Objective Investigated the clinical features and risk factors of pulmonary metastasis in children with papillary thyroid carcinoma aiming to provide guide for clinical work.Methods Collected the informations of 40 patients with under the age of 14,who underwent surgery in the Thyroid surgery of the First Affiliated Hospital of ZhengZhou University and confirmed for the papillary thyroid carcinoma by the postoperative pathology.At the same time,excluded studies with history of head and neck malignancy or lyphoma or secondary thyroid cancer,papillary thyroid carcinoma with hyperthyroidism and cases of imcomplete informations.The age of the 40 patients was 3 to 14 years old,12 were boy and 28 were girl.The largest tumor diameter was 7.5 cm,and the smallest was 0.3 cm.Tumor lesions were solitary in 22 cases and multiple lesions were in 18 cases.There were 33 cases of cervical lymph node metastases and 7 cases of no cervical lymph nodes.There were 10 cases of pulmonary metastasis and 30 cases of non-pulmonary metastasis.This research adopted chi-square test and Logistic regression statistical analysis of related risk factors and clinical features,including patients' age,gender,tumor diameter,number of lesions,surgical methods,neck lymph node metastasis,and pulmonary metastasis.Results The positive rate of plumonary metastsis in children with papillary thyroid carcinoma was 25％ (10/40),statistical analysis found that the positive rate of children with lung metastasis (x2 =8.620,P =0.003),tumor diameter over 2 cm (x2 =5.763,P =5.763) and the difference was statistically significant higher.Logistic regression analysis showed that the number of risk factors was multifocal papillary thyroid carcinoma in children lung metastasis (OR =13.058,P =0.028).Conclusions Higher lung metastasis is a clinical feature of thyroid papillary carcinoma in children.The risk of lung metastasis was significantly higher for children with thyroid papillary carcinoma who had multiple lessions.

Objective To discuss the value of tension-free hernia repair to recurrent inguinal hernia in elderly patients.Methods 38 eases with recurrent inguinal hernia in elderly patients were treated with shaped polyproplene tension-free hernioplasty.Results All eases were operated successfully.In the follow-up period ranged from 6 to 42 months.No Serious postoperation complications were found,no recurrent case recurred.This treatment is effective.Conclusion Tension-free hernia repair has many advantages,such as safety,easily manipulation,minimal invasion,rapid recovery,lower recurrence.It is a perfect and ideal surgical operation for the recurrent inguinal hernia in elderly patients.

Objectives To investigate the effects of glucose on apoptosis rate of cultured endothelial progenitor cells (cEPCs). Methods The peripheral blood of healthy adults was isolated by density gradient centrifugation, and mononuclear cells (MNCs) were inducted to differentiate at cultured conditions.EPCs were identified by Dil-acLDL and FITC-UEA-1 as double fluorescent-positive cells. The effectsof glucose at different concentrations on apoptosis rate of the harvested EPCs were measured by fluorescent microscope and fluorescence-activated cell sorting (FACS) after staining with Annexin V-FITC and PI. Results No significant differences were observed in apoptosis rate between samples treatedwith 5.6mmol/l glucose and 11. 1 mmol/l. P ＞0. 05). 25.5 mmol/L glucose enhanced the EPCsapoptosis rate in a time-dependent manner( P ＜0. 05). Conclusion High concentration glucose can accelerate apoptosis rate of EPCs in a time-dependent manner.

Objective To study the relationships among the expression of inhibitors of DNA binding 1 (ID-1) , Ki-67 and Bcl-2 in esophageal squamous cell carcinoma (ESCC) ,and to investigate the potential role of ID-1 in the carcinogenesis of ESCC. Methods One hundred and eighteen cases of surgical resected ESCC specimens and 20 cases of normal tissues ( sampled far from the tumors, as control) were involved. Immunohistochemical technique was applied to detect the expression of ID-1, Ki-67 and Bcl-2. Results The positivity and staining intensity of ID-1 , Ki-67 and Bcl-2 in ESCC were higher than those in normal tissues. Positive immunological reactions of ID-1, Ki-67 and Bcl-2 were found in 86.44% (102/118) , 81.36% (96/118) and 59. 32% (70/118) cases of examined tumor samples, respectively. The expression of ID-1 and Bcl-2 were positively correlated with the histological grades, while the Ki-67 expression showed negative correlation with differentiation degree. No relationship was found among age, sex, lymph node metastasis and the expression of ID-1, Ki-67 and Bcl-2 in ESCC tissues. Conclusion ID-1 expression may be participated in the regulation of apoptosis in ESCC cells, but may not be considered as a biomarker for evaluation of ESCC metastasis.

Objective: To analyze the clinical characteristics of patients with asthma-chronic obstructive pulmonary overlap syndrome (ACOS). Methods: From January 2015 to December 2017, 40 patients with ACOS, 40 patients with asthma and 40 patients with chronic obstructive pulmonary disease(COPD) in Zhoushan Hospital were collected.The general information, laboratory test indicators, lung function test indicators and FEV₁ mutation after bronchodilator test were compared among the three groups. Results: There were statistically significant differences in age[(45.36±5.27) vs. (54.45±4.69) vs. (67.57±5.18), F=9.334, P=0.004], the proportion of smoking patients (92.50% vs. 75.00% vs. 60.00%, χ²=11.550, P=0.003), and the proportion of family history of asthma (7.50% vs. 20.00% vs. 30.00%, χ²=6.562, P=0.038) among the patients with ACOS, asthma and COPD.The percentage of eosinophils in peripheral blood [(8.46±0.94)% vs. (6.13±0.78)% vs. (3.75±0.45)%, F=11.626, P=0.001] and the serum IgE levels [(353.41±45.74)IU/mL vs. (252.65±30.45)IU/mL vs. (155.26±22.77)IU/mL, F=7.605, P=0.001] were decreased in turn, the differences were statistically significant.The FEV₁/FVC% and FEV₁% pred in the ACOS group were lower than those in the asthma group [(54.26±6.86)% vs. (72.43±8.52)%, t=10.506, P=0.001 and (50.35±6.22)% vs. (62.60±7.52)%, t=7.939, P=0.001], however, there were no significant differences compared with the COPD group[(54.26±6.86)% vs. (53.88±7.25)%, t=0.241, P=0.810 and (50.35±6.22)% vs. (50.56±6.46)%, t=0.148, P=0.883]. The proportion of small airway dysfunction in the ACOS group was higher than that in the asthma group (82.50% vs. 57.50%, χ²=5.952, P=0.015), however, there was no statistically significant difference compared with COPD group(82.50% vs. 85.00%, χ²=0.092, P=0.762). The RV/TLC% in the ACOS group was higher than that in the asthma group [(46.71±5.31)% vs. (32.46±4.52)%, t=12.924, P=0.001], however, there was no statistically significant difference compared with the COPD group [(46.71±5.31)% vs. (46.92±5.75)%, t=0.170, P=0.866]. The DLCO% in the ACOS group was lower than that in the asthma group [(64.37±4.66)% vs (82.62±4.53)%, t=17.760, P=0.001], but higher than that of the COPD group [(64.37±4.66)% vs. (51.25±4.35)%, t=13.017, P=0.001]. After bronchodilator test, the FEV₁ mutation rate of the ACOS group was higher than that of the COPD group [(20.86±2.05)% vs. (6.52±0.55)%, t=42.730, P=0.001], but there was no statistically significant difference compared with the asthma group [(20.86±2.05)% vs. (21.13±2.14)%, t=0.576, P=0.566]. Conclusion Compared with asthma patients, the age of ACOS patients is older, the percentage of peripheral blood eosinophils and the level of serum IgE are lower, the pulmonary ventilation function is lower, the airway dysfunction is more significant, the residual volume is more significant, the lung diffuse function is lower, acidic granulocyte airway inflammation is mild.But compared with patients with COPD, the age of ACOS patients is younger, the percentage of peripheral blood eosinophils and serum IgE levels are higher, the lung diffuse function is higher, and acidic granulocyte airway inflammation is heavier.

Objective:To analyze the changes in T lymphocyte subsets, B lymphocytes and NK cells in children with active tuberculosis (TB) and their clinical significance.Methods:T lymphocyte subsets, B lymphocytes and NK cells in peripheral blood samples of 106 patients with acute TB (TB group) and 106 healthy children (healthy control group) were detected by flow cytometry and compared between different groups.Results:The percentages of CD3 + T, CD4 + T and NK cells as well as the CD4 +/CD8 + T cell ratio were significantly lower in the TB group than in the healthy control group ( Z=-3.783, P=0.000; Z=-5.401, P=0.000; Z=-3.434, P=0.001; Z=-2.014, P=0.044). The percentages of double negative T (DNT) and B cells in the TB group were significantly higher than those in the healthy control group ( Z=2.765, P=0.006; Z=6.880, P=0.000). No significant difference in the percentage of CD8 + T or double positive T (DPT) cells was observed between the two groups ( P>0.05). The expression of peripheral lymphocyte subsets varied in TB children of different age groups (0-<3, 3-<6, 6-<10 and 10-<16 years old). There were significant differences in CD3 + T, DNT and B cells among the four age groups ( H=10.081, P=0.018; H=14.583, P=0.002; H=8.498, P=0.037). The percentage of CD4 + T cells was significantly lower in children with extrapulmonary TB than in those with pulmonary TB ( Z=-3.068, P=0.002). No statistically significant difference in other lymphocyte subsets was found between children with extrapulmonary and pulmonary TB ( P>0.05). Conclusions:Tuberculosis could lead to immune dysfunction in children. Dynamic monitoring of the changes in peripheral lymphocyte subsets in children with TB could be conducive to better assessment of immune status and providing personalized treatment.

ObjectiveTo observe the influence of Danshen injection on the serum levels of TNF-α,IL-6 in patients with acute pancreatitis(AP).Methods70 patients with AP were randomly divided into the experimental and control group.The two groups were given conventional anti-inflammatory,antisecretory,antispasmodic,inhibition of pancreatic secretion treatment,and the experimental group were treated with Danshen injection.Before trealment and 1,2,4,6 days after treatment,the serum TNF-α,IL-6 levels were measured in both groups.The time of blood and urine amylase(AMS) returned to normal was observed in both groups.Results2,4,6d after treatment,the serum TNF-α,IL-6 of the observation group were lower than that of the control group( all P ＜ 0.05 ) ;The blood AMS recovery time of the observation group was ( 2.55 ± 0.71 ) d,which had no significant difference with that of the control group(2.46 +0.82)d(t =0.32,P ＞0.05 ),while urinary AMS recovery time of the observation group was (4.30 ±0.72 ) d,which was shorter than that of the control group ( 6.84 ± 0.88 ) d ( t =0.02,P ＜ 0.05 ).ConclusionDanshen injection could reduce the serum TNF-α,IL-6 levels in patients with AP,and had no effect on the serum amylase,with the trend of faster lower urinary amylase.

Objective To explore the anti-infection mechanism of carboxyamidotriazole (CAI) through studying the effects of CAI on the proliferation, apoptosis and degranulation of RBL-2H3 mass cells.Methods Compound 48/80 (C48/80) was used to induce the model of activation and degranulation in RBL-2H3 cells.The morphological change of cell degranulation was observed by neutral red staining.The release levels of histamine and β-hexosaminidase were measured by ELISA method and chromogenic assay, respectively.The cell activity was determined by CCK-8 method.And cell apoptosis was detected by Hoechst 33342 fluorescent staining.Results Compared with the control group, 10, 20, 40 μmol/L CAI inhibited C48/80-induced degranulation of RBL-2H3 cells in different degrees.CAI (20, 40 μmol/L) reduced the histamine release (P<0.01), and CAI (40 μmol/L) decreased the β-hexosaminidase release (P<0.01).In addition, the viability and apoptosis of RBL-2H3 cells were not affected at the concentrations of CAI used.Conclusions CAI can effectively inhibit the activation and degranulation of RBL-2H3 mast cells, and this effect is not through cytotoxicity.The anti-infection effect of CAI may partially due to the down-regulation of mast cell activity.

Objective To study the clinical significance of EGFR mutation in patients with advanced non -small cell lung cancer combined with malignant pleural effusion,and to provide reliable theoretical basis for clinical treatment .Methods 3 0 patients of advanced non -small -cell lung cancer complicated with malignant pleural effusion in Zhoushan island area were selected.DNA was extracted in the pleural effusion and EGFR 19,21 two loci of gene mutation was detected by sequencing PCR.EGFR and clinical characteristics of the patients (gender,age,smoking history,disease types of cases and in the level of CEA level)was compared.Results Among the 30 cases,4 cases of gene mutation,1 case of male patient,3 cases of female patients,4 cases of adenocarcinoma,4 cases of non smokers, 2 cases of EGFR19 deletion,2 cases of EGFR21 mutation.Among them,3 patients were treated by biological target therapy,the survival time was more than 1 year,and there were no obvious adverse reactions,and the effective rate was 75.00%.Conclusion The gene mutations of EGFR were detected in the patients with advanced non -small cell lung cancer combined with malignant pleural effusion,and the mutation rate 13.30%,which was high in female,non smoker and adenocarcinoma,and it could be used to treat the tumor.

Diagnostics is one of the most important bridge courses for medical students from basic to clinical. Doctor-patient communication runs through the whole process of patient diagnosis and treatment. How to improve medical students' ability of doctor-patient communication? Our teaching team has carried out continuous reform and explored the scientific effective teaching mode. Recently, through the construction of "doctor-patient communication skills" quality online course, efforts have made to build an online and offline blended learning mode, which has gradually realize the integration with diagnostics teaching, and has achieved remarkable results. It also provides a scientific practical basis for the integration of doctor-patient communication and other clinical courses, which is worthy of promotion.