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Objective To confirm the predictive value of diaphragm thickening fraction (DTF) on successful weaning by bedside ultrasound in patients with myasthenia gravis crisis. Methods A prospective study was conducted. The patients with myasthenia gravis crisis undergoing mechanical ventilation admitted to Department of Critical Care Medicine of the Affiliated Hospital of Qingdao University from March 2015 to February 2017 were enrolled. All patients underwent a low level pressure support mode of spontaneous breathing test (SBT), and rapid shallow breathing index (RSBI) was recorded. The indicators of right diaphragm thickness at the end of inspiration (DTei) and expiration (DTee) were determined by bedside ultrasound at 5 minutes and 60 minutes of SBT, and DTF was calculated, the changes in above parameters were observed during SBT. The patients were divided into successful weaning group and failure weaning group, and the differences in above indexes were compared between the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of DTF and RSBI at 60 minutes of SBT on successful weaning. Results A total of 37 patients were enrolled in the study. Ultrasonic measurement data of 63 person-times at 5 minutes of SBT and 50 at 60 minutes of SBT were obtained. There were no statistical differences in RSBI, DTei, DTee, and DTF at 5 minutes of SBT between successful weaning group (n = 33) and failure weaning group (n = 30). At 60 minutes of SBT, compared with successful weaning group (n = 33), the patients in failure weaning group (n = 17) had a higher RSBI (times·min-1·L-1: 80.41±29.08 vs. 63.94±23.84, t = 2.146, P = 0.037), and lower DTee, DTei and DTF [DTee (mm): 22.00±6.25 vs. 25.45±4.99, t = 2.127, P = 0.039; DTei (mm): 27.94±6.19 vs. 38.48±6.15,t = 5.731, P = 0.000; DTF: (24.46±14.11)% vs. (62.04±30.21)%, t = 4.845, P = 0.000]. There were no statistical differences in RSBI, DTei, DTee, and DTF between 5 minutes and 60 minutes of SBT in 33 person-time successful weaning (all P > 0.05). In 17 person who had 60 minutes of SBT but failed weaning, the RSBI at 60 minutes of SBT was significantly higher than that at 5 minutes (times·min-1·L-1: 80.41±29.08 vs. 57.29±22.46, t = 2.400, P = 0.029), and DTei and DTF were significantly decreased [DTei (mm): 27.94±6.19 vs. 35.35±6.84, t = 3.024, P = 0.000; DTF:(24.46±14.11)% vs. (61.89±23.97)%, t = 5.810, P = 0.000], but the change of DTee during SBT showed no statistical significance. ROC curve analysis showed that the area under ROC curve (AUC) of DTF at 60 minutes of SBT for predicting successful weaning was 0.898; when DTF ≥ 27.9% as the cut-off point, the sensitivity was 93.9%, specificity was 70.6%. The AUC of RSBI for predicting successful weaning was 0.669; when RSBI ≥ 86.50 times·min-1·L-1 as the cut-off point, the sensitivity was 81.8%, specificity was 52.9%. Conclusion DTF at 60 minutes of SBT is the effective index of successful weaning prediction in mechanical ventilation patients with myasthenia gravis crisis.
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Purpose To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinomas (PTC) by exploring the relationship between quantitative parameters of time-intensity curve (TIC) of CEUS for PTC and tumor size and metastasis of cervical lymph nodes.Materials and Methods 124 patients with PTC confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University were retrospectively analyzed.According to maximum diameter of lesions (D),the lesions were divided into three groups with D＜1.0 cm,1.0 cm ≤ D ≤ 2.0 cm and D＞2.0 cm.The lesions were also divided into LN(+) group with lymph node metastasis and LN(-) group without lymph node metastasis based on pathology of cervical lymph nodes.The features of CEUS and quantitative parameters of TIC of the above groups were analyzed.Results ① The CEUS showed that the PTC nodules were mainly concentric and heterogeneous enhancement.Thyroid carcinoma with D＜1.0 cm and 1.0 cm≤D≤2.0 cm showed low enhancement (45/57,31/42),while thyroid carcinomas with D＞2.0 cm exhibited high enhancement (14/25),and the difference was significant (P＜0.05).① With the increase of the diameter of PTC,the peak intensity [(12.75 ± 3.77)％,(15.53 ± 3.62)％,(18.11 ± 4.28)％],the area under the curve [(820.52±289.19)％.s,(873.84± 156.19)％· s,(1118.8± 152.48)％ ·s] and the ratio of the perfusion defects (24.56％,52.38％,72.00％) were increased,and the differences were statistically significant (P＜0.05).③ The cervical lymph node metastasis rate of PTCs with isoenhancement or hyperenhancement patterns showed by CEUS was significantly higher than that with hypoenhancement (P＜0.05).The peak intensity and the area under the curve of LN (+) group were higher than that of LN (-) group,and the differences were statistically significant (P＜0.05).Conclusion There were significant differences in imaging features of CEUS between the PTC nodules with different size and lymph node metastasis,which can provide valuable information for clinical diagnosis.
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Objective To explore the correlation between quantitative parameters of blood perfusion with contrast-enhanced ultrasound (CEUS) and microvessel density (MVD),microvessel area (MVA) in papillary thyroid carcinoma (PTC).And to investigate the value of CEUS in evaluating the angiogenesis in PTC before operation.Methods Totally 69 cases of patients with papillary thyroid carcinoma were selected from April 2014 to October 2016 in the Affiliated Hospital of Qingdao University.The CEUS characteristics of 69 patients with papillary thyroid carcinoma confirmed by pathology were retrospectively analyzed.The patients were divided into three groups according to maximum diameter of lesions (＜ 1 cm group,1-2 cm group and ＞ 2.0 cm group),and two groups according to pathologic reports (neck lymph node metastatic and nonmetastatic groups).The blood perfusion parameters between or among different groups were evaluated by ttest or one-way ANOVA.Immunohistochemical staining were performed to evaluate the MVD,MVA in the surgical specimens,and the correlation of quantitative parameters with MVD,MVA were assessed by Spearman.Results (1) Peak Intensity (Peak),area under the curve (AUC),MVD and MVA of thyroid carcinoma were lower than the surrounding normal thyroid tissue (14.95 ± 4.96 vs 22.67±6.11,970.01±263.20 vs 1798.35±563.67,118.91±31.32 vs 206.27±39.58,8.58±-2.68 vs 18.47±3.13),and the differences were statistically significant (t=-8.700,-11.061,-14.377 and-20.532,all P ＜ 0.05).(2)With the increase of the lesion's maximum diameter,Peak,AUC,MVD and MVA increased,and the differences were statistically significant (t=0.000,0.000,0.000,0.000;t=0.027,0.044,0.033,0.000;t=0.027,0.044,0.033,0.000,all P ＜ 0.05).(3) Papillary thyroid carcinoma with lymphatic involvement had significantly higher values of Peak,AUC,MVD and MVA than those without lymphatic involvement (16.86±4.36 vs 13.80±3.55,1128.16±290.85 vs 874.39±192.27,114.12±30.69 vs 103.67±22.19,10.30 ± 2.44 vs 7.54 ± 2.29),and the differences were statistically significant (t=3.177,4.366,6.336 and 4.742,all P ＜ 0.05).(4) A positive correlation existed between the Peak,AUC and MVD,and the differences were statistically significant (r=0.506,0.478,all P ＜0.05).Peak,AUC and MVA showed positive correlation,and the differences were statistically significant (r=0.648,0.653,all P ＜ 0.05).TP,MTT and MVD,MVA showed no correlations (all P ＞ 0.05).Conclusions The values of Peak and AUC calculated from CEUS were correlated to MVD and MVA.CEUS may be used to evaluated the angiogenesis of PTC before operation.And CEUS is helpful for prediction of prognosis of PTC.
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Objective To investigate the diagnostic value of PIgP/SC in diagnosis of primary hepatic cancer.Methods 58 patients with primary hepatic cancer,60 patients with liver cirrhosis and 60 healthy volunteers were studied.4 ml fasting venous blood was collected from all subjects.Serum level of AFP was detected with electrochemical chemiluminescence immunoassay system and plasma PIgR/SC level was detected by ELISA method.The level of PIgR/SC and AFP was detected at one week after surgical resection in patients with hepatic cancer.Results The levels of AFP and PIgR/SC in the three groups were significantly different (P＜0.01),and PIgR/SC was higher than that in patients with cirrhosis and volunteers (P＜0.01).There was no significant difference between patients with liver cirrhosis and liver cirrhosis(P＞0.05).AFP was higher in patients with HCC than patients with cirrhosis and volunteers.AFP was higher in patients with cirrhosis than volunteers,and the difference was statistically significant(P＜0.01).Sensitivity of PIgR/SC and AFP was 89.3％ and 54.8％,specificity was 84.6％ and 91％,Youden index was 0.751 and 0.458,AUC was 0.920 and 0.761,respectively.There was significant difference in AUC (Z=3.251,P＜0.05) of the two detection indexes for detection of primary hepatic cancer.Conclusion The value of PIgR/SC in diagnosis of primary liver cancer may by higher than that of AFP.
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Objective To evaluate the relationship between characteristics of cervical cancer at contrast-enhanced ultrasound and prognostic factors.Methods Thirty-five patients with pathologically confirmed cervical cancer were enrolled in this retrospective analysis.All the patients accepted contrast-enhanced ultrasound examination before the surgery.Relationships between the characters of contrast-enhanced ultrasound and the expression of ki-67 antigen(cell proliferation marker),tumor diameter,lymph node metastasis and histologic grade were studied.Results (1)Compared to the surrounding normal tissue, the cervical cancer had statistically significant differences in time to peak and peak intensity(P <0.05),the former was shortened,and the latter was increased.(2 )The ratio of perfusion defect and heterogeneous enhancement were significantly higher in tissues,including the ki-67 positive expression tissue,poorly differentiated or larger tumors (≥ 2.0 cm in diameter)(P < 0.05 ).(3 )Compared to the ki-67 negative expression group,time to peak of the ki-67 positive expression group was shorter and the peak intensity was higher,the differences were statistically significant (P < 0.05 ).(4 )The peak intensity of poorly differentiated cervical cancers was significantly higher than that of the other groups (P <0.05).Conclusions Enhancement patterns and parameters of contrast-enhanced ultrasound were associated with prognosis, which may be useful in noninvasive prediction of the patients with cervical cancers.
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To establish a consumables supermarket management system to realize the informatized management of the consumables supermarket. The system used SOA as the main architecture, and IIS manager as the pub-lishing tool. The system had the workload, materials and financial resources decreased while the efficiency in-creased, and made the supervisor master the sale information timely. Consumables supermarket informatized management may decrease the hospital's needs for current capital as well as the links, while increase the hospital effi-ciency greatly.
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Objective To investigate the influencing factors of strain ratio(SR) value in differential diagnosis of benign and malignant thyroid nodules by using real-time tissue elastosonography (RTE).Methods One hundred and seventy-one patients with a total of 171 thyroid nodules were analyzed retrospectively.Their images,including 2D ultrasound,color Doppler flow imaging (CDFI) and RTE were reviewed and conventional ultrasonic features (including the maximum diameter,composition,shape,magin,calcification,intranodular blood flow,depth) and SR value were recorded.Receiver-operating characteristic (ROC) curve was employed to assess the diagnostic efficiency of SR value in differentiating malignant nodules from benign ones.Firstly,the correlation between the aforementioned factors and SR value was assessed by using malignant lesions as the research subjects.And then,the multiple linear regressions (MLR) was employed to evaluate the influence of particular features which turned out to be an important disturbing factor affecting SR value of the lesion in the first step of analysis and pathological type in all nodules (benign and malignant) on SR value.Results With a cut-off point of SR value 3.67,the sensitivity and specificity of SR value in differential diagnosis of benign and malignant thyroid nodules was 85.6％ and 81.1 ％,respectively,and the area under ROC curve was 0.891.Correlation between the maximum diameter and calcification and SR value was significant(r =0.345 and 0.261 respectively,P ＜0.05).However,there was no significant correlation between other features(5 factors) and SR value(P ≥0.05).MLR indicated that the maximum diameter,calcification and the type of pathology of the nodule were associated with SR value (P ＜ 0.05).Among them,pathological nature was the most significant impact factor with a standardized coefficient 0.494).Conclusions SR value can be used to evaluate the hardness of thyroid nodules semi-quantitatively.Its value mainly depends on the pathological nature of the nodules.The maximum diameter and calcification are also the influencing factors of SR value.However,the composition,shape,margin,intranodular blood flow and depth have no obvious effect on SR value.
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Objective To investigate the feasibility of self‐control materials serum thyroid hormone detected in the clinical labo‐ratory internal quality control in applications .Methods The serum thyroid hormone test results in patients with high‐value ,the ser‐um was mixed with a certain proportion of the healthy population ,dubbed serum control materials ,after aliquots -20 ℃ .Every o‐riginal supporting quality control and simultaneous detection of free thyroxine (FT4) ,three free triiodothyronine (FT3) ,thyroid stimulating hormone (TSH) ,thyroglobulin (TG) ,thyroid‐microglobulin antibody (TMA) ,thyroglobulin antibodies (TGA) and other thyroid hormone six items detected before the appearance of control samples was observed continuously detected six months to observe stability ;used EXCELL do J‐L maps ,statistical mean of each project within six months ,CV and uncontrolled number of observed values in the internal quality control applications .Results Within 6 months after the product was frozen homemade quali‐ty control serum soluble appearance clear and transparent ,no precipitation and turbidity ;1 ,3 ,6 ,10 ,15 ,30 ,45 ,60 ,90 ,120 day of the first magnitude and no significant changes in thyroid hormone ;compared with the original quality control materials ,low CV values . In the six months internal quality control applications ,the cumulative results of each project without 1 ,3 ,6‐month and six months significantly different ;project and six months mean cumulative comparison between the mean drift or change in trend did not ap‐pear ;items and cumulative CV were in control of the allowable range (CV <1/3 times within total variation );6 months of internal quality control work ,runaway alarm :13s ,2 times ,22s ,1 times ,R4s ,1 times .Conclusion Serum thyroid hormone homemade frozen control samples have better stability ,and can replace its import control materials ;internal quality control in their daily activities , through EXCELL test results for J‐L diagram precision can find instability timely corrective treatment to ensure that thyroid func‐tion test results are reliable ,worthy of clinical application .
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Objective To explore the value of virtual touch tissue quantification (VTQ) elastography and its influencing factors in identifying benign and malignant thyroid nodules.Methods A retrospective analysis was conducted in 210 cases of 240 thyroid nodules.Their images,including 2D ultrasound,color Doppler flow imaging (CDFI) and VTQ elastography,were reviewed,and the scanning view,the maximum diameter of the nodule,inside blood flow,calcifications and its depth beneath the skin were recorded.The value of shear wave velocity(SWV) in identifying benign and malignant thyroid nodules was calculated using receiver operating characteristic (ROC) curve.The influences of the maximum diameter of the nodules,calcifications,internal blood flow,the depth beneath skin and scanning views as well as type of pathology on the value of SWV were analyzed using multiple linear regressions (MLR).Results The sensitivity and specificity of VTQ in differential diagnosis of benign and malignant thyroid nodules was 74.8％ and 73.4％,respectively,and the area under ROC curve was 0.799.MLR indicated that the maximum diameter of the nodule,the type of pathology and internal blood flow were correlated with the SWV value (P ＜0.05),of which,the type of pathology was the important factor (standardized coefficient was-0.312).Microcalcifications,the depth of the nodules located and the scanning surface were not significantly related to SWV value (P ＞0.05).Conclusions VTQ can quantitatively provide the information on the hardness of thyroid tissue,which is of a definite value in the differential diagnosis of the nodules.The pathology of the nodule,its internal blood flow and maximum diameter are the factors that affect the value of SWV,and not its depth,scanning views and microcalcifications.
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Viral myocarditis(VMC) has been threatening children's health severely.Its mechanisms are not completely clear and lack of dependable therapeutic methods.Studies have demonstrated that apoptosis occurs in VMC.The apoptosis pathways including death-receptor pathway and mitochondrial-mediated pathway participate in cardiocytes apoptosis in VMC.Endoplasmic reticulum pathway is a novel apoptosis pathway that takes part in cardiocytes apoptosis causing by other stress.And crosstalk exists in the three pathways.It may be of potential therapeutic value that these apoptosis pathways could be harnessed.
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<p><b>OBJECTIVE</b>To observe the effect of Huzhang on the progress of pulmonary fibrosis in rats, evaluate the role of Huzhang in this process and explore its mechanism.</p><p><b>METHOD</b>Wistar male rats were randomized into 7 groups (normal control group, model group, positive control group, prophylactic group, 3rd day treatment group, 7th day treatment group and 14th day treatment group). Bleomycin was administered by intratracheal injection to produce pulmonary fibrosis groups except the normal control group. The positive control group began to be given DXM (4 mL x kg(-1) x d(-1)) on the day of the model-making. The normal control group and model group were given NS (4 mL x kg(-1) x d(-1)) on the day of the model-making. The prophylactic group was given reagent (4 mL x kg(-1) x d(-1)) 2 days ahead of the model-making, whereas the 3rd day treatment group, the 7th day treatment group and the 14th day treatment group given the same dose respectively on the third day, the seventh day and the fourth day behind of the model-making. Lung tissue was stained with hematoxylin-eosin (HE) and Masson's trichrome to determine the pathological grading. The lung fibroblast (LF) was cultured in vitro by way of pancreatic enzyme digestion, which was used to detect the contents of the expression of MMP-2 and TIMP-1mRNA with RT-PCR method.</p><p><b>RESULT</b>Compared with those in the model group, the alveolitis, pulmonary fibrosis and collagen accumulation were significantly alleviated in the positive control group, Huzhang prophylactic group and each treatment groups. In the positive control group, Huzhang prophylactic group, the 3rd day treatment group, the 7th day treatment group and the 14th day treatment group, the expression of MMP-2 mRNA was weaker significantly than that in the BLM model group (P < 0.05 or P < 0.01) except that on the 42nd day. The expression of TIMP-1mRNA was also weaker significantly than that in the BLM model group at all set times in all treatment groups (P < 0.05 or P < 0.01). The inhibition of TIMP-1 lasted until the 42nd day.</p><p><b>CONCLUSION</b>Huzhang inhibited the expression of MMP-2mRNA and TIMP-1mRNA of lung fibroblast in different periods to reduce the alveolitis and pulmonary fibrosis, which was probably one of the anti-fulmonary fiborsis mechanisms of Huzhang.</p>
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Animals , Humans , Male , Rats , Disease Models, Animal , Drugs, Chinese Herbal , Therapeutic Uses , Fibroblasts , Metabolism , Matrix Metalloproteinase 2 , Genetics , Metabolism , Pulmonary Fibrosis , Drug Therapy , Genetics , Metabolism , Random Allocation , Rats, Sprague-Dawley , Tissue Inhibitor of Metalloproteinase-1 , Genetics , MetabolismABSTRACT
BACKGROUND: Recently, the survival rate of premature infants increases year by year, but the cerebral growth of premature infants is immature, so the intellectual development of premature infants is slower than that of normal infants.OBJECTIVE: To explore the effect of family-oriented early intervention,which took material nutrition, information stimulation and petting as main interventional content, on level of intellectual development in premature infants in infantile age.DESIGN: Randomized sampling controlled observation.SETTING: Department of Pediatrics, Clinical Medical College of ShanPARTICIPANTS: Totally 35 premature infants of 31-36 weeks (18 males and 17 females) were enrolled as early interventional subjects, who were born at Jinan Municipal Central Hospital between May 2000 and July 2002. Meanwhile, 33 premature infants of 31-36 weeks (18 males and 15females) born in the same period and 49 mature neonates (26 males and 23females) were enrolled in control group.METHODS: The family-oriented early intervention, which considered nutrition, information stimulation and petting as chief interventional content,were performed in premature infants, and health archives was established.Taction and point massage were conducted. Home visit was done twice in one month. One routine health examination was determined at 3, 6 and 10months in the two control groups. The level of intellectual development was assessed in infants of 10-month old of each group with Gesell Developmental Schedules (GDS) and Japanese S-M Social Living Ability Scale.MAIN OUTCOME MEASURES: Evaluation of level of intellectual development in infants of each group.RESULTS: In the premature interventional group, 1 premature infant died, 2 withdrew from the study, and 32 eligible cases with the eligible rate of 91.4%; Among the 33 premature infants in the premature control group, there were 3 withdrawing from the study, and 30 eligible cases with the eligible rate of 90.9%. Among the 49 infants in the term infant control group, there were 3 withdrawing from the study and 46 eligible cases with the eligible rate of 93.9%. ①Developmental quotient (DQ) at each area of Gesell and evaluation of Japanese S-M Social Living Ability Scale were significantly higher in the premature interventional group than those in the premature control group at 10 months old. There were extremely significant differences in suitability, fine activity, language and individual social behavior. ②DQ at each area of Gesell and evaluation result of Japanese S-M Social Living Ability Scale were lower in the premature interventional group than those in the term infant control group at 10 months old, which had obvious difference. ③Evaluation in premature infants aged oyer 35 weeks of the interventional group was lower than that in the term infant control group, but there was insignificant difference (P ＞ 0.05).CONCLUSION: Early intervention has a marked effect in improving the intellectual developme nt of premature infants, and some premature infants can recover to the level of term infants in intelligence development after intervention.
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Objective: Signet-ring cell carcinoma is a relatively rare cancer which occurs principally in the stomach,colon-rectum,bladder and breast,but seldom in other parts.This article analyzes the clinical and pathologic features of 3 extremely rare cases of primary signet-ring cell carcinoma in the uterus.Methods: Three cases of primary signet-ring cell carcinoma in the uterus were observed by HE and immunohistochemical staining,their clinical features analyzed and the relevant literature reviewed.Results: Of the 3 cases,2 presented nodose tumors in the cervix while the other in the uterine cavity.Histologically,there was a diffuse infiltration of the tumor cells,with an appearance of signet-ring cells.Periodic acid-Sciff(PAS) staining revealed PAS-positive diastase resistant introcytoplasmic material.Immunohistochemically,the tumor cells were positive for CK and CEA.Conclusion: Primary signet-ring cell carcinoma of the uterus is extremely rare.It is always necessary to rule out a metastatic neoplasm by clinical examination and to differentiate it from other tumors/lesions with signet-ring cell features.
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Objective The genotoxicty and its molecular mechanism of environmental tobacco smoke (ETS) were discussed through the oxidative DNA damage induced by environmental tobacco side_stream smoke(ETSS). Methods DNA adduct 8_hydroxydeoxyguanosine (8_OHdG) was used as a biomarker of oxidative DNA damage. The level of 8_OHdG in DNA exposed to ETSS was detected by HPLC_EC.On the molecular biological level,the biological oxidative ability of ETSS on DNA molecule was studied.Organic and inorganic components in ETSS were analyzed by GC_MS and AAS respectively. Results Particles and VOCs in ETSS could directly induce oxidative DNA damage and form 8_OHdG.It was found that there were 123 and 84 kinds of organic compounds in particles and volatile organic compounds of tobacco smoke side stream,and 7 kinds of inorganic compounds in ETSS.Some components especially quinones and polyphenols in ETS,could produce free radicals in vitro by the auto_oxidation without any biological activity systems,and with the catalytic reaction of metals,the DNA aduct 8_OHdG was produced. Conclusion It was proved that ETS had biological oxidative ability on DNA and expressed direct genotoxicity.8_OHdG was a fine biomarker of effect of oxidative DNA damage.