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 summarize the laboratory findings of a case of hemolytic disease of the fetus and newborn (HDFN) caused by Rh system anti-c antibodies and to review the literature, so as to explore the characteristics of anti-c HDFN. Methods: The ABO blood type, Rh blood type, direct antiglobulin test (DAT) results, and the presence of unexpected antibodies and their titers were determined by serological methods. The cases of anti-c HDFN in our laboratory in China and abroad were statistically analyzed, and the incidence of severe HDFN caused by anti-c, anti-D and anti-E was compared. Results: The blood type of the child was B (Rh CcDee) with a positive DAT. Anti-c antibody was detected in both serum and eluate, with a serum antibody titer of 4. The mother’s blood type was AB (Rh CCDee) with a negative DAT, and anti-c antibody was detected in the serum with a titer of 128. Among 20 cases of anti-c HDFN, 17 were DAT positive, and 9 (45%, 9/20) underwent blood transfusion or exchange transfusion. The incidence of severe HDFN was 47.60% (10/21) for anti-c, 47.60% (10/21) for anti-D and 31.30% (5/16) for anti-E. Conclusion: Maternal pregnancy and/or blood transfusion are the main reasons for the production of Rh alloantibodies such as anti-c. The prevention and management of anti-c should be similar to that of anti-D. Rh antigen-matched (five antigens of Rh blood group) transfusion is necessary for women of childbearing age to avoid antibody production, and Rh typing and antibody screening during prenatal examination is recommended to ensure early detection, intervention and treatment.

Tripterygium wilfordii is a traditional Chinese medicinal herb belonging to the genus Tripterygium in the Celastraceae family， which has the effects of clearing heat and detoxifying， dispelling wind and dampness， and invigorating blood circulation to relieve pain， and is used to treat diseases such as rheumatoid arthritis， glomerulonephritis， nephrotic syndrome， lupus erythematosus， scabies， and stubborn tinea. Its chemical composition is diverse. Among them， triptolide（TP） is one of the main active and toxic components of T. wilfordii. It has significant biological activities such as anti-inflammation， anti-tumor， and immunosuppression. However， it causes serious adverse reactions such as liver and kidney function damage and reproductive system disorders. At the same time， TP has poor water solubility and low bioavailability， and the enhancement of bioavailability by increasing the dosage undoubtedly improves the exposure of the drug in non-target organs， leading to the occurrence of adverse reactions， and these largely limit the clinical application of TP. Based on this， this article extracted relevant data from the Web of Science， PubMed， and China National Knowledge Infrastructure（CNKI） databases， summarized the research on the adverse reactions of TP in recent years， and reviewed the progress of toxicity reduction research from the perspectives of structural modification， novel drug delivery systems， and compatibility. Structural modification can precisely alter the chemical structure of TP， reduce the activity of its toxic groups， and retain its biological activity while fundamentally reducing the occurrence of adverse reactions. New drug delivery systems can achieve targeted delivery of TP， increase its concentration in target organs， and reduce its exposure in non-target organs， thereby enhancing therapeutic efficacy and reducing adverse effects. In addition， the combination of TP with Chinese medicine compound， single-flavored Chinese medicine or monomer can reduce the adverse effects of TP and enhance the efficacy to different degrees， which is of clinical value. This paper systematically explains attenuation research from the above three perspectives， aiming to provide a theoretical basis for the full utilization of biological activity and drug development of TP.

Helicobacter pylori(HP)infection is a Class Ⅰ carcinogen in gastric cancer,closely related to the occurrence of gastric cancer.Many studies have shown that HP eradication has a preventive effect on gastric cancer.However,2.7%-6.1%of patients with early gastric cancer who have been eradicated after endoscopic submucosal dissection(ESD)can still develop metachronous gastric cancer(MGC),and the mechanism of its occurrence is still unclear.In this review,the atrophy of gastric mucosa and intestinal metaplasia cannot be completely reversed after HP eradication,the excessive proliferation of gastric mucosa epithelial cells,the accumulation of genetic abnormalities,the homeostasis imbalance of the epigenetic group,changes in immune microenvironment,the abnormality of stem cells in gastric mucosa,chromatin accessibility,and changes in chromosome remodeling were discussed in the mechanism of carcinogenesis caused by the above molecular changes after ESD and HP eradication in early gastric cancer.

Objective·To investigate the efficacy and safety of hypertonic dextrose prolotherapy(DPT)in the treatment of postherpetic neuralgia.Methods·Seventy-eight patients with postherpetic neuralgia who visited the Department of Pain of The Affiliated Hospital of Xuzhou Medical University from June 2019 to December 2022 were selected.The patients were randomly assigned to a control group and a research group in a 1∶1 ratio,with 39 patients in each group.The control group was treated with traditional analgesic solution,while the research group was treated with traditional analgesic solution combined with DPT.Visual analog scale(VAS)was used to evaluate the patients'pain level before and after treatment,flow cytometry was used to measure the patients'T-cell subsets,and enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of C-reactive protein(CRP),interleukin-6(IL-6),and IL-10 cytokines.The VAS scores were compared between the two groups of patients before and at 1,2,4,8,and 12 weeks after treatment.CD4+/CD8+,CRP,IL-6,IL-10 levels,and the incidence of adverse reactions before and 2 weeks after treatment were compared between the two groups.Results·There was no statistically significant difference in sex ratio,age,and disease duration between the two groups of patients.The VAS scores of the two groups of patients at 1,2,4,8,and 12 weeks after treatment were significantly lower than those before treatment,and the differences were statistically significant(all P<0.05).The VAS scores of the research group at 1,2,4,8,and 12 weeks after treatment were significantly lower than those of the control group(all P<0.05).There was no statistically significant difference in basal CD4+/CD8+,CRP,IL-6 and IL-10 levels between the two groups of patients.IL-6 and CRP levels in the research group were significantly lower after treatment than those in the control group,and the differences were statistically significant(all P=0.000).CD4+/CD8+ and IL-10 levels were significantly higher in the research group than those in the control group after treatment,and the difference was statistically significant(all P=0.000).No adverse reactions such as local nerve damage,epidural hematoma,infection,pneumothorax or allergy occurred in both groups of patients during the treatment.Conclusion·DPT can significantly reduce the pain of PHN patients,improve patients'T lymphocyte subpopulations and cytokine expression,and can be safely applied to the clinic.

The brain’s neural circuits consist of a large number of highly unstable networks. Despite the existence of many internal and external factors that continuously disturb the balance, our brains employ an array of homeostatic mechanisms that allow neurons or neural circuits to sense how active they are, and when they deviate from a target value, whereby a force must be generated to move neuronal activity back toward this target. Sleep is one of the well-known physiological states in the regulation of homeostasis. Sleep pressure increases during wakefulness and decreases during sleep. When sleep is lost (e.g., sleep deprivation), this loss is compensated by extending or strengthening subsequent sleep. These phenomena are known as sleep homeostasis. The dysregulation of sleep homeostasis accompanies brain-related diseases such as schizophrenia, bipolar disorder, major depressive disorder, and autism spectrum disorder. More importantly, it can significantly undermine the basis of traditional sleep hygiene practices for these diseases. Therefore, clarifying the mechanisms of sleep homeostasis is important for therapy, but it remains an unsolved mystery. In addition to pharmacological treatment, non-invasive brain stimulation has become one of the most promising tools for clinical treatment in recent years due to its low cost, portability and low incidence of side effects. In order to promote relevant technologies, this review will focus on the electrophysiological mechanisms of sleep homeostasis. We first discuss the electrophysiological marker of sleep homeostasis, slow-wave activity, then move to the neuronal firing rates, finally discuss more aspects of sleep homeostasis, including differences in brain area, sleep stages, learning and individual differences.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective To investigate the distribution and seasonal fluctuations of visceral leishmaniasis vectors sandflies in Lüliang City, Shanxi Province, so as to provide insights into assessment of the visceral leishmaniasis transmission risk and formulation of visceral leishmaniasis control measures. Methods A total of 12 natural villages were sampled from Shilou County, Lishi District, Lanxian County, Linxian County and Wenshui County in Lüliang City, Shanxi Province from June to September, 2023, and sandflies were captured using light traps from 7 breeding habitats, including farmers’ houses, sheep pens, cattle pens, chicken coops, pig pens, mule and horse pens, and loess-cave dwellings. Following morphological identification of the sandfly species, the distribution of sandflies and the seasonal fluctuations of the sandfly density were analyzed. In addition, the Leishmania was detected in sandflies using a real-time fluorescence quantitative PCR assay. Results A total of 2 831 sandflies were captured with 156 light traps in Lüliang City from June to September, 2023, including 2 638 female sandflies (93.18%) and 193 male sandflies (6.82%), and the average density was 16.91 sandflies/(light-night). The seasonal fluctuations of the sandfly density all appeared a unimodal distribution in all survey sites, and the sandfly density peaked in July and then declined rapidly. Among all types of breeding habitats, the greatest sandfly density was found in sheep pens [39.04 sandflies/(light-night)]. In addition, 4.08% (2/49) of the sandfly samples were tested positive for Leishmania nucleic acid as revealed by the real-time fluorescence quantitative PCR assay. Conclusions Sandflies were widely distributed in Lüliang City, Shanxi Province in 2023, and the peak of the sandfly density was observed in July, which had a visceral leishmaniasis transmission risk. Intensified surveillance of visceral leishmaniasis and sandfly vectors is required and targeted vector control is recommended.

Objectives:To explore the prognostic significances of geriatric nutrition risk index (GNRI), controlling nutritional status (CONUT), and prognostic nutritional index (PNI) in patients with heart failure.Methods:This was a retrospective study. Patients with heart failure admitted to the Department of Cardiology, the first affiliated hospital of Sun Yat-sen University from September 16, 2013 to December 28, 2017 were enrolled. Clinical data of patients were collected and patients were followed up. GNRI, CONUT and PNI scores of patients were calculated. Cox proportional risk model was used to evaluate the relationship between the above three nutritional status scores and the risk of all-cause death in patients with heart failure, and restricted cubic spline analysis was used to verify the relationship. Subgroup analysis was performed based on left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, number of heart failure comorbidities, systolic blood pressure, creatinine, body mass index, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blockers, and use of spironolactone.Results:A total of 2 016 patients with heart failure aged (67.7±13.0) years old were enrolled, including 1 230 (61.0%) males. All patients were followed up until September 15, 2021. Multivariate Cox proportional hazard models showed that increased GNRI score was significantly associated with reduced risk of all-cause mortality in patients with heart failure ( HR=0.989, 95% CI 0.982-0.996, P=0.001), while CONUT and PNI scores were not associated with all-cause mortality (both P>0.05). Restricted cubic spline analysis showed no U-shaped relationship between the scores and all-cause death. Subgroup analysis suggested that the prognostic value of GNRI score was predominant in patients not using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker ( Pinteraction=0.024), while there was no statistically significant difference between groups in other subgroup analyses ( Pinteraction>0.05). Conclusions:Increased GNRI score is associated with reduced risk of all-cause mortality in patients with heart failure and may serve as an effective tool to assess nutritional status in patients with heart failure.

In the field of healthcare service, it is crucial to optimize medical innovation services by combining the preferences of health service providers and demanders (i.e., stakeholders). The best-worst scaling (BWS) method is a recently developed stated preference method for assessing preferences with distinctive advantages. Nevertheless, there is a lack of a comprehensive introduction to stakeholder preference assessment using BWS, thus constraining its applications and promotion. This paper introduces the process of using BWS to assess service providers' preferences for the Shared Medical Appointment for diabetes (SMART), an integrated healthcare service of medicine and health management, in the hope of providing reference for researchers for promoting the use of BWS in implementation research.