In the current international situation, there is the possibility of nuclear war and nuclear terrorism. The nuclear and radiological emergency in the event of an accident should be enhanced. The World Health Organization (WHO) issued a publication on January 27, 2023, updating the list of drugs recommended for stockpiling in response to radiation and nuclear emergencies, which was the first update since 2007. The list of recommended drug stocks in the publication includes drugs to prevent or reduce the effects of radiation, as well as drugs used to treat injuries after exposure. Based on the list of drugs, this article reviews the emergency response to nuclear and radiological accidents, the general situation of emergency drug stockpiles, drug reserves in some countries, and current considerations, with a view to providing references for emergency medical rescue in nuclear and radiological accidents in China.

Objective:To explore the different coagulation state in patients with adenomyosis and its clinical significance.Methods:Clinical data of the patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. (1) Differential coagulation state between 25 healthy women and 25 patients with adenomyosis were compared during menstrual and non-menstrual periods. (2) The coagulation indexes of 145 patients with adenomyosis (observation group 1) and 129 patients with cervical intraepithelial neoplasia grade Ⅲ (control group 1) who underwent hysterectomy in non-menstrual period were compared. (3) The coagulation indexes of 154 patients with adenomyosis (observation group 2) and 147 women without myometrial lesions (control group 2) who underwent endometrial curettage during uterine bleeding period were compared. (4) Correlations of coagulation index with cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9) and uterine volume in patients with adenomyosis were analyzed. Results:(1) The coagulation state of each health women during the menstrual and non-menstrual period showed no significant differences (all P>0.05). For the 25 patients with adenomyosis, fibrinogen [FIB; 2.61 g/L(2.50-3.10 g/L)] and D-dimer [0.60 mg/L (0.40-1.00 mg/L)] in the menstrual period were significantly higher than those in the non-menstrual period [2.25 g/L (1.90-2.70 g/L) and 0.27 mg/L (0.20-0.40 mg/L), respectively; both P<0.01], while thrombin time [TT; 16.70 s (16.10-17.40 s)] in the menstrual period was significantly lower than that in the non-menstrual period [17.95 s (17.20-18.40 s); P<0.01]. (2) In the non-bleeding period, D-dimer [0.26 mg/L (0.20-0.40 mg/L)] and platelet count [257.0×10 9/L (212.0×10 9/L-308.5×10 9/L)] of observation group 1 were significantly higher than those of control group 1 (all P<0.01). Besides, FIB ( r=0.237, P=0.004) and D-dimer ( r=0.373, P<0.001) were positively correlated with CA 125, while prothrombin time (PT; r=-0.208, P=0.012) and internationalized normalized ratio of plasma prothrombin time (PT-INR; r=-0.201, P=0.015) were negatively correlated with CA 19-9. (3) In the bleeding period, PT [10.70 s (10.10-11.20 s)] and PT-INR [0.93 (0.90-1.00)] of observation group 2 were significantly lower than those of control group 2 (all P<0.01), while D-dimer [0.41 mg/L (0.20-0.80 mg/L)] was significantly higher than that in the control group 2 ( P<0.001). Furthermore, FIB ( r=0.252, P=0.038) and D-dimer ( r=0.321, P=0.008) were positively correlated with uterine volume, while activated partial thromboplastin time (APTT; r=-0.190, P=0.018) and TT ( r=-0.304, P=0.012) were negatively correlated with uterine volume. (4) During non-menstrual period and uterine bleeding period, APTT and TT in patients of observation group 1 and 2 combined with anemia were significantly lower than those of non-anemia patients (all P<0.05). Conclusion:Patients with adenomyosis have a tendency to hypercoagulability in both the uterine bleeding and non-bleeding periods, which may be related to enlarged uterine volume, increased serum CA 125 and anemia.

Objective:To assess impact of radiation from nuclear power on the surrounding environment, a dose assessment model was constructed and relevant dose coefficients were determined through refined animal models.Methods:Zebrafish is one of the most important aquatic model animals in the radiation hazard assessment of nuclear power liquid effluent. A geometric model of zebrafish containing internal bones and visceral organ was established for dose estimation. The internal and external dose coefficients (DC) of the zebrafish model were calculated by Monte Carlo method with seven nuclides as the source term, 3H, 40K, 58Co, 60Co, 110Ag, 134Cs, 137Cs, which are common in nuclear liquid effluents and environmental monitoring. Results:The level of nuclide gamma energy determines dose coefficients for external radiation. The dose coefficients of most nuclides in internal organs was higher than that in whole body, and the internal organ dose of 58Co was 165% higher than that in whole body. The internal radiation dose coefficients of the model established in this study was relatively high, and the internal radiation dose coefficients caused by 60Co was 2.6 times of existing ellipsoid model, which suggested that the different internal materials and the choice of different particle types would affect the energy deposition. Conclusions:Refining of model animals is important. Accurate assessment of the organs dose coefficients of model animals is helpful to assess the radiation effects on non-human species.

Objective To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma. Methods Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups. Results Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P<0.001). However, there was no significant difference between the two groups in the presence of no lobulation, and obscured margin (P>0.05). Conclusions EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild?type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation.

Objective: To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma. Methods: Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups. Results: Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P<0.001). However, there was no significant difference between the two groups in the presence of no lobulation, and obscured margin (P>0.05). Conclusions EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild-type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation.

OBJECTIVE： To investigate absorption kinetic characteristics of main active components as 4-（glucoseoxy）- glucoseoxybenzyl cinnamate （A1）， 2-isobutyl malic acid （A2）， 1，4-bis [4-（glucoxy） benzyl]-2-isobutyl malic acid ester （A3）， dihydrophenanthrenes 1 （A4） and 1，4-bis [4-（glucosoxy） benzyl]-2-isobutyl malic acid ester-2-（4-O-cinnamoyl-6-O-acetyl） glucoside （A5） from ethanol extract of Bletilla striata in the intestines of rats. METHODS： Using puerarin as internal standard， UPLC-MS/MS was used to determined the concentration of A1-A5 in intestinal circulation fluid. The determination was performed on Acquity UPLC BEH C18 column with mobile phase consisted of acetonitrile （containing 0.1％ formic acid）-water （containing 0.1％ formic acid） （gradient elution） at the flow rate of 0.35 mL/min. The column temperature was 45 ℃， and sample size was 3 μL. The positive ion and negative ion scanning were carried out in the multiple reaction monitoring mode by electrospray ion source. The ion pairs for quantitative analysis were m/z 593.2→431.1 （A1）， m/z 189.0→129.0 （A2）， m/z 725.3→457.2 （A3）， m/z 347.1→332.1 （A4）， m/z 1 059.3→793.1 （A5）， m/z 417.0→267.0 （internal standard）. In the in vivo intestinal circulation perfusion model， using accumulative absorption transfer rate （A） and absorption and transformation rate constant （Ka） as indexes， the effects of different doses of ethanol extract from B. striata （low-， medium-， high-dose were 166， 333，667 μg/mL，respectively）， bile， P-glycoprotein （P-gp） inhibitors （verapamil） and different intestinal segments on the absorption of above 5 components were investigated. RESULTS： The linear range of A1， A2， A3， A4 and A5 were 0.22-14.00， 0.34-21.75， 1.99-127.16， 0.15-9.75， 0.16-10.00 μg/mL（r＞0.99）. The limits of quantitation were 0.22， 0.34， 1.99， 0.15， 0.16 μg/mL， respectively. The lowest detection limits were 0.028， 0.085， 0.251， 0.035 and 0.010 μg/mL. RSDs of inter-day and intra-day were all lower than 10％. The recoveries ranged 83.60％-106.91％. Matrix effect did not affect the determination of the substance to be measured. A and Ka values of A1 in B. striata ethanol extract low-dose and medium-dose groups were significantly higher than high-dose group； A value of A3 in low-dose group was significantly higher than medium-dose and high-dose groups （P＜0.05 or P＜0.01）. A and Ka values of A1 and A3 in non-ligation group were significantly lower than control group， while A and Ka values of A4 were significantly higher than control group （P＜0.05 or P＜0.01）. A and Ka values of A1 and A3 in P-gp inhibitor group were significantly lower than control group （P＜0.05 or P＜0.01）. A values of A1 in jejunum group， ileum group and colon group， Ka value of A1 in colon group， A and Ka values of A2 in colon group， A value of A3 in ileum group， A and Ka values of A4 in ileum group and colon group， A values of A5 in jejunum group and ileum group as well as Ka value of A5 in jejunum group were all significantly lower than duodenum group. Ka values of A3 in jejunum group， ileum group and colon group were significantly higher than duodenum group （P＜0.05 or P＜0.01）. CONCLUSIONS： Established UPLC-MS/MS method is specific， sensitive and simple， and it can be used for quantitative analysis and pharmacokinetic study of A1-A5. The 5 active components in B. striata ethanol extract are absorbed by the whole intestine， and the intestinal segments are different. A1 and A3 are absorbed more in intestinal tract and may be saturated. Bile can inhibit intestinal absorption of A1 and A2， but promoted intestinal absorption of A4. A1-A5 may not be the substrate of P-gp.

Objective: To investigate the value of platelet count in predicting the efficacy of rituximab treatment in chronic primary immune thrombocytopenia (ITP). Methods: A retrospective study was conducted in 103 chronic ITP patients hospitalized in our medical center between January 2011 and December 2014. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of platelet count in different time points were analyzed for the predictor of treatment response. Optimal cutoff values were established using ROC analysis. Results: A total of 103 patients were included in the study. There were 46 males and 57 females, with a median age of 30 (18-67) years. At day 1, 3 and 7 after the first dose of rituximab, there was no significant difference in platelet counts between the success group (PLT≥50×10⁹/L after treatment) and the failure group (PLT≤50×10⁹/L after treatment) (P>0.05). At day 14 after rituximab treatment (PTD 14), platelet counts became significantly different in the success and failure groups[41(8-384)×10⁹/L vs 23(0-106)×10⁹/L, P=0.003], and remained different thereafter, with increasing significance in the subsequent follow-ups. Patients were divided further using an optimal cut-off platelet count of 50×10⁹/L on PTD 14, PTD 30, and PTD 60, and PPV and NPV values were calculated for predicting eventual success and failure. Conclusion Response can be predicted by obtaining platelet counts at 14, 30 and 60 days after rituximab treatment. The study proposed a protocol that guides patient monitoring and management planning.

Objective To investigate the imaging features of perivascular epithelioid cell tumor of liver (PEComa),and to improve the diagnostic level of the disease. Methods A retrospective analysis of imaging manifestations was performed on 11 cases of hepatic hemangioma confirmed by surgery and pathology. All patients underwent CT and MRI examination before PET/CT examination ,then received operation. Results Eleven cases were solitary hepatic lesions ,10 of which were located in the right lobe of the liver ,and 1 in the left. The lesions were round or quasi-circular and the diameter ranged from about 13.5cm to about 1.8 cm,with an average of 5.7 cm. CT plain scanning showed that the liver was slightly lower density ,with clear boundary. The smaller lesions were homogeneous density,while the larger ones were not,and the lower density area was visible. Enhancement of peripheral lesions in the arterial phase was enhanced. The lesions in the portal vein were not uniformly enhanced , and visible separation was found in large lesions. In the delay phase ,the lesions were significantly decreased or slightly lower. MRI plain scan showed the lesion T1WI showed moderate signal or slightly low signal ,and large lesion signal was not uniform,and T2WI lesions showed slightly high signal while DWI lesions high signal and the enhanced features were similar to those of CT. PET/CT examination showed that visible radioactive uptake of abnormal concentration or uneven concentration were found in lesions with diameter larger than 3.0 cm,and the maximum SUV value ranged from 12.2 to 3.6,with an average value of 5.7. Lesions with diameter less than 3.0 cm showed a slight concentration of radioactive uptake and the highest SUV value was 4.7,with an average value of 2.9. The only 11.8 cm lesion showed no significant radioactivity ,which was as the same as that of normal liver tissue. Delayed PET/CT imaging(1 hour)showed that SUV values of all lesions were decreased in varying degrees. Conclusion PET/CT imaging of perivascular epithelioid cell tumor of liver has its characteristics. The combina-tion of PET/CT imaging and routine imaging examination will benefit the improvement of diagnosis level obviously.

Objective To establish an improved hemisection model of spinal cord injury(SCI)in rats with less severe injury and increased sur-vival rate. Methods Female Sprague-Dawley rats(n=20)were randomly divided into 2 groups:standard and improved hemisection model of SCI. Basso-Beattie-Bresnahan(BBB)scores were carried out to determine the hindlimb locomotor function at 1 d,3 d,1 week and 2 weeks post SCI,respectively. In addition,duration of operation,blood loss,location of posterior midline,and success rate of spinal cord exposure during the second surgery were used as the main parameters to evaluate the significance of the new model. Results Compared with the standard hemisection model,the improved hemisection model of SCI exhibited shorter duration of operation,less blood loss,higher BBB score,more accurate location of posterior midline,and higher success rate of spinal cord exposure during the second surgery. Based on the improved hemisection model of SCI, transplantation model of scar tissue in spine cord was then successfully constructed with a success rate above 70%. Conclusion The improved hemisection model of SCI shows significant advantages in many aspects related to the operation,which is applicable to the study of SCI,especially the non-acute SCI.

Objective: To analyze the difference of bleeding frequency, plain radiographic (X-ray) , risk factors in hemophilic arthropathy progression and the Arnold-Hilgartner classification. Methods: A retrospective study was conducted in 211 hemophilia patients hospitalized in our medical center between January 2007 and December 2010, some patients with hemarthrosis were followed up for 5 years. Results: All patients were male, including 150 hemophilia A (HA) and 61 hemophilia B (HB) . The HA patients bled more frequently than HB patients with annualized total bleeding rate 20.5 (0-48) vs 13 (1-40) ; annualized joint bleeding rate 13.5 (0-38) vs 8 (0-33) , especially in moderate hemophilia [26 (1-48) vs 12 (1-36) , P<0.001; 18 (0-36) vs 7.5 (0-26) , P=0.001], but severe hemophilia had no difference in bleeding frequency [33 (1-41) vs 26 (1-40) , P=0.702; 22 (0-36) vs 18 (0-33) , P=0.429]. The condition of the affected joints of 108 HA and 54 HB was evaluated on roentgenography. In HA patients, the Arnold-Hilgartner classification increased with the severity ratings (r=0.063, P=0.004) . However, similar associations were not found in HB patients (r=0.045, P=0.082) . Five years later, 36 HA and 19 HB patients received the same joint X-ray, there were no significant differences in joints radiographic progression between the total HA and HB groups (z=1.941, P=0.052) . However, significant difference between moderate HA and HB was observed (z=0.076, P=0.002) . Multivariate unconditioned Logistic analysis showed that annualized joint bleeding rate [P<0.001, OR=1.166 (95%CI 1.097-1.239) ] and articular structural injuries [P=0.018, OR=2.842 (95% CI 1.196-6.755) ] were independent risk factors for the joints radiographic progression. Conclusion The study suggests that there was a difference in bleeding phenotype between HA and HB, especially in moderate hemophilia. HB patients showed mild but progressive development over time, compared with HA patients. Annualized joint bleeding rate and articular structural injuries were independent risk factors for the joints radiographic progression.