Efficacy of work-amusement activities combined with daytime rehabilitation technology for schizophrenia in remission / 中国基层医药

Objective:To investigate the efficacy of work-amusement activities combined with daytime rehabilitation technology for schizophrenia in remission.Methods:A total of 218 patients with schizophrenia in remission who received treatment in Shaoxing 7 th People's Hospital from September 2018 to April 2020 were prospectively included in this study. They were randomly divided into an observation group ( n = 109) and a control group ( n = 109). Both groups were treated with routine drugs. Based on this, the control group was treated with daytime rehabilitation technology, and the observation group was treated with daytime rehabilitation technology combined with work-amusement activities. After 12 weeks of treatment, curative effect, Positive and Negative Symptom Scale (PANSS) and Montreal Cognitive Assessment (MoCA) scores were compared between the two groups. Results:After 12 weeks of treatment, total response rate in the observation group was significantly higher than that in the control group (91.74% vs. 77.06%, χ2 = 8.92, P < 0.05). After treatment, PANSS score in the observation group was significantly decreased compared with that before treatment [(33.12 ± 4.19) points vs. (40.54 ± 5.32) points, t = 11.44, P < 0.05). After treatment, PANSS score in the control group was significantly decreased compared with that before treatment [(35.02 ± 4.33) points vs. (40.54 ± 5.32) points, t = 8.55, P < 0.05). After treatment, PANSS score in the observation group was significantly lower than that in the control group ( t = 3.29, P < 0.05). After treatment, MoCA score in the observation group was significantly increased compared with that before treatment [(27.14 ± 2.89) points vs. (23.39 ± 2.48) points, t = 10.28, P < 0.05]. After treatment, MoCA score in the control group was significantly increased compared with that before treatment [(26.02 ± 2.73) points vs. (23.41 ± 2.56) points, t = 7.28, P < 0.05]. After treatment, MoCA score in the observation group was significantly higher than that in the control group ( t = 2.94, P < 0.05). Conclusion:The efficacy of work-amusement activities combined with daytime rehabilitation technology is marked on schizophrenia in remission, which can markedly improve mental symptoms and cognitive function.

Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty: a randomized controlled trial / 中国针灸

OBJECTIVE@#To investigate the clinical effect of aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty and the influence on hypercoagulation.@*METHODS@#Seventy-three patients of knee osteoarthritis with lower extremity venous thrombosis after total knee arthroplasty (KOA) were randomly divided into an observation group (37 cases, 2 cases dropped off) and a control group (36 cases, 1 case dropped off). The patients in the control group took orally rivaroxaban tablets, 10 mg a time, once a day. On the basis of the treatment as the control group, the aconite-isolated moxibustion was applied to Yongquan (KI 1) for the patients of the observation group, once daily and 3 moxa cones were used in each treatment. The duration of treatment was 14 days in both groups. Before treatment and 14 days into treatment, the ultrasonic B test was adopted to determine the conditions of lower extremity venous thrombosis in the two groups. Before treatment, 7 and 14 days into treatment, the coagulation indexes (platelet [PLT], prothrombin time [PT], activated partial prothrombin time [APTT], fibrinogen [Fib] and D-dimer[D-D]), the blood flow velocity of the deep femoral vein and the circumference of the affected side were compared between the two groups separately, and the clinical effect was evaluated.@*RESULTS@#Fourteen days into treatment, the venous thrombosis of the lower extremity was relieved in both groups (P<0.05), and that of the observation group was better than the control group (P<0.05). Seven days into treatment, the blood flow velocity of the deep femoral vein was increased compared with that before treatment in the observation group (P<0.05), and the blood flow rate in the observation group was higher than that in the control group (P<0.05). Fourteen days into treatment, PT, APTT and the blood flow velocity of the deep femoral vein were increased in the two groups compared with those before treatment (P<0.05); and PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all reduced in the two groups (P<0.05). Compared with the control group 14 days into treatment, the blood flow velocity of the deep femoral vein was higher (P<0.05), PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all lower in the observation group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 85.7% (30/35) in the control group (P<0.05).@*CONCLUSION@#Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban can effectively treat lower extremity venous thrombosis after total knee arthroplasty, relieve hypercoagulation, accelerate the blood flow velocity and alleviate swelling of the lower extremity in the patients with knee osteoarthritis.

Development of General Practice in Communities From the Perspective of Supply and Demand / 中国医学科学院学报

Objective To put forward suggestions for improving the scheme of general practice for functional communities from the perspective of supply and demand,guide the efficient use of the resources of general practice by the communities,and incorporate the general practice of communities into hierarchical diagnosis and treatment management. Methods In July 2021,stratified random sampling was employed to conduct the questionnaire surveys of the young and middle-aged (demand side) and the general practitioners (supply side),respectively.SPSS 20.0 was used for data analysis. Results The two sides had the same cognition about the main reasons for not signing a contract with a family doctor,which were the lack of knowledge about general practitioners and the lack of face-to-face communication opportunities.They had the same response about the form of services,with high acceptance of medical services via WeChat,outpatient consultation,and the internet.There were differences in service content between the two sides.The top three demands of the young and middle-aged were appointment registration and referral in superior hospitals,medication guidance,and massage,acupuncture,and moxibustion.The top service self-rated by general practitioners was personalized guidance and report interpretation of physical examination,and the bottom was massage,acupuncture,and moxibustion. Conclusions The general practice varies between the demand and supply sides.General practitioners should be encouraged to enter and learn functional communities and provide personalized services,thus improving the general medical service in functional communities.

Second metabolites comparative analysis of Codonopsis pilosula (Franch.) Nannf. from different origins based on extensively targeted metabolomics / 药学学报

We performed an extensively targeting metabolomic detecting using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) to compare the secondary metabolites in Dang shen [Codonopsis pilosula (Franch.) Nannf.] from Shanxi and Gansu provinces. The findings showed that 161 secondary metabolites in 6 groups (phenolic acids, flavonoids, lignans and coumarins, alkaloids, terpenoids, others) were found from Dang shen in Changzhi city of Shanxi province and Dingxi city of Gansu province. There were 98 secondary metabolites which is differed significantly. In comparison to Dingxi city, 33 different secondary metabolites of Dang shen in Changzhi city had a greater relative content, whereas relative content of 65 different metabolites in Dingxi city was higher. Metabolic pathway enrichment analysis revealed that phenolic acids and flavonoids were significantly different in the secondary metabolites of Dang shen from different producing places. This may be one of the reasons for the difference in the quality of Dang shen in Shanxi and Gansu provinces. This work compared and analyzed the secondary metabolites of Dang shen from Dingxi city in Gansu province and Changzhi city in Shanxi province for the first time, which lays the foundation for further study on the quality of Dang shen.

Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer / 亚洲男科学杂志(英文版)

Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer (mCRPC). Here, we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate (AA). We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018. All cases received AA plus prednisone as first-line therapy during mCRPC. Primary end points were biochemical progression-free survival (bPFS) and overall survival (OS). The risk groups were defined based on multivariate analysis. A total of 42 (41.6%) and 25 (24.8%) patients achieved 30% and 50% decline in prostate-specific antigen (PSA), respectively, after corticosteroid switching. The median bPFS and median OS on AA plus dexamethasone were 4.9 (95% confidence interval [CI]: 3.7-6.0) months and 18.8 (95% CI: 16.2-30.2) months, respectively. Aldo-keto reductase family 1 member C3 (AKR1C3) expression (hazard ratio [HR]: 2.15, 95% Cl: 1.22-3.80, P = 0.008) and baseline serum alkaline phosphatase (ALP; HR: 4.95, 95% Cl: 2.40-10.19, P < 0.001) were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS. Only baseline serum ALP >160 IU l-1 (HR: 3.41, 95% Cl: 1.57-7.38, P = 0.002) together with PSA level at switch ≥50 ng ml-1 (HR: 2.59, 95% Cl: 1.22-5.47, P = 0.013) independently predicted poorer OS. Based on the predictive factors in multivariate analysis, we developed two risk stratification tools to select candidates for corticosteroid switching. Detection of serum ALP level, PSA level, and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.

Acupoint selection rules of acupuncture for pseudobulbar palsy dysphagia / 中国针灸

OBJECTIVE@#To analyze the acupoint selection rules of acupuncture for pseudobulbar palsy dysphagia using data mining technology.@*METHODS@#The literature of acupuncture for pseudobulbar palsy dysphagia published from January 1, 1990 to May 1, 2021 was retrieved from CNKI, SinoMed, Wanfang, VIP, and PubMed databases. Acupuncture prescription database was established. The frequency of acupoint selection was analyzed by Microsoft Excel 2016; Apriori algorithm was used to analyze the association rules and draw the high-frequency acupoint co-occurrence network diagram; SPSS21.0 was used to perform clustering analysis.@*RESULTS@#A total of 87 literature was included, involving 89 acupuncture prescriptions and 71 acupoints. Fengchi (GB 20) was the most frequently-used acupoint; the commonly-selected meridians were gallbladder meridian, conception vessel, governor vessel and stomach meridian; the acupoints located at the neck were the most frequently-used acupoints; the crossing points were commonly selected among the special acupoints. The most commonly-used acupoint combination was Jinjin (EX-HN 12) plus Yuye (EX-HN 13).@*CONCLUSION@#The modern acupuncture for pseudobulbar palsy dysphagia usually selects local acupoints, especially the neck acupoints such as Fengchi (GB 20) and Lianquan (CV 23). The acupoints in the front and back are concurrently selected with needles towards the disease location.

A prospective clinical study of endoscopic foam sclerotherapy combined with rubber band ligation in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids (with video) / 中华消化内镜杂志

Objective:To evaluate the safety and long-term effectiveness of endoscopic foam sclerotherapy (FS) combined with endoscopic rubber band ligation (ERBL)in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids.Methods:Consecutive patients diagnosed as having grade Ⅱ-Ⅲ internal hemorrhoids in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January to December 2020 were prospectively enrolled in the study, and randomly divided into ERBL group and FS combined with ERBL group. The 24 h visual analogue scale (VAS) for pain and 1-week degree of bleeding were evaluated after the treatment. After follow-up of 6 months, the effectiveness of treatment was evaluated.Results:A total of 84 patients with age of 54.4±7.9 years were enrolled, 57.1% (48/84) males, and 73.8% (62/84)grade Ⅱ internal hemorrhoids. Forty-three patients were assigned to the ERBL group and 41 to the FS combined with ERBL group. There was no significant difference between the two groups in baseline data ( P>0.05). In the FS combined with ERBL group, the mean amount of polidocanol foam was 13.8±2.5 mL, the mean number of injection site was 4.7±1.2, and the median scores of VAS was 0 (0, 3), which was significantly lower than that of ERBL group [2 (0, 4), Z=-2.116, P=0.034]. The bleeding rate 1 week after treatment in the ERBL and FS combined with ERBL group were 20.9% (9/43) and 29.3% (12/41), respectively, and mild bleeding was the main symptom. There was no significant difference between the two groups in the bleeding degree ( U=807.0, P=0.378). After 6 months of follow-up, the total effective rates in the ERBL group and the FS combined with ERBL group were 81.4% (35/43) and 90.2% (37/41), respectively ( U=684.5, P=0.044). Conclusion:FS combined with ERBL can effectively relieve post-treatment perianal pain, and improve the long-term effectiveness.

A randomized and controlled study of transcranial magnetic stimulation for the treatment of non-organic insomnia / 中华物理医学与康复杂志

Objective:To observe the clinical effect of repeated transcranial magnetic stimulation (rTMS) on non-organic insomnia using college students.Methods:A total of 72 college students with non-organic insomnia were recruited and randomly divided into an observation group and a control group, each of 36, according to a random number table. The observation group was given rTMS treatment on the left dorsolateral prefrontal cortex at 1Hz and an intensity 130% of the resting motor threshold for 20min once daily, 5 days a week for 4 weeks. The control group was given sham magnetic stimulation. Depression, anxiety, sleep status and cognitive functioning were quantified before and after the treatment.Results:After 4 weeks of treatment, significant improvement was observed in the treatment group (though not in the control group) in total Pittsburgh sleep quality index scores, and in all of its dimensions except hypnotic medicine. The average Hamilton depression and anxiety scale scores of both groups had improved significantly after the intervention, but the improvement was significantly greater in the treated group. Significant improvement was also observed in the average visual space and executive function score, attention score, delayed memory score and total score of the observation group using the Montreal cognitive assessment compared with before the treatment and compared with the control group.Conclusions:Repeated transcranial magnetic stimulation can improve the sleep quality, emotional state and cognitive functioning of college students with non-organic insomnia.

Analysis of genetic variants in four children with congenital hyperinsulinemia / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis of four children with congenital hyperinsulinemia (CHI).@*METHODS@#The four children were subjected to high-throughput whole exome sequencing (WES). Candidate variants were validated by Sanger sequencing.@*RESULTS@#WES analysis has identified 4 variants in the ABCC8 gene and 1 variant in GLUD1, including a ABCC8 c.382G>A variant in case 1, compound heterozygous c.698T>C and c.4213G>A variants of the ABCC8 gene concomitant with a de novo 14.9 Mb microduplication of chromosome 15 in case 2, and ABCC8 c.331G>A variant in case 3, and de novo c.955T>C variant of the GLUD1 gene in case 4. Of these, c.698T>C of the ABCC8 gene and c.955T>C of the GLUD1 gene were unreported previously. Based on the American College of Medical Genetics and Genomics guidelines, the c.382G>A(p.Glu128Lys), c.698T>C(p.Met233Thr) and c.4213G>A(p.Asp1405Asn) variants of ABCC8 gene and c.955T>C(p.Tyr319His) variant of GLUD1 gene were predicted to be likely pathogenic(PM1+PM2+PP3+PP4, PM1+PM2+PM5+PP3+PP4, PM1+PM2+PP3+PP4 and PS1+PM1+PM2+PP3), and the c.331G>A (p.Gly111Arg) variant of ABCC8 gene was predicted to be uncertain significance(PM1+PM2+PP4).@*CONCLUSION@#The variants of the ABCC8 and GLUD1 genes probably underlay the pathogenesis of CHI in the four patients. Above results have facilitated clinical diagnosis and genetic counseling for the affected families.

Effects of escitalopram in the treatment of treatment-resistant depression / 中国基层医药

Objective:To observe the clinical effect of escitalopram in the treatment of treatment-resistant depression (TRD).Methods:A total of 90 patients with TRD who admitted to the Seventh People's Hospital of Shaoxing from January 2017 to January 2019 were divided into group A and group B by the random number table method, with 45 cases in each group.All subjects were given conventional treatment.On this basis, group A was treated with citalopram, and group B was treated with escitalopram.The clinical effect and adverse reactions were compared between the two groups.Results:The scores of Hamilton depression scale (HAMD) and clinical global impression (CGI) of group B after medication[(8.27±1.44)points and (2.82±0.74)points] were significantly lower than those of group A[(15.14±2.35)points and (4.87±1.33)points]( t=16.721, 9.035, all P<0.05). The total effective rate in group B after treatment (91.11%) was higher than that in group A (71.11%) (χ 2=5.874, P<0.05). The incidence of adverse reactions in group B (8.88%) was lower than that in group A (24.44%) (χ 2=3.920, P<0.05). Conclusion:Escitalopram is significantly effective in the treatment of TRD.It can effectively relieve the symptoms and reduce the incidence of adverse reactions.

Efficacy of the herbal cake-separated moxibustion with new-type moxibustion device on urinary retention after spinal cord injury / 中国针灸

OBJECTIVE@#To compare the clinical effect of the herbal cake-separated moxibustion with new-type moxibustion device combined with bladder function exercise and simple bladder function exercise on improving urinary retention after spinal cord injury.@*METHODS@#Sixty-eight patients were randomly divided into a control group and an observation group, 34 cases in each group. The bladder function exercise was given in the control group. On the basis of the treatment in the control group, herbal cake-separated moxibustion with new-type moxibustion decice was applied at Shenque (CV 8), Guanyuan (CV 4), Qihai (CV 6), Zhongji (CV 3) for 30 min, once a day in the observation group. The two groups were treated for 4 weeks as a course, 2 courses of treatment were needed. Bladder maximum volume, bladder residual urine volume and urinary tract infection before and after treatment were compared, and the clinical efficacy was evaluated in the two groups.@*RESULTS@#The total effective rate in the observation group was 88.2% (30/34), which was better than 64.7% (22/34) in the control group (<0.05). The increase of bladder maximum volume and decrease of bladder residual urine volume in the observation group were significantly better than those in the control group (<0.01). At the 4th, 6th and 8th weeks for treatment, the improvement of urinary tract infection in the observation group was better than that in the control group (<0.05).@*CONCLUSION@#At the same time of bladder function training, herbal cake-separated moxibustion with new-type moxibustion device could improve urinary retention after spinal cord injury.

Preliminary clinical efficacy of percutaneous plate internal fixation with fracture reduction oriented forcep for lower humeral fractures / 中华创伤杂志

Objective To investigate the preliminary clinical efficacy of percutaneous plate internal fixation with fracture reduction oriented forcep in the treatment of lower humeral fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with lower humeral fractures admitted to Wuzhong People's Hospital of Suzhou from October 2013 to March 2015. There were 25 males and 21 females, aged 19-76 years, with an average age of 45. 7 years. A total of 22 patients ( percutaneous group) were treated with minimally invasive percutaneous internal fixation with self-developed fracture reduction oriented forcep according to the dimensionality reduction method (DRM). The other 24 patients (control group) were treated with open reduction internal fixation. The length of incision, operation time, intraoperative blood loss, fracture healing time, the American Foot and Ankle Surgery Association ( AOFAS ) ankle-hindfoot score at the last follow-up, and postoperative complications were compared between the two groups. Results All patients were followed up for 12-24 months, with an average of 14. 6 months. There were statistically significant differences between percutaneous group and control group in incision length [(7.1 ±0.8)cm vs. (8.8 ±0.7)cm, operation time [(32.5 ±4.9)min vs. (39.2 ±4.3)min], intraoperative blood loss [(8.0 ±2.7) ml vs. (31.0 ± 11.4)ml], and fracture healing time (16.4 ±2.3)weeks vs. (19.5 ±2.9)weeks], respectively (all P<0.05). In percutaneous group, the AOFAS ankle-hindfoot score was (92.3 ±5.9)points (range, 75-99 points ) , and the overall results were good and excellent in 21/22 ( 96％) including excellent results in 18 patients, good in three, fair in one and poor in 0. In control group, the AOFAS ankle-hindfoot score was (91.8 ±4.9)points (range, 76-99 points), and the overall results were good and excellent in 23/24 (96％) including excellent results in 20 patients, good in three, fair in one and poor in 0. There was no significant difference in the excellent and good rate between two groups (P>0. 05). Poor wound healing was observed in one patient in control group. No case of nonunion was found in either group. Conclusion For lower humeral fractures, the percutaneous plate internal fixation with fracture reduction oriented forcep has the characteristics of simple operation, shortened operation time, reduced soft tissue injury and blood loss, and quick healing of the fracture, which is worthy of clinical application.

Minimal invasive microscopic tooth preparation based on endodontic, periodontal and functional health / 华西口腔医学杂志

Tooth preparation is the primary and core operation technique for dental esthetic restoration treatment, due to its effect of providing restoration space, bonding interfaces and marginal lines for dental rehabilitation after tooth tissue reduction. The concept of microscopic minimal invasive dentistry put forward the issue of conducting high-quality tooth preparation, conserve tooth-structure, protect vital pulp and periodontal tissue simultaneously. This study reviewed the concepts, physiology background, design and minimal invasive microscopic tooth preparation, and in the meantime, individualized strategies and the two core elements of tooth preparation (quantity and shape) are listed.

Effect of acupuncture on blood pressure variability in elderly patients with cerebral infarction complicated with essential hypertension / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of acupuncture on blood pressure variability (BPV) in elderly patients with cerebral infarction complicated with essential hypertension.@*METHODS@#Seventy-six elderly patients with cerebral infraction complicated with essential hypertension were randomized into an observation group and a control group, 38 cases in each group. acupuncture and nifedipin were given in the control group. On the basis treatment in the control group, the and acupuncture was applied at Renying (ST 9), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36) and Taichong (LR 3) in the observation group for 30 min. The treatment was given once a day, 5 times a week for 8 weeks. The 24-hour ambulatory blood pressure was monitored in the two groups. The changes of blood pressure and blood pressure variability were observed before and after 8 weeks of treatment, and the occurrence of adverse reactions during the treatment were recorded.@*RESULTS@#The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), daytime SBP, DBP, nighttime SBP and DBP were reduced in the two groups after 8 weeks of treatment (0.05).@*CONCLUSION@# and acupuncture method can effectively control the blood pressure and blood pressure variability in the elderly patients with cerebral infraction complicated with essential hypertension.

Effect of Recombinant Protein in the Spacer Domain on ADAMTS13 Activity / 中国实验血液学杂志

OBJECTIVE@#To obtain the recombinant protein of spacer domain in von Willebrand factor cleaving protease (ADAMTS13), and further study its biological function in ADAMTS13.@*METHODS@#The prokaryotic expression vector was constructed by using the template of plasmid with full-length ADAMTS13, and then transfected into E coli., following the induction of IPTG with the low temperature (30 ℃). The recombinant protein was purified with Ni-NTA agarose column by gradient imidazole. The purity and immune activity of purified products were identified with SDS-PAGE and Western blot respectively. By Adding the recombinant protein to the plasma of immune-mediated thrombotic thrombocytopenic purpura (iTTP) patients, the activity of ADAMTS13 was tested.@*RESULTS@#The prokaryotic expression vector was successfully constructed and the protein of spacer domain with the high purity was obtained. Western blot showed that the recombinant fragment could both react with monoclonal antibody against 6×His and polyclonal sheep IgG against ADAMTS13 (Gln34-Trp688). The protein formed a main lane at the position of 15 kDa with SDS-PAGE. It was demonstrated that the recombinant protein could efficiently elevate the ADAMTS13 activity in plasma of iTTP patients to reach normal level by functional experiment.@*CONCLUSION@#The recombinant protein has high purity and immune activity, which provides the experimental basis for further research on mechanism of iTTP involved in spacer domain.

Diagnostic strategies of diffuse sclerosing variant of papillary thyroid carcinoma / 国际外科学杂志

Objective To explore the proper and effective diagnostic strategies of diffuse sclerosing variant of papillary thyroid carcinoma.Methods Clinical data of 18 patients with diffuse sclerosing variant of papillary thyroid carcinoma who had been treated from September 2012 to September 2017 were analyzed retrospectively.Results The mean age of 18 patients was 28.5 years old,the ratio of man and woman was 1.0 to 3.5,and the neck mass (the thyroid gland diffusely enlarge) was the primary symptom of diffuse sclerosing variant of papillary thyroid carcinoma (89％,16/18);parts of patients with larger mass (3.2 to 4.5 cm) presented the sense of neck swelling (33％,6/18) or dysphagia (6％,1/18).Two patients (11％,2/18) presented hypothyroidism and hoarseness.The results of ultrasonography showed that the diffuse enlarged thyroid gland (89％,16/18),hypoechoic (78％,14/18),heterogeneous echogenicity (100％,18/18),diffuse microcalcification (89％,16/18),ill-defined tumor margin (100％,18/18) and the suspicious cervical lymph node (83％,15/18) were common features.CT scan showed that there were many suspicious cervical lymph nodes (100％,15/15).The results of fine needle aspiration cytology for the thyroid gland showed that all of the patients (100％,16/16) were diagnosed with papillary thyroid carcinoma,and cervical lymph node biopsy found lateral lymph node metastasis (100％,2/2).Postoperative pathological paraffin section indicated that most of the patients coexisted with Hashimoto thyroiditis (72％,13/18) and were found lymph node metastasis (central lymph node:89％,16/18;lateral lymph node:83％,15/18).Conclusions The young lady,the high rates of coexisting with Hashimoto thyroiditis,the diffuse enlarged thyroid gland,diffuse microcalcification and the suspicious cervical lymph node metastasis were the common features of ultrasonography in diffuse sclerosing variant of papillary thyroid carcinoma.The clinical features combined with the characteristics of ultrasonography and fine needle aspiration would be helpful for the early diagnosis and the surgery of diffuse sclerosing variant of papillary thyroid carcinoma.

Research progress of diffuse sclerosing variant papillary thyroid carcinoma / 国际外科学杂志

Diffuse sclerosing variant papillary thyroid carcinoma,one of the variants of papillary thyroid carcinoma,nearly account for 0.7％ to 6.6％ of papillary thyroid carcinoma.It is an aggressive tumor that shows higher rates of recurrence,metastasis and persistent disease compares to classic papillary thyroid carcinoma,thus diffuse sclerosing variant papillary thyroid carcinoma needs stricter and more exhaustive operation.Since the incidence of diffuse sclerosing variant papillary thyroid carcinoma is low,many physicians lack of understanding of the disease,it's often missed diagnosis or misdiagnosed.Consequently.In order to let physicians understand more about diffuse sclerosing variant papillary thyroid carcinoma,this paper will elaborate the epidemiology,clinic and pathology features of it.

Clinical study of combined detection of troponin T,myoglobin and NT-ProBNP in diagnosis of myocardia linfarction / 国际检验医学杂志

Objective To observe the clinical application of combined detection of troponin T(cTnT),myoglobin(Myo) and NT-ProBNP in the diagnosis of myocardial infarction(MI).Methods A total of 913 cases of acute chest pain complaints to our hospital for examination and treatment from January 2012 to December 2015 were selected and divided into the acute MI group and non-acute MI group according to the final diagnostic results.The cTnT,Myo and NT proBNP levels were detected in all subjects.The differences of cTnT,Myo and NT-proBNP levels were observed in the two groups.The sensitivity and specificity of single indicator detection,2-indicator combined detection and 3-indicator combined detection for diagnosing MI were observed.Results The levels of cTnT,Myo and NT-proBNP in the acute MI group were significantly higher than those in the non-acute MI group,the difference was statistically significant(P<0.05).The sensitivity and specificity of the two-indicator combined detection were higher than those of cTnT,Myo and NT-proBNP single detection,the sensitivity and specificity of the 3-indicator combined detection were 95.18% and 89.86% respectively,which were significantly higher than those of the single indicator test and the two-indicator combined detection.Conclusion The combined examination of cTnT,Myo and NT-proBNP has important significance in the diagnosis of MI,can improve the specificity and sensitivity of MI diagnosis and provides a reliable basis for clinical treatment.

The feasibility and clinical effect of laparoscopic cholecystectomy in patients with cirrhosis / 医学研究生学报

Objective Clinicians are very cautious on operationsof laparoscopic cholecystectomy(LC) in patients with cirrhosis because of its high risk.And few researches were carried out on this situation.This article aimed to summarize the LC in cirrhotic patients with cholecystolithiasis and cholecystitis, observe the clinical therapeutic effect and analyze the feasibility of this treatment.Methods The clinical data of 112 operation cases of cholecystolithiasis and cholecystitiswith cirrhosis were retrospectively analyzed from January 2012 to December 2015 in Department of General Surgery, Changzhou Third People's Hospital.According to different surgical methods, all patients were divided into laparoscopic cholecystectomy group (n=56) and open cholecystectomy group (n=56).Peroperative period indicators including operation time, intraoperative blood loss, Postoperative exhaust time, postoperative hospital stay and complications were recorded, data were analyzed to evaluate the clinical effect.Results Compared with open cholecystectomy group, laparoscopic cholecystectomy group had shorter operative time[(54.28±15.34)min vs (91.63±20.09)min,P=0.000];less intraoperative blood loss[(73.42±4.28)mL vs (98.54±7.16)mL,P=0.000], shorter Postoperative exhaust time and postoperative hospital stay(P=0.000).The complication incidence in laparoscopic cholecystectomy group were lower than that in open cholecystectomy group(7.14% vs 21.43%, P<0.05).Conclusion Operation of laparoscopic cholecystectomy on cirrhotic patients has a high clinical efficacy.It is safe and feasible to carry out such an operation on the basis of strict indication and reasonable risk assessment.

Clinical Observation of Recombinant Human Interferon α2b Combined with Bozhi Glycopeptides and Thymopentin in the Treatment of HBeAg-positive Chronic Hepatitis B / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of recombinant human interferon α2b (rhIFN α2b) combined with bozhi glycopeptides or thymopentin in the treatment of chronic hepatitis B (CHB).METHODS:Ninety HBeAg-positive CHB patients were selected from our hospital during Jan.2014-Jan.2015 and then randomly divided into group A,B,C,with 30 cases in each group.Group A was given rhINF α2b for injection (Pseudomonas) 5 million IU subcutaneously,qod;group B was additionally given Bozhi glycopeptides injection 4 mL added into 5％ Glucose injection 250 mL,ivgtt,qd,on the basis of group A;group C was additionally given Thymopentin for injection 2 mg added into 5％ Glucose injection 250 mL,ivgtt,qd,on the basis of group A.Three groups were treated for 24 weeks.The rate of ALT recovering to normal,negative rate of HBeAg,transformation rate of HBeAg/anti-HBeAg serum,negative rate of HBV-DNA and the decrease of HBsAg and HBV-DNA were compared among 2 groups after 4,8,12,24 weeks of treatment.The occurrence of ADR was recorded.RESULTS:After 4,8,12 weeks of treatment,there was no statistical significance in the rate of ALT recovering to normal,negative rate of HBeAg,transformation rate of HBeAg and the decrease of HBsAg among 3 groups (P＞0.05).After 4 weeks,negative rate of HBV-DNA in group B,C were significantly higher than group A;the decrease of HBV-DNA in group C were more significant than group A and B,with statistical significance (P＜0.05).After 8,12 weeks of treatment,the negative rate of HBV-DNA and the decrease of HBV-DNA in group B,C were significantly higher than group A,with statistical significance (P＜0.05);but there was no statistical signifi cance between group B and C (P＞0.05).After 24 weeks of treatment,there was no statistical significance in the rate of ALT recovering to normal,transformation rate of HBeAg,the decrease of HBsAg and negative rate of HBsAg among 3 groups (P＞0.05).The negative rate of HBsAg,negative rate of HBV-DNA and the decrease of HBV-DNA in group B,C were significantly higher than group A,with statistical significance (P＜0.05);there was no statistical significance between group B and C (P＞0.05).There was no statistical significance in the incidence of ADR among 3 groups(P＞0.05).CONCLUSIONS:rhIFN α2bcombined with bozhi glycopeptides or thymopentin shows good inhibitory effect on CHB,therapeutic efficacies of them are similar in the rate of ALT recovering to normal,but transformation rate of HBeAg,the decrease of HBsAg and negative rate of HBeAg.