Objective To build an intelligent interactive discharge follow-up platform,and to explore its applica-tion effect in the management of discharge follow-up.Methods A research team was established to construct the intelligent interactive discharge follow-up platform,which includes 3 modules,namely follow-up plan customization module,follow-up execution module,and information backup and statistical analysis module.The discharge follow-up data of branch A and B of a tertiary hospital in Beijing from January to December 2022 were selected.Patients in branch A were given manual telephone follow-up by nurses,and patients in branch B were applied by the intelli-gent interactive discharge follow-up platform,and the follow-up efficiency of the 2 branches was compared.100 cas-es of discharged patients in each of 2 hospital branches were randomly selected as research subjects,and the fol-low-up time and nursing manpower of 2 groups were compared.Results The follow-up rate and effective follow-up rate of branch A were 99.96％and 95.10％,while those of branch B were 99.84％and 99.66％,respectively,and the difference was statistically significant(x2=19.028,2 081.008,P＜0.001).The opinion collection rate of branch A was 0.47％,which was higher than that of the branch B(0.01％)(x2=249.365,P＜0.001).The time and nursing man-power spent on follow-up was even less.Conclusion The intelligent interaction discharge follow-up platform real-izes human-robot multi-party intelligent interaction,which can release nursing manpower and time,improve the fol-low-up rate of discharged patients.

Objective:To explore the application of online challenge training mode and analyze its application effect in standardized training of new nurses.Methods:Using the map training mode of the online training platform, a challenge game was designed and applied in the standardized training of new nurses. Using the convenience sampling method, 309 new nurses who joined Beijing Friendship Hospital, Capital Medical University from 2020 to 2021 were selected and grouped according to their starting date. The 103 nurses who joined in 2020 were set as the control group and traditional training was used. The 206 nurses who joined in 2021 were set as the research group and a challenge training mode was used. The scores and pass rates of theoretical assessment and OSCE assessment as well as the scores of core competency were compared between the two groups after training. A self-made questionnaire for satisfaction survey was used to investigate the satisfaction of nurses in the research group with the challenge training mode. The t-test and chi-square test were perform using SPSS 23.0. Results:Compared with the control group, the research group showed significantly higher score [(83.32±6.30) vs. (81.59±7.62)] and pass rate (94.66% vs. 83.50%) of theoretical assessment, significantly higher score [(92.19±5.08) vs. (90.66±5.47)] and pass rate (100.00% vs. 97.09%) of OSCE assessment, and a significantly higher total score of core competencies [(193.61±34.94) vs. (177.55±36.91)] ( P<0.05). Moreover, 98.06% (202) of nurses believed that the challenge training mode could stimulate learning interest and motivation, and preferred the online challenge mode training method. Additionally, 93.69% (193) of nurses believed that online learning was more efficient, and 96.60% (199) of nurses thought that online training saved time. Conclusions:The online challenge training mode can effectively stimulate the learning interest of new nurses, improve their core abilities, and increase their satisfaction with the training. This method is worth implementing and promoting in standardized nurse training.

Objective To investigate the diagnosis value of contrast-enhanced ultrasound (CEUS) in the differentiation of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) of the liver with ≤3 cm of maximum diameter. Methods The image characteristics in 48 lesions of HCC with maximum diameter≤3 cm and 48 lesions of FNH with maximum diameter≤3 cm confirmed by pathology were retrospectively analyzed. The phase changes, enhancement patterns and enhancement characteristics of the lesions in the two groups were compared. Results All lesions in the two groups showed high-echo in the arterial phase. The contrast arrival time in HCC group and FNH group was 17(15, 19) s and 15(12, 18.75) s (P＝0.017); the peak time in the two groups was 21(17, 25) s and 22(19, 26) s (P＞0.05). The main enhancement patterns of HCC group and FNH group in arterial phase were homogeneous enhancement and centrifugal enhancement, respectively. All HCC lesions showed homogeneous enhancement, which was significantly higher than FNH (2.08%, P＜0.05); 97.91% of FHN lesions showed centrifugal enhancement, which was higher that of HCC lesions (0, P＜0.05). During the CEUS process, 87.5% of HCC lesions showed “rapid fill-in and rapid wash-out”, which was significantly higher than that of FNH lesions（8.33%，P＜0.05）; 91.67% of FNH lesions showed “rapid fill-in” and “synchronous/slow wash-out” which was significantly higher than that of HCC lesions （12.50%，P＜0.05）. Conclusion CEUS is helpful in the differential diagnosis of FNH and HCC with maximum diameter≤3 cm．

Objective To monitor the quality of intravenous infusions in a constructed closed-loop tracking system,and to discuss its application effect.Methods The information program is reinvested in a team for the closed-loop tracking system of the intravenous infusion.There are modules of processing medical orders,pharmacy preparations,execution procedures with the doctor's orders,as well as the computing module.The system was put into clinical trial operation in November 2021 and officially applied in January 2022.Specifically,the number of infusion-related adverse events/red-light alert is recorded and compared before(January to December 2021)and after(January to December 2022)the application of the system.Random sampling method has been performed in a ward to investigate the amount of abnormal infusion for the comparison.Results It is shown that it occurred 3 times for the infusion-related adverse events before the operation of the system,and a time after that.In the neurological inpatients,we observe the amount of red-light alert as 5,120.25±775.82 before the system operation,and 1,518.25±74.77 after that.It is shown to decline by 70.35％on average with statistical significance on the total difference(P＜0.001).Monthly amount of infusion in the ward is 5,184 with 155 times of overfast(2.99％)for 775 minutes in total,and with 207 times of slow(3.99％)for 1,035 minutes in total.The average handling time per contact is 5 minutes.Conclusion The closed-loop tracking system for intravenous infusion quality monitoring can track and record the whole process of intravenous infusions.It is expected to provide accurate and objective data for closed-loop quality inspection on clinical nursing practice,which is conducive to nursing managers for any potential problems during infusion processing timely,to promote standardized nursing operations,and to further improve the safety of inpatients with intravenous infusion and medication.

Objective:To investigate the contrast-enhanced ultrasound (CEUS) features of inflammatory hepatocellular adenoma (I-HCA).Methods:The contrast-enhanced ultrasound features I-HCA of 28 cases from April 2009 to November 2019 in Zhongshan Hospital, Fudan University were retrospectively analyzed, including arterial phase enhancement pattern, the homogeneity of enhancement, subcapsular enhancement, and the internal perfusion defect. All I-HCA lesions were divided into >5 cm group( n=9) and ≤5 cm group( n=19), the CEUS features between the two groups were compared. Results:All I-HCA lesions were hyper-enhanced in the arterial phase, among which 39.3% (11/28) showed diffuse filling, 39.3%(11/28) showed centripetal filling, and 21.4%(6/28) showed centrifugal filling pattern. Twenty-five percent (7/28) of I-HCAs showed heterogeneous enhancement, 10.7% (3/28) revealed unenhanced areas within the lesions. Subcapsular vessels were observed in 67.7 (21/31) of I-HCA lesions. Heterogeneous enhancement and unenhanced areas were more frequently detected in lesions >5 cm ( P=0.020, 0.026, respectively), while there was no difference in the enhancement pattern and subcapsular vessels between the two groups ( P>0.05). Inportal venous phase, 42.9%(12/28) of I-HCAs showed hypo-enhancement, and 57.1%(16/28) of lesions showed washout in late phase. According to "hyper-enhancement in arterial phase, sustained hyper- or iso-enhancement in portal venous and late phase" by CEUS, the diagnostic accuracy of benign lesion was 42.9%(12/28). According to any of hyper-enhancement pattern in arterial phase, subcapsular vascular enhancement, and sustained hyper- or iso-enhancement in portal venous and late phase, the diagnostic accuracy of I-HCA was 71.4% (20/28). Conclusions:CEUS is valuable in the diagnosis of inflammatory hepatocellular adenoma.

Objective:To investigate the clinical feasibility of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the quantitative assessment of blood perfusion of hepatocellular carcinoma (HCC).Methods:Between January 2020 and August 2021, 36 HCC patients (39 lesions in total) confirmed by pathology and clinical diagnosis without any treatment from Zhongshan Hospital, Fudan University were enrolled and underwent both 2D-CEUS and 3D-CEUS examinations. Each examination last for 150 s and all images were recorded, and then the data were analyzed. A region of interest was manually drawn along the margin of the whole tumor and then the time-intensity curve (TIC) generated. The following perfusion parameters were extracted: peak intensity (PI), peak time (TTP), ascending slope (AS), mean transit time (MTT) and area under the curve (AUC). After calculating the quality of fit (QOF) of the curve, the intraobserver agreement of the 3D-CEUS quantitative parameters obtained by the same doctor between two times were assessed, and the consistency of the 3D-CEUS and 2D-CEUS quantitative parameters was evaluated when QOF>75%. The differences of the quantitative parameters between different groups (divided by depth of 8 cm and necrosis rate of 50%, respectively) in 3D-CEUS were compared.Results:There were 38 lesions (97.4%, 38/39) with QOF>75% in 3D-CEUS. The intraobserver agreement was excellent, the intraclass correlation efficient(ICC) values was 0.85-0.99. The consistency of the time quantitative parameters (TTP and MTT) were high (the ICC values of 0.87 and 0.91), and the correlation of intensity quantitative parameters were substantial, the rs values were 0.71, 0.72 and 0.71. The differences in 3D-CEUS quantitative parameters of the two groups of lesions with different depths were statistically significant (all P<0.05); but there were no significant differences in quantitative parameters between the two groups with different necrosis rate (all P>0.05). Conclusions:Quantitative 3D-CEUS is an useful and creditable tool in evaluating the blood perfusion of HCC, especially when the depth of lesion was less than 8 cm.

Objective To investigate the imaging features of dysplastic nodules with a focus of hepatocellular carcinoma ( DN-HCC ) on contrast-enhanced ultrasound ( CEUS ) and to improve the diagnostic accuracy . Methods The clinical data of 60 patients and CEUS imaging of 62 hepatic nodules [DN-HCCs , n =54 ;dysplastic nodules (DN) , n =8] pathologically proved were reviewed retrospectively . According to Contrast Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) , the lesions were categorized . Results Significantly different CEUS patterns between DN-HCCs and DNs were observed ( P < 0 .05) . During the arterial phase ,54 DN-HCC lesions showed various enhancement patterns [ hypervascular ,59 .3％ ( 32/54 ) ;nodule-in-nodule ,9 .3％ ( 5/54 ) ;isovascular ,13 .0％ ( 7/54 ) and hypovascular ,18 .5％ (10/54)] . Of the 54 DN-HCC lesions ,44 .4％ (24/54) showed washout during the late phase .Of the 8 DN lesions ,62 .5％ (5/8) showed iso-enhancement during the arterial phase ,25％ (2/8) showed hypo-enhancement ,and 12 .5％ (1/8) showed hyper-enhancement . No DN lesion showed washout during the late phase .According to CEUS LI-RADS (LR) algorithm ,27 .8％ (15/54) DN-HCCs were LR-5 ,46 .3％ (25/54) DN-HCCs were LR-4 ,25 .9％ (14/54) DN-HCCs and 100％ (8/8) DNs were LR-3 . Regarding hyper-enhancement ( including local hyper-enhancement ) during the arterial phase or hypo-enhancement (including local hypo-enhancement) during the late phase as the diagnostic standard of DN-HCC , the diagnostic sensitivity , specificity and accuracy value were 83 .3％ , 87 .5％ and 83 .9％ , respectively . Conclusions The imaging features of hyper-enhancement during the arterial phase or hypo-enhancement during the late phase on CEUS are useful to diagnose DN-HCCs .

Objective To explore the value of contrast-enhanced ultrasound(CEUS) on the diagnosis of undetected liver cancer.Methods The study was focused on 85 consecutive patients from Jan 2015 to Sep 2016.The patients suspected liver cancer by clinical symptoms and other imaging studies were examined for regular gray-scale ultrasound and CEUS.Results Ninety-two lesions in 85 patients were confirmed by surgery,clinic manifestation and other imaging.All lesions including invisible or poorly invisible with greyscale ultrasound were examined by CEUS with the guideline of MRI imaging.Twenty lesions were detected by grey-scale ultrasound,89 lesions were detected by CEUS.The maximum diameter of those hepatic lesions was 20 mm × 18 mm,the minimum lesions was 8 mm × 6 mm.All the lesions were isoechoic,slightly hyperechoic or hypoechoic on grey-scale sonogram with mostly indistinctive margins.After SonoVue administration,82 lesions (92.1 ％) displayed as hyper-enhanced in arterial phase and 7 lesions (7.9 ％) as iso-enhanced.Sixty-one lesions(68.5 ％) showed hypo-enhanced and 28 lesions (31.5 ％) showed iso-enhanced in portal-vein phase.Seventy-four lesions(83.1 ％) showed hypo-enhancement and 15 lesions (16.9 ％) also showed iso-enhanced in late phase.The average enhancement time began at (15.3 ±6.1)s,reached to peak at (25.2 ± 8.8)s and decreased from (95.7 ± 57.8)s.Among 89 lesions,61 lesions (68.5％) were accordanced with fast in fast out and 28 lesions (31.5％) were no fast in fast out.The percentage of no fast in fast out on CEUS in undetected liver tumor was higher than in common liver tumor,the comparative difference was statistically significant (P ＜ 0.01).Conclusions Contrast-enhanced ultrasound has a more characteristic performance in undetected liver cancer and the higher detection rate than grey scale ultrasound.

Objective To evaluate the imaging features of hepatic epithelioid angiomyolipoma (EAML) on contrast-enhanced ultrasound (CEUS). Methods The imaging features of pathologically proved hepatic EAML lesions in 17 patients who had undergone baseline ultrasound and CEUS examinations were evaluated retrospectively. Results All of the cases were single lesion.70.6% (12/17) of the lesions were hypoechoic on ultrasound and 82.4% (14/17) of the lesions were heterogeneous.Flow signals were detected in 88.2% (15/17) of the lesions and 82.4% (14/17) of the lesions showed ringlike or arc arterials peripherally on color Doppler flow imaging (CDFI).The value of RI was 0.38-0.56.On CEUS,all lesions exhibited remarkable hyperenhancement in the arterial phase. 29.4% (5/17) of the lesions showed branched enhancement,70.6% (12/17) of the lesions showed diffusely entire enhancement.Strong ring-like enhancement peripherally was detected in 29.4% (5/17) of the lesions.88.2% (15/17) of the lesions were detected homogeneously enhancement during the peak period on CEUS. Washout of contrast agent and hypoechogenicity to surrounding liver tissue during portal or late phase were observed in 41.2% (7/17) and 64.7% (11/17) of the cases retrospectively.Conclusions The combination of real-time CEUS and baseline US can improve the correct diagnosis of hepatic EAML.

Objective To evaluate the correlation and consistency of dynamic three-dimensional contrast-enhanced ultrasonography ( 3D-CEUS ) and two-dimensional contrast-enhanced ultrasonography (2D-CEUS) in the time-intensity curve ( TIC) parameters of quantitative analysis in liver neoplasms. Methods Thirty patients were examined with 2D-CEUS and dynamic 3D-CEUS.The dynamic raw data were analyzed by quantitative analysis software. The regions of interest were manually selected around the entire lesion;TIC curves were generated and fitted respectively. Quality of fit ( QOF) was used to evaluate the degree of fit between the fitted curve and the initial ccoefficients of S,PI and AUC were 0.92,0.72 and urve. The corresponding 2D-CEUS and 3D-CEUS quantitative parameters of the same lesion were compared,including peak intensity ( PI),slope ( S),area under curve (AUC),time to peak (TTP) and mean transit time (MTT). The correlation of the intensity-related quantitative parameters and the consistency of the time-related quantitative parameters were analyzed between the two kinds of CEUS. Results The consistency of time related quantitative parameters,including MTT and TTP,were 0.97 and 0.96,and the correlation were 0.94 and 0.93. The correlation 0.65,respectively. Conclusions The quantitative results of 3D-CEUS are stable and reliable,and have fair concordance with 2D-CEUS. Dynamic 3D-CEUS can be used for clinical evaluation of the blood perfusion of liver neoplasms.