Background Depressive symptoms have become a significant factor affecting the physical and mental health of the occupational population, and workers in petroleum refining enterprises face multiple stressors in their work environment. Objective To explore the impact of occupational noise exposure on depressive symptoms among workers in a petroleum refining enterprise. Methods This cross-sectional study was conducted in July 2024 using a questionnaire survey among workers of a petroleum refining enterprise in Hainan Province. Basic information of the subjects was collected. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms, the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality, and the Chinese version of the Effort-Reward Imbalance (ERI) scale was used to evaluate occupational stress. Chi-square test was employed to compare the differences in reporting depressive symptoms among populations with different characteristics. Binary logistic regression models were used to analyze the impact of occupational noise exposure and other factors on depressive symptoms. Results The overall positive rate of depressive symptoms in the study population was 42.7%. The results of the multifactor analysis indicated that compared with the control group, employees in both the low-exposure and high-exposure groups had elevated odds of depressive symptoms, with OR (95%CI) of 2.244 (1.131, 4.454) and 1.970 (1.009, 3.850), respectively. This association remained robust after adjusting for potential confounders, including gender, age, work tenure, and other occupational exposures. Additionally, female [OR (95%CI)=1.483 (1.039, 2.118)], exposure to benzene, toluene, or xylene [OR (95%CI)=1.621 (1.208, 2.174)], sleep disturbance [OR (95%CI)=3.772 (2.942, 4.838)], and occupational stress [OR (95%CI)=2.018 (1.575, 2.585)] were also significantly associated with higher odds of depressive symptoms. Conclusion The positive rate of depressive symptoms is relatively high among employees in this petrochemical enterprise, and occupational noise exposure may be a risk factor for depressive symptoms.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To analyze the clinical efficacy and learning curve of robotic-assisted Warshaw procedure using the da Vinci system.Methods:Clinical data of 91 consecutive patients with pancreatic body and tail lesions undergoing robotic-assisted Warshaw procedure at Qingdao University Affiliated Hospital from October 2021 to April 2023 were retrospectively analyzed, including 21 males and 70 females, aged (50.2±14.3) years. Patient characteristics, operative time, and intraoperative blood loss were recorded. The learning curve was constructed using cumulative sum (CUSUM) analysis, with case number on the x-axis and CUSUM values on the y-axis. Linear fitting was performed, and the model with the highest determination coefficient was selected as the optimal fitting model. The learning process was divided into two phases based on the inflection point of the CUSUM learning curve: the learning phase and the proficiency phase. Perioperative outcomes were compared between these two phases.Results:All 91 procedures were successfully completed using the da Vinci robotic system with R0 resection margins. There were no perioperative mortalities or reoperations due to postoperative splenic infarction. The operative time was (227.84±76.68) min. The optimal fitting equation for the CUSUM learning curve was: CUSUM=0.005 640X 3-1.501X 2+ 92.59X-183.1. The CUSUM learning curve showed an inflection point at case 39, dividing the learning process into the learning phase (cases 1-39) and proficiency phase (cases 40-91). Compared to the learning phase, the proficiency phase demonstrated significantly shorter operative time [(203.0±75.6) min vs. (260.9±65.5) min], less intraoperative blood loss [50.0 (20.0, 50.0) ml vs. 100.0 (50.0, 100.0) ml], and reduced postoperative drainage duration [(8.7±2.4) d vs. (10.8±3.2) d] (all P<0.05). Conclusion:The robotic-assisted Warshaw procedure feasible for patients with pancreatic body and tail lesions. Surgeons require approximately 39 cases to complete the learning curve and achieve proficiency in this procedure.

Objectives:To explore the efficacy of robotic-assisted retroperitoneal benign tumor resection and to analyze its learning curve.Methods:This is a retrospective case series study. The data of patients who underwent robotic-assisted retroperitoneal benign tumor resection from August 2015 to February 2023 at the Department of Retroperitoneal Tumor Surgery was analyzed retrospectively. There were 24 males and 45 females, with an age of (46.3±10.6) years (range: 19 to 76 years). The perioperative data, postoperative pathological results, and follow-up data were recorded. The cumulative sum (CUSUM) method was used to analyze the robotic system setup time and operative time to plot the learning curve. A linear regression model was applied to determine the best-fit curve, selecting the model with the highest R2 value. Based on the vertex of the learning curve for surgical time, the patients were divided into a learning group and a mastery group. The general data and perioperative conditions of the two groups were compared. Independent sample t-tests, Mann-Whitney U tests, and χ2 tests were used for comparisons. Results:All 69 patients successfully completed the surgery without intraoperative complications. The diameter of tumors was (49.7±18.6) mm (range: 16 to 131 mm). The setup time for the robotic surgical system was (35.3±9.8) minutes (range: 20 to 61 minutes); the surgical time was (169.2±36.5) minutes (range: 70 to 305 minutes); intraoperative blood loss ( M(IQR)) was 10.0 (15.0) ml (range: 2.0 to 200.0 ml). The tumors in 32 patients (46.4%) were adherent to major blood vessels. All patients were discharged without complications. The follow-up period lasted until February 2024, and no patients required reoperation, readmission, or died due to retroperitoneal benign tumors. There were no severe long-term complications, and no radiological evidence of tumor recurrence was found. The best-fit equation for the learning curve based on surgical time was CUSUM=0.010X3-1.648X2-68.573X-61.091, and the best-fit equation for the learning curve based on robotic system setup time was CUSUM=0.0018X3-0.285X2+10.460X+57.541 (where X represents the number of surgeries). The R2 values of 2 learning curve models were 0.953 and 0.957, respectively, and the fit model tests had P<0.05. The inflection point of the learning curve based on surgical time was the 28th case, which is considered the minimum number of surgeries required to achieve proficiency in robotic-assisted retroperitoneal benign tumor resection. Based on this, the patients were divided into a learning group (cases 1 to 28) and a mastery group (cases 29 to 69). The surgical time for the learning group was significantly longer than that of the mastery group ((194.7±30.0) minutes vs. (151.9±31.4) minutes, t=4.126, P<0.01). No statistically significant differences were found for other parameters (all P>0.05). Conclusions:Robotic-assisted retroperitoneal benign tumor resection is feasible. The minimum number of surgeries required to achieve proficiency in overcoming the learning curve is about 28 cases.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To analyze the clinical efficacy and learning curve of robotic-assisted Warshaw procedure using the da Vinci system.Methods:Clinical data of 91 consecutive patients with pancreatic body and tail lesions undergoing robotic-assisted Warshaw procedure at Qingdao University Affiliated Hospital from October 2021 to April 2023 were retrospectively analyzed, including 21 males and 70 females, aged (50.2±14.3) years. Patient characteristics, operative time, and intraoperative blood loss were recorded. The learning curve was constructed using cumulative sum (CUSUM) analysis, with case number on the x-axis and CUSUM values on the y-axis. Linear fitting was performed, and the model with the highest determination coefficient was selected as the optimal fitting model. The learning process was divided into two phases based on the inflection point of the CUSUM learning curve: the learning phase and the proficiency phase. Perioperative outcomes were compared between these two phases.Results:All 91 procedures were successfully completed using the da Vinci robotic system with R0 resection margins. There were no perioperative mortalities or reoperations due to postoperative splenic infarction. The operative time was (227.84±76.68) min. The optimal fitting equation for the CUSUM learning curve was: CUSUM=0.005 640X 3-1.501X 2+ 92.59X-183.1. The CUSUM learning curve showed an inflection point at case 39, dividing the learning process into the learning phase (cases 1-39) and proficiency phase (cases 40-91). Compared to the learning phase, the proficiency phase demonstrated significantly shorter operative time [(203.0±75.6) min vs. (260.9±65.5) min], less intraoperative blood loss [50.0 (20.0, 50.0) ml vs. 100.0 (50.0, 100.0) ml], and reduced postoperative drainage duration [(8.7±2.4) d vs. (10.8±3.2) d] (all P<0.05). Conclusion:The robotic-assisted Warshaw procedure feasible for patients with pancreatic body and tail lesions. Surgeons require approximately 39 cases to complete the learning curve and achieve proficiency in this procedure.

Objectives:To explore the efficacy of robotic-assisted retroperitoneal benign tumor resection and to analyze its learning curve.Methods:This is a retrospective case series study. The data of patients who underwent robotic-assisted retroperitoneal benign tumor resection from August 2015 to February 2023 at the Department of Retroperitoneal Tumor Surgery was analyzed retrospectively. There were 24 males and 45 females, with an age of (46.3±10.6) years (range: 19 to 76 years). The perioperative data, postoperative pathological results, and follow-up data were recorded. The cumulative sum (CUSUM) method was used to analyze the robotic system setup time and operative time to plot the learning curve. A linear regression model was applied to determine the best-fit curve, selecting the model with the highest R2 value. Based on the vertex of the learning curve for surgical time, the patients were divided into a learning group and a mastery group. The general data and perioperative conditions of the two groups were compared. Independent sample t-tests, Mann-Whitney U tests, and χ2 tests were used for comparisons. Results:All 69 patients successfully completed the surgery without intraoperative complications. The diameter of tumors was (49.7±18.6) mm (range: 16 to 131 mm). The setup time for the robotic surgical system was (35.3±9.8) minutes (range: 20 to 61 minutes); the surgical time was (169.2±36.5) minutes (range: 70 to 305 minutes); intraoperative blood loss ( M(IQR)) was 10.0 (15.0) ml (range: 2.0 to 200.0 ml). The tumors in 32 patients (46.4%) were adherent to major blood vessels. All patients were discharged without complications. The follow-up period lasted until February 2024, and no patients required reoperation, readmission, or died due to retroperitoneal benign tumors. There were no severe long-term complications, and no radiological evidence of tumor recurrence was found. The best-fit equation for the learning curve based on surgical time was CUSUM=0.010X3-1.648X2-68.573X-61.091, and the best-fit equation for the learning curve based on robotic system setup time was CUSUM=0.0018X3-0.285X2+10.460X+57.541 (where X represents the number of surgeries). The R2 values of 2 learning curve models were 0.953 and 0.957, respectively, and the fit model tests had P<0.05. The inflection point of the learning curve based on surgical time was the 28th case, which is considered the minimum number of surgeries required to achieve proficiency in robotic-assisted retroperitoneal benign tumor resection. Based on this, the patients were divided into a learning group (cases 1 to 28) and a mastery group (cases 29 to 69). The surgical time for the learning group was significantly longer than that of the mastery group ((194.7±30.0) minutes vs. (151.9±31.4) minutes, t=4.126, P<0.01). No statistically significant differences were found for other parameters (all P>0.05). Conclusions:Robotic-assisted retroperitoneal benign tumor resection is feasible. The minimum number of surgeries required to achieve proficiency in overcoming the learning curve is about 28 cases.

Background Workers engaged in benzene-exposed or benzene-containing solvent-exposed operations in China are predominantly subjected to a low concentration of benzene series compounds, and prolonged exposure to low concentrations of benzene, toluene, and xylene (BTX) may have implications for blood pressure. Objective To investigate the influence of low-concentration BTX exposure on the blood pressure of workers, aiming to provide a basis for enterprises to devise associated health management strategies to mitigate the occurrence of hypertension among workers exposed to low concentrations of BTX. Methods Using a cross-sectional design, 884 workers from a petroleum refining enterprise in Hainan who participated in an occupational health examination in 2022 were selected as the study population, and were divided into an exposure group of 649 workers and a control group of 235 workers based on their reporting of BTX exposure or not. Data on workplace BTX concentrations and health examinations of the study subjects were collected and questionnaires were administered. In addition, S-phenylmercapturic acid (S-PMA), hippuric acid (HA), and methyl hippuric acid (MHA, including the three isomers 2-MHA, 3-MHA, and 4-MHA) were measured in the urine of the workers using high-performance liquid chromatography-tandem triple quadrupole mass spectrometry to assess internal BTX burden. The effects of low-concentration BTX exposure on blood pressure were analyzed. Results In 2022, the concentrations of benzene, toluene, and xylene of all monitoring points did not exceeded the national limits by either time-weighted average (TWA) or short-term exposure limit (STEL), indicating low-concentration BTX exposure. Regarding the internal burden of BTX, the concentrations of benzene metabolite S-PMA, toluene metabolite HA, and xylene metabolites 3-MHA and 4-MHA in the urine samples in the exposure group were higher than those in the control group (P < 0.05). The correlation analysis showed a positive correlation between urinary S-PMA concentration and diastolic blood pressure in the workers (r=0.265, P < 0.05). Differences in systolic and diastolic blood pressure distributions were statistically significant among workers grouped by sex, age, work years, educational levels, monthly income, body mass index (BMI), alcohol use, dietary oil, and types of residential address (P < 0.05). Significant differences in systolic blood pressure distribution were observed among workers by smoking status and levels of labor intensity (P < 0.05). Compared with the control group, the workers in the exposure group exhibited a significant increase in diastolic blood pressure (P < 0.05). The results of multiple linear regression showed that age, sex, and BMI had statistically significant effects on systolic blood pressure (P < 0.05), while age, work years, and BMI had statistically significant effects on diastolic blood pressure (P < 0.05). The systolic blood pressure of age > 35 years, male, overweight and obese workers was significantly higher than that of age ≤ 35 years, female, and underweight workers, and the diastolic blood pressure of age > 35 years, work years > 5 years, and obese workers was higher than age ≤35 years, ≤5 years of service, and underweight workers. Low-concentration BTX exposure was one of the main influencing factors for elevated diastolic blood pressure, and the exposed workers showed a 1.337 mmHg increase in diastolic blood pressure compared to the control group (P < 0.05). Conclusion Low-concentration BTX exposure, work years > 5 years, and obesity may elevate blood pressure among petroleum refininig workers. Regular blood pressure monitoring and enhanced health interventions for this occupational group are warranted.

Objective To analyze the current status and influencing factors of elevated blood pressure among employees in a large petroleum refining enterprise in Hainan Province. Methods A total of 940 workers from a petroleum refining enterprise in Hainan Province was selected as the study subjects using the convenience sampling method. The results of their health status survey, occupational medical examination, and occupational stress measurement were collected. Results The detection rate of elevated blood pressure in the study subjects was 23.9% (225/940), with the detection rate of normal blood pressure and hypertension of 17.7% (166/940) and 6.3% (59/940), respectively. The detection rate of occupational stress was 28.8% (271/940). The result of multivariate logistic regression analysis showed that workers aged 30 -<40, 40 -<50, and ≥50 years had a higher risk of elevated blood pressure than those aged <30 years after controlling for confounding factors such as gender, residential address, length of service, education level, personal monthly income, smoking status, physical exercise, salt intake, oil intake, occupational stress, and high temperature exposure (all P<0.05). Workers in the body mass index (BMI) overweight group and obese group had a higher risk of elevated blood pressure than those in the normal group (all P<0.05). The risk of elevated blood pressure was higher in workers who drinks than those who did not (P<0.05). Workers exposed to noise levels of 85-90 dB(A) had a lower risk of elevated blood pressure compared to those exposed to noise levels >90 dB(A) (P<0.05). Conclusion Age, BMI, drinking status, and noise exposure levels are independent influencing factors for elevated blood pressure among workers in this petroleum refining enterprise. Blood pressure management should be strengthened for workers aged ≥30 years, overweight, obesity, alcohol consumption and with noise exposure intensity > 90 dB(A).

Objective:To clarify the elements of post competency of public health professionals and technical personnel, and construct a post competency index system of public health professionals and technical personnel.Methods:Referring to the Hay Group Competency Dictionary and literature review method, the post competency information elements of public health professional and technical personnel were constructed, and were revised through the expert consultation method. Unit-level stratified sampling was used, and 120 public health professionals were invited to evaluate the importance of the elements. SPSS 26.0 was used for data analysis, the continuous data were expressed in ( x ± s) mode, and Pearson was used to study the degree of correlation of each dimension. Finally, the post competency index system for public health positions was constructed by using the factor analysis method to extract the common factor as the first-level index. Results:The index system contained 7 first-level indicators (43 items), including public health practice skills, clinical practice skills, professional basic subject knowledge, personal professional accomplishment, public health authority and management ability, public health leadership, and public health methodology knowledge. Its weight coefficients (%) were 20.03, 17.48, 15.89, 15.68, 13.98, 12.82 and 4.11, respectively. The elements with the highest materiality scores were personal protection, responsibility and professionalism.Conclusion:Personal protection and other public health practical skills and personal professional qualities such as sense of responsibility and professionalism are the core elements of public health positions, and it is recommended to strengthen the training of public health professionals' public health practical skills in actual work, and pay attention to the cultivation of personal professional qualities, so as to establish a better team of public health talents.