TSH suppression therapy plays an important role in differentiated thyroid carcinoma. It can lower mortality and recurrence rate in high risk patients. Meanwhile, it also has potential side effects on cardiovascular and skeletal systems. Thus, TSH suppressive therapy should be individualized in regard to its possible benefit and potential adverse effects.

BRAFV600E mutation is the most common genetic alteration in the papillary thyroid carcinoma.It plays an important role in the tumorigenesis,invasiveness and metastasis of the papillary thyroid carcinoma.Testing of BRAFV600E mutation is of great value in diagnosis,which also can be used as a prognostic maker of papillary thyroid cancer.Inhibitors treatment targeted to BRAF kinase and its downstream effectors is a new area in the treatment of BRAFV600E mutated thyroid cancer.

Objective To study the effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid,through establish an animal model by simulating total thyroidectomy and parathyroid damage during surgical operation.Methods Experimental rabbits for the study were randomly divided into A,B,C,D four groups (n =8),Group A (control group):simple exposure,exploration thyroid and parathyroid;group B (vascular injury group):total thyroidectomy and ligation bilateral parathyroid blood supply but keep the surrounding membrane;Group C (membrane damage group):total thyroidectomy and damage membrane but reservations blood supply.Group D (composite damage group):total thyroidectomy plus membrane and blood both damage;All animals were monitored of serum calcium and PTH,preoperative 1 days and postoperative 1 st day,3rd day,5th day,7t day;cut the parathyroid HE staining to observed survival of parathyroid tissue and pathology damage when 7th day after operation.Results (1) Animals in each group preoperative serum calcium and PTH were no significant difference (P ＞0.05);(2)Group A postoperative serum calcium decreased,but at 5th day returned to preoperative level (P ＞ 0.05);Group B and C postoperative 1st day,3rd day,5th day serum calcium decreased significantly(P ＜ 0.05)and to the lowest at 1 d and then gradually recovered,but group C faster recovered than group B (P ＜ 0.05);Group D postoperative 1 st day,3rd day serum calcium continued to decline significantly (P ＜ 0.05);(3) Group A postoperative serum PTH decreased,but at 7th days returned to preoperative level (P ＞ 0.05).Group B and C postoperative 1st day,3rd day,5th days serum PTH decreased significantly(P ＜0.05)and to the lowest at 1 d and then gradually recovered,but from postoperative 3rd day group C faster recovered than group B(P ＜ 0.05);Group D postoperative 1 st day,3rd day serum PTH continued to decline significantly (P ＜ O.05);(4) Pathology results:Group A parathyroid filled with chief cells and a small amount of vacuolar changes (5％ to 10％);Group B parathyroid hemorrhage,necrosis (40％ to 50％),part of the cell degeneration (30％ to 40％),center with fibrosis,seen granuloma and hyperplasia of parathyroid tissue in surrounding;Group C parathyroid bleeding (10％ to 20％),part of the cell degeneration (10％ to 20％);Group D parathyroid severe necrosis,almost no normal parathyroid tissue,significant fibrosis,less residual parathyroid tissue was scattered.Conclusions (l) The recover of Parathyroid function is influenced by the type of parathyroid in situ injury during thyroidectomy,composite damage of blood supply and membrane of parathyroid is the most serious,parathyroid ischemia necrosis,the function can not be restored,pure blood supply damaged,some can restore function,and the parathyroid gland with vascular pedicle can be recovered quickly.(2) Severe blood supply and membrane damaged,and even free parathyroid should be transplanted immediately during operation.

Objective To investigate the cause of reoperation for high differentiated thyroid carcinoma and the risk factors of neck lymph node metastasis in reoperation. Methods Retrospectively reviewed the clinical data of 54 high differentiated thyroid cancer patients from 1998 to 2005, who received reoperation and neck lymph node dissection simultaneously. Results The residual thyroid carcinoma rate and lymph node metastasis rate were higher in 39 patients who initially received partial thyroidectomy than in 15 who previousely underwent radical operation(P <0. 05). Age less than 45 years, lymphadenectasis before initial operation, tumor residued or relapsed, muhicentricity of primary cancer and blurred boundary between cortex and medulla of lymph node were the risk factors for ipsilateral lymph node metastasis(P <0. 05), while mul-ticentricity of primary cancer and contralateral thyroid cancer were the risk factors for contralateral lymph me-tastasis (P < 0. 05). Conclusions Individual standard radical operation and necessary lymph node dissection are important measures to prevent recurrence and reoperation. Completion thyroidectomy and modified or selec-tive neck dissection are recommended for reoperation patients with the risk factors of lymph node metastasis.

Objective To study the clinical value of peritoneal cavity non-drainage after the operation of acute perforating appendicitis.Methods 196 patients with perforating appendicitis were randomly divided into drainage group and non-drainage group.The incidence rates of wound infection and ankylenteron and hospital durations in the two groups were observed and compared with each other.Results The incidence rate of wound infection and ankylenteron were 19.0%,10.7% in the drainage group and 8.0%,4.5% in the non-drainage group respectively(P0.05).The mean postoperative hospital stay of the drainage group was(9.3?2.7)days,which was significantly longer that of the non-drainage group(5.1?1.9)days,P

Objective To discuss the influence of preventive calcium supplementation on the recovery of parathyroid glands function after total thyroidectomy.Methods 232 patients meeting the selected criteria were randomly assigned to group A and B,and then divided into group A1 (87 cases,PTH ＞8 pg/ml)and A2 (30 cases,PTH ＜8 pg/ml),group B1(83 cases,PTH＞8 pg/ml)and B2(32 cases,PTH ＜8 pg/ml) based on the lowest parathyroid hormone( PTH )value within 3 days after surgery.All patients in group A were immediately supplemented 10％ calcium gluconate intravenously 6 g/d after operation.For group B,post operative calcium supplementation was not given,however,anyone whose PTH ＜ 8 pg/ml was supplemented 10％ calcium gluconate intravenously 6 g/d no matter hypocalcemia occurred or not.The level of serum calcium and PTH of all patients were assayed before operation and at the 1st,2nd,3rd day,1st week and 1st month after operation.In additon,patients with hypocalcemia received serum calcium and PTH detection at the 2nd and 3rd week.Whether hypocalcemia and hypoparathyroidism occurred or not was recorded.Results ( 1 )The serum PTH was obviously higher in group A1 than in group B1 at the 1st week after operation( P ＜0.05 ).The serum calcium was obviously higher in group A1 than in group B1 at the 1st,2nd,3rd day and 1st week after operation(P ＞0.05).The hypocalcaemia and symptomatic hypocalcaemia incidence were obviously lower in group A1 than in group B1 (P ＜ 0.05 ).(2)① Group A2 had obviously higher level of serum PTH than group B2 at the 1 st,2nd,and 3rd week after operation ( P ＜0.05 ) and returned to normal level of serum PTH earlier than group B2.② Group A2had obviously higher level of serum calcium than group B2 from the 1 st day to the 3rd week after operation ( P ＜ 0.05 ) and returned to normal level of serum calcium earlier than group B2.③ The hypocalcaemia and symptomaic hypocalcaemia incidence ware obviously lower in group A2 than in group B2 (P ＜ 0.05 ).Conclusion The preventive calcium supplementation is beneficial for the recovery of the function of parathyroid glands after total thyroidectomy.

Objective To explore the dynamic variation rule of drainage fluid parathyroid hormone ( dPTH) , serum parathyroid hormone ( PTH) and serum calcium after thyroidectomy .According to the variation rule, the survival , function and prognosis of the parathyroid which retained at the original place can be predicted . Methods From Apr.2012 to Aug.2012, 90 patients who underwent thyroidectomy in Thyroid Surgery Center of the First Affiliated Hospital of Kunming Medical University were chosen as the research object .All of the objects'operations were performed by the same surgeon team and they were divided into four groups according to different surgical methods ( group A:bilateral thyroidectomy group , group B:bilateral thyroidectomy and central neck dis-section group , group C: bilateral thyroidectomy and functional neck dissection group , and group D: unilateral thyroidectomy group ) .Parathyroid retention situation during operation and the occurrence of hypocalcaemia after operation were recorded .Blood samples were taken between 7am and 8am in the 4 consecutive days after opera-tion to detect serum calcium and serum parathyroid hormone .All of the 90 patients had the drainage tube and their drainage fluid were taken for testing dPTH .The levels of serum calcium , PTH and dPTH were analyzed by statistical analysis of repetitive measure analysis of variance ( ANOVA) .Results The mean postoperative maxi-mum serum calcium was in group D and the minimum was in group C .There was no obvious difference in terms of serum calcium between group A and group B .However , the serum calcium showed an upward trend in each group.The mean postoperative maximum PTH was in group D and the difference has statistical significance com -pared to the other 3 surgical methods.The minimum was in group B and group C .However, it showed an upward trend with time in each group .The difference of dPTH in each group had no statistical significance and it showed a downward trend in all the 4 groups.Low serum calcium and hypocalcaemia occurred to 22 cases and 13 cases respectively after operation .The low serum calcium cases in each group were 12, 3, 4 and 2 respectively and hy-pocalcaemia cases in each group were 4, 3, 1 and 1 respectively.Conclusions By monitoring dPTH, PTH and serum calcium after thyroidectomy , the survival and function of parathyroid retained at the original place can be e-valuated comprehensively .Furthermore, it also helps to estimate prognosis .dPTH at a high level after operation is a direct evidence that parathyroid retained at the original place survives .Low PTH and high dPTH after thyroid-ectomy illustrates the operation just affects the way that PTH secreted into blood and the parathyroid retained at the original place can still secrete large amount of PTH .PTH will return to normal gradually with reconstruction and healing of microcirculation around parathyroid .Persistent low serum PTH after operation , low dPTH after 24 hours and the early advent of hypocalcaemia suggest the parathyroid retained at the original place was injured seri -ously and its blood supply was damaged obviously and more than one parathyroid were affected .Secretion function of parathyroid will remarkably decrease .

Background:Functional gastrointestinal disorders(FGIDs)is a common disease of digestive system which severely affects the quality of life. Recently,more and more attentions have been paid to the relationship between FGIDs and psychological factors. Aims:To investigate the relationship between FGIDs and psychological factors and related treatment. Methods:A total of 270 patients with FGIDs admitted from Sept. 2013 to Sept. 2014 at Anhui No. 2 Province People’s Hospital were enrolled. Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were used to evaluate the mental state of patients,and symptom severity of digestive system was scored. Patients with psychological abnormalities received conventional therapy to relieve digestive symptoms,and those who failed from conventional therapy were assigned into refractory group and others were assigned into response group. Patients in refractory group were further divided into conventional therapy group and combined therapy group for receiving paroxetine in addition to conventional therapy. Results:The rates of anxiety and depression were 61. 5%(166 / 270)and 57. 0%(154 / 270),respectively. The scores of HAMA and HAMD were positively correlated with the score of digestive symptoms(r = 0. 585,P < 0. 01;r = 0. 584,P <0. 01)in patients with anxiety and depression in response group. The scores of HAMA,HAMD and digestive symptoms in response group after conventional therapy were significantly decreased(P < 0. 05),while the scores of HAMA and HAMD in refractory group after therapy were significantly higher than those in response group before therapy(P < 0. 05). The scores of HAMA,HAMD and digestive symptoms in combined therapy group were significantly lower than those in conventional therapy group(P < 0. 05). Conclusions:Relationship is found between FGIDs and psychological factors,and antidepressants might contribute to the amelioration of symptoms of FGIDs.

BACKGROUND:Cel replacement therapy as an effective strategy for reconstruction of the central nervous system has very broad application prospects.
OBJECTIVE:To investigate the effect of stereotactic transplantation of neural stem cels into the brain on the neuromotor function of craniocerebral trauma rats.
METHODS:Twenty male Sprague-Dawley rats were equivalently randomized into study and control groups. Animal models of craniocerebral trauma were made using the improved free-fal method in the rats. Then, model rats in the study and control groups were given parenchymal transplantation of embryonic neural stem cels and the same volume of culture medium with no stem cels at 1 day after injury, respectively. Neuromotor function of rats was assessed based on the neurological severity scores. At 2 weeks after transplantation, brain tissues were taken for hematoxylin-eosin staining, anti-BrdU, glial fibrilary acidic protein, β-tubulin III and tyrosine hydroxylase immunohistochemistry staining.
RESULTS AND CONCLUSION:The neurological severity scores in the study group were significantly lower than those in the control group at 1 and 2 weeks after injury (P< 0.05). In the study group, there were many BrdU-positive neural stem cels in the brain tissues, some of which were positive for glial fibrilary acidic protein, β-tubulin III and tyrosine hydroxylase; while in the control group, there was no BrdU-positive cel in the brain tissues. Experimental findings show that neural stem cels stereotacticaly transplanted into the brain can proliferate and differentiate in the brain lesion, and thereby notably improve the neuromotor function of rats with craniocerebral trauma.

Objective:To define the role of lymph tracers in lymph node dissection and pathological examination of papillary thyroid carcinoma. Methods:Patients with papillary thyroid carcinoma who met inclusion criteria were enrolled and randomly assigned into the three groups, namely, carbon nanoparticle (CN), methylene blue (MB), and conventional surgery (CS) groups. The number of detected lymph nodes in each group was summed, and pathological examination was conducted. Histological examination of the lymph node specimens in the tracer group was performed based on the classification of staining and nonstaining groups. Results:Major complications such as anaphylaxis did not occur after injection of CN and MB. The average of the detected lymph nodes was higher in the tracer group than in the CS group, and the detection rate of the lymph node was higher in the CN group than in the MB group. In addition, the rate of cancer metastasis was higher in the group with stained lymph node than in the group with unstained lymph node. The index of the CN group was higher than that of the MB group. Conclusion:The tracing effect and lymphatic tropism of CNs were stronger than MB. The thyroid lymph tracer technique may promote the normalization and thoroughness of lymph node dissection in thyroid cancer.