Objective:To investigate the main occupational hazards,occupational protection facilities and workers'health examination in 17 plywood manufacturing enterprises in Guangxi,so as to provide valuable basis for ensuring workers'physical and mental health.Methods:A total of 17 plywood enterprises in Guangxi were selected as the observation objects.Through the occupational hazard assessment survey,the occupational hazards in the working environment and the collection of workers'occupational health examination data,the main occupational health problems were comprehensively analyzed and evaluated.Results:The over-standard rates of wood dust,formaldehyde,noise,and high temperature in 17 plywood manufacturing enterprises were 5.6%,28.1%,24.9%,and 29.1%,respectively.The noise in 17 enterprises exceeded standards,the mood dust and formaldehyde in 5 enterprises exceeded standards,and high temperature in 2 enterprises exceeded standards.The coincidence rate of dustproof and poisonproof facilities in production protection was 98.3%,the coincidence rate of heat-proof facilities was 88.2%and the coincidence rate of noise protection facilities was 76.5%.The coincidence rate of wearing and using personal protective equipment was 52.9%,and the coincidence rate of installing eyewash spray devices was 58.8%.The total physical examination rate in 17 enterprises was 42.6%(705/1 654),and the abnormal detection rate of physical examination was 14.6%,among which the abnormal detection rates of hearing,chest X-ray,and lung function were 7.4%,2.1%,and 1.7%,respectively.Conclusions:The main occupational health problems in 17 plywood manufacturing enterprises in Guangxi are wood dust,formaldehyde,noise,and high temperature,especially noise.The prevention and control effects of wood dust and formaldehyde are good,but the prevention and control measures for high temperature and noise need to be further strengthened.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

ObjectiveTo explore the mechanism of Qihuang Yiqi Shexue prescription （QHYQSX） in the treatment of immune thrombocytopenia （ITP） model mice based on the autophagy mediated by the adenosine monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR）/Unc-51-like kinase 1 （ULK1） signaling pathway. MethodFifty BALB/c mice were randomly divided into normal group， model group， high- and low-dose QHYQSX groups， and prednisone group， with 10 mice in each group. The ITP model was induced by intraperitoneal injection of anti-platelet serum （APS） of guinea pig. On the 8th day of the APS injection， drugs were administered by gavage for 14 days. Peripheral blood platelet （PLT） count and hemoglobin （Hb） concentration were detected. Spleen and thymus were separated， weighed， and the organ index was calculated. Sternum was sampled for bone marrow smear， and bone marrow megakaryocytes were classified under a microscope. Thrombopoietin （TPO）， interleukin-6 （IL-6）， IL-10， tumor necrosis factor-α （TNF-α）， transforming growth factor-β₁ （TGF-β₁）， and interferon-γ （IFN-γ） in the serum were detected by enzyme-linked immunosorbent assay（ELISA）. AMPK， mTOR， ULK1， microtubule-associated protein light chain 3 （LC3）， Beclin1， and p62 mRNA expression levels in the spleen were detected by Real-time fluorescence-based quantitative polymerase chain reaction （Real-time PCR）. The protein expression of AMPK， p-AMPK， p-mTOR， p-ULK1， LC3Ⅱ/LC3Ⅰ， Beclin1， and p62 in the spleen was detected by Western blot. ResultCompared with the normal group， the model group showed reduced peripheral blood PLT count， Hb， and TPO levels （P<0.05，P<0.01）， increased spleen and thymus indexes （P<0.01）， decreased number of bone marrow megakaryocytes （P<0.01）， elevated serum levels of IL-6， TNF-α， and IFN-γ （P<0.01）， and reduced IL-10 and TGF-β₁ levels （P<0.01）. Compared with the model group， the groups with drug intervention showed increased PLT counts and TPO levels （P<0.01）， decreased spleen and thymus indexes （P<0.05， P<0.01）， elevated number of bone marrow megakaryocytes （P<0.05， P<0.01）， reduced serum levels of IL-6， TNF-α， and IFN-γ （P<0.05， P<0.01）， and up-regulated IL-10 and TGF-β₁ levels （P<0.05，P<0.01）. Compared with the low-dose QHYQSX group， the high-dose QHYQSX group and the prednisone group showed different degrees of significant differences in improving PLT counts and levels of cellular inflammatory factors （P<0.05， P<0.01）. Real-time PCR and Western blot results showed that compared with the normal group， the model group showed up-regulated mRNA expression of AMPK， LC3， and Beclin1 and protein expression of p-AMPK/AMPK， LC3Ⅱ/LC3Ⅰ， and Beclin1 in the spleen （P<0.05， P<0.01）， and down-regulated mRNA expression of mTOR， ULK1， and p62 and protein expression of p-mTOR， p-ULK1， and p62 （P<0.05， P<0.01）. Compared with the results in the model group， high- and low-dose QHYQSX and prednisone could down-regulate the mRNA expression of AMPK， LC3， and Beclin1 and protein expression of p-AMPK/AMPK， LC3Ⅱ/LC3Ⅰ， and Beclin1 in the spleen （P<0.05， P<0.01）， and up-regulate the mRNA expression of mTOR， ULK1， and p62 and protein expression of p-mTOR， p-ULK1， and p62 （P<0.05， P<0.01）. ConclusionQHYQSX may inhibit excessive autophagy by regulating the AMPK/mTOR/ULK1 signaling pathway， thereby regulating immune intolerance and playing a role in the treatment of ITP.

To investigate the distribution and clinical significance of nuclear dense fine speckled (DFS) pattern in various diseases. A total of 95 289 patients who received DFS tests at Peking Union Medical College Hospital from January 2019 to December 2020 were included in this study. The results of indirect immunofluorescence assay (IIF) for detection of antinuclear antibody (ANA) were evaluated. The positive rates of ANA and DFS were 39.60% (37 733/95 289) and 1.19% (1 139/95 289) respectively. The positive rate of DFS in ANA-positive patients was 3.02% (1 139/37 733). DFS and ANA positivity were significantly different among different age groups rather than gender. The positivity rate of DFS reached the peak (55.57%, 633/1 139) in young patients between 21-40 years, while positive ANA with negative DFS was mainly observed in patients between 41-60 years (37.26%, 13 636/36 594). Additionally, single ANA-positivity were mainly detected in rheumatology department (59.23%, 18 402/31 066), whereas positive DFS was more common in obstetrics and gynecology department (3.08%, 49/1 593). There were 82.88% (944/1 139) patients with positive DFS diagnosed with non-autoimmune disease (non-AID), and 19.49%(222/1 139) with dermatosis. Positive DFS with higher titer (≥1∶320) was detected more frequently in autoimmune disease (AID) patients (5.13%, 10/195) than in non-AID patients (1.69%, 16/944) ( P<0.05). The DFS pattern is rare in ANA positive patients, which is mainly observed in women between 21-49 years. High titer of DFS is prevalent in AID patients, but positive DFS is detected more in non-AID patients, especially those with dermatosis.

Objective To compare the clinical effect of minimal invasive drilling cranium from frontal part and craniotomy from temporal in the treatment of patients with cerebral hemorrhage in basal ganglia.Methods From August 2011 to August 2017,126 cases with cerebral hemorrhage in basal ganglia in the People's Hospital of Meishan were divided into observation group and control group,with 63 cases in each group.The observation group was treated by minimal invasive drilling cranium,and the control group was treated by craniotomy.The clinical treatment effect,operation indicators (operation time,amount of intraoperative bleeding,operation cost,discharge time) and nervous function recovery were analyzed.Results The operation time,amount of intraoperative bleeding,operation cost,discharge time of observation group were (31.6 ± 10.3) min,(20.9 ±5.8)mL,(2.1 ± 1.0) thousand CNY,(15.3 ± 0.9) d,respectively,which were better than those of the control group [(214.2 ± 46.8) min,(94.1 ± 56.2) mL,(15.0 ±4.8) thousand CNY,(21.4 ±0.4)d] (t =13.56,11.94,19.65,8.39,all P ＜0.05).The effective rate and the nerve function score between the two groups had no statistically significant differences (all P ＞ 0.05).Conclusion The minimal invasive drilling cranium from frontal part has advantages of small surgical trauma,short operation time,less bleeding in the operation,low death rate,less cost of operation,short hospitalization time and good drainage effect,and thus it is worthy of clinical application.

OBJECTIVETo study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA).

METHODSEighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale.

RESULTSCompared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (P<0.05). Sufentanil dosage and incidence of EA during recovery of group A were also lower than those of group B (P<0.05). Time to regain consciousness and time to reach modified Aldrete's score≥12 of group A were longer than those of group B (P<0.05). No statistical difference was observed between other indexes of the two groups.

CONCLUSIONSAs an anesthetic used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

The morbidity of nutritional risk and malnutrition generally increase in inpatients. The clinical nutritional therapy is gradually recognized by health care providers. The ways of nutritional therapy include oral nutritional supplement (ONS),intubation feeding and parenteral nutrition with ONS for the first choice. This paper summarized the application status of ONS in many fields of clinic so as to provided references for nurses to understand fully and apply ONS in standard.

This review outlined the status of malnutrition in hospitalized patients around the world, introduced the application of various nutritional screening tools and elaborated the important effects of nutrition risk evaluation and intervention on clinical outcome of patients. To solve the problem of shortage of systematic and cooperative work in clinical nutrition management in China, software of nutrition screening and management was designed so as to simplify the nutrition management process and provide a powerful guarantee for promoting clinical nutrition treatment work.

We investigated the antibiotic‐resistant genes and genetic diversity of Pseudomonas aeruginosa from patients in hospital ,the smear samples from hospital and clinic environment ,and from medical staff’ hands respectively in 2011‐2012 in Nanshan District of Shenzhen .Polymerase chain reaction were used to detect the 20 kinds of antibiotic‐resistant genes (TEM , VEB,CARB,OXA,SHV,PER,GES,GTX,SPM,GIM,IMP,VIM,DHA,oprD,Aac(6′)‐Ⅰ ,Aac(6′)‐Ⅱ ,Aac (3′)‐Ⅰ ,A ac(2″)‐Ⅰ ,qacE1‐sull and int‐Ⅰ) .Multilocus sequencing typing was used to analyze the clonal complexes .The 11 kinds resistant genes TEM ,SHV ,IMP ,DHA ,Aac(6′)‐Ⅰ ,Aac(6′)‐Ⅱ ,Aac(3′)‐Ⅰ ,Aac(2″)‐Ⅰ ,qacE1‐sull ,int‐Ⅰand oprD were detected ,for the positive rates respectively ,and which were 8 .1% ,6 .4% ,4 .8% ,9 .7% ,4 .8% ,14 .5% ,9 .7% , 56 .5% ,8 .1% ,and 8 .1% ;the loss rate of oprD gene was 61 .2% .The 19 antibiotic resistance gene profiles existed in 52 Pseudomonas aeruginosa strains .Multilocus sequencing typing found 39 sequence types and 5 clonal complexes in 62 Pseudo‐monas aeruginosa strains ,CC244 and ST856 were dominant .There were some differences of antibiotic resistance gene profiles between different samples ,the Pseudomonas aeruginosa strains from patients carried multiple resistant genes .In our research , the Pseudomonas aeruginosa had the genetic diversity and the dominant clonal complexes existed .