Objective To study the clinical features and treatment experience in the treatment of thoraco abdominal injury with diaphragmatic rupture.Methods Clinical data of 27 patients suffering from thoraco-abdominal injury with diaphragmatic rupture were analysed retrospectively.Results Injuries of this kind are usually complicated involving mostly the organ injuries,which are not obvious in clinical indications. In the present study group,27 cases were treated surgically,of whom 24 healed and 3 died(11.1%).Conclusion Early diagnosis and timely operation are the key steps in reducing the complications and mortality.

Objective To report the surgical procedure and its results of enlargement annulus for double valve replacement in small aortic root. Methods There were 7 patients with small aortic root undergoing double valve replacement. Mean age of 42 years (from 34 to 52 years). The diameters of aortic annulus ranged from 17 to 20?mm. The aortotomy was extended through the commissure that separates the left and noncoronary cusps of the aortic valve. The aortic annulus was divided, and the incision was extended into anterior leaflet of the mitral valve as inverse "Y". The anterior leaflet of the mitral valve was excised 3～5?mm to its root. A prosthetic patch was attached to the aortic-mitral valve so the aortic annulus was enlarged. The prosthetic valve was implanted. Moreover, it was attached to the prosthetic patch, at the root of the anterior leaflet of the mitral valve. Results The diameters of aortic annulus after operation were enlarged to 4～7?mm. The prosthetic valve (21～23?mm) was implanted in aortic valve position and the prosthetic valve (25～27?mm) in mitral valve position. There were no operative and postoperative deaths. One patient was re-operated for bleeding. All patients were followed up from 1 to 26 months and their cardiac function was significantly improved. Conclusion This surgical procedure is safe and effective for replacement, for double valve replacement in small aortic root.

The present report is concerned with the surface structure of the metacercaria of Pa-ragonimus iloktsuenensis as visualized with the scanning electron microscopy. The meta-cercariae were obtained from the liver of tne Sesarma dehaani collected in Yingkou county, Liaoning Province.The tegumental spines of the metacercaria are single-pointed and densely distributed over the entire body and are slightly different in size and shape in different parts of the body. On the forebody of the ventral surface, a vertical ridgeline can be seen in the middle of the spines.In addition to the short spines, there are two circles of non-ciliated papillae on both lips of the oral and the ventral suckers. Around the oral sucker, there are 12 papillae on the outer circle and 6 on the inner circle; around the ventral sucker, there are 6 papillae on both the outer and inner circles. No sensory papillae were found around the ventral sucker. On each side of the anterior part of the ventral side, 8 to 10 pairs of papillae are arranged in two rows.

DNA methylation is one of the most important epigenetic mechanism and molecular biological basis in tumor suppressor gene silencing.It is now well recognized that solid malignant tumors can release a significant amount of genomic DNA into systemic circulation,and with more than 90％ of this total circulating cell-free DNA derived from tumor tissue,which can reflect the overall cell heterogeneity of the tumor itself.In breast cancer,the presence of abnormally high DNA concentrations in plasma has been reported,and changes in the levels of these circulating DNA associated with tumor burden and progression have been confirmed repeatedly.Accumulating data strongly suggested that DNA methylation patterns found in circulating cell free DNA were similarly with the primary tumor,and could be a useful biomarker in early diagnosis,prognosis assessment,and recurrence monitoring for breast cancer patients.Here,we summarize the latest advances in this research field.

Objective Neonatal sepsis (NS) is one of the main causes of neonatal death.Immune therapy is an important way in the comprehensive treatment of NS.This study investigated several databases in order to find the clinical evidence for the immunological treatment of neonatal sepsis (NS),and to explore its clinical application value.Methods Systematic reviews and randomized (or quasi-randomized) controlled trials (RCT) for immunological treatment of NS in newborn infants were searched from the databases of MEDLINE,EMBASE and Cochrane Library.The relevant literatures were statistically analyzed.Results Six systematic reviews (including 37 RCTs) were found to be involved in the therapy,and the drugs included intravenous immunoglobulin (containing high level of IgM),antistaphylococcal immunoglobulins,neutrophile granulocyte,granulocyte colony-stimulating factor,granulocyte-macrophage colony-stimulating factor,pentoxifylline and glutamine.Pentoxifylline could decrease the mortality (Z =2.71,P =0.006 8),shorten the hospitalization (Z =2.01,P =0.044),and reduce the incidence rate of necrotizing enterocolitis (NEC) (Z =1.67,P =0.095) of the NS infants.No therapeutic effect was found for other drugs in the treatment of NS.Conclusions Current clinical evidence for the immunological treatment of NS indicates that only Pentoxifylline could decrease the mortality,reduce the incidence rate of NEC and shorten the hospitalization of infants with NS.However,current evidence is only a small scale sampling and lacks multicenter studies.Researchers are encouraged to undertake large scale and well-designed multicenter trials to confirm the effectiveness of the immunological treatment of NS.

Objective To investigate the anatomical relation between Zuckerkandl's tubercle and recurrent laryngeal nerve and the superior parathyroid glands anatomy in endoscopic thyroidectomy.Methods From Jul.2012 to Jun.2014 implementation of the 120 cases of endoscopic thyroid surgery (at least one side of the line lobectomy) intraoperative Zuckerkandl tubercle of the presence, all the patients from Subei People's Hospital and location of the relationship between anatomy recurrent laryngeal nerve and superior parathyroid glands.Zuckerkandl tubercle identified by intraoperative recunent laryngeal nerve to expose and superior parathyroid glands.Results Zuckerkandl tubercle appear in the vast majority of cases: on the left is 86％ (51/59), 88％ in the right side (65/74), most of superior parathyroid glands were located on the top of Zuckerkandl tubercle.Looking for recurrent laryngeal nerve by Zuckerkandl tubercle method is more direct, can reduce surgical bleeding and shmten the operation time.Conclusion Recurrent laryngeal nerve and superior parathyroid glands and have close anatomical relationship with Zuckerkandl tubercle.In endoscopic thyroidectomy by intraoperative discern Zuckerkandl tubercle can better avoid injury recurrent laryngeal nerve and superior parathyroid glands.

Breast cancer is one of the most common malignant tumors in clinic,and its pathogenesis has been extensively studied by people.miRNA play an important regulatory role in normal breast cell proliferation and apoptosis,they are widely involved in the occurrence and development of breast cancer and are attracting more and more attention as new tumor markers.The Wnt/β-catenin signaling pathways involved in breast cancer and other malignancies have long been confirmed.Recent studies have shown that a variety of important members of the Wnt/β-catenin signaling pathway can be regulated as miRNA target genes,affecting the occurrence and development of breast cancer.At the same time,Wnt/β-catenin signaling pathway changes can also cause the expression of related miRNA changes.Both miRNA and Wnt/ β-catenin signaling pathways play an important regulatory role in the pathogenesis of breast cancer,but the complex regulatory relationship between them has not been elucidated yet.Therefore,in this review,the roles of miRNA and Wnt/β-catenin signaling in breast cancer and its relationship with each other are reviewed in order to gain a deeper understanding of the complex pathogenesis of breast cancer and to explore new diagnostic molecular markers and therapeutic targets for breast cancer,provide a new idea for the diagnosis and treatment of breast cancer.

Objective:To investigate the association between serum thyroid level and prognosis of critically ill children with euthyroid sick syndrome(ESS).Methods:The clinical data and serum thyroid hormone levels of 176 children with ESS who were admitted to the Department of Pediatric Intensive Care Medicine at West China Second Hospital of Sichuan University from January 2015 to April 2021 were retrospectively collected.According to the prognosis, the children were divided into improved group and invalid group, as well as basic disease group and non basic disease group, and the differences of thyroid hormone between two groups were compared.The pediatric risk of mortality Ⅲ(PRISMⅢ) scores within 24 hours of admission were assessed, and the correlation between thyroid hormone level and PRISMⅢ score was analyzed.Results:Among 176 critically ill children with ESS, the most common diseases were sepsis(31.8%), severe pneumonia (23.8%) and heart failure(10.7%), respectively.The levels of free T3(FT3), T3, free T4(FT4) and T4 in invalid group were significantly lower than those in improved group ( P<0.05), but there was no statistical difference in thyroid-stimulating hormone(TSH) level between two groups( P>0.05). The levels of FT3, T3, FT4 and T4 were negatively correlated with PRISMⅢ score( r=-0.419, -0.459, -0.341, -0.383, respectively, P<0.05), and there was no correlation between TSH level and PRISMⅢ score ( P>0.05). The common underlying diseases of severe children with ESS were malnutrition(31/98), heart disease(30/98), hematologic neoplasms(15/98), and bronchopulmonary dysplasia(10/98). The median age of children in basic disease group was younger than that in non-basic disease group(0.7 years old vs. 2.0 years old, P<0.05); The proportion of children with underlying diseases in invalid group was 24.5%, which was significantly higher than that of children without underlying diseases (6.4%), and the difference was statistically significant ( P<0.05); There were no significant differences in the levels of FT3, T3, FT4, T4 and TSH between two groups ( P>0.05). Conclusion:In critically ill children, a variety of diseases can lead to ESS, and sepsis is the most common disease.Young children with underlying diseases should be more alert to ESS.The more severe the disease, the greater the decline of FT3, T3, FT4 and T4 levels.When low T3, T4 and TSH occur simultaneously, the prognosis of the children may be worse.Thyroid hormone level could be used as an indicator to evaluate the prognosis of critically ill children, which is needed further studies to explore.

Objective To summarize the clinical characteristics of children with Kawasaki disease (KD) in pediatric intensive care unit(PICU). Methods Medical record of children with KD at PICU were collected. At the same time,29 cases of KD in PICU were 1∶3 matched by age,gender and the time admitted in hospital with those admitted in general pediatric department(control group). Results PICU patients had longer length of hospital stay,longer fever duration compared with control group. In addition,patients in PICU had higher neutrophil percentage,C reaction protein,creatinine,urea nitrogen,N￣terminal natriuretic peptide and procalcitonin,but lower hemoglobin,blood platelet and albumin compared with the control group. What′s more,patients in PICU tended to find hemoglobin<100 g/L,platelet<150×109/L,albumin<30 g/L,abnor￣mal in urine routine and echocardiographic and more likely to have fever longer than 10 days when used intra￣venous immunoglobulin(IVIG) compared with control group. And PICU patients were more likely to require therapy with antibiotics,albumin,glucocorticoid and the second dose of IVIG. Some part of children in PICU group were treated with IVIG and glucocorticoid because of doubted severe infection before KD diagnosed,all patients in the control group used IVIG after the diagnosis. Conclusion Patients who admitted in PICU are severe and not typical in clinical manifestation. These patients are easily misdiagnosed as sepsis and more likely to be IVIG￣refractory and have coronary artery damage. We still worry that somebody might be misdi￣agnosed as sepsis,who are treated with IVIG and get better. Because they are not diagnosed as KD,these pa￣tient would not followe up like KD,but have potential risk of cardiovascular disease and need more alarming.

Epithelial mesenchymal transition is a kind of important pathophysiological phenomenon,which refers to a biological processe that epithelial cell turns into another cell with mesenchymal phenotype undergoing a specific procedure.Once the tumor cell acquires mesenchymal cell molecular phenotype,it will enable stationary epithelial cells to gain the ability to migrate and invade as single cells,being easy to break away from the original tumor and move to the distal organs with blood flow.The occurrence of epithelial mesenchymal transition involves a variety of signal transduction pathways,which relates to inducing factors,transcription factors and so on.The occurrence and development of breast cancer is influenced by many factors and many signal transduction pathways.In recent years,the research of tumor suppressor and tumor resistance is more extensive.In this paper,a review of epithelial mesenchymal transition related signaling pathways in breast cancer is presented.