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We reported a case of polyglandular syndrome induced by programmed death-1(PD-1) inhibitors. The patient was a 51-years-old male with non-small cell lung cancer, treated with PD-1 inhibitor nivolumab/pembrolizumab because of postoperative subcarinal lymph node metastasis indicated by PET-CT. During 14 cycles of PD-1 inhibitor treatment, the patient successively developed primary hypothyroidism, and type 1 diabetes mellitus(T1DM). More than five months after the withdrawal of pembrolizumab, the patient experienced recurrentce. Laboratory examinations showed mild hyponatremia and hypopituitarism including ACTH and growth hormone(GH)/insulin-like growth factor-1(IGF-1) insufficiency. This is the first report of a patient diagnosed as polyglandular syndrome caused by PD-1 inhibitor. In particularly, the hypothyroidism and T1DM did not improve after drug withdrawal, while hypopituitarism was further aggravated. This case reminds us that we should pay more attention to the changes of endocrine function during and after the treatment of PD-1 inhibitor, so that we can make the correct diagnosis and take proper medical measures timely, to avoide missed diagnosis, and improper treatment.
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Objective To probe into competence situation of the triage nurse in Children's Hospital, so as to provide the reference for the standardized management. Methods A total of 262 triage nurses in more than 20 Children's Hospital from all over the country. Results There were 255 women(97.3%,255/262);the age was(31.5 ± 3.8);among them,245 case were from the tertiary hospital and 17case from the two-levelhospital.Nearly 70.99%(186/262)of subjects had an undergraduate degree. Triage nurses(65.27%,171/262)had a working life of less than or equal to 5 years with the primary title (69.08%, 181/262). About half of the subjects (50.76%,133/262) did not receive professional training. A total of 173 subjects'workplace had a work experience requirements that was more than 2 years.After a comparison of different years of work experience in Two or three level children, the difference was statistically significant(P<0.05).Nearly 96.18%(252/262)of triage nurses agreed that they should be trained systematically and standardized.Nearly 92.75%(243/262)and 88.17%(231/262)agreed that the triage standards and National or provincial and municipal unified grading standards should be established, respectively. Conclusion It is essential that triage nurses should be trained and assessed systematically, Establishing a comprehensive, high quality and strong triage nursing team to meet the needs of practical work,which is an urgent problem for the hospital administrators.
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@#ObjectiveTo observe the effect of language rehabilitation training on stroke patients with complete aphasia.Methods10 stroke patients with complete aphasia were treated with language rehabilitation training.ResultsAfter training, scores of hearing, naming, reciting, reading, and writing of patients were significant higher than that before training (P<0.05—0.01).Conclusion Language rehabilitation training plays an active role in rehabilitation of stroke patients with complete aphasia.