Objective To explore the objective characteristics of tongue in primary immune thrombocytopenia(ITP);To provide references for accurate syndrome differentiation.Methods Totally 112 patients with ITP were divided into groups according to their platelet count,TCM symptoms and drug treatment lines.Infrared thermal imager,hygrometer,colorimetry and image analysis software were used to detect the temperature,humidity,colorimetry and morphology of tongue body(TB),tongue coating(TC)and sublingual vessel(SV),and analyze their characteristics.The tongue was divided into five areas:tip of tongue(T),middle of tongue(M),behind of tongue(B),middle left of tongue(ML)and middle right of tongue(MR),and its temperature was measured.Humility(H)of tongue and tongue coating were measured by hygrometer.The images of tongue body,tongue coating and sublingual collaterals were taken,and the chromaticity indexes of R,G,B,L,a,b were analyzed by Adobe Photoshop 2023.The width,length and tortuosity of sublingual collaterals were under morphological analysis.Results ① Comparison of platelet count groups:compared with 30-50 platelet count group and more than 100 platelet count group,the TB-R of 51-100 platelet count group decreased(P<0.05,P<0.01),and compared with 30-50 platelet count group,the TB-a of 51-100 platelet count group decreased(P<0.01);compared with platelet<30 group and platelet 30-50 group,the TC-H of platelet>100 group increased(P<0.05,P<0.01);compared with platelet>100 group,the length of sublingual collaterals in platelet<30 group was longer(P<0.05).② Comparison of different TCM symptom groups:compared with the bleeding group and asymptomatic group,the M and SV-B in the fatigue group decreased(P<0.05,P<0.01);compared with the asymptomatic group,the TC-b in the anxious group was significantly higher(P<0.05).③ Comparison of administration groups:compared with the Danazol group and Chinese materia medica group,the TC-H in the glucocorticoid group was significantly higher(P<0.05,P<0.01).Conclusion There are differences in tongue characteristic indexes among ITP patients with different platelet counts,TCM symptoms and drug treatment lines,which can measure of tongue indexes to provide references for accurate syndrome differentiation of ITP.

Objective To explore the objective characteristics of tongue in primary immune thrombocytopenia(ITP);To provide references for accurate syndrome differentiation.Methods Totally 112 patients with ITP were divided into groups according to their platelet count,TCM symptoms and drug treatment lines.Infrared thermal imager,hygrometer,colorimetry and image analysis software were used to detect the temperature,humidity,colorimetry and morphology of tongue body(TB),tongue coating(TC)and sublingual vessel(SV),and analyze their characteristics.The tongue was divided into five areas:tip of tongue(T),middle of tongue(M),behind of tongue(B),middle left of tongue(ML)and middle right of tongue(MR),and its temperature was measured.Humility(H)of tongue and tongue coating were measured by hygrometer.The images of tongue body,tongue coating and sublingual collaterals were taken,and the chromaticity indexes of R,G,B,L,a,b were analyzed by Adobe Photoshop 2023.The width,length and tortuosity of sublingual collaterals were under morphological analysis.Results ① Comparison of platelet count groups:compared with 30-50 platelet count group and more than 100 platelet count group,the TB-R of 51-100 platelet count group decreased(P<0.05,P<0.01),and compared with 30-50 platelet count group,the TB-a of 51-100 platelet count group decreased(P<0.01);compared with platelet<30 group and platelet 30-50 group,the TC-H of platelet>100 group increased(P<0.05,P<0.01);compared with platelet>100 group,the length of sublingual collaterals in platelet<30 group was longer(P<0.05).② Comparison of different TCM symptom groups:compared with the bleeding group and asymptomatic group,the M and SV-B in the fatigue group decreased(P<0.05,P<0.01);compared with the asymptomatic group,the TC-b in the anxious group was significantly higher(P<0.05).③ Comparison of administration groups:compared with the Danazol group and Chinese materia medica group,the TC-H in the glucocorticoid group was significantly higher(P<0.05,P<0.01).Conclusion There are differences in tongue characteristic indexes among ITP patients with different platelet counts,TCM symptoms and drug treatment lines,which can measure of tongue indexes to provide references for accurate syndrome differentiation of ITP.

To improve the effectiveness of bedside localization of nasointestinal tube(NIT)and facilitate the placement of nasointestinal tube into jejunum,we established a procedure and composed a teaching verse for bedside placement of nasointestinal tube based on relevant classical literature and our own practices.Verse content:enteral nutrition means a successful strategy to improve the outcome in critically ill patient management,never hesitate to place nasointestinal tubes when necessary.There are several methods to deal with it,but popularizing it remains a long way off.Half-sitting and swallowing into the esophagus,freely withdrawing signifies the stomach cavity.Passing through the pylorus using light tension on the tube in the right lateral decubitus position.Arriving at the jejunum with low resistance in the left lateral decubitus position.What are the signs of intragastric coiling?Tube return out of nose is the initial observation,Failure of air insufflation indicates tube coiling.Dyeing location surpasses imaging.Vacuum test is the most sensitive,Sequential change from acid to base is specific.Methylene blue test is dramatical for localization.Combining three methods is enough to navigate.Abdominal plain film is the goldan standard and can still be used in ultrasonic era.3-D image establishes overall view.CT reveals the tube route exactly.The teaching verse has become a powerful tool for clinical teaching of manual nasointestinal tube placement in a concise and easy-to-remember form.

Objective:To study the feasibility and safety of percutaneous jejunal drainage in treatment of hepatolithiasis after choledochojejunostomy.Methods:The clinical data of 24 patients with hepatolithiasis after choledochojejunostomy treated by percutaneous jejunal drainage at the Cholelithiasis Center, Shanghai East Hospital Affiliated to Tongji University from May 2021 to May 2022 were retrospectively analyzed. There were 16 males and 8 females, aged (50.46±10.89) years old. Ultrasound and X ray guided percutaneous jejunography was performed under local anesthesia for patients with hepatolithiasis after choledochojejunostomy. Then the fistula was directly dilated to 16.0Fr, and percutaneous jejunal choledochoscopy was performed 3 days later. The success rate, complication rate and stone removal rate were analysed.Results:Twenty-four patients were treated with percutaneous jejunography, with a success rate of 79.2%(19/24), including 19 patients after anterior colonic cholangiojejunostomy with a success rate of 94.7%(18/19), and 5 patients after retrocolonic cholangiojejunostomy with a success rate of 20.0%(1/5). There was no complication including bleeding, intestinal leakage and bile leakage. In 19 patients with successful percutaneous jejunography, the success rate of fistula dilation was 100%(19/19), and there was no complication. Five patients with failed percutaneous jejunography underwent open choledocholithotomy through the jejunal output-loop, and bile leakage occurred in one patient. Thirteen patients with anastomotic stenosis, 5 with intrahepatic biliary strictures, and 6 with anastomotic and intrahepatic biliary strictures were diagnosed by choledochoscopy and selective cholangiography in these 24 patients. After choledochoscopic electrotomy, cylindrical balloon dilation, stone removal, stenting and other treatments, the stenosis relief rate was 100%(24/24), and the clearance rate of intrahepatic bile duct stones was 91.7%(22/24).Conclusion:Percutaneous jejunal drainage was a feasible, safe and minimally invasive method for treatment of hepatolithiasis after choledochojejunostomy. The procedure was especially suitable for patients with anterior colonic cholangiojejunostomy.

Despite the deepening of research on breast cancer,improving of treatment techniques,there are still many patients will appear local-regional recurrence after surgery.For patients with local recurrence after radical mastectomy,according to whether the postoperative radiotherapy performed,prognosis and treatment protocols are absolutely different.As for patients with local recurrence after breast-conserving surgery,more and more studies have shown that lumpectomy (secondary breast conserving surgery) combined with brachytherapy can achieve a similar effect with radical surgery in recent years,so it is a worth considering treatment protocol.

Objective To investigate the impact of lack of progesterone receptor ( PR) expression on the prognosis of patients with operable ER ( estrogen receptor)?positive invasive breast cancer. Methods We retrospectively analyzed the clinicopathological features, treatment and survival data of 318 women with ER+/PR+ and ER+/PR? invasive breast cancer. Results Among the 318 patients, there were 219 PR?positive and 99 PR?negative cases. The 5?year overall survival ( OS ) rate was 92. 5%, and the 5?year disease?free survival ( DFS) rate was 87. 2% in the 318 ER?positive patients. Among them, the 5?year OS rates were significantly different between the PR?positive group (94.6%) and PR?negative group (87.8%, P=0.020), and the 5?year DFS rates were also significantly different from each other (89.8% and 81.6%, respectively, P=0.019).Univariate analysis showed that PR status, tumor size, T stage, axillary lymph node metastasis, and clinical stage were prognostic factors for OS ( P<0.05 for all) . Multivariate analysis showed that lack of PR expression, T stage ≥2, and positive axillary lymph node metastasis were independent risk factors for poor DFS and OS in ER?positive breast cancer patients ( P<0. 05 for all ) . Subgroup analysis showed that lack of PR expression was not significant in predicting poor DFS or OS when patients were in stageⅠ or with a small tumor (≤2 cm) (P>0.05 for all), and also showed that premenopausal women with PR?negative disease had poorer DFS and OS than PR?positive patients ( P<0.05 for both) . Conclusions Lack of PR expression is an independent risk factor for poor prognosis in patients with operable ER?positive invasive breast cancer, especially in patients with a large tumor (>2 cm) , advanced clinical stage ( StageⅡ or Ⅲ) or in premenopausal status.

Objective To investigate the impact of lack of progesterone receptor ( PR) expression on the prognosis of patients with operable ER ( estrogen receptor)?positive invasive breast cancer. Methods We retrospectively analyzed the clinicopathological features, treatment and survival data of 318 women with ER+/PR+ and ER+/PR? invasive breast cancer. Results Among the 318 patients, there were 219 PR?positive and 99 PR?negative cases. The 5?year overall survival ( OS ) rate was 92. 5%, and the 5?year disease?free survival ( DFS) rate was 87. 2% in the 318 ER?positive patients. Among them, the 5?year OS rates were significantly different between the PR?positive group (94.6%) and PR?negative group (87.8%, P=0.020), and the 5?year DFS rates were also significantly different from each other (89.8% and 81.6%, respectively, P=0.019).Univariate analysis showed that PR status, tumor size, T stage, axillary lymph node metastasis, and clinical stage were prognostic factors for OS ( P<0.05 for all) . Multivariate analysis showed that lack of PR expression, T stage ≥2, and positive axillary lymph node metastasis were independent risk factors for poor DFS and OS in ER?positive breast cancer patients ( P<0. 05 for all ) . Subgroup analysis showed that lack of PR expression was not significant in predicting poor DFS or OS when patients were in stageⅠ or with a small tumor (≤2 cm) (P>0.05 for all), and also showed that premenopausal women with PR?negative disease had poorer DFS and OS than PR?positive patients ( P<0.05 for both) . Conclusions Lack of PR expression is an independent risk factor for poor prognosis in patients with operable ER?positive invasive breast cancer, especially in patients with a large tumor (>2 cm) , advanced clinical stage ( StageⅡ or Ⅲ) or in premenopausal status.