Familial non-medullary thyroid carcinoma (FNMTC) is de fi ned as the presence of two or more affected fi rst-degree relatives with non-medullary thyroid cancers without other known familial syndromes. FNMTC is one of the most inheritable forms of all cancers, with a high risk of a first-degree relative developing the disease. Compared with sporadic non-medullary thyroid carcinoma (NMTC), FNMTC presents at a younger age and is associated with a higher incidence of multifocal disease and metastasis. This in-creased aggressiveness has been hypothesized to translate into higher recurrence rates and decreased survival of patients with FNMTC. The genes involved in the pathogenesis of FNMTC are yet to be elucidated, although some recent studies identified several predisposi-tion loci with a high degree of genetic heterogeneity. Since 2005, next-generation sequencing (NGS) technologies have been developing as rapid, high-throughput, and cost-effective approaches to fulfill medical sciences and research demands. With the use of NGS, the un-derlying causative genes can be directly distinguished via systematic filtering, through which the identified gene variants are verified for novelty and functionality.

Disability is one of the common geriatric syndromes.Researches addressing elderly disability are still in starting stages.Both opportunities and challenges occur in this field.In this review,we summarized the definition and diagnostic criteria popular assessment tools for the diagnosis of elderly disability,the disease burden and relevant studies regarding elderly disability.

Objective To study CT features of thymoma,so that to improve the accuracy of CT diagnosis and differential diagnosis.Methods 31 cases of thymomas proved by surgery and pathology were examined with conventional CT scans.CT findings of thymoma were analyzed.Results The lesions in 27 cases(87.1%)were located in the anterior upper and middle mediastinum.There were benign lesion in 11,including mass-cardiovascular interface(MCI) with convex type(8 cases),flatness type(1 cases) and concave type(2 cases).20 cases were malignant lesion,including MCI with cast type(18 cases) and concave type(2 cases).Irregular invasion to adjacent organs was found in 11 cases,others included pericardiac effusion(n=6),pericardial and mediastinal invasion(n=2),pleural effusion(n=4),pneumonia(n=2),lung,bone,mediastinal lymphadens metastasis(n=2) and liver,pancreas metastasis(n=1).Conclusion CT scans is of significant value in diagnosis and differential diagnosis of thymoma.

Objective To evaluate the efficacy of different doses of dexmedetomidine combined with propofol for drug-induced sleep endoscopy (DISE) in the patients with snoring.Methods Sixty patients with snoring,aged 24-62 yr,with body mass index of 24-37 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective DISE,were randomly divided into either group Ⅰ or group Ⅱ,with 30 patients in each group.In Ⅰ and Ⅱ groups,dexmedetomidine was infused over 10 min in a loading dose of 0.4 and 0.8 μg/kg,respectively,followed by an infusion of 0.4 μg · kg-1 · h-1.At 15 min of dexmedetomidine infusion,propofol was given by target-controlled infusion with the initial target plasma concentration (Cp) of 1.0 μg/ml.At 2 min after the target effect-site and plasma concentrations were balanced,the Cp of propofol was increased/decreased by 0.2 μg/ml to maintain the Cp of propofol stable during DISE.Bispectral index (BIS) value was recorded before anesthesia (T1),at 10 and 15 min of dexmedetomidine infusion (T2,3),at 2 min after the target effect-site and plasma concentrations were balanced (T4),at the beginning of DISE (T5),when the fiberoptic laryngoscope was placed at the site of oropharynx (T6),at the end of DISE (T7),at emergence (T8),and while discharge from the examination room (T9).Richmond Agitation Sedation Scale (RASS) scores were recorded at T1-4.Sleep was recorded within 15 min of dexmedetomidine infusion.The emergence time,discharge time,and anesthetics-related adverse events were recorded.Results All the patients completed DISE successfully.BIS values were maintained at 75-90,and RASS scores ≤ 4 during dexmedetomidine infusion.BIS values were maintained at 65-75 during DISE.Compared with group Ⅰ,BIS values were significantly decreased at T4,and RASS scores were significantly increased at T2-4,the sleep rate was significantly increased within 15 min of dexmedetomidine infusion,the Cp of propofol was significantly decreased during DISE,the emergence time was significantly prolonged (P＜0.05),and no significant change was found in the discharge time and anesthetics-related adverse events in group Ⅱ (P＞ 0.05).Conclusion Dexmedetomidine infused at 0.4 μg · kg-1 · h-1 after infusion of a loading dose of 0.8 μg/kg combined with propofol provides better efficacy for DISE in the patients with snoring.

Humans ; Language Development Disorders ; complications ; Presbycusis ; complications

Objective To evaluate the value of acute kidney injury network (AKIN) criteria for predicting hospital mortality in post-cardiosurgery elderly patients. Methods From October 2006 to January 2007, the elderly patients who underwent coronary artery bypass grafting or valve replacement operation were enrolled in this study. The medical data included gender, age, operation type, perioperative hemodynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed according to the AKIN criteria, and severity of illness was determined after surgery by calculating Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ ) score. Results A total of 225 patients underwent cardiac surgery during this period, 169 patients were male (75. 1%), while 56 were female (24. 9%), mean age was (66. 7±5. 0) years old. The overall hospital mortality rate was 5.8% (13/225). According to AKIN criteria, there were 125 patients with acute kidney injury (55.6%), and the hospital mortality of stage 1, 2 and 3 patients were 2. l%(2/96), 9. 1% (1/11) and 50. 0% (9/18) respectively. A significant increase was observed in mortality based on AKIN criteria (P<0. 01). By applying the area under the receiver operating characteristic curve, the AKIN criteria had a good discriminative power. Conclusions Both the incidence and mortality rate of acute kidney injury in the post-cardiosurgery elderly patients are high, the AKIN criteria is a simple and valuable method with a good prognostic capability for evaluating acute kidney injury.

Objective The rate of post -operative complications has been increased with the changes in patients' age,prolonged duration, more severe and diffused lesions, and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit ( ICU ) after coronary artery bypass graft surgery (CABG). Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital Between June 1, 2006 and December 31,2007 were divided into two groups based on their stay duration in the ICU. Prolonged stay in ICU was defined as 5days or more. Univariate and multivariate analysis ( logistic regression) were used to identify the risk factors. The discrimination and calibration of the result were tested after the risk factors were determined. Results Fifty one patients had prolonged ICU stay, accounting for 3.14% of total cases. Multivariate logistic analysis showed that the age of patients, peripheral vascular diseases, critical status before operation, LVEF, operative status, mitral regurgitation, postoperative respiratory failure,postoperative renal failure, secondary thoracotomy for postoperative bleeding were associated risk factors. Conclusion Prolonged ICU stay after CABG surgery can be predicted based on the above factors. For patients with these risk factors, more pre-and postoperative care strategies are needed.

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.

Objective To study on the effectiveness of endoscopic ultrasonography(EUS)in detec- ting insulinoma preoperatively.Methods Fifteen patients with clinical and biochemical signs of insulinoma were examined by EUS using a radial-scanning ultrasound endoscope and abdominal ultrasonography,CT, DSA prior to surgery.The outcome was evaluated on the basis of surgery and examination of the resected specimens.Results Fifteen patients with 16 lesions of insulinoma were identified by surgery and pathology. The aceuraey of diagnosis with EUS was 13/15(86.7%),and that with B-US,CT,DSA was 3/15(20%), 5/15(33.3%),9/14(64.3%)respectively.In the 14 lesions identified by EUS,10 lesions were depicted to be hypoechogenic,1 lesion was isoechogenic and 3 lesions were hyperechogenie.All 14 lesions were well demarcated and surrounded by normal pancreatic tissue.The minimum size of the lesion visualized by EUS was 0.5cm.Ten lesions were correctly detected by EUS with size of 0.5～2.0cm.EUS missed diagnosis in 2 lesions not for their small size.EUS falsely indicated a 10mm lesion from two lesions inside the head of pancreas.One lesion outside the pancreatic tail and one lesion in the pancreatic head were missed by EUS in another case.Conclusion EUS is superior in assessing the location of pancreatic insulinoma than other ima- ging methods such as B-US,CT,DSA.