Objective To study the clinical features and treatment of 12 cases of lupus vulgaris.Methods A comprehensive study was performed on 12 patients with lupus vulgaris.The clinical and histopathological features,misdiagnosis,treatment and prognosis of this entity were analyzed.Results Of these patients,83.3％ had a history of local trauma before the occurrence of lupus vulgaris.All the patients showed an early onset and long clinical course of lupus vulgaris,absence of obvious symptoms and variety in skin lesions.Lupus vulgaris was misdiagnosed at the first visit in all the patients.The final diagnosis was confirmed by histopathology,purified protein derivative (PPD) test,acid-fast staining,Mycobacterium tuberculosis culture,DNA sequencing,etc.Satisfactory outcomes were achieved in these patients after standard anti-tuberculosis treatment.Conclusions Lupus vulgaris is easy to be misdiagnosed and improperly treated due to its complicated clinical features.Clinicians should expand their knowledge about this entity,which can be diagnosed by histopathology and culture.

Objective: To understand the survival status and influencing factors of first-ever stroke patients, so as to provide evidence for improving the quality of life and prognosis of stroke patients. Methods: Demographic information, medical history, smoking history, and alcohol consumption history of newly diagnosed stroke cases first reported in 2017 in Xiaoshan District were collected through the Hangzhou Chronic Disease Surveillance and Management System. Patients were followed up for 5 years, with stroke death as the outcome event. The survival rate was calculated using the Kaplan-Meier method, and factors affecting survival time of first-ever stroke patients were identified using a multivariable Cox proportional hazard regression model. Results: A total of 3 886 patients first-ever stroke patients were included, the cases of cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, and stroke unspecified as to whether it was hemorrhagic or ischemic (unspecified) accounted for 86.93%, 11.45%, 1.06% and 0.57%, respectively. There were 2 047 males (52.68%) and 1 839 females (47.32%), with a mean onset age of (72.01±11.61) years. By the end of the follow-up on December 31, 2022, 906 patients died from stroke, with a median follow-up time of 62.00 (interquartile range, 35.00) months. The 1-year survival rate was 87.35% (95%CI: 86.30%-88.41%), the 3-year survival rate was 82.11% (95%CI: 80.88%-83.34%), and the 5-year survival rate was 76.64% (95%CI: 75.26%-78.02%), respectively. Multivariable Cox proportional hazard regression analysis showed that onset age of ≥75 years (HR=5.543, 95%CI: 3.822-8.039), being treated at township-level hospitals (HR=5.934, 95%CI: 4.027-8.743), history of hypertension (HR=1.566, 95%CI: 1.317-1.863), history of chronic ischemic heart disease (HR=1.611, 95%CI: 1.362-1.906), smoking history (HR=1.455, 95%CI: 1.190-1.778), alcohol consumption history (HR=1.323, 95%CI: 1.067-1.641), stroke subtype of intracerebral hemorrhage (HR=3.442, 95%CI: 2.923-4.053) and unspecified (HR=6.843, 95%CI: 4.353-10.756) were associated with higher mortality risk among first-ever stroke patients. Conclusion The 5-year survival rate of first-ever stroke patients was 76.64%, which was influenced by age of onset, hospital level for diagnosis and treatment, stroke subtype, medical history, smoking and alcohol consumption.

Objective: To investigate the trends in incidence of malignant tumors in Xiaoshan District, Hangzhou City from 2015 to 2020, so as to provide the evidence for improving the control strategy for malignant tumors. Methods: Data on incidence of malignant tumors in Xiaoshan District from 2015 to 2020 were collected through Hangzhou Municipal Chronic Disease Monitoring Management System. The crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were calculated, and the trends in incidence of malignant tumors were analyzed using average annual percent change (AAPC). Results: The crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were 476.95/105, 333.30/105, 257.01/105, 28.30% and 425.79/105 in Xiaoshan District from 2015 to 2020, which all appeared a tendency towards a rise (AAPC=4.36%, 3.82%, 3.99%, 3.79% and 5.20%, all P<0.05). The crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were 491.47/105, 313.31/105, 251.51/105, 28.78% and 338.82/105 among men, and both the crude incidence and truncated age-standardized incidence for 35 to 64 years appeared a tendency towards a rise (AAPC=3.00% and 1.73%, both P<0.05), while the crude incidence, Chinese population-standardized incidence, world population-standardized incidence, cumulative incidence for 0 to 74 years, and truncated age-standardized incidence for 35 to 64 years of malignant tumors were 462.98/105, 348.46/105, 262.13/105, 27.74% and 504.91/105 among women, which all appeared a tendency towards a rise (AAPC=5.77%, 5.72%, 5.79%, 5.65% and 7.48%, all P<0.05). The incidence of malignant tumors appeared a tendency towards a rise with age, and the crude incidence of malignant tumors showed a tendency towards a rise among people at ages of 15 to 44 years and 45 to 64 years (AAPC=9.85% and 4.88%, both P<0.05). Lung cancer, thyroid cancer, colorectal cancer, breast cancer and gastric cancer were the five most common cancers, accounting for 59.63% of all malignant tumors, and the incidence of lung cancer, thyroid cancer, colorectal cancer and breast cancer all showed a tendency towards a rise (AAPC=5.90%, 13.01%, 4.60% and 4.47%, all P<0.05). Conclusions The incidence of malignant tumors showed a tendency towards a rise in Xiaoshan District from 2015 to 2020. The rise in the incidence of malignant tumor was higher in females than in males, and malignant tumors tended to develop at a young age. Lung cancer, thyroid cancer, colorectal cancer, breast cancer and gastric cancer are major malignancies that threaten human health in Xiaoshan District.

Objective:To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection.Methods:Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared.Results:Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant ( P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ 2=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ 2=11.49, P<0.01) . Conclusion:FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.

Objective:To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection.Methods:Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared.Results:Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant ( P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ 2=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ 2=11.49, P<0.01) . Conclusion:FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.

Objective To investigate the effect of continuous 4C nursing model on coronary heart disease rehabilitation and provide basis for nursing intervention.Methods From January to June 2015, 90 patients with coronary heart disease hospitalized in Shaoxing People's Hospital were selected as the research object by convenient sampling method. Patients were divided into two groups according to the sequence of hospital admission, with the single number as the control group and the even number as the observation group, each group had 45 patients. Patients in the control group received conventional care model. Patients in the observation received continuous 4C intervention model. The quality of life of two groups of patients and readmission rates were compared.Results All dimensions of quality of life in observation group were higher than those of control group 6 months after discharge, the differences were statistically significant (t=4.159, 3.373, 2.150, 2.162, 3.597, 2.042, 3.913, 2.144;P<0.05). There was no significant difference in readmission rates between the two groups (χ2=0.714,P=0.398).Conclusions The continuous 4C nursing model can improve the quality of life of patients with coronary heart disease, which is worth popularizing and applying.

Objective This review aimed at assessing the diagnostic efficacy of contrast-enhanced single-photon emission computed tomography (SPECT) in the diagnosis of mandibular invasion by oral cancers. Methods Five databases were searched electronically on August 5, 2016. The reference lists of included studies were hand searched. Quality assessment was performed by two reviewers in duplicate with tools suggested by Cochrane's handbook. Furthermore, the data extraction of included studies was delivered. Meta-analysis was performed using STATA 11.0. Results Ten studies with 460 participants were included. One study had a low risk of bias, and two studies had a high risk of bias. The remaining seven studies had an unclear risk of bias. Meta-analysis results showed that SPECT had a pooled sensitivity of 0.99 [95% confidence interval=0.87-
1.00]. Sensitivity was 0.99 on Q* point. The specificity of 0.61 and the area under summary receiver operating characteristic curve (SROC) were 0.93 [95% confidence interval=0.90-
0.95]. The pooled positive likelihood ratio was 2.555. The negative likelihood ratio was 0.015. The diagnostic odd ratio was 5.115. Conclusion SPECT had high sensitivity, which became suitable for excluding bone invasion by oral cancers. However, its specificity was relatively low, indicating its limited capability in confirming diagnosis. Therefore, surgeons should perform this method under certain conditions.