Objective To investigate the diagnostic value of pyruvate kinase M2 ( PKM2) gene expression in papillary thyroid carcinoma ( PTC). Methods Quantitative real-time PCR ( RT-qPCR) was used to detect the expression of PKM2 mRNA in benign thyroid nodules, PTC, and normal thyroid cells around nodules of fine-needle aspiration (FNA) specimens. Immunohistochemistry ( IHC) was used to detect the expression of PKM2 protein in thyroid tissue after thyroidectomy. The receiver operating characteristic curve was constructed to evaluate the diagnostic value of PKM2 in PTC. Results The expression of PKM2 mRNA was detectable in FNA specimens of thyroid nodules,higher in PTC than those in normal thyroid tissue and benign thyroid nodules (P<0.01). PKM2 expression level was correlated with diameter of PTC ( P<0.05) , but had no correlation with lymph node metastasis, BRAFV600E mutation, and American Joint Committe on Cancer( AJCC) stage ( P>0.05) . The expression level of PKM2 mRNA in FNA specimens of thyroid nodules was paralleled with the expression level of PKM2 protein in postoperation pathological tissues. The accuracy, sensitivity, specificity of PKM2 gene in the diagnosis of PTC were 62.8％, 46.9％, and 95.7％, respectively. The accuracy and sensitivity of PKM2 combined with BRAFV600E were increased to 87.6％and 83.7％. Conclusion Detection of PKM2 gene in FNA specimens is highly specific in the diagnosis of PTC, making it a valuable molecular marker for preoperative diagnosis. The combination of PKM2 and BRAFV600E detection shows a higher diagnosis efficiency.

BACKGROUND: Although more and more accurate and personalized detection and assistive tools are used in the field of orthopedics with the development of technology, the preoperative CT is still the first-line examination choice of many orthopedic surgeons. Therefore, to master the lumbar spine CT imaging performance is not only the basis of spine surgeons, but also the cornerstone of spinal nail surgery. OBJECTIVE: Through CT imaging technique, we measured the parameters of lumbar pedicle imaging, and understood its internal structure as the basis for the choice of screws, in order to improve the safety and accuracy of nail surgery. METHODS: Totally 36 cases without lumbar vertebrae-related disease undergoing lumbar vertebra and abdominal cavity CT scan were randomly selected, including 20 males and 16 females at the age of (43.3±12.3) years. PACS was used to reconstruct lumbar vertebrae, and the related imaging parameters were measured. RESULTS AND CONCLUSION: (1) There was no significant difference between the left and right sides of the pedicle for paired t-test (P >0.05). (2) Pedicle sagittal angle had downward trend, the level of change was small; L4increased relative to L3; L5level was minimum at the average of -1.3°. Pedicle transverse angle had gradually increased trend, and maximum at L5; the average was 25.4°. (3) The length of the pedicle channel increased first and then decreased in the lumbar segment; the longest average was 52.2 mm in the L2segment, the shortest at L5, with an average of 47.4 mm. (4) The pedicle height was slightly narrowed at L1-L3levels; the smallest was 15.4 mm (L3mean), and reached the maximum in the L5at 22.7 mm (L5mean). Cancellous bone height also showed the same trend, the minimum in the L3at 10.2 mm, the maximum in the L5at 17.9 mm. (5) Lumbar pedicle width showed an upward trend, L1minimum of 7.7 mm, L5maximum of 12.5 mm. Cancellous bone width also became a similar upward trend; the narrowest L1, averagely 4.9 mm; the maximum L5, averagely 8.5 mm. (6) Overall, the upper lumbar pedicle channel was slender, while the lower lumbar spine was slightly short. (7) The parameters of the pedicle can be used as the basis for selecting the appropriate screw. At the same time, lumbar pedicle morphology has a certain difference, and there is a certain law. Accurately grasping its structure and image characteristics of pedicle screw fixation is the basis of surgery. The preoperative imaging data collection and assessment, combined with the general situation of patients, and the development of personalized programming, will help in improving the safety and accuracy of screw placement.

Objective Previous studies suggested that overerpression of Slit2 results in abnormal Alzheimer's disease-like behavior and cognition impairment in mice. The aim of this study is to investigate the relationship between overerpression of Slit2 and accumulation and clearance of amyloid-β in aging mice by comparing the differential expression of genes for accumulation and clearance of amyloid-β in aging Tg-Slit2 and Tg-2576 mice. Methods 14-month old male C57BL/6, Tg-Slit2 and Tg-2576 mice were used to detect the expression of Aβ1 - 40 and Aβ1 - 42 in brain by immunohistochemistry. Further, the total RNA in the brain of these mice were extracted, identified and inversely transcripted to cDNA, then the cDNA was detected by PCR array. The expression of genes in the brain of Tg-Slit2 and Tg-2576 mice were analyzed. Results Comparing with the Tg-2576 mice in the same age, accumulation of Aβ was not found in the brain of Tg-Slit2 and C57BL/6 mice. The result from PCR array analysis showed that comparing with the same aged C57BL/6 mice, there were 16 up-regulated genes and 8 down-regulated genes in the brain of Tg-Slit2 mice and 14 up-regulated genes and 17 down-regulated genes in the brain of Tg-Slit2 mice. The expression of amyloid beta precursor protein (APP) in the brain of the three group mice was not changed. The expression of presenilin 2 ( Psen2) related with Aβ production was significantly up-regulated in the Tg-2576 mice. In addition, the expression of low density lipoprotein receptor-related protein ( LRP) 6 and 9 were markedly decreased in the Tg-2576 mice. Notably, these genes were not changed in the brain of the aging Tg-Slit2 mice. Conclusions The accumulation of Aβ in the brain are not found in 14-month Tg-Slit2 mice, In addition, different from Tg-2576 mice, the significant changes of expression of Aβ-related genes is not found in the brain of Tg-Slit2 mice.

Objective To investigate the effect of intracranial pressure fluctuation on the prognosis of patients with traumatic brain injury (TBI).Methods A retrospective case series study was conducted on the clinical data of 30 patients with TBI hospitalized between June 2012 and June 2014.There were 21 males and 9 females,aged (43.0 ± 19.8) years.After the intracranial pressure probe was implanted,the intracranial pressure of TBI patients was monitored continuously and the data were recorded per minute.A single cosine method was used in analyzing the circadian rhythm of intracranial pressure data.Furthermore,the ratio of the amplitude of the circadian parameter (A) to the median (M) value (A/M) was selected to evaluate the biologic rhythm of patients.The correlations of circadian rhythm parameter A/M with Glasgow Outcome Scale (GCS) and with extended Glasgow Outcome Scale (GOS-E) were analyzed using linear regression.Results The circadian rhythm was observed in all patients regardless of injury severity (P ＜ 0.01).The circadian rhythm parameter A/M of intracranial pressure was positively correlated with the GCS of patients at discharge (R2 =0.346,F =14.797,P ＜0.01) and with the GOS-E (R2 =0.356,F =15.502,P ＜ 0.01).Conclusion The intracranial pressure fluctuation of TBI patients follows circadian rhythm,which might be correlated with the prognosis of TBI patients.

Objective To explore the effectiveness and safety of fiberbronchoscope combined with cryotherapeatic equipment in treatment of bronchial foreign body in children.Methods 72 children with bronchial foreign body received fiberbronchoscope combined with cryotherapeatic equipment, then the complications were observed during and after the operation.Results Bronchial foreign bodies were successfully removed in all the patients. Among the 72 cases, transient hypoxia was the most common complication during the operation which happened in 37 cases and most occurred in the small age group, and decreased with the age increasing; cough or worsening of cough was the most common complication after the operation which happened in 20 cases; No serious complications were found during the follow-up.Conclusion Although it has some complications when bronchial foreign body received the fiberbronchoscope combined with cryotherapeatic equipment, but the operation time is short, and the complication is mild. It has great application value and security.

The chinmedomics method was used to explore the effect of Nanshi capsule on endogenous metabolites of rats with kidney-yang deficiency syndrome, investigate the metabolites and metabolic pathways closely related to kidney-yang deficiency syndrome (KYDS)and identify the therapeutic basis of Nanshi capsule(NPC)as well as its action mechanism for KYDS. The routine biochemical indexes of serum were detected and histomorphology was observed. Based on the chinmedomics technology platform, discriminatory analysis in multivariate modes was conducted for rat blood and urine, thus to investigate the biomarkers of KYDS and the therapeutic effect of NPC against KYDS. Meanwhile, the main constituents of NPC in rat serum were also detected to analyze its correlation between the constituents in vivo and the biomarkers of KYDS, and determine the potential effective compounds for therapeutic effect. Eleven biomarkers of KYDS were identified in the rat models, involving steroid hormone biosynthesis, tryptophan metabolism and tyrosine metabolism. It was found that NPC could regulate steroid hormone biosynthesis, tryptophan metabolism and tyrosine metabolism; PCMS analysis showed that caffeic acid, 2-hydroxy-1-methoxy-anthraquinone, 1-hydroxy-2-methoxyanthraquinone, ferulic acid glucuronide conjugation, deacetylasperulosidic acid, cynaroside, betaine and umbelliferone were the main effective compounds of NPC for KYDS. In this study, cynaroside, betaine, umbelliferone and other compounds in NPC could integrally regulate the disturbance of metabolic profile in KYDS by improving the hormone synthesis, hormone synthesis pathway, hormone synthesis and release pathway in tyrosine metabolism and linoleic acid synthesis pathway in linoleic acid metabolism. These results indicated that the NPC had the characteristics of multi-pathway, multi-target and overall regulation in the treatment of KYDS. Chinmedomics approach can provide methodology support to discover innovative drug from traditional Chinese medicine.

Objective To evaluate the efficacy and safety of small-middle endoscopic sphincterotomy combined with endoscopic papillary balloon dilation for patients with extrahepatic bile duct stone. Methods The patients with special duodenal papilla included 38 cases, and those with normal duodenal papilla 143 cases. 38 patients had received SEST + EPBD, 143 had received MEST + EPBD. Results 181 patients had received SMEST + EPBD in our hospital and the related data were retrospectively analyzed. All 181 patients were successfully removed, the success rate was 100.00 %. There was no perforation occurred postoperatively, but mild acute pancreatitis occurred in 8 patients (4.42 %, 8/181) and bleeding occurred in 9 patients. The three major early complications rate were 9.93 %(17/181), which was cured by the conservative management. Conclusion SMEST plus EPBD is a safe and effective treatment for extrahepatic bile duct stone, with retaining the feature of sphincter of duodenal papilla, especially for patients with special duodenal papilla.

Objective To discuss the relationship between serum anti-Phosphalipase A2 receptor (PLA2R) antibodies and glomerular IgG4 subclass in patients with membranous nephropathy and evaluate the diagnostic value of the two markers.Methods Patients diagnosed as membranous nephropathy from October 2011 to April 2014 in Peking Union Medical College Hospital were included and divided into IMN and SMN groups accoding to their clinical diagnosis.Serum anti-PLA2R antibodies and glomerular IgG subclasses were both detected by indirect immunofluorescence assay.Receiver operator characteristic curves were used to evaluate the diagnostic efficiency of anti-PLA2R antibodies and glomerular IgG4.Results Prevalence of serum anti-PLA2R antibodies of IMN patients was 69.5％ (41/59); prevalence of MLN patients was 4.8％ (1/21).Within the IMN group,thirty-five patients showed positive results of both serum anti-PLA2R antibodies and glomerular IgG4; Six patients were positive for serum anti-PLA2R antibodies but negative for glomerular IgG4; Seventeen patients were positive for glomerular IgG4 but negative for serum anti-PLA2R antibodies; one patient was negative for both tests.The sensitivity of serum anti-PLA2R antibody was 69.5％ and the specificity was 95.2％; the sensitivity of glomerular IgG4 was 89.8％ and the specificity was 52.3％.The sensitivity of the combined marker consisting of serum anti-PLA2R antibody and glomerular IgG4 was 59.3％ and the specificity was 100％.Four out of the six patients secondary to HBV infection,one out of the three patients secondary to Sj(o)gren syndrome,one out of the three patients secondary to malignant tumor showed positive results of serum anti-PLA2R antibodies.Conclusions Serum antiPLA2R antibodies were of high prevalence among IMN patients; the prevalence among SMN patients varied with etiologies.Results of serum anti-PLA2R antibodies and glomerular IgG4 were helpful to rule out secondary etiologies in the diagnosis of membrnous nephropathy.

INTRODUCTIONThis study aimed to examine the long-term clinical outcomes of coronary fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in a real-world population in an Asian tertiary centre.

MATERIALS AND METHODSAll patients who underwent FFR measurement for intermediate coronary lesions in our centre from June 2002 to December 2009 were enrolled. A threshold of FFR ≤0.75 was used for revascularisation. All the patients were prospectively followed-up for major adverse cardiac events (MACE) of death, myocardial infarction (MI), target vessel revascularisation (TVR) and stent thrombosis.

RESULTSBased on FFR measurement, 368 (57%) patients were treated medically while 278 (43%) underwent revascularisation. At a mean follow-up duration of 29.7 ± 16 months, 53 (14.4%) patients in the medical therapy group and 32 (11.5%) patients in the revascularised group experienced MACE (P = 0.282). There were no statistical differences in all the clinical endpoints between the 2 groups.

CONCLUSIONMedical therapy based on FFR measurement is associated with low incidences of MACE at long-term follow-up.

Adult ; Aged ; Aspirin ; therapeutic use ; Coronary Stenosis ; complications ; diagnosis ; therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; methods ; Platelet Aggregation Inhibitors ; therapeutic use ; Retrospective Studies ; Ticlopidine ; analogs & derivatives ; therapeutic use ; Treatment Outcome

Aged ; Cardiac Catheters ; Combined Modality Therapy ; Coronary Restenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; therapeutic use ; Percutaneous Coronary Intervention ; instrumentation ; Stents ; Treatment Outcome ; Tubulin Modulators ; administration & dosage ; therapeutic use