Objective To discuss the incidence, clinical features, diagnostic methods, treatment and prognostic factors of Hodgkin lymphoma of breast. Methods The clinical data, diagnosis, treatment and prognosis of one male patient diagnosed as Hodgkin lymphoma of breast were retrospectively analyzed, and literatures were reviewed. Results The 71-year-old male patient had a main physical sign of a local painless lump in breast. The lump increased progressively, associated with generalized lymphadenopathy, skin itching and sweats. Pathologic results showed the diagnosis of classical Hodgkin lymphoma (Ann Arbor stage: ⅢEB). The patient eventually died after 7 months following the combined chemotherapy. Conclusions Hodgkin lymphoma of breast is a rare disease lacking in specific clinical manifestations. It is difficult to clarify the diagnosis before operation, and its definite diagnosis largely depends on pathological and immunohistochemical examination. The combination of chemotherapy with radiotherapy may have a favorable efficacy, with the poor diagnosis.

Objective To investigate the metabolite changes in the preschool children with autism spectrum disorder (ASD) using MR spectroscopy (MRS) and explore the associations between image findings and clinical variables, which may provide a noninvasive brain biochemical method for the early diagnosis and prevention of autism. Methods Twenty one cases of preschool ASD children (3-6 years old) and age-and sex-matched 20 preschool healthy controls underwent single voxel short (SVS) short TE (TE=30 ms) MRS. The absolute metabolite concentrations in the anterior cingulate cortex (ACC) , anterior middle anterior cingulate cortex (aMCC) and posterior cingulate (PCC) were quantitatively analyzed using LCModel software. Two independent sample t tests were used for analysis. The relationships between metabolite concentrations and diagnostic and statistical manual of mental disorders (DSM-IV) , childhood autism rating scale (CARS) and autism behavior checklist (ABC) were analyzed by Pearson correlation analysis. Results Compared to control subjects, ASD patients had significantly lower N-acetylaspartate (NAA) values (4.35 ± 0.80, 6.34±0.82, 8.04±0.97 mmol/L respectively) in ACC, aMCC and PCC (t=2.640, P=0.012;t=2.182, P=0.035;t=3.343, P=0.002) , had significantly lower choline (Cho) 1.32±0.22 mmol/L (t=2.905, P=0.006) and glutamine and glutamate complex (Glx) 10.02 ± 0.88 mmol/L (t=2.090, P=0.043) in PCC. Cho, total creatine (tCr) , myo-Inositol (MI) and Glx levels did not differ between groups in other aforementioned regions (P>0.05). Negative correlations between the NAA ualues in the PCC and CARS (r=-0.504, P=0.020) were detected, and no significant correlation among DSM-IV, CARS, ABC and other metabolite values (P>0.05). Condnsions The biochemical changes in the preschool children with ASD in cingulate reflect the neuronal loss, structural or functional damage and cell membrane enzyme metabolic dysfunctions, may reveal the pathological basis of ASD. These results may provide noninvasive and quantitative methods for the diagnosis and prognosis evaluation of ASD child.

Objective: To investigate the changes of ambient dose equivalent rate in 99mTcO4- single photon emission computed tomography (SPECT) of the thyroid among patients with hyperthyroidism, so as to provide insights into radiation protection guidance. Methods: Patients with hyperthyroidism who underwent 99mTcO4- SPECT of the thyroid in a tertiary hospital were enrolled. The ambient dose equivalent rate was measured at different time points following 99mTcO4- infection and at sites with different distances from patients' neck, and the effects of time post-injection, distance from patients' neck, 24-hour thyroidal radioiodine uptake and thyroid weight on the ambient dose equivalent rate were examined using a generalized linear mixed model. Results: Totally 100 patients with hyperthyroidism were enrolled, including 24 men and 76 women and with a mean age of (38.5±14.0) years. The generalized linear mixed model was statistically significant (F=6 610.165, P<0.001), and patients' thyroid weight, time post-injection and distance from patients' neck significantly affected the ambient dose equivalent rate (F=57.967, 15 988.574, 11 200.645, all P<0.001), and the ambient dose equivalent rate positively correlated with patients' thyroid weight and negatively correlated with time post-injection and distance from patients' neck. Conclusions The ambient dose equivalent rate is affected by patients' thyroid weight, time post-injection and distance from patients' neck among patients with hyperthyroidism undergoing 99mTcO4- SPECT of the thyroid. Delay in contact with patients or keeping distance from patients may be effective for radiation protection.

OBJECTIVETo observe the clinical efficacy on senile female bladder neck obstruction treated with acupoint application, therapy and western medication.

METHODSFifty cases of senile female bladder neck observation were randomized into an obstrvation group and a control group, 25 cases in each one. Tamsulosin hydrochloride capsules were taken orally in the two groups, 0.2 mg every night, continuously for 100 days. In the observation group, with radix aconiti lateralis preparata, semen brassicae and fructus ligustri lucidi contained, bushentongyu plaster was used at Shenque (CV 8), Sanyinjiao (SP 6), Pangguangshu (BL 28), Zhongji (CV 3) and Sanjiaoshu (BL 22), once every two days. Eight treatments made one session and 6 sessions were required totally. The international prostate symptom score (IPSS), the bother score (BS), the residual volume (RV) and the maximal urinary flow rate (MFR) were observed before and after treatment in the two groups. The clinical efficacy was compared between the two groups.

RESULTSEvery score in IPSS after treatment was reduced apparently as compared with that before treatment in the two groups (all P < 0.01). The improvements in feeling of incomplete, bladder emptying, intermittency < 2 h, urgency, interupted urination and nocturia in the observation group were more advantageous than those in the control group (all P < 0.05). The total effective rate was 95.65% (22/23) in the observation group, higher than 85.71% (18/21) in the control group (P < 0.05). After treatment, RV, MFR and BS were significantly different as compared with those before treatment (all P < 0.05).

CONCLUSIONThe combined therapy of acupoint application of bushentongyu plaster and oral administration of tamsulosin hydrochloride capsules achieves the significant efficacy on senile female bladder neck obstruction as compared with the simple administration of tamsulosin hydrochloride capsules.

Acupuncture Points ; Aged ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Middle Aged ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; drug therapy ; physiopathology ; Urination

Objective: The prevalence of HIV/AIDS in people aged ≥50 years is increasing in China, resulting in another focus for AIDS prevention and control. A Meta-analysis was conducted to evaluate the HIV infection, its area and time distributions in people aged ≥50 years in China to provide evidence for the prevention and control of HIV/AIDS. Methods: Information on HIV infection rate in people aged ≥50 years in China were collected from Wanfang digital database, China National Knowledge Infrastructure (CNKI), PubMed and Embase. The R Studio1.1.456 software was used to calculate the pooled infection rate, and assessed the publication bias. Results: A total of 30 studies which covered 13 provinces were selected. From 2010 to 2018, the pooled HIV infection rate in people aged ≥50 years was 1.68% (95%CI:1.00%-2.79%). The HIV infection rate (2.60%) was higher in eastern China than in central and western China (0.16%, 2.13%). Conclusion The overall HIV infection rate in people aged ≥50 years is generally high in China. It is important to control the HIV infection in this population to facilitate the AIDS prevention and control in China.

Objective:To systematically evaluate and integrate qualitative research on the real experience of moral distress among Intensive Care Unit (ICU) nurses.Methods:Qualitative researches on the moral distress of ICU nurses were searched through computers in PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, WanFang Database, VIP, and China Biology Medicine disc. The search period was from the establishment of the database to April 15, 2023. The quality evaluation of the included studies was conducted using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center (2017) in Australian. The aggregation integration method was used to integrate the results.Results:A total of 13 articles were included, and 42 main results were extracted and categorized into 9 categories. Three integrated results were synthesized, namely the generation and experience of moral distress among ICU nurses, the impact of moral distress on ICU nurses, and the coping styles to moral distress among ICU nurses.Conclusions:Nursing managers should attach importance to the moral distress experience of ICU nurses, reduce the negative impact of moral distress on ICU nurses, and enhance their moral resilience.

Objective:To evaluate the methodological quality and measurement characteristics of children's needs assessment tools.Methods:Literature on children's needs assessment tools was searched in Cochrane Library, PubMed, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang Data, VIP, and China Biology Medicine disc. The search period was from database establishment to April 2, 2023. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline was used to evaluate the methodological quality and measurement characteristics of assessment tools, and integrate the evaluation results to form recommendations.Results:Six studies were included in total. The recommended opinions for the two evaluation tools (Needs of Children Questionnaire and Male Adolescent Health Needs-Assessment Scale) were A level. The recommended opinions for the four evaluation tools were B level. The Male Adolescent Health Needs-Assessment Scale had high cultural specificity.Conclusions:The evidence quality of the Needs of Children Questionnaire is relatively high and can be temporarily recommended for use, but other measurement characteristics still need further verification.

[Objective]To present Professor HE Ruoping's clinical experience in treating esophageal cancer.[Methods]Through the follow-up study,relevant medical cases were collected,organized and analyzed to describe the clinical experience of Professor HE Ruoping in the treatment of esophageal cancer in terms of the etiology and mechanism of the disease,and the rules and methods of treatment.A medical record was attached as evidence.[Results]Professor HE Ruoping believes that the pathogenic characteristic of esophageal cancer is a deficiency in origin and an enrichment in symptom.Deficiency in origin indicates weakness in Zang and Fu,while enrichment in symptom suggests there're Qi stagnation,phlegm,blood stasis and hot toxin."Strengthen healthy Qi,eliminate pathogens,and treat according to the symptoms"is the therapeutic approach used to treat esophageal cancer.The aim is to strengthen Zang and Fu,specifically the spleen,stomach and kidney.Treatments for anti-cancer mainly include moving Qi and dissipating mass,eliminating phlegm and removing blood stasis,clearing heat and toxin,etc.It emphasizes that the elimination of pathogenic factors should be carried out in an appropriate manner and should not hurt the body's positive Qi.Treating according to the symptoms means treating patients with various kinds of uncomfortable symptoms after surgery,radiotherapy and local stent placement to improve their quality of life.In the attached medical case,the above three principles were carried through the whole treatment process,and achieved good therapeutic effect.[Conclusion]By expounding the principle of"strengthen healthy Qi,eliminate pathogens and treat diseases according to the symptoms",it has summarized Professor HE Ruoping's clinical experience in the treatment of esophageal cancer,which is of some significance for the clinical treatment of this disease.

Objective To explore the efficacy and clinical value of texture analysis of conventional MRI image for the preoperative classification of meningiomas. Methods The MR images of 101 meningioma cases were retrospectively analyzed, all of them underwent routine MRI before operation, and confirmed by surgery and pathology,of whom 81 cases in WHO Ⅰ,19 cases in Ⅱand 1 case in Ⅲ.The maximum diameter of the tumor in MRI images was outlined as ROI by the Image J software.The histograms and grey-level co-occurrence matrix(GLCM)were used to measure the texture parameters,such as maximum value,minimum value,standard deviation(SD),skewness,kurtosis,angular second moment,contrast,inverse different moment, entropy, correlation and so on, and compared with postoperative pathological grading results.The independent sample t test or the Mann-Whitney U test was used to compare the difference of the histogram and the gray level co-occurrence matrix parameter of the MRI images between low-grade and high-grade meningiomas. ROC curves for statistically significant parameters were used to confirm their efficacy in predicting the preoperative grade of meningiomas.Results (1)In histogram parameters,the SDs of T2WI,FLAIR,ADC(SDT2WI,SDFLAIR,SDADC)of low grade meningioma were 14.764(10.928,17.932),9.753 (7.385,13.618) and 12.171 (9.138,19.691), the high grade meningiomas were 19.252 (13.580,25.715), 13.568 (8.936,17.108) and 16.636 (13.166,21.498), respectively. The difference between the two groups was statistically significant(Z values were-2.863,-2.250,-2.247,P respectively 0.004,0.024,0.025).The skewness values (SkeADC, SkeFLAIR) of ADC sequence and FLAIR sequence of low-grade meningiomas were 1.377 ± 1.172 and-1.327 ± 0.930, respectively, and the high-grade meningiomas were 2.503 ± 1.613 and-0.827±0.834,respectively.The differences between the two groups were statistically significant (t values were-2.196,-3.129, P values were 0.002,0.030, respectively). (2) In the GLCM parameters, entropy (EntT1WI, EntT2WI, EntFLAIR, EntADC) of the enhanced T1WI, T2WI, FLAIR and ADC sequences of low grade meningiomas were 6.881(6.174,7.305),6.534±0.598,6.019±0.588,6.040±0.588,high-grade meningiomas were 7.079 (6.742,7.739), 7.014 ± 0.514,6.370 ± 0.703,6.576 ± 0.450, respectively. And the difference between the two groups was statistically significant (Z=-2.007, t values were-3.294,-2.327,-3.245, P values were 0.045,0.001,0.022,0.002,respectively).(3)The ROC curves of EntADCand SkeADCwere plotted, and the area under the curve(AUC)was 0.768 and 0.710,respectively.Combined EntADC,SkeADCand EntT2WI were the best for the classification of meningiomas,and AUC was 0.799.Conclusion Texture analysis can provide more quantification information, which can be more accurately distinguishing high grade meningiomas and low grade meningiomas before surgery.

Objective:To explore the value of gadolinium-ethoxybenzyl- diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI nomogram model for preoperative prediction of Ki-67 expression in hepatocellular carcinoma (HCC).Methods:Data of 85 patients of HCC confirmed by postoperative pathology, who underwent preoperative Gd-EOB-DTPA enhanced MRI between September 2016 and August 2019 in the First Affiliated Hospital of Soochow University were retrospectively evaluated. According to postoperative immunohistochemistry Ki-67 index, the 85 patients were divided into Ki-67 low expression group(Ki-67 index ≤10%, n=20) and Ki-67 high expression group (Ki-67 index >10%, n=65). Clinical data (hepatitis, cirrhosis, etc.), qualitative imaging parameters (tumor margin, capsule, etc.) were compared by χ 2 test and quantitative parameters [lesion-to-normal parenchyma ratio-arterial phase (LNR-AP), lesion-to-normal parenchyma ratio-portal phase (LNR-PP), lesion-to-normal parenchyma ratio-equilibrium phase (LNR-EP) and lesion-to-normal parenchyma ratio-hepatobiliary phase (LNR-HBP)] were compared by independent sample t test. The above statistically significant parameters were included in multivariate logistic regression to identify the independent predictors of Ki-67 high expression and then the nomogram model for predicting Ki-67 expression of HCC was established. Results:alpha-fetoprotein (AFP) tumor margin, arterial rim enhancement between the Ki-67 low expression group and the Ki-67 high expression group had significant differences (χ 2 were 8.196, 10.538 and 4.717, respectively, P<0.05). LNR-AP, LNR-PP, LNR-EP and LNR-HBP between the two groups had significant differences ( t were 2.929, 2.773, 2.890 and 3.437, respectively, P<0.05).The result of multivariate logistic regression revealed that AFP≥20 μg/L, non-smooth tumor margin and low LNR-HBP were the independent predictors of Ki-67 high expression (odds ratio were 4.090, 3.509 and 0.042, respectively, P<0.05).The Gd-EOB-DTPA enhanced MRI nomogram model for predicting Ki-67 expression of HCC was established successfully. The Area under the receiver operating characteristic curve of the nomogram was 0.837 and the corrected predictive curve fitted the ideal curve, which suggested the model had a good predictive efficiency. Conclusion:Gd-EOB-DTPA enhanced MRI nomogram model has great value in preoperative prediction of Ki-67 expression of HCC, which provided a personalized prediction method for Ki-67 expression in patient with HCC.