Objective To compare the changes of serum cystatin C(CysC),cytokeratin 19 fragment(CYfra21-1)and neuro-spe-cific enolase(NSE)levels before and after surgery in the patients with lung cancer.Methods ELISA and the chemiluminescence method were adopted to detect the levels of serum CysC,CYfra21-1 and NSE before and after operation in 33 patients with lung cancer and the detection results were compared with those in 35 health people.Results The serum CysC,CYfra21-1 and NSE levels in the lung cancer patients were significantly higher than those in the normal control group(P <0.01);which had statistically sig-nificant difference between before and after operation(P <0.05);the serum CysC,CYfra21-1 and NSE levels in 3 months after op-eration still had statistically significant difference compared with the normal people(P <0.05),moreover the serum CysC level was positively correlated with serum CYfra21-1and NSE levels(r =0.601 8,0.596 6,P <0.01 ).Conclusion Detecting serum cyscC, CYfra21-1 and NSE level change has certain clinical value for evaluating the prognosis and the disease condition monitoring of the patients with lung cancer.

Objective: To investigate the first appearance and geographic distribution of hantaviruses in China. Methods: Some sequences of M segment of hantaviruses isolated in China were retrieved from GenBank. Some recently sequenced viruses which have not been registered in GenBank were obtained from authors who reported them. Program MEGA 3. 1 was employed for the phylogenetic analysis of the above virus sequences. Nucleotide divergence rates were estimated by comparing the closely related sister sequences isolated in the same geographical region at no less than a 5-year interval. Based on these calculated divergence rates, together with their isolating time and region, we explored the first appearance and geographic distribution of hantaviruses in China. Results and conclusion: The distribution of hantaviruses was in cluster, with Guizhou Province having the most subgenotypes. which supports the previous hypothesis that hantaviruses first appeared in Guizhou Province of China. A novel subgenotype virus was found in Anhui Province, indicating that it might be easier for the virus to have mutation in Anhui Province. We also found that Gou3 strain might be the earliest one to separate from a common ancestral strain; it is speculated that hantaviruses migrated in China about 315 years ago.

Objective To evaluate the influence of lumbar disc herniation type on the curative effect of percutaneous lumbar discectomy (PLD). Methods 158 patients were classified into two groups including contained and discontained herniation according to clinical symptoms and diagnostic images. They were treated by meanes of the same technique in nonvascular intervention. Their curative effects were compared with each other in this study. Results The curative and total effective rates were 81.1% and 98.5% respectively in contained group, 7.7% and 38.5% in discontained group without serious complications. The duration of follow up ranged from 3 months to 73 months. Conclusions PLD is a effective procedure for lumbar disc herniation, which is relatively simple and safe with rapid recovery and without serious complications. It should be confirmed in simple contained herniation only.

Hepatocellular carcinoma ( HCC) , as one of the most common malignant neoplasms , has a relatively high morbidity and mortality rate worldwide.MicroRNAs (miRNAs),a type of comparatively conserved endogenous small non-coding RNAs, function as pivotal regulators involved in various biological functions through the post -transcriptional regulation of gene expression .Some miRNA genes are arranged into a intandem model and reside close together on the same chromosome , forming miRNA clusters . These clustered miRNAs are mostly located on polycistronic transcripts and expressed at similar levels.In the human imprinted 14q32 region, 52 miRNA genes are organized as a large cluster which spans about 220 kb of the long arm ( q) .Lines of evidence show that dysregulation of miRNAs in this cluster are involved in the development of HCC .This review summarizes the structural characteristics of 14 q32 miRNA cluster as well as its impact on HCC in initiation and progression .

Objective To explore the surgical technique and clinical effect of combined great toe wraparound flap and second toe tissue flap transfer for subemergency reconstruction of grade Ⅲ and Ⅳ thumb defect.Methods From July,2011 to March,2014,12 patients of grade Ⅲ and Ⅳ thumb defect were treated by transfering combined great toe wrap-around flap and second toe tissue flap transfer.The second toe tissue flap was carried out to cover donor site defect of the big toe.Results All the 12 transplants survied and were followed up for 6 to 24 months.The reconstructed thumbs had near nomal appearace and good fuction,2-point discrimination ranged from 0.6 cm to 0.8 cm.According to the trial standard of upper limb part of functional assessment of the Hand Surgery Branch of Chinese Medical Association,among the 12 eases,there were excellent in 9,good in 3.Impact on the donor foot was minor with limited complications.The patients were able to weight-bearing walking after one months of operation.For long-term follow-up,no case had successive ulces,obvious pain and claudication.Conclusion The reconstructed thumbs by great toe wrap-around flap combined with the tissue flap of second toe had near nomal appearace and good fuction.

Objective To investigate the diagnosis and treatment of cervical intraepithelial neoplasia and their clinical effect Methods The cases who were diagnosed as CIN through cytology, colposcopy biopsy and histopathological diagnosis were collected from January 2004 to June 2009 in Songjiang Hospital Affiliated to Shanghai Jiaotong University School. Drug therapy, physical therapy, cervical conization and hysterectomy were performed according to the lesion degree of CIN and patients' willingness. Some cases were further treated with surgery, radiotherapy or chemotherapy according to the pathological findings of the initial excision specimens. With long-term follow-up at 6,24 months after the treatment,we performed a comparative analysis on pathological diagnosis and therapeutic effects. Results Seven hundred and fifty cases of CIN were diagnosed after cervical cancer screening,among which,460 cases of CIN Ⅰ ,180 cases of CINⅢⅡ and 110 cases of CIN Ⅲ. Five hundred and Senventy-eight cases received treatment, among which, 46 cases received drug treatment After 6 months, focus disappeared in 32 cases, sustained in 10 cases, upgraded in 2 cases and canceration occurred in 2 cases. 13 cases received physical therapy,no recurrence occured. Four hundred and thirty-five cases received conization treatment, 34 cases with focus upgraded and 4 case recurred after the operation. 84 cases received hysterectomy, of which, 11 cases focus upgraded after the operation and no recurrence. The cases with focus upgraded or recurred all received additional treatment. The effective rate of physical therapy,conization treatment and hysterectomy on all grades of CIN was more than 98% at 2 years, and 69. 7% of drug treatment. The omission diagnostic rate of colposcopy guided biopsy on invasive carcinoma was 2. 2% , and the residual rate of focus of hysterectomy specimens after conization was 16. 2% . Conclusion Colposcopy including multi-point biopsy has high accuracy and specificity in early diagnosis of CIN . Cervical conization is the main method of the treatment of CIN. Patients with CIN Ⅲ and without desire of fertility should consider the removal of the uterus after cervical conization. Drug conservative therapy of CIN should be chosen carefully.

One hundred and twenty-two patients with confirmed cervical intraepithelial neoplasia (CIN), as a result of occasional screening for uterine cervix cancer in our out-patient clinic between July 2006 and August 2007, and 122 control patients with cervicitis who received colposcopy during the same period were enrolled in this study. Our results showed that 72% participants didn't receive uterine cervix cancer screening during the past 2 years; 55% women had premarital sexual behavior. CIN was most commonly seen in 30 to 34 year old women. Occasional screening could identify 75% CIN. In comparison with the control group, the incidence of earlier first sexual behavior, marriage, and delivery, multiple pregnancy, and frequent abortion was significantly increased in the study group (P < 0.05). We suggest that increased access to uterine cervix cancer screening might be more important than technical improvement.

Objective:To evaluate the effect of presurgical nasal mode(PNM)combined with nasal diorthosis in the treatment of na-sal deformity and incomplete unilateral cleft lip(IUCL)in infants.Methods:35 infants with IUCL were treated by PNM followed by nasal diorthosis and cheiloplasty.The nasal asymmetry was analysed by measurments of nostrils height,nostrils width and nasal colu-mella angle skewness on the photographs at the initial visit(T0),pre-operation(T1),1 week after operation(T2),1 month after opera-tion(T3)and a year after operation(T4).The other 35 infants with IUCL without PNM treatment were served as the controls.Re-sults:Compared with the controls,the symmetry of nostrils height,nostrils width,nasal columella angle skewness in PNM treated children were significantly improved at T0-T1 and T1-T2(P ＜0.05).there was no significant difference at T2-T3 and T3-T4(P >0. 05).Conclusion:Nasal asymmetry can be improved by presurgical nasal mode treatment followed by preliminary nasal deformity di-orthosis and cheiloplasty.

Objective:Recent studies have shown that in contrast to decrease in distal gastric adenocarcinoma (DGA), incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased noticeably in numerous counties. However, the reasons remain unclear. This study evaluated the possible differences in the expression of KLF4, SP1, and Cyclin D1 in AEG and DGA, and explored the potential carcinogenesis of AEG. Methods:Immunohistochemistry was performed on paraffin-embedded tissues to evaluate the pu-tative differences in the expressions of KLF4, SP1, and Cyclin D1 at protein level between AEG (n=58) and DGA (n=47). The patholog-ical significance of these markers between the two groups was also compared and analyzed. Results:The percentage of positive KLF4 expression was significantly lower in DGA than in AEG (P<0.05). Lower KLF4 expression was found both in well-or moderately dif-ferentiated cases and in poorly differentiated cases with DGA compared with their AEG counterparts (P<0.05). However, positive stain-ing for SP1 was significantly higher in DGA (P<0.05). No significant difference was found in the expression of Cyclin D1 between the two groups. Further analysis showed that in DGA, the positive expression of KLF4, SP1, and Cyclin D1 were significantly correlated with lymph node metastasis. In AEG, only Cyclin D1 expression was correlated with lymph node metastasis (P<0.05). No correlation was found among the expression of KLF4, SP1, and Cyclin D1 in AEG. In DGA, KLF4 was inversely correlated with SP1 and Cyclin D1 (r=-0.334 and r=-0.341, respectively, P<0.05), and SP1 was positively correlated with Cyclin D1 expression (r=0.340, P<0.05).Conclusion:Different expression patterns and clinicopathological significance of KLF4, SP1, and Cyclin D1 were observed between AEG and DGA, suggesting the putative difference in the carcinogenesis and progression of AEG and DGA.

Objective To build a Monte Carlo dose verification tool for IMRT Plan by implanting an irradiation source model into DPM code and to extend the ability of DPM to calculate any incident angles and irregular-inhomogeneous fields.Methods The virtual source and the energy spectrum unfolded from the accelerator measurement data were used,in combination with optimized intensity maps,to calculate the dose distribution of the irradiation irregular-inhomogeneous field.The irradiation source model of accelerator was substituted by a grid-based surface source.The contour and the intensity distribution of the surface source were optimized by IMRT.The dose calculation was realized by combining the position of the emitter with the fluence map from the IMRT plan.The weight of the emitter was decided by the grid intensity.The direction of the emitter was decided by the combination of the virtual source and the emitting position.The weighted fraction of the emitter was also combined with the flux grid intensity based on the particle transport model of DPM code.Results The accuracy of calculation was verified by comparing with the measured data.It was illustrated that the differences were acceptable (＜ 2％ inside the field,2-3 mm in the penumbra).The dose calculation of irregular field by DPM simulation was also compared with that of FSPB (Finite Size Pencil Beam).The passing rate of gamma analysis was 95.1％ for peripheral lung cancer.The regular field and the irregular rotational field were all within permissible range of error.The calculation time of regular fields were less than 2 h,and that of the test of peripheral lung cancer was 160 min.Conclusions The adapted DPM code with its simple irradiation source model is faster than that with classical Monte Carlo procedure.Its computational accuracy and speed satisfy the clinical requiremcnt,and it can be useful as a Monte Carlo dose verification tool for IMRT Plan.