Medullary thyroid carcinoma (MTC) arises from parafollicular or C cells, and accounts for 5% - 10% of all thyroid cancers. MTC is hereditary in about 25% of cases. Lymph node and distant metastasis can appear in an early time, so early diagnosis and treatment is essential. In this review, the main performance of laboratory and imaging are described. The current management and preventive measure are also described.

Objective To investigate the effect of acute physiology and chronic health evaluationⅡ ( APACHEⅡ) scoring system on evaluating the severity and prognosis in severe acute pancreatitis(SAP). Methods The APACHEⅡ scores were analyzed in 52 patients with SAP. Results The mean APACHEⅡ score of SAP was 16.60?9.07(8～40), and there were significant differences between the scores not only in Grade SAPⅠand Grade SAPⅡ(?

Objective To investigate the role of individualized and staged enteral nutrition in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 204 cases of SAP treated with individualized stage enteral nutrition in our hospital from January 2000 to March 2008 were retro-spectively analyzed, Results The liver function and serum lipid and diet returned to the normal level after the treatment.Pancreatic encephalopathy disappeared.The patients recovered and were dis-charged from the hospital with the extraction of feeding tube.Enteral nutrition was adjusted based on the monitoring results in the hospitalization period that brought less effect to the pseudocyst of pancre-as, and then discharged from the hospital with the feeding tube.The pseudocyst in 49 cases disap-peared spontaneously and it was cured with internal drainage for 3 months in other 32.The time of en-teral nutrition was 20-95 d.Conclusion Enteral nutrition is safe and necessary after the acute stage of SAP.To ensure the enteral nutrition to play a more important role in the treatment of SAP, we must pay more attention on the individualization and stage of enteral nutrition.

Objective To investigate the mental health status and related personality type of psychological clinic adoleScent in general hospital and provide data for psychology treatment and intervention.Methods 219 adolescence consulters in 2006 were tested by symptom checklist(SCL-90) and eysenck personality questionnaire(EPQ).The caseswere separatedthree age groups,A group(16～20 years old),B group(21～25 years old),C group(26～30 years old)and disposed by SPSS 13.0.Results All factor scores of SCL-90 in psychological clinic adolescents were higher than those of youth norm in China(P＜0.01).The scores of female consulters were significant higher than those of male in depression(P＜0.05).The incident rate of mild mental obstacle(factor score＞2)in 3 age groups were significant different.The incidence rate of B and C groups were higher A group(P＜0.01).The factor scores were positive associated with P in EPQ and negative associated with L in EPQ.The obsession score of SCL-90 was negative associated with E in EPQ.Conclusions The mental health status of psychological clinic adolescents was not as good as norm adolescents.In psychological consulting and psychological health service,measures in different age and different personality could help build up healthy personality and effectively promote the development of mental health.

Objective To improve the management of blunt pancreatic trauma, and to explore the strategy of preserving the pancreatic endocrine and exocrine function to the full extent. Methods 20 cases of blunt pancreatic trauma were reviewed and analyzed retrospectively. The methods of operative treatment were analysed. Results All patients were cured. Depending on the general condition, abnomial signs and main pancreatic duct(MPD) injuries at the time of admission, patients received immediate operation or nonoperative treatment. Because of severe peritonitis and demonstrated MPD injury, 10 patients underwent immediate operations, including simple drainage in 6 cases, distal pancreatectomy in 1 patient, external drainage of the injured pancreatic duct for the second operation in 3 cases. Without the demonstrated MPD injury or clinical deterioration, 10 patients received nonoperative treatment under strict observation initially. 3 patients completed the nonoperative course and 7 patients underwent delayed operations, including Roux-en-Y pancreatic cyst-jejunostomy in 3 cases, external drainage of pseudocyst in e cases, pancreaticoduodenectomy in 1 patient because of the expanded hematoma in pancreatic head. Conclusions Blunt pancreatic trauma could receive individual pancreas-preserving treatment, which could improve the operational safety, avoid the resection of pancreas and preserve the pancreatic endocrine and exocrine function to the full extent.

ObjectiveTo evaluate the clinical application of Kugel hernioplasty via anterior approach for inguinal hernia repair.MethodsA retrospective study was made to analyze the clinical data of 851 cases(956 hernias) treated with Kugel hernioplasty via anterior approach for inguinal hernias from November 2005 to May 2011.ResultsOperative duration was(42 ± 11) minutes.The postoperative complications were detected on 21 hernias of seroma,8 hernias of hematoma,12 hernias of sub dermal ecchymosis,26 hernias of foreign body sensation and 5 hernias of recurrence.No incision infection occurred.Conclusions Kugel hernioplasty via anterior approach can repair and strengthen the whole anatomy area of myopectineal orifice.It is available for various kinds of inguinal hernias.

ObjectiveTo study the changes of serum levels of tumor n(ee)rosis factor-α (TNF-α),diamine oxidase (DAO),the expression of tight junction protein-1 (zonula occludens 1,ZO 1 ) in acute necrotizing pancreatitis (ANP) rats after ulinastatin intervention.Methods SD male rats were randomly divided into sham operation (SO) group,ANP group and ulinastatin treatment group.ANP model was induced by injecting 5％ sodium taurocholate into biliary and pancreatic duct.The rats were sacrificed at 6 and 24 hours,and then the levels of TNF-α,DAO and pathology change in pancreatic and intestinal were determined.The expression of bowel mucosa ZO-1 mRNA and protein was detected by RT-PCR and immunohistochemistry.ResultsSix hours after ANP induction,massive pancreatic necrosis and inflammatory cells infiltration were present,while epithelium necrosis of villi in ileum,vessel hemorrhage and inflammatory cells infiltration was found.The pathologic injury of pancreas and ileum in ulinastatin group was reduced when compared with that in ANP group.The serum levels of TNF-α were ( 10.83 ± 0.96),( 181.89 ± 4.93 ),( 128.23 ± 2.40) ng/L in SO group,ANP group and ulinastatin group; and the activities of DAO were (354.79 ±3.67),(117.21 ±5.58),(282.98 ± 9.12 ) U/L; the expressions of ZO 1 protein were 10.00 ± 1.87,1.20 ± 0.84,5.80 ±2.86; and the expressions ofZO 1 mRNA were 0.878 ±0.015,0.466 ±0.023,0.778 ±0.033.The serum level of TNF-α in ANP group was significantly higher than that in SO group,while the activities of DAO,expressions of ZO 1 mRNA and protein in ileum were significantly lower than that in SO group ( P ＜ 0.05 ).The serum level of TNF-α in ulinastatin group was significantly lower than that in ANP group,while the activities of DAO,expressions of ZO 1 mRNA and protein in ileum were significantly higher than that in ANP group (P ＜ 0.05).ConclusionsUlinastatin may inhibit the over release of TNF-α and improve plasma DAO activity,then increase the expression ofZO-1 mRNA and protein,thus protect the intestinal mucosa barrier.

Objective To explore the factors affecting the prognosis of pancreatic cancer patients,using COX risk model to carry on the statistical analysis of 154 cases of pancreatic carcinoma.Methods Retrospectively analyzed 154 pancreatic cancer cases' history date treated in April 2001-April 2008 of Fujian Medical University Union Hospital.Survival rate was caculated by Kaplan-Meier estimation while survival cruve was analysed by Log-rank test.Prognostic factors were studied by multivariate analysis with COX proportional hazards survival model.Results In this group,survival time was from 1 to 106 months and the median survival time was 8 months.Overall survival rates at 6 months,12 months,18 months,36 months were 58.4％,29.2％,16.3％ and 3.7％ respectively.Multivariate revealed that independent prognostic factors were follows:TNM tumor staging,operation mode and synthetic therapy.Conclusions The prognosis of patients with pancreatic carcinoma is determined by multiple factors.Patients of advanced TNM staging have a poorer prognosis.Radical resection and comprehensive treatment of patients prognosis is better.

Objective We increase the soluble expression of artificial tandem hybrid ubiquitin binding domains ( ThUBD) in prokaryotic cytoplasm of Escherichia coli BL21 ( DE3 ) , which offer an effective and special profiling for ubiquitin conjugates( UbC) .Methods Codon optimization of the ThUBD was performed, followed by analysis of codon relative adaptiveness based on relative frequency of synonymous codon ( RFSC) of E.coli.Further induced expression and yeast ubiquitin conjugate enrichment quantified the soluble ThUBD-S and tested the ability to bind UbC.Results The statistical result showed that the percentage of codon of the highest usage frequency was increased from 48%to 75%, and codon adaptation index( CAI) was increased from 0.63 to 0.88 after codon optimization, which might suggest a higher expression of the ThUBD in E.coli BL21 (DE3).The subsequent SDS-PAGE indicated that the soluble target protein was increased four times, which accounted for 13.06%of total cell lysis.Further ubiquitinated proteome of yeast demonstrated that the ability to bind and enrich UbC of optimized ThUBD-S did not change compared with original ThUBD.Conclusion The expression of ThUBD-S can quadruple after codon optimization.At the same time, codon optimization does not impact its soluble expression and the ability to bind UbC.

Objective To evaluate clinical application of Kngel patch in treating recurrent inguinal her-nia. Methods The clinical data of 65 patients with 77 sides recurrent inguinal hernia performed open preperitoneal inguinal hernia repairs from January 2005 to June 2009 were analyzed retrospectively. Kugel hernia patches were used in the operations. Results The operating time for unilateral hernia expended 40 ～ 150(76.5±20. 4) min. Postoperative pain was minimal and no incision infection appeared. The postopera-tive complications were 4 cases of uroschesis,6 cases of inguinoscrotal seroma, 2 cases of inguinoscrotal he-matoma and 3 cases of serotal hydrops. No serious complications such as sensation of foreign body, inguinal chronic pain and recurrence were observed during the follow-up of 3 to 54 months. Conclusions Open preperitoneal hernia repair with Kngel patch for adult recurrent inguinal hernia reparation is rational and fea-sible.