Objective To analyze the anticoagulation in patients with atrial fibrillation.Methods A retrospective analysis of anticoagulant therapy situation in 926 patients with atrial fibrillation was conducted,in order to sum up experience and improve the understanding of atrial fibrillation.Results In 926 patients with atrial fibrillation,there were no anticoagulant therapy in 675 patients,accounting for 72.89%,while only 251 cases received the treatment of anticoagulation,accounting for 27.11%.Only 66 patients aged>75 years were treated with anticoagulant therapy,accounting for 33.17%.The patients with coronary heart disease,in 17.60% and with anticoagulation treatment,the patients with diabetes in 28.37% and received anticoagulation therapy,28.32% patients with anticoagulation therapy in patients with hypertension,30.77% patients with cardiac insufficiency with anticoagulant therapy.Choice of treatment of aged>75,hypertension,coronary heart disease,clinical treatment strategies and patients were the main factors that affected the use of warfarin,but only>75 years of age,coronary heart disease,choice of treatment factors with statistical significance of three factors(OR=7.02,12.73,4.79,all P<0.05).675 cases without anticoagulant therapy in 101 patients with non warfarin treatment indications without the use of warfarin anticoagulation treatment,accounted for 14.96%.In addition,there were 574 AF patients with warfarin treatment indications and treatment with warfarin,analysis of its causes:63 cases had anticoagulant contraindications,172 cases for the doctor too much about bleeding complications,440 patients were not in accordance with the requirements of the detection of INR.Conclusion The positive effect of warfarin in prevention of ischemic stroke,but in basic hospital application of warfarin anticoagulation in patients with severe AF deficiency,should raise the awareness of risk of grassroots medical staff and patients of atrial fibrillation complicating embolism,do a good job of educating patients,to reduce the incidence of embolic events in patients with atrial fibrillation.

Objective To study whether the hyaluronidase could infiltrate through the wall of blood vessel and further dissolve the hyaluronic acid within the arteries .Methods Rabbit abdominal aorta in 2 mm of diameter was filled with hyaluronic acid , which was then immersed in a high concentration of hyaluronidase for 90 minutes.The treated hyaluronic acid within artery was observed using optical microscope and laser diffraction particle size analyzer , to detect the change of particle size;Immunohistochemical study of blood vessels was performed to detect whether hyaluronidase penetrate the walls of the blood vessels;Hyaluronidase was injected into the vessel and immersed in saline , permeability of which was detected using ninhydrin dyeing and enzyme assay test .In addition, three patients of vision defects caused by hyaluronic acid injection were observed , two cases of which had received retrobulbar injection of hyaluronidase .Results After immersed within hyaluronidase , the particle sizes of hyaluronic acid had no changes compared with control group ( immersed within saline ) under the analysis of the laser diffraction analyzer and optical microscope .In immunohistochemical experiment , hyaluronidase was only detected in the outside wall of artery .Clinical cases showed that the retrobulbar injection of hyaluronidase could not decrease the symptoms of vision loss .Conclusions To an artery in a diameter of 2 mm, hyaluronidase could not penetrate through the arterial wall to dissolve the hyaluronic acid within the vessel . Thus, for the cases of ophthalmic artery embolism , retrobulbar injection of hyaluronidase may not be a logical solution .

Objective To study whether the hyaluronidase could infiltrate through the wall of blood vessel and further dissolve the hyaluronic acid within the arteries .Methods Rabbit abdominal aorta in 2 mm of diameter was filled with hyaluronic acid , which was then immersed in a high concentration of hyaluronidase for 90 minutes.The treated hyaluronic acid within artery was observed using optical microscope and laser diffraction particle size analyzer , to detect the change of particle size;Immunohistochemical study of blood vessels was performed to detect whether hyaluronidase penetrate the walls of the blood vessels;Hyaluronidase was injected into the vessel and immersed in saline , permeability of which was detected using ninhydrin dyeing and enzyme assay test .In addition, three patients of vision defects caused by hyaluronic acid injection were observed , two cases of which had received retrobulbar injection of hyaluronidase .Results After immersed within hyaluronidase , the particle sizes of hyaluronic acid had no changes compared with control group ( immersed within saline ) under the analysis of the laser diffraction analyzer and optical microscope .In immunohistochemical experiment , hyaluronidase was only detected in the outside wall of artery .Clinical cases showed that the retrobulbar injection of hyaluronidase could not decrease the symptoms of vision loss .Conclusions To an artery in a diameter of 2 mm, hyaluronidase could not penetrate through the arterial wall to dissolve the hyaluronic acid within the vessel . Thus, for the cases of ophthalmic artery embolism , retrobulbar injection of hyaluronidase may not be a logical solution .

Objective To compare the value of 7 different thyroid imaging reporting and data systems(TI-RADS)for differentiating benign and malignant thyroid nodules under the context of Hashimoto thyroiditis(HT).Methods A total of 338 thyroid nodules in 200 HT patients were enrolled,including 167 benign and 171 malignant ones.Kwak-TIRADS,American Thyroid Association(ATA)guideline,American Association of Clinical Endocrinologists(A ACE)/American College of Endocrinology(ACE)/Associazione Medici Endocrinologi(AME)guideline,K-TIRADS of Korean Society of Thyroid Radiology,EU-TIRADS of European Thyroid Association,American College of Radiology(ACR)-TIRADS and 2020 Chinese guidelines for malignant risk stratification of thyroid nodules by ultrasound proposed by the superficial organs and vessels group of the ultrasound medicine branch of the Chinese Medical Association(C-TIRADS)were used for grading of benign and malignant thyroid nodules.Taken pathological results as gold standards,the diagnostic efficacy of 7 kinds of TI-RADS were analyzed.Results The sensitivity of Kwak-TIRADS,ATA guideline,A ACE/ACE/AME guideline,K-TIRADS,EU-TIRADS,ACR-TIRADS and C-TIRADS for differentiating benign and malignant thyroid nodules under the context of HT was 97.08％,98.25％,99.42％,95.91％,99.42％,90.06％and 99.42％,respectively,the specificity was 88.02％,83.23％,82.04％,88.02％,82.04％,86.83％and 84.43％,respectively,and the area under the curve(AUC)was 0.946,0.913,0.907,0.934,0.909,0.916 and 0.960,respectively.The sensitivity of C-TIRADS,EU-TIRADS and A ACE/ACE/AME guideline were all higher than that of K-TIRADS and ACR-TIRADS(all P＜0.05),and the specificity of Kawk-TIRADS and K-TIRADS were both higher than that of C-TIRADS,ATA guideline,EU-TIRADS and AACE/ACE/AME guideline(all P＜0.05),while AUC of C-TIRADS and Kawk-TIRADS were both higher than that of the rest 5 kinds of TI-RADS(all P＜0.05).According to Kwak-TIRADS,ATA guideline,AACE/ACE/AME guideline,K-TIRADS,EU-TIRADS,ACR-TIRADS and C-TIRADS,the malignant rate of different grades nodules identified with the same TI-RADS were significant different(all P＜0.05),which all raised with the increase of TI-RADS grade.Conclusion C-TIRADS and Kawk-TIRADS had better value for differentiating benign and malignant thyroid nodules under the context of HT,among which C-TIRADS had higher sensitivity and Kawk-TIRADS had higher specificity.

Objective To observe the correlations of clinical,multi-modal ultrasonic and pathological features of papillary thyroid carcinoma(PTC)with BRAF V600E mutation.Methods Patients with clinically suspected malignant thyroid lesions were prospectively collected.After the results of pathology and gene test were obtained,PTC patients were divided into BRAF V600E mutation(+)(mutant group)and BRAF V600E mutation(-)(wild-type group)according to BRAF V600E gene test.Univariate analysis and multivariate logistic regression were used to compare clinical,conventional ultrasound,contrast-enhanced ultrasound(CEUS)and pathological manifestations between groups,so as to screen the independent risk factors of PTC BRAF V600E gene mutation.Results A total of 116 PTC patients(116 lesions)were enrolled,including 77 in mutant group and 39 in wild-type group.Statistical differences of thyroid peroxidase antibody(TPO-Ab)level,lesion size,orientation,margin and microcalcification observed on conventional ultrasound,changes of lesion size and the mean transit time(MTT)shown on CEUS,as well as of extramembranous invasion,cervical central lymph node metastasis,complicated with benign nodules shown by pathology were found between groups(all P＜0.05).TPO-Ab level,lesion orientation and changes of lesion size after enhancement shown by multi-modal ultrasound,and pathological cervical central lymph node metastasis were all independent predictive factors for PTC BRAF V600E gene mutation(OR=0.175,3.868,5.769,6.943,all P＜0.05).Conclusion Patients'TPO-Ab level,lesion orientation,changes of lesion size after enhancement shown by multi-modal ultrasound and pathological cervical central lymph node metastasis were all independently associated with PTC BRAF V600E gene mutation.