Parathyroid carcinoma is a rare endocrine tumor.Clinical manifestations are varied with multiple organs involved,mainly due to hypercalcemia.So far the etiology and pathogenesis of parathyroid carcinoma are still unclear and preoperatively diagnosis is difficult.Technetium-99 m sestamibi scan and ultrasound can help to find the early lesions.Complete surgical resection with suspicious involved lymph nodes is the recommended treatment.Parathyroid carcinoma is insensitive to chemotherapy and radiotherapy.New immune therapy yields unsure efficacy.Therapeutic effect and prognosis mainly depend on primary surgical resection of the tumor.The disease recurs in more than 50％ of patients with poor prognosis.

Objective To evaluate the effect of low dose fentanyl on target plasma concentration (CP) of propofol (P) given by target controlled infusion (TCI) required to prevent response to proseal laryngeal mask insertion in 50% of patients (EC50). Methods Forty-six ASA Ⅰor Ⅱ patients aged 20-50 yr with body mass index ≤ 30 kg/m2 undergoing elective gynecological laparoscopy were randomly divided into 2 groups (n=23each):propofol group (P) and propofol-fentanyl group (PF). Anesthesia was induced with TCI of propofol. The initial Cp of propofol TCI was set at 2.5 μg/ml in group PF and 4 μg/ml in group P. Following equilibration between plasma and effect site concentration of propofol, fentanyl 1 μg/kg (in group PF) or normal saline (in group P) was injected iv. Laryngeal mask airway (LMA) was inserted at 3.5 min after fentanyl administration. EC50 was determined by up-and-down sequential trial. The ratio of Cp between the two consecutive patients was 1.2 in group P and 1.1 in group PF. LMA insertion response was defined as nausea, bucking and/or body movement during insertion. "Probit method was used to calculate the Echo and 95 % confidence interval required to prevent LMA insertion response. Results The EC50 and 95 % confidence interval of propofol given by TCI required to prevent LMA insertion response was 4.68 (4.20-5.21)μg/ml in group P and 2.63 (2.45-2.83) μg/ml in group PF. There was significant difference between the 2 groups. Conclusion Fentanyl 1 μg/kg iv can significantly reduce the Cp of propofol TCI required to prevent LMA insertion response.

Objective:To clarify the mechanism of crisis serum' mediated gametocyte infectivity to the mosquito vector Methods:Observing the effects of mouse serum , which was obtained 5 days after P yoelii infection (D5 serum) on gametocyte infectivity by IFA and mosquito live feeds, and the production of IFN ??TNF ??IL 4 and NO - 2 in the hosts in vivo and in vitro by ELISA and Griess reaction And to investigate the ability of malaria parasitized red blood cell extract (PRBC extract) to induce NO Results:The development of the gametocytes from mice 5 days postinfection into ookinetes were completely inhibited D5 serum was not immediate to inhibit gametocyte development, which was injected intravenously into the mice 3 days after P yoelii infection But 4 h later after injection D5 serum stimulated the increasing IFN ? and NO production and inhibited gametocyte infectivity Moreover, PRBC extract showed the ability to induce NO Conclusion:Infected host serum blocks transmission of P yoelii via a nitric oxide dependent mechanism

Objective To summarize the experience of combination use of biliary stent placement and drainage with primary suture of the common bile duct in the treatment of choledocholithiasis. Methods Laparoscopic common bile duct exploration combined with flexible choledochoscopy was performed in 16 patients with choledocholithiasis from June 2005 to March 2006. During the operation, a patented “biliary stent for internal drainage” was introduced into the common bile duct, and primary sutures were performed to close the bile duct. Postoperatively, the stent was removed under gastroscope or duodenoscope. Results All the 16 operations were successfully accomplished without conversions to open surgery. The operative time was 90~260 min (mean, 145 min). The biliary stent was removed 5~7 days after the surgery. Follow-up for 3~12 months showed no residual stones or biliary stenosis. Conclusions Combination use of biliary stent drainage and primary suture of the common bile duct in the treatment of choledocholithiasis is safe and feasible.

Objective To explore the clinical effect of laparoscopic exploration on incarcerated inguinal hernia.Methods 38 patients with incarcerated inguinal hernia were randomly divided into open operation group (19 cases) and laparoscopic group(19 cases) by using the digital table method.The open operation group used Lichtenstein tension-free repair method.The laparoscopic group used the transabdominal preperitoneal(TAPP) repair method.The hospitalization days,operation time,degree of pain,bleeding loss,postoperative time return to normal activities,postoperative complications and the postoperation recurrence of two groups were compared.Results The hospitalization days,operation time,degree of pain,bleeding loss,postoperative time return to normal activities,incidence rate of complications in the laparoscopic group were (5.11±1.29)d,(43.05±8.10)min,(2.79±1.08)points,(20.42±9.69)mL,(14.11±3.81)d,15.79% respectively,which of the open operation group were (6.79±1.80)d,(48.32±6.82)min,(4.21±1.13)points,(28.42±7.99)mL,(18.26±3.77)d,47.37% respectively,there were significant differences between the two groups in terms of above indicators(t=-3.31,-2.17,-3.95,-2.78,-3.38,x2=4.38,all P<0.05).Conclusion TAPP is a safe and effective operation for incarcerated inguinal hernia treatment,with the advantages of minimal invasion and less complications.

BACKGROUND:The development of stem cel transplantation and genetic modification technology provides new ideas and methods for the treatment of pulmonary hypertension. OBJECTIVE:To investigate the therapeutic effects of transplantation of human telomerase reverse transcriptase (hTERT)-transfected human amniotic mesenchymal stem cels in pulmonary hypertension rats. METHODS:Human amniotic mesenchymal stem cels were cultured and purified in vitro, and then transfected with adenovirus-medicated hTERT. Sixty-six adult Wistar rats were enroled to prepare pulmonary hypertension models through intraperitoneal injection of 60 mg/kg monocrotaline and then 63 model rats were randomly assigned into three groups: model group treated with transplantation of 1 mL of L-DMEMvia the jugular vein, cel transplantation group treated with transplantation of 1 mL of untransfected human amniotic mesenchymal stem cel suspension, and transfection group treated with transplantation of 1 mL of human amniotic mesenchymal stem cel suspension transfected with hTERT. Hemodynamic changes, plasma endothelin-1 level, hypertrophy index of the right ventricle and myocardial cel apoptosis were compared among different groups at 3 weeks after transplantation. RESULTS AND CONCLUSION:After 3 weeks of treatment, there were no differences in the arterial blood pressure of the three groups (P > 0.05); however, the systolic pressure of the pulmonary artery and mean pulmonary arterial pressure were significantly lower in the transfection group than the model group and cel transplantation group (P < 0.05). Hypertrophy index of the right ventricle had no difference among the three groups (P> 0.05). The level of plasma endothelin-1 was significantly lower in the transfection group than the model group and cel transplantation group (P < 0.05). Apoptosis in myocardial cels was significantly reduced in the transfection group compared with the model group and cel transplantation group (P< 0.05). Experimental findings suggest that the transplantation of hTERT-transfected human amniotic mesenchymal stem cels can improve the hemodynamic levels in pulmonary blood vessels of pulmonary hypertension rats to protect vascular endothelial cels and reduce myocardial cel apoptosis.

Objective To investigate the clinical characteristics of stroke in young patients with cardiac myxoma.Methods Medical records of young patients (aged between 18-44 years) diagnosed with cardiac myxoma in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2005 to March 2016 were retrospective reviewed.Results A total of 117 cases were included (85 female and 32 male)with the average age (36 ±7)years old.Most myxomas (83.8％) were located in the left atrium,7.7％ were in the right atrium,3.5％ were in the both atriums,2.6％ were in the left ventricle,and a few were in the left atrium plus left ventricle and in the right ventricle.Of all the patients,24 (20.5％) (16 women and 8 men) were complicated with cerebral infarction.Among them,3 patients were with lower extremity arterial embolisms.Two patients were with cerebral hemorrhage.The cerebral infarction mainly involved in the distribution area of the internal carotid artery.Infarctions involving 2 or more cerebral vessels were found in 4 cases.Most subjects (58.3％) manifested with hemiplegia,and some (18.2％) with syncope.The proportion of the left atrial myxoma in patients with cerebral infarction (100.0％) was significantly higher than those in patients without cerebral infarction (85.1％,P =0.044).Subjects with tumor diameter less than 3 cm were more frequently complicated with cerebral infarction (37.5％ vs 13.8％,P =0.009).A logistic analysis showed that the odds ratio of myxoma with tumor diameter less than 3 cm for cerebral infarction was 3.750 (95％ CI 1.343-10.470).Conclusions Cardiac myxoma is more common in young women,and often complicated with cerebral infarction.The infarctions are mainly distributed in internal carotid artery system,and some are involved in multiple vascular systems.The incidence of stroke is associated with the position of the myxoma.Smail-size myxoma cannot be ignored for its risk of stroke.

Objective To explore the role of ADSCs and PRP in soft tissue defect repairing .Methods Harvest adipose tissue from inguinalis fat pad of SD rats ,isolation ,culture ,and identification the ADSCs through three differentiation method .Take 30 male SD rats about 6-7 weeks old randomly .Randomly selected 12 rats been take blood from heart .Preparation the PRP with modi-fied appel method .To count platelet of whole blood and PRP under microscope .Take the remaining rats .Divided the rat into 3 groups(n=6 in each group) randomly ,of which group A treatment with ADSCs and PRP ;Group B treatment with ADSCs ;Group C treatment whit PRP .Selected one side of skin defect wound for test randomly and the relative side skin defect is for control ,Handle all of the control wound to group D ;Observe the grow th of granulation tissue on the wound surface ;observe the inflammatory sur-rounding and the degree about epithelial .statistical analysis and record the wound size ,and calculation the shrinkage rate of wound in different periods .Record the time of completely healing time .Histologic observation of the wound healing tissue .Results Plate-let counting showed platelet of PRP is 5 .21 times than whole blood .The wound completely healed time :group A (18 .25 ± 1 .44 ) days ,group B(19 .13 ± 1 .28)days ,group C(19 .72 ± 0 .87)days ,group D(22 .31 ± 1 .65) days ,The time of each treatment group and control group was significantly obvious(P< 0 .05) .At 3 ,7 ,11 and 15 days after experimental treatment ,compared with the control group the experiment group of wound contraction rate was significantly obvious (P<0 .05) .Conclusion Application of AD-SCs with PRP can enhance the quality and shorten the wound healing time than used them alone .

Objective To measure the setup errors and organ movements of patients with esophagus carcinoma during radiotherapy and find a reasonable margin from the clinic target volume (CTV) to the planning target volume (PTV). Methods (1) Set-up veri cation: Forty-two cases of untreated esophageal cancer were enrolled into this study. The physicist firstly made the planning according to the doctor requests and ensured the best distribution at the target. Thereafter, the 0° and 90° digitally reconstructed radiograph (DRR) was transmitted to the iView GT workshop. Meanwhile, two copies of cross-cut electronic portal image (EPI) were required before radiotherapy. Two doctors confirmed the variance of the osteal mark from the EPI and DRR,and output a 3D direction (left to right, superior to inferior, anterior to posterior) of the setup errors through the iView GT software. (2)Breathing motion:Ten cases of untreated esophageal cancer were enrolled into this study.Three distinct breathing levels were deflned: FB (free breathing), EBH (expiration with breath-held) and IBH (inspiration with breath-held). We gave the treatment planning in FB, then by moving the isocenter to EBH and IBH, we recalculated the dose distribution without changing the field angle, shape and weighing (Mus). Displacements were analyzed at four points (anterior, posterior, right lateral and left lateral) and five levels of target (upper, quarter, isocenter, three-quarter and lower). Results (1) The systematic setup errors were -0.23 cm, -0.02 cm and -0.06 cm, and the random errors were 0.44 cm, 0.45 cm and 0.44 cm at the direction of left to right(LR), superior to inferior (SI), anterior to posterior(AP), respectively. (2) The organ movements were 0.3 cm, 0.6cm and 0.3cm at the LR, SI, AP, respectively. Conclusions As an alternative, the root-sum-of-squares of set-up error and organ motion are suggested by σtot=√ (σITV2+σSM2). The CTV to PTV margins are 0.8cm left to right, 0.78cm superior to inferior, 0.5cm anterior to posterior.

Osteoarthritis is mainly caused by the degenerative changes of cartilage and cartilage extracellular matrix,while Aggrecanases degradate Proteoglycans which are the major components of cartilage.This review includes three aspects:(1) We have concluded the major enzymes(ADAMTS-4 and ADAMTS-5) which regulate the metabolism of cartilage extracellular matrix.Meanwhile,we have summarized the structure of aggrecanases(ADAMTS-4 and ADAMTS-5) and introduced the function of each regional structure;(2) We have concluded the way cytokines and glycosaminoglycans regulate the metabolism of aggrecanases,and discussed the regulation and control principle of cytokines and glycosaminoglycan;(3) We have summarized the majority of inhibitors to the aggrecanases,introduced the endogenic inhibitors,and put our emphasis on the extrinsic inhibitors(chelating agents,polypeptides and so on).Through deeper research on the enzymes,it will help us further understand the pathogenesis of osteoarthritis,and open up new avenues to clinical treatment.Abstract:SUMM ARY Osteoarthritis is mainly caused by the degenerative changes of cartilage and cartilage extra-cellular matrix,while Aggrecanases degradate Proteoglycanswhich are the major components of cartilage.This review includes three aspects:(1) W e have concluded the major enzymes(ADAMTS-4 and ADAMTS-5) which regulate the metabolism of cartilage extracellular matrix.Meanwhile,we have sum-marized the structure of aggrecanases(ADAMTS-4 and ADAMTS-5) and introduced the function of each regional structure;(2) W e have concluded the way cytokines and glycosam inoglycans regulate the metab-olism of aggrecanases,and d iscussed the regulation and control principle of cytokines and glycosam inogly-can;(3) W e have summarized the majority of inhibitors to the aggrecanases,introduced the endogenic inhibitors,and put our emphasis on the extrinsic inhibitors(chelating agents,polypeptides and so on).Through deeper research on the enzymes,it will help us further understand the pathogenesis of osteoar-thritis,and open up new avenues to clinical treatment.