0.05). There were 7 cased in the polypropylene mesh group had abdominal discomfort due to stiffness, which higher than that of the expanded polytetrafluroethylene patch and control groups (P 0.05). CONCLUSION: Both prosthetic patches are safe and effective when used in the repair of inguinal hernia in aged patients with low recurrence rate, especially, the expanded polytetrafluroethylene patch, which is more comfortable than polypropylene mesh.

Objective To study the effect of erythropoietin on cardiac function of the patients with acute mycardial infarction (AMI). Methods 48 patients with AMI successfully treated with thrombolytic therapy were randomized into two group,2000 units of recombinant human erytfu-opoietin(rh-EPO) were administrated once a time in therapeutic group,3 times on alternate days in one week and total for 4 weeks. The peak value of serum creatine kinase(CK) and creatinkinase isozyme MB (CK-MB)were measured, myocardial infarct size (S) was estimated by Hindmen's QRS scoring system, and the diameter of left ventricular end diastolic(LVEDd) and left ventricular injection fraction (LVEF) were determined with echocardiography at the 4th weekend in both groups. Results CK, CKMB and S in therapeutic group were lower than in control group (P < 0.05). LVEDd and LVEF were also improved in the therapeutic group. Conclusion rh-EPO can significantly lessen the size of isehemia and infarct myocardium, mitigate the infarction degree and improve the cardiac function slightly in AMI patients.

Objective To evaluate regenerative nerve and functional recovery of target muscle in rats with sciatic nerve defect bridged by acellular nerve allograft made through chemical extraction.Methods Sciatic nerve of SD rats was processed in a volume fraction of 3％ Triton X-lO0 solution and 40 g/L sodium deoxycholate solution.Morphology of myelin sheath,axons and basal lamina tubes of sciatic nerve segments was observed under the light microscopy before and after the chemical processing.Twenty-five Wistar rats were divided into acellular nerve allograft group (n =10),autograft group (n =10) and normal control group(n =5) according to the random number table.A 1 cm sciatic nerve defect was created in acellular nerve allograft group and autograft group,and was respectively bridged by acellular nerve allograft and autograft.Sciatic nerve function index (SFI) was measured every two weeks.Twelve weeks after surgery,nerve conduction velocity (NCV),recovery rate of compound muscle action potential (CMAP) and recovery rate of muscle force were measured in each group.Results Cellular components including myelin sheath and axons were removed thoroughly,but the basal lamina tubes were preserved completely.At postoperative 2,4,6,8,10 and 12 weeks,SFI in normal control group (-1.7±5.9,-0.3 ±2.5,0.8 ±4.1,-1.4±3.6,-2.5 ±5.7 and-2.1±3.2) was superior over autograft group (-94.3±3.7,-90.1±4.1,-63.7±7.8,-51.9±8.2,-48.8±8.6 and -44.3 ± 10.5) and acellular nerve allograft group (-97.1 ± 5.3,-91.2 ± 6.1,-70.6 ± 5.5,-60.4±6.2,-58.2 ±10.2 and-56.4 ±8.0) (P ＜0.01).At postoperative 6,8,10 and 12 weeks,SFI in autograft group were better than those in acellular nerve allograft group (P ＜0.05).NCV [(61.6 ± 8.1) m/s],recovery rate of CMAP[(98.7 ± 5.9) ％] and recovery rate of muscle force [(101.8 ± 6.6) ％] in normal control group were higher than those in acellular nerve allograft group [(22.3 ± 4.7) m/s,(40.3 ± 9.2) ％ and (43.8 ± 9.3) ％] and those in autograft group [(29.0 ±5.5) m/s,(52.5 ± 10.6) ％ and (54.3 ± 10.5) ％] (P ＜ 0.01).NCV,recovery rate of CMAP and recovery rate of muscle force in autograft group were better than those in acellular nerve allograft group (P ＜ 0.05).Conclusions Acellular nerve segments are harvested satisfactorily by chemical extraction.Sciatic nerve defect in rats can be cured with the acellular nerve allograft,but the repair effect of autograft is relatively better.

Objective To explore the diagnostic value of the combined detection of serum Dickkopf-1 (DKK1 )and EB viral capsid antigen immunoglobulin A (VCA-IgA)in patients with nasopharyngeal carcinoma (NPC).Methods Serum levels of DKK1 and VCA-IgA were measured by enzyme-linked immunosorbent assay (ELISA)for the 80 patients with NPC and 65 normal controls.Receiver operating characteristic (ROC) curve was used to calculate the diagnostic value.Results The serum levels [M(QR )]of DKK1 in patients with NPC were significantly higher than those in normal controls [580.773 (429.1 46 )pg/ml vs.31 6.1 74 (252.965)pg/ml],with a significant difference (Z=4.846,P<0.000 1 ).ROC curves showed that the opti-mum diagnostic cutoff for serum DKK1 was 611.981 pg/ml,with an area under curve (AUC)of 0.734 (95%CI:0.654-0.81 5,50.0% sensitivity,96.9% specificity).Measurement of VCA-IgA demonstrated an AUC of 0.71 4 (95%CI:0.631-0.798,47.5% sensitivity,95.4% specificity).The combined detection of DKK1 and VCA-IgA demonstrated an AUC of 0.849 (95%CI:0.783-0.91 4,76.3%sensitivity,95.4%spe-cificity).For patients with early-stage NPC,the detection effect of combined detection of DKK1 and VCA-IgA was much better than that in normal controls,with a significant difference (χ2 =23.784,P <0.001 ). Conclusion Serum DKK1 has potential diagnostic value for NPC.Combined detection of DKK1 and VCA-IgA may aid the early diagnosis of NPC.

Objective To study the values of neck dissection for thyroid carcinoma who received nonstandard operation and help to choose good re-operation methods. Methods Retrospective investigation was carried out in 38 cases of neck dissection for thyroid carcinoma patients who received nonstandard operation during 1997 to 2005, and 32 cases were treated with neck dissection. Results Pathological results confirmed there were 73.68 % with residual tumor, positive rate of thyroid was 47.38 %, and that cervical lymph node was 57.89 %. Conclusion The residual rate of cervical lymph nodes of reoperated patients with thyroid carcinoma was relatively higher, so neck dissection for thyroid carcinoma who received nonstandard operation was necessary.

Objective To compare the treatment outcome of underwent surgery plus radiotherapy and radiotherapy/chemoradiotherapy plus salvage surgery for stage Ⅲ/Ⅳ laryngeal carcinoma,to investigate an optimized treatment for the patients of stage Ⅲ/Ⅳ laryngeal carcinoma.Methods Clinical data from 103 patients with stage Ⅲ (39 cases) or stage Ⅳ (64 cases) laryngeal carcinoma were retrospectively analyzed.The patients were divided into surgery plus radiotherapy group (S±R,46 cases) and radiotherapy/chemoradiotherapy plus salvage surgery group (R±S,57 cases).Overall survival,relapse free survival,and laryngeal preservation rate were used to compare the treatment outcome between two groups.Multivariate regression models were used to analyze the independent factors for survival and laryngeal preservation rate.Results Survival rate was higher in S±R group than in R±S group [2 year overall survival/relapse free survival 74.7 ％ (34/46) / 72.4 ％ (33/46) vs 46.4 ％ (26/57) / 40.9 ％ (23/57),P ＜ 0.05].Laryngeal preservation rate was higher in R±S group than in S±R group [93.0 ％ (15/46) vs 32.6 ％ (53/57),P ＜ 0.05].Multivariate analysis demonstrated that treatment modality and T stage were independent factors for long-term survival,while treatment modality was the only an independent factor for laryngeal preservation rate.Conclusions Surgery plus radiotherapy result in better survival and lower laryngeal preservation rate than radiotherapy/chemoradiotherapy plus salvage surgery in treatment of stage Ⅲ/Ⅳ laryngeal carcinoma.Surgery plus radiotherapy should be the first choice for treatment of locally advanced laryngeal carcinoma.Improvement of the quality of life could be achieved by laryngeal preservation surgery and phonation reconstruction procedures.

Objective To evaluate the pattern of lateral cervical metastases and to investigate the risk factors for lateral cervical lymph node metastases in paoiuary thyroid carcinoma patients with clinical negative lateral neck lymph node.Methods 73 patients with paoiuary thyroid carcinoma who underwent prophylactic lateral neck dissections(level Ⅱ-Ⅵ or level Ⅱ-ⅣandⅥ) were reviewed retrospectively on their medical records paoiuary thyroid carcinoma.None of patients in this study had a clinically positive lymph node.Neck dissection specimens were obtained for histological analysis for node metastasis with respect to the individual neck levels.Results Occult metastases in lateral neck were observed in 12(16.4 ％)patients.9.6 ％,0,13.6 ％,9.6 ％,0,4.8 ％ and 42.4 ％ patients had histologically positive lymph nodes in levels Ⅱa,Ⅱb,Ⅲ,Ⅳ,Va,Vband Ⅵ respectively.In multivariate analysis,lymphatic metastases in level Ⅵ was associated with lateral neck metastasis(OR=7.3,P=0.020)in cN0 patients with paoiuary thyroid carcinoma.Conclusion Levels Ⅲ,Ⅱa and Ⅳwere the most common stages showing occult lymph node metastases.Prophylactic lateral neck dissections may be omitted in the treatment of cN0 PTC patients ff level Ⅵ lymphatic metastases are not found on histological exam.

Objective To evaluate if Ⅵ region lymph nodes metastasis status can be a reliable indicator in prediction of lateral lymph nodes metastasis in papillary thyroid carcinoma (PTC) with negative cervical lymph nodes (cN0).Methods Retrospectively reviewed the medical records from January 2003 to October 2011 of 73 patients with PTC who underwent prophylactic lateral neck dissection (Ⅱ-Ⅴ region or Ⅱ-Ⅳ region).The relationship between cervical lymph nodes metastasis and lateral lymph nodes metastasis was assessed.Results The rate of lateral lymph nodes metastasis was 16.4％(12/73).The rate of Ⅵ region lymph nodes metastasis was 42.5％(31/73).Multivariate analysis showed that Ⅵ region lymph nodes metastasis was the risk factor of lateral lymph nodes metastasis in cN0 patients with PTC(OR =7.3,P=0.020).Conclusion Ⅵ region lymph nodes metastasis status can be a reliable indicator of lateral lymph nodes metastasis in cN0 patients with PTC.

Objective To evaluate the feasibility and validity of near infrared fluorescence imaging with indocyanine green in sentinel node biopsy for cN0 oral carcinoma.Methods Thirty cases of previously untreated oral carcinoma staged cT1-3 N0M0 were enrolled in this study.1 ml of indocyanine green (25 mg/ 5 ml) was injected both around the primary tumor in a 4 quadrant pattern and in the base of the tumor before skin incision.After elevation of the platysma flap and posterior retraction of the sternocleidomastoid muscle,fluorescence images were taken with a near infrared fluorescence detector until the hotspots were captured,then the hotspot lymph nodes were removed.Lymph nodes identified with fluorescent hotspots and verified in vivo were defined as sentinel nodes,and they were harvested and sent together with neck dissection specimen for pathologic study.Results Sentinel nodes were successfully harvested in all 30 cases.The number of sentinel nodes per case varied from 1 to 9,with an average number of 3.4.Routine pathology demonstrated that occult metastasis was exclusively found in the sentinel nodes in 5 cases (16.67％),and all the other lymph nodes were free from metastasis.No tracer associated adverse effects occurred in this series.Conclusion Near infrared fluorescence imaging with indocyanine green has a high detection rate in sentinel node biopsy for cN0 oral/oropharyngeal carcinoma and the sentinel nodes can evaluate the cervical metastatic status accurately.It is an easy,feasible and promising method,which is worthy of further investigation.

[ABSTRACT]OBJECTIVEThis study was designed to compare the quality of life between patients who
underwent a tongue reconstruction with radial forearm flap (RFF) and infrahyoid myocutaneous flap (IHMCF) after hemiglossectomy for their tongue cancers, and to figure out an optimal reconstructive method for the defects resulted from hemiglossectomy.METHODSA non-randomized case-control study was performed on 24 patients with tongue squamous cell carcinoma who underwent a standard hemiglossectomy combined with perfectly tongue reconstruction from June 2005 to June 2012. All of the cases were without tongue base invasion. Of the 24 cases, 19 had T2 disease, 5 had T3 disease, and they were divided into RFF group (n=10) and IHMCF group (n=14). The quality of life were evaluated one year after operation using EORTC-QLQ30 and FACT-H&N35 and compared between the two groups.RESULTSThe scores were comparable between the two group with regard to all domains of EORTC-QLQ30,with all P values>0.05.The scores of swallowing(P=0.005), speech (P=0.008), teeth (P=0.014), and cough (P=0.009) domains were significantly higher in IHMCF group than in RFF group, with P value of 0.005, 0.008, 0.014 and 0.009 respectively, while the other domains of FACT-H&N35 were comparable between the two groups, with allP values>0.05.CONCLUSIONOverall quality of life was similar in the two groups. Oral function domains were better in IHMCF group than in RFF group. When guarantee of flap survival is available, IHMCF could be used as a good alternative flap to RFF in tongue reconstruction after hemiglossectomy.