Purpose:To investigate the expression and clinical significance of estrogen receptor and Cyclin D1 in the differentiated thyrord carcinoma. Methods:We investigated the expression of ER and Cyclin D1 in thyroid normal tissue, thyroid adenoma and DTC by SP immunohistochemical technique. We have collected 89 specimens from surgical resections, and all the sections were formalin-fixed and paraffin-embedded, each has detailed clinical data, two pathologists classified the histopathologic types. DTC 43 cases (papillary thyroid carcinoma, 39 cases, follicular thyroid carcinoma, 4 cases); thyroid follicular adenoma 30 cases, and 16 cases of normal thyroid tissues taken from around the thyroid adenoma. Results:The positive rates of ER and CyclinD1 in the DTC were 53.5%(23/43), 65.1%(28/43) respectively; the positive rates of ER and CyclinD1 in the thyroid adenoma were 26.7%(8/30), 36.7%(11/30) respectively; the positive rates of ER in normal thyroid tissues were 12.5%(2/16), while CyclinD1 were negative. The ER expression in DTC was significantly higher than that in the thyroid adenoma and the normal thyroid tissues(P

Objective To explore the method of repairing skin defects in the foot, the ankle and the lower one-third of the lower leg with anterolateral island flaps of the lower leg formed by isolating peroneal artery from the anterior interosseous membrane of the lower leg. Methods 46 adult cadavers' lower legs were anatomized, to observe the blood supply of the anterolateral skin, the lateral anterior malleolar artery anastomoses with anterior perforating branches of the peroneal artery, and the relationship between peroneal vessels and interosseous membrane of the lower legs. Clinically, 8 cases(7 males, 1 female, age ranged from 7 to 48 years) of skin defects of the feet, the ankles and the lower one-third of the lower legs were repaired with anterolateral island flaps of the lower leg by isolating the peroneal vessels from the anterior interosseous membrane of the lower legs from June 1996 to August 2004. The flaps were cut into sizes between 7 cm ? 4 cm and 23 cm ? 12 cm. Results Averaged 3.2 anterior branches stem from the lower one-third of the peroneal artery, extend through the foremina in the interosseous membrane, pass the anterior intermuscular septum of the lower leg, arrive and provide nutrition to the anterolateral skin of the lower leg. The lateral anterior malleolar artery anastomosed with the lowest perforating branch of the peroneal artery to form the lateral malleolar artery arch. The peroneal vessels easily isolated after incision of the interosseous membrane of the lower leg. Eight cases were performed on transposition of the anterolateral island flaps with the artery pedicles of the lower leg. All the patients were followed up from 1 to 8 years, with a mean of 3 years. Only 1 case was necrosis at the distal one-third of the flap. The others totally survived without diabrosis and swelling. The ankle and phalanges had normal movement. The color and texture of the flaps were excellent. The sensation of flaps recovered in 4 cases by suture superficial peroneal nerve. All cases suffered hypoesthesia at the 3rd and 4th toe web. Conclusion Isolating peroneal artery and vein from the anterior interosseous membrane of the lower leg proved easy to perform. Peroneal artery are not main blood vessels and the excision of them affects blood supply to the foot insignificantly. The skin flaps thus formed are ideal for repairing skin defects of the foot, the ankle and the lower one-third of the lower leg.

OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.

METHODSIn the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.

RESULTSThe blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.

CONCLUSIONSIt is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Arteries ; anatomy & histology ; Cadaver ; Female ; Foot ; blood supply ; innervation ; Forefoot, Human ; injuries ; surgery ; Humans ; Male ; Muscle, Skeletal ; anatomy & histology ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Transplant Donor Site ; surgery

Objective To detect the expression levels of vascular endothelial growth factor D ( VEGF-D) , D2-40 and MMP-7 in papillary thyroid carcinoma ( PTC) and to explore their relationship with micro lymphat-ic density, distribution,and cervical lymph node metastasis .Methods SP immunohistochemistry was used to study the expression of VEGF-D, D2-40 and MMP-7 in 38 cases of PTC with cervical lymph node metastasis , 45 cases of PTC without cervical lymph node metastasis , and 22 cases of normal thyroid tissues .Micro lymphatic density ( MLD) was counted .Results The expression level of VEGF-D in PTC with cervical lymph node metasta-sis and normal thyroid tissues had significant difference (χ2 =13.074, P=0.000, P<0.0167).The expression level of D2-40 in PTC with and without cervical lymph node metastasis had significant difference ( P<0.05 ) . MMP-7 expression in PTC with and without cervical lymph node metastasis had statistical significance ( 91.67%vs 73.33%, P<0.05).MLD in PTC with and without cervical lymph node metastasis and in normal thyroid tis-sues had statistical difference (11.7 ±3.5 vs 8.9 ±3.1 vs 3.9 ±2.7, P<0.05).Conclusion VEGF-D, D2-40 and MMP-7 are highly expressed in PTC and they are possibly related with cervical lymph node metastasis of PTC.

Objective To explore surgical methods of repairing tibial skin defect using the anterolateral crural island flap.Methods The location,external diameters,anastomosis and distribution of perforators from the anterior tibial artery and the peroneal artery in the anterior septum were observed in 40 cadaveric specimens.Arterial angiography was performed in 4 fresh legs.Clinically,11 cases with tibial skin defect were repaired with the anterolateral crural island flap.There were 7 males and 4 females,with an average of 36 years (20-59 years).The area of the skin defect ranged from 6 cm×4 cm to 12 cm×4 cm.Results An arterial chain was formed by the interconnection of the superficial peroneal artery,the anterior septocutaneous perforator from distal part of the anterior tibial artery and the anterior end-perforator of the peroneal artery.It ran in the anterior septum and went along with the superficial peroneal nerve to supply blood to adjacent fascia and skin.The external diameters of the three perforators were (1.4±0.4) mm,(1.0±0.4) mm and (1.5±0.4) mm respectively,and the external diameter of the arterial chain was (0.6±0.2) mm.Clinically,we designed 4 methods to repair 11 cases of tibial skin defect successfully with the anterolateral cnnal island flap.The anterior septocutaneous perforator from distal part of the anterior tibial artery was used as pedicle in 2 cases;ascending branch of the anterior septocutaneous perforator from distal part of the anterior tibial artery was used as pedicle in 3 cases;descending branch of the anterior septocutaneous perforator from distalpart of the anterior tibial artery was used as pedicle in 3 cases;ascending branch of the anterior end-perforator of the peroneal artery was used as pedicle in 3 cases.The area of the flaps ranged between 7 cm×5 cm and 13 cm×5 cm.All patients were followed up with a mean time of 1.5 years.All flaps survived totally without diabrosis and swelling.Conclusion The anterolateral island flaps pedicled with perforators arising from the anterior septum of the lower leg is a good choice for surgeons to repair tibial skin defect.

Objective To explore the methods of repairing great toe soft tissue defect with the reverse medial pedis island flap with transverse artery of great toe.Methods This study was made up of two parts:an anatomical study and clinical application.In the anatomical study,49 cadaveric feet were injected with red latex and then anostomosis,distribution and external diameters of transverse artery of great toe,the deep branches of the first plantar metatarsal arteries and the deep branches of medial plantar artery were observed.From September 2006 to December 2012,8 cases of soft-tissue defects with the retrograde-flow medial pedis island flaps were harvested to cover the soft tissue defects of great toe.Soft tissue defect was form 2.5 cm × 3.5 cm-3.5 × 4.5 cm.Results There was an arterial circle under the first metatarsophalangeal joint which consisted of transverse artery of great toe,tibial proper plantar digital artery of great toe,fibular proper plantar digital artery of great toe and the distal part of first plantar metatarsal artery.This arterial circle under the first metatarsophalangeal joint and arterial network on the surface of abductor hallucis was responsible for the blood supply of the flap of medial pedis.The diameter of the pedicle was great,and the length of the pedicle was longer than in previous reported.In terms of clinical application,all patients were followed up with the mean of 10 months (range fromn 6-24 months).All flaps survived totally without diabrosis and swelling.The walking and weight-bearing were normal and the blood supply of foot was good.Conclusion Using of arterial circle under the first metatarsophalangeal joint,the medial pedis island flap has a reliable retrograde blood supply.The reverse point of the reverse medial pedis flap moved forward to th interphalangeal joint.This flap should be considered as a preferential way to reconstruct soft-tissue defects of the great toe.

Objective To observe the development of Schistosoma japonicum after single sexual infection and double sexual infection respectively. Methods A single Oncomelania hupensis snail was infected by a single schistosome miracidium. The lar?va were induced and released from the snail after 60?day incubation at 26℃. The mice were infected by the larva(single sexual infection)and dissected 40 days after the infection. All the worms were collected and the sex of the larvae was determined by the sex of the adult worms. Then,the mice and rabbits were infected by single sex of larvae(single sexual infection)and double sex of larvae(double sexual infection)respectively. The mice and the rabbits were dissected 40 days after the infection. All the worms were collected and measured under a microscope. Results All the male or female worms were collected from the mice and rabbits after single sexual infection. There were three main forms of worms after dissection of double sexual infection of mice and rabbits:folded mature male and female,male or female. Few folded male and immature female were found. Only the double sexual larva infected mice or rabbits had schistosome eggs in the liver and the liver had typical schistosome egg nodules. The sin?gle sexual larva infected mice or rabbits had no schistosome eggs or schistosome egg nodules in the liver tissues. The single male larva could develop to worms with the testis,and with a little smaller size compared to the mature folded male,while the single sexual infection female worm could not develop to the mature stage with much thinner and smaller compared to the mature folded female. Conclusions The male or female worms from single sexual infection are smaller than those from double sexual infection (mature worms?folded male and female). So it is necessary to check single sex worms in vessels of intestinal mucosa thoroughly in the sentinel mice when no schistosome eggs were found in the liver.

Objective: To compare the effectiveness before and after the adjustment of schistosomiasis control strategies in Nanjing City, so as to provide the evidence for improving schistosomiasis control interventions. Methods: The prevalence of Schistosomasis japonicum infections in humans, livestock, Oncomelania hupensis and sentinel mice was collected in Nanjing City from 1993 to 2018, and the prevalence of S. japonicum infections in humans, livestock, sentinel mice and O. hupensis, and the areas of snail habitats, areas of infected snail habitats and snail control areas were compared before (1993-2004) and after (2005-2018) the adjustment of schistosomiasis control strategies to evaluate the effectiveness. Results: The prevalence of S. japonicum infections in humans, livestock, O. hupensis and sentinel mice was 0.77% and 0.02% (χ2=6 430.634, P<0.001), 0.46% and 0.01% (χ2=344.401, P<0.001), 0.19% and 0.11% (χ2=239.685, P<0.001), and 34.35% and 1.56% (χ2=1 856.286, P<0.001) in Nanjing City before and after the adjustment of schistosomiasis control strategies, respectively. The median areas (interquartile range) of snail habitats, infected snail habitats and snail control were 4 175.37 (1 301.65) and 2 366.44 (885.27) hm2 (Z=-3.755, P<0.001), 870.49 (1 001.75) and 0 (158.89) hm2 (Z=-3.654, P<0.001) and 1 383.23 (793.57) and 5 031.94 (629.11) hm2 (Z=-4.320, P<0.001) in Nanjing City before and after the adjustment of schistosomiasis control strategies, respectively. Conclusions After the adjustment of schistosomiasis control strategies, remarkable effects on schistosomiasis control has achieved in Nanjing City, where the transmission of schistosomiasis was interrupted. Nevertheless, the strategy requires to be continued and improved to move towards elimination of schistosomiasis in Nanjing City.

Objective To explore a surgical treatment of skin defects on the thumb by reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle.Methods The origin,courses and distribution of dorsoulnar artery of thumb from 70 adult cadaveric hand specimens perfused by red latex were explored.Skin defects on the thumb of 8 cases were repaired with reverse-flow island flaps on dorsal thumb web.The cut areas of flaps vary from 4.5 cm × 3.0 cm to 7.5 cm × 4.0 cm.Results There were 4 types of the dorsoulnar artery of thumb basing on the origin and courses.Type Ⅰ was outside the first dorsal interosseous muscle type,which was the dorsoulnar artery of thumb mainly originated from the first dorsal metacarpal artery and cross through the surface of the first dosal interosseous muscle(42.9％).Type Ⅱ was under the first dorsal interosseous muscle type,which was from the thumb principal artery or deep branch of radial artery and run under the first dorsal interosseous muscle(41.4％).Type Ⅲ was mixed type from the anastomose point of above two arteries at the level of the first metacarpophalangeal joint(11.4％).Type Ⅳ was absence type (4.3％).Eight flaps fully survived.Excellent texture and satisfying appearance of the flaps as well as normal thumb web function were verified after 8 months' follow-up.Conclusion It is significant to determine the type of dorsoulnar artery of thumb to decide different operations due to the artery's considerable variation.The reverse-flow island flap on dorsal thumb is an ideal method to repair soft tissue defect on the thumb for its convenient operating and little effect in the donor area.

Objective To evaluate the effect of comprehensive control for schistosomiasis with emphasis on environmental modification in the Bianmin River water system of Nanjing City.so as to provide scientific evidence for making up further control measures in this water system.Methods Schistosome infections of Oncomelania snails in the waterway.sentinel mice in water and neighbouring human were investigated longitudinally from 1998 to 2007,and the changes of huaman infection rates in differentyears,the infection rates of sentinel mice and snails in different settings were analyzed and compared.Results A total of 77 395 snails collected from the Bianmin River water system were dissected from 1998 to 2007,and among them,27 snails were infected with Schistosoma japonicum,with a total snail infection rate of 0.03%.A total of 61 039 snails collected from the neighbouring marshland which connected to the Yangtze River wore dissected,and among them,257 were infected with S.japonicum,with a total snail infection rate of 0.42%,and there was a significant difference compared with that in the water system(χ~2=248.55,P<0.01).After the protection works in the waterway,the infection rates of sentinel mice in the water system decreased from 69.68% in 1998 to 17.50% in 2001.with a reduction rate of 74.89%.Two years afterthe clearance ofmarshlandinthewaterway,no infected sentinel mouse was found.The infection rates of residents from 1998 to 2007 were 1.96%,1.37%,1.34%,1.60%,0.30%, 0.26%,0.16%,0.10%,0.04% and 0,respectively,andthe rates declined year by year afterthecomprehensive control.Conclusions The control measures based on the elimination of snail habitats in the waterway that is connected to the Yangtze River have achieved obvious effect.However,the clearance of the re-emerging snail habitats should be carried out termly to consolidate the control effect.