Objective To investigate the clinical value of strain ratio in differential diagnosis of thyroid tumors,compared with the evaluation based on elastography scores.Methods Elastography examinations were performed in 67 patients with 92 thyroid tumors.Ultrasonic elastograms were evaluated according to the four- and five-score system respectively.Strain ratio of the tumor and the surrounding tissue was also calculated.Clinical value of the three evaluations was compared with pathological findings as the reference standard.Results The area under the curve:0.885 for the four-score,0.904 for the five-score,0.961 for the strain ratio.When a cutoff point of 3 was used,four-score and five-score showed a sensitivity of 78.0%,a specificity of 86.3%,an accuracy of 82.6% and a sensitivity of 80.5%,a specificity of 88.2%,an accuracy of 84.8%,respectively.When a cutoff point of 3.57 was introduced,the strain ratio had 92.7% sensitivity,92.2% specificity,92.4% accuracy.Conclusions Strain ratio was more helpful in diagnostic performance of thyroid tumors as a new semi-quantitative method than elastography scores.

BACKGROUND:The authors' experiments of the earlier stage proved that the hypocrellin B photodynamic therapy(HB-PDT) can cause selective injuries to choriocapillaries. It is not known whether changing the therapeutic parameters would gain a different result regarding the choriocapillaries after the hypocrellin B photodynamic treatment for a month.OBJECTIVE: To observe the features of Chinchilla rabbit choriocapillaries after HB-PDT treatment and to probe into the research prospect of using HB-PDT to treat choroidal neovascularization (CNV) and of using green light as the light source for PDT.DESIGN: A single sample study.SETTING: Laser Department of the Chinese PLA General Hospital.MATERIALS: The trial was conducted at the Laser Department and the Department of Pathology of the Chinese PLA General Hospital as well as the Department of Photoelectric Engineering of Beijing University of Science and Engineering. The materials included photosensitizing agent hypocrellin B (HB), a green laser transmitter, fundus fluorescence camera and transmission electronic microscope.METHODS: The 532 nm green laser transmitter and slit-lamp microscope were connected by light fiber. Chinchilla rabbits of 2.5 to 3.5 kg was narcotized generally and HB(1. 0 mg/kg) was injected into the marginal ear vein. HB was excited with the green laser of 532 nm. The power density of the light spot on fundus was 300 mW/cm2, and the energy density 30 J/cm2. Laser was applied immediately after HB injection and the diameter of the light spot was 2 000 μm. Direct observation of retina, fluorescein fundus angiography and observation with light microscope and electronic microscope were conducted on the 1st, 7th and 28th days respectively after PDT to find the biological features of retina and the choroid.MAIN OUTCOME MEASURES: Non-selective injury of retina through direct observation of the fundus; obliteration of the choriocapillaries detected through fluorescein fundus angiography; the position and extent of non-selective injury in retina and the structural changes of the choriocapillaries observed through the light microscope; the ultrastructural changes of the fundus observed through the electronic microscope.RESULTS: One day after PDT, photodynamic thrombosis was formed in choriocapillaries being illuminated and the external layer of retina was apparently injured. On the 7th day, injury of endothelial cells of the choriocapillaries was aggravated without obvious changes of the main vessels of choroid. On the 28th days, fibrous tissue appeared where the choriocapillaries had been and the glass membrane became thickened. Repair and proliferation of RPE cells appeared in the laser illuminated area.CONCLUSION: The biological effect in the target area and non-selective injury in the non-target area began to appear from the 1st to the 7th day after PDT and continued to aggravate. That would be repaired by fibrous tissues from the 28th day. It deserves further studies to treat age-related macular degeneration or other diseases in fundus characterized with choroidal neovascularization.

Objective To study the changes and clinical significance of glutathione redox-state in patients with chronic heart failure.Methods A total of 81 hospitalized CHF patients(NYHA heart function grade from Ⅱ to Ⅳ)and a total of 28 paroxysmal supraventricular(PSVT)patients without other diseases(controlled group)were recruited in Cadiovascular Wards of the First Affiliated Hospital of Suzhou University from Jun.2006 to Mar.2007.The plasma concentration of GSH and GSSG was determined by using glutathione reductase recycling method(GR-DTNB).Redox potential(EhGSH/GSSG)was calculated using Nernst equation according to the concentration of reduced and oxidized glutathione.Results(1)The concentration of GSH was significantly lower in CHF group compared with control group(P

Objective To discuss the imaging appearances and causes of hepatic pseudolesions around the falciform ligament.Methods 40 patients (23 cases of A-type,17 cases of B-type) of hepatic pseudolesion around the falciform ligament examined by CT were collected.Combined with pathology of 2 cases,follow-up of 6 cases,MRI findings in 5 cases,and with the relevant literature reviewes,the density change of CT plain and enhanced scan and the causes of hepatic pseudolesion around the falciform ligament were analyzed retrospectively.Results There were low density in 25 cases,isodensity in 13 cases,high density in 2 cases in arterial phase,density lower than that of liver in 40 cases in portal phase,low or slightly low density in 27 cases and isodensity in 13 case of A-type in delayed phase.Of 40 cases,there were isointense in 2 cases of A-type in any sequence,and no sigal changes on out-phase images;there were intensity decline on out-phase images comparing to in-phase images in 3 cases of B type.Of 6 CT follow-up cases,there were no changes in 2 cases of A-type and shrinked or disappear in 4 cases of B-type;and there were more shrinked in 1 B-type case of MRI follow-up again after one month.Conclusion Hepatic pseudolesion of A-type can be resulted from focal fatty infiltration,and that of B-type can be caused by special blood-supply.They have characteristics in locations,and characteristic imaging appearances on CT and MRI images,and they can be clearly diagnosed generally.

Objective To explore the effect of inhibiting Akt phosphorylation on tumor necrosis factor related apoptosis inducing ligand (TRAIL)-induced apoptosis of human non-small cell lung cancer (NSCLC) H1299 cells with wild type EGFR and KRAS.Methods The TRAIL-induced apoptosis was examined by the Annexin V-FITC/PI.The expressions of TRAIL-activated Akt phosphorylation and p-Akt were measured by Western blot.After cells were treated with LY294002, an inhibitor of PI3K-Akt pathway, Annexin V-FITC/PI and Western blot were used to analyze the alteration of TRAIL-induced apoptosis and Akt phosphorylation, respectively.Results H1299 cells were not sensitive to TRAIL-induced apoptosis.When TRAIL concentration was 100 ng/ml, the apoptosis rate of the test group was significantly higher than that of the control group [(15.06±1.29) ％ vs (3.56±0.50) ％, t =66.953, P =0.000].When TRAIL concentration was 500 ng/ml, the difference was not statistically significant compared with apoptosis rate of 100 ng/ml TRAIL group [(18.65±2.09) ％ vs (15.06±1.29) ％, t =2.423, P =0.136].The expression level of Akt phosphorylation in H1299 cells was increased by TRAIL in a time-dependent way.When cells were pretreated with LY294002, TRAIL-induced Akt phosphorylation was suppressed to baseline level.At the same time, the apoptosis rate in LY294002-treated group was significantly higher than that in TRAIL group [(41.65±4.62) ％ vs (15.82±0.61) ％, t =39.028, P =0.001].Conclusions TRAIL-induced Akt phosphorylation can antagonize TRAIL-induced apoptosis.Inhibition of Akt phosphorylation can significantly enhance the sensitivity of NSCLC H1299 cells with wild type EGFR and KRAS to TRAIL-induced apoptosis.

Objective To explore CT and MRI imaging in the application of newly diagnosed esophageal cancer staging.Methods 200 patients with newly diagnosed esophageal cancer were selected as the research object, who voluntarily accepted the chest CT and MRI examination.Newly diagnosed esophageal cancer pathological results and CT,MRI features were observed.Spiral CT,MRI for T staging of esophageal cancer and N staging diagnosis were compared.Results In 200 patients,including 160 cases of squamous cell carcinoma,30 cases of adenocarcinoma, 10 cases of other types,T1 ,T2 ,T3 and T4 clinical staging period were respectively 19 cases,47 cases,81 cases and 53 cases,while N0 and N1 period were 65 cases and 135 cases respectively.The lesion diameter was 10 -22 (16.5 ± 4.6)mm.CT and MRI showed irregular thickening of the esophageal wall,CT showed equal or slightly lower density, T1 WI was MRI or low signal,T2 WI showed a slightly higher signal.Enhanced scanning,a substantial part of lesion enhancement,while the dead part had no enhancement.In T1 ,T2 of the diagnosis of esophageal carcinoma,MRI had higher diagnostic sensitivity and accuracy compared with CT,and the difference was statistically significant (χ2 =4.32,3.89,all P <0.05).In T3 ,T4 of the diagnosis of esophageal carcinoma,there were no statistical significance of MRI and CT of the diagnostic sensitivity,specificity and accuracy rate difference (P >0.05).By using the joint appli-cation of the two methods,the diagnostic sensitivity and accuracy were significantly higher than that used alone,the difference was statistically significant (χ2 =4.12,3.98,all P <0.05).In the diagnosis of N0 and N1 in esophageal cancer,MRI had a higher sensitivity,there were statistically significant difference compared with CT (χ2 =4.54, 4.23,all P <0.05).The two methods had no significant difference in N0 and N1 phase specific diagnosis of esophage-al cancer and the correct rate (P >0.05).The combined application of MRI and CT significantly improved the diag-nostic sensitivity and accuracy.Compared with the single application,the difference was statistically significant (χ2 =4.32,4.54,all P <0.05).Conclusion MRI is more sensitive to diagnosis T1 ,T2 stage and N0 ,N1 stage in esopha-geal carcinoma.Combined application of MRI and CT can improve the diagnostic sensitivity and accuracy.

Objective To describe the psychological experience of the patients with end-stage cardiopathy in China. Methods Phenomenology method was used in the study. Fifteen end stage cardiopathy patients received a non-structured interview. Results Four themes were extracted including heavy psychological burden about the disease and the selection of treatment options; complex psychological responses to families and relatives; wishing of social support;lose heart to personal future and prospects. Conclusions The patients on the end stage cardiopathy have complicated and intensive psychological responses. Medical staff should focus on the emotional of these patients, and provide effective strategies to promote patients'physical and psychological rehabilitation.

Objective To evaluate the postoperative prognosis of the modification of diet in renal disease formula (MDRD) in coronary artery bypass graft surgery (CABG) in hospital or 4 years after hospitalization. Methods Two hundred and seventy-two CABG patients were divided into 3 groups according to the levels of estimated glomerular filtration rate (eGFR) including 35 cases in eGFR < 60 ml/min group, 119 cases in 60 ≤ eGFR < 90 mL/min group and 118 cases in eGFR ≥90 ml/min group. The prognostic factors of CABG patients were analyzed by COX proportional hazards models. Kaplan-Meier survival analysis was used to compare survival curves among the three groups stratified by eGFR levels. The Log-rank statistic was used for comparing between groups. Results By multivariate COX regression adjustment for body mass index, smoking, hypertension, hyperlipaemia, diabetes mellitus, previous MI, perioperative PCI and etc. , the relative risk (RR) of the increasing age for cardiac events was 1.077(95% CI 1.002-1.158,P =0.044). RR of left ventricular ejection fraction (LVEF) was 0.005(95% CI 0.000-0.456,P =0.022). RR of eGFR was 0.968(95% CI 0.948-0.988,P =0.002). The survival rate in the first, second, third and fourth year were same in every group. The survival rate of group with eGFR < 60 ml/min, 60 ≤ eGFR < 90 ml/min and eGFR≥ 90 mL/min was 76.4%, 93.1%, and 96.6%. The survival rates among three groups were statistically significant. In the survival curve of 4 year follow-up after CABG, the survival rate of group with eGFR < 60 mL/min was lower than that of 60 ≤ eGFR < 90 ml/min group and eGFR ≥ 90 ml/min group. Conclusions The preoperative eGFR is an independent risk factor in evaluating cardiac events in hospital and after hospitalization. It has a higher prognosis value in patients undergoing CABG.

Objective To summarize the characters of the elastograms of different pathological nodules, and to observe the value of elastography in differentiating benign from malignant thyroid solid nodules. Methods One hundred and sixteen patients with thyroid nodules were enrolled in the study and 122 nodules were detected in total. All of them were examined by elastography and conventional ultrasound. Five sonographers were invited to evaluate the nodules double blinded basing on the images and the four-point system proposed by Fukunari. The interobserver agreement was evaluated by Kappa coefficient. Diagnostic performances of the five readers were compared by the ROC curves. Distributions of elastography scores of different pathological nodules were compared by one-way ANOVA. Results Interobserver agreements on scoring the nodules were moderate. Mean value of benign nodules was obvious lower than that of the malignant ones. The mean score of nodular goiters was 2.67 ± 0.89, range from 1 to 3. Most of the adenomas got score of 2, but the score of thyroiditis was quite high. No significant differences were found between the comparison of thyroiditis and thyroid cancers. Areas under the ROC curve (AUC) of the five readers were 0.82,0.81,0.79,0.73 and 0.83 respectively. When 3.5 was choosen as the cut-off point, the sensitivity of elastography was 82.4%, and specificity was 71.6%. Conclusions Elastography was really a useful technique for it can provide a new index for the differential diagnosis of thyroid nodules. However, the 4-point score system is not comprehensive enough.

Objective To evaluate the quality of life and influencing factors in patients with breast cancer after breast-conserving surgery, so as to provide theoretical support for preoperative health education and postoperative rehabilitative intervention for these patients. Methods 120 breast conserving surgery (BSC) and 140 modified radical mastectomy (MRM) patients were assessed with Functional Assessment of Cancer Therapy-Breast (FACT-B V4.0) one week after operation. Life quality was evaluated between the two groups, and the influencing factors were also analyzed. Results Postoperative breast cancer patients after breast conserving surgery were with good breast complementary attention, lower emotion state. The other scores of quality of life had no statistical difference. Influencing factors on the quality of life of breast cancer patients were anxiety state, relationship of family members, position of surgery and character type. Conclusions It suggests that nursing specialists should make out corresponding, scientific and reasonable nursing intervention schemes based on the characteristics of different groups of people to ease psychological burden, and elevate the quality of life effectively for postoperative breast conserving surgery patients.