Objective:To investigate the correlation of programmed death receptor-1(PD-1)and V-domain im-munoglobulin suppressor of T-cell activation(VISTA)expression with the imbalance of helper T lymphocytes(Th)1/Th2,Th17/regulatory T cells(Treg),and Th22 in the microenvironment of endometrial cancer(EC).Methods:From March 1,2020 to June 30,2023,94 patients with EC(EC group),94 patients with atypical hyperplasia of the endometrium(AH),and 94 controls without uterine and endometrial diseases such as EC and AH(control group)were selected for treatment at the Tangshan Maternal and Child Health Hospital.The expression of PD-1 and VIS-TA in various tissues and the levels of Th1/Th2,Th17/Treg,and Th22 in the endometrial microenvironment were compared.Pearson analysis was used to investigate the correlation between the expression of PD-1 and VISTA in tissues and the imbalance of Th1/Th2,Th17/Treg,and Th22 in the EC microenvironment.The positive expression of PD-1 and VISTA in tissues of patients with different pathological characteristics was also compared.Results:①The expression of PD-1 and VISTA was higher in EC group and AH group than that in the control group,and high-er in EC group than AH group,with statistically significant differences(P＜0.05).In both EC group and AH group,Th1/Th2 and Th17/Treg levels in the microenvironment were lower than those in the control group,while Th22 level was higher.EC group showed lower Th1/Th2 and Th17/Treg levels but higher Th22 level than AH group,with statistically significant differences(P＜0.05).②No correlation was found between the expression of PD-1 and VISTA and the Th1/Th2,Th17/Treg,and Th22 in the microenvironment in control group(P＞0.05).In AH group and EC group,the expression of PD-1 and VISTA was negatively correlated with the Th1/Th2 and Th17/Treg lev-els in the microenvironment(r＜0,P＜0.05),but positively correlated with Th22 level in the microenvironment(r＞0,P＜0.05).③In EC patients,the expression of PD-1 was related with clinical stage,invasion depth,and lymph node metastasis(P＜0.05);VISTA expression was related with clinical stage and lymph node metastasis(P＜0.05).Conclusions:The high expression of PD-1 and VISTA in EC is closely associated with the imbalance of Th1/Th2,Th17/Treg,and Th22 in the tumor microenvironment,as well as the tumor ivasiveness.The dual inhibi-tion strategy targeting PD-1 and VISTA immune checkpoints may offer a novel approach for EC treatment.

Objective To explore the effects and mechanisms of Changpu Yujin Tang(CPYJT)on the NOD-like receptor thermal protein domain associated protein 3/cysteinyl aspartate specific proteinase-1/Gasdermin D(NLRP3/Caspase-1/GSDMD)signaling pathway-mediated neuroinflammation in rats with Tourette syndrome(TS).Methods SPF-grade male SD rats were randomly divided into the Control and TS groups.After successful modeling in the TS group,the rats were randomly divided into the Model,Tiapride,and CPYJT groups,and were treated with the corresponding drugs for 4 weeks.After the treatment,the rats' behavior was scored,H & E staining was used to observe pathological changes in the striatum,ELISA was used to measure the content of IL-1β and IL-18,RT-qPCR was used to detect the expression of NLRP3 and ASC mRNA,and Western blot was used to detect the expression of NLRP3,ASC,Caspase-1,Cleaved-Caspase-1,GSDMD,and GSDMD-NT proteins.Results Compared with the Control group,the Model group showed increased scores of stereotyped and motor behaviors(P＜0.01),pathological changes in the striatal tissue,increased content of IL-1β and IL-18(P＜0.01),and upregulated expression of NLRP3,ASC mRNA,and NLRP3,ASC,Caspase-1,Cleaved-Caspase-1,GSDMD,and GSDMD-NT proteins(P＜0.01).Compared with the Model group,the Tiapride group and the CPYJT group showed decreased scores of stereotyped and motor behaviors(P＜0.01),improved pathological damage in the striatal tissue,reduced content of IL-1β and IL-18(P＜0.01),and inhibited expression of NLRP3,ASC mRNA,and NLRP3,ASC,Caspase-1,Cleaved-Caspase-1,GSDMD,and GSDMD-NT proteins(P＜0.01).Conclusion The therapeutic effect of CPYJT on TS is related to the inhibition of the neuroinflammatory response mediated by the NLRP3/Caspase-1/GSDMD signaling pathway.

Objective:To establish a reference interval for serum iodine of pregnant women with normal thyroid function and to analyze the relationship between serum iodine and thyroid disease risk.Methods:From July 2022 to October 2023, using cross-sectional survey method, pregnant women aged 18 to 48 years old who had lived in iodine-deficient areas in the six provinces of China (Shanxi Province, Fujian Province, Yunnan Province, Xinjiang Uygur Autonomous Region, Zhejiang Province, and Anhui Province) for more than six months were selected as the survey subjects. Blood samples were collected, serum iodine was tested, and the percentile method was used to establish a reference interval for serum iodine of pregnant women with normal thyroid function. Meanwhile, serum levels of free thyroxine, thyroid stimulating hormone, thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) were tested, and logistic regression was used to analyze the relationship between serum iodine and thyroid disease risk.Results:A total of 1 409 pregnant women from 6 provinces were investigated, including 1 087 with normal thyroid function and 322 with abnormal thyroid function. The median serum iodine level of pregnant women with normal thyroid function was 79.74 μg/L, and the preliminary reference interval for serum iodine was 47.57 - 128.96 μg/L. When serum iodine levels were lower (< 47.57 μg/L), pregnant women had a significantly increased risk of developing TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis ( OR = 4.44, 2.91, 3.41, 41.67, 23.43, P < 0.05). When serum iodine levels were high (> 128.96 μg/L), pregnant women had a significantly increased risk of developing hyperthyroidism ( OR = 9.91, P = 0.001). Conclusions:The reference interval for serum iodine of pregnant women with normal thyroid function is successfully established. Low serum iodine levels are associated with an increased risk of TgAb positivity, TPOAb positivity, hypothyroxinemia, hypothyroidism, and autoimmune thyroiditis, while high serum iodine levels are associated with an increased risk of hyperthyroidism.

Objective:To identify the latent profiles of kinesiophobia in elderly patients with chronic obstructive pulmonary disease (COPD) and explore associated influencing factors.Methods:Elderly COPD patients were selected using a convenience sampling method from the respiratory departments of three Grade A tertiary hospitals in Anhui Province between July 2023 and January 2024. Data were collected using a general demographic questionnaire, the Tampa Scale of Kinesiophobia (TSK), and the Physical Activity Rating Scale (PARS-3). Latent profile analysis was performed using Mplus 8.3, and multinomial Logistic regression was applied to identify influencing factors associated with different latent classes.Results:A total of 348 questionnaires were distributed, and 330 valid responses were obtained, with a valid response rate of 94.83%. The mean TSK score of the 330 patients was (44.53±6.60). Kinesiophobia in elderly COPD patients could be classified into three latent categories: high kinesiophobia-low perceived exercise benefit (25.8%, 85/330), moderate kinesiophobia-low perceived exercise risk (40.9%, 135/330), and low kinesiophobia-high perceived exercise benefit (33.3%, 110/330). Multinomial Logistic regression analysis showed that physical activity level, educational background, body mass index, disease severity, and employment status were the influencing factors of kinesiophobia classification (all P<0.05) . Conclusions:Kinesiophobia in elderly COPD patients presents with distinct classification characteristics. Healthcare providers should develop and implement targeted interventions based on the identified profiles and their influencing factors to help patients reduce their fear of physical activity.

Objective To explore the clinical application effects of artificial dermis in the repair of traumatic finger skin defects with bone exposure.Methods From January 2022 to January 2024,10 patients with fingertip skin defects and bone exposure,totaling 10 fingers,were treated.The defect areas ranged from 0.5 cm × 1.0 cm to 1.0 cm × 1.5 cm.After debridement,the wounds were covered with artificial dermis,and regular dressing changes were performed postoperatively.The artificial dermis was removed 3-4 weeks post-surgery.The wound healing,skin appearance,and sensory recovery of the fingertip were evaluated.Results All 10 fingertip wounds healed successfully,with a healing time of 3 to 4 weeks.Patients were followed up for more than 3 months,and the wound healing was satisfactory.The finger pads appeared full,the skin was smooth and flat with no obvious scarring,and the texture was soft.Skin sensory ability recovered well,with no pain or hypersensitivity,and the two-point discrimination ability reached 3 to 8 mum.According to the upper limb function evaluation standards set by the Hand Surgery Society of the Chinese Medical Association,the sensory recovery of all 10 fingertips achieved an S3+level,with a good to excellent rate of 100％.Conclusion The primary repair of fingertip skin defects with bone exposure using artificial dermis resulted in no donor site damage.The surgical procedure is safe and simple,and the appearance and sensory function of the fingers have recovered well,demonstrating reliable efficacy.

Objective To explore the diagnostic value of combined detection of Krebs Von den Lungen-6(KL-6),C-reactive protein(CRP),and some indicators in blood routine for lung injury in patients with influ-enza A virus infection.Methods A total of 92 patients with influenza A admitted to the hospital in December 2023 were selected as the observation group.Based on whether there were obvious texture changes such as patchy and ground glass opacities in the lungs on X-ray examination,the patients were divided into a lung inju-ry positive group(T1 group,30 cases)and a lung injury negative group(T2 group,62 cases).Additionally,53 healthy individuals who underwent physical examinations during the same period were selected as the control group.Peripheral blood routine,CRP,and KL-6 levels were detected.Peripheral blood routine,CRP,and KL-6 levels were compared between the observation group and control group,and between T1 group and T2 group.receiver operating characteristic(ROC)curve were used to evaluate the diagnostic efficacy of individual indica-tors and combined detection for patients with lung injury who infected with influenza A.Results Compared with the control group,white blood cell count,neutrophil ratio,monocyte ratio,neutrophil/lymphoid ratio(NLR),monocyte/lymphoid ratio(MLR),platelet/lymphoid ratio(PLR),CRP and KL-6 levels in the obser-vation group were increased,while the lymphocyte ratio and platelet count decreased(P<0.05).Compared with the T2 group,the CRP and KL-6 levels increased and the incidence of anemia increased in the T1 group(P<0.05).The results of binary Logistic regression analysis showed that blood routine,KL-6,and CRP were all influencing factors of lung injury in patients with influenza A(P<0.05).The area under the curve of single detection of KL-6,CRP,blood routine,the combined detection of KL-6 and CRP,and the combined detection of KL-6,CRP and blood routine were 0.679,0.641,0.604,0.727 and 0.781.Conclusion KL-6 combined with CRP and blood routine testing has high diagnostic efficacy for lung injury in patients with influenza A and has significant clinical significance.

By combining the origin and research progress of the combination of disease and syndrome, the core pathogenesis, this article explored the research ideas and methods of the core pathogenesis of TCM. It is found that modern TCM is mostly guided by the idea of classification-staging-syndrome differentiation, the main prescription of the main disease, the special prescription of the special disease, and the idea of "dynamic-fixed sequential". The tongue image syndrome differentiation method, clustering analysis method, drug test syndrome method, compound pathogenesis method, "evidence-based pathogenesis-syndrome treatment system" research model, and the integration of traditional Chinese and Western medicine theory were used to explore the core pathogenesis of TCM under the condition of disease. Combined with the advantages of modern medical disease differentiation and TCM syndrome differentiation, the individualized diagnosis and treatment methods of integrated traditional Chinese and Western medicine have been continuously improved, in order to solve the stage contradictions of different clinical stages, effectively delay the progression of the disease and improve the prognosis of the disease.

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 understand the individual radiation dose levels and changes of occupational external exposure among radiation workers in a steel group from 2020 to 2023, and to provide a basis for strengthening radiation protection in the group. Methods According to the Specifications for individual monitoring of occupational external exposure (GBZ 128-2019), individual monitoring was conducted using a thermoluminescent dosimeter, with each monitoring cycle lasting 90 days, totaling four cycles per year. Individual monitoring data of occupational external exposure among radiation workers in the steel group from 2020 to 2023 were collected for statistical analysis. Results A total of 5889 monitoring records were collected from radiation workers across 37 affiliated units of the steel group during the period of 2020-2023. The average annual effective dose was 0.150 mSv, the maximum annual effective dose was 3.84 mSv, and 0.3% monitored workers showed annual effective doses exceeding 1 mSv. The average annual effective dose in 2023 was 0.146 mSv, which was lower than in 2020 but higher than in 2021 and 2022 (Z = −6.657 to 14.129, P < 0.001). The number of monitored workers in industrial and medical sectors accounted for 86.9% and 13.1%, respectively. Their average annual effective doses were 0.152 mSv and 0.140 mSv, respectively, and the difference was statistically significant (Z = −7.969, P < 0.001). In the industrial sector, the average annual effective dose for the monitored workers in industrial radiography was significantly higher than other occupations (Z = −8.094, P < 0.001). There was a significant difference in average annual effective dose among workers of different occupational categories in the medical sector (H = 67.040, P < 0.001). The average annual effective doses were relatively high for diagnostic radiology and nuclear medicine. Additionally, the average annual effective doses for male and female radiation workers were 0.150 mSv and 0.152 mSv, respectively (P > 0.05). Conclusion The average annual effective dose of radiation workers in the steel group was at low levels for four consecutive years, which meet the requirements of the national standard. However, to maintain the individual radiation dose levels of radiation workers as low as reasonably achievable, it remains necessary to strengthen radiation protection management in the steel group.

Objective To investigate the levels and influencing factors for eye lens dose of interventional radiology workers, and to provide a basis for reasonable and scientific radiation protection. Methods Thermoluminescent eye lens dosimeters were used to monitor the left and right eye lens doses of interventional radiology workers in real time during different surgical positions and varying eye protection conditions. The annual eye lens doses for the operators were estimated based on their yearly workload. The differences in eye lens doses under different conditions were analyzed and the influencing factors were identified. Results For individual interventional operations, the range of personal dose equivalent H_p(3) of the left eye of interventional radiology workers was ( < MDL ~ 418.33) μSv, the median (Q₁, Q₃) was 9.29 ( < MDL, 40.79) μSv, and the mean was 40.79 ± 70.36 μSv. The estimated annual eye lens doses were 4.05 mSv and 17.80 mSv based on the median and mean values of the eye lens dose of a single operation multiplied by average annual frequency of operations per person, respectively. The left eye lens dose was higher than the right eye lens dose of the same operator (Z = −4.24, P < 0.05), and the dose of the right eye lens was strongly positively correlated with that of the left eye lens. The left eye lens dose of the first surgeon was higher than that of the second surgeon in the same operation (Z = −3.10, P < 0.05). The eye lens dose was influenced by operator position (χ² = 9.149, P = 0.002, OR = 8.343), eye protection (χ² = 4.619, P = 0.032, OR = 4.352), and air kerma area product (χ² = 8.032, P = 0.005, OR = 5.488). Conclusion According to the results of this study, a significant portion of interventional operators have eye lens doses that approach or exceed international occupational dose limits. It is recommended to pay attention to the operation frequency of the first operator and the air kerma area product of interventional operation, and strengthen radiation protection and dose monitoring for the eye lens of interventional radiology workers.