Objective To investigate the effect of computer-aided diagnosis(CAD)as a"second reader"integrated in prostate cancer(PCa)multiparametric magnetic resonance imaging(mpMRI)on the diagnostic performance.Methods Sixty-four patients were recruited retrospectively.Six readers were divided into 3 groups according to the experience.Unknown the pathologic diagnosis,readers graded according to prostate imaging reporting and data system(PI-RADS)v2.1 and accepted or rejected the revision of PI-RADS v2.1 scores by CAD.Using pathology as the gold standard,the diagnostic efficiency,diagnostic confidence and reading time of PI-RADS v2.1 were compared before and after CAD assistant.Results On the level of lesions,without CAD,the area under the curve(AUC)of reader A1 was higher than B1,C1 and C2,and the AUC of reader A2 was higher than C1 and C2,the difference was statistically significant(P＜0.05).While the difference of AUC among other readers were not significant(P＞0.05).With CAD,the difference of AUC among all readers were not significant(P＞0.05).On the level of patients,the mean AUC of all readers with CAD[0.903,95％confidence interval(CI)0.848-0.958]was higher than that without CAD(0.863,95％CI 0.800-0.929),the differ-ence was statistically significant(F=6.52,P=0.040).The difference of AUC between without and with CAD assistance was-0.040(95％CI-0.078--0.003),standard deviation was 0.016,the difference was statistically significant(t=-2.55,P=0.040).The diag-nostic confidence of readers was improved significantly with CAD(P＜0.05).Besides,the average reading time of each case required an additional 0.8 min.Conclusion After integrating CAD into PCa mpMRI diagnosis as a"second reader",the performance of less experienced readers can be improved and show similar diagnostic efficiency with experienced readers.

Objective:To evaluate the clinical application potential of a novel prostate specific membrane antigen (PSMA) targeted PET tracer 68Ga-PSMA-NYM032 in patients diagnosed initially with prostate cancer. Methods:A total of 63 patients (age (68.7±8.7) years) with suspected prostate cancers who received 68Ga-PSMA-NYM032 PET/CT imaging in Affiliated Hospital of Jiangnan University between March 2022 and January 2023 were enrolled prospectively. The diagnostic efficiency of 68Ga-PSMA-NYM032 PET/CT imaging was evaluated in a patient-centered manner. The ROI was drawn to obtain SUV max by semi-quantitative analysis with visual analysis, and the diagnostic threshold of SUV max was obtained by ROC curve analysis. The correlations of SUV max in primary foci with total prostate specific antigen (tPSA) and Gleason score (GS) were analyzed by Spearman rank correlation analysis. Based on the D′Amico risk stratification (prostate specific antigen (PSA)>20 μg/L and ≤20 μg/L, GS>7 and ≤7), the detection rates of metastases by 68Ga-PSMA-NYM032 PET/CT imaging in different stratifications were analyzed by Fisher exact test, and the differences between SUV max of metastases in different stratifications were determined by Mann-Whitney U test. Results:The accuracy of 68Ga-PSMA-NYM032 PET/CT imaging was 92.06%(58/63), the sensitivity was 96.55%(28/29), the specificity was 88.24%(30/34), the positive predictive value was 87.50%(28/32), the negative predictive value was 96.77%(30/31), and the optimal SUV max threshold was 6.9. 68Ga-PSMA-NYM032 showed varying degrees of high uptake in the primary foci of prostate cancer, and SUV max were positively correlated with tPSA and GS ( rs values: 0.657, 0.592, P values: <0.001, 0.001). Stratified analysis showed a statistically significant difference in the detection rate of bone metastases by 68Ga-PSMA-NYM032 PET/CT between the GS>7 and GS≤7 subgroups (9/17 vs 1/12; P=0.019), while no statistical significances were observed in the detection rates of bone metastases or lymph node metastases of another subgroups (all P>0.05). In addition, none of the differences in SUV max of metastases in patients with different stratifications were statistically significant ( z value: from -1.57 to -0.50, all P>0.05). Conclusions:68Ga-PSMA-NYM032 PET/CT imaging has good diagnostic efficacy for prostate cancer, and it may provide a new strategy for the precise diagnosis and treatment of prostate cancer. Besides, GS stratification may affect the detection rate of bone metastases by 68Ga-PSMA-NYM032 PET/CT imaging.

Objective:To analyze the delivery room disaster vulnerabilities of 7 tertiary hospitals in Liaoning Province, evaluate the nursing management disasters vulneratility, and provid support for emergency management of delivery room nursing.Methods:The Kaiser model analysis was used to design a disaster vulnerability assessment form for the delivery room, combined with the actual risk prevention and control in the delivery room. The survey was conducted from March 18 to 27, 2020 by paper questionnaire among 200 nursing staff in the delivery room, and the risk values for emergencies were calculated and the matrix distribution was analyzed and evaluated.Results:Totally 190 valid questionnaires were collected. The top 10 risk events faced by the delivery room were epidemic outbreaks, failure to adequately protective equipment for emergency admission to the delivery room, maternal poor protection awareness, nursing staff were contaminated with amniotic fluid and body fluids, poor maternal compliance with midwife orders, shortage of supplies of medical care protective equipment, nursing staff suffered needlestick injuries, high fever in patients, masks and gloves were worn or removed incorrectly, and doctor-patient tension due to poor compliance.Conclusion:Kaiser model-based hazard vulnerability analysis of delivery rooms can provide an important basis for risk identification and early warning and emergency plan improvement and formulation, which should be applied flexibly with the actual and specific characteristics of delivery rooms and dynamic changes of risks.

Objective:To investigate the characteristics and reliability of a novel sub-classification of Wilkins type III lateral-flexion supracondylar fracture of the humerus in children.Methods:A retrospective cohort study was used to analyze the clinical data of 92 children with supracondylar fracture of the humerus admitted to Provincial Children′s Hospital of Anhui Medical University from January 2013 to August 2021, including 38 males and 54 females, aged 2-13 years [(8.5±2.4)years]. Lateral-flexion Wilkins type III supracondylar humeral fractures were classified into two subtypes according to the fracture features: type IIIA ( n=14), complete fracture with the distal fragment displaced anteriorly and laterally, with no obvious anterior or posterior inclination (<10°) or rotation; type IIIB ( n=78), complete fracture with the distal fragment displaced anteriorly and laterally, with significant anterior or posterior inclination (>10°) or rotation. The incidence and risk ratio of ulnar nerve injury and open reduction were compared between the two subtypes of the fracture. The weighted Kappa method was used to test the inter- and intra-observer agreement of the two new subtypes. Results:Of all, 15 children had ulnar nerve injury, among which 1(6.7%) was type IIIA and 14(93.3%) were type IIIB; while other 77 children had no ulnar nerve injury. The risk of ulnar nerve injury in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=2.84, 95% CI 0.34- 25.56, P>0.05). The open reduction was performed in 11(73.3%) out of the 15 children with ulnar nerve injury, but in 18(23.4%) out of the 77 children with no ulnar nerve injury. The risk of open reduction in children with ulnar nerve injury was 9-fold higher than that in children without ulnar nerve injury ( OR=9.01, 95% CI 2.28- 33.17, P<0.01). Open reduction was performed in 29 children, among which 2(6.9%) were type IIIA and 27(93.1%) were type IIIB. The risk of open reduction in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=3.17, 95% CI 0.66-15.24, P>0.05). The intra-observer Kappa value was 0.49±0.09(95% CI 0.31-0.66), indicating a moderate agreement. The inter-observer Kappa value was 0.80±0.06(95% CI 0.68-0.91), indicating a strong or very strong agreement. Conclusions:Wilkins type IIIB lateral-flexion supracondylar fracture of the humerus in children is more likely to be accompanied by ulnar nerve injury and to be opt to open reduction in comparion with type IIIA. The new subtyping has reliable inter-observer and intra-observer consistency, and is able to facilitate the prediction of surgical plans.

Objective:To construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes and evaluate its reliability and validity so as to provide a scientific assessment scale for clinical practice.Methods:The literature review, group discussion, expert consultation method and questionnaire survey method were used to construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes. Based on the theory of knowledge, attitude and practice, the initial scale was developed through literature review. The Delphi method was used to conduct two rounds expert consultation to develop the pre-test scale. From August to October 2020, a total of 230 pre-discharge patients from China-Japan Union Hospital of Jilin University were selected as the research subjects. The reliability and validity of the scale were tested.Results:The formal scale included 32 items and 4 dimensions. The scale-level content validity index was 0.79-1.00, unanimity scale-level content validity index ( S- CVI/ UA) was 0.81, and average scale-level content validity ( S- CVI/ Ave) was 0.95. The Cronbach's α coefficient of the scale was 0.955, and the half-reliability was 0.846. Conclusions:The Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes has good reliability and validity, which can provide a scientific and effective assessment tool for clinical practice.

Objective:To investigate the association between the pathogenesis of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B and the frequency and function of plasmacytoid dendritic cell (pDC) in patients HBeAg-positive chronic hepatitis B virus infection.Methods:A total of 49 HBeAg (+ ) patients with chronic hepatitis B virus infection in immune tolerance phase (IT) and 100 patients in immune clearance phase (IC) were enrolled. The viral serological indicators and liver function were detected. Peripheral venous blood samples were collected. The peripheral blood pDC frequency and the quantitative expression of co-stimulatory molecule CD86 were detected by flow cytometry, and the correlation between the onset of chronic hepatitis B and the frequency and function of pDC was analyzed.Results:In IC group, hepatitis B surface antigen (HBsAg) levels, HBeAg levels and hepatitis B virus (HBV) DNA loads were significantly lower than those in IT group, and alanine aminotransferase (ALT) levels in IC group were significantly higher than that in IT group; pDC% in IC group was significantly lower than that in IT group; CD86 + pDC% and CD86 mean fluorescentintensity (MFI) showed no significant difference between the two groups. In the IC group, the baseline pDC% was negatively correlated with ALT levels, while CD86 + pDC%, CD86MFI, and CD86 antibody binding capacity (ABC) had no remarkable correlation with ALT levels. Conclusions:The frequency of pDC was correlated with the pathogenesis of CHB. The lower the frequency of pDC in patients with CHB, the more prone to hepatitis. Therefore, increasing the frequency of pDC may inhibit the occurrence of hepatitis.

Objective To evaluate the predictive value of multiparametric MRI (mpMRI)for extracapsular extension (ECE)in patients with prostate cancer.Methods The imaging of prostate mpMRI was performed in 52 consecutive patients with prostate cancer,who underwent subsequent radical prostatectomy.MR images were interpreted retrospectively by one experienced radiologist, who was blinded to any clinical details.According to Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2),suspecious lesions were graded and recorded.Lesions with PI-RADS&ge;4 were further categorized in terms of ECE and correlated with radical prostatectomy pathology by using side-by-side comparison.Receiver operating characteristic (ROC)curves were used to calculate accuracy,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV),in order to evaluate diagnostic performance of ECE scoring system.Results Totally 55 prostate cancer foci with PI-RADS&ge;4 were correctly identified by the radiologist.The area under the ROC of ECE score was 0.694 (P=0.013)and ECE score 3 was considered as the best cutoff point with accuracy,sensitivity,specificity,PPV and NPV of 69.3%, 70.4%,67.9%,67.9% and 70.4%,respectively.Conclusion mpMRI is a relatively reliable noninvasive technique for assessment of ECE in clinical practice.

Objective To study the irrational intravenous (IV) medication orders and promote rational medication applications.Methods A retrospective analysis was conducted to analyze the irrational prescriptions from January to December 2016.Results Among 39 948 IV medication orders reviewed, there were 134 irrational prescriptions of cytotoxic drugs (0.33％) and 222 irrational prescriptions of total parenteral nutrition(TPN)(0.56％).Within 356 irrational prescriptions, 19 had improper amount of diluent(5.34％), 95 inappropriate dosage(26.69％), 12 drug incompatibility(3.37％), 8 wrong diluent (2.24％) and 222 inappropriate TPN orders (62.36％).Conclusion The interventions of the clinical pharmacists are needed to reduce medication errors and improve the drug safety and effectiveness.

Objective To evaluate the feasibility of 80 kVp tube voltage combined with adaptive statistical iterative reconstruction (ASiR)in low dose contrast media split-bolus 2-phase CTU.Methods Sixty patients with hematuria were recruited in this study.All the patients (80 kVp Group,n=30;120 kVp Group,n=30)underwent split-bolus 2-phase CTU (80 kVp Group:35 mL and 60 mL;120 kVp Group:50 mL and 70 mL).CTU images were reconstructed with 30％ ASiR in 80 kVp Group and with filtered back projection (FBP)in 120 kVp Group.Subjective and objective analysis of CTU images were accomplished by two qualified and independent readers.The radiation dose was evaluated by ED and SSDE.The image score,noise,attenuation value and CNR of urinary tract,and radiation dose were compared by Mann-Whitney rank sum test.Results There was no significant difference in the image quality between two groups (Z =-1.791,P =0.073).The noise of 80 kVp Group were higher than that of 120 kVp Group (Z =-6.299,P <0.001 ), while there was no significant difference of attenuation value between the two groups (Z =-1.204 --0.163,P =0.228 -0.871,except bladder),as well as the CNRs (Z =- 1.818 --0.202,P =0.069 -0.840).The ED and SSDE of 80kVp Group were significantly lower than those of 120 kVp Group (Z =-6.655--6.653,P <0.001).Conclusion The protocol of 80 kVp tube voltage combined with iterative reconstruction in low dose contrast media split-bolus 2-phase CTU is feasible for clinical application,with reduction of radiation dose and acceptable diagnostic image quality.

Purpose In order to improve the detection rate and diagnostic accuracy of clinically significant prostate cancer (PCa),prostate imaging reporting and data system version 2 (PI-RADS v2) was introduced to standardize multi-parametric MRI (mp-MRI) assessment classification standard.This study was designed to analyze the missed diagnosis and misdiagnosis of PCa when PI-RADS v2 was used as a diagnosis standard.Materials and Methods With step-section pathology as a "Golden Standard",mp-MR1 data of 52 patients with PCa were retrospectively analyzed,the problems confronted by radiologists when reading films with PI-RADS v2 were summarized,and the emphasis was given on missed diagnosis and misdiagnosis.Results 114 PCa foci were identified through stepsection pathology,including 83 clinically significant PCa.MRI found 91 suspicious lesions,in which 63 were true positive,with the misdiagnosis rate of 30.8％.The rate of missed diagnosis of PCa was 38.6％,and the rate of missed diagnosis of clinically significant PCa was 24.1％.Conclusion There will be relatively high rate of misdiagnosis and missed diagnosis when PI-RADS v2 is used as a diagnostic standard.