One hundred patients were diagnosed with coronary heart disease through dual-source CT coronary angiography (DSCTA) in our hospital,including 53 cases aged ≥60 y (elderly group) and 47 cases ＜60 y (middle-aged group).The curved-planar reconstruction (CPR),maximal intensity projection (MIP) and other post-processing reconstruction techniques were used to evaluate the indicators and differences of coronary stenosis ≥ 50％ ; the X-ray coronary angiography (CAG) findings were regarded as the gold standard.The evaluable rates of coronary arteries through DSCTA were 97.0％ and 98.6％ for two groups (P ＞0.05).The positive rate of coronary artery stenosis ≥ 50％ in elderly group was higher than that of middle-age group ( 12.6％ vs 9.0％ P ＜0.05 ).The rates of multi-vessel disease in elderly group (28.3％ ) was also significantly higher than that of middle-age group (6.4％,P ＜0.05 ).The sensitivity,specificity,positive predictive value and negative predictive value in evaluation of coronary artery stenosis ≥ 50％ for elderly patients were 92.3％,98.0％,88.0％ and 98.9％ respectively; those for middle-aged patients were 96.0％,99.0％,90.6％ and 99.6％ respectively ( P ＞0.05 ).DSCTA imaging provides an effective screening and evaluation method for coronary heart disease in elderly and middle-aged patients.

Objective:To consolidate ten years of clinical experience on the application of breast fiberoptic ductoscopy (FDS) in breast intra-ductal lesion. Methods:The clinical data of 1 368 cases of patients with nipple discharge were retrospectively collected and analyzed. Results:Significant differences were observed in the FDS diagnoses of patients with nipple discharge. The rates of tumor de-tection by FDS diagnosis were significantly higher when bloody and serous nipple discharge was used rather than milky and watery nip-ple discharge. For non-tumor nipple discharge, local drug perfusion via FDS was an effective treatment. A total of 303 patients had tu-mor resection or segmentectomy under localization via FDS, and 44 had segmentectomy after breast duct infusion of methylene blue. The diagnostic rate of localization via FDS (97.0%) was higher than that of breast duct infusion of methylene blue (86.4%). Conclu-sion:FDS is an accurate method for diagnosing patients with nipple discharge. In addition, it is also a good local drug perfusion method for patients with breast inflammatory nipple discharge ductoscopy. For patients with tumorous nipple discharge, localization via FDS can help improve the detection of the lesions, which can be removed by surgery.

Objective To investigate into hand hygiene facilities and worker's practice of hand hygiene during 120 ambulance services in a capital city.Methods With the standard Observation Form publicized by the World Health Organization,field observation was carried out to monitor hand hygiene facilities and the practice of hand hygiene in workers during ambulance services provided by four service centers.Results A total of seven ambulances and 80 times of services were observed across a span of 21 days.The provision and position of hand hygiene facilities were found very limited in these ambulances.Of 656 times of presence of indictors for hand hygiene,the overall compliance rate was 3.04％ reflecting the practice of hand hygiene in ambulance workers.The compliance rate was found to be 0 (0/291),1.96％ (1/51),13.64％ (3/22),5.21％ (16/307) and 0(0/2) before touching patients,after body fluids exposure risk,before clean/aseptic procedures and after touching patients' surroundings respectively.Conclusions Poor practice of hand hygiene which was revealed in 120 ambulance services suggests the great need for education and training to improve patient safety and occupational health.

Objective To explore the feasibility and value of laparoscopic-assisted surgery(LAS) for colorectal cancer.Methods The clinical data of 51 cases of LAS for colorectal cancer were reviewed retrospectively.Of them,3 cases were converted to open operation,and in 48 cases LAS for colorectal cancer was completed.Among them,9 cases underwent right hemicolectomy,8 cases left hemicolectomy,14 cases sigmoid resection,9 cases rectal anterior resection,and 6 cases Miles operation.Results No intra-operative deaths occurred. The average operation time was 195(150-320)min with 120(40-300)mL average blood loss.The average number of lymph nodes excised was 8(2-26).The time of bowel function recovery was 20-72h after operation.The average hospital stay after operation was 8(7-10)d.No major intra-operative blood loss nor postoperative complications were observed.The follow-up time was from 3-54months for 45(88.2%) patients.Two cases with Ducke′s C rectal cancer died,one died of liver metastasis 17 months after operation,and the another died of diffuse peritoneal metastasis 19 months after operation.There was no trocar port tumor metastasis and no local tumor recurrence at the small abdominal incision.Conclusions LAS of colorectal cancer is technically feasible and has advantages such as less surgical trauma,less bleeding and quick recovery.It is a mini-invasive,safe and efficient treatment for colorectal cancer.

Objective:To evaluate whether the decrease in peripheral blood monocyte count was a potential predictor for neutropenia in patients with nasopharyngeal carcinoma and cervical cancer.Methods:The medical records of 95 patients with nasopharyngeal carcinoma and cervical carcinoma who received intensity-modulated radiation therapy (IMRT) combined with paclitaxel liposomes and platinum (TP) synchronous chemotherapy and presented with neutropenia in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were retrospectively analyzed. Paired sample t-test was used to assess whether the number of days when the monocytes initially dropped/decreased to lowest level/eventually increased to normal value was significantly less than those of the neutrophils. In addition, the chi-square test was performed to determine the correlation between the degree of reduction in the absolute neutrophil count (ANC) and baseline absolute monocyte count (AMC). Results:The change trend of AMC was consistent with that of ANC in the two cycles of concurrent chemotherapy. The number of days when AMC initially decreased/decreased to the lowest level/finally increased to normal value was significantly less than that of ANC (4 d vs. 6 d, 4 d vs. 10 d, P<0.001; 5 d vs. 6 d, 6 d vs. 9 d, 7 d vs. 12 d, P<0.001). However, no correlation was found between the baseline level of monocytes and the degree of subsequent neutropenia [(AMC<0.4×10 9) vs.( AMC≥0.4×10 9)=32 vs. 63, P=0.172]. Conclusions:Decreased monocyte count is an important potential predictor for neutropenia and a significant indicator for guiding the next monitoring of neutrophil count and treatment with granulocyte colony-stimulating factor.

BACKGROUND AND PURPOSE: There is conflicting evidence in the literature on the association between benzodiazepines (BDZs) and the risk of dementia. This meta-analysis aimed to determine the relationship between the long-term usage of BDZs and the risk of dementia. METHODS: The PubMed and Embase databases were systematically searched for relevant publications up to September 2017. The literature search focused on observational studies that analyzed the relationship between the long-term use of BDZs and the risk of dementia. Pooled rate ratios (RRs) with 95% confidence interval (CI) were assessed using a random-effects model. The robustness of the results was checked by performing subgroup and sensitivity analyses. RESULTS: Ten studies were included: six case–control and four cohort studies. The pooled RR for developing dementia was 1.51 (95% CI=1.17–1.95, p=0.002) in patients taking BDZ. The risk of dementia was higher in patients taking BDZs with a longer half-life (RR=1.16, 95% CI=0.95–1.41, p=0.150) and for a longer time (RR=1.21, 95% CI=1.04–1.40, p=0.016). CONCLUSIONS: This meta-analysis that pooled ten studies has shown that BDZ significantly increases the risk of dementia in the elderly population. The risk is higher in patients taking BDZ with a longer half-life (>20 hours) and for a longer duration (>3 years).
Aged ; Benzodiazepines* ; Cohort Studies ; Dementia* ; Half-Life ; Humans

Objective: To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies. Methods: In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed. Results: (1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲ of TTTS and 7/11 in the stage Ⅳ of TTTS (P>0.05). The average gestational age was (33.6±3.0) weeks in stage Ⅲ of TTTS compared with (36.5±2.4) weeks in the stage Ⅳof TTTS (P<0.05). Conclusions RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. Type Ⅱand type Ⅲ sIUGR may choose this technique as a priority. Compared with stage Ⅲ of TTTS, the live birth rate and the gestation age at delivery in stage Ⅳ of TTTS, there are no significant differences.

We analyzed the characters of Sagliker syndrome by reporting a case of Sagliker syndrome and reviewed literature. We found that Sagliker syndrome had low incidence rate, young onset age, and was more common in women. There were high levels of alkaline phosphatase and parathyroid hormone in the blood of the patients. Patients with Sagliker syndrome with primary onset of non-diabetic nephropathy usually had chronic glomerulonephritis. We thought that secondary hyperparathyroidism in patients with Sagliker syndrome was induced by parathyroid hyperplasia, but high levels of alkaline phosphatase and parathyroid hormone in the blood of the patients with the secondary hyperparathyroidism were the main cause of Sagliker syndrome. Parathyroidectomy could stop the progress of Sagliker syndrome, but it could not reverse the occurrence of skeletal malformation.
Alkaline Phosphatase ; Chronic Disease ; Diabetic Nephropathies ; Female ; Humans ; Hyperparathyroidism, Secondary ; Parathyroidectomy ; Syndrome

Objective:To analyze and compare the pathological data characteristics of patients with simple papillary thyroid carcinoma (PTC) and PTC combined with Hashimoto’s thyroiditis (HT), so as to provide clinical treatment ideas.Methods:A retrospective analysis was performed on the medical records of 326 PTC patients who met the requirements and underwent surgical treatment in the Department of Thyroid and Breast Surgery, Nanjing Hospital of Traditional Chinese Medicine from Jan. 2020 to May. 2022. There were 81 males and 245 females. They were divided into PTC group and HT-PTC group, according to whether they were combined with HT. Clinical data were collected and organized. The collection indicators included patient gender, age, body mass index (BMI), five preoperative thyroid function items including free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), BRAF gene mutation, single or bilateral lesions, single or multiple lesions, largest postoperative pathological tumor lesions diameter, cervical lymph node metastasis (LNM) status, etc. At the same time, all patients were divided into CLNM group and no CLNM group according to CLNM status. The two groups were compared in terms of gender, age ≥55 years old, whether combined with HT, number of lesions, unilateral and bilateral, extraglandular invasion, microcarcinoma, and BRAF gene. Statistical software was used to analyze the results. t test, χ2 test, and logistic regression analysis were adopted. P<0.05 indicates that the difference is statistically significant. Results:The proportion of female patients in both groups was higher, and the proportion of female patients in the HT-PTC group (90/100, 90%) was higher than that in the PTC group (155/226, 69.59%). HT-PTC patients were younger than patients in the PTC group (43.03±12.72 vs. 43.70±12.63) years old, and their TSH (2.71±1.69 vs. 2.02±1.46) uIU/mL was higher. The differences were statistically significant (all P<0.05). There were no statistically significant differences in BMI, FT3, FT4, T3, or T4 (all P>0.05). The HT-PTC group had a lower proportion of BRAF gene mutations [87/100 (87%) vs. 212/226 (93.8%) ], a smaller maximum tumor diameter (1.06±0.73 vs. 1.32±0.97 cm), and a lower proportion of CLNM [37 /100 (37%) vs. 118/226 (52.2%) ]. The number of LNMs with metastasis is less (3.33±2.21 vs. 4.76±4.00), and it was more likely to be multifocal [44/100 (44%) vs. 73/226 (32.74%) ]. All differences were statistically significant (all P<0.05), and the differences in bilateral gland lobes involvement and extra-glandular invasion were not statistically significant. When accompanied by CLNM, gender (male vs. female) [55/100 (35.45%/64.52%) vs. 26/145 (15.2%/84.85%) ], age ≥ 55 years (yes vs. no) [21/134 (13.55) %/86.45%) vs. 50/121 (29.24%/70.76%) ], HT (yes vs. no) [37/118 (23.87%/76.13%) vs. 63/108 (36.84%/63.16%), number of lesions (single focus vs. multiple focus) [90/65 (41.94%/50.06%) vs. 119/52 (69.59%/30.41%) ], microcarcinoma (yes vs. no) [83/72 (53.55%/45.45%) vs. 139/32 (81.29%/18.71%) ] and extraglandular invasion (with vs. without) [38/117 (24.52%/75.48%) vs. 27/144 (17.42%/84.21%) ] had statistics significance (both P<0.05). There was no statistical significance in bilateral lesion involvement or BRAF gene mutation (all P>0.05). Multivariate logistic regression analysis showed that age, microcarcinoma, HT, gender, and number of lesions were independent risk factors for CLNM, and male gender and multifocal cancer were risk factors for CLNM. Age ≥55 years, microcarcinoma, and combined HT were negatively associated with CLNM. Conclusions:HT may promote the occurrence of PTC, but can inhibit its development. In the short term, patients with HT can have a better prognosis than those with simple PTC.

Objective:To study the effect of micro-course teaching combined with teacher standardized patient combined with objective structured clinical examination (TSP/OSCE) on clinical practice teaching of pediatric nursing.Methods:Forty nurses who performed clinical practice in Pediatrics Department from February 2019 to July 2019 were selected as the control group, and traditional teaching was adopted in the group. In addition, 42 nurses who performed clinical practice in Pediatrics Department from August 2019 to January 2020 were selected as the research group, and the micro-course teaching combined with TSP/OSCE mode teaching was adopted in the group. Two groups of nurses' theoretical and practical skills assessment results were analyzed, and a questionnaire survey was conducted to assess nurses' satisfaction with the teaching of pediatric nursing clinical practice training mode. SPSS 22.0 was used for t test and chi-square test. Results:The research group nurses' theoretical and practical skills assessment scores were better than those of the control group, and the difference was statistically significant ( P=0.000).The nurses in the research group were more satisfied than those in the control group with such eight aspects as improving practical skills, emergency response capabilities, humanistic care and service capabilities, communication skills, and stimulating their interest in nursing learning. There were statistically significant differences ( P<0.05). Conclusion:The use of micro-teaching combined with TSP/OSCE mode in the clinical practice teaching of pediatric nursing can improve nurses' clinical practice ability and increase nurses' satisfaction in pediatric training.