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Purpose@#Central lymph node metastasis (CNM) are highly prevalent but hard to detect preoperatively in papillary thyroid carcinoma (PTC) patients, while the significance of prophylactic compartment central lymph node dissection (CLND) remains controversial as a treatment option. We aim to establish a nomogram assessing risks of CNM in PTC patients, and explore whether prophylactic CLND should be recommended. @*Materials and Methods@#One thousand four hundred thirty-eight patients from two clinical centers that underwent thyroidectomy with CLND for PTC within the period 2016–2019 were retrospectively analyzed. Univariate and multivariate analysis were performed to examine risk factors associated with CNM. A nomogram for predicting CNM was established, thereafter internally and externally validated. @*Results@#Seven variables were found to be significantly associated with CNM and were used to construct the model. These were as follows: thyroid capsular invasion, multifocality, creatinine > 70 μmol/L, age 1 cm, body mass index 1 ng/mL. The nomogram had good discrimination with a concordance index of 0.854 (95% confidence interval [CI], 0.843 to 0.867), supported by an external validation point estimate of 0.825 (95% CI, 0.793 to 0.857). A decision curve analysis was made to evaluate nomogram and ultrasonography for predicting CNM. @*Conclusion@#A validated nomogram utilizing readily available preoperative variables was developed to predict the probability of central lymph node metastases in patients presenting with PTC. This nomogram may help surgeons make appropriate surgical decisions in the management of PTC, especially in terms of whether prophylactic CLND is warranted.
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Objective To evaluate the application of the standard manual labeling on identification of retinopathy of prematurity ( ROP) images in deep learning. Methods According to the International Classification of ROP,different periods of ROP were classified into stage disease and plus disease in this study. From Joint Shantou International Eye Center from August 2009 to July 2018, a total of 1464 labeled fundus retinal photographs were divided randomly by stratified sampling into 3 groups:stage disease group(subgroup 1:173,subgroup 2:117) was used to train for labeling stage disease,whereas plus disease group(subgroup 1:163,subgroup 2:116) was used to train for labeling plus disease,and consistent labels group consisted of 895 consistent labeled images on both disease. Graders consisted of senior experts,3 senior ophthalmologists and 2 interns,and received training for classification and labeling on ROP fundus images. The results were compared among the doctors and doctors with deep learning,and the agreement between non-experts doctors and the reference standards, and deep learning and the reference standards were tested. Results After the first training,the overall agreement rate of the senior ophthalmologist group and the intern group were lower than 90％ for both two disease labeling. After two to three times of training, in image of consistent labels group,overall agreement rates of senior ophthalmologists and intern doctor's were 98. 99％ ( Kappa=0. 979),99. 22％ (Kappa=0. 984) on stage disease,and 97. 43％ (Kappa=0. 914),98. 11％ (Kappa=0. 935) on plus disease,respectively. The agreement on stage disease using deep learning based on human-machine combination was 94. 08％,Kappa value was 0. 880,which achieved good degree. Conclusions Standardized manual labeling can improve the intelligentization of deep learning on identification of ROP images,and be considered as an innovative method of homogenization and standardized training for doctors in ophthalmology.
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Objective To evaluate the effective and safety of ultrasound-guided percutaneous portal vein guide wire placement adjunct to thrombolytic catheter,which treating portal vein thrombosis after liver transplantation.Methods From Jan 2012 to Dec 2015,a total of 6 patients (5 male,1 female,average age 50.6 years old,age range 41-65 years old) with portal vein thrombosis after liver transplantation were retrospectively studied.The diagnosis was confirmed by contrast enhanced ultrasound (CEUS) with hypoechonic and no enhancement in portal vein.With ultrasound-guided a 18-guage guide wire was placed in right branch of portal vein,and a guidewire was placement.After exchanging the catheter,the thrombosis was confirmed again by venography.A thrombolytic catheter was placed and local thrombolysis therapy was performed.Results The guidewires were successfully placed in 6 patients.The thrombolytic catheters were successfully placed in 5 patients (day 2-60 after operation),and failed in 1 patient (9 years after operation).With 5-11 days urokinase injection,the patency of portal vein was found in 5 patients,of which 4 patients was treated by angioplasty and stent placement.With 16-31 months follow-up,the patency of portal vein was maintained.Neither server complication nor related-death was occurred.Conclusions Ultrasound-guided percutaneous portal vein guide wire placement adjuncts thrombolytic catheter is effective and safety for treating portal vein thrombosis after liver transplantation.
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Aim To investigate the relationship between monocyte chemoattractant protein-1(MCP-1) and pulmonary artery hypertension after acute pulmonary thromboembolism(PTE), and to explore the effects and mechanisms of resveratrol with MCP-1 in the acute PTE as well.Methods The acute PTE model of Sprague-Dawley rats was replicated using self-thrombosis.The rats were randomly divided into five groups(Normal, Solvent, acute PTE, antibody Cl142, and resveratrol), and 1h, 4h, 8h and 3 points were observed in each group.A model of acute PTE was established by infusion of an autologous blood clot into the pulmonary artery through a polyethylene catheter.Resveratrol or Cl142, dissolved in 1％ dimethyl sulfoxide(DMSO), was administered to the animals through caudalvein 1 h prior to the beginning of acute PTE modeling.Rats in normal control group and solvent control group were injected with normal saline and 1％ DMSO respectively.The mean pulmonary artery pressure(MPAP) and the mRNA and protein expression of MCP-1 were measured at each time point.Results ① The acute PTE group MPAP, MCP-1 mRNA and protein expression were significantly higher than those of the control group(P<0.05) at the same time;② The resveratrol group′s MPAP and MCP-1 mRNA, protein expression were significantly lower than those of the acute PTE group(P<0.05) at the same time;③ The Cl142 group MPAP and MCP-1 mRNA, protein expression were markedly reduced in the acute PTE group(P<0.05) at the same time.Conclusions The large expression of MCP-1 after acute PTE is involved in the formation of pulmonary hypertension after acute PTE.Resveratrol can reduce the pressure of pulmonary artery after acute PTE by down-regulating the MCP-1 expression.
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<p><b>OBJECTIVE</b>To investigate the expression and significance of miR-125a and anti-apoptotic protein Mcl-1 in intestinal tissue after massive small bowel resection in intestinal adaptation.</p><p><b>METHODS</b>Sprague-Dawley rats (54 male rats, 8-week old) were divided into 3 groups randomly, including two control groups. Rats in the experiment group were subjected to 70% massive small bowel resection. Rats in the resection group underwent simple intestinal resection and anastomosis. Rats in the control group underwent laparotomy alone. A 5 cm intestine approximately 1 cm distal to the anastomosis was harvested a week after operation. Expression of Mcl-1 was assessed by immunohistochemistry and real-time PCR was used to detect the expression of miR-125a in intestinal tissue.</p><p><b>RESULTS</b>The positive expression of Mcl-1 in the experiment group was 18.8%(3/16), significantly lower than that in the control group(76.5%, 13/17) and the resection group (83.33%, 15/18)(both P<0.01). The expression of miR-125a in the experiment group was 1.92, significantly higher than that in the control group (1.01) and the resection group (1.05)(both P<0.01).</p><p><b>CONCLUSION</b>miR-125a and anti-apoptotic protein Mcl-1 may play an important role in intestinal adaptation process and they may regulate each other through a certain pathway.</p>
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Animals , Male , Rats , Anastomosis, Surgical , Disease Models, Animal , Intestine, Small , Metabolism , General Surgery , MicroRNAs , Metabolism , Myeloid Cell Leukemia Sequence 1 Protein , Metabolism , Rats, Sprague-Dawley , Short Bowel Syndrome , MetabolismABSTRACT
Objective To compare the feasibility and safety of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Methods A retrospective study was performed on 37 patients who underwent pancreaticoduodenectomy for duodenal carcinoma or pancreatic head tumors at the First Hospital of Sun Yat-sen University from April 2006 to December 2010.Pancreatic anastomosis was carried out either using pancreaticogastrostomy (n＝ 19) or pancreaticojejunostomy (n=18).The operative time,intraoperative bHood Hoss,postoperative pancreatic Heak,mortaHity and Hength of hospitaH stay were compared between the two groups. ResuHts The mean operative time,intraoperative bHood Hoss,incidence of pancreatic fistuHa,mortaHity rate and mean Hength of postoperative hospitaH stay were (372.1 ±79.5) min vs (351.0±69.2) min; (693.5± 412.8) mH vs (645.1±488)ml; 10.5％ (2/19) vs 11.1％ (2/18); 5.3％ (1/19) vs 5.6％ (1/18); and (17.5± 8.9)d vs (16.1± 7.6)d,respectively.The differences between the two groups were not statistically significant.Conclusion Pancreaticogastrostomy appears to be a feasible and safe alternative to pancreaticojejunostomy for the pancreatic remnant after pancreaticoduodenectomy.
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ObjectiveTo study the molecular genetic mechanism of para-bombay phenotype in two individuals.MethodsThe proband was a female.When the proband donated blood,because the forward blood group wasn't coincident with her reverse blood group,the blood and saliva specimen from proband and her family members were sent to Guangzhou Blood Center for further identification.Routine serological techniques were used to determine proband's and her family members' blood group and ABH antigen in saliva.The coding regions of FUT1 and FUT2 gene,exon 6 and exon 7 of ABO gene were amplified by polymerase chain reaction using proband's and her family members' genomic DNA.All amplified products were analyzed after being directly sequenced.The two-base deletion regions of FUT1 gene were certified by cloning and haplotype sequencing.Results Proband's and her little brother's blood group were identified as para-bombay while other family members' blood group were normal.Two-base deletion heterozygous mutations of FUT1 gene were found in proband and her brother,AG deletion at position 547-552 and TT deletion at position 880-882,which caused a reading frame shift and a premature stop eodon.Meanwhile,880-882del TT heterozygous mutation was found in proband's grandfather and her father and 547-552del AG heterozygous mutation was found in proband's mother and her little sister.ResultsOf cloning and haplotype sequencing certified that these two-base deletion mutations occurred at 547-548 and 881-882 position respectively.Three new mutations were found in FUT2 gene,390C ＞ T,418A ＞ T and 749G ＞ A,which could cause the change of amino acid at position 140Ile ＞ Phe and 250Arg ＞ Gln.Conclusions Two-base deletion heterozygous mutations in different positions in FUT1 gene were found in 2 individuals,which maybe the molecular genetic mechanism of para-bombay phenotype.Heterozygous deletion mutation in one-strand DNA wouldn't change the ABO blood group.Three new mutations were also found in FUT2 gene.( Chin J Lab Med,2012,35:815-819)
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PBL,problem based learning,is a kind of teaching model for resolving problems. Based on the present teaching situation of our university,my experience in NewYork University and my teaching experience for overseas students,this article elucidated the importance and necessity of PBL teaching model in overseas student education and put forward a suitable PBL teaching method.
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Objective To study the effect of Konjac polysaccharide (KP) on motilin (MOT) and somatostatin (SS) of gastrointestinal tissue in mice. Methods The mice were divided into four groups randomly. Normal control group (NC) was given normal feed. High, middle, low dose KP treated groups (KPH,KPM,KPL)were given KP 0.8, 0.4, 0.2g per 100g normal feed. The level of motilin and somatostatin of gastrointestinal. tissue was determined simultaneously by radioimmunassay, and blood glucose was determined by blood glucose analyzer after 20 d. Body weight, adipose tissue and wet weight of stool were also examined. Results The level of motilin of stools of KPH group was 8.26?0.53ng/g ,which increased compared with NC group.Somatostatin was 207.32?21.89 ng/g ,which decreased compared with NC group. The differences between two groups were significant (P
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Objective To investigate the inhibitive effect of Konjac polysaccharide(KP) on intestinal absorption function of mice and its mechanism.Method Mice were divided into normal control(N),high fat(HF),and high,middle,low dose KP(KPH,KPM,KPL) treated groups.Intestinal mucosa Na+-K+-ATPase activity was determined by UV spectrophotometry,blood glucose was determined by fast meter after twenty days.Body weight,fecal wet weight and dry weight were also examined.Results Na+-K+-ATPase activity of HF and KPH groups were 16.2?1.48 and 11.2?1.10 ?mol Pi/(mg prot?h),respectively.Body weight and postprandial blood glucose were 34.3?2.07 g,7.5?1.15 mmol/L and 28.1?1.95g,4.8?0.73 mmol/L,respectively.The differences between two groups were significant(P