Objective:To investigate the application value of dual-energy CT in the differential diagnosis of lung metastases and benign nodules in breast cancer.Methods:The data of 96 patients with pathology-confirmed breast cancer at the Fifth Affiliated Hospital of Wenzhou Medical University from March 2017 to June 2021 were analyzed retrospectively. All patients received dual-energy chest CT scans within 2 weeks before surgery. All 96 patients were female, aged 31-84 (56±12) years. A total of 207 pulmonary nodules from 96 patients were classified into 81 lung metastases and 126 benign nodules according to pathological findings. Conventional CT features [longest diameter, boundary, location and CT value difference between arterial and venous phases (ΔCT) of nodules] and dual-energy CT parameters [standardized iodine concentration (NIC), slope of energy spectrum (λ HU) and normalized effective atomic number (nZ eff) in arterial and venous phases] were analyzed and measured. The χ 2 test, independent samples t test and Kruskal-Wallis rank-sum test were used to analyze the differences of conventional CT features and dual-energy CT parameters between lung metastases and benign nodules. First, the least shrinkage and selection operator (LASSO) regression method was used to screen conventional CT features and dual-energy CT parameters, and then logistic regression analysis was performed to screen out independent risk factors for lung metastases. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of CT parameters alone and logistic model in differentiating lung metastases from benign lung nodules. Results:There were statistically significant differences between lung metastases and benign nodules in longest diameter, ?CT, NIC, λ HU and nZ eff in arterial and venous phases (all P<0.05). LASSO regression and binary logistic regression analysis showed that the venous phase λ HU (OR=59.413, 95%CI 14.233-248.002, P<0.001) and the venous phase nZ eff (OR=4.508, 95%CI 2.787-7.290, P<0.001) were independent risk factors for predicting lung metastases. Among them, the venous phase λ HU had the highest diagnostic efficiency, with an area under curve (AUC) of 0.794 and an accuracy of 74.88%. The AUC of the logistic model constructed by combining the venous phase λ HU and the venous phase nZ eff could reach 0.958, and the accuracy was improved to 92.27%, which was significantly higher than the efficacy of the two alone ( Z=6.02, 9.54, all P<0.001). Conclusion:Dual-energy CT has great application value in the identification of lung metastases and benign nodules in patients with breast cancer, especially when combined with venous phase λ HU and venous phase nZ eff, the diagnostic efficiency is further improved.

Objective:To explore the impact of pediatric nurses' presenteeism behavior and emotional commitment on psychological capital, so as to provide a reference for promoting pediatric nurses' positive organizational behaviors.Methods:From July to August 2020, convenience sampling was used to select pediatric nurses from three ClassⅢ hospitals in Henan Province as the research objects. The general information questionnaire, Presenteeism Behavior Questionnaire, Emotional Commitment Scale and Psychological Capital Scale were used for investigation. Pearson correlation and structural equation model were used to analyze the relationship between presenteeism behavior, emotional commitment and psychological capital. A total of 897 questionnaires were distributed, and 673 valid questionnaires were returned with the effective response rate of 75.03%.Results:Among 673 pediatric nurses, the scores of the Presenteeism Behavior Questionnaire, Emotional Commitment Scale and Psychological Capital Scale were (6.16±1.52) , (28.26±5.67) and (81.40±10.60) respectively. The results of Pearson correlation analysis showed that presenteeism behavior was negatively correlated with emotional commitment and psychological capital ( P<0.05) , and emotional commitment was positively correlated with psychological capital ( P<0.01) , and the differences were statistically significant. The structural equation model showed that presenteeism behavior and emotional commitment had a direct effect on psychological capital (effect values were -0.32 and 0.42, respectively) , and presenteeism behavior also had an indirect effect on psychological capital through emotional commitment (effect value was -0.48) . Conclusions:Emotional commitment acts as an intermediary between presenteeism behavior and psychological capital. Nursing managers should take effective measures to create a good organizational atmosphere, reduce presenteeism behavior, and improve the psychological capital of pediatric nurses.

Objective: To explore and clarify the correlation between short-term aggressive intrasegmental recurrence (AIR) and functional magnetic resonance imaging after radiofrequency ablation of hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 1 262 patients with HCC who underwent radiofrequency ablation (RFA) in our hospital from January 2012 to June 2018, all patients were confirmed by pathology as HCC, of which 30 patients were found to have AIR during radiographic follow-up within 3 months after surgery, another 35 patients with disease progression who were controlled in a short period of time were randomly selected as the control group. All the enrolled patients underwent dynamic enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging (DWI) scanning before surgery, and the differences in clinical data, lesion location, and functional magnetic resonance parameters between the two groups were compared, and their correlation with AIR after RFA was analyzed. Chi-square test, t test and Pearson test were used. Results: The lesions in the AIR group were significantly more in the Ⅰand Ⅳsegments than that in the control group (P<0.05), and there was no significant difference in other liver segments (P>0.05). There was no significant difference in the lesion morphology between the two groups (P>0.05), and there was a significant difference in the early enhancement pattern of the lesions (P<0.05), and the early arterial enhancement rate and apparent diffusion coefficient (ADC) value of the AIR group were significantly lower than the control group (P<0.05). Further correlation analysis found that early enhancement of the arterial artery, early arterial enhancement rate, ADC value and lesion location were associated with AIR and were positively correlated, r values were 0.455, 0.633, 0.518, 0.375 and 0.287 (P<0.05). Conclusion The short-term AIR and functional imaging parameters (arterial early enhancement, early arterial enhancement rate, ADC value) and the liver segment (Ⅰ and Ⅳ) were highly correlated with radiofrequency ablation.

Objective:To explore the attitudes of parents of critically ill children to resuscitation companionship and its influencing factors so as to provide a scientific basis for improving the experience of children and their families in the rehabilitation process.Methods:A cross-sectional survey method was used, and parents of critically ill children who were hospitalized in Children's Hospital Affiliated to Zhengzhou University from August 2018 to August 2019 were selected by convenience sampling. The general data questionnaire and Family Presence During Resuscitation Benefits-Risks (FPDR-BRS) were used to investigate the attitudes of parents of critically ill children to the resuscitation companion and influencing factors were analyzed. A total of 200 questionnaires were distributed, 189 of which were effective, with an effective recovery rate of 94.5%.Results:The total scores of FPDR-BRS of 189 parents of critically ill children were (74.75±22.54) points. Univariate analysis showed that the total scores of FPDR-BRS of parents of critically ill children had statistically significant differences in the relationship with children, parents' occupations, cultural level and presence or absence of resuscitation experience ( P<0.05) . Multiple linear regression analysis showed that the relationship with children, parents' occupation and cultural level were the influencing factors of attitude to resuscitation companionship ( P<0.05) . Conclusions:Parents of critically ill children have a moderate level of recognition for resuscitation companionship. The relationship with children, parents' occupation and cultural level are factors that influence the attitude to resuscitation companionship. Medical staff should formulate targeted interventions based on the influencing factors of attitude to resuscitation companionship so as to improve the experience of children and their families during the resuscitation process.

Objective:To analyze the current status of recessive absence of pediatric nurses and to explore the relationship between recessive absence of pediatric nurses and magnetic nursing work environment and psychological empowerment.Methods:A cross-sectional survey method was adopted, pediatric nurses from Henan Children's Hospital and Henan Provincial People's Hospital from March to May 2019 were selected as research objects by the convenience method. The general information questionnaire, the Chinese version of the Essentials of Magnetism ScaleⅡ (EMOⅡ) , the Chinese version of the Psychological Empowerment Scale (PES) and the Chinese version of the Stanford Presenteeism Scale (SPS-6) were used to investigate them. Pearson correlation analysis and hierarchical regression analysis were used to analyze the relationship between recessive absence of pediatric nurses and magnetic nursing work environment and psychological empowerment. A total of 465 questionnaires were distributed in this study, and 452 valid questionnaires were recovered, with a recovery rate of 97.2%.Results:The total scores of the Chinese version of EMO Ⅱ, the Chinese version of PES and SPS-6 of 452 pediatric nurses were respectively (129.21±11.64) , (38.91±7.04) and (17.42±4.21) . The results of Pearson correlation analysis showed that recessive absence of pediatric nurses was negatively correlated with magnetic nursing work environment and psychological empowerment ( P<0.05) . The univariate analysis showed that there were statistically significant differences in the scores of the Chinese version of the SPS-6 scale for pediatric nurses with different ages, marital statuses, job titles and average night shifts per month ( P<0.05) . The results of hierarchical regression analysis showed that gender, marital status and the average night shifts per month in the demographic data all affected the recessive absence of pediatric nurses. After controlling demographic data, the better the working environment of magnetic nursing, the lower the level of recessive absence, which could independently explain 35.7% of the total variation. And the higher the level of psychological empowerment, the lower the level of recessive absence, which can independently explain 40.4% of the total variation. Conclusions:The phenomenon of recessive absences in pediatric nurses is more obvious, which is closely related to magnetic nursing work environment and psychological empowerment. Nursing managers should improve the magnetic nursing working environment and the level of psychological empowerment to reduce the level of recessive absence of pediatric nurses and improve the quality of nursing.

From September to October 2018, a questionnaire survey was conducted on the status of diabetes management, basic equipment allocation, complication screening and follow-up, basic drug supply and health education among 136 grassroots institutions in Nanjing. Doctors in the 136 grassroots institutions who had received diabetes specialist training accounted for 18.2% (358/1 968) of total general practitioners. The management rate of diabetes patients was 98.67% (196 352/199 000) , and the standard management rate was 88.63%(174 024/196 352).The screening and follow-up rates of diabetic complications were 89.0%(121/136) and 61.2%(74/121) for glycosylated hemoglobin; 64.7%(88/136), 58.0%(51/88) for urine microalbumin;51.5% (70/136), 62.9%(44/70) for diabetic foot; 44.9%(61/136), 42.6%(26/61) carotid ultrasonography; 32.4%(44/136) and 59.1%(26/44) for fundus examination; 17.6%(24/136) and 33.3%(8/24) for ankle brachial index. The rates of screening for glycosylated hemoglobin, urinary microalbumin, diabetic foot, carotid B ultrasound, fundus and ankle brachial index in urban areas were significantly higher than those in the suburbs (both P<0.05). The diabetes health education was regularly conducted in 92.0%(126/136) of grassroots institutions. At present, the grassroots institutions in Nanjing have established health archives for most diabetic patients and conducted health education regularly, but the professional training and the screening of diabetic complications need to be strengthened.

Objective To investigate the prevalence and risk factors of H-type hypertension among middle-aged and elderly people in Beijing community. Methods A cross-sectional study by recruiting 1 458 middle-aged and elderly people from a cohort of the "Beijing Longitudinal Study of Aging" in 2009 was conducted. All participants were asked to complete a standardized questionnaire, physical examination and laboratory examinations. Hyperhomocysteinemia was defined as homocysteine (Hcy) > 15 μmol/L, and H- type hypertension was defined as having hypertension and hyperhomocysteinemia simultaneously. The prevalence of H-type hypertension was estimated by using the results of 2000 Beijing population census to weight the data. Multivariate Logistic regression analysis was preformed to estimate the associated factors of H-type hypertension. Results The age was (69.48 ± 8.09) years, and the distribution of Hcy was skewed with the median of 16.56 μmol/L. After weight, the prevalence of hyperhomocysteinemia was 57.20% (834/1 458), and the prevalence of H-type hypertension was 35.32% (515/1 458), accounting for 59.47% (515/866) in patients with hypertension. The ageing, male, hyperuricemia, estimated glomerular filtration rate (eGFR) and insufficiency of fishes/ shrimps were independent risk factors of H-type hypertension ( OR = 2.30, 1.04, 1.02, 0.95 and 0.67; 95% CI 1.54-3.44, 1.02-1.06, 1.04-1.06, 0.94-0.97 and 0.46-0.97; P＜0.01 or＜0.05). Conclusions The proportion of H-type hypertension is high in the middle-aged and elderly people in Beijing community. Lowering uric acid, protection of renal function and intake sufficient fishes and shrimps might prevent and control H-type hypertension.

Objective To explore the clinical value of the dual-low-dose with low tube voltage for head and neck CTA. Methods One hundred and sixty patients who were clinically suspected head and neck vascular disease underwent CTA procedure were propective selected, and whose body mass index (BMI) was also lower than 25 kg/m2. Forty cases were randomly selected as conventional group(120 kV,150 mAs, iodine 320 mg/ml), the other 120 cases were as the low dose group. The low dose group divided into three subgroups according to the random number table method, which were low iodine group (37 cases;120 kV,150 mAs, iodine 270 mg/ml), low tube voltage group (42 cases;100 kV,150 mAs, iodine 320 mg/ml) and low iodine and tube voltage group (41 cases;100 kV,150 mAs, iodine 270 mg/ml). The carotid bifurcated CT value, standard deviation (SD), signal-to-noise ratio (SNR), iodine intake and effective radiation dose (ED) of the four groups were recorded,all data undertook statistical analysis useing one-way ANOVA. Meanwhile, the subjective image quality score was applied to evaluate the image quality, and the differences among groups were compared by Wilcoxon signed ranks test. Results The image quality score were (2.85±0.19),(2.33 ± 0.34),(2.26 ± 0.32),(2.87 ± 0.22) in the four groups, and there was no statistical difference between groups(P>0.05).The carotid bifurcated CT value were respectively (380±30),(314±27),(514±52) and (425±28) HU in conventional, low iodine, low tube voltage and dual-low-dose groups, and the iodine intake were (18.85±2.10), (15.75±1.78), (18.53±1.98), (15.62±1.92) g, the ED of the four groups were (1.74±0.14), (1.73± 0.11), (1.32 ± 0.08) and (1.35 ± 0.09) mSv, the difference were all statistically significant (P<0.01). Furthermore, the iodine intake and the effective radiation dose in dual-low-dose group were significantly lower than the conventational group. Conclusions Head-and-neck CTA with dual-low-dose scan can provide same quality images as using 100 kV and high dose iodine contrast agent, and which also significantly reduced the ED and iodine intake greatly. Thus, this scanning program has great clinical value.

Objective To investigate the risks of self-rated health in the ≥55-year elderly in Beijing and the occurrence of stroke.Methods The subjects (n=2 101;aged ≥55) from Beijing longitudinal study of aging (BLSA) were collected by Xuanwu Hospital,Capital Medical University from January 1992 to December 2016.One hundred and twenty-one subjects with stroke at baseline and 92 with incomplete information were excluded,and finally,1 888 elderly patients without cerebrovascular disease at baseline were included in the analysis.Based on the actual situation,the self-rated health was to identify an item that matched their current state from good,general to poor.The deadline for the survey was December 31,2012.The competitive risk model was used to assess the health self-rated status and the risk of stroke.Non-stroke deaths,including cancer and car accidents were treated as competitive events.Results Of the 1 888 subjects enrolled,946 (50.1%) self-rated health were good,616 (32.6%) were general,and 326 (17.3%) were poor;438 (23.2%) had stroke,751 (37.8%) had non-stroke death,and 699 (37.0%) were right censored data.Using the competing risk model and adjusting the age,sex,living area,marital status,education level,smoking,alcohol consumption,physical exercise,hypertension,diabetes mellitus,coronary heart disease,and body mass index,the occurrence of stroke in patients with poor self-rated health was 1.44 times (95%CI 1.11-1.87,P<0.01) as good as those who were good.Conclusion In the self-rated health of the elderly ≥55 years old in Beijing,the people with poor self-rated health increased the occurrence of stroke after considering the competitive risks.

Objective To explore the effect of chest circumference index adjusting tube voltage techniquey on image quality and radiation dose at coronary CTA. Methods One hundred and twenty consecutive patients [body mass index(BMI)<25 kg/m2] with suspected coronary heart disease (CHD) undergoing coronary CT angiography were prospectively selected and divided into 2 groups at random:conventional group and low dose group. Low dose group was divided into the following three subgroups according to different chest circumferences:A group(<80 cm, n=16), B group(80 to 90 cm, n=44) and C group (>90 cm, n=20). All patients were examined by coronary CTA. The patients in conventional group were performed using retrospective ECG-gating technology and reconstructed by filtered back projection algorithm. The tube voltage/tube current was 120 kV/1 000 mAs. Prospective ECG?gating technology and iterative algorithm reconstruction were used in low dose group. The tube voltages/currents were 80 kV/150 mAs, 100 kV/150 mAs, 120 kV/150 mAs in A, B, C group, respectively. Image quality was assessed by subjective evaluation (image quality score) and objective evaluation (signal?to?noise ratio).The effective radiation dose was calculated. Analyses of the differences between groups were compared with image quality, radiation dose by single factor variance and Wilcoxon signed ranks test.Results The image quality scores and signal?to?noise ratio of aorta were respectively (3.47 ± 0.38), (3.48 ± 0.27), (3.45 ± 0.32), (3.46±0.29) and (15.5±3.6), (15.8±3.6), (15.8±4.1), (16.2±3.9) in conventional, A, B and C groups, there was no statistical difference between the four groups (P=0.24, 0.43). The effective radiation dose of four groups were respectively (17.15 ± 3.25), (0.88 ± 0.02), (1.38 ± 0.05), (2.32 ± 0.04) mSv, the difference was statistically significant (P=0.02). The effective radiation dose of A, B, C group was significantly lower than that in the conventional group. Conclusion Chest circumference index adjusting tube voltages technology at coronary CT angiography can effectively reduce the effective radiation without compromise of image quality.