Objective To compare the morphology differences in small shadows of occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") between computed tomography (CT) and digital radiography (DR) imaging. Methods A total of 1 010 pneumoconiosis patients were selected as the research subjects using a judgment sampling method. Chest DR imaging and CT imaging were performed on patients, and the differences in small shadow morphology between the two images were compared. Results In both DR and CT images of patients, circular small shadows identified as p, q, and r shapes accounted for 76.2%, 11.5%, and 1.3%, respectively, while irregular small shadows were identified in 1.8% of cases. There was medium high consistency between DR and CT in detecting these four types of small shadow morphology (Kappa=0.72, P<0.01). The detection rate of irregular small shadows (including interlobular septal thickening, ground-glass opacity, and/or centrilobular emphysema) by CT images was 54.0% (545/1 010), with 88.6% (483/545) of these cases also showing small circular shadows. Irregular small shadows in CT images were mostly identified as p small circular shadows in DR images, accounting for 88.8% (484/545). The results of DR and CT images for p/p, p/q, q/p, q/q, q/r, r/q and r/r in small circular shadows showed medium high consistency (Kappa =0.52, P<0.01). Conclusion The results of CT and DR imaging for pneumoconiosis with small shadow were of medium high consistency, with CT demonstrating advantages in detecting irregular small shadow morphology of pneumoconiosis. CT images can be used to describe the shape of circular small shadow as DR images, and irregular small shadow can be described as interlobular septal thickening, ground-glass opacity, and/or centrilobular emphysema.

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology has the characteristics of high specificity and high throughput, making it rapidly applied and developed in the field of clinical testing. Its application in the monitoring of therapeutic drugs can effectively improve the quantitative accuracy and sensitivity, and formulate a personalized and optimal dosing plan for patients. However, this technology still faces some challenges, and automation, quality control, and quantitative traceability will be the future development direction.

To improve the understanding of clinicians on the diagnostic criteria and treatment principlis of pulmonary alveolar proteinosis(PAP),which is a rare respiratory disease.European Respiratory Society published the first edition guidelines for PAP,including a systematic review of the literature and the application of the grading of recommendations,assessment,development and evaluation(GRADE)approach to assess the certainty of evidence and the strength of recommendations.Five questions of patient,intervention,comparison,outcome(PICO)and two narrative questions were developed.Recommendations and evidence-based evidence were given,including management of PAP,whole lung lavage,granulocyte-macrophage colony-stimulating factor(GM-CSF)therapy,rituximab,plasma exchange,and lung transplantation.In addition,recommendations were given for the use of GM-CSF antibody testing,bronchoalveolar lavage,and lung biopsy.This study is to interpret the main content of the guideline.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To establish a scientifically standardized nursing quality evaluation index system that conformed to the characteristics of enteral nutrition in critically ill patients, with the aim of providing reference for evaluating the nursing quality of enteral nutrition in critically ill patients.Methods:Using the three-dimensional quality evaluation model of "structure-process-outcome" as the theoretical framework, the content of each level of the evaluation index system was preliminarily formulated by literature analysis. From May to July 2022, the Delphi expert consultation method was used to conduct two rounds of consultation with 21 experts to determine the index system.Results:In the two rounds of consultation, the effective response rates of the questionnaire were 85.71% (18/21) and 100.00% (18/18) , respectively. The expert authority coefficients were 0.867 and 0.878, respectively. The expert Kendall's W of the overall index were respectively 0.092 and 0.187 ( P<0.01) . The final nursing quality evaluation index system of enteral nutrition in critically ill patients included 3 first level indicators, 9 second level indicators, and 60 third level indicators. Conclusions:The constructed nursing quality evaluation index system of enteral nutrition in critically ill patients has put forward clear requirements and quality standards for enteral nutrition nursing for critically ill patients, which has good scientific and reliable characteristics and can provide reference for the nursing quality evaluation of enteral nutrition in critically ill patients.

The Brodmann area(BA)-based map is one of the most widely used cortical maps for studies of human brain functions and in clinical practice;however,the molecular architecture of BAs remains unknown.The present study provided a global multiregional proteomic map of the human cerebral cortex by analyzing 29 BAs.These 29 BAs were grouped into 6 clusters based on similarities in proteomic patterns:the motor and sensory cluster,vision cluster,auditory and Broca's area cluster,Wernicke's area cluster,cingulate cortex cluster,and heterogeneous function cluster.We identified 474 cluster-specific and 134 BA-specific signature proteins whose functions are closely associated with specialized functions and disease vulnerability of the corresponding clus-ter or BA.The findings of the present study could provide explanations for the functional connec-tions between the anterior cingulate cortex and sensorimotor cortex and for anxiety-related function in the sensorimotor cortex.The brain transcriptome and proteome comparison indicates that they both could reflect the function of cerebral cortex,but show different characteristics.These pro-teomic data are publicly available at the Human Brain Proteome Atlas(www.brain-omics.com).Our results may enhance our understanding of the molecular basis of brain functions and provide an important resource to support human brain research.

Objective:To investigate the application of accurate endoscopic retrograde cholangiopancreatography (ERCP)drainage guided by IQQA ?-Liver CT(an image interpretation and analysis system)to preoperative jaundice reduction for hilar cholangiocarcinoma. Methods:Data of 12 patients with hilar cholangiocarcinoma who planned to receive surgical treatment in the hepatobiliary surgery department of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from May 2017 to December 2018 were reviewed. All patients were treated with ERCP drainage before surgery. The procedure success rate, postoperative drainage volume and postoperative complications of the patients were analyzed.Results:ERCP was successful in all patients, and the median daily volume of endoscopic nasobiliary drainage was 675 mL(400-1 500 mL). Only 1 patient developed postoperative cholangitis, and another patient developed postoperative mild pancreatitis. The mean serum total bilirubin was 173.3±62.8 μmol/L in the patients before ERCP, which decreased to 35.6±13.9 μmol/L before surgery.Conclusion:Accurate ERCP drainage can effectively reduce the serum bilirubin level in patients with hilar cholangiocarcinoma and reduce the incidence of cholangitis after the procedure, creating favorable conditions for subsequent surgical operations.

Objective:To evaluate the effect of different reconstruction images on cardiac dose evaluation by comparing the differences between 4D-CT series and special reconstruction images in evaluating the dose-volume index of cardiac structures.Methods:ECG 4D-CT series were scanned in 15 female patients with left breast cancer. The images of 0-95% 20 phases were reconstructed at an interval of 5% cardiac cycle. The maximum intensity projection (MIP), minimum intensity projection (MinIP), average intensity projection (AIP) and sum intensity projection (SIP) images were obtained by special reconstruction of 4D-CT series. Left ventricle (LV) and left anterior descending coronary artery (LADCA) were delineated on 4D-CT and special reconstruction series, respectively. The intensity-modulated radiation therapy plan of the left breast cancer was designed on the basis of 0% phase, and the cumulative dose (Dose-cumulate) of 20 phases was obtained by deformation registration. The doses of 0% phase were deformed and registered to MIP, MinIP, AIP and SIP images to obtain the corresponding dose distribution. The dose-volume indexes of LV and LADCA based on different CT images were compared.Results:In the evaluation of dose-volume index of LV, compared with 4D-CT series, the change rates of V 5Gy, V 30Gy, V 40Gy, D max and D mean on MIP images were 3.8%, 2.0%, 0.9%, 3.8% and 1.7%, respectively. There was significant difference in V 5 and D max between MIP and 4D-CT (both P<0.05). Compared with 4D-CT, the change rates of D max on MinIP, SIP and AIP images were 2.5%, 3.1% and 1.5%, respectively (all P<0.05). In the evaluation of dose-volume index of LADCA, only the change rate of D max on four special reconstructed images was<5%( P<0.05). Conclusions:In the dose-volume evaluation of LV, the V 30Gy, V 40Gy and D mean obtained by MIP are basically equivalent to those obtained by 4D-CT series, which can be used to substitute 4D-CT series to evaluate the dose-volume. The special reconstruction image of LADCA can not replace 4D-CT series.

Objective:To explore the nursing problems in ICU patients with enteral nutrition-related diarrhea and to constantly standardize the nursing practice of ICU nurses in the prevention and management of enteral nutrition-related diarrhea.Methods:Using convenience sampling method, 367 ICU patients who received enteral nutrition treatment in the Department of critical care medicine of the Tenth People's Hospital Affiliated to Tongji University from October 2019 to June 2020 were selected as the research objects. According to the time, they were divided into three groups: 129 cases before nursing process practice (October to December 2019) as the control group, 117 cases in the first round of action research (January to March 2020) as the action group 1, 121 cases in the second round of action research (April to June 2020) as the action group 2. A group interview method was used to identify problems in nursing of enteral nutrition-related diarrhea. According to the spiral cycle of "plan-action-observation-reflection", the nursing procedure for prevention and management of enteral nutrition-related diarrhea in ICU was formulated and improved. The incidence, duration, and severity scores of diarrhea in the three groups were compared, and interview the nurse's nursing experience.Results:The incidence of diarrhea in action group 1 was lower than that of control group, duration was less than that of control group, and severity score was lower than that of control group, and the differences were statistically significant ( P<0.05) . The incidence of diarrhea in action group 2 was lower than that of action group 1, duration was less than that of action group 1, and severity score was lower than that of action 1 group, and the differences were statistically significant ( P<0.05) . The topics extracted from the group interviews with nurses included "emergent scientific interest" "the joy of solving clinical problems" "benefit from clinical work". Conclusions:The ICU nursing process of prevention and management of enteral nutrition-related diarrhea based on action research can significantly reduce the incidence, duration and severity of diarrhea, improve the quality of diarrhea nursing, enhance nurses' sense of career benefit and stimulate nurses' interest in scientific research.

Objective: To analyze the clinical characteristics of one living-related kidney transplant recipient infected with 2019 coronavirus disease (COVID-19) . Method: The clinical diagnosis and treatment of one relative renal transplant recipient after the occurrence of COVID-19 were analyzed retrospectively, including the course of onset, clinical manifestations, blood routine test, renal function, lung CT scan, nucleic acid detection, outpatient and inpatient therapies and outcomes. Result: The case was diagnosed as COVID-19 (severe type) with influenza A virus infection. The clinical symptoms were gradually relieved and the lung lesions were absorbed through the treatment of reduce and stop taking immunosuppressant, antiviral therapy of abidol/oseltamivir, prevention of bacterial infection, hormone anti-inflammatory, oxygen inhalation, nutritional support and adequate rest. Conclusion This case present typical characteristics of COVID-19 in epidemiological investigation, clinical manifestation, examination, pulmonary imaging and etiology. After comprehensive treatment including reduce and stop immunosuppressive therapy, clinical cure was achieved. The long-term effect of COVID-19 on this immunosuppressive patient remains follow-up.