Objective To investigate the urinary iodine level and the thyroid function of early pregnant women in Qingdao,to explore the relationship between the iodine nutritional status and hypothyroidism.Methods 326 early pregnant women (<12 gestational weeks)were collected.The urinary iodine concentration and serum thyroid stimulating hormone (TSH),free thyroxine (FT4 ),thyroid peroxidase antibody (TPOAb)were detected. Results The median of urine iodine of pregnant women was 176.57μg/L,and the ratios of iodine deficient,iodine adequate,iodine more than adequate and iodine excessive groups were 3 8.65%,41.10%,15.95% and 4.30%.The total ratio of innormal urine iodine was 58.9%(192 /326).The differences between the ratios of the iodine deficient group,iodine excessive group and iodine adequate group both had statistically significant(χ2 =4.308,P <0.05;χ2 =4.826,P <0.05 ).There was no effect of iodine intake levels on serum thyroid peroxidase antibody.Conclusion There is no iodine deficiency among early pregnant women in Qingdao,but still individuals expose iodine deficiency.Iodine deficiency and iodine excessive are the risk factors of hypothyroidism during early pregnancy women,so we commend to detect the urinary iodine level.

Objective To study the influence of intravenous injection of dezocine and fentanyl under general anesthesia on analepsia and analgesia after children appendectomy.Methods 86 children needed peritoneoscope appendectomy were enrolled in the study.All patients were randomized into two groups.The patients in group A were given intravenous injection of dezocine at half an hour before the end of the operation.The patients in group B were given intravenous injection of fentanyl before the end of the operation.The operation length,the postoperative catheter removal time and the heart rate,respiratory rate,mean arterial pressure,blood pressure saturability at the time of stopping using narcotic (T1),the time of catheter removal (T2),10min after catheter removal (T3) of the two groups were observed and recorded.At half an hour after catheter removal,Riker sedation-agitation scale and FLACC of two groups were estimated.Results The heart rate[(112.47±8.06)beats/min,(111.29±9.03)beats/min] and mean arterial pressure[(69.49±7.33)mmHg,(68.72±6.93)mmHg] of group A at T2,T3 were significantly lower than those of group B[heart rate: (126.98±7.24)beats/min,(131.54±8.62)beats/min and mean arterial pressure: (76.81±5.18)mmHg,(72.05±3.76)mmHg, heart rate tT2=3.294,tT3=5.018;mean arterial pressure tT2=4.029,tT3=2.287,all P<0.05].Besides,the FLACC score[(3.62±0.73)points] and Riker score[(2.93±0.75)points] of group A at half an hour after catheter removal were significantly lower than those of group B[(5.06±0.92)points,(3.96±1.17)points,tFLACC=6.390,tRiker=2.119,all P<0.05].Conclusion Intravenous injection of properdezocine at half an hour before the end of the operation has good postoperative analgesia effect for children appendectomy and children wake up in a more stable state,and the occurrence rate of postoperative analgesia and adverse reaction is low, so it has less influence on cardiovascular reaction and is applicable for clinical application.

Objective To evaluate the accuracy of vasopressin (VP) secretion in the late phase of septic shock for predicting patient outcomes and further investigate its relationship with the prognosis of septic shock.Methods Fifty-five patients presented at late phase of septic shock,who were admitted to the intensive care unit of our hospital,were enrolled.Their VP secretion was measured.The method for measurement was as follows:3％ sodium chloride solution 600 ml was infused over 2 h,serum concentrations of VP and sodium were measured before and after infusion,the difference in VP before and after infusion (△VP) and in Na before and after infusion (△Na) was calculated,and △VP/△Na was used to reflect VP secretion.The patients were divided into either abnormal secretion of VP group (△ VP/△ Na ≤ 0.5 ng/mmol) or normal secretion of VP group (△VP/△Na＞0.5 ng/mmol) according to △VP/△Na ratio.Immediately before testing VP secretion,venous blood samples were collected for determination of serum lactic acid and C-reactive protein concentrations.The consumption of vasoactive drugs at the moment of enrollment and 28-day fatality rate were recorded.Results There were 30 cases in abnormal group (54％) and 25 cases in normal group (46％).Compared with normal group,the serum lactic acid,C-reactive protein concentrations and consumption of dopamine or norepinephrine were significantly increased,and the 28-day fatality rate was increased (67％ vs 40％) in abnormal group.ROC curve analysis showed that when △VP/△Na 0.5 ng/mmol was used as the criteria for determining prognosis,the sensitivity was 66.7％,specificity was 64.0％,and the area under the ROC curve was 0.828.Conclusion VP secretion in the late phase of septic shock may affect patient prognosis.

Objective To evaluate the effect of rhubarb on intestinal mucosal damage in septic rats by comparing with ulinastatin.Methods A total of 84 healthy Sprague-Dawley rats (half male,half female),aged 3 months,weighing 200-330 g,were randomly divided into 5 groups according to the random number table:control group (group C,n =6),sham operation group (group S,n =6),sepsis group (group Sep),rhubarb group (group R,n=24) and ulinastatin group (group U,n=24).Sepsis was induced by cecum ligation and puncture.In group R,rhubarb 1.2 g/100 g was dissolved in normal saline at room temperature,3 and 4 h later the filtrate about 2-3 ml was obtained and injected through a gastric tube into stomach once every 12 h,and 72 h later sepsis was induced.In group U,ulinastatin 50 000 U/kg (in 2 ml of normal saline) was injected once every 24 h,and 72 h later sepsis was induced.In Sep,R and U groups,at 6,12,24 and 48 h after ligation (T1 4),blood samples were collected from the orbital venous plexus for determination of plasma diamine oxidase (DAO) activity.Results The activity of plasma DAO was significantly higher at T1-4 in Sep,R and U groups than in C and S groups.The activity of plasma DAO was significantly lower at T3,4 in R and U groups than in Sep group.There was no statistical difference in the plasma DAO activity between R group and U group.Conclusion Rhubarb can reduce intestinal mucosal damage in septic rats,which is similar to that of ulinastatin.

Objective To investigate the vasopressin (VP) response to increasing osmotic pressure in the late-phase of septic shock patients.Methods Thirty-seven septic shock patients hospitalized in intensive care unit (ICU) of the First Hospital of Hebei Medical Unive~ity from January 2012 to September 2013 were enrolled.All patients received 3％ hypertonic saline solution infusion.Serum concentrations of VP and sodium were measured before and after hypertonic saline solution infusion.Patients with ratio of difference in VP and sodium before and after infusion of 3％ hypertonic saline (△VP/△Na) ≤0.5 pg/mmol were defined as nonresponders,and who ＞0.5 pg/mmol defined as responders.The age,acute physiological and chronic health evaluation Ⅱ (APACHE Ⅱ) score,blood pressure,albumin level,vasoactive drug between the two groups were also analyzed.Results VP level in the nonresponsive group (n=20,54.05％) was markedly lowered before (ng/L:10.41 ± 1.70 vs.18.25 ± 5.90,t=5.29,P＜0.01) and after (ng/L:11.36 ± 1.90 vs.24.33 ± 5.46,t=9.33,P＜0.01) 3％ hypertonic saline solution infusion,compared with that in the responsive group (n =17,45.95％).All patients in the two groups were given dopamine (DA) or norepinephrine (NE) for maintaining blood pressure,and the dose in the nonresponsive group were higher than those in the responsive group [DA (μg· kg-1· min-1):14.91 ± 3.78 vs.8.64 ± 1.69,t =-5.02,P＜ 0.01 ; NE (μg· kg-1· min-1):1.03 ± 0.48 vs.0.38 ± 0.12,t=-3.12,P＜0.01].Three patients were given DA plus NE in the nonresponsive group while patients in the responsive group received only single drug therapy.The age,APACHE Ⅱ score,blood pressure,albumin level,sodium level before and after hypertonic saline solution infusion between the two groups were not statistically different.Conclusion VP secretion to osmotic challenge was impaired and decreased in the late-phase of septic shock,prompting dysfunction in VP synthesis.

Objective To investigate the prognostic value of decreased vasopressin (VP)modulation in the late-phase of septic shock. Methods A prospective study was conducted. Fifty-five septic shock patients hospitalized in intensive care unit (ICU)of the First Hospital of Hebei Medical University from January 2012 to February 2014 were enrolled. All patients received 3% hypertonic saline solution infusion. Serum concentrations of sodium and VP were measured before and after hypertonic saline solution infusion. Patients with ratio of difference in sodium and VP before and after infusion of 3%hypertonic saline (△VP/△Na)≤0.5 pg/mmol were defined as non-responders,and who>0.5 pg/mmol were defined as responders. The levels of lactic acid,C-reactive protein (CRP),and vasoactive drug〔dopamine(DA)and norepinephrine(NE)〕usage between the two groups were compared. The 28-day mortality,live time in the dead,and ICU day in survivors were analyzed between the two groups. The receiver operating characteristic curve (ROC curve)was drawn to assess prognostic value of VP. Results There were 30 cases (54.5%) in non-responsive group,and 25 (45.5%)in responsive group. There were no significant differences in the age,acute physiology and chronic health evaluationⅡ (APACHEⅡ)score,central venous pressure (CVP),blood pressure, plasma albumin level,sodium level before and after hypertonic saline solution infusion between the two groups. The baseline level of VP in the non-responsive group was markedly lower than that of the responsive group (ng/L:10.66± 1.57 vs. 17.13 ±5.12,t=6.091,P<0.001). After hypertonic saline solution infusion,the VP level was also significantly decreased compared with that in the responsive group(ng/L:11.65±1.74 vs. 22.50±5.31,t=9.758,P<0.001). The non-responders showed higher lactic acid (mmol/L:3.04±0.55 vs. 2.28±0.38,t=-5.881,P<0.001) and CRP (mg/L:117.9±23.0 vs. 94.9±17.0,t=-4.143,P<0.001),and received larger dosage of vasoactive drugs〔DA(μg·kg-1·min-1):14.8±3.9 vs. 8.9±1.6,t=-5.725,P<0.001;NE(μg·kg-1·min-1):0.96±0.42 vs. 0.40± 0.09,t=-5.625,P<0.001〕for maintaining blood pressure compared with those in responders. The non-responsive group showed higher 28-day mortality(66.7%vs. 40.0%,χ2=3.911,P=0.048)and longer ICU day(days:9.9±2.3 vs. 6.7±1.7,t=-4.044,P<0.001),but the live time in the dead showed no difference between non-responsive group and responsive group(days:5.8±1.9 vs. 6.1±2.3,t=0.384,P=0.704). ROC curve showed that the area under ROC curve(AUC)forΔVP/ΔNa predicting the outcome was 0.828,and theΔVP/ΔNa threshold value of 0.5 pg/mmol had the sensitivity of 66.7%and specificity of 64.0%for prediction of the outcome(95%confidence interval:0.722-0.934). Conclusion Osmotic pressure-regulated VP secretion was impaired and decreased in the late-phase of septic shock, and made the sense in prognosis.

Objective To compare the effects of four different analgesic techniques on hyperglycemia and stress response to abdominal hysterectomy so as to select a more reasonable analgesic model. Methods Forty-eight patients were randomly divided into four groups: groupⅠreceived 0.2% ropivacaine+fentanyl 2 ?g/mL+ 0.008% ondansetron for PCEA; groupⅡreceived fentanyl 8 ?g/mL+ 0.008% ondansetron for PCIA; groupⅢ received 0.2% ropivacaince+tramadol 2 mg/mL+0.008% ondansetron for PCEA and groupⅥ received tramadol 8 mg/mL+ 0.008% ondansetron for PCIA. The four groups all included loading dose of 5 mL, bolus of 1mL with lock time of 10 minutes and background 1 mL/h. The level of blood glucose, insulin and cortisol were observed at five points: before anesthesia, at 2nd hour, 24th hour, 48th hour and 72th hour after the end of surgery. Results All the four analgesic techniques produced satisfactory pain relieve. Hyperglycemia was inhibited more efficiently in groupⅠand group Ⅲ than in groupⅡ and groupⅥ(P

Objective To explore the expression level of Ki67 and its correlation with clinicopathological types and prognosis of patients with breast cancer.Methods Clinical data of 93 patients with breast cancer and 20 patients with benign breast diseases were collected from Jan.2013 to Dec.2015,and the correlation between Ki67 and pathological parameters and laboratory parameters were analyzed.Results Among the 93 patients with breast cancer,the Ki67 index was 1% to 90%,with median of 21.65%.Ki67 index was correlated with tumor grade,tumor size and human epidermalgrowth factor receptor-2(HER2,P<0.05).However,Ki67 index was without correlation with age,menopausal status,tumor TNM stage,lymph node metastasis,estrogen receptor(ER) and progesterone receptor(PR,P>0.05).Ki67 index of patients with triple negative breast cancer,patients with non-triple negative breast cancer and patients with benign breast diseases were 30.15%,20.26% and 4.67%,which were with significant difference(P<0.04).Ki67 index was also related to the breast cancer subtypes(P<0.05),and serum potassium and hematocrit levels of patients with breast cancer(P<0.05).Conclusion Ki67 index could be used for the diagnosis,treatment and prognosis of patients with breast cancer.

Objective:To analyze the prenatal clinical characteristics and genetic etiology of Wolf-Hirschhorn syndrome manifested by severe fetal growth restriction (FGR).Methods:Clinical data of three pregnant women admitted to Changsha Hospital for Maternal and Child Health Care from 2018 to 2020 due to severe FGR with or without other malformations diagnosed by prenatal ultrasound were collected. Amniotic fluid samples obtained by ultrasound-guided amniocentesis were analyzed by conventional G-banding staining technique and single nucleotide polymorphism array (SNP array). Parental peripheral blood cells were collected for SNP array to verify the source of variation.Results:(1) The karyotypes of both case 1 and 2 were normal, while case 3 had an abnormal karyotype of 46,XN,der(4)(9pter→9p23::4p15.31→4qter). (2) SNP array indicated a 7.8 Mb microdeletion in 4p16.3p16.1 cytoband in case 1 and a 5.5 Mb microdeletion in 4p16.3p16.2 cytoband in case 2, which were both de novo copy number variations. Case 3 harbored a 19.88 Mb deletion in 4p16.3p15.31 and a 10.89 Mb duplication in 9p24.3p23. (3) All three fetuses were diagnosed as Wolf-Hirschhorn syndrome, and their parents chose to terminate the pregnancies after genetic counseling. Conclusions:Considering the possibility of genetic disease, invasive prenatal diagnosis is suggested when prenatal ultrasonography showed severe FGR, regardless of other malformations, to clarify the cause and guide genetic counseling.

Objective To study the effective sterilization method of laparoscopic instruments. Methods Using 2 different methods to sterilize the same laparoscopic instruments,and then compared the effects of sterilization. Results The bactericial rate of the 2 methods were both 100%. Conclusion The Huiri sterilizing method only need 40 minutes,which fits the requirement of one by one operation.