Clinical data of 150 pregnant women,who were confirmed with maternal thyrotoxicosis during January 2010 to January 2014,including 104 cases of gestational transient thyrotoxicosis (GTT) and 46 cases of Graves disease (GD),were retrospectively analyzed;65 normal pregnant women served as controls.Patients with GD had lower body mass index (BMI) than those with GTF and normal controls [(18 ± 5),(20 ± 4) and (22 ± 4) kg/m2,respectively,P ＜ 0.05].The frequency of thyrotoxic history and hyperthyroidism symptoms in GD patients were significantly higher than that in GTT patients [33％ (15/46) vs.3％ (3/104) and 52％ (24/46) vs.15％ (16/104),respectively,both P ＜0.01].In the first trimester,patients with GD presented lower TSH levels than those with GTT and controls(M =0.021,0.045and 1.660 mU/L,respectively,P ＜ 0.05) and higher free T4 (FT4) (M =24.99 vs.19.99 pmol/L,P ＜0.05),free T3 (FT3) (7.10 vs.5.85 pmol/L,P ＜ 0.05),thyroid peroxidase antibody (TPOAb) (99.22vs.4.54 kU/L,P ＜ 0.05) and thyrotrophin receptor antibody (TRAb) (5.28 vs.0.11 U/L,P ＜ 0.05)levels than patients with GTT.In the second trimester,there were 67％ (70/104) GTT patientsand 4％ (2/46) GD patients had normal TSH;and FT4 returned to normal in 82％ (85/104) GTT patientsand 17％ (8/46) GD patients.In the third trimester,there were 100％ (104/104) GTT patients and 9％ (4/46)GD patients had normal TSH;and FT4 returned to normal in 100％ (104/104) GTT patients and 48％ (22/46)GD patients.

Objective To discuss clinical effects of early (<48 hours after injury) fraeture exter-nal fixation in treatment of severe traumatic brain injury (TBI) combined with extremity fracture. Meth-ods The study involved patients with no statistical difference in aspects of age, sex, GCS, fracture ,distri-bution and general condition. According to different treatment methods at early stage (<48 hours), the pa-tients with TBI were divided into Group A (early extremity fracture external fixation) and Group B (early extremity fracture traction or cast immobilization). A comparative observation was done on complications in-cluding bedsore, pneumonia and deep venous thrombosis and on duration in ICU, hospitalization, time for fracture healing and mortality in two groups. Results Incidence rate of bedsore, pneumonia, deep ve-nous thrombosis and mortality in Group A was lower than that in Group B (P<0.05), and Group A had shorter time for ICU, hospitalization and fracture healing (P < 0.05). Conclusion For patients with se-vere TBI combined with extremity fracture, early fracture external fixation is more effective to reduce com-plications, shorten the recovery time and reduce mortality, compared with conservative methods.

Objective To investigate the clinical benefit response (CBR) in treating the unresectable pancreatic carcinoma by applying the EUS guided iodine-125 seed implantation combined with chemotherapy of gemeitabine and comparing chemotherapy of gemcitabine alone. Methods Forty-one patients with unresectable pancreatic carcinoma were randomly divided into two groups, one group (Group A) included 21 cases which underwent EUS-guided iodine-125 seed implantation combined with gemcitabine chemotherapy, the rest 20 cases (Group B) were treated with gemcitabine chemotherapy alone. EUS-guided iodine-125 seed implantation were carried according to the treatment plan system (TPS), following chemotherapy after 1 week. Gemcitabine was administered at the dose of 1 000 mg/m2, through intravenous administration once a week for 3 consecutive weeks every 4 weeks. CBR was assessed. Results CBR of Group A was 57.1% and median time to CBR was 1 week and median duration of CBR was 21 weeks, while CBR of Group B was 25%, and median time to CBR was 4 weeks and median duration of CBR was 15 weeks (P<0.01). Conclusions EUS-guided iodine-125 seed implantation combined with chemotherapy of gemcitabine was superior to gemcitabine chemotherapy alone in the term of CBR in patients with unresectable pancreatic carcinoma.

Objective To study the changes of subgroups of peripheral blood T lymphocytes in the patients infected with the 2009 pandemic influenza A ( H1N1 ) virus of different severity type. Method A total of 66 patients infected by H1N1 evidenced by RT-PCR admitted from September 2009 to January 2010 were divided into three groups: mild type ( B group, n = 47 ), cured patients of severe and critical severe type ( C group, n = 14) and died patients ( D group, n =5), according to the severity and prognosis. A total of 20 healthy volunteers served as control group( A group). Peripheral blood lymphocyte count, CD3+,CD4+ and CD8+ T lymphocyte count were detected by flow cytometry at the different time points. Fever duration and H1N1 virus negative time were compared. Statistical analysis were performed by using SAS version 9.13 software and the data were processed with ANOVA and SNK test. Results Lymphocyte count, CD3+,CD4+ and CD8+ T lymphocyte count declined in the early period in all the groups, and there were significant differences compared with A group (P＜0. 05), while rised with the clinical progression in group B and C,and those of C group were lower than B group ( P ＜ 0.05 ), but those of D group were always low. Fever duration and H1N1 virus negative time were (4.4 ± 1.6) days vs. (4.4 ± 1. 4) days, ( 12.9 ± 3. 1 ) days vs.( 10.2 ± 2.6) days and ( 15.2 ± 7.3 ) days vs. ( 13.3 ± 2.9 ) days respectively, and there were significant differences among the three groups ( P ＜ 0.05 ). Conclusions The cellular immune function was seriously damaged when patients were infected with H1N1. Further more, the changes of lymphocyte count, CD3+ , CD4+and CD8+ T lymphocyte count were tightly related with the degree of severity and prognosis. These findings can be used for clinical diagnosis and treatment.

Objective To evaluate the role of postmastectomy radiotherapy in four subgroups of high-risk breast cancer patients, who were grouped by the status of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (Her-2). Methods A total of 437 invasive breast cancer patients with T3-4N1 or N2-3 and available immunohistochemistry results of ER, PR and Her-2 were retrospectively analyzed. Patients were classified into 4 subgroups according to hormone receptors (ER or PR, Rec) and Her-2 status:Rec-/Her-2-(triple negative), Rec-/Her-2 +, Rec +/Her-2 + and Rec +/Her-2-. Rec-was defined as ER-and PR-. Rec + was defined as ER + and/or PR +. Her-2 positive was defined as Her-2 + + or Her-2 + + +. End points were isolated locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS) and overall survival (OS). Results The median follow up time was 48 months. Sixty-nine (15. 8%) patients were Rec-/Her-2-, 62 (14. 2%) Rec-/Her-2 +, 89 (20.4%) Rec +/Her-2 + and 217 (49.7%) Rec +/Her-2-. 480(93.4%) patients received chemotherapy and 352(80. 5%) received radiotherapy. Radiotherapy significantly reduced the 5-year LRR rates of all the four subgroups (Rec-/Her-2-: 13.1% vs. 33. 3%, Rec-/Her-2 + :9. 3% vs. 21.2%, Rec + /Her-2 + :9. 7% vs. 47.0%, Rec +/Her-2-:3. 2% vs. 15.4%). Radiotherapy significantly lowered the 5-year DM rates (26. 7% vs. 49.4%, 27.6% vs. 67. 5%, 18.4% vs. 100%) and improved the 5-year DFS rate (66. 7% vs. 33. 3% , 67.7% vs. 33. 3% , 72. 6% vs. 0%) as well as OS (73.9% vs. 25.2% ,69. 8% vs.41.5%, 91.0% vs. 32. 8%) of patients with Rec-/Her-2-, Rec-/Her-2 + and Rec +/Her-2 +. Conclusions In high-risk breast cancer patients, all subgroups of patients grouped by ER, PR and Her-2 status can benefit from postmastectomy radiotherapy.

ObjectiveTo evaluate the inter-and intra-fractional clinical target volume (CTV) positioning errors of patients receiving postoperative simplified intensity-modulated radiotherapy (SIMRT) using cone beam computed tomography (CBCT).MethodsTwelve patients with liver tumors underwent postoperative SIMRT.CBCT images were acquired before and after the treatment.The clipbox volume for registration included the fiducial markers in the tumor bed and excluded the ribs and vertebral bodies.If any translational parameter of setup error before treatment exceeded 3 mm or rotational parameter exceeded 3°,the treatment couch was adjusted and a verification CBCT was acquired to assess residual setup error.Automatic bone match was used.A total of 214 acquisitions of CBCTs in 111 groups were analyzed.Inter-fractional translational CTV positioning errors in left-right (x),superior-inferior (y) and anterior-posterior (z) axis were calculated in 111 groups,and intra-fractional translational CTV positioning errors in 70 groups.Clinical to planning target volume (PTV) margins were calculated according to the formula:margin =2.0 ∑ + 0.7σ ( ∑ is systematic error,σ is random error).ResultsInter-fractional translational CTV positioning errors in x,y and z axis were -0.03 mm,-0.43 mm,1.02 mm,with systematic error ( ∑ ) of 1.50 mm,5.89 mm,1.97 mm,and random error (σ) of 1.76 mm,4.13 mm,2.42 mm,respectively.Intra-fractional translational CTV positioning errors in the x,y,z axis were 0.04 mm,0.86 mm,- 0.46mm,with systematic error (∑) of 0.46 mm,1.14 mm,0.31 mm,and random error (σ) of 0.95 mm,1.38 mm,0.91 mm,respectively.The calculate CTV to PTV margins were 4.5 mm,15.0 mm,5.8 mm in the x,y,z axis,respectively.ConclusionsThe CTV errors were inevitable when patients with liver tumors received SIMRT.Fiducial markers placed in tumor bed during operation were helpful for accurate positioning error analysis.

Objective To find the related factors of the unsuccessful unsedated colonoscopy. Methods Clinical data of 1 726 consecutive subjects who underwent colonoscopy without sedation from April 2014 to January 2015 at the second affiliated hospital of Soochow university were analyzed. Data included characteristics of the patients (age, gender, body mass index, degree of education, the bowel-cleaning drugs, previous colonoscopy experience, bowel habits, history of chronic disease, history of sport, history of abdominal or pelvic surgery, the indication of colonoscopy, mood, quality of bowel preparation, and presence/absence of colonic diverticulum), the characteristics of the physicians (procedure experience, the instrument handling method). These factors were analyzed to evaluate their impact on result of unsedated colonoscopy. Results This study included 1 726 patients (male/female: 927/799). These patients' average age was 50.04 years old, the cecal intubation rate was 91.6%, and the average intubation time was 10.27 minutes. The multiple regression analysis showed the elderly patient, lower BMI, irritability, consti﹣pation, poor bowel preparation were associated with the lower cecal intubation rate. Conclusions The elderly patient, lower BMI, irritability, constipation and poor bowel preparation were associated with the failure of unsedated colonoscopy. In clinical practice, quality improvement programs are needed to improve the rate of total colonoscopy.

Objective Use MRS technology to detect in vivo Glx concentration of Zelanian rabbits' muscle.Methods Tweenty Zelanian rabbits are collected,SS-PRESS sequence is applied to check their Signal Ratio of Glx/TCr.After deta collection,draw blood and do the biopsy of the FOV's muscle tissue immediately.Mensurate the rabbits' blood Crn concentration,Glx and TCr concentration in muscle.Research the correlation between the above factors,attempt using the MRS Glx/TCr Signal Ratio and blood Crn concentration to predict muscular Glx concentration.Results The correlation between MRS Glx/TCr Peak Ratio and muscular Glx/blood Crn concentration ratio is 0.681.A linear regression formula is obtained: The predict Value of Glx concentration in muscle(?mol/g muscle)= Glx/TCr Peak Ratio ? Crn concentration in blood(mg/dl)?28.754-0.631.Conclusion Using a linear regression formula to predict the muscular Glx concentration,the results can reflect the level of the true values without biopsy,though it's not accurate enough for quantitatively analysis.

Objective: To study the mechanism of jindengshanggen (JDSG) oral liquid's anti infectiion effect.Methods: inhibition on bacteria growth, resistance to Escherichia coli endotoxin and measurement of monocytic phagocaryosis in mice were taken. Results: The effects of JDSG oral liquid is probably not due to the inhibition on bacteria growth, but rather due to its stimulation on other anti infection mechanisms in human body. The enhancement of immune response and toxin tolerance may be one of the mechanisms for JDSG oral liquid to cure acute pharynx infection. Conclusions: These results provide a basis for clinical application of JDSG.

Objective The benefit of adjuvant chemoradiotherapy remains controversial for gastric cancer patients treated with more than D1 dissection. This retrospective analysis is to distinguish the first site of recurrence in patients treated with curative resection and more than D1 dissection and to find any feasible adjuvant concurrent chemoradiotherapy recommendation for them. Methods All patients treated between January 2002 and December 2004 who met the following criteria were analyzed: primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and more than D1 lymphadenectomy,pathologically staged as T3-4N0-1 M0, or any Tx N2-3M0. There were 297 patients analyzed and 19.5%,52. 2%, 17. 8% , 10. 4% of patients had stage Ⅱ ( T3 N0 M0, T1 N2 M0 ), Ⅲa, Ⅲb and Ⅳ ( M0 ) diseases,respectively. 76. 1% of patients received adjuvant chemotherapy, while Only 2 patients underwent adjuvant radiotherapy. Failure patterns and the prognostic factors for locoregional recurrence were analyzed. Results The median follow-up time was 61 months and the follow-up rate was 92. 3%. 145 patients developed recurrence with a median recurrent time of 26 months. Locoregional recurrence was observed in 82 patients and distant metastasis in 79 patients. Gastric stump, anastomosis, intra-abdominal lymph nodes were the most common sites of locoregional recurrence. Liver and lung were the most frequent sites of distant metastasis. Prognostic variables for locoregional recurrence were identified after univariate analysis,including pathologic type ( χ2 = 11.50, P = 0. 009 ), total number of dissected lymph nodes ( χ2 = 6. 65,P =0. 010), the number of positive lymph node ( χ2 =5. 80,P =0. 016), lymph node capsular invasion ( χ2 =pathologic type, total number of dissected lymph nodes, lymph node capsular invation, AJCC TNM stage and Borrmann type were independent prognostic factors for locoregional recurrence ( χ2 = 6. 77,19. 33,17. 84 and 6. 02,P =0. 009,0. 000,0. 000 and 0. 014). ConclusionsLocoregional recurrence remains the main cause of failure for locally advanced gastric or gastroesophageal cancer patients even though the patients have had more than D1 lymphadenectomy. The role of adjuvant concurrent hemoradiotheray for those patients is warranted.