177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To explore the application effect of breakthrough series (BTS) quality improvement model in the prevention of catheter-related bloodstream infection in hospitalized patients with indwelling non-cuffed catheter (NCC).Methods:Using a non synchronous pre and post control study method, convenience sampling was used to select NCC patients from four hospitals in Tianjin from January to September 2022 who received conventional nursing plans as the control group, and NCC patients from February to October 2023 who received nursing plans based on the BTS quality improvement model as the observation group. Compared the incidence of NCC related bloodstream infections between two groups of patients, the implementation of key preventive measures for NCC related bloodstream infections by nursing staff, and patient satisfaction.Results:Among the 984 patients included in the control group, there were 687 males and 297 females, aged (62.43 ± 13.77) years old; among the 959 patients included in the observation group, there were 651 males and 308 females, aged (61.96 ± 13.89) years old. After applying the improved model, the incidence of NCC related bloodstream infections in the observation group was 0.12‰ (1/8 676), lower than the control group′s 0.71‰ (7/9 827), and the difference was statistically significant ( χ 2=4.37, P<0.05) ;the implementation rate of key measures for preventing NCC related bloodstream infections in the observation group was 90.00% (54/60) for catheter outlet care and 91.67% (55/60) for maximizing sterile barrier, both higher than 70.37% (38/54) and 75.93% (41/54) in the control group, with statistical significance ( χ2=7.03, 5.30, both P<0.05); the total satisfaction rate of patients in the observation group was 92.91% (891/959), which was higher than 58.64% (577/984) in the control group, and the difference was statistically significant ( χ2=15.28, P<0.05). Conclusions:The implementation of BTS quality improvement model is helpful to improve the nursing quality of patients with indwelling NCC dialysis and improve the patient outcomes.

Objective:To investigate the status quo and influencing factors of social isolation of parents of children with autism spectrum disorder in order to provide theoretical basis for clinical intervention measures.Methods:A total of 340 parents of children with autism spectrum disorder who visited the Children′s Developmental Behavior Center of Third Affiliated Hospital of Sun Yat sen University were selected by the convenience sampling method as research objects during July to November 2023. A cross-sectional survey was investigated by a general information questionnaire, General Alienation Scale, Social Avoidance and Distress Scale, Affiliate Stigma Scale, Family APGAR Index, Chinese Simplified Version of Social Support Scale, and Social Responsiveness Scale.Results:A total of 323 valid questionnaires were collected, including 235 mothers and 88 fathers; 33 individuals aged 25-29 years, 233 individuals aged 30-39 years, and 57 individuals aged 40-60 years. The subjective social isolation score of parents of children with autism spectrum disorder was 33.24 ± 4.92 and the objective social isolation score was 4.00(2.00,7.00). The results of multiple linear regression analysis showed that the subjective social isolation of parents of children with autism spectrum disorder was influenced by factors including self-assessed health status, whether they worked full-time or not, whether they were satisfied with the division of labor in the family caring for their children, affiliate stigma, family care, and social support (all P<0.05); and the objective social isolation of parents was influenced by factors including the severity of autism symptoms, self-assessed health status, affiliate stigma, and family care (all p<0.05). Conclusions:Parents of children with autism spectrum disorder had some degree of social isolation, and the level of subjective social isolation was higher than objective social isolation. Healthcare professionals should pay attention to parents of autistic children who have high levels of symptom severity, poor self-rated health, do not work full-time, and are dissatisfied with the division of labor in the family caring for their child, and take measures to reduce the affiliate stigma, and to increase the level of family care and social support, so as to improve the social isolation of parents of children with autism spectrum disorder.

Objective:To explore the imaging features of 18F-fluorodeoxyglucose (FDG) PET/CT (high-resolution CT, HRCT) imaging in focal organizing pneumonia (FOP). Methods:Patients with solid nodular FOP ( n=45; 33 males, 12 females, age (58±9) years) and early peripheral non-mucinous solid lung adenocarcinoma ( n=47; 21 males, 26 females, age (63±10) years) confirmed by postsurgical pathology between May 2012 and December 2018 in Zhongshan Hospital, Fudan University were retrospectively analyzed. All patients underwent 18F-FDG PET/CT (HRCT) imaging followed by surgery within 3 weeks. The imaging findings and characteristics of the lesions were recorded. Differences of the maximum standardized uptake value (SUV max) and maximum diameter between FOP and adenocarcinoma were analyzed by Mann-Whitney U test or t′ test. Spearman correlation or Pearson correlation analysis was performed to analyze the relation between SUV max and maximum diameter. Binary logistic regression analysis was performed to identify the predictive factors for FOP. Finally, the receiver operating characteristic (ROC) curve analysis was used for evaluation of diagnostic efficiency. Results:The SUV max of FOP was lower than that of lung adenocarcinoma (3.1(1.7, 4.9) vs 6.5(3.8, 9.3); z=-4.598, P<0.01), and the maximum diameter of FOP was smaller than that of lung adenocarcinoma ((18.0±6.3) mm vs (21.8±4.3) mm; t′=-3.424, P<0.01). The SUV max was positively correlated with the maximum diameter in FOP group ( r s=0.509, P<0.01), while the SUV max of lung adenocarcinoma was not correlated with the lesion size ( r=0.076, P>0.05). HRCT of the PET/CT system showed the fusiform shape were more common in FOP ( χ2=9.549, P<0.05). Multivariate regression analysis identified that SUV max≤7.1, diameter≤18.3 mm, and fusiform shape were independent factors to predict FOP, with odds ratio ( OR) of 10.585, 4.674, 9.073, respectively (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) of SUV max≤7.1 combined with diameter≤18.3 mm and fusiform nodule was 0.860, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 97.8%(44/45), 70.2%(33/47), 75.9%(44/58), 97.1%(33/34), and 83.7%(77/92), respectively. Conclusion:SUV max≤ 7.1 combined with maximum diameter≤ 18.3 mm and fusiform shape may predict solid nodular FOP.

Objective To establish a mouse model of lung adenocarcinoma brain metastasis with human luc+-PC?9 cells stably expressing luciferase and to compare the evaluation values of bioluminescence imaging and18 F?FDG ( 18 F?flu?orodeoxyglucose) SPECT/CT in these models. Methods Suspension of luc+?PC?9 cells was injected into the left ventri?cle of BALB/c nude mice to establish a mouse model of brain metastasis from lung cancer. Bioluminescence imaging and18 F?FDG SPECT/CT were used to evaluate the metastasis of tumors as compared with HE?staining pathology as a golden standard. Results The success rate of brain metastases was 85% through injecting luc+?PC?9 cells into the left ventricle. The number of tumor cells was positively related to the intensity of light, with a linear correlation (R2 =0. 96). Fluores?cence was observed in the brain, spine and femur by bioluminescence imaging, and the metastases were confirmed by H&E pathological examination. 18 F?FDG SPECT/CT observed abnormal density collective foci in the spine or femur but not in the brain. Conclusions Injection of tumor cell suspension into the mouse left ventricle is a good method to establish a brain metastasis of lung cancer. Bioluminescence has a higher sensitivity and specificity in detecting brain metastasis and bone metastasis, with advantages of real?time, dynamical and non?invasive detection of tumor metastasis growth. 18 F?FDG SPECT/CT does not have superiority in detection of brain metastases but is suitable for detecting bone metastasis.

Objective To evaluate the diagnostic value of 18F-FDG PET/CT in patients with pancreatic neoplasm.Methods Fifty-three patients (36 males,17 females; age:(60.3±8.9) years) who underwent 18F-FDG PET/CT examination for suspected pancreatic tumor were retrospectively analyzed.Thirtytwo of them underwent dual-time point imaging.The characteristics of PET/CT images and serum CA19-9 were reviewed.Pathological results were used as a gold standard for evaluating the diagnostic value of PET/CT.Two-sample t test,paired t test and ROC curve analysis were used for data analysis.Results Thirtynine patients were finally diagnosed with pancreatic cancer and the other fourteen patients with benign disease.With SUVmax cutoff value of 3.13,the sensitivity and specificity of single-time point 18F-FDG PET/CT for diagnosis of pancreatic cancer were 92.3％ (36/39) and 9/14,respectively.The SUVmax was significant different between pancreatic cancer group and benign disease group (6.16±2.89 vs 3.37± 1.58; t =4.46,P＜0.01).Combined with the level of CA19-9,the diagnostic sensitivity and specificity were 69.2％ (27/39)and 13/14,respectively.The SUVmax of the early scan (5.45±2.43) was significantly different from that of the delayed scan (6.87±2.93) in pancreatic cancer group (t =8.25,P＜0.01),whereas no difference could be found in the benign group (3.18±1.28 vs 4.18±2.49; t=2.24,P＞0.05).With the SUVmax cutoff value of 3.3,the sensitivity,specificity and accuracy in the early scan were 87.0％ (20/23),6/9 and 81.2％ (26/32),respectively.While with the SUVmax cutoff value of 3.0,the sensitivity,specificity and accuracy in the delayed scan were 95.7％ (22/23),5/9 and 84.4％ (27/32),respectively.Conclusion 18 F-FDG PET/CT is a useful tool in the differential diagnosis of benign from malignant pancreatic diseases.

Objective To learn the impacts of major diagnosis, other diagnoses, major surgery and other surgeries on the grouping of DRGs, and to optimize the DRGs data grouping quality by analyzing the main influencing factors of DRGs.Methods Based on regrouping results of the 1 940 questionable cases which have been corrected, using SPSS 13.0 to study the impacts of the questions found on the grouping of DRGs.Results 438 Patient records affecting DRGs grouping were regrouped according to major diagnosis, other diagnoses, major surgery and other surgeries.Influences of the above four groups on the grouping vary in general For comparison between two groups, P＞0.007 1 between main surgery and other surgeries;while P＜0.007 1 for comparison between other groups.Conclusion The highest influence of grouping was found in questionable major diagnosis, much higher than such other factors as other diagnoses, major surgery and other surgeries.This conclusion conforms to the steps of basic DRGs grouping logic-sorting the eases according to major diagnosis first of all Correct naming of surgery influences DRGs grouping, but the influence extent of major surgery and other surgeries is close.

Objective To assess the memory function of hyperthyroid patients at different disease durations and investigate the value of cerebral blood flow (CBF) imaging in the detection of memory dysfunction in related regions.Methods Thirty-seven hyperthyroid patients (10 males,27 females; mean age (39.27± 10.58) years) and 28 healthy volunteers (8 males,20 females; mean age (35.80±9.41) years) were enrolled into this prospective study.The patients were divided into two subgroups: short duration group (duration ≤ 6 months; n =15),long duration group (duration ＞6 months ; n =22).Wechsler memory scale was used for memory assessment,and cancellation test was used for attention assessment.Self-rating depressions scale (SDS) and self-rating anxiety scale (SAS) were used for mood disorder assessment.99Tcm-ECD SPECT CBF imaging was performed at rest for all patients and controls on the same day.SPM 2.0 was used to investigate the differences of rCBF between the two groups.Two independent samples t test was used for the comparisons of memory and attention scores between patients and controls,also between patients with short and long disease durations.Multiple stepwise regression was used for factor analysis of memory state.Results Scale total score (92.27±17.50 vs 101.75±11.70; t=-2.476)and memory quotient (91.32±17.76 vs 100.29±9.43 ; t =-2.421) were significant different between patients and controls (both P＜0.05).The scale total score and memory quotient in patients with long disease duration were significant lower than those of controls(88.77±16.69 vs 101.75±11.70,t=-3.231; 86.18±16.73 vs 100.29±9.43,t=3.770,both P＜0.05).The memory quotient was significant lower in patients with long disease duration than those with short disease duration(86.10± 17.13 vs 98.87± 17.00; t =2.212,P＜0.05).There was no significant difference in memory quotient and scale total score between short duration group and controls (t=-0.754,0.910,both P＞0.05).CBF was reduced in the limbic system of hyperthyroid patients and the involved area was larger in patients with long disease duration.Age,attention score,serum FT4 level and reduced CBF in left pulvina nuclei,left lateral geniculate body and right amygdale were the statistically significant factors for impaired memory function in hyperthyroid patients (b=-0.393-0.685,all P＜0.05).Conclusions Memory impairment could be significant in hyperthyroid patients with long disease duration.CBF imaging could reflect the degree of dysfunction at specific brain regions responsible for memory impairment in these patients.

Objective:To investigate the influence of water tank on endotoxin(ET)content in hemodialysis fluid.Methods:Specimens of hemodialysis fluid were collected from 36 hemodialysis centers in Shanghai from Nov 2010 to Oct 2012,and the ET content in hemodialysis fluid were detected by chromogenic substrate method.Results:A total of 2694 samples have been obtained from 36 hemodialysis centers during the 2 years’period.The contents of ET below 0.1 EU/mL were detected in 2348 (87.16%)samples,between 0.1 EU/mL and 0.5 EU/mL in 260(9.65%)samples,and above 0.5 EU/mL in 86(3.19%) samples.Water tanks were used in 19 of the 36 hemodialysis centers.ET contents of hemodialysis fluid in the hemodialysis cen-ters which used water tanks were higher than those didn’t use water tanks,and the difference showed statistical significance (P <0.05).Conclusion:The usage of water tank could significantly increase the ET content in hemodialysis fluid.Monitoring of water storage equipment should be strengthened.

Objective:To analyze the 99 Tcm-methylene diphosphonate single photon emission computed tomography/spiral computed tomography (SPECT/CT)fusion imaging of bone metastases in patients with lung cancer and to evaluate the value of SPECT/CT in differentiating metastases from benign bone lesions.Methods:A total of 113 patients with bone metastases from lung cancer confirmed by pathology underwent bone scintigraphy and SPECT/CT imaging.Metastatic bone sites,quantity,up-take of radiotracer,and CT manifestations of each lesion were analyzed via bone scintigraphy imaging and SPECT/CT fusion imaging.Results:A total of 482 lesions from 113 patients were analyzed in this study.Among them,429 lesions were metasta-ses.Metastatic sites included spine(50.6%),thorax (29.1% ),pelvis (17.0%),extremities (2.1%),and skull(2.1%).CT manifestations were osteoblastic (41.0%),osteolytic (50.3%),mixed (4.0%),and normal (4.7%).Among these lesions, the proportion of hot spots displayed on SPECT/CT pictures was 90.7%(389/429),and the proportion of lesions with normal uptake of radiotracer was 9.3%(40/429).There were 53 benign lesions in 23 patients with bone metastasis.Conclusions:The most frequent metastatic sites in patients with lung cancer are spine and thorax.Bone metastasis from squamous carcinoma is more com-mon than from other types of lung cancer.The common CT manifestations are osteoblastic.The sensitivity and specificity of SPECT/CT fusion images for the diagnosis of bone metastatic lesions of lung cancer are high.