Abnormal thyroid function is high risk for pregnancy.Studies from clinical observation and animal experiments have indicated that maternal sub clinical hypothyroidism during the first gestational term may lead to impairment of brain development of offspring,and early diagnosis and effective treatment may prevent the damage.Therefore,it is suggested that screening thyroid function before gestational 8 weeks in pregnant women is initiated.The changes in thyroid function during pregnancy are related to these changes in maternal thyroid physiology can lead to confusion in the diagnosis or evaluation of thyroid abnormalities.Establishment of trimester-specific reference ranges is urgently needed.Local iodine nutritional statue and testing reagent effect the measured value of thyroid function in general population,so it is recommend that all regions and hospitals should establish their own pregnancy reference ranges.

Objective To investigate the relationship between the level of serum brain natriuretic peptide(BNP) and the severity of coronary artery disease in elderly patients with coronary heart disease(CHD).Methods We recruited 498 elderly CHD patients undergoing coronary angiography(CAG) from our hospital.Based on CAG results,patients were divided into two groups:406 patients with lesion of vessel(s)and ≥50％ vessel stenosis as the CHD group,and the other 92 patients with ＜ 50％ vessel stenosis as the negative control group.Their clinical data such as left ventricular ejection fraction(LVEF) and serum BNP was recorded.The patients was further divided into 177 single-,129 double-,100 triple-,and 92 negative vessel disease groups according to the number of vessels with significant stenosis.The patients with CHD were divided into three different age groups:(1) A group:60-69 years old,254 patients ;(2) B group:70-79 years old,112patients;(3)C group:equal or greater than 80 years old,40 patients.Serum levels of BNP were measured before CAG.The relationship between BNP and the severity of coronary disease was analyzed.Results The level of BNP was significantly elevated in the CHD group[(387.5±132.3)ng/L]than the negative control group [(58.6±22.1) ng/L](t =23.83,P ＜ 0.01).The level of BNP was significantly enhanced(F =87.42,P ＜0.01) along with the increasing number of coronary artery Stenosis,with single vessel disease group(202.2±116.6)ng/L,double vessel disease group(487.5±152.3)ng/L and triple vessel disease group(768.7±264.3) ng/L; the level of BNP significantly increased(F =57.33,P ＜ 0.01) along with increasing age,with A group(182.6±93.1)ng/L,B group(352.2±121.2)ng/L and C group(491.2±158.7) ng/L.The level ofLVEF did not change in the procedure(P ＞ 0.05).Conclusion The levels of BNP were closely associated with the severity of coronary artery disease and were a strong clinical predictor for myocardial ischemia.

Objective To explore the effect of hyperglycemia on the survival time, duration of disease remission and complications during induction chemotherapy for acute lymphocytic leukemia(ALL). Methods The treatment-related complications in 98 adult ALL patients with or without hyperglycemia were retrospectively analyzed. Survival time and complete remission duration(CRD) were evaluated using Kaplan-Meier method. Cox regression analysis was used to examine whether hyperglycemia was an independent predictor of disease recurrence and death. Results ALL patients with hyperglycemia were found to be older, and more likely to occur thrombocytopenia. ALL patients with hyperglycemia had a shorter CRD and survival time, and were more likely to develop infection and neuropathy. Conclusion Hyperglycemia during induction chemotherapy for ALL increased the frequency of infection and the risk of disease recurrence and death.

Objective To compare the efficacy and side effect between Paracetamol and Tramadol Hydrochloride Tablet and Paracetamol and Dihydrocodeine Tartrate Tablet on chronic pain. Methods From October, 2013 to October, 2015, 84 patients with chronic pain were divided into group A (n=42) and group B (n=42), who took two Tramadol tablets or Dihydrocodeine Tartrate tablets, three times a day orally for five days. They were assessed with Numerical Rating Scale (NRS), and the incidence of satisfaction and side effect were in-vestigated. Results The score of NRS decreased in both groups after treatment (t>9.402, P<0.001), and there was no significantly difference between them (t=0.461, P=0.941). No significant difference was observed in incidence of pain relief and satisfaction between two groups (χ2=0.979, P=0.323). The incidence of constipation (χ2=5.864, P=0.006) and abdominal distention (χ2=9.946, P=0.002) were less in group A than in group B, but the incidence of nausea was more (χ2=4.934, P=0.026), while the incidence of dizziness, vomiting and tiredness was no significantly different between two groups (χ2<1.451, P>0.061). Conclusion The analgesic efficacy is similar of both drugs, but different in side effects of gastrointestine.

Objective To analyze the detection rates,species distribution and drug-resistance of urinary fungal infection in elderly patients at Beijing Hospital from 2011 to 2013,in order to provide the basis for the reasonable clinical use of anti-epiphyte medicines.Methods Totally 263 patients with an average of 79.6 years old were collected from Beijing Hospital.The urine from freshly voided midstream or bladder puncture was collected under aseptic condition for fungal culture,then the strains of epiphytes were identified by using API 20C AUX.The drug sensitivity was tested with ATB fungus3.Results 263 strains of epiphytes were isolated from the 2 983 urine samples,of which 92 were C.tropicalis,85 were C.glabrata,77 were Candida albican,and 9 were other fungus candida.The rates of drug resistance to fluconazole were 14.1 ％ (13 strains),37.6 ％ (32 strains) and 15.6％ (12 strains),and to itraconazole were 16.3％(15 strains),35.3％(30 strains) and 9.1％(7 strains),respectively.All of the 263 strains were not found to have drug resistance to amphotericin.Conclusions The isolation rate of urinary fungal infections is 8.8％ in Beijing Hospital.The majority of the tested fungal are C.glabrata,C.tropicalis and Candida albican,the former has higher resistance rate to azoles,and the two latter have better sensitivity to azole,and all of them have the sensitivity to amphotericin.

Objective To investigate the effects of continuous stellate ganglion block (SGB) on serum thyroid hormone and cortisol levels in patients with severe brain injury.Methods Eighty ASA Ⅱ or Ⅲ patients with severe brain injury aged 22-61 yr undergoing emergency craniotomy were randomly divided into 2 groups ( n = 40 each): control group (group C) received routine treatment only and continuous SGB group (group SGB) received continuous SGB with 0.2% ropivacaine besides routine treatment. SGB was performed on the operated side after induction of general anesthesia and tracheal intubation. An epidural catheter was placed. A bolus of 0.2% ropivacaine 7 ml was followed by continuous infusion of 0.2% ropivacaine at a rate of 2 ml/h. Continuous SGB was maintained for 48 h. Successful SGB was confirmed by increase in skin temperature by ≥1.5℃ behind earlobe on the operated side.Venous blood samples were obtained at 30 min before and 3 and 7 day after operation for determination of serum thyroid stimulating hormone (TSH), triiodothyronine (T3) ,thyroxine (T4) , reverse triiodothyronine(rT3) and cortisol concentrations. Glasgow prognosis score was used to evaluate the clinical results at 3 months after operation. Results Serum T4 , rT3 , TSH and cortisol concentrations were significantly lower while the serum T3 concentration was higher in the SGB group than in group C at 3 and 7 d after operation. The clinical results were significant better in SGB group than in group C according to Glasgow prognosis scores at 3 months after operation. Conclusion Continuous SGB can inhibit the stress response, and improve hypothalamus-pituitary-thyroid gland axis function and is helpful to patient's recovery from injury.

Objective To evaluate the effects of parecoxib on cellular immune function during patientcontrolled intravenous analgesia (PCIA) with butorphanol after modified radical mastectomy in patients.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 36-60 yr,weighing 48-82 kg,scheduled for elective modified radical mastectomy,were randomly divided into 2 groupe (n =30 each):control group (group C) and parecoxib group (group P).PCIA with butorphanol 10μg/kg was used at the end of operation.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In group P,parecoxib 40 mg was injected intravenously at the end of operation and 12,24 and 36 h after surgery,while in group C,the equal volume of normal saline was injected.VAS score was maintained at ≤4.When VAS score≥5,butorphanol was injected intravenously as a rescue analgesic.Blood samples were obtained from the right internal jugular vein at 5 min before induction of anesthesia,2 h after skin incision,and 6 h and 1,3,7 days after surgery for determination of the levels of T lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8+) and natural killer (NK) cells (by flow cytometry).CD4+/CD8+ was calculated.The number of attempts,the number of successfully delivered doses and requirement for rescue analgesics were recorded at 2,6,12,24 and 48 h after surgery.Adverse effects were also recorded after surgery.Results Compared with group C,the number of attempts and requirement for rescue analgesics were significantly decreased,the number of successfully delivered doses was increased,and the levels of CD3+,CD4+,CD4+/CD8+ and NK cells were decreased at 1 day after surgery (P ＜ 0.05).There was no significant difference in adverse effects between the two groups (P ＞ 0.05).Conclusion Parecoxib can enhance the efficacy of postoperative PCIA with butorphanol and reduce the consumption of butorphanol thus improving cellular immune function after modified radical mastectomy in the patients.

AIM: To investigate the effect of electro-acupuncture (EA) at Zusanli (ST36) on proinflammatory factors induced-multiple organ dysfunction in rats with sepsis. METHODS: Sixty four male Wastar rats were used to develop the sepsis model by cecal ligation and puncture (CLP). The animals were randomly divided into 4 groups (n=16 in each group): CLP+EA (CLP/EA), CLP+sham EA (CLP/SEA), vagotomy+ CLP+SEA (VA/CLP/SEA) and vagotomy+CLP+EA (VA/CLP/EA). Zusanli point (ST36) was electroacupunctured with constant voltage (2-100 Hz, 2 mA for 0.5 h) 20 min after CLP surgery. Bilateral cervical vagotomies were performed in rats in VA/CL/SEA and VA/CLP/EA groups. Twelve hours after CLP, animals were sacrificed and liver, kidney and jejunum were harvested for evaluating the contents of tumor necrosis factor-α (TNF-α), myeloperoxidase (MPO) and diamine oxidase (DAO). The rate of water content (WCR) of the organs was determined. At the same time, the plasma levels of alanine aminotransferase (ALT) and creatinine (Cr) in each group were also detected. RESULTS: The levels of ALT and Cr in plasma, as well as TNF-α, MPO and WCR in organ tissues were markedly lower, and the activity of DAO in jejunum tissue was obviously higher than that in CLP/SEA group at 12 h after CLP (all P<0.05). The levels of ALT, Cr, TNF-α, MPO and WCR in VA/CLP/SEA group and VA/CLP/EA group were significantly higher, the activity of DAO was obviously lower than that in CLP/SEA group (all P<0.05). No statistical difference in all above measurements between VA/CLP/EA group and VA/CLP/SEA) group was observed (all P>0.05). CONCLUSION: The results indicate that EA at Zusanli point obviously decreases the levels of TNF-α in liver, kidney and jejunum tissues after CLP, and alleviates the tissue edema and dysfunction of those organs. Vagotomy decreases or eliminates the effects of EA, suggesting that activation of cholinergic anti-inflammatory pathway is one of the main mechanisms to induce the effects of EA at ST36 on CLP sepsis.

Objective To analyze thyroid papillary carcinoma (PTMC) neck lymph node metastasis (LNM) related factors,and further to explore the diagnostic value of ultrasonography in LNM.Methods A retrospective analysis of 384 cases of patients with PTMC confirmed by pathology and ultrasonic data were performed,according to the presence of cervical lymph node metastasis,they were divided into transfer group (116 cases) and nontransfer group (268 cases).Analysis was made to summarize the clinical and sonographic features of the two groups.Chi-square test and the multi-factor Logistic regression analysis were used to study the risk factors.Results ①The single factor analysis of sonographic features showed that the factors of gender (X 2 = 3.893,P = 0.048),age (P = 0.001),tumor diameter (P = 0.008), boundary(X 2 =6.327,P =0.012),acoustic halo (X2 = 15.562,P =0.001),and place (X 2 =9.441 ,P =0.024) were statistical different between the two groups;②Multiariable Logistic regression analysis showed that:patient age,tumor diameter,and acoustic halo were independent risk factors for PTMC neck lymph node metastasis,if Logistic model was used to predict the probability P =0.50 as a threshold,its accuracy was 74.2%,and the area under the ROC curve was 0.744.Conclusions Patients with age ≤ 45 years, tumor diameter ≥ 0.7 cm,located in the lower pole,boundary with uneven acoustic halo,were prone to LNM,and easy to Ⅵ area,suggest preventive cleaning lymph node in central region.

Objective: To observe the acute toxicity of Ke'erxing Capsules (KC) in mice and its long-period toxicity in rats. Methods: The maximal tolerance dose was tested by gastric infusion of single oral dose of KC. Three groups of rats (in high, moderate and low dosage of KC) were administered with repeated gastric infusion of KC for 8 weeks. Body weight, hematological and hematobiochemical parameters, coefficient and histomorphological figure of organs (the heart, liver, spleen, lungs, kidneys, adrenals, testes, prostate, pancreas, uterus, brain, thymus) were examined in 8 weeks and 2 weeks after the cessation of KC. Results: The oral maximal tolerance dose of KC in mice was more than 4000 mg/kg (equal to 600 times of clinical dose). General conditions were changed and the body weight was increased slowly in high-dosage group. The coefficient of prostate was increased in high-dosage group and moderate-dosage group and recovered to normal 2 weeks after stopping the drug. Conclusion: KC has a certain effect on mice and rats but the effect was reversible.