Objective:To understand the impact of menopausal hormone therapy(MHT)on bone turnover markers(BTMs)in menopausal women and explore the feasibility of BTMs as efficacy monitoring indicators for MHT.Methods:Menopausal women who visited the Menopause Clinic and Gynecological Endocrine Clinic of our hospital from January 2018 to August 2022,received MHT and had regular reexaminations of BTMs were selected.According to the treatment plan at the initiation of MHT,they were divided into the estrogen group(continuous or cyclic sequential therapy or continuous combined therapy)and the tibolone group.All patients had reexaminations of BTMs,including osteocalcin(OC),beta C-terminal telopeptide of type Ⅰ collagen(β-CTX),and procollagen type Ⅰ N-terminal propeptide(P1NP),before treatment and at 6 months,12 months and 24 months after treatment.Meanwhile,their bone mineral density examination results in our hospital were collected.The BTMs before and af-ter treatment in each group were compared,as well as the changes in BTMs after treatment compared with those before treatment between the two groups.Meanwhile,the changes in bone mineral density were analyzed.Results:The levels and abnormal rates of BTMs(β-CTX,P1NP,OC)in both the estrogen group and the tibolone group were significantly decreased at 6,12,and 24 months after treatment compared with those before treatment,and the differences were statistically significant(P＜0.05).When comparing the changes in BTMs after treatment compared with those before treatment between the two groups,there was no statistically significant difference(P＞0.05).The incidences of osteopenia and osteoporosis in patients at 12 months and 24 months after treat-ment had no significant changes compared with those before treatment,and the differences were not statistically significant(P＞0.05).The lumbar spine bone mineral density was significantly improved at 12 months and 24 months after MHT treatment compared with that before treatment,and the differences were statistically significant(P＜0.05).The bone mineral densities of the femoral neck and hip were not significantly improved at 12 months and 24 months after MHT treatment compared with those before treatment,and the differences were not statisti-cally significant(P＞0.05).Conclusion:The anti-bone resorption effects of the two MHT regimens are similar.The BTMs(OC,β-CTX,PINP)are significantly decreased after 6 months of treatment and can maintain their ef-fectiveness.BTMs can be used as one of the important monitoring methods for the efficacy of menopausal hor-mone therapy.

Objective:To understand the impact of menopausal hormone therapy(MHT)on bone turnover markers(BTMs)in menopausal women and explore the feasibility of BTMs as efficacy monitoring indicators for MHT.Methods:Menopausal women who visited the Menopause Clinic and Gynecological Endocrine Clinic of our hospital from January 2018 to August 2022,received MHT and had regular reexaminations of BTMs were selected.According to the treatment plan at the initiation of MHT,they were divided into the estrogen group(continuous or cyclic sequential therapy or continuous combined therapy)and the tibolone group.All patients had reexaminations of BTMs,including osteocalcin(OC),beta C-terminal telopeptide of type Ⅰ collagen(β-CTX),and procollagen type Ⅰ N-terminal propeptide(P1NP),before treatment and at 6 months,12 months and 24 months after treatment.Meanwhile,their bone mineral density examination results in our hospital were collected.The BTMs before and af-ter treatment in each group were compared,as well as the changes in BTMs after treatment compared with those before treatment between the two groups.Meanwhile,the changes in bone mineral density were analyzed.Results:The levels and abnormal rates of BTMs(β-CTX,P1NP,OC)in both the estrogen group and the tibolone group were significantly decreased at 6,12,and 24 months after treatment compared with those before treatment,and the differences were statistically significant(P＜0.05).When comparing the changes in BTMs after treatment compared with those before treatment between the two groups,there was no statistically significant difference(P＞0.05).The incidences of osteopenia and osteoporosis in patients at 12 months and 24 months after treat-ment had no significant changes compared with those before treatment,and the differences were not statistically significant(P＞0.05).The lumbar spine bone mineral density was significantly improved at 12 months and 24 months after MHT treatment compared with that before treatment,and the differences were statistically significant(P＜0.05).The bone mineral densities of the femoral neck and hip were not significantly improved at 12 months and 24 months after MHT treatment compared with those before treatment,and the differences were not statisti-cally significant(P＞0.05).Conclusion:The anti-bone resorption effects of the two MHT regimens are similar.The BTMs(OC,β-CTX,PINP)are significantly decreased after 6 months of treatment and can maintain their ef-fectiveness.BTMs can be used as one of the important monitoring methods for the efficacy of menopausal hor-mone therapy.

Purpose To investigate the clinical value of multi-center digital mammography radiomics nomogram model in predicting triple-negative breast cancer(TNBC).Materials and Methods The digital mammograms of 462 patients with pathologically confirmed breast cancer from November 2016 to March 2022 were retrospectively analyzed,including 243 cases from Yijishan Hospital of Wannan Medical College(institution 1),106 cases from Fuyang People's Hospital(institution 2)and 113 cases from Taihe People's Hospital(institution 3).According to the results of immunohistochemistry,a total of 349 breast cancer patients in institution 1 and institution 2 were randomly divided into the training group(244 cases,including 41 TNBC and 203 non-TNBC)and the validation group(105 cases,including 18 TNBC and 87 non-TNBC)according to the ratio of 7∶3,113 breast cancer patients(24 TNBC and 89 non-TNBC)from institution 3 were included in the external validation group.Comparing the mediolateral oblique and cranial cauda digital mammography images,the mammography imaging with larger lesion areas were selected,and the image segmentation and radiomics feature extraction were performed.The radiomics model was constructed by using Logistic regression.The clinicopathological parameters and radiomics scores were used to construct a nomogram.Receiver operating characteristic and decision curve analysis were used to evaluate the model performance.To compare The predictive performance between the models was compared.Results Finally,four radiomics features closely related to TNBC were selected to construct an radiomics model.The area under the curve,sensitivity and specificity of TNBC predicted by the radiomics model in training group,validation group and external test group were 0.868,90.24%and 72.91%,0.827,72.22%and 75.86%,0.837,70.83%and 78.65%,respectively.The area under the curve,sensitivity and specificity of TNBC predicted by the combined model in the training group,validation group and external test group were 0.903,80.49%and 86.70%,0.890,77.78%and 88.51%,0.870,62.50%and 85.39%,respectively.The combined model was better than the single image omics model in predicting TNBC,and the difference was statistically significant between the training group and the verification group(Z=2.061,2.064,both P<0.05),but not between the external test group(Z=1.223,P=0.221).In three group,decision curve analysis showed that the nomogram predicted a higher net benefit than the radiomics model for triple-negative breast cancer.Conclusion The radiomics model has high diagnostic efficiency in predicting TNBC,and the nomogram model combined with the radiomics score and histological grading can further improve the prediction efficiency.

The construction of a medication safety culture is important for medication safety management and rational drug use.The construction of medication safety culture standards is formulated based on relevant national policies and regulations,accreditation standards for hospitals,expert opinions,the current situation,and the development trend of the healthcare industry.With scientificity,general applicability,instructive guidance,and practicality,they standardized basic requirements,management processes,and improvement of the construction of medication safety culture.To facilitate understanding and the implementation of the standards,we describe the process of standards formulation and explain the key points of the standards.

Objective:To study the correlation between transcutaneous bilirubin (TcB) level measured from shielded skin and total serum bilirubin (TSB) level after phototherapy in premature infants.Methods:From July 2019 to July 2021,preterm infants with jaundice admitted to the Department of Neonatology of our hospital and received phototherapy were prospectively enrolled in the study. The infants were assigned into 26~31w group, 32~34w group and 35~36w group according to their gestational ages. During phototherapy, the forehead, the chest and the perineum were shielded. TcBs were measured at the above mentioned areas three times each before and after phototherapy and TSB was measured from venous blood samples.Results:A total of 306 premature infants were included, with 51 cases in 26~31w group, 126 cases in 32~34w group and 129 cases in 35~36w group. Before phototherapy, TcBs of the forehead, the chest and the perineum of all infants were correlated with TSB ( r=0.699, 0.913, 0.734, P<0.001) with TcB of the chest showed the best correlation. A linear regression equation was established using the TSB before phototherapy and the TcB of the chest: TSB=0.634+0.912TcB. After phototherapy, TcBs of the forehead, the chest and the perineum of all infants were also correlated with TSB ( r=0.586, 0.879, 0.690, P<0.001) with TcB of the chest showed the best correlation and the linear regression equation was TSB=1.910+0.736TcB. Conclusions:For preterm infants with gestational age of 26~36w, TcB of the shielded chest skin after phototherapy is correlated with TSB and a linear regression model can be established.

Objective:To respond to the national requirements on the construction of research integrity, and improve the capacity building of research integrity at hospitals.Methods:Dealing with research integrity problems identified at hospital before 2018, measurements that include " policy and procedures development, standardization of the management of scientific research activities, and optimizing the scientific and technological evaluation system" were adopted to promote the construction of research integrity. Such corrective activities were monitored to summarize experiences and lessons for the continuing improvement of research integrity construction.Results:Both " heteronomy" and " self-discipline" of research integrity have been sublimated simultaneously, at the same time, a tailored research integrity management system with the characteristics of local hospitals has been established.Conclusions:Updating institutional policy and procedures, taking paper management as a priority, as well as research integrity training, these measurements played important roles in promoting the research integrity capacity building at hospitals.

Objective:To understand the clinical features of vancomycin-associated drug-induced hypersensitivity syndrome (DIHS) in children.Methods:Case reports on vancomycin-associated DIHS in children were collected by searching the relevant databases home and abroad up to May 31, 2020. Patients′ relevant information (sex, age, primary disease, time from medication to onset of DIHS, main symptoms, organs and systems involved, hematological changes, RegiSCAR score, treatment and outcome) was extracted and descriptively analyzed.Results:A total of 12 children with DIHS caused by vancomycin were enrolled in the study, including 10 males and 2 females. Their ages ranged from 22 months to 17 years, with a median age of 14 years. The median time from vancomycin exposure to occurrence of DIHS was 17 days, ranging from 5 to 35 days. The main clinical features were fever (12 patients, 100.0%), rash (12 patients, 100.0%), lymphadenopathy (8 patients, 66.7%), and mucosal injury (5 patients, 41.7%). Among the 12 children, 9 (75.0%) had liver injury, 4 (33.3%) had kidney injury, 2 (16.7%) had lung injury, 1 (8.3%) had spleen injury, and 1 (8.3%) had myocardial injury. Blood routine examination showed increased eosinophilia in the 11 children (91.7%) and increased atypical lymphocytosis in 5 children (41.7%). After the diagnosis of DIHS, vancomycin was discon-tinued in all the 12 children. After treatments with glucocorticoids, antihistamines, gammaglobulins, etc. (1 patient underwent liver transplantation), 11 children (91.7%) were improved and 1 (8.3%) died.Conclusions:The clinical manifestations of DIHS caused by vancomycin in children are typical, mainly manifested by fever, rash, lymphadenopathy, etc. The damaged organs are mainly the liver, followed by the kidneys. Most of the children have a good prognosis, and a few may have severe organ damage leading to death.

Objective:To understand the clinical features of vancomycin-associated drug-induced hypersensitivity syndrome (DIHS) in children.Methods:Case reports on vancomycin-associated DIHS in children were collected by searching the relevant databases home and abroad up to May 31, 2020. Patients′ relevant information (sex, age, primary disease, time from medication to onset of DIHS, main symptoms, organs and systems involved, hematological changes, RegiSCAR score, treatment and outcome) was extracted and descriptively analyzed.Results:A total of 12 children with DIHS caused by vancomycin were enrolled in the study, including 10 males and 2 females. Their ages ranged from 22 months to 17 years, with a median age of 14 years. The median time from vancomycin exposure to occurrence of DIHS was 17 days, ranging from 5 to 35 days. The main clinical features were fever (12 patients, 100.0%), rash (12 patients, 100.0%), lymphadenopathy (8 patients, 66.7%), and mucosal injury (5 patients, 41.7%). Among the 12 children, 9 (75.0%) had liver injury, 4 (33.3%) had kidney injury, 2 (16.7%) had lung injury, 1 (8.3%) had spleen injury, and 1 (8.3%) had myocardial injury. Blood routine examination showed increased eosinophilia in the 11 children (91.7%) and increased atypical lymphocytosis in 5 children (41.7%). After the diagnosis of DIHS, vancomycin was discon-tinued in all the 12 children. After treatments with glucocorticoids, antihistamines, gammaglobulins, etc. (1 patient underwent liver transplantation), 11 children (91.7%) were improved and 1 (8.3%) died.Conclusions:The clinical manifestations of DIHS caused by vancomycin in children are typical, mainly manifested by fever, rash, lymphadenopathy, etc. The damaged organs are mainly the liver, followed by the kidneys. Most of the children have a good prognosis, and a few may have severe organ damage leading to death.

Objective To explore the clinical characteristics and risk factors of occult pneumonia in advanced elderly patients.Methods A total of 170 advanced elderly patients with community-acquired pulmonary infection in geriatric department of Xijing hospital from January 2014 to October 2017 were enrolled.Patients were divided into two groups:the observation group (with occult pneumonia,n=80)and the control group(without occult pneumonia,n =90).Clinical data of patients were collected,and clinical characteristics and related risk factors of occult pneumonia in elderly patients were analyzed.Results There was no statistically significant difference in the positive rate of sputum culture and the distribution of pathogenic bacteria between the two groups (P ＞ 0.05).Gram-negative bacteria predominated in pathogenic bacteria.The hospitalization time was longer in the observation group than in the control group[(17.3 ± 3.0) d vs.(10.3 ± 3.9) d,P ＜ 0.05].The mortality rate was higher in the observation group than in the control group(10.0 ％ vs.3.3 ％,P ＜ 0.05).The age was older in the observation group than in the control group[(87.0± 1.7) years vs.(82.0± 2.4) years,P ＜ 0.05].The incidences of diabetes,Alzheimer's disease,hypothyroidism and long-term bed rest were higher in the observation group than in the control group (P ＜ 0.05).Multivariate logistic regression analysis showed that age (OR =6.93),dementia (OR =4.32),hypothyroidism(OR =4.89) were independent risk factors for occult pneumonia (P ＜ 0.05).Conclusions The pathogenic bacteria in advanced elderly patients with occult pneumonia are mainly gram-negative bacteria.The positive rate of CT scan confirmed-occult pneumonia is much higher than that by chest X-ray.The advanced elderly patients with occult pneumonia have longer hospitalization time and higher mortality rates.Old age,senile dementia and hypothyroidism are independent risk factors for occult pneumonia in advanced elderly patients.

Objective To retrospect the literature review related psychological resilience of cancer patients at home and abroad in recent 10 years, and analyze the application status, main problems and provide the corresponding countermeasures. Methods The literature review was searched by the way of key words in China National Knowledge Infrastructure database ( CNKI) and basic search in Pubmed from 2006 to 2015. Then the year, number, design and contents of the research were concluded into analysis. Results Research about psychological resilience of cancer patients was developed late but the number was rising; the research design were mostly observational study and lots of research focused on the adult patients with breast cancer or gynecological cancer; research contents mainly included current situation and affecting factors of quantitative analysis.Conclusions We find out psychological resilience of cancer patients has been attracted great attention by domestic scholars but with limited research content, uneven distribution of study. The experimental research, qualitative research has not been carried out, so the quality of nursing literature still needs to be improved.