Thyroid cancer is one of the commonest head and neck cancer. According to the recent research, VI lymph nodes (also called the front area, including thyrocricoid lymph nodes, tracheal surrounding lymph nodes, thyroid surrounding lymph node,recurrent laryngeal nerve lymph nodes, retropharyngeal lymph nodes) is the most common site of involvement in the differentiated thyroid carcinoma. Thyrocricoid lymph nodes known as the Delphian lymph node(DLN) is located between the thyroid cartilage and the cricoid cartilage. The DLN is one of the most accurate predictor. This paper reviewed the clinical significance of the DLN, the role of DLN metastasis in papillary thyroid cancer, and the relationship between tumor size, multicentricity and DLN metastasis. We also discussed the association between DLN metastasis and additional central compartment metastasis, as well as lateral compartment metastasis.
Carcinoma ; pathology ; Carcinoma, Papillary ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Neck ; Neck Dissection ; Recurrent Laryngeal Nerve ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology

Objective To investigate the effects of transplantated tumor capillary permeability under microbubble enhanced diagnostic ultrasound exposure.Methods Fourty eight rats were randomly divided into four groups after Walker 256 carcinomas were subcutaneousely implanted,named the control group (A),microbubbles group (B),ultrasound group (C),microbubbles and ultrasound group (D).Using Evans blue(EB) as the indicator for tumor capillary permeability,the microbubbles were injected through the vein with diagnostic ultrasound frequency as 1.75 MHz,mechanical index as 1.4.The spillover of EB was estimated under confocal laser microscope,meanwhile the contents of EB in the tumor tissues were calculated according to the standard curve and spectrophotometry.Results EB spillover was observed around the capillaries in the group D,while EB spillover was only observable on capillary in group A,B and C.The EB content was also significantly higher than those in group A,B and C.Conclusions Exposure to both diagnostic ultrasound and microbubbles results in increased capillary permeability of rat tumor tissues,which might become a potential therapeutic method on clinical chemotherapy.

Objective To investigate the feasibility of transfecting gene into HepG2 by therapeutic ultrasound combined with microbubble,and to explore the optimal ultrasonic parameters for high transfection efficiency.Methods HepG2 cells were cross-interval planted in 24-well plates.EGFP plasmid DNA and microbubbles were added to the cultured HepG2 and three parameters of the therapeutic ultrasound were optimized.Firstly,set ultrasonic intensity gradient (group A,from A1 to A5),which were 0.4 W/cm,0.8 W/cm2,1.2 W/cm2,1.6 W/cm2 and 2.0 W/cm2 respectively.Secondly,set the duty cycle gradient group (group B,from B1 to B3),which were 10％,20％ and 50％ respectively.Lastly,set the exposure time group(group C,from C1 to C3),which were 30 s,90 s and 180 s.After 24 hours,the expression of GFP was observed by fluorescence microscopy,the transfection rates was detected by flow cytometry,the cell death were assessed by trypan blue exclusion.Results The plasmid transfection efficiency was varied under different ultrasonic parameters.Within a certain range,the increasing of parameters can improve the transfection efficiency,but when the parameters were too large (eg.the intensity＞1.6 W/cm2 or 50％ duty cycle),the actual transfection efficiency decreased due to the increased cell death.When the ultrasonic intensity was 1.2 W/cm2,the transfection efficiency and mortality were better than the other subgroups of group A.When the duty cycle was 20％,the transfection efficiency and mortality rate were better than the other subgroups of group B.Continue to increase the exposure time over 90 s was not statistically significant (P ＞0.05) for transfection efficiency and cell mortality.Conclusions The ultrasound-targeted microbubble destruction is an efficient method for gene delivery in vitro.The transfection efficiency vary greatly under different parameters,so optimization parameters is conducive to the promotion of gene transfection.

Objective To compare bolus infusion and replenishment using real low mechanical index contrast enhanced ultrasound in assessing the change of renal cortical perfusion.Methods Using dopamine (i.v.) at the dose of 0.5,2.0,5.0μg · kg- 1 · min- 1 to change renal blood perfusion of 20 rabbits,then during bolus or contant injection of SonoVue,at coded pulse inversion mode,real-time contrast ultrasound was performed,the latter method needed destroying microbubble at a high MI when amplitude reach a steady state,then recording the replenishment,peak intensity(A) and time to peak (PPT) were obtained through raw time-intensity curve,and slope rate of TIC(k) was acquired by curve fitting,standard effective renal plasma flow(ERPF) was measured through 4-aminohippuric acid clearancerate method,meanwhile correlations between ERPF and parameters were analyzed,as well as the paired samples t test for each parameter before and after dopamine administration.Results The ascending branchs of raw TIC of bolus infusion increased sharply and were approximately straight,then descended gradually,while that of replenishment looked like two straightlines with different slopes,then stayed horizontal Both the value of A of two methods were positively correlated with ERPF ( r b =0.85,r re =0.66),and were different at the same ERPF,meanwhile the value of TTP were negatively correlated with ERPF( r b =-0.92,r re =- 0.76),and there were no statistically difference between the two methods.k from Gamma fitting was far from correct,while k from exponential fitting was apparently correlated with ERPF ( r re =0.77 ).Conclusions Both bolus injection and constant injection-replenishment method can assess renal cortical blood perfusion,TIC parameters A and TTP represent regional blood volume fraction and microbubble velocity respectively.Bolus-infusion with real low mechanical index is more precise and available.Comparing with k,TTP is more appropriate to reflect perfusion velocity.

BACKGROUND: Presently, the kidney source is limited. Urinary fistula-induced nephrectomy of transplanted kidney is regrettable. Reasonable diagnosis of urinary fistula should be paid great attention by workers of organ transplantation. OBJECTIVE: To study the diagnosis and treatment of the urinary fistula in kidney transplantation patients. METHODS: The clinical data of 16 patients with the urinary fistula following kidney transplantation, who was recruited from the Organ Transplantation Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, were retrospectively analyzed. RESULTS AND CONCLUSION: The morbidity of the urinary fistula following kidney transplantation was 1.26%, the conservative treatment were used to 13 cases of simple urinary fistulas, 11 of 13 cases were successful (84.6%). 2 case failed (15.4%), pedicled omentum grafts were successful used to treat 3 cases of complex urinary fistulas after renal transplantation by one operation. Intensive care and active measures should be given to the urinary fistula patients after kidney transplantation. The key to the successful treatment involved with the diagnosis in early stage and the correct measures. With biological characteristics of omentum, applying pedicled omentum grafts to repair complex urinary fistulas and simple urinary fistulas which were failure of the conservative treatment after renal transplantation has advantages as followings, convenient to draw material, recovering tissue quickly and low recurrence rate. It is fit for clinic.

Objective To investigate the value of ultrasound guided autobiopsy technology in interventional diagnosis of pulmo-nary peripheral disease .Methods 117 cases of pulmonary peripheral disease proved by X-ray or CT ,confirmed by ultrasound ,but could not be identified the nature by the examination above ,were biopsied under the guidance of ultrasound .Results All the 117 ca-ses were biopsed successfully .115 cases of them had definite pathological results ,the pathological positivity rate was 98 .3% ,in which contained 20 cases of chronic inflammation ,14 cases of tuberculosis ,30 cases of squamous cell carcinoma ,45 cases of adeno-carcinoma ,6 cases small cell undifferentiated carcinoma .No complication ,such as pneumatothorax ,hemoptysis ,bleeding occurred during the operation .Conclusion The ultrasound guided autobiopsy technology in interventional diagnosis of pulmonary peripheral disease is a safe and effective technique ,the tissues obtained from ultrasound guided autobiopsy were adequate to pathological slide which can provide the basis of the clinical diagnosis .

Objective To study the clinical effect and complications of modified autogenous fat grafting for breast augmentation.Methods The datas of 29 patients with improved autogenous fat grafting for breast augmentation and 32 patients with traditional autogenous fat grafting for breast augmentation were summarised.The adipocyte survival rate,complications and patient satisfaction survey after 3 and 6 months of transplantation were evaluated.PAAG breast augmentation and normal breast tissue specimens were detected by HE staining and immunofluorescence staining to analyze the safety of autogenous fat grafting for breast augmentation.Results Both of adipocyte survival rates and satisfaction of patients who recieved improved autogenous fat grafting were significantly higher than those of patients with traditional autogenous fat grafting(P ＜ 0.05),both two methods with less complications,the difference was not significant (P ＞ 0.05).The immunofluorescence tests showed that there was no inflammatory reaction and immune dysfunction of autogenous fat grafting,which had no difference with the results of the normal tissues (P ＞ 0.05).Conclusion Autogenous fat grafting for breast augmentation is safe and reliable,and modified autogenous fat grafting for breast augmentation can obviously increase the adipocyte survival rate after transplantation.

Objective To investigate the effect of the side of cerebral lesion on the outcome in patients with ischemic stroke.Methods A total of 407 consecutive anterior circulation ischemic stroke patients within 14 days after symptom onset were recruited prospectively.The basic data ofthe e,~ISes were collected,such as the National Institutes ofHealth Stroke Scale (NU-ISS)and the side ofcerebral lesion.The modified Rankin Scale(mRS)was used to evaluate the prognosis of the patients at 6 raomhs.Results Of the 407 patients recruited,230 patients (56.5%)Were left hemisphere stroke,177(43.5%)were fight hemisphere stroke.After multivariable logistic recession analysis,the age(odds ratio[OR]1.022,95% confidence interval[CI]1.001-1.043,P=0.040),the side of lesion(OR 1.999.95%CI1.179.3.389.P=0.010),the time from onset to admission(OR1.006,95%(7/1.002-1.010,P=0.007),the outcome of the anterior circulation ischcmic stroke at 6 months aftel"onset.The outcome of the right hemisphere stroke Was significantly worse than that of the left hemisphere stroke.The onset-admission time in patients with right hemisphere stroke(median 12 h,median 39.61 h)was significantly delayed compared to the patients with left hemisphere stroke(median 12 h,median 22.72 h;Z=-2.962,P=0.003).Condusions The outcome of the left hemisphere stroke at 6 months after onset is superior to the right hemisphere stroke,and it mau be associated with the delayed admission.

Objective To assess metabolic alterations in the human basal ganglia area during maturation and aging by using 2D chemical shift imaging (2D CSI) of proton magnetic resonance spectroscopy (1H-MRS). Methods Seventy healthy subjects were examined by 2D CSI. 2D CSI imaging acquisition was performed in the bilateral caudate, lentiform and thalamus. 1H-MRS was processed to determine the metabolite ratios, including NAA/Cho, NAA/Cr, Cho/Cr. Seventy healthy subjects were divided into 3 groups:20 to 39 years of age group, 40 to 59 years of age group and 60 to 87 years of age group. The three groups of healthy participants were compared. Results There was a significant decrease with aging in the NAA/Cho ratio in the bilateral lcntiform, thalamus and left caudate, and a significant decrease with aging in NAA/Cr ratio in the bilateral thalamus,right lentiform and left caudate (P<0.05), whereas the Cho/Cr ratio was significantly increased in the bilateral lentiform with aging(P<0.05). Conclusions The results of 1H-MRS show significant changes in the level of metabolites during the process of aging. This technique may play an important role in clinical studies and applications for various conditions of metabolic disorders of the human brain.

Objective To investigate current situation of teaching competition and to put forward some feasible suggestions for improving the teaching competition of theoretical course for young teachers. Methods Questionnaire survey was conducted for 126 teachers including the effect of teaching competi-tion on effective teaching atmosphere,comprehensive teaching results,teaching ability and recommenda-tions for improvement. SPSS software was used to do statistical analysis andχ22 test was applied. P<0 . 05 stands for statistically significant difference. Results Investigation results demonstrated that teaching competition of theoretical course was conducive to forming effective teaching atmosphere,achieving better teaching effect and improving teaching ability of teachers . A χ22 test was performed on the cognition of the cultivating of classroom management ability;results demonstrated that there were significant differ-ences between teachers with more than 10 years education age and those with less than 10 years education age(χ22=4.375,P=0.0365). Conclusions Teaching competition of theoretical course is an effective way to cultivate young teachers teaching ability. Teaching competition should be combined with training and feedback and evaluation should be more scientific and objective in order to improve young teachers' teaching ability.