Objective:To compare the differences of actual absorbed doses of liver malignant tumors after 90Y-selective internal radiation therapy (SIRT) evaluated by 90Y PET/CT and 90Y bremsstrahlung (BRS) SPECT/CT imaging, and to compare the image quality of the 2 imaging methods. Methods:Twenty-one patients (15 males and 6 females; age: (52.4±15.4) years) with liver malignant tumors (15 cases of primary liver cancer, 6 cases of liver metastases; 39 lesions) between September 2021 and August 2022 were retrospectively analyzed. All patients underwent both 90Y PET/CT imaging and 90Y BRS SPECT/CT imaging in the Department of Nuclear Medicine, Hainan Cancer Hospital. The ratios of the actual absorbed doses based on 90Y PET/CT imaging and 90Y BRS SPECT/CT imaging to the lowest standard absorbed dose(100 Gy) for tumor response were calculated. The image contrast and distinguishability of the two imaging methods were scored. Wilcoxon signed rank test and Wilcoxon rank sum test were used for data analysis. Results:The tumor absorbed doses evaluated by 90Y PET/CT and 90Y BRS SPECT/CT were 143.94(55.91, 233.48) Gy and 107.82(53.59, 157.53) Gy respectively. The doses evaluated by 90Y PET/CT were higher than the standard threshold in 24 lesions, while 19 lesions showed higher evaluated doses by 90Y BRS SPECT/CT than the standard threshold. Compared with 90Y PET/CT, 90Y BRS SPECT/CT underestimated the tumor absorbed dose of -24.25%(-32.32%, -12.14%). The ratio of dose evaluated by 90Y PET/CT to the lowest standard threshold was 1.33(0.56, 1.91), which was higher than that of dose evaluated by 90Y BRS SPECT/CT to the lowest standard threshold (0.97(0.47, 1.25); z=0.04, P<0.001). PET/CT image contrast was scored 0, 1, 2, 3 in 2, 2, 12, 23 lesions respectively, and SPECT/CT image contrast was scored 0, 1, 2, 3 in 2, 3, 16, 18 lesions respectively ( z=-1.29, P=0.199). The distinguishability scores of 0, 1, 2 based on PET/CT images were found in 3, 15, 21 lesions, while those based on SPECT/CT images were found in 4, 32, 3 lesions respectively ( z=-2.79, P=0.005). Conclusion:90Y PET/CT imaging is superior to 90Y BRS SPECT/CT imaging in radiation dose evaluation and tumor focus differentiation in patients with liver malignant tumors after 90Y-SIRT.

Regulated cell death (RCD), including apoptosis, pyroptosis, necroptosis, and ferroptosis, is regulated by a series of evolutionarily conserved pathways, and is required for development and tissue homeostasis. Based on previous genetic and biochemical explorations of cell death subroutines, the characteristics of each are generally considered distinctive. However, recent in-depth studies noted the presence of crosstalk between the different forms of RCD; hence, the concept of PANoptosis appeared. Cancer, a complex genetic disease, is characterized by stepwise deregulation of cell apoptosis and proliferation, with significant morbidity and mortality globally. At present, studies on the different RCD pathways, as well as the intricate relationships between different cell death subroutines, mainly focus on infectious diseases, and their roles in cancer remain unclear. As cancers are characterized by dysregulated cell death and inflammatory responses, most current treatment strategies aim to selectively induce cell death via different RCD pathways in cancer cells. In this review, we describe five types of RCD pathways in detail with respect to tumorigenesis and cancer progression. The potential value of some of these key effector molecules in tumor diagnosis and therapeutic response has also been raised. We then review and highlight recent progress in cancer treatment based on PANoptosis and ferroptosis induced by small-molecule compounds, immune checkpoint inhibitors, and nanoparticles. Together, these findings may provide meaningful evidence to fill in the gaps between cancer pathogenesis and RCD pathways to develop better cancer therapeutic strategies.

Objective:To investigate the implementation status of sepsis hour-1 bundle strategy for patients with septic shock in emergency department.Methods:A total of 116 septic shock patients admitted to the emergency department from January 2020 to December 2020 were included in this prospective study, and the implementation of sepsis bundles and the clinical outcomes of patients were recorded.Results:Among 116 patients, 20 cases (17.2%) had lactic acid monitored within 1 h, 20 cases (17.2%) had blood culture before antibiotics, 82 cases (70.1%) received broad-spectrum antibiotics, 16 cases (13.8%) received fluid resuscitation ≥30 ml/kg, and 57 cases (49.1%) received vasoactive drugs during resuscitation. Finally, the sepsis hour-1 bundle strategy was fully implemented only in 13 cases (11.2%). Compared with the group with incomplete implementation of sepsis hour-1 bundle strategy, the volume of fluid recovery in the group with full implementation was significantly increased [33.7 (30.0,37.5) vs. 8.9(7.3,10.8) ml/kg, Z=-4.78, P<0.001], mean artery blood pressure significantly increased [70.0 (70.0,76.7) vs. 67.7 (61.7,76.7)mmHg(1 mmHg=0.133 kPa) , Z=-2.00, P<0.001], and lactic acid significantly decreased [3.0 (2.0,3.2) vs. 4.4 (3.7,7.2) mmol/L, Z=-2.76, P=0.006]. However, there were no significant differences in ICU mortality, in-hospital mortality and 28-day mortality between the two groups ( P>0.05). Conclusions:Septic shock patients in emergency department have poor compliance with the implementation of sepsis hour-1 bundle strategy, and relevant management training should be strengthened.

Objective:Objectives To introduce the preliminary experience of flexible vacuum-assisted ureteral access sheath(FV-UAS) in the treatment of upper urinary calculi in retrograde intrarenal lithotripsy(RIRS).Methods:The clinical data of 11 patients with upper urinary calculi who were treated in Jiangxi Provincial People's Hospital from August to September 2021 were analyzed retrospectively. There were 6 males and 5 females, with the mean age of 48 years (32-72 years), the mean size of stone of 15.5 mm (11-20mm), and the mean stone volume of 1 958 mm3 (1 108-4 036 mm3), including 1 case with upper ureteral calculi, 10 cases with renal calculi, and 2 cases with calculi in multiple renal calyces. Ureteral stents were placed in 2 cases preoperatively. There were 2 cases of grade Ⅱ hydronephrosis according to Grignon classification. All patients were treated by retrograde intrarenal lithotripsy, and the FV-UAS(F12/14) was used during the operation. FV-UAS can be passively bent(>90°) with the bending of the flexible ureteroscopy(f-URS), and connect vacuum suction devices. The method of placing the FV-UAS during the operation was the same as traditional ureteral access sheath. The FV-UAS should be as close to the target stone as possible by the f-URS during the operation. F6 ureteral stent was routinely indwelled for 2-4 weeks. The operation time, postoperative complications, and stone volume clearance rate were summarized and analyzed, and stone volume clearance rate was calculated as(1-residual stone volume/preoperative stone volume)×100%. The stone volume was obtained by CT 3-D reconstruction preoperatively and first day postoperatively.Results:All patients underwent RIRS successfully at the first stage, with the usage of FV-UAS(F12/14)during the operation. The mean operation time was 57.1 minutes(34-90 minutes), and the mean stone volume clearance rate was 98.9%(94.8%-100.0%)on the first day postoperatively. Seven cases reached 100.0% stone-free rate, and 4 cases presented residual calculi. The mean hemoglobin drop was 0.8 g/L, and 1 case presented vomiting without fever on the first day postoperatively. For the 4 cases with residual calculi, no residual stone was found by B-ultrasound when the ureteral stent was removed.Conclusions:Our preliminary study found that it is feasible and safe to use FV-UAS in RIRS, which can follow the f-URS to extend into the renal pelvis and renal calyces. Vacuum-assist can increase the probability of stone-free.

Objective:The characteristics of women with false elevated testosterone were analyze and the literature was reviewed to provide reference for clinical laboratory identification of false elevated testosterone.Methods:The characteristics of three patients with false elevated testosterone in Peking Union Medical College Hospital were analyzed retrospectively, and the results of different detection platforms and methods for the determination of testosterone levels were compared. International and domestic literatures related to false elevation of testosterone and detection methods of testosterone were searched for a comprehensive analysis from PUBMED and CNKI.Results:The levels of testosterone in 3 female patients were elevated by immunoassay and normal by mass spectrometry. They were excluded from the diagnosis of hyperandrogenemia. A total of 38 literatures related to testosterone detection were retrieved, of which 9 case reports of pseudohyperandrogenemia, among which 12 cases of pseudohyperandrogenemia were reported in 2 domestic literatures in 2021. All cases were confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Previous studies have clearly indicated that the result of routine immunoassay in clinical laboratory for the determination of female testosterone have poor correlation with the results of LC-MS/MS, with varying degrees of deviation.Conclusions:Immunoassay tests for female testosterone is susceptible to interference and lead to elevated false results. It is suggested that clinical laboratories evaluate the detection methods used and establish a identification program, and confirm samples with suspected pseudoelevated testosterone elevation using other immune platforms or LC-MS/MS.

Objective:To investigate the current situation of occupational hazards in automobile manufacturing enterprises in Shandong Province.Methods:From February to May 2019, the convenience sampling method was adopted to conduct on-site occupational health surveys with 20 automobile manufacturing enterprises in Shandong Province as the survey subjects, to detect the occupational hazard factors in the workplaces and individual exposure levels, and to analyze the occupational health check results of operators.Results:There were 13 small-sized, 4 medium-sized and 3 large-sized enterprises among the 20 automobile manufacturing enterprises. The detection results of benzene and toluene in the workplaces met the occupational exposure limits, and the detection results of welding fumes, manganese and its compounds, and xylene exceed the occupational exposure limits. The maximum short-term exposure concentration ( CSTE) of welding fume in the air of workplaces was 24.23 mg/m 3, and the over-standard rate was 11.0% (16/146) . The maximum time-weighted average concentration ( CTWA) of welding fume of operators is 10.60 mg/m 3, and the over-standard rate was 11.0% (8/73) . The maximum CSTE of manganese and its compounds in the air of workplaces was 0.879 mg/m 3, and the of manganese and its compounds of operators was 0.175 mg/m 3, and the over-standard rate was 5.7% (4/70) . The maximum xylene CSTE in the air of workplaces was 230.00 mg/m 3, and the over-standard rate was 3.9% (2/51) . The maximum xylene CTWA of operators was 70.40 mg/m 3, the over-standard rate was 3.6% (1/28) . Among the 4775 workers exposed to occupational hazards, 38 (0.80%) were suspected of electric welder's pneumoconiosis, 27 (0.57%) were suspected of manganese poisoning and 31 (0.65%) were suspected of chronic low-concentration benzene and benzene series poisoning. The detection rates of suspected occupational diseases among workers in small and medium-sized enterprises were relatively high, 2.86% (30/1048) and 4.51% (51/1132) respectively. There was a statistically significant difference in the detection rates of suspected occupational diseases among the operators of different scale automobile manufacturers ( P<0.05) . Conclusion:The exposure levels of electric welding fumes, manganese and its compounds in welding jobs and xylene exposure levels in spray painting jobsin Shandong Province's automobile manufacturing enterprises are more serious. The supervision and management of occupational hygiene should be strengthened, the working environment should be improved, and the health of welding and painting workers should be protected.

Objectives:To investigate the diagnostic value of whole blood quantitative PCR for DNA load of Epstein-Barr virus (EBV) in post-transplant lymphoproliferative disease (PTLD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) .Methods:A total of 694 patients with hematologic diseases who underwent allo-HSCT at the Hematology Department of Peking University First Hospital from April 2004 to April 2019 were included, and their data were retrospectively analyzed.Results:①Among the 694 cases, 29 cases (22 males and 7 females, with a median age of 22 (1-52) years) developed PTLD after allo-HSCT with a cumulative incidence of 4.2% and a median onset time of 2.1 (0.8-20.6) months. ② Univariate analysis showed that age<30 years, diagnosis with aplastic anemia, human leukocyte antigen (HLA) mismatch, use of antithymocyte globulin (ATG) in preconditioning regimens, and EBV reactivation were the risk factors for the occurrence of PTLD. Multivariate analysis showed that EBV reactivation was an independent risk factor for the occurrence of PTLD. ③Further analysis of EBV reactivation cases showed that the peak value of EBV-DNA load was significantly higher in the PTLD group than that in the non-PTLD group ( P<0.001) and the incidence of PTLD increased with the increase of EBV-DNA load. Receiver operating characteristic (ROC) curve analysis indicated that PTLD was more likely to be diagnosed when the EBV-DNA load was >1.19×10 6 copies/ml (sensitivity 0.800 and specificity 0.768) . ④All patients with PTLD received rituximab-based treatment, with an overall response rate of 86.2% and an overall survival rate of 54.3%. Conclusion:The PTLD occurrence after allo-HSCT is highly correlated with EBV reactivation, and the higher the EBV-DNA load, the greater the risk of PTLD occurrence. The dynamic monitoring of EBV-DNA load plays an important role in predicting PTLD occurrence.

Objective:To investigate the current situation of occupational hazards in automobile manufacturing enterprises in Shandong Province.Methods:From February to May 2019, the convenience sampling method was adopted to conduct on-site occupational health surveys with 20 automobile manufacturing enterprises in Shandong Province as the survey subjects, to detect the occupational hazard factors in the workplaces and individual exposure levels, and to analyze the occupational health check results of operators.Results:There were 13 small-sized, 4 medium-sized and 3 large-sized enterprises among the 20 automobile manufacturing enterprises. The detection results of benzene and toluene in the workplaces met the occupational exposure limits, and the detection results of welding fumes, manganese and its compounds, and xylene exceed the occupational exposure limits. The maximum short-term exposure concentration ( CSTE) of welding fume in the air of workplaces was 24.23 mg/m 3, and the over-standard rate was 11.0% (16/146) . The maximum time-weighted average concentration ( CTWA) of welding fume of operators is 10.60 mg/m 3, and the over-standard rate was 11.0% (8/73) . The maximum CSTE of manganese and its compounds in the air of workplaces was 0.879 mg/m 3, and the of manganese and its compounds of operators was 0.175 mg/m 3, and the over-standard rate was 5.7% (4/70) . The maximum xylene CSTE in the air of workplaces was 230.00 mg/m 3, and the over-standard rate was 3.9% (2/51) . The maximum xylene CTWA of operators was 70.40 mg/m 3, the over-standard rate was 3.6% (1/28) . Among the 4775 workers exposed to occupational hazards, 38 (0.80%) were suspected of electric welder's pneumoconiosis, 27 (0.57%) were suspected of manganese poisoning and 31 (0.65%) were suspected of chronic low-concentration benzene and benzene series poisoning. The detection rates of suspected occupational diseases among workers in small and medium-sized enterprises were relatively high, 2.86% (30/1048) and 4.51% (51/1132) respectively. There was a statistically significant difference in the detection rates of suspected occupational diseases among the operators of different scale automobile manufacturers ( P<0.05) . Conclusion:The exposure levels of electric welding fumes, manganese and its compounds in welding jobs and xylene exposure levels in spray painting jobsin Shandong Province's automobile manufacturing enterprises are more serious. The supervision and management of occupational hygiene should be strengthened, the working environment should be improved, and the health of welding and painting workers should be protected.

Objective To compare the value of ultrasound-guided fine-needle aspiration (FNA) and core needle biopsy (CNB) in diagnosing benign and malignant cervical lymph nodes.Methods A retrospective analysis was performed on 88 patients who received biopsy for cervical lymph node enlargement from January 2015 to May 2017.FNA (n =39) or CNB (n =49) were performed respectively to compare the sensitivity,specificity and accuracy of the two methods in diagnosing benign and malignant cervical lymph node enlargement.Results 84.6％ (33/39) of FNA cases were successfully collected,and 98％ (48/49) of FNA cases were successfully collected for definite pathological diagnosis (P =0.000).The sensitivity,specificity and accuracy of FNA and CNB in diagnosing malignant cervical lymph nodes were 90.9％ and 97.2％,94.1％ and 100％,92.3％ and 98％,respectively.Compared with FNA,there were statistically significant differences in sensitivity,specificity and accuracy in differentiating benign and malignant lymphatic lesions in cervical enlargement (P ＜0.01).The sensitivity and specificity of FNA and CNB in diagnosing cervical lymph node metastatic carcinoma were 100％ and 100％,95.2％ and 100％.Compared with FNA,there was no statistically significant difference in the sensitivity to the diagnosis of cervical lymph node metastatic carcinoma (P =0.102).Conclusions CNB is superior to FNA in sensitivity,specificity and accuracy in diagnosing cervical lymphadenopathy.However,when metastatic cancer was diagnosed,FNA was not significantly different from CNB in sensitivity (P =0.102),and FNA was recommended as the first choice.

Objective To evaluate the effect of case-PBL method and case-PBL method combined with SPSS software on the teaching of medical statistics for medical undergraduates. Methods Students from two classes major in experimental medicine from Nantong University Xingling College were selected as Experimental Class 1 ( using case-PBL teaching ) and Experimental Class 2 ( using case-PBL teaching combined with SPSS software). Each class attended lessons for five times. The teachers would send cases for each lesson one week in advance, and students would form into groups to access information, learn and discuss independently. Representatives from groups spoke in class, members would complement and discuss, while teachers offered guidance, review, analysis and summary. We shortened the discussion time in the class, and added instructions on the operation steps of SPSS software for case analysis and how to interpret the analysis result correctly in Experiment Class 2 . The Control Class received traditional teaching . Questionnaires, process assessment and final assessment were used to evaluate teaching effectiveness. SPSS 21.0 software was used to implement variance analysis and chi-square test for comparison between groups. Results The scores of the two experimental classes were higher than those of the control class in the five process assessments ( P<0 . 05 ) . Experimental Class 2 was the best in three section process assessments including those of t-test, the rank sum test and the straight-line correlation (P<0.05). However, there was no difference in the theoretical test scores among the three classes (P=0.670). 94％-100％of the students in the two experimental classes believed that the teaching effects of the case-PBL method and case-PBL method combined with SPSS software were better than the traditional teaching method (P<0.05) in such areas as stimulating interest in learning, improving learning efficiency, etc. Students in Experimental Class 2 were more prone to think these methods improved teaching effect. Conclusion The case-PBL teaching combined with the application of SPSS software will further help students to systematically grasp the statistical knowledge and cultivate statistical practice ability . However , neither methods will improve students' theoretical test scores.