[ABSTRACT]OBJECTIVETo evaluate the clinical value of ultrasound guided fine-needle aspiration (US-FNA) in the diagnosis of thyroid nodules with different size.METHODSThe clinical data of 122 thyroid nodules of 109 cases referred to FNAC for diagnosis were retrospectively reviewed. The final operating histological results of 122 nodules were considered gold standard. RESULTSNon-diagnostic FNAC results occurred in 17 nodules (13.9%). FNAC achieved a sensitivity of 78.6%, a specificity of 93.9%, a positive predictive value of 93.6%, a negative predictive value of 78.3%, and a total accuracy of 85.7%. There was no significant difference between the diameter of the nodule≤1 cm group and>1 cm group, except negative predictive value. The non-diagnostic results rate was no significant difference between groups of different nodule size, benign or malignant nodules, and different operators. CONCLUSIONFNAC is a sensitive, specific and accurate method for differential diagnosis of thyroid nodules.

AIM:To clarify the impact of heart shock factor 4b (Hsf4b) K65R mutation on the regulation of downstream protein expression .METHODS:Non-functional Lys mutant plasmid pWZL-blast-HA-Hsf4b/K65R was genera-ted by replacing single , homologous amino acids using KOD-Plus-Mutagenesis-Kit.Mouse lens epithelial mLEC stable cell lines expressing Hsf4b or Hsf4b/K65R were constructed by lentivirus infection .The expression of Hsf4b in the mutant and the wildtype mLEC cells was confirmed by Western blotting .The expression of Hsf4b downstream proteins such as heat shock protein ( Hsp)70, Hsp90, Hsp27 and CryAB was examined by Western blotting and real-time PCR.RESULTS:The results of PCR and DNA sequencing confirmed the successful construction of mLEC Hsf 4b/K65R mutant.The K65R mutation didn’t influence Hsf4b expression in the mLEC cells.After K65R mutation in Hsf4b, the expression levels of Hsp27 and CryAB were down-regulated and the expression of Hsp 70i and Hsp90a upregulated.CONCLUSION: pWZL-blast-HA-Hsf4b/K65R can be used to construct a stable cell line by infecting with lentivirus .Hsf4b/K65R mutation influ-ences the regulation of downstream heat shock proteins .

Objective To understand the application of drug eluting stent (DES) in renal functional insufficient patients, and to assess its safety and effectiveness, especially the occurrence of stent thrombosis(ST) after DES implantation and its related factors. Methods The subjects were all the patients underwent percutaneous coronary intervention (PCI) as well as at least one DES admitted to Beijing Anzhen Hospital consecutively from July 2003 to June 2005. All patients were divided into 2 groups: Group Ⅰ with normal or mild renal insufficiency (Ccr≥60 ml/min),and Group Ⅱ with moderate to severe renal functional insufficiency (Ccr ＜ 60 ml/min). All of the clinical, angiography and intervention data were recorded. ST was adjudicated by the definition of ARC Dublin. The rates of MACCE in hospital and during the follow-up between the 2 groups were compared. Results There were 2377 patients enrolled in the study, of which 2020 ( 85.0% ) patients presented Ccr ≥ 60 ml/min, and 357( 15.0% ) presented Ccr ＜ 60ml/min. The case fatality during follow-up in group Ⅰ was significantly higher than that in group Ⅱ (4. 5% vs. 1.2%, P ＜ 0. 001 ). However, the incidences of ST were not significantly different between each stage of disease( P ＞0. 05 ). The results from Cox regression showed that renal functional insufficiency was not a risk factor of death,whereas multivessel coronary artery disease [OR = 1. 929(95% CI: 1. 178 -3. 157),P =0. 009] ,diabetes [OR = 1. 914(95% CI:1. 055 -3. 470) ,P =0. 033] and age [OR = 1. 051 (95% CI:1. 005 -1. 099 ) ,P = 0. 030] were independent risk factor of death after DES implantation in patients with moderate to severe renal functional insufficiency. Conclusions Compared with normal renal function or mild renal patients, the longterm case fatality is higher in moderate and severe renal functional insufficiency patients. However, the higher case fatality does not due to the increase of ST.

First aid skills are very important in the process of disaster medical rescue methods. Some first aid skills is rarely applied in clinical work at ordinary times, resulting in relevant medical personnel grasp of these skills being not enough skilled. This training method combined with the sim-ulator, has the characteristics and advantages of being close to the real, operational and repeatable. The main training program consists of 6 basic skills such as ventilation, hemostasis, bandaging, fixing, handling, basic life support. By simulating the real disaster scenario and simulation cases, we have targeted a single first aid skills training and multiple comprehensive ability training of first aid skills to trainees. To evaluate the training effect we have examined the individual skills of our trainees, with excellent performance as the goal, and in the comprehensive skills ability assessment we have paid attention to the emergency team's team cooperation ability. By the application of comprehensive simu-lation training and evaluation, the trainees can master all kinds of first aid skills in a short period of time.

Objective To explore the effect of different cold ischemia (CI)times on the patterns of intra-graft T cell activation gene-3 (TCA-3) expression early after isogeneic half liver transplantation (PLT)in mice. Methods The models of C57BL/6 full-size(FS) and PLT were established.The CI time was 1,4 and 8 h.Specimen were collected at 4 and 24 h post-reperfusion.Ribonuclease protection assays (RPA)was used to evaluate serial mRNA expression of the TCA-3 chemokine in all mice.Histopathology was used to examine cold ischemia injury in the liver grafts. Results A total of 45 control and 30 PLTs were performed.The survival rate at 7 day after control and PLT was 100％.Quantitative analysis demonstrated the levels of TCA-3 mRNA expression were low at 4 h after reperfusion in control group with 1,4,8 h CI.The levels of TCA-3 significandy increased at 4 h after reperfusion in PLT group with CI of 1,4,8 h and the difference between the two groups was statistically significant ( F =7.41,P ＜ 0.05 ). TCA-3 mRNA expression significantly decreased at 24 h after reperfusion in two groups. But the difference was not statistically significant ( P ＞ 0.05 ). Histopathology showed severer cold ischemia injury in PLT grafts compared with control grafts. Conclusions The expression of TCA-3 significandy increased early after PLT and played an important role in cold ischemia injury.TCA-3 could be used as the early therapeutic target for reducing ischemia injury in PLT grafts.

In order to better match the teaching hours of clinical anesthesiology with the teaching content of modem anesthesia, the teachers must take full advantage of various supplementary teaching methods in the limited teaching hours to help enhance the students' enthusiasm in active learning, help the students concentrate on the crucial points and apply their knowledge and ultimately improve the teaching quality.

Objective To investigate the feasibility and effects of endoscopic surgical treatment of lumbar intervertebral disc herniation associated with veitebral osteochondrosis.Methods From June 2008 to December 2015,276 cases of lumbar intervertebral disc herniation associated with vertebral osteochondrosis were treated with endoscopic surgery,including 185 men and 91 women,with an average 39.2 years old (range,16-65 years old).The involved level included L2.3 in 2 cases,L3.4 in 9 cases,L4,5 in 126 cases and L5S1 in 139 cases.On preoperative axial CT,the diameter of ossification was more than half of the transverse or sagittal diameter of the spinal canal in 89 cases,and no more than half of the transverse and sagittal diameter of the spinal canal in 187 cases.All patients were operated on the side with serious symptom,181 cases were operated with mobile microendoscopic discectomy (MMED),and 95 cases were operated with percutaneous endoscopic surgery,including percutaneous transforaminal endoscopic discectomy (PTED) in 61 cases and the percutaneous interlaminar endoscopic discectomy (PIED) in 34 cases.The operation and complications were analyzed.Results The soft herniation,broken disc material and the periphery of compressing ossification were removed under the endoscope in all cases,until the nerve was well decompressed.However,the ossification was not complete resected.Dural sac tear occurred in 3 cases of MMED.In the early stage of PTED,2 cases converted to MMED because of intraoperative pain and difficulty,and one case had exiting nerve root injury.At the final follow-up of 12-60 months (average,20.6 months),visual analogue scale decreased from preoperative 8.5±1.2 to 1.0±0.9,Oswestry disability index decreased from preoperative 40.2±8.6 to 3.1±3.0.According to Macnab scale,the results were excellent in 89,good in 154 cases,moderate in 33 cases.Conclusion For most lumbar intervertebral disc herniation associated with vertebral osteochondrosis,good results can be achieve by removal of herniated and broken intervertebral disc and decompression of nerve with endoscope.Therefore,we speculate that the soft disc herniation and spinal stenosis are main pathogenic factors,and that the complete resection of ossification is not needed.

Objective To know the prevalence of chronic obstructive pulmonary disease(COPD) in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS) in Kunming Yunnan Province, and the clinical symptom of OS.Methods Retrospective study of 4 636 cases of patients with snoring, excluding COPD in addition to chronic respiratory disease and assess the patient`s condition.The test included AHI, BMI, Epworth sleepiness scale, lung function.The index of OS was confirmed by AHI>5 times/h and FEV1/FVC<70%.Results During the period of 2006 to 2012, he prevalence of COPD in patients with OSAHS was 10.1% [95% confidence interval (CI) 9.1%-11.1%] in Kunming Yunnan Province.And male`s OS prevalence rate is higher than the female(male 10.2%;female 9.7%).The OS patients` average age was 56.9±14.1, the mean AHI was (47.46±26.79) times/h, and the average FEV1/FVC was 60.09%±23.57%.Polysomnographyresults show that patients suffered obvious hypoxiaat night in both OSAHS group and OS group, but it was more significant in OS group.Pulmonary function test showed that OS patients have more serious chronic obstructive pulmonary disease.Conclusions The prevalence of COPD in OSAHS patients was high in Kunming, Yunnan Province, and the prevalence rate in old group reached more than 24%.In addition, the sympotms of patients with OS were more severe than those with only OSAHS or COPD in lung function and hyoxemia.

Objective To study the effects of different drying processes on the effective constituents in Wen Codonopsis pilosula (WPP) Decoction Pieces; To develop the optimized producing and preparing integration process based on fresh WPP.MethodsFresh WPP in harvest period was prepared respectively as follows:① Fresh WPP was dried to different percentage (30%–100%) of original moisture contents of crude drugs at 80℃ in oven, then sliced and dried at 50℃ to obtain eight decoction pieces of WPP (XⅠYP1–8).② The fresh WPP was baked to 50% of water content of crude drug under different temperatures (50–120℃), respectively, then sliced and dried at 50℃ to obtain eight decoction pieces of WPP (XⅡYP1–8).③ Dried WPP was moistened, sliced and naturally dried, then were renamed as traditional decoction pieces. The contents of lobetyolin and atractylenolideⅢ was determined by HPLC. The phenol-sulfuric acid and colorimetric method were applied respectively to detect contents of polysaccharide and total flavonoids. The contents of aqueous and alcoholic extracts were determined simultaneously. Results The contents of alcoholic extracts (55.36%), aqueous extracts (54.91%) and atractylenolideⅢ (10.95 μg/g) in XⅠYP3 pieces were higher than other decoction pieces.Conclusion The optimized process was that fresh WPP was baked to water content of 50% at 80℃, then sliced and dried. Compared with conventional preparing methods,the integration process was time-saving and effort-saving. Meanwhile, the prepared pieces have higher content of active ingredients.

BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.