Objective To analyze the clinical characteristics,diagnosis and treatment of thyroid micro-carcinoma.Methods The clinical data of 52 cases of thyroid micro-carcinoma operated from 2003 to 2008 were analyzed retrospectively.Results All of the 52 cases were confirmed as thyroid micro-carcinoma by postoperative pathologic exam;30 cases(57.7%) were discovered by intraoperative frozen section and 22 cases were not.Micro-calcification ratio on ultrasound was 35.19%.11 cases were diagnosed as malignant tumor on ultrasound scan preoperatively.Lobectomy of involved lobe with subtotal thyroidectomy of contra-lateral lobe was performed in 38 cases,3 cases of bilateral total thyroidectomy,3 cases of unilateral lobectomy and isthmectomy,5 cases of ipsilateral subtotal lobectomy and 3 cases of ipsilateral lobectomy with isthmectomy were performed.Combined central region lymph nodes dissection was adopted in 27 cases(positive 11/27,40.74%).Follow-up rate was 96.2%,with time ranging from 3 months to 5 years.No recurrence or mortality was discovered.Conclusions(1)B type ultrasound is the first choice for preoperative screening.(2) lpsilateral thyroid lobectomy with contralateral subtotal thyroidectomy combined with central region lymph node dissection is advocated.

Objective To investigate the diagnosis and treatment of Hashimoto's diseaseconcomitant with thyroid carcinoma. Methods Clinical data of 74 cages of thyroid carcinoma occuring on the background of Hashimoto's disease were retrospectively analyzed. Results All cases were papillary carcinoma pathologically.The serum TGAb and McAb level elevated in 56 and 68 cases,respectively.While TPOAB level was all elevated.45 cages underwent unilateral thyroideetomy and contralateral subtotal thyroidectomy,1 case did bilateral near total thyroidectomy,26 cases did unilateral thyroidectomy.and 2 cases with bilateral thyroidectomy.All cases underwent combined central region lymph nodes dissection(positive rate was 27%,20/74),10 cases underwent modied lymph node resection.69 cases were followed up rangins from 1 month to 7 years,with median length of 29 months.4 cases were re-admired for modified lymph nodes resection. Conclusion TGAb、McAb、FNAB and ultrasound is the main procedure forscreening Hashimoto's disese accompanied with thyroid carcinoma preoperatively.Radical thyroideetomy iS the therapy of choice.

0.05).Seventy patients were followed up from 3 months to 8 years post-operatively,with tumor-free survival in 67 cases,and cervical lymph nodes metastasis in 3 cases.No permanent hypo-parathyroidism or paralysis of recurrent laryngeal nerves occurred.Conclusions Total thyroidectomy is advised for bilateral thyroid carcinoma.It is necessary to emphasize the importance of resection of the central region lymph nodes.

Objective To study the clinical significance of platelet, coagulation ,and fibrinolysis alteration in perioperative period in patients with different Child classifications of cirrhosis. Methods Alterations on the platelet count and the indices of coagulation and fibrinolysis in 17 cases of Child B class who underwent portal-systemic shunt, and 6 cases of Child C class who underwent portal-azygus vein disconnection were detected. Results Before operation,except the decrease in platelet count, there as no significant difference in the indices of other platelet function, coagulation and fibrinolysis in patients with Child B class compared with control group. While in patients with Child C class, the platelet count decreased, and GMP-140, FPA and D-dimer increased greatly. After operation, GMP-140 increased in patients with Child B class, while decreased in patients with child C class. The platelet count and factorⅧ:C in patients with Child C class decreased significantly compared with those with Child B class. Conclusions Operation may induce DIC in patients with Child C class, so it is necessary to determine the fibrinogen and factorⅧ:C during the operation.

Objective To analyze the effect of autologous bone marrow stem cells transplantation in treatment of patients with decompensated cirrhosis. Methodls Seventy-eight patients (aged from 26 to 67) with decompensated cirrhosis, including 56 with hepatitis B, 21 with alcoholic cirrhosis and 1 with schistosomial cirrhosis, were included. Bone marrow was aspirated from poster superior spine. After isolation and purification, the stem cells were transplanted into liver via hepatic artery. The liver function, laboratory parameters and Child-Tureotte-Pugh scores were evaluated in 2,4 and 8 weeks after transplantation. Results At the 4th week after transplantation, the level of albumin was increased obviously from (32.9±5.58) g/L to (38.32±6.45) g/L,whereas the alanine aminotransferase was decreased from (96.92±83.91) U/L to (73.48±18.46)U/L. It was revealed that the prothrombin time was decreased from (16.66±3.91) s to (15.52±3.35) s and fibronegen increased from (2. 22 ± 0. 88) g/L to (2. 58±0. 88) g/L. After transplantation, appetite was improved in 72 cases (92.3%), ascites was decreased in 70 cases (89.7%) and abdomen distention was ameliorated in 68 cases (87.2%). There was no complications related to the transplantation. Conclusion Transplantation of autologous bone marrow stem cells is a safe and effective method in treatment of patients with decompensated cirrhosis.

Objective To observe the inhibitory effect on metastasis and growth of pancreatic cancer in mice by injection of KAI1 gene in vivo. Methods Pancreatic cancer cell line MiaPaCa Ⅱ was used to construct the nude mice models bearing tumors, then the mice were divided into normal saline group, Ad group and Ad-KAI1 group. Since the 10th days of model construction, the Ad-KAI1 was injected every 7 d and repeated twice, then the tumor size, the weight of liver, lung and their pathologic changes were evaluated. Results The tumor sizes were not significantly different between the three groups. The weight of lung and liver of Ad-KAI1 group was (0.366±0.041) g and (1. 35±0.21) g, respectively; the weight of lung and liver of Ad group was (0.57±0.065) g and (1.58±1.828) g, respectively; the weight of lung and liver of control group was (0.66±0.13)g and (1.95±0.344)g, respectively. The difference between Ad-KAI1 group and control group was significantly different (t = 5.984, P < 0. 05), and there was no significant difference between Ad group and control group (t=1.089, P > 0.05). The number of pulmonary, liver and lymph node metastasis in Ad-KAI1 group was (1±1), (2±1) and (2±2), respectively; in Ad group was (6±2), (5 ±1), (10±2), respectively; in control group was (7±2), (6±2), (11±3), respectively. The difference between Ad-KAI1 group and control group was significantly different (t = 7.44, 4.34, 8. 16, P < 0.05), while the difference between Ad group and control group was not significantly different (t=0.92, 0.64, 0.42, P >0.05). Conclusions KAI1 gene directly injected into tumors of nude mice may inhibit the growth and metastasis of pancreatic cancer.

Objective To compare the effect of autologous bone marrow stem cells transplantation on liver function between first and second transplantation in decompensated liver cirrhosis patients.MethodsA total of 45 decompensated liver cirrhosis patients were enrolled, and 23patients in first transplantation group were transplanted with autologous bone marrow stem cells through femoral artery when condition was stable after medical treatment.In second transplantation group, 22 patients were accepted second transplantation in 4-12 month after the first transplantation.All the patients undergone routine blood test, congulation test and liver function examination at the fourth week and eighth week after transplantation.ResultsEight weeks after transplantation, the liver function was improved obviously in both first and second autologous bone marrow stem cells transplantation.The level of albumin in patients of second transplantation group increased from (37.26± 5.90) g/L before transplantation to (42.49 ± 4.80) g/L (P＜0.01), alanine aminotransferase (ALT) decreased from (57.05±45.51) U/L to (44.86±29.19) U/L (P＜0.05),aspartate aminotransferase (AST) decreased from (39.14-±-15.07) U/L to (53.73 ± 24.98) U/L(P＞0.05).Congulation parameters were also improved, prothrombin time (PT) decreased from (16.15±3.01) s to (14.63±2.32) s (P＜0.01), fibrinofen (Fib) increased from (2.44±0.61) g/L to (3.00±0.81) g/L (P＜0.01).Compared with first transplantation group, the albumin level was higher in second autologous bone marrow stem cells transplantation group, which increased from (38.00±6.33) g/L to (42.49±4.80) g/L (P＜0.05), AST and ALT also improved obviously, and there was significant difference between two groups.Meanwhile, Child-Pugh scores decreased from (7.22±0.67) to (6.67±[0.71) (P＜0.05).But there was no significant difference in bilirubin, FIB and PT.ConclusionThe second transplantation of autologous bone marrow stem cells could further improve liver function and maintain symptoms remission of liver cirrhosis.

OBJECTIVETo investigate whether the impairment of grafted liver after transplantation was induced by the same inflammatory cells in cold and warm ischemia.

METHODSMale SD rats were divided into two groups randomly, 24 grafted livers in each group were stored for 120 or 240 min at 4 degrees Centigrade Ringer's solution. Also male SD rats were divided into three groups, in which 24 grafted livers in each group were experienced warm ischemia ranged from 90, 120 to 150 min from non-heart-beating donor. The recipients were killed after 1, 3, 6, and 24 hours of transplantation for sample collection.

RESULTSAlong with the prolongation of cold and warm ischemia time, the serum ALT and AST levels were increased gradually after transplantation. Light microscopy showed some necroses in hepatocytes after 3 and 6 hours of transplantation in cold ischemia, and some neutrophilic infiltration in sinusoids. There were a large number of hepatocytes necroses after 3, 6 hours of transplantation in warm ischemia from non-heart-beating donor and a lot of lymphocytic infiltration in sinusoids. The findings in electron microscopy were as the same as those found in light microscopy, and the lymphocytes which infiltrated in sinusoids in warm ischemia were identified as T lymphocytes in electron microscopy.

CONCLUSIONSThe impairment of grafted livers after transplantation seems to be induced by two different inflammatory cells in cold and warm ischemia, that is, neutrophils mediate the cold ischemia-reperfusion, and T lymphocytes mediate the warm ischemia-reperfusion from non-heart-beating donor.

Alanine Transaminase ; blood ; Animals ; Aspartate Aminotransferases ; blood ; Graft Survival ; physiology ; Hepatocytes ; pathology ; ultrastructure ; Liver ; blood supply ; physiopathology ; ultrastructure ; Liver Transplantation ; physiology ; Male ; Neutrophils ; physiology ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; physiopathology ; T-Lymphocytes ; physiology ; Temperature ; Time Factors

Objective To explore the relationship between serum lipoxygenin A4(LXA4)and S100 calc-binding protein A4(S100A4)levels and disease and disease outcome in children with primary nephrotic syn-drome(PNS).Methods A total of 168 children with PNS admitted to Nanjing Mingji Hospital from March 2020 to March 2022 were selected as the study objects,and 150 healthy children who came to Nanjing Mingji Hospital for physical examination were selected as the control group.The children with PNS were divided into remission group(n=73)and attack group(n=95)according to disease activity.Serum LXA4 and S100A4 levels were detected by enzyme-linked immunosorbent assay.The patients were followed up for 1 year after discharge and were divided into good prognosis group(n=138)and poor prognosis group(n=30)according to the prognosis.Spearman correlation analysis was used to investigate the relationship between serum LXA4,S100A4 levels and disease activity.The predictive value of serum LXA4 and S100A4 in the prognosis of PNS children was evaluated by receiver operating characteristic(ROC)curve.Multivariate Logistic regression was used to analyze the prognostic factors of PNS children.Results The serum levels of LXA4 and S100A4 in the remission group and the attack group were higher than those in the control group,and the serum levels of LXA4 and S100A4 in the attack group were higher than those in the remission group(P＜0.05).The serum levels of LXA4 and S100A4 were positively correlated with disease activity in children with PNS(r=0.593,0.546,P＜0.05).The good prognosis group had significantly lower serum levels of LXA4 and S100A4 than the poor prognosis group(P＜0.05).The area under the curve(95％CI)of serum LXA4 and S100A4 for pre-dicting the outcome of PNS in children was 0.767(0.756-0.888)and 0.846(0.824-0.863),respectively.The area under the curve of the joint(95％CI)was 0.905(0.879-0.924).Compared with the good progno-sis group,the poor prognosis group had significantly higher proportion of nephritis type,24 h urinary protein,hematuria,and urine protein clearance time,and significantly lower proportion of simple type,total protein,and IgM levels(P＜0.05).The multivariate Logistic regression analysis showed that hematuria(OR=2.300,95％CI 1.598-3.312),24 h urinary protein 121.25 mg/24 h(OR=2.098,95％CI 1.489-2.956),LXA4≥95.64 ng/L(OR=2.627,95％CI 1.737-3.973),and S100A4≥248.15 ng/L(OR=2.729,95％CI 1.777-4.192)were risk factors for poor prognosis in children with PNS(P＜0.05).Conclusion The serum levels of S100A4 and LXA4 are increased in children with PNS,and are related to disease activity and progno-sis,which may be used as potential markers for evaluating the condition and prognosis of PNS.