The effects of different dose of methimazole (MMI) and different mode of drug administration were compared in patients with Graves' disease. 155 patients were divided into 5 groups at random: group A 10 mg MMI 3 times daily, group B 30 mg once daily, group C 5 mg 3 times daily, group D 15 mg once daily, group E 10 mg daily. The durations to achieve euthyroidism were not significantly different in group A, B, C and D (3.9? 1.5, 3.8? 1.3, 4.1 ? 1 .6 4.1 ?1.7 weeks respectively), but in group E (7.8?2.1 weeks) it was apparently longer than in other groups. The rate of side-effects occurring in patients treated with 30 mg, 15 mg and 10 mg daily was 37.7%, 14.7% and 5.6% respectively. Intrathyroidal concentrations of MMI were measured by means of high-performance liquid chromalo-graphy in 25 patients who underwent thyroidectomy. There was no difference of MMI concentrations in thyroid glands between the patients treated with 15 mg/d (39.1 ?15.2 ?mol/kg) and those with 30 mg/d(42.4? 14.3 ?mol/kg), or between the patients receiving the same dose on divided daily dose and single daily dose. These data demonstrate that 15 mg MMI as a single daily dose is reasonable and effective for the treatment of hyperthyroidism.

Thyroid nodules are very common.Its etiological factors include hyperplasia,adenomas,cancer,cysts,and thyroiditis.Most of thyroid nodules are benign.The management of thyroid nodules whether thyroidectomy or observation is according to their nature.So,the key of the therapy is to identify that they are benign or malignant.We should comprehensive evaluate patients' history,physical examination,laboratory examination,and auxiliary examination for judging the nature of thyroid nodules and making decision in the choose of thyroidectomy or observation.

Objective To investigate the signal pathways involved in the effects of thyroid stimulating antibody(TSAb)on the secretory function of cultured thyrocytes.Methods (1)With the method of enzyme-linked immunosorbent assay (ELISA),the PKA and PKC activities were observed.(2)Inhibitors or activators of protein kinases (PKA and PKC) were used to activate or block the signal pathways and the secretion of T3 measured by radioimmunoassay.Results (1)TSAb activated both PKA and PKC in thyrocytes in a dose-,time-dependent manner(.P.

50Gy) in solitary or limited BM subgroup seemed to survive longer. However in the Cox mu ltivariate analysis, only KPS, numbers of BM, extracranial systemic metastasis a nd chemotherapy were significant prognostic factors. Just as those of RPA subgro ups, the median survival from the start of WBRT was 3, 9, 16 months in 3 PI subg roups respectively.Conclusions:Overall survival in BM from breast cancer remains p oor. KPS, numbers of BM, extracranial systemic metastasis and chemotherapy were independent prognostic factors. RPA classification can predict the prognosis of patients with BM from breast cancer, so can the PI model.

OBJECTIVE:To explore the anti-shear force,stability and plasticity of reconstruction plate implantation,and to investigate its role in treating acetabular fractures complicated by free bone graft in the joint.METHODS:A computer-based online search of Science Direct and Ei databases (1960-01/2009-10) was performed for related English articles with the keywords of "acetabular fractures,modified ilioinguinal approach,reconstruction plate".In addition,CNKI and CBM database (1994-01/2009-10) were searched for related Chinese articles with the same key words in Chinese.Moreover,related works were manually searched.Studies regarding reconstruction plate implantation in treating acetabular fractures were included,including basic and clinical experiments.RESULTS:Acetabular top is weight loading region of human body,and the fracture should be reducted by the operation.Prior to reconstruction plate for acetabular fracture fixation,bone hook,and Kirschner wire can be used for temporary fixation,and the plate bending angle should be adjusted to accordant with lateral posterior wall or medial anterior wall of the acetabular top,followed by screw threading for fracture fixation.In addition,the screw entrance angle is very important.If the fixation of one plate is not satisfactory,one or two cancellous bone screw or Kirschner wire can be used to enhance the fixation.But the Kirschner wire tail should be bended to prevent dislocation into the pelvic cavity.Moreover,additional plate can be used for further fixation.Reconstruction plate fixation has advantages of anti-shear force,high stability and plasticity,which fully adapt the special appearance of acetabulum.Moreover,the incidence of postoperative plate loosening and breakage is low,and the satisfaction is high.Free bone blocks can be temporarily fixed by Kirschner wire,followed by reconstruction plate fixation.CONCLUSION:Reconstruction plate fixation has good clinical effect and few complications in treating acetabular fractures complicated by free bone blocks in the joint.

Objective To compare the air permeability,water absorption and water locking properties of two different foam dressings,thus to provide theoretical and experimental evidence to alternative optimization for acute and chronic wound.Methods Five Mepilex foam dressings(group 1) and PermaFoam Comfort dressings(group 2) each was selected.Simulated wound exudation was made by NaCl and CaCl·H2O.The water-absorbing rate of dressings at post immersion 24 h (PIH),the water-absorbing speed of dressings at post immersion 1,5,10,20 min,the diffusion diameter of exudation dripped on the surface of dressings for 5 min,the beaker filled with exudation was sealed tightly by dressing for 24 h,and the weight was gotten before and after 24 h.Statistical analysis was performed.Results (1) The water-absorbing rate:the group 1(616±19)% was significantly higher than (313±13)% of the group 2 (t=29.137,P<0.01);(2) The water-absorbing speed:the group 1 (119.68±2.59)g·s-1·m-2,(24.39±0.62)g·s-1·m-2,(12.33±0.29)g·s-1·m-2,(12.33±0.29)g·s-1·m-2 were significantly higher than those of the group 2[(65.85±4.37)g·s-1·m-2,(13.82±1.03)g·s-1·m-2,(7.16±0.41)g·s-1·m-2,(3.66±0.12)g·s-1·m-2,t=23.704,t=19.708,22.947,31.764,all P<0.01];(3) The water holding capacity:the group 1 (5.66±0.15)cm was significantly higher than (2.2±0.12)cm of the group 2,(t=39.089,P<0.01);(4) The air permeability:there was no statistically significant difference between the two groups(t=0.189,P>0.05).Conclusion The Mepilex foam dressing is more suitable for the early stage of acute wound with large exudation in short time,while the PermaFoam Comfort dressings is better for chronic wound or the later period of acute with less exudation in a relative slow seepage velocity.

Objective To observe the changes of brain oxygenation in patients with extremely severe craniocerebral injury and the therapeutic effect of early normobaric hyperoxia.Methods Sixtyeight patients with extremely severe craniocerebral injury treated from January 2011 to January 2013 were assigned to two groups according to the random number table:50％ oxygen breathing for one week in control group (34 cases) and 80％ oxygen breathing for one week in treatment group (34 cases).Blood samples from jugular vein and radial artery were collected at 1,3,5,and 7 days to measure indices of blood gas analysis,i.e.,PaO2,PjvO2,CaO2,CjvO2,Da-jvO2,CERO2 and Djv-a Lac.GCS and content of neuron-specific enolase (NSE) were recorded as well.Results Values of PaO2 at each time point and GCS at 5 and 7 days were significantly higher in treatment group than in control group (P ＜0.05).Djv-a Lac at 3,5 and 7 days and NSE at 7 days revealed significantly higher levels in treatment group than in control group(P ＜ 0.05).Whereas at each time point,there were no significant differences between the two groups in aspects of PjvO2,CaO2,CjvO2,Da-jvO2 and CERO2 (P ＞ 0.05).Conclusion Early use of 100％ oxygen in patients with extremely severe craniocerebral injury may be beneficial to the prognosis.

Objective To assess the impact of learning curve on perioperative complications in laparoscopic radical prostatectomy (LRP) by a series of consecutive 200 cases in a single center.Methods Two hundred patients who were biopsy proved prostatic carcinoma and underwent LRP were retrospectively evaluated.All the operations were performed by professor Ma Lulin.The patients were divided into 4 groups according the time of operation.All the clinical data,including age,body mass index (BMI),preoperative PSA level,biopsy Gleason score,and clinical stage were collected.Operative parameters and peri-operative complications were evaluated,including operative time,blood loss,transfusion rate,and perioperative complications.The complications were evaluated by Clavien classification system.Results Age,BMI,PSA,prostate volume,biopsy Gleason score and clinical stage had no significant difference among the 4 groups (P ＞ 0.05).The operative time was gradually lowered from group one to group four.Significantly less blood loss occurred after every 50 cases of LRP (P ＜ 0.001).The complication rates were 15.5％ in this series,28.0％,18.0％,12.0％ and 4.0％ for group one to group four respectively.The complication rate reduced as experience was gained (P =0.008).The rates of mild complications were 24.0％,14.0％,6.0％ and 4.0％,and severe complication rates were 4.0％,4.0％,6.0％ and 0,respectively.Conclusion With experience was gained and technique was improved,the operative time and blood loss of LRP decreased and complication rate reduced substantially.

Objective To explore the expression and significance of N-cadherin in urothelial bladder cancer and analyse its relation to clinicpathologic and prognosis of bladder cancer.Methods The expression of N-cadherin in 145 urothelial bladder cancer and 25 normal bladder tissues was detected by immunuhistochemisty,and correlations between N-cadherin and clinicopathologic features were analysed.Results The positive rate of N-cadherin protein was significantly higher in bladder cancer than in normal bladder tissue (P＜0.01).The positive rate of N-cadherin protein was 38.6％ in G1 bladder cancer,58.4％ in G2-G3 bladder cancer,and its difference was significant (P =0.028).The expression was significantly lower in non-muscle-invasive bladder cancer than in muscle invasive bladder cancer (45.7％ vs 64.7％,P=0.029).The muscle-invasive bladder cancer patients were followed up 4-103 months.Among those,the overall survival with positive expression of N-cadherin protein was 24.2％ (8/33),and the overall survival with negative expression of N-cadherin protein was 66.7 ％ (12/18).Kaplan-Meier analysis showed the positive expression of N-cadherin was significantly associated with overall survival of patients with muscle-invasive-bladder cancer (P=0.002 2).Multivariate Cox analysis showed that N-cadherin expression was an important prognostic factor.Conclusions The expression of N-cadherin protein was high in bladder cancer.The detection of the expression of N-cadherin protein is associated with the diagnosis and prognosis of bladder cancer.

Objective To investigate the diagnostic value of microscopic observation drug susceptibility assay (MODS) in extrapulmonary tuberculosis. Methods MODS technology was constructed by using 24-well cell culture plate and liquid culture.Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS were used to detect Mycobacterium tuberculosis in 74 pleural fluid samples collected from patients with tuberculous pleurisy,63 cerebrospinal fluid samples collected from patients with tuberculous meningitis and 18 samples collected from non-tuberculosis suspects.The immunochromatography was used to distinguish Mycobacterium tuberculosis from nontuberculosis mycobacteria. The results of Ziehl-Neelsen smear, Lowenstein-Jensen culture and MODS were compared by x2 test.Results The positive rates of MODS,Lowenstein-Jensen culture and Ziehl-Neelsen smear were 58.1 ％ (43/74),18.9 ％ (14/74 ) and 6.8％ (5/74),respectively in tuberculous pleurisy patients; 54.0％(34/63),20.6％ (13/63) and 4.8％ (3/63),respectively in tuberculous meningitis patients.The positive rate of MODS technology was significantly higher than that of Lowenstein Jensen culture in tuberculous pleurisy patients (x2 =24.00,P＜0.01) and tuberculous meningitis patients (x2 =14.97,P ＜ 0.01). Each Mycobacterium obtained from MODS and Lowenstein-Jensen culture was identified as Mycobacterium tuberculosis by immunochromatography.All of the 18 pleural fluid and cerebrospinal fluid samples which collected from non-tuberculosis suspects were all negative detected by Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS.The median time to culture positive of MODS was 9 days in cerebrospinal fluid and 14 days in pleural fluid samples,which were both significantly shorter than that of Lowenstein-Jensen culture (31 days in both cerebrospinal fluid and pleural fluid samples). Conclusion Compared to conventional microbiological diagnosis methods,MODS is a rapid detection method of Mycobacterium tuberculosis with a higher positive detection rate,which is suitable for rapid diagnosis of extrapulmonary tuberculosis.