Objective: To review the experience of using the transit time flow measurement(TTFM) in coronary artery bypass grafting(CABG). Methods: From Sept.2001 to May, 2002,90 cases underwent CABG. Among them, 40 cases with off-pump beating heart (OPCAB) and 50 with conventional coronary bypass grafting. All graft patency were verified intraoperatinlly with TTFM. The flow value of left internal mammary artery (LIMA) in 30 cases was also detected by the same way before grafting to left anterior descending (LAD). Results: There was no operative death and severe complications. The mean flow value of LIMA in 30 cases was (42.9?33.0)ml/min. The actual blood flow value, measured simultaneously by exsanguination was (37.4?28.8)ml/min. Excellent correlation was demonstrated. The mean pulsatility index value (PI) was 1.00?0.04. The flow curve showed both diastolic and systolic filling. The mean flow value of LIMA to LAD, saphenous vein graft (SVG) or radial artery (RA) to circumflex coronary artery (LCX) or diagonal (D), SVG or RA to right coronary artery (RCA) or post anterior artery (PDA) were (29.9?9.5)ml/min, (33.7?17.5)ml/min and (31.5?19.2)ml/min. The PI values were 2.47?0.88, 4.00?1.90 and 2.60?1.30, respectively. The typical flow curve was shown in all LIMA to LAD, and SVG (or RA) to LCX (or D). Blood flow filling was mainly during diastole with minimal systolic peaks during the isovolumetric ventricular contraction. SVG or RA to RCA presents a particular flow pattern characterized by a dual filling. 6 grafts were revised basing on unsatisfied flow curves, PI, and the mean flow or all of them. Significant technical error such as conduit kinking, stenosis of distal anastomosis was found. Conclusion: The patency of graft in CABG can be verified in intraoperatively by use of TTFM. The decision of checking or revising a graft can be made basing on parameters acquired from the TTFM device. To correctly analyze the parameters warrants good clinical results.

Objective To investigate the cause of reoperation for high differentiated thyroid carcinoma and the risk factors of neck lymph node metastasis in reoperation. Methods Retrospectively reviewed the clinical data of 54 high differentiated thyroid cancer patients from 1998 to 2005, who received reoperation and neck lymph node dissection simultaneously. Results The residual thyroid carcinoma rate and lymph node metastasis rate were higher in 39 patients who initially received partial thyroidectomy than in 15 who previousely underwent radical operation(P <0. 05). Age less than 45 years, lymphadenectasis before initial operation, tumor residued or relapsed, muhicentricity of primary cancer and blurred boundary between cortex and medulla of lymph node were the risk factors for ipsilateral lymph node metastasis(P <0. 05), while mul-ticentricity of primary cancer and contralateral thyroid cancer were the risk factors for contralateral lymph me-tastasis (P < 0. 05). Conclusions Individual standard radical operation and necessary lymph node dissection are important measures to prevent recurrence and reoperation. Completion thyroidectomy and modified or selec-tive neck dissection are recommended for reoperation patients with the risk factors of lymph node metastasis.

BRAFV600E mutation is the most common genetic alteration in the papillary thyroid carcinoma.It plays an important role in the tumorigenesis,invasiveness and metastasis of the papillary thyroid carcinoma.Testing of BRAFV600E mutation is of great value in diagnosis,which also can be used as a prognostic maker of papillary thyroid cancer.Inhibitors treatment targeted to BRAF kinase and its downstream effectors is a new area in the treatment of BRAFV600E mutated thyroid cancer.

TSH suppression therapy plays an important role in differentiated thyroid carcinoma. It can lower mortality and recurrence rate in high risk patients. Meanwhile, it also has potential side effects on cardiovascular and skeletal systems. Thus, TSH suppressive therapy should be individualized in regard to its possible benefit and potential adverse effects.

Postoperative hypothyroidism is the most common complication following thyroidectomy,and thyroxine replacement is needed to maintain thyroid function.Levothyroxine (L-T4) is the preferred drug for the treatment of hypothyroidism.L-T4 therapy can be initiated immediately after thyroid operation,and the dosages are influenced by target serum TSH and several other factors.Special consideration should be taken for such patients,including patients with poor compliance,during pregnancy,and elderly patients.Thyroid function should be measured every 4 to 6 weeks,optimal dosages are adjusted according to target serum TSH individually,avoiding under-treatment or over-treatment.T3 in divided doses or L-T4/T3 combination therapy can be served as alternative for those failed to L-T4 therapy alone.

AIM:To study the chemical constituents of the leaves of Cyclocarya Paliums(Batal.) Iljinskaja. METHODS: Chemical constituents were separated through chromatographic methods and their structures were elucidated by spectral analysis. RESULTS: Six compounds were isolated from the chloroform fraction through 75% alcohol extraction from the leaves of Cyclocarya Paliums.Their structures were elucidated as ?-Sitosterol(1),Behenic acid(2),3?,20-dihydroxyl-5?-Pregnanes(3),Kaempferol(4),?-amyrin(5),?-amyrone(6). CONCLUSION: Compounds 3?,20-Dihydroxyl-5?-Pregnanes(3),?-amyrin(5) and ?-amyrone(6) are isolated from this plant for the first time.

Objective To study the clinical value of peritoneal cavity non-drainage after the operation of acute perforating appendicitis.Methods 196 patients with perforating appendicitis were randomly divided into drainage group and non-drainage group.The incidence rates of wound infection and ankylenteron and hospital durations in the two groups were observed and compared with each other.Results The incidence rate of wound infection and ankylenteron were 19.0%,10.7% in the drainage group and 8.0%,4.5% in the non-drainage group respectively(P0.05).The mean postoperative hospital stay of the drainage group was(9.3?2.7)days,which was significantly longer that of the non-drainage group(5.1?1.9)days,P

Background: There is no gold standard for the diagnosis and monitoring of inflammatory bowel disease (IBD).As immune system plays crucial role in the pathogenesis of IBD,some immune-specific serum antibodies are considered to be useful tools for the diagnosis and differential diagnosis of the disease.Aims: To investigate the clinical significance of serum antibodies,including anti-Saccharomyces cerevisiae antibody (ASCA) and perinuclear anti-neutrophil cytoplasmic antibody (pANCA) in IBD.Methods: Serum samples were obtained from 91 consecutive IBD patients from Feb.2015 to May 2016 at the First Affiliated Hospital of Soochow University.Of them,52 were Crohn's disease (CD) and 39 were ulcerative colitis (UC).Serum samples of 36 non-IBD patients were served as controls.ASCA-IgG and ASCA-IgA were detected by ELISA,and pANCA by indirect immunofluorescence assay.Using clinical diagnosis as gold standard,crosstabs statistics was performed to measure the diagnostic accuracy of ASCA and pANCA,and ROC curve,Pearson Chi-square test and Fisher's exact test were employed for analyzing the correlations of these two serum antibodies with IBD,CD,UC,and the location of the disease.Results: Both serum ASCA-IgG and IgA were correlated with CD (AUC=0.626 and 0.614),while UC was correlated with ASCA-IgA only (AUC=0.486).Serum pANCA had relevance to IBD (r=0.342),CD (r=-0.262) and UC (r=0.614);its sensitivity and specificity for IBD and UC were superior to those for CD (P＜0.05).In CD patients,ASCA-IgG was associated with terminal ileal disease (P＜0.05),and pANCA was associated with colonic involvement (P＜0.05).In UC patients,both ASCA-IgG and IgA were correlated with terminal ileal disease (P＜0.05).Conclusions: Serum ASCA and pANCA may be helpful for discrimination between CD and UC when the diagnosis of IBD is established.Furthermore,they are closely associated with the disease location,ASCA is related with the terminal ileal disease and pANCA is related with colonic involvement.

Objective To investigate the effect of brain natriuretic peptide (BNP) on serum angiotensin-converting enzyme (ACE) 2 levels in acute heart failure patients with reduced ejection fraction (HFrEF). Methods A total of 106 patients with acute HFrEF were selected, and were divided randomly into control group and trial group. The control group was under routine treatment, while the trial group was under routine treatment combined with lyophiluzed recombinant human BNP for 24-hour. Cardiac functional parameters were measured by echocardiography both at the enrollment and the end of 7-day treatment. Serum levels of ACE2 and N-terminal pro-BNP (NT-proBNP) were determined using commercially available ELISA kits at the enrollment, the end of 24-hour treatment, and the end of 7-day treatment,respectively. Results A total of 103 patients with acute HFrEF were enrolled (control group=51, trial group=52). There were no significant differences in the use of drugs (e.g., aspirin) and serum biochemical indices (e.g. cardiac troponin I, creatinine) before treatment between these two groups. Compared to systolic blood pressure (SBP) at admission, SBP on the second day after treatment were significantly decreased in two groups (P<0.05). Compared to left ventricular ejection fraction (LVEF) at admission, LVEF values were significantly elevated on the seventh day after treatment in two groups ( P<0.05). There were no significant differences in SBP, diastolic blood pressure (DBP), and LVEF at admission between these two groups (P>0.05);there were also no significant differences in DBP on the second day after treatment, and LVEF on the seventh day after treatment (P>0.05), while SBP was significantly higher on the second day after treatment in control group than that of trial group (P < 0.05). Serum levels of NT-proBNP were decreased with the prolongation of time in two groups. Serum levels of ACE2 were decreased with the prolongation of time in control group, while were increased initially following decreased (which were still higher on the seventh day after treatment than that at admission) with the prolongation of time in trial group. Serum levels of NT-proBNP were higher after 2 days treatment or 7 days of treatment in control group than those of trial group, while serum levels of ACE2 were decreased after 2 days of treatment or 7 days of treatment in control group than those of trial group (P<0.05). Conclusion Patients with acute HFrEF may benefit from BNP by increasing serum ACE2 levels.

Objective To study the effects of different type of parathyroid damage to the postoperative functional recovery of parathyroid,through establish an animal model by simulating total thyroidectomy and parathyroid damage during surgical operation.Methods Experimental rabbits for the study were randomly divided into A,B,C,D four groups (n =8),Group A (control group):simple exposure,exploration thyroid and parathyroid;group B (vascular injury group):total thyroidectomy and ligation bilateral parathyroid blood supply but keep the surrounding membrane;Group C (membrane damage group):total thyroidectomy and damage membrane but reservations blood supply.Group D (composite damage group):total thyroidectomy plus membrane and blood both damage;All animals were monitored of serum calcium and PTH,preoperative 1 days and postoperative 1 st day,3rd day,5th day,7t day;cut the parathyroid HE staining to observed survival of parathyroid tissue and pathology damage when 7th day after operation.Results (1) Animals in each group preoperative serum calcium and PTH were no significant difference (P ＞0.05);(2)Group A postoperative serum calcium decreased,but at 5th day returned to preoperative level (P ＞ 0.05);Group B and C postoperative 1st day,3rd day,5th day serum calcium decreased significantly(P ＜ 0.05)and to the lowest at 1 d and then gradually recovered,but group C faster recovered than group B (P ＜ 0.05);Group D postoperative 1 st day,3rd day serum calcium continued to decline significantly (P ＜ 0.05);(3) Group A postoperative serum PTH decreased,but at 7th days returned to preoperative level (P ＞ 0.05).Group B and C postoperative 1st day,3rd day,5th days serum PTH decreased significantly(P ＜0.05)and to the lowest at 1 d and then gradually recovered,but from postoperative 3rd day group C faster recovered than group B(P ＜ 0.05);Group D postoperative 1 st day,3rd day serum PTH continued to decline significantly (P ＜ O.05);(4) Pathology results:Group A parathyroid filled with chief cells and a small amount of vacuolar changes (5％ to 10％);Group B parathyroid hemorrhage,necrosis (40％ to 50％),part of the cell degeneration (30％ to 40％),center with fibrosis,seen granuloma and hyperplasia of parathyroid tissue in surrounding;Group C parathyroid bleeding (10％ to 20％),part of the cell degeneration (10％ to 20％);Group D parathyroid severe necrosis,almost no normal parathyroid tissue,significant fibrosis,less residual parathyroid tissue was scattered.Conclusions (l) The recover of Parathyroid function is influenced by the type of parathyroid in situ injury during thyroidectomy,composite damage of blood supply and membrane of parathyroid is the most serious,parathyroid ischemia necrosis,the function can not be restored,pure blood supply damaged,some can restore function,and the parathyroid gland with vascular pedicle can be recovered quickly.(2) Severe blood supply and membrane damaged,and even free parathyroid should be transplanted immediately during operation.