Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of rare simultaneous ipsilateral renal multifocal tumors. Methods The clinical data of a patient with clear cell renal cell carcinoma(ccRCC)and primary renal leiomyosarcoma(LMS)with liver metastasis were retrospectively analyzed. Results The 70-year-old male patient was admitted due to space-occupying lesions of the right kidney detected by physical examination for 12 days. CT showed space-occupying lesions in the upper and middle parts of the right kidney, suggestive of renal cell carcinoma or renal angiosarcoma. He underwent radical nephrectomy. Postoperative pathology showed the tumor in the upper pole of the right kidney with morphology of ccRCC(solid acinar clear cells), but immunohistochemical(IHC)results showed CK(+), EMA(+), CD10(-), PAX-8(-)(rare phenotype); the tumor in the middle of the kidney showed LMS characteristics(spindle cells, active mitosis), Vim(+)and SMA(+). Four months after operation, abdominal CT scan revealed liver metastasis. The biopsy confirmed metastatic LMS, with IHC results showing Vim(+), CD10(+), RCC(+), CK8/18(-), CK7(-), SMA(+), and Caldesmon(+). Subsequently, a liver biopsy combined with microwave ablation of the tumor was performed. The patient was treated with tirelizumab and anlotinib, but the tumor still progressed. The patient died 11 months after operation. Conclusion Simultaneous ipsilateral ccRCC and LMS are extremely rare in clinic, and the prognosis is poor. At present, there is no standardized treatment plan. Surgery is the main treatment for simultaneous multifocal tumors. After surgery, the pathological characteristics of the two tumors should be considered to formulate a comprehensive drug treatment strategy targeting at different biological behaviors so as to provide reference for clinical practice.

Objective:To explore the application effects of mind map-based health education in improving rehabilitation of patients with traumatic cervical spinal cord injury after surgery.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with traumatic cervical spinal cord injury admitted to Zhengzhou Orthopedic Hospital from August 2019 to September 2023, including 51 males and 13 females, aged 20-75 years [(52.7±12.5)years]. The injured segments were located at C 3/4 in 8 patients, at C 4/5 in 18, at C 5/6 in 22, and at C 6/7 in 16. The American Spinal Injury Association (ASIA) Scale was grade A in 3 patieats, grade B in 15, grade C in 18, and grade D in 28. All the patients underwent cervical decompression and fusion with internal fixation. Thirty-two patients received conventional nursing health education after surgery (conventional education group), while the other 32 patients received mind map-based nursing health education (mind map education group). Readiness for hospital discharge scale (RHDS) and quality of discharge teaching scale (QDTS) were used to compare the discharge readiness and quality of discharge instruction between the two groups at 4 hours before discharge. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and post-traumatic growth inventory (PTGI) were used to compare the anxiety, depression, and post-traumatic growth levels between the two groups before the health education, at discharge, and at 6 months after discharge. The incidence of complications was also compared between the two groups at 6 months after discharge. Results:All the patients were followed up for 6 months. At 4 hours before discharge, the total scores of RHDS and QDTS were (86.5±7.8)points and (142.9±2.7)points in the mind map education group, which were higher than (75.2±5.3)points and (125.3±2.3)points in the conventional education group ( P<0.01). Before the health education, no statistically significant differences were found in SAS scores, SDS scores, or PTGI total scores between the two groups ( P>0.05). At discharge, the SAS and SDS scores were (41.6±0.9)points and (41.4±1.1)points in the mind map education group, which were lower than (47.2±0.8)points and (47.0±0.7)points in the conventional education group ( P<0.01); the PTGI total score was (72.4±4.3)points, which was higher than (53.8±2.3)points in the conventional education group ( P<0.01). At 6 months after discharge, the SAS and SDS scores were (31.2±0.8)points and (31.0±1.0)points in the mind map education group, which were lower than (44.6±1.1)points and (42.4±0.9)points in the conventional education group ( P<0.01); the PTGI total score was (85.8±1.9)points, which was higher than (68.0±1.6)points in the conventional education group ( P<0.01); the complication rate was 6% (2/32) in the mind map education group, which was lower than 34% (11/32) in the conventional education group ( P<0.05). Conclusion:Compared with conventional nursing health education, mind map-based nursing health education can improve the discharge readiness and quality of discharge instruction for patients with traumatic cervical spinal cord injury after surgery, alleviate negative emotions such as anxiety and depression, improve their psychological status, promote post-traumatic growth, and reduce the incidence of complications.

Objective To evaluate the accuracy of multiparametric imaging on the dual-source CT through acceptance and commissioning testing, and to provide a reference for standardized clinical application. Methods Both the adult and pediatric dual-source CT scanning modes were used to scan the electron density phantom, and identical multiparametric image reconstruction tasks were performed, including the conventional CT images, the mixed CT images, the virtual monoenergetic images, the iodine images, the electron density images, and the effective atomic number images. Results In the adult scanning mode, the virtual monoenergetic CT numbers showed the greatest difference for the cortical bone (1722 HU at 40 keV vs. 30 HU at 80 keV), with smaller differences observed for other materials as their atomic numbers decreased. The pediatric scanning mode exhibited a similar trend, with the largest difference occurring at 40 keV (1393 HU). In the adult scanning mode, the deviations between the theoretical and measured iodine concentration values were all within 5%, whereas in the pediatric scanning mode, the largest deviation was 15% for an iodine concentration of 2.0 mg/mL. For the electron density, the largest deviation between the theoretical and measured values occurred in the LN450 lung (9.18% in the adult scanning mode and 8.96% in the pediatric scanning mode); the deviations for the LN300 lung were all below 7.2%, for aluminum below 6.3%, and for other tissues within 3%. For the effective atomic number, the deviations between the theoretical and measured values were all within 5% in both scanning modes. Conclusion To ensure the accuracy and reproducibility of the dual-source CT applications, a comprehensive acceptance testing protocol should be established to guarantee the safety and precision of the CT localization process.

OBJECTIVE: To observe the clinical efficacy of acupuncture and moxibustion combined with medication in the treatment of functional constipation in elderly with yang deficiency and qi stagnation and its effect on emotional disorder. METHODS: A total of 86 elderly patients with functional constipation of yang deficiency and qi stagnation were randomly divided into an acupuncture and moxibustion group (43 cases, 1 case dropped out, 1 case was eliminated) and a medication group (43 cases, 1 case dropped out). The medication group was treated with lactulose oral solution, once a day；in the acupuncture and moxibustion group, on the basis of the treatment in the medication group, acupuncture at intestinal three points (bilateral Tianshu [ST25], Shangjuxu [ST37] and Guanyuan [CV4] were selected, 30 min each time, once every other day) combined with thunder-fire moxibustion (Shenque [CV8] was selected, 30 min each time, once every other day) was given. Both groups were treated for 4 weeks. Before and after treatment, the patient assessment of constipation symptoms (PAC-SYM) score, defecation situation (defecation interval time, defecation time, defecation frequency) and the scores of TCM syndrome, patient assessment of constipation quality of life (PAC-QOL), Pittsburgh sleep quality index (PSQI), self-rating anxiety scale (SAS), self-rating depression scale (SDS) were observed in the two groups. The clinical efficacy and safety of the two groups were evaluated. RESULTS: Compared before treatment, after treatment, the PAC-SYM scores, defecation interval time, defecation time, TCM syndrome scores, PAC-QOL scores, SAS scores and SDS scores in both groups were decreased (P<0.05), the defecation frequency was increased (P<0.05) in the two groups; the PSQI score in the acupuncture and moxibustion group was decreased (P<0.05). The PAC-SYM score, defecation interval time, defecation time, TCM syndrome score, PAC-QOL score, PSQI score, SAS score and SDS score after treatment in the acupuncture and moxibustion group were lower than those in the medication group (P<0.05), and the defecation frequency in the acupuncture and moxibustion group was higher than that in the medication group (P<0.05). The total effective rate of the acupuncture and moxibustion group was 92.7% (38/41), which was higher than 73.8% (31/42) in the medication group (P<0.05). The incidence of adverse reactions in the acupuncture and moxibustion group was 2.44% (1/41), while that in the medication group was 4.76% (2/42), there was no significant difference between the two groups (P>0.05). CONCLUSION Acupuncture and moxibustion combined with medication could improve the defecation situation, emotional disorder, quality of life in elderly patients with functional constipation of yang deficiency and qi stagnation.
Humans ; Moxibustion ; Constipation/drug therapy* ; Female ; Aged ; Male ; Acupuncture Therapy ; Treatment Outcome ; Qi ; Middle Aged ; Yang Deficiency/drug therapy* ; Aged, 80 and over ; Combined Modality Therapy ; Acupuncture Points

Objective To investigate the predictive ability of cyst fluid characteristics for malignant intraductal papillary mucinous neoplasms (IPMNs). Methods We prospectively collected fresh cyst fluid from patients undergoing pancreatic resection at the Department of Hepatobiliary Pancreatic Spleen Surgery, Changhai Hospital, Shanghai, from September 2023 to December 2024, who were ultimately pathologically confirmed with IPMN. We assessed the characteristics of cyst fluid, including viscosity, clarity, and color, and explored its predictive performance for benign or malignant. Results A total of 40 patients with IPMN were included. The sensitivity of the string sign （+） for diagnosing high-grade dysplasia/ invasive carcinoma （HGD/IC） was 90.9%, specificity was 92.9%, and accuracy was 76.0%. The cyst fluid of intestinal-type IPMN often exhibited a gelatinous consistency, and there was no significant difference in the distribution of gelatinous consistency between the HGD/IC group and the low-grade dysplasia （LGD） group. There were no significant differences in CEA, glucose, and amylase levels in the cyst fluid between the HGD/IC group and the LGD group. Conclusions The characteristics of pancreatic cyst fluid, especially viscosity, can effectively predict the benign or malignant nature of IPMN.

Objective To investigate the application of flipped classroom combined with teaching film-reading model in the teaching of filamentous fungal morphology for refresher doctors and evaluate its effect.Methods Fifteen refresher doctors taking microbiology from the 2022 batch of Guangdong Provincial People's Hospital were selected as the control group,and fifteen from the 2023 batch were se-lected as the experimental group.The"Morphological identification of Aspergillus and Mucor" was selected as the teaching content.The experimental group adopted flipped classroom combined with teaching film-reading model for teaching and the control group adopted tra-ditional teaching mode.The theoretical scores,operational scores,film-reading scores,and total scores of the two groups before and af-ter the implementation of teaching were compared and the teaching effect of the experimental group was evaluated using the Question-naire Star.Results The median scores of operational,film-reading,and total scores in the experimental group and control group were 40,30,and 95.5 and 36,27,and 85.5,respectively,and all the three scores in the experimental group were significantly higher than those in the control group(P＜0.05).Conclusion The flipped classroom combined with teaching film-reading model helps to improve the teaching effect of filamentous fungal morphology for refresher doctors,with high satisfaction,and can provide reference for subse-quent filamentous fungal morphology teaching.

Objective To investigate the application of flipped classroom combined with teaching film-reading model in the teaching of filamentous fungal morphology for refresher doctors and evaluate its effect.Methods Fifteen refresher doctors taking microbiology from the 2022 batch of Guangdong Provincial People's Hospital were selected as the control group,and fifteen from the 2023 batch were se-lected as the experimental group.The"Morphological identification of Aspergillus and Mucor" was selected as the teaching content.The experimental group adopted flipped classroom combined with teaching film-reading model for teaching and the control group adopted tra-ditional teaching mode.The theoretical scores,operational scores,film-reading scores,and total scores of the two groups before and af-ter the implementation of teaching were compared and the teaching effect of the experimental group was evaluated using the Question-naire Star.Results The median scores of operational,film-reading,and total scores in the experimental group and control group were 40,30,and 95.5 and 36,27,and 85.5,respectively,and all the three scores in the experimental group were significantly higher than those in the control group(P＜0.05).Conclusion The flipped classroom combined with teaching film-reading model helps to improve the teaching effect of filamentous fungal morphology for refresher doctors,with high satisfaction,and can provide reference for subse-quent filamentous fungal morphology teaching.

Objective:To explore the application effects of mind map-based health education in improving rehabilitation of patients with traumatic cervical spinal cord injury after surgery.Methods:A retrospective cohort study was conducted to analyze the clinical data of 64 patients with traumatic cervical spinal cord injury admitted to Zhengzhou Orthopedic Hospital from August 2019 to September 2023, including 51 males and 13 females, aged 20-75 years [(52.7±12.5)years]. The injured segments were located at C 3/4 in 8 patients, at C 4/5 in 18, at C 5/6 in 22, and at C 6/7 in 16. The American Spinal Injury Association (ASIA) Scale was grade A in 3 patieats, grade B in 15, grade C in 18, and grade D in 28. All the patients underwent cervical decompression and fusion with internal fixation. Thirty-two patients received conventional nursing health education after surgery (conventional education group), while the other 32 patients received mind map-based nursing health education (mind map education group). Readiness for hospital discharge scale (RHDS) and quality of discharge teaching scale (QDTS) were used to compare the discharge readiness and quality of discharge instruction between the two groups at 4 hours before discharge. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and post-traumatic growth inventory (PTGI) were used to compare the anxiety, depression, and post-traumatic growth levels between the two groups before the health education, at discharge, and at 6 months after discharge. The incidence of complications was also compared between the two groups at 6 months after discharge. Results:All the patients were followed up for 6 months. At 4 hours before discharge, the total scores of RHDS and QDTS were (86.5±7.8)points and (142.9±2.7)points in the mind map education group, which were higher than (75.2±5.3)points and (125.3±2.3)points in the conventional education group ( P<0.01). Before the health education, no statistically significant differences were found in SAS scores, SDS scores, or PTGI total scores between the two groups ( P>0.05). At discharge, the SAS and SDS scores were (41.6±0.9)points and (41.4±1.1)points in the mind map education group, which were lower than (47.2±0.8)points and (47.0±0.7)points in the conventional education group ( P<0.01); the PTGI total score was (72.4±4.3)points, which was higher than (53.8±2.3)points in the conventional education group ( P<0.01). At 6 months after discharge, the SAS and SDS scores were (31.2±0.8)points and (31.0±1.0)points in the mind map education group, which were lower than (44.6±1.1)points and (42.4±0.9)points in the conventional education group ( P<0.01); the PTGI total score was (85.8±1.9)points, which was higher than (68.0±1.6)points in the conventional education group ( P<0.01); the complication rate was 6% (2/32) in the mind map education group, which was lower than 34% (11/32) in the conventional education group ( P<0.05). Conclusion:Compared with conventional nursing health education, mind map-based nursing health education can improve the discharge readiness and quality of discharge instruction for patients with traumatic cervical spinal cord injury after surgery, alleviate negative emotions such as anxiety and depression, improve their psychological status, promote post-traumatic growth, and reduce the incidence of complications.

Objective:To investigate the application effect of discharge preparation service based on theory of goal attainment on patients with cervical spinal cord injury.Methods:A retrospective cohort study was conducted to analyze the clinic data of 60 patients with cervical spinal cord injury admitted to Zhengzhou Orthopedics Hospital from January 2017 to December 2022, including 49 males and 11 females, aged 23-79 years [(52.2±13.5)years]. Patients were all treated with cervical decompression fusion and internal fixation. Patients admitted from January 2017 to December 2019 were treated with conventional nursing intervention (conventional nursing group, n=30) and patients admitted from January 2020 to December 2022 were treated with discharge preparation service based on theory of goal attainment (discharge preparation service group, n=30). The readiness for hospital discharge of the two groups was compared using the Chinese version of Readiness for Hospital Discharge Scale (RHDS) at 4 hours before discharge. The degree of cervical spinal cord dysfunction of the two groups were compared using Japanese Orthopedic Association (JOA) score before intervention, at discharge and at 6 months after discharge. The complication and unplanned readmission rates of the two groups were compared at 6 months after discharge. Results:All the patients were followed up for 6 months. At 4 hours before discharge, the scores of the three parameters of RHDS containing personal status, adaptability and anticipatory support and the total score of the discharge preparation service group were (20.9±3.5)points, (35.9±2.2)points, (30.4±3.0)points and (87.1±7.8)points respectively, higher than those of the conventional nursing group [(16.2±1.7)points, (32.5±2.2)points, (26.3±2.1)points and (75.0±5.6)points respectively] ( P<0.01). There was no statistically significant difference in the JOA score of the two groups before intervention ( P>0.05). The JOA scores of the discharge preparation service group at discharge and at 6 months after discharge were (11.8±1.7)points and (13.8±1.5)points respectively, higher than those of the conventional nursing group [(10.3±1.8)points and (11.6±1.9)points respectively] ( P<0.01). At 6 months after discharge, the complication rate of the discharge preparation service group was 6.7% (2/30), lower than that of the conventional nursing group [36.7% (11/30)] ( P<0.05). The unplanned readmission rate of the discharge preparation service group was 3.3% (1/30), lower than that of the conventional nursing group [23.3% (7/30)] ( P<0.05). Conclusion:For patients with cervical spinal cord injury, discharge preparation service based on theory of goal attainment can improve the discharge readiness, promote spinal functional recovery and reduce the complication and unplanned readmission rates.

Objective:To Compare perioperative indicators of open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD) using propensity score matching (PSM).Methods:A retrospective analysis of the clinical data of 167 patients with periampullary lesions who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Zhengzhou University from January 2018 to March 2022. The cohort included 100 males and 67 females, with age of (58.92±11.47) years. Based on the surgical approach, patients were divided into three groups: OPD group ( n=67), LPD group ( n=58), and RPD group ( n=42). Clinical data such as gender, age, operation time, and postoperative complications were collected. PSM was employed to eliminate confounding factors and evaluate the effect of different surgical methods on perioperative outcomes. Results:After PSM, there were 42 cases in the OPD group, 29 cases in the LPD group, and 25 cases in the RPD group. The baseline characteristics of the three groups were compared, and no statistically significant differences were found (all P>0.05). The operation time in the LPD group was longer than that in the OPD group [6.0 (5.1, 7.1) h vs. 4.8 (4.1, 5.3) h, Z=221.50, P<0.001] and the RPD group [6.0 (5.1, 7.1) h vs. 5.3 (4.5, 6.0) h, Z=222.00, P=0.015], with statistically significant differences. The intraoperative blood transfusion volume in the OPD group was higher than that in the RPD group [0 (0, 600.0) ml vs. 0 ml], with a statistically significant difference ( Z=368.50, P=0.011). The length of hospital stay in the OPD group was longer than that in the LPD group [15.5(12.8, 22.3) d vs. 11.0(9.5, 16.0) d, Z=354.50, P=0.003] and the RPD group [15.5(12.8, 22.3) d vs. 11.0(8.5, 15.5) d, Z=289.00, P=0.002], with statistically significant differences. The duration of intravenous analgesic use in the OPD group was longer than that in the RPD group [1.5(0, 3.0) d vs. 0(0, 1.0) d], with a statistically significant difference ( Z=310.50, P=0.004). Additionally, the time to gastric tube removal after surgery in the OPD group was longer than that in the LPD group [3.0(2.0, 4.0) d vs. 2.0(2.0, 3.0) d, Z=392.50, P=0.009] and the RPD group [3.0(2.0, 4.0) d vs. 2.0(1.0, 3.5) d, Z=297.50, P=0.003], with statistically significant differences. There were no statistically significant differences in postoperative complications among the three groups. Conclusion:Compared with LPD, RPD had a shorter operation time; compared with OPD, both LPD and RPD were able to reduce hospital stay and intravenous analgesic use, and decrease intraoperative blood transfusion.