Objective:To investigate the biological effects of acute high-dose radon exposure on mice.Methods:BALB/c male mice aged 6 to 8 weeks were exposed once in an HD-3 ecological radon chamber with an average radon concentration of 7 × 10 5 Bq/m 3 for 10 h. Mice were weighed, their lung tissues and blood samples were collected at 1, 2 and 3 months after exposure. Control groups were set up at the three time points with four mice in each group. For these mice, the lung tissue pathology was observed using hematoxylin-eosin (HE) staining method, routine blood tests were conducted using a hematology analyzer and the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in the serum and lung tissues were measured using corresponding assay kits. Results:The HE staining result revealed that compared to the control groups, the experimental groups exhibited thickening of alveolar walls and increased infiltration of granulocyte, whose degrees, however, reduced over time and displayed no significant difference at 3 months after exposure. There was no significant difference in body weight or blood routine between the experimental and control groups. The detection result revealed decreased SOD levels in the lung tissues at 2 months after exposure, which were (11.34 ± 1.03) U/mgprot and (9.75 ± 0.71) U/mgprot, respectively for the control and experimental groups ( t = 2.54, P < 0.05). The MDA levels in lung tissue increased at 1 month after exposure, which were(2.30 ± 0.24) and (2.77 ± 0.29) nmol/mgprot, respectively for the control and experimental groups ( t = 2.49, P < 0.05). At 3 months after exposure, the SOD and MDA levels differed insignificantly between the control and experimental groups ( P > 0.05). Conclusions:After acute high-dose radon exposure, the mice suffered damage to the lung tissue, with changes in their oxidative stress indicators being detected. However, these effects gradually diminished at 3 months after exposure. Additionally, acute high-dose radon exposure did not give rise to significant changes in the body weight or routine blood result of the mice.

Objective:To provide strategical reference for large-scale colorectal cancer screening with full regional coverage by analyzing the results of the first colorectal cancer screening in the target population in Linhai city,Zhejiang Province. Methods:The target population of 50-74 years old in Linhai were invited to take part in the colorectal cancer screening program from 2020 to 2021.The risk of colorectal cancer of the participants were preliminarily evaluated by questionnaire and qualitative fecal occult blood test(FOBT),and participants with positive screening results were suggested to take colonoscopy test for further evaluation.The screening results were collected and analyzed. Results:A total of 71 942 people were screened from 2020 to 2021,and 15 1 70 of them were found positive in preliminary screening.The positive rate in males was significantly higher than that in females(x 2=724.005,P＜0.001),and the positive rate was highest in the population of 60-69 years old during preliminary screening.The compliance rate of colonoscopy was 24.1 9％with no significant difference between males and females(x 2=0.256,P=0.61 3),showing a decreasing trend as the age increases.From 2020 to 2021,the detection rate of lesions by colonoscopy was 52.92％,with 47 case of colorectal cancer(CRC),333 case of advanced colorectal adenoma,561 case of non-advanced colorectal adenoma and 1 001 case of benign lesions.The detection rate of lesions in males was much higher than that in females(x 2=82.451,P＜0.001).The detection rates of lesions,advanced colorectal adenoma,and non-advanced adenoma showed increasing trends with the age.The compliance rate of colonoscopy,the detection rate of lesions,and the detection rate of CRC,advanced colorectal adenoma,and non-advanced adenoma were 32.94％,69.53％,2.87％,1 6.85％and 1 9.71％,respectively,in participants who were both assessed as high-risk according to questionnaire evaluation and FOBT positive,the highest among all participants.The compliance rate of colonoscopy in 2021 was obviously higher than that in 2020(32.11％vs 1 9.09％,P＜0.001),but no significant difference was found in the detection rate of lesions between 2021 and 2020(P＞0.05). Conclusion:From 2020 to 2021,the compliance rate of colonoscopy was low and the detection rate of colorectal lesions was high during the screening of colorectal cancer in the target population in Linhai,Zhejiang Province.It is necessary to enhance the public awareness of the importance of colorectal cancer screening,standardize the enrollment criteria,and improve the compliance of colonoscopy,in orderto give full play to primary screening in the general public.

OBJECTIVE： To provide experience and reference for the study of medical insurance budget impact analysis （BIA） in China. METHODS： Retrieved from PubMed， ProQuest， CNKI， Wanfang database and CBM， related literatures about medical insurance BIA research in China and the United States were collected since the establishment of the database. The basic information， analysis results and data sources were summarized and sorted out， and descriptive analysis of the included literature was carried out on basis of seven key elements such as model design， research perspective， treatment cost， reference scenario， target population， research time limit and discount/inflation， sensitivity analysis. RESULTS： A total of 72 literatures were included in this study， involving 24 （33.33％） studies in China， 48 （66.67％） studies in the United States； the indications of 45 studies were chronic diseases （62.50％）， and those of 21 studies were acute diseases （37.50％）. Among the research methods， 49 studies （68.06％） used BIA alone and 23 studies （31.94％） adopted BIA combined with pharmaceutical economics. In terms of model design， 50 studies （69.44％） adopted cost calculation models. In terms of research perspective， 60 studies （81.94％） were based on the perspective of medical insurance department research. In the calculation of treatment cost， 69 studies （95.84％） included drug cost. In terms of reference scenarios， 61 studies （84.72％） compared the economics of different drug-based treatment groups. For target population， only 31  （43.06％） studies used real world data. In terms of research duration and discount/inflation， 14 studies （19.44％） used treatment or length of hospitalization to indicate research duration， and 19 studies （26.39％） used discount rate or inflation rate to adjust costs. As for sensitivity analysis， 62 studies （86.11％） conducted sensitivity analysis， of which 49 （68.06％） used single factor sensitivity analysis. CONCLUSIONS： There are still some limitations in medical insurance BIA research literature in China and the United States， such as unreasonable use of data， incomplete coverage of the cost， and unreasonable setting of sensitivity analysis variables. It is recommended that BIA research should standardize data sources to improve the quality of budget evidence quality， reasonably evaluate market size to improve the authenticity of prediction， scientifically set variables and their scope of change to improve the stability of results， establish BIA research paradigms or evaluating standards so as to guide BIA research scientifically.

Objective To investigate the variation characteristics of peripheral platelet parameters in children with dengue fever and to assess their use and value in diagnosis,prognosis and treatment for dengue fever.Methods Platelet parameters of 69 pediatric patients with dengue fever in acute febrile phase and remission period and 103 healthy controls were compared.The difference of platelet parameters between the liver function injury group and the normal liver function group,the coagulation dysfunction group and the coagulation function normal group,the severe group and the mild group with dengue fever was compared,the causes of thrombocytopenia in children with dengue was investigated so as to better understand the situation of bone marrow producing platelets.Results P-LCR,PDW,MPV were significantly higher in patients in acute febrile phase of dengue fever,compared with the healthy subjects(P＜0.01),while PCT,PLT were significantly lower in patients in acute febrile phase of dengue fever,compared with the healthy subjects(P＜0.01).MPV was significantly lower in patients with abnormal hepatic function when compared with patients with normal hepatic function(P＜0.05),while other platelet parameters did not show significant differences(P＞0.05).PLT and PCT were significantly lower in the severe patients than those in the mild patients(P＜0.05),while other platelet parameters did not show significant differences(P＞0.05).Peripheral platelet parameters did not show significant differences between patients with or without abnormal coagulation function (P＞0.05).Conclusion Peripheral platelet parameters may play a role in the diagnosis,treatment and prognosis of dengue fever in children.

OBJECTIVE:To put forward relevant suggestions for formulating and implementing medical insurance budget impact analysis(BIA)research guideline in China. METHODS:The medical insurance BIA guidelines or relevant documents were retrieved from ISPOR,Canada and the United States. Their similarities and differences were compared. The experiences of them were summarized in respects of research framework,data source and report format of medical insurance BIA. RESULTS &CONCLUSIONS:ISPOR,Canada,USA and other guidelines or relevant documents have some similarities in normalization requirements of research perspectives,target population calculation based on natural reason and epidemiological data,3-5 years as the research time limit and some other respects. But the calculation of additional costs as drug price addition,distribution fee should be specifically adjusted according to the unique characteristics of the health systems of countries or regions. Based on the actual conditions of our own health care system,our country can draw up the guidelines for medical insurance BIA impact analysis,which contain model design,research perspective,target population,current use of intervention measures,prediction on the effects of new intervention measure introduction on the market,cost,time range,discount and uncertainty analysis of current and new interventions,situational analysis and verification,so as to better play its role in the formulation and adjustment of medical insurance catalogues and in drug price negotiations.

Objective To investigate the outcome of a new designed extramedullary femoral osteotomy module and to compare with conventional intramedullary system in clinical study.Methods The extramedullary femoral osteotomy module was designed with the extramedullary alignment rod connecting with the T type rod at right angle,and it had a 5°-7° adjustable valgus design.The positioning module fixation screw was parallel with the epicondylar axis.The coronal plane of the distal femur bone cut was orientated by the extramedullary alignment rod pointing to the inguinal midpoint,and the sagittal plane was orientated by the extramedullary alignment rod keeping parallel with the distal femoral medullary cavity.The terminal distal femoral bone cut was conducted with suitable osteotomy after the orientation.Sixty patients who underwent unilateral total knee arthroplasty (TKA) from October 2015 to March 2016 were randomly divided into intramedullary and extramedullary group for prospective controlled study.Blood loss,drainage and the incidence of deep vein thrombosis (DVT) were evaluated at one week postoperatively.Knee valgus angle and femoral prosthesis flexion angle were analyzed at two weeks postoperatively.Moreover,the extramedullary femoral osteotomy module was used in 273 patients (78 males and 195 females) with an average age of 68.7 (range,57-82 years old) who underwent unilateral TKA from April 2016 to January 2017.Blood loss,operation duration and lower limb ultrasonography preoperatively and at one week postoperatively were recorded.Knee valgus angle and femoral prosthesis flexion angle were measured at 2 weeks postoperatively.Range of knee motion and Hospital for Special Surgery (HSS) knee score at six weeks postoperatively were also reported.Results In the randomized controlled trial,blood loss and drainage in extramedullary group was less than that in intramedullary group (t=-3.330,P=0.004).There was no significant difference in the incidence of DVT at 1 week postoperatively (x2=2.269,P=0.132) and the knee valgus angle and femoral prosthesis flexion angle at 2 weeks postoperatively within the two groups.In the clinical application,operation time was 60.13± 13.69 min,and blood loss and drainage was 109.11±70.73 ml.There were four cases of popliteal vein thrombosis,nine cases of posterior tibial vein thrombosis,and seventeen cases of muscular venous thrombosis at one week postoperatively.The incidence rate of DVT was 11.0％.There was no symptomatic pulmonary embolism at three months postoperatively.Knee valgus angle was 7.34°±0.69°,and 211 knees accounting for 77.3％ were in the range of ±3° error.Femoral prosthesis flexion angle was 6.43°±1.59°,and 273 knees were all in the range of ±10° error.Range of knee motion improved from 54.52±5.96 preoperative to 86.20±4.92 at six weeks postoperative.HSS knee score improved from 100.88°±7.51° preoperative to 110.42°±7.08° at six weeks postoperative.Conclusion The new designed extramedullary femoral osteotomy module used in distal femoral osteotomy during TKA can significantly reduce the risk of bleeding and the incidence rate of DVT postoperatively.Furthermore,patients can obtain as excellent prosthesis position and limb alignment as conventional intramedullary system.

Objective: To investigate the clinicopathologic and prognostic features of Claudin-low breast cancers (CLBC). Methods: Tissue microarray sections were scored semiquantitatively for the immunohistochemical expression of claudin-1, -3, -4, -7 and -8 in 233 cases of invasive breast cancers collected from Qingdao Central Hospital from January 2010 to December 2011. Results: The expression rate of Claudin-3 (72/212, 33.9%) and -4 (56/212, 45.2%) was most similar, and Claudin-4 showed the highest expression. Twenty one cases (21/212, 9.0%) were diagnosed as CLBC, with triple-negative breast cancer (TNBC) accounted for the highest proportion (11/21, 52.4%). Among the CLBC cases, the invasive carcinoma no special type (66.7%, 14/21) and metaplastic carcinoma (14.3%, 3/21) were mostly seen, while metaplastic squamous carcinoma did not show Claudin-low pattern. Compared to the non CLBC in this cohort, CLBC had higher proportion of histologic grade 3 and tumors larger than 2 cm, and the proportions were slightly lower than TNBC. Patients with CLBC had lower 5 year disease-free(P>0.05) and overall survival rates(P=0.018). Conclusion CLBC shows distinct clinicopathologic and prognostic features comparing to other subtypes, and is associated with poor prognosis.

Objective To study the benefit of prophylactic antibiotics (PA) in totally percutaneous aortic endovascular repair (PEVAR) in the catheterization laboratory for reducing stent-graft infection and postimplantation syndrome (PIS). Methods The clinical data were analyzed of patients undergoing thoracic endovascular aortic repairs. The patients were divided into non-PA group and PA group according to the use of prophylactic antibiotics before PEVAR. The diagnosis of infection was made by two senior physicians with reference to Hospital Acquired Infection Diagnostic Criteria Assessment released by the Ministry of Health of China. Results The 95 enrolled patients included 35 with PA and 60 without PA group, who were comparable for baseline characteristics. Infection-related deaths occurred in 1 case in non-PA group and retrograde Stanford type A dissection and death occurred in 1 case in PA group (1.67%vs 2.85%, P=1.00). The PA and non-PA groups showed no significant difference in the incidence of postoperative infection (5%vs 2.86%, P=1.000), hospital stay (9.30±7.21 vs 10.06±5.69, P=0.094), infection-related mortality (1.67% vs 0%, P=1.00), or postoperative fever (70.90% vs 91.43%, P=0.20). The body temperature showed significant variations at different time points after procedure (F=19.831, P<0.001) irrelevant to the use of prophylactic antibiotics (F=0.978, P=0.326). Conclusion The current data do not support the benefit of PA in reducing postoperative infection and PIS in patients undergoing PEVAR, but the patients without PA may have worse clinical outcomes in the event of postoperative infections.

Objective To study the benefit of prophylactic antibiotics (PA) in totally percutaneous aortic endovascular repair (PEVAR) in the catheterization laboratory for reducing stent-graft infection and postimplantation syndrome (PIS). Methods The clinical data were analyzed of patients undergoing thoracic endovascular aortic repairs. The patients were divided into non-PA group and PA group according to the use of prophylactic antibiotics before PEVAR. The diagnosis of infection was made by two senior physicians with reference to Hospital Acquired Infection Diagnostic Criteria Assessment released by the Ministry of Health of China. Results The 95 enrolled patients included 35 with PA and 60 without PA group, who were comparable for baseline characteristics. Infection-related deaths occurred in 1 case in non-PA group and retrograde Stanford type A dissection and death occurred in 1 case in PA group (1.67%vs 2.85%, P=1.00). The PA and non-PA groups showed no significant difference in the incidence of postoperative infection (5%vs 2.86%, P=1.000), hospital stay (9.30±7.21 vs 10.06±5.69, P=0.094), infection-related mortality (1.67% vs 0%, P=1.00), or postoperative fever (70.90% vs 91.43%, P=0.20). The body temperature showed significant variations at different time points after procedure (F=19.831, P<0.001) irrelevant to the use of prophylactic antibiotics (F=0.978, P=0.326). Conclusion The current data do not support the benefit of PA in reducing postoperative infection and PIS in patients undergoing PEVAR, but the patients without PA may have worse clinical outcomes in the event of postoperative infections.

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures