Objective To evaluate the effectiveness of transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) and TACE combined with 125I interstitial brachytherapy in the treatment of primary hepatocellular carcinoma(HCC) and to compare the results of the two therapies.Methods Fifty patients with HCC underwent TACE and RFA during laparotomy and 34 patients received TACE and radioactive 125I particle seeding.Four weeks after the procedure,dynamic enhanced CT or MR scanning was performed for a check.If the lipiodol deposit was poor,TACE was repeated.Follow-up check was made at regular intervals to observe the results.Results One month after the treatment,the local control rate of the tumor for TACE +RFA and TACE + 125I particle seeding combination therapy was 98.0% and 97.1%,respectively.No statistically significant difference existed between the two therapies.Conclusions Both TACE combined with RFA or with 125I particle seeding are effective therapies for HCC,which can be regarded as an ideal alternative therapy for patients who have failed to respond to TACE alone.

Updated guidelines on the management of non-Hodgkin lymphoma (2015.V2) have been issued by the National Comprehensive Cancer Network (NCCN) in March 3, 2015.The Castleman disease (CD) is included for the first time.References from relevant publications, the standards for diagnosis and treatment of CD are described in detail and it also provides professional healthcare with clear guidance on the management of patients with CD.

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 understand the etiology of acute hepatitis B (AHB) in adults and investigate the mechanisms of hepatic injury and viral clearance in AHB. Methods One hundred and twenty adult AHB patients were enrolled. Epidemiological and clinical data were collected from the case history records or face-to-face inquiry, and serum samples were collected during hospitalization and follow-up. To observe dynamic patterns of AHB etiology, the markers of hepatitis B virus (HBV) were detected by enzyme-linked immunosorbent assay (ELISA); the level of HBV DNA and HBV genotype were determined by real-time polymerase chain reaction (PCR). Enumeration data were analyzed by non-parametric rank sum test. Comparison between groups was done by t test and that between rates of samples was done by Pearson χ2 test. Results Serum HBV DNA was positive in 48.33% of patients at the time of diagnosis with mean level of 9.84×04 copy/mL, and became undetectable after 12.5 days on average. The median levels of serum alanine aminotransferase (ALT) were 1600 U/L and 1490 U/L in HBV DNA positive and negative groups, respectively (z=-0. 678, P=0. 498). However, the mean levels of serum ALT were (2058±123) U/L and (1393±139) U/L in groups of HBV DNA<1×104 copy/mL and>1×104 copy/mL, respectively, which was significantly different (t=-2.17, P=0. 049). Genotype B accounted for 52.5%, genotype C 42.5 and genotype B and C mixed type 5.0% in 58 patients with HBV DNA positive. Eight patterns of serum HBV markers were presented at first visiting. HBsAg(+), HBeAg(+), anti-HBc(+), anti-HBc IgM(+) and HBsAg(+), anti-HBe(+), anti-HBc(+), anti-HBc IgM(+) were the most common patterns, which accounted for 38.3% and 30.0%, respectively. The dynamic patterns of serum HBV markers of 28 AFIB patients were prospectively followed up. The rate of serum FIBsAg loss was 100. 0% and the median time of negative-conversion was 3 weeks. The cumulative positive rate of anti-HBs was 85.7% after 52 weeks of follow-up. The rate of serum HBeAg loss was 100.0%. HBeAg was negative in 53.6% of patients at first visiting and the rest of patients achieved negative within 4 weeks after onset. The positive rate of anti-HBe was 82.1% during 52 weeks of follow-up. Total anti-HBc (including IgG and IgM) was keeping positive in all patients within 52 weeks, and the negative rate of anti-HBc IgM was 39. 3% after followed up for 52 weeks. Conclusions Rapid HBV clearance andserum HBV marker conversion are significantly different between AHB and chronic hepatitis B.

According to the recommended diagnostic criteria of obese adults in Asia-Pacific region,8 284 cases of middle-aged and elderly people in Uygur and Han populations were collected randomly to study the status and distribution characteristics of two nationalities.Standardized prevalences of obesity were 20.1 2%in Uygurs and 23.077%in Hans.Woman in Hans reached the highest prevalence.Alcohol-drinking,abnormal giycometabolism,and serum cholesterol levels were the most relevant risk factors.

As a heteronomy,the code of medical ethics plays an important role in sustaining the trust between physicians and patients.Based on a comparative analysis of the domestic and foreign codes of medical ethics,and field survey on such trust at tertiary hospitals in Beijing,as well as medical providers’moral characteristics,this article analyzed the causes that “goodwill”is insufficient in the trust in terms of internal and external factors;and then,in respect of heteronomy as a basis,it put forward suggestions to improve code of medical ethics in order to rebuild such trust.

Physician-patient trust is the basis of informed consent,and the informed consent institution is supposed to strengthen the trust.However,it affects trust in an opposite way in practice. This research aimed to analyze the relationship between informed consent and physician-patient trust,and provide with the advice,recommending on such rebuilding.

The study found that the physician-patient trust crisis results from overreliance on technology trust instead of interpersonal trust and institutional trust. The alleged “Paternalistic government innovation”in healthcare service has caused wastes of healthcare resources and gap below public expectancy due to its incompetence in resolving social problems,further eroding institutional legality and intensifying such crisis.This research aimed to identify government accountabilities in building such trust from three aspects.

Objective To evaluate and compare the value of predicting diseases such as hypertension and arteriosclerosis of the body mass index(BMI) and percent body fat(PBF),so as to provide the basis for evaluation of obesity.Methods Totally 3149 common residents in Jiangsu province were surveyed using the method of stratified and cluster sampling.Effective data included height,weight,PBF,blood pressure and brachial-ankle pulse wave velocity(baPWV).Obesity was defined by percent body fat with the evaluation of WHO and ASBP.Areas under ROC curves(AUC)of BMI and PBF were estimated by the nonparametric test and then the two diagnostic tests were compared by predictive value of related diseases.Results(1)Predictive value of BMI to diagnose obesity(defined by PBF):AUC are respectively 0.949(for WHO standard)、0.906(for ASBP standard)in women and 0.864 in men.In age group,the 20-39 years have the highest AUC of BMI to predict obesity.P＜0.01 for above nonparametric tests.(2)According to ROC curves we got the adjusted cut-off points of BMI are respectively 26 kg/m2 in men and 25 kg/m2 in women for WHO standard or 26 kg/m2 in men and 23 kg/m2 in women for ASBP standard,while the specificity of predicting obesity decreased from 90％ ～ 99％ to 76％ ～87％,but the sensitivity significant increased from 17％ ～ 43％ to 78％ ～ 89％;After adjusting the cutoff points of BMI,the value of kappa of prevalence of obesity increased from 0.475 to 0.537 in men and 0.115 to 0.655 in women.(3)To predict hypertension,areas of BMI were 0.688(95％CI:0.656-0.720) in men and 0.745 (95％CI:0.708-0.782) in women,similarly,of PBF were 0.687 (95％CI:0.655-0.718) in men and 0.723(95％CI:0.681-0.764)in women;To predict arteriosclerosis there showed highly consistency that the areas of BMI were 0.613(0.586-0.641)in men and 0.692(95％CI:0.659-0.726)in women,meanwhile,for PBF they were 0.635 (95％CI:0.608-0.663) in men and 0.683 (95％CI:0.648-0.718) in women (P＜0.01).(4) Paired test of the two areas under ROC curves showed that PBF had higher diagnostic value than BMI in men to predict arteriosclerosis(u=2.05,P＜0.05),however,no statistical difference in women(u=0.75,P＞0.05)and in predicting hypertension(u=0.75 to men and u=1.26 to women,P＞ 0.05).Conclusions Using BMI and PBF can all predict hypertension and arteriosclerosis effectively,thus,obesity can be evaluated suitably by both BMI and PBF in large-scale population study,especially in women and youth.Relatively,WHO standard of PBF is more suitable for Chinese population to evaluate obesity than ASBP standard.

The professional competency of medical informatics graduates from China Medical University in 1992-2011 was investigated, the requirements of employers for their professional competency were analyzed, and the current medical informatics curriculum system was evaluated with suggestions put forward for the reform of medical informatics curriculum system, including revision of its training target, measures for curriculum system reform, and improvement of confidence.