Objective To explore the value of video-assisted thoracoscopic thymectomy in the treatment of myasthenia gravis. Methods A prospective randomized controlled study,fifty-four patients who were preoperatively confirmed to be MG from 2005 to 2008 were divided into VATS group (27 cases) and conventional thoracotomy group (27 cases). Thymectomy and dissection of all fatty tissue anterior to the pericardium were performed in both the groups. The operation time,blood loss,chest drainage time,hospital stay and outcomes of the two groups were recorded and compared. Results In the VATS group,one patient was converted to open surgery because of electrocoagulation injury and brachiocephalic vein. Compared with the conventional group,the patients in the VATS group had fewer blood loss [(43.0?5.2) ml vs (117.6?17.2) ml,t=-21.196,P=0.000],shorter operation and postoperative drainage time [(89.4?15.0) min vs (98.4?12.5) min,t=-2.377,P=0.021;and (2.2?1.6) d vs (4.2?1.3) d,t=-5.003,P=0.000,respectively],and shorter postoperative hospital stay [(7.0?1.2) d vs (11.0?2.5) d,t=-7.379,P=0.000].In the conventional group,3 patients developed MG crisis and 9 had lung infection,while none of the VATS group developed the crisis,and 2 showed lung infection (P=0.236; ?2=5.295,P=0.021). The 54 patients were followed up for 6 to 24 months with a mean of 18.6 months,during the period,the MG symptoms were improved in 80.8%(21/26)of the patients in VATS group and 85.2% (23/27)in conventional group (Z=-0.126,P=0.899). Conclusions Extended thymectomy by VATS is safe and feasible with the advantage of less invasion,less surgical trauma and pain,lower rate of complication,and good curative effect.

According to the present deficiency existing in contractual community medical service financing mechanism,it analyzed the financing difficulties and mutual interest game from the angle of game analysis of the various stakeholders in the financing process,explored the reasonable optimizing strategies for improving financing mechanism.The purposes aimed as:(1) determine the responsibility of each contractual community health financing body,reduce the fund shortage phenomenon caused by the lack of responsibility;(2) promote the stability and sustainable development of the financing mechanisms,to provide sufficient power to the development of contract services;(3) it was conducive to vigorously promote the contractual community medical service and lay the foundation for the grading system.

Objective To evaluate the role of TVS in assessing endometrial pathology in women with postmenopausal bleeding and in evaluating the depth of myometrial invasion in endometrial carcinoma.Methods A group of 111 women with postmenopausal bleeding were examined by TVS,endometrial thickness,echotexture,blood flow characteristics were evaluated.Results An endometrial thickness less than 5 mm was associated with normal or benign condition.This suggested that endometrial biopsy or curettage might not be necessary in this situation,visualization of abnormal blood flow within the endometrium in the endometrial carcinoma with mean resistance index constituted a statistical difference compared with that of benign endometrium(P<0.05).TVS accurately detected depth of myometrial invasion in endometrial carcinoma,and had significant relation with pathologic assessment(r=0.98,P<0.001).Conclusion TVS could be implemented as a routine first-step procedure in patients with postmenopausal bleeding.

Objective To study the thyroid volume(TV) of patients with autoimmune thyroid disease (AITD) and the iodine intake and the factors associated with the goiter of patients with AITD.Methods Questionnaires,physical examination,urinary iodine concentration and thyroid B ultrasound were performed in cases of newly diagnosed patients with AITD.Result The TV of patients with AITD did not associated with the urinary iodine concentration (P ＞ 0.05).The TV associated with patients gender and age and goiter of palpation (P ＜ 0.05).Conclusion The U-shape relation did not show between iodine and goiter in patients with AITD.The goiter of patients with AITD did not associated with the iodine intake.

Objective To explore the predictive value of response to neoadjuvant chemotherapy(NAC)in local advanced breast cancer with contrast-enhanced ultrasound(CEUS)of axillary lymph node.Methods CEUS of metastatic axillary lymph nodes in 58 patients stacng Ⅱ-Ⅲ breast cancer was performed before and after NAC treatment. The enhancement patterns and parameters of time-intensity curve were assessed and compared with the pathology.Results The clinic response evaluation were drug-effective in 35 cases and no change in 23 ones.There Were no significant differences in enhancement patterns between no-change and drugeffective groups.Lymph node cortex arriving time was longer in drug-effective cases than that in no-change ones after NAC,whereas it showed no significant differences before NAC.Statistical significant difierence in enhancement duration(ED)was found between the two groups before NAC,which decreased markedly in drug-effective case8 after NAC.Histopatholngic response could be predicted with a sensitivity of 77% and a specificity of 90% by standardized ED below 275 seconds after NAC.No significant difference was found in time to peak(TP),peak intensity(PI)between the two groups.Conclusion The perfusion pattern of axillary lymph node CEUS after NAC Was insufficient to predict curative effect.But the lymph node cortex arriving time and enhancement duration may be of value in the prediction of clinical response to chemotherapy.

BACKGROUND: Chinese medicine is rich in recognition and treatment for rheumatoid arthritis(RA) and has achieved attractable progression in researches of recent several years,characterized by variable therapeutic methods, definite therapeutic effects and few toxic side effects. Therefore, it is important scientifically and socially to further search for the effective drugs and methods for the treatment of RA in the field of Chinese medicine. There are few reports on whether Chinese herbs inhibit or block the destruction of cartilage and bone and promote their metabolism and repair for damage or not by variable approaches,targets and links in RA occurrence.OBJECTIVE: To probe into the mechanism of Chinese herbal tongbiling on cartilage destruction.DESIGN: Complete random design and control experimental study based on the experimental animals.SETTING: Golden Chamber teaching and research room of guangzhou university of traditional Chinese medicine.MATERIALS: The experiment was performed in Comprehensive Experimental Room of First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from August 2002 to December 2003,in which,35female Wistar rats were employed,clean grade,weighted(110±20) g,provided by Animal Experimental Room of First Military Medical University of Chinese PLA, with qualified animal No. 2002A041.After 3 days adaptive breeding,Wistar rats were randomized into normal group,model group and total alkaloidal of tongbiling group(TBL group). TBL was extracted in Phytochemistry Room of Tropical Disease Institute of Guangzhou University of Traditional Chinese Medicine.METHODS: The animal model was prepared on rats with collagen-induced arthritis. After treated with gastric infusion in groups,the pathological sections were done on phalangeal joint of rat and chondropathy was observed after routine HE staining. The chondrocytes were cultured. The chondrocytes were stimulated with rrIL-1β in vitro and resulted in matrix decomposition of chondrycyte to prepare pharmaceutical model,TBL of various concentrations added and dexamethasone(DXM) was applied in the control. After 48 hours culture,the upper clear solution if cell was collected and glycosaminoglycan (GAG) content was measured with alcian blue method,and nitric oxygen (NO) content was assayed with method of aqua fortis reduction.MAIN OUTCOME MEASURES:①Primary results: Effect of TBL on phalangeal chondropathy in rats with collagen-induced arthritis and on matrix decomposition of chondrocyte induced by rrIL-1β.②Secondary results: Effect of TBL on induction of NO synthesis from chondrocytes by rrIL-1β.RESULTS:①It was indicated in evaluation on HE pathological section of phalangeal joint: The severity of cartilage destruction in TBL group was less than that in model group(P<0.05).②TBL of various concentrations and DXM inhibited remarkably the decomposition of choncrocyte proteoglycan (P<0.01) and NO synthesis (P<0.01).CONCLUSION: TBL inhibits phalangeal cartilage destruction of rats with collagen-induced arthritis. It is indicated in the results of experiment in vitro that TBL is against the decomposition of choncrocyte proteoglycan,which is probably achieved by inhibiting NO synthesis.

Objective To construct p66shc gene interfering lentivirus vectors recombination and transfect it to 293T cells ,RNA interfering was carried out to induce p66shc gene silence ,so as to provide basis for further study of the p66shc function .Methods Screening of three RNA targets which were named after p66shc‐shc1 ,p66shc‐shc2 ,p66shc‐shc3 ,cloned into the pLenR‐GPH vec‐tor ,which contained green fluorescent protein(GFP) and transformed into DH5αcells .The positive clone were picked out for right sequencing and transfected to 293T cells with pRsv‐REV ,pMDlg‐pRRE ,pMD2G .The expression of GFP in inverted fluorescence microscope confirmed the virus packaging success .Fluorescence quantitative PCR and Western blot technology were used to investi‐gate the expression of p66shc at the molecular and protein levels ,p66shc‐shc1 target of effective silencing p66shc gene was selected to prepare for subsequent tests .Results The shRNA lentivirus vector was constructed which could express p66shc and was trans‐fected into 293T cells successfully .Fluorescence quantitative PCR and Western blot technology were used to investigate p66shc gene silence by RNA interference .Conclusion The lentivirus RNAi vector of targeted expression p66shc could induce p66shc gene si‐lence at the molecular and protein levels after transfected into 293T cells by RNA interference .

ObjectiveTo evaluate the implication of ultrasonographic features of primary breast cancer tumors and axillary lymph nodes in predicting axillary lymph nodes metastasis in patients with breast cancer.MethodsA total of 108 patients with breast cancer were underwent examination of primary breast tumors and axillary lymph nodes by high frequency linear-array probes of ultrasound.The ages of patients,locations of primary tumors,numbers of tumors,maximum diameters of tumors,the longitudinal transverse axis ratio of tumors,mass boundary,ultrasonic patterns,micro-calcification,classification of blood supply,color pixel density(CPD),peak systolic velocity,resistance index,the longitudinal transverse axis ratio of axillary lymph nodes and maximum cortical thickness of axillary lymph nodes were recorded.ResultsOut of 108 patients with breast cancer,the longitudinal transverse axis ratio of tumor were greater than 1 in 75 (69.4 ％ ),micro-calcification in 57(52.8 ％ ),classification of blood supply were Ⅱ - Ⅲ in 57 (52.8％ ),CPD were greater than or equal to 10％ in 48 (44.4％),maximum cortical thickness of axillary lymph node were greater than or equal to 3 mm in 51 (47.2％),and longitudinal transverse axis ratio of lymph nodes were less than 1.5 in 59 (54.6％).Univariate analysis revealed that these six parameters were correlated to the axillary lymph node metastasis in breast cancer ( P ＜0.05).However,ages of patients,location of tumor in the breast,numbers of tumors,maximum diameters of tumors,mass boundary,ultrasonic patterns,peak systolic velocity and resistance index were not related to the axillary lymph node metastasis( P ＞0.05).Multivariate logistic regression analyses showed that CPD (OR:16.337,95％ CI:4.537- 58.826),longitudinal transverse axis ratio of lymph nodes (OR:3.754,95％ CI:1.269- 11.108) and microcalcificationand (OR:3.033,95 ％ CI:1.040 - 8.840) were risk factors of axillary lymph nodes metastasis in patients with breast cancer.ConclusionsThe application of ultrasonography in patients with breast cancer is useful in predicting axillary lymph nodes metastasis.

Objective To evaluate the effect of Budesonide combined with Poractant Alfa(pulmonary surfactants,PS) on preventing the bronchopulmonary dysplasia (BPD) in preterm infants.Methods One hundred and twenty preterm infants 6 hours after birth(gestational ages≤32 weeks and birth weights ≤1500 g)admitted to the Department of Newborn Medicine,the Affiliated Hospital of Southeast Medical University from October 2013 to February 2015 were randomly divided into 4 group(30 cases in each group).Group A was a control group,group B was neonatal respiratory distress syndrome(NRDS) group,group C was NRDS with PS group,and group D was NRDS with PS and Budesonide group.Thirty-two-week preterms without other diseases and without uptaking oxygen within 48 h were assigned as group A.Group B were treated by continuous uptaking oxygen with continuous positive airway pressure(CPAP) (oxygen uptaken lasting more than 48 h and oxygen concentrations more than 40％).Group C were treated with 100 mg/kg PS within 48 h on the basis of group B.Group D were treated with 0.25 mg/kg Budesonide suspension for inhalation on the basis of group C.The pH value,partial pressure of oxygen [pa(O2)],partial pressure of carbon dioxide [pa(CO2)] in the blood gas analysis were all detected in all groups before treatment,1,6,12,24 and 48 hours after using drug,respectively.All groups were also observed for whether to use respirator assisted ventilation,the duration of high oxygen use,the total time of uptaking oxygen,the rate of using PS again,the rate of BPD,the total hospitalization days and the adverse effects.The adverse effects included high blood pressure,high blood sugar,necrotizing enterocolitis and the incidence of nosocomial infection.Results Compared with group B,the pH value at 1 and 6 hours after using drugs,the pa(O2) and pa(CO2) at 1,6 and 12 hours after using drugs were improved obviously in the group C,and the differences were statistically significant (all P＜0.01).Compared with group B,the above indicators were improved more obvious in group D,and the differences were statistically significant (all P＜0.01).Moreover,compared with the group B,the oxygen inhalation duration,the rate of having a respirator assisted ventilation and using PS again,and the incidence of BPD were obviously decreased in other groups,the differences were statistically significant (all P＜0.05).The incidence of BPD in group D was less than that of group C,and the differences were statistically significant (3.33％ vs 10.00％,x2=4.00,P=0.046).The total oxygen time and the rate of adverse effects of each group were similar.The differences were not statistically significant (all P＞0.05).Conclusions Budesonide combined with Poractant Alfa can prevent BPD in preterm infants.Its effect is better than the simple use of Poractant Alfa,and the rate of adverse effects are not increased significantly.

Objective To systematically describe and analyze the patient safety culture assessment outcomes of medical workers in China,so as to provide scientific evidence for developing corresponding intervention measures.Methods Such databases as Web of Science,PubMed,Ovid,EBSCO,Google Scholar,CBM,VIP,CNKi and WanFang Data were used to collect studies published before December 2014,on patient safety culture assessment of medical workers in mainland China.Two reviewers independently screened,extracted and cross-checked the data,and the disagreements were resolved by discussion or by consulting a third reviewer.The qualitative synthesis method was used to analyze the study results.Results Of the total 1 721 records,65 studies were included,and most of them were cross-sectional studies.The patient safety culture assessment instruments were foreign scales by the translation and revision for the Chinese version for 52 studies,and self-made questionnaire for the other 13 studies.The main factors influencing the patient safety culture of Chinese medical workers included seniority,department,educational background,experience of patient safety training and so on.Conclusions Many studies have been carried out for patient safety culture,but the research obj ects mostly are nursing staffs,without extensive research on other professional medical workers.Hospitals should strengthen the teams,the patient safety training,and build patient safety culture that is fair and open to safeguard patient safety.