Objective To explore the clinical value and significance of elastography technique used in the diagnosis of thyroid nodules .Methods The preoperative imaging data of pathologically confirmed 138 patients with thyroid nodules(160 nodules) were retrospectively analyzed .The imaging characteristics of routine preoperative ultra-sound and elastography were compared and the results were compared with the histopathological findings ,thus to eval-uate the clinical value of elastography in the diagnosis of thyroid nodules .Results Of 160 thyroid nodules in 138 pa-tients,129 nodules (80.63%) were histologically confirmed benign ,31 nodules (19.38%) were confirmed malig-nant.According to the elastic graph color grading standards of ultrasound elastography , in 129 benign nodules, 113 nodules (86.82%) were 0~Ⅱ grade,16 nodules(13.18%) wereⅢ~Ⅳ grade.Of 31 malignant nodules,4 nodules (12.90%) were 0~Ⅱgrade,27 nodules (87.10%) wereⅢ~Ⅳgrade.The diagnosis coincidence rate of conventional ultrasound was 66.25%,which was significantly lower than 87.50%of elastosonography (χ2 =20.32, P=0.000).The specificity,sensitivity,positive predictive value and negative predictive value of routine ultrasound were 61.29%,67.44%,87.88%,31.15%,which were significantly lower than those of ultrasound elastography (87.10%,87.60%,96.58%,62.79%)(χ2 =15.04,P=0.000;χ2 =5.39,P=0.022;χ2 =5.92,P=0.019;χ2 =10.24,P=0.001).Conclusion Compared with conventional ultrasound ,ultrasound elastography technique has ob-vious advantages in the differential diagnosis of benign and malignant thyroid nodules ,which has very important clini-cal value and should be popularized and applied in clinical diagnosis .

Objective struclured clinical examination (OSCE) is a kind of examination which could objectively evaluate the students′clinical skills.Nowadays,OSCE are wildly applied in medical educational field throughout the world.Timely discussion and analysis on the problems existed in the implementation process of OSCE is necessary.Measures should be taken to improve the OSCE examination and to meet the requirements of higher clinical practice training level such as increasing clinical skill simulation training hardware investment,optimizing settings and conlents of the examination and the test stations as well as introducing standardized patients (SP) and other measures.

In this study,with the mechanism for teaching supervision in military colleges and universities construction as the starting point,the author makes an in-depth analysis of the problems existing in the current teaching supervision system of military academies,such as the imperfect mechanism,the limitation of the function,the lack of full-time staff,the lag of information technology and so on,and investigates and surveys the status quo of teaching supervision at home and abroad.It also puts forward some countermeasures,such as constructing the comprehensive supervision system,realizing the function transformation,promoting the innovation of the mode,expanding the connotation of the supervision,optimizing the structure of the team,developing the professional training,and strengthening the information construction and so on.

Objective To clone cDNA encoding troponin T of Schistosoma japonicum(SjTnT),and evaluate the protective efficacy induced by recombinant SjTnT in BALB/c mice against S. japonicum challenge infection. Methods The SjTnT gene was amplified from 28-day-schistosome cDNAs by PCR and then subcloned into pET28a(+). The recombinant SjTnT protein (rSjTnT)was expressed in Escherichia coli BL21(DE3)cells. The serum specific to rSjTnT was prepared by immunized BALB/c mice with the recombinant antigen,and the immunogenicity of rSjTnT was detected by Western blotting and ELISA. The immuno-protective efficacy induced by rSjTnT in BALB/c mice was evaluated according to the reduction in worm and egg counts. Results The cDNA encoding SjTnT was successfully cloned and expressed in E. coli. Western blotting showed that rSjTnT had a good immunogenicity. The high level of specific IgG antibodies was detected,and 33.89% worm reduction and 43.94% liver egg reduction were obtained in mice vaccinated with rSjTnT combined with Seppic 206 adjuvant compared with those in the adjuvant control group. Conclusions rSjTnT could induce partial immuno-protection against S. japonicum infec-tion in BALB/c mice. This study provided a basic for understanding the biological function of SjTnT.

Objective To investigate and analyze the changes of serum interleukin-34(IL-34),rheumatoid factor(RF) and nuclear factor κB receptor activator ligand(RANKL) in patients with rheumatoid arthritis Its relationship with osteoporosis.Methods A total of 40 patients suffering from rheumatoid arthritis in the hospital between January 2016 and January 2017 were included in the study group,and 40 healthy subjects who underwent the same period of physical examination at the same time were enrolled as controls.By enzyme-linked immunosorbent assay(ELISA) were detected in 2 groups of serum IL-34 and RANKL levels were detected by latex agglutination assay of serum RF levels in 2 groups,and routine testing in patients with bone mineral density,erythrocyte sedimentation rate(ESR),C reactive protein(CRP) and anti CCP antibody.And the modified DAS28 score of disease activity of rheumatoid arthritis evaluation.Results The levels of serum IL-34,RF and RANKL in the study group were significantly higher than those in the control group(P＜0.05).The incidence of osteoporosis in the study group was significantly higher than that in the control group(P＜0.05).The levels of IL-34,RF and RANKL in the osteoporosis patients were significantly higher than those in the normal group(P＜0.05).The Spearman correlation analysis showed that the serum IL-34 levels were positively correlated with ESR,CRP,anti-CCP and DAS28 (P＜ 0.05).There was a negative correlation between serum IL-34,RF and RANKL levels and bone mineral density(P＜0.05).Conclusion The levels of serum IL-34,RF and RANKL in patients with rheumatoid arthritis were significantly increased,and the above indexes were negatively correlated with bone mineral density.It suggested that IL-34 may be involved in osteoporosis.

Objective:To evaluate the functional status and assistive facilities requirements for the elderly with disabilities in rural areas of Liaoning Province, and to provide reference for the configuration of assistive facilities and the construction of further rehabilitation management mode for the elderly with disabilities.Methods:A total of 929 disabled rural elderly people in 15 deep poverty-stricken areas in Liaoning Province from 2019 to 2020 were selected to evaluate the functional status and needs of assistive devices by using general information questionnaire, disability status questionnaire and assistive device evaluation form for disabled elderly people.Results:There were 149 cases (16.0%) with grade 1 disability, 465 cases (50.1%) with grade 2 disability, 178 cases (19.2%) with grade 3 disability and 137 cases (14.7%) with grade 4 disability. The elderly with disabilities mainly had difficulties in long-distance walking, bathing, toilet use, defecation control, short distance walking, squatting, and transfer. The proportion of disabled elderly was 89.8% (834/929), 84.9% (789/929), 82.6% (767/929), 79.9% (742/929), 76.6% (712/929), 76.1% (707/929) and 60.5% (562/929), respectively. With the increase of disability severity, bathing, short walking, metastasis, shopping and preparing meals accounted for the greater proportion of the elderly with disabilities, and the differences were statistically significant ( P< 0.01). The elderly with disabilities had the greatest demand for wheelchairs, followed by mattresses for preventing stress injuries and four-legged walking sticks, with a demand rate of 56.3% (523/929),9.4% (87/929) and 7.0% (65/929), respectively. The elderly with different levels of disability had different needs on ordinary wheelchair, pressured-injury mattress, four-legged walking stick, stool chair, wheelchair with toilet seat and common walking stick, and the needs had statistically significant differences ( P<0.01). Conclusions:The elderly with disabilities in rural areas of Liaoning Province are mainly moderate to severe, mainly physical disabilities, and have great obstacles in self-care and daily living activities, with the highest demand for ordinary wheelchairs, anti-stress injury mattresses and four-legged canes. In the future, further intervention measures and rehabilitation management models should be developed according to the assessment results of the functions and assistive devices of the elderly with disabilities in rural areas, so as to meet the nursing and rehabilitation needs of the elderly with disabilities and improve their life quality.

In this study, 155 residents who participated in the standardized residency training in neurology department of Second Affiliated Hospital of Army Medical University from 2016 to 2018 were included, all of whom were medical university graduates. The training duration in neurology department was 3 months. Each physician was assigned the first mock exam to each of his tutors and took the one to one mode to carry out clinical practice teaching. First, theoretical teaching, then clinical observation, and finally clinical practice. In addition, a typical case seminar was held every two weeks. After the combined teaching, the average scores of theoretical examination were (96.78 ± 10.14) points, and the average scores of operation examination was also significantly increased (98.36 ± 11.38) points. The percentage of excellent people assessed by Mini-CEX scale was as high as 88%. The teaching approach of tutorial and seminar teaching model not only consolidates medical theory knowledge, improves clinical skills, but also enhances the ability of analyzing and solving problems and contributes to establishment of rigorous clinical thinking, which lays a solid foundation for training excellent neurology clinical specialists.

Objective:To evaluate the risk factors for diaphragmatic dysfunction of patients with sepsis and septic shock, and the application value of bedside ultrasound.Methods:Patients with sepsis and septic shock in the Intensive Care Unit (ICU), General Hospital of Ningxia Medical University from January 2020 to May 2021 were prospectively recruited as the research subjects, general postoperative patients and healthy volunteers were admitted as postoperative control and normal control groups. General clinical data were collected, patients with sepsis and septic shock were dynamically observed high sensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6), serum albumin, transferrin, prealbumin levels, blood lactate, Pcv-aCO 2, ScvO 2, etc.; and indirect calorimetry was used to measure the resting energy level of the patient to calculate the missing energy value. Bedside ultrasound was used to dynamically evaluate the changes of diaphragm excursion (DE),inspiratory diaphragm thickness, and expiratory diaphragm thickness, to calculate relevant parameters. DE<10 mm or diaphragmatic thickness fraction (DTF) < 20% was diagnosed as diaphragmatic dysfunction. Results:(1) On day 1 in the ICU, the DE of the septic shock group, sepsis group and postoperative control group were significantly lower than that in the normal control group [10.3 (9.0, 13.6) mm, 12.3 (9.1, 15.0) mm, 12.9 (10.5, 15.7) mm vs. 22.0 (16.0, 24.6) mm, all P<0.05], and the incidence of DTF<20% was significantly higher than in the normal control group (32.7%, 41.9%, 33.3% vs. 0 %, all P<0.05), and the incidence of DE<10 mm in the septic shock group and sepsis group was significantly higher than that of postoperative control group and normal control group (36.7%, 35.5% vs. 10.0%, 0%, respectively, all P<0.05). On day 7, the DE in the septic shock group was significantly lower than that in the sepsis group [10.5 (6.8, 13.5) mm vs. 14.4 (10.6, 18.6) mm, P<0.05].(2) Correlation analysis of each index: The DE of patients with sepsis and septic shock on day 1, 3, and 7 was negatively correlated with the hs-CRP ( r=-0.253, -0.436, -0.455, all P<0.05); On day 3, DE was also negatively correlated with IL-6 ( r=-0.338, P=0.009); and DTF was negatively correlated with hs-CRP ( r=-0.375, P=0.004). On day 1, there was a positive correlation between DTF and serum transferrin levels in patients with sepsis and septic shock ( r=0.221, P=0.049). On day 3 and 7, the DE was positively correlated with serum prealbumin levels ( r=0.318, 0.408, both P<0.05). Conclusions:Patients with sepsis and septic shock have developed diaphragmatic dysfunction on day 1 in the ICU, which is mainly manifested as decreased in diaphragm mobility and diaphragmatic thickness fraction, and is related to inflammation and high protein catabolism.

Objective:To explore the inhibitory mechanism of herb cake-partitioned moxibustion on tumor growth in colitis-associated colorectal cancer(CAC)based on histone lysine demethylase 4D(KDM4D). Methods:Inbred male Sprague-Dawley rats were randomly divided into a normal group,a CAC group,a herb cake-partitioned moxibustion group,and an inhibitor group.Except the normal group,rats in the other three groups were treated with azoxymethane(AOM)combined with dextran sulfate sodium(DSS)to make CAC rat models.Rats in the normal group and the CAC group did not receive interventions;rats in the herb cake-partitioned moxibustion group received moxibustion at Qihai(CV6)and bilateral Tianshu(ST25),2 cones for one point each time,once a day for 30 d with 1-day rest every week;rats in the inhibitor group received intraperitoneal injection of KDM4D inhibitor,5-chloro-8-hydroxyquinoline(5-c-8HQ),once a day for 30 d.After intervention,the general condition,colon length,tumor number and volume,and histopathological colon changes were observed.The expression of adenomatous polyposis coli(APC),axis inhibitor(Axin),cyclin D1,matrix metalloproteinase(MMP)-7 and MMP-9 mRNAs were detected by real-time quantitative polymerase chain reaction.The proliferating cell nuclear antigen(PCNA),cleaved caspase3,KDM4D,APC,and Axin proteins were detected by immunohistochemistry. Results:Compared with the normal group,the general condition was poor,the colon length was significantly shortened(P<0.01),the number and volume of colonic tumors were increased(P<0.01),the structure of glandular duct was obviously disordered with"back-to-back"and cowall phenomenon,and also high-grade adenocarcinoma formed;the protein expression levels of PCNA and KDM4D were significantly increased(P<0.01),while cleaved caspase3,APC,and Axin were significantly reduced(P<0.01);the mRNA expression levels of cyclin D1,MMP-7,and MMP-9 were significantly increased(P<0.01),while APC and Axin were significantly reduced(P<0.01)in the CAC group.Compared with the CAC group,the general condition was improved,the length of colon was significantly increased(P<0.01),the number and volume of the colonic tumors were reduced(P<0.05),and the colon tissues showed epithelial cell proliferation with enlarged and deep staining nuclei,dysplasia and inflammatory cell infiltration;the protein expression levels of PCNA and KDM4D were significantly reduced(P<0.01),while the cleaved caspase3,APC,and Axin were significantly increased(P<0.01);the mRNA expression levels of cyclin D1,MMP-7,and MMP-9 were reduced(P<0.05),while the APC and Axin were increased(P<0.05)in the colon tissues of rats in the herb cake-partitioned moxibustion group and the inhibitor group. Conclusion:Herb cake-partitioned moxibustion regulated abnormally expressed KDM4D in CAC rats,activated APC and Axin,the upstream molecules of Wnt/β-catenin pathway,inhibited abnormally activated downstream molecules of Wnt/β-catenin pathway.This may be a key mechanism of herb cake-partitioned moxibustion in inhibiting CAC tumor growth.

Objective:To explore the value of current indications for fetal pulmonary valvuloplasty (FPV) by summarizing the postnatal diagnosis, treatment, and prognosis of fetuses with pulmonary atresia with intact ventricular septum (PA/IVS) and right ventricular hypoplasia (RVH).Methods:This prospective study was conducted at the Heart Center of Women and Children's Hospital, Qingdao University from September 2018 to March 2021, which included pregnant women who were (1) with fetal PA/IVS and RVH; (2) unable to receive FPV due to fetal position or gestational age despite the indications; (3) given integrated pre- and postnatal management. Prenatal fetal echocardiography assessment, postnatal diagnosis, treatment, and follow-up were summarized using Wilcoxon matched-pair signed-rank test.Results:A total of 35 singleton pregnant women were diagnosed with fetal PA/IVS and RVH by ultrasonic cardiogram and admitted during the study period. Among the 28 fetuses meeting the FPV indications, 18 underwent FPV, while the other 10 did not due to inappropriate fetal position or gestational age. After excluding four terminated pregnancies, the rest six cases were enrolled. The median gestational age at the initial prenatal fetal echocardiography diagnosis was 28.9 weeks (28.3-30.4 weeks). Compared with the initial evaluation, the fetal right ventricular to left ventricular length/diameter ratio [0.8 (0.6-0.9) vs 0.6 (0.5-0.8)] and tricuspid regurgitation velocity [4.7 m/s (3.2-5.1 m/s) vs 4.1 m/s (3.3-4.8 m/s)] were increased, while tricuspid valve Z value [－0.8(－1.6-0.8) vs 0.4 (－0.3-1.9)] and single-ventricular predictive score [0.5 (0.0-2.0) vs 2.0 (1.0-3.0)] were decreased when re-evaluated six weeks later ( T were－2.21, 2.00,－2.20, and 2.00; all P<0.05). All of the six fetuses were born alive with a median gestational age of 38.9 weeks (37.3-40.1 weeks). The median weight was 3 425 g (3 100-4 160) g after being transferred to cardiac intensive care unit. The median age was 12.5 d (0.0-20.0 d) at the first surgical intervention. The median follow-up duration was 15 months (11.8-18.5 months). At initial diagnosis, the single-ventricular predictive score was 1-2 points in four fetuses, and =3 points in two fetuses. There was no death during follow-up. Four patients achieved anatomical biventricular circulation, one achieved clinical biventricular circulation, and one still needed further follow-up, with single-ventricular predictive score at initial diagnosis of 1-3, 3, and 2 points, respectively. Conclusions:The prognosis is good in fetuses with PA/IVS and RVH who have FPV indications but do not receive intrauterine intervention, which suggests that the current FPV indications may be too broad, and a more suitable FPV indication need to be further explored given the difficulty of implementing FPV.