Background The quality of occupational health technical services is directly linked to the protection of workers' health rights and the efficacy of occupational disease prevention and control. However, the industry still faces critical challenges: sporadic instances of institutional non-compliance and persistent irregularities in professional practice continue to undermine overall service performance. Objective To assess the current quality status of occupational health technical services in Zhejiang Province and propose countermeasures for quality improvement, providing a scientific basis for policy optimization and service delivery quality enhancement. Methods A total of 69 occupational health technical service institutions in Zhejiang Province that obtained formal accreditation as of April 30, 2024, were sampled, including 3 public institutions and 66 private institutions (comprising 3 formerly Class-A, 28 formerly Class-B, 11 formerly Class-C, and 24 newly certified institutions). Following the Technical Protocol for Quality Monitoring of Occupational Health Technical Service in Zhejiang Province and the Technical Protocol for Proficiency Testing of Occupational Health Detection in Zhejiang Province, a quality assessment task force comprising national and provincial experts was established. Evaluation was conducted across four dimensions: qualification maintenance and compliance, standardization of technical services, authenticity of technical services, and proficiency testing, utilizing a combination of document review, on-site inspections, and technical skill assessments. Results The occupational health technical service institutions in Zhejiang Province were predominantly private entities (82.5%), with significant disparities in overall service quality. The pass rates for qualification maintenance and compliance, technical service standardization, technical service authenticity, and the excellence rate for laboratory proficiency testing were 81.5%, 80.7%, 97.3%, and 90.4%, respectively. Regarding qualification maintenance, the pass rates for "environmental conditions" (49.8%, 56.7%) and "instrumentation and equipment" (58.2%、65.6%) were significantly lower for formerly Class-C and newly certified institutions compared to other categories. In terms of technical standardization, "standardized on-site inspections" recorded the lowest pass rate (67.4%), with newly certified institutions at only 48.0%. Regarding technical service authenticity, formerly Class-C institutions exhibited issues such as missing raw chromatograms for blank samples (85.7% pass rate). In laboratory proficiency testing, public and formerly Class-A institutions achieved 100% excellence rates, but the performance of formerly Class-C and newly certified institutions was comparatively weak; specifically, the failure rate for organic analysis in formerly Class-C institutions reached 20%; the failure rate for dust testing items in newly certified institutions was 10.3%. Conclusion The overall quality of occupational health technical services in Zhejiang Province still requires significant improvement, particularly in basic institutional conditions, the standardization of on-site inspections, and laboratory proficiency in organic and dust analysis. Formerly Class-C and newly certified institutions should be the primary focus of quality management efforts. Differentiated regulatory strategies are recommended, alongside strengthening interim and ex-post supervision to gradually enhance the quality of occupational health technical services across all institutions.

Cardiovascular diseases （CVD）， particularly atherosclerosis， represent a major global health burden. Recent studies have revealed that innate immune cells such as monocytes and macrophages can develop immune memory after an initial stimulus， a phenomenon termed “trained immunity”. Growing evidence indicates that trained immunity serves as an underlying mechanism of chronic inflammation in atherosclerotic cardiovascular diseases. This review focuses on outlining the key effector cells involved in trained immunity and their mechanisms of formation， including processes such as metabolic reprogramming and epigenetic modifications， which collectively lead to a heightened immune response upon secondary stimulation. Furthermore， this review systematically summarizes the role of trained immunity in the initiation and progression of atherosclerosis， and elaborates on various therapeutic strategies targeting trained immunity along with their application prospects.

Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective To evaluate the application of problem-based learning(PBL)and case-based learning(CBL)combined with ideological-political elements in surgical clinical ethics.Methods Eighty graduate students of grade 2022 majoring in surgery from Peking Union Medical College were selected as the subjects for the clinical ethics course offered in the first semester of the 2022-2023 academic year.They underwent the innovative pedago-gies of PBL and CBL combined with ideological-political elements.The satisfaction investigation and questionnaire surveys were performed to evaluate the effects.Results A total of 78 valid questionnaires were received.The results showed that 96.2%of students believed that this course supported them to understand the fundamental prin-ciples and knowledge of surgical clinical ethics and 94.9%of students expressed their willingness to expand their knowledge,indicating high satisfaction with the course.There were 91%of students acknowledged this model in terms of improving active learning and 93.6%stated that the course helped in developing good professional ethics.Most students responded positively to this model because of its contribution to enhance core clinical competencies.Conclusions The PBL and CBL combined with ideological-political elements have a better effect on surgical clini-cal ethics with high satisfaction of the students.

Objective To investigate the therapeutic potential and prophylactic value of concomitant administration of nonsteroidal anti-inflammatory drug(NSAID)and antimicrobial agents in mitigating the incidence and severity of trauma-induced sepsis.Methods A retrospective cohort study encompassed the collection of clinical records from trauma patients managed in the department of intensive care unit(ICU)of Daping Hospital,Army Medical University(Third Military Medical University)from June 2008 to June 2024.Based on administered therapeutic protocols,patients were stratified into a control group(receiving antibiotic monotherapy)and a experimental group(undergoing adjunctive therapy with NSAID in conjunction with antimicrobial agents).Intergroup comparisons were performed to elucidate differences in baseline clinical characteristics and laboratory indices pertinent to therapeutic outcomes.Results A total of 268 trauma patients were included,with 72 patients in the control group and 196 patients in the experimental group.The majority of cases involved open trauma(67.5%)and injuries sustained from traffic accidents(44.0%),reflecting the principal mechanisms of injury.The respiratory tract was the most common site of infection(67.5%),with Acinetobacter baumannii(A.baumannii)emerging as the leading causative microorganism(18.0%).Among therapeutic agents,ibuprofen represented the most frequently employed NSAID(59.8%),whereas cephalosporins constituted the predominant class of antimicrobials(30.5%).Following intervention,the lymphocyte percentage(LYM%)was markedly elevated in the experimental group relative to control group[0.14(0.09,0.20)vs.0.12(0.09,0.15),P<0.01].In contrast,the levels of white blood cell count(WBC),neutrophil percentage(NEU%),D-dimer,glucose(Glu),and lactic acid(Lac)were significantly reduced[WBC(×109/L):8.82(6.36,12.96)vs.12.10(7.78,15.54);NEU%:0.76(0.67,0.81)vs.0.78(0.72,0.83);D-dimer(μg/L):2208.0(889.5,3301.5)vs.2943.9(1735.4,4997.6);Glu(mmol/L):6.8(6.2,7.9)vs.7.7(6.6,9.2);Lac(mmol/L):0.9(0.6,1.2)vs.1.1(0.8,1.5),all P<0.05].The experimental group demonstrated a significantly reduced incidence of traumatic sepsis compared with the control group[15.8%(31/196)vs.26.4%(19/72),P<0.05].Conclusion The combination of NSAID and antimicrobial agents exerts its protective effect by attenuating inflammatory and stress responses,reestablishing immune homeostasis,correcting coagulopathy,and enhancing tissue perfusion,thereby significantly decreasing the incidence of traumatic sepsis and contributing to improved prognostic outcomes in injured patients.

A microchannel-based electrochemiluminescence(ECL)sensor was developed for detection of tetracycline(TC)utilizing luminol/H2O2 as ECL reporting system.The low excitation potential of luminol/H2O2 effectively mitigated the impact of clamping voltage,thereby enhancing the detection performance of the microchannel-based ECL sensor.The microchannel modified with TC aptamer selectively recognized and captured target TC.The positively charged TC reduced the surface charge density within the microchannel,thereby increasing the ionic current in the microchannel,leading to change of ECL signal of system.The experimental conditions such as electrolyte concentration,TC-aptamer concentration,and reaction time between TC and TC-aptamer were optimized.Under optimal conditions,the difference of ECL signal in the absence and presence of TC(?ECL)exhibited a good linear relationship with TC concentration in the range from 1.00 ng/mL to 200 ng/mL,with a detection limit as low as 0.69 ng/mL.The sensor had good selectivity and was successfully used in detection of TC in milk samples.

Objective:To evaluate the efficacy of Tongdu Tiaoshen acupuncture combined with low-frequency electrical pulse in the treatment of neurogenic bladder (NB) caused by spinal cord injury (SCI); To explore its effects on urodynamics.Methods:A randomized controlled trial study was conducted. A total of 116 patients with NB caused by SCI in the First Affiliated Hospital of Hunan University of Chinese Medicine from January 2022 to June 2024 were selected as the observation objects and divided into 2 groups with random number table method, with 58 cases in each group. On the basis of conventional bladder function training, the control group was given low-frequency electronic pulse therapy, while the observation group was treated with the Tongdu Tiaoshen method on the basis of the control group. Both groups were treated continuously for 3 months. The urination conditions of the patients were observed before and after the treatment respectively, and the residual urine volume, single urine volume within 24 hours, the number of urine leaks within 24 hours, and the number of urinations within 24 hours were recorded; urodynamic parameters such as bladder volume, urine flow rate, detrusor pressure, bladder compliance, and detrusor contractility were measured using a urodynamic analyzer; the severity of NB symptoms was evaluated using the Chinese version of the Neurogenic Bladder Symptom Scale (NBSS), and the quality of life was evaluated using the Chinese version of the Short Form Health Assessment Scale (SF-Qualiveen). The levels of IL-1β, IL-6 and TNF-α were detected by ELISA. Adverse reactions were recorded during the treatment period and the clinical efficacy was evaluated.Results:The total effective rate was 91.38% (53/58) in the observation group and 75.86% (44/58) in the control group. There was a statistically significant difference between the two groups ( χ2=5.10, P=0.024). After treatment, the residual urine volume, single urine volume within 24 hours, frequency of urine leakage within 24 hours, and frequency of urination within 24 hours in the observation group were lower than those in the control group ( t values were -15.68, 3.75, -3.81, and -7.54 respectively, P<0.01). The bladder capacity, urine flow rate, detrusor pressure, bladder compliance and detrusor contractility were higher than those of the control group ( t values were 11.04, 7.49, 9.76, 5.65 and 4.36 respectively, P<0.01), while the NBSS score and SF-Qualiveen score were lower than those of the control group ( t values were -10.82 and -9.83 respectively, P<0.01). No obvious adverse reactions occurred in either group during the treatment period. Conclusion:Tongdu Tiaoshen acupuncture combined with low-frequency electrical pulses can improve the bladder function of NB caused by SCI, restore urodynamics, and improve the quality of life. Its mechanism may be related to the inhibition of inflammatory responses.

Objective:To investigate the liver-protective effect of Peipi Shugan Decoction (PSD) in rats with liver fibrosis through network pharmacology and experimental animal models.Methods:TCMSP was used to retrieve the active components of Peipi Shugan Decoction, GeneCards database was used to obtain the liver fibrosis related targets, and Venny 2.1 was used to obtain the intersection targets. A protein-protein interaction (PPI) network was constructed using the STRING 12.0 database, and Go function and KEGG pathway enrichment analysis were performed through David database. A total of 60 male Sprague-Dawley (SD) rats were divided into two groups: a blank control group ( n=10) and a model establishment group ( n=50) with random number table method. Liver fibrosis models were induced in the model group by intraperitoneal injection of a 40% CCl?- olive oil solution. After successful modeling, the rats were randomly assigned to the following groups ( n=10 per group): model group, colchicine group, and Peipi Shugan Decoction low-, medium-, and high-dosage groups. The colchicine group received colchicine suspension at 0.2 ml/kg via intragastric administration. Peipi Shugan Decoction low-, medium-, and high-dosage groups were administered the decoction at dosages of 2.81, 5.63, and 11.25 g/kg, respectively. The blank control and model groups received an equal volume of normal saline. All treatments were administered once daily for 8 consecutive weeks. HE staining and Masson staining were used to observe the morphological changes of liver tissue and the deposition of collagen fibers. he levels of GPT, GOT and ALP were detected by automatic biochemical analyzer. The expressions of JAK2/STAT1 signaling pathway related proteins, α - smooth muscle actin (α-SMA) and Collagen Ⅰ in rat liver were detected by Western blot. The expression of α-SMA protein in liver tissue was detected by immunohistochemistry. The number and ratio of CD4 + T cells and CD8 + T cells in liver tissue were analyzed by flow cytometry. The levels of IL-6, IL-1β and TNF-α in serum were detected by ELISA. Results:A total of 94 active components were screened out from Peipi Shugan Decoction; the prediction analysis results revealed that this compound formula shared 122 common targets with liver fibrosis diseases; The top five core targets with degree values in the PPI network are AKT1, TNF, IL-6, TP53, and IL-1β. GO enrichment analysis further indicated that Peipi Shugan Decoction mainly achieved anti-liver fibrosis effects by regulating JAK2/STAT1 signaling pathway and other mechanisms. Compared with the model group, the colchicine group and Peipi Shugan Decoction low-, medium-, and high-dosage groups exhibited decreased serum levels of GPT, GOT, ALP, IL-6, TNF-α, and IL-1β ( P<0.05), as well as reduced expression of α-SMA in liver tissue ( P<0.05). Peipi Shugan Decoction medium- and high-dosage groups showed increased protein expression of p-STAT1/STAT1 in liver tissue ( P<0.05), while Peipi Shugan Decoction high-dosage group demonstrated decreased α-SMA protein expression ( P<0.05). Additionally, Peipi Shugan Decoction medium- and high-dosage groups exhibited reduced expressions of CD4 + and CD8 + ( P<0.05). Conclusions:Peipi Shugan Decoction has the characteristics of multi-component, multi-target and multi-pathway in the treatment of liver fibrosis. Its mechanism is mainly related to activating the JAK2/STAT1 signaling pathway, inhibiting cellular inflammatory responses and hindering the activation of hepatic stellate cells (HSC).

Objective Under the guidance of meridian-sinew(jingjin)theory,the correlation between foot-yangming jingjin lesions and X-ray imaging findings such as medial space and lateral space in femorotibial joint and their ratio,degree of subluxation of femorotibial joint,and the Insll-Salvati index in the patients with knee osteoarthritis(KOA).Methods From January 2019 to November 2021,a total of 66 patients diagnosed as KOA at the Third Affiliated Hospital of Guangzhou University of Chinese Medicine were selected as the study subjects.The patients were divided into the foot-yangming jingjin group and non-foot-yangming jingjin group according to the presence of foot-yangming jingjin lesions.The X-ray postero-anterior and lateral radiography of the knee joint under weight bearing was performed,and imaging parameters of the two groups were measured.Afterwards the pain Visual Analogue Scale(VAS)scores and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)scores in the two groups were evaluated,the differences between the two groups'X-ray imaging findings and scale scores were compared,and the various X-ray imaging findings in the two groups were analyzed.Results(1)Under X-ray postero-anterior radiography of the knee joint,the medial space and lateral space in femorotibial joint and their ratio in non-foot-yangming jingjin group were lower than those in foot-yangming jingjin group,and degree of subluxation of femoro-tibial joint was higher than that of foot-yangming jingjin group(P<0.05 or P<0.01).(2)The ratio of length of patellar tendon to length of patella(LT:LP)under X-ray lateral radiography in foot-yangming jingjin group was significantly greater than that of the non-foot-yangming jingjin group(P<0.01).(3)The scores of pain VAS and WOMAC in non-foot-yangming jingjin group were both significantly higher than those in foot-yangming jingjin group(P<0.05),while the differences of the scores of WOMAC items such as joint stiffness and physiologic function,and the total WOMAC scores between the two groups were not statistically significant(P>0.05).Conclusion Foot-yangming jingjin lesions in KOA may be closely related to the relatively high position of patella under X-ray lateral radiography,and non-foot-yangming jingjin lesions may be closely related to the narrowing of the medial femorotibial joint space,the increase of medial-lateral space ratio,and the severity of subluxation under X-ray postero-anterior radiography.

Jiegengtang is a basic formula for treating sore throat and cough. By means of bibliometrics， this study conducted a textual research and analysis on the key information such as formula origin， decocting methods， and clinical application of Jiegengtang. After the research， it can be seen that Jiegengtang is firstly contained in Treatise on Febrile and Miscellaneous Disease， which is also known as Ganjietang， and it has been inherited and innovated by medical practitioners of various dynasties in later times. The origins of Chinese medicines in this formula is basically clear， Jiegeng is the dried roots of Platycodon grandiflorum， Gancao is the dried roots and rhizomes of Glycyrrhiza uralensis， the two medicines are selected raw products. The dosage is 27.60 g of Glycyrrhizae Radix et Rhizoma and 13.80 g of Platycodonis Radix， decocted with 600 mL of water to 200 mL， taken warmly after meals， twice a day， 100 mL for each time. In ancient times， Jiegengtang was mainly used for treating Shaoyin-heat invasion syndrome， with cough and sore throat as its core symptoms. In modern clinical practice， Jiegengtang is mainly used for respiratory diseases such as pharyngitis， esophagitis， tonsillitis and lung abscess， especially for pharyngitis and lung abscess with remarkable efficacy. This paper can provide literature reference basis for the modern clinical application and new drug development of Jiegengtang.