Objective:To evaluated the safety and feasibility of dissection of lymph nodes posterior to right recurrent laryngeal nerve (ⅥB compartment) in endoscopic thyroidectomy through gasless axillary posterior approach.Methods:A total of 350 cases with right lobe papillary thyroid carcinoma (PTC) who underwent endoscopic lobectomy, isthmusectomy and central compartment neck dissection via gasless axillary posterior approach based at the Department of General Surgery, Nanfang Hospital, Southern Medical University from June 2020 to December 2022 were retrospectively analyzed. Summarize the clinical, pathological characteristics, and postoperative complications of the patients. SPSS 25.0 was used for statistical analysis of the data.Results:All 350 patients underwent endoscopic surgery successfully, with no conversion to open surgery. There were 303 females and 47 males, with an average age of (36.3±9.2) years. Of those, 287 patients were in pT1a stage, 62 in pT1b stage, and one patient in pT2 stage. There was no T3 or T4 stage patient. The mean numbers of yielded lymph nodes in right central compartment and ⅥB compartment were 8.11±4.65 (range, 1-31) and 2.62±1.86 (range, 1-12), respectively. ⅥB compartment metastasis was detected in 52 (14.86%) of 350 patients. The incidence of transient recurrent laryngeal nerve injury was 0.86%(3/350). Postoperative hematoma occurred in three patients (0.86%).Conclusion:The dissection of ⅥB compartment in endoscopic thyroidectomy through gasless axillary posterior approach is safe and feasible in selected PTC patients

The construction of a medication safety culture is important for medication safety management and rational drug use.The construction of medication safety culture standards is formulated based on relevant national policies and regulations,accreditation standards for hospitals,expert opinions,the current situation,and the development trend of the healthcare industry.With scientificity,general applicability,instructive guidance,and practicality,they standardized basic requirements,management processes,and improvement of the construction of medication safety culture.To facilitate understanding and the implementation of the standards,we describe the process of standards formulation and explain the key points of the standards.

Objective: To determine imaging features that may help predict the presence of placenta accreta, placenta increta or placenta percreta on prenatal MRI scanning in order to identify the most diagnostic findings. Methods: The prenatal MRI scan data of placenta accreta, placenta increta or placenta percreta (placenta implantation group, n=15) and normal placenta(placenta normal group, n=15) diagnosed and treated by surgical pathology from January 2010 to December 2017 in the People's Hospital of Huadu District were retrospectively analyzed.Two expert MRI doctors were blinded to the patients' true diagnosis and were asked to score a total of 10 MRI features of the placenta and adjacent structures.The interrater reliability was assessed using kappa statistics.The features with a moderate kappa statistic or better(kappa>0.40 ) were then compared with the true diagnosis for each observer. Results: Eight of the scored features had an interobserver reliability of kappa>0.40: placenta previa(κ=0.89); abnormal uterine bulging(κ=0.57); intraplacental hemorrhage(κ=0.45); the presence of dark intraplacental bands on T₂W imaging(κ=0.76); flow-empty blood vessels in placenta(κ=0.67); border on placenta and uterus blurring(κ=0.63); heterogeneity of signal intensity on T₂-weighted(T₂W) imaging(κ=0.53); and continuity of myometrium was interrupted(κ=0.64). Using Fisher's two-sided exact test, there were statistically significant differences between the proportion of patients with placental invasion and those without placental invasion for three of the features: abnormal uterine bulging(P=0.015, P=0.011); heterogeneity of T₂W imaging signal intensity(P=0.006, P=0.013); and presence of dark intraplacental bands on T₂W imaging(P=0.032, P=0.010). Conclusion MRI can be a useful adjunct to ultrasound in diagnosing placenta accreta prenatally.Three features that are seen on MRI in patients with placental invasion appear to be useful for diagnosis: uterine bulging; heterogeneous signal intensity within the placenta; and the presence of dark intraplacental bands on T₂W imaging.

Purpose To explore the feasibility of low radiation dose combined with lowdose contrast agent in thyroid CT enhanced scan and investigate the benefit of reducing radiation hazard and contrast agent damage to thyroid.Materials and Methods 120 patients assigned for thyroid enhanced CT scan were prospectively and randomly divided into four groups (each group was 30 patients).Group A:radiation dose 120 kV,180 mA,contrast agent dose 1.2 ml/kg;group B:radiation dose 120 kV,180 mA,contrast agent dose 1.0 ml/kg;group C:radiation dose 100 kV,100 mA,contrast agent dose 1.2 ml/kg;group D:radiation dose 100 kV,100 mA,contrast agent dose 1.0 ml/kg.CT values,background sign,background noise of thyroid were measured;signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated;CT dose index of volume (CTDIvol),dose length product (DLP),and the effective dose (ED) were recorded and calculated.The image quality was evaluated and the data was statistically analyzed by two radiologists.Results CT values,background sign and background noise of thyroid,as well as CTDIvol,DLP,ED among four groups were statistical significant (P＜0.05);there was no significant difference in SNR,CNR and image quality scores among four groups (P＞0.05).Conclusion It is beneficial of reducing radiation hazard and side-effect of contrast agent from low radiation dose combined with low-dose contrast agent under the condition of ensuring diagnostic image quality.

The biologically active constituents in Gynostemma pentaphyllum are dammarane-type glycosides,called gypenosides.They are believed to be the highest contents of this herb,easy to obtain,and mainly active in anti-tumor,controlling the blood glucose,lipid-lowering,cardiovascular protection,etc.The saponins may change into sub-glucoside after hydrolysis,for the intemal acetal glucoside structure is vulnerable to acid,alkali,and enzyme degradation.Through searching the literatures in recent years,this paper summarized the chemical constituents in the hydrolyzed products of gypenosides,for providing references to discover novel and more active lead compounds.

Objective To evaluate the value of multi-slice spiral CT Low-dose scanning technology in thyroid enhanced scan. Methods Eighty patients were randomly divided into four groups including Group A:120 kV,180 mA;Group B:120 kV,100 mA;Group C:100 kV,180 mA and Group D:100 kV,100 mA.The subjective image quality was evaluated and scored.Thyroid CT val-ue,image background noise (N),image signal to noise ratio (SNR),CT dose index (CTDIvol),dose length product (DLP),and the effective radiation dose (ED)were measured and compared.Results The subjective image scores and SNR of these four groups were 3.90±0.31 and 26.34±3.13,3.75±0.44 and 25.08 ±1.87,3.70 ±0.47 and 25.86 ±2.38,3.60 ±0.60 and 24.87 ±2.20 respectively.There were no significantly statistical differences among the subjective image scores and SNR (P > 0.05 )of the 4 Groups.Thyroid CT values,N,CTDIvol,DLP and ED were (1 68.55 ± 13.39)HU,(6.48 ±0.84)HU,(10.95 ±0.00)mGy, (145.67±8.79)mGy·cm,(0.73±0.04)mSv in Group A,(170.70±11.34)HU,(6.83±0.45)HU,(6.08±0.00)mGy,(84.58± 4 .9 4)mGy· cm,(0 .4 2 ±0 .0 3 )mSv in Group B,(1 8 5 .2 0 ±2 2 .3 5 )HU,(7 .1 9 ±0 .8 6 )HU,(6 .5 9 ±0 .0 0 )mGy,(8 9 .8 6 ± 3 .2 6 )mGy· cm,(0 .4 5 ±0 .0 3 )mSv in Group C,(1 9 0 .5 5 ±2 1 .3 8 )HU,(7 .6 6 ± 1 .0 1 )HU,(3 .6 6 ±0 .0 0 )mGy,(5 0 .2 0 ± 1 .8 9 )mGy·cm,(0.25±0.01)mSv in Group D respectively.There were significantly statistical differences among different thyroid CT values,N,CTDIvol,DLP and ED (P <0.05).Conclusion Multi-slice spiral CT low-dose scanning technology in thyroid en-hanced scan can guarantee the image quality and effectively reduce thyroid radiation dose.

Objective To investigate the possible role of oxidative stress in the protection of hydrogen sulfide during renal ischemia reperfusion.Methods Male Wistar rats were randomly divided into 3 groups: sham operation (Sham) group, renal ischemia reperfusion (IR) group subject to occlusion of left renal pedicle for 45 min then reperfusion for 24 h, and sodium hydrosulfide (NaHS) preconditioning group with continuous infusion of NaHS (450 nmol/min) by left renal artery for 10 min before ischemia reperfusion.Renal injuries were evaluated by PAS staining.The protein levels of NADPH oxidase (NOX) 4, NOX2 were analyzed by Western blotting.The reactive oxygen species (ROS) level of renal tissue was determined by dihydroethidium (DHE) staining assay.Renal superoxide dismutase (SOD), malonic dialdehyde (MDA) and Scr, BUN were evaluated by chromatometry assay.Cell apoptosis were evaluated by TdT-mediated dUTP nick end labeling (TUNEL) staining.Results Compared with Sham group, in IR group the renal NOX4 and NOX2 protein expressions, the existence of acute tubular necrosis and ROS expression were up-regulated (all P ＜ 0.01);MDA, Scr, and BUN were increased and SOD was decreased significantly in IR-treated kidney (all P ＜ 0.01);Moreover, more apoptotic cells presented in the risk zone of IR-treated kindey (P ＜ 0.01).The effects induced by IR were inhibited by NaHS.Compared to that in IR group, NaHS precondition reversed IR-induced damages of renal function and renal tissue, increased SOD activity and decreased MDA expression (all P ＜ 0.05), as well as reduced the expression of NOX4, NOX2 and ROS (all P ＜ 0.05).Moreover, NaHS precondition reduced apoptosis after IR (P ＜ 0.05).Conclusions NaHS alleviates renal ischemia reperfusion injury through inhibiting oxidative stress.Hydrogen sulfide can decrease ROS by inhibiting the activation of NOX, further inhibit the activation of NOD-like receptor, and alleviate kidney damage.

Objective Dendritic cell-associatedC-type lectin-1 ( Dectin-1) is one of the most important receptors in antifungal innate immune response.This study was to construct a recombinant adenovirus vector expressing themurine Dectin-1gene and acquire a high-concentration adenovirus by amplification and purification. Methods The PCR amplification product CLEC7A-pIRES2-EGFP was cloned into the intermediate vector pDONR221, and then recom-bined with the backbone vector pAD/CMV/V5-DEST to produce a re-combinant plasmid pAD-CLEC7A-pIRE2S -EGFP.The recombinant plasmid was linearized with Pac I and transfected into human embryon-ic kidney ( HEK293) cells to produce recombinant adenovirus pAD-CLEC7Ap-IRES 2-EGFP. The adenovirus was propagated in the HEK293 cells and purified by filtering through the cellulose acetate membrane and concentrating column.Fluorescence microscopy and re-al-time PCR were used to determine the expression of the Dectin-1 gene. Results PCR identification, enzyme digestion, and sequen-cing results manifested theDectin-1 gene in the vector, with the final adenovirus titer of 5×1011 IU/mL.Fluorescence microscopy revealed green fluorescence and real-time PCR assay confirmed that the expression of Dectin-1 was improved by 8677.25 times. Conclusion A relatively high-titer adenovirus expressing Dectin-1 was acquired,which may help to further study the high expression of Dectin-1 in anti-fungal innate immunity in vitro and in vivo.

Objective To investigate whether the nod-like receptor (NLR) pathway is involved in protection of hydrogen sulfide (H2S) preconditioning during renal ischemia reperfusion.Methods Male Wistar rats were randomly divided into 3 groups:sham operation (Sham) group,renal ischemia/ reperfusion (I/R) group subjected to occlusion of left renal pedicle for 45 min then reperfusion for 24 hours,and sodium hydrosulfide (NaHS) preconditioning group with continuous infusion of NaHS (300 nmol/min) by left renal artery for 15 min before I/R treatment.Renal injuries were evaluated by HE staining.The protein levels of NOD1,NOD2,nuclear NF-κB P65 and caspase-1 were analyzed by Western blot assay.The protein level of MCP-1 and IL-1β expressions was determined by immunohistochemical staining assay.Cell apoptosis were evaluated by Tunel staining assay.Results In I/R group,the renal NOD1 and NOD2 protein expressions were upregulated.Moreover,the nuclear NF-κB P65 expression was also elevated with an increase in its target genes-MCP-1 and IL-1β (All P ＜ 0.01).HE staining revealed the existence of acute tubular necrosis in I/R kidney.TUNEL staining revealed more apoptotic cells in risk zone with the activation of caspase-1 of I/R-treated kidney(P ＜0.01).NaHS preconditioning reversed I/R-induced increase in the expression of NOD1 and NOD2(P ＜0.05).NaHS preconditioning also reduced I/R-induced activation of NF-κB P65 (P ＜ 0.05) and upregulation of MCP-1 and IL-1β (P ＜ 0.01).Moreover,NaHS preconditioning attenuated inflammation,repressed caspase-1 activation and reduced apoptotic cells after I/R.Conclusion Hydrogen sulfide preconditioning can alleviate renal ischemia/reperfusion injury by Nod-like receptor dependent on inflammatory pathway.

Objective To evaluate the diagnostic value of ultrasonography (USG) and contrast-enhanced computer tomography (CT) for thyroid carcinoma.MethodsThe results of the review of the preoperative CT and those of the original US reports were compared with the histopathologic results in 73 cases of thyroid carcinoma who underwent radical operation and central compartment dissection from November 2009 to November 2011.ResultsThe final diagnostic rate of thyroid carcinoma with USG was 69.9％,CT of that was 80.8％.There were no significant difference between them (P =0.077).The diagnostic rate of metastatic lymph node in the central compartment with USG was 61.6％,positive predictive value was 64.0％,negative predictive value was 60.4％.The diagnostic rate of metastatic lymph node in the central compartment with CT was 67.1％,positive predictive value was 61.7％,negative predictive value was 76.9％.There were not significant difference between them(P =0.848,P =0.152,P =0.489).Conclusion There was no significant difference between USG and CT in The final diagnostic rate of thyroid carcinoma and its lymph node metastasis in the central compartment.