Three rounds of expert consultation were conducted,and the effective response rate of the questionnaire was 100％.The authoritative coefficient of the third round of expert consultation was 0.89,and the Kendall's coefficient of concordance for expert opinion was 0.322.The established index system included 3 first-level indexes,6 second-level indexes,and 16 third-level inde-xes.Thirteen of third-level indexes could be directly obtained from the hospital information system.Conclusion The quality control index system for neonatal HAI management established in this study is relatively scientific,with rational weights and all quantifiable indexes.It can be used for vertical and horizontal evaluations of neonatal HAI management quality,providing a reference for the continuous improvement of neonatal HAI management work.

Multi-conjugate vaccine and polyvalent vaccine can reduce the number of vaccinations, improve vaccination efficiency, and provide wider protection against diseases, and can not only brings convenience to recipients but also reduce healthcare costs, making it a key focus in modern vaccine development. However, even if the components of the vaccine are derived from already approved monovalent vaccines, it must still be considered as a new vaccine and undergo randomized controlled clinical trials to evaluate their safety and efficacy in humans. Due to the inclusion of multiple antigens, clinical evaluation must consider the potential interactions between or among the components, as well as the impacts of adjuvants, preservatives, and other ingredients on the vaccines' safety and efficacy. These factors introduce certain specific challenges in the clinical evaluation of multi-conjugate vaccine and polyvalent vaccine. This article summarizes the key elements and methods of clinical study design for multi-conjugate vaccine and polyvalent vaccine in terms of safety, immunogenicity, and protective efficacy, and discuss the problems and challenges exisitng in vaccine clinical evaluation to provide reference for the standardization of clinical study design of multi-conjugate vaccine and polyvalent vaccine.

The impact of vaccines on public health and their effectiveness in controlling infectious diseases partly depends on their coverage rate, which refers to the proportion of individuals vaccinated within a specific population. Vaccination coverage is foundational data for vaccine immunization programs, a key parameter for evaluating and monitoring the implementation of vaccination plans, and an important data point in real-world post-market studies of vaccines. Additionally, research on vaccination coverage is becoming increasingly prevalent in vaccine evaluation, primarily used to establish the risk of disease incidence in populations with different vaccination coverage rates in order to assess the protective effectiveness of vaccines. This paper reviews the research methods used to assess vaccine coverage both domestically and internationally, as well as their applications in evaluating vaccine effectiveness. It also analyzes and compares the advantages and disadvantages of different research methods for measuring vaccination coverage and discusses the significance of monitoring and improving vaccine coverage rates. The goal is to promote research and application of vaccination coverage rates in China, providing a scientific basis for post-market vaccine studies and for local administrative departments to formulate immunization policies.

Quality control of pediatric musculoskeletal ultrasound(MSKUS)must be integrated throughout the entire diagnostic process.Its core lies in a thorough understanding of the growth,development,and pathophysiological characteristics of the pediatric musculoskeletal system,mastery of MSKUS examination techniques,and the establishment of a systematic and comprehensive diagnostic framework.This review focuses on the core aspects of pre-examination,during examination,and post-examination to describe the quality control points and strategies for pediatric MSKUS.

Objective Utilizing patient journey mapping to decipher disease management behaviors,barriers,and needs in young and middle-aged liver transplant recipients,providing implications for self-management optimization and quality of life improvement.Methods Using purposive sampling,12 young and middle-aged liver transplant patients who attended outpatient clinics or were hospitalized in liver transplant center of a tertiary hospital in Qingdao were selected for semi-structured interviews from September to November 2024.Thematic extraction and analysis were performed using Colaizzi's 7-step analysis,ultimately resulting in the development of a patient journey map.Results The journey stages were divided into transplantation decision-making period,transplantation waiting period,perioperative period,and post-discharge management period,and the journey key elements were designed as behaviors,barriers,and needs.A total of 25 themes were extracted,including behaviors(such as referrals to higher-level hospitals,verification of treatment options),barriers(such as lack of decision-making autonomy,health information-seeking barriers),and needs(such as shared decision-making,financial assistance).Ultimately,resulting in a map of the disease management journey for young and middle-aged liver transplant recipients.Conclusion The behaviors,barriers,and needs in disease management among young and middle-aged liver transplant recipients demonstrate distinct phase-specific patterns.Healthcare providers should deliver precise and dynamic interventions tailored to each clinical phase,aiming to foster optimal self-management behaviors,address phase-specific banriers,and meet evolving patient needs throughout the transplant continuum.