Objective:To evaluate features and underlying pathogenesis of glucose metabolic disorder in pediatric patients with hyperthyroidism.Methods:The levels of blood glucose,insulin,c-peptide,glucagon,cortisol,T 3,T 4,TSH,TGA,TMA were measured in 29 patients with hyperthyroidism.20 normal age-matched children served as controls.In addition,fasting and post-prandial 60-minute erythrocyte insulin receptor of 14 children with hyperthyroidism and 7 normal age-matched controls were measured using insulin radioreceptor assay.Results:Incidence of glucose metabolic disorder was 34.5%.Incidence of glucose metabolic disorder in patients with more than one year course was higher compared with cases with less than one year course.In hyperthyroidism with glucose metabolic disorder,levels of glucose,insulin,insulin/glucose,insulin/glucagon at post-prandial 60 minute increased significantly.Numbers of fasting insulin receptor of high and low affinity in erythrocyte membrane were lower than post-prandial insulin receptor.Conclusion:Glucose metabolic disorder with impaired glucose tolerance and insulin resistance are present in patients with hyperthyroidism.The longer the course of the disease,the higher the incidence of glucose metabolic disorder.The decrease in the number of insulin receptor in target cells might play an important role in the mechanisms of glucose metabolic disorder and insulin resistance in children with hyperthyroidism.

Objective To observe the effectiveness of tendon allograft in the treatment of old knee medial collateral ligament in‐jury .Methods Thirty‐two cases of old knee medial collateral ligament injury were treated .Tendon allograft was used to reconstruct old injury of knee medial collateral ligament and was fixed in bone with absorbable screws in operation .Results All incisions were healed by first intention .No infection ,deep vein thrombosis ,or other postoperative complications occurred .Thirty two cases were followed up fro 12 to 58 months with an average of 30 months .At 3 months after operation ,the knee X ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm .According to the Lysholm Scale score average (92 .3 ± 4 .2) ,the results were excellent in 20 cases ,good in 11 cases ,and fair in 1 case with excellent rate of 97% at last follow up ,the knee scores were (42 .5 ± 5 .3) before operation and (92 .3 ± 4 .2) after operation ,showed significant difference(P<0 .05) .Conclusion Anatomical reconstruction of old injury of knee medial collateral ligament with tendon allograft is all‐sided and the fixation method was solid .The operation is easy to operate and achieves better effectiveness .

Objective To investigate the clinical value of serum procalcitonin(PCT),C-reactive protein(hs-CRP),white blood cell count(WBC)and neutrophil percentage(NEU％)in the early diagnosis of sepsis caused by different pathogenic bacteria infection to provide a risk assessment for sepsis patients.Methods The clinical data of 117 patients with sepsis caused by bloodstream infection in the intensive care unit(ICU)of our hospital from Oct.2013 to Oct.2015 were retrospectively analyzed.All patients were performed blood culture before antibiotics use and divided into the G+ bacteria group and G-bacteria group according to the results of blood culture.PCT,hs-CRP,WBC and NEU％ were detected in all cases.The differences in the detection results between the two groups were analyzed and the correlation between PCT with APACHE-Ⅱ and SOFA scores was evaluated.Results Among 117 cases of sepsis,78 cases were in the G+ bacteria group and 39 cases were in the G-bacteria group;compared with the G+ bacteria group,PCT in the G-bacteria group had obvious change and the difference was statistically significant(P＜0.05),while the detection results of hs-CRP,WBC and NEU in the G-group had little change(P>0.05);the serum PCT level was positively correlated with the SOFA score in the G-bacteria group(r=0.536,P＜0.05),but had no correlation with the APACHE-Ⅱ score(P>0.05);serum PCT level had no correlation with the APACHE-Ⅱ score and SOFA score in the G+ bacteria group(P>0.05).Conclusion PCT has some value in the early differential diagnosis and prognosis of sepsis caused by different pathogens,and it is more sensitive to G-bacteria.

Objective To observe the clinical effect of small dose mifepristone combined with traditional Chinese medicine in the treatment of uterine gland disease.Methods 76 patients with uterine gland disease were selected,they were divided into the observation group(n =38) and control group(n =38) by using random number table method.The control group was treated with small dose of mifepristone,while the observation group was treated with small dose of mifepristone combined with traditional Chinese medicine.The clinical curative effects of the two groups were compared.Results After treatment,in the observation group,the pain degree of patients [(21.30 ± 6.70) points],influence activity level [(17.30 ± 12.00) points],activity loss [(1.80 ± 0.70) spots] and grades of dysmenorrheal [(0.60 ± 0.20) stages] were lower than those in the control group,the differences were statistically significant (t =5.645,7.023,4.932,3.994,all P ＜ 0.05).After treatment,in the observation group,the uterine volume [(56.20 ± 2.00) mm3],CA125 level [(32.10 ± 2.10) U/mL] were lower than those of the control group (t =4.024,4.413,all P ＜ 0.05).The incidence rate of adverse reaction of the observation group was 7.89％,which was significandy lower than that of the control group,the difference was statistically significant (x2 =14.757,P ＜ 0.05).The patients were followed up for 8 months,the recurrence rate of the observation group was 5.26％,which was lower than 26.32％ of the control group,the difference was statistically significant (x2 =16.678,P =0.000).The menstrual recovery ratio less than or equal to three months of the control group was 81.58％,which was signifi candy higher than 63.16％ of the control group,the difference was statistically significant (x2 =8.484,P =0.003).Conclusion In the treatment process of adenomyosis,the small dose of mifepristone combined with traditional Chinese medicine can alleviate the clinical symptoms,reduce the pain and reduce the volume of uterus,and it has less adverse reaction,safe and reliable,it is worth of clinical application.

Higher medical education should bring the superiority of the course into play,and develop the bioethics education effectively.We should arouse medical undergraduate's respect and enthusiasm for bioethics,help them reevaluate their value concept and learn to use basic theory of bioethics to guide the medical service.Thus medical science can develop in a healthy way.

Purpose To observe the ultrasonographic features of periventricular-intraventricular hemorrhage (PIVH) in preterm infants, to evaluate the value of cranial ultrasound for early diagnosis of PIVH. Materials and Methods 555 cases of premature children underwent bedside cranial ultrasound examination, characteristics of their ultrasound images were retrospectively analyzed and categorized with Papile grading, gradeⅢandⅣPIVH were defined as severe bleeding. Results 125 PIVH cases (22.52%) were detected by ultrasound, of which 111 cases (88.8%) were Papile gradeⅠ, manifested as hyperechoic group localized in the rear and below lateral ventricle anterior horn and in the sulcus of hypothalamic caudate nucleuscaudate;7 cases (5.6%) were Papile gradeⅡ, manifested as increased echogenicity, irregular widen or isolated mass shadow of the choroid plexus within the triangle zone and posterior horn of the lateral ventricle;7 cases (5.6%) were Papile gradeⅢ, manifested as hyperechoic group within the lateral ventricle with ventricular dilatation. 7 cases (1.26%) were severe PIVH. Overall incidence rates of PIVH in premature children whose gestational age was <32 weeks and ≥ 32 weeks were 45.05% and 16.89% respectively; overall incidence rates of PIVH for preterm infants whose birth weight were <1500 g and ≥ 1500 g were 44.16% and 19.04%, overall incidence of PIVH of preterm infants with gestational age<32 weeks and birth weight<1500 g was significantly higher than their contemporaries with gestational age≥32 weeks and birth weight ≥1500 g, and the differences were statistically significant (χ2=40.334, 23.978; P<0.01). Conclusion Incidence of PIVH becomes higher when the gestational age of preterm child is smaller and the birth weight is lower. Performing routine cranial ultrasound examination for preterm infants is important for early diagnosis of PIVH and Papile grading, thus will instruct the clinical intervention in early stage.

Objective To introduce an improved method of continuous intradermal suture,and to evaluate its clinical efficacy for the closure of surgical incisions.Methods Eighty-two patients were enrolled in this study,including 37 cases of nevus,10 cases of basal cell carcinoma,16 cases of sebaceous cyst,6 cases of lipoma,8 cases of seborrheic keratosis,3 cases of dermatofibroma and 2 cases of depressed scar.All the patients were managed by simple surgical excision with the shortest length of postoperative incisions being 0.8 cm and the longest length being 12 cm.An improved method of continuous intradermal suture was used for the closure of all the postoperative incisions.Specifically,an absorbable thread with a small triangle needle in both ends was inserted through and pulled out from the dermal layer at one side of the incision,and then inserted through and pulled out from the dermal layer at the opposite side of the incision,which was repeated until the incision was entirely closed.Results Among the 82 patients,80 achieved primary healing,and 2 developed erythematous painful swelling at the incision site 2 days after the operation,which disappeared after symptomatic treatment for 5 days.During 3-6 months of follow-up,the incisions closed leaving a flat and smooth surface in 78 patients,and proliferative scar formed in 4 patients,which was obviously improved after local injection with glucocorticoids.No disruption of incisions was observed.Conclusion The improved method of continuous intradermal suture can be applied to the closure of skin defects in the face,neck,trunk and extremities with a favorable healing outcome and cosmetic result.

Objective To investigate the VATS lobectomy and lymph node dissection impact on lung function and the survival rate in patients with different pathological types of lung cancer.Methods One hundred and twenty five cases of lung cancer patients underwent laparoscopic lobectomy and mediastinal lymph node dis-section as research subjects from June 2009 to September 2011 in our hospital.The patients were divided into pa-thology group( AG) ,squamous cell carcinoma( SG) and large cell carcinoma group( LG) according to the type of cancer.The clinical effects were observed before and after surgery,lung function and survival rate.Results LG Group in operative time,blood loss and postoperative chest tube drainage were higher than SG group AG group( P<0.05);AG group blood loss,postoperative chest tube drainage,blood transfusion after surgery and postoperative recovery times were higher than the SG group(P<0.05);LG group was higher than AG group(P<0.05)in terms of FVC%;LG Group,AG group in FVC%,FEF50%,FEF75%respects SG group were significantly differ-ent(P<0.05);18-month survival rate of patients in each group after the first follow up results of less than 12 months(P<0.05).SG group at 12,18-month survival rates were higher than AG group and LG group(P<0.05).Conclusion Laparoscopic lobectomy combined treatment of pathological lymph node dissection in pa-tients with different types of lung cancer,large cell carcinoma surgery operative time,blood loss and postoperative chest tube drainaged are higher than adenocarcinoma,squamous cell carcinoma;squamous cell survival and physi-cal evaluation of patients are higher than the other groups.

The incidence of adenocarcinoma of esophagogastric junction is increasing worldwide during recent decades.The therapeutic strategies have been transformed from surgery alone to multimodal treatments involing also perioperative chemoradiotherapy.Although there are still many problems on preoperative staging,surgical approach,excisional extent and perioperative chemoradiotherapy regimen,multidisciplinary team collaboration can provide an optimal diagnosis and treatment to achieve the principles of standardization and individualization in malignant tumor,which will prolong the survival and improve the quality of life for every patient.

Prolactin (PRL) is a multi-functional hormone mainly from pituitary gland. PRL receptors exist ubiquitously in all tissues and organs of immune system and PRL modulates local and systemic immune activities. PRL is involved in many physiological and pathological immune responses. The function of PRL in autoimmune diseases, organ transplantation and tumor occurrence has been explored in recent years. This article is to review the progress of prolactin in the immunology-related field.