Objective To assess the value of CT in identification and diagnosis of benign and malignant calcified thyroid nodules.Methods Retrospective analysis was performed on the CT data of 313 surgically and pathologically confirmed cases with 378 calcified nodules.Based on the size,morphology,and number,calcification was divided into microcalcification (d≤2 mm and axis displayed in only one cross-section),coarse calcification (d＞2 mm or displayed in two or more cross-sections),annular calcification (arc or annular),and multiple microcalcifications (solitary multiple microcalcification without a soft tissue lump);a distribution of microcalcification,coarse calcification,and annular calcification as well as a clearer enhanced periphery or internal calcification than nonenhanced data in benign and malignant thyroid nodules were observed.Results The 378 nodules consisted of 259 benign nodules (68.5％) (all were nodular goiters) and 119 malignant nodules (31.5％) (including 111 papillary thyroid carcinomas,4 follicular carcinomas,3 medullary thyroid carcinomas and 1 lymphoma).Microcalcification was more common in malignant nodules (MNs) than in benign nodules (BNs),with a rate of 43.6％ vs 12.4％,respectively (P≤0.05),and its sensitivity,specificity,positive predicted value,and negative predicted value were 42.9％,87.6％,61.4％ and 76.9％,respectively.Coarse calcification,annular calcification,and clearer enhanced periphery or internal calcification than nonenhanced data were more common in BNs than in MNs,with rates of 52.9％ vs 20.2％ (P≤0.05),66.0％ vs 42.0％ (P≤0.05) and 43.2％ vs 19.3％ (P≤0.05),respectively,whose sensitivity,specificity,positive predicted value and negative predicted value were 66.0％ vs 22.4％ vs 43.2％,58.0％ vs 86.6％ vs 80.7％,77.4％ vs 78.4％ vs 83％,and 43.9％ vs 33.9％ vs 39.8％,respectively.Two multiple microcalcifications without a soft tissue lump were MNs (papillary thyroid carcinoma).Conclusions Microcalcification and multiple calcifications are conducive to the diagnosis of MNs,whereas coarse calcification,annular calcification,and clearer enhanced periphery or internal calcification than nonenhanced data benefit the diagnosis of BNs,but the low specificity and high false positive rate suggest that the judgment of BNs or MNs should not depend on coarse calcification alone.

Objective To investigate the diagnostic value of computed tomography (CT) histogram analysis for thyroid malignant solitary coarse calcification nodules (MSCN).Methods A total of 89 thyroid solitary coarse calcification nodules (coarse calcification ≥5 mm,no definite soft tissue around calcification) confirmed either by surgery or histopathological examination in 86 patients enrolled in this study from Jan.2009 to Dec.2015 were evaluated,including 33 MSCN from 32 patients and 56 benign solitary coarse calcification nodules (BSCN) from 56 patients.Overall,27 cut-off values were calculated by N (4 ≤ N ≤ 30) times of 50 Hounsfield units (HU) in the range of 200 HU to 1500 HU,and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for MSCN and BSCN.The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic (ROC) curve analysis.Results In the 24 groups with an ROC area under the curve (AUC) of more than 0.7,at a cut-off value of 1150 HU and at an area percentage of no less than 98.4％,the ROC AUC reached a maximum of 0.86,and the accuracy,sensitivity,and specificity were 70.8％,93.9％,and 57.1％,respectively.At a cut-off value of 450 HU and at an area percentage of no less than 46.3％,the accuracy,sensitivity,and specificity were 76.4％,48.5％,and 92.9％,respectively.At a cut-off value of 550 HU and at an area percentage of no less than 81.5％,the accuracy,sensitivity,and specificity were 75.3％,33.3％,and 100％,respectively.Conclusions In comparison with the cut-off value of 1150 HU with an area percentage of no less than 98.4％,the sensitivities for the cut-off value of 450 HU with an area percentage of no less than 46.3％ and for the cut-off value of 550 HU with an area percentage of no less than 81.5％ were lower;however,the specificities increased significantly,providing an important basis for reducing the misdiagnosis of MSCN.

Objective To investigate the expression of blood CD +4 CD +25 Treg GITR,CD +4 T cell GITRL in children with asthma,and the role of them in asthmatic inflammation.Methods 50 cases of severe asthma were selected,and were controlled with thirty two healthy children.The venous blood was collected both in the period of acute episode and clinic remission.The mean fluorescence intensity of CD +4 CD +25 Treg GITR and CD +4 T cell GITRL was detected by flow cytometry.Results The expression of CD +4 CD +25 Treg GITR in the asthma acute period group was (24.2 ±8.2)MFI,which was significantly lower than (28.5 ±6.0)MFI in the control group(t =2.5,P <0.05).While there was no significant difference of CD +4 T cell GITRL expression between the asthma acute period group[(5.2 ±3.6)MFI]and the control group[(4.6 ±1.0)MFI](t =1.1,P >0.05).Moreover,the expression of CD +4 CD +25 Treg GITR in the asthma in remission group after treatment was (29.5 ±8.3)MFI,which was significantly higher than that in acute period group before treatment(t =-9.9,P <0.01 ).Whereas,there was no significant difference of CD +4 T cell GITRL expression in asthma group between in remission after treatment[(5.7 ±3.6)MFI] and in acute period before treatment(t =-1.6,P >0.05).Furthermore,there was no significant correlation between levels of CD +4 CD +25 Treg GITR and CD +4 T cell GITRL.Conclusion The level of CD +4 CD +25 Treg GITR in acute period asthmatic patients was decreased,but it was increased in remission,but no changes of CD +4 T cell GITRL expression were observed.GITR/GITRL signal system might be involved in the asthmatic inflammation procession.

Objective To summarize the key points for nursing children with Kasabach-Merritt syndrome (KMS) treated by transcatheter arterial scleroembolization (TASE) during perioperative period. Method The perioperative treatment and key nursing points for 39 children with KMS undergoing TASE from September 2013 to September 2015 in our hospital were summarized and analyzed retrospectively. Results About 39 children with KMS went through TASE successfully. The operational time ranged from 0.8 to 2.7 hours. The patients were discharged in 2~11 days after TASE. There was 1 case of thrush, 3 cases of respiratory infection symptoms before TASE and 2 cases of hemangioma ulcer after TASE, which were cured by treatment and nursing. Conclusion The careful care to the patients with angeioma lesions, prevention and nursing of hemorrhage, nursing during glucocorticoid treatment, strict observation on the disease condition and prevention of complications after TASE can ensure the smooth implementation of TASE, and promote their recovery from KMS.

Objective To investigate the factors of term pregnancy fetal distress at term pregnancy and intervention midwifery cesarean section and vaginal fetal distress. Methods All 104 cases of full-term pregnancy with maternal fetal distress in labor were random divided into observation group and control group from our hospital from October 2012-October 2013, each group had 52 cases. Mothers in the control group were given vaginal midwifery, maternal in the observation group were used cesarean section, fetal distress factors and maternal and neonatal outcomes of two groups were compared and analyzed. Results Fetal distress factor (placenta, umbilical cord factors, maternal factors, fetal factors or amniotic fluid, etc.) of two groups were compared, the difference was not statistically significant (P>0.05). The inci dence of postpartum hemorrhage, neonatal asphyxia, hypoxic ischemic encephalopathy, fetal growth restric-tion,puerperal infection and hypoproteinemia of the observation group were 5.77%,5.77%, 3.85%,1.92%, 11.54%,9.62%,compared with 9.62%, 7.69%, 5.77%, 1.92%, 7.69%, 5.77%in the control group,the difference was not statis-tically significant (P>0.05). Single factor factors Logistic regression analysis results showed that the umbilical cord and placenta, fetal and maternal,amniotic fluid dung are independent risk factors of fetal distress. Multiple factors Logistic regression analysis results showed that fetal and maternal,amniotic fluid dung are independent risk factors of fetal dis-tress. neonatal deaths of two groups did not occur. Conclusion Vaginal delivery applications and cesarean surgery in treatment of fetal distress of full-term pregnancy can get better maternal and neonatal outcomes, should be based on the specific circumstances of women to choose the appropriate mode of delivery.

Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; therapy

We report a case of chromoblastomycosis caused by , which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with strain KX078407. The susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.
Animals ; Chromoblastomycosis ; Humans ; Laser Therapy ; Lasers, Solid-State ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Terbinafine ; Treatment Outcome