Objective To discuss the exposing methods of recurrent laryngeal nerve(RLN)in thyroid surgery for reducing the nerve injury.Methods We analyzed 267 cases with thyroid tumors retrospectively.In all the cases,RLN were anatomically exposed.Results Of all the cases the injury rate of RLN was,0.38%.Conclusion The anatomic relation of RLN is relatively complicated along its journey;the injury of RLN can be reduced with designed exposal during the thyroid surgery.

Objective To investigate the effect of antisense VEGF on radiation sensitivity of esophageal cancer cells in vivo.Methods Sixteen male BLBA/C/nu nude mice were randomly divided into 4 groups and prepared cells were injected subcutaneously on paw pat of mice(2?106/100 ?L/mice): The size of the subcutaneous tumors was measured before and after irradiation and transfection.The effect of treatment was evaluated by speed of tumor growth. The expression level of VEGF was examined in different groups by RT-PCR,western blotting respectively.Results The absolute growth delay (AGD)for antisene group, irradiation group and antisene plus irradiation group was 3.0?2.6, 10.1?5.4 and 27.4?3.1 days,and nominal growth delay (NGD) was 24.4?3.1 days. The enhancement factor of antisense VEGF for radiotherapy was 2.41. A decreased expression level of endogenous VEGF mRNA and protein were found in antisene group by RT-PCR and western blotting analysis.Conclusion Antisense VEGF and radiotherapy may enhance radiotherapic effect for esophageal cancer xenografts.

Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Objective To analyze the outcomes and prognostic factors of esophageal carcinoma treated with three-dimensional eonformal radiotherapy (3DCRT). Methods From January 2001 to August 2007, 209 patients with esophageal carcinoma treated with 3DCRT were retrospectively analyzed. The local control rotes, the survival rates and the related prognostic factors were evaluated with SPSS 11.5 software. Results The follow-up rate was 98. 1% by December 2008. The number of patients followed up for 1,3, 4 and 5 years was 209,131,95 and 56, respectively. The 1-, 3- and 4-year local control rates were 74. 9%, 50. 4% and 45. 8%, respectively. The 1-, 3-and 4-year overall survival rates were 64. 6%, 30. 8% and 23.6%, respectively, with a median survival time of 18 months. Univariate analysis showed that the significant prognostic factors included the degree of dysphagia, tumor site, lesion length in barium esophagogram and CT image, the largest diameter of lesion in CT image, T stage, N stage, clinical TNM stage, short term effect, and degree of acute esophagitis. Multivariate analysis revealed that the degree of dysphagia, primary tumor site, clinical stage, and radiotherapy technique (3DCRT or late half course 3DCRT) were independent prognostic factors. Conclusions Three-dimensional conformai radiotherapy is effective and feasible in the treatment of esophageal cancer. The degree of dysphagia, primary tumor site, and clinical stage are independent prognostic factors for survival of patients treated with 3DCRT.

Objective To investigate the clinical value of human soluble endothelial protein C receptor (sEPCR) after heart valve replacement.Methods 78 cases of patients with heart valve replacement in the Second Affiliated Hospital of Nantong University from January 2005 to June 2016 were selected as the research objects,who were divided into embolic group and control group,38 cases in embolic group and 40 cases in control group,the index of two groups 1 d preoperative,while dynamic monitoring international standardization ratio (INR) and embolism,were detected,of which INR and sEPCR were examined.The INR and sEPCR oftwo groups was compared with t test.Results The INR and sEPCR of two groups 1 d preoperative had no significant difference (1.24±0.32 vs 1.23±0.19,34.91±9.14 μg/L vs 35.56±10.22 μg/L;t=0.17,P =0.868;t=0.30,P=0.768,respectively).The average value of dynamic monitoring INR in control group had no significant difference when compared with the results of embolism (1.86±0.95 vs 1.93±0.97,t=0.32,P=0.748).But the sEPCR had significant difference (101.33±27.15 μg/L vs 41.67±11.82 μg/L,t=12.69,P=0.000).Conclusion The important indexes of sEPCR could effectively guide the anticoagulant treatment,especially those who with the sEPCR value too high,the embolic threatening should be paid attention to.

Background and purpose: DNA methylation is an important mechanism for regulating gene expression, and plays an important role in the tumorigenesis. Study shows that DNA methylation is a potentially promising biomarker in tumor diagnosis, prognosis as well as treatment selection. This study aimed to analyze the methylation status and assessed possible clinical value of 3 DNA repair genes BRCA1, GSTP1 and MGMT in breast cancer samples of Chinese women. Methods:Using methylation speciifc PCR (MSP), we analyzed the methylation status of 3 DNA repair genes BRCA1, GSTP1 and MGMT in 106 paired breast tumors and corresponding normal tissues. Results: The methylation rates of BRCA1, GSTP1 and MGMT were 24.5% (26/106), 29.2% (31/106) and 18.9%(20/106) in breast cancer tissues, which were higher than those (7.5%, 11.3%and 4.7%) in paired normal breast tissues, respectively (P<0.01). Methylation in at least one of the genes was found in 50.9%(54/106) of the breast cancer and 19.8%(21/106) in paired normal breast tissues. And the mean number of genes hypermethylated in each tumor and paired normal breast tissues were 0.73 and 0.24, respectively (P<0.000 1). The methylation status of BRCA1 was more frequent in the younger patients than in the older patients (P=0.007) and most BRCA1 methylated patients were ER negative (P=0.020). Methylation status of GSTP1 was signiifcantly correlated with tumor size, lymph node metastasis (P=0.028 and 0.033, respectively). MGMT methylation was significantly correlated with tumor stage, higher tumor grade and lymph node metastasis (P=0.016, 0.025 and 0.030, respectively). High frequency simultaneous methylation of these 3 genes was more often in those with higher tumor stage and lymph node metastasis (P=0.028 and 0.007, respectively). Conclusion:Hypermethylation of BRCA1, GSTP1 and MGMT genes may be linked to various known clinicopathological features of breast cancer in Chinese women, and the increasing multiple gene methylation in tumors may indicate an aggressive phenotype for breast cancer. Detection of the methylation status of these genes may be useful for identifying patients at high risk for breast cancer.

Objective To compare the target dosimetric distribution and clinical outcome in patients with stage Ⅲ non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT).Methods The clinical data of 419 patients with stage Ⅲ NSCLC treated with either 3DCRT or IMRT were retrospectively analyzed.Among them,there were 338 male and 81 female patients,and the median age was 63 years (range:32-84 years).There were 340 patients treated with 3DCRT and 79 with IMRT,and the median prescribed dose was 60 Gy (range:50-76Gy).One hundred and forty patients were treated with radiotherapy alone and 279 were treated with chemoradiotherapy.The target dosimetric distribution was evaluated with dose-volume histogram (DVH)parameters.The overall survival (OS) rate was calculated using the Kaplan-Meier method and analyzed by the log-rank test.Results When comparing the clinical data,the patients treated with 3DCRT were in older ages,and had advanced N and clinical stages (P =0.01,0.00,and 0.00,respectively).When comparing the target DVH parameters,the patients treated with IMRT had larger planning target volume (PTV) (P =0.01),significantly lower clinical target volume (CTV) D CTV D90,PTV D and PTV V65-V60 (P =0.05-0.01),significantly higher V5-V20 in both lungs,higher esophagus D longer esophagus in the radiation field,higher linear energy transfer between 45 and 55 keV/μm (LET45-LET55),and higher spinal cord Dmean(P =0.03-0.00).The follow-up rate was 97.4％.After radiotherapy,the 1-,3-,and 5-year OS rates were 65.5％,26.1％,and 18.5％,respectively,and the median survival time was 20 months.There were no significant differences in OS rate and the incidence of acute radiation pneumonitis and radiation esophagitis between patients treated with IMRT and 3DCRT (P =0.06,0.73,0.13).Stratified analysis showed that,when comparing the patients treated with IMRT with those treated with 3DCRT,the survival rate was only lower in male patients,patients in stage T3-T4 or N0-N2,and those without chemotherapy (P =0.04,0.04,0.02,0.00).Conclusions The treatment outcomes of patients with stage Ⅲ NSCLC undergoing IMRT and 3DCRT are comparable.IMRT shows a potential dosimetric advantage,but the result needs further investigation.

Objective To evaluate the prognostic significance of 3 clinical stage system in 3-dimensional conformal radiotherapy (3DCRT) for esophageal squamous cell carcinoma. Methods From January 2004 to August 2007, 179 cases of esophageal squamous cell carcinoma were treated with 3DCRT.Before radiation, each patient was staged with UICC 2003 TNM stage, stage of Chinese esophageal cancer cooperation group (cooperation group' stage), and Zhu's clinical stage respectively. Concordance of each clinical stage and prognosis was analyzed with SPSS 11.5. Results In 179 cases of esophageal cancer,Concordance was better in T stage ( Kappa = 0. 271 ) than in TNM stage ( Kappa = 0. 167 ) between cooperation group' stage and Zhu's stage. Among them, 98 cases was staged with UICC stage, concordance of T stage was better between UICC-T and cooperation group' T stage (Kappa =0. 261 ) than between UICCT and Zhu's T stage (Kappa = 0. 045 ) ;concordance of TNM stage was better between UICC-TNM and Zhu's TNM stage ( Kappa = 0. 597 ) than between UICC-TNM and cooperation group' TNM stage ( Kappa =0. 299 ). With multivariate analysis, T ( χ2 value is 11.58, 26. 00 and 51.05, all P ＜ 0. 01 ), N ( χ2 value is 15.28, 16. 10 and 16. 10,all P＜0. 01), M (χ2 value is 5.59, 27.78 and 27.78,all P＜0. 01), and TNM (χ2 value is 15.77, 34,35 and 51. 10,all P＜0. 01 ) stage in 3 kinds of clinical stage were independent prognostic factors. In UICC stage, T1-T3 was difficult to definite and the prognosis was not significantly different in T1 -T3 stage. Conclusions In this study, 3 kinds of clinical stage could evaluate prognosis of esophageal cancer after radiotherapy;cooperation group' stage and Zhu's stage need further application, with further accuracy needed.

The development of the imaging technology enables diagnostic methods of detect intracranial aneurysms diversified. In recent years, the diagnosis of aneurysms was confirmed by digital subtraction angiography (DSA) which was regarded as the "gold standards". However, CT angiography (CTA), which appears as a fast, non-invasive, and easily achievable examination, is becoming as a new option in clinic. With the development of the CT facility and upgrade of the workstation software, CTA is more widely used in both diagnosing and treating intracranial aneurysm. This article reviews the sensitivity and specificity of CTA in the detection of intracranial aneurysms, and systematically analyzes its advantages and disadvantages as well as its development, imaging methods.

Objective To analyze the prognosis of 225 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods, and investigate the practicality and predictive value of the clinical staging. Methods From March 2001 to July 2007, 225 patients with esophageal carcinoma received 3DCRT treatment. The prescribed doses were ranged from 5000 -7000 cGy with the median dose of 6400 cGy, 25 patients received accelerative radiation of 300 cGy per fraction after conventional radiotherapy of 3000 -4000 cGy, 57 patients received concurrent chemotherapy with or without consolidation chemotherapy. All the patients were divided into subgroups of different T stages, different N stages and different TNM stages. Local control rates, survival rates were observed and Cox regression analysis were performed to search valuable prognostic factors. Results The following-up rate was 99. 6%. The 3-and 5-years following-up number were 116 and 33 patients, respectively. The 1 -,3-,and 5-year local control rates were 77. 2% ,48.2% and 34. 5%, respectively. The 1-,3-,and 5-year overall survival rates were 68.4% ,33.7% and 20. 8%, respectively. The median survival time was 20 months. There were significant difference between survival curves for T1-4 stages, N0-2 stages and Ⅰ - Ⅲ stages with x2 value of 13.07,20. 49 and 17.16, with P value of 0. 004,0. 000 and 0. 000, respectively. For the group of stage Ⅰ, Ⅱ and Ⅲ, the 1-,3-,and 5-year survival rates were 89.4% ,56. 1% ,and 37.8% ;69.6% ,32. 4% ,and 18.0%and 47. 2%, 19. 5%, and 13. 0%, respectively. According to the result of Cox regression analysis, the tumor length of CT scan, clinical N stage, short term restlt were most valuable predictive factors.Conclusions The clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately, clinical N stage may have more closely association with prognosis, however, some details of the staging program need more consummate.