Objective To investigate the incidence of autoimmune and nonautoimmune thyroid diseases in patients with breast cancer.Methods Clinical and ultrasound evaluation of thyroid gland,detection of serum thyroid hormone and related antibodies,and fine-needle aspiration of thyroid gland were performed in 100 breast cancer patients and 100 control individuals during the period from 2004 to 2008.Results The mean values of anti-thyroid peroxidase antibodies were significantly higher in breast cancer patients than that in control individuals [(104.56±21.54) U/ml vs (22.16±4.65) U/ml,(P=0.030)].The incidence rates of autoimmune and nonautoimmune thyroid diseases were higher in breast cancer patients than that in control individuals[38 ％ (38/100) vs 17 ％ (17/100),P=0.0009,26 ％ (26/100) vs 9 ％ (9/100),P =0.0016,respectively].Conclusion The results indicate an increased incidence of autoimmune and nonautoimmune thyroid diseases in breast cancer patients.

Objective To investigate a new method of a long term culture for rat islets in vitro. Methods Rat islets marked by green fluorescent protein (GFP) were cocultured with Sertoli cell for 20 weeks. Histological studies were performed on islet group and coculture group in 1w, 3w, 10w, 15w, 20w of culture by light, fluorescent and electron microscopy. Insulin released was measured by radioimmunoassay. Results In islet group, islet viability and the number of insulin positive cells were significantly decreased after 3w of culture, cumulative quantities of insulin for 24 hours and the stimulation index also fell rapidly under this condition, meanwhile the ultrastructure of islets was destroyed. However, under coculture condition, culture time of islets was prolonged in vitro, islet viability and the number of insulin positive cells were significantly increased, cumulative quantities of insulin for 24 hours and the stimulation index maintained at high level, and the ultrastructure of islets remained normal even after 20w of culture. Conclusion Coculture of rat islets with Sertoli cells may promote islet growth and prolong culture time, and it is a new method of a long term culture of islets in vitro.

ObjectiveTo study the teaching method of childbirth turning point and enhances teaching effect in the normal birth of the gynecology and obstetrics department teaching. MethodsAfter carting on the different form the teaching, to 382 students of Qujing medical high school, we carry on the one-to-one skill operation inspection and make the contrastive analysis of the achievement test scores of the students in the experimental group and the control group. Results There is remarkable difference between the conventional experiment teaching and the experiment teaching of adding giant pelvis ( P＜0.01 ). ConclusionThe giant pelvis's application can enhance the teaching effect enormously in the childbirth turning point teaching, and this method has the application and the promoted value.

Purpose To investigate the relation of EGFR and KRAS gene mutations with the pathological characteristics in non-small cell lung cancer (NSCLC).Methods The EGFR and KRAS gene mutations were detected and analyzed in 64 patients with NSCLC by capillary electrophoresis and fluorescent probe method.Results In 64 cases,the EGFR gene mutations were detected in 27 patients (42.2％);the KRAS gene mutations in 8 patients (12.5％).The EGFR and KRAS mutations synchronized in 4 patients (6.25％).The mutations rate of EGFR was related to gender,histology type and smoking condition (P ＜ 0.05).There was no association between mutation of EGFR gene with the age,differentiation,lymph node metastasis and TNM stages (P ＞ 0.05).The mutations rate of KRAS gene was higher in adenocarcinoma patients than that in squamous carcinoma (P ＜ 0.01).There was no relationship between mutation of KRAS gene with the gender,age,smoking condition,differentiation,lymph node metastasis and TNM stages (P ＞ 0.05).Conclusion In NSCLC,EGFR gene mutations rate is higher than KRAS gene mutation.The mutation rate of EGFR gene is higher in female,adenocarcinoma and never smokers;the mutations rate of KRAS mutations is higher in patients with adenocarcinoma.The mutations in EGFR and KRAS can exist at the same time.

Objective To evaluate the reliability of serum catecholamine concentrations in reflecting the depth of dexmedetomidine-based general anesthesia.Methods Forty patients,aged 30-45 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅱ,undergoing elective laparoscopic hysterectomy under general anesthesia,were divided into 2 groups (n =20 each) using a random number table:dexmedetomidine-based general anesthesia group (group Ⅰ) and general anesthesia group (group Ⅱ).Dexmedetomidine was intravenously infused as a loading bolus of 1 μg/kg over 10 min before induction of anesthesia,followed by an infusion of 0.5 μg · kg-1 · h-1 until 30 min before the end of operation in group Ⅰ.The equal volume of normal saline was given instead of dexmedetomidine in group Ⅱ.Anesthesia was induced with iv midazolam 0.05 mg/kg,propofol 1 mg/kg,cisatracurium 0.15 mg/kg and sufentanil 0.4 μg/kg.Anesthesia was maintained with iv infusion of remifentanil 0.1-0.3 μg · kg-1 · min 1,1％-2％ sevoflurane inhalation and intermittent iv boluses of cisatracurium.Before administration of dexmedetomidine,at the end of administration of the loading dose,at the end of intubation,at the end of skin incision,after establishment of pneumoperitoneum and at the end of operation (T0-5),venous blood samples were taken from the peripheral vein for determination of concentrations of epinephrine (E) and norepinephrine (NE) in serum (by enzyme-linked immunosorbent assay).Results Compared with group Ⅱ],the serum NE and E concentrations were significantly decreased at T1-4 in group Ⅰ (P＜0.05).Compared with the baseline at T0,the serum NE and E concentrations were significantly decreased at T1 in group Ⅰ,and increased at T2-4 in group Ⅱ (P＜0.05).Conclusion The serum catecholamine concentration produces poor reliability in reflecting the depth of dexmedetomidine-based general anesthesia,and thus it is not a suitable monitoring index.

Objective:To explore the causes of self-management dilemma in young and middle-aged patients with recurrent acute pancreatitis from the perspectives of nurses, patients and patient caregivers, in order to provide reference for developing self-management intervention plans that meet the needs of patients.Methods:Using the descriptive phenomenological methods from qualitative research, 15 patients with recurrent acute pancreatitis, six nurses and nine caregivers from the Hepatobiliary Pancreatic Surgery Ward of the Second Norman Bethune Hospital of Jilin University from November 2021 to December 2022 were selected for semi-structured in-depth interviews. The Colaizzi 7-step method was used to analyze and refine the theme.Results:Two main themes were extracted to explain the difficulties in self-management of young and middle-aged patients with recurrent acute pancreatitis. The internal reasons for the self-management dilemma included cognitive biases in the importance of self-management, limited access to self-management knowledge and negative attitudes towards self-behavior management, and the external reasons for self-management dilemma included insufficient inclusiveness of the external environment towards diseases, fear of disease progression, multiple burdens caused by diseases and busy work.Conclusions:Young and middle-aged patients with recurrent acute pancreatitis experience multiple difficulties in the process of self-management. Clinical medical staff should explore self-management models with contemporary characteristics, enhance patient self-management ability and quality of life, reduce disease recurrence rate.

Objective:To compare the efficacy and impact on the quality of life of elderly patients of minimally invasive percutaneous nephrolithotomy(MPCNL)and retrograde intrarenal surgery(RIRS)in the treatment of unilateral upper ureteral calculi larger than 1.0 cm in diameter.Methods:A total of 104 patients were prospectively collected from January 2021 to December 2022 in the First Hospital of Shanxi Medical University.Based on the inclusion and exclusion criteria, 88 patients were finally included, 32 patients in the MPCNL group and 56 patients in the RIRS group, and the independent samples t-test, χ2 test, or Fisher's exact probability method were used to compare the differences in the general information, stone characteristics, and intraoperative and postoperative indexes between the two groups, and the quality-of-life scores were applied with the SF-36 Health Survey form. Results:There were no significant differences in age[(67.52±7.41)years and(67.38±7.25)years], gender[male/female: 19/13 cases and 36/20 cases], body mass index[(23.74±2.93)kg/m 2 and(23.70±2.57)], stone location(left/right: 20/12 cases and 38/18 cases), degree of hydronephrosis(mild/moderate/severe: 9/20/3 cases and 16/38/2 cases), stone maximum diameter[(14.12±3.69)mm and(13.34±2.99)mm], stone CT values[(1 035.7±275.7)HU and(973.3±253.8)HU]and postoperative complications[15.6%(5/32)and 14.3%(8/56)]between the two groups of patients( P>0.05).However, there were significant difference in stone clearance rate[96.9%(31/32) vs.80.4%(45/56)], and the operation time[(44.44±9.91)min vs.(54.69±11.94)min]between the two groups.The hospital stay in the RIRS group was shorter than that in the MPCNL group[(5.27±2.27)d vs.(8.00±2.19)d, P<0.05].There was no significant difference in the scores of eight dimensions between the two groups before surgery( P<0.05).At the day of discharge, patients in the MPCNL group had significantly lower mean scores than the RIRS group on six different subscales of the SF-36 questionnaire, namely, physical functioning, role-physical, bodily pain, social functioning, role-emotional and mental health.No differences in the mean scores for general health and vitality between the two groups were noted.In terms of SF-36 scores at one month after operation, the MPCNL group had lower scores in physical pain and social function than the RIRS group and the difference was statistically significant( P<0.05).No differences in the mean scores for other domains at one month after operation between patients undergoing MPCNL and those undergoing RIRS were noted. Conclusions:For patients with unilateral upper ureteral calculi larger than 1.0 cm in diameter, MPCNL has higher stone-free rate and shorter operation time than RIRS, but longer hospitalization time, and MPCNL has a greater impact on the quality of life of patients with ureteral calculi than RIRS in many aspects.

Objective To investigate the association between serum 25(OH)D3 and high sensitive C -reac-tive protein (hs-CRP),tumor necrosis factor -alpha (TNF-α),interleukin-6 (IL-6) inflammatory markers in non-obese patients with type 2 diabetes mellitus (T2DM).Methods From June 2015 to September 2015,in this cross-sectional study,120 non-obese patients with T2DM(female in 58 cases,male in 62 cases) in Taiyuan Central Hospital were selected as T2DM group,and 120 non-obese patients with T2DM and 96 healthy subjects ( control group) were recruited.The serum concentrations of glucose,HbA1c,insulin,25( OH) D3 and inflammatory markers including TNF-α,IL-6 and hs-CRP were measured.A homeostatic model of insulin resistance (HOMA-IR) was also evaluated.The clinical and biochemical characteristics of T 2DM were observed in the group of vitamin D deficien-cy group,vitamin D insufficiency group and vitamin D normal group.And the relativities were analyzed between it with hs-CRP,TNF-α,IL-6,HOMA-IR,INF,FBG,BMI,WHR,and so on.The relativities were observed between 25(OH)D3 with all the factors.Results The mean serum concentration of 25(OH)D3 in the non -obese T2DM group was (10.65 ±3.55)ng/mL,which was significantly lower than (18.44 ±5.21)ng/mL in the normal control group (t＝-6.84,P ＝0.012).The levels of serum TNF -αand IL -6 in the T2DM group were (15.51 ± 4.87)ng/L and (18.12 ±4.13) ng/L,respectively,which were significantly higher than those in the control group [(8.99 ±2.54)ng/L,(8.89 ±2.07)ng/L](t＝7.95,10.04,P＝0.017,0.007).The proportions of deficiency,insufficiency and normal of vitamin D in T2DM patients were 60.83%,31.67%and 7.50%,respectively .The levels of TNF-αand IL-6 in the serum 25(OH) D3 deficiency group were significantly higher than those in the normal 25(OH)D3 group [(17.93 ±4.94)ng/L vs.(10.30 ±4.52)ng/L,F＝6.897,P＝0.026;(20.14 ±4.99)ng/L vs. (16.39 ±5.06)ng/L,F＝10.589,P＝0.017].There was a significant correlation between serum 25(OH)D3 and HOMA-IR(r＝-0.041;P＝0.030),TNF-α(r＝-0.229;P＝0.040) and IL -6 levels (r＝-0.299;P＝0.032),but there was no significant correlation with inflammatory factor hs -CRP and fasting blood glucose. Conclusion Vitamin D deficiency is common in patients with T2DM,and systemic chronic inflammation may also play an important role in the pathogenesis of T 2DM.This study shows that vitamin D may play an important role in the pathogenesis of insulin resistance and chronic systemic inflammatory response,an important pathogenesis of T2DM.

Objective To investigate the incidence of abnormalities and adverse reactions of intrauterine device ( IUD) by three‐dimensional transvaginal ultrasound ,and guide the correct selection of IUD . Methods Female volunteers who came to our hospital for health check‐up from July 2016 to February 2018 were selected as subjects to obtain information of the belt loop time and number of loops . T hree‐dimensional transvaginal ultrasound was used to observe and record the IUD types and positions . T he incidence of location abnormalities ,adverse reactions and cervical lesions of differnet types of IUD were retrospectively analyzed . Results T wo thousand one hundred and thirteen eligible subjects were included in the study ,including 423 cases of McuIUD ,506 cases of circular ring ,405 cases of uterine ring ,372 cases of T‐ring and 407 cases of γ ring . T he statistical analysis showed that the incidence of adverse reactions after wearing rings was as high as 34 .07% ,and the adverse reaction rate of different IUD was different . McuIUD had the highest incidence of adverse reactions ,compared with the circular ring ,the uterine ring ,the T‐ring , and the γ ring ( 47 .99% vs 25 .88% ,27 .41% ,37 .10% ,33 .66% ; all P ＜ 0 .05 ) . Different IUD had different incidence of adverse reactions . T he low back pain rate in McuIUD and γ ring were higher than the other 3 IUDs . T he low back pain rate of McuIUD was higher than the circular ring ,the uterine ring and the T‐ring ( 23 .4% vs 15 .71% ,14 .07% ,13 .7 1% ; all P ＜ 0 .01 ) . Different types of IUD had different incidence of location anomalies . T he descending rate of the circular ring was higher than that of the McuIUD and γ ring ( 6 .32% vs 3 .30% ,3 .19% ; all P＜ 0 .05 ) ,and no statistically significant difference compared with the uterine ring and T‐ring ( 6 .32% vs 3 .45% ,4 .30% ; all P ＞0 .05 ) . T he incarceration rate of the mother ring was higher than that of the circular ring ,uterine ring and T‐ring ( 3 .07% vs 0 ,0 .25% ,0 .54% ;all P ＜0 .01) . T he intrauterine rotation rate of uterine ring and γ ring were higher than that of McuIUD , circular ring and T‐ring ( all P ＜0 .01) . Pregnancy ＞1 and ring times ≥2 were related with the occurrence of adverse reactions of IUD ( P ＜ 0 .05 ) . T he incidence of cervical erosion in the T‐ring was the highest compared with the McuIUD ,circular ring ,uterine ring ,and γ ring ( 30 .65% vs 16 .78% ,16 .80% ,18 .02% , 17 .69% ; all P ＜0 .01) . Conclusions The incidence of adverse reactions is higher in women with different types of IUD . T he incidence of different types of abnormal IUD position is different . T he frequency of pregnancy and band ring are related to the occurence of adverse veactions to IUD .

To evaluate the changes of myocardial viability and systolic function in rabbits with different ischemic periods by layer‐specific strain of ultrasound speckled tracking imaging ( ST I) and low dose dobutamine stress echocardiography ( LDDSE ) . Methods T hirty‐six rabbits were randomly divided into 3 groups( n ＝12) : ①myocardial infarction group Ⅰ :coronary artery occlusion for 45 min ; ②myocardial infarction group Ⅱ :coronary artery occlusion for 60 min ; ③ myocardial infarction group Ⅲ :coronary artery occlusion for 90 min . Echocardiography examinations were performed at baseline ,after ligation and low dose dobutamine stress . After the experiment ,rabbits were killed and the hearts were taken to assess viable or nonviable mycardium , triphenyl tetrazolium chloride and Evans blue staining were applied . Results ①After coronary artery ligation ,left ventricular ejection fraction( LVEF) decreased in 3 groups ( all P ＜ 0 .05 ) , the ventricular global endocardial longitudinal strain ( GSLsys‐endo ) , global myocardial longitudinal strain( GSLsys‐mid) ,and global epicardial longitudinal strain( GSLsys‐epi) decreased in 3 groups ( all P ＜ 0 .05 ) ,the longitudinal strain of endocardium ( SLsys‐endo ) ,longitudinal strain of myocardium ( SLsys‐mid) ,longitudinal strain of epicardium ( SLsys‐epi) decreased in viable myocardial ( all P＜0 .05) ; ②While low dose dobutamine stressing ,the GSLsys and SLsys increased in each groups ,and the GSLsys‐endo ,GSLsys‐mid ,GSLsys‐epi and SLsys‐endo of viable segments in each group were increased ( P＜0 .05) ; ③After ligation and low dose dobutamine stress ,the GSLsys in endocardium in three groups were different( P ＜0 .05) ,and the SLsys in endocardium of viable segments in three groups were different ( P＜0 .05) . Conclusions Layer‐specific strain of STI combined with LDDSE can accurately evaluate the changes of myocardial viability and systolic function in different ischemic periods ,and the longitudinal strain of endocardium is more sensitive ;moreover ,with the increase of coronary artery occlusion time ,the infarcted myocardium increases ,myocardial viability and systolic function decrease .