ObjectiveTo seek the approach to the initial diagnosis of pulmonary embolism through analysis and conclusion of the clinical features of pulmonary embolism.MethodsThe high risk factors,clinical manifestation and results of common auxiliary examinations of 23 patients with pulmonary embolism were analyzed retrospectively.ResultsThere were 91.30％(21/23)patients with high risk factors.The common symptoms were dyspnea (91.30％,21/23) and chest tightness (69.57％,16/23 ),while the triad of pulmonary embolism merely accounted for 13.04％ (3/23).And other symptoms included palpitation,chest pain,hemoptysis and syncope,etc.Blood gas analysis indicated that there were hypoxemia and hypocarbia.The positive rate of D-dimer was 91.30％ (21/23).The abnormal rate of electrocardiogram was 91.30％( 21/23 ) and the abnormal rate of echocardiography was 86.96％(20/23).ConclusionAppropriate approach to the initial prognosis can help to establish the diagnosis of patients with suspected pulmonary embolism as early as possible,as well as differentiate other cardiopulmonary diseases.

Objective Improving the hospital operation management , preparing for the establishment of the digital operation room and achieving the fine management goal .Methods Based on the actual medical and clinical demand, combined with the standard of the operation management , designed and analyzed the management rules and processes of the perioperative information management system .Results Straightened out the information management rules and procedures of the operation room , strengthened the communication , feedback and sharing of the periopera-tive medical information , and improved the work efficiency , the operation quality and the utilization rate of the opera-tion room.Conclusion The smooth management process and the efficient use of information are the keys to promote the hospital management by means of informationization .

According to the Rules for the Implementation of the Standards for Review of Level 3 General Hospital (2011) of Formor Ministry of Health,the paper analyzes the requirements of review of level 3 general hospital for decision support,and takes the Sixth Affiliated Hospital of Sun Yat-sen University as an example to introduce the decision support solution and the application of Decision Support System (DSS).

Objective: To compare the accumulative scores of cerebrovascular hemodynamic parameters (CVHP) in different populations and to analyze the relationship between the change of accumulative scores and the risk of stroke. Methods: A total of 10 565 participants aged 40 years and above were selected from a cluster sampling community-based population. Their risk factors were investigated and CVHP was evaluated. The CVHP scores were accumulated by a unified approach, and the incidence of stroke was followed up. The participants were grouped into health adult, single factor exposure, multiple-factor exposure, and newly developed stroke during the follow-up period. The differences of CVHP accumulative scores and the change law among the 4 groups were compared respectively according to age and sex. Results: The accumu-lative scores of the mean (SD) CVHP in the health adult, single factor exposure, multiple-factor exposure, and newly developed stroke groups were 86.44 (20.69), 72.07 (28.10), 60.82(34.64), and4.01 (29.36) in men respectively, and they were 83.95 (22.19), 67.97 (29.73),59.91 (31.34), and 42.64 (28.00) in women respectively, which had a tendency to gradually decrease. The accumulative scores of CVHP and their distributions at the same age stage in all the 4 groups had significant differences (P ＜ 0.01 ). The accumulative scores of CVHP and their distributions for the same factors between all age groups also had significant differences (P ＜0. 01). Conclusions: The accumulative scores of CVHP had a tendency to gradually decrease from the health adults, risk factor exposure to high risk status before stroke. The decrease of the accumulative scores is closely associated with the increase of stroke risk, which can be used as a predictor of stroke.

Objective:To establish a 10-year comparison table of cerebrovascular function score and first stroke risk, and to provide a new method for screening of high-risk population of stroke.Methods:In the beginning of 2003, a cohort for studing stroke risk factors in those aged 40 years and over was established in a community of Shanghai by cluster sampling. The common risk factors of stroke were investigated with a unified questionnaire, and the cerebrovascular function (cerebral vascular hemodynamic indexes, CVHI) was measured. The baseline study was completed from April to June 2003 and December 2004 to January 2005, respectively. The incident of first stroke and all cause of death were followed up year by year. The follow-up period was up to December 31, 2014. The 10-year incidence of first stroke was calculated according to the baseline score of cerebrovascular function, and the score-risk control table was established to estimate 10-year first stroke risk in each score group. The role of cerebrovascular function score in stroke was also estimated.Results:The follow-up term of 10 565 participants was (10.26±2.00) years, and 350 patients had first stroke during the follow-up. The trend 10-year incidence of first stroke both in men and women was significantly increased with the decrease of the score of cerebrovascular function (trend χ2=296.125, P<0.01). As the 10-year risk of first stroke was higher than 5% and higher than 10%, the corresponding CVHI score was lower than 70 and 40 points in males and lower than 30 and 20 points in females. When the scores of cerebral vascular function were divided by every 25 points, incidence of first stroke in each group from top to bottom was 1.9%, 4.7%, 10.8%, 15.2% in males and 1.6%, 4.4%, 4.8%, 11.4% in females, respectively. As compared to the top, the relative risk (95% CI) of first stroke in the lower groups was 2.61(1.67-4.07), 6.46(4.22-9.89), 9.74(6.53-14.52) for males and 2.82(1.93-4.12), 3.15(1.99-4.99), 8.12(5.65-11.68) for females, respectively. Multivariate analysis showed that the factors being selected into the regression equation were cerebrovascular function score, age, hypertension history, stroke family history and smoking history, among which the role of cerebrovascular function score was the strongest. Conclusion:The risk of first stroke increases significantly with the decrease of cerebrovascular function score, which can be used to assess the 10-year risk of first stroke.

According to the differentiation of symptamcomplex theory of Spleen Deficiency on myasthenia grvis, with our clinical experience of treatment for some years. Astragalus Saponins and Buzhong Yiqi compound were selected to make phannaceutic experiment for peripheral blood mononuclear cells culture of 14 samples of 10 myasthenia gravis patients. Two controlled groups were given with the treatment of dexamethasone and 60Co respectively. The results showed that liters of nAchR-Ab in cells culture superatants were significantly decreased by watersoluble Astragalus saponias (418.8-2328 fmol/rnl- 0 fmol/ml in 6 cases; 1143 -1235 fmol/ml - 43-157 fmol/ml in 2 cases). Buzhong Yiqi compund could enhance the immunoregulatory action.

Objective To evaluate the sensitivity and specificity of various assays in diagnosing Cushing′s syndrome. Methods The plasma cortisol, urinary free cortisol (UFC), circadian rhythm in cortisol secretion and dexamethasone suppression test were assessed in 173 patients clinically diagnosed Cushing′s syndrome. The data were compared with the postoperative pathologic diagnosis. Results The normal diurnal rhythm of cortisol secretion was lost in 92.9% patients with Cushing′s syndrome. The loss of normal diurnal rhythm of cortisol secretion of 2 time points occurred in 85.1% (8:00, 16:00) and 91.8% (8:00, 24:00), and that of 3 time points (8:00, 16:00, 24:00) in 94.7% of the cases. The excretion of UFC was increased in 91.7% of patients with Cushing′s syndrome. Low-dosedexamethasonedidnotsuppressthe excessive secretion of glucocorticoid in 79.7% (1 mg) and 84.3% (2 mg) patients with Cushing′s syndrome. The basal level of plasma cortisol was raised in 75.6% patients. The sensitivity of 8 mg dexamethasone suppression test was 50%-70% as the standard was set at 50% suppression, and specificity was more than 95%. Conclusion The most sensitive tests for Cushing′s syndrome are the loss of normal circadian rhythm of cortisol secretion and increased UFC. The method of 3 time points is more sensitive than that of 2 time points in the assessment of circadian rhythm. The 8 mg dexamethasone suppression test is the most useful method in differentiating Cushing′s disease from adrenal adenoma.

Objective:To explore the effect of nurse-led multidisciplinary collaborative nutrition management on cancer patients.Methods:Using the convenient sampling method, 106 cancer patients in Henan Provincial People's Hospital from January 2019 to December 2020 were selected as the research objects. According to the admission time, the patients were divided into two groups. A total of 51 patients admitted from January to December 2019 were selected as the control group, while 55 patients admitted from January to December 2020 were selected as the research group. The control group was given routine nutrition intervention, while the research group was given nurse-led multidisciplinary nutrition management on the basis of the control group. Nutritional grading and Quality of Life Instruments for Cancer Patients-Core Module (EORTC QLQ-C30) scores before and after intervention were compared between the two groups. The target achievement of nutritional management and the occurrence of gastrointestinal adverse reactions were counted.Results:After intervention, nutrition of the research group was better than that of the control group and EORTC QLQ-C30 score was higher than that of the control group, and the differences were statistically significant ( P<0.05) . The achievement rate of nutrition management goals in the research group was 67.27% (37/55) , higher than 39.22% (20/51) in the control group, and the difference between the two groups was statistically significant ( P<0.05) . The incidence of gastrointestinal adverse reactions in the research group was 3.64% (2/55) , lower than 17.65% (9/51) in the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The implementation of nurse-led multidisciplinary collaborative nutrition management in cancer patients can improve their nutritional status and quality of life, increase the rate of achieving nutritional management goals and reduce the incidence of gastrointestinal adverse reactions.

OBJECTIVETo evaluate efficacy and optimal cut-off-point through cerebral vascular hemodynamic indexes (CVHI) examination to predict stroke.

METHODSA number of 20,333 people at 35 years old and over were checked by CVHI and accumulative score was calculated according to the value of detected indexes. Risk factors of stroke were investigated simultaneously. One hundred and sixty-eight patients with stroke occurred during 4-year following up. Typical syndromes and signs stroke were used as golden standard to evaluate screening efficacy of CVHI.

RESULTSScore of optimal cut-off-point of cerebral vascular hemodynamic indexes was under 75 in ROC curve analyses. Sensitivity, specificity, accuracy, positive and negative predictive values, positive and negative likelihood ratios as well as Youden's index for predicting stroke within 4 years after examination were found to be 87.50%, 67.70%, 67.86%, 2.21%, 99.85%, 2.71, 0.18 and 0.55 respectively. Sensitivity and positive predict values for predicting cerebral vascular thrombosis were superior to predicting cerebral hemorrhage. Positive predicting value in risk exposure population was higher than that of overall population. Coefficiency of variation of cerebral vascular hemodynamic examination was 4.03%. The agreement rate of examination between two physicians was 97.62% and Kappa value was 0.94.

CONCLUSIONThe score of optimal cut-off-point of cerebral vascular hemodynamic indexes examination was 75. Both Efficacy and reliability for predicting stroke seemed to be good, especially for predicting cerebral vascular thrombosis.

Adult ; Aged ; Brain ; physiopathology ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Stroke ; diagnosis ; physiopathology

Oropharyngeal carcinoma is a highly heterogeneous disease that is mainly caused by tobacco and alcohol abuse or high-risk human papillomavirus (HPV) infection. HPV-positive oropharyngeal carcinoma and HPV-negative oropharyngeal carcinoma have obvious differences in etiology, epidemiology and prognosis; therefore, different methods should be adopted for treatment. It is known that the TP53 gene is not mutated in HPV-positive oropharyngeal carcinoma, and radiation therapy can activate it and induce cell apoptosis via DNA damage. There are common repair pathways to DNA damage, such as nonhomologous end joining, and this pathway is more sensitive to radiotherapy under the inhibition of HPV oncoprotein. In addition, the further activation of the immune response under the effect of radiation also participates in the elimination of tumors. In this paper, we reviewed the research on the sensitivity of HPV-positive oropharyngeal cancer to radiotherapy to provide a scientific basis for targeted treatment for various pathogenic factors and clinical stages of oropharyngeal cancer in the future.