Objective:To explore the standardization of totally implantable venous power port of nursing process in CT enhancement and application effect of contrast medium injection, so as to provide a safer and more efficient way for contrast medium injection in CT enhanced examination for patients with malignant tumors.Methods:A non-randomized prospective study was conducted, 358 patients with malignant tumors were selected in Sun Yat-sen Memorial Hospital, Sun Yat-sen University who underwent CT enhanced examination from August 1, 2022 to July 31, 2023, 179 patients who had been implanted totally implantable venous power port were selected as the experimental group, and the standardized nursing procedure was given. The other 179 patients were the control group, using radiology routine high-pressure intravenous indwelling needle as the contrast medium access, with routine peripheral venous nursing process. The incidence of contrast medium extravasation during CT enhanced examination was observed and compared between the two groups.Results:All the patients were included. There were 85 males and 94 females, aged (55.50±11.72) years old in the control group. There were 83 males and 96 females, aged (54.50±12.24) years old in the experimental group. The incidence of contrast medium extravasation was 0 in the experimental group and 3.35%(6/179) in the control group. The difference between the two groups was statistically significant (Fisher exact probability, P<0.05). Conclusions:The application of standardized nursing procedure of totally implantable venous power port to the injection of contrast medium in CT enhanced examination of malignant tumor patients, can significantly reduce the incidence of contrast medium extravasation.

Objective:To evaluate the value of Treponema pallidum ( Tp)-specific antibody index in the diagnosis, staging, and typing of neurosyphilis (NS). Methods:Fifty patients diagnosed with NS at the West China Hospital of Sichuan University from March 2020 to December 2022 were recruited as the experimental group, and 50 non-NS syphilis patients were enrolled during the same period as the control group. Cerebrospinal fluid (CSF) and matched serum samples along with clinical data were collected. Clinical and Laboratory Standards Institute (CLSI) EP06-Ed2 file was used to analyze the linear range of electrochemiluminescence immunoassay for Tp-specific antibody detection, and the Tp antibody index was calculate for all subjects. The correlation of Tp antibody index, IgG index, IgG synthesis rate, and albumin quotient with other clinical indicators was evaluated by the coefficient of correlation, and the diagnostic efficacy of these indicators in NS was analyzed using the receiver operating characteristic (ROC) curve. Results:All the deviations from linearity of electrochemiluminescence immunoassay for detecting Tp antibodies in serum and CSF samples were within the allowable deviation from linearity. Compared with the non-NS group, the NS group showed a significant increase in the Tp antibody index ( P<0.05), with no significant differences observed among the groups of different subtypes, severity, or receiving treatment or not ( P>0.05). Tp antibody index, IgG index, and IgG synthesis rate were positively correlated with serum Tp antibody, CSF Tp antibody, trace protein, and nucleated cell count ( P<0.05). Taking 14.99 as the cut-off value for NS diagnosis, the diagnostic sensitivity of Tp antibody index was 74.0% (95%CI: 60.5%-84.1%), and the specificity was 94.0% (95%CI: 83.8%-98.4%), with the area under the ROC curve of 0.897, which was larger than that of albumin quotient, IgG index, and IgG synthesis rate. Conclusions:This study finds a significant increase in the Tp antibody index in NS patients with good diagnostic sensitivity and specificity, providing reference for the diagnosis of NS.

This paper mainly explored the application of medical games in doctor-patient communication in pediatric otorhinolaryngology. Taking the "Little Warrior Break Through" medical game service of Shenzhen Longgang District Otolaryngology Hospital as an example, doctors, nurses and social workers formed a multidisciplinary and interdisciplinary team. Focusing on the three major problems in pediatric otorhinolaryngology, namely, the tense doctor-patient relationship, the insufficient doctor-patient communication, and the difficulty of children to cooperate with treatment, the team carried out a series of themed medical games covering the three stages of admission preparation, preoperative counseling, and postoperative rehabilitation for pediatric otolaryngology patients and their families. This paper showed that medical games can effectively help children and their families to ease tension, promote doctor-patient communication, increase the symmetry of doctor-patient information, improve children’s adaptation and acceptance of diseases, and ease the tense doctor-patient relationship. It is hoped that the exploration of the medical game service of "Little Warrior Break Through" will inspire medical social work, and then build micro-operation methods in clinical practice to help construct a harmonious doctor-patient relationship.

Objective:To summarize the clinical features, treatments and prognoses of aggressive natural killer cell leukemia (ANKL) in children.Methods:Clinical data and follow-up results were retrospectively reviewed for one hospitalized case of ANKL in June 2019.Through a literature search, the relevant items were retrieved from the databases of China National Knowledge Infrastructure, WanFang and PubMed using the Chinese and English keywords of "aggressive natural killer cell leukemia" and "children" up to December 2021.Results:This 8-year-old girl was diagnosed with ANKL by flow cytometric immunophenotype and immunohistochemical stain.Fever was the initial manifestation accompanied by sallow complexion, fatigue, enlargement of liver, spleen and lymph node and hematopenia of three lines.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed after chemotherapy.As of April 2022, the child stayed in a disease-free survival state after follow-ups for over 2 years.The literature search finally yielded 7 eligible Chinese and 10 English reports with a total of 17 pediatric ANKLs.In this group, there were fever (n=15), rash (n=1), perineal mass (n=1) and diarrhea, vomiting and other digestive tract symptoms (n=1). Six cases were misdiagnosed during an early stage of disease.4 cases received chemotherapy alone, 3 cases received chemotherapy regimen for acute lymphoblastic leukemia, 1 child died and one death occurred after received chemotherapy regimen of "cisplatin + vincristine + doxorubicin + ifosfamide". Allo-HSCT was performed in 5 patients after remission with chemotherapy and one child died from multiple organ failure at 9 months after allo-HSCT.Nine cases gave up treatment.Conclusions:ANKL has a rapid disease progression, diverse clinical manifestations, easy misdiagnosis and poor prognosis.For suspected ANKL cases, clinicians perform multiple bone perforations at multiple sites and immunophenotype by flow cytometry as soon as possible to confirm the diagnosis.Currently allo-HSCT offers a long-term survival of ANKL patients.

Objective:To translate and revise the Workplace Breastfeeding Support Scale (WBSS) , and test its reliability and validity.Methods:Brislin translation mode was used to translate and back translate WBSS. The scale items were revised and improved through cultural debugging and pre-tests. From June to September 2020, convenience sampling was used to select 320 mothers of children from the Department of Children Health of Tongren Maternal and Child Health Hospital as the research object. The Chinese version of WBSS was used to investigate the breastfeeding support of the mothers of the children in the workplace. The critical ratio method and the correlation coefficient method were used to analyze the items of the scale, and the content validity index ( CVI) and exploratory factor analysis were used to evaluate the validity of the scale. The Cronbach's α coefficient, split-half reliability coefficient and test-retest reliability coefficient were used to evaluate the reliability of the scale. Results:The item-level CVI of the Chinese version of WBSS was from 0.833 to 1.000, and the average scale-level CVI of the scale was 0.958. The exploratory factor analysis extracted three common factors, and the cumulative variance contribution rate was 57.973%. The Cronbach's α coefficient of the Chinese version of WBSS was 0.805, and the split-half reliability coefficient was 0.800, and the test-retest reliability coefficient was 0.948. The final Chinese version of WBSS included 12 items in three dimensions (colleague support, environmental support, facility support) . Conclusions:The Chinese version of WBSS has good reliability and validity, and can be used to assess the status of breastfeeding support in the workplace.

Objective:To analyze the characteristics of malaria epidemic situation before and after malaria elimination in Qiandongnan Prefecture, and to provide the basis for establishment of effective strategies and measures to consolidate the achievements of malaria prevention and control.Methods:The data of malaria cases in 16 counties (cities) of Qiandongnan Prefecture from 2005 to 2018 were collected, and descriptive epidemiological method was used to analyze the infection rate of Plasmodium among local residents and floating population before (2005-2011) and after (2012-2018) elimination of malaria, and the characteristics of population distribution, seasonal distribution, species of Plasmodium and types of malaria vectors were analyzed. Results:Before elimination of malaria, total of 1 412 cases of malaria were reported, among those cases, 1 361 cases were local cases, accounting for 96.39% of the total cases. After elimination of malaria, total of 17 cases were reported, all of them were imported cases. After comparison of malaria cases before and after the elimination, the proportion of people aged from 18 to 60 was 70.54% (996/1 412) before the elimination, all 17 imported cases were 18-60 years old after the elimination, and the proportion of children/students decreased from 24.65% (348/1 412) before the elimination to 0 after the elimination. The peak incidence of malaria cases before the elimination was from June to October, and cases occurred every month. After the elimination, the imported cases were sporadic. Plasmodium vivax was the main species of Plasmodium before the elimination (98.58%, 1 392/1 412), and Plasmodium falciparum was mainly imported after the elimination (70.59%, 12/17). Before and after the elimination, Anopheles sinensis, the malaria vector, was the dominant population, but no distribution of Anopheles minimus and Anopheles anthropophagus was found after 2015. Conclusions:After the elimination of malaria in Qiandongnan Prefecture, there is a risk of local malaria cases caused by imported cases. It is suggested that local authorities should focus on the treatment of suspected malaria cases and vector surveillance of overseas returnees in the future.

Objective:Serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a useful biomarker of bacterial infection. However, the diagnostic value of sTREM-1 of alveolar fluid in pulmonary infection is still unclear. This article aimed to explore the value of sTREM-1 of alveolar fluid in the early diagnosis of ventilator-associated pneumonia (VAP) by systematic review of relevant literatures.Methods:CNKI, Wanfang, VIP, PubMed/Medline and Embase databases were retrieved. Articles on diagnosis of VAP by sTREM-1 before June 30, 2019 were collected. QUADAS-2 scale provided by Cochrane Collaboration Network was used to evaluate the quality of diagnostic experiments. RevMan 5.3 and Stata 13.0 software were used to complete Meta-analysis. The levels of sTREM-1 between VAP and non-VAP patients were analyzed by Meta-analysis, and then diagnostic test Meta-analysis was conducted. Heterogeneity, sensitivity and publication bias were analyzed.Results:A total of 24 articles were enrolled. QUADAS-2 scale indicated that the selected literature had low bias and high clinical adaptability. ① In Meta-analysis of sTREM-1 level in alveolar fluid, 20 articles were selected and found to have high heterogeneity ( I2 = 94.4%, P = 0.000). The random effects models were used for Meta-analysis. It was indicated that the sTREM-1 level in alveolar fluid of VAP group was significantly higher than that of non-VAP group with significant difference [standardized mean difference ( SMD) was 1.47, 95% confidence interval (95% CI) was 1.00-1.95, Z = 6.14, P = 0.000]. By subgroup analysis and Meta-regression analysis, no source of heterogeneity was found. Sensitivity analysis suggested that the results of this Meta-analysis were robust and credible, and Begg funnel plot analysis showed that there was no significant publication bias ( Z = 1.46, P = 0.143). ② A total of 18 articles were included in the Meta-analysis of diagnostic experiments. Deek funnel plot showed publication bias ( P = 0.012). The combined sensitivity was 0.87 (95% CI was 0.81-0.91), specificity was 0.80 (95% CI was 0.73-0.86), and diagnostic odds ratio ( DOR) was 26 (95% CI was 13-50). Subgroup analysis of three different sources of alveolar fluid (bronchoalveolar lavage fluid, endotracheal aspiration fluid and exhaled ventilator condensate) showed that STREM-1 had a certain value in early diagnosis of VAP. The I2 of combined DOR was 35.4%, and I2 of sensitivity was 79.46%, I2 of specificity was 77.61%, suggesting heterogeneity in the selected literature. Subgroup analysis found that nationality, subject design, sample source, sample size and diagnostic "gold criteria" were related to heterogeneity, but not age. The area under synthetic receiver operating characteristic (SROC) curve (AUC) was 0.90 (95% CI was 0.87-0.92). Conclusions:The detection of sTREM-1 level in alveolar fluid can be used for the early diagnosis of VAP with high sensitivity and specificity. If combined with other biomarkers, it may have more diagnostic value.

PD-1/PD-L1 signaling pathway as a T cell immune response co-stimulatory signaling pathway plays an important role in adaptive immunity. PD-1 is a major co-receptor expressing on T cells, binding with its ligands(PD-L1 and PD-L2), PD-1 can inhibit T cell activation and protect the body against the attacks from its own immune system. In addition to adjusting and maintaining autoimmune tolerance, in tumor cells PD-L1 expression is up-regulated, while in the virus-infected T cells PD-L1 expression is also upregulated. PD-1 / PD-L1 are involved in the tumor and infectious pathogen immune evasion, thus blocking the PD-1 / PD-L1 signaling pathway has become a hot research of cancer and chronic diseases. Currently, there are several anti-PD-1 or PD-L1 monoclonal antibodies approved by the FDA to enter clinical studies, which have shown significant anti-cancer effect.

Objective To study the relationship between cardiovascular diseases (CVD) and ischemia modified albumin (IMA) in patients with type 2 diabetes mellitus (T2DM).Methods Ninety-six patients with T2DM were selected as T2DM group retrospectively,and 60 cases of healthy physical examination were selected as control group,the patient' s medical history data were collected,the IMA was detected and Doppler ultrasound examination was performed.The relationship between serum IMA level and some laboratory parameters were analyzed.Results Twenty-eight cases (29.2％,28/96) occurred CVD among 96 cases of T2DM patients.The level of IMA in T2DM group was higher than that in control group [(58.25 ± 11.84) kU/L vs.(23.38 ± 6.41) kU/L],there was significant difference (P ＜ 0.05).The levels of IMA in T2DM combined with CVD group (28 cases) and T2DM not combined with CVD group (68 cases) were(91.46 ± 13.63),(47.91 ± 9.38) kU/L; the level of IMA in T2DM combined with CVD group was higher than that in T2DM not combined with CVD group and control group,there was significant difference (P ＜ 0.05).All patients completed echocardiography,Spearman correlation analysis between IMA and echocardiography indicators showed that the level of IMA was positively correlated with left ventricular end-diastolic diameter (r =0.546,P =0.031),interventricular septal thickness (r =0.427,P =0.039),posterior wall diameter of left ventricle at end-diastolic (r =0.582,P =0.026) and left venifieular mass index (r =0.339,P =0.042),and IMA was negatively correlated with ejection fraction of left ventricle (r =-0.561,P =0.024).Multivariable Logistic regression analysis showed that IMA,high-sensitivity C reactive protein,diabetes duration,fasting blood glucose levels were independent risk factors for CVD.Conclusions Serum IMA level is significantly higher in T2DM patients.IMA level is a related risk factor for CVD.

Objective To investigate the correlation between homocysteine(Hcy) and atheroscIerosis (AS) in type 2 diabetic patients.Methods A total of 98 type 2 diabetic patients in Donghua Hospital Affiliated to Sun Yet-Sen University were enrolled in this study and served as diabetic group.Meanwhile diabetic patients were divided into aged group(aged ＞65 years old) and young and middle aged group(＜65 years old).Fortynine healthy volunteers were used as control group.Intima-media thickness(IMT) and atherosclerotic plaqlles of the extracranial common carotid artery were detected by high-resolution B-mode ultrasoograph.Fasting plasma glucose (FPG),postprandial 2 h glucose (2 hPG),glycosylated hemoglobin (HbA1 c),total cholesterol (TC),total triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),creactive protein(CRP) and Hcy were measured.Correlation analysis of Hcy and IMT with other parameters was performed.Results Hcy level in patients with type 2 diabetes were (34.15 ± 10.25) μmol/L,significantly higher than those in healthy control group((8.46 ± 3.62) μmol/L,P =0.014).Hcy level in age group((40.63 ± 11.78) μmol/L) was significantly higher than that of young and middle aged group((26.54 ±9.38) μmol/L,P =0.028).IMT value and plaque detection rate in elderly patients were (1.28 ±0.26) mm and 66.1％ (20/41),significantly higher than that in the young and middle aged group((1.02 ±0.20) mm and 38.9％,P =0.041,0.027).Multiple stepwise regression analysis showed that age (OR =1.46,95％ CI:1.18-6.36,P =0.029),duration of diabetes (OR =2.62,95％ CI:1.78-7.43,P ＜ 0.001),LDL-C (OR =1.54,95％CI 1.19-6.27,P =0.028),CRP(OR =1.38,95％ CI 1.11-4.84,P =0.032),Hcy(OR =2.45,95％ CI 1.34-6.61,P =0.018)) were independent risk factors for carotid AS.Conclusion The Hcy level significantly increase in type 2 diabetic patients.Hcy,age,duration of diabetes,LDL-C,CRP are independently risk factors of neck AS.