Objective To investigate the feasibility and effects of minimally invasive video-assisted parathyroidectomy(MIVAP)for parathyroid adenoma or cyst.Methods A 2 cm skin transverse incision was made above the suprasternal notch.Without gas insufflation,a cavity was built with retractors.Under endoscopic assistance,parathyroidectomy was performed by using a harmonic scalpel(3 cases of nonfunctioning parathyroid cyst and 7 cases of parathyroid adenoma accompanying hyperparathyroidism).Results The operation was successfully accomplished in all the 10 cases,without conversions to open surgery.The operative time was 20～70 min(mean,40 min).No hoarseness,choking cough,or hemorrhage occurred.A transient hypocalcemia developed in 3 cases.All the patients were followed for 2～18 months(mean,9 months),with satisfactory curative and cosmetic results.Conclusions Minimally invasive video-assisted parathyroidectomy appears to be a safe and effective treatment with good cosmetic results and postoperative outcomes.

Objective To define the indications and evaluate the results of various surgical treatment options in patients with nonparasitic hepatic cysts. Methods The clinical data of 284 patients with nonparasitic hepatic cysts treated in our hospital from January 1995 to December 2005 were retrospectively analyzed. Results Percutaneous aspiration and sclerotherapy were performed in 161 cases and complications occurred in 9 (5.59%), recurrence in 53 (32.92%) and the mortality was 0%.Open surgery was conducted in 71 cases and the complications occurred in 16 (22.54%), recurrence in 8 cases (11.27%) and the mortality was 2.82%. Laparoscopic surgery was employed in 52 cases and complications occurred in 7 ( 13.46%), recurrence in 6 (11.54%) and the mortality was 1.92%.Conclusion There is currently no general agreement in the literature concerning when nonparasitic hepatic cysts should be treated. Laparoscopic surgery was more favorable than other therapeutic options.However, we should choose individually suitable methods according to different clinical symptom of patients.

Objective To compare the treatment effects of gastric bypass (GBP) and biliopancrtic diversion (BPD) in non-insulin dependent diabetes mellitus rats,and investigate the mechanism.Methods Forty GK rats with diabetes mellitus were randomly allocated into four groups:GBP group; BPD group; food restriction group ( FR group) and control group with 10 rats in each group.Rats in GBP group and BPD group received GBP and BPD procedures respectively.Rats in FR group were fed with basic feed of 15 g and free access to water.There was no food restriction in rats in control group.The operation time,mortality was recorded.The fasting body weight was measured every week.The plasma glucose,insulin-like growth factor-1 (IGF-1),and leptin concentrations,were measured before treatment and 1,2,3,4,8,16 week after treatment.Results The mean operation time was (25 ± 4) min in GBP group and (35 ± 6) min in BPD group; one rat died in GBP group and 3 rats died in BPD group,and the difference between the two groups was statistically significant (P ＜ 0.01 ).The levels of plasma glucose,IGF-1 and leptin were not statistically significant among these groups before treatment.There was no significant difference in plasma glucose and leptin concentrations in the control group.The levels of plasma glucose and leptin in rats in FR group began to decrease 2 weeks later,at the 4th week,the levels of plasma glucose and leptin was significantly lower than that before treatment,and it lasted for the 16 th week,but the level of IGF-1 were significantly different.The levels of plasma glucose and leptin in rats in GBP group and BPD group began to decrease and IGF-1 began to increase 2 weeks after operation,and it lasted for the 16th week,[plasma glucose:(6.8 ± 1.0),(6.3 ± 0.8 ) mmol/L vs.(13.9±2.6),(14.1 ±2.6)mmol/L; leptin:(16.1±3.3),(17.2±3.2)pg/ml vs.(29.4±3.9)pg/ml,(29.4±3.9); IGF-1:(166.1±8.3),(142.2±8.2)ng/L vs.(119.4±8.8),(109.8±7.9)ng/L,P＜0.01],but the levels of plasma glucose and leptin was not statistically different between the two groups.The level of IGF-1 in GBP group was significantly higher than that in BPD group (P ＜ 0.05).Conclusions Both GBP and BPD can effectively control plasma glucose concentration for rats with diabetes.The possible mechanism is related to decreased leptin and increased IGF-1.Group GBP had a better outcome in operation time,mortality and increasing IGF-1 than those in group BPD.

Objective To investigate the strategy to improve successful treatment for severe acute pancreatitis (SAP). Methods The study period was divided into from 1992 to 2000, and from 2001 to 2009.The patients during these two phases were comparable as regard to sex and age. Results The proportion of patients received anti-inflammatory medications from 2001 to 2009 was 88.7% (94/106), medications which can improve the pancreatic microcirculation were used in 93.4% (99/106), early enteral nutrition was used in 58.5% (62/106), medications which can protect intestinal barrier function were used in 98.1% ( 104/106),all these parameters were significantly higher than those (22.4%, 19/85; 43.5%, 37/85; 29.4%, 25/85;17.7%,15/85) from 1992 to 2000. Also from 1992 to 2000, more patients underwent operation such as basin-shaped open drainage, pancreatic necrosis debridement. While more patients underwent operation such as laparoscopic drainage, CT or B-ultrasound guided percutaneous drainage from 2001 to 2009. The proportion of patients underwent surgical treatment decreased from 56.5% (48/85) to 32. 1%(34/106); the survival rate increased from 68.8% to 84.0%. Conclusions The research progress of medications was the foundation to improve successful treatment for SAP. Operation was an important option during SAP therapy. The individualized treatment was beneficial to improve successful treatment for SAP.

Objective To evaluate the lung protection of remote limb ischemic preconditioning during one-lung ventilation (OLV) in the patients undergoing esophageal cancer resection.Methods Seventyone patients of both sexes,aged 30-64 yr,with body mass index of 15-28 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective esophageal cancer resection,were randomly divided into control group (group C,n =34) and remote limb ischemic preconditioning group (group RLIP,n =37) using a random number table.Patients in group RLIP received three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on one upper arm before OLV.Before OLV (T0),at 1 and 2 h of OLV (T1,2),at 20 min after re-expansion of the collapsed lung (T3),and at 2 h after operation (T4),blood samples were drawn from the radial artery for blood gas analysis,oxygenation index (PaO2/FiO2) and alveolar-arterial oxygen gradient (A-aDO2) were calculated.At T0,T2,T3 and T4,blood samples were collected from the radial artery for determination of plasma tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6),and IL-10 concentrations.Results Compared with group C,PaO2/FiO2 was significantly increased,and A-aDO2was decreased at T1,2,the plasma TNF-α concentrations were decreased at T2-4 (P＜0.05),and no significant change was found in the plasma IL-6 and IL-10 concentrations and rate of abnormal pulmonary function at T1-4 in group RLIP (P＞O.05).Conclusion Although remote limb ischemic preconditioning can produce lung protection during OLV in the patients undergoing esophageal cancer resection,it provides no clinical significance.

Objective To investigate the curative effect of endoscopic thyroidectomy via breast areola approach.Methods The clinical data of 28 cases of endoscopic thyroidectomy via breast areola approach were retrospectively summarized.Results The mean diameter ofthe tumor Was 2.9(1.7～4.2)cm.The mean operative time Was 128(95～165) min.Pathologic data:adenoma in 15 cases,nodular goitar in 12 csses,papillary carcinoma indicated intraoperatively by frozen section in 1 case.One case occurred temporary hoarseness.No intraoperative and postoperative hemorrhea and convulsion after operation.Minor pain and discomfort in anterior chest continued for 7～19d in 18 cases,all without taking painkillers,satisfaction rate of beauty was 90 percent.Condusions Endoscopic thyroidectomy via breast areola approach is safe and feasible for patients with thyroid diseases,and has excellent cosmetic results.

Objective To explore the relationship between social norms and smoking intention, among male smokers in China. Methods A total 3 621 (with 95.8% of effective response rate) male smokers were selected and investigated with questionnaires from August to November in 2013.Univariate logistic regressions and multivariate logistic regressions were conducted to find the associations between social norms, smoking intention and quitting attempts. Results Smokers perceived low pro-quitting social norms from their family members, friends and other people around.With a 1 point increase in pro-quitting social norms score, smokers′ willingness to quit in the next 6 months increased by 69% (OR=1.69, 95%CI:1.48-1.94), and smokers were 86% more likely to quit(OR=1.86, 95%CI:1.66-2.08). Conclusion Pro-quitting social norms is proved to be an independent predictor for smoking intention, quitting attempts among male smokers in China.Therefore, future intervention should aim to establish pro-quitting social norms for smoking cessation.

Objective:To investigate the effects of birth intervals on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM).Methods:This retrospective study recruited 445 pregnant women with GDM who received prenatal examinations and delivered in Peking University First Hospital-Ningxia Women Children's Hospital from January 2020 to December 2021. Based on the birth interval classification standard recommended by WHO and the American College of Obstetricians and Gynecologists, these subjects were divided into three groups: shorter group (<18 months, n=69), normal group (18-59 months, n=213) and longer group (≥60 months, n=163). Analysis of variance, Chi-square test, and multivariate logistic regression model were used for statistical analysis. Results:There were statistically significant differences in the maternal age at this and previous pregnancy [(30.6±4.1), (30.8±3.8) vs (32.7±3.7) years; (22.7±2.4), (26.3±2.9) vs (29.9±4.1) years] and the incidence of oligohydramnios [10.1% (7/69), 1.9% (4/213) vs 3.1% (5/163)] and preterm birth [14.5% (10/69), 5.2% (11/213) vs 1.8% (3/163)] between the shorter, normal, and longer groups (all P<0.05). After adjusting for confounding factors in the present pregnancy, the risks of oligohydramnios, preterm birth, and low birth weight increased in the shorter group [ OR (95% CI): 4.73 (1.75-12.85), 5.54 (1.37-22.42) and 9.54 (3.05-29.82), all P<0.05] and so did the risk of postpartum hemorrhage in the longer group [ OR (95% CI): 4.45 (1.72-11.49), P<0.05]. Conclusions:Both longer and shorter birth intervals can affect maternal and infant outcomes of GDM patients. Postpartum healthcare should be strengthened for GDM patients who desire more children to help them maintain an appropriate birth interval, thus promoting maternal and infant health.

OBJECTIVETo understand the effects of the IL-1, TNF-alpha cytokines on the pathogenesis of periapical lesions by investigating its gene expression in rat.

METHODSThe model was established by surgically exposing mandibular molar teeth and left open to permit infection from the oral environment. The SD rats were killed at 1, 2, 3, 4 weeks and mandibular molar teeth X-ray were taken. In situ hybridization was used to test IL-1alpha, IL-1beta, TNF-alpha mRNA expression in periapical area and the kinds of positive cells were identified. Using image analysis system analyzed gene expression semi-quantified.

RESULTSIL-1alpha, IL-1beta and TNF-alpha mRNA were all expressed beginning at 1 week, peaked at 3 weeks, and declined somewhat at 4 weeks, but IL-1beta mRNA was expressed at much lower levels with the same kinetics (P<0.01). Most of the staining occurred in areas that had heavy inflammatory infiltrate, fibroblasts, or endothelial cells. There was a statistically significant correlations between the area of periapical lesion and the number of positively stained cells for IL-1alpha and for TNF-alpha (IL-1alpha: r=0.875, P<0.001; TNF-alpha: r=0.858, P<0.001), and between the number of positive cells for IL-1alpha and that of for TNF-alpha (r=0.969, P<0.001).

CONCLUSIONSIL-1alpha and TNF-alpha genes are highly expressed in developing periapical lesions in rat, which supports the hypothesis that these two cytokines play a key role in pulpal and periapical pathogenesis, including the concomitant bone destruction.

Animals ; In Situ Hybridization ; Interleukin-1 ; genetics ; physiology ; Periapical Periodontitis ; etiology ; immunology ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; genetics ; physiology

BACKGROUNDMinimally invasive video-assisted thyroidectomy (MIVAT) has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy (CT) for papillary thyroid microcarcinoma (PTMC).

METHODSThirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin (TG) and ultrasonic results were followed up.

RESULTSAll the patients took levothyroxine for suppressing thyroid stimulating hormone (TSH) after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results.

CONCLUSIONSMIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.

Adult ; Carcinoma ; Carcinoma, Papillary ; Female ; Humans ; Male ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Postoperative Complications ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; adverse effects ; methods ; Treatment Outcome ; Video-Assisted Surgery ; methods