Objective To investigate the application effects of ultrasonic scalpel combined with bipolar coag-ulation tweezers on open thyroid surgery.Methods 80 cases of thyroidectomy patients were randomly selected.These patients were divided into two groups by random cluster sampling method,whch were the study group (n =40)and control group (n =40).The control group of patients were given ultracision ligature methods combined with traditional therapy,while the study group of patients were given ultrasonic scalpel combined with bipolar coagulation tweezers treatment.And then the surgical related indicators and complications of the two groups of patients were statistically an-alyzed.Results Compared with the control group of (90.5 ±3.6)min,(6.5 ±0.6)d,(40.5 ±2.0)mL,(50.3 ± 1.4)mL and (6.6 ±0.5)cm,the operative time and length of stay of the study group of patients[(58.5 ±5.4)min and (3.4 ±0.2)d]were significantly shorter (t =6.965,3.143,all P <0.05);the blood loss and postoperative drainage of (5.0 ±1.4)mL and (1.0 ±0.6)mL were significantly less (t =4.541,3.747,all P <0.05);the cut diameter of (3.8 ±0.3)cm was significantly shorter (t =3.365,P <0.05);the complication rate of 2.5% (1 /40) was significantly lower than the control group 10.0%(4 /40)(χ2 =9.35,P <0.05).Conclusion The application effects of ultrasonic scalpel combined with bipolar coagulation tweezers on open thyroid surgery are obvious.

Background: Emerging evidences have indicated that the composition of gut microbiota was significantly influenced by central nervous system diseases. The digestion and metabolism disturbances of patients with amyotrophic lateral sclerosis (ALS) might be strongly associated with ALS; however, this has rarely been evaluated in these populations. This study was to evaluate bacterial and archaeal composition of gut flora and the corresponding metabolism performance of these micro-organisms in fecal samples of patients with ALS. Methods: A comparative study was performed on the intestinal microbiota from eight patients with ALS and eight healthy individuals at Huadong Hospital during November 2017 to April 2018; meanwhile, the metabolite concentrations of human endotoxin, short-chain fatty acids (SCFA), NO₂-N/NO₃-N, and γ-aminobutyric acid were also evaluated by spectrophotometry methods. The correlations between intestinal microbiota and metabolite concentration were compared between the two groups using one-way analysis of variance; the relative abundance of beneficial and harmful micro-organisms in fecal samples was also analyzed. Results: In general, the richness and evenness of bacterial and archaeal communities of healthy individuals were healthier than that of patients with ALS. The phylum Firmicutes/Bacteroidetes ratio, genus Methanobrevibacter showed an enhancive tendency in patients with ALS, whereas the relative abundance of beneficial micro-organisms (genera Faecalibacterium and Bacteroides) presented a significant decrease tendency in patients with ALS. In addition, the average concentrations of human endotoxin, SCFA, NO₂-N/NO₃-N, and γ-aminobutyric acid in patients with ALS and healthy individuals were 64.2 vs. 65.3 EU/mL, 57.5 vs. 55.3 μg/mL, 5.7 vs. 5.3 ng/mL, and 6.1 vs. 5.4 μmol/L, respectively, indicating that the digestion and metabolism functions of gastrointestinal tract of patients might decline with this disease. Conclusions The relative abundance of beneficial and harmful micro-organisms respectively showed decrease and increase tendency in patients with ALS.

The Effect of arsenic trioxide (As(2)O(3)) on myelomonocytic progenitor cells of patients with myelodysplastic syndrome was studied. Bone marrow CFU-GM was assayed in the agar semi-solid culture, and the bone marrow cells were incubated in liquid culture and the expressions of CD33, CD15 and bcl-2 on the marrow cells were detected by APAAP method in 24 patients. The suppressive effects of As(2)O(3) to CFU-GM were increased with the rise of As(2)O(3) concentrations. The suppression of As(2)O(3) (0.388 micro mol/L) to cluster formation was stronger than to colony formation, the suppressive rates were 70.78% vs 34.05% in low-risk group, and 86.76% vs 65.86% in high-risk group (P < 0.01), respectively. 0.194 micro mol/L of As(2)O(3) decreased clusters and increased colonies in low-risk group, but decreased clusters and did not change colonies in high-risk group. High concentration (1.94 micro mol/L) of As(2)O(3) downregulated the expression rate of CD33 and CD15 in both groups, and low concentration (0.194 micro mol/L) downregulated the expression rate of CD33 and upregulated the expression rate of CD15 in low-risk group, but decreased expression of CD33 and did not alter CD15 in high-risk group. At the same time, the high concentration of As(2)O(3) downregulated expression of bcl-2 and resulted in karyopyknosis and cytoplasm condensation; low concentration generated similar effect on expression of bcl-2 and cell morphology in high-risk group, but did not affect in low-risk. It is concluded that As(2)O(3) suppressed myelopoiesis and impelled myelomonocytic cells to apoptosis, low concentration of As(2)O(3) induced the proliferation and differentiation of myelomonocytic cells in low-risk group, however, suppressed the growth of myelomonocytic cells and accelerated the cells apoptosis in high-risk group.

OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.

Summary: The effect of rosiglitazone as the ligand of peroxisome proliferator-activated receptorγ (PPARγ) inhibiting the TLR4 expression in ischemic lobes in partial hepatic ischemia/reperfusion injury (IRI) in BABL/C mice and the action of rosiglitazone inhibiting the TLR4 receptor-mediated inherent immune response were investigated. The model of the mouse partial hepatic ischemia/reperfusion injury was established. All the animals were randomly divided into 3 groups: rosiglitazone group, vehicle (dimethylsulphoxide, DMSO) group and sham operation group. The hepatic samples were collected when mice were sacrificed 0, 2, 4 and 6 h after reperfusion following 1h ischemia to analyze the acute phase of hepatic IRJ. The dynamic expression of TIR4 mRNA was detected quantitatively by real-time-PCR, and the levels of TNF-α, IL-10 and ALT in portal vein were determined in all groups. After restoration of blood supply, the expression of TLR4 mRNA in ischemic lobes was detected in 0, 2, 4 and 6h after reperfusion following 1h ischemia in rosiglitazone group and vehicle group. The most intensive expression of TLR4 mRNA was present at 4 h after reperfusion in ischemic lobes in vehicle group. As compared with vehicle group, the expression of TLR4 mRNA in ischemic lobes in rosiglitazone group was significantly decreased at 4h after reperfusion. The level of IL-10 in portal vein was markedly up-regulated in rosiglitazone group as compared with vehicle group. Contrarily, the levels of TNF-α and ALT in portal vein were markedly down-regulated in rosiglitazone group as compared with vehicle group at every time point in mouse partial hepatic IRI model. Rosiglitazone could alleviate the hepatic IRI by inhibiting TLR4 receptor-mediated inherent immune response.

Objective : To explore the expression of chemokine CXCL1 in proliferative infantile hemangioma (IH) , and to study the effect of exogenous CXCL1 on hemangioma stem cells (HemSCs) . Methods : Immunohistochemistry was used to explore the expression of CXCL1 in proliferative IH specimens.Primary HemSCs were isolated from IH tissues by CD133 magnetic beads.5 groups of CXCL1 with different concentrations(0,10,20,50 and 100 ng/ml) were co-cultured with HemSCs, and the effects of exogenous CXCL1 on HemSCs were studied by cell viability and migration experiments. Results : CXCL1 was expressed in the interstitial tissues of proliferative IH.The overall expression of CXCL1 in proliferative IH was low, but the expression of CXCL1 in the proliferative IH interstitial tissues was higher than that of the adjacent interstitial tissues.The CXCL1 positive area rate was(0.773±0.101)% in the tumor compared with(0.268±0.081)% in the adjacent tumor, and the difference was statistically significant(t=7.843,P<0.001).Exogenous CXCL1 promoted the proliferation of HemSCs, and there were statistical differences after adding different concentrations of CXCL1 to HemSCs for 24,48,and 72 h(F=14.610,P<0.001;F=14.430,P<0.001;F=5.388,P<0.01).But the exogenous CXCL1 did not affect the migration ability of HemSCs. Conclusion The expression of CXCL1 in proliferative IH interstitial tissues is higher than that in adjacent interstitial tissues, and exogenous CXCL1 promotes the proliferation of HemSCs.