OBJECTIVE Attempt to visualize the hypopharyngeal anatomy and related structures in normal adults with ultrasound. METHODS Sonographic features of laryngopharynx were confirmed by comparable tissue sections of 6 corpses at the same level. Then, the laryngopharynx of 30 men and 30 women were examined by ult rasound and thei r sonographic images were evaluated. RESULTS In male or female volunteers, perfect visualization pattern was obtained in all (100％) pyriform sinuses, 60％ or 93.3％ postcricoid areas,66.7％ or 93.3％ posterior pharyngeal walls, 96.7％ or 100％ thyroid cartilages, 63.3％ or 93.3％ arytenoid cartilages, 70％ or 93.3％ vocal cords,and 83.3％ or 96.7％ ventricular bands. CONCLUSION The ultrasonic visualization of laryngopharynx and its related structures are satisfactory in healthy adult women. For adult men, the pyriform sinus and thyroid cartilage can be best identified while the identification of vocal cords and ventricular bands is less satisfactory. However, postcricoid region, pharyngeal posterior wall, and arytenoid cartilage are the most difficult to detect.

Objective To investigate the characteristics of hospitalized elderly schizophrenia patients combined with somatic diseases.Methods A cross-sectional study was conducted on hospitalized elderly schizophrenia patients using a questionnaire developed by ourselves at three mental health centers in Shanghai.Gender,age,length of education,course of disease,somatic diseases (hypertension,diabetes,hyperlipidemia,organic cerebral disease,and heart disease),antipsychotic medication as well as other relevant information were collected.Meanwhile,body mass index,body height and other relevant indexes were measured.Results Among 304 subjects,176 (57.9 ％) were complicated with somatic diseases,including 120 (39.5％) with hyperlipidemia,113 (37.2％) with hypertension and 78 (25.7％) with diabetes mellitus as the top three somatic diseases.Patients who were overweight or took atypical antipsychotics were more susceptible to somatic diseases (both P＜0.05);female patients were more susceptible to heart disease and diabetes than male patients (P ＜0.05);patients aged 70 years and over were susceptible to hypertension and hyperlipidemia than those under 70 years old (P＜0.05).Somatic diseases were related to age (over 70 years old),overweight and use of atypical antipsychotics in hospitalized elderly schizophrenia patients (P＜0.05).Conclusions The incidence of somatic diseases in hospitalized elderly schizophrenia patients is relatively high,and the most common somatic diseases are hyperlipidemia,hypertension and diabetes mellitus.Age,overweight and use of atypical antipsychotics are the influence factors for somatic diseases in these patients.

Twenty eight polycystic ovarian syndrome (PCOS) patients complicated with insulin resistance, whose testosterone and luteinizing hormone levels were normal, received metformin treatment (500 mg b.i.d) for 3 months.Blood anti-Müllerian hormone (AMH) levels, endocrine and metabolic parameters were measured before and after treatment.The mean levels of AMH were not significantly changed after 3 months of treatment [(8.4±3.2) vs.(8.5±3.2) μg/L, P=0.148].However, the BMI[(27.6±4.1) vs.(29.3±4.4)kg/m2], fast glucose[(5.32±0.47) vs.(5.55±0.71)mmol/L], fast insulin [(93.3±17.8) vs.(147.7±44.1)pmol/L] and homeostasis model assessment of insulin resistance (HOMA-IR) (3.17±0.71 vs.5.27±1.85) were significantly decreased after treatment (all P<0.05).The results indicate that metformin treatment may not significantly affect serum AMH levels, although it can improve the insulin resistance and reduce the BMI value in PCOS patients.

Objective:To evaluate the efficacy and safety of temporary loop ligation of the infrarenal abdominal aorta for control ofintraoperative blood loss in patients with pernicious placenta previa.Methods:We retrospectively analyzed the clinical data of 14 patients with pernicious placenta previa,who underwent temporary loop ligation of the infrarenal abdominal aorta for control of blood loss during cesarean section between July 2013 and December 2014.Results:Eight patients received conservative management to preserve the uterus and 6 patients underwent cesarean hysterectomy.The occlusion time of the abdominal aorta was (31.42±12.67) min.The average estimated intraoperative blood loss was (1 117.85±745.13) mL.The volume of packed red blood cell transfusion was (3.91±3.24) units,and the volume of fresh frozen plasma transfusion was (192.85± 156.71) mL.Post-operative histologic diagnosis revealed 6 cases of placenta percreta,4 of increta,3 of accreta and 1 non-creta.All patients experienced an uneventful postoperative recovery.Conclusion:In patients with pernicious placenta previa,temporary ligation of the infrarenal abdominal aorta provide a safe and effective means for controlling intraoperative hemorrhage during cesarean section.Additionally,the procedure may provide an opportunity to preserve fertility by avoiding a cesarean hysterectomy.

Objective To prepare a kind of 99Tcm-labeled estrogen receptor (ER) SPECT imaging agent,and evaluate its binding characteristics with ER by in vitro and in vivo studies.Methods EDL was prepared from estrone and then reacted with GAP to synthesize GAP-EDL.Then,GAP-EDL was labeled with 99Tcm to obtain 99Tcm-GAP-EDL.Cell uptake and blocking assays were performed in vitro on MCF-7and MDA-MB-231 cells.The biodistribution study of 99Tcm-GAP-EDL was performed on normal BALB/c mice at 30,60,120,180 and 240 min post injection.Nude mice bearing either MCF-7 or MDA-MB-231derived tumors were injected with 99Tcm-GAP-EDL,and subjected to γimaging at 1,2,4 h post injection.The mice injected with excess unlabeled GAP-EDL or estradiol were used as the blocking control.Two-sample t test was used for data analysis.Results The radiolabeling yield of 99Tcm-GAP-EDL was (98.8 ±0.5) ％ and the radiochemical purity after 24 h was over 90％.The cell uptake rate of MCF-7 cells at 240min was (4.84± 0.21) ％,which was significantly higher than that of MDA-MB-231 cells ((2.11±0.21) ％;t =15.96,P＜0.05).99 Tcm-GAP-EDL uptake rate of MCF-7 cells in blocking groups ((2.31 ± 0.28) ％ and (2.05±0.35) ％) decreased significantly compared to that of non-blocking group(t=11.52,11.16,both P＜0.05).Biodistribution studies showed that 99Tcm-GAP-EDL was mainly metabolized by the liver and kidneys,and exhibited quick blood clearance.Gamma imaging showed high uptake in MCF-7 tumors 1 h post injection and the uptake reached the highest at 4 h,while there was little 99Tcm-GAP-EDL uptake in MDA-MB231 tumors and blocked MCF-7 tumors.Conclusions 99Tcm-GAP-EDL may be prepared under mild conditions with high labeling purity and stability.The in vitro and in vivo characteristics of 99Tcm-GAP-EDL suggest that it may be a promising probe for ER positive tumor imaging.

Objective To investigate the effect of gonadotropin-releasing hormone analogue(GnRH-a) on pregnancy outcome in patients with endometriosis infertility after laparoscopic surgery.Methods Two hundred and twenty two patients treated with laparoscopic surgery for endometriosis infertility in Jiaxing Maternal and Child Health Care Hospital between January 2010 and December 2012 were enrolled and 184 patients completed the study.Patients were randomly assigned to two groups:110 patients in GnRH-a group received long-acting GnRH-a (3.75 mg injection every 28 d for 3 times) before trying to conceive,74 patients in control group were directly trying to conceive for 1 to 36 months.According to endometriosis fertility index (EFI),patients were further subgrouped:GnRH-a group 1 (EFI scores =6-10,n =83),GnRH-a group 2 (EFI scores =0-5,n =27),control group 1 (EFI scores =6-10,n =55) and control group 2 (EFI scores =0-5,n =19).The cumulative pregnancy rate (CPR) and abortion rate were compared among groups and subgroups.Results The patients were followed up for 1 to 36 months after trying to conceive,with a median follow-up time of 14 months.The total CPR was 62％ (114/184),the median time for gestation was 11 months.Within the first 6 months after operation,the CPR in GnRH-a group and its subgroups were lower than those in corresponding control groups,with significant difference between GnRH-a group and control group [9％ (10/110) vs.32％ (24/74),x2 =16.00,P ＜0.01],GnRH-a group 1 and control group 1 [8％ (7/83) vs.38％ (21/55),x2 =18.10,P ＜0.01].Within 12 months,24 months and 36 months,the CPR in GnRH-a group and its subgroups were all higher than those in corresponding control groups [66％ (55/83) vs.49％ (27/55),x2 =4.05,P ＜ 0.05].The pregnant rate within 12 months in GnRH-a group was 88％ (63/72),which was not significantly different to that in control group [76％ (32/42),x2 =2.44,P ＞ 0.05].Kaplan-Meier analysis showed that there were no significant difference in CPR between GnRH-a group and control group,GnRH-a group 1 and control group 1,GnRH-a group 2 and control group 2 (all P ＞ 0.05).The median time for gestation in GnRH-a group and its subgroups were shorter than those in corresponding control group.The median time for gestation in GnRH-a group was 10 (95％ CI:8.2-11.8) months and that in control group was 17 (95％ CI:1l.8-22.1) months.The abortion rate in GnRH-a group and control group was 11％ (7/72) and 26％ (11/42),respectively (x2 =4.34,P ＜ 0.05).Conclusion Administration of GnRH-a for 3 cycles can improve postoperative pregnancy rate within 1 year and reduce the abortion rate for endometriosis infertile patients after laparoscopic surgery especially for these with strong fertility.

[ABSTRACT]OBJECTIVETo evaluate the clinical value of ultrasound guided fine-needle aspiration (US-FNA) in the diagnosis of thyroid nodules with different size.METHODSThe clinical data of 122 thyroid nodules of 109 cases referred to FNAC for diagnosis were retrospectively reviewed. The final operating histological results of 122 nodules were considered gold standard. RESULTSNon-diagnostic FNAC results occurred in 17 nodules (13.9%). FNAC achieved a sensitivity of 78.6%, a specificity of 93.9%, a positive predictive value of 93.6%, a negative predictive value of 78.3%, and a total accuracy of 85.7%. There was no significant difference between the diameter of the nodule≤1 cm group and>1 cm group, except negative predictive value. The non-diagnostic results rate was no significant difference between groups of different nodule size, benign or malignant nodules, and different operators. CONCLUSIONFNAC is a sensitive, specific and accurate method for differential diagnosis of thyroid nodules.

Objective To understand the current situation of dispensary setting and personnel of community health service centers in Pudong New District in Shanghai (hereinafter referred to as Pudong New District).Methods Questionnaire survey covering the 45 community health service centers in Pudong New District was used.Results 42 community health service centers were equipped with TCM dispensaries among the 45 total units (93.3%);12 of them adopted outsourcing mode (26.7%);the average area of community dispensary was (32.3 ± 17.3)m2;the average number of TCM practitioners was 3.5 ± 2.0 people.Conclusion Community health service centers need to increase the allocation area of TCM dispensary and improve qualification of TCM practitioners.

Objective To evaluate the diagnostic value and misdiagnosis cause of echocardiography (UCG) and CT in aorto-left ventricular tunnel (ALVT). Methods UCG and CT of 5 patients who were diagnosed as ALVT by surgical operation during August 2010 to October 2014 in Wuhan Asia Heart Hospital were reviewed and analyzed. Results By UCG, 4 cases were diagnosed as ALVT. The abnormal tunnel between aortic root and left ventricle could be clearly displayed with two dimensional echocardiography. On color Doppler flow image (CDFI), it could be clearly demonstrated that the blood flow went into aorta from left ventricle in systolic period via aortic valves and ALVT, and back to left ventricle in diastolic period via ALVT. Bicuspid aortic valve (BAV) was found in 2 patients, and aortic valve reflux in 1 patient. According to Hovaquimian classification, 2/4 patients were diagnosed as ALVT of typeⅠ, and other 2 patients as ALVT of typeⅡ. One case was misdiagnosed as left coronary artery-left ventricle fistula. By CT, 2 cases were diagnosed as ALVT and 1 case was misdiagnosed as left coronary artery-left ventricle fistula. Conclusion The combination of UCG and CT is a reliable technique in the diagnosis of ALVT, which has significance in therapeutic strategy making and prognosis prediction.