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.

Intraductal papillary mucinous neoplasm (IPMN) is a kind of epithelial neoplasms of mucin-producing cells arising in the main duct and/or branch ducts of the pancreas,and it is one of the precancerous lesions of the pancreatic cancer.With the development of pathology and radiology,the diagnostic rate of IPMN has been gradually increased and given a new understanding on the pathological characteristics,clinical diagnosis and treatment of IPMN.This review overviewed the classification,diagnosis,management and prognosis of IPMN,aiming to deepen the understanding of IPMN and improve the level of diagnosis and treatment.

Objective To investigate the effects of thyroid stimulating antibody (TSAb) on the thyroid peroxidase (TPO) activity and its signal transduction pathways in cultured thyrocytes. Methods The TPO activity in primary cultured human thyrocytes was determined by amended guaiacol oxidation assay. At the same time, inhibitors of signal transduction were applied and the roles of cAMP/protein kinase A (PKA), phosphatidylinositol (PIP 2)/Ca 2+and tyrosine protein kinase (TPK) pathway on the TPO activity in cultured thyrocytes were observed. Results TSAb significantly enhanced the TPO activity in cultured thyrocytes, and the peak of TPO activity (360% of controls) reached with 4 mg/ml TSAb for 48 h. Addition of PKA inhibitor for blocking cAMP/PKA pathway decreased TPO activity by 79.2% (P

Objective To summarize the clinical experience of laparoscopic appendectomy(LA).MethodsA retrospective analysis was conducted on the clinical data of 683 patients with appendicitis treated by LA,including 258 cases of chronic appendicitis,425 cases of acute appendicitis(87 cases of complicated appendicitis).ResultsThe procedure was completed in all the patients without conversion to open surgery.The operation time was 30 min in average(15-150 min).The average hospital stay was 4d (2-15d).Postoperative complications included 26 cases of incision infection,3 cases of abdominal abscess,1 case of appendical mesenterium hemorrhage,1 case of small intestine fistula and 1 case of appendical stump fistula.The patients were followed up for 2 to 12 months with a mean of 6 months,during which no intestinal adhesive obstruction occurred.Conclusion LA is safe and effective for appendicitis,with advantages of minimal trauma,lighter pain,quicker recovery,shoter hospital stay,less complications and so on.For complicated appendicitis,the abundant surgical experience and proficient endoscopic technique are indispensable to reduce the occurrence of complications effectively.

Objective To compare the air permeability,water absorption and water locking properties of two different foam dressings,thus to provide theoretical and experimental evidence to alternative optimization for acute and chronic wound.Methods Five Mepilex foam dressings(group 1) and PermaFoam Comfort dressings(group 2) each was selected.Simulated wound exudation was made by NaCl and CaCl·H2O.The water-absorbing rate of dressings at post immersion 24 h (PIH),the water-absorbing speed of dressings at post immersion 1,5,10,20 min,the diffusion diameter of exudation dripped on the surface of dressings for 5 min,the beaker filled with exudation was sealed tightly by dressing for 24 h,and the weight was gotten before and after 24 h.Statistical analysis was performed.Results (1) The water-absorbing rate:the group 1(616±19)% was significantly higher than (313±13)% of the group 2 (t=29.137,P<0.01);(2) The water-absorbing speed:the group 1 (119.68±2.59)g·s-1·m-2,(24.39±0.62)g·s-1·m-2,(12.33±0.29)g·s-1·m-2,(12.33±0.29)g·s-1·m-2 were significantly higher than those of the group 2[(65.85±4.37)g·s-1·m-2,(13.82±1.03)g·s-1·m-2,(7.16±0.41)g·s-1·m-2,(3.66±0.12)g·s-1·m-2,t=23.704,t=19.708,22.947,31.764,all P<0.01];(3) The water holding capacity:the group 1 (5.66±0.15)cm was significantly higher than (2.2±0.12)cm of the group 2,(t=39.089,P<0.01);(4) The air permeability:there was no statistically significant difference between the two groups(t=0.189,P>0.05).Conclusion The Mepilex foam dressing is more suitable for the early stage of acute wound with large exudation in short time,while the PermaFoam Comfort dressings is better for chronic wound or the later period of acute with less exudation in a relative slow seepage velocity.

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.

Objective To observe the changes of brain oxygenation in patients with extremely severe craniocerebral injury and the therapeutic effect of early normobaric hyperoxia.Methods Sixtyeight patients with extremely severe craniocerebral injury treated from January 2011 to January 2013 were assigned to two groups according to the random number table:50％ oxygen breathing for one week in control group (34 cases) and 80％ oxygen breathing for one week in treatment group (34 cases).Blood samples from jugular vein and radial artery were collected at 1,3,5,and 7 days to measure indices of blood gas analysis,i.e.,PaO2,PjvO2,CaO2,CjvO2,Da-jvO2,CERO2 and Djv-a Lac.GCS and content of neuron-specific enolase (NSE) were recorded as well.Results Values of PaO2 at each time point and GCS at 5 and 7 days were significantly higher in treatment group than in control group (P ＜0.05).Djv-a Lac at 3,5 and 7 days and NSE at 7 days revealed significantly higher levels in treatment group than in control group(P ＜ 0.05).Whereas at each time point,there were no significant differences between the two groups in aspects of PjvO2,CaO2,CjvO2,Da-jvO2 and CERO2 (P ＞ 0.05).Conclusion Early use of 100％ oxygen in patients with extremely severe craniocerebral injury may be beneficial to the prognosis.