Objective To explore the effect of the continuous quality improvement ( CQI) on shortening the patients ’ waiting time and improving the satisfaction of the waiting time in transfusion room . Methods The CQI procedure including setting up CQI groups , collecting and analysis the data , analyzing the cause, setting goals, making improvement plan and implement method , evaluating effect, summarizing and formulating the consolidation measures etc were carried out , and the patients’ waiting time and the satisfaction of the waiting time in transfusion room were compared before and after the implementation of the CQI . Results The average patients’ waiting time in transfusion room was (18 ±3) min after the implementation of the CQI, and was significantly lower than (30 ±5 ) min before CQI, and the difference was statistically significant (t=20.580, P<0.05).The satisfaction of the waiting time in transfusion room was 89% after the implementation of the CQI, and was significantly higher than 65% before CQI, and the difference was statistically significant (χ2 =9.416, P=0.024).Conclusions The nurses find out the best way to solve the problem and strengthen the team cooperation spirit through the implementation of the CQI and the utilization of team wisdom.The nurse work flow is smoothly, and the performance evaluation mechanism is reasonable , which greatly enhance the work enthusiasm and efficiency , shorten the patients ’ waiting time, and improve the patients’ satisfaction.

Zuckerkandl tubercle is the extension of thyriod gland. For the past few years, more and more surgeons and anatomists have become interested in it. Clinically, surgeons usually rely on specified anatomical landmarks to avoid injuries to the recurrent laryngeal nerve, including the laryngeal branches and the superior parathyroid in thyroid surgery, such as the bottom corner of the thyroid cartilage, the inferior thyroid artery, lower pole of thyroid, tracheoesophageal groove, suspensory ligament of thyroid gland and so on. As the specified landmarks, they have several common characteristics:on the one hand, their location should be constant; on the other hand, they should be easy to observe and touch, meanwhile convenient and practical.As a new anatomical landmark, Zuckerkandl tubercle is in accordance with the above characteristics and prevalent in the population. Therefore, Zuckerkandl tubercle could become an important landmark to identify the the recurrent laryngeal nerve, including the laryngeal branches and the superior parathyroid in thyroid surgery. This essay aims to briefly analyze the role of Zuckerkandl tubercle in thyroid surgery.

Objective To set up a standard for surgical classification of cavernous transformation of the portal vein (CTPV) and their management strategy according to the classification.Methods The clinical data of 63 CTPV cases were analyzed retrospectively,the classification and the corresponding treatment strategy were evaluated.Results According to the imaging examination,surgical treatment and long-term follow-up,CTPV was classified into four types:Type Ⅰ:cavernous transformation involving main trunk of the portal vein and intrahepatic branches.Portasystemic shunt (mesocaval and splenocaval shunt)(or plus port-azygous devascularization) were used for this type;Type Ⅱ:cavernous transformation in the main trunk and proximal SV or SMV.Portasystemic shunt (mesocaval and splenocaval shunt) or plus portazygous devascularization were applied;Type Ⅲ:cavernous transformation involving the whole portal system.Portopulmonary shunt (splenopneumopexy) or inferior mesenteric-caval shunt plus port-azygous devascularization were suggested;Type Ⅳ:any types aforementioned accompanied by biliary and /or pancreatic abnormalities.The treatment should focus on main symptoms and two-stage operation.Conclusions Doppler ultrasound and multi-slice spiral CT (MSCT) three dimensional (3D) reconstruction are the mainstay for the diagnosis of CTPV;Correct diagnosis,classification as well as individualized management are of great importance in the treatment of adult CTPV.

Objective To explore the local application of immunosuppressant in improving the survival rate of the transplanted islet cells and systemic side effects.Methods The streptozocin of 200 ms/kg was injected into the abdominal cavity of the Wistar rats，the blood sugar was tested after 48，and 72 hours，and the rats with two consecutive measurements ≥20 mol/L were taken as the experimental animal model.The dose of pancreatic islet cells transplanted into the abdominal cavity was 8 000 IE,/kg，and that of cyclosporine dosage was 1.5 mg/(100 g·d).The pancreatic islet cells were divided into three groups：(1)systemic immunosuppressive agents through stomach lavage with the intraperitoneal injection of microencapsulated islet cells；(2)pure intraperitoneal injection of microencapsulated islet cells；(3)intraperitoneal injection microencapsulated activated carbon particles loaded with immunosuppressants，and mieroencapsulated islet cells.Changes of blood glucose and pathological in rats after transplantation were detected.Results The blood glucose of group 3 and group 1 showed no significant difference(P＞0.05)，as well as compared with group 2(P＞0.05).But the local application of immune agents could prolong the effective time of the islet cells and attenuate the fibrotic extent of the surrounding islets when compared with the control group,the C peptide level in applicating immunosuppressive agents group was significantly hisher in the immunosuppressive group than the pure transplantation group.ConclusionCompared with the systemic immune suppression via stomach lavage，local application of slow-release immunosuppressive agents showed the same effects of activated carbon particles，with a prolonged the effective time of islet cell and reduced topical side effects in the latter.

Objective To investigate the feasibility and effect of visualization teaching method using HC visual laryngoscope for the standardized training of endotracheal intubation in emergency department.Methods Forty standard-trainee doctors were divided into two groups randomly.20 standard-trainee doctors in team N were taught using the conventional teaching method of emergency medicine for the standardized training of endotracheal intubation,and the other 20 standard-trainee doctors in team HC were taught by visualization teaching method using HC visual laryngoscope.After 1 month training,comparisons of the success rate of tracheal intubation in airway management simulator,the time consumed for intubation and the number of attempt on successful intubation cases,and the satisfaction score with the teaching mode scored by standard-trainee doctors between the two groups were done.Results The one-attempt success rate and the success rate of tracheal intubation in airway management simulator by the standard-trainee doctors in group HC were significantly higher than those in group N (40％ vs.10％,85％ vs.55％),while the number of attempt and the time consumed for successful intubation were significantly less than those in group N[(1.65±0.61) vs.(2.27±0.66),(79.00±8.35) s vs.(89.36±12.03) s).The satisfaction score with this teaching mode and teaching effect of standard-trainee doctors in group HC were significantly higher than those in group N (8.10±0.74 vs.6.55±1.05,8.15±0.80 vs.6.85±0.91).Conclusions The visualization teaching method with application of HC visual laryngoscope for standardized training of endotracheal intubation in emergency department could improve the success rate and efficiency of tracheal intubation in airway management simulator for standard-trainee doctors,and this teaching method may be better than the conventional teaching method on teaching mode presenting some feasibility.

Objective To investigate the feasibility and effect of scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine. Methods Sixty standard-trained doctors were randomly(random number) divided into two groups. Thirty standard-trained doctors in team A were taught using the traditional teaching modality of emergency medicine, and the rest in team B were trained using the method of scene simulation combined with multiple-station mini-CEX evaluation. At the end of standardized training, comparisons of the examination results of mini-CEX evaluation and the satisfaction of standard-trained doctors with the teaching mode were done between two groups. Results The scores of team B on medical interviewing skills, clinical judgment, counseling skills, proper presentation/efficiency and overall clinical competence were significantly higher than those of team A[(7.26±0.36),(7.63±0.39),(7.22±0.34),(7.26±0.45), (7.75±0.24) vs. (6.81±0.42),(7.24±0.39),(6.90±0.44),(6.97±0.50),(7.21±0.32)],while there were no significant differences in scores on physical examination skills and humanistic qualities/professionalism between two teams [(7.60±0.36),(7.92±0.35) vs. (7.42±0.30),(7.98±0.32)]. The satisfaction with the mini-CEX evaluation of both teachers and standard-trained doctors in team B were significantly higher than those in team A [(7.40±0.30), (7.46±0.28) vs. (7.06±0.38), (6.91±0.38)]. The satisfaction of standard-trained doctors in team B with the teaching mode and teaching effect were significantly higher than those in team A[(8.17±0.78),(8.59±0.66) (6.67±0.73), (6.80±0.72)]. Conclusions The scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine may improve some of the clinical skills of standard-trained doctors, and thus this teaching reform was feasible.

OBJECTIVE: To ascertain the feasibility of using shear wave velocity (SWV) in assessing the stiffness of carotid plaque by supersonic shear imaging (SSI) and explore preliminary clinical value for such evaluation. MATERIALS AND METHODS: Supersonic shear imaging was performed in 142 patients with ischemic stroke, including 76 males and 66 females with mean age of 66 years (range, 45–80 years). The maximum, minimum, and mean values of SWV were measured for 129 carotid plaques. SWVs were compared between echolucent and echogenic plaques. Correlations between SWVs and serum homocysteine levels were investigated. Based on neurological symptom, the surrogate marker of vulnerable plaque (VP), binary logistic regression was performed and area under curve (AUC) of homocysteine only and homocysteine combing SWVmean was calculated respectively. RESULTS: Echogenic plaques (n = 51) had higher SWVs than echolucent ones (n = 78) (SWVmin 3.91 [3.24–4.17] m/s vs. 1.51 [1.04–1.94] m/s; SWVmean, 4.29 [3.98–4.57] m/s vs. 2.09 [1.69–2.41] m/s; SWVmax, 4.67 [4.33–4.86] m/s vs. 2.62 [2.32–3.31] m/s all p values < 0.01). Pearson correlation analysis showed that stiffness of plaques was negatively correlated with homocysteine level. R values for SWVmin, SWVmean, and SWVmax were −0.205, −0.213, and −0.199, respectively. Binary logistic regression analysis showed that sex (p = 0.008), low-density lipoprotein (p = 0.015), triglycerides (p = 0.011), SWVmean (p = 0.004), and hyper-homocysteinemia (p = 0.010) were significantly associated with symptomatic ischemic stroke. Receiver operating characteristic curves revealed that SWVmean combing serum homocysteine level (AUC = 0.67) presented better diagnostic value than serum homocysteine only (AUC = 0.60) for symptomatic ischemic stroke. CONCLUSION: Supersonic shear imaging could be used to quantitatively evaluate stiffness of both echolucent and echogenic carotid plaques. More importantly, SWVs of plaques were not only correlated to serum homocysteine level, but also associated with symptomatic ischemic stroke, suggesting that SSI might be useful for understanding more about VP.
Area Under Curve ; Biomarkers ; Female ; Homocysteine ; Humans ; Lipoproteins ; Logistic Models ; Male ; ROC Curve ; Stroke ; Triglycerides

Objective To study the protective effect of Shenmai injection (SI)on the behavior change in adult rats after neonatal maternal separation.Methods Neonate-mother separation (NMS) animal model was replicated.The rats in maternal separation group were separated for 3 h per day on postnatal days 2 to 21.Neonatal rats were divided randomly into three groups (n =12):control group,model group (NMS),experimental group (SI).Each group had twelve rats.After two months,the behavior changes of adult rats were tested.The expression of Bcl-2 in hippocampus was detected by immunohistochemical method.Results The total distances in experimental group and model group were (15.17 ± 5.32),(12.32 ± 2.74) m with significant difference (P ＜ 0.05).The average speeds in experimental group and model group were (0.09 ± 0.03),(0.07 ± 0.04) m · s-1 with significant increase (P ＜ 0.05),But not to the same as that of control group.The expression of hippocampus Bcl-2 in model group,control group and experimental group were 110.34 ± 37.32,92.62 ± 52.13,152.17 ± 29.65 with significantly increased in model group compared with control group (P ＜0.05);while decreased in experimental group compared with model group (P ＜0.05).But not to the same as that of control group.Conclusion Shenmai injection possibly can improve the cognitive impairment,which may be related to the upregulation of the expression level of apoptosis gene Bcl-2.

Deep vein thrombosis(DVT)is a common peripheral vascular disease in clinical practice.The lack of precise and efficient early diagnostic techniques renders it susceptible to being overlooked or misdiagnosed,and therefore,identifying trustworthy biomarkers is a major issue that has to be resolved.In this study,the endogenous metabolites in the urine of DVT rats were screened by metabolomics technology based on gas chromatograph-mass spectrometry(GC-MS)and the characteristic metabolites were identified by multiple feature selection algorithms and multivariate statistical analysis,for the development of a machine learning-based diagnostic model for DVT.The urine samples in metabolic cage in the thrombus development phase(between 48 and 72 h)of rats were collected,which was used as the models for inferior vena cava ligation.The metabolic profiles of the control group and DVT were obtained using the GC-MS method.A total of 176 kinds of endogenous metabolites were identified in rat urine through comparison with the FiehnLib database,26 kinds of differential metabolites associated with DVT were screened through a combination of the Mann-Whitney U test and orthogonal partial least squares discriminant analysis(OPLS-DA),and 13 kinds of significant metabolites strongly correlated with DVT were further evaluated in conjunction with various machine learning feature selection techniques.For DVT diagnosis,machine learning models such as Gaussian Naive Bayes(GNB),support vector machine(SVM),logistic regression(LR),and linear discriminant analysis(LDA)were developed.The diagnostic model constructed using 13 kinds of key metabolites demonstrated excellent accuracy and stability,and surpassed the predictive performance of the models utilizing 176 kinds of metabolites and 26 kinds of differential metabolites,as evidenced by examination and comparison of each model's efficacy.The study showed that the integration of multiple feature selection algorithms for analyzing metabolite information in DVT rat urine was capable of effectively identifying reliable potential markers of DVT.Furthermore,the developed machine learning model offered a novel technical approach for the automated diagnosis of DVT.

ObjectiveTo investigate the clinical features of systemic lupus erythematosus (SLE) patients with fever and find out the related factors.MethodsData was collected by the same methods in the past ten years in fifteen hospitals in Jiangsu province and then the data wereretrospectively analyzed.The potentially possible risk factors of fever in SLE were selected and then analyzed by chi-square test,Wilcoxon rank sum test and Logistic regression analysis.ResultsAll 1762 patients were investigated.Seven hundred and twenty-nine had active fever.Age at hospitalization,initially treated patients,photosensitivity,serositis,nervous system involvement,generalized lymphadenopathy/hepatosplenomegaly,white blood cell count (WBC),haemoglobin (HB),erythrocyte sedimentation rate (ESR),C-reaction protein (CRP),alanine aminotransferase(ALT),albumin(ALB),serum creatinine (Scr),complement C3,anti-dsDNA antibodies positive rate,anti-Sm antibodies positive rate,SLEDAI score and past therapies were factors associatedwith SLE fever.Logistic regression analysis showed that abnormal WBC count (OR=1.396,95％CI 1.114-1.711,P=0.004),CRP(OR=1.005,95％CI 1.002-1.009,P=0.002),ALT(OR=1.003,95％CI 1.001-1.005,P=0.005),Scr (OR=0.997,95％CI0.995-0.999,P=0.007),HB (OR=0.986,95％CI 0.981-0.992,P=0.000),age (OR =0.984,95％ CI 0.974-0.993,P=0.001 ) and past usage of cyclophosphamide (CTX) (OR =0.557,95％CI 0.382-0.813,P=0.002) were correlated with SLE fever.ConclusionFever is one of the most common clinical manifestations of SLE patients.Leucopenia,elevated CRP levels,liver function abnormalities,anemia,younger age are risk factors for SLE fever,while renal impairment and past usage of CTX are protective factors.