[Summary] Pancreatic neuroendocrine tumors( P-NETs) is the most important cause of mortality for patients with multiple endocrine neoplasia type 1 ( MEN1 ) . Improved outcome depends on early diagnosis and optimal management. In this perspective, we are discussing the updated studies and challenges regarding as biochemical screening, tumor localization, prognosis prediction, surgery and therapy of advanced diseases.

The outstanding progress in the molecular basis of thyroid carcinoma has offered a tool for the development of new drugs,mainly tyrosine kinase inhibitors (TKIs).A number of TKIs are now being applied to the treatment of thyroid carcinomas.Recent clinical trials of TKIs in patients with advanced thyroid cancer have shown some promising preliminary results.This review summarizes the most relevant achievements in the field and the challenges we are facing.

BACKGROUND: One major reason for transplanted kidney failure is BK virus (BKV) associated nephropathy, which leads to renal inadequacy and ureteral obstruction. OBJECTIVE: To identify the incidence of BKV viremia in kidney transplant recipients, as well as to analyze the risk factors of BKV infection. DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Urology, Affiliated Beijing Friendship Hospital of Capital Medical University from September 2001 to December 2007. PARTICIPANTS: One hundred and twenty-one renal transplant patients, and 20 renal failure patients, who underwent hemodialysis were served as control group. METHODS: The viral load in plasma was quantified with a real-time PCR method. The recipients were divided into the PV+ group (BKV DNA positive blood samples) and PV- group (BKV DNA negative in blood samples) according to the detection outcomes. The gender, age, cold ischemia time, immunosuppressive agent, donor type and other clinical parameters were compared between 2 groups. MAIN OUTCOME MEASURES: Logistic regression was performed to determine risk factors for BKV infection. RESULTS: The incidence rate of BKV viremia accounted for 24.7% (30/121) of kidney recipients, which was higher than the control group (1/20), the difference between them was significant (P = 0.03). Logistic regression found that cold ischemia time (RR 3.34, 95% CI 2.76-5.60) and cadaver donation (RR 2.19, 95% CI 1.32-3.97) were significantly related to BKV viremia. However, ages of recipients, time of collecting samples, and intravenous glucocorticoid therapy was independence to BKV viremia. CONCLUSION: Kidney recipients are the high risk population who are susceptive to BKV infection. Cold ischemia time and cadaver donation may be the risk factors of BKV viremia.

Repeat cervical cytologic testing,human papillomavirus(HPV)testing and immediate colposcopy are currently the most general managements in women with atypical squamous cells of undetermined significance(ASCUS)result.However,the efficacy of these three methods is hampered by strong subjectivity,high false negative and positive rates.With the development of the aetiology of cervical cancer,there is good evidence that biomarkers for persistent HPV infection,HPV integration,instability of host genes and malignancy triage ASCUS more objectively and efficiently.The three-dimensional multiparameter biomarker-based detection may be the predominant method for the triage of women with abnormal cervical cancer screening result.

Objective To establish the quality standard for Yuyuan Mingmu Granula. Methods Radix Et Rhizoma Notoginseng,Fructus Schisanrae Chinesis,Flos Scophorae and Fructus Forsythiae were identified by TLC. The content of loganin was determined by HPLC. Results Under the selected conditions,clear and specific spots were obtained. For content determination,the linear range of loganin was 0.084 ?g～0.840 ?g,r=0.999 9,the average recovery was 98.5 %(n=6)and RSD was 1.29 %. ConcLusion The method is proved to be simple and specialized with a good reproductivity and can be used to control the quality of Yuyuan Mingmu Granula.

Objective To investigate the risk factors and predictors of poor outcome in full-term neonates with severe hyperbilirubinemia. Methods Data were retrospectively collected from 326 neonates with severe hyperbilirubinemia hospitalized between January 1, 2012 and December 31, 2012. Results A total of 326 full-term neonates with severe hyperbilirubinemia were included in this study (181 males and 145 females). The average gestational age was 39.12±1.17 weeks. Two hundred and sixty (260) cases were followed up successfully by phone while 66 cases were lost to follow-up. Infection (74.40%) and hemolytic disease (51.19%) were the main causes of severe hyperbilirubinemia. Multiple factors regression analysis found that threshold TSB was an independent risk factor of poor outcome (OR=2.02, 95%CI:1.13~3.62, P=0.018). The outcome of neonates with BIND scored between 0-6 had poor prognosis and some of them were reversible, and the outcome in those scored between 7-9 were of worse prognosis. Threshold TSB, USB and B/A ratio in group of poor outcome were signiifcantly higher than those in other groups and their area under the ROC curve evaluating the prognosis was 0.682, 0.671 and 0.698, respectively. With TSB at 474.5 μmol/L, UCB at 449.15 μmol/L and B/A at 0.923 mg/g, Youden index was the higest. The results of BAEP, OSE, MRI and NBNA were not signiifcantly different between groups with or without poor outcome. Conclusions Threshold TSB is an independent risk factor of poor outcome in full-term newborns with severe hyperbilirubinemia. BIND score is a very good predictor of outcome. TSB threshold, USB and B/A ratio are the predictors of outcome, but their diagnostic values are limited. NBNA, hearing screening and hyperintense globus pallidus on T1W1 in the acute phase of jaundice might not related with neurologic prognosis.

This paper focuses on the requirements of joint operations under informationization in the future,and system-atically analyzes the characteristics of medical protection with regard to epidemic causes and surveillance,prevention meas-ures,mental health,and nuclear,chemical and biological protection.This paper elaborates on the basic principles of medical protection and raise proposals about health and epidemic protection so as to provide references for health support of PLA during joint operations.

OBJECTIVETo investigate the application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis.

METHODSFrom July 2005 to June 2013, 25 patients with multi-segmental myelopathic cervical spondylosis were treated by the expanding forming under the plate through cervical spatium intermusculare approach including 16 males and 9 females with an average age of 56.5 years old ranging from 35 to 78 years old. Among them, 10 cases were onset without causes slowly, 7 cases were onset without causes suddenly, 8 cases were onset after mild trauma or tired. JOA scoring, incidence of postoperative axial symptoms and imaging studies were used to evaluate the effect.

RESULTSTwenty-five cases were followed up for 6 months to 7 years and 6 months with an average of 2 years and 9 months. There were no infection, cerebrospinal fluid leakage after the operation, and complications such as nerve damage were occurred. The operation time was 120 to 150 min, the bleeding was 300 to 500 ml. Imaging examination showed vertebral canal sagittal diameter increased, the vertebral canal increased significantly in the cross sectional area of the spinal cord, cervical curvature was straighten in 4 cases (2 cases of them became normal sequence). There were no more cases of cervical protruding and segmental instability increased. Postoperative walking ability enhanced, the finger activity of majority of patients improved on flexibility, grip strength, and accuracy of using chopsticks improved, numbness and chest waist band feeling had different degree of reduce, preoperative urine impairment were improved to varying degrees. Preoperative JOA scores were 3 to 13 points with an average of (8.86 ± 4.25) points; Postoperative 12 months' JOA scores were 7 to 17 points with an average of (13.76 ± 3.56) points, period was 60.19% in average, JOA score had statistically difference between before and after operation (P < 0.05). The result were excellent in 14 cases, good in 6 cases, and fair in 4 cases and poor in 1 case.

CONCLUSIONApplication of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis, through muscular clearance, can retain complete cervical back muscle, maintain stability of cervical spine, and vertebral canal can get effective decompression at the same time.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; Female ; Humans ; Laminectomy ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Spondylosis ; surgery

OBJECTIVETo explore the surgical method and its effects of adjacent spinal segment degeneration after anterior cervical fusion.

METHODSFrom March 2000 to March 2011, 27 patients with spinal segment degeneration who had accepted the operation of anterior cervical fusion were treated with surgical treatment. There were 16 males and 11 females with an average age of 55.3 years (ranged from 48 to 72 years). JOA scores and image examination were used to evaluate the clinical effects.

RESULTSAll patients were followed up for 1.8 to 7.2 years with an average of 3.6 years. All pathological segments obtained fully decompression with good spinal bombe, no internal fixation loosening and cervical spine instability were found. Nerve root pain had disappeared and nerve function had significantly improved. Before operation, 3 days after operation and at last follow-up, JOA scores were 9.15 +/- 3.46, 13.96 +/- 2.79 and 13.52 +/- 2.91, respectively, and there was significant difference between preoperation and postoperation (P < 0.05). Intervertebral height and physiological curvature improved obviously than preoperation (P < 0.05).

CONCLUSIONIn order to relief spinal compression and rebuild spinal stability, a surgical treatment will be recommend to adjacent spinal segment degeneration combining spinal nerve symptoms and physical sign as soon as possible. Selecting an appropriate surgery to treat different compressed segment would receive satisfactory results.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; adverse effects

Objective To evaluate the differentiation diagnostic value of acoustic radiation force impulse imaging (ARFI) technique to the benign and malignant breast lesions .Methods A total of 87 breast masses in 84 patients were selected and per‐formed the routine ultrasound ,virtual touch imaging(VTI) and virtual touch quantification(VTQ) examination .The shear wave ve‐locity was obtained .The average optical density of the tumor was obtained by processing the VTI images by using the image J soft‐ware .The pathological results served as the gold standard and the ROC curve was drawn .Finally ,the significance of ARFI was e‐valuated .Results All 87 pathologically verified breast tumors included 31 malignant lesions and 56 benign lesions .In malignant le‐sions ,there were 21 lesions with VTQ value≥3 .49(threshold value) and 10 lesions with VTQ value<3 .49 .In benign lesions ,there were 3 lesions with VTQ value≥3 .49 and 53 lesions with VTQ value<3 .49 .In malignant lesions ,there were 28 lesions with the mean optical density value≥202 .25(threshold value) and 3 lesions with the mean optical density value<202 .25 .In benign lesions , there were 6 lesions with the mean optical density value≥202 .25 and 50 lesions with the mean optical density value<202 .25 .There were statistically significant differences in the shear wave velocity measured by VTQ and average optical density measured by VTI between malignant and benign lesions(P=0 .000) .The sensitivity ,specificity ,positive predictive value ,negative predictive value ,ac‐curacy rate and Youden index of conventional ultrasound were 96 .8% ,67 .8% ,62 .5% ,97 .4% ,78 .2% ,0 .645 ,respectively ;which for ARFI were 93 .5% ,98 .2% ,96 .7% ,96 .5% ,96 .6% and 0 .917 ,respectively .Conclusion The ARFI is superior to the conven‐tional ultrasound in the specificity and accuracy rate in diagnosing breast tumor .