Objective To investigate the diagnostic value of CT signs of ipsilateral central lymph node metastasis (ICLNM) in single papillary thyroid carcinoma (PTC) by multivariate regression analysis.Methods The CT data of 302 single PTC with diameter ＞1.0 cm confirmed by operation and pathology were retrospectively analyzed.The optimal thresholds of lymph node metastasis diameter were obtained by receiver operating characteristic (ROC) curve analysis.And multivariate regression analysis was used to analyze the relation between lymph node size,degree of enhancement,calcification or cystic degeneration,central turbidity,positive lateral cervical lymph nodes and the ICLNM positivity.Results In 302 PTC,the proportion of ICLNM positive and negative was 63.6％ (192/302) and 36.4％ (110/302),respectively.According to the ROC curve,with the increase of lymph node diameter,the sensitivity of diagnosing lymph node metastasis decreased and the specificity increased.When the threshold was 0.4 cm,Youden index was the largest (0.358),and the sensitivity and specificity was 50.5％ and 80.3％,respectively.Multivariate analysis showed that the diameter≥0.4 cm,high enhancement,central turbidity and lateral cervical lymph nodes positivity were the independent risk factors of ICLNM,and the OR values were 4.189[95％ CI (2.037-8.617)],3.875 [(95％ CI (1.561-9.617)],4.054[(95％CI (2.230-7.371)] and 8.735 [(95％ CI (1.093-69.831)],respectively.Calcification or cystic degeneration was not statistically significant in ICLNM.Conclusions The diameter ≥0.4 cm,high enhancement,central turbidity and lateral cervical lymph nodes positivity are the independent risk factors of ICLNM.Although calcification or cystic degeneration is not the independent risk factor,it has high accuracy for ICLNM positivity.The accurate identification of these signs can help surgeons to take a more thorough surgical treatment and has great significance to reduce postoperative recurrence.

Objective: To evaluate the design and clinical application of forearm proximal radial inferior cubital artery perforator flap. Methods: The clinical data of 11 patients with defects of anterior elbow from June 2013 to June 2018 were analyzed retrospectively, in which including 8 male and 3 female, mean age is 51.5 years old, ranged from 48 to 76 years old. The sizes of soft tissue defects ranged from 7.5 cm×4.5 cm to 14 cm×7 cm. Forearm proximal inferior cubital artery perforator flaps were used to repair the defects according to flap their location, size and shape, in which the largest is 15 cm×10 cm and the smallest is 7 cm×5 cm. To evaluate the effect according to flap survival, infection control, elasticity and color, appearance, the scar of the donor site, cutaneous sense, and satisfaction of patients. The elbow efficacy and function were evaluated according to Mayo criteria and the swelling degree of flap was also evaluated. Results: All the flaps survived in 11 cases, the incisions in donor and recipient site were primary healing. The survival of flaps is good and the appearance, color and elasticity are close to normal, on the other hand, the scar at the donor site is small after 6 to 36 months follow-up. The efficacy is satisfied in 8 cases, general in 3 cases and no dissatisfactory. The function of elbow is excellent in 4 cases, good in 6 cases and general in 1 case. Skin swelling rating in early stage is 1st degree in 6 cases, 2nd degree in 3 cases, 3rd degree in 2 cases; in later stage is 1st degree in 8 cases, 2nd degree in 2 cases, 3rd degree in 1 case. Conclusions The anatomic position of forearm proximal radial inferior cubital artery perforator flap is constant, the blood supply is good, and the operation method is simple and safe which could be a new supplementary method and be available for clinical selection to repair the soft tissue defects of elbow.

Objective To investigate the diagnostic significance of CT in thyroid benign solitary coarse calcification nodules (BCCN).Methods A total of 56 BCCN confirmed by surgical pathology in 55 patients were evaluated,and they were compared with 33 papillary thyroid carcinoma (PTC) in 32 patients.The distribution differences of the average CT values and the maximum CT values in BCCN and PTC were observed.The optimal thresholds of the average CT values and the maximum CT values in BCCN and PTC were established by re ceiver operating characteristic(ROC) curve analysis.Results The average CT values in BCCN and PTC were significantly different (t=4.992,P=0.000).The ROC area under curve (AUC) was 0.757 (95％ confidence interval 0.0657-0.0857).When the critical value was 743.4 Hu,Youden index was the largest and the sensitivity and specificity was 48.2％ and 93.9％,respectively.When the critical value was 891.1 Hu,the sensitivity and specificity was 21.4％ and 100％,respectively.The maximum CT values in BCCN and PTC were significantly different (t=5.029,P=0.000).The ROC AUC was 0.775 (95％ confidence interval 0.0681-0.0869).When the critical value was 1201.5 Hu,Youden index was the largest and the sensitivity and specificity was 51.7％ and 91.0％,respectively.When the critical value was 1373.5 Hu,the sensitivity and specificity was 42.9％ and 100％,respectively.Conclusions CT value is of great significance to the diagnosis of BCCN and has high specificity.Compared with the average CT value,the maximum CT value has a relatively higher sensitivity,providing an important base for reducing unnecessary surgical trauma.

Objective To preliminarily investigate the role of Vitamin C in cecal ligation and puncture-induced septic brain injury.Methods Male specific pathogen free (SPF) Sprague-Dawley male rats were randomly assigned into control group,sham operation group,sepsis group and sepsis therapy group.The rats in sepsis group were prepared by cecal ligation and puncture.The rats in sepsis therapy group were injected sodium ascorbate through the tail vein 3 h after the cecal ligation and punature procedure.The animals in other groups were subjected only to subcutaneous bolus injection of 9 g/L saline only.Animals were evaluated by neurologic reflex scores before sacrifice and brain tissues were quickly removed at the indicated time points.Reactive oxygen species (ROS),superoxide dismutase (SOD),malondialdehyde (MDA),nitric oxide (NO),inducible nitric oxide synthase (iNOS) and catalase (CAT) were determined by using enzyme assay kits.Hematoxylin-eosin (HE) staining was used to observe morphological changes in brain tissues.Results The survival rate of the sepsis group (30％ at 7th day) was significantly lower than that of the control group (100％ at 7th day)and sham operation group(100％ at 7th day).The survival rate of the sepsis therapy group (45％ at 7th day)was significantly higher than that of the sepsis group(P ＜ O.05).The neurological reflex assessment began to decrease at 6 h in sepsis group and reached the lowest at 24 h (6.00 ± 0.53).The sepsis therapy group (7.62 ± 0.52) was significantly higher (P ＜ 0.05) than the sepsis group and began to recover at 72 h (8.63 ±0.52).ROS,SOD,MDA,NO and iNOS in the sepsis group and the sepsis therapy group reached a peak at 24 h,which decreased at 72 h.The value in sepsis therapy group was significantly decreased than that in the sepsis group,and the difference was statistically significant(P ＜0.05).CAT changed in the opposition.The SOD/CAT in sepsis group was the highest 24 h after the operation,while the ratio in sepsis therapy group was significantly improved.SOD/CAT and MDA were positively correlated(r =0.968,P ＜ 0.05).HE staining showed significant damage to the brain tissue structure in the sepsis group,however some improvement was observed in the sepsis therapy group.Conclusion Vitamin C can significantly improve the survival rate and encephalopathy prognosis in the cecal ligation and puncture SD rat models.The mechanism may be related to the reduction of oxidative stress.

Objective To evaluate the clinical effect of the perforator fascial flap of the lower leg for the repair of large skin and soft tissue defects around the ankle in the elderly.Methods A retrospective case series study was conducted on the clinical data of 23 elderly patients with skin and soft tissue defect around the ankle joint admitted to Xinhua Hospital (Chongming) Affiliated to Medical College of Shanghai Jiaotong University,from November 2013 to December 2017.There were 13 males and 10 females,aged 65-78 years (mean,71 years).The wound areas around the ankle joint ranged from 13.5 cm × 5.5 cm to 16.0 cm × 8.5 cm.According to the position,size,and shape of the wound area around the ankle joint of the lower leg,the perforator fascia flap was designed and transferred for repairing.The maximum flap area was 17.0 cm × 9.5 cm while the minimum area was 14.0 cm ×6.5 cm.According to the conditions of survivals of the skin flap,elasticity,color,appearance,infection control,donor site scar,skin sensation,joint activity,patient satisfaction,etc.,the ankle and foot function was evaluated by referring to Tornetta and other standards.Besides,the swelling degree of the flap was graded.Results A total of 21 flaps survived and the wound at both donor site and recipient site obtained stage Ⅰ union.Two cases of skin edge necrosis occurred at the distal end of the flap,and the wounds at the donor and recipient sites were completely healed after dressing change.The patients were followed up for 6-48 months,with an average of 15 months.The flaps had good survival,satisfactory shape,and small scar at donor site,with similar elasticity and color with the surrounding normal skin.Twenty patients were satisfied with the efficacy and three were fine with the outcome.In terms of functional evaluation of the ankle and foot,the results were excellent in eight patients,good in 12,and fair in three.Flap swelling grading was as follows:degree Ⅰ in 16 patients,degree Ⅱ in 5,and degree Ⅲ in 2 at the early stage;degree Ⅰ in 20 patients,degree Ⅱ in 2,and degree Ⅲ in 1 at the later stage.Conclusion In repairing large skin and soft tissue defects around the ankle in the elderly,the perforator fascia flap of the lower leg transferring is a convenient,safe,and reliable method with less damage,which can promote the wound healing and functional recovery of ankle and foot.

Objective: To report the method and effect of in situ suturing technique for severe amputation of facial composite tissues. Methods: We in situ sutured severely amputated composite tissues of facial region in 14 cases in emergency by vessels and nerves anastomosis from May 2004 to December 2017. Results: All replanted composite tissues survived in 13 cases. Edge necrosis of auricle occurred in 1 case because of serious contusion and it was cured after dressing changed. The color and appearance of the replanted composite tissues were close to normal after 3 to 48 months′ follow-up. Conclusions In situ suturing technique in emergency is the ideal treatment for severe amputation of composite tissues of facial region.

Objective To discuss the predictive value of multiple ultrasonic features combination in diagnosis of thyroid papillary carcinoma (PTC) more than 1.0 cm in diameter. Methods The ultrasonic features of 258 PTC nodules from 251 patients and 207 nodular goiter (NG) nodules from 190 patients in the First People′s Hospital of Hangzhou were retrospectively analyzed. All the nodules were confirmed by pathological examination after surgery. The ultrasonic features included the shape of nodules, internal echo,anteroposterior/transverse diameter ratio (A/T), and microcalcification. The χ2 test was used to analyze the differences of ultrasonic features between PTC and NG. Multi-variate analyses (Logistic regression) was used to analyze the predictive risk ultrasonic features of PTC. The sensitivity and specificity of ultrasonic features were analyzed based on the gold standard of pathological results. Results There were significantly differences between 258 PTC nodules and 207 NG nodules in irregular shape, hypoechogenicity,A/T > 1 and microcalcification (χ2 values were 121.511, 105.411, 41.483, 121.072, all P < 0.01). The results of Logistic regression showed that irregular shape, hypoechogenicity, A/T>1 and microcalcification were risk ultrasonic features of PTC. And their OR values were 5.013 (95%CI 2.919-8.610), 5.811 (95%CI 3.411-9.901), 15.399 (95%CI 7.576-31.301), 4.141 (95%CI 1.687-10.164) respectively. The sensitivity and specificity of single ultrasonic feature were 26.0%-79.5% and 71.5%-96.1%; the sensitivity and specificity of two ultrasonographic features combination were 11.2%-57.0% and 92.3%-99.0%; and the sensitivity and specificity of three or four ultrasonographic features combination were 8.1%-31.8% and 99.0%-99.5%.Conclusions Irregular shape, hypoechogenicity, A/T> 1 and microcalcification of thyroid neoplasm are important ultrasonic features of PTC. Although the sensitivity of single ultrasonic feature in diagnosing PTC is higher than that of multiple features combination, it has a lower specificity. Therefore, combination of multiple ultrasonographic features can improve the specificity in diagnosing PTC and reduce the misdiagnosis of PTC.

OBJECTIVETo investigate the effect of quercetin on apoptosis and feedback regulation of MDM2-p53 in multiform glioblastoma U87 cells in vitro.

METHODSU87 cells exposed to different concentrations of quercetin (50, 100, and 150 µmol/L) were examined with flow cytometry, RT-PCR and Western blotting for detecting the cell apoptosis, MDM2 mRNA expression, and p53 and caspase-3 expressions.

RESULTSQuercetin induced obvious apoptosis in U87 cells in a concentration-dependent manner, with apoptosis rates of (12.40∓0.70)% at Q0, (22.53∓0.72)% at Q50, (29.06∓0.81)% at Q100, and (31.5∓0.45)% at Q150. Quercetin significantly increased the expressions of MDM2 mRNA and active caspase-3 protein but decreased the expression of p53 in the cells.

CONCLUSIONQuercetin promotes the apoptosis of multiform glioblastoma U87 cells mediated by caspase-3 and influences the feedback balance of MDM2-p53.

Apoptosis ; Caspase 3 ; metabolism ; Cell Line, Tumor ; drug effects ; Glioma ; metabolism ; pathology ; Humans ; Proto-Oncogene Proteins c-mdm2 ; metabolism ; Quercetin ; pharmacology ; Tumor Suppressor Protein p53 ; metabolism

Objective To analyze CT characteristics of patients with primary parathyroid hyperplasia ( PPH) , parathyroid adenoma ( PA) , atypical parathyroid adenoma ( APA) , and parathyroid carcinoma ( PC) and to evaluate the value of CT in the diagnosis and differential diagnosis of primary hyperparathyroidism ( PHPT ) . Methods CT scan of 134 pathologically proved PHPT patients with complete clinical and laboratory data were retrorespectively analyzed .The similarities and differences of CT features in patients with PPH , PA, APA and PC were studied.Results Among 140 lesions in the 134 patients, 130 cases had solitary parathyroid mass and 4 cases had 10 parathyroid masses , including 22 lesions in 17 patients with PPH, with the diameter ranging from 0.6 cm to 2.8 cm(1.2 ±0.6)cm, 106 lesions in 105 patients with PA, with the diameter ranging from 0.3 cm to 3.2 cm (1.1 ±0.6)cm, 10 lesions in 10 patients with APA, with the diameter ranging from 0.9 cm to 3.3 cm(2.6 ± 0.6)cm, and 2 lesions in 2 patients with PC, with the diameter ranging from 2.1 cm to 3.0 cm(2.6 ±0.6)cm. 124 lesions were located in tracheo-esophageal groove or at the side of trachea on CT .The boundaries between the parathyroid and thyroid gland were low density .3 lesions did not appear .9 lesions were located at the area over the manubrium sterni among 13 lesions which were ectopic.CT images showed round (29.9%,41/137), oval (38.0%,52/137), triangular(19.7%, 27/137), and cylindrical(12.4%,17/137) tumors in 137 lesions.The density of lesions were 30-66 Hu(45.0 ±12.3)Hu on non-enhanced CT scan, and 59-209 Hu(121.8 ±32.7)Hu on enhanced scan .Different pathological lesions had no statistical difference on location ( left upper , left lower , right upper, right lower, ectopic)(χ2 =15.839), linear low density sign(χ2 =1.896), shape(χ2 =10.945), non-enhanced CT(χ2 =0.915) or enhancement CT(χ2 =6.165)(P>0.05).Different pathological lesions had statistical significance on sizes(χ2 =18.395, P<0.05).The diameter of APA-PC was bigger than that in PH-PA.99 lesions exhibited homogeneous enhancement , and 38 lesions exhibited heterogeneous enhancement .The necrosis rate of APA-PC was more than that of PH-PA(χ2 =7.929, P<0.05).Conclusions The lesions origi-nate from parathyroid if they are located in tracheo-esophageal groove or at the side of trachea with hyperparathy-roidism.Multiple lesions help in PH diagnosis .Large size and necrosis in lesions imply APA or PC .The location (left upper, left lower, right upper, right lower, ectopic), shape, density and the degree of enhancement of the lesions have not specificity for diagnosis of PHPT .

Objective To assess the clinical diagnosis value of CT guided transthoracic core needle biopsy in patients with pathological changes.Methods The pathological diagnosis was performed after getting the tissue by the groovy needle punctured the lesion.Results The 165 patients included 153 focal pulmonary diseases and 12 diffuse pulmonary diseases,the defined pathological diagnostic rate was 92.1%,false negative rate was 3.9%,18.9%in malignant and benign pathological changes;and complication presented in 33.3%,pneumothorax,bleeding,hemoptysis and hypodermic haematoma were 17.0%,7.9%,7.3%and 1.2%,respectively.Conclusion The technique of pulmonary percutaneous biopsy under CT guided is a perfect method for qualitative diagnosis of difficult pulmonary pathological changes:it is of great clinical application.