Isobaric tags for relative and absolute quantitation quantitative proteomics research of human lens epithelial cells after ultraviolet-B irradiation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the changes of protein expressions in human lens epithelial cells(SRA01/04)undergoing oxidative damage, hoping to provide new protein target for the pathogenesis of age-related cataract(ARC).METHODS: SRA01/04 cells were divided into experimental group and control group. In the experimental group, cells were irradiated with ultraviolet-B(UVB)for 10min to establish the model of oxidative damage, whereas cells in the control group were untreated. Protein expression profile from the two groups was sequenced by isobaric tags for relative and absolute quantitation(iTRAQ). The filtering criteria that fold change >1.2 and p<0.05 was used to determine the differentially expressed proteins(DEPs). Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)database were utilized for functional enrichment analysis of the top 50 DEPs with either up-regulated or down-regulated significance. Furthermore, Pathway commons software was used to establish the protein-protein interaction(PPI)network.RESULTS: Overall, 552 DEPs were screened out. A total of 176 DEPs were up-regulated in the experimental group compared with the control group, including HMGB1 and USP1, while 376 DEPs were down-regulated, including POLR2A and POLR2B. GO and KEGG enrichment analysis indicated that the top 50 DEPs with up-regulated or down-regulated significance were involved in various crucial biological processes and signaling pathways. PPI network revealed that oxidative damage repair(ODR)-related proteins might play a key role in UVB-induced oxidative damage.CONCLUSIONS: The expressions of multiple proteins, especially ODR-related proteins, can be altered in SRA01/04 cells via UVB irradiation. These findings may provide cellular-related insights into the pathogenesis of ARC and into proteins or pathways associated with therapeutic targets.

Assessment and Management of Axillary Lymph Nodes for Breast Cancer Under Concept of Precision Therapy / 肿瘤防治研究

The status of axillary lymph nodes is important for the staging, treatment, and prognosis of breast cancer. The arrival of the era of precision medicine highlights the importance of axillary lymph nodes status assessment. Magnetic resonance imaging, positron emission tomography/computed tomography, and new imaging examinations can be used in the assessment of axillary lymph nodes, in addition to routine examinations, such as physical examination and breast ultrasound. Sentinel lymph node biopsy is the most significant method for the assessment of axillary lymph nodes. Emerging evidence suggests that axillary lymph node dissection can be avoided in patients with negative or 1–2 positive sentinel lymph nodes. The ratio of inflammatory indicators may be a reliable predictor of lymph node metastases. Specific elder patients can have a good prognosis without axillary procedure. In this paper, we review and summarize the controversies surrounding the assessment methods and management of axillary lymph nodes. We hope to provide new perspectives for the axillary lymph node diagnosis and management of breast cancer patients under the concept of precision therapy.

Value of intraoperative frozen pathological examination in evaluating lymph node involvement in papillary thyroid carcinoma / 肿瘤研究与临床

Objective:To investigate the predictive effect of intraoperative selective lymph node frozen pathological examination on central lymph node metastasis in thyroid papillary carcinoma (PTC).Methods:A total of 721 PTC patients who underwent primary radical thyroidectomy and central lymph node dissection in Xuanwu Hospital of Capital Medical University from January 2015 to June 2019 were selected. All patients underwent intraoperative selective lymph node frozen pathological examination. According to the paraffin section pathological diagnosis results, there were 449 cases of thyroid micropapillary carcinoma (PTMC) and 272 cases of non-PTMC. The association of the frozen pathological examination results of intraoperative prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes with the pathological results of postoperative central lymph nodes was analyzed in all patients and those with central lymph node positive confirmed by postoperative pathological examination in different groups stratified by tumor long diameter, including 192 cases in PTMC group, 142 cases in long diameter >1 cm and <2 cm group and 55 cases in long diameter ≥2 cm group; postoperative paraffin pathological results were treated as the gold standard. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis were calculated.Results:There were 42.8% (192/449) and 72.4% (197/272) of PTMC patients and non-PTMC patients with central lymph node metastasis, respectively. Among 192 PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 28.1% (47/167), 61.4% (70/114) and 53.8% (91/169), respectively based on the intraoperative frozen pathological diagnosis. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 72.4% (139/192) and 27.6% (53/192), respectively. Among 197 non-PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 49.7% (82/165), 51.6% (96/186) and 64.7% (112/173), respectively based on the intraoperative frozen pathological results. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 84.8% (167/197) and 15.2% (30/197), respectively. The sensitivity of intraoperative lymph node frozen pathological results in the diagnosis of central lymph node metastasis for patients with thyroid capsule involvement in PTMC group, long diameter > 1 cm and < 2 cm group and long diameter ≥ 2 cm group was 81.7% (116/142), 81.7% (103/126) and 92.2% (47/51), respectively.Conclusions:Cervical central lymph node metastasis of PTC is common. Intraoperative frozen pathological examination of prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes can effectively predict whether the central lymph nodes are involved, and this hint is more obvious when the tumor long diameter is more than 2 cm and the thyroid capsule is involved.

Investigation of the current situation of nipple-sparing mastectomy: a large multicenter study in China (CSBrs-003) / 中华医学杂志(英文版)

BACKGROUND@#Mastectomy techniques have been extended to nipple-sparing mastectomy (NSM). This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications.@*METHODS@#The clinical data of 615 patients (641 surgeries) undergoing NSM from January 1st, 2018 to December 31st, 2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery.@*RESULTS@#The proportion of NSM surgery performed in this study was 2.67% (17/641). Malignant breast tumors accounted for the majority of NSM surgery (559/641, 87.2%). A total of 475 (77.3%) patients underwent NSM combined with reconstructive surgery. The rate of reconstruction decreased with age in our study, and implants were the most common option (344/641, 53.7%) in reconstruction. Radial incision was the most selected method regardless of reconstruction. However, for those who underwent reconstruction surgery, 18.4% (85/462) of cases also chose curvilinear incision, while in the simple NSM surgery group, more patients chose circumareolar incision (26/136, 19.1%). The tumor-to-nipple distance (TND) influenced postoperative complications (P = 0.004). There were no relationships between postoperative complications and tumor size, tumor location, histologic grade, molecular subtype, nipple discharge, and axillary lymph nodes.@*CONCLUSIONS@#NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery. But the proportion of NSM surgery performed is still low in nationwide centers of China. The selection criteria for appropriate surgical methods are important for NSM in clinical practice. To optimize clinical applications of NSM, further multicenter prospective randomized controlled studies are needed.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR1900027423; http://www.chictr.org.cn/showprojen.aspx?proj=38739.

Focus issues of breast-conserving surgery in early breast cancer / 国际外科学杂志

Breast-conserving surgery (BCS) has become a standard surgical method for early breast cancer.However,with the standardization of BCS,there are still many core issues in clinical practice.First of all,although the indications for BCS generally reach a consensus,the effects of age and tumor size on BCS are still worthy of attention;in addition,how to ensure the negative margin and repair tissue defect that achieve better breast shape are the key to the success of BCS;what's more,the improvement of margin evaluating methods and the application of oncoplastic technic,neoadjuvant chemotherapy,axillary sentinel lymph node biopsy,mastoscopic technique in the BCS,new artificial materials and 3D printing technology,all for the development of BCS provides a better future.This article will summarize the above-mentioned focus issues on early breast cancer.

Focus issues of breast-conserving surgery in early breast cancer / 国际外科学杂志

Breast-conserving surgery (BCS) has become a standard surgical method for early breast cancer. However, with the standardization of BCS, there are still many core issues in clinical practice. First of all, although the indications for BCS generally reach a consensus, the effects of age and tumor size on BCS are still worthy of attention; in addition, how to ensure the negative margin and repair tissue defect that achieve better breast shape are the key to the success of BCS; what′s more, the improvement of margin evaluating methods and the application of oncoplastic technic, neoadjuvant chemotherapy, axillary sentinel lymph node biopsy, mastoscopic technique in the BCS, new artificial materials and 3D printing technology, all for the development of BCS provides a better future. This article will summarize the above-mentioned focus issues on early breast cancer.

Ganoderic acid A protects lens epithelial cells from UVB irradiation and delays lens opacity / 中国天然药物

A contributory role of oxidative stress and protection by antioxidant nutrients have been suspected in cataract formation. Ganoderic acid A (GAA), an effective lanostane triterpene, is widely reported as an antioxidant. The aim of this study is to investigate the potential effects of GAA on cataract formation. After lens epithelial cells (LECs) were exposed to UVB radiation for different periods, cell viability, apoptosis-related protein levels, malondialdehyde (MDA) and superoxide dismutase (SOD) activities were monitored. We found that cell viability, the Bcl-2/Bax ratio and SOD activity were increased, while Cleaved caspase-3 levels and MDA activity were decreased compared with those in UVB-impaired LECs after GAA treated. Furthermore, GAA activated PI3K/AKT in UVB-impaired LECs and effectively delayed the occurrence of lens opacity in vitro. In conclusion, these findings demonstrated that GAA exhibited protective functions in SRA01/04 cells and rat lenses against UVB-evoked impairment through elevating cell viability and antioxidant activity, inhibiting cell apoptosis, activating the PI3K/AKT pathway and delaying lens opacity.

Establishment of non-alcoholic steatohepatitis mouse model induced by Western diet combined with low-dose carbon tetrachloride / 上海交通大学学报（医学版）

Objective • To construct a non-alcoholic steatohepatitis (NASH) mouse model by the combination of Western diet (WD) and low-dose carbon tetrachloride (CCl4), and explore the time nodes of typical NASH pathological changes. Methods • Male 8-week C57BL/6 mice were fed WD and intraperitoneally injected with CCl4 at a dose of 2 μL/g of body weight per week to construct NASH models. At different time points, the fasting blood glucose, and the levels of triacylglyceride, glutamic-pyruvic transaminase and glutamic-oxaloacetic transaminase were tested; glucose tolerance was tested at the 24th week. Besides, the liver index was calculated and oil red O staining, Sirius red staining, hematoxylin-eosin staining and TUNEL test were conducted to evaluate liver pathological changes after liver sampling. Results • Between the control group and model group, there was no significant difference in fasting blood glucose and glucose tolerance test result, while the significant differences of liver index were observed at the 8th, 12th and 24th week (P<0.05). And at the 24th week, the levels of triacylglyceride, glutamic-pyruvic transaminase and glutamic-oxaloacetic transaminase were higher in the model group than those in the control group (P<0.05). According to the results of oil red O staining, Sirius red staining, hematoxylin-eosin staining and TUNEL test, in the model group, a large amount of small lipid droplets accumulation in the liver tissues was detected and hepatocytes were mainly in apoptotic state at the 8th week; large lipid droplets, hepatocellular ballooning and spot-like necrosis were observed, and hepatocyte apoptosis persisted at the 16th week; stage 3 fibrosis of liver was observed, and the number of spot-like necrosis increased but lipid droplets decreased, while hepatocytes were mainly in a proliferative state at the 24th week. Conclusion • The mouse model of NASH can be established successfully by WD combined with low-dose CCl4, which can simulate the pathologic features of NASH in a short time.

High-performance liquid chromatography-mass spectrometry-based serum metabolic profiling in patients with HBV-related hepatocellular carcinoma / 南方医科大学学报

OBJECTIVE@#To explore the diagnostic value of the serum metabolites identified by high-performance liquid chromatography-mass spectrometry (HPLC/MS) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).@*METHODS@#A total of 126 patients admitted to Tianjin Third Central Hospital were enrolled, including 27 patients with HBV-related hepatitis with negative viral DNA (DNA-N), 24 with HBV-related hepatitis with positive viral DNA, 24 with HBV-related liver cirrhosis, 27 with HBV-related HCC undergoing surgeries or radiofrequency ablation, and 24 with HBV-related HCC receiving interventional therapy, with 25 healthy volunteers as the normal control group. Serum samples were collected from all the subjects for HPLC/MS analysis, and the data were pretreated to establish an orthogonal partial least- squares discriminant analysis (OPLS-DA) model. The differential serum metabolites were preliminarily screened by comparisons between the HBV groups and the control group, and the characteristic metabolites were identified according to the results of non-parametric test. The potential clinical values of these characteristic metabolites were evaluated using receiver operator characteristic curve (ROC) analysis.@*RESULTS@#A total of 25 characteristic metabolites were identified in the HBV- infected patients, including 9 lysophosphatidylcholines, 2 fatty acids, 17α-estradiol, sphinganine, 5-methylcytidine, vitamin K2, lysophosphatidic acid, glycocholic acid and 8 metabolites with few reports. The patients with HBV- related HCC showed 22 differential serum metabolites compared with the control group, 4 differential metabolites compared with patients with HBV-related liver cirrhosis; 10 differential metabolites were identified in patients with HBV-related HCC receiving interventional therapy compared with those receiving surgical resection or radiofrequency ablation. From the normal control group to HBV-related HCC treated by interventional therapy, many metabolites underwent variations following a similar pattern.@*CONCLUSIONS@#We identified 25 characteristic metabolites in patients with HBV-related HCC, and these metabolites may have potential clinical values in the diagnosis of HBV-related HCC. The continuous change of some of these metabolites may indicate the possibility of tumorigenesis, and some may also have indications for the choice of surgical approach.

Clinical analysis of umbilical venous catheters/peripherally inserted central catheters associated pericardial effusion and cardiac tamponade in neonates / 中国新生儿科杂志

Objective To study the clinical manifestations,imaging features,treatment and outcome of umbilical venous catheters/peripherally inserted central venous catheters (UVC/PICC) associated pericardial effusion (PCE) and cardiac tamponade (CT) in neonates.Method Clinical data of cases with UVC/PICC associated PCE/CT that were found in neonatal intensive care unit of five hospitals in Shanxi province from January 2017 to December 2018 were extracted and retrospectively reviewed.Result In total,there were 632 cases received UVC/PICC insertions in 5 hospitals.7 cases of which were identified as PCE (1.0％) on echocardiography during the period of catheter indwelling,among which 5 cases suffered from PCE complicated CT (0.7％).7 cases with PCE included 6 premature infants and 1 full term infants with mean gestational age (32.6 ± 3.8) weeks and mean birth weight 1 550 (1 200,3 960) g.The mean age of PICC/UVC insertion was 14 h (1 ～ 19 h),the mean age of PCE/CT developed was 69 h (13 ～104 h) after insertion.The most common presentations included apnea/respiratory distress (7 cases),cyanosis/desaturation (7 cases),tachycardia (3 cases),bradycardia/asystole (5 cases).UVC/PICC tip ectopic was found in 6 cases after the symptoms of PCE emerged (4 cases at T6-T7 and 1 case at T12 vertebra level on chest X-ray,and 1 case at right atrium on echocardiogram).UVC/PICC tip was normal in 1 case (tip at T7-T8 vertebra level on chest X-ray).5 cases recovered after removal of catheter,pericardiocentesis and drainage of effusion;1 case recovered after removal of UVC without pericardiocentesis;1 case underwent pericardiocentesis,continued infusion for 5 h after extubated the UVC into inferior vena cava,then deceased.Conclusion UVC/PICC tip ectopic is the main cause of UVC/PICC associated PCE/CT.Immediate bedside echocardiography should be performed to any patient with UVC/PICC indwelling,who develops sudden unexplained apnea/respiratory distress,cyanosis,tachycardia/bradycardia/asystole.Timely removal of catheter and pericardiocentesis drainage may be life-saving.

Effects of blue light on the thickness of corneal epithelium and full-thickness of the cornea in mice by optical coherence tomography angiography / 眼科新进展

Objective To investigate the effects of blue light on the thickness of corneal epithelium and full-thickness of the cornea in mice by optical coherence tomography angiography (OCTA).Methods Totally 40 mice were collected and randomly divided into experimental group and control group,with 20 mice in each group,and the experimental mice were raised in the blue light environment from 8 to 16 hours per day,while the controls were reared in normal environment.Then the thickness of corneal epithelium and full-thickness of the cornea in both groups were measured by OCTA before irradiation and one week,two weeks,one month,two months and three months after irradiation,respectively.Results Compared with pre-irradiation,the thickness of corneal epithelium of all regions did not change significantly in both groups at 1 week,2 weeks,and 1 month after irradiation,and the differences were not statistically significant (all P ＞ 0.05).Compared with before irradiation,the corneal epithelium thickness of the control group at 2 months and 3 months after irradiation did not change significantly,and there was no significant difference (both P ＞ 0.05).Compared with the control group,the corneal epithelium at central,nasal 5 mm,inferior 5 mm,and temporal 5 mm regions in the experimental group were significantly thickened,and the differences were statistically significant (all P ＜0.05).Three months after irradiation,compared with the control group,the thickness of corneal epithelium in the central and inner regions of the cornea and nasal 6 mm and temporal 6 mm regions of the experimental group were significantly thickened,and the differences were statistically significant (all P ＜ 0.05).There was no significant change in the corneal full thickness between the experimental group and the control group before irradiation and 1 week,2 weeks,1 month,2 months,and 3 months after irradiation,and the differences were not statistically significant (all P ＞ 0.05).Furthermore,the difference in the extremum value of corneal epithelial thickness,namely the maximum and the minimum,was significantly different in both groups (P ＜ 0.05),but the difference in the extremum value of the full-thickness of the cornea was not significant in the two groups (P ＞ 0.05).Conclusion The blue light can change the thickness of corneal epithelium in mice,and the change of the central region is obvious,but the full-thickness of the cornea do not significantly change in a short term.

Application of optical coherence tomography angiography in donor selection in xenocorneal transplantation / 眼科新进展

Objeetive To compare the thickness of corneal epithelium and full-thickness of the cornea among New Zealand rabbits,cats and the human using optical coherence tomography angiography (OCTA) technology as to explore the morphological basis for different animals as experimental models of xenocorneal transplantation.Methods Totally selected 12 New Zealand male rabbits and 12 male cats were included in this study and divided into group A and B.Then the thickness of corneal epithelium and full-thickness of the cornea of both eyes in the two groups were measured with OCTA technology,and according to the distance from the center of the cornea,the cornea was divided into 17 areas by System software.The center of the cornea was a diameter of 2 mm around the center of the cornea,with the inner ring and outer ring of 5 mm and 6 mm in diameter,respectively;and the inner and outer ring region was again divided into 8 areas,including superior side (S),superior nose side (SN),nasal side (N),inferior nose side (IN),inferior side (I),inferior temporal side (IT),temporal side (T),superior temporal side (ST).Then the thickness of corneal epithelium and full-thickness of the cornea in each region were measured for comparing the difference of New Zealand rabbits' and cats' corneal thickness with the human's.Results The thickness of corneal epithelium and full-thickness of the cornea of cats were both thicker than those of rabbits.The full-thickness of the cats' cornea became thinner from the central to the peripheral side,and the difference of thickness between the T5,ST5,S5,SN5,N5 areas and the central of the cornea was statistically significant (all P ＜0.05);the thickness of corneal epithelium in the ST5,S5,SN5 areas was significantly thicker than the central area (all P ＜0.05);And this was true of the rabbits' full-thickness of the cornea,and the difference in the full-thickness of the cornea between the T5,IT5,IN5,N5,T6,N6 area and the central region was statistically significant (all P ＜ 0.05);meanwhile there were also significant difference in the thickness of corneal epithelium between the ST5,S5,SN5,ST6,S6,SN6 areas and the central area (all P ＜ 0.05).Additionally,there were significant differences in the thickness of corneal epithelium and full-thickness of the cornea between the two experimental animals and humans (all P ＜ 0.05).Conclusion The cornea of cats possesses similar regions in corneal full-thickness and epithelial thickness as well as the distribution to human cornea,so cats have superiority to the rabbits for the potential donor of xenocorneal transplantation in human beings.

Epidemiological survey of age-related macular degeneration in population aged ≥50 years in Funing county, Jiangsu / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the prevalence of age-related macular degeneration (ARMD) among people aged 50 years and above in Funing county,Jiangsu province.METHODS:Survey research.Random cluster sampling was used in selecting individuals aged ≥ 50 years in 30 clusters in Funing county.Proportions were compared by using the x2 test and the means compared by using the ttest.Logistic regression was used to detect possible factors of ARMD such as age and gender.RESULTS:A total of 6145 persons aged 50 years were enumerated and 5947 (96.78％) participants were received visual acuity test and eye examination.The prevalence of ARMD was 7.53％,with a total of 448 individuals (633 eyes).The prevalence of blindness and visual impairment for presenting visual acuity were 4.13％ and 11.96％,respectively.The prevalence of blindness and visual impairment for presenting visual acuity were 4.45％ and 7.79％,respectively.Older were significant risk factors of ARMD (OR=1.01,P=0.04).CONCLUSION:The prevalence of ARMD was higher among people aged 50 years and above in Funing county,Jiangsu province.ARMD is one of the leading cause of visual impairment.

Establishment of Acute Immunological Liver Injury Wistar Rat Model Induced by Concanavalin A / 广州中医药大学学报

Objective To explore the dosage and injection method of concanavalin A(Con A) for inducing Wistar rats into the acute hepatic injury model. Methods (1)According to the dosage of Con A, 42 Wistar rats were randomly divided into groups A, B, C, D, E, N, 7 rats in each group. Group N was given tail intravenous injection of normal saline as normal control group. Groups A, B, C, D, E were given intravenous injection of 4, 8, 16, 30, 40 mg/kg of Con A respectively. At the 8th hour after modeling, the levels of alanine transaminase(ALT), aspartate aminotransferase(AST), albumin(ALB), interleukin(IL)-2 , IL-10, interferon (IFN)-γ, and tumor necrosis factor(TNF)-αwere detected. And HE staining was used to observe the pathological feature of hepatic tissue. (2)According to the injection method of Con A, 21 Wistar rats were randomly divided into normal control group, intraperitoneal injection group and tail intravenous injection group, 7 rats in each group. The dosage of Con A for the rats in intraperitoneal injection group and tail intravenous injection group was 16 mg/kg. At the 8th hour after modeling, the levels of serum ALT, AST, and ALB were determined. Results The number of abnormal deaths in various dose Con A groups at the end of each experiment was 0 in groups A, B, C, and 2 in group D, and 7 in group E. A small amount of spotty necrosis, inflammatory cell infiltration, and hepatic lobule with almost integrity of structure were found in groups A, B, while obvious bridging-like necrosis was seen in groups C, D. Serum ALT, AST, and ALB levels in intraperitoneal injection group had no statistically significant difference as compared with the normal control group. Conclusion Tail intravenous injection of 16 mg/kg of Con A can be used to induce an acute immunological liver injury rat model successfully.

Change of intestinal flora and its relationship with IL-23/IL-17 axis in pa-tients with ulcerative colitis / 中国病理生理杂志

AIM:To investigate the change of intestinal flora distribution and its relationship with interleukin -23(IL-23)/IL-17 axis in ulcerative colitis(UC)patients.METHODS:The fresh fecal samples from 20 patients with ac-tive UC and 20 healthy controls were collected.The distribution of the flora was analyzed by direct smear and traditional bacterial culture.The changes of bacteria were detected by real-time PCR.The hemoglobin,albumin,erythrocyte sedimen-tation,and C-reactive protein levels were tested routinely.Both normal and damaged mucosal tissues of UC patients were examined and obtained by colonoscopy,and further assessed by Mayo scoring,Baron grading and HE staining.The expres-sion of IL-17 and IL-23 was observed by immunohistochemistry and Western blot.RESULTS:(1)The degree of flora im-balance in active UC patients was higher than that in the healthy controls(P<0.05).(2)The results of aerobic culture showed that the number of Escherichia coli in the UC patients was significantly lower than that in the normal controls(P<0.01),while Enterococcus was increased obviously(P<0.01).The results of anaerobic culture revealed that the numbers of Bacteroidetes,Bifidobacterium bifidum and Lactobacilli in the UC patients were significantly decreased(P<0.01).(3) Quantitative analysis of target bacteria showed that the relative quantification of Escherichia coli,Bacteroidetes,Bifidobacte-rium bifidum and Lactobacilli in the UC patients was significantly lower than that in the normal subjects,and the number of Enterococcus was significantly increased(P<0.01).(4)Compared with control group,no significant change of hemoglo-bin in the UC patients was ovserved,albumin was significantly decreased(P<0.05), but erythrocyte sedimentation and C-reactive protein levels were elevated obviously(P<0.01).(5)The Mayo score, Baron grade, and histopathological score were all increased(P<0.01).(6)High IL-17 and IL-23 expression levels were detected in the UC patients(P<0.01).(7)Correlation analysis showed that the average absorbance values of IL -17 and IL-23 expression were positively correlated with Baron grade(r=0.717,P=0.02;r=0.849,P=0.016)and pathological score(r=0.660, P=0.03;r=0.675,P=0.032).Meanwhile, the average absorbance value of IL-23 expression was negatively correlated with the number of Escherichia coli(r =-0.699, P =0.025), and positively correlated with Enterococcus(r =0.872, P =0.010).Furthermore,the average absorbance value of IL-17 expression was positively correlated with Enterococcus(r=0.764,P=0.046),and both of them were not correlated with other bacteria.CONCLUSION: Obvious flora imbalance exists in active UC patients,changed intestinal microflora is closely related with the degree of inflammation.IL-23/IL-17 axis,as a key factor in the development of UC,may be related to the changes of intestinal microflora.The interaction be-tween intestinal microflora and IL-23/IL-17 axis plays an important role in the pathogenesis of UC.

The clinical application and learning curve of endoscopic thyroidectomy via chest-areolar approach / 实用医学杂志

Objective To examine the clinical effect and learning curve of endoscopic thyroidectomy via chest-areolar approach in the treatment of benign thyroid nodules. Methods From January 2012 to May 2016,49 patients underwent endoscopic thyroidectomies via chest-areolar approach in Xuanwu Hospital ,Capital medical university. The clinical characteristics ,prognosis and operation time were retrospectively analyzed. The patients were divided into 9 groups according to the surgical sequence ,and the learning curves were analyzed by using moving average method. Results 49 endoscopic thyroidectomies via chest-areolar approach were performed successfully. The average size of the nodules was(2.80 ± 0.62)cm. 10 patients underwent bilateral thyroidectomy and 39 underwent unilateral thyroidectomy. The average operation time was(157.49 ± 21.23)min. 2 cases received re-operation due to postoperative pathology of malignancy. There were no postoperative recurrent laryngeal nerve injuries. 11 patients suffered from asymptomatic hypocalcemia with parathyroid hormone in the normal range. All of the patients were satisfied with the cosmetic results. The learning curves indicated that 35 endoscopic thyroidectomies were needed to be performed in the early study stage. Conclusions For surgeons with experience of conventional thyroidectomies,endoscopic thyroidectomy via chest-areolar approach is feasible and safe for selected patients. There is a significant learning curve in the application of endoscopic thyroidectomy. In the early study stage of endo-scopic thyroidectomy,35 cases are basically required for beginning surgeons to practice the surgical operation.

Advances in Physical Activity among Patients post Operation for Breast Cancer (review) / 中国康复理论与实践

Physical activity is closely related to the quality of life of postoperative patients with breast cancer, which is expressed in fre-quency, duration, intensity, and others factors. There is no uniform measurement of physical activity, the common measurements may be classified as subjective and objective, such as exercise log, physical activity questionnaire and self-reported physical activities of the former;doubly labeled water, indirect calorimetry, motion sensors and heart rate monitors of the latter. The age, educational level, social and eco-nomic status, and body mass index are related to the level of physical activity in patients post operation for breast cancer, while illness and treatment, psychological and social support, and health-related quality of life also affect the level of physical activity, which suggest that such patients need to improve their physical activity before operation.

Value of contrast enhanced ultrasound combined with elastography in differential diagnosis of thyroid imaging reporting and data system 4 thyroid nodules / 中华医学超声杂志（电子版）

Objective To assess the diagnostic value of contrast enhanced ultrasound (CEUS),elastography and their combined use in diagnosing thyroid nodules of thyroid imaging reporting and data system (TI-RADS) 4. Methods From November 2011 to August 2016, 159 TI-RADS 4 nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CEUS and elastography before surgery. Multivariate logistic regression models were established for CEUS and CEUS combined with elastography to diagnose thyroid malignancy. The diagnostic performances of CEUS, elastography and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The sensitivity,specificity, accuracy, positive predictive value, negative predictive value and omission diagnostic rate of CEUS, elastography and their combined use were compared by Chi-square test. Results The CEUS features significantly predicting malignancy were heterogeneous enhancement, hypoenhancement, without or incomplete ring-enhancement and later time to peak than the surrounding parenchyma (χ2=24.378, 69.194,29.434 and 7.375, all P 0.05). Conclusion The diagnostic value of CEUS combined with elastography was remarkably significant in the differential diagnosis of TI-RADS 4 nodules.

Logistic regression analysis of multi-mode ultrasonography in the diagnosis of thyroid carcinoma / 中华医学超声杂志（电子版）

Objective To evaluate the diagnostic value of gray-scale ultrasonography (GSU) combined with contrast-enhanced ultrasonography (CEUS) and real-time elastography imaging (EI) in solid thyroid nodules.Methods A total of 124 solid nodules were collected from Xuanwu Hospital of Capital Medical University from September 2011 to November 2014, including 49 benign nodules and 75 malignant nodules conifrmed by surgical pathology. The data of multimodal imaging were retrospectively analyzed and compared with the pathological results. The parameters among the groups were compared byχ2 test. Four diagnostic models including the statistically signiifcant independent variables were established accord to different combinations of routine ultrasound examination. The binary Logistic regression equation using the pathological results as the dependent variable Y and the ultrasound features of thyroid nodules as independent variableX was established for calculating the area under the receiver operator curve (ROC) and multiple regression analysis furthermore.Results There were statistically significant differences in aspect ratio, margin condition, echo type, CEUS features, elastic imaging score and elastic strain rate of benign and malignant thyroid nodules(χ2=13.966, 7.106, 24.215, 17.250 and 27.158,P<0.05).The four Logistic regression models were statistically signiifcant (χ2=5.37, 5.37, 8.155, 8.155, allP<0.05). By using modelⅠ,Ⅱ,Ⅲ andⅣ, the diagnostic sensitivity, speciifcity and accuracy of malignant nodules were (73.8%, 75.9%, 79.7%, 83.3%), (67.5%, 70.7%, 85.2%, 86.7%), and (71.8%, 74.2% 81.8%, 84.4%) respectively. The area under the ROC of logistic equation predicted values were (0.778, 0.809, 0.875 and 0.898, allP<0.01). Multivariate categorical analysis showed that aspect ratio, margin condition and the elastic strain rate ratio (χ2=13.73, 7.541 and 11.461, allP<0.05) of thyroid nodules were effective diagnostic indicators. Conclusions Our study indicated that CEUS and EI could be helpful modality for GSU to improve the diagnostic accuracy of thyroid nodules. The combined application of multi mode ultrasound examination has a high diagnostic value.

Analysis of clinical competence assessment in the graduation examination for surgical professional degree postgraduates and surgical residents in Beijing / 中华医学教育探索杂志

Objective To investigate clinical competence assessment in the graduation examination for surgical professional degree postgraduates and surgical residents in Beijing. Methods Data of clinical competence assessment of graduation examination for surgical postgraduates from Capital Medical University (CMU) and residents from Beijing surgical residency training programs in 2013 were summarized and ana-lyzed. SPSS 11.5 software was used to do t test and chi square test to the corresponding data line. Results There were 118 surgical postgraduates in clinical medicine from CMU and 274 residents from Beijing surgi-cal residency training programs, who attended final clinical competence assessment. There were significant differences between the postgraduate and resident clinical competence assessment system. The differences included their organization in charge of examination and the contents of assessment system. The assessment system of clinical competence for the surgical postgraduates did not involved communication skills, reading and analysis of laboratory tests and imaging investigation. The score of case analysis in the postgraduate group was higher than that in the resident group [(84.6±1.1) vs. (82.2±10.2), P=0.039], however the score of surgical skill assessment in postgraduate group was significantly lower than that of the resident group [(78.2 ±14.0) vs. (90.5 ±6.3), P=0.000]. In addition, the rate in the score being higher or equal to 70 of case note, case analysis and surgical skill assessment between postgraduates and residents was significantly different (P<0.05). Conclusion Clinical competence assessment system for the surgical postgraduates should be adapted to their training goal. In addition to the process assessment, the objective structured clinical skills examination (OSCE) can be as a reasonable postgraduate graduation examination mode.