Background The job content of aircraft maintenance workers is complex, with high intensity and high requirements, and they are prone to work-related musculoskeletal disorders (WMSDs), but related research is relatively rare. Objective To investigate the positive rate of WMSDs among aircraft maintenance workers, evaluate ergonomic load, and analyze the risk factors of WMSDs. Methods We used a self-compiled questionnaire for WMSDs and the Quick Exposure Checklist (QEC) to investigate the basic situation, positive rate of WMSDs, and the ergonomic load of 2271 male maintenance workers in 6 departments of an aircraft maintenance company, including airline maintenance, overall overhaul, accessory/landing gear overhaul, engine overhaul, product customization, and power assist. We used a logistic regression model to analyze the risk factors of WMSDs in the neck, shoulder, hand/wrist, and lower back. Results The positive rate of WMSDs in the past 12 months was 70.4% (1598/2271) and the positive rate of WMSDs in different body parts ranged from 6.6% to 49.5%, with the top three parts of lower back, neck, and knee, respectively. There were statistically significant differences in the positive rate among different departments (P<0.05). The average QEC scores for neck, hand/wrist, and back (static) were moderate, while those for shoulder and back (dynamic) were high, and the body part specific positive rate of WMSDs increased with the increase of ergonomic load level. Working years (5-<10 years, ≥20 years), working with back flexed or twisted or side bent (moderately, excessively), high maximum force level exerted by one hand, and feeling difficult (sometimes, often) and stressful (moderately, very) while working were associated with higher risks of lower back pain (OR=1.486, 1.505; 2.151, 3.769; 1.637; 2.110, 2.407; 1.637, 1.794; P<0.05). Working years (15-<20 years, ≥20 years), working with head/neck bent or twisted (occasionally, continuously), feeling difficult (sometimes) and stressful (very) while working were associated with higher risks of neck pain (OR=1.731, 1.586; 3.732, 8.341; 1.633; 1.696; P<0.05). Working years (15-<20 years, ≥20 years), working with hands in a high position (at shoulder or above), very frequent shoulder/arm movements, feeling difficult (sometimes, often) and stressful (moderately, very) while working were associated with higher risks of shoulder pain (OR=1.587, 1.709; 1.299; 1.521; 1.643, 2.239; 1.659, 1.977; P<0.05). Working with wrist at deviated or bent angle, high repetition of similar movements, feeling difficult (sometimes, often) and stressful (moderately, very) while working were associated with higher risks of hand/wrist pain (OR=1.692; 1.670; 1.827, 2.884; 2.190, 2.625; P <0.05) . Physical exercise after work (≥3 times·week⁻¹) was associated with a lower risk of neck pain (OR=0.582, P<0.05). Shift workers were at a lower risk of shoulder pain and hand/wrist pain (OR=0.737 and 0.554, P<0.05). Conclusion The high positive rate of WMSDs symptoms among aircraft maintenance workers is related to individual, occupational ergonomic, and psychological factors, and active prevention and intervention should be taken.

【Objective】 To evaluate the therapeutic effect of probiotics on core symptoms in patients with autism spectrum disorder (ASD), in order to provide theoretical basis for the treatment and intervention of ASD. 【Method】 Articles published from January 2000 to May 2023 on the effect of probiotics on core symptoms in ASD children were retrieved from 7 databases, including Chinese Biomedical Literature Service System (SinoMed), Wanfang Data Knowledge Service Platform, VIP Citation Database, and China National Knowledge Infrastructure (CNKI), PubMed, Embase, and Web of Science.Meta-analysis was performed using RevMan 5.4.Effect size, combine heterogeneity test sensitivity analysis and subgroup analysis were calculated. 【Result】 Totally 10 studies with 343 patients were included in this Meta-analysis.Meta-analysis showed that there was statistically significant difference in ASD core symptom score between the intervention group and the control group (SMD=-0.34, 95%CI: -0.55 - -0.12, P<0.05).Subgroup analysis showed that the efficacy of the trial conducted in Asian populations was not significant (SMD=-0.32, 95%CI: -0.63 - 0.00, P=0.05).In Caucasian populations, the therapeutic effect was significant (SMD=-0.35, 95%CI: -0.65 - -0.06, P<0.05).Grouped by age, it was found that the efficacy was not significant in trials involving adults (SMD=-0.12, 95%CI: - 0.57 - 0.33, P=0.61), but significant in trials involving only minors (SMD=-0.40, 95%CI: -0.65 - -0.16, P<0.05).According to the treatment course grouping, the intervention for less than 3 months (SMD=-0.35, 95%CI: -0.66 - -0.03, P<0.05) and more than 3 months (SMD=-0.33, 95%CI: -0.62 - -0.03, P<0.05) showed significant therapeutic efficacy.Grouped by bacterial strains, the efficacy of a single microbial community was not significant (SMD=-0.16, 95%CI: -0.46 - 0.15, P>0.05), while the efficacy of a composite microbial community was significant (SMD=-0.51, 95%CI: -0.81 - -0.21, P<0.05). 【Conclusions】 Probiotic therapy is effective in improving the core symptoms of ASD patients, but is influenced by factors such as race, age and probiotic strain. Composite microbiota has better efficacy in Caucasian and underage populations.

Chimeric antigen receptor (CAR)-T cell therapy has achieved remarkable success in the treatment of hematological malignancies. Based on the immunomodulatory capability of CAR-T cells, efforts have turned toward exploring their potential in treating autoimmune diseases. Bibliometric analysis of 210 records from 128 academic journals published by 372 institutions in 40 countries/regions indicates a growing number of publications on CAR-T therapy for autoimmune diseases, covering a range of subtypes such as systemic lupus erythematosus, multiple sclerosis, among others. CAR-T therapy holds promise in mitigating several shortcomings, including the indiscriminate suppression of the immune system by traditional immunosuppressants, and non-sustaining therapeutic levels of monoclonal antibodies due to inherent pharmacokinetic constraints. By persisting and proliferating in vivo, CAR-T cells can offer a tailored and precise therapeutics. This paper reviewed preclinical experiments and clinical trials involving CAR-T and CAR-related therapies in various autoimmune diseases, incorporating innovations well-studied in the field of hematological tumors, aiming to explore a safe and effective therapeutic option for relapsed/refractory autoimmune diseases.

Hip surgery is often associated with moderate to severe postoperative pain due to exten-sive invasion.A safe and effective postoperative pain treatment can promote patients'recovering activities and facilitate the early functional recovery of the hip after the surgery.Although the routinely used intrave-nous self-controlled analgesia has an exquisite analgesic effect,it carries the risks of postoperative nausea and emesis,excessive sedation,intestinal paralysis,and even respiratory depression.As an alternative to transversus abdominis plane block(TAPB),lumbar quadratus block(QLB)has been gradually applied to the hip joint surgery.In this paper,we review the anatomical basis and characteristics of QLB and its clini-cal application in hip surgery,in order to provide the postoperative analgesia application of QLB.

Objective To investigate the imaging manifestations of inflammatory bowel disease-associated spondyloarthritis(IBD-SpA).Methods A retrospective analysis was conducted on 85 patients with inflammatory bowel disease(IBD)who underwent abdominal CT and MRI examinations.Patients with pregnancy,lactation,psoriasis,tumors,and other conditions were excluded through medical record screening,all patients met the diagnostic criteria for IBD.The presence of spondyloarthritis(SpA)was confirmed through ima-ging findings,and the imaging characteristics of the location and bone changes of SpA were observed.Twenty patients who under-went abdominal CT examination during the same period were selected as the control group.Results A total of 85 patients with IBD under-went CT and MRI examinations,the detection rate of MRI(37.6％)was significantly higher than that of CT(30.6％)(P＜0.05).Based on comprehensive imaging features,5 cases of grade 1,13 cases of grade 11,11 cases of grade Ⅲ,and 3 cases of grade Ⅳ,IBD-SpA were diagnosed.In the control group,1 case of sacroiliitis was detected,of which 1 case of grade Ⅱ.The detection rate of CT in the IBD group(30.6％)was significantly higher than that in the control group(5％)(P＜0.05).Conclusion The incidence of SpA is relatively high in patients with IBD.Both CT and MRI have certain diagnostic value for IBD-SpA.CT has diagnostic advantages in bone sclerosis and joint space narrowing,while MRI can better reflect minor lesions and early bone marrow edema changes.The com-bination of CT and MRI examinations can provide diagnostic evidence for clinicians and effectively improve patient symptoms.

Objective To explore the feasibility and rationality of advanced integrated two-stage laparoscopic simulation training course in standardized training of surgical residents.Methods From December 2019 to December 2021,the advanced integrated two-stage laparoscopic simulation training course was carried out among 2019-2020 surgical residents who received standardized training in our hospital.The course was divided into two stages.In the first stage,BEST(best essential surgical technology training)course,adopted Darwin? endoscopic training system,Tianyan? endoscopic training system,Microport? 3D laparoscopic training system and simple simulative models were used.The second stage,BEST PLUS course,same platform as that in BEST course and in vitro animal models were used.The questionnaire survey method(before and after class questionnaire)was adopted to evaluate the curriculum setting,such as curriculum form,simulators,teaching method,time arrangement,curriculum difficulty,training effect,curriculum satisfaction and so on.Results A total of 37 surgical residents completed the two-stage course training and the questionnaire survey.The overall satisfaction rate with the curriculum setting was 100%.There were 32 residents(86.5%)thought that first stage training course could significantly improve their clinical skills,35 residents(94.6%)thought that second stage training course could significantly improve their clinical skills,and 36 resident(97.3%)thought that the first stage curriculum could significantly help them improve performance in the second stage curriculum.Conclusions The trainees had a high degree of recognition and satisfaction for the advanced integrated two-stage laparoscopic simulation training course.The overall design of course was reasonable and feasible,and was attractive to trainees.

Per- and polyfluoroalkyl substances (PFASs) are persistent organic pollutants (POPs). They are widely used in food packaging, tableware coating, stain resistant furniture, and other industrial production. Humans are exposed to PFASs on a daily basis through drinking water and intaking food, use of consumer products containing PFASs, and occupational exposure during the production of PFASs or related products. A growing body of toxicological studies has shown that PFASs exposure disrupts the thyroid hormone (TH) system and causes hypothyroidism, which is further supported by population epidemiological studies. PFASs can damage thyroid follicular cells and sodium/iodine transporters to impair iodine uptake by thyroid cells. They interfere with the synthesis of thyroglobulin, reduce the activity of thyroid peroxidase, and affect the synthesis and secretion of TH. They interfere with TH transportation and biological effects via TH competitive binding thyroid transporter or thyroid hormone receptor. They suppress TH signaling pathway and deiodinase activity, interfere negative feedback mechanism, and accelerate TH metabolism and excretion. The processes of TH synthesis, transport, degradation, and biological effects may all be affected by PFASs exposure. This paper described possible toxic mechanisms of PFASs on the thyroid from four aspects: TH biosynthesis, transport, action on target cells, and metabolic excretion stage, and summarized the thyroid toxicity associated with PFASs exposure.

Background Aluminum and fluoride are neurotoxic, and aluminum exposure alone is closely related to the overall cognitive function of operational workers. It is unclear about the effect of aluminum and fluoride interactions on cognitive function. Objective To evaluate a potential interaction effect of blood aluminum and urinary fluoride on the overall cognitive function of workers working in an aluminum plant. Methods Using cluster sampling, 230 workers in the electrolysis workshop of an aluminum group company in Shanxi Province were selected, and plasma aluminum concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and urinary fluoride by ion-selective electrode. The study participants were divided into a low blood aluminum group and a high blood aluminum group according to the median (M) of blood aluminum concentration, and a low urinary fluoride group and a high urinary fluoride group by a predetermined cutoff point (2.160 mg·L⁻¹). The Montreal Cognitive Assessment-Beijing (MoCA-BJ) was used to assess overall cognitive function of the workers. Logistic regression model was used to analyze the relationship between blood aluminum, urinary fluoride, and mild cognitive impairment (MCI), including multiplicative interaction analysis and correlation analysis; R language was used to fit an additive interaction model of blood aluminum and urinary fluoride on MCI and to calculate synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (API). Results Among the 230 operational workers, the median blood aluminum concentration (P₂₅, P₇₅) was 40.11 (25.16, 58.89) µg·L⁻¹, and there were 104 cases of abnormal urinary fluoride, with an abnormality rate of 45.2%. There was a multiplicative interaction (OR=7.783, 95%CI: 1.377, 43.991) and no additive interaction (RERI=0.030, 95%CI: −0.498, 0.559; API=0.018, 95%CI: −0.279, 0.316; S=1.049, 95%CI: 0.519, 2.118) for the effect between blood aluminum and urinary fluoride on overall cognitive function of the workers. The logistic regression analysis showed that the risk of MCI was 12.105 (95%CI: 2.802, 52.287) times higher in workers with both high blood aluminum and high urinary fluoride than in those with low blood aluminum and low urinary fluoride, after adjusting for selected influencing factors. Conclusion Occupational exposure related high blood aluminum and high urinary fluoride are risk factors for cognitive dysfunction, and the coexistence of both indicators increases the risk of MCI in workers with occupational aluminum exposure, with a multiplicative interaction.

Objective:To analyze and summarize the implementation effect of basic essential surgical training (BEST) course of laparoscopic skills over the past 10 years and the practical experience in updating course content and models.Methods:The pre-class assessment questionnaires, basic laparoscopic operation assessment results, and post-class assessment questionnaires of the students who participated in the BEST course of laparoscopic skills were collected. According to the period of the course construction, the students were divided into two groups, namely students who used the course of single training system in the early stage (traditional group) and students who used the course integrating a variety of training systems after the course model was updated in the later stage (test group). The two groups were compared for the scores of track circle moving, tunnel crossing, and high and low columns, as well as their subjective evaluation of course setting and implementation effect. The t-test, Wilcoxon test, or chi-square test was conducted according to the data type using SPSS 13.0. Results:The time for 150 traditional group students to complete track circle moving, tunnel crossing, and high and low columns was 1.08 min (0.81 min, 1.60 min), 2.20 min (1.60 min, 3.27 min), and 4.86 min (3.28 min, 6.36 min), respectively, while the time for 75 test group students to complete the three operations was 1.27 min (0.87 min, 1.83 min), 2.57 min (1.58 min, 4.07 min), and 4.35 min (2.90 min, 6.42 min), respectively, with no significant difference between the two groups ( P>0.05). In terms of students' subjective evaluation of the course, a higher percentage of the test group students were satisfied with classroom environment, teaching method arrangement, training equipment, training opportunities, helping clinical work, and meeting pre-class expectations than those in the traditional group. Conclusion:The constantly updated BEST course can ensure the training quality of trainees and obtain their higher satisfaction. The benefits of this course in clinical practice can be further verified through long-term follow-up of these trainees.

Objective: To examine the correlation between visuospatial construction ability and occupational aluminum exposure among aluminum workers, so as to provide the evidence for early protection of occupational injury among aluminum workers. Methods: A total of 442 workers in an aluminum factory in Shanxi Province were selected using a cluster sampling method, and participants' demographic features and occupational history were collected. The blood aluminum concentration was measured using inductively coupled plasma mass spectrometry (ICP-MS), and the visuospatial construction ability was evaluated with the Cube Copying Test (CCT) of the Chinese version of the Montreal Cognitive Assessment (MoCA). The correlation between the visuospatial construction ability and blood aluminum concentration was examined using a multivariable logistic regression model. Results: A total of 442 aluminum workers were enrolled, and all participants were male, with a mean age of (43.40±7.31) years, labor service duration of (23.64±8.35) years and a mean blood aluminum concentration of 33.87 µg/L. Of all participants, there were 206 workers with impaired visuospatial construction ability (46.61%), including 127 workers with blood aluminum concentrations of >33.87 µg/L (61.65%); 190 workers with educational duration of 6 to 9 years (92.23%), 118 electrolytic aluminum workers (57.28%), 114 workers with work shifts (55.34%), and 123 workers with a very good sleep quality (59.71%). Multivariable logistic regression analysis revealed that blood aluminum concentrations of >33.87 µg/L (OR=2.490, 95%CI: 1.531-4.052), educational duration of 6 years or more (OR: 0.075-0.246, 95%CI: 0.015-0.622), work type as a non-electrolytic aluminum worker (OR=0.838, 95%CI: 0.425-0.987), work shift (OR=1.179, 95%CI: 1.078-1.435) and a very good sleep quality (OR=0.104, 95%CI: 0.012-0.896) significantly correlated with impaired visuospatial construction ability among aluminum worker. Conclusion Impaired visuospatial construction ability correlates with occupational aluminum exposure among aluminum workers.