To provide prevention and control strategies of occupational exposure risks to cytotoxic drug in medical institutions， improve the awareness of protection among medical staff，and reduce potential occupational exposure risks，the Guidelines for the Prevention and Control of Occupational Exposure Risk to Cytotoxic Drugs in Medical Institutions is developed. Based on the World Health Organization Guidelines Development Manual，the exposure risk issues of the cytotoxic drug collected from the time that it entered the hospital to the several stages after delivery to hospital，such as transportation，receipt，storage，unpacking，dispensing，use of finished products，and waste disposal. Delphi method is used to construct identification of clinical issues，and evidence-based research method is used to develop relevant evidence. Quality evaluation is conducted by using the recommended GRADE method. The consensus is reached on the recommendation opinions and evidence levels through expert consensus method. By combining engineering controls，administrative controls and personal protective equipment at different levels，a graded control approach is established. A total of 37 clinical issues are identified，resulting in 36 recommendations. This guideline provides reference and supplementation for the formulation of cytotoxic drug prevention and control measures in medical institutions.

Single-cell or low-input multi-omics techniques have revolutionized the study of pre-implantation embryo development.However,the single-cell or low-input proteomic research in this field is rela-tively underdeveloped because of the higher threshold of the starting material for mammalian embryo samples and the lack of hypersensitive proteome technology.In this study,a comprehensive solution of ultrasensitive proteome technology(CS-UPT)was developed for single-cell or low-input mouse oocyte/embryo samples.The deep coverage and high-throughput routes significantly reduced the starting material and were selected by investigators based on their demands.Using the deep coverage route,we provided the first large-scale snapshot of the very early stage of mouse maternal-to-zygotic transition,including almost 5,500 protein groups from 20 mouse oocytes or zygotes for each sample.Moreover,significant protein regulatory networks centered on transcription factors and kinases between the MII oocyte and 1-cell embryo provided rich insights into minor zygotic genome activation.

Objective:To investigate the efficacy of autologous fat grafting in the treatment of stable linear scleroderma.Methods:A retrospective analysis was performed on 40 patients with stable linear scleroderma who received autologous fat grafting from October 2017 to November 2020 in the Department of Dermatology, Xijing Hospital, Air Force Medical University. There were 22 males and 18 females, aged 12 - 36 (18.2 ± 4.82) years. Skin lesions involved the forehead in 16 cases, the perioral area in 4, the lower jaw in 2, the cheek in 9, the trunk in 5, and the lower limb in 4, and the size of depressed skin defects was 3 - 24 cm 3. The patients′ subjective satisfaction rate, the decrease in the size of depressed skin defects, and the incidence of adverse reactions after autologous fat grafting were analyzed during the follow-up. Results:Six months after the grafting, 40 patients were followed up and evaluated, and the size of depressed skin defects markedly decreased. The satisfaction rate for appearance improvement after the first grafting was 60% (24/40) ; 35 patients received the second grafting, with a satisfaction rate of 88.6% (31/35) ; 17 received the third grafting, with a satisfaction rate of 94.1% (16/17) ; the total satisfaction rate was 87.5% (35/40). After the grafting, local skin unevenness was observed in the grafting area in 3 patients, and in the liposuction area in 2. The incidence rate of postoperative adverse reactions was 12.5% (5/40) .Conclusion:Autologous fat grafting was markedly effective in the treatment of stable linear scleroderma.

Objective : To investigate the expression and clinical significance of classic vascular endothelial growth factor A (VEGFA) and vasotropic mimicry factor matrix metalloproteinase 14 (MMP⁃14) in lung adenocarcinoma(LUAD) . Methods : The expression levels of MMP⁃14 and VEGFA genes and proteins in LUAD and their correlation with survival and prognosis were analyzed using TCGA and UALCAN databases . Serum of 69 patients with LUAD and 20 healthy subjects (control group) was collected , and the contents of MMP⁃14 and VEGFA were detected by ELISA and chemiluminescence , respectively , to analyze the correlation between the two and the clinicopathological features of tumors and their value in prediction and diagnosis of LUAD . Results: The levels of MMP⁃14 and VEGFA in LUAD tissues and serum were higher than those in control group . There were significant differences in serum VEGFA and MMP⁃14 expression levels among early stage group , advanced stage group and control group (P< 0. 001) . MMP⁃14 was higher in T3 /T4 stage than that in T1 /T2 stage (P = 0. 045) , higher in N2 /N3 stage than that in N0 /N1 stage (P = 0. 035) , and higher in the pleural metastasis group than that in the non⁃pleural metastasis group (P = 0. 034) . VEGFA level was higher in M 1 than M0 (P = 0. 025) . Elevated VEGFA level was a risk factor for LUAD (P = 0. 002) . The area under the curve (AUC) of MMP⁃14 , VEGFA and CEA alone was 0. 793 , 0. 849 and 0. 851 , respectively , and the AUC of the combined test was 0. 952 . The overall survival ( OS) and disease specific survival (DSS) of MMP⁃14 and VEGFA low expression group were longer than those of MMP⁃14 and VEGFA high expression group (P < 0. 05) . Conclusion High expression of MMP⁃14 and VEGFA in LUAD is associated with the growth , invasion and metastasis of LUAD , respectively , and has implications for survival prognosis determination .

Objective:To investigate the effects of IL-28B in a mouse model of dextran sulfate sodium (DSS)-induced colitis and to analyze the possible mechanism.Methods:Thirty-five male C57BL/6 mice were randomly divided into the following groups with seven mice in each group: control group, DSS group and three IL-28B groups (1.25 μg, 2.5 μg and 5 μg). The mice in the DSS group and IL-28B groups were fed with 2.5% DSS solution and from day 3, the IL-28B groups were given intraperitoneal injection of corresponding IL-28B every day and the DSS group was treated with PBS. During the experiment, the disease activity index (DAI) was evaluated daily. On day 8, the mice were sacrificed and peripheral blood, spleen, mesenteric lymph node and colon samples were collected. The colon samples were observed, measured in length and stained with HE, and histopathological scores were calculated based on HE staining. Changes of immune cells in different samples were detected by flow cytometry. ELISA was used to detect the expression of IL-12, IL-10, IL-1β, IL-6, IL-4 and IL-13 in serum and colon tissues.Results:Compared with the DSS group, the IL-28B group (2.5 μg) had lower DAI scores [(9.40±1.67) vs (3.50±1.73), P<0.01], less shortening of the colon [(5.16±0.61) cm vs (6.91±0.60) cm, P<0.01] and significantly lower histopathological scores [(7.33±0.58) vs (4.33±0.58), P<0.01]. Moreover, compared with the DSS group, the IL-28B group (2.5 μg) showed decreased macrophages in the peripheral blood [(21.39±3.21)% vs (15.63±2.98)%, P<0.05] and spleen [(3.03±0.28)% vs (2.05±0.48)%, P<0.05], and significantly increased mean fluorescence intensity of M2 macrophages in the colon [(1 361.00±293.40) vs (2 074.00±87.61), P<0.05]. IL-12 expression in colon tissues and IL-1β expression in serum were reduced, and IL-10, IL-4 and IL-13 expression in colon tissues was significantly increased in the IL-28B group (2.5 μg) as compared with those in the DSS group [IL-12: (31.72±6.92) pg/mg vs (5.41±3.41) pg/mg; IL-1β: (48.01±16.13) pg/ml vs (12.27±6.26) pg/ml; IL-10: (184.70±46.82) pg/mg vs (444.30±157.80) pg/mg; IL-4: (2.23±0.27) pg/mg vs (3.64±0.80) pg/mg; IL-13: (11.79±0.99) pg/mg vs (22.59±1.92) pg/mg; all P<0.05]. Conclusions:IL-28B might alleviate the severity of acute enteritis in mice by increasing the secretion of IL-4 and IL-13, regulating macrophage differentiation and modulating the expression of inflammatory factors.

Objective:To investigate the effect of cranioplasty with polyetheretherketone (PEEK) after craniectomy in patients with traumatic brain injury (TBI).Methods:A retrospective case series study was used to analyze the clinical data of 85 TBI patients undergone craniectomy admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from February 2017 to April 2021, including 57 males and 28 females, aged 7-70 years [(40.8±15.5)years]. Patients′ Glasgow Coma Scale (GCS) was 6-15 points [15 (13, 15)points]. All patients underwent PEEK cranioplasty as scheduled. The extended Glasgow Outcome Scale (GOSE) was used to evaluate the neurological function before, at 3 and 6 months after operation. After excluding 33 patients with preoperative GOSE score of 8 points, 52 patients with preoperative GOSE score less than 8 points were analyzed on the degree of GOSE improvement. Patients′ satisfaction with PEEK repair was evaluated through telephone interviews at 6 months postoperatively. The incidence of complications were observed during hospitalization and within 6 months postoperatively.Results:All patients were followed up for 6-7 months [6 (6, 7)months]. The GOSE was 6 (5, 8)points before operation, 6 (5, 8)points at 3 months after operation, and 7 (5, 8)points at 6 months after operation. There was no significant difference in GOSE at 3 months after operation and before operation ( P>0.05), but it was significantly increased at 6 months after operation when compared to the preoperative level ( P<0.05). With regards to GOSE, there were 10 patients with mild amelioration but 42 with no amelioration at 3 months after operation, while 4 patients with significant amelioration and 31 with no amelioration were observed at 6 months after operation ( P<0.05). For PEEK repair, Patients′ satisfaction was very high in 43 patients, high in 33, general in 7 and poor in 2. A total of 25 patients had postoperative complications during hospitalization and within 6 months postoperatively, with the incidence of complications of 29%. Specifically, there was 1 patient with wound infection, 1 new epilepsy, 8 epidural hemorrhage, 13 subcutaneous effusion, 1 subcutaneous effusion, severe infection and material exposure, and 1 severe infection, new-onset epilepsy and subcutaneous effusion. Repair materials were removed in 2 patients due to multiple complications; other patients obtained alleviation via treatment, without affect on their daily life. Conclusion:PEEK cranioplasty following craniectomy for TBI patients can improve prognosis, attain high satisfaction and has low incidences of postoperative infection and exposure of repair materials.

Objective:To evaluate the prediction value of preoperative Fibrinogen(FIB) in combination with neutrophil-lymphocyte ratio(NLR)for the prognosis of operable pancreatic cancer patients.Methods:The clinical data of 124 patients who underwent radical resection for pancreatic cancer in our hospital from Jan 2010 to Dec 2018 were retrospectively analyzed.The patients were divided into three groups according the high and low NLR, FIB value which defined by the receiver operating characteristic curve (ROC). The clinicopathological data and overall median survival time were compared between the three groups.Results:Univarate analysis showed that age, tumor stage, NLR, FIB and F-NLR score were associated with the prognosis( P<0.05), while multivariate analysis showed that high F-NLR score was the independent prognostic factor. The median survival time of patients with F-NLR scores 0, 1 and 2 group was 30.6, 20.3 and 13.9 months( P<0.05). The prognosis of high F-NLR score was significantly worse than that of low F-NLR score( P<0.05). Conclusions:A high preoperative F-NLR score was a promising predictor for the prognosis of pancreatic cancer patients after radical resection.

Objective:To investigate the effects of different mechanical ventilation methods on respiratory function in elderly patients in the steep Trendelenburg position undergoing general anesthesia.Methods:This was a randomized controlled study.Sixty patients scheduled for elective laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia were randomly divided into the lung protective ventilation strategy group(the P group)and the traditional ventilation strategy group(the T group)(n=30, each group). The setting for the P group included FiO 2 at 50%, tidal volume at 6 ml/kg, respiratory rate at 14-16/min, positive end expiratory pressure(PEEP)at 5 cmH 2O, with sustained lung inflation by pressure control every 30 min and the pressure at 30 cmH 2O for 30 s. The setting for the T group included FiO 2 at 50%, tidal volume at 10 ml/kg, and respiratory rate at 10-12/min.Anesthesia was maintained by sevoflurane, remifentanil and cis-atracurium.Driving pressure(DP), mean airway pressure(P mean)and end-tidal carbon dioxide(EtCO 2)were recorded at T1(5 mins after intubation), T2(after pneumoperitoneum), T3(30 mins after pneumoperitoneum), T4(1h after pneumoperitoneum), T5(2h after pneumoperitoneum), T6(3h after pneumoperitoneum)and T7(end of surgery). Arterial blood partial pressure of carbon dioxide(PaCO 2), alveolar-arterial oxygen partial pressure difference[P(A-a)O 2]and oxygenation index(OI)were recorded at T0(entering the operating room), T1, T3, T4, T5, T6, T8(after extubation)and T9(24h after operation). Arterial-end-tidal carbon dioxide partial pressure difference[P(a-et)CO 2]was recorded at T3, T4, T5 and T6. Results:DP in the P group was lower than in the T group at each time point( P<0.01). The P mean in the P group at each time point was higher than in the T group( P<0.01). EtCO 2 was higher in the P group than in the T group at T1( t=0.751, P<0.01)and T2( t=2.830, P<0.01). PaCO 2 was higher in the P group than in the T group at T1( t=1.435, P<0.01), T3( t=2.469, P<0.01)and T4( t=1.359, P<0.05). There were no statistic differences in P(A-a)O 2, OI and P(a-et)CO 2 between the two groups at any time point( P>0.05). Conclusions:Compared with the traditional ventilation strategy, the lung protective ventilation strategy has lower DP and higher P mean during laparoscopic radical prostatectomy, while it has no advantage in lung oxygenation.The lung protection ventilation strategy can be safely used in laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia.

Objective: To explore the effect of RW splints on the position and occlusal relationship of classⅡ malocclusion patients with temporomandibular disorder (TMD) to provide a basis for the diagnosis and design of this kind of patient. Methods : Fifteen patients with class Ⅱ malocclusions with TMD were enrolled in this study. After 8 months of RW-splint treatment, the changes in jaw position (∠ANB, SN-MP, ∠S-G0/N-Me) and occlusal relationship (molar, cuspid teeth displacement and anterior overbite/overjet value) were recorded by a condylar displacement measuring instrument at the CR position and CO position. Results: After RW-splint treatment, the mean values of ∠ANB (t=4.971, P=0.001) and ∠SN-MP (t=9.895, P ＜ 0.01) were increased in all 15 patients, and the mean value of S-G0/N-Me (t=5.342, P=0.005) was decreased. The mean values of the distal movement of the first molars on the left and right sides of the mandible were (1.57 ± 0.79) mm and (1.69 ± 1.29) mm, respectively; the mean values of the distal movement of the canines on the left and right sides of the mandible were (1.54 ± 0.50) mm and (1.51 ± 1.08) mm, respectively; and the mean values of the overbite were (1.16 ± 0.60) mm and (1.99 ± 0.85) mm, respectively. Conclusion After RW-splint treatment, the jaw rotates clockwise, and the relationship between the molars and canines changes obviously in class Ⅱ patients with TMD, which provides a reference for the diagnosis and treatment plan of this kind of patient.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.