Objective To evaluate the features of ultrasound and elastography of chronic lymphocytic thyroiditis (CLT) with different thyroid functions,analyze the course of the disease and provide a basis for clinical treatment.Methods A total of 77 patients with CLT were retrospectively analyzed in the Department of Ultrasound,Fourth Affiliated Hospital of Harbin Medical University from September 2013 to September 2014.The patients were divided into four groups based on thyroid function,including 20 patients with hyperthyroidism,18 patients with hypothyroidism,20 patients with subclinical hypothyroidism,and 19 patients with euthyroidism.According to 6 indicators consisted of the thyroid size (volume,thickness of the lateral lobe,thickness of the isthmic portion),flow classification(0,Ⅰ,Ⅱ,Ⅲ),the peak systolic velocity (PSV) of the superior thyroid artery(STA),resistance index (RI) of the STA,echo types (diffuse,localized) and ultrasound elastic rate (E2/E1),the features of ultrasound and elastography of CLT were analyzed.According to the thyroid echo types and different thyroid functions,the change of E2/E1 was analyzed and the relationship between E2/E1 in different thyroid function and thyroid function (thyroid stimulating hormone,TSH) was compared.Results The volume,thickness of the lateral lobe of hypothyroidism,subclinical hypothyroidism,hyperthyroidism and euthyroidism groups were respectively as follows:(14.25 ± 4.15),(11.79 ± 3.22),(9.84 ± 2.63),(5.61 ± 1.35) ml and (2.35 ± 0.27),(2.15 ± 0.24),(1.97 ± 0.16),(1.62 ± 0.22) cm,and the differences between different groups were statistically significant (F =27.77,35.56,all P ＜ 0.05).The thickness of the isthmic portion was respectively as follows:(0.53 ± 0.09),(0.47 ± 0.06),(0.44 ± 0.06),(0.38 ± 0.06) cm,and the differences between different groups were not statistically significant (F =14.76,P ＞ 0.05).The PSVs were respectively as follows:(50.53 ± 10.61),(42.93 ± 7.81),(64.96 ± 12.20),(34.74 ± 6.05) cm/s,and the differences between different groups were statistically significant (F =36.06,P ＜ 0.05).The RIs were respectively as follows:0.59 ± 0.04,0.60 ± 0.02,0.63 ± 0.02,0.60 ± 0.02,and the differences between different groups were not statistically significant (F =7.66,P ＞ 0.05).Patients with euthyroidism had Color Doppler Flow Imaging (CDFI) pattern 0 (52.6％,10/19).Patients with subclinical hypothyroidism had CDFI pattern Ⅰ (60.0％,12/ 20).Patients with hypothyroidism had CDFI pattern Ⅱ (66.7％,12/18).Patients with hyperthyroidism had CDFI pattern Ⅲ (55.0％,11/20).The thyroid gland echo in CLT groups was mainly diffuse hypoechoic pattern (62.3％,48/ 77).Focal hypoechoic pattern and diffuse hypoechoic pattern without heterogeneous linear hypoechoic were mainly seen in the groups of hyperthyroidism and euthyroidism (66.7％,26/39).Diffuse hypoechoic pattern with heterogeneous linear hypoechoic and nodular changes were mainly seen in the groups of hypothyroidism and subclinical hypothyroidism (86.9％,33/38).The E2/E1 in focal hypoechoic pattern,diffuse hypoechoic pattern without heterogeneous linear hypoechoic pattern,diffuse hypoechoic pattern with heterogeneous linear hypoechoic and nodular changes were by turns:1.30 ± 0.48,1.68 ± 0.38,1.97 ± 0.55,2.27 ± 0.63,and the differences between different groups were statistically significant (F =32.47,P ＜ 0.05).The E2/E1 in hyperthyroidism,euthyroidism,subclinical hypothyroidism,and hypothyroidism were by turns:1.12 ± 0.50,1.69 ± 0.12,2.21 ± 0.20,2.45 ± 0.32,and the differences between different groups were statistically significant (F =64.54,P ＜ 0.05).The correlation coefficient between E2/E1 and serum TSH was 0.742,which was significant (P ＜ 0.01) in different thyroid function groups.Conclusions CLT with different thyroid functions has different features of ultrasound and elastography.E2/E1 can reflect the hardness of the thyroid parenchyma to a certain extent,and assess the thyroid function and the course of the disease,can prevent the occurrence of hypothyroidism early.

Objective To evaluate the effectiveness of clinical rotation training in pain department for general practitioner.Methods Totally 31 general practitioners of 3 years program in the First Affiliated Hospital of Chongqing Medical University were involved in clinical rotation training in pain department form August 2008 to December 2011.Training lasted for one month.Clinical rotation training in pain department was conducted for general practitioners by studying rules and regulations,treatment methods,imaging data and clinical practice.Evaluation was made according to the treatment,theoretical knowledge,interpersonal skill and professional competency of general practitioners.Measurement data were expressed as mean ± standard deviation ((-x) ± s) while enumeration data were expressed as rate.Descriptive analysis of the data was used.Results Average total number of patients managed by 31 general practitioners was (15 ± 2),average total number of disease species was (5 ±2),average number of case discussion and small lecture participated was 1 ～2,average number of nerve block participated as assistant was (40 ± 5) and average number of minimally invasive surgery visited and studied was (2 ± 2).Residency duties were skillfully completed and assessment score was (85 ± 4.50).Conclusions Through clinical rotation training,general practitioners can understand common disease diagnosis and treatment category; familiarize clinical evaluation methods and master standards of diagnosis and treatment in pain department.Meanwhile,they would learn doctor-patient communication to establish a good therapeutic relationship with patients.

the incidence of the complication.

OBJECTIVETo study the chemical constituents of the rhizomes of Smilax ferox which was widely used in the folk.

METHODThe constituents of the rhizomes of S. ferox were isolated and purified by repeated silica gel column, MCI column, Sephadex LH-20 column and RP C18 column chromatography, and their structures were elueidated on the basis of spectral analysis.

RESULTSix compounds were identified as dihydrokaempferol (1), kaempferol (2), astilbin (3), engeletin (4), resveratrol (5), beta-sitosterol (6), respectively.

CONCLUSIONAll compounds were obtained from this plant for the first time.

Plant Extracts ; analysis ; isolation & purification ; Rhizome ; chemistry ; Smilax ; chemistry

Objective To explore the application value of ultrasound elasticity index ratio and elasticity index methods in differential diagnosis of different sizes of benign and malignant thyroid nodules.Methods Clinical examination data of patients who were hospitalized for thyroid nodules were collected and were retrospectively analyzed in the Fourth Affiliated Hospital of Harbin Medical University from January 2015 to January 2016.The elasticity index ratio and elasticity index were used to diagnose benign and malignant thyroid nodules,and the results were compared with pathological diagnosis.The thyroid nodules were fell into three groups according to the maximum long diameter:＜ 1,1-2,and ＞ 2 cm.Using the above two methods,the sensitivity,specificity and accuracy were analyzed in benign and malignant thyroid nodules with different sizes.And the receiver operating characteristic curve (ROC) was drawn.Results A total of 90 patients (108 nodules) were enrolled in the study and they were from thyroid nodular surgery,28 male cases,62 female cases,mean age (44.1 ± 11.5) years,and ranged from 20 to 69 years old.Seventy benign nodules and 38 malignant nodules were diagnosed with pathology.Sixtythree benign nodules and 45 malignant nodules were diagnosed via the ultrasound elasticity index ratio method.Compared with the pathological diagnosis,13 were misdiagnosed and 6 were omission diagnosed in malignant thyroid nodules.Sixty-three benign nodules and 45 malignant nodules were diagnosed via the ultrasound elasticity index method.Compared with the pathological diagnosis,16 were misdiagnosed and 9 were omission diagnosed in malignant thyroid nodules.Sensitivities of elasticity index ratio method in ＜ 1,1-2,and ＞ 2 cm groups were 91.7％,86.0％,and 75.0％;specificities were 88.9％,78.6％,and 79.2％,and accuracies were 90.0％,81.0％,and 77.8％;and differences in sensitivity and accuracy of the two methods were statistically significant (x2 =76.4,70.8,P ＜ 0.05).Sensitivities of elasticity index method in ＜ 1,1-2,and ＞ 2 cm were 83.3％,78.6％,and 66.7％;specificities were 83.3％,75.0％,and 75.0％,and accuracies were 83.3％,76.0％,and 72.2％.Differences in sensitivity and accuracy of the two methods were statistically significant (x2 =82.8,74.5,P ＜ 0.05).The area under the ROC curve of elasticity index ratio and of elasticity index was 0.814 and 0.766,respectively,and the difference was statistically significant (Z =0.896.P ＜ 0.05).Conclusions In the differential diagnosis of different sizes of benign and malignant thyroid nodules,the elasticity index ratio method is better than the elasticity index method.The diagnostic value on ≤ 2 cm nodules is higher.

OBJECTIVETo profile the clinicopathologic features of a series of grey zone lymphoma (GZL) cases with hybrid features of diffuse large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma (CHL), with a purpose to gain an in-depth understanding of the borderline B-cell neoplasm.

METHODSThe clinical, morphologic and immunophenotyical characteristics of 16 cases were retrospectively analyzed.

RESULTSThe patients were mostly male adults, with a male to female ratio of 1.7: 1.0 and a mean age of 40.2 years. Eight patients presented with peripheral nodal lesions and five cases with mediastinal involvement. Histologically and immunophenotypically, the 16 cases were classified into three sub-categories. In 4 cases, the morphologic features resembled CHL more closely, but the neoplastic cells showed uniform and intense positive staining of CD20 (pattern 1). Although the initial impression of the other 8 cases was that of DLBCL, the expression levels of CD20 and PAX5 were variable, and CD30 or CD15 was positive (pattern 2). A characteristic feature of pattern 3, observed in the remaining 4 cases, demonstrated a broad spectrum of morphology with hybrid features of both CHL and DLBCL. The neoplastic cells in pattern 3 were positive for CD20, CD30 and CD15. EBV-LMP1 was detected in 6 of the 11 tested cases. Clinically, most patients with GZL seemed insensitive to immuno-chemotherapy of the R-CHOP regimen.

CONCLUSIONSThe diagnostic criteria for GZL with features intermediate between DLBCL and CHL is proposed by the three histologic patterns commonly seen in these lesions. Cases presented with peripheral lesions might differ from those with mediastinal presentation pathologically. At current time, there is no effective treatment for these borderline B-cell lymphomas and the prognosis is poor.

Adolescent ; Adult ; Aged ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antigens, CD20 ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Diagnosis, Differential ; Doxorubicin ; therapeutic use ; Female ; Hodgkin Disease ; drug therapy ; metabolism ; pathology ; Humans ; Ki-1 Antigen ; metabolism ; Lewis X Antigen ; metabolism ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; metabolism ; pathology ; Male ; Middle Aged ; PAX5 Transcription Factor ; metabolism ; Prednisone ; therapeutic use ; Prognosis ; Retrospective Studies ; Rituximab ; Vincristine ; therapeutic use ; Viral Matrix Proteins ; metabolism ; Young Adult

Objective:To investigate the adult thyroid structural abnormalities and epidemiological characteristics in different regions of Heilongjiang Province.Methods:From December 2017 to November 2018, 30 survey sites were selected in 13 prefecture-level cities under the jurisdiction of Heilongjiang Province by the population probability sampling (PPS) method, and 120 local residents aged 20 to 70 who lived for more than 1 year in the local area were selected from each survey site for thyroid ultrasound examination. The occurrence of thyroid structural abnormalities in different genders, ages and regions were analyzed.Results:A total of 3 870 residents were investigated, including 1 248 males and 2 622 females, aged (48.3 ± 12.6) years; 2 075 urban residents and 1 795 rural residents. A total of 2 144 cases of thyroid structural abnormalities were detected, with a total detection rate of 55.40% (2 144/3 870); among them, 1 476 cases of thyroid focal nodular lesions, 359 cases of diffuse lesions, and 309 cases of diffuse lesions with focal nodules, the detection rates were 38.14%, 9.28%, and 7.98%, respectively. The detection rate of thyroid structural abnormalities was 61.25% (1 606/2 622) in women and 43.11% (538/1 248) in men, the difference was statistically significant (χ 2=111.899, P < 0.01). There was significant difference in the total detection rate of thyroid structural abnormalities among different age groups (χ 2=185.959, P < 0.01); and with the increase of age, the total detection rate of thyroid structural abnormalities showed an upward trend (χ 2trend=173.576, P < 0.01). There was significant difference in the total detection rate of thyroid structural abnormalities in adults among different prefecture-level cities (χ 2=108.487, P < 0.01); but there was no significant difference in the total detection rate of thyroid structural abnormalities between urban and rural (χ 2=0.103, P > 0.05). Conclusions:The main thyroid structural abnormalities in Heilongjiang Province are focal nodular lesions. The detection rate of women is higher than that of men, and the older the age, the higher the detection rate. There are differences in the detection rate of thyroid structural abnormalities in adults of different prefecture-level cities, but there is no significant difference between urban and rural.

OBJECTIVE: To identify phytochemical constituents present in the extract of flowers of Xanthoceras sorbifolia and evaluate their anti-oxidant and anti-hyperglycemic capacities. METHODS: The AlCl₃ colorimetric method and Prussian Blue assay were used to determine the contents of total flavonoids and total phenolic acids in extraction layers, and the bioactive layers was screened through anti - oxidative activity in vitro. The Waters ACQUITY UPLC system and a Waters ACQUITY UPLC BEH C₁₈ column (2.0 mm × 150 mm, 5 μm) were used to identify the ingredients. And anti-oxidative ingredients were screened by off-line UPLC-QTOF-MS/MS-free radical scavenging. The ameliorative role of it was further evaluated in a high-fat, streptozotocin-induced type 2 diabetic rat model and the study was carried out on NADPH oxidase (PDB ID: 2CDU) by molecular docking. RESULTS: Combined with the results of activity screening in vitro, the anti - oxidative part was identified as the ethyl acetate layer. A total of 24 chemical constituents were identified by liquid chromatography-mass spectrometry in the ethyl acetate layer and 13 main anti-oxidative active constituents were preliminarily screened out through off-line UPLC-QTOF-MS/MS-free radical scavenging. In vivo experiments showed that flowers of X. sorbifolia could significantly reduce the blood glucose level of diabetic mice and alleviate liver cell damage. Based on the results of docking analysis related to the identified phytocompounds and oxidase which involved in type 2 diabetes, quercetin 3-O-rutinoside, kaempferol-3-O-rhamnoside, isorhamnetin-3-O-glucoside, and isoquercitrin showed a better inhibitory profile. CONCLUSION The ethyl acetate layer was rich in flavonoids and phenolic acids and had significant anti-oxidant activity, which could prevent hyperglycemia. This observed activity profile suggested X. sorbifolia flowers as a promising new source of tea to develop alternative natural anti-diabetic products with a high safety margin.