Cyclic neutropenia (CN) is relatively rare in clinical practice, and cases complicate with intestinal fistula have not been reported yet. This article reports a 45 year old female patient with CN and intestinal fistula, hoping to improve clinical experience in the diagnosis and treatment of such diseases.

The discovery of hemoglobin variants with low oxygen affinity,diagnostic methods,prognosis of carriers,and developments in analyzing hemoglobin oxygen-carrying and-releasing abilities are reviewed in this article in order to draw the attention of related clinical departments and to provide references for optimizing the process of diagnosis and treatment.Hemoglobin variants with low oxygen affinity originate from gene mutations encoding hemoglobin and autosomal dominant inheritance.The diagnosis should be combined with clinical manifestations and family history and differentiated from methemoglobinemia.A decrease in pulse oxygen saturation(SpO2)is often the first abnormality observed in asymptomatic carriers of hemoglobin variants with low oxygen affinity.Laboratory examinations include arterial blood gas analysis,hemoglobin oxygen affinity testing,protein analysis and gene sequencing.Most carriers do not require specific treatment and have a good prognosis,who should avoid acute hypoxic injuries induced by strenuous exercise,emotional stress,or high temperature.Moreover,health practitioners should pay attention to their responses to anesthetics,agents that induce oxidative stress,drugs that increase hemoglobin oxygen affinity,and prostacyclins.Hemoglobin oxygen-carrying and-releasing analysis is a promising tool to identify carriers of hemoglobin variants with low oxygen affinity because it does not involve unnecessary or invasive examinations and is of significant values for clinical diagnosis and treatment.

Objective:To investigate the level of occupational health literacy (OHL) among workers in the electronic manufacturing industry, analyze the influencing factors, and provide a scientific basis for occupational health promotion work.Methods:From July to September 2022, a stratified cluster random sampling method was adopted, and 870 workers from 20 large, medium, small and micro electronic manufacturing enterprises in Guangdong Province were selected as the research subjects. The OHL level of workers was investigated by using the "Personal Questionnaire for Monitoring and Surveying Occupational Health Literacy of National Key Populations", and the influencing factors were analyzed by binary logistic regression.Results:The OHL level of workers in electronic manufacturing industry was 36.09% (314/870). The OHL levels in the four dimensions of occupational health legal knowledge, basic knowledge of occupational health protection, healthy work methods and behaviors, and basic skills of occupational health protection were 39.08% (340/870), 78.97% (687/870), 56.55% (492/870), and 22.41% (195/870), respectively. logistic regression analysis showed that junior high school, senior high school/vocational high school/technical secondary school education, and average monthly income of 5000-6999 yuan and ≥7000 yuan were protective factors for high OHL levels among workers ( P<0.05) . Conclusion:The OHL level of workers in the electronic manufacturing industry is relatively low, and the promotion and intervention of OHL should be actively carried out to effectively improve the health literacy level of workers, focusing on workers with low education and low income.

Objective:To investigate the level of occupational health literacy (OHL) among workers in the electronic manufacturing industry, analyze the influencing factors, and provide a scientific basis for occupational health promotion work.Methods:From July to September 2022, a stratified cluster random sampling method was adopted, and 870 workers from 20 large, medium, small and micro electronic manufacturing enterprises in Guangdong Province were selected as the research subjects. The OHL level of workers was investigated by using the "Personal Questionnaire for Monitoring and Surveying Occupational Health Literacy of National Key Populations", and the influencing factors were analyzed by binary logistic regression.Results:The OHL level of workers in electronic manufacturing industry was 36.09% (314/870). The OHL levels in the four dimensions of occupational health legal knowledge, basic knowledge of occupational health protection, healthy work methods and behaviors, and basic skills of occupational health protection were 39.08% (340/870), 78.97% (687/870), 56.55% (492/870), and 22.41% (195/870), respectively. logistic regression analysis showed that junior high school, senior high school/vocational high school/technical secondary school education, and average monthly income of 5000-6999 yuan and ≥7000 yuan were protective factors for high OHL levels among workers ( P<0.05) . Conclusion:The OHL level of workers in the electronic manufacturing industry is relatively low, and the promotion and intervention of OHL should be actively carried out to effectively improve the health literacy level of workers, focusing on workers with low education and low income.

Objective:To assess the optimal timing and short-term clinical efficacy of sinus drug-eluting stent placement in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods:The minimum sample size was calculated using G-power 3.1.9.7 software. From March 2021 and May 2023, a total of 114 eligible patients with CRSwNP were recruited in this study at the Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University. The patients were randomly assigned to three groups: the control group, the intraoperative stent group, and the postoperative stent group. In the intraoperative stent group, drug-eluting stents were implanted during endoscopic sinus surgery (ESS), while patients in the postoperative stent group received drug-eluting stent 2 weeks after ESS, following routine debridement of the surgical cavity. Bilateral ethmoid sinus stenting was performed for both stent groups, while the control group only underwent ESS with standard postoperative cavity debridement. All subjects were followed up at 2, 4, 8, and 12 weeks postoperatively. Nasal symptom Visual Analog Scale (VAS) scores and endoscopic evaluations of the ethmoid cavity-assessing obstruction, crusting, polypoid mucosal changes, epithelialization of ethmoid cavity, need for intervention, and complications such as middle turbinate lateralization and adhesions-were collected to evaluate the treatment efficacy of three groups. Statistical analyses were performed using GraphPad Prism 9. Analysis of variance (ANOVA) was applied to analyze continuous variables among the three groups, and chi-square tests were used for categorical variables.Results:Among 114 CRSwNP patients, 21 lost follow-up patients and 7 postoperative oral corticosteroid intervention patients were excluded. Finally, 86 patients were included in the analysis, including 45 males and 41 females, aged 18-65 years. The cohort comprised 29 in the control group, 29 in the intraoperative stent group, and 28 in the postoperative stent group. Successful bilateral ethmoid sinus stent implantation was achieved in both stent groups. At 4 weeks postoperatively, compared with the control group, both stent groups showed significant improvements in nasal congestion and rhinorrhea scores ( P<0.05). At 8 weeks, the postoperative group continued to demonstrate superior outcomes in these two symptoms (both P<0.05), while the intraoperative group only showed significant improvement in nasal congestion ( P<0.05). No significant differences were observed in facial pressure, olfactory loss, or nasal dryness scores among the three groups (all P>0.05). Endoscopic evaluation revealed that both stent groups had significant improvements in ethmoid sinus obstruction scores at 4 weeks compared with the control group, with the postoperative group maintaining this advantage at 8 weeks ( P<0.05). At 2 weeks, the intraoperative stent group had higher crusting scores than other groups ( P<0.05). At 2 weeks after stent implantation, the postoperative stent group had significantly lower crusting scores than the intraoperative stent group ( P<0.001). The intraoperative group had a significantly lower incidence of ethmoid sinus edema and polypoid changes at 4 weeks compared with the control group ( P<0.05), while the postoperative group showed reduced rates of these pathological changes at 4, 8, and 12 weeks (all P<0.05). The postoperative stent group had significantly higher rates of ethmoid sinus mucosal epithelialization at 8 and 12 weeks postoperatively compared with the control group. The intraoperative stent group required fewer interventions than the control group at both 8 and 12 weeks, while the postoperative stent group maintained lower interventions rates at all follow-up points after implantation (all P<0.05). Additionally, the incidence of complications was significantly lower in both stent groups compared with the control group ( P<0.05). Overall, stent implantation at different time points showed similar efficacy, with the postoperative group demonstrating more stable outcomes and less crusting/coagulation formation compared with the intraoperative group. Conclusions:The implantation of corticosteroid sinus stents in the ethmoid sinuses effectively controls postoperative inflammation, promotes mucosal epithelialization, and reduces postoperative intervention rates. Stent implantation two weeks after surgery is feasible. Adjusting the timing of stent placement can minimize crust formation and maximize the corticosteroid effect, thereby facilitating a benign course of the surgical site.

Objective:To assess the optimal timing and short-term clinical efficacy of sinus drug-eluting stent placement in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods:The minimum sample size was calculated using G-power 3.1.9.7 software. From March 2021 and May 2023, a total of 114 eligible patients with CRSwNP were recruited in this study at the Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University. The patients were randomly assigned to three groups: the control group, the intraoperative stent group, and the postoperative stent group. In the intraoperative stent group, drug-eluting stents were implanted during endoscopic sinus surgery (ESS), while patients in the postoperative stent group received drug-eluting stent 2 weeks after ESS, following routine debridement of the surgical cavity. Bilateral ethmoid sinus stenting was performed for both stent groups, while the control group only underwent ESS with standard postoperative cavity debridement. All subjects were followed up at 2, 4, 8, and 12 weeks postoperatively. Nasal symptom Visual Analog Scale (VAS) scores and endoscopic evaluations of the ethmoid cavity-assessing obstruction, crusting, polypoid mucosal changes, epithelialization of ethmoid cavity, need for intervention, and complications such as middle turbinate lateralization and adhesions-were collected to evaluate the treatment efficacy of three groups. Statistical analyses were performed using GraphPad Prism 9. Analysis of variance (ANOVA) was applied to analyze continuous variables among the three groups, and chi-square tests were used for categorical variables.Results:Among 114 CRSwNP patients, 21 lost follow-up patients and 7 postoperative oral corticosteroid intervention patients were excluded. Finally, 86 patients were included in the analysis, including 45 males and 41 females, aged 18-65 years. The cohort comprised 29 in the control group, 29 in the intraoperative stent group, and 28 in the postoperative stent group. Successful bilateral ethmoid sinus stent implantation was achieved in both stent groups. At 4 weeks postoperatively, compared with the control group, both stent groups showed significant improvements in nasal congestion and rhinorrhea scores ( P<0.05). At 8 weeks, the postoperative group continued to demonstrate superior outcomes in these two symptoms (both P<0.05), while the intraoperative group only showed significant improvement in nasal congestion ( P<0.05). No significant differences were observed in facial pressure, olfactory loss, or nasal dryness scores among the three groups (all P>0.05). Endoscopic evaluation revealed that both stent groups had significant improvements in ethmoid sinus obstruction scores at 4 weeks compared with the control group, with the postoperative group maintaining this advantage at 8 weeks ( P<0.05). At 2 weeks, the intraoperative stent group had higher crusting scores than other groups ( P<0.05). At 2 weeks after stent implantation, the postoperative stent group had significantly lower crusting scores than the intraoperative stent group ( P<0.001). The intraoperative group had a significantly lower incidence of ethmoid sinus edema and polypoid changes at 4 weeks compared with the control group ( P<0.05), while the postoperative group showed reduced rates of these pathological changes at 4, 8, and 12 weeks (all P<0.05). The postoperative stent group had significantly higher rates of ethmoid sinus mucosal epithelialization at 8 and 12 weeks postoperatively compared with the control group. The intraoperative stent group required fewer interventions than the control group at both 8 and 12 weeks, while the postoperative stent group maintained lower interventions rates at all follow-up points after implantation (all P<0.05). Additionally, the incidence of complications was significantly lower in both stent groups compared with the control group ( P<0.05). Overall, stent implantation at different time points showed similar efficacy, with the postoperative group demonstrating more stable outcomes and less crusting/coagulation formation compared with the intraoperative group. Conclusions:The implantation of corticosteroid sinus stents in the ethmoid sinuses effectively controls postoperative inflammation, promotes mucosal epithelialization, and reduces postoperative intervention rates. Stent implantation two weeks after surgery is feasible. Adjusting the timing of stent placement can minimize crust formation and maximize the corticosteroid effect, thereby facilitating a benign course of the surgical site.

Cyclic neutropenia (CN) is relatively rare in clinical practice, and cases complicate with intestinal fistula have not been reported yet. This article reports a 45 year old female patient with CN and intestinal fistula, hoping to improve clinical experience in the diagnosis and treatment of such diseases.

With the continuous progress of human assisted reproductive technology(ART),more genetic diseases have been discovered and the use of innovative technologies is intended to reduce genetic risks,and the reproductive rights of infertile couples have been protected and satisfied to a greater extent.However,in some special genetic cases,offspring rights need to be fully considered.This paper conducted an ethical analysis of an"ectodermal dysplasia"case asking for the implementation of human ART to assist in pregnancy,revealing the ethical dilemmas in the implementation of ART for patients with genetic diseases,which were caused by the contradiction between the protection of the patient's reproductive rights and the offspring rights,as well as the contradiction between the implementation of ART and the blocking of genetic risk.According to the literature review,it is proposed that in the diagnosis,treatment,and ethical judgment process of genetic cases,informed consent should be fully fulfilled.Based on the ethical foundation of care,narrative medicine methods should be used to form doctor-patient joint decision-making,avoiding paternalism.Meanwhile,sufficient information support should be provided and the ethical supervision mechanism should be improved to effectively solve the ethical dilemmas.

Objective:To compare the efficacy of pars plana vitrectomy (PPV) combined with human amniotic membrane (hAM) plugging technique or internal limiting membrane (ILM) flap insertion technique for high myopia macular hole retinal detachment (MHRD).Methods:A non-randomized controlled clinical study was performed.Sixteen eyes of 15 patients with high myopia MHRD treated in the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from July 2020 to August 2021 were included.All patients underwent PPV and were divided into hAM plug group (7 eyes of 7 patients) and the ILM insertion group (9 eyes of 8 patients) based on the different plugging materials.The best corrected visual acuity (BCVA) and intraocular pressure were measured before surgery and at 1 week, 1, 3, and 6 months postoperative, respectively.Slit-lamp microscopy combined with lenses, scanning laser ophthalmoscope and optical coherence tomography (OCT) were used to examine the fundus, the macular hole closure and retinal reposition.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (No.SH9H-2021-T322-2). Written informed consent was obtained from each subject.Results:The retinal reattachment was achieved in 6 eyes in the hAM plug group and all 9 eyes in the ILM insertion group after initial surgery.The macular hole closure was observed in 5 eyes in the hAM plug group and 8 eyes in the ILM insertion group after initial surgery, and there was no statistical difference in the macular hole closure rate between the two groups ( P>0.05). There were significant differences in the overall comparison of BCVA between the two groups over time ( Ftime=4.420, P<0.05). Postoperative BCVA at different time points was better than preoperative BCVA in each group, but the differences were not significant (all at P>0.05). There was no significant difference in the overall comparison of BCVA between the two groups ( Fgroup=0.183, P>0.05). Two eyes in the hAM plug group and 4 eyes in the ILM insertion group developed transient ocular hypertension, which returned to normal after 1 week of treatment. Conclusions:Both PPV combined with hAM plugging technique and ILM insertion technique are safe and effective for the treatment of MHRD in high myopia.The hAM plugging technique can not only achieve anatomical reduction but also functional recovery of the retina even in complicated fundus conditions.

ObjectiveTo analyze the epidemic characteristics of measles and rubella in Pudong New Area of Shanghai from 2013 to 2022， and to provide data support for the elimination of measles and rubella. MethodsEnzyme linked immunosorbent assay was used to detect IgM antibodies in serum samples. The sequence of 630 nucleotides at the C-terminal of N gene of measles virus was amplified by reverse transcription-polymerase chain reaction and the phylogenic tree was constructed. ResultsA total of 1 529 suspected cases of measles were detected from 2013 to 2022， among which the positive rate of measles IgM antibody was 33.55% （513/1 529）. The highest positive rate （20.73%） was from March to May ， and the positive rate of rubella IgM antibody was 6.80% （104/1 529）. The positive rate of both IgM was higher in males than that in females （P<0.05）. The IgM against measles was mainly detected in 0‒ years old （63.16%， 96/152） and 20‒ years old （45.61%， 161/353）. The IgM against rubella was mainly detected in 10‒20 years old （27.27%， 18/66）. The IgM antibody could be detected more easily from 4 to 28 days after eruption， and the IgM antibody positive rate of measles/rubella from 2020 to 2022 was significantly lower than previous years （2013‒2019）. There were 2 D8 genotype strains， and the rest were H1a gene subtypes. ConclusionThe positive rate of IgM antibodies against measles/rubella in Pudong New Area of Shanghai decreased significantly. People aged 0‒ years and 20‒ years old are more susceptible to measles， and rubella is concentrated in 10‒ years old. It is necessary to strengthen the vaccination of school-age children， in order to achieve the goal of eliminating measles. The age group with high risk of exposure should be checked for vaccination status to ensure the enhanced immunization， and the surveillance of imported measles cases should be strengthened.