Objective To explore the reason of misdiagnosis and discuss the reoperation in thyroid carcinoma.Methods The data of 77 patients that had reoperation because of misdiagnosis were analyzed.Results The daignosis of all 77 cases were only based on pre-operative physical and uhrasound examination.The post-reoperative follow up (3～41 monthes):no case was found local recurrence.Conclusions The preoperative frozen section may avoid misdaignosis and the effect of reoperation for misdaignosed cases are satisfactory.

OBJECTIVETo observe the therapeutic effects of continuous plasma filtration absorption (CPFA) treatment on burn sepsis.

METHODSThirty burn patients with sepsis hospitalized in Beijing Fengtai You'anmen Hospital from July 2009 to October 2012 were treated by CPFA for twice besides routine treatment. The blood samples were collected at five sites (A, B, C, D, and E, respectively) of blood purification equipment before and after CPFA, before and after hemoabsorption, and before hemofiltration. The plasma levels of TNF-α, IL-1β, IL-6, IL-10, interleukin-1 receptor antagonist (IL-1RA), soluble tumor necrosis factor receptor (sTNFR) I , and sTNFR-II from sites A, C, and E were determined with ELISA before CPFA was performed for the first time, and those from sites B and D were determined with ELISA after CPFA was performed for the first time. Plasma levels of the above-mentioned cytokines from sites A and B were determined with ELISA before CPFA and after CPFA was performed for the second time. The data of plasma levels of IL-1βP3, IL-1RA, sTNFR-I, sTNFR-II, and TNF-α before CPFA and after CPFA was performed for the second time were collected for calculation of the ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α. The expression rate of human leukocyte antigen DR (HLA-DR) on the CD14 positive monocytes, acute physiology and chronic health evaluation (APACHE) II score, body temperature, pulse, respiratory rate, and leukocyte count of patients were evaluated or recorded before CPFA and after CPFA was performed for the second time. Patients'condition was observed. Data were processed with paired t test.

RESULTSThe plasma levels of TNF-α, IL-1β, IL-6 and IL-10 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the first time (with t values respectively 7.05, 5.23, 4.73, 2.37, P values below 0.01). After CPFA was performed for the first time, the plasma levels of TNF-α, IL-1β, and IL-6 from site D were significantly lower than those from site C before CPFA was performed for the first time (with t values respectively 5.48, 2. 17, 1.78, P < 0.05 or P <0.01). The plasma levels of all cytokines were close between site B after CPFA was performed for the first time and site E before CPFA was performed for the first time (with t values from 0.04 to 1.05, P values above 0.05). The plasma levels of TNF-α, IL-1β, and IL-6 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the second time (with t values from 1.87 to 5.93, P <0.05 or P <0.01). The ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α, and expression rate of HLA-DR were increased significantly after CPFA was performed for the second time as compared with those before CPFA (with t values from 3.99 to 7. 80, P values below 0.01). APACHE II score after CPFA was performed for the second time was 11 ± 6, which was lower than that before CPFA (22 ± 7, t =4.63, P <0.01). After CPFA was performed for the second time, body temperature, pulse, and respiratory rate of patients were improved (with t values from 1.95 to 3.55, P values below 0.05) , and the leukocyte count was significantly decreased (t =4.36, P <0.01) as compared with those before CPFA. All patients survived and were discharged with length of stay of (27 ± 31) d, and no adverse effects occurred during CPFA treatment.

CONCLUSIONSCPFA, which combines hemoabsorption and hemofiltration, can facilitate the treatment of burn sepsis by decreasing the level of pro-inflammatory cytokines efficiently, alleviating systemic inflammatory response, and improving the immune status.

Adsorption ; Aged ; Biomarkers ; blood ; Burns ; blood ; complications ; immunology ; Cytokines ; blood ; Fluid Therapy ; Hemofiltration ; methods ; Hospitalization ; Humans ; Inflammation Mediators ; blood ; Interleukin 1 Receptor Antagonist Protein ; blood ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Sepsis ; blood ; immunology ; therapy ; Treatment Outcome ; Tumor Necrosis Factor-alpha

Objective To construct the engineering bacteria expressing the recombinant human Kunitz protease inhibitor domain of amyloid protein precursor variant (rhKD/APPvar)in Pichia pastoris,and to establish the methods suitable for large-scale fermentation and purification of rhKD/APPvar.Methods The rhKD/APPvar expression vector was constructed based on the rhKD/APPvar-pPICZαexpression vector. Two restriction enzyme loci (ApaⅠ and SacⅡ)were added to two flanks of KD/APP and human KD/APP activity center RAM was replaced by the active site of BPTI KAR.After the rhKD/APPvar-pPICZαexpression vector was transformed into Pichiapastoris,optimized expression and purification of rhKD/APPvar was performed.The rhKD/APPvar was purified with cation exchange chromatography and desalting.Results The results of digestion identification and DNA sequencing analysis demonstrated that the recombinant plasmid rhKD/APPvar-pPICZα was successfully constructed and transfected into pastoris X-33. The SDS-PAGE analysis results indicated that rhKD/APPvar expressed after the induction of methanol and the relative molecular weight was 6 700.After a series of experiments the optimal expression conditions of rhKD/APPvar were obtained as follows:the optimal pH was 6.0 and the optimal induction time point was about the 5 th day for the strain.After purified the purity of rhKD/APPvar was about 95%.Conclusion KD/APPvar-pPICZ is successfully constructed;after expression in Pichia pastoris and purification,the rhKD/APPvar protein is obtained.

Hyperuricemia and metabolic syndrome were studied in 17 762 subjects of Tianjin Municipality from July 2007 to July 2009. The overall prevalence rate of hyperuricemia was 12. 16% (2160cases) , the rate in males was significantly higher than that in females (15. 71% vs. 6. 51% , P <0. 01).The overall prevalence rate of metabolic syndrome was 25. 56% (4540 cases) , the rate in males was also higher than that in females (28. 17% vs. 21. 40% , P <0. 01). Binary logistic regression analysis disclosed that females with high uric acid were twice likely to suffer from metabolic syndrome than males; and female ≤ 44 years with hyperuricemia had the highest odd ratio for metabolic syndrome.

OBJECTIVETo investigate the relationship between degree of abnormal deeper lateral femoral notch between anterior cruciate ligament tear.

METHODSThe radiograph and MRI image material of 16 patients with anterior cruciate ligament injury from January 2013 to November 2013 were reviewed including 14 males and 2 females with an average age of 28.3 years old ranging from 18 to 52 years. Eleven cases was on right side and 5 on left. Survey tool of PASC imaging system was used to measure the depth of lateral femoral notch in patients with abnormal indicated by lateral X-ray view or sagittal view of MRI in knee joint,while clinical data,physical examination,image material in arthroscopy of these patients were retrospective researched.

RESULTSFour patients had an abnormal lateral femoral notch with the depth of 2 mm on lateral X-ray and sagittal MRI, while positive anterior drawer sign and Lachman test as well as anterior cruciate ligament tears on MRI, and completed tears were comfirmed on the operation of arthroscopy. Two patients without abnomal lateral femoral notch on lateral view of X-ray while with the depth of 1 mm on sagittal view of MRI were also coupled with positive anterior drawer sign and Lachman test as well as anterior cruciate ligament tears on MRI, and one of them were comfirmed completed anterior cruciate ligament tears on the arthroscopy operation and completed tear could not comfirmed on another one because of disagreed with arthroscopy operation.

CONCLUSIONThere appears to be an association between abnormal lateral femoral notch on lateral view of knee with anterior cruciate ligament tears. An abnormal deeper lateral femoral notch is an indirect evidence for anterior cruciate ligament tears.

Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Female ; Femur ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

Objective To discuss the metastasis principle of cervical lymph nodes in CN0 papillary thyroid carcinoma(PTC) and to define the proper surgery scope.Methods Clinical data of the 450 cases of CN0 PTC patients undergoing surgery from Feb.2008 to Feb.2011 in the First Hospital,Jilin University were retrospectively analyzed.Results There were 219 (48.67％) pN + cases and 231 (51.33 ％) pN0 cases.In CN0 PTC cases,lymph node metastasis was most commonly detected in area Ⅵ,about 46.22％ (208/450) (unilateral cancer 41.08％,bilateral cancer 58.09％).The lymph node metastasis rate was 4.44％ (20/450),6.00％ (27/450),and 8.89％ (40/450)respectively in area IIa,area Ⅲ,and area Ⅳ.The metastasis of lymph node was rare in Vb area,only about 2.22 ％ (10/450).No metastasis was found in the 2 cases undergoing area I lymph node dissection.When the tumor diameter was no less than 1.0 cm,capsule invaded or multifocal,male,＜ 45 years old,lymph node metastasis rate was significantly increased (P ＜ 0.05).In addition,when the tumor was located at the upper pole of the thyroid,the lymph node metastasis rate was 33.57％ (48/143) in Ⅱa,Ⅲ,Ⅳ areas in the affected side.When the tumor was at the lower pole of the thyroid,the lymph node metastasis rate was 10.48％ (13/124)in the contralateral area Ⅵ.Conclusion Lymph node metastasis occurs most commonly in area Ⅵ in PTC,followed by area Ⅱ a,area Ⅲ,area Ⅳ.Routine lymph node dissection in area Ⅵ is recommended for the initial surgery.When the tumor diameter is ≥ 1.0 cm,thyroid capsule invasion is involved or more than 3 metastasized lymph nodes were found in area Ⅵ,the range of lymph node dissection should properly be expanded to area Ⅱa-Ⅳ.When the tumor is located at the lower pole of the thyroid,area Ⅵ in the contralateral side should be cleaned.If the tumor is located at the upper pole of the thyroid,area Ⅱa,Ⅲ,Ⅳ in the affected side should be cleaned.

Objective: To explore whether the lung ultrasound(LUS) score can be used to assess and predict the criticality of neonates with pulmonary disease at an early stage. Methods: The newborns born in the obstetrics department of Affiliated Hospital of Jining Medical University from April to October 2018 were transferred to the neonatal intensive care unit due to respiratory distress. The children underwent LUS examination and scoring at 2 hours after birth. The correlation analysis were performed between LUS score and neonatal critical illness score (NCIS ), NCIS+ single index, respectively. And the ROC curve was used to analyze the value of LUS score in predicting neonatal criticality. Results: ①The LUS score of non-critical neonates was significantly lower than that of critically ill newborns, the difference was statistically significant (P=0.005); LUS score was an independent risk factor for critical neonates (OR=1.71, 95% CI: 1.059-2.765, P=0.028). ②The correlation coefficient between LUS score and NCIS was -0.48 (P=0.002). The correlation coefficient between the LUS score and the NCIS+ single index was -0.44 (P=0.005). ③The area under the ROC curve of LUS score predicting neonatal criticality was 0.88 (95% CI: 0.725-0.965, P<0.000 1), the optimal diagnostic threshold was 6 points with sensitivity of 80% and specificity of 100%. Conclusions The LUS score at a postnatal age of 2 hours after birth can early assess and predict the criticality of neonates with pulmonary disease. And the LUS score greater than 6 has the highest diagnostic value.

BACKGROUNDMammalian target of rapamycin (mTOR) is involved in a caspase independent form of programmed cell death called autophagy. The aim of this research was to investigate the effects of rapamycin and 3-methyladenine (3-MA) on autophagy, proliferation, apoptosis, and cell-cycle parameters of rat bone marrow-derived endothelial progenitor cells (EPCs).

METHODSMononuclear cells isolated from rat bone marrow were treated with rapamycin (0.01, 0.1, 1, or 10 µg/L) or 3-MA (1.25, 2.5, 5, or 10 mmol/L) for 24 hours. Expression of the autophagy marker protein LC3-II was analyzed by Western blotting. Apoptosis and cell-cycle progression were analyzed by flow cytometry. Cell proliferation was measured using the MTT assay.

RESULTSRapamycin treatment of EPCs induced apoptosis and autophagy and inhibited proliferation and cell-cycle progression in a dose-dependent manner. Treatment with 5 mmol/L 3-MA promoted cell proliferation; in contrast, treatment with 10 mmol/L 3-MA promoted apoptosis and induced S-phase arrest.

CONCLUSIONSRapamycin treatment of EPCs induced apoptosis and autophagy. Low concentrations of 3-MA had no significant effect on the proliferation and apoptosis of EPCs; The 5 mmol/L group promoted cell proliferation, but had no effect on the apoptosis; the 10 mmol/L group inhibited the proliferation and promoted apoptosis through the cell cycle.

Adenine ; analogs & derivatives ; pharmacology ; Animals ; Apoptosis ; drug effects ; Autophagy ; drug effects ; Cell Cycle ; drug effects ; Cell Proliferation ; drug effects ; Cells, Cultured ; Rats ; Sirolimus ; pharmacology

OBJECTIVETo explore the influence of conventional metal materials in oral cavity on brain magnetic resonance imaging (MRI).

METHODSFour kinds of metal materials (metal ligature wire, forging hard and slotless denture, casting nichrome denture, casting copper alloy denture) in oral cavity were scanned through MRI. FSE sequence T1 weighted imaging (FSE T1), EPI diffusion-weighted imaging (DWI) sequence of ordinary, Propeller DWI imaging were used.

RESULTSIn FSE T1 sequence, metal ligature wire and forging hard and slotless denture produced serious false image, casting nichrome denture produced moderate false image, casting copper alloy denture produced only little false image. In EPI DWI sequence, obvious magnetic-sensitive false image were produced in the dissection tissue of the brain by metal ligature wire. While in Propeller DWI sequence, magnetic-sensitive false image were greatly reduced and satisfactory images were formed.

CONCLUSIONDifferent metal materials in oral cavity have different influence on the MRI. The false images produced by different metal materials are closely related to the type of the material. Magnetic-sensitive false images can be eliminated by Propeller DWI technique.

Dental Materials ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging

Objective To explore whether the lung ultrasound( LUS) score can be used to assess and predict the criticality of neonates with pulmonary disease at an early stage . Methods T he new borns born in the obstetrics department of Affiliated Hospital of Jining M edical University from April to October 2018 were transferred to the neonatal intensive care unit due to respiratory distress . T he children underwent LUS examination and scoring at 2 hours after birth . T he correlation analysis were performed between LUS score and neonatal critical illness score ( NCIS ) ,NCIS +single index ,respectively . And the ROC curve was used to analyze the value of LUS score in predicting neonatal criticality . Results ①T he LUS score of non‐critical neonates was significantly lower than that of critically ill newborns , the difference was statistically significant ( P ＝0 .005) ; LUS score was an independent risk factor for critical neonates ( OR＝1 .71 ,95%CI :1 .059－2 .765 , P ＝ 0 .028 ) . ② T he correlation coefficient between LUS score and NCIS was －0 .48 ( P ＝0 .002) . T he correlation coefficient between the LUS score and the NCIS + single index was －0 .44 ( P＝0 .005) . ③T he area under the ROC curve of LUS score predicting neonatal criticality was 0 .88 ( 95%CI :0 .725－0 .965 , P ＜0 .000 1) ,the optimal diagnostic threshold was 6 points with sensitivity of 80% and specificity of 100% . Conclusions The LUS score at a postnatal age of 2 hours after birth can early assess and predict the criticality of neonates with pulmonary disease . And the LUS score greater than 6 has the highest diagnostic value .