Objective To explore the characteristics of diagnosis and treatment of thoracoabdominal combined injuries (TCI). Methods A retrospective study was carried out in 92 cases of TCI treated surgically, among whom were 41 cases (44.57%) with penetrating injury caused by sharp instument and 51 (55.43%) with blunt injury. Traffic injury was commonly seen. The injuries due to different causes and their clinical signs as well as operative measures were analyzed. Results Of 92 cases, 42 (45.65%) had diaphragmatic ruptures preoperatively, 88 (95.65%) diaphragmatic rupture was found in the first operation and was repaired; 4 (4.35%) did not receive disgnosis due to neglect of the diaphragm in operation; and 13 (14.13%) died. Conclusions TCI is a special type of multiple trauma with severe and complicated injuries and a high mortality. The diagnosis should be based on the mechanism of trauma and volume of bleeding. In the meantime, special attention should be paid to avoiding the missed diagnosis of diaphragmatic injuries. The treatment principle is thoracic injury first and laparotomy second.

Objective To investigate the effects of different marriage modes of parents on mental health of Mosuo middle school students.Methods Basic information questionnaire and symptom checklist-90 (SCL-90)were adopted to compare and to analyze 226 Mosuo students' mental health condition with regard to different marriage modes of parents.Results (1) In the comparison between the students from Monogamous Marriage families and the students from the Walking marriage families,the mean scores of somatization and depression were higher in the former group than in the latter group(0.73 ± 0.59 vs 0.58 ± 0.46,P＜ 0.05 ;0.87 ±0.65 vs 0.70 ±0.52,P＜ 0.05).(2)Among the students fromWalking marriage families,the mean scores of interpersonal sensitivity,depression,anxiety and phobic anxiety were higher in girls than those in boys (1.10 ± 0.76 vs 0.80 ±0.47,P＜0.05;0.83 ±0.54 vs 0.58 ±0.48,P＜0.05;0.99 ±0.71 vs 0.62 ±0.48,P＜0.05;0.99 ±0.77 vs 0.55 ± 0.53,P＜ 0.05).(3) Among the students from Walking-Marriage families,some students had closer relationship with their fathers,and some were closer to maternal uncles,the mean scores of somatization,obsessivecompulsive factor and hostility were higher in the former sub-group than in the latter sub-group (0.69 ± 0.52 vs 0.43 ±0.34,P＜0.05;1.22 ±0.46 vs 1.01 ±0.59,P＜0.05;0.94±0.66 vs0.65 ±0.57,P＜0.05).Conclusion The mental health status of Mosuo students are different regarding the marriage modes of their parents.In the Walking-Marriage families,the mental health of Mosuo students has relationship with their gender and the male whom the students are closer to.

Objective To probe timely diagnosis and surgical intervention of traumatic diaphragmatic rupture(TDR). Methods The clinical data of 161 patients with TDR treated surgically in our department during the past 17 years were analyzed retrospectively in respects of diagnostic methods,accuracy of preoperative judgment of TDR,incidence of diaphragmatic hernia,surgical procedures and outcome,etc. Results There were 139 males and 22 females at a mean age of 32.4 years(9-84 years),with average ISS of 27.8 points(13-66 points).Of all patients,65.2%had shock at admission.For these 161 patients,36 suffered from blunt injuries and 125 from penetrating injuries.For diaphragmatic injury.preoperative diagnostic rate was 88.9%for blunt injuries and 78.4%for penetrating injuries (P＞0.01).The incidence of diaphragmatic hernia was 94.4%in blunt injuries and 14.4%in penetrating injuries(P＜0.05).In this series,thoracotomy was performed in 30 patients,laparotomy in 106,thoracotomy plus laparotomy in 18 and combined thoraco-laparotomy in 7,with overall fatality rate of 10.6%and a mean ISS of 41.6 points.The mortality rate was 22.2%in blunt injuries and 7.2%in penetrating injuries(P＜0.01).The main causes for death were hemorrhagic shock and septic complications; Conclusions Blunt diaphragmatic injury can be diagnosed by radiographic signs of diaphragmatic hernia.According to"offside sign",which implies a thoracic wound with positive physical or radiological signs in the abdomen or in the thorax,penetrating diaphragmatic injury can be recognized.To deal with diaphragmatic hernia,it is important to judge the vitality of viscera.Penetrating injury has a relatively good prognosis.

Objective: To identify Xanthii Fructus and secure its quality and safety in medication. Methods: Total ge-nomic DNA was extracted from Xanthii Fructus and its adulterants. ITS2 sequences were amplified, and purified PCR products were sequenced. Sequence assembly and consensus sequence generation were performed using the CodonCode Aligner V 4.2. The Kimura 2-Parameter (K2P) distances were calculated using MEGA 5.0. The neigh-bor-joining (NJ) phylogenetic trees were constructed. Results: The intraspecific genetic distances of Xanthii Fructus were 0. The interspecific genetic distances between Xanthii Fructus and its adulterants were ranged from 0.009 to 0.542. The NJ tree showed that Xanthii Fructus could differ from its adulterants obviously. Conclusion: ITS2 can be used to identify Xanthii Fructus from its adulterants effectively, and our study further confirmed the effectiveness of ITS2 to identify traditional Chinese medicinal materials.

Objective To explore the correlation between lipoprotein a (Lpa),fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD).Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology,Affiliated Hospital of North China University of Science and Technology were selected as the research objects,and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination (MMSE).According to the results of MMSE,patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases).The cognitive impairment group was further divided into mild cognitive impairment group (100 cases),moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases).Lpa level was detected by latex immunoturbidimetry,FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed.Results (1) Compared with the control group (Lpa:(101.67±37.37) rmg/L,FIB:(3.02±0.67) g/L,D-D:(231.49±95.00) mg/L),the levels of Lpa,FIB and D-D in normal group (Lpa:(150.58± 89.55) mg/L,FIB:(3.48 ± 0.80) g/L,D-D:(287.79± 125.25)mg/L) and cognitive impairment group (Lpa:(257.98 ± 189.23) mg/L,FIB:(3.86± 0.97) g/L,D-D:(347.23± 120.69) rmg/L)increased significantly (all P＜0.01).Compared with the cognitive normal group,the levels of Lpa,FIB and D-D in cognitive impairment group increased significantly (all P＜0.01).(2)Compared with mild cognitive impairment group (Lpa:169.08±51.63 mg/L,FIB:(3.10±0.69)g/L,D-D:(288.91±92.58) mg/L),the levels of Lpa,FIB and D-D of in moderate cognitive impairment group (Lpa:(236.78± 107.15) mg/L,FIB:(3.52±0.67) g/L,D-D:(345.03± 132.68) mg/L),severe cognitive impairment group (Lpa:(292.65±108.19) mg/L,FIB:(4.04±1.08) g/L,D-D:(401.58±84.87) mg/L)increased significantly (all P＜0.01).Compared with the moderate cognitive impairment group,the levels of Lpa,FIB and D-D in the severe cognitive impairment group increased significantly (all P＜0.01).(3) The ROC curve was fitted with cognitive impairment as state variable.The area under the ROC curve of Lpa was 0.706,P＜0.01,95％ CI was (0.646-0.766),the area under the ROC curve of FIB was 0.613,P=0.001,95％ CI was (0.548-0.679),and the area under the ROC curve of D-D was 0.670,P＜0.01,95％ CI was (0.604-0.736).(4) Lpa,FIB and D-D were positively correlated with the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases (rLpa =0.522,P＜0.01;rFIB =0.410,P＜0.01;rD-D =0.488,P＜0.01).Conclusion Serum Lpa,FIB and D-D are closely related to the degree of vascular cognitive impairment and cognitive impairment in patients with ischemic CSVD,which may be involved in the occurrence and development of cognitive impairment.Detection of serum levels of Lpa,FIB and D-D is of great clinical value in the early diagnosis,assessment and treatment of cognitive impairment in ischemic CSVD.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.

COVID-19 associated Guillain-Barré syndrome (GBS) caused by peripheral nerve damage after SARS-CoV-2 infection is one of the most common COVID-19 related nervous system inflammatory diseases, with high incidence of respiratory failure and mortality. Positive SARS-CoV-2 RNA in cerebrospinal fluid of COVID-19 associated GBS patients has been rarely reported. This paper reports 4 patients with COVID-19 associated GBS in China who developed neurological symptoms 4-15 days after fever and were confirmed SARS-CoV-2 infection. All patients presented with progressive weakness of both lower limbs, 3 patients with autonomic dysfunction such as defecation and urination disorders, and 1 patient with polycranial neuritis and Miller-Fisher syndrome such as bilateral facial palsy, dysphagia, diplopia and ataxia. Nerve conduction velocity and F wave were abnormal in 3 patients, and motor conduction pathway was abnormal in 1 patient. Anti-ganglioside antibodies were tested in 3 patients, and GD1a-IgG was positive in 1 patient. All 4 patients underwent metagenomic next-generation sequencing examination in blood and cerebrospinal fluid. SARS-CoV-2 RNA was positive in blood and cerebrospinal fluid of 3 patients, and SARS-CoV-2 RNA was positive in cerebrospinal fluid of 1 patient.

The incidence of thyroid cancer has continued to increase. Most thyroid cancer patients have good prognosis, but there are still some patients who will develop into the middle or late stage. The status of cytotoxic treatment in thyroid cancer treatment is controversial. Chemotherapy, as a classical malignant tumor treatment, has its unique significance for the special type and the special period of thyroid cancer. Chemotherapy can be an option for systemic treatment if no other treatment is available for patients of differentiated thyroid carcinoma refractory to radiodine in rapid progression and life-threatening period. For patients of anaplastic thyroid cancer in progression period, chemotherapy can be selected if there are no other treatments in clinical trials. And "Chemical therapy plus" treatment model might play an important role in thyroid treatment, because with the development of targeted drugs and immunotherapy, chemotherapy combined with other treatments can reduce the dosage of chemotherapy drugs to reduce the toxic side effect, and can improve other therapeutic effects.

Objective To analyze the application value of a Nomogram model established on clinical and ultrasound features of thyroid in modifying classification results of the Chinese Thyroid Im-aging Reporting and Data System(C-TI-RADS)by ultrasound physicians.Methods The clinico-pathological ultrasound materials of patients with surgical resection for thyroid nodules in Sichuan Pro-vincial People's Hospital(training set,n=841)and Sichuan Mianyang 404 Hospital(external vali-dation set,n=295)from January 2021 to December 2022 were retrospectively analyzed,and preop-erative thyroid ultrasound was used to classify thyroid nodules by C-TI-RADS.Univariate and Multi-variate Logistic regression analyses were used to screen independent predictors in the training set and a Nomogram model was constructed,and Bootstrap resampling was used for internal validation;ultrasound physicians in Sichuan Mianyang 404 Hospital were charged in external verification based on this Nomogram model.Receiver operating characteristic(ROC)curve and calibration curve were drawn to evaluate the efficacy of the model and its clinical value in modifying the classification results by C-TI-RADS.Results Univariate and Multivariate Logistic regression analyses showed that gender,age,maxi-mum diameter of nodules,the number of nodules,ultrasound abnormalities of cervical lymph nodes and C-TI-RADS classification were the independent factors for predicting the modified classification results of C-TI-RADS by ultrasound physicians(P＜0.05).Consistency index of the Nomogram model constructed based on these factors was 0.842(95％CI,0.816 to 0.867),the area under the curve(AUC)was 0.842,sensitivity was 92.9％,specificity was 63.7％,and accuracy was 75.9％.The prediction results of the Nomogram model were in good agreement with the actual situa-tion in both the training set and the external validation set.Conclusion Nomogram model based on clinical and ultrasound features of thyroid shows good predictive accuracy in modifying classification results of C-TI-RADS by ultrasound physicians,which has potential clinical application value.

Objective To analyze the application value of a Nomogram model established on clinical and ultrasound features of thyroid in modifying classification results of the Chinese Thyroid Im-aging Reporting and Data System(C-TI-RADS)by ultrasound physicians.Methods The clinico-pathological ultrasound materials of patients with surgical resection for thyroid nodules in Sichuan Pro-vincial People's Hospital(training set,n=841)and Sichuan Mianyang 404 Hospital(external vali-dation set,n=295)from January 2021 to December 2022 were retrospectively analyzed,and preop-erative thyroid ultrasound was used to classify thyroid nodules by C-TI-RADS.Univariate and Multi-variate Logistic regression analyses were used to screen independent predictors in the training set and a Nomogram model was constructed,and Bootstrap resampling was used for internal validation;ultrasound physicians in Sichuan Mianyang 404 Hospital were charged in external verification based on this Nomogram model.Receiver operating characteristic(ROC)curve and calibration curve were drawn to evaluate the efficacy of the model and its clinical value in modifying the classification results by C-TI-RADS.Results Univariate and Multivariate Logistic regression analyses showed that gender,age,maxi-mum diameter of nodules,the number of nodules,ultrasound abnormalities of cervical lymph nodes and C-TI-RADS classification were the independent factors for predicting the modified classification results of C-TI-RADS by ultrasound physicians(P＜0.05).Consistency index of the Nomogram model constructed based on these factors was 0.842(95％CI,0.816 to 0.867),the area under the curve(AUC)was 0.842,sensitivity was 92.9％,specificity was 63.7％,and accuracy was 75.9％.The prediction results of the Nomogram model were in good agreement with the actual situa-tion in both the training set and the external validation set.Conclusion Nomogram model based on clinical and ultrasound features of thyroid shows good predictive accuracy in modifying classification results of C-TI-RADS by ultrasound physicians,which has potential clinical application value.