The effects of different dose of methimazole (MMI) and different mode of drug administration were compared in patients with Graves' disease. 155 patients were divided into 5 groups at random: group A 10 mg MMI 3 times daily, group B 30 mg once daily, group C 5 mg 3 times daily, group D 15 mg once daily, group E 10 mg daily. The durations to achieve euthyroidism were not significantly different in group A, B, C and D (3.9? 1.5, 3.8? 1.3, 4.1 ? 1 .6 4.1 ?1.7 weeks respectively), but in group E (7.8?2.1 weeks) it was apparently longer than in other groups. The rate of side-effects occurring in patients treated with 30 mg, 15 mg and 10 mg daily was 37.7%, 14.7% and 5.6% respectively. Intrathyroidal concentrations of MMI were measured by means of high-performance liquid chromalo-graphy in 25 patients who underwent thyroidectomy. There was no difference of MMI concentrations in thyroid glands between the patients treated with 15 mg/d (39.1 ?15.2 ?mol/kg) and those with 30 mg/d(42.4? 14.3 ?mol/kg), or between the patients receiving the same dose on divided daily dose and single daily dose. These data demonstrate that 15 mg MMI as a single daily dose is reasonable and effective for the treatment of hyperthyroidism.

Thyroid nodules are very common.Its etiological factors include hyperplasia,adenomas,cancer,cysts,and thyroiditis.Most of thyroid nodules are benign.The management of thyroid nodules whether thyroidectomy or observation is according to their nature.So,the key of the therapy is to identify that they are benign or malignant.We should comprehensive evaluate patients' history,physical examination,laboratory examination,and auxiliary examination for judging the nature of thyroid nodules and making decision in the choose of thyroidectomy or observation.

Objective To investigate the signal pathways involved in the effects of thyroid stimulating antibody(TSAb)on the secretory function of cultured thyrocytes.Methods (1)With the method of enzyme-linked immunosorbent assay (ELISA),the PKA and PKC activities were observed.(2)Inhibitors or activators of protein kinases (PKA and PKC) were used to activate or block the signal pathways and the secretion of T3 measured by radioimmunoassay.Results (1)TSAb activated both PKA and PKC in thyrocytes in a dose-,time-dependent manner(.P.

50Gy) in solitary or limited BM subgroup seemed to survive longer. However in the Cox mu ltivariate analysis, only KPS, numbers of BM, extracranial systemic metastasis a nd chemotherapy were significant prognostic factors. Just as those of RPA subgro ups, the median survival from the start of WBRT was 3, 9, 16 months in 3 PI subg roups respectively.Conclusions:Overall survival in BM from breast cancer remains p oor. KPS, numbers of BM, extracranial systemic metastasis and chemotherapy were independent prognostic factors. RPA classification can predict the prognosis of patients with BM from breast cancer, so can the PI model.

Objective Tyrphostin AG1024(3-Bromo-5-t-butyl-4-hydroxybenzylidenemalonitrile) is a specific insulin like growth factor type Ⅰ receptor tyrosine kinase blocker,this study is to investigate the effect of AG1024 on the proliferation and apoptosis of hepatocellular carcinoma cell lines.Methods Treated with AG1024 on vailed concentrations(0～40 μmol/L),human hepatocellular carcinoma cel lines HepG2 and SMMC-7721 were observed for morphological and molecular biology changes,the effect of AG1024 on the cell lines proliferation invasion ability as well as apoptosis was evaluated. Results MTT showed that AG1024 dose-dependently inhibited the proliferation of hepatocellular carcinoma cells,flow cytometry suggested that AG1024 significantly promoted cell lines apoptosis,the cell invasion assay indieated that AG1024 significantly inhibited cell's invasion ability.RT-PCR showed over-expression of IGF-IR in liver cancer cells.and AG1024 dose-dependently increasedtheexpressionofcytochreme C. According totheresultsof Western, blotting,the phosphor-ERK and procaspase-3 were down-regulated while the total ERK remained unchanged. Conclusion AG1024 as a specific IGF-IR blocker blocks the downstream signaling cascade and thus inhibits the proliferation of hepatocellular carcinoma cells and induces cell's apoptosis.

OBJECTIVE:To explore the anti-shear force,stability and plasticity of reconstruction plate implantation,and to investigate its role in treating acetabular fractures complicated by free bone graft in the joint.METHODS:A computer-based online search of Science Direct and Ei databases (1960-01/2009-10) was performed for related English articles with the keywords of "acetabular fractures,modified ilioinguinal approach,reconstruction plate".In addition,CNKI and CBM database (1994-01/2009-10) were searched for related Chinese articles with the same key words in Chinese.Moreover,related works were manually searched.Studies regarding reconstruction plate implantation in treating acetabular fractures were included,including basic and clinical experiments.RESULTS:Acetabular top is weight loading region of human body,and the fracture should be reducted by the operation.Prior to reconstruction plate for acetabular fracture fixation,bone hook,and Kirschner wire can be used for temporary fixation,and the plate bending angle should be adjusted to accordant with lateral posterior wall or medial anterior wall of the acetabular top,followed by screw threading for fracture fixation.In addition,the screw entrance angle is very important.If the fixation of one plate is not satisfactory,one or two cancellous bone screw or Kirschner wire can be used to enhance the fixation.But the Kirschner wire tail should be bended to prevent dislocation into the pelvic cavity.Moreover,additional plate can be used for further fixation.Reconstruction plate fixation has advantages of anti-shear force,high stability and plasticity,which fully adapt the special appearance of acetabulum.Moreover,the incidence of postoperative plate loosening and breakage is low,and the satisfaction is high.Free bone blocks can be temporarily fixed by Kirschner wire,followed by reconstruction plate fixation.CONCLUSION:Reconstruction plate fixation has good clinical effect and few complications in treating acetabular fractures complicated by free bone blocks in the joint.

ObjectiveTo compare the clinical characteristic and postoperative histopathological parameters in different prostate size and to assess the effect of prostate volume on histopathological outcomes in patients after laparoscopic radical prostatectomy. MethodsTwo hundred and sixteen patients from 2006 to 2011 who were proved prostatic carcinoma by biopsy and performed laparoscopic radical prostatectomy wewe retrospectively evaluated.All patients were divided into the small group ( ＜ 30 ml,103 cases),intermediate group(30 -60 ml,71 cases) and large group ( ＞60 ml,42 cases) according to prostate volume.Clinical variables included age,body mass index (BMI),preoperative PSA level,prostate volume,percentage of positive needles,clinical stage,and biopsy Gleason score (GS).Histopathological parameters included pathological GS,upgrading or not compared to biopsy GS,pathological stage and surgical margins status.Preoperative clinical variables and postoperative histopatholgogical parameters were compared among the 3 prostate groups. ResultsPatients with smaller prostates had lower PSA levels than those with intermediate and larger prostates (P =0.000).They also had worse histopathological outcomes such as pathological GS ( P =0.034 ),upgrading of GS ( P =0.037 ),and pathological stage ( P =0.025 ).35.0％ of patients in smaller prostate group had a positive surgical margin compare to 33.8％ and 19.0％ in intermediate and larger prostate groups,but there was no significant difference (P =0.152).ConclusionMen with smaller prostate may have more high-grade cancer and more advanced disease after laparoscopic radical prostatectomy.

Objective To determine relative risk factors for positive surgical margins in extraperitoneal laparoscopic radical prostatectomy(LRP). Methods From February 2004 to September 2007,33 patients(mean age 70 years old)with prostate cancers underwent extraperitoneal LRP.All patients were diagnosed by pathology preoperatively.Gleason score:3+3 14 cases(43%),3+4 11 cases(33%),4+3 6 cases(18%),4+4 2 cases(6%).Clinical stage:T1a-T1b 4 cases(12%),T1c 14 cases(43%),T2a-T2b 5 cases(15%),T2c10 cases(30%).Logistic regression analyses were performed. Results LRP was successfully performed on 31 cases.There were 2 cases converted to open surgery.Nine cases(27%)had PSMs.There were 6 cases(67%)and 4 cases(17%)of clinical stage T2c in PSM and negative surgical margin(NSM)groups respectively(P=0.010).There were 3 cases(33%)and 0(0)with high Gleason score(higher than 7)in PSM and NSM cases(P=0.015).There were 4 cases(44%)and 5 cases(21%)with t-PSA higher than 20dg/ml in PSM and NSM cases respectively(P=0.178).In these 9 cases,there were 4 cases(44%)positive with DRE.However there were 9 in the 24 NSM cases(38%)(P=0.509).Clinical stage T2c was independently positively correlated with PSM(OR=24.69).High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml were positively correlated with PSM. Conclusions Clinical stage is positively correlated with PSM.It is an independent factor.High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml mignt be the risk factors in predicting PSM and should be used together with clinical stage.Positive DRE findings may be also useful to predict PSM.

Objective To investigate the diagnostic value of microscopic observation drug susceptibility assay (MODS) in extrapulmonary tuberculosis. Methods MODS technology was constructed by using 24-well cell culture plate and liquid culture.Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS were used to detect Mycobacterium tuberculosis in 74 pleural fluid samples collected from patients with tuberculous pleurisy,63 cerebrospinal fluid samples collected from patients with tuberculous meningitis and 18 samples collected from non-tuberculosis suspects.The immunochromatography was used to distinguish Mycobacterium tuberculosis from nontuberculosis mycobacteria. The results of Ziehl-Neelsen smear, Lowenstein-Jensen culture and MODS were compared by x2 test.Results The positive rates of MODS,Lowenstein-Jensen culture and Ziehl-Neelsen smear were 58.1 ％ (43/74),18.9 ％ (14/74 ) and 6.8％ (5/74),respectively in tuberculous pleurisy patients; 54.0％(34/63),20.6％ (13/63) and 4.8％ (3/63),respectively in tuberculous meningitis patients.The positive rate of MODS technology was significantly higher than that of Lowenstein Jensen culture in tuberculous pleurisy patients (x2 =24.00,P＜0.01) and tuberculous meningitis patients (x2 =14.97,P ＜ 0.01). Each Mycobacterium obtained from MODS and Lowenstein-Jensen culture was identified as Mycobacterium tuberculosis by immunochromatography.All of the 18 pleural fluid and cerebrospinal fluid samples which collected from non-tuberculosis suspects were all negative detected by Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS.The median time to culture positive of MODS was 9 days in cerebrospinal fluid and 14 days in pleural fluid samples,which were both significantly shorter than that of Lowenstein-Jensen culture (31 days in both cerebrospinal fluid and pleural fluid samples). Conclusion Compared to conventional microbiological diagnosis methods,MODS is a rapid detection method of Mycobacterium tuberculosis with a higher positive detection rate,which is suitable for rapid diagnosis of extrapulmonary tuberculosis.

Objective To assess the impact of learning curve on perioperative complications in laparoscopic radical prostatectomy (LRP) by a series of consecutive 200 cases in a single center.Methods Two hundred patients who were biopsy proved prostatic carcinoma and underwent LRP were retrospectively evaluated.All the operations were performed by professor Ma Lulin.The patients were divided into 4 groups according the time of operation.All the clinical data,including age,body mass index (BMI),preoperative PSA level,biopsy Gleason score,and clinical stage were collected.Operative parameters and peri-operative complications were evaluated,including operative time,blood loss,transfusion rate,and perioperative complications.The complications were evaluated by Clavien classification system.Results Age,BMI,PSA,prostate volume,biopsy Gleason score and clinical stage had no significant difference among the 4 groups (P ＞ 0.05).The operative time was gradually lowered from group one to group four.Significantly less blood loss occurred after every 50 cases of LRP (P ＜ 0.001).The complication rates were 15.5％ in this series,28.0％,18.0％,12.0％ and 4.0％ for group one to group four respectively.The complication rate reduced as experience was gained (P =0.008).The rates of mild complications were 24.0％,14.0％,6.0％ and 4.0％,and severe complication rates were 4.0％,4.0％,6.0％ and 0,respectively.Conclusion With experience was gained and technique was improved,the operative time and blood loss of LRP decreased and complication rate reduced substantially.