Objective To investigate the CT and MRI findings of different types of small round cell tumor(SRCT)in the nasal cavity and sinuses.Methods A retrospective analysis was conducted on the imaging data and clinical data of 35 SRCT patients confirmed by pathology.Thirty-one SRCT patients underwent CT examination,and 19 SRCT patients underwent MRI examination.Results There were 20 cases of tumors that invaded the nasal cavity and 19 cases involved the sinuses,including 11 cases of the maxillary sinus,7 cases of the ethmoid sinus,2 cases of the sphenoid sinus,and 1 case of the frontal sinus.CT findings of SRCT were all soft tissue masses.Lymphoma was relatively homogeneous with mild bone destruction,and usually involved nasal vestibular skin.Rhabdomyosarcoma(embryonic type)happened at an early age and easily caused bone destruction and metastasis.Melanoma generally occurred in the nasal septum and nasal cavity,which was prone to bleeding.Small cell neuroendocrine carcinoma was heterogeneous,with moderate to significant enhancement,bone absorption and destruction were often noticed.The MRI manifestations of SRCT were equal or long signal on T1WI,high signal on T2WI,and significant diffusion limitation on diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)except for melanoma.On contrast-enhanced images,lymphoma showed mild to moderate enhancement,rhabdomyosarcoma showed typical"grape sign",and small cell neuroendocrine carcinoma showed"sieve"and"map-like"obvious enhancement.Typical melanoma showed a high signal on T1WI and a low signal on T2WI and usually caused bleeding.The MRI findings were related to the presence of melanoma and hemorrhage within the lesion.Conclusion SRCT of the nasal cavity and sinuses have a high degree of malignancy and poor prognosis,CT and MRI have many similar manifestations.Combining clinical data,bone destruction,MRI enhancement,and DWI sequence can effectively distinguish different types of SRCT,as well as squamous cell carcinoma of the nasal cavity and sinuses and adenoid cystic carcinoma.

Objective To compare the value of multimodal ultrasound and ultrasound-guided fine-needle aspiration biopsy(US-FNAB)for distinguishing benign and malignant thyroid nodules of Chinese thyroid imaging reporting and data system(C-TIRADS)grade 4.Methods Data of 247 thyroid nodules in 201 patients were retrospectively analyzed,including 193 malignant and 54 benign noes.Taken postoperative pathology as the gold standards,the value of multimodal ultrasound,i.e.the combination of conventional ultrasound,shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS)and US-FNAB for distinguishing benign and malignant thyroid nodules were compared.Results The sensitivity,specificity,accuracy,misdiagnosis rate and rate of missed diagnosis of conventional ultrasound for diagnosing malignant thyroid nodules was 86.53％,59.26％,80.57％,40.74％and 13.47％,respectively,of SWE was 78.76％,74.07％,77.73％,25.93％and 21.24％,respectively,of CEUS was 90.16％,77.78％,87.45％,22.22％and 9.84％,respectively,while of multimodal ultrasound was 97.93％,88.89％,95.95％,11.11％and 2.07％,respectively,and of US-FNAB was 89.64％,96.30％,91.09％,3.70％and 10.36％,respectively.The sensitivity,specificity and accuracy of multimodal ultrasound for distinguishing benign and malignant thyroid nodules were higher,while the misdiagnosis rate and missed diagnosis rate were lower than those of conventional ultrasound,SWE and CEUS alone.The sensitivity,accuracy and misdiagnosis rate of multimodal ultrasound were higher,while its specificity and missed diagnosis rate were both lower than those of US-FNAB(all P＜0.05).Conclusion For distinguishing benign and malignant thyroid nodules of C-TIRADS grade 4,multimodal ultrasound had higher sensitivity and accuracy but higher misdiagnosis rate,while US-FNAB had higher specificity but also higher missed diagnosis rate.

Injury monitoring is an important approach for injury control and is an important part of comprehensive disease monitoring. With the development of medical digitalization, an intelligent injury monitoring system has been created in Yinzhou District, Ningbo City, Zhejiang Province using artificial intelligence techniques based on Ningbo Municipal Health Information Platform and has been applied across the district since 2019. The manual card-reporting mode has been transformed to intelligent card-reporting mode in this system, which achieves functions of epidemiological analyses of the monitoring data, early warning of high-incidence injuries, classified management of injury and quality control of report cards. Nearly 300 thousand cards have been automatically reported since the system was online available since November 2022, and the epidemiological characteristics of injury were preliminarily understood, which provide data supports to early earning and interventions of injury. The intelligent injury monitoring system greatly improves the injury monitoring efficiency and card-reporting quality, and saves a large number of manpower and material resources, which provides a powerful technical support to widespread injury monitoring.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*

The cause and treatment of refractory hyperglycemia in a critically ill coronavirus disease 2019 (COVID-19) patient during treatment were analyzed retrospectively, indicating that novel coronavirus infection may cause damage to glucose metabolism, so the monitoring and control of blood glucose should be strengthened in clinical treatment.

OBJECTIVE To explore t he significance of reducing the incidence rate of airway burn of CO2 laser laryngeal surgery by spreading the idea of grading prevention st rateg y. M ETHODS We retrospectively reviewed the data of laryngeal lesions treated by the endoscopic CO2 laser surgery from Feburary 1992 to December 2016. The period was divided into two stages, the first one is from Feburary 1992 to December 2008, and the second one is from January 2009 to December 2016. We will distinguish the difference of airway burn between the two stages. RESULTS Four cases of airway burn were found in the first stage including 3 cases of glottic cancer and 1 case of vocal cord polyp with Reink's edema. But no airway burn happened in the second stage. Two cases of endotracheal intubation cuff broken by laser were found promptly, but with FiO2 decreasing from 70% to 30%, wet gauze filling subglottic region and the endotracheal tube reserved, the laser surgery proceeded till airway burn happened. The endotracheal intubation cuffs of the remaining two cases kept intact intraoperatively, the FiO2 was 70% when airway burn happened. One case had the cervical tracheal stenosis with long-term tracheotomy, The other 3 cases had no postoperative complications. CONCLUSION The grading prevention strategy is helpful for reducing airway burn during the CO2 laser surgery of larynx.

OBJECTIVE To explore the strategy of diagnosis and therapy of lingual ectopic thyroid(LET). METHODS We retrospectively reviewed the clinical data of6 cases of LET, and figured out the clinical features, imaging characteristics, therapy and prognosis.RESULTS 6 lingual ectopic thyroids were diagnosed by the Tc-99m thyroid static imaging; 3 cases accepted surgery, one only took oral levothyroxine, and one selected watch and see. 3 cases of lingual ectopic thyroid accepted the ectopic thyroid transposition and took oral levothyroxine postoperatively. Pharynx foreign body sensation and sleep snoring disappeared one month later. The lingual ectopic thyroid carcinoma resection was performed by direct laryngoscope in one case which was lost to follow up.CONCLUSION The thyroid static imaging is specific to the diagnosis of the LET. The indications of the surgery were obvious symptoms such as airway obstruction, snoring and pharyngeal foreign body sensation, and mass hemorrhage, cystic degeneration and carcinogenesis. The principle of therapy is to retain thyroid function as far as possible and comprehensive use of surgery, thyroid hormone replacement and iodine radiotherapy to improve symptoms, prevention and treatment of hypothyroidism.

Objective: To explore the effectiveness of Balint group on compassion fatigue among oncology nurses. Methods: From January to December 2016, 35 oncology nurses from one general hospital were enrolled. 18 cases were allocated in the observation group and 17 cases in the control group by computer randomization. Nurses in the observation group were received a total of 8 times Balint Group activities, with 2 times a month and 1.5 hours each time, which is aiming to discuss difficult cases encountered in the clinic to help nurses have a deeper experience and a better understanding of the emotions and behaviors, fantasies and needs between nurse-patient interaction. Nurses in the control group without intervention. All the Participants were requested to complete the survey of the Professional Quality of Life (ProQOL) , the Jefferson Scale of Empathy-Health Professionals (JSE-HP) , and the General Health Questionnaire (GHQ) at pre and post intervention. Results: Before intervention, two group of nurses in age, working years, marriage, and education were not statistically significant (P>0.05). There was no difference in the scores of empathy, compassion satisfaction, secondary traumatic stress, and General health (P>0.05). After intervention, the scores of JSE-HP and its three dimensions of perspective taking, emotional care, and trans-positional consideration in the observation group had significantly higher than the control group (P<0.05). The level of compassion satisfaction in the observation group was higher, and the general health status was lower (P<0.05). There was no statistically difference in the level of burnout and secondary traumatic stress between two groups (P>0.05) . Conclusion Balint group has a positive role in promoting nurses’empathetic skills, compassion satisfaction and mental health.

Objective To investigate the effects of “patient-family-community”health promotion mode on patients with impaired glucose regulation(IGR).Methods Using the function of random case samples in SPSS,we randomly chose an experimental village and a control village respectively from all villages in Zhuqiao of Pudong New Area.Altogether 75 IGR patients who met the requirement were filtered in the two villages. According to the villages they belonging to,39 of them were divided into experimental group and 36 to control group.From March 201 4 to August 201 4, subjects in the experimental group were intervened by“patient-family-community”health promotion mode,while participants in the control group used the regular health guidance.We compared the test score of knowledge-attitude-practice (KAP) questionnaire,family APGAR questionnaire and blood glucose between two groups.Results Relevant indexes of the two groups before intervention showed no difference (P >0.05).After intervention,the knowledge(K),attitude(A)and practice (P)test scores of the experimental group were (8.85 ±1 .31 ),(8.87 ±1 .77)and (6.92 ±2.67),higher than (5.86 ±2.37),(6.78 ±2.92)and (3.89 ±3.02)of the control group(Z =-5.1 89,-3.299,-4.042;P <0.05).The APGAR test scores of the experimental group(7.56 ±1 .90)was higher than(6.47 ±1 .77)of the control group(t =2.571 ,P <0.05).The FPG,2hPG and HbA1 c of the experimental group were (5.86 ± 0.50)mmol/L,(8.02 ±0.72)mmol/L and(5.73 ±0.42)%,which were lower than (6.1 1 ±0.45)mmol/L, (8.60 ±0.97)mmol/L and(5.97 ±0.53)% of the control group (t =-2.293,-2.383,-2.1 70;P <0.05).Conclusions Applying “patient-family-community”health promotion mode can improve the KAP, family function of IGR patients,control their blood glucose better and prevent diabetes.

The improvement of diagnostics teaching system,including the establishment of curriculum system and evaluation system,is the base of promoting clinical- medicine teaching.Our study showed that the theoretical knowledge and clinical skill of medical students could be improved by constructing clinical diagnostics curriculum system and improving organization management and assessment system,which could pave the way for the transition from medical students to clinicians.