Objective To study the perioperation management and surgical therapy of Graves' disease accompanied with severe thyroid gland enlargement. Methods 32 cases of Graves' disease with severe thyroid gland enlargement were included in our study and their symptom control, perioperation management, surgical therapy and postoperative complication treatment were analysed retrospectively. Results There was no surgical death among the 32 patients. The incidence of postoperative complications was 21.9%. And among them, 2 cases had respiratory tract obstruction, 2 cases temporary hypocalcemia and 3 cases mild hypothyroid. ConclusionFor Graves' disease, surgical therapy has a satisfactory effect but a higher incidence of complication.

Objective To investigate the influence of indomethacin to the unite treatment effect on chronic phase myeloid leukemia (CML-CP) with interferon alpha-2b (IFNα-2b) and low dose cytarabine (LD-Ara-C).Methods 22 CML-CP patients were randomly divided into two groups.Control groups (10 cases) injected with IFNα-2b (3 million units),injection frequency was q.o.d,the duration of treatment was about 3-18 months,cytarabine (Ara-C) by slowly intravenous driped (30 mg/d).In this treatment schedule,every course of treatment sustained 10 days,and with a 2 weeks interval.During this process,patients in treatment group were treated with hydroxyl urea only when their WBC in peripheral blood exceed 20×109/L,otherwise,discontinue it.Treatment group (12 cases),on the first day of treatment with IFNα-2b and Ara-C,added indomethacin (25 mg) through oral administration,the frequency was t.i.d.During treatment in the two group,the end point of observation was completely hematology ease,at the same time,these indicators in the two groups needed to be compared,the time when WBC begin to fall,the time when WBC fall to normal range,the time when immature cells returned to normal,the time which complete hematological remission and the highest temperature of patients after IFNα-2b was subcutaneous injected.Results The time when WBC begin to fall in treatment group was (4.2±2.7) d,and the time was (5.0±2.5) d in control group (t =0.714,P ＞ 0.05).In treatment group,the time when WBC fall to normal range was(10.0±4.5) d,and the time was (12.0±4.5) d in control group (t =1.036,P ＞ 0.05).The time when immature cells returned to normal in treatment group was (14.2±4.8) d,and the time was (19.0±3.6) d in control group (t =2.609,P ＜ 0.02).The time which complete hematological remission was achieved in control group was (45.8±5.6) d,but it was (53.9±10.5) d in control group (t =2.314,· P ＜ 0.05).Meanwhile,the fever degree after IFNα-2b was subcutaneous injected obviously achieved improvement in treatment group (x2 =12.041,P ＜ 0.005).Conclusion The advantage of indomethacin to the unite treatment with IFNα-2b and LD-Ara-C on CML mainly lays in which cound alleviated the adverse reaction such as flu-like of IFN,and more,there are synergy effect in antagonist CML.

Objective To investigate the clinical diagnostic significance of detecting T in peripheral blood lymphocyte subsets (CD4+,CD8+ and the ratio of pulmonary tuberculosis with diabetes) and explore drug therapy of the five thymus peptide combined anti-tuberculosis on the diabetes complicated with pulmonary tuberculosis.Methods Eighty cases of pulmonary tuberculosis complicated with diabetes mellitus were selected as our treatment subject,who were treated with anti-tuberculosis drug treatment and five thymus peptide regulating immunity treatment.T lymphocyte subsets (CD4 +,CD8 + and their ratio) were detected.Meanwhile acid-fast bacilli and image detection were performed.Another 80 cases were as our control group that treated with anti-tuberculosis drug.Results Following the thymus peptide five treatment for 1,2,and 6 months,T lymphocyte subsets were (CD4+:(34.34 ± 7.32) ％,(39.23 ± 6.62) ％,(41.06 ± 7.13) ％),(CD8+:(31.42 ±8.91)％,(32.52 ±8.58)％,(32.12 ±8.59)％),(CD4+/CD8+:(1.23 ±0.31),(1.34 ±0.30),(1.36 ± 0.32),higher than that of before treatment (30.26 ± 8.25) ％,(30.36 ± 9.86) ％,(1.13 ± 0.42) CD4 +.Through 2 months treatment,CD4+,CD4+/CD8+ of patient in treatment groups were different with that of control group (P ＜ 0.01 or P ＜ 0.05).80 patients after anti-TB plus application thymopentin regulating immunity for 2 months,normal sputum negative conversion rate of CD4+ was 97.2％ and improvement rate was 98.0％.However cases with high CD4+ T lymphocyte subsets showed 78.6％ negative rate of acid-fast bacilli and 88.0 ％ cured rate,and there was significant difference (x2 =4.764,7.680,respectively,P ＜ 0.05).Conclusion Thymic peptide five might have the ability of improving the cellular immune function in patients with pulmonary tuberculosis and diabetes.The prognosis is better when T lymphocyte subsets CD4+ of patient was back to normal through treatment.

Objective To investigate the mechanism of alternation of PKC activify in liver ischemia preconditioning(IP). Methods After establishment of rat liver IP model, PKC inhibitor and activator were utilized to analyze the phosphorylation of PKC and P44/42MAPKs and HSP expression, and cellular structure was also observed. All of the data were statistically analyzed. Results Compared with the control group without IP, the phosphorylation of PKC was significantly increased in IP treated models and PKC activated group(P

OBJECTIVE To investigate the reasons and preventive measures of recurrent laryngeal nerve injury during operation in patients with benign thyroid neoplasm. METHODS The clinical data of 2243 cases with benign thyroid neoplasm were reviewed. The relations among different neoplasm regions, different procedures and injury of recurrent laryngeal nerve were analyzed. RESULTS Injury incidence of recurrent laryngeal nerve in this study was 3.0 %. In cases with nodular goiter on the dorsum of thyroid and recurrent laryngeal nerve exposed during operation, injury incidence of recurrent laryngeal nerve was 1.0 %. And there was no recurrent laryngeal nerve injury in cases with nodular goiter on other region of the thyroid. In cases used locality protection during operation, injury incidence of recurrent laryngeal nerve was 7.6 % when benign lesions on the dorsum of thyroid and was 0.17 % when benign lesions on other region of the thyroid. CONCLUSION In cases with nodular goiter or adenoma on the dorsum of thyroid, exposing recurrent laryngeal nerve is necessary during operation and in cases with benign lesions on other region of thyroid, locality protection is useful. There are three major routes for recurrent laryngeal nerve exposure.

Objective To investigate the effect of local application of triamcinolone acetonide in promoting wound healing and recurrence after granulomatous lobular mastitis (GLM) operation. Methods The clinical data of 55 GLM patients with the diameter > 5 cm were retrospectively analyzed, and all patients treated with incision drainage to breast abscess and removal of inflammatory lesions. Thirty - one patients were treated with routine dressing change after operation (control group), and 24 patients were treated with routine dressing change and triamcinolone acetonide injection after operation (experiment group). The wound dressing time, recovery rate and recurrence rate were compared between 2 groups, and hormone related adverse reaction of experiment group was observed. Results The wound dressing time in experiment group was significantly shorter than that in control group:(58 ± 19) d vs. (71 ±25) d, and there was statistical difference (P<0.05). There were no statistical differences in the recovery rate and recurrence rate between experiment group and control group:91.7%(22/24) vs. 83.9%(26/31) and 9.1%(2/22) vs. 15.4% (4/26), P>0.05. The patients of experiment group did not have the hormone related adverse reaction. Conclusions The local application of triamcinolone acetonide after GLM operation can accelerate the wound healing, and it may also contribute to higher recovery rate and lower recurrence rate.

Objective:To investigate how urothelial carcinoma-associated 1 (UCA1) and miR-18a modulates acquired tamoxifen resistance and the relevant mechanisms in estrogen receptor (ER) positive cancer cells.Methods: qRT-PCR was performed to detect UCA1 and miR-18a expression in breast cancer cells.Dual luciferase assay was performed to detect the binding between miR-18a and UCA1 3′UTR.Tamoxifen sensitive MCF-7 cells were transfected with UCA1 expression vector or miR-18a inhi-bitors.Tamoxifen resistant LCC9 and BT474 cells were transfected with UCA1 siRNA or miR-18a mi-mics.CCK-8 assay was performed to detect cell viability.Soft agar assay was performed to assess cell colony formation.Flow cytometric analysis was performed to check cell cycle distribution.Results: UCA1 was significantly upregulated in tamoxifen resistant LCC2,LCC9,and BT474 cells than in tamoxifen sensitive MCF-7 cells.UCA1 expression was significantly upregulated in MCF-7 cells after treatment with 0.1 μmol/L tamoxifen.UCA1 overexpression enhanced cell viability of MCF-7 cells after tamoxifen treatment,while UCA1 siRNA significantly suppressed viability of LCC9 and BT474 cells after tamoxifen treatment.In MCF-7 cells,compared with vector control+tamoxifen group,the average cell colony number and colony size of the UCA1+tamoxifen group was 19.0％ more and 29.0％ larger respectively,while the proportions of the cells in G1 phase and in S phase were 7.3％ lower and 6.7％ higher respectively.In BT474 cells,compared with siRNA control+tamoxifen group,the average cell colony number and colony size of the si-UCA1+tamoxifen group were 54.0％ less and 42.0％ smaller respectively,while the proportions of the cells in G1 phase and in S phase were 9.0％ higher and 6.2％ lower respectively.UCA1 directly interacted with miR-18a and reduced its expression in ER positive breast cancer cells.Knockdown of miR-18a increased viability of MCF-7 cells after tamoxifen treatment,while miR-18a overexpression significantly reduced viability of BT474 cells after tamoxifen treatment.In MCF-7 cells,compared with miRNA inhibitor control+tamoxifen group,the average cell colony number and colony size of the miR-18a inhibitor+tamoxifen group were 15.0％ more and 33.0％ larger respectively,while the proportions of the cells in G1 phase and in S phase were 8.8％ lower and 5.3％ higher respectively.In BT474 cells,compared with miRNA control+tamoxifen group,the average cell colony number and colony size of the miR-18a mimics+tamoxifen group were 47.0％ less and 25.0％ smaller respectively,while the proportions of the cells in G1 phase and in S phase were 13.3％ higher and 7.9％ lower respectively.Conclusion: UCA1 can increase tamoxifen resistance of ER positive breast cancer cells via competitively inhibiting of miR-18a.

Objective To evaluate the impacts of the two different gastrectomy methods on the quality of life,complication and prognosis in proximal gastric cancer.Methods One hundred and two cases of proxi-mal gastric cancer in Tung Wah Hospital were collected for retrospective analysis.They were divided into proxi-mal gastrectomy/gastroesophagostomy (PG)group (n =50)and total gastrectomy/esophagojejunostomy (TG) group (n =52),according to the methods of gastrectomy and reconstruction.The postoperative complications, nutritional status and prognosis of the two groups were compared.Results The incidence of reflux esophagitis was obviously higher in PG group than that in TG group (38.0% vs 1 9.2%,χ2 =4.464,P =0.035).No sig-nificant differences were found between the two groups in the incidences of postoperative infection,bleeding and anastomotic leakage (χ2 =0.063,P =1 .000;χ2 =0.001 ,P =0.978;χ2 =0.31 1 ,P =0.577).There were no significant differences between PG and TG group in total plasma protein [(65.26 ±4.1 0)g/L vs (65.33 ± 3.75)g/L,t =-0.402,P =0.688],albumin [(39.76 ±2.1 7)g/L vs (39.59 ±2.04)g/L,t =1 .778,P =0.076],hemoglobin [(1 07.33 ±1 1 .1 0)g/L vs (1 08.09 ±1 1 .1 7)g/L,t =-1 .502,P =0.1 33]and weight loss [1 .00 ~8.00 kg vs 0.50 ~8.20 kg,t =-1 .622,P =0.1 05]in one year postoperatively.All cases were followed-up for 7 months to 1 0 years.No significant differences were found between PG and TG group in the incidences of anastomotic tumor recurrence (4.0% vs 5.8%,χ2 =0.1 71 ,P =0.679),metastasis (24.0% vs 28.8%,χ2 =0.308,P =0.579)and median survival time (53.6 months vs 49.8 months,χ2 =2.564,P =0.1 09).Conclusion Compared with PG group,the incidence of postoperative reflux esophagitis is effectively reduced,and the incidences of malnutrition,tumor recurrence and metastasis and death are not increased in TG group.Hence,TG should be a safe and effective surgery strategy.

Objective To compare the incidence of recurrent laryngeal nerve (RLN) injury in thyroidectomy with or without exposing RLN. Methods Records of 704 patients in our hospital undergoing thyroidectomy were retrospectively studied, among whom 472 patients underwent thyroidectomy with RLN being exposed and 232 underwent thyroidectomy without RLN being exposed. Results The incidence of RLN temporary damage and permanent damage in RLN exposed group was 1.49% (7/472) and 0, while it was 6. 03% (14/232)and 2. 16%(5/232) in the non-exposed group. There was statistic difference between the two groups in terms of permanent injury incidence and operation duration (P ＜ 0. 01). Conclusions Although the operation duration was prolonged in RLN exposure group, RLN exposure during operation is very helpful to prevent recurrent laryngeal nerve injury. Therefore, it's necessary to expose RLN during operation in sub-total thyroidectomy and total thyroidectomy.

Objective To investigate the pancreaticoenterostomy technique using end to end anastomosis of remianing pancreas and jejunum with jejunum mucus preserved. Methods 28 cases underwent pancreatectomy were observed and analyzed from May 2005 to August 2009. There were 26 cases underwent duodenopancreatectomy and 2 cases underwent the pancreatectomy of pancreas body and tail. All cases used the end to end pancreaticoenterostomy, remnant pancreas was directly anastomosed with jejunum without destroy of jejunal mucosa. During the operation, 2.0 cm～2.5 cm long remnant of pancreas was pulled into jejunum without mucosa destroyed. Then, the cut end of the jejunum was fixed on the pancreatic remnant correspondingly by interrupted suture. Finally, a 7-silk suture was used to bind the jejunum and the pancreatic remnant together 1 cm away from the cut surface of the pancreatic remnant. Results 1 case underwent operated again due to bleeding of the pancreatic remnant. 28 patients recovered and discharged from hospital without having the complication of pancreatic fistula. Conclusions Because of the complicated suturation methods, the conventional pancreaticoenterostomy consumes more time. But it still has rather high incidence of pancreatic fistula.The new pancreaticoenterostomy which we used can shorten the operating time and integrity and binding stomas. It is effective to lower the incidence of pancreatic fistula.