Objective To investigate the changes and the significances of pregnant women with hypothyroidism companied with gestational diabetes mellitus.Methods 76 cases of hypothyroidism and subclinical hypothyroidism companied with gestational diabetes mellitus pregnant women admitted to our department from Sept 2014 to Mar 2016 were selected as the observation group.According to the levels of FT3,FT4 and TSH,the observation group were divided into two group(A group and B group).Cobas e601 was used to examine TSH and PT,APTT,TT,FIB and ATⅢ were determined with ACL-TOP.PLT,MPV and PDW were determined by Sysmex2000i.Results FIB (3.98±1.74 g/L),MPV (10.18±1.53 fl)and PDW (15.03％±1.54％)in A group were significant higher than those in B group (3.91±1.62 g/L,9.37±1.48 fl,14.41％± 1.35％％) and the control group (3.47±1.43 g/L,8.96±1.42 fl,13.67％±1.26％).FIB,MPV and PDW in B group was higher than those in the control group.PT (12.26±1.41 s,12.21±1.39 s) and APTT (31.80±8.72 s,30.43±8.54 s) in A group and Bgroup were higher than those in the control group (12.13 ± 1.32 s,29.24± 8.37 s).Otherwise,AT Ⅲ (78.47％± 10.36％,79.58％ ± 10.22％) in A group and B group was significant lower than that in the control group (86.56％±8.86％).There were distinct difference (t=3.072～6.153,P＜0.05).Conclusion The disorder of blood coagulation existed in pregnant women with hypothyroidism companied with gestational diabetes mellitus.Early diagnosis and intervention can reduce the occurrence of thrombotic disease and cardiovascular disease.

Objective:To explore the clinical significance of serum nuclear factor κ B, interleukin(IL)-4, IL-10, IL-12, interferon(IFN)- γ expression in subclinical hypothyroidism with gestational diabetes mellitus.Methods:Thirty pregnant women with subclinical hypothyroidism combined with gestational diabetes mellitus in Tangshan Maternal and Child Health Hospital from January 2017 to October 2018 were retrospectively analyzed as group A. Thirty three pregnant women with subclinical hypothyroidism were selected as group B, 35 pregnant women with gestational diabetes mellitus as group C and 40 healthy pregnant women as control group.ELISA was used to detect NF-κB, IL-4, IL-10, IL-12 and IFN-γ, and the results were analyzed and compared.Results:The serum levels of NF-κB were (15.91±5.68), (13.22±5.23), (12.97±5.11), (9.74±3.85) μg/L, IL-12 were (28.91±6.84), (21.64±5.72), (22.23±5.91), (13.68±3.76) ng/L, and serum IFN-γ levels were (23.74±5.55), (18.26±4.63), (17.85±4.31), (12.69±3.85) ng/L in A, B, C and the control group respectively.There were statistically significant differences in the three indicators between groups ( F=5.118, 6.821, 7.133, all P<0.05), and group A was higher than group B, C and control, the differences were statistically significant (all P<0.05); the levels of serum IL-4 in group A, B, C and control group were (8.91±3.99), (10.84±4.47), (11.27±4.62), (13.68±5.46) ng/L, respectively.The levels of serum IL-10 were (10.91±3.86), (13.05±4.58), (12.83±4.69), (15.82±5.33) ng/L, respectively.The differences of serum IL-4 and IL-10 between groups were statistically significant ( F=5.075, 5.616, all P<0.05), and serum IL-4 and IL-10 in group A were lower than those in group B, group C and control group.The levels of serum IL-4 and IL-10 in group B and C were lower than those in control group (all P<0.05). Conclusion:The activation of NF-kB signaling pathway and its related cytokines may be the influencing factors for the development of subclinical hypothyroidism with gestational diabetes mellitus.

Objective:To explore the imaging features and clinical effect of accordion maneuver in promoting the bone healing at the docking site after tibial transport under ultrasonic monitoring.Methods:Retrospective analysis was conducted on the clinical data of 16 patients with tibial bone transport who were admitted to the Department of Orthopedics, the second Hospital of Shanxi Medical University from May 2018 to October 2019. All the patients were treated with accordion maneuver to promote bone healing at the docking site under ultrasound monitoring. There were 14 males and 2 females, aged (45.3±14.3) years (range: 6 to 61 years). Before tibial bone transport, the length of the tibial defect of 16 patients was (6.0±2.6) cm (range: 2.0 to 12.1 cm). The operation steps of accordion maneuver were as follows: pressurization for 2 weeks, suspension for 12 days, distraction for 2 weeks, retraction for 2 weeks, and then stop the operation to consolidate the bone mineralization. During accordion treatment, ultrasound was used to monitor the size of hematoma, Adler grade of blood flow signal and the changes of new callus in and around the docking site. X-ray was performed to monitor bone healing at the docking site. Pearson correlation coefficient was used to analyze the correlation between the size of hematoma, the resistance index of blood flow signal and the bone healing time of the docking site. Paley healing criterion was used to evaluate the bone healing and functional recovery of the patients.Results:During accordion maneuver, ultrasound examination showed that the Adler grade of blood flow signals around the docking site increased gradually before retraction and then decreased gradually, but the degree of callus mineralization continued to increase gradually. After 2 weeks of pressure on the docking site, hematoma was observed in 14 patients by ultrasound examination. X-ray showed that all docking sites had bony healing, with the healing time of (30.8±4.9) weeks (range: 23 to 40 weeks).The size of the hematoma was negatively correlated with the healing time of the docking site ( r=-0.819, P<0.01). No hematoma was found in 2 patients, and after continuous observation for 20 weeks, there was still no obvious callus connection at the docking site. After bone cortical removal, ultrasound examination showed hematoma formed at the docking site. Accordion maneuver was continued, and the docking site healed at 30 and 32 weeks after surgery, respectively. There was a negative linear correlation between hematoma size at 2 weeks of compression and the blood flow resistance index at 2 weeks of retraction in 16 patients ( r=-0.801, P<0.01). The patients were followed-up for (14.5±3.2) months (range: 10.6 to 20.2 months). At the last follow-up, 12 patients were evaluated as excellent and 4 were evaluated as good by Paley healing criteria. Conclusion:The distraction and compression stress applied in accordion maneuver can promote bone healing at the docking site, and ultrasound can monitor early signs of bone healing at the docking site to help determine the tendency of bone healing.

Objective:To explore the imaging features and clinical effect of accordion maneuver in promoting the bone healing at the docking site after tibial transport under ultrasonic monitoring.Methods:Retrospective analysis was conducted on the clinical data of 16 patients with tibial bone transport who were admitted to the Department of Orthopedics, the second Hospital of Shanxi Medical University from May 2018 to October 2019. All the patients were treated with accordion maneuver to promote bone healing at the docking site under ultrasound monitoring. There were 14 males and 2 females, aged (45.3±14.3) years (range: 6 to 61 years). Before tibial bone transport, the length of the tibial defect of 16 patients was (6.0±2.6) cm (range: 2.0 to 12.1 cm). The operation steps of accordion maneuver were as follows: pressurization for 2 weeks, suspension for 12 days, distraction for 2 weeks, retraction for 2 weeks, and then stop the operation to consolidate the bone mineralization. During accordion treatment, ultrasound was used to monitor the size of hematoma, Adler grade of blood flow signal and the changes of new callus in and around the docking site. X-ray was performed to monitor bone healing at the docking site. Pearson correlation coefficient was used to analyze the correlation between the size of hematoma, the resistance index of blood flow signal and the bone healing time of the docking site. Paley healing criterion was used to evaluate the bone healing and functional recovery of the patients.Results:During accordion maneuver, ultrasound examination showed that the Adler grade of blood flow signals around the docking site increased gradually before retraction and then decreased gradually, but the degree of callus mineralization continued to increase gradually. After 2 weeks of pressure on the docking site, hematoma was observed in 14 patients by ultrasound examination. X-ray showed that all docking sites had bony healing, with the healing time of (30.8±4.9) weeks (range: 23 to 40 weeks).The size of the hematoma was negatively correlated with the healing time of the docking site ( r=-0.819, P<0.01). No hematoma was found in 2 patients, and after continuous observation for 20 weeks, there was still no obvious callus connection at the docking site. After bone cortical removal, ultrasound examination showed hematoma formed at the docking site. Accordion maneuver was continued, and the docking site healed at 30 and 32 weeks after surgery, respectively. There was a negative linear correlation between hematoma size at 2 weeks of compression and the blood flow resistance index at 2 weeks of retraction in 16 patients ( r=-0.801, P<0.01). The patients were followed-up for (14.5±3.2) months (range: 10.6 to 20.2 months). At the last follow-up, 12 patients were evaluated as excellent and 4 were evaluated as good by Paley healing criteria. Conclusion:The distraction and compression stress applied in accordion maneuver can promote bone healing at the docking site, and ultrasound can monitor early signs of bone healing at the docking site to help determine the tendency of bone healing.

Objective:To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF).Methods:220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ2 test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results:There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group ( P ?