Objective To evaluate the intraoperative identification of ectopic parathyroid tissue in the central neck region using autofluorescence point-spectral analysis(AFPSA)combined with immune colloidal gold technique(ICGT),for guiding total parathyroidectomy(TPTX)or clean parathyroidectomy(CPTX)in the management of secondary hyperparathyroidism(SHPT).Methods Retrospectively collected and compared the clinical data of 64 patients with SHPT from October 2019 to June 2023.In the observation group,TPTX was performed as the initial procedure in 36 cases,followed by sampling of suspicious targets using AFPSA in the central neck area and subsequent detection through ICGT.CPTX was then conducted if a positive result was obtained.On the other hand,the control group consisted of 28 cases where only TPTX was performed without any additional tests during surgery.The surgical data,parathyroid hormone(PTH)levels,blood calcium levels,blood phosphorus levels,alkaline phosphatase(ALP)levels,regression of clinical symptoms,changes in parathyroid function and occurrence of hypocalcemia were compared between these two groups.Results In the observation group,there were 9 cases of AFPSA-ICGT positivity,including 2 left-sided cases,4 right-sided cases,and 3 thymic cases;among these posi-tive cases,there were a total of 10 locations with mildly hyperplastic or nonhyperplastic microscopic parathyroid tissue.The difference in the number of total parathyroid glands removed(including ectopic)between the two groups was statistically significant(P<0.05).At both 3 and 6 months postoperatively,ALP levels in the observation group were significantly lower than those in the control group(P<0.01 and P<0.001 respectively);at 6 months postoperatively,differences in PTH and blood phosphorus levels between the two groups were also statistically significant(P<0.05 and P<0.001 respectively).Joint bone pain and skin itching recurred in some patients within the control group at six months after surgery(P<0.05),whereas recurrence of SHPT was less frequent within the observation group compared to controls(P<0.05);however,no statistically significant differences were observed regarding postoperative hypoparathyroidism or hyperparathyroidism as well as hypocalcemia between either groups.Conclusion The AFPSA-ICGT intraoperative test can be utilized to guide surgery for SHPT,enabling accurate and efficient identification as well as safe targeting of parathyroid tissues that may not exhibit obvious hyperplasia in the central cervical region.

Objective:To analyze the medication rule of Duan Fujin in the treatment of liver cirrhosis based on data mining method.Methods:By searching for and collecting the medical records of patients with liver cirrhosis treated by Traditional Chinese Medicine master Duan Fujin, counting the frequently used Chinese medicines and analyzing their association rules to carry out the system cluster analysis of frequently showed medicines, and to gain new prescriptions.Results:A total of 162 prescriptions of Professor Duan Fujin were collected, including 115 Chinese medicines, most of which are bitter and pungent in terms of taste. The medicines which are frequently used are Bupleuri Radix, Curcumae Radix, Poria, Trionycis Carapax, Glycyrrhizae Radix; the medicine pairs which are frequently appeared are Bupleuri Radix- Curcumae Radix, Bupleuri Radix- Poria, Curcumae Radix- Poria, Curcumae Radix- Trionycis Carapax, Bupleuri Radix- Trionycis Carapax, Curcumae Radix- Poria- Bupleuri Radix, Curcumae Radix- Trionycis Carapax- Bupleuri Radix, Curcumae Radix- Glycyrrhizae Radix- Bupleuri Radix, Bupleuri Radix- Chuanxiong Rhizoma- Curcumae Radix, Curcumae Radix- Trionycis Carapax- Poria, Bupleuri Radix- Trionycis Carapax- Poria. Cluster analysis shows that there are two new prescriptions: the first prescription plays the role of invigorating spleen and removing dampness, regulating qi and resolving phlegm, which is composed of Pinelliae Rhizoma, Citri Reticulatae Pericarpium, Glycyrrhizae Radix, Amomi Fructus, Aurantii Fructus, Poria, Atractylodis Macrocephalae Rhizoma, Ginseng Radix, Magnoliae Officinalis Cortex, Arecae Pericarpium, Hordei Fructus Germinatus, Crataegi Fructus; the second prescription plays the role of invigorating Qi and activating blood circulation, Ruanjian Sanjie, which is composed of Angelicae Sinensis Radix, Astragali Radix, Trionycis Carapax, Ostreae Concha, Curcumae Radix, Corydalis Rhizoma, Persicae Semen, Toosendan Fructus, Paeoniae Radix Rubra, Salviae Miltiorrhizae Radix, Curcumae Rhizoma, Moutan Cortex, Hedyotis diffusa Willd. Conclusion:The treatment of liver cirrhosis by Duan Fujin's mainly focuse on soothing and promoting the liver qi, softening the hard and disperse the knot, promoting blood circulation and removing blood stasis, strengthening the spleen qi and removing dampness.

【Objective】 To compare the macrolide resistance, molecular characteristics and multilocus antigen sequence typing (MAST) of Bordetella pertussis (Bp) collected from Xi’an and Shanghai so as to provide reference for prevention of pertussis and optimize vaccination strategies. 【Methods】 Erythromycin, azithromycin and clarithromycin susceptibility of clinical isolates collected from Xi’an and Shanghai during 2018 and 2019 were determined by E-test. PCR was used to detect the drug-resistant genes and mutation sites. MAST was employed to do molecular typing for the strains. The differences in macrolide resistance and MAST types between Xi’an and Shanghai were compared. 【Results】 Totally 34 strains from Xi’an and 26 strains from Shanghai were isolated. There were differences between Xi’an and Shanghai in the macrolide resistance (χ²=13.650, P<0.001). The composition ratio of MAST types of pertussis strains was also different between Xi’an and Shanghai (χ²=18.642, P<0.001) in that the prn1/ptxP1/ptxA1/fim3-1/fim2-1 strains dominated in Xi’an, while the prn1/ptxP1/ptxA1/fim3-1/fim2-1 and prn2/ptxP3/ptxA1/fim3-1/fim2-1 were almost half and half in Shanghai. A2047G site mutation was detected in all the macrolide-resistant strains, but not in all sensitive strains. Methylase genes ermA and ermB were detected in some macrolide-resistant strains. No other macrolide-resistant genes were found in resistant strains and no mutation or drug resistance gene was found in all the susceptible strains. 【Conclusion】 Differences existed between Xi’an and Shanghai in the macrolide resistance and MAST types of Bordetella pertussis strains. Further monitoring of Bordetella pertussis in China is required to better understand the resistance and evolution of the pathogen.

Objective:To analysis the prognosis related factors of patients with small cell cancer of the esophagogastric junction treated by surgery.Methods:The clinicopathologic data of 129 patients with small cell cancer of the esophagogastric junction underwent surgery treatment in the Fourth Hospital of Hebei Medical University from January 2004 to December 2010 were retrospectively analyzed. Univariate survival survival was performed by Kaplan-Meier method and Log rank test. Multivariate survival was analyzed by using Cox proportional hazard model.Results:Radical surgery was performed in 123 patients, whereas other 6 cases were conducted palliative operation. The 5-year overall survival (OS) rate of this cohort was 21.0% and median survival time was 25.7 months. The 5-year progression free survival (PFS) rate of this cohort was 11.0% and median PFS time was 19.1 months. The univariate analysis result showed that operation manner, radical or not, tumor length, lymph node metastasis, TNM stage, intravascular cancer embolus surgical margin positive or not, the expression of Syn, comprehensive treatment and radiochemotherapy after progression were associated with the OS of these patients ( P<0.05). Multivariate analysis result showed that lymph node metastasis, radiochemotherapy after progression were independent risk factors of OS ( P<0.05). Univariate analysis result showed that operation manner, radical or not, tumor length, TNM stage, lymph node metastasis, intravascular cancer embolus, surgical margin positive or not, the expression of Syn, comprehensive treatment and radiochemotherapy after progression were associated with PFS ( P<0.05). Multivariate analysis showed that lymph node metastasis and radiochemotherapy after progression were independent risk factors of PFS ( P<0.05). Conclusions:The prognosis of small cell cancer of the esophagogastric junction patients remains poor. Lymph node metastasis and radiochemotherapy after progression are regarded as independent prognostic factors of these patients.

Objective:To analysis the prognosis related factors of patients with small cell cancer of the esophagogastric junction treated by surgery.Methods:The clinicopathologic data of 129 patients with small cell cancer of the esophagogastric junction underwent surgery treatment in the Fourth Hospital of Hebei Medical University from January 2004 to December 2010 were retrospectively analyzed. Univariate survival survival was performed by Kaplan-Meier method and Log rank test. Multivariate survival was analyzed by using Cox proportional hazard model.Results:Radical surgery was performed in 123 patients, whereas other 6 cases were conducted palliative operation. The 5-year overall survival (OS) rate of this cohort was 21.0% and median survival time was 25.7 months. The 5-year progression free survival (PFS) rate of this cohort was 11.0% and median PFS time was 19.1 months. The univariate analysis result showed that operation manner, radical or not, tumor length, lymph node metastasis, TNM stage, intravascular cancer embolus surgical margin positive or not, the expression of Syn, comprehensive treatment and radiochemotherapy after progression were associated with the OS of these patients ( P<0.05). Multivariate analysis result showed that lymph node metastasis, radiochemotherapy after progression were independent risk factors of OS ( P<0.05). Univariate analysis result showed that operation manner, radical or not, tumor length, TNM stage, lymph node metastasis, intravascular cancer embolus, surgical margin positive or not, the expression of Syn, comprehensive treatment and radiochemotherapy after progression were associated with PFS ( P<0.05). Multivariate analysis showed that lymph node metastasis and radiochemotherapy after progression were independent risk factors of PFS ( P<0.05). Conclusions:The prognosis of small cell cancer of the esophagogastric junction patients remains poor. Lymph node metastasis and radiochemotherapy after progression are regarded as independent prognostic factors of these patients.

Objective: To understand the economic burden caused by hand-foot-mouth disease (HFMD) in Xi’an, in order to provide scientific basis for government departments to allocate health resources rationally. Methods: New cases of HFMD were selected randomly from designated hospitals in city and district level in Xi’an, 2018, Direct and indirect economic costs of patients caused by HFMD were collected using a questionnaire survey, hospital charging system inquiry as well as follow-up survey. Factors affecting the economic burden of HFMD were analyzed. Results: A total of 438 mild as well as 60 severe cases were surveyed, with the overall medical insurance participation rate of 89.76%(447/498). The median of per capita direct economic burden of mild and severe cases were 635 and 7 972 yuan respectively, and the median of per capita indirect economic burden of mild and severe cases were 130 and 233 yuan respectively, in Xi’an. The overall economic burden attributable to HFMD was 23.1 million yuan in Xi’an 2018, in which the direct economic burden was 19.3 million yuan, indirect economic burden was 3.8 million yuan. Multiple Logistic regression analysis showed that the approach of diagnosis, type of cases, days of treatment and type of pathogen had significant influence on the economic burden of HFMD(P<0.05). Conclusion The economic burden of HFMD was heavy in Xi’an. Controling and reducing the incidence rate, as well as increasing the medical insurance coverage and reimbursement rate would lighten the economic burden caused by HFMD effectively.

Objective To explore the correlation factors and clinical significance of lymph node metastasis in right recurrent laryngeal nerve of thyroid papillary carcinoma (PTC).Methods Ninty-eight consecutive patients with PTC who were underwent total thyroidectomy with routine central lymph node dissection in the Second People's Hospital of Hefei from January 2015 to August 2017 were analyzed.The right paratracheal lymph nodes in the central compartment lymph nodes were divided into the level Ⅵ-A (anterior) and level Ⅵ-B (posterior,that was lymph node posterior to recurrent laryngeal nerve) compartments by recurrent laryngeal nerve.The lymph node metastasis of Ⅵ-B area during central compartment lymph node dissection was analyzed.We drew the receiver-operating characteristic curve (ROC) for right neck Ⅵ-A number of lymph node metastasis,and calculated the area under the curve (AUC) and Youden index.Results Among 98 cases,16 cases occurred Ⅵ-B district lymph node metastasis (16.33％).Single factor analysis results showed that lymph node metastasis in Ⅵ-B area of PTC patients were related to the tumor size (x2 =12.864,P ＜0.001),tumor capsular invasion (x2 =16.354,P ＜ 0.001),the right neck Ⅵ-A area lymph node metastasis (x2 =16.065,P ＜ 0.001),tumor number (x2 =15.593,P ＜ 0.001) and neck lymph node metastasis (x2 =21.098,P ＜0.001),but they were not related to the patients' gender,age and lesion location (all P ＞ 0.05).Lymph node metastasis in Ⅵ-B area of PTC patients were related to the number of right neck Ⅵ-A area lymph node metastasis.When the number of right neck Ⅵ-A metastatic lymph nodes was 2.5,the sensitivity and specificity were 70.60％ and 70.00％ respectively,AUC was 0.754,and Youden index was 0.406.Conclusion For patients with PTC,primary tumor diameter ＞ 1 cm,tumor extracapsular invasion,Ⅵ-A area lymph node metastasis,multiple tumor and lateral cervical lymph node metastasis were the predictive factors for the lymph node metastasis in Ⅵ-B area.When the number of right neck Ⅵ-A area metastatic lymph nodes was greater than 3,we should dissect Ⅵ-B area.

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Objective To investigate the current status of hand hygiene(HH) among health care workers(HCWs) in clinical laboratories in medical institutions in Xi'an City.Methods HH status of HCWs in clinical laboratories in medical institutions in Xi'an was performed random on-the-spot sampling and monitoring.Results A total of 240 HH specimens of HCWs in clinical laboratories in 80 medical institutions in Xi'an City were collected, 127 detected results were qualified, the total qualified rate was 52.92%.The qualified rates of medical institutions were as follows: municipal hospitals 62.67%,workers' hospitals 55.95%,private hospitals 40.74%;comprehensive medical institutions 67.68%,specialized medical institutions 42.55%;tertiary medical institutions 79.63%(n=43),secondary and below medical institutions 45.16%(n=84),there were significant differences in HH qualified rate among HCWs in different types of medical institutions(all P<0.01).Of different HH detection items, detection rates of Escherichia coli and Staphylococcus aureus were 0.83% and 8.33% respectively.There were significant differences in HH compliance rates among HCWs of all age groups(χ2=9.103,P<0.05), HCWs aged≥50 years had the highest qualified rate of HH(71.43%), followed by those aged<30 years (67.82%),HCWs in 40~ year age group had the lowest HH qualified rate (39.66%).Conclusion The qualified rate of HH of HCWs in clinical laboratory of medical institutions in Xi'an City is low, it is necessary to enhance the procaution awareness of HCWs in clinical laboratories, strengthen quality control of HH, strictly implement standard hand-washing procedures to reduce occurrence of HAI.

Objective To compare the difference of three methods testing the antibiotic susceptibility of mucoid Pseudomonas aeruginosa in order to provide accurate and reliable antibiotic susceptibility result for clinic.Methods A total of 630 mucoid Pseudomonas aeruginosa were collected from Linyi People′s Hospital during January 2015 to December 2016.They mainly come from respiratory medicine and the most common specimen source was sputum.All specimens were examined in 2 h.The strains isolated from the same patient were discarded.Antibiotic susceptibility was tested by the automatic microorganism analyzer VITEK2 compact, E-test, which was reference method, and K-B disk.The results of three methods were analyzed and compared by χ2 test.Results The result of E-test showed that antibiotic sensitivity of 630 mucoid Pseudomonas aeruginosa was above 52.7% except for Cefepime (39.2%).The result of K-B disk was compared with E-test, the antibiotic sensitivity of mucoid Pseudomonas aeruginosa to imipenem (72.4% vs 52.7%) and amikacin (48.6% vs 71.1%)had significant difference (χ2=8.283 7 and 10.533 8, P<0.05).The result of VITEK2 compact showed that the antibiotic susceptibility of mucoid Pseudomonas aeruginosa to imipenem(70.8% vs 52.7%), cefepime(60.8% vs 39.2%), gentamicin (87.6% vs 74.1%)and levofloxacin(81.3% vs 65.4%) was significant higher than the result of E-test (χ2=6.935 2,9.331 2,5.885 6 and 6.466 5, P<0.05).For tobramycin, piperacillin/tazobactam and ciprofloxacin, the result of three methods is more consistent.Compared to VITEK2 compact, the consistency between K-B disk and E-test was higher.The rate of very major error and major error were between 0.0%-4.8% (Amikacin 12.2%) and minor error was 4.6%-20.3%.Conclusions The drug sensitivity of mucoid Pseudomonas aeruginosa is different between various methods.The result of K-B disk and E-test using blood MH is more reliable than VITEK2 compact.