Objective To study the diagnosis of chronic lymphocytic thyroiditis (CLT), and the treatment of CLT companied with other thyroid diseases. Methods Clinical data of 63 cases of CLT were analyzed retrospectively. Results 26 cases were diagnosed by non-operative methods (11 cases by fine needle aspiration biopsy, FNAB). The rest of 37 cases were operated on because of misdiagnosis as other thyroid disease and then comfirmed as CLT by pathology. Of them, 2 were companied with nodular goiter, 6 with Graves' disease, 1 with thyroid adenoma and 2 with carcinoma, respectively. 19 cases were treated by thyroixine, 3 were not treated, 4 treated by operation after thyioxine managment and 37 were treated by operation. Non-operation group had rather satisfied effect in short-term period. 29 cases (78.4%) in operation group were followed up for 1 to 6 years, and 5 cases had hypothyroidism. Conclusions It is necessary to have complete serum immunologic examination and FNAB for suspect patients.They have to be examined carefully in order to avoid omitting complications and incsease the rate of diagnosis.Non-operative treatment is the major therapy of CLT. If CLT is companied with other thyroid disease, operation or non- operation should be adopted according to the pathological type.

Objective To investigate the characteristic, diagnosis and treatment of occult breast carcinoma(OBC). Methods The clinical data of 12 cases of OBC were analyzed retrospectively.Results All patients showed axillary node enlargement as the first sign and were operated on. The operation included axillary node excision (ANE) in 1 patient, axillary node excision plus simple mastectomy in another one, radical mastectomy in 6, and modified radical mastectomy in the other 4,respectively. Eleven patients (91.7%) were followed up for 1-15 years. During the follow up, 1 patient who underwent axillary node resection and 1 who received ANE plus simple mastectomy died of systemic metastasis,18 and 22 months after operation respectively;another case who subjected to radical mastectomy had axillary lymph node metastasis 3 years after the operation,and was re operated on,but the patient died of lung metastasis 4 years after the reoperation. And the others still survived, in which 2 have lived for over 3 years, 2 over 5 years, and 4 over 10 years. Conclusions For axillary mass which causes are uncertain, the possibility of OBC should be considered.Meanwhile excision and pathological examination are necessary. The metastatic histological structure of the axillary nodes usually provide important clue for the source of tumor. Radical or modified mastectomy is the best treatment,and post operative chemotherapy and/or radiotherapy should be done.

Objective To investigate the change of the serum matrix metalloproteinase-13 (MMP-13) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and the correlations of MMP-13 and TIMP-1 with bone metabolic markers or bone mineral density(BMD) in aged postmenopausal Chinese women.Methods One hundred and twenty women aged 48-65 years with postmenopausal were selected as subjects.They were divided into normal group(n =28),low bone mass group (n =36) and osteoporosis group (n =56) accordance with the WHO standard.The levels of serum MMP-13,TIMP-1,estradiol (E2),Osteoprotegerin (OPG),Osteoprotegerin ligand (OPGL),Procollagen terminal propeptide of N (PINP),and Type Ⅰ collagen cross-linked C terminal peptide(CTX) were measured using enzyme linked immunosorbent assay(ELISA).And the ratios of MMP-13 to TIMP-1 were calculated.Bone mineral density(BMD) of the lumbar spine,femoral neck,Fahrenheit and greater trochanter were measured using dual energy X-ray absorptiometry.Results There was significant difference of serum MMP-13 concentrations in normal controls,low bone mass group and osteoporosis group((27.08 ± 1.41) μg/L,(45.64 ± 1.62) μg/L and (44.25 ± 1.21) μg/L; F =110.314,P =000),and serum MMP-13 concentrations in low bone mass group and osteoporosis group higher than that in normal controls (P ＜ 0.05),serum MMP-13 concentrations in low bone mass group higher than that in osteoporosis group,but there was on significant difference(P ＞ 0.05).But Serum TIMP-1 concentrations in three groups was no significant difference (F =10.721,P =0.801).The ratio between MMP-13 and IIMP-1 was 0.185 ± 0.062,0.311 ± 0.053,0.332 ± 0.063 respectively,and there was significant difference of the three groups (F =137.771,P =0.000),and the ratio of the low bone mass group and osteoporosis group higher than the normal group(P ＜0.05),but there was no significant difference between the two groups.In osteoporosis group,Negative correlations between MMP-13,and BMD,E2 and OPGL,were found (r =-0.296,-0.198,-0.301,-0.298,-0.233 respectively,P ＜ 0.05).Meanwhile positive relations were found between MMP-13 and OPG,PINP,CTX (r =0.228,0.315,0.312 respectively,P ＜ 0.05).In low bone mass group,the level of MMP-13 was significantly relative with BMD (the lumbar spine,Fahrenheit),E2 and CTX (r =-0.188,-0.196,-0.235,0.289 respectively,P ＜ 0.05).Conclusion There are significant correlations between serum MMP-13,ratios of MMP-13 and TIMP-1 and bone metabolism marker and BMD.MMP-13 level may increase with increases in osteoporosis and osteopenia.The increases of serum MMP-13 and the decrease of ratio of MMP-13 to TIMP-1 might be biomarkers in high bone turnover state,such as postmenopausal osteoporosis and early stage of osteopenia.

Objective To explore the expressions of Dectin-1 and Toll-like receptor 4 (TLR4)and the secretory charateristics of inflammatory factors of the Aspergillus fumigatus infected cornea of the rats,and to clarify theirs role in the pathogenesis of rat keratitis.Methods 40 SD rats were separated into control group (n = 10)and aspergillus keratitis group (n=30).The rats in aspergillus keratitis group were infected by Aspergillus fumigatus in two eyes for 12,24 and 48 h,and the cornea tissue was took and ELISA kit was used to detect the level of inflammatory cytokines IL-1,TNF-a,IL- 6,IL-10,and NF-κB;immunohistochemistry,Western blotting and RT-PCR methods were used to determine the Dectin-1 and TLR4 protein and mRNA expressions.Results The rat models were successfully established.The eyes of the rats in control group were limpid tested by corneal slit lamp, however,there existed a clear boundary film on the surface of eyes of the rats in aspergillus keratitis group infected for 12 h,white infiltrates and bloodshot in the eyes in 24 h group and the white infiltrates were further strengthened and almost covered the entire eyes in 48 h group. The order of inflammatory cytokines IL-1,TNF-α,IL-6,IL-10, NF-κB was:48 h group> 24 h group> 12 h group> control group (P < 0.05),so did the expression levels of Dectin-1 and TLR4 protein and mRNA in various groups tested by Western blotting and RT-PCR methods.The expression levels of Dectin-1 and TLR4 were increased with the prolongation of time investigated by immunohistochemical staining.Conclusion Dectin-1 and TLR4 are secreted in excess after the eyes are infected with fumigatus,which promotes the expressions of related inflammatory cytokines and results in the occurrence of keratitis.

Infantile spasms constitutes an unique,age-specific epilepsy syndrome of early infancy characterized by epileptic spasms often accompanied by neurodevelopmental regression and an electroencephalograph finding of hypsarrhythmia.For the complex and various etiologies,the pathogenesis remains unclear.Although the relevant guidelines and consensuses are being updated all the time,but proven therapies are still limited because of efficacy,tolerability,at times even availability.In this paper,the current findings regarding up-to-date advances in the treatment of infant spasms were reviewed,especially in use of the corticosteroid and vigabatrin as well as the quality-of-care indicators for infantile spasms.

Objective To analyze the effect on reproductive potential of salpingectomy in child-bearing period women.Methods Two hundred and forty-six tubal pregnancy patients were chosen,among whom 164 patients performed salpingectomy were classified as research group,and 82 patients retained ipsilateral tubal through conservative treatment were classified as control group.The levels of sex hormone,ovarian volume,sinus number of follicle,ovulation rate,reproductive outcome and reproductive status were compared between 2 groups.Seven patients were lost in research group,and 3 patients were lost in control group.Results One,three and six months after β-human chorionic gonadotrophin (β-hCG) put back,the serum levels of follicle stimulating hormone (FSH),luteinizing hormone (LH) in research group were significantly higher than those in control group,FSH:(10.00 ±4.82) U/L vs.(6.69 ± 2.71) U/L,(9.11 ± 3.77)U/L vs.(6.81 ± 2.80) U/L,(8.30 ± 3.49) U/L vs.(6.41 ± 2.41) U/L;LH:(8.74 ± 3.56) U/L vs.(6.10 ± 2.59)U/L,(9.42 ± 3.09) U/L vs.(5.79 ± 2.10) U/L,(7.96 ± 2.53) U/L vs.(6.50 ± 2.71) U/L,and there were statistical differences (P ＜ 0.05).One and three months after β-hCG put back,the serum levels of estradiol (E2) and anti-Mullerian hormone (AMH) in research group were significantly lower than those in control group,E2:(111.44 ± 22.24) pmol/L vs.(128.22 ± 24.01) pmol/L,(108.74 ± 21.67) pmol/L vs.(126.30 ± 23.78) pmol/L;AMH:(3.22 ± 0.85) μ g/L vs.(3.64 ± 0.87) μ g/L,(3.67 ± 0.94) μ g/L vs.(3.83 ± 1.12) μ g/L,and there were statistical differences (P ＜ 0.05).Six months after β-hCG put back,there was no statistical difference in the serum levels of E2 and AMH:(127.85 ± 24.42) pmol/L vs.(131.28 ± 25.54) pmol/L and (4.35 ± 1.34) μ g/L vs.(4.47 ± 1.76) μ g/L,P ＞ 0.05.In salpingectomy patients,the ovarian volume and the sinus number of follicle at lesion side (salpingectomy side) after treatment of 6 months were significantly lower than those in no lesion side:(8.86 ± 2.36) cm3 vs.(9.74 ± 2.31) cm3 and (5.10 ± 1.14) pieces vs.(7.26 ± 2.52) pieces,and there were statistical differences (P ＜ 0.05).After treatment of 2 years,the rate of ectopic pregnancy in control group was significantly higher than that in research group:12.66％ (10/79) vs.5.10％(8/157),and there was statistical difference (P ＜ 0.05).Especially,the patients who retained ipsilateral tubal conservative treatment had higher ectopic pregnancy rate:8.86％ (7/79) vs.0,and there was statistical difference (P ＜ 0.05).Conclusions Salpingectomy can affect the reproductive potential,but it can decrease the probability of ectopic pregnancy.Whether patients with tubal pregnancy need to be treated by salpingectomy,depends on the extent of tubal lesions and fertility desire of the patients.

Purpose To explore the expression of two epithelial-mesenchymal transition (EMT) regulators,Sry-related high mobility group box 4 (SOX4) and enhancer of zeste homolog 2 (EZH2),in breast cancer tissues and their clinicopathologic significances.Methods The expression of SOX4 and EZH2 was detected by immunohistochemistry of EnVision twostep in paraffin-embedded tissue sections from 241 cases of breast cancer and 126 cases of paracancerous breast tissues.The relationship between their expression and clinicopathologic characteristics was statistically analyzed,and their correlation was also analyzed.Results In breast cancer tissues and paracancerous breast tissues,the high expression rates of SOX4 were 82.2％ and 57.1％ respectively,while the high expression rates of EZH2 were 80.1％ and 47.6％ respectively.Their expression in breast cancer tissues was higher than that in paracancerous breast tissues (P ＜ 0.05).High SOX4 expression was correlated with lymph node metastasis,high TNM stage,and overexpression of HER-2 (P ＜ 0.05),while high EZH2 expression was correlated with high histological grade,lymph node metastasis,ER negativity,EGFR positivity and high poliferation index of Ki67 (P ＜ 0.05).There was a positive correlation between SOX4 and EZH2 expression in breast cancer tissues (rs =0.256,P ＜0.001).Conclusion EMT regulators SOX4 and EZH2 might be responsible for the metastasis of breast cancer,which are upregulated in breast cancer tissues.They may act as potential biomarkers to predict the metastasis of breast cancer.

OBJECTIVE:To comparison the clinical efficacy and safety of sitagliptin and Repaglinide in the treatment of new-ly diagnosed patients with type 2 diabetes mellitus. METHODS:214 newly diagnosed patients with type 2 diabetes mellitus were randomly divided into study group and control group with 107 cases in each group according to random number table method. Both group received routine diabetes diet,health education and suitable exercise. Control group was treated with Repaglinide tablet 1.0 mg,tid;while study group was treat with Sitagliptin tablet 100 mg,qd. Lab indexes,FBG,PBG,HbA1c and BMI were observed in 2 groups before and after treatment. ADR were compared between 2 groups. RESULTS:There was no statistical significance in lab indexes between 2 groups before and after treatment (P>0.05). After treatment,FBG,PBG,HbA1c were significantly de-creased significantly in 2 groups,with statistical significance (P<0.05),there was no statistical significance between 2 groups (P>0.05). BMI of 2 groups were increased significantly,and the study group was higher than the contrd group,with statistical sighificance (P<0.05). Patients in the study group had no hypoglycemia,while 3 patients in the control group suffered from it, there was statistical significance (P>0.05). CONCLUSIONS:Sitagliptin is similar with repaglinide in therapeutic efficacy;both can effectively reduce blood glucose of elderly patients with newly diagnosed type 2 diabetes mellitus,and the incidence of hypo-glycemia was low,the saterty was good,but sitagliptin has a better control of BMI in patients.

BACKGROUND:The animal model of high fat diet-induced obesity is the first choice for the study of human obesity. Leptin and its receptor expression play an important role in the high fat diet-induced obesity and obesity resistant, but the exact mechanism and the role of swimming are not clear.
OBJECTIVE:To explore the effect of 7-week swimming on serum leptin and leptin receptor expression in hypothalamus in rats with high fat diets.
METHODS:A total of 60 Sprague-Dawley rats were fed with high fat diets for 8 weeks. Thediet-induced obeseand obese resistant rats were selected based on the body weight. 14 obese rats were equaly divided into two groups: obese group and obese-exercise group; and 14 obese resistant rats were equaly divided into two groups: obese resistantgroup and obese resistant-exercise group. Al the rats were continualy given high fat diets. Exercise groups accepted free swimming training for 7 weeks at the same time.
RESULTS AND CONCLUSION:Compared with the obese group, obese-exercise group had obviously decreased in body weight, fat pad weight, fat pad weight/body weight and serum leptin concentration. And obese-exercise group had obviously increased receptor mRNA expression in hypothalamus. There was no significant change in above indexes betweenthe obese resistant group and obese resistant-exercise group. Theresults showed that swimming exercise can increase energy consumption and improve metabolism, which decreased the concentration of leptin and effectively improved leptin receptor expressionin the hypothalamus to ease leptin resistance and improve the body’s metabolism.

Objective To analyze the difference of the peripherally inserted central venous catheter (PICC) and central venous catheter (CVC) in cancer chemotherapy.Methods All eligible studies on PICC and CVC were searched in China National Knowledge Infrastructure,Wanfang database and VIP database.The Jadad scale was used for quality assessment of all the included studies.All analysis were conducted in Stata 12.0.Results Thirty-six studies with a total of 4920 cases of patients were included in this meta-analysis,with 2349 cases in PICC group and 2571 cases in CVC group.PICC group had advantages in puncture success rate for the first time,the average puncture time,the average catheter time than the CVC group.PICC group had fewer complication,such as the hemopneumothorax incidence,the strayed artery incidence and catheter infection incidence; however,the phlebitis incidence was higher than the CVC group.Conclusions PICC has some advantages specific in simple operation,a long retention time,fewer complications and safety.Therefore,PICC can be widely used in cancer chemotherapy.