Objective To investigate the role of smear examination of wound secretion in early diagnosis and treatment of gaseous gangrene after trauma.Methods The data of 10 881 patients,who were carried to our hospital more than one hour after injuries from April 2003 to April 2006,were collected.Smear examination of wound secretion had been performed in these patients.Results Among the 10 881 wounded patients,11 patients developed gaseous gangrene,taking up 0.10%.Among the 11 gaseous gangrene patients,5 were caused by vehicle crash,3 by machine,2 by stone,1 by gun-shot injury.As for the wounded locations,7(63.6%)patients were in lower extremity,and 3(27.3%)patients in upper extremity,and 1 patient in mandible with head and neck wounds.The onset time of gaseous gangrene was(3.3?2.2)d.The 11 patients were completely cured.Seven patients with open comminuted fracture and lost limb function were performed with wound limb amputation,3 patients with injuries without fractures and 1 patient with mandible combined head and neck wounds were immediately treated with surgical debridement,cephalosporins,and hyperbaric oxygen(HBO). Conclusion Gas gangrene was extremely rare in injury patients but it was life-threatening,so doctors should pay more attention.Cleaning-up the wounds and debridement were critical for prevention of infection,and HBO might serve as an useful assistant method.Smear examination of wound secretion was helpful in early diagnosis and treatment of gaseous gangrene after trauma.

Objective:To explore the efficacy and safety of different surgical methods in papillary thyroid carcinoma (PTC) patients with negative cervical lymph nodes (cN0) and to provide theoretical basis for the selection of surgical procedures. Methods:A total of 225 PTC cN0 patients were selected and divided into two groups according to the operation method. Only 110 patients underwent total thy-roidectomy, whereas the 115 cases in the lobectomy group underwent ipsilateral lobectomy and isthmus resection. Al patients were treated with ipsilateral central lymph node dissection. We analyzed both groups of patients in terms of surgery, hospitalization, pathological characteristics, complications, follow-up, and recurrence. Results:(1) The length of incision, blood loss, operation time, and length of stay were not significantly different between the two groups (P>0.05). (2) In the total resection group, the number of multiple foci of the cancer cases was significantly more than that of the lobectomy patients (P<0.05). The average tumor diameter in both groups were not significantly different (P>0.05). Between the two groups, the number of central lymph node dissection and total lymph node metastasis, and the number of cases with central lymph node metastasis were not significantly different (P>0.05). Likewise, the incidence rates of mistakenly cut parathyroid, extremely low blood calcium levels, temporary larynx return nerve paralysis, and superior laryngeal nerve injury were not significantly different between the two groups (P>0.05). No permanent hypocalcemia or permanent recurrent laryngeal nerve injury occurred. (3) All patients were followed up for 2-4.5 years. No recurrent cases were reported in the total resection group. For the lobectomy group, 8 patients with adenocarcinoma had contralateral tumor metastasis and underwent contralateral lobe resection, whereas 4 patients suffered from ipsilateral neck lymph node metastasis at the side area and underwent functional lymph node clearance. Significant differences were noted in the metastasis and recurrence rates between the two groups of patients (P<0.05). No deaths were reported during the follow-up period. Conclusion:For PTC cN0 patients, total thyroidectomy with joint ipsilateral central lymph node clearance can reduce the residual tumor, metastasis, and risk of recurrence,compared with surgery limited to the affected lobe and isthmus. Postoperative complications were not significantly increased.

Objective To study the risk factors for thyroid papillary carcinoma in patients aged over 65 years,and to investigate the etiology of thyroid papillary carcinoma.Methods A total of 784 patients with thyroid nodules screened by ultrasound were grouped according to different iodine intakes,gender,age,diet,smoking history and history of radiation therapy.The incidence of thyroid papillary carcinoma was compared among the different groups.Pathogenic factors for thyroid papillary carcinoma were analyzed.Results 55 patients (7.0％) were diagnosed as thyroid papillary carcinoma among 784 patients.Gender,age,iodine intake,smoking history and history of radiation therapy were the pathogenic factors for papillary thyroid carcinoma.Thyroid papillary carcinoma was common in older women,patients with high-iodine intake and patients with the history of radiation therapy.The incidence of thyroid papillary carcinoma was higher in patients with high iodine intake than with normal-iodine intake or low-iodine intake [22.8％ (31/136) vs.1.9％％ (10/517),10.7％ (14/131),x2 =75.07,P＜0.01].The incidence of thyroid papillary carcinoma was higher in female than in male elderly patients [8.0％ (49/612) vs.3.5％ (6/172),P＜0.05].The incidence of thyroid papillary carcinoma was higher in patients with the history of radiation therapy than without the history of radiation [11.6％ (14/121) vs.6.2％ (41/663),P＜0.05].Conclusions The main risk factors for thyroid papillary carcinoma are living environment,gender,age,diet,smoking history and history of radiation therapy,which are more influenced by external factors.

Objective To investigate exogenous PTEN gene transfected human breast cancer cell line MDA MB 468. MethodsUsing the lipofectamine 2000 transfection technique,wild type PTEN gene was transducted into an in vitro cultured highly metastatic breast cancer cell line MDA MB 468.After transfection, the cells were selected by G418.Then resistant clones were chosen and expanded in DMEM culture medium. RT PCR, immunohistochemical method and western blot were used to determine the expression of target genes. ResultsAn anti G418 cell clone was established and expanded in culture. The transfected PTEN gene MDA MB 468 cells showed expression of PTEN mRNA and PTEN protein. ConclusionHuman breast cancer cell line MDA MB 468 established in this study expresses consistently exogenous PTEN genes.

The effects and mechanisms of exogenous phosphatase and tensin homolog deleted from chromosome ten (PTEN) gene on phosphatase activity-dependent apoptosis of breast cancer cell line MDA468 were investigated. PTEN gene packaged with lipofectin was transferred into breast cancer cell line MDA468 and parental MDA468 cells served as controls. RT-PCR and Western blot were done to detect the expression of target genes. The expression of phosphospecific protein kinase B (PKB/Akt) and focal adhesion kinase (FAK) protein stimulated by epidermal growth factor (EGF) was also detected. Apoptosis was determined by flow cytometry with a double-staining method using FITC-conjugated annexin V and PI. MDA468 cells transfected with PTEN gene could express PTEN mRNA and protein. PTEN decreased the phosphorylation level of AKT protein and down-regulated FAK protein expression in MDA468 stimulated by EGF. The apoptosis rate was 21.68%. PTEN induced breast cancer apoptosis phosphatase activity-dependently. The mechanism is possibly related with phosphoinositide 3-kinase (PI3K)/protein kinase B (PKB)/AKT signaling pathway. Those results may provide new clues on the gene therapy in breast cancer.

Objective To investigate the expression of 5-lipoxygenase activating protein gene (ALOX5AP) polymorphism in the patients with cerebral infarction,and explore its relationship with cerebral infarction susceptibility.Methods Patients with cerebral infarction and healthy volunteers were selected for this study,whose venous blood was extracted and detected with polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP).Haplotype A (SG13S114T,SG13S89G,SG13S32A,SG13S25G),haplotype B (SG13S377A,SG13S114A,SG13S41A,SG13S35G),and their nucleotide polymorphism loci were observed.Results Single nucleotide polymorphism (SNP)-SG13S114,SNP-SG13S32 and HapA carrying rate were significantly different between patients with cerebral infarction and healthy volunteers (P ＜0.05).SNP-SG13S114 and SNP-SG13S32 were independent risk factors of cerebral infarction (OR ＞ 1.0,P ＜ 0.05).Conclusions The morbidity of cerebral infarction in Wenling City was influenced by SNP-SG13S114,SNP-SG13S32,and HapA carrying rate.

Objective To study the expression changes and significance of human telomerase reverse transcriptase (hTERT)-mRNA and mutant p53 protein in thyroid carcinoma tissues in the elderly.Methods The expression level of hTERT-mRNA was examined by in situ hybridization in 50 samples of thyroid carcinoma tissues from the elderly and 41 samples of thyroid carcinoma tissues from the non-elderly and 30 samples of thyroid benign lesions.The expression level of p53 was examined by immunohistochemistry in all subjects.Results The positive rate of hTERT-mRNA was 96.0％ (48/50),85.3％ (35/41) and 10.0％ (3/30) in thyroid carcinoma tissues from the elderly,the non-elderly and thyroid benign lesions respectively,and there were significant differences between the three groups (x2=73.61,P=0.000).The positive rate of p53 was 92.0％ (46/50),85.3％ (35/41) and 13.3％ (3/30) in thyroid carcinoma tissues from the elderly,the non-elderly and thyroid benign lesions respectively,and there were significant differences between the three groups (x2 =62.30,P =0.000).Conclusions The positive rates of hTERT-mRNA and p53 in thyroid carcinoma tissues are higher in the elderly than in the non-elderly,which can be used to evaluate the biological behavior and prognosis of thyroid carcinoma in the elderly,and they play the important roles for targeted therapy.

Objective To investigate the effect of nerve growth factor on the levels of serum S100 protein and interleukin-6 (IL-6) in patients with acute brain injury.Methods 70 cases with acute craniocerebral injury from March 2013 to May 2015 in department of cerebral surgery of Tianjin port hospital were selected and divided into two groups according to random number method.The control group (35 cases) received conventional symptomatic treatment, the study group (35 cases) received conventional treatment on the basis of mouse nerve growth factor for injection, with a consecutive treatment of two weeks.On admission, one and two weeks after admission, the Glasgow coma scale ( GCS) score was recorded, serum S100 beta protein and IL-6 levels were measured by enzyme-linked immunosorbent assay ( ELISA ) and the clinical curative effect of cerebral edema eliminate was compared.Results After two weeks’ treatment, the total efficacy in control group was lower than that in study group (77.14% vs.94.29%) ( P<0.05).The GCS score of two weeks after admission in study group was lower than that in control group, serum levels of neuron-specific enolase (NSE), myelin basic protein ( MBP) , S100βprotein and IL-6 of one and two weeks after admission in study group were lower than those in control group ( P<0.05).Conclusion The nerve growth factor could decrease the levels of serum S100βand IL-6 and alleviate inflammation in patients with acute craniocerebral injury and the effect is obvious.

Objective:To investigate the diagnostic value of microRNA-19(miR-19)and microRNA-21(miR-21)in elderly patients with differentiated thyroid carcinoma(DTC), and to analyze the relationship of miR-19 and miR-21 expression with pathological characteristics in elderly patients with DTC.Methods:A total of ninety-six elderly DTC patients visiting our hospital from January 2015 to January 2018 were included in this retrospective study.They underwent cervical lymph node puncture biopsy and radical surgery for thyroid cancer.The expression levels of miR-21 and miR-19 were detected in lymph node tissues, thyroid cancer tissues and normal para-cancerous tissue.The differences in miR-21 and miR-19 expression levels between three different pathological tissues in elderly patients were analyzed.The correlation of miR-21 and miR-19 expression levels with different clinico-pathological features in elderly patients was observed.Results:The expression levels of miR-21 from low to high were(0.92±0.33)in para-cancerous tissue, (3.41±0.64)in lymph node tissue and(4.28±1.56)in DTC tissue respectively( F=296.683, P<0.01), the difference was statistically significant( F=296.683, P=0.01). While, there was no significant difference in the expression levels of miR-19 among different tissues( P>0.05). Spearman correlation test showed that the expression level miR-21 in DTC tissue was positively correlated with that in lymph node tissue and para-cancerous tissue( r values were 0.724, 0.801, all P<0.01), while the expression level of miR-19 showed no correlation of DTC tissues with lymph node and para-cancerous tissues( r=0.127 and 0.165, P>0.05). The expression level of miR-21 in lymph node tissue was positively correlated with that in para-cancerous tissues( r=0.705, P<0.01), but the expression level of microRNA-19 had no correlation between the two kinds of tissues( r=0.191, P>0.05). There was no significant difference in the expression of miR-21 in cervical lymph nodes among patients with different gender and tumor diameter( P>0.05). The expression level of miR-21 in cervical lymph nodes was significantly higher in stage Ⅲ patients than in stage Ⅰ-Ⅱ patients( P<0.05). The expression level of microRNA-21 in cervical lymph nodes was higher in patients with extra-glandular infiltration than without extra-glandular infiltration( P<0.05). The expression of microRNA-19 in cervical lymph nodes showed no significant difference regardless of sex, tumor diameter, tumor stage, extra-thyroid invasion. Conclusions:MiR-19 may not be involved in the development of DTC in elderly patients, and microRNA-21 may play an important role in the development of DTC in elderly patients, especially in the process of tumor invasion and metastasis.Early cervical lymph node puncture for miR-21 detection helps early diagnose and evaluate DTC, to provide a basis for the choice of treatment options.

Objective To summary the experience in diagnosis and surgical treatment of differentiated thyroid carcinoma (DTC). Methods The clinical data and follow-up results of 167 cases of DTC were retrospectively analysed. Results (1) The accurate rate of preoperative cytology diagnosis was 76.9%(97/126). (2)121 patients were diagnosed as thyroid carcinoma before or during operation. Histologic examination after primary operation revealed that the carcinoma spread to the isthmus and the opposite lobe in 5 cases. 57 cases were followed up with only 2 cases recurred 2 and 3 years after the operation, and 3 died 6 to 10 months after operation. (3)87.5%(42/48)cases of the reoperation were due to misdiagnosis as benign lesions in primary operation. Histologic examination revealed that residual tumor in the remnant thyroid tissue was found in 45.2%(19/42)cases, and residual tumor in the lymph nodes of the suffered side in 19.0%(8/42)cases. 30 cases were followed up without any recurrence. Conclusions (1) Cytological diagnosis must be paid great attention to preoperatively; (2) Excision of the suffered lobe, isthmus and greater partial of the opposite lobe, along with clearing the enlarged lymphnodes of the isolateral side are generally performed for the DTC; (3) Reoperation due to misdiagnosis as benign lesions in primary operation must remove the remnant tissue of thyroid and the isolateral lymphnodes. The cases should also be followed up even if enough excising is performed in primary operation.