Objective To investigate the value of preoperative risk assessments and countermeasures on ultrasound-guided radiofrequency ablation for benign thyroid nodules.Methods The preoperative risk assessments of 311 benign solid thyroid nodules in 274 patients were divided into level 0-Ⅳ,among which 38 nodules on level 0,69 nodules on level Ⅰ,36 nodules on level Ⅱ,59 nodules on level Ⅲ,109 nodules on level Ⅳ.Treatments were performed by moving shot technique or multiplanar shot technique,using Leverage Displacement or Hydrodissection to prevent the adjacent vital structures from thermal injuries.Results 311 thyroid nodules were completely ablated.In ablating the 59 nodules on risk level Ⅲ,thermal injuries were effectively avoided in 30 cases by using Leverage Displacement,while recurrent laryngeal nerve injuries happened in 2 cases using Hydrodissection for 29 nodules.The difference between these two methods on risk level Ⅲ had no statistical significance(P =0.237).To avoid thermal injuries during ablation for 109 nodules on risk level Ⅳ,using Leverage Displacement for 102 nodules,recurrent laryngeal nerve injuries happened in 1 case,while using Hydrodissection for 7 nodules,recurrent laryngeal nerve injuries happened in 2 cases.The difference between the two methods on risk level Ⅳ had statistical significance(P =0.010).No thermal injury happened during ablation for 143 nodules on risk level 0-Ⅱ.Conclusions Preoperative risk assessment on thyroid nodules is helpful in preventing potentially avoidable complications.Proper use of Leverage Displacement can protect adjacent vital structures from thermal injuries during ablation for nodules,which is easy and simple to handle and has a certain practical application value.

Cytokinesis ; Micronucleus Tests

Objective:To ascertain the optimized ultrasonic condition for extraction of flavone from Radix Astragali by orthogonal design. Methods: The contents of calycosin-7-O-?-D -glucoside and formononetin were taken as the indices and were determined. The ultrasonic time (10 min, 20 min, and 30 min), concentrations of methanol (50%, 75% and 100%) and times of extraction (1, 2, and 3) were analyzed by orthogonal design; the best ultrasonic condition was ascertained and compared with those of soak extraction and Soxhlet extraction. Results: Ultrasonic with 100% methanol twice (20 minutes each time) was the optimized condition for extraction of flavone from Radix Astragali. The efficiency of ultrasonic extraction was better than those of soak extraction and Soxhlet extraction. Conclusion: Compared with other methods, the ultrasonic extraction of flavone from Radix Astragali is efficient, quick and simple.

Objective To evaluate the effect of resistance training on glucolipid metabolism in a population with pre-diabetic metabolism (PDM).Methods Sixty persons with PDM were randomly divided into a resistance training group,an aerobic training group and a control group,each of 20 members.The exercise intervention groups exercised 3 times a week for 12 weeks in accordance with the exercise prescription,while the control group was without any regular aerobic exercise or resistance training.Before and after the 3 months of exercise training,fasting blood glucose (FBG),2 hours postpradial blood glucose (PBG),HbAlc,and lipid profile were tested.Body mass index (BMI),waistline,and blood pressure were also measured.Results Before the intervention,there were no significant differences in any of the average values among the 3 groups.In the resistance group,the average FBS (5.52 ± 0.52 mmol/L),HbA1 c (5.92 ± 0.36％) and TG (1.65 ± 0.92 mmol/L) had all decreased significantly after the training.In the aerobic group the average waistline,dilated blood pressure,FBG and HbAlc had decreased significantly.In the control group the average 2hrs PBG and LDL-C had both increased significantly compared to 3 months earlier.Compared with the resistance group,the average 2hrs PBGs were significantly higher in both the aerobic and control groups after the training.Moreover,compared with the aerobic group,the value in the control group was also significantly higher.Conclusion Both resistance training and aerobic exercise can lower fasting blood glucose and HbA1 c in PDM patients without obvious effect on BMI or low density lipoprotein level.Compared with aerobic exercises,resistance training had significant advantages in decreasing 2-hour postprandial blood glucose.

Objective To translate the Female Sexual Function Index(FSFI) into Chinese and establish its psychometric properties among ordinary Chinese people and diabetes patients.Methods A two-phase study design was applied.The Chinese version of FSFI was established by translation and back translation,then the reliability and validity of the FSFI were evaluated.Results The content validity coefficient of FSFI was 0.953.The test-retest reliability in each dimension had good correlations (r value was 0.817～0.922),with the highest correlation coefficient in vaginal lubrication dimension (0.922) and arousal dimension the minimum (0.817).In all samples (including diabetes and non diabetes) a reliability coefficients of the Cronbach alpha of each dimension was from 0.760 to 0.874.The Cronbach alpha of each dimension for the diabetic group was from 0.783 to 0.882,and from 0.757 to 0.865 in the non-diabetes group.Pearson correlation of each dimension was very good in total samples,the diabetes group,and the non-diabetes group.Conclusions The psychometric properties of the FSFI demonstrated satisfactory validity and reliability.The Chinese version of FSFI is a reliable and valid measure to evaluate the sexual function in Chinese women.

Objective To investigate the diagnosis and treatment of anaplastic carcinoma of the pancreas.Methods The clinical data of 10 patients with anaplastic carcinoma of the pancreas who were admitted to the Zhongshan Hospital from January 1999 to June 2010 were retrospectively analyzed.Computed tomography was carried out preoperatively and surgical plan was designed according to the site of tumors.Chemoradiotherapy was applied postoperatively.Patients were followed up till March 2012 by phone call and out-patient examination.The clinical and imaging features,pathological characteristics,treatment and follow-up data were analyzed.The clinical and pathological features were analyzed by descriptive statistics.The continuous data were described as (x) ± s,and categorical data were presented by frequency and precentage.Results The tumors located at the head of the pancreas were observed in 5 patients,tumor located at the neck of the pancreas in 1 patient,and tumors located at the body and tail of the pancreas in 4 patients.Two patients underwent pancreaticoduodenectomy (PD),2 underwent PD + extended lymph node dissection,1 underwent PD + portal vein reconstruction,1 underwent pancreatectomy,4 underwent resection of body and tail of pancreas and splenectomy.The size of the tumors ranged from 2.0 cm × 2.0 cm × 2.0 cm to 14.0 cm × 12.0 cm × 9.0 cm.Duodenal and biliary invasion was observed in 4 patients,superior mesenteric vein-portal vein invasion in 1 patient,splenic artery invasion in 1 patient.Neural invasion was observed in 8 patients,including 4 patients with lymph node metastasis.The results of immunohistochemical staining showed that 10 patients were with positive expression of cytokeratin 7,and 1 patient was with positive expression of vimentin.Nine patients were followed up,2 patients did not receive postoperative chemoradiotherapy,6 received chemotherapy with Gemicitabine and 1 received interventional treatment.The survival time of the 9 patients ranged from 8 to 20 months,and the median survival time was 12 months.Eight patients died of tumor recurrence and metastasis.Conclusions Pancreatic anaplastic carcinoma is a distinct rare variant of pancreatic ductal adenocarcinoma.Pancreatic anaplastic carcinoma has high malignancy,definite diagnosis depends on pathological examination,and the surgical plan should be made according to the result of imaging examination.Conventional radiotherapy and chemotherapy are ineffective for the treatment of this disease.

The article reviewed the effects of resistance training,aerobic exercise in patients with diabetes and pre-diabetes,based on the metabolic characteristics in patients with pre-diabetes,and aimed at providing theoretical reference for exercise in the prevention and control of diabetes mellitus.

Objective To investigate the histological features,biological features,clinical treatment and prognosis of pancreatic acinar cell carcinoma.Methods A retrospective review of 10 patients with pancreatic acinar cell carcinoma treated in our hospital from 1999 to 2008 was conducted and the clinical features,imaging changes,pathologic feature,treatment course and follow-up data were collected.Results There were 9 men and 1 woman with a mean age of (62±8) years old.Tumors were located in the uncinate process in 1 patient,head of pancreas in 7,body and tail in 2.The median size of these tumors was 4.5 cm×4.7 cm;common bile duct and intrahepatic bile duct,pancreatic duct dilation was detected in 7 cases,and superior mesenteric vein was invaded in 2 cases.Of the 10 patients,8 received pancreaticoduodenectomy,among these 8 patients,3 had extended lymph node dissection,2 had portal vein resection and replacement;2received resection of pancreatic body and tail as well as splenectomy.Histologically,the size of these tumors were 4.0 cm×3.3 cm×3.4 cm.Macrescopically,duodenum was invaded in 5 patients,superior mesenteric vein was invaded in 2 patients and neural invasion was present in 7 cases.Lymph node metastasis was noted in 6 cases.Follow-up data was available in 9 patients and 1 patient was lost in follow-up.The survival ranged from 3 to 51 months with a median survival 18 months,and 9 patients died of tumor recurrence and metastasis after operation.Conclusions Pancreatic acinar cell carcinoma should be recognized as a distinct tumor entity and it may not be sensitive to radiotherapy or chemotherapy.The biological features of pancreatic acinar cell carcinoma should be investigated further.

Objective To investigate the application value of percutaneous sinus-tract cholangioscopy in the diagnosis and treatment of residual intra-and extra-hepatic bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 1 045 patients with intra-and extra-hepatic bile duct stones who underwent percutaneous sinus-tract cholangioscopy or stone extraction in the Second Affiliated Hospital of Zhejiang University from January 2003 to June 2016 were collected.Patients received percutaneous sinus-tract cholangioscopy or stone extraction at 6-8 weeks after T tube drainage.Observation indicators:(1) diagnosis and stone extraction situstions:cases with residual stones,stone extraction frequency and clearance rate;the critics of clearance rate are no residual stone dnring operation combined with B ultrasound or T-tube cholangiography;(2) postoperative complications:incidence and management of postoperative complications,prognosis and ClavienDindo classification for postoperative complication;(3) follow-up situation.T-tube was removed when there was no residual stone.Patients were followed up by outpatient examination up to April 2017.B ultrasound reexamination was performed to detect the recurrence of stone once every 3-6 months.Results (1) Diagnosis and stone extraction situstions:among 1 045 patients,results of cholangioscopy showed 147 wihout bile duct stones and 898with bile duct stones.Of 898 patients,2 618 times cholangioscopic explorations for stone extraction were performed,with a maximum frequency of 16 times,and 851 had stones clearance,with a overall clearance rate of 94.77％(851/898).The clearance rates of extra-and intra-hepatic bile duct stones were 100.00％(221/221) and 93.06％(630/677).Of 47 patients with residual stones,16 didn't receive cholangioscopy due to branches stricture or occlusion of intrahepatic duct,13 failed to take out stone due to T-tube dislodgement (9 cases) and improper placement (4 cases) induced closed T-tube sinus tract,7 had T-tube sinus tract duodenal fistula,6 gave up stone extraction,3 was due to longer sinus tract induced bending and 2 was due to T-tube sinus tract fracture.(2)Postoperative complications:among 1 045 patients,297 had level Ⅰ-Ⅱ mild complications and 13 had level Ⅲand above severe complications.The common complications included fever,vomiting,diarrhea and so on;the special complications included T-tube sinus tract duodenal fistula of 13 patients,T-tube sinus tract fracture of 4 patients,rupture of broken stones pole of 3 patients,massive hemobilia of 2 patients,acute pancreatitis of 2patients and cardiac arrest of 1 patient.The above complications were improved by symptomatic and supportive treatments.(3) Follow-up situation:among 1 045 patients,558 received long-term follow-up,with follow-up time of 10-171 months and a median time of 79 months.Eight-four patients had stone recurrence.Of 13 patients with recurrence of extrahepatic bile duct stones,7 took out stones by endoscopic retrograde cholangio pancreatography (ERCP) and 6 underwent reoperations.Of 71 patients with recurrence of intrahepatic bile duct stones,43underwent reoperations and 28 received conservative treatment.Conclusions Percutaneous sinus-tract cholangioscopy for residual intra-and extra-hepatic bile duct stones is safe and effective,with good diagnosis and treatment values and a high clerance rate.The integrity of T-tube sinus-tract is a key of complete stones removal.

Objective To study the immediate effect of applying a portable functional electrical stimulation device (PUEFESD) to the upper extremities of stroke patients.Methods Twenty stroke survivors were selected.Pairs of electrodes of the PUEFESD were applied on the dorsal and palm sides of the affected forearm and thenar to stimulate the extensors and flexors as well as the thenar muscles sequentially according to a programmed protocol.Functional evaluation was conducted before and immediately after the stimulation.All participants were assessed with regard to their motor function and performance in the activities of daily living using an upper extremity function test (UEFT),the upper extremity motor function portion of the Fugal-Meyer assessment (FMA),and rating with the modified Barthel index (MBI).A visual analogue scale (VAS) was used to evaluate pain in the affected upper extremity.Results The patients' average FMA score was 19.4 ± 7.1 before the stimulation and 30.4 ± 9.6 after.The corresponding UEFT scores were 3.6 ± 3.7 and 26.9 ± 5.9,and the average MBI scores were 53.8 ± 26.2 and 65.8 ± 17.7.All of these increases were statistically significant.The average VAS score,however,did not change significantly.Conclusions Functional electric stimulation can quickly improve upper extremity function and the ADL ability of stroke patients,but pain is not relieved significantly.