Background Due to the unique working environment and numerous occupational disease hazards, workers in mining industry are particularly susceptible to psychological problems such as occupational stress. Objective To understand the current status of occupational stress, depressive symptoms, anxiety symptoms and sleep quality of workers in ferrous and non-ferrous metal mining industry in Gansu Province, and to explore the effects of occupational stress on depressive symptoms, anxiety symptoms, and sleep. Methods From April to December 2022, the workers of 25 large, medium, and small and micro enterprises were selected by stratified cluster random sampling and surveyed in ferrous and non-ferrous metal mining industry in Gansu Province. The Occupational Health Literacy Questionnaire of National Key Population, Core Occupational Stress Scale, Patient Health Questionnaire-q, Generalized Anxiety Disorder, and Self-administer Sleep Questionnaire were used to collect basic information, occupational stress, depressive symptoms, anxiety symptoms, and sleep quality of the workers. Chi-square test was used to compare occupational stress, depressive symptoms, anxiety symptoms and sleep disorders among different categories. Logistic regression model was used to study the effects of occupational stress on depressive symptoms, anxiety symptoms, and sleep quality. Results In this study, 2192 workers in mining industry were surveyed, of which 2087 returned valid questionnaires, and the recovery rate of valid questionnaires was 95.2%. Among them, 728 (38.4%) reported occupational stress. There were statistically significant differences in the positive rate of occupational stress among workers by gender, age, marital status, education level, average monthly income, length of service, enterprise size, and night shifts (P<0.001). The positive rates of depressive symptoms, anxiety symptoms, and sleep disorders in the mining industry workers were 85.6%, 49.8%, and 47.3%, respectively. The positive rates of depressive symptoms, anxiety symptoms, and sleep disorders among workers with higher occupational stress were higher than those among workers without occupational stress (P<0.001). The logistic regression analysis showed that occupational stress was a common risk factor for depressive symptoms (OR=3.29, 95%CI: 2.26, 4.79), anxiety symptoms (OR=2.87, 95%CI: 2.33, 3.53), and sleep disorder (OR=1.78, 95%CI: 1.46, 2.16). In addition, length of service and enterprise-scale were also risk factors for depressive symptoms, anxiety symptoms, and sleep disorders. In the 5−<10 and 10−<20 years of service groups, the risks of reporting depressive symptoms were 1.80 (95%CI: 1.18, 2.74) and 1.73 (95%CI: 1.10, 2.71) times higher than that of workers with less than 1 year of service, respectively; the risks of reporting anxiety symptoms were 1.98 (95%CI: 1.42, 2.76) and 2.11 (95%CI: 1.48, 3.01) times higher than that with less than 1 year of service, respectively; the risks of reporting sleep disorders were 1.58 (95%CI: 1.15, 2.16) and 1.78 (95%CI: 1.29, 2.45) times higher than that with less than 1 year of service, respectively. Workers in large enterprises were inclined to report more depressive symptoms, anxiety symptoms, and sleep disturbances than those in micro and small enterprises (OR=3.53, 95%CI: 2.41, 5.16; OR=2.49, 95%CI: 1.98, 3.13; OR=2.10, 95%CI: 1.67, 2.62). Conclusion The occupational stress level of mining industry workers in Gansu Province is high, and reporting occupational stress, 5−<10 and 10−<20 working age groups, and large enterprises are important risk factors affecting workers' mental health and sleep. It is necessary to increase the attention and develop intervention programs for mental health of miners in the working age group of 5−20 years old and in large enterprises.

ObjectiveTo investigate the incidence of hypertension and its influencing factors in community-dwellers at risk for high blood pressure in Minhang District of Shanghai， and to provide scientific evidence for the community management. MethodsA retrospective cohort study was conducted using the electronic health records of community-dwellers at risk for high blood pressure in Minhang District， Shanghai from January 1， 2011 to December 31， 2017. The study end-point was the occurrence of hypertension，and the followup was finished in December 2021. A total of 17 265 community-dwellers at risk for high blood pressure were enrolled in our study. Log-rank test and Cox regression analysis were used to determine the influencing factors. ResultsAfter 6.04 years of follow-up， the hypertension incidence among community-dwellers at risk for high blood pressure in Minhang District of Shanghai was 25.5%. Family history of hypertension （HR=1.250， 95%CI： 1.168‒1.338）， family history of stroke （HR=1.295， 95%CI： 1.080‒1.553）， history of diabetes （HR=1.203， 95%CI： 1.076‒1.345）， daily smoking （HR=1.187， 95%CI： 1.087‒1.296）， overweight （HR=1.393， 95%CI：1.308‒1.484）， obesity（HR=1.903， 95%CI： 1.719‒2.106）， high values of normal blood pressure （HR=1.275， 95%CI： 1.195‒1.359） and advanced age （HR=1.033， 95%CI： 1.030‒1.036） were all risk factors. Emaciation （HR=0.649， 95%CI： 0.500‒0.840） was a protective factors. ConclusionBlood pressure monitoring should be strengthened for people elderly， with family history of hypertension， family history of stroke， diabetes or high values of normal blood pressure， so as to diagnose hypertension early. Timely intervention measures should be taken for community-dwellers with unhealthy lifestyles such as smoking， overweight and obesity.

ObjectiveTo investigate the acute effects of compound air pollution on children’s respiratory function. MethodsUsing panel group study design， 223 students in five classes of grade 4 from two primary schools （a， b） in Xuhui and Hongkou districts of Shanghai were randomly selected to measure pulmonary function and exhaled nitric oxide （FeNO）. The first three tests were carried out from May to June in 2020， and the fourth test was carried out from September to December in 2021. At the same time， the daily and hourly mean values of PM_2.5， PM₁₀， SO₂， NO₂， O₃ and CO was collected from the nearby air quality monitoring points of the two schools during the same period ， as well as meteorological monitoring data （temperature， humidity， wind speed and atmospheric pressure）. The linear mixed effect model was used to analyze the effects of air pollution on pulmonary function and respiratory inflammation in the summer. ResultsThe results of single pollutant model showed that PM_2.5， PM_10， SO₂ and NO₂ were positively correlated with FeNO， and the effect was reflected in lag0， lag1 and lag3 （P<0.05）. PM_2.5， PM₁₀ and NO₂ were negatively correlated with the changes of lung function FEF_25%， FEF_50%， FEF_75%， FeF_25%-75%， PEF， FVC， FEV1 and FEV1/FVC， and the effect was reflected in lag0 to lag3 days （P<0.05）. The results of the dual pollutant model showed that the concentration changes of SO₂ and NO₂ were significantly correlated with the decrease of FEV1 when combined with O₃ or PM_2.5 （P<0.01）， and the concentration changes of PM_2.5 was significantly correlated with the increase of FeNO when O₃， SO₂ and NO₂ were combined respectively （P<0.01）. The effects of the dual pollutant model were greater than the effect of PM_2.5 single pollutant model. ConclusionThe health effects of different air pollutants on children’s respiratory tract function indexes in summer are different. The combined effects of two pollutants on the lung function of children increased to different degrees. Although air pollution is light in summer， it still has an impact on children’s respiratory tract function index and inflammation index， and the combined effect of dual pollutants is more significant than that of single pollutant.

Objective:To analyze the safety and efficacy of PD-1 inhibitors versus chemotherapy or ipilimumab in advanced melanoma.Methods:PubMed,CNKI,VIP and Wanfang databases were searched to collect randomised controlled trials of PD-1 inhibi-tors in treatment of advanced melanoma.The search time was from the establishment of the database to May 1,2022.Two reviewers independently screened the literature,extracted data,and assessed risk of bias of included studies.Meta-analysis was performed using RevMan5.4 and STATA16 software.Results:A total of 7 studies were included.Meta-analysis results show that:①Safety:Compared with chemotherapy,PD-1 inhibitor treatment had fewer adverse events,especially in the blood system;compared with ipilimumab alone,PD-1 inhibitor combined with ipilimumab had more adverse events,especially liver function indicators;there was no signifi-cant difference in the incidence of total adverse events between PD-1 inhibitor monotherapy and ipilimumab monotherapy.②Efficacy:The PFS,OS and ORR of PD-1 inhibitor versus chemotherapy or ipilimumab were HR=0.54,95%CI(0.45,0.62),P<0.05,HR= 0.69,95%CI(0.58,0.80),P=0.03 and OR=3.16,95%CI(2.59,3.86),P<0.05,respectively.Conclusion:PD-1 inhibitors have good efficacy in treatment of advanced melanoma,while different combination methods and different control treatments may have different efficacy.Limited by the quantity and quality of included studies,more research evidence is needed to support this.

Background and purpose:For patients with human epidermal growth factor receptor 2(HER2)-positive metastatic breast cancer,trastuzumab treatment can prolong the overall survival and significantly improve the prognosis of patients.However,the reference original research trastuzumab(Herceptin?)is more expensive.Biosimilars have comparable efficacy and safety profiles while increasing patient access to treatment.This clinical trial aimed to evaluate the efficacy,pharmacokinetics,safety and immunogenicity of the trastuzumab biosimilar AK-HER2 compared to trastuzumab(Herceptin?)in patients with HER2-positive metastatic breast cancer.Methods:This multi-center,randomised,double-blind phase Ⅲ clinical trial was conducted in 43 subcenters in China.This study complied with the research protocol,the ethical principles stated in the Declaration of Helsinki and the quality management standards for drug clinical trials.It was approved by the hospital's medical ethics committee.The clinical trial registration agency is the State Food and Drug Administration(clinical trial approval number:2015L04224;clinical trial registration number:CTR20170516).Written informed consent was obtained from subjects before enrollment.Enrolled patients were randomly assigned to the AK-HER2 group and the control group,respectively receiving AK-HER2 or trastuzumab(initial loading dose 8 mg/kg,maintenance dose 6 mg/kg,every 3 weeks as a treatment cycle,total treatment time is 16 cycles)in combination with docetaxel(75 mg/m2,treatment duration is at least 9 cycles).The primary endpoint of this clinical trial was the objective response rate(ORR9)between the AK-HER2 group and the control group in the 9th cycle.Secondary efficacy endpoints included ORR16,disease control rate(DCR),clinical benefit rate(CBR),progression-free survival(PFS)and 1-year survival rate.In this study,100 subjects(AK-HER2 group to control group=1:1)were randomly selected for blood sample collection after the 6th cycle of medication,The collection time points were 45 minutes after infusion(the end of administration),4,8,24,72,120,168,336,and 504 hours after the end of administration.After collection,blood samples were analyzed by PK parameter set(PKPS).Other evaluation parameters included safety and immunogenicity assessment.Results:A total of 550 patients with HER2-positive metastatic breast cancer were enrolled in this clinical trial between Sep.2017 and Mar.2021.In the AK-HER2 group(n=237),129 subjects in the experimental group achieved complete response(CR)or partial response(PR),and the ORR9 was 54.4%.There were 134 subjects in the control group(n=241)who achieved CR or PR,and the ORR9 was 55.6%.The ORR9 ratio between the AK-HER2 group and the control group was 97.9%[90%confidence interval(CI):85.4%-112.2%,P=0.784],which was not statistically significant.In all secondary efficacy endpoints,no statistically significant differences were observed between the two groups.We conducted a mean ratio analysis of pharmacokinetics(PK)parameters between the AK-HER2 group and the control group,and the results suggested that the pharmacokinetic characteristics of the two drugs are similar.The incidence of treatment emergent adverse event(TEAE)leading to drug reduction or suspension during trastuzumab treatment was 3.6%(10 cases)in the AK-HER2 group and 8.1%(22 cases)in the control group.There was statistically significant difference between the two groups(P=0.027).The incidence rate was significantly lower in the AK-HER2 group than in the control group,and there was no statistically significant difference among the other groups.The differences in the positive rates of anti-drug antibodies(ADA)and neutralizing antibodies(NAB)between groups were of no statistical significance(P=0.385 and P=0.752).Conclusion:In patients with HER2-positive metastatic breast cancer,AK-HER2 was comparable to the trastuzumab(Herceptin?)in terms of drug efficacy,pharmacokinetics,safety and immunogenicity.

Humans ; Nephrotic Syndrome ; Hematopoietic Stem Cell Transplantation ; Tissue Donors ; Transplantation Conditioning ; Graft vs Host Disease

Child ; Humans ; Granulomatous Disease, Chronic/complications* ; Pneumonia

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

Objective:To analyze the clinical characteristics and outcomes of patients with invasive fungal sinusitis (invasive fungal rhinosinusitis, IFR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and explored the risk factors for IFR after allo-HSCT.Methods:Nineteen patients with IFR after allo-HSCT at Peking University People’s Hospital from January 2012 to December 2021 were selected as the study group, and 95 patients without IFR after allo-HSCT during this period were randomly selected as the control group (1:5 ratio) .Results:Nineteen patients, including 10 males and 9 females, had IFR after allo-HSCT. The median age was 36 (10–59) years. The median IFR onset time was 68 (9–880) days after allo-HSCT. There were seven patients with acute myeloid leukemia, five with acute lymphoblastic leukemia, two with myelodysplastic syndrome, two with chronic myeloid leukemia, one with acute mixed-cell leukemia, one with multiple myeloma, and one with T-lymphoblastic lymph node tumor. There were 13 confirmed cases and 6 clinically diagnosed cases. The responsible fungus was Mucor in two cases, Rhizopus in four, Aspergillus in four, and Candida in three. Five patients received combined treatment comprising amphotericin B and posaconazole, one patient received combined treatment comprising voriconazole and posaconazole, nine patients received voriconazole, and four patients received amphotericin B. In addition to antifungal treatment, 10 patients underwent surgery. After antifungal treatment and surgery, 15 patients achieved a response, including 13 patients with a complete response and 2 patients with a partial response. Multivariate analysis revealed that neutropenia before transplantation ( P=0.021) , hemorrhagic cystitis after transplantation ( P=0.012) , delayed platelet engraftment ( P=0.008) , and lower transplant mononuclear cell count ( P=0.012) were independent risk factors for IFR after allo-HSCT. The 5-year overall survival rates in the IFR and control groups after transplantation were 29.00%±0.12% and 91.00%±0.03%, respectively ( P<0.01) . Conclusion:Although IFR is rare, it is associated with poor outcomes in patients undergoing allo-HSCT. The combination of antifungal treatment and surgery might be effective.

Objectives:To determine the effect of glucose-6-phosphate-dehydrogenase (G6PD) deficiency on patients’ complications and prognosis following allogeneic stem cell hematopoietic transplantation (allo-HSCT) .Methods:7 patients with G6PD deficiency (study group) who underwent allo-HSCT at Peking University People's Hospital from March 2015 to January 2021 were selected as the study group, and thirty-five patients who underwent allo-HSCT during the same period but did not have G6PD deficiency were randomly selected as the control group in a 1∶5 ratio. Gender, age, underlying diseases, and donors were balanced between the two groups. Collect clinical data from two patient groups and perform a retrospective nested case-control study.Results:The study group consisted of six male patients and one female patient, with a median age of 37 (range, 2-45) years old. The underlying hematologic diseases included acute myeloid leukemia ( n=3), acute lymphocytic leukemia ( n=2), and severe aplastic anemia ( n=2). All 7 G6PD deficiency patients achieved engraftment of neutrophils within 28 days of allo-HSCT, while the engraftment rate of neutrophils was 94.5% in the control group. The median days of platelet engraftment were 21 (6–64) d and 14 (7–70) d ( P=0.113). The incidence rates of secondary poor graft function in the study group and control group were 42.9% (3/7) and 8.6% (3/35), respectively ( P=0.036). The CMV infection rates were 71.4% (5/7) and 31.4% (11/35), respectively ( P=0.049). The incidence rates of hemorrhagic cystitis were 57.1% (4/7) and 8.6% (3/35), respectively ( P=0.005), while the bacterial infection rates were 100% (7/7) and 77.1% (27/35), respectively ( P=0.070). The infection rates of EBV were 14.3% (1/7) and 14.3% (5/35), respectively ( P=1.000), while the incidence of fungal infection was 14.3% (1/7) and 25.7% (9/35), respectively ( P=0.497). The rates of post-transplant lymphoproliferative disease (PTLD) were 0% and 5.7%, respectively ( P=0.387) . Conclusions:The findings of this study indicate that blood disease patients with G6PD deficiency can tolerate conventional allo-HSCT pretreatment regimens, and granulocytes and platelets can be implanted successfully. However, after transplantation, patients should exercise caution to avoid viral infection, complications of hemorrhagic cystitis, and secondary poor graft function.