Objective:To explore the influence of the value of the echocardiography in the detection of cancer therapeutics-related cardiotoxicity by World Alliance Societies of Echocardiography(WASE) study.Methods:Tirty-seven breast cancer patients underwent echocardiography at baseline before chemotherapy (T0) and after the second (T2), fourth (T4), sixth (T6) chemotheraphy cycles in Qilu Hospital of Shandong University from March 2017 to March 2018. According to different guidelines[ASE lower limit of normal left ventricular ejection fraction(LVEF-LLN) 53%, ESC LVEF-LLN 50% and the WASE study (Women LVEF-LLN 58%, Asian Women LVEF-LLN 59%)], the number of patients with myocardial injury during chemotherapy was evaluated, and compared with the global longitudinal strain(GLS) standard, the percentages of patients with myocardial injury in different standards were analyzed.Results:With the up-regulation of LVEF-LLN, more patients with early myocardial damage were found. During chemotherapy, 1 patient showed left ventricular ejection fraction (LVEF) fell by >10% from baseline to LVEF<50% (2016 ESC Guidelines), 3 patients showed LVEF fell by >10% from baseline to LVEF<53% (2014 ASE Guidelines), 7 patients for LVEF fell by >10% from baseline to LCVEF<58%, and 9 patients for LVEF fell by >10% from baseline to LVEF<59%, which was still less than the number of patients detected by GLS criteria (18 patients), but the sensitivity of LVEF fell of >10% from baseline to LVEF<59% was not statistically different from GLS standard ( P>0.05). Conclusions:With the up-regulation of LVEF-LLN, the sensitivity of LVEF in evaluating early myocardial damage was increased, but GLS was still the most sensitive index to monitor the cancer therapeutics-related myocardial damage.

Objective To compare the diagnostic value of CT and NE for lesions of nasal cavity and paranasal sinus area.Methods 80 cases of nasal and paranasal sinus diseases which were examined by both CT and NE at same period and proved by pathology.were reviewed.Results Compare with results of pathology,the accucy rate of both CT and NE was identical in diagnosing sinusitis and tumours of paranasal sinus,NE was higher than CT in nasal and paranasal sinus polyp and nasal cavity tumour,turbinate hyperplasia CT was higher than NE in paranasal sinus cyst and anatomic variations.Conclusion Pathologic biopsy can be taken under NE guide to understand the shape,texture and colour of the illness focus CT can show the size,shape and anatomy relation between lesion and its neighbor tissue.The diagnosis may more perfectly through NE combined with CT.

With the increasing incidence of breast cancer, the relationship between tumor and immune function has attracted more and more attention. This article reviews the relationship between breast cancer and T lymphocyte subsets, in order to explore the changes of immune function before and after operation in breast cancer patients, so as to select appropriate surgical methods, radiotherapy, chemotherapy and immunotherapy for the patients.

Objective:To revise the family resilience assessment scale (FRAS) in patients with stroke and to evaluate its psychometric properties and applicability.Methods:FRAS was authorized and translated into Chinese.The scale items were revised based on the interview results of 13 patients with stroke and 11 caregivers and the opinions of 20 experts in related fields.A convenience sampling method was used to sample neurology and neurosurgery inpatients from 2 tertiary hospitals in Hangzhou twice from June to November 2022, with 325 questionnaires (sample 1) distributed the first time for item analysis and exploratory factor analysis, and 285 questionnaires (sample 2) distributed the second time for confirmatory factor analysis, criterion validity and reliability test.Data analysis was conducted by SPSS 26.0 and AMOS 24.0.Results:The exploratory factor analysis extracted 6 common factors(family beliefs, family spirit, family connection, family resources, family communication, family collaboration) with 32 items.Confirmatory factor analysis showed that the model fit well( χ2/ df=2.67, RMSEA=0.025, CFI=0.98, GFI=0.90, IFI=0.98, RMR=0.031). The cronbach's α coefficient of the total scale was 0.96, and 0.82-0.92 for the dimensions.The 2-week retest reliability was 0.99.The total scale score was positively correlated with the validity scale (family resilience scale) ( r=0.882, P<0.001). Conclusion:The family resilience scale for patients with stroke has good reliability and validity and can be used to assess the family resilience of patients with stroke.

Objective: To explore the molecular mechanism of Taoren-Honghua herb pair (THP) on syndrome of bloodstasis based on the network pharmacology. Methods: We collected THP's compounds from traditional Chinese Medicinedatabases and input them into Pharm Mapper to get their potential targets, and collected the known targets of compoundsby Scifinder. Then we did KEGG-pathway analysis by DAVID database. Finally draw and analyze the network byCytoscape by information above. Results: Seventeen compounds of THP acquired 74 known targets, which was associatedwith four modules: improving the hemodynamics, anticoagulation, anti-inflammation, regulating apoptosis andproliferation. We also got 317 potential targets through PharmMapper and got 128 signaling pathway through pathwayenrichment including 39 disease-related pathways, 25 endocrine-related pathways, 11 immune-related pathways and soon. Conclusion: The four modules of the known target are exactly related to the four characteristics of the syndrome ofblood stasis. The potential targets and the 128 signal pathways involve a variety of pathophysiological processes of thesyndrome of blood stasis. These reflect the molecular mechanism of THP intervention in the syndrome of blood stasis

Objective: To compare the distribution characteristics of left ventricular configuration in Chinese adult patients with hypertension under Chinese and international standard using echocardiography. Methods: A total of 201 patients with primary hypertension were included in the study.Left ventricular end systolic left atrial diameter (LAD), ascending aortic diameter (AO), left ventricular end diastolic diameter (LVDd), left ventricular posterior wall thickness (PWTd) and ventricular septal thickness (IVSd) were measured and then relative wall thickness (RWT), left ventricular mass (LVM), left ventricular mass index (LVMI) were calculated. Left ventricular systolic left atrial volume (LAV) was measured by Simpson′s biplane method and left atrial volume index (LAVI) was then calculated. Ganau classification was done according to Chinese and international standard respectively. The differences of left ventricular configuration in hypertension were compared. Results: According to the Chinese standard, the analytic results of left ventricular configuration showed that there were 103 cases (51.2%) in normal configuration (NG) group, 28 cases (13.9%) in concentric remodeling (CR) group, 52 cases (25.9%) in eccentric hypertrophy (EH) group and 18 patients (9.0%) in hypertrophic (CH) group, respectively. Whereas, according to the international standard, there were 47 cases (23.4%) in NG group, 93 cases (46.3%) in CR group, 18 cases (8.9%) in EH group and 43 cases (21.4%) in CH group.Each group in the configuration analysis had significant difference between Chinese and international standard (P<0.01). Patients with left atrial enlargement according to the Chinese and international standard had statistical difference in the EH and CH groups (P<0.05). Conclusions Analysis of left ventricular configuration according to the Chinese and international standard has significant difference. According to Chinese standard, it may be more accurate to reflect the changes of left ventricular configuration in Chinese hypertensive population, so as to evaluate the changes of left heart structure and function more accurately.

Family physicians contracted service is an important choice to deepen the reform of China′s healthcare reform and achieve the strategic goal of " health for all" . In order to effectively promote the contracted service, the central government has successively issued a number of policy documents, which are echoed by the localities in their proactive explorations, achieving remarkable results. But there are also multiple roadblocks hindering the contracted service to progress. This article referred to the three-circle theory and studied policy implementation from the three dimensions of policy value, policy resources, and policy impetus. A thorough analysis of the problems in the implementation process revealed such main problems as insufficient family physicians, inadequacy of supporting policies and low level of policy acceptance among the young healthy age groups. The follow-up work will promote the long-term implementation of the family physicians contracted service policy by enriching the family physicians team, enriching supporting policies, and focusing on promotions to key age groups.

Objective To investigate the effects of the extent of regional lymph node dissection on the prognosis of patients with T4 gallbladder carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with T4 gallbladder carcinoma who underwent radical cholecystectomy in the 4 medical centers between January 2013 and December 2016 were collected,including 31 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,16 in the First Affiliated Hospital of Xi'an Jiaotong University,11 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 6 in the Affiliated Hospital of North Sichuan Medical College.There were 27 males and 37 females,aged from 35 to 77 years,with a median age of 59 years.Sixty-four patients underwent radical cholecystectomy and regional lymph node dissection.According to the extent of intraoperative lymph node dissection,25 patients (13 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,6 in the First Affiliated Hospital of Xi'an Jiaotong University,4 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 2 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct,hepatoduodenal ligament,back of head of pancreas,next to common hepatic artery and celiac trunk were allocated into the extended dissection group,39 patients (18 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,10 in the First Affiliated Hospital of Xi'an Jiaotong University,7 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 4 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct and hepatoduodenal ligament were allocated into the control group.Observation indicators:(1) postoperative complications;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival up to January 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was evaluated with the independentsample t test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.The survival curve was drawn using the KaplanMeier method,and the comparison of survival rates was done by the Log-rank test.Results (1) Postoperative complications:64 patients with T4 gallbladder carcinoma underwent successful radical cholecystectomy and regional lymph node dissection,without intraoperative death.Twelve patients had different degrees of postoperative complications.Four of 7 patients undergoing extended radical cholecystectomy had postoperative complications.Twenty-five patients in the extended dissection group were cured by conservative treatment,including 4 with intraperitoneal infection and 2 with pancreatic leakage,with a complication incidence of 24.0％ (6/25).Thirtynine patients in the control group were cured by conservative treatment,including 5 with intraperitoneal infection and 1 with gastric retention,with a complication incidence of 15.4％ (6/39).There was no statistically significant difference in the complication incidence between the two groups (x2=0.284,P＞0.05).(2) Follow-up and survival situations:64 patients were followed up for 1-60 months.The postoperative overall median survival time was l l months.The postoperative median survival time,1-,3-and 5-year cumulative survival rates were respectively 18 months,80％,16％,9％ in the extended dissection group and 8 months,21％,4％,0 in the control group,with a statistically significant difference in the prognosis between the two groups (x2=14.744,P＜ 0.05).Conclusions On the premise of practiced surgical skill,extended regional lymph node dissection cannot increase incidence of surgical complication in patients with T4 gallbladder carcinoma after radical resection.Actively extending lymph node dissection up to near common hepatic artery,peri-celiac trunk and back of head of pancreas can improve long-term survival and prognosis.

Objective To explore the effect of blended teaching model based on "Rain Class" in general practitioner training.Methods Random sampling method was adopted in which totally 132 general practitioners were divided into two groups,66 in experimental group,66 in the control group.Blended teaching method and traditional teaching method was implemented in the experimental group and the control group,respectively.At the end of the course,unified examination questions were used to evaluate the teaching effect,and questionnaires were used to investigate the students' evaluation of the "rain classroom" teaching method.Results The final exam score of experimental group was significantly higher than that of control group [(82.95 ± 12.86) vs.(60.45 ± 18.91),P=0.000].Further stratification analysis was conducted according to educational background,and the average score of low education group in the observation group was significantly higher than that of high education group [(88.06 ± 9.12) vs.(49.66 ± 13.88),P=0.000].55.3％ of the general practitioners in experimental group were very satisfied with "Rain Class" teaching,34.8％ satisfied,and only 9.9％ of the general practitioners were dissatisfied.Conclusion Blended teaching model could help to promote the exchange and interaction between students and teachers and improve learning efficiency and clinical ability.

Objective:To report the clinical manifestation and genetic characteristics of a case of de novo Huntington′s disease due to paternal intermediate alleles. Methods:Clinical data and imaging features of a middle-aged female, who complained of unstable walking without positive family history and was admitted to Xuanwu Hospital, Capital Medical University on September 20, 2022, were retrospectively analyzed. The serum samples of the patient and her parents were used to screen HTT gene dynamic mutation in accordance with the principle of informed consent and voluntary. And the relevant literatures were reviewed. Results:This is a 38-year-old female with progressive course, who presented as ataxia, involuntary movement at the end of extremities, dystonia, and cognitive impairment. Imaging results showed atrophy of bilateral caudate nuclei, as well as decreased glucose metabolism of bilateral caudate nuclei, putamen and partial cortex. Genetic testing showed the abnormal expansion of polymorphic trinucleotide (CAG) repeats in HTT gene and confirmed the diagnosis of Huntington′s disease. The CAG repeat length of the patient was 17/47 (pathopoiesis), of the father was 17/35 (intermediate alleles), and of the mother was 17/17 (normal). Conclusions:Paternal intermediate alleles may cause the first case of Huntington′s disease in a family. Importantly, HTT gene screening should be performed for the patient and parents when the diagnosis of Huntington′s disease is clinically possible despite negative family history, to prevent the misdiagnosis.