Objective:To conduct a comparative analysis of the radiation damage to zebrafish embryos and the associated biological mechanism after ultra-high dose rate (FLASH) and conventional dose rate irradiation.Methods:Zebrafish embryos at 4 h post-fertilization were exposed to conventional and FLASH irradiation (9 MeV electron beam). The mortality and hatchability of zebrafish after radiation exposure were recorded. Larvae at 96 h post-irradiation underwent morphological scoring, testing of reactive oxygen species (ROS) levels, and analysis of changes in oxidative stress indicators.Results:Electron beam irradiation at doses of 2-12 Gy exerted subtle effects on the mortality and hatchability of zebrafish embryos. However, single high-dose irradiation (≥ 6 Gy) could lead to developmental malformation of larvae, with conventional irradiation showing the most significant effects ( t = 0.87-9.75, P < 0.05). In contrast, after FLASH irradiation (≥ 6 Gy), the ROS levels in zebrafish and its oxidative stress indicators including superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) were significantly reduced ( t = 0.42-15.19, P < 0.05). There was no statistically significant difference in ROS levels in incubating solutions after conventional and FLASH irradiation ( P > 0.05). Conclusions:Compared to conventional irradiation, FLASH irradiation can reduce radiation damage to zebrafish embryos, and this is in a dose-dependent manner. The two irradiation modes lead to different oxidative stress levels in zebrafish, which might be a significant factor in the reduction of radiation damage with FLASH irradiation.

Fire safety is crucial for the regular operation of large public hospitals.This paper elaborates on the funda-mental guidelines for fire safety management in large hospitals.Under the framework of collaborative governance theory,it also analyzes and points out that the standardization of peoples behavior in hospitals and the integrity of fire safety facilities are the pri-mary factors influencing the efficacy of fire safety management.Subsequently,based on management practices,it suggests focu-sing on"five synergies"in enforcing primary responsibility for fire safety,namely,the implementation of fire safety main respon-sibilities in synergy,the regular inspection and rectification of fire hazards in synergy,the training and evaluation of basic fire safety skills in synergy,the lifecycle management of fire safety facilities in synergy,and the building of a fire safety management team in synergy.This approach aims to maximize overall fire safety effectiveness and comprehensively enhance the level of fire safety management in hospitals.Finally,the paper discusses and calls for further enhancements in the management of fire safety in large public hospitals.

Objective:To explore the effect and safety of endoscopic tubular musculoskeletal tumor surgery (ETMS) technology in spinal tumors.Methods:Clinical data were retrospectively collected from 18 spinal tumor patients who were treated with ETMS technology at Tianjin Medical University Cancer Institute and Hospital ( n=16) or the Affiliated Hospital of Qingdao University ( n=2) from November 2022 to December 2023. The total cohort included 11 males and 7 females, with the age at 60.3±8.6 years (range of 41-76). Two cases were diagnosed with benign tumors, four patients were diagnosed with spinal hematologic malignancies while other 12 cases were patients with spinal metastases. After localization under the C-arm X-ray machine, the spinal endoscopic channel is established using dilators. Soft tissue is dissected under endoscopic guidance to create an artificial cavity. Subsequently, the saline medium relied upon by the spinal endoscopic technique is removed, and posterior decompression and tumor curettage are performed using tubular techniques. Frankel grade classification and paraplegia index were used to evaluate the improvement of postoperative function and the VAS score was performed in pain scoring. The surgical complications and tumor evaluation were observed by postoperative outpatient and telephone follow-up. Results:The ETMS technology was successfully completed in all 18 patients with the mean operation time of 240.3±80.2 min. The median of intraoperative bleeding was 200.0(172.5, 350.0) ml and the mean postoperative drainage was 131.4±69.5 ml. The median value of postoperative hospitalization days was 6.0(4.0, 10.25) d. The paraplegia index decreased from 1.5(0, 3.0) preoperatively to 0(0, 1.25) postoperatively ( Z=-2.599, P=0.009). All the patients presented an improvement in Frankel grading after surgery except for one patient (downgrading from grade E to grade D). There was significantly difference in Frankel grading between preoperative and postoperative groups ( Z=2.812, P=0.005). The median value of preoperative VAS score was up to 5.5(4.0, 7.0) while the median value at postoperative, one month after surgery and three months after surgery were 1.5(1.0, 2.25), 1.0(0, 1.0) and 0(0, 1.0), respectively (χ 2=44.641, P<0.001). The 3-month postoperative VAS improvement rate was 91.2% (range 75%-100%). During a mean follow-up period of 7.6±6.2 months, none of the 18 patients presented surgical complications or tumor recurrence at surgical region. Only one patient died at 3.2 months after surgery until the last follow-up due to respiratory failure after lung tumor progression. The mean survival of the total cohort was up to 13.3 [95% CI (11.5, 15.0)] months. The 16 cases with spinal metastases or spinal hematological malignancies had a mean survival of 13.2 [95% CI (11.3, 15.0)] months. Conclusion:The ETMS technology presented good efficacy and safety in treatment of spinal tumors with low blood supply and with diameter less than 5cm.

Objective:To understand the satisfaction evaluation of contracted residents with " Internet plus" family doctor services and to explore its influencing factors.Methods:From November to December 2021, a stratified random sampling method was used to select 360 contracted residents who had utilized " Internet plus" family doctor services from community health service centers or township health clinics in various counties, cities, or districts of a city in Shandong Province for on-site questionnaire surveys. The purpose was to understand their awareness and satisfaction with the " Internet plus" family doctor services. At the same time, key informant interviews were conducted with contracted residents according to the principle of intensity sampling and information saturation, to collect their opinions and suggestions on the implementation process and model construction of " Internet plus" family doctor services. Descriptive analysis was performed on the data, and a binary logistic regression model was used to analyze the factors affecting the satisfaction of contracted residents with " Internet plus" family doctor services.Results:352 valid questionnaires were obtained. Among the respondents, 108 (30.6%) were very familiar or relatively familiar with the " Internet plus" family doctor service policy, and 251 (71.3%) expressed a high level of satisfaction with the overall " Internet plus" family doctor service. Gender, monthly income status, frequency of participation in health education activities, and satisfaction with the doctor′s daily service attitude, medical technical level, medical service charge level, and the level of communication between the service team and family members were factors affecting the satisfaction of contracted residents with " Internet plus" family doctor services ( P<0.05). Interview results showed that 38 people (95.0%) believed that there were issues with the current implementation of " Internet plus" family doctor services in China, such as the lack of an effective policy support environment, the need to improve the publicity and mobilization effects of contracting institutions, poor service cognition levels among the population, concerns about service quality, misunderstandings about internet-related concepts, network " panic" caused by electronic fraud phenomena, and cultural level differences among the elderly that limited the use of services. Conclusions:The overall satisfaction of contracted residents with the " Internet plus" family doctor services was relatively good. Various factors affected the satisfaction evaluation of contracted residents. It is important to focus on the differences in service psychological perception among contracted residents with different demographic characteristics, strengthen the construction of service teams and service platforms, and improve the public′s cognition and participation in " Internet plus" family doctor services to promote the continuous development of " Internet plus" family doctor services.

In recent years, the development of bispecific antibodies (bsAbs) has been rapid, with many new structures and target combinations being created. The boom in bsAbs has led to the successive issuance of industry guidance for their development in the US and China. However, there is a high degree of similarity in target selection, which could affect the development of diversity in bsAbs. This review presents a classification of various bsAbs for cancer therapy based on structure and target selection and examines the advantages of bsAbs over monoclonal antibodies (mAbs). Through database research, we have identified the preferences of available bsAbs combinations, suggesting rational target selection options and warning of potential wastage of medical resources. We have also compared the US and Chinese guidelines for bsAbs in order to provide a reference for their development.

Hematopoietic stem cell (HSC) transplantation is the only curative therapy for many diseases. HSCs from umbilical cord blood (UCB) source have many advantages over from bone marrow. However, limited HSC dose in a single CB unit restrict its widespread use. Over the past two decades, ex vivo HSC expansion with small molecules has been an effective approach for obtaining adequate HSCs. Till now, several small-molecule compounds have entered the phase I/II trials, showing safe and favorable pharmacological profiles. As HSC expansion has become a hot topic over recent years, many newly identified small molecules along with novel biological mechanisms for HSC expansion would help solve this challenging issue. Here, we will give an overview of HSC biology, discovery and medicinal chemistry development of small molecules, natural products targeting for HSC expansion, and their recent clinical progresses, as well as potential protein targets for HSC expansion.

We reported a 54-year-old female patient with severe tricuspid regurgitation, who received mechanic valve in the mitral position 15 years ago. The patient’s Society of Thoracic Surgeons score was 8.27%, and was intolerant to open heart surgery, so she was recommended for transcatheter tricuspid valve replacement via right vena jugularis interna. The procedures were guided by echocardiography and X ray fluoroscopy on November 13, 2021, the prosthesis was implanted successfully, and the patient was recoved without any adverse events. After 1 month follow-up, her general condition was apparently improved.

Objective:To compare the effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap(ALTPF) harvested from superficial and deep layer of the superficial fascia.Methods:A retrospective analysis was performed on 31 patients who had small-and medium-sized soft tissue defects in the extremities and admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2020 to February 2021. All the patients were repaired with ALTPFs. The sizes of defect ranged from 5.0 cm×3.5 cm to 17.0 cm×6.0 cm, and the flaps sized from 6.0 cm×4.0 cm to 20.0 cm×6.0 cm. Fifteen ALTPFs were harvested from superficial layer of superficial fascia (modified group), and 16 harvested from deep layer of superficial fascia (traditional group). The flap donor sites were sutured directly using the "Zunyi suture method". Appearance of scars was assessed within the Vancouver Scar Scale (VSS) and in addition the width of scars was been recorded. The data of the 2 groups were statistically analyzed. There was statistically significant difference when P<0.05. Results:All flaps were successfully viable. All wounds healed in Ⅰ stage and donor incisions healed in Ⅰ stage at 2-3 weeks after the surgery. All patients entered postoperative follow-up for 6 to 26 months, with a mean of 10.7 months. There was no ischaemic necrosis at the donor margin. There was no significant difference between circumference of thighs between the modified group and traditional group [ (0.10±0.40) cm and (0.03±0.39) cm, respectively]( P>0.05). VSS were found lower in the modified group (2.00±1.46) than that in the traditional group (3.06±1.61)( t=2.132, P=0.039), as well as the scars were found smaller at the widest point[(6.67±3.85) cm and(16.06±6.63) cm, respectively. t=2.807, P=0.005]. The differences were statistically significant( P<0.05). Conclusion:Small-and medium-sized ALTPFs, harvested in the superficial layer of superficial fascia, can reduce the width of the donor scar, improve the surgical outcome and increase patient satisfaction.

Objective:To investigate the epidemiological characteristics of COVID-19 caused by 2019-nCoV Delta variant in Shangyu district, Shaoxing of Zhejiang province in 2021, and provide evidence for the improvement of COVID-19 control and prevention measures.Methods:The incidence data of COVID-19 in Shangyu from December 7 to 21, 2021 was obtained from Shangyu District Center for Disease Control and Prevention. The epidemiological characteristics of the cases, i.e. the population, time and space distributions, were analyzed, and the incubation period and time-varying reproduction numbers ( R t) were calculated. Results:From December 7 to 21, 2021, a total of 380 COVID-19 cases caused by 2019-nCoV Delta variant were detected in Shangyu, the median age of the cases was 52 years, M ( Q1，Q3: 38, 61). The male to female ratio of the cases was 1∶1.25, and the cases were mainly workers (36.58%) and farmers (27.63%). The epidemic affected 9 townships (or community) of Shangyu, especially Caoe and Baiguan communities with the cases accounting for 57.10% and 31.53% respectively. The median incubation period of cases was 4.00 days, M ( Q1，Q3: 3.00, 5.75). The basic reproduction number ( R0) was 4.06, and the R t was 5.62 in early phase of the outbreak (the highest) and continuously decreased to less than 1.00 within 10 days after the detection of the outbreak. The number of COVID-19 cases decreased to 0 within 14 days after the outbreak (December 7-21), and the main detection methods were screening in centralized isolation (55.53%) and home isolation (40.00%). The infection rates of close contacts and secondary close contacts were 2.06% and 0.46% respectively. Conclusion:The epidemic of COVID-19 in Shangyu characterized by short incubation period, large number of infected people, and case clustering, suggesting the strong transmission of Delta variant (B.1.617.2). Comprehensive prevention and control measures, such as management of close contacts and secondary close contacts, and high-risk area, are essential for the rapid control of the epidemic.

Objective:To investigate the surgical methods of sacroiliac joint dislocation with ipsilateral sacrosacral wing fracture through the lateral-rectus approach (LRA) for exposure, fracture reduction and fixation, and nerve exploration and decompression, and to evaluate its clinical efficacy.Methods:Data of 12 patients with sacroiliac joint dislocation and ipsilateral sacral wing fracture treated with LRA for exposure, reduction and fixation of sacroiliac wing fracture and sacroiliac joint dislocation, lumbosacral trunk nerve exploration and decompression (combined with lumbosacral trunk nerve injury) were retrospectively analyzed from January 2016 to July 2019. They were 3 males and 9 females, aged 34.35±16.32 years (13-58 years). The time from injury to operation was 29.25±25.49 d (7-96 d). By the Tile classification, there were 7 cases of type C1.3, 1 case of type C2, 4 cases of type C3. Among them, 8 cases were combined with ipsilateral or bilateral lumbosacral nerve injury. The grade of nerve injury: 6 cases of complete injury and 2 cases of partial injury. Interval time from injury to surgery: less than 1 week: 1 case, 1-2 weeks: 2 cases, 2-3 weeks: 4 cases, >3 weeks: 5 cases. Surgery was performed through LRA, the sacroiliac joint was exposed outside the peritoneum, and the sacral fracture and sacroiliac joint dislocation were reduced. At the same time, the lumbosacral nerve was decompressed and loosened for patients with lumbosacral nerve injury. Then the posterior ring was fixed with a sacroiliac screw or a transsacroiliac joint plate attached to the bony surface.Results:All the 12 cases underwent the operation successfully. The average surgical time was 172.08±36.8 min (range, 105-230 min) and the mean blood loss was 981.67±369.44 ml (range, 400-1 700 ml). Postoperative X-ray and CT indicated an excellent reduction of fracture. One patient with bladder dysplasia had wound fat liquefaction after operation, and no other surgery-related complications. During the follow-up period of 12-72 months, all sacral fractures healed, and the healing time was 7.7±3.38 weeks (6-12 weeks) without complications such as loss of fracture reduction and internal fixation failure. At the 1-year follow-up, 6 of the 8 patients with lumbosacral nerve injury recovered completely, one recovered partially, and the other one had no recovery without nerve exploration.Conclusion:LRA is an ideal surgical approach for treatment of sacroiliac joint dislocation complicated with ipsilateral sacral wing fracture and lumbosacral nerve injury, because it can well expose the medial pelvic joint from the sacroiliac joint to the symphysis pubis, allow direct release of the lumbosacral plexus nerve compressed and stretched, and together with traction of the lower limbs, lead to satisfactory fracture reduction.