Objective To compare and analyse the advantages and disadvantages of carpal arthroscopy and small incision surgery in the treatment of carpal tunnel syndrome (CTS). Methods 48 patients with unilateral carpal tunnel syndrome (CTS) who fulfilled the inclusion criteria in the Department of Orthopedics of Kiang Wu Hospital in the two-year period from November 2020 to October 2022 were analyzed in a retrospective study, and were divided into a carpal arthroscopy group and a small incision group according to the treatment modality, and were followed up for at least 13 weeks after surgery. The incision length, duration of surgery, hospital stay, postoperative recovery time, surgical complications, pain scores at 2 weeks, 6 weeks, and 13 weeks after surgery, and two-point discrimination sensation data were recorded for statistical analysis to assess the efficacy and safety of the treatment. Results The carpal arthroscopy group was significantly better than the small incision group in terms of incision length, duration of surgery, hospital stay, and postoperative recovery time, and there was no postoperative bleeding, hematoma, neurological injury, recurrence, and other problems in either group. There were no postoperative complications such as bleeding, hematoma, nerve injury, recurrence, neuroma, muscle abnormality of the hand or wrist, etc. The pain scores at 2 weeks after surgery suggested that the carpal arthroscopy group was better than the small incision group, and there was no significant difference in the pain scores of the two groups at 6 weeks and 13 weeks after surgery, and the two-point discrimination sensation at 2 weeks, 6 weeks, and 13 weeks after surgery. Conclusion Carpal arthroscopy treatment of carpal tunnel syndrome has the advantages of effective treatment, being less invasive, resulting in fewer complications and a shorter recovery time, which is worthy of promotion.However, it requires a higher level of surgical skills and still has some therapeutic limitations

Objective To explore the relationship between serum levels of CA125, HE4, and ROMA index and the clinicopathological characteristics of postmenopausal women with endometrial cancer(EC). Methods From June 2016 to September 2022, postmenopausal EC patients who underwent comprehensive staging surgery in the Department of Obstetrics and Gynecology, Kiang Wu Hospital, Macau were enrolled in this retrospective study. Preoperative serum levels of CA125 and HE4 were measured, and the ROMA index was calculated. Clinical materials and postoperative pathological results were recorded in detail. Results A total of 57 postmenopausal EC patients were enrolled, including 47 cases with endometrioid EC and 10 cases with non-endometrioid EC. There were no significant differences in CA125, HE4, and ROMA index in patients with endometrioid EC compared to non-endometrioid EC patients (P>0.05). In patients with endometrioid EC, CA125, HE4, and ROMA increased with the escalation of tumor cell differentiation, but the differences were not statistically significant (P>0.05). There were no significant differences in CA125, HE4, and ROMA among patients with different depths of myometrial invasion (P>0.05). Patients with lymphovascular space invasion or lymph node metastasis(LNM) showed higher levels of CA125, HE4, and ROMA compared to negative counterparts, but only the differences in CA125 and ROMA between LNM patients and non-LNM patients were statistically significant (P<0.05). Conclusion Serum CA125 and ROMA index can serve as auxiliary indicators for preoperative assessment of lymph node metastasis risk in postmenopausal patients with endometrioid EC.

Objective To analyze semen examination reports from November 2018 to November 2022 in Kiang Wu Hospital. We aimed to explore the results of routine semen analysis and sperm quality, in order to provide guidance of suitable assisted reproductive techniques for infertile men. Methods Patients' semen samples were evaluated according to the World Health Organization (WHO) criteria for routine semen analysis, dividing patients into groups meeting the standard for semen quality and not meeting it, respectively. Additionally, the study analyzed the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes for patients with normal and abnormal sperm analysis results. Results Out of 3090 semen routine analysis, 1972 individuals (63.82%) met the standard criteria. The average age was 37.35 years, with an average total sperm count of 314.61×10 6, a forward motility rate of 45%, and an immotile sperm proportion of 35%. In contrast, 1118 individuals (36.18%) did not meet the standard criteria, with an average age of 31.33 years, an average total sperm count of 136.30×10 6, a forward motility rate of 18%, and an immotile sperm proportion of 55%. Sperm morphology analysis (SMA) was performed on 750 samples, with 333 meeting the standard, accounting for 44.40%, with an average age of 35.11 years. Additionally, 228 patientshad mild abnormalities, accounting for 30.40% with an average age of 35.09 years, whereas 189 cases had severe abnormalities, accounting for 25.2% with an average age of 36.48 years. The total fertilization rate innormal SMAgroup showed no significant difference comparing to that ofmild abnormal group, however ,significantly higher than that of severeabnomal group. Moreover, the IVF normal fertilization rate was significantly higher in the SMA normal group comparing to the SMA mild abnormal group. There were no significant differences in total fertilization rates and normal fertilization rates among the groups receiving ICSI treatment. Conclusion Routine semen analysis and sperm quality analysis are crucial indicators for assessing male fertility. Abnormal sperm morphology is a primary cause of male infertility. Semen routine analysis can enhance the diagnostic accuracy of male infertility, and the results of sperm quality analysis can assist in the selection of appropriate assisted reproductive techniques.

Objective To analyze the admission rate of patients at Kiang Wu Hospital, Macau (hereinafter referred to as 'our hospital') due to ADRs and related factors. Methods A retrospective studywas performed, and data were collected from unintentional admissions of adult patients who met the inclusion criteria from April 2023 to September 2023. Two clinical pharmacists gathered patients' basic information and assessed the causality, type, severity, and avoidability of all suspected ADRs. Logistic regression analysis was used to evaluate the related factors associated with the occurrence of ADRs at the time of admission. Results A total of 4,919 patients were included in the study, 54.7% were female, with a mean age of 64.8±19.3 years. 228 patients experienced ADRs at the time of admission, resulting in an incidence rate of 4.6%, while 151 patients were admitted due to ADRs, with an incidence rate of 3.1%. A total of 242 ADR events were identified, with 278 instances of drug involvement. The number of medications taken (five or more) and the presence of diabetes were identified as key factors in the multifactorial analysis of ADRs. 211 patients were admitted to the internal medicine wards, accounting for 92.5% of those who experienced ADRs at the time of admission. The most common ADRs were bleeding/INR abnormalities (29.8%) and electrolyte disturbance (13.6%), with the most frequently involved drug classes being cardiovascular drugs (29.5%) and drugs affecting the blood and blood forming organs (27.0%). Conclusion This study fills a gap in local ADR data and highlights the need for targeted interventions for high-risk populations and high-risk medications to reduce the occurrence of ADRs.

Objective This study aims to understand the current situation of nurses’ knowledge, attitudes, and behaviours on the prevention of pressure injury in a hospital in Macao. Explore the differences between the socio-demographic characteristics of nurses and the perceived factors of work environment on the behaviour of pressure injury prevention,the correlation between the knowledge, attitudes, and behaviours of pressure injury prevention. Methods Through cross-sectional surveys and studies, using convenient sampling methods, structured questionnaires are used to collect data. Results Finally, 213 valid questionnaires were collected. The overall average score of nurses in a hospital in Macao on the knowledgeof pressure injury prevention is 70%, and the overall average scores of attitudes and behaviours ofpressure injury prevention are 77.20% and 76.80% respectively. There are significant differences between the work department, whether the subjects have read related literatures about pressure injury in recent one year and nurses’ behaviours on pressure injury prevention. There is a significant positive correlation between nurses’ knowledge, attitudes, and behaviours about the prevention of pressure injuries. Conclusion The nurses of a hospital in Macao have slightly poor knowledge of the prevention of pressure injury injuries; their attitudes and behaviours regarding the prevention of pressure injuries are acceptable. Therefore, it is recommended to comprehensively strengthen the on-the-job training of nurses for pressure injury, formulate a pressure injury assessment mechanism, and increase related resources, to strengthen nurses' knowledge, attitudes, and behaviours about pressure injury prevention and improve the quality of care for pressure injury.

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Objective To investigate the distribution of allergens in Macau children to provide a scientific basis for the prevention of allergic diseases. Methods The laboratory results of allergens detection in children from the year 2022 were selected to study the distribution of allergens, with a total of 173 cases related to food allergens and 239 cases related to inhaled allergens. Statistical analysis was performed to find out the relationship between the distribution of allergens and factors such as sex, gender, and season. Results Positive rate of food allergies was 56.65% and inhaled allergies were 70.29%. Among the food allergens, for the panel related to seafood and meat, the top 3 most detected allergens were egg white , milk and salmon, for fruit and nuts panel, the oat , kiwi and peanuts were thetop 3 most detected allergens. For inhaled allergies, the top 3 most detected allergens were dermatophagoidespteronyssinus, cat danderand dog dander. From the statistical analysis, the positive rate of inhaled allergens increasedwithage, but positive rate of food allergens decreasedand the differences between the findings were statistically significant. Conclusion There are differences in allergen positivity rates among different age groups, therefore, understanding the distribution of allergens among children in an early stage is important to promote early intervention and prevention of allergic diseases, and also facilitate the diagnosis and treatment of allergic diseases.

Objective  To analyze differences in brain structure volumes among patients with Alzheimer's disease(AD), mild cognitive impairment(MCI), and cognitively normal older adults using structural magnetic resonance imaging(sMRI) technology.  Methods  A total of 67 AD patients, 77 MCI patients and 174 normal controls(NC) were included. All participants underwent 3D T1-weighted images (T1WI) scanning, Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). The T1WI of all subjects were processed using MR brain structure automatic segmentation software to obtain the volume and volume percentage of each brain region. SPSS v25.0 was used for statistical analysis, and covariates included age, gender, years of education and whole brain volume.  Results  There were significant differences in the volume of multiple brain regions among the three groups (P＜0.05). Compared with the NC group, the volume of the ventricular system-related regions in the MCI group increased significantly, while the volume of the middle part of the corpus callosum decreased significantly. Compared with the NC group, the volume of the whole brain gray matter and multiple brain regions in the AD group decreased significantly, and the volume of the ventricular system-related regions increased significantly. Compared with the MCI group, the volume of the ventricular system-related regions in the AD group increased significantly, and the volume of some brain regions decreased significantly. There were significant differences in the volume percentages of multiple brain regions among the three groups. Compared with the NC group, the volume percentages of the ventricular system-related regions in the MCI group increased significantly, and the volume of the middle part of the corpus callosum decreased significantly. Compared with the NC group, the volume percentages of the whole brain gray matter and multiple brain regions in the AD group decreased significantly, and the volume percentages of the ventricular system-related regions increased significantly. Compared with the MCI group, the volume percentage of the ventricular system-related areas in the AD group increased significantly, and the volume percentage of some brain regions decreased significantly.  Conclusion  The segmentation and measurement of brain volumes can assist in the clinical diagnosis of AD. Ventricular system dilatation and atrophy of the middle corpus callosum may facilitate the early identification of MCI.

Objective Reviewing the effectiveness of in-hospital cardiorespiratory arrest (IHCA) treatment in the past three years after the establishment of the medical emergency team (MET) and will provide more reference for improving the process. Methods A retrospective analysis of the initiation of MET in Kiang Wu Hospital from July 2020 to June 2023, including the initiation time, location, and clinical data of relevant patients, was performed. Results A total of 82 cases were collected, including 14 cases in the first year, 26 cases in the second year, 42 cases in the third year, 50 males (61%) and 32 females (39%), with an average age of 75.5±16.7 years old, the youngest is 24 years old, and the oldest is 97 years old. Non-administrative office hours accounted for 67.1% of the start-up period. The starting place was mainly in the ward, accounting for 70.7%, and the starting department was mainly internal medicine, accounting for 64.6%. Among the patients who started MET, 56 cases required CPR, accounting for 68.3%, and 52 cases of tracheal intubation (accounting for 63.4%) , and defibrillation in 18 cases (22%). The average arrival time after the start of MET was 3±1 minutes. The average rescue time was 29±17minutes. Among the rescue results, 30 cases died, and 52 cases were successfully rescued, accounting for 63.4%. During the rescue of IHCA patients, family members requested DNACRP during rescues in 11 cases, accounting for 19.6%. After excluding DNACPR patients, the rescue success rate of IHCA patients treated by the MET team was 55.6%, and the mortality rate was 44.4%. The 30-day mortality rate was 60%, and the mortality rate of >80 years old was significantly higher in the age group. Conclusion In our hospital, most patients with MET-activated are critically ill and require urgent treatment. MET can provide timely and effective treatment. Among them, elderly patients generally have a poor prognosis.

Objective To evaluate the role of preoperative magnetic resonance imaging (MRI) in decision-making for pelvic lymph node dissection (PLND) in patients with endometrial cancer. Methods From January 2016 to March 2024, patients with endometrial cancer who underwent surgical treatment in the Obstetrics and Gynecology Ddepartment of Kiang Wwu Hospital were enrolled in this study. Clinical materials were collected and postoperative pathological results were used as the gold standard to evaluate the diagnostic efficacy of preoperative MRI examination for uterine myometrial infiltration and pelvic lymph node metastasis. Results 84 patients with endometrial cancer were adopted for final analysis. The sensitivity, specificity, and accuracy of MRI in evaluating deep uterine myometrial infiltration (MI≥50%) were 60.7%, 91.1%, and 81.0%, respectively. The sensitivity, specificity, and accuracy of MRI in evaluating pelvic lymph node metastasis were 27.3%, 89.3%, and 79.1%, respectively. When MRI indicating deep myometrial infiltration, pelvic lymph node metastasis, or a combination of both were applied to predict pathological diagnosis of pelvic lymph node metastasis, the Youden index of MRI indicating deep myometrial infiltration as the predictive indicator is the highest, at 0.495. Conclusion In our hospital, compared with MRI diagnosis of pelvic lymph node metastasis, selective PLND based on MRI diagnosis of deep myometrial infiltration is a more reasonable preoperative evaluation plan.

家族性致死性失眠症(familial fatal insomnia, FFI)是一種少見的常染色體顯性遺傳性朊蛋白疾病，臨床常表現為頑 固性失眠、自主神經功能及運動障礙。自1986年Lugaresi 在意大利發現全球第一例後，國內外也有不少病例報導。目前基因檢測是唯一診斷“金標準”，PRNP基因發生變異是其主要特點。該病進展迅速、致死率高、預後差、起病樣式多樣化。本病例為本院確診的首例。

Objective To study the clinicopathologic features, and immunophenotype of IgG4-related disease (IgG4-RD), improve clinicians’ and pathologists’ understanding of this disease. Methods The clinical features and pathologic changes were observed and analyzed in 15 cases with IgG4-RD, and relevant literatures were reviewed. Results The mean age of the patients was 66 years. The male-to-female ratio was 7:3. The involved site were mainly the submandibular gland and lymph nodes, followed by the parotid gland, lung and testis. The main pathological changes are stromal sclerosis characterized by an increase in IgG4+ plasma cells on immunostaining. Conclusion IgG4-RD, a rare disease, has no characteristic clinical manifestation. A definitive diagnosis depends on biopsy and immunohistochemistry.

Objective To investigate the relationship between human leukocyte antigen (HLA)-G expression and prognosis in serous ovarian carcinoma (SOC) patients. Methods The clinical and pathological data of SOC patients were retrospectively analyzed, and the expression of HLA-G in SOC tissues was detected by immunohistochemistry, and its relationship with clinicopathological features and prognosis was analyzed. Results HLA-G was positive in 77.08% (37/48) SOC tissues. In 94.44% HLA-G low-expression group, the clinicopathologic stage was advanced stage (III-IV), which was sinificantly different from that in the high-expression group. Howerver, there was no difference in pathological grade between the two groups. The average survival time of patients in the low-HLA-G expression group was 62.77±7.82 months, and that of patients in the high HLA-G expression group was 92.13±15.2 months. The Kaplan-Meier survival analysis revealed that the 5-year survival rate of the high-HLA-G expression group was 75%, which was higher than that of the low-expression HLA-G group of 52%, but the difference was not statistically significant. Cox regression analysis revealed that chemotherapy resistance was a predictor of adverse OS in SOC patients (HR=10.700, 95%CI=3.433~33.349, P =0.000), whereas high expression of HLA-G was a protective factor (HR=0.132, 95%CI=0.035~1.098, P =0.045). Conclusion HLA-G is highly expressed in SOC compared with normal tissues. The expression of HLA-G was low in advanced (stage III-IV) SOC patients, but was not related to the pathological grade. The SOC patients with low HLA-G expression have a worse prognosis, which may be related to chemotherapy resistance.

Objective The aim of this study was to determine the clinical characteristics, management and outcome of patients with PPHN in Kiang Wu Hospital, and review the latest management of PPHN. Methods To retrospectively analyze the clinical manifestations, treatment and prognosis of PPHN treated in the NICU from January 2016 to May 2020. Results A total of 14 PPHN patients were diagnosed in the NICU. The prevalence and mortality are similar to those reported in developed countries. The main risk factor is elective cesarean section. Conclusion The management in our unit is highly attach to lastest guideline, early observation of clinical features and echocardiogram results is the key point to timely treatment of PPHN patients.

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Osteogenesis imperfecta (OI), also known as brittle bone disease, is a phenotypically diverse disorder due to deficiencies in the synthesis of type I collagen. OI is a disease characterized by brittle bones and frequent fractures with minimal trauma leading to skeletal deformities. Its incidence is estimated at 1 per 20,000 births. Though rare, it is the most common inherited disorder of connective tissue. Principally, it affects bone, but it also impacts other tissues rich in type I collagen, such as joints, eyes, ears, skin, and teeth.

AIH is a chronic disease of unknown origin characterized by persistent inflammation and necrosis in the liver, which can progress to liver cirrhosis. The disease's progression can be slow, and patients may present with a wide range of symptoms, from no symptoms at all to sudden, severe hepatic failure. The diagnosis of AIH can be easily made using the IAH scoring system. In patients with impaired liver function, it is important to investigate for AIH by ruling out viral hepatitis, drug-induced hepatitis, and alcoholic hepatitis, and by conducting tests for autoimmune markers. The standard treatment for AIH is immunosuppressive therapy. Although AIH is relatively uncommon, it can be fatal if left untreated; however, early diagnosis and treatment often result in a favorable response. Our objective is to bring attention to AIH and emphasize the importance of increased awareness of this disease in patients with unexplained liver impairment.

Objective This study aimed to investigate the status of self-management of patients on maintenance hemodialysis in Macau, and to explore the factors influencing patients’ self-management. Methods This was a across-sectional survey study. Patients with maintenance hemodialysisviaarteriovenous fistula were eligible for the study. Recruitment was conducted in the largest hemodialysis center in Macau from December 2020 to February 2021. The Hemodialysis Patient Self-Management Scale was used toinvestigate the patients’ self-management behaviors. Statistical analysis of data was performed using SPSS22.0 software. Results The total score of self-management behavior of 185 patients undergone maintenance hemodialysis ranged from 23 to 62, with an average of 40.94±8.21(total score 80 points).The disease-related factors such as dialysis years, dialysis frequency, and complications had no statistically significant impact on self-management behaviors (P >0.05). Age, education level,and per capita monthly family income have impacts on the patients’ self-management behaviors (P <0.05), which explained 31.0% of the total variation. Conclusion The scores of the self-management behavior of the patients on maintenance hemodialysis in Macau are low , and are affected by individual physiological and social factors of patients. Nurses in hemodialysis centers should formulate individualized and targeted interventions, to improve the self-management behavior of the patients.

The COVID-19 pandemic has had a severe impact on individual health and social development. The virus primarily attacks the respiratory tract mucous membrane, leading to varying degrees of respiratory dysfunction and complications, even resulting in death. After the pandemic was satisfactorily controlled, many male patients who had been infected with COVID-19 sought medical help for various sexual dysfunctions. Existing researches indicate that the causes of sexual dysfunction in males following COVID-19 infection include both psychological and organic factors. There is relatively limited domestic reporting on this topic. This article reviews domestic and international literatures and researches to explore the reasons and potential pathophysiological mechanisms of COVID-19-related male sexual dysfunction and provides a summary.

Objective To compare the effects of two different oxygen flow rates on respiratory function in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) under intravenous anesthesia via high-flow nasal cannula (HFNC). Methods Elderly patients were randomly divided from January 2021 to March 2022 into two groups: the low-flow group (n=28) underwent an oxygen flow 20L/min HFNC, patients in the high-flow group (n=30) underwent an oxygen flow of 40 L/min HFNC. Intravenous anesthesia with propofol targeted controlled infusion combined with fentanyl were administered in patients in both groups. The partial pressure of venous oxygen (PvO₂), partial pressure of venous carbon dioxide (PvCO₂) and pH of patients before operation and 45 min after anesthesia induction were documented. Differences between groups at the same time point and intra-group differences at different time points were compared. The incidence of SpO₂ less than 95%, requiring airway intervention and surgical interruption caused by body movement were compared between the two groups. Results A total 58 cases There was no significant difference in PvO2, PvCO₂ and pH between the two groups at the same time point. Intra-group differences at different time points were compared, there was no significant difference between the PvO₂, PvCO₂ and pH of patients in the low-flow group 45 minutes after anesthesia induction compared with those before surgery. The PvO₂and PvCO₂values in the high-flow group 45 minutes after anesthesia induction were significantly higher than those before surgery, and the pH value was significantly lower than that before operation (P <0.05). There was no significant difference in propofol dosage between the two groups. There was no significant difference between the two groups in terms of the incidence of SpO₂ lower than 95%, need for airway intervention, or interruption of surgery due to patient movement. Conclusion HFNC therapy at a rate of 20L/min can ensure adequate oxygen supply within 45 minutes for elderly patients undergoing ERCP under intravenous anesthesia without causing carbon dioxide retention.

Objective To compare the transradial and transfemoral access for diagnostic cerebral angiography with respect to efficacy, safety and patient satisfaction. Methods Consecutive patients presenting for diagnostic cerebral angiography were selected to undergo right radial or femoral access randomly from 1 Jul. 2021 to 31 May 2023. Primary outcome was ability to answer the predefined diagnostic goal of the cerebral angiogram using the initial access site and was assessed with a noninferiority design. Secondary outcomes included complications and patient satisfaction. Results A total of 283 patients were enrolled, 144 and 139 for right radial and femoral access, respectively. The diagnostic goal of the angiogram was achieved in 98.5% patients who underwent attempted femoral access compared with 96.5% patients who underwent radial access, confirming non-inferiority of the transradial approach. Secondary outcomes revealed no major complications, and similar frequency of minor complications between the two approaches, though post-procedure recovery time was significantly shorter for transradial patients. We identified a subset of 86 patients who underwent both transradial and transfemoral cerebral angiograms and compared clinical outcomes and patient satisfaction measures between the 2 groups. Patient satisfaction results significantly favored the radial access. Conclusion In patients undergoing diagnostic cerebral angiography, transfemoral and transradial access achieve procedural goals with similar effectiveness and safety, though patients strongly prefer the radial approach. These findings support consideration of adopting a radial-first strategy for diagnostic cerebral angiography.

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神經源性膀胱(Neurological Bladder, NB)是腦卒中後預後不良的重要預測因子，反映未來功能恢復不佳及死亡率較高。報導顯示卒中後急性期有40.5%患者需要留置尿管，當中26.3%出現拔管失敗情況，長期留置尿管亦增加尿路感染風險，因此改善排尿功能，早期拔除尿管對促進患者功能恢復、降低致殘率具有重要的臨床意義。提供更精準刺激的重覆外周磁刺激(repetitive Peripheral Magnetic Stimulation, rPMS)，近年亦初步應用於NB治療中。本文介紹應用rPMS成功治療卒中後尿管拔除困難患者2例。

Improving the hospital's humanistic care requires continuous optimization through three-pronged approaches: quality management, professional education and the continued development of humanistic care, and personal cultivation. Quality management optimization can be deconstructed into personnel, equipment and facilities, service provision, rules and regulations and work processes, providing a friendly environment, and monitoring employee performance. The professional education and the continued development of humanistic care is divided into a three-level system of initial training (communication skills and etiquette, combining medical knowledge with communication skills), advanced training (improving emotional intelligence and cultivating empathy, handling special scenes, life and death education), continuous development and monitoring of educational effectiveness. Personal self-grooming and maturation, emphasizing on persistence of set goals, self-evaluation and pursuit for continuous enhancement of communication skills using positive thinking.

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Atlantoaxial joint dislocation in children is a common disease in children's orthopedics. Most children can be treated conservatively. Conventional traction therapy is the most commonly used conservative treatment method, but there are certain limitations. We successfully treated a child with traumatic atlantoaxial dislocation with Chinese manipulative repositioning,and combined with the relevant literature,we discussed the current status of the treatment of this disease and the advantages of Chinese manipulative therapy.

Objective To summarize the typical ultrasonographic features of true umbilical cord knots and improve its diagnostic accuracy rate with the use of 2D ultrasound combined with 3D HD-live Flow Technology. Methods True umbilical cord knots diagnosed by 2D ultrasound combined with 3D HD-live Flow Technology and confirmed after delivery were analyzed retrospectively from October 2020 to October 2022. Results 6 patients were singleton pregnancy and full-term born via cesarean delivery,and proved to have single true knot of umbilical cord after delivery. Prenatal ultrasound revealed that all true knots of the umbilical cord were located near the fetal neck, the umbilical cord blood vessels entered the knot from one side, rotated, entangled, and then passed out from the other side. The shape of the knots did not change during follow up and observation. Conclusion Recognizing the sonographic features of true umbilical cord knot can help to distinguish it from the false knots and other abnormalities of the umbilical cord shape.

Objective To explore the characteristics of dysphagia and disease outcomes of patients hospitalized with COVID-19 infection and did not receiving intubation treatment at Kiang Wu Hospital in Macau. Methods A total of 65 hospitalized patients with COVID-19 infection for the first time were included in the study. They were divided into the dysphagia group and the normal group by swallow evaluating. The patient characteristics and dietary conditions were observed before discharge and during 3 months-follow- up. Results (1)52 patients (80%) had difficulty in swallowing food of different textures; (2)46 patients required indwelling gastric tubes ,and the average time of indwelling gastric tubes was 17.82 days. (3)All patients had their gastric tubes removed during the follow-up 3 months later, but 3 patients still had dysphagia on food grade of liquid consistency; (4)Patients with dysphagia were older than non-dysphagia patients (P<0.05) and had more previous respiratory diseases, such as asthma or COPD (P<0.05), and patients with delirium during hospitalization were more likely to have dysphagia (P<0.05); whereas sex , smoking habits, and the need for oxygen therapy during hospitalization had no significant impact on the occurrence of dysphagia in these patients (P>0.05). (5) Comparing the positive results of V-VST with the MMASA score results, MMASA has high sensitivity and specificity in predicting dysphagia. Conclusion Non-intubated patients infected with COVID-19 may also have dysphagia, it may adversely affect a patient's recovery from COVID-19. A standardized bedside assessment protocol can help promptly identify dysphagia and minimize the risk of spread of infection.

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Objective To detect and compare of EGFR mutation by immunohistochemistry and ARMS PCR, explore the possibility of substitution for EGFR gene mutation detection by ARMS PCRin lung adenocarcinoma.  Methods Cell smears, histological and cell blocks were used to detect EGFR mutation by ARMS PCR and delE746-A750 and L858R mutant proteins by immunohistochemistry, and the detection results of both methods were relatively analyzed.  Results EGFRmutant proteins in 116 cases of lung adenocarcinomaare detected by immunohistochemistry. In 39 cases of immunohistochemical score of 0, 29 cases (74.4%) had ARMS PCR mutations. In 5 cases of immunohistochemical score of 1, 4 cases (80.0%) had ARMS PCR mutations. In 14 cases of immunohistochemical score of 2, 14 cases (100%) had ARMS PCR mutations.In58 cases of immunohistochemical score of 3, 58 cases (100%) had ARMS PCR mutations. With an immunohistochemical score of <1+ as negative and >2+ as positive, the sensitivity of immunohistochemistry was 69.2%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 25.6%.  Conclusion The immunohistochemical detection for EGFR delE746-A750 and L858R mutant protein is a simple, fast and easy to interpret method, and this method can be used as a substitution for EGFR ARMS PCR mutation detection, or a primary screen protocol.

較長時間的術後禁飲禁食導致患者出現口渴、焦慮、煩躁等負面情緒，不僅增加了患者躁動、導管脫出、墜床、切口出血的風險，甚至發生血流動力學紊亂、血糖波 動、譫妄，延緩患者康復。隨着禁飲時間的持續，患者口渴難受程度甚至超過了疼痛。加速康復外科(enhanced recovery after surgery, ERAS)是以患者為中心，核心是減輕手術患者心理和生理創傷的應激反應，促進術後康復。術後早期經口飲食(early oral feeding, EOF)已成為ERAS的重要環節之一。目前，術後飲食的具體時間、種類、數量，尚缺乏統一標準。為進一步提高術後患者滿意度，本文就術後早期少量飲食的研究進行綜述。

Objective To investigate the clinical characteristics of juvenile idiopathic arthritis (JIA) through retrospective analysis of pediatric cases, providing references for early diagnosis and treatment.  Methods Clinical data of diagnosed case between 2019 to 2024 were analyzed retrospectively, focusing on age, gender, subtypes, clinical features, and disease progression.  Results The mean age of onset of the 8 patients was 9 years and 1 month (male-to-female ratio 1:1). Subtype distribution included systemic JIA (1 case), polyarticular JIA (1 case), oligoarticular JIA with iridocyclitis (2 cases), andenthesitis-related JIA (4 cases). Systemic JIA was treated with ibuprofen and corticosteroids, while other subtypes received methotrexate combined with etanercept or adalimumab, supplemented by rehabilitation. All cases showed clinical improvement.  Conclusion JIA exhibits heterogeneous manifestations requiring differential diagnosis from other systemic disorders. Common complications include joint dysfunction and uveitis-induced visual impairment, highlighting the necessity of early recognition and aggressive therapeutic intervention.

Objective To compare analgesic effect, side effect and quality of recovery score between Opioid-free anesthesia(OFA) method and traditional opioid-based anesthesia(OA) in gynecology laparoscopic surgery.  Methods From January 2022 to December 2023, female patients undergoing gynecology laparoscopic surgery under general anesthesia, were divided randomly into two groups, OFA group and OA group. We analyzed the differences between the two groups in terms of analgesic effect, side effect and quality of recovery score.  Results Tracheal extubation time and Qor-40 score in OFA group are superior to control group, with statistically significant difference. There is no statistical difference in postoperative Numerical Rating Scale(NRS) in 1,6,12,24hand side effects such as nausea, vomiting and instability of blood pressure. Fluctuation of heart rate is more obvious in OFA group, with statistical significance.  Conclusion Qor-40 score and extubation time are better in OFA, which is competitive to OA in analgesic effect, and improve the perioperative experience in female patients.

Objective This study is based on the BEERS and STOPP criteria, combined with the actual medication usage at Kiang Wu Hospital (KWH), Macao, to develop a comprehensive list of potentially inappropriate medication (PIM) screening items. It analyzes the PIM use in hospitalized elderly patients aged 80 or above in the internal medicine department of KWH and explores the associated risk factors.  Methods A retrospective cohort study design was adopted, collecting data from hospitalized internal medicine patients aged 80 years or older in KWH between January 1, 2023, and December 31, 2023. Data included demographics, comorbidities, physiological factors, and medication use. PIM screening was performed based on the 2023 version of the BEERS and STOPP criteria, and the risk factors for PIM use were explored using multivariate logistic regression analysis.  Results The screening rates based on STOPP and BEERS criteria were 96.93% and 91.73%, respectively, and the mean number of PIMs per capita was 3.53±1.95 and 3.16±1.86, respectively (P＜0.001). The most common reasons for PIM were the use of medications requiring caution, central nervous system drugs, and drugs that increase the risk of falls. Multivariate regression analysis revealed that, compared to mild PIM, the risk factors for moderate PIM based on the BEERS criteria were diabetes, gout, and hyperuricemia; the risk factor for severe PIM was peripheral vascular embolism; and the common risk factors for moderate and severe PIM were depression and anxiety, as well as a hospital stay longer than 20 days. Based on the STOPP criteria, the risk factors for moderate PIM compared to mild PIM were having more than five chronic diseases, peripheral vascular embolism, and a hospital stay longer than 20 days; the common risk factors for moderate and severe PIM were heart failure, osteoporosis, and a history of fractures.  Conclusion Managing medications in elderly patients presents unique challenges, with PIMs being particularly prevalent. Effective clinical management requires a comprehensive approach that considers individual variations, comorbid conditions, and drug-specific factors. Priority should be given to addressing modifiable risk factors (e.g., extended hospital stays) while maintaining vigilant monitoring of non-modifiable factors (e.g., multiple comorbidities). A three-tiered intervention strategy is recommended: (1) regular medication regimen reviews, (2) selection of safer therapeutic alternatives when available, and (3) implementation of personalized monitoring protocols for high-risk medications. Successful implementation requires close collaboration between physicians and pharmacists, coupled with the integration of a severity-based PIM classification system into electronic health records to systematically enhance medication safety.

Objective To explore the influencing factors of hemorrhagic transformation after cerebral infarction in patients with non-valvular atrial fibrillation.  Methods A retrospective analysis was conducted on 91 inpatients with non-valvular atrial fibrillation and cerebral infarction admitted to Kiang Wu Hospital in Macau from January 2020 to December 2022. They were divided into a non-hemorrhagic transformation group (n=64) and a hemorrhagic transformation group (n=27) based on imaging changes. Collect clinical data and imaging results of patients, explore risk factors for hemorrhagic transformation.  Results (1) Comparing the NIHSS score, cortical cerebral infarction and large-area cerebral infarction between the non- hemorrhagic transformation group and the hemorrhagic transformation group, the difference was statistically significant (P<0.05); (2)NIHSS score, cortical cerebral infarction and large-area cerebral infarction are independent influencing factors of hemorrhagic transformation (P<0.05).  Conclusion NIHSS score, cortical cerebral infarction and large-area cerebral infarction are related to hemorrhagic transformation after cerebral infarction in patients with non-valvular atrial fibrillation and are independent high-risk factors.

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Objective To establish a localized adult CT localized Diagnostic Reference Level (DRL) by using the Radimetrics platform and apply it in Continuous Quality Improvement (CQI), to provide baseline data for regional radiation protection.  Methods Retrospective analysis of CT plain scan dose data in adults (head, neck, chest, abdominopelvic regions) from 2020 to 2024 at Kiang Wu Hospital. Key metrics (CTDIvol, DLP) were extracted and analyzed statistically, including mean, standard deviation, median, and 75th percentile (P75). The baseline 2020 P75 data were compared horizontally with US ACR and Chinese DRLs. Annual data from 2021-2024 were analyzed longitudinally for mean value trends, and the mean reduction ratios of CTDIvol and DLP after optimization were calculated.  Results Cross-sectional Comparison: The 2020 baseline P75-CTDIvol values(55.4, 12.3, 4.73, and 12.2 mGy, respectively) were all better than ACR data(a decrease of 1.1% to 63.6%); except for the head, the other three parts were also better than the Chinese data(a decrease of 23.1%-64.1%). P75-DLP values showed a similar trend. Longitudinal Comparison: From 2021 to 2024, the mean CTDIvol and DLP of each part were significantly lower than the baseline data, among the mean CTDIvole of the head and chest decreased by 6.0%-12.1%, and the mean DLP decreased by 11.2%- 13.7%; and the annual reduction rate of the mean CTDIvol after optimization tended to be stable.  Conclusion By establishing our hospital's DRL and implementing CQI measures through the Radimetrics platform, the CT radiation dose was effectively reduced, and providing a scientific basis for localized DRL.

Objective Urine metabolomics analysis was performed to identify metabolite markers for glomerular filtration rate.  Methods A total of 145 volunteers who were tested in Kiang Wu Hospital in Macau from June 2019 to June 2020 were recruited. The urine of 145 subjects with different degrees of renal function was analyzed using non-targeted metabolomics technology.  Results The study found potential markers and related metabolic pathways related to renal filtration function. Significant metabolites include 398 metabolites. The top 10 were glycine, N6-acetyl-L-lysine, 17 β-estradiol 3-β-D-glucuronic acid, N -Acetyl-L-2-amino-6-oxopimelate, N-acetyldesmethylphosphinothricin, citric acid, L-cysteine, androsterone glucuronide), N6-acetyl-LL -2,6-diaminopimelic acid, aminoadipic acid. Metabolic pathways included the ABC transporter pathway, the protein digestion and absorption pathway, the tryptophan pathway, the amide-tRNA synthesis pathway, the steroid hormone biosynthesis pathway, and the arginine-proline metabolic pathway.  Conclusion These urinary metabolites are associated with renal function. It provides a reliable basis for the targeted development of metabolites related to renal function, and becomes possible for renal function evaluation with urine samples in the future.