Objective To evaluate the curative effect of local immunotherapy with dexamethasone in healing Graves disease.Methods We divided the 76 patients diagnosed as Graves disease in the Second Affiliated Hospital of Xuzhou Medical College from Jan.2004 to Aug.2006 into two groups randomly.The therapy group(38 cases)were treated with oral drug and local immunotherapy,while the contrast group were treated with oral drug.Then we observed and analyzed the results of the two groups.Results There're 35 cases having exceptional curative effect such as rapid significance,short period of treatment and lasting effect in the therapy group,while only 28 cases having the less exceptional curative effect in the contrast groups.The difference was quite noticeable(P

OBJECTIVE To study the antibacterial activity of pazufloxacin in vitro against bacteria isolated from(patients) with respiratory and urinary tract infection,compared with levofloxacin,ciprofloxacin,cefuroxime and(cefotaxime) to provide guideline for clinical application.METHODS The infected bacteria were identified by the(fully) automatic VITEK system.The susceptibility test was determined by MIC method and K-B disk diffusion method respectively.RESULTS The sensitivity of most Gram-negative bacteria to pazufloxacin was basically the same to levofloxacin,cefotaxime, etc.However,the sensitivity of Pseudomonas and Acinetobacter to(pazufloxacin) was higher than to other four antibiotics;the sensitivity of Gram-positive cocci,particularly(Streptococcus) to(pazufloxacin) was obviously lower than cephalosporins and no better than other quinolones.(CONCLUSIONS) The antibacterial activity of pazufloxacin in vitro against the bacteria isolated from patients with(respiratory) and urinary tract infection is comparatively strong,especially in the urinary system.Pazufloxacin has an excellent broad-(spectrum) and strong antibacterial activity.However,the antibacterial activity against Gram-positive cocci is(expected) to promote.

Purpose:To study the determining prognostic factors that affect the survival of patients with bilateral breast cancer. Methods:The records of 21 women with bilateral breast cancer were analyzed.4(19%) presented simultaneous bilateral tumor.17(81%)developed bilateral breast cancer with interval in between. Patients were treated with surgery, radiation treatment and chemotherapy. Analysis of high risk factors of breast cancer and possible relation to postoperative survival was carried out.Results:The size of the tumor, the number of involved axillary nodes, and the adequacy of the initial treatment still remain the major prognostic factors ,correlated with the time interval between two cancers. 2 year, 5 year, 10 year, survival was recorded to be 90%, 71.4%, 66.7%. Conclusions:If treatment is correct for bilateral breast cancers, its 5 year survival rate still rather high. Time interval between two breast cancers was the most prominent prognostic factor, correlated with the overall survival. The early diagnosis and prompt adequate treatment of the seconed primary breast cancer are still the key to longer survival rates of bilateral breast cancer.

Objective : To examine the association between dietary patterns during pregnancy and gestational diabetes mellitus (GDM), so as to provide the evidence for guiding the establishment of healthy and balanced dietary patterns and reducing the prevalence of GDM. Methods: Pregnant women who underwent oral glucose tolerance tests in Hangzhou Obstetrics and Gynecological Hospital from 2020 to 2021 were enrolled, and their demographic information were collected using questionnaires. Pregnant women's diets during the past three months were collected using Food Frequency Questionnaires (FFQs), and dietary patterns were extracted using principal component analysis. In addition, the association between dietary patterns and risk of GDM was examined using a multivariable logistic regression model. Results: A total of 1 689 pregnant women were included, with a median age of 28.53 (interquartile range, 2.47) years and a median gestational age of 26.00 (interquartile range, 2.00) weeks. Five dietary patterns were identified according to pregnant women's types of diets, including meat-based diets, dessert-fruit-refined grain diets, plant-based diets, eggs-milk-nut diets and whole-grain diets, with a cumulative contribution rate of 58.76%. The prevalence of GDM was 24.57% (415 cases) among the study subjects. Multivariable logistic regression analysis showed that pregnant women with scores in the highest quartile (Q4) of the meat-based diets had an increased risk of GDM (OR=1.372, 95%CI: 1.043-2.055) relative to those with scores in the lowest quartile (Q1), and pregnant women with Q4 scores of the dessert-fruit-refined grain diets had an increased risk of GDM (OR=1.743, 95%CI: 1.397-2.432) relative to those with Q1 scores, while pregnant women with Q4 scores of the plant-based diets had a reduced risk of GDM (OR=0.382, 95%CI: 0.346-0.613) relative to those with Q1 scores. Conclusion A plant-based dietary pattern may reduce the risk of GDM, while meat-based and dessert-fruit-refined grain dietary patterns may increase the risk of GDM.

objective To evaluate the diagnostic efficiency of magnetic resonance imaging(MRI)for rheumatoid arthritis(RA).Methods The major international databases was searched by computer and Other methods to collect control studies about MRI for the diagnosis of RA,the searching deadline was December 2009.Data were screened and extracted by inclusion criteria.Meta-disc software Was used for statistics,including sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio(OR)and heterogeneity analysis.Results Twelve random control tests were included.Meta-analysis indicated that sensitivities of vities of synovitis,bone-erosion and tendenosynovitis were 81%~100%,48%～100%and 67%～96%while specificities of them were 64%～89%,16%~100%and 21%-74%respectively for RA patients(≤2vears).Sensitivities of synovitis and bone-erosion were 91%and 84%while specificities of them were 70%and 81%for RA Datients (>2 years).Conclusion Synovitis shown by MRI is helpful for the diagnosis of earlv and med-to-late RA.Diagnostic values of bone-erosion and tendonosynovitis demonstrated by MRI for earlv RA were not clear.The sample size of the included studies is small and some studies lack of control groupsput the conclusion of this meta-analysis liable for bias.We suggest that better designed and larger sample clinical studies are necessary.

Based on the conception analysis of the organizational change leadership of the upper-and mid-level nursing manager,this review described connovations of the organizational change leadership and its applications in nursing field at home and abroad,and pointed out the current research status,limitations and the inspirations we got,so as to provide references for promotion and evaluation of the upper-and midlevel nursing manager's organizational change leadership.

Objective To explore the effects of Six-Step standardized communication procedure in improving the communication ability of nurses.Methods C-I-CARE communication procedure was converted into Chinese.The Chinese version of Six-Step standardized communication procedure was Yi Kan,Er Yin,San Gaozhi,Si Wen,Wu Da,Liu Zaijian.The procedure was propagandized by making posters,setting up computer desktop,training nurses by lectures,video and role play.The effects were evaluated by pre and post self-control test among 100 nurses.Results The average score of communication behavior of 100 nurses after applying standardized communication procedure increased from 2.55±0.67 to 4.44±0.59 (t=-23.174,P＜0.001).In 2015,the nursing department received 622 silk banners and commendatory letters for appreciating nursing work,increased by 18.9％ compared to 2014.The discharged patient satisfaction increased from 94.2％ to 96.93％.The satisfaction of doctors to nurses' collaboration was 99.86％.There was no nursing complaint or dispute caused by bad communication.Conclusion The application of procedure and standardized communication method can improve the communication ability of nurses,optimize the relationship between nurses and patients and increase patient satisfaction.

Objective:To investigate the type and severity of skin adverse reactions induced by afatinib in the treatment of lung cancer, and to analyze their correlation with anti-lung cancer efficacy.Methods:A case-case-control study was conducted on lung cancer patients treated with afatinib in ZhongDa Hospital, Southeast University from December 2016 to January 2018. The type and severity of skin adverse reactions were evaluated in 76 patients with lung cancer based on the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 4.0, and these patients were divided into 3 groups according to the severity of skin lesions, including grade-0, -1, and -2/3 groups. The patients underwent chest computed tomography (CT) examination every 3 months, and the tumor response to afatinib was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) . Anti-lung cancer efficacy of afatinib was compared among the patients with different grades of skin lesions by using the Kruskal-wallis H rank sum test. Results:After treatment with afatinib, 44 of the 76 patients with lung cancer achieved stable condition or partial remission, and 32 experienced disease progression. Skin adverse reactions occurred in 69 patients, and manifested as acneiform lesions in 42 (55.3%) patients, paronychia in 35 (46.1%) , mucosal erosions in 30 (39%) , hair changes in 8 (10.5%) , and hand-foot syndrome in 6 (7.9%) . Improvement was achieved in 3, 7 and 34 cases in the grade-0, -1, and -2/3 groups ( n = 7, 19 and 50 respectively) , respectively. There was a significant difference in the response rate among the 3 groups ( χ2 = 6.117, P = 0.047) , and the response rate was significantly higher in the grade-1 and -2/3 groups than in the grade-0 group (both P < 0.001) , and higher in the grade-2/3 group than in the grade-1 group ( P < 0.001) . Conclusion:The treatment of lung cancer with afatinib can cause various types of skin lesions, such as acneiform lesions, paronychia, mucosal erosions, hair changes and hand-foot syndrome, and the higher the severity of the skin lesions, the more marked the anti-lung cancer efficacy of afatinib.

Objective: Non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR)-activating mutations have higher response rate and more prolonged survival following treatment with single-agent EGFR tyrosine kinase inhibitor (EGFR-TKI) compared with patients with wild-type EGFR. However, all patients treated with reversible inhibitors develop acquired re-sistance over time. The mechanisms of resistance are complicated. The lack of established therapeutic options for patients after a failed EGFR-TKI treatment poses a great challenge to physicians in managing this group of lung cancer patients. This study evaluates the in-fluence of EGFR-TKI retreatment following chemotherapy after failure of initial EGFR-TKI within at least six months on NSCLC pa-tients. Methods:The data of 27 patients who experienced treatment failure from their initial use of EGFR-TKI within at least 6 months were analyzed. After chemotherapy, the patients were retreated with EGFR-TKI (gefitinib 250 mg qd or erlotinib 150 mg qd), and the tumor progression was observed. The patients were assessed for adverse events and response to therapy. Targeted tumor lesions were as-sessed with CT scan. Results:Of the 27 patients who received EGFR–TKI retreatment, 1 (3.7%) patient was observed in complete re-sponse (CR), 8 (29.6%) patients in partial response (PR), 14 (51.9%) patients in stable disease (SD), and 4 (14.8%) patients in progres-sive disease (PD). The disease control rate (DCR) was 85.2%(95%CI=62%-94%). The median progression-free survival (mPFS) was 6 months (95%CI=1-29). Of the 13 patients who received the same EGFR-TKI, 1 patient in CR, 3 patients in PR, 8 patients in SD, and 2 patients in PD were observed. The DCR was 84.6%, and the mPFS was 5 months. Of the 14 patients who received another EG-FR-TKI, 0 patient in CR, 6 patients in PR, 6 patients in SD, and 2 patients in PD were observed. The DCR was 85.7%, and the mPFS was 9.5 months. Significant difference was found between the 2 groups in progression-free survival but not in response rate or disease control rate. Conclusion:Retreatment of EGFR-TKIs can be considered an option after failure of chemotherapy for patients who were
previously controlled by EGFR-TKI treatment.

Objective To discuss the value of early prediction and evaluation using ultrasound-guided diffuse optical tomography (US-guided DOT) of neoadjuvant chemotherapy (NCT) for breast cancer.Methods Sixty-two primary breast cancer patients were included.Before every neoadjuvant chemotherapy and surgery,the total hemoglobin concentration(Hb) was measured by US-guided DOT.According to the RECIST 1.1 standard,62 patients were divided into partial response (PR) group,complete response (CR) group,progressive disease(PD) group and stable disease(SD) group.According to the Miller and Payne (MP) grading system,the patients were divided into poor efficacy group(MP grade 1-3) and the effect of excellent group (MP grade 4-5).According to the postoperative pathological results,patients were divided into pathologic complete response(pCR) group and non pCR group.Hb with imaging and postoperative pathological results were analyzed.Results All of the 62 patients finished the NCT.After first cycle of chemotherapy and all chemotherapy,the value of Hb in the above groups had different degrees of decline,and the difference among the groups was statistically significant(P ＜0.001).When the descending value of Hb was 44.5 as the threshold for early prediction of NCT efficiency,the area under the curve of ROC (Az) was 0.745,and the sensitivity was 75.0％,specificity was 73.1％,positive predictive value was 79.4％,negative predictive value was 67.9％,and accuracy was 74.2％,respectively.Conclusions In the process of neoadjuvant chemotherapy of breast cancer,the decrease of Hb value is positively related to the therapeutic effect of chemotherapy.The change of Hb value can predict and evaluate the efficacy of neoadjuvant chemotherapy in the early time.