Objective To study the anatomic characteristics of Zuckerkandl's tubercle (ZT) and its clinical relevance as an anatomic landmark of the recurrent laryngeal nerve (RLN) in thyroid surgery.Methods This study involved 147 (106 with benign thyroid diseases and 41 with malignancies) patients who underwent thyroidectomy.ZT was measured and classified based on the Pelizzo classification.The relationship between ZT and the RLN and the relationship between the RLN and the inferior thyroid artery were recognized and classified.Results 233 (107 left and 126 right) thyroid gland lobes were dissected and ZT was identified in most patients (left in 93.5％ and right in 96.0％).The distribution of ZT according to grade was as follows:Grade 0,left 16.0％ and right 13.2％ ; Grade Ⅰ,left 32.0％ and right 27.3％ ; Grade Ⅱ,left 46.0％ and right 44.6％ ; Grade Ⅲ,left 6.0％ and right 14.9％.There was no significant difference on classification between the left-sided and right-sided ZTs.In terms of the relationship between the ZT and the RLN,it was classified as follows:Type A,left 92.9％ and right 93.3％ ; Type B:left 0 and right 0; Type C:left 7.1％ and right 6.7％.Similarly,there was no significant difference between the left sided and the right sided.The ZT grade was correlated with the course of the RLN:the higher the ZT grade was (that is,the greater the size of the ZT),the more often was the course of RLN behind the back of the ZT; the lower the ZT grade (that is,the smaller the size of the ZT),the more often was the course of RLN running by the lateral of the ZT.Considering the incidence of being dangerous type of RLN,the right sided (19.0％) was higher than the left sided (8.3％).The relationship between the ZT and the RLN does not relate to RLN course across the inferior thyroid artery.Conclusions As an important anatomic landmark,the ZT is essential for locating and dissecting the RLN during thyroid surgery,and its classification is a guide to RLN dissection and preservation.

Objective To evaluate retrospectively the role of 18 F-fluorodeoxyglucose (FDG) PET/CT associated with MRI in the localization of epileptogenic foci. Methods Sixty-seven patients with medically resistant epilepsy were included from 2003 to 2008. All underwent 18F-FDG PET/CT and MRI for presurgical evaluation as well as post-surgical evaluation 12 to 65 months after operation. Based on postoperative seizure occurrence, patients were divided into two groups. One group was free of seizures ( Engel classification Ⅰ, Group 1) and the other was with postoperative seizure occurrence of any type ( Engel classification Ⅱ-Ⅳ, Group 2). X2-test or Fisher's exact test was used for the statistical analysis. Results About 71.6% (48/67) patients were defined as group 1, and 19 patients were group 2 ( 11 were Engel Ⅱ , 5 were Engel Ⅲ, and 3 were Engel Ⅳ ). In Group 1, no statistically significant difference was found between concordant (45/63) and discordant findings (3/4) with regard to 18F-FDG PET/CT and MRI images (Fisher's exact test, P ＞0.05). For 41 patients that showed focal abnormality both on MRI and 18F-FDG PET/CT, 80.5% (33/41) were found in group 1. For 20 patients that showed focal lesions on MRI while with multi-focal or generalized abnormal metabolism on 18F-FDG PET/CT, 11 (55.0%) were in group 1 and9 (45.0%) were group 2. There was no significant difference (33/41 vs 11/20, X2 =4.34, P ＜0.05 ). Conclusion 18F-FDG PET/CT associated with MRI may offer more helpful information for pre-surgical evaluation and prediction of prognosis of epileptic patients.

Objective To induce the experimental corneal neovascularization(CRNV) by alkali burn,and explore the methods for quantitative analysis of CRNV and observation of permeability of CRNV. Methods Thirty-six C57BL/6 mice were selected and divided into experiment group(n=30) and control group(n=6).For the experiment group,alkali burn was induced by application of filter paper with 1mol/L sodium hydroxide to the cornea for 5 s.For the control group,no intervention was conducted.Areas of CRNV were measured on day 4,7,10 and 14 after alkali burn.Histological examinations of cornea were performed with HE staining on day 3, 7,10,16 and 28 after alkali burn.On day 10,endothelial cell marker CD31 was used with immunohistochemical staining for CRNV counting,and fluorescence angiography(FA) was employed to reveal the permeability of CRNV.Corneal ulceration and hyphema were observed everyday.Results CRNV developed after alkali burn,and extincted afterwards.Axenic coneal ulceration and hyphema were frequently observed,with the incidences of 6.7% and 10.0%,respectively.Histologic changes of corneal tissues at different time points could be observed with HE staining.On day 10, CRNV could be labeled and counted with immunohistochemical staining for CD31 antibody,and the permeability of CRNV could be detected by FA. ConclusionCRNV counting with immunohistochemical staining for CD31 antibody and measurement of area of CRNV are appropriate methods for quantitative analysis of CRNV.FA is an effective method in the detection of permeability of CRNV.

Objective To investigate the effect of different operations for cardia carcinoma on the postoperative anastomotic stoma complications.Methods Between December,2000 and May,2007,the clinical data 156 patients with carcinoma of gastric cardia who received different operations were analyzed retrospectively.Results The thoracoabdominal incision was performed in 57 cases,abdominal incision in 68 and left thoracic incision in 31 cases.The occurrence rate of anastomotic stoma complications in the patients with thoraco-abdominal,abdominal and left thoracic incision was 7.0%(4/57),7.4%(5/68),and 12.9%(4/31),respectively.The occurrence rate of anastomotic stoma complications in the patients using 25 mm end-end autosuture was 4.2%(4/95),in using of the 28mm autosuture group was 16.1%(P=0.0102).Conclusions The occurrence rate of anastomotic stoma complications can be reduced by choosing correct operation methods and using autosuture correctly.

The significantly high prevalences of cholelithiasis in patients with spinal cord injury (SCI) are related to impaired sympathetic innervations to the gallbladder. Sonography before and after the ingestion of a standard fatty meal is usually applied in evaluation of gallbladder function. This paper reviewed the innervations of gallbladder, sonography application in evaluation of gallbladder function and the relationship between SCI and cholelithiasis.

Current occupational health and occupational medicine teaching content focused on the detection of harmful factors,and more belonged to validation experiments.Closed-end management of experimental teaching,experimental report-based performance evaluation methods and single model of teaching methods reduced the students' study interesting,lack of problem-solving abilities.Therefore,it is necessary to optimize the experimental curriculum,adopt an open experimental teaching,build a reasonable experimental evaluation system and promote the diversification of teaching model.

Objective To analyze the substitutions at amino acid residues of neuraminidases ( NAs) in influenza B virus strains isolated in Jiangsu province from 2010 to 2012 and to further understand the genetic evolution of NAs in those influenza B virus strains .Methods Forty strains of influenza B virus isolated in Jiangsu province from 2010 to 2012 were screened out for this study .A two-step reverse transcrip-tion PCR ( RT-PCR) was performed to amply the gene fragments encoding the neuraminidases of influenza B virus strains.The PCR products were purified and then sequenced in an ABI 3730XL Genetic Analyzer.The evolutionary characteristics of NA gene were analyzed by using DNAStar , Bioedit, MEGA 5.0 and BEAST 1.8.0 softwares.Results The phylogenetic tree analysis of the NA genes showed that the NAs of 28 Vic-toria strains were derived from the Yamagata lineage .There were reassortments between the Victoria lineage-HA and theYamagata lineage-NA.Some of the strains added a glycosylation site at position 462.No substitu-tion was found in important enzyme active sites and neuraminidase inhibitor resistant sites .The Bayesian MCMC analysis showed that the estimated mean evolutionary rate for NA gene was 1.74×10-3(95%HPD:1.46×10-3-2.06×10-3) substitutions/site/year.The dN/dS ratio (ω), an indicator of selective pressure, was 0.24.Conclusion The important amino acid sites of NA were relatively conservative and the evolution -ary rate for NA gene was low .The dN/dS ratio was less than one , indicating that the NA gene was under pu-rifying selection .

Objective To explore the effect of 1-alpha,25-dihydroxy-cholecalcifero(1,25(OH)2D3)on liver fibrosis and its mechanism. Methods Degree of liver fibrosis was assessed through pathological detection and blood biochemical examination of liver function. Immunohistochemical assay was used to detect expressions of α-SMA,TGF-βand collagen I to observe activation level of hepatic stellate cells. Impact of 1,25(OH)2D3 on CD4+T cell differentiation was analyzed by flow cytometry,ELISA,and RT-PCR. Results 1,25(OH)2D3 improved the structure of the liver tissue and liver fibrosis. Expressions of collagen I ,TGF-βandα-SMA were significantly ele-vated in the liver tissue in rats with fibrosis(P < 0.05)but were markedly decreased after treatment with 1,25 (OH)2D3(P < 0.05). After 1,25(OH)2D3 treatment,the proportion of Th17 cells reduced while that of Th2 in-creased;concentration levels of IFNγ,IL-17A,and IL-22 markedly declined but IL-4 elevated(P>0.01);and ex-pressions of RORγt and T-bet decreased whereas GATA3 expression increased(P>0.01);as compared with those in the control group. Conclusions 1,25(OH)2D3 can alleviate the degree of liver tissue by lowering HSC activation and regulating Th cell differentiation.

Objective To understand the self-assessment of health status,health effects,active awareness of weight control and behavior of urban occupational populations with different body mass index (BMI ).Methods With random cluster sampling survey in two monitoring areas,1 175 cases aged 18 to 45 were selected,consisted of public servants, enterprise administrators and institution personnel groups.Results In the urban occupational populations in Hangzhou City,the overweight rate was 21.70%,and the obesity rate was 6.04%.The awareness rate of underweight,normal weight,overweight and obesity crowd for health effects to the body was 98.95%,98.81%,96.08% and 95.77%respectively;and for mental health effects was 90.53%,92.44%,83.92% and 81.69% respectively;and for weight control confidence was 82.11%,79.18%,72.94%and 50.70%respectively.The awareness rate decreased with increased body weigh with significant difference (P<0.05 ).There was no significance differences in weight control behaviors and accumulation of weight control behaviors (P >0.05 ).Conclusion There was significantly difference in people with different BMI about the awareness of overweight obesity impact on personal health and weight control activity,but there was no difference in that of weight control behaviors.

Objective To investigate the accuracy of low-dose dual-source computed tomography (DSCT) coronary angiography in the step-and-shoot (SAS) mode for the diagnosis of coronary artery stenosis in comparison with conventional coronary angingraphy (CCA).Methods Prospective multiple-center study, 46 patients[mean age(58±9) years;bedy mass index(BMI) (25±3) kg/m2]underwent both DSCT in the SAS mode and CCA within 14 days.The inclusion criteria for contrast-enhanced CT: (1) heart rate less than 65 times/rain (bpm).(2) regular sinus rhythm, heart rate fluctuations within the range of 6 bpm. (3) holding breath well, breath-hold time is about 12-15 s.The exclusion criteria:(1) allergy to iodinecontaining contrast medium, nephropathy (serum creatinine level 120 μmol/L), heart failure and serious arrhythmias.(2) patients with coronary stents or bypass grafts.(3) heart rate can not be controlled very well (4)the patient could not take nitroglycerin.(5)BMI 30 kg/m2.(6) other heart disease: carcliomyopathy, valvular disease etc.Sensitivity, specificity, negative (NPV) and positive predictive value (PPV) were determined with CCA as standard of reference.The Kappa value between the two modalities and the two observers was calculated.Radiation dose values were measured.Results Mean heart rate during scanning was (61±6)bpm.99.19% (614/619) coronary segments were depicted with a diagnostic image quality. The vessel-based sensitivity, specificity, PPV, and NPV for the diagnosis of coronary artery stenosis were 96.2% (75/78), 88.2% (60/68), 90.4% (75/83), and 95.2% (60/63), respectively.The Kappa value between the two modalities was 0.848 (P=0.000).The mean effective dose of the SAS-CTCA was (2.95± 0.96) rosy(1.26-4.32 mSy).Conclusion In selected patients, DSCT coronary angiography in the SAS mode have good image quality, which allows for the accurate diagnosis of coronary stenosis at a low radiation dose.