Purpose: Preoperative localization plays an important role in secondary hyperparathyroidism (SHPT) surgery. The advantages of neck ultrasound (US) include high availability and low cost. However, the reported sensitivity of US is 54%– 76%, and the reason for missed parathyroid glands (PGs) on US has been rarely addressed. Methods: Fifty-four patients who were diagnosed with renal SHPT from September 2020 to March 2022 were included in this retrospective study. Preoperative localization included surgeon-oriented US and technetium 99m-sestamibi singlephoton emission CT (SPECT)/CT. Results: A total of 212 PGs were pathologically confirmed, resulting in a success rate of 96.2% (52 of 54). Using echo, 193 PGs (91.0%) were accurately localized, while 19 glands (9.0%) were not identified, including those in ectopic positions (n = 12, at thymus or intrathyroid or others), of small size (<1 cm, n = 6), or overlapping with an ipsilateral PG (n = 1). US accurately detected 4 PGs in 36 (66.7%) patients, while SPECT/CT localized 4 glands in 19 patients (35.2%). Although the number of US-detectable PGs was not associated with success rate, it showed a significant negative correlation with surgical time (rs = –0.459, P = 0.002). Conclusion US detected 4 glands in 66% of SHPT patients with a sensitivity of 90% for localization. Ectopic position and small size were the most common reasons for the failure to detect PG on US. Complete preoperative echo localization might shorten operating time.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is an increasingly common liver disease worldwide. MAFLD is diagnosed based on the presence of steatosis on images, histological findings, or serum marker levels as well as the presence of at least one of the three metabolic features: overweight/obesity, type 2 diabetes mellitus, and metabolic risk factors. MAFLD is not only a liver disease but also a factor contributing to or related to cardiovascular diseases (CVD), which is the major etiology responsible for morbidity and mortality in patients with MAFLD. Hence, understanding the association between MAFLD and CVD, surveillance and risk stratification of MAFLD in patients with CVD, and assessment of the current status of MAFLD management are urgent requirements for both hepatologists and cardiologists. This Taiwan position statement reviews the literature and provides suggestions regarding the epidemiology, etiology, risk factors, risk stratification, nonpharmacological interventions, and potential drug treatments of MAFLD, focusing on its association with CVD.

【Objective】 To explore the relationship between the storage time of leukodepleted red blood cells and transfusion adverse reactions by analyzing the occurrence of transfusion adverse reactions of patients after leukodepleted red blood cells transfusion from four hospitals. 【Methods】 By using the electronic medical record management system, the collection and transfusion dates of leukodepleted red blood cells from four hospitals in Enshi Prefecture from 2018 to 2022, as well as the information on transfusion adverse reactions, were retrieved. 【Results】 From 2018 to 2022, a total of 697 61 bags of leukodepleted red blood cells were transfused in four hospitals, resulting in 166 cases of transfusion adverse reactions, among which 93 were allergic reactions, 63 were non hemolytic febrile reactions, and 10 were others, with a total incidence rate of transfusion adverse reactions at 0.24%. The average storage time of leukodepleted red blood cells with and without transfusion adverse reactions was (20.25±6.31) and (19.88±5.50) days, respectively. With a storage time of 7 days as the threshold, the incidence of transfusion adverse reactions was the lowest for a storage time of 15~21 days. The incidence of transfusion adverse reactions of leukodepleted red blood cells in two groups (with storage days ≤21 days and >21 days) was not statistically significant(P>0.05). 【Conclusion】 Allergic reactions were the main type of transfusion adverse reaction caused by leukodepleted red blood cells, and the incidence of transfusion adverse reactions decreased and then increased with the prolongation of the storage time of leukodepleted red blood cells. There was no significant difference in the incidence of transfusion adverse reactions with leukodepleted red blood cells stored for ≤ 21 days and >21 days.

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m², fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m², male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.
Adult ; Aged ; Humans ; Male ; Female ; Middle Aged ; Aged, 80 and over ; Blood Pressure/physiology* ; Diabetes Mellitus, Type 2/epidemiology* ; Antihypertensive Agents/therapeutic use* ; Smoking ; Body Mass Index ; Hypertension/epidemiology*

Child ; Consensus ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional ; Respiratory System

Objective: To investigate the feasibility of endoscopic lateral neck dissection via the breast and transoral approaches (ELNDBTOA) for papillary thyroid carcinoma (PTC). Methods: From February 2015 to April 2019, 10 patients with PTC (cN1b) including 1 male and 9 females aged from 22 to 53 years old received ELNDBTOA in the General Surgery Department of Zhongshan Hospital, Xiamen University. Total thyroidectomy, the central lymph node dissection and the selective neck dissection (levels Ⅱ, Ⅲ and Ⅳ) were performed endoscopically via the breast approach, and then the residual lymph nodes were dissected via transoral approach. The medical records, operation time, blood loss, complications and postoperative follow-up outcomes were analyzed retrospectively. SPSS 22.0 software package was used for statistical processing of clinical data of patients. Results: All cases were successfully treated with ELNDBTOA without transfer to open surgery. The average operative time was (362.5±79.7) min, the blood loss was (23.0±14.9) ml, and the postoperative hospital stay was (5.1±1.3) days. The mean number of harvested cervical lymph nodes were (34.2±25.8), and the mean number of positive lymph nodes were (6.5±4.9). Lymph nodes were dissected by the further dissection via oral approach in 6 patients and a total of 9 lateral lymph nodes were havested from 2 of the 6 patients, with 3 positive lymph nodes. Two patients had transient skin numbness in the mandibular area and recovered within two weeks. One patient developed transient hypoparathyroidism and recovered within two months. No secondary bleeding, recurrent laryngeal nerve paralysis, chylous leakage, neck infection, permanent hypoparathyroidism or other complications were observed. The follow-up time was from 16 to 66 months with a median of 42.5 months, no tumor recurrence or metastasis occurred, and also no obvious deformity, abnormal sensation or movement in the chest, neck and mouth was observed. Conclusions: ELNBTOA is safe and feasible, with good cosmetic outcome.
Adult ; Female ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Neck Dissection ; Retrospective Studies ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/surgery* ; Thyroidectomy ; Young Adult

Objective To compare the efficacy of traditional laparoscopic radical resection of sigmoid colon and rectal specimens without abdominal incision laparoscopic surgery. Methods From January 2015 to December 2016 in our hospital to implement selected laparoscopic assisted sigmoid colon cancer surgery patients in 34 patients with abdominal incision rectal specimens of laparoscopic sigmoid colon resection of colorectal cancer patients without abdominal incision group. As to the choice of 1 ~ 2 pairs in the same period of age, gender, as the control group were given laparoscopic assisted sigmoid colon body mass index similar to radical surgery in 68 patients with operation time. Comparing the two kinds of laparoscopic surgery, perioperative bleeding, postoperative exhaust time postoperative pain score, complications, surgery, postoperative hospital stay, additional analgesic treatment, length of bowel resection, proximal and distal margin, tumor size, lymph node dissection the number of pTNM staging. Results The abdominal surgery time without incision group of sigmoid colon cancer patients, intraoperative bleeding was significantly higher than control group, abdominal incision group of sigmoid colon cancer patients with postoperative exhaust time, postoperative pain awake score, postoperative 1 d pain score was significantly lower than the control group, there was statistical significance the difference (P < 0.05); the two group of sigmoid colon cancer patients with bowel resection length of proximal margin, tumor size, number of lymph node dissection, there was no significant difference in pTNM staging (P > 0.05). Abdominal incision group were followed up for 5~8 months, average 6 months; the control group were followed up for 6 ~ 9 months, an average of 7 in August, there were no tumor recurrence and metastasis. Conclusion Compared with traditional laparoscopic surgery, abdominal incision rectal specimens of laparoscopic radical resection of sigmoid colon cancer can significantly reduce the pain of patients, shorten the postoperative exhaust time, tumor root Treatment effect is similar

Objective To learn the timeliness and reasons for the delay in discovering outbreaks via a dengue fever outbreak in Zhejiang Province,and try to improve our disease monitoring system.Methods Epidemic and clinic data were collected by searching cases and epidemiological investigation,and clinic behavior of cases in dengue fever outbreak were described,then the risk factors involved in the delay in discovering outbreak were analyzed.Results Totally 46 cases were found in this outbreak,among which 36 (78.28％) cases were infected before.The onset date of the first case we found was on July 15 th,57 day before the outbreak confirmation.According to the results,95.65％ of cases see a doctor after their sickness,and the rate of three day hospital visiting was 93.36％ (42/46),among which the rate of three day hospital visiting before pathogen confirmation was 91.67％ (33/36),and there was no statistic significance in diagnostic rate before and after pathogen confirmation(P =1.00).Conclusion Cases in this dengue outbreak presented high and timely outpatient rate.Thus,the delay confirmation of dengue fever outbreak was caused by the low sensitivity of doctors in all levels of hospital.More training on dengue fever diagnosis for doctors should be carried out in the future to control and prevent dengue fever more efficiently.

OBJECTIVETo investigate the expression of anaplastic lymphoma kinase (ALK) gene fusion antibody in non-small cell lung cancer (NSCLC) and explore the clinicopathological significance.

METHODSUsing manual immunohistochemistry (IHC) with D5F3 rabbit monoclonal antibody, we detected the expression of ALK gene fusion protein in 519 cases of NSCLC. The relations of ALK fusion protein with the clinical characteristics of the patients and the histological classification of the tumors were analyzed. The expressions of ALK fusion protein were compared between surgical specimens and biopsy samples, and the consistency of manual IHC results was evaluated with the results of a fully automated IHC instrument and fluorescence in situ hybridization (FISH).

RESULTSThe positivity rate of ALK fusion protein was 11.37% (59/519) among the cases detected by manual IHC. The patients tended to have a young age of onset (P=0.048) and most of the tumors were adenocarcinoma. In the surgical specimens, ALK fusion protein was expressed mostly in invasive mucinous adenocarcinoma (P<0.01), and it was a high risk factor of lymph node metastasis [OR=2.188(95%C.I:1.161-4.122)]. No statistical difference was found in the test results of manual IHC between surgical specimens and biopsy samples. The results by manual IHC suggesting a strong expression were consistent with the results by automated IHC and FISH.

CONCLUSIONManual IHC can be reliable for screening ALK fusion arrangement in patients with NSCLC.

Adenocarcinoma ; genetics ; Antibodies ; Carcinoma, Non-Small-Cell Lung ; genetics ; Gene Fusion ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Lung Neoplasms ; genetics ; Receptor Protein-Tyrosine Kinases ; genetics ; immunology

Objective To evaluate the effectiveness of intern doctor training by 360 degree evaluation scale and to provide references for formulating targeted training plan. Methods A 360-degree evaluation scale with 6 subscales(Attendings, Peers, Nurse, Patients, Directors and Students) was employed to measure the status quo of medical education , represented by professional ethics and communication skills, among 129 intern doctors in medical clinical college. Cronbach's alpha was used to evaluate the reliability of the scale,one-way ANOVA was used to compare the difference of score among different scorers,and t test and Mann-Whitney test were employed to compare scores be-tween male group and female group, 5-year class and 8-year class (The significance level was set at P<0.05). Results Cronbach' α coefficients were 0.878, 0.948, 0.914, 0.908, and 0.934 for six sub-scales and 0.964 for the general scale. There were significant differences in evaluation scale scores a-mong differ-ent evaluators(P<0.01). After being adjusted by weight index, the average scores of pro-fessional ethics and communication ability & interpersonal relationship were ( 92 . 52 ± 8 . 09 ) and (93.32±8.67) respectively. No differences was observed between male and female, 5-year class and 8-year class(P>0.05). Conclusions 360 degree evaluation scale has reasonable reliability and it can provide valuable references for future similar survey in China. Meanwhile, intern doctors exhibit rela-tively good performances in professional ethics and communication ability & interpersonal relationship in the present study.