Objective:To explore the potential factors related to the recurrence of benign and borderline breast phyllodes tumor (PT) and establish a nomogram to predict the recurrence rate of PT.Methods:The clinicopathological and imaging data of 65 patients with benign and borderline PT who were treated in Dongguan People’s Hospital from June 2016 to December 2019 were retrospectively analyzed. The univariate and multivariate logistic regression were used to analyze the independent risk factors for recurrence, and a nomogram was constructed accordingly. The receiver operating characteristics (ROC) curve was drawn and the area under the curve (AUC) was calculated. A calibration curve was established by bootstrap method to evaluate calibration performance. The clinical utility of this predictive model was demonstrated by decision curve analysis (DCA).Results:Univariate logistic regression analysis showed that the time interval between mass discovery and treatment (TIMDT)>6 months, uneven MRI enhancement pattern, ultrasonic findings(irregular shape, uneven edge, tumor lobulation, uneven internal echo, punctate strong echo, moderate/abundant blood flow signal and cystic structure) were related to PT recurrence (all P<0.050). Multivariate logistic regression analysis showed that TIMDT>6 months (OR=32.230, 95%CI: 2.343-443.367, P=0.009), uneven MRI enhancement pattern (OR=16.786, 95%CI: 1.030-273.431, P=0.048) and ultrasonic tumor lobulation (OR=14.861, 95%CI: 1.155-191.205, P=0.038) were independent risk factors for PT recurrence. A nomogram was constructed based on these three independent risk factors. The AUC of ROC was 0.906 (95%CI: 0.811-1.000), the sensitivity was 83.3% and the specificity was 88.7%. The calibration curve of the model showed a good calibration efficiency. The DCA curve displayed high clinical net benefit from predicting PT recurrence at a threshold of 0.04-0.96.Conclusion:The benign and borderline breast PT patients with the following features (TIMDT>6 months, uneven MRI enhancement pattern, and ultrasonic tumor lobulation) are in high risk of recurrence. The nomogram based on these three factors shows a strong ability to predict the recurrence of PT, indicating high potential in clinical application.

摘要：随着全国对高校思想政治工作的重视，思政教育在高等职业教育中的地位日益突显。急救护理技术实训操作课是思政元素的重要承载体，将思政内容纳入急救护理技术实训教学尤为重要。本文以《急救护理技术实训》课程为例,探析了专业课程与思政元素相融合的重要性以及具体改革措施，以期全面提升高等职业教育学生的综合职业素养，为社会培养更多高素质技术技能型护理人才。

课程思政是指在教学过程中将专业课程教学与思想政治教育有机融合,找准结合点,抓住切入点,贯穿全程,真正做到"传道、授业、解惑".我们以急救护理技术的心肺脑复苏术教学为例,将课程思政与课堂教学结合,以期为护理专业课程思政提供参考.

探讨基于乐学在线高职外科护理课程教学资源库建设的实践研究.外科护理要求学生在学习课程的同时掌握相关的基本理论和基本技能.为了更好地解决外科护理课程的教学重点及难点,基于乐学在线的外科护理教学资源库的建设,采用信息化环境与学科特点相结合,构建"线上线下"混合式教学模式,具有一定的创新价值和应用意义.

护理专业中高职衔接是卫生职业教育和护理事业发展的必然趋势.以调研材料为基础,分析目前广东省护理专业中高职衔接存在的问题,并提出相应对策,从而为广东省护理专业中高职的有机衔接提供参考.

目的 探讨在老年腹股沟疝治疗中,腹腔镜疝修补术及开放式无张力疝修补术的应用效果.方法 以80例老年腹股沟疝患者作为观察对象,将其随机分为接受腹腔镜疝修补术治疗的腹腔镜组及接受开放式无张力疝修补术治疗的开放组,每组40例.对比两组手术及术后恢复情况.结果 开放组手术时间及住院费用明显低于腹腔镜组(P<0.05),而腹腔镜组术中出血量、住院时间、术后疼痛持续时间均明显低于开放组(P<0.05).此外,腹腔镜组术后并发症发生率明显低于开放组(P<0.05).结论 腹腔镜疝修补术及开放式无张力疝修补术在老年腹股沟疝的治疗中各有优势,临床上可根据患者实际情况选择应用.

OBJECTIVE Postoperative chylothorax remains a life-threatening complication after esophagectomy for esophageal cancer .In this study , we analyze the causes of chylothorax and identify the prevention strate-gies.METHODS Clinical data of 254 patients with esophageal cancer undergone esophagectomy from November 2012 to November 2014 were retrospectively reviewed .According to the management of thoracic duct , patients were assigned to two groups:prophylactic thoracic duct ligation group ( ligation group ,n=132 ) and thoracic duct preserva-tion group ( control group ,n=122 ) .The occurrence rates of chylothorax ,and surgical approach were compared be-tween the two groups.RESULTS The occurrence rates of postoperative chylothorax were 0.25%in ligation group, and 10.36%in control group (P<0.05).CONCLUSION Chylothorax post-esophagectomy was mainly caused by injury of the thoracic duct .Prophylactic thoracic duct ligation could effectively prevent postoperative chylothorax .

Objective To investigate the clinical efficacy of treatment of chloasma with Abdominal Acupuncture and its mechanism.Methods 90 female patients with melasma were randomly divided into A、 B、 C 3 group,n = 30,respectively Abdominal Acupuncture、acupuncture、freckle cream intervention,the results of data analysis using statistical software SPSS17.0.Results ①Clinical observations,3 the majority of patients with different degrees of symptoms improved,but aggravate or no improvement in some patients,and less abdominal pain or painless needle more easily accepted by patients,treatment no significant adverse reactions occur;②A group of lesion size,color score before and after treatment were significantly different(P<0.05),B group lesion area score before and after treatment were significantly different(P<0.05),color score before and after treatment no significant differences(P>0.05),C group lesion area,the color score before and after treatment showed no significant difference(P>0.05),3 group index has declined significantly(P<0.05),A group of indices fell the most obvious;③The clinical effects of the 3 groups were significantly different(P<0.05),A group effect was significant.Conclusion Abdominal Acupuncture treatment of chloasma a significant effect,no significant adverse reactions.

Objective:To observe and compare the therapeutic effect of warming needle moxibustion and Haitongpi decoction washing on cold-dampness and damp-heat types of gonarthritis.Methods:30 cases of each type is ready,warming needle moxibustion and Haitongpi decoction washing method for treating for a month,using the SF-MPQ and knee function score table to evaluate treatment.Results:Warming needle moxibustion and Haitongpi decoction washing skin have a good effect on the patients of gonarthritis,their knee pains,swelling,flexion and extension are better improvement.The total effective rates were 90% and 87%,but both had no significant difference in efficiency(P>0.05);Evaluation before and after treatment had a significant difference(P<0.01);It is better improvement for cold-dampness type of patients than the damp-heat type of patients(P<0.05).Conclusion:Warming needle moxibustion and Haitongpi decoction washing on the gonarthritis of osteoarthritis of the knee have a very significant effect,especially for the patients of cold-dampness type.

目的:观察标准化薄氏腹针辨证治疗黄褐斑的临床疗效.方法:30例女性黄褐斑患者采用标准化薄氏腹针辨证治疗,根据<黄褐斑的临床诊断和疗效标准>评价临床疗效.结果:临床观察发现,患者症状多数有不同程度的改善,治疗过程中无明显不良反应出现;治愈12例,显效9例,好转4例,无效5例,平均下降指数1.04±0.82.结论:标准化薄氏腹针辨证治疗黄褐斑疗效显著,无明显不良反应.

目的:探讨电子喉镜在喉部疾病诊断中的价值及其在喉部疾病治疗中的作用。方法:采用电子喉镜对有喉部症状的患者行喉部检查和治疗。结果:3628例患者顺利接受了检查,并得到诊断。768例声带息肉和249例声带小结患者在电子喉镜下作了息肉或小结的切除,113例下咽和喉部的异物患者在电子喉镜下取出异物,91例其他喉部疾病患者接受了电子喉镜下的相应治疗。结论:电子喉镜是喉部疾病诊断和治疗的一种新的有用工具,值得推广应用。

目的:探讨电子喉镜在喉部疾病诊断中的价值及其在喉部疾病治疗中的作用.方法:采用电子喉镜对有喉部症状的患者行喉部检查和治疗.结果:3628例患者顺利接受了检查,并得到诊断.768例声带息肉和249例声带小结患者在电子喉镜下作了息肉或小结的切除,113例下咽和喉部的异物患者在电子喉镜下取出异物,91例其他喉部疾病患者接受了电子喉镜下的相应治疗.结论:电子喉镜是喉部疾病诊断和治疗的一种新的有用工具,值得推广应用.

老年性耳聋是指因听觉器官衰老退变,出现双耳对称性、渐进性的听力减退而引起的耳聋,或是指老年人中出现的非其他疾病原因引起的耳聋[1].随着年龄的增长,老年人会出现记忆力衰退、毛发变白、牙齿脱落等衰老现象.

因材施教长期以来一直是教育理论和实际工作者研究和讨论的焦点之一,面对目前新形势,因材施教势必成为我们中等医学职业教育提高教学质量的新课题.我们应根据新形势的变化,制定新的教学大纲和教材,而分层教学法则是因材施教思想的精髓,以达到因材施教的目的.