Computer science is not important enough in the medical university curriculum and students do not like this course. Therefore, game-teaching methods were employed to enrich teaching methods,to make medical teaching more vivid and to promote medical students' learning interests. In this paper,application of game-learning idea in the medical teaching process was discussed from multiple aspects including the story of the game,incentives of the game and the punitive measures of the game.

Objective To investigate the distinct clinicopathological characteristics among different variants of papillary thyroid microcarcinoma(PTMC).Methods The clinicopathological data of 600 PTMC patients treated in Tianjin Medical University Cancer Hospital from July 2015 to December 2015 were analyzed retrospectively.Chi-square test was used to compare the distinct clinicopathological features among different variants and multivariate Logistic regression analysis was performed for independent predictors for lymph node metastasis (LNM).Results Conventional variant (43.0％),follicular variant (46.7％),and encapsulated variant (7.7％),accounted for 97.3％ of all cases.Follicular variant had the largest tumor size and encapsulated variant had highest rate of calcification and no extrathyroidal extension.The incidence of LNM was the highest in conventional variant followed by follicular variant and then by encapsulated variant.Maleness,age ＜ 45,calcification,minimal extrathyroidal extension and multifocality were independent risk predictors for LNM.Conclusions Follicular variant are the most common in PTMC,whose aggressiveness is far below conventional variant PTMC patients.Independent risk predictors for cervical LNM were maleness,age ＜ 45,tumor calcification,minimal extrathyroidal extension and multifocality.

Objective To explore the clinical therapeutic effects of Ⅰ-stage or delayed Ⅰ-stage cervical plexus reinnervation for recurrent laryngeal nerve(RLN)injuries. Methods During the process of neck dissection of papillary thyroid carcinoma,18 cases with recurrent laryngeal nerve deficit underwent cervical plexus reinnervation on Ⅰ-stage or delayed Ⅰ-stage RLN prosthosis basis.Therapeutic effects were evaluated by fibrolaryngoscope and voice evaluation preoperatively and postoperatively. Results All the cases were followed-up for 3 months to 2 years(average 8 months).Abductory motion of the vocal cords of 16 patients totally or partly restored,and not improved in 2 patients,with the recovery rate of abductory motion of the paralyzed vocal cords of 88.9%(16/18).Patient's phonation was restored totally or partially in 16 cases and the hoarseness was ameliorated significantly. Conclusions Cervical plexus-RLN reinnervation should be considered as a suitable treatment for unilateral vocal cord paralysis.One stage or delayed one stage cervical plexus reinnervation for recurrent laryngeal nerve injury is convenient and easy to perform.Postoperatively the abductory motion of vocal cord could be restored by this reinnervation satisfactorily.

Objective To introduce the processes of vascularized parathyroid gland reservation and parathyroid autotransplantation applied in thyroidectomy. Methods In 46 cases who underwent total/near total thyroidectomy, in situ vascularized parathyroid gland reservation was performed in 24 cases,isolated parathyroid autotransplantation was performed in 5 cases, in situ vascularized parathyroid gland reservation of 1～2 parathyroid glands combined with immediately transplantation of the remaining isolated parathyroid glands were performed in 17 cases. Results Five cases suffered from transient hypocalcaemia, including 2 cases of vascularized parathyroid gland reservation and 3 cases of vascularized parathyroid gland reservation in 1～2 parathyroid glands combined with immediately transplantation of other parathyroid glands. Two cases who received parathyroid autotransplantation suffered from hypocalcaemia and received conservative treatment with activated vitamin D3 and caleium for 4 weeks or 8 weeks. Permanent hypoparathyroidism occurred in 1 case of 46 cases which undergone the total/near total thyroidectomy(2.2%). Conclusion Application of vascularized parathyroid gland reservation and parathyroid autotransplantation in total/near total thyroidectomy could reduce the incidence rate of post-operative hypoparathyroidism.

Objective To establish a rat model of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and evaluate the liver function after surgery.Methods Fifty male SD rats were randomly divided into two groups: experimental group (ALPPS group) and control group (PVL group).Selective portal vein ligation in PVL group was performed on the caudal lobe, left lateral and left median lobes, while the right lobe, the right median lobe was preserved to regenerate.ALLPS group was treated in the same way as PVL group, but also underwent liver partition in situ.After surgery, 5 rats were sacrificed on day 1, 3,7, 10 and 14 in each group to observe the weight of body and the right median lobe,respectively.The venous blood and liver tissue were obtained for testing alanine aminotransferase (ALT),aspartate aminotransferase (AST), serum albumin (ALB), total bilirubin (TBil) and observing the histological changes in liver injury after surgery.Results After surgery, the body weight decreased progressively, but then increased in both groups.Since the first day after surgery, the body weight began to decrease,reached the lowest value on 3 d, and then on day 7 the body weight in PVL group returned to preoperative levels.However, the body weight was still lower than that before surgery [(3.7 ± 2.7) ％ vs (-3.0 ± 1.9)％, P＜0.05].On day 3, 7, 10 and 14, the hepatic regeneration rate (HRR) of the fight median lobe in ALPPS group was obviously higher than that in PVL group (P ＜ 0.05).On day 1, the serum ALT and AST levels in two groups were elevated dramatically and then gradually decreased, which in ALPPS group were significantly higher than those in PVL group (P ＜ 0.05).There were no significant differences at other time points.On day 1 and 3, the serum ALB in ALPPS group was obviously lower than that in PVL group [(25.4±1.7)g/Lvs (31.4±1.5)g/L, P＜0.05;(25.0±2.0)g/Lvs (31.8±1.5)g/L, P＜ 0.05], respectively.More focal necrosis of liver were observed in ALPPS group on day 1, which were more than those in PVL group.Conclusions This method could successfully establish a ALPPS rat model and proved that ALPPS could induce accelerated hepatic regeneration and more severe early hepatocyte injury compared with PVL.This ALPPS experimental model provides a basis for further research on ALPPS, especially for clarifying the mechanisms of liver regeneration and tumor recurrence, and exploring the reasons for various ALPPS related complications, which play a significant role in its clinical application.

Objective To investigate the effect of portal vein ligation combined with in situ splitting on liver regeneration in rats .Methods Seventy-five healthy male Sprague-Dawley rats were selected and randomly assigned into sham operation group ( S) , portal vein ligation group ( PVL) and portal vein ligation combined with in situ splitting group ( ALPPS) .On 1 d, 3 d, 7 d, 10 d, 14 d after operation , the hepatic regeneration rate ( HRR) of right median lobe was calculated , the serum alanine aminotransferase ( ALT) , aspartate aminotransferase (AST), IL-6, HGF, VEGF were detected.mRNA of IL-6, HGF, TNF-α, TGF-βwas assayed by real-time PCR, and the hepatic proliferating cell nuclear antigen ( PCNA) labeling index was evaluated by immunohistochemistry .Results Comparing with PVL group , the HRR of the right median lobe obviously increased on day 3, 7, 10 and 14 in ALPPS group (P<0.05), and ALT and AST level were increased on 1 d (P<0.05).On day 1 and 3, the content of serum IL-6, HGF and VEGF were all in-creased in ALPPS group [(70.7 ±14.6) pg/ml vs.(134.2 ±31.4) pg/ml; (0.70 ±0.04) ng/ml vs. (0.74 ±0.02) ng/ml;(82.1 ±12.6) pg/ml vs.(103.5 ±14.7) pg/ml], respectively (P<0.05).The mRNA expression of IL-6, HGF, TNF-α, TGF-βand the PCNA labeling index were also increased in ALPPS group in comparison with those in PVL group on day 1 and 3 (P<0.05).All the indexes in the two groups were all higher than those in the group S ( P<0 .05 ) .Conclusions Portal vein ligation combined with in situ splitting could significantly enhance liver regeneration .The possible mechanisms were related to the inflammation reaction and stress response caused by in situ splitting and up-regulation of cytokines in the regenerating lobe after portal vein ligation combined with in situ splitting , especially IL-6, HGF and TNF-α.

Aurora-A is a mitotic serine/threonine kinase that is evolutionally conserved and localized at the centrosome. Aurora-A activation is required for mitotic entry, centrosome maturation, and centrosome separation. Aurora-A is frequently amplified and/or over-expressed in breast, ovarian, esophageal, colon, lung, and bladder cancers. Aurora-A has recently become a new target of malignant tumors. The Aurora-A inhibitor can be combined with other chemotherapeutic drugs to provide a new way for cancer treatment. In this study, we review the function and inhibitor of Aurora-A kinase.

ObjectiveTo investigate the clinical biocharacteristics,treatment,prognosis and the factors that influence prognosis of anaplastic thyroid carcinoma(ATC). MethodsThe clinical data of 108 ATC patients treated at our institution from January 1981 to April 2009 and follow-up results were retrospectively reviewed.ResultsThe median survival time of 108 patients was 6 months.The overall 1-year,2-year,5-year survival rate was 40.3％,30.9％ and 21.9％ respectively.Univariate analysis showed the factors influencing the prognosis of ATC patients were tumor size, distant metastases, stage,leukocytosis, radiotherapy, localresection, postoperativeradiotherapyandmultimodalitytherapy.Multivariate analysis indicated that tumor size,stage,leukocytosis and radiotherapy were independently associated with the prognosis.ConclusionsAnaplastic thyroid carcinoma is rare but highly aggressive malignancy with poor prognosis. ATC patients should receive multimodality therapy,especially local resection and postoperative radiotherapy.Even inoperable patients could benefit from radiotherapy.

Objective:To evaluate the role of Tg in diagnosis of lateral cervical lymph node recurrence in papillary thyoid cancer(PTC)after radioactive iodine(RAI) therapy.Methods:From Jan 2012 to Aug 2018, 22 PTC patients who received RAI therapy after operation were reoperated for lateral cervical lymph node recurrence. The clinical data was retrospectively analyzed.Results:The median recurrence time was 30.5 (5-86) months. All 22 patients received RAI therapy after the first operation, and the median dose of RAI was 250mCi(100-700 mCi) and the episode of RAI therapy ranged from 1 to 4. All 22 PTC patients underwent neck reoperation, among which 20 cases were identified to have lymph node metastasis. The median number of lymph nodes dissected was 31 (8-83) and median number of metastatic lymph nodes was 4 (1-19) . The diagnostic accuracy of ultrasonography in detecting lymph node metastasis was 90.9%. Before reoperation, the median Tg was 1.305 (0.10-99.51) μg/L, with the cutoff value of Tg being 0.2 μg/L, and its sensitivity and specificity were 80.0% and 100%, respectively. The median stimulated Tg was 5.89 (0.14-255.80) μg/L in the 10 patients, with the cutoff value of stimulated Tg of 2 μg/L, and its sensitivity and specificity were 88.9% and 100%, respectively.Conclusions:The serum Tg level is helpful for monitoring the recurence of PTC, but recurrence cannot be completely ruled out for those with low Tg.

Objective To analyze and compare the ultrasound characteristics in different pathologic classifications of thyroid carcinoma.The ultrasound characteristics of thyroid carcinoma were investigated in order to determine the clinical diagnosis and clinical stasing of thyroid carcinoma.Methods In this study,407 cases of thyroid carcinoma were enlisted for ultrasonic typing of thyroid carcinoma according to the ultrasound features.The resuh was used for clinical staging of thyroid carcinoma. Results Combined ultrasound mediated clinical stage has a higher accuracy rate and specificity,its accuracy rate of T stage is 93.9%,for No stage is 86.1%,for N1a stage is 80%,for Nlb stage is 74.9%.Preoporative US detected 51.5% occult metastatic LN.Conclusion Ultrasound has a very important effectiveness for the evaluation.staging,location of thyroid carcinoma and cervical lymph node metastasis.