Objective To explore optimized method of estimating 131I effective half-life(EHL) in patients with Graves' disease(GD).Methods The EHL was obtained by measuring thyroid radioactive iodine uptake (RAIU) of 126 patients (32 males,94 females,average age (38.47± 11.49) years) with GD at 4,24,48,96,120,144,168,192 and 216 h.Two-sample t test,bivariate correlation analysis and curve estimation were used for statistical analysis.Results The EHL of 126 patients was 0.5-7.5 (4.70±1.46) d.The EHL was 3.0-7.5(5.25±1.01) d and 0.5-6.0(3.24±1.52) d in group A (94 patients,without advanced peak of RAIU) and group B (32 patients,with advanced peak of RAIU),respectively,and the difference between the 2 groups was significant (t =8.499,P＜0.01).The EHL had no significant correlation with RAIU4h/RAIU24h(r=-0.177,P＞0.05) in group A,while it had negative correlation with RAIU4h/RAIU24h in group B (r =-0.724,P＜0.01).In group A,the EHL of patients with RAIU24h/RAIU48h ＞100％ was 3.0-7.5 (5.11 ±0.98) d,the EHL of patients with RAIU24h/RAIU48h ≤ 100％ was 4.0-7.0(5.91±0.94) d (t=3.141,P＜0.01).In group B,when RAIU4h/RAIU24h+RAIU24h/RAIU48h was used as the independent variable in S curve model to estimate the EHL,the result was the best (R2=0.930,F=397.22,both P＜0.01,b0 =-3.038 0,b1 =9.659 4).Conclusions In order to optimally estimate EHL,patients should be grouped according to 131I turnover.In patients with advanced peak of RAIU,the EHL should be calculated by using formula of (RAIU4h/RAIU24h +RAIU24h/RAIU48h).If no advanced peak of RAIU exists,patients should be further divided according to RAIU24h/RAIU48h ＞ 100％ or RAIU24h/RAIU48h ≤100％,and the EHL mean value of each group is taken as the estimated EHL.

Educational narrative is the application of narratology in the field of education.This paper introduced the definition of educational narrative and its characteristics of life,situationality and reflexivity,and then discussed the applicableness of the application of educational narrative in the medical ethics education.Based on this,it proposed the effectiveness means,namely that to improve theory quality and enhance the ability of narration,clarify the narrative theme and select material carefully,take care of medical students' growth and listen to their voice.

Objective To analyze the antibiotic resistance of ureaplasma urealyticum(UU) in vitro in Yangjiang,and instruct the clinical treatment for the ureaplasma urealyticum infection.Methods 538 secretion samples of urethra and cervix were collected and cultured ureaplasma urealyticum in vitro,the drug sensitive test of UU from 253 patients was conducted and detected their drug resistance.Results The 253 positives cases were found in 538 samples.The drug sensitive test results were:the highest sensitivity rates were clarithromycin(731%) and roxithromycin(679%).The resistance rates of rest drugs were azithromycin(771%),josamycin(708%),minocycline(664%),ciprofloxacin(538%),sparfloxacin(435%),doxycycline(423%),the total resistance rate was 489%.Conclusion To treat the ureaplasma urealyticum infection,the first choices are clarithromycin and roxithromycin.

Objective To determine the clinical characteristic, main treatment, and prognosis for the sake of more effective treatments for critically ill patients with H1N1 influenza. Methods Eight critically ill patients with H1N1 influenza in intensive care unit were retrospectively studied, including clinical characteristics, indexex of correlation, and prognosis. Results The acute physiology and chronic health evaluationⅡ score was 19.0±7.8. Five patients died, 4 of whom were caused by respiratory failure. The number of platelets in dead patient was lower than that in healing and improved ones(χ2=8.000,P＜0.05).All the 4 patients treated with glucocorticoid died, 5 out of the 6 patients received invasive mechanical ventilation rather than noninvasive mechanical ventilation, and 3 of them who complicated barotraumas in the lung died at last. Conclusion Critically ill patients with H1N1 influenza have high mortality. Respiratory failure is the main cause of death. Critically ill patients with H1N1 influenza should not be treated with glucocorticoid. Patients who need mechanical ventilation should be treated with invasive mechanical ventilation with low tidal volume and low positive end-expiratory pressure.

Objective To investigate effect of sorafenib on serum hepatoma marker in patients with advanced hepatocellular carcinoma. Methods 101 patients with advanced hepatocellular carcinoma were selected, and divided into two groups.50 cases in control group were treated with routine clinical treatment, and 51 cases in experimental group were treated with sorafenib on the basis of control group.The survival time, adverse reactions, VEGF, CTGF, HIF-1 and OPN levels were compared after the treatment.Results The survival time of experimental group was higher than control group (P<0.05).Compared with control group, the serum levels of VEGF、CTGF,HIF-1, OPN,AFP, CEA, and CA199 in experiment group were lower (P<0.05,P <0.01).There were no significant differences of total adverse reactions between experimental group and control group. Conclusion Sorafenib can effectively prolong survival time of patients with advanced hepatocellular carcinoma, reduce serum VEGF, CTGF, HIF-1 alpha and OPN levels.

Objective: To analyze the clinical features and diagnostic and therapeutic procedure of microtia in Klippel-Feil syndrome(KFS), and to summarize the experiences on diagnosis and treatment of this kind of rare disease to avoid misdiagnosing. Methods: Between May 2014 and July 2015, six patients with microtia were diagnosed with suspected cervical vertebral malformation through physical examination and X-ray. Then they underwent additional examinations to evaluate the degree of deformities and relative risks: pure tone test, chest CT, cervical spine CT, temporal CT, echocardiography and ultrasonic on kidney and ureters. Ear reconstruction was performed with soft tissue skin expander and autogenous rib cartilage framework. Results: The six patients were diagnosed as KFS with microtia, which had different degree of cervical fusion and thoracic vertebral fusion. Some of them had rib deformity, scoliosis, congenital renal malformation and so on. Of 6 patients, scar formation occurred in 1 case after ear reconstruction, whose new ears had good position and appearance at 1 month after stage II. After operation, 6 cases were followed up for 8-20 months (median, 12 months), none of them had nerve injury. Five cases had completed the third stage. All of them were well-healed after one month. Three cases were followed up for 3-11 months, the reconstructed ears had a three-dimensional configuration, and the cranioauricular angle of the reconstructed ears were similar to the opposite ears. Conclusions The primary step of comprehensive therapy in microtia with KFS is to diagnose definitely. Enhancing perioperative management can reduce surgery-related risks. It is ought to pay attention to nerve injury in a long-term follow-up.

Objective To understand the current status of research on lung cancer immunotherapy to provide a reference for further investigation and future topic selection in this field. Methods CiteSpace visualization analysis software was used to analyze 400 Chinese studies in CNKI and 5 001 English studies in the Web of Science database from 2005 to 2021, with "lung cancer" and "immunotherapy" as keywords. Keyword co-occurrence analysis was performed on 17 English studies of "Lung Cancer" "Immunotherapy" and "Single cell sequencing" in the Web of Science database. Results "Non-small cell lung cancer" "immunosuppressants" "PD-L1" "dendritic cells" and "cytokine-induced killer cells" are current research hotspots in lung cancer immunotherapy. Monoclonal antibody drugs including nivolumab, pembrolizumab, atezolizumab, and durvalumab are hotspot drugs. Immunotherapy combined with chemotherapy as well as PD-L1 expression have become the focus of continuous research. The majority of studies on lung cancer immunotherapy are conducted in the United States, followed by China. Conclusion Lung cancer immunotherapy has gradually become a research hot spot in China. In the future, in-depth research is needed to provide cutting-edge directions for lung cancer immunotherapy.

Objective:To explore the research progress and hotspots of nurse-led care models in China, in order to provide references for further research.Methods:The Papers related to nurse-led care models included before 2019 were retrieved from Wanfang database and based on core nursing periodicals from Chinese S&T Journal Citation Reports(Natural Science)(2018 edition), used Bicomb2.0 for word frequency analysis of key words, then used SPSS22.0 for clustering analysis.Results:Totally 118 references and 33 high frequency keywords were retrieved. The number of literature about nurse-led showed a fluctuating upward trend. Researchers could get most of the information about nurse-led intervention mode from Journal of Nursing Science, Chinese Nursing Research and Chinese Nursing Management. By cluster analysis, the hotspots of nurse-led mainly involved critical illness, tumor, chronic disease, community rehabilitation and so on. Conclusions:The nurse-led model has been used in many kinds of diseases and has formed a certain scale, but there is still more room for development. Nursing experts from different regions should strengthen cooperation to improve the nurse-led intervention mode.

Objective: To seek an accurate and objective method to locate reconstructed auricles and design frameworks with digital technology for microtia patients with craniomaxillofacial asymmetry, improving the symmetry of the postoperative ears. Methods: From September 2014 to February 2016, 50 unilateral microtia patients with craniomaxillofacial asymmetry who were scheduled for auricular reconstruction were included in the study. The digital models of the patients′ ears and heads were based on the scan data preoperatively, which were collected by the three dimensional(3D) photogrammetric scanning technique. The reconstructed auricle was positioned by the mirror image of the contralateral side on the digital models. Based on the location, the morphological parameters and the corrective parameters of the autogenous cartilage frameworks could be obtained. With the guidance of the above information, ear reconstruction with tissue expander could be carried out. Results: Auricular and craniofacial morphology could be reflected vividly by the digital models. Meanwhile, the location and parameters of the reconstructed ear could be acquired. And the outcomes of the 50 reconstructed ears were satisfactory with symmetrical appearance. With 1 to 8 months (average 6.8 months) of follow-up, both the doctors and the patients were satisfied with the postoperative result. Conclusions Utilizing the location and parameters which were obtained from the digital models based on 3D photogrammetric scanning is an accurate and objective way to gain more symmetrical result in clinical ear reconstruction for microtia patients with craniomaxillofacial asymmetry.

Objective: To discuss the strategy for dealing with the failed reconstructed ears. Methods: From January 2010 to January 2015, 14 cases (14 ears) were admitted to our department because of failed reconstructed ears. It was impossible to improve their appearance greatly just by adjusting the original structures. We had to take out the framework and re-reconstruct the ear with autologous costal cartilages. Depending on the conditions of soft tissue, we divided them into three groups: Group 1, 8 ears(57.1%), the soft tissue could be reused simultaneously after being dealt with appropriately although the original frameworks were distorted badly. We took out the original frameworks, harvested cartilages again, fabricated the new frameworks and wrapped them with the original soft tissue. Group 2, 4 ears(28.6%), the structures were damaged completely, just with the constricted scars and skin graft clinging on the mastoid bone. We wrapped the new framework with axial temporal superficial fascia flap and then covered the wound with skin graft; Group 3, 2 ears(14.3%), the structures were distorted seriously. The skin flap covering the framework constricted badly while the post-auricular fascia flap was unspent. We took out the framework, implanted the skin expander under the spread skin flap, and then re-reconstructed the ear with expansion method. Results: 13 of 14 cases( 92.9%)were rebuilt successfully. The new ears maintained the landmark subunits 1 month after surgery. In 1 case (7.1%) from group 3, the creased skin had a rupture during skin expansion period. The expander had been taken out, and then a new one was replaced 3 months later. Follow-up period was 3-12 months. The structures of all the 14 rebuilt ears were stable and much better than before. Conclusions Good results could be achieved when appropriate method was selected for failed reconstructed ear. The condition of soft tissue of distorted reconstructed ear should be considered.