Objective To evaluate the safety and effectiveness of TACE with radiofrequency ablation (RFA) in treatment of renal cell carcinoma.Methods Data of 23 cases of renal cell carcinoma were retrospectively analyzed.Firstly all patients were treated with renal TACE,and then RFA under the guidance of ultrasound and CT was performed 3 to 4 weeks later.The therapeutic effects were evaluated by enhanced CT or MR scans during the follow-up period.Meanwhile,the changes of Karnofsky Performance Status (KPS) scores and renal functions between preoperative and postoperative periods were also evaluated.Results To the end of the follow-up,in all 23 patients 21 cases (21/23,91.30％) survived and 2 cases died (2/23,8.70 ％).KPS scores and serum creatinine levels were observed in all 23 patients at the initial stage and the end of the follow-up period,there were no significant differences (all P＞0.05).At the end of follow-up,16 cases were complete remission,5 were partial remission and 2 were progressive disease.Conclusion TACE combined with RFA is a safe and effective method in treatment of renal cell carcinoma with less trauma,less complication and more effective.

Objective:To investigate the relationship between mild cognitive impairment (MCI) and time in target range (TIR) and time below target glucose range (TBR) in elderly patients with type 2 diabetes.Methods:Ninety-five elderly patients with type 2 diabetes who were admitted to the Henan Provincial People′s Hospital from November 2017 to November 2018 were selected. Patients were assessed for cognitive function using the Montreal cognitive assessment (MoCA), and were classified into mild cognitive impairment group (MCI group) and non-mild cognitive impairment group (non-MCI group) according to the scores; all enrolled patients were scanned with a glucose monitoring system to record TIR and TBR within the first 24 hours of admission.Results:The MoCA score of the patients in the MCI group was (21.3±3.7)point, which was significantly lower than that in the non-MCI group (28.2±1.2)point, P<0.01); the TIR of the patients in the MCI group was significantly lower than that in non-MCI group [(50.6±24.5)% vs (65.8±28.7)%, P<0.01], the TBR of patients in the MCI group was significantly higher than that in the non-MCI group [(6.6±3.2)% vs (1.2±1.9)%, P<0.01]. Correlation analysis showed that MoCA score was negatively correlated with TBR ( r=-0.892, P<0.01) and positively correlated with TIR ( r=0.816, P=0.001). Multivariate linear regression analysis showed that when adjusted for diabetic duration and HbA 1C, TIR and TBR were independent risk factors for MoCA scores. Conclusion:The cognitive level of elderly patients with type 2 diabetes is closely related to TIR and TBR. At the same time, we must pay attention to TBR while increasing TIR.

Objective To explore the clinical value of lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors.Methods Totally 1 252 patients with hepatic tumors treated by radiofrequency ablation were analyzed.RITA cluster multipole radio needles were used in all cases.Local anesthesia with lidocaine was used before percutaneous puncture,and the dosage was 2 mg/kg of body mass.The initial dose of remifentanil was injected with pump at 0.05 μg/(kg · min) during operation.Mean arterial pressure (MAP),heart rate (HR) and saturation of peripheral oxygen (SPO2) were recorded 24 h before radiofrequency ablation (T0),at the beginning of operation (T1),30 min after operation (T2) and at the end of surgery (T3).Visual analogue scale (VAS) was used to assess the analgesic effect during the whole ablation procedure.Results Radiofrequency ablation were successfully performed in 1 250 patients (1 250/1 252,99.84％).The average time was (59.02 ±14.63) min.The average dosage of remifentanil was (242.22± 22.73)μg.The average VAS score was (2.42± 1.13) points.Compared with the preoperative T0 time point,SPO2 did not change significantly at each time of T1,T2 nor T3,but MAP and HR were significantly higher than those before operation (both P＜0.05).VAS scores were significantly higher in patients with tumors size ＞5 em than those in patients with tumors size ≤5 cm (P＜0.05).VAS scores were significantly higher in patients with lesions under hepatic capsule and in diaphragm dome than in patients with lesions in other parts (both P＜0.05).Severe anesthesia related complications occured in 2 patients,related to the respiratory inhibitory effect of remifentanil,and the patients were completely recovered after corresponding treatment.Conclusion Lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors can effectively relieve the pain in patients.Tumor size and tumor location are the main impact factors on analgesic effect.

Objective To understand effects of the interventional operation on thyroid,peripheral blood indexes and chromosomal aberrations (CA) of peripheral lymphocyte of children with congenital heart disease (CHD).Methods Follow-up studies were conducted in 70 child patients undergoing cardiac catheterization and 23 with open heart surgery as control from 2010 to 2013.Postoperative follow-up examinations included thyroid ultrasound,blood routine indexes and analyses of CAs.Results Difference in thyroid ultrasound abnormality rate was not statistically significant between children with cardiac catheterization and control group (40.0％ vs.43.5％,P ＞ 0.05).There was no significant difference in white blood cell (WBC) count between interventional group and control group (P ＞ 0.05).The effects of disease type and operation time on thyroid ultrasound and WBC count were not observed (P ＞ 0.05).The frequency of chromosome aberrations,including acentric fragment,dicentrics and translocation in interventional group [(0.76 ± 0.07) ％],was higher than in control group [(0.25 ± 0.07) ％,(Z =-3.631,P ＜ 0.05],and the rates of acentric fragment and translocation were also higher in interventional group (Z =-2.531,-2.397,P ＜ 0.05).Conclusions Effect of intervention therapy on thyroid structure and WBC count in children with CHD was not observed,but the genotoxic effects remain in children with cardiac catheterization.

Objective:To evaluate the safety and effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT).Methods:Data of 15 patients undergoing TIPS for HCC with Vp4 PVTT and portal hypertension (PTN) in Peking University First Hospital from July 2018 to February 2023 were retrospectively analyzed, including 14 males and 1 female, aged (61.5±11.1) years old, ranging from 40 to 78 years old. The success rate of TIPS, portal pressure gradient (PPG) before and after procedure, perioperative adverse effects and complications were recorded. The survival status of patients was followed up by telephone review after surgery. Kaplan-Meier method was used for survival analysis.Results:The procedure of TIPS was performed uneventfully in all patients, with a technical success rate of 100% (15/15). PPG before and after TIPS were (31.73±5.48) mmHg (1 mmHg=0.133 kPa) and (17.60±3.66) mmHg, respectively, and the difference was statistically significant ( P<0.001). No perioperative death, hepatic artery or bile duct injury, acute liver failure or other major complications occurred. Compared with the preoperative status, the performance status scores [0(0, 0) vs. 3(3, 3)] and Child-Pugh scores [6(5, 8) vs. 9(8, 10)] were lower in patients one month after TIPS (all P<0.05). The median survival time was 228 d. Kaplan-Meier curves showed that the cumulative survival rates at 3, 6, 12 and 24 months after TIPS were 100%, 64.3%, 32.7% and 8.2%, respectively. Conclusion:TIPS could be safe and effective for HCC with Vp4 PVTT and severe PTN.

Objective:To establish a multidisciplinary information-based blood glucose management dominated by nurses, improve the specialized knowledge of non-endocrinological liaison nurses, and achieve homogenization of blood glucose management in the whole hospital.Methods:A multidisciplinary blood glucose management system was established in the hospital with the help of internet technology. From August to December 2018, specialized training was provided to totally 86 liaison nurses from 58 wards. Virtual wards were constructed using information technology, and remote treatment was provided to diabetic patients. A total of 10 wards were selected out of 58 wards, and the 212 diabetic patients who were admitted to the 10 wards in May 2018 were included into the control group, and the general consultation system in the hospital was adopted for them. Totally 238 diabetic patients admitted in May 2019 were included into the experimental group, and were subjected to multidisciplinary information-based blood glucose management. The diabetes knowledge of the liaison nurses before and after the training as well as the blood glucose management quality and patient satisfaction of the two groups of patients were compared.Results:After the training, the diabetes-related knowledge scores of the liaison nurses increased, and the difference was statistically significant compared with that before the training ( P<0.05) . The fasting blood glucose compliance rate at discharge, 2 h postprandial blood glucose compliance rate, in-hospital glycosylated hemoglobin detection rate, glucose tolerance detection rate, and patient satisfaction of the experimental group were 97.48%, 92.02%, 83.61%, 44.79%, and 99.16% respectively, all higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Creating a virtual ward and implementing multidisciplinary informatized-based blood glucose management can improve the quality of blood glucose management and satisfaction of diabetic patients, which is of certain clinical significance and is worth promoting in clinical practice.

Objective:To explore the effect of intervention strategy based on concept of behavioral goal attainment on medication compliance of patients with hyperthyroidism after discharge.Methods:Using the convenient sampling method, a total of 104 patients with hyperthyroidism who were admitted to Henan Provincial People's Hospital from January to November 2019 were selected as the research objects. They were divided into the control group and the observation group by simple random grouping method, with 52 cases in each group. The control group was given routine follow-up nursing intervention, while the observation group was given follow-up nursing intervention based on the concept of behavioral goal attainment. Before intervention and 12 weeks after intervention, medication compliance, mastery of knowledge, uncertainty, self-efficacy and serological indexes including thyroid stimulating hormone (TSH) , free thyroxine (FT 4) and free triiodothyronine (FT 3) were compared of the two groups. Results:There was no statistically significant difference in scores of compliance, hyperthyroidism-related knowledge questionnaire, uncertainty and self-efficacy and serum TSH, FT 4 and FT 3 levels in the control group before and after intervention ( P>0.05) . After 12 weeks of intervention, scores of compliance, hyperthyroidism-related knowledge questionnaire and self-efficacy score and serum TSH level of the observation group were higher than those before the intervention and the control group, while uncertainty score and serum FT 4 and FT 3 levels were lower than those before intervention and the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Intervention strategies based on concept of behavioral goal attainment can not only improve medication compliance of patients with hyperthyroidism, but also enhance the ability of patients to master disease-related knowledge, which has positive significance for controlling of disease development.

Objective:To explore the effect of teach-back method combined with motivational interviewing in diabetic patients.Methods:From June 2018 to June 2021, 188 diabetic patients admitted to Henan Provincial People's Hospital were selected as subjects by convenience sampling. The subjects were divided into the intervention group and the control group, with 94 cases in each group, according to the number of visits to the hospital at the time of admission. The patients in the control group were given routine diabetes health education, and the patients in the intervention group received the teach-back method combined with motivational interviewing. The blood glucose, knowledge, attitude and practice, self-management ability and quality of life were compared between the two groups before and after the intervention.Results:The fasting blood glucose, 2-hour postprandial blood glucose of the two groups of patients after intervention were lower than those before intervention, and the fasting blood glucose, 2-hour postprandial blood glucose of the intervention group after intervention were lower than those of the control group, and the differences were all statistically significant ( P<0.05) . The knowledge, attitude, practice scores and total scores of the two groups after intervention were higher than those before intervention, and the knowledge, attitude, practice scores and total score of the intervention group after intervention were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The dimension scores of self-management ability of the two groups after the intervention were higher than those before the intervention, and the dimension scores of self-management ability of the intervention group after intervention were higher than those of the control group, with statistical differences ( P<0.05) . The dimension scores and total score of quality of life in the two groups after intervention were lower than those before intervention, and the dimension scores and total score of quality of life in the intervention group after intervention were lower than those in the control group, with statistical differences ( P<0.05) . Conclusions:The teach-back method combined with motivational interviewing can effectively improve the knowledge, attitude, practice and self-management ability of diabetic patients, which is beneficial to the improvement of blood glucose control and quality of life, and is worthy of clinical promotion.

Objective:To observe any effect of family rehabilitation interventions based on digital health management on elderly type 2 diabetes mellitus (T2DM) patients with sarcopenia.Methods:One hundred elderly T2DM patients with sarcopenia who had been discharged from hospital after treatment were divided into an observation group and a control group, each of 50. Both groups continued the diet control and training begun during their hospitalization, but the observation group was additionally provided with family rehabilitation based on digital health management. Before and after 3 months, the glucose and lipid metabolism and sarcopenia of both groups were evaluated with related symptom indexes, and their levels of diabetes self-management were compared.Results:Significant improvement was observed in both groups, but the average glucose and lipid metabolism indexes and sarcopenia-related symptom indexes of the observation group were significantly better than the control group′s averages. Their diabetes self-management was also significantly superior.Conclusion:Family rehabilitation based on digital health management can significantly improve glucose and lipid metabolism and muscle mass in elderly T2DM patients with sarcopenia. Such intervention is worthy of promotion and application in clinical practice.

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions . Methods Retrospectively analyzed the contrast-enhanced ultrasound model and angiographic predictive model of 465 cases of the A prospective multicenter study of breast nodules contrast-enhanced ultrasound" that led the Sichuan Provincial People′s Hospital from January 2016 to April 2017 ,which included 69 cases of breast precancerous lesions and 396 other types benign lesions ,and the sensitivity ,specificity and accuracy of the diagnosis of breast precancerous lesions were calculated . Results The sensitivity of ultrasound predictive model for the diagnosis of precancerous lesions was 60 .9％ and AUC was 0 .681 . Precancerous lesions mainly showed non-concentricity , increased homogeneity , and increased lesions;other types of benign lesions mainly showed non-centripetal ,high uniformity enhancement and lesion size unchanged . Conclusions Contrast-enhanced ultrasound shows a potential value in the differential diagnosis of precancerous lesions and other types of benign lesions ,that can help clinicians to take early intervention measures for breast precancerous lesions ,but there are still many problems to be solved .