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OBJECTIVE：To reference for the rational use of sodium va lproate in clinic. METHODS ：By retrospective analysis，blood concentration monitoring results of sodium valproate and medical record data in 856 patients were collected from the Affiliated Tianyou Hospital of Wuhan University of Science and Technology during Jan. 2016-Dec. 2018. The dosage form of sodium valproate ，monitoring times of therapeutic drugs ，monitoring results of steady-state blood concentration of sodium valproate up to the standard ，dosage adjustment and the combination with carbamazepin ，fluconazol and carbapenem drugs were analyzed. Fisher exact test was used to analyze the factors influencing the steady-state blood concentration of sodium valproate up to the standard. RESULTS ：A total of 1 270 cases of sodium valproate were monitored in 856 patients，involving 407 males and 449 females，with age of （38.2±13.8）years and body mass of （52.3±10.0）kg. Among 1 270 cases of monitoring ，steady-state blood concentration of sodium valproate in 554 cases were in the range of 50-100 µg/mL，and 43.6％ of which reached the standard. The rate of reaching the standard in patients with multiple monitoring was higher than patients with single monitoring ；the dosage of patients with last monitoring reaching the standard was higher than that of patients with the first monitoring reaching the standard. The rate of reaching the standard in Sodium valproate sustained-release tablet group was higher than general Sodium valproate tablet group；the carbamazepin/fluconazol free group was higher than the carbamazepin combination group and fluconazol combination group；the carbapenem free group was higher than the carbapenem combination group （all P＜0.05）. CONCLUSIONS ：Clinical pharmacists should pay attention to the monitoring of sodium valproate treatment drugs ， strengthen the publicity and 3551851542@qq.com education of patients and their families ，and try to use Sodium valproate sustained-release tablets. When patients additionally receive carbapenem drugs like carbamazepin or fluconazol ， the standard level of sodium valproate will be reduced ，then the dosage of sodium valproate should be adjusted.
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Objective To explore the value of high frequency ultrasound in differential diagnosis in dorsal thyroid (including gland dorsal or posterior) nodules.Methods Ultrasonographic features of 101 patients with ultrasonography suspected or misdiagnosed nodules in the dorsal area of the thyroid gland,which were then confirmed by pathology or hyaluronography/gastroscopy,were retrospectively analyzed.Ultrasonographic homogeneity (other nodules with similar ultrasonographic features were found in the ipsilateral gland),parenchyma homology (nodule parenchyma was continuous with glandular parenchyma) and blood homology (blood flow signals in nodules were continuous with those in glandular parenchyma) were applied as indicators for determinng thyroid nodules.Double-line sign or vascular arch sign at the edge of nodules served as an indicator for determining parathyroid nodules.Results Of the 101 cases,there were 46 thyroid nodules,35 parathyroid nodules,7 enlarged lymph nodes;6 esophageal diverticulum,6 esophageal cancer,1 cleft cyst.The determination of thyroid nodules by at least one of ultrasonographic homogeneity,parenchyma homology and blood homology showed sensitivity of 73.5 ％,specificity of 96.5 ％ and accuracy of 85.8％.In the determination of parathyroid nodules by double-line sign or vascular arch sign at the edge of nodules,sensitivity,specificity and accuracy was 54.1％,85.5 ％ and 74.5 ％,respectively.Conclusions Nodules in the dorsal area of the thyroid gland have different sources,and the understanding of corresponding characteristic ultrasonographic appearances is helpful for improving the differential diagnosis of these nodules.
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Objective To analyze the changes of benign and malignant thyroid nodules during followup and to increase the diagnostic accuracy.Methods The ultrasonographic changes of 161 thyroid nodules confirmed by pathology were retrospectively analyzed,including size,internal components,echogenicity,margin,microcalcification,anteroposterior to transverse dimension ratio(A/T) and the relationships with thyroid capsule,and the change of cervical lymph nodes.Results Ninety-three benign thyroid nodules and 68 malignant thyroid nodules were enrolled in this study,the changes in size,internal components,microcalcification,the relationships with glandular capsule,and cervical lymph nodes were significantly different (P ＜ 0.05),while the echogenicity,margin,and A/T were not significantly different,benign nodules changed more easily in size and internal components,while malignant nodules changed more easily in microcalcification.Both the nodules broken the thyroid capsule or cervical lymph nodes exhibited malignant signs suggest probable malignancy.Conclusions Analyzing the ultrasonographic changes during follow-up contributes to identify benign and malignant thyroid nodules.
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Objective To investigate the impact factors of real-time shear wave elastography ( SWE) by using the ultrasound phantoms . Methods The noduled phantoms with different densities and viscosities and background phantoms with three textures ( soft ,medium ,and hard) were prepared by using gelatin as the main ingredient . Nodule phantoms were embedded in background phantom in different depths . The elasticity ( Emax ) was measured by SWE . Factorial designed was used to evaluate the effects of various factors ,including density ,viscosity and depth of nodule phantom and texture of background phantom on Emax of nodule phantom . Binary Logistic regression was used to analysis the effects of various factors , including density ,viscosity ,diameter ,depth of nodule phantom and texture of background phantom on the window phenomenon . Results The density ,viscosity and the Emax of nodule phantoms increased as the gelatin ratio increased . The Emax of nodule phantoms in shallow position ( depth < 3 .0 cm ) were higher than those in deep position ( depth ≥ 3 .0 cm) . In hard-background phantoms ,the Emax of nodule phantoms was maximal ,soft-background phantoms was minimal . Main effects of the density ,viscosity ,depth of nodule phantoms and texture of background phantoms on Emax of nodule phantoms were different ,and all of the factors had interactive effects ( P < 0 .05 ) . The density ,viscosity ,diameter and depth of nodule phantoms were independent risk factors of the windowphenomenon ( P < 0 .05 ) . According to OR ( 23 .846 ,0 .093 ,and 0 .003 ,respectively) ,reduced density and viscosity ,or increased diameter and depth of nodule phantoms ,could increase the incidence of the window phenomenon . Conclusions The density and viscosity of self-making ultrasound phantoms can be easily and flexibly controlled .Density ,viscosity , diameter ,depth of nodule and texture of background are the impact factors of shear wave elastography .