This article was aimed to explain the distribution of syndrome and study the change of pathogenesis in patients of acute exacerbation of chronic obstructive pulmonary disease risk-window (AECOPD-RW) based on clini-cal investigation. The data of the traditional Chinese medicine (TCM) syndrome of patients diagnosed as AECOPD into AECOPD-RW were collected from 8 hospitals. The database was established. Data was analyzed with SPSS 13.0 software. The results showed that among 15 basic syndromes, the syndrome of lung-qi deficiency was with the high-est frequency, which was followed by the syndrome of kidney-qi deficiency and syndrome of phlegm-dampness. A-mong 14 combined syndromes, the syndrome of lung-kidney qi deficiency and the syndrome of phlegm-dampness ac-cumulated in the lung were with the highest frequency. The common syndromes of AECOPD-RW were the syndrome of lung-kidney qi deficiency combined with the syndrome of phlegm-dampness accumulated in the lung, the syn-drome of lung-kidney qi deficiency, the syndrome of lung-spleen qi deficiency combined with the syndrome of phlegm-dampness accumulated in the lung, the syndrome of lung-spleen qi deficiency, the syndrome of lung-kidney qi-yin deficiency combined with the syndrome of phlegm-dampness accumulated in the lung, the syndrome of lung-kidney qi-yin deficiency, the syndrome of lung-kidney qi deficiency combined with the syndrome of phlegm-stasis accumulated in the lung, and the syndrome of lung-kidney qi-yin deficiency combined with the syndrome of phlegm-stasis accumulated in the lung. It was concluded that the main common syndromes of AECOPD-RW was the mixture of deficiency and excess. There was relatively less pure deficiency and excess syndrome.

Objective:To investigate clinical features and prognosis of purulent meningitis in premature infants versus full-term infants and to better understand purulent meningitis and improve the diagnosis and treatment of purulent meningitis in infants. Methods:The clinical data of 54 infants with purulent meningitis who received treatment in Shanxi Children's Hospital, China between January 2017 and December 2019 were included in this study. The included infants were divided into preterm group (gestational age < 37 weeks, n = 11) and full-term group (gestational age 37-42 weeks, n = 43) according to different gestational ages. Clinical features and cerebrospinal fluid biochemical indexes (white blood cell count, protein concentration, glucose level) as well as total effective rate were compared between the preterm and full-term groups. Results:The main clinical features of neonatal purulent meningitis were fever, bradykinesia, low amount of milk intake, convulsion, lethargy, irritability, increased intracranial pressure, hypotonia or hypertonia. Hypotonia was the prominent manifestation in the preterm group, while fever, convulsion and bradykinesia were the prominent manifestations in the full-term group. White blood cell count and cerebrospinal fluid glucose level in the preterm group were significantly higher than those in the full-term group ( t = 2.215, 2.023, both P < 0.05), but cerebrospinal fluid protein level in the preterm group was significantly higher than that in the full-term group ( t = 2.437, P < 0.05). There was no significant difference in total effective rate between preterm and full-term groups [90.91% (10/11) vs. 90.70% (39/43), χ2 = 0.001, P > 0.05]. Conclusion:The clinical features of neonatal purulent meningitis are not specific, and the clinical features of premature infants with purulent meningitis are not typical. It is necessary to carefully observe the clinical manifestations of premature infants with purulent meningitis and detect the biochemical indexes of cerebrospinal fluid to strive for early diagnosis and treatment.

Extracorporeal membrane oxygenation (ECMO), a kind of life support technology that can replace lung and heart function, is widely used in critical respiratory and circulatory exhaustion. Because of the serious diseases and the use of interventional catheters, patients receiving ECMO life support are often administrated with broad-spectrum antimicrobial agents, which increase the risk of fungal infection. Fungal infection during ECMO can increase mortality. How to effectively control fungal infection is a thorny problem faced by clinicians. During the treatment of ECMO, the patient's physiological status, ECMO oxygenation membrane, circulation pipeline and other factors may change the pharmacokinetic profiles of antifungal drugs, thereby affect the clinical efficacy of drugs. This artical reviews the pharmacokinetic characteristics of antifungal drugs during ECMO support, in order to provide references for clinical antifungal treatment.

Objective:To analyze the relationship between surgical resection range and prognosis of medullary thyroid carcinoma.Methods:Clinical data of 39 patients with medullary thyroid carcinoma treated in Shanghai Sixth People′s Hospital from Jan 2017 to Mar 2020 were retrospectively analyzed.Results:There were 13 males and 26 females, age ranging from 26 to 72 years old. Preoperative calcitonin levels increased from 21.5 to 20 000 ng/L. Tumor stage: stage Ⅰ was 35.9%, stage Ⅱ 23.1%, stage Ⅲ 25.6%, stage Ⅳ 15.4%. The proportion of lymph node metastasis in central region was 53.8% (21/39). The proportion of lateral cervical lymph node metastasis was 43.6% (17/39), which was statistically related with the preoperative calcitonin level ≥200 ng/L. The median follow-up was 10 months, and the biochemical and anatomical cure rates were 66.7% and 33.3% respectively. Transient recurrent laryngeal nerve palsy, temporary and permanent hypothyroidism were 2.6%, 23% and 2.6%, respectively. There was no postoperative hemorrhage, infection, lymphatic leak or death.Conclusions:Bilateral total thyroidectomy, and at least ispilateral central lymph node dissection were advocated for patients with MTC. When preoperative calcitonin level ≥200 ng/L, lateral cervical lymph node dissection is advised.

One of the major risks of total thyroidectomy, especially with central cervical lymph node dissection, is unintentional resection and devascularization of the parathyroid gland (PG) , which leads to temporary or permanent hypoparathyroidism (hypoPT) and causes hypocalcemia. Nowadays postoperative hypoPT is one of the most troubling complications for both surgeons and patients all around the world. In addition, primary or renal hypoPT requires the removal of pathological PG (s) . However, rapid identification of PGs, particularly ectopic or excess PG, could be sometimes difficult. Currently, the identification and protection of PGs mainly depend on the experience of surgeons and auxiliary methods such as fast frozen pathology, the negative imaging through nano-carbon, or PTH test strip, still have some limitations. As initial researches show, near-infrared autofluorescence imaging and optical coherence tomography can accurately perform the real-time identification of PGs; indocyanine green fluorescence or laser speckle contrast imaging can help to judge the activity of PGs intraoperatively. The basic principle, clinical application and prospect of these optical techniques in thyroid and parathyroid surgery will be reviewed in our article.

The occurrence and progression of thyroid cancer are related to a series of molecular changes and the activation of signaling pathways, which is the basis of targeted therapy. For inoperable locally advanced, metastatic and refractory thyroid cancer, especially anaplastic thyroid cancer, the efficacy of targeted therapies, particularly tyrosine kinase inhibitors (TKIs) , has been demonstrated in clinical trials. TKIs can relieve clinical symptoms, improve patients’quality of life, prolong the progress free survival, and even create opportunities for radical operation or reoperation. This article reviews and summarizes the key molecular events in tumorigenesis and progression of thyroid cancer, and analyzes the results of clinical studies on the efficacy and safety of different TKIs in refractory advanced thyroid cancer, in order to provide reference and assistance for individualized targeted therapy of patients.

Hypercalcemic crisis (HC) is a rare but critical electrolyte disorder, which may result in death if rapid correct management is not given due to the injury of the neurologic, cardiovascular and renal systems. Severe primary hyperthyroidism (PHPT) is listed as the most common cause of hypercalcemic crisis. Prompt surgical removal of the parathyroid glands is the most effective cure for HC. Nevertheless, hypercalcemic crisis after a successful parathyroidectomy is infrequent. Now, we report a case admitted to the Department of General Surgery of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital about a successful therapy of hypercalcemic crisis postparathyroidectomy in Sep. 2019, aiming to remind clinicians of the individualized program of calcium supplement after surgery of hyperparathyroidism and emphasize the value of renal dialysis in HC.