Objective:To analyze clinical and histopathological diagnoses of patients with solid tumors localized on the perianal and external genitalia regions, aiming to help clinicians correctly identify benign and malignant tumors.Methods:A retrospective analysis was conducted on clinical, histopathological, and dermoscopic features, diagnosis and treatment of 389 patients diagnosed with solid tumors localized in the perianal and external genitalia regions in the Department of Dermatology, Peking University Third Hospital from January 2016 to May 2023.Results:Among the 389 patients with solid tumors in perianal and external genitalia regions, 123 were males and 266 were females, with the age being 8 - 89 (41.86 ± 16.62) years. Based on the histological classification of skin tumors, melanocytic tumors were the most common type (33.16% [129/389]), followed by other tumors (21.59%, 84/389), keratinocytic tumors (21.08%, 82/389), soft tissue and neural tumors (13.62%, 53/389), and appendageal tumors (10.54%, 41/389). There were 83.03% (323/389) of benign tumors and 16.97% (66/389) of malignant tumors. Melanocytic nevus was the most common benign tumor, mostly involving the labia majora of females and mons pubis of males. Among the malignant tumors, squamous cell carcinoma was relatively common in females (40%, 10/25), while extramammary Paget′s disease was relatively common in males (39.02%, 16/41). The initial misdiagnosis rate of Bowenoid papulosis was the highest (11/11), followed by squamous cell carcinoma (78.26%, 18/23) and basal cell carcinoma (40%, 4/10) ; there was no significant difference in the initial misdiagnosis rate between different gender groups or different age groups (both P>0.5). A total of 367 patients underwent surgical excision under local anesthesia and all showed a good prognosis; the remaining 22 with malignant tumors were treated with photodynamic therapy, extended resection, free flap transfer, etc., and experienced no recurrence during the follow-up of 3 months to more than 3 years. Conclusions:Solid tumors in the perianal and external genitalia regions were polymorphous, melanocytic tumors, keratinocytic tumors and other tumors accounted for a large proportion, while malignant tumors were relatively rare, and some were easily misdiagnosed. Most of the tumors in the regions had a good prognosis, without recurrence after the surgical resection.

Objective To explore the characteristic categories of presenteeism among ICU nurses and analyse the influencing factor.Methods A convenience sampling method was adopted to select 391 ICU nurses as the study subjects from four Grade IIIA hospitals in Zhejiang Province in May 2023.A general information questionnaire,the Stanford presenteeism scale-6,and Maslach burnout inventor were used in the survey.R language was used for latent profile analysis,and univariate analysis and multinomial logistic regression analysis were employed to explore the influencing factors of the latent profiles.Results A total of 391 ICU nurses completed the survey,with the score of presenteeism at 16.10±4.64,which was at medium level.The score of presenteeism was further divided into four latent classes:low work limitation-low work energy type accounted for 13.04%,high work limitation-moderate work energy type accounted for 24.55%,low work limitation-high work energy type accounted for 4.86%,moderate work limitation-moderate work energy type accounted for 57.55%.The influencing factors include average monthly income,the score of emotional exhaustion and personal fulfillment dimensions in job burnout(all P<0.05).Conclusion The incidence of presenteeism among the ICU nurses has distinctive classification characteristics.Based on the identified influencing factors,nursing managers should provide individualised interventions to the ICU nurses with different latent profiles of characteristic categories to reduce the presenteeism among the nurses and thereby to improve the quality of nursing services.

Objective To analyze the etiology and clinical characteristics of multiple clustered polyps in the ileocecal region.Methods Nine patients with multiple clustered polyps only in the ileocecal region found from 2017 to 2022 were retrospectively collected,and their etiology and clinical characteristics were analyzed.Results There were 9 patients with multiple clustered polyps in the ileocecal region in this group.There were 7 males and 2 females.The age of onset was 28～73 years old,52(40.0,62.5)years old.There were 8 cases of abdominal discomfort or abdominal pain,4 cases of chronic diarrhea,2 cases of mucous stool and 1 case of dry stool.The number of polyps ranged from 4～17,and the diameter of polyps ranged from 0.2～1.0 cm.Pathological examination showed chronic inflammation of ileocecal mucosa with polyp formation in 8 cases,and canalicular adenoma with mild dysplasia in 1 case.7 cases ate more red meat food or processed products.6 cases had repeat colonoscopy,and 3 cases had recurrence.Conclusion Multiple clustered polyps appearing only in the ileocecal region are a special type of polyps closely related to inflammation,and endoscopic surgery is recommended followed by attention to control inflammation.

Objective:To compare the testing effects of different testing methods in the functional inspection of precision surgical scissors and needle holders.Methods:By consulting relevant literature and professional books,three testing methods and materials for precision surgical scissors and needle holders were selected.The cutting performance of the precision surgical scissors were tested by gauze cloth,cotton wool,and silicone film method in the Interlock surgical instrument testing set.The clamping performance of precision needle holder was tested by using light,needle clips,and thread clamping method in the Interlock surgical instrument testing set.100 pieces of precision surgical scissors and needle holders which were qualified for cleaning and disinfection in the hospital were selected for effectiveness testing,and a self-made satisfaction questionnaire to investigate the satisfaction of surgeons with the use of instruments.Results:After 100 precision surgical scissors tested using three methods of gauze,cotton wool,and silicone film,the qualified number of cutting performance was 94,76,and 58,respectively,the difference was statistically significant(x2=36.526,P<0.05).The satisfaction rate of surgeons with the use of precision surgical scissors passed the silicone film test was the highest at 100%,followed by cotton wool cloth at 82.0%,and the gauze method at the worst at 67.0%,the difference was statistically significant(x2=48.439,P<0.05).After 100 precision needle holders were tested by using three methods of light irradiation,needle clamping,and wire clamping,the qualified number of clamping performance was 96,78,and 62,respectively,the difference was statistically significant(x2=38.160,P<0.05).The satisfaction rate of surgeons with the precision needle holders passed the clamp line test was the highest at 100.0%,followed by the clamp needle at 79.0%,and the worst under light at 62.0%,the difference was statistically significant(x2=57.705,P<0.05).Conclusion:The function and quality of precision surgical scissors and needle holders tested by the test objects in Interlock Surgical Instrument Test Suite can objectively and accurately reflect the functional status of surgical scissors and needle holders,provide reference for regular maintenance and upkeep of instruments,and ensure safe use of instruments.

Spontaneous abortion is one of the most common complications of pregnancy， and two or more spontaneous abortions in a row are defined as recurrent spontaneous abortion （RSA）， of which about half of patients have unknown etiology. However， the pathogenesis of unexplained RSA （URSA） has not been elucidated， and the lack of effective treatment has made it one of the key and difficult points in the field of obstetrics and gynecology. This article conducts a literature review of recent research on URSA and finds that the pathogenesis of URSA is related to the imbalance of immune tolerance at the maternal-fetal interface， apoptosis of trophoblast cells， inhibition of angiogenesis， and activation of immune responses. Immunotherapy （including cell therapy， cytokine therapy， and immunosuppressive intervention）， hormone drugs， anticoagulant regimens， and traditional Chinese medicine therapies are commonly used in clinical practice to intervene in URSA， but the safety and effectiveness of some therapies are still controversial.

ObjectiveTo assess the level of internal exposure to PCP in a community population in Shanghai， to investigate the factors affecting the level of PCP， and to analyze the correlation between the exposure and thyroid hormone levels. MethodsA total of 464 residents of a community in Shanghai were selected as the study subjects. A questionnaire survey was conducted to obtain the demographic information， dietary situation， lifestyle and behavioral habits， and disease history of the individuals， and blood samples were collected. Gas chromatography-electron trap was applied to determine the PCP levels in serum. Multicategorical logistic regression analysis was used to analyze the possible influencing factors of PCP exposure in humans. Thyroid hormone levels were used as the dependent variable and serum PCP as the independent variable. Multiple linear regression analysis was used to assess the association between PCP and thyroid hormones in the community population after controlling the confounding factors such as age， gender， literacy， annual personal income， and chronic diseases. ResultsThe detection rate of serum PCP in 464 subjects was 90.3%， and the median serum PCP level was 0.43 μg·L^-1. The differences in PCP levels among different age groups were statistically significant. There were no significant differences in PCP levels among different gender and BMI groups. The study of PCP exposure factors showed that age， frequency of using plastic products， consumption of freshwater fish， type of occupation， annual income， and consumption of tea or coffee were the potential influencing factors for PCP exposure. Among them， age， frequency of using plastic products， consumption of tea or coffee， and consumption of freshwater fish were positively associated with PCP levels， and annual personal income was negatively associated with it. The results of multiple linear regression analysis showed that among men， PCP levels were positively correlated with TSH （b=0.105， 95%CI：0.017‒0.313） and negatively correlated with FT4 （b=-0.026， 95%CI：-0.057‒0.004）， and among women， PCP levels were positively correlated with TSH （b=0.092， 95%CI：-0.211‒0.904） and FT3 （b=0.017， 95%CI：-0.058‒0.230） and negatively correlated with FT4 （b=-0.013， 95%CI：-0.011‒0.037）. ConclusionSerum PCP detection is common among community residents in Shanghai. Different demographic characteristics or behavioral habits may increase or decrease PCP exposure. PCP exposure then affects human thyroid hormone levels.

Objective To construct a rehabilitation nursing program for stroke patients based on the international classification of functioning, disability and health (ICF). Methods The relevant domestic and foreign literatures were systematically searched, and a draft of the rehabilitation nursing program for stroke patients based on the 17 functional items in the four dimensions of ICF functional evaluation was constructed. The Delphi method was used to consult experts to further improve the program. Results A total of 16 experts completed two rounds of expert consultation. The expert authority coefficients of the first and second rounds of consultation were 0.897 and 0.897, respectively, with coefficient of variations ranging from 0.05 to 0.27 and 0.05 to 0.19, respectively. The Kendall's W coefficients were 0.384 and 0.452 (χ²=104.375, 122.831, P < 0.001), respectively. In the final rehabilitation nursing program for stroke patients, there were four first-level indicators (functional domains), 17 second-level indicators (intervention contents), and 73 third-level indicators (specific measures). Conclusion The rehabilitation nursing program for stroke patients based on ICF is scientific and reliable, and may provide theoretical support and practical guidance for the rehabilitation nursing of clinical stroke patients.

ObjectiveTo investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on walking function of stroke patients at recovery stage. MethodsFrom January, 2021 to January, 2022, 60 stroke inpatients at recovery stage from Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine were randomly divided into group A (n = 20), group B (n = 20) and group C (n = 20). All the groups accepted conventional rehabilitation therapy and lower limb robot-assisted training, while group B accepted pseudo-rTMS, and group C accepted high-frequency rTMS, for four weeks. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Timed 'Up and Go' Test (TUGT) and gait analysis before and after treatment. ResultsThe score of FMA-LE, TUGT, pace, stride width, stride, double support phase time, affected side support phase time, affected side swing phase time, healthy side support phase time and healthy side swing phase time improved after treatment in all the groups (|t| > 5.990, P < 0.001), and all the indexes improved the most in group C (F > 3.210, P < 0.05), except double support phase time. ConclusionHigh-frequency rTMS could facilitate the recovery of lower limb function and walking of stroke patients at recovery stage.

Objective:To explore the prescription and medication law of Traditional Chinese Medicine (TCM) compounds in the treatment of vascular dementia (VD) based on patent database.Methods:TCM compounds with patents about VD were retrieved from Chinese patent announcement website of the State Intellectual Property Office and CNKI. The retrieval time was from the establishment to the databases to 31 st, March 2022. The frequency, clusteringand association analysis were carried out with the help of TCM inheritance auxiliary platform (V2.5). The medication law was analyzed. Results:154 TCM compound patents for the treatment of vascular dementia were screened, involving 227 kinds of Chinese materia medica. Among them, Acori Tatarinowii Rhizoma (44 times, 28.57%) was used more frequently, and the common medicinal pair was Salviea Miltiorrhizae Radix et Rhizoma- Acori Tatarinowii Rhizoma (17 times, 11.03%). The medicinal property was mainly warm, the taste was mainly sweet, and the meridian was mainly liver meridian. Those with high confidence based on association rules were " Corni Fructus -Acori Tatarinowii Rhizoma" (0.90), " Corni Fructus -Rehmannize Radix et Praeparata" (0.90). Based on the complex network, it was concluded that the core drugs were 14 groups such as " Rehmannize Radix et Praeparata- Cistanches Herba- Corni Fructus". The new prescriptions extracted by entropy cluster analysis included 7 groups such as " Rehmannize Radix et Praeparata, Cistanches Herba, Corni Fructus and Asparagi Radix". Conclusion:The treatment of VD by TCM compounds with national patents is mainly based on tonifying deficiency, promoting blood circulation and removing blood stasis, eliminating phlegm and dampness, expelling wind and dredging collaterals, opening orifices and resuscitation, which can provide reference for clinical practice and new drug research and development.

Objective:To explore the differential diagnosis value of preoperative D-dimer in renal oncocytoma (RO) and chromophobe renal cell carcinoma (Ch-RCC) .Methods:From January 2015 to April 2022 in the Second Hospital of Anhui Medical University, clinical data of 47 cases of rare renal tumors were collected. According to postoperative pathology, patients were divided into RO group (15 cases) and Ch-RCC group (32 cases). General clinical data and preoperative blood indicators were analyzed. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to evaluate the differential diagnosis value of D-dimer between RO and Ch-RCC.Results:There were no significant differences between two groups in gender ( χ2=0.41, P=0.522), age ( t=0.50, P=0.618), hypertension ( χ2<0.01, P=0.994), diabetes ( P=0.541), smoking history ( χ2=1.67, P=0.196), tumor laterality ( χ2=0.67, P=0.414). Besides, preoperative D-dimer was significantly higher in the Ch-RCC group [0.47 (0.29, 0.77) μg/ml] in comparison with RO group [0.21 (0.19, 0.27) μg/ml], with a statistically significant difference ( Z=4.44, P<0.001). In addition, there were no significant differences in hemoglobin ( t=-1.61, P=0.116), platelet ( t=0.26, P=0.800), leucocyte ( t=0.10, P=0.921), neutrophil ( t=-0.87, P=0.390), lymphocyte ( Z=0.82, P=0.418), monocyte ( Z=1.43, P=0.153), neutrophil-lymphocyte ratio ( Z=0.09, P=0.927), platelet-lymphocyte ratio ( t=0.42, P=0.676), and lymphocyte-monocyte ratio ( Z=-0.96, P=0.338) between Ch-RCC group and RO group. ROC curve analysis showed that when the cut-off value of preoperative D-dimer was 0.78 μg/ml, the AUC for differential diagnosis of RO and Ch-RCC was 0.90 (95% CI: 0.82-0.99, P<0.001), with a sensitivity of 0.78 and a specificity of 1.00. Conclusion:Preoperative level of D-dimer is significantly increased in Ch-RCC patients, which exhibits favourable preoperative differential diagnosis value between Ch-RCC and RO.