Objective To evaluate the value of CT and MRI in diagnosis and directing clinical management of vertebral burst fracture.Methods The imaging features of vertebral burst fracture in 66 cases were analyzed,including cervical vertebrae 6,thoracic vertebrae 3,thoracolumbar area 48,and lumbar vertebrae 9 cases.There were 50 male and 16 female,the average age was 35 years.CT and MRI were taken in all patients.Results CT clearly demonstrated the vertebrae and accompanying appendix fracture,spinal canal stenosis and retropulsed fragment.While MRI in showing injury and tear of ligament and intervertebral disc,abnormal signals due to spinal cord compression were superior to CT.Conclusion CT in combination with MRI in diagnosis and directing surgical management is of important value.

ObjectiveTo survey the incidence of depression in rheumatoid arthritis (RA) and explore the related factors.MethodsOne hundred and fifty-nine patients with RA were investigated.All of them were assessed by depression scale and Hamilton Depression Rating Scale.A mono-variate and multivariate Logistic regression analysis were carried out to determine the factors that best related to the occurrence of depression in RA.ResultsThe overall incidence rate was 39.6％.The regression analysis showed that factors related to the occurrence of depression in RA were HAQ-DI (OR=3.276,95％CI 1.315-7.814,P=0.003),the number of tender joints (OR=2.252,95％CI 1.117-3.362,P=0.029),low-income families (OR=1.629,95％CI 1.215-2.437,P=0.031 ) and serum CRP level (OR=1.528,95％CI 1.112-2.294,P=0.040).ConclusionDepression is common in patients with RA.Patients who havehigh HAQ-DI,CRP and from low-income families with more tender joints tend to develop depression.

OBJECTIVE: To investigate the value of combination of thyroid imaging reporting and data system (TI-RADS) and enhanced flow (e-Flow) in the qualitative diagnosis of thyroid nodules; and to compare the diagnostic efficiency between e-Flow and color doppler flow imaging (CDFI. METHOD: The study chose 133 patients with 179 nodules (127 benign, 52 malignant nodules) who had per-operative ultrasound examination of their thyroid using grey-scale ultrasound, CDFI, e-Flow, and their noudles were graded by TI-RADS. Then the ultrasound diagnostic value were compared with their surgical pathology results by TI-RADS; TI-RADS and CDFI; TI-RADS and e-Flow, and diagnostic efficiency between e-Flow and CDFI were compared. RESULT: The results revealed that combination of TI-RADS and e-Flow had a higher sensitivity (94.23%, P < 0.05). There was no statistically significant difference between TI-RADS and the combination of TI-RADS and CDFI. Likewise, there was no significant difference between the combination of TI-RADS and e-Flow and the combination of TI-RADS and CDFI. The e-Flow showed a higher sensitivity, specificity and accuracy compare to the CDFI. CONCLUSION Combining e-Flow and TI-RADS could improve the sensitivity in qualitative diagnosis of thyroid nodules. Also, e-Flow has a better diagnostic efficiency of thyroid nodules.
Diagnosis, Differential ; Diagnostic Imaging ; Humans ; Sensitivity and Specificity ; Thyroid Nodule ; diagnosis ; diagnostic imaging ; Ultrasonography

Objective To investigate the iodine nutritional status in the key populations before and after the adjustment of salt iodine content in Yantai of Shandong.Methods In 2010 (the pre-adjustment period) and 2014,2015 (the post-adjustment period),the changes in the residents' iodized salt,the goiter prevalence and urinary iodine of children aged 8-10,the urinary iodine of pregnant women,and the iodine content of drinking water before and after the adjustment were analyzed.Results The coverage rate of iodized salt and the edible rate of qualified iodized salt were 98.27％ and 97.28％,respectively before the adjustment of salt iodine content,and 97.44％ and 96.14％ after the adjustment.The mean of salt iodine after the adjustment (21.96 mg/kg) was significantly lower than that of 2010 (31.45 mg/kg,t =66.29,P ＜ 0.05).The goiter prevalence of children aged 8-10 by thyroid palpation was 0.92％ in 2010,while it was 1.89％ by ultrasonic in 2014,2015.There was significant difference in the iodine nutritional status of children in 2010 (191.0 μg/L) and in 2014,2015 (173.0 μg/L,Z =3.56,P ＜ 0.05).The difference of iodine nutritional status in pregnant women between pre-adjustment (154.0 μg/L) and post-adjustment (130.4 μg/L) was also significant (Z =5.54,P ＜ 0.05).The median of water iodine was 5.4 μg/L after the adjustment.There were 52 towns with medians of water iodine below 10 μg/L.Conclusions The coverage rate of iodized salt and the edible rate of qualified iodized salt have all met the national standard before and after the adjustment of salt iodine content.The mean of salt iodine during 2014,2015 is significantly lower than that of 2010.Before and after the adjustment,the goiter rates of children aged 8-10 are all below 5％.The adjustment of salt iodine content is more suitable to children aged 8-10 than to pregnant women currently.It is suggested that pregnant women eat more foods rich in iodine.

Objective To study the clinical features of congenital glucose-galactose malabsorption (CGGM),and to improve the understanding of CGGM.Method Clinical manifestations and treatment process of one patient with CGGM in our hospital were retrospectively analyzed.From 1966 to 2016 May,Chinese medical database and PUBMED were searched using Malabsorption syndrome,dehydration,hypernatremia , diarrhea , newborn , carbohydrate metabolism ,andglucose/galactose malabsorption as key words.The clinical features of CGGM reported in literatures were summarized.Result The patient in our hospital was a full-term female infant naturally delivered.The onset of the disease was on the 9th day after birth,and the clinical manifestations included severe diarrhea,severe dehydration,hypernatremia,metabolic acidosis and malnutrition.After intravenous infusion and symptomatic treatment,dehydration,hypernatremia and metabolic acidosis were corrected.However,there was no improvement of diarrhea characterized with watery and acidic stools,and neither was weight gain.Glucose loading test was negative,and fructose loading test was positive.Diarrhea was improved markedly using diagnostic carbohydrate-free formula,so CGGM was diagnosed clinically.SLC5A1 homozygous IVS7-2 A ＞ G mutation was detected which confirmed the diagnosis of CGGM.With carbohydrate-free formula feeding,the body weight of the infant was increased.Followed up for 2 months now,her body length and body weight were at P25 and P22 on growth curve respectively,and no obvious neurological sequela was observed.Our literature review revealed 7 reports including 48 cases of CGGM children.Literature review showed that:most children with CGGM (79.2％) had the onset within 7 days of life;main clinical features included diarrhea (100％),dehydration (100％),and malnutrition (54.2％);22.9％ of patients with carbohydrate-free formula and 27.1％ with fructose matrix formula were fed well;no death was detected,77.1％ had normal weight gain,and 91.7％ had normal development of the nervous system.Conclusion CGGM is rare.The symptoms include severe watery and acidic stools with onset during neonatal period.CGGM is associated with severe complications such as hypertonic dehydration and hypernatremia.The diagnosis is established based upon typical clinical manifestations,sugar loading test and SLC5A1 gene detection.Carbohydrate-free formula feeding is effective.

Objective To compare remifentanil?propofol target?controlled infusion ( TCI ) with sufentanil?propofol TCI for sedation and analgesia in the patients undergoing local anesthesia. Methods Sixty patients, aged 17?54 yr, with body mass index <30 kg∕m2, scheduled for elective plastic surgery underlocal anesthesia, were equally and randomly divided into remifentanil group (group R) and sufentanil group(group S) by using a random number table. Remifentanil (the initial target plasma concentration 1?? 0ng∕ml) and propofol (the initial target plasma concentration 1?? 0 μg∕ml) were given by TCI in group R.Sufentanil (the initial target plasma concentration 0?? 10 ng∕ml) and propofol (the initial target plasma con?centration 1?? 0 μg∕ml) were given by TCI in group S. The target plasma concentration was adjusted to main?tain the modified Observer′s Assessment of Alertness∕Sedation Scale score of 2 or 3. The occurrence of painresponses, hypoxemia, bradypnea and∕or apnea was recorded during operation. The total amount of propofolconsumed was calculated. Results There was no significant difference in the incidence of pain response,hypoxemia, bradypnea and∕or apnea, and total amount of propofol consumed between the two groups (P >0?? 05). Conclusion Remifentanil?propofol TCI provides similar sedative and analgesic efficacy to that a?chieved by sufentanil?propofol TCI in the patients undergoing local anesthesia.

Objective To evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL), retrograde ureterolithotripsy(URSL) and percutaneous ureterolithotripsy(PCL) in the treatment of proximal ureteral calculi. Methods A total of 397 patients with proximal ureteral calculi treated by ESWL,URSL or PCL ftom September 2001 to December 2005 were retrospectively analyzed. Results Among 397 patients,83 patients with a mean stone size of 1.23 cm were treated by ESW L.Of then.13 patients transferred to URSL or ureterolithotomy and the stone-free rate of ESWL 1 month later was 65.7%(46/70).TWO hundred and thirteen patients with a mean stone size of 1.21 cm were treated by URSL and 101 patients with a mean stone size of 1.50 cm were treated by PCL.The stone-free rate of URSL and PCL 1 month after the treatment was 88.2%(172/195)and 96.9%(95/98),respectively.Eighteen patients in URSL group and 3 patients in PCL group trans-ferred to ureterolithotomy.ESWL had a statistically lower stone-free rate than that of URSL and PCL (P＜0.001),both in patients with stone size≤1 cm and＞1 cm.For patients with stone size＞1 cm,PCL achieved a higher stone-free rate than URSL(P=0.005).PCL also had a higher stone-free rate than URSL in treating patients with stone size≤1 cm but there was no statistical difference between them. Conclusions ESWL can still be used as first-line treatment choice for proximal ureteral stones less than 1cm.For patients with proximal ureteral stones larger than 1cm.URSL and PCL are more proper treatment modalities since they can achieve higher stone-free rate and have acceptable low complications.

Objective To investigate the independent factors influencing the efficacy of pre-hospital CPR effect. Method The data base with 1376 cases was set up with EpiData software by means of questionnaires and the information was provided by the survivals from cardiopulmonary arrest( CA)saved with cardiopulmonary resuscitation(CPR), and the data were analyzed with SPSS 13.0 software to carry out binary logistic regression. Through single factor analysis, the factors with emerged statistical significance were chosen as variances. Results With regard to the restoration of spontaneous circulation(ROSC), the rescue did by the first witness was the protective factor(PF)( OR = 2.21, P = 0.001, 95.0% CI=1.356-3.602); the male was the risk factor(RF) contrasted with the female( OR = 0. 515, P =0. 006, 95.0%0 CI = 0.320 - 0. 26) ; ages between 20 and 29 years old had higher likelihood of ROSC than group ≥81 years old( OR = 3.241, P = 0.026, 95.0%CI = 1.146 -9.138); the length of CA time before CPR was RF(OR = 0.913, P = 0.000, 95.0%CI = 0.887-0.948);ventricular fibrillation(VF) was PF compared with asystole( OR = 5.092, P = 0.000, 95.0%CI=2.927 -8.861); electric shock was PF(OR = 3.384, P = 0.000, 95.0%CI = 2.033 - 5.635); epinephrine dosage 0 - 4 mg had higher likelihood of ROSC than > 5 nag dosage( OR = 3. 255, P = 0. 001, 95.0% CI = 1. 606 -6.597). In respect of probability about victims at the tittle reached hospital alive, ages of 2- 12 and 13 - 19 years old had higher rations than ≥81 years old( OR = 12.818, P = 0.029, 95.0% CI = 1.299 - 126.508)( OR = 10.505, P = 0.036, 95.0% CI = 1.161-95.058); the length of CA time before CPR was RF(OR =0.862, P = 0.000, 95.0%CI = 0.821-0.906); VF was PF compared with asystole(OR = 7.330, P =0.000, 95.0%CI = 3.962 - 13.560). Conclusions ECG change before CPR, rescue by the first witness,electric shock, the length of CA time before CPR, epinephrine dosage, gender and age were independent influencing factors of pre-hospital CPR for the emergency of ROSC. Age, the length of CA time before CPR and ECG before CPR were influencing factors of pre-hospital CPR for patients at the time transferred to hospital alive.

OBJECTIVETo screen for FOXL2 gene mutations in 6 patients with blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES), and explore their genotype-phenotype correlation.

METHODSPeripheral venous blood samples were collected from the patients for the extraction of genomic DNA. PCR and Sanger sequencing were employed to analyze the coding region and flanking sequences of the FOXL2 gene. Pathogenicity of the identified mutations was verified through literature review and bioinformatic analysis.

RESULTSA heterozygous c.672_701dup30 mutation was found in the probands from the two familial cases, while three heterozygous mutations (two were novel), namely c.462_468del (p.Pro156Argfs*113), c.251T to A (p.Ile84Asn) and c.988_989insG (p.Ala330Glyfs*204) were detected in the three sporadic cases. Literature review and bioinformatic analysis indicated that all these mutations are pathogenic.

CONCLUSIONIdentification of causative mutations in the BPES patients has provided a basis for genetic counseling and reproductive guidance. The novel mutations have enriched the mutation spectrum of the FOXL2 gene.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Blepharophimosis ; diagnosis ; genetics ; China ; Female ; Forkhead Box Protein L2 ; Forkhead Transcription Factors ; genetics ; Genetic Association Studies ; Humans ; Male ; Molecular Sequence Data ; Pedigree ; Skin Abnormalities ; diagnosis ; genetics ; Urogenital Abnormalities ; diagnosis ; genetics ; Young Adult

OBJECTIVETo analyze the clinical features and mutation of MUT gene in a Chinese patient with isolated methylmalonic acidemia.

METHODSThe clinical characteristics and laboratory tests data were collected. Genomic DNA was extracted from peripheral blood leukocytes. The 13 exons and their flanking sequences of the MUT gene were amplified with polymerase chain reaction and subjected to direct DNA sequencing.

RESULTSThe patient has featured failure to thrive, lethargy, seizure, hypotonia, severe ketoacidosis and hyperammonemia. Tandem mass results showed reduction of multiple acylcarnitine. Urine organic acid testing showed pronounced increase in methylmalonate excretion. Homocysteine was normal. The patient showed no response to vitamin B12 treatment. The above results suggested that the patient had isolated methylmalonic acidemia. DNA sequencing analysis confirmed that the patient has carried two MUT gene mutations, c.755dupA and a novel mutation c.944dupT.

CONCLUSIONInherited metabolic disease screening plays an important role in the diagnosis of clinical diseases. However, to confirm the results will need gene mutation analysis.

Amino Acid Metabolism, Inborn Errors ; enzymology ; genetics ; Base Sequence ; Female ; Humans ; Infant, Newborn ; Methylmalonyl-CoA Mutase ; genetics ; Molecular Sequence Data ; Mutation