AIM: To analyze the correlation between ocular surface status and serum lipids in patients with meibomian gland dysfunction(MGD)during pregnancy, and to provide new ideas for the management and treatment of MGD during pregnancy.METHODS: Totally 120 pregnant women(240 eyes)treated in our hospital from May 2021 to May 2022 were selected and they were divided into MGD group(60 cases, 120 eyes)and control group(60 cases, 120 eyes)according to the presence or absence of MGD. All subjects received the ocular surface disease index scores(OSDI)and underwent examinations of meibomian gland morphology and function, tear film and blood lipid.RESULTS: The scores of OSDI, the related indexes of meibomian gland, corneal fluorescein staining(FL)scores, total cholesterol(TC), triglyceride(TG)and low density lipoprotein-cholesterol(LDL-C)in the MGD group were significantly higher than those in the control group(P<0.05). The scores of fluorescein breakup time(FBUT), Schirmer Ⅰ test(SIt)and high-density lipoprotein cholesterol(HDL-C)in the MGD group were significantly lower than those in the control group(P<0.05). Correlation analysis showed that the scores of TG, TC, LDL-C were negatively correlated with the values of FBUT(rs =-0.702, -0.647, -0.710, all P<0.001).CONCLUSION: The level of blood lipids in pregnant patients with MGD is significantly increased, and the levels of TC, TG and LDL-C may be related to the stability of tear film.

Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Objective:To translate the perceived stressors in intensive care units Scale into Chinese version,and to validate its validity and reliability and in intensive healthcare professionals.Methods:The Perceived Stressors in Intensive Care Units Scale was translated according to the Brislin translation model.After cultural adjustment,495 ICU healthcare professionals were selected to evaluate the validity and reliability of the scale,and univariate analysis was conducted on the scores of the Scale with different characteristics.Results:The Chinese version of the scale re-tained 40 items,and 6 common factors were extracted after exploratory factor analysis.The cumulative variance contribution rate reached 58.21％.Confirmatory factor analysis showed a basic fit of the model(x2/df=2.85,CFI=0.93,TLI=0.93,RMSEA=0.09).The total Cronbach coefficient of the scale was 0.940 and the split-half relia-bility was 0.87.The retest reliability after 2 weeks was 0.92.The item-level content validity index of the Chinese version of The Perceived Stressors in Intensive Care Units Scale was 0.83～1.00,the scale-level content validity index was 0.93,and the average content validity was 0.98.Comparison of the total scores of scale among ICU healthcare professionals with different occupations,professional titles,marital status and working years showed sta-tistically significant differences(P＜0.05).Conclusion:The Chinese version of the Perceived Stressors in Intensive Care Units Scale is proved to be a good instrument with acceptable validity and reliability.

Objective:To investigate the changes in liver injury and oxidative-antioxidant level in mice exposed to X-rays at varying doses.Methods:Fifty-four 8-week-old male C57BL/6J mice were divided into three groups, namely the control, 2 Gy irradiation, and 4 Gy irradiation groups. Then, each of the groups was further divided by days post-irradiation (i.e., 1, 3, and 7 d), and so nine sub-groups ( n = 6). After irradiation was performed as planned, all the mice were dissected and weighed, and their liver indexes were calculated to determine any histopathological changes in the liver. The peripheral blood cell count and the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were detected. Furthermore, spectrophotometry was also used to determine the superoxide dismutase (SOD) activity, the malondialdehyde (MDA) concentration, and the reduced glutathione (GSH) concentration in liver tissues. Results:Compared to the control group, mice undergoing irradiation exhibited a significant reduction in body weight ( F = 84.03, 27.11, 25.50, P < 0.001), but significantly increased liver indexes ( F = 28.40, 17.75, P <0.001) at 1, 3, and 7 d post-irradiation. Pathological observations of these mice revealed liver injury, which proved related to dose and time course. The counts of leukocytes, neutrophils, and lymphocytes in peripheral blood decreased significantly ( F = 8.42-22.91, P < 0.05), trending downward with an increase in the radiation dose. For mice in the 4 Gy irradiation group, their AST and ALT levels increased significantly at 1 d post-irradiation ( H = 7.24, 7.82, P < 0.05), and their ALP levels rose notably at 1 and 3 d post-irradiation ( F = 11.86, 9.75, P < 0.05). Furthermore, their MDA and SOD levels initially rose and then dropped but their GSH levels exhibited an opposite trend at 1, 3, and 7 d post-irradiation. There was a positive correlation between their MDA levels in the liver and the degree of damage to histopathological lesions at 1, 3, and 7 d post-irradiation ( r = 0.30, P < 0.001). Conclusions:A model for radiation-induced liver injury of mice was preliminarily established in this study. It can be concluded that X-rays at varying doses affect the severity of liver injury, pathological grade, peripheral blood cell count, liver function index, and liver oxidative and antioxidant levels of mice, presenting a certain relationship between dose and time course effects.

Sedentary bad habits and unhealthy diets in modern lifestyles have led to an upward trend in the incidence of obesity, and a series of diseases related to obesity have also gradually received attention. Multiple sclerosis is a chronic inflammatory disease of the central nervous system, and obesity has a common inflammatory component with most chronic diseases. Therefore, this paper reviews the research progress on the relationship between obesity and multiple sclerosis in order to better understand the role of obesity in the management of multiple sclerosis.

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO₂, NO₂, CO, PM_2.5, PM₁₀, and maximum 8 h O₃ concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM_2.5, NO₂, SO₂, and O₃ were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM_2.5, NO₂, SO₂ and O₃ were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Background The thyroid gland is one of the organs sensitive to ionizing radiation, and there are few studies on the effects of long-term exposure to low doses of ionizing radiation on the thyroid gland of radiation workers. Objective To investigate thyroid abnormalities in workers in medical radiology departments in Guangdong Province and to identify potential influencing factors of thyroid abnormalities. Methods A total of 1657 radiation workers from 48 hospitals in Guangdong Province were selected as survey subjects using convenience sampling, and their personal dose monitoring results and health examination information were retrospectively analyzed to determine the factors affecting thyroid abnormalities. Results The M (P₂₅, P₇₅) of thyroid absorbed dose (D_T) was 1.55 (0.65, 3.96) mGy in the 1657 investigated workers. The attribute-specific medians of D_T were 1.29, 1.38, 1.99, and 3.51 mGy for departments of diagnostic radiology, interventional radiology, radiotherapy, and nuclear medicine, respectively; and 1.10, 1.55, and 1.80 mGy for job titles of nurse, technician, and physician, respectively. Differences in D_T by gender, age, years of radiological work, age of radiation exposure onset, occupational category, and job title were statistically significant (Z=−6.35, H=708.52, 918.20, 31.19, 95.64, 39.28, P<0.05). The positive rate of thyroid abnormalities in investigated workers was 46.53% (771/1657). Among them, the positive rate of abnormal thyroid function was 22.87% (379/1657), that of abnormal thyroid morphology was 33.98% (563/1657), and that of thyroid nodule was 26.55% (440/1657). The differences in thyroid abnormality rates by gender, age, years of radiation work, age of radiation exposure onset, D_T, and job title of radiation workers were statistically significant (χ²=51.89, 49.64, 20.54, 18.29, 12.07, 16.16, P<0.05). The differences in abnormal thyroid function positive rate by gender, age of radiation exposure onset, and job title were statistically significant (χ²=26.21, 6.21, 8.32, P<0.05). The differences in the positive rates of abnormal thyroid morphology and nodules were statistically significant by gender, age, years of radiological work, age of radiation exposure onset, D_T, and job title (abnormal thyroid morphology, χ²=40.24, 64.17, 37.63, 15.17, 19.28, 15.05; nodules, χ²=31.41, 77.98, 42.11, 19.16, 21.70, 13.52, P<0.05). The positive rates of thyroid abnormality, thyroid morphology abnormality, and nodules all showed a linear increasing trend with increasing age, years of radiation work, and age of radiation exposure onset (P<0.05). The results of logistic regression analysis indicated that the factors influencing thyroid abnormalities were female (OR=2.17, 95%CI: 1.72-2.74), increased years of radiological work (OR=1.04, 95%CI: 1.03-1.06), onset of radiation exposure in age groups of 30-34 and ≥35 years (OR=1.63, 95%CI: 1.12-2.37; OR=2.58, 95%CI: 1.74-3.29), and working in department of diagnostic radiology (OR=1.40, 95%CI: 1.07-1.84). Conclusion Long-term exposure to low doses of ionizing radiation has an effect on thyroid abnormalities in medical radiation workers. Among them, being female, physicians, and working in department of diagnostic radiology are at a higher risk of abnormal thyroid function; being female, increased years of radiation work, and radiation exposure onset at age ≥30 years are associated with a higher risk of reporting abnormal thyroid morphology.

Multiple sclerosis (MS) is an idiopathic inflammatory demyelinating diseases of the central nervous system, the underlying cause of which has not been cleared. Previous studies have shown that the pathogenesis of MS is related to the destruction of blood brain barrier, furthermore the drugs used to treat MS have a certain protective effect on the function of blood brain barrier. Therefore, this review combines the research progress at home and abroad to clarify the relationship between the blood brain barrier and MS in pathogenesis and treatment, proposing possible orientation of development.

Breast cancer is a systemic malignant tumor caused by multiple pathogenic factors， and its pathological mechanism is complex and has not been clarified so far. It has gradually become the largest killer threatening women's life. The common method for the treatment of breast cancer is lesion resection combined with radiation and chemical therapy， endocrine therapy， or targeted therapy. However， due to the limitations of western medicine therapies， there are still considerable breast cancer patients with poor disease control and high tumor recurrence rate in clinical practice. At the same time， the side effects and complications produced by these therapies affect the quality of life of patients. Therefore， it is urgent to develop new drugs or find safe and effective alternative therapies against breast cancer. Volatile oil （VO）， as a unique volatile component of Chinese herbal medicines， has anti-inflammatory， antiviral， and anti-tumor activities. It has been applied in the treatment of breast cancer and has demonstrated good efficacy by exerting the unique effects of strengthening healthy Qi， eliminating pathogenic factors， moving Qi， resolving stasis， warming Yang， soothing liver， and relieving depression. The recent studies have confirmed that VO and its chemical components can prevent and treat breast cancer via multiple mechanisms， while there is a lack of systematic review. The relevant literature published in recent years has demonstrated that VO can inhibit the occurrence and development of breast cancer by regulating the level of estrogen， inhibiting the proliferation and inducing the apoptosis of cancer cells， enhancing immunity， resisting inflammation， and regulating emotions. We introduced the pathogenesis of breast cancer， as well as the mechanisms and advantages of VO in the prevention and treatment of breast cancer， aiming to provide new ideas for the research on VO in the treatment of breast cancer.

Objective:To evaluate the difference of dosimetry between three-dimensional and two-dimensional plans based on CT images of occult perforation in brachytherapy of cervical cancer, aiming to provide clinical reference.Methods:A total of 817 patients with cervical cancer received simple intrauterine (intrauterine tandem plus vaginal colpostats) three-dimensional brachytherapy in Chongqing University Cancer Hospital from January 2019 to December 2020 were retrospectively reviewed. Among them, 16 patients had occul uterine perforation. Based on Oncentra Brachy Therapy plan system, the single prescription dose was 6Gy. Three-dimensional (3D group) and two-dimensional (2D group) plans were designed on the perforated CT images The target volume, conformal index (CI), conformal index coformity index (COIN) and organs-at-risk (OAR) D 2cm 3 parameters were used to assess the plans between two groups. Results:The incidence of pccult uterine perforation was 1.96%(16/817) during brachytherapy for cervical cancer. The volume of prescription dose curve in the 3D group was (40.74±14.98) cm 3, significantly smaller compared with (91.46±19.71) cm 3 in the 2D group ( P<0.05), whereas the volume of the high-risk clinical target area wrapped by prescription dose curve did not significantly differ between two groups ( P>0.05). The CI and COIN in the 3D group were 0.79±0.10 and 0.72±0.96, significantly higher compared with 0.38±0.09 and 0.37±0.18 in the 2D group (both P<0.05). The D 2cm 3 of bladder, rectum, sigmoid colon, small intestine in the 3D group were (306.06±77.57) cGy, (252.27±72.60) cGy, (127.25±62.84) cGy and (228.79±94.90) cGy, significantly lower than (548.03±164.21) cGy, (411.16±118.74) cGy, (227.45±94.48) cGy and (450.95±157.96) cGy in the 2D group (all P<0.05). Conclusions:Application of image guidance in brachytherapy of cervical cancer is helpful to detect occult uterine perforation. When occult uterine perforation occurs, the use of three-dimensional plan can basically meet the clinical needs, which is significantly better than the two-dimensional plan.