Objective To evaluate the diagnostic value of US, ECT, CT and MRI in primary hyperparathyroidism (PHPT). Methods Data of 34 PHPT patients with diagnosis confirmed by postoperative pathology were retrospectively reviewed from January 1, 1990, through March 31, 2004. Results The preoperative diagnosis in 22 out of 25 cases (88%) undergoing preoperative ultrasonography of the neck with a positive result was verified by intraoperative findings. For 99m Tc-MIBI, CT and MRI, the positive results were 95%, 69% and 100% respectively. Conclusion Ultrasonography and 99m Tc-MIBI should be considered as the first choice for preoperative loci localization in patients with PHPT. Ultrasonography and 99m Tc-MIBI in combination is more sensitive and accurate for the localization of PHPT.

Objective To explore the diagnosis and treatment of primary hyperparathyroidism (PHPT). Methods Clinical data of 35 cases of PHPT were retrospectively analyzed. Results 23 out of 26 cases (88.5%) undergoing preoperative ultrasonography with a positive result were verified by intraoperative (findings). For ECT, the positive rate was 21 out of 23 cases (95.5%). Unilateral neck explorations (UNE) was performed in 27 cases of parathyroidoma. Two cases of parathyroid hyperplasia were treated by UNE and the other two cases by bilateral neck exploration (BNE). The procedure for 3 cases of parathyroid carcinoma was the same as that for papillary thyroid carcinoma. Unilateral resection of thyroid and parathyroid was done in a case of parathyroidoma with malignant change. Emergency excision of parathyroidoma, after (emergency) medical management, was performed in a patient with parathyroid storm, and the symptoms (subsided) postoperatively. All cases developed hypocalcemia in various degrees after surgery, but the symptoms were relieved with the use of calcium gluconate. Conclusions PHPT could be diagnosed according to (co-elevated) calcemia and PTH. Ultrasonography and ECT should be considered as the methods of first choice for preoperative localization. UNE of parathyroidoma could be feasible if accurate image localizations are (available). Radionuclear guided parathyroid resection could be performed in the patients with ectopic parathyroid disease or lesions without accurate localization. Aggressive surgical exploration after medical control of (symptoms) is the first choice of treatment when parathyroid storm is diagnosed.

Objective To investigate the role of muhiplex ligation-dependent probe amplification(MLPA) in identifying fetal aneuploidy of chromosomes 13,18,21,X,and Y. Methods From June 2007 to December 2008,263 samples(prenatal diagnosis group),including amniotic or umbilical cord blood from pregnant women who required prenatal diagnosis,were processed in parallel by MLPA and conventional karyotype to detect fetal aneuploidy.Another 26 samples(fetal death group).ineluding retained abortion and fetal death,were also processed bv MLPA. Results Five cases of 21-trisomy,4 eases of 18-trisomy,1 case of 13-trisomy and 3 cases of 45,X were identified among the prenatal diagnosis group by MLPA,and the results were consistent with karyotype.Two cases of 45,X and 1 case of 18-trisomy were identified among the retained abortion and fetal death group. Conclusions MLPA is a rapid,efficient,simple,reliable and economical technique in detecting most common chromosomal aneuploidies and have important clinical value.

Objective To investigate the risk factors of pulmonary metastasis and prognosis of patients with rectal cancer after anterior resection of rectal cancer.Methods The retrospective case-control study was adopted.The clinical data of 421 patients with rectal cancer who underwent anterior resection at the First Hospital of China Medical University from August 2010 to December 2014 were collected.The patients were followed up by outpatient examination and telephone interview once three months in the first postoperative year,once half a year in the second postoperative year,and then once a year.The follow-up included satuses of pulmonary metastasis and survival of patients after anterior resection of rectal cancer.The end point of follow-up was death of the patients or 31 December,2014.The risk factors of pulmonary metastasis and prognosis in patients after anterior resection of rectal cancer were analyzed.Measurement data with normal distribution were presented as x-± s and measurement data with skewed distribution were presented as M(range).The pulmonary metastasis rate/curve and survival rate/curve were calculated and drawn by the Kaplan-Meier method.The comparisons of pulmonary metastasis rate and survival rate were done using the Log-rank test.The univariate analysis was done using the chi-square test and Log-rank test.The multivariate analysis was done by Logistic regression model and COX regression model.Results Of the 421patients,389 patients were successfully followed up with a median time of 34 months (range,11-53 months) and a follow-up rate of 92.40％ (389/421).Ninety-four,168 and 127 patients were detected in Ⅰ,Ⅱ and Ⅲ stages of TNM stage.There were 29 patients diagnosed with postoperative pulmonary metastasis with the diagnosis time of (21 ± 9) months.The 3-year cumulative incidence of pulmonary metastasis after anterior resection of rectal cancer was 2.2％ in patients of Ⅰ stage,3.0％ in patients of Ⅱ stage and 17.4％ in patients of Ⅲ stage,showing significantly increase trend as the increase of the TNM stage (x2=19.927,P ＜ 0.05).The 29 patients with pulmonary metastasis did not receive chemoradiotherapy including 6 patients receiving pulmonary metastatic nodule recection.Nineteen patients were survived and 10 patients were dead.The survival time of patients diagnosed with pulmonary metastasis was (13 ±9)months and the 3-year cumulative survival rate was 75.7％,whereas the survival time of patients without postoperative pulmonary metastasis was (35 ±9)months and the 3-year cumulative survival rate was 94.3％,showing significant difference between the 2 kinds of patients (x2 =25.219,P ＜ 0.05).The univariate analysis showed that the preoperative carcinoembryonic antigen (CEA) level,degree of tumor differentiation,depth of invasion and lymph node metastasis were risk factors affecting pulmonary metastasis after anterior resection of rectal cancer (x2=4.745,7.250,5.379,18.796,P ＜ 0.05),and the multivariate analysis showed that lymph node metastasis was an independent risk factor affecting postoperative pulmonary metastasis [OR =4.167,95％ confidence interval (CI):1.608-10.801,P ＜ 0.05].The univariate analysis showed that the preoperative CEA level,distribution and number of pulmonary metastatic nodule and lymph node metastasis were risk factors affecting the prognosis of patients with pulmonary metastasis after anterior resection of rectal cancer (x2=13.793,7.246,6.284,4.076,P ＜ 0.05),and the multivariate analysis showed that the preoperative CEA level ＞ 5 μg/L was an independent risk factor affecting the prognosis of patients (HR =13.489,95 ％ CI:1.407-129.297,P ＜ 0.05).Conclusions Pulmonary metastasis after anterior resection of rectal cancer is common.Lymph node metastasis is a high risk factor affecting postoperative pulmonary metastasis,and preoperative CEA level ＞ 5 μg/L is an independent risk factor affecting the prognosis of patients with postoperative pulmonary metastasis.

Objective To summarize our experience in the prevention and treatment of accessory hepatic duct injury during operation on biliary tract.Methods The clinical data of 26 cases with accessory hepatic duct were retrospectively reviewed.Results Of 26 cases,the accessory hepatic duct were type I in 38.5%(10/26),and no complications including bile leakage,biliary infection and obstructive jaundice developed after division and ligation of the accessory hepatic duct;26.9%(7/26) were type II,among which,the accessory hepatic duct were injured in 3 cases,but no case developecl complications after relevant treatment;23.0%(6/26) were type III,among which,injury of accessory bile duct occurred in 2 cases.Of them,1 case developed bile leakage and was cured by reoperation.7.7%(2/26) were type IV and 3.9%(1/26) was type V.The cases of type IV and V were not damaged.Conclusions To prevent injury of accessory hepatic duct,pre-and intra-operation identification of the condition is very important,and especially by intraoperative cholangiography.Different types of accessory hepatic duct injury should be treated by different approaches. Accessory hepatic duct of type I might be cut and ligated.Type II accessory bile duct which(enters) the cystic duct and should be protected,but,if damaged,different methods of treatment are used,(depending) on the caliber of accessory hepatic duct.Type III and IV also should be protected,but,when damaged,the accessory hepatic duct should be repaired or performed an internal draining.

Objective To study the effect of bel-2 siRNA on apoptosis of HL-60 cells.Methods bcl-2 siRNA was synthesized in vitro transcription with silencer siRNA construction kit.The synthesized siRNA was transfected into HL-60 cells with Amine siPORT transfection.We used MTT flow cytometer and hoechst 33258 flourescence stainning t0 evaluate cell proliferation and apoptosis. Results.Bcl-2 siRNA could partially inhibit the growth of HL-60 cells.After incubated with bcl-2 siRNAl for 48 hours,HL-60 cells exhibited morphologic characteristic of apoptosis including chromatin condensation,crescents formation and nuclear fragmentation.Conclusion Effective bcl-2 siRNA can induce apoptosis and inhibit cell proliferation.

Objective To explore the clinical charateristics,diagnosis and treatment of solid pseudopapillary tumors of the pancreas (SPTP).Methods 40 SPTP cases admitted in the First Hospital of China Medical University from 2004 to 2014 were analyzed retrospectively.Results Among 40 cases,male to female ratio was 1 ∶ 7 with the average age of 33.8 years.Major clinical manifestations included abdominal pain or discomfort and palpable abdominal masses.CT and MRI accuracy for detecting the location of tumors was better than B Ultrasonic.Surgical procedure included spleen preserving distal pancreatectomy in 15 cases,distal pancreatectomy with splenectomy in 9 cases,tumor enucleation in 11 cases,pancreaticoduodenectomy in 3 cases,duodenum preserving pancreas head resection in 2 cases.30 postoperative cases were followed-up with the mean follow-up time of 58.4 months and were all doing well.Conclusions SPTP is a tumor with low-grade malignant potentiality.Cystic and solid tumors of the pancreas found among young women are highly suspected as SPTP.Surgery is the main method of treatment and the prognosis is good.

Objective To explore the expression of peripheral T cell subgroup (CD3+,CD4+,CD8+,CD4+CD25 high regulatory T cells) and the level and significance of serum cytokines in patients with silicosis.Methods One hundred and six cases patients with silicosis were collected in the Fifth People''s Hospital of Suzhou as study subjects and 56 healthy subjects as control group.Flow cytometry was used to detect the peripheral CD3+,CD4+,CD8+ and CD4+CD25 high regulatory T cells (Treg) of the patients and the control group,while chemiluminescence immunoassay was utilized to measure the peripheral serum soluble interleukin-2 receptor (sIL-2R),interleukin 6 (IL-6),interleukin 8 (IL-8) and tumor necrosis factor α (TNF-α).Results (1) The percentages of peripheral CD3+,CD4+ and CD8+ in the silicosis group were all lower than those in the control group (t=3.755,3.828,2.347,P<0.05);the percentage of Treg cells was higher in the silicosis group than in the control group,the difference was statistically significant (t=-8.345,P<0.05).Compared with the control group,based on the one-way analysis of variance,the differences in CD3+,CD4+,CD8+ and CD4+CD25 high cells were all statistically significant (F=5.620,8.007,26.71,P<0.05);in the silicosis group,the percentage of CD4+ T cells was lower in stage III than in stage I (t=3.424,P<0.05);compared with the control group,the percentages of Treg cells in the silicosis group were lower in all stages (t=-7.934,-9.445,-5.096,P<0.05).(2) The levels of peripheral sIL-2R,IL-6,IL-8 and TNF-α in the silicosis group were higher than those in the control group,the difference were statistically significant(t=-6.952,-4.506,-2.551,-5.670,P<0.05);compared with the control group,based on the one-way analysis of variance,the differences in sIL-2R,IL-6 and TNF-α in all stages were statistically significant (F=11.03,11.31,13.22,P<0.0001);the sIL-2R was higher in patients with stage III silicosis than that of stage I (t=-2.882,P<0.05);IL-6 was significantly higher in stage II and III silicosis group than that of stage I group (t=-3.022,-2.632,P<0.05),and TNF-α was higher in patients with stage II silicosis than patients with stage I silicosis (t=-2.322,P<0.05).(3) The level of peripheral Treg cells was negatively correlated with the percentages of CD3+ and CD8+ cells in patients with silicosis (r=-0.357,-0.508,P<0.05);sIL-R2 was positively correlated with IL-6,IL-8 and TNF-α,respectively (r=0.483,0.199,0.392,P<0.05);TNF-α was positively correlated with IL-6 and IL-8,respectively (r=0.338,0.338,P<0.05).Conclusion Patients with silicosis have abnormal expression in peripheral T cell subgroups,significantly increased Treg cell and dysfunctional cytokines,which may be associated with the pathogenesis of silicosis,the detection of these indicators may have significance of diagnosis,staging,disease monitoring and prognosis of the diseases.

Objective To evaluate application feasibility of Array CGH in genetic diagnosis of clinical complex chromosomal abnormalities.Methods Two patients of genetic counseling and two patients of prenatal diagnosis were selected from Xiamen Maternity & Child Health Care Hospital during the period of December 2010 to December 2011.Under aseptic conditions 2-4 ml peripheral blood was collected in EDTA and 2-3 ml Cord Blood was collected through cordocentesis after genetic counseling and preoperative examination.G-banded chromosome analysis and genome DNA extraction were carried out on the four cases.The whole genome of four cases were scanned and analyzed by Array CGH.The results of Array CGH were confirmed by FISH.Results Array CGH detected different kinds of duplications and deletions in several chromosomes.Most of these duplications and deletions were not detected by karyotype analysis.The results of Array CGH showed duplication of 4p16.3-4p15.31,deletion of 4p16.3 in the first case,duplication of Xp11.22-Xq11.1 in the second case,duplication of 4p16.3-4p15.32,deletion of 2q37.3 in the third case and duplication of 2q21.2-2q32.1,deletion of 2q14.3-2q21.1 in the fourth case.These duplications and deletions were confirmed by FISH.Conclusions Compared with conventional cytogenetic analysis,Array CGH can not only accurately detect micro deletion and micro duplication with high resolution and sensitivity but also identify breakpoints precisely.Array CGH can provide the basis for clinical genetic diagnosis.

Objective To investigate the clinical characteristics and surgical treatment of gastrointestinal stromal tumors (GIST) of the duodenum.Methods The clinical data of 39 patients with duodenal GISTs from 1992 to 2010 were analysed retrospectively.Results The most common symptoms of duodenal GISTs were alimentary tract hemorrhage,occuring in 18 cases of the 39 cases (46％).Clinical diagnosis established by CT in 22 cases (69％).Duodenoscopy performed in 18 cases established the definite diagnosis of GIST in 15 (83％).Duodenal GISTs were most commonly located in the descending portion of the duodenum in 27/39 cases (69％).All 39 cases received surgical treatment,with R0 resection in 34 cases,including partial resection of the duodenum in 47％ (16/34),pancreaticodenectomy in 35％(12/34),segmental resection of the duodenum in 3 cases,subtotal gastrectomy in 3 cases; One died perioperatively and postoperative complications developed in 9 cases,which were cured by conservative therapy.The 1,3,5 year survival rate was 90％,72％,41％ for those receiving R0 resection.Conclusions The abdominal CT scan with contrast and duodenoscopy are helpful to establish the diagnosis of duodenal GISTs.Surgical procedures depend on the size and site of the lesion for R0 resection.To decrease postoperative recurrence and prolong survival adjuvant therapy with Imatinib is necessary.