Background::Pulmonary embolism (PE) is a severe and acute cardiovascular syndrome with high mortality among patients with autoimmune inflammatory rheumatic diseases (AIIRDs). Accurate prediction and timely intervention play a pivotal role in enhancing survival rates. However, there is a notable scarcity of practical early prediction and risk assessment systems of PE in patients with AIIRD.Methods::In the training cohort, 60 AIIRD with PE cases and 180 age-, gender-, and disease-matched AIIRD non-PE cases were identified from 7254 AIIRD cases in Tongji Hospital from 2014 to 2022. Univariable logistic regression (LR) and least absolute shrinkage and selection operator (LASSO) were used to select the clinical features for further training with machine learning (ML) methods, including random forest (RF), support vector machines (SVM), neural network (NN), logistic regression (LR), gradient boosted decision tree (GBDT), classification and regression trees (CART), and C5.0 models. The performances of these models were subsequently validated using a multicenter validation cohort.Results::In the training cohort, 24 and 13 clinical features were selected by univariable LR and LASSO strategies, respectively. The five ML models (RF, SVM, NN, LR, and GBDT) showed promising performances, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.962-1.000 in the training cohort and 0.969-0.999 in the validation cohort. CART and C5.0 models achieved AUCs of 0.850 and 0.932, respectively, in the training cohort. Using D-dimer as a pre-screening index, the refined C5.0 model achieved an AUC exceeding 0.948 in the training cohort and an AUC above 0.925 in the validation cohort. These results markedly outperformed the use of D-dimer levels alone.Conclusion::ML-based models are proven to be precise for predicting the onset of PE in patients with AIIRD exhibiting clinical suspicion of PE.Trial Registration::Chictr.org.cn: ChiCTR2200059599.

Subclinical seizures (SCS) are paroxysmal electroencephalogram (EEG) events that do not accompany obvious subjective or objective behavioral changes. They are not uncommon in EEG monitoring, with an intracranial EEG detection rate of about 50%-60%, significantly higher than the scalp EEG detection rate of about 10%. SCS most frequently occur in patients with temporal lobe epilepsy. In terms of EEG characteristics, SCS often remain confined to the epileptogenic zone but can also spread outside of it. Their value in localizing the epileptogenic zone is comparable to that of clinical seizures (CS). Additionally, the concordance between SCS and CS localization is associated with favorable surgical outcomes, indicating the significant value of SCS in focal epilepsy. A systematic review of domestic and international research on SCS is provided in this paper, aiming to enhance understanding in this area.

Objective:To understand the current situation of mood disorders in patients with thoracic and lumbar osteoporotic fractures and to preliminarily explore its influencing factors.Methods:A cross-sectional survey method was used to select 212 patients with thoracic and lumbar osteoporotic fractures from Department of Orthopedics, West China Hospital, Sichuan University, from January 2018 to September 2020 as the research subjects. The general information questionnaire, Huaxi Emotional-distress Index, Pittsburgh Sleep Quality Index (PSQI) and pain Visual Analogue Scale (VAS) were used to investigate them.Results:The incidence of mood disorders in patients with thoracic and lumbar osteoporotic fractures was 10.38% (22/212). The results of multivariate regression analysis showed that age, days of injury, PSQI score and pain VAS score were the influencing factors of emotional disturbance in patients with thoracic and lumbar osteoporotic fractures ( t values were -3.72-7.66, all P<0.05). Conclusions:Patients with thoracic and lumbar osteoporotic fractures have mood disorders. Age, injury days, PSQI score and VAS score are related to the occurrence of mood disorders in patients with thoracic and lumbar osteoporotic fractures. More attention should be payed to the influencing factors of mood disorders in patients,and timely measures should be taken for individualized intervention.

Synchronous bilateral primary breast cancer refers to the simultaneous occurrence of primary cancers in both breasts. The overall morbidity is low. However, with the detection of occult breast cancer increasing recently, it shows an upward trend. The pathogenesis is not yet clear, old age, family history of primary breast cancer, sclerosing adenopathy of precancerous lesions and pathological characteristics of first cancer are currently recognized risk factors. Compared with unilateral breast cancer, prognosis for synchronous bilateral primary breast cancer is poor. Raise the risk awareness of high-risk women, check regularly to find non-palpable lesions as soon as possible. By taking various preventive treatments for patients with high-risk unilateral breast cancer, the incidence of breast cancer can be effectively reduced and the prognosis of patients can be improved. By reviewing the literature at home and abroad, it systematically expounds the risk factors, histopathological features, prognosis and preventive treatment of synchronous bilateral breast cancer.

Objective:To analyze the viral nucleic acid and cytokines in 12 children with 2019-nCoV infection.Methods:Clinical and laboratory data of the children diagnosed with 2019-nCoV infection in Guangzhou Women and Children′s Medical Center from January to April 2020 were retrospectively analyzed. Throat and anal swabs were collected on alternate days for the detection of 2019-nCoV nucleic acid by fluorescence quantitative PCR. Flow cytometry was used to detect serum cytokines including IFN-γ, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-17F, IL-22, TNF-α and TNF-β during the early (both throat and anal swab tests were positive), the intermediate (throat swab test was negative, while anal swab test remained positive), and the convalescence (both throat and anal swab tests were negative) stages of infection.Results:A total of 12 children were enrolled in this study. The male-to-female ratio was 5∶1. The average age was (7.0±4.3) years. There were two asymptomatic, five mild and five common cases. No severe or critical cases were involved. Initially, throat and anal swab nucleic acid tests were simultaneously positive in nine children newly diagnosed in our hospital and the median time of viral shedding in throat swab was longer than that in throat swab [32 (4.5, 45.0) d vs 3 (2, 9) d, Z=11.0, P=0.010]. The median difference of viral shedding time between anal swab and pharyngeal swab was 25.5 (1.5, 42.8) d. The overall levels of serum cytokines IL-17A, IL -4 and IL-5 in different stages of the disease (early, intermediate and convalescence stage) were statistically different ( Z or F, P values were 8.33, 0.016; 5.36, 0.010 and 6.56, 0.004, respectively), and a significant increase was observed in the intermediate stage of infection. IL-17F, IL-2 and IL-22 were all increased during the infection, but there was no significant statistical difference among the three stages ( P>0.05). Conclusions:It was noted that intestinal viral shedding needed a longer time. Although the infectivity has not been determined, higher requirements have been put forward for disease prevention and control. Cytokines secreted by Th2 and Th17 cells were involved in the immune response in children with non-severe 2019-nCoV infection. Monitoring viral shedding and cytokine changes in pediatric patients would be conducive to disease assessment.

Objective:To study the patterns of tocilizumab (TCZ) use, its efficacy and safety in patients with rheumatoid arthritis (RA) in routine clinical practice.Methods:A total of 407 patients with RA were enrolled from 23 centers and treated with TCZ within 8 weeks prior to the enrollment visit, and were followed for 6-month. The patterns of TCZ treatment at 6 months, the effectiveness and safety outcomes were recorded. Statistical analysis was performed using SAS version 9.4.Results:A total of 396 patients were included for analysis, in which 330 (83.3%) patients received TCZ combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 16.7%(66/396) received TCZ monotherapy. At baseline, TCZ was initiated in 56.6%(224/396) and 9.6%(38/396) of patients after failure of DMARDs and other biological agents (bDMARDs) respectively. During the 6-month follow-up period, the mean frequency of TCZ administration was (3.7±1.6), the mean TCZ dosage was (7.4±1.2) mg/kg, and the mean interval between doses was (40±13) days. 120(25.8%) patients were on TCZ treatment at the end of the study. Improvements in disease activity, systemic symptoms and patient report outcomes were observed at the end of the study. 22.7%(90/396) patients experienced at least one treatment related adverse event, and 8 patients experienced at least one serious adverse event.Conclusion:This study demonstrates that TCZ treatment is effective in patients with RA when being treated for 6 months with an acceptable safety profile. The duration of TCZ treatment needs to be extended.

Objective:To explore the application effect of perforator pedicle flap in the wound repair after resection of the medium and large-sized keloids in the trunk.Methods:From January 2018 to January 2019, 10 patients, aged from 20 to 53 years old, with medium and large-sized keloids in the trunk were treated, including 3 cases in the anterior chest, 3 cases in the umbilical region, 4 cases in the lower abdomen, 8 cases were women and 2 cases were men. The size of keloids were 2.0 cm×3.0 cm to 5.0 cm×9.0 cm, and all keloids were accompanied with infection. Scars and infected tissues were removed and contracture was released completely. Pedicled flaps with intercostal perforator artery(3 cases), paraumbilical perforator artery(3 cases) or groin perforator artery(4 cases) were elevated and advanced or rotated to cover the wound. Early radiotherapy was delivered to the scar bed 5-10 Gy each time with a total dose of 15 to 20 Gy over 3 daily fractions after surgery. And other treatments, such as topical silicone gel, corticosteroid intralesional injection and elastic clothing compression were taken as adjuvant therapy. The scars were assessed by the Vancouver Scar Scale, and local morphology, hair distribution, itching, pain and patient satisfaction were analyzed and evaluated after 12 months to 24 months follow-up.Results:All flaps survived and the incisions healed primarily. The local morphology and hair distribution were normal, and the itching and pain were relieved obviously. The Vancouver Scar Scale scores vary from 1 to 6 in 9 patients. Incision hypertrophic scar with the Vancouver Scar Scale score of 9 occurred in one noncompliance patient who didn’t follow up on time and refuse to take the adjuvant treatments. 8 patients were extremely satisfied with the treatment effect, and 2 patients were satisfied with the treatment effect.Conclusions:For medium and large-sized keloids in the trunk, combined modality therapy, including local perforator pedicled flaps transplantation, early radiotherapy, topical silicone gel, elastic compression and etc, will achieve satisfied clinical effects.

Objective:To explore the application effect of perforator pedicle flap in the wound repair after resection of the medium and large-sized keloids in the trunk.Methods:From January 2018 to January 2019, 10 patients, aged from 20 to 53 years old, with medium and large-sized keloids in the trunk were treated, including 3 cases in the anterior chest, 3 cases in the umbilical region, 4 cases in the lower abdomen, 8 cases were women and 2 cases were men. The size of keloids were 2.0 cm×3.0 cm to 5.0 cm×9.0 cm, and all keloids were accompanied with infection. Scars and infected tissues were removed and contracture was released completely. Pedicled flaps with intercostal perforator artery(3 cases), paraumbilical perforator artery(3 cases) or groin perforator artery(4 cases) were elevated and advanced or rotated to cover the wound. Early radiotherapy was delivered to the scar bed 5-10 Gy each time with a total dose of 15 to 20 Gy over 3 daily fractions after surgery. And other treatments, such as topical silicone gel, corticosteroid intralesional injection and elastic clothing compression were taken as adjuvant therapy. The scars were assessed by the Vancouver Scar Scale, and local morphology, hair distribution, itching, pain and patient satisfaction were analyzed and evaluated after 12 months to 24 months follow-up.Results:All flaps survived and the incisions healed primarily. The local morphology and hair distribution were normal, and the itching and pain were relieved obviously. The Vancouver Scar Scale scores vary from 1 to 6 in 9 patients. Incision hypertrophic scar with the Vancouver Scar Scale score of 9 occurred in one noncompliance patient who didn’t follow up on time and refuse to take the adjuvant treatments. 8 patients were extremely satisfied with the treatment effect, and 2 patients were satisfied with the treatment effect.Conclusions:For medium and large-sized keloids in the trunk, combined modality therapy, including local perforator pedicled flaps transplantation, early radiotherapy, topical silicone gel, elastic compression and etc, will achieve satisfied clinical effects.

Objective: To improve the recognition of ectopic adrenocorticotropic hormone syndrome. Methods: The diagnosis and treatment of a 43 years old female patient with multiorgan involvement mimic dermatomyositis was analyzed and discussed. Results: The patient presented with fatigue, edema, skin pigmentation, neuropsychiatric abnormalities, hypertension, hypokalemia, hyperglycemia and other systemic involvement, was finally diagnosed with ectopic adrenocorticotropic hormone syndrome caused by paraganglioma of the anterior mediastinum. After surgical removal of the tumor, her clinical symptoms immediately relieved, meanwhile related hormone levels returned to normal. Conclusion Although paraganglioma-induced ectopic adrenocorticotropic hormone syndrome is rare in clinical practice, more attention should be paid to this specific situation.

In order to improve work environment for nurses and establish magnet hospital,nursing council was created in year of 2015,consisting of unit-based council,clinical resources council,nursing core council,nursing coordinating council and supportive system,to lead nurses to participate in nursing management and decision-making.After two years' implementation,profession nursing management index was increased from 174.13±43.90 to 170.25±38.98,and nursing management mode was transformed into shared governance,clinical nurses admitted nursing council system,and they believed it improved their awareness of responsibility and interpersonal support.Implementation of nursing council have positive effects on establishment of magnet hospital.