The clinical data of 192 patients undergoing endoscopic thyroidectomy via thoracic and mammary approach from June 2010 to July 2015 were retrospectively analyzed.Tunnel bleeding occurred in 11 cases (hemorrhage group),which was associated with the incorrect level of puncture(P ＜ 0.01).The tunnel bleeding was stopped by percutaneous packet-suturing in all 11 cases.There were no significant differences in postoperative drainage [(65.4 ± 7.5) and (63.8 ± 7.1) ml],subcutaneous petechiae [1/11 and 1.1％ (2/181)],nursing costs[(135 ±20) and(132 ± 16) yuan],postoperative hospital stay[(4.5 ± 1.6) and (4.4 ± 1.3) d] and rehemorrhage [0/11 and 0.6％ (1/181)] between hemorrhage and nonhemorrhage groups.The results show that percutaneous packet-suturing is reliable and effective method for tunnel bleeding without additional postoperative complications.

Objective To explore the feasibility and safety of right ventricular septal pacing with active fixation electrodes.Methods This was a randomized and control clinical trial.Patients implanted with pacemaker were randomly divided into two groups.One group underwent the right ventrieular high septal pacing with the active fixation electrodes(RVS group),and the other group underwent the right ventricular apical pacing with the passive fixation electrodes(control group).The parameter was recorded in two groups in and after operation and compared accordingly.Results (1)There were no significant differences in the procedure time between two groups[averaged(59.6±3.2)and(60.2±3.7)minutes respectively].But the time of exposing X-ray was significant longer in RVS group.(2)There was no significant difference in acute implanting measurement,except perioperative and postoperative threshold 1 month in RVS group was higher than that in control group(P＜0.05 or＜0.01).After 3 months,there was no significant difference.(3)Impedance decreased significantly in 1 month and 3 months in RVS group[P＜0.01 or＜0.05).(4)There was no difference in R-wave sensing between two groups.(5)After 100%pacing,the mean QRS duration Was shorter in RVS group,but the difference was not significant.(6)Operations in two groups came off smoothly and there were no complications.Conclusion It is feasible and secure to pace from RVS with active fixation electrodes.

ObjectiveTo observe the modified Xiaoqinglong decoction and its ingredient-reduced prescription on plasma levels of IL-5 and TNF-ct in rats,and to explore its mechanism of treating AR.To make clear the law of combination in modified Xiaoqinglong decoction.MethodsThe modified Xiaoqinglong decoction was divided into six groups,namely,reinforcing qi group,warming yang group,expelling retained morbid fluid group,reinforcing qi and warming yang group,reinforcing qi and expelling retained morbid fluid group,warming yang to expel retained morbid fluid group.90 rats were randomly divided into nine groups,namely,normal control group,model group,reinforcing qi group,warming yang group,expelling retained morbid fluid group,reinforcing qi and warming yang group,reinforcing qi and expelling retained morbid fluid group,warming yang to expel retained morbid fluid group,and the whole decoction group,with 10 rats in each group.Rat model of allergic rhinitis was made by the use of adjuvant systemic antigen sensitization and local attack,the normal control group and model group were fed with normal saline,the other groups were treated with appropriate drugs,once a day oral administration,continuous for 4 weeks.Detected plasma IL-5 and TNF-α levels of each group in rats.ResultsThe contents of plasma IL-5 (16.0±2.7)mg/L and TNF-α (57.5±8.0)mg/L in the model group was significantly increased,while it was significantly reduced in the reinforcing qi group,warming yang group,expelling retained morbid fluid group,refinorcing qi and warming yang group,reinforcing qi and expelling retained morbid fluid group,warming yang to expel retained morbid fluid group with plasma IL-5[each group was (12.9± 3.1) mg/L、(11.8 ±2.8) mg/L、(12.0±2.3) mg/L、(12.3±2.3) mg/L、(11.1±2.1)mg/L、(11.2±2.5)mg/L、(8.42.3)mg/L respectively]and TNF-α[each group was (27.7±5.7)mg/L、(29.5 ± 3.7) mg/L、(31.2 ± 4.9) mg/L、(28.1 ± 2.8) mg/L、(33.4 ± 5.6) mg/L、(26.3 ± 3.9) mg/L、(21.6 ±4.9) mg/L respectively],the whole decoction group effect was significant compared with the other treated groups (P＜0.05).ConclusionThe modified Xiaoqinglong decoction and its ingredient-reduced prescription can regulate plasma levels of IL-5 and TNF-α.The modified Xiaoqinglong decoction had best results in reinforcing qi,warming yang and expelling retained morbid fluid.

ObjectiveTo study the different clinical effects of using 5 kinds of hemostatic surgeries to manage the intractable postpartum hemorrhage and analyse the risk factors of failed hemostasis.Methods From Jan.2007 to Jul.2011,96 patients with intractable postpartum hemorrhage were studied retrospectively and grouped by the first step surgical treatment.The hemostatic surgeries included uterine tamponade (tamponadegroup ), pelvicbloodvessels ligation(ligationgroup), pelvical arterial embolization (embolization group), uterine compression sutures (sutures group)and uterine compression sutures combining tamponade (combined group).The intraoperative and postoperation datum were compared among groups,so dose the treatment outcomes.Multivariate analysis were used for failed hemostasis.Results( 1 ) The blood loss of 96 patients ranged from 1200 to 9100 ml,and 71 patients had a succeed hemoatasis after employing these surgeries and 25 failed.(2) The blood loss before hemostasis surgeries in tamponade group and embolization group was statisically greater than in sutures group ( P ＜ 0.05 ).Blood loss during the hemostasis surgeries in ligation group was statistically greater than in embolization and sutures groups ( P ＜0.05).The operating time of embolization group was statistically shorter than ligation group,sutures group and the combined group (P ＜ 0.05 ).(3) Fine of 96 patients had uterine atony and 43 had a successful hemostasis with the success rate about 78％.Forty-six had placenta previa and 39 success with success rate 85％.Thirty-three had placenta accrete and 13 of which succeed in hemostasis with success rate about 39％.In patients with uterine atony and placenta previa,the difference of hemostasis rate in groups had no statistically significant ( P ＞ 0.05 ).In patients with placenta accrete,the hemostasis rate in embolization group was higher than in others groups (P ＜ 0.01 ). (4) The multivariate analysis found that scar uterus,placenta accrete and coagulation defects were the risk factors of failed hemotasis.The OR value respectively was 2.9 (95 ％ CI:1.1 - 7.6 ),17.9 ( 95 ％ CI:5.6 - 56.3 ) and 16.2 ( 95 ％ CI:3.2 - 83.5 ).Embolization had some extent of protective effection ( OR =0.9,95 ％ CI:0.8 - 0.9 ).Conclusions ( 1 ) Five kinds of hemostatic surgeries were all effective.Though the success rate among groups did show statistical difference,pelvical arterial embolization has the comparative advantage of shorter operating time,less operating blood loss and higher success rate in placenta accrete.(2) Since scar uterus,placenta accrete and coagulation defects were the risk factors of failed hemostasis,sufficient preparation should be made for patients with these risk factors and the hemostatic surgeries should be choosed individually.

Objective To compare the image quality and adverse effects among different concentrations of nonionic iodinated con-trast media in hysterosalpingography (HSG).Methods 99 female infertile patients were recruited in this study for HSG and were averagely divided into Group A,B and C.The application of contrast media were as follows:iomeprol injection(400 mg I/mL)for Group A,iopamidol injection (370mg I/mL)for Group B,iohexol injection(300 mg I/mL)for Group C.The image quality was in-dependently evaluated by two doctors using a 3-point scale (1 -3 score)and adverse effects were recorded.Results (1 )Scores of image quality:all images met diagnostic desire with (2.55±0.5 1)score in Group A,(2.42±0.50)score in Group B,(2.21±0.42) score in Group C.There were statistically significant differences among goups(H =7.790,P =0.022).Kappa values were 0.693 in Group A,0.687 in Group B,0.672 in Group C.(2)Adverse effects:4 cases in Group A(12.12%),3 cases in Group B(9.09%), 2 cases in Group C(6.06%),which showed no statistically significant differences(χ2 = 0.733,P =0.693).Conclusion The three kinds of concentrations of nonionic iodinated contrast media can all be applied in HSG.The higher of iodinated concentration,the better of image contrast.

Objective To evaluate the effect of combined multiple interventional methods in treatment of acute deep venous thrombi (DVT) in lower extremities caused by military training. Meth-ods All 25 patients with DVT were treated with embolectomy by using Fogarty catheter. Of all, three pa-tients were treated only with embolectomy, six underwent embolectomy plus percutaneous transluminal an-gioplasty (PTA), 11 received PTA plus ultrasound ablation and five were implanted with stent-grafts. The clinical results were analyzed retrospectively. Results Based on angiography during operation, the ob-structed iliofemoral vein received complete recanalization in 24 patients, with the perioperative luminal di-ameter ≥71%. Partial recanalization of the entrance of common iliac vein to inferior vena cava was failed in one patient. All 25 patients were followed up for an average 34 months after operation, which showed that 24 patients received satisfactory results with normal military training and that the other one with failed recanalization of vena iliaca still felt swelling pain in lower extremity after training. Conclusion Com-bined multiple interventional methods can remarkably improve the therapeutic effect for DVT caused by military training.

Objective:Bioinformatics was used to analyze the gene expression profile of renal chromophobe cell carcinoma (RCCC) to find out the key genes of RCCC.Methods:Chromophobe renal cell carcinoma gene chip data GSE15641 and GSE11151 were downloaded from the GEO database. Using R software packages such as " Affy" and " limma" in R software to screen differentially expressed genes, combining with David and STRING online bioinformatics tools to analyze the regulatory network of differentially expressed genes and construct protein-protein interaction (PPI) network, the Hub gene was screened through the Cytohubba plug-in of Cytoscape software.Results:A total of 261 differentially expressed genes were screened, including 194 down-regulated genes and 67 up-regulated genes. Gene enrichment (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed to explore their biological functions. In GO enrichment analysis, biological processes were mainly enriched in cell secretion, gluconeogenesis and cell proliferation regulation; in cell composition, they were mainly enriched in exosomes, plasma membranes and their components; in molecular function, they were mainly enriched in heparin binding; in KEGG pathway analysis, they were mainly enriched in metabolic pathway, antibody biosynthesis pathway and renin angiotensin system pathway. PPI network was constructed by using online bioinformatics tools. The top 10 Hub genes were screened by using cytohubba plug-in in Cytoscape software, which were pipecolic acid and sarcosine oxidase (PIPOX), hydroxyacid oxidase 2 (HAO2), kynurenine 3-monooxygenase (KMO), solute carrier family 2 member 2 (SLC2A2), formimidoyltransferase cyclodeaminase (FTCD), angiogenin (ANG), APOBEC1 complementation factor (A1CF), aldehyde dehydrogenase 8 family member A1 (ALDH8A1), vitamin D binding protein (GC), histidine rich glycoprotein (HRG).Conclusions:Bioinformatics analysis of differentially expressed genes in renal chromophobe cell carcinoma can effectively explore the interaction information of these differentially expressed genes, and provide new ideas for the treatment of renal chromophobe cell carcinoma.

Objective To explore the effect of airway humidification on lung injury as a result of mechanical ventilation with different tidal volume(VT). Methods Twenty-four male Japanese white rabbits were randomly divided into four groups:low VT with airway humidification group,high VT with airway humidification group,low VT and high VT group without humidification,with 6 rabbits in each group. Mechanical ventilation was started after intubation and lasted for 6 hours. Low VT denoted 8 mL/kg,while high VT was 16 mL/kg,fraction of inspired oxygen (FiO2)denoted 0.40,positive end-expiratory pressure(PEEP)was 0. Temperature at Y piece of circuit in airway humidification groups was monitored and controlled at 40℃. Arterial blood gas analysis,including pH value,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),lung mechanics indexes, including peak airway pressure(Ppeak)and airway resistance(Raw),and lung compliance was measured at 0,2,4, 6 hours of mechanical ventilation. The levels of tumor necrosis factor-α(TNF-α)and interleukin-8(IL-8)in plasma and bronchoalveolar lavage fluid(BALF)were determined by enzyme linked immunosorbent assay(ELISA). The animals were sacrificed at the end of mechanical ventilation. The wet to dry(W/D)ratio of lung tissues was calculated. Histopathologic changes in the lung tissueies were observed with microscope,and lung injury score was calculated. Scanning and transmission electron microscopies were used to examine the integrity of the airway cilia and the tracheal epithelium. Results Compared with low VT group,pH value in high VT group was significantly increased,PaCO2 was significantly lowered,and no difference in PaO2 was found. Ppeak,Raw,and lung compliance were significantly increased during mechanical ventilation. There were no significant differences in blood gas analysis and lung mechanics indexes between low VT with airway humidification group and low VT group. Compared with high VT group,PaCO2 in high VT with airway humidification group was significantly decreased,Ppeak raised obviously,and no difference in pH value,PaO2,Raw and pulmonary compliance was found. Compared with low VT with airway humidification group,no difference in blood gas analysis(PaCO2,mmHg,1 mmHg=0.133 kPa)was found,but Ppeak(cmH2O,1 cmH2O=0.098 kPa),Raw(cmH2O),and lung compliance(mL/cmH2O)were increased significantly in high VT with airway humidification group(PaCO2 at 2 hours:27.96±4.64 vs. 36.08±2.11,4 hours:28.62±2.93 vs. 34.55±5.50, 6 hours:29.33±2.14 vs. 35.01±5.53;Ppeak at 0 hour:14.34±1.97 vs. 8.84±1.32,2 hours:17.33±0.52 vs. 11.17±2.14,4 hours:17.83±0.98 vs. 12.67±2.06,6 hours:18.67±1.22 vs. 13.50±2.16;Raw at 0 hour:37.36±5.14 vs. 27.05±2.93,2 hours:43.94±6.58 vs. 31.95±3.56,4 hours:48.04±6.07 vs. 35.24±3.50, 6 hours:50.33±6.34 vs. 36.66±3.64;pulmonary compliance at 6 hours:2.28±0.18 vs. 1.86±0.37,all P<0.05). The lung W/D ratio in high VT group was significantly higher than that of the low VT group(6.17±2.14 vs. 3.50±1.52, P<0.05). W/D in high VT with airway humidification group was higher than that of low VT with airway humidification group but without statistically significant difference(5.17±2.14 vs. 3.00±1.10,P>0.05). Microscopic observation showed that cilia were partially detached,adhered and sparse in low VT group,while cilia in high VT group showed serious detachment and lodging. Remaining cilia were sparse,with lodging,and cellular structure was damaged. Lung tissue pathological injury score in the high VT group was significantly higher than that of low VT group(6.17±2.14 vs. 3.50±1.52,P<0.05). Cilia density and cellularity were normal in low VT with airway humidification group,and no difference in lung tissue pathological injury score was found compared with low VT group(3.00±1.10 vs. 3.50±1.52, P>0.05). Cilia were severely detached,adhered and lodging,and cellularity were not obvious in high VT with airway humidification group,and lung tissue pathological injury score was elevated significantly than that of the low VT with airway humidification group but without statistically significant difference(5.17±2.14 vs. 3.00±1.10,P>0.05). TNF-α and IL-8 concentrations showed no change in plasma and BALF in all groups during ventilation,and no significant difference was found among the groups. Conclusions Airway humidification can alleviate pathological lung injury,damage of cilia and cellular structure in trachea caused by mechanical ventilation with low and high VT. High VT with humidification can result in serious pulmonary edema.

OBJECTIVETo detect potential mutation of MLC1 gene in a child affected with megalencephalic leukoencephalopathy with subcortical cysts (MLC).

METHODSClinical symptoms of the patient were retrieved. Peripheral blood DNA samples from the patient, her parents and healthy controls were collected. Potential mutation of the MLC1 gene was detected by polymerase chain reaction and Sanger sequencing.

RESULTSThe patient presented with severe motor developmental delay and a giant skull. Magnetic resonance scan showed diffuse white matter swelling in bilateral hemispheres. DNA sequencing identified a novel homozygous c.177-c.180delC mutation of the MLC1 gene. The parents of the patient both carried a heterozygous mutation c.177-c.180delC but had a normal phenotype.

CONCLUSIONA novel MLC1 mutation c.177-c.180delC has been identified in a patient with MLC. The mutation is presumably disease-causing and has derived from parents who are both carriers.

Child, Preschool ; Cysts ; genetics ; Female ; Hereditary Central Nervous System Demyelinating Diseases ; genetics ; Humans ; Membrane Proteins ; genetics ; Mutation

This study was aimed to analyze the correlation between CT perfusion parameters, e. g. perfusion (PF), blood volume (BV), peak enhancement image (PEI), time to peak (TTP), and the microvessel density (MVD) of cervical cancer. CT perfusion scans were carried out in 31 patients with cervical cancer. After their surgical resections, we obtained 31 cases of cervical cancer specimens, and 15 cases of adjacent normal cervical specimens as control group, then these 46 specimens were used in MVD detection through immunohistochemical CD34 staining. The MVDs of the tumor group were significantly higher than those in the control group, and the former seems to increase with the clinical stages with a positive correlation. The PF and PEI values have positive correlations with corresponding MVD values. The PF value of squamous carcinoma group has correlation with corresponding MVD value. The PF and PEI values of poorly differentiated group have correlations with corresponding MVD values. The PF, PEI and BV values of II-III stage group are positively correlated with corresponding MVD values. The PF value of lymph metastasis or non-lymph metastasis group both have correlations with corresponding MVD values. We found that CT perfusion parameters were positively correlated with corresponding MVD values in cervical cancer. Our results suggest that CT perfusion is a new method which could reflect tumor angiogenesis, histological malignant grade, invasion, and clinical stage. It will help us determine the tumor staging and prognosis.
Adenocarcinoma ; blood supply ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Squamous Cell ; blood supply ; diagnostic imaging ; Contrast Media ; Female ; Humans ; Microvessels ; pathology ; Middle Aged ; Neovascularization, Pathologic ; diagnostic imaging ; Perfusion Imaging ; Radiographic Image Interpretation, Computer-Assisted ; Tomography, Spiral Computed ; methods ; Uterine Cervical Neoplasms ; blood supply ; diagnostic imaging ; Young Adult