Objective To assess the value of ultrasound elastography (UE) in the differential diagnosis of benign and ma‐lignant breast masses.Methods Clinical data of 180 female patients with breast masses were collected. A total of 180 masses in these patients were detected by ultrasound (US) and UE to primarily identify the benign or malignant masses before surgery. The diagnostic coincidence rate and values of ROC curve were compared based on the postoperative pathologic results between the two diagnosis methods.Results Forty‐eight benign masses and 127 malignant masses were correctly diagnosed by UE ,and 38 benign masses and 112 malignant masses by US. The sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive value were higher in UE group than in US group ,and there were significant statistical differences (P<0.05 for all). Furthermore ,the value of area under the ROC curve (AUC) in UE group was 0.926 ,significantly higher than that in US group (0.899) (Z=2.8 ,P<0.05).Conclusion UE has the advantages of high sensitivity ,specificity and accuracy in differential di‐agnosis of the nature of breast masses. In terms of some disadvantages of UE ,UE should be combined with US in the diagnosis of benign and malignant breast diseases.

Hearing Loss ; complications ; diagnosis ; metabolism ; Humans ; Multiple Acyl Coenzyme A Dehydrogenase Deficiency ; complications ; diagnosis

Objective To analyse the effect of octreotide combined with compound coenzyme on Th17/CD4 +CD25 +Foxp3 + regulatory T cells imbalance in patients with purulent appendicitis.Methods 150 patients with acute suppurative appendicitis were randomly divided into experimental group and control group, 75 cases in each group.Patients of two groups underwent appendicitis laparoscopic resection, then the control group were given conventional treatment and experimental group were given subcutaneous injection of octreotide on the basis of conventional treatment.Th17, CD4 +CD25 +Foxp3 +regulation T cells ( Treg) , and Th17 /Treg balance were analyzed.ResuIts Compared with control group, Th17/Treg imbalance of experimental group recovered better: the proportion of Th17, Treg, and Th17/Treg ratio decreased (P<0.05); the expression levels of related transcription factor, RORγt and Foxp3 mRNA decreased (P<0.05); serum cytokine (IL-4, IL-6, IL-10, IL-17, IL-23 and TGF beta) and C-reactive protein (CRP) content decreased (P<0.05);serum interferon gamma (IFN-gamma) content increased (P<0.05).ConcIusion Octreotide combined with compound coenzyme could correct Th17/Treg imbalance in suppurative appendicitis patients, improve the immune function of patients and affect the prognosis of patients.

OBJECTIVE: To investigate the pure tone audiometry characteristics and curative effect in sudden hearing loss patients with hypertension. METHOD: One hundred and fifty-seven inpatients (168 ears) with hypertension suffered from sudden hearing loss were included in this study. We retrospectively analyzed the audiological index of these patients by comparing the pure tone audiometry (PTA) among patients in the aspects of gender, age, affected side, duration of hypertension, with or without inducement, concomitant symptoms and other combined diseases. The hearing threshold at different frequency was also compared, as well as the curative effect among patients with diverse audiological characteristics. RESULT: Of the contemporaneous sudden hearing loss patients (874 cases), the prevalence of hypertension was 17.96%, where the male ones accounted for. 28.69% (103/359) and the female ones accounted for 19.42% (54/278) respectively with statistically significant difference between genders (P < 0.01). The prevalence of hypertension in 34-44 years old group, 45-49 years old group, 60-69 years old group and over 70 years old group was 12.69% (25/197), 22.51% (70/311), 47.62% (40/84), 48.89% (22/45) respectively, which were statistically different (P < 0.01). The number of impaired ears with audiogram configuration characterized by rise type, downslope type, flat type and completely deafness type was 18 (10.71%), 61 (36.31%), 41 (24.40%), and 48 (28.57%), respectively. The decrease of hearing threshold in PTA were increasingly severe as the increasing impaired-frequency, and the difference of the degree of hearing impairment among these three types of frequencies was statistically significant (P < 0.01). The hearing threshold means of each frequency had no significant difference among patients with various gender, age and Cardiovascular Risk Stratification (P > 0.05). The hearing threshold means of each frequency of unilateral hearing loss patients was significantly higher than that of bilateral hearing loss patients (P < 0.05). The hearing threshold means at 125 Hz, 250 Hz, 500 Hz and 1 kHz showed significant difference among patients with different duration of hypertension (P < 0.05). The total effective rate of sudden hearing loss in patients with hypertension was significantly lower than that in the sudden hearing loss patients without hypertension (19.64%, 61.57% respectively, P < 0.01). The total effective rate presented significant difference among patients with different duration of hypertension and different Cardiovascular Risk Stratification (P < 0.05). CONCLUSION The prevalence of sudden hearing loss in hypertension patients was higher in male than in female, which rose with age and combined disease. The hearing threshold means at mid-frequency and high-frequency were higher than that at low-frequency. The total effective rate of sudden hearing loss was relatively low in patients with hypertension. The longer the duration of hypertension and the higher the Cardiovascular Risk Stratification, the lower the total effective rate. Comprehensive understanding of audiological characteristics and hypertension condition plays a crucial role in type-specific treatment of sudden hearing loss.
Adult ; Aged ; Audiometry, Pure-Tone ; Deafness ; Female ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; complications ; Hearing Loss, Unilateral ; Hearing Tests ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

OBJECTIVE: The aim of this retrospective study was to analyze the recovery rate of sudden sensorineural hearing loss in children, and explore the prognostic factors in order to guide the clinical diagnosis and treatment. METHOD: A retrospective review was conducted for the prognosis of children with sudden sensorineural hearing loss during the past 5 years (from November 2010 to May 2015) in Chinese PLA General Hospital. This paper have a complete clinical data of 101 patients (113 ears)with sudden hearing loss, ranging from 0 to 18 years old Patients were divided into four groups according to hearing recovery and eight putative prognostic factors were analyzed. RESULT: Among 101 patients (113 ears), the ratio of male and female was 60:53. Treatment was initiated from 1 to 183 days after disease onset, with an average of (18.5 ± 22.1) d. Bilateral and unilateral hearing loss were 24 ears and 89 ears, respectively. The proportion of mild hearing loss, moderate hearing loss, severe hearing loss and profound hearing loss were 7.1%, 6.2%, 23.9% and 62.8%, respectively. Vertigo and tinnitus occurred in 54.9% and 77.9% of the patients, respectively. After the treatment, the complete recovery rate was 9.7% and the overall recovery rate was 36.3%. The degree of hearing loss, earlier treatment onset, sex and bilateral involvement were significantly associated with hearing recovery (P < 0.05). CONCLUSION Sudden sensorineural hearing loss in children was generally identified as severe and profound hearing loss, but after positive and timely treatment, it can be improved or even cured. The mild hearing loss, earlier treatment onset, unilateral hearing loss and female were positive prognostic factors. The concurrence of tinnitus or vertigo, the results of ABR and DPOAE had no significant influence on prognosis.
Adolescent ; Child ; Child, Preschool ; Female ; Hearing Loss, Sensorineural ; diagnosis ; Hearing Loss, Sudden ; diagnosis ; Hearing Loss, Unilateral ; diagnosis ; Hearing Tests ; Humans ; Infant ; Infant, Newborn ; Male ; Prognosis ; Retrospective Studies ; Tinnitus ; complications ; Vertigo ; complications

OBJECTIVE: To analysis the characteristics of sudden sensorineural hearing loss (SSHL) patients with tinnitus, and explore the relationship of characteristics of tinnitus and audiology. METHOD: Patients diagnosed as SSHL with tinnitus were studied in the research. All patients' clinical features were analyzed, such as tinnitus frequency, pure tone audiometry, tinnitus, hearing loss degree, results of residual inhibition test. RESULT: Thirty cases were identified as mild degree hearing loss, 13 cases as moderate degree, 28 cases as severe degree and 34 cases as profound degree. And hearing impaired frequency of 13 cases was ascertained at low-frequency, 39 cases at middle-high-frequency, and 53 cases at full-range-frequency. The incidence of patients with low-frequency was about 41. 9% (44/105), and it was about 21. 9% (23/105) in those with middle-frequency. And it was 36. 2% (38/105) in cases of high-frequency tinnitus. The chi-square test show statistically significant differences between patients with the low-frequency, middle-frequency and high-frequency of the hearing loss (P<0. 05). In tinnitus residual inhibition test, positive rate of convergence type masking curve was about 72.0%, tinnitus separated type masking curve 20.0%, overlapping type was 57.9%, and the spacing type was 43.5%. There was a statistically significant difference among cases with different type masking curve (P<0. 05)with the spacing residual inhibition test positive rate. CONCLUSION There are individual differences of clinical characteristics among SSHL patients with tinnitus. Tinnitus frequency is consistent with the frequency of hearing loss. Patients had the more serious the degree of hearing loss, who had more serious tinnitus grading. Cases with the converged type curve will be fit for tinnitus masking. Therefore, combining the tinnitus detection with the audiological tests, we could obtain the clinical characteristics of SSHL patients with tinnitus.
Audiometry, Pure-Tone ; Deafness ; Hearing Loss ; Hearing Loss, Sensorineural ; complications ; pathology ; Humans ; Tinnitus ; complications ; pathology

OBJECTIVETo analyze the clinical characteristics, prognosis and therapeutic effects of sudden sensorineural hearing loss (SSHL) patients associated with vertigo, and to investigate the strategy of diagnosis and treatment.

METHODSWe retrospectively analyzed the clinical characteristics of 240 patients diagnosed as SSHL with vertigo, who were treated in the Chinese PLA General Hospital from July 2008 to August 2012. Various factors affecting the therapeutic effects were analyzed, such as audiological features, vestibular function tests, genders, audiograms, lasting before seeing a doctor, courses of vertigo and vascular factors.

RESULTAmong the contemporaneous SSHL patients (873 cases), the cases with vertigo accounted for 27.49% (240/873). Among the 240 patients with vertigo, the cases with different hearing impaired degree of mild, moderate, severe and profound were 30, 13, 28 and 34, respectively, primarily by the profound cases. Detailed vestibular function tests were performed in 97 patients, with 54 cases having unilateral vestibular disfunction and 43 patients having normal vestibular function, among which 23 cases were diagnosed as benign paroxymal positional vertigo (BBPV). The relationship between vestibular function and different hearing impaired degrees or various audiogram types had no statistically significant difference. 219 cases had detailed records of the onset time of cochlear and vestibular symptoms, including 122 patients with cochlear symptoms and dizziness occurring simultaneously. After standardized drug treatment, the total effective rate was 46.67%, with recovery in 17 cases, excellent in 34 cases, better in 61 cases and poor in 128 cases, respectively. Statistical analysis showed that different genders, audiogram types, vertigo courses of time, the results of vestibular function and neck vascular ultrasounds were not related to the curative effects, while, the treatment time after onset was significantly associated with treatment effects.

CONCLUSIONSSSHL with vertigo has a high incidence, primarily single side affected, with relatively severe hearing impairment, and total deafness and downslope hearing curve mainly. Vestibular function can be normal or low in SSHL patients with vertigo, with a higher incidence of BPPV. Vestibular and cochlear symptoms occur simultaneously in more than half of the patients. The detection rate of vestibular dysfunction gradually increased, as the degree of hearing loss increased, without statistical significance although. The therapeutic effects of sudden hearing loss with vertigo cases have no relationship with dizziness duration or vestibular function, while the disease course plays an important role in treatment.

Benign Paroxysmal Positional Vertigo ; complications ; Cochlea ; physiopathology ; Deafness ; Dizziness ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; complications ; Hearing Tests ; Humans ; Prognosis ; Retrospective Studies ; Vestibular Function Tests ; Vestibule, Labyrinth ; physiopathology

ObjectiveTo explore the clinical efficacy of Gouteng prescription in treating the patients with primary hypertension with anxiety disorder due to yang hyperactivity and heat toxin and the impact of the formula on the balance of inflammatory cytokines. MethodA total of 98 patients diagnosed with primary hypertension and anxiety disorder were randomized into control and observation groups. On the basis of conventional western medicine treatment for hypertension， the control group （47 patients） was treated with Shugan Jieyu capsules for 8 weeks， while the treatment group （51 patients） with Gouteng prescription for 8 weeks. The two groups were compared in terms of the blood pressure level， 24-hour blood pressure variability， Hamilton anxiety scale （HAMA） score， Pittsburgh sleep quality index （PSQI） score， quality of life （SF-36 scale） score， traditional Chinese medicine （TCM） syndrome score and efficacy， incidence of adverse reactions， and the levels of interleukin （IL）-1β， IL-6， IL-10， and IL-4 in the serum of peripheral blood. ResultThe final trial was completed with 95 patients， including 46 in the control group and 49 in the observation group. The treatment in both groups lowered the blood pressure and blood pressure variability （P<0.05， P<0.01）. The observation group outperformed the control group in recovering the systolic blood pressure （SBP）， 24-hour mean systolic blood pressure （24 h SBP）， 24-hour systolic blood pressure variability （24 h SBPV）， and 24-hour diastolic blood pressure variability （24 h DBPV） （P<0.05）. After treatment， the HAMA and PSQI scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower HAMA and PSQI scores than the control group （P<0.05）. Compared with those before treatment， the SF-36 scores in both groups increased （P<0.05， P<0.01）. After treatment， the observation group had higher scores of physiological function （PF）， bodily pain （BP）， social function （SF）， role-emotional （RE）， and mental health （MH） indicators than the control group （P<0.05）. After treatment， the TCM syndrome scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower score than the control group （P<0.05）. The total response rate regarding TCM syndrome in the observation group was 85.71% （42/49）， which was higher than that （63.04%， 29/46） in the control group （χ²=6.621， P<0.05）. The treatment in both groups lowered the levels of pro-inflammatory cytokines （IL-1β， IL-6） and elevated the levels of anti-inflammatory cytokines （IL-10， IL-4） （P<0.05， P<0.01）， and the changes were more obvious in the observation group than in the control group （P<0.05）. There were no adverse events during the research process. ConclusionGouteng prescription can recover the blood pressure level， reduce blood pressure variability， suppress anxiety state， improve sleep and quality of life， decrease TCM syndrome score， increase total response rate， lower serum IL-1β and IL-6 levels， and elevate serum IL-10 and IL-4 levels in the patients with primary hypertension complicated with anxiety disorder due to yang hyperactivity and heat toxin. It may exert the effects by regulating the balance of pro-inflammatory and anti-inflammatory cytokines.

OBJECTIVE: To screen the allergens of trichloroethylene-induced occupational medicamentosa-like dermatitis( OMDT) by patch test,and explore methods for OMDT auxiliary diagnosis and trichloroethylene( TCE) allergic population screening. METHODS: A total of 20 subjects diagnosed with OMDT were selected as case group,and 22 nonOMDT healthy workers exposed to TCE≥12 weeks were selected as control group. Different concentrations of TCE and its main metabolites such as chloral hydrate( CH),trichloroethanol( TCOH) and trichloroacetic acid( TCA) were used as allergens in a skin patch test in workers of these two groups. Another 20 new workers exposed to TCE < 12 weeks without OMDT were tested as validation group. They were tested with a patch test at a mass fraction of 15. 00% CH and follow-up observations were performed until 12 weeks of TCE exposure. RESULTS: The patch test of TCE,CH,TCOH and TCA were negative in the control group. In the case group,the patch test positive rate for 50. 00% TCE was 10. 00%,the patch tests were negative in 25. 00%,10. 00% and 5. 00% TCE. The CH patch test positive rate was 100. 00% with the CH mass concentrations of 15. 00%,10. 00% and 5. 00%. The TCOH patch test positive rates were 90. 00%,75. 00% and50. 00%,with the corresponding concentration of 5. 00%,0. 50% and 0. 05%. The TCA patch test positive rates were50. 00% and 0. 00% with the TCA concentrations of 5. 00% and 0. 50% respectively. When the mass concentration was5. 00%,the patch test positive rates in case group from high to low were CH,TCOH,TCA and TCE( P < 0. 01). And the patch test positive rates of CH and TCOH showed no statistical significant difference( P > 0. 05). The patch test positive rate of TCOH increased with increase of TCOH mass concentrations( P < 0. 01). The patch test positive rates for 5. 00%TCA was higher than that of 0. 50% TCA( P < 0. 01). The patch test positive rate in 0. 50% TCOH was higher than that of 0. 50% TCA( P < 0. 01). In the validation group,the patch test of 15. 00% CH was negative,and there was no OMDT case found during the follow-up 12 weeks of TCE exposure. CONCLUSION: The metabolites CH and TCOH of TCE may be the main allergens of OMDT after exposure to TCE. The CH and TCOH patch test can be an auxiliary diagnosis method for OMDT. The CH patch test could be used as a method for screening population allergic to TCE.

OBJECTIVE: To investigate the levels of cortisol and inflammatory factors and their influencing factors in patients with occupational noise-induced hearing loss(ONID). METHODS: A total of 106 ONID patients were selected as the ONID group, and 50 healthy participants without noise exposure were selected as the control group by judge sampling method. The levels of salivary cortisol in the two groups were detected by enzyme-linked immunosorbent assay.The serum levels of cortisol, tumor necrosis factor alpha(TNF-α), interleukin-6(IL-6) and C-reactive protein(CRP) in the peripheral blood were detected by electrochemiluminescence assay. Tinnitus Handicap Inventory was used to evaluate the disability levels of tinnitus in ONID patients. RESULTS: The level of salivary cortisol in the morning and in the nighttime, and cortisol, TNF-α, IL-6 in the serum were higher in the ONID group compared with that in the control group(P<0.05). There was no significant difference in the serum level of CRP between these two groups(P>0.05). Spearman correlation analysis results showed that the level of cortisol in the saliva and in the serum was not correlated with TNF-α and IL-6(P>0.05). Analysis of multiple linear regression showed that the levels of serum cortisol and salivary cortisol in the morning in the ONID patients were positively correlated with noise exposure level(P<0.05). The level of TNF-α in the serum was positively correlated with tinnitus score(P<0.05). CONCLUSION: Hyperactivity of hypothalamus-pituitary-adrenal axis and inflammation activation may exist in patients with ONID. The cortisol can be used as a biomarker for the effect of noise-stress.