Objective:To investigate the application of diagnostic criteria for common occupational radiation-induced diseases to radiation workers, in order to provide a basis for the revision, publicity and standardization of the standards.Methods:Radiation workers were selected from 1 city, 7 provinces and 1 corporation by using cluster random sampling method from January 2021 to May 2021. Awareness of the criteria and the effects of ionizing radiation, and the suggestions for diagnostic works were investigated and analyzed.Results:A total of 2 839 radiation workers were investigated. There were differences in the awareness of different diagnostic criteria, the inclusions in complex diagnostic criteria, the materials required for applying for diagnosis, and the ways of knowing the diagnostic criteria( χ2=416.06, 2 924.14, 83.45, 895.67, 815.94, P<0.001). The correct understanding rates of deterministic effects and stochastic effects were 80.63% and 43.64%, respectively. The acceptance rates in applicable materials were 96.79% for occupational exposure history, 94.72% for occupational health monitoring records and 93.55% for individual monitoring of occupational exposure, respectively. Pre-employment training rate was 80.20%, on-job training rate was 81.19%, and untrained rate was 3.77%. The suggestions to the diagnosis of occupational radiation-induced diseases are to strengthen training, pay attention to individual monitoring, occupational health examination, and strengthen health supervision and law enforcement. Conclusions:Radiation workers have a low awareness rate of certain diagnostic standards and a high awareness rate of diagnostic procedures. Publicity and training of health effects of ionizing radiation and diagnostic criteria of occupational radiation-induced diseases should be strengthened. Diagnostic procedure should be optimized.

随着我国对核能的不断开发和探索，核技术在国民经济等各领域发挥了重要作用 [1,2]。另一方面，避免采取可能危及核设施安全运行和危及核物质安全的行动，是国家安全的底线。确保核与辐射安全，把核安全纳入国家安全整体工作当中，是党和国家对人民做出的庄严承诺，而核应急工作是确保核安全的重要保障 [3,4]。

本文把核事故、核武器损伤及核恐事件作为主要的事故源项,对其致伤因素和损伤类型进行分析研判,探讨事故场景和救援方案的设计要点,指导核应急医学救援演练的方案设计,以期提升队伍的综合医学救援能力.

依据核应急医学救援的原则,包括体表污染、放射损伤、内污染和复合伤的诊断和处理原则,结合担任核应急医学现场救援队伍和专科医疗救治任务的相关科室,包括急救和重症医学、放射医学、核医学、放射治疗学及其它临床学科的能力建设,提出多学科沟通、多单位合作的理念,充分发挥各相关专科的技术长项并取长补短,协力做好核应急医学现场救援和院后救治工作.

目的 分析老年Ⅲ期不可切除非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受同步放化疗后的预后影响因素.方法 回顾性分析2015年2月-2018年2月于成都医学院第二附属医院住院的150例老年Ⅲ期不可切除NSCLC患者的临床资料,根据是否接受联合巩固化疗分为同步放化疗组和同步放化疗联合巩固化疗组.分析治疗和生存情况;采取Kaplan-Meier法和Cox多因素回归方法分析患者预后的影响因素.结果 随访中位时间为18个月(12个月～35个月),1年生存率为78.0％,中位生存时间为14个月.采取同步放化疗联合巩固化疗不能提高老年Ⅲ期不可切除非小细胞肺癌患者的生存率.男性、吸烟、腺癌、肿瘤直径＞3 cm和有胸膜侵犯的NSCLC患者无进展生存期和总生存率明显缩短.经单因素和多因素回归分析,性别(男性)、吸烟、病理分型为腺癌、肿瘤直径＞3 cm以及有胸膜侵犯是NSCLC患者无进展生存期和总生存时间的独立预后影响因素.结论 NSCLC患者无进展生存期和总生存时间与性别(男性)、吸烟、病理分型为腺癌、肿瘤直径＞ 3cm以及有胸膜侵犯等因素有关,与是否采取联合巩固化疗无关.

Purpose: An anatomical and histological study of the conjoint fascial sheath of the levator and superior rectus (CFS) was carried out by using the cadavers for teaching. Methods: Three adult Asian cadaver heads fixed in formalin were used. The CFS was exposed by the same surgeon in each case. Then the CFS was observed and measured in vivo and ex vivo. And the CFS, the levator and the frontal muscle were removed from the same eye for histological study. Results: The CFS was located 2.1 ± 0.4 mm posterior to the fornix. A special muscle sheath of the levator was observed. The special muscle sheath and the tendon of the superior rectus were fused to the CFS through loose connective tissue. Hematoxylin-Eosin (HE) staining showed a large amount of connective tissue on examination of the CFS by microscopy. Double staining with Victoria-blue and Masson trichrome staining confirmed elastic fibers and collagen fibers in the CFS tissues. Conclusions: If ptosis correction surgery is performed by looking for the CFS from the upper edge of the conjunctiva, in fact, only a special part of the muscle sheath of the levator in the CFS, but not the integral CFS, is used in the surgery. The histological results confirm that the CFS is a fibrous tissue membrane with both elasticity and toughness. Perhaps the best choice is to recombine the special muscle sheath of the levator in the CFS with the levator muscle tissue during ptosis correction surgery to suspend the eyelids.

以核应急医学救援分队常用装备的使用和维护为主要内容,对辐射监测、医学救援、机动车辆、后勤物资及通信保障等装备进行分类介绍,并结合日常培训、演练演习和维护工作体会,对如何提升装备的使用和维护水平进行讨论.

目的:比较不同工龄组的核从业人员血清早衰细胞因子:骨特异性碱性磷酸酶(Serum bone alkaline phosphates,BALP),抗酒石酸酸性磷酸酶-5b(Tartrate-resistant acid phosphatase isoform-5b,TRACP-5b)的表达情况.方法:将2015年9月至2016年2月,在我院体检的核从业人员216例根据工龄随机分成5组,其中工龄0～3年组36例,工龄3～8年组37例,工龄8～15年组63例,工龄15～25年组56例,工龄＞25年组24例.同时选取正常对照组41例,早晨6:00～8:00采集空腹静脉血,采用酶联免疫吸附法(Enzyme linked immunosorbentassay,ELISA)测定血清BAlP和TRACP-5b的水平.结果:BALP的表达水平随工龄增长而降低,在“15～25年工龄组”表达最低;TRACP-5b表达水平随工龄增长而增高,在“15～25年工龄组”表达最高;“15～25年”工龄组的核从业人员,血清早衰细胞因子BALP以及TRACP-5b的表达与其他工龄组存在显著差异.结论:核从业人员的“15～25年”工龄期是早衰的易发时期,血清BALP以及TRACP-5b可作为早衰发生的预警指标,据此变化制定针对性的职业照护方案,对核从业人员的实施更完备的职业防护.

目的 通过测定酒后呼出气体酒精浓度的动态变化,为制定酒后作业的安全措施提供依据.方法 选择9名男性志愿者定时定量饮用52％(体积分数)白酒,选取14个时间点,动态测量饮酒后呼出气体中的酒精浓度(BrAC),并转换为血液酒精浓度(BAC).结果 饮酒100 ml后2h,有8人BAC超过检测限值(8 mg/100 ml).饮酒200 ml后5h,有8人BAC超过酒驾限值(20 mg/l00 ml).结论 从事高危作业人群,工作日的中午休息时间不宜饮酒.若晚上饮用超过200 ml白酒,第2天上午不宜从事高危作业.

卫生部于2010年1月对护理工作提出了“服务改革大局，夯实基础护理，改善护理服务，树立行业新风，促进医患和谐，提高患者满意程度”的总体要求，并决定自2010年开始，在全国卫生系统开展以“夯实基础护理，提供满意服务”为主题，以“患者满意、社会满意、政府满意”为目标的“优质护理服务示范工程”活动[1]。为达到该目标，我院开展了以患者满意度调查为主要评估方法的优质护理服务活动，并根据调查结果持续改进，显著提高了我院的护理质量。

临床资料患者女，43岁。因左足第三趾甲下结节6个月入院。患者自诉前6个月，无明显诱因左足第三趾甲下出现一约绿豆大小结节，趾甲轻微上抬，无自觉症状，无外伤史，未予特殊处理。结节逐渐增大，趾甲上抬明显，触痛，修剪趾甲时易出血。曾被诊断为“化脓性肉芽肿”和“寻常疣”，给予抗生素及冷冻治疗无效。平素体健，无其它内科病史，常穿高跟鞋，家族无类似疾病史。体格检查：系统检查未见明显异常。皮肤科检查：左足第三趾末端甲下一约1 cm ×1 cm类圆形质硬结节，表面角化粗糙，趾甲上抬畸形，无明显压痛(图1)。

1 临床资料 患者,女,78岁.因"左膝反复红斑、糜烂、结痂伴瘙痒2年"入院.2年前患者左膝关节出现一块蚕豆大小的红斑,伴瘙痒,搔抓后出现糜烂,有少量渗液,按"湿疹"治疗,效果不佳.皮损逐渐扩大,形成斑块,触之有浸润感,时有结痂,在院外某医院诊断为"慢性溃疡",予抗感染治疗无效,遂来我院就诊.起病以来,患者二便正常,体重无明显变化.否认高血压、糖尿病等病史,余无特殊.个人史及家族史无特殊.全身检查:未见明显异常,全身浅表淋巴结未扪及肿大.皮肤科检查:左侧膝关节有一约2.5cm×1.5cm 大小不规则的淡红色斑块,边界欠清,肥厚浸润,有少许脱屑,未见糜烂、渗液(图1).实验室检查:血常规、尿常规、大便常规、肝肾功、血糖、电解质未见异常,血脂稍高于正常,心电图窦性心动过缓,胸部CT、B超未见占位性病变,骨扫描未见异常.

患者女,53岁.躯干、四肢丘疹、结节进行性增多2年,瘙痒1年就诊.2年前患者背、臀部出现数个黄豆大丘疹,黄褐色,逐渐长大并在丘疹部位出现烫伤样水疱,可结痂自愈.患者自觉面部浮肿,不伴自觉症状.1年前,双下肢出现黄豆至拇指头大丘疹、结节,部分结节中央溃烂,结痂.患者自觉面部、躯干瘙痒,以面部明显,经常搔抓,眉毛被摩擦脱落.曾在多家医院诊断为“神经性皮炎、结节性痒疹”,治疗无效.患者无神经麻木,四肢未见畸形.

Objective To explore the expression of human papilloma virus (HPV)infection, proliferating cell nuclear antigen (PCNA) and P53 immunoreactions in cervical squamous cell carcinoma (SCC) and their possible correlation with the carcinoma occurrence and development. Methods From October 2005 to November 2009, clinical data of 35 cervical squamous cell carcinoma cases(SCC group) and 13 cervical erosion cases (cervical erosion group) were reviewed and compared with their immune-pathological data of human papilloma virus infection and/or proliferating cell nuclear antigen and/or P53 expressions. This study was detected by immunohistochemistry SP methods in the carcinoma tissues. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Centre for Nuclear Industry 416 Hospital. Informed consent was obtained from all participants. Results The positive immunoreactive rates of human papilloma virus infection, proliferating cell nuclear antigen and P53 in SCC group were significantly higher than those of cervical erosion group (P<0.05). The strongest proliferating cell nuclear antigen expression was associated with the lower differentiation of pathological grades (P<0.05), but human papilloma virus infection and P53 were not related to the tumor grades. Conclusion Human papilloma virus infection and P53 may play important roles in the pathogenesis of cervical squamous cell carcinoma. The over expression of proliferating cell nuclear antigen may indicate the worse carcinoma pathological grades, that may help to predict the prognosis for cervical squamous cell carcinoma patients. Key words: human papilloma virus (HPV) infection; proliferating cell nuclear antigen (PCNA); P53; cervical squamous cell carcinoma

^131I已广泛应用于甲状腺疾病的诊断、治疗。本研究用^131I溶液对大鼠灌胃，旨在观察不同剂量的^131I对大鼠胃黏膜是否有损伤作用，现报道如下。一、材料与方法1．材料。一级SD大鼠80只，雌雄各半，体质量0．13～0．2kg，由四川大学实验动物中心提供，动物许可证号：川实动管10；^131I口服溶液购自成都中核高通同位素股份有限公司，成人平均剂量为按体质量4．44MBq／kg，大鼠灌胃剂量为成人平均剂量的6.25倍。

131Ⅰ已广泛应用于甲状腺疾病的诊断、治疗.本研究用131Ⅰ溶液对大鼠灌胃,旨在观察不同剂量的131Ⅰ对大鼠胃黏膜是否有损伤作用,现报道如下.

患者 女性,36岁.阴道大出血3 h入院.查体:全身皮肤黏膜未发现有黑痣糜烂破溃.浅表淋巴结无肿大.妇科检查:外阴无异常.宫颈上见-4 cm×3 cm×3 cm的肿块,将整个宫颈口遮拦,并与左侧阴道穹窿融合.肿块表面呈紫黑色,可见活动性出血.宫体中位,饱满.双附件未见异常.

Objective: Try to extract PHA form small white beans which is sold in market.Methods:Fine powder of small white bean were marinated in 0.9% normal saline for 48 hours.The centrifugalized and filtered extract is tested in the trial of lymphocyte chromosome cultivation,compared with the PHA from Yi Hua company,checking its evaluation as mitogen.Results:The PHA extracted from white small bean,similar to the PHA from Yi Hua company,can stimulate lymphocyte transforming to lymphoblast.Conclusion: The PHA extracted from white small bean can settle for preparation of chromosome in normal laboratory condition.

目的改变染色体制备过程中的培养条件,在确保收获第一次核分裂细胞的前提下,改善染色体形态。方法缩短淋巴细胞培养时间至44h,加秋水仙素时间至培养开始后的第30小时。秋水仙素用量为0.04μg/ml。结果染色体呈紫红色,长短适中,染色体间分离良好,染色体单体间分叉。结论总培养时间为44h,在培养开始后的第30小时加入秋水仙素,能保证培养出来的染色体属于第一次核分裂;缩短了秋水仙素的处理时间,可大大改善染色体的形态。

患者男性,61岁.因左腰、腹部疼痛1月余入院.入院前10余天,曾在外院行左输尿管体外碎石,近3天疼痛加剧,但能自行缓解;无肉眼血尿.查体:左肾区有叩击痛,左输尿管区无明显压痛.实验室检查:尿红细胞(+);血白细胞8.1×109/L,红细胞4.86×1012/L;PSA 1.4 ng/ml(正常值＜4.0 ng/ml).