Objective To investigate the value of high frequency color doppler ultrasound for screening thyroid diseases in physi-cal examination people .Methods The detectable information of thyroid diseases using high frequency color doppler ultrasound in 1 413 physical examination people was analyzed .Results A total of 588 cases of the 1 413 people were detected to have thyroid dis-eases with positive rate of 41 .61% ,and the detectable rate increased with aging .The positive rate of female (349 cases ,54 .96% ) was statistically higher than that of male(239 cases ,30 .72% ) .Within the 588 people ,111 cases were diagnosed as diffused thyroid diseases and 488 cases were diagnosed as thyroid nodules by high frequency color doppler ultrasound .Twenty cases were confirmed to have thyroid carcinoma by pathologic examination ,with 3 males and 17 females .Twelve lesions were less than 1 .0 cm in diameter and were diagnosed as microcarcinoma .The smallest lesion was 6 mm × 5 mm .Conclusion The high frequency color doppler ultra-sound was useful in screening for thyroid diseases ,especially for carcinoma ,and should be used as routine examination item .

Objective To study the correlation between hyperhomocystinemia and the property of cerebral artery plaque,and the pathogenic mechanism of hyperhomocystinemia resulting in acute cerebral stroke.Methods 60 patients with acute ischemic stroke were chosen.30 patients with normal homocysteine were classified as control group.The other 30 patients with hyperhomocystinemia were classified as observation group.High resolution magnetic resonance imaging(HRMRI) and multi contrast plaque imaging technique were used to measure the cerebral artery plaque burden,the fat ratio of plaques,the hemorrhage within the plaque and fibrouscap rupture.The number of inflammatory cells in the plaque and the density of the new blood vessels were identified using the transfer constant of the contrast medium.Results In the observation group,4 cases with low-risk plaques (13.33％),10 cases with middle-risk plaques (33.33 ％) and 16 cases with high-risk plaques (53.33 ％).In the control group,13 cases with low-risk plaques (43.33％),6 cases with middle-risk plaques (20.00％),11 cases with high-risk plaques (36.67％).The number of intraplaque hemorrhage were 18 cases (60.00％) in the observation group,and 8 cases (26.67％) in the control group.The number of fibrouscap rupture were 21 cases (70.00％) in the observation group,and 13 cases (43.33％) in the control group.Risk stratification of vulnerable plaques in cerebral atherosclerosis (U =-2.032,P =0.042),intraplaque hemorrhage (x2 =6.79,P =0.009) and fibrouscap rupture (x2 =4.34,P =0.037) in the observation group was higher than that in the control group.The number of inflammatory cells in plaques and the density of the new blood vessels in the observation group was (0.188 ± 0.265)Ktrans/min,which in the control group was (0.118 ± 0.183)Ktrans/min.The number of inflammatory cells in the plaque and the density of the new blood vessels in the observation group was higher than that in the control group (t =11.831,P =0.000).Conclusion Hyperhomocystinemia causes intraplaque hemorrhage,fibrouscap rupture,inflammatory cell activity and neovascularization in plaques,accelerates cerebral atherosclerosis and increases the incidence of ischemic stroke events.

Objective:To optimize the base formula of boric acid cream,and investigate its quality. Methods:Using central composite design-response surface methodology,with the viscosity of cream as the index,the amounts of Cremophor A6,Cremophor A25,cetyl alcohol,stearyl alcohol,isooctadecyl isooctadecanoate,jojoba oil and light liquid paraffin were optimized. The appearance characteristics,particle size,viscosity and stability of the preparation and the content of boric acid were studied. Results:The optimal conditions were as follows:50 g Cremophor A6-Cremophor A25(3 ∶2),65 g cetyl alcohol-stearyl alcohol(3∶7),and 125 g isooctadecyl isooctadecanoate-jojoba oil- light liquid paraffin(5 ∶3 ∶2). According to the optimal formula,the cream showed the property of semi-fluid cream,the content of boric acid was 98. 5% of the labeling amount,and the viscosity was about 1. 64 × 104 mPa·s. The predicted value was equivalent to the measured one,and the stability of the preparation was promising. Conclusion:The central composite design-response surface methodology used in the base optimization of boric acid cream is simple with high precision and good predictability,and the quality of the preparation is stable and controllable.

Objective To investigate the value of conventional ultrasound combined with contrast‐enhanced ultrasound in qualitative diagnosis of benign and malignant cervical lymph nodes (LNs) .Methods Totally 129 enlarged LNs in 112 cases were performed the 2‐dimensional ,color Doppler ultrasound ,and grey‐scale contrast‐enhanced ultrasound(CEUS)examinations .LNs were divided into the benign group and malignant group according to pathologic results .The aspect ratio ,eccentric medulla or medulla de‐fect ,echo type ,blood supply distribution ,contrast‐enhancement pattern and distribution equilibriuym of contrast agent were com‐pared between the two groups .Results The most of aspect ratio in the benign LNs group were ≥ 2 ,the cortex and medulla were uniform with symmetric increase and without microcalcification ,the blood supple was mainly the non‐blood flow type or hilar type , in contrast‐enhanced ultrasound ,the majority were the early hilar and medullar enhancement ,showing the centrifugally full filling ;the most of aspect ratio in the malignant LNs group were <2 ,medulla was eccentric or loss ,partial of LNs showed the increased parenchymal echo accompanied with cystic lesion and microcalcification ,the blood supply was mainly the peripheral and mixed types ,and the non‐hilar and medulla started enhancement pattern .The ultrasonographic parameters mentioned above were statisti‐cally different between the two groups ,in which the non‐hilar and medulla started enhancement patterns had the highest sensitivity and accuracy for diagnosing malignant LNs ,the positive predictive values of these parameters were higher ,whereas the negative predictive values were lower .Conclusion The conventional ultrasound combined with contrast‐enhanced ultrasonography has a higher practical value in qualitative diagnosis of cervical LNs ;the comprehensive judgment of multiple indicators can increase the differentiating ability for benign from malignant LNs .

Objective To explore the effect of videos on health education to the spinal surgery patients during perioperative period. Methods About 99 patients with lumbar, cervical vertebra disease were randomized into two groups with random digit number:50 in the experimental group and 49 in the control group. Videos was used in the health education combined with routine health education model of perioperative health education in the former group and the health education was done in regular way in the control group. The two groups were compared in terms of hospital nursing service awareness, rehabilitation knowledge awareness, accuracy in perioperative nursing skill. Result The rate of knowledge about hospitalization nursing and the accuracy of rehabilitation nursing skills were significantly higher than those in the control group (P<0.05). Conclusions Video-assisted health education has changed the traditional way for health education, It is helpful for nurses to better implement health education program. It is beneficial for patients to strengthen memory. It can improve the perioperative knowledge and the accuracy in rehabilitation nursing skills.

Objective To evaluate the effect of situational health education in pancreatic cancer patients with diabetes mellitus (DM).Methods A total of 60 pancreatic cancer patients with DM was randomly assigned to the control group (n =30) and the study group (n =30).The control group received conventional nursing,while the study group received situational health education.Fasting blood glucose (FBG),2-hour plasma glucose (2 hPG),incidence of complications,average hospital stay and average hospital charges were observed during the perioperative period.Results FPG and 2 hPG were not significantly different between the two groups at baseline (P ＞ 0.05).After intervention,FPG,2 hPG,incidence of complications,average hospital stay and average hospital charges of the two groups were significantly decreased (P ＜ 0.05).FPG and 2 hPG were significantly lower than those of the control group (P ＜ 0.05).The incidence of complications was 6.67％ in the study group,which was lower than 26.67％ of the control group;the average hospital stay was (18.37 ± 4.03)d,which was shorter than (29.70 ± 4.53)d of the control group;the average hospital charges was (31.7 ± 5.5)thousand yuan,which was shorter than(52.1 ± 4.6)thousand yuan;the differences were statistically significant (P ＜ 0.05).Conclusions Situational education could improve glycemic control of pancreatic cancer patients with DM.It could also reduce the incidence of complications,shorten the length of hospital stay and reduce the cost of treatments.

Objective To explore the effect of different blood glucose monitoring frequency on blood glucose fluctuation and control in type 2 diabetes mellitus patients with intensive insulin therapy .Methods One hundred and twenty type 2 diabetes mellitus patients with intensive insulin therapy were chosen and randomly divided into three groups .The three times group received 3 times monitoring including fasting , after breakfast and bedtime , and the five times group received 5 times monitoring including fasting , after breakfast , before supper , bedtime and before dawn , and the eight times group received the 8 times monitoring including before and after every meal , bedtime and before dawn , and the changes of the hemoglobin A 1 c ( HbA1 c) were observed for 4 weeks before and after the treatment .Results The average levels of HbA 1 c in the three groups were decreased 4 weeks after treatment in the three groups , and the difference was not statistically significant ( F=0.301, P>0.05).No difference was found in the fasting blood glucose and blood glucose before supper in the three groups (F=1.450, t=1.760;P>0.05).The levels of blood glucose after breakfast were respectively (8.78 ±0.90), (9.08 ±0.63), (7.49 ±1.01) mmol/L in the three groups, and the level of blood glucose in the eight times group was better than those of the three and five times groups , and the difference was statistically significant (F=23.340,P<0.05).The levels of bedtime blood glucose were respectively (8.07 ±0.59), (8.32 ±0.75), (7.28 ±0.54) mmol/L in the three groups, and the blood glucose fluctuation range in the eight times group was lowest, and the difference was statistically significant (F=32.880, P<0.05).The level of blood glucose before dawn in the eight times group was (6.68 ±0.59) mmol/L, and was better than (7.75 ±0.77) mmol/L in the five times group, and the difference was statistically significant (t=4.170, P<0.01).The average levels of 24 h blood glucose in the three groups were respectively (8.33 ±1.20), (8.26 ± 0.97), (7.84 ±1.15) mmol/L, and the blood glucose control in the eight times group was best , and the difference was statistically significant (F=22.36, P<0.05), and the detection rate of hypoglycemia was 33.3%in the small hours.Conclusions The blood glucose fluctuation range in the eight times group is minimum.The many times blood glucose monitoring in type 2 diabetic patients with intensive insulin therapy , at least 3 times daily, can reduce and prevent the incidence of hypoglycemia .

Objective To explore the clinical feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal othotopic ileal neobladder (TIOIN).Methods A consecutive series of 4 patients (2 male,2 female),who underwent RARC with TIOIN by a single surgeon,were included in the retrospective study,between March 2017 and June 2017.Their age ranged from 59 to 71 years,which the mean age was (65.7 ± 4.9) years.Preoperative urinary CT scan,cystoscopic examination and transurethral resection of bladder tumor were performed for diagnosis.Among these,2 patients underwent side-to-side bowel anastomosis using a linear stapler,while hand-sewn anastomosis was performed in the other 2 patients.The detubularized bowel segment was arranged in a U shape,and then the two medial borders were closed to create the posterior wall of the neobladder,which completed a partial U shape and anastomosed with the end of urethra.After placing the single J stents into the ureter,the uretero-neobladder was anastomosed.To close the urine reservoir,each border of the U-shaped segment was folded again and sutured to form a sealed pouch.Results All operations were performed successfully.The average operation time for RARC was 93.2 min (ranging 79-117 min).The average operation time for urinary diversion was 214.2 min (ranging 163-251 min).The mean estimated blood loss was 304.5 ml (ranging 200-400 ml).The mean hospital stay was 20.5 d (ranging 13-32 day).The number of dissected lymph node ranged from 11 to 16 (mean 3.7 ± 2.6).All the surgical margins were negative.The time for postoperative out-of-bed activity and bowel function recovery was 2-3 days and 3-4 days,respectively.The single-J stents were removed 1 months after operation,generally.No urine leakage was noticed after removing the drainage tube and catheter.The lymph leakage was observed in one case,which was resolved 15 days post-operatively after given nutrient therapy.The performance of urinary continence was satisfactory,except one patient complained about the nocturnal incontinence.After the regular pelvic exercise,the symptom improved two months after the operation.Hydronephrosis and intestinal leakage were not observed.Conclusions Our initial experience showed that RARC with TIOIN is feasible and alterative for experienced surgeon.

Objective:To evaluate the diagnostic value of relative lesion length in differentiating extrahepatic bile duct infiltrating cholangiocarcinoma with inflammation.Methods:From October 2014 to February 2018, 24 cases of infiltrating extrahepatic cholangiocarcinomas confirmed operatively and pathologically and 23 cases of extrahepatic bile duct inflammation confirmed clinically from the Third People′s Hospital of Datong City were respectively enrolled in this study. Upper abdomen MR and/or CT image data of all patients were respectively reviewed. The extrahepatic duct wall was defined as wall thickening with obvious enhancement. The length of the lesion was measured. L lesion/L duct was referred as the ratio of the lengths of lesion to extrahepatic bile duct (common hepatic duct+common bile duct)was calculated. The difference in the average values of L lesion/L ductbetween the cholangiocarcinomas group and inflammation group was analyzed with t test, and the differential diagnostic efficacy of L lesion/L ductratio was analyzed with receiver operating characteristic curve (ROC) test. Results:Significant difference was found in the length of lesion between the extrahepatic cholangiocarcinoma group [(22.01±1.86) mm] and the cholangitis group [(47.36±2.81) mm] ( P<0.01). The average ratio of L lesion/L ductwere 0.26±0.02 for the cholangiocarcinomas group and 0.54±0.03 for the inflammation group, respectively ( P<0.01). The area under the ROC curve of L lesion/L duct in diagnosis of the infiltrating extrahepatic cholangiocarcinomas was 0.92. With <0.40 as cut-off point, the diagnostic sensitivity and specificity were 87.5% and 82.6%, respectively. Conclusion:The L lesion/L ductmight be taken as an important diagnostic sign in differentiation between infiltrating extrahepatic cholangiocarcinomas and extrahepatic bile duct inflammation.

Objective To compare the effects of visual rigid laryngoscope and visual laryngoscope in nasotracheal intubation(NTI)for patients with cervical spine immobilization simulated difficult airway.Methods Ninety patients scheduled for selective surgery under general anesthesia requiring NTI,52 males and 38 females,aged 18-64 years,BMI 18.5-25.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were scheduled for selective surgery under general anesthesia requiring NTI.Before anesthesia induction,the spinal surgeon selected an appropriate cervical collar and adjusted it to fix patient's neck to establishing difficult airway sim-ulation model.All patients were randomly assigned into two groups:visual rigid laryngoscope(group R)and common visual laryngoscope(group C),45 patients in each group.NTI was performed using either visual rigid laryngoscope or visual laryngoscope in groups R and C,respectively.The nasal passage time,glottic exposure time,intubation time,number of successful first intubation attempts,and intubation attempts were recorded.Glottic exposure was assessed using the Cormack-Lehane(C-L)grading system,and the intuba-tion condition was quantitatively evaluated using the modified nasal intubation difficulty scale(NIDS).The blood pressure and heart rate were measured at baseline(T1),immediately after intubation(T2),and at 1 minute(T3)and 3 minutes(T4)after intubation.The occurrence of intubation-related complications(nasal bleeding,sore throat,hoarseness)was recorded.Results Compared with group C,the nasal passage time and proportion of successful intubations without difficulty were significantly increased in group R,and the glottic exposure time and intubation time were significantly decreased in group R(P<0.05).Compared with group C,the HR and MAP at T2 and T3 were significantly decreased in group R(P<0.05).Com-pared with group C,group R had significantly lower incidence rates of nasal bleeding,sore throat,and hoarseness(P<0.05).There were no statistically significant differences in the first intubation success rate,number of intubation attempts,or C-L grade between the two groups.Conclusion Patients with cer-vical spine immobilization simulated difficult airway,both visual rigid laryngoscope and visual laryngoscope can be performed safely and effectively in NTI.Compared with visual laryngoscope,visual rigid laryngoscope can provide faster glottic exposure,shorter intubation time,lower intubation difficulty,less hemodynamic impact,and lower incidence of complications.