Analysis of individual dose monitoring results for medical radiation workers from occupational external exposure in Chongqing City, 2016-2020 / 中国热带医学

@#Abstract: Objective　To retrospectively analyze the individual dose monitoring of radiation workers in Chongqing City from 2016 to 2020, so as to provide scientific reference for occupational health monitoring and radiation protection. Methods　Radiation workers who performed individual dose monitoring in Chongqing Center for Disease Control and Prevention from 2016 to 2020 were selected as the research objects, and the monitoring data were collected and analyzed. Results　A total of 40 926 individuals were included in this study, with a total of 135 622 person-years. The average annual individual effective dose of radiation workers over the five-year period was 0.56 mSv. NR1 and NR5, the ratio of the number of works receiving annual individual does exceeding 1 and 5 mSv to the to the total monitor workers were 13.019% and 0.335%. The annual effective dose per capita in Chongqing City showed a trend of first decreasing, then increasing and then decreasing again over the study period, with significant differences between different years (F=971.754, P<0.001). Although there were some differences in the variation trend of annual effective dose among different occupational categories, the overall trend was decreasing year by year. The average annual effective dose of nuclear medicine and interventional radiology was relatively high, and the difference was not statistically significant (P>0.05). The average annual effective dose of industrial flaw detection and accelerator operator in industrial application was relatively higher, and the difference was not statistically significant (P>0.05). There were statistically significant differences in the per capita effective doses of different occupational categories of medical application in different years (F=8.892-682.852, P<0.001). Among them, the per capita annual effective doses of five occupational categories of medical application were the highest in 2016, and the per capita annual effective doses of interventional radiology were the highest in 2018 and 2019. Conclusions　The per capita annual effective dose of radiation staff in Chongqing has decreased year by year from 2016 to 2020, and remained at a relatively low level that meets national standards. The monitoring results suggest that the radiation staff of nuclear medicine, interventional radiology, industrial non-destructive testing and accelerator operator should give special attention to protect their occupational health and safety.

Investigation on radon exposure level in 38 districts and counties in Chongqing / 中国热带医学

@#Abstract: Objective　In order to understand the radon exposure level of homes in Chongqing, this survey was carried out on the indoor radon concentration in 38 districts and counties of Chongqing. Methods　According to the population ratio of every 100 000 people, one monitoring site was arranged, and the number of parallel samples was 10% of the distribution sites. The monitoring sites covered 38 districts and counties in Chongqing. A total of 1 019 residential monitoring sites in 38 districts and counties in Chongqing were measured with radon accumulation detectors from July 2020 to June 2021. Results　The five districts/counties in Chongqing having the highest average concentration of residential radon in the year were Xiushan County 78.8 Bq/m3, Qianjiang District 78.0 Bq/m3, Yubei District 73.9 Bq/m3, Youyang County 71.4 Bq/m3 and Shapingba District 69.8 Bq/m3. The five districts/counties with the lowest mean concentration of indoor radon were 37.6 Bq/m3 in Zhongxian County, 36.4 Bq/m3 in Changshou District, 33.7 Bq/m3 in Kaizhou District, 33.2 Bq/m3 in Liangping District and 27.3 Bq/m3 in Wushan County. The concentration levels of radon in four seasons were 46.0 Bq/m3, 53.4 Bq/m3, 45.1 Bq/m3 and 59.5 Bq/m3, respectively. The concentration of radon was higher in Summer and Winter, and lower in Spring and Autumn, and the difference of concentration among four seasons was statistically significant (P<0.001). The radon concentration of newly built buildings after 2017 was relatively high, up to 61.8 Bq /m3, but there was no statistical significance in radon concentration in different building ages (P>0.05). The concentration of radon in rooms of buildings with less than 10 floors was higher, up to 63.2 Bq /m3, and there were significant differences in radon concentration among rooms of different floors (P<0.05). The average annual radon concentration in houses in Chongqing was about (51.6±19.5) Bq/m3, and the average annual effective dose of inhaling radon and its progeny by house-related people was about (1.38±0.52) mSv. Conclusion　The average annual radon concentration level of houses in Chongqing is within the standard limit value recommended by China, but the prevention and control of radon should be strengthened.

Protective effect of dexmedetomidine against organ dysfunction in a two-hit model of hemorrhage/resuscitation and endotoxemia in rats

Dexmedetomidine (DEX), a selective agonist of α2-adrenergic receptors, has anti-inflammation properties and potential beneficial effects against trauma, shock, or infection. Therefore, this study aimed to investigate whether DEX might protect against multiple-organ dysfunction in a two-hit model of hemorrhage/resuscitation (HS) and subsequent endotoxemia. Eighty Wistar rats were randomized into four groups: NS (normal saline), HS/L (HS plus lipopolysaccharide), HS/L+D (HS/L plus dexmedetomidine), and HS/L+D+Y (HS/L+D plus yohimbine). Six hours after resuscitation, blood gas (PaO2) and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urine nitrogen (BUN), creatinine (Cr), TNF-α, IL-β, IL-6, IL-8, IL-10, and nitric oxide (NO) were measured. The histopathology was assayed by staining. Malondialdehyde (MDA) and superoxide dismutase (SOD) levels and heme oxygenase-1 (HO-1) were assayed. The PaO2 levels in HS/L rats were lower whereas the ALT, AST, BUN, Cr, TNF-α, IL-β, IL-6, IL-8, IL-10, and NO levels were higher compared to the control group. The HS/L+D increased PaO2 and further increased IL-10 and decreased ALT, AST, BUN, Cr, TNF-α, IL-β, IL-6, IL-8, and NO levels of the HS/L groups. In addition, the MDA in the HS/L groups increased whereas SOD activity decreased compared to the control group. Moreover, the HO-1 expression levels were increased by DEX administration in lung, liver, and kidney tissues. Lungs, livers, and kidneys of the HS/L group displayed significant damage, but such damage was attenuated in the HS/L+D group. All of the above-mentioned effects of DEX were partly reversed by yohimbine. DEX reduced multiple organ injury caused by HS/L in rats, which may be mediated, at least in part, by α2-adrenergic receptors.

Relationship between obstructive sleep apnea-hypopnea syndrome and aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and aortic dissection (AD). Methods    Fifty three patients with AD diagnosed by CTA in our hospital from January 2016 to January 2018 were selected. All the patients with AD were scored by the STOP-BANG questionnaire. The patients who scored more than or equal to 3 received polysomnography (PSG) after surgical or conservative treatment, and according to whether the sleep apnea-hypopnea index was higher than or equal to 5. Fifty-three patients were divided into an OSAHS group and a non OSAHS group. Results    There were 18 patients with 17 males and 1 female at average age of 43.3±8.4 years in the OSAHS group, and 35 patients with 23 males and 12 females at average age of 56.6±12.9 years in the non OSAHS group. There was no statistical difference between the two groups in the Stanford classification of aortic dissection, the time of onset, personal history, the history of diabetes, coronary heart disease and hyperlipidemia, or post-treatment systolic/diastolic blood pressure before sleep (P>0.05). The age of patients in the OSAHS group was significantly less than that in the non OSAHS group (P<0.01), the proportion of men/women (P=0.021), weight (P<0.01), height (P=0.028), body mass index (P<0.01), and post-treatment systolic/diastolic blood pressure after waking up (P=0.028,P=0.044) in the OSAHS group were significantly higher than those in the non OSAHS group. In the OSAHS group, the proportion of previous hypertension was significantly higher than that in the non OSAHS group (P=0.042).   Conclusion    AD patients combined with OSAHS are mostly male patients. The number of young and high-fat people is significantly more than that in the non OSAHS group. OSAHS may be one of the risk factors for young, high-fat men with AD.

Effects of levosimendan on patients undergoing valve replacement / 中国胸心血管外科临床杂志

@#Objective    To investigate the effect of postoperative use of levosimendan on patients with valve replacement. Method    Patients with valvular diseases who underwent valve replacement were prospectively enrolled during Jan 2014 to May 2018 in Qingdao Municipal Hospital, randomized to a levosimendan-treated group (n=93) and a control group (n=92) preoperatively. Patients in both groups underwent the same routine treatment preoperatively and postoperatively. In addition, patients in the levosimendan-treated group underwent levosimendan intravenous infusion 24 hours after entering ICU postoperatively. The clinical effect of the two groups was compared. Results    Compared to the control group, the cardiac output(CO, 5.2±1.0 L/min vs. 4.4±1.1 L/min on the seventh day after surgery) and left ventricular ejection fraction (LVEF, 55.7%±2.5% vs. 50.5%±2.2% on the seventh day after surgery) of levosimendan-treated group were increased significantly at different time points(1 day, 3 days and 7 days after surgery)(P<0.05), and the brain natriuetic peptid (BNP) level (312.5±34.6 pg/ml vs. 455.4±45.2 pg/ml on the seventh day after surgery) was less than that of the control group (P<0.05). The dosage (11.5±1.8 mg/kg vs. 20.4±2.1 mg/kg) and administration time of vasoactive agents in the levosimendan-treated group were significantly lower or shorter than those in the control group (70.4±11.2 h vs. 110.5±12.1 h, P<0.05). The ICU stay length, and the total incidence of adverse events were less than those of the control group (P<0.05). Conclusion    Postoperative use of levosimendan immediately after surgery can significantly improve the   cardiac function status of patients who underwent valve replacement, reduce the dosage of vasoactive agents, shorten the time of ICU hospitalization, reduce the incidence of adverse events and enhance the patient’s recovery after valve replacement.

Recent advances in the vascular brain injury of cognitive function network / 中国脑血管病杂志

Vascular cognitive impairment and dementia (VCID) , characterized with progressive worsening of executive function,learning and memory ability,is a clinical syndrome associated with vascular etiologies. Vascular injury leads to the compromise of integrity in the anatomical network connectivity and functional network connectivity within white matter, cortical gray matter and subcortical gray matter of the brain. Recent advances of VCID at different levels, from molecule and cell to brain structure, functional network and clinical disease,are summarized in this review.

ER Stress-Mediated Cell Damage Contributes to the Release of EDA+ Fibronectin from Hepatocytes in Nonalcoholic Fatty Liver Disease / 华中科技大学学报（医学）（英德文版）

Fibronectin containing extra domain A (EDA+ FN),a functional glycoprotein participating in several cellular processes,correlates with chronic liver disease.Herein,we aim to investigate the expression and secretion of EDA+ FN from hepatocytes in nonalcoholic fatty liver disease (NAFLD) and the underlying mechanisms.Circulating levels of EDA+ FN were determined by ELISA in clinical samples.Western blotting and flow cytometry were performed on L02 and HepG2 cell lines to analyze whether the levels of EDA+ FN were associated with endoplasmic reticulum (ER) stress-related cell death.Circulating levels of EDA+ FN in NAFLD patients were significantly higher than those in control subjects,and positively related with severity of ultrasonographic steatosis score.In cultured hepatocytes,palmitate up-regulated the expression of EDA+ FN in a dose-dependent manner.Conversely,when the cells were pretreated with 4-phenylbutyrate,a specific inhibitor of ER stress,up-regulation of EDA+ FN could be abrogated.Moreover,silencing CHOP by shRNA enhanced the release of EDA+ FN from hepatocytes following palmitate treatment,which was involved in ER stress-related cell damage.These findings suggest that the up-regulated level of EDA+ FN is associated with liver damage in NAFLD,and ER stress-mediated cell damage contributes to the release of EDA+ FN from hepatocytes.

Treatment of AO/OTA 31-A3 intertrochanteric femoral fractures with a percutaneous compression plate

OBJECTIVE: AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute. METHOD: Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed. RESULTS: The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97). Patients with a poor quality of reduction were more likely to have pain results (p = 0.001). A trend existed toward the presence of a poor quality of reduction (p = 0.05) in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000). CONCLUSION: The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device. .

Competency-based training - revolution in medical education in Neurosurgery / 中华医学教育探索杂志

In the medical field, the innovation education is to cultivate residents in China, which is an important way to senior medical elite. By analyzing competency-based neurosurgery residency training mode, the training methods for innovative ability of competency-based neurosurgeon are further discussed, for the purpose of reforming the training mode of neurosurgeon, improving creative ability and scientific clinical thinking ability.