Objective To study the corelation of mucosal involvement and corticosteroid dosage in the control of bullous pemphigoid(BP). Methods One hundred and three in-patients with bullous pemphigoid hospitalized during 1988 - 2002 were retrospectively analyzed for their mean corticosteroid dosage for controlling the disease and the duration for complete relieving the skin lesions, as well as the duration to start corticosteroid tapering. All the patients were divided into two groups: group A (37 cases) with mucosal involvement and group B (66 cases) without mucosal involvement. Results The mean corticosteroid dosage used to control the disease in group A was much higher than that in group B (t = 3.488, P 0.05). Conclusion Patients with mucosal involvement require a higher dosage of corticosteroids to control the disease.

Objective To investigate the effect of group psychological counseling and peer education on depressive and anxiety symptoms of pregnant females with selective multiple pregnancy reduction in second trimester. Methods Sixty-two pregnant females with selective multiple pregnancy reduction in second trimester were randomly divided into intervention group(n=30)and control group (n=32), two groups of pregnant women all received routine nursing. The pregnant women of intervention group received group psychological counseling and peer education for one month before multiple pregnancy reduction. Results Before the intervention, the anxiety levels of the two groups of pregnant women were not significantly different. After the intervention, the intervention group had less anxiety symptoms than before the intervention[ before(54.2 ± 3.2)points,after(43.4 ± 3.1)points,t=13.250,P=0.000].After the intervention, the intervention group had less anxiety symptoms than the control group[the intervention group(43.4±3.1)points, the control group(50.0±4.4)points,t=6.712,P=0.000].Before the intervention, the depression levels of the two groups of pregnant women were not significantly different. After the intervention, the depression levels of the control group was not significantly different than those before the intervention. After the intervention, there was significantly lower depression score of the intervention group than that of the control group(P < 0.05) [before(56.9 ± 3.5)points, after(45.3 ± 2.5)points, t=14.773,P=0.000].After the intervention, the intervention group had lower depression score than the control group[the intervention group (45.3 ± 2.5) points, the control group (54.6 ± 3.0) points, t=12.802,P=0.000]. Conclusions Group psychological counseling and peer education can effectively improve depressive and anxiety symptoms of pregnant females with selective multiple pregnancy reduction in second trimester.

Objective:To explore the effect of therapeutic communication on infusion safety, disease uncertainty, coping styles, anxiety and depression in patients with emergency infusion.Methods:A total of 126 patients treated with infusion patients in emergency department in Jiangsu Provincial People's Hospital, the First Affiliated Hospital of Nanjing Medical University from July 2019 to December 2019 were selected and divided into two groups by random digits table method with 63 cases in each group. Patients in the control group received routine nursing, and patients in the intervention group received therapeutic communication nursing intervention on this basis. The incidence of adverse events of infusion during the intervention of the two groups of patients was observed. The disease uncertainty, coping styles, anxiety and depression were evaluated by Mishel's Uncertainty in Illness Scale (MUIS), Medical Coping Mode Questionnaire (MCMQ), Self-rating Anxiety Scale (SAS) and Self-rating Depressive Scale (SDS) before and after intervention.Results:The final collection of 109 patients with complete questionnaire, the recovery rate was 86.51% (109/126), including 55 cases in the intervention group, 54 cases in the control group. The incidence of adverse events of infusion was 16.36%(9/55) in the intervention group and 29.63%(16/54) in the control group, and there was significant difference( χ2 value was 5.057, P<0.05). There was no significant difference in the score of MUIS, MCMQ, SAS, SDS before the intervention between the two groups ( P>0.05). After the intervention, the uncertainty, unpredictability, lack of information and complexity dimension of the intervention group patients' MUIS scores were respectively (17.76 ± 2.49), (12.03 ± 2.51), (11.82 ± 2.12), (11.74 ± 2.24), which were lower than those in the control group (24.72 ± 2.94), (16.31 ± 2.27), (16.13 ± 2.51), (15.39 ± 2.31), the differences were significant( t values were -13.346- -8.375, P<0.05). The confront score of the intervention group patients' MCMQ was (19.13 ± 2.62) higher than that in the control group(13.79 ± 1.96), the avoidance and yield scores were respectively (8.71 ± 1.34), (9.81 ± 1.17), which were lower than those in the control group (14.57 ± 1.93), (15.12 ± 1.86), the differences were significant( t values were 12.031, -18.441, -17.875, P<0.05). The scores of SAS and SDS in the intervention group were (29.43 ± 3.62), (27.67 ± 3.11) respectively, which were lower than those in the control group (37.44 ± 5.31), (40.12 ± 4.92), the differences were significant( t values were -9.216, -15.821, P<0.05). Conclusions:Therapeutic communication can reduce the risk of emergency infusion, reduce the uncertainty of patients to the disease, improve patients' countermeasures to the disease, relieve patients' anxiety and depression, and improve the nursing quality of emergency infusion patients.

Objective: To explore the correlation among plasma level of brain natriuretic peptide (BNP), serum D-dimer level and patient's status in patients with acute pulmonary embolism (APE).Methods: A total of 122 APE patients who were hospitalized from Mar 2012 to Dec 2015 were selected.According to right heart function and clinical symptoms, patients were divided into low risk group (n=61), medium risk group (n=36) and high risk group (n=25);after discharge, all patients were followed up for six months, then according to survival or not, they were divided into survival group (n=105) and death group (n=17).Plasma BNP and serum D-dimer levels were measured and compared among all groups, then correlation among BNP, D-dimer levels and severity of patient's status was analyzed.Results: Compared with low risk group, there were significant rise in levels of plasma BNP [(133.28±74.92)ng/L vs.(273.89±179.29)ng/L vs.(834.80±509.09)ng/L] and serum D-dimer [(761.80±333.65)ng/ml vs.(966.67±370.33)ng/ml vs.(1228.40±569.11)ng/ml] in medium risk group and high risk group, and those of high risk group were significantly higher than that of medium risk group, P<0.01 all.Compared with survival group, there were significant rise in levels of plasma BNP [(257.33±27.11)ng/L vs.(696.47±64.92)ng/L] and serum D-dimer [(818.57±64.92)ng/ml vs.(1513.25±48.14)ng/ml] in death group, P<0.01 all.Pearson correlation analysis indicated that plasma BNP, serum D-dimer levels were significant positively correlated with severity of patient's status (r=0.69, 0.41, P<0.01 both), and plasma BNP level was significant positively correlated with serum D-dimer level (r=0.79, P=0.002).Conclusion: Measurements of plasma BNP and serum D-dimer in APE patients are help to assess severity of patient's status and short-term prognosis, and provide basis for clinical individualized therapy.

Objective To explore the distribution characteristics of ankle-brachial index ( ABI) examination for peripheral arterial dis-ease in diabetic patients, and to provide basis for clinical diagnosis. Methods Randomly selected 110 cases of patients who were admitted into our hospital from February 2014 to January 2015, and divided them into the observation group (34 cases with diabetic lower extremity peripheral vascular lesions) and the control group (76 cases without diabetic lower extremity peripheral vascular lesions). Measured the ABI of the two groups, and analyzed the value of ABI data range for the diagnosis of diabetic lower extremity peripheral vascular lesions. Mean-while, analyzed the risk factors of peripheral arterial disease in diabetic patients according to ABI. Results The sensitivity of ABI for diag-nosis of diabetic lower extremity peripheral vascular lesions was 91. 18%, and the coincidence rate was 95. 36%, the specificity was 98. 68%, the misdiagnosis rate was 8. 82%, and the omission diagnostic rate was 8. 82%. ABI of the observation group was obviously lower than that of the control group, and the difference was statistically significant (P<0. 05). Conclusion ABI examination could be basis of clinical diagnosis and important standard of disease assessment for peripheral arterial disease in diabetic patients. It is suggested to strengthen the control of blood glucose, blood pressure and weight of patients with diabetes in order to reduce the risk of morbidity.

Objective To understand the disinfectant resistance of clinically isolated Escherichia coli (E.coli)and carriage of disinfectant resistance genes.Methods Disinfectant resistance gene sugE (c ),sugE (p ),qacEΔ1 ,and qacE of 82 isolates of E.coli were detected with polymerase chain reaction (PCR),minimal inhibitory concentra-tions (MICs)were measured with agar dilution methods.Results Among 82 E.coli isolates,positive rates of dis-infectant resistance gene sugE (c ),sugE (p ),qacEΔ1 ,qacE,sugE (c )+qacEΔ1 ,and qacE+qacEΔ1 +sugE (c ) were 84.15% (n=69),1 .22% (n=1),76.83% (n=63),73.17 % (n=60),68.29% (n=56),and 59.76% (n=49)respectively.There was no significant differences in carriage status of four disinfectant resistance genes be-tween extended-spectrumβ-lactamases (ESBLs)-producing and non-ESBLs-producing strains,as well as cefepime sensitive and resistant strains (all P >0.05);MIC values of benzalkonium chloride,cetylpyridinium chloride,am-monium bromide,and triclosan for 82 isolates of E.coli were all > standard stain;MIC values of chlorhexidine for 32 isolates of E.coli were all > standard stain,for 50 other E.coli strains were all ≤ standard strain.There were no significant difference in MIC values of benzalkonium chloride,cetylpyridinium chloride,ammonium bromide,and triclosan between ESBLs-and non-ESBLs-producing strains,as well as cefepime sensitive and resistant strains(all P >0.05);while MIC values of chlorhexidine showed a significant difference (both P <0.05).Conclusion Detection rates of disinfectant resistance gene qacE,qacEΔ1 ,and sugE(c)in E.coli from clinical specimens are high,MICs of disinfectants such as benzalkonium chloride for E.coli are generally higher than standard strain.

Objective:To investigate the clinical features, imaging features, gene diagnosis, treatment and prognosis of autosomal dominant lateral temporal epilepsy (ADLTE) with heterozygous RELN mutation.Methods:Clinical data of an ADLTE family caused by a heterozygous mutation in the RELN gene diagnosed in September 2019 at Qilu Hospital of Shandong University were collected. The clinical characteristics of ADLTE were analyzed, and literature review was conducted.Results:The male proband, 22 years old, was admitted with the clinical manifestations including seizures begun at temporal lobe, which specifically manifested as a sudden emergence of binaural hum, lasting for more than 10 seconds, and the symptoms can self-recover quickly. Half a month later, generalized tonic-clonic seizures attacked subsequently after a similar auditory aura. There were no abnormal findings in interictal electroencephalography (EEG) and magnetic resonance imaging (MRI). Following the family history, his father had similar auditory symptoms around the age of 20, and occasional secondarily generalized tonic-clonic seizures appeared. Antiepileptic drug can control better. The whole exome sequencing of three people in the family revealed that both the proband and his father had NM-005045: c.6068T>C heterozygous mutation in the RELN gene.Conclusions:ADLTE mostly occurs in juveniles or early adulthood. The main clinical manifestations are focal seizures with auditory auras, which can be followed by generalized tonic-clonic seizures. There are no abnormal findings in the interictal EEG and MRI. ADLTE is sensitive to drug treatment and has good clinical prognosis. The study identified a novel heterozygous mutation NM-005045: c.6068T>C in RELN gene, which is responsible for the development of ADLTE.

Objective To compare the efficacy and safety of everolimus combined with endocrine therapy and fulvestrant in patients with estrogen receptor-positive advanced breast cancer progressed after endocrine thera-py. Methods Ninety-three breast cancer patients were selected from January 2014 to February 2017. The primary end points were progression-free survival and clinical benefit rate and the secondary end points was tolerability. Re-sults The progression-free survival in fulvestrant group was slightly higher than that in the everolimus group(13.4 months vs 12.2 months,P = 0.297). The clinical benefit rates were 46.15% and 31.71% in fulvestrant group and everolimus group,respectively. Patients treated with fewer than 2 lines and endocrine resistant patients benefited more from fulvestrant but without statistical difference. The main adverse events related to everolimus were stomati-tis,with a prevalence rate of about 26% and a localized pneumonia with a prevalence rate of about 10%. The main adverse reaction of fulvestrant was the injection site reaction. Conclusions The efficacy of everolimus in combina-tion with endocrine therapy is not superior to that of fulvestrant for the treatment of advanced breast cancer pro-gressed after endocrine therapy. After weighing the clinical benefits and quality of life,fulvestrant may be better for patients treated with fewer than 2 lines and endocrine resistance.

Objective: To explore the clinical and radiological features of myelin oligodendrocyte glycoprotein (MOG) antibody associated disease. Methods: The clinical data of 22 MOG antibody associated disease cases treated in the Department of Neurology, Qilu Hospital of Shandong University from January 2017 to June 2019 were retrospectively analyzed. The clinical data of MOG antibody associated disease were summarized, including clinical and imaging features. Results: Of the 22 included patients with MOG antibody associated disease, the average age was 38.5 years, 13 were male and nine were female. Among them, 11 cases manifested as aquaporin-4 (AQP4)-negative neuromyelitis optica spectrum disorder (NMOSD), four cases optic neuritis, two cases transverse myelitis, one case acute disseminated encephalomyelitis (ADEM), two cases cortical encephalitis and two cases vestibular neuronitis. Magnetic resonance imaging (MRI) results showed that multiple anatomical areas were involved. Among the nine patients with optic nerve involvement, five patients had longitudinally extensive optic nerve lesions, which were longitudinally enhanced. In eight patients, MRI lesions in the spinal cord showed mostly long or short segments involvement, involving 2-5 spinal cord segments. Five cases involved the cervical spinal cord, six cases involved the thoracic spinal cord, and one case involved the lumbar spinal cord. Brain MRI abnormalities were found in 13 cases and the lesions were mostly patchy and point-shaped. MRI lesions demonstrated T₂ hyperintensity and some of them could be strengthened, which may involve the basal ganglia, thalamus, radiographic crown, frontal temporal lobe, brain stem and other parts. Among them, 16 patients were sensitive to high-dose intravenous/oral methylprednisolone in the acute phase. Seven patients had recurrence after two months to two years of follow-up. Conclusions MOG antibody associated disease include multiple manifestations. Among them, AQP4-negative NMOSD is the most common form. The clinical manifestations of patients showed diversity. Imaging is characterized by multiple parts involvement such as optic nerve, spinal cord, and brain. Most patients are sensitive to high-dose intravenous/oral methylprednisolone, and have a good prognosis in the acute phase, but some patients may relapse.

Objective:To analyze the etiology and clinical characteristics of hospitalized children with fever and cervical lymphadenopathy in general hospital, so as to provide evidence for clinical diagnosis and treatment.Methods:Fifty-six children with fever and cervical lymphadenopathy in the pediatric ward at the Peking University Third Hospital from January 1, 2016 to December 31, 2020 were analyzed retrospectively.They were divided into<6 years old group( n=33) and ≥6 years old group( n=23) according to their ages.The differences of etiological composition among different age groups were analyzed.According to the causes of disease, the cases were divided into infectious disease group and non-infectious disease group.The dynamic changes of etiological composition year by year were analyzed, and the laboratory examination and treatment of children were summarized. Results:Among the 56 cases, 53 cases were confirmed, including 17 cases(30.36%)of acute suppurative lymphadenitis, 13 cases(23.21%)of Kawasaki disease, 13 cases(23.21%)of infectious mononucleosis, seven cases(12.50%)of respiratory tract infection and three cases(5.36%)of histiocytic necrotizing lymphadenitis.As for Kawasaki disease, there were significantly more children in the <6 years old group than that in the ≥ 6 years old group( P=0.005). During the past 5 years, the proportion of infectious diseases have decreased year by year, and the proportion of non-infectious diseases have increased year by year.The difference was statistically significant( χ2=11.443, P=0.022). The levels of leukocyte, neutrophil and quick C-reactive protein in children with non-infectious diseases were higher than those in infectious disease group.The differences were statistically significant(all P<0.05). Among the 56 children, 54 cases(96.4%)were treated with antibiotics.There was no significant difference in the usage rate of antibiotics between the infectious disease group and the non-infectious disease group( χ2=0.019, P=0.890). Conclusion:The main diseases of fever with cervical lymphadenopathy in pediatric inpatients in general hospital are acute suppurative lymphadenitis, Kawasaki disease and infectious mononucleosis, respectively.During the past 5 years, the proportion of non-infectious diseases has increased year by year, but the usage rate of antibiotics has not declined.Clinical attention should be paid to the rational use of antibiotics.