Objective To explore the relationship between the status of the cervical lymphatic metastasis of papillary thyroid carcinoma(PTC)at cNo stage and tumor recurrence and the patient' s prognosis.Methods The clinical data of 498 cNo PTC patients admitted from 1986 to 1990 were retrospectively analyzed.Results All the patients were followed up for more than 10 years.16 patients died of PTC,among them 3 for metastasis,13 for local recurrence.The total cervical lymphatic metastasis rate in these 498 patients was 52.2％,in 260 cases in which detailed data were available: rate was 14.1％ in zone Ⅱ,27.1％ in zone Ⅲ,24.6％ in zone Ⅳ,12.5％ in zone Ⅴ,and 20.1％ in zone Ⅵ respectively.According to the appearances of microscopic pathology,the cervical lymphatic metastasis rates in 498 cases of cNo PTC were collected as following: uncapsuled group was 65.6％,extracapsular group was 64.5％,extralobal group was 56.5％,involved the surrounding tissue and structure group was 52.0％,focal cancerous focus group was 33.3％,latent sclerosis group was 26.9％,encapsuled and introcapsule group was 0.The cervical recurrence rate was only 2％ in the complete function neck dissection group and 9.9％ in the selective center neck dissection group.Conclusions In cNo PTC the most common cause of death was local recurrence.Prophylactic function complete neck dissection should be performed for cNo PTC cases of highly invasive type such as without tumor capsule,extracapsular,extralobal or surrounding tissue invasion.

Objective To explore the value of somatostatin receptor scintigraphy(SRS) in evaluating the immune activity of orbital inflammatory pseudotumor associated with systemic vasculitis.Methods Twenty-five patients with orbital inflammatory pseudotumor associated with systemic vasculitis (10 males,15 females,average age:(51.2± 14.2) years) underwent SRS.The uptake ratio (UR) of orbital inflammatory pseudotumor was obtained.(1) Patients were divided into group A (with immune activity) and group B (without immune activity) according to Birmingham vasculitis activity score (BVAS).The difference of UR between the 2 groups was compared by two-sample t test.The difference of UR before and after treatment in 12 patients was also compared.(2) Based on the results by BVAS,ROC curve was used to obtain the cut-off value of UR,as well as the diagnostic efficiency and Youden index.The consistency between SRS and BVAS was calculated.(3)Patients were divided into two groups according to the cut-off value of UR and the prognosis difference between them was compared by Fisher exact test.(4)The expression of SSTR2 and SSTR5 was observed by immunohistochemistry.Results (1) UR in group A was significantly higher than that in group B (2.09±0.44 vs 1.32±0.46,t =5.94,P＜0.01).After glucocorticoids treatment,the UR in group A reduced significantly (t=4.07,P＜0.01),but not in group B (t=1.76,P＞0.05).(2)ROC curve analysis identified UR cut-off value as 1.66,with the sensitivity of 87.5％,specificity of 95.7％,positive predictive value of 95.2％,negative predictive value of 88.0％,accuracy of 91.3％ and Youden index of 83.2％.The consistency between SRS and BVAS was strong (Kappa =0.840).(3) The prognosis was significantly different between patients with UR≥ 1.66 and UR＜1.66 (P＜0.05).(4) The immunohistochemical results revealed high expression of SSTR2 and SSTR5 in inflammatory cells in patients with immune activity.Conclusion SRS has potential value in evaluating the immune activity of orbital inflammatory pseudotumor associated with systemic vasculitis.

Objective To understand the development situation of the purified protein derivative of tuberculin (PPD) test ,the prevalence of tuberculosis(TB) among the school students in Guangxi and the related influence factors of strong positive result in order to provide the basis for establishing the physical examination system of student TB in Guangxi .Methods The PPD test was conducted in the students participating in the survey firstly ,then the students with strong positive PPD test results and the TB sus-picious symptoms and the suspected TB cases were performed chest X-ray and sputum smear examination .The related factors in the students with strong positive PPD test results and non-strong positive PPD test results were comparatively analyzed .Results To-tally ,53 217 students received the PPD test with the positive rate of 5 .74% (3 055 cases) and the strong positive rate of 1 .46%(775 cases) .The detection rate of active TB was 0 .03% (15 cases) .The χ2 test and the Logistic regression analysis showed that the age group and the regional distribution were the influence factors of strong positive PPD test result (P<0 .05) .Conclusion The preliminary screening by the PPD test and then conducting chest X-ray and sputum smear examination are the effective method for find TB in school and the TB clinic .At the same time the TB screening should be strengthened in the schools in high epidemic areas of TB ,especially the college students .

Objective To investigate the risk factors and prognosis of perioperative myocardial infarction in the patients undergoing noncardiac surgery. Methods Clinical data of 562 patients who had accepted non-cardiac surgery was collected and retrospectively analyzed. The risk factors, treatments and outcomes of all these patients were recorded and analyzed. Results A total of 19 out of the 562 patients had perioperative myocardial infarction ( PMI) . The incidence was 3. 4% . The mean occurrence time was (43. 5 ± 12. 7)h after operation. Eleven PMI patients (11 ∕ 19) were non-ST-segment elevation myocardial infarction and eight patients (8 ∕ 19) were ST-segment elevation myocardial infarction. Thirteen PMI patients were left coronary artery occlusion and six patients were right coronary artery occlusion. Advanced age, history of myocardial infarction, unstable angina, change of ST-T segment on electrocardiography (ECG), multivessel diseases, diabetes,hypertension,and high risk non-cardiac surgery were the risk factors of PMI and positively correlated to PMI. Sixteen PMI (16 ∕ 19) patients accepted PCI treatment and three patients (3 ∕ 19) accepted drug conservative treatment. Two patients had unstable angina attack after treatment and one patient had arrhythmia. The heart function in two patients decreased by one or more than one class within the follow up of 1 year. No patient had recurrent acute myocardial infarction or deceased during follow-up. Conclusions Many factors could lead to PMI. Making preoperative assessment, recognizing patients of high risks and dealing with patients who had PMI in time was necessary.

Objective To compare the rates of major adverse cardiovascular events(MACE)and bleeding events of three different antiplatelet strategies during temporary withdrawal of antiplatelet therapy for non-cardiac surgery within 1 year after drug-eluting stent (DES)implantation.Methods Retrospectively analyzed 42 patients who had accepted non-cardiac surgery and required temporary withdrawal of antiplatelet therapy within 1 year after drug-eluting stent implantation. The patients were divided into three groups according to the bridging antiplatelet strategies they received.All patients discontinued clopidogrel 5 to 7 days before the non-cardiac surgery. The tirofiban group was treated with intravenous tirofiban 0.4ug/kg·min in the first 30 min followed 0.1μg/(kg·min). The dosage was reduced by half for patients whose Creatinine clearance were less than 30 ml/min.The low molecular weight heparin group was treated with subcutaneous enoxaparin (Clexane 4000 AxaIU, once per day) .The asprin group was given only oral asprin(100 mg, once per day) . Tirofiban and low molecular weight heparin were continued until clopidogrel was resured. Perioperative cardiovascular events and serious bleeding were recorded. Results The rates of major adverse cardiac events in the tirofiban and the low molecular weight heparin group were lower than the aspirin group. Acute myocardial infarction caused by confirmed in-stent thrombosis was diagnosed in one patient in the aspirin group. One case of asymptomatic ST-T changes was found in the low molecular weight the aspirin group. 3 cases in the aspirin group presented ST-T changes on ECG and among them 1 case was STEMI due to LAD thrombosis requiring primary and 2 other cases were agina pectoris.There were no significant differences in bleeding events among the three groups.Conclusions Potential for the perioperative management with tirofiban or low molecular weight heparin is safe and feasible for patients who had recently undergone DES implantation and required noncardiac surgery with the interruption of antiplatelet therapies.

Objective To learn the applications and patient experience of mobile payment technology as used in the hospital outpatient service.Methods 342 outpatients using mobile technology (APP)were chosen from the hospital information system for survey,and 300 outpatients registering in the conventional process were chosen as a control.Data of the doctor-seeing experiences of the two groups were analyzed statistically.Results Waiting queue reminder function is found with the highest patient usage among the three officially launched APPs,accounting for 83.6%.The appointment and cellphone payment functions exert the greatest impact on patient experience,boasting a patient satisfaction of 90%. All these functions can save totally one hour for an outpatient.Conclusions The mobile payment technology can significantly reduce outpatient waiting time,and improve outpatient experiences.Such technology therefore needs more promotions and connection with medical insurance system for the sake of outpatients.

Euphorbia kansui (EK) is a toxic herbal drug, and often used after vinegar-processing to reduce its toxicity. In present study, a 1H-NMR based metabonomic approach was used to evaluate the detoxification effect of vinegar-processed EK. The water extracts of EK and VEK were administered orally to male SD rats at doses of 9 g x kg(-1) x d(-1) for 1 week, respectively, and one more week observation was further conducted. The control group was orally given with saline. Histopathological studies of liver samples on the 8th and 15th day were conducted, and the metabolites of rat urine and liver were analysed by 1H-NMR. Histopathological studies of liver samples from EK and VEK treated rats showed no negative impacts. In metabonomic analyses of urines, changes of metabolites indicated liver damages, kidney lesions and imbalance of gut microbes in the second week. VEK-treated rats showed a quite lower toxicity compared with EK-treated ones. The present study revealed that the metabonomic approach might be helpful for the evaluation of toxicity of EK and detoxic effect of VEK.
Acetic Acid ; chemistry ; Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; chemistry ; pharmacokinetics ; toxicity ; Euphorbia ; chemistry ; Inactivation, Metabolic ; Liver ; drug effects ; metabolism ; Magnetic Resonance Spectroscopy ; Male ; Metabolomics ; methods ; Rats ; Rats, Sprague-Dawley ; Urinalysis

Objective To study the significance of the cerebrospinal fluid(CSF)lactate level in diagnosing neonatal bacterial meningitis(BM). Methods The CSF samples were collected from neonates admitted to Neonatal Ward of Children's Hospital of Fudan University between January 2014 and March 2015. CSF lactate and glucose con-centrations were measured with blood - gas analyzer. CSF and serum glucose levels were measured with glucometer. The enrolled neonates were divided into 2 groups based on CSF culture,CSF white blood cells(WBCs)and clinical presenta-tion:observation group(neonates with BM)and control group(neonates without BM). Statistical analysis of data was performed with Stata 12. 0. Results A total of 93 infants(16 assigned to observation group and 77 assigned to control group)met the inclusion criteria. Neonates in observation group had higher median CSF lactate level(4. 2 mmol/ L)and CSF lactate/ glucose ratio(L/ Gcsf)(2. 32 mmol/ L),than those in control group(1. 3 mmol/ L,0. 52),and there were significant differences(Z = - 6. 19,- 5. 92,all P ﹤ 0. 05). CSF glucose levels were lower in observation group(me-dian,1. 25 mmol/ L)than those in control group(median,2. 5 mmol/ L),and the difference was significant(Z = 4. 97, P ﹤ 0. 05);CSF/ serum glucose ratio(CSF/ Sglu)were lower in observation group(median,0. 44 vs 0. 81 in control group),and the difference was significant(Z = 4. 43,P ﹤ 0. 05). The optimal CSF lactate cutoff point of 2. 2 mmol/ L had a positive predictive value(PPV)of 72. 7% and negative predictive value(NPV)of 100. 0% for bacterial meningi-tis. The optimal L/ Gcsf cutoff point of 1. 24 had a PPV of 94. 1% and NPV of 100. 0% . The optimal CSF glucose cutoff point of 2. 0 mmol/ L had a PPV of 65. 0% and NPV of 95. 9% . The optimal CSF/ Sglu cutoff point of 0. 6 had a PPV of 60. 0% and a NPV of 96. 9% . Conclusion CSF lactate may be an excellent biomarker for early diagnosis of neo-natal BM.

Objective To investigate the current status of moral distress in clinical nurses,and analyze its influential factors.Methods A total of 240 clinical nurses were recruited by stratified sampling method.They were investigated with general situation questionnaire and moral distress scale.Results The average score of moral distress was (2.66±0.41).Multiple linear regression analysis showed that department of work and qualification were influencing factors on moral distress of clinical nurses.Conclusions This study found that nurses' moral distress was above the middle level.Some targeted measures should be taken by nursing managers,in order to help decrease nurses' moral distress.

Technological improvement for microorgnism isolation is important since isolation provides substantial materials for the exploitation of new microbial resources. In this study, a new approach, dispersion and differential cetrifugation (DDC), was applied in the isolation of acidophilic and acidoduric streptomycetes from 12 acid soil samples. Contrast with traditional method, the new approach yielded satisfying results with 2 - 20 times isolation efficiency and good selectivity. 45 representatives out of 249 streptomycetes isolates, which belonged to 12 color groups, showed morphology and cell wall type consistent with streptomycetes. The optimum pH range for their growth were between pH 4.5 - 5.5. It is proved that we succeeded in the rare-streptomycetes isolation using DDC approach.