Objective To build clinical nursing pathway for artificial abortion operation and explore the effect of this method. Methods The nursing pathway was designed and carried out. The satisfaction degree with nursing, status of patients' awareness about contraception and artificial abortion operation was compared before and after the nursing pathway was implemented. Results Before and after the nursing pathway was implemented,the proportion of missing item of operation record was 0.636 and 0.013, the satisfaction degree with nursing was 77.0% and 92.3%, rate of patients' awareness about contraception and artificial abortion operation was 47.6% and 96.1%. Conclusions The clinical nursing pathway for artificial abortion operation may improve the degree of satisfaction- and the status of patients' awareness about contraception and artificial abortion operation, and decline the proportion of missing item of operation note, it ensures high nursing quality and safety surgery, which is worthy of popularizing.

Objective:To elucidate the changes in apparent diffusion coefficients(ADC)by quantify diffusion weighted (DW)magnetic resonance imaging(MRI)in patients with Alzbeimer's disease(AD),and the relationship between micro-structure changes of white matter(WM)and the cognitive impairment thereof.Methods:The DW-MRI was performed in 30 probable AD patients and 30 normal controls with normal-appearing white matter(NAWM).The ADC was measured in different WM areas.The neurologic and neuropsychological assessments were examined with mini-mental state examination(MMSE)in patients.The ADC were determined in standard regions of the frontal,temporal,occipital and parietal white matter,genu,splenium of the corpus callosum.Results:The value of ADC was higher in frontal,splenium corpus callosum,temporal,and parietal white matter of AD group than that of control(P ＜ 0.01).There was no significant difference in the ADC value of genu and occipital white matter between AD and control groups(P＞ 0.05).The score of MMSE was 24.1±0.8 in AD group.The ADC values of parietal,splenium of the corpus callosum and frontal white matter were significantly negatively correlated with MMSE scores in AD group(P ＜ 0.05 or P ＜ 0.01).There was no correlation between the ADC values of genu of the corpus eallosum,temporal and occipital white matter with the MMSE score(P ＞ 0.05).Conclusion:The quantitative DWI analysis of MRI DWI may be helpful in assessing WM abnormalities in AD.The parietal WM abnormalities may play an important role in the development of dementia.It was showed that Alzheimer's cognitive decline with ADC value and micro-structure of white matter was closely related.

Objective To evaluate the efficacy and safety of pentoxifyline (PTX) on the treatment of collagen-induced arthritis in rats. Methods Wistar rat arthritis model was induced by bovine Ⅱ collagen (BⅡC) . The rats were randomly divided into four groups including normal control group, CIA control group treated with normal saline, indometaein group and PTX group. The body weight, the hind paw volumes, the arthritic index of all rats at different time points were observed and measured. At the end of the experiment, the radiographic changes and the synovial pathology score of rat ankle joints were evaluated to analyze the treatment role of PTX on CIA inflammation. Results The collagen-induced arthritis model was induced successfully at 11~13 days after first immunization with type Ⅱ collagen. After administration, the rat weights of PTX group were higher than that of CIA group (P<0.01) and no significant difference was found between PTX group and normal control group since week three. The degree of swelling of ankle joints in PTX group was decreased since the 17th day. At week five, the volumes of hind paw in PTX group and indometacin group was not different from that in normal control group (P>0.05). Compared with CIA group, the degree of synovial swelling of PTX group and indometacin group was decreased, synovial proliferation and inflammatory cell infiltrations was mild, and vascular hyperplasia and pannus was significantly declined. No cartilage erosion and necrosis was found. The pathological score of PTX group and indometacin group was significantly decreased(P<0.01). The parenchyma of ankle joint was swollen and no osteoporosis and bone erosion was found in PTX group and indometacin group. Conclusion PTX can ameliorate the symptoms and inhibit the swollen of rat arthritis. It is effective and with good safety profile.

AIM: To further investigate preventive effects of Shenfu(SF) injection, a Chinese herb drug, on acute renal ischemic reperfusion injury (IRI). METHODS: After SF or normal saline was administered intravenously one time a day for four days, the renal ichemia-reperfusion(I-R) model was established by occlusion of right renal artery and vein for an hour and reperfusion for three hours after left nephroectomy. The activity of superoxide dismutase (SOD), content of malondialdehyde(MDA) in serum and renal tissue, and content of nitric oxide (NO),concentrations of Na + and Ca 2+ , numbers of WBC adhesion in renal tissue were detected and light and electronic microscopy were used for the detection of the renal histological changes. RESULTS: SF lowered significantly MDA content in either renal tissues or serum , concentration of Na +, the number of WBC adhesion, and scores of tubules in renal tissue after renal I-R, and the SOD activity in renal tissues and serum and NO content in renal tissue were obviously increased by SF.In addition,renal histomorphological damage in either light or electronic microscope were lightened by SF. But Ca 2+ concentration in renal tissue appeared to be only mildly affected. CONCLUSION: The mechanisms that SF protects renal structure and function against acute renal IRI may be involved in increasing SOD activity,scavenging directly oxygen free redicals(OFR),raising NO content,inhibiting WBC adhesion and recruiment,preventing Na + influx to form Na + overload.

Objective To investigate the role of myeloid dendritic cells(mDC)in the pathogenesis of ankylosing spondylitis (AS),and to study the mechanism of tumour necrosis factor (TNF)-α blocker on the treatment of AS by counting the number of mDC before and after the treatment.Methods Peripheral blood from 21 AS patients treated with 50 mg rhTNFR-Fc and 15 AS patients treated with placebo were investigated at week 0,week 2 and week 6 in a randomized,double-blind,placebo-controlled trial.Three-color flow cytometry analysis was used to investigate the change of the number of mDC before and after the treatment.And their correlation with the clinical parameters was analyzed.Results MHC Class Ⅰ positive mDC(Lin-/CD11c+/HLA-abc+)in AS patients was slightly less than in healthy controls (not statistically significant).No significant change in MHC Class Ⅰ mDC number was observed after drug treatment.The number of MHC Class Ⅱ mDC cells was not correlated with clinical parameters.Conclusion The treatment with rhTNFR-Fc in AS induces a significant upregnlation of MHC-Ⅱ DC.

Purpose To summarize the characteristics of computed tomography enteroclysis (CTE) in active ulcerative colitis (UC), and to explore the value of multi-slice CTE in the evaluation of UC. Materials and Methods Thirty-five patients with active UC confirmed by clinical manifestation, colonoscopy and pathology underwent CTE examination in the study. According to the modiifed Mayo-score, the patients were divided into mild group, moderate group and severe group, and the CTE manifestations were compared among the three groups. Results Among 35 patients, 6 patients were in the mild group, 13 in the moderate group, and 16 in the severe group. Submucosal bubbles had signiifcant differences between mild and moderate groups (P<0.05), bowel wall stratiifcation, disappearance of haustra and enlarged mesenteric lymph nodes were signiifcantly different between moderate and severe groups (P<0.05), and engorged vasa recta was significantly different between the 3 groups (P<0.05). However, bowel wall thickening, mural hyperenhencement, narrow lumen and fatty deposits around the rectum showed no difference between the three groups (P>0.05). Conclusion Multi-slice CTE can provide image features of bowel wall, intestinal tube and structures outside intestine in the evaluation of UC, thus it is useful in the diagnosis of active UC as well as in its clinical grading.

The real-time reported data of treated patients from July 2017 to June 2019 Nanxiang Hospital of Jiading District were collected from chest pain center platform. The results showed that the average time of completing ECG examination from the first medical contact was 1.3 to 6.9 min with a median of 1.9 min (1.7, 2.2), meeting the quality control requirements (10 min); the time required to obtain troponin test results was 13.0 to 48.4 min with a median of 14.1 min (13.4, 18.1), meeting the requirements for quality control of 20 min; time from entry to transfer out of PCI patients was 19.0-100.0 min, with median 37.2 (29.3, 66.6) min, basically reaching quality control (30 min); the entering catheter chamber rate of STEMI patients was 50.0% to 100.0% with a median of 100.0% (73.3%, 100.0%), meeting the requirements of quality control (≥50%). Through the active construction, the main quality control indicators were well reached, the reported cases were basically stable, and the disease distribution was basically reasonable in the primary-level chest pain centers. Informed notification of transshipment and subsequent management of low-risk chest pain patients need to be further strengthened. It is suggested that the construction of chest pain centers should establish long-term normal working mechanism, strengthening the control of key quality control indicators, to play the important role of the regional treatment system.

Effectively assessing oxygen delivery and demand is one of the key targets for fluid resuscitation in sepsis. Clinical signs and symptoms, blood lactic acid levels, and mixed venous oxygen saturation (S O 2) or central venous oxygen saturation (ScvO 2) all have their limitations. In recent years, these limitations have been overcome through the use of derived indicators from carbon dioxide (CO 2) such as mixed veno-arterial carbon dioxide partial pressure difference (P -aCO 2, PCO 2 gap, or ΔPCO 2), the ratio of mixed veno-arterial carbon dioxide partial pressure difference to arterial-mixed venous oxygen content difference (P -aCO 2/Ca- O 2). P -aCO 2, PCO 2 gap or ΔPCO 2 is not a purely anaerobic metabolism indicator as it is influenced by oxygen consumption. However, it reliably indicates whether blood flow is sufficient to carry CO 2 from peripheral tissues to the lungs for clearance, thus reflecting the adequacy of cardiac output and metabolism. The P -aCO 2/Ca- O 2 may serve as a marker of hypoxia. S O 2 and ScvO 2 represent venous oxygen saturation, reflecting tissue oxygen utilization. When oxygen delivery decreases but tissues still require more oxygen, oxygen extraction rate usually increases to meet tissue demands, resulting in decreased S O 2 and ScvO 2. But in some cases, even if the oxygen delivery rate and tissue utilization rate of oxygen are reduced, it may still lead to a decrease in S O 2 and ScvO 2. Sepsis is a classic example where tissue oxygen utilization decreases due to factors such as microcirculatory dysfunction, even when oxygen delivery is sufficient, leading to decrease in S O 2 and ScvO 2. Additionally, the solubility of CO 2 in plasma is approximately 20 times that of oxygen. Therefore, during sepsis or septic shock, derived variables of CO 2 may serve as sensitive markers for monitoring tissue perfusion and microcirculatory hemodynamics. Its main advantage over blood lactic acid is its ability to rapidly change and provide real-time monitoring of tissue hypoxia. This review aims to demonstrate the principles of CO 2-derived variables in sepsis, assess the available techniques for evaluating CO 2-derived variables during the sepsis process, and discuss their clinical relevance.

OBJECTIVETo compare the CT image of gastrointestinal schwannomas (GIS) and gastrointestinal stromal tumors(GIST), and to find the CT features to be helpful for differentiation of GIS from GIST.

METHODSClinical and iconography data of 15 GIS patients and 50 GIST patients who underwent stomach CT scan with postoperatively confirmed histopathology between January 2000 and July 2014 in our department were collected retrospectively. CT findings of these two tumors were compared. Then the ROC curve was drawn based on the significant CT findings and area under the curve (AUC) was calculated to assess the sensibility and specificity for the differential diagnosis of GIS and GIST.

RESULTCT findings, such as the tumor size, shape, cystic change, perilesional lymph nodes, vessel seeding, enhancement pattern and degree, absolute and standardized CT value were significantly different between GIS and GIST(all P<0.05). Among the CT findings, tumor size, cystic change, perilesional lymph nodes, enhancement pattern and arterial phase standardized CT value (Sa) were better differential than others (all AUC>0.7). Tumor size showed the highest sensibility(90%), and cystic change and Sa showed the highest specificity(87%).

CONCLUSIONSGIS seems to show a homogeneous tumor more frequently, presenting light and moderate enhancement pattern and obvious enhancement of perilesional lymph nodes, while GIST seems to reveal malignant features, such as abundant blood supply, larger volume, frequent necrosis and cystic change. Cystic change and Sa value possess the better differential ability in diagnosis of these two tumors.

Objective:To investigate the value of a preoperatively MRI-based deep learning (DL) radiomics machine learning model to distinguish low-grade and high-grade soft tissue sarcomas (STS).Methods:From November 2007 to May 2019, 151 patients with STS confirmed by pathology in the Affiliated Hospital of Qingdao University were enrolled as training sets, and 131 patients in the Affiliated Hospital of Shandong First Medical University and the Third Hospital of Hebei Medical University were enrolled as external validation sets. According to the French Federation Nationale des Centres de Lutte Contre le Cancer classification (FNCLCC) system, 161 patients with FNCLCC grades Ⅰ and Ⅱ were defined as low-grade and 121 patients with grade Ⅲ were defined as high-grade. The hand-crafted radiomic (HCR) and DL radiomic features of the lesions were extracted respectively. Based on HCR features, DL features, and HCR-DL combined features, respectively, three machine-learning models were established by decision tree, logistic regression, and support vector machine (SVM) classifiers. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each machine learning model and choose the best one. The univariate and multivariate logistic regression were used to establish a clinical-imaging factors model based on demographics and MRI findings. The nomogram was established by combining the optimal radiomics model and the clinical-imaging model. The AUC was used to evaluate the performance of each model and the DeLong test was used for comparison of AUC between every two models. The Kaplan-Meier survival curve and log-rank test were used to evaluate the performance of the optimal machine learning model in the risk stratification of progression free survival (PFS) in STS patients.Results:The SVM radiomics model based on HCR-DL combined features had the optimal predicting power with AUC values of 0.931(95%CI 0.889-0.973) in the training set and 0.951 (95%CI 0.904-0.997) in the validation set. The AUC values of the clinical-imaging model were 0.795 (95%CI 0.724-0.867) and 0.615 (95%CI 0.510-0.720), and of the nomogram was 0.875 (95%CI 0.818-0.932) and 0.786 (95%CI 0.701-0.872) in the training and validation sets, respectively. In validation set, the performance of SVM radiomics model was better than those of the nomogram and clinical-imaging models ( Z=3.16, 6.07; P=0.002,<0.001). Using the optimal radiomics model, there was statistically significant in PFS between the high and low risk groups of STS patients (training sets: χ2=43.50, P<0.001; validation sets: χ2=70.50, P<0.001). Conclusion:Preoperative MRI-based DL radiomics machine learning model has accurate prediction performance in differentiating the histopathological grading of STS. The SVM radiomics model based on HCR-DL combined features has the optimal predicting power and was expected to undergo risk stratification of prognosis in STS patients.