Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Objective To evaluate the surgical technique and outcome of the extended radical resections for hilar cholangiocarcinoma.Methods A patient with Bismuth-Corlette type Ⅳ Klatskin's tumor, which invaded the secondary intrahepatic bile duct and the pancreatic portion along the common bile duct, underwent the HPLT_ X . And then, the digest cannel was reconstructed according to the Child's methods. By using immunohistochemistry, the expression of cytokeratin9, 17, CEA and hepatocyte protein was detected. After operation, the immunosuppressive agents consisting of Tacrolimus and steroids were given; lamivudine and HBIg were used to prevent HBV from recurrence.Results Pathologic examination revealed low differentiated adenocarcinoma and immunohistochemistry stains confirmed the positive expression of cytokeratin9 and 17, carcinoembryonic antigen, and the negative expression of hepatocyte protein. Neither the margins of resection nor periductal lymph nodes were pathologically involved. She was currently alive for 17 months after the operation, the liver graft function was within normal range, and the patient was back to the previous work without any evidence of recurrent cancer. The tumor marker in plasma was decreased to the controllable level.Conclusion The HPLT_ X may be the treatment choice for unresectable Klatskin's tumor and provide the higher rate of radical resection and better prognosis.

Objective To study the expression of VEGF and microvascular density (MVD) in pancreatic carcinoma and their prognostic value. Methods The protein expression of VEGF and MVD were determined with immunohistochemistry in 48 cases of pancreatic ductal carcinomas, which were surgically resected and pathologically confirmed. Results In 64.6% of pancreatic carcinomas the expression of VEGF was positive, and it was significantly higher than that of normal pancreatic tissues (P

BACKGROUND:Screw loosening and shedding may occur after osteoporosis associated with lumbar degenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect.
OBJECTIVE:To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis.
METHODS:Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were col ected. Al patients were divided into two groups according to the treatment method:poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group.
RESULTS AND CONCLUSION:There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P>0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurological symptoms caused by new symptoms during fol ow-up period. The bone mineral density was not improved gradual y in poly(methyl methacrylate) group with fol ow-up time prolonging;however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pul ing out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.

Objective To observe the therapeutic efficacy of ultrastructural dense acupotomy treatment in treating lumbar intervertebral disc herniation (LIDH). Methods Seventy-two LIDH patients were randomized into a treatment group and a control group, 36 in each group. The treatment group was intervened by ultrastructural dense acupotomy treatment, while the control group was by conventional acupuncture. The therapeutic efficacy was evaluated after a course of treatment. The visual analogue scale (VAS) was adopted for assessing pain, and the Japanese Orthopaedic Association (JOA) score for estimating the symptoms, signs, and functional activities. Results The VAS and JOA scores were significantly changed in both groups after intervention (P＜0.01). There were significant differences in comparing the changes of VAS and JOA scores between the two groups (P＜0.01, P＜0.05). The total effective rate was 97.2% in the treatment group versus 80.6% in the control group, and the difference was statistically significant (P＜0.05). Conclusion Ultrastructural dense acupotomy treatment is an effective approach in treating LIDH.

Objective To investigate the effects of vitamin E (VE) on renal ischemia/reperfusion (I/R) injury of rats.Methods A total of 18 male Wistar rats were randomly divided into sham-operated group,I/R group,VE + I/R group,and each group of 6 rats.All the animals were killed at the end of 24 h of reperfusion.Nephridial tissue were examined by light microscopy,and the level of blood urea nitrogen(BUN) and serum creatinine (SCr) were measured.The protein expressions of tumor necrosis factor α (TNF-α) were detected by Western blotting.Results Compared with sham-operated group,tubulointerstitial pathological injury in I/R group was significantly aggravated,which was shown by HE and PAS stain.Compared with I/R group,the degree of morphological changes as well as renal dysfunction in VE + I/R group were obviously lessened.Meanwhile,the levels of BUN,SCr in I/R group,VE + I/R group were (10.13 ± 2.14) mmol/L and (7.67 ± 1.63) mmol/L,(80.33 ±7.15) μmol/L and (63.67 ±5.40) μ mol/L,significantly higher than those in shamed-operated group ((3.85 ± 0.21) mmol/L,(48.67 ± 3.61) μmol/L;P ＜ 0.05).And the level of BUN and SCr in VE + I/R group were significant lower than those in I/R group(P ＜0.05).Western Blotting showed that the protein expressions of TNF-α in VE + I/R group were obviously lower compared with those in group of I/R without VE treatment (P ＜ 0.05).Conclusion Vitamin E can attenuate over-expressions of TNF-α in kidney following I/R,thus protect against structural damages and renal dysfunction in I/R rat models.

Objective The international multidisciplinary lung adenocarcinoma classification was published by IASLC/ ATS/ERS in 2011.This study aimed to explore the clinicopathologic characteristics of lung adenocarcinoma based on IASLC/ATS/ERS classification and validate its clinical diagnostic and therapeutic value.Methods 2 056 cases of surgical resection from Shanghai Chest Hospital were classified according to the new classification and clinical information were retrospectively reviewed.The clinicopathologic characteristics based on new classification were analyzed statistically.Results Our data indicated that women were in high risk of lung adenocarcinoma; The average age of onset was 59-year-old; the female patients were younger than the male patients (58.7 years vs 60.2 years,P ＜ 0.01) ; Average tumor diameter was 2.6 centimeter; right lung was more popular than left and superior lobe than the inferior one.Acinar predominant subtype and papillary predominant subtype were frequently observed.Micropapillary predominant subtype and solid predominant subtype were identified to be more aggressive than other histopathologic subtypes.Most patients were classified as stage Ⅰ(71.7％),which were predominantly stage Ⅰa (53.1％).Conclusion The new classification is superior to reflect the clinicopathologic characteristics of lung adenocarcinoma and satisfy clinical needs,especially contributing to change and update the surgical strategy of early stage lung adenocarcinoma.

AIM:To investigate the role of damaged mitochondria in dendritic cell ( DC) apoptosis induced by Vibrio vulnificus (Vv) and its possible mechanism.METHODS: DC2.4 cells were co-cultured with Vv 1.1758 strain. Fluorescent probes DCFH-DA and Fluo-8-AM were used to detect reactive oxygen species ( ROS) and intracellular Ca 2+concentration in the invaded cells , respectively .The cellular apoptotic rates and mitochondrial membrane potential (Δψm ) were measured by flow cytometry.The expression of nuclear factor-kappa B p65 (NF-κB p65) and tumor necrosis factor-al-pha (TNF-α) was detected by Western blotting.RESULTS:Vv 1.1758 induced DC2.4 cell apoptosis.Vv 1.1758 bacte-ria invaded into the DC2.4 cells by binding with cellular membrane though the end of the body .In the invaded DC2.4 cells, the visible mitochondrial damage, elevated ROS and intracellular Ca2+levels, and declinedΔψm were presented.Af-ter 1 h of co-culture, NF-κB p65 began to rise and reached the peak at 5 h, and then slightly decreased at 6 h.The TNF-αlevel increased after 2 h of co-culture and reached the peak at 6 h.CONCLUSION:The damaged mitochondria play an important role in DC apoptosis induced by Vv , and its possible mechanism may associate with the elevation of ROS and in-tracellular Ca2+level, and the declined Δψm.Meanwhile, NF-κB p65 and TNF-αare potential critical signaling molecules in the process of apoptosis .

Objective To evaluate the safety and feasibility of totally thoracoscopic anatomic pulmonary segmentectomy (TTAS) for the treatment of the peripheral stage ⅠA non small cell lung cancer(NSCLC).Methods The study involved 50 consecutive patients undergoing totally thoracoscopic anatomic segmentectomy (TTAS) from September 2010 to November 2012 in the First People's Hospital affiliatied to Nanjing Medical University.The diameter of the tumors were less than 2 cm [(mean diameter(1.35 ±0.48) cm].All lymph node sampling of N1 and N2 were neglive,All patients received symtematic lymph node dissection.The pulmonary vessels were individually ligated,and the bronchi were closed using an endoscopic stapler.The intersegmental plane was identified using the demarcation between the resected(inflated) and preserved(collapsed) lungs.Staplers were used for intersegmental dissection.Results The mean operative time and intraoperative bleeding were (191.5 ± 50.4) min and (49.2 ± 54.6) ml respectively.The chest tube drainage duration was (3 ± 1) days.The number of stapler cartridges used for intersegmental division was 3.9 ±0.8.The mean number of lymph nodes and nodal stations dissected were 12.6 ± 2.8 and 6.0 ± 1.5 respectively.No mortality and complications were observed 30 days after the surgery.Further,no local recurrence or metastases were observed during follow-up.Conclusion Totally thoracoscopic anatomic segmentectomy(TTAS) is a feasible and safe technique.With systematic lymph node dissection,TTAS can be a reasonable therapeutic option for stage ⅠA NSCLC.

Objective To study the diagnostic value of calcification in differentiating benign and malignant thyroid lesions. Methods CT images of 318 consecutive patients with pathologically proven thyroid lesions were retrospectively reviewed by two radiologists. The following characteristics of calcification on CT images were evaluated: (1) size (≤2 mm indicating microcalcification and > 2 mm or shelly and irregular shape indicating macrocalcification, and both features indicating mixed calcification), (2) number (single or multiple) and (3)location (internal or edge). χ~2 test was used for statistical analysis. Results Oft he 318 cases, 48 were diagnosed as malignant (papillary carcinoma 26, follicular carcinoma 7, medullary carcinoma 3 and microcarcinoma 12) and 270 were benign (nodular goiter 36, adenoma 170, nodular goiter with adenoma 38 and adenoma with Hashimoto's thyroiditis 26). Calcification was found in 60 cases (18.9%). Among them 21 (papillary carcinoma 12,microcarcinoma 6,follicular carcinoma 2 and medullary carcinoma 1) were malignant(43.8%) and 39(nodular goiter 6, adenoma 13,nodular goiter with adenoma 19 and adenoma with Hashimoto's thyroiditis 1) were benign (14.4%) (P < 0.01). Sensitivity and specificity for diagnosing thyroid carcinoma were 43.8% (21/48) and 85.6% (231/270), respectively. Microcalcification was found in 37 cases (malignant 8, benign 29) and macrocalcification was found in 23 cases(malignant 13, benign 10) (P < 0.01) . Sensitivity and specificity of macrecalcification for diagnosing thyroid carcinoma were 61.9% (13/21) and 74.4% (29/39), respectively. Single calcification was found in 31 cases (malignant 13, benign 18) and multiple calcification was found in 29 cases(malignant 8, benign 21) (P >0.05). Internal calcification was found in 15 cases of malignant lesions(71.4%) and 12 of benign lesions(30.8%); Edge calcification was found in 6 cases of malignant and 27 of benign, (P <0.01). Sensitivity and specificity of internal calcification for diagnosing thyroid carcinoma were 71.4% (15/21) and 69.2% (27/39), respectively. Conclusion Internal calcification or(and) macrocalcification of the thyroid lesions may strongly suspect thyroid carcinoma and fine-needle aspiration or surgery should be further performed.