In order to accurately master and understand the national occupational health standard Diagnosis for Occupational Radiation Thyroid Disease(GBZ 101-2020), the significance of the publication of this standard, the relevant background, the basic principles of the revision, the main basis for technical content revision, and the application of the standard are described. To provide guidance for t the physcians for occupational disease diagnosiss to understand the diagnostic principles, make correct diagnosis and avoid confusion in using the standard, so as to better protect the occupational health rights of radiation workers.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.

Objective:To investigate the application of diagnostic criteria for common occupational radiation-induced diseases to radiation workers, in order to provide a basis for the revision, publicity and standardization of the standards.Methods:Radiation workers were selected from 1 city, 7 provinces and 1 corporation by using cluster random sampling method from January 2021 to May 2021. Awareness of the criteria and the effects of ionizing radiation, and the suggestions for diagnostic works were investigated and analyzed.Results:A total of 2 839 radiation workers were investigated. There were differences in the awareness of different diagnostic criteria, the inclusions in complex diagnostic criteria, the materials required for applying for diagnosis, and the ways of knowing the diagnostic criteria( χ2=416.06, 2 924.14, 83.45, 895.67, 815.94, P<0.001). The correct understanding rates of deterministic effects and stochastic effects were 80.63% and 43.64%, respectively. The acceptance rates in applicable materials were 96.79% for occupational exposure history, 94.72% for occupational health monitoring records and 93.55% for individual monitoring of occupational exposure, respectively. Pre-employment training rate was 80.20%, on-job training rate was 81.19%, and untrained rate was 3.77%. The suggestions to the diagnosis of occupational radiation-induced diseases are to strengthen training, pay attention to individual monitoring, occupational health examination, and strengthen health supervision and law enforcement. Conclusions:Radiation workers have a low awareness rate of certain diagnostic standards and a high awareness rate of diagnostic procedures. Publicity and training of health effects of ionizing radiation and diagnostic criteria of occupational radiation-induced diseases should be strengthened. Diagnostic procedure should be optimized.

Objective:To investigate the relationship between prolonged PR interval and carotid atherosclerosis(CAS)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 537 middle-aged and elderly inpatients with T2DM in the Southern Branch of the Sixth People′s Hospital of Shanghai Jiaotong University from January 2019 to January 2021 were selected as the research objects. Color Doppler ultrasound was used to detect bilateral carotid artery intima-media thickness(CIMT). The subjects were divided into carotid atherosclerosis group(CAS group, n=352)and non-carotid atherosclerosis group(NCAS group, n=185). The difference in the PR interval of ECG between the two groups was compared. Pearson or Spearman rank correlation analysis was used for evaluating the correlation of PR interval and CAS lesions with various clinical index. The relationship between PR interval and CAS lesions was adopted by multivariate logistic regression analysis. Results:The average PR interval of middle-aged and elderly patients with T2DM was(164.57±23.02)ms. The average PR interval in CAS group was significantly higher than that in NCAS group [(169.76±24.28) vs (154.70±16.42)ms, P<0.01]. The results of multifactorial logistic regression analysis showed that age, low density lipoprotein-cholesterol, serum osteocalcin, and PR interval were independent factors influencing the development of CAS lesions in middle-aged and elderly patients with T2DM( OR=1.079, 1.936, 0.879, 1.039, respectively, P<0.05 or P<0.01)where each 1 ms increase in PR interval was associated with a 3.9% increase in the risk of CAS in middle-aged and elderly patients with T2DM( OR=1.039, 95% CI 1.006-1.073, P=0.020). Multivariate logistic regression analysis showed that middle-aged and elderly type 2 diabetic patients with PR interval≥158 ms were 4.072 times more likely to have CAS lesions than those with PR interval<158 ms( OR=4.072, 95% CI 1.417-11.702, P<0.01). Conclusion:The PR interval of electrocardiogram is correlated with CAS lesions in middle-aged and elderly patients with T2DM. Middle-aged and elderly type 2 diabetic patients with significantly prolonged PR interval should be reminded to screen for CAS lesions early.

Objective:To improve the accuracy of the coding of occupational radiation diseases in China, to provide standardized basis for the research on the management of such diseases as well as the informatization management of medical records and the formulation of relevant policies, and to improve the level of prevention and control.Methods:According to the nomenclature and disease characteristics of occupational radiation diseases in China, the diseases were coded by ICD-10 coding rules.Results:The system of occupational radiation diseases in China is the sum of all kinds of diseases caused by ionizing radiation, which is different from the common clinical symptom. The coding of such diseases must be based on the location, clinical manifestations, pathological changes, and other characteristics.Conclusions:The accuracy of occupational radiation diseases coding directly affects the accuracy of disease statistical data. Standardizing the coding of these diseases is a very necessary supplement to the system of occupational radiation diseases in China.

Objective:To investigate the late effects induced by external ionizing radiation through long-term follow-up of the victims exposed to 60Co radiation source at " 4.26" accident in Henan in 1999, and to provide valuable experience in the radiological medicine. Methods:Medical observations of the clinical symptoms, signs, eye lens examination and previous medical history of the five exposed victims were performed and recorded. The changes of the laboratory routine examinations, immune function, thyroid function, reproductive hormone levels, tumor markers, radiation genetic indicators as well as ultrasound examination of thyroid, cardiac, reproductive system, electrocardiogram, chest CT were systematically reviewed.Results:The typical radiation-induced cataract was found in " Mei" 2-3 years after 60Co accidental irradiation. 13 years after irradiation, the cataract surgery and intraocular lens implantation in left eye were performed followed by the same operation in right eye in November 2019. Different degrees phacoscotasmus under the posterior capsule or equatorial part of the eyes were also found in the rest of victims. ECG result of " Mei" indicated myocardial ischemia 7 years after accident. " Tian" confirmed diagnosis coronary heart disease 12 years after irradiation, and the surgery about coronary angiography heart stent implantation was taken at 20 years after irradiation. Five victims showed increased serum total cholesterol and/or triglycerides, and 4 victims showed bilateral or unilateral common carotid atherosclerotic plaque formation. Higher levels of thyroid stimulating hormone (TSH) were observed in " Mei" at 11 years after the irradiation. The thyroglobulin antibody (TGA)and thyroid microsomal antibody (TMA) were obviously increased in " Yi" , accompanied by thyroid uneven found by ultrasound. The thyroid nodules in " Mei" and " Min" were observed at 15 years after irradiation. The diagnosis of diffuse large B cell lymphoma(DLBL) in " Tian" was confirmed at 13 years after irradiation. Slightly higher of Neuron-specific enolase(NSE) were found in " Tian" , " Min" and " Yi" . A small nodule was detected from chest CT of " Tian" . Most of the chromosome aberrations observed in peripheral blood lymphocytes from the victims were stable chromosomal aberration such as translocation (t) with a few dicentric chromosome (dic) and acentric fragment (ace) in " Wang" and " Tian" . Conclusions:Ionizing radiation can cause variable degrees of deterministic effects in lens, thyroid gland and cardiovascular circulatory system and stochastic effects such as neoplasm. The genetic damages will last long in the patients.

Objective: To investigate the clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities. Methods: From January 2016 to November 2017, 14 patients (9 males and 5 females, aged 19 to 54 years) with skin and soft tissue defects in extremities accompanied with tendon and bone exposure were admitted to our unit. The size of skin and soft tissue defects after debridement ranged from 7 cm×3 cm to 10 cm×7 cm. The defects were repaired with free superficial femoral artery femoral triangle perforator flaps, with size ranging from 13.0 cm×2.0 cm to 20.0 cm×4.5 cm. The medial femoral cutaneous nerve was applied to the flap. The perforator flap was grafted onto the medial femoral cutaneous nerve in 6 patients. The donor sites were sutured directly. The survival of flaps and the follow-up of patients were observed. Results: All flaps of 14 patients survived successfully. The recipient sites and donor sites were healed completely in 13 patients, and 1 patient with partial skin necrosis at the edge of flap was healed after treatment. All patients were followed up for 6 months to 1 year after the operation. The flaps were in good shape, with nearly normal color and soft texture and no cicatrix contracture deformity. The flaps recovered protective sense in 6 patients who had medial femoral cutaneous nerve grafting, and the sensory recovery of the flap was slightly worse in the remaining 8 patients. There was no significant complications on the appearance and walking of the donor thigh in 14 patients, only a linear scar was left on the inner thigh, and no numbness was felt in the donor sites of patients. Conclusions The free superficial femoral artery femoral triangle perforator flap is an ideal therapy for repairing skin and soft tissue defects in extremities.

Objective To explore the mediating effect of coping styles on the relationship between social support and self-management among young patients with newly-diagnosed type 2 diabetes(T2DM).Methods A total of 169 young patients with newly-diagnosed T2DM at China-Japan Friendship Hospital were investigated with the Medical Coping Mmodes Questionnaire,Social Support Rating Scale and the Summary of Diabetes Self-Care Activities.Results Among young patients with newly-diagnosed T2DM,there was a positive correlation between social support and confronce coping style(r =0.250,P＜0.01).The confronce coping style was positively correlated with self-management(r=0.367,P＜0.01).Confronce coping style could explain 15.3%variance of self-management(P＜0.01).Confronce coping style had a mediating effect on the relationship between social support and self-management.Conclusions Confronce coping style has a predictive role on self-management among young patients with newly-diagnosed T2DM,and confronce coping style has a mediating effect between social support and self-management.

Objective To examine the prospective associations between airflow obstruction (AFO) and risks of major chronic diseases morbidity in Chinese adults.Methods Samples of this study were from the China Kadoorie Biobank.A total of 486 996 participants aged 30 to 79 years (mean 51.5 years) at the baseline study,were included after excluding those who self-reported of having heart disease,stroke and cancer at baseline.AFO was defined under the Global Initiative on Obstructive Lung Disease (GOLD) criteria and forced expiratory volume per one second in percentage of the expected one (FEV1％P).Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease,cerebrovascular disease and lung cancer after adjusted for potential confounders.Results Over a period of 7 years through the follow-up program,the incident cases of ischemic heart disease,cerebrovascular disease and lung cancer appeared as 24 644,36 336 and 3 218,respectively.Compared with people without AFO,the HR (95％CI) of GOLD-1 to GOLD-4 were 0.89 (0.78-1.01),1.05 (0.98-1.12),1.29 (1.18-1.40) and 1.65 (1.42-1.91) respectively for ischemic heart disease.The HR (95％ CI) of GOLD-1 to GOLD-4 were 0.96 (0.70-1.26),1.12 (0.96-1.31),1.38 (1.14-1.65) and 1.48 (1.05-2.02) respectively for lung cancer.No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found.However,each 10％ decrease in FEV1％P was associated with 7.2％ (95％CI:6.4％-8.0％),3.6％ (95％CI:3.0％-4.3％) and 10.5％ (95％CI:8.4％-12.6％) increased the risks of ischemic heart disease,cerebrovascular disease and lung cancer respectively.The results were persistant when stratified by smoking status.Conclusion Higher degree of AFO seemed to be associated with the risks of ischemic heart disease,cerebrovascular disease and lung cancer morbidity among the Chinese adults.

OBJECTIVE:To compare the efficacy and safety of ferrous succinate or Shengxuening in the adjuvant treatment of renal anemia in patients with diabetic nephropathy peritoneal dialysis (CAPD). METHODS:64 diatetic nephropathy CAPD pa-tients with renal anemia were randomly divided into observation group (32 cases) and control group (32 cases). All patients re-ceived subcutaneous injection of insulin for blood glucose control (adjusted the insulin dosage based on fasting blood glucose lev-els),hypertension patients actively controlled blood pressure,corrected acid-base and electrolyte balance disorders,orally received fo-lic acid and vitamin B12,ambulant CAPD,then rhEPO was subcutaneously injected with initial dose of 100-150 U/(kg·week) for 2-3 times and other conventional treatment. Based on it,observation group received 1 g of Shengxuening tablet,3 times a day;control group received 0.2 g Ferrous succinate tablet,3 times a day. The treatment course for both groups was 16 weeks. The rhEPO dose was monthly adjusted to make Hb 100-120 g/L. Clinical efficacy,serum iron,serum ferritin,total iron binding capacity,transfer-rin saturation before and after treatment,Hb,Hct,hs-CRP,rhEPO dose before treatment and after 4,8,12 and 16 weeks of treat-ment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:There was no significant difference in the total effective rate between 2 groups (P>0.05). After treatment,serumiron,total iron binding capacity,transferrin saturation,Hb and Hct in 2 groups were significantly higher than before,and it gradually increased by treatment time,serum ferritin,hs-CRP was sig-nificantly lower than before,and it gradually decreased by treatment time,the differences were statistically significant(P<0.05);but there was no significant difference between 2 groups(P>0.05). The rhRPO dose in observation group 8,16 and 16 weeks af-ter treatment and in control group 8 weeks after treatment were significantly lower than 4 weeks after treatment,and 12 and 16 weeks after treatment in observation group were lower than control group,the differences were statistically significant (P<0.05). The incidence of adverse reactions in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). CONCLUSIONS:Based on conventional treatment,both ferrous succinate and Shengxuening show good ef-ficacy in the adjuvant treatment of renal anemia with diabetic nephropathy CAPD,both can improve anemia and iron metabolism, while Shengxuening is superior to ferrous succinate in terms of improving microinflammatory state and reducing rhEPO dose,with better safety.