Objective To evaluate the efficacy of medial femoral tubed skin flap combined with penile elongation for repairing long-segment penile defects.Methods From June 2009 to January 2015,13 cases of long-segment penile defects were treated by medial femoral tubed skin flap with pe nile elongation.Results All cases were followed up for 0.5 to 5.0 years.All flaps survived and all patients had the minor scar in donor areas,with good appearance and feeling of penis.The length of pe nis in flaccid state was 6.3±1.6 cm.The length of penis in erection state was 8.5±1.2 cm;The circumference of penis was 5.3±1.9 cm.1.0 cm × 0.7 cm of necrosis at distal parts occurred in one case early after operation,and healed after dressing changes.Two cases had tumid appearance which influenced penile appearance and sexual intercourse.It was improved by local liposuction.No feeling and e rectile dysfunction developed during the following-up.Except 5 cases who did not married,the other married patients and their partners were satisfied or quite satisfied with sexual intercourse activity.Conclusions Medial femoral tubed skin flap combined with penile elongation is a good method for the treatment of long-segment penile defects.The prosthetic penis could have suitable length,good ap pearance,good feeling and erectile function.

Objective To investigate the clinical pathological factors of papillary thyroid microcarcinoma (PTMC) with clinically node-negative sides of neck stage central lymph node metastasis.Methods Analysis of 136 cases of cNo stage of PTMC of clinical and pathological data,and using the PCR method for the detection of BRAFV600E mutation in the paraffin coated tissue.Results One hundred and thirty-six cases with PTMC lymph node metastasis rate was 38.2％ (52/136),BRAFV600E mutation rate was 44.9％ (61/136).Single factor analysis showed that the lymph node metastasis was related with BRAFV600E mutation and capsular invasion (P＜ 0.05).The size of the tumor was close to significant level (P=0.057).Multiple regression analysis showed that BRAFV600E mutation and capsular invasion were independent factors for affecting the central lymph node metastasis (P ＜ 0.05).Conclusion The routine central lymph node dissection should be performed in patients with BRAFV600E mutation and tumor invasion.

Objective To investigate the effect of superomedial pedicle mammaplasty in the treatment of the deformity of hypermastia,and secondary deformity after implants or polyacryamide hydrogel removal.Methods Thirty-six patients underwent a new technique for mammaplasty.This technique involved a superomedial pedicle with or without Würinger's horizontal septum which was used to repair the deformity of hypermastia,and secondary deformity after implants or polyacryamide hydrogel removed.Results In our series,the new nipple-to-sternal-notch distance was (20.10±1.94) cm postoperatively.Mean nipple elevation was 7.5 cm (range 4 13 cm),and there were no he matoma and partial or complete nipple-areolar complex (NAC) necrosis occurred.Minimal wound dehiscence occurred in two cases (5.56 ％),the rest cases were healed in stage Ⅰ.Twenty eight patients were followed up for 6 to 18 months.NAC sensibilities were comparable before and after operation,and good breast shapes were produced with unconspicuous incision scar in all cases.Conclusions Superomedial pedicle mammaplasty could achieve satisfactory results with respect to breast contouring and scar,meanwhile maintain the NAC viability and sensibility.

Objective To realize independent 3D dose calculation for intensity-modulated radiotherapy (IMRT) by building a two-source beam model of medical linear accelerator combined with a collapsed-cone convolution/superposition (CCCS) algorithm.Methods Two-source beam models of medical linear accelerators (Varian and Elekta) were built to calculate the 3D dose distributions using the CCCS algorithm.Scp,percent depth dose,and off-axis dose distribution were compared with the scanning data of ion chamber to confirm the calculation model.Twelve intensity-modulated treatment plans from each accelerator (a total of 24 plans) were selected for comparison.The calculation results of treatment planning system (TPS) were independently validated,and further compared with the measurement results of detector matrix.Results The dose deviations at the center of rectangle fields were lower than 1%,the deviation between doses at the same position in the field was not higher than 1%,and the positional deviation in the penumbra region was not higher than 1 mm.Gamma analysis based on 3%/3 mm standard was used to compare the results calculated by detectors and TPS.The pass rates were higher than 90%.Conclusions The independent 3D dose calculation for IMRT based on two-source beam model combined with CCCS algorithm has been successfully set up.The comparison between regular field and IMRT plan indicates that this method and calculation model can be used for independent 3D dose calculation of clinical plan.

Hepatocellular carcinoma is one of the largest causes of cancer-related deaths worldwide for which there are very limited effective treatment options.The ubiquitin-proteasome pathway(UPP) has rapidly become acknowledged as both critical mechanism for cellular biological function and a latent target of regulation of cancer-related disease.This review focus on the role of ubiquitin-proteasome pathway in hepatocellular carcinoma and its correlation factors(HBV、P27、NF-?B,et al),in order to find novel therapeutic interventions against the genesis and development of hepatocellular carcinoma.

Objective To investigate the effect of telephone call follow-up on compliance with opening-mouth exercises among nasopharyngeal carcinoma(NPC)patients with radiotherapy-induced difficulty in opening mouth.Methods Sixty four nasopharyngeal carcinoma patients undergoing radiotherapy were randomized into control group(n=31)and observation group(n=31).The former group was given health education and instructions for functional exercises of opening mouth at discharge and regular return visits after discharge,and the observation group received regular telephone call follow-ups by an appointed nurse besides the same treatment as in the control group.The two groups were compared in regard to the compliance with the exercises of opening mouth and the incidences of difficulties in opening mouth at the first and second years after discharge. Results The compliance of the observation group was significantly higher that in the control group(P<0.01).The incidences of difficulties in opening mouth in the observation group were significantly smaller than that in those of the control at the first and second years after discharge(P<0.01). Conclusion Telephone call follow-ups are effective in the improvement of compliance of functional exercises in NPC patients with radiotherapy-induced difficulty in opening mouth,the reduction of the incidence of mouth-opening problems and the improvement of their quality of life.

Objective To investigate the method and effect of free autogenous palmaris longus tendon transplantation in the treatment of moderate and severe cicatricial ectropion.Methods The autogenous palmaris longus tendon was obtained through a small lateral proximal wrist band incision (lengths from 4 cm to 6 cm).The graft was properly sutured to the exposed tarsus and the attachments of inner and outer canthus.Local skin flap was rotated to cover the tendon and to repair the wound.Results Six man (8 eyes) with moderate and severe cicatricial ectropion were treated in our department,all case of ectropion were rectified after operation.The eyeballs were well contacted with lower eyelid and no recurrence of eetropion,epiphora and corneal exposure during 6 to 18 months' follow-up.The tension of the lower eyelid was abiding with satisfied effects.Conclusions The palmaris longus tendon is easy to obtain and there is no harm to the donor site.The cicatricial ectropion could be repaired with self-palmaris longus tendon transplantation with lasting effect and the recurrence rate is lower,which is well worthy popularizing.

AIM: To establish a HPLC method for determining notoginsenoside R_1, ginsenoside Rg_1, Rb_1 and Rd in Suxiong Pill (Radix et Rhizoma Notoginseng, Flos Carthami, Rhizoma Chuanxiong). METHODS: A Kromasil C_ 18 column was used. The mobile phase was acetonitrile-water in linear gradient elution. The detection wavelength was 203 nm. RESULTS: The linear range was at 1.20-6.02 ?g(r= 0.999 6 ) for notoginsenoside R_1, 5.60-27.99 ?g(r= 0.999 9 ) for ginsenoside Rg_1, 2.84-14.20 ?g(r= 0.999 9 )for ginsenoside Rb_1, 0.51-2.55 ?g(r= 0.999 7 ) for ginsenoside Rd. The average recoveries (n=6) were 96.4% (RSD= 1.9% ) , 103.7% (RSD= 0.8% ), 106.6% (RSD= 1.3% ), 98.5% (RSD= 1.1% ), respectively. CONCLUSION: The method is simple, reliable, accurate and can be applied to the quality control of the preparation.

Objective To explore the strategy of repairing penile defect after necrosis caused by shortwave diathermy.Methods Between January 2004 and June 2012,18 cases with penile defect after necrosis caused by shortwave diathermy were admitted in our hospital.The age of those patients ranged from 18 to 55 years old (mean 34 years old).Among them,15 cases have been married.All patients have the history of penile shortwave diathermy therapy after surgery.After debridement,penile complete defect was found in 6 cases,incomplete defect was found in 10 cases and corpus cavernosum and corpus spongiosum partly defect was found in 2 cases.Under general anesthesia,we applied penis extent in 10 cases with incomplete defect,forearm free flap in 2 cases with penile complete defect,abdominal artery perforators flap in other 4 cases with penile complete defect.In 2 cases with corpus cavernosum and corpus spongiosum partly defect,the scrotal septal skin flap and fascia pedicle flap was used for 1-stage urethral reconstruction and costicartilage was implanted for 2-stage cavernosum reconstruction.Results 18 patients were followed up for 0.5-10.0 years (mean 2.3 years).16 cases with penile complete defect or incomplete defect had normal length after operation,ranged from 6.3 to 9.2cm.During erectile phase,the length of their penis ranged from 8.7 to 11.5 cm.No feeling abnormality or erectile dysfunction was complained.All patients exhibited the excellent morphology and felling of penis with minor scar in donor site.Early (half a month) complications included distant flap necrosis in 1 case and disruption of the wound in 1 case,which were cured after debridement and conventional treatment.After one year,we did not see the flap atrophy.One case had tumid which influenced penile beautiful and sexual intercourse.It was improved by local liposuction.One month after surgery,two patients with corpora cavernosa and corpus spongiosum partial defect had normal voiding.No feeling and erectile dysfunction were complained during the following-up.Conclusions According to the characteristics of the penile defect due to the shortwave diathermy,selecting the optimal skin flap and individual repair strategy are the keys to successful treatment.

Chinese Physician Declaration and Medical Professionalism in the New Millennium-Physician De-claration in the United States and European countries are two significant documents that promote and cultivate phy-sicians′professionalism. Researches showed that the two declarations were basically the same in the background and guiding ideology. However, influenced by the historical tradition, cultural characteristics, medical and health system, medical science technological development, and social psychological factors, there exists difference in terms of perceive and practice. The differences manifest in the comprehension and grasping, ethnical theory basis, the nature and the degree of standard abilityand practice guarantee of physicians′professionalism. Therefore, study on the differences between the two declarations is beneficial to the construction of physicians′professionalism in our country.