To improve class teaching quality,we must concentrate on the leading factor: teacher,the key factor: design,and the subjective factor: students.

Objective To evaluate the clinical features and efficiency of surgical treatment in elderly patients with parathyroid tumor.Methods Clinical data of 12 cases (aged 60-83 years) was retrospectively analyzed.Their main complaints varies individually,including bone and muscle trouble in 9 patients,abdominal problem in 7 ones,and kidney stone in 6 ones.PTH level ranged from 78 to 2850 μg/L,and calcium level 2.6-4.5 mmol/L.Parathyroidectomy was carried out in 8 patients,while extended excision of suspected tissues in 6 ones.Intraoperative PTH determination was routinely performed.Results A drop by at least 50％ in PTH level was achieved in all cases after 10 minutes of tumor-bearing tissues excision.A much improvement of main complaints was shown in all cases about 1 week postoperatively.During the follow-up period from 18 to 48 months,both PTH and calcium levels were still in normal range in 9 patients,relapse was noticed in two cases 1 or 2 years after operation respectively.One patient died even after successful excision of parathyroid tumor.Conclusions PTH and calcium level determination is advised in elderly patients with suspected parathyroid tumor,and surgical treatment is generally safe and effective.

OBJECTIVE To study and evaluate the surgical management of cervical anastomotic stricture of the esophagus and its efficiency. METHODS Cervical anastomotic stricture resulted from colon by-pass for patients with esophagus stricture due to corosive in 5 cases,and gastric pull-up in 3 with esophagus carcinoma,one patient suffered serious esophagus stricture at its upper end because of previous radiation,and failed to the anastomoticplasty RESULTS All of them failed to respond to prior dilation. Anastomoticplasty was used in 6 of them,local flap,colon by-pass and jejunal free flap interposition was chosen based on the patient's situation. The operation got succeeded at its first time in seven patients,and at its second time in two cases. Normal oral feeding was restored in seven of them,and semiliguid feeding in the other two. CONCLUSION Surgical treatment is reliable in dealing with patients with problem of anastomotic stricture of the cervical esophagus.

OBJECTIVE To evaluate the clinical features of tumors primarily in the pterygopalatine fossa, and the efficiency of surgical management for these lesions. METHODS The clinical data of 7 cases with tumors primarily in the pterygopalatine fossa were retrospectively studied. Three of them were primary diseases, i.e. fibrous histiocytoma, neurofibroma and cholesteatoma. The other 4 cases were secondary tumors mainly located in pterygopalatine fossa. There were 1 case with epithelial-myoepithelial carcinoma, 1 case with adenoid cystic carcinoma , 1 case with recurrent inverted nasal papilloma, 1 case with recurrent malignant fibrous histiocytoma. Approaches to tumors in pterygopalatine fossa lesions included lateral rhinotomy, and transnasal or transantrum approaches under the nasal endoscope. RESULTS The patient suffered from adenoid cystic carcinoma developed local recurrence 4 months after operation, and extended resection of the recurrent tumor with laser was performed again. No further recurrence was found after following-up for 3 years. Neither local recurrence nor regional metastasis was found in the remaining 6 cases with a follow-up period of 2 to 4 years. The main complication was oronasal fistula. CONCLUSION CT scan or MRI is the main method to the early diagnosis of pterygopalatine fossa tumors. Lateral rhinotomy, endoscopic trasnnasal or transantrum approaches are feasible procedures to resect the tumors.

ObjectiveTo investigate the clinical effects and side-effect of mesenchymal stem cell(MSCs) transplantation on spinal cord injury(SCI),traumatic brain injury(TBI),multiple sclerosis(MS) or Parkinson's disease(PD).MethodsThe bone marrow(222～350 ml) of 11 patients with SCI(n=6),TBI(n=3),MS(n=1) or PD(n=1) were harvested from the patients' ilia and then MNCs were isolated.The MNCs were injected intravenously or into subarachnoid space by lumbar puncture.The neural function and side-effect were observed before and after MSCs transplantation and the patients were followed up.ResultsThe data demonstrated the improvement of sense and motor function in 5 patients with SCI,one had no improvement by 2 months following-up.These patients' sense and motor levels improved obviously.Their muscle strength of lower extremity increased,the muscular tone decreased and urinary bladder function improved.Changes in neurological deficits and improvements in function may appear within 2 days after transplantation,most of them within 2 weeks.There were significantly amelioration in 3 patients with TBI treated with MSCs transplantation,one of them could walk with cane independently after 3 months.One's PVS score elevated from 5 to 8 scales after transplantation.The tremor was alleviated after 1 week,and the muscular tone decreased,which lead to reduce the dose of Madopar after 3 months,in patient with PD.The patient with MS showed no improvement in short time.The side-effect included fever(7/11),headache(2/11) and abdominal dissension(1/11).1 patient feel numb in his legs while injection into subarachnoid,and appeared meningeal stimulation after injection.ConclusionThere were significantly clinical effects in treatment of SCI,TBI,MS,and PD with MSCs transplantation in short time,and with few side-effect. The long-term clinical effects need more observation with larger samples.

Objective:To investigate the value and influence factors of preoperative and intraoperative localization of ectopic hyperparathyroidism (EHPT).Methods:Results of 99mTc-sestamibi ( 99mTc-MIBI), neck ultrasound, contrast CT and intraoperative local venous parathyroid hormone (IOLVPTH) were retrospectively analyzed in 205 patients with primary hyperparathyroidism (PHPT) suspected of EHPT. Results:Incidence of EHPT was 16.6% (34 cases), and 36 ectopic lesions were detected. The proportion of EHPT in antero-superior mediastinum, intrathyroidal, in the retropharyngeal region, in carotid sheath, in the prevertebral region and intrapericardial were 44.1% (15 cases), 29.4% (10 cases), 11.8% (4 cases), 5.9% (2 cases), 5.9% (2 cases) and 2.9% (1 cases), respectively. Contrast CT was the most sensitive (86.1%, 31 lesions/36 lesions) for EHPT, followed by 99mTc-MIBI (66.7%, 24 lesions/36 lesions), IOLVPTH monitoring (61.8%, 21 lesions/34 lesions) and neck ultrasound (55.6%, 20 lesions/36 lesions). Contrast CT was most sensitive,100% in detecting deep-located EHPT lesions, whereas IOLVPTH had advantages in detecting intrathyroidal EHPT lesions, with a sensitivity of 100.0%.The combined use of 99mTc-MIBI and neck ultrasound showed a sensitivity of 77.8% in the localization of EHPT. Conclusions:Contrast CT is highly sensitive in the localization of EHPT. The combined use of preoperative imaging and IOLVPTH monitoring helps to higher localization for EHPT.

Objective To evaluate the efficiency of 99Tcm-sestamibi (MIBI) in the diagnosis of parathyroid diseases with primary hyperparathyroidism.Methods One hundred and four cases with primary hyperparathyroidism underwent MIBI and parathyroidectomy between May 2010 to November 2013 were reviewed.With MIBI,single adenoma was found in 91 cases,two adenomas in 5 cases,carcinoma and hyperplasia in 3 cases respectively.Primary hyperparathyroidism was diagnosed based on the associated symptoms and signs in 93 patients,while it was indicated in 11 asymptomatic patients due to the presence of hypercalcemia in health examination.Parathroid hormone levels ranged from 98 to 2 800 ng/L,and serum calcium levels were between 2.56-4.23 mmol/L.Results The sensitivity of MIBI for total diseased parntyroids was 84.0％ (100/119),and that for parathyroid adenoma,parnthyroid carcinoma,atypical adenoma and primary parathyroid hyperplasia was 87.1％ (88/101),3/3,2/2 and 7/13,respectively.Conclusions MIBI is efficient in the diagnosis of parathyroid diseases with primary hyperparathyroidism.The size and cystic degeneration of parathroid disease are two common factors decreasing MIBI reliability,and thyroid nodule is additional source leading to false-positive results.

Objective:To study relative risk factors for temporarily inhibited parathyroid hormone (PTH) secretion after surgery of primary hyperparathyroidism (PHPT).Methods:Seventy-two cases with PHPT from October 2017 to March 2019 in Beijing Chaoyang Hospital were analyzed retrospectively, including 22 males and 50 females aged from 13 to 83 years old. They were reviewed and divided into a complete inhibition group (24 cases, PTH=0 pg/ml), an incomplete inhibition group (23 cases, 0

Objective To evaluated the results of surgical treatment for primary hyperparathyroidism coexistent with thyroid cancer.Methods From March 2007 to May 2014,27 patients suffered thyroid carcinoma coexistent with primary hyperparathyroidism with pathological and laboratory confirmation were studied retrospectively.In 8 of 27 cases thyroidectomy and parathyroidectomy were performed separately,with interval time of 3 to 26 months,and in the remaining cases both procedures were done simultaneously.During surgery quick PTH evaluation and calcium measure were routinely performed.Results Postoperative temporary hypoparathyroidism was found in 26 of 27 cases,and postoperative permanent hypoparathyroidism developed in 4 cases that underwent separate operation.Limited movement of vocal cord was showed in 4 cases after parathyroidectomy,but it lasted no more than 2 months.No permanent paralysis of recurrent laryngeal nerve was found.No thyroid cancer or hyperparathyroidism was found with follows-up of 11 to 43 months.Conclusions Thyroidectomy and parathyroidectomy performed separately have higher risk to develop hypoparathyroidism than they are done simultaneously.PTH and calcium should be evaluated in patients with thyroid carcinoma whenever available.

GLKs (GOLDEN 2-LIKEs) are a group of plant-specific transcription factors regulating the chloroplast biogenesis, differentiation and function maintains by triggering the expression of the photosynthesis-associated nuclear genes (PhANGs). The GLKs also play important roles in nutrient's accumulation in fruits, leaf senescence, immunity and abiotic stress response. The expression of GLK genes were affected by multiple hormones or environmental factors. Therefore, GLKs were considered as the key nodes of regulatory network in plant cells, and potential candidates to improve the photosynthetic capacity of crops. Since numerous researches of GLKs have been reported in plants, the biological function, molecular mechanism of GLKs genes and its applications in breeding were summarized and a GLK-mediated signaling network model was developed. This review may facilitate future research and application of GLKs.
Chloroplasts/genetics* ; Gene Expression Regulation, Plant ; Photosynthesis/genetics* ; Plant Breeding ; Transcription Factors/metabolism*