Objective To explore the value of intensity ratio(IR)of lesion to non-tumor liver parenchyma on contrast-enhanced ultrasound(CEUS)Kupffer phase for differentiating hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC)/metastatic liver carcinoma.Methods Totally 54 patients with HCC(HCC group),30 with IHC and 51 with liver metastatic carcinoma(non-HCC group)diagnosed by pathology were retrospectively enrolled.Quantitative parameters derived from CEUS time-intensity curves,including peak intensity(PI),time to peak(TTP),wash-in area under the curve(WiAUC),wash-out area under the curve(WoAUC),wash-in and wash-out area under the curve(WiWoAUC)of lesion in vascular phase and IR of lesion to non-tumor liver parenchyma in Kupffer phase were compared between groups,and a combined diagnostic model was established based on parameters being significantly different between groups using binary logistic regression analysis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to evaluate the efficacy of each CEUS parameter alone and the combined model for differentiating HCC and IHC/liver metastatic carcinoma.Results In HCC group,PI,WoAUC and WiWoAUC were all higher(all P＜0.001),while IR was significantly lower than those in non-HCC group(P＜0.001).The AUC of PI,WoAUC,WiWoAUC and IR for differentiating HCC and IHC/metastatic liver carcinoma was 0.673,0.741,0.738 and 0.736,respectively,all lower than that of combined model(0.862,all P＜0.05).Conclusion IR of lesion to non-tumor liver parenchyma on CEUS Kupffer phase could be used to differentiate HCC and IHC/metastatic liver carcinoma.Combining with quantitative parameters on CEUS vascular phase could improve differentiating efficiency.

Objective To observe the value of noninvasive right ventricular pressure-strain loop(RVPSL)for quantitative evaluation on right ventricular myocardial function changes in liver cirrhosis patients after TIPS.Methods Totally 26 cases of liver cirrhosis who would undergo TIPS were prospectively recruited as liver cirrhosis group.Echocardiography was performed before and 1 week,1 month after TIPS,and parameters of right ventricular myocardial function,including routine right ventricular echocardiography,right ventricular strain and right ventricular myocardial work were acquired.Meanwhile,30 healthy adults were recruited as control group,and the above parameters were recorded.Then these parameters were compared between groups,also before and after TIPS within liver cirrhosis group,and the changes of right ventricular myocardial function after TIPS were evaluated.Results Right ventricular global work index(RVGWI),right ventricular global constructive work(RVGCW)and right ventricular global wasted work(RVGWW)in liver cirrhosis group were higher than those in control group at all time points(all P＜0.05).One weak and 1 month after TIPS,right ventricular global longitudinal strain(RVGLS)and right ventricular free wall longitudinal strain(RVFWLS)in liver cirrhosis group were all higher than those in control group(all P＜0.05).In liver cirrhosis group,RVGWI,RVGCW and RVGWW 1 week after TIPS were all higher than those before TIPS and 1 month after TIPS(all P＜0.05),while RVGLS 1 weak and RVGWI 1 month after TIPS were both higher than those before TIPS(both P＜0.05).Conclusion Noninvasive RVPSL could be used to sensitively and quantitatively evaluate right ventricular function changes in patients with liver cirrhosis after TIPS.

Objective To observe the value of noninvasive right ventricular pressure-strain loop(RVPSL)for quantitative evaluation on right ventricular myocardial function changes in liver cirrhosis patients after TIPS.Methods Totally 26 cases of liver cirrhosis who would undergo TIPS were prospectively recruited as liver cirrhosis group.Echocardiography was performed before and 1 week,1 month after TIPS,and parameters of right ventricular myocardial function,including routine right ventricular echocardiography,right ventricular strain and right ventricular myocardial work were acquired.Meanwhile,30 healthy adults were recruited as control group,and the above parameters were recorded.Then these parameters were compared between groups,also before and after TIPS within liver cirrhosis group,and the changes of right ventricular myocardial function after TIPS were evaluated.Results Right ventricular global work index(RVGWI),right ventricular global constructive work(RVGCW)and right ventricular global wasted work(RVGWW)in liver cirrhosis group were higher than those in control group at all time points(all P＜0.05).One weak and 1 month after TIPS,right ventricular global longitudinal strain(RVGLS)and right ventricular free wall longitudinal strain(RVFWLS)in liver cirrhosis group were all higher than those in control group(all P＜0.05).In liver cirrhosis group,RVGWI,RVGCW and RVGWW 1 week after TIPS were all higher than those before TIPS and 1 month after TIPS(all P＜0.05),while RVGLS 1 weak and RVGWI 1 month after TIPS were both higher than those before TIPS(both P＜0.05).Conclusion Noninvasive RVPSL could be used to sensitively and quantitatively evaluate right ventricular function changes in patients with liver cirrhosis after TIPS.

Objective To explore the value of intensity ratio(IR)of lesion to non-tumor liver parenchyma on contrast-enhanced ultrasound(CEUS)Kupffer phase for differentiating hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC)/metastatic liver carcinoma.Methods Totally 54 patients with HCC(HCC group),30 with IHC and 51 with liver metastatic carcinoma(non-HCC group)diagnosed by pathology were retrospectively enrolled.Quantitative parameters derived from CEUS time-intensity curves,including peak intensity(PI),time to peak(TTP),wash-in area under the curve(WiAUC),wash-out area under the curve(WoAUC),wash-in and wash-out area under the curve(WiWoAUC)of lesion in vascular phase and IR of lesion to non-tumor liver parenchyma in Kupffer phase were compared between groups,and a combined diagnostic model was established based on parameters being significantly different between groups using binary logistic regression analysis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to evaluate the efficacy of each CEUS parameter alone and the combined model for differentiating HCC and IHC/liver metastatic carcinoma.Results In HCC group,PI,WoAUC and WiWoAUC were all higher(all P＜0.001),while IR was significantly lower than those in non-HCC group(P＜0.001).The AUC of PI,WoAUC,WiWoAUC and IR for differentiating HCC and IHC/metastatic liver carcinoma was 0.673,0.741,0.738 and 0.736,respectively,all lower than that of combined model(0.862,all P＜0.05).Conclusion IR of lesion to non-tumor liver parenchyma on CEUS Kupffer phase could be used to differentiate HCC and IHC/metastatic liver carcinoma.Combining with quantitative parameters on CEUS vascular phase could improve differentiating efficiency.

Objective To observe the correlations of conventional ultrasound and contrast-enhanced ultrasound(CEUS)features with expression level of Ki-67 of intrahepatic cholangiocarcinoma(ICC).Methods A total of 77 patients with pathologically confirmed ICC were retrospectively enrolled.According to the expression level of Ki-67 of target lesions,the patients were divided into high expression group(Ki-67≥20%,n=53)and low expression group(Ki-67＜20%,n=24).The features showed on conventional ultrasound and CEUS were compared between groups,and the variables being significantly different were analyzed with multivariate logistic regression to select ultrasonic features being correlated with Ki-67 expression level of ICC.Results The mean maximum diameter of ICC in high expression group was larger than that in low expression group([6.2±2.0]cm vs.[5.2±1.9]cm,P=0.041),and the percentage of ICC with maximum diameter>5 cm in high expression group was higher than that in low expression group(66.04%vs.33.33%,P=0.007).No significant difference of the lesions shape,border nor the internal echogenicity showed on conventional ultrasound was found between groups(all P＞0.05).The percentage of ICC with peripheral rim enhancement and enlargement after enhancement in high expression group were both higher than those in low expression group(both P＜0.05),but no significant difference of the enhancement pattern,the presence or absence of non-enhance area within the lesion nor the peak intensity of lesions was found between groups(all P＞0.05).The maximum diameter larger than 5 cm(OR=5.612,P=0.004)and peripheral rim enhancement(OR=3.880,P=0.025)were both independent factors for predicting high Ki-67 expression level of ICC.Conclusion ICC with the maximum diameter larger than 5 cm and peripheral rim enhancement on CEUS might indicate high expression level of Ki-67,which was helpful for clinical treatment decisions.

Objective:To investigate the current status of professional identity among the clinical medical postgraduates and its correlation with mentoring function and professional competency, so as to provide reference for optimizing the training mode of clinical medicine postgraduates.Methods:A questionnaire survey was conducted among 217 academic and professional full-time postgraduates from Batch 2016 to 2018 majoring in clinical medicine in Peking University Health Science Center in 2019. The contents included four aspects: basic information, preliminary questionnaire of professional identity, mentoring function scale and professional competency. SPSS 26.0 was used for t test, one-way ANOVA, Kruskal-Wallis H test, and Pearson correlation analysis to analyze the status of professional identity and its correlation with professional competency and mentoring function. Results:Both professional and academic clinical medicine postgraduates had high scores of the overall level and four factors, and there was no statistical significance in the scores between the two groups ( P >0.05). There were significant differences in the overall level, behavior and appropriateness of professional identity among different grades of professional postgraduates ( P<0.05). Correlation study showed that the professional identity was significantly positively correlated with the total score of professional competency and mentoring function ( P<0.001). Further interview survey showed that the role of supervisor and employment prospects also played an important role in the elevation of professional identity. Conclusion:The overall degree of professional identity of academic and professional postgraduates is good and closely related to professional competency and mentoring function and for professional postgraduates, the overall level of professional identity of senior students is better. It is suggested that besides focusing on their professional competency, it is necessary to further optimize the employment policy of academic postgraduates and the training of tutors for professional postgraduates.

OBJECT IVE To provide scientific evidence for the quality standard research of Qingyi mixture （QM）qualitatively and quantitatively. METHODS The high performance liquid chromatography （HPLC）fingerprint of QM was established ，and the chemical pattern recognition analysis was carried out. At the same time ，the contents of 8 components such as chlorogenic acid in the preparation were determined. The determination was performed on Agilent SB-C 18 column with 0.1％ phosphoric acid-acetonitrile as mobile phase （gradient elution ）at the flow rate of 0.6 mL/min. The column temperature was 35 ℃，and detection wavelength was set at 254 nm. Similarity Evaluation System of Chromatographic Fingerprint of Traditional Chinese Medicine（2012 edition），SPSS 20.0 and SIMCA 14.1 were used to perform similarity evaluation ，cluster analysis （CA），principle component analysis （PCA）and orthogonal partial least squares-discriminant analysis （OPLS-DA）of QM samples. RESULTS A total of 22 common peaks were calibrated by 15 batches of QM ，and the similarity was over 0.975. Twenty-two common peaks were assigned and 8 of them were identified. CA ，PCA and OPLS-DA divided the 15 batches of QM into two categories. Meanwhile，5 differential components were screened out ，i.e. peak 9（cichoric acid ），peak 14（baicalin），peak 18，peak 19 and peak 21 （baicalein）. The contents of 8 components，such as chlorogenic acid ，ferulic acid ，cichoric acid ，hesperidin， baicalin，salvianolic acid B ，baicalein and paeonol ，were 0.077-0.094，0.165-0.190，0.100-0.114，0.083-0.107，0.556-0.615，0.288-0.314，0.152-0.188 and 0.114-0.128 mg/g，respectively. CONCLUSIONS The established HPLC fingerprint and content determination method can provide reference for the quality standard research of QM.

Objeetive To investigate the relationship among social avoidance and acceptance of disability in burn patients.Methods Totally 127 patients were investigated using Social Avoidance and Distress Scale (SADS),Acceptance of Disability Scale (AODS),demographic information questionnaire and disease related information sheet.Results The points of burn patients' SADS was (21.38±6.75),One-way ANOVA showed that gender,marital status,special parts burns,amputation affected social avoidance significantly.The total score and factors scores of acceptance of disability were all negatively related to the score of social avoidance.Regression analysis showed that acceptance of disability,head burns,gender were the independent risk factors of depression.Conclusions Acceptance of disability were negatively related to social avoidance; Nurse can help them accept the reality of disability,develop the confidence to partici-pate in social communication,and improve the social adaptability.

Objective To understand the mutual relation of general self-efficiency and high quality care among clinical nurses .Methods Using the General Self-Efficiency Scale ( GSES) and the quality nursing care brief questionnaire , we surveyed 120 nurses selected from a hospital in Xiamen .Results The mean score of GSES was (2.41 ±0.82), which was lower than the norm score of (2.95 ±0.53).The difference was significant (t=-4.385,P<0.05).The mean score of quality nursing care brief questionnaire was (94.84 ± 12.49).Nurses, with different age, titles and working years, had significant differences in the score of GSES (t=4.464, 2.55, 2.89, respectively;P<0.05).There was a positive relationship between nurses ’ general self-efficacy and high quality care (r =0.245,P<0.05).Multiple linear regression analysis revealed that attitude towards work , technical ability and timely operation were the influencing factors of nurses ’ general self-efficacy scores .Conclusions The general self-efficacy of nurses should be improved .Nursing administrators should pay attention to nurses ’ general self-efficacy and encourage them to adopt active communication skills , and strengthen their conviction and take some measures , such as increasing propaganda , clearing the meaning of high quality care , so as to promote the development of nursing staff .