Objective To investigate the correlation between serum proprotein convertase subtilisin/kexin 9 (PCSK9) level and the severity of angiographic coronary artery disease (CAD) in elderly patients with acute myocardial infarction (AMI) complicated with type 2 diabetes mellitus (T2DM). Methods The patients over the same period were divided into three groups:the elderly patients with AMI and T2DM (observation group, n=46), the elderly non diabetic patients with AMI (positive control group, n=34) and patients with chronic stable coronary heart disease (negative control group, n=33). The serum PCSK9 level was detected by enzyme-linked immunosorbent (ELISA) in three groups. The correlation between serum PCSK9 level and low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), glycosylated hemoglobin (HbA1c), high sensitive C reactive protein (Hs-CRP) and Gensini score were analyzed. Results The levels of PCSK9, HbA1c, Hs-CRP and Gensini score showed a gradually increased tendency in negative control group, positive control group and observation group. Multiple comparison differences between groups were statistically significant (P<0.05). The serum PCSK9 level was positively correlated with Hs-CRP and Gensini score in observation group (P<0.05), and showed no correlation with HbA1c, TG, TC, LDL-C and HDL-C (P>0.05). Conclusion The serum level of PCSK9 is positive correlated with the severity of CAD, which can be used to determine the severity of coronary artery lesions in elderly patients with AMI complicated with T2DM.

Objective To discuss the protection of parathyroid and application of nano-carbon suspen-sion in thyroid surgery .Methods 80 cases were randomly divided into 2 groups:the experimental group which were injected nano-carbon into thyroid during thyroidectomy , and the control group without any injection .Results There were 5 cases with hypocalcemia and 5 cases with PTH decrease in the experimental group , and there were 15 cases and 14 cases respectively in the control group .Pathological results showed that misresection of par-athyroids occurred in 6 cases of the control group(11 parathyroid glands)were while it didn't happen in the experi-mental group .Conclusion Nano-carbon can help to identify and protect the parathyroid , decreasing the proba-bility of parathyroid gland damage during thyroid surgery .

Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery.Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed,and the patients with preoperatively known high-risk characteristics were excluded.One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines.The proportion of patients who need secondary surgery was estimated basing on pathological characteristics.Result In this group,49％ patients would have to undergo a secondary surgery if they took lobectomy as the initial operation.Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery.Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation.

Objective To study fragile histidine triad gene(FHIT) gene mRNA expression in 60 samples of papillary thyroid carcinoma(PTC) and matched adjacent non-concerous tissues (NCE),and to explore the role of FHIT gene in the development in PTC.Methods Reverse transcription polymerase chain reaction(RT-PCR) was used to detect FHIT gene mRNA expression in 60 samples of PTC and matched NCE.Results In PTC tissues,the positive rate of FHIT gene mRNA expression was 45.0％ (27/60),lower than that in NCE tissues (100.0％,60/60).FHIT gene mRNA expression was correlated with pathology stage,TNM stage and lymph node metastasis (P ＜ 0.05).Conclusion FHIT loss and transcript abnormality might play important roles in proliferation and metastasis of PTC,and might be a useful marker for evaluating the biological behavior of PTC.

Objective To construct a]entiviral expression vector carrying CCDC67 and to obtain CCDC67 efficient and stable expression in mammalian cells.Methods The DNA fragment of CCDC67 coding sequence was amplified by PCR with designed primer from the cDNA library including CCDC67 gene,and then subcloned into GV208 vector with in-fusion technique to generate the lentiviral expression vector,GV208-CCDC67.The positive clones were screened by PCR and the correct CCDC67 was confirmed by sequencing.Recombinant lentiviruses were produced in 293T cells after the cotransfection of GV208-CCDC67,and packaging plasmids of pHelper 1.0 and pHelper 2.0 Green fluorescent protein (GFP)expression in 293T cells was observed to evaluate gene delivery efficiency.CCDC67 protein expression in 293T cells was detected by Western blot.Resuits The lentiviral expression vector carrying CCDC67 was successfully constructed and CCDC67 protein expression was detected in 293T cells.Conclusion The recombinant lentivirus GV208-GFP-CCDC67 is successfully constructed and it lays a foundation for further molecular function study of CCDC67.

Objective To investigate the relationship between thyroid and breast multiple primary carci-nomas.Methods A total of 24 cases of multiple primary tumors of thyroid and breast admitted from Jan .2011 to Jun.2013 in First Affiliated Hospital of Zhengzhou University were retrospectively analyzed .Results The 24 samples were confirmed as the tumor of thyroid and breast by ultrasonography .The patients underwent operation and adjuvant therapy after fine-needle aspiration biopsy , mammography and other relevant examinations .All the malignancies of thyroid and breast were confirmed by pathology .Among the 24 cases, 19 patients were invasive ductal carcinomas , 2 patients were diagnosed as intraductal carcinomas , 1 patient was confirmed as intraductal papillary carcinoma , 1 case was invasive lobular carcinoma with invasive ductal carcinoma , and 1 case was inva-sive ductal carcinoma with intraductal carcinoma .All the thyroid malignancies were papillary thyroid carcinomas . The results of immunohistochemistry indicated that , among the 24 patients of thyroid and breast multiple primary carcinomas , 11 cases were ER (+) in both thyroid cancers and breast cancers , moreover , 8 cases were ER (-) in both thyroid cancers and breast cancers .The difference between the expression of ER in the tumors of thyroid and breast had no statistical significance (P>0.05).Conclusions Ultrasonography is a simple and effective im-aging method that can discover the multiple primary tumors of thyroid and breast .For patients of thyroid cancer , breast cancer should be excluded routinely .The thyroid should also be examined simultaneously in breast cancer patients.Once the possibility of one gland tumor is discovered , we should pay more attention to the other gland . Particularly, the other gland should be examined carefully for patients with ER (+).

Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for non-recurrent laryngeal nerve (NRLN).Methods From Oct.2013 to Apr.2016,2846 patients underwent thyroidectomy with the application of IONM,and 11 patients with non-recurrent laryngeal nerve were analyzed.Results 11 cases of NRLN were all accurately identified by IONM,and no injury of NRLN occurred during thyroid surgery.Conclusions NRLN is uncommon in clinical and it is difficult to be predicted before surgery and easy to be injured.The application of IONM can reduce the possibility of NRLN injury remarkably.

Objective Methylation of anti-oncogene can be demethylated by related drugs which can help the inactivated gene to express again .This study aims to study the effects of the demethylating agent 5-Aza-2′-deoxycytidine on the growth of human thyroid papillary cancer cell line TPC-1 and mRNA and protein expres-sion of KLF4.Methods TPC-1 cells were treated with different concentration of 5-Aza-CdR.MTT was used to detect the influence of 5-Aza-CdR on cell proliferation .RT-PCR was used to detect mRNA and protein expression levels of KLF4.Results After being treated with 5-Aza-CdR for 24 hours, 48 hours, and 72 hours, the growth of TPC-1 cells was inhibited and the inhibition was in time and concentration depended manner .After treatment with 5-Aza-CdR, mRNA and protein expression levels of KLF 4 were increased, and the difference had statistical significance(P<0.05).Conclusion 5-Aza-CdR can inhibit the cell viability of TPC-1 cells through upregulat-ing KLF4 expression , which may provide experimental basis for 5-Aza-CdR in treating thyroid cancer .

Anaplastic thyroid cancer (ATC) is a rare malignancy, accounting for 1%-2% of all thyroid cancers, however, ATC accounts for the majority of deaths from thyroid cancer. Currently, the main comprehensive treatments are surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy. Based on the latest American Thyroid Association guidelines and the related literatures, we summarize the most reasonable and effective therapeutic strategies to improve the survival rate of patients with ATC as well as the quality of life.

ObjectiveTo explore the relationship between serum sCD40L level and coronary stenosis degree in acute coronary syndromes(ACS) patients with different glucose tolerance conditions.Methods154 patients with ACS were divided into normal glucose tolerance group ( NGT),impaired glucose tolerance group (IGT) and type 2 diabetes group (T2DM) according to the OGTT.The levels of serum sCD40L were detected by ELISA,and all patients underwent coronary angiography in order to calculate their Gensini score.Then the relationship between serum sCD40L level and coronary stenosis was analyzed by statistics.ResultsThe Gensini scores of IGT[(41.8 ± 19.8)score] and T2DM groups [(40.1 ± 18.7)score] were higher than NGT group [(21.9 ± 15.3)score] ( P ＜0.01 ),but there was no statistical difference between IGT and T2DM ( P ＞ 0.05 ) group.The serum sCD40L levels of IGT[(2.46 ± 0.79 )ng/ml]were higher than NGT group [(2.12 ± 0.81 )ng/ml] ( P ＜ 0.05 ),and the serum sCD40L levels in T2DM group [( 2.57 ± 0.68) ng/ml] were obviously higher than NGT group [( 2.12 ± 0.81 ) ng/ml] ( P ＜ 0.01 ).The serum sCD40L levels in T2DM group were higher IGT group,but there was no statistical difference between T2DM and IGT groups( P ＞0.05).Statistical analysis revealed that serum sCD40L levels had no statistical difference among the three groups and it had no relationship with coronary stenosis ( r =-0.147,P ＞0.05).ConclusionsCD40/CD40L activation would occur in the patients of ACS with wildly abnormal blood sugar,not only in those who had diabetes with much higher blood sugar.The serum sCD40L level in the ACS patients with abnormal glucose tolerance had no relationship with the severity of coronary stenosis.