The classifications of the thymoma and their pathologic diagnosis is closely related to the clinical treatment of the disease. Similarly, it is a focal on the clinicopathologic study today. In this paper,the classification of the thymoma and their developing process in the histopathological changes was extensively discussed, and various type of the histopatholgic characteristic of the tumor was compared. It was suggested the new edition of the thymoma classifications of WHO should be operated in practical work. Additionally, the B1 type thymom, the thymic lymphoma and the histopathological changes of thymus in myasthenia gravis patients were described respectively, and it was also considered that the new edition of the thymoma classifications of WHO had some incomplete aspects in the pathological diagnosis.

Objective To research pacemaker cells outside conductive system of rat and mouse heart. Methods Paraffin and frozen serial sections (stained with HE, Masson, cholinesterase technique), and ultrastructural sections, from atrial tissue of 10 rats and 15 mice were observed by light and electron microscopy to find latent pacemaker-like cells. Results Some round or elliptical cells were scattered and irregularly detected in right and left atrial tissue of rat and mouse. Their nuclei were larger, plasma was clearer and cellular organelles were fewer than those of working myocyte. These cells were similar to pacemaker cells in sinoatrial node.Conclusion There are some pacemaker-like cells in right and left atrial tissue of rat and mouse. The finding can provide a morphological basis for ectopic beat of atrium.

Objective To investigate the microenvironment of the thymus on lymphocytes, dendritic cells and epithelial cells were studied in patients with myasthenia gravis.Methods (1) The thymus specimens of 25 cases were examined using light microscopy,in which 10 were males,15 females with an average age of 31 years old. The lymphoid tissue with proliferation was in 13 cases, without proliferation in 12 cases. Additionally, 7 cases had congenital heart disease (the average age was 27 years old) and the thymus of an infant (1 case) was examined. (2) Immunohistochemical staining for CD1a?CD4?CD8?CD20?CD45RO?S 100?CKPan and EMA were performed onto the specimens. Some of them with positive dendritic cells on S 100 and CD1a were counted. Results (1) It showed that the positive cells of CD1a located at cortical areas of the thymus with or without lymphoid tissue proliferation in MG and non MG cases. However, there were some positive cells in the medulla, Hassall corpuscles and the vascular space areas of the thymus. (2) The CD4 staining was negative. (3) The expression of CD8 and CD45RO was expressed in the medulla, peripheral areas of the Hassall corpuscles and vascular space of the thymus. (4) CD20 was expressed in the medulla and the germinal central areas. (5) The expression of S 100 for dendritic cells were 23.5 and 47.5 per 100 mm 2 in both having medullary follicular hyperplasia and no follicular hyperplasia groups. The CD1a were 2.1, 3.8 per 100 mm 2, respectively. The statistic was significant as compared with both groups with or without proliferation of thymus medulla. (6) The expression of CK was located in the cortex, medulla and Hassall corpuscles. But EMA, CEA were negative. Conclusions (1) There were expressions of suppressive T cells (CD8) and B lymphocytes (CD20) with or without the thymus medullary lymphoid follicular hyperplasia. (2) The changes of numerous quantity of the dendritic cells on the thymus were displayed which showed a relation to the proliferation of T, B lymphocytes and the formation of germinal central of thymus.It suggested that the dendritic cells and the other stromal cells of the thymus may serve as an important role in MG occurrence.

Objective MicroRNAs (miRNAs) are of important clinical value in various tumors.However, few studies are reported about their role in thymic epithelial tumors.This article aims to explore differential expression profile of miRNAs in type B3 thymoma and thymic carcinoma.Methods This study included the pathological data about 45 cases of type B3 thymoma and thymic carcinoma surgically treated in our hospital from January 2012 to January 2015, of which 3 cases of type B3 thymoma (control group) and another 3 cases of thymic carcinoma (case group) were subjected to miRNA microarray for determination of the differential expressions of miRNAs in the tumor tissues.The up-and down-regulated miRNAs were calculated, their target genes were predicted via online databases, and the thymus-related genes were identified.Results Totally, 32 differentially expressed miRNAs (including miR-125b-1-3p, miR-3175, and miR-4462) were up-regulated and another 19 (including miR-361-5p, miR-130a-3p, and miR-3651) down-regulated in thymic carcinoma.AKT1, C9, CD19, CDC42, LSS, and MYC were identified as the target genes of miR-377-5p, ADCYAP1R1, ASPA, CAD, and CD63 as the target genes of miR-458-5p, and AKAP12, CD28, FOXP1, and MDM4 as the target genes of miR-183-5p.Conclusion Differentially expressed miRNAs were identified in type B3 thymoma and thymic carcinoma and their target genes predicted using the prediction software, which may provide some valid evidence for further study of thymic epithelial tumors.

Objecyive To investigate the perioperative nursing of type Ⅱ diabetes mellitud treated by laparoscopic gastric bypass surgery.Methods Pefioperative nursing and follow up were performed for twenty five patients with type Ⅱ diabetes who were treated by laparoscopic gastric bypass surgery.Results The conditions of these patients were improved significantly by prompts of fasting blood glucose and 2h post-prandial blood glucose after glucose tolerance test was performed for every patient.Conclusions Pertinent perioperative nursing has proactive effect on recovery of patients with type diabetes mellitus and treated by laparoscopic gastric bypass.

Objectives:To study the clinicopathological changes of mediastinum lesions.　Methods:Specimens from 405 cases of mediastinum lesions from 1967 to 1997 were studied.　Results:Sex ratio, male to female was 216 to 189, median age was 26 years. There were 230(56.8%) cases of tumors and tumor-like lesions, 172(42.5%) cases manifested with myasthenia gravis. Case composition, 113 cases of thymus lesion(49.1%), 36 cases(15.7%) of germ cell tumors, 30 cases(13.0%) of neurological neoplasm, 6 cases(2.6%) of lymphoma, and 29 cases(12.6%) of cysts. Location, 165 cases(71.7%) were in the front mediastinum in which thymoma was the commonest, 6 cases(2.6%) were in the middle mediastinum in which lymphoma was the commonest, 30 cases were from the posterior mediastinum in which neurological tumors were the commonest. Follicular proliferation of the thymus was observed in 145 cases(84.3%) of MG, and 27 cases did not(15.7%) . Thirty eight cases(22.1%) of MG were from thymoma, and 12 cases(7.0%) from microscopic thymoma.　Conclusions: Prognosis of MG with thymus follicular proliferation was better than those without proliferation and thymoma, fortunately, most thymus with MG were follicular proliferative. Microscopic thymoma could be discovered on pathology. Thymus tumors consisted more than half of the mediastinum neoplasm, the incident of lymphoma was low.

Objective To analyze the factors that influence joint function after plate fixation of unstable pelvic fractures.Methods A retrospective study was conducted to analyze the 109 patients with unstable pelvic fracture who had been treated with plate fixation from January 2007 to September 2014.They were 69 men and 40 women,23 to 72 years of age (average,46.3 years).By the Tile classification,15 cases were type B1,37 type B2,14 type B3,19 type C1,16 type C2,and 8 type C3.Their postoperative joint function was evaluated according to the Majeed criteria for functional evaluation.There were 86 cases in the good-to-excellent group (78.9％) and 23 in the fair-to-poor group (21.1％).Their data were analyzed in terms of gender,age,preoperative injury severity scale (ISS),body mass index (BMI),operation time,fracture type,reduction quality,postoperative complications,bone density,and postoperative weight bearing time.The influential factors were determined using Logistic regression analysis.Results All the 109 patients obtained a mean follow-up of 18.7 months (from 12 to 53 months).Preoperative ISS (P =0.000),fracture type (P =0.008),reduction quality (P =0.009) and postoperative complications (P =0.000) were identified as the factors influencing joint function after plate fixation of unstable pelvic fractures.Conclusion Preoperative assessment by ISS,a clear understanding of the pelvic fracture type,anatomical reduction of the fracture and efforts to reduce postoperative complications can effectively improve functional recovery of the joint after plate fixation of unstable pelvic fractures.

Objective To evaluate the effect of proximal femoral nail antirotation (PFNA) with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture.Methods Between January 2007 and June 2012,21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting.There were 9 men and 12 women with the mean age of 54 years (range,27-76 years).In the initially failed internal fixation,dynamic hip screw (DHS) was used in 7 cases,locking proximal femoral plate (LPFP) in 8 cases,Gamma nail in 2 cases,proximal femoral nail (PFN) in 2 cases and home-made reconstruction nail in 2 cases.Results Mean operation time was 150 minutes (range,100-240 minutes) and mean blood loss was 800 ml (range,400-2,000 ml).There were no serious complications during operation.Mean follow-up was 26 months (range,6-66 months).Bone healing was achieved at mean 4 months (range,3-8 months) in all cases.Harris hip score was (42.1 ±3.2) points (range,36-48 points) before operation and (87.2 ± 3.8) points (range,62-94 points) at the final follow-up,with significant improvement in hip function (P ＜ 0.05).At the final follow-up,no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130° (range,110°-142°).Conclusions Once the fracture patients with strong ability of action,massive proximal femoral residuals,and non-serious hip injury,revision PFNA internal fixation with autogenous bone grafting is effective.Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications.

Objective To investigate effect of arthroscopic ankle arthrodesis in the treatment of endstage post-traumatic ankle arthritis.Methods Between July 2007 and December 2010,21 patients with post-traumatic ankle arthritis underwent arthroscopic arthrodesis in our hospital.There were 14 males and 7 females,aged from 21 to 68 years (average,37 years).Before operation,conservative treatments were unsuccessful in all patients.During operation,the articular cartilage was removed completely,and then micro-fracture was made in bone near articular surface.Then,the operating ankle were reduced and fixed provisionally with Kirschner wires.A C-arm X-ray system was used to confirm the reduction of operating ankle,and the operating ankle was fixed with cannulate screws if the reduction was satisfactory.Two patients also underwent arthroscopic subtalar arthrodesis.After operation,the affected ankle was fixed with plaster for six weeks.Then partial weight-bearing were allowed and gradually increased until bone union.Results All patients were followed up for 1 to 4 years (average,1.8 years).All affected ankle achieved bone union after 10 to 16 weeks (average,12 weeks).No early complications occurred,such as poor wound healing and infection.Subtalar arthritis with pain occurred in 3 patients; the symptom relieved in 2 of them after conservative treatment and in 1 patient after subtalar arthrodesis.The VAS score improved from preoperative 8.1±1.5 to 2.7± 1.1 one year postoperatively,which showed statistical significance (t=3.153,P=0.005).Conclusion Arthroscopic ankle arthrodesis provides an alternative method for treating end-stage post-traumatic ankle arthritis,which has some advantages,such as less surgical trauma,more beautiful incision and higher fusion rate.However,it needs special equipments and a learning curve.

Purpose To investigate the clinicopathological changes of the diffuse-type giant cell tumor of the bone and joint. Methods 42 cases of the diffuse-type giant cell tumor of the bone and joint were studied and the follow-up data were reviewed. Results The male patients were 19 and the female were 23, with the male to female ratio of 1 ∶ 1. 2. The age of the patients was 8~69 years (the average age was 37. 6). It was displayed that the patients presented local pain and swelling (34 cases), including dysfunction (18 ca-ses) of the bone and joint. Clinically, the lesions located on the knee joint ( 71. 4%) in 30 cases, the hip and ankle in 9 cases (21. 4%), and the wrist elbow in 3 cases (7. 1%). 27 cases were examined by MRI. Among them, the diffuse-type giant cell tumor was diagnosed in 9 cases (33. 3%). The effusive lesions of the joint presented in 5 cases, the non-specific synovial lesions and others in 3 cases. The obviously diffuse hyperplasia of synovial cells with nodular growth pattern was found. However, a high proliferative in-dex of the tumor cells and the rich-cell tumor were found. But there was no tumor necrosis. Histopathologically, the tumor cells of dif-fuse-type giant cell tumor contained marked brown pigments, multinucleated giant cells formation and a lot of lymphocytes proliferation or follicular reaction in 17 cases (40. 5%) with invasive growth and involvement of the joint and surrounding tissue. 6 cases recurred (20%) , including 2 cases with 2 times. Conclusions The diffuse type-giant cell tumors most commonly involve the knee, followed by the hip and ankle. Preoperative examination of MRI can be help for the diagnosis of the tumor. Histopathologically, diffuse-type gi-ant cell tumor with synovial cells rich-hyperplasia and the villous structures formation more likely recur. The main biological character-istics of diffuse-type giant cell tumor are invasive growth pattern, usually into the soft tissue around the joints.