Objective To evaluate the clinical value of ultrasonography in diagnosis of benignPHand malignant thyroid nodules by binary Logistic regression model.Methods A retrospective analysis of 240 cases of thyroid nodules confirmed by pathology after operation excision was conducted.173 nodules were benign as control group,67 nodules were malignant as observation group.The ultrasonic features of thyroid nodules were collected.The factor had statistics significance by x2 test between the two groups were analyzed by binary Logistic regression.A logistic regression model was created.The ROC curve was drawn and the area under the curve was calculated.Results There were statistically significant differences among boundary,aspect ratio,shape,internal echo,calcification,acoustic halo,cervical lymphadenectasis between the control group and observation group(x2=45.392,7.590,30.039,24.168,37.406,6.893,16.078,all P<0.01).And after Logistic regression analysis,six variables that entered the regression equation were boundary(P=0.000,OR=8.437),aspect ratio(P=0.000,OR=12.816),microcalcification of the nodules(P=0.000,OR=8.893),shape(P=0.000,OR=8.791),internal echoes(P=0.001,OR=8.313)and cervical lymphadenectasis(P=0.001,OR=6.891).The accuracy of the model was 90.7%(223/246)in predicting malignant nodules in thyroid.The area under the ROC curve was(0.904±0.031).Conclusion The binary Logistic regression can be used to differentiate malignant and benign thyroid nodules,and make a more accurate judgment for the nodules in thyroid.

Objective To observe the clinical efficacy ofXing Nao Kai Qiao (brain-awakening and orifice-opening) needling plus thunder-fire moxibustion in treating vertebrobasilar ischemia.Method Fifty-five patients with vertebrobasilar ischemia were randomized into a treatment group of 26 cases and a control group of 29 cases. The treatment group was intervened byXing Nao Kai Qiao needling plus thunder-fire moxibustion, while the control group was by oral administration ofYangxue Qingnao granules. The blood flow of vertebrobasilar arteries were observed by using ultrasonic Doppler blood-flow detector before and after intervention, and the clinical efficacies were compared between the two groups.Result The recovery and markedly-effective rate and total effective rate were respectively 61.5% and 96.2% in the treatment group, versus 34.5% and 89.7% in the control group, and the differences were statistically significant (P<0.01,P<0.05). The VS and VD of vertebral arteries and VS of basilar arteries were significantly changed after intervention in the treatment group (P<0.05). The VS of basilar arteries was significantly changed after intervention in the control group (P<0.05). After treatment, The VS of vertebral and basilar arteries in the treatment group was significantly different from that in the control group (P<0.05).ConclusionXing Nao Kai Qiao needling plus thunder-fire moxibustion is an effective approach in treating vertebrobasilar ischemia.

OBJECTIVE:To explore the efficacy and safety of leflunomide combined with prednison in the treatment of membra-nous nephropathy. METHODS:43 patients with primary membranous nephropathy were randomly divided into control group(21 cas-es) and test group (22 cases). Control group given cyclophosphamide interrupted shocks combined with prednison,test group re-ceived leflunomide combined with prednison,the treatment course for both groups was 12 months. 6 months after the treatment,clini-cal efficacy,changes in renal function and serum lipids indexes before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in test group was 63.64%,which was significantly higher than control group (23.81%),the difference was statistically significant (P<0.05). After treatment,urine protein in 2 groups significantly de-creased,plasma albumin significantly increased,serum creatinine,serum cholesterol,triglycerides and low-density lipoprotein signifi-cantly decreased,the differences were statistically significant(P<0.05);and the changes of above-mentioned indexes(except blood cholesterol)in test group were more significantly than control group,the differences were statistically significant(P<0.05). The inci-dence of adverse reactions in test group was 9.09%,control group was 9.52%,there was no significant difference between 2 groups (P>0.05). CONCLUSIONS:Compared with cyclophosphamide interrupted shocks combined with prednison,the efficacy of lefluno-mide combined with prednison in the treatment of membranous nephropathy is more definite,and the improvement of renal function and serum lipids indexes is more obvious.

ObjectiveTo investigate the effect of tranexamic acid on inflammatory response in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Sixty ASA Ⅰ -Ⅲ and NYHA Ⅰ -Ⅲ patients of both sexes,aged 45-64 yr,with body mass index 16-22 kg/m2,undergoing elective OPCABG,were randomly divided into 2 groups ( n =30 each):control group (group C) and tranexamic acid group (group T).Anesthesia was induced with iv injection of midazolam,fentanyl and pipecuronium.The patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Tranexamic acid 1 g was infused intravenously over 30 min after induction followed by continuous infusion at 400 mg/h until the end of operation in group T.While equal volume of normal saline was given in gtoup C.Anesthesia was maintained with inhalation of isoflurane and intermittent (i)v boluses of fentanyl and pipecuroninm.Venous blood samples were taken before induction,at the end of operation and 24 h after operation for determination of Hb,platelet count,prothrombin time,international normalized ratio and plasma D-dimer and IL-6 concentrations.The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation.The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was recorded.The complications during hospital stay were also recorded.ResultsCompared with group C,the plasma concentrations of D-dimer and IL-6 were significantly decreased at the end of operation and 24 h after operation,and the volume of chest tube drainage and the requirement for transfusion of allogeneic red blood cells and fresh frozen plasma were significantly decreased after operation in group T ( P ＜ 0.05 or 0.01).There was no significant difference in Hb,platelet count,prothrombin time and international normalized ratio between the two groups (P ＞ 0.05).No complications occurred during hospital stay in the two groups.ConclusionTranexamic acid can reduce inflammatory response in patients undergoing OPCABG.

Objective To explore the clinical features,diagnosis and treatment of serious pyogenic infection in deep neck. MethodsFrom January 2002 to April 2005,the clinical data of 22 patients hospitalized with serious pyogenic infection in deep neck were collected and retrospectively analysed. Results All the patients suffered unilaterally.Besides the symptoms of infection,dyspnea,pain in swallowing,limitation of mouth opening and progressive limitation of cervical activity were presented.Bacterial cultivation were performed in 14 patients and positive results were detected in six.Fourteen of all the 22 patients were cured with antibiotics,and abscess incision drainage was carried out in the other eight.Preoperative cervical PA-LAT X-ray photography and contrast-enhanced CT scanning were performed on one and seven patients,respectively,all of which indicated the formation of abscess.All the patients were cured except one who died of cerebral infarction and multiorgan dysfunction. Conclusion Imaging evaluation plays a significant role in the preoperative diagnosis and systemic treatment of serious pyogenic infection in deep neck.Bacterial cultivation provides reliable evidence for the etiopathogenisis and helps to make the effective treatment.

OBJECTIVETo investigate the effect of different pressure oxygen pre-breathing in preventing decompression sickness of rats.

METHODSForty male SD rats were randomly divided into 4 groups: decompression sickness (DCS) group and three oxygen pre-breathing groups with 1 ATA, 2 ATA and 3 ATA pressure respectively. The rats of DCS group were placed in the hyperbaric chamber and the chamber was compressed evenly within 3 minutes to depths of 7 absolute atmosphere(ATA) and held at the designated depth for 60 min, then decompressed (3 min) at constant speed to the surface pressure. After that, the rats were taken out for further detection. While the rats of oxygen pretreatment groups pre-breathed different pressure oxygen for 20 min before entering into chamber. The mortality and behavioral of rats were observed with 30 min post decompression. The dry/wet ratio of the lung, protein levels in the bronchoalveolar lavage fluid (BALF), and the inflammatory cytokine tumor necrosis factor (TNF-alpha) expression were also tested.

RESULTSCompared with that of the DCS group, the mortality and morbidity of oxygen pre-breathe groups didn't change obviously. But the total BALF protein level and the inflammatory cytokine TNF-alpha expression of 1 ATA oxygen pre-breathe group were obviously decreased, while the dry/wet ratio of lung as obviously increased instead (P < 0.05).

CONCLUSIONAlthough preoxygenation can' t obviously change the mortality and mobidity of rats, normal pressure oxygen pre-breathing can mitigate the protein infiltration in BALF and the expression of inflammatory cytokine in lung tissue.

Animals ; Bronchoalveolar Lavage Fluid ; chemistry ; Decompression Sickness ; Diving ; Lung ; pathology ; Oxygen ; physiology ; Pressure ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; metabolism

Objective To analyze the CT manifestations of mesenteric panniculitis,so that to improve CT diagnosis of mesenteric panniculitis.Methods Seven patients with mesenteric panniculitis,which were diagnosed according to the CT criteria,were analyzed.Results The fatty masses with defined margins and around the root of the jejunum were found in all patients at CT scan,and there were no enhancement after administration of contrast medium.The masses were sharply defined with abdominal and retroperitoneal fat.There were pseudo-capsule in 7, "arcus adiposus sign" in 5. Enlargement of lymph nodes in the masses and retroperitoneum in 2 cases were seen,respectively.4 patients had abdominal operations,one patient was in combination with carcinoma of head of pancrease.Conclusion Certain features of the CT manifestations of mesenteric panniculitis can be found,CT is effective for the diagnosis of mesenteric panniculitis.

Objective To better understand the clinical features and the diagnosis of monoclonal gammopathy of undetermined significance (MGUS) associated with systemic lupus erythematosus (SLE).Methods A case of MGUS with SLE were described including clinical manifestations and pathologic data.Literatures were also reviewed.Results The patient was admitted because of proteinuria.Laboratory findings showed monoclonal gammopathy.However,both bone marrow exam and iconography showed no signs of multiple myeloma.Lupus nephritis Ⅳ + Ⅴ was proved by kidney biopsy.Prednisone and tacrolimus were used with significant clinical improvement.Conclusion MGUS associated with SLE is not rare.MGUS criteria based on 2003 international MM working group should be used to differentiate MGUS from MM.Monoclonal protein level,plasma cell in bone marrow and free light chain are risk factors for MM progression.Treatment is based on lupus disease activity and organ damage severity.

To explore the clinical manifestations, diagnosis and treatment of pulmonary thromboembolism associated with protein C (PC)/protein S (PS) deifciency. Two male patients 29 and 26 years old diagnosed with PC deifciency and/or PS deifciency were retrospectively analyzed and related literatures were reviewed. The most common symptoms were pain in the lower limbs with chest pain or decreased vision. Color dopper lfow imaging (CDFI) showed lower deep venous phlebothrombosis. Multislice CT angiography (CTA) revealed pulmonary embolism. The level of serum homocysteine (HCY) increased and the level of plasma PC/PS content decreased to PC 57.4%, and PS 28.9%in patient 1, while PS 33.4%in patient 2. Poor routine anticoagulant response was observed. After the diagnosis of PC/PS deficiency, vitiamin B6 and B12 anticoagulant therapy was added, and the symptoms in the patients improved significantly. Congenital thrombophilia should be taken into consideration for young patients with lower deep venous thrombosis and pulmonary embolism which occur recurrently without obvious predisposing causes before 40. Plasma PC/PS concentrations or activity help a lot in the diagnosis and treatment.

Objective To identify the risk factors for early postoperative elevation in body temperature in patients undergoing coronary artery bypass grafting (CABG).Methods Nine hundred and forty-one patients of both sexes,aged 14-70 yr,were assigned into hyperthermia (≥ 38 ℃) group or non-hyperthermia (＜ 38 ℃) group according to the bladder temperature at 8h after operation.Factors including age,sex,height,weight,complications (hypertension,hyperlipemia,diabetes),history of smoking and drinking,preoperative blood pressure,heart rate,ejection fraction,routine blood examination,routine urine examination,and respiratory function examination,intraoperative cardiopulmonary bypass (CPB) and hormone,operation time,extubation time,duration of stay in the intensive care unit,and blood pressure,heart rate,ejection fraction,routine blood examination,and routine urine examination at the end of operation,and postoperative analgesia were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for early postoperative elevation in body temperature after CABG.Results Six hundred and ninety patients developed early postoperative elevation in body temperature (73.3％).Logistic regression analysis showed that preoperative respiratory dysfunction,preoperative ejection fraction ≤ 50％ and CPB were independent risk factors for early postoperative hyperthermia after CABG (P ＜ 0.05).Conclusion Preoperative respiratory dysfunction,preoperative ejection fraction≤ 50％ and CPB are independent risk factors for early postoperative elevation in body temperature in patients undergoing CABG.