Although thyroid nodules are less common in children than in adults，some benign nodules enlarge with age，causing symptoms or aesthetic concerns. Preserving thyroid function is crucial due to its role in children's growth and development. Thermal ablation，a safe and minimally invasive technique，offers a new option for treating benign thyroid nodules in children. This article reviewed the indications，methods，outcomes，and complication management of thermal ablation，in order to provide a reference for clinical practice.

Objective To explore the impact of factors such as economic level,regional differences,and healthcare policies on the medical costs and the clinical treatment behaviors for benign prostatic hyperplasia(BPH)using big data technology.Methods A combination of qualitative and quantitative approaches was employed,including descriptive statistical analysis,central tendency analysis,comparative analysis,and structural analysis to explore regional differences in the treatment of BPH and the underlying causes.Results The mean medical cost per case in the provincial capital city(19 502 yuan)was significantly higher than that in the prefecture-level city(16 526 yuan),with a difference of 2 976 yuan(+18%).Moreover,the cost distribution was more dispersed in the provincial capital([8 370 yuan-26 344 yuan]vs.[9 687 yuan-21 974 yuan]in the prefecture-level city).However,the provincial capital demonstrated better hospitalization efficiency,with a significantly shorter mean length of stay(9.24 days vs 10.21 days,-10.5%).All these differences were statistically significant(P<0.01).Payment methods influenced surgical choices.In the provincial capital,43.99%of patients underwent transurethral resection of the prostate(TURP),with no cases of holmium laser enucleation of the prostate(HOLEP).In contrast,the prefecture-level city reported 22.71%of patients receiving plasmakinetic resection of the prostate(PKRP)and 19.19%undergoing HoLEP.Significant differences were observed in antibiotic utilization patterns.The most commonly used antibiotic in the provincial capital was piperacillin-tazobactam(19.96%),while cefotaxime dominated in the prefecture-level city(21.11%).Notably,ertapenem was frequently used in the provincial capital but rarely in the prefecture-level city,potentially due to cost considerations(P<0.05).Regional preferences were evident in antispasmodic medication;phloroglucinol injection was used in 80%of cases in the prefecture-level city,while anisodamine hydrobromide injection predominated in the provincial capital(P<0.05).For BPH-specific medications,although tamsulosin hydrochloride sustained-release capsules were the primary choice in both regions,the prefecture-level city showed significantly higher usage(80.11%vs 49.17%).Finasteride tablets were more commonly prescribed in the provincial capital(39.03%vs.14.14%,P<0.05).Conclusion Economic levels,healthcare policies,and different hospitals significantly influence clinical decision-making and medical expenses.Hospitals should enhance refined management,while healthcare policy reforms need to advance from multiple perspectives and levels to improve the efficiency and equity of healthcare services.

Objective To explore the impact of factors such as economic level,regional differences,and healthcare policies on the medical costs and the clinical treatment behaviors for benign prostatic hyperplasia(BPH)using big data technology.Methods A combination of qualitative and quantitative approaches was employed,including descriptive statistical analysis,central tendency analysis,comparative analysis,and structural analysis to explore regional differences in the treatment of BPH and the underlying causes.Results The mean medical cost per case in the provincial capital city(19 502 yuan)was significantly higher than that in the prefecture-level city(16 526 yuan),with a difference of 2 976 yuan(+18%).Moreover,the cost distribution was more dispersed in the provincial capital([8 370 yuan-26 344 yuan]vs.[9 687 yuan-21 974 yuan]in the prefecture-level city).However,the provincial capital demonstrated better hospitalization efficiency,with a significantly shorter mean length of stay(9.24 days vs 10.21 days,-10.5%).All these differences were statistically significant(P<0.01).Payment methods influenced surgical choices.In the provincial capital,43.99%of patients underwent transurethral resection of the prostate(TURP),with no cases of holmium laser enucleation of the prostate(HOLEP).In contrast,the prefecture-level city reported 22.71%of patients receiving plasmakinetic resection of the prostate(PKRP)and 19.19%undergoing HoLEP.Significant differences were observed in antibiotic utilization patterns.The most commonly used antibiotic in the provincial capital was piperacillin-tazobactam(19.96%),while cefotaxime dominated in the prefecture-level city(21.11%).Notably,ertapenem was frequently used in the provincial capital but rarely in the prefecture-level city,potentially due to cost considerations(P<0.05).Regional preferences were evident in antispasmodic medication;phloroglucinol injection was used in 80%of cases in the prefecture-level city,while anisodamine hydrobromide injection predominated in the provincial capital(P<0.05).For BPH-specific medications,although tamsulosin hydrochloride sustained-release capsules were the primary choice in both regions,the prefecture-level city showed significantly higher usage(80.11%vs 49.17%).Finasteride tablets were more commonly prescribed in the provincial capital(39.03%vs.14.14%,P<0.05).Conclusion Economic levels,healthcare policies,and different hospitals significantly influence clinical decision-making and medical expenses.Hospitals should enhance refined management,while healthcare policy reforms need to advance from multiple perspectives and levels to improve the efficiency and equity of healthcare services.

Although thyroid nodules are less common in children than in adults，some benign nodules enlarge with age，causing symptoms or aesthetic concerns. Preserving thyroid function is crucial due to its role in children's growth and development. Thermal ablation，a safe and minimally invasive technique，offers a new option for treating benign thyroid nodules in children. This article reviewed the indications，methods，outcomes，and complication management of thermal ablation，in order to provide a reference for clinical practice.

Objective To explore the effect of the diagnosis and endoscopic minimally invasive surgical treatment of non-cystic congenital pyriform sinus fistula(CPSF)in children.Methods Clinical data of 76 children with non-cystic CPSF were retrospectively analyzed from October 2017 to May 2022.Larygoscope,neck color ultrasound,esophageal barium meal,neck CT,and magnetic resonance imaging(MRI)were performed,and temperature-controlled ablation radio-frequency was performed under general anesthesia supported by laryngoscope guidance.Results The internal fistula in the pyriform fossa was seen under laryngoscope.Imaging examination shows that the fistula was connected to the pharynx.Postoperative complications:hoarseness in 3 cases and deciduous tooth loss in 3 cases.After a follow-up period of 12～40 months,there was 1 recurrence in 46 newly treated patients and 1 recurrence in 30 non newly treated patients.No recurrence was observed during the follow-up period after re-endoscopic radiofrequency plasma surgical electrodes plasma cauterization.Conclusion The symptoms of CPSF are non-specific.The discovery of the internal fistula under endoscopy is the gold standard for diagnosis.Ultrasound can be used as the initial screening method for diagnosis.Esophageal barium meal combined with CT examination can improve the diagnostic rate,and MRI can assist in diagnosis.The temperature-controlled ablation radio-frequency technique under supportive laryngoscope has the advantages of safety,minimally invasive,aesthetic,convenient,and repeatable operation,and can be used as the preferred method for the treatment of non-cystic CPSF in children.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

The integrated management of multi-campus public hospitals is a mandate for national assessment and compul-sory requirement for high-quality advancement of public hospitals.A challenge in multi-campus hospital management is to accel-erate the standardization of various hospital campuses and facilitate the information sharing among them.Based on the manage-ment practices of multi-campus hospitals in Ningxia,this paper discussed the challenges encountered in the integrated manage-ment of multi-campus hospitals.It proposed strategies to enhance homogeneous management and inter-hospital coordination in multi-hospital and multi-campus hospital to provide valuable references.

Background:Ischemic colitis is a gastrointestinal emergency caused by intestinal wall ischemia,and in severe cases,it can even be life-threatening.Currently,there is a lack of reliable detection methods for ischemic colitis.Clinically,there is an urgent need for a specific detection method to improve the early diagnosis rate of ischemic colitis.Aims:To explore the values of serum vascular endothelial growth factor(VEGF)and plasma D-dimer levels for early diagnosis of ischemic colitis.Methods:A total of 40 patients with ischemic colitis admitted from June 2021 to June 2023 at the Affiliated Jinhua Hospital,Zhejiang University School of Medicine were served as the experimental group.Meanwhile,51 patients with acute enteritis were served as controls.The clinical manifestations,as well as the laboratory,radiological,and endoscopic results were compared between the two groups.A binary Logistic regression model was employed to analyze the risk factors for the onset of ischemic colitis.ROC curve was used to assess the diagnostic performance of serum VEGF and plasma D-dimer levels for the early diagnosis of ischemic colitis.Results:Compared with the control group,the proportion of patients with abdominal pain accompanied by hematochezia,and the serum VEGF and plasma D-dimer levels in the experimental group were significantly increased(all P<0.05).The results of binary Logistic regression model indicated that serum VEGF and plasma D-dimer levels were the risk factors for onset of ischemic colitis(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum VEGF and plasma D-dimer for diagnosing ischemic colitis were 0.93 and 0.88,respectively.The combination of these two indicators could further increase the diagnostic specificity and the AUC.Conclusions:Serum VEGF and plasma D-dimer levels can be served as early diagnostic markers for ischemic colitis.The combination of these two indicators can greatly improve the early diagnostic performance.

Background:Ischemic colitis is a gastrointestinal emergency caused by intestinal wall ischemia,and in severe cases,it can even be life-threatening.Currently,there is a lack of reliable detection methods for ischemic colitis.Clinically,there is an urgent need for a specific detection method to improve the early diagnosis rate of ischemic colitis.Aims:To explore the values of serum vascular endothelial growth factor(VEGF)and plasma D-dimer levels for early diagnosis of ischemic colitis.Methods:A total of 40 patients with ischemic colitis admitted from June 2021 to June 2023 at the Affiliated Jinhua Hospital,Zhejiang University School of Medicine were served as the experimental group.Meanwhile,51 patients with acute enteritis were served as controls.The clinical manifestations,as well as the laboratory,radiological,and endoscopic results were compared between the two groups.A binary Logistic regression model was employed to analyze the risk factors for the onset of ischemic colitis.ROC curve was used to assess the diagnostic performance of serum VEGF and plasma D-dimer levels for the early diagnosis of ischemic colitis.Results:Compared with the control group,the proportion of patients with abdominal pain accompanied by hematochezia,and the serum VEGF and plasma D-dimer levels in the experimental group were significantly increased(all P<0.05).The results of binary Logistic regression model indicated that serum VEGF and plasma D-dimer levels were the risk factors for onset of ischemic colitis(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum VEGF and plasma D-dimer for diagnosing ischemic colitis were 0.93 and 0.88,respectively.The combination of these two indicators could further increase the diagnostic specificity and the AUC.Conclusions:Serum VEGF and plasma D-dimer levels can be served as early diagnostic markers for ischemic colitis.The combination of these two indicators can greatly improve the early diagnostic performance.

{L-End}Objective To analyze the current status of occupational stress and its influencing factors among workers in pharmaceutical enterprises in Beijing City. {L-End}Methods A total of 860 employees from six pharmaceutical enterprises in Beijing City were selected as the research subjects using convenience sampling method. The Chinese version of the New Brief Job Stress Questionnaire was used to evaluate the occupational stress, and multiple linear regression analysis was used to analyze the influencing factors of occupational stress. {L-End}Results The detection rate of high occupational stress was 1.40% (12/860). The results of multiple linear regression analysis showed that the workers with higher education level and longer length of service had a higher risk of high occupational stress (all P<0.01). Workers who were satisfied with their jobs had a lower risk of high occupational stress than those who were unsatisfied with their jobs (P<0.01). Workers who were satisfied with life had a significantly lower risk of high occupational stress than those who were unsatisfied with life (P<0.01). {L-End}Conclusion The detection rate of high occupational stress in workers of pharmaceutical enterprises is relatively low. Occupational stress is mainly affected by individual factors such as education level and length of service, and work and life satisfaction. Improving job and life satisfaction is helpful to reduce occupational stress level.