Objective:To develop and validate a perioperative oral care protocol for patients undergoing oral vestibular approach endoscopic thyroid cancer radical surgery, providing practical guidance for clinical nursing.Methods:The protocol was constructed through literature analysis and Delphi expert consultation. A prospective non-randomized controlled study was conducted using convenience sampling, enrolling 60 patients who underwent oral vestibular approach endoscopic thyroid cancer radical surgery at the First Affiliated Hospital with Nanjing Medical University Thyroid Center between August 2023 and May 2024. Participants were divided into control group (from August to December, 2023) and experimental group (from January to May, 2024) based on admission dates with 30 cases in each group. The control group received routine care, while the experimental group received the developed oral care protocolin on the basis of the control group. Postoperative pain scores, mouth-opening difficulties, and oral cleanliness were compared on days 1, 3, and 7 after surgery.Results:The final protocol comprised 7 first-level indicators (team collaboration, health education, preoperative oral assessment, preoperative management, intraoperative management, postoperative management, and discharge follow-up), 17 second-level indicators, and 49 third-level indicators. The control group had 4 males and 26 females, with an age of (29.57 ± 5.34) years; the experimental group had 6 males and 24 females, with an age of (29.87 ± 6.25) years. On postoperative days 1, 3, and 7, the pain scores were 3.87 ± 1.01, 3.30 ± 0.92, and 2.53 ± 0.68 in the control group and 3.20 ± 0.87, 2.10 ± 0.76, and 1.50 ± 0.51 in the experimental group, respectively. The differences between the two groups were statistically significant ( t = 2.89, 5.12, 6.34, all P<0.05). For mouth-opening difficulties, the control group had 6, 13, and 15 patients with grade I on postoperativedays 1, 3, and 7, respectively, while the experimental group had 10, 20, and 25 patients with gradeⅠ. The control group had 20, 14, and 14 patients with gradeⅡonpostoperative days 1, 3, and 7, respectively, while the experimental group had 17, 10, and 5 patients with gradeⅡ. The control group had 4, 3, and 1 patients with grade Ⅲ on postoperative days 1, 3, and 7, respectively, while the experimental group had 3, 0, and 0 patients with grade Ⅲ. There were 0 cases in both groups with grade Ⅳ. The differences between the two groups on postoperative days 3, and 7 were statistically significant ( χ2 = 10.45, 18.67, both P<0.05). For oral cleanliness, the control group had 3, 4, and 5 patients with excellent cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 11, 16, and 19 patients with excellent cleanliness. The control group had 20, 22, and 23 patients with good cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 18, 13, and 10 patients with good cleanliness. The control group had 7 (23.33%), 4 (13.33%), and 2 (6.67%) patients with poor cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 1 (3.33%), 1 (3.33%), and 1 (3.33%) patients with poor cleanliness. The differences between the two groups were statistically significant ( χ2 = 9.19, 11.32, 16.68, all P<0.05). Conclusions:The developed perioperative oral care protocol is scientifically sound, feasible, and practical. Following the intervention, significant decreases in pain scores, alleviation of trismus symptoms, and marked improvements in oral cleanliness were observed in patients compared to pre-intervention assessments, and worth further clinical application.

Objective:To explore the clinical and genetic characteristics of dyskeratosis congenita (DC).Methods:A retrospective analysis was conducted on the clinical, laboratory, imaging, pathological, genetic, and treatment data of 6 DC patients diagnosed at the Children′s Hospital of Zhejiang University School of Medicine from January 2010 to June 2025.Results:Among the 6 DC patients, 1 case was of Hoyeraal-Hreidarsson syndrome, 4 were male, and 2 were female. The diagnosis age 0.9-6.1 years. All 6 cases presented with bone marrow failure; 5 cases had a classic triad of skin and mucous membrane (mucosal leukoplakia, abnormal skin pigmentation, nail dystrophy); 5 cases had growth retardation, among which 2 cases had intrauterine growth retardation. Two cases had diarrhea and 1 case had abnormal liver function; 1 case had stiff and deformed limbs, accompanied by limited mobility, and dry and obstructive balanitis; 1 case had recurrent eyelid inflammation, middle ear inflammation, and nasal inflammation. All 6 cases had decreased B cell numbers, and 4 cases also had decreased natural killer cell numbers. There were 3 cases of children with cytomegalovirus (CMV) infection, of which 1 case of CMV infection led to retinal frosted branch angiitis and subsequent intracranial CMV infection resulting in death, and 1 case had CMV enteritis and died of hemophagocytic syndrome. Among 4 cases of boys, 3 cases had DKC1 gene variations and 1 case had an unknown variation gene; 2 cases of girls had TINF2 gene variations. The TINF2 c.860T>A (p.L287Q) variation site was a new mutation. Among 6 patients with DC, 2 cases died, 3 cases survived and 1 case was lost to follow-up.Conclusions:The DKC1 and TINF2 genes are common pathogenic genes in patients with DC. Bone marrow failure is a clue for the early identification of DC. The triad of skin and mucous membrane is its typical clinical manifestation. Children with DC generally have reduced B cells and natural killer killer cells, and have a high risk of fatal CMV infection. The overall prognosis is poor.

Objective:To develop and validate a perioperative oral care protocol for patients undergoing oral vestibular approach endoscopic thyroid cancer radical surgery, providing practical guidance for clinical nursing.Methods:The protocol was constructed through literature analysis and Delphi expert consultation. A prospective non-randomized controlled study was conducted using convenience sampling, enrolling 60 patients who underwent oral vestibular approach endoscopic thyroid cancer radical surgery at the First Affiliated Hospital with Nanjing Medical University Thyroid Center between August 2023 and May 2024. Participants were divided into control group (from August to December, 2023) and experimental group (from January to May, 2024) based on admission dates with 30 cases in each group. The control group received routine care, while the experimental group received the developed oral care protocolin on the basis of the control group. Postoperative pain scores, mouth-opening difficulties, and oral cleanliness were compared on days 1, 3, and 7 after surgery.Results:The final protocol comprised 7 first-level indicators (team collaboration, health education, preoperative oral assessment, preoperative management, intraoperative management, postoperative management, and discharge follow-up), 17 second-level indicators, and 49 third-level indicators. The control group had 4 males and 26 females, with an age of (29.57 ± 5.34) years; the experimental group had 6 males and 24 females, with an age of (29.87 ± 6.25) years. On postoperative days 1, 3, and 7, the pain scores were 3.87 ± 1.01, 3.30 ± 0.92, and 2.53 ± 0.68 in the control group and 3.20 ± 0.87, 2.10 ± 0.76, and 1.50 ± 0.51 in the experimental group, respectively. The differences between the two groups were statistically significant ( t = 2.89, 5.12, 6.34, all P<0.05). For mouth-opening difficulties, the control group had 6, 13, and 15 patients with grade I on postoperativedays 1, 3, and 7, respectively, while the experimental group had 10, 20, and 25 patients with gradeⅠ. The control group had 20, 14, and 14 patients with gradeⅡonpostoperative days 1, 3, and 7, respectively, while the experimental group had 17, 10, and 5 patients with gradeⅡ. The control group had 4, 3, and 1 patients with grade Ⅲ on postoperative days 1, 3, and 7, respectively, while the experimental group had 3, 0, and 0 patients with grade Ⅲ. There were 0 cases in both groups with grade Ⅳ. The differences between the two groups on postoperative days 3, and 7 were statistically significant ( χ2 = 10.45, 18.67, both P<0.05). For oral cleanliness, the control group had 3, 4, and 5 patients with excellent cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 11, 16, and 19 patients with excellent cleanliness. The control group had 20, 22, and 23 patients with good cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 18, 13, and 10 patients with good cleanliness. The control group had 7 (23.33%), 4 (13.33%), and 2 (6.67%) patients with poor cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 1 (3.33%), 1 (3.33%), and 1 (3.33%) patients with poor cleanliness. The differences between the two groups were statistically significant ( χ2 = 9.19, 11.32, 16.68, all P<0.05). Conclusions:The developed perioperative oral care protocol is scientifically sound, feasible, and practical. Following the intervention, significant decreases in pain scores, alleviation of trismus symptoms, and marked improvements in oral cleanliness were observed in patients compared to pre-intervention assessments, and worth further clinical application.

Objective:To explore the clinical and genetic characteristics of dyskeratosis congenita (DC).Methods:A retrospective analysis was conducted on the clinical, laboratory, imaging, pathological, genetic, and treatment data of 6 DC patients diagnosed at the Children′s Hospital of Zhejiang University School of Medicine from January 2010 to June 2025.Results:Among the 6 DC patients, 1 case was of Hoyeraal-Hreidarsson syndrome, 4 were male, and 2 were female. The diagnosis age 0.9-6.1 years. All 6 cases presented with bone marrow failure; 5 cases had a classic triad of skin and mucous membrane (mucosal leukoplakia, abnormal skin pigmentation, nail dystrophy); 5 cases had growth retardation, among which 2 cases had intrauterine growth retardation. Two cases had diarrhea and 1 case had abnormal liver function; 1 case had stiff and deformed limbs, accompanied by limited mobility, and dry and obstructive balanitis; 1 case had recurrent eyelid inflammation, middle ear inflammation, and nasal inflammation. All 6 cases had decreased B cell numbers, and 4 cases also had decreased natural killer cell numbers. There were 3 cases of children with cytomegalovirus (CMV) infection, of which 1 case of CMV infection led to retinal frosted branch angiitis and subsequent intracranial CMV infection resulting in death, and 1 case had CMV enteritis and died of hemophagocytic syndrome. Among 4 cases of boys, 3 cases had DKC1 gene variations and 1 case had an unknown variation gene; 2 cases of girls had TINF2 gene variations. The TINF2 c.860T>A (p.L287Q) variation site was a new mutation. Among 6 patients with DC, 2 cases died, 3 cases survived and 1 case was lost to follow-up.Conclusions:The DKC1 and TINF2 genes are common pathogenic genes in patients with DC. Bone marrow failure is a clue for the early identification of DC. The triad of skin and mucous membrane is its typical clinical manifestation. Children with DC generally have reduced B cells and natural killer killer cells, and have a high risk of fatal CMV infection. The overall prognosis is poor.

Objective:To investigate the value of multi-parametric analysis based on dual-layer detector spectral CT (DLCT) in predicting the initial recurrence risk for papillary thyroid carcinoma (PTC).Methods:From November 2021 to October 2022, 102 PTC patients confirmed by pathology were retrospectively collected at the First Affiliated Hospital of Nanjing Medical University in this cross-sectional study. There were 25 males and 77 females, with an age of (42±13) years old. The initial recurrence risk assessment for PTC patients was categorized into a low-risk group (75 cases) and an intermediate-high-risk group (27 cases). Clinical data, including age, gender, body mass index, history of nodular goiter, history of Hashimoto thyroiditis, and preoperative thyroid function, were collected. Tumor morphological features, including size, location, shape, aspect ratio, the degree of thyroid capsule contact, calcification, and cystic change, were evaluated. Quantitative DLCT parameters, including iodine concentration (IC), standardized iodine concentration (NIC), effective atomic number (Z eff), standardized effective atomic number (NZ eff), electronic density (ED), CT values under different energy levels (40-200 keV, 30 keV intervals) and slope of energy spectrum curve (λ HU) both in the arterial and venous phase were measured. The differences in clinical, morphological features, and spectral CT quantitative parameters between the two groups were compared using independent sample ttest, Mann-Whitney U test, or χ2 test. Multivariate logistic regression analyses were used to construct three models based on clinical and morphological features, quantitative DLCT parameters and their combination, respectively. The receiver operating characteristic curve was used to evaluate the predictive performance of these models for the initial recurrence risk of PTC patients, and the area under the curve (AUC) was compared using the DeLong test. Results:Significant differences were found in gender, lesion long diameter, lesion short diameter and calcification between the low-risk group and intermediate-high-risk groups ( P<0.05). The arterial phase IC, arterial phase Z eff, arterial phase λ HU, arterial phase CT 40 keV, venous phase NIC and venous phase NZ eff in intermediate-high-risk group were significantly lower than those in the low-risk group ( P<0.05). The logistic regression analysis revealed that the clinical model included gender ( OR=2.895, 95% CI 1.047-8.002, P=0.040) and lesion long diameter ( OR=1.142, 95% CI 1.042-1.251, P=0.004), with an AUC of 0.720, sensitivity of 63.0%, and specificity of 78.7% in predicting the initial recurrence risk of PTC patients. The DLCT quantitative parameter model included arterial phase IC ( OR=0.580, 95% CI 0.370-0.908, P=0.017), venous phase NIC ( OR=0.077, 95% CI 0.011-0.536, P=0.010), and venous phase NZ eff ( OR=0.002, 95% CI 0.001-0.103, P=0.009), with an AUC of 0.774, sensitivity of 71.9%, and specificity of 70.0%. The AUC of the combined model was 0.857, with a sensitivity of 74.1%, and specificity of 88.0%, outperforming the clinical model ( Z=2.92, P=0.004) and the DLCT quantitative parameter model ( Z=2.07, P=0.046). Conclusion:Multi-parametric analysis based on DLCT can help predict the initial recurrence risk for PTC, and combining it with clinical and morphological features, the predictive accuracy can be improved.

Objective To explore the impact of the connect,introduce,communicate,ask,respond,exit(CICARE)communication model combined with feedback health education model on the compliance and anxiety level of elderly outpatients before colonoscopy.Methods A total of 346 patients aged ≥60 who visited the Outpatient Department,the Second Hospital of Jiaxing City for the first time and underwent colonoscopy from September to December 2023 were randomly divided into control group(n=86),communication group(n=84),feedback group(n=86),and combined group(n=90)using random number table method.The control group were provided routine education to patients undergoing colonoscopy through watching colon preparation videos,verbal education,and written propaganda educational materials;The communication group were implemented health education for colonoscopy by using the CICARE communication model;The feedback group were implemented health education for colonoscopy by using feedback method;The combined group were implemented the above education to patients by using the CICARE communication model combined with feedback method.The compliance with colon preparation,intestinal cleanliness,and patient anxiety scores before colonoscopy were evaluated and compared among the four groups.Results There were no statistically significant differences in dietary compliance and medication compliance among the four groups(P＞0.05),but there was a statistically significant difference in exercise compliance(P＜0.05).Different educational methods had statistical significance on patients'intestinal cleanliness and anxiety scores(P＜0.001),and further post hoc comparisons showed that the education method of the combined group could improve the overall intestinal cleanliness score and reduce patient anxiety score.Conclusion The health education model of the CICARE communication method combined with feedback has a significant effect on health education for elderly patients,which can improve the compliance with colon preparation and reduce patient anxiety scores.

Objective: To compare the difference in somatic gene mutation of PTC subtypes between 114 patients with papillary thyroid carcinoma (PTC) and The Cancer Genome Atlas (TCGA) database. Methods: Totally 114 PTC patients admitted to The First Affiliated Hospital of Nanjing Medical University were recruited. The 18 hotspot genes associated with thyroid cancer were detected in thyroidectomy specimens were using next generation sequencing. PTC data were downloaded from the TCGA database in the cBioPortal website, and the difference in the somatic gene mutation was compared between 114 PTC patients and the TCGA database Results: The 114 PTC patients included 73 women (64.04%) and had a mean age of (39.23±13.18) years. The prevalence of BRAF V600E (66.67% vs. 48.68%), TERTp (3.51% vs. 0.41%), PDGFRA (1.75% vs. 0%), PTEN (3.51% vs. 0.41%) and TP53 gene mutations (4.39% vs. 0.61%) was significantly higher among the 114 PCT patients than in the TCGA database (P<0.05). The prevalence of BRAF V600E (80.88% vs. 54.99%), TP53 (7.35% vs. 0.57%) and TSHR gene mutations (2.94% vs. 0%) was significantly higher in classical PTC(CPTC) patients than in the TCGA database, and the prevalence of BRAF V600E (36.84% vs.13.86%) and TERTp gene mutations (10.53% vs. 0%) was significantly higher in follicular variant PTC (FVPTC) patients than in the TCGA database. According to the American Thyroid Association Risk Stratification of Thyroid Cancer Recurrence, the prevalence of BRAF V600E and TP53 gene mutations was 77.14% and 8.57% among moderate-risk CPTC patients, the prevalence of BRAF V600E gene mutation was 27.27% among low-risk FVPTC patients, and the prevalence of TERTp gene mutation was 33.33% among moderate-risk FVPTC patients, which were all higher than in the TCGA database (55.10%, 0%, 3.28%, and 0%, respectively; P<0.05). Conclusion There are significant differences in the type and rate of somatic gene mutations between 114 PTC patients and the TCGA database.

Objective:To investigate the prevalence of hyperuricemia (HUA), patients′ awareness of HUA, and related factors among elderly in community.Methods:The health check-up data of 6 897 residents aged over 65 years in Gumei Community of Shanghai were collected from January 2019 to January 2020. There were 1 156 subject with increased serum uric acid levels (HUA group) and 5 741 with normal uric acid levels (non-HUA group). The differences of clinical indicators between HUA group and non-HUA group were analyzed and the risk factors of HUA was determined by multivariate logistic stepwise regression. A questionnaire survey on the knowledge of HUA and the adoption of relevant health behaviors was conducted among HUA patients.Results:The overall prevalence was 16.8% (1 156/6 897) in this population. The prevalence in males was significantly higher than that in females[26.4%(842/3 195) vs. 8.5%(314/3 702), P<0.001); and the prevalence in females increased with age (χ 2=7.56, P=0.023). Body mass index(BMI), waist circumference(WC), total cholesterol(TC), triglyceride(TG), serum creatinine, alanine aminotransferase(ALT) and albumin/urine creatinine ratio(UACR) in the HUA group were significantly higher than those in the non-HUA group, while estimated glomerular filtration rate(eGFR) and high-density lipoprotein(HDL) were lower than those in the non-HUA group (all P<0.01). The prevalence of hypertension, decreased renal function, overweight or obesity, abdominal obesity, fatty liver and renal cyst in HUA group was significantly higher than that in non-HUA group (all P<0.01). High values of TG, low-density lipoprotein(LDL), WC, hypertension and fatty liver were risk factors for HUA( OR=1.14, 1.20, 1.03, 1.43, 2.19; P<0.01); while female gender, eGFR, HDL and glycosylated hemoglobin A1c(HbA1c) were protective factors for HUA( OR=0.32, 0.94, 0.65, 0.78; P<0.01). The questionnaire survey was conducted among 1 090 HUA patients, and the results showed that 73.2% (798 cases) were aware of the disease after the health check-up results released; only 30.9% (337 cases) knew the diagnostic criteria of HUA, 21.1% (230 cases) knew that HUA needed life-long follow-up care, 56.3% (614 cases), 49.2% (536 cases) and 47.9% (522 cases) thought that HUA should eat less seafood, broth and soya bean products, 17.0%(185 cases) were atcohol drinker and the awareness rates of above questions in patients with gout were higher than those in patients without gout ( P<0.05). Conclusion:The study shows that the prevalence of HUA among the elderly in Gumei community of Shanghai is high, and the HUA related knowledge levels and health behavior performance are not ideal, especially for HUA patients without gout, therefore health education should be strengthened for elderly residents in the community.

Objective:To explore the diagnostic value of radiomics based on arterial-venous mixed images derived from dual-energy CT (DECT) data in diagnosis of cervical lymph nodes (LNs) metastasis of papillary thyroid cancer (PTC).Methods:From June 2017 to December 2018, eighty-four patients with preoperatively DECT scanning and pathologically confirmed PTC (129 non-metastatic LNs and 97 metastatic LNs) in the First Affiliated Hospital of Nanjing Medical University were included in this study. The clinical and imaging data of all patients were retrospectively analyzed. The training cohort consisted of 62 PTC cases with 156 LNs (91 non-metastatic LNs and 65 metastatic LNs). An independent validation cohort consisted of 22 PTC patients with 70 LNs (38 non-metastatic LNs and 32 metastatic LNs). Semi-automatic LNs segmentation was conducted on arterial-venous mixed images derived from DECT using Syngo.via Frontier Radiomics software. Totally 1 226 radiomics features were extracted from arterial-venous mixed images for each LN. The least absolute shrinkage and selection operator (LASSO) regression was applied for radiomics features selection and signature building. The logistic regression modeling was used to construct diagnostic models based on the CT image features of LNs (model 1), the radiomics signature (model 2) and the combination of the CT image features and radiomics signature (model 3). An intuitive nomogram was plotted for model 3. The ROC curve analyses and area under the curve (AUC) were performed to evaluate the diagnostic efficiency of the three models, with the performances compared using the Delong test.Results:Model 1 was developed with LNs shape, degree of enhancement, pattern of enhancement, calcification and extra nodal extension. Three arterial phase radiomics features were selected and used to establish radiomics signature using LASSO regression (model 2). Model 3 was developed with LNs size, shape, degree of enhancement and radiomics signature. In both the training and validation cohort, model 3 showed the best diagnostic performance (AUC=0.965, 0.933), followed by model 2 (AUC=0.947, 0.910), and both these two models significantly outperformed model 1 (AUC=0.850, 0.846) (training cohort, Z=4.066 and 3.758, P both<0.001; validation cohort, Z=2.871 and 1.998, P=0.017 and 0.042) respectively. Conclusion:The radiomics model based on arterial-venous mixed images derived from DECT data can realize effective diagnosis of LNs metastasis in patients with PTC; and the combination model of radiomics signature with CT image features can further improve the diagnostic accuracy.

OBJECTIVE: To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in children's hospital. METHODS: We randomly enrolled 100 children pre-screened by traditional method in the outpatient department of Children's Hospital of Zhejiang University from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m away from the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guidance sheet and took the temperature again. The children with red guidance sheet were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic through COVID-19 patients-only entrance. The children with yellow guidance sheet were guided to fever clinic. The children with green guidance sheet could go with their parents to the designated area, and then went to the corresponding consultation area. Health education was carried out throughout the treatment, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups. RESULTS: The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) s for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4) s ( CONCLUSIONS The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.
Adult ; Betacoronavirus ; COVID-19 ; Child ; Coronavirus Infections/diagnosis* ; Humans ; Internet ; Outpatient Clinics, Hospital ; Pandemics ; Pneumonia, Viral/diagnosis* ; SARS-CoV-2 ; Surveys and Questionnaires ; Time ; Triage/standards*