超声引导下关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(益赛普)治疗血友病性关节病

目的 观察超声引导下关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白（益赛普）治疗血友病性关节病（HA）的价值。方法 回顾性分析32例接受超声引导下穿刺关节腔注射益赛普的HA患者，对比观察治疗前及治疗后1个月血友病关节健康评分（HJHS）、视觉模拟评分（VAS），以及超声所示目标关节增生滑膜厚度、血流信号、Melchiorre及中国早期血友病性关节病超声检测（HEAD-US-C）评分，评估其治疗价值。结果 对32例均成功完成超声引导下穿刺关节腔及腔内注射益赛普，共对18例膝关节、7例肘关节及7例踝关节进行治疗。术后未出现感染、出血等并发症。治疗后1个月，目标关节HJHS、VAS、Melchiorre评分、HEAD-US-C评分及增生滑膜最大厚度、平均厚度、血流信号均低于治疗前（P均<0.01）。结论 超声引导下关节腔内注射益赛普治疗HA安全、有效。     

Building a Culturally Responsive Workforce: Faculty of Color in Nursing Education

The representation of nursing faculty of color is disproportionate to that in the general population, despite recruitment and retention strategies. Boosting the presence of nursing faculty of color requires an understanding of factors that undermine diversity initiatives and calls for the adoption of innovative practices. This article addresses the importance of racial and ethnic diversity within nursing education. Furthermore, it examines the factors that prevent the recruitment and retention of a racially and ethnically diverse nursing faculty workforce and provides evidence-based recommendations for increasing diversity among nursing faculty and nursing organizations.     

早孕期监测子宫动脉多普勒参数在预测低危人群不良妊娠结局的价值

目的 建立妊娠11~13+6周子宫动脉多普勒参数在低危人群中的正常参考值，同时评估其对不良妊娠结局的预测价值。方法 收集2019年6月至2021年6月于我院行产前超声检查的妊娠11~13+6周孕妇，根据妊娠结局分组。收集两侧子宫动脉多普勒指标，包括搏动指数（PI）、阻力指数（RI）、舒张早期是否有切迹，以及孕妇基本临床资料和胎儿出生信息，将以上相关参数进行统计学分析。结果 最终纳入800例孕妇，包括正常妊娠结局组740例和不良妊娠结局组60例。两组孕妇体质量指数（BMI）、分娩孕周和胎儿出生体质量比较，差异均有统计学意义（均P＜0.05）。随着孕周的增加，子宫动脉两侧平均搏动指数（mPI）、平均阻力指数（mRI）和两侧舒张早期切迹检出率均呈逐渐下降的趋势。ROC曲线分析显示，mPI、mRI及两侧舒张早期切迹预测妊娠结局的曲线下面积（AUC）分别为0.542、0.574、0.521，三者联合预测妊娠结局的AUC为0.648；孕妇BMI、年龄mPI、mRI及两侧舒张早期切迹预测妊娠结局的AUC为0.751。结论 建立了低危人群在妊娠11~13+6周子宫动脉多普勒参数的正常参考值范围。在妊娠11~13+6周单纯应用子宫动脉多普勒参数预测妊娠结局的价值有限，将子宫动脉参数与临床相关指标结合可提高对不良妊娠结局的预测价值。     

Preoperative comprehensive malignancy risk estimation for thyroid nodules: Development and verification of a network-based prediction model

BackgroundIn order to avoid excessive treatment of thyroid nodules in the clinic, it is necessary to find a simple and practical analysis method to comprehensively and accurately reflect benign or malignant thyroid nodules. This study aimed to construct and validate a comprehensive and reliable network-based predictive model using a variety of imaging and laboratory criteria for thyroid nodules to stratify the risk of malignancy prior to surgery.MethodsWe retrospectively analyzed data from patients who underwent surgical treatment for thyroid nodules at the Thyroid and Breast Diagnosis and Treatment Center of Weifang Hospital of Traditional Chinese Medicine between January 2018 and December 2020. Binary logical regression analysis was performed to predict whether nodules were malignant or benign. The developmental dataset included 457 patients (January 2018–December 2020). The validation set included separate data points (n = 225, January 2018–December 2020).ResultsIn this study, criteria that showed significant predictive value for malignant nodules included TI-RADS: 4b (p = 0.065); Bethesda IV, Bethesda V, Bethesda VI (P < 0.0001); BRAF^V600E mutation (P < 0.0001); Calcitonin>5 pg/ml (p = 0.0037); and FNA-Tg>30 ng/ml (p = 0.0003). A 10-grade risk scoring system was developed. The risk of malignancy risk ranged from 2.06% to 100% and was positively associated with increasing risk grade. The areas under the receiver-operating characteristic curve of the development and validation sets were 0.972 and 0.946, respectively.ConclusionA simple, comprehensive and reliable web-based predictive model was designed using a variety of imaging and laboratory criteria to stratify thyroid nodules by probability of malignancy.     

超声及应变式弹性成像预测超声引导下腘静脉置入血管鞘用于治疗下肢深静脉血栓形成成功与否

目的 分析超声及应变式弹性成像预测超声引导下置入腘静脉血管鞘治疗下肢深静脉血栓形成(DVT)成功与否的价值。方法 回顾性分析103例接受超声引导下置入患侧腘静脉血管鞘的DVT患者的术前超声资料,比较置入血管鞘失败与成功病例腘静脉超声及应变式弹性成像表现差异;绘制差异有统计学意义超声参数的受试者工作特征曲线,获得其预测血管鞘置入失败的阈值,对每个参数阈值赋值1分,得到联合超声评分,以实际置入结果为标准,评价超声单一参数及联合评分的预测效能。结果 103例中,对100例行单侧、3例行双侧腘静脉置入血管鞘,包括左侧腘静脉71支、右侧35支,共106支腘静脉;对其中95支腘静脉置入血管鞘成功(成功组),11支失败(失败组)。相比成功组,失败组腘静脉内径及腘静脉与腘动脉内径比值均较小,血栓为等或高回声,与血管壁边界模糊,腘静脉应变式弹性评分为硬。以超声单一参数及联合评分预测置入血管鞘成功与否的曲线下面积分别为0.909、0.926、0.865、0.899、0.958及0.940(P均＜0.001)。结论 患侧腘静脉超声及应变式弹性成像能有效预测对下肢DVT患者行超声引导下置入腘静脉血管鞘成功与否。