Objective To compare image quality and clinical usefulness between single breath-hold three-dimensional magnetic resonance cholangiopancreatography with compressed sensing(3D BH-CS-MRCP)and with gradient and spin-echo(3D BH-GRASE-MRCP)and conventional three-dimensional breath-triggered magnetic resonance cholangiopancreatography(3D RT-MRCP).Methods A retrospective analysis was performed in 48 patients(26 males and 22 females,mean age of 53.14±15.19 years),who underwent 3D BH-GRASE-MRCP,3D BH-CS-MRCP and 3D RT-MRCP from September to December 2023.Pancreaticobiliary duct visibility,motion artifacts,background suppression,and overall image quality were scored on a 5-point scale by two radiologists.The relative contrast ratio of three bile duct segmentations(common bile duct,left and right intrahepatic bile ducts)were calculated,and the acquisition time of the three sequences was recorded.Friedman test with a post-hoc test was performed to compare image acquisition time,qualitative and quantitative results.Results The acquisition time was significantly shorter in the two breath-hold groups than for conventional 3D RT-MRCP(P＜0.001).There were no significant differences in overall image quality,motion artifacts,common bile duct and primary branch of intrahepatic bile duct among the three groups.The relative contrast ratio,intrahepatic biliary secondary branch visibility and background suppression score of 3D RT-MRCP and BH-CS-MRCP were significantly higher than those of BH-GRASE-MRCP(P＜0.01).The pancreatic duct(proximal,middle,distal)visibility score of 3D RT-MRCP was significantly better than that of BH-GRASE-MRCP(P=0.002,0.043,0.001),but the gallbladder and gallbladder duct visibility score of BH-GRASE-MRCP was higher than that of 3D RT-MRCP(P=0.036).There was no significant difference between 3D RT-MRCP and BH-CS-MRCP scores except for the middle and distal pancreatic duct visibility.Conclusion Breath-hold 3D MRCP with GRASE and CS can give us feasible options for pancreaticobiliary diagnosis,which significantly shortens the acquisition time without reducing the overall image quality.Compared with BH-GRASE-MRCP,BH-CS-MRCP has better consistency in pancreaticobiliary duct visibility and background suppression.

In the context of aging population, the issue of polypharmacy among elderly patients with mental disorders has become increasingly prominent.Cognitive decline and depressive symptoms render these patients more vulnerable to medication-related risks, while poorly managed physical illnesses further complicate their treatment.To address these challenges, this paper proposes a series of management strategies that emphasize the critical role of pharmacists in conducting medication reviews.A comprehensive assessment of drug risks, benefits, and patient adherence is essential.The proposed strategies not only require careful consideration of patients' clinical needs and individual preferences but also highlight the importance of multidisciplinary team collaboration to reach a consensus on medication therapy.The use of clinical decision support systems as an auxiliary tool is recommended to enhance the scientific rigor of medication decision-making.Furthermore, pharmacists can optimize medication regimens through scientifically validated methods and promote patient or family involvement in self-management to improve acceptance and adherence to treatment adjustments.

Objective To explore the correlation between pre-pregnancy body mass index (BMI) and the risk of difficult airway during labor and delivery through grading changes of Mallampati test (MT). Methods A total of 354 primiparous women who delivered at Obstetrics and Gynecology Hospital of Fudan University from October 2020 to April 2021 were enrolled and categorized into low BMI, normal BMI, and high BMI groups based on pre-pregnancy BMI. Changes in MT grading were analyzed during early labor, postpartum (20 minutes to 1 hour after placental delivery), and 48 hours postpartum. A multifactor logistic regression model was used to analyze the factors increased MT grading postpartum. Results Among the 354 participants, 97 (27.4%) exhibited increased MT grading postpartum, with the proportion of women classified as MT grade 3-4 rising from 39 (11.0%) during early labor to 77 (21.8%) postpartum. By 48 hours postpartum, the number of women with MT grade 3-4 decreased to 21 (5.9%). Multifactor logistic regression analysis showed that low pre-pregnancy BMI (vs high BMI: OR＝2.15, 95%CI 1.02-4.53, P＝0.045) and snoring history during pregnancy (OR＝2.32, 95% CI 1.38-3.90, P＝0.001) were independent risk factors for postpartum MT grading elevation. Conclusions MT grading might increase postpartum in parturients, with low pre-pregnancy BMI and prenatal snoring history identified as significant risk factors for elevated MT grading after delivery.

Objective To explore the application of graded nursing based on humanistic care in frail elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 138 patients with COPD treated in Qinhuai Branch,The General Hospital of Eastern Theater Command from October 2020 to April 2023 were randomly assigned into two groups by a random number table,with 69 patients in each group.The control group received routine nursing care based on humanistic care,and the observation group were given routine nursing and graded nursing care according to the frailty scale.Clinical indicators,self-efficacy,treatment compliance and quality of life were compared between the two groups.Results After intervention,the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),blood oxygen saturation(SpO2),and the scores of self-decision-making,self-stress reduction and positive attitude of the two groups were improved,especially in the observation group(P<0.05).The compliance rate of observation group was higher than that of control group(97.10%vs.84.06%,P<0.05).The scores of vitality(VT),physical pain(BP),physiological function(RP),social function(SF),emotional function(RE),physiological function(PF),mental health(MH)and overall health(CH)in the observation group were higher than those in the control group(P<0.05).Conclusion The combined application of graded nursing based on frailty scale and humanistic care in COPD patients can effectively improve the quality of routine nursing,patient's self-efficacy,treatment compliance,illness status,and quality of life.

AIM: To investigate the efficacy and safety of intense pulsed light(IPL)combined with meibomian gland massage and tobramycin and dexamethasone ophthalmic ointment in treating dry eye(DE)with meibomian gland dysfunction after phacoemulsification(PHACO).METHODS: A total of 100 cases(100 eyes)of DE patients with meibomian gland dysfunction after receiving PHACO in our hospital from January 2022 to December 2023 were selected and divided into control group(receiving meibomian gland massage + eye ointment)and observation group(receiving IPL + meibomian gland massage + eye cream treatment)according to different treatment methods, with 50 cases(50 eyes)in each group. The score of meibomian gland secretion, tear film break-up time(BUT), clinical efficacy and safety were compared between the two groups.RESULTS: After treatment, the scores of the meibomian gland secretion status decreased in both groups, and the observation group had lower scores(all P<0.05). After treatment, the BUT increased in both groups, and the observation group had higher BUT(P<0.05). The clinical efficacy of the observation group(98%)was higher than that of the control group(84%; P<0.05). In addition, the incidence of adverse reactions in the observation group(6%)was lower than that in the control group(20%; P<0.05).CONCLUSION: IPL combined with meibomian gland massage and tobramycin and dexamethasone ophthalmic ointment can effectively improve the clinical efficacy of DE patients after PHACO surgery, reduce adverse reactions, and have high safety.

Hepatitis B cirrhosis is the most significant component of liver cirrhosis in China， and there is a significant increase in the mortality rate of patients after progression from hepatitis to liver cirrhosis. A large number of studies have shown that gut microbiota may influence the progression of hepatitis B cirrhosis， including the impact on the regulation of inflammatory response and intestinal immunity， the inhibition of HBV， and the production of ammonia-like substances. This article reviews the research advances in the changes in gut microbiota in hepatitis B cirrhosis patients and explores new ideas for the treatment of hepatitis B cirrhosis by intervening in gut microbiota.

The new cultural construction of high-quality development of public hospitals proposes a patient-oriented ap-proach.People with disabilities,represented by the hearing-impaired community,faces many difficulties in the process of seeking medical care,and their needs have not been adequately addressed.This inadequacy adversely affects the development of harmoni-ous doctor-patient relationships and the patient medical experience.This study takes the deaf assistance outpatient clinic,first es-tablished by Shanghai East Hospital as an example to elaborate the practice of cultural brand construction under the leadership of Party building.Medical social workers,healthcare professionals,and volunteers work together to build a cultural brand through institutional guarantees,detailed care,and the establishment of a full process service system.This is expected to provide refer-ences for the construction of hospital cultural brands..

We report a case of anti-IgLON5 disease with a motor neuron disease-like presentation admitted to the Department of Neurology, Xuanwu Hospital, Capital Medical University in July 2021. The patient was a 71-year-old female who presented with the chief complaint of limb weakness persisting for 4 months. She showed progressive limb weakness accompanied by muscle atrophy. Electromyography (EMG) revealed extensive neurogenic damage. Initial serum evaluation for neural-specific autoantibodies was positive for IgLON5-Ab (1∶100). Repeat testing confirmed IgLON5-Ab positivity with a titer of 1∶1 000. The patient was diagnosed with anti-IgLON5 disease and treated with methylprednisolone and immunoglobulin, leading to clinical improvement. We found four relevant articles reporting a total of 11 similar cases. Thus, in this study, we analyzed a total of 12 cases, including our patient. Based on their clinical manifestations, these cases can be categorized into two types: amyotrophic lateral sclerosis(ALS)type and isolated bulbar type. Six cases—three males and three females—presented with the ALS type. Of these, three cases had diffuse limb weakness accompanied by muscle atrophy(two cases had diffuse hyperreflexia and one had a normal tendon reflex); one case presented with neck extensor weakness and bilateral asymmetric upper extremity weakness and was hyperreflexic at the bilateral patellar tendons; one case displayed asymmetric weakness in both lower limbs with normal deep reflexes, and one case exhibited neck weakness with hyperreflexia. EMG revealed diffuse lower motor neuron disease involving two or three regions. All patients tested positive for serum anti-IgLON5 antibodies. Four were also positive for anti-IgLON5 antibodies in cerebrospinal fluid, two were negative, and six were not tested. Among the 11 patients who received immunotherapy, 4 showed partial improvement in clinical symptoms, 2 exhibited transient improvement, 2 remained stable, and 3 showed no improvement. Testing for IgLON5-Ab should be considered among patients presenting with bulbar symptoms or ALS-like features, especially those with acute or subacute onset, rapid progression, autonomic dysfunction, vocal cord paralysis requiring tracheotomy, cognitive impairment, or involuntary movements. Early diagnosis and treatment may improve clinical symptoms and reduce adverse outcomes.

Objective:To improve the understanding of the clinical manifestation of immunoglobulin G 4-related disease (IgG 4-RD) with neurological involvement. Methods:Patients presenting with neurological symptoms and biopsy-confirmed IgG 4-RD were enrolled between March 2014 and March 2024 from the Department of Neurology of Xuanwu Hospital of Capital Medical University. Medical record data of all patients were retrospectively reviewed, including clinical manifestations, laboratory findings, radiological results, pathology, treatments, and outcomes. RD were enrolled between March Results:Nine patients (five males, four females; median age at onset: 63 years) were included in the study. Neurological manifestations consisted of pachymeningitis in six cases, peripheral nerve involvement in two, and brain parenchyma involvement in one. Four patients displayed isolated neurologic symptoms. The most common clinical manifestations were headache and cranial nerve palsy, each involving five cases. Magnetic resonance imaging showed thickening and enhancement of the dura mater in the six patients with pachymeningitis. Four of these cases involved the posterior cranial fossa, 3 presented with an inflammatory pseudotumor, and 2 involved the spinal cord. Four patients with pachymeningitis had normal serum IgG 4 concentrations. Eight patients exhibited elevated serum C-reactive protein or erythrocyte sedimentation rates, with some also showing decreased complement C3 and C4 levels. Cerebrospinal fluid immunoglobulin was elevated in all nine cases. In all cases, histopathologic biopsy results showed extensive infiltration of lymphocytes and plasma cells, with the latter displaying IgG 4+abnormalities. All patients received glucocorticoid therapy, with six also receiving immunosuppressants. All patients were followed up for a median of 30 months, with outcomes including two complete remissions, five partial remissions, one unchanged condition, and one death. Six patients experienced a relapse. Conclusions:Isolated hypertrophic pachymeningitis is the most common manifestation of IgG 4-RD, often occurring in the absence of elevated serum IgG 4 levels. Peripheral nerve and brain parenchyma involvement can also be seen. Clinical manifestations are non-specific, and histopathologic biopsy is frequently required for diagnosis. Although the disease responds well to hormone treatment, recurrence is common. Early combined immunosuppressive therapy can improve prognosis.

Objective:To explore the effects of radical resection of pelvic autonomic nerve sparing cervical cancer on urodynamics, sexual function and prognosis of patients with cervical cancer.Methods:A total of 76 patients with cervical cancer admitted to Dingzhou People’s Hospital from Jan. 2021 to Jan. 2023 were selected as research objects, and all patients were divided into control group and study group by random number table method, with 38 cases in each group. The control group was treated with traditional laparoscopic radical cervicectomy, and the study group was treated with laparoscopic radical cervicectomy preserving pelvic autonomic nerve. Perioperative indexes, preoperative and postoperative urodynamics, tumor markers, sexual function and postoperative adverse reactions were compared between the two groups.Results:The operation time of the observation group was longer than that of the control group ( P<0.05). The exhaust time and defecation time of the observation group were lower in the observation group than in the control group ( P<0.05). There was no significant difference in the amount of blood loss or lymph node dissection between the two groups ( P>0.05). There was no significant difference in urodynamic indexes between the two groups before surgery ( P>0.05). In the observation group after surgery, the bladder compliance, maximum urine flow rate and maximum detrusor systolic blood pressure were (81.55±13.18 mL/cm H 20, 20.46±4.65 L/s, 35.09±7.41 cm H 20), while they were (60.14±10.27) mL/cm H 20, (14.48±3.92) L/s, (28.15±6.94) cm H 20 in the control group. The observation group were higher than the control group ( P<0.05). There was no significant difference in maximum bladder volume between the two groups ( P>0.05). There was no significant difference in sexual function scores between the two groups before surgery ( P>0.05). The scores of sexual desire, vaginal wetness and pain, sexual arousal and orgasm, and sexual satisfaction in the observation group were higher than those in the control group ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05) . Conclusion:Radical resection of pelvic autonomic nerve preserving cervical cancer can improve urodynamic indexes and sexual function of patients with cervical cancer, and has the same efficacy as conventional laparoscopic radical resection of cervical cancer without increasing adverse reactions, and has a good effect and safety.