Objective To investigate the evaluation of virtual touch tissue quantification(VTQ)in differential diagnosis of thyroid benign and malignant nodules and its influence factors.Methods 127 patients with thyroid lesions and its adjacent normal thyroid tissue at the same depth were examined with VTQ.Test results were performed by shear wave velocity value (SWV) on the long axis dimension of the nodules.The maximum(Vmax),minimum(Vmin) value of SWV of thyroid lesions and the SWV(Vn) value of surrounding normal tissue were recorded.The mean value of SWV (Vm) and the ratio of Vm and Vn (Vm/n) were calculated.SWV value of benign and malignant nodules and different pathological types of nodules were analyzed.Receiver-operating characteristic curve(ROC) was drawn to assess the diagnostic efficiency.Results The Vmax,Vmin,Vm,Vm/n of malignant lesions [(4.61 ± 2.65) m/s,(2.74 ± 2.23) m/s,(2.99 ± 0.82)m/s,(1.69 ± 1.07)m/s,respectively] were obviously higher than that of benign nodules [(2.78 ± 0.96)m/s,(1.75 ± 0.60)m/s,(2.31 ± 0.38)m/s,(0.94 ± 0.23)m/s,respectively,P ＜0.01].The SWV value of thyroid papillary carcinoma was higher than that of nodular goiter,thyroid adenoma and Hashimoto's thyroiditis(P ＜0.05).The SWV value of Hashimoto's thyroiditis was higher than that of thyroid adenoma and nodular goiter (P ＜ 0.05).No significant differences of SWV value were found between thyroid adenoma and nodular goiter (P ＞ 0.05).Contrast the area under the receiver-operating curves above four groups of different SWV values,the results showed that Vm had the highest diagnostic value in diagnosis of benign and malignant thyroid nodules.When the best cut-off point of Vm was 2.48 m/s,the diagnostic value was highest and the sensitivity and specificity were 97％ and 81 ％.Conclusions VTQ could be used to quantify and evaluate the hardness of thyroid nodules and provided important value for the differential diagnosis of benign and malignant thyroid nodules.

Biliary Tract Diseases ; Humans ; MicroRNAs

Objective:To analyze therapeutic effect and safety of triple intensive anti -platelet therapy on patients with acute myocardial infarction (AMI) complicated type 2 diabetes mellitus (T2DM) .Methods:A total of 100 AMI + T2DM patients were enrolled and equally divided into routine treatment group (received aspirin and clopi‐dogrel treatment based on routine treatment ) and tirofiban group (received tirofiban based on routine treatment group) .Platelet count (PLT) ,platelet activating factor (PAF) ,prothrombin time (PT) ,activated partial thrombo‐plastin time (APTT) ,fibrinogen (Fg) ,left ventricular ejection fraction (LVEF) ,left ventricular fractional short‐ening (LVFS) ,stroke volume (SV) and therapeutic effect were measured and compared between two groups .All patients were followed up for six months ,incidence rates of major adverse cardiovascular events (MACE) and vari‐ous hemorrhage events were compared between two groups .Results :Compared with routine treatment group ,there were significant reductions in PLT [(18.2 ± 2.5) 109/L vs .(15.8 ± 1.4) 109/L] and PAF [(138.6 ± 10.2)μg/L vs . (61.5 ± 3.1)μg/L] (P<0.05 ,<0.01);and significant rise in LVEF [ (56.9 ± 5.2)% vs .(64.2 ± 4.6)% ] ,LVFS [ (30.4 ± 3.3)% vs .(39.8 ± 4.5)% ] ,SV [ (43.2 ± 3.4) ml vs .(74.5 ± 4.6) ml] and total effective rate (76.0%vs .96.0% ) in tirofiban group , P<0.05 all .After six-month follow-up ,there were no significant difference in incidence rates of MACE and bleeding between two groups , P>0.05 all .Conclusion:Therapeutic effect of triple in‐tensive anti-platelet therapy is significant in AMI + T2DM patients ,and its adverse reactions and prognosis have no difference with those of dual anti -platelet therapy .

[Objective]To discuss the effective treatment of complicate intertrochanteric hip fracture.[Method]Thirty-five cases with complicate intertrochanteric hip fracture.The class of fracture,surgery method,operating time,complicatico,union rate of fracture were amounted statisti cally.[Result]All the 35 cases were surgical treated,l 4 cases with PFN(priemeral femur nail),21 cases with DHS(dynamic hip screw)with mean time of operation 1.8 h(1.5~3 h),mean amount of blood loss during operation 300 ml(150~500 ml),mean time in bed 2.4 monthes (1.2~3 monthes),mean following-up time 12 months(6~16months).Thirty-one cases got union,3 cases union time delayed,1 case nounion,union rate was 88.5%.Four cases suffered hip iversion( 11.4%),the screw in the neck removed in 6 cases(8.5%),5 cases feeled pain in hip( 14.2% ).[Conclusion]The complicate intertrochateric hip fracture is a kind of fracture which can not be treated easily.Using PFN and DHS can not control the stability effectively.Additional fixation of the greater trochantar fracture is necessary.Added out-fixation and avoid early bearing are useful.

[Objective]To evaluate the effect of nonoperative and operative treatment in calcaneal fractures.[Method]Operative effect of 38 cases of calcaneal fracture of all kinds(42 foots)were analyzed.Accordind Essex-Loprestis classification,6 foots suffered type I tongue fracture,28 foots suffered compressed fracture(type Ⅱ),8 foots suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction interal fixation by Buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domestically) from the extended "L" lateral approach.Postoperatively,no patient needed plaster fixation.All patients started non-weight-bearing fuctional exercise at 2-3days,gradual weight-bearing walking at 6-8 weeks.The result of operated group was compared with nonoperative treatment group.The follow-up period was from 10 months to 36 months,with an average of 17monthes.[Result]Assessed the effect by Maryland foot score,the base line included every foot.Total excellent and good rate in operative group was 93%,it was 100% in type I fracture group,96% in type Ⅱ fracture group,75% in type Ⅲ fracture group.The result of nonoperative treatment group was:total excellent and good rate was 67%,it was 92% in type I fracture group,77% in type Ⅱ fracture group,there was not excellent and good patients in type Ⅲ fracture group.[Conclusion]It is important to regain the flatness of subtalar joint and calcaneocuboid joint,maintain the normal shape of foot.The authors recommend that type Ⅱ and type Ⅲ fractures of calcaneus according Essex-Loprestis classification were treated with open reduction and interal fixation by Buttress plate.By selecting the appropriate approach,proper reducting and postoperative treating rightly,it is an ideal measure to treat calcaneal fracture by selection of treatment method acciding to patient's individual status and fracture type.

[Objective] To investigate the clinical significance of changes in serum biochemical factors in trauma patients,and to improve the initial determination of the injury degree and rescue ratio.[Method]From April 2002 to December 2004,48 trauma patients were divided into two groups of serious and slight injury by ISS score.The author monitored the concentration of serum GLU,CR,BUN,LDH,CK,CKMB,LDL,GPT,GOT,IgG,IfA,IgM,C3,C4,CRP and the WBC,PLT,BT(body temperature)at the first day and after 3,7,14 days,recorded the therapy method and results.The difference between the two groups was compared by statistic method.[Result]In 48 patients,There were 12 in slight injury group,36 in serious injury group.The concentration of GLU,LDH,CK,CKMB,CRP in serious group was more than that in slight group,but the concentration of LDL,IgG,IgA,IgM,C3,C4 was lower(P0.05).There were 6 patients suffered MODS,2 cases suffered ARDS,3 patients suffered upper digestive tract bleeding,2 cases combined with infection,1 case suffered DIC,and I death in serious group;there was 1 MODS,1 infection and no death in slight group.[Conclusion]The combined use of the AIS-ISS90 score and serum biochemical factors is advantageous to the determination of injury degree and prognosis.

Objective The evaluate action of serum L-arginine levels for predicting development of pregnant women with PIH,and analyze its effectiveness as clinical predictor.Methods Collecting 186 patients was performed a retrospective study.The PIH pregnant women was the experiment group,and the health pregnant women was the control group.In order to analyse the effect,the levels of L-arginine were measured in the early,middle and late period of pregnant women.Compared with the serum L-arginine in different groups with x2-test and t-test based on data type.Results Experimental group and control group subjects in age (x2 =2.426,P=0.119;t=1.218,P=0.229) and smoking before pregnancy (x2 =2.088,P=2.088),there was no significant differences,but the two groups of patients with BMI (x2 =8.772,P=0.003) and parity (x2 =6.083,P=0.014) was statistically.In different stages of pregnancy,the concentration of serum L-arginine had no statistical differences,and in the concentration of umbilical cord blood,serum L-arginine also had no statistical difference.There was a statistical differences in the serum L-arginine concentration of the cord blood for different number of pregnancies,but the concentrations of L-arginine in cord blood and in serum L-arginine.There were no significant difference in age,BMI and smoking pregnant.According to ROC curve analysis,for the diagnostic of concentration in serum L-arginine and in umbilical cord blood,the results indicate low efficiency to the diagnosis of pregnancy hypertension during pregnancy.Conclusion L-arginine level and the development of PIH and body mass index and maternal correlation for the pregnant women.Because the sample size limitations,L-arginine in the diagnosis of PIH also needs to be further research to determine the effectiveness of predicting.

Objective:To analyze the clinical therapeutic effect and safety of bare metal stent (BMS)application in patients with coronary heart disease (CHD)complicated impaired glucose tolerance (IGT).Methods:The data of 68 CHD + IGT patients undergoing stent implantation in our hospital were retrospectively analyzed.According to kind of implanted stents,they were divided into BMS group (n=36)and drug eluting stent (DES)group (n=32). Thrombolysis in myocardial infarction (TIMI)flow grade and Gensini score of coronary lesion were compared be-tween two groups via reviewing coronary angiography six months after operation.Incidence rates of re-stenosis,a-cute thrombosis,sub-acute thrombosis,revascularization and sudden death were compared between two groups after one year follow-up.Results:There were no significant difference in TIMI grade and Gensini score of coronary le-sion between two groups after operation (P>0.05).Compared with DES group after one-year follow-up,there were significant reductions in incidence rates of acute thrombosis (6.25% vs. 2.78%), sub-acute thrombosis (15.63% vs.5.56%)and sudden death (6.25% vs.2.78%)in BMS group (P<0.05 all),but there were no signif-icant difference in incidence rates of re-stenosis and revascularization between two groups (P>0.05).Conclusion:Application of bare metal stent can reduce incidence rate of postoperative complications and possess better therapeu-tic effect in patients with coronary heart disease complicated impaired glucose tolerance.

Objective To investigate the curative effect and safety of endoscopic nose biliary drainage (ENBD) through endoscopic retrograde cholangiopancreatography (ERCP) to treat for elderly patients with acute severe cholangitis in primary hospital.Methods Forty-two elderly patients with acute severe cholangitis were collected,the patients received ENBD through ERCP.The changes of clinical symptoms and signs,imaging examinations and laboratory examinations before and after treatment were compared.Results All 42 patients received ENBD through ERCP,40 patients were cured,1 patient failed in ERCP and then was turned to surgical operation,and 1 patient whose cholangitis condition got better died of respiratory failure because of chronic obstructive pulmonary disease (COPD).Conclusion ENBD through ERCP is a safety and effective treatment which was used to treat for elderly patients with acute severe cholangitis in primary hospital,so this technique is worthy popularizing in primary hospital.