Objective To investigate the characteristics and risk factors of central lymph node metastasis in clinically node negative (cN0) papillary thyroid carcinoma (PTC) (T1 or T2 stage) coexisting with Hashimoto' s thyroiditis (HT).Methods A total of 398 patients undergoing thyroidectomy with central lymph node dissection were enrolled in the study.Patients were divided into the trial group (PTC with HT)and the control group (PTC without HT).The difference of the clinicopathological characteristics between the 2 groups and risk factors for central lymph node metastasis were analyzed.Results Among the total 398 patients,98 (24.6％)had coexistent HT.Central lymph node metastasis rate was similar in the 2 groups (40.8％ vs 41.3％).The number of dissected central lymph nodes was significantly more in the trial group than in the control group (4.9 vs 2.9,P＜0.01) while the number of metastatic lymph nodes had no statistical significance between the 2 groups (1.0 vs 1.0).Univariate analysis showed that tumor size＞1 cm was significantly associated with central lymph node metastasis in the trial group (P＜0.01).Male,＜45 years,tumor size＞1 cm,and tumor located in the middle/lower third of lobe were all significantly associated with central lymph node metastasis in the control group (P＜0.01).Multivariate analysis showed that tumor size＞1 cm was independent predictor for central lymph node metastasis in the trial group,while female,＜45 years,tumor size＞1 cm,and tumor located in the middle/lower third of lobe were all independent predictors for central lymph node metastasis in the control group.Conclusions The number of central lymph nodes was larger in cN0 PTC coexisting with HT patients than that in PTC patients,but there was no statistical difference in the number of metastatic lymph nodes between cN0 PTC with and without HT.Central lymph node dissection is recommended when tumor size 1 cm in cN0 PTC coexisting with HT patients.

Objective To confirm whether taxotere combined with mild hyperthermia will have synergistic effects,and to explore their joint mechanism of action.Methods Firstly the effective concentration of taxotere was determined by using MTT method to observe the effect of docetaxel on proliferation of human breast cancer cell line MCF-7.Then three samples of in vitro cultured human breast carcinoma MCF-7 cells were prepared,termed the the taxotere group,the taxotere plus mild hyperthermia group and the control group,and treated with effective concentration of taxotere exclusively or in combination with mild hyperthermia,or left without any special treatment.The taxotere plus mild hyperthermia group was subdivided into 5 subgroups according to the temperatures used (39.0 ℃,39.5 ℃,40.0 ℃,40.5 ℃,41.0 ℃) MTT assays were used to measure the proliferation and invasive capacity of the cells and their effective concentrations.Flow cytometry was used to detect cell apoptosis rates and any cell cycle changes in the control group.Western blotting was used to detect any changes in the expression of mitogen-activated protein kinases (MAPKs),Bcl-2/Bax,heat shock protein-70 (HSP-70) and P-gp.Results The taxotere with mild hyperthermia group demonstrated a significantly higher rate of apoptosis than that in the taxotere and control groups.There were also more cells in the G2/M phase observed.Combining taxotere with mild hyperthermia was found after 24 h to have significantly increased p-ERK,p-JNK,p38,HSP-70 and P-gp protein levels and to have significantly decreased Bcl-2 protein expression in contrast with the other two groups.Conclusions Combining taxotere with mild hyperthermia showed synergistic effects in vitro.It seemed to be limiting the accumulation of MCF-7 cells in the G2/M phase and activating the signal pathways of MAPKs while inhibiting the activation of Bcl-2/Bax signal pathways.Combining taxotere and mild hyperthermia can accelerate the expression of HSP70 and P-gp in MCF-7 cells.Hyperthermia might induce chemotherapy resistance.

Objective To analyze the normal reference values of left ventricular longitudinal peak systolic strain (LS) and strain rate (LSr) by two-dimensional speckle tracking imaging (2D-STI) in healthy children at different ages.Methods Clinical ultrasound data of 330 healthy children who taking physical examination in our hospital from September 2015 to November 2016 were collected and retrospectively.They were divided into 7 groups according to their ages,that is,neonate group (0 to 28 days old),infant group (28 days to 1 year old),toddle group (1 to 3 years old),pre-school group (3 to 6 years old),school age group (6 to 9 years old),pre-adolescence group (9 to 13 years old) and adolescence group (13 to 18 years old).2D-STI was performed in the 3 apical projections of left ventricle (LV).The regional peak systolic longitudinal strain and strain rate of LV were measured.Results ① Significant differences were found in the LS and LSr values from 6 segments of the same wall (P ＜ 0.05),and the LS and LSr values were gradually increased from basal segment to apical segment.②There were no significant differences in the LS,LSr and global LS (GLS) values of 18 segments between sexes (P ＞ 0.05).③ Except the basal segments of posterior wall,inferior wall and posterior septum,LS value was gradually elevated with the increase of age (LS ＜LSinfant ＜ LStoddler,pre-shool and school age ＜ LSpre-adolescence and adolescence),So was GLS value.④LS in 18 segments had a positive correlation with age,and the value of apical segment in lateral wall was most remarkably correlated (r =0.551,P ＜0.01);Regional LS had a negative correlation with heart rate,and that of middle segment in lateral wall was the most apparent (r =-0.625,P ＜ 0.01);GLS was positively influenced by age (r =0.665,P ＜ 0.01) and negatively affected by heart rate (r =-0.625,P ＜ 0.01).⑤The heterogeneities were found in the correlations of regional LSr with age and heart rate in segments and in the LSr among different age groups.Conclusion Normal reference values of LV peak LS and LSr are established for healthy children at different ages,and they possess their own characteristics.

Objective To evaluate the efficacy of a two-step infusion therapy with meropenem against noso-comial multi-drug resistant Pseudomonas aeruginosa infections in elderly patients with chronic obstructive pulmonary disease.Methods 112 elderly patients with nosocomial multi-drug resistant Pseudomonas aeruginosa infections and chronic obstructive pulmonary disease were randomized into two groups:two-step infusion therapy group ( rapid first-step infusion in 30 minutes and slow second-step infusion in 2.5 hours) and traditional 30 minutes infusion therapy group.The antibiotic clinical efficacy and bacteriological efficacy were observed between two groups .Results The clinical efficacy of observation group and control group were 82.2%(46/56) vs 57.1%(32/56).The difference was statistically significant(χ2 =10.185,P<0.05);The bacteriological efficacy of observation group and control group were 75.0%(42/56) vs 46.4%(26/56),The difference was statistically significant (χ2 =10.265,P<0.05). Conclusion The clinical efficacy and bacteriological efficacy of two-step infusion therapy with meropenem against nosocomial multi-drug resistant Pseudomonas aeruginosa infections in elderly patients with chronic obstructive pulmo -nary disease were superior to the traditional therapy .

Objective To investigate the role of AcrAB-TolC efflux pump in fluoroquinolones resistance by Shigella. spp and to explore the significance of AcrAB-TolC efflux pump on mutation of acrR, soxS and marOR as well as on drug re?sistence. Methods Drug resistant bacteria were selected by Kirby-Bauer disk diffusion test. After addition of efflux pump inhibitor carbonylcyanide-m-chlorophenylhydrazone (CCCP), change of minimal inhibitory concentration (MIC)s of nilidixic acid, Levofloxacin, ofloxacin, ciprofloxacin and Norfloxacin were examined. The DNA binding region of acrA, acrB, soxS, acrR and marOR gene in these mutants were amplified by PCR and sequenced. Results Among the 159 clinical isolates of Shigella,11 strains are resistant to fluoroquinolone. After the addition of CCCP, MICs of 2 fluoroquinolone resistant strains decreased; the MICs of 7 fluoroquinolone resistant strains did not change; MICs of 2 fluoroquinolone resistant strains in?creased. The corresponding nucleotides C, A, T, T on the 36th to 39th of marOR gene were missing, showing by sequencing, in fluoroquinolone resistent strains which might be regulated by the efflux pump gene AcrAB-TolC. Conclusion Efflux pump inhibitor could restrain the activity of efflux partially. The mutations of marOR might play an important role in fluoroquino?lone resistent by shigella.

Objective To explore carrying rates of class 1, class 2 integrons as well as ISCR1 in Shigella isolates and their connection with drug resistance. Methods Antibiotic sensitivities were detected by K-B disk diffusion in 159 clinical isolates. Total bacteria DNA was prepared through boiling the isolates and the DNA was then used as template for PCR am?plification. PCR, ZSCR1 and sequencing analyse of integrons were applied to all of them. Results were compared by Blast and GenBank. Results Antibiotic sensitivity results showed that in the S. flexneri strains the incidence of resistance to tet?racycline and streptomycin were 88.68%and 81.13%in the S. flexneri strains while the incidence of resistant to chloram?phenicol and trimethoprim-sulfamethoxazol were both 56.60%, and the incidence of multidrug drug resistance was 77.36%. In the sonnei strains, the incidence of resistance to ampicillin, trimethoprim-sulfamethoxazo were 97.17% and 95.28%, 83.96%and 76.42%respectively, and the incidence of multidrug resistance was 98.11%. Among all isolates, 118 were class 1 integron positive , 70 were class 2 integron positive and 89 were double positives. For those 118 isolates that are positive of class 1 integron, 23 were typical while 95 weres atypical. The gene cassettes of typical class 1 integrons contains aadA2, aa?dA1, dfrⅠ, blaoxa-10 and blaoxa-1. IntI1, aadA, blaoxa-1 and IS1 were included in the gene cassetes of the atypical class 1 integrons. Class 2 integrons positive isolates carried gene cassttes which include dfrA1, satl and aadA1. No ISCR1 was found in any isolate. Integron carriage strains were closely associated with higher rate of multiple antibiobic resistance com?pared with the organisms without integrons (90.65%,50%, P<0.05). Conlusion Class 1 and class 2 integrons were widely existence in Shigella isolates and were related to the multidrug resistance.

Objective:To construct lentiviral vector which can overexpression miR-137 and produce lentivirus by lentivirus packaging system, and to explore its infection efficiency and expression in HEK293T cells.Methods: miR-137 sequence was chemically synthesized and cloned into lentiviral vector GV209, and the recombinant plasmid containing human miR-137 was obtained and identified.Then miR-137 recombinant plasmid together with two helper plasmids were transfected into HEK293T cells using Lipofectamine 2000.After the HEK293T cells were infected in multiplicity of infection(MOI) 40 for 48 h, the expression of green fluorescent protein (GFP) was observed by fluorescence microscope and the expression level of miR-137 was detected by fluorescence quantitative PCR.Results:The sequencing results showed that the inserted gene sequence was completely consistent with the published human miR-137 gene sequence in GenBank.The GFP was observed in the HEK293T cells infected with miR-137 overexpression lentivirus under fluorescence microscope.The fluorescence quantitative PCR results showed that the expression level of miR-137 in the cells infected with overexpression lentivirus was 12.74 times higher than that in the control cells.Conclusion:The lentivirus containing miR-137 gene is successful packaged, and it could efficiently infect the HEK293T cells.

Objective To analyze the differences and feasibility of non-invasive intracranial pressure monitoring and invasive intracranial pressure monitoring in patients with subarachnoid hemorrhage (SAH) at early stage,an explore the correlation of intracranial pressure and scores of Glasgow Coma Scale (GCS) with digital electroencephalogram data (cerebral state index [CSI],eleetromyographic [EMG]) obtained by cerebral state monitoring (CSM).Methods Synchronous line of 33 parents with SAH,having 3-12 GCS scores,was chosen in our study; early invasive intracranial pressure monitoring (lumbar puncture manometry/ventricular drainage manometry) and non-invasive intracranial pressure monitoring (flash visual evoked potential [F-VEP] monitoring),and brain function condition monitoring (CSI and EMG) were performed on these patients; the difference of non-invasive and invasive monitoring and the correlation of intracranial pressure with these indicators were analyzed.Results Non-invasive and invasive intracranial pressure monitoring results showed no significant difference in patients with SAH(t=-0.069,P=0.946; t=-0.158,P=0.876).The intracranial pressure was negatively correlated with CSI (r=-0.898,P=0.000) and positively correlated with EMG (r=0.938,P=0.000); GCS scores showed positive correlation with CSI (r=0.472,P=0.011) and showed no relation with intracranial pressure and EMG (r=-0.047,P=0.814; r=-0.170,P=0.388).In addition,after intracranial pressure being controlled and GCS scores being adjusted,partial correlation analysis indicated that CSI and EMG had no correlation (r=0.288,P=0.138).Conclusion Spontaneous F-VEP monitoring results have a high correlation with the results of lumbar puncture manometry and ventricular drainage manometry; intracranial pressure has correlation with CSI and EMG; dynamic intracranial pressure monitor trends are consistent with the changes of disease condition.

OBJECTIVETo explore the diagnostic value of MRI in the transient dislocation of the patella.

METHODSThe DR and MRI data of 35 patients with acute patellar transient dislocation from January 2015 to December 2017 were retrospectively analyzed, including 12 males and 23 females, ranging in age from 10 to 23 years old, with an average of 17 years old. The differences between DR and MRI diagnosis and surgical or discharge diagnosis were compared, and the difference between them in diagnosis of knee anatomical position, bone injury, signs and soft tissue injury were compared. The R statistical software WiLcoxon signed rank test (WiLcoxon signed rank test) was used for statistical analysis.

RESULTSAll 35 MRI findings were completely consistent with postoperative or discharge diagnosis. According to MRI, 7 cases of high patella and 7 cases of patella subluxation were diagnosed. According to DR, 7 cases of high patella and 0 cases of patella subluxation were diagnosed. Fourteen dislocations were diagnosed by MRI and 7 dislocations were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of abnormal position of patella(=10, <0.05). Total 112 cases of bone injuries were diagnosed by MRI, and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of bone injuries(=16, <0.05). Total 43 cases of soft tissue injuries were diagnosed by MRI, and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of soft tissue injuries (=21, <0.05). Total 35 cases of hydrops of the knee joint were diagnosed by MRI, and 30 were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of hydrops of the knee joint(=32, >0.05).

CONCLUSIONSMRI is superior to DR in the diagnosis of acute temporal bone dislocation. MRI should be used as the first choice for imaging diagnosis of acute temporal bone dislocation. It can avoid missed diagnosis and misdiagnosis.

Objective To evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy ( RA) followed by drug eluting stent ( DES) implantation in treating patients with heavily calcified coronary lesions.Methods Clinical characteristics , coronary angiogram , intravascular ultrasound images , peri-procedure and follow-up data ( including death , myocardial infarction and target lesion revascularization ) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed.IVUS examination was carried out before RA , after RA and stent implantation to guide whether further RA or post dilatation was needed.According to the arc of calcification , the patients were divided into group A (90°-270°,18 cases) and group B (271°-360°,26 cases).Results In A and B group, the arc of calcification was (195 ±71)°in group A and (345 ±23)°in group B(P<0.01), length of calcification was (34.4 ±11.8)mm in group A and (20.0 ±6.6) mm in group B ( P<0.05).Number of burrs used and size of largest burr used were similar between 2 groups (both P>0.05).Acute cross sectional area gain after RA was (0.43 ±0.32)mm2 in group A and (0.53 ±0.38)mm2 in group B (P>0.05).After RA, there was significant decrease in the arc of calcification in group B compared with baseline ( ( 324 ±52 ) °vs.( 345 ±23 ) °, P <0.05 ).The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups ( all P<0.05 ).The final minimal lumen area after stenting were similar between 2 groups (P>0.05).Procedure success rate was 100%(44/44) without any major complications such as death , acute myocardial infarction and coronary perforation.During the ( 16.6 ±6.3 ) months follow-up, there was 1 death in group A , 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.Conclusion Heavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.