Objective To evaluate the expression of serum vascular endothelial growth factor ( VEGF ) on recurrence and/or metastasis following surgery in patients with differentiated thyroid carcinoma,and to ana1yze the relationship between serum VEGF and serum thyroglobulin levels.Methods The serum samples were obtained from 25 patients with pulmonary metastasis, 43 cases with locoregional recurrence, 30 cases without recurrence and/or metastasis and 30 normal subjects were selected as control.The levels of serum VEGF were analyzed by enzyme-linked immunosorbent assay( ELISA) ,the levels of serum thyroglobulin were analyzed by chemiluminescence method. Results The level of serum VEGF[(864.3 ±200.3)ng/L] in patients with pulmonary metastasis were significantly higher than that in patients with locoregional recurrence[(393.3 ±96.3)ng/L],without recurrence and /or metasta-sis[(276.6 ±47.7)ng/L] and normal subjects[(268.6 ±36.9)ng/L](t=11.04,14.34,14.66,all P<0.05), while there was no significant difference of serum VEGF level between without recurrence and /or metastasis and normal subjects (t=0.73,P>0.05).It showed linear correlation between serum VEGF and thyroglobulin levels on recurrence and/or metastasis following surgery in patients with differentiated thyroid carcinoma ( r=0.902 2, P<0.001) .Conclusion The serum VEGF level was significantly elevated in patients with locoregional recurrence and pulmonary metastases, the serum VEGF can be used as a auxiliary index to predict recurrence and /or metastasis following surgery in patients with differentiated thyroid carcinoma.

Objective To evaluate the expression of vascular endothelial growth factor (VEGF)and endostatin (ES) in the serum of patients with differentiated thyroid cancer at the time of before and after operation and postoperative recurrence. Methods The serum samples were obtained from 7 patients with postoperative lung metastasis and 21 patients with local recurrence after operation.The serum samples from 30 normal subjects were obtained as control.The levels of serum VEGF and serum endostatin were analyzed by enzyme-linked immunosorbentassay (ELISA).Thelevelsofserumthyroglobulinwereanalyzedby Chemiluminescence method.Statistical analysis was performed with t-test using SPSS 13.0 software.Pearson correlation analysis was performed for the correlation between serum VEGF and serum ES and thyroglobulin.ResultsThe levels of serum VEGF and serum ES in patients with lung metastasis 3 weeks after operation were significantly lower than those before operation and at the time of recurrence [ VEGF:( 210.3 ± 30.4) ng/L vs (412.6 ±57.3) ng/L and(619.5 ± 126.4) ng/L,P ＜0.05 ;ES:(25.2 ±6.2)ng/L vs (34.3 ±7.6)ng/L and (38.6 ± 8.7) ng/L,P ＜ 0.05 ].And the levels of serum VEGF and serum ES in patients with local regional recurrence 3 weeks after operation were significantly lower than those before operation and at the time of recurrence [ VEGF:(209.3 ±36.7) ng/L vs (399.4 ±56.3) ng/L and (406.5 ±59.2) ng/L,P ＜0.05;ES:(25.7 ± 4.7 ) ng/L vs ( 35.2 ± 6.8 ) ng/L and ( 31.2 ± 7.6 ) ng/L,P ＜ 0.05 ].The expression of serum VEGF and serum ES in patients with pulmonary metastasis were significantly higher than those in patients with local regional postoperative recurrence ( P ＜ 0.05 ).There was a linear positive correlation between serum VEGF,serum ES and thyroglobulin levels in the patient with recurrent differentiated thyroid cancer( r =0.752,0.349,P ＜0.01 ).Conclusion The serum VEGF and serum ES level were significantly elevated in patients with differentiated thyroid cancer before operation and recurrence.The serum VEGF and serum ES were importantindicators to reveal the biological behaviors of differentiated thyroid cancer.

Objective To evaluate the expression of serum vascular endothelial growth factor(sVEGF) in differentiated thyroid carcinoma(DTC)patients before and after thyroidectomy and when recurrence occured.To analyze the relationship between serum VEGF and serum thyroglobulin(Tg)level.Methods sVEGF levels of 30 cases of DTC (7 patients with pulmonary metastasis,23 patients with locoregional recurrence)were determined by enzyme-linked immunosorbent assay(ELISA) before and after thyroidectomy and when recurrence occured.The levels of serum Tg and thyroglobulin antibodies (TgA) were detected by chemiluminescence method.The results were compared with those of the 30 cases of normal controls.Results sVEGF levels had no significant difference between pulmonary metastasis group and locoregional recurrence group before operation (t =0.373,P ＞ 0.05),but they were significantly higher than those in the normal control group(t =8.597 and 14.14 respectively,all P ＜ 0.05).sVEGF levels in patients with pulmonary metastasis or locoregional recurrence were significantly reduced at the 3rd week after operation and the difference had statistical significance with those before operation(t =5.977,11.50,P ＜ 0.05).The difference of postoperative level of sVEGF in patients with pulmonary metastasis,locoregional recurrence and in patients of normal control group had no statistical significance (t =1.593,1.525,P ＞ 0.05).sVEGF levels in patients with pulmonary metastasis or locoregional recurrence were significantly higher after recurrence than those before recurrence (t =7.387,12.16,P ＜ 0.05).After recurrence sVEGF levels in patients with pulmonary metastasis were significantly higher than those in patients with locoregional recurrence (t =4.167,P ＜ 0.05) It showed a positive linear correlation between serum Tg level and sVEGF level in DTC patients with recurrence(r =0.786,P ＜ 0.01).Conclusion sVEGF is significantly elevated in DTC patients before operation and with postoperative recurrence,making it an important indicator to reveal the biological behaviors of DTC.

ObjectiveTo explore the effect of combined usage of expanding coronal decompressive craniectomy and sequential dural incision for treating severe bilateral frontal contusion (SBFC).Methods Forty-three patients with SBFC were randomly divided by sequential single day after hospitalization into two groups.Observation group(23 cases) treated with expanding coronal decompressive craniectomy and sequential dural incision.Control group (20 cases) treated with standard hemicraniectomy and routine dural incision.ResultsThe occurrence rate of acute cephalocele was significantly lower in observation group [ 17.4％(4/23) ] than that in control group [ 55.0％(11/20) ] (P ＜ 0.05).According to Glasgow outcome scale (GOS) score of six-month observation after operation,17 cases(73.9％,17/23) of observation group got favourable recovery or moderate deficit,other 6 cases(26.1％,6/23) got severe deficit,persistent vegetative status or death.While only 8 cases(40.0％,8/20) got favourable recovery or moderate deficit,12 cases ( 60.0％,12/20 ) got severe deficit,persistent vegetative status or death in control group.The rate of favourable recovery and moderate deficit of two groups had statistical significance (P ＜ 0.05).ConclusionCombination application of expanding coronal decompressive craniectomy and sequential dural incision is an effective method to treat patients with SBFC,and can obviously improve the rate of successful rescue and decrease the rate of mortality and disability.

Objective To evaluate the outcomes of distal leg and foot-ankle reconstruction with rotated single pedicel reverse sural neurocutaneous island flaps. Methods From June 2011 to January 2016, seventeen distal leg and foot-ankle defects cases repaired with rotated single pedicel reverse sural neurocutaneous island flap were analyzed retrospectively. In this study, 13 cases were male, and 4 cases were female. Age ranged from 25 to 65 years old, with an average age of 42.0 ± 8.3 years. Seven cases were distal leg defects, 3 cases were ankle defects, 3 cases were heel defects, and 4 cases were acrotarsium defects; all cases had bone and tendon exposure. The defects ranged from 5.0 cm × 7.0 cm-6.0 cm × 12.0 cm. The flap size ranged from 5.0 cm × 7.0 cm-8.0 cm × 15.0 cm. Results All 17 cases survived completely, without thanatosis, blisters and vascular crisis. The follow-up period was 12-48 months, and the mean was (20.0 ± 11.1) months. The color and elasticity of the flaps was excellent, with satisfactory appearances. Function and appearance of donor sites was not affected. Conclusions The rotated single pedicel reverse sural neurocutaneous island flaps have no injury on main nerves and arteries. The flaps have wide rotation angle and less invalid fold in the pedicel. The simple operation has satisfactory effects and high survival rate. It is a relatively easy procedure that can be applied toward repairing of distal leg and foot-ankle soft tissue defect.

Objective To evaluate the effect of health education path on advanced schistosomiasis patients with splenomega-ly in perioperative period. Methods A total of 60 advanced schistosomiasis patients with splenomegaly in perioperative period were randomly divided into an observation group and a control group (30 cases each group). The patients in the observation group were intervened by the nursing and health education from admission to discharge according to the standardized process of health education path,while those in the control group were implemented with the conventional health education. Then the satis-faction of nursing work,hospital stays,hospitalization expenses and mastery of health knowledge of the patients in the two groups were investigated and the results were compared. Results The satisfaction rates of nursing work of patients in the obser-vation group and the control group were 90%and 60%,respectively,the difference between them was statistically significant (χ2=7.57,P<0.05). The average hospitals stays of the above two groups were 14.0 ± 3.5 d and 19.0 ± 6.8 d(t=2.85,P<0.01),respectively,and the average hospitalization expenses were(1.5 ± 0.5)thousand Yuan and(2.2 ± 0.7)thousand Yuan (t=24.57,P<0.01),respectively,both of the differences were statistically significant. On the 10th day after surgery,the mas-tery rates of the health knowledge of the two groups were 96.7%and 50.0%,respectively,the difference was statistically signifi-cant(χ2=16.86,P<0.001). Conclusions The implementation of the health education path can promote the rehabilitation of advanced schistosomiasis patients with splenomegaly,and increase the satisfaction as well as improve the mastery of the health knowledge of the patients. Meanwhile,it also can cut down the hospital stays and save the hospitalization expenses.

The prevalence of acute flaccid paralysis (AFP) associated with EV71 and the genetic variation in Fujian , China from 2003 to 2012 was investigated in this study .Descriptive epidemiology was used to analyze the epidemiologic and clinical features of AFP cases associated with EV 71 .Phylogenetic analysis was performed to explore the genetical characteris-tics of EV71 based on the complete VP1 nucleotide and amino acid sequences .Results showed that the mean incidence of EV71-associated AFP in children under 15 years old was 2 .24/10 000 000 in Fujian Province during 2003 and 2012 ,based on the number of EV71 isolates and the reported AFP cases .And the incidence has increased since 2008 .The EV71 strains isolated from the AFP cases or from the healthy contacts were distributed in 9 prefectures of Fujian Province ,most in the months of May and June .Of 76 .0% (19/25) of AFP cases associated with EV 71 were the children under 3 years and the male-to-female ratio was 1 .5 :1 .Twenty out of twenty-two cases (90 .91% ) had fevers before the onset of paralysis .Most cases had unilater-al limb paralysis (14/22 ,63 .6% ) .Typical manifestations of hand-foot-and-mouth disease (HFMD) were observed in five cases before the onset of paralysis .Residual paralysis was observed in two cases during the follow-up visits .The strains isolated from 25 cases belonged to genotype C4 .All other strains belonged to subtype C4a except the subtype C4b strains isolated in 2003 .The homology among the strains was high in 2009-2011 ,and the homology among these strains and the representative strains in Fuyang ,Anhui Province was also in the high level .Therefore ,it was possible that the isolated strains had the same origin and might cause the epidemic .In conclusion ,an AFP surveillance system could be developed for analyzing the incidence of AFP associated with EV71 ,determining the features of the isolates ,and describing the intensity and trends of EV71 epidem-ics .

Objective:To analyze a Risk Scale for Emergence Agitation After General Anesthesia in Children (the EA risk scale) into simplified Chinese and evaluate the reliability and validity in children with strabismus correction surgery.Methods:After obtaining the authorization of the original author, the English version of the EA risk scale was translated, translated back and culturally debugged to form the Chinese version of the EA risk scale. Then 279 children with strabismus correction surgery were selected from a tertiary hospital of ophthalmology in Tianjin and were investigated to validate the scale.Results:The correlation coefficients of each item and the total score of the scale were respectively 0.768 (item 1) ,0.717(item 2), 0.676(item 3), 0.634(item 4) (all P < 0.01). Content validity index of the scale was 0.920, and each item was 0.80-1.00. One factors including 4 items were identified using exploratory factor analysis, accounting for 62.052% of the total variance. The optimal cut-off value for the EA risk in children was 10, with the AUG was 0.816, specificity of 0.704, and sensitivity of 0.839. The Cronbach α coefficient for the total scale was 0.819, and the intraclass correlation coefficient value between the scorers was 0.835. Conclusion:The Chinese version of the EA risk scale has good reliability and validity. The items are concise, clear, and easy to understand. It is suitable for clinical departments as a preliminary screening tool to identify emergence agitation after general anesthesia on children with strabismus correction surgery and to assess the risk of its occurrence.

Objective To evaluate the outcomes of thumb reconstruction with dorsal thumb rotated single pedicel reverse island flap.Methods 49 thumb-tip defects cases with dorsal thumb rotated single pedicel reverse island flap were analyzed retrospectively.37 dorsal thumb reverse island flap were performed,and 12 ulnar-dorsal reverse island flaps were performed.Results The operation time was 40-60 minutes.The mean time was 45 minutes.All 49 cases survived completely.The color of the flaps was purple,and blisters in the surface of the flaps after 1-2 days in 2 cases.After took out stitches partly,the blisters were dried and crusted,the color of the flaps with better blood circulation was normal.The follow-up period was 3-24 months,all thumbs had satisfactory appearances and functions.The two-point discrimination was 6-9mm in flaps inosculated with nerve,that was 8-10 mm in flaps inosculated without nerve.The color,texture and elasticity of flaps were excellent,and the donor sites had not been defected.Conclusion Dorsal thumb rotated single pedicel reverse island flap is a reliable option to restore function as well as appearance,long vascular pedicle with skin strap,wide rotation angle,high rate of survival.It avoided damages to the well-known arteries and nerves.It is a relatively facile procedure that can be applied toward resurfacing thumb tip defects.

Objective To research CpG and Al(OH)3 adjuvants enhancing immunogenicity of hepatitis C virus(HCV) recombinant ptotein combined vaccine(TIE).Methods BALB/c mice were immunized with candidate vaccine TFE using CpG,Al(OH)3,Al(OH) 3 + CpG,or freund's adjuvant(FA) as the adjuvant.Five mice were sacrificed after 10 d of the last immunization.Specific antibodies in sera were tested by enzyme-linked immunosorbent assay(ELISA).Splenic cells were isolated and levels of IFN-γ,IL-4 and cytotoxic T lymphocyte(CTL) cytotoxicity assay were messuredin vitro.The remaining mice were subcutaneouly injected with 1 × 106 SP2/0-NS3 cells on the back to investigate the protective effects.The differences of means between groups were compared by LSD-t test.Results The specific CTL activity of TFE + A1(OH) 3 + CpG group was higher than TFE + FA group and TFE + CpG group(P ＜ 0.05).The level of IFN-γsecreting cells in TFE + Al(OH)3 + CpG group was higher than that in TFE + M(OH)3 group or TFE + CpG group(P ＜ 0.05).Conclusion Combining Al(OH) 3 and CpG could enhance specific cellular immunogenicity of candidate HCV vaccine TFE.TFE + M(OH) 3 + CpG could effetively prevent the attack of tumor cell SP2/0-NS3 expressing nonstructural protein NS3 of HCV.