Transumbilical single-incision laparoscopy surgery splenectomy plus pericaudial devascularization in one case with portal hypertension: the first report.

OBJECTIVE: Single-incision laparoscopy surgery (SILS) has rapidly developed as both a cosmetic advantage of natural orifice translumenal endoscopic surgery and a standard surgical procedure. In this article, the authors report on the new technique of SILS splenectomy plus pericaudial devascularization with conventional laparoscopic instruments. METHODS: The technique of SILS splenectomy plus pericaudial devascularization in one patient with portal hypertension was introduced. RESULTS: The procedure was feasible with conventional laparoscopic instruments. Operative time was 240 minutes, and blood loss was 350 mL. No intraoperative or postoperative complications, such as secondary hemorrhage or pancreatic leakage, were recorded. The patient was fully recovered, and the single umbilical scar was well healed. CONCLUSION: SILS splenectomy plus pericaudial devascularization is feasible when performed by experienced laparoscopic surgeons. It may have the same cosmetic advantage as natural orifice translumenal endoscopic surgery and may offer the safety of conventional laparoscopic operation. As far as the authors are aware, this is the first report.

Lessons learnt after 12 years experience in laparoscopic cholecystectomy at a single center.

BACKGROUND/AIMS: This study was conducted to determine the results obtained with laparoscopic cholecystectomy (LC) at the Department of the First Minimal Invasive Surgery and Bile Duct Surgery, Sheng Jing Hospital of China Medical University. The authors compared current six years results with those at the former six years of the experience and developing a guideline. METHODOLOGY: Between May 1997 and May 2009, 2400 LCs were performed at the "Department of the First Minimal Invasive Surgery and Bile Duct Surgery, Sheng Jing Hospital of China Medical University"; 952 patients were operated on between May 1997 and May 2003, and 1,448 between Jun 2003 and May 2009. Data describing the peri-operative interventions, operative methods and maneuvers, complications and methods of preventing them was collected and analyzed. RESULTS: Mean hospital stay was 3.75 days. Conversion to open surgery was required for 0.46% of cases (11 patients). The surgical complication rate was 0.66%, with the most frequent being bile duct complications (0.42%) and bleeding (0.08%). Two patients died (0.08%). When the results (1997-2003 vs. 2003-2009) were compared, the differences in the history of a previous operation (30 vs. 23.8%, p = 0.001), role of the resident in LC (4.4 vs. 28.2%, p < 0.001), number of LCs for chronic calculous cholecystitis (52.42 vs. 66.16%, p < 0.001), for acute calculous cholecystitis (13.76 vs. 6.5%, p < 0.001) and for gallbladder polyp (32.76 vs. 26.45%, p = 0.001) and mean hospital stay (4.65 vs. 2.85 days, p = 0.034) was observed. In the latter 1448 cases (60.3%), LC was done without the need for routine urinary catheter or gastric tube insertion. CONCLUSIONS: These results should be interpreted with caution as this is a retrospective study with much uncontrolled bias. We can rely on our practice to accumulate and summarize our experience to formulate perioperative interventions, gradually develop routines management protocols and shorten the learning curve.

Target versus sub-target dose of renin-angiotensin system inhibitors on survival in elderly patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis / 老年心脏病学杂志（英文版）

BACKGROUND@#The efficiency of the target versus sub-target dose of renin-angiotensin system inhibitors (RASIs) in elderly patients with heart failure (HF) with reduced ejection fraction (HErEF) remains unclear.@*METHODS@#PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from database inception through March 2022 for randomized controlled trials (RCTs) and observational studies considering the effect of the target versus sub-target dose of RASIs on survival in elderly patients (≥ 60 years) with HErEF. The primary outcome was all-cause mortality. The secondary outcomes were cardiac mortality, HF hospitalization, and the composite endpoint of mortality or HF hospitalization. A meta-analysis was conducted to generate combined hazard ratio (HR) and 95% CI.@*RESULTS@#Seven studies (two RCTs and five observational studies) enrolling 16,634 patients were included. A pooled analysis suggested that the target versus sub-target dose of RASIs led to lower rates of all-cause mortality (HR = 0.92, 95% CI: 0.87-0.98, I2 = 21%) and cardiac mortality (HR = 0.93, 95% CI: 0.85-1.00, I2 = 15%) but not reduced rates of HF hospitalization (HR = 0.94, 95% CI: 0.88-1.01, I2 = 0) and the composite endpoint (HR = 1.03, 95% CI: 0.91-1.15, I2 = 51%). However, the target dose of RASIs was associated with a similar primary outcome (HR = 0.85, 95% CI: 0.64-1.14, I2 = 0) in a subgroup of very elderly patients > 75 years of age.@*CONCLUSIONS@#Our analysis suggests that the target dose of RASIs has a better survival benefit in elderly patients with HFrEF compared to the sub-target dose of RASIs. However, the sub-target dose of RASIs is associated with a similar mortality rate in very elderly patients > 75 years of age. Future high-quality and adequately powered RCTs are warranted.

Construction and validation of a risk prediction model of intermediate cesarean section for primiparous women with failed vaginal delivery trial / 中华全科医师杂志

Objective:To construct and validate a prediction model for the risk of intermediate cesarean delivery for primiparous women with failed vaginal trial of labor.Methods:Clinical data of 6 128 pregnant women who gave birth in the Affiliated Hospital of Jining Medical College from January 2019 to December 2020 were collected. The puerpera was randomly divided into train set ( n=4 290) and validation set ( n=1 838). The factors influencing the conversion to cesarean section in primiparous women with failed vaginal trial of labor were analyzed with univariate and binary multivariate logistic regression, and a risk prediction model was established based on the influencing factors. The predictive power of the model was assessed by receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness-of-fit test in train set and validation set. Results:Among 6 128 pregnant women 1 042 cases failed in vaginal trial of labor and were transferred to cesarean section. Univariate analysis showed age, occupation, gestational weight gain, days of gestation, body temperature before delivery, fetal heart condition at delivery, fetal abdominal circumference, Bishop score, premature rupture of membranes, gestational illness, mode of induction of labor, labor analgesia, and fetal orientation were significantly associated with converting to cesarean delivery (all P<0.05). The multivariate binary logistic regression analysis showed that the age, gestational weight gain, body temperature, gestational co-morbidities, days of gestation, premature rupture of membranes, amniotic fluid contamination, induction of labor, and abnormal occipital position were independent risk factors for intermediate cesarean delivery ( OR=1.03-8.06, all P<0.05); while height, occupation, Bishop score, and labor analgesia were protective factors for intermediate cesarean delivery ( OR=0.17-0.96, all P<0.05). A risk prediction model was constructed based on the risk factors and protective factors. In train set, the area under the ROC curve(AUC) of the model was 0.902 (95% CI: 0.89-0.92, P<0.001), with the best cutoff value of 0.138, the sensitivity and specificity were 0.837 and 0.825, respectively; and the Hosmer-Lemeshow goodness-of-fit test showed P=0.192. In validation set the AUC of the model was 0.917 (95% CI: 0.90-0.93, P<0.001), and the sensitivity and specificity were 0.826 and 0.851, respectively; the total correct rate of the model was 87.21% (1 603/1 838). Conclusion:The risk prediction model of failed vaginal trial of labor in primiparous women for intermediate cesarean delivery constructed in this study has good clinical prediction efficacy and high correctness rate.

Carcinoma-associated fibroblast-derived lysyl oxidase-rich extracellular vesicles mediate collagen crosslinking and promote epithelial-mesenchymal transition via p-FAK/p-paxillin/YAP signaling / 国际口腔科学杂志·英文版

Carcinoma-associated fibroblasts (CAFs) are the main cellular components of the tumor microenvironment and promote cancer progression by modifying the extracellular matrix (ECM). The tumor-associated ECM is characterized by collagen crosslinking catalyzed by lysyl oxidase (LOX). Small extracellular vesicles (sEVs) mediate cell-cell communication. However, the interactions between sEVs and the ECM remain unclear. Here, we demonstrated that sEVs released from oral squamous cell carcinoma (OSCC)-derived CAFs induce collagen crosslinking, thereby promoting epithelial-mesenchymal transition (EMT). CAF sEVs preferably bound to the ECM rather than being taken up by fibroblasts and induced collagen crosslinking, and a LOX inhibitor or blocking antibody suppressed this effect. Active LOX (αLOX), but not the LOX precursor, was enriched in CAF sEVs and interacted with periostin, fibronectin, and bone morphogenetic protein-1 on the surface of sEVs. CAF sEV-associated integrin α2β1 mediated the binding of CAF sEVs to collagen I, and blocking integrin α2β1 inhibited collagen crosslinking by interfering with CAF sEV binding to collagen I. CAF sEV-induced collagen crosslinking promoted the EMT of OSCC through FAK/paxillin/YAP pathway. Taken together, these findings reveal a novel role of CAF sEVs in tumor ECM remodeling, suggesting a critical mechanism for CAF-induced EMT of cancer cells.

Production of carboxylic acids by metabolically engineered Yarrowia lipolytica: a review / 生物工程学报

Yarrowia lipolytica is a non-conventional yeast with unique physiological and metabolic characteristics. It is suitable for production of various products due to its natural ability to utilize a variety of inexpensive carbon sources, excellent tolerance to low pH, and strong ability to secrete metabolites. Currently, Y. lipolytica has been demonstrated to produce a wide range of carboxylic acids with high efficiency. This article summarized the progress in engineering Y. lipolytica to produce various carboxylic acids by using metabolic engineering and synthetic biology approaches. The current bottlenecks and solutions for high-level production of carboxylic acids by engineered Y. lipolytica were also discussed, with the aim to provide useful information for relevant studies in this field.

Advances in adaptive laboratory evolutionary engineering to microbial breeding / 生物工程学报

In recent years, adaptive laboratory evolution (ALE) has emerged as a powerful tool for basic research in microbiology (e.g., molecular mechanisms of microbial evolution) and efforts on evolutionary engineering of microbial strains (e.g., accelerated evolution of industrial strains by bringing beneficial mutations). The ongoing rapid development of next-generation sequencing platforms has provided novel insights into growth kinetics and metabolism of microbes, and thus led to great advances of this technique. In this review, we summarize recent advances in the applications of long-term and short-term ALE techniques mainly for microbial strain engineering, and different modes of ALE are also introduced. Furthermore, we discuss the current limitations of ALE and potential solutions. We believe that the information reviewed here will make a significant contribution to further advancement of ALE.

Total flavonoids from Saussurea involucrata attenuate inflammation in lipopolysaccharide-stimulated RAW264.7 macrophages via modulating p65, c-Jun, and IRF3 signaling pathways

Objective: To investigate the anti-inflammatory effects of the total flavonoids from Saussurea involucrata on lipopolysaccharides (LPS)-stimulated murine RAW264.7 macrophages and explore its underlying mechanism of action. Methods: Total flavonoids from Saussurea involucrata were extracted using chromatographic column method. Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. The production of nitric oxide was detected by Griess assay and the release of cytokines (IL-10 and TNF-α) and chemokines (MCP-1, MIP-1a, and CCL5/RANTES) was determined by ELISA to evaluate the anti-inflammatory activity of total flavonoids from Saussurea involucrata. Moreover, nuclear translocation of p65, c-Jun, and IRF3 was detected by immunofluorescence microscopy and Western blotting analysis was performed to determine the expression of related proteins. Results: Total flavonoids extracted from Saussurea involucrata were 751.5 mg/g and the content of rutin was 506.5 mg/g. The production of inflammatory mediators including nitric oxide, cytokines, and chemokines was effectively inhibited by total flavonoids from Saussurea involucrata. Meanwhile, total flavonoids also suppressed the nuclear translocation of p65, c-Jun, and IRF3 in LPS-stimulated RAW264.7 cells. The LPS-induced expression of iNOS and COX-2 was remarkably reduced by treatment with total flavonoids from Saussurea involucrata. Moreover, total flavonoids decreased the expression levels of p-IKKa/β, p-TBK1, p-p38, p-ERK, p-JNK, p-p65, p-c-Jun, and p-IRF3 in LPS-exposed RAW264.7 macrophages. Conclusions: Total flavonoids from Saussurea involucrata potentially inhibit the secretion of pro-inflammatory mediators, which may be related to inhibition of p65, c-Jun, and IRF3 signaling pathways in LPS-stimulated RAW264.7 cells.

Total flavonoids from Saussurea involucrata attenuate inflammation in lipopolysaccharide-stimulated RAW264.7 macrophages via modulating p65, c-Jun, and IRF3 signaling pathways

Objective: To investigate the anti-inflammatory effects of the total flavonoids from Saussurea involucrata on lipopolysaccharides (LPS)-stimulated murine RAW264.7 macrophages and explore its underlying mechanism of action. Methods: Total flavonoids from Saussurea involucrata were extracted using chromatographic column method. Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. The production of nitric oxide was detected by Griess assay and the release of cytokines (IL-10 and TNF-α) and chemokines (MCP-1, MIP-1a, and CCL5/RANTES) was determined by ELISA to evaluate the anti-inflammatory activity of total flavonoids from Saussurea involucrata. Moreover, nuclear translocation of p65, c-Jun, and IRF3 was detected by immunofluorescence microscopy and Western blotting analysis was performed to determine the expression of related proteins. Results: Total flavonoids extracted from Saussurea involucrata were 751.5 mg/g and the content of rutin was 506.5 mg/g. The production of inflammatory mediators including nitric oxide, cytokines, and chemokines was effectively inhibited by total flavonoids from Saussurea involucrata. Meanwhile, total flavonoids also suppressed the nuclear translocation of p65, c-Jun, and IRF3 in LPS-stimulated RAW264.7 cells. The LPS-induced expression of iNOS and COX-2 was remarkably reduced by treatment with total flavonoids from Saussurea involucrata. Moreover, total flavonoids decreased the expression levels of p-IKKa/β, p-TBK1, p-p38, p-ERK, p-JNK, p-p65, p-c-Jun, and p-IRF3 in LPS-exposed RAW264.7 macrophages. Conclusions: Total flavonoids from Saussurea involucrata potentially inhibit the secretion of pro-inflammatory mediators, which may be related to inhibition of p65, c-Jun, and IRF3 signaling pathways in LPS-stimulated RAW264.7 cells.

Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy.

Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment.

Clinical effect of noninvasive sputum aspiration combined with atomization inhalationin the treatment of pediatric bronchiolitis / 中国实用护理杂志

Objective To observe and analyze the clinical effect of noninvasive sputum aspiration combined with atomization inhalation in the treatment of pediatric bronchiolitis. Methods Totally 79 children with bronchiolitis diagnosed from January 2016 to December 2017 were selected. The children were divided into observation group (40 cases) and control group (39 cases) by double blind method of stratified random sampling. The observation group were treated with atomization inhalation after noninvasive sputum aspiration;and the control group were treated with the traditional inhalation of sputum according to the condition of the disease.The improvement effect of the symptoms before and after the treatment of the two groups was compared. Results After treatment, the improvement of symptoms in the two groups included cough, fever, wheezing, shortness of breath, lung rales, daily sputum aspiration and hospital stay were (5.34±1.06) d, (1.82±0.35) d, (2.66±0.85) d, (1.76±0.39) d, (4.37±1.29) d, (6.38± 1.39) times, (6.31 ± 0.82) d in the observation group, (6.25 ± 0.98) d, (2.34 ± 0.41) d, (3.08 ± 0.94) d, (2.56 ± 0.41) d, (5.39 ± 1.33) d, (8.31 ± 1.52) times, (8.25 ± 1.09) d in the control group, the difference was statistically significant( t=2.084-8.954, P<0.05). Respiratory function improvement including arterial oxygen saturation,heart rate,respiratory rate was 0.96±0.03, (110.85±4.16) times/min, (29.49±1.87) times/min in the observation group, 0.92±0.03, (119.34±4.22) times/min, (35.14±1.95) times/min in the control group,the difference was statistically significant(t=5.925, 9.005, 13.146, P<0.05). The effective rate of the observation group was 97.50％ (39/40), which was significantly higher than that of the control group 79.49％(31/39), the difference was statistically significant (χ2=4.688, P<0.05).The satisfaction rate of the family members of the observation group of the nebulization and sputum suction service was 100.00％(40/40), which was significantly higher than that of the control group (87.18％, 34/39), the difference was statistically significant (χ2=13.698, P<0.05). Conclusions Noninvasive sputum aspiration combined with atomization inhalation is effective in the treatment of pediatric bronchiolitis. It can relieve airway obstruction, improve asthma symptoms, shorten the time of hospitalization, and the operation is convenient and safe.

Feasibility and safety of single-incision laparoscopic surgery in gastric benign and malignant diseases.

We systematically searched Medline and Cochrane Library and the related references occurred in the citations until February 2013 and included all the cases who suffered from gastric benign and malignant diseases where single incision laparoscopic surgery was performed. A total of 69 cases with gastric diseases undergoing SILS surgery were reviewed to evaluate the feasibility, safety, and potential benefits of SILS for the gastric diseases. Demographic data, morphologic characterisation of the lesion, and perioperative parameters were analyzed retrospectively. The initial experience with SILS for benign gastric diseases and early gastric cancer showed that it is feasible and safe when performed by experienced laparoscopic surgeons. Despite the limited number and technical difficulties it can be proposed in selected patients.

Comparison between superb microvascular imaging and histopathology for the evaluation of carotid artery atherosclerotic plaque neovascularization / 中华健康管理学杂志

Objective To investigate the significance of superb microvascular imaging (SMI) for the detection of neovascularization in carotid atherosclerotic plaques.Methods SMI detected 28 carotid atherosclerotic plaques in 28 patients who underwent carotid endarterectomy.The SMI grade of carotid plaque neovascularization was assigned based on the following grading system:Grade 0,no neovascularization;grade 1,some neovascularization;grade 2,neovascularization observed in the shoulder of the plaque;and grade 3,widely distributed new blood vessels.SMI was used to evaluate the degree of blood flow,maximum flow velocity,and resistance index of the new vessels in the plaque.Microvascular density was measured with CD31 staining.Results Clear correlations were observed between neovascularization density on histopathological staining of the plaque and the degree of blood flow detected with SMI (rs=0.788,P ＜ 0.001).The classification of neovascular blood flow in the plaque was positively correlated with plaque thickness (rs=0.686,P=0.002).Of the 28 cases,neovascularization was detected in 23;of these 23 cases,the direction of blood flow was from the adventitia to the intima in 17 (75％) cases,while 6 (25％) cases showed an irregular direction of blood flow.The mean neovascular flow velocity was (5.620±0.131) cm/s,and the mean neovascular resistance index was 0.660 ± 0.090.Conclusion SMI is useful for the evaluation of carotid atherosclerotic plaque neovascularization.

Transumbilical single-incision laparoscopic multiple organ procedures: initial experience of 20 cases.

BACKGROUND: Cure of disease with the least possible injury is an ideal of surgery. Herein we share our experience with transumbilical single-incision laparoscopic multiple organ procedures using conventional instruments. SUBJECTS AND METHODS: We reviewed data from 20 patients who underwent transumbilical single-incision laparoscopic surgery of multiple organs between May 2009 and March 2012 at Shengjing Hospital. All 20 patients had laparoscopic cholecystectomy, which was combined with appendectomy in 16 patients, resection of hepatic hemangiomas in 2 patients, and partial gastrectomy for gastric mesenchymal tumor in 2 patients. All procedures were successful with conventional laparoscopic instruments placed through a single operating portal of entry created within the umbilicus. RESULTS: All the operations were successfully completed without conversion to conventional laparoscopic or open surgery. No intraoperative complications occurred. Patients were satisfied with the therapeutic and cosmetic outcomes. CONCLUSIONS: Transumbilical single-incision laparoscopic combined procedures appear to be a technically feasible alternative to standard laparoscopic procedures in simultaneous management of two different coexisting pathologies. Larger studies are required to confirm these findings.

The comparison of superb microvascular imaging to color and power Doppler flow imaging in the diagnostic value of thyroid nodules / 中华超声影像学杂志

Objective@#To compare the visualization ability for thyroid nodular vascularity among superb micro-vascular imaging (SMI), power Doppler flow imaging (PDFI), and color Doppler flow imaging(CDFI), and determine optimal vascular findings for the diagnosis of thyroid nodules.@*Methods@#A total of 58 thyroid nodules from 50 patients were enrolled, including 27 benign nodules (benign group) and 31 malignant nodules (malignant group). Vascular patterns of these nodules were detected by SMI, PDFI and CDFI, respectively.@*Results@#Thyroid cancer was characterized by type III vascular pattern. "Only central vascularity" performed best in detecting thyroid cancers. When using the criterion, SMI performed a better specificity (96.3%) and sensitivity (77.4%) than PDFI (92.5%, 41.9%) and CDFI (88.9%, 48.3%); and the specificity of SMI was significantly higher than the others (all P<0.01).@*Conclusions@#The sign of only central vascularity is of value in distinguishing malignant thyroid nodules. SMI is better on presenting thyroid nodular vascularity than CDFI and PDFI, and it could be used to differentiate thyroid nodules.

Expression of WNT4 and its inhibitory factor SFRP1 in renal tissue of diabetic nephropathy rats / 基础医学与临床

Objective To observe the change of expression of WNT4/β-catenin signaling pathway and its inhibitory factor secreted frizzled-related protein 1 (SFRP1) in renal tissue in diabetic nephropathy(DN) rats, and to explore its possible role in the development of renal fibrosis. Methods Rats were randomly divided into normal control(NC) group and DN group, and equipped with 8 in each group. The IDDM model was prepared by tail vein injection of STZ 55 mg/kg. Hemotoxyin and eosin、Periodic Acid-Schiff and Masson stain were used to observe the morphological structure and fibrotic lesions in renal tissue;Immunohistochemical analysis was used to observe the protein expression of WNT4 and β-catenin in renal tissue;Western blot was used to detect the protein expression changes of WNT4, SFRP1, β-catenin, p-GSK-3β, GSK-3β, Collagenl, a-SMA, E-cadherin in renal tissue in each group;The mRNA expression of WNT4 and SFRPl in renal tissues of rat was detected by realtime PCR. Results Compared with NC group, renal tissue fibrosis was obvious in DN group. Compared with NC group, the protein and mRNA expressions of WNT4 significantly increased (P＜0.05), the protein expressions of β-catenin, p-GSK-3β, α-SMA and collagen I significantly increased (P < 0.05), the protein expressions of Ecadherin significantly decreased (P＜0. 05), the protein and mRNA expression of SFRPl significantly decreased (P＜0.05). Conclusions In the case of DN, the signal pathway of WNT4/β-catenin is abnormal activation. The expression of SFRPl is decreased, and that may inhibit this pathway and promote the development of renal fibrosis in DN.

Modified method for umbilical reconstruction after single-incision laparoscopic surgery / 中国现代普通外科进展

Objective:To introduce a modified method for umbilical reconstruction after single-incision laparoscopic surgery.Methods:Between June 2012 and June 2015,173 patients underwent single-incision laparoscopic cholecystectomy at our institution.All the patients adopted our modified method for umbilical reconstruction.Results:All the surgeries were successful.The umbilical incision healed well with good cosmetic result.Conclusion:The modified method for umbilical reconstruction can improve cosmesis and decrease the possibility of incision hernia after single-incision laparoscopic surgery.More studies are needed to evaluate definitive clinical advantages of this technique.

The value of 18 MHz high-frequency linear array ultrasound probe in the diagnosis of thyroid anterior capsular invasion / 中华医学超声杂志（电子版）

Objective To investigate the value of 18 MHz high-frequency linear array ultrasound probe in the diagnosis of thyroid anterior capsular invasion,and compare it with the conventional high-frequency ultrasound probe.Methods Seventy-three nodules in 68 patients in Peking Union Medical College Hospital from December 2015 to March 2016 underwent conventional and 18 MHz high-frequency probes examination before operation and were compared with pathological results.The accuracy,sensitivity and specificity of the 18 MHz high-frequency linear array probe and the conventional high-frequency probe were determined.The consistency between the gold standard and the diagnosis by using two different frequency probes was measured using Kappa statistics.Additionally,diagnostic accuracy of different frequency probes was further evaluated according to the area under the ROC curve.Results The diagnostic consistency test of the total sample of 73 nodules:capsular abutment as the diagnostic criterion,the diagnostic consistency of 18MHz high-frequency probe was good (Kappa=0.803,P ＜ 0.01).The specificity,positive predictive value and accuracy were superior to the conventional high-frequency probe (90.7％ vs 69.8％,87.1％vs 68.3％,90.4％ vs 79.5％).The area under the ROC curve was 0.903,higher than that of the conventional high-frequency probe (0.816),which demonstrated that the former had better diagnostic accuracy.If the disruption of the perithyroidal echogenic line as another diagnostic criterion,the diagnostic consistency of the 18 MHz and conventional high-frequency probe was general,the Kappa value were 0.677 and 0.518.The sensitivity,positive predictive value,negative predictive value and accuracy of conventional high-frequency probe were inferior to the 18 MHz high-frequency probe (53.3％ vs 70.0％,74.5％ vs 82.0％,88.9％ vs 91.3％,78.1％ vs 84.9％).Conclusions The 18 MHz high frequency probe is a feasible tool for accurate prediction of the distance between tumor and thyroid anterior capsular and anterior capsular invasion,and it is helpful for the diagnosis of the preoperative staging and the prognosis of PTC.

Metabolic Characteristics of Lethal Bradycardia Induced by Myocardial Ischemia / 法医学杂志

Objective T o explore the m etabolic characteristics of lethal bradycardia induced by m yocardial ischem ia in rat's serum . Methods A rat m yocardial ischem ia-bradycardia-sudden cardiac death (M I-B-SC D ) m odel w as established, w hich w as com pared w ith the sham-operation group. T he m etabolic pro-file of postm ortem serum w as analyzed by gas chrom atography-m ass spectrom etry (G C-M S ), coupled w ith the analysis of serum m etabolic characteristics using m etabolom ics strategies. Results T he serum m etabolic profiles w ere significantly different betw een the M I-B-SC D rats and the control rats. C om pared to the control rats, the M I-B-SC D rats had significantly higher levels of lysine, ornithine, purine, serine, alanine, urea and lactic acid; and significantly low er levels of succinate, hexadecanoic acid, 2-ketoadipic acid, glyceraldehyde, hexendioic acid and octanedioic acid in the serum . T here w ere som e correlations am ong different m etabolites. Conclusion T here is obvious m etabolic alterations in the serum of M I-B-SC D rat. B oth lysine and purine have a high value in diagnosing M I-B-SC D . T he results are expected to provide references for forensic and clinical applications of prevention and control of sudden cardiac death.

Metabolic Characteristics of Lethal Bradycardia Induced by Myocardial Ischemia / 法医学杂志

OBJECTIVES@#To explore the metabolic characteristics of lethal bradycardia induced by myocardial ischemia in rat's serum.@*METHODS@#A rat myocardial ischemia-bradycardia-sudden cardiac death （MI-B-SCD） model was established, which was compared with the sham-operation group. The metabolic profile of postmortem serum was analyzed by gas chromatography-mass spectrometry （GC-MS）, coupled with the analysis of serum metabolic characteristics using metabolomics strategies.@*RESULTS@#The serum metabolic profiles were significantly different between the MI-B-SCD rats and the control rats. Compared to the control rats, the MI-B-SCD rats had significantly higher levels of lysine, ornithine, purine, serine, alanine, urea and lactic acid; and significantly lower levels of succinate, hexadecanoic acid, 2-ketoadipic acid, glyceraldehyde, hexendioic acid and octanedioic acid in the serum. There were some correlations among different metabolites.@*CONCLUSIONS@#There is obvious metabolic alterations in the serum of MI-B-SCD rat. Both lysine and purine have a high value in diagnosing MI-B-SCD. The results are expected to provide references for forensic and clinical applications of prevention and control of sudden cardiac death.