Pituitary metastasis is a rare tumor complication, and papillary thyroid carcinoma is a tumor with low hematogenous dissemination tendency. Here we report a rare case with pituitary metastasis from papillary thyroid cancer. This patient was 43 years old and was admitted to our hospital because of " blurred vision in the right eye" . She had partial thyroidectomy because of thyroid nodule 8 years ago, and was diagnosed as papillary thyroid carcinoma, but without any further treatment onwards. After admission, MRI revealed a pituitary mass protruding through the sella turcica into the right sphenoid sinus. Neuro-endoscopic transsphenoidal resection was performed to relieve visual impairment. Pathological result was papillary thyroid carcinoma pituitary metastasis. She underwent thyroidectomy 2 months later. Because tumor of the left lobe invaded the esophagus, it was resected palliatively, and adjuvant therapy with radioactive iodine was performed subsequently. This case suggests that long-term management of papillary thyroid carcinoma should be strengthened to reduce the risk of recurrence and metastasis, additionally radioiodine therapy is an important complementary treatment.

Objective To investigate the diagnostic efficiency of 64-slice CT coronary angiography (CTCA) to myocardial ischemia of coronary stenosis. Methods ~(99m) Tc-MIBI myocardial perfusion imaging (MPI) and 64-slice CTCA were performed in 30 patients with myocardial ischemia of coronary stenosis. Three coronary arteries were divided in to 12 segments in each patient, the diagnostic efficiency of CTCA to myocardial ischemia of coronary stenosis were eveluated taking MPI as diagnostic standard, and stenoses ≥50% and ≥75% as the cutoff value. Results In 9 patients, perfusion defected were found (6 reversible, 3 fixed) on MPI. A total of 327 coronary arteries' segments were analyzed, quantitative CTCA revealed stenoses ≥50% in 25 segments (7.65%) and stenoses ≥75% in 12 segments (3.67%). When the cut-off was ≥50%, the sensitivity, specificity, negative and positive predictive value (NPV, PPV) and accuracy of CTCA by the abnormal images of MPI as diagnostic standard to observe abnormal arteries was 68.42%, 96.14%, 99.01%, 52.00% and 95.41%, respectively; and 66.67%, 99.04%, 98.73%, 66.67% and 97.55%, respectively, when cut-off at ≥75%. Taking abnormal MPI as diagnostic standard to observe the patients, the sensitivity, specificity, NPV, PPV and accuracy of CTCA was 66.67%, 57.14%, 80.00%, 40.00% and 60.00% respectively, with the cut-off at ≥50%; and was 55.56%, 85.71%, 81.82%, 62.50% and 76.67%, respectively, with the cut-off at ≥75%.Conclusion Sixty-four-slice CTCA is a reliable tool to rule out functionally relevant myocardial ischemia of coronary artery disease. However, further examination is necessory for patients with abnormal CTCA.

ObjectiveTo evaluate the intermediate term efficacy of posterior stabilized (PS) total knee arthroplasty(TKA) and posterior cruciate-retaining(CR) TKA and explore the clinical related problem.MethodsThe clinical data of 84 patients (87 knees) who treated with primary TKA from May 1992 to May 2006 were analyzed retrospectively.The intermediate term efficacy was compared between PS TKA (PS group,41 cases with 43 knees) and CR TKA (CR group,43 cases with 44 knees).ResultsAll the patients were followed up for 5-10(7.6 ± 1.5 ) years,no infection,dislocation or neurovascular injury occurred in both groups.But 1 knee occurred intraoperative posterolateral femoral condyle fracture in PS group.The lateral retinacular release rate was 2.3％ ( 1/43 ) and 2.3％ (1/44) in PS group and CR group,respectively.The incidence of anterior knee pain was 4.7％(2/43 ) and 4.5％(2/44) after 6 months surgery in PS group and CR group.The incidence of anterior knee pain was 0 at the end of follow-up in both groups.There was no significant difference in the lateral retinacular release rate and the incidence of anterior knee pain between two groups (P ＞0.05).The range of motion and American knee society score(KSS) was similar and no statistical difference was found between two groups(P ＞ 0.05 ).The incidence of patellar tilt or subluxation in X-ray was 2.3％ (1/43) and 2.3％ (1/44) at the end of follow-up in PS group and CR group.There was no significant difference between two groups (P ＞ 0.05 ).At the end of follow-up,no osteolysis,X-ray radiolucent zone and prosthesis loosening were found in both groups.There was no revision owing to loosening or other reasons.ConclusionsThe intermediate term efficacy of PS TKA and CR TKA is near a tie.However,the future efficacy still need further follow-up.

Objective To compare sinus tarsi approach(STA) and extensile L shape approach (ELA) in the surgical treatment of calcaneal fractures. Methods A total of 51 cases of calcaneal fractures treated from May 2014 to December 2016 were enrolled. Twenty of them were performed ORIF via the sinus tarsi approach, while the other 31 cases were performed ORIF via lateral extensile L shape approach. X-ray films were taken postoperatively to record the changes of B?hler angle and Gissane angle. The AOFAS, VAS and SF-36 scores were adopted to assess the therapeutic effect. Results The average follow-up period of STA group was 15.5 months. And patients in ELA group were followed up for an average period of 18.4 months. All the fractures in the series had a boney union at or before the final follow-up. The final correction of B?hler angle (34.60 ± 2.91)° , and Gissane angle (114.45 ± 2.91)° was significantly increased in the STA group; and the final correction of B?hler angle (33.55 ± 2.73)° , and Gissane angle (112.81 ± 4.15)° was also significantly increased in the ELA group; while there was no significant difference between the two groups. The final AOFAS scores , VAS scores and SF-36 scores of the STA were (83.56 ± 7.13), (1.78 ± 0.89), (88.95 ± 4.31) scores, while those in ELA group were (81.91 ± 9.89), (2.01 ± 1.33) and (86.65 ± 4.95) scores. There was no significant difference between the two groups (P>0.05). No wound problem happened in STA group, but there were 2 cases who had wound complications in ELA group. Conclusions No significant difference is found between the two groups in the short-term efficacy of the treatment for calaneal fracture. However, STA has the advantages of lower soft tissue complication rate.

Objective: To evaluate the efficacy of 3LL/GM-CSF tumor vaccine combined with pacilitaxel chemotherapy in treatment of mice bearing transplanted Lewis lung carcinoma. Methods: The tumor vaccine 3LL/GM-CSF was prepared by infecting Lewis lung carcinoma cell line 3LL with adenovirus encoding GM-GSF. Mice model of Lewis lung carcinoma was established by subcutaneous injection of 2?104 3LL cells into C57BL/6(H-2b)mice. The sensitivity of Lewis lung carcinoma cell line-3LL to the treatment of pacilitaxel was detected in vivo and in vitro. The mice tumor model was first treated with pacilitaxel chemotherapy and then with 3LL/GM-CSF, or first with 3LL/GM-CSF and then with pacilitaxel. Tumor growth and the long-term survival of mice were observed after treatment. The immune memory and cytotoxicity against target cells were studied in the mice. Results: Pacilitaxel at 100 nmol/L killed 32.10% 3LL cells after 24 hour in vitro; but pacilitaxel at 5-25 mg/kg only had a poor effect on growth of 3LL cells in vivo. The tumors rebated in 70% of mice treated with pacilitaxel chemotherapy and 3LL/GM-CSF vaccination successively, and the survival of these mice was obviously longer than that of pure pacilitaxel chemotherapy group (70.0 days vs 27.5 days). The killing rate of 3LL/GM-CSF after pacilitaxel chemotherapy was 41.35% on day 3. Meanwhile, the survival mice could resist the re-attack of 3LL cells (2?104). We also noticed that first treatment with 3LL/GM-CSF and then pacilitaxel chemotherapy had no effect on tumors. Conclusion: Application of tumor vaccine shortly after pacilitaxel chemotherapy can induce specific immune responses and prolong the survival of experimental mice, which provide a basis for future clinical practice.

Objective To compare the complication and cost-effectiveness of the deep inferior epigastric perforator(DIEP) flap and transverse rectus abdominis myocutaneous(TRAM) flap.Methods From January 2000 to December 2014,all patients who underwent DIEP flap and TRAM flap in the People's Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology, were selected.Eleven patients underwent immediate breast reconstruction with TRAM flaps and 19 patients with DIEP flaps.The treatment cost,length of hospitalization, and complication in the two year after surgery for each group were compared.Results For the major complications,there were 5 cases appeared fat necrosis in TRAM group, and 1 case in DIEP group,the differences was statistically significant(P=0.016).One case appeared flap loss in TRAM group,and DIEP group was zero,both of the two group had no abdominal wall hernia, there was no significant difference (P ＞ 0.05).For the minor complications, there were 4 cases appeared postoperative hematoma in TRAM group, and 1 case in DIEP group, the difference was statistically significant(P =0.047).Two cases appeared wound dehiscence in TRAM group,and DIEP group was 1 case, 1 case happened infection in TRAM group,there was no statistically significant difference(P＞0.05).The treatment costs were (14 133.12±1 546.88)yuan for the TRAM group and (16 838.94± 3 006.05)yuan the DIEP group, the difference was statistically significant (P =0.010).The hospital stay was (17.28± 2.08)days for the pedicled TRAM group and (18.39±2.87) days for the DIEP group,the different was not statistically significant(P＞0.05).Conclusion The DIEP flap has a better clinical outcomes,but more expensive.

BACKGROUND:Joint replacement surgery becomes difficult because of the abnormal changes in hip joint, especial y on the acetabular side. Therefore, the treatment on acetabulum is very important during total hip arthroplasty in patients with hip dysplasia. OBJECTIVE:To investigate the clinical therapeutic effects of total hip arthroplasty with onlay bone graft for treatment of CroweIII and IV adult hip dysplasia. METHODS:A total of in 14 patients with adult hip dysplasia were retrospectively analyzed. According to Crowe method, there were 11 cases of type III and 3 cases of type IV. Al patients underwent total hip arthroplasty. Autologous femur neck was used to make an onlay bone graft around the acetabulum during replacement. Radiographs were analyzed after replacement and during fol ow-up. Clinical efficacy was assessed using Harris standard. RESULTS AND CONCLUSION:Al patients were fol owed up for 1-9 years, averagely 4.5 years. Bone graft was partial y absorbed within 1 year after replacement in 4 patients, and began to grow 2 years later. Radiographs showed that al bone graft was fused to host bone. The average coverage rate of bone grafts on acetabulum was 36%. None hip was needed to be rebuilt up to now. Harris score of hip joint function increased from 35 points (26-52 points) before surgery to 91 points during final fol ow-up. Total hip arthroplasty with onlay bone graft is an effective method in treatment of CroweIII and IV adult hip dysplasia.

Gastric cancer (GC) is a common malignant tumor of the digestive tract in China. It is characterized by high morbidity, mortality, and proportion of patients in advanced stages. In the past years, chemotherapy was used as the main treatment for GC. Subsequently, targeted therapy with trastuzumab was approved to treat HER2-positive GC. However, the progress of drug development and clinical studies has been limited by the high heterogeneity of GC. In recent years, research on immunotherapy and new targets for therapeutic exploration in GC has made great strides. Herein, we provide a brief review of the progress of the research on targeted therapy and immunotherapy for GC.

OBJECTIVEThrough comparative study on pulmonary function damage of coke oven workers exposed to coke oven emissions with the same group before and after five years, and further explore the relationship between the coke oven emissions and injury in pulmonary function of coke oven worker.

METHODSSelect a coking plant in Shanxi 165 coke oven workers (exposed group) and 52 auxiliary workers (control group) for the study, using a uniform questionnaire to collect workers' personal information. Fixed workplace air samples collected periodically. Air samples of benzo (a) pyrene concentrations was measured by high pressure liquid chromatograph. Pulmonary function of research object was measured by portable spirometer respectively in 2009 and 2013, and comparative analysis on it.

RESULTSThe concentration of B(a)P was no significant difference in the same area between 5 years in 2009-2013. Compared with 2009, 2013 control workers lung function index and the abnormal rate had no significant difference (P > 0.05). But FVC%, FEV1.0%, MVV%, VC% and FEF25% of exposed workers in 2013 was significantly lower than in 2009, FVC%, FEV1.0%, VC% and FEF25% pulmonary dysfunction rate in 2013 was also significantly higher than in 2009, difference was statistically significant (P < 0.05). Workers emerging pulmonary function abnormalities mainly distributed in furnace roof and side. furnace roof group FVC%, FEV1.0%, VC% additional abnormal number (rate) was significantly higher than furnace floor and the control group (P < 0.05), and furnace side groop was significantly higher than the control group, the difference was statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that after 5 years FVC%, FEV1% and VC% of abnormal lung function emerging adjusted OR of furnace roof workers were 7.939, 5.966 and 4.956. For abnormal of FVC%, FEV1%, VC% and MVV%, the contacting coke seniority is a risk factor. There is a positive interaction between contacting coke seniority and furnace roof (P < 0.05).

CONCLUSIONCoke oven workers lung function damage associated with exposureing to coke oven emissions, coke oven emissions exposure level and exposure time are the main factors of coke oven workers in lung function damage, there is a positive interaction between the two factors.

Air Pollutants, Occupational ; adverse effects ; analysis ; Benzo(a)pyrene ; adverse effects ; analysis ; Cohort Studies ; Coke ; Humans ; Lung ; drug effects ; physiopathology ; Occupational Exposure ; adverse effects ; Respiratory Function Tests ; Risk Factors ; Surveys and Questionnaires

Background: Hypothermia is a crucial environmental factor that elevates the risk of cardiovascular disease, but the underlying effect is unclear. Objectives: This study examined the role of cold stress (CS) in cardiac injury and its underlying mechanisms. Methods: In this study, a chronic CS-induced myocardial injury model was used; mice were subjected to chronic CS (4°C) for three hours per day for three weeks. Results: CS could result in myocardial injury by inducing the levels of heat shock proteins 70 (HSP70), enhancing the generation of creatine phosphokinase-isoenzyme (CKMB) and malondialdehyde (MDA), increasing the contents of tumor necrosis factor-α (TNF-α), high mobility group box 1 (HMGB1) interleukin1b (IL-1β), IL-18, IL-6, and triggering the depletion of superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH). Multiple signaling pathways were activated by cold exposure, including pyroptosis-associated NOD-like receptor 3 (NLRP3)-regulated caspase-1-dependent/Gasdermin D (GSDMD), inflammation-related toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88)-mediated nuclear factor kappa B (NF-κB), and mitogen-activated protein kinase (MAPK), as well as oxidative stressinvolved thioredoxin-1/thioredoxin-interacting protein (Txnip) signaling pathways, which play a pivotal role in myocardial injury resulting from hypothermia. Conclusions These findings provide new insights into the increased risk of cardiovascular disease at extremely low temperatures.