Objective To explore the expression of matrix metalloproteinase （MMP）-2 in patients with papillary thyroid cancer （PTC） recurrence or residuum and its value of clinical application. Methods The serums from 68 patients with thyroid disease underwent operation and 15 health examinations under stomachs empty from March 2009 to December2009 in this hospital were gathered. Sixty-eight patients with thyroid disease were divided into PTC with lymph node metastasis （LNM） group （n=19），PTC recurrence or residuum with LNM group （n=17），PTC without LNM group （n=10），and benign thyroid disease group （n=22） according to the postoperative pathological findings，15 health examinations as control group. The expression of MMP-2 of serum sample was detected by ELISA method. The difference of the expression of MMP-2 in each group was analyzed. Results The expressions of MMP-2 in the PTC recurrence or residuum with LNM group，PTC with LNM group，PTC without LNM group， benign thyroid disease group，and the control group were （1 724.00±762.24） ng/ml，（1 329.16±776.59） ng/ml，（1 489.61±546.53） ng/ml，（1 264.87±817.27） ng/ml，and （608.43±88.63） ng/ml，respectively. The expressions of MMP-2 in the PTC with LNM group and PTC recurrence or residuum with LNM group were significantly higher than those in the benign thyroid disease group （P＜0.05） and the control group （P＜0.05），respectively，which in the PTC without LNM group was significantly higher than that in the control group （P＜0.05）. There was no significant difference of MMP-2 expression of serum between the benign thyroid disease group and the control group （P＞0.05），which were no significant difference among the other threemalignant disease groups （P＞0.05）. The MMP-2 positive expression rates were 79%，76%，80%，41%，and 20% in the PTC with LNM，PTC recurrence or residue with LNM group，PTC without LNM group，benign thyroid disease group，and control group，respectively. The MMP-2 positive expressions rates of serums were not significantly different among three malignant disease groups （P＞0.05），but which were significantly higher than those of the benign thyroid disease group （P＜0.01） and control group （P＜0.01），respectively. Conclusions The MMP-2 level of serum can be used as an index to judge preoperative thyroid nodules，which can not be use to determine whether PTC metastasis or not.
ObjectiveTo explore the effectiveness and safety of tranexamic acid (TXA) in anterior approach surgery for thoracolumbar fractures.MethodsFrom January 2017 to January 2020, a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group (n=33) and control group (n=35). Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion, while the ones in the control group were given 15 mg/kg of normal saline at the same time. Basic data of the patients were collected. The hemoglobin concentration, hematocrit, coagulation and fibrinolysis indexes of the patients were monitored preoperatively, 24-hour postoperatively, and 72-hour postoperatively. The intraoperative blood loss and wound drainage of the patients were recorded. The incidence of blood transfusion and thrombotic events were collected. Statistical analysis was performed.ResultsThere was no significant difference in age, sex, body mass index, operation time, fracture location distribution, anesthesia classification of American Society of Anesthesiologists, neurologic grade of American Spinal Injury Association, injury time, or length of hospital stay between the two groups (P>0.05). Compared with those in the control group, the total blood loss [(1 398.49±312.24) vs. (1 642.30±357.78) mL, P=0.003], intraoperative blood loss [(432.83±74.76) vs. (486.31±86.51) mL, P=0.008], and wound drainage [(276.73±89.42) vs. (389.24±125.71) mL, P<0.001] in the TXA group reduced. No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit (P>0.05), but the 24-hour postoperative hemoglobin concentration [(112.67±20.59) vs. (102.64±19.41) g/L, P=0.042] and hematocrit [(32.25±4.12)% vs. (30.13±4.28)%, P=0.042] in the TXA group were higher than those in the control group. The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control group (6.1% vs. 25.7%, P<0.05). There was no statistically significant difference in preoperative, 24-hour postoperative, or 72-hour postoperative prothrombin time, international standardized ratio, activated partial prothrombin time, platelet count, fibrinogen, d-dimer, or fibrinogen degradation products between the two groups (P>0.05), and no thrombotic complications were found.ConclusionTXA has good efficacy and safety in the anterior approach surgery for thoracolumbar fractures.
Objective To summarize the experience of medical rescue conducted in Aba prefecture after the Wenchuan earthquake in order to provide information for similar tasks in seismo-active regions. Methods We participated and witnessed the whole process of medical rescue through 100 days after the quake. Data regarding the medical rescue work, work mode, performance and problems were collected and analyzed. Results Twelve counties out of the 13 counties in Aba prefecture were affected by the earthquake, including 2 most-hit counties and 5 most-hit areas. A total of 20 233 people died and 7 873 disappeared. Aba Prefectural Headquarters for Earthquake Resistance and Disaster Relief was set up and medical rescue teams were dispatched to the disaster area immediately after the quake: ① From May 12 to May 15 2008, 20 local medical teams comprising 138 healthcare professionals and 14 teams involving 428 professionals from other regions arrived at the most-hit areas. Through 7 days after the quake, medical treatment was provided for 6 285 patient-times. ② A total of 1 444 healthcare professionals participated in the medical rescue work. Through August 20, 355 579 outpatients and 7 028 inpatients were treated in the prefectural medical institutions and on-site medical centers. Of those, 6 726 were discharged, 604 were severely wounded, 20 died and 456 were transferred to other regions for further treatment. 2 703 operations were performed for the wounded and psychological treatment was provided for 4 630 person-times. Conclusion The medical rescue work in Aba prefecture after the Wenchuan earthquake was effective and efficient. Management of human resources and medical devices should be strengthened to enhance the ability of emergency response.
Objective To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. Methods A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups (n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups (P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. Results The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group (P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased (P<0.05). And there was no significant difference in VAS score between the two groups at each time point (P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups (P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation (P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation (P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation (P>0.05). Conclusion Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.
Under the vigorous promotion of national policies, by the end of 2018, the construction of the national medical consortium has been fully launched, and all public tertiary hospitals have actively participated in the construction of medical consortium. The practice of lead-type close medical consortium in West China Hospital of Sichuan University is an innovative exploration in the context of the new national medical reform. Combining the social responsibilities, location characteristics, functional orientation of West China Hospital of Sichuan University, and the remarkable results of the lead-type close medical consortium, this article elaborats three distinctive features of the lead-type close medical consortium, namely the cooperation between the government and the hospitals as the cornerstone, the hierarchical collaboration as the core, and the medical care and great health as the guiding principle, to provide a reference for the construction of a high-quality and efficient medical and health service system in China.
Objective To investigate the expression of Fascin-1 protein in colorectal adenocarcinoma, and the relationship with its clinicopathologic features. Methods The expressions of Fascin-1 protein in colorectal adenocarcinoma tissues of 60 cases, colorectal adenoma tissues of 30 cases and normal mucosa tissues (4 cm distance to neoplasm) of 30 cases were detected by Microwave-EliVisionTM immunohistochemistry method, and the relationship between the expression of Fascin-1 protein in colorectal adenocarcinoma tissues and its clinicopathologic characteristics was analyzed. Results The expression of Fascin-1 protein was located in cytoplasm. The positive expression rates of Facsin-1 protein were 3.3% (1/30), 30.0% (9/30) and 53.3% (32/60) in normal mucosa tissues, colorectal adenoma tissues and colorectal adenocarcinoma tissues, respectively. The expression of Fascin-1 was gradually increased in these three tissues, and there was statistical difference among the three tissues (Plt;0.05). The expessions of Fascin-1 protein in patients with serous membrane invasion, lymph node metastasis and TNM Ⅲ+Ⅳ were higher than those of non-serous membrane invasion, non-lymph node metastasis and TNM Ⅰ+Ⅱ (Plt;0.05), but there was no significant difference among different differentiation degrees (Pgt;0.05). Conclusion The high expression of Fascin-1 protein is correlated to high invasion ability and lymph node metastasis, which can play as a sensitive index in predicting the invasion and metastasis of colorectal adenocarcinoma.
Objective To understand the demands of residents in postgraduate medical education for faculty doctors and provide useful information to teaching hospitals. Methods Two hundred residents were interviewed through questionnaires. Results Demands for faulty doctors were consistent in the following 5 fields: faculty’s synthetic diathesis, adaptability to social and medical changes, information management and research, cooperation and teamwork, and innovation and continuous self-improvement (Pgt;0.05). However, with regard to the faculty doctors’ professionalism, teaching models and atmosphere, the demands of residents in the different stages of postgraduate medical education differed significantly (Plt;0.05). Conclusion Teaching hospitals continuously improve faculty doctors’ abilities and pay much attention to residents’ role transformation.
Objective To explore the expressions of Galectin-3, Fascin-1, and β-catenin protein in colorectal adenocarcinoma and the relations to clinicopathologic characteristics. Methods The expressions of Galectin-3, Fascin-1, and β-catenin protein were detected in 60 cases of colorectal adenocarcinoma, 30 cases of adenoma, and 30 cases of normal mucosa by microwave-EliVisionTM immunohistochemistry method, and analyzed the expressions of them and the relations to clinicopathologic characteristics. Results The expression rate of Galectin-3, Fascin-1, and β-catenin protein in CRC was 68.3% （41/60）, 53.3% （32/60）, and 81.7% （49/60） respectively, which was 46.7% （14/30）, 30.0% （9/30）, and 43.3% （13/30） respectively in adenoma, and 20.0% （6/30）, 3.3% （1/30）, and 13.3% （4/30） respectively in normal mucosa, the differences had statistical significance （P＜0.05）. The expressions of Galectin-3, Fascin-1, and β-catenin protein had statistically significant correlation with the TNM stage, invasive degree, and lymph node metastasis of colorectal adenocarcinoma （P＜0.05, P＜0.01）. The expressions of Galectin-3 and β-catenin protein had statistically significant correlation with the different differentiation degree of colorectal adenocarcinoma （P＜0.05）, but the expression of Fascin-1 protein was not related to differentiation degree of colorectal adenocarcinoma （P＞0.05）.The expressions of Galectin-3, Fascin-1, and β-catenin protein had not statistically significant correlation with the patient’s age and gender, and tumour size （P＞0.05）.There were positive correlations between the Galectin-3 and Fascin-1 or β-catenin （r=0.728，P＜0.01；r=0.696，P＜0.01）, and there was positive correlation between β-catenin and Fascin-1 （r=0.507，P＜0.01）. Conclusions The high expressions of Galectin-3, Fascin-1, and β-catenin protein in colorectal adenocarcinoma tissues are some extent correlated to the high invasive ability and lymph node metastasis, which could be used for the indexes to predict the invasion and metastasis in colorectal carcinoma potentially.
Objective To explore the predictive value of CT signs combined with clinicopathological features for single cN0 papillary thyroid microcarcinoma (PTMC) central lymph node metastasis (CLNM). Methods A retrospective analysis of the CT signs and clinicopathological characteristics of 115 cases of single cN0 PTMC confirmed by surgery and pathology was performed, and univariate and multivariate logistic regression analysis were used to analyze the relationship between the contact between tumor and thyroid edge, tumor calcification, tumor location, tumor diameter, age, gender, thyroglobulin level and CLNM. According to the different contact range between tumor and thyroid edge in CT signs, the patients were divided into three groups: <1/4 group, 1/4–<1/2 group and ≥1/2 group. The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge was analyzed by using χ2 test. Results Among 115 cases of single cN0 PTMC, there were 26 cases and 89 cases with CLNM positive and negative, respectively. Univariate analysis showed that contact between tumor body and thyroid edge, tumor diameter, age, and gender were associated with CLNM positive (P<0.05). Further multivariate logistic regression analysis showed that thyroid marginal contact, age <45 years old and male were associated with CLNM positive (P<0.05). The proportion of CLNM positive patients in different contact areas between tumor body and thyroid edge (between the three groups ) was statistically different (P<0.05). The pairwise comparison among the three groups showed that the proportion of CLNM positive patients were statistically different (P<0.0167 after correction). Conclusions Tumor body contact with thyroid edge, age <45 years and male were independent risk factors for CLNM in patients with single cN0 PTMC. The combination of multiple risk factors can further improve the preoperative evaluation level of CLNM in patients with PTMC. Excluding clinical characteristic factors, the wider the contact area between the tumor and the thyroid edge, the higher the risk of CLNM, which provides a reasonable basis for selective central lymph node dissection.
Objective To summarize the experience of epidemic prevention in order to offer the first-hand data for reconstruction after the earthquake and epidemic control and prevention in the active seismic zone. Method We collected and analyzed the data of epidemic control and prevention and summarized their strengths and weaknesses. Results Of the 13 counties in Aba Prefecture, 12 were affl icted with 2 worst-hit counties and 5 worse-hit disaster areas. A total of 20 233 people were dead and 7 873 people were missing. Health system was severely damaged. Aba Center of Disease Control and Prevention started the contingency plan and sent 4 epidemic prevention teams to the disaster areas. With the combination of local materials and external aids, the epidemic prevention network of county, township and village was established. (1) Environment cleaning and el imination: up to August 27, 2008, 2 591 group times of teams involving 88 298 person times and 5 294 set times of vehicles were allocated. Disinfection area covered 18 181.3 m2 including 14 132 dumps, 33 271 cesspits and 154 391 breeding grounds of mosquitoes, fl ies and mice. (2) Critical supervision for the safety of drinking water and food: up to June 20, 21 central ized and 1 032 dispersed water supply sources were restored. We monitored 829 drinking water samples, among which 594 were qual ified with the qual ified rate of 66.59%. (3) A total of 86 396 people were resettled in 17 temporary sites. (4) Wild dogs were killed in Kala-azar epidemic areas. Mosquitoes, flies and mice were supervised once a week. (5) Disease supervision: A total of 762 cases in 15 legal infectious diseases were found within 90 days after the earthquake, and no death was found. No outbreak of infectious epidemic situations and burst publ ic health events was reported. A total of 57 157 Hepatitis A vaccinations were inoculated in the children aged from 18 months to 12 years old and 16 268 in children aged from 13 to 16 years old, medical staff, mil itary personnel and first-l ine workers. A total of 4 435 Japanese encephal itis vaccinations were inoculated in people in Xiaojin county. On June 15, routine inoculation cl inic recovered and on July 1, expansive inoculation was started on schedule. Conclusion Phased victory is gained in epidemic control and prevention in Aba Prefecture, although it is only a latter-wit. It is suggested that a long-term system of the earthquake disaster as well as human and environmental protection should be reconsidered through the first-hand data of anti-epidemic measures of the Wenchuan earthquake.