Objective To predict the radiation impact of discharging wastewater containing uranium within the specified limit generated during the normal operation of a new production line at a nuclear fuel plant on the receiving water body and its downstream, and to provide a reference for the management of radioactive liquid effluent discharge from nuclear facilities. Methods Based on the technical guidelines for environmental impact assessment, literature on radiation environmental impact assessment, and data collected from on-site investigations, appropriate hydrological parameters and prediction models were selected to analyze and predict the variation pattern of radioactive nuclide uranium along the receiving water body and the radiation exposure of nearby residents. Results The maximum increase in uranium concentration in the receiving water body and its downstream caused by the discharge of uranium-containing wastewater was 1.14 μg/L. The maximum predicted concentration was 2.75 μg/L after adding the background data of the water body. The resulting maximum individual annual effective dose for the public was 1.49 × 10⁻⁴ mSv/a. Conclusion The maximum predicted uranium concentration in the receiving water body and its downstream is lower than the uranium concentration limit of 30 μg/L specified in the Standards for Drinking Water Quality (GB 5749-2022). The maximum individual annual effective dose for the public is much lower than the control value of 0.2 mSv/a specified in the Radiation Protection Regulations for Uranium Processing and Fuel and Fuel Manufacturing Facilities (EJ 1056-2018). The radiation impact is acceptable.

Objective To investigate the radionuclide radium-226 and natural uranium content in the main agricultural products around a decommissioned uranium tailings pondand to determine the radioactivity level in the food around the tailings pond. Methods From 2017 to 2021, several samples of rice and beans were collected in the surrounding area of the tailings pond for five consecutive years, and the concentrations of radium-226 and natural uranium were measured by a high-purity germanium gamma spectrometer. The annual accumulated effective dose of internal exposure caused by radium-226 ingested through local standard human diet was estimated by the indirect method. Results The detection rate of natural uranium in rice was 96.0%, and the detection rate of radium-226 was 74.0%; the detection rate of natural uranium in beans was 96.7%, and the detection rate of radium-226 was 73.3%. The annual accumulated effective dose caused by radium-226 ingested through diet was about 170.22 μSv/a in surrounding residents. Conclusion The concentrations of radium-226 and natural uranium in the main agricultural products around the tailings pond are within the limit of the national standard. By comparing with the research results in related fields in China, the radiation effects caused by radium-226 ingested through dieton the residents around the tailings pond are acceptable.

【Objective】 To analyze the cost-effectiveness of ELISA grey area strategy through establishing the health economics model. 【Methods】 The serological grey area strategy evaluation model was composed of screening strategy subdecision tree, pathogen infection subdecision tree and pathogen detection subdecision tree. The key parameters in the model were obtained from literatures and research data. The cost-effectiveness of setting ELISA grey area strategy was compared by software, and multifactor sensitivity analysis was conducted. 【Results】 After setting the ELISA grey area, extra samples(5.86 cases/100 000) with serological false negativity could be detected, including HBV samples at 4.93/100 000, HCV samples at 0.27/100 000, HIV samples at 0/100 000, syphilis samples at 0.66/100 000. To yield an additional seropositive sample out of every 100 000 blood donors, blood center will afford extra 1 million yuan about. 【Conclusion】 Through this study, a cost-effectiveness evaluation model of serological detection strategy was established. Although the ELISA grey area setting can yield a small number of seropositive samples, the cost is much higher than the current affordability.

Objective:To explore a convenient and effective method for calculating intraoperative blood loss in liposuction and volume reduction surgery for establishing intraoperative autologous blood transfusion threshold.Methods:Patients’ clinical, laboratory and surgery related information were collected. The influence of different factors such as the total amount of liposuction, bloody fluid, operation time, and patients’ weight change on blood loss during operation were analyzed. The difference of volume between blood loss recorded by doctors and theoretical calculations was compared. The formula of blood loss during operation was conducted, and then the threshold of autologous blood transfusion was established.Results:A total of 1 136 patients with liposuction due to lymphedema were recruited. There were 65 males and 1 071 females, the median age was 56 years in the non-transfusion group and 55 years in the transfusion group. The total amount of liposuction, bloody fluid, operation time, and body weight changes in patients with liposuction surgery were statistically positively correlated with intraoperative blood loss (spearman coefficient were 0.590, 0.584, 0.560, 0.520, respectively, P<0.01). The theoretical blood loss calculated by the Hemoglobin balance formula is (753.0±418.2) ml. According to the calculated value of blood loss, the intraoperative blood loss fitting formula y(ml)=0.082×total liposuction+ 365, is abtained. The threshold for reinfusion of autologous blood is 2 900 ml of liposuction amount. Conclusions:In this study, a convenient calculation method of blood loss in liposuction and volume reduction surgery was constructed, and a threshold for autologous blood transfusion in surgery was set up. Thus, the indication of early blood transfusion was established.

Objective:To explore a convenient and effective method for calculating intraoperative blood loss in liposuction and volume reduction surgery for establishing intraoperative autologous blood transfusion threshold.Methods:Patients’ clinical, laboratory and surgery related information were collected. The influence of different factors such as the total amount of liposuction, bloody fluid, operation time, and patients’ weight change on blood loss during operation were analyzed. The difference of volume between blood loss recorded by doctors and theoretical calculations was compared. The formula of blood loss during operation was conducted, and then the threshold of autologous blood transfusion was established.Results:A total of 1 136 patients with liposuction due to lymphedema were recruited. There were 65 males and 1 071 females, the median age was 56 years in the non-transfusion group and 55 years in the transfusion group. The total amount of liposuction, bloody fluid, operation time, and body weight changes in patients with liposuction surgery were statistically positively correlated with intraoperative blood loss (spearman coefficient were 0.590, 0.584, 0.560, 0.520, respectively, P<0.01). The theoretical blood loss calculated by the Hemoglobin balance formula is (753.0±418.2) ml. According to the calculated value of blood loss, the intraoperative blood loss fitting formula y(ml)=0.082×total liposuction+ 365, is abtained. The threshold for reinfusion of autologous blood is 2 900 ml of liposuction amount. Conclusions:In this study, a convenient calculation method of blood loss in liposuction and volume reduction surgery was constructed, and a threshold for autologous blood transfusion in surgery was set up. Thus, the indication of early blood transfusion was established.

Objective To investigate the effect of a modified preputial flap urethroplasty in twostage treatment of severe hypospadias.Methods The clinical characteristics of the severe hypospadias patients (41 cases) who underwent the staged urethroplasty by using the procedure of preset urethral plate with preputial flap from January 2015 to December 2016 were analyzed retrospectively.We used a modified method (modified group,23 cases):Form the distal urethra with the transected distal urethral plate by using tubularize incised plate (TIP) procedure during the first stage operation,after completely straightened the penis,urethral plate was preseted with transverse preputial flap at the penis shaft.While in the traditional group (18 cases),urethral plate was preseted with preputial flap by using Bracka procedure after transecting urethral plate.The corresponding missing part of urethra underwent urethroplasty at the second stage operation six months later.The patients in the modified group were 9 to 18 months old,and the median age was 13 months;meatus were located at the penis shaft in 10 cases,scrotum in 12 cases,perineum in 1 case.The patients in the traditional group were 9 to 18 months old,and the median age was 13 months;meatus were located at the penis shaft in 6 cases,scrotum in 10 cases,and perineum in 2 cases.There was no statistic difference in age and meatus position between the two groups.Results During the first stage operation,distal urethra was repaired by 13-19 mm,with an average of (14.5 ± 1.3) mm,and the proximal urethra was repaired by 0-6 mm,with an average of (3.1 ± 2.4) mm at the modified group.While at the traditional group,the length of proximal urethra was repaired of 0-9 mm,with an average of (5.6:±:2.9) mm.The urethral length required for reconstruction was measured during the second stage operation,with an average of (26.3:t:4.4) mm in the modified group and (40.5 ± 3.3) mm in the traditional group (P ＜ 0.05).There were 3 case of urethral stricture after removed the catheter,with 2 cases in the modified group and 1 case in the traditional group.Postoperative follow-up was 2 to 3 years,with an average of 2.4 years.There were 3 cases (3/23,13.0％) of urethral fistula in the modified group and 3 cases (3/18,16.7％) in the traditional group.Ascended testis occured in 2 patients in the traditional group after operation.No case of urethrostenosis,diverticulum,chordee or concealed pennis was recorded.There was no significant difference in postoperative complications between the two groups (P ＞ 0.05).Conclusions The modified staged preputial flap method shorten the new forming urethra by making full use of its own materials at the second stage operation,which was helpful to reduce complications.

Objective To investigate the value of bedside lung ultrasound B-line score in the diagnosis of acute heart failure (AHF). Methods A retrospectively analysis was conducted. The adult patients presenting with acute dyspnea in intensive care unit (ICU) of Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2016 to June 2017 were enrolled. An 8-zone lung ultrasound was performed and plasma B-type natriuretic peptide (BNP) level was tested in all patients. AHF was determined as the final diagnosis by two experienced ICU doctors according to the diagnostic criteria of AHF. Patients were divided into two groups: AHF group and non-AHF group. The levels of BNP and B-line score were compared between the two groups, and the diagnostic value of BNP and B-line score in AHF was evaluated. Results Fifty-six patients were included in this study, with 32 of men and 24 of women,and with an average age of 77.3±8.8. Thirty-six patients were diagnosed as AHF. The level of BNP and lung ultrasound B-line score in AHF group were higher than those in non-AHF group [BNP (ng/L): 1 640.4±1 078.4 vs. 236.9±124.9,B line score: 12.8±5.3 vs. 5.4±1.8, both 1 < 0.01]. There was a strong correlation between elevated BNP levels and an increased B-lines score (R2 = 0.712, 1 = 0.000). The receiver operating characteristic curve (ROC) showed that when the cut-off of lung ultrasound B-line score was 8.5, AHF could be discriminated from dyspnea caused by other diseases (sensitivity was 77.8%, specificity was 95%, positive likelihood ratio was 15.56, negative likelihood ratio was 0.23).The area under the ROC curve (AUC) of lung ultrasound B-line score was 0.917 [95% confidence interval (95%CI) =0.847-0.987, 1 = 0.000], slightly lower than that of plasma BNP [0.979 (95%CI = 0.951-1.008)]. Conclusion Lung ultrasound B-line score was highly specific, but moderately sensitive for identifying patients with AHF.

Objective To assess the effectiveness of pre-hospital therapeutic hypothermia after out-of-hospital cardiac arrest (OHCA) for survival and neuro-protection.Methods Databases such as Medline, ScienceDirect, Embase, Highwire, Cochrane Library, CNKI and Wanfang digital database were searched from January 2000 to March 2017 to retrieve randomized controlled trials (RCTs) on pre-hospital therapeutic hypothermia after OHCA. Thereafter, the studies retrieved were screened based on predefined inclusion and exclusion criteria. Data were extracted and the quality of the included studies was evaluated. A Meta-analysis was performed using the Cochrane Collaboration RevMan 4.3 software. Analysis of publication bias was depicted by funnel plot.Results Eight studies involving 3555 cases were included, among which 1804 cases were assigned to the treatment group and 1751 cases to the control group. Meta-analysis showed that compared with in-hospital therapeutic hypothermia, pre-hospital therapeutic hypothermia did not improve the survival rate of patients with OHCA [odds ratio (OR) = 1.00, 95％ confidence interval (95％CI) =0.85-1.18,P = 0.99], and neurological outcome at hospital discharge (OR = 0.97, 95％CI = 0.80-1.16,P = 0.71), but the body temperature was significantly lowered at admission [weighted mean difference (SMD) = -0.88, 95％CI = -1.03 to-0.73,P < 0.00001]. The funnel plot suggested that there was no publication bias in the 8 studies. But due to the low number of studies, the publication bias could not be completely excluded.Conclusion Pre-hospital therapeutic hypothermia after OHCA can decrease temperature at hospital admission, but cannot increase the survival rate and neurological outcome at hospital discharge.

OBJECTIVE: To evaluate the advantages and clinical value regarding the ambulatory surgery for thyroid.
 METHODS: A total of 66 patients (including 16 cases of differentiated thyroid cancer, 50 cases of benign thyroid tumors) from June 2014 to April 2015 in Center for Ambulatory Surgery of Xiangya Hospital were enrolled for this study and served as an exprimental group. All patients met pre-established ambulatory surgery criteria for thyroid. According to medical records, 133 patients with similar conditions to the experimental group were chosen as a control group. All of operations in two groups were completed by the same doctors. The time of operation, amount of bleeding during operation, drainage after the operation, operation method, resection range, histological features, surgical complications, average days of hospitalization, average hospitalization cost, the rate of re-admission and the satisfaction of patients were compared between the 2 groups. 
 RESULTS: Time of operation and amount of bleeding during operation were not significantly different between the 2 groups (P>0.05). In terms of drainage after operation and resection range, there were obvious differences between the 2 groups (P<0.05). The resection range and the amounts of drainage in the experimental group were less than those in the control group. More patients in the experimental group chose endoscopic thyroid surgery compared with those in the control group (P<0.05). The rate of surgical complications and re-admission was not different (P>0.05), but average days of hospitalization and average hospitalization cost were less in the experimental group (P<0.05). Patients were satisfied with ambulatory thyroid surgery (P<0.05).
 CONCLUSION Under certain criteria, ambulatory surgery for thyroid is a new operation method, which is safe, high-efficient, convenient, economy and time-efficient. It can decrease average days of hospitalization and average hospitalization cost obviously, and provide a reasonable choice for certain patients. The selection of endoscopic thyroid surgery was not conflict with selection of ambulatory thyroid surgery.
Ambulatory Surgical Procedures ; Drainage ; Endoscopy ; Hospitalization ; Humans ; Thyroid Neoplasms

There was almost one hundred years since surgical stapler invention to now. Using stapler (stitching instrument) in surgery has many advantages, such as stitching fast, easy to operating, few side effects and complications. It makes tumor excision surgery can’t be cut focus in past possible and improving the curative effect of the surgery. Surgical staplers also give difficult surgery and new technology strong supports. In the last ten years, for cheap price and rapid development of the technology level, domestic staplers’ market share is increasing year by year and breaking the foreign monopoly product. In open surgery, domestic stapler has progressively more than foreign brands. In endoscopy surgery, domestic staplers also have a place. In current, surgical staplers are used more and more popular in the domestic tertiary medical institutions and becoming indispensable tools in many surgeries. Surgical staplers (stitching instrument) are broadly used in esophageal reconstruction, gastrointestinal tract reconstruction, endoscopic surgery in pulmonary bulla resection, uterus resection, pancreas resection, duodenum resection