Objective To investigate the correlation between level Ⅱ cervical lymph node metastasis (CLNM) and thyroid disease background,tumor size,location,and local lymph node metastasis in patients with papillary thyroid carcinoma (PTC).Methods A thyroid cancer database was established using Access database software.62 patients with PTC undergoing neck dissection in the 1st Department of Head and Neck surgery of Sichuan Cancer Hospital from Aug.2013 to Mar.2014 were retrospectively reviewed in terms of their sex,age,thyroid disease background,number of nodules,tumor size,location,and CLNM.Results 30 out of 62 patients had level Ⅱ cervical lymph node metastasis (Ⅱa:27 cases,Ⅱb:6 cases).13 out of 23 patients without history of other thyroid disease had level Ⅱ CLNM,9 out of 17 patients with Hashimoto's thyroiditis had level Ⅱ CLNM,3 out of 18 patients concomitant with nodular goiter had level Ⅱ CLNM and 2 patients concomitant with hyperthyroidism and having received radioactive iodine 131 treatments had level Ⅱ CLNM.Among patients with level Ⅱ CLNM,2 patients had tumors ＜10 mm,17 patients had tumors between 10 mm and 40 mm,and 4 patients had tumors ＞40 mm.Most of the tumors (11/17) with level Ⅱ CLNM were located in the upper polar of the thyroid,while the rest were located in the middle (12/23) and lower (3/12) region of thyroid.Conclusions Level Ⅱ CLNM is a common feature of thyroid carcinoma.It has been well accepted that level Ⅱ cervical lymph node should be dissected when extracapsular invasion or CLNM to level Ⅲ or Ⅳ occurs.In addition to traditional risk stratification,level Ⅰ CLNM is correlated with tumor size,location,and thyroid disease background.Therefore,close attention should be paid to level Ⅱ cervical lymph node when tumors are located in the upper polar of thyroid and individualized treatment should be chosen for each patient.

Objective To discuss the preventive strategy of complications in reoperation of differentiated thyroid carcinoma (DTC).Method Clinical data of 114 patients with DTC who needed reoperation because of recurrence or inadequate operation were reviewed retrospectively.The reoperations included total thyroidectomy for 101 cases,lobectomy for 13 cases,central compartment neck dissection for 94 cases,and lateral neck dissec tion for 65 cases.Results 8 cases (8.77％) suffered from temporary RLN injury,one patient (0.88％) has permanent nerve palsy.Nerve dysfunction recovered after reoperation in 4 cases who had suffered from recurrent laryngeal nerve palsy in previous operations.Transient hypoparathyroidism occured in 10 patients (8.77％),and per manent hypoparathyroidism happened to 2 patients (1.75％).Conclusion For patients undergoing reoperation,detailed preoperative examination,proper operative approach,meticulous dissection on the thyroid capsule,visual identification of RLN followed anatomic landmark and intraoperative nerve monitoring (IONM) are key factors to reduce complications in reoperation of DTC.

Objective To analyze the pulse-field gel electrophoresis (PFGE) patterns and antibiotic resistance of Salmonella enteritidisstrains isolated in Longyan city in order to provide reference for effective control, clinical diagnosis and treatment of outbreaks of food-borne diseases.Methods Seventy-seven Salmonella enteritidis strains isolated from food poisoning cases, livestock and poultry meat samples collected for food safety risk monitoring and sporadic cases in 2014 and 2016 were analyzed by PFGE.Antibiotic susceptibility testing was carried out to determine the minimum inhibitory concentrations (MIC) of 16 common antibiotics to 57 strains.Results Seventeen PFGE types were identified among the 77 Salmonella strains including three predominant types (P4, P6 and P8) and were grouped into three major pulsotypes (Cluster1-3) at 90% similarity level.The predominant types causing outbreaks of Salmonella enteritidis infection were P8, P6, P4 and P14, which were responsible for five cases of food poisoning.These isolated strains were highly resistant to nalidixic acid (93%), followed by resistance towards ampicillin (74%) and streptomycin (54%).Forty-one strains were resistant to three or more antibiotics (71.93%).Conclusion The PFGE types of Salmonella enteritidis strains isolated in Longyan city exhibit polymorphism and are clustered into three major pulsotypes.PFGE molecular typing can provide early-warning of sporadic outbreaks and help to identify the sources of infections in Salmonella enteritidis-related food poisoning.Attentions should be paid to multidrug resistant Salmonella enteritidis.Surveillance for multidrug resistant strains and usage of antibiotics should be strengthened.

Objective To explore the value of intraoperative neuromonitoring (IONM) for recurrent laryngeal nerve (RLN) injury during difficult thyroid carcinoma operation.Methods Data of 102 patients admitted from Nov.2012 to Nov.2015 who underwent complex thyroid carcinoma operation were retrospectively analyzed.Among the 102 patients,39 were receiving the first operation due to local advanced thyroid cancer,and 63 were receiving the second operation.According to whether IONM was applied,the patients were divided into the observation group(57 patients) and the control group(45 patients).Difference of the time cost in exposing and dissecting RLN and RLN injury rate between the two groups was compared.Results The time cost in exposing and dissecting RLN was shorter in the observation group ((7.88±1.55)min) than in the control group ((12.60±3.56)min),with statistical difference (t=-2.449,P=0.044).Three patients (5.26％) in the observation group and 7 patients(15.56％) in the control group had temporary RLN injury,with no statistical difference (P=0.161).No one in the observation group and 2 patients (4.44％) in the control group had permanent RLN injury,and the difference had no statistical significance(P=0.192).Conclusions On the basis of normative surgical procedure,IONM technology can reduce the time of exposing and dissecting RLN,and it has practical value in reducing the risk of RLN injury in difficult thyroid carcinoma operation.

Pulmonary hypertension (PH) is an extremely malignant pulmonary vascular disease of unknown etiology. ADAR1 is an RNA editing enzyme that converts adenosine in RNA to inosine, thereby affecting RNA expression. However, the role of ADAR1 in PH development remains unclear. In the present study, we investigated the biological role and molecular mechanism of ADAR1 in PH pulmonary vascular remodeling. Overexpression of ADAR1 aggravated PH progression and promoted the proliferation of pulmonary artery smooth muscle cells (PASMCs). Conversely, inhibition of ADAR1 produced opposite effects. High-throughput whole transcriptome sequencing showed that ADAR1 was an important regulator of circRNAs in PH. CircCDK17 level was significantly lowered in the serum of PH patients. The effects of ADAR1 on cell cycle progression and proliferation were mediated by circCDK17. ADAR1 affects the stability of circCDK17 by mediating A-to-I modification at the A5 and A293 sites of circCDK17 to prevent it from m1A modification. We demonstrate for the first time that ADAR1 contributes to the PH development, at least partially, through m1A modification of circCDK17 and the subsequent PASMCs proliferation. Our study provides a novel therapeutic strategy for treatment of PH and the evidence for circCDK17 as a potential novel marker for the diagnosis of this disease.