Objective To systematically analyze the medical radiation exposure levels in a district of Ningbo City and to provide a scientific basis for the reasonable and effective control of medical radiation exposure. Methods Based on the radiological diagnosis frequency and dose information system, basic medical radiation exposure data were collected, such as radiation doses received by patients in various X-ray diagnostic examinations, from all 13 public medical institutions in a district of Ningbo City from January 1 to December 31, 2020. The data were analyzed for the percentage and collective effective dose of various diagnostic examinations, the distribution of examinations by sex and age, and the number of patients undergoing two or more examinations and their cumulative doses within multiple time intervals. Results Among medical X-ray diagnostic examinations in the district, the percentages of CT examination and routine photography examination were 50.88% and 47.93%, respectively, and the collective effective dose of CT examination accounted for 97.75%. By age and sex, the frequency of examination was the highest in the age group of 45-54 years, and the frequency of examination in the male was higher than that in the female before age 55. The annual effective dose for two patients exceeded 100 mSv. Conclusion In this study, CT examination accounted for up to 50.88% of all medical X-ray diagnostic examinations, and contributed 97.75% of the collective effective dose, highlighting the need for particular attention to the justification of medical radiation exposure from CT.

Objective:To investigate the potential value of cerebral glucose metabolism characteristics in anti-leucine-rich glioma-inactivated protein 1 (LGI1) antibody-related encephalitic patients during acute phase as the clinical indicator of disease outcomes.Methods:From October 2019 to December 2023, 28 patients (18 males, 10 females; age (56.6±11.9) year) with anti-LGI1 antibody-related encephalitis diagnosed at Huashan Hospital, Fudan University were prospectively enrolled. All patients received baseline brain 18F-FDG PET imaging and were divided into different subgroups according to the prognosis (good prognosis and poor prognosis groups) and recurrence (recurrence and non-recurrence groups) after follow-up. The difference of Montreal Cognitive Assessment (MoCA) score between the two groups was compared by Mann-Whitney U test. Statistical parametric mapping (SPM) analysis was used to analyze the PET images of different groups by independent-sample t test, and the characteristics of cerebral glucose metabolism of patients with different outcomes were obtained. Results:MoCA scores between the recurrence group ( n=6) and the non-recurrence group ( n=22; 14.0(9.8, 20.5) vs 22.0(18.0, 24.0); Z=2.17, P=0.030), and between the poor prognosis group ( n=13) and the good prognosis group ( n=15; 14.0(10.0, 22.0) vs 22.0(19.8, 25.3); Z=2.47, P=0.013) were significantly different. Compared with the good prognosis group, the cerebral glucose metabolism in the poor prognosis group was decreased in the bilateral frontal lobe, lateral temporal lobe, inferior parietal lobule and cingulate gyrus, but increased in the brainstem, bilateral lentiform nucleus and bilateral paracentral lobule/postcentral gyrus (all t=1.71, all P<0.05). Compared with the non-recurrence group, the metabolism of bilateral medial frontal gyrus, anterior cingulate gyrus, bilateral insula, superior temporal gyrus and thalamus decreased in the recurrence group, while the metabolism of bilateral precentral gyrus, inferior frontal gyrus and bilateral lentiform nucleus increased (all t=1.71, all P<0.05). Conclusion:18F-FDG PET imaging reveals the differences in brain metabolism of anti-LGI1 antibody-related encephalitic patients at baseline with different outcomes (prognosis, recurrence or not), which can provide a new perspective for the clinical evaluation of the disease at baseline.

Objective:To prepare aldolylated hyaluronic acid-modified antimicrobial carbon dots (AHA-CDs) eye drops and evaluate its antibacterial activity against Staphylococcus aureus in vitro and in vivo. Methods:AHA-CDs eye drops were synthesized by modifying small particle size positively charged carbon dots and introducing aldehyde-based hyaluronic acid.The AHA-CDs were characterized by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy.The antibacterial activity of AHA-CDs against Staphylococcus aureus was evaluated using the microdilution method, plate counting, and live-dead bacteria fluorescence staining in vitro.The mouse bacterial keratitis model was established by removing the corneal epithelium after ring drilling and inoculating Staphylococcus aureus.Eighteen conventional female C57BL/6 mice aged 6-8 weeks were selected and divided into a blank control group, an AHA-CDs-treated group and a tobramycin-treated group of 6 mice each using random number table method, and the mice were treated with phosphate buffer saline, 80 μg/ml AHA-CDs, and 80 μg/ml tobramycin eye drops three times daily for 5 consecutive days accordingly to assess antibacterial activity against Staphylococcus aureus in vivo.Another 12 mice were divided into an AHA-CDs group and a normal control group using the random number table method, with 6 mice in each group, which were treated with 80 μg/ml AHA-CDs and phosphate buffer saline for 7 days.The mice were then sacrificed.Their eyeballs were removed and stained with hematoxylin-eosin to observe and compare the morphology and integrity of the eyeballs between the two groups to evaluate the treatment's biosafety.The use and care of the animals complied with the principles of the ARRIVE guidelines.The study protocol was approved by the Ethics Committee of the Experimental Animal Care of Henan Eye Hospital (No.HNEECA-2022-17). Results:The successful preparation of AHA-CDs was demonstrated by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. In vitro studies showed that the minimum inhibitory concentration of AHA-CDs against Staphylococcus aureus was approximately 8 μg/ml, which effectively inhibited bacterial growth at a lower concentration.Plate counting results showed that only 20% of the bacteria survived after 10 minutes of treatment with AHA-CDs.Fluorescence staining of live/dead bacteria showed obvious red fluorescence signals after 4 hours of treatment with AHA-CDs and SP-CDs. In vivo studies showed that, after 5 days of treatment with AHA-CDs eye drops, the corneas of mice with bacterial keratitis were obviously transparent, and the corneal epithelium was basically repaired.In contrast, the tobramycin-treated group exhibited incomplete epithelial repair and mild corneal edema. In vivo safety evaluation revealed that the eye tissue morphology remained intact and no structural abnormalities were observed after AHA-CDs treatment. Conclusions:AHA-CDs eye drops have superior antibacterial effects in vivo and in vitro, and inactivate bacteria rapidly and effectively.

Objective To investigate the impact of sintilimab combined with TP chemotherapy regimen on immune function and prognostic survival in patients with advanced esophageal cancer.Methods A total of 82 patients with advanced esophageal cancer who received treatment in the hospital from January 2022 to October 2023 were enrolled.They were divided into two groups with 41 cases in each group using the random number table method.The control group was given the TP chemotherapy regimen,while the observation group was treated with sintilimab in addition to the TP chemotherapy regimen used in the control group.The treatment cycle was 21 days,and both groups received 4 cycles of treatment.After that,the observation group received sintilimab monotherapy for maintenance treatment for at least 1 year.The disease control rate(DCR)and objective response rate(ORR)of the patients were recorded.The immune function,levels of inflammatory factors and tumor markers before and after treatment were compared between the two groups.The swallowing function and quality of life of the patients before and after treatment were evaluated using the Swallowing Safety Assessment(SSA)and the Quality of Life Instruments for Cancer Patients-Esophageal Cancer(QLICP-ES).The occurrence of adverse reactions was also recorded.After the start of treatment,the patients were followed up for 18 months,and the overall survival(OS)and survival rate were recorded.Results In the observation group,the partial remission rate and disease control rate were 53.66%and 87.80%respectively,both higher than those in the control group.After treatment,the levels of CD3+and CD4+in the observation group were(50.48±5.61)%and(37.96±4.69)%respectively,which were higher than(44.73±5.12)%and(33.15±4.21)%in the control group.The immune function of the observation group was improved compared with the control group,while the levels of inflammatory factors and tumor markers were lower than those in the control group.The swallowing function and quality of life were significantly improved compared with the control group(P<0.05).The 18-month follow-up results showed that the median overall survival(OS)in the observation group was 16(9,17)months,and that in the control group was 9(7,14)months.The OS in the observation group was longer than that in the control group(χ2=13.394,P<0.001).The 18months survival rates in the observation group and the control group were 60.98%(25/41)and 36.59%(15/41)respec-tively,with the observation group being higher than the control group(χ2=4.881,P=0.027).Conclusion The sintilimab combined with TP chemotherapy regimen is beneficial for improving immune function and enhancing the survival status of patients with advanced esophageal cancer.

Objective:To prepare aldolylated hyaluronic acid-modified antimicrobial carbon dots (AHA-CDs) eye drops and evaluate its antibacterial activity against Staphylococcus aureus in vitro and in vivo. Methods:AHA-CDs eye drops were synthesized by modifying small particle size positively charged carbon dots and introducing aldehyde-based hyaluronic acid.The AHA-CDs were characterized by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy.The antibacterial activity of AHA-CDs against Staphylococcus aureus was evaluated using the microdilution method, plate counting, and live-dead bacteria fluorescence staining in vitro.The mouse bacterial keratitis model was established by removing the corneal epithelium after ring drilling and inoculating Staphylococcus aureus.Eighteen conventional female C57BL/6 mice aged 6-8 weeks were selected and divided into a blank control group, an AHA-CDs-treated group and a tobramycin-treated group of 6 mice each using random number table method, and the mice were treated with phosphate buffer saline, 80 μg/ml AHA-CDs, and 80 μg/ml tobramycin eye drops three times daily for 5 consecutive days accordingly to assess antibacterial activity against Staphylococcus aureus in vivo.Another 12 mice were divided into an AHA-CDs group and a normal control group using the random number table method, with 6 mice in each group, which were treated with 80 μg/ml AHA-CDs and phosphate buffer saline for 7 days.The mice were then sacrificed.Their eyeballs were removed and stained with hematoxylin-eosin to observe and compare the morphology and integrity of the eyeballs between the two groups to evaluate the treatment's biosafety.The use and care of the animals complied with the principles of the ARRIVE guidelines.The study protocol was approved by the Ethics Committee of the Experimental Animal Care of Henan Eye Hospital (No.HNEECA-2022-17). Results:The successful preparation of AHA-CDs was demonstrated by transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. In vitro studies showed that the minimum inhibitory concentration of AHA-CDs against Staphylococcus aureus was approximately 8 μg/ml, which effectively inhibited bacterial growth at a lower concentration.Plate counting results showed that only 20% of the bacteria survived after 10 minutes of treatment with AHA-CDs.Fluorescence staining of live/dead bacteria showed obvious red fluorescence signals after 4 hours of treatment with AHA-CDs and SP-CDs. In vivo studies showed that, after 5 days of treatment with AHA-CDs eye drops, the corneas of mice with bacterial keratitis were obviously transparent, and the corneal epithelium was basically repaired.In contrast, the tobramycin-treated group exhibited incomplete epithelial repair and mild corneal edema. In vivo safety evaluation revealed that the eye tissue morphology remained intact and no structural abnormalities were observed after AHA-CDs treatment. Conclusions:AHA-CDs eye drops have superior antibacterial effects in vivo and in vitro, and inactivate bacteria rapidly and effectively.

Objective To investigate the impact of sintilimab combined with TP chemotherapy regimen on immune function and prognostic survival in patients with advanced esophageal cancer.Methods A total of 82 patients with advanced esophageal cancer who received treatment in the hospital from January 2022 to October 2023 were enrolled.They were divided into two groups with 41 cases in each group using the random number table method.The control group was given the TP chemotherapy regimen,while the observation group was treated with sintilimab in addition to the TP chemotherapy regimen used in the control group.The treatment cycle was 21 days,and both groups received 4 cycles of treatment.After that,the observation group received sintilimab monotherapy for maintenance treatment for at least 1 year.The disease control rate(DCR)and objective response rate(ORR)of the patients were recorded.The immune function,levels of inflammatory factors and tumor markers before and after treatment were compared between the two groups.The swallowing function and quality of life of the patients before and after treatment were evaluated using the Swallowing Safety Assessment(SSA)and the Quality of Life Instruments for Cancer Patients-Esophageal Cancer(QLICP-ES).The occurrence of adverse reactions was also recorded.After the start of treatment,the patients were followed up for 18 months,and the overall survival(OS)and survival rate were recorded.Results In the observation group,the partial remission rate and disease control rate were 53.66%and 87.80%respectively,both higher than those in the control group.After treatment,the levels of CD3+and CD4+in the observation group were(50.48±5.61)%and(37.96±4.69)%respectively,which were higher than(44.73±5.12)%and(33.15±4.21)%in the control group.The immune function of the observation group was improved compared with the control group,while the levels of inflammatory factors and tumor markers were lower than those in the control group.The swallowing function and quality of life were significantly improved compared with the control group(P<0.05).The 18-month follow-up results showed that the median overall survival(OS)in the observation group was 16(9,17)months,and that in the control group was 9(7,14)months.The OS in the observation group was longer than that in the control group(χ2=13.394,P<0.001).The 18months survival rates in the observation group and the control group were 60.98%(25/41)and 36.59%(15/41)respec-tively,with the observation group being higher than the control group(χ2=4.881,P=0.027).Conclusion The sintilimab combined with TP chemotherapy regimen is beneficial for improving immune function and enhancing the survival status of patients with advanced esophageal cancer.

Objective:To investigate the potential value of cerebral glucose metabolism characteristics in anti-leucine-rich glioma-inactivated protein 1 (LGI1) antibody-related encephalitic patients during acute phase as the clinical indicator of disease outcomes.Methods:From October 2019 to December 2023, 28 patients (18 males, 10 females; age (56.6±11.9) year) with anti-LGI1 antibody-related encephalitis diagnosed at Huashan Hospital, Fudan University were prospectively enrolled. All patients received baseline brain 18F-FDG PET imaging and were divided into different subgroups according to the prognosis (good prognosis and poor prognosis groups) and recurrence (recurrence and non-recurrence groups) after follow-up. The difference of Montreal Cognitive Assessment (MoCA) score between the two groups was compared by Mann-Whitney U test. Statistical parametric mapping (SPM) analysis was used to analyze the PET images of different groups by independent-sample t test, and the characteristics of cerebral glucose metabolism of patients with different outcomes were obtained. Results:MoCA scores between the recurrence group ( n=6) and the non-recurrence group ( n=22; 14.0(9.8, 20.5) vs 22.0(18.0, 24.0); Z=2.17, P=0.030), and between the poor prognosis group ( n=13) and the good prognosis group ( n=15; 14.0(10.0, 22.0) vs 22.0(19.8, 25.3); Z=2.47, P=0.013) were significantly different. Compared with the good prognosis group, the cerebral glucose metabolism in the poor prognosis group was decreased in the bilateral frontal lobe, lateral temporal lobe, inferior parietal lobule and cingulate gyrus, but increased in the brainstem, bilateral lentiform nucleus and bilateral paracentral lobule/postcentral gyrus (all t=1.71, all P<0.05). Compared with the non-recurrence group, the metabolism of bilateral medial frontal gyrus, anterior cingulate gyrus, bilateral insula, superior temporal gyrus and thalamus decreased in the recurrence group, while the metabolism of bilateral precentral gyrus, inferior frontal gyrus and bilateral lentiform nucleus increased (all t=1.71, all P<0.05). Conclusion:18F-FDG PET imaging reveals the differences in brain metabolism of anti-LGI1 antibody-related encephalitic patients at baseline with different outcomes (prognosis, recurrence or not), which can provide a new perspective for the clinical evaluation of the disease at baseline.

Objective With the increase in pet-owning households in China, veterinary clinics have increased at an annual rate of 19.86%. However, the management blind area that may exist in multi-department supervision has led to a significantly worse working environment of radiation workers in veterinary clinics than that of medical institutions. The purpose of this study was to understand the levels of occupational external exposure of radiation workers in veterinary clinics in China, analyze the occupational risks faced by radiation workers in veterinary clinics, contribute to the protection of the occupational health of radiation workers, and provide data and scientific basis for the formulation of national relevant regulations and standards. Methods The individual dose monitoring data of radiation workers in selected veterinary clinics in 2022 were obtained from the National Individual Dose Registration System. Results This study involved 1868 radiation workers from 1216 veterinary clinics in 28 provinces and municipalities in China. The maximum annual effective dose was 8.93 mSv, the annual collective dose was 536.77 man·mSv, the average annual effective dose was 0.29 mSv, and the median was 0.15 mSv. The largest proportion of individuals (94.5%) received a dose of less than 1.0 mSv, while 5.4% had doses ranging from 1.0 mSv to less than 5.0 mSv. For radiation workers with an annual effective dose of 1.0 mSv and above, the individual distribution ratio of radiation workers in veterinary clinics was significantly higher compared with those in medical institutions and industrial applications (P < 0.05). Conclusion The levels of occupational external exposure of radiation workers in veterinary clinics meet the requirements of national standards. However, attention should still be paid to the radiation protection of radiation workers in veterinary clinics. This includes enhancing the responsibility awareness of veterinary clinic owners, strengthening protection training for radiation workers, protecting the occupational health of practitioners, and preventing the occurrence of occupational radiation diseases.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Objective To investigate the effect of microRNA-223(miR-223)on prostate cancer cell damage by regulating the Kelch-like epichlorohydrin related protein 1(Keap1)/nuclear factor E2 related factor 2(Nrf2)/antioxidant response element(ARE)signaling pathway.Methods The prostate cancer cell line PC3 was cultured and randomly divided into control,down-regulated miR-223,and up-regulated miR-223 groups.Changes in miR-223 expression,cell proliferation rate,cell migration number,cell invasion number,apoptosis rate,and expression level of Keap1/Nrf2/ARE signaling pathway were explored.Results Compared with the control group,the cell invasion number,cell migration number,cell proliferation rate,Nrf2 and ARE expression increased at 24,48 and 72 h in down-regulated miR-223 group,while the expressions of miR-223,Keap1 and apoptosis rate decreased(P<0.05).Compared with the down-regulated miR-223 group,24,48 and 72 h cell proliferation rate,cell invasion number,cell migration number,ARE and Nrf2 expression decreased in the up-regulated miR-223 group,while miR-223,apoptosis rate and Keap1 expression increased(P<0.05).Conclusion Regulation of miR-223 effectively ameliorates prostate cell injury,and the mechanism may be related to the Keap1/Nrf2/ARE signaling pathway.