Objective To explore the value of Chinese thyroid imaging reporting and data system(C-TIRADS)combined with intranodular and perinodular stiffness for distinguishing benign and malignant thyroid nodules.Methods Data of routine ultrasound and ultrasonic shear wave elastography(SWE)in 117 patients with thyroid nodules confirmed by fine needle aspiration cytology(FNAC)and/or surgical pathology were retrospectively analyzed.The nodules were classified according to C-TIRADS and SWE parameters of nodules and surrounding 2 mm glands measured with SWE technique,including Young's modulus of thyroid nodules(E)and perinodular glandular(Eshell)(the maximum[Emax/Eshellmax],the mean[Emean/Eshellmean]and the minimum[Emin/Eshellmin]as well as standard deviation[ESD/EshellSD]values).Then receiver operating characteristic(ROC)curve was drawn,and area under the curve(AUC)was calculated to assess the efficacy of C-TIRADS,SWE and the combination for differentiating benign and malignant thyroid nodules.Results Totally 117 thyroid nodules of 117 patients were enrolled,including 50 benign and 67 malignant ones.SWE parameters of malignant thyroid nodules were higher than those of benign ones(all P＜0.001).AUC of C-TIRADS for differentiating benign and malignant thyroid nodules was 0.736,with sensitivity of 79.10％,specificity of 68.00％and accuracy of 74.36％.AUC of Emax,Emean,Emin and ESD was 0.816,0.752,0.664 and 0.705,respectively,of Emax was the highest.AUC of Eshellmax,Eshellmean,Eshellmin and EshellSD was 0.834,0.804,0.693 and 0.697,respectively,of Eshellmax was the highest,which was not statistically difference with that of Emax(Z=1.044,P=0.297).AUC of C-TIRADS+Emax and C-TIRADS+Eshellmax was 0.835 and 0.843,respectively,being not significantly different(Z=0.574,P=0.566)but higher than that of C-TIRADS(AUC=0.736,Z=2.510,2.230,both P＜0.05),with diagnostic specificity and accuracy both higher than those of C-TIRADS(all P＜0.05).Conclusion C-TIRADS combined with intranodular and perinodular stiffness could be used to effectively distinguish benign and malignant thyroid nodules,which might improve diagnostic efficiency of C-TIRDAS.

【Objective:】 To understand the development of narrative medicine in medical schools and the cognitive level of narrative medicine among medical students. 【Methods:】 Taking 2,353 medical students nationwide as the research subjects, Knowledge, Attitude/Belief, Practice (KAP) questionnaire was distributed online to conduct a survey. The survey results were analyzed from the perspectives of general knowledge, ways to understand narrative medicine, and cognitive level of parallel medical records. 【Results:】 44.50% of the survey respondents had never learned about narrative medicine, and 50.79% of them had never heard of parallel medical records. 26.80% of the survey respondents had participated in the training of narrative medicine courses, while most medical students learned about narrative medicine through other ways. 【Conclusion:】 This paper showed that the majority of the survey respondents are not familiar with the key concepts of narrative medicine. By introducing the concept of big culture in anthropology into medical college education or exploring the perspective of doctor-patient interaction, integrating communication models to improve doctor-patient relationships. The current popularization level of parallel medical records and narrative types among medical students is not good, and the cultivation of cultural sensitivity and reflective ability may help promote the teaching and application of parallel medical records. Multiple learning pathways lay the foundation for further teaching, and build a diversified teaching system to enrich the course content, which should be the focus of promoting narrative medicine education in the future.

Objective:The study takes the Youth Research Project of National Natural Science Foundation of China (NSFC) as an example, analyzes the development and management optimization strategy of such research project in a children′s hospital, to provide reference for the training of pediatric young talents.Methods:Personnel interview and questionnaire survey were adopted to analyze the common characteristics of project application and approval, trend of change, demand and bottleneck challenges of the NSFC Youth Research Project from 2016 to 2022.Results:The total number of approved project were increasing while the rate of the bids fluctuated, and the distribution of department, gender and age are not balanced, full-time scientific research personnel, male, young age and other factors have the advantages of being approved. Five influential factors, including scientific research accomplishment, supporting conditions, research foundation, methods & skills, and scientific research atmosphere and environment, were identified as necessary components of getting funded. The survey also founded that two thirds of the needs run through the whole application process that from the topic selection, nurtured seed-funding, team-building and proposal development.Conclusions:This study puts forward a management plan for youth scientific research projects in children′s hospital from three aspects that including hospital, department and individual. The management department should strengthen the transformation from " full application" to " effective application" , at the same time, more attention should be paid to the selection, training and resource allocation to further optimize the training strategy of youth talents.

Objective:To investigate whether astaxanthin (AST) down-regulates dynamin-related protein 1 (Drp1) through activating the silent mating type information regulation 2 homolog-1 (SIRT1) signaling pathway, thereby attenuating contrast-induced acute kidney injury.Methods:Forty adult male Sprague-Dawley rats weighing 160-180 g were randomly divided into five groups: sham surgery group (Sham group), contrast medium injury group (CM group), astaxanthin-intervention group (AST+CM group), SIRT1 inhibitor Ex527 intervention group (Ex527+CM group), and astaxanthin combined with Ex527 intervention group (AST+Ex527+CM group). After 72 hours of modeling, heart blood was removed and kidney tissues were collected for follow-up testing. Serum creatinine (Scr), blood urea nitrogen (BUN), and oxidative stress-related indexes total superoxide dismutase (T-SOD) and malondialdehyde (MDA) were measured by biochemistry; hematoxylin and eosin staining was performed to observe the pathological changes in the kidney; mitochondrial morphology and number were observed by transmission electron microscopy; reactive oxygen species (ROS) levels were detected by ROS staining in frozen sections; TUNEL staining was performed to detect apoptosis level. The expression levels of SIRT1, p53, peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), Drp1 and apoptosis-related proteins Bcl-2 and Bax were detected by Western blotting.Results:(1) Compared with the CM group, Scr and BUN level were significantly lower, T-SOD level was higher and MDA level was lower in the AST+CM group, while T-SOD level decreased and MDA level increased after the combination of Ex527 (all P<0.05). (2) ROS expression was lower in the AST+CM group compared to the CM group and higher after the combination of Ex527 (both P<0.05). (3) The number of apoptotic cells was significantly reduced in the AST+CM group compared to the CM group and increased after the combination of Ex527 (both P<0.05). (4) The protein expression levels of SIRT1, PGC-1α and Bcl-2 were increased and the protein expression levels of p53, Drp1 and Bax were decreased (all P<0.05) in the AST+CM group compared with the CM group, and the protein expression levels of SIRT1, PGC-1α and Bcl-2 were decreased and the protein expression levels of p53, Drp1 and Bax were increased when Ex527 was combined (all P<0.05). Conclusion:Astaxanthin can inhibit Drp1-mediated mitochondrial fission by activating the SIRT1 pathway, thereby reducing contrast-induced acute kidney injury in rats.

Objective:To study the classification of persistent fifth aortic arch (PFAA) and the value of echocardiography in the diagnosis of PFAA.Methods:A total of 16 cases (male 6, female 10, at ages from 7 days to 4 years and 2 months old, the median age was 3 months) diagnosed with PFAA in Beijing Children′s Hospital Affiliated to Capital Medical University from January 2013 to June 2019 were studied retrospectively. The diagnosis standard, differential methods and misdiagnosed analysis of different subtypes of PFAA by echocardiography were summarized and analyzed.Results:The 16 cases included 1 case of type A1 double lumen aortic arch, 8 cases of type A2 single-lumen aortic arch, 3 cases of type B1 with pulmonary atresia and 4 cases of type B3 pulmonary artery branch arising from the distal end of ascending aorta. Only one patient of double lumen aortic arch missed diagnosis by echocardiography, and the rest were accurately diagnosed by echocardiography. CTA was performed in 13 cases, including 9 cases of type A, 1 case of type B1 and 3 cases of type B3, which confirmed the echocardiography diagnosis. Seven cases of Type A2 were operated.Conclusions:PFAA is a rare and complicated aortic arch malformation, which is divided into four major classification and multiple subtypes. Echocardiography can diagnose the PFAA and its classification, it is of great clinical significance for the early diagnosis, treatment and prognosis of children.

In China's 13th Five-Year Plan, it points out that it is necessary to establish a family-based and community-based old-age service model. As a result, there is a growing demand for community old-age service. As the core technology of geriatric medicine, comprehensive geriatric assessment (CGA) has been widely applied in various clinical fields. This paper mainly summarizes the basic concept of CGA and the research progress and application of CGA in community old-age service.

Objective To improve the efficiency of result reporting and ensure the accuracy of the results by establishing autoverification system in Clinical Chemistry and Immunology Laboratory.Methods The study followed the requirements of the Clinical Laboratory Standards Institute(CLSI)AUTO-10A and ISO 15189:2012.In addition,seven categories of verification rules were encoded using the autoverification function of the CentraLink?Data Management System on the Aptio?Automation platform.These rules included Clinical Diagnostic Standard(CS), Sample Status(SS), Quality Control Severity(QS), Instrument Error Flags Severity(IS), Normal Severity(NS), Delta Check Severity(DS), and Logical Assessment Standard(LS).Various modules of Aptio Automation,laboratory information system(LIS)and hospital information system(HIS)were integrated using the CentraLink system to establish the autoverification system.Results The autoverification system was set up and tested from August 2015 to April 2016.In total, the system ran 4 496 425 tests on 366 180 chemistry specimens.The overall autoverification rate for tests performed increased from 53.4% to 87.0%.Glucose had the highest rate (98.3%)while CKMB had the lowest rate(63.6%).Average TAT for result verification decreased by 97.7%,from 46.3 minutes to 3.7 minutes.The system ran 410,040 tests on 160 119 chemiluminescence specimens.The autoverification rate for tests performed increased from 40.2%to 89%.C-P had the highest rate(98.4%)while A-TPO had the lowest rate(58.7%).Average TAT for result verification decreased by 77.4%,from 14.6 minutes to 3.3 minutes.From May 2016 to January 2017(when autoverification was employed),compared with the same period in 2014(when manual verification was employed),the following changes were observed with no increase in staff capacity:a)Volume of routine chemistry tests increased by 46.4%,and median TAT for tests decreased by 41.9%, from 118 minutes to 83 minutes; b)Volume of chemiluminescence tests increased by 24.5%and median median TAT for tests decreased by 52.4%, from 131 minutes to 86 minutes;c)Median TAT for critical values decreased by 50.5%; d)Rates of tests that did not go through autoverification were 88.2% for NS,6.05% for SS, 2.40% for DS,2.00% for LS, 0.97%for IS,and 0.43% for CS; e)Rates of abnormal specimen status identified by Aptio Automation were 7.13‰for jaundice,5.39‰ for blood lipids,2.20‰ for hemolysis,0.17‰ for barcode error, and 0.15‰ for insufficiency;f)Error rate decreased to 0.00%;and g)staff satisfaction increased from 85%to 100%.Conclusion Autoverification of results by using the CentraLink Data Management System can achieve quality control over the entire process of clinical laboratory testing, ensure accuracy of test results, improve work efficiency, decrease TAT, minimize the error rate, avoid skill variation of staff, reduce the pressure of performing manual verification,and improve medical security.

Objective The aim of the present study is to evaluate the reliability and validity of the Mandarin version of the PP (MPP) .Methods The first step in the establishment was to translate the original English version into mandarin version with the method of cross -culture translation .The reliability was performed with the internal consistency analysis and test -retest reliability .The validity was performed for the content validity and structure va-lidity .The samples were from 80 Chinese CI children ,and 43 parents answered this questionnaire again 1 month lat-er to evaluate the test -retest reliability .The average age at cochlear implantation were 26 ± 14 months ,ranging from 7 months to 68 months ,the average duration of CI use were 10 ± 7 months ,ranging from 0 month to 24 months .Results The reliability analysis indicates that the Cronbach'sαcoefficient was 0 .797 ,except for the well-being and happiness ,education ,whose coefficients are respectively 0 .303 ,and 0 .341 ,all of the other sundomainscoefficient were greater than 0 .5 ,indicating the internal consistency was good .Test -retest reliability of the scale Cronbach'sαwas satisfactory .All subdomains and total score of the scale coefficients were greater than 0 .70(P<0 .01) .The validity analysis indicated that the pearson correlation coefficients among the total scale and the 8 subdo-mains were 0 .395~0 .992 ,the correlation coefficients among each subdomains were 0 .09~0 .654 ,which confirmed with the psychological characteristics ,proving its good structure validity .Conclusion The Chinese version of the PP show s good reliability and validity and can be used to evaluation the quality of life in mandarin CI children.

Pupose To explore the role of histogram analysis of apparent diffusion coefficient (ADC) maps obtained from multiple b value diffusion weighted imaging (DWI) in the assessment of progression of high-grade glioma (HGG) treated with chemoradiotherapy so as to determine the optimal b value.Materials and Methods Forty-one consecutive patients with HGG proved histopathologically who had undergone concurrent chemoradiotherapy at Second Hospital of Hebei Medical University from September 2014 to October 2015 were enrolled in the study.All the subjects underwent diffusion weighted MR imaging before and after therapy with b values of 0,1000,2000 and 3000 s/mm2.Based on the clinical and radiographic follow-ups,the patients were divided into progression and nonprogression groups.ADC maps were calculated according to hyperintense FLAIR lesions after completion of chemoradiotherapy.The fifth percentile (C5) in terms of cumulative histograms in different b-value ADC maps in multiple b value DWI was calculated,and the C5 of each ADC map between progression and non-progression groups was compared.Moreover,receiver operating characteristic analysis was used to determine the best cutoff values and diagnostic accuracy for predictors in the differentiation of true progression from non-progression.Results The C5 of all different b value ADC maps were significantly lower in the progression group than those in the non-progression group (P＜0.01).In terms of the accuracy of assessing the progression after therapy,the C5 in the high b value ADC maps was significantly higher than that in the low b value ADC maps.The area under the receiver operating characteristic curve (AUC) of the C5 was 0.717,0.832,0.909,0.933 and 0.937 respectively in the 5 ADC maps [ADC(1000/0),ADC(2000/0),ADC(30000/0,ADC(3000/1000) and ADC(3000/2000)].When the cutoff value of C5 was 405.6 mm/s2 in ADC(3000/2000) map,the sensitivity,specificity,positive predictive value and negative predictive value were 90.9％,89.7％,89.9％ and 91.0％,respectively.Conclusion The C5 in ADC map can effectively differentiate tumor progression of HGG,and that of high b values have higher accuracy.

Objective To evaluate the application value of ADC of different b-value ADC maps in multiple b-value DWI for assessment of early treatment response and detection of tumor progression.Methods Totally 47 postoperative patients with glioma were enrolled.All of them accepted chemoradiotherapy after operation.Conventional MRI and multiple b-value DWI (b=0,1 000,2 000,3 000 s/mm2) scans were performed.The mean and minimal ADC values (ADC and ADCrmin) were measured in 5 differrent corresponding ADC maps,such as ADC(1 000/0),ADC(/2 000/0),ADC(3 000/0),ADC(3 000/1000） and ADC(3 000/2 000).And the relative values (rADC and rADCmin) were calculated.The differences of ADC values among different reaction types (complete response,partial response,stable disease and progressive disease)and between progressive and non-progressive groups were compared.ROC analysis was used to determine the best cutoff values and diagnostic efficiency of ADC value for diagnosis of tumor progression.Results The rADC in ADC(3 000/0),ADC(3 000/1000） and ADC(3 000/2 000) maps were significantly different among different response types and between progressive group and non progressive group (all P＜0.05).The ADC in ADC(3 000/1000） and ADC(3000/2 000) maps were significantly different among different response types and between progressive group and non-progressive group (all P＜0.05).The ADC and rADC in ADC(3 000/2 000) map had the maximum area under curve (0.86,0.84).When ADC and rADC in ADC3 000/2 000 map were 408.65 × 10-6 mm2/s and 1.12,the sensitivities and specificities were 89.3 ％0,71.0 ％00 and 92.9 ％,77.4 ％,respectively.Conclusion The ADC and rADC in high b-value ADC maps are helpful to discriminate the early treatment response from tumor progression,which can provide valuable information for identification of tumor progression of glioma after treatment.