Objective To evaluate the role of cabon nanoparticles for dissecting lymph nodes and preserving parathyroid glans in patients with differentiated thyroid carcinoma undergoing total thyroidectomy plus bilateral central neck dissection.Metheds From Sep.2015 to Feb.2016,100 patients in Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine with thyroid carcinoma undergoing primarily total thyroidectomy plus bilateral central neck dissection were randomly divided into carbon nonoparticle group and the contol group.The numbers of total dissected lymph nodes,the lymph node posterior to fight recurrent laryngeal nerve,metastasized lymph nodes,inadvertent parathyroidectomy,the parathyroid hormone and serum total calcium were measured.Results The average counts of lymph nodes in carbon nonoparticle group (10.96±5.43)were more than those in the control group at (8.22±4.40)lymph nodes,(t＝2.78,P＝0.01).The average counts of lymph node posterior to fight recurrent laryngeal nerve in carbon nonoparticle group (1.62±1.95)were more than those in the control group at (0.76±1.21)lymph nodes,(t＝2.66,P＝0.01).The numbers of metastasized lymph nodes was 2.02±2.40 in carbon nonoparticle group and 1.84±2.61 in the control group.The difference had no statistical significance(t＝0.36,P＞0.05).The amount of PTH and the decrease of PTH discrepancy one day after surgery between the two groups had no statistical difference (t＝0.23,P＞0.05),(t＝l.04,P＞0.05).The carbon nonoparticle group had 2％(1/50)mistakenly parathyroid gland removed incidence,on contrary,the control group had 6％(3/50)mistakenly removed incidence.The difference had no statistical significance(x2＝0.26,P＞0.05).Conclusion Carbon nonoparticle can improve the central lymph node detection rate,but the protection of the parathyroid glands is more likey to depend on the experience of the operator and the vascular protection.

Objective To investigate the clinical efficacy of conventional treatment combined with flupentixol and melitracen in patients with reflux esophagitis (RE).Methods From June 2012 to March 2015, a total of 182 patients were selected as study subjects from newly diagnosed RE patients.The anxiety and depression scores were evaluated according to Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD).And then patients were divided into HAMA and HAMD negative conventional treatment group and combined treatment group, HAMA and HAMD positive conventional treatment group and combined treatment group.Rabeprazole and mosapride were administrated in conventional treatment group.For patients in combined treatment group, on the base of conventional treatment flupentixol and melitracen were added.The treatment course was eight weeks.The degree of anxiety and depression, RE symptoms and mucosal healing under gastroscope were evaluated before and after treatment.Adverse drug reaction was observed.Chi square test or t test was performed for statistical analysis.Results Eight weeks after treatment, the scores of HAMA and HAMD in HAMA and HAMD positive combined treatment group were 7.930 ±3.832 and 9.630 ± 3.650, which were both lower than those of conventional treatment group (11.660 ± 4.108 and 12.170 ± 4.459), and the differences were statistically significant (t=3.683 and 2.233;both P＜0.05).The symptom scores of heartburn, regurgitation, chest pain of HAMA and HAMD positive combined treatment group were 0.700±0.591,0.780± 0.629 and 0.720±0.621, respectively, which were lower than those of conventional treatment group (1.280 ± 0.502, 1.370 ± 0.610 and 1.040 ± 0.842), and the differences were statistically significant (t =5.133, 4.413 and 2.114, all P＜0.05).There were no statistical significance in symptoms scores between HAMA and HAMD negative combined treatment group and conventional treatment group (all P＞0.05).After treatment, the mucosal healing rate of HAMA and HAMD positive combined treatment group was 91.3％ (42/46), which was higher than that of conventional treatment group (71.7 ％, 33/46), and the difference was statistically significant (x2 =5.845, P =0.016).The incidence of adverse events of HAMA and HAMD negative combined treatment group was 4.8％ (2/42), and that of HAMA and HAMD positive combined treatment group was 2.2％(1/46).Conclusions The conventional treatment combined with flupentixol and melitracen in RE patients accompanied with anxiety and depression was remarkable and safe.RE patients without obvious anxiety or depression, preventive use of antianxiety and antidepressant medicine can not improve the efficacy.

Objective To investigate the clinical features,diagnosis and treatment of medullary thyroid microcarcinoma (MTMC).Methods The clinical data of 14 patients with MTMC from Mar.2012 to Sep.2016 were retrospectively reviewed.All cases were treated with surgery and pathologically proved to be MTMC.Results All patients were sporadic MTMC.Calcitonin and CEA levels were measured before surgery in 11 patients.The median values were 81.61 (3.36-1187) pg/ml and 7.42 (0.81-90.75) ug/ml,respectively.All patients were followed up postoperatively.During a median follow-up of 24 months (8-63 months),no death happened.Regional lymph node metastasis occurred in 8 patients (57.14％),and lateral lymph node metastasis in 5 cases (35.71％).The rate of postoperative calcitonin abnormal was significantly higher in patients with lateral lymph node metastasis (P＜0.01).6 cases (42.86％) had abnormal postoperative calcitonin,among whom 5 cases had preoperative baseline calcitonin level higher than 100 pg/ml.Patients having abnormal postoperative calcitonin suffered from higher calcitonin and CEA baseline (P＜0.05).The tumor size was similar in two groups (P＞0.05).Conclusions For patients with thyroid nodules,preoperative screen of calcitonin can effectively detect MTC.Patients with elevated CEA also need to exclude the possibility of MTC.Compared with tumor size,calcitonin baseline is more important to surgical options and postoperative outcomes.Lateral lymph node metastasis,baseline calcitonin ＞100 pg/ml indicates abnormal postoperative calcitonin.

Objective To analyze and compare the differences in application of 24-hour dietary recall and dietary balance index (DBI) in dietary survey and evaluation of patients with type 2 diabetes mellitus,meanwhile investigate their nutrition status.Method This was a cross-sectional study.A total of 100 type 2 diabetes inpatients at the age of 19-59 were recruited from Shanghai Jiaotong University Affiliated Sixth People's Hospital from December 2013 to February 2014.They were surveyed and evaluated by 24-hour dietary recall and DBI respectively.Result The micronutrient intake in patients with type 2 diabetes was not sufficient.Compared with RNI,the intake of vitamin B1,B2,and calcium was less than 50％.The average of DBI lower bound score (DBI-LBS) of the 100 patients was 32.1±6.1,65％; the patients were in moderate or severe deficit of food intake.DBI higher bound score (DBI-HBS) was 4.4±2.8.No significant excess intake problem was found.Dietary quality distance was 36.4±6.9.Eighty-seven percent of them had a dietary patterns of mode B.Conclusion Dietary patterns in type 2 diabetes patients were not reasonable.Nutrition education and nutrition intervention for type 2 diabetes should be emphasized.The two methods can be used to evaluate dietary quality independently,but it would be better to evaluate the quality of the patients' diet using two dietary survey methods together.

OBJECTIVE:To compare the contents of loganic acid,swertiamarin,6′-O-β-D-glucosyl gentiopicroside,gentiopi-croside,sweroside,isoorientin and isovitexin in wild and cultivated Gentiana officinalis,and to provide basis for rational use of G. officinalis. METHODS:UPLC method was adopted. The separation was performed on ACQUITY UPLC? BEH C18 column (50 mm × 2.1 mm,1.7 μm) with mobile phase consisted of methanol-0.04% phosphoric acid (gradient elution) at the flow rate of 0.3 ml/min. The detection wavelength was set at 242 nm,and column temperature was 30 ℃. RESULTS:For loganic acid,swertiama-rin,6′-O-β- D-glucosyl gentiopicroside,gentiopicroside,sweroside,isoorientin and isovitexin,a good linearity was obtained in the range of 2.1-537.1 μg,1.05-270 μg,0.92-236 μg,11.1-2 830 μg,0.75-192 μg,0.167-102 μg,0.216-52.80 μg(r≥0.999 5), respectively. Their average recoveries were 97.72%-99.84%(RSD≤3.39%,n=6). The contents of loganic acid,swertiamarin, 6′-O-β-D-glucosyl gentiopicroside,gentiopicroside,sweroside and isoorientin in the wild sample were higher than in the cultivat-ed;the content of isovitexin was lower than the cultivated,but there was no statistical significance(P>0.05). The sum of gentiopi-croside and loganin acid content were all higher than 2.5% in both wild and cultivated samples,and met the requirements of 2015 edition of Chinese Pharmacopoeia(first part). CONCLUSIONS:The content difference of 7 indicative constituents in wild and cul-tivated G. officinalis is not statistically significant,and the indicative constituents of the pharmacopoeia is qualified.

ObjectiveTo investigate the features and methods of clinical diagnosis and treatment of elderly patients with acute calculous cholecystitis. MethodsA retrospective analysis was performed for the clinical data of elderly patients who were diagnosed with acute calculous cholecystitis in 451 Hospital of PLA from June 2012 to June 2015. After admission, all patients received fasting treatment, electrocardiographic monitoring, anti-infective therapy, and maintenance of body fluid balance and stable blood pressure and glucose. According to patients condition choose laparoscopic cholecystectomy open cholecystectomy, open cholecystectomy and common bile duct exploration. ResultsA total of 129 patients were enrolled; among these patients, 119 had acute calculous cholecystitis, 2 had gallstones with adenomatous hyperplasia of the gallbladder mucosa, 6 had pyogenic cholecystitis, and 2 had gallbladder gangrene. Among the patients enrolled, 52 were complicated by at least one internal disease. Among them, 67 underwent emergency surgery since there were no significant improvements in symptoms, and 62 showed relief of symptoms and underwent surgical treatment at other times. Of all patients, 108 underwent laparoscopic cholecystectomy, 9 underwent laparoscopy and were converted to open cholecystectomy, and 9 underwent open cholecystectomy and common bile duct exploration. All the surgeries were successful and all the patients were cured and discharged. There were no deaths. ConclusionElderly patients with acute calculous cholecystitis are in a critical condition and often complicated by various internal diseases. Laparoscopic cholecystectomy is the most commonly used therapeutic method. Clinicians should be fully prepared before surgery, take the perioperative management seriously, and accurately judge the surgical indications and timing.

ObjectiveTo investigate the diagnosis, treatment, and outcome of Mirizzi syndrome in patients undergoing laparoscopic cholecystectomy (LC). MethodsA retrospective analysis was performed on the clinical data of 32 patients who underwent LC in the 451 Hospital of PLA from December 2006 to December 2014 and experienced Mirizzi syndrome during the perioperative period. Intraoperative diagnosis, selection of surgical procedures, and evaluation of treatment outcome were summarized. ResultsAmong these patients with Mirizzi syndrome, 8 were diagnosed before surgery and 24 were diagnosed during LC. According to the Csendes classification, 23 patients had type Ⅰ, 7 had type Ⅱ, 1 had type Ⅲ, and 1 had type Ⅳ Mirizzi syndrome. A total of 30 patients completed LC, and they all had type I or Ⅱ Mirizzi syndrome. One patient with type Ⅱ disease underwent LC and common bile duct exploration. Two patients with type Ⅲ or Ⅳ disease were converted to open surgery; the type Ⅲ patient underwent bile duct end-to-end anastomosis, and the type Ⅳ patient underwent choledochoenterostomy. ConclusionMirizzi syndrome is difficult to diagnose, and ultrasonography is the preferred method of examination. A combination of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can improve preoperative diagnostic rate. Most cases of type Ⅰ and Ⅱ Mirizzi syndrome can be treated by LC. Open surgery should be considered for type Ⅲ and Ⅳ cases to avoid biliary tract injury.

Objective To assess the effectiveness of a novel mobile health patient management system involving doctors, nurses, and patients ( TRIO mode) on glycemic control and self-monitoring of blood glucose (SMBG) compliance among the type 2 diabetes mellitus ( T2DM) patients using basal insulin standardization treatment in China. Methods From April 2014 to April 2015, 416 hospitals in 110 cities of 30 provinces, municipalities, and autonomous regions across China were selected to participate in the program. A Online-to-Offline ( O2O) integrated mobile health patients management system with mobile terminals for the doctors, nurses, and patients was applied in the program for patient education, follow-up, and data collection. For all the newly recruited patients, the baseline information was collected and a first-day patient education program were provided by a designated nurse. In the 12-week follow-up period, data of basal insulin doses and fasting plasma glucose ( FPG) values were collected from the patients by text messages or tracking phone call by the nurse. The patients also received timely standardized patients health education and glycemic control guidance by participating in thepatient education forum anddoctors' hotline in order to help them achieve the glycemic control goals. Results A total of 102 524 patients using basal insulin treatment were eligible and enrolled in the program. 64 420 patients completed the 12 weeks follow-up and provided at least one FPG value at all five follow-ups. In total, 62. 6% (40 334 / 64 420) of the patients reached the FPG control target(FPG≤7. 0 mmol/ L) at the end of follow-up period. The weekly average FPG for patients with complete SMBG data decreased from 10. 58 mmol/ L to 6. 91 mmol/ L while the FPG control rates increased from 13. 4% to 69. 2% . The weekly average FPG for the patients provided incomplete SMBG data decreased from 10. 54 mmol/ L to 7. 13 mmol/ L while the FPG control rates increased from 13. 6% to 62. 2% . The FPG control rates for the patients provided complete SMBG were 1. 74 times higher than those patients provided incomplete SMBG. Based on a GEE model, the average decline of the FPG and the increase of the FPG control rates were significantly better for patients who provided complete SMBG as compared to the patients with incomplete SMBG data. The results of the multivariate logistic regression analysis showed that factors such as receiving the first-day education, participating in the follow-up patient education forum, and the doctors' hotline were significantly associated with the improvement of the SMBG compliance, the treatment adherence, and the FPG control rates. The SMBG compliance and the treatment adherence for patients who completed first-day education were 1. 68 times and 1. 22 times higher, respectively. For the patients who participated in follow-up education activities, their SMBG compliance and treatment adherence were 3. 17 times and 3. 36 times higher, respectively. Conclusion The innovativeTRIOmobile health patient management mode was feasible and effective for better managing the type 2 diabetes patients initiated on basal insulin treatment in China. Active participation in the first-day education program and the follow-up patient education activities can effectively improve the SMBG compliance and the treatment adherence, and therefore play an important role in helping patient achieving FPG control in a faster manner.

Objective To evaluate the role of glycogen synthase kinase 3 beta (GSK-3β) in lipid emulsion-induced inhibition of bupivacaine-induced apoptosis in cardiomyocytes of rats using RNA interference (RNAi) adenovirus infection method.Methods H9C2 cells were transferred into 96-well cell plates at a density of 1× 105 cells/ml after culture and then divided into 8 groups (n =10 each) using a random number table:control group (group C),bupivacaine group (group B),lipid emulsion group (group LE),bupivacaine plus lipid emulsion group (group B+LE),control plus GSK-3βRNAi adenovirus (GSK-3βi) group (group C+GSK-3βi),bupivacaine plus GSK-3βi group (group B+GSK-3βi),lipid emulsion plus GSK-3βi group (group LE+GSK-3βi) and bupivacaine plus lipid emulsion plus GSK-3βi group (group B+LE+GSK-3βi).ln B,LE and B+LE groups,the cells were incubated with culture medium containing 1 mmol/L bupivacaine,1％ lipid emulsion and 1 mmol/L bupivacaine plus 1％ lipid emulsion,respectively.In C+GSK-3βi,B+GSK-3βi,LE+GSK-3βi and B+LE+GSK-3βi groups,the cells were incubated with the drugs mentioned above on 2nd day after being infected by adenovirus.At 24 h after incubation with drugs,the expression of Bax and Bcl-2 was determined by Western blot,and the apoptosis rate was calculated using DAPI staining.Results Compared with group C,the expression of Bax was significantly upregulated,the expression of Bcl-2 was down-regulated,and the apoptosis rate was increased in group B (P＜0.05).Compared with group B,the expression of Bax was significantly down-regulated,the expression of Bcl-2 was up-regulated,and the apoptosis rate was decreased in group B+LE (P＜0.05).Compared with group B+LE,the expression of Bax was significantly up-regulated,the expression of Bcl-2 was downregulated and the apoptosis rate was increased in group B+LE+GSK-3βi (P＜0.05).Conclusion The mechanism by which lipid emulsion inhibits bupivacaine-induced apoptosis in cardiomyocytes of rats is associated with GSK-33.

Objective:To investigate the application value of shear wave elastography (SWE) and real-time tissue elastography (RTE) in differential diagnosis of thyroid Amereican College Radiology (ACR) TR5 nodules.Methods:Patients who underwent ultrasound examination at the Fourth Affiliated Hospital of Harbin Medical University from August 2018 to June 2019 diagnosed as ACR TR5 nodules were surveyed, and received SWE and RTE examinations to evaluate the nodules hardness. The receiver operating characteristic curve (ROC curve) was drawn to obtain the best diagnostic cutoff value for the Young's modulus maximum (Emax) of the benign and malignant thyroid ACR TR5 nodules using SWE technique; using the 5-point method, the elasticity score (ES) was used to evaluate the benign and malignant ACR TR5 nodules by RTE technology, and the pathological results were regarded as "gold standard". The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of SWE, RTE and two elastography techniques in differential diagnosis of benign and malignant thyroid ACR TR5 nodules were compared.Results:A total of 65 patients were enrolled, with a total of 73 ACR TR5 nodules. The optimal Emax threshold for differential diagnosis of ACR TR5 nodules by SWE technology was 41.8 kPa, and 32 malignant nodules and 41 benign ones were determined. Of the 73 ACR TR5 nodules using RTE technology, 38 had ES scores of 1 to 3 and 35 had ES scores of ≥4. Pathological results showed that among 73 thyroid ACR TR5 nodules, benign nodules accounted for 45.21% (33/73), malignant nodules accounted for 54.79% (40/73). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SWE, RTE and two elastography techniques for differential diagnosis of benign and malignant thyroid ACR TR5 nodules were 72.50%, 77.50%, 87.50%; 90.91%, 87.88%, 87.88%; 80.82%, 82.19%, 87.67%; 90.63%, 88.57%, 89.24% and 73.17%, 76.32%, 85.29%.Conclusions:Ultrasound elastography of two different imaging principles of SWE and RTE is an effective method for differential diagnosis of benign and malignant thyroid ACR TR5 nodules. The combination of the two is more advantageous.