Objective To investigate the perioperative management and video-assisted thoraco-scopic (VATS) extended thymectomy for myasthenia gravis ( MG ). Methods A total of 102 patients who received extended thymectomy for MG from June 2000 to August 2007 were divided into 2 groups by operative approach: 51 in the VATS group and 51 in the full median sternotomy group. The clinical features, including operation time, operation blood loss, post-operative drainage, inci-dence of crisis, hospital stay, and the 1-year total effective rate after the operation were compared. Complications were treated exactly and cholinesterase inhibitors were applied to control the symptom of MG before the operation. The whole thoracic gland and fat in the anterior mediastinum were removed. Steroid, cholinesterase inhibitors and plasmapheresis were used to prevent and cure masthemic crisis after the operation. Results No patients died in the operation and hospitalization. There was no sig-nificant difference in the operation time [(128.14±34.82) min vs. (130.46±28.71) min] and the 1-year total effective rate after the operation (85.8% vs. 87.2% )in the 2 groups(P>0.05).The operation blood loss, postoperative drainage, incidence of crisis, and postoperative hospital stay in the median sternotomy group were higher or longer than those in the VATS group [(93.77±21.64) mL vs. (45.42±10.96)mL,P<0.05; (174.65±21.64)mL vs. (101.33±28.76) mL,P <0.01;7.84% vs. 1.96%, P<0.05;(14.23±3.17)d vs. (8.37±1.18)d, P<0.05)]. Conclusion VATS extended thymectomy for myasthenia gravis is safe, less invasive and effective. Preoperative preparation and the perioperative managemant can decrease the incidence of crisis. The plasmapheresis is the key of curing masthemic crisis.

BACKGROUND:There is always a controversy about nonsurgical and surgical repair of acute Achiles tendon rupture. Except retrospective analysis, there is a lack of high-level evidence-based medicine data.
OBJECTIVE:To systemicaly evaluate the clinical effectiveness of the nonsurgical versus surgical treatment for acute closed rupture of the Achiles tendon.
METHODS:The randomized controled trials about the nonsurgical versus surgical treatment for acute Achiles tendon rupture were searched in PubMed, EMbase, CBM, CNKI, Ovid, and WanFang Data by computer as wel as in relevant journals by hand, which were reported before February 2014. The Cochrane Library (Issue 1, 2014) was also retrieved. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then Meta-analysis was conducted using RevMan 5.2 Software.
RESULTS AND CONCLUSION:Nine randomized controled trials were included, and totaly 874 patients were involved, 441 cases in the nonsurgical group and 433 in the surgical group. The results of Meta-analysis showed that compared with the surgical group, the incidence of complications was lower [OR=0.41, 95%CI(0.26, 0.63), P< 0.000 1], but the rate of tendon re-rupture [OR=2.86, 95%CI(1.62, 5.02),P=0.000 2] and incidence of cicatricial adhesion [OR=0.07, 95%CI(0.03, 0.19),P < 0.000 1] were higher in the nonsurgical group. However, there were no significant differences between the two groups in patient satisfaction, superficial infection, motion recovery, and deep infection. Compared with the surgical treatment, the nonsurgical treatment can reduce the incidence of complications, but has a higher incidence of re-rupture. Because of sample-size and methodological quality restrictions, this conclusion needs further verification of large-sample, multicenter, and high-quality randomized controled trials.

Objective To evaluate the efficacy of surgical treatment of Ebstein's anomaly with modified Carpentier's repair technique. Methods ⑴Enlarging the anterior leaflet with a pericardium patch; ⑵The edge of posterior leaflet was sewed to the edge of anterior leaflet or septal leaflet in favor of enlarging the area of leaflet; ⑶Annulus was reinforced with the terylene ring covered with pericardium; ⑷Adjustable Devega's procedure. Results 31 patients with Ebstein's anomaly underwent modified Carpentier's repair operation from Jan 1992 to May 2003 in our institution. There was one patient died after operation because of a fatal cardiac dysfunction, and no late deaths. During the followed-up period of 6～94 months, all surviving patients had a marked improvement of heart function, and 6 cases were in class I, 21 in class II and 3 in class III. There were no postoperative rhythm disturbances. Conclusion The modified Carpentier's repair technique is feasible and possesses a good outcome.

[Objective] To investigate the effect of the ER stress on the process of nonalcoholic fatty liver disease which is induced by methionine-choline deficient diet.[Methods] C57/BL mice were randomly divided into 8 groups (n =10),group 1-4was given normal diet,5-8 group was given MCD diet.Then took one group from both normal diet and MCD diet in the 2nd,4th,6th,8th week,recorded each group's body weight and liver weight.The liver fibrosis and inflammation in mice were analyzed by histopathological staining and NAS.The expressions of endoplasmic reticulum stress markers such as p-PERK,p-eIF2α,CHOP were detected by Western Blot and real time fluorescent quantitative PCR (q-PCR).[Results] ①The ALT and AST in serum,TG and TC in liver tissue were both higher in MCD group,the same as NAS;②The expressions of PERK,eIF2α,CHOP were significantly higher than the nommal diet group,while the GADD34 expression was lower.What's more,as time went by,the difference was more obvious;3.There was a significant correlation between the ERS index and NAS score in MCD group.[Conclusion]The liver damage and inflammatory response was lifted gradually in the mice fed with MCD diet.The ER stress may take an important role in this process.

Objective: To investigate the late identification and its influencing factors of newly reported HIV/AIDS cases in Shangcheng District, Hangzhou City, so as to provide insights into the development of strategies for early detection and identification of HIV/AIDS cases. Methods: Basic information, identification routes and CD4+T lymphocyte counts among newly reported HIV/AIDS cases in Shangcheng District from 2013 to 2022 were collected through the Chinese Disease Prevention and Control Information System. The proportion of late identification of newly reported HIV/AIDS cases was analyzed, and factors affecting late identification was analyzed by a multivariable logistic regression model. Results: Totally 1 052 HIV/AIDS cases were newly reported in Shangcheng District from 2013 to 2022, including 1 011 males (96.10%), and had a mean age of (32.90±12.39) years. There were 333 cases with late identification, accounting for 31.65%. The proportions of late identification have no significant changing trend from 2013 to 2022 (P>0.05). Multivariable logistic regression analysis showed that HIV/AIDS cases aged 25 years and older (25 to 49 years, OR=1.894, 95%CI: 1.350-2.658; 50 years and older, OR=3.010, 95%CI: 1.838-4.928) had a higher risk of late identification, while HIV/AIDS cases with college degree and above (OR=0.655, 95%CI: 0.459-0.936) and identified by voluntary counseling and testing (OR=0.542, 95%CI: 0.380-0.772) had a lower risk of late identification. Conclusions The proportion of late identification of newly reported HIV/AIDS cases in Shangcheng District from 2013 to 2022 was 31.65%. Age, educational level and identification route were important factors affecting late identification of HIV/AIDS cases in Shangcheng District.

Objective:To determine the role of stress in myocardial protection of ischemic preconditioning (IPC).
Methods:hTirty rabbits were randomly divided into an IPC group, an etomidate (Etom) group, an ischemic/reperfusion (IR) group, a methylprednisolone (MP) group and a sham group. hTe ratio of infarction size versus risk area (infarct/risk) was calculated. hTe elevations of the serum creatine kinase (CK) activity and cardiac troponin I (cTnI) concentrations as well as the serum cortisol concentrations were measured.
Results:hTe percentages of infarct/risk in the IPC group, the MP group, the IR group, and the Etom group were (5.86±2.81)%, (11.28±3.62)%, (26.79±4.53)%, and (18.19±3.72)%, respectively. The elevations of the serum CK activity in the IPC group, the MP group, the IR group, and the Etom group were (255±89), (314±160), (855±371), and (768±404) U/L, respectively. hTe elevations of serum cTnI concentrations in the IPC group, the MP group, the IR group, and the Etom group were (3.6±0.6),(6.1±2.2), (8.1±3.6), and (6.4±1.6)μg/L, respectively. Those indicators among the groups were signiifcantly different (P<0.05). Cortisol reaction was markedly diminished in the Etom group.
Conclusion: A blunted cortisol reaction can markedly reduce the benefit of IPC while methylprednisolone shows cardioprotective effects, suggesting that stress might be involved in the myocardial protection of IPC.

AIM　The purpose is to study the non-isothermal decomposition process and mechanics of vitamin B6. METHOD　The TG technique was used to observe between 30～700℃. RESULTS　The decomposition of vitamin B6 was performed by two stages. Vitamin B6 loses HCl at the first stage together with losing H2O. The kinetic equation obtained was dα/dt=A*e-E/RT*1/2(1-α)3; activation energy obtained was 325.27 kJ/mol; and preexponential factor A obtained was 7.22×1032/s as well. CONCLUSION　Vitamin B6 is rather thermal stable, and it loses HCl together with losing H2O at temperature range of 173℃～271℃.

Objective To establish the model of myocardial infarction by ligation of the left anterior descending branch in rats.Method Adult inbred strain Wistar rats were randomly divided into sham group(n=6) and model groups(n=79).Model of myocardial infarction were established by ligation of the left anterior descending branch.The electrocardiogram(ECG),HE staining tissue sections,and heart function of the rats were compared in the two groups.Results Rats in the model group had showed special changes of ST-T and Q wave in ECG,show serious necrosis of myocytes and proliferation of fibrous tissue compared with rats in the sham group.The left ventricular systolic pressure(LVSP),left ventricular develop pressure(LVDP),?dp/dt_(max),heart rate(HR) were significantly decreased in the rats of model group than those of the sham group(P

Nitrogen is one of the most important nutrient elements for plants and a major limiting factor in plant growth and crop productivity. Glutamine synthase (GS) is a key enzyme involved in the nitrogen assimilation and recycling in plants. So far, members of the glutamine synthase gene family have been characterized in many plants such as Arabidopsis, rice, wheat, and maize. Reports show that GS are involved in the growth and development of plants, in particular its role in seed production. However, the outcome has generally been inconsistent, which are probably derived from the transcriptional and post-translational regulation of GS genes. In this review, we outlined studies on GS gene classification, QTL mapping, the relationship between GS genes and plant growth with nitrogen and the distribution characters, the biological functions of GS genes, as well as expression control at different regulation levels. In addition, we summarized the application prospects of glutamine synthetase genes in enhancing plant growth and yield by improving the nitrogen use efficiency. The prospects were presented on the improvement of nitrogen utility efficiency in crops and plant nitrogen status diagnosis on the basis of glutamine synthase gene regulation.
Arabidopsis ; Genes, Plant ; Glutamate-Ammonia Ligase ; genetics ; Nitrogen ; metabolism ; Oryza ; Plants ; enzymology ; genetics ; Triticum ; Zea mays

Papillary thyroid carcinoma is the most common pathology type of thyroid carcinoma with the following biological characteristics:low malignancy,slow progress,longer duration,good prognosis,but it is prone to lymph node metastasis.Lateral lymph node metastasis relates with patients' age,sex,tumor size,tumor location,capsular invasion/extra-thyroidal extension,muli-focality and the number of positive central lymph nodes.Understanding the influencing factors of the lateral lymph node metastasis has important clinical significance for determining the lymph node dissection scope and the indications for the patients with thyroid carcinoma.