Objective:To study the risk and pattern of deaths caused by various diseases in the population and in the case of long-term occupational X-ray exposure.Methods:Using a combination of retrospective and prospective cohort research methods, an exposure group of medical X-ray diagnostic workers who worked in the radiology department of Jiangsu Provincial Hospital between 1950 and 1980 and a control group of medical workers from other departments who did not work with radiolog during the same period in the same hospital were selected to form a study cohort. The cumulative number of person years of observation in the cohort during 1950-2011 was calculated, and the Cox regression model was used to calculate the risk of deaths of medical X-ray diagnostic workers for various diseases through adjusting sex, attained age, birth age, and starting working age.Results:A total of 6 953 follow-up visits was completed to the cohort, including 3 649 in the radiation group and 3 304 in the control group, with a total of 347 362 person years of observation. There were 2 099 deaths in the cohort as of December 31, 2021. Cox regression results showed that diseases with a significantly higher risk of death in the radiation group compared with the control group were: all-cancer ( RR=1.20, 95% CI: 1.04-1.39, Z=2.56, P<0.05, including lung cancer RR=1.52, 95% CI: 1.17-1.98, Z=3.10, P<0.01, and pancreatic cancer RR=1.96, 95% CI: 1.11-3.46, Z=2.31, P<0.05); diseases of the circulatory system ( RR=1.29, 95% CI: 1.06-1.57, Z=2.58, P<0.01); endocrine, nutritional and metabolic diseases ( RR=1.90, 95% CI: 1.06-3.42, Z=2.14, P<0.05). Stratified analyses showed that, of male workers, the radiation group had an increased risk of death caused by all-cancer and lung cancer ( Z=3.50, 2.92, P<0.01); of the age group at starting ages 26 to 30, the radiation group had an increased risk of death distributed to circulatory diseases ( Z=2.06, P<0.05); and in the age group at attained ages elder than 61 years, the radiation group had an increased risk of death distributed to all cancers, lung cancer, and circulatory diseases ( Z=2.90-4.31, P<0.01). Conclusions:As has been shown, threre is an increasing risk of death distributed to lung cancer, pancreatic cancer, and circulatory diseases in medical X-ray diagnostic workers in Jiangsu province. Further in-depth research in related areas may be conducted in the future.

Objective:To understand the basic situation of occupational internal exposure to 131I among nuclear medicine staff in Jiangsu province, and to analyze the relevant factors that contribute to the formation of internal exposure. Methods:A four-year external direct measurement of thyroid organ counting was conducted on nuclear medicine staff who underwent 131I treatment in Jiangsu province. The result were statistically analyzed, and the effective dose of accumulated internal exposure was estimated. The relationship between the detection rate of internal exposure and 10 possible factors was analyzed. Results:A total of 847 person-times were monitored during the monitoring period, of which 345 person-times were detected for 131I, with a detection rate of 40.7%. The highest individual monitoring result for internal exposure was 24.83 kBq, with an average value of 77.3 Bq and a median of 28.3 Bq among the detected individuals. The average committed effective dose of internal exposure for staff was 0.201 mSv, with a median of 0.074 mSv among the detected individuals. Conclusions:There is statistically significant difference in the detection rate of individual doses of internal exposure among nuclear medicine staff in each year. It has been observed that the main factors related to the detection rate are age, hospital grade, job position, location, whether there is an automatic dispensing operation, operating method, exposure level and length of exposure. Sufficient attention should be given to the situation of internal exposure, and further effective monitoring should be conducted on all such staff members.

Objective:To investigate the basic situation of occupational internal exposure to 131I among staff in the nuclear medicine department. Methods:Direct in- vitro measurements of thyroid doses from internal exposure were conducted for six months on 36 staff members of a hospital′s nuclear medicine department in Nanjing using the ORTEC Detective-100 portable high-purity germanium (HPGe) spectrometer. The cumulative effective doses were estimated, and the distribution of internal doses and their relationship with job type and external doses were analyzed. Results:During the monitoring period, a total of 203 monitorings were made. Of the monitoring result, 85.7% were below the recording level. Of the result exceeding the recording level, 12.8% were below the investigation level, while 1.5% exceeded the investigation level. The highest personal internal dose during the monitoring period was 2.54 mSv, the lowest was 0.015 mSv, and the median was 0.094 mSv.Conclusions:During the monitoring period, 14.3% of the monitored staff had result above the recorded levels. In the working environment of radionuclide treatment, there is no significant difference in the internal dose received between doctors, nurses, technicians, or other relevant personnel.

[Objective] To investigate the antigen and gene frequency distribution of the MNS blood group system in the Han population of voluntary blood donors in Suzhou, and to explore the polymorphism of rare MNS blood group genes, in order to improve the construction of the local rare blood group database. [Methods] A total of 8 034 whole blood samples were randomly collected from Han blood donors at our station from October 2023 to June 2024. The MNS blood group phenotypes were identified using serological methods. Gene frequencies were analyzed and compared with those of ethnic populations in other regions. Rare MNS phenotype samples were subjected to gene sequencing. [Results] The distribution of MNS blood group system phenotypes within the population was as follows: the MM, NN, and MN phenotypes accounted for 23.00%, 27.12%, and 49.88% respectively; the SS, ss, and Ss phenotypes accounted for 0.30%, 90.99%, and 8.70% respectively. The gene frequencies of M, N, S, and s were 0.4794, 0.5206, 0.0465, and 0.9534 respectively. Chi-squared tests confirmed adherence to Hardy-Weinberg equilibrium with P-values of 0.997 and 0.349, showing statistical significance compared to some other regional ethnic populations (P<0.05). Additionally, one rare serological phenotype, S-s-, with a frequency of 0.01%, was identified. [Conclusion] The MNS blood group system in the Han population of voluntary blood donors in Suzhou exhibits polymorphism and regional distribution characteristics. Gene frequencies differ from those observed in other regions of China. It is essential to enhance the establishment of a rare blood type database in Suzhou to provide data support for precise clinical transfusion.

Objective:To study the risk and pattern of deaths caused by various diseases in the population and in the case of long-term occupational X-ray exposure.Methods:Using a combination of retrospective and prospective cohort research methods, an exposure group of medical X-ray diagnostic workers who worked in the radiology department of Jiangsu Provincial Hospital between 1950 and 1980 and a control group of medical workers from other departments who did not work with radiolog during the same period in the same hospital were selected to form a study cohort. The cumulative number of person years of observation in the cohort during 1950-2011 was calculated, and the Cox regression model was used to calculate the risk of deaths of medical X-ray diagnostic workers for various diseases through adjusting sex, attained age, birth age, and starting working age.Results:A total of 6 953 follow-up visits was completed to the cohort, including 3 649 in the radiation group and 3 304 in the control group, with a total of 347 362 person years of observation. There were 2 099 deaths in the cohort as of December 31, 2021. Cox regression results showed that diseases with a significantly higher risk of death in the radiation group compared with the control group were: all-cancer ( RR=1.20, 95% CI: 1.04-1.39, Z=2.56, P<0.05, including lung cancer RR=1.52, 95% CI: 1.17-1.98, Z=3.10, P<0.01, and pancreatic cancer RR=1.96, 95% CI: 1.11-3.46, Z=2.31, P<0.05); diseases of the circulatory system ( RR=1.29, 95% CI: 1.06-1.57, Z=2.58, P<0.01); endocrine, nutritional and metabolic diseases ( RR=1.90, 95% CI: 1.06-3.42, Z=2.14, P<0.05). Stratified analyses showed that, of male workers, the radiation group had an increased risk of death caused by all-cancer and lung cancer ( Z=3.50, 2.92, P<0.01); of the age group at starting ages 26 to 30, the radiation group had an increased risk of death distributed to circulatory diseases ( Z=2.06, P<0.05); and in the age group at attained ages elder than 61 years, the radiation group had an increased risk of death distributed to all cancers, lung cancer, and circulatory diseases ( Z=2.90-4.31, P<0.01). Conclusions:As has been shown, threre is an increasing risk of death distributed to lung cancer, pancreatic cancer, and circulatory diseases in medical X-ray diagnostic workers in Jiangsu province. Further in-depth research in related areas may be conducted in the future.

Objective:To understand the basic situation of occupational internal exposure to 131I among nuclear medicine staff in Jiangsu province, and to analyze the relevant factors that contribute to the formation of internal exposure. Methods:A four-year external direct measurement of thyroid organ counting was conducted on nuclear medicine staff who underwent 131I treatment in Jiangsu province. The result were statistically analyzed, and the effective dose of accumulated internal exposure was estimated. The relationship between the detection rate of internal exposure and 10 possible factors was analyzed. Results:A total of 847 person-times were monitored during the monitoring period, of which 345 person-times were detected for 131I, with a detection rate of 40.7%. The highest individual monitoring result for internal exposure was 24.83 kBq, with an average value of 77.3 Bq and a median of 28.3 Bq among the detected individuals. The average committed effective dose of internal exposure for staff was 0.201 mSv, with a median of 0.074 mSv among the detected individuals. Conclusions:There is statistically significant difference in the detection rate of individual doses of internal exposure among nuclear medicine staff in each year. It has been observed that the main factors related to the detection rate are age, hospital grade, job position, location, whether there is an automatic dispensing operation, operating method, exposure level and length of exposure. Sufficient attention should be given to the situation of internal exposure, and further effective monitoring should be conducted on all such staff members.

Objective:To investigate the basic situation of occupational internal exposure to 131I among staff in the nuclear medicine department. Methods:Direct in- vitro measurements of thyroid doses from internal exposure were conducted for six months on 36 staff members of a hospital′s nuclear medicine department in Nanjing using the ORTEC Detective-100 portable high-purity germanium (HPGe) spectrometer. The cumulative effective doses were estimated, and the distribution of internal doses and their relationship with job type and external doses were analyzed. Results:During the monitoring period, a total of 203 monitorings were made. Of the monitoring result, 85.7% were below the recording level. Of the result exceeding the recording level, 12.8% were below the investigation level, while 1.5% exceeded the investigation level. The highest personal internal dose during the monitoring period was 2.54 mSv, the lowest was 0.015 mSv, and the median was 0.094 mSv.Conclusions:During the monitoring period, 14.3% of the monitored staff had result above the recorded levels. In the working environment of radionuclide treatment, there is no significant difference in the internal dose received between doctors, nurses, technicians, or other relevant personnel.

Objective:To explore the impact of the hospital health literacy environment on patients′ postoperative pain self-management behaviors, aiming to provide insights for hospitals to implement the Comprehensive Pain Management Pilot Work Program in hospitals and to promote self-health management among patients with other diseases or symptoms. Methods:From November to December 2023, a convenience sampling method was used to select postoperative patients from three grade A tertiary general hospitals in Zhejiang Province for an on-site questionnaire survey. The Chinese version of brief health literacy screen (BHLS), short-form health literacy environment scale (SF-HLES) and postoperative pain self-management behavior questionnaire (PPSMB) were used as survey tools to investigate the health literacy level of patients, the health literacy environment of the hospital, and the postoperative pain management behaviors of patients. Two-way ANOVA was used to compare the impact of different dimensions of the hospital health literacy environment on postoperative pain management behaviors among patients with different levels of health literacy. Multiple linear regression analysis was used to explore the relationship between the hospital health literacy environment, individual health literacy, and patients′ postoperative pain self-management behaviors, and to discuss the impact of individual health literacy on patients′ postoperative pain self-management behaviors under different hospital health literacy environments.Results:341 valid questionnaires were collected. The average score of the hospitals′ SF-HLES was (73.62±19.54) points. The average score of the patients′ BHLS was (9.65±2.88) points. The average score of the patients′ PPSMB was (25.99±6.35) points. Two-way ANOVA results showed that the interaction between individual health literacy and the clinical dimension ( F=5.463, P=0.020) and structural dimension ( F=6.470, P=0.011) of the hospital health literacy environment had a statistically significant impact on patients′ postoperative pain self-management behaviors, while the interaction with the interpersonal dimension ( F=0, P=0.984) had no statistically significant impact on pain self-management behaviors. Simple effect analysis indicated that only in the high health literacy environment of the clinical and structural dimensions did the difference in pain self-management behaviors between patients with good health literacy and those with limited health literacy had statistical significance ( P<0.001). Multiple linear regression analysis results showed that for each 1-point increase in the patients′ BHLS score, their PPSMB score increased by 3.74 points ( β1=0.832, P<0.001); for each 1-point increase in the hospital′s SF-HLES score, the patients′ PPSMB score could increase by 0.198 points ( β2=0.610, P<0.001). In a low health literacy environment, individual health literacy did not affect pain self-management behaviors ( P>0.05); however, in a high health literacy environment, for each 1-point increase in the patients′ BHLS score, their PPSMB score correspondingly increased by 4.037 points ( β4=0.317, P<0.001). Conclusions:The positive impact of individual health literacy on pain self-management is contingent upon a high-quality hospital health literacy environment. This suggests that optimizing the hospital health literacy environment is a necessary precondition for implementing the relevant content of the Comprehensive Pain Management Pilot Work Program and can provide a reference for promote self-health management among patients with pain and other diseases or symptoms.

Objective:To investigate WS 582-2017 Specifications for testing of quality control in X and γ ray stereotactic radiotherapy system (hereinafter referred to as WS 582-2017) with respect to its current status, existing problems and evaluation since its implementation in Beijing, Chongqing, Jiangsu and Sichuan. Methods:The evaluation of this standard was carried out by means of field survey, questionnaire survey and expert seminar. In accordance with the WS 582-2017 implementation assessment programme, a total of 153 professionals involved in the implementation of WS 582-2017 from 80 radiological health technical service institutions, health supervision institutions and medical institutions of two municipalities and two provinces were surveyed in 2023. The investigation was carried out by using a combination of cluster sampling and stratified sampling and through sampling professionals with of different institution characteristics and different technical titles. The general survey method was used for Jiangsu province, while the cluster sampling method was used for others, with 153 individulas from 80 institutions being sampled for the investigation.Results:The awareness rate of WS 582-2017 was 80.39%, of which 90.85% considered it to be scientific and rigorous, 81.05% considered it to be operational and 97.39% considered it to be in consistency with the relevant regulatory standards, 90.20% considerd it to have played an important role in promoting radiological protection optimization for radiotherapy, 90.85% considered the implementation of it to have played a significant role in the quality control of standarded testing of radiotherapy equipment, and 86.93% considered the implementation of it to have played a significant role in enhancing the professional competence of relevant technicians.Conclusions:The overall implementation of WS 582-2017 in two municipalities and two provinces is good, with scientific and operable technical contents and the remarkable effect achieved in its implementation. However, the WS 582-2017 needs to be further improved in some areas, and training on the standard needs to be strengthened to improve the awareness rate of it.

Objective:This study aimed to analyze cytomegalovirus (CMV) reactivation and its influencing factors in patients with B-lymphocyte malignancy who received chimeric antigen receptor T (CAR-T) cell therapy.Methods:This study retrospectively reviewed patients with B-lymphocyte malignancy who received CAR-T cell therapy in the First Affiliated Hospital of Soochow University from January 2021 to December 2023. The data of patients who underwent CMV-DNA detection and/or pathogen metagenomic sequencing twice or more within 100 days after CAR-T cell therapy were analyzed. The clinical characteristics of the CMV reactivation and non-activation groups were compared. The factors related to CMV reactivation were analyzed with the Chi-square test and nonparametric rank sum test, and the risk factors were examined with Logistic regression.Results:This study included 86 patients, among whom 18 (20.9%) had CMV reactivation, and the median time of reactivation was 20 (1-95) days. All of the 18 patients had CMV viremia, and no CMV disease was observed. Seven patients turned to the latent state after continuing acyclovir antiviral therapy, and 11 patients returned to the latent state after upgrading the antiviral therapy to first-line drugs, including ganciclovir and foscarnet sodium. Six or more courses of anti-tumor treatment before CAR-T cell therapy, allogeneic hematopoietic stem cell transplantation within 2 years before CAR-T cell therapy, non-remission before treatment, and the use of high-dose glucocorticoids and/or tocilizumab were related to CMV reactivation, among which allogeneic hematopoietic stem cell transplantation within 2 years pre-treatment and the use of high-dose glucocorticoids and/or tocilizumab treatment were independent risk factors for CMV reactivation.Conclusion:Patients with B-lymphocyte malignancy who received CAR-T cell therapy have the risk of CMV reactivation, especially for those who received allogeneic hematopoietic stem cell transplantation within 2 years pre-treatment and those who received high-dose glucocorticoids and/or tocilizumab treatment.