Objective To explore the difference of pharmacokinetic parameters derived from dynamic contrast enhanced (DCE) MRI between primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM).Methods Data of 17 patients with PCNSL and 21 patients with GBM were retrospectively analyzed.All patients underwent DCE MRI.The pharmacokinetic parameters (K,Kep,Ve) and the initial (60 s) area under the Gd concentration-time curve (iAUC) of peri-tumoral parenchymas (PT),enhancement tumors (ET) and contralateral normal parenchyma (NP) were obtained.The differences of various parameters were compared among different regions of PCNSL and GBM using one-way ANOVA.The differences of various parameters of PT,ET and NP were compared using independent samples t-test.Results There were statistical differences of K,Kep in ET,Kep in PT between PCNSL and GBM patients (all P＜0.05),as well as of K,Kep,Ve,iAUC in PCNSL and GBM patients between ET and PT (all P＜0.05).However,K and Kepof PT showed statistical differences compared with those of NP in GBM patients (both P＜0.05),so did Ktrans between PT and NP in PCSL patients (P＜0.05).Conclusion The pharmacokinetic parameters derived from DCE MRI based on extended Tofts Linear can promote differential diagnosis between PCNSL and GBM.

Forty-one patients with COVID-19 (22 males and 19 females with the age of 24~94 years) from February to March 2020 were enrolled in the study, including 15 severe or critically ill cases (severe group) and 26 moderate cases (non-severe group). The CT findings of intrapulmonary lesions at admission were evaluated and compared between severe and non-severe groups. There were significant difference between severe and non-severe groups in the aspects of the presence or absence of pure ground-glass opacity (GGO) (χ 2=10.791), GGO with focal consolidation (χ 2=5.512), sheet consolidation (χ 2=27.359), crazy paving sign (χ 2=8.343), thickening of the bronchial wall (χ 2=14.473), air bronchogram sign (χ 2=4.977), and pleural effusion (χ 2=6.561), all P<0.05. Multivariate logistic regression analysis showed that range of lesion involvement was a relevant factor for severe cases( OR=0.029,95 %CI:0.001-0.647, P=0.026). The study indicates that CT features are diverse in COVID-19 patients; there is lack of pure GGO, but more GGO with focal consolidation. The appearance of sheet consolidation and crazy paving sign and wide-range of lesion involvement and pleural effusion in CT findings may be indications for severe COVID-19.

Objective:To search, evaluate and summarize the best evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy, and to provide reference for clinical practice in order to reduce the complications during labor, such as the proportion of instrument delivery, prolonged labor duration, uterine rupture, postpartum hemorrhage, etc. Standardize the management process of induction of labor with oxytocin, improve the satisfaction of pregnant women to participate in the decision of induction of labor, and improve the outcome of the newborn.Methods:Take the evidence-based nursing method, in view of the full-term pregnancy pregnant women oxytocin drip induced labor evidence-based labor management problems, nearly 10 years related literature retrieval from January 1st 2011 to April 9th, 2021, the Australian JBI evidence-based health care center of literature quality evaluation criteria and evidence classification system, all kinds of research evaluation and classification of retrieval.Results:Early detection to 340 articles, and eventually into 9 articles, including 1 clinical decision, 6 guides, 2 pieces of system evaluation. Totally 45 pieces evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy were sumarized, including induced labor time, oxytocin side effects, induced labor before evaluation, induced labor of guardianship, infusion solution, such as health education, and other seven aspects.Conclusions:The present study summarized 45 pieces of best evidence on the management of labor induced by oxytocin infusion during term pregnancy, which provided some evidence-based basis for midwives, obstetric nurses and managers. Through the application of the best evidence, it is beneficial to improve the outcome of pregnant women in the neonatal perinatal period, standardize the process of inducing labor with oxytocin, and improve the quality of obstetric care.

OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of generic drugs and original drugs of voriconazole. METHODS The information of patients who used voriconazole generic drugs selected in National Centralized Drug Procurement （generic drug group） or non-selected original drugs （original drug group） in the treatment of fungal infection was collected from the our hospital. The propensity score matching was carried out to eliminate bias. The comprehensive efficacy was evaluated according to clinical efficacy， image findings and microbiological test， and stratified analysis of different populations was conducted based on fungal species， underlying diseases， etc.， the efficacy of different stratifications was evaluated. Evaluation of safety was performed by using the incidence of adverse reactions. The total cost， defined daily doses （DDDs） and defined daily dose cost （DDDc） were used to evaluate the cost-effectiveness. RESULTS A total of 436 patients were included， and there were 190 patients in each group after matching. In terms of efficacy， the effective rates of voriconazole generic drugs and original drugs were 62.63% and 59.47% （P＝0.528）； in terms of safety， the incidence of adverse reactions caused by generic drugs and original drugs of voriconazole was 13.68% and 7.89%， respectively（P＝0.069）. In terms of cost-effectiveness， the average total cost of generic drugs was 4 636.26 yuan， and that of original drugs was 8 613.20 yuan （P＜0.001）. After the implementation of National Centralized Drug Procurement， replacement rate of generic drugs increased to 87.30%， and DDDc decreased by 59.08%. CONCLUSIONS The efficacy and safety of voriconazole generic drugs are similar to those of original drugs in the treatment of fungal infection， and it is more cost-effective in terms of treatment cost.

Objective    To evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods     An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. Results    A total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P<0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P<0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P<0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P<0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P<0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion     Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.