Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

ABSTRACT The Association Standard of Practice Specification for Manipulation of Drugs was released by Zhejiang Council for Health Services Promotion in 2023. This standard contains the basic conditions, operating procedures, quality control, storage and validity management, in particular, it provides a detailed and operable process in various dose division modes, which provides a working basis for its work. In this paper, the development background of the group standard and the main technical content of the group standard are interpreted in detail, aiming to provide guidance and reference for the publicity and implementation of the standard.

Objective:To explore the value of spectral CT in the preoperative evaluation of solid lung adenocarcinoma with different pathological grades based on the 2011 and 2020 version of the pathological grading system.Methods:A total of 76 cases of solid lung adenocarcinoma confirmed by surgery in Renji Hospital, School of Medicine, Shanghai Jiao Tong University, from January 2019 to September 2021 were analyzed retrospectively. All cases were divided into groups according to the grading system for invasive adenocarcinoma proposed by the International Association for the Study of Lung Cancer (IASLC) in 2011 and 2020 (G low group included G1 and G2 adenocarcinoma, G high group included G3 adenocarcinoma). The tumors with stage Ⅰ and Ⅱ were non-advanced and the tumors with stage Ⅲ and Ⅳ were advanced. The clinical manifestations (gender, age, smoking history and stage), routine CT parameters (tumor size, morphological characteristics, plain CT value and enhancement degree) and spectral parameters [iodine concentration, effective atomic number, enhanced monochromatic CT attenuation values of 40-200 keV (CT 40 keV-CT 200 keV), and the slope of spectral curve (k value)] were compared between G low group and G high group using independent sample t-test or Mann-Whitney U test. And the efficacy of each parameter for indicating G high adenocarcinoma was analyzed using receiver operating characteristic curve analysis and area under the curve (AUC), and the Z test was used to compare the AUC. Results:Seventy-six cases were included (59 cases of G low group and 17 cases of G high group in 2011 version; 46 cases of G low group and 30 cases of G high group in 2020 version). Among the 76 cases, 62 cases were non-advanced stage (50 cases of G low group and 12 cases of G high group in 2011 version; 37 cases of G low group and 25 cases of G high group in 2020 version) and 14 cases were advanced stage (9 cases of G low group and 5 cases in G high group in both 2011 and 2020 version). Among the non-advanced adenocarcinomas, the CT parameters of enhancement degree, k value and CT 40 keV-CT 60 keV in arterial phase and enhancement degree, k value and CT 40 keV-CT 70 keV in venous phase of G high group in 2011 grading system were significantly lower than those of G low group ( P<0.05), while other parameters were similar between G low and G high group in 2011 grading system ( P>0.05); and the CT parameters of CT 60 keV in arterial phase and CT 50 keV-CT 70 keV in venous phase of G high group in 2020 grading system were significantly lower than those of G low group ( P<0.05). Among the advanced adenocarcinomas, all of the clinical and CT parameters were similar between G low and G high group in both 2020 and 2011 grading systems ( P>0.05). For the non-advanced adenocarcinomas, there was medium to good efficacy of the CT parameters of enhancement degree, k value and CT 40 keV-CT 60 keV in arterial phase and enhancement degree, k value and CT 40 keV-CT 70 keV in venous phase for diagnosing 2011 grading system G high adenocarcinoma (AUC=0.700-0.853), with CT 50 keV in venous phase as the best; while the diagnosis efficacy of CT parameters of CT 60 keV in arterial phase and CT 50 keV-CT 70 keV in venous phase was poor for 2020 grading system G high adenocarcinoma (AUC=0.652-0.688), with CT 60 keV in venous phase as the best. After combining smoking history and CT 60 keV in venous phase, the diagnosis efficacy for 2020 grading system G high adenocarcinoma was slightly improved (AUC=0.772), but the difference had no significance ( Z=0.93, P=0.176). Conclusion:The spectral parameters are useful for distinguishing the pathological grades of solid lung adenocarcinoma. And the detecting efficacy for G high adenocarcinoma of IASLC 2011 version is slightly better than that of 2020 version.

Objective:To explore the value of dual-layer spectral detector CT in differentiating the diagnosis of lung cancer and inflammatory nodules.Methods:A total of 92 patients undergoing enhanced chest scan from March 2019 to September 2020 at Renji Hospital, School of Medicine, Shanghai Jiaotong University, were retrospectively enrolled in the study. The conventional CT parameters, spectral CT parameters were measured and the nodules′ morphological characteristics were analyzed. Later the factors with statistical significance were identified as independent variables in a logistic regression model to establish models for predicting malignant nodules. ROC curve was used to assess the diagnostic performance for the conventional CT model, spectral CT parameters and combined model, respectively. Differences in the area under the ROC curve (AUC) were analyzed by the DeLong test.Results:Lobulated sign (42 and 8, respectively, χ2=10.779, P=0.001), short burr sign (41 and 7, respectively, χ2=11.911, P=0.001), pleural indentation sign (45 and 9 respectively, χ2=11.705, P=0.001), vascular convergence sign (35 and 8, respectively, χ2=5.337, P=0.021) and the venous phase iodine concentrations (IC) value [(2.1±0.5) mg/ml, (2.3±0.5) mg/ml, t=-2.464, P=0.016], normalized iodine concentrations (NIC) value (0.40±0.06, 0.45±0.08, t=-6.943, P<0.001), and Z-effective (Z eff) values (8.38±0.21, 8.49±0.19, t=-2.122, P=0.037) were significantly different between the lung cancer group and the inflammatory group, while other CT signs and CT indicators were not significantly different between the lung cancer group and the inflammatory group ( P>0.05). The conventional CT model was established with lobulated sign, short burr sign, pleural indentation sign, vascular convergence sign, and the AUC for differential diagnosis of lung cancer and inflammatory nodules was 0.827. The spectral CT parameter model was established with venous phase IC, venous phase NIC, and venous phase Z eff value, and the AUC for differential diagnosis of lung cancer and inflammatory nodules was 0.899. The conventional CT model combined spectral CT parameter model was established with the significant factors in the univariate analysis, and the AUC for differential diagnosis of lung cancer and inflammatory nodules was 0.925. The AUC of the combined model showed no significant difference from that of the spectral CT parameter model ( Z=1.794, P=0.073). However, AUC of the combined model was significantly higher than that of evaluation based on conventional CT alone ( Z=2.156, P=0.031). Conclusion:Spectral CT parameters combined with conventional CT signs can improve the differential diagnosis efficiency between lung cancer and inflammatory nodules.

Objective To explore the effect of recombinant human tissue plasminogen activator(rt-PA) intravenous thrombolytic therapy combined with antiplatelet therapy on the recurrence of cardio cerebral vascular adverse events in patients with mild acute ischemic stroke (AIS).Methods From December 2015 to December 2017,74 patients with mild AIS treated in Shaoxing Central Hospital were selected in the research.According to the random number table method,the patients were divided into two groups,with 37 cases in each group.The control group received rt-PA intravenous thrombolysis,and the combined group was treated with antiplatelet therapy on the basis of the control group.The serum creatinine(SCr),alanine transaminase(ALT) and platelet count(PLT) were compared before and after treatment in the two groups,and the scores of the Barthel index scale and the modified Rankin scale were compared between the two groups.The incidence of cardiovascular adverse events in 3 months of the two groups was also recorded.Results There were no statistically significant differences in liver and kidney function indicators between the two groups before and after treatment (t =0.30,0.27,0.20,0.77,0.03,0.64,all P ＞ 0.05).Before treatment,the Barthel index scale scores in the combined group and control group[(74.97 ±4.74)points,(61.95 ± 4.24) points] were significantly increased,and the increasing degree in the combined group was more significant than that in the control group(t =12.45,P ＜ 0.05).The modified Rankin scale scores in the combined group and control group[(1.16 ± 0.37) points,(2.05 ± 0.45) points] were significantly decreased compared with those before treatment,and the reduction degree of the combined group was more significant than that in the control group(t =9.29,P ＜ 0.05).The total incidence rate of bleeding events,cardiovascular events,cerebrovascular events and death events in the combined group(5.41％) was significantly lower than that of the control group(27.03％) (x2 =4.87,P ＜ 0.05).Conclusion rt-PA intravenous thrombolytic therapy combined with antiplatelet therapy can effectively improve the nerve function and daily activity of patients with mild AIS.It can also effectively reduce the incidence of cardiovascular and cerebrovascular adverse events,and thus help to improve the prognosis and improve the quality of life.Therefore,it has good clinical application value.

Objective To explore the effect of nurse-social worker-college student volunteer team guide on care-giving competence of the primary caregivers for the long-term bedridden elderly. Methods The research was conveniently focused on a total of 60 long-term bedridden elderly and 30 primary caregivers, pension caregiver in welfare home from March to May 2015. The nurse-social worker-college student volunteer team guide for the primary caregivers included distributing health manual, training skill, psychological support, respite care and so on. The intervention lasted for 3 months, twice a month, 150 minutes each time. This was a self comparison study. The care competence for the primary caregivers and self-care ability of daily activities for the long-term bedridden elderly were conducted before and after intervention. Results Before intervention, the total score of care-giving competence was 59.07 ± 13.42. After intervention, the total score was 66.64 ± 14.16. Before intervention, the scores of caring knowledge, operation technique, behavior and attitudes, decision-making and self-efficacy were as follows:18.48±3.46, 17.95±3.98, 12.16±3.08, 7.98±2.56. Whereas, after intervention, the scores were as follows:20.32±3.58, 20.48±2.74, 14.29±3.03, 9.65±2.07. Each dimension score after intervention was significantly higher than that before intervention (t=-2.87--2.02, P<0.01). For bathing, dressing, indoor transferring and eating in self-care ability of daily activities, the numbers of people in 60 long-term bedridden elderly were 8, 13, 21, 18 before intervention and 17, 24, 43, 29 after intervention. The self-care ability of daily activities of the primary caregivers such as bathing, dressing, indoor transferring and eating after intervention were significantly higher than that before intervention (χ2=4.093-4.857, P<0.05). Conclusions Nurse-social worker-college student volunteer team guide can enhance the care-giving competence of the primary caregivers as well as improve the self-care ability of daily activities for the long-term bedridden elderly.

Objective: To investigate the association between etheno-DNA adduct and the promoter of DNA methylation levels of cyclin dependent kinase inhibitor 2A (P16), Ras association domain family 1 (RASSF1A) and O-6-methylguanine-DNA methyltransferase (MGMT) in workers with occupational exposure to diesel engine exhaust (DEE). Methods: We recruited 124 diesel engine testing workers as DEE exposure group and 112 water pump operator in the same area as control group in Henan province in 2012 using cluster sampling. The demographic data were obtained by questionnaire survey; urine after work and venous blood samples were collected from each subject. The urinary etheno-DNA adducts were detected using UPLC-MS/MS, including 1,N6-etheno-2'-deoxyadenosine (εdA) and 3,N4-etheno-2'-deoxycytidine(εdC). The DNA methylation levels of P16, RASSF1A, and MGMT were evaluated using bisulfite-pyrosequencing assay. The percentage of methylation was expressed as the 5-methylcytosine (5mC) over the sum of cytosines (%5mC). Spearman correlation and multiple linear regression were applied to analyze the association between etheno-DNA adducts and DNA methylation of P16, RASSF1A, and MGMT. Results: The median (P₂₅-P₇₅) of urinary εdA level was 230.00 (98.04-470.91) pmol/g creatinine in DEE exposure group, and 102.10 (49.95-194.48) creatinine in control group. The level of εdA was higher in DEE exposure group than control group (P<0.001). DNA methylation levels of P16, RASSF1A and MGMT were 2.04±0.41, 2.19 (1.94-2.51), 2.22 (1.94-2.46)%5mC in exposure group, and 2.19±0.40, 2.41 (2.11-2.67), 2.44 (2.15-2.91)%5mC in control group. DNA methylation levels were lower in exposure group (P values were 0.005, 0.002 and 0.001, respectively). Spearman correlation analysis showed that DNA methylation levels of P16, RASSF1A, and MGMT were negative associated with urinary εdA level (r values were -0.155, -0.137, and -0.198, respectively, P<0.05). No significant correlation was observed between the εdC level and any measured DNA methylation levels (P>0.05) . Multiple linear regression confirmed the negative correlation between εdA and DNA methylation levels of P16, RASSF1A, and MGMT in non-smoking group (β (95%CI) was -0.068 (-0.132--0.003), -0.082 (-0.159--0.004) and -0.048 (-0.090--0.007), P values were 0.039, 0.039 and 0.024, respectively). Moreover, εdC was negative associated with DNA methylation level of MGMT in non-smoking group (β (95%CI) was -0.094 (-0.179--0.008), P=0.032). Conclusion DEE exposure could induce the increased of εdA and decreased of DNA methylation levels of P16, RASSF1A and MGMT.

Objective To investigate the reference range and influeing factors of the nuclear division index (NDI) of peripheral blood lymphocyte in Chinese general population in Anhui province.Methods We selected 281 subjects from the general poulation in Anhui province,without occupational exposure to genetic toxicants and no chronic disease history.We used questionnaires to collect occupational history,age,gender,region,body mass index,smoking,and alcohol drinking status etc.NDI was measured by cytokinesis block micronucleus assay in peripheral blood lymphocytes,and the related factors were also analyzed.And NDI was used as the dependent variable,age,gender and other factors as independent variables to conduct stepwise multiple linear regression.Results We found the data of NDI according with normal distribution,and the nuclear division index was 1.71±0.22,the minimum value was 1.10 while the maximum was 2.36.The results showed that NDI value of the males (1.67±0.20) were lower than that of the females (1.76±0.24),the difference was statistically significant (t=-3.65,P＜0.001);current smokers NDI (1.66±0.18) lower than non-smokers (1.73±0.24) differences were statistically significant (t=3.06,P=0.002);the NDI of drinking groups (1.66±0.20) was lower than that of non-drinking population (1.74±0.23),the differences was statistically significant (t=3.15,P=0.002);Using multiple stepwise linear regression calibration factors and found that gender was an independent factor of NDI (β=0.098,sx =0.027,t=3.66,P＜0.001).Conclusion We set the reference value on the nuclear division index among general population of survey areas in this study,it could provide a reference for similar studies and will provide reference for better evaluation of the effects of hazards on the body.

Objective To investigate the effect of coil embolization without the assistance of balloon dilation or stenting for the treatment of newly ruptured very small intracranial aneurysms.Methods A group of 26 subarachnoid hemorrhage (SAH) patients treated in our hospital from August 2010 to April 2013 were enrolled;a total of 26 very small intraeranial aneurysms were identified.All anemysms were firstly spored by CT angiography or MR angiography,and then,followed by digital subtraction angiography (DSA) or 3D-DSA for determination of operation plans.General anesthesia was applied for all patients.Coil embolization was performed without the assistance of balloon dilation or stenting.All aneurysms were rechecked by DSA at 3 and 12 months after embolization.Results After the coiling procedure,18 aneurysms were completely embolized,3 were close to complete embolizaiton,2 were partly embolized,and 3 aneurysms re-ruptured and then completely embolized.All patients were fully recovered to independent living at discharge.The 12 months post-procedure DSA recheck revealed no changes for the 18 aneurysms with complete embolization,stable blood flow for the 3 with close-to-complete embolization,no re-rupture or re-bleeding for the 2 partly embolized aneurysms,and complete embolization for the 3 aneurysms re-ruptured during the procedure.Conclusion Coil embolization alone without the assistance of balloon dilation or stenting may achieve satisfactory results for the treatment of newly ruptured very small intracranial aneurysms.

Objective To investigate the reference range and influeing factors of the nuclear division index (NDI) of peripheral blood lymphocyte in Chinese general population in Anhui province.Methods We selected 281 subjects from the general poulation in Anhui province,without occupational exposure to genetic toxicants and no chronic disease history.We used questionnaires to collect occupational history,age,gender,region,body mass index,smoking,and alcohol drinking status etc.NDI was measured by cytokinesis block micronucleus assay in peripheral blood lymphocytes,and the related factors were also analyzed.And NDI was used as the dependent variable,age,gender and other factors as independent variables to conduct stepwise multiple linear regression.Results We found the data of NDI according with normal distribution,and the nuclear division index was 1.71±0.22,the minimum value was 1.10 while the maximum was 2.36.The results showed that NDI value of the males (1.67±0.20) were lower than that of the females (1.76±0.24),the difference was statistically significant (t=-3.65,P＜0.001);current smokers NDI (1.66±0.18) lower than non-smokers (1.73±0.24) differences were statistically significant (t=3.06,P=0.002);the NDI of drinking groups (1.66±0.20) was lower than that of non-drinking population (1.74±0.23),the differences was statistically significant (t=3.15,P=0.002);Using multiple stepwise linear regression calibration factors and found that gender was an independent factor of NDI (β=0.098,sx =0.027,t=3.66,P＜0.001).Conclusion We set the reference value on the nuclear division index among general population of survey areas in this study,it could provide a reference for similar studies and will provide reference for better evaluation of the effects of hazards on the body.