Objective To further research the urinary monitoring of the maternal thyroid functional status ,the levels of urine thyroid hormones were analyzed during pregnancy .Methods This study recruited 30 cases of healthy pregnant women at 9-12 ges-tational weeks .Their random urine specimens were collected every four weeks until delivery .The concentrations of urine thyrotro-pin(uTSH) ,urine free triiodothyronine(uFT3) and urine free tetraiodothyronine(uFT4) were detected by electrochemical lumines-cence immunoassay(ECLIA) .The urine retinol binding protein(uRBP) was detected by enzyme immunoassay (EIA) .After correc-ted by uRBP ,the statistical analysis was done to analyze the variation of the ratio of uTSH and uRBP (uTSH/uRBP) ,the ratio of uFT3 and uRBP(uFT3/uRBP)and the ratio of uFT4 and uRBP(uFT4/uRBP)during pregnancy .Results The median levels of u-rine thyroid hormone parameters were obtained from the healthy pregnant women every four weeks and were compared among dif-ferent stages .The difference of uFT3/uRBP and uFT4/uRBP was statistically significant (F= 6 .222 ,P< 0 .05 ;F= 5 .078 ,P<0 .05) ,and the levels of them varied linearity during pregnancy (F=27 .480 ,P<0 .05 ;F=23 .959 ,P<0 .05) .The difference of uT-SH/uRBP had no statistical significance(F=2 .731 ,P=0 .054) .Conclusion After corrected by uRBP ,the levels of uFT3 and uFT4 of healthy pregnant women decreased linearity among different gestational stages ,and the levels of uTSH had no noticeable change .

Objective:To evaluate the efficacy and safety of dl-3-butylphthalide ( NBP) injection and soft capsules in the treat-ment of acute middle cerebral artery infarction. Methods:Sixty-one patients with acute cerebral infarction in the left middle cerebral artery in 72 hours of onset of ischemic stroke with score of 5-25 according to the national institutes of health stroke scale ( NIHSS) were randomly divided into the observation group (n=31) and the control group (n=30). The control group was treated with the routine treatment, while the observation group was sequentially treated with NBP injection and soft capsules additionally. The treatment course was 90 days. Before the treatment, the NIHSS score was evaluated in both groups to compare the neurologic impairment degree. After the treatment, the daily living skills assessment was performed by Barthel index ( BI) and modified Rankin score ( mRS) , and the ad-verse reactions were recorded. Results:Before the treatment, the NIHSS score in the two groups had no statistical significance ( P>0. 05). After the treatment, the BI in the observation group and the control group was (88. 55 ± 16. 74) and (70. 67 ± 26. 18), and mRS was (1. 87 ± 1. 02) and (2. 53 ± 1. 40), respectively, suggesting the observation group had more favorable outcome than the con-trol group (P≤0. 05). The incidence of adverse reactions had no significant difference between the groups. Conclusion: dl-3-Bu-tylphthalide sequential therapy should be regarded as an effective and safe method for acute cerebral infarction, which can improve the daily living skills and 90-day outcome of patients.

OBJECTIVETo analyze and evaluate the fatigue of shoulder skeletal muscle caused by different lifting loads with surface electromyography (sEMG).

METHODSAccording to the loading standard of1 Repetition Maximum (1RM), ten male volunteers performed 3 tasks of upper limb flexion, i.e. 10%, 50% and 90%-1RM. During action process, the signals of Upper Trapezius (UT), Lower Trapezius (LT), Serratus Anterior (SA) and Anterior Deltoid (AD) were recorded by sEMG. The Mean Amplitude (MA) served as an index to evaluate the changes in skeletal muscle fatigue.

RESULTSThe scores of Borg were 15.6, 15.9 and 15.2 for 3 loads of 10%-1RM, 50%-1RM and 90%-1RM, respectively (P > 0.05). The mean amplitudes (MAs) of Upper Trapezius, Lower Trapezius, Anterior Deltoid and Serratus Anterior in shoulders increased obviously. Under the load intensity of 10%-1RM, the MAs of Upper Trapezius and Anterior Deltoid increased significantly (P < 0.05), which were 0.898 and 0.736, respectively. After the exhaustion, the contribution of mean amplitude in shoulder muscle did not change significantly (P > 0.05).

CONCLUSIONThe low-load action for long time can induce easily the fatigue of upper trapezius and anterior deltoid.

Adult ; Electromyography ; Humans ; Lifting ; Male ; Muscle Fatigue ; physiology ; Muscle, Skeletal ; physiology ; Shoulder ; physiology ; Workload

OBJECTIVETo evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach.

METHODSFrom August 2009 to March 2011, 15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage: the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis, and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach.

RESULTSAll patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed, but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria, the results were excellent in 2 cases, good in 7, fair in 4, and poor in 2.

CONCLUSIONThe posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures, faciliate the management of this difficult fracture pattern.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery

OBJECTIVETo observe the efficacy of Zaozhu Yinchen Recipe (ZZYCR) on non-alcoholic steatohepatitis (NASH) patients, and to explore its effect on serum free fatty acid (FFA) and tumor necrosis factor alpha (TNF-alpha).

METHODSTotally 120 patients with NASH were randomly assigned to the treatment group (60 cases, treated with ZZYCR, one dose per day) and the control group (60 cases, treated with Silibin Meglumine Tablets, 20 mg each time, thrice per day). The therapeutic course for all was 24 weeks. Serum levels of ALT and AST activities, TC and TG levels were detected before and after treatment. Peritoneal CT was performed in all patients, and CT ratios of liver and spleen calculated. NAFLD activity score (NAS) and degree of hepatic fibrosis were assessed using pathological examinations of liver tissue, and efficacy also evaluated. Serum contents of FFA and TNF-alpha were also detected.

RESULTSCompared with before treatment in the same group, activities of ALT and AST, serum levels of TC, TG, FFA, and TNF-alpha, NAS, scores of symptoms and signs all obviously decreased, degree of hepatic fibrosis was obviously improved in the two groups (P < 0.05, P < 0.01). These changes were more obviously seen in the treatment group (P < 0.05). After 24-week treatment, the total effective rate and total clinical efficacy were 80.00% (48/60 cases) and 85.00% (51/60 cases) in the treatment group, obviously higher than those in the control group [60.00% (36/60 cases) and 73.33% (44/60 cases) respectively], with significant difference (P < 0.05, P < 0.01).

CONCLUSIONZZYCR could improve the clinical efficacy of NASH patients, and its mechanism might be associated with inhibiting serum levels of FFA and TNF-alpha.

Drugs, Chinese Herbal ; therapeutic use ; Fatty Acids, Nonesterified ; blood ; Humans ; Non-alcoholic Fatty Liver Disease ; drug therapy ; Tumor Necrosis Factor-alpha ; blood

Objective To investigate the Influence of beta-thalassemia minor on four different HbA1c detection systems.Methods All 65 blood samples from March 2014 to August 2014 were collected from Zhongshan Hospital of Sun Yat-sen University , and divided to normal control group ( 40 cases ) , no diabetic group(20 cases) and diabetic group (5 cases) combining with beta-thalassemia minor.The fresh mixed whole-blood samples were used for transferring value-assignment in order to improve the comparability of Bio-Rad variant ⅡTurbo, Primus Ultra2 ,Roche Modular PPI to Bio-Rad Variant Ⅱwhich was NGSP Ⅰlaboratory certificated.The whole-blood concentration of HbA 1c were measured by four detection systems . Differences between normal control group and no diabetic group were compared using the Independent Samples T Test.Then Taking the Primus Ultra 2 as comparable system and others as experimental system ,the HbA1c results from no diabetic group and diabetic group were compared by the standardization NGSP Ⅰlaboratory and statistical techniques of consistency test .Results Compared with Variant Ⅱ detection system, after transferring value-assignment, deviations of Variant Ⅱ, Modular PPI and Variant Ⅱ Turbo were -6%to +6%.The HbA1c testing results from normal control group and no diabetic group had no statistical significance (P>0.05).Linear regression analysis demonstrated that the correlation coefficient of Primus Ultra2 with Variant Ⅱ, Modular PPI, VariantⅡTurbo were 0.995, 0.999 and 0.995, respectively (P<0.01).The percentage deviation of the reference system and experimental system was -6.0% to+6.0%.Conclusion There was no obviously significant influence of beta-thalassemia minor on Bio-Rad Variant Ⅱ,Bio-Rad variant ⅡTurbo,Primus Ultra2,Roche Modular PPI detection systems.

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in evaluating the invasive area of hilar cholangiocarcinoma. Methods Clinical data of 103 patients with hilar cholangiocarcinoma who received conventional ultrasound and CEUS examination in Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to March 2013 were analyzed retrospectively. The patients were conifrmed by contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or surgical pathological examination. There were 70 males and 33 females with mean age of (59±13) years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients received conventional ultrasound and CEUS examination both. The display of invasive area of hilar cholangiocarcinoma by two methods was observed. The contrast-enhanced CT, MRI or surgical pathological examination were regarded as the gold standards. The diagnostic accordance rates of invasive area of hilar cholangiocarcinoma by two methods were calculated and compared using Chi-square test. Results For conventional ultrasound, 28 cases were with ill-deifned tumor borders and 75 cases were with well-deifned or poorly deifned tumor borders, in which 33%(25/75) of the tumor invasive areas were intraductal, 67%(50/75) were intraductal and extraductal. In arterial phase of CEUS, tumors in 51.4%(53/103) of patients were displayed hyper-enhanced, 28.2%(29/103) were homo-enhanced, and 20.4%(21/103) were hypo-enhanced. In venous phase, tumors in 100%(103/103) of patients were displayed hypo-enhanced. For CEUS, 16.5% (17/103) of the tumor invasive areas were intraductal, 83.5% (86/103) were intraductal and extraductal. The diagnostic accordance rate was 59.2%(61/103) by conventional ultrasound and was 99.0% (102/103) by CEUS. The diagnostic accordance rate of CEUS was signiifcantly higher than that of conventional ultrasound (χ2=17.611, P<0.05). Conclusion Compared with conventional ultrasound, CEUS can evaluate the invasive area of hilar cholangiocarcinoma more accurately.

Objective To investigate current situation of Chinese clinical microbiological laboratories participating in management of healthcare-associated infection and antimicrobial use.Methods Fourteen provinces (municipalities), autonomous regions and army hospitals in seven regions of China were selected, the participation of clinical microbiological laboratories in the consultation of HAI diseases, specimen quality control, antimicrobial use, and management of multidrug-resistant organisms (MDROs) before 2000 and every five years from 2000 to 2015 were investigated, the surveyed results were analyzed statistically.Results A total of 187 hospitals were investigated, in 2015, 96 and 172 hospitals (51.34％, 91.98％) participated in the consultation of infectious diseases and multi-department collaborative management on MDROs respectively.However, 44 hospitals (23.53％) still manually performed statistical analysis on drug susceptibility, only 26 hospitals (13.90％) had the ability of identifying homology of pathogens.Rate of MDRO surveillance data feedbacked to clinical departments increased from 66.84％ (n=125) in 2010 to 95.72％ (n=179) in 2015, the frequency of feedback was mainly monthly and quarterly;rate of antimicrobial susceptibility results feedbacked to clinic departments increased from 62.03％ (n=116) to 94.12％ (n=176), 82.35％ (n=154) of clinical microbiological laboratories conducted quarterly feedback;the quality control rate of microscopic sputum smear before sputum culture increased from63.10％ (n=118) to 87.17％ (n=163);rate of bilateral double blood culture increased from 35.83％ (n=67) to 72.73％ (n=136);rates of other aseptic body fluid culture (except blood and urine) increased from 4.86％ to 5.74％;differences were all significantly different between 2010 and 2015 (all P＜0.05).Conclusion Clinical microbiological laboratories have played an important role in promoting the development of HAI management in China, especially during the period of 2011-2015.However, the homology analysis on HAI pathogens, informatization of result feedback, and sterile body fluid specimens detection need to be further strengthened.

OBJECTIVETo investigate the effects of long-term hormone replacement therapy (HRT) on the breasts of postmenopausal women using mammary ultrasonography.

METHODSAn open randomized clinical study was designed. The percutaneous estradiol gel was used in a cyclic regimen combined with micronized progesterone (MP) or medroxyprogesterone acetate (MPA). Sixty healthy women (natural menopause for 1 to 5 years) were recruited and divided into four groups according to the dosage of estrogen and two kinds of progestin. All were given for 25 days per month. Mammary ultrasonography was used to observe breast glandular section thickness, breast duct width, the morphology of lobular unit and the blood flow of color Doppler imaging at baseline and every year from the second to seventh year of HRT. The serum estradiol was also measured from the 15th to 25th day of the cycle. Breast pain was recorded by the subjects.

RESULTS(1) The breast glandular section thickness after HRT was larger than that of before HRT. The breast glandular section thickness became larger gradually over time while the breast duct width became smaller over time. The breast duct width of the fifth year of HRT was significantly different from that of the sixth year (P < 0.05). (2) Twenty-two persons had new breast structure changes after HRT, and the accumulated incidence was 41.5%. New solid lesions formation occurred in five subjects (8.3%) and new cyst formation occurred in one subject (1.7%). After the second year of HRT, the serum estradiol level of the subjects with breast structure changes was higher than that of without breast structure changes and in the sixth year of HRT, and the difference was significant (P < 0.05). After the second year of HRT, the breast glandular section thickness of the subjects with breast structure changes was larger than that of without breast structure changes and in the fifth and sixth year of HRT, the difference was significant (P < 0.05). (3) After HRT, the serum estradiol level of subjects with mastalgia was higher than that of without mastalgia and in the second and sixth follow-up year, the difference was significant (P < 0.05).

CONCLUSIONSThere is an increasing trend of the percentage of glandular tissues of the breast after HRT. There is an increasing trend of the serum estradiol level and the breast glandular section thickness among the subjects with the breast structure changes; there is an increasing trend of the serum estradiol level among the subjects with mastalgia. Mammary ultrasonography can be used to monitor breast structure changes and breast lesions during HRT.

Aged ; Breast ; pathology ; Estradiol ; therapeutic use ; Estrogen Replacement Therapy ; adverse effects ; Female ; Humans ; Medroxyprogesterone Acetate ; therapeutic use ; Menopause ; Middle Aged ; Time Factors ; Ultrasonography, Mammary

Objective:To investigate the diagnostic value of serum matrix metalloproteinase 3 (MMP-3) combined with anti-mutant citrulline vimentin antibody (anti-MCV) and rheumatoid factor (RF) in rheumatoid arthritis (RA).Methods:A retrospective study was conducted to select 78 patients diagnosed with RA, 30 with Sjogren′s syndrome (SS), 25 with connective tissue disease (CTD), and 38 with antiphospholipid syndrome (APS) from the Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University from August 2022 to April 2024. In the same period, 50 healthy controls were selected from the physical examination center of our hospital. Fasting peripheral blood RF, anti-streptolysin O (ASO), C-reactive protein (CRP), erythrocyte deposition rate (ESR), interleukin-6 (IL-6), procalcitonin (PCT), anti-keratin antibody (AKA), anti-MCV, MMP-3, anti-cyclic citrullinated peptide (anti-CCP) level. Fasting peripheral blood MMP-3 levels in SS, CTD, APS patients and healthy control group were compared, Spearman correlation analysis was used to evaluate the correlation between MMP-3 levels and various indicators, and logistic regression analysis was used to screen the related influencing factors of RA occurrence. The diagnostic value of serum MMP-3, anti-MCV, RF and combined detection for RA was evaluated by receiver operating characteristic (ROC) curve.Results:There were statistically significant differences in RF, CRP, ESR, IL6, AKA, antiMCV, MMP-3 and anti-CCP between RA group and healthy control group (all P<0.001), while there were no statistically significant differences in PCT and ASO between the RA group and the healthy control group (all P>0.05). Serum MMP-3 level in the RA group was significantly higher than that in SS, CTD, APS and healthy control group, and the difference was statistically significant (all P<0.05). MMP-3 was positively correlated with anti-CCP, CRP, ESR, anti-MCV, RF and AKA ( r=0.403, 0.532, 0.530, 0.431, 0.427, 0.391, all P<0.05). Multivariate logistic regression analysis showed that MMP-3 ( OR=1.082, P=0.02), anti-MCV ( OR=1.015, P=0.049) and RF ( OR=1.046, P=0.036) were independent risk factors for RA. ROC curve showed that when the cut-off value of MMP-3 was 53.10 ng/ml, the area under the curve for diagnosing RA was 0.889, the sensitivity was 74.5%, and the specificity was 96.0%. The area under ROC curve of MMP-3 combined with anti-MCV and RF for the diagnosis of RA was 0.975, the sensitivity was 88.2%, and the specificity was 99.7%. Conclusions:MMP-3 has a certain value in the differential diagnosis of RA, and MMP-3 combined with anti-MCV and RF is of great significance in the auxiliary diagnosis of RA.