Objective To evaluate the diagnosis and differential diagnosis methods for chronic lymphocytic thyroiditis(CLT).Methods One hundred and eight patients with CLT were treated in our department during recent 20 years,the clinical data were analyzed retrospectively.The diagnostic methods included thyroid function measurement,anti-thyroid antibody measurement,image detection,fine needle aspiration,diagnostic drug therapy and biopsy exam during operation.The preoperative examinations and diagnoses of 94 patients,who had received operation,were compared with postoperative pathological results.Results Forteen of the 108 cases did not receive any operation,of whom,9 had a definite diagnosis of CLT by fine needle biopsy under color ultrasound and 5 by drug(prednisone) diagnostic treatment.Before operation,57 patients were diagnosed as nodular goiter,16 as thyroid cancer and 13 as nodular goiter associated with hyperthyroidism.Only 8 patents were diagnosed as CLT with nodular goiter.Postoperative pathological reports were simple CLT in 59 cases(62.7%),CLT with nodular goiter in 19(20.2%),CLT with hyperthyriodism in 10(10.6%)and CLT with thyroid cancer in 6(6.3%).The preoperative misdiagnosis rate reached 91.5%(86cases).Conclusions It is easy for CLT to be misdiagnosed because of the complex clinical manifestations.Careful analysis of examination results,especially thyroid function measurement,anti-thyroid antibody measurement and image detection is significant for confirming the diagnosis.The fine needle biopsy and diagnostic drug treatment are better methods for CLT diagnosis.Unwarranted operation should be avoided in patients with CLT.

Objective To find out whether inpatients with acute ischaemic stroke and atrial fibrillation (AF) have higher rate of renal dysfunction than without AF,and analyze risk factors associated with renal dysfunction.Method 374 patients with acute ischaemic stroke and AF were enrolled,which cases have complete data.500 patients were randomly selected as the non-AF group.To compare the prevalence of renal dysfunction [eGFR ＜ 60 mL/(min· 1.73 m2)] of two groups.Non-conditional Logistic regression analysis was used to detemmine the factors associated with renal dysfunction.Results 374 patients in AF group,114 (30.5％) were renal dysfunction;500 patients in non-AF group,75 (15％) were renal dysfunction (P =0.000,OR =2.485).The eGFR of AF and non-AF group was (77.75 ± 39.89) mL/(min· 1.73 m2) and (96.93±39.14) mL/(min · 1.73 m2).In Logis tic regression analysis,heart dysfunction (OR =2.057),hypertension (OR =1.826),diabetes (OR =1.897),hypevuricemia (OR =3.161) were found to be associated with renal dysfunction.Conclusions Adult patients with acute ischaemic stroke and AF have a higher rate of renal dysfunction than acute ischaemic stroke without AF.Heart dysfunction,hypertension,diabetes,hyperuricemia were factors associated with renal dysfunction.

Objective:To compare the cardiovascular effects of sufentanyl and fentanyl as combined with propofol in anesthesia during laparoscopic cholecystectomy(LC).Methods:Patients undergoing LC were randomly divided into two groups: 60 patients in the Sufentanyl group(group S,0.3 ?g/kg) and 53 patients in the Fentanyl group(group F,3 ?g/kg).The mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),and cardiac index(CI) were recorded before induction,before pneumoperitoneum,after pneumoperitoneum and at the end of operation.Results:There was no difference in MAP,HR,CO or CI between the two groups before induction.The values of HR and CO increased significantly in group F after preumoperitoneum comparing with the values before preumoperitoneum(P

Esophageal cancer is the leading cause of cancer-related deaths worldwide.A single intraoperative intervention is unlikely to benefit the outcome.A multimodal management plan that includes the use of TEA seems to demonstrate improved results in high-volume centers.Anesthetic management may contribute to the containment of pulmonary morbidity and anastomotic leakage by the use of TEA,protective ventilation strategies during OLV,prevention of tracheal aspiration,and judicious fluid management.

Immune response after blood transfusion is closely related to prognosis of the patients receiving blood productions. Thus, the safety and effectiveness are paid increasing attention.This article reviews immunological consequence and clinical manifesta-tions and response strategies after transfusion, which aims to provide reference for clinical transfusion decisions.

Objective To investigate the effect of anomalous pancreaticobiliary ductal union on the injuries of pancreas.Methods 10 health cats were treated by a 4～6 cm incision in biliary and pancreatic duct adjacent to duodenum, and interrupted suture was made to induce the model of anomalous pancreaticobiliary ductal union.The pancreatic tissues were harvested during model induction and 6 months after model induction,and histopathological changes were evaluated by electron microscopic examination and the level of maleic dialdehyde (MDA) were determined.Results Seven out of 10 cats survived surgery and remained alive for 6 months.6 months later,the pancreas appeared to be in the color of dark red and hyperemia,edema was present.Dilated pancreatic duct could be found in three of them.Light microscopic examination suggested there was inflammatory cell infiltration in the pancreas in 3 cats;mesenchymal vascular proliferation and white cell adhesion was present in the pancreas in 4 cats.Electron microscopic examination suggested rough endoplasmic reticulum expanding in the shape of pool,swelling mitochondria disaggregated and increased in number,Golgi complex became well developed.The preoperative level of MDA in pancreatic tissue was (1.23±0.7 ) nmol/mg prot,which increased to (2.90±1.9 ) nmol/mg prot 6 months later with statistically significant difference (F=4.80,P=0.0215 ).Conclusions This animal model demonstrated that anomalous pancreaticobiliary ductal union may cause injury to the pancreas,and antioxidant treatment may alleviate this injury.

Objective: To observe the effect of atorvastatin on the level of serum high sensitivity C reactive protein(Hs-CRP) in young adult patients with hyperlipemia.Methods: Seventy-six young adult patients(aged 18-39 years) with hyperlipemia were treated with atorvastatin at 20 mg/d for 8 weeks.The levels of serum Hs-CRP and lipid were determined before and after the treatment.Results: The level of serum Hs-CRP was obviously higher than normal in the hyperlipemia patients and significantly decreased after 8 weeks of atorvastatin treatment(P

Objective To investigate the efficacy and safety of dexmedetomidine on prevention of emergence agitation in adult patients during recovery period after abdomen surgery.Methods 1 20 ASA I -II patients scheduled for elective abdominal surgery under general anesthesia were randomly divided into three groups:dexmedetomidine group (group A),midazolam group (group B)and the saline control group (group C),40 cases in each group.40min before the end of surgery,dexmedetomidine 0.6μg/kg was continued intravenous infusion 1 0min in group A,midazo-lam 30μg/kg and 1 mL physiological saline were respectively intravenously injected in group B and group C.The post-operative recovery room (PACU)of restlessness,sedation,blood pressure,SpO2 and extubation time were observed. Results In of midazolam group,the time of anesthesia recovery[(1 8.2 ±1 .9)min],extubation[(32.1 ±3.9)min] and PACU staying[(48.7 ±3.1 )min]were significantly longer compared with the dexmedetomidine group[(1 3.1 ± 2.4)min,(26.5 ±2.2)min and (39.8 ±3.4)min,P =0.023,0.040 and 0.003]and the saline group[(1 2.6 ± 2.3)min,(24.8 ±2.9)min and (38.6 ±4.3)min,P =0.01 7,P =0.023 and P =0.001〗.The postoperative seda-tion scores of dexmedetomidine [(2.3 ±0.2 )points,P =0.025 ]and midazolam group [(2.4 ±0.1 )points,P =0.020]were significantly higher than the saline control group[(1 .1 ±0.5)points].The postoperative agitation score of dexmedetomidine (1 .3 ±0.5)points was lower than midazolam group [(2.5 ±0.5)points,P =0.01 1 ]and the saline control group[(2.4 ±0.6)points,P =0.020].HR and MAP of three groups at 2 min before extubation were observed,in the immediate extubation and at 5 min after extubation,the HR of dexmedetomidine group[(62.7 ± 4.1 )times/min,(67.3 ±3.4)times/min and (63.2 ±4.3)times/min]was significantly delayer than midazolam group [(72.3 ±3.4)times/min,(84.9 ±5.3)times/min and (82.1 ±3.1 )times/min],(P =0.002,P =0.001 and P =0.001 )and the saline control group [(73.6 ±2.9 )times/min,(85.3 ±4.7 )times/min and (83.3 ± 4.5)times/min],(P =0.001 ,P =0.023 and P =0.038)at the three time.In the immediate extubation,the MAP of patients in dexmedetomidine group[(87.3 ±4.2)mmHg)]was lower than midazolam group[(93.1 ±4.3)mmHg, P =0.001 ]and the saline control group[(95.6 ±5.8)mmHg,P =0.001 ].At 5 min after extubation,the MAP of patients in both of dexmedetomidine[(84.5 ±3.1 )mmHg)]and midazolam[(85.1 ±2.9)mmHg]group were lower than that in the saline control group[(92.3 ±4.6)mmHg,P =0.023 and P =0.038〗.Conclusion Dexmedetomi-dine could be one of the ideal drug to relieve emergence agitation in adult patients during recovery period after abdo-men surgery and the curative effect is better than midazolam.

Objective To evaluate the effect of hydrogen-rich saline on the regulatory T cells (Tregs ) in the peripheral blood during global cerebral ischemia-reperfusion (I/R ) in rats .Methods Seventy-seven male Sprague-Dawley rats ,aged 2-3 months ,weighing 260-300 g ,were randomly divided into 3 groups using a random number table:sham operation group (group S , n=11) ,group I/R (n=33) ,and hydrogen-rich saline group (group H , n=33 ) .Global cerebral I/R was produced by 4-vessel occlusion method .The bilateral carotid arteries were blocked for 15 min followed by reperfusion in I/R and H groups .In group H ,0.6 mmol/L hydrogen-rich saline 5 ml/kg was injected intraperitoneally at 0 and 6 h of reperfusion ,while the equal volume of normal saline was injected instead in the other two groups .Before ischemia (T0 ) in group S and at 6 ,24 and 72 h of reperfusion (T1-3 ) in I/R and H groups ,7 rats were chosen ,the blood samples from the peripheral vein were collected for determination of the number of Tregs . Then the animals were sacrificed and the spleen was removed for measurement of transforming growth factor-β1 (TGF-β1) content .The left 4 rats of each group were sacrificed at T0 and T1-3 and the brains were obtained for examination of the pyramidal cell morphology in the hippocampal CA 1 region and for determination of the number of pyramidal cells in brain tissues .Results Compared with group S , the number of pyramidal cells in the hippocampal CA1 region ,the number of Tregs in the peripheral blood and content of TGF-β1 in the spleen were significantly decreased at T1-3 in group I/R ( P<0.05) .Compared with group I/R ,the number of pyramidal cells in the hippocampal CA 1 region and the number of Tregs in the peripheral blood at T2-3 ,and the content of TGF-β1 in the spleen at T1-3 were significantly increased ( P<0.05) ,and the pathological changes of pyramidal cells were attenuated in group H .Conclusion The mechanism by which hydrogen-rich saline attenuates global cerebral I/R injury may be related to the increased number of Tregs in peripheral blood and promoted secretion of TGF-β1 in rats .

In our study, we adopted a schedule plan management of the Project Management Body of Knowledge(PMBOK)in the management practice of the expefimental research on "The Research in Teaching and Inheritance of Experience of Famous and Veteran Doctors of TCM "which was supposed by " tenth five years "plan of national science and technology as a key program. We tried to establish a project planning based on the special features of TCM and the characters of the project. This planning played a significant support role in the top project design and ensuring the smooth implementation of the research.