There were some ethical problems in the implementation of certificate of authorization of cancer pa -tients, such as doctors dominate the signing process and show no respect for patients ′rights and interests .It pro-posed to improve rules and regulations , increase transparency , to setup informed consent platform define and verifi-cation, emphasize the licensee to perform the duty of communication , strengthen the construction of the medical staff ethics , in order to safeguard the rights and interests of patients , promote the rational and effective use of medi-cal resources .

Objective:To compare and analyse the clinical outcome, advantages and disadvantages of submental artery island flap (SAIF) and free anterolateral thigh flap (ALTF) in the repair and reconstruction of tongue after radical surgery of tongue cancer.Methods:From January, 2016 to December, 2018, a total of 40 patients received tongue repair and reconstruction with either SAIF or ALTF after radical resection of tongue cancer. There were 28 males and 12 females, with an average age of 51 years old. Eighteen patients received tongue repair and reconstruction with SAIF and 22 with ALTF. Postoperative follow-up were carried out and the clinical data were collected. Swallowing, speech and softness of the tongue between the 2 repair methods were compared and statistically analysed. P<0.05 indicated a significant statistical difference between 2 groups. Results:All flaps survived. One ALTF had a venous vascular crisis. The flap survived after the removal of thrombus at the anastomotic site. Functional recovery of tongue was analysed after the follow-up of 12-48 months. It was found that there was no significant difference in speech function between the 2 groups (SAIF vs ALTF: 13 vs 15, P=0.206). The swallowing dysfunction in SAIF group was significantly higher than that of the ALTF group (SAIF vs ALTF: 15 vs 7, P=0.014). Moreover, the average time of surgery in SAIF group (3.5 h) was significantly less than that of the ALTF group (6.8 h), which had statistically significance ( P<0.05). Conclusion:The SAIF and ALTF are ideal flaps for repairing the tongue defect caused by tongue cancer surgery. SAIF features a simple surgical procedure and a short time for flap taking. ALTF provides sufficient amount of tissue to cover the scars left by the surgery, reduce donor site complications, and benefit the recovery of swallowing and speech functions.

Objective To investigate the effect of Doula delivery ball apparatus combined with correct occipitoposterior.Methods Four hundred primiparas whose dilatation of cervix of 3 cm and position of foetus was occipitopostenor position, were randomly divided into observation group and control group according their wishes, and each group of 200 cases.Doula delivery ball was used for the observation group,while the free body position, the traditional delivery mode was the control group.The vaginal delivery rate, degree of pain, postpartum 2 h bleeding volume and neonatal asphyxia rate were compared between the two groups.Results The degree of pain Ⅲ degree was 4.0％ (8/200) ,lower than the control group(50.0％ (100/200), x2 =11.55,P＜0.01).The vaginal delivery rate in observation group was 84.5％ (169/200), higher than that in control group (60.5％ (121/200);x2 =28.905,P=0.001).Postpartum 2H bleeding was (156.3±53.2) ml, lower than the control group((268.1±54.6) ml, t =20.70, P＜0.01).The Postpartum bleeding rate was 0.5％ (1/200), lower than that in control group (4.0％ (8/200) ,P =0.018).Conclusion Doula delivery ball is applied to the first active stage of labor can effectively relieve pain, promote the safety of natural childbirth.

Objective To explore the correlation between resistins rs2161490and rs1423096 genotype with type 2 diabetes mellitus (T2DM)in Guangdong.Methods Collected 178 blood of newly diagnosed T2DM in the Second Affiliated Hospital of Guangzhou Medical University from January 2015 to November 2015 as the patient group and 192 blood of healthy physi-cal examination as the control group.Analysis of the two groups of gene distribution frequency was to reach the genetic equi-librium,comparative two gene loci frequencies of resistin rs2161490 and rs1423096 in case group and control group was sta-tistically significant,and compared the distribution frequency of rs2161490 locus T→C and rs1423096 locus A→G between the patient group and the control group.Then made a logistic regression analysis:analysing the risk two loci each genotype of resistin rs2161490 and rs1423096 to T2DM,adjust of the gender and age,and the changes of the risk of the two variables. Comparative blood lipids biochemical indexes between case group and the control group,mode the correlation analysis be-tween TG,CHOL,HDL-C and LDL-C levels of serum lipids in patients with rs2161490 and rs1423096 each genotypewere performed.Results The sample was consistent with Weinberg Hardy’s law of inheritance,which was representative of the population,comparing two gene loci frequency of resistin rs2161490 and rs1423096 of case group and control group:com-parinng CT,TT,CC of rs2161490 genotype,there was no statistically significant difference (P=0.834,>0.05),and com-parinng AA,AG,GG of rs2161490 genotype,there was no statistically significant difference (P=0.960,>0.05).Each gen-otypes with T2DM risk analysis,there was no statistically significant difference(P>0.05).Adjusting the risk change after the two variables,gender and age,there was no statistically significant difference (P>0.05);TG,CHOL,HDL-C and LDL-C in each of the genes expression levels correlation analysis,there was no statistically significant difference (P>0.05).Con-clusion Analysis results showed that the frequency of two loci all genotypes in the case group and control group were no statistical significance (P>0.05).The risk of two loci gene type of rs2161490 with rs1423096 and type 2 diabetes were be-fore and after the covariate adjustment had no statistical significance (P>0.05 ).Each genotype of rs2161490 with rs1423096 and lipid levels had no statistical significance (P>0.05).Thus infer that two genotypes is not risk for type 2 dia-betes genes in guangdong area.

Objective The objective of this study was to evaluate the prognostic value of postoperative prognostic nutritional index(p-PNI)in the prognosis of colorectal cancer patients.Methods Retrospective analytical cases came from 89 patients with radical resection of colorectal cancer confirmed by the pathological section in Nanjing Drum Tower Hospital Suqian City People's Hospital from August 2009 to August 2012.The p-PNI was calculated based on the results of blood routine and biochemical tests after the first visit to the hospital.The Youden index was calculated using the receiver operating characteristic curve(ROC),and the PNI value combined with the best sensitivity and specificity was used as the threshold for the PNI packet.Kaplan-Meier method was used to study the effect of p-PNI on postoperative prognosis of patients with colorectal cancer.Cox regression model was selected to study the effect of p-PNI on the prognosis of colorectal cancer patients after surgery.Results The p-PNI of 89 cases of colorectal cancer patients was 25.18~60.74(43.81±6.47).The p-PNI in patients(less than 70 years old)was significantly increased when the number of lymph node metastases was less than 4,the preoperative CEA was less than 5ng/mL,and the intraoperative hemorrhage was less than 150 mL(P<0.05).When the p-PNI value was 43,the Youden exponent was the largest.Data analysis showed that p-PNI was correlated with age,lymph node metastasis,intraoperative blood loss and preoperative CEA(P<0.05).The survival rate of patients with high p-PNI was higher than that of low p-PNI group(X2=15.639,P<0.001).Single factor and multivariate analysis confirmed that p-PNI was an independent factor in the prognosis of patients with colorectal cancer(HR=2.179,95% CI:1.057~3.561,P<0.001).Conclusion p-PNI is an independent prognostic factor in patients with colorectal cancer,which is associated with long-term prognosis after surgery.

Objective To investigate the risk factors, treatment methods and significance of the cervical venous angle lymph node metastasis in differentiated thyroid cancer. Methods The clinical data of 222 patients with thyroid papillary carcinoma from December 2012 to January 2014 were collected. The surgical methods, complications and postoperative complications and pathology were analyzed. Results Lymph node metastasis was found in 133 cases. when VI lymph node was positive , the lateral cervical lymph node positive rate was 43%(57/133) inⅡDistrict, 54%(72/133) inⅢDistrict,ⅣDistrict 45%(60/133) inⅣDistrict, 60%(80/133) in jugular angle, and 6%(8/133) in V District. The levels of bleeding volume, operation time and hospitalization time in functional neck dissection (FND) group were significantly higher than those in anterior cervical muscle group and reserved anterior cervical muscle group (P<0.05). Single factor analysis showed that diameter of the tumors, thyroid membrane invasion and central region lymph node metastasis had correlations with venous angle lymph metastasis (P<0.01). Logistic regression analysis showed that thyroid membrane invasion (OR=3.539), central region lymph node metastasis (OR = 1.617), diameters of the tumors (OR = 1.321)were the risk factors of cervical venous angle lymph node metastasis. Conclusions Patients with tumor diameter equal to or more than 1.5 cm, thyroid membrane invasion and lymph node metastasis number greater than or equal to 2 should be performed with lateral neck lymph node dissection. Also the venous angle lymph node dissection should be done in these patients so as to increase radical rate.

Objective To compare the advantages and disadvantages of two approaches of laparoscopic radical resection for right colon cancer.Methods The data of 41 patients with right colon cancer in our hospital from March 2015 to December 2016 were analyzed retrospectively,who were randomly divided into the caudal-to-cranial group(n=23) and classical medial-to-lateral group(n=18) according to different approaches.The operation time,intraoperative blood loss,conversion rate,the number of lymph nodes dissection,hospital stay time and postoperative complications between two groups were compared.Results The operation time,intraoperative blood loss,the conversion rate of the caudal-to-cranial group were better than those of the classical medial-to-lateral group,the differences were significant(P<0.05).There was no significant difference in hospital stay time,the number of lymph nodes dissection and postoperative complications between two groups.Conclusion Laparoscopic radical resection for right colon cancer by caudal-to-cranial approach is easy to operate and dissect,it can shorten the operation time,decrease the intraoperative blood loss,which is worthy of clinical promotion.

Objective To evaluate the feasibility and efficacy of suspended method in scar hidden technology in laparoscopic appendec-tomy ( LA) . Methods 27 patients underwent scar hidden laparoscopic appendectomy with the aid of suspended method. Silver probe was pierced abdominal cavity,bended into a hook shape and fixed appendix,then underwent appendectomy. Results 27 patients finished surgery successfully,the operative time was 25~100 min ( mean, 45 min) ,the blood loss during operation was 10~50 mL ( mean,20 mL) ,the hos-pital stay was 3~8 d ( mean,4 d) . Conclusion Scar hidden technology in laparoscopic appendectomy with the aid of suspended method is safe,feasible and further improves the cosmic result.

Objective To investigate the risk factors and revision strategies for rod fracture in patients with severe kyphoscoliosis following posterior vertebral column resection (PVCR).Methods Between June 2003 and June 2011,7 patients (4 males and 3 females) who developed rod fractures following PVCR in our institution were retrospectively reviewed.The average age was 24.4 years (range,12-39 years) at the time of primary surgeries.The occurrence times and locations of the rod fractures were recorded and the risk factors for the fractures were analyzed.Results The occurrence times of the rod fractures ranged from 6 to 53 months.Five cases of fracture occurred within 2 years after the primary surgeries,while the other 2 cases occurred more than 4 years after the primary surgeries.Six cases of fracture occurred at levels of osteotomies and 1 case occurred at 1 level below the osteotomy.The potential reasons for rod fractures were listed as follows:(1)residual kyphosis (1 case); (2) residual kyphosis combined with unsteady gait (1 case); (3) residual kyphosis combined with single rod fixation (1 case); (4) residual kyphosis combined with malposition of titanium mesh cage (1 case); (5) residual kyphosis combined with anterior column defect; (6) injury (2 cases).Six patients underwent revision surgeries,5 patients received one-stage combined anterior-posterior approach surgeries,while 1 patient received single posterior surgery.They were followed up for 12 to 22 months (average,18months).At final follow-up,all patients obtained satisfying corrections and graft fusion,without internal fixationrelated complications.Conclusion Rod fractures mostly occur at levels of osteotomies within 2 years after PVCR.Residual kyphosis is the main risk factor for the rod fracture.Injury,anterior column defects,unsteady gait,single rod fixation and malposition of titanium mesh cage also increase risks of rod fractures.