Objective To compare the application of granule embedding，singlepoint homogenization，and multipoint homogenization for parathyroid autologous transplantation in central lymph node dissection for thyroid cancer. Methods A retrospective analysis of 99 cases of thyroid papillary carcinoma from January 2016 to October 2018 underwent total thyroidectomy and central lymph node dissection.All patients underwent autologous transplantation of a Inferior parathyroid gland，35 cases with granule embedding method，31 cases with single point injection method and 33 cases with multipoint injection method.The blood calcium and PTH values preoperative，one day after surgery，one week after surgery，one month after operation and three months after operation were compared. Results There were no significant differences in serum calcium and PTH levels between the three groups preoperative，one day after surgery，one week after surgery and 3 months after surgery（P>0.05）.The levels of serum calcium and PTH were higher in the multipoint injection than in the other two groups 1 month after surgery（P<0.05）. Conclusion Multipoint injection method is safe and reliable for autologous transplantation of parathyroid gland.The recovery of parathyroid function is faster and worthy of clinical promotion.

Objective To explore the clinical application of serum specific miRNAs in the diagnosis of thyroid papillary carcinoma. Methods Ninety-two patients with papillary thyroid cancer admitted to our hospital from January 2017 to May 2019 were selected as the study group.In the same period, 92 healthy people served as control group, while 92 benign thyroid tumors patients served as benign group.Total RNA was extracted from serum samples of all subjects,and the relative expression levels of microRNA-221, microRNA-222 and microRNA-455 were detected by fluorescence quantitative PCR.The expression of three kinds of microRNAs in three groups of subjects was compared.The expression of three kinds of microRNAs in patients with different clinicopathological characteristics in the study group was compared, and the diagnostic efficacy of the three kinds of microRNAs was analyzed by ROC working curve. Results The serum levels of three kinds of miRNAs in the study group were significantly higher than those in the control group; the expressions of miRNAs-455 were significantly higher in patients over 45 years old, with tumors larger than 1 cm, with single lesion and with extraglandular invasion; the expressions of miRNAs-221 and miRNAs-222 were significantly higher in patients with lymph node metastasis and extraglandular invasion.The above results were all P<0.05.The expression of miRNA-221, miRNA-222 and miRNA-455 in the diagnosis of papillary thyroid cancer were 0.813, 0.802 and 0.794, respectively. Conclusion The expression of serum miRNA-221, miRNA-222 and miRNA-455 in patients with thyroid papillary cancer is significantly increased. The expression of miRNAs can reflect the lesion, metastasis and infiltration of cancer. Serum-specific miRNAs has certain value in the diagnosis of thyroid papillary cancer, but the sensitivity and specificity of the diagnosis still need further study.

Objective To investigate the effect of mesangial thyroid resection in patients with papillary thyroid carcinoma and its effect on long-term prognosis. Methods A total of 105 patients with thyroid papillary carcinoma who underwent radical thyroidectomy from December 30，2015 to January 30，2019 were enrolled.Among them，35 patients underwent mesangial thyroid resection（observation group），70 patients underwent conventional central lymph node dissection（control group）.The surgical indexes，postoperative complications，and postoperative serum parathyroid hormone（PTH）and serum calcium levels were compared between the two groups.The deadline of follow-up time was December 2019，the end of follow-up was death，and the effect of lymph node dissection and clinicopathological data on death rate was observed. Results The operation time of the observation group was longer than that of the control group，and the difference was statistically significant（P<0.05）.There was no significant difference in the amount of intraoperative blood loss，postoperative hospital stay，and time to get out of bed after surgery between the two groupst（P>0.05）.There were no significant differences in serum PTH and serum calcium between the two groups before and after surgery（P>0.05）.Serum PTH and serum calcium were lower in two groups on the first day after operation than that before surgery，and the serum PTH was lower in two groups on the third day after operation than that before surgery（P<0.05）.There were no significant differences in the incidence of postoperative laryngeal nerve injury，permanent laryngeal nerve injury，wound infection，postoperative bleeding，total complications，and secondary surgery in two groups（P>0.05）.The follow-up time was 12～48 months and the median follow-up time was 36.9 months.〖JP2〗 Kaplan-Meier analysis and Log-ranktest showed that the 〖JP〗cumulative survival rate of patients with mesangial thyroid resection was higher than that of patients with non-mesangial thyroid resection（P<0.05）.Multivariate 〖LM〗analysis showed that TNM staging，extra-glandular invasion，lymph node metastasis，and mesangial thyroid resection were independent prognostic factors for survival rate（P<0.05）. Conclusion The short-term effect of mesangial thyroid resection is not much different from that of conventional central lymph nodes，but its death rate is low and the prognosis is good.

Objective To investigate the effect of ω-3 fish oil fat emulsion combined with early enteral nutrition on intestinal function and short-term prognosis in patients with severe craniocerebral trauma. Methods The 98 patients with severe craniocerebral trauma admitted to our hospital from March 2017 to March 2019 were randomly divided into control group and observation group，49 cases in each group.The patients in the control group were treated with early enteral nutrition，while the patients in the observation group were treated with ω-3 fish oil fat emulsion on the basis of the control group.Both groups were treated for 2 weeks.The Glasgow coma index score（GCS），neurological deficit degree（NIHSS），acute physiological and chronic health status score（APACHE II），intestinal mucosal barrier function and short-term prognosis were compared between the two groups before and after treatment. Results Affter treatment，the GCS score of the observation group was higher than that of the control group（P<0.05）.After treatment，the NIHSS and APACHE II score of the observation group was lower than that of the control group（P<0.05）.The levels of serum D-lactic acid and endotoxin in the observation group were lower than those in the control group after treatment（P<0.05）.The prognosis of the observation group was better（79.59%）than that of the control group（51.02%）（P<0.05）. Conclusion ω-3 fish oil fat emulsion combined with early enteral nutrition has a good effect on severe craniocerebral trauma patients，can improve the intestinal mucosal barrier function，and has a good prognosis in the near future.

Objective To investigate the expression pattern of PDLIM3 in the aorta of patients with aortic dissection (AD) and its clinical significance. Methods Aortic tissue specimens from aortic dissection patients(n=34) and heart transplant recipients(n=22) who received surgical treatment in Tongji Hospital from January 2017 to December 2018 were collected.The structural changes of aortic wall were observed by hematoxylin-eosin(HE) staining and elastic fiber staining (EVG).Real-time quantitative PCR (RT-PCR) was used to detect the mRNA expression levels of PDLIM3 in aortic samples.The correlation between the expression levels of PDLIM3 and the aortic diameter was analyzed by using Pearson correlation analysis. Results HE and EVG staining showed that the middle layer of aortic wall became thinner, elastic fiber fracture increased, vascular smooth muscle cellloss and with smaller volume and morphology changes.The mRNA expression levels of PDLIM3 in aorta of patients with aortic dissection were significantly down-regulated compared with that of the transplanted recipients(P<0.05).Pearson correlation analysis showed that the expression of PDLIM3 gene was not significantly associated with the aortic diameter of patient with aortic dissection. Conclusion PDLIM3 expression level is down-regulated in aorta of patients with aortic dissection and may be associated with the occurrence of aortic dissection in patients.

Objective To explore the therapeutic effect of lung transplantation for end-stage lung diseases，and to summarize the experience of perioperative treatment of lung transplantation. Methods The perioperative period clinical data of 13 cases of lung transplantation between December 2016 and September 2019 were analyzed retrospectively. Results The main diagnosis was chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis in 4 cases，respectively，and bronchiectasis in 3 cases.There was 1 case of pneumoconiosis and 1 case of Kartagener syndrome.7 cases underwent bilateral lung transplantation，3 cases received left unilateral lung transplantation and 3 cases received right unilateral lung transplantation.There were 3 deaths during perioperative period.The cause of death was Acinetobacter Baumannii combined with Pseudomonas Aeruginosa infection in 1 case，Klebsiella Pneumoniae infection in 1 case，and 1 case was dead of cardiac arrest.The remaining 10 cases were cured and discharged. Conclusion Lung transplantation is an effective method for the treatment of end-stage lung diseases.The emergency salvage surgery has little effect.

Objective To explore the relationship between the different aged patients characteristic who diagnosed triple negative breast cancer（TNBC）and the prognosis. Methods The TNBC patients with non-metastatic were enrolled to this study from January 2005 to December 2012，who divided into three groups according to age，elder group（＞65 age）was 81 cases，middle-age group（40～65 age）was 202 cases and young group（＜40 age）was 82 cases respectively.The patients characteristic and the methods of treatment were compared among three groups，meanwhile，the survival was analyzed by Kaplan-Meier and the survival of prognosis was analyzed by Cox risk model. Results The cancer-historic，size of tumor，number of axillary lymph nodes and TNM stages were not significant difference among three groups（P＞0.05）; However，there were significant difference in the methods of treatment among them（P＜0.05）; The median follow-up was 5.5 years（4.1～7.9 years），The 5-years relapse-free survival（RFS），distant relapse free survival（DRFS）were 75.9% and 82.3% in young group，which were significant lower than 81.2%，87.0% of the middle aged group and 83.3%，88.6% of the elderly group（P＜0.05）;The 5-years disease specific survival were 79.5%、80.1% and 82.4% in three groups（P＞0.05）;Cox risk model reveal that ages and methods of operation were independently factors for the prognosis. Conclusion The patients characteristic who diagnosed triple negative breast cancer（TNBC）are not related to ages，however，the youngest patients，the worst prognosis for the TNBC patients.

Objective To observe and search whether the patients fall into SAP with PICS will suffer more serious immunosuppression or not compared with those without PICS through clinical and laboratorial evidence and offer the reference to clinical diagnosis. Methods This study was about 63 SAP patients.According to academic reports，SAP patients were divided into PICS group with 23 patients and non-PICS group with 40 cases.We considered patients occur immunosuppression if they suffered secondary infections.Blood samples were collected to examined concentrations of ALCs and spd-l1. Results Compared with the control group，the ALCS count of SAP patients decreased significantly within 3 weeks after admission（P < 0.05），and the level of SPD L1 increased significantly within 1 month.Secondary infections occurred overall in the PICS group，compared with only 27.5% in the non-PICS group（P<0.05）.There was no statistical difference in ALCs and sPD-L1 between two groups in the early stage of onset of SAP.However，after 2 weeks there is significant difference in ALCs and sPD-L1 in SAP patients with PICS and without PICS. Conclusion SAP patients with PICS suffer from more severe immunosuppression with higher incidence of secondary infections.

Objective To explore the expression of microfibril-associated protein 2 (MFAP2) in colorectal cancer (CRC) and its clinical and prognostic value. Methods RT- qPCR and Western blot were used to detect the expression of MFAP2 mRNA and protein in CRC cells and tissues, respectively.Then, immunohistochemical assay was used to detect the expression level of MFAP2 protein in 65 pairs of CRC and corresponding adjacent tissues, and the correlation of its expression with clinicopathological factors and patients' prognosis were further investigated. Results Compared to normal colorectal epithelial cell, the mRNA and protein expression of MFAP2 in CRC cells was significantly increased (P＜0.05, respectively).Consistently, the mRNA and protein expression of MFAP2 in CRC tissues was significant higher than that of paired adjacent normal tissues (P＜0.05, respectively). Immunohistochemical analysis showed that MFAP2 protein was highly expressed in CRC tissues with a positive rate of 60%, and the high expression of MFAP2 were significant association with tumor grade, depth of invasion, lymph node metastasis, vascular invasion, nerve invasion and TNM stage (P＜0.05, respectively). Survival analysis indicated high expression of MFAP2 was significantly associated with poor prognosis in patients with CRC(P＜0.05), and further univariate and multivariate analysis showed that high expression of MFAP2 protein was an independent factor affecting the prognosis of patients with CRC (HR=3.733,95% CI:1.509～9.229,P=0.004). Conclusion MFAP2 is up-regulated in CRC, and its high expression is closely related to the unfavorable clinicopathological features and prognosis of patients. These results indicate that MFAP2 may become a new prognostic marker and potential therapeutic target of CRC patients.

Objective To study the clinical effect of procedures for prolapse and hemorrhoids（PPH）and excision for thrombosed external hemorrhoid in acute incarcerated mixed hemorrhoids. Methods 82 acute incarcerated mixed hemorrhoids patients treated from September 2014 to May 2018 in our hospital were selected and randomly assigned to two groups，41 cases each group.The control group was treated with Milligan-Morgan surgery; the observation group was treated with PPH plus excision for thrombosed external hemorrhoid.The therapeutic effect，operation conditions and complications were probed. Results The total effective rate in the observation group（95.12%）was significantly higher than control group（85.37%）（P＜0.05）; the operation time and bleeding volume showed no significant differences（P＞0.05）; the hospitalization time and wound healing time in the observation group was shorter than control group（P＜0.05）; the incidence rate of complications in the observation group（2.44%）was significantly lower than control group（19.51%）（P＜0.05）.There was no difference in VAS scores between the two groups before operation.The scores of 3 hours，12 hours and 24 hours after operation were significantly lower than those before operation，and the scores of 3 hours，12 hours and 24 hours after operation in the observation group were lower than those in the control group（P＜0.05）. Conclusion The procedures for prolapse and hemorrhoids plus excision for thrombosed external hemorrhoid can remarkably increase the effective rate，shorten the hospitalization time and wound healing time，and reduce the incidence rate of complications.

Objective To compare the efficacy of Laparoscopic-assisted anorectoplasty (LAARP) and Posterior sagittal anorectoplasty(PSARP) with Total urogenital mobilization(TUM) for high- and intermediate-type Persistent Cloaca(PC) by vertical comparison. Methods Twenty-five girls with high- and intermediate-type PC who underwent LAARP between November 2005 and March 2016 were retrospectively analyzed. Data of 9 girls with high- and intermediate-type PC who underwent PSARP plus TUM between March 1999 and May 2004 were collected as control. The duration of operation, estimated blood loss, postoperative hospital stay, complications and anal function (Krickenbeck classifiction) were compared between groups. Results The 2 groups were comparable in baseline data.LAARP group presented shorter operative time[(124.32±8.74)min vs. (186.67±65.53)min，P＜0.05], less estimated blood loss [(15.84±9.80)ml vs.(42.78±24.25)ml,P＜0.05]，shorted postoperative hospital stay[(6.32±1.11)d vs. (10.11±1.90)d,P＜0.05] and lower morbidity of postoperative complication[ 16.0%(4/25) vs.66.7%(6/9),P＜0.05] when compared with PSARP group. According to Krickenbeck classification, the overall bowel function score of LAARP group was better than that of PSARP group[(10.39±1.50） vs. （8.89±1.54），P＜0.05] ，children in LAARP group had better constipation score than those in PSARP group(P＜0.05), however, the rates of voluntary bowel movement and soiling were similar in two groups（P＞0.05）. Conclusion Compared with PSARP combined with TUM, LAARP is safe effective in the treatment of high- and intermediate-type PC. Meanwhile, LAARP technique can acquire some advantages such as less traumatic, better cosmetic results and faster recovery; it seems to be more suitable for the treatment of children with high- and intermediate-type PC.

Objective To explore the value of urodynamics（UDS）in the diagnosis of chronic prostatitis/chronic pelvic pain syndrome（CP/CPPS）. Methods We retrospectively analyzed the urodynamic data of 204 patients diagnosed as CP/CPPS from January 2015 to April 2019.The results of urodynamic examination were analyzed，including free uroflowmetry，filling cystometry，and pressure-flow study. Results A total of 204 men were included.The mean Qmax was（14.3±6.4）ml/s，ranging 3.8 to 62.5 ml/s.The mean voided volume（Vv）was（339.6±126.3）ml，ranging 91.2 to 801.2 ml.Vv＜300ml was found in 80 cases（39.2%），and Vv＞500ml in 23（11.3%）.The flow rate curve pattern of normal bell-shape demonstrated in 92 cases（45.1%），low flat curve pattern in 96（47.1%），wavy curve in 16（7.8%），post void residual（PVR）＞50ml in 13（6.4%）.Urodynamic studies demonstrated increased sensation of bladder in 61 of cases（29.9%），detrusor over-activity in 26（12.7%），small cystometric capacity in 24（11.8%），weak detrusor in 130（63.7%），acontractile detrusor 6（2.9%），bladder outlet obstruction in 14（6.9%），and normal UDS in 44（21.6%）. Conclusions UDS examination can identify specific types of lower urinary tract dysfunction in patients with CP / CPPS，and then take targeted treatment.

As the incidence of thyroid disease continues to rise，the need for surgical treatment is increasing.Total thyroidectomy and central lymph node dissection are important methods for clinical treatment of thyroid cancer.However，the incidence of postoperative complications of hypoparathyroidism and hypocalcemia is still relatively high.The main reason for the complications is the inaccurate identification of the parathyroid glands during the surgical procedure.In recent years，many scholars at home and abroad have reported a variety of new parathyroid gland recognition techniques during surgery，and this article reviews and analyzes these technological advances.

In recent years the precise diagnosis and treatment of thyroid cancer have made great progress and widely applied clinically, which include the judgment of benign and malignant, malignant risk stratification, inheritance and target therapy. It provides new guidelines for the individualized management of thyroid cancer. We try to introduce the applications of molecular diagnosis in thyroid cancer from the above aspects.

Objective The epidemic COVID-19 is high infectivity and susceptibility.Elderly patients are prone to critical illness in the course of disease development.Providing the severe patients endotracheal intubation in time to increase the oxygenation is conducive to improve the prognosis.The COVID-19 severe patients are with respiratory support，and clinicians and nurses wear biosafety level-3（BSL-3）protective medical equipment，so there are great difficulties during the airway assessment and the position confirmation for the endotracheal tube.It is an important supplement for the intubation technique to accomplish the airway assessment and position judgment rapidly and conveniently under the assist of endobronchial ultrasonography.Endobronchial ultrasonography is valued as visual diagnosis device in endotracheal intubation for COVID-19 patients.In the course of endotracheal intubation diagnosis and treatment of critically ill patients in this epidemic，it enjoys the reputation of "visual instrument".

The outbreak and epidemic of new coronavirus pneumonia pose a threat to the life and health of the people in the affected areas.Under the special situation of severe epidemic area and public health level I response，how to make diagnosis and treatment for patients with spontaneous pneumothorax on the basis of scientific protection timely：How to diagnose patients with new coronavirus pneumonia quickly，how to carry out clinical operation reasonably，how to perform emergency surgery for patients with surgical indications，and how to manage postoperative patients scientifically are all problems facing thoracic surgeons in this special situation.Combined with the latest policy guidelines，literature reports and the prevention experience of thoracic surgery department in our unit，this paper briefly summarizes the above problems.

Objective To discuss the corona virus 2019 ward management of breast cancer in severe areas. Methods Retrospective analysis during the period of the outbreak，hospitalized patients in our hospital，the hospital process，ward，presence of infection after follow-up of patients discharged from hospital and the hospital care，cleaning personnel during the infection. Results Hospital appointments，a total of 30 patients，reservation period patients had no fever，cough and lack of suspicious symptoms including 2 cases（1 case of chemotherapy patients，1 case of targeted therapy）in patients with CT in clinic found when screening line grinding glass patchy shadow，negative two nucleic acid detection，still advises patients to community isolation，temporarily not chemotherapy The remaining 28 patients had no suspicious symptoms when they were admitted to the hospital，and they did not leave the ward during their hospitalization with CT and no obvious abnormalities in white blood cells and lymphocytes.All the 15 nurses and 2 cleaners who participated in the work of the ward had no obvious discomfort.During the 14-day observation period after discharge，the patient's body temperature was normal and there was no discomfort. Conclusion COVID-19 coronavirus is highly infectious，has its unique biological characteristics，and has certain influence on normal medical treatment.However，under the strict prevention and control measures，the diagnosis and treatment of breast cancer disease can still be carried out gradually and safely.