Objective:To investigate the effects of normal iodized salt diet on urinary iodine concentration and iodine uptake rate in patients with differentiated thyroid cancer (DTC) before 131I treatment. Methods:A prospective study was conducted on patients with DTC (59 male patients and 130 female patients, age (43.7±12.2) years) who received 131I treatment for the first time after total thyroidectomy in the First Affiliated Hospital of Zhengzhou University between January 2021 and April 2022. Patients were divided into normal iodized salt diet group and limited iodized salt diet group according to whether iodized salt diet was administered 4 weeks before 131I treatment. The age, gender, urinary iodine concentration, iodine uptake rate and tumor risk stratification of the two groups were compared by independent-sample t test or χ2 test. In addition, according to the concentration of urinary iodine, patients were divided into group a1 (urinary iodine <200 μg/L) and group a2 (urinary iodine ≥200 μg/L). Logistic regression analysis was used to analyze the factors affecting urinary iodine concentration. Results:The urinary iodine concentration of normal iodized salt diet group was not significantly different from that of non-iodized salt diet group ((140.53±76.66) vs (121.74±74.64) μg/L; t=1.67, P=0.489). The iodine uptake rates at 2 h, 4 h and 24 h in the 2 groups were (3.77±1.06)% vs (3.42±0.97)%, (3.33±1.07)% vs (3.21±1.15)%, (2.90±2.60)% vs (3.23±2.94)%, respectively ( t values: 2.33, 0.68, -0.81, all P>0.05). There were no significant differences in age ( t=0.56, P=0.889), gender ( χ2=1.33, P=0.250) and tumor risk stratification ( χ2=0.14, P=0.709) between the two groups. Logistic regression analysis showed that tumor risk stratification was associated with urinary iodine concentration (odds ratio ( OR)=3.914, 95% CI: 1.505-10.176; P=0.005). Conclusion:Normal iodized salt diet may have no effect on urinary iodine concentration and iodine uptake rate of patients with DTC before 131I treatment.

Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

Objective To explore the prognostic value of pretreatment 18F-fluorodeoxyglucose (FDG) PET/CT in pediatric neuroblastoma (NB).Methods Twenty-seven NB patients (18 males,9 females;average age (4.6±2.4) years) confirmed by pathology from June 2012 to November 2015 were retrospectively included.All patients had detailed clinical and follow up data.They underwent 18F-FDG PET/CT scan before any treatment,and the largest diameter of primary tumors,maximum standardized uptake value (SUVmax) of primary tumor (Tmax),SUVmax of liver (Lmax),Tmax/Lmax ratio,clinical staging,serum ferritin,serum lactate dehydrogenase (LDH) and serum neuron-specific enolase (NSE) were recorded as prognostic factors.Patients were followed up after treatment for 3-32 months (median:24 months).KaplanMeier survival analysis was used to analyze the influence of Tmax and Tmax/Lmax ratio on 2-year progression free survival (PFS).Cox regression analysis was used to comprehensive analyze the influence of various factors on PFS.Results Of the 27 patients,12(44.4％) experienced disease progression during the follow-up period.Univariate analysis showed that N-myc gene amplification,serum LDH,serum NSE,serum ferritin,the largest diameter of primary tumors,Tmax and Tmax/Lmax ratio were significant prognostic factors for 2-year PFS.The multivariate analysis showed that only the Tmax and Tmax/Lmax,ratio were independent prognostic factors for 2-year PFS.Conclusion 18F-FDG PET/CT can provide effective information on the prognostic information for pediatric NB patients.

Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome.Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females;mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed.The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient.Three male patients had left-sided secondary varicoceles.Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta.The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area,and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became fiat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression.Results Stenting was successfully accomplished in all 12 patients.Mean operative time was 62 min (50-125 min),estimated blood loss was 35 ml(20-100 ml),and the hospital stay after operation was 8 days (6-12 days).Three patients had a transient orthostatic intolerance,and they were cured by conservative treatment.With a mean follow up of 14 months (5-30 months),symptoms of hematuria and flank pain resolved in 7/8 and 1/1,respectively.Varicoceles were cured in all three patients.One case got partial relief because of recurrent hematuria due to excessive exercise.Ultrasonography showed that extravascular stent was in the right place,and the angle between abdominal aorta and superior mesenteric artery became normal.The inner diameter of left renal vein was decreased,and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth.Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome.

Objective To evaluate the efficacy and complications of flexible ureteroscopy for the treatment of upper urinary tract calculi in children.Methods The clinical data of upper urinary tract calculi in 20 children including 16 male and 4 female,treated by using flexible ureteroscopy,were collected from January 2014 to May 2015 in the First Affiliated Hospital of Zhengzhou University.The mean age was 6.4 years (ranging from 2.7-15.0 years old).Among them,6 cases had upper ureteral calculi and 14 cases had renal calculi.All the calculi was found unilaterally with on the left side in 12 cases and on the right side in 8 cases.Ipsilateral mild to moderate hydronephrosis were found in all of the cases.The mean stone size was 1.2 cm (ranging from 0.5-1.8 cm).All the cases were treated through retrograde flexible ureteroscopy holmium laser lithotripsy after the invalid conservative through conservative treatment.Double J tube was left routinely in the sick side 1 week before operation to expand the internal diameter of the ureter.A double J stent was left in place for 1 month after operation as a routine.Results The flexible ureteral access sheath failed to insert into the upper ureter in 2 cases because of the narrow ureter,then the flexible ureteroscopy was inserted into ureter through wire directly.The flexible ureteral access sheath was successfully inserted into the ureter for the others and flexible ureteroscopy were inserted through flexible sheath.The mean operative time was 38 min (ranging from 20-60 min).The patients were discharged from hospital after a mean of 4.5 days (ranging from 3-7 days).The rate of stone-free in one-stage was more than 90％.There were residual small stones in the lower calices of kidney in 2 cases.The perfusion liquid volume during the operation was 500 mL(ranging from 200-1 000 mL).There was no major perioperative complication,while transient macroscopic hematuria and fever were common complications after operation.The stone search was performed successfully in the whole 14 cases.NO residual stone could be found through ultrasound and kidney ureter bladder plain and Double-J stent was removed 1 month after operation.Conclusions Flexible ureteroscopy produces high stone-free rate and clinical safety for upper urinary calculi in children.However,the complications of flexible ureteroscopy lithotripsy cannot be ignored and sufficient preoperative preparation and careful perioperative safety control should be required.

The standardized training of resident physicians of Chinese medicine specialized graduate students (standardized training) is a great reform of clinical postgraduate education and a major initiative to improve professional degree graduates education. It contributes to higher professional qualities of clinicians in China. At this stage, the standardized training in our school just started and some problems existed such as department arrangement, training and checking system, curriculum and tutors instruction. Here, taking the standardized training in our school as an example, this paper discussed some issues on the training and put forward suggestion. This will help standardize our training, improve the training quality of our graduate students and develope medical professional talents.

Objective To explore the expression of Tiaml in clear cell renal cell carcinoma and analyze its correlations to pathology of disease and prognosis.Methods The expressions of Tiam1 protein in 107 specimens of human clear cell renal cell carcinoma and 20 specimens of normal renal tissues were detected by immunohistochemical staining and its clinical significance was then analyzed.Results The expression of Tiam1 protein was higher in renal cancers than in the adjacent normal tissues ( P ＜ 0.01 ).Tiam1 protein expression rates were 47.6％ and 72.7％ in Ⅰ - Ⅱ and Ⅲ - Ⅳ tumors,while 49.3％ and 76.5％ in T1 - T2 and T3 - T4 tumors,respectively ( P ＜ 0.01 ).Expression of Tiam1 protein was higher in lymph node positive renal carcinoma tissues than in lymph node negative renal carcinoma tissues ( 71.7％ versus 47.5％,P ＜ 0.05 ).The expression of Tiam1 in carcinoma tissues showed a positive relationship with tumor vascular invasion (81.3％ versus 48.0％,P ＜ 0.01 ).In patients followed-up 5 - 8 years,Kaplan-meier analysis and the log-rank test showed that the 5-year survival was significantly different between the group of lower and higher Tiaml expression groups ( 84.4％ versus 46.8％,P ＜ 0.05 ).Conclusions The expression of Tiaml protein was higher in human primary renal carcinoma than in normal renal tissues.The positive rate of Tiam1 protein expression was related to classification,TNM stage,lymph node metastasis and vascular invasion.The detection of the expression of Tiaml protein may be helpful in the diagnosis and prognosis of renal carcinoma.

Objective To investigate the effects of solifenacin on the detrusor instability of patients with overactive bladder (OAB).Methods A total of 20 outpatients with OAB of.1 - 20 ( mean, 8 )years, 12 males and 8 females, aged 21 - 83 ( mean, 43) years were included in this study.Five mg solifenacin was given orally once daily for 12 weeks.Before and after treatment, overactive bladder symptom score (OABSS), patient perception of bladder condition symptoms rating scale (PPBC), and filling cystometry was performed.Results Before and after solifenacin administration, significant decrease were detected in term of unstable detrusor waves ( 2.3 ± 2.4) vs (0.6 ± 1.3 ) ( P ＜ 0.05 ), and detrusor overactivity ( DO ) disappeared in 6 patients.Bladder capacities at first desire to void and maximum bladder capacity were significantly increased (P ＜0.01 ).Bladder compliance and detrusor pressure at maximum urine flow had no significant difference (P ＞ 0.05 ).All patients had significant improvement in OAB symptoms evaluating by OABSS and PPBC ( P ＜ 0.05 ).Six patients had mild side effect of dry mouth and could be relieved by drinking more water.Conclusion Urodynamically, solifenacin decreases the detrusor overactivity, increases the bladder capacity and improves the quality of life of OAB patients.

Objective To investigate the antitumor effect of specific cytotoxic T lymphocytes induced by renal cell carcinoma multiple antigen peptide dendritic cell (DC) vaccine in vitro. Methods Dendritic cells were induced by hGM-CSF,hIL-4 from blood.Peptide of renal cell carcinoma cell line (RCC786-0)was got by citrate-phosphate buffer elution.Peripheral blood mononuclear cell was cultured.Multiple antigen peptide DC cell vaccine was obtained by acid-eluted peptide pulsed DC.The tumor antigen specific CTL was generated from activated T cell by vaccine.Killing activity of the tumor antigen specific CTL was activated by vaccine. Results Antigen peptide DC cell vaccine could show a strong cytotoxic activity of CTLs(31.93±5.05%),which was much higher than control groups(5.88±2.26%,8.03±6.70%,9.70±2.09%,9.35±3.58%). Conclusion Renal cell carcinoma antigen peptide DC vaccine could show a high antitumor effect in vitro.