Parathyroid carcinoma is a rare endocrine tumor.Clinical manifestations are varied with multiple organs involved,mainly due to hypercalcemia.So far the etiology and pathogenesis of parathyroid carcinoma are still unclear and preoperatively diagnosis is difficult.Technetium-99 m sestamibi scan and ultrasound can help to find the early lesions.Complete surgical resection with suspicious involved lymph nodes is the recommended treatment.Parathyroid carcinoma is insensitive to chemotherapy and radiotherapy.New immune therapy yields unsure efficacy.Therapeutic effect and prognosis mainly depend on primary surgical resection of the tumor.The disease recurs in more than 50％ of patients with poor prognosis.

Objective To evaluate the effect of low dose fentanyl on target plasma concentration (CP) of propofol (P) given by target controlled infusion (TCI) required to prevent response to proseal laryngeal mask insertion in 50% of patients (EC50). Methods Forty-six ASA Ⅰor Ⅱ patients aged 20-50 yr with body mass index ≤ 30 kg/m2 undergoing elective gynecological laparoscopy were randomly divided into 2 groups (n=23each):propofol group (P) and propofol-fentanyl group (PF). Anesthesia was induced with TCI of propofol. The initial Cp of propofol TCI was set at 2.5 μg/ml in group PF and 4 μg/ml in group P. Following equilibration between plasma and effect site concentration of propofol, fentanyl 1 μg/kg (in group PF) or normal saline (in group P) was injected iv. Laryngeal mask airway (LMA) was inserted at 3.5 min after fentanyl administration. EC50 was determined by up-and-down sequential trial. The ratio of Cp between the two consecutive patients was 1.2 in group P and 1.1 in group PF. LMA insertion response was defined as nausea, bucking and/or body movement during insertion. "Probit method was used to calculate the Echo and 95 % confidence interval required to prevent LMA insertion response. Results The EC50 and 95 % confidence interval of propofol given by TCI required to prevent LMA insertion response was 4.68 (4.20-5.21)μg/ml in group P and 2.63 (2.45-2.83) μg/ml in group PF. There was significant difference between the 2 groups. Conclusion Fentanyl 1 μg/kg iv can significantly reduce the Cp of propofol TCI required to prevent LMA insertion response.

BACKGROUND:The development of stem cel transplantation and genetic modification technology provides new ideas and methods for the treatment of pulmonary hypertension. OBJECTIVE:To investigate the therapeutic effects of transplantation of human telomerase reverse transcriptase (hTERT)-transfected human amniotic mesenchymal stem cels in pulmonary hypertension rats. METHODS:Human amniotic mesenchymal stem cels were cultured and purified in vitro, and then transfected with adenovirus-medicated hTERT. Sixty-six adult Wistar rats were enroled to prepare pulmonary hypertension models through intraperitoneal injection of 60 mg/kg monocrotaline and then 63 model rats were randomly assigned into three groups: model group treated with transplantation of 1 mL of L-DMEMvia the jugular vein, cel transplantation group treated with transplantation of 1 mL of untransfected human amniotic mesenchymal stem cel suspension, and transfection group treated with transplantation of 1 mL of human amniotic mesenchymal stem cel suspension transfected with hTERT. Hemodynamic changes, plasma endothelin-1 level, hypertrophy index of the right ventricle and myocardial cel apoptosis were compared among different groups at 3 weeks after transplantation. RESULTS AND CONCLUSION:After 3 weeks of treatment, there were no differences in the arterial blood pressure of the three groups (P > 0.05); however, the systolic pressure of the pulmonary artery and mean pulmonary arterial pressure were significantly lower in the transfection group than the model group and cel transplantation group (P < 0.05). Hypertrophy index of the right ventricle had no difference among the three groups (P> 0.05). The level of plasma endothelin-1 was significantly lower in the transfection group than the model group and cel transplantation group (P < 0.05). Apoptosis in myocardial cels was significantly reduced in the transfection group compared with the model group and cel transplantation group (P< 0.05). Experimental findings suggest that the transplantation of hTERT-transfected human amniotic mesenchymal stem cels can improve the hemodynamic levels in pulmonary blood vessels of pulmonary hypertension rats to protect vascular endothelial cels and reduce myocardial cel apoptosis.

Objective To summarize the experience of combination use of biliary stent placement and drainage with primary suture of the common bile duct in the treatment of choledocholithiasis. Methods Laparoscopic common bile duct exploration combined with flexible choledochoscopy was performed in 16 patients with choledocholithiasis from June 2005 to March 2006. During the operation, a patented “biliary stent for internal drainage” was introduced into the common bile duct, and primary sutures were performed to close the bile duct. Postoperatively, the stent was removed under gastroscope or duodenoscope. Results All the 16 operations were successfully accomplished without conversions to open surgery. The operative time was 90~260 min (mean, 145 min). The biliary stent was removed 5~7 days after the surgery. Follow-up for 3~12 months showed no residual stones or biliary stenosis. Conclusions Combination use of biliary stent drainage and primary suture of the common bile duct in the treatment of choledocholithiasis is safe and feasible.

Objective To explore the clinical effect of laparoscopic exploration on incarcerated inguinal hernia.Methods 38 patients with incarcerated inguinal hernia were randomly divided into open operation group (19 cases) and laparoscopic group(19 cases) by using the digital table method.The open operation group used Lichtenstein tension-free repair method.The laparoscopic group used the transabdominal preperitoneal(TAPP) repair method.The hospitalization days,operation time,degree of pain,bleeding loss,postoperative time return to normal activities,postoperative complications and the postoperation recurrence of two groups were compared.Results The hospitalization days,operation time,degree of pain,bleeding loss,postoperative time return to normal activities,incidence rate of complications in the laparoscopic group were (5.11±1.29)d,(43.05±8.10)min,(2.79±1.08)points,(20.42±9.69)mL,(14.11±3.81)d,15.79% respectively,which of the open operation group were (6.79±1.80)d,(48.32±6.82)min,(4.21±1.13)points,(28.42±7.99)mL,(18.26±3.77)d,47.37% respectively,there were significant differences between the two groups in terms of above indicators(t=-3.31,-2.17,-3.95,-2.78,-3.38,x2=4.38,all P<0.05).Conclusion TAPP is a safe and effective operation for incarcerated inguinal hernia treatment,with the advantages of minimal invasion and less complications.

Objective:To clarify the mechanism of crisis serum' mediated gametocyte infectivity to the mosquito vector Methods:Observing the effects of mouse serum , which was obtained 5 days after P yoelii infection (D5 serum) on gametocyte infectivity by IFA and mosquito live feeds, and the production of IFN ??TNF ??IL 4 and NO - 2 in the hosts in vivo and in vitro by ELISA and Griess reaction And to investigate the ability of malaria parasitized red blood cell extract (PRBC extract) to induce NO Results:The development of the gametocytes from mice 5 days postinfection into ookinetes were completely inhibited D5 serum was not immediate to inhibit gametocyte development, which was injected intravenously into the mice 3 days after P yoelii infection But 4 h later after injection D5 serum stimulated the increasing IFN ? and NO production and inhibited gametocyte infectivity Moreover, PRBC extract showed the ability to induce NO Conclusion:Infected host serum blocks transmission of P yoelii via a nitric oxide dependent mechanism

Objective To investigate the clinical characteristics of stroke in young patients with cardiac myxoma.Methods Medical records of young patients (aged between 18-44 years) diagnosed with cardiac myxoma in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2005 to March 2016 were retrospective reviewed.Results A total of 117 cases were included (85 female and 32 male)with the average age (36 ±7)years old.Most myxomas (83.8％) were located in the left atrium,7.7％ were in the right atrium,3.5％ were in the both atriums,2.6％ were in the left ventricle,and a few were in the left atrium plus left ventricle and in the right ventricle.Of all the patients,24 (20.5％) (16 women and 8 men) were complicated with cerebral infarction.Among them,3 patients were with lower extremity arterial embolisms.Two patients were with cerebral hemorrhage.The cerebral infarction mainly involved in the distribution area of the internal carotid artery.Infarctions involving 2 or more cerebral vessels were found in 4 cases.Most subjects (58.3％) manifested with hemiplegia,and some (18.2％) with syncope.The proportion of the left atrial myxoma in patients with cerebral infarction (100.0％) was significantly higher than those in patients without cerebral infarction (85.1％,P =0.044).Subjects with tumor diameter less than 3 cm were more frequently complicated with cerebral infarction (37.5％ vs 13.8％,P =0.009).A logistic analysis showed that the odds ratio of myxoma with tumor diameter less than 3 cm for cerebral infarction was 3.750 (95％ CI 1.343-10.470).Conclusions Cardiac myxoma is more common in young women,and often complicated with cerebral infarction.The infarctions are mainly distributed in internal carotid artery system,and some are involved in multiple vascular systems.The incidence of stroke is associated with the position of the myxoma.Smail-size myxoma cannot be ignored for its risk of stroke.

This study is to establish a cell-based model targeting to neuraminidase (NA) of the 2009 H1N1 influenza A virus. NA is an influenza virus structural protein with enzymatic activity of the cleavage of HA-sialic acid interaction to release new viral particles from cells. A model of HIV-1 (pNL4-3.Luc.R(-)E(-)) based pseudovirions packed with HA [hemagglutinin, A/VietNam/1203/2004 (H5N1)] and NA [A/California/04/2009 (H1N1)] was established to evaluate compounds activities on NA function. The viral release can be blocked by neuraminidase inhibitors, oseltamivir and oseltamivir carboxylate, with IC50 of (61 +/- 31) nmol L(-1) and (5.5 +/- 2.9) nmol L(-1) respectively. A point mutation of H275Y on NA leads oseltamivir-resistance. This corresponding mutation was introduced into the system which was also confirmed by oseltamivir and oseltamivir carboxylate.

Objective To investigate the correlation between drug resistance and β-actamase genes of multi-drug resistance Acinetobacter baumannii (MDR-AB) in neonatal intensive care unit to provide evidence for rational antibiotics administration and nosocomial infection control.Methods Twenty-six MDR-AB strains were separated and collected from clinical specimens.The minimum inhibitory concentrations of 13 antimicrobial agents were determined by agar dilution method.Genotypes of β-lactamase were detected by polymerase chain reaction.Results The resistant rates of the 26 strains to Ceftazidime,Cefoxitin,Piperacillin-tazobactam and Ciprofloxacin were 100.0%.About 80.8% to 96.2% of these strains were resistant to the other antimicrobial drugs.Among the 26 MDR-AB strains,100% (26/26) strains possessed oxa-51,77% (20/26) possessed oxa-23 gene,54% (14/26) carried arnpC gene,both oxa-23 and ampC were identified in 42% (11/26) strains,while oxa-24,oxa-58,imp-1,imp-4 and vim-2 gene were not identified.Conclusions The drug resistance of Acinetobacter baumannii is serious,oxa-23 and ampC are the major plactamase genes carried by MDR-AB in neonatal intensive care unit.

Objective To evaluate the value of diagnosis of NOF by plain film and CT.Methods Radiographic and CT findings in 14 patients (male 11,female 3;age range,9～51 years)with non-ossifying fibroma proved pathologically and surgically were analysed.Results The age of 9 patients (64.3%)was between 10 and 20 years.Most of non-ossifying fibromas occured in lower extremity,especially around the knee.The X-ray findings could be divided into two types:(1)Cortical type(6 cases);(2)Medullary type(8 cases).The CT signs included:(1)Local destruction of the adjacent cortex;(2)Bone septum;(3)Well-defined sclerotic edge near the medulla.Conclusion Most of the NOF of bone can be diagnosed correctly by radiography and CT.