Objective To analyze the current situation of healthcare-associated infection (HCAI) management of fever clinics among different levels of medical institutions in Wuhan, and to provide a scientific basis for improving hospital infection management. Methods In January 2023, a network questionnaire survey was conducted on medical institutions with fever clinics in Wuhan. Results A total of 72 medical institutions were investigated, of which 58.33% had CT, and 48.61% had fever clinics for children. The total qualified rate of HCAI management was 78.28%. The qualified rates of four primary indicators, including hospital management, diagnosis and treatment environment protection, training and education, and implementation of infection control measures, were 82.27%, 71.49%, 75.93%, and 81.31%, respectively. There were statistical differences among different levels of medical institutions (all P<0.01). Among the 13 secondary indicators, the qualified rates of 7 indicators were more than 80%, with the highest being medical item management (93.06%), medical waste disposal (89.72%), and personnel management (83.33%), and the lowest being facilities and equipment (66.32%), and patients and accompanying personnel education (66.67%). Among the 65 tertiary indicators, 30 had a pass rate great than 80%. Conclusion Wuhan actively promotes the construction of fever clinics in medical institutions, and the overall situation of HCAI management is good. However, there are still some problems to varying degrees, especially in the layout procedures, hand hygiene, and staff training of fever clinics in secondary and lower medical institutions, which should be further strengthened.

【Objective】 To explore the application of machine learning in scientific and rational blood preparation and predictive analysis for surgical blood usage before liver transplantation surgery. 【Methods】 Clinical basic information including gender, age, clinical diagnosis and surgical methods of 356 liver transplantation patients were collected. The duration (Time) and preoperative laboratory test results of hemoglobin (Hb), hematocrit (Hct), platelet count (Plt), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), total bilirubin (TBIL), albumin (ALB), creatinine (Crea) and total protein (TP), as well as the amount of intraoperative blood transfusion were collected. A machine learning model capable of predicting the risk of massive blood transfusion during liver transplantation surgery was established by Python, and was evaluated to select the optimal predictive model. 【Results】 Among the 7 machine learning models constructed, the logistic regression model performed the best (AUROC: 0.90, F1 score: 0.82), with an accuracy of 79.44% and precision of 79.69%, followed by the random forest classifier (AUROC: 0.87, F1 score: 0.83), with an accuracy of 79.44% and precision of 77.94%. 【Conclusion】 Establishing a machine learning prediction model by Python is of significant clinical importance for scientific blood preparation, predicting the risk of massive blood transfusion and ensuring the safety of blood use in liver transplantation surgery.

Objective To observe the value of feature pyramid network(FPN)for automatic segmentation and semantic feature classification of spontaneous intracerebral hemorrhage(sICH)hematoma showed on non-contrast CT.Methods Non-contrast CT images of 408 sICH patients in hospital A(training set)and 103 sICH patients in hospital B(validation set)were retrospectively analyzed.Deep learning(DL)segmentation model was constructed based on FPN to segment the hematoma region,and its efficacy was assessed using intersection over union(IoU),Dice similarity coefficient(DSC)and accuracy.Then DL classification model was established to identify the semantic features of sICH hematoma.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of DL classification model for recognizing semantic features of sICH hematoma.Results The IoU,DSC and accuracy of DL segmentation model for 95％sICH hematoma in training set was 0.84±0.07,0.91±0.04 and(88.78±8.04)％,respectively,which was 0.83±0.07,0.91±0.05 and(88.59±7.76)％in validation set,respectively.The AUC of DL classification model for recognizing irregular shape,uneven density,satellite sign,mixed sign and vortex sign of sICH hematoma were 0.946-0.993 and 0.714-0.833 in training set and validation set,respectively.Conclusions FPN could accurately,effectively and automatically segment hematoma of sICH,hence having high efficacy for identifying semantic features of sICH hematoma.

ObjectiveTo systematically review the efficacy and safety of laparoscopic choledochoscopy combined with holmium laser lithotripsy through a meta－analysis. MethodsThis study was conducted based on PRISMA guidelines， with a PROSPERO registration number of CRD42023406221. Chinese databases including CNKI， Wanfang Data， and VIP and foreign language databases such as PubMed， Embase， the Cochrane Library， and Web of Science were searched for original articles on traditional laparotomy versus laparoscopic choledochoscopy combined with holmium laser lithotripsy in the treatment of bile duct stones. Dichotomous variables were assessed by odds ratio （OR） and 95% confidence interval （CI）， while continuous variables were assessed by weighted mean difference （WMD） and 95%CI， and a sensitivity analysis was performed for outcome measures with relatively high heterogeneity. The Begg test and Egger test were used to evaluate publication bias. Stata 15.0 and Review Manager 5.3 were used to perform the statistical analysis. ResultsA total of 26 retrospective studies from China were included in this study， with 2 238 patients in total. The meta－analysis showed that compared with traditional laparotomy for the treatment of bile duct stones， laparoscopic choledochoscopy combined with holmium laser lithotripsy had significantly shorter time of operation （WMD＝－1.26， 95%CI： －1.36 to －1.16， P<0.001）， length of hospital stay （WMD＝－1.93， 95%CI： －2.64 to －1.12， P <0.001）， and time to bowel function recovery （WMD＝－1.52， 95%CI： －1.68 to －1.35， P<0.001）， significantly less intraoperative blood loss （WMD＝－1.79， 95%CI： －1.93 to －1.66， P<0.001）， a significantly lower rate of intraoperative residual stone （OR＝0.15， 95%CI： 0.11－0.20， P<0.001）， and significantly fewer complications （OR＝0.17， 95%CI： 0.13－0.23， P<0.001）. ConclusionCompared with traditional laparotomy， laparoscopic choledochoscopy combined with holmium laser lithotripsy shows better efficacy in the treatment of bile duct stones.

Objective:To explore the value in differentiating Borrmann Ⅳ type gastric cancer (BT4-GC) from gastric diffuse large B-cell lymphoma (DLBCL) using a nomogram based on CT texture analysis (CTTA) and morphological characteristics.Methods:From June 2011 to December 2020, a total of 60 patients with BT4-GC and 24 patients with DLBCL were retrospectively collected in Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University. Morphological characteristics were evaluated, including major location, long axis range, circumferential range, mucosal line status, and perigastric enlarged lymph nodes. CTTA parameters were calculated using venous CT images with a manual region of interest. The morphological characteristics and CTTA parameters between BT4-GC and DLBCL were compared by χ 2 test, Fisher exact test or Mann-Whitney U test. The multivariate binary logistic regression analysis was used to filter factors into the diagnostic model and construct a nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of CTTA parameters and the diagnostic model in differentiating BT4-GC from DLBCL. Results:For morphological characteristics, mucosal line status showed a significant difference between BT4-GC and DLBCL (χ 2=12.99, P<0.001). For CTTA parameters, 16 parameters showed significant differences between BT4-GC and DLBCL (all P<0.05). The area under the ROC curve (AUC) of 16 CTTA parameters in differentiating BT4-GC from DLBCL was 0.662-0.833. Percentile 90 showed the highest AUC of 0.833 (95%CI 0.736-0.906). The mucosal line status (OR 4.82, 95%CI 1.21-19.25, P=0.026) and percentile 90 (OR 1.09, 95%CI 1.04-1.15, P=0.001) were brought into the diagnostic model and constructed a nomogram. The AUC of the model in differentiating BT4-GC from DLBCL was 0.898 (95%CI 0.813-0.953), sensitivity was 0.833, and specificity was 0.817. Conclusions:The nomogram based on CTTA percentile 90 and morphological characteristics mucosal line status can effectively distinguish BT4-GC from DLBCL and shows high diagnostic efficacy.

Objective: To assess the feasibility of nuclear score combined with cyclin D1 immunocytochemistry in classifying indeterminate thyroid nodules with fine-needle aspiration (FNA) cytological diagnosis of Bethesda category Ⅲ-Ⅴ. Methods: A consecutive cohort of 118 thyroid FNA specimens with indeterminate diagnosis (TBSRTC category Ⅲ-Ⅴ) and available histopathologic follow-up data were collected between December 2018 and April 2022 at the Department of Pathology, Beijing Hospital, China. These cases were subjected to cytological evaluation and cyclin D1 immunocytochemistry. The optimal cut-off points of a simplified nuclear score and the percentage of cyclin D1-positive cells for the diagnosis of malignancy or low-risk neoplasm were determined using the receiver operating characteristic (ROC) curves and area under the ROC curve (AUC). The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of nuclear score and cyclin D1 immunostaining were evaluated from the crosstabs based on cut-off points. The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining was estimated using ROC curve analysis. Results: Nuclear grooves, intra-nuclear inclusions and chromatin clearing were more commonly found in malignancy/low-risk neoplasms than benign lesions (P=0.001, P=0.012 and P=0.001 respectively). A cut-off point of≥2 for the simplified nuclear score was sensitive for defining malignancy/low-risk neoplasm, and its PPV, NPV, sensitivity and specificity were 93.6%, 87.5%, 99.0% and 50.0% respectively. A positive cut-off point of 10% positive thyroid cells in cyclin D1 immunostaining demonstrated sensitivity of 88.5%, specificity of 100%, PPV of 100% and NPV of 53.8% for correctly detecting thyroid malignancy or low-risk neoplasm. The sensitivity and PPV of simplified nuclear score combined with cyclin D1 immunostaining were 93.3% and 100%, respectively. Both specificity and NPV were maintained at high levels (100% and 66.7%, respectively). The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining in detecting thyroid malignancy/low-risk neoplasm was increased to 94.1% compared to using either of them alone. Conclusions: Combing simplified nuclear score and cyclin D1 immunostaining on FNA cytology specimens can increase the diagnostic accuracy in classifying thyroid nodules of indeterminate cytological categories. Thus, this supplementary approach provides a simple, accurate, and convenient diagnostic method for cytopathologists so that may reduce unnecessary thyroidectomies.
Humans ; Thyroid Nodule/pathology* ; Biopsy, Fine-Needle ; Cyclin D1 ; Immunohistochemistry ; Thyroid Neoplasms/pathology* ; Retrospective Studies

【Objective】 To investigate the association between HLA-A, B, DRB1 alleles and chronic renal failure (CRF) in Han population of Shandong Peninsula. 【Methods】 Sequence specific oligonucleotide probe-polymerase chain reaction (PCR-SSO) was used to genotype 880 patients with CRF in the Han population of Shandong Peninsula. The allele frequencies of HLA-A, B and DRB1 were compared with 865 hematopoietic stem cell voluntary donors, and the association between HLA gene polymorphism and CRF was analyzed. 【Results】 A total of 33 HLA-A alleles, 76 HLA-B alleles and 39 HLA-DRB1 alleles were detected in the study group. DRB1^*11∶01 (6.70% vs 4.45%) and DRB1^*12∶02 (8.69% vs 5.90%) in CRF group were significantly higher than those in the control(Pc<0.05), and B^*15∶11 (1.82% vs 3.64%) among CRF group was significantly lower compared with the control(Pc<0.05). The frequency of three loci haplotypes A^*30∶01 -B^*13∶02 -DRB1^*07∶01 (16.61% vs 7.61%), A^*33∶03 -B^*58∶01 -DRB1^*03∶01 (4.57% vs 1.62%) and A^*02∶07 -B^*46∶01 -DRB1^*09∶01 (4.06% vs 1.09%) in CRF patients were significantly higher than that of the control(Pc<0.05), which were strongly correlated with CRF. 【Conclusion】 The data on the association of HLA-A, B, DRB1 alleles and haplotype polymorphisms with CRF in Shandong Peninsula has been obtained in this study. DRB1^*11∶01 and DRB1^*12∶02 may be the susceptibility risk factors for development of CRF, and B^*15∶11 may be protective genes against development of CRF, and A^*30∶01 -B^*13∶02 -DRB1^*07∶01, A^*33∶03 -B^*58∶01 -DRB1^*03∶01 and A^*02∶07 -B^*46∶01 -DRB1^*09∶01 may be the susceptible haplotypes in Han population of Shandong Peninsula.

Objective:To explore the effect of social skill training on the frustration and self-esteem of schizophrenics.Methods:From December 2020 to May 2021, 100 schizophrenics hospitalized in the same ward of the Huai'an Third People's Hospital of Jiangsu Province were selected as the research object by convenience sampling. The patients were randomly divided into the control group and the observation group with 50 cases each. The control group received routine nursing, while the observation group carried out social skills training on the basis of the control group. Before and 8 weeks after the intervention, the frustration, self-esteem and social function of the patients in the two groups were evaluated with the Defeat Scale (DS), Rosenberg Self-esteem Scale (SES) and the Scale of Social Function in Psychosis Inpatients (SSPI) .Results:Before intervention, there was no statistical difference in scores of frustration, self-esteem and social function between the two groups ( P>0.05). After intervention, the scores of frustration in the two groups were lower than those before intervention, and the scores in the observation group were lower than those in the control group, with statistical differences ( P<0.01). The scores of self-esteem and social function in the two groups were higher than those before intervention, and the scores in the observation group were higher than those in the control group, with statistical differences ( P<0.05) . Conclusions:Social skill training can improve the mental state of schizophrenics, reduce their frustration, adjust their self-esteem, and improve their social functions.

Objective To explore the value of ultrasound elastography in the non-invasive monitoring of liver elasticity of stable recipients at different stages after liver transplantation. Methods Clinical data of 73 stable recipients after liver transplantation were collected. According to the time after liver transplantation, all patients were divided into the early group (n=25) and medium-to-long group (n=48). In addition, 38 healthy subjects were assigned into the control group. The ultrasound indexes and liver function indexes were statistically compared among each group. The ultrasound elastography indexes of liver and spleen were analyzed, and their correlation with liver function indexes was analyzed. Results Compared with the control group, the ultrasound indexes, alanine aminotransferase (ALT), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were significantly increased in the early group (all P < 0.05), and the ultrasound indexes in the medium-to-long group were significantly increased, whereas the GGT level was significantly decreased (all P < 0.05). Compared with the early group, the right oblique diameter of liver, ALT, GGT and ALP levels were significantly decreased in the medium-to-long group (all P < 0.05). Compared with the control group, the sound touch elastography (STE) and sound touch quantify (STQ) values of liver and STE value of spleen in the early group and medium-to-long group were significantly increased (all P < 0.05). Compared with the early group, the ultrasound elastography indexes of liver and spleen in the medium-to-long group were remarkably decreased (all P < 0.05). The ultrasound elastography indexes of liver were weakly correlated with the ALT, aspartate aminotransferase (AST) and GGT levels, significantly correlated with ALP level. The STE value of spleen was weakly correlated with the ALP level. The STE value of liver was significantly correlated with the STQ value of liver. The STE and STQ values of liver were weakly correlated with the STE value of spleen. Conclusions The characteristics of liver elasticity in stable recipients after liver transplantation are various among different stages. Persistent monitoring of liver elasticity may provide a novelnon-invasive monitoring method during follow-up after liver transplantation.

【Objective】 To investigate the distribution characteristics of Rh blood group antigen phenotypes, haplotypes and irregular antibodies between patients in our hospital and local blood donors, so as to ensure safe and effective blood transfusion and improve the rationality and scientificity of clinical blood transfusion. 【Methods】 A total of 113 326 blood samples, from hospitalized patients in our hospital and local blood donors from October 2015 to March 2020, were subjected to Rh antigen typing and irregular antibody detection. The frequency of Rh phenotypes, haplotypes, and irregular antibodies were retrospectively analyzed and calculated. Chi square test was used to compare the data among different population groups. Rh antigen typing and irregular antibody detection were completed using the automatic blood group analyzer. 【Results】 The prevalence of negative RhD was 0.36% (408/113 326). The most prevalent Rh phenotype was DCCee [40.69%(46 112/ 113 326)] followed by DCcEe [36.82%(41 727/ 113 326)]. Anti-E was the most common irregular antibody, accounting for [0.26%(295/ 113 326)], and DCe [62.51%(70 840/ 113 326)] was the most common haplotype. The most common Rh phenotypes and haplotypes in Caucasians in Germany, North Indian and North African were DCcee, DCCee and Dccee, while DCe, DCe and Dce, respectively. 【Conclusion】 The distribution characteristics of Rh phenotypes, haplotypes and irregular antibodies of patients in our hospital and local blood donors were in line with the distribution characteristics of the population in northern China. Corresponding plans concerning blood storage and collection, as well as the establishment of Rh blood type registry should be carried to effectively ensure the safety, rationality and accuracy of clinical blood transfusion.