[Interpretation of specification for service of cancer screening for workers].

As the backbone force of China's social and economic construction, the health status of workers is closely related to the nation's productivity and social development. Currently, cancers have become one of the major diseases threatening the health of workers. However, there are still many shortcomings in the cancer screening services for the workers. To standardize cancer screening services for workers, ensure the quality of screening services, and improve the overall screening effectiveness, 19 institutions, including Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences, have jointly formulated the Group Standard "Specification for service of cancer screening for workers (T/CHAA 023-2023)". This standard follows the principles of "legality, scientific rigor, advancement, and feasibility" and combines the frontier scientific advances in cancer screening. It clarifies the relevant requirements for service principles, service design, service delivery, service management, service evaluation, and improving worker cancer screening. Implementing this group standard will help connect the common screening needs of workers, employers, and cancer screening service providers, standardize the screening process, improve screening quality, and ultimately increase the early diagnosis rate and survival rate of cancer patients. Consequently, this group standard will help safeguard workers' health rights and interests, ensure the labor force resources, promote the comprehensive coordinated and sustainable development of society, and contribute to realizing the "Healthy China 2030" strategic policy.

[Clinical analysis of 10 cases of multi-center tumor necrosis factor receptor-associated periodic syndrome].

Objective: To summarize the clinical characteristics of tumour necrosis factor receptor-associated periodic syndrome (TRAPS) in children. Methods: The clinical manifestations, laboratory tests, genetic testing and follow-up of 10 children with TRAPS from May 2011 to May 2021 in 6 hospitals in China were retrospectively analyzed. Results: Among the 10 patients with TRAPS, including 8 boys and 2 girls. The age of onset was 2 (1, 5) years, the age of diagnosis was (8±4) years, and the time from onset to diagnosis was 3 (1, 7) years. A total of 7 types of TNFRSF1A gene variants were detected, including 5 paternal variations, 1 maternal variation and 4 de novo variations. Six children had a family history of related diseases. Clinical manifestations included recurrent fever in 10 cases, rash in 4 cases, abdominal pain in 6 cases, joint involvement in 6 cases, periorbital edema in 1 case, and myalgia in 4 cases. Two patients had hematological system involvement. The erythrocyte sedimentation rate and C-reactive protein were significantly increased in 10 cases. All patients were negative for autoantibodies. In the course of treatment, 5 cases were treated with glucocorticoids, 7 cases with immunosuppressants, and 7 cases with biological agents. Conclusions: TRAPS is clinically characterized by recurrent fever accompanied by joint, gastrointestinal, skin, and muscle involvement. Inflammatory markers are elevated, and autoantibodies are mostly negative. Treatment mainly involves glucocorticoids, immunosuppressants, and biological agents.

[Analysis on the current situation and influencing factors of residents' satisfaction with the built environment of China's Hygienic City Initiative].

Objective: To understand the current situation and the main influencing factors of residents' satisfaction with the built environment of China's Hygienic City Initiative. Methods: From the list of China's hygienic cities (excluding county-level cities), 61 cities were randomly selected in equal proportion and the eligible respondents were randomly selected by using the "Questionnaire Star" network platform to carry out the online questionnaire survey. A self-made satisfaction evaluation scale was used to investigate the satisfaction of the included respondents with the urban built environment and search for relevant data on the city level. The two-level multi-factor mixed effect model was constructed to analyze the influencing factors of residents' satisfaction with the built environment of China's Hygienic City Initiative. Results: The age range of 2 465 respondents was mainly between 18 and 40 years old (79.9%), with males being the main group (45.8%). The total score of residents' satisfaction with the built environment of China's hygienic cities was (69.14±13.24) points. Based on four standardized dimensions of sense of gain, the result showed that the satisfaction of urban governance had the highest score (65.08 points), followed by urban environmental sanitation (63.68 points), urban lifestyle (59.97 points) and urban basic function (59.02 points). The analysis results of the two-level multi-factor mixed effect model showed that compared with residents with an annual average concentration of inhalable fine particles in the environment>48 micrograms/cubic meter, residents with an average concentration between 38 and 48 micrograms/cubic meter [ß (95%CI): 1.65 (0.08, 3.21)] and≤37 micrograms/cubic meter or less [ß (95%CI): 1.98 (0.53, 3.43)] had higher satisfaction. Compared with residents whose proportion of the secondary industry to GDP was≤40.9%, residents in cities with a larger proportion had a lower satisfaction level [residents with a proportion of 40.9%-48.03%, ß (95%CI):-2.21 (-3.93, -0.49); residents with a proportion greater than 48.03%, ß (95%CI):-2.58 (-4.58, -0.59)]. Compared with residents with a junior high school or lower education level, residents with a higher education level had a lower satisfaction level [ß (95%CI):-2.37 (-4.57, -0.17)]. Residents of universities and above [ß (95%CI):-3.82 (-6.05, -1.60)], regularly participate in physical exercise [ß (95%CI): 5.78 (4.71, 6.84)] and self-rated good health status [ß (95%CI): 6.39 (5.33, 7.45)] had a higher satisfaction level. Conclusion: The satisfaction of residents with the built environment of China's hygienic cities is still acceptable. Satisfaction is related to individual characteristics such as residents' cultural level, type of residence, frequent participation in physical exercise, and self-rated good health status, as well as urban-level factors such as green coverage rate in built-up areas, annual average concentration of inhalable fine particles, and the proportion of GDP in the secondary industry.

[Residents' sense of acquisition and influencing factors in China's Sanitary City Initiative].

Objective: To analyze the residents' sense of acquisition (recognition, perceptibility and satisfaction) and influencing factors in China's Sanitary City Initiative. Methods: A cross-sectional survey was conducted from December 2020 to February 2021. The data about the residents' sense of acquisition were collected by using questionnaire from 2 465 residents who were aged ≥18 years and had lived in local communities for at least one year in 31, 14 and 16 cities with national sanitary city title in eastern, central and western China the influencing factors of residents' sense of acquisition in China's Sanitary City Initiative were analyzed by using multivariate multilevel model. Results: The total score of residents' sense of acquisition in China's Sanitary City Initiative was 231.15±32.45. After converting the scores according to the 100-score standardized method, the results showed that the recognition score, perception score and the satisfaction score were 85.02, 59.08 and 61.42, respectively. The results of influencing factors analysis showed that education level, gender, marital status, age, prevalence of physical exercise and self-assessment of health status were correlated with the scores of residents' recognition (ß:1.24-2.54,all P<0.05); the concentration of inhalable fine particles , the green coverage of built-up area, the level of GDP per capita and the type of residential community, prevalence of physical exercise and self-assessment of health status were correlated with the score of residents' perception (ß:1.76-8.86,all P<0.05); the concentration of inhalable fine particles , the green coverage of built-up area, the level of GDP per capita and the type of residential community, education level, prevalence of physical exercise and self-assessment of health status were correlated with the score of residents' satisfaction (ß:1.34-6.26,all P<0.05). Conclusions: The total score of residents' sense of acquisition in China's Sanitary City Initiative was relatively high, indicating that the policy has been widely recognized. The detailed management of policy implementation should be strengthened in the future, and more attention needs to be paid to actual needs of the residents to further improve the residents' sense of acquisition in China's Sanitary City Initiative.

[Recommendations for the diagnosis and treatment of Behçet's syndrome in China].

Behçet's syndrome (BS) is classified among variable vessel vasculitis with unknown etiology and extensively heterogeneous clinical features. It is easily missed or misdiagnosed due to the lack of a specific laboratory diagnosis index. Based on the evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed the standardization of diagnosis and treatment of BS. The purposes are: (1) To standardize the detection and interpretation of key indicators for BS; (2) To standardize rational management for BS patients with topical and systemic organ involvement to reduce complications and improve outcomes.

[Expression of tuftelin protein and its clinical value in HBV-related liver cancer tissues].

Objective: To analyze the expression of tuftelin protein (TUFT1) and its clinical value in hepatocellular carcinoma (HCC)-related liver cancer tissues. Methods: The biological information data of TUFT1 mRNA expression in liver cancer and non-cancer tissues were analyzed from the TCGA and Oncomine database. After the approval of the ethics committee, the self-pairing method was used to collect the postoperative cancer and para-carcinoma tissues of 132 HCC cases hospitalized between January 2009 and December 2014. Tissue microarray and immunohistochemistry (IHC) were used to analyze the expression of TUFT1 in liver tissues. According to IHC staining, liver cancer was divided into high TUFT1 and low/no expression group. Combined with clinical data, the clinicopathological characteristics were statistically analyzed between and within the groups. The 5-year overall survival (OS) and disease-free survival (DFS) was analyzed by correlation analysis. Results: IHC staining showed that TUFT1 in cancer tissue was localized in the cytoplasm and cell membrane, and its positive expression rate was significantly higher in the liver cancer group (87.1%) than the para-carcinoma group (64.4%) (χ (2) = 18.563, P < 0.001). TUFT1 expression intensity in patients with liver cancer was significantly correlated with HBeAg positive (χ (2) = 4.080, P = 0.043), tumor size (χ (2) = 9.388, P = 0.002), vascular invasion (χ (2) = 14.885, P < 0.001), TNM stage (χ (2) = 13.516, P < 0.001) and ascites (χ (2) = 5.940, P = 0.015). TUFT1 high expression was negatively correlated with OS and DFS (P < 0.001). Conclusion: The overexpression of TUFT1 is closely related to HBV replication, vascular invasion and poor prognosis, and it is expected to become a useful marker for liver cancer diagnosis and prognosis.

[Analysis of a pedigree with inherited factor V deficiency caused by compound heterozygous mutation].

Objective: To explore the molecular pathogenesis of a family with hereditary factor Ⅴ (FⅤ) deficiency. Methods: All the exons, flanking sequences, 5' and 3' untranslated regions of the F5 of the proband, and the corresponding mutation sites of the family members were analyzed via direct DNA sequencing. The CAT measurement was used to detect the amount of thrombin produced. The ClustalX software was used to analyze the conservation of mutation sites. The online bioinformatics software, Mutation Taster, PolyPhen-2, PROVEAN, LRT, and SIFT were applied to predict the effects of mutation sites on protein function. The Swiss-PdbViewer software was used to analyze the changes in the protein model and intermolecular force before and after amino acid variation. Results: The proband had a heterozygous missense mutation c.1258G>T (p.Gly392Cys) in exon 8 of the F5, and a heterozygous deletion mutation c.4797delG (p.Glu1572Lys fsX19) in exon 14, which results in a frameshift and produces a truncated protein. Her grandfather and father had p.Gly392Cys heterozygous variation, whereas her maternal grandmother, mother, little aunt, and cousin all had p.Glu1572LysfsX19 heterozygous variation. The ratio of proband's thrombin generation delay to peak time was significantly increased. Conservation analysis results showed that p.Gly392 was located in a conserved region among the 10 homologous species. Five online bioinformatics software predicted that p.Gly392Cys was pathogenic, and Mutation Taster also predicted p.Glu1572Lys fsX19 as a pathogenic variant. Protein model analysis showed that the replacement of Gly392 by Cys392 can lead to the extension of the original hydrogen bond and the formation of a new steric hindrance, which affected the stability of the protein structure. Conclusion: The c.1258G>T heterozygous missense mutation in exon 8 and the c.4797delG heterozygous deletion mutation in exon 14 of the F5 may be responsible for the decrease of FⅤ levels in this family.

[Clinical analysis of golimumab in the treatment of severe/refractory cardiovascular involvement in Behcet syndrome].

OBJECTIVE: To explore the effectiveness and safety of golimumab in the treatment of severe/refractory cardiovascular Behcet syndrome (BS). METHODS: We retrospectively analyzed the clinical data of nine patients diagnosed with severe/refractory cardiovascular BS and treated with golimumab from February 2018 to July 2020 in Peking Union Medical College Hospital. We analyzed levels of erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP), imaging findings, and the doses of glucocorticoids and immunosuppressive agents during the period of combined treatment with golimumab. RESULTS: Nine patients were enrolled, including 8 males and 1 female, with a mean age and median course of (37.0±8.6) years and 120 (60, 132) months, respectively. Seven patients presented with severe aortic regurgitation combined with other cardiovascular involvement secondary to BS. Two patients presented with large vessel involvement, including multiple aneurysms and vein thrombosis. Prior to golimumab treatment, seven patients were treated with glucocorticoids and multiple immunosuppres-sants [with a median number of 3 (1, 3) types] while still experienced disease progression or elevated inflammation biomarkers during postoperative period. Eight patients with disease progression, uncontrolled inflammation and history of severe postoperative complications required effective and fast control of inflammation during perioperative period. One patient had adverse reaction with tocilizumab and switched to golimumab during perioperative period. The patients were treated with golimumab 50 mg every 4 weeks, along with concomitant treatment of glucocorticoid and immunosuppressants. After a median follow-up of (16.3±5.6) months, all the patients achieved clinical improvement. Vascular lesions were radiologically stable and no vascular progressive or newly-onset of vascular lesions was observed. The eight patients who experienced cardiac or vascular operations showed no evidence of postoperative complications. The ESR and hsCRP levels decreased significantly [16.5 (6.8, 52.5) mm/h vs. 4 (2, 7) mm/h, and 21.24 (0.93, 32.51) mg/L vs. 0.58 (0.37, 1.79) mg/L (P < 0.05), respectively]. The dose of prednisone was tapered from 35 (15, 60) mg/d to 10.0 (10.0, 12.5) mg/d. No prominent adverse reactions were observed. CONCLUSION: Our study suggests that golimumab is effective in the treatment of severe/refractory cardiovascular BS. Combination immunosuppression therapy with golimumab contributes to control of inflammation, reduction of postoperative complications and tapering the dose of glucocorticoids or immunosuppressants.

[Progress in interferon: A treatment of Behcet syndrome].

Behcet syndrome (BS) is a chronic systemic inflammatory disorder involving vessels of all sizes, characterized by relapsing episodes of oral and/or genital ulcers, as well as skin lesions. Ocular, vascular, gastrointestinal, neurological system involvement can cause significant morbidity and mortality. Glucocorticoids and immunosuppressants are the cornerstones for the management of BS. Biologic agents has been recommended for severe and/or refractory BS. Interferon-α (IFN-α) had multiple biological effects, such as antiviral and antiproliferative, that could regulate both innate and adaptive immunity in BS. Growing evidence showed the efficacy of IFN-α in severe and/or refractory BS. Many studies have demonstrated that IFN-α has comparable effectiveness and tolerance profiles as anti-tumor necrosis factor (TNF) agents for Behcet's uveitis with a much lower cost and steroid-and immunosuppressant-sparing effects. IFN-α has been recommended as second-line therapy for ocular involvement of BS in EULAR (The European League Against Rheumatism) 2018. IFN-α also improves mucocutaneous lesions in BS with the dosage from 3 to 9-12 million IU three times per week. A few cases indicated the therapeutic potential of IFN-α in intestinal BS. As a new trial of IFN-α in vascular BS (VBS), a recent study revealed the lower relapse rate and higher recanalization rate with IFN-α in lower extremity deep vein thrombosis (DVT). Another two case reports presented the efficacy of IFN-α in pulmonary artery involvement in BS. Also, case reports have shown successful treatment in refractory neurological involvement. There are two subtypes of IFN-α commonly used in autoimmune diseases, named IFN-α2a and IFN-α2b. IFN-α2a seemed more effective than IFN-α2b, especially in ocular and mucocutaneous involvement of BS. Side effects of IFN-α are dose-dependent and not severe. The most frequent side effects are flu-like syndrome, mild leukopenia and alopecia. Considering the potential risk of tuberculosis (TB) and hepatitis B virus (HBV) reactivation of TNF-α inhibitors, IFN-α is safe due to its anti-HBV effect and protective effect on TB. In conclusion, IFN-α is a promising choice for severe and/or refractory BS patients, especially for those who are intolerant or contraindicant to other biological agents, such as TNF inhibitors. Further prospective controlled studies are warranted to confirm the efficacy and safety of IFN-α in BS.

[Quantitative analysis of national hygienic city policies in China from the perspective of policy tools].

Objective: To give some suggestions on the policy optimization of the establishment of National Hygienic City from the perspective of policy system. Methods: Policy documents were searched in WanFang Database and websites of ministries and commissions directly affiliated to the State Council with the key words of hygienic city, and analyzed by using the content analysis and quantitative analysis, based on the theory and perspective of policy tools and the two-dimensional analysis framework. Results: Among the 161 policy documents, supply-based, environment-based, and demand-based policy tools accounted for 6.83% (11/161), 83.85% (135/161), and 9.32% (15/161) respectively. Policy planning, policy implementation, policy supervision, and policy evaluation tools accounted for 10.56% (17/161), 63.35% (102/161), 21.74% (35/161), and 4.35% (7/161) respectively. Conclusion: The government should reduce its dependence on environmental policy tools, especially strategic measures, and attach importance to the use of supply-based policy tools and demand-based policy tools. At the same time, it should pay attention to the formulation of more practical policy tools in the process of policy evaluation.

[Efficacy and safety of anti-tumor necrosis factor α monoclonal antibodies in 16 patients with severe/refractory vasculo Behcet's disease].

Objective: To explore the efficacy and safety of anti-tumor necrosis factor alpha (TNFα) monoclonal antibodies (mAbs) for severe/refractory vasculo-Behcet's disease (BD). Method: The clinical data of severe/refractory vasculo-BD patients treated with anti-TNFα mAbs were retrospectively analyzed. Response of anti TNFα mAbs was analyzed. The dosage changes of glucocorticoid, the level of erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hsCRP) before and after treatment were recorded, as well as side effects. Result: Sixteen patients were enrolled. Arterial lesions were reported in 12 patients, including 9 with arterial aneurysm, 6 with arterial dilation, 2 with stenosis and 2 with occlusion. Seven patients presented venous thrombosis, including lower extremity veins (n=6), cerebral venous sinus (n=2) and inferior vena cava system (n=2). Two cases had both arterial and venous involvement. Before the application of TNFα mAbs, all 16 patients failed to response to prednisone or its equivalent dose of 40 (7.5-90) mg/d in combination with cyclophosphamide, methotrexate, thalidomide or azathioprine for median 4 (0-156) months. After a mean duration of treatment for (17.1±6.5) months, 15 patients achieved complete remission and 1 patient achieved partial remission. Three patients received surgery without any postoperative complications. After using anti TNFα mAbs, the dosage of prednisone [5(0-12.5)mg/d vs. 40(7.5-90)mg/d, P<0.01], ESR [(7.3±4.6) mm/1h vs. (33.5±26.7) mm/1h, P<0.01] and hsCRP [1.9(0.2-11.4) mg/L vs. 24.3(0.4-113.9) mg/L, P<0.01] were significantly decreased. Side effects were observed in 2 patients. One developed pulmonary infection 12 months after adalimumab with conventional treatment. Another patient had allergy to infliximab then switched to adalimumab. Conclusion: In combination with corticosteroids and immunosuppressants, anti-TNF α mAbs are effective and well-tolerated in severe/refractory vasculo-BD, with a favorable steroid -sparing effect and rare postoperative complications.

[Interpretation for the group standard of Health check-up guide for rural residents].

With the acceleration of the population aging in China, the health problems and the demands of health services such as health check-up for rural residents should attract the attention of the whole society. The group standard entitled Health check-up guide for rural residents (T/CHAA 005-2019), was written by experienced researchers from Chinese Center for Disease Control and Prevention and other professional institutes coordinated by Chinese Health Association. The standard aims to establish a service model that takes health information collection as a means, health risk assessment, health risk intervention and information services as the core, improving the health of rural residents as the target.

[Overview of logistic regression model analysis and application].

Logistic regression is a kind of multiple regression method to analyze the relationship between a binary outcome or categorical outcome and multiple influencing factors, including multiple logistic regression, conditional logistic regression, polytomous logistic regression, ordinal logistic regression and adjacent categorical logistic regression. This paper illustrates the basic principle, independent variable selection and assignment, applied condition, model evaluation and diagnosis for multiple logistic regression model. Moreover, the principle and application for polytomous logistic regression and ordinal logistic regression models were also introduced. By providing SAS codes and detailed explanations of the result for an example of obesity, readers could be able to better understand logistic regression model, and apply this method correctly to their research and daily work, so as to improve their capacity of the data analysis.

[An overview of multiple linear regression model and its application].

Multiple Linear Regression (MLR) is a generalization of simple linear regression and is one of the commonly used models in multivariate statistical analysis. This article introduces the MLR model from the perspective of practical application. Four parts, including basic principle, application examples, the application condition and diagnosis, and the extension of the model, are sequentially illustrated in this article. Particularly, in the last part, alternative methods of the model are introduced when the application condition of the model is not met. We sincerely hope that this article could make our audiences have a better understanding of the MLR model in order to improve the efficiency of data utilization and statistical analysis by correctly performing this model in their research.

[Overview of multivariate regression model analysis and application].

Analyses of the multivariate regression model are ued very widely in the medical research. Analytical methods of the mutivariate regression model including multiple linear regression, logistic regression, Poisson regression and Cox proportional hazard model were introduced in this article. The contents of the article covered the application conditions of regression models, analytical procedures, strategies of selecting independent variables, extended discussions of regression models and application notes. It is expected that authors could understand the principle of the mutivariate regression model, accurately use these analytical methods in their research, improve the efficiency of data utilization, and enhance the level of statistical analyses.

[Abnormal expression of Wnt3a and inhibiting role of its molecular-targeted intervening in hepatocellular carcinoma].

Objective: To investigate the Wnt3a expression in tissues of HCC and its gene knockout on effects of HepG2 cell proliferation or xenograft tumor growth. Methods: Hepatic Wnt3a expressions in 87 HCC and their matched surrounding tissues were observed by tissue microarray and immunohistochemistry for analyzing its clinicopathological characteristics; Wnt3a-knockout HepG2 cell lines were established by Crispr/cas9-sgRNA system and genomic cleavage efficiency was verified at gene level by surveyor assay. The relative proteins were confirmed by Western blotting; Cell Counting Kit-8 assay was used to examine cell proliferation after knocking-out Wnt3a successfully, and the nude mice HepG2 cell xenograft tumors delete that the relationship between Wnt3a and HCC growth. Results: The positive Wnt3a with brown staining particles was mainly distributed in cytosol and membrane of hepatocytes. The incidence of hepatic Wnt3a expression in cancerous tissues (95.4%) was significantly higher (χ (2) = 47.754, P < 0.001) than that in their surrounding tissues (49.4%). The high Wnt3a expression was 70.1% in the HCC and only 14.9% in the surrounding tissues. High Wnt3a expression was associated with poorly-differentiated grade, liver cirrhosis, HBV infection, portal vein invasion, TNM stage and 5-year survival rate. After knocked-out by Crispr/cas9-sgRNA system successfully, Wnt3a expression was down-regulated significantly at gene or protein level. Key molecule ß-catenin in cytoplasma was obviously inhibited. HepG2 cell lines proliferation was suppressed in time-dependent manner. The nude mice HepG2 cell xenograft tumors confirmed that the knock-out of Wnt3a could significantly supressed HCC growth with slower speed (t = 6.418, P < 0.001), smaller volume(869.4 ± 222.5 mm(3) vs 355.0 ± 99.9 mm(3), t = 5.168, P < 0.001), and lighter weight (0.88 ± 0.20 g vs 0.35 ± 0.11 g, t = 5.628, P < 0.001)compared with the control group. Conclusion: Abnormal expression of Wnt3a could be expected as a promising target for HCC gene therapy.

[The 466th case:myasthenia,fever,blurred vision and pancytopenia].

A 45-year-old woman was admitted to the Department of Rheumatology and Immunology, Peking Union Medical College Hospital, due to weakness of the upper limbs, fever, and blurred vision. She was clinically diagnosed as systemic lupus erythematosus overlapped primary biliary cirrhosis, with renal, retinal, hematological and musculoskeletal involvement, combined with severe pulmonary infection and respiratory failure. Treated with glucocorticoids, ursodeoxycholic acid, antibiotics and respiratory support, the patient got better. A couple of days later, her fever recurred and platelets count dropped to 30×10(9)/L, hemoglobin to 78 g/L, fibrinogen to<1.5 g/L, ferritin to 1 640 ng/ml, natural killer (NK) cell count to 8/µl, the activity of NK cells 2% (reference value 9.5%-23.5%), considering the occurrence of hemophagocytic lymphohistiocytosis (HLH). Cytomegalovirus pp65 antigenemia test: 13 positive cells/2×10(5) WBC. Considered the possibility of HLH caused by cytomegalovirus infection and treated by 250 mg ganciclovir intravenous drip twice a day for a full course. The temperature of the patient was gradually reduced to 36.5 ℃, the count of platelets were increased to 229 ×10(9)/L, the hemoglobin was increased to 94 g/L, and the fibrinogen was increased to 3.26 g/L. When there were unexplained critical signs of the primary disease during systemic lupus erythematosus treatment, severe complications such as infection, HLH, thrombotic thrombocytopenic purpura should be taken into account.

[Prevalence of musculoskeletal disorders and related factors in female greenhouse workers in Shandong province].

Objective: To study the prevalence of musculoskeletal disorders (MSDs) and related factors in female greenhouse workers. Method: A questionnaire survey was conducted among 851 female greenhouse workers in Shandong province in 2015. Results: The incidence of MSDs among the female greenhouse workers was 82.79%. For the MSDs in female greenhouse workers, the top four affected body sites were low back (65.82%), knees (49.10%), neck (25.75%) and shoulder (23.47%). Multivariate logistic regression analysis showed that age ≥50 years (OR=2.098, 95%CI: 1.353-3.252), working years ≥20 (OR=1.703, 95%CI: 1.116-2.599), repetitive work (OR=1.903, 95%CI: 1.183-3.061), standing for prolonged time (OR=2.902, 95%CI: 1.183-7.120) and frequent slightly bending down (OR=2.979, 95%CI: 1.823-4.867) were the main risk factors for MSDs in female greenhouse workers. Aiding tools was the protective factor (OR=0.400, 95%CI:0.229-0.697). Conclusions: The findings showed a relatively higher prevalence of MSDs in female greenhouse workers. It is necessary to take appropriate measures to prevent and control the incidence of MSDs in female greenhouse workers.

[Key signal molecules of wingless-related integration pathway and targeted therapy for liver cancer].

Hepatocellular carcinoma is one of the most common digestive system tumors. Its occurrence and development are considered as multi-factorial and multi-step process. Recent studies have shown that wingless-related integration (Wnt) pathway plays an important role in the HCC progression and is associated with malignant transformation of hepatocytes, HCC metastasis, drug resistance and liver cancer stem cells. This article analyzes the expression of key signaling molecules in Wnt pathway and its value in diagnosis, prognosis and targeted therapy, and outlines the research progress of Wnt pathway targeted drugs for the treatment of HCC, with a view to providing targeted therapy research for HCC reference.