Simultaneous concurrence of subacute thyroiditis and Graves' disease is rare.We present one case of subacute thyroiditis with Graves' disease and combine with other reports to explore the clinical characteristics and therapeutic considerations.If subacute thyroiditis is considered coexisting simultaneously with Graves' disease,radioactive iodine uptake,thyroid autoantibody,fine-needle aspiration of thyroid gland,thyroid nuclide imaging examination,etc,should be done to make correct diagnosis and to adjust the therapeutic plan.

The author used five Chinese medicinal herbs,Barbat skullcap,Wolly yam,Anemarrhena,Phellodendron bark,and Dandelion herb,to make up decoctions to treat urinary tract infection(UTI). Ex-trinsic bacteriostatic experiments for colibacillus and bacillus proteus,which commonly occure in urinarytract infection,were observed.The result shows that both Barbat skullcap and Wolly yam are most effectivein treating UTI.So single Chinese medicinal herb can also be used in clinical.

Objective To understand the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Methods Taking a survey among the pre-hospital emergency physicians(80 people)and nurses(248 people)by Questionnaire of ethics conflicts during pre-hospital emergeney service,to investigate the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Resulls (8.046±6.990)%of the patients who needed treatments refused to be treated completely,and(14.544±10.558)%of them refused partially.(14.451±14.747)% of the patients who needed ambulance transport refused to be delivered.In the patients who refused treatments and transportation.payment problem accounted for(23.52±19.79)%,(22.22±20.84)%of them did not believe they needed.(5.77±4.47)%of them wished to die,(19.44.4±18.65)%of them were hard to be idenfified.Other reasons accounted for(30.08±25.78)%.(20.31.4±16.66)% of the patients refused the ambulance crews' judge for some state.(29.66.4±24.02)%of the patients who got the pre-hospital emergency service were not necessary to call an ambulance.(22.1 l±19.52)%of the patients' demand conflicted with pre-hospital emergency services network management system.Conclusions There exists some conflicts between the pre-hospital patients and ambulance crews' determinations.

Objective To investigate the independent factors influencing the efficacy of pre-hospital CPR effect. Method The data base with 1376 cases was set up with EpiData software by means of questionnaires and the information was provided by the survivals from cardiopulmonary arrest( CA)saved with cardiopulmonary resuscitation(CPR), and the data were analyzed with SPSS 13.0 software to carry out binary logistic regression. Through single factor analysis, the factors with emerged statistical significance were chosen as variances. Results With regard to the restoration of spontaneous circulation(ROSC), the rescue did by the first witness was the protective factor(PF)( OR = 2.21, P = 0.001, 95.0% CI=1.356-3.602); the male was the risk factor(RF) contrasted with the female( OR = 0. 515, P =0. 006, 95.0%0 CI = 0.320 - 0. 26) ; ages between 20 and 29 years old had higher likelihood of ROSC than group ≥81 years old( OR = 3.241, P = 0.026, 95.0%CI = 1.146 -9.138); the length of CA time before CPR was RF(OR = 0.913, P = 0.000, 95.0%CI = 0.887-0.948);ventricular fibrillation(VF) was PF compared with asystole( OR = 5.092, P = 0.000, 95.0%CI=2.927 -8.861); electric shock was PF(OR = 3.384, P = 0.000, 95.0%CI = 2.033 - 5.635); epinephrine dosage 0 - 4 mg had higher likelihood of ROSC than > 5 nag dosage( OR = 3. 255, P = 0. 001, 95.0% CI = 1. 606 -6.597). In respect of probability about victims at the tittle reached hospital alive, ages of 2- 12 and 13 - 19 years old had higher rations than ≥81 years old( OR = 12.818, P = 0.029, 95.0% CI = 1.299 - 126.508)( OR = 10.505, P = 0.036, 95.0% CI = 1.161-95.058); the length of CA time before CPR was RF(OR =0.862, P = 0.000, 95.0%CI = 0.821-0.906); VF was PF compared with asystole(OR = 7.330, P =0.000, 95.0%CI = 3.962 - 13.560). Conclusions ECG change before CPR, rescue by the first witness,electric shock, the length of CA time before CPR, epinephrine dosage, gender and age were independent influencing factors of pre-hospital CPR for the emergency of ROSC. Age, the length of CA time before CPR and ECG before CPR were influencing factors of pre-hospital CPR for patients at the time transferred to hospital alive.

Objective: To evaluate the effect of echocardiography for occluding the multiple seconded atria1 septal defects ( MASD) in relevant patients.
Methods: A total of 42 MASD patients were selected by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The transcatheter closure was monitored by TTE and X-ray, the effect of treatment was evaluated by TTE, ECG and chest X-ray at 24 hours and 1, 3, 6 months after the procedure. There were 38 patients with 2 defects, 3 with many central small defects and 1 with 3 defects. The patients included 17 male and 25 female with the mean age of (32.6 ± 13.4) years.
Results: The size and distance of the defects were measured with 4 cardiac chambers cross sectional study. The mean diameter of bigger defect from up to down was (9-27) mm, with the mean of (20.7 ± 6.1) mm, from front to back was (8-23) mm, with the mean of (16.9 ± 5.7) mm;the mean diameter of small defect from up to down was (3-12) mm, with the mean of (6.8 ± 3.6) mm. The length of the defect interva1 was (4-18) mm, with the mean of (7.9 ± 2.6) mm. There were 4 patients with 2 defect interval at 8.7 mm who received 2 occluders without post-operative lfow shunt. The rest 38 patients received 1 Amplatzer occluder which was (14-36) mm with the mean of (25.1 ± 6.4) mm which was (6.9 ± 1.7) mm larger than echocardiographic prediction. The success rate of implantation was 100%. There were 17 (40.5%) patients with post-operative lfow shunt. The patients were followed-up for (6-36) months, with the mean of 18.7 months, there were 11 (26.2%) patients with small amount of lfow shunt at 3 months after the operation.
Conclusion: Echocardiography is important for choosing the type and size of occluder devices, in-operative monitoring and post-operative effect evaluation for treating the ASD patients.

Objective To investigate CT,clinical and pathological features of primary pulmonary lymphoepithelioma-like carcinoma (LELC). Methods The clinical,CT and pathological data of 22 patients with pulmonary LELC confirmed by pathology were analyzed retrospectively, including 8 males and 1 4 females whose ages were from 1 8 to 88 years old.Results Among 22 cases,1 2 patients were found by physical examination,2 patients had cough and sputum,7 patients had cough hemoptysis and 1 patient was found by re-examination after breast cancer surgery.On CT,all cases manifested single mass in the lung,and the longer diameters ranged from 1.5 cm to 1 1 cm,in which there were central type tumors in 8 cases and peripheral type tumors in 14 cases.Nineteen masses showed homogeneous density in non-enhanced scan,and the cavity,irregular calcification and small patchy necrosis were seen in each 1 case.After contrast-media injected,masses were mild-moderately or evidently enhanced in 7 cases and 1 5 cases respectively.Eighteen cases had well defined border and unclear border in 4 cases.Vascular encasement were found in 6 central type tumors,8 tumors squeezed peripheral vascular and 8 cases had clear demarcation between tumors and vascular.Nineteen tumors were surgically removed,in which 7 cases appeared metastasis of lymph node.Histopathology showed that the tumor cells had large volumes,unclear boundaries,large nuclei,growing in syncytial nest-like patches.There were abundant lymphocyte and plasma cell infiltration in tumor’s mesenchyma.EBER were done in 1 6 cases and the results were all positive.Conclusion CT feature of pulmonary LELC manifestes that the masses are mostly single,large size, homogeneous density,clearly boundary,shallow lobulated and significantly enhancement.Vascular encasement is the feature of central pulmonary LELC,and peripheral LELC is more likely to occur in the sub-pleural region.Final diagnosis should be combined with clinical and pathological diagnosis.

OBJECTIVETo explore the relationship between temperature and non-accidental mortality in Guangzhou, Changsha and Kunming;to evaluate the temperature-related risk of mortality; and thereby to provide scientific evidence for enacting the policy to tackle climate changes.

METHODDaily meteorology data and mortality data were collected in 2006-2009 in Guangzhou, Changsha and Kunming. Distributed lag non-linear model (DLNM) was established and applied in a case-crossover design, which controlled the secular trend of time, to estimate the specified effects of temperature on non-accidental mortality at conditions of lag 0-2, lag 0-18 and lag 0-27 days, respectively.

RESULTAn obvious seasonal periodicity was found in non-accidental mortality in Guangzhou, Changsha and Kunming during 2006-2009. The mortality number was comparatively high in the winters, and some high temperature days in summer; but was comparatively low in springs and autumn. An L-shaped relationship was found between temperature and mortality in Guangzhou and Kunming and a U-shaped relationship was found in Changsha. When daily mean temperature exceeded 28.2 °C, 24.5°C and 23.2°C, as average temperature increase 1°C, non-accidental mortality increased 4.56% (95%CI:2.74%-6.63%), 5.66% (95%CI:0.22%-12.65%) , -3.94% (95%CI:-32.77%-39.01%) , respectively; when daily mean temperature below 24.8°C, 20.0°C and 17.3°C, as average temperature decrease 1°C, the corresponding increase in non-accidental mortality were 3.28% (95%CI:2.41%-4.10%) (lag 0-18 days), 1.35% (95%CI:0.31%-1.77%) (lag 0-2 days) and 2.42% (95%CI:1.08%-3.27%) (lag 0-27 days) , respectively. The effects of hot weather were acute and short term; while the effects of cold weather had a several days delay, but a longer persistence.

CONCLUSIONSExtreme cold and hot temperature could increase the risk of non-accidental mortality in Guangzhou, Changsha and Kunming. The effects of cold weather had a several days delay, but a longer persistence.

China ; epidemiology ; Climate Change ; Cross-Over Studies ; Humans ; Mortality ; Seasons ; Temperature

Objective To evaluate the impacts of air temperature on years of life lost(YLL) among the residents in Guangzhou and Zhuhai,Guangdong province. Methods Daily mortality and meteorology data in Guangzhou and Zhuhai were collected,and distributed lag non-linear model (DLNM)was used to evaluate the cumulative and delayed effects of daily air temperature on YLL of total non-accident mortality. The accumulative effect of air temperature on mortality under the extreme high temperature(0-1 days)and extreme low temperature(0-13 days)situation in Guangzhou and Zhuhai were analyzed respectively. Results The average YLL was 1 928.0 in Guangzhou and 202.5 in Zhuhai. The exposure-response functions seemed to be non-linear. The hot effect seemed to be acute and reached the peak at the same day,while the cold effect reached the peak at 5th days and lasted for about two weeks. Low temperature had stronger gross effect than high temperature had. The cold effect among males was greater than that among females in Guangzhou. The hot/cold effect on YLL was greater in people aged ≥65 years than in people aged <65 years and in people suffering from respiratory disease than in people suffering from cardiovascular disease in both Guangzhou and Zhuhai. Conclusion The effects of high and low temperatures on YLL were obvious,and the impact of low temperature was greater. The elderly and people suffering from respiratory disease or cardiovascular disease are the vulnerable populations.

OBJECTIVETo explore the impact of the socio-economic factors on the temperature-mortality association in different cities in southern China.

METHODSDaily mortality registration data, meteorological data and air pollution data of the cities as Changsha and Kunming during 2006-2009, and cities as Guangzhou and Zhuhai during 2006-2010, were collected to explore modifying effects, stratified by age, gender, education and place of death, of socio-economic factors on the association between temperature and mortality, by distributed lag non-linear model. The accumulative effect of temperature-mortality were separately analyzed in each city, under the high temperature (0-3 days) and low temperature (0-20 days) situation. The association between temperature and mortality was evaluated by general linear threshold model. The above process was firstly adopted to analyze the impact in single city and then Meta analysis was applied to analyze the impact in several cities by effect-combine.

RESULTSThe relationship between temperature and mortality in the four cities showed nonlinearity. The minimum mortality risk was separately 23.5 °C, 20.5 °C, 25.0 °C and 26.0 °C in Changsha, Kunming, Guangzhou and Zhuhai. The results of effect-combine showed that low-temperature (RR = 1.67, 95%CI:1.54-1.80) has a higher gross effect than high-temperature (RR = 1.11, 95%CI:1.01-1.18) on population. With the age increasing, risk of death increased both under high and low temperature situation, and the effect of low temperature was greater (RR = 1.83, 95%CI:1.65-2.04) for the elderly than it of high temperature (RR = 1.17, 95%CI:1.03-1.33). The mortality risk among females (cold and hot effects(95%CI) were 1.75(1.57-1.97) and 1.11(0.99-1.25), respectively)was higher than it among males (cold and hot effects(95%CI) were 1.59(1.45-1.77) and 1.11(1.03-1.19), respectively). Whereas the mortality risk on higher education population was significantly higher (cold and hot effects (95%CI) were 1.89(1.48-2.45)and 1.34(1.19-1.48), respectively) than it on other educated people.

CONCLUSIONAge, gender, educational level and place of death showed modifying effects on the association between temperature and mortality. The elderly, women and highly educated people were vulnerable to the temperature influence on mortality.

Aged ; Air Pollution ; China ; Cold Temperature ; adverse effects ; Female ; Hot Temperature ; adverse effects ; Humans ; Male ; Mortality ; Nonlinear Dynamics ; Risk ; Socioeconomic Factors

Objective To estimate the effect of daily diurnal temperature range (DTR) on mortality in different areas in China.Methods A time series study using the data collected from 66 areas in China was conducted,and Meta-analysis was used to analyze the estimates of associations between DTR and daily mortality.Modifying effects of extremely low and high DTR-mortality relationship by season and socioeconomic status (SES) were also evaluated respectively.Cumulative excess risk (CER) was used as an index to evaluate the effects.Results The information about 1 260 913 registered deaths were collected between 1 January 2006 and 31 December 2011,we found the relationship between extreme DTR and mortality was non-linear in all regions and the exposure-response curve was J-shaped.In central and south areas of China,the result indicated the obvious acute effect of extremely high DTR,and the mortality effect in central area (CER=5.1％,95％CI:2.4％-7.9％) was significant higher than that in south area (CER=4.5％,95％CI:1.7％-7.3％).Regarding to the modification of seasons,the cumulative mortality effect of DTR in cold season (CER=5.8％,95％CI:2.5％-9.2％) was higher than that in hot season (CER=3.1％,95％CI:1.1％-5.1％).Generally,deaths among the elderly (≥75 years) were associated more strongly with extremely high DTR.Conclusions The mortality effects of extremely DTR in different areas and seasons showed different characteristics,that in central area and in cold season it was significantly stronger.After modified by season and SES,DTRs were the greatest threat to vulnerable population,especially to the elderly (≥75 years).Therefore,more attention should be paid to vulnerable groups and protection measures should be taken according to the local and seasonal conditions.