Humans ; Surgeons ; Thyroid Neoplasms ; surgery ; Thyroidectomy

Objective To assess the effect of continuous renal-replacement therapy (CRRT) dose on the outcome of acute renal failure (ARF) patients with meta-analysis of randomized controlled trials (RCTs). Methods Studies were identified by systematic search of peer-reviewed publications in Medline, EMBASE and Cochrane library database through June 2010. All the RCTs that compared the incidence of clinical outcome such as mortality, need for chronic dialysis between standard and low dose CRRT were eligible. The pooled relative risk (RR) for clinical outcome was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup and sensitivity analysis. Results Six eligible studies were identified. By meta-analysis, standard dose CRRT was associated with non-significant 13% mortality risk reduction (RR 0.87, 95%CI 0.70-1.07, P=0.19)and 13% composite outcome risk reduction of chronic dialysis dependence and mortality (RR 0.87, 95%CI 0.69-1.09, P=0.21), but the trend toward increased chronic dialysis dependence risk among survivors (RR 1.43, 95%CI 0.94-2.18, P=0.09). The overall test for heterogeneity among cohort studies was significant (P=0.001, I2=76.2%). The risk of mortality was modality was significantly lower in some studies of which delivered dose was moer than 35 ml·kg-1·min-1,modality was continuous venous-venous hemofiltration (CVVH) and major cause was non-sepsis treated with standard dose CRRT. Conclusions Standard dose CRRT in patients with ARF does not improve survival, renal recovery and composite outcome, but decreases mortality in important subgroups including those with higher delivered dose, CVVH and non-sepsis.

Objective To investigate the distribution pattern of the ADAS-Cog scores among the elderly in Beijing and to evaluate the application of ADAS-Cog in distinguishing patients with mild Alzheimer's disease (AD) and healthy elderly. Methods In total, 1616 healthy elderly (NC), 125 elderly patients with non-AD disorders (ND), and 310 patients with probable AD including 201 patients with mild AD and 109 patients with moderate AD (by NINCDS-ADRDA criteria) were recruited in the study and their cognitive performance was measured by the ADAS-Cog.Results In NC group, those older than 80 years and those with less than 5 years schooling scored highest. There was statistically significant correlation between the total scores of the ADAS-Cog and age and duration of schooling in NC group (F=14.34, 113.27,both P<0.01). No correlation was suggested in the mild AD group. The total score of ADAS-Cog was significantly associated with duration of schooling in both moderate AD and ND groups (F=4.18, 8.72, both P<0.05). The total score of ADAS-Cog differentiated the patients with mild AD from NC healthy elderly with AUC ranging from 0.69 to 0.82 in each subgroup by age, and from 0.75 to 0.88 in subgroups by durations of schooling with the highest AUC of 0.88 in the subgroup having more than 15 years of schooling education. Conclusions The ADAS-Cog score in the healthy elderly is significantly associated with age and duration of schooling education. The ADAS-Cog can be applied in the cognitive assessment of Chinese AD patients. The total score of ADAS-Cog could efficiently differentiate patients with mild AD from healthy elderly, especially in subjects with higher education level.

Objective To investigate the value of MR perfusion-weighted imaging(PWI)in the evaluation of therapeutic effect of brain metastases with gamma knife.Methods Treatment by gamma knife before and after that 3 months or 6 months PWI studies were penformed respectively in 22 patients with brain metastases .Maps of relative regional blood volume(rCBV)and mean transit time(MTT)were obtained.The ratios of rCBV and MTT of lesions were analyzed.Results rCBV of tumors in 22 cases was increased.The ratios of maximum rCBV of the lesions and opposite side were 6.16?3.12 and 1.18?0.17 respectively.The ratios of MTT of the tumors was 1.44?0.53.After gamma knife treatment,9 of 22 cases appeared decreased rCBV,but the ratios of MTT were no changing,of them,3 cases presented cerebral necrosis.13 of 22 cases,the ratios of rCBV were increased in varied degree after treatment by gamma knife,and 6 cases presented brain radionecrosis.Conclusion PWI is a significant method in evaluating the therapeutic effect of brain metastases with gamma knife

Objective To explore the diagnostic value of MR fast imaging sequences in fetal lung congenital cystic adenomatoid malformation(CCAM).Methods 8 cases with suspected CCAM by US were examined with MRI fast sequences,including single shot turbo spin echo (SSTSE)and balanced fast field echo(B-FFE),and undergone axial,sagital and coronal scanning sections of fetal chests.MRI findings were compared with surgery(2 fetuses),autopsy (3 fetuses)and CT examination (3 fetuses).Results 7 fetuses with CCAM and 1 fetus with bronchopulmonary sequestration(BPS)diagnosed by MRI were confirmed by following surgery,autopsy and CT examination.Among the 7 CCAM cases,2 leisions were on the left side,while the other 5 lesions were on the right side.Fur-thermore,2 cases were cystic type and the rest 5 cases were mass type.The BPS was located in the lower left lung lobar.Conclusion MR fast imaging sequences in fetal can clearly demonstrate location,type and extent of CCAM and can provide important supplement information of the prenatal fetal ultrasound examination.

Objective To explore the relationship of MDR1 and its encoded product P-gp expressions with clinical efficacy of transcatheter arterial chemoembolization (TACE)in primary liver cancer and their clinical significance.Methods We selected 108 patients with primary liver cancer who came to our hospital between June 2010 and June 2013 as observation subjects.Meanwhile 50 healthy people in our hospital for liver biopsy were selected as controls.MDR1 mRNA level in observation group and control group was determined by real-time quantitative PCR.P-gp protein level was analyzed by immunohistochemistry.According to P-gp level,the 108 patients were divided into drug-resistance groups and non-resistance group;the relationship between P-gp expression level and clinical efficacy was analyzed.Results MDR1 mRNA level in liver tissues significantly enhanced in observation group compared with that in control group (P <0.05).In observation group 32 patients had the ratio of MDR1 mRNA level-normal level of more than 2 and 76 patients had the ratio of MDR1 mRNA level-normal level of less than 2. Immunohistochemistry revealed that MDR1 encoded product P-gp was brownish yellow, mainly expressed in the cell surface of liver cancer cells.There were 35 P-gp protein-negative patients (non-resistance group)and 73 positive patients (resistance group).Clinical efficacy was significantly higher in non-resistance group (74.28%)than in resistance group (43.28%)(P <0.05).The 1 year and 2-year cumulative survival rates were 54. 12% and 27.40% in resistance group and 77.14% and 42.86%% in non-resistance group.They were significantly higher in the latter group (P <0.05 ).Conclusion The overexpressed MDR1 encoded product P-gp in primary liver cancer is associated with multidrug resistance in tumor chemotherapy,suggesting that P-gp can be used as one of the guiding clinical markers of chemotherapy.

Objective To study the percentages of polymorphonuclear leukocytes (PMN), mononuclear cells (MNC) and fibroblastic cells (FBC) in different post-traumatic intervals after skeletal muscle me-chanical injury in rats. Methods The rat model of skeletal muscle mechanical injury was established. The rats were divided into injured groups (6 h, 12 h, 1 d, 3 d, 7 d, 10 d and 14 d after injury ) and con-trol group. The percentages of PMN, MNC and FBC in different post-traumatic intervals after skeletal muscle mechanical injury were assessed with HE staining and image analysis. Results At post-injury 6-12 h, the percentages of PMN and MNC infiltration appeared in injured sites and that of PMN reached peak. At 1 d, the percentage of MNC infiltration appeared and reached peak, while that of PMN de-creased. At 3-7 d, the percentage of FBC gradually increased, while that of PMN and MNC decreased. At 10-14 d, the percentage of FBC reached peak. Conclusion The percentages of PMN, MNC and FBC in injured zones showed time-dependent changes, which might be used as reference index for determination of age of skeletal muscle injury.

Objective:To understand the influencing factors of free education for rural order-oriented medical students and to explore the willingness of students to serve at the grass-roots, so as to provide reference for further optimizing the free education of medical students.Methods:A self-designed questionnaire survey was performed among 196 medical undergraduates majoring in free clinical medicine in one medical university of Shandong Province in March 2018 and 198 undergraduates majoring in general clinical medicine enrolled in the same year. The results of the survey were analyzed by SAS 9.2, and chi-square test, rank sum test and logistic regression were used to make statistic analysis.Results:The factors such as score of the national university entrance exam (wald χ2 = 52.309, P < 0.001), household registration location (wald χ2 = 9.304, P = 0.002), whether the only child in the family (wald χ2 = 12.608, P < 0.001), average monthly income of the family (wald χ2 = 5.557, P = 0.018), decision makers (wald χ2 = 15.206, P = 0.002) and willingness to serve at the grass-roots medical institutions (wald χ2 = 67.832, P < 0.001) had influence on medical students' choice of free education for order directional medical students. There were 113 (57.65%) of the free medical students intended to work at the grass-roots, while only 16 (8.08%) of the general medical students who were willing to work at the grass-roots. Conclusion:The implementation of free education for order-oriented medical students policy can satisfy the wishes of some people who have the willingness to serve at the grass-roots, but their family income and college entrance examination scores are not high. However, there are still some problems, which need the joint efforts of the government health departments and the training colleges and universities, and the corresponding follow-up support policies should be issued by the state at the same time.

97 cases of jaw bone fractures were treated with rigid internal fixation.16 cases had malocclusion postoperation.The etiology was analyzed and the prevention methods were proposed.Intermaxillary elastic traction or fixation and craniomaxillofacial fixation or craniomentum elastic traction were performed to treat the malocclusion.By this way,14 cases were cured.1 case was operated again to resume the normal occlusion,1 case received occlusal adjustment.Incomplete reduction,incorrect operative performance,deficiency of postoperative intermaxillary fixation and incorrect intermaxillary fixation were the main causes to malocclusion.So anatomic in time reduction,correct operative performance,intermaxillary fixation,application of craniomaxillofacial fixation or craniomentum elastic traction instead of intermaxillary fixation for some special cases are effective methods to correct postoperative malocclusion.

OBJECTIVE: To investigate the possibility of thyroidectomy/lobectomy without drainage after surgery. METHOD: Eighty-eight consecutive cases with thyroid mass have been underwent operations including: lobectomy group(42 cases), thyroid lobectomy with contralateral partial thyroidectomy group (17 cases) and total thyroidectomy group (29 cases) from 2013. 06 to 2014. 06 in Nanjing Tongren Hospital. FIfteen patients with thyroid operation in other hospital were collected from 2014. 01 to 2014. 06, the recovery of postoperative incision were compared. RESULTS: Eighty-four cases were smoothly discharged from hospital except 4 thyroidectomy cases suffered from a small amount of effusion in surgical cavity. Our postoperative wound recovery were more in line with the principle of cosmetology compared with other hospital operation group. CONCLUSION Drainage following thyroidectomy is not essential, if the thyroid surgery is meticulous in each step of the surgery, and can increase the effect of beauty.
Drainage ; methods ; Humans ; Postoperative Period ; Thyroid Diseases ; Thyroidectomy