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.

In this work, starting from 4-hydroxycoumarin, three series of 22 coumarin derivatives, among which 8 have not been reported in the literature, were synthesized and their in vitro anti-inflammatory activities and mechanisms of action were preliminarily investigated using mouse macrophage model. The results showed that most of the derivatives could significantly inhibit the production of pro-inflammatory factor NO, with compounds 2e, 2f, 2g, 2h, 2i, 2j, 4e, and 4f showing better anti-inflammatory activity than the positive control drug dexamethasone. Further experiments showed that compounds 2h and 4f significantly inhibited the production of pro-inflammatory factors IL-6, TNF-α and IL-1β in RAW264.7 macrophages, and could, therefore, be used as lead compounds for further studies.

This case report presents a 16-year-old male patient with deficiency of adenosine deaminase 2(DADA2). The patient had a history of Raynaud′s phenomenon with digital ulcers since childhood. As the disease progressed, the patient developed retinal vasculitis, intracranial hemorrhage, skin necrosis, severe malnutrition, refractory hypertension, and gastrointestinal bleeding. Genetic testing revealed compound heterozygous mutations in the ADA2 gene (paternal c.1072G > A pathogenic mutation + maternal c.1065C > A variant of unknown clinical significance). ADA2 enzyme activity was significantly reduced (0.1 U/L). A multidisciplinary treatment team developed an individualized plan to address key issues, including nutritional support, blood pressure control, rehabilitation, pain management, and balancing anticoagulation/bleeding risks. After systematic intervention, the patient′s condition showed partial improvement. This case reveals clinical challenges such as anticoagulation decisions and nutritional support of DADA2. It also emphasizes the importance of early molecular diagnosis, tumor necrosis factor-α inhibitor targeted therapy, and multidisciplinary collaboration in management, underlining the core value of precision medicine in rare disease management.

Objective: To analyze the trends in new diagnosis rates of HIV/AIDS cases in Huzhou City, Zhejiang Province from 2009 to 2023, so as to provide the basis for improving HIV/AIDS prevention and control strategies. Methods: Data of newly reported HIV/AIDS cases in Huzhou City from 2009 to 2023 were collected through the Chinese Disease Prevention and Control Information System. The new diagnosis rate was calculated as the ratio of newly reported HIV/AIDS cases within one year to the permanent resident population during the same period. The gender, age, and regional distribution characteristics of new diagnosis rates of HIV/AIDS cases were described. The trends were analyzed using average annual percent change (AAPC) and annual percent change (APC). Results: A total of 2 088 new HIV/AIDS cases were reported in Huzhou City from 2009 to 2023, with an average annual new diagnosis rate of 4.53/105. The new diagnosis rates showed an overall increasing trend from 2009 to 2023 (AAPC=12.745%, P<0.05), with rapid growth during 2009 to 2015 (APC=32.734%, P<0.05) but no significant trend during 2015 to 2023 (P>0.05). The average annual new diagnosis rate was significantly higher in males than in females (7.54/100 000 vs. 1.40/100 000, P<0.05). Male new diagnosis rate trend closely mirrored the overall population pattern, while females showed a continuous upward trend without clear inflection point (AAPC=12.575%, P<0.05). Age-specific analysis revealed average annual new diagnosis rates of 2.75/100 000, 6.16/100 000 and 3.83/100 000 for AIDS/HIV cases aged <25, 25-<50 and ≥50 years, respectively. The cases aged <25 years showed no significant trend (P>0.05), while the cases aged 25-<50 and ≥50 years followed patterns similar to the overall population. The average annual new diagnosis rates of HIV/AIDS cases in Wuxing District, Nanxun District, Deqing County, Changxing County and Anji County were 6.54/100 000, 3.43/100 000, 3.45/100 000, 3.56/100 000 and 4.94/100 000, respectively, showing overall upward trends (AAPC=9.672%, 27.599%, 11.800%, 18.896% and 10.254%, all P<0.05). Conclusions The new diagnosis rate of HIV/AIDS cases showed an overall upward trend in Huzhou City from 2009 to 2023. Cases are mainly concentrated among males, people aged 25-<50 years and Wuxing District, making them key targets for HIV/AIDS prevention and control.

Objective : To explore the role and mechanism of 25-hydroxycholesterol (25-HC) in inflammatory bow- el disease (IBD) in mice． Methods : All mice were divided into three groups : the control group was fed normally ; the DSS model group was fed with 2. 5% dextran sulfate sodium (DSS) solution ; the DSS + 25-HC experimental group was fed with 2. 5% DSS solution and he mice in the experimental group were intraperitoneally injected with 25-HC．The symptom changes of the mice were evaluated by assessing the disease activity index(DAI) ，and the tis- sue changes were judged by histological scoring．The expression of interleukin-17 and its signaling pathways in the mice were detected by Western blot，qRT-PCR, immunohistochemistry /fluorescence，and flow cytometry．Combined with the detection of tight junction proteins in the intestinal epithelium of the mice，the mechanism by which 25-HC affects IBD in mice was explored． Results : In comparison to the DSS control group，The DSS + 25-HC experimen- tal group mice exhibited a reduction in body weight ( F = 30. 1，P ＜0. 000 1) ，a shortened colon ( F = 63. 8，P < 0. 05) ，and elevated DAI(F = 774. 5，P＜0. 000 1) and histopathological scores(F = 141. 5，P＜0. 05) ．Addition- ally，the expression of tight junction-associated proteins(ZO-2，Occludin，JAM and Claudin-4) was found to be sig- nificantly reduced．The level of IL-17 significantly decreased，and its expression level was positively correlated with tight junction proteins． Conclusion 25-HC inhibited IL-17 production by colonic γδ T cells through the RORγt pathway，aggravated mucosal injury，and promoted the development of DSS-induced acute colitis in mice．

Objective To compare the short-term outcomes and postoperative complications of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)in the treatment of early colorectal cancer.Methods A total of 110 patients with early colorectal cancer who were admitted to Suining Central Hospital from June 2020 to June 2022 were prospectively enrolled and randomly assigned to two groups by random number table.Of them,58 patients underwent ESD and 52 patients underwent EMR.Operation related indexes,inflammatory factors(interleukin-6[IL-6],tumor necrosis factor-α[TNF-α],and C-reactive protein[CRP])before operation and 3 days after operation,and postoperative quality of life index(QL-Index)were compared between the two groups.The complications of the two groups were observed.Results The operation time,hospital stay,postoperative exhaust time,defecation time,and intraoperative blood loss in ESD group were lower than those in EMR group,and the rates of complete resection and en bloc resection in ESD group were higher than those in EMR group(P<0.05).The levels of IL-6,TNF-α and CRP were increased 3 d after operation in both groups,but the levels of IL-6,TNF-α and CRP in ESD group were lower than those in EMR group(P<0.05).The total score of QL-Index and the scores of activity,daily activities,health,and overall situation in ESD group were significantly higher than those in EMR group(P<0.05).The incidence of complications in ESD group was higher than that in EMR group,without significant difference(P>0.05).Conclusion The pocket ESD can effectively promote postoperative rehabilitation,increase resection rate,reduce postoperative inflammation,and improve the quality of life of patients with early colorectal cancer,and there is no obvious complication.

Objective:To investigate the correlation of antinuclear antibody (ANA) with clinical response to infliximab (IFX) in patients with Crohn′s disease (CD) .Methods:Patients who were diagnosed as CD and treated with IFX in Nanjing Drum Tower Hospital from January 2018 to September 2021 were retrospectively studied. The correlation analysis was used to explore the correlation between ANA and clinical response. These patients were divided into two groups according to the ANA titer after 25 weeks of IFX treatment. The differences in clinical data between the two groups were assessed by univariate analysis. The variables with P<0.15 in univariate analysis and having clinical significance were further analyzed by multivariate Logistic regression to determine the independent risk factors of the induction of ANA. Results:A total of 82 patients with CD were included. Forty-one (50.0%) patients were set as positive group, and 41 (50.0%) patients were set as negative group. In terms of clinical response, the clinical response rates of two groups were 68.3% and 41.5%, and the difference was significant (χ 2 = 5.959, P = 0.015) . Positive group was divided into 1∶100 subgroup ( n = 17) , 1∶320 subgroup ( n = 11) and ≥1∶1000 subgroup ( n = 13) . The clinical response rates of three groups were 41.2%, 45.5% and 7.7% respectively, and the difference was not statistically significant (χ 2 = 5.334, P = 0.084) . The incidences of adverse events in the two groups were 17.1% and 7.3%, and the difference was not significant (χ 2 = 1.822, P = 0.177) . Univariate analysis showed that the difference of total protein (TP) before IFX treatment between the positive group and negative group was statistically significant ( P<0.05) . Multivariate logistic regression analysis showed that age ( OR = 1.060, 95% CI: 1.015 ~ 1.107, P = 0.008) and the baseline TP ( OR = 1.110, 95% CI: 1.023 ~ 1.205, P = 0.012) were the independent risk factors for the induction of ANA. Conclusions:The formation of ANA may affect the clinical response of IFX, so the ANA titer should be monitored regularly during the IFX therapy. In addition, age and baseline TP are related to the formation of ANA.

Objective:To investigate the correlation of antinuclear antibody (ANA) with clinical response to infliximab (IFX) in patients with Crohn′s disease (CD) .Methods:Patients who were diagnosed as CD and treated with IFX in Nanjing Drum Tower Hospital from January 2018 to September 2021 were retrospectively studied. The correlation analysis was used to explore the correlation between ANA and clinical response. These patients were divided into two groups according to the ANA titer after 25 weeks of IFX treatment. The differences in clinical data between the two groups were assessed by univariate analysis. The variables with P<0.15 in univariate analysis and having clinical significance were further analyzed by multivariate Logistic regression to determine the independent risk factors of the induction of ANA. Results:A total of 82 patients with CD were included. Forty-one (50.0%) patients were set as positive group, and 41 (50.0%) patients were set as negative group. In terms of clinical response, the clinical response rates of two groups were 68.3% and 41.5%, and the difference was significant (χ 2 = 5.959, P = 0.015) . Positive group was divided into 1∶100 subgroup ( n = 17) , 1∶320 subgroup ( n = 11) and ≥1∶1000 subgroup ( n = 13) . The clinical response rates of three groups were 41.2%, 45.5% and 7.7% respectively, and the difference was not statistically significant (χ 2 = 5.334, P = 0.084) . The incidences of adverse events in the two groups were 17.1% and 7.3%, and the difference was not significant (χ 2 = 1.822, P = 0.177) . Univariate analysis showed that the difference of total protein (TP) before IFX treatment between the positive group and negative group was statistically significant ( P<0.05) . Multivariate logistic regression analysis showed that age ( OR = 1.060, 95% CI: 1.015 ~ 1.107, P = 0.008) and the baseline TP ( OR = 1.110, 95% CI: 1.023 ~ 1.205, P = 0.012) were the independent risk factors for the induction of ANA. Conclusions:The formation of ANA may affect the clinical response of IFX, so the ANA titer should be monitored regularly during the IFX therapy. In addition, age and baseline TP are related to the formation of ANA.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for circular superficial esophageal cancer.Methods:A retrospective analysis was conducted on 74 consecutive cases of circular superficial esophageal squamous cell carcinoma treated with ESD at Nanjing Drum Tower Hospital from January 2015 to December 2019. The success rate of ESD, curative resection rate, incidence of complications, and additional treatment were mainly observed.Results:One case was transferred to surgery, and the remaining 73 cases successfully completed ESD treatment. The success rate of ESD was 98.6%. Postoperative pathology of ESD revealed that 39 cases achieved curative resection, with a curative resection rate of 53.4% (39/73). Intraoperative muscle layer injury occurred in 15 cases (20.5%), and intraoperative perforation occurred in 1 case (1.4%). Two cases (2.7%) experienced delayed bleeding, and one case (1.4%) experienced delayed perforation. Eleven cases were lost to follow-up, and the remaining 62 cases received follow-up for 36.4±19.0 months. Among the follow-up cases, 12 underwent additional surgery and 5 cases additional chemotherapy and radiotherapy. Among the 57 patients with follow-up data who did not underwent surgery, 49 developed esophageal stenosis after ESD, with an incidence rate of 86.0%.Conclusion:ESD for circular superficial esophageal cancer is generally safe, but it is prone to muscle layer injury during the operation, with a low curative resection rate, a high incidence of postoperative esophageal stenosis, and a high proportion of additional surgical procedures.