Comprehensive occupational hazard risk assessment in employers is a core component of the pilot program for occupational health classification supervision and law enforcement. The quality and effectiveness of classification-based supervision are directly affected by both the assessment process and its outcomes. However, several issues have emerged since the implementation of the pilot program on the comprehensive risk assessment, including an excessive number of self-assessment items, lack of implementation basis for certain self-assessment items, misinterpretation for certain self-assessment items, inconsistencies between evaluation criteria and existing standards, incomplete implementation of some items, omission of comprehensive risk assessment elements, unclear definitions of key industries and key occupational hazards, and inconvenient assessment procedures on comprehensive risk assessment. To enhance the applicability, accuracy, and objectivity of the comprehensive risk assessments conducted by employers, it is recommended to optimize self-assessment items, standardize risk assessment content, tailor comprehensive risk assessments to actual workplace conditions, refine the identification of key industries and key occupational hazards, improve comprehensive risk assessment methodologies, and establish clear grading rules for the comprehensive risk assessment.

Abstract The etiology and pathogenesis of myopia among children and adolescents remain unclear. As crucial regulatory mediators in the body, inflammatory cytokines have drawn increasing attention for their potential role in the onset and progression of myopia. The study examines the relationship between systemic inflammation and intraocular inflammation and myopia, explores the inflammatory mechanisms underlying myopia development, and discusses intervention strategies targeting related signaling pathways for myopia treatment. It aims to provide new insights for the prevention and control of myopia in children and adolescents.

Objective: To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies. Methods: In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR. Results: Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9% , and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60± 1.01 ) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR =1.38, 1.82, 1.55; AL/CR: β =0.01, 0.03, 0.03; all P <0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia ( OR =1.26, 1.49, both P <0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL ( β=0.14, P < 0.05). Conclusions Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

Objective: To explore two visual acuity standards for examining uncorrected visual acuity (UCVA) to define poor vision in lower grade elementary school students, and to compare the difference of screening myopia rates when combined with non cycloplegic auto refraction (NCAR), so as to provide a scientific basis for standardizing UCVA examination methods using CAR as the gold standard of authenticity and reliability. Methods: From March 22nd to April 9th, 2023, a total of 549 first and second grade students aged 7-8 years from a primary school in Hefei City were selected for the study by convenient cluster sampling method. Two methods were employed for UCVA examination:the first method involved charts where the student could not make mistakes in identifying at least half of the characters per line (V1), and the second method used charts with character sizes ranging from 4.0 -4.5, 4.6-5.0 and 5.1-5.3, without allowing 1, 2 and 3 errors per line (V2). While NCAR was performed, then 187 students underwent CAR examination. Paired Wilcoxon rank-sum test and McNemar test were used to compare the differences between V1 and V2 methods in defining poor vision and screening myopia rates. Using CAR as the gold standard, the authenticity and reliability of defining screening myopia rates through the combination of V1 and V2 methods along with NCAR were evaluated. Results: The UCVA examination results for V1 and V2 showed statistically significant differences in both the right eye [5.0(4.9,5.0), 4.9(4.8,5.0)] and the left eye [ 5.0 (4.9,5.0), 4.9(4.8,5.0)] ( Z=-13.95, -13.34, P <0.01). The detection rates of poor vision for the right eye were 43.53% for V1 and 63.21% for V2, and the left eye with 44.08% for V1 and 62.11% for V2, with statistically significant differences ( χ 2= 106.01 , 95.09, P <0.01). When screening myopia rates were assessed for UCNA methods combined with NCAR, the right eye rates were 21.49% for V1 and 24.59% for V2, and the left eye rates were 21.31% for V1 and 23.13% for V2, with statistically significant differences ( χ 2=15.06, 8.10, P <0.01). Using CAR as the gold standard, the detection rates in the right eye and left eye were 16.58 % and 17.11%, respectively. The Youden indices for defining screening myopia in the right eye were 0.80 for V1 and 0.79 for V2, and the left eye with 0.85 for V1 and 0.83 for V2. The agreement rates for the right eye were 91.98 % for V1 and 89.30% for V2, and the left eye with 94.12% for V1 and 91.98% for V2. The Kappa values for the right eye were 0.73 for V1 and 0.67 for V2, and the left eye with 0.81 for V1 and 0.75 for V2. Conclusions Authenticity and reliability of two UCVA examination methods combined with NCAR in defining screening myopia are higher in V1 than V2 methods. It is recommended to unify the visual acuity examination methods by requiring the correct identification of more than half of the total number of visual markers in a row.

Objective: To analyze the effects of outdoor activities, sedentary behaviors and sleep duration on the risk of poor vision among primary and secondary school students after replacing them with each other, so as to provide a reference for precise intervention in the prevention and control of myopia among children and adolescents. Methods: From March to May 2023, a stratified cluster random sampling method was used to select 6 132 students in grades 4 to 12 in Hefei, Wuhu, Suzhou and Chizhou cities in Anhui Province. A questionnaire survey was conducted to collect the basic information, outdoor activities, sedentary behavior, and sleep duration, and a visual inspection was carried out by 5 m standard logarithmic visual acuity chart. The single activity model, segmentation model and isotemporal substitution model were used to analyze the relationship between outdoor activities, sedentary behaviors, sleep, and poor vision, and stratified analysis was performed by gender. Results: The detection rate of poor vision among the 6 132 primary and secondary school students was 76.9%, and the detection rate of poor vision was higher for girls ( 81.1 %) than for boys (72.6%), and the difference was statistically significant ( χ 2=61.37, P <0.01). The results of the single activity model and segmentation model showed that outdoor activity and sleep duration were correlated with a reduced risk of poor vision in primary and secondary school students ( OR =0.87, 0.88; 0.88, 0.91), while sedentary behavior was correlated with an increased risk of poor vision ( OR =1.05, 1.03) ( P <0.05). The results of the isotemporal substitution model showed that replacing the same amount of sedentary behavior with 1 h/d of outdoor activity was associated with 15% reduction in the risk of poor vision ( OR = 0.85), and replacing the same amount of sedentary behavior with 1 h/d of sleep was associated with a 12% reduction in the risk of poor vision ( OR =0.88) ( P <0.05). The results of the isotemporal substitution model stratified by gender showed that replacing the same amount of sedentary behavior with 1 h/d of outdoor activity and 1 h/d of sleep were associated with 22% and 8% reduction in the risk of poor vision in male students ( OR =0.78, 0.92), and replacing the same amount of sedentary behavior with 1 h/d of sleep was associated with 18% reduction in the risk of poor vision in female students ( OR =0.82) ( P <0.05). Conclusion Replacing sedentary behavior with 1 h/d of outdoor activity for boys and 1 h/d of sleep for girls and boys could reduce the risk of poor vision.

OBJECTIVE To compare the metabolomic characteristics of stage T1 papillary thyroid carcinoma(PTC)and nodular goiter(NG),and the relationship between metabolites and lymph node metastasis of PTC.METHODS Serum samples were collected from 60 patients with stage T1 PTC and 30 patients with NG who underwent thyroidectomy at the Department of Otolaryngology Head and Neck Surgery,Civil Aviation General Hospital between September 2021 and April 2022.The PTC group was divided into the N+ group with lymph node metastasis and the N-group without lymph node metastasis according to the presence or absence of lymph node metastasis.The serum metabolites of the N+ and N-groups and the PTC and NG groups were compared and analyzed using an ultra-performance liquid chromatography-mass spectrometry(UPLC-Q-Exactive-MS)coupled platform,and principal component analysis(PCA),partial least squares discriminant analysis(PLS-DA),and orthogonal partial least squares discriminant analysis(OPLS-DA)was performed using SIMCA-P 14.1 software.OPLS-DA modeling,combined with FDR-corrected Mann-Whitney-Wilcoxon test results and metabolite difference multiples in the two groups undergoing comparison,etc.to screen for potential small molecule metabolic markers,and to establish a joint diagnostic model by binary logistic regression analysis.RESULTS There were no significant differential metabolites between the N+ group with lymph node metastasis and the N-group without lymph node metastasis.Seven differential metabolites were found between PCA patients and NG patients,and the five relevant metabolic pathways were the pentose phosphate pathway,pentose and glucuronide interconversion,glycolysis/gluconeogenesis,fructose,and mannose metabolism,and fatty acid biosynthesis.The differential metabolite with an area under the ROC curve>0.9 was D-glyceraldehyde 3-phosphate,and another N-undecanoylglycine,uronic acid,and the area under the ROC curve for three metabolites,N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,was>0.8.CONCLUSION PTC patients differed from NG patients mainly in glucose metabolism and lipid metabolism,and D-glyceraldehyde 3-phosphate could be distinguished from NG patients with the aid of N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,combined with imaging findings.Also,no significant differences in serum metabolites were found in the N+ group compared with the N-group,and the presence or absence of lymph node metastases did not affect serum metabolites in patients with stage T1 PTC.

Objective: The study aims to analyze the prevalence and associated factors of myopia among 4 to 9 grade students in Guangdong Province in 2022, so as to provide a scientific basis for targeted intervention measures for myopia in children and adolescents. Methods: From September to October 2022, stratified cluster random sampling was used to select 29 095 of 4 to 9 grade students from Guangzhou, Jiangmen, and Meizhou in Guangdong Province for myopia screening and questionnaire surveys. The Chisquare test was applied to compare the differences between groups, and multivariable Logistic stepwise regression analysis was used to analyze factors associated with myopia. Results: The myopia detection rate of 4 to 9 grade students was 61.7%, with detection rates of 51.5% for 4 to 6 grade primary school students and 71.95% for 7 to 9 grade junior high school students. Multivariable Logistic regression analysis showed that higher myopia rates were detected among girls (OR=1.39, 95%CI=1.30-1.49), students with one (OR=1.82, 95%CI=1.69-1.96) or both parents having myopia (OR=2.86, 95%CI=2.56-3.18), and indoor sedentary time >6 h(OR=1.28, 95%CI=1.17-1.39) in the 4 to 6 grade. Lower myopia rates were detected in the county (OR=0.92, 95%CI=0.86-0.99) and outdoors at recess activities (OR=0.88, 95%CI=0.81-0.95). Meanwhile, higher myopia rates were detected among girls (OR=1.84, 95%CI=1.69-1.99), students with one (OR=1.87, 95%CI=1.71-2.04) or both parents having myopia (OR=3.03, 95%CI=2.63-3.50), and indoor sedentary time >6 h/d (OR=1.11, 95%CI=1.01-1.23) in the 7 to 9 grade. Lower myopia rates were detected in the county (OR=0.74, 95%CI=0.68-0.80), outdoors at recess activities (OR=0.83, 95%CI=0.76-0.91), and outdoor activity time ≥2 h/d(OR=0.87, 95%CI=0.80-0.95)(P<0.05). Conclusions The detection rate of myopia among 4 to 9 grade students in Guangdong Province is relatively high. Place of recess activities, daily outdoor activity and indoor sedentary duration are associated with myopia. Therefore, targeted intervention measures should be adopted, such as appropriately increasing outdoor activity to reduce the occurrence of myopia among primary and middle school students.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective: To explore the association of vitamin D deficiency with anxiety and depressive symptoms as well as their comorbidity, so as to provide references for improving the mental health of children and adolescents. Methods: From October to December 2021, a total of 1 323 students from four middle schools in Shenzhen were selected by using convenience sampling method for a questionnaire survey and physical examination. Fasting blood samples were collected to detect vitamin D levels. The Chi square test and multiple Logistic regression model were used to analyze the association of vitamin D deficiency with anxiety and depressive symptoms and their comorbidity among middle school students. Results: The detection rates of anxiety, depressive, and thier comorbidities in middle school students were 33.0%, 21.5% and 16.3%, respectively. After adjusting for confounding factors, vitamin D deficiency was positively associated with the risk of anxiety symptoms ( OR=1.59, 95%CI =1.02-2.46), depressive symptoms ( OR=1.94, 95%CI =1.22-3.09) and anxiety depressive comorbid symptoms ( OR=1.75, 95%CI =1.06-2.90) in secondary school students ( P ＜0.05). Conclusion Vitamin D deficiency is associated with an increased risk of anxiety, depressive and their co morbidity symptoms in middle school students, and the directionality of the association should be further studied.

Objective: To analyze the association between non-school sedentary time and myopia among primary and secondary school students with different levels of physical activity, so as to provide data for precise measures to prevent and control myopia. Methods: From September to December 2019, stratified cluster sampling was used to select 7 872 primary and secondary students in grades 4 to 12, middle and high school students from Hefei, Suzhou, Chizhou and Wuhu Cities in Anhui Province. Face-to-face questionnaires and vision examinations were conducted to collect demographic information, physical activity time, sedentary study time and visual health status. Potential categories were analyzed for different types of physical activity time, and Logistic regression was used to assess the relationship between non-school sedentary time and myopia at different levels of physical activity. Results: A total of 2 976 primary and secondary school students were found with high physical activity levels and 4 896 primary and secondary school students with low physical activity levels. The proportion of low physical activity was higher in girls than in boys (68.7% vs . 55.6%), and the differences were statistically significant ( χ 2=143.97, P <0.01). The overall screening myopia rate was 48.2%, with statistically significant differences among female students (53.0%) compared with male students (43.3%), urban students ( 51.8 %) compared with rural students (44.5%), and longer non-school sedentary time students (60.6%) compared with average (45.1%) and shorter (42.1%) non-school sedentary time students, and the differences were statistically significant ( χ 2=73.15, 41.96 , 161.74, P <0.01). Adjusting for confounders such as residence, grade, gender, age, father s education, mother s education, and body mass index (BMI), multivariate Logistic regression analysis revealed that prolonged after-school sedentary study was positivety correlated with myopia among primary and secondary school students of low physical activity levels ( OR=1.52, 95%CI=1.27-1.83, P <0.01), and there was no statistical association between after-school sedentary time and myopia in primary and secondary school students with high physical activity levels ( P >0.05). Conclusion Attention should be paid to non-school sedentary time for primary and secondary school students with low physical activity levels. And students who spend a lot of time sitting outside of school should be encouraged to maintain high physical activity levels to reduce the risk of myopia.