Objective:To explore the diagnostic value of C-TIRADS combined with artificial intelligence-assisted diagnosis S-Detect technology in the differential diagnosis of thyroid nodules.Methods:A total of 237 thyroid nodules patients (237 thyroid nodules)with ultrasound examination and definitive pathologic results in Henan Cancer Hospital from April to September 2020 were retrospectively analyzed. The nodules were diagnosed according to C-TIRADS guidelines, and then by S-Detect technology combined with C-TIRADS guidelines. The ROC curve was plotted with the pathological results as the gold standard, and the area under the ROC curve, sensitivity, specificity and accuracy of the diagnosis results between the two groups were compared.Results:Among the 237 thyroid nodules, 105 were benign and 132 were malignant.The area under the ROC curve of C-TIRADS diagnosis alone and C-TIRADS diagnosis combined with artificial intelligence were 0.869 and 0.942 respectively, the difference between the two groups was statistically significant (χ 2=36.11, P<0.001); When Category 4A was used as the cutoff value of benign and malignant differential diagnosis, the specificity and accuracy of C-TIRADS classification of artificial intelligence-assisted diagnosis was significantly higher than that of C-TIRADS alone, and the difference was statistically significant(83.81% vs 47.62%, 90.72% vs 75.53%, all P<0.05). Conclusions:C-TIRADS combined with artificial intelligence-assisted diagnosis S-Detect technology has a high efficiency in the diagnosis of thyroid nodules and can improve the specificity and accuracy of thyroid nodules diagnosis and reduce unnecessary biopsy.

Objective: To analyze the use of preexposure prophylaxis (PrEP) among male students who had sex with men (MSM) with different sexual behavior patterns using potential categories, so as to provide evidence for determining the use patterns of PrEP consistent with MSM. Methods: A questionnaire survey was conducted by proportional sampling method on MSM in 31 provincial administrative regions in mainland China from 20 October to 30 December 2021, a total of 1 040 students were selected for the study. Latent variable analyses were conducted on a total of seven sexual behavioral characteristics, including knowledge of sexual partner HIV infection, frequency of condom use, number of sexual partners, engaging in group sex, provision of commercial sex, use of sex aids, and history of sexually transmitted infections (STIs) in the past year. And demographic characteristics were analyzed by Logistic regression analysis. The rates of PrEP awareness, willingness to use and usage rate in different sexual behavior risk groups were investigated. Results: Student MSM could be divided into two potential category groups:a lowrisk behavior group (82.4%) and a highrisk behavior group (17.6%). The PrEP usage rate (15.8%) was higher in the highrisk behavior group, and the difference was statistically significant compared to the lowrisk behavior group (7.2%) (χ2=13.43, P<0.05). Student MSM residing in the northeast, south, and northwest of China, in the pilot city, and with a sex role of "0.5" (possible acceptance and insertion of sexual behavior) were more likely to be in the highrisk behavior group (OR=3.13, 3.07, 3.87, 2.22, 1.66, P<0.05). Conclusion Student MSM in highrisk and lowrisk sexual differs in the behavior of PrEP, and targeted interventions should be implemented to promote the use of PrEP and reduce HIV infection in this population.

Objective: To investigate the current situation and related factors of antiretroviral therapy (ART) among HIV infected male students engaging in men who have sex with men (MSM), so as to provide the reference data for HIV prevention and treatment. Methods: In November 2021, 137 MSM students from 31 provincial administrative regions in China were recruited. An online survey was conducted to collect data on demographic characteristics, ART status, CD4 count, and HIV viral load before treatment. Logistic regression was used to analyze the factors related the effectiveness of ART in MSM. Results: Among the included research subjects, 14.6% had late detection of HIV,97.1% of participants were currently undergoing ART. Among those whose ART duration was less than 6 months, while 76.9% were undergoing ART. Logistic regression indicated that HIV infected students who received ART for more than 24 months ( OR =5.28, 95% CI =1.38-20.22) had a higher rate of successful HIV suppression. HIV infected students who reported physical sensory side effects ( OR =0.08, 95% CI =0.01-0.71) and cognitive side effects ( OR =0.28, 95% CI =0.09-0.90) were more likely to experience failure of ARI inhibition ( P <0.05). Conclusions There is still room for improvement in the efficacy of ART among MSM students. Strategies to improve treatment adherence must consider individual variances among HIV infected patients and the side effects of medications when designing treatment plans.

Objective:To explore the influencing factors of unplanned extubation (UEX) in elderly patients with chronic diseases, so as to provide a reference for the prevention of UEX.Methods:From March 2019 to May 2020, convenience sampling was adopted to select 152 elderly chronic diseases patients carrying tubes in the longterm in the Second Medical Center of the Chinese People's Liberation Army General Hospital as the research object. This study counted the occurrence of UEX in patients, and conducted univariate analysis and Logistic regression analysis on the factors that might lead to the occurrence of UEX.Results:A total of 36 cases of UEX occurred in 152 patients, with an incidence rate of 23.68%. Multivariate Logistic regression analysis showed that wakefulness, lethargy, and complete bed rest were independent risk factors for the occurrence of UEX, and the differences were statistically significant ( P<0.05) . Conclusions:The incidence of UEX in elderly patients is high, which is mainly affected by the state of consciousness and activity. At the management level, the risk assessment tools should be improved, the nursing risk training of the caregivers should be strengthened, and the risk awareness level should be improved. At the nursing level, we should focus on high-risk groups, formulate personalized UEX intervention strategies, strengthen health education for patients when they are discharged from the hospital, perform predictive care, minimize the incidence of UEX, and improve the quality of life of elderly patients carrying tubes.

Objective:To explore the influencing factors of accidental falls outside the hospital in elderly patients with accidental injury in the Emergency Department, so as to provide a basis for preventing accidental injuries.Methods:Convenience sampling was used to select 210 emergency elderly patients who visited the hospital due to accidental injuries from November 2017 to May 2020 in the Second Medical Center, People's Liberation Army General Hospital as the research object. Patients were investigated with the self-designed Out-of-hospital Accidental Injury Consultation Questionnaire. Single factor analysis and binomial Logistic regression were used to analyze the influencing factors of falls in elderly patients. A total of 210 questionnaires were distributed in this survey, and 180 valid questionnaires were returned with the valid response rate of 85.71%.Results:A total of 147 falls occurred among 180 elderly patients in the Emergency Department, and the incidence of falls was 81.7%. Binomial Logistic regression analysis showed that old age, outdoor, chronic diseases and no use of walking aids were independent risk factors for falls ( P<0.05) . Conclusions:The main types of accidental injuries in elderly patients are falls. Strengthening the nursing education of fall prevention measures, improving compliance with medications, choosing suitable walking aids or trying other new fall prevention technologies, and establishing a multi-party participation model can effectively prevent and reduce the occurrence of falls in elderly patients.

Objective:To evaluate and share the novel method for recruiting participants in clinical trials of vaccines in emergency situations.Methods:To publish recruitment notice in local areas of Wuhan through websites and medium, and guide interested persons to log in to the“Clinical Trials of SARS-CoV-2 Vaccine Reservation and Health Declaration System”to appoint and register their health information. The "Health Declaration System" provides each volunteer evaluation and risk levels to preliminarily exclude those who do not meet the inclusion criteria. Researchers review the qualified volunteers by telephone, organize them to go to the vaccination site, and finally conduct a strict medical screening to determine the final subjects.Results:A total of 4 819 people and 5 132 people registered in the Phase Ⅰ and Phase Ⅱ recruitment system respectively, with men 2 912 (60.43%) and 2 887 (56.25%) more than women 1 907 (39.57%) and 2 245 (43.75%), mostly in the 20-39 age group, with 3 211 (66.63%) and 3 966 (77.28%). All 13 districts in Wuhan have interested residents to participate clinical research.The initial qualified rate of the Phase Ⅱ recruitment system was higher than that of Phase Ⅰ, with men 2 047 (70.28%) and 2 135(73.95%), higher than women 1 083 (56.80%) and 1 472 (65.57%); 440 and 689 people were reviewed by telephone in Phase Ⅰ and Phase Ⅱ respectively, and the number of verified volunteers was about 440 (35.00%) and 689 (67.20%); Of the 201 603 people who arrived at the vaccination site, 12 and 26 of them were positive for the SARS-CoV-2 antibody with an antibody positive rate of 6.00% and 4.31% respectively.Conclusion:The novel method for recruiting subjects in this clinical study is efficient and reliable, and the recruitment situation of Phase Ⅰ had set a good example for Phase Ⅱ but the medium-and long-term compliance of subjects and the separation of willingness and behaviors still need to be further studied.

Objective: To explore the pre-exposure prophylaxis (PrEP) awareness, willingness, uptake patterns, barriers and needs among Chinese student men who have sex with men (MSM), so as to provide relevant evidence for targeted interventions with PrEP. Methods: A proportional sampling method was used to conduct a cross sectional survey of MSM aged 16 years and older residing in 21 provinces, municipalities, and autonomous regions in mainland China between October 20 and December 20, 2021, to collect information on demographic and sexual behavioral characteristics, and 923 students of them were selected as the subjects of this study. The chi-square test and Fisher s test were used for univariate analysis, followed by multivariate Logistic regression to analyze the influencing factors of PrEP awareness and uptake. Results: According to the cascade analysis method, the awareness, willingness, uptake and adherence rates of PrEP among the student MSM were obtained as 88.95%, 67.36%, 13.20% and 45.21 %, respectively. HIV testing more than once in the last 3 months, and all of them were aware of the HIV test results of their sexual partners, and those with high frequency of condom use had a higher rate of awareness ( OR =2.32, 1.79, 1.69, P <0.05). Willingness rates were higher for those from the pilot city, using substances, and HIV testing more than once in the last 3 months ( OR =2.13, 1.65, 1.69, P <0.05). Higher rates of uptake were found among those from high risk and pilot areas, presence of commercial sex, substance use, and high literacy ( OR =5.60, 3.54,2.81, 1.92, 4.54, P <0.05). Adherence rates were higher among those who used one pill per day or both ( OR =12.77, 13.26, P <0.05). The barriers and needs faced by student MSM were primarily personal concerns about medication side effects, preventative effects, and confidence in sexual behavioral styles, and the high cost of medication and related service costs. Conclusions The student MSM population in China is characterized by high awareness, low willingness, low uptake, and low adherence to PrEP. Targeted interventions should be considered and tailored by the departments to facilitate PrEP promotion among student MSM.

Objective:To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) in achalasia of cardia (AC) patients with the long course.Methods:A total of 159 AC patients who received POEM from January 2015 to March 2022 in the First Affiliated Hospital of Soochow University were divided into the long course group (≥10 years) and the non-long course group (<10 years). The baseline information, POEM procedure and postoperative recurrence were compared and the differences between the recurrent patients and non-recurrent patients in the long course group were explored.Results:The age (57.09±14.30 years VS 42.08±15.68 years, t=5.569, P<0.001), the rate of treatment history [28.9% (13/45) VS 9.6% (11/114), χ2=9.319, P=0.020], the proportion of Henderson grade Ⅲ esophagus [17.8% (8/45) VS 6.1% (7/114), χ2=7.020, P=0.030] in the long course group were significantly higher than those in the non-long course group. The recurrence rate in the long course group was significantly higher than that in the non-long course group [33.3% (15/45) VS 14.9% (17/114), χ2=6.811, P=0.009]. In the long course group, the age (62.50 ± 16.94 years VS 53.77 ± 12.95 years, t=-2.121, P=0.040), and the rate of treatment history [53.3% (8/15) VS 16.7% (5/30), χ2=6.544, P=0.016] in the recurrent patients were higher than those in the non-recurrent patients. Conclusion:POEM is safe and effective for long-course AC patients. In patients with the long course, the aged patients with previous treatment are more likely to relapse.

Objective:To evaluate and share the novel method for recruiting participants in clinical trials of vaccines in emergency situations.Methods:To publish recruitment notice in local areas of Wuhan through websites and medium, and guide interested persons to log in to the“Clinical Trials of SARS-CoV-2 Vaccine Reservation and Health Declaration System”to appoint and register their health information. The "Health Declaration System" provides each volunteer evaluation and risk levels to preliminarily exclude those who do not meet the inclusion criteria. Researchers review the qualified volunteers by telephone, organize them to go to the vaccination site, and finally conduct a strict medical screening to determine the final subjects.Results:A total of 4 819 people and 5 132 people registered in the Phase Ⅰ and Phase Ⅱ recruitment system respectively, with men 2 912 (60.43%) and 2 887 (56.25%) more than women 1 907 (39.57%) and 2 245 (43.75%), mostly in the 20-39 age group, with 3 211 (66.63%) and 3 966 (77.28%). All 13 districts in Wuhan have interested residents to participate clinical research.The initial qualified rate of the Phase Ⅱ recruitment system was higher than that of Phase Ⅰ, with men 2 047 (70.28%) and 2 135(73.95%), higher than women 1 083 (56.80%) and 1 472 (65.57%); 440 and 689 people were reviewed by telephone in Phase Ⅰ and Phase Ⅱ respectively, and the number of verified volunteers was about 440 (35.00%) and 689 (67.20%); Of the 201 603 people who arrived at the vaccination site, 12 and 26 of them were positive for the SARS-CoV-2 antibody with an antibody positive rate of 6.00% and 4.31% respectively.Conclusion:The novel method for recruiting subjects in this clinical study is efficient and reliable, and the recruitment situation of Phase Ⅰ had set a good example for Phase Ⅱ but the medium-and long-term compliance of subjects and the separation of willingness and behaviors still need to be further studied.

Objective To observe the functional recovery situation after prostate cancer radical opera-tion with maximal preservation of the periprostatic structures (MS-RARP).Methods Sixty-seven patients with localized prostatic cancer undergoing MS-RARP in the Second Affiliated Hospital of Army Military Med-ical University from June 2019 to June 2022 were selected as the study subjects.The changes of urinary con-trol function,erection function,quality of life and total prostate specific antigen (t-PSA) were compared at the time between before operation and postoperative 6 weeks,3 months,6 months,12 months.The expanded pros-tate cancer index composite index (EPIC-50) was used to evaluate the urinary control function,the interna-tional index of erectile function (IIEF-5) questionnaire was used to evaluate the erection function of the pa-tients,and EPIC-50 and the american urological associated symptom score rating scale (AUA-SS) were used to evaluate the life satisfaction of the patients.Results The urinary control function recovery rate,erection function recovery rate and life quality satisfaction rate in postoperative 6 weeks,3 months,6 months,12 months were 71.8％,95.5％,97.3％ and 98.1％;31.7％,38.1％,41.3％ and 44.4％;38.9％,83.6％,88.1％ and 97.0％,respectively.The median t-PSA was gradually decreased,which were 0.026(0.010,0.410),0.009 (0.003,0.060),0.006(0.001,0.050)and 0.004(0.001,0.006)ng/mL,respectively.The life quality satisfac-tion rates at various postoperative time points were significantly increased when compared with before opera-tion (P<0.05).t-PSA was significantly decreased compared with before operation (P<0.05).Conclusion RARP could protect the postoperative urinary function and sexual function,and increase the postoperative life quality of the patients.