OBJECTIVE: To investigate the value of each single and combined applications of ultrasound thyroid imaging reporting and data system (TI-RADS), ultrasonic shear wave elastography in the diagnosis of thyroid microcarcinoma (TMC). METHOD: 323 patients with thyroid tiny nodules confirmed by surgery and pathology were analyzed prospectively. Then their TI-RADS and shear wave elastography features were summarized. SWE elasticity indices (mean, minimum and maximum value of interest) of nodules were measured. The surgical pathology results were regarded as the gold standard to calculate the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TI-RADS, shear wave elastography and their combination in the diagnosis of TMC. The receiver operating characteristic (ROC) curve of TI-RADS, shear wave elastography and combined application of both were drawn. The area under the ROC curve were calculated. Furthermore, the value of combined application of both examinations in the diagnosis of thyroid microcarcinoma (TMC) was investigated. RESULT: From 323 nodules,253 were thyroid carcinomas and 70 were benign. Areas under the ROC curves (AUC) of SWE parameters were 0. 648,0. 629 and 0. 605. For SWE, the optimal cut-off value according to ROC curve was SWE_max = 65.50 kPa and SWE_mean = 37.50 kPa. Generally, the sensitivity, specificity, accuracy, PPV and NPV were 88.14%, 82.86%, 87.00%, 94.89% and 65.91% for TI-RADS, and 49.01%, 74.29%, 54.49%, 87.32% and 28. 73% for SWE. There were statistically significant differences in the sensitivity, accuracy, PPV and no statistically significant differences in the specificity, and NPV. The sensitivity,specificity, accuracy, PPV and NPV were 95.26%, 67.14%, 89.16%, 91.29% and 79.66% for combined application of both. The area under the ROC curve of TI-RADS, shear wave elastography and their combination were 0.763, 0.616, 0.804. For nodules ≤ 5 mm, the sensitivity, specificity, accuracy, PPV and NPV were 91.67%, 66.67%, 87.07%, 92.44% and 64.29%. However, for nodules 5-10 mm,the sensitivity,specificity, accuracy, PPV and NPV were 98.50%, 67.44%, 90.91%, 90.34% and 93.55%. CONCLUSION The diagnose of TMC can be further improved by combined application of ultra-sonic TI-RADS and SWE.
Carcinoma ; complications ; Elasticity Imaging Techniques ; Humans ; Predictive Value of Tests ; Sensitivity and Specificity ; Thyroid Gland ; pathology ; Thyroid Neoplasms ; diagnosis

Objective To investigate the antimicrobial resistance of Haemophilus influenzae in Peking Union Medical College Hospital for rational clinical treatment.Methods A total of 223 strains of H .influenzae were collected from patients from Jan-uary 2008 to December 2011.The antimicrobial susceptibility was tested by Kirby-Bauer method.Production of beta-lactamase was detected using nitrocefin disks.WHONET 5.6 software was used to analyze the data of susceptibility testing.Results Tri-methoprim-sulfamethoxazole and tetracycline were the two antimicrobial agents to which the H .influenzae strains were most resistant.Theβ-lactamase positive ampicillin resistant strains accounted for 15.9 %,andβ-lactamase negative ampicillin resist-ant strains accounted for 8.9%.Conclusions H .influenzae is mainly isolated from respiratory specimens.Majority of the anti-microbial agents still show good antibacterial activity against H .influenzae strains.However,H .influenzae isolates are highly resistant to trimethoprim-sulfamethoxazole and tetracycline.

Objective To analyze of internal strength in patients with chronic disease,make clear the concept development,property,prerequisites,outcome and evaluation index of internal force.Methods To retrieve the relevant research literature in the knowledge service platform of Pubmed,PsycINFO and Chinese CNKI,Wanfang data,using the Rodgers analysis method to analyze the evolution of the concept of internal force.Results The molding process of internal strength of patients with chronic diseases included 4 defining characteristics:self concept,support,development and transcendence.Conclusions Rodgers evolution concept analysis method can help medical workers make clear concept essence of internal strength,deepening their cognition and understanding,so as to provide the basis for the implementation of the related research and clinical interventions.

BACKGROUND:Osteoporosis caused by diabetes melitus as common secondary osteoporosis has been paid more and more attention recently. Zoledronic acid serves as a novel drug for osteoporosis, and its effect on osteoblasts in vivo remains unclear. OBJECTIVE:To investigate the changes of the expression of bone morphogenetic protein 2 andNoggin in the femur of type 1 diabetes melitus rats and the effect of zoledronic acid on them. METHODS:Models of type 1 diabetes melitus were established by intraperitoneal injection of streptozotocin in 130 Wistar rats. 3 days later, rats with blood sugar > 16.7 mmol/L for three consecutive times were considered as successful models, 120 in total. These models were randomly divided into model, prevention and treatment groups. Rats in the prevention and treatment groups were intravenously administered zoledronic acid (0.1 mg/kg) on the day of modeling and 2 weeks after model establishment. An additional 40 rats were injected with citrate buffer solution as control group. RESULTS AND CONCLUSION: Compared with the control group, femur bone mineral density, serum alkaline phosphatase levels, and femur bone morphogenetic protein 2 mRNA expression levels were significantly lower in the model group (P < 0.05), butNoggin mRNA expression significantly increased (P < 0.05). Compared with the model group, bone mineral density and bone morphogenetic protein 2 mRNA expression levels were significantly higher in the prevention and treatment groups (P < 0.05), butNoggin mRNA expression significantly lower (P < 0.05), and serum alkaline phosphatase levels gradualy restored. These results indicated that the bone metabolic disturbance occurs in early stage in rats with type 1 diabetes melitus. Zoledronic acid can promote bone formation, increase bone density, and improve bone metabolism.

Objective To establish a single nucleotide polymorphisms genotyping (SNP) method for a convenient, accurate, and routine analysis of clinical samples. Methods Based on the design of oligonucleotide probe, the assay was performed through three steps:the conjunction of the detection probe, universal amplification, labeling and ELISA reaction. The genotype of each SNP was revealed by reading signals of each set of reaction tubes. This assay was applied to detect sixty-two plasma samples of lung cancer for circulating DNA for three SNPs of EGFR, c.2573T＞G(L858R), EGFR, c.2582T＞G＞T(G719C). Results were compared with those obtained by direct sequencing. Results The heterozygote mutation was identified for L858R by both methods, although no mutation was detected for L861Q and G719C. Six samples were identified as heterozygotes with the new method, and only two samples were unambiguously identified as heterozygotes by the direct sequencing. Two additional samples could not be identified as heterozygotes because the peak of mutant allele was very low compared with that of wild allele. Conclusion The developed method enabled accurate identification of SNP in a convenient manner, and which is adapted to routine analysis from heterogeneous samples unambiguously.

Objective To investigate the expression of triggering receptor expressed on myeloid cells receptor-1 (TREM-1) in plasma and bronchoalveolar lavage fluid (BALF) and its correlation with Galactomannan,IFN,IL-6 and IL-10 in Aspergillus infected mice.Methods Cyclophosphamide (CTX) was intraperitoneally injected and fumigatus spore suspension was inhaled by nose to establish the immunocompromised invasive pulmonary aspergillosis (IPA) mouse model.Healthy controls,immunocompromised only and IPA only groups were also established.Each group had 6 mice.After inoculation,mice were sacrificed.Lung tissue specimens,BALF,and plasma samples were collected.Plasma and BALF soluble TREM-1 (sTREM-1),Galactomannan,IFNγ,IL-6,and IL-10 were detected by ELISA.Results Positive Aspergillus fumigatus was found by tissue culture in the lung.Infiltration of inflammatory cells,blood congestion and interstitial lung tissue injury were observed in histological sections of both IPA and immunocompromised IPA mice.Compared to IPA group [(453.78 ± 74.18) ng/L,P ＜ 0.001;(10.21±1.46) ng/L,P＜0.001] and control group [(245.16 ±65.85) ng/L,P＜0.001;(6.60 ± 3.74) ng/L,P ＜ 0.001],the plasma and BALF sTREM-1 significantly increased in immunocompromised IPA group [(1 537.64 ± 359.52) ng/L;(20.12-± 2.72) ng/L].Compared to control group,both the BALF sTREM-1 in IPA group (P =0.041) and the plasma and BALF Galactomannan,IFNγ,IL-6,and IL-10 levels in IPA and immunocompromised IPA groups were significantly higher (P ＜0.01).Pearson correlation analysis showed that plasma and BALF sTREM-1 were significantly correlated with Galactomannan (r =0.83,P ＜ 0.001;r =0.82,P ＜ 0.001),IFNγ (r =0.79,P＜0.001;r=0.61,P＜0.01),IL-6 (r=0.81,P＜0.001;r=0.66,P＜0.01),andIL-10 (r=0.70,P =0.001;r =0.54,P =0.02).Conclusions Plasma and BALF sTREM-1 appears highly expressed in Aspergillus infected mice.sTREM-1 in mice plasma and BALF is closely correlated with Galactomannan,IFNγ,IL-6,and IL-10 levels,which suggests that sTREM-1 has great diagnostic value during invasive fungal infection.

Objective To investigate and analyze the status of psychological stress and career maturity of nursing postgraduates to study the relationship between psychological stress and career maturity. Methods A total of 556 full-time postgraduates were chosen as the research objects, the psychological stress and career maturity questionnaires of the postgraduates were used for the self-assessment survey analysis of the status of psychological stress and career maturity of 6 different colleges and universitiespostgraduates. SPSS17.0 was conducted to sort and analyze data. Results The status of investigation: the total score of career maturity of the postgraduates was 66.50 ± 9.80, average score for 2.02±0.30, and professional self-knowledge score was significantly higher in 9 dimensions. The total score of psychological stress was 101.50±14.37, average score for 3.17±0.45, and professional development in 8 dimensions was under the most pressure.The analysis of influence factors: the factors of career maturity including , professional attitude, professional orientation and planning and scientific research consciousness (F=4.988, F=8.087, F=4.573, P < 0.05);the factors of psychological stress including native place, professional attitude, professional orientation and planning (t=6.020, F=3.518, F=7.913, P<0.05). There was a negative correlation relationship between psychological stress and career maturity of the postgraduates(r=-0.208, P < 0.05). Conclusions The level of career maturity is low, and there is moderate psychological pressure of the postgraduates. The results show that the level of career maturity can be negative predict by psychological stress. Under the guidance of professional competence to strengthen the overall quality of training can effectively relieve the negative impact of psychological stress on career maturity.

A new teaching method was developed in the curriculum of Harmful Microorganisms Control Technology.It is characterized by students’ self-learning followed by student’s instruction.Both students and teacher have succeeded in this model after four stages of practice,in which a pleasant learning atmosphere was created in the classroom.An effective interaction between teacher and students was achieved.Students are viewed as main objects in the classroom and they are encouraged to ask questions,to formulate their own ideas,or to find things out for themselves.Thus,students’ abilities including presentation,communication,competition,and cooperation were enhanced.By adapting their role to the new teaching method,teachers have also improved their teaching skill and strategies.

Objective To observe the effects of five flavonoids include rutin(RU),dihydromyricetin(DMY),hesperetin(HP),daidzein(DA)and hydroxysaffor yellow A(HYSA)on myocardiocyte apoptosis induced by H2O2 and to explore their relationships with Keshan disease and the possible mechanism.Methods Primary cultured cardiocytes of neonatal rats were randomly divided into control group,model group,and flavonoids preincubation group.The cardiocyte apoptosis was examined by fluorescent staining,the rates of apoptosis were detected by flow cytometry,the expression of Bcl-2 family proteins associated with apoptosis were observed:by Western blot.Results Compared with model group[(24.33±6.51)%],RU[(13.95±3.80)%],DA[(11.82±3.50)%],HYSA[(12.33±3.78)%]could decreased the rate of apoptosis(P＜0.05).The five flavonoids could up-regulate Bcl-2 expression,down-regulate Bax expression,and increase the Bcl-2/Bax ratio[RU(0.989±0.094),DMY(0.931±0.280),HP(0.980±0.095),DA(1.049±0.092),HYSA(1.031±0.039),vs model(0.490±0.046),the difference had statistical significances(P＜0.05)],but the Bcl-xl did not significantly changed(P＞0.05).Conclusions RU,DMY,HP,DA and HYSA have antiapoptotic effects on cardiomyocyte via regulating Bcl-2 and Bax,which gives us a hint in prevention and treatment of Keshan disease.

Objective To study the etiological effect between the spatial variation of lumbar facet orientation and the degenerative lumbar spondylolisthesis(DLS)in axial,sagittal and coronal plane.Methods 85 patients with DLS at L4 and 110 controlsreceived X-ray and CT scanning.The facet angle at L4-L5 was measured in axial,sagittal and coronal plane.Results Compared with the control group, the DLS-angles were lesser and the difference between the left and right was greater in axial,coronal plane(P <0.05).But were greater in sagittal plane(P <0.05).Conclusion The DLS-angles are more sagittal in axial plane,more level in sagittal plane and more erect in coronal plane.The change of spatial orientation in the facet joint is one of etiological factors of degenerative lumbar spondylolisthesis.