Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.

Clinical trial is an important step of in vitro diagnostic reagents research and development. Based on the Guiding Principles and the key points of inspect on the spot, combined with the actual work experience, the article focuses on the prominent problems in the whole process of in vitro diagnostic reagent clinical trials. It is helpful to improve the level of hospital drug clinical trial centre and the quality of in vitro diagnostic reagent clinical trials by analyzing the issues.
Clinical Trials as Topic ; Indicators and Reagents/administration & dosage* ; Reagent Kits, Diagnostic

Objective To explore the safety and clinical value of percutaneous ultrasound‐guided core needle biopsy( PUS‐CNB) and endoscopic ultrasound‐guided fine needle aspiration( EUS‐FNA ) in pancreas mass . Methods Ultrasound‐guided biopsy were performed in 109 cases who were difficult to diagnose to get specimens from the highly suspicious parts of the lesions by avoiding vessels . PUS‐CNB were performed in 82 cases , EUS‐FNA in 19 cases and both in 8 cases . T he site and size of lesions were recorded preopeartion . Specimens with clear pathological diagnosis were considered as satisfactory materials . Specimens that were impossible to puncture due to the existence of high risk factors in the process of puncture were considered as unsuccessful biopsy . All patients were followed up after biopsy and complications were recorded . Results The satisfaction rate and success rate of PUS‐CNB were 98 .89% and 100% ,the diagnostic accuracy and false negative rate were 97 .78% and 2 .22% . T he satisfaction rate and success rate of EUS‐FNA were 96 .15% and 96 .30% ,the diagnostic accuracy and false negative rate were 80 .77% and 23 .81% . T here were no serious complications such as pancreatic fistula ,hemorrhage and needle transfer at the needle site after puncture . Conclusions Both PUS‐CNB and EUS‐FNA are safe and effective methods for the diagnosis of benign and malignant pancreatic lesions and have high clinical values . Reasonable selection of EUS‐FNA and PUS‐CNB can safely and reliably identify and diffentiate the benign and malignant pancreatic lesions .

Objective: To explore the safety and clinical value of percutaneous ultrasound-guided core needle biopsy(PUS-CNB) and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in pancreas mass. Methods: Ultrasound-guided biopsy were performed in 109 cases who were difficult to diagnose to get specimens from the highly suspicious parts of the lesions by avoiding vessels. PUS-CNB were performed in 82 cases, EUS-FNA in 19 cases and both in 8 cases. The site and size of lesions were recorded preopeartion. Specimens with clear pathological diagnosis were considered as satisfactory materials. Specimens that were impossible to puncture due to the existence of high risk factors in the process of puncture were considered as unsuccessful biopsy. All patients were followed up after biopsy and complications were recorded. Results: The satisfaction rate and success rate of PUS-CNB were 98.89% and 100%, the diagnostic accuracy and false negative rate were 97.78% and 2.22%. The satisfaction rate and success rate of EUS-FNA were 96.15% and 96.30%, the diagnostic accuracy and false negative rate were 80.77% and 23.81%. There were no serious complications such as pancreatic fistula, hemorrhage and needle transfer at the needle site after puncture. Conclusions Both PUS-CNB and EUS-FNA are safe and effective methods for the diagnosis of benign and malignant pancreatic lesions and have high clinical values. Reasonable selection of EUS-FNA and PUS-CNB can safely and reliably identify and diffentiate the benign and malignant pancreatic lesions.

Objective To assess the therapeutic efficacy of subcutaneous transplantation pancreatic cancer in nude mice model with different size microbubbles. Methods Eighteen Balb/C nude mice with subcutaneous pancreatic carcinoma xenografts were divided into three groups:group A( 6 mice) did not received microbubbles and ultrasonic irradiation;group B(6 mice) received standard microbubbles and ultrasonic cavitation treatment;group C(6 mice) received up-sized microbubbles and ultrasonic cavitation treatment.Body weight and tumor size of nude mice were measured respectively at the time points of 0,7, 14,21 days after three times ultrasound radiation and before ultrasound treatment. Tumor volumes were calculated.Then the mice were sacrificed finally. Results There was no significant difference in tumor volumes among three groups before treatment( P > 0.05). Tumor volume continued to increase in all groups.Compared with group A,growth rate in group B and group C were lower,growth rate in group B was higher than that in group C,the difference was statistically significant( P < 0.05). There was no significant difference in the parameters of regional blood volume(RBV) and regional blood flow(RBF)among three groups before treatment( P > 0.05). RBV and RBF were decreased significantly after 3 days treatment in group B and group C( P <0.05),the RBV and RBF in group C were lower than those in group B,the differences were statistically significant( P <0.05).There was no significant difference in the body weight of nude mice before and after radiation among three groups during the follow-up period( P >0.05). Conclusions The cavitation effect of up-sized microbubbles is more efficient for mice subcutaneous pancreatic cancer xenograft tumor inhibition compared with standard microbubbles.

Objective: To evaluate the diagnostic value of BRAF V600E mutation combined with shear wave elastography(SWE) for thyroid nodules of Bethesda Ⅲ diagnosed by fine-neddle aspiration(FNAC). Methods: One hundred and seventeen thyroid nodules diagnosed as Bethesda Ⅲ in the department of ultrasound and confirmed by BRAF V600E gene detection, SWE examination and surgery were collected. BRAF V600E detection, SWE examination and both combined with pathological results were using to retrospective analysis. Results: There were 75 benign nodules and 42 malignant nodules according to pathology. Sensitivity and negative predictive value of BRAF V600E combined with SWE were higher than single BRAF V600E mutation detection and SWE with statistically significant(P=0.01, 0.001; P=0.029, 0.01, respectively). There were no statistically differences between single BRAF V600E mutation detection and SWE for Bethesda Ⅲ nodules(P=0.483, 0.645). Conclusions BRAF V600E mutation detection combined with SWE can improve the sensitivity and negative predictive value in the diagnosis of Bethesda Ⅲ thyroid nodules.

Objective:To share a drug treatment experience for multiple drug resistant Pseudomonas aeruginosa.Methods:A retrospective analysis of the pharmaceutical care participated by clinical pharmacist for one case of intervertebral space infection with multiple drug resistant Pseudomonas aeruginosa was carried out.Results:Pharmacists participated in the whole treatment process,made the combined antimicrobial regimen (fosfomycin + ceftazidime + ciprofloxacin),and adjusted the time sequence.As a result,satisfactory curative effect was obtained.Conclusion:The infection with multiple drug resistant Pseudomonas aeruginosa may be treated with the three-drug therapy.Clinical pharmacists can play a positive role in the treatment of complicated infections.

OBJECTIVE:To evaluate the rationality of cefoxitin use in our hospital. METHODS:Evaluation index and evalua-tion criteria were established on the basis of DUE. The relative weight of evaluation index were calculated by using attribute-based AHM weight method,and the gas between medical orders and complete rational ones were evaluated by using TOPSIS processing method. The proportion of rational medical orders were calculated to evaluate the rationality of drug use. RESULTS:Among 116 medical records,there were 19%reasonable medical orders(including 4.3%complete reasonable medical orders,5 cases),50%ba-sically reasonable medical orders(58 cases)and 31% unreasonable medical orders(36 cases). CONCLUSIONS:It is reasonable and feasible to use AHM weighted TOPSIS method to evaluate the rationality of cefoxitin. The utilization of cefoxitin in our hospital is basically reasonable,but there are still many problems.