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.

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.

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.

The cartilage-protective effect of ginkgolide C(GC)on the two modeling modalities was investigated based on joint pain,degree of cartilage pathology,ECM degradation process,and level of inflammatory mediator production in rats.Twenty-five SD rats were selected and randomly di-vided into five groups:the control group(Control group),model 1 group(ACLT group),adminis-tration 1 group(ACLT+GC group),model 2 group(MIA group),and administration 2 group(MIA+GC group.)The rats were euthanized after 4 weeks of the test.Femur,tibia and blood samples were collected from the right hind limb of rats.The degree of pathology in the femur and tibia of rats was assessed by saffron O solid green staining and OARSI score.Immunohistochemis-try was used to detect the expression levels of collagen Ⅱ and MMP-13 in cartilage.ELISA was used to detect the changes in the levels of MMP-3,MMP-13,CTX-Ⅱ,COMP,COX-2,INOS,IL-1β,and TNF-α in the serum of rats.Cold sensitivity test and knee extension vocalization test were conducted to detect the degree of joint pain in rats.ACLT could cause more severe structural dam-age to articular cartilage compared with the MIA group.The OARSI scores and the expression of MMP-13 in femur and tibia,and the serum levels of MMP-13,MMP-3,CTX-Ⅱ,and COMP were higher in the ACLT group than those in the MIA group.However,the levels of inflammatory me-diators COX-2,IL-1β,and TNF-α were significantly lower in the ACLT group than in the MIA group(P＜0.0l).GC intervention reduced the OARSI score(P＜0.05 or P＜0.01)and pain scores,inhibited the ECM matrix degrading enzymes(MMP-13,MMP-3),cartilage metabolism markers(CTX-11,COMP),and inflammatory mediators(COX-2,INOS,IL-1β and TNF-α)ex-pression,and promoted collagen Ⅱ synthesis.Both modeling methods resulted in cartilage damage.In particular,the OA model constructed by ACLT+PMMx method in rats had obvious joint dam-age,which was favorable to investigate the degree of cartilage structural damage.GC attenuated cartilage pathological changes,pain severity and inflammatory response in the rat OA model in both groups,thus exerting a cartilage-protective effect.

Objective:To explore the sequential chemotherapy efficacy of different chemotherapeutic regimens in ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma.Methods:A retrospective analysis was conducted on clinical and pathological data of 100 patients with platinum-sensitive ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma treated at Peking University Peopel′s Hospital from January 1992 to January 2019. All patients underwent staging surgery or cytoreductive surgery followed by adjuvant chemotherapy. Based on different postoperative adjuvant chemotherapy regimens, patients were divided into the sequential chemotherapy group (70 cases) and the conventional chemotherapy group (30 cases). Clinical and pathological characteristics, chemotherapy efficacy, adverse reactions, and prognosis were compared between the two groups.Results:(1) Clinical and pathological characteristics: the age, tumor types (including ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma), pathological types, International Federation of Gynecology and Obstetrics (FIGO) stage, postoperative residual disease size, presence of neoadjuvant chemotherapy, and total number of chemotherapy cycles were compared between the sequential chemotherapy group and the conventional chemotherapy group. There were no statistically significant differences observed in these characteristics between the two groups (all P>0.05). (2) Chemotherapy efficacy: the median sum of complete response (CR)+partial response (PR) duration in the sequential chemotherapy group was 80.0 months (range: 39 to 369 months), whereas in the conventional chemotherapy group, it was 28.0 months (range: 13 to 52 months). A statistically significant difference was observed between the two groups ( Z=-7.82, P<0.001). (3) Chemotherapy adverse reactions: in the sequential chemotherapy group, 55 cases (79%, 55/70) experienced bone marrow suppression and 20 cases (29%, 20/70) had neurological symptoms. In the conventional chemotherapy group, these adverse reactions occurred in 11 cases (37%, 11/30) and 2 cases (7%, 2/30), respectively. Statistically significant differences were observed between the two groups for both bone marrow suppression and neurological symptoms (all P<0.05). For the other chemotherapy adverse reactions compared between the two groups, no statistically significant differences were observed (all P>0.05). (4) Prognosis: during the follow-up period, the recurrence rate in the sequential chemotherapy group was 73% (51/70) and in the conventional chemotherapy group was 100% (30/30). The median sum of recurrence-free interval was 70.5 months (range: 19 to 330 months) in the sequential chemotherapy group and 15.0 months (range: 6 to 40 months) in the conventional chemotherapy group. Statistically significant differences were observed between the two groups for both recurrence rate and median recurrence-free interval (all P<0.01).In the sequential chemotherapy group, the median progression-free survival (PFS) time was 84.0 months (range: 34 to 373 months), and the median overall survival (OS) time was 87.0 months (range: 45 to 377 months). In contrast, in the conventional chemotherapy group, the median PFS time was 30.5 months (range: 14 to 60 months), and the median OS time was 37.5 months (range: 18 to 67 months). Statistically significant differences were observed between the two groups for both PFS and OS (all P<0.001). In the sequential chemotherapy group, the 3-year, 5-year, and 10-year OS rates were 100% (70/70), 93% (65/70), and 21% (15/70), respectively. In contrast, in the conventional chemotherapy group, the OS rates were 50% (15/30) at 3 years, 3% (1/30) at 5 years, and 0 at 10 years, respectively. The two groups were compared respectively, and the differences were statistically significant (all P<0.05). Conclusions:Sequential chemotherapy significantly prolongs PFS and OS in patients with ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma. The efficacy is superior to that of the conventional chemotherapy, with manageable adverse reactions. The use of sequential chemotherapy as first-line treatment for patients with ovarian epithelial carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma is recommended.

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.

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.