Objective To detect the expression level and procoagulant activity of tissue factor (TF)in the blood and urine in patients with type 2 diabetic nephropathy (DN),and investigate its related clinical significance.Methods A total of 120 DN patients were collected and divided into 3 groups according to urinary albumin and creatinine ratio:normal albuminuria group (＜3.4 mg/mmol) with 64 cases,microalbuminuria group ( ≥3.4 mg/nunol,and ＜ 34.1 mg/mmol) with 35 cases and macroalbuminuria group (≥34.1 mg/mnol) with 21 cases.Twenty healthy persons were enrolled as control group.The expression of monocytes TF in peripheral blood was detected by flow cytometric analyzer.The expression ofTF in the blood and urine was detected by ELLSA.The prcoagulant activity of TF was detected by one-stage coagulation.Results The expressions of monocytes TF in normal albuminuria group,microalbuminuria group and macroalbuminuria group [ (4.32 ± 1.25 )％,(5.01 ± 1.73)％,( 1 1.83 ± 2.14)％ ] were significantly higher than that in control group [(0.84 ± 0.36)％ ](P ＜0.01).TF procoagulant activity in normal albuminuria group,microalbuminuria group and macroalbuminuria group [ ( 64.3 ± 21.2),( 67.1 ± 17.3 ),( 113.8 ± 44.4)mU/L] were obviously higher than that in control grouP [ (23.8 ± 16.4) mU/L](P＜ 0.01 ).The expression of monocytes TF in normal albuminuria group and microalbuminuria group had no statistical significance (P＞0.05),while the expression in macroalbuminuria group had significant difference compared with that in normal albuminuria group and microalbuminuria group (P ＜ 0.01 ).The expression of TF in the blood and urine of DN patients was obviously higher than that of control group (P ＜ 0.01 ).The expression of TF in the blood was positively correlated with that in urine (r =0.684,P ＜ 0.01 ).Conclusions The expressions of TF in the blood and urine in DN patients increase and its procoagulant activity enhances.The expression level of TF has a closed relationship with the increase of albuminuria.

Objective To summarize the experiences and lessons drawn from iatrogenic bile duct injury. Methods The clinical records of 52 patients with iatrogenic bile duct injuries were studied retrospectively. Results The injuries of 48 cases were resulted from extrahepatic bile duct operation,2 cases from partial gastrectomy and 2 cases from hepatectomy.The locations of injuries were at the juncture of common hepatic duct and common bile duct in 34 cases, the common hepatic duct in 6 cases ,the common bile duct in 6 cases ,the juncture of left and right hepatic duct in 4 cases,and the left and right hepatic duct each in 1 case respectively.Complete bile duct injuries were seen in 30 cases,and partial injuries in 22 cases .All patients were treated by operation. 8 cases were immediately discovered at the time of the initial operation and direct repair or end to end anastomosis with T tube stent was done in 5 of the cases,direct insertion of T tube drain in 1 case and Roux en Y hepaticojejunostomy in 1 case, all with good results;and in the another, a choledo choduodenostomy was performed,but re operation by Roux en Y hepaticojejunostomy was done 3 years later,due to stricture of the anastomosis.For the 44 cases in which the bile duct injury was detected after the initial operation, Roux en Y hepaticojunostomy was done in 31 cases,hepaticoduodenostomy in 8 cases, drainage of common bile duct in 2 cases,plastic repair of common bile duct defect with jejunal flap in 1 case, hepaticojejunostomy (Longmire) in 1 case,and removal of stitches between the anterior and posterior wall of the common bile duct in 1 case.In the whole series,4 patients died,and 41 of 48 surviving patients were followed up.The excellent result rate was 82.9%,and 7 cases with poor results were cured by reoperation with Roux en Y cholangiojejunal anastomosis 2 months to 5 years after operation. Conclusions The key to improvenment of treatment results of iatrogenic bile duct injury is awareness of its acurrence,early diagnosis , and eraly repair of the bile duct.The method of surgical therapy depends on the location and type of injury,and the time of detection after the injury.Roux en Y cholangiojejunal anastomosis gives the best results.

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 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 report the clinical results and the advantages/disadvantages of anterolateral thigh flap (ALT) and forearm flap (FAF) in reconstruction of head and neck defect after cancer ablation. Methods 20 FAFs and 12 ALTs were performed to repair the head and neck tumor ablation defects. Of the 20 FAFs, 7 were used for repair of the through and through buccal defects, 4 for circumferential bypopharyngeal defects, 2 for plate defects, 1 for parotid area skin defect, 4 for floor of the mouth defects, and 2 for defect, of the base of the tongue, while of the 12 ALTs, 3 were used for repair of the defects of the base of the tongue, 4 for plate defects, and 5 for the floor of the mouth and/or lower gum defects. Survival of the flaps, function of the recipient site, and impact to the donor site were compared between these two groups to analyze the advantages/disadvantsges and key technique details of these two flaps. Results 19 FAFs totally survived. Vascular crisis occurred in 2 cases of FAF, of which 1 flap survived after conservative treatment, while the other 1 developed partial necrosis. All the 12 ALTs survived, without vascular crisis. 2 of the 14 planed ALTs were abandoned and replaced by FAFs, of which 1 because of absence of the perforating branch and the other 1 because of injury of the perforating branch. Secondary defects of the ALTs could be closed primarily, while secondary defects of the FAFs should be closed with skin grafts. Conlusion Both ALT and FAF can be performed with high survival rate. Each has its own advantages. Selection of the donor site deponds on situation of the defect and purpose of the reconstruction.

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.

ObjectiveTo compare the exposure, identification of parathyroid and postoperative complications between total thyroidectomy (TT) and subtotal/near total thyroidectomy (S/NT) for bilateral multiple thyroid nodules. MethodsA total of 278 cases were performed TT and S/NT randomly from Dec. 2006 to Dec.2009. The histology, identification of parathyroid and recurrent laryngeal nerves (RLN), and incidence of complications were compared between the 2 surgical procedures. The data were processed with t test or x2 test.Results227 cases were estimated to be benign preoperatively, among whom 28 cases ( 12.3％ ) were diagnosed as focal cancer by postoperative pathology. The identification rate of parathyroid was 96.5％ in TT group and 60.4％ in S/NT group (P＜0.05). The mean postoperative serum calcium level was 2.057 +0.016 mmol/L in TT group and 2. 15 + 0.019 mmol/L in S/NT group (P ＜ 0.05 ). The incidence rate of transient hypoparathyroidism (HPT) was 16.9％ in TT group and 5.7％ in S/NT group (P＜0.05). There was no statistical difference between the 2 groups in terms of the incidence rate of permanent HPT and transient recurrent laryngeal nerves (RLN) palsy ( P ＞ 0.05 ). The incidence rate of permanent HPT was higher in reoperation cases ( 11.1％ ) than in primary surgery cases (0.0％) in TT group ( P ＜0.05 ). ConclusionBased on the accurate technique under microscope field, TT is a safe surgical procedure for primary surgery with bilateral multiple thyroid nodules.

[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.

Objective To study the efficacy of different anti-adhesion agents used in preventing tubal obstruction after recanalization.Methods Five hundred and eight patients with tubal obstruction were divided into 245 cases in control group,108 cases in chitosan group;113 cases in sodium hyaluronate group and 42 cases in lipiodol group.The patients in control group were injected with anti-inflammation agents after recanalizatian,while other groups were injected with chitosan,sodium hyaluronate or lipiodol at dose of 2-3 ml in every therapeutic group.The rate of location of tubal obstruction and tubal recanalization were recorded during operation.Then patients in every group were followed up on tubal patency after 3 months,and pregnancy rate after 12 months.Results Among 1016 fallopian tubes in 508 patients,there were 330 tubes occlusion at isthmus portion and 563 tubes occlusion at interstitial portion of fallopian tube.Thirtyseven fallopian tubes were ablated because of ectopic pregnancy,86 fallopian tubes were unobstructed.(1)The recanalization rate were 95.7% (179/187) in chitosan group,97.9% (191/195) in sodium hyaluronate group,98.7% (75/76) in lipiodol group and 97.7% (425/435) in control group,which did not show statistical difference (P＞0.05).(2) The rates of tubal patency after 3 months of 91.7% (99/108) in chitosan group and 88.5% (100/113) in sodium hyaluronate group were significantly higher than 71.4% (30/42) in lipiodol group and 74.3% (182/245) in control group (P ＜0.05).(3)The rates of intrauterine pregnancy after 12 months were 48.1% (52/108) in chitosan group and 41.6% (47/113) in sodium hyaluronate group,which were significantly higher than 23.8% (10/42) in lipiodol group and 24.1% (59/245) in control group (P ＜ 0.05).Conclusion Chitosan and sodium hyaluronate could be effective to prevent tubal obstruction after interventional recanalization and increase pregnancy rate.