Clinical data were retrospectively analyzed in 20 cases with Hashimoto's thyroiditis complicated with subacute thyroiditis from February 2009 to April 2013.85％ of the patients showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Thyroid peroxidase antibody (TPOAb) was found in 95 ％ of the patients,while thyroid globulin antibody (TgAb) in 100％.Uptakes of radioactive iodine were lowered.Symptoms such as fever or pain were ameliorated quickly after treatment with glucocorticoids or non-steroidal anti-inflammatory drugs.

Objective To evaluate the usefulness of contrast enhanced ultrasound in the diagnosis of breast lesions. Methods Contrast enhanced ultrasound was performed after administration of SonoVue in 104 patients scheduled for surgical tumor removal. The enhancement morphology was classified as non, peripheral,homogeneous,regional,or heterogeneous enhancement based on distribution of enhancing areas. All breast lesions enhancement morphology were analyzed, and the diagnostic value of contrast enhanced ultrasound was calculated. Results The prevalence of non enhancement was significantly higher in benign lesions than in malignant ones(P = 0.013),and the prevalence of peripheral enhancement was significantly higher in malignant lesions than in benign ones (P = 6.02 × 10-7). Conclusions Contrast enhanced ultrasound is useful in diagnosis of breast lesions.

Objective To study the gene expressions of nestin and stem cell factor(SCF)in neurons after ischemia-reperfusion injury in rat brain. Methods Thirty-six adult female rats were subject to left middle cerebral artery occlusion for 1.5h and different hours of reperfusion. In site hybridization was used to examine the expression of nestin and SCF mRNA in the rats subjected to 2h, 6h, 12h, 24h, 2d, 3d, 7d, 14d of reperfusion and sham-operation group (n=4). Results (1) Nestin expression in cortex, striatum and extraventricular zone was weak in the sham-operation group, and increased markedly in the ischemic hemisphere compared with sham-operation group except of reperfusion 2h in cortex, 2h, 6h in striatum, 2h, 6h and 14d in extraventricular zone. (2)SCF expression in cortex, striatum and extraventricular zone was weak in the sham-operation group, and increased markedly in the ischemic hemisphere compared with sham-operation group except of reperfusion 2h, 6h, 12h in cortex, 2h, 6h in striatum, 2h and 14d in extraventricular zone. Conclusion It is suggested that SCF expression might enhance the proliferation of neural stem cells following ischemia-reperfusion in rats.

Objective To investigate the clinical and radiological features of medullary infarction (MI), and to compare the clinical characteristics of lateral medullary infarction (LMI) and medial medullary infarction (MMI).Methods Patients diagnosed as acute MI who were treated from January 2009 to December 2014 in Department of Neurology, Peking University Third Hospital, were retrospectively enrolled in the study and data were analyzed including risk factors, clinical features, laboratory findings, radiological characteristics, etiology and outcomes.Results A total of 62 cases of MI were enrolled with 48 cases of LMI and 14 cases of MMI , including 2 cases of bilateral MMI.The mean onset age of LMI and MMI was 60.2 ± 12.3 and 56.9 ± 14.2, respectively.The frequently affected location of LMI was the middle and upper part of medulla [40 cases (83.3％)].The common symptoms and signs of LMI were dizzy (38 cases ,79.2％), sensory disturbance (33 cases ,68.8％), dysarthria (32 cases ,66.7％), dysphagia (30 cases ,62.5％), diminished pharyngeal reflex (30 cases, 62.5％), Homer's sign (29 cases, 60.4％), ataxia (26 cases, 54.2％) and nausea or vomiting (25 cases, 52.1％).The frequently affected location of MMI was the upper part of medulla (13 cases, 92.9％).The common symptoms and signs of MMI were motor dysfunction (12 cases, 85.7％), sensory disturbances (11 cases, 78.6％), dizzy (10 cases, 71.4％) and dysarthria (10 cases, 71.4％).Infarctions caused by atherosclerosis were found in 35 cases of LMI (72.9％) and 12 cases of MMI (85.7％).Five cases (10.4％) of LMI died in hospital, while 1 case (7.1％) of MMI died in hospital.No lesion was found in 16 cases (25.8％) by MRI-DWI within the first 24 hours of onset.Conclusions Our study showes that the mean onset age of LMI is older than that of MMI.The lesion of LMI is frequently located in the upper and middle medulla, whereas the lesion of MMI is mostly in the upper medulla.The prognosis of LMI is worse than that of MMI.Atherosclerosis of the vertebral arteries is the predominant vascular pathology in MI.

Objective To explore the significance of motor unit number estimation (MUNE) by using multiple point stimulating technique to evaluate patients with Hirayama disease (HD).Methods Multiple point stimulating technique was used to estimate the motor unit number of abductor pollicis brevis and abductor digiti minimi in 35 normal subjects [14-33 years old,mean (20.9 ±4.0) years old,33 men and 2 women]without nerve and muscle disease and 69 patients definitely diagnosed as HD [16-35 years old,mean (21.46 ±6.61 ) years old,67 men and 2 women].The differences between the two groups were examined by Fisher's exact test and t test.Results There were 42 patients with atrophy and 27 patients with normal clinical manifestation of left hand.For right hand there were 54 patients with atrophy and 15 normal.For controls,the MUNE value of left abductor pollicis brevis was 226.97 ± 30.59,while that of right side was 22g.31 ± 25.35.The MUNE value of left abductor digiti minimi was 237.43 ± 30.78,while that of right side was 240.20 ± 37.73.For HD patients,the MUNE of left abductor pollicis brevis and abductor digiti minimi was 145.66 ± 126.10 ( t =5.07,P ＜ 0.01 ) and 102.20 ± 112.67 ( t =9.31,P ＜ 0.01 )respectively,while those of right hand was 149.72 ± 117.80 ( t =5.31,P ＜ 0.01 ) and 64.23 ± 69.27 ( t =16.76,P ＜0.01 ) respectively.MUNE of left abductor digiti minimi in 17 patients that was below 200 among 27 patients with normal clinical manifestation (x2 =9.57,P =0.002).MUNE of right abductor digiti minimi in 12 patients that was below 200 among 15 patients with normal clinical manifestation ( x2 =4.64,P =0.03).Conclusions The differences of MUNE values by multiple point stimulating technique between the normal subjects and the HD patients is significant,which suggests this method is very useful to evaluate HD in the early state.

ObjectiveTo investigate the correlation of ultrasonographic features of mesenteric fibromatosis and its pathological findings.MethodsTen mesenteric fibromatosis confirmed histopatho1ogica1ly in Peking Union Medical College Hospital were retrospectively reviewed.Results There were 7 females and 3 males. Their ages ranged 32~74 years (mean age 50.5±13.1 years). Of the 10 cases, 5 occurred in mesentery of the small bowels, 4 in the mesocolons, and 1 in junction portion of duodenum and jejunum. On ultrasound image, the diameters of the masses were 4.3~22.0 cm (mean 8.8±5.2 cm). 6 were regular and 4 were irregular. 9 of 10 cases were well-defined and 1 was poor defined. 6 has capsule echoic. All the 10 cases were hypoechoic. 9 presented as solid mass and 1 was solid-cystic leision. On gross pathology,they were solid, firm, grey and yellowish. Histopathology, there were boundles of fibroblasts in collagenous stroma with scarce degeneration. The cystic changes noted on sonograms corresponded histopathologically to areas of myxoid and cystic degeneration.ConclusionsMesenteric fibromatosis is a rare disease with characteristic ultrasonographic features, which were well correlated with their pathology findings. They mostly presents as well-circumscribed masses with hypoecho, regular shape and little vascularity. Ultrasound was important in the diagnosis of this disease.

Objective Tumor size discrepancy in measurement between real-time ultrasonic elastography and conventional uItrasound(US) was found in some breast lesions.The study was designed to investigate the value of the feature in the diagnosis of breast cancer,and its relationship with the margin features on gray-scale US.Methods Both US and real-time elastogram using a Hitachi EUB-8500 US system were performed in 308 consecutive Datients.The margin features on US and the size measured on both methods were documented.A lesion was defined as a significant size discrepancy when a larger size measured at elastogram.Sensitivity,specificity,and overall accuracy of feature to diagnosis malignancy were determined by surgical pathology as gold standard.Results There were total 166 benign,163 malignant and 3 borderline lesions.of 99 lesions with larger measurement on elastography,there were 91 malignant lesions and 8 benign lesions.By the feature of size discrepancY,the sensitivity,specificity and accuracy was achieved 55.8%,96.9%,75.7%,respectively.The size measured on elastogram was statistically larger than that on gray scale US(t=-11.0,P＜0.05).The ratio of indistinct,angular and spiculated margin characteristics were significantly higher in breast cancers with larger size measurement than those with unchanged or decreased size measurement(P＜0.05).Conclusions The increased size-measurement at elastography is helpful to diagnosis breast cancers.And it is more likely to be present in breast cancers with indistinct,angular or spiculated margin.

Background and purpose:Three-dimensional power Doppler angiography (3D-PDA) is a new technique to investigate the vessels in the organs, but the research in thyroid is limited. The purpose of this research was to investigate three-dimensional power Doppler angiography (3D-PDA) in differentiating malignant from benign thyroid nod-ules.Methods:This study prospectively evaluated 103 lesions in 94 patients who were scheduled for surgery. The patients underwent preoperative 3D-PDA scanning. Analysis of the 3D-PDA characteristics includes blood flow pattern, the num-ber of blood vessels, the shape of vessels, the spatial distribution of the vessels, the existence of rich local blood flow within nodules or in the parenchyma surrounding the nodules. This study also analyzed the difference between the benign lesions and the malignant lesions.Results:There were 50 benign lesions and 53 malignant lesions. The sensitivity and specificity of irregular vessels, the asymmetry spatial distribution, rich local blood flow within nodules or in the parenchyma surround-ing the nodules were 64.2%, 96.0%; 56.0%, 88.0%; 54.7%, 96.0%; 60.4% and 94.0%, respectively. The sensitivity, speci-ficity, positive predictive value, negative predictive value and accuracy of 3D-PDA were 83.0%, 94.0%, 93.6%, 83.9% and 90.3%, respectively.Conclusion:3D-PDA provides a useful tool to investigate vascularization of thyroid leisions.This technique is feasible for clinical application and plays an important role in diagnosis of thyroid nodules.

Objective To evaluate the efficacy of systemic glucocorticoids and intravenous immunoglobulin (IVIG)for the treatment of toxic epidermal necrolysis (TEN). Methods Clinical data on TEN inpatients treated with systemic glucocorticoids alone or in combination with IVIG were collected from the Department of Dermatology, First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2012. Therapeutic outcomes were evaluated in these patients. Statistical analysis was carried out by using a multiple linear regression analysis, binary logistic regression analysis and Cox regression analysis with the SPSS 16.0 software. Results A total of 48 inpatients with TEN were included in this study. Multiple linear regression analysis showed that the maximum daily dose of glucocorticoids for disease control was decreased gradually over years (β=-0.461, P=0.004). However, binary logistic regression analysis revealed no obvious changes in the frequency of administration of IVIG over years. Cox regression analysis showed that both hospitalization duration (RR=0.351, 95.0%CI:0.150-0.825)and the time required for the control of skin lesions (RR=0.492, 95.0%CI:0.245-0.986)decreased with the increase in the frequency of IVIG administration. In addition, with the increase in the maximum daily dose of glucocorticoids for disease control, the time required for the control of skin lesions was also shortened (RR=0.997, 95.0%CI:0.994 -1.000), while no obvious changes were observed in hospitalization duration. Conclusions IVIG shows superiority in controlling lesions, reducing complications and improving the prognosis of TEN. Compared with systemic glucocorticoids, IVIG shows better therapeutic efficacy and less adverse effects, and may be preferentially selected.

Objective To observe the effects of expressions of neurocyte adhesion molecule (NCAM) and growth associated protein-43 (GAP-43) in neurological function recovery following cerebral ischemia-reperfusion in rats. Methods The model of focal ischemia-reperfusion in SD rat was induced by intraluminal middle cerebral artery (MCA) occlusion with a nylon monofilament suture. In situ hybridization (ISH) was performed to examine the expression of NCAM mRNA and GAP-43 mRNA at 2,12 h and 1,2,3,7,14 d after reperfusion and in sham-operated controls. Results There was no functional deficit and little expression of NCAM mRNA and GAP-43 mRNA in brain cells in rats of the sham-operated group. In the experimental group, NCAM mRNA expression was observed after reperfusion for 2 h in cortex and striatum and peaked at 12 h and was still higher at 7 d. The neurological function improved at reperfusion of 3 d~14 d compared to reperfusion 2 h. In the ischemic cortex and striatum, GAP-43 mRNA expression demonstrated "double-peak" at 12 h and 2 d after reperfusion, then decreased gradually to the level of sham-operated group at 14 d. Conclusion The increasing NCAM expression might be an important factor of the neural reparation and GAP-43 might enhance the neurological functional recovery with ischemic brain injury in rat.