Objective To investigate the impact of calcification on differential diagnosis of thyroid nodule using shear wave elastography (SWE). Methods One hundred and forty-six patients with thyroid nodules were prospectively enrolled in the study. Ultrasound observations included nodule size, boundary, shape, envelope, internal echotexture, posterior acoustic enhancement, and the relationship with surrounding tissue. According to the presence of internal calciifcation, patients were divided into calciifcation group (groupⅠ) and no calciifcation group (groupⅡ). Real-time shear wave elastography (young′s modulus value) were taken in both groups. Taking surgical pathologic results as the gold standard, receiver operating characteristic (ROC) curve of SWE in diagnosis of benign and malignant thyroid nodule were drawn for two groups respectively. Results In groupⅠ, 25 cases were benign and 38 cases were malignant. The malignant incidence was 60%. Among them the rate of malignant nodules in microcalcification group was 92%(24/26). The incidence of malignant nodules in coarse calcification group was 38%(14/37). The area under the curve (AUC) of SWE in groupⅠwas 0.564. In groupⅡ, 67 cases were benign and malignant had 16 cases. Using 30.43 kPa as the diagnostic point of young′s modulus value, the sensitivity, speciifcity, accuracy and AUC were 93.2%, 81.2%, 84.8%and 0.824. Conclusion In no calciifcation group, SWE is more meaningful in the differential diagnosis of benign and malignant thyroid nodules.

Objective To make contrast analysis of sleeve lobectomy and wedge resection in lung cancer treatment by observing the clinical curative effect.Methods 100 patients with lung cancer using random table method, all the patients were divided into the observation group ( 50 cases, treated with sleeve resection ) , control group (50 cases,treated with wedge resection),follow-up after treatment lasted respectively for 3 years.Results In the two groups,anastomotic fistula incidence and mortality rates of the observation group were 4%,6%;6% and 8% in the control group,there were no statistical difference (χ2 =0.00,0.00,all P>0.05);the positive rate of stump cancer cell bronchial in the observation group was 4%,it was obviously less than 16% in the control group,and the differ-ence was obvious (χ2 =4.00,P<0.05) .The anastomotic scar tissue hyperplasia and recurrence rate of the observa-tion group during the follow-up period were 2%,2%;which were lower than 16%,18% of the control group (χ2 =4.40,7.11,all P<0.05).The 1,3 year survival rates of the observation group were 92%,64%,which were higher than 62%and 42%of the control group (χ2 =12.70,4.86,all P<0.05).Conclusion Taking sleeve resection for bronchogenic carcinoma can effectively control the positive rate of bronchial stump with cancer cells,inhibit anasto-motic scar tissue hyperplasia,reduce the recurrence rate,and the curative effect is very good,which is worth of clinical application.

Objective:Summarize and analyze the clinical features of immune checkpoint inhibitor (ICI)-related colitis.Methods:From January 2019 to September 2020, the clinical data of 8 patients with ICI-related colitis from Peking Union Medical College Hospital were retrospectively collected and including the onset of ICI-related colitis, clinical symptoms, endoscopic and pathological findings, treatment, comorbidities and resuming of ICI. Independent sample t test was used for statistical analysis. Results:Eight patients were all male, and the median age (range) was 66 years old (55 to 74 years old), 7 cases were diagnosed with stage Ⅳ lung cancer and 1 case was diagnosed with stage Ⅲc pyelo-carcinoma. Among 8 patients, 4 cases of ICI-related colitis occurred during combination of anti-programmed death-1 (PD-1) treatment and chemotherapy, 2 cases occurred during anti-PD-1 monotherapy after combination of anti-PD-1 treatment and chemotherapy, and 2 cases occurred after anti-PD-1 monotherapy. The median time (range) was 44 d (27 to 128 d) from initial anti-PD-1 treatment to the onset of ICI-related colitis and the median time (range) was 8 d (6 to 35 d) from last anti-PD-1 treatment to onset of ICI-related colitis. The ICI efficacy of 4 patients had partial response, 2 patients had stable disease, 1 patient had disease progression, and 1 patient′s condition was not assessed. All 8 patients had moderate to severe extensive colitis. The main clinical manifestation was diarrhea (5/8), 3 patients accompanied by abdominal pain. The endoscopic findings were diffuse mucosal erosion, accompanied by ulcer in 2 patients. The main pathologic findings were cryptitis or crypt abscess, accompanied by apoptosis in 2 patients. Eight patients were all treated with glucocorticoids, among them 2 patients were further treated with biologics, due to the insufficient efficacy of glucocorticoid treatment, 4 patients had opportunistic infections. The initial prednisone dose for patients with opportunistic infections and patients without opportunistic infections was (85.00±52.60) and (60.00±23.09) mg, respectively. The prednisone treatment course was (8.75±4.03) and (7.50±3.11) weeks, respectively, and the differences were not statistically significant (both P>0.05). The colitis relapsed in all 3 patients after resuming of ICI. Conclusions:ICI-related colitis had corresponding ICI treatment history and clinical, endoscopic, and histopathological features. Glucocorticoid is the main treatment, and it is prone to relapse after resuming of ICI.

Objective To explore the effect of knowledge,attitudes,and practices (KAP) health education model on the self-care skill among cancer patients with peripherally inserted central catheter (PICC),and to implement the effective health education methods.Methods Totals of 66 cases of cancer patients with PICC were randomly divided into control group(n =35 ) and the experimental group (n =31 ).The control group received routine health education whlie the experimental group received KAP health education regarding strengthened self-care knowledge of PICC,establishment in self care attitude or belief,promotion in self care practice.Before and after intervention,we apply the Exercise of Self-care Agency Scale (ESCA) to asses the extent to which individuals take action toward their health care.Results After intervention,experimental group was higher than the control group significantly in ESCA total score [ ( 117.07 ± 13.75 ) vs ( 101.14 ± 11.56) ],self care skills [ (31.52 ± 3.67 ) vs (26.74 ± 3.46) ],self care responsibility [ (22.39 ± 3.89 ) vs ( 16.03 ±2.80) ],self-concept [ ( 23.39 ± 3.36 ) vs ( 18.83 ± 3.43 ) ],and the difference was statistically significant (t=-3.717,-5.242,-7.685,-5.434,respectively;P＜0.05).Conclusions KAP health education model appears effective in improving the self-care agency among cancer patients with PICC.

Coronary artery disease (CAD) is a multifactorial disease in which inflammation plays a central role.This study aimed to investigate the association of inflammatory markers such as the neutrophil to lymphocyte ratio (NLR),the Global Registry of Acute Coronary Events (GRACE) score with in-hospital mortality of elderly patients with acute myocardial infarction (AMI) in an attempt to explore the prognostic value of these indices for elderly AMI patients.One thousand consecutive CAD patients were divided into two groups based on age 60.The laboratory and clinical characteristics were assessed retrospectively by reviewing the medical records.The NLR and GRACE score were calculated.In the elderly (≥60 years),patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) had significantly higher NLR than did those with unstable angina (UA) and stable angina pectoris (SAP) (P＜0.01).The NLR was considerably elevated in older AMI patients compared with their younger counterparts (＜60 years) (P＜0.05).In elderly AMI patients,the NLR was considerably higher in the high-risk group than in both the low-risk and medium-risk groups based on the GRACE score (P＜0.05 and P＜0.01,respectively),and the NLR was positively correlated with the GRACE score (r=0.322,P＜0.001).Either the NLR level or the GRACE score was significantly higher in the death group than in the surviving group (P＜0.05).By curve receiver operator characteristic curve (ROC) analysis,the optimal cut-off levels of 9.41 for NLR and 174 for GRACE score predicted in-hospital death [ROC area under the curve (AUC) 0.771 and 0.787,respectively,P＜0.001].It was concluded that an elevated NLR is a potential predictor of in-hospital mortality in elderly patients with AMI.

Aim To evaluate the effects of salvianolic acid B ( Sal B ) on bone metabolism and its potential mechanism in high fat diet ( HFD) mice.Methods Thirty C57BL/6J male mice were divided into three groups with 10 mice each, namely normal , HFD and HFD+Sal B.HFD and HFD+Sal B mice were treated with HFD, and HFD+Sal B group mice were also with Sal B (125 mg· kg -1· d-1).After 12 weeks' treat-ment, femurs were harvested .The effects of Sal B on biomechanical strength were evaluated by biomechani-cal tests, and the effects of Sal B on bone microstruc-ture were evaluated by Safranin O/fast green staining and hematoxylin and eosin staining .The expression of nuclear factor-kappa B ( NF-κB)-p65 and NADPH ox-idase 4 ( Nox4 ) and cathepsin K in femurs was deter-mined by immunohistochemical staining . Results Maximum load and elastic load significantly decreased ,and the trabeculae became thinner and irregular in the femurs of HFD mice , while Sal B treatment could re-verse the descending biomechanical strength and the disorganized femurs bone micro-structures in HFD mice.In addition, the expressions of Nox4, NF-κB-p65 and cathepsin Kmarkedly increased in HFD mice , and Sal B possessed the ability to down-regulate the ex-pression of Nox4, NF-κB-p65, and cathepsin K in the femurs triggered by HFD .Conclusions Sal B treat-ment improves bone metabolism via regulating Nox 4/NF-κB/cathepsin K signaling pathway in HFD mice . The findings contribute to the understanding and exten-sion of the applications of Salvia miltiorrhiza and its constituents on osteoporosis .

Objective To evaluate the value of transesophageal echocardiography (TEE) in transthoracic minimally invasive device closure of ventricular septal defect(VSD).Methods A total of 164 cases of VSD were recruited as candidates to receive transthoracic minimally invasive device closure between January 2007 and October 2010,including 138 perimembranous VSDs,3 muscular VSDs and 23 supracristal VSDs.Among these groups,85 male patients were included.Four-champer view,five-champer view,left ventricular long-axis view,short-axis view and right ventricular inflow view were detected to evaluate the availability of device closure.Results A total of 152 cases(92.7%)were successfully closed with a device.All the patients were followed up more than 3 months arranged with a standard protocol.No complete atrioventricular block (CAVB) or associated valvular complications were observed.Three of the five cases with traced residual shunt after device closure closed spontaneously.Conclusion TEE plays an important role in transthoracic minimally invasive device closure of ventricular septal defect,which has been proved by the good follow-up results without CAVB and associated valvular complications.

Nanoporous ZnO was used as a carrier to prepare drug solid dispersion, the mechanism of which to improve the drug dissolution was also studied. Nanoporous ZnO, obtained through chemical deposition method, was used as a carrier to prepare indomethacin and cilostazol solid dispersions by melt-quenching method, separately. The results of scanning electron microscope, surface area analyzer, fourier transform infra-red spectroscopy, differential scanning calorimeter and X-ray diffraction showed that drugs were implanted into nanopores of ZnO by physical adsorption effect and highly dispersed into nanopores of ZnO in amorphous form, moreover, these nanopores strongly inhibited amorphous recrystallization in the condition of 45 degrees C and 75% RH. In addition, the results of the dissolution tested in vitro exhibited that the accumulated dissolutions of indomethacin and cilostazol solid dispersions achieved about 90% within 5 min and approximately 80% within 30 min. It was indicated in this study that the mechanism of drug dissolution improvement was associated with the effects of nanoporous ZnO carrier on increasing drug dispersion, controlling drug in nanopores as amorphous form and inhibiting amorphous recrystallization.
Anti-Inflammatory Agents, Non-Steroidal ; administration & dosage ; chemistry ; Calorimetry, Differential Scanning ; Drug Carriers ; Indomethacin ; administration & dosage ; chemistry ; Microscopy, Electron, Scanning ; Nanostructures ; Phosphodiesterase 3 Inhibitors ; administration & dosage ; chemistry ; Solubility ; Spectroscopy, Fourier Transform Infrared ; Tetrazoles ; administration & dosage ; chemistry ; X-Ray Diffraction ; Zinc Oxide ; chemistry

OBJECTIVETo evaluate the use of clinical nutritional support in critical SARS patients, and the relationship between blood glucose levels/insulin administration amount and outcome.

METHODSTwenty-one SARS patients who reached the standard of Ministry of Health's "critical level" were transferred into our ICU in an average of 11 days after onset and enrolled in this clinical trial. All patients underwent respiratory support and clinical nutrition support as scheduled. For about 60 kg patient per day 3347.2 kJ(800 kcal), 36 g protein, and 125 g carbohydrate was given intravenously; 4184 kJ(1000 kcal), 38 g protein, and 125 g carbohydrate was provided by enteral route. MCT/LCT as fat resource shared 50% calories intake. All patients received similar doses of intravenous Methylprednisolone(about 200 mg/d). Blood glucose, serum albumin, blood lymphocyte counts, and serum alanine transminase (ALT) were checked on the first admission day in ICU and on the 12th day after nutrition therapy was started. Insulin was started to pump in to maintain the blood glucose levels between 4.44-7.78 mmol/L (80-140 mg/dl) when the levels exceeded normal range.

RESULTSUpon admission into ICU, all patients had poor nutrients intake for an average of 11 days and 16 patients (76.2%) were diagnosed as malnutrition. Parenteral and enteral nutrition therapy were then offered for an average of 12 days. On the 12th day, the serum albumin increased [(28.5 +/- 2.2)] g/L vs (37.0 +/- 4.1) g/L] (P = 0.0001) and so did the lymphocytes count [(0.74 +/- 0.47)] x 10(9)/L vs (1.22 +/- 0.73) x 10(9)/L] (P = 0.02). The blood glucose maintained at lower level in the surviving patients when compared with those who died [(9.5 +/- 2.3) mmol/L vs (6.3 +/- 1.8) mmol/L] [(196 +/- 70) mg/dl vs (110 +/- 21) mg/dl] (P = 0.0002), and the abnormally high ALT levels presented in some of the patients decreased but not significantly (81.0% vs 57.1%) (P = 0.18). In order to keep blood glucose within the range 4.44-7.78 mmol/L (80-140 mg/dl), only 18.8% of the surviving patients needed insulin intervention as opposed to 80.0% of those who died (P = 0.03). The amount of insulin used in the surviving group was significant lower than that in the group who died [(24 +/- 2) IU/d vs (72 +/- 9) IU/d] (P = 0.01).

CONCLUSIONSEleven days after SARS onset, most of the critical patients presented with malnutrition. Some improved nutrition related parameters may be associated with clinical nutritional support. The surviving patients required less insulin when compared to those who died. 80.0% of the patients who died need insulin versus only 18.8% of the surviving patients. Due to the difficulty of SARS management, this study was not a randomized controlled clinical trial. More clinical trials will be needed for checking the results of this investigation.

Adult ; Blood Glucose ; metabolism ; Enteral Nutrition ; Female ; Humans ; Insulin ; administration & dosage ; Male ; Malnutrition ; blood ; etiology ; therapy ; Middle Aged ; Nutritional Support ; Parenteral Nutrition ; Severe Acute Respiratory Syndrome ; blood ; complications ; therapy ; Treatment Outcome

Objective To analysis the E protein epitopes of dengue virus type 1-4, Japanese encephalitis virus and yellow fever virus and to distinguish the shared or specific epitopes among them. Methods Bioinformatic software DNAStar was used to analyze the hydrophilicity, flexibility, surface probability and antigenicity of dengue virus type 1-4, Japanese encephalitis virus and yellow fever virus E prtein amino acid sequences. The influence of secondary structure was also considered. Based on the bio-informatic analysis of E protein epitopes, 6 specific epitopes were amplified and inserted into prokaryotic expression vector pMAL-c2x. The vectors was then transferred into E.coli BL21 (DE3) and Rosetta (DE3). Isopropyl-β-D-thiogalactoside (IPTG) was used to induce the expression of gene segments and SDS-PAGE were used identify the expression proteins. The antigenieity was tested, using Western blot. Results 15 shared epitopes and 47 specific epitopes were forecasted by bioinformatic analysis, and 6 specific epitopes from dengue virus type 1-4, Japanese encephalitis virus and yellow fever virus E protein were expressed in E.coli successfully. Two specific antigenic determinant from dengue virus type 1 and dengue virus type 2 were confirmed using Western blot, while the others epitopes shown no antigenic reaction property. Conclusion Two specific antigenic determinant were confirmed, under Western blot.