Objective To evaluate the value of dual energy CT with Lung Vessels application in diagnosing pulmonary embolism (PE) of children.Methods Forty-seven patients with nephrotic syndrome and aged ≤ 18 years old (32 male,15 female,mean age 15 years) underwent dual-energy CT pulmonary angiography (CTPA).Two radiologists recorded the presence or absence of emboli and counted the clots on a per-patient and per-lobe basis with Lung Vessels,respectively.With conventional CTPA as reference standard,sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) of Lung Vessels application to detect PE were computed for two readers.Inter-reader agreement was also calculated.Results Conventional CTPA detected 51 clots in 35 lung lobes in 13 patients,giving PE incidence was 27.6％ (13/47) for this cohort.On a per-patient basis,readers 1 and 2 detected 25 and 21 patients with PE with Lung Vessels,corresponding to sensitivities,specificities,PPVs,and NPVs of 100.0％ (13/13),58.6％ (17/29),43.3％ (13/30),100.0％ (17/17) and 100.0％ (13/13),76.5％ (21/29),50.0％ (13/26),100.0％ (21/21),respectively.On a per-lung lobe basis,readers 1 and 2 detected 74 and 63 clots with Lung Vessels,respectively,corresponding to sensitivities,specificities,PPVs,and NPVs of 94.3％ (33/35),79.5％ (159/200),44.6％ (33/74),98.7％ (159/161) and 97.1％ (34/36),85.5％ (171/200),54.0％ (34/63),98.8％ (171/173),respectively.On a per-clot basis,134 and 105 clots were detected with Lung Vessels application,corresponding to sensitivities,specificities,PPVs,and NPVs for DECT of 96.1％ (49/51),64.9％ (159/245),36.3％ (49/135),98.7％ (159/161) and94.1％ (48/51),75.0％ (171/228),45.7％ (48/105),98.3％ (171/174)for readers 1 and 2,respectively.Excellent or good inter-reader agreement was observed on a per-patient,per-lobe and per-clot basis (Kappa =0.828,0.859,0.695 ; all P ＜ 0.01).Conclusions Dual-energyCT with Lung Vessels application has a high sensitivity and negative predictive value for PE detection in children.More clots are detected with Lung Vessels application than conventional CTPA,which deserve further investigation.

Objective To investigate clinical effects differences of ropivacaine combined with two doses of sufentanil on labor analgesia.Methods300 lying-in women with painless childbirth in the period from January 2016 to December 2016 in department of obstetrics in Deqing hospital of traditional Chinese medicine were chosen and randomly divided into two groups including A group (150 cases) with ropivacaine combined with conventional doses of sufentanil for 7.5μg and B group (150 cases) with ropivacaine combined with low doses of sufentanil for 2.5μg;the block onset time of sensory and motor, arrival time at the maximum block level, modified Bromage score, Apgar score, VAS score at different time points and adverse reaction rate of both groups were compared.ResultsTwo groups of maternal sensory and motor block work time and reach the highest block plane comparative differences had no statistical significance.The modified Bromage score of B group were significant better than A group(P<0.05).The adverse reaction rate of B group were significant lower than A group(P<0.05).ConclusionCompared with conventional dosage sufentanil, luo pp paid in combination with low dose used in epidural sufentanil analgesia can obviously reduce the working time, improve the quality of anesthesia and reduce the incidence of adverse reactions, is suitable for clinicians to choose application.

Objective To establish the animal model of chronic thromboembolic pulmonary hypertension(CTEPH) and to compare the accuracy of dual-energy CT (DECT) pulmonary angiography and histopathology for detecting CTEPH. Methods Eighteen canines were included in the study. All canines underwent paracentesis, embolization, CT scanning, pressure measurement and tranexamic acid feeding. The procedures were repeated every two weeks, until systolic/diastolic pressure in canines was≥30/15 mmHg or mean pulmonary artery pressure ≥ 20 mmHg.And then canines were sacrificed for histopathology examination. For CT pulmonary angiography (CTPA)in DE mode and DECT lung perfused blood volume (Lung PBV) images, the presence or absence of PE or perfusion defects were recorded on a per-canineand aper-lobe basis. With histopathological results as reference standard, the sensitivity, specificity of CTPA and lung PBV to detect PE were computed for two readers. The pairedχ2 test (McNemar test) was used to analyze the difference in diagnostic accuracy between CTPA and Lung PBV. Inter-reader agreement was also calculated with kappa test. Results CTEPH was demonstrated in 13 canines. On a per-canine basis, both readers found uneven and peripheral perfusion defects with DECT in 11 canines (84.6%, 11/13); while 5 canines (38.5%, 5/13) had cutoff or sudden stenosis of pulmonary arteries with CTPA;on a per-lobe basis,
both readers had sensitivities of 14.3%(5/35), 83.3%(30/36), specificities of 100.0%(30/30), 100.0%(29/29), accuracies of 53.8%(35/65), 90.8%(59/65)for CTPA and DECT, respectively. DECT had a higher sensitivity(χ2=-4.690,P<0.01)and accuracy(χ2=8.284,P<0.01) in detecting CTEPH. Excellent and moderate inter-reader agreements were observed with CTPA and DECT (Kappa=0.938, 0.572, both P<0.001). Conclusions It is feasible to make a CTEPH animal model with autologous thrombus. DECT shows a higher accuracy than CTPA to detect CTEPH in this canine model study.

Objective To retrieve literature on physician-patients relations for analysis of current studies and hotspots. Methods Papers on physician-patient relations published from January 2013 to September 2017 were retrieved in PubMed using such key words as "physician-patient relations" and"nurse-patient relations" respectively for analysis and comparison. Bibliographies of literature on such relations were downloaded, and their publication years, journals, and countries of the journal, as well as their first authors were also analyzed. High frequency words were chosen using a new method based on Zipf's law to identify the cut-off points of high-low frequency words in the corpus. Then the co-word matrix was formed using BICOMB2 to calculate the frequency of main key words,and a dendrogram was developed using SPSS 24.0 for clustering analysis. Results A total of 4 924 papers on physician-doctor relations were reviewed using 74 key words with occurrence higher than 31 times, and 2 145 papers on nurse-patient relations were retrieved using 41 key words with occurrence higher than 25 times. Co-word clustering analysis found six research focuses in recent five years: "informed consent and ethical issues","communication barriers", "trust", "implementation and construction of training courses for improving the relationship between doctors and patients","hospice care", and "patient participation in shared decision-making". It also found four research focuses on nurse-patient relations: "health knowledge, attitude and behavior", "communication and psychological nursing", "psychiatry and hospice care", and "patient centered and patient education". Conclusions Co-word clustering analysis found six research focuses in the recent five years helps understand the current situation and development trend.

Objective: To evaluate the occupational health risk of decorative coating manufacturing enterprises and to explore the applicability of occupational hazard risk index model in the health risk assessment, so as to provide basis for the health management of enterprises. Methods: A decorative coating manufacturing enterprise in Hebei Province was chosen as research object, following the types of occupational hazards and contact patterns, the occupational hazard risk index model was used to evaluate occupational health risk factors of occupational hazards in the key positions of the decorative coating manufacturing enterprise, and measured with workplace test results and occupational health examination. Results: The positions of oily painters, water-borne painters, filling workers and packers who contacted noise were moderate harm. And positions of color workers who contacted chromic acid salts, oily painters who contacted butyl acetate were mild harm. Other positions were harmless. The abnormal rate of contacting noise in physical examination results was 6.25%, and the abnormality was not checked by other risk factors. Conclusion The occupational hazard risk index model can be used in the occupational health risk assessment of decorative coating manufacturing enterprises, and noise was the key harzard among occupational harzards in this enterprise.

Objective:To investigate the preoperational nutritional condition for the children with congenital heart disease,and to analyze the relevant factors.Methods:According to the standards of WHO,the Z-scores was used to assess the nutritional condition for the children,and the generational information questionnaire,State-Trait Anxiety Inventory,Self-Rating Depression Scale and Parent Understanding Questionnaire were used to analyze the maternal factors.Results:Stunting,underweighting and wasting represented the poor nutritional conditions,which accounted for 28.6％,25.3％ and 25.3％,respectively.Maternal accurate perception and the psychological problems such as anxiety and depression were the main relevant factors.Conclusion:The poor nutritional condition for the congenital heart disease was serious.It is very important to improve the maternal accurate perception and to relieve the maternal psychological problems for changing the nutritional condition through appropriate health education and effective intervention.

Objective? To investigate the current situation of the self-efficacy in the main caregivers of pediatric enterostoma patients and its influencing factors, to provide scientific basis for formulating continuing nursing intervention measures for children with enterostomy. Methods? A cross-sectional investigation was carried out. The primary caregivers of the pediatric enterostoma patients who were treated in a ClassⅢ Grade A children's specialized hospital in Shanghai during January 2016 to October 2017 were selected by convenience sampling method. A self-designed general information questionnaire, General Self-Efficacy Scale (GSES), and Hamilton Depression Rating Scale (HAMA) were applied in the investigation. Univariate analysis and multiple linear regression analysis were applied to analyze the influencing factors of self-efficacy. A total of 92 questionnaires were sent out, and 90 were recovered, with a valid rate of 97.83%. Results? The median score of GSES among the 90 primary caregivers of the pediatric enterostoma patients was 24, ranging from 13 to 36, which was at a median to low level. The result of univariate analysis showed that there were significant differences in the distribution of caregivers' self-efficacy scores in terms of education level, residence, family monthly income, health insurance, family structure type and doctor-patient communication level (P＜ 0.01). Multivariate linear regression analysis showed that caregivers' educational level, family type, anxiety level and family monthly income were the main factors affecting their self-efficacy. Conclusions? The self-efficacy level of the main caregivers of children with enterostoma needs to be improved. We should strengthen doctor-patient communication for caregivers with lower education, encourage seeking social support, expand information acquisition, enhance care ability and improve the quality of life of children.

Objective:To analyze the genetic characteristics of the complete genome of a strain of human respiratory syncytial virus (HRSV) in Qinghai province in 2024.Methods:A total of 300 samples were collected during 2024 influenza surveillance in Qinghai province sentinel hospitals from patients with fever accompanied by severe respiratory infection symptoms. We used real-time fluorescent quantitative reverse transcription polymerase chain reaction RT-PCR) method to screen out HRSV subtype B (HRSVB) positive specimens, whole genome sequencing was performed on positivespecimens meeting the requirements for the sequencing. After downloading the global representative HRSVB genotypes at GenBank database, sequence alignment was performed, related evolutionary tree was built and the calculation and analyses of genetic distance were done, analyses of HRSVB sequencing of sequence homology of nucleotides, amino acids and amino acid mutation were performed.Results:The first strain in Qinghai, China/qinghai/2024-03 had a complete sequence of 15 140 bp nucleotides, with HRSV′s all structural characteristics, and subtype HRSVA prototype strain Long strains of nucleotide the lowest homology was 80.0%, and subtype HRSVB prototype strain nucleotide homology was above 94.7%. The result indicated that the first strain in Qinghai belonged to HRSVB subtype. Genetic evolution shows China/qinghai/2024-03 and USA/WA-S23450/2021 (OR326803.1) and Germany/2021 (OR795235.1) all belong to a branch, they have the closest relationship. Phylogenetic analysis of G gene showed that the strain belonged to BA9 genotype of HRSVB subtype, and the hypervariable regions of the genome were SH and G genes.Conclusions:In this study, the complete genome sequence of HRSV China/qinghai/2024-03 was obtained for the first time, and the basic molecular structural characteristics were elucidated, which filled the gaps in the gene and amino acid data of HRSV in our province, and also provided a basis for HRSV epidemiology.