Objective To observe the application effects of expander between collarbone and first rib space in Peripherally Inserted Central Catheter (PICC ).Methods A total of 1 20 PICC patients with chemotherapy were recruited from April 201 4 to April 201 5 and were divided into control group (54 cases, routine tube)and observation group (66 cases,self-designed expander between collarbone and first rib space) according to the method of random number table.And then,we compared the success rate of tubing and puncturing at once,operation time,catheter misplacement,mechanical phlebitis,the incidence of infection between two groups.Results The success rates of tubing and puncturing at once,operation time in observation group were better than those in control group with significant differences (P <0.05).There were statistically significant differences in catheter misplacement,mechanical phlebitis,the incidence of infection of patients between two groups (P <0.05).Conclusions The expander between collarbone and first rib can effectively decrease the incidence of complications and improve the effects of PICC.

Objective:To evaluate the value of preoperative prediction of vessel invasion (VI) of locally advanced gastric cancer by machine learning model based on the venous phase enhanced CT radiomics features.Methods:A retrospective analysis of 296 patients with locally advanced gastric cancer confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from July 2011 to December 2020 was performed. The patients were divided into VI positive group ( n=213) and VI negative group ( n=83) based on pathological results. The data were divided into training set ( n=207) and test set ( n=89) according to the ratio of 7∶3 with stratification sampling. The clinical characteristics of patients were recorded, and the independent risk factors of gastric cancer VI were screened by multivariate logistic regression. Pyradiomics software was used to extract radiomic features from the venous phase enhanced CT images, and the minimum absolute shrinkage and selection algorithm (LASSO) was used to screen the features, obtain the optimal feature subset, and establish the radiomics signature. Four machine learning algorithms, including extreme gradient boosting (XGBoost), logistic, naive Bayes (GNB), and support vector machine (SVM) models, were used to build prediction models for the radiomics signature and the screened clinical independent risk factors. The efficacy of the model in predicting gastric cancer VI was evaluated by the receiver operating characteristic curve. Results:The degree of differentiation (OR=13.651, 95%CI 7.265-25.650, P=0.003), Lauren′s classification (OR=1.349, 95%CI 1.011-1.799, P=0.042) and CA199 (OR=1.796, 95%CI 1.406-2.186, P=0.044) were independent risk factors for predicting the VI of locally advanced gastric cancer. Based on the venous phase enhanced CT images, 864 quantitative features were extracted, and 18 best constructed radiomics signature were selected by LASSO. In the training set, the area under the curve (AUC) of XGBoost, logistic, GNB and SVM models for predicting gastric cancer VI were 0.914 (95%CI 0.875-0.953), 0.897 (95%CI 0.853-0.940), 0.880 (95%CI 0.832-0.928) and 0.814 (95%CI 0.755-0.873), respectively, and in the test set were 0.870 (95%CI 0.769-0.971), 0.877 (95%CI 0.788-0.964), 0.859 (95%CI 0.755-0.961) and 0.773 (95%CI 0.647-0.898). The logistic model had the largest AUC in the test set. Conclusions:The machine learning model based on the venous phase enhanced CT radiomics features has high efficacy in predicting the VI of locally advanced gastric cancer before the operation, and the logistic model demonstrates the best diagnostic efficacy.

Background::Sentinel lymph node (SLN) biopsy is gradually accepted as the standard of care in breast cancer patients with down-staged axillary disease after neoadjuvant chemotherapy (NAC). However, it is still difficult to precisely define pre-NAC clinical node-positive (cN1) and post-NAC clinical node-negative (ycN0). This prospective single-center trial was designed to evaluate the feasibility and accuracy of standard targeted axillary dissection (TAD) after NAC in highly selective pre-NAC cN1 patients (not considering ultrasound-based axillary ycN staging).Methods::This prospective trial included patients with initial pre-NAC cT1–3N1M0 invasive breast cancer but with a rigorous definition of cN1 from the Affiliated Cancer Hospital of Zhengzhou University. When NAC was effective (including complete and partial responses) and preoperative axillary palpation was negative, preoperative ultrasound-based axillary staging was not considered, and all patients underwent TAD followed by axillary lymph node (LN) dissection. The detection rate (DR) and false-negative rate (FNR) of TAD were calculated.Results::A total of 82 patients were included, and 77 of them were eligible for data analysis. The DR for TAD was 94.8% (73/77). There were 26 patients with one abnormal LN at the time of diagnosis based on ultrasound, 45 patients with two, and 2 patients with three. One patient had one TAD LN, four patients had two TAD LNs, and 68 patients had three or more TAD LNs. Preoperative axillary palpation yielded negative results for all 73 patients who successfully underwent TAD. Preoperative ultrasound-based ycN0 and ycN+ conditions were detected for 52 and 21 cases, respectively. The FNR was 7.4% (2/27) for standard TAD (≥3 SLNs), which was lower than that of all successful TAD (≥1 SLN; 10.0%, 3/30).Conclusions::In rigorously defined pre-NAC cN1 breast cancer patients, standard TAD is feasible for those with negative axillary palpation after NAC, and FNR is also less than 10%.Registration::chictr.org.cn, ChiCTR2100049093

Objective:To explore the effects of mindfulness-based cognitive therapy (MBCT) on cognitive function and quality of life among Alzheimer disease (AD) patients so as to provide a research basis for clinical treatment and nursing.Methods:From November 2018 to August 2019, we selected 186 AD patients in Department of Neurology and met the inclusion and exclusion criteria at Nanhu Branch of China-Japan Union Hospital of Jilin University as the research objects. All patients were divided into research group and control group with the method of random number table, 93 cases in each group. Patients in control group were given routine nursing and discharge follow-up, and patients in research group were treated MBCT based on routine nursing for two months. We compared the scores of Mini-mental State Examination (MMSE) and Quality of Life-Alzheimer's Disease (QOL-AD) of patients between two groups at the time of enrollment and two months after intervention.Results:Two groups all completed the intervention and evaluation of this study, and no cases were withdrawn. The total score and dimension scores of QOL-AD of patients in research group were higher than those in control group two months after intervention with statistical differences ( P<0.05) . However, there was no statistical difference in the score of MMSE two months after intervention between two groups ( P>0.05) . Conclusions:A single 8-week MBCT intervention for AD patients can effectively improve the quality of life, but the improvement of patients' cognitive function still needs to be confirmed.