Objective To investigate the effects of low-dose ionizing radiation on the thyroid status and hormone levels of radiation workers. Methods Radiation workers who underwent occupational health examinations at a hospital in Guangzhou from 2015 to 2022 were selected as the subjects of this study. The levels of FT3, FT4 and TSH were analyzed, and the thyroid abnormality status of radiation workers in different groups were compared. Results A total of 1152 participants were included in this study, consisting of 885 (76.82%) males and 267 (23.18%) females, with an average age of (35.26 ± 10.16) years. The prevalence of thyroid abnormalities was 9.38%, which was significantly higher in females (13.86%) than in males (8.02%) (P < 0.05). The TSH level of females [(2.15 ± 1.29) mIU/L] was higher than that of males [(1.85 ± 1.20) mIU/L], while the levels of FT3 [(5.10 ± 0.64) pmol/L] and FT4 [(15.84 ± 2.32) pmol/L] in females were lower than those in males [(5.23 ± 0.63) pmol/L and (16.61 ± 2.75) pmol/L, P < 0.05]. The FT3 of industrial workers [(5.25 ± 0.63) pmol/L] was higher than that of medical workers [(5.10 ± 0.63) pmol/L], while the TSH of industrial workers [(1.80 ± 1.12) mIU/L] was lower than that of medical workers [(2.15 ± 1.37) mIU/L]. FT4 levels decreased with increasing age and duration of occupational exposure. Multivariable logistic regression analysis revealed that sex was a significant independent predictor of thyroid abnormalities among radiation workers. Female workers were more likely to experience thyroid abnormalities (β = −0.62, P < 0.05). Conclusion Low-dose ionizing radiation may have a certain impact on the thyroid status of radiation workers, especially for female workers, which requires further attention and research.

Evoked Potentials ; Social Isolation ; Attention ; Humans

BACKGROUND:At present,measurement osteotomy technique and gap balance technique are the two main surgical methods in total knee arthroplasty.Both methods have their advantages and disadvantages.By adjusting the osteotomy angle,the gap balance technique can reduce the release of soft tissue and obtain a more balanced flexion and extension space.The clinical efficacy of gap balance technique is superior,but this surgical method lacks tools and is easily influenced by the surgeon's surgical experience and subjective judgment,with more errors.Measurement osteotomy technique has a short learning curve,but it relies on anatomic markers and is prone to many complications due to inaccurate positioning.In recent years,many instrument companies have successively developed and launched tools that can improve the quality of surgery.However,there are still few reports about the tool. OBJECTIVE:To compare the clinical efficacy of gap balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty,and explore the value of Offset Repo-Tensor in total knee arthroplasty. METHODS:The medical records of 85 patients with total knee arthroplasty were collected and divided into two groups according to the operation method.Group A consisted of 44 patients who underwent total knee arthroplasty using a gap balance technique combined with Offset Repo-Tensor.Group B consisted of 41 patients who underwent total knee arthroplasty using measurement osteotomy technique.Surgical time,American Knee Society Score,knee range of motion,changes in lower limb alignment,and postoperative complications were compared between the two groups to evaluate the clinical efficacy of gap balance technique combined with Offset Repo-Tensors in total knee arthroplasty. RESULTS AND CONCLUSION:(1)All 85 patients were followed up.(2)Postoperative knee range of motion in both groups was higher than that before surgery(P<0.05),and the improvement in group A was more significant than that in group B(P<0.05).(3)American Knee Society Score in both groups after surgery was higher than that before surgery(P<0.05),and the American Knee Society Score in group A was higher than that in group B at 2 weeks,1,3 months,and the last follow-up(P<0.05).(4)The operation time of group A was slightly shorter than that of group B,but the difference was not significant(P>0.05).(5)The lower limb alignment in both groups was improved after operation,but there was no significant difference between the two groups(P>0.05).(6)The complication rate of group A(2%)was lower than that of group B(7%),but there was no significant difference between the two groups(P>0.05).(7)It is indicated that compared with the measurement osteotomy technique,the combination of Offset Repo-Tensor and gap balance technique can elevate the clinical effect and improve the function and motion range of the knee joint.

Objective:To explore the relevant risk factors and prognosis of patients with intrahepatic cholangiocarcinoma (ICC) who experienced recurrence within 6 months after surgeryMethods:This retrospective study included a total of 259 patients with ICC a treated at He'nan Provincial People's Hospital and He'nan Cancer Hospital from Jan 2018 to Jan 2020. The clinical and pathological data ,differences between the group with recurrence within 6 months and the group without recurrence within 6 months were compared using the chi-square test. Logistic regression analysis was used to determine the relevant risk factors for recurrence within 6 months. Kaplan-Meier method was used to construct survival and recurrence curves, and survival rates were calculated.Results:The overall survival and recurrence-free survival of patients in the group with recurrence within 6 months were significantly shorter. CA19-9, tumor longitudinal diameter, microvascular invasion, and neural invasion were identified as independent risk factors for recurrence within 6 months after ICC surgery ( P<0.001). Conclusion:The patient population experiencing recurrence within 6 months after ICC surgery has an extremely poor prognosis and possesses a specific tumor microenvironment. CA19-9, tumor longitudinal diameter, microvascular invasion, and neural invasion were identified as independent risk factors for recurrence within 6 months after ICC surgery.

Objective:To investigate the lipidomics differences of CD4+T immune cells in diabetic kidney disease(DKD)mice,and screen out the differential metabolites with biological significance.Methods:CD4(L3T4)MicroBeads immunomagnetic beads were used to isolate CD4+T immune cells from spleen of BKS.Cg-Dock7m+/+Leprdb/J mice with spontaneous DKD;the purity of CD4+T cells were identified by flow cytometry.The non-targeted lipidomics of CD4+T cells were detected by LC-MS/MS,and the differ-ential metabolites were analyzed.Results:A total of 463 metabolites were detected by LC-MS.PCA and OPLS-DA analysis showed that the metabolic components were significantly separated;twenty-four differential metabolites were screened out.KEGG and enrich-ment analysis showed that the differential metabolites involved in the disorder of glycerol phospholipid metabolism.Conclusion:Phos-pholipid metabolism of CD4+T cells is closely related to the occurrence of DKD.Phospholipid metabolism targeting DKD CD4+T cells in DKD may be a new direction of DKD treatment.

Surgery is the preferred treatment for resectable esophageal cancer, but in locally advanced esophageal cancer, the effect of surgery alone is not ideal, so surgery-based comprehensive treatment is the best option. Neoadjuvant therapy has become a standard treatment in the treatment of locally advanced resectable esophageal cancer. Neoadjuvant therapy includes neoadjuvant chemotherapy, radiochemotherapy, immunotherapy, targeted therapy, etc. With the significant efficacy and acceptable toxicity of immunotherapy in the first-line and second-line treatment of advanced esophageal cancer, neoadjuvant immunotherapy has become a research hotspot of locally advanced resectable esophageal cancer. This article reviews the latest research progress and some limitations of neoadjuvant immunotherapy in locally advanced resectable esophageal cancer.

Objective:To investigate the clinicopathological features of Crooke cell tumor of adrenocorticotropic hormone differentiation specific transcription factor (TPIT, also known as transcription factor 19, TBX19) lineage neuroendocrine tumors.Methods:Six cases of Crooke cell tumor diagnosed at the First Affiliated Hospital of University of Science and Technology of China, Hefei, China from October 2019 to October 2023 were collected. The clinical and pathological features of these cases were analyzed.Results:Among the six cases, one was male and five were female, with ages ranging from 26 to 75 years, and an average age of 44 years. All tumors occurred within the sella turcica. Clinical presentations included visual impairment in two cases, menstrual disorders in one case, Cushing′s syndrome in one case, headache in one case, and one asymptomatic case discovered during a physical examination. Preoperative serum analyses revealed elevated levels of cortisol and adrenocorticotropic hormones in two cases, elevated cortisol in two cases, elevated adrenocorticotropic hormone in one case, and one case with a mild increase in prolactin due to the pituitary stalk effect. Magnetic resonance imaging revealed uneven enhancement of masses with maximum diameters ranging from 1.7 to 3.2 cm, all identified as macroadenomas. Microscopically, tumor cells exhibited irregular polygonal shapes, solid sheets, or pseudo-papillary arrangements around blood vessels. The cell nuclei were eccentric or centrally located, varying in size, with abundant cytoplasm. Some tumor cells showed perinuclear halo. Immunohistochemistry demonstrated diffuse strong positivity for TPIT in five cases, focal weak positivity for TPIT in one case, diffuse strong positivity for adrenocorticotropic hormone in all cases, and faint staining around the nuclei in a few cells. CK8/18 showed a strong positive ring pattern in more than 50% of tumor cells, focal weak positive expression of p53, and the Ki-67 positive index ranged 1%-5%. Periodic acid-Schiff staining revealed positive cytoplasm and negative perinuclear areas.Conclusions:Crooke cell tumor is a rare type of pituitary neuroendocrine tumors. Its pathological characteristics include a distinctive perinuclear clear zone and immunohistochemical markers, such as CK8/18 exhibiting a ring or halo pattern. This entity represents a high-risk subtype among pituitary neuroendocrine tumors, displaying a high risk of invasion and a propensity for recurrence. Accurate diagnosis is crucial for the postoperative follow-up and multimodal treatment planning.

Objective:To explore the effect of early intermittent enteral nutrition (EN) in critically ill patients after cardiac surgery.Methods:We developed an early EN feeding regimen for critically ill patients after cardiac surgery. A prospective analysis was conducted on 178 critically ill patients admitted to the Cardiothoracic Surgery Intensive Care Unit of a tertiary hospital in Shanghai from May 2022 to May 2023. They were divided into the control group ( n=88) and the observation group ( n=90) using a random number table method. The control group received routine EN feeding, while the observation group received early intermittent EN feeding. Comparison between groups was performed in terms of the tolerability and interruption of EN administration, nutrition related outcome indicators, and prognosis indicators. Results:The observation group had significantly lower rates of abdominal distension, diarrhea, nausea and vomiting (or reflux), and EN interruption, as well as shorter duration of EN interruption, compared to the control group ( P<0.05). After 7 days of early EN, 87.8% of patients in the observation group met the calorie goal, which was significantly higher than that of 22.5% in the observation group ( P<0.05). The nutritional related indicators (serum prealbumin, hemoglobin, actual intake of nutritional fluids) were also better in the observation group patients compared to the control group ( P<0.05). The duration of mechanical ventilation and length of ICU stay in the observation group were significantly shorter than those in the control group, with statistical significance ( P<0.05). There was no significant difference in the length of hospital stay between the two groups. Conclusion:Early EN program can improve the symptoms of feeding intolerance in patients, reduce the occurrence and duration of feeding interruption, increase the rate of calorie goal fulfillment, improve nutritional status,and promote patient recovery and outcome in critically ill patients after cardiac surgery.

Objective:To analyze and verify the distribution characteristics of radiation dose on the body surface of surgeons in cardiovascular interventional treatment,so as to provide theoretical basis for studying the characteristics of radiation dose and implementing radiation protection correctly.Methods:During cardiovascular interventional surgery,three pieces of lead protective clothing(designated as lead protective clothing A,B,and C)were provided in the room of digital subtraction angiography(DSA)equipment.Each piece of these protective clothing included one lead scarf,one lead vest and one lead apron,and the lead equivalents of them were all 0.5 mmPb.A thermoluminescence dosimeter was placed on the outer surface of the lead protective clothing that was worn by surgeon,and the radiation dose values of the front and back,vertical and horizontal surfaces of the three pieces of lead protective clothing were compared.Results:The measured average values of the front dosimeter of the three pieces of lead protective clothing were respectively(296.2±31.9)mSv,(196.3±20.2)mSv and(299.4±33.0)mSv,which were significantly higher than those of the back of the lead protective clothing,and the differences were statistically significant(Z=-5.522,-5.115,-4.817,Z=-5.522,-5.115,-4.817,P<0.05).The values of abdominal radiation doses on the vertical plane of the three pieces of lead protective clothing were the highest,which were respectively(356.7±58.2)mSv,(217.7±31.8)mSv and(387.4±46.3)mSv.The measured values of the dosimeter on the left side of the horizontal plane of the A,B of lead protective clothing were respectively(341.6±58.5)mSv and(229.1±32.4)mSv,which were all higher than that on the right side,with statistical significances(Z=5.890,9.068,P<0.05).The measured value of the left side of lead protective clothing was respectively higher than that of the middle side and the right side,and the differences were statistically significant(Z=5.846,9.766,P<0.05).Conclusion:The radiation dose of the front of the body surface of surgeon who undergo DSA intervention is significantly higher than that in the back of that,and the radiation dose of the abdomen on the vertical plane of the body is the highest,and the radiation dose of horizontal plane appears a decreasing trend from left to right.The detected dose data and distribution characteristics of radiation can provide research basis for radiation protection.

Objective:To sort out China's emergency rescue material support policies and management systems for responding to major infectious disease emergencies in China,to analyze the effects of policy implementation at each stage,and to improve emergency management capabilities of public hospitals.Methods:The China National Knowledge Infrastructure(CNKI),Wanfang,VIP and he State Council Policy Document databases from 1949 to 2023 were searched,and 538 research literatures related to major infectious disease emergencies and emergency rescue material support were retrieved,and 79 research literatures were finally included according to the inclusion and exclusion criteria.The relevant policy documents,research reports and academic articles were sorted and analyzed using literature analysis methods,emergency management theory and organizational resilience theory.Results:The 79 research literatures on the evolution of emergency rescue material support policies in response to major infectious disease emergencies in China can be divided into four stages and three periods.14 research papers were included in the embryonic period of emergency management,including the two stages from the founding of People's Republic of China to the period before the reform and opening up(7 papers)and from the reform and opening to the SARS epidemic in 2003(7 papers),during which the government was in a single response and decentralized and extensive management mode.30 research papers were included in the comprehensive coordination emergency management model period,which was from the after of the SARS epidemic in 2003 to the beginning of 2018,during which the first"one plan,three systems"(emergency response plan,emergency management system,mechanism and legal system)were proposed and gradually moved towards informatization and intelligence.35 research papers were included in the comprehensive emergency management model period,which began in early 2018,and the main feature was the establishment of a centralized and unified emergency management system at the national level.Public hospitals can learn from the current situation of emergency rescue material support policy and management system in China and enhance the emergency management capabilities from the whole process of before,during,and after emergencies.Conclusion:The policy evolution in three stages has gradually adapted to the complex public health emergencies,which could better realize the mature stage of legalization,intelligence and refinement of emergency management of China.Public hospitals should closely follow the requirements of the national policy system,continuously improve the emergency management mechanisms and enhance the ability to deal with major infectious disease emergencies.