Objective:To investigate the imaging manifestations and diagnostic significance of multislice spiral CT angiography for aortic intramural hematoma.Methods:Forty-three patients with aortic intramural hematoma who received digital subtraction angiography or multislice spiral CT angiography in Yiwu Central Hospital from November 2017 to September 2018 were included in this study. The misdiagnosis rate and image quality were compared between the two imaging examination methods.Results:The misdiagnosis rate of digital subtraction angiography was 6.98% (3/43) and that of multislice spiral CT angiography was 4.65% (2/43). There was no significant difference in the misdiagnosis rate between the two methods ( P > 0.05). The numbers of patients receiving multislice spiral CT angiography with grade III image quality ( n = 4) and grade IV image quality ( n = 2) were lower than those of patients receiving digital subtraction angiography ( χ2 = 3.957 and 4.074, both P < 0.05). There were no significant difference in the numbers of patients with grade I and II image quality between the two methods (both P > 0.05). Multislice spiral CT angiography showed that among 43 patients, 18 patients had non-ulcerative aortic wall hematoma, 25 patients had ulcerative aortic wall hematoma. Among patients with aortic wall hematoma, 14 patients had moderate or more amount of pleural effusion, with the average thickness of hematoma tissue of 11.42 mm, the maximum diameter of the involved ascending aorta of 56 mm, and the maximum diameter of the involved descending aorta of 44 mm. Conclusion:Multislice spiral CT angiography is superior to digital subtraction angiography in the diagnosis of aortic wall hematoma because it provides clearer images, which can help better present lesion changes.

Objective To explore nurses′attitudes to patient engagement in patient safety and analyze the influencing factors. Methods With convenient sampling, a total of 580 nurses of 12 hospitals in Shanghai received a questionnaire survey for nurses′attitude to patient participation and patient safety. The higher score after statistical analysis explains the better attitude.Results Average score of nurses′ attitudes to patient engagement in patient safety was (4.039 2±0.518 72), while average score of decision-making participation was (4.000 60± 0.568 75), and caring-related involvement was (94.192 2±0.573 74) and complaint-related involvement was (3.437 4±0.798 40). There is significant difference in attitude of nurses in different levels of hospitals and different educational background to “patient participating in patient safety” ( F=8. 832, 3. 935;P<0. 05 ) . Conclusions Nurses′ attitude to patient engagement in patient safety is quite positive. Caring-related involvement is more welcomed than decision-making participation and complaint-related involvement among Shanghai nurses. Hospital level and educational background are the key influencing factors.

Objective To understand the situation on nurses′ perceptions of patient participation in patient safety and its influencing factors. Methods A total of 551 in-service nurses were recruited by convenience sampling. They were investigated with the scale of medical staff′ perception of patient participation in patient safety.Results The mean of nurses′ perception of patient participation in patient safety was (3.68± 0. 57)with a medium level. The score of decision participation (3.76±0.64) was significantly higher than that of caring participation (3.71±0.63), and the score of caring participation was higher than that of complaining participation (3.33±0.85). There were statistically significant differences in the scores of nurses′perceptions of patient participation in patient safety among different ages, years of working, professional titles, departments and educational background (P<0.05).Conclusions The situation of nurses′ perceptions of patient participation in patient safety is not satisfactory. Nurses should take patient participation in patient safety into account, guide and encourage patients to participate in patient safety.

Background::The calcineurin inhibitor (CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation; however, the long-term prognosis of grafts has not been significantly improved. The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts. Sirolimus (SRL) has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts. Presently, the regimen and timing of SRL application after renal transplantation vary, and clinical data are scarce. Multicenter prospective randomized controlled studies are particularly rare. This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods::Patients who receive four weeks of a standard regimen with CNI + mycophenolic acid (MPA) + glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study. At week 5, after the operation, patients in the experimental group will receive an additional administration of SRL, a reduction in the CNI drug doses, withdrawal of MPA medication, and maintenance of glucocorticoids. In addition, patients in the control group will receive the maintained standard of care. The patients’ vital signs, routine blood tests, routine urine tests, blood biochemistry, serum creatinine, BK virus (BKV)/cytomegalovirus (CMV), and trough concentrations of CNI drugs and SRL at the baseline and weeks 12, 24, 36, 48, 72, and 104 after conversion will be recorded. Patient survival, graft survival, and estimated glomerular filtration rate will be calculated, and concomitant medications and adverse events will also be recorded.Conclusion::The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.Trial registration::Chinese Clinical Trial Registry, ChiCTR1800017277.

Objective:This study aims to evaluate the prognostic effect of peripheral blood cells in multiple myeloma (MM) patients treated with bortezomib.Methods:The clinical data of 155 newly diagnosed MM patients in two blood disease treatment centers from January 2014 to December 2016 were retrospectively studied. All patients received bortezomib as the first-line treatment. The results of the peripheral blood cell counts, including absolute neutrophil count, absolute monocyte count (AMC) , hemoglobin level, mean corpuscular volume (MCV) , and platelet count, and other clinical features were analyzed.Results:AMC (>0.6×10 9/L) , MCV (>99.1 fl) , and platelet count (<150×10 9/L) significantly affected patients’ PFS and OS. The above three factors were assigned 1 point, respectively, to form the blood cell score. The analysis showed that 64 cases (41.3% ) had a score of 0, 57 cases (36.8% ) had 1, 32 cases (20.6% ) had 2, and 2 cases (1.3% ) had 3. The median PFS of the four groups were 42.8 m, 26.5 m, 15.8 m, and 6.4 m, respectively ( P<0.001) . The median OS were NR, 48.2 m, 31.1 m, and 31.4 m, respectively ( P=0.001) . Multivariate analysis suggested that the blood cell score (2-3 vs 0-1) and the proportion of marrow plasma cells (>30% ) were independent prognostic factors for PFS ( HR=1.95 and 1.76, respectively) , while age (>65y vs ≤65y) , R-ISS stage (3 vs 1-2) , and blood cell score (2-3 vs 0-1) were independent prognostic factors for OS ( HR=2.08, 2.13 and 2.12, respectively) . Conclusion:As an easy-to-access biomarker, the blood cell score can be used to evaluate the prognosis of newly diagnosed MM patients in the era of new drugs, but it is still necessary to expand the cases and make further confirmation in the prospective study.