Objective To discuss the appropriate excision area of the thyroid microcacinoma. Methods 46 patients with thyroid microcarcinoma confirmed by pathology result were analyzed, in which 28 patients under-went thyroid lobectomy of lesion side and subtotal lobectomy of the other;8 patients were treated with subtotal lo-bectomy of both side;3 patients were treated with lobectomy of one side and partial resection of the other, while the rest 7 patients underwent the surgery of lesion side lobectomy and neck dissection plus subtotal lobectomy of the other side. Results No complicaitons were observed. All patients were follow-uped for 1 ～ 5 years. 2 patients were disgnosed as recurrance 3 years and 4 years after the operation respectively. The rest survived without recur-rance. Conclusions The appropriate surgery approach for thyroid microcacinoma might be lesion side lobectomy and subtotal lobectomy of the other side.

Objective:To detect the levels of dendritic cells(DCs)in peripheral blood of patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD)and explore the relationship between the content of DCs with AECOPD.Methods:The levels of DCs subsets( mDCs and pDCs) in peripheral blood with thirty-four cases of AECOPD and fifteen cases of healthy persons were measured by flow cytometry with four-color fluorescent analysis;and the pulmonary function tests in every subjects were evaluated by spirometry.Results:Compared with the control group,the levels of mDCs and pDCs inAE COPD groups with GOLDⅠ,GOLDⅡ, GOLDⅢand ClassⅣwere significantly higher( P<0.05) ,and with the severity of lung function in AECOPD patients,the levels were also increased( P<0.05).Conclusion:The levels of mDCs and pDCs inAE COPD patients were higher and significantly correlated with the severity of the disease,suggesting that DCs may be involved in the inflammation reaction process of COPD.

Objective To investigate the pathogenic constitution of thyroid nodular diasease and it' s di-agnosis and treatment.Methods A retrospective analysis was performed on data of 576 patients accepted hospi-tal therapy with thyroid nodular diasease from January 2004 to June 2008.Results Definite diagnosis of all easeswere made by surgery biopsy or fine needle aspiration-cytology.529 eases were benign lesions, another 47 eases were malignant lesions.Condusions Ultra-sound , FNAC and frozen sections have important value in differenti-al diagnosis for the thyroid nodules, nodular goiter is most common, and which have a close relationship with thy-roid carcinoma.Regular surgical resection would reduce the recurrence of thyroid nodular diasease and avoid missed diagnosis for thyroid carcinoma.

Objective To summarize the experience of how to preserve parathyroid glands and their function in thyroidectomy. Methods Data of 872 patients with thyroid carcinoma who entered our hospital from May. 2006 to Oct. 2009 were retrospectively analyzed. Results Parathyroid damage rate was 2. 06% (18/872)and permanent hypoparathyroidism was 0. 23% (2/872). All occurred in total thyroidectomy. Conclusions Preserving blood supply for parathyroid and avoiding direct contusion or misresection are important for preventing hypoparathyroidism in thyroidectomy. Calcium supplementation should be given to patients with obviously low serum calcium level after surgery to prevent permanent hypoparathroidism.

Objective To discuss the operative technical details in reducing complications after thyroid diseases reoperation, especially how to choose operative method and preserve laryngeal recurrent nerve and parathyroid gland. Methods The study protocols of 183 patients undergoing reoperation for thyroid disease from Jan. 2000 to Mar. 2009 were reviewed. There were 115 cases of benign and 68 cases of malignant thyroid diseases to observe the postoperative complications. Results The rates of temporary and permanent laryngeal recurrent nerve injury were 4.92% (9/183) and 1.64% (3/183), respectively. The rates of temporary and permanent hypocalcemia were 4.37% (8/183) and 0.55% (1/183), respectively. The rate of postoperative internal hemorrhage was 0.55%(1/183). Conclusions The thyroid reoperation was more difficult and can seduced a high rate surgical complication. The thyroid reoperation can be successfully performed if the operators could pay attention to the operative skill.

ObjectiveByreportinga fatalcaseof severelupusnephritis(LN) complicated with invasive aspergilluspneumonia and meningitis and reviewing the associated literatures,to provide a way of early diagnosis andproper management for the patients suffering from systemic lupus erythematosus(SLE) and invasive fungus infection(IFI).MethodsThe onset,diagnosis and treatment course of the disease were described and associated literatures werereviewed to analyze and summary the diagnostic methods,common pathogenic bacteria and predisposing factors of SLE patients with IFI.ResultsApplication of IFI guideline for cancer patients and those undergoing hematopoietic stem cell transplantation could be helpful in the early diagnosis and treatment of SLE patients complicated with IFI.The most common pathogen of SLE patient suffering from IFI was cryptococcus neoformans and aspergillus,not candida albicans.The mainpredisposingfactorswerehighlupusactivityandimmunosuppressant.Conclusions Guideline of IFI for cancer patients and those undergoing hematopoietic stem cell transplantation is also helpful for the SLE patients complicated with IFI.The most common pathogens of IFI in SLE patients are cryptococcusneoformansand aspergillus.The predisposing factors are high lupus activity and immunosuppressant.

Objective To study the effect of fosinopril on the expression of NADPH oxidase subunit p22phox mRNA and the extracellular matrix (ECM) accumulation in the kidneys of rats with diabetes mellitus . Methods Diabetic rats induced by streptozotocin were randomly divided into control group(DM group) and fosinopril group (fosinopril 10 mg'kg-1·d-1) (DM+Fosin group) and treated for 12 weeks . Expression of p22phox mRNA of NADPH oxidase in kidneys was measured by RT-PCR . The expression of fibroneetin was studied by immunohistochemistry and matrix metalloproteinases 9 activity was detected by Zymography . Meanwhile, the kidney hypertrophy index, serum creatinine level and 24-hour urinary protein excretion were evaluated . Results The expression level of p22phox mRNA in the kidneys of DM+Fosin group rats was decreased by 45% than that of DM group at week 4 (P＜0 .05) . At week 8 fosinopril significantly decreased the expression of glomerular and tubulointerstitial fibronectin by 52,5% and 42 .9% respectively (P＜0 .05), while increased MMP-9 activity by 29 .6% (P＜0 .05) compared with DM group . Fosinopril significantly decreased 24-hour urinary protein excretion of diabetic rats from week 8 . Serum creatinine level, 24-hour urinary protein excretion and kidney hypertrophy index were significantly decreased by 35 .9%, 50 .2% and 17 .2% in rats of DM+Fosin group than those of DM group at week 12 (P＜0 .05) . Fosinopril did not affect blood sugar significantly . Conclusion Fosinopril has beneficial effect on diabetic nephropathy partly through inhibiting the expression of NADPH oxidase p22 phox mRNA .

Objective To investigate and analyze the experience of planting and maintaining implantable venous access ports(IVAP) in management of post-operative breast cancer patients. Methods Breast cancer pa-tients receiving IVAP after surgery from Mar. 2011 to Jun. 2014 were retrospectively analyzed. The relative com-plications were documented and summarized during implanting operation. Results 468 patients received IVAP, among whom 451 patients underwent piercing implantation via right internal jugular vein, 15 patients underwent piercing implantation via right subclavian vein, and 2 patients underwent piercing implantation via left internal jugular vein. The mean cathe tering leng th was 12.8 cm for patients receiving IVAP via right internal jugular vein, ranging from 12 to 15 cm. Thereinto, 30(6.4%) patients experienced shot-term complications including 16 cases of puncture difficulty, 5 cases of accidental arterial puncture, 2 cases of extravasation, 2 cases of blood aspiration dif-ficulty and 5 cases of arrhythmia. Three cases had long-term complications as the following:one case of catheter-re-lated infection, one case of catheter lost, and one case of incision rupture. Conclusions IVAP is a safe and effec-tive intravenous infusion device. It is crucial to choose individualized implanting access and length by professional surgical team.

AIM: To investigate the role of reactive oxygen species (ROS) in transforming growth factor-?1 (TGF-?1)-induced regulation of plasminogen activator inhibitor-1 (PAI-1) expression and plasmin activity. METHODS: Growth arrested and synchronized rat mesangial cells were stimulated by TGF-?1. In some experiments,cells were pretreated with BSO or with antioxidant NAC. Intracellular ROS production was visualized using a fluorescent dye. PAI-1 protein secretion by mesangial cells was measured by Western blot and PAI-1 mRNA by both RT-PCR and Northern blot. Plasmin activity was determined using a synthetic fluorometric plasmin substrate. RESULTS: Exogenous TGF-?1 significantly increased intracellular ROS concentration and upregulated PAI-1 mRNA and protein expression in mesangial cells and reduced the plasmin activity. TGF-?1-induced upregulation of PAI-1 mRNA expression was exaggerated by BSO[DL-buthionine-(S,R)-sulfoximine]. NAC (N-acetylcysteine) effectively reversed TGF-?1-induced PAI-1 mRNA overexpression and plasmin activity decreasing. CONCLUSION: TGF-?1 increases intracellular ROS generation. ROS acts as a signaling molecular to mediate TGF-?1-induced PAI-1 overexpression and decrease in plasmin activity.

Objective To investigate the value of intraoperative neuromonitoring(IONM) for preventing recurrent laryngeal nerve(RLN) injury in thyroid surgery.Methods 1087 consecutive patients undergoing thyroid surgery at Wuhan Central Hospital from Oct 2010 to Dec 2012 were evaluated.277 cases(the study group) underwent thyroidectomy with RLN identification by naked eye plus IONM.810 cases(the control group)underwent thyroidectomy with RLN identification by naked eye only.Results In the control group,733 RLNs (90.49％,733/810)were successfully identified and 77 RLNs were failed to be identified.In the study group,all the 277 RLNs(100％,277/277)were successfully identified.28 cases had postoperative temporal RLN injury,among whom 26 cases were in the control group and 2 cases were in the study group.18 cases in the control group and 2 cases in the study group recovered in 2 weeks after surgery.The rest recovered in 2 months after surgery.RLN injury rate was significantly lower in the study group than in the control group.There was no significant difference in RLN injury for low-risk surgical patients between the 2 groups; however,the study group had advantages in RLN injury than the control group for high-risk patients.Conclusions IONM in thyroid surgery can improve the recognition rate of RLN during thyroidectomy.IONM can significantly reduce the incidence of RLN injury,especially in high-risk surgery.