Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.

Objective To explore the influence of the protection motivation theory (PMT) on the self-nursing ability of high-risk diabetic foot (DF) patients. Methods The outpatients in our hospital were selected with high-risk DF between January 2013 and May 2014, randomly divided into the control group and PMT group, 52 cases in each group. Guided under the protection motivation theory, PMT group received a six-month health education and management; and the control group accepted conventional health education of diabetes. Before and after the intervention, some observation indexes of the two groups respectively were evaluated including the ability of diabetic foot self-nursing, foot condition, fasting blood sugar, 2 h postprandial blood glucose. Result After six months, the scores of the self-care ability of diabetic foot and foot condition from the patients of PMT group were higher than that of PMT group before the intervention and that of control group after intervention (P<0.05). Conclusion PMT can help patients with high-risk DF enhance their foot self-care ability, improve their foot condition, control their blood sugar, and prevent the DF onset.

ObjectiveTo study the diagnostic value of sonographic “Leopard pattern” sign in breast hyperplasia.MethodsTwo hundred and twenty-three female patients in Beijing Friendship Hospital from October 2012 to April 2013 were choosen. All the cases were diagnosed as mammary gland hyperplasia clinically, and their breast ultrasound images show the breast imaging-reporting and data system (BI-RADS) grad was 0 or 1. These patients were divided into 3 groups according to their age, Group A: 20 to 35 age (36 cases), Group B: 36 to 50 age (102 cases), and Group C: order than 50 year-old (85 cases). The pathological diagnosis were obtained by ultrasound guided breast biopsy. With pathological diagnosis as the gold standard and “Leopard sign” as ultrasound diagnostic criteria, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated. The consistency between the ultrasonic and the pathological diagnosis were analyzed by Kappa statistical test.ResultThe diagnostic consistency test of the total sample of 223 cases: in terms of the ultrasonic Leopard sign” for the diagnosis of breast hyperplasia, the sensitivity was 69% (59/85),the specificity was 46% (64/138), the accuracy was 55% (123/223), the positive predictive value was 44% (59/133), the negative predictive value was 71% (64/90), the consistency was poor (Kappa=0.14,P<0.05). Group A:the sensitivity was 90% (18/20), the specificity was 50% (8/16),the accuracy was 72% (26/36), the positive predictive value was 69% (18/26), the negative predictive value was 80% (8/10), the consistency was good (Kappa=0.42, P<0.05);Group B:the sensitivity was 70% (33/47), the specificity was 49% (27/55),the accuracy was 59% (60/102), the positive predictive value was 54% (33/61), the negative predictive value was 66% (27/41), the consistency was poor (Kappa=0.19,P<0.05); Group C: the sensitivity was 44% (8/18), the specificity was 43% (29/67), the accuracy was 44% (37/85), the positive predictive value was 17% (8/46), the negative predictive value was 74% (29/39), the consistency was poor (Kappa=0.08,P<0.05).Conclusion“Leopard pattern” sign is not suitable as an independent standard in diagnosing breast hyperplasia disease.

Objective To investigate clinical and histopathological manifestations of cutaneous plasmacytosis.Methods The clinical and histopathological data were collected from 7 cases of cutaneous plasmacytosis and analyzed retrospectively.Results Of the 7 patients,2 were female,and 5 were male.The average age was 42.4 years,and the duration of disease ranged from 2 to 10 years.All the 7 patients presented with multiple slow progressive brown patches and plaques.No abnormality was observed in routine examinations of blood,urine and faeces,electrocardiogram and abdominal ultrasonography in the 7 patients.Three patients underwent serum IgG detection,and their serum levels of IgG were all higher than reference values.Two patients were subjected to cytological examination of bone marrow,which showed the percentage of plasma cells (mainly mature plasma cells) was up to 5％.Histopathological examination of 7 cases showed pigmentation in the basal layer of the epidermis,and infiltration mainly consisting of lymphocytes and mature plasma cells around the blood vessels in the dermis.Immunohistochemical study revealed that the ratio of κ to λ light chain was approximately 1∶ 1,and the plasma cells were strongly positive for IgG.IgG4 was positive in very few plasma cells in 1 case,and negative in the other 6 cases.Conclusion The etiology of cutaneous plasmacytosis is still unclear,but it has characteristic clinical and histopathological manifestations.

OBJECTIVEThe aim of this study was to detect the plasma concentration of OLC1 (overexpressed in lung cancer 1) protein as a potential cancer biomarker, and evaluating its clinical application value in the diagnosis of non-small cell lung cancer (NSCLC).

METHODSWe prepared OLC1 antibody with OLC1 full length protein, in 5-6-week old Bal B/c mice. Each mouse was immunized four times at a dose of 15-30 µg antigen protein, and the interval between two consecutive immunizations was two weeks. Antibody screening was made by ELISA and Western blot, and a double antibody sandwich ELISA kit was developed. We used this established ELISA kit to detect the plasma concentration of OLC1 protein in 281 NSCLC patients and 92 gender- and age-matched healthy controls. Area under the receiver operating characteristic curve (AUC) was used to evaluate the detection efficacy of OLC1.

RESULTSWe obtained 11 OLC1 monoclonal antibodies and successfully established the ELISA kit to detect the plasma concentration of OLC1 with a detection range from 1.95 ng/ml to 62.50 ng/ml. OLC1 concentration in the case group (124.69 ng/ml) was significantly higher than that in the control group (67.07 ng/ml, P < 0.001). In the scenario of distinguishing NSCLC from control group, AUC result was 0.69. When the cut-off was set at 67.72 ng/ml, the sensitivity and specificity was 84.4% and 51.1%, respectively. In term of distinguishing early lung cancer (IA) from normal controls, the AUC, sensitivity and specificity were 0.68, 77.8% and 54.4%, respectively.

CONCLUSIONThe plasma concentration of OLC1 protein is significantly elevated in NSCLC patients. OLC1 may be as a potential cancer biomarker applied in clinical diagnosis.

Adult ; Animals ; Antibodies, Monoclonal ; Biomarkers, Tumor ; blood ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; blood ; diagnosis ; immunology ; Early Detection of Cancer ; methods ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Lung Neoplasms ; blood ; diagnosis ; immunology ; Male ; Mice, Inbred BALB C ; Middle Aged ; Oncogene Proteins ; blood ; immunology ; ROC Curve ; Sensitivity and Specificity ; Young Adult

Objective To compare the etiological constitution of recurrent miscarriage (RM) between patients with consecutive two and three or more miscarriages through combining the routine examination results and embryonic karyotype. Methods Patients with a history of two or more consecutive clinical miscarriages(≤12 weeks of gestation)consulting in the RM clinic of the First Affiliated Hospital of Sun Yat-sen University from March 2011 to January 2016 were collected. Six hundred and ninety-six with detailed history recorded, routine clinical examinations of RM and at least once embryonic karyotype were ultimately enrolled in this study. Their etiological constitution of RM were analyzed in groups of consecutive two and three or more miscarriage. The etiologies of RM in analysis consisted of women age, body mass index (BMI), chromosome abnormalities of couples, uterine abnormalities, endocrinology abnormalities and antiphospholipid syndrome(APS). Results (1)Among 696 patients, the abnormal embryonic karyotypes was 60.6%(422/696)and routine RM etiologies was 32.2%(224/696), leaving the ratio of unexplained RM was only 29.0%(202/696).(2)A total of 717 embryo karyotype were found in 696 patients, included 21 cases with twice embryo karyotype results the percentage of normal embryo was 39.7%(285/717), while abnormal ones was 60.3%(432/717). Among the types of abnormal karyotype, the most common ones (>10%)were trisomy 16(19.2%, 83/432), monosome X(11.3%, 49/432)and trisomy 22(10.9%, 47/432). (3)Among the 696 RM patients, the number of two and three or more miscarriages were respectively 446(64.1%,446/696)and 250(35.9%,250/696). Comparing groups of three or more miscarriages with two miscarriages, there were significant differencein older age as well as uterine adhesion(P<0.05). But no difference was found in body mass index(BMI), the rates of chromosome abnormalities of couples, uterine abnormalities except uterine adhesion, endocrinology abnormalities and APS (all P>0.05) between two groups. Conclusions The abnormal embryonic karyotype is the most common cause of first-trimester RM. The etiological constitution of two and three or more recurrent miscarriages is accordant, suggesting that routine clinical examination and the embryonic karyotype should be started following two consecutive clinical early miscarriages.

Objective    To evaluate the timing of chest tube removal after resection of lung or esophageal cancer. Methods    A prospective randomized controlled study was performed. From June 2014 to February 2016, 150 patients suspected as the cancer of lung or esophagus undergoing neoplasm resection and lymph node dissection in our single medical unit were classified into 3 groups according to the random number generated by SPSS17.0 with 50 patients in the each group. The drainage volume for chest tube removal was ≤100 mL/d in the group Ⅰ, 101–200 mL/d in the group Ⅱ, and 201–300 mL/d in the group Ⅲ. Chest radiography was performed 48 hours following chest tube removal. Results    The 127 patients (108 males and 19 females, with an average age of 59.0±8.7 years) eligible for analysis consisted of 45 patients in the group Ⅰ, 41 in the group Ⅱ, and 41 in the group Ⅲ respectively after the 23 patients were excluded from this study who were diagnosed as benign lesions through intraoperative frozen pathology (n=20) and postoperative complications (empyema in 2 patients and chylothorax in 1 patient). Age, sex, types of neoplasm, and comorbidities except procedures via video-assisted thoracic surgery (and laparoscopy) showed no significant difference among the three groups (P>0.05). No mortality was observed in this study. There were postoperative complications in 6 patients and its distribution had no statistical differences among the three groups (P>0.05). The mean postoperative duration of chest tube was 181.0±68.2 h, 111.0±63.1 h, 76.0±37.2 h, the mean drainage volume was 1 413.0±500.9 mL, 1 005.0±686.4 mL, 776.0±505.8 mL, and the mean hospital stay time following chest tube removal was 19.0±9.7 d, 14.0±8.0 d, 9.0±4.8 d in the group Ⅰ,Ⅱ and Ⅲ,  respectively; there was a significant difference among the three groups (P=0.000). The 13 patients required reintervention after chest tube removal due to pleural effusion accumulation and it had no difference among the three groups (P>0.05). Chest pain relieved essentially after chest tube removal in all patients. Conclusion    A drainage volume of ≤300 mL/d as a threshold for chest tube removal after resection of lung or esophageal cancer can shorten postoperative hospital stay and accelerate early recovery of the patients.

Objective: To observe the root and root canal morphology of mandibular second molars in Western Guangxi by CBCT, to provide a reference for clinical diagnosis and treatment. Methods: In total, 564 patients′ 1 128 mandibular second molars that satisfy the inclusion criteria were analyzed with a planmecaromexis CBCT machine and its own image analysis software. The patients′ gender, age and ethnic differences in the root and canal morphology and the symmetry of the bilateral root and canal were statistically analyzed. Results: Among the 1 128 mandibular second molars, 662 were the Zhuang ethnic group and 384 were the Han ethnic group, and 82 were other ethnic groups; the double root type and C-shaped root type accounted for a relatively high proportion: 73.94% and 24.47%, respectively. The detection rates of the double root type were higher in males than in females (P < 0.05); the detection rates of the C-shaped root type were higher in females than in males (P <0.05); the root type of the teeth was mainly double-rooted in the Zhuang ethnic group (P<0.01). The incidence of type IV in the mesial root of the double root type mandibular second molar was the highest (P < 0.01), and the incidence of type I in the distal root was the highest (P < 0.01). The C-shaped root canal is more continuous at the mouth of the root canal, more downward corresponds to a worse continuity: in three different levels of root canal orifice, root middle and root apex, the root canal orifice is dominated by the C1 type, and both root middle and root apex are mainly C3-type (P < 0.01). The difference in symmetry of bilateral roots and root canals was statistically significant among different gender groups, age groups, and ethnic groups (P < 0.05): there were more males than females, the results in the 18-35-year-old group and the Zhuang ethnic group were higher. Conclusion The root and root canal morphology of mandibular second molars in western Guangxi people are complex and changeable. The roots are mainly double root type in the Han ethnic group and the Zhuang ethnic group. C-shaped roots are also common. The detection rate of C-shaped roots in the Zhuang ethnic group was higher, and the symmetry rate of bilateral roots and that of bilateral root canals was higher in the Zhuang ethnic group than in the Han ethnic group.