Objective To evaluate the postoperative pain induced by various therapeutic catheters after abdominal surgery.Methods A prospective study was conducted in patients selected based on the inclusion criteria.The general condition of the patients was recorded,and nutritional risk screening was performed.The indwelling of therapeutic catheters after abdominal surgery were recorded,including urinary catheter,nasogastric tube,peritoneal drainage tube,common bile duct drainage tube,wound drainage tube,central venous catheter and peripherally inserted central catheter.The pain caused by each type of catheters was evaluated using visual analog scale at 24,48 and 72 hours after tube/catheter insertion.Results A total of 157 patients were selected,including 70 males and 87 females,aged (60.5 ± 12.5) years,with a body mass index of (23.8 ± 3.2) kg/m2,and a total nutritional risk rate of 42％.According to visual analog scale scores,the degrees of pain due to the therapeutic catheters,in descending order,were as follows:4.9 ± 1.7 for nasogastric tube,3.6 ± 0.9 for wound drainage tube,3.0 ±0.9 for urinary catheter,2.6 ±0.9 for central venous catheter,2.4 ± 1.0 for peritoneal drainage tube,1.9 ± 0.7 for common bile duct drainage tube,and 1.8 ± 0.8 for peripherally inserted central catheter.The catheter-induced pain accounted for (44.9 ± 14.1)％ of the total pain during the hospital stay.Conclusions Nasogastric tube,wound drainage tube and urinary catheter can increase the pain of patients.It is therefore recommended to remove the indwelling tubes as early as possible if only the removal does not harm the outcome of the patient.

Objective To summarize the perioperative clinical care experience of parenteral and enteral nutrition supports in post-hepatectomy patients.Methods The clinical data of 146 consecutive post-hepatectomy patients in Beijing Hospital were collected and analyzed.For these patients,nutritional risk screening (NRS) 2002 was performed after admission,enteral nutrition support was provided before operation,and enteral and parenteral nutrition supports were provided after operation.Nutritional parameters,clinical outcomes,and nursing methods were evaluated.Results Among these 146 patients,91 patients had≥3 NRS2000 scores,and the remaining 55 patients scored ＜ 3.A total of 118 patients were administrated with enteral and pareteral nutrition;the average enferal nutrition time was 9.6 days,and the average pareteral nutrition time was 5.4 days.The average onset time of passage of gas by anus afar operation was (70.7±17.1) hours.Three patients died,15 patients suffered from infections after operation,and 13 patients experienced other complications.The median hospital stay was 25.5 days.Conclusions Post-hepatectomy patients need take nutritional risk screening after admission and receive appropriate nutritional supports in the perioperative period.It is equally important to strengthen clinical nursing for nutrition support.

Background and purpose:This study investigated the value of cervical ultrasound and TSH-sup-pressed thyroglobulin in the diagnosis of recurrence or metastasis of differentiated thyroid carcinoma (DTC).Methods:This study analyzed the data on 196 thyroid carcinoma patients who underwent neck dissection after clinically sus-pecious recurrence of DTC in Peking Union Medical College Hospital from Aug. 2010 to Dec. 2014. Among the 196 patients, 62 patients sonographically suspecious recurrence after total thyroidectomy and/or radioactive iodine ablation therapy were enrolled in this study. The ultrasonic features of lymph node involvement were retrospectively analyzed. The value of the ultrasonic features in the diagnosis of lymph node involvement and a TSH-suppressed serum Tg level in the diagnosis of recurrence or metastasis of DTC was also evaluated.Results:Of the 62 patients, 59 were pathologi-cally conifrmed with lymph node involvement, 1 case with local recurrence and 2 cases without recurrence or metasta-sis. There were 121 ultrasonographically suspected lymph nodes, conifrmed by pathology, 92 were metastatic ltsions, 25 were non-metastatic, 3 were ifbrous tissue and 1 was striated muscle. The positive predictive rate of cyst, calciifcation or hyper-echogenicity in cortex was 100% in the diagnosis of lymph node involvement. There was a signiifcant difference in disordered vascularity and cyst in cortex between metastatic and non-metastatic lymph nodes. Forty-nine patients were positive for Tg, whereas 13 were negative. The accuracy, sensitivity and speciifcity of TSH-suppressed serum Tg in the diagnosis of recurrence or metastasis of DTC were 82.3%, 81.7% and 100%.Conclusion:The disordered vascularity and cyst in cortex of the lymph node are highly speciifc indexes in diagnosing lymph node involvement. TSH-suppressed serum Tg level has high diagnostic value for detection of recurrence or metastasis of DTC. Cervical ultrasound can identify recurrent or metastatic lesions in both Tg-positive and Tg-negative patients.

Objective To compare diagnostic values of the 2015 American Thyroid Association (ATA) Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer with the thyroid imaging reporting and data system (TI-RADS) for sonographic malignancy risk stratification of thyroid nodules.Methods From November 2011 to December 2015,485 thyroid nodules in 331 patients (mean age,42.9 years± 10.4)were included in this study.Characteristics includingsize,composition,shape(nonparallel or parallel),margin,echogenicity,calcifications and extrathyroidal extension of thyroid nodules were evaluated.Every nodule was stratificated by criteria set by TI-RADS and ATA guidelines,and malignant rate of each risk stratification were calculated and analysed.With pathology as the gold standard,different cutoff were taken to diagnose malignant nodules,and the sensitivity,specifity,positive predictive value,negativepredictive value and accuracy of the two methodologies were calculated at each cutoff.And the two methodologies were evaluated and measured by ROC curve.Finally their Kappa value were calculated at the best cutoff.Results Of the 485 thyroid nodules,96 were benign and 389 were malignant.The malignancy rates under TI-RADS category 2,3,4a,4b,4c,and 5 nodules were 0,12.0％ (3/25),22.2％ (10/45),29.8％ (14/47),99.2％ (261/363) and 100％ (101/101).Malignancy rates under ATA guidelines of benign,very low,low,intermediate,and high suspicion for malignancy were 0,12.5％ (1/8),16.1％ (10/62),27.7％ (13/47),and 99.2％ (365/368).There were significant differences inside each patterns (P ＜ 0.01) respectively and high correlation between risk stratification with TI-RADS (r=0.70) and ATA guidelines (r=0.83).Areas under the ROC curve of the TI-RADS and ATA guidelines classifications were 0.966 and 0.959.Best cut-off point for diagnosing malignant by TI-RADS and ATA guideline classifications were ≥ 4c and ≥ high suspicion,and at that point,diagnostic value of TI-RADS and ATA guidelines were nearly the same(sensitivity,93.1％vs 93.8％;specificity,97.9％ vs 96.9％;PPV,99.5％ vs 99.2％;NPV,75.7％vs 79.5％;and accuracy,94.0％vs94.4％),and there was no significant differences (P=0.50,P=0.50,P=0.50,P=0.53,P=0.55),Kappa=0.97.Conclusions Both TI-RADS and the ATA guidelinesprovide effective malignancy risk stratification for thyroid nodules.The diagnosticvalue of TI-RADS when considering ≥ 4c and ATA guidelines when considering ≥ high-suspicion nodules as malignant were nearly the same and both high.