The ultrasound part of “2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer” is comprehensive and informative. The content includes the indications for thyroid ultrasound and aspects needed to be evaluated, malignancy risk prediction based on sonographic pattern, decision-making based on ultrasound appearances, follow-up of benign thyroid nodules and surveillance of persistent and recurrent thyroid cancer with ultrasound. Compared with 2009 version of American Thyroid Association (ATA) guidelines, there is a great deal of development. The most important revision was that it analyzed ultrasound pattern of risk stratiifcation of malignancy in thyroid nodules and gave a detailed description of relevant concepts and definitions. Altogether, the new guidelines provided an algorithm for evaluation and management of patients with thyroid nodules based on sonographic pattern and ifne needle aspiration (FNA) cytology. Comprehensive review of the guidelines and appropriate adjustment in practices will make ultrasound examination more reasonable and may enhance the level of medical practices basically..

ObjectiveTo study the relationship between carotid sclerosis and lipoprotein (LP) (a) in patients with coronary artery disease. MethodsOne hundred and fifty-nine coronary artery disease patients with coronary arteriongraphy (CAG) positive were selected as the study group, and Gensini points were taken in these patients. Forty CAG normal patients was in control group, and all of them were examined with ultrasound, and serum levels of LP (a) were tested. According to ultrasound, study group were divided into 4 subgroups: normal intima group(24 cases), mild stenosis group(41 cases), moderate stenosis group (82 cases) and severe stenosis group ( 12 cases). ResultsThe rate of carotid sclerosis in study group [84.9％ (135/159)] was significantly higher than that in control group [42.5％ ( 17/40 )] (P ＜ 0.01 ). Gensini points in moderate and severe stenosis group were significantly higher than those in normal intima and mild stenosis group (P ＜ 0.05 or ＜ 0.01 ), Gensini points in severe stenosis group were significantly higher than those in moderately group(P ＜ 0.01 ), but there was no significant difference between mild stenosis group and normal intima group(P ＞ 0.05 ). The level of LP(a) in study group[(35.27 + 23.38) mg/L] was significantly higher than that in control group[(23.13 ± 16.56) mg/L](P＜ 0.01 ). The level of LP(a) in mild stenosis group was significantly lower than that in moderate and severe stenosis group(P＜ 0.05 or ＜ 0.01 ), and there was no significantly difference compared with that in normal intima group(P＞ 0.05 ). ConclusionsCarotid sclerosis ultrasonic testing helps to predict the risk degree of coronary artery disease. The level of LP(a ) is closely related with carotid sclerosis and has important value in judging the condition of patients with coronary artery disease.

OBJECTIVETo explore rest, cold compress and elevate (RICE) with rest, compress and elevate (RCE) without cold for the treatment of acute ankle sprain, in order to clear mid-term clinical effects.

METHODSEighty-nine patients with acute ankle sprains were collected from January 2013 to March 2014,including 30 males and 59 females aged from 18 to 60 years old with an average of 36 years old; the time from injury to hospital ranged from 3 to 24 h with an average of 9 h. All patients were divided into two groups according to visiting sequence. There were 45 patients in RICE group, and 45 patients in RCE groups. The main therapeutic effect index was evaluated by Karlsson scoring, and secondary therapeutic effect index was pain and satisfactory VAS scores. Safety index evaluated by adverse event.

RESULTSOn the 2nd weeks after injury, Karlsson score in RICE group was 44.66 ± 11.58, and 46.67 ± 8.52 in RCE group, while there was no statistical significance between two groups in Karlsson scores (P > 0.05). Karlsson score of two groups after treatment were higher than before treatment. There was no significantly meaning in pain and satisfactory VAS scores between two groups (P > 0.05). No adverse reaction were occurred between two groups.

CONCLUSIONCold compress did not receive much more final gains, and no evidence showed cold compress could affect recovery of joint function.

Acute Disease ; Adolescent ; Adult ; Ankle Injuries ; physiopathology ; therapy ; Case-Control Studies ; Cold Temperature ; Female ; Humans ; Male ; Middle Aged ; Sprains and Strains ; physiopathology ; therapy

Objective To explore the effect of psychological behavioral intervention for the parents of the inpatients with schizo-phrenia .Methods 76 firstly hospitalized cases of schizophrenia were randomly divided into the psychological behavior intervention group and the routine group with 38 cases in each group .The parents in the intervention group were implemented the psychological behavior intervention .All patients were assessed with the Family Concern Index Questionnaire (APGAR) ,the Brief Psychiatric Rat-ing Scale(BPRS) and Inpatient Psychiatric Rehabilitation Outcome Scale (IPROS) .Results The obtained family support level in the intervention group was significant higher than that in the routine group (P<0 .01);the scores of BPRS and IPROS in the interven-tion group were significantly lower than those in the routine group(P<0 .01);the total APGAR scores were negatively correlated with the total BPRS scores(r= -0 .496 ,P<0 .01) and the total IPROS scores(r= -0 .453 ,P<0 .01) .Conclusion The psycho-logical behavior intervention conduces to guide the parents of firstly hospitalized inpatients with schizophrenia to provide the effec-tive family support to the patients for promoting their rehabilitation .

To study the chemo-preventive effect of the supercritical extracts from Angelica sinensis (SFE-AS) on induced colorectal carcinoma in mice by using the AOM/DSS-induced male mice colorectal carcinoma model, and discuss its possible action mechanism. Male Balb/c mice were subcutaneously injected with single dose of azoxymethane (AOM, 10 mg x kg(-1) body weight). One week later, they were given 2% dextran sodium sulfate (DSS) in drinking water for 7 days to induce colorectal carcinoma. Each drug group was orally administered with supercritical extracts from Angelica sinensis at 15, 30, 60 mg x kg(-1) until the 17th week. The tumor incidence rate of the SFE-AS group, mice tumor-bearing quantity and tumor-bearing volume of the SFE-AS group were lower than that of the AOM/DSS model control group, which may be related with the significant reduction of PCNA, COX-2, iNOS in the AOM/DSS-induced mouse colorectal carcinoma model associated with inflammation by SFE-AS. According to the results of this study, SFE-AS showed an intervention effect in the incidence and development of AOM/DSS-induced mouse colorectal carcinoma associated with inflammation, and could be further used in chemo-preventive studies on human colorectal carcinoma.
Angelica sinensis ; chemistry ; Animals ; Azoxymethane ; adverse effects ; Colonic Neoplasms ; chemically induced ; genetics ; immunology ; prevention & control ; Colorectal Neoplasms ; chemically induced ; genetics ; immunology ; prevention & control ; Cyclooxygenase 2 ; genetics ; metabolism ; Dextran Sulfate ; adverse effects ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Proliferating Cell Nuclear Antigen ; genetics ; immunology

Background and purpose:This study investigated the value of cervical ultrasound and TSH-sup-pressed thyroglobulin in the diagnosis of recurrence or metastasis of differentiated thyroid carcinoma (DTC).Methods:This study analyzed the data on 196 thyroid carcinoma patients who underwent neck dissection after clinically sus-pecious recurrence of DTC in Peking Union Medical College Hospital from Aug. 2010 to Dec. 2014. Among the 196 patients, 62 patients sonographically suspecious recurrence after total thyroidectomy and/or radioactive iodine ablation therapy were enrolled in this study. The ultrasonic features of lymph node involvement were retrospectively analyzed. The value of the ultrasonic features in the diagnosis of lymph node involvement and a TSH-suppressed serum Tg level in the diagnosis of recurrence or metastasis of DTC was also evaluated.Results:Of the 62 patients, 59 were pathologi-cally conifrmed with lymph node involvement, 1 case with local recurrence and 2 cases without recurrence or metasta-sis. There were 121 ultrasonographically suspected lymph nodes, conifrmed by pathology, 92 were metastatic ltsions, 25 were non-metastatic, 3 were ifbrous tissue and 1 was striated muscle. The positive predictive rate of cyst, calciifcation or hyper-echogenicity in cortex was 100% in the diagnosis of lymph node involvement. There was a signiifcant difference in disordered vascularity and cyst in cortex between metastatic and non-metastatic lymph nodes. Forty-nine patients were positive for Tg, whereas 13 were negative. The accuracy, sensitivity and speciifcity of TSH-suppressed serum Tg in the diagnosis of recurrence or metastasis of DTC were 82.3%, 81.7% and 100%.Conclusion:The disordered vascularity and cyst in cortex of the lymph node are highly speciifc indexes in diagnosing lymph node involvement. TSH-suppressed serum Tg level has high diagnostic value for detection of recurrence or metastasis of DTC. Cervical ultrasound can identify recurrent or metastatic lesions in both Tg-positive and Tg-negative patients.

Objective To evaluate the clinical diagnostic value of nucleic acid amplification (TB- RNA),bacteriophage-based assay,3D culture and smear on the detection of Mycobacteria tuberculosis.Methods 291 clinical sample including 110 sputum,54 thoracic fluid,37 throat swab,31 bronchial fluid,13 cerebrospinal fluid,12 urine,8 lymph fluid and 20 others (pericardial effusion,feces, blood and abdominal fluid) and gynecological specimen (including 6 leucorrhoea and menstrual blood) were analyzed by these four methods.Results Among the 291 clinical samples,the positive rate of mycobacteria tuberculosis for TB-RNA,bacteriophage-based assay,3D culture and smear were 37.1%,28.9%,27.5% and 10.3%.The sensitivity and specificity of the TB-RNA,bacteriophage-based assay,3D culture and smear were 54.3% & 100%,41.7% & 88.9%,31.7% & 93.5% and 14.6% & 98.9%,respectively.Conclusions TB-RNA is an effective clinical diagnostic method for Mycobacteria tuberculosis.Although the sensitivity of smear is poorer than others,it is a universal testing method in clinical laboratory due to low cost.The positive rate of mycobacteria tuberculosis for 3D culture is lower than that of bacteriophage-based assay and TB-RNA.Although the time to result for 3D culture might last for few weeks,the isolates can be used for drug resistance screening and bacterial identification.

OBJECTIVETo investigate the effect of oleic acid on the proliferation and secretion of pro-inflammatory mediators of human normal fibroblasts and scar fibroblasts.

METHODSHuman normal fibroblasts and scar fibroblasts were cultured in vitro and respectively divided into seven groups according to the random number table, with 8 samples in each group. Cells in blank control (BC) group were routinely cultured without addition of other agents. Cells in ethanol-control (EC) group were cultured with medium with the addition of 2% absolute ethanol. Cells in oleic acid groups were cultured with the addition of oleic acid in concentration of 0.25, 0.50, 1.00, 2.00, or 4.00 mmol/L in 2% absolute ethanol. The growth of cells in each group was observed with trypan blue staining on post culture day (PCD) 1-5. On PCD 2, structure of cells in BC, EC, and 1.00 mmol/L oleic acid groups was observed under inverted phase contrast microscope and transmission electron microscope; cell cycle of BC, EC, and 1.00 mmol/L oleic acid groups was measured by flow cytometer; cell proliferation activity in each group was measured by MTT assay; the level of NO in supernatant was assayed by Griess assay; the levels of TNF-α, IL-1β, IL-6, and IL-8 in supernatants in each group were determined by enzyme-linked immunosorbent assay. Data were processed with multifactor and repeated measurement design analysis of variance.

RESULTS(1) There was no significant difference in each index of normal fibroblasts and scar fibroblasts between BC group and EC group. (2) The numbers of normal fibroblasts and scar fibroblasts in 2.00 and 4.00 mmol/L oleic acid groups were significantly lower than those in corresponding BC and EC groups on PCD 2-5 (with F values respectively 13.773 and 11.344, P values all below 0.01). (3) On PCD 2, the numbers of normal fibroblasts and scar fibroblasts in 1.00 mmol/L oleic acid groups decreased, and the cells were aggregating, rounding, and easy to drop off. Cellular membrane disruption, vacuolar degeneration of mitochondrion, pyknosis, and lipid droplets were observed. (4) The percentages of G0/G1 and G2/M phases of normal fibroblasts in 1.00 mmol/L oleic acid group [(93.56 ± 9.98)%, (2.01 ± 0.75)%] were significantly higher than those in BC group [(84.23 ± 10.96)%, (0.37 ± 0.16)%, with F values respectively 3.026, 34.751, P < 0.05 or P < 0.01], while the percentage of normal fibroblasts in S phase [(4.42 ± 0.87)%] was markedly lower than that in BC group [(16.06 ± 1.74)%, F = 136.120, P < 0.01]. The percentages of scar fibroblasts of G0/G1 and G2/M phases in 1.00 mmol/L oleic acid group [(93.86 ± 13.90)%, (1.89 ± 0.66)%] were significantly higher than those in BC group [(83.88 ± 10.42)%, (0.41 ± 0.17)%, with F values respectively 3.529, 32.710, P < 0.05 or P < 0.01], and the percentage of scar fibroblasts in S phase [(3.87 ± 0.63)%] was markedly lower than that in BC group [(15.89 ± 2.02)%, F = 116.508, P < 0.01]. (5) The proliferation rates of normal fibroblasts and scar fibroblasts in 0.50-4.00 mmol/L oleic acid groups were significantly lower than those in corresponding BC and EC groups (with F values respectively 215.945 and 194.555, P < 0.05 or P < 0.01). (6) The content of NO in supernatant of normal fibroblasts in all oleic acid groups was obviously higher than that in BC and EC groups (F = 30.240, P < 0.05 or P < 0.01). The contents of NO in supernatants of scar fibroblasts in 1.00-4.00 mmol/L oleic acid groups were significantly higher than that in BC and EC groups (F = 12.495, P < 0.01). The contents of TNF-α and IL-6 in supernatants of normal fibroblasts and scar fibroblasts in 2.00 and 4.00 mmol/L oleic acid groups were obviously higher than those in corresponding BC and EC groups (with F(TNF-α) values respectively 6.911, 3.818, F(IL-6) values respectively 16.939, 11.600,P < 0.05 or P < 0.01). The contents of IL-1β in supernatants of normal fibroblasts and scar fibroblasts in groups of every concentration of oleic acid were significantly higher than those in corresponding BC and EC groups (with F values respectively 25.117, 9.137, P values all below 0.01). The contents of IL-8 in supernatants of normal fibroblasts in 1.00-4.00 mmol/L oleic acid groups were markedly higher than those in BC and EC groups (F = 2.717, P < 0.05 or P < 0.01). The contents of IL-8 in supernatants of scar fibroblasts in 2.00 and 4.00 mmol/L oleic acid groups were significantly higher than those in BC and EC groups (F = 3.338, P < 0.05). There was no statistically significant difference in above indexes between normal fibroblasts and scar fibroblasts in the same concentration of oleic acid group (with F values from 0.120 to 3.766, P values all above 0.05).

CONCLUSIONSAlthough oleic acid in high concentration inhibits the proliferation of scar fibroblasts, it also inhibits the proliferation of normal fibroblasts. Oleic acid in high concentration can cause excessive and continued inflammatory reaction by promoting the secretion of pro-inflammatory mediators of normal fibroblasts and scar fibroblasts, and they are detrimental to wound healing.

Cell Proliferation ; drug effects ; Cells, Cultured ; Cicatrix ; metabolism ; Fibroblasts ; cytology ; drug effects ; secretion ; Humans ; Inflammation Mediators ; metabolism ; Oleic Acid ; pharmacology

OBJECTIVETo explore the effect of Qiling Decoction (QD) combined highly active antiretroviral treatment (HAART) on expression levels of peripheral blood Th17 and Treg cells in HIV/AIDS patients.

METHODSTotally 55 HIV/AIDS patients were randomly assigned to the treatment group (28 cases) and the combination group (27 cases). Besides, 21 HIV negative patients were recruited as the healthy control group. Those in the treatment group received HARRT alone, while those in the combination group received HAART combined QD. The observation lasted for 24 weeks. Meanwhile, according to peripheral blood CD4+ T cell counts before treatment, HIV/AIDS patients were assigned to three subgroups. For patients in subgroup 1, 1 cells/microL < CD4+ T cell counts < or = 100 cells/microL; For patients in subgroup 2, 101 cells/microL < CD4+ T cell counts < or = 200 cells/lL; For patients in subgroup 3, 201 cells/microL < CD4+ T cell counts < or = 350 cells/microL. Expression of peripheral blood Th17 and Treg cells, and number of CD4+ T cell counts were detected using flow cytometry (FCM)in HIV/AIDS patients at the pre-treatment baseline, week 4, 12, and 24, as well as those in the healthy control group.

RESULTSCompared with the healthy control group, CD4+ T cell counts and the baseline expression level of Th17 cells in the peripheral blood of HIV/AIDS patients significantly decreased, the expression level of Treg cells significantly increased P < 0.01). Compared with before treatment in the same group, CD4+ T cell counts all increased at week 4, 12, and 24 in the two treatment groups, showing statistical difference (P < 0.05, P < 0.01). There was no statistical difference in the effective rate at various CD4+ T cell levels between the two groups (P > 0.05). There was no statistical difference in expression levels of Th17 and Treg cells between the combination group and the treatment group at any time point (all P >0.05). The Th17/Treg ration significantly increased in the combination group after 24 weeks of treatment, showing statistical difference when compared with the treatment group (U = 2.135, P = 0.038).

CONCLUSIONQD could improve the immune balance of Th17/Treg cells, which might be one of its mechanisms for improving HIV/AIDS patients' immunity.

Acquired Immunodeficiency Syndrome ; drug therapy ; immunology ; Adult ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Case-Control Studies ; Drugs, Chinese Herbal ; therapeutic use ; Female ; HIV Infections ; drug therapy ; immunology ; Humans ; Male ; Middle Aged ; Phytotherapy ; T-Lymphocytes, Regulatory ; cytology ; Th17 Cells ; cytology

Objective: To evaluate the effect of continuous care on patients with high risk of diabetic foot in China. Methods: A random control of continuing care for patients with diabetes foot at high risk before June 2018 was published in the full text of the Chinese VP full text database (VIP), the full text database (CNKI), the Chinese biomedical literature database (CBM), Wan Fang, PubMed, Science Library. The test (randomized clinical trial), by 2 researchers, according to the inclusion and exclusion criteria, the literature quality was evaluated and extracted by the document quality standard of Cochrane cooperation network, and the different subgroups were divided according to the difference of the determination time of each outcome index, and the RevMan5.3 software was used to match the data. The required literature is analyzed by Meta. Results: A total of 13 randomized clinical trials were included in the Mate analysis, including 1 450 subjects, 721 in the intervention group and 729 in the control group. The results showed that continuous nursing could effectively reduce the value of fasting blood glucose (combined effect MD=-1.34, 95%CI -1.44--1.24, P < 0.01), and effectively reduce the value of glycosylated hemoglobin (combined effect MD=-0.75, 95%CI -1.24- -0.27, P=0.002), and reduce the diabetic foot in patients with diabetic foot risk(combined effect RR=0.31, 95%CI 0.24-0.40, P<0.01). Continuous care could improve patients′ self-management ability and self-foot nursing ability. Conclusions Continuous care can reduce the fasting blood glucose, glycosylated hemoglobin and the incidence of diabetic foot in high-risk patients with diabetic foot, improve their self-management ability and self-foot nursing ability, which is of great significance to prevent and reduce the occurrence and development of diabetic foot.