Heart Valve Prosthesis Implantation ; Humans ; Tricuspid Valve Insufficiency ; diagnosis ; etiology ; therapy

Dermatomycoses ; drug therapy ; Drug Therapy, Combination ; Humans ; Medicine, Chinese Traditional ; Phytotherapy ; Sexually Transmitted Diseases ; drug therapy ; Skin Diseases ; drug therapy ; Skin Diseases, Viral ; drug therapy

Female ; Humans ; Laryngeal Diseases ; etiology ; Middle Aged ; Parathyroid Neoplasms ; complications

Adolescent ; Antimetabolites, Antineoplastic ; administration & dosage ; Child ; Child, Preschool ; Female ; Humans ; Infusions, Intravenous ; Leucovorin ; administration & dosage ; Lymphoma, Non-Hodgkin ; drug therapy ; Male ; Methotrexate ; administration & dosage ; adverse effects ; blood ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy

Objective To study needs of training of trainers(ToT)in mini-clinical evaluation exercise(mini-CEX)and its effectiveness.Methods One hundred and fourteen doctors involved in TOT for mini-CEX were interviewed with questionnaire before and after training for their satisfaction of training and fifty of them scored the training videos.Results Before the training.39%(44/114)of doctors involved in TOT knew mini-CEX and 97%(111/114)of them hoped to know how to carry out mini-CEX thronsh training.When the training finished,30%(34/114)tO 55%(63/114)of them could completely understand seven items of examinations of mini-CEX.Fifty doctors involved in TOT scored the training videos after the training.There was signifieant difference in scores between TOT and standard scoring on training video 1 for teaching of coronary heart disease and video 2 for teaching of hematochezia(P<0.05).No significant difference Was found in scores between TOT and standard scoring on the video 3 for teaching of abdomihal pain(P>0.05).as well as those between TOT with five or less years experience and those with more than five years experience(P>0.05).Conclusions Currently,doctors involved in TOT have more demands on mini-CEX.However,effectiveness of short-course training for mini-CEX is not satisfactory,and pattern of its training should be improved further.

Objective To investigate the epidemiological characteristics of gonorrhea,and to analyze its temporal-spatial clustering in Zhejiang province.Methods Data on the incidence and demographic characteristics of gonorrhea in Zhejiang province from January 2004 to December 2012 were obtained from the China Information System for Disease Control and Prevention.The population,time and space distributions of gonorrhea were described.Epidemic curve and incidence maps were drawn.A space-time permutation scan statistic was used to detect space-time clusters,and spatial autocorrelation analysis was performed to calculate the Moran's I value and draw Local Indicators of Spatial Association (LISA) cluster maps.Results In Zhejiang province,a total of 199 956 cases of gonorrhea were reported with a decreasing trend in incidence rate from 2004 to 2012.The male to female ratio was 3.51:1 (155 634/44 331).People aged between 25 and 60 years accounted for 75.21％ of these patients,whereas the constituent ratio of people aged 0-1 years and ＞ 60 years increased with time.The incidence rate of gonorrhea was significantly higher in middle and north parts than in the south part of Zhejiang province,and higher in summer than in winter and spring with the peak incidence observed in August.Thirteen temporal-spatial clusters were detected,with the large clusters in Hangzhou,Huzhou,Ningbo,Shaoxing and their neighbor counties/cities/ districts,as well as some counties/cities/districts in Jinhua.All of the above clusters lasted 4.5 years.LISA maps showed an increasing trend in high-high aggregation counties/cities/districts which spread from the north to south part of Zhejiang province.Conclusion There is a temporal-spatial aggregation of gonorrhea in Zhejiang province with young and middle-aged men as the main affected population.

Objective To investigate the survival status and pathogens in adult patients with severe community-acquired pneumonia (SCAP) for the past ten years in our hospital. Methods A total of 159 adult patients with SCAP were enrolled for this study from January 2007 to December 2016 in our hospital. Patients were divided into early stage group (from January 2007 to December 2011, n=71) and late stage group (from January 2012 to December 2016, n=88). The clinical data, pathogen distribution and prognosis were compared between two groups. Results (1) The proportion of patients with blood urea nitrogen (BUN) > 7.1 mmol/L was significantly higher in late stage group than that of early stage group (P<0.05). There were no significant differences in baseline data, vital signs, imaging findings and other laboratory examinations between the two groups (P>0.05). (2) For distribution of pathogens, 42 and 49 cases were detected pathogens in early stage group and late stage group. The detection rate of Legionella pneumophila was significantly higher in late stage group than that in early stage group (26.5% vs. 7.1%, P<0.05). (3) For complications, the incidence of septic shock was significantly higher in late stage group than that in the early stage group (22.7%vs. 9.9%, P<0.05). The fatality rate within 30 d after admission was significantly higher in late stage group than that of early stage group (43.2%vs. 25.4%, P<0.05). Results of multi-factor Cox proportional hazard regression analysis showed that septic shock and respiratory acidosis were independent risk factors of mortality in early stage group (P<0.05) while septic shock, chronic obstructive pulmonary disease (COPD) and multi-lobar infiltrates were independent risk factors of mortality in late stage group ( P<0.05). Conclusion In the past ten years, basic clinical characteristics of adult patients with SCAP in our hospital have changed little, but detection rate of legionella has showed increasing trend, and the short-term mortality rate has increased. Whether or not patients are combined with septic shock is a key factor affecting the prognosis.

Objective To analyze the ultrasonic features of thyroid microcarcinoma (TMC) and the causes of misdiagnosis. Methods The ultrasonic features including shape, margin, echogenecity, microcalcification, vascularity and lymphadenopathy were analyzed retrospectively in 26 pathologically-proven TMC patients. Results In 26 cases, 11 cases were diagnosed correctly before operation (11/26, 42.31%), 12 cases were misdiagnosed (12/26, 46.15%) as adenoma or benign nodule, and 3 cases were missed diagnosed (3/26, 11.54%). Among the 23 cases detected on ultrasound, 21 cases were solid and hypoechoic (21/23, 91.30%);19 cases were ill-defined (19/23, 82.61%);12 cases were taller than wide in shape (12/23, 52.17%); 14 cases had microcalcification (14/23, 60.87%); 7 cases showed central or peripheral blood flow signals (7/23,30.43%) with arterial resistance index>0.70 in 3 lesions and<0.70 in 4 lesions. Conclusions Several ultrasonographic features are helpful in identiifcation of TMC, including hypo/iso-echogenecity, ill-deifned margin, taller-than-wide shape, microcalciifcation, arterial signals with high resistance index, and abnormal lymphadenopathy. Moreover, for cases with multiple lesions, to the potential co-existence of benign and malignant lesions should be considered.

Objective To investigate the safety and short-term efficacy for evaluation of the low-profile visualized intraluminal support device (LVIS stents )compression and lantern release shapes for the treatment of wide-necked intracranial aneurysms. Methods From December 2014 to October 2015,15 patients with intracranial wide-neck aneurysm (16 aneurysms)received LVIS stent treatment, whose stent shapes had shortening changes were analyzed retrospectively. Thecompression mode refers to the length of LVIS stent to be shorter for more than 5 mm than the label release value by operation. Thelantern mode refers to the widened diameter of LVIS stent at the neck of aneurysm. The metal coverage rate in the posterior communicating segment of internal carotid artery after stent compression was calculated, and its safety and efficacy were assessed immediately after procedure and at 3 months after procedure. Results (1 )Using LVIS stent-assisted treatment,16 wide-necked aneurysms were treated,including 8 posterior communicating aneurysms,6 ophthalmic aneurysms,one anterior choroidal artery aneurysm and one M2 bifurcation fusiform aneurysm. The aneurysm neck was 1. 8 to 8. 0 mm (mean 3. 9 ± 1. 7 mm). A total of 15 LVIS stents were implanted (one patient with 2 aneurysms were treated with 1 stent). All the stents were released by using compression mode,and 4 of the patients (4 stents)also used the lantern mode at the same time. (2 ) After LVIS stenting,the Raymond grade Ⅰ embolization was in 10 aneurysms (62.5%),the covered branch arteries were patent immediately after procedure. (3)No perioperative technology-related hemorrhagic and ischemic complications occurred. The success rate of stent implantation was 100%(15/15). (4)The metal coverage rate after stent compression in the internal carotid artery posterior communicating segment was 30. 3%-38. 5%(mean 35. 0 ± 2. 8%). (5)After LVIS stent implantation,15 patients were followed up by whole brain DSA for 3 to 5 months (mean 3. 2 ± 0. 5), 14 aneurysms were cured on imaging (Raymond gradeⅠ),and no aneurysm recurred. All branch arteries covered by the stents did not have vascular occlusion. There was no in-stent restenosis or parent artery occlusion. The total disability rate was 6. 7%(1/15),and no patient died. Conclusions LVIS stents can increase aneurysm neck metal coverage rate and short-term cure rate throughcompression andlantern modes,while does not affect the covered branches. Choosing the appropriate cases for thelanternmode may be beneficial to the short-term protection of the vascular branches at the aneurysm necks.

Objective To evaluate the mental status of malignant hematologic patients, explore the morbidity of depression in malignant hematologic patients, and investigate valid interventional treatment on them. Methods 134 malignant hematologic patients were evaluated by SDS and HAMD, and 49 patientswere selected who was diagnosed depressive disorder then randomly divided into 2 groups. One was experimental group and the other control group. The patients of experimental group were treated with antidepressant drug and mental intervention during common therapy, while the patients of control group only took common therapy. The change of immunological function after treatment was detected. Results The morbidity of depression in malignant hematologic patients was 37 %. The scores of SDS and HAMD were significandy decreased and the depressive symptoms were notablely improved in experimental group and there were significant differences after treatment and before treatment (P <0.01), but there was no significant difference in control group (P >0.1). The NPY plasma levels significantly increased after treatment in experimental group(P <0.01), but there was no significant difference in control group(P >0.05); the CD+4/CD+4 values of patients in the experimental group were significantly increased after treatments. Statistical analysis revealed significant differences in the experimental group patients between pre-treat and after-treat (P <0,05),but no obvious difference in the patients of control group (P>0.5). Conclusion Mental intervention and antidepressive treatment can improve all of the depression, immunological function and quality of life of malignant hematologic patients.