A preliminary study of ultrasound shear-wave elastography in evaluation of lumbar multifidus stiffness in healthy adults / 中华超声影像学杂志

Objective:To explore the repeatability of ultrasound shear wave elastography (SWE) in evaluating the Young′s modulus (E) of the lumbar multifidus (LM) and the difference in E of the bilateral LM, and to analyze the E′s change ratio of LM and its impact factors at upright and 90° forward bend positions.Methods:A total of 60 healthy volunteers, selected from interns, standardized training residents and refresher doctors in department of diagnostic ultrasound of Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from July to December in 2020, were examined twice by SWE to estimate the E value of LM at prone, upright and 90° flexion positions, respectively. Firstly, the intraclass correlation coefficient (ICC) was applied to test the reliability between the two repeated measurements.Secondly, the differences in E of the bilateral LM were discussed. The discrepancies in the E value of male and female volunteers at prone, upright and 90° flexion positions and the change ratio of the E value at upright and 90° forward bend positions were also discussed, respectively. Finally, Spearman correlation coefficient was utilized to evaluate the correlations of E and its change ratio with gender, age, BMI and activity level at upright and 90° forward bend positions, respectively.Results:The ICC value in LM measured by SWE was in the range of 0.691 to 0.951. No obvious change in bilateral E values of the same posture was observed for an individual(all P>0.05). The change ratios of E at upright and 90° flexion positions were approximate to 2 and 7, respectively. Moreover, at prone position, the E value exhibited negative correlation with age and activity level of self-assessment ( rs=-0.300, P=0.020; rs=-0.383, P=0.002). The E in female was higher compared with that in male. At active states the change ratio in E was positively correlated with age and activity level ( rs=0.278, P=0.031; rs=0.495, P<0.001), and the E′s change ratio in male was higher than that in female. Conclusions:SWE possesses excellent repeatability in evaluating the E value of LM with no significant difference in E of bilateral LM. The E′s change ratio in LM varies with different contraction strategies and changes with age, sex and self-reported activity level.

Analysis of Thalassemia Gene Carriers in 19 482 Pregnant Women from 2015 to 2019 in Guilin, Guangxi / 中国实验血液学杂志

OBJECTIVE@#To investigate the types and frequencies of thalassemia genes carried by the pregnant women in Guilin, Guangxi Zhuang Autonomous Region, China.@*METHODS@#From January 2015 to December 2019, blood samples of the pregnant women who visited the Outpatients of Obstetrics clinic and Eugenics Genetic clinic in Affiliated Hospital of Guilin Medical University were collected. Gap-PCR was used to detect deletional α-thalassemia, PCR-RDB to detect the gene mutations of non-deletional α-thalassemia and β-thalassemia, and MLPA or DNA sequencing to detect rare thalassemia mutations. Different types and frequencies of thalassemia mutations carried by pregnant women were analyzed statistically.@*RESULTS@#A total of 19 482 blood samples were collected, including 3 801 thalassemia gene carriers (19.51%). Seven types of α-thalassemia gene mutation were detected with a carrier rate of 15.43%. Among them, --@*CONCLUSION@#Guilin is a high-risk area for thalassemia. Alpha-thalassemia is dominated by --

High frequency ultrasound combined with ultrasound-guided core needle biopsy for the diagnosis of primary thyroid lymphoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.

Risk factors for postoperative septic cardiomyopathy in septic patients / 中华麻醉学杂志

Objective:To identify the risk factors for postoperative septic cardiomyopathy (SCM) in septic patients.Methods:The perioperative medical records of septic patients admitted to the intensive care unit (ICU) of Second Affiliated Hospital of Soochow University, First Affiliated Hospital of Soochow University and Suzhou Municipal Hospital after surgery from January 2017 to November 2020 were retrospectively collected.The patients were divided into SCM group and non-SCM group (NSCM group) according to whether or not SCM developed within 48 h after operation.Multivariate logistic regression analysis was used to identify the risk factors for SCM.Results:A total of 269 patients were included in this study, including 49 patients in SCM group and 220 patients in NSCM groups.Compared with group NSCM, the rate of laparoscopic surgery, the Sequential Organ Failure Assessment (SOFA) at the time of entering ICU, the serum concentration of lactate at the time of entering ICU, the highest serum concentration of lactate, the highest serum concentration of procalcitonin, the maximum consumption of norepinephrine and the highest body temperature were increased, and the minimum platelet count was decreased in group SCM ( P<0.1). The results of logistic regression analysis showed that SOFA score at the time of entering ICU and laparoscopic surgery were the risk factors for the development of postoperative SCM in septic patients ( P<0.05). The risk for SCM was increased by 34.273 times when the SOFA score at the time of entering ICU was ≥7 ( P<0.05). Conclusion:Laparoscopic surgery and SOFA score ≥7 at the time of entering ICU are the risk factors for the development of postoperative SCM in septic patients.

To study the use of different assessment methods in predicting perioperative outcomes in patients with acute cholecystitis and decompensated cirrhosis / 中华肝胆外科杂志

Objective:To study the use of different assessment methods in predicting perioperative outcomes in patients with acute cholecystitis and decompensated cirrhosis.Methods:A retrospective study was performed on 28 patients with acute cholecystitis and decompensated cirrhosis (MELD ≥ 15) who underwent laparoscopic surgical intervention from January 2016 to August 2020 at the Third People Hospital of Xinjiang Uygur Autonomous Region. These patients were divided into 2 groups according to the severity of acute cholecystitis grading in the Tokyo Guidelines 2018 (TG18): TG18 grade Ⅰ for the mild cholecystitis group ( n=15) and TG18 grade Ⅱ and grade Ⅲ for the moderate and severe cholecystitis group ( n=13). 16 patients with a MELD score ranging from 5 to 15 and with TG18 grade Ⅰ were used as the control group. The operation-related conditions, surgical injuries and surgical complications were compared among the three groups. Results:Of 44 patients with acute cholecystitis and decompensated cirrhosis included in this study, there were 28 males and 16 females, aged (57.3±5.9) years. Significantly more patients in the moderate and severe cholecystitis group (13/13) suffered from cholecystitis due to stone impaction than the control group (11/16) and the mild cholecystitis group (10/15) ( P<0.05). When compared to the control group, patients in the mild cholecystitis group and the moderate and severe cholecystitis group had significant increases in operative time, intraoperative bleeding, amount of abdominal drainage, abdominal drainage time, delayed feeding time and hospital stay ( P<0.05). These perioperative outcomes were further and significantly increased in the moderate and severe cholecystitis group when compared to the mild cholecystitis group ( P<0.05). The blood bilirubin levels, blood creatinine levels and MELD scores after surgery were significantly better in both the mild cholecystitis group and the moderate and severe cholecystitis group on postoperative day 3 when compared to those before treatment ( P<0.05). The Child score was significantly better in the control group after surgery than that before surgery ( P<0.05). The grade Ⅰ-Ⅱ surgical complication rate was significantly higher in the moderate and severe cholecystitis group (11/13) than the mild cholecystitis group (5/15, χ 2=7.479), and the control group (4/16, χ 2=10.208) ( P<0.05). There were no significant differences in the grade Ⅲ-Ⅴ surgical complication rates among the three groups (all P>0.05). The overall surgical complication rate was significantly higher in the moderate and severe cholecystitis group (12/13) than the mild cholecystitis group (7/15, χ 2=7.385), and the control group (5/16, χ 2=11.023), (all P<0.05). Conclusions:The MELD score when combined with the severity grading for acute cholecystitis of the TG18 was effective to evaluate the perioperative risks of patients with acute cholecystitis and decompensated cirrhosis. Patients with a MELD score ≥ 15 and TG18 Ⅱ or Ⅲ had significantly higher risks after minimally invasive surgery.

Diagnostic value of BRAF V600E mutation combined with 2015 American Thyroid Association ultrasound pattern in patients with cytologically indeterminate thyroid nodule / 中华超声影像学杂志

Objective:To investigate the value of BRAF V600E mutation combined with 2015 American Thyroid Association (ATA) Guidelines ultrasound (US) pattern in fine-needle aspiration (FNA) cytology of thyroid nodules with atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS).Methods:This study retrospectively enrolled 96 consecutive patients with 101 AUS/FLUS thyroid nodules who underwent preoperative US, FNA, and BRAF V600E mutation analysis. All AUS/FLUS nodules were classified based on US pattern-based risk stratification of 2015 ATA Guidelines. With postoperative pathology as the gold standard, the diagnostic value of BRAF V600E mutation, US pattern and the combination of two methods were compared.Results:Postoperative pathology confirmed 33 benign nodules and 68 malignant nodules. The mutation rates of BRAF V600E in AUS/FLUS nodules was 51.5%. The sensitivity, specificity, and accuracy of BRAF V600E in the diagnosis AUS/FLUS nodules were 72.1%, 90.9% and 78.2%, respectively. The ROC curve demonstrated that the best cut-off of US pattern was high suspicion. The sensitivity, specificity, and accuracy of US pattern in the diagnosis of AUS/FLUS nodules were 63.2%, 81.8% and 69.3%, respectively. The accuracy of US pattern in determining AUS/FLUS nodules without BRAF V600E mutation was 70.6%. The sensitivity, specificity, and accuracy of the combination of two methods in the differential diagnosis of AUS/FLUS nodules were 89.7%, 75.8%, and 85.1%, respectively. The combination had the highest sensitivity ( P<0.05). Conclusions:BRAF V600E mutation has a good diagnostic value for differentiating benign and malignant AUS/FLUS nodules. Combined with US pattern, the differential diagnostic value for AUS/FLUS nodules without BRAF V600E mutation can be improved, and the sensitivity can be raised.

The value of focal echogenicity types in diagnosing different thyroid nodules / 中华超声影像学杂志

Objective:To explore the applicational value of identifying different types of echogenic foci and distinguishing the lesions between benign and malignant lesions in histopathology classification.Methods:The detailed clinical data of 223 patients (264 thyroid nodules) with echogenic foci in preoperative ultrasound from October 2018 to December 2019 in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The echogenic foci were categorized as big comet-tail artifact, small comet-tail artifact, microcalcification, coarse calcification, peripheral calcification and eggshell calcification. At the same time, other ultrasonographic features were included in order to comparatively analyze with postoperative pathological findings. Independent samples t test and univariate chi-square test were performed to obtain meaningful information of sex, age, body mass index (BMI), thyroid stimulating hormone (TSH), serum free triiodothyronine (FT 3), serum free thyroxine (FT 4), aspect ratio, composition, margin, echo type, echogenic foci; Logistic regression analysis was performed to screen out the independent influence factors in order to forecast malignant lesions. Spearman correlation analysis was performed to determine the ralationships between the clinical indicators and the pathologic results of thyroid lesions. Results:Among the 264 lesions, there were 219(83.0%) malignant nodules and 45(17.0%) benign nodules. For malignant lesions, except for big comet-tail artifact, other types of echogenic foci were all founded, including 152(69.4%) microcalcification, 41(18.7%) small comet-tail artifact, 17(7.8%) coarse calcification, 7(3.2%) peripheral calcification, 2(0.9%) eggshell calcification. While in benign lesions, there were 13(28.9%) microcalcification, 9(20.0%) coarse calcification, 8(17.8%) peripheral calcification, 6(13.3%) small comet-tail artifact, 6(13.3%) big comet-tail artifact, 3(6.7%) eggshell calcification with all echogenic foci types included. Univariate analysis showed that differences between benign and malignant lesions regarding age, serum FT 4, aspect ratio, composition, margin, echo type, echogenic foci were statistically significant (all P<0.05), Logistic regression analysis indicated that age, serum FT 4, hypoechoic, solid, small comet-tail artifact and microcalcification were independent influence factors for malignancy( OR=0.946, 0.026, 47.656, 9.032, 7.925, 12.767; all P<0.05), age and serum FT 4 were correlated with the pathologic results of thyroid lesions ( rs=-0.259, -0.156; all P<0.05). Conclusions:It is highly suggestive of malignancy when the thyroid lesions are solid, hypoechoic, and echogenic foci type is small comet-tail artifact or microcalcification.

Correlation between body mass index and clinicopathological characteristics of papillary thyroid carcinoma / 中华内分泌外科杂志

Objective:To analyze the relationship between body mass index (BMI) and clinicopathological characteristics of papillary thyroid carcinoma (PTC) .Methods:The clinicopathological data of 1025 PTC patients who underwent surgery therapy in Department of Endocrine and Breast surgery of the First Affiliated Hospital of Chongqing Medical University from Jan. 2016 to Dec. 2017 were retrospectively analyzed. BMI was calculated according to height and weight, and patients were divided into normal weight group (BMI<24 kg/m 2) and overweight and obese group (BMI≥24 kg/m 2) . The differences in clinicopathological characteristics of PTC patients in different BMI groups were compared, and the correlation between BMI and clinicopathological characteristics of PTC patients was studied. In addition, 342 PTC patients who underwent BRAF V600E and TERT gene tests were compared with different BMI groups to explore the relationship between BMI and BRAF V600E and TERT gene mutations. Results:In this research, there were 591 (57.66%) patients in the normal weight group and 434 (42.34%) patients in the overweight and obese group. Univariate analysis showed that BMI was associated with gender, age and Hashimoto’s thyroiditis. There were more male gender ( P<0.001) , and age≥55 years ( P<0.001) in overweight and obese groups, and less with Hashimoto’s thyroiditis ( P=0.045) in overweight and obese groups. There was no correlation between BMI and the clinicopathological features of PTC, such as bilaterality, multiformity, tumor size, etc. Otherwise, BMI was a weak protective factor for numbers of lymph node metastasis>5 of PTC ( OR=0.947, CI95%=0.9900-0.997, P=0.037) , and it was not correlated with extra thyroidal extension. There were no significant correlation between BMI and the clinicopathological characteristics of PTC patients of different genders, such as tumor size, bilaterality, extra thyroidal extension, lymph node metastasis, etc. A significant relationship was found between BMI and BRAF V600E mutation in PTC patients ( P=0.044) , while it was not correlated between BMI and TERT mutation ( P=0.516) . Conclusions:Our study suggests that BMI is associated with age, gender, hashimoto’s thyroiditis and BRAF V600E mutation in PTC patients, while there was no significant correlation with the aggressiveness in PTC. More radical treatment for PTC patients who were overweight or obese is not recommended.

Patterns of central lymph node metastasis of the cN0 papillary thyroid carcinoma located in the isthmus and their significance to the choice of operative method and scope / 中华内分泌外科杂志

Objective:To investigate the patterns and risk factors of central lymph node metastasis in node-negative neck (cN0) papillary thyroid carcinoma located in the isthmus. To discuss different operation methods and the postoperative complications to find out the appropriate surgical approach and scope.Methods:Forty-eight patients with cN0 papillary thyroid carcinoma located in isthmus for surgery at the First Hospital of Chongqing Medical University from Jan. 2013 to Dec. 2019 were reviewed retrospectively. They were divided into two groups: the lymph node metastatic group and the lymph node non-metastatic group. The metastatic lymph node group was further divided into the group with the number of lymph node metastasis ≤5 and the lymph node metastasis > 5. The clinical features, including gender, age, number and size of tumor, extrathyroidal extension, and whether combined with Hashimoto’s thyroiditis, the incidence of central lymph node metastasis and related factors, the scope of surgery, postoperative complications and recurrence were analyzed. SPSS 21.0 statistical software was used for statistical analysis, t test was used for measurement data, and χ2 test was used for counting data. Results:Among 48 patients, 27 had lymph node metastasis, with a metastatic rate of 56.25% (27/48) . Lymph node metastasis in pretracheal, prelaryngeal, left and right paratracheal lymph node was present in 47.9%, 22.9%, 20.8% and 16.7% of the patients respectively. The proportion and risk of lymph node metastasis were significantly increased in patients with tumor size>1 cm ( P=0.014, OR=6.78, 95% CI:1.59-28.95) . In patients with the number of lymph node metastasis > 5, the incidence of tumor size > 1 cm, prelaryngeal, left and right paratracheal lymph node metastasis was significantly higher than that of patients with lymph node metastasis ≤5 ( P=0.008, P=0.033, P=0.025, P=0.027) . There was a higher proportion of pretracheal or prelaryngeal lymph node metastasis in patients with left paratracheal lymph node metastasis ( ( P=0.008, P=0.007) . Multivariate analyses of risk factors associated with paratracheal lymph node metastasis indicated that the paratracheal lymph node metastasis correlated with the metastasis of pretracheal and (or) prelaryngeal lymph node ( P=0.016, OR=5.92, 95% CI:1.39-25.3) . In 48 patients with cN0 isthmic PTC, 43 cases underwent total thyroidectomy plus bilateral central lymph node dissection, and 5 patients reseived extended isthmus resection plus prelaryngeal and pretracheal lymph node dissection. 21 (41.8%) patients in total thyroidectomy group had PTH reduction, which was a transient hypoparathyroidism. 48 patients were followed up for 1-6 years without recurrence or metastasis. Conclusions:cN0 isthmic papillary thyroid carcinoma has a high incidence of central lymph node metastasis. Pretracheal and prelaryngeal lymph node are the most common metastatic location. For patients with tumor size>1 cm, a total thyroidectomy plus bilateral prophylactic central lymphadenectomy is needed. However, for patients without capsular invasion, tumor size≤1 cm, without pretracheal and prelaryngeal lymph node metastasis confirmed by intraoperative fast-frozen pathology, extended isthmus resection plus prophylactic pretracheal and prelaryngeal lymphadenectomy can be selected for reducing the complications of operation.

A case report of lamotrigine related recurrent cough / 中华神经科杂志

The cough related with lamotrigine in a patient with epilepsy was analyzed and summarized. According to the criteria of adverse drug reaction, the cough of the patient was the certain adverse reaction of lamotrigine. It is necessary to realize cough is an adverse reaction of lamotrigine, which is helpful to avoid the misdiagnosis and mistreatment of cough.

Research on the electro-clinical aspects of epilepsy patients with breach rhythm / 中华神经科杂志

Objective:To investigate the clinical characteristics and electroencephalogram (EEG) of epilepsy patients with breach rhythm, improve clinical understanding of breach rhythm and avoid over-interpretation.Methods:Twelve epilepsy patients with breach rhythm who visited the Department of Neurology, Xijing Hospital, the Air Force Military Medical University from January 2016 to January 2017 were collected retrospectively. The clinical data, including etiology, clinical manifestations, EEG features and prognosis were summarized, and outpatient and telephone follow-up was performed for at least three years.Results:The clinical data of 12 patients with epilepsy with breach rhythm were collected, including eight males and four females, aged 36-78 years. After analysis, it was found that brain trauma was the most common cause of breach rhythm. Among them, two cases of skull defect were not repaired, eight cases were repaired with skull titanium mesh, one case was repaired with skull polymethylmethacrylate, and one case was repaired with skull polyetheretherketone. The distribution of the breach rhythm in 12 patients was consistent with the abnormal area of the skull. The breach rhythm can be expressed as high amplitude and fast frequency, or low amplitude and slow frequency and appear individually (similar to sharp waves, spikes). On the basis of pleomorphic slow waves, 10 patients were mixed with sharp waves and spike waves, and imaging confirmed that they had brain damage in corresponding parts. All of the 12 patients had a history of seizures, with tonic-clonic seizures and (or) focal seizures being the most common. Three patients with breach rhythm had no clinical seizures for more than five years, and had been taking antiepileptic drugs for epileptic spikes on EEG, and they were given reduction and discontinuation of the drugs and were seizure-free for three years during follow up.Conclusions:Skull repair is a common cause of breach rhythm, and repair materials with different resistances cause different waveforms and frequencies. Breach rhythm, epileptiform discharge and other pathological slow-wave activities can exist at the same time. Breach rhythm is a benign variant phenomenon which needs no special treatment.

Mechanism of Talibin-1 regulating vascular remodeling of aortic dissection in mice / 中华普通外科杂志

Objective:To explore the role and mechanism of Talin-1 in mouse aortic dissection.Methods:Sixty male FVB mice were evenly divided into groups of blank, model, Talin-1 up-regulation, Talin-1 up-regulation control, Talin-1 down-regulation, and Talin-1 down-regulation control. Except mice in the blank group, mice were treated with β-aminopropionitrile (BAPN) combined with angiotensin to construct a mouse aortic dissection model. Hematoxylin-eosin and vascular elastic fiber staining (EVG) were used to observe the aorta and elastic fiber morphology and structure. Western blot was used to detect the phosphorylation levels of FAK and ERK1 / 2 in mouse aortic tissue.Results:The success rate of aortic dissection in model mice was 70%, and there was no aortic dissection appeared in the blank group.No mice died during the experiment. The incidence of aortic dissection in the Talin-1 down-regulated group was 100%, which was significantly higher than that in the Talin-1 down-regulated control group( P<0.05). The incidence of aortic dissection in the Talin-1 up-regulated group was 20%, significantly lower than that in the Talin-1 up-regulated control group. The wall thickness of the aorta of mice in the Talin-1 down-regulated group was accompanied by hematoma or pseudocavity formation. The median elastic fiber content was higher than that in the Talin-1 downregulation control group( P<0.05). The content of elastic fibers in the blood vessel wall of mice in the Talin-1 up-regulation group was significantly higher than that in the Talin-1 up-regulation control group.The down-regulation of Talin-1 significantly inhibited FAK phosphorylation, and instead promoted ERK1/2 phosphorylation( P<0.05). Conclusions:Down-regulation of Talin-1 may reduce the elastic fiber content in the aorta of mice by activating the ERK1/2 signaling pathway, leading to vascular remodeling of the aortic wall and promoting the occurrence of aortic dissection.

Determination of individualized PEEP during lung-protective ventilation in patients undergoing general anesthesia: comparison of pulmonary electrical impedance tomography and dynamic lung compliance / 中华麻醉学杂志

Objective:To compare the efficacy of individualized PEEP determined by lung electrical impedance tomography (EIT) and dynamic lung compliance (Cdyn) during lung-protective ventilation strategies in the patients undergoing general anesthesia.Methods:Sixty patients of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 18.5-28.0 kg/m 2, undergoing elective surgery with general anesthesia and endotracheal intubation in the Second Affiliated Hospital of Soochow University, were selected.Lung-protective ventilation strategy was applied in supine position after general anesthesia.The peak value of PEEP did not exceed 10 cmH 2O, with an increment/decrement of 2 cmH 2O for titration.The corresponding Cdyn value and lung EIT data were collected during titration.The patients were divided into 2 groups ( n=30 each) using a random number table method: titration first increased and then decreased group (group A) and titration first decreased and then increased group (group B). The determination method of individualized PEEP: Cdyn method was the PEEP corresponding to the maximum Cdyn value; EIT method was obtained through PV500 PC software analysis.The level and success rate of individualized PEEP determined by the Cdyn and EIT methods were compared, and the ICC consistency analysis of the determined individualized PEEP was performed. Results:Compared with the Cdyn method, the success rate of individualized PEEP determined by EIT method was significantly increased, and the level of individualized PEEP was decreased in the two group ( P<0.05). In group A, the individualized PEEP titrated by the EIT and Cdyn methods showed good agreement (the ICC value of the increment-Cdyn and increment-EIT methods was 0.761, P<0.05; the ICC value of the decrement-Cdyn and decrement-EIT methods was 0.763, P<0.05). In group B, the individualized PEEP titrated by the EIT and Cdyn methods showed good agreement (the ICC value of the increment-Cdyn and increment-EIT methods was 0.809, P<0.05; the ICC value of the decrement-Cdyn and decrement-EIT methods was 0.797, P<0.05). Conclusion:The agreement between the individualized PEEP determined by lung EIT method and Cdyn method during lung-protective ventilation is good in the patients undergoing general anesthesia, and the success rate of EIT method is higher, and the level of individualized PEEP is lower.

The predictive study of ultrasound parameters combined with serological indicators for Gleason score risk after prostate cancer surgery / 中华超声影像学杂志

Objective:To establish the prediction model of postoperative Gleason score (GS) risk of prostatic cancer (PCa), and to compare the diagnostic efficacy of the model and each independent risk factor for PCa medium-high risk group.Methods:The clinical data of 362 patients who accepted transrectal prostate biopsy in the Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from January 2018 to December 2019 were analyzed retrospectively, and a total of 343 patients with prostate cancer who met the enrollment criteria were selected. According to the GS grading system, these patients were divided into low risk group, moderate risk group and high risk group. At first, the single factor analysis and Spearman rank correlation were used to find out the effective indicators with good correlation with GS risk. Then, multiple linear regression equation was applied for multi-factor analysis to obtain the independent risk factors and the prediction model for predicting GS risk, and then the ROC curve was used to compare the diagnostic efficacy of each independent risk factor and prediction model for PCa medium-high risk group.Results:In the single factor analysis, the differences of all indicators in GS risk were statistically significant (all P<0.05). In the correlation analysis with GS risk, except for the indicators of prostate volume (all P>0.05), the other indexes had linear correlations with the different risks of GS (all P<0.05). Among them, the total prostate specific antigen and two-dimensional ultrasound (2D-US) score showed moderate positive correlations( rs=0.402, 0.579, all P<0.001), contrast enhanced ultrasound (CEUS) score showed a high positive correlation ( rs=0.709, P<0.001), and the rest indexes showed low positive correlations. Multiple linear regression was used to obtain two independent risk factors of 2D-US score ( X1) and CEUS score ( X2) for the prediction of GS risk, then, a prediction model was established: Y=0.863+ 0.066 X1+ 0.27 X2, the corresponding linear coefficient differences were statistically significant(all P<0.05). By the ROC analysis, the areas under the curves of 2D-US score, CEUS score and the prediction model were 0.838, 0.906 and 0.907, respectively. Conclusions:2D-US score and CEUS score are independent risk factors for predicting postoperative GS risk, and the diagnostic efficacy of the prediction model is higher than those of the 2D-US score and CEUS score for the medium-high risk group.

Laboratory study on chain-killing efficacy of four gel baits / 上海预防医学

Objective To study the first-time killing efficacy and the chain-killing efficacy of four gel baits against Blattella germanica: 1% chlorpyrifos, 0.05% fipronil, 2.15% imidacloprid, and 0.5% dinotefuran and provide a basis for drug selection in controlling Blattella germanica. Methods Laboratory killing efficacy test was conducted according to the national standard GB/T 13917.7-2009 and the chain-killing efficacy test was conducted for three rounds.The first round of chain efficacy test was conducted by feeding the cockroaches killed in the laboratory efficacy test, and each next round by feeding the cockroaches killed in the last round.Median lethal time (LT50), 95% confidence limit, and toxicological regression equation of each test were calculated by software DPS V9.01. Results The LT50 of the efficacy test with 1% chlorpyrifos gel bait was 0.745 5 (0.603 4-0.890 3) d.The LT50 of the first, second and third chain experiments increased by 3.30, 2.18 and 2.76 times, respectively.The LT50 of the efficacy test with 0.05% fipronil gel bait was 0.846 5(0.464 7-1.228 0)d, and increased by 5.42, 2.09 and 1.48 times, respectively, in the first, second and third chain experiments.The LT50 of the efficacy test with 2.15% imidacloprid gel bait was 3.192 1(2.865 0-3.506 0)d, and increased by 1.13, 1.65 and 1.15 times, respectively in the first, second and third chain experiments.The LT50 of the efficacy test with 0.5% dinotefuran gel bait was 0.997 1(0.805 8-1.191 6) d, and increased by 3.85, 1.37 and 1.78 times, respectively in the first, second and third chain experiments. Conclusion In the laboratory killing efficacy test, 1% chlorpyrifos, 0.05% fipronil, and 0.5% dinotefuran gel baits are better than 2.15% imidacloprid gel bait.In the chain-killing efficacy test, 2.15% imidacloprid and 0.5% dinotefuran gel baits are better than 1% chlorpyrifos and 0.05% fipronil gel baits.Based on our results, we recommend the use of 0.5% dinotefuran gel bait for comprehensive and sustained killing effect.

Outcomes of surgical treatment for carotid body tumor without preoperative embolization: a single-center retrospective study / 中华普通外科杂志

Objective:To investigate the outcomes of surgical treatment for carotid body tumor(CBT) without preoperative embolization at our institution.Methods:101 patients undergoing surgical treatment for CBT without preoperative embolization from 2011 to 2016 were followed-up for 2 years.Results:Complete resection of the CBT was achieved in all 101 cases(100%). Post-operative adverse events(AEs) mostly observed during hospitalization were as tongue bias(Ⅰ: 4, 36.4%; Ⅱ: 8, 19.5%; Ⅲ: 13, 26.5%), hoarseness(Ⅰ: 1, 9.1%; Ⅱ: 4, 9.8%; Ⅲ: 7, 14.3%), dysphagia (Ⅰ: 0; Ⅱ: 2, 4.9%; Ⅲ: 7, 14.3%) and local hematoma(Ⅰ: 0; Ⅱ: 0; Ⅲ: 1, 2.0%). No other serious AEs were observed. The total incidence of AEs was 5(45.5%) in type Ⅰ patients, 14(34.1%) in type Ⅱ, and 28(57.1%) in type Ⅲ. At the end of 2 years of follow-up, there was no AEs in type Ⅰ patients. The number of patients with adverse events in type Ⅲ was greater than that in type Ⅱ ( P>0.05). Three most frequently injured cranial nerves were hypoglossal nerve(21.9%), vagus nerve(20.3%), and recurrent laryngeal nerve(18.8%). Conclusion:Surgical management without preoperative embolization for CBT patients does not increase the risk of complications nor is it related to prognosis.

Risk factors for preoperative full stomach in patients undergoing emergency surgery / 中华麻醉学杂志

Objective:To identify the risk factors for preoperative full stomach in the patients undergoing emergency surgery.Methods:American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged≥18 yr, with body mass index ≥15 kg/m 2, scheduled for elective emergency surgery, were included.The operation bed was adjusted to 30° head-high and feet-low position.Ultrasound images of gastric antrum were observed in the right decubitus position, and the ultrasonic images were evaluated qualitatively and quantitatively.The ultrasonic image was qualitatively assessed as having empty antrum, liquid or solid.Three images were obtained during the diastolic period of gastric antrum when quantitative assessment was performed.The longest diameter (D1) and the widest diameter (D2) of the images were measured three times and averaged to calculate the cross-sectional area of gastric antrum [CSA=(D1×D2×π)/4]. The gastric volume was calculated [GV=27.0+ (14.6×CSA)-(1.28×age)]. When the result was<0, the gastric volume was 0.GV/body weight was calculated, and GV/body ≤1.5 ml/kg was considered as empty stomach.When gastric content was solid or GV/body weight>1.5 ml/kg, it was considered as full stomach.Patients were divided into 2 groups according to whether they presented with a full stomach: empty stomach group (group E) and full stomach group (group F). The patients′ fasting time, coexisting diseases and types of operation were recorded.Multivariate logistic regression analysis was performed on the indicators with statistically significant differences between groups to identify the risk factors for preoperative full stomach in the patients undergoing emergency surgery. Results:One hundred and seventy-nine cases were finally included, with 121 cases in group E and 58 cases in group F. Compared with group E, the fasting time was <6 h, and the incidence of coexisting diabetes was increased in group F ( P<0.05). Coexisting diabetes mellitus was an independent risk factor for preoperative full stomach in the patients undergoing emergency surgery ( P<0.05), and OR (95% confidence interval) was 11.968 (2.392-59.870). Conclusion:Coexisting diabetes mellitus is an independent risk factor for preoperative full stomach in the patients undergoing emergency surgery.

The application value of the tissue dispersion quantitative analysis technique in differentiating thyroid nodules / 中华超声影像学杂志

Objective:To investigate the application value of the ultrasonic elastic tissue dispersion quantitative analysis technique in differentiating thyroid nodules.Methods:A total of 164 nodules in 143 patients with thyroid nodules were examined by elastography ultrasound at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to November 2014. Eleven parameters were obtained by the tissue dispersion quantitative analysis software. These parameters were compared between benign and malignant groups by Mann-Whitney U test. The correlations between all the parameters and the pathologic results of thyroid nodules were analyzed by Spearman analysis. The receiver operating characteristic(ROC) curve of the parameter with the highest correlation coefficient was constructed. The cut-off value was calculated. Results:All parameters except correlation (CORR) had statistically significant differences between the groups of benign and malignant thyroid nodules(all P<0.01). Moreover, except CORR, the other parameters were correlated with the pathologic results of thyroid nodules(all P<0.05), with the highest coefficient in area ration of low-strain region (%AREA)( r s=0.818). ROC curves were constructed to estimate the clinic values of %AREA in diagnosis of thyroid cancer, the area under ROC curve was 0.991 for %AREA, the cut-off point was 74.83%, the sensitivity and specifity was 98.1% and 89.8%, respectively. Conclusions:The tissue dispersion quantitative analysis technique has high value in the differential diagnosis of benign and malignant thyroid nodules.

Predictive model for cervical lymph node metastasis of papillary thyroid carcinoma based on ultrasound and thyroglobulin infine-needle aspirate fluid detection / 中华超声影像学杂志

Objective:To establish a predictive model of lateral lymph node metastasis in patients with papillary thyroid carcinoma(PTC), and further to compare the diagnostic efficiency of this model with the suspected abnormal lymph node thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for lateral lymph node metastasis.Methods:The preoperative clinical and ultrasonographic data of 110 patients (257 lymph nodes) who underwent PTC cervical lymph node dissection were retrospectively analyzed. According to the postoperative pathological results, they were divided into lateral lymph node metastasis and non-metastasis group. Regression analysis was used to screen out independent risk factors affecting lateral lymph node metastasis and establish a predictive model. The ROC curve was used to evaluate the diagnostic efficacy and the best diagnostic cut-off point.Results:Prediction model: Logit( P)=-2.987+ 2.189(S/L ratio of lymph nodes)+ 1.748(hilum absent)+ 2.030(hyperechoic)+ 1.849(vascular abnormalities). The sensitivity, specificity, accuracy and AUC of the prediction model in the diagnosis of lateral lymph node metastasis were 92.1%, 83.9%, 87.9% and 0.929, respectively. The Homser-Lemeshow goodness of fit test showed that the Logistic model has a good fitting effect. The sensitivity, specificity, accuracy, and AUC of FNA-Tg in the diagnosis of lateral lymph node metastasis were 87.4%, 95.4%, 90.3% and 0.968, respectively. The sensitivity, specificity, accuracy, and AUC of the combined diagnosis of the predictive model and FNA-Tg were 92.9%, 96.9%, 94.2% and 0.989, respectively. Conclusions:The model has a good predictive value for PTC cervical lymph node metastasis. Combined with FNA-Tg, it can improve its diagnostic efficiency and provide more valuable information for the decision-making of clinical surgical procedures.

Effects of hemodialysis combined with uremic clearance granule on serum protein-bound uremic toxins in patients with end-stage renal disease / 中国基层医药

Objective:To evaluate the effects of hemodialysis(HD) combined with uremic clearance granule(UCG) on serum protein-bound uremic toxins in patients with end-stage renal disease(ESRD).Methods:From January 2018 to May 2019, 80 patients with ESRD who received maintenance HD at Jiangning Hospital Affiliated to Nanjing Medical University were allocated into HD+ UCG group and HD group according to the random digital table method, with 40 cases in each group.The HD group received HD and conventional treatment, HD+ UCG group was given UCG on the basis of the HD group.The follow-up lasted 24 weeks.The pre-dialysis concentration of p-cresyl sulfate (PCS) and indoxyl sulfate (IS) were measured and compared before and after treatment.Results:Before treatment, there were no statistically significant differences in PCS and IS between the two groups(all P>0.05). After treatment for 8, 16, 24 weeks, the concentrations of PCS in the HD+ UCG group were (19.58±13.25)mg/L, (18.44±11.78)mg/L, (18.03±11.94)mg/L, respectively, and the IS levels in the HD+ UCG group were (24.28±15.36)mg/L, (23.54±15.07)mg/L, (23.69±14.83)mg/L, respectively, which were all lower than those in the HD group[PCS: (25.64±16.73)mg/L, (23.26±14.15)mg/L, (24.86±15.31)mg/L; IS: (36.72±19.48)mg/L, (33.59±17.38)mg/L, (33.92±16.61)mg/L], the differences were statistically significant( t=2.057, 2.103, 2.318, 2.615, 2.413, 2.701, all P<0.05). And no serious adverse reactions occurred in all patients. Conclusion:Administration of UCG orally can decrease the concentration of serum protein-bound uremic toxins such as PCS and IS continuously and effectively in patients with ESRD.