Objective To explore the value of spiral CT in differentiation between benign and malignant thyroid tumor.Methods CT findings of thyroid tumor confirmed by the pathology in 50 patients,were retrospectively analyzed and in comparison with the data of operation and pathology.Results There were benign tumor(n=35)and malignant tumor(n=15)in this study.All the benign tumors were thyroid adenoma.The malignant tumors included thyroid carcinoma(n=14)and lymphoma(n=1).All the cases of thyroid benign tumors demonstrated clear margin and homogeneous enhancement.Cystic area and curvilinear or mass calcification could be seen in some cases.Some characteristic signs,such as irregular tumor outline,fine discrete granular and irregular calcification,heterogeneous enhancement,invading neighbor structures and cervical lymph node metastasis,could only been seen in thyroid malignant tumors.Conclusion Spiral CT has a notable advantage in differential diagnosis between benign and malignant thyroid tumor.

Objective To analyze the early renal function of donors after nephrectomy.Methods Clinical data of 467 cases of living kidney donors during the period from April,2010 and November,2014 in our center were retrospectively analyzed.Data on serum creatinine (Scr),glomerular filtration rate (GFR),serum uric acid (UA),and urine microproteins before operation and three days,seven days,one month and three months after operation were collected to evaluate the impact of nephrectomy on early renal function after operation for donators.Results Before operation and three days,seven days,one month,three months after operation,the average serum creatinine (Scr) level was (59.9±12.8),(85.8±21.0),(91.2±21.3),(92.8±21.6),(91.0±21.3) μmol/L,respectively; The GFR were (113.5±25.3),(75.1± 17.9),(70.3± 15.2),(68.5± 16.0),(69.5± 15.1) ml/min,respectively; The levels of uric acid were (292.60±79.58),(142.18±55.28),(228.41±66.39),(321.31± 83.72),(346.61±87.21) μmol/L,respectively; All these data above-mentioned after operation reached statistical significance compared with that before operation (P ＜ 0.05).Parameters including urine IgG,urine albumin,urine retinol-binding protein and urine β2-microglobulin post-operation time point were significantly different when compared with relative parameters pre-operation (P ＜ 0.05).Conclusions Nephrectomy has significant influence on GFR,uric acid,and urine microprotein for donors in the early stage after operation.It's worth to evaluate nephrectomy's long-term effect on the renal function of donors in clinical practice.

Objective:To investigate the effect of nursing profession practice model on key competence of intravenous therapy specialized nurses.Methods:A total of 30 nurses were selected in People`s Hospital of Wanning by using professional practice model. The effect of key competence and intravenous therapy-related adverse events were evaluated.Results:Before training, the scores of professional attitude, professional theoretical knowledge, professional practical skills, critical thinking ability, and communication and coordination ability, nursing management ability, professional development ability were (2.74±0.66) points, (2.28±0.57) points, (2.62±0.48) points, (2.52±0.32) points, (2.38±0.38) points, (2.68±0.70) points, (2.32±0.48) points. After training, those scores were (4.02±0.88) points, (4.10±0.60) points, (3.97±0.61) points, (3.69±0.38) points, (3.78±0.60) points, (4.07±0.87) points, (3.86±0.69) points, the differences were statistically significant ( t values were 6.542-12.226, P<0.05). The incidence of phlebitis, transfusion reaction, transfusion leakage, unplanned extubation, catheter-related infections in 2016 were 0.28% (53/18 731), 0.17% (31/18 731), 0.19% (35/18 731), 0.05% (10/18 731), 0.33% (62/18 731), those adverse events were 0.12% (37/23 183), 0.07% (17/23 183), 0.09% (20/23 183), 0.01% (3/23 183), 0.19% (45/23 183) in 2018, the differences were statistically significant ( χ2 values were 5.466-15.074, P<0.05 or 0.01). Conclusion:Nursing professional practice model can promote the key competence of intravenous therapy specialized nurses and decrease the incidence of intravenous therapy-related adverse events.

Objective To investigate the rate of hippocampus injury during whole brain radiotherapy for intracranial metastasis and explore the effect of whole brain radiotherapy in reducing the radiotherapy induced neurocognitive dysfunction of hippocampu and provide reference for the treatment of intracranial metastatic tumors. Methods The intracranial metastases in 123 patients from January 2015 to December 2016 were enrolled in this study. The MRI image data before and after radiotherapy were analyzed retrospectively.The anatomical position of tumor and the hippocampus in patients with intracranial metastasis was outlined.According to outlined position, the relationship between location of intracranial metastatic tumor and the hippocampus was analyzed, and the probability of the hippocampal damage by tumor radiotherapy was calculated in the treatment of intracranial metastatic brain. Neurocognitive dysfunction improvement by protective irradiation of hippocampus was compared between different radiotherapy methods. Results Four hundred and seventeen intracranial metastatic tumors were observed in 123 patients, among which the sites of 15 tumors(3.60%) were within the 5mm of hippocampus, the sites of 146 tumors(35.01%)were 5-10 mm from the hippocampus, and the sites of 256 tumors(61.39%) were beyond 10 mm of hippocampus. The distribution of 417 metastatic tumors in the brain was as followings: 137 tumors (32.85%) were in frontal lobe, 98 tumors(23.50%) were in temporal lobe, 59 tumors(14.15%)were in parietal lobe, 46 tumors(11.03%)were in occipital lobe, 41 tumors (9.83%) were in cerebellum and 36 tumors (8.63%) were in basal ganglia. Using helical tomotherapy, intracranial metastasis radiotherapy and volumetric modulated arc radiotherapy, the rate of patients with cognitive dysfunction induced by hippocampal injury was 1.96%(1/51), 10.26%(4/39)and 18.18% (6/33), and there was significant difference (χ2= 6.595, P = 0.000). Conclusions The hippocampus injury possibility is very small, when whole brain radiotherapy is used in the treatment of intracranial metastatic tumors. Avoiding the hippocampus in radiation therapy of intracranial metastasis has high feasibility, among which the helical tomotherapy can effectively reduce hippocampus injury and improve patients'cognitive function.

Objective:To investigate the clinical value of serum cystatin C(Cys C) and neutrophil gelatinase associated lipocalin(NGAL) combined with cardiac biomarkers in the evaluation of sepsis with renal injury in children.Methods:The clinical data of 130 children with sepsis(67 cases in sepsis non AKI group and 63 cases in septic AKI group)admitted to pediatric intensive care unit(PICU) at Hunan Children′s Hospital from May 2018 to December 2019 were retrospectively analyzed.The differences of serum Cys C, NGAL and cardiac related biomarkers between sepsis and septic kidney injury were analyzed and compared.Results:The levels of serum Cys C, NGAL and amino-terminal pro-brain natriuretic peptide(NT-proBNP) in children with septic AKI were significantly higher than those in children of sepsis non AKI group(all P<0.01). There were no significant differences in creatine kinase isoenzyme(CK-MB)and high-sensitivity troponin T(cTnT-hs) between two groups (all P>0.05). The levels of CK-MB, cTnT-hs, NT-proBNP, Cys C and NGAL in the dead children were significantly higher than those in the surviving children ( P<0.05). In terms of predicting of AKI, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.724, 0.759 and 0.747, respectively.Regarding predicting the survival and death of sepsis, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.719, 0.722 and 0.769, respectively.In predicting the prognosis of children with sepsis and kidney injury, the area under the ROC curve of NGAL, Cys C and NT proBNP were 0.683, 0.651 and 0.682, respectively.The binary Logistic regression equation was established by Cys C, NGAL and NT-proBNP, Y=0.970 NGAL+ 0.9441 BNP+ 1.815 Cys C-2.944.In predicting kidney injury, evaluating prognosis of sepsis and predicting prognosis of sepsis with kidney injury, the area under ROC curve of new variable Y were 0.882, 0.802 and 0.808, respectively. Conclusion:NGAL, Cys C and NT-proBNP can be used to judge sepsis and sepsis with kidney injury alone.The evaluation value of combined detection of three indexes is better than that of single index.Therefore, the combined use of the three indicators may be better to judge the condition of children with sepsis and kidney injury.

OBJECTIVETo compare the differences in the therapeutic effects on allergic rhinitis between scraping therapy and cetirizine and observe the differences in the clinical therapeutic effects of scraping therapy on the disease of different differentiated patterns/syndromes.

METHODSThe included participants of allergic rhinitis were randomized into a western medication group and three scraping therapy groups, named a lungdeficiency and cold group, a spleendeficiency group and a kidneydeficiency group, 20 cases in each one. In the western medication group, cetirizine was prescribed for oral administration, 10 mg, once a day, totally for 4 weeks. In the scraping therapy groups, the scraping therapy was applied to the running courses of the large intestine meridian of hand-, the governor vessel and the bladder meridian of foot-, focusing on Yingxiang (LI 20), Yintang (GV29), Hegu (LI 4) and Fengmen (BL 12). In the lungdeficiency and cold group, the scraping focused on the lung meridian of hand-, Feishu (BL 13), Taiyuan (LU 9), Fengchi (GB 20) and Lieque (LU 7). In the spleendeficiency group, the scraping focused on the spleen meridian of foot-, Pishu (BL 20) and Zusanli (ST 36). In the kidneydeficiency, the scraping focused on the kidney meridian of foot-, Mingmen (GV 4) and Shenshu (BL 23). The scraping therapy was given once a week, 4 treatments as one session and 1 session required (4 weeks). Separately before treatment, after treatment and in 3-month follow-up visit, the total score of the main symptoms of allergic rhinitis (sneezing, runny nose, nasal obstruction and nasal itch) was observed and the clinical therapeutic effects were evaluated.

RESULTSThe total symptom scores in the patients of the 4 groups after treatment were all reduced as compared with those before treatment (all<0.05). After treatment and in the follow-up visit, the total symptom scores of the 3 scraping therapy groups were lower than those in the western medication group (all<0.05), and the score in the lungdeficiency and cold group was lower than those in the spleendeficiency group and the kidneydeficiency group (all<0.05). After treatment and in the follow-up visit, the therapeutic effects in the 3 scraping therapy groups were better than those in the western medication group (all P<0.05).

CONCLUSIONThe scraping therapy on the basis of the meridians and acupoints selection achieves the definite therapeutic effects on allergic rhinitis of different differentiated patterns/syndromes, which is better than cetirizine. This therapy achieves the much significant short-term and long-term therapeutic effects on allergic rhinitis differentiated as lung qi deficiency and cold.

Objective:To study the role of myocardial work parameters in early identification of myocardial injury in neonatal asphyxia.Methods:From July 2020 to December 2021, neonates diagnosed with mild neonatal asphyxia admitted to the Department of Neonatology of our hospital within 24 h after birth were prospectively enrolled into the asphyxia group. Neonates without asphyxia during the same period were selected as the control group and matched with the asphyxia group for gender, gestational age and birth weight at a ratio of 1:1~1:2. The asphyxia group was subgrouped into preterm asphyxia group and term asphyxia group. All neonates received echocardiography within 24 h after birth. Multiple parameters were measured including M-mode, two-dimensional image, Doppler image, global longitudinal strain (GLS) and myocardial work parameters [global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE)]. The level of serum N-terminal pro brain natriuretic peptide (NT-proBNP) was recorded in the asphyxia group. The data were compared between the asphyxia group and the control group. Correlations between myocardial work parameters and other parameters were analyzed.Results:A total of 33 cases were in the asphyxia group and 43 cases were in the control group. The preterm asphyxia group (18 cases) showed significantly lower GWI and GCW than the preterm control group (18 cases) [GWI: (702±153) mmHg vs. (879±205) mmHg, GCW: (1 016±221) mmHg vs. (1 200±271) mmHg] ( P<0.05). No differences existed in GLS, GWW and GWE. The term asphyxia group (15 cases) showed significantly lower GWW than the term control group (25 cases) [45.0 (30.0, 65.0) mmHg vs. 71.0 (35.5,85.5) mmHg] ( P<0.05). No differences existed in GLS, GWI, GCW and GWE. GWI was negatively correlated with serum NT-proBNP level ( r=-0.327, P<0.05). Conclusions:GWI and GCW may indicate myocardial injury in preterm neonates with mild asphyxia.