Objective To investigate and analyze the current situation of radiation protection in non-medical radiation institutions in Nantong, China, 2023, and to provide data support for local health supervision departments to formulate more scientific and reasonable occupational health management measures. Methods Based on the radiation health information management platform of Jiangsu Province, the data reported in 2023 were collected through online questionnaire survey. Seven institutions were selected for on-site test. The survey and test data were analyzed. Results There were 1277 radiation workers in 178 institutions. The rate of individual dose monitoring was 87.31%, the rate of radiation protection training was 88.65%, and the rate of occupational health examination was 89.81%. There were significant differences in the indicators among different counties (cities and districts) (P < 0.001). The detection rate of institutions with serious occupational hazards was 92.11%, and the status evaluation rate was 85.52%. The detection rate of institutions with moderate occupational hazards was 86.27%. The installation rates of X/γ radiation protection detector and personal dose alarm instrument were 82.02% and 89.32%, respectively. The installation rates were significantly higher in high-radiation workplaces such as those with gamma irradiation devices (P = 0.004, P = 0.001). The qualified rate of 74 tested pieces of equipment was 100%. Conclusion All indicators of occupational health management in non-medical radiation institutions in Nantong are lower than the average levels of Jiangsu Province. The detection and reporting rates of radiation occupational disease hazard factors still fall short of the targets set in the national “14th Five-Year Plan” for occupational disease prevention. This indicates deficiencies in the construction of local occupational health management system and implementation of related regulations. It is suggested that the health authorities should take corresponding measures according to local conditions.

Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies.Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing'an District,Shanghai.semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate.Data were analyzed via Braun's style of thematic analysis.Results 4 themes and 10 sub-themes were identified.Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty).Theme 2:supportive environment dilemmas(lack of information support delays decision-making;lack of family support increases decision-making stress;insufficient economic support increases the burden of decision-making).Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity).Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences).Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas.Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.

Objective:To explore the journey map of patients with chronic constipation during fecal microbiota transplantation.Methods:This study adopted phenomenological methods. From October to December 2023, purposive sampling was used to select chronic constipation follow-up patients who underwent fecal microbiota transplantation at the Intestinal Microecology Center of Shanghai Tenth People's Hospital as respondents for semi-structured interviews. Colaizzi 7-step analysis method and NVivo 11.0 software were used for data analysis.Results:A total of 15 interviewees were interviewed. During fecal microbiota transplantation, the journey map of constipation patients included stages, mood changes, touchpoints, themes, emotional experiences and opportunities. The patient's experience and needs were summarized into three themes and ten sub-themes, including pre-transplant adaptation disorders to new environments (unfamiliarity and confusion-admission coordination disorders, anxiety and expectations-diverse complex emotions, puzzle and helplessness-asymmetric doctor and patient information), effectiveness-related psychological and social experiences in transplantation (attention and expectations-longing for positive efficacy, perception of benefits and risk avoidance, shame and inferiority-treatment stigmatization experience, questioning and despair-unrealized expectations, treatment resistance-sensitive economic burden), post-transplant transition dilemmas (inaccessible medical services-lack of continuous treatment and nursing, disease recurrence troubles) .Conclusions:This study visualizes the experiences and needs of constipation patients during microbiota transplantation through a patient journey map and identifies multidimensional issues and needs of patients. Clinical medical and nursing staff should pay attention to the needs of patients at different stages of the treatment process when formulating intervention programs to improve the quality of fecal microbiota transplantation nursing.

Objective:To evaluate the efficacy and safety of anti-programmed cell death 1 (PD-1) receptor monoclonal antibody (MoAb) in patients with advanced hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE) combined with tyrosine kinase inhibitor (TKI).Methods:From February 2019 to February 2020, 56 HCC patients who relapsed after TACE-TKI treatment in Department of Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University were enrolled. All patients received anti-PD-1 MoAb (sintilimab injection) and followed up every 6 weeks. According to mRECIST, the curative effect was evaluated as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). Objective response rate (ORR) and disease control rate (DCR), progression-free survival (PFS) and treatment-related adverse events (TRAEs) were recorded. Univariate analysis by Chi-square test and binary logistic regression model was used to determine the influencing factors of DCR. The Kaplan-Meier method and Cox proportional hazard regression model were used to analyze the survival data.Results:A total of 48 patients were enrolled in this study including 42 males and 6 females, with a median age of 55 years (29-71 years). ECOG scores comprised of 0 in 24 cases, 1-2 in 24 cases. Thirty-six patients were in Child-Pugh grade A of liver function and 12 cases were grade B. The median follow-up time was 4.5 months. There were 2 patients achieved CR, 12 patients with PR and 16 with SD. ORR was 29.2%, DCR was 62.5%. The independent influencing factors of DCR was ECOG score and AFP level ( P=0.031, P=0.012). Median PFS was 4.1 months (95% CI 2.7-5.4 months), and ECOG score was the independent influencing factor of PFS ( P=0.042). Treatment-related adverse events were reported in 70.8% (34/48) patients. Incidence of grade Ⅲ-Ⅳ TRAEs was 22.9% (11/48). Conclusion:In patients with HCC who relapse from TACE and TKI treatment, anti-PD-1 monoclonal antibody is efficacious safe especially in those with ECOG 0 score.

Objective:To evaluate the performance of two-dimensional fundamental sonosalpingography combined with saline infusion pelvic sonosalpingography(abbreviated as "2DFS+ SIPS" in this article) for assessing fimbrial part′s morphology and function of fallopian tubes.Methods:A total of 246 infertile women were collected from Zhejiang Provincial People′s Hospital from May 2018 to December 2019. They underwent dynamic three-dimensional harmonic sonosalpingography(abbreviated as "4DHS" in this article) first. Cases which were diagnosed as bilaterally tubal obstruction would be excluded. 2DFS+ SIPS was performed in 230 patients. Among them, 21 underwent laparoscopy and dye test(LDT) within 6 months and the results were regarded as golden standard.Results:①Tubes which were diagnosed as complete obstruction would be excluded. The total display rate of remaining fimbrial parts by using 2DFS+ SIPS and 4DHS were 77.4% and 24.0% respectively, which had statistically difference( P<0.001). ②According to 2DFS+ SIPS, fimbrial parts were classified into 3 types: normal, suspected abnormal and abnormal.Normal fimbrial parts accounted for 86.4% while suspected abnormal ones accounted for 13.6% under the condition of patency; abnormal fimbrial parts accounted for 81.2% while suspected abnormal ones accounted for 18.8% under the condition of partial obstruction. The difference in the proportion of normal and abnormal fimbrial parts according to different tubal patency was statistically significant( P<0.001). ③Fimbrial parts were classified into normal (normal fimbrial parts) and abnormal (suspected abnormal and abnormal fimbrial parts) further according to 2DFS+ SIPS, the results were compared with LDT. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Youden′s index were 92.0%, 100%, 88.2%, 80.0%, 100%, 0.88, respectively. The consistency analysis showed the results of 2DFS+ SIPS and LDT were highly consistent (Kappa=0.828). ④All the side effects occured during the procedure or within 30 minutes after the procedure were self-limited.No serious complications were observed. Conclusions:2DFS+ SIPS is a preferred method for assessment of fimbrial part′s morphology and function, with its advantages of non-invasiveness, intuition, and accuracy. This combination could provide objective imaging basis for choosing clinical treatment strategies and predicting prognosis.

Traumatic brain injury (TBI) is a central nervous system disease with increasing incidence,morbidity and mortality worldwide.TBI can affect the integrity of neuron,causing neuronal axons damage or death of neurons,which results in serious sequelae.After TBI,astrocytes (AST) in the cerebral cortex will be activated into reactive astrocytes (RAS).RAS in the early stage of TBI has a certain repair effect on the injury.However,RAS will proliferate to form glial scars,which has adverse effects on nerve function repair after injury.Therefore,controlling the status of RAS is the key to the treatment of TBI.In recent years,it has been proved that RAS can be transdifferentiated into neurons by transdifferentiation technology,which can not only remove glial scars,but also integrate with the microenvironment at the injury site to replace the injured neurons,which is of great significance for the repair of nerve function after TBI.This article reviews the types of transdifferentiation and the different pathways of RAS transdifferentiation into neurons,aiming to have a better understanding of the research progress of RAS transdifferentiation into neurons to repair TBI.

Objective To investigate the correlations between the FBN1 gene mutation types and the clinical phenotype . Methods 87 probands with Marfan or Marfan-like syndromes and their family members were enrolled in this study ( total 300 cases).The clinical manifestations of each patients involving the ocular, cardiovascular system, skeletal system and other im-plicated systems were collected and evaluated .According to the clinical manifestations , these patients were divided into two groups, namely aortic dissection group and aortic root aneurysm group.Blood samples were taken from patients and DNA se-quencing was performed on each patient by the genetic aortic disease gene Panel .The detected single nucleotide variants ( SNVs)/indel were interpreted according to the ACMG guidelines, and the pathogenic variation was confirmed through Sanger sequencing.The aortic wall tissue was obtained from MFS patients who underwent surgery .The correlations between genotypes and clinical phenotypes were further explored by comparing the aortic wall tissue histological specimens of each genotype pa-tient.Results A total of 92 FBN1 mutations(31％) were detected in 300 people with Marfan syndromes or Marfan-like syn-dromes, 18 of which were undiscovered mutations.There were 49 missense mutations(53.26％), 13 splicing mutations (14.13％), 17 frameshift mutations(18.48％), and 13 nonsense mutations(14.13％).In this cohort, 24 cases had aortic dissection and 25 cases were aortic root aneurysm.Statistical analysis revealed that patients with aortic dissection mostly ap-peared in frameshift mutations(29.17％ vs.4.00％, P =0.017).However, patients with aortic root aneurysm mostly ap-peared in missense mutations(72.00％ vs.37.50％, P =0.015), and accompanied with ectopia lentis(41.67％ vs. 8.33％, P=0.008).Pathological specimens staining found that elastic fibers in the aortic wall of patients with frameshift mu-tations are sparser, and the smooth muscle cells are more deficient and more disorganized than patients with missense muta-tions.Conclusion FBN1 gene frameshift mutations result a lack of elastic fibers and disorganized smooth muscle cells in aor-tic wall and are presented more in patients with aortic dissection than aortic root aneurysm .

Objective To evaluate the clinical outcomes and prognosis of older human immunodeficiency virus (HIV )-infected patients under antiretroviral therapy (ART ) in China .Methods This study was carried out in a retrospective cohort of HIV-infected patients initiated ART between January 2004 and December 2012 at The First Affiliated Hospital ,China Medical University .The patients were enrolled and divided into two groups ,including <50 years group (young and middle-aged group) and≥50 years group (older group) .Immunological and virological responses and mortality were analyzed . Data were analyzed by t test ,chi-square test ,two-way analysis of variance and log-rank test .Results Totally 291 subjects were included ,among whom 97 subjects were older patients and 194 subjects were young and middle-aged patients .Male was predominate in both groups ,which accounted for 91 .8％ and 87 .6％ ,respectively .The CD4+ T lymphocyte count in the older group before treatment was (151 .9 ±96 .2) cells /μL ,which was significantly lower than that in the young and middle-aged group (183 .4 ± 93 . 5) cells/μL (t= 2 .657 , P=0 .009) .At month 12 of treatment ,the CD4+ T lymphocyte count in the older group was significantly lower than that in the young and middle-aged groups (t= 2 .120 , P=0 .035) ,while there was no statistically significant difference between the two groups at month 24 (t=1 .025 ,P=0 .299) .The percentage of CD4+ T lymphocyte count increasing to 500 cells/μL in the older and youth groups during follow-up were 11 .3％ and 16 .0％ ,respectively (χ2=1 .127 ,P =0 .376) .Log-rank analysis showed that the mean times of virus inhibition in older group and young and middle-aged group were 7 .9 (95％ CI:6 .8-8 .5) and 7 .6 (95％ CI:6 .5 -9 .3) ,respectively ,with no statistically significant difference (χ2 =0 .002 , P=0 .961) .Virological failure was reported in 4 patients (4 .1％ ) in older group and 11 patients (5 .7％ ) in young and middle-aged group . Chi-square test showed no statistically significant difference between the two groups (χ2 = 0 .15 , P= 0 .78) .During follow-up , 19 .6％ (19/97) in older group and 3 .6％ (7/194) in young and middle-aged group died .The former was significantly higher than the latter (χ2 = 21 .113 , P< 0 .01 ) .Conclusions Older patients show a poor immunologic response ,similar viral suppression and higher risk of mortality compared with young and middle-aged patients . Future research should be aimed at the feasible and specific strategy for early diagnosis and timely treatment for older patients to improve treatment efficacy and reduce mortality .

Objective To further investigate the accuracy of the real-time three-dimensional echocardiography(RT-3DE) in evaluating right ventricular(RV) systolic function.Methods RT-3DE,MRI and SPECT were used to study a total 30 patients including 10 with coronary artery disease,7 with hypertension,5 with cardiomyopathy,5 with atrial septal defect,and 3 with pulmonary hypertension.The RV end-diastolic volume(RVEDV),RV end-systolic volume(RVESV),RV stroke volume(RVSV) and RV ejection fraction(RVEF) were measured.The correlation and the difference between different modalities were compared.Results RT-3DE had a good correlation with MRI in RVEDV,RVESV,RVSV and RVEF (rEDV =0.811,rESV =0.837,rSV =0.818,and rEF =0.701).Also RT-3DE had a correlation with SPECT in RVEDV,RVESV,and RVSV(rEDV =0.526,rESV =0.493,rSV =0.514),but there was no correlation between RT-3DE and SPECT in RVEF (rEF =0.235).Conclusions RT-3DE can assess RV systolic function accurately.

Objective To study the alternations of regulatory T cells in early HIV infected patients and its association with disease progression.Methods Fifty-one untreated HIV infected patients were enrolled and divided into 3 groups according to their infection time and CD+4 T cell levels(30 early HIV infected patients,15 typical progressors,6 AIDS patients).Twenty normal controls were enrolled.There were no significant differences between the age and sex among four groups.Blood was drawn by venipuncture from each subject in EDTA tubes and the levels of CD+4 CD+25 Foxp3 + regulatory T cells were detected by FACSAria flow-cytometry.Spearman correlation was used to detect association between CD+4 CD+25 Foxp3 + regulatory T cells and the absolute CD+4 T cells,viral load and activation of T cells.Results The levels of CD+4 CD+25Foxp3+ regulatory T cells showed the tendency of increasing tendency from normal control to early HIV infected patients,asymptomatic HIV infected patients and AIDS patients.Early HIV infected patients was significantly lower than that in AIDS group [3.79(2.11 - 5.43) % vs 8.09(4.90 - 8.90) %,Z = - 2.29,P = 0.022].The levels of CD+4 CD+25 Foxp3 + Treg cells were associated with viral set point(r = 0.479,P =0.038) and inversely associated with CD+4 T cells(r = -0.455,P =0.011) and closely associated with HLA-DR expression on CD+3 T cells(r = 0.533,P = 0.002).Conclusions The ratio of CD+4 CD+25 Foxp3 +regulatory T cells of early HIV infected patients was significantly increased and associated with viral set point and CD+4 T cell counts,which indicate that alternation of regulatory T cell may be an important factor contributing to the disease progression in early HIV infection.