Objective To investigate the curative effects of old age severe chronic obstructive pulmonary disease (COPD) patients inhaled Glucocorticoids with the special devices (Turbuhaler).Methods Seventy-six cases of elderly patients with severe acute exacerbation of COPD patients (53 males,23 females) were divided into experimental group(n =38) and control group(n =38),respectively,according to the random number table.In 10 days of therapy,patients of experimental group inhaled budesonide powder of inhalation 0.2 mg twice daily;Control group inhaled oxygen atomization budesonide suspension 1mg twice daily.The changes of panting symptom were observed.Three months followed-up,the test team inhaled budesonide powder of inhalation 1 mg twice daily,control group stopped inhaling drugs,all patients of panting symptom were observed,also were six-minutes walking distance,the frequency of acute exacerbation and adverse reaction.Intent and compliance program data analysis were performed of the experimental data.Results At the end of the stage of therapy,panting symptom of two group patients were all improved (F =8.746,7.952 respectively,P ＜ 0.05) ; Wheezing score between the two groups 1,5,10 days of treatment differences were not statistically significant(P ＞ 0.05).But the incidence rate of adverse reaction in experimental group was significantly lower than that of control group(x2 =11.372,P ＜0.01),and the treatment costs of test team was significantly lower than that of control group(t =4.573,P ＜ 0.01).At the start of the follow-up period (week 0),two groups of acute exacerbation frequency,wheezing,peak expiratory flow and 6 minutes walking distance had no significant difference(P ＞ 0.05).When follow-up period was at tne end of 12 weeks.The test group of patients with acute exacerbation frequency was significantly lower than the control group(aF within grouP =9.343,aF between groups =16.343,the aF interaction =20.017 ; P ＜ 0.05),wheezing in the control group was significantly mitigate (bF within group =8.537,b F between groups =11.453,bF interaction =13.071 ; P ＜ 0.05),and peak expiratory flow rate than the control group improved significantly (cF within group =9.015,cF between groups =12.426,cF interaction =14.852 ;P ＜ 0.05),6 min walking distance increased significantly compared with the control group (d F within group =12.263,d F between groups =21.371,d F interactive =24.651 ; P ＜ 0.05),the differences were statistically significant.Conclusion Elderly patients with moderate to severe COPD inhaled Glucocorticoids,with the special devices(Turbuhaler),not only in acute exacerbation stage the panting symptom was controlled; but also in stable phase the frequency of acute exacerbation was decreased,and the exercise tolerance was improved.Curative effect is obvious withsafety and well-tolerated.

Objective To explore the curative effect of inhaled tiotropium upon patients of stable chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension.Methods A total of 76 patients (Male/Female =51/25) of stable COPD complicated with pulmonary hypertension were recruited from January 2010 to June 2011.According to table of random digit,they were divided into test group (n =38,M/F =26/12) and control group (n =38,M/F =25/13).Patients of control group inhaled formoterol powder 4.5 μg bid,took oral theophylline sustained-release tablets 0.1 g hid.According to the demand of patient's condition,anti-infective agents and sticky phlegm lyticagent were used.Patients of test group inhaled tiotropium dry powder (18 μg,qd) in addition to the above regimen.All changes in six-minute walk test (SMWT),pulmonary arterial systolic pressure and panting symptom score were recorded at the end of 16 weeks and compared with the baseline.The primary endpoint was the changes in exercise capacity as assessed by SMWT and pulmonary arterial systolic pressure.Safety and tolerance were also investigated.Intent-to-treat and per-protocol analyses were performed.Results After a follow-up period of 16 weeks,both pulmonary arterial systolic pressure and panting symptom score decreased and SMWT walking distance increased (45 ± 16) m in the test group.Compared with the control group,the difference had statistical significance (P ＜ 0.05) and obvious adverse reaction did not occur.Conclusions For patients of stable COPD complicated with pulmonary hypertension,inhaled tiotropium dry powder decreases pulmonary pressure to various extents and improves exercise tolerance and panting symptom.And tolerance is satisfactory.

Colonoscopy has been accepted as the standard method for evaluation of colon and rectum,its success rate depends on the quality of bowel preparation. Aims:To evaluate the cleanliness and tolerance of fractionated dose versus single dose polyethylene glycol electrolyte solution( PEG-ES) bowel preparation regimens for colonoscopy. Methods:A total of 427 consecutive asymptomatic individuals undergoing colorectal cancer screening were enrolled and randomly assigned into 2 groups. Subjects in group A drank 1. 5 L PEG-ES on the eve and 4 hours before colonoscopy, respectively;subjects in group B received a single dose of 3 L PEG-ES 5 hours before colonoscopy. Score and degree of Boston bowel preparation scale(BBPS)and PEG-ES related adverse effects of the two groups were assessed and compared. Results:There were no significant differences in gender,age and cecal insertion rate between group A and group B(P ﹥ 0. 05). Score of BBPS was significantly higher in group A than in group B(P ﹤0. 01). Both regimens met the requirement of conventional colonoscopy,however,the cleanliness of colon was graded as excellent in more subjects of group A( P ﹤ 0. 01),and less subjects of group A complained PEG-ES related nausea(P ﹤0. 05). Logistic regression analysis revealed that the PEG-ES drinking pattern was associated with cleanliness of colon and occurrence of nausea( P ﹤ 0. 05). Conclusions:Fractionated dose PEG-ES regimen provides a better colonic cleansing quality and tolerance for bowel preparation of colonoscopy,which is superior to that of single dose regimen.

Objective:To investigate the predictive value of lymph node size for ipsilateral central lymph node metastasis (ICLNM) of papillary thyroid microcarcinoma (PTMC) in CT examination.Methods:The CT data of 229 patients with single PTMC admitted to the Department of Oncology, Hangzhou First People’s Hospital, Affiliated to Zhejiang University School of Medicine from Jan. 2018 to Jun. 2019 were retrospectively analyzed. All cases were confirmed by surgery and pathology. The ipsilateral central lymph nodes were divided into <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group according to their maximun diameters, and the distribution difference of positive and negative ICLNM among the three groups were observed and analyzed by χ 2 test. Results:In 229 PTMCs, the proportion of positive and negative ICLNM were 29.69% (68/229) and 70.31% (108/155) , respectively. Positive ICLNM in <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group accounted for 11.43% (16/140) , 64.29% (36/56) and 81.82% (27/33) , respectively. When 0.2 cm and 0.4 cm were used as the threshold to determine positive ICLNM, the values of χ 2 and P between groups were 87.663 and <0.001. The sensitivity and specificity of diagnosing lymph node metastasis were 79.75% (63/79) and 82.67% (124/150) , 34.18% (27/79) and 96% (144/150) , respectively. The proportions of high enhancement, calcification and cystic degeneration were 3.2% (5/155) , 0.7% (1/155) and 0 (0/155) , respectively. Conclusions:In CT examination of patients with PTMC, the diameter of lymph nodes less than 0.2 cm highly indicates negative ICLNM. The proportion of positive ICLNM increased with increasing lymph node diameter, and the diameter of lymph nodes less than 0.4 cm highly indicates positive ICLNM.

Objective:To investigate the predictive value of dual-phase enhanced CT for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) .Methods:The CT data of 220 central lymph nodes in 182 cases of PTMC confirmed by surgery and pathology were retrospectively analyzed. The lymph nodes were divided into 0.3 cm-0.4 cm group, 0.4 cm-0.5 cm and ≥ 0.5 cm groups according to the size of them. The CT values of arterial phase and venous phase of lymph nodes were measured, respectively. The distribution of dual-phase CT values of lymph nodes in the three groups was analyzed by t test. The optimal threshold values of dual-phase enhanced CT values of lymph nodes in each group were obtained by receiver operating characteristic (ROC) . Results:The area under ROC curve of arterial phase CT in predicting CLNM was 0.717, 0.707 and 0.761, the optimal threshold was 71.4Hu, 63.3Hu and 72.9Hu, and the sensitivity and specificity were 50.0% and 92.3%, 63.6% and 81.0%, 52.4% and 82.9%, respectively. The area under the ROC curve of venous phase CT value in predicting CLNM was 0.744, 0.729, and 0.662, the optimal thresholds were 71.1 HU, 80.3 HU, and 61.3 HU, and the sensitivity and specificity were 52.8% and 87.2%, 54.2% and 86.7%, 82.6% and 46.7%, respectively. The sensitivity and specificity of dual-phase combined CT values in predicting CLNM in 3 groups were 44.1% and 94.7%, 50.0% and 88.1%, 52.4% and 85.4%, respectively.Conclusion:Dual-phase enhanced CT can effectively predict central lymph node metastasis of PTMC, and the combination of the two can further improve the specificity of predicting CLNM and provide an important basis for reducing unnecessary surgical trauma.

Objective:To determine the clinical factors affecting Central lymph node metastases (CLNM) of single Papillary thyroid carcinoma (PTC). To predict the value of age for CLNM under different genders and the status of Hashimoto’s thyroiditis (HT) .Methods:The clinical data of 4 115 patients with PTMC (≤10.0 mm) and 664 patients with PTC (> 10.0 mm) in Hangzhou First People’s Hospital affiliated to Westlake University Medical School from Jan. 2010 to Aug. 2023 were retrospectively analyzed, and the independent risk factors of PTMC and PTC CLNM were identified by univariate and multivariate logistic regression analysis. According to different gender and HT status, the patients were divided into male group, female group, HT group and non-HT group. The optimal age threshold and diagnostic efficacy of CLNM in each subgroup were determined by Receiver operating characteristic area under the curve (AUC) .Results:The proportion of CLNM in 3451 PTMCs and 664 PTCs was 27.2% (937/3451) and 58.9% (391/664) ( χ2=256.565, P<0.050), respectively. Univariate and multivariate regression analysis showed that larger tumor ( OR 1.230), male ( OR 2.085), older age ( OR 0.960) and HT ( OR 0.697) were independent predictors of the occurrence of CLNM in PTMC. Only male ( OR 1.460) and older ( OR 0.963) PTC were independently associated with CLNM. Subgroup analysis showed that the age-predicted AUC of CLNM in male, HT and non-HT patients in PTC were higher than that of PTMC, which were 0.642-0.689 and 0.635-0.659, respectively. The age thresholds of female, HT and non-HT subgroups in PTC were lower than those in PTMC, which were 38.5 to 39.5 years old and 41.5 to 42.5 years old, respectively. Conclusions:Larger tumor, male, older patients and HT can independently predict the risk of CLNM in PTMC, while only male and older people can independently predict the risk of CLNM in PTC. There are certain differences in the age of CLNM occurrence between PTMC and PTC patients with different genders and HT combination status. It is of great significance to correctly understand these differences for providing personalized clinical treatment.