Objective To investigate the conventional ultrasonic and elastographic characteristics of papillary thyroid micro-carcinomas(PTMC) suffered in normal and Hashimoto's thyroiditis(HT).Methods A total of 227 patients with 249 nodules that were confirmed by surgery or biopsy were included in this study.The cases were divided into normal group and HT group.All patients underwent conventional ultrasound and elastography (static pressure).The sonographic characteristics and strain ratio (SR) value were evaluated.Results In the normal group,the ratio between male and female was 1 ∶ 2.9,while in HT group,it was 1 ∶ 11,which was significant different between the two group (P =0.002).Sonographic characteristics that had no significant difference between the two groups (P ＞0.05) include:boundary,shape,vertical and horizontal ratio,halo,echogenicity,calcification,posterior shadowing,vascularity on color Doppler ultrasonography.The strain ratio value was statistically different between the two groups (P =0.034),with 3.44 ± 1.03 in normal group and 3.13 ± 1.13 in HT group.Conclusions The conventional ultrasonographic features of PTMC were similar in both normal thyroid and HT.However,females suffering HT were more susceptible to PTMC,and the strain ratio value of PTMC concomitant HT decreased.

Objective The expression of TNF-α was detected in sera of rabbits treated by ulinastatin with acute lung injury in duced by underwater explosion.Methods Rabbits were randomly divided into two groups such as the injured group and ulinastatin therapy group.Established underwater explosion device was used to cause acute lung injury in rabbits.TNF-α in sera of the rabbits were measured by ELISA at 4,12 and 24 hours after the explosion.The SPSS17.0 software was used to analyze the data and P＜0.05 was considered to be significant.Results There was no significant difference between the concentrations of TNF-α in the sera of rabbits in the injure group (538.20±201.43 ng/L) and that of in the ulinastatin group (386.90± 109.22 ng/L,t=2.088,P=0.051) at 4 hours after burst.However,there was evidently decreased in the level of TNF-α in the ulinastatin group (400.60 ± 78.98 ng/L) compared with the injury group (573.80 ± 178.24 ng/L,t =2.809,P =0.012) at 12 hours after burst.Moreover and TNF-α in the ulinastatin group (356.10 ± 130.99 ng/L) was also decreased compared to the injure group (552.30± 169.64 ng/L,t=2.895,P=0.010) at 24 hours after burst.Conclusion The TNF-α expression in sera of the rabbits in ulinastatin group were dramatically decreased than thai of in injury group at 12 hours after burst,which may be benefit to rabbits with acute lung injury induced by underwater explosion.

Objective To investigate the clinical characteristics,treatment,and prognostic factors for Langerhans cell histiocytosis (LCH) in children.Methods A retrospective review of patients diagnosed as LCH was carried out between January 2007 and December 2012 in Beijing Children's Hospital,Capital Medical University.Target patients were divided into multi-organ high-risk groups (Group Ⅰ),multi-organ low-risk groups (Group Ⅱ),single-organ groups (GroupⅢ),and the corresponding intensity of chemotherapy was given.SPSS 17.0 statistical software was used to analyze the findings.The correlations among the affected organ,the early treatment response and the prognosis were analyzed.Results A total of 217 patients were analyzed including 127 boys and 90 girls with ratio of 1.4 ∶ 1.0 and a median age of 36 months (ranged from 2 months to 14 years) on the diagnosis of LCH,and there were 132 cases (60.8％) in group Ⅰ,33 cases (15.3％) in group Ⅱ and 52 cases (23.9％) in group Ⅲ.The median age on diagnosis was 20 months in group Ⅰ,42 months in group Ⅱ and 72 months in group Ⅲ.The most frequently affected organ was the bone (176 cases,81.2％).Among 217 patients,55 cases (25.3％) had recurrence and 12 cases died.The rate of 3-year overall survival was expected to be 90.78％.The rate of 3-year event free survival was expected to be 76.5％.Myelosuppression,liver function damage and infection were the most common side effects due to chemotherapy with the percentages of 48.4％ (105 cases),24.0％ (52 cases) and 12.4％ (27 cases).Risk organs involvement and no-response to initial therapy (after 6 weeks) indicated a worse prognosis (x2 =10.60,12.84,P =0.017,0.001).Conclusions Incidence of LCH in boys is slightly higher than girls in children.Peak age at onset of LCH in children is 1-3 years old.Bone is the most frequent involved organ.Involvement of risk organs and no-response to initial therapy are key factors in determining worse prognosis.A rescue therapy should be introduced earlier in these patients.

Objective The concentration of NE and TNF-α was detected for elucidating the change of them in sera and bronchoalveolar lavage fluid (BALF) of rabbits with acute lung injury interposed by XueBiJing therapy in underwater explosion.Methods Underwater explosion decive was applied to cause acute lung injury of rabbits.The 20 rabbits were randomly divided into two groups which were injury group and XueBiJing therapy group,respectively.The concentration of NE and TNF-α in sera and BALF were detected by ELISA method in 24 hours after bursting.Results The concentration of TNF-α in sera (353.30±166.86 ng/L) of rabbits in therapy group were significantly lower than those in injury group (552.30± 169.64 ng/L;t=2.645,P =0.016).The concentration of NE in sera (63.40 ± 36.09 ng/ml) were lower than that of rabbits in injury group (97.60 ± 36.20 ng/ml;t=2.116,P=0.049).At the same time the concentration of NE in BALF (102.10± 9.50 ng/ml) of rabbits in therapy group were significantly lower than those in injury group (136.70± 13.60 ng/ml;t=6.593,P=0.000).Conclusion The expression of TNF-α in sera and NE in sera and BALF in rabbits with acute lung injury interposed by XueBiJing in underwater explosion were lower than those of injury group.

Objective To investigate the effect of duodenal-jejunal bypass(DJB) on glucose metabolism and the expression of ileum proglucagon mRNA in Goto-Kakizaki (GK) type 2 diabetic rats.Methods 18 male GK rats and 1 8 male Wistar rats were randomly divided into 4 groups:GK operation group(group A),GK sham operation group(group B),Wistar operation group (group C),Wistar sham operation group (group D).There were 9 rats in each group.The fasting blood glucose and GLP-1 levels were measured before and at the 8th weekafter surgery.Oral glucose tolerance test was measured,and the area under blood glucose concentration curve wascalculated.Ileum tissues were obtained 8 weeks postoperatively and reverse transcriptase polymerase chain reac-tion was used to detect ileum PG mRNA expression after the operation.Results At the 8th week after surgery,the fasting blood glucose of group A decreased from(8.73 ± 1.30) mmol/L to(5.86 ±0.57) mmol/L(P ＜0.05).Area under blood glucose concentration curve decreased from preoperative(60.23 ± 5.14)mmol · h/L to (47.80 ±1.79) mmol· h/L(P ＜ 0.05).Fasting serum GLP-1 in group A increased from (7.69 ± 0.74) pmol/L to (29.00 ±4.85) pmol/L while postprandial GLP-1 increased from(15.74 ± 5.71) pmol/L to (45.78 ± 7.26) pmol/L (P ＜0.05).At the 8th week after surgery,the ileum PG mRNA level in group A was significantly higher than that in group B(P ＜ 0.05).Conclusions DJB can directly improve glucose metabolism in non-obese type 2 diabetic rats,and the operation has no hypoglycemic effect on normal blood glucose.The increased expression of ileum PG mRNA might contribute to the hypoglycemic effect of the surgery.

Liver-injury caused by chemicals is a common question in modern clinic. Professor LI Ping proposes ‘drug yellow’theory to guide TCM differential treatment. In this paper, the author will analyze the chemicals by the proved cases of drug-induced severe liver damage.

Objective To investigate the clinical characteristics,treatment and prognosis of single-system Langerhans cell histiocytosis (LCH) in children.Methods A retrospective analysis was performed in single-system LCH patients registered between January 2006 and December 2012 in Beijing Children＇s Hospital Affiliated to Capital Medical University.The patients were divided into 2 groups:the bone involvement group and the other organ involvement group.The patients were assessed at 5 weeks,11 weeks,25 weeks,3 months,6 months,1 year and 3 years.The data were analyzed by using SPSS 17.0 software.Results A total of 112 patients (66 boys and 4,6 girls) with a median age of 5 years at diagnosis of LCH were analyzed.The most frequently affected organ was the bones(91 cases,81.3％),followed by skin(15 cases,13.4％).Few patients (27.6％) had acentral nervous system risk lesion,who were younger than those with other bone lesion(2.5 years vs 6.6 years).Patients with bone lesions were diagnosed at a significantly older age than other patients(5.6 years vs 1.5 years) (P ＜ 0.01).All patients received chemotherapy that included Prednisone and Vinblastine for 25 weeks.Twenty-five patients (22.3 ％) showed reactivation.Of these,4 patients exhibited reactivation in the pituitary.Three-year overall survival rate was expected to reach 100％,and no-event survival was expected at (73.22 ± 4.47) ％.Age of less than 2 years old was the factor of reactivation (P =0.033);sex,organ involvement and member of bone involved were not related with reactivation (P =0.679,0.142,0.639).Conclusions The bones were the frequent involvement organ in single-system LCH patients.These patients have a good prognosis.The rate of reactivation of single system-LCH can be decreased by chemotherapy.

Objective:To understand the clinical characteristics and prognosis of Langerhans cell histiocytosis (LCH) with skin-limited lesion.Methods:A retrospective analysis was performed on clinical characteristics and prognosis of 16 skin-limited LCH patients, out of 578 LCH patients who were hospitalized in Beijing Children′s Hospital during December 2013 to June 2018.Results:A total of 16 skin-limited LCH cases, accounted for 2.7% of all 578 cases, were included.Among which, sex ratio (male vs.female) was 1.28∶1.00.Median ages of skin eruption occurrence and of diagnosis of the disease were 3.5 months (3 days to 2 years and 5 months) and 6 months (2 months 14 days to 2 years and 8 months) in this group.Among the 16 cases, seborrheic dermatitis-like lesions(11 cases, 68.7%) was the most common, and the trunk was most frequently involved[75.0% (12 cases)]. Serine/threonine protein kinase gene V600E [ BRAF (p.V600E)] mutation was detected in pathological specimens from 10 skin-limi-ted cases, with 9 cases being positive.Plasma samples from 5 positive cases were further detected for BRAF (p.V600E) mutation, and 4 positive results were gained.Of all 16 patients, 11 cases (68.7%) were treated.Remission were achieved in 3-6 months from treatment start in patients treated whether according to the Histiocyte Society′s LCH-2009 protocol for 25 weeks(6 cases, 37.5%), or with topical mometasonefuroate for 3 months (3 cases, 18.8%). Two patients(12.5%) with solitary cutaneous lesions underwent excision biopsy (one face and one prepuce) and were considered to be in remission immediately after surgery.None of these patients suffered from the recurrence of the disease.The remaining 5 patients (31.3%) with skin-limited LCH were just evaluated regularly, and achieved remission in 3-6 months of commencing observation.Among these untreated patients, 1 with consistently positive BRAF (p.V600E) mutation in plasma had bone involvement in the 24 th month of assessment, and was then treated based on the Histiocyte Society′s LCH-2009 Protocol.No clinical or imageological evidence supporting disease progression was found on this patient.Median follow-up period was 32.8 months (2.9-63.9 months). Except one patient, none of the rest cases had active disease till follow-up ended.Two-year event free survival(EFS) of this research was (92.3± 7.4)%.There was no significant difference between EFS of treated group and that of observation group( χ2=1.250, P=0.264). Conclusions:Skin-limited LCH often occurs in infants and newborns, with strong heterogeneity in clinical manifestations, laboratory indicators, and pathogenesis.Seborrheic dermatitis-like lesions were the most common cutaneous type.The prognosis of the patients is excellent despite progressing into multisystem involvement can be seen in a few patients.

With the increasing incidence of cardiovascular diseases,Professor WANG Yongyan has adhered to the traditional principles while embracing innovation,proposing to apply the theory of"the heart governing the spirit"to the prevention and treatment of cardiovascular diseases.He emphasized that it is crucial to preserve the spirit before the onset of disease,which includes maintaining a balanced diet,regular lifestyle,avoiding excessive labor,maintaining a serene and unfettered mind,and nurturing the spirit within.For those already suffering from disease,preventing progression and deterioration requires adjusting the spirit,and skilled practitioners should first inspect the patient's spirit by examining the eyes,tongue,facial complexion,and overall physical condition.In treatment,adjusting the spirit involves distinguishing between different imbalances of qi,blood,yin,yang,cold,heat,deficiency,and excess,and employing appropriate method to calm and nourish the spirit accordingly.After the illness,nurturing the spirit is essential,including spiritual nourishment through exercise,dietary therapy,emotional therapy,and external treatments.By applying the theory of"the heart governing the spirit"throughout the prevention,treatment,and rehabilitation of cardiovascular diseases,Professor WANG Yongyan's approach effectively prevents the occurrence of cardiovascular diseases,controls their progression,inhibits deterioration,and improves the prognosis of patients.

Objective: To compare the efficacy and safety of short course and high-dose Dexamethasone (HDD) and conventional Prednisone as first-line strategy for children newly diagnosed as primary immune thrombocytopenia (ITP). Methods: This study analyzed pre-experimental data of a single center prospective randomized controlled clinical trial.Newly diagnosed but untreated ITP patients enrolled at the Department of Blood and Cancer Center, Beijing Children's Hospital, Capital Medical University from November 2016 to May 2017 were randomized into HDD group[Dexamethasone 0.6 mg/(kg·d), intravenous injection for 4 days]and Prednisone group[Prednisone 2 mg/(kg·d) for 14-28 days and then tapered within 1-2 months, the course of treatment less than 3 months]. Initial response, sustained response and adverse effects after therapy were observed in 2 groups. Results: Sixty-six children with ITP were included in the study: 32 patients were in the HDD group and 34 patients were in the Prednisone group.Two groups were matched in the baseline characteristics including gender, age, platelet counts and disease course before therapy and bleeding assessment (all P>0.05). The initial response (the response of HDD group within 10 days of treatment and Prednisone group within 28 days of treatment): overall initial response had no statistical difference between the HDD group and the Prednisone group[90.6%(29/32 cases) vs.100.0%(34/34 cases), χ²=1.528, P>0.05]. HDD group had a lower incidence of complete response compared with that in the Prednisone group[54.4%(19/32 cases) vs.94.1%(32/34 cases), χ²=11.330, P=0.001]; median time of response in two groups showed no statistically difference (2 d vs.1 d, Z=-0.149, P>0.05). There was no significant difference in the recovery of skin and mucosal bleeding after treatment between the Dexamethasone group and the Prednisone group (Z=-1.413, -1.031, all P>0.05). The sustained response (the response lasted for up to 6 months and above): overall and complete sustained response had no statistically difference between the HDD group and the Prednisone group [92.9%(26/28 cases) vs.85.3%(29/34 cases), P=0.594; 78.9% (15/19 cases) vs.81.3%(26/32 cases), P=1.000]. Log-rank test showed no significant difference in the duration of response between 2 groups (P=0.341). The side effects in the Prednisone group included weight gain or Cushing sign (94.1%) and mental and emotional changes (23.5%); in the HDD group 15.6% of children had infection, without other glucocorticoid-related side effects.There was no significant difference in the incidence of infection between two groups[15.6%(5/32 cases) vs.26.5%(9/34 cases), P=0.281]. All of the above infections were of respiratory tract infections and mild gastrointestinal infections. Conclusions Efficacy of the HDD group in the initial and sustained responses is similar, but side effects were apparently lower compared with that in the Prednisone group.However, a large multicenter randomized controlled clinical study is necessary to confirm this result.