Background and purpose:To evaluate the treatment regimens used for patients with yolk sac tumors of the ovary and prognostic factors in our hospital. Methods:Clinical data for the patients with yolk sac tumors of the ovary were analyzed retrospectively. Patients were divided into four groups: patients in A group received nonsparing surgery and platinum-based chemotherapy; in B group received nonsparing surgery and non-platinum-based chemotherapy; in C group received fertility-sparing surgery and platinum-based chemotherapy; in D group received fertility-sparing surgery and non-platinum-based chemotherapy. 5-year survival rate and prognostic factors were analyzed.Results:The overall 5- year survival rate was 69.2 %. The 5- years survival rates were 81.8 %, 40.0 %, 82.6% and 50.0% for A, B, C and D group, respectively. Platinum-based chemotherapy achieved significant survival benefit (82.4% vs. 44.4%, P0.05). Clinical stage, the size of residual tumor and Platinum-based chemotherapy were the mainly prognostic factors in multianalysis.Conclusions:Fertility-sparing surgery with a postoperative plainum-based chemotherapy should be the ideal modality for the treatment of yolk sac tumors of the ovary. Staging and tumor-reductive surgery were most associated with the prognosis of the patients.

Small cell carcinoma of cervix (SCCC) is a rare and high malignant neuroendocrine tumor.Because of its strong invasion,metastasis in early stage and easy recurrence,the prognosis is poor.Its diagnosis is based on pathomorphology,and immune-histochemistry biomarkers can improve its diagnosis.Combined therapy is recommended.Postoperative platinum/etoposide (PE),vincristine/adriamycin/cyclophosphamide (VAC) or taxel/carboplatin(TP) chemotherapy can improve the prognosis.

Objective To investigate the clinicopathologic features,the complications of splenectomy and the survival of epithelial ovarian cancer patients with splenic metastasis.Methods A retrospective study was performed of 32 pailents with epithelial ovarian cancer who underwent splenectomy for tumor cytoreduction at Zhejiang Cancer Hospital between Jan 1998 and Jun 2006.Results Of 32 patients,23 patients(72%)were serous adenocarcinoma and 9 were non-serous adenocarcinoma.According to pathological grade,none was of G1,11 were of G2,21 were of G3.Postoperatively,20 patients were left with no residual tumor.7 were with≤2 cm and 5 were with＞2 cm residual tumor.Postoperative complications developed in 8 patients(25%),including subphrenic abscess,wound infection,gastric perforation,gastrorrhagia,phlebothrombosis,and bowel obstruction.The median follow up was 38 months,estimated 2-year and 5-year overall survival were 70%and 36%.Univariate analysis revealed that histological grade,residual tumor and courses of chemotherapy were influencing factors of the survival(P＜0.05),but multivariate analysis indicated that only residual tumor and courses of chemotherapy independently influenced survival(P＜0.05).Conclusions In epithelial ovarian cancer patients with splenic metastasis,low grade serous adenocarcinoma is most common.Splenectomy as part of cytoreductive surgery is associated with modest morbidity and mortality.Residual tumor and courses of chemotherapy are independent factors associated with the prognosis of the patients.

Objective To discuss the clinicopathologic characteristics and risk factors for lung metastasis of early-stage cervical cancer after radical hysterectomy. Methods The complete clinicopathologic data of patients with lung metastasis of cervical cancer after radical surgery from January 2008 to December 2013 admitted in Zhejiang Cancer Hospital were retrospectively analyzed by univariate and multivariate analysis. Results (1)There were 38 cases of early cervical cancer suffered from lung metastasis after radical hysterectomy during the period. The median age at diagnosis of cervical cancer was 46 years, the average lung metastasis time was 13 months after operation, 50.0%(19/38) cases occurred in the first year. Thirty-one cases were squamous cell carcinoma and 7 cases were non-squamous cell carcinoma.(2)Univariate analysis showed that age,clinical stage, manner of tumor growth, tumor grade, perineuronal invasion, para-aortic lymph node metastasis were not significant effect on postoperative lung metastasis(all P>0.05). But tumor size, histologic types, depth of stromal invasion, uterine body infiltration, lympho-vascular space invasion,pelvic lymph node metastasis, positive margin and abnormal tumor markers were significantly correlated with postoperative lung metastasis(all P<0.05). Multivariate analysis showed that only tumor size, histologic types and pelvic lymph node metastasis were independent risk factors for lung metastasis of cervical cancer(P<0.05). Conclusions Patients of early-stage cervical cancer with lung metastasis mostly occurs within 1 year after radical hysterectomy. Local large tumor lesions (tumor size>4 cm), non-squamous cell carcinoma and pelvic lymph node metastasis were more likely to have lung metastasis.

Objective:To investigate of AIDET communication model in caring for type 2 diabetes mellitus of hospitalized patients.Methods:A total of 113 patients with type 2 diabetes mellitus treated in our department from January 2018 to November 2019 were enrolled, and divided into the control group(receiving a conventional communication mode)and the observation group(receiving an AIDET communication mode)according to a time order in the selecting of the research patients.The changes of self-care behavior and glucose metabolism index were evaluated and analyzed between the two groups.Results:On admission, the fasting blood glucose, 2-h postprandial blood glucose and glycosylated hemoglobin were(9.1±1.7)mmol/L, (13.8±2.9)mmol/L and(8.4±3.5)% in the observation group, and(9.4±2.1)mmol/L, (14.1±3.2)mmol/L and(8.1±2.9)% in the control group, respectively, with no statistically significances( P>0.05). At discharge, the observation group versus the control group showed a statistically significantly improved levels in FPG of(5.9±1.5)mmol/L vs.(7.8±1.9)mmol/L, in 2h-PBG of(10.1±3.7)mmol/L vs.(12.8±3.9)mmol/L and in glycosylated hemoglobin of(6.3±1.2)% vs.(7.5±0.9)%, respectively( P<0.05). The scores of management of poor blood glucose, foot care, blood glucose monitoring, medication compliance, regular exercise and diet control were higher in the observation group than in the control group at discharge( P<0.05). Conclusions:The application of AIDET communication mode can effectively enhance the self-care behavior of patients and help improve the glucose metabolism in hospitalized patients with type 2 diabetes mellitus.It has very positive effects on controlling the development of type 2 diabetes mellitus and improving the quality of life.

Objective To explore the clinical characteristics in patients with histiocytic necrotizing lymphadenitis (also called Kikuchi-Fujimoto' s disease,KD) and meningitis.Methods We reported a patient who developed meningitis preceding the other presentations of KD with abnormal serum autoimmune phenomena,and systematically reviewed 19 cases of KD with meningitis that had been reported worldwide,and analyzed the clinical parameters and treatments.Results The present case was a 25-year-old female subject with serum antinuclear factor antibody and anti-ribonucleoprotein antibody positive.The patient recovered after treatment with steroid and no recurrence was appeared.Among the 19 patients,the average age was 20.2 years,sex ratio was 10:9 (10 female:9 male),7 patients had abnormal serum autoimmune phenomena,7 patients'initial symptom was meningitis and 5 patients were administrated with steroid.Conclusions The onset age in KD with meningitis is earlier than the common KD,and sex ratio in KD with meningitis is close to 1∶ 1.A definitive diagnosis of the disease is determined by a lymph node biopsy at present.

OBJECTIVE: To probe the role of clinical pharmacists in drug use of patients with severe pneumonia. METHODS: Clinical pharmacists participated in the treatment for a patient with ESBLs producing Klebsiella pneumoniae severe pneumonia. The patient was given cefoperazone tazobactam combined with moxifloxacin and ganciclovir initially. Clinical pharmacists suggested stopping cefoperazone tazobactam and moxifloxacin and additionally using meropenem according to the elevation of hemogram infection indexes; suggested stopping ganciclovir and continuously using meropenem according to the results of sputum culture; suggested providing cefoperazone sulbactam de-escalation sequential therapy for ESBLs producing Klebsiella pneumoniae and stopping cefoperazone sulbactam and azithromycin according to clinical symptoms of the patient. RESULTS: The physicians adopted the suggestions of clinical pharmacists. After treatment, body temperature and lab indexes of the patient recovered to normal; the result of sputum culture turned to negative. Chest CT showed that the infection focus was obviously absorbed compared to before. After discharged from hospital and followed up, the patient was found to have a good prognosis. CONCLUSIONS: Through actively participating in drug therapy, based on lab indexes and results of sputum culture, clinical pharmacists provide pharmaceutical care and adjust medication plan to improve treatment rate of patients with severe pneumonia and the safety and effectiveness of drug treatment, be of great significance to promote the rational use of antibiotics.

Objective To assess the effectiveness of traditional Chinese Medicine (TCM ) syndrome differentiation treatment for diabetic nephropathy in elderly patients. Methods A total of 96 elderly patients with diabetic nephropathy admitted to our hospital from January 2015 to December 2017 were recruited and divided into a regular care group (n= 48)and a TCM group(n= 48).Both groups received conventional treatment ,with TCM syndrome differentiation treatment added to the TCM group. The effectiveness of the treatment modalities was compared. Results In the regular care group ,significant effectiveness was observed in 12 patients ,effectiveness in 24 patients ,and ineffectiveness in 12 patients ,with a total effectiveness rate of 75％ .In the TCM group ,significant effectiveness was seen in 18 patients ,effectiveness in 27 ,and ineffectiveness 3 ,with a total effectiveness rate of 93％. The total effectiveness rate of the TCM group was higher than that of the regular care group(χ2 =6.400 ,P=0.011).After treatment ,fasting blood glucose ,2 h postprandial blood glucose , urea nitrogen ,creatinine ,and 24 h urine protein in the TCM group were significantly lower than in the regular care group and than pre-treatment levels(P<0.05). Conclusions TCM differentiation can not only significantly improve the treatment effectiveness in elderly patients with diabetic nephropathy ,but also relieve the clinical symptoms.

Objective:To observe the application and efficiency of Bushen Huoxue Plaster in senile subjects with diabetic kidney disease with Qi-Yin Deficiency with Blood stasis.Methods:A total of 100 elderly diabetic kidney disease(DKD)patients with Qi-Yin deficiency and Blood stasis syndrome in Endocrinology Department of Zhejiang Province Traditional Chinese and Western Medicine Hospital from February 2020 to May 2021were randomly divided into observation group(n=50)receiving TonifyingKidney and Activating Blood Paste plus TCM directional drug penetration therapy instrument for 10 days and control group(n=50)receiving placebo paste plus TCM directional drug penetration therapy instrument for 10 d. Main symptom score, overall syndrome score, urinary albumin/ creatinine ratio were observed and recorded.Results:After treatment, the observation group versus the control groups showed the statistically significant improvement in dry mouth and pharynx[(0.06±0.24)versus(0.30±0.68)score point, in feeling tired[(0.49±0.76)versus(0.98±1.02)score point], in spontaneous sweating or sweating after exercise[(0.08±0.27) vs.(0.32±0.69)score point], in limb numbness[(0.49±0.64) vs.(0.83±0.93)score point], in urination obstruction[(0.20±0.53) vs.(0.55±0.92)score point], and in total syndrome score[(1.65±2.06) vs.(3.36±2.53)score point, (all P<0.05)].The mean Ridit value of urinary albumin/creatinine ratio decreased in the observation group of chronic kidney disease stage A2 was 0.595 being higher than 0.405 in the control group, and the difference was statistically significant( P<0.05). Conclusions:The kidney-helping and blood-activating paste can improve the clinical symptoms of senile patients, and may have a certain effect on improving the urine albumin/creatinine ratio of patients with early diabetic kidney disease, and it is worthy of clinical application.

Objective:To explore the mediating effect of perceived organizational support on the relationship between personality traits and perceived self-efficacy of male nurses.Methods:A total of 766 male nurses from 20 level-A general hospitals in Shandong province were selected by convenience sampling method in December 2020. The general status questionnaire, the simplified version of Big Five Personality Inventory, the Perceived Organizational Support Scale and the General Self-efficacy Scale were used to investigate them.Results:The total score and average item score of 766 male nurses' sense of organizational support was 44.05±9.31, 3.38±0.72, and the total score and average item score of general self-efficacy was 26.19±5.65, 2.62±0.57. In 766 male nurses, perceived organizational support had a partial mediating effect on neuroticism and openness, with effect values of 21.71% and 10.19%, respectively. In addition, perceived organizational support had a complete mediating effect on conscientiousness and self-efficacy.Conclusions:The organizational support and self-efficacy of 766 male nurses were above average, and organizational support played a mediating role in the relationship between neuroticism, openness, conscientiousness and general self-efficacy.Nursing managers should give more organizational support to male nurses to change the influence of neuroticism, responsibility, agreeableness and open personality traits on self-efficacy, so as to improve the level of self-efficacy of male nurses.