Objective To analyze thyroid papillary carcinoma (PTMC) neck lymph node metastasis (LNM) related factors,and further to explore the diagnostic value of ultrasonography in LNM.Methods A retrospective analysis of 384 cases of patients with PTMC confirmed by pathology and ultrasonic data were performed,according to the presence of cervical lymph node metastasis,they were divided into transfer group (116 cases) and nontransfer group (268 cases).Analysis was made to summarize the clinical and sonographic features of the two groups.Chi-square test and the multi-factor Logistic regression analysis were used to study the risk factors.Results ①The single factor analysis of sonographic features showed that the factors of gender (X 2 = 3.893,P = 0.048),age (P = 0.001),tumor diameter (P = 0.008), boundary(X 2 =6.327,P =0.012),acoustic halo (X2 = 15.562,P =0.001),and place (X 2 =9.441 ,P =0.024) were statistical different between the two groups;②Multiariable Logistic regression analysis showed that:patient age,tumor diameter,and acoustic halo were independent risk factors for PTMC neck lymph node metastasis,if Logistic model was used to predict the probability P =0.50 as a threshold,its accuracy was 74.2%,and the area under the ROC curve was 0.744.Conclusions Patients with age ≤ 45 years, tumor diameter ≥ 0.7 cm,located in the lower pole,boundary with uneven acoustic halo,were prone to LNM,and easy to Ⅵ area,suggest preventive cleaning lymph node in central region.

Objective To assess the application effect of the catheter management software on the management of Indwelling urinary catheter in the Emergency intensive care unit (EICU). Methods A prospective control study of targeted surveillance of catheter-associated urinary tract infection was conducted from January 2014 to December 2015 in EICU. The patients were divided into two groups. The patients in control group (131 patients) were treated from January 1, 2014 to December 31, 2014 and received routine catheter management, and the patients in test group (135 patients) were treated from January 1, 2015 to December 31, 2015, and received catheter management by software. The catheter management software was developed and applied, and the process specification which collaborated with the software was established. The quality of the catheter management including the omission rate of the catheter management, the rate of urinary catheter-associated urinary tract infections (CAUTI) and the rate of catheter used etc were evaluated after the software's application. Results Through software applications, the omission rate of the catheter management, the omission rate of urine drainage bag replacementand the omission rate of urinary catheter replacement in test group were significantly lower than those in control group:0 vs. 36.64%(48/131), 0 vs. 15.27%(20/131) and 0 vs. 9.92%(13/131), P<0.01 or<0.05. The performance rate of catheter daily management in test group was significantly higher than that in control group: 99.26%(134/135) vs. 64.12%(84/131), P<0.01. The rate of CAUTI in test group was significantly lower than that in control group: 1.90‰ vs. 9.16‰, χ2=4.843, P=0.028. The rate of catheter used in test group was significantly lower than that in control group: 60.74%(82/135) vs. 73.28%(96/131), P<0.01. Conclusions The development and the establishment of the management software can improve the rate of implement, and declinethe rate of CAUTI.

Objective To investigate the correlation of BRAF mutation frequency with cervical lymph node metastasis ,and to compare the ultrasonic characteristics in patients with BRAF mutation in papillary thyroid carcinoma ( PTC) different subtypes . Methods The tumor samples were collected from 139 PTC patients who underwent thyroidectomy . And they were classified by histological subtype into 3 groups:classic variant of papillary thyroid carcinoma (CVPTC) group( 34 cases) ,follicular variant of papillary thyroidcarcinoma (FVPTC) group(36 cases) ,tall cell variant (TCV) group(69 cases) . The BRAF mutation frequency and the correlation with cervical lymph node metastasis among 3 groups were analyzed , then the ultrasonic characteristics with BRAF mutation in PTC different subtypes were compared . Results①The frequency of BRAF mutation was statistically significant different in different subtypes( χ2 =6 .390 , P =0 .041) ,and the frequency in TCV was 86 .9％ . There was also a statistical difference between BRAF mutation frequency and cervical lymph node metastasis among three subtypes ( χ2 = 13 .106 , P =0 .041) .②There was no statistically significant difference among the three groups in nodule number ,echo level , internal structure ,boundary ,crossbar ,morphology and acoustic halo of patients with BRAF mutation ( P >0 .05) . ③ A single factor analysis was performed for the ultrasonographic characteristics of patients with BRAF mutation ,and there were significant statistical differences among the 3 groups in calcification type (χ2 = 21 .7 , P = 0 .001 ) and close to the envelope (χ2 = 7 .726 , P = 0 .021 ) . ④ Multivariate logistic regression showed that BRAF mutation was an independent influence factor affecting the calcification type of different histological subtypes in PTC patients.Conclusions ①BRAF mutation is correlated with cervical lymph node metastasis in different PTC subtypes . ② BRAF mutation is an independent influence factor affecting the morphology type of different calcification subtypes in PTC . The CVPTC group is mainly microcalcification ,and the TCV group is mainly macrocalcification .

Objective: To perform an epidemiological survey of the first case with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Pinghu City of Jiaxing City, Zhejiang Province on March 13, 2022, so as to provide insights into the management of coronavirus disease (COVID-19) epidemics. Methods: According to the requirements of the Protocol on Prevention and Control of COVID-19 (8th Edition), epidemiological investigations were performed among 39 cases with SARS-CoV-2 infections in Pinghu City from March 13 to 20, 2022. Cases' demographics, clinical symptoms, history of immunization and exposure were collected, and close contacts were identified. Pharyngeal swabs were sampled from infected cases for detection of SARS-CoV-2 nucleic acid and whole-genome sequencing, and the source of infection and transmission route were investigated. Results: The index case for this COVID-19 epidemic was an imported case from Shanghai Municipality, who infected 6 persons via aerosol transmission when playing in the badminton venue of Pinghu National Fitness Center on March 9; subsequently, one of these infected cases infected another 18 persons when playing in the badminton venue of Jiadian Village Resident's Fitness Center in Zhapu Township on March 12. Sixteen confirmed cases were reported, and all cases were mild; another 23 asymptomatic cases were diagnosed, with no death reported. This epidemic occurred from March 11 to 20, with 3 generations of spread and a median incubation period of 3 days. The SARS-CoV-2 infected cases had a median age of 33.5 (interquartile range, 12.0) years and included 36 cases with a history of COVID-19 vaccination. There were 16 cases with fever, cough, runny nose and sore throat, and 13 cases with imaging features of pneumonia. The effective reproductive number (Rt) of the COVID-19 epidemic was 7.73 at early stage, and was less than 1 since March 21. Whole-genome sequencing identified Omicron BA.2 variant among 33 cases, which had high homology with the index cases. Conclusion This epidemic was a cluster of COVID-19 caused by imported Omicron BA.2 variant infection from Shanghai Municipality, and the COVID-19 transmission was mainly caused by indoor aerosols.

Objective:To investigate the relationship of HRAS gene mutation and lymph node metastasis and ultrasonographic characteristics in differentiated thyroid carcinoma (DTC).Methods:The clinical data of 162 patients with DTCs who underwent thyroidectomy and confirmed by postoperative pathological examination in Beijing Friendship Hospital from January 2014 to February 2019 were retrospectively analyzed. There were 139 patients with papillary thyroid carcinoma (PTC group) and 23 patients with follicular thyroid carcinoma (FTC group); the PTC were further classified as classic variant of papillary thyroid carcinoma (CVPTC, n=34), follicular variant of papillary thyroid carcinoma (FVPTC, n=36) and tall cell variant (TCV, n=69). Tissue HRAS mutation frequency was detected in 162 DTC patients and 19 patients with follicular adenoma (FA); blood HRAS mutation frequency was detected in 195 healthy subjects. The correlation between HRAS mutation (IVS1-82del gctgggcctggg) and cervical lymph node metastasis was analyzed, and the ultrasonographic characteristics of DTC patients were also analyzed. Results:The frequency of HRAS mutation in DTC patients was higher than that in healthy controls[37.0%(60/162) vs. 26.2%(51/195), χ2=4.538, P=0.03], while there was no significant difference between FTC and FA [39.1%(9/23) vs. 5/19, χ2=0.769, P=0.38]. In DTC patients there was no significant difference in cervical lymph node metastasis between HRAS mutation group and wild type group [57.3% (43/75) vs. 42.6% (32/75), χ2=1.898, P=0.16]. Among CVPTC, FVPTC and TCV patients, the rates of cervical lymph node metastasis were 7/12, 8/14 and 48.0% (12/25) in HRAS mutation group, while those were 50.0% (11/22), 40.9% (9/22) and 43.1% (19/44) in wild-type group, respectively (χ2=1.009, P=0.98).There were 9 patients with HRAS mutation in FTC group, and the cervical lymph node metastasis in mutation group and wild-type group was 5/9 and 4/14, respectively ( P=0.38). The ultrasonographic characteristics of PTC patients with HRAS mutation were more likely to have clear boundaries [66.7%(34/51) vs. 42.0%(37/88); χ 2=7.833, P<0.01] and not close to the membrane[84.3%(43/51) vs. 65.9%(58/88);χ2=5.506, P=0.02]. Conclusion:DTC patients are more likely to have HRAS (IVS1-82del gctgggcctggg) mutation, and the ultrasonic characteristics of DTC patients with HRAS mutation are likely to have clear boundaries and be not close to the membrane.