Objective To investigate the factors associated with postoperative recurrence of benign thyroid nodules and its retreatment. Method A retrospective analysis was made on the pathologies, operative indications, and the types of operations in 51 postoperative recurrent cases with benign thyroid nodules in a poriod of 18 years. Result The recurrences were associated with the pathology, number of nodules, the indications and types of primary surgery. Among the 51 cases there were 29 cases with nodular goiter and 22 cases with thyroid adenoma. 21 patients had had simple nodular resection, 16 patients had partial lobe resection, 9 patients had subtotal thyroidectomy and 5 patients had thyroid lobectomy. Among 38 cases receiving reoperation, 19 cases had lobectomy, 3 cases had lobectomy plus opposite subtotal thyroidectomy, 7 cases had subtotal thyroidectomy and 9 cases had bilateral subtotal thyroidectomies without serious postoperative complications. 32 cases were followed up after secondary operation with an average period of 7 years, among which 1 case with multinodular goiter had recurrence. Conclusion Strict restriction on thyroidectomy for patients with mutinodular goiter and giving up simple nodular enucleation could help reduce postoperative recurrence of benign thyroid nodules.

Due to its effectiveness and specificity,RNA interference (RNAi) technology is widely used in the treatment of tumor,viral infectious and metabolic diseases.Noninvasively tracing the delivery of therapeutic RNA molecules in vivo and evaluating the therapeutic effects are important to promote the clinical application of RNAi technology.Molecular imaging allows noninvasive visualization of biological processes at the cellular and molecular level in vivo.It can be used to monitor the biodistribution of therapeutic RNA molecules and to assess the effects of the RNAi.This article reviews the advance of molecular imaging in monitoring the delivery of RNAi molecules and evaluating the therapeutic effects of RNAi.

Objective To investigate the relationship of epidermal growth factor receptor (EGFR) mutation with clinical features of baselines as well as serum CEA level in patients with recurrent non-small cell lung cancer (NSCLC). Methods A total of 54 patients with first recurrence of advanced lung cancer who had received chemotherapy were included in this study. ADx-ARMS was performed to detect EGFR gene mutations in surgical specimens taken from the primary tumor. Serum CEA level was measured by the electrochemical luminescence method. Results The mutation rate of EGFR was significantly higher in females than in males (χ2= 11.868, P =0.006), with a total mutation rate of 60.8%in 106 patients. The rate was higher in adenocarcinoma than in other histological types(χ2=6.002,P=0.014), and significantly higher in non-smokers than in smokers (χ2= 8.502,P=0.004) and in the patients with serum CEA level over or equal to 5.0 ng/mL than those with CEA level less than 5.0 ng/mL (χ2=22.543,P=0.000). A multivariate analysis revealed that a higher serum CEA level at the time of disease recurrence was associated with EGFR gene mutations (P = 0.002). Conculsions Serum CEA level is closely associated with the presence of EGFR gene mutations in patients with first recurrence of advanced NSCLC. A higher serum CEA level at the time of disease recurrence is independently associated with EGFR gene mutations. CEA level can be used as a potential indicator to determine EGFR mutation.

OBJECTIVE: To observe the effects of Feiji Formula, a compound traditional Chinese herbal medicine, on lung cancer metastasis in mice. METHODS: The lung cancer metastasis model of mice was established in this experiment study. Twenty-four mice were randomly divided into three groups: untreated group, cisplatin group and Feiji Formula group. Mice in the Feiji Formula group were treated with Feiji Formula decoction; in cisplatin group, with cisplatin by intraperitoneal injection; and in the untreated group, with normal saline (NS). After twenty-day treatment, the body and tumor weights as well as the number of metastatic tumors in both lungs of each mouse were measured. RESULTS: The body weight of mice in cisplatin group was significantly less than that of Feiji Formula group and untreated group (P<0.01); the tumor weight of mice in cisplatin group and Feiji Formula group was markedly lower than that of untreated group (P<0.01); and the number of metastatic tumors in cisplatin group and Feiji Formula group was markedly lower than that of the untreated group (P<0.01), no significant difference between the Feiji Formula group and cisplatin group in terms of the weights and the numbers of metastatic tumors in bilateral lungs. CONCLUSION: Feiji Formula can suppress tumor growth and decrease the number of lung metastatic tumors in the mice, and maintain the body weight of the mice.

ObjectiveIn order to confirm the value of high resolution frequency(HFUS) ultrasonography in the early diagnosis of psoriatic arthritis(PsA).MethodsTwenty-nine patients with psoriatic arthritis reporting sixty-nine finger pain and 30 patients with rheumatoid arthritis reporting seventy finger pain and 20 healthy volunteers underwent X-ray and US evaluation.The ultrasonographic characteristics and blood flows in the joints were checked with high resolution ultrasonography.Bilateraljoints were compared each other in every patient.Comparisons between groups were tested by x2 test.ResultsSonographic positive signs were found in all the involved joints in 29 PsA patients,joint effusion in 42 fingers (61％).Synovial thickening was found in 38 fingers (55％).Bone erosions were found in 28 fingers(41％),tenosynovitis were found in 40 fingers (58％),soft tissue inflammation was revealed in 29 fingers (42％).Enthesitis were foundin 30 fingers (43％).In RA patients,joint effusion was found in 52 fingers (74％) and synovial thickening in 48 fingers (69％).Bone erosions were found in 33 fingers (47％).Tenosynovitis,soft tissue inflammation and enthesitis were not found in RA patients.ConclusionHigh resolution ultrasonography is an easy,safe and effective method for the early diagnosis of pathological changes of small joints in psoriatic arthritis.

Obj ective In the body of stereotactic radiotherapy ( SBRT ) , using Cone Beam is the matc-hing precision of soft tissue and bone anatomy ,translation between evaluation organization and internal organiza-tion in the rotation of the lung cancer patients with tumor location error ,location correction .Methods Applica-tion varian companies in the United States has the airborne imaging system clinac -ix linear accelerator apparatus treatment of 8 cases of lung cancer patients .By CBCT and SBRT comparison before and after the treatment for each patient and evaluate internal instant translation and rotation of the body of the patients with SBRT postures , tumor location and tumor center of baseline shift score changes .Results Based on the difference between of the anatomy of the bone and soft tissue match position is 3.0 mm(0~8.3 mm).The patient′s tumor location in 3-d median change is 1.4 mm(0~12.2 mm)and 12.2 mm(0~13.2 mm).The median baseline offset between 3 d score is 2.2 mm(0~4.7 mm).The rest of the system error and random error about 1 °.Conclusion In Lung cancer SBRT transformation to improve treatment of lung tumor process , change the position of tumor center is mainly affected by the body′s internal organization instant translation and rotation .

Objective The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy(VATET) as a treatment for non-thymomatous myasthenia gravis (NTMG) and to identify prognostic factors for thymectomy.Methods Retrospectively analyzed clinical datas of 112 patients received VATET for the treatment of NTMG.Clinical efficacy and variables influencing outcome were evaluated by Kaplan-Meier method and Cox proportional hazards regression analysis.Results At 3.2 years averaged (1.5-6.2 years) of follow-up,none of these patients were lost to follow up.According to the MGFA post-intervention status,54 patients(48.2％) obtained complete stable remission during follow-up,21 patients(18.8％) obtained pharmacologic remission,10 patients (8.9％) obtained minimal manifestations,7 patients (6.3％) improved,20 patients(17.8％) unchanged,and none of these patients were worse or died of MG.By multivariate analysis,the chance of complete stable remission was significantly increased when age ＜ 40 years (P ＜ 0.01,OR =3.468),symptom duration ＜ 12 months(P ＜ 0.01,OR =3.203) and the presence of thymic hyperplasia (P ＜ 0.01,OR =3.064).Conclusion Video-assisted thoracoscopic extended thymectomy achieved satisfactory long-term results in patients with nonthymomatous myasthenia gravis,while age,symptom duration,the presence of thymic hyperplasia correlated with response to operation.

Objective To investigate the vascular compliance markers (C1 and C2) and pulse wave velocity in relative with other physiological indexes in a cohort of young normotensive people in Beijing. Methods Two hundred and seventy normotensive volunteers (112 men and 158 women aged 16 to 30 years) were invovled,completed questionnaires of demographic information. Large (C1) and small (C2) arterial compliance were derived from arterial pulse wave contour analysis. Pulse wave velocity(carotid-femoral PWV and carotid-radial PWV)was determined by Complior SP. Results In both male and female C1 correlated positively with height and weight,and negatively with systolic(SBP),mean arterial blood pressure(MAP),pulse pressure(PP),and heart rate(HR),in which PP showed the best correlation with C1;C2 was inversely related with SBP,diastolic blood pressure(DBP),MAP and HR,in which SBP showed the best correlation with C2;cfPWV correlated positively with DBP and age,crPWV correlated positively with age,DBP,height and weight. Conclusion Blood pressure,heart rate were the important influential factors of large and small arterial compliance in both males and females,while diastolic blood pressure was determinant for pulse wave velocity.

Objective To explore the method of demonstrating main operative section of facial recess approach with multi-slice CT by using double oblique muttiplanar reconstruction.MethodsSimilarly as surgical procedure of facial recess approach,30 (60 eras) normal temporal bones in cadavers were reconstructed to observe main operative sections and anatomical marks.Main images of operative section of facial recess approach were reconstructed using double oblique multiplanar reconstruction on multislice CT.With the reference of operative anatomical marks,the ratios of visibility of anatomical marks on the transverse plane,coronal plane,sagittal plane and double oblique were calculated and compared.The degree,of which major anatomical landmarks were displayed on the same plane ( axial,coronal,sagittal,or doubleoblique sagittal plane),was classified using the following criteria: level 4: 100％ of anatomical landmarks were presented in the same plane; level 3: 90％ to 99％ of anatomical landmarks were presented in the same plane; level 2: 80％ to 89％ of anatomical landmarks were presented in the same plane; level 1: 70％ to 79％ of anatomical landmarks were presented in the same plane ; level 0: ＜ 70％ of anatomical landmarks were presented in the same plane.Classification data were tested by chi-square test.Results Four key operative section were involved in facial recess approach,which were of oblique sagittal orientation.The central mark of the first key operative section was semicircular canal by using double oblique multi-planar reformation.On reconstructed images of the first key operative section,horizontal reference line was short process of incus,and the angle adjusting the reference line on the transverse plane was 22.15° ±5.22°.On the reconstructed images of the first key operative section,coronal reference line was tympanic segment of facial canal,and the angle adjusting the reference line on the coronal plane was 14.35° ± 4.02°.On the reconstructed images of the second key operative section,the central mark was fossa incudis,the horizontal reference line was short process of incus and the angle was 20.15° ± 5.52°,while the coronal reference line was tympanic segment of facial cana,and the angle was 13.15° ± 3.33°.On the reconstructed operative images of the third key section,the central mark was pyramidal eminence,the horizontal reference line was the horizontal portion of the facial nerve and the angle was 32.53° ±5.22°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.05° ± 4.43°.On the fourth reconstructed images of the key operative section,the central mark was the posterior border of round window,the horizontal reference line was the superior border of oval window,and the angle was 50.15° ± 8.02°,while the coronal reference line was the tympanic segment of facial nerve,and the angle was 15.25° ± 4.12°.For the four planes (double-oblique sagittal,axial,coronal,or sagittal plane),the results of the degree to which they could include the major anatomical landmarks in the same layer of the first section were: level 4 in 60 sides,level 2 in 12 sides and level 3 in 48 sides,level 2 in 15 sides and level 3 in 45 sides,level 3 in 10 sides and level 4 in 50 sides,respectively.The results of the second section were: level 4 in 60 sides,level 2 in 11 sides and level 3 in 49 sides,level 2 in 13 sides and level 3 in 47 sides,level 3 in 11 sides and level 4 in 49 sides,respectively.The results of the third section were: level 4 in 60 sides,level 2 in 10 sides and level 3 in 50 sides,level 2 in 11 sides and level 3 in 49 sides,level 3 in 9 sides and level 4 in 51 sides,respectively.The results of the fourth section were: level 4 in 60 sides,level 2 in 9 sides and level 3 in 51 sides,level 2 in 8 sides and level 3 in 52 sides,level 3 in 5 sides and level 4 in 55 sides,respectively.The four planes differed significantly in the degree to which they could include the major anatomical landmarks in the same layer ( x2 =123.3200,121.4231,122.4011,125.4213,all,P ＜ 0.05 ).The visibility ratio of every section is 100％ (60/60).Conclusion Double oblique multi-planar reformation is a new method to demonstrate landmarks of operative section of facial recess approach in one slice.The reconstructive images of operative section with double oblique multi-planer reconstruction may provide valuable information for operation.

Objective To observe the changes in serum vancomycin trough concentration,and explore its optimal dosage in critical patients.Methods A retrospective study was conducted.Data of 66 patients who used vancomycin during July 2010 to May 2012 in surgical intensive care unit (SICU) of the First Affiliated Hospital of Sun Yat-Sen University were collected and analyzed.According to the endogenous creatinine clearance rate (CCr),the patients were divided into two groups:CCr normal group (≥ 70 mL/min) and CCr lowered group (＜70 mL/min).The distribution of vancomycin serum trough concentration between two groups,relationship between vancomycin serum trough concentrations and CCr,and the influence of vancomycin serum trough concentrations on the prognosis was analyzed.The difference between actual dosage and the recommended dosage in guideline was compared between two groups.Results 119 times of vancomycin serum trough concentration in 66 patients were enrolled,and it was found that only 20.17％ (24/119) reached the target concentration (15-20 mg/L),45.38％ (54/119)＜ 15 mg/L and 34.45％ (41/1 19) ＞20 mg/L.Vancomycin serum trough concentration in CCr normal group (55 cases) was (13.11 ± 6.84) mg/L,among them 65.5％ (36/55) attained lower trough concentrations (＜ 15 mg/L).In the subgroup with 15-20 mg/L trough serum concentrations,vancomycin doses were significantly lower than that of recommendation (g/d:1.95 ± 0.61 vs.2.73 ± 0.32,F=1.739,P=0.001).Vancomycin serum trough concentration in CCr lowered group (64 cases) was (20.49 ± 8.12) mg/L,with 51.5％ (33/64) of them showed higher trough concentrations (＞20 rag/L).In the subgroup with 15-20 mg/L vancomycin trough serum concentration,vancomycin doses were higher than that of recommendation (g/d:1.08 ±0.49 vs.0.78 ±0.19,F=11.294,P=0.062).There was no significant difference in 28-day mortality between patients with targeting trough serum concentrations and those without [22.2％ (4/18) vs.18.8％ (9/48),x2=0.009,P=0.924].Serum creatinine [odds ratio (OR)=1.001,95％ confidence interval (95％CI):0.990-1.012,P=0.000],vancomycin doses (OR=0.600,95％CI:0.251-1.434,P=0.003),age (OR=0.985,95％CI:0.955-1.015,P=0.015) and body mass index (OR=1.013,95％CI:0.967-1.062,P=0.022) were found to be correlated to serum trough concentrations by multiple linear regression analysis.Conclusions The rate of vancomycin serum trough concentrations reaching the standard is low in critical patients,so constant monitoring is necessary.Creatinine,vancomycin dosage,age and body mass index show a relatively significant influence on the serum trough concentrations,and they should be taken into consideration in dosage to be given.