ObjectiveTo analyze the association between the outcome of exophthalmos and the curative effect of hyperthyroidism in Graves disease after 131I therapy.Methods Five hundred and thirty-eight cases of Graves disease accompanied with exophthalmos and hyperthyroidism who received 131I therapy from January 2001 to January 2010 were reviewed retrospectively,and the association between the outcome of exophthalmos and the curative effect of hyperthyroidism was analyzed.ResultsThe effective rate of hyperthyroidism after 131I therapy was 94.8％ (510/538).The effective rate of exophthalmos after 131I therapy was 73.2％(394/538).And the effective rate of hyperthyroidism with exophthalmos was 71.6％ (385/538).The incidence of improvement,inefficiency,exacerbation was 75.5％ (385/510),21.0％ (107/510),3.5％( 18/510) in hyperthyroidism effective patients ( 510 cases ) and 32.1％ ( 9/28 ),50.0％ ( 14/28 ),17.9％ ( 5/28 )in hyperthyroidism ineffective and recrudescence patients(28 cases),there was significant difference between the two patients (P ＜ 0.05 ).The incidences of improvement,inefficiency,exacerbation were 78.1％(281/360),18.9％(68/360),3.1％(11/360) in hyperthyroidism cured patients(360 cases),78.2％(36/46),17.4％ (8/46),4.3％ (2/46) in hypothyroidism patients(46 cases),there was no significant difference between the two (P ＞ 0.05 ).The incidence of improvement,inefficiency,exacerbation was 86.4％ ( 229/265 ),9.8％(26/265 ),3.8％( 10/265 ) in mild exophthalmos after 131I therapy(265 cases),59.9％(106/177),35.6％(63/177),4.5％(8/177) in moderate and severe inactive exophthalmos after 131I therapy( 177 cases),there were significant differences in the inciclence of improvement and inefficiency between the two patients (P＜0.05).For patients with moderate and severe active exophthalmos,glucocorticoids therapy could obtain satisfactory effect.Conclusion131I therapy is an effective method for Graves disease with exophthalmos,and there is a significant association between the outcome of exophthalmos and the curative effect of hyperthyroidism.

Objective To investigate the clinical value of serum cystatin C in the early renal function impairment in elderly patients wtih chronic congestive heart failure (CHF). Methods Serum cystafin Cwas measured in 60 cases with chronic CHF (CHF group), 40 cases with cardiovascular diseases and compensated heart function (compensated heart function group), and other 20 elderly normal volunteers(controlgroup). The correlation between cystafin C, B-type natriuretic peptide (BNP) and LVEF was evaluated. Results The levels of eystatin C in CHF group [(1.86±0.37)mg/L]was higher than that in compensated heart function group [(1.32±0.56) mg/L]and control group [(1.05±0.43) mg/L], P < 0.01. Cystatin C was positively correlated with BNP (r = 0.528,P< 0.01)and negatively correlated with LVEF (r=-0.463, P<0.01). In CHF group, the level of cystatin C and the incidence rate of renal failure was higher in the patients with BNP≥500 ng/L than those with BNP < 500 ng/L. Conclusions Cystatin C is a marker dearly impairment of renal function in elderly patients with chronic CHF. The more severe the heart failure, the more obvious the glomorular filtration function impairment shows.

Objective To evaluate the methods of standard patient (SP)combined with case-based learning (CBL ) in humanistic quality cultivation for interns in the department of thoracic surgery. Methods Medical interns in the department of thoracic surgery were divided randomly into experimental(n=30)and control group(n=30)respectively. In experimental group,SP combined with CBL was used while in control group traditional teaching was used. At the end of the study,teaching effect was assessed by the final examination and questionnaires and the data were processed by t test andX2 test. P<0.05 signifies statistical differences. Results There was no significant difference in test scores between the two groups (P>0.05). Scores of history-taking,medical check-up,paper writing quality in the final examination in experimental group were significantly higher than those in control group(P<0.01). Satisfaction degrees of doctor-patient communication,responsibility and service attitude in experimental group were better than those of control group(X2=16.484,10.335,20.376,32.851,P<0.01). Conclusions SP combined with CBL teaching method can stimulate the students' interests in thoracic surgery practice,improve the doctor-patient relationship and strengthen the ability of human-istic concern. It is a better clinical thoracic practice teaching method and it is beneficial to cultivating medical students with humanistic concern.

Introduction: Tuberculosis is the second leading cause of death under the category of infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis (TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis. Case presentation: A 28-year-old Malay woman with no significant medical history presented to HUSM with one month history of on and off fever, two weeks history of generalised limbs weakness and one week history of dysphagia. She was reported to have experienced visual hallucination and significant weight loss. Her laboratory result is significant for leukocytosis, elevated ESR and hypernatremia. Non-enhanced and contrast CT scan of the brain showed severe bilateral frontal cerebral atrophy. Cerebral spinal fluid (CSF) for multiplex PCR for Mycobacterium tuberculosis complex was positive. She was promptly started on anti-TB regime combined with dexamethasone. Subsequent follow-up showed significant improvement. Conclusion: This is a rare clinical manifestation of Tuberculous meningitis that demonstrates the importance of recognising and initiating the treatment early to reduce disabilities and improve clinical outcome.

Background: While cardiac implantable electronic devices (CIED) are increasingly used, real-world data on the mortality rate due to mechanical complications of CIED is scarce. Objective: This study aimed to determine longitudinal trends in mortality attributed to mechanical complications of CIED. Methods: We queried the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research and performed serial cross-sectional analyses of national death certificate data for mechanical complications of CIED-related mortality among the United States population aged ≥ 35 years from 1999 to 2020. Cardiovascular disease (ICD-10: I00–I99) was listed as the underlying cause of death, and mechanical complication of the cardiac electronic device (ICD-10: T82.1) was stated as the contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals. Linear regression was used to calculate for the significance of the annual percent of changes in AAMRs. Results: 1237 cardiovascular deaths related to mechanical complications of CIED were identified between 1999 and 2020. The AAMR dropped significantly from 0.45 per 1,000,000 individuals in 1999 to 0.21 per 1,000,000 individuals in 2020 (p < 0.01). Cumulative AAMRs were higher in males than females (0.39 per 1,000,000 individuals vs. 0.26 per 1,000,000 individuals, p < 0.01), higher in White populations than African American populations (0.32 per 1,000,000 individuals vs. 0.30 per 1,000,000 individuals, p < 0.01), and higher in the rural areas than in the urban areas (0.50 per 1,000,000 individuals vs. 0.27 per 1,000,000 individuals, p < 0.01). Conclusion While the cardiovascular deaths related to mechanical complications of CIED were decreasing over the past decades, disparities in the AAMRs across sex, races and geographical region still present.

Objective To analyze sonographic characteristics of the automated breast volume scanner (ABVS) in non-mass-like breast carcinoma.Methods 49 patients with non-mass-like breast carcinoma were confirmed by pathology after operation.All of the patients underwent ABVS,the sonographic characteristics of internal echo and microcalcifications in the lesions,the retraction phenomenon in coronal plane and surrounding change were analyzed.All the lesions were assessed by breast imaging reporting and data system (BI-RADS).Results In 49 patients with non-mass-like breast carcinoma,27(55.10％) cases were ductal carcinoma in situ,21 (42.86％) cases were infitrating ductal carcinoma,and 1 (2.04％) case were infitrating lobular carcinoma.The findings of ABVS:43 (87.76 ％) lesions appeared as segmental hypoechoic areas,41 (83.67％) lesions appeared as scattered or clustered microcalcifications,6(12.24％) lesions appeared as the retraction phenomenon in coronal plane,and 1 (2.04％) lesion appeared as pachyderma and subcutaneous dropsy.Microcalcifications in ductal carcinoma in situ appeared more than that in infitrating ductal carcinoma (85.19 ％ vs 80.95 ％,P =0.715) ;the retraction phenomenon in coronal plane of infitrating ductal carcinoma were higher than that of ductal carcinoma in situ(19.05％ vs 7.41％,P =0.383),but there were no significant difference in those between ductal carcinoma in situ with infitrating ductal carcinoma(P ＞0.05).All the cases were assessed according to BI-RADS,including 4a-5 category 44 cases,0-2 category 5 cases.The coincidence rate in diagnosis of ABVS were 89.80％.Conclusions The ABVS features of non-mass-like breast carcinoma are characteristic.Segmental hypoechoic areas,microcalcifications and the retraction phenomenon in coronal plane are important for the diagnosis of non-mass-like breast carcinoma,ABVS can improve the detect ability and decrease the missed diagnosis of non-mass-like breast carcinoma.

OBJECTIVE: To observe the clinical effect of 5% D-fructose injectio on energy supply in surgery patients. METHODS: By setting 5% glucose injectio as control,the influence of 5% D- fructose injectio on blood sugar level,liver and kidney function indices was detected.RESULTS: 5% D-fructose injectio did not influence liver and kidney functions, serum uric acid and RESULTS: of routine examination of blood and urine.Compared with control group, the change of blood sugar level in experiment group was slighter.CONCLUSION: 5% D-fructose injectio is effective and safe for energy supply in surgery patients.

Background The incidence of posterior capsular opacification (PCO) is increasing with the growing of cataract surgery rate.Recent researches provend that disintegrin has inhibitory effect on PCO,and echistatin is one of the disintegrin prime families.Objective This study was to investigate the effects of disintegrin and echistatin on proliferation,adhestion and migration in human lens epithelial cells (LECs) line (SRA01/04).Methods Human LECs line at logarithmic growth phase was used in the study.Cells were cocultured with medium and different concentrations of echistatin (0,2.5,5.0,7.5,10.0,15.0,20.0 mg/L) for different time.The proliferative inhibitory rates of LECs were detected by MTT method 24,48 and 72 hours after cultured.Anti-adhesion effect of echistatin were analyzed by the same assay in 90 minutes.Cell scratching test was performed to evaluate the migration ability of LECs.The width of the scratch was recorded in the culture plate covered with cells under an inverted microscope.After being cultured for 24 hours and 48 hours with echistatin,cell migration distances was examined.Results Compared with the 0 mg/L echistatin group,cells proliferation was obviously inhibited.After cultured with 2.5,5.0,7.5,10.0,15.0,20.0 mg/L echistatin,the proliferation inhibitory rate was 2.6％,15.4％,21.2％,34.7％,46.1％,58.2％ at 24 hours;6.6％,21.9％,38.2％,50.0％,60.7％,76.9％ at 48 hours and 9.8％,29.0％,46.6％,63.4％,69.1％,92.4％ at 72 hours,respectively.The absorbance value (A) in the 5.0,7.5,10.0,15.0,20.0 mg/L groups were significantly lower than that in the 0 mg/L group (P＜ 0.05).With the prolongation of acting time of Ecs,the A value of the cells was gradually reduced,with statistically significant difference (P＜0.05).The adhesion inhibitory rate was 2.6％,15.0％,26.1％,35.3％,45.2％ and 54.5％ in the 2.5,5.0,7.5,10.0,15.0,20.0 mg/L group,respectively.Compared with the result in the 0 mg/L group,the A value in the 5.0,7.5,10.0,15.0,20.0 mg/L group was statistically significant (P＜0.05).After cultured for 24 hours and 48 hours,cell migration distance shortened in the 5.0,7.5,10.0,15.0,20.0 mg/L group,showing a statistically significant difference among them (P＜0.05).Cell migration distance was gradually shortened with the lapse of action time of Ecs with the significant difference (P ＜ 0.05).Conclusions echistatin has inhibitory effects on proliferation,adhestion and migration for human LECs in vitro in time-and dose-dependent manner.It is inferred that echistatin may play a role in the prevention and treatment of PCO.

Objective: To clone cDNA encoding Ⅴ-Ⅶ extra-cellular domains of VEGF receptor KDR and investigate biological activity of the recombinant protein. Methods: Total RNA from the umbelical venous endothelial cells was obteined. From it, KDR cDNA was cloned into the BamH1 and Kpn 1 sites of pQE31 and made expressed with induction of IPTG. The recombinant protein was purified, refolded and determined for its biological activities. Results: The expression system could express the human recombinant extra-cellular protein of KDR with expression level accounting for 5% of the total bacterial protein. After renaturation, the recombinant protein could bind to 125 I-VEGF and suppress endothelial cell proliferation and angiogenesis of chick chorioallantoic membrance induced by VEGF. Conclusion: Human KDR extra-cellular domain can be expressed in E coli and after being refolded, has an action of binding to VEGF.

Objective To discuss clinical effects and indications of minimally invasive tension band technique in treatment of transverse patella fractures.Methods Thirty-eight patients with transverse patella fracture (close or slightly polluted open ones) were treated with minimally invasive tension band technique from July 1997 to June 2005 in our department.Twenty-six were fixated with percutaneous Kirschner wire tension hand and 12 with percutaneous cannulated screw tension band.The reduction,movement range and function of the knee were analyzed.Results Surgeries went on uneventfully.All the cases were followed up from six months to 6.5 years (average,32 months).Fracture healing time lasted from 6 to 12 weeks,averaging 7.7 weeks.No such compli- cations as traumatic arthritis occurred.Reduction was excellent in 21 cases,good in 11 and fair in six,with the good-to-excellent rate being 84.2%.All the affected knee joints could move in normal range.The functional re- covery was assessed as excellent in 34 cases and good in four.Conclusions Internal fixation with minimally invasive tension band technique is good for treatment of transverse patella fractures.It is chiefly fit for close or slightly polluted open fractures with limited wound,and can also be used for the comminuted fractures if the bone fragments are no more than three and the fracture site is suitable.