Objective To investigate and analyze the occupational stress levels and influencing factors among radiation workers in China, and provide a reference for alleviating occupational stress and promoting mental health. Methods Using the general situation questionnaire, Effort-Reward Imbalance questionnaire, and radiation protection knowledge questionnaire, a convenience sampling method was adopted to investigate the occupational stress of 243 radiation workers in Liaoning, Fujian, Guangdong, and Xinjiang provinces. The independent samples t-test, one-way analysis of variance, chi-square test, and binary logistic regression were used to analyze the influencing factors. Results The average score of Effort-Reward Imbalance was 0.97 ± 0.22, and 100 (41.15%) radiation workers had occupational stress. There were significant differences in the detection rate of occupational stress among radiation workers of different ages, working years in radiation positions, monthly incomes, daily sleep durations, and daily working hours (P < 0.05). Logistic regression analysis identified daily working hours as a factor contributing to occupational stress. Conclusion The occupational stress among radiation workers in China is relatively severe. It is recommended to pay attention to the associated risks and implement targeted intervention measures to reduce the impact of occupational stress.

Objective To analyze the impact of different maze structures of medical electron linear accelerator on the radiation level at the entrance of the treatment room. Methods The Monte Carlo simulation method was used to compare the radiation field distribution in two accelerator rooms with different maze widths and to conduct a detailed analysis of the radiation levels. Results The radiation level at the entrance of the accelerator room with a wide maze was significantly higher than that at the entrance of a compact maze. The neutron radiation level at the entrance of the narrow maze model decreased by 38.6% compared to the wide maze model, and the level of X-ray radiation also showed a declining trend. Conclusion When designing medical electron linear accelerators, a compact maze structure should be adopted to reduce the setting of unnecessary space, thereby lowering the radiation level at the entrance of the treatment room and enhancing the effectiveness of radiation protection.

Objective To investigate the current situation of occupational stress among radiation workers in nuclear power plants in China, to explore the factors influencing occupational stress, and to provide a reference for improving occupational stress. Methods A convenient sampling method was adopted to investigate the occupational stress of 100 radiation workers in two nuclear power plants in Fujian and Liaoning, using the general situation questionnaire, effort-reward imbalance questionnaire, and the radiation protection knowledge questionnaire. Independent samples t-test, one-way analysis of variance, chi-square test, and binary logistic regression analysis were used to examine the current situation of occupational stress and the influencing factors. Results The average value of effort-reward imbalance was 0.99 ± 0.15 and 47 (47%) radiation workers had occupational stress. There were significant differences in the detection rate of occupational stress among radiation workers with different ages, years of radiation work, monthly incomes, sleep durations (day), and exercise habits (P < 0.05). Logistic regression analysis showed that monthly income, sleep duration (day), and exercise habits were the influencing factors for occupational stress. Conclusion The occupational stress of radiation workers in nuclear power plants is a serious issue influenced by many factors. Attention should be given to this issue, and targeted interventions should be implemented to improve the social and working environment of this occupational group and reduce the level of occupational stress.

Objective:To observe the clinical effect of retrograde distal tibial intramedullary nail fixation in the treatment of proximal ankle fracture of the distal tibia.Methods:A three-dimensional CT examination of 40 adult tibias was performed to measure anatomical indicators such as the posterior medial posterior torsion angle of the distal tibia, the height of torsion, and the height of the safety zone for nail placement. Based on the anatomy database of the human skeleton model, a retrograde distal tibial nail and its supporting instruments were developed in accordance with the anatomical characteristics of the distal tibia and the proximal ankle of Chinese people. From June 2019 to June 2023, a total of 25 patients with distal tibial proximal ankle fractures treated with retrograde intramedullary nail internal fixation in the 909th Hospital were retrospectively analyzed. There were 18 males and 7 females, aged 41.3±10.8 years (range, 22-65 years). The sample size was 1∶1 matched according to gender and age. Twenty-five patients with distal tibial proximal ankle fractures who underwent antegrade intramedullary nail fixation during the same period were matched, including 20 males and 5 females, aged 41.2±9.4 years (range 19-60 years). The reduction quality, postoperative Baird-Jackson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, ankle range of motion and complications were observed.Results:All patients were successfully operated and followed up for 14.4±3.5 months (range, 12-24 months). The intraoperative blood loss and hospitalization time in retrograde intramedullary nail group were 33.12±7.38 ml and 10.32±1.75 d, less than 49.04±10.22 ml and 13.16±2.69 d in antegrade intramedullary nail group, and the difference was statistically significant ( P<0.05). The reduction quality was excellent in 23 cases and good in 2 cases in the retrograde intramedullary nail group, and was excellent in 17 cases and good in 8 cases in the anterograde intramedullary nail group. The proportion of excellent reduction quality in the retrograde intramedullary nail group was higher than that in the anterograde intramedullary nail group, and the difference was statistically significant (χ 2=4.500, P=0.034). The Baird-Jackson score and AOFAS ankle and hindfoot score in the retrograde intramedullary nail group were 85.6±2.5 and 85.8±3.3 at 3 months after operation, lower than those at 1 year after operation 95.3±3.1 and 95.8±3.6, and the difference was statistically significant ( P<0.05). The Baird-Jackson score and AOFAS ankle and hindfoot score of the antegrade intramedullary nail group were 85.1±3.3 and 86.1±2.5 at 3 months after operation, lower than 95.2±2.7 and 94.9±3.5 at 1 year after operation, and the difference was statistically significant ( P<0.05). There was no significant difference in Baird-Jackson score and AOFAS ankle and hindfoot score between the two groups at 3 months and 1 year after operation ( P>0.05). At the last follow-up, there was no ankle stiffness, neurovascular injury, deep vein thrombosis, infection or breakage of internal fixation in the two groups. Conclusion:The treatment of distal tibial proximal ankle fractures with retrograde intramedullary nail fixation has satisfactory reduction quality, good postoperative function recovery, and is helpful for early postoperative rehabilitation.

Objective To investigate the value of serum latent transforming growth factor beta binding protein 2(LTBP2),urocortin 1(Ucn1),and cluster of differentiation 90(CD90)levels in the diagnosis and severity assessment of endometriosis(EMT).Methods A total of 103 EMT patients who underwent diagno-sis and treatment in the hospital from January 2020 to December 2023 were selected as the experimental group.The experimental group was separated into a severe group and a mild group.In addition,82 healthy in-dividuals who underwent physical examinations in the hospital were selected as the control group.The correla-tion analysis of serum LTBP2,Ucn1,and CD90 levels was performed using Pearson.Multivariate Logistic re-gression was applied to analyze the influencing factors of EMT.Receiver operating characteristic(ROC)curve was applied to evaluate the diagnostic value of serum LTBP2,Ucn1,and CD90 for EMT.Results Compared with the control group,the serum levels of LTBP2,Ucn1,and CD90 in the experimental group showed an in-crease trend(P＜0.05).There was positive correlation between serum LTBP2,Ucn1,and CD90 in the experi-mental group(r=0.377,0.344,0.246,P＜0.001,＜0.001,=0.012).The serum levels of LTBP2,Ucn1,and CD90 were significantly higher in the mild group and the severe group than those in the control group(P＜0.05).The serum levels of LTBP2,Ucn1,and CD90 in the mild group were obviously lower than those in the severe group,and the differences were statistically significant(P＜0.05).The interleukin(IL)-4 level in the experimental group was lower than that in the control group,and the proportions of menstrual pain and pelvic surgery were higher than those in the control group,and the differences were statistically significant(P＜0.05).Serum levels of LTBP2,Ucn1,and CD90,menstrual pain,and a history of pelvic surgery were risk factors for EMT(P＜0.05),while IL-4 level was a protective factor for EMT(P＜0.05).The area under the curve of serum LTBP2,Ucn1,CD90,and their combination for EMT diagnosis was 0.788,0.801,0.810,and 0.916,with sensitivity of 63.11％,63.11％,62.14％,and 84.47％.The combination of the three(Z LTBP2-triple combination=4.054,P＜0.001,ZUcn1-triple combination=3.966,P＜0.0 01,Z CD90-triple combination=4.193,P＜0.001)had higher diagnostic value for EMT.Conclusion Patients with severe EMT have higher levels of serum LTBP2,Ucn1,and CD90.The com-bination of serum LTBP2,Ucn1,and CD90 has certain diagnostic value for EMT.

Purpose BRCA1/2 gene germline variants of the uncertain significance(VUS)are categorized into five clas-ses based on their risk levels,and three classes require regular periodic analysis due to their unclear clinical significance.The aim of this study was to investigate the influence of updating var-iation evidences on the VUS sites and guide clinical diagnosis and treatment.Methods The VUS sites in BRCA1/2 gene were analyzed.971 samples(breast or ovarian cancer)that un-derwent BRCA1/2 germline testing were stored.The VUS sites in BRCA1/2 gene were further reinterpreted by integrating the following evidences,including population frequency database,disease database,computer software prediction,co-segregation evidence,allelic evidence and population cohort evidence to determine whether the variation classification was changed.Results The number of the patients with VUS sites was 142,accounting for 14.6％(142/971).The total number of VUS sites was 128,among which the proportions of missense muta-tion,synonymous mutation,in-frame non-shifted mutation and non-coding region mutation were 70.3％,4.7％,3.1％and 21.9％,respectively.Reinterpretation of VUS sites discovered that 11.7％(15/128)of VUS sites could be downgraded to Class 2,likely benign.Conclusion With the continuous in-creasing evidences of germline variation,the variation classifica-tion of VUS sites will be changed after periodic analysis.

Objective:To investigate the driver gene mutation status and prognostic influencing factors in patients with operable lung adenosquamous carcinoma (LASC).Methods:A retrospective case series study was conducted. Clinical and pathologic data were retrospectively collected from patients with LASC who underwent surgical treatment at the Second Affiliated Hospital of Air Force Military Medical University from January 2008 to December 2018, and the patients' surgically resected specimens were sequenced for epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (KRAS) genes. The distribution of driver gene EGFR and KRAS mutations in patients was analyzed, and the differences in the distribution of mutations among patients stratified by clinical factors were compared; disease-free survival (DFS) of patients stratified by clinical factors was analyzed by the Kaplan-Meier method, and the comparison between groups was performed by the log-rank test.Results:A total of 106 patients were included, including 64 (60.4%) males and 42 (39.6%) females, aged (58±10) years old. Patients with EGFR and KRAS gene mutations accounted for 38.7% (41/106), of which 33.0% (35/106) were patients with EGFR mutations and 5.7% (6/106) were patients with KRAS mutations. The EGFR mutation loci included 19del, L858R, L861Q and 20in, and the KRAS mutation loci included G12A, G12D, G12C and G12V. Patients aged ≤65 years old, female, with lesions in the lower lobe of the left lung, non-squamous cell carcinoma as the main pathological component, and with a smoking index of <400 were more likely to have EGFR and KRAS gene mutations, but the differences were not statistically significant (all P>0.05), and there was no statistically significant difference in the proportions of patients with EGFR and KRAS gene mutations among patients with different TNM stages, T stages and N stages (all P > 0.05). The median follow-up time was 51 months (range: 14-96 months). The difference in DFS among patients with different N stages was statistically significant ( P= 0.002), and the DFS of N 0 stage was better than that of N 1, N 2 and N 3 stages, and the differences were statistically significant (all P < 0.05). The median DFS time of N 0, N 1 and N 2 stages was 44.4, 17.5 and 23.9 months, respectively, and the median DFS time of N 3 stage (1 case) was 8.7 months. Patients with different TNM stages had a tendency to have differences in DFS, but the difference was not statistically significant ( P = 0.060); the difference in DFS between patients with different pathological components was not statistically significant ( P = 0.177); patients without pleural invasion had a tendency to have better DFS than patients with pleural invasion, but the difference was not statistically significant ( P = 0.252). The difference in DFS between patients with and without driver gene EGFR and KRAS mutations was not statistically significant ( P = 0.809), and further subgroup analysis showed that the difference in DFS among mutated patients with different TNM stages was not statistically significant ( P = 0.684). Conclusions:The driver gene EGFR and KRAS mutations are more common in patients with early LASC; DFS may be related to TNM stage and N stage, but may not be related to the mutation status of EGFR and KRAS genes, the type of pathology, or whether or not the pleura is invaded.Objective To investigate the driver gene mutation status and prognostic influencing factors in patients with operable lung adenosquamous carcinoma (LASC). Methods A retrospective case series study was conducted. Clinical and pathologic data were retrospectively collected from patients with LASC who underwent surgical treatment at the Second Affiliated Hospital of Air Force Military Medical University from January 2008 to December 2018, and the patients' surgically resected specimens were sequenced for epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (KRAS) genes. The distribution of driver gene EGFR and KRAS mutations in patients was analyzed, and the differences in the distribution of mutations among patients stratified by clinical factors were compared; disease-free survival (DFS) of patients stratified by clinical factors was analyzed by the Kaplan-Meier method, and the comparison between groups was performed by the log-rank test. Results A total of 106 patients were included, including 64 (60.4%) males and 42 (39.6%) females, aged (58±10) years old. Patients with EGFR and KRAS gene mutations accounted for 38.7% (41/106), of which 33.0% (35/106) were patients with EGFR mutations and 5.7% (6/106) were patients with KRAS mutations. The EGFR mutation loci included 19del, L858R, L861Q and 20in, and the KRAS mutation loci included G12A, G12D, G12C and G12V. Patients aged ≤65 years old, female, with lesions in the lower lobe of the left lung, non-squamous cell carcinoma as the main pathological component, and with a smoking index of <400 were more likely to have EGFR and KRAS gene mutations, but the differences were not statistically significant (all P>0.05), and there was no statistically significant difference in the proportions of patients with EGFR and KRAS gene mutations among patients with different TNM stages, T stages and N stages (all P > 0.05). The median follow-up time was 51 months (range: 14-96 months). The difference in DFS among patients with different N stages was statistically significant ( P= 0.002), and the DFS of N 0 stage was better than that of N 1, N 2 and N 3 stages, and the differences were statistically significant (all P < 0.05). The median DFS time of N 0, N 1 and N 2 stages was 44.4, 17.5 and 23.9 months, respectively, and the median DFS time of N 3 stage (1 case) was 8.7 months. Patients with different TNM stages had a tendency to have differences in DFS, but the difference was not statistically significant ( P = 0.060); the difference in DFS between patients with different pathological components was not statistically significant ( P = 0.177); patients without pleural invasion had a tendency to have better DFS than patients with pleural invasion, but the difference was not statistically significant ( P = 0.252). The difference in DFS between patients with and without driver gene EGFR and KRAS mutations was not statistically significant ( P = 0.809), and further subgroup analysis showed that the difference in DFS among mutated patients with different TNM stages was not statistically significant ( P = 0.684). Conclusions The driver gene EGFR and KRAS mutations are more common in patients with early LASC; DFS may be related to TNM stage and N stage, but may not be related to the mutation status of EGFR and KRAS genes, the type of pathology, or whether or not the pleura is invaded.

{L-End}Objective To analyze the effects of night shift work and overweight/obesity on blood pressure of workers in chemical fiber industry. {L-End}Methods A total of 1 004 workers of a chemical fiber factory were selected as the study subjects using convenient sampling method, and their blood pressure and body mass index were measured. Multiple linear regression model was used to analyze the relationship between night shift work and blood pressure, and multiple logistic regression was used to assess the independent impact and combined impact of night shifts and overweight/obesity on the risk of hypertension. {L-End}Results Compared with the non-night shift workers, the prevalence of hypertension in night shift workers was increased (5.3% vs 13.0%, P<0.05), with elevated systolic and diastolic blood pressure (both P<0.05). The results of multiple linear regression analysis showed that the systolic blood pressure and diastolic blood pressure of the night shift workers were higher than those of the non-night shift workers (both P<0.05), and the systolic blood pressure and diastolic blood pressure of overweight/obesity workers were higher than those of non-overweight/obesity workers (both P<0.01). The results of multiple logistic regression analysis showed that the risk of hypertension in night shift workers and overweight/obesity workers was higher than that in non-night shift workers and non-overweight/obesity workers [odds ratio (OR) and 95% confidence interval (CI) were 2.49 (1.04-5.99) and 2.65 (1.77-3.95), both P<0.05]. Night shift work and overweight/obesity showed a synergistic effect on blood pressure of workers. Compared to non-overweight/obesity non-night shift workers, overweight/obesity night shift workers had a higher risk of hypertension (OR=4.93, 95%CI: 1.70-14.29, P<0.01). {L-End}Conclusion Night shift work could lead to elevated blood pressure in workers in the chemical fiber industry, which is a potential risk factor for hypertension. The synergistic effect of night shift work and overweight/obesity may contribute to the increased risk of hypertension.

Objective To investigate the effectiveness of esketamine aerosol inhalation combined with Ⅰ-gel laryngeal mask and Wellead bronchial occluder for thoracoscopic single lung ventilation surgery.Methods Seventy-five thoracic surgery patients,39 males and 36 females,aged 28-64 years,BMI 18-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected for thoracoscopic surgery.Patients were randomly di-vided into three groups by digital table method:esketamine nebulizing inhalation combined with Ⅰ-gel laryn-geal mask and Wellead bronchial sealer group(group EW),Ⅰ-gel laryngeal mask combined with Wellead bronchial sealer group(group LW),and tracheal catheter combined with Wellead bronchial sealer group(group TW),25 cases in each group.The insertion time,extraction time,awakening time,and the highest PETCO2 value during single lung ventilation were recorded in the three groups.Airway peak pressure(Ppeak)and dynamic lung compliance(Cdyn)were recorded during 15 minutes of supine double-lung ven-tilation and 15 minutes of lateral single-lung ventilation.The changes of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8)and other inflammatory factors in alveolar lavage fluid at 10 mi-nutes before single lung ventilation(T0),10(T1),30(T2),60 minutes(T3)after single lung ventila-tion,and at the end of single lung ventilation(T4),lung collapse score on the operative side,postoperative coughing,hoarseness,sore throat,and atelectasis occurred.Results Compared with group TW,the ex-traction time and awakening time of groups EW and LW were significantly shortened(P＜0.05),Ppeak was significantly decreased and Cdyn was significantly increased in group EW during double lung and single lung ventilation(P＜0.05),and Ppeak was significantly decreased and Cdyn was significantly increased in group LW during single lung ventilation(P＜0.05),TNF-α,IL-6 and IL-8 were significantly decreased at T2-T4 in groups EW and LW(P＜0.05),and the incidence of cough and throat pain was significantly de-creased(P＜0.05).Compared with group LW,Ppeak and Cdyn were significantly decreased in group EW during double lung and single lung ventilation(P＜0.05),and TNF-α,IL-6,and IL-8 were significantly decreased at T2-T4(P＜0.05).There were no significant differences in the insertion time,the highest val-ue of PET CO2 and the lung collapse score among the three groups,and no case of atelectasis occurred among the three groups.Conclusion The use of esketamine aerosol inhalation combined with Ⅰ-gel laryngeal mask and Wellead bronchial occluder for thoracoscopic surgery can ensure the required ventilation during surgery,significantly reduce airway irritation during general anesthesia induction and recovery,reduce pneumonia re-action,and improve lung compliance,which is worthy of clinical promotion.

While lobectomy is the standard surgical procedure for early-stage non-small cell lung cancer (NSCLC), sublobectomy (segmentectomy/wedge resection) has been gaining progress in early-stage peripheral NSCLC in recent years because it preserves more lung parenchyma and has the advantages of good postoperative lung function, relatively less trauma, and faster recovery. However, there has been a lack of standardized randomized clinical trials to study the survival benefits of sublobectomy. The results of a high-profile study from the USA, CALGB140503, have been the subject of intense industry debate since its presentation at the 2022 World Conference on Lung Cancer (IASLC WCLC 2022). The study, which was published in The New England Journal of Medicine on February 9, 2023, was designed to investigate whether sublobectomy was not inferior to lobectomy in terms of survival in patients with early-stage peripheral NSCLC (tumor diameter≤2 cm). The results showed that sublobectomy was not worse than lobectomy for survival in patients with T1aN0M0 peripheral NSCLC with tumor diameter≤2 cm and pathologically confirmed negative hilar and mediastinal lymph nodes. Sublobectomy, including anatomical segmentectomy and wedge resection is an effective NSCLC treatment. The results of this study provide strong evidence for the improved outcomes of sublobectomy in terms of lung function protection and are expected to promote the further use of sublobectomy. However, given the limitations of this study, whether sublobectomy, especially wedge resection, can become a standard procedure still needs to be explored. This paper presents an interpretation of this study and we invite experts in the field to discuss its usefulness in guiding clinical practice and summarise its limitations.