Objective To summarize the experiences in treating 30 cases of skin soft tissue defects in head and neck by applying repeated expansion, and to explore an effective and satisfactory method of massive defect repair in head and neck. Methods Skin soft tissues were repeatedly expanded for 1 to 3 times after the first expansion. Massive skin defects in head and neck were repaired several times by useing repeated expansion of flap. The size of the skin defects ranged from 29cm?24cm to 10cm?8cm. The indications, complications and experiences in the treatment were discussed. Results A total of 30 cases were treated. Complication incidences of every expansive procedure were 27%, 15%, 14% and 0% respectively . After 6～12 months postoperative follow-up, the appearance and functional restoration was satisfactory. Conclusion Repeated expansion is an excellent method of repairing massive defects in head and neck.

Objective To analyze the sandtray topics of the children with behavior problems according to the grounded theory method.Methods Collected and described children' s sandtray topics of different types of behavior problems,age and gender.And analyzed them base on a 3 levels coding list compiling according to the ground theory method.Results The frequency of “negative theme” (3.33 ± 1.25 ) was higher than “positive theme” (0.81 ± 1.25 ) with significant difference (P＜0.01) in feature level 1.Age factor had significant effect upon the frequency of “positive theme” in feature level 1 (P ＜ 0.05 ).And also had impact on “harmony”,“ development” in features level 2 (F =3.039,P ＜ 0.05 ).Gender factor,interaction of gender and age had significant effects on frequency of “negative theme” in feature level 1 (F =5.395,P ＜ 0.05 ; F =4.222,P ＜ 0.05 ).Conclusion The characteristics of the children' s sandtay with behavioral problems mainly are “negative theme”.And it shows different features in children with different gender or age.

Objective To determine the long-term outcomes of cN0 papillary thyroid carcinoma without elective central compartment neck dissection. Methods The clinical data of 180 patients with clinically lymph node negative papillary thyroid carcinoma who were treated in our center between 2000 and 2005 were retrospectively analyzed. All of these patients did not receive elective central compartment neck dissection. Clinicopathological characteristics including gender,age,surgical range,pathologic type,tumor size,and extrathyroidal extension(ETE)or not were collected. Results After a median follow-up period of 90 months,only one patient died of stroke without tumor. Sixteen patients had tumor recurrence:seven patients had a recurrent disease in residual thyroid tissue,two in the thyroid bed,six in central compartment,eight in lateral cervical compartment,and one in lung. The 10-year overall survival,disease-specific survival,and recurrence-free survival was 99.4%,100%,and 87.9%,respectively. The 10-year accumulative lymph node recurrence rate in central compartment and lateral compartment was 7.8% and 7.0%,respectively. ETE was an independent risk factor for central compartment lymph node recurrence. Male gender(P=0.010)and ETE(P=0.028)were independent risk factors for lateral compartment lymph node recurrence. Conclusions The prognosis of patients with cN0 papillary thyroid carcinoma without elective central compartment neck dissection is good after ten years of follow-up. Male gender and ETE are independent risk factors for lateral compartment lymph node recurrence.

Objective To explore the effect of gender on the concentration of D-dimer between the healthy and the patients with aortic dissection.Methods From January 2015 to January 2016,53 patients with aortic dissection were treated in a hospital and 50 patients of health control group were matched by age,Sysmex CS5100 was used to detect the concentration of D-dimer in the selected population,and the results were analyzed statistically.Results In the same age group,the concentration of D-dimer in healthy control group female was higher than that in male,difference was statistically significant (t=5.357,P<0.05);The concentration of D-dimer in male patients with aortic dissection group was higher than that of female patients,difference was statistically significant(t=-2.041,P<0.05).The concentration of D-dimer in patients with aortic dissection group was higher than that of the healthy control group,difference was statistically significant(t=5.757,P<0.05).Conclusion The concentration of D-dimer between healthy adults and patients with aortic dissection exist gender differences,and it has a certain correlation.

Objective To study the role of OIf-1/EBF associated zinc finger protein (OAZ),a transcription factor encoded by a positional systemic lupus erythematosus (SLE) candidate gene,in the function of mesenchymal stem cells (MSC) of SLE patients by silencing this gene.Methods OAZ mRNA levels of bone marrow MSC obtained from 5 SLE patients and 5 healthy controls were detected by real-time PCR.Bone marrow MSC obtained from 6 SLE patients were incubated with specific siRNAs for 3 days,then cells were harvested for OAZ measurement,Idl-3 and CCL2 mRNA levels were tested by real-time PCR,and levels of CCL2 were detected in culture supernatants using ELISA.Differences between groups were analyzed using t-test or MannWhitney test.Results ① OAZ mRNA levels of bone marrow MSC were significantly elevated in SLE patients (0.013±0.016) compared to healthy controls (0.001±0.000,P=0.009).② After OAZ silencing,the expression levels of OAZ,Id1,Id2 and ld3 mRNA were significantly decreased (△Ct 10.3±0.7,15.2±1.6,8.1±1.4,10.5±0.6 vs 8.7±0.7,14.1±1.2,7.1±1.5,9.8±0.6) (P all ＜0.05).③ Both the expression levels of CCL2 mRNA (△Ct 2.2±1.1 vs 3.0±1.1 ) and the levels of CCL2 protein in culture supernatants [(341±29) pg/ml vs (304±19) pg/ml] were significantly increased in OAZ silencing group comparing to those in the control group (P all ＜0.05).Conclusion OAZ gene expression is significantly elevated in bone marrow MSC of SLE patients.OAZ may affect autoantibody production in SLE patients by regulating CCL2 expression.

BACKGROUND: After reviewing the literature, the author found that most of the epidemiological data related to cancer pain was reported by physicians from the point of view of treatment, or of patients' response to the treatment. Although the nurses in oncology department are most direct participants in the cancer pain management, there is less investigation about the nurses' knowledge, attitudes to and skills of cancer pain management.OBJECTIVE: The purpose of this investigation was to provide information so as to suggest the nursing managers and educators in specifically propagating and disseminating the knowledge of cancer pain management.DESIGN: A sampled investigation.SETTING: Integrated Medicine Ward, College of Clinical Oncology,Peking University.PARTICIPANTS: The participants of this investigation were 128 nurses who took part in the National Tumor Care Academic Exchanges and Seminar Conference held in June 1998.METHODS: This investigation was carried out through a survey questionnaire and the questionnaire was designed on the basis of the Cancer Analgesics Questionnaire (for nurses use only) established by the Oncology Profession Committee of Chinese Nursing Association in 1993, furthermore,suggestions from experts were adopted.MAIN OUTCOME MEASURES:①The perception about "three-step analgesic ladder";②currently most commonly used analgesics in clinical;③assessment methods for cancer pain④knowledge of being addicted to analgesics⑤attitude of nursing staff to cancer pain management.RESULTS: The number of those who could correctly designate the relationship of three steps and pain intensity was 82(64.0% ). Only one person could correctly write down the contents of three steps analgesic ladder (0.7%) . Physician's orders for analgesics for cancer pain in the responders' hospitals were classified into the following types: temporary order:54.0%; when necessary, 38.0%; long-term order, 24.0%. But none of the nurses could mark correctly the range of mild, moderate and severe grade on the scale. Only 49.2% (63/128) of the nurses considered that "The pain scale should be determined according to the cancer patients' self-perception to the pain intensity(chief complaint)" . Among the responders, only 12.5% (16/128) of them accepted that "the incidence of addiction occurred as a result of analgesics used for pain control is less than 1% ". Only 26. 5% (34/128) of the responders could distinguish the concepts of tolerance, physical dependence, and addiction.CONCLUSION: From the results of the investigation, we can see that, the nursing professionals do not have sufficient knowledge about "three-step analgesic ladder". The popularization of related knowledge among nurses has been delayed severely. Nurses will obtain the knowledge of cancer pain management by clinical experience instead of in regular ways. The attitude of nursing personnel to cancer pain treatment is one of the important factors that affect the pain management. The frontline nurses should master the pharmacological characteristics of opioids so as to explain it to the patients and their relations distinctly. Nurses should bring into play a more powerful action in reducing the "addiction-phobia" due to their professional characteristics. We suggest that the latest new progress in cancer pain treatment should be incorporated into the normal textbooks on the management of cancer pain. We also propose that the methods of cancer pain treatment,contents of the principle of drug prescription be included in the training of a medical care personnel of oncology professional before entering into clinic.

Background Magnetic activated cell sorting(MACS)is a new immunomagnetic separation technique.It's principle is based on the specialized recognition between the antibody and antigen.When directed or indirected coupled with the 50 nm magnetic beads,the antibody can linked with the cells which express the corresponding antigen,and then leads to the magnetic cell separation in a high intensity and high-gradient magnetic field.The method has higher separative purity and recovery and been made use of enriching tumor cells and tumor stem cells.It could be also utilized to enrich the rare tumor cells in fluid specimen.Objective To evaluate the enriching efficiency of detecting free cancer cells in analogue malignant ascites using MACS and a panel of tumor-specific markers.Methods Five species of tumor cell lines correlated to the diseases resulting in malignant ascites were selected and the expressions of EpCAM,CAl25,CEA,TAG-72 and their mixture in these tumor cell lines were detected using immunofluorescence reactions and flow cytometry(FCM).The tumor cells were spiked into mononuclear cells by different ratios to analogue the main ingredients of malignant ascites.The efficiency of MACS combinded with mixture antibodies in separating tumor cells was compared with single antibody.Results The FCM revealed that the expression of the mixture antibodies in 5 tumor cancer cell lines was significantly higher than that in single antibody.The mean recovery rates of spiked tumor cells were enhanced by using a panel of monoclonal antibodies combined with MACS than single antibody,especially in two gastric cancer cells and colon cancer cells(69.18%±20.84%VS 45.23%±11.54%,78.75%±15.42%vs 59.73%±16.64%and 85.63%±12.30%VS 76.88%±8.65%,respectively),the ovarian cancer cells was the next(32.49%±3.58%vs31.79%±4.82%),and the liver cancer cells was the lowest(11.78%±0.43%VS 7.16%±0.46%).Conclusions The detection of free cancer cells from malignant ascites by MACS combined with a panel of monoelonal antibodies is more effectively than single antibody.The method has the potencial value of clinical application to the malignant ascites caused by gastroenteric tumor.

Objective To explore the interaction model of social capital, mental health,occupational burnout, turnover intention and the related influence factors on nurses. Methods By random cluster sampling, investigated 723 nurses with Nurses' Turnover Intention Inventory, the Maslach Burnout Inventory, Social Capital Questionnaire and Chinese Health Questionnaire, then explored the interaction model by path analysis. Results Nurses' position can influence their social capital(the path coefficient was 0. 124), social capital and occupational turnout can influence nurses' mental health(the path coefficient were -0. 231,0. 151), the mental health and occupational turnout both can influence nurses' turnover intention directly(the path coefficient were 0. 088,0. 151 ), the model is acceptable(CMIN/DF 1. 645, GFI 0. 984, AGFI 0. 966, IFI 0. 941, CFI 0. 937, RMSEA 0. 037).Conclusion Social capital can provide a new perspective for nurses' management, developing the social capital resources can relieve nurses' mental problems effectively; relieving the turnout and mental problem can decrease nurses' turnover intention finally.

Objective To investigate the appropriate surgical procedure for unilateral papillary thyroid microcarcinoma (PTMC).Methods Clinical data of 323 patients with unilateral PTMC in Cancer Hospital of Chinese Academy of Medical Sciences from 1999-2007 were retrospectively studied.Survival outcomes and prognostic factors were analyzed.Results After a median follow-up of 102 (range,12-188) months,the 10-year overall and disease-specific survival was 95.3％ and 98.9％.The 10-year recurrence-free survival was 85.5％.The 10-year cumulative recurrence rate of residue glands was 6.5％.Capsular invasion,pT stage and clinical stage were significant predictive factors for recurrence of residue glands (all P ＜ 0.05).Cox regression multivariate analysis showed that pT stage (HR 2.153,95％ CI 1.231-3.767,P =0.007) was independent predictive factor.Of the 311 patients treated with non-total thyroidectomy,the 10-year cumulative recurrence rate of residue glands was 6.8％ Conclusions Unilateral PTMC has a good prognosis and hemithyroidectomy (lobectomy and isthmusectomy) is an appropriate surgical pattern.Extrathyroidal extension is a significant predictor for recurrence.

Objective To determine the expression levels of SOCS2 in the mouse livers under starvation, diabetes and obese conditions and to study the effect of SOCS2 on gluconeogenesis.Methods Animals were divided into 3 groups: C57BL/6J mice, the control group was fed ad libtum and the experimental group was fasted for 24 h.Diabetes model db/db and the control db/m mice were fed ad libitum.Obese model ob/ob and the control C57BL/6J mice were fed ad libitum.All the mice above were sacrificed and total RNA was isolated from mouse livers and reverse transcribed to cDNA.The expression of SOCS2 and gluconeogenesis genes in the mouse livers in the 3 groups above were detected by real-time quantitative PCR.SOCS2 was overexpressed in the primary C57BL/6J mouse hepatocytes by the adenovirus system.The effect of SOCS2 on glucose production was measured by glucose output assay.Results C57BL/6J mouse hepatic SOCS2 expression was suppressed by starvation status.The expression of SOCS2 was decreased in the livers of db/db and ob/ob mice.In contrast, the key regulators of gluconeogenesis, PGC-1α, PEPCK and G6Pase exhibited the opposite expression pattern as SOCS2 in the livers underidentical starvation, diabetes and obese conditions.The protein was Mr 23 000 and glucose production was inhibited after SOCS2 being overexpressed in the primary C57BL/6J mouse hepatocytes by adenovirus system.Conclusions SOCS2 may inhibit gluconeogenesis in the C57BL/6J mouse primary hepatocytes, and SOCS2 may be a potential target for the treatment of type Ⅱ diabetes.