Objective To study the effect of thrombolysis of inta-arterial infusion of different concentrations of urokinase(UK) in dogs. Methods 25 healthy crossbreeding dogs were divided into five groups, with five dogs in each group. Every dog was injected with self-thrombus from carotis interna artery to embolize its distal part or branchers. Treatment with different concentrations of UK was initiated 2 hours after setting up the model of cerebral embolism by carotis interna artery. The dose of each group was: A(control group), 0.9% physiological sodium chloride solution; B,1 200U/ml UK; C,6 000U/mlUK; D, 12 000U/mlUK; E, 60 000U/mlUK. Angiography and CT scannings were performed before and after thrombolysis. Pathologic examination was performed 24 hours after embolism. Results The rate of recanalization of groups A,B were 0 but 100% for groups C,D and E, Judged by angiographies after thrombolysis, group C,D and E had significantly better reperfusion compared with group A,B(P

Objective To emphasize the importance of embolization of nonbronchial systemic arteries in treatment of acute and life-threatening massive hemoptysis.Methods In a series of 146 patients with hemoptysis who underwent bronchial artery embolization,we found 12 cases whose blood supply were from 17 nonbronchial systemic arteries and hemoptysis was more than 300 ml blood within 24 hours.Embolic materials included absorbable gelatin sponge(GS),kelp micro gelatin(KMG),polyvinyl alcohol(PVA) particles and metal coils. Results In the 12 cases with 17 nonbronchial systemic arteries (4 were intercostal,3 internal mammary,3 thyrocervical trunk,3 inferior phrenic,1 left gastric,2 originated from the inferior aortic arch,and 1 originated from anterior abdominal aortic wall).Five cases were embolized by GS alone,2 cases by KMG,3 cases by GS+PVA,and 2 cases by GS+PVA+metal coils.Eight cases were performed embolization once,3 cases were performed twice and 1 case was performed three times.No significant complications developed related to embolization,except that 1 patient had transient eyesight decrease after embolization of thyrocervical trunk and 2 patients had chest pain after embolization of intercostal artery which resovled without any treatment.Conclusions During bronchial artery embolization for hemoptysis patients,all supplying artery should be searched and found.Even after successful embolization of bronchial arterys for hemoptysis patients,nonbronchial systemic arterial supply should still be taken into account.

Objective To study the value of breast vascularity in differential diagnosis of benign and malignant breast lesions. Methods The data of 37 patients with benign and malignant breast lesions in the Second Hospital of Shanxi Medical University from February 2017 to November 2017 were respectively analyzed. The number, diameter, length and breast-feeding arteries of bilateral breast vessel were recorded in the maximal intensity projection (MIP) of magnetic resonance imaging (MRI) and were scored according to Sardanellie. The patients were divided into the benign group and the malignant group according to the pathological results. Besides, ≥2 cm group and <2 cm group was also divided according to the maximum diameter of lesions. The differences in number and score of vascularity in both groups were compared. And the diagnostic efficacy of MRI was evaluated based on Sardanellie score and breast-feeding arteries. Results There were no significant differences in the number and score of vascularity between bilateral breast in benign breast lesions group (1.11 ±0.35 vs. 1.22 ±0.45, t= 0.19, P= 0.85; 0.89 ±0.38 vs. 0.95 ±0.21, t= 0.25, P=0.80). The number and score of vascularity of the affected side were higher than those of the healthy side in breast malignant lesions group (2.61 ±1.29 vs. 0.61 ±0.21, t= 6.18, P= 0.00; 1.78 ±0.65 vs. 0.61 ±0.21, t=6.30, P=0.00 respectively). The number and score of vascularity were statistically different between benign and malignant breast lesions (t= 8.57, P< 0.001; t= 12.61, P< 0.001). The number of vascularity in the malignant group was higher than that in the benign group with the maximum diameter of lesion<2 cm (1.27 ± 0.59 vs. 2.57±0.98, t=90.5, P< 0.05), and there was no significant difference in the scores of vascularity in the malignant group and the benign group (1.09 ±0.43 vs. 1.86 ±0.38, t= 87.0, P> 0.05); The number and score of vascularity in the malignant group were higher than those in the benign group with the maximum diameter ≥2 cm (0.92±0.63 vs. 2.64±1.50, t=47.5, P<0.05; 0.92±0.33 vs. 1.73±0.79, t=53.5, P< 0.05). There was no significant improvement in the diagnostic efficacy of MRI based on the score of vascularity and positive breast-feeding arteries in the identification of benign and malignant lesions when the maximum diameter of lesions were<2 cm, and it had a high diagnostic efficacy when the maximum diameter of lesions were ≥2 cm. Conclusions The vascularity of breast can be clearly seen by using breast dynamic contrast enhanced (DCE) MRI. The increase and score of vascularity in the differential diagnosis of benign and malignant breast lesions have a certain application value. The positive of breast-feeding arteries may increase the diagnostic efficiency of MRI.

Objective To probe the reasonable range of central lymph node dissections(CLNs)for papillary thyroid carcinoma (PTC) in cN0 T1/T2 by analyzing the metastasis regulations of PTC in cN0 T1/T2.Methods Data of 891 PTC patients in cN0T1/T2 cases according to the research criterion from Oct.2013 to Sep.2017 were analyzed.All the patients were under the treatment of the same group of surgeons in Department of Thyroid Surgery of the First Affiliated Hospital of the Kunming Medical University and had undergone operation of bilateral total resection of thyroid gland and central lymph node.The clinical and pathological data were collected.Univariate and multivariate analysis were used to investigate the risk factors of central neck lymph node metastasis and high volume central neck lymph node metastasis.Results ①Univariate analysis showed that gender (P=0.002),age(P=0.002),multiform(P=0.000),nodular goiter(P=0.000)and with Hashimoto's(P=0.031)had significant influence in prevalence of CLN node metastasis.Gender(P=0.010)and tumor size(P=0.000)showed significant influence in prevalence of high volume CNL node metastasis.In multivariate analysis,age (OR=0.962,OR=2.856)and nodular goiter(OR=0.969,OR=3.012)showed the independent risk factor of CNL node metastasis and high volume CNL node metastasis.②The numbers of lesion in unilateral lesion were not correlated with IpsiCLNs and Cont-CLNs metastasis (P=0.347,P=0.653).The tumor diameter was correlated with Ipsi-CLNs and ContCLNs metastasis (P=0.010,P=0.000).The tumor diameter of bilateral multifocal carcinoma was correlated with LN-prRLN-CLNs metastasis (P=0.019).The tumor diameter of left and right unilateral single focal lesion was not correlated with LN-prRLN-CLNs metastasis(P=0.684,P=0.072).Conclusions According to the study,it is recommended that the PTC in cN0 T1/T2 should routinely undergo preventive central lymph nodes dissection in the case of technical support:①Preventive overall CLND is recommended for unilateral non-microscopic carcinoma and bilateral multiform carcinoma,especially in those older than 55.②For patients with unilateral single or multifocal microscopic carcinoma,only ipsilateral central lymph nodes dissection can be considered.③ Generally,routine dissection is not necessary for the lymph nodes of the right recurrent laryngeal nerve in the central region of the neck.However,for bilateral non-small cancers and right non-small cancers,LN-prRLN-CLNs dissection is recommended.

Teaching rounds is an important part of clinical teaching practice, therefore, we established a demonstration team for teaching ward rounds. By formulating standard operation procedure for teaching rounds and encouraging innovation on teaching models, the team played a demonstration role in the clinical teaching rounds, which not only made up the shortcomings in teaching, but also improved the teaching level of clinical teachers and the quality of clinical training.

Using chemoproteomic techniques, we first identified EIF2AK2, eEF1A1, PRDX3 and VPS4B as direct targets of berberine (BBR) for its synergistically anti-inflammatory effects. Of them, BBR has the strongest affinity with EIF2AK2 via two ionic bonds, and regulates several key inflammatory pathways through EIF2AK2, indicating the dominant role of EIF2AK2. Also, BBR could subtly inhibit the dimerization of EIF2AK2, rather than its enzyme activity, to selectively modulate its downstream pathways including JNK, NF-κB, AKT and NLRP3, with an advantage of good safety profile. In EIF2AK2 gene knockdown mice, the inhibitory IL-1β, IL-6, IL-18 and TNF-α secretion of BBR was obviously attenuated, confirming an EIF2AK2-dependent anti-inflammatory efficacy. The results highlight the BBR's network mechanism on anti-inflammatory effects in which EIF2AK2 is a key target, and inhibition of EIF2AK2 dimerization has a potential to be a therapeutic strategy against inflammation-related disorders.

A series of new monobactam sulfonates is continuously synthesized and evaluated for their antimicrobial efficacies against Gram-negative bacteria. Compound 33a (IMBZ18G) is highly effective in vitro and in vivo against clinically intractable multi-drug-resistant (MDR) Gram-negative strains, with a highly druglike nature. The checkerboard assay reveals its significant synergistic effect with β-lactamase inhibitor avibactam, and the MIC values against MDR enterobacteria were reduced up to 4-512 folds. X-ray co-crystal and chemoproteomic assays indicate that the anti-MDR bacteria effect of 33a results from the dual inhibition of the common PBP3 and some class A and C β-lactamases. Accordingly, preclinical studies of 33a alone and 33a‒avibactam combination as potential innovative candidates are actively going on, in the treatment of β-lactamase-producing MDR Gram-negative bacterial infections.