[Objective] To conduct a retrospective statistical comparison of alanine aminotransferase (ALT) test values in blood donors prior to blood collection, aiming to analyze the objective characteristics of the population with elevated ALT levels (ALT>50 U/L) and provide reference data for adjusting the screening eligibility threshold for ALT. [Methods] The preliminary ALT screening data of 30 341 blood donor samples collected prior to blood donation from three smart blood donation sites at the Shenzhen Blood Center between 2022 and 2023 were extracted and compared with data from a health examination department of a tertiary hospital in Shenzhen (representing the general population, n=24 906). Both datasets were categorized and statistically described. A retrospective analysis was conducted to examine the associations between ALT test results and factors such as donors' gender, age, ethnicity, donation site, donation season, and frequency of blood donation. [Results] The ALT levels in both blood donors and the general population were non-normally distributed. The 95th percentile of ALT values was calculated as 61.4 U/L (male: 67.8 U/L, female: 39.3 U/L) for blood donors and 58.1 U/L (male: 63.7 U/L, female: 51.2 U/L) for the general population. The non-compliance rates (ALT>50 U/L) were 7.65% (2 321/30 341) in blood donors and 7.08% (1 763/24 906) in the general population. There were significant differences (P<0.05) in the ALT failure rate among blood donors based on gender, age, and donation site, but no significant differences (P>0.05) during the blood donation season. There was no statistically significant difference (P>0.05) in the positive rates of four serological markers (HBsAg, anti HCV, HIV Ag/Ab, anti TP) for blood screening pathogens between ALT unqualified and qualified individuals (2.05% vs 1.5%). If the ALT qualification threshold was raised from 50 U/L to 90 U/L, the non qualification rates of male and female blood donors would decrease from 9.82% (2 074/21 125) to 2.23% (471/21 125) and from 2.70% (249/9 216) to 0.75% (69/9 216), respectively. Among the 154 blood donors who donated blood more than 3 times, 88.31% of the 248 ALT test results were in the range of 50-90 U/L. Among them, 9 cases had ALT>130 U/L, and ALT was converted to qualified in subsequent blood donations. [Conclusion] There are differences in the ALT failure rate among blood donors of different genders and ages, and different blood donation sites and operators can also affect the ALT detection values of blood donors. The vast majority of blood donors with ALT failure are caused by transient and non pathological factors. With the widespread use of blood virus nucleic acid testing, appropriately increasing the ALT qualification threshold for blood donors can expand the qualified population and alleviate the shortage of blood sources, and the risk of blood safety will not increase.

Purpose To evaluate the diagnostic value of Chinese thyroid imaging reporting and data system(C-TIRADS)and American thyroid association(ATA)guidelines in papillary thyroid carcinoma(PTC).Materials and Methods A total of 259 patients(339 nodules)with definite pathological results after thyroid nodule surgery in the 909th Hospital of the Joint Logistic Support Force(the Affiliated Southeast Hospital of Xiamen University)from July 2019 to May 2021 were divided into benign thyroid nodule group(150 cases,210 nodules)and PTC group(109 cases,129 nodules).General data and nodule ultrasonographic characteristics of the two groups were retrospectively analyzed.Nodules were classified by the two guidelines,and were compared with surgical pathological results,the receiver operating characteristic curve was drawn to evaluate the diagnostic value of the two guidelines for PTC.Results There were statistically significant differences between the two groups in the malignant ultrasonographic features of"solid,blurred/irregular edges or extrathyroid invasion,verticality,low or very low echo,microcalcification"(χ2=123.67,132.71,103.82,4.58,137.93,all P<0.05),and most commonly seen in the PTC group.Unlike C-TIRADS,61 nodules were not clearly classified in the ATA guidelines,accounting for 17.99%(61/339).The areas under the curves of C-TIRADS and ATA guidelines were 0.952(0.924-0.972)and 0.942(0.911-0.964),with no statistically significant differences(Z=0.943,P=0.346).The optimal cutoff values of the two groups were 4b and highly suspicious malignancy,and the sensitivity,specificity and accuracy were 0.930(120/129)vs.0.822(106/129),0.857(180/210)vs.0.943(198/210),0.885(300/339)vs.0.897(300/339),respectively.There were significant differences in sensitivity and specificity(χ2=6.99,8.57,both P<0.01),C-TIRADS had the highest sensitivity,ATA guidelines had the highest specificity,but there was no significant difference in accuracy(χ2=0.24,P=0.622).Conclusion Both C-TIRADS and ATA guidelines may be highly effective in the diagnosis of PTC,but C-TIRADS can be applied to the ultrasonographic manifestations of all thyroid nodules,and is less affected by the clinical experience of sonographers,so it is easier to be promoted in clinical practice.

A 26-year-old female patient was admitted to the hospital with recurrent infection of the incision after resection of a back sebaceous cyst,and the pus culture showed Mycobacterium abscessus.Clinical pharmacists reviewed relevant guidelines and literature,analyzed and summarized drug selection,drug resistance,adverse drug reactions and coping strategies,sequential treatment plans and treatment courses,and assist physicians in formulating individualised anti-infective treatment plans.Initially imipenem,amikacin and azithromycin were given according to bacterial culture results.Secondly,according to the results of drug sensitivity,they were changed to tigecycline,amikacin and clarithromycin.Finally,due to the adverse drug reaction of tigecycline and the recurrence of sinus in the patient,and considering the possibility of imipenem and clarithromycin resistance,the anti-infection regimen was adjusted in time to cefoxitin,amikacin and azithromycin.During treatment,the clinical pharmacist monitors drug effectiveness and adverse reactions,combining pharmacy expertise with clinical practice.After the treatment,the patient improved and was discharged.After discharge,azithromycin and omacycline were successively given to continue anti-infection treatment,and the incision on the patient's back basically healed through follow-up.Clinical pharmacist involvement in Mycobacterium abscessus anti-infective drug selection can provide individualised drug regimens for patients,ensure the safety and effectiveness of medication for patients,and provide references for the treatment and management of similar patients.

Objective:To explore the trajectory of postpartum post-traumatic stress disorder (PP-PTSD) in women of advanced maternal age and its influencing factors.Methods:From September 2021 to March 2023, convenience sampling was used to select women of advanced maternal age in the Department of Gynecology and Obstetrics at Taizhou Hospital of Zhejiang Province as participants. Parturients were surveyed at one week, one month, six months, and 12 months after delivering using General Information Questionnaire, Post-traumatic Stress Disorder Check-list-civilian Version, Social Capital Scale, and 10-item Connor-Davidson Resilience Scale. The latent growth mixture model was used to analyze the trajectory of PP-PTSD.Results:A total of 467 questionnaires were distributed, and 456 valid questionnaires were collected, with a valid rate of 97.64%. There were four types of PP-PTSD trajectories in women of advanced maternal age, namely non PP-PTSD type (71.27%, 325/456), early onset-gradual recovery type (12.06%, 55/456), early onset-prolonged type (9.21%, 42/456), and late onset-risk type (7.46%, 34/456). Univariate analysis showed that delivery mode, pregnancy complications, social capital, and psychological resilience were potential categories of influencing factors for the trajectory of PP-PTSD in women of advanced maternal age ( P<0.05) . Conclusions:There is population heterogeneity in the trajectory of PP-PTSD among women of advanced maternal age. It is recommended that medical and nursing staff dynamically monitor the PP-PTSD of women of advanced maternal age, identify their trajectory types early, and develop precise intervention measures based on classification.

DRG payment reform is an important means to control the unreasonable growth of medical expenses, improve the quality of medical services and achieve a win-win situation among three sides of hospitals, medical insurance and patients. This study adopted the Smith policy implementation process model to analyze the difficulties in the DRG policy implementation process from four aspects(idealized policies, policy implementation institutions, target groups, and policy environment), including the deviation between policy connotations and actual needs; the interest objectives of all parties were not completely aligned, the target group lacked a sense of identity, and the social impact and technological support needed to be improved. It was suggested that optimization should be carried out from four dimensions: policy supply coordination and precision, performance evaluation and personnel literacy, target group cognitive level and participation willingness, and policy implementation environment and atmosphere, in order to synergistically promote the effective implementation of DRG policies.

Objective:To investigate the characteristics and relationship between the location of lower extremity deep vein thrombosis (DVT) and the site of pulmonary embolism in hospitalized patients.Methods:The data of patients with lower extremity DVT diagnosed by ultrasound examination and pulmonary embolism diagnosed by CT pulmonary angiography from December 2017 to December 2021 were analyzed retrospectively. According to the location of lower extremity DVT, the patients were divided into mixed DVT, proximal DVT, and distal DVT which was further divided into anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis. Mixed DVT was referred to the presence of both proximal and distal DVT. According to the involved site of pulmonary artery, pulmonary embolism was divided into three types: main pulmonary artery, left or right pulmonary artery trunk embolism, lobar pulmonary artery embolism and segmental pulmonary artery embolism. The location of lower extremity DVT, the site of pulmonary embolism, the clinical manifestation (shortness of breath, chest tightness, chest pain, hemoptysis, cough, lower limb swelling, lower limb pain, syncope, fever) and risk factors (fracture/trauma, tumor, diabetes, hypertension, atrial fibrillation, infection, surgery, autoimmune diseases, paralysis, pregnancy) of venous thromboembolism (VTE), and the level of D-dimer were analyzed.Results:A total of 209 patients were enrolled finally, including 127 patients with left lower extremity DVT (60.8%) and 82 with right lower extremity DVT (39.2%). Mixed DVT accounted for 39.2%, proximal DVT accounted for 17.3%, and distal DVT accounted for 43.5% (anterior/posterior tibial vein and peroneal vein thrombosis accounted for 14.8%, calf muscular venous thrombosis accounted for 28.7%). The incidences of main pulmonary artery embolism, left or right pulmonary artery trunk embolism in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [41.5% (34/82), 38.8% (14/36) vs. 16.2% (5/31), 10.0% (6/60)], with statistically significant differences (all P < 0.05). The incidences of pulmonary segmental artery embolism in the anterior/posterior tibial vein or peroneal vein thrombosis were higher than those in the mixed DVT and proximal DVT [41.9% (13/31) vs. 26.8% (22/82), 30.6% (11/36)], but the difference was not statistically significant (both P > 0.05). The incidences of pulmonary segmental artery embolism in the calf muscular venous thrombosis were significantly higher than those in the mixed DVT and the proximal DVT [66.7% (40/60) vs. 26.8% (22/82), 30.6% (11/36)], and the difference was statistically significant (both P < 0.05). The levels of D-dimer in patients with calf muscular venous thrombosis combined with main pulmonary artery embolism, left or right pulmonary artery trunk embolism were significantly higher than those in patients with calf muscular venous thrombosis combined pulmonary segmental artery embolism (mg/L: 6.08±3.12 vs. 3.66±2.66, P < 0.05). There were no significant differences in D-dimer levels in other patients with DVT combined with pulmonary embolism in different sites. In terms of the clinical manifestations of VTE, the incidences of lower limb swelling in the mixed DVT and proximal DVT were significantly higher than those in the anterior/posterior tibial vein or peroneal vein thrombosis and calf muscular venous thrombosis [54.9% (45/82), vs. 29.0% (9/31), 15.0% (9/60), both P < 0.05], the incidences of lower limb swelling in the proximal DVT were significantly higher than those in the calf muscular venous thrombosis [41.7% (15/63) vs. 15.0% (9/60), P < 0.05], there were no significant difference in the other clinical manifestations among the DVT groups. There was no significant difference in the incidence of VTE risk factors among the groups. Conclusions:The DVT of inpatients mostly occurred in the left lower limb, and the incidence of distal DVT was higher than that of proximal DVT. Mixed DVT and proximal DVT combined with pulmonary embolism mostly occurred in the main pulmonary artery, left or right pulmonary artery trunk, while distal DVT combined with pulmonary embolism mostly occurred in the pulmonary segmental artery. The levels of D-dimer in patients with lower extremity DVT combined with main pulmonary artery or left and right pulmonary artery trunk embolism were higher than those in patients with pulmonary lobe and segmental artery embolism. The incidence of lower extremity swelling in patients with mixed DVT and proximal DVT was higher than that in patients with distal DVT.

ObjectiveTo observe the effect of Kinesio taping on salivation after stroke. MethodsFrom October, 2019 to January, 2021, 40 patients with salivation after stroke were randomly divided into control group (n = 20) and experimental group (n = 20). Both groups received routine medicine, routine rehabilitation for dysphagia and rehabilitation nursing, while the experimental group received Kinesio taping in addition, for three weeks. They were assessed with Functional Oral Intake Scale (FOIS), Water Swallow Test (WST) and Teacher Drooling Scale (TDS) before and after treatment. ResultsOne case dropped in the experimental group. The scores of FOIS, TDS and WST improved in both groups after treatment (|Z| > 2.000, P < 0.05), and improved more in the experimental group than in the control group (|Z| > 3.045, P < 0.01). ConclusionKinesio taping may relieve the salivation of patients with dysphagia after stroke.

Integrins are transmembrane receptors that have been implicated in the biology of various human physiological and pathological processes. These molecules facilitate cell-extracellular matrix and cell-cell interactions, and they have been implicated in fibrosis, inflammation, thrombosis, and tumor metastasis. The role of integrins in tumor progression makes them promising targets for cancer treatment, and certain integrin antagonists, such as antibodies and synthetic peptides, have been effectively utilized in the clinic for cancer therapy. Here, we discuss the evidence and knowledge on the contribution of integrins to cancer biology. Furthermore, we summarize the clinical attempts targeting this family in anti-cancer therapy development.

Objective: This study aimed to investigate the impact of polycystic ovary syndrome (PCOS) on fertility-sparing treatment in young patients with atypical endometrial hyperplasia (AEH) or endometrioid endometrial cancer (EEC). Methods: A total of 285 patients with EEC (n=76, FIGO stage IA, without myometrium invasion) or AEH (n=209) who received progestin-based fertility-sparing treatment were evaluated retrospectively. Among the 285 patients, 103 (36.1%), including 70 AEH cases and 33 EEC cases, were diagnosed with PCOS. General characteristics, cumulative 16- and 32-week complete response (CR) rate, pregnancy outcome and recurrence were compared between patients with or without PCOS. Results: The cumulative 16-week CR rate was lower in the PCOS group than in the non-PCOS group (18.4% vs. 33.8%, p=0.006). Patients with PCOS took longer treatment duration to achieve CR (7.0 months vs. 5.4 months, p=0.006) and shorter time to relapse after CR (9.6 months vs. 17.6 months, p=0.040) compared with non-PCOS group. After adjusting for patient age, body mass index, PCOS, homeostasis model assessment-insulin resistance index, and serum testosterone levels, we found that body mass index ≥25 kg/m2 (HR=0.583; 95% CI=0.365–0.932; p=0.024) and PCOS (HR=0.545; 95% CI=0.324–0.917; p=0.022) were significantly correlated with lower 16-week CR rate. Conclusion PCOS was associated with lower 16-week CR rate, longer treatment duration and shorter recurrence interval in patients with AEH or EEC receiving fertility-preserving treatment.

Objective To explore the relationship between the typing of MSCT and prognosis in infant with interstitial pneumonia (IP).Methods MSCT features of 44 infants with IP were analyzed retrospectively and classified according to the pathological pro-gress.The relationship between the MSCT typing and clinical prognosis was statistically analyzed.Results The result of the MSCT typing was as follows:the exudation in 22 cases,the proliferation in 18 cases and the ruin in 4 cases.There was significant difference for the clinical prognosis among the different MSCT groups (P＜0.01 ).And there was a significant correlation between the MSCT typing and clinical prognosis (r＝0.784,P＜0.01).The prognosis of the exudation type was better than the proliferation type,and both of them were better than the ruin type.Conclusion Based on the MSCT features,MSCT typing reveals the inflammatory patho-logical process of the infant IP,which plays an important role in treatment options decision and prognosis prediction.