Objective:To investigate the effect of homocysteine (Hcy) on peripheral vascular plaque formation in patients with type 2 diabetes mellitus (T2DM) combine subclinical hypothyroidism (SCH), and to provide guidance for clinical medication and prognosis judgement.Methods:A total of 125 patients with type 2 diabetes admitted to the NO.3201 Hospital from 2018 Jan to Dec 2019 were selected. 125 patients with type 2 diabetes mellitus were divided into T2DM without plaque group (40 cases), plaque group (23 cases), T2DM with SCH without plaque group (25 cases) and plaque group (37 cases) according to thyroid function and whether they had peripheral vascular plaque. Data were collected to analyze the influencing factors of peripheral vascular disease.Results:(1) The incidence of vascular plaque in T2DM group and T2DM with SCH group was 36.5%(23/63) and 59.7%(37/62), respectively, with significant difference ( P<0.05). (2) There were significant differences in serum thyroid stimulating hormone (TSH), apolipoprotein A (ApoA), triglyceride (TG) and Hcy between T2DM group and T2DM with SCH group ( P<0.05); there was significant difference in low-density lipoprotein (LDL-C) and Hcy between T2DM groups with or without plaque ( P<0.05); there were significant differences in ApoA and Hcy between T2DM with SCH group with or without plaque ( P<0.05). (3) Logistic regression analysis showed that Hcy was the risk factors for the occurrence of vascular plaque in T2DM and T2DM with SCH group ( OR=1.640, 2.695, P<0.05). (4) Receiver operating characteristic (ROC) curve showed that the area under the curve of Hcy in T2DM group was 0.842 and Youden index was 15.75 μmol/L; The Hcy's area under ROC curve was 0.945 and Youden index was 12.9 μmol/L in T2DM with SCH. Conclusions:Hcy is closely related to the presence of peripheral vascular plaque in T2DM patients with subclinical hypothyroidism. The detection of blood Hcy level can provide new ideas for early diagnosis and treatment of peripheral vascular lesions in T2DM patients with SCH.

Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.MethodsFrom Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification.Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months.No necrosis of humeral head appeared and 30 (83.3％) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.

Objective To observe the pathologic type and degree of traumatic recurrent anterior dislocation of the shoulder by means of arthroscopy and discuss clinical results of modified Bristow method and arthroscopic Bankart reconstruction so as to provide refeFences for selecting operation methods.Methods A retrospective study was done off 62 patients(62 shoulders,44 males and 18 females.at av-erage age of 39.8 years.ranging from 21 to 67 years)with anterior recurrent dislocation of shoulder (mean duration of 87 months)admitted into our hospital from July 1997 to Oetcher 2007.All patients un-derwent preoperative arthroscopic examination that showed pathologic changes including injury of shoulder and humerus head,Bankart injury severity and laxitas of humerus glenoid ligament of articular capsule,which were used as referenee of surgical procedures.Modified Bristow's method or arthroscopic suture anchor Bankart reconstruction were performed according to arthroscopic results(pathologic change).The patients were assessed with the University of California at Los Angeles(UCLA)shoulder rating scale.Results There were 45 patients treated with modified Bristow,s method and 17 with arthroscopic suture anchor Bankart reconstruction.The follow.uD for mean 64.2 months showed that pre-and post-operative mean UCLA scores were(22.6±4.4)points and(29.8±4.2)points respectively(P＜0.01),the mean forward flexion(136.8±14.2)°and(156.6±17.8)°respectively(P＜0.01)and the mean ex-ternal rotation in 90°abduction(52.5±16.4)°and(72.4±11.3)°(P＜0.01).There were no redis-location at final follow-up,but there were 6 patients(9.6%)with positive apprehension test.Of all,60 patients(97%)returned to their pre-injury.work. Conclusions Observation of pathologic change of surgical procedure.Both modified Bristow's method and arthruscopic Bankart reconstruction are good methtxts for treatment of recurrent anterior shoulder dislocation under conditions of successful management of pathologic change of shoulder, restoration of normal anatomic structure of shoulder ioint and strict indi-cation control.

4-Hydroxycoumarins ; blood ; Animals ; Chromatography, High Pressure Liquid ; methods

usions DCUS could initial estimate the pathological typing of advanced gastric caner before operation.

Objective To evaluate clinical value of double contrast-enhanced ultrasonography(DCUS)in diagnosing gastric stromal tumors(GST). Methods The medical records of 26 patients with a histological diagnosis of GST were retrospectively reviewed. The correlation between DCUS features and pathological findings of the lesions was compared. Results Total 26 cases of GST were divided into low risk group( 16 cases) and high risk group (10 cases). The size,contour,liquefactive necrosis and enhancement distribution of lesions were markedly correlated with the pathobiologic behaviour of the tumor ( P ＜0.05). There was no significant difference in border and metastasis of lesions between two groups( P ＞0.05). It was shown that DCUS supplied statistically significant improvement in the localization diagnosis and detection of liquefactive necrosis versus oral contrast-enhanced ultrasonography ( P ＜ 0.05 ). Conclusions DCUS is considered as a valuable tool in diagnosing location as well as pathobiological behaviour of GST. It can provide the guidance and reference comments for treatment algorithms.

Objective To study the interobserver variabilities and the differential diagnosis value of Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-US) lexicon for small ( ≤ 2 cm) breast nodules. Methods Between January 2009 and December 2011, 289 patients with small (≤2 cm) breast nodules (n=317) were included. According to sizes, the lesions were divided into two groups, i.e., 0-1 cm (n=160) group and 1-2 cm (n=157)group. Each lesion was described independently by 3 radiologists using BI-RADS-US lexicon. Interobserver variabilities were assessed by Kappa test. Chi-square test was used to compare the frequency difference of the descriptors between malignant and benign lesions. Sensitivity, speciifcity, accuracy, positive predictive value and negtive predictive value were calculated. Results (1)Moderate agreements were obtained for lesion shape, orientation, margin, echo pattern, surrounding tissue and calciifcations (κ=0.44, 0.57, 0.48, 0.43, 0.51 and 0.57) in 0-1 cm group. Substantial agreements were obtained for lesion shape, orientation, margin and echo pattern (κ=0.65, 0.61, 0.64 and 0.63) in 1-2 cm group. (2)Irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo and microcalciifcations were more frequently found in malignant nodules than in benign nodules in 0-1 cm group [52.3% (34/65) vs 20.0% (19/95), 38.5%(25/65) vs 13.7%(13/95), 75.4%(49/65) vs 32.6%(31/95), 18.6%(12/65) vs 0 (0/95) and 10.8%(7/65) vs 2.1%(2/95);χ2=18.19, 13.08, 28.22, 16.39 and 3.95;P=0.000, 0.000, 0.000, 0.000 and 0.047]. Similarly, irregular shape, non-parallel orientation, non-circumscribed margin, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were signiifcantly more frequent found in malignant nodules than in benign nodules in 1-2 cm group [74.2%(49/66) vs 12.1%(11/91), 36.3%(24/66) vs 5.5%(5/91), 93.9%(62/66) vs 22.0%(20/91), 37.9%(25/66) vs 3.3%(3/91), 30.3%(20/66) vs 7.7%(7/91), 15.2%(10/66) vs 0 (0/91) and 16.7%(11/66) vs 4.4%(4/91);χ2=62.59, 24.21, 79.40, 31.22, 13.73, 12.30 and 6.67;P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000 and 0.010]. (3)In both groups, a good sensitivity was demonstrated (75.4%&93.9%) when using the non-circumscribed margin as a criterion for malignancy, and high speciifcity was achieved in two groups (80.0%-100%and 87.9%-100%) when other descriptors including irregular shape, non-parallel orientation, echogenic halo, shadowing, changes of Cooper′s ligament and microcalciifcations were used as differentiation criteria. Conclusions Good interobserver agreement can be achieved using the BI-RADS-US lexicon in the diagnosis of small breast nodules. Non-circumscribed margin are proved as the most valuable sign for screening malignant breast lesions ≤ 2 cm. High speciifcity was found for irregular shape, nonparallel orientation, echogenic halo, shadowing, Cooper′s ligament changes and microcalciifcations, which can help biopsy and preoperative diagnosis.

Objective To identify Anaplasma species circulating among livestock and rodents from Xitianmu Mountain area in Zhejiang province , Southeastern China and to analyze variations regarding to their 16S rRNA gene.Methods Samples of spleen, liver and blood were collected to extract DNAs .The 16S rRNA gene fragments of Anaplasma species were amplified by using a nested PCR and then sequenced .Ho-mology analysis was conducted by using BLAST program .The multiple sequence alignment and phylogenetic analyses comparing with the sequences of other Anaplasma species in GenBank were conducted by using MEGA 5.0 software.Results The 16S rRNA gene fragments of Anaplasma were detected in 1 cattle, 8 goats, 5 Rattus confucianus, 1 Apodemus agrarius, 1 Berylmys bowersi and 1 squirrel out of 129 animals. The natural infection rate of Anaplasma was 13.2% in animals from Xitianmu Mountain area in Zhejiang . The alignment and phylogenetic analyses indicated that there were at least four Anaplasma species prevalent in livestock and rodents from Xitianmu Mountain area , including Anaplasma phagocytophilum, Anaplasma marginale, Anaplasma centrale and Anaplasma bovis.Moreover, there was a variant that obviously differed from Anaplasmma bovis and other Anaplasma sp.in GenBank.Conclusion The Anaplasma infection was detected among livestock and rodents from Xitianmu Mountain area in Zhejiang province .A newly discovered variant in rodents was likely to be a novel species .More close attention should be paid to Anaplasma infec-tion among human in Xitianmu Mountain area .

Objective To survey bacterium pollution state on the surface of medical equipment maintenance tools,and thenobserve the disinfection effect of ozone.Methods Totally 30 medical equipment maintenance tools including screwdriver,hexagona wrench and multimeter from certain hospital were placed in ozone disinfection cabinet,and then disinfected by ozoneup to 5 minutes.Samples on the surface of tools were collected by cotton swabs before and after disinfection,cultured for 48hours in 37 ℃,and then the bacterial colony counts were measured and analyzed,and pathogenicity bacteria were identified.The pollution couditions on kinds of tools were compared.Results The surface of the tools was polluted severely,bacterialcolony counts of which before disinfection reached (132.68±37.02) cfu/cm2,and decreased to (6.44±1.08) cfu/cm2 after 5-minutes' disinfecting.There was statistically significant difference in the bacterial counts before and after the disinfection (P＜0.01),and the inactivation ratio was up to 95.15％.Pathogenicity bacteria such as staphylococcus aureus and escherichia coliwere detected before the disinfection,and killed after that.The bacteria counts were significantly different in the three kindsof tools,and the screwdriver gained the highest count while the multimeter had the lowest one.Conclusion The surface ofmedical equipment maintenance tools is polluted by bacteria severely,including some pathogenicity bacteria,and should be disinfected regularly.Ozone can kill bacteria rapidly,and the tools can achieve sanitary standard after 5-minutes' ozone disinfecting.

'Social beings' model of standardized training program for residents in Shanghai is one of the important measures in the health care reform. According to the requirements of the standardized training of residents in thoracic surgery, the article preliminarily explored the standardized training model for residents from four aspects such as individualized treatment of different professional backgrounds, focus-ing on the training needs of residents with different starting point of social beings, developing training programs for different training time and combining the master's degree graduate education. And based on the characteristics of thoracic surgery, it also summed up the past experience and explored the clinical practice teaching.