Objective To analyze the pathological diagnosis of patients with clinically diagnosed eczema,to describe the spectrum of skin diseases tending to be misdiagnosed as eczema,and to investigate factors associated with their misdiagnosis.Methods A retrospective study was performed on 400 patients who were clinically diagnosed as eczema and received pathological examination at the dermatology clinic of Peking University Third Hospital from August 2006 to April 2013.Skin biopsy specimens were re-reviewed for these patients,and pathological diagnosis was made in combination with clinical presentations.Results Of the 400 outpatients with clinically diagnosed eczema,110 (27.5％) were finally diagnosed as non-eczema skin diseases pathologically,including 16 cases of psoriasis,13 bullous pemphigoid (BP),11 lichen planus (LP),9 cutaneous amyloidosis,8 mycosis fungoides (MF),14 skin malignancies,and 39 other skin diseases.The highest misdiagnosis rate was observed in people aged 60 to 79 years (33.9％) and lesions at the genital sites (46.2％).Conclusions Many conditions tend to be misdiagnosed as eczema in clinic,including psoriasis,BP,LP,cutaneous amyloidosis,MF and skin malignancies.Misdiagnosis is rather frequent in elderly people and eczematous lesions in genital areas,and pathological examination should be taken actively for uncertain cases.

Objective To establish an effective method for determination of synthetic cannabinoid JWH-122 by the high-performance liquid chromatography (HPLC), which is controled by China’s Regulations on non-clinical narcotic and psychoactive drug. Methods Methanol-deionized water (50%-50%) was used as mobile phase for gradient elution. In addition to the initial concentration in organic phase, gradient steepness, column temperature, flow rate and other chromatographic conditions, the determine wavelengths were tested so as to ifnd out optimal experimental conditions. Linearity range and speciifcity were tested under optimal conditions, and actual samples were used to verify the method established. Results Under the condition of ultraviolet spectrum detection wavelength at 221nm, initial concentration of 70%, organic phase gradient steepness of 0.5%/min, lfow rate at 1.2 ml/min and column temperature of 30℃,excellent linearity of JWH-122 was observed at 0.002mg/mL-0.1mg/mL and the detection limit (S/N≥3) was 0.1μg/mL. The test of actual samples suggested that JWH-122 was able to be well separated from the sample under the optimal conditions. Conclusion Our method has advantages of rapidity, sensitivity, accuracy and excellent separation efifciency, and is capable of the detection of synthetic cannabinoid JWH-122 of the novel “spice” drugs.

Objective To study the effect on the environmental radioactivity level and the health of the residents in Shanghai when Qinshan Nuclear Power Station(QNPS) has been in normal operational condition for 17 years. Methods The field monitoring and the sampling analytical method were used for monitoring the radioactivity level in outdoor environment, drinking water, food and soil. Results The outdoor natural radiation level and the radioactivity level in the sample of the environmental media were on the normal background level. There was no distinct change in the environmental radiation level of Jinshan Area when QNPS was in normal operational condition. The radioactivity level in the environmental media was far lower than the limit values specified by the national standard GB. The effective dose of the outdoor natural external exposure for the residents is about 0.102 mSv/a and the effective dose of the internal exposure from the artificial radionuclides 90Sr and 137Cs in food for the residents is about 0.488 μSv/a. Conclusions There is no effect of the radioactive contamination on the environmental radioactivity level and the health of the residents in Shanghai when QNPS has been in normal operational condition for 17 years.

OBJECTIVE:To explore the new model and feasibility of the combination of ward round conducted by business president and pharmaceutical administration.METHODS:The organization form,procedures,content and experience of ward round conducted by business president were introduced based on the practice of our hospital.RESULTS & CONCLUSIONS:The pharmaceutical ward rounds conducted by business president are carried out once a month in our hospital to intervene irrational medication by means of medication survey,administration intervention and education with guidance and supervision of rational use of drug as core.Multi-disciplinary cooperation is effective measure for improving rational use of drug.It can strengthen public perception on rational use of drug in all areas by enhancing experience at key point which is worth of spreading.

Objective:To investigate the characteristics of diagnostic radiology and the situation of repeated examinations at medical institutions of Jinshan district, and put forward strategies and suggestions for the correct guidance on and reasonable applications of various medical exposures.Methods:The cases data on radiological examinations at medical institutions in Jinshan district, obtained in 2017 from Shanghai Municipal Health Commission Information Center Platform, was used to describe the characteristics of population distribution of patients, examination types, examination areas, diagnosed diseases, number of repeated examinations and the result of radiological examinations.Results:The main types of radiological examinations in Jinshan district were the CT scans and the conventional X-ray diagnosis, accounted respectively for 53.2% and 44.7% of the total radiological examinations. The radiological examinations were mainly performed on household registration (77.3%). The number of radiological examinations on males was close to on females, with examination frequency of 49.4% for males and 50.1% for females. The greatest frequency of radiological examinations was found in the age group older than 41 years, accounting for 77.1% of CT scans and 65.2% of the conventional X-ray diagnosis. The main examination sites of the CT scans at Jinshan medical institutions were chest (32.8%), abdomen (19.4%), brain (16.1%) and spine (11.4%), and for the conventional X-ray diagnosis were chest (43.2%) and limbs (39.6%). The main departments applying for radiological examinations are surgery (39.7%) and medicine (27.1%). The numbers of radiological examinations are, respectively, diseases of the respiratory system (19.8%), the injury, poisoning and some other consequences of external causes (15.8%), and the diseases of musculoskeletal system and connective tissue (15.8%). The positive rate of the conventional X-ray diagnosis was 53.1%, and the positive rate of CT scans was 73.5%. The conventional X-ray diagnosis and CT scans contributed higher specific rates of repeated examinations, accounting for 9.3% and 7.9% of the total of such type examination, respectively.Conclusions:CT scans in Jinshan district accounted for more than half of the total frequency of radiological examinations, therefore, interventions should be imposed on certain types of phycians and patients types.

OBJECTIVETo evaluate whether intraoperative autologous donation (IAD) can reduce perioperative blood transfusion for patients underwent mitral valve replacement (MVR).

METHODSA total of 318 patients received implementation of IAD from January 2011 to December 2013 were analyzed retrospectively, and compared with 517 patients of the previous 36-month period (from January 2008 to December 2012). The method of small-volume retrograde autologous priming, strict blood transfusion standard along with IAD together constituted a progressive blood-saving strategy. Statistical methods including Students' t-test, Pearson's χ(2) test, Kruskal-Wallis analysis and multivariate Logistic regression model were used for comparisons of the data.

RESULTSThere were no significant difference between IAD group and non-IAD group considering preoperative patient demographics, characteristics and preoperative comorbidities. However, IAD group significantly reduced number of patients transfused with intra/post-operative packed red-blood cell (PRBC) (55(17.0%) vs. 215 (42.1%), χ(2)=53.0, P=0.000), and had significantly reduced postoperative chest tube output (150(380) ml vs. 700(660) ml, H=195.648, P=0.000), length of stay ((16±6) d vs. (20±8)d, t=9.60, P=0.000). But hematocrit were lower in IAD group (30%±5% vs.33%±4% at end of operation, t=7.76, P=0.000; 30%±4% vs. 32%±5% at discharge, P=0.000, t=3.86). Multivariate logistic aggression analysis revealed that age, IAD and smoking history were factors influencing the probability of intra or postoperative blood transfusion.

CONCLUSIONImplementation of blood conservation strategies based on intraoperative autologous donation in mitral valve replacement surgery can significantly reduce intra/postoperative blood transfusion as well as postoperative complications.

Blood Transfusion, Autologous ; Bloodless Medical and Surgical Procedures ; Cardiac Surgical Procedures ; methods ; Hematocrit ; Humans ; Logistic Models ; Mitral Valve ; surgery ; Postoperative Complications ; Retrospective Studies

Objective To investigate the common initial clinical presentations of primary Sj(o)gren's syndrome (pSS) with pulmonary complications,and to explore the differences between patients with extraglandular manifestations at disease onset (EGM) and those with glandular manifestations at disease onset (GM).Methods A total of 1 341 hospitalized SS patients from 2003 to 2012 were retrospectively reviewed.Of them,102 hospitalized patients with pSS'associated lung disease were analyzed and included.Case control study was performed to explore the differences between the EGM group and the GM group.Results Fifty-one percent of patients were presented with EGM at onset,with significantly shorter disease duration [36 (12,156) m vs 102 (48,159) m,x2=-2.41,P=0.016].Although the mean diagnose time was similiar,only 4％ of the EGM group could be confirmed the pSS diagnose at onset,which was significantly less frequently than that of the GM group (34％,22=15.29,P＜0.01).Case control study revealed that hyperglobulinemia,elevated RF titers and anti-SSA and/or anti-SSB test positive were less predominant in the EGM group [IgG 16(12,21) g/L vs 21 (15,28) g/L,x2=-2.15,P=0.032;22 (20,171) U/ml vs 104 (20,238) U/ml,x2=-l.98,P=0.048;33％ vs 72％,x2=15.78,P＜0.01].The predicted value of TLC and FVC were lower [(87±23)％ vs (97±20)％,x2=-1.96,P=0.050;(8±28)％ vs (100±27)％,x2=-1.70,P=0.089] and HRCT score was higher in EMG group [12(88,15) vs 8(5,13),x2=-1.82,P=0.070].Conclusion EMG at onset is the common initial manifestation of pSS'associated lung involvement.Pulmonary complication is more progressively and severe than those with MG at onset.Anti'SSA positive,elevated RF titer and hyperglobulinemia are not predominant for patients with EMG at onset.

Objective To explore the distribution and application of diagnostic X-ray procedures in Shanghai through investigating the 49 sample medical institutions,to provide the theoretical basis of protective strategies for medical exposure.Methods According to the grade of medical institutions,stratified random samplings were used to select 49 medical institutions.The basic information of the surveyed medical institutions and person-times of various types of X-ray diagnostic procedures were gathered by radiology information system and manual recording.Results In the sampled medical institutions,393 sets of X-ray equipment were engaged in X-ray diagnostic radiology,and the total number of X-ray diagnostic imaging was 4 442 662.The gender ratio of male and female was 1 ∶0.99.The total frequency of diagnostic X-ray procedures was 1 228 examinations per thousand population,including 304 examinations per thousand population of CT scan,105 examinations per thousand population of dental radiography.Conclusions The frequency of diagnostic X-ray procedures in 2016 increased compared with the data surveyed during the period of the " 11th Five-year Plan",in which the frequency of CT procedures increased significantly.

Objective:To construct back propagation (BP) neural network model to predict the dose required for 131I therapy for hyperthyroidism and to calculate the personalized dose plan for patients. Methods:A complete set of data of patients treated for hyperthyroidism radioaiodine was collected from the nuclear medicine departments of several medical colleges in Shanghai, including history, examination result, treatment course, etc. As a result, a prediction model was established. The predicated result for BP neural network, radial basis function (RBF) neural network and Support Vector Machine (SVM) were compared by means of small sample data. The optimal model was selected to predict administrated dose and to finally test the accuracy of the model.Results:The average errors in BP neural network, RBF neural network and SVM model based on small samples were 5.53%, 7.09% and 9.64%, respectively. After comparison, BP neural network was selected to build the prediction model. 30 cases of data were selected by random sampling to verify the BP neural network. The mean error, mean square error, minimum error and maximum error of the prediction result were 7.22%, 0.053, 0.57% and 13.78%, respectively.Conclusions:In this study, a neural network prediction method was proposed to provide a more accurate dose for patients in need of radioiodine therap for hyperthyroidism, and to reduce the possibility of radiation damage or the unsatisfactory therapeutic effect caused by insufficient dose. It has clinical practical significance in providing the reference for clinicians to evaluate the administrated dose.

Objectve:To observe the change of functional connectivity(FC)characteristic and its correlation with cognitive flexibility in type 2 diabetes mellites(T2DM)patients with cognitive flexibility decreased.Methods:A retro-spective analysis was performed in 24 T2DM patients with cognitive flexibility decreased(T2DM+CD),34 T2DM pa-tients without cognitive flexibility decreased(T2DM-CD)and 31 healthy controls(HC).Wisconsin Card Sorting Test(WCST)and the Stroop Color Word Test(Stroop)were respectively used in three groups of subjects to assess cognitive flexibility and functional magnetic resonance imaging(fMRI)scans was used to assess the FC.The differences of cogni-tive flexibility were found between three groups of subjects.The differences of FC between the bilateral(Left and Right,L.and R.)striatum(ST)and the dorsolateral prefrontal cortex(dlPFC)were found between three groups of subjects.Further analysis was focused on the interactive effect of T2DM and cognitive flexibility on FC changes.Results:Com-pared with T2DM-CD and HC,the number of response administered,errors responses,perseverative response,and time in WCST of T2DM+CD were significantly increased,while the number of correct responses was decreased.In Stroop,the number of correct,word-color contradiction and correct word-color indifference in T2DM+CD were lower than HC.In T2DM+CD,FC between L.ST-L.dlPFC,R.ST-L.dlPFC and R.ST-R.dlPFC were decreased,and decreased FC between R.ST-R.dlPFC was associated with cognitive flexibility scale scores.There existed an interactive effect between T2DM and cognitive flexibility on FC changes.Conclusion:Decreased FC between ST and dlPFC is the neural mechanism of cognitive flexibility impairment in T2DM.