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Objective:To retrieve the relevant guidelines and expert consensus on self-management of patients with high-risk foot diabetes, and analyze the content of high-quality guidelines and expert consensus recommendations, so as to provide a reference for the construction of a guidance program for self-management of patients with high-risk foot diabetes.Methods:Computer-retrieved clinical practice guidelines and expert consensus for self-management of patients with high-risk foot for diabetes from databases, guideline networks, and related professional websites. The search period was from January 1, 2012 to June 5, 2022. The quality of the included literature was evaluated and the evidence was extracted and integrated by 2 researchers. Experts were invited to evaluate the summarized evidence.Results:According to the quality of literature, a total of 12 guidelines (10 at level A and 2 at level B) and 3 expert consensus (expert discussion and decision) were included, and 8 themes were defined as regular follow-up, self-assessment, foot and decompression management, exercise management, nutrition management, indicator management, psychological management, and health education, a total of 28 recommendations. Among them, there were 23 A-level recommendations and 5 B-level recommendations.Conclusions:The quality of the guidelines and expert consensus included in this study is high,the recommended level of the summarized evidence is high. This study provides the reference and basis for the clinical staff to construct and guide the clinical practice of self-management of high-risk diabetic foot patients.
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Objective:To investigate the correlation between the consumption level of probiotic products and post-stroke depression (PSD).Methods:Patients with ischemic stroke visited the Department of Neurology, the Third Affiliated Hospital of Naval Medical University from May 2021 to January 2022 were prospectively enrolled. According to self-rating depression scale (SDS), they were divided into PSD group (SDS score ≥53) and non-PSD group (SDS score <53). The influence factors of PSD were determined by comparing the demographic data, clinical data and consumption level of probiotic products between the two groups. Multivariate logistic regression analysis was used to determine the independent correlation between PSD and the consumption level of probiotic products. Results:A total of 120 patients with ischemic stroke were enrolled, including 39 (32.5%) in the PSD group and 81 (67.5%) in the non-PSD group. Multivariate logistic regression analysis showed that after adjusting for potential confounding factors, the severity of infarction (odds ratio 1.276, 95% confidence interval 1.138-1.432; P<0.001) and the consumption level of probiotic products (odds ratio 0.300, 95% confidence interval 0.098-0.916; P=0.035) were the independent influencing factors of PSD. Conclusion:The consumption level of probiotic products is an independent protective factor for PSD, and higher consumption level of probiotic products is associated with lower PSD incidence.
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Objective@#To observe the clinical effect of escitalopram in the treatment of alcohol-dependent patients with depressive symptoms and its influence on social function recovery.@*Methods@#From January 2016 to December 2017, 80 alcohol-dependent patients with depressive symptoms in the Seventh People's Hospital of Wenzhou were selected and divided into two groups by random digital table method, with 40 cases in each group.The observation group was treated with escitalopram.The control group was treated with placebo for 2 months.The scores of depression, social dysfunction screening scale, quality of life and incidence of adverse reactions were compared between the two groups.@*Results@#After treatment for 1 month and 2 months, the depression scores of the observation group were (15.02±2.23)points and (9.02±2.12)points, respectively, which were lower than those of the control group[(20.13±2.12)points, (15.24±2.15)points](t=10.504, 13.029, all P<0.05). After treatment for 1 month and 2 months, the scores of the screening scale for social functional defects in the observation group were (2.85±1.23)points and (0.89±0.52)points, respectively, which were lower than those in the control group[(4.13±1.62)points, (2.52±1.16)points](t=3.930, 8.110, all P<0.05). The scores of physical health, mental health, physical life, social function and total quality of life in the observation group were (87.47±5.69)points, (84.63±5.21)points, (87.16±5.24)points, (85.46±5.95)points and (86.12±5.95)points, respectively, which were higher than those of the control group[(79.58±5.93)points, (76.72±7.82)points, (79.28±5.57)points, (75.92±5.45)points, (78.46±5.85)points](t=5.995, 5.257, 6.435, 7.384, 5.733, all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).@*Conclusion@#Escitalopram in the treatment of alcohol-dependent patients with depressive symptoms has good effect, not only helps to improve the depression, but also helps to promote the recovery of social function of the patients, and the safety is relatively high.
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Objective To observe the clinical effect of escitalopram in the treatment of alcohol -dependent patients with depressive symptoms and its influence on social function recovery .Methods From January 2016 to December 2017,80 alcohol -dependent patients with depressive symptoms in the Seventh People ＇s Hospital of Wenzhou were selected and divided into two groups by random digital table method ,with 40 cases in each group.The observation group was treated with escitalopram.The control group was treated with placebo for 2 months.The scores of depression,social dysfunction screening scale , quality of life and incidence of adverse reactions were compared between the two groups.Results After treatment for 1 month and 2 months,the depression scores of the observation group were (15.02 ±2.23)points and (9.02 ±2.12)points,respectively,which were lower than those of the control group[(20.13 ±2.12) points,(15.24 ±2.15) points] ( t ＝10.504,13.029,all P ＜0.05).After treatment for 1 month and 2 months,the scores of the screening scale for social functional defects in the observation group were (2.85 ±1.23)points and (0.89 ±0.52)points,respectively,which were lower than those in the control group [(4.13 ± 1.62)points,(2.52 ±1.16)points]( t＝3.930,8.110,all P＜0.05).The scores of physical health ,mental health, physical life,social function and total quality of life in the observation group were (87.47 ±5.69) points,(84.63 ± 5.21)points,(87.16 ±5.24) points,(85.46 ±5.95) points and (86.12 ±5.95) points,respectively,which were higher than those of the control group [(79.58 ±5.93)points,(76.72 ±7.82)points,(79.28 ±5.57)points,(75.92 ± 5.45) points,(78.46 ±5.85) points] (t＝5.995,5.257,6.435,7.384,5.733,all P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Escitalopram in the treatment of alcohol -dependent patients with depressive symptoms has good effect ,not only helps to improve the depression,but also helps to promote the recovery of social function of the patients ,and the safety is relatively high.
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@#Recently,the incidence of chronic disease has been increasing rapidly every year,which contributes to heavy burdens on society. Chronic disease management（CDM）has become an effective solution. At present,CDM in China is still at an early age,without a widely accepted and efficient model for lack of theoretic and practical support. By analyzing and comparing CDM models in China and abroad,we summarizes that CDM in China needs to be guaranteed by government and law,strengthened by the construction of medical team,promoted by an integrated service network,and implemented by hierarchical diagnosis and treatment of multi-departments.
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Objective To evaluate the diagnostic value of ultrasonography and MRI in the diagnosis of placenta accrete.Methods First,the relevant literatures about placenta accrete were retrieved at home and abroad,then the data were extracted and Meta-analysis was performed.The combined sensitivity and specificity of ultrasound and MRI and AUC were obtained.Results The combined sensitivity of ultrasonography was 0.80,specificity was 0.88,AUC was 0.88;combined sensitivity of MRI was 0.86,specificity was 0.90,AUC was 0.93.Conclusion Ultrasound and MRI are very valuable in the diagnosis of placenta accrete.However,MRI is a useful complement of ultrasound,and the diagnostic value is slightly better than that of ultrasound.The diagnostic value will be higher when they combined together.
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Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging ( IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T2WI, IVIM (14 b values, b=0?1 000 s/mm2), and contrast?enhanced T1 scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer ( stage ≥Ⅱb ) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi?exponential model to generate three parameters, containing pure diffusion coefficient ( D ) , pseudodiffusion coefficient ( D?) , and perfusion fraction ( f ) . Apparent diffusion coefficient ( ADC ) was obtained using the mono?exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment ( 0?96 × 10-3 vs. 1?77 × 10-3 mm2/s, P=0?000;0?76 × 10-3 vs. 1.34± 0?12 × 10-3 mm2/s, P=0?000;0?14% vs. 0?24%, P=0?012). The above three values significantly increased after two weeks of treatment (all P=0?000) and kept increasing until the end of the treatment. In contrast, the D? value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.
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The First Affiliated Hospital of Nanjing Medical University has adopted a strategy of brand development in the process of continuing medical education.Given the different recipients,the First Affiliated Hospital of Nanjing Medical University has established four types of brand-based education modes,namely Jinling high-level forum of clinical medicine,hospital management school,management salon,and clinical case discussion in English.The influence and competitiveness of the brand of hospital continuing education should be elevated through the following methods:adhering to the brand development orientation-to fulfill the public responsibility and cultivate medical talents; establishing appraisal mechanism of continuing medical education; transforming thinking of management department; relying on new media propaganda and expanding domestic and international communication.
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<p><b>OBJECTIVE</b>To explore the preoperative diagnostic value of MR diffusion weighted imaging (DWI) for metastatic lymph nodes in patients with gastric cancer.</p><p><b>METHODS</b>Between December 2011 and December 2012, 52 gastric cancer patients(34 men, 18 women) underwent preoperative MR DWI. The apparent diffusion coefficient(ADC) and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve(ROC) analysis.</p><p><b>RESULTS</b>A total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [(1.059±0.196)×10(-3) mm(2)/s] was significantly lower than that of non-metastatic nodes [(1.402±0.285)×10(-3) mm(2)/s, P<0.001]. With ADC threshold of 1.189×10(-3) mm(2)/s, the sensitivity, specificity and area under the curve(AUC) were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%(39/52). The short diameter of metastatic lymph nodes [(8.08±3.99) mm] was significantly longer than that of non-metastatic lymph nodes [(6.75±2.70) mm, P=0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3%(35/52).</p><p><b>CONCLUSIONS</b>MR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.</p>
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Female , Humans , Male , Diffusion Magnetic Resonance Imaging , Lymphatic Metastasis , Magnetic Resonance Imaging , ROC Curve , Stomach Neoplasms , PathologyABSTRACT
<p><b>OBJECTIVE</b>To compare the accuracy of CT and MR including diffusion-weighted imaging(DWI) in preoperative diagnosis and T staging of gastric cancer.</p><p><b>METHODS</b>Forty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging (including DWI, T2 weighted and dynamic enhanced imaging) preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated.</p><p><b>RESULTS</b>Overall T staging accuracy in MR including DWI was significantly higher than that in CT imaging(87.8% vs. 65.9%, P=0.004). MR had a better inter-observer agreement than CT(Kappa=0.813, 0.603, respectively).</p><p><b>CONCLUSION</b>MR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.</p>
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Humans , Biopsy , Contrast Media , Diffusion Magnetic Resonance Imaging , Gastroscopy , Magnetic Resonance Imaging , Neoplasm Staging , Stomach Neoplasms , PathologyABSTRACT
Objective To evaluate the interstital MR lymphography using positive lymphotropic contrast agent for differentiation of metastatic lymph nodes from inflammatory lymph nodes hyperplasm.Methods Eighteen New Zealand white rabbits weighted at 2.0-2.5 kg were used.Inflammatory hyperplastic popliteal lymph node model was established in 9 rabbits by injection of complete freund adjuvant into the interdigitial skin of the dorsal aspect of one hind leg,and tumor-bearing popliteal lymph node model was established in another 9 rabbits by injection of VX~2 tumor cell suspension.The popliteal lymph nodes of another hind leg of all 18 rabbits were assigned to the normal contral group.In each group,every rabbit underwent MR lymphography examination before and after the inoculation.Volumes of 0.2 ml of Gd[DTPA-bis(2-aminoethoxy)ethane]polymeric contrast agent(Gd-poly-DTPA-EOEA)injection were injected subcutaneously into the dorsal feet of both hind legs of two groups of rabbits.T_1-weighted 3D gradient-echo images were obtained,and source images were used to reconstruct images of MIP before and after the administration of agent.The maximum short-axis diameter(MSAD)of each popliteal lymph node was measured on the enhanced 3D MIP images,and the signal-to-noise ratio(SNR)measurement was performed in the largest popliteal node of each rabbit at each time point in delayed scan.Independentsamples t test was used to compare the sizes of popliteal nodes in MSADs between inflammatorily hyperplastic and tumor-bearing nodes after the inoculation,and the values of SNRs of popliteal nodes at each time point between inflammatorily hyperplastic,tumor-bearing and normal popliteal lymph nodes.Imaging results of the popliteal nodes were analyzed and correlated with pathological findings.Results All of the rabbits were successfully inoculated except of the 2 rabbits in tumor-bearing nodal group.The size in MSAD of 13 inflammatorily hyperplastic and 11 tumor-bearing nodes was(1.32±0.14)and(1.33±0.12)cm,respectively.There was no significant statistical difference between the sizes of the two groups(t=0.186,P＞0.05).At the time of 5,15,30,60,90,120 minutes after the injection of the agent,the value of SNR of 9 inflammatorily hyperplastic and 9 contralateral normal nodes was 17.31±0.37 and 17.19±0.29,27.42±0.50 and 27.39±0.48,38.44±0.47 and 38.19±0.27,37.10±0.09 and 36.97±0.10,36.32±0.61 and 36.20±0.80,34.60±0.44 and 34.71±0.32,respectively.There was no significant statistical difference between the values of the two groups(t=0.78,0.14,1.43,1.00,0.36,-0.62,respectively,P＞0.05).The value of SNR of seven tumor-bearing and seven contralateral normal nodes was 6.00±0.22 and 17.21±0.28,7.87±0.16 and 27.17±0.23,8.14±0.24 and 38.16±0.19,8.09±0.28 and 36.94±0.30,7.59±0.20 and 35.96±0.72,7.50±0.14 and 34.81±0.27,respectively.There was significant statistical difference between the values of the two groups(t=-84.00,-182.72,-261.27,-186.48,-100.22,-239.00,respectively,P＜0.01).At each time point,inflammatorily hyperplastic nodes had significantly higher values of SNRs compared to tumor-bearing nodes(t=83.97,174.07,158.49,152.71,96.06,154.57,respectively,P＜0.01).A complete or part signal filling defect occurred in the tumor-bearing lymph node on the MR lymphographic images.Conclusions The internal anatomy and function of the lymph nodes were effectively visualized by interstitial MR lymphography with positive lymphotropic contrast agent,which provide a sensitively diagnostic way for the differentiation of benign lymph nodes from malignant ones.
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Objective To investigate psychology state of AIDS-phobia population. Methods 50 AIDS-pho-bia patients and 50 healthy controls were enrolled and tested with SCL-90,EPQ, LES and social support scale. Results Scores of SCL-90 in AIDS-phobia patients are significantly more than those in controls. Scores of anxiety, depres-sion,compulsion,dread and somatization in AIDS-phobia patients are significantly more than those in controls. Scores of negative life event scale in AIDS-phobia patients are significantly more than those in controls. Scores of positive life event scale in AIDS-phobia patients are significandy less than those in controls. Scores of social support scale in AIDS-phobia patients are significantly less than those in controls. Conclusions Anxiety, depression, compulsion, dread and somatization are primary clinical manifestation of AiDS-phobia. Personal character,negative life event and lack of social support might be nosogenesis correlated with AIDS-phobia.
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Objective To explore the feasibility of echo planar imaging with short time inversion recovery(STIR-EPI)diffusion weighted imaging with background signal(DWIBS)suppression in breast cancer.Methods The diffusion weighted imaging(DWI)with background suppression(b=800 mm2/s)was performed in 26 patients with breast cancer.Apparent diffusion coefficient(ADC)of all lesions,vere measured and compared.3D maximum intensity projection(3D-MIP)and reverse black and white technique were used to show the lesions.DWI and DWIBS were performed and compared for the detection of breast cancer. Randomized blocks analysis of variance was used for the ADC values in different breast tissues.the ADC values in breast cancer and benign lesion were compared using t test.The paired chi square tes:was used for the detection rate of breast cancer in two different imaging methods.Results Most of the breast cancers were hyperintense on DWI(b:800 mm2/s).,rhe ADC value of caneer tissue was(0.93±0.25)×10-3mm2/s,tumor necrosis was(2.06±0.17)×10-3 mm2/s,normal breast tissue was (1.92±0.23)×10-3 mm2/s and metastatic lymph node was(1.10±0.14)× 10-3mm2/s and the differenees were statistically significant between two structures(P＜0.01).The signal of the tissue8 around the breast cancer was decreased on DWIBS with 3 D-MIP and reverse black and white technique and similar to positron emission tomography(PET).DWIBS sequence detected more breast cancers(92.3/)and metastatic lymph nodes(88.4/)than DWI sequence did(57.6/and 42.3/,respectively,X2:8.307,P＜0.05;X2=12.235,P＜0.05).The ADC values in breast cancer(1.09±0.17)×10-3mm2/s and benign lesion (2.15±0.53)×10-3 mm2/s had significant statistical differences(t=8.626,P＜0.05).conclusion Diffusion weighted MRI with background suppression can detect more lesions than DWI and can be potentially applied for the detection of the breast cancer eombining the ADC value.
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Objective: To discuss the application of BALANCE-FFE sequence in abdominal MRCP.Methods:100 patients of abdominal diseases were examined by BALANCE technique. Results: The signal of BALANCE-FFE sequence was high in abdominal MRCP examination, and BALANCE image of the coronal scan was excellent. Conclusion:The biliary tract had obviously high signal intensity acquired by BALANCE sequence. The gallstone and the stenosis could be seen. The tissue out of the bile duct, the head of pancrease and the lymph could also be seen. The BALANCE sequence could be used as a supplement of conventional MRCP.