Subacute thyroiditis can cause destruction of thyroid follicles and subsequent transient thyrotoxicosis.In cases of simultaneous occurrences of subacute thyroiditis and Graves' disease,the former may be missed and thus may further exacerbate thyrotoxicosis.Herein,we report in detail a case with abrupt onset of thyrotoxic heart disease when taking anti-thyroid medications,in order to call attention to the diagnosis and treatment of concomitant Graves' disease and subacute thyroiditis.

Objective To evaluate the accuracy of air column width difference (ACWD) between inflation and deflation of the cuff of the endotracheal tube (ETT) in predicting post-extubation stridor (PES).Methods A total of 102 intubated patients of both sexes and all ages,who were mechanically ventilated for ≥24 h in the intensive care unit,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,were enrolled in the study.After the patients were in a stable condition and recovered consciousness and myodynamia,they were weaned from the ventilator,and ultrasound examination of the larynx was performed to determine ACWD between ETT cuff inflation and deflation.PES was assessed using blinding nethod after extubation,and the patients were divided into 2 groups depending on whether or not the patients developed PES:PES group (group P) and non-PES group (group N).Results There were 94 patients in group N and 8 patients in group P.Compared with group N,ACWD was significantly decreased in group P (P＜ 0.05).The cut-off value of ACWD determined by the receiver operating characteristic curve was 1.65 mm,the sensitivity and specificity of ACWD were 0.830 and 0.750,respectively,and the area under the receiver operating characteristic curve was 0.801.Conclusion For the intubated patients who are mechanically ventilated for ≥24 h in an intensive care unit,ACWD between ETT cuff inflation and deflation＜ 1.65 mm can effectively predict PES.

This paper introduces the nursing care of two children with type 1 diabetes during continuous glucose monitoring. In addition to psychological care,diet instruction and insulin therapy,the nurses actively communicated with the children and their parents,introduced the principle and advantages of continuous glucose monitoring system (CGMS) to promote the children and parents to cooperate with the medical staff. Moreover,the insert site of CGMS was changed from inferior abdomen to up-per lateral buttock according to the physiological character of children. As a result,the CGMS was completed successfully in the 2 eases,which provided reliable reference for the regulation of treatment plan.

To investigate the relationship between serum glutamic acid decarboxylase antibody (GAD-Ab)titer and the first-phase insulin release (1PH)in newly-diagnosed type 2 diabetic patients. 1053 newly-diagnosed type 2 diabetic patients were divided into 3 groups, including 71 individuals with GAD-Ab≥1 U/ml (positive group), 171 individuals with GAD-Ab ranging from 0 to 1 U/ml (negative-1 group), and 811 individuals with GAD-Ab=0 (negative-2 group). IPH was evaluated by arginine stimulation test. In the patients of negative-2, negative-1, and positive groups, the respective values of 1 PH were subsequently decreased significantly (P< 0. 01) , and the detection rates of the decreased insulin secretion were 74. 85%, 87. 13%, and 100%, respectively. Stepwise regression analysis indicated that disease duration, GAD-Ab titer, HbA_1C, and body mass index were the major independent contributing factors. The titer of GAD-Ab has an important impact on 1PH defect in type 2 diabetic patient. Detection of GAD-Ab not only provides an evidence for clinical type, but would also be helpful in determining the islet β-cell function.

Objective To analyze the association of blood uric acid level with the severity of coronary artery stenotic changes, metabolic syndrome (MS), and its components. Methods A total of 343 individuals ( male 223,female 120) who underwent coronary angiography and had complete data on MS and serum uric acid were collected. The severity of coronary artery disease (CAD) was assessed by the coronary stenesis index (CSI). MS was diagnosed according to the Guideline on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. Results (1)The mean uric acid level was significantly lower in women than in men [ ( 306.3±76.9 vs 358.9±85.2 ) μmol/L, P＜0.01 ]. The prevalence of MS and its components showed no difference between men and women. (2) The uric acid level in women with 3 components was higher than those with1( P＜0. 01 ) or 2 ( P＜0.05 ) components of metabolic disorders, but not in men. (3) Quartiles of concentration of uric acid were computed. Compared with those in the lowest quartile of uric acid, women in the highest quartile had higher CSI score [ 7.0 (2.5-12.0) vs 2. 0( 0.0-6.0), P= 0. 025 ]. Moreover, the uric acid level was higher in women with multivessel lesions than nonCAD patients [ (327.0±81.9 vs 284.9±78.6) μmol/L, P = 0.033 ]. However, no correlation was found between uric acid level and the severity of coronary artery lesion in men. (4) Logistic regression showed that age (β=0.042, P=0. 007) and dyslipidemia(β=0.836, P=0. 037 ) were the independent risk factors of CAD in men, and hypertension(β=1. 127, P=0.039) and dyslipidemia(β=0.901, P=0.009)in women. Conclusions In women with higher uric acid level, the clustering of metabolic abnormalities was increased, and the coronary artery lesion was more severe. High uric acid level might be a marker of CAD for women.

Objective To analyze the clinical characteristics of coronary artery disease (CAD) in patients with nonalcoholic fatty liver disease ( NAFLD). Methods Totally 234 subjects underwent coronary angiography, including 148 men and 86 women with complete data on metabolic syndrome ( MS) and abdominal ultrasonography; the mean age was 66. 6 years. The severity of CAD was assessed by coronary stenosis index (CSI). Metabolic syndrome was diagnosed according to the Guideline on Prevention and Treatment of Blood lipid Abnormality in Chinese Adults. Results Ultrasonography revealed that 62 patients had NAFLD (26. 5%). In patients with NAFLD, the prevalence of central obesity was higher than those without NAFLD (75. 8% vs 50. 0% , P< 0.01). With regards to age, CAD patients with NAFLD were more common in patients under 60 years (27.4% vs 13.7% , P=0.005). CSI score was similar in CAD subgroup and CAD & NAFLD subgroup (P>0.05), however the age of patients in CAD & NAFLD subgroup was significantly lower compared to CAD subgroup ( P = 0.006). According to the results of logistic regression, central obesity was the independent risk factor of NAFLD (β= 1.701, P<0.001). Logistic regression demonstrated that age was independently associated with CAD (β = 0.032, P=0.027). Further more, multiple stepwise regression analysis showed that age was the single parameter that best predicted CSI score (β= 0. 125, P = 0. 022). Conclusions It is important to screen coronary artery disease in middle aged patients with central obesity or NAFLD.

Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.

OBJECTIVETo evaluate the best cut-off point, sensitivity and specificity of body mass index (BMI), waist circumference (WC) and Waist-to-hip ratio (WHR) in predicting of abdominal visceral obesity.

METHODSAbdominal visceral fat area (VA) was measured with magnetic resonance image (MRI) in 690 subjects (men: 305, women: 385). Meanwhile, BMI, WC, WHR were assessed. Receiver operating characteristic (ROC) curve was used as index for analysis.

RESULTS1) 61.7% of over-weight/obesity (OW/OB) and 14.2% of normal weight (NW) individuals were abdominal visceral obesity (VA >/= 100 cm(2)) by MRI diagnosis. 2) VA was significantly positively correlated with anthropometric variables (BMI, WC, WHR), in which WC was the best (r = 0.73 - 0.77, P < 0.001). 3) The best cut-off points of these anthropometric parameters in assessing abdominal visceral obesity were as follow: BMI: 26 kg/m(2), WC: 90 cm, WHR: 0.93. Among them WC showed most sensitive and specific. 4) 95% men and 90% women appeared abdominal visceral obesity in subjects with BMI >/= 28 kg/m(2) or WC >/= 95 cm.

CONCLUSIONBMI, WC, WHR can all predict abdominal visceral obesity, with WC the best.

Adipose Tissue ; metabolism ; Adult ; Aged ; Aged, 80 and over ; Body Constitution ; Body Mass Index ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Obesity ; metabolism ; physiopathology ; Predictive Value of Tests ; Sensitivity and Specificity

OBJECTIVE: To compare the hemostatic efficacy and safety of endoscopic band ligation(EBL) and endoscopic hemoclip placement(EHP) for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract. METHODS: Between February 2004 and October 2006, 34 patients with Dieulafoy lesions in the upper gastrointestinal tract were prospectively enrolled,including 22 cases of lesions in the stomach,10 in gastrointestinal stoma,and 2 in duodenal, who were randomly assigned to undergo EBL (n=16) or EHP (n=18). The therapeutic results of these 2 groups were compared. RESULTS: The median number of O-ring or hemoclip required in the EBL group and the EHP group was similar. The rate of primary haemostasis,recurrent bleeding,transfer into surgery, complications, and average stay and blood transfusion requirements did not significantly differ in the 2 groups (P>0.05). CONCLUSION In this study, no significant differences are detected in the efficacy and the safety of EBL vs. EHP for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract.
Adult ; Aged ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastric Mucosa ; surgery ; Gastrointestinal Hemorrhage ; surgery ; Hemostasis, Endoscopic ; methods ; Humans ; Ligation ; methods ; Male ; Middle Aged ; Prospective Studies ; Surgical Instruments

The case-based teaching was inserted in the lecture-based teaching in clinical microbiol-ogy. The teachers conducted the case-based teaching through proper selection of cases, leading students to discuss and analyze cases. The students explored and reported from the cases independently. Finally, the teachers summarized and evaluated from the case-based teaching. The combination of case-based teaching and lecture-based study stimulated the students' interest in learning and motivation, consolidated their theoretical knowledge, cultivated their abilities of self-learning and clinical idea, and made the correlation between the theory and the clinical practice closely. These methods improved the teaching quality of clinical microbiology.