Occipitocervical fusion (OCF) is used to treat the instability of the cranio-cervical junction due to various reasons (such as trauma, rheumatoid arthritis, infection, tumor, congenital malformations and degeneration). A satisfactory fusion rate can be obtained and the stability of the occipital neck can be reconstructed by OCF. Dysphagia is one of the most common complications after OCF, which seriously affects the quality of life of patients after surgery. This article mainly focuses on the evaluation and prediction methods of dysphagia after OCF, and summarizes related research in the past 16 years, and provides guidance and direction for how to predict the occurrence of dysphagia during OCF and the evaluation of postoperative dysphagia. The evaluation of dysphagia is mainly conducted using the Bazaz dysphagia score, swallowing quality of life scale (SWAL-QOL) and eating assessment tool-10 (EAT-10) score. However, the clinical prediction of dysphagia is mainly based on the changes of cervical curvature parameters (O-C 2 angle, O-EA angle, Oc-Ax angle, PI angle). At present, there are many methods for clinical evaluation and prediction of dysphagia, but the best evaluation method is still uncertain. We reviews the evaluation and prediction methods of postoperative dysphagia of OCF, showing that the Bazaz dysphagia score, SWAL-QOL score and EAT-10 score scale are suitable for evaluating postoperative dysphagia of OCF. During OCF operation, adjustment of O-C 2 Angle >-5°, O-EA Angle >100°, Oc-Ax Angle >65°, and increase of postoperative PI Angle from preoperative PI Angle (that is, dPI Angle) ≥0° can reduce the probability of dysphagia to a certain extent.

Objective To analyze the epidemiological characteristics of occupational hand-arm vibration disease (OHAVD) in Guangdong Province from 2006 to 2022. Methods The data of newly reported OHAVD cases and suspected occupational disease cases in Guangdong Province from 2006 to 2022 was collected from the Report Card of Occupational Diseases and Report Card of Suspected Occupational Diseases using Occupational Diseases and Health Hazard Factors Monitoring Information System under China Disease Prevention and Control Information System. Epidemiological characteristics of the newly reported OHAVD cases and related suspected occupational disease reports were analyzed. Results A total of 660 newly reported OHAVD cases were reported in Guangdong Province from 2006 to 2022. The number of cases showed a periodic fluctuating trend over the years. Males accounted for 98.64% of the newly reported OHAVD cases with a median age of 38 years and a median hand-transmitted vibration exposure period of 8.7 years. These cases were predominantly distributed in the Pearl River Delta region, including Zhongshan City, Dongguan City, Guangzhou City, Shenzhen City and Foshan City, accounting for 99.25%. The manufacturing enterprises had 98.79% of the cases, investment enterprises of Hong Kong, Macao and Taiwan merchants of China had 83.18% of the cases, and large- and medium-sized enterprises had 92.73% of the cases. The 660 cases were distributed in 440 enterprises, but there were some characteristics of group outbreaks. There were 20 enterprises (4.55% of the total number of enterprises) had more than three cases involving 219 cases (33.18%). There were five enterprises which had more than 10 cases and the cases number ranged from 12 to 56. Among 382 newly reported OHAVD cases from 2014 to 2022, 44.24% were identified as suspected occupational diseases before diagnosis, of which 59.76% (101/169) were determined by occupational health inspection institutions. Conclusion Newly reported OHAVD cases in Guangdong Province were aggregated in terms of regional distribution, industry, enterprise ownership, and enterprise scale, with a risk of group outbreaks. It is suggested to enhance the OHAVD prevention and control in male workers exposed to hand-transmitted vibrations in the Pearl River Delta's manufacturing enterprises.

Objectives:To investigate the imaging characteristics and incidence rate of nuchal ligament calci-fication in asymptomatic population.Methods:The clinical and imaging data of 318 asymptomatic volunteers were analyzed retrospectively,including the incidence,morphological classification,and segmental distribution of nuchal ligament calcification.The volunteers were divided into two groups based on the presence of nuchal ligament calcification,and differences in gender,age,body mass index(BMD,and lower cervical intervertebral parameters between the two groups were analyzed.Based on the Roussouly classification,differences in cervi-cothoracic parameters between the groups were analyzed.Finally,the correlation between the degree of nuchal ligament calcification and the aforementioned factors was studied to identify the risk factors for nuchal liga-ment calcification.Results:Among the 318 asymptomatic subjects,the incidence of nuchal ligament calcifica-tion was 23.27％.There were statistically significant differences in gender ratio,age,and BMI between the calcification of nuchal ligament group(ONL+)and non-calcification of nuchal ligament group(ONL-)(P＜0.001).The calcification of nuchal ligament was classified morphologically as follows:Local calcification 50.0％,con-tinuous calcification 27.0％,segmental calcification 7.0％,mixed calcification 9.0％and unclassified calcifica-tion 7.0％.The incidence of nuchal ligament calcification in each segment was as follows:C2/3 1.4％,C3/49.5％,C4/5 55.4％,C5/6 63.5％,and C6/7 18.9％.Compared with the ONL-group,the angular displacement(AD)and horizontal displacement(HD)of the ONL+group were significantly increased(P＜0.001).Based on the Roussouly classification,significant statistical differences in cervicothoracic parameters such as O-C2,C2-C7 SVA,and T1 slope(TS)were found between the ONL+group and the ONL-group(P＜0.05).Pearson correlation analysis showed that the degree of nuchal ligament calcification had a moderate correlation with AD,O-C2,and C2-C7 SVA,and a strong correlation with HD and TS.Multivariate logistic analysis revealed that HD was the most significant risk factor for nuchal ligament calcification,followed by O-C2,age,and AD.Conclusions:The incidence of nuchal ligament calcification was higher in asymptomatic men who were older and had a high body mass index.Cervicothoracic parameters(O-C2,C2-C7 SVA and TS)and segmental parameters(AD,HD)were significantly increased in the group of nuchal ligament calcification,and were correlated with the degree of nuchal ligament calcification.

Purpose/Significance To understand the fragmented reading behavior of the core user group of hospital libraries,and to propose countermeasures to improve the reading service.Method/Process The fragmented reading behavior data of 3 user groups(doc-tors,nurses,and medical technicians)in Children's Hospital of Soochow University are collected through the questionnaire method,and the characteristics of fragmented reading behavior of each group of users are analyzed.Result/Conclusion Fragmented reading has be-come an important informal learning approach for core users of hospital libraries.Users with different positions,titles and educational backgrounds have different fragmented reading behaviors.Hospital libraries can improve the level of fragmented reading service by provi-ding diversified reading services,promoting the learning type fragmented reading platforms,integrating collection resources and optimizing the overall spatial layout.

Retinal pigment epithelial (RPE) is primarily impaired in age-related macular degeneration (AMD), leading to progressive loss of photoreceptors and sometimes choroidal neovascularization (CNV). mTOR has been proposed as a promising therapeutic target, while the usage of its specific inhibitor, rapamycin, was greatly limited. To mediate the mTOR pathway in the retina by a noninvasive approach, we developed novel biomimetic nanocomplexes where rapamycin-loaded nanoparticles were coated with cell membrane derived from macrophages (termed as MRaNPs). Taking advantage of the macrophage-inherited property, intravenous injection of MRaNPs exhibited significantly enhanced accumulation in the CNV lesions, thereby increasing the local concentration of rapamycin. Consequently, MRaNPs effectively downregulated the mTOR pathway and attenuate angiogenesis in the eye. Particularly, MRaNPs also efficiently activated autophagy in the RPE, which was acknowledged to rescue RPE in response to deleterious stimuli. Overall, we design and prepare macrophage-disguised rapamycin nanocarriers and demonstrate the therapeutic advantages of employing biomimetic cell membrane materials for treatment of AMD.

Objective:To study the risk factors of necrotizing enterocolitis (NEC) after surgery for intestinal atresia.Method:From August 2013 to June 2020, children with intestinal atresia receiving surgery in our hospital were retrospectively reviewed. The patients were assigned into NEC group and non-NEC group according to the occurrence of postoperative NEC. Demographic data and clinical characteristics were summarized and the risk factors for postoperative NEC were analyzed using Logistic regression analysis method.Result:A total of 96 infants were enrolled and NEC occurred in 13 patients (13.5%) after surgery for intestinal atresia. Compared with the non-NEC group, the NEC group were diagnosed of intestinal atresia [4.0(1.5,6.0)d vs. 1.4(0,2.0)d, P<0.001] and received surgery [4.8(2.0,7.0)d vs. 3.1(1.0,4.0)d, P=0.034] at later ages. The incidences of complex intestinal atresia [76.9%(10/13) vs. 44.6%(37/83), P=0.030] and blood transfusion [46.2%(6/13) vs. 13.3%(11/83), P=0.007] in the NEC group were higher than the non-NEC group. Logistic regression analysis showed that the age of initial diagnosis of intestinal atresia ( OR=3.346, 95% CI 1.493~7.500, P=0.003), complex intestinal atresia ( OR=9.052, 95% CI 1.119~73.209, P=0.039) and blood transfusion ( OR=6.835, 95% CI 1.399~33.380, P=0.018) were independent risk factors for postoperative NEC. Conclusion:Patients with delayed diagnosis of intestinal atresia, complex intestinal atresia and blood transfusion within 48 hours after surgery should be monitored for the occurrence of postoperative NEC.

Posterior tibial slope (PTS) is used to describe the sagittal alignment of the tibial plateau of the knee. As its values indicate the steepness or gentleness of the tibial platform, it is an important basis for knee surgery, such as total knee replacement (TKA), anterior cruciate ligament/posterior cruciate ligament reconstruction (RACL/RPCL) and tibia high-level osteotomy (HTO), and affects the indication and efficacy of knee surgery. Since there has been no consensus description of PTS at present in clinical practice in China, this paper intends to discuss PTS from perspectives of epidemiology, measurement, its influence on knee joint activity, relationship between subchondral bone and knee ligament, and its significance in various knee joint operations. This review hopes to contribute to the knee surgery after the surgeons have a comprehensive understanding of the clinical significance and applications of PTS.

Retinitis pigmentosa (RP),one of the common forms of hereditary retinal dystrophies (HRD),is typified by significant genetic heterogeneities.Executed by the spliceosome,precursor mRNA (pre-mRNA) splicing is a highly regulated process by which introns are removed and exons are ligated together.To date,more than 80 genes have been involved in RP etiology.Specially,8 of these genes (PRPF3,PRPF8,PRPF31,PRPF6,PRPF4,SNRNP200,RP9 and DHX38) encode proteins essential for pre-mRNA splicing and are expressed ubiquitously.However,mutations of these RP causative pre-mRNA splicing genes exclusively result in only retinal phenotypes,and the mechanism remains unknown.In this review,we recapitulate splicing process,summarize the mutations identified in pre-mRNA splicing genes related to RP and discuss conceivable hypothesis explaining for the consequent retinaspecific phenotypes.

Objective To investigate the change in body weight over time in rectal cancer patients receiving radiotherapy and the correlation between setup errors and weight loss,and to establish the image-guided radiotherapy regimens in different periods of treatment.Methods A total of 24 postoperative patients with rectal cancer admitted to our hospital in 2016 were selected.Before each fraction of radiotherapy,the body weight was recorded,and the patients underwent cone-beam computed tomography (CBCT) with different frequencies in every week.The planning CT was matched with CBCT to obtain setup errors.The paired t test was used for difference analysis;the Pearson method was used to analyze the correlation between setup errors and weight loss.Results Body weight was measured 456 times in the 24 patients,and these patients underwent CBCT scans and image registration 456 times.Two patients were excluded because of treatment discontinuance.In the first and second weeks,there was no significant change in body weight.In the third week,the mean weight loss was 1.53 kg.In the fourth week,the mean weight loss was 2.48 kg.In the fifth week,the mean weight loss was 3.24 kg.The setup errors obtained by CBCT image registration in the superior-inferior (SI),anterior-posterior (AP),and left-right (LR) directions were 0.19 cm,0.20 cm,and 0.18 cm,respectively,in the first week,0.18 cm,0.17 cm,and 0.15 cm,respectively,in the second week,0.20 cm,0.22 cm,and 0.21 cm,respectively,in the third week,0.19 cm,0.25 cm,0.24 cm,respectively,in the fourth week,and 0.34 cm,0.33 cm,and 0.31 cm,respectively,in the fifth week.The Pearson correlation analysis showed that weight loss increased the setup errors,with P values of 0.140,0.046,and 0.044 in the SI,AP,and LR directions,respectively.Conclusions For rectal cancer patients receiving radiotherapy,the body weight decreases significantly in the late period (especially in the fifth week),which influences the setup errors.Therefore,in the fourth and fifth weeks of radiotherapy for rectal cancer,the weight loss should be closely monitored,and the number of CBCT scans can be increased before the treatment fraction to ensure the accuracy and optimization of treatment.

The distal radioulnar joint (DRUJ) is one of the most important joints connecting hand and forearm,playing an important role in maintaining normal rotation of the hand and forearm and stability of the wrist.Serious DRUJ dislocation can lead to functional limitation of the forearm and wrist.DRUJ displacement is not uncommon clinically,but often missed.It is usually associated with a distal radioulnar fracture,with an incidence ranging from 10％ to 19％.Without correct and effective diagnosis and treatment,it will lead to chronic pain,dysfunction and other complications.There are various treatments for DRUJ displacement,like initiative splint fixation,percutaneous fixation with kirschner wire,soft tissue reconstruction,joint fusion and joint replacement at the end-stage,and arthroscopic techniques as well which are increasingly popular in recent years.All these treatments ease the patients' pain to a certain extent,but also bring about complications of different severities.Currently,reconstruction of the DRUJ stability using elastic suspension system may be a new treatment alternative in the future because it has gradually attracted the attention from experts.