Objective: To evaluate the quality consistency of the original product ( DIOVAN ) and generic valsartan capsules ( VSC) . Methods:The dissolution of the two capsules in four media was monitored by the UV method described in Chinese Pharmaco-poeia ( ChP 2010 edition) . The f2 similarity factor approach was used to evaluate the dissolution similarity between DIOVAN and VSC and the production quality of the enterprises. Meanwhile, the homogeneity in the same batch was studied by dissolution precision and the reproducibility in the different batches were also evaluated by a similar equivalent limit method to show the production quality of the manufacturers. Results:The dissolution of VSC and Diovan in pH 6. 8 phosphate buffer medium was both above 85% in 15 min. The f2 similarity factors in the other three media ( water, pH 4. 5 acetate buffer and 0. 1 mol·L-1 HCl) were all above 50. The relative standard deviation ( RSD) of precision in the same batch was less than 10%. Among the different batches, dissolution limit value ( Q) was within the range of the upper and lower limit value of probability levels (δ) . Conclusion:The f2 similarity factor results indicate the in vitro dissolution of the reference drug ( DIOVAN) and generic drug ( VSC) is consistent in the four media. The production quali-ty of generic manufacturer is also good with promising homogeneity and reproducibility evaluation results.

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 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.

[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.

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.

Objective To indentify Streptobacillus moniliformis isolated from the knee joint pus by 16S rRNA gene sequencing and biochemical reactions and explore the clinical value of the method. Methods The bacterial 16S rRNA gene sequence-based identification, bacterial morphology, VITEK 2 automate systems, API 20NE strips, API 20E strips and API 50CH were performed to identify the rare bacteria. Results The bacteria grew slow on blood agar and chocolate agar and were inhibited on Maconkey agar. The bacterial colony on blood agar tookes the form of 1~2 mmomelette, which was translucent and moist with circular protrusion and smooth edges. They were Gram-staining negative and in catenation, its thalli 1~3μm, round, oval or fusiform. Vitek 2 GN-13, API 20NE and API 20E were unable to reach the identification of the bacteria. 16S rRNA gene sequencing showed the bacteria were similar to streptobacillus moniliformis by 100%. Conclusion The rare bacteria isolated from left knee joint are streptobacillus moniliformis. 16S rRNA gene sequences combined with the biochemical reactions is accurate in the identification of these bacteria.

Objective To explore the risk of tuberculosis infection in patients with malignant tumors.Methods The sputum samples and blood samples from 396 patients with malignant tumor and 80 healthy subjects were detected by modified Roche cul-ture,real-time fluorescence quantitative PCR,colloidal gold,T cell spots(TSPOT.TB)and single immunodiffusion(SRID).Results The positive rate of the experimental group of 396 cases of malignant tumor patients with five kinds of methods for detection of Mycobacterium tuberculosis were improved Lowenstein Jensen 12.1%(48/396),real-time PCR(169/396)42.7%,colloidal gold 38.9%(154/396),TSPOT.TB 44.9%(178/396),SRID 10.4%(41/396).In the control group,the positive result was detected only by real-time fluorescent PCR 8.7%(7/80),colloidal gold 6.3%(5/80),and TSPOT.TB 27.5%(22/80).The differences of the results of the same detection method were statistically significant(P<0.01).The experimental group was grouped according to the location of the lesion,and there was no statistical difference between the indexes of each group(P>0.05).In comparison with other types of tumor,there were no statistical differences in every index of every group(P>0.05).But the positive rates of liver cancer patients were lower than those of other types of tumor,and all the positive rates of lung cancer patients were higher than those of other types of tumor.Conclusion Patients with malignant tumor is a high-risk group of TB infection.It is suggested that early screening and regular monitoring of TB infection should be done for patients with malignant tumor,so as to achieve early de-tection and early treatment.

Objective To investigate the molecular epidemiology and antimicrobial resistance status of uropathogenic Escherichia coli (UPEC) in senior population in Putuo District ,Shanghai .Methods A total of 72 UPEC strains were isolated from elderly inpatients with urinary tract infections in Putuo Hospital ,Shanghai University of Traditional Chinese Medicine from January 2013 to March 2015 .The strains were characterized by multi‐locus sequence typing (MLST ) .The β‐lactamase gene and the plasmid mediated quinolone resistance (PMQR) gene were detected ,and the mutations of quinolone resistance‐determining regions (QRDR) in gyrA and parC genes were demonstrated .In vitro drug susceptibility test was performed .Continuous variables were compared using t test and categorical variables were compared using chi‐squared test or Fisher exact test .Results The UPEC strains showed different resistance rates to ciprofloxacin ,cefotaxime and trimethoprim‐sulfamethoxazole ,which were 76 .4% ,73 .6% and 65 .3% , respectively .UPEC still remained highly sensitive to imipenem ,meropenem ,amikacin and piperacillin‐tazobactam .Among 72 isolates ,55 (76 .4% ) of 49 (68 .1% ) extended‐spectrum β‐lactamase (ESBL )‐positive strains harbored blaCTX‐M genes .Among the 55 ciprofloxacin resistant strains ,51 (92 .7% ) had three or four mutations in QRDR of gyrA and parC genes .The “hot‐spot” mutations of QRDR were located at amino acid position 83 and 87 in gyrA gene and at positions 80 and 84 in parC gene .Forward analysis by MLST showed that the most frequent sequence types (ST ) were ST131 (18/72 ,25 .0% ) , ST1193(7/72 ,9 .7% ) ,ST405 (7/72 ,9 .7% ) ,ST38 (5/72 ,6 .9% ) and ST648 (3/72 ,4 .2% ) .ST131 isolates were predominant in ST which caused community‐onset urinary tract infections .Multiple drug‐resistance were detected in ST 131 ,ST405 ,ST38 and ST648 which were mainly producing blaCTX‐M ESBL .Conclusions Community‐acquired multiple drug‐resistant UPEC strains such as ST131 clone are prevalent in elderly patients .Thus ,monitoring of molecular epidemiology would be beneficial to prevent the prevalence of multiple drug‐resistant UPEC .

Transjugular intrahepatic portosystemic shunt (TIPS) can effectively reduce portal hypertension, prevent recurrent esophagogastric variceal bleeding, and relieve intractable ascites. TIPS involves vessel puncture, expansion of puncture tract within the liver parenchyma, and stent implantation, and may cause various complications. The effective prevention and treatment of TIPS-related complications have become a new direction for research in TIPS. This article reviews the intraoperative and postoperative complications of TIPS and related preventive and treatment strategies.