Objective:To observe the effect of local excision under ultrasonography with immediate mammoplasty in granulomatous lobular mastitis.Methods:Fifty-three patients with granulomatous lobular mastitis admitted from Jan 2017 to Jul 2020 were retrospectively analyzed. Combined with sonographic findings and clinical manifestations, patients were divided into four types: type Ⅰ, single mass; Type Ⅱ, single mass located in one quadrant with one or no skin lesion; Type Ⅲ, multi-quadrant involved with one or no skin lesion; Type Ⅳ, multiple abscesses with multiple lesions in the skin. Twenty-five patients underwent wide local excision (control group); Twenty-eight patients underwent local excision under ultrasonography with immediate mammoplasty (experiment group). Patients with erythema nodosum or in type Ⅳ were given antibiotics and corticosteroid therapy preoperatively for 1 week and postoperatively for 5 days. The others went straight to surgery.Results:All patients were followed up for 1 year. In the experiment group, 28 patients had primary wound healing, and 3 patients had poor wound healing after operation (all were of type Ⅳ). The control group had 6 cases of recurrence(were of type Ⅲ and type Ⅳ). There was significant difference of the recurrence rate between the two groups (0 vs. 24%, χ 2=6.033, P=0.014), and the aesthetic effect of local excision under ultrasonography with immediate mammoplasty was better than that of wide local excision(93% vs. 68%, χ 2=5.330, P=0.020). Conclusion:The recurrence rate of local excision under ultrasonography with immediate mammoplasty is low, and with a satisfactory cosmetic effect.

Objective:To evaluate the effect of high-flow nasal cannula (HFNC) oxygen on the early respiratory distress in patients with acute paraquat poisoning.Methods:This prospective study included patients who were hospitalized in the Emergency Department of First Hospital of China Medical University diagnosed and were diagnosed with acute PQ poisoning from May 1, 2017 to May 1, 2018. Inclusion criteria: acute PQ poisoning patients with dyspnea, and meet the following conditions: dyspnea with RR > 25 beats/min or PCO 2 < 32 mmHg. The following information were recorded: RR, SpO 2, HR and MAP before and 15 min, 30 min, 1 h, 2 h, 4 h, 6 h, 12 h and 24 h after HFNC application, as well as and arterial blood gas before and 6 h, 24 h after HFNC application. The improvement of RR, SpO 2, HR, MAP, PCO 2, PO 2, pH and Lac were compared before and after HFNC. Mann-Whitney U rank test and Chi-square test were used and a P<0.05 was regarded as statistically significant. Results:A total of 50 patients were included in the study. After 28 days of follow-up, 26 patients survived and 24 died. There was no difference between the two groups in gender and age. There were differences in PQ oral doses, urinal PQ concentration, Lac and PaCO 2 between the two groups. HFNC significantly reduced the RR and HR of all patients at all time points, and PaCO 2 was significantly increased at 6 h after application, 36 mmHg(34, 38) mmHg vs 30 mmHg (27, 32) mmHg ( P<0.05), while MAP, SpO 2, PO 2, and pH had no significant differences. RR and HR of the survival group were significantly lower than those of the non-survival group, as well as the maximum flow rate, 35 L/min (25, 40) L/min vs 55 L/min(50, 60) L/min ( P<0.01). Conclusions:HFNC can significantly reduce the early respiratory frequency and heart rate of patients with acute PQ poisoning and improve dyspnea. Meanwhile, it can significantly reduce the patients' oxygen consumption and improve the relative or absolute hypoxic state of patients after poisoning.

Objective:To analyze the clinical symptoms and laboratory characteristics of patients with brucellosis combined with osteoarthritis.Methods:A retrospective analysis was conducted on the medical records of 168 patients with brucellosis who were hospitalized at the Jining Public Health Medical Center, Shandong Province from January 2021 to December 2022. Based on the imaging examination results, they were divided into combined osteoarthritis group and non combined osteoarthritis group. The demographic characteristics, clinical symptoms, and laboratory test results of the two groups of patients were compared and analyzed.Results:Among 168 patients with brucellosis, there were 83 patients with concurrent osteoarthritis, 85 patients without concurrent osteoarthritis, the males and females ratio was 2.73 ∶ 1.00 (123 ∶ 45), and the age was 56 (46, 64) years old. The median age of patients in combined osteoarthritis group was higher than that of patients in non combined osteoarthritis group (58 years vs 53 years, Z = - 2.89, P = 0.004). In clinical symptoms, the incidence of back pain, fatigue, and joint muscle pain in patients of combined osteoarthritis group was significantly higher than that in the non combined osteoarthritis group [75.9% (63/83) vs 56.5% (48/85), 30.1% (25/83) vs 15.3% (13/85), 47.0% (39/83) vs 17.6% (15/85), χ 2 = 7.07, 5.27, 16.58, P < 0.05]. In laboratory tests, the erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hs-CRP) levels in patients of combined osteoarthritis group were higher than those in the non combined osteoarthritis group [27.0 (17.0, 34.0) mm/h vs 21.0 (10.5, 34.0) mm/h, 22.7 (14.3, 43.4) mg/L vs 17.9 (10.8, 34.2) mg/L, Z = - 2.51, - 2.00, P < 0.05]. Among patients with combined osteoarthritis, combined spondylitis accounted for the highest proportion (55.4%, 46/83), followed by peripheral arthritis (51.8%, 43/83). Conclusion:Osteoarthritis is a common complication of brucellosis, and patients of brucellosis with concurrent osteoarthritis have clinical features such as lower back pain, fatigue, and joint muscle pain, with significantly elevated of ESR and hs-CRP level.

Objective:To explore the application effect of case management mode led by specialist nurses in bladder perfusion for patients undergoing chemotherapy after bladder cancer surgery.Methods:A total of 96 patients receiving bladder perfusion treatment in Xinxiang Central Hospital from March 2018 to June 2019 were selected by the convenient sampling method and they were divided into the observation group and the control group according to random number table method, with 48 patients in each group. The control group adopted routine management, while the observation group adopted case management led by specialist nurses. Mishel Uncertainty in Illness Scale (MUIS) and Functional Assessment of Cancer Therapy-feneric Scale (FACT-G) were used to respectively evaluate the disease uncertainty and quality of life of patients of the two groups. The compliance rate and complication rate of bladder perfusion, MUIS and FACT-G scores were compared between the two groups.Results:All 48 patients in the observation group completed the entire course of chemotherapy. In the control group, 7 patients did not complete the entire course of chemotherapy, including 1 patient who withdrew from the study at the 10th month without complete data collected. Finally, 48 cases were collected in the observation group and 47 cases collected in the control group. The compliance rate of bladder perfusion in the observation group was higher than that in the control group (100.00% vs. 85.52%) , and the difference was statistically significant (χ 2=10.305, P=0.001) . The total incidence of bladder perfusion complications in the observation group was lower than that in the control group (14.58% vs. 55.32%) , and the difference was statistically significant (χ 2=17.382, P<0.001) . At the 8th and 12th months, the MUIS scores of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . At 4, 8, and 12 months, the FACT-G scores of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The differences in the interaction effects, intergroup effects and time effects of MUIS and FACT-G scores between the two groups were statistically significant ( P<0.05) . Conclusions:With the prolongation of bladder perfusion treatment time, the uncertainty of bladder cancer patients gradually increases and quality of life decreases. The case management mode led by specialized nurses can improve the compliance and quality of life of patients with bladder perfusion treatment, reduce the incidence of complications and disease uncertainty and improve management efficiency of bladder perfusion treatment.

Objective:To explore the effect of inpatient palliative care in patients with end-stage heart failure.Methods:From July 2019 to January 2021, convenience sampling was used to select 97 patients with end-stage heart failure admitted to the Cardiovascular Department of Henan Provincial Chest Hospital as the research subject. The patients were divided into the control group ( n=48) and the observation group ( n=49) with the random number table. The control group conducted routine nursing, and the observation group carried out inpatient palliative care on this basis. The 21-Item Depression Anxiety Stress Scale (DASS-21) , General Self-efficacy Scale (GSES) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used to compare the adverse psychological state, self-efficacy and quality of life of the two groups of patients. Results:Before intervention, there were no significant differences in DASS-21, MLHFQ and GSES scores between the two groups ( P>0.05) . After intervention, the DASS-21 and MLHFQ scores of the observation group were lower than those of the control group, and the GSES score was higher than that of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Inpatient palliative care can effectively relieve the adverse psychological state of patients with end-stage heart failure and improve their self-efficacy and quality of life.

Objective:To compare the effectiveness of the Cancer Fatigue Scale (CFS) and the Revised Piper Fatigue Scale (PFS-R) in screening cancer-related fatigue (CRF) in lung cancer patients with chemotherapy.Methods:This study was a cross-sectional study. From June 2022 to March 2023, convenience sampling was used to select 162 lung cancer patients who underwent chemotherapy in the Oncology Department of Jiangsu Cancer Hospital as the study subject. CFS and PFS-R were used for CRF screening, using the diagnostic criteria proposed in the Clinical Practice Guidelines for Cancer-related Fatigue in China as the gold standard. The area under the receiver operating characteristic ( AUC), sensitivity, specificity, and Youden index of the two screening tools were compared. Results:The incidence of CRF in lung cancer chemotherapy patients was 61.1% (99/162). According to the presence of CRF, the patients were divided into CRF group ( n=99) and non-CRF group ( n=63). The CFS score and PFS-R score of patients in the CRF group were higher than those in the non-CRF group, and the differences were statistically significant ( P<0.05). The AUC of CFS was 0.840 with an optimal cutoff value of 2.470, and the sensitivity, specificity, and Youden index were 0.758, 0.873, and 0.631, respectively. The AUC of PFS-R was 0.918 with an optimal cutoff value of 4.500, and the sensitivity, specificity, and Youden index were 0.899, 0.937, and 0.836, respectively. The AUC of PFS-R was higher than that of CFS, and the difference was statistically significant ( Z=2.232, P<0.05) . Conclusions:Compared with CFS, PFS-R has a better evaluation effect and is more suitable as a screening tool for CRF in lung cancer patients with chemotherapy.

Objective To estimate the treatment effect of a tumor necrosis factor ? alpha antagonist (etanercept) on Stevens?Johnson syndrome induced by drugs. Methods After exclusion of tuberculosis, hepatitis, severe infections and tumors, 17 patients with drug?induced Stevens?Johnson syndrome were treated with subcutaneous injections of 25 mg(initial dose, 50 mg)etanercept once every 3 days for 6 times. Meanwhile, supportive therapies and compound glycyrrhizin injections were given to counteract inflammation and protect the liver. Results All of the patients were cured. Body temperature in 15 febrile patients gradually decreased within 24- 48 hours after the first injection of etanercept, and returned to normal in 72 hours. The number of vesicles stopped increasing, and lesion color turned from bright red to dull red within 24 hours. Skin condition was evidently controlled within 72 hours, and skin appearance almost returned to normal after 2 weeks of treatment, and was completely restored after 4- 5 weeks. The recovery of mucous membrane was slower than that of skin. Serum aminotransferase levels gradually declined after the first dose of etanercept and almost returned to normal in 2-4 weeks in 14 patients. Serum levels of urea nitrogen and creatinine began to decrease after 1- 2 weeks of treatment. The serum level of tumor necrosis factor?alpha nearly dropped into or was maintained in the normal range within 3 weeks after the start of treatment. Conclusion Early usage of tumor necrosis factor?alpha antagonists at an adequate dose is beneficial to the rapid control of Stevens?Johnson syndrome.

Objective To investigate the clinical implications of serum tenascin-C (TNC) levels for lung injury and the prognosis in acute paraquat (PQ) poisoning patients.Methods Clinical data of acute PQ poisoning patients hospitalized in Emergency Department of First Hospital of China Medical University from January 1 to December 31,2017 were prospectively collected.Patients' serum samples were obtained on admission and serum TNC levels were quantified by a commercially available enzymelinked immunosorbent assays (ELISA) kit.Patients were followed up to 28 d after poisoning and divided into the survival and non-survival groups.The differences of clinical data together with serum TNC level between the two groups were analyzed by univariable analysis.The correlation between serum TNC level and liver function,renal function and artery blood gas results was analyzed.Logistic regression analysis was used for assessing the independent risk factors of death.ROC curves of related parameters were plotted and the area under the curve (AUC) was calculated.Results Eighty-two patients were enrolled in this study:35 patients in the non-survival group and 47 patients in the survival group.There was no significant difference of data on admission between the two groups,including pH,PaO2,Cr,BUN,ALT,TBil,AMS,TNC,lung CT positive rate.But PaCO2,Lac,urine paraquat concentration and serum TNC level on admission were significantly different between the survival and non-survival groups.Furthermore,serum TNC level was correlated significantly with the worst PaO2 value,pH,and lung CT positive rate within 72 h from admission,especially the worst PaO2 value (r=-0.801,P＜0.01).Logistic regression analysis showed that the serum TNC level on admission was an independent risk factor for the prognosis of acute PQ poisoning patients.The AUC was 0.895 and the cutoff value was 41.9 ng/mL.Conclusion The early serum TNC level in acute PQ poisoning patients can predict the degree of lung injury and evaluate the prognosis.

Objective:To develop and validate an clinical prediction model for the risk of breast cancer-related lymphedema (BCRL).Methods:Breast cancer patients who were prepared to undergo axillary lymph node dissection were propsectively enrolled, indocyanine green combined with Photodynamic Eye (PDE) was applied to reveal the arm lymphatic flow . The arm lymphatic fluorescence images were collected to calculate the proportion of arm lymph flow above and below the axilla vein. Volumetric measurements of both arms and subjective questionnaire were performed to evaluate the occurrence of lymphedema. A difference in volume between the arms >10% was defined as lymphedema. Univariate logistic regression analysis was used to analyze the relationship between each factor and BCRL. The stepwise forward method was used to include multiple factors in the logistic regression analysis to establish the prediction model.Results:Three hundred and twelve patients were enrolled. Fourty-five (14.4%) patients developed BCRL. Using the coefficients obtained from multivariate analysis, BMI ( OR 95% CI: 1.34 (1.25-1.77), P<0.05), chemotherapy ( OR 95% CI: 2.26 (1.97-2.63), P<0.05), regional lymph node radiotherapy ( OR 95% CI: 1.59 (1.05-2.41), P<0.05) and the proportion of arm lymph flow above the level of the axillary vein ( OR 95% CI: 0.70 (0.68-0.81), P<0.05) were identified as independent predictive factors for BCRL, and the following prediction equation was derived: Y=0.369×(BMI at surgery)+0.713×(taxane-based chemotherapy)+0.862×(radiotherapy)-9.058×(proportion of the arm lymph above the axillary vein)-6.859 8. The ROC curve was screened to the optimal boundary value of 0.118 6 by the Youden's index. The sensitivity, specificity, positive predictive value and negative predictive value of prediction of this model were 93.3%, 79.4%, 73.3%, 98.6%, respectively. Conclusion:With the guidance of the predictive model, particular patients who need the preservation of axillary lymphatic system can be identified, and timely intervention can be carried out.

Objective:To examine the effect of“lesion removal plus whole breast exploration and washing plus micro-plastic surgery”in granulomatous lobular mastitis.Methods:A single-center prospective randomized controlled study method was used to enroll patients diagnosed with granulomatous lobular mastitis for whom surgical procedures were projected from March 2017 to September 2019 at Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University. The sample size is determined by the superiority test. Based on the literatures and the previous work, the two groups require 97 cases. Fifty-two patients underwent“lesion removal+whole breast exploration and washing plus micro-plastic surgery”(observation group). Forty-five cases underwent“empirical breast lesion resection plus fascia tissue flap plasty plus nipple and areola correction”(control group). The primary study endpoint is the recurrence rate, and the secondary study endpoints include surgical complications, incision healing time, and postoperative patient satisfaction. Independent sample t test, Wilcoxon rank-sum test, χ2 test and Fisher exact test were used for comparison between groups. Results:All procedures were completed successful, with no severe complications. All patients were followed up for (15.2±1.9) months (range: 12 to 24 months). There were no significant differences in incidence of postoperative complications (7.7% (4/52) vs. 6.7%(3/45), P=1), drainage time ((8.6±0.6) days vs. (8.4±0.8) days, t=1.921, P=0.053) and hospital stay ((7.7±0.6) days vs. (7.6±0.5) days, t=1.633, P=0.102) between the two groups. The recurrence rate of the observation group was lower significantly than that of the control group (3.8% (2/52) vs. 24.4%(11/45), χ2=8.819, P=0.003). The observation group had better cosmetic effects ( Z=-2.657, P=0.008) and patient satisfaction than control group ( Z=-5.730, P=0.000). Conclusion:The “lesion removal plus whole breast exploration and flushing plus micro-plastic surgery” has a good therapeutic effect and cosmetic value for patients with refractory granulomatous lobular mastitis.