Objective To observe the consistency of 5.0T and 1.5T MR spectroscopy(MRS)for quantitating proton density fat fraction(PDFF)of liver.Methods Lipid emulsion models with lipid content of 0,5％,10％,15％,20％,25％and 30％were prepared.1H-MRS were collected using 5.0T and 1.5T MR scanners,respectively,and PDFF were obtained with jMRUI software.Totally 23 people,including 11 cases of fatty liver and 12 healthy adults were prospectively collected,and volume of interest(VOI)in the liver were selected to acquire 1H-MRS,and PDFF were obtained with jMRUI software and corresponding workstation,respectively.The consistencies of PDFF measured with different methods were analyzed.Results PDFF of lipid emulsion models with lipid content of 0,5％,10％,15％,20％,25％and 30％measured with jMRUI software and workstations based on 5.0T and 1.5T 1H-MRS all had good consistencies and being positively correlated,so were PDFF of liver tissue measured with jMRUI software and workstations based on 5.0T and 1.5T 1H-MRS.Conclusion 5.0T and 1.5T 1H-MRS had good consistency for quantitating liver PDFF.Measuring liver PDFF with workstation in clinical practice was helpful to simplifying workflow.

Objective:To investigate the knowledge of Sixth Chinese national consensus report on the management of Helicobacter pylori infection ( treatment excluded) (hereinafter referred to as sixth national consensus) and 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment (hereinafter referred to as the guideline)among medical staff from general hospitals in Hainan. Methods:From February 20 to May 7, 2023, a questionnaire survey on the diagnosis and treatment of Helicobacter pylori ( H. pylori) infection was conducted among 1 463 medical staff from 15 general hospitals in Hainan Province. The questionnaire was drawn up according to the sixth national consensus and the guideline, covering knowledge of 6 sections, induding H. pylori related diseases, detection of H. pylori, eradication, prevention and influence factors of eradication of H. pylori, etc. Chi-square test was used for statistical analysis. Results:A total of 1 463 valid questionnaires were collected with the effective responsive rate of 100.00%.The 1 463 subjects included 225 gastroenterologists and 1 238 other medical staff(including 503 physicians from other departments, 264 surgeons and 471 medical technologists and pharmacists). About 78.67%(177/225)of gastroenterologists agreed that the overall infection rate of H. pylori in China was more than 20%, the awareness rate was higher than that of other medical staff (physicians from other departments 65.41%(329/503), surgeons 61.74%(163/264), medical technologists and pharmacists 60.30%(284/471); the following datas were sorted by this position), and the difference was statistically significant ( χ2=30.97, P<0.001). About 51.11%(115/225) of gastroenterologists considered that H. pylori serological antibody test could not be used as a diagnostic method for current infection, the awareness rate was higher than that of other medical staff(22.07%(111/503), 14.02%(37/264), 12.31%(58/471)), and the difference was statistically significant( χ2 =152.66, P<0.001). Proton pump inhibitor and potassium-competitive acid blocker should be discontinued for 2 weeks, and antibiotics and bismuth should be discontinued for 4 weeks before urea breath test, and the awareness rates of gastroenterologists were higher than those of other medical staff (38.67%(87/225) vs. 23.26%(117/503), 19.70%(52/264), 18.47%(87/471); 60.89%(137/225) vs. 26.64%(134/503), 25.76%(68/264), 23.78%(112/471)), and the differences were statistically significant ( χ2 =133.70 and 165.51, both P<0.001). For refractory H. pylori infection, 98.67%(222/225)of gastroenterologists agreed with the individualized diagnosis and treatment of H. pylori infection should be guided by bacterial culture, antibiotic susceptibility test or drug resistance gene test, and the awareness rate was higher than that of other medical staff (91.85%(462/503), 93.56%(247/264), 93.21%(439/471)), and the difference was statistically significant( χ2=20.55, P=0.002). About 70.67% (159/225) of gastroenterologists recommended a bismuth containing quadruple regimen, 80.44% (181/225) supported a 10 to 14 day H. pylori eradication course, and the awareness rates were higher than other medical staff (46.92%(236/503), 33.33%(88/264), 32.91%(155/471); 67.20%(338/503), 59.09%(156/264), 53.93%(254/471)), and the differences were statistically significant ( χ2=111.25 and 59.99, both P<0.001). The understanding rates of the sixth national consensus and the guideline in gastroenterologists was 85.33% (192/225), which was higher than that of other medical staff (64.21%(323/503), 66.67%(176/264), 57.96%(273/471)), and the difference was statistically significant ( χ2=85.47, P<0.001). Conclusions:Gastroenterologists from general hospitals in Hainan Province have a better understanding of the sixth national consensus and the guideline than other medical staff. However, there is still a lack of deep understanding of the sixth national consensus and the guideline, and it is necessary to further strengthen the learning and application of the sixth national consensus and the guideline.

Purpose: This study was performed to analyze the rule of confluence of the caudate lobe bile duct (CLD) into the left hepatic duct (LHD) and to discuss the protective strategy during left hemihepatectomy. Methods: MRI of 400 patients and T-tube angiography images of 100 patients were collected, and the imaging rules of the confluence of the CLD into the LHD were summarized. The clinical data of 33 patients who underwent left hemihepatectomy using the protective strategy were analyzed. Results: MRI and T-tube angiography images showed that the length from the confluence point of the CLD into the LHD to the confluence of the left and right hepatic ducts was 1.19 ± 0.40 cm and 1.26 ± 0.39 cm, respectively. The average angle between the longitudinal axis of the 2 bile ducts was 68.27° ± 22.59° and 66.58 ± 22.88°, respectively. Coronal and cross-sectional images showed that inflow from the foot side to the cranial side was noted in 79.8% and 82.0% of patients, respectively, and inflow from the dorsal to the ventral side was observed in 84.5% and 88.0%, respectively. Based on these imaging rules, the safe transection length and plane were summarized, and the CLD was effectively protected in 33 cases of left hemihepatectomy. Conclusion In left hemihepatectomy, the LHD should be transected at least 1.5 cm away from the confluence of the left and right hepatic ducts, and the plane of transection should be oblique to the dorsal side at an angle of 45° with the LHD, these parameters represent an effective strategy to protect the CLD.

Primary prostate synovial sarcoma (PPSS) is rare in clinic. One patient was admitted to our hospital in May 2021. The patient was admitted to the hospital because of the physical examination. Preoperative pelvic enhanced MR, PETCT and preoperative puncture pathology suggested that pelvic soft tissue sarcoma was likely. Robot-assisted radical resection of pelvic tumor was performed, and the unilateral PPSS was diagnosed by postoperative pathology, immunohistochemistry and gene detection. Patients were treated with ifosfamide + adriamycin adjuvant chemotherapy one month after operation, and Proton therapy radiotherapy five months after operation. Follow-up for more than 2 years showed that the patients were generally in good condition, and no recurrence or metastasis was found in imaging.

Objective:To develop an evaluation index system for the management ability of general practice team leaders in community health service centers.Methods:Based on literature review, key insider interviews and other methods, the framework and indicator pool for management capability of general practice team leaders were formed. Two rounds of Delphi consultations with 15 experts were conducted from July to October 2021, and the evaluation index system of general practice team leaders' management ability established.Results:All 15 experts had at least 5 years of work experience, including 10 engaging in clinical general practice, 3 in public health and 2 in community management. The response rates for the two rounds of expert consultation was 15/15, and the expert authority coefficient was 0.84, with Kendall's W coefficient of 0.35 ( P<0.001) and 0.46 ( P<0.001), respectively. Finally, the evaluation index system of the management ability of general practice team leaders was established, which consisted of 5 primary indicators (personal quality, special business management, organizational management, teaching and research management, strategy and culture building), 11 secondary indicators and 37 tertiary indicators. Conclusions:The management capability evaluation index system general practitioner team leaders of the community health centers has been established in this stu, which may be used for the training and selection of general practice team leaders in the community health centers.

Objective:To investigate the outcomes and influencing factors of newly diagnosed prediabetic subjects aged 40 years and above in Guiyang.Methods:A total of 10 015 residents aged 40 years and above were recruited from the Yunyan community, Guiyang, from May to August 2011. Physical examination, laboratory measurements, and questionnaires were conducted. The follow-up survey was conducted in July 2014. A total of 2 530 newly diagnosed prediabetic subjects at baseline were included in the analysis.Results:The 3-year cumulative morbidity of diabetes mellitus was 14.3%, and the risk of diabetes mellitus in combined impaired fasting glucose(IFG)and impaired glucose tolerance(IGT)groups was significantly higher than that in isolated IFG(i-IFG)or isolated IGT(i-IGT)group( P<0.01). High baseline fasting plasma glucose, 2 h plasma glucose, and HbA 1C levels were the independent risk factors for the development of diabetes( OR=1.836, 95% CI 1.374-2.454; OR=1.398, 95% CI 1.261-1.550; OR=2.526, 95% CI 1.804-3.538, all P<0.01)and the inhibitory factors for reversion to normal glucose tolerance( OR=0.511, 95% CI 0.409-0.638; OR=0.715, 95% CI 0.661-0.774; OR=0.638, 95% CI 0.500-0.816, all P<0.01). High level of high density lipoprotein-cholesterol(HDL-C)was an promoting factor for reversion to normal glucose tolerance( OR=1.306, 95% CI 1.017-1.678, P=0.036). Subjects in the highest tertile of baseline HbA 1C level and body mass index(BMI)change before and after follow-up(ΔBMI=follow-up BMI minus baseline BMI)had a higher risk of diabetes mellitus than those in the lowest tertile( OR=2.398, 95% CI 1.733-3.322; OR=2.402, 95% CI 1.859-3.105, both P<0.01). The risk of diabetes mellitus in the significant weight loss group was reduced by 40.4% compared with the non-significant weight loss group when the subjects were divided into two groups according to the cutoff of the lower tertile of ΔBMI( RR=0.596, 95% CI 0.463-0.766, P<0.01). Conclusion:The risk of diabetes mellitus in combined IFG/IGT group was significantly higher than that in i-IFG or i-IGT group. High baseline fasting plasma glucose, 2 h plasma glucose, and HbA 1C levels were the independent risk factors for the development of diabetes. High level of HDL-C was an promoting factor for reversion to normal glucose tolerance. Weight loss can significantly reduce the risk of progression to diabetes in individuals with prediabetes.

Objective:To observe the differences in scleral lamina curvature (SLC) of patients with pseudoexfoliation glaucoma (PXG), primary open-angle glaucoma (POAG), and primary chronic angle-closure glaucoma (CPACG) were compared and analyzed and their significance was analyzed.Methods:A retrospective clinical study. From June 2017 to December 2020, 30 PXG (PXG group), POAG (POAG group) and CPACG patients (CPACG group) diagnosed at Eye Center of Cangnan County people's Hospital of Zhejiang Province (Cangnan Hospital Affiliated to Wenzhou Medical University) were included in the study. The age difference between the three groups of patients was statistically significant ( t=17.925, P=0.001); gender composition ratio ( χ2=2.158, P=0.276), intraocular pressure ( t=4.993, P=0.078), and axial length ( t=1.956, P=0.532), central corneal thickness ( t=1.407, P=0.724), average visual field defect ( t=2.725, P=0.496), optic disc retinal nerve fiber layer thickness ( t=2.185, P=0.492) in comparison, the differences were not statistically significant ( P>0.05). The frequency-domain optical coherence tomography deep-enhanced imaging (OCT EDI) technology was used to measure the average and 0°, 30°, 60°, 90°, 120°, 150° SLC of the affected eyes, and calculate the SLC index (SLCI) and SL curve depth (SLCD). Quantitative data comparison between groups used independent sample t test. Count data comparison used χ2 test. Univariate and multivariate logistic regression analysis were used for correlation analysis. Results:The results of OCT EDI examination showed that the SLC of eyes with PXG and CPACG was significantly steep, while the SLC of eyes with POAG was relatively flat. Except for the angle of 150°, the other 6 angles of SLCI and SLCD in the PXG group and CPACG group were higher than those in the POAG group, and the differences were statistically significant ( P<0.05). However, there was no statistically significant difference between PXG group and CPACG group for 7 angles of SLCI and SLCD ( P>0.05). Logistic regression analysis showed that the average SLCI [odds ratio (OR)=1.498, 95% confidence interval ( CI) 1.137-2.018, P=0.001], age ( OR=1.074, 95% CI 1.019-1.143, P=0.016) was significantly correlated with PXG; mean SLCI ( OR=1.625, 95% CI 1.192-1.997, P=0.001), intraocular pressure ( OR=1.383, 95% CI 1.106-1.993, P=0.012) was significantly correlated with CPACG. POAG group ( β=0.143, 95% CI 0.032- 0.208, P=0.016), CPACG group ( β=0.132, 95% CI 0.079-0.315, P=0.043) intraocular pressure was correlated with mean SLCI; all factors of PXG group were correlated with SLCI without correlation ( P>0.05). Conclusion:Compared with POAG, the SLC of eyes with PXG and CPACG is steeper and related to disease occurrence.

Objective:To evaluate the early analgesic effect of new non-steroidal anti-inflammatory drugs 0.1% bromofenac sodium hydrate eye drops in pterygium surgery and the efficacy and safety on relieving the irritative symptoms.Methods:One hundred patients (112 eyes) with pterygium who were treated in Cangnan People′s Hospital (Cangnan Hospital Affiliated of Wenzhou Medical University) from January 2016 to September 2017 were selected and divided into observation group and control group by the hospital sequence, with 50 patients in each group. Before operation and 7 d after operation, the patients in two group were given topical tobramycin eye drops (4 times a day), and the patients in observation group were given 0.1% bromofenac sodium hydrate eye drops twice a day on the base of tobramycin eye drops. The patients were investigated early after operation and the pain scores of the two groups were compared 6, 8, 24, 48 and 72 h after operation.The corneal epithelial healing was compared too.Results:The pain scores in observation group 6, 8, 24, 48 and 72 h after operation were significantly lower than that in control group [(0.96 ± 0.13) scores vs. (2.21 ± 0.07) scores, (0.90 ± 0.05)scores vs. (1.71 ± 0.30) scores, (0.71 ± 0.07) scores vs.(1.54 ± 0.09) scores, (0.51 ± 0.04) scores vs. (1.31 ± 0.10) scores, (0.21 ± 0.02) scores vs. (0.80 ± 0.1) scores], and the differences were statistically significant ( P<0.05). The corneal wound healing rate of the two groups 2 or 3 d after operaion had no significant differences and the corneal wound healing rate 7 d after operaion was 100.0% (57/57, 55/55) in two groups. Conclusions:In pterygium surgery patients, using 0.1% bromfenac sodium hydrate drops before and after operation to relieve pain is valid, and can effectively relieve early postoperative pain.

Tongbu therapy, involving removing in reinforcing, is an important thought proposed by China’s famous TCM doctor ZHOU Le-nian in treating spleen and stomach diseases. This article discussed the significance of understanding of the pathogenesis, treating rules and methods, and specific prescribing and medication of chronic diarrhea, which will enlighten clinical doctors.

Objective To investigate the occurrence factors of duodenobiliary reflux (DBR) after endoscopic sphincterotomy (EST ) .Methods A total of 198 patients with choledocholithiasis hospitalized in the digestive department of the hospital from Sep-tember 2012 to February 2016 were selected and given duodenal papilla EST .The DBR occurrence was judged and the occurrence factors were investigated ,meanwhile the Oddi sphincter function was measured and long term complications were followed up .Re-sults All patients successfully completed EST ,the average common bile duct diameter in 198 cases was (2 .24 ± 0 .24)cm ,the aver-age common bile duct stones number was 3 .63 ± 1 .12 ;the maximum diameter of common bile duct stones was (1 .02 ± 0 .19)cm . There were 12 cases of DBR after EST ,the occurrence rate was 6 .1% ,the average radioactivity was (3 .39 ± 0 .89)MBq .The post-operative Oddi sphincter systolic peak and contraction frequency were (31 .49 ± 4 .22)mm Hg and (3 .78 ± 0 .53) times /min ,which were significantly lower than those before operation (P<0 .05);and the postoperative Oddi sphincter basic pressure and common bile duct pressure were (8 .23 ± 1 .03)mm Hg and (3 .32 ± 0 .45)mm Hg respectively ,which had no statistical difference compared with preoperation (P>0 .05) .The Logistic regression analysis showed that complicating gallbladder stone ,diameter of common bile duct ,frequency difference of Oddi sphincter contraction before and after operation ,number of stones and maximum diameter of stone were the main risk factors for postoperative DBR occurrence (P<0 .05) .All cases were followed up for 6 months ,18 cases developed long term complications ,the incidence rate was 9 .1% ,including 4 cases of reflux cholangitis ,6 cases of bile duct stric-ture ,4 cases of papillary stenosis and 4 cases of recurrence .Conclusion DBR after duodenal papilla EST is common ,which can re-sult in the Oddi sphincter function decrease and increase of long-term complications ,and needs to actively strengthen prevention and management .