Objective To evaluate the predictive value of dual-modality ultrasound,incorporating conventional ultrasound and ultrasound elastography,in combination with S-Detect for cervical lymph node metastasis(CLNM)in patients with papillary thyroid carcinoma(PTC).Methods A retrospective analysis was conducted on the clinical data of 135 patients diagnosed with PTC who received treatment at the First Affiliated Hospital of Shihezi University between November 2023 and August 2024.For all patients,clinical baseline characteristics,conventional ultrasound findings,ultrasound elastography results,and S-Detect analysis data were collected.Independent predictors of CLNM in PTC were identified,and predictive models were developed.Receiver operating characteristic(ROC)curves were generated to compare the area under the curve(AUC)of the models.The most effective predictive model was selected to construct a risk probability nomogram,and the predictive performance and clinical applicability of this nomogram were subsequently evaluated.Results Age,maximum nodule diameter,boundary characteristics,capsular invasion,transverse-sectional morphological findings assessed by S-Detect,and ECI-based elasticity grading were identified as independent predictors of CLNM in PTC(all P<0.05).The AUC of the predictive model constructed using these six variables was 0.890(95%CI:0.835～0.945).The calibration curve demonstrated strong agreement between predicted and observed outcomes,and decision curve analysis indicated that the nomogram provided a favorable net clinical benefit within a threshold probability range of 2%to 91.5%.Conclusions Age,maximum nodule diameter,boundary characteristics,capsular invasion,sonographic features assessed by S-Detect in the transverse plane,and ECI-based elasticity grading are independent predictors of CLNM in PTC.A nomogram model incorporating these parameters demonstrates effective performance in predicting the likelihood of CLNM.

Enhancing the proactive risk management function of the Rapid Response System(RRS)can effectively im-prove its critical care capabilities.Panyu Hospital of Traditional Chinese Medicine of Guangzhou(Panyu Hospital Guangzhou University of Chinese Medicine)has established the ABCDE-RRS system for critical care,which stands for Able(enhanced post capacity),Broad(diverse quality control),Comprehensive(full participation),Deep(continuous talent cultivation and system optimization),and Early(proactive risk management).This system ensures that the number of critically ill hospitalized patients continues to grow(an increase of 8.99％in the first three quarters of 2024 compared to the same period last year,P＜0.05)while effectively reducing the all-cause mortality rate of hospitalized patients(a decrease of 0.05％in the first three quarters of 2024 compared to the same period last year,P＜0.05).It also enhances the safety culture awareness among all staff(an in-crease of 39.05％after implementation,P＜0.05)and improves patient satisfaction with the hospital(the comprehensive patient evaluation ranking of public hospitals in Guangzhou improved from 17th to 12th place).By establishing an effective operational model for ABCDE-RRS and a tiered talent training model for RRS,this provides a replicable template for the construction of RRS in primary hospitals.

Objective To evaluate the predictive value of dual-modality ultrasound,incorporating conventional ultrasound and ultrasound elastography,in combination with S-Detect for cervical lymph node metastasis(CLNM)in patients with papillary thyroid carcinoma(PTC).Methods A retrospective analysis was conducted on the clinical data of 135 patients diagnosed with PTC who received treatment at the First Affiliated Hospital of Shihezi University between November 2023 and August 2024.For all patients,clinical baseline characteristics,conventional ultrasound findings,ultrasound elastography results,and S-Detect analysis data were collected.Independent predictors of CLNM in PTC were identified,and predictive models were developed.Receiver operating characteristic(ROC)curves were generated to compare the area under the curve(AUC)of the models.The most effective predictive model was selected to construct a risk probability nomogram,and the predictive performance and clinical applicability of this nomogram were subsequently evaluated.Results Age,maximum nodule diameter,boundary characteristics,capsular invasion,transverse-sectional morphological findings assessed by S-Detect,and ECI-based elasticity grading were identified as independent predictors of CLNM in PTC(all P<0.05).The AUC of the predictive model constructed using these six variables was 0.890(95%CI:0.835～0.945).The calibration curve demonstrated strong agreement between predicted and observed outcomes,and decision curve analysis indicated that the nomogram provided a favorable net clinical benefit within a threshold probability range of 2%to 91.5%.Conclusions Age,maximum nodule diameter,boundary characteristics,capsular invasion,sonographic features assessed by S-Detect in the transverse plane,and ECI-based elasticity grading are independent predictors of CLNM in PTC.A nomogram model incorporating these parameters demonstrates effective performance in predicting the likelihood of CLNM.

Enhancing the proactive risk management function of the Rapid Response System(RRS)can effectively im-prove its critical care capabilities.Panyu Hospital of Traditional Chinese Medicine of Guangzhou(Panyu Hospital Guangzhou University of Chinese Medicine)has established the ABCDE-RRS system for critical care,which stands for Able(enhanced post capacity),Broad(diverse quality control),Comprehensive(full participation),Deep(continuous talent cultivation and system optimization),and Early(proactive risk management).This system ensures that the number of critically ill hospitalized patients continues to grow(an increase of 8.99％in the first three quarters of 2024 compared to the same period last year,P＜0.05)while effectively reducing the all-cause mortality rate of hospitalized patients(a decrease of 0.05％in the first three quarters of 2024 compared to the same period last year,P＜0.05).It also enhances the safety culture awareness among all staff(an in-crease of 39.05％after implementation,P＜0.05)and improves patient satisfaction with the hospital(the comprehensive patient evaluation ranking of public hospitals in Guangzhou improved from 17th to 12th place).By establishing an effective operational model for ABCDE-RRS and a tiered talent training model for RRS,this provides a replicable template for the construction of RRS in primary hospitals.

Objective:To explore the effect of intraspinal labor analgesia on labor progress, maternal and infant outcomes.Methods:Two hundred cases of full-term singleton primiparous women in head position admitted to the Second Affiliated Hospital of Shantou University Medical College from March 2019 to March 2020 were selected as the research subjects. According to the random number table method, they were divided into the control group (100 cases, natural delivery) and the analgesia group (100 cases, analgesia delivery). The visual analoguescore (VAS), progress of labor, and the outcome of delivery between the two groups werecompared.Results:The VAS scores of the analgesic group at 10, 30 and 60 min after analgesia were lower than those in the control group: (1.30 ± 0.17) scores vs. (9.50 ± 0.53) scores, (0.50 ± 0.22) scores vs. (9.50 ± 0.16) scores, (0.40 ± 0.28) scores vs. (9.50 ± 0.34) scores, the differences were statistically significant ( P<0.05). The first stage of labor in the analgesia group was longer than that in the control group: (347.6 ± 54.4) min vs. (325.8 ± 58.5) min; but the active stage, the second stage of labor, the third stage of labor and the total duration of labor in the analgesia group were shorter than those in the control group: (184.3 ± 39.5) min vs. (202.9 ± 42.7) min, (57.8 ± 17.9) min vs. (85.3 ± 16.9) min, (7.7 ± 5.0) min vs. (16.3 ± 5.2) min, (503.6 ± 131.4) min vs. (596.5 ± 175.7) min, the differences were statistically significant ( P<0.05). The 2 h and 24 h postpartum hemorrhage in the analgesia group were significantly lower than those in the control group: (223.64 ± 80.34) ml vs. (276.97 ± 82.35) ml, (331.57 ± 92.47) ml vs. (384.59 ± 94.25) ml, the differences were statistically significant ( P<0.05). The rate of normal delivery and the use of oxytocin in the analgesia group were higher than those in the control group: 91.0%(91/100) vs. 75.0%(75/100), 83.0%(83/100) vs. 49.0% (49/100), the differences were statistically significant ( P<0.05). In the newborn Apgar scores, the muscle tension, pulse, reflex response, respiration score and total score in the analgesia group were significantly higher than those in the control group ( P<0.05). The neonatal distress in the analgesia group was lower than that in the control group: 4.0%(4/100) vs. 15.0%(15/100), the difference was statistically significant ( P<0.05). Conclusions:Intravertebral labor analgesia can shorten the time of parturient delivery, reduce postpartum hemorrhage, improve the Apgar score of newborns, increase the pregnancy rate, and improve maternal and infant outcome.

Objective To explore whether the pattern of dysphagia verified using videofluoroscopic swallowing study (VFSS) was associated with the Iocation of the infarction in stroke patients.Methods Ninety-two patients with dysphagia (admitted between January 2015 and August 2016) who had first onset of cerebral infarction confirmed by magnetic resonance imaging were included in this study.They were divided into a unilateral brainstem group (n =29),a left hemisphere (cortex + white matter) group (n =37) and a right hemisphere (cortex + white matter) group (n=26) according to the location of the stroke.All subjects were evaluated using VFSS,and the oral transit time (OTT),triggering of pharyngeal swallowing (TPS),presence of residue in the vallecular and pyriform sinus,penetration,aspiration,cough reaction and upper esophageal sphincter (UES) opening were recorded and compared among the three groups.Results There were no significant differences among the three groups in OTT (X2 =0.712,P=0.918),TPS (1.564,P =0.458),penetration (X2 =5.615,P=0.060) and cough reaction (X2 =5.882,P=0.053).The unilateral brainstem group had significantly more residue in the vallecular and pyriform sinus than the left hemisphere group (X2=6.508,P=0.011).Aspiration was significantly more frequently found in the unilateral brainstem group than in the left hemisphere group (X2=7.803,P =0.005).The unilateral brainstem group was more likely to have insufficient UES opening than the left hemisphere (X2=29.555,P＜0.001) and right hemisphere groups (X2=24.630,P＜0.001).Conclusions Unilateral brainstem stroke is more likely to cause dysphagia than the unilateral cerebral hemisphere stroke,characterized by the abnormal residue in the vallecular and pyriform sinus,aspiration and the degree of UES opening.No significant differences were found in the dysphagia between stroke survivors with stroke in right and left hemispheres.