Objectives To observe the effects of varied doses of L-thyroxin sodium ( L-T4) on congenital hypothyroidism ( CH) and to determine appropriate dose for early therapeutic intervention. Methods Totally, 108 cases of confirmed CH were divided into two groups (54 in each group). All the cases were administered with L-T4 at varied doses( 10. 1? - 15. 0 ?g ? kg-1? d-1 for large-dose group and 6. 0 - 10. 0 ?g ?kg-1? d-1 for small-dose group) after their parents were trained for basic knowledge of CH by specialists. Their serum levels of T3, T4 and TSH, as well as their body height, weight and head circumference, were measured during follow-up. L-T4 was maintained at doses of 1. 0 - 4. 0 ?g ? kg -1 ? d-1 when their serum levels of T3, T4 and TSH returned to normal. Results All the 108 cases had their clinical symptoms quickly improved and development and growth accelerated after L-T4 substitution. Their serum level of T3 returned to normal in all cases, that of T4 did not return to normal in six cases of large-dose group and in 16 cases of small-dose group, and that of TSH did return to normal in 22 cases of large-dose group and in 39 cases of small-dose group, respectively, after one-month treatment, with a significant difference between the two groups. Cases in large-dose group gained more weight in average than those in small-dose group when they were three months old. Conclusions Early therapeutic intervention for babies with CH with L-thyroxin sodium of 10. 1 -15. 0 ?g ? kg-1? d-1 could quickly correct abnormal function of their thyroid and could avoid abnormal development of their intelligence due to CH.

Objective To investigate the expression of scaffold protein palladin in pancreatic ductal adenocarcinoma (PDAC) tissues and to discuss its clinicopathological significance.Methods 56 samples of PDAC and corresponding adjacent normal pancreas (NP) tissues were collected.Another 10 samples of chronic pancreatitis (CP) tissues were collected.Western blot analysis and immunohistochemistry assay were performed to detect the expression of protein palladin.The correlation of palladin expression with clinicopathological factors of PDAC was analyzed.Results Western blot analysis revealed that the expression of palladin in PDAC,CP and NP tissues were respectively 0.93±0.07,0.41±0.07 and 0.20±0.06,and the expression of palladin was significantly increased in PDAC tissues compared with NP and CP tissues (P ＜ 0.05),and its expression was significantly increased in CP tissues compared with NP tissues (P ＜ 0.05).Immunohistochemical staining showed that palladin was mainly expressed in activated myofibroblasts in PDAC tissues.The rate of palladin expression was 79 ％ (44/56),which was higher than that in NP tissues (2/10) and CP tissues (4/10),and its expression was found to be correlated with the degree of tumor differentiation,lymph node metastasis and clinical TNM classification (P ＜ 0.05),and it had no correlation with patient' s sex,age,tumor location and distant metastasis (P ＞ 0.05).Conclusions Scaffold protein palladin is highly expressed in PDAC tissues,and it is expressed in the activated myofibroblasts within tumor microenvironment.Scaffold protein palladin may be involved in the invasion and metastasis of PDAC.

Objective To study the effect of gambogic acid on apoptosis and autophagy in human hepatoma cells HepG2, and to detect its possible mechanism. Methods After exposure of HepG2 cells to gambogic acid at different concentration for 24 h, cell proliferation rates was determined by MTT assay, apoptosis rate was detected by the flow cytometry (FCM), formation of autophagic vacuoles was observed by the monodansyl cadaverine (MDC) fluorescence staining, expression level of apoptosis-related proteins Bax, bcl-2 and autophagy related protein Beclin 1 was detected by Western blot. Results HepG2 cell growth was inhibited by the gambogic acid dose dependence. After exposure to gambogic acid at 0, 2.0, 4.0 and 8.0 μmol/L for 24 h, cell apoptosis rate was significantly increased to 5.31 %, 29.18 %, 31.50 % and 46.09 %(P <0.05), MDC average fluorescence intensity was also significantly increased to 6.3 ±1.1, 82.6 ±4.5, 132.9±15.7 and 157.7±9.0 (P<0.01). Western blot showed that gambogic acid could promote the expression of apoptosis protein Bax (0.17 ±0.02, 0.75 ±0.06, 0.78 ±0.05, 0.89 ±0.10, P <0.05), and decrease the expression of anti-apoptosis protein bcl-2 (1.18 ±0.04, 0.90 ±0.06, 0.64 ±0.08, 0.57 ±0.05, P <0.05), meanwhile, it could also increase the expression of autophagy related protein Beclin (0.67±0.03, 0.92±0.04, 0.95±0.07, 1.04±0.06, P<0.05). Conclusion Gambogic acid can inhibit the growth of human hepatoma HepG2 cells by inducing apoptosis and autophagic cell death.

Objective To summarize the clinical experiences of liver transplantation.Methods Of the nine patients, four operation was standard orthotopic liver transplantation,the latter five were the piggyback liver transplantation.The immunosuppressive protocols included methylprednisolone FK506 and mycophenolatemofeti. Meanwhile intravenous antihepatitis B immunoglobulin and Lamivudine were used to prevent hepatitis B recurrence.Results All patients were cured.Conclusion Liver transplantation can be employed for liver disease both cirrhosis and carcinoma as a conventional surgery.It is an effective way for the treatment of no metastatic liver carcinoma.The immunosuppressive protocols included methylprednisolone FK506 and mycophenolatemofeti,it can prevent immune rejection.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.