the clinical practice quality has been improved and the comprehensive practice quality of medical students has been cultivated through applying PBL teaching method,bilingual teaching and multimedia teaching.

Objective:To evaluate the operative time,blood loss,conversion rate toopen surgery,and operative complications formodi-fied Miccoli mode endoscopic thyroidectomy at different stages,under different surgical conditions and with diffrent techniques,in order to explore the learning curve of modified Miccoli mode endoscopic thyroidectomy and its influence factors.Methods:Clinical data of 362 operative cases of benign thyroid tumore performed between June 2005 and June2008 by a single doctor were reviewed.The patients were sequentially divided into three groups,with 30 cases in each group(without considering the size and site of the mass).The operative time,blood loss,conversion rate to open surgery and operative complications were compared between the three groups.Results:The op-erative time in group A,group B and group C were(104.3?29.6)min,(79.5?21.9)min,and(73.67?17.6)min,respectively.There were significant differences in operative time,between the three groups.2 patients in group A converted to open surgery for blood loss,and 1 patient had a temporary injury of recurrent laryngeal nerves.There were significant differences blood loss between the three groups.The influencing factors were as follows.The operative time for the masses of 2 to 4 centimeters was significantly shorter than that for the masses of shorter than 1 centimeter or longer than 5 centimeters.The size cased the same difference for the blood loss.The operative time for the masses in the middle and upper part was significantly shorter than the masses in other parts,the site also did bring about sig-nificant differences in blood loss.The technique of constructing cavity,imaging and ultrasonic calpel to stop bleeding had obvious impact on operative time and blood loss.The operative time for radical thyroidectomy was longer than than for partial thyroidectomy,while 2 pa-tients had a temporary injury of recurrent laryngeal nerves after the adical thyroidectomy.The significant differences in blood loss were found.Conclusion:The learning curve of the modified Miccoli mode endoscopic thyroidectomy requires approximately 30 cases to achieve more proficiency.Advanced technology and equipment,proper choice of patients and simple way of operation can passivate the learning curve of this kind.

Each woman of childbearing age has the right to enjoy reproduction, including cancer patients. Breast cancer is the most common malignant tumor in women. Many factors led to the significant increase of young patients with fertility problems, and the majority of doctors neglected their reproductive requirements in clinical work. Given the comprehensive treatment, almost every young patient suffers from fertility decline and even loss. Patients who chose to get pregnant also harbor a variety of concerns. This paper reviews the effects of comprehensive treatment on fertility, preservation strategies, pregnancy and prognosis, optimal time for pregnancy, and other aspects and provides guidance for young breast cancer patients in their reproduction choices.

Objective To summarize the clinical characters,diagnosis and surgical treatment of primary hyperparathyoidism (PHPT).Methods The diagnosis,treatment and efficacy of 35 cases of PHPT were retrospectively reviewed.Results PHPT presented a variety of clinical manifestations,and occoured to different age groups without significant gender differences.All the 35 cases had elevated blood calcium and PTH.All patients underwent preoperative ultrasonography and 99Tcm-MIB imaging,and the positive rates were 68.6％ and 97.1％ respectively.34 patients received surgical treatment,among whom 30 cases had parathyroid adenoma,1 case had parathyroid hyperplasia and 3 cases had parathyroid carcinoma.Through operation,31 cases were cured,2 cases improved,and 1 case of parathyroid carcinoma suffered from lung metastasls.Conclusions PHPT can be diagnosed according to co-elevated serum calcium and PTH.Ultrasonography combined with 99Tcm-MIB imaging should be recommend for preoperative localization.The main cause of PHPT is solitary parathyroid adenoma.PTPT can be cured by surgery.Minimally invasive parathyroidectomy with accurate location is an efficient surgical strategy,and the prognosis is favorable.

ObjectiveTo construct the eukaryotic expression vector of human HYAL1 gene and obtain MCF-7 and ZR-75-30 cell clones expressing HYAL1 gene stably.MethodsThe cDNA encoding HYAL1 gene of human breast cancer was amplified by RT-PCR from the total RNA isolated from human MDA-MB-435S cells and inserted into pcDNA3.1/V5-His-TOPO vector.The recombinant plasmid was transferred into MCF-7 and ZR-75-30 cells.ResultsA 1332-bp DNA fragment was successfully amplified from human MDA-MB-435S cell.Restriction enzyme digestion analysis and DNA sequencing showed that HYAL1 gene was inserted into recombinant vector.RT-PCR analysis revealed that HYAL1 gene could be expressed stably in the transfected MCF-7 and ZR-75-30 and it had strong invasive potential.ConclusionThe eukaryotic expression vector of human HYAL1 gene was successfully constructed.MCF-7 and ZR-75-30 cell clones that can express HYAL1 gene were obtained and can promote the invasion.

Objective To study the effects of HYAL1 gene overexpression on invasive, angiogenic and proliferative ability of breast cancer cell lines MCF-7 and ZR-75-30. Methods Double-chamber co-culture technique was applied to construct the invasive model and angiogenic model in vitro, which was used to detect the invasive and angiogenic potential of breast cancer cell; MTT and flow cytometry were used to detect the proliferation of breast cancer cells. Results Breast cancer cells overexpressing HYAL1 gene showed stronger invasive potential and angiogenic potential than control cells, but had no significant difference on proliferative potential. Conclusion Overexpression of HYAL1 gene can promote the invasion and angiogenesis of breast cancer cells in vitro, but not affect the proliferation.

Objective:To explore the tracing effect of nano-carbon in the cervical lymph nodes of papillary thyroid carcinoma (PTC) and the guiding role of the dissection strategy of the contralateral lymph nodes.Methods:The medical records of 516 patients with PTC in Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University from Jan. 2013 to Dec. 2017, including cN0 patients (436 cases) and cN1 patients (80 cases) , were retrospectively analyzed. There were 137 males and 379 females, the male to female ratio was 1.00:2.76. During the operation, nano-carbon was used to trace lymph nodes, and the number of lymph nodes in each lateral area (area II, III, IV) was collected, and the rate of black stained and non-black stained lymph node metastasis (LNM) was calculated based on the postoperative pathological results. SPSS 22.0 statistical software was used for analysis, t test was used for measurement data, and χ2 test was used for count data. Results:In 436 patients with cN0, the black-stained LNM rate in zone II ( P=0.002) , the black-stained LNM rate in zone III ( P=0.000) , and the black-stained LNM rate in zone IV ( P=0.002) were higher than those of non-black stained LNM. The rate of black-stained LNM in 80 cN1 patients (Ⅱ, Ⅲ, Ⅳ) was also higher than that of non-black-stained LNM (0.011, 0.019, 0.015) . The rate of black-stained LNM in cN0 patients affected the LNM in areas Ⅱ and Ⅳ ( P=0.000, P=0.000) . In patients with cN1, the black-stained LNM rate in zone Ⅲ had an effect on zone Ⅱ (0.030) ; it had no effect on the black-stained LNM rate in zone Ⅳ (0.315) . Conclusion:The black-stained LNM rate of the posterior zone (zone Ⅱ, Ⅲ, Ⅳ) with nano-carbon can represent the LNM rate of the lateral zone and help guide the lymph node dissection in the lateral zone. In addition, the black-stained LNM rate of zone Ⅲ can affect zone Ⅱ. The LNM rate in zone IV has the role of sentinel lymph nodes in the lateral zone.

Objective:To analyze the factors related to metastasis of contralateral central lymph node (CLN) in cN0 papillary thyroid car-cinoma (PTC) and discuss the indications for CLN dissection. Methods:We enrolled 149 unilateral PTC patients who underwent total thyroidectomy and prophylactic bilateral (CLN) dissection. This work analyzed the relationship of gender, age, extrathyroidal extension, multifocality, thyroiditis, ipsilateral central lymph nodes, and prelaryngeal lymph node with CLNs. Results:The rates of metastasis to ip-silateral and contralateral central compartments were 73.2%and 23.5%, respectively. In univariate analysis, gender, age, tumor size, multifocality, and thyroiditis were not important in predicting contralateral central compartment lymph node metastasis (P=0.792, 0.097, 0.531, 0.269, and 1.000, respectively);by contrast, extrathyroidal extension (P=0.017), prelaryngeal lymph nodes (P=0.006), and ipsilateral CLNs (P<0.001) are related to CLN metastasis. However, multivariate analysis showed that ipsilateral central metastasis was an independent risk factor for lymph node metastasis in the contralateral central region when the number of ipsilateral central metas-tases is≥3 (P=0.010). Conclusion:Extracapsular invasion, prelaryngeal lymph nodes, and ipsilateral CLN influence the metastases of CLN. Bilateral CLN dissection should be performed when the number of ipsilateral central metastases is≥3 and there is merger of ex-tra-laryngeal lymph nodes or capsule invasion.

Objective To discuss the surgical method and efficacy of adult Dandy-Walker syndrome ( DWS) through retrospective anal-ysis and literature review .Methods There were 3 cases of adult DWS in our hospital from August 2010 to August 2011.One case of them was given posterior cranial fossa cyst peritoneal shunt , and the surgery adopted ordinary high voltage shunt .Case 2 was given left side of the lateral ventricle peritoneal shunt , and the surgery adopted ordinary high voltage shunt .Case 3 was given posterior cranial fossa cyst peritoneal shunt combined with left side of the lateral ventricle peritoneal shunt , and the surgery adopted double-end high voltage shunt .The two ends of the shunt were respectively linked with the diverter valve and abdominal cavity drainage tube through T -branch pipe .Results Among the 3 patients, there was 1 case failed to ease the headache symptoms , and it was relieved one month later .The preoperative symptoms of the oth-er 2 cases disappeared immediately after the surgery .During the 4 years of follow-up,preoperative symptoms of the 3 patients disappeared , and there was no positive signs .Conclusion For adult patients with symptomatic DWS ,shunt surgery can eliminate symptoms ,relieve the tension of the posterior fossa cyst ,achieve good curative effect , and there was no surgical complication .