For pancreatic neoplasms, the current clinical treatment strategy is mainly using standard surgical methods, including pancreaticoduodenectomy, distal pancreatectomy with splenectomy, and total pancreatectomy. Standard surgical methods require a larger resection, including resection of some surrounding organs and a large amount of pancreatic parenchyma. The endocrine and exocrine functions of the pancreas are easily damaged. Moreover, since the standard surgical procedure involves the reconstruction of the digestive tract at multiple anastomoses, there is a high risk of pancreatic, biliary, and intestinal fistulas occurring postoperatively. Therefore, function-preserving pancreatic surgery is recommended for some benign and low-grade pancreatic neoplasms. This type of surgery can treat pancreatic diseases while preserving more peripancreatic organs, pancreatic parenchyma and relatively complete digestive tract continuity, thereby improving the patient′s short-term and long-term quality of life. In addition, with the development of laparoscopy and da Vinci robotic technology, minimally invasive technology-assisted pancreatic surgery has been carried out in clinical practice. They have been shown to be sufficiently safe and effective. This article reviews several common clinical pancreatic function-preserving surgical methods and their corresponding clinical applications and technical development status from the perspectives of preserving more peripancreatic organs, preserving more pancreatic parenchyma, and promoting pancreatic function recovery.

Objective:To investigate the value of implantable cardiac monitor (ICM) in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods:This was a multi-center, prospective cohort study. Between June 2018 and April 2021, patients over the age of 60 with unexplained syncope at Beijing Hospital, Fuwai Hospital, Beijing Anzhen Hospital and Puren Hospital were enrolled. Patients were divided into 2 groups based on their decision to receive ICM implantation (implantation group and conventional follow-up group). The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up. Kaplan‐Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups. A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results:A total of 198 patients with unexplained syncope, aged (72.9±8.25) years, were followed for 558.0 (296.0,877.0) d, including 98 males (49.5%). There were 100 (50.5%) patients in the implantation group and 98 (49.5%) in the conventional follow-up group. Compared with conventional follow-up group, patients in the implantation group were older, more likely to have comorbidities, had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram, and had a lower body mass index (all P<0.05). During the follow-up period, positive cardiac arrhythmia events were recorded in 58 (58.0%) patients in the ICM group. The diagnosis rate (42.0% (42/100) vs. 4.1% (4/98), P<0.001) and the intervention rate (37.0% (37/100) vs. 2.0% (2/98), P<0.001) of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group (all P<0.001). Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group ( HR=11.66, 95% CI 6.49-20.98, log-rank P<0.001). Multivariate analysis indicated that ICM implantation, previous atrial fibrillation, diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope (all P<0.05). Conclusions:ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope, and increases diagnostic efficiency in patients with unexplained syncope.

For pancreatic neoplasms, the current clinical treatment strategy is mainly using standard surgical methods, including pancreaticoduodenectomy, distal pancreatectomy with splenectomy, and total pancreatectomy. Standard surgical methods require a larger resection, including resection of some surrounding organs and a large amount of pancreatic parenchyma. The endocrine and exocrine functions of the pancreas are easily damaged. Moreover, since the standard surgical procedure involves the reconstruction of the digestive tract at multiple anastomoses, there is a high risk of pancreatic, biliary, and intestinal fistulas occurring postoperatively. Therefore, function-preserving pancreatic surgery is recommended for some benign and low-grade pancreatic neoplasms. This type of surgery can treat pancreatic diseases while preserving more peripancreatic organs, pancreatic parenchyma and relatively complete digestive tract continuity, thereby improving the patient′s short-term and long-term quality of life. In addition, with the development of laparoscopy and da Vinci robotic technology, minimally invasive technology-assisted pancreatic surgery has been carried out in clinical practice. They have been shown to be sufficiently safe and effective. This article reviews several common clinical pancreatic function-preserving surgical methods and their corresponding clinical applications and technical development status from the perspectives of preserving more peripancreatic organs, preserving more pancreatic parenchyma, and promoting pancreatic function recovery.

{L-End}Objective To establish the norm of Core Occupational Stress Scale (COSS) for electronic manufacturing industry workers in China. {L-End}Methods A total of 3 049 workers from five electronic manufacturing enterprises in four prefecture-level cities concentrated distribution of the electronics manufacturing industry in China were selected as research subjects using a stratified sampling method. COSS was used to investigate occupational stress levels, and the mean norm, percentile norm and threshold norms were established. {L-End}Results The average score of COSS for the electronic manufacturing industry workers in China was (43.5±7.4) points, and the average scores of social support, organization and reward, demand and effort, and autonomy dimensions were (9.5±3.1), (15.1±3.9), (13.1±3.0), and (5.7±2.0) points, respectively. A total score of 0.0-<47.0 points was determined as no occupational stress, 47.0-<51.0 points as mild occupational stress, 51.0-≤54.0 points as moderate occupational stress, and >54.0 points as severe occupational stress. {L-End}Conclusion The norm of COSS for workers in China's electronics manufacturing industry has been established, which can provide a reference for the evaluation and intervention of their occupational stress levels.

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

Objective:To explore the diagnostic and grading value of combination of 68Ga -1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid- D-Phe1-Tyr3-Thr8-octreotide ( 68Ga-DOTA-TATE) and 18F-flurodeoxyglucose ( 18F-FDG) dual probes in multi-parameter positron emission tomography (PET)/magnetic resonance (MR) imaging in pancreatic neuroendocrine neoplasm (PNEN). Methods:From April 9th, 2020 to February 24th, 2022, in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the clinical data and the imaging of 68Ga-DOTA-TATE PET/MR and 18F-FDG PET/MR of 59 patients with pancreatic tumors (27 male, 32 female, aged 22 to 75 years old(51.8±13.3) years old), confirmed by surgical or biopsy pathology were retrospectively analyzed. All the cases were divided into PNEN group (42 cases) and non-PNEN group (17 cases) according to pathological results. Among which 39 patients with PNET were further divided into grade 1 group (G1 group, 27 cases) and grade 2 group (G2 group, 12 cases). Non-zero parameters were selected via the least absolute shrinkage and selection operator (LASSO) regression approach, and a logistic regression model was established by combination of the selected features and the corresponding non-zero coefficients. The measurement data with non-normal distribution were compared by Mann-Whitney U test. The receiver operating characteristic (ROC) curve were used to detemine the optimal cut off value to assess the dignostic efficiency. Results:Compared with those of non-PNEN group, the parameters of PNEN group increased, which included maximum standard uptake value of 68Ga-DOTA-TATE(SUV Gmax, 46.70 (22.37, 76.35) vs. 7.12 (4.75, 8.64)), mean standard uptake value of 68Ga-DOTA-TATE(SUV Gmean, 25.50 (13.18, 43.90) vs. 3.65 (2.89, 4.69)), peak standard uptake value of 68Ga-DOTA-TATE (SUV Gpeak, 27.17 (12.39, 46.97) vs. 5.46 (4.12, 6.56)), total lesion somatostatin receptor (SSR) expression (TLSRE, 68.21 (32.52, 440.96) vs. 26.02 (14.87, 69.57)), SUV Gmax/maximum standard uptake value of 18F-FDG (SUV Fmax, 12.71 (3.80, 21.70) vs. 1.10 (0.52, 2.35)), tumor to background ratio of 68Ga-DOTA-TATE (TBR G, 13.31 (5.54, 22.38) vs. 1.57 (1.31, 2.66)), tumor to liver ratio of 68Ga-DOTA-TATE(T/L G, 6.54 (2.90, 9.63) vs. 0.74 (0.65, 0.94)), tumor to spleen ratio of 68Ga-DOTA-TATE (T/S G, 2.36 (0.97, 3.70) vs. 0.25 (0.23, 0.38)), tumor to mediastinum ratio of 68Ga-DOTA-TATE (T/M G, 104.41 (34.03, 206.52) vs. 16.00 (12.87, 21.46)), SUV Gmax/minimum apparent diffusion coeffecient (ADC min, 55.14 (22.50, 96.37) vs. 6.76 (4.39, 12.76)) and SUV Gmean/ADC min (34.57 (13.47, 55.13) vs. 3.57 (2.46, 6.81)), and the differences were statistically significant ( U=28.00, 25.00, 32.00, 198.00, 54.00, 31.00, 28.00, 19.00, 10.00, 56.00 and 44.00, all P<0.01). The area under the curve (AUC) and diagnostic accuracy of dual-probe PET/MR imaging in the diagnosis of PNEN and non-PNEN were 0.941 and 96.6%, respectively. The AUC and diagnostic accuracy of model Y 1 in the diagnosis of PNEN and non-PNEN were 0.959 and 96.6%, respectively. There was no significant difference in AUC between model Y 1 and dual-probe PET/MR imaging in PNEN diagnosis ( P>0.05), however combining model Y 1 could improve the accuracy of PNEN diagnosis (100.0%). Compared with those of PNET G1 group, the parameters of G2 Group were higher, which included the maximum diameter of tumor (2.69 cm (2.08 cm, 5.00 cm) vs. 1.50 cm (1.20 cm, 2.50 cm)), metabolic tumor volume (MTV, 7.56 mL (4.45 mL, 53.57 mL) vs. 2.16 mL (1.22 mL, 5.48 mL)), total lesion glycolysis (TLG, 22.24 (11.95, 189.85) vs. 3.81 (2.11, 18.67)), tumor to background ratio of 18F-FDG (TBR F, 2.94 (2.00, 3.96) vs. 1.48 (1.29, 3.72)), tumor to liver ratio of 18F-FDG (T/L F, 2.32 (1.35, 2.98) vs. 1.08 (0.90, 2.17)) and SSR-expressing tumor volume (SRETV, 8.00 (3.06, 40.00) vs. 1.91 (0.95, 4.88)), and the differences were statistically significant ( U=66.00、66.00、77.00、93.00、90.00、65.50, all P<0.05). The maximum diameter of tumor was the best single parameter for the differential diagnosis of PNET G2 and G1, AUC was 0.796 and the cutoff value was 1.90 cm. The model Y 2, which combined the maximum diameter of tumor and TBR G had an AUC of 0.835 for the differential diagnosis of PNET G2 and G1. There was no significant difference in AUC between the maximum diameter of tumor and model Y 2 ( P>0.05). However the combination of the maximum diameter of tumor and model Y 2 could improve the accuracy of differential diagnosis of PNET G2 and G1 (94.87%). Conclusion:The combination of multi-parameter of 68Ga-DOTA-TATE and dual-probe 18F-FDG PET/MR imaging can improve the diagnostic and grading accuracy of PNEN, which may be helpful in the selection of clinical treatment for patients.

AIM: To investigate the effect of flutamide on mitochondrial biogenesis and the regulating effect of anoxidative pathway Nrf2 on it. METHODS: Human hepatocyte HepG2 cells were treated with flutamide (0-50 μmol/L) for 24 h, then mtDNA copy number and protein expression of mitochondrial biogenesis were detected by RT-PCR and WB. The effects of ERK1/2 and the role of Nrf2 pathway in mitochondrial biogenesis were further observed by gene knockdown and protein activation/inhibition methods. RESULTS: Flutamide interfered mitochondrial biogenesis concentration-dependently, the mtDNA copy number, ERK1/2 and PGC-1α proteins increased with the dose. ERK1/2 inhibition and activation regulated flutamide-induced mtDNA copy number and PGC-1α expression, and inhibition of Nrf2 pathway also affected flutamide-induced mtDNA copy number and expression of PGC-1α, as well as ERK1/2 expression. CONCLUSION: Flutamide affects mitochondrial biogenesis, and the antioxidant pathway Nrf2 may be involved in the regulation of flutamine-induced mitochondrial biogenesis by regulating ERK1/2.

Objective: New infectious diseases have become a global problem that seriously threatens human life and health and social development, which greatly increases the demand of CT examination for outpatients with fever. Through the discussion of the examination room design of the special CT for epidemic prevention, it can provide reference for medical institutions and reduce cross infection. Methods: Based on the requirements of CT equipment installation and environment, combined with the special requirements of epidemic prevention in fever clinic, the paper analyzed the location of examination room, room layout, site construction method, air purification and disinfection, intelligent image aided diagnosis of special CT for epidemic prevention, and put forward the design scheme. Results: Through the detailed analysis of the key points of engineering technology and the requirements of infection prevention and control of CT examination room, the design scheme of the examination room was given. Conclusions The establishment of special CT for epidemic prevention can meet the needs of clinical examination and effectively reduce cross infection. The design scheme given in this paper has certain reference value and can provide effective help for medical institution.

OBJECTIVE: To evaluate the ability of health emergency drill for sudden poisoning incidents in Guangdong Province. METHODS: A double-blinded method was used to organize 22 teams in Guangdong Province to conduct a health emergency drill which contained preliminary and repeated drill. The preliminaries contained blind sample analysis,theoretical examination and skills assessment. The repeated drills was desktop network exercise carried out for the teams ranked top 10 in the preliminaries. RESULTS: In the preliminary round,the median( M) of total score among the 22 teams was 72. 5. Among them,blind sample analysis,theoretical examination and skills assessment were 71. 0,61. 4 and 76. 5,respectively. The total score of skill assessment was higher than that of theoretical assessment( P < 0. 05). The passing rate of 22 teams was 68. 2%(15/22),and the failure rate was 31. 8%(7/22). The failing teams all came from the nonPearl River Delta region. The total preliminary scores,passing rate,the total scores of blind sample analysis and skills assessment of the teams in Pearl River Delta Region were higher than that in the non-Pearl River Delta region( P < 0. 01).In the theoretical examination,the scores of detection and investigation were both higher than that of medical rescue( P <0. 05). For the skills assessment,the scores of decision-making,personal protection and poisoning detection were in the top three,the scores of the medical rescue and investigation were relatively low( P < 0. 05). In the repeated round,the M of desktop exercise was 55. 0,passing rate was 20. 0%,and the failure rate was 80. 0%. CONCLUSION: The health emergency response capacity for sudden poisoning incidents in Guangdong Province needs to be improved. The construction of emergency response capacity for emergency poisoning in the non-Pearl River Delta region should be strengthened,especially the training on strengthening theoretical and practical knowledge of poisoning medical treatment and poisoning investigation.

OBJECTIVE: To explore an objective evaluation mode for emergency response capacity on sudden poisoning incidents. METHODS: Based on the health emergency drills and blind design,22 teams in Guangdong Province were recruited to participate in the first round of evaluation,including blind sample analysis,theoretical examination( poisoning medical rescue,detection and investigation) and skills assessment( poisoning medical care,poisoning investigation,personal protection,poisoning detection and emergency decision-making). Then,the top 10 teams in the first round of evaluation were proceeded to desktop exercise in the second round of evaluation. The evaluation results were compared with the local gross domestic product( GDP) from 2011 to 2015 by Spearman rank correlation analysis. RESULTS: The median scores of the 4 sections were as follows: blind sample analysis was 71. 0,theoretical examination was 61. 4,skills assessment was 76. 5,and the desktop exercise was 55. 0. The rates of excellent for assessment of blind sample analysis,theoretical examination and skills assessment were 22. 7%,4. 5% and 0. 0%,while the failure rates were 31. 8%,45. 5% and 4. 5%,respectively. The rates of failure in medical rescue and investigation in theoretical examination were63. 6% and 50. 0%,the rates of failure in medical rescue and investigation in skills assessment were 40. 9% and 31. 8%,respectively. The middle-grade and passing rates of the top 10 teams in the desktop exercise were 10. 0%,and the failure rate was 80. 0%. There was a moderate positive correlation between the emergency response capacity for emergent poisoning and local GDP( Spearman rank correlation coefficient > 0. 700,P < 0. 05). CONCLUSION: The evaluation mode of emergency response capability assessment combined with actual combat and desktop emergency drill is established successfully. It can objectively test the assessment of emergency response capabilities.