Objective To investigate the feasibility,safety and efficacy of endoscopic thyroid surgery and the traditional surgical method,in order to further promote the application of endoscopic technology in thyroid surgery.Methods 72 patients from July 2009 to July 2011 in Shaoxing City People's Hospital undergoing endoscopic surgical treatment and 36 cases treated by traditional thyroid surgery were collected,and the surgical data,recovery-conditions and patients' satisfaction were analyzed.Results Except the operation time,the observed indicators of the two laparoscopic groups were superior to those of the conventional thyroid group(P ＜ 0.05).The operation time,flap area,subcutaneous tunnel set-up time,postoperative 24 h visual analogy scale (VAS) score of the sternum group were superior to the areola path group (P ＜ 0.05).The difference of intraoperative blood loss,hospital stay,patient's satisfaction for the 2 groups had no statistical significance(P ＞0.05).Conclusions Laparoscopic surgery is superior to conventional thyroid surgery in treatment effects and patients' satisfaction.As for the surgical path,sternum path is slightly superior to the areola path.Surgeons should choose the best surgical approach and the path according to patients' specific conditions.

Studies on survivin over the past several years have shown it has significant association with cancer, its encoding protein play a important role in control of mitosis and/or apoptosis and the activity of cellullar immunologic response in cancer patients. Survivin is the finding of its splice variants make it more valuble. The multi-subcellular localization of survivin is consistent with its multiple functions in cellular metabolisms and responses. The mechanisms and the subcellular localization by which these splice variants differentially affect cancer development are unclear. This review article will update the role of survivin, and its splice variants in the mitosis/cell cycle, apoptosis, tumorigenesis, chemoprevention, drug/radiation resistance, and cancer therapeutics.

Objective To discuss the effects of vitamin C in vitro,on human cancer HeLa cell multiplication and apoptosis, in order to promote vitamin C in the tumor treatment application. Methods the morphology changeof cervical cancer Hela cell was observed under the inverted microscope;the effects of vitamin e on Hela cell by MTT assay; cell cyele and weakly perishing rate was analysed rate was analysed by Flow CytoMeter;applying the agarose gelatin electricity swims to analyse weakly perishes in the process the cell gene group DNA change. Results Vitamin C hinders the HeLa cell by the density and the time dependence way to the G0/G1 period, suppresses it to grow and to induce weakly perishes. Conclusions Vitamin C may suppress the HeLa cell to grow, causes the cell to hinder to the G0/G1 period and induces cell weakly perishing.Its reason possibly was HPV E6 protein expression surrenders to restoring the function of P53 gene.

Aim To study tumor suppressor gene OPCML,DAPK methylation changes during the process of CasKi cell apoptosis induced by trichosanthin, and to explore the correlation and the role between cervical cancer cell apoptosis and tumor suppressor gene methylation so as to find new demethylation drugs.Methods ① MTT was applied to assay the inhibition of TCS to CasKi cell proliferation and flow cytometry was used to analyze cervical CasKi cell apoptosis induced by trichosanthin; ② Methylation-specific PCR(MSP) technology was applied to detect cervical cancer and during cell apoptosis process OPCML and DAPK gene promoter methylation status of CpG islands.Results In CasKi cervical cancer cells,OPCML and DAPK gene promoter region showed a high degree of CpG island methylation status, by trichosanthin treatment,the growth of CasKi markedly was inhibited, and flow cytometry analysed the characteristic sub-G1 peak,OPCML and DAPK gene promoter region showed no CpG island methylation of performance.Conclusions During the process of CasKi cell apoptosis induced by trichosanthin,OPCML and DAPK gene demethylated significantly,accordingly, trichosanthin might be a new methylation inhibitor,and there might be some correlation between cell apoptosis and tumor suppressor gene methylation.And OPCML and DAPK gene methylation tests might become new clinical indicators for the early detection of cervical cancer.

Objective To compare the efficacy of ureteroscopic lithotripsy ( URL) combined with occlusion devices and mini-invasive percutaneous nephrolithotomy ( MPCNL) in the treatment of upper incarcerated ureteral stones. Methods A total of 89 patients with unilateral upper ureteral calculi were enrolled from April 2011 to July 2013, 42 of which were treated with MPCNL and 47 of which were treated by rigid ureteroscopic lithotripsy combined with occlusion devices. Resuts There were no significant differences in the success rate of primary lithotripsy (97.6% vs.95.7%, χ2 =0.000, P=1.000).No marked differences were detected in the stone clearance rate (97.5% vs.95.6%, χ2 =0.000, P=1.000), complication rate (7.1% vs.8.5%, χ2 =0.000, P=1.000) and operation time [(80.2 ±11.9) min vs.(65.1 ±10.9) min, t =6.248, P=0.000] between the two groups.The hospitalization time in the URL group was (3.5 ±1.5) d, which was obviously shorter than that in the MPCNL group , in which it was (7.3 ±1.5) d(t=11.931, P=0.000). Conclusion URL combined with occlusion devices can obtain satisfactory results as well as MPCNL in the treatment of upper ureteral calculi by proper case selection and careful operation performance .

Objective To evaluate the performance of an improved skin prick test in infantile eczema.Methods A self-controlled study was carried out in 248 infants with eczema.Improved and conventional skin prick tests were conducted with 8 allergens on the left and right flexural forearm of the subjects,respectively.Results Positive results of skin prick test were found in the left flexural forearm of 38.3％ of the infants,and in the right flexural forearm of 38.7％ of the infants,with no significant difference between the two methods in the detection rate of allergens (P ＞ 0.05).The most common sensitizing allergens were house dust mite and Dermatophagoides culinae as shown by both methods.Conclusions The improved skin prick test displays an acceptable performance with simple and safe procedure in the detection of allergens in infants with eczema,and can provide reliable evidence for clinical diagnosis.

This research mainly analysed the section of clinical experience in the reporl of"A panoramic snapshot of medical students'education at the beginning of the 21st century"and gave a brief introduction to the mainstream medical education in No,hem Amercia according to the literature.At last,the enlightment from the report and reformation of our clinical practice were put forward.

Objective To study the relationship between blood uric acid(BUA)level and oxidative stress in the elderly. Methods One hundred and eighteen healthy subjects who aged 60years and over were recruited.They were divided into 3 groups according to the serum uric acid level:(1)Control group:BUA 142-416 μmol/L;(2)Hyperuricemia group Ⅰ:BUA 417-470 μmol/L;(3)Hyperuricemia group Ⅱ:BUA＞470 μmol/L.Serum xanthine oxidase(XO)activity,superoxide dismutase(SOD)activity,total antioxidation capacity(TAOC)and peroxide concentration were examined. Results (1)No significant differences in TAOC[control group:(8.40±2.09),Hyperuricemia group Ⅰ:(8.13±1.92)and Hyperuricemia group Ⅱ:(7.95±1.54)U/ml,all P＞O.05)and in SOD activity[control group:(80.57±15.44),Hyperuricemia group Ⅰ:(81.37±11.92)and Hyperuricemia group Ⅱ:(87.45±11.38)U/ml,all P＞0.05)among the 3 groups were found.The serum peroxide level and XO activity were significantly higher in hyperuricemia group Ⅰ and Ⅱ[XO activity:(9.17±1.68) vs.(9.32±1.87)U/ml,all P＜0.05;serum peroxide:(149.5±25.7)vs.(150.7±23.1)μmol/L,all P＜0.05]than in group control[XO activity:(7.81±1.84),serum peroxide:(122.5±33.8)].(2)Multifactorial regression analysis showed TAOC was related to age,triglyceride and uric acid(all P＜0.05),XO activity was related to uric acid(P＜0.05)and peroxide concentration was related to age and uric acid(all P＜0.05). Conclusions This study supports the presence of the xanthine oxidase-related oxidative stress in the elderly with hyperuricemia.

Objective To investigate the harmonization of results of Prothrombin time(PT),International Normalized Ratio(INR),activated partial thromboplastin time(APTT),fibrinogen(FIB)and thrombin time(TT)with different coagulation analyzers in different or sanle clinical laboratory.Methods PT,INR,Am,FIB and TT for the same quality control material were detected with 14 different coagulation analyzers,which are distributed in 12 clinical laboratories and classified into A,B and C group.MeaJlwhile,PT,INR,APTT,FIB of 139 samples were detected with two different coagulation aJlalyzers in the same laboratory.Results There was no significant difference for detection of level 3 of both INR and TT among the three group analyzers(P＞0.05),but there was significant difference for other tests (P＜0.05).The comparison between groups showed that there was high percentage(66.7%)of consistency for detection of INR,FIB-C and TT between group B and C.The results of two different coagulation analvzers ( ACL Futura and CA 510)in same laboratory showed that there was no significant difference(P＞0.05)for detection of PT,INR,PT-FIB and FIB-C between them,and there was good eorrelation for them in detecting PT,INR,APTT,PT-FIB and FIB-C(r＞0.975).Analysis of bias showed that the bias of PT,INR,PT-FIB and FIBC between the two different coagulation analyzers was acceptable according to CLIA'88.Conclusion There are good agreement for the results between different coagulation analyzers based upon the similar Drinciple in coagulation analysis.

Objective To investigate the protection of superior parathyroid glands by improving dissection procedure of thyroid superior pole in total thyroidectomy surgery.Methods 136 consecutive cases undergoing two-step dissociating procedure of thyroid superior pole(the improved group) in total thyroidectomy plus central compartment dissections from Sep.2012 to Oct.2015 were retrospectively analyzed.Intraoperative observation of superior parathyroid and incidences of postoperative hypoparathyroidism were compared with conventional surgical methods (the conventional group) containing 113 cases from Jun.2009 to Sep.2012.All operations were performed by the same treatment group.Results Intraoperatively,249 (249/272,91.5％) superior parathyroid glands were identified in the improved group and 215 (215/226,95.1％) superior parathyroid glands were identified in the conventional group.The difference had no statistical significance (P＝0.114).Whereas,among identified superior parathyroid glands,242 (242/249,97.1％)of them were conserved in situ in the improved group and 198 (198/215,92.0％) were conserved in situ in the conventional group.The difference had no statistical significance (P＝0.013).Among superior parathyroid glands conserved in situ,225 (225/242,93.0％) had good blood supply in the improved group and 170(170/198,85.9％) in the conventional group.The difference had statistically significance (P＝0.001).28 (28/136,20.5％) patients displayed temporary hypoparathyroidism and 2 (2/136,1.5％) cases suffered permanent hypoparathyroidism in the improved group after surgery.Whereas,in the conventional method group,a higher incidence was observed in 37 (37/113,32.7％) cases of temporary hypoparathyroidism and 7 (7/113,6.2％) cases of permanent hypoparathyroidism respectively.The difference had statisticall significance (P＝0.003).Conclusions Two-step dissociating procedure technique offers protective effect on superior parathyroid glands function.It is worthy of popularization.