Objective:To analyze the reasons of misdiagnosed cases in the intraoperative frozen pathological diagnosis of breast disease and explore effective measures and practices for targeted and standardized quality control.Methods:A retrospective analysis was conducted on 2 421 cases of breast intraoperative frozen pathological examination performed at Renmin Hospital of Wuhan University from Apr. 2020 to Dec. 2021. The results of intraoperative frozen pathological examination were compared with postoperative pathological results to calculate the overall concordance rate and misdiagnosis rate. Pathological classification and causative analysis were performed for misdiagnosed cases. Standardized management was implemented to address the identified issues, and an analysis was conducted on 2248 cases from Feb. 2022 to Nov. 2023 to compare the overall concordance rate and misdiagnosis rate before and after management.Results:The comparison between intraoperative rapid frozen pathology diagnosis and postoperative paraffin pathology diagnosis showed that among the 2 421 breast specimens, there were 2 377 cases (98.18%) with concordant results and 44 cases of misdiagnosis, resulting in a misdiagnosis rate of 1.82%. The pathological types of 44 misdiagnosed cases were analyzed, among which 10 cases were lymph node metastatic carcinoma, 5 were lobar tumors, 3 were intraductal papillary tumors, 7 were carcinoma in situ and common hyperplasia each, and 4 were carcinoma in situ, sclerosing adenopathy, and other invasive carcinoma each. Through the analysis of causes, it was found that poor slide quality, the need for immunohistochemistry assistance, careless slide reading, missed critical lesions, and other factors contributed to misdiagnosis, with variations in the causes of misdiagnosis among different pathological types. After implementing standardized management, the overall concordance rate significantly improved (98.93%) and the misdiagnosis rate significantly decreased (1.07%) .Conclusions:Intraoperative frozen pathological diagnosis is of great significance in the treatment of breast diseases. The targeted standardized quality control can help early detection and solve problems, reduce the differences between different doctors and technicians, and improve the accuracy of intraoperative frozen pathological diagnosis.

Objective:To analyze the reasons of misdiagnosed cases in the intraoperative frozen pathological diagnosis of breast disease and explore effective measures and practices for targeted and standardized quality control.Methods:A retrospective analysis was conducted on 2 421 cases of breast intraoperative frozen pathological examination performed at Renmin Hospital of Wuhan University from Apr. 2020 to Dec. 2021. The results of intraoperative frozen pathological examination were compared with postoperative pathological results to calculate the overall concordance rate and misdiagnosis rate. Pathological classification and causative analysis were performed for misdiagnosed cases. Standardized management was implemented to address the identified issues, and an analysis was conducted on 2248 cases from Feb. 2022 to Nov. 2023 to compare the overall concordance rate and misdiagnosis rate before and after management.Results:The comparison between intraoperative rapid frozen pathology diagnosis and postoperative paraffin pathology diagnosis showed that among the 2 421 breast specimens, there were 2 377 cases (98.18%) with concordant results and 44 cases of misdiagnosis, resulting in a misdiagnosis rate of 1.82%. The pathological types of 44 misdiagnosed cases were analyzed, among which 10 cases were lymph node metastatic carcinoma, 5 were lobar tumors, 3 were intraductal papillary tumors, 7 were carcinoma in situ and common hyperplasia each, and 4 were carcinoma in situ, sclerosing adenopathy, and other invasive carcinoma each. Through the analysis of causes, it was found that poor slide quality, the need for immunohistochemistry assistance, careless slide reading, missed critical lesions, and other factors contributed to misdiagnosis, with variations in the causes of misdiagnosis among different pathological types. After implementing standardized management, the overall concordance rate significantly improved (98.93%) and the misdiagnosis rate significantly decreased (1.07%) .Conclusions:Intraoperative frozen pathological diagnosis is of great significance in the treatment of breast diseases. The targeted standardized quality control can help early detection and solve problems, reduce the differences between different doctors and technicians, and improve the accuracy of intraoperative frozen pathological diagnosis.

Objective: Analyzing the characteristics of consonant errors in children with functional dysarthria in different age groups and the effect of speech training provides a reference for clinical treatment. Methods : This study followed medical ethics, and informed consent has been obtained from patients. Speech data from 388 patients with functional dysarthria were retrospectively studied. They were divided into two groups at the age of 6, namely, the preschool group (4-6 years old) of 226 patients and the school age group (6-13 years old, including 6 years old) of 162 patients. The characteristics of consonant pronunciation errors from four aspects were analyzed: average number of errors, pronunciation location, pronunciation method, and error type. One-on-one speech training was conducted, with a training frequency of once a week and once for 30 minutes. The training method was carried out in the order of phoneme training, syllable training, vocabulary training, sentence training, and short text and conversation training. The effects of speech training in the two groups were compared. Results: Analysis by pronunciation location: both age groups had the highest frequency of errors in tongue tip posterior sounds; the school age group had the lowest error frequency for labiodental consonants, and the preschool group had the lowest error frequency for bilabial consonants. According to the analysis of pronunciation mode, both age groups had the highest error frequency of aspirated affricate and the lowest error frequency of nasal sound. Analysis by error type: both age groups are mainly characterized by substitution and omission. Compared with the preschool group, most consonants of patients in the school group tend to improve in terms of pronunciation location, pronunciation mode, and error types. Compared with the preschool group, the two types of errors-palatalization and lateralization-increased in frequency in the school group, but the trend of increased lateralization was not statistically significant. After 6.7 and 5.5 sessions of speech training, the pronunciation of the preschool group and the school-age group significantly improved; the cure rate of the school-age group was 84.9% (118/139), and that of the preschool group was 77.1% (91/118). There was no statistically significant difference in the cure rate between the two groups. Conclusion Functional dysarthria may improve with age, but it may not completely self-heal. Children of different age groups can achieve good treatment results through scientific and reasonable speech training.

Objective:To explore the status and influencing factors of incontinence-associated dermatitis among elderly inpatients in 52 hospitals nationwide, and to analyze the nursing of elderly inpatients with incontinence, so as to provide a reference for clinical intervention.Methods:On March 31, 2021, convenience sampling was used to select 14 675 elderly inpatients from 52 hospitals across the country as the research object. The self-designed Incontinence-associated Dermatitis Questionnaire for Elderly Inpatients was used to collect general demographic data, health status, incontinence, and skin nursing. Binomial Logistic regression was used to investigate the influencing factors of incontinence-associated dermatitis in elderly inpatients.Results:Among 14 675 elderly inpatients, the prevalence rates of xerosis cutis, incontinence and incontinence-associated dermatitis were 38.78% (5 691/14 675) , 11.06% (1 623/14 675) and 1.91% (280/14 675) , respectively. The prevalence of mild, moderate and severe incontinence-associated dermatitis were 1.27% (186/14 675) , 0.55% (81/14 675) , and 0.09% (13/14 675) , respectively. Among the nursing of 1 623 elderly inpatients with incontinence, the items with low implementation rate were the use neutral lotion to clean skin (14.17%, 230/1 623) , use of skin protectant after moisturizing (17.68%, 287/1 623) , moisturizing after cleansing the skin (28.90%, 469/1 623) . The results of binomial Logistic regression analysis showed that xeroderma, fecal incontinence, urinary and fecal incontinence, ≥2 kinds of combined medication, and hospital stay >30 days were risk factors for incontinence-associated dermatitis in elderly inpatients.Conclusions:The risk factors of incontinence-associated dermatitis in elderly inpatients mainly include xerosis cutis, type of incontinence, ≥2 kinds of combined medication, and hospital stay >30 days.

Objective:To investigate the diagnostic value of GATA binding protein 3 (GATA3) , mammaglobin (MGB) and gross cystic disease fluid protein-15 (GCDFP-15) in breast cancer.Methods:Immunohistochemistry was performed to detect the expression of GATA3, MGB, GCDFP-15, estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor 2 (HER2) and Ki-67 in breast cancer. The breast cancer was divided into primary/metastatic breast cancer, hormone receptor positive/negative, or different molecular types of breast cancer according to the tissue origin and immunophenotype. The positive rates of GATA3, MGB and GCDFP-15 were statistically analyzed.Results:The positive rate of GATA3 in primary/metastatic breast cancer (92.5%; 94.25%) was significantly higher than that of MGB (42.11%; 29.17%) and GCDFP-15 (55.77%; 31.34%) ( P<0.01) , and GATA3 had better sensitivity for evaluating the tumor of unknown origin, especially in malignant hydrops. In addition, the positive rate of MGB and GCDFP-15 in hormone receptor negative and triple negative breast cancer was low, which further increased the difficulty of diagnosis of these two kinds of metastatic breast cancer. However, the positive rate of GATA3 in hormone receptor negative (90.38%) or triple negative breast cancer (85.29%) was significantly higher than that of MGB (20.00%; 5.00%) and GCDFP-15 (35.09%; 33.33%) ( P<0.01) , suggesting that it had great potential diagnostic value in hormone receptor negative and triple negative metastatic breast cancer and was a specific marker superior to MGB and GCDFP-15. Conclusion:GATA3 has a higher diagnostic value than MGB and GCDFP-15 for the assessment of tumors of unknown origin, especially in malignant hydrops, or breast cancer with an immunophenotype of hormone receptor negative and triple negative breast cancer.

Objective To investigate the expression and significance of CD68,E-cadherin and transforming growth factor-β1 (TGF-β1) in breast cancer.Methods Immunohistochemistry was used to detect the expression of CD68,E-cadherin and TGF-β1 in breast cancer tissues.The relationship between the expression of proteins with the clinicopathological parameters and the recurrence of breast cancer was analyzed.And the correlation among the three proteins was also analyzed.Results The positive expression rate of CD68 and E-cadherin was 70.4％ and 72.6％,respectively,which was significantly higher than that in adjacent tissues(CD68:x2=44.278,P=0.000;TGF-β1:x2=121.529,P=0.000).The positive expression rate of E-cadherin in breast cancer was 29.1％,which was significantly lower than that in adjacent tissues(x2=244.965,P=0.000).The expression of CD68 protein was closely related to clinical stage (x2=11.720,P=0.003),lymph node metastasis (x2=9.394,P=0.002) and ER status (x2=5.204,P=0.023).The expression of E-cadherin protein was significantly correlated with the histological grade(x2=6.561,P=0.038) and lymph node metastasis(x2=6.892,P=0.009),and the expression of TGF-β1 protein was significantly correlated with the histological grade(x2=6.427,P=0.040) and ER status(x2=5.755,P=0.016) of patients.The three proteins were all significantly related to the 5 year recurrence of breast cancer (CD68:γ=0.152,P=0.021;TGF-β1:γ=0.157,P=0.017:E-cadherin:γ=-0.145,P=0.028).The expression of CD68 protein was negatively correlated with E-cadherin protein (γ=-0.151,P=0.022),and positively correlated with the expression of TGF-[β1 (γ=0.200,P=0.002).E-cadherin protein was negatively correlated with the expression of TGF-β1 protein(γ=-0.143,P=0.031).Conclusion CD68 positive cells (tumor associated macrophages,TAMs),E-cadherin and TGF-β1 may be involved in the progression of breast cancer,detection of the expression will provide the theoretical basis and guidance for the clinical pathological diagnosis and treatment of breast cancer.

Purpose To study the clinicopathologic features and differential diagnosis of primary mucosal melanoma of the nasal cavity (PMMNC).Methods 17 cases of PMMNC diagnosed from January 2003 to September 2016 were studied by clinical pathological analysis and immunohistochemical staining,and relevant literatures were reviewed.Results 73％ of the PMMNC was characterized by unilateral nasal congestion and intermittent epistaxis and 61％ of the PMMNC occurred in the nasal septum and nasal side wall.Microscopically,the organizational structure and morphology were complex and diverse,which had several cell types including epithelioid cell type (6cases,35.3％),spindle cell type (3 cases,17.6％) and snall cell type (5 cases,29.4％),the other 3 cases (17.6％)were mixed cell type.Mitotic activity and tumor necrosis were more likely to be seen in PMMNC,among other clinicopathological features with a small amount of fibrous stroma and melanoma and rich blood vessels.The immunohistochemical study showed that the positive rate of S-100 and HMB-45 were both 93.8％(15 cases) and those of Melan-A and vimentin were both 87.5％ (14 cases),while CK and EMA were both negative (16 cases).Conclusion PMMNC is a rare disease and the phenotype of S-100,HMB-45,Melan-A and vimentin are useful for diagnosis of PMMNC.

Objective To explore the clinicopathological features and diagnosis of adenoid cystic carci noma of the breast (ACCB).Methods Clinical data of 3 cases of ACCB were collected and followed up to observe the clinical pathological features.Immunohistochemistry was used to determine the immune phenotype.Results All the 3 cases were female,aging from 55 to 72 years old (61 years old as the average).The tumors were found in subareolar region well-circumscribed.ACCB was characterized by the presence of a dual cell population of luminal and basaloid cells arranged in cribriform and tubular-trabecular patterns.On immunohistochemical staining,the myoepithelial cells expressed SMA,CK5/6,P63,CD117 and the glandular epithelium cells were mostly positive for CK18,EMA,CK7,while no expression of ER,PR,HER-2,CD10 was observed.Conclusions ACCB is a rare neoplasm with a triple-negative,basal-like phenotype,but exhibits an indolent clinical behavior.The diagnosis can be worked out by evaluation of clinical characterstics,histological and immunohistochemical features.

Objective To identify the association of oxygen saturation of arterial hemoglobin (SaO2) with late-onset hypertension in the Chinese Han population located in the Daxinganling area.Methods A total participants were selected by convenience sampling methods from the Daxinganling area.All data were collected from each person by the questionnaire record of physical examinations as well as biochemical index measuring.SaO2 was noninvasively measured with finger pulse oxymetry,the reported SaO2 was the average of three readings taken 10 seconds apart.Results There were significant differences for SaO2 within the population of individuals,the mean SaO2 values was 97.71%±6.14%,with range from 88% to 100%.There was association of SaO2 with sex,BMI and age.SaO2 level declined with BMI and age increasing.Particularly,it was found that the risk increasing to hypertension was marked association with SaO2 rapid drop.During the period from 40-50 years of age,SaO2 declined from 97.85% to 97.64%,The risk to hypertension increased more than 10 times(P<0.001).That implicated hypoxia mightinvolve in the etiology of hypertension.Conclusions The preliminary results demonstrated the rapid decline of SaO2 with lapse of age may be one of the major risk factors to hypertension,it may be helpful to explain late-onset hypertension to some extent at least.

Objective To explore the application and effect of Quality Control Circle (QCC) in improving the overall quality of new nurses.Methods Totally 6 QCC teaching activities were conducted in 6 pilot departments throughout Suqian Hospital of TCM, which involved 31 new nurses as an observation group, while another 46 new nurses from other departments received the traditional one-to-one teaching model as a control group for 6 months. Their comprehensive competency composed of theoretical knowledge, practical skills and on-site reply examined by the steering group from the Nursing Dept. was compared, in addition to their average core competency score measured with Competency Inventory for Registered Nurse (CIRN).Results The 6 QCC activities for the observation group showed better scores, and the new nurses in this group had better theoretical knowledge, practical skills, on-site reply as well as core competency scores than the new nurses in the control group (P<0.01).Conclusions The QCC teaching model can improve new nurses' theoretical learning, practical ability and core competency and contribute to their better comprehensive quality, thus worthy of further promotion in clinical practice.