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.

Objective To understand the direct medical expense for surgical patients with splenomegalic advanced schisto?somiasis and its influencing factors,so as to provide evidences for relevant departments to improve the rescue strategy of ad?vanced schistosomiasis. Methods The data about the expenses of patients with splenomegalic advanced schistosomiasis hospi?talized in Xiangyue Hospital affiliated to Hunan Institute of Schistosomiasis Control from January 2010 to August 2014 were col?lected,the hospitalization expense and hospital stays of the patients were analyzed,and the factors influencing the hospital ex?penses were analyzed by the univariate and multi?factor analyses. Results From January 2010 to August 2014,totally 249 cas?es were hospitalized in the hospital,their average hospital stays and hospital expenses were 28.92 d and 18 896.13 Yuan,and both of them were increased year by year. Among all the kinds of expenses,the constitution ratios of the medicine expenses were the highest,and those in the 5 years were all above 44%. The results of the univariate and multi?factor analyses showed that the hospital stays,the amount of intraoperative bleeding,liver function classification,postoperative complications,age,portal hy?pertensive gastropathy were the influencing factors of the hospital expenses. Conclusion Presently,the burden of the direct hospital expenses of the patients with splenomegalic advanced schistosomiasis is still heavy. The government should further im?prove the proportion of the compensation of medical assistance and perfect the medical aid scheme. Meanwhile ,the hospitals should strengthen the management and standardize medical behavior to reduce the hospitalization expenses of the patients.

Objective To understand the current distribution and characteristics of advanced schistosomiasis patients who accepted medical assistance in Hunan Province in 2015,so as to provide the evidence for perfecting the policy and measures of the medical assistance to advanced schistosomiasis patients. Methods The patients who had been diagnosed as advanced schis-tosomiasis were verified and confirmed according to the standard of the medical assistance to advanced schistosomiasis patients in Hunan Province in 2015. The epidemiological survey was conducted to investigate the demographic characteristics,history of diagnosis and treatment,and medical assistance to these persons. Results There were 3850 advanced schistosomiasis patients who accepted the medical assistance in Hunan Province in 2015,and among them,2664 patients were male(69.19%),and 1186 were female(30.81%). Most of them(92.82%)came from the main schistosomiasis endemic areas,such as Yueyang, Changde and Yiyang. There were 2369 cases of ascites(61.53%),1466 cases of splenomegaly(38.08%),15 cases of colon proliferation and dwarf(0.39%). The mean age of advanced schistosomiasis patients who accepted the medical assistance was (62.94 ± 11.67)years old,with 64.31% of them being more than 60 years old. The age of initial diagnosis of advanced schistoso-miasis was(53.85 ± 21.32)years old,and it was concentrated in 40-60 years old(68.57%). The mean duration of advanced schistosomiasis was(9.58 ± 10.06)years,and it was mainly distributed in 10 years(75.95%). The mean duration from initial diagnosis of schistosomiasis to advanced schistosomiasis was(22.33 ± 14.20)years. The priority of the medical assistance to ad-vanced schistosomiasis patients was given to the county hospitals(76.57%);and the effective rate of assistance was 94.46%. To-tally 86.57% of the patients with advanced schistosomiasis got the medical insurance(rural cooperative medical care,urban medical care,etc.). Conclusions The burden of the medical assistance to advanced schistosomiasis patients is still heavy be-cause of many patients and low cure rate in Hunan Province. The ascites patients and high age patients should be the important objects of the medical assistance.

Objective To investigate the lens and pituitary dose impacted by additional filtration and collection field in head and neck DSA examinations. Methods All images were acquired by a Philips ALLura Xper FD 20 DSA machine. The combination of the different collection fields (48 cm, 42 cm, 31 cm, 22 cm) and additional filtrations (0.9 mmCu+1.0 mmAl, 0.4 mmCu+1.0 mmAl, 0.1 mmCu+1.0 mmAl) were adjusted when the anthropomorphic phantom filled with dosimeter was scanned in anterioposterior and lateral positions with 2D?DSA and 3D?DSA. The dose area product (DAP), air kerma (AK) and the radiation dose values of bilateral lens and pituitary were measured and recorded. The 2D and 3D?DSA regional absorption dose on lens and pituitary were analyzed using t' test, the correlations between DAP and AK parameters and different regional absorption doses were evaluated by Pearson rank correlation coefficient. Results Absorption doses of left lens, right lens and pituitary with 2D?DSA (n=12) were as following:(2.77 ± 0.68), (6.23 ± 3.54), (8.65 ± 2.62) mGy, while the parameters with 3D?DSA (n=12) were (1.78 ± 0.82), (2.18±1.15), (3.32±0.64) mGy, respectively;the results revealed a significant difference (t'=3.20, 3.76 and 6.85, P<0.01). DAP [(8 739±5 731) mGy·cm2] had a relationship with absorption dose of pituitary, left lens and right lens [(5.988 ± 3.299),( 2.258 ± 0.872),( 4.207 ± 3.303) mGy, r values were 0.766, 0.684, 0.727; P<0.01]. AK values was (31 ± 23) mGy and it had a relationship with pituitary absorption dose (r value was 0.894, P<0.01). The lens dose was reduced when the additional filtration was increased and the collection field was decreased, the radiation dose of the pituitary was reduced when both the additional filtration and the collection field were increased. Conclusions In the head and neck DSA examinations, the radiation dose of the lens and the pituitary had different changes with the different additional filters and collecting fields. The organ dose with 3D?DSA was significantly less than that with 2D?DSA.

Objective To investigate the effect of different additional filtration thickness of DSA on image quality and radiation dose with cerebral angiography. Methods Prospective collected 90 patients with DSA examination of the whole cerebral artery, patients were divided into A, B and C group according to the time of the examination, each group included 30 cases. Patients underwent conventional DSA, the additional filtration of group A, B and C were (1.0 mmAl+0.1 mmCu), (1.0 mmAl+0.4 mmCu) and (1.0 mmAl+0.9 mmCu), respectively. Dose area product (DAP), air kerma (AK), tube current and tube voltage of anteroposterior and lateral radiography of the whole brain were recorded, and scored the image quality. Eye lens organ dose values were obtained by using simulation phantom and LiF dosemeter under A, B and C groups with three different additional filtrations for cerebral angiography. The image quality scores and the radiation dosewere analyzed by one-way ANOVA tests or Kruskal-Wallis tests. Results The image quality comprehensive score of three groups showed significant difference (F=40.07,P<0. 01), which were (3.8±0.4), (3.6 ± 0.5) and (3.0 ± 0.6), respectively. The DAP and AK value of anteroposterior and lateral radiography of three groups also showed significant difference (P<0.05), B and C group were lower than the A group. Left and right eye lens organ dose were decreased along with the increase of the additional filtration thickness, and the difference between the 3 groups also had significant difference (P<0.01). Conclusion Both the image quality and radiation dose can acquire when conducted the whole brain DSA with 1.0 mmAl+0.4 mmCu additional filtration.

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.

Objective To explore the status of depression in patients with advanced schistosomiasis and its influencing fac-tors,so as to provide the evidence for improving psychological interventions. Methods A total of 206 patients with advanced schistosomiasis were investigated with the self-designed general information questionnaire,the Self-Rating Depression Scale,and WHOQOL-BREF Form. Results Among the 206 cases,the incidence of depression was 69.4%,and depression was negatively related to the quality of life(P = 0.000). The multiple logistic regression analysis showed that the times of hospitalization(β=0.442,P=0.007)was a risk factor for depression,while the high education levels(β=-0.583,P=0.011)and the history of por-tal hypertension operation(β=-0.917,P=0.000)were the protective factors. Conclusion The incidence of depression in ad-vanced schistosomiasis patients is high,and it is influenced by various factors. Therefore,we should take corresponding interven-tions to reduce its occurrence.

Objective: To analyze the characterisitics of the death cases suspected to be related to vaccination in Fujian Province from 2012 to 2017. Methods: A total of 33 death cases information which was suspected to be related to the vaccinations from 2012 to 2017 were extracted from Chinese Adverse Events Following Immunization Information System (AEFI). The autopsy reports and the conclusions made by AEFI investigation diagnosis expert committee were collected at the same time. The inoculation data were obtained through the Fujian province Immunization Program Information System. The AEFI incidence, rare vaccine reaction incidences and mortality rates following immunization were figured out to analyze the characterisitics of the death cases associated with vaccination. Results: The age of deuths cases was from 26 days to 52 months. Among 33 cases, 23 were males, and 8 were due to vaccine-related reaction, and the others were due to coincidental events. The number of rare vaccine reaction cases from 2012 to 2017 were 2,3,6,8,7 and 7, respectively. The highest AEFI incidence was measles and rubella combined attenuated live vaccine [38.88 (95%CI: 36.85-40.91)/100 000 dose], and the lowest was trivalent oral poliomyelitis attenuated live vaccine [2.01 (95%CI: 1.73-2.30)/100 000 dose]. The highest rare vaccine reaction incidence was measles and rubella combined attenuated live vaccine [15.04 (95%CI: 13.78-16.30)/100 000 dose], and the lowest was trivalent oral poliomyelitis attenuated live vaccine [0.38 (95%CI: 0.25-0.50)/100 000]. The highest mortality rate was inactivated poliomyelitis vaccine [0.26 (95%CI: 0.04-0.54)/100 000 doses], and the lowest mortality rate was measles, mumps and rubella combined attenuated live vaccine [0.01 (95%CI: 0.00-0.08)/100 000 doses]. The Spearman correlation analysis showed that there were correlations between AEFI incidence and rare vaccine reaction incidence (r=0.64, P=0.048), there were no correlations between AEFI incidence and mortality rate (r=-0.34, P=0.329), and there were no correlations between rare vaccine reaction incidence and mortality rate (r=-0.25, P=0.484). Conclusion Neither AEFI incidence nor rare vaccine reaction incidence was correlation with mortality rate. The main causes of death following vaccination were coincidental events.

Objective: To investigate the relationship between V-raf murine sarcoma viral oncogene homologue B1 (BRAF)^V600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma (PTC) with different recurrence risk stratification. Methods: From March 2014 to September 2017, 134 PTC patients (45 males, 89 females; age: 16-72 years) who underwent ¹³¹I treatment in the Department of Nuclear Medicine of Liaocheng People′s Hospital and had undergone BRAF^V600E mutation detection were retrospectively analyzed. The recurrence risk during surgery was divided into 3 levels: low-, medium- and high-risk. Each recurrence risk group was divided into 3 subgroups according to the postoperative follow-up results: non-metastasis group, cervical lymph node metastasis group and pulmonary metastasis group. BRAF^V600E mutation rates in different groups were compared (χ² test). Results: The BRAF^V600E mutation rate was 55.22%(74/134) in 134 PTC patients. The mutation rates were not significantly different in the 3 metastasis subgroups for low-risk patients (n=46; χ²=2.39, P>0.05). In medium-risk patients (n=47), the mutation rate in neck lymph node metastasis group (16/19) was higher than that in pulmonary metastasis group (3/8) and non-metastasis group (25.00%, 5/20; χ² values: 5.89 and 13.75, both P<0.05), while there was no difference between pulmonary metastasis group and non-metastasis group (χ²=0.44, P>0.05). In high risk patients (n=41), the mutation rate in neck lymph node metastasis group (85.00%, 17/20) was higher than that in the pulmonary metastasis group (5/13) and non-metastasis group (1/8; χ² values: 7.68 and 13.08, both P<0.01), while there was no difference between pulmonary metastasis group and non-metastasis group (χ²=1.64, P>0.05). Conclusion The BRAF^V600E mutation is closely related to neck lymph node metastasis after operation in middle- and high-risk patients with PTC, but it does not significantly increase the probabilities of neck lymph node metastasis in low-risk patients and pulmonary metastasis in low-, medium- and high-risk patients.