Objective To Explore the significance of successful exposing and recognizing Zuckerkandl's tuhercle(ZT)during thyroidectomy.Methods Three hundred and seventy patients(501 sides) underwent lobectomy or total thyroidectomy from January 2009 to June 2011 were included in this study.The ZT was assessed in terms of its presence or absence,size and anatomical association with the recurrent laryngeal nerve(RLN)and superior parathyroid(SP).Results ZTs were found in 412 of 501 sides ( 82.2％ ),among which 368(89.3％ ) ZTs were located in the middle third of the lateral lobe of the thyroid gland.ZTs passed over the RLN in 379 of 412 sides(92.0％ ).When the ZTs were located in the middle or lower third of the lateral lobe of the thyroid gland,the SPs were all located in the cranial portion of ZT.The SP was adhered to the ZT in 80.1％ of the cases.RLN damage rate was 0.40％,and no SP damage occurred.Conclusion Exposing and recognizing Zuckerkandl's tubercle during thyroidectomy is of important clinical significance,which helps to identify and protect RLN and SP,so as to reduce surgical complications.

Eosine Yellowish-(YS) ; Frozen Sections ; Hematoxylin ; Humans ; Staining and Labeling

Objective To study the influence of various doses and injection rates of contrast agent on CT perfusion in rabbits' liver with a deconvolution mathematical model. Methods Eight rabbits were enrolled in the experiment. Randomized block design was adopted. The treatment factor (contrast medium injection rate) was classified into 0.5, 1.0, 1.5 ml/s, while the subjects were divided into 3 blocks with contrast medium injection dose of 0.5, 1.0 and 1.5 ml/kg. The data obtained at CT perfusion imaging were then transferred to the workstation. Absolute values of 7 perfusion parameters (hepatic arterior fraction, blood flow, blood volume, permeability surface, mean transmit time, hepatic artery perfusion and portal vein perfusion) were measured with perfusion software (Perfusion 3). Results The dose of contrast medium had significant effect on peak enhancement of the aorta, the portal vein and liver tissue (P<0.05), whereas the injection rates had significant influence on the arrival time to peak enhancement of the aorta and the portal vein. However, the dose of contrast medium and injection rates had no significant effect on perfusion parameters (P>0.05). Conclusion CT perfusion imaging with a deconvolution mathematical model can quantify the hemodynamic functional status in liver with stable results. This technique does not need strict confinement to dose and injection rate of contrast medium, and has great potential value to be put into clinical use.

BACKGROUND:Medical devices from animals are commonly used in clinical application. Despite their efficiency is widely accepted, their safety, especialy immunity has been concerned. OBJECTIVE:To investigate immunity risk control to medical devices from animals for safety consideration. METHODS:Using “α-Gal antigen, immunity, xenotransplantation” in Chinese and English as the key words, the first author conducted a computer search of Science direct database (www.sciencedirect.com), Wiley-Blackewel database (http://onlinelibrary.wiley.com) and Wanfang database (www.wanfang.com.cn) through screening the titles and abstracts. RESULTS AND CONCLUSION:Increasing evidence shows that, Gal α1-3Gal antigen (α-Gal antigen) is recognized as the major antigen and abundantly expressed on glycoconjugates of non-primate mammals and New World monkeys. In contrast, the α-gal epitope is not expressed on glycoconjugates of humans and Old World monkeys. Instead, they produce a very large amount of natural anti-α-Gal antibody that specificaly binds the α-gal epitope. The binding of human natural anti-α-Gal to α-gal epitopes expressed on non-primate mammal animals was expected to be unique immunological barrier in xenotransplantation. Therefore, it is important to choose raw materials, reduce or eliminate the α-Ggal epitope, establish highα-Ggal epitope detection methods with high sensitivity and good repeatability for achieving a greater safety and efficiency of medical devices from animals.

Aneuploidy ; Biomarkers, Tumor ; metabolism ; DNA, Neoplasm ; genetics ; Humans ; Laryngeal Neoplasms ; metabolism ; pathology ; Lymphatic Metastasis ; Nucleolus Organizer Region ; metabolism ; Proliferating Cell Nuclear Antigen ; metabolism ; S Phase

Objective: To observe the clinical effect of traditional Chinese medicine enema combined with rhubarb acupoint in the treatment of severe acute pancreatitis(SAP) complicated with paralytic ileus. Methods: A total of 60 SAP patients complicated with paralytic ileus treated in the First People's Hospital of Huzhou from June 2015 to June 2017 were selected and randomly divided into two groups by random lottery method, with 30 cases in each group.The two groups were treated with routine anti-infection and rehydration.The control group was treated with traditional Chinese medicine enema combined with placebo, and the observation group was treated with traditional Chinese medicine enema combined with rhubarb on Shenque acupoint, and the two groups were treated for 7d.The recovery time of blood amylase, bowel sounds recovery time, first self defecation time, local complications and mortality were observed in the two groups. Results: The recovery time of blood amylase, the recovery time of intestinal sound and the time of the first defecation were (8.87±2.30)d, (2.88±1.09)d and (3.51±1.32)d, respectively, which were significantly shorter than those of the control group [(10.29±2.01)d, (3.67±1.30)d and (4.57±1.41)d], the differences were statistically significant(t=-3.601, -3.607, -4.251, all P<0.001). The incidence rate of local complications in the observation group was 6.7%(2/30), which was significantly lower than 36.7%(11/30) in the control group(χ²=16.875, P<0.001), and there was no statistically significant difference in the mortality rate between the two groups(χ²=3.333, P=0.068). Conclusion The application of Chinese medicine enema combined with the acupoint of rhubarb in the treatment of SAP patients complicated with paralytic ileus can effectively promote the recovery of intestinal peristalsis, shorten the duration of paralytic intestinal obstruction, reduce the complications and improve the clinical effect.

Objective: To explore the effect and safety of fractional 1565 nm laser on white striae gravidarum (SG) in abdomen and observe the influencing factors of treatment effect. Methods: Thirty-six patients, aged 24-39 years old, were randomly divided into two groups(group A, n=16, group B, n=20): patients in group A underwent two passes of laser treatment: striae were locally scanned at moderate level energy(35 mJ/μb) with high density(300 dot/cm²), and high level energy (45 mJ/μb)with low density(150 dot/cm²)was adopted for the whole area.Group B received one pass of treatment at moderate energy with high density 35 mJ/μb, 300 dot/cm²). All patients received three laser treatments at a 6 weeks interval. Improvement of SG appearance was assessed by blinded reviewers, 3 months after the last treatment, using a percentage category scale. Meanwhile, patients satisfaction was evaluated. The impact of skin aging on laser treatment was evaluated. Patient satisfaction scores and side effects were evaluated. Results: All patients completed the overall trial. The average improvement of scores was 1.69±0.95, which contributed to a fairly good response rate of 88.89%. The patients satisfactory and very satisfactory rate was 58.3%(21/36). There was no significant difference in improvement score between group A(1.88±0.89) and group B(1.55±1.00) (P< 0.01). The operation duration of group B was shorter than group A, (29.6±4.9)min vs.(53.7±5.5)min, P<0.05. There was a moderate negative correlation between aging and laser treatment effect (r=-0.553). The abnormal color of skin(erythema and post-inflammatory hyperpigmentation) in group A lasted longer than group B, (9.17±4.03)d vs. (6.73±2.29)d, P<0.05.The pain score during treatment was tolerable, with the score of 2.61±0.76. Conclusions The treatment with fractional 1565 nm laser can improve the appearance of SG. It is more timesaving when the entire implicated area treated by one pass at moderate level energy with high density. Skin aging will discount the effect.

Objective To investigate the clinical therapy of early internal fixation combined with perforator flap for forearm open fractures of Gustilo types Ⅲ B & Ⅲ C.Methods A retrospective study was conducted of the 45 patients with forearm open fracture of Gustilo type ⅢB or Ⅲ C who had been treated from July 2012 to October 2016 at Department of Traumatic Orthopaedics,The Ninth People's Hospital of Wuxi.They were 26 men and 19 women,aged from 20 to 61 years (average,41 years).Twenty cases were Gustilo type ⅢB and 25 Gustilo type ⅢC.By AO classification,8 cases were type A,21 ones type B,and 16 ones type C.The wound size ranged from 4 cm × 3 cm to 36 cm × 8 cm.Thirty-three patients were treated by primary internal fixation plus secondary transfer with a perforator flap,12 ones by secondary internal fixation plus transfer with a perforator flap.The period from injury to secondary flap transfer ranged from 5 to 20 days (average,12 days).In this series,36 anterolateral thigh perforator flaps,5 latissimus dorsal muscular flaps and 4 lateral arm flaps were transferred.Results All the 45 free flaps survived with no deep infection or osteomyelitis.Partial necrosis happened at the distal ends of 2 latissimus dorsal muscular flaps which were cured by skin graft.Postoperative circulatory crisis happened after transfer of an anterolateral thigh perforator flap which survived with 5 cm skin necrosis at the distal end after successful surgical exploration.Superficial wound infection happened in 12 patients with no deep or bone infection.All the patients were followed up for 12 to 36 months (average,18.5 months).All the flaps were soft in texture,with varying degrees of pigmentation.The sensory recovery was S2 in 8 flaps,S3 in 29 flaps,and S4 in 8 flaps.Obvious scar hyperplasis was observed at the donor site in 5 cases while no obvious scar hyperplasis was observed in the other 40 ones.All the fractures got united after 4 to 14 months (average,8.6 months).Nonunion happened in 2 patients who were treated with autologous iliac graft 8 months after operation.By Anderson criteria,the curative efficacy was assessed as excellent in 15 cases,as good in 21,as fair in 7 and as poor in 2,yielding an excellent to good rate of 80.0％.Conclusion Early internal fixation combined with perforator flap transfe is an effective strategy for treatment of forearm open fractures with soft tissue defects of Gustilo types Ⅲ B &Ⅲ C,due to its advantages of shortened treatment period,possibility for early rehabilitation,decreased complications and satisfactory functional recovery.

Objective To investigate the expression of BRCA1 in familial thyroid cancer (FTC) and the relationship between BRCA1 expression and clinicopathologic features.Methods The expression of BRCA1 protein and mRNA was detected respectively by immunohistochemistry and RT-PCR in 37 FTC tissues,35 sporadic thyroid carcinoma tissues and 35 normal thyroid tissues.Results BRCA1 mRNA expression was significantly downregulated in FTC (0.210±0.025) compared with sporadic thyroid carcinoma(0.943±0.021) and normal thyroid tissues(1.001±0.087)(P＜0.01).The positive rate of BRCA1 protein expression was significantly lower in FTC(56.8％,21/37) than that in sporadic thyroid carcinoma(85.7％,30/35) and normal thyroid tissues(94.5％,33/35) (P＜0.05).There was a correlation between BRCA1 protein expression and FTC clinicopathologic features (P＜0.05).FTC patients with lower BRCA1 protein expression tended to have higher risk for bilateral carcinoma,lymph node metastasis,capsular invasion,morbidity under 30 years old and more than 2 patients in a family.Conclusions The expression of BRCA1 protein and mRNA is downregnlated in FTC.BRCA1 protein might serve as a potential biomarker for predicating biological behavior and prognosis of FTC.