Objective To analyze the characteristics and causes of an occupational acute carbon monoxide poisoning incident caused by a nitrogen generator malfunction. Methods The workers and the workshop from an electronic component manufacturing company in Guangzhou City, which had an occupational acute carbon monoxide poisoning incident, were selected as the research subjects using the retrospective investigation method. Relevant data of worksite survey of occupational health, clinical records of poisoning patients, and occupational disease diagnosis data were collected for analysis. Results A total of 15 workers who experienced discomfort in this incident, were from the final inspection workshop using high-purity nitrogen (purity of 99.999%). The short-term exposure concentration of carbon monoxide in the workplace air at three oven operating posts using high-purity nitrogen was 64.1, 581.0, and 142.0 mg/m³, respectively, while the concentration in the workplace air at the oven operating posts using regular nitrogen and the nitrogen-generating room was <0.1 mg/m³. Carboxyhemoglobin saturation levels in the 15 patients ranged from 2.000%-17.300%. Occupational acute mild carbon monoxide poisoning was diagnosed in nine patients, occupational acute carbon monoxide exposure reactions was diagnosed in six patients. This poisoning incident was caused by machine malfunction and improper operation, leading to occupational acute carbon monoxide poisoning. Conclusion Companies using nitrogen production machine should enhance their ability to identify carbon monoxide risks, strengthen training and management of workers, establish emergency response plans for nitrogen production and use, ensure proper maintenance of production equipment, and optimize operational procedures to prevent acute poisoning incidents.

[摘 要] 目的：探讨白蛋白结合型紫杉醇联合PD-1抑制剂用于治疗一线化疗失败的骨与软组织肉瘤的疗效及安全性。方法：回顾性分析北京积水潭医院骨肿瘤科2017年8月至2020年8月收治的一线化疗失败的晚期骨与软组织肉瘤患者。患者接受白蛋白结合型紫杉醇（125~140 mg/m2，第1天和第8天）与PD-1抑制剂（信迪利单抗或特瑞普利单抗，每21 d一次）联合治疗。每2个治疗周期评估1次疗效，按RECIST 1.1标准评估肿瘤疗效，按NCI-CTCAE5.0标准评估不良反应。结果：共20名患者纳入研究，完成1至8个治疗周期，中位治疗周期数为3个。所有患者均可评估疗效，完全缓解4例（20%），部分缓解0例，稳定9例（45%），疾病进展7例（35%）。客观缓解率（ORR）为20%，疾病控制率（DCR）为65%。中位无进展生存期（PFS）为3.0个月。治疗期间主要不良反应包括2级白细胞减少（40%）、1-2级神经毒性反应（20%），以及2级甲状腺功能减退（10%）。结论：白蛋白结合型紫杉醇联合PD-1抑制剂治疗为一线化疗失败的晚期骨与软组织肉瘤患者提供了一种潜在的治疗选择，其不良反应可控，值得开展更大样本的前瞻性研究进一步验证其疗效。

To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources.

[Abstract]Objective To explore the predictive value of plaque characteristic index based on coronary CT angiography(CCTA)for disease-specific myocardial ischemia in stable coronary artery disease(CAD).Methods 90 stable CAD patients admitted to Zhongshan Hospital,Fudan University from October 2020 to March 2022 were prospectively enrolled,including 135 target vessels with stenosis degree ranging from 30%to 90%.All participants sequentially underwent CCTA,ICA,and fractional flow reserve(FFR)measurement within 2 weeks.Based on the presence or absence of significant hemodynamic stenosis,all patients were divided into myocardial ischemic population(FFR≤0.8,n=30)and non ischemic population(FFR＞0.8,n= 60),135 target blood vessels were divided into a disease-specific myocardial ischemia group(FFR≤0.8,n=36)and a non disease-specific myocardial ischemia group(FFR＞0.8,n=99).Univariate and subsequent forward stepwise multivariate logistic regression analyses were used to assess independent predictors of myocardial ischemia,and CCTA-derived plaque characteristics index logistic regression model was created.Receiver operating characteristic(ROC)analysis was used to analyze the diagnostic performance of CCTA-derived plaque characteristics index on detecting myocardial ischemia.Results There were no significant differences in age,body mass index,gender,cardiovascular risk factors,and medication between myocardial ischemia population and non-ischemia population.Compared with the non-lesion-specific ischemia group,plaque length,plaque area,percent area stenosis,total atheroma volume,vessel volume and lipid rich volume,positive remodeling and napkin-ring signs were significantly higher in lesion-specific group,while minimum luminal area(MLA)was significantly lower.MLA(OR=0.303,95%CI 0.178-0.517,P＜0.001)and total atheroma volume(TAV,OR=1.006,95%CI 1.002-1.010,P=0.003)were found to be the significant independent predictors of myocardial ischemia.The regression equation of CCTA-derived plaque characteristic index for predicting probability was P=1/[1+e-(-1.194 41×MLA+0.006 058×TAV+0.600 912)].The area under the ROC curve(AUC)of CCTA-derived plaque characteristic index on detecting myocardial ischemia was 0.879(95%CI 0.811-0.928),and the overall diagnostic accuracy,sensitivity,specificity,PPV and NPV were 80.0%,83.3%,78.8%,58.8%,and 92.9%,respectively.Conclusions CCTA-derived plaque characteristic index performs well in diagnosing lesion-specific myocardial ischemia,showing its great clinical application prospect.

Objective:To explore and think about the project management model of investigator-initiated trial (IIT), and the project management of industry sponsored trial (IST), we should standardize the management process of clinical research projects initiated by researchers, improve the management system of clinical research in medical institutions, improve the quality management level of clinical research, and protect the rights and interests of research participants.Methods:By taking the clinical research management of a medical and health institution in Hainan province as an example, one of the first pilot areas for the standardized management of clinical research by the National Health Commission, the difficulties in the management of clinical research initiated by researchers were sorted out, to analyze and standardize the management of clinical research project initiated by researchers.Results:Discussion Project management was the primary link and basic guarantee of standardized management of clinical research, and scientific and feasible project management was a powerful hand to carry out deep and high-quality IIT.Conclusions:It can be manifested in a Hainan provincial public medical institution that a feasible project management was the basement in carrying out the profound and high quality IIT. It is advicable to make full use of policy advantages and clinical resources to produce high-quality research results as well as build a high-level research hospital.

Objective:To investigate the clinicopathological characteristics of dedifferentiated endometrial carcinoma/undifferentiated endometrial carcinoma (DDEC/UDEC) with loss of expression of SMARCA4.Methods:A total of 10 cases with loss of expression of SMARCA4 were diagnosed at Fujian Cancer Hospital between January 2019 and December 2023. A retrospective analysis was conducted on the clinical characteristics, morphology, immunophenotype, molecular classification, and prognosis.Results:(1) Clinical characteristics: among 10 cases of DDEC/UDEC with loss of expression of SMARCA4, the patients′ age ranged from 48 to 65 years, with a median age of 56 years.Five cases were classified as International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ-Ⅱ, while the remaining five were categorized as stages Ⅲ-Ⅳ. (2) Pathological features: tumor cells exhibited poor cell adhesion, with common intravascular tumor emboli (8/10), occasional vacuolated nuclei (6/10), rhabdoid cells (4/10), and starry sky phenomenon formed by tissue cell phagocytosis apoptosis bodies or fragments (4/10). Six cases (6/10) showed loss of mismatch repair (MMR) protein expression, two cases (2/10) exhibited p53 mutant expression, and five cases (5/10) tested positive for programmed cell death ligand 1 (PD-L1). (3) Molecular subtyping: molecular subtyping revealed POLEmut in 1 case (1/10), mismatch repair deficient (MMR-d) in 5 cases (5/10), p53 abn in 1 case (1/10), and no specific molecular profile (NSMP) in 3 cases (3/10). (4) Prognosis: the follow-up period ranged from 7 to 42 months, with a median of 20 months. Five patients succumbed to the tumor, whereas the remaining five exhibited no recurrence during subsequent postoperative evaluations. The 2-year progression-free survival rates and overall survival rates were 58.3% and 52.5%, respectively.Conclusions:Loss of expression of SMARCA4 occurs in approximately 1/5 of DDEC/UDEC, which presents with an aggressive clinical course and a poor prognosis. About half of them show MMR protein loss expression and PD-L1 positive expression, suggesting that there might be benefit from treatment with immune checkpoint inhibitors.

Over the past decade, significant progress has been made in pediatric bone tumor lower limb lengthening techniques, with Ilizarov stretching osteogenesis as the fundamental foundation. Individualized traction adjustments facilitate efficient bone regeneration. While external fixation devices, such as Ilizarov circular frames and unilateral braces, offer user-friendly convenience, they often entail prolonged treatment durations and a myriad of associated complications. In cases with specific parameters, such as bone defects <5 cm, epiphyseal growth modulation techniques present viable therapeutic avenues. Lengthening prostheses can be employed, particularly for substantial bone defects, leveraging minimally invasive and non-invasive designs to mitigate complications. There remains a pressing need to enhance materials and structural integrity effectively combat infections and mechanical failures. Intramedullary lengthening nails, exemplified by the Precice nail, boast high comfort and a low infection risk, yet effective complication management remains critical. Contemporary treatment paradigms prioritize individualized treatment plans, aiming to curtail treatment durations and complications through material enhancements and refined fixation methodologies. The forthcoming evolution and cost-effectiveness of domestically manufactured bone lengthening technologies represent pivotal realms of scholarly inquiry and practical application, with the overarching objective of ameliorating the quality of life for children contending with limb length discrepancies post bone tumor surgery while simultaneously diminishing complication rates.

Dedifferentiated chondrosarcoma (DDCS) is a rare, high-grade variant of chondrosarcoma with a poor prognosis, making its diagnosis and treatment particularly challenging. Comprehensive imaging plays a crucial role in the initial diagnosis, while image-guided biopsy remains an essential tool for confirming the disease. Surgical intervention remains the primary treatment modality, and selecting an appropriate surgical approach based on the patient's condition is critical. Achieving wide or radical surgical margins is vital for reducing the risk of local recurrence and distant metastasis. Unfortunately, DDCS demonstrates limited sensitivity to both radiotherapy and chemotherapy, and current advancements in these therapeutic approaches remain in the exploratory phase. In recent years, efforts by both domestic and international researchers to incorporate novel therapies such as immunotherapy and targeted therapy have yielded promising, results. Given the rarity of DDCS, existing clinical studies are largely limited to case reports or small retrospective studies, highlighting the need for larger, more robust studies to strengthen the evidence base. This review aims to summarize the latest progress in the diagnosis and treatment of DDCS, offering insights to guide clinical practice and inform future research directions.

Objective:To explore the effect of the isolated organ laparoscopic simulation training teaching mode in laparoscopic partial nephrectomy training.Methods:A 39-hour in vitro organ laparoscopic simulation training for 12 urologists who had previously participated in laparoscopic basic technique training but had not independently completed laparoscopic partial nephrectomy in Peking Union Medical College Hospital. The training was conducted twice a week for 3 months from April to June 2022. Five modules, namely ultrasonic knife separation training, ultrasonic knife cutting training, vascularization training, blunt separation training, and partial nephrectomy and wound closure training, were used to provide targeted training for the decomposition of laparoscopic partial nephrectomy, and each training item was assessed and scored according to the scoring rules. At the same time, a questionnaire was used to find out the level of confidence of the 12 physicians in completing the operation and each step in the procedure, so as to assess the changes in the operational skills and psychological quality of the physicians before and after training using paired t-tests or Wilcoxon paired rank sum tests. Results:After the training, the assessment scores of operations in all surgeons were significantly improved. The training scores of ultrasonic knife separation training, ultrasonic knife cutting training, blood vessel nudity training, blunt separation training, and partial nephrectomy and traumatic suture improved from (8.5±0.3), (6.9±0.3), (4.2±0.4), (6.6±0.4), and (5.6±0.7) to (9.8±0.2), (9.6±0.3), (9.3±0.2), (9.4±0.3), and (9.8±0.2), respectively( P<0.05). The average operation time for the partial renal excision and traumatic suture training improved from (47.5±5.8) minutes to (21.6±5.1) minutes( t=18.72, P<0.001). At the same time, self-confidence in completing the operation was also significantly improved from 2(1, 3) before the training to 4(4, 4) after the training ( Z=-3.002, P =0.003). Conclusions:After laparoscopic simulation training with isolated organs, physicians with no previous experience in partial nephrectomy can become proficient in all steps of the procedure, complete the resection of the renal tumor and suturing of the wound within 30 minutes, and gain confidence in the operation of all steps of partial nephrectomy.

Objective To investigate the characteristics of pulmonary artery diameter in patients with human immunodeficiency virus(HIV)infection-associated pulmonary hypertension(PAH),and to explore the clinical significance of pulmonary artery diameter correlation indices combined with tumor necrosis factor-α(TNF-α)for early screening and diagnosis of HIV-associated pulmonary hypertension,aiming to provide valuable clinical insights.Methods A retrospective analysis was conducted on 65 HIV-infected patients admitted to the Eighth Hospital Affiliated to Guangzhou Medical University between May 2017 and December 2023.Based on echocardiog-raphy findings,the patients were categorized into an observation group(23 cases with PAH)and a control group(42 cases without PAH).Measurements of pulmonary artery diameter(PA),distal pulmonary artery diameter(dPA),and aortic diameter were obtained in both groups,and the ratio of dPA to aortic diameter(rPA)was cal-culated.Additionally,serum TNF-α levels were recorded.The clinical significance of each index in early screening and diagnosis of HIV-related pulmonary hypertension was analyzed.Results The PA,dPA,rPA,and TNF-α levels in the observation group were significantly higher compared to those in the control group.Pearson linear correlation analysis revealed a significant positive correlation between TNF-α and both dPA and rPA.Two-column correlation analysis demonstrated a significant association between HIV-PAH and PA,dPA,rPA,as well as TNF-α(P<0.05).The combined measurement of serum TNF-α with dPA and rPA exhibited an area under the curve(AUC)of 0.891 for diagnosing HIV-APAH,with a sensitivity of 0.870 and specificity of 0.881.Conclusion The combination of pulmonary artery diameter and TNF-α provides a more accurate indication of the presence of HIV-PAH,enabling early screening,follow-up,or intervention in high-risk patients.This finding holds significant implications for enhancing patient prognosis.