The evolution of renewable energy and its impact on employment in China: assessing the role of education.

Renewable energy has an established role in improving environmental quality and economic growth. However, the nexus between renewable energy, education, and employment have yet to be disclosed in detail. Therefore, our primary focus in this analysis is to investigate the impact of renewable energy investment and education on the employment level in China. The empirical analysis is based on the novel quantile autoregressive distributed lag (QARDL) technique that can measure the estimates across quantiles. From the estimates of the QARDL model, we confer that renewable energy investment and education significantly and positively impact the employment level in China in the long run. In short-run, renewable energy investment does not have any noticeable impact on the employment level, while the rise in the education level help increases the employment rate in China. Moreover, the long-term positive impact of economic growth and information and communications technology (ICT) is more pronounced.

Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study.

BACKGROUND: Maternal and child health (MCH)-related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. OBJECTIVE: This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. METHODS: A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks' gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women's self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. RESULTS: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). CONCLUSIONS: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings.

Isolated systolic hypertension and insulin resistance assessment tools in young and middle-aged Chinese men with normal fasting glucose: a cross-sectional study.

The vital role of insulin resistance (IR) in the pathogenesis of isolated systolic hypertension (ISH) has been expounded at the theoretical level. However, research on the correlation between some specific IR indicators and ISH is still rare, especially at different glycemic statuses. We conducted this study to explore the association between three IR indicators and ISH among young and middle-aged adults with normal fasting plasma glucose (NFG). This large cross-sectional study included 8246 young and middle-aged men with NFG and diastolic blood pressure < 90 mmHg. The homeostasis model assessment for IR (HOMA-IR) index, triglyceride glucose (TyG) index, and the metabolic score for IR (METS-IR) were calculated with the corresponding formula. The proportions of ISH among young and middle-aged men were 6.7% and 4.4%, respectively. After fully adjusting, only HOMA-IR rather than TyG and METS-IR was significantly associated with ISH. Moreover, fully adjusted smooth curve fitting showed that the association between HOMA-IR and ISH were approximately linear in both two age groups (P for non-linearity were 0.047 and 0.430 in young and middle-aged men, respectively). Among young and middle-aged men with NFG, using HOMA-IR instead of noninsulin-dependent IR indicators may have advantages in the hierarchical management of ISH. Further longitudinal research may be needed to determine their potential causal relationship.

A novel risk assessment model of contrast-induced nephropathy after percutaneous coronary intervention in patients with diabetes.

The purpose of our study was to develop a simple clinical pre-procedure risk model based on clinical characteristics for the prediction of contrast-induced nephropathy (CIN) and major adverse cardiac events (MACEs) after percutaneous coronary intervention (PCI) in patients with diabetes. A total of 1113 patients with diabetes who underwent PCI with contrast exposure were randomized into a development group (n = 742) and a validation group (n = 371) in a 2:1 ratio. CIN was defined as an increase of either 25% or 0.5 mg/dL (44.2 µmol/L) in serum creatinine within 72 hours after contrast infusion. A simple CIN risk score based on independent predictors was established. Four variables were identified for our risk score model: LVEF < 40%, acute coronary syndrome (ACS), eGFR < 60, and contrast volume > 300 mL. Based on this new CIN risk score, the incidence of CIN had a significant trend with increased predicting score values of 5.9%, 32.9% and 60.0%, corresponding to low-, moderate- and high-risk groups, respectively. The novel risk assessment exhibited moderate discrimination ability for predicting CIN, with an AUC of 0.759 [95% CI 0.668-0.852, P = .001] in the validation cohort. It also had similar prognostic values for one-year follow-up MACE (C-statistic: 0.705 and 0.606 for new risk score and Mehran score, respectively). This novel risk prediction model could be effective for preventing nephropathy in diabetic patients receiving contrast media during surgical procedures.

Micro-XRF mapping and quantitative assessment of Cd in rice (Oryza sativa L.) roots.

Understanding Cd uptake and distribution in rice roots is important for breeding varieties that do not accumulate Cd in the grain to any large extent. Here, we examined the physiological and molecular factors responsible for Cd uptake and transport differences between two japonica rice cultivars prescreened as high (zhefu7) or low (Xiangzaoxian45) accumulators of Cd in the grain. No significant differences in Cd uptake between the two cultivars were observed; however, Xiangzaoxian45 retained most of the absorbed Cd in the roots, whereas zhefu7 showed higher transport of Cd from the root to the shoot, regardless of the duration of exposure to Cd. The inability to sequester Cd into root vacuoles caused high accumulation of Cd in the grain in zhefu7, whereas inefficient transport of Cd from roots to shoots in Xiangzaoxian45 caused low accumulation of Cd in the grain. Cd sequestration in the roots and transport from the root to the shoot were greatly influenced by the expression patterns of transport-related genes OsHMA3 and OsHMA2, respectively. Further, micro-X-ray fluorescence spectroscopy mapping confirmed that more Cd was sequestered in the roots of Xiangzaoxian45 than in those of zhefu7, with a significant amount of Cd localized in the root hairs, as well as in the meristematic and elongation zones, and dermal and stele tissues. Therefore, we propose that effective Cd sequestration in root vacuoles was the major determinant of divergent Cd-accumulation patterns in the two rice cultivars under study.

Obtaining elevation of Oncomelania Hupensis habitat based on Google Earth and it's accuracy evaluation: an example from the Poyang lake region, China.

Schistosomiasis japonicum is a major zoonosis that seriously harms human health and affects social and economic development in China. The control of Oncomelania Hupensis, the only intermediate host of schistosome japonicum, is one of the integrated measures for schistosomiasis control in China. Acquiring updated elevation data of snail habitat environment, as well as it's spatial analysis, play an important role for the risk evaluation and precise control of schistosomiasis transmission and prevalence. Currently, the elevation database of snail habitat environment in schistosomiasis epidemic areas has not been available in the world, which affects the development of research and application work regarding to snail control. Google Earth(GE) can provide massive information related to topography, geomorphology and ground objects of a region due to its indisputable advantages such as wide use, free charge and rapidly updating. In this paper, taking the Poyang lake region as a example, we extracted elevation data of snail-inhabited environment of the lake from GE and established a elevation correction regression model(CRM) for acquiring accurate geospatial elevations, so as to provide a decision-making reference for snail control and risk evaluation of schistosomiasis in China. We developed a GE Application Programming Interface(API) program to extract elevation data from GE, which was compared with the actual elevation data obtained from topographic map of the Poyang Lake bottom. Then, a correction regression model was established and evaluated by 3 index, Mean Absolute Error(MAE), Root Mean Squared Error(RMSE) and Index of Agreement(IOA) for the accuracy of the model. The elevation values extracted from GE in 15086 sample grid points of the lake ranged from 8.5 m to 24.8 m. After the sample points were divided randomly to three groups, the mean elevations of three groups were 13.49 m, 13.52 m and 13.65 m, respectively, with standard deviation ranged from 2.04-2.06. The mean elevation among three groups has no statistic difference (F = 1.536, P = 0.215). A elevation correction regression model was established as y = 6.228 + 0.485×. the evaluation results for the accuracy of the model showed that the MAE and RMSE before correction was 1.28 m and 3.95 m respectively, higher than that after correction, which were 0.74 and 1.30 m correspondingly. The IOA before correction (-0.40)was lower than that after correction(0.34). Google Earth can directly or indirectly get access to massive information related to topography, geomorphology and ground objects due to its indisputable advantages. However, it still needs to be converted into more reliable and accurate data by combining with pre-processing tools. This study used self-developed API program to extract elevation data from GE through precisely locating and improved the accuracy of elevation by using a correction regression model, which can provide reliable data sources for all kinds of spatial data researches and applications.

Percutaneous device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect.

BACKGROUND: Percutaneous device occlusion and minimally invasive surgical repair for perimembranous ventricular septal defect (pmVSD) are two typical methods to reduce the invasiveness of the conventional operation through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. METHODS: Inpatients with isolated pmVSD who had undergone percutaneous device occlusion or minimally invasive surgical repair from June 2009 to June 2012 were reviewed for a comparative investigation between the two procedures. RESULTS: Procedure success was achieved in 80 percutaneous (93.0%) and in 113 surgical (98.3%) procedures (p=0.076). Percutaneous patients were older, with a smaller VSD size than surgical patients (16±11.7 vs 3.8±2.4 mm, p<0.001; 4.0±1.2 vs 4.3±1.3 mm, p=0.034, respectively). Major complications occurred in 1 percutaneous (1.2%) and in 4 surgical (3.5%) procedures (p=0.602), and minor complications occurred in 27 percutaneous (33.3%) and in 37 surgical (32.2%) procedures (p=0.991). The surgical repair cost 31% less than the device occlusion (¥20,565±¥3,497 vs ¥29,795±¥2,643, p<0.001), where most of the cost was attributed to the occluder in the amount of ¥19,500. CONCLUSIONS: Compared with device occlusion, minimally invasive surgical repair can provide comparable efficacy and complication rates. In addition, it is 31% cheaper than device occlusion. In low-income countries where health care resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.

[Intravascular ultrasound assessment of chitosan/heparin layer-by-layer self assembly coating stent on late stent malapposition and vessel remodeling in porcine model].

OBJECTIVE: To investigate late stent malapposition or vessel remodeling post chitosan/heparin layer-by-layer self assembly coating stent (LBL) implantation in porcine. METHODS: A total of 32 stents [bare metal stent (BMS, n = 9), sirolimus-eluting stent (SES, n = 11) and LBL (n = 12)] were implanted into coronary arteries of 16 porcine. Intravascular ultrasound (IVUS) was performed immediately after stenting and at 1 month after stenting to measure vessel area (VA), stent area (SA) and lumen area (LA). Neointima area (NA) was measured at 1 month post stenting by IVUS to detect signs of stent malapposition and to determine remodeling index (RI). Histopathology was performed at 1 month post stenting to observe vessel wall structure and stent malapposition status. RESULTS: No sign of stent malapposition was detected, VA and SA/LA were similar among groups immediately after stent implantation. At 1 month follow-up, none of three groups showed stent malapposition. VA, SA, NA and LA were (7.30 ± 0.77), (6.83 ± 0.76), (1.40 ± 0.96) and (5.43 ± 0.88) mm(2) in LBL group, (7.13 ± 0.69), (6.63 ± 0.71), (0.28 ± 0.35) and (6.34 ± 0.89) mm(2) in SES group, (7.48 ± 0.70), (7.00 ± 0.52), (2.69 ± 1.58) and (4.31 ± 1.28) mm(2) in BMS group. VA and SA were similar among groups (all P > 0.05). LA in LBL group was smaller than SES group (P < 0.01) and significantly larger than in BMS group (P < 0.05).NA in LBL group was larger than SES group (P < 0.01) and significantly smaller than in BMS group (P < 0.05).RI in LBL, SES and BMS groups was 0.95 ± 0.07, 1.02 ± 0.04 and 0.98 ± 0.04 (P > 0.05). CONCLUSIONS: There is no late stent malapposition or abnormal remodeling post LBL, SES and BMS implantation up to 1 month in this porcine model. LA in LBL group is smaller than SES group and larger than BMS group at 1 month after implantation in this porcine model.

[Virtual histology intravascular ultrasound assessment of coronary atherosclerotic plaques in diabetic patients].

OBJECTIVE: To evaluate the components and characteristics of coronary atherosclerotic plaques in type 2 diabetic patients using virtual histology intravascular ultrasound (VH-IVUS). METHODS: In vivo atherosclerotic plaques (over 50% angiographic diameter stenosis) of the three main coronary arteries were analyzed by gray-scaled IVUS with planar and volumetric VH-IVUS in consecutive patients examined between September 2008 and March 2009. Patients were divided into two groups: diabetic mellitus (DM) group with 22 patients (39 lesions) and non-DM group with 46 patients (69 lesions). RESULTS: At the minimal lumen area (MLA) site, the percentage of NC (necrotic core) area (19.4% +/- 1.2% vs. 15.1% +/- 1.1%, P = 0.015) and dense calcium (DC) area (15.2% +/- 1.6% vs. 10.7% +/- 1.1%, P = 0.016) were significantly larger while fibrotic tissue (FT) area (56.7% +/- 2.3% vs. 64.8% +/- 1.8%, P = 0.007) was smaller in DM group than in non-DM group. Likewise, volumetric VH-IVUS analysis showed that the percentage of NC volume (21.3% +/- 1.3% vs. 16.5% +/- 1.1%, P = 0.008) and DC volume (16.6% +/- 1.4% vs. 11.3% +/- 1.1%, P = 0.003) were significantly larger while FT volume (55.1% +/- 2.1% vs. 63.9% +/- 1.8%, P = 0.003) was significantly smaller in DM group than in non-DM group. Moreover, significantly higher incidence of VH-TCFA (thin-cap fibro atheromas) was evidenced in the DM group than in the non-DM group (69.2% vs. 42.0%, P = 0.009). However, the remodeling index and the positive remodeling frequency were similar between the 2 groups. CONCLUSION: Incidence of necrotic core, dense calcium plaque and vulnerable plaques in stenotic lesions was higher in DM patients than in non-DM patients.

Quantitative and qualitative assessment of non-obstructive left main coronary artery plaques using 64-multislice computed tomography compared with intravascular ultrasound.

BACKGROUND: There are few reports of quantitative and qualitative measuring of left main coronary artery (LMCA) plaques by multislice computed tomography coronary angiography (MSCTA), especially when compared with intravascular ultrasound (IVUS) as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS. METHODS: A total of 91 patients (53 men, 38 women, mean age (64.78 +/- 9.19) years) were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index (kappa) for the agreement between MSCTA and IVUS was calculated. Minimal lumen area (MLA), external elastic membrane cross-sectional area (EEM-CSA) and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques. RESULTS: The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index (kappa = 0.744, P < 0.001) indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 (P < 0.01). The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively (both P < 0.01). The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were (52.52 +/- 15.71) HU, (108.32 +/- 43.44) HU and (604.16 +/- 377.67) HU (P < 0.001). Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%. CONCLUSIONS: Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.

[Intravascular ultrasound assessment of sirolimus-eluting stent restenosis or thrombosis after stent implantation].

OBJECTIVE: To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). METHODS: IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (no-event group) underwent SES implantations. RESULTS: Compared with the no-event group, minimum stent area [MSA, (4.6 +/- 1.6) mm(2) vs. (5.8 +/- 1.6) mm(2), P < 0.01], minimum stent diameter [(2.2 +/- 0.5) mm vs. (2.5 +/- 0.4) mm, P < 0.01], and stent expansion [(69.2 +/- 20.7)% vs. (80.6 +/- 17.2)%, P < 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0 +/- 0.6 vs. 1.7 +/- 0.6, P < 0.05) was significantly larger in the event group. Incidence of MSA < 4.0 mm(2) (43.3% vs. 14.7%, P < 0.01) and stent expansion < 60% (40.7% vs. 11.8%, P < 0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0 +/- 15.5)% vs. (38.4 +/- 17.6)%, P < 0.01]. Independent predictors of post SES ISR or early thrombosis were MSA (OR:0.7, 95%CI:0.5 - 0.8, P < 0.01) and proximal residual plaque burden (OR: 280.7, 95%CI: 17.2 - 40 583.6, P < 0.01). CONCLUSION: Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.

Assessment of left ventricular segmental function after autologous bone marrow stem cells transplantation in patients with acute myocardial infarction by tissue tracking and strain imaging.

BACKGROUND: Emerging evidence suggests that stem cells can be used to improve cardiac function in patients after acute myocardial infarction. In this randomized trial, we aimed to use Doppler tissue tracking and strain imaging to assess left ventricular segmental function after intracoronary transfer of autologous bone-marrow stem cells (BMCs) for 6 months' follow up. METHODS: Twenty patients with acute myocardial infarction and anterior descending coronary artery occlusion proven by angiography were [corrected] randomized into intracoronary injection of bone-marrow cell (treated, n = 9) or diluted serum (control, n = 11) groups. GE vivid 7 and Q-analyze software were used to perform echocardiogram in both groups 1 week, 3 months and 6 months after treatment. Three apical views of tissue Doppler imaging were acquired to measure peak systolic displacement (Ds) and peak systolic strain (epsilonpeak) from 12 segments of LV walls. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were obtained by Simposon's biplane method. RESULTS: (1) 3 months later, Ds and epsilonpeak over the infract-related region clearly increased in the BMCs group [Ds: (4.49 +/- 2.71) mm vs (7.56 +/- 2.95) mm, P < 0.01; epsilonpeak: (-13.40 +/- 6.00)% vs (-17.06 +/- 6.05)%, P < 0.01], but not in the control group [Ds: (4.74 +/- 2.67) mm vs (5.01 +/- 3.23) mm, P > 0.05; epsilonpeak: (-13.84 +/- 6.05)% vs (-15.04 +/- 6.75)%, P > 0.05]. At the same time, Ds over the normal region also increased, but the Ds enhancement was markedly higher in the BMCs group than that in the control group [(3.21 +/- 3.17) mm vs (0.76 +/- 1.94) mm, P < 0.01]. Parameters remained steady from the 3rd to 6th month in either group (P > 0.05). (2) LVEF in treated and control groups were almost the same at baseline (1st week after PCI) [(53.37 +/- 8.92)% vs (53.51 +/- 5.84)%, P > 0.05]. But 6 months later, LVEF in the BMCs group were clearly higher than that in the control group [(59.33 +/- 12.91)% vs (50.30 +/- 8.30)%, P < 0.05]. (3) There were no evident difference in EDV or ESV between two groups at baseline [EDV: (113.74 +/- 23.24) ml vs (129.94 +/- 32.72) ml, P > 0.05; ESV: (57.12 +/- 18.66) ml vs (62.09 +/- 17.68) ml, P > 0.05]. Three months later, EDV and ESV in the control group were markedly greater than those in the BMCs group [EDV: (154.89 +/- 46.34) ml vs (104.85 +/- 33.21) ml, P < 0.05; ESV: (82.91 +/- 35.79) ml vs (49.54 +/- 23.32) ml, P < 0.05]. But EDV and ESV did not change much from 3rd to 6th month in either group (P > 0.05). CONCLUSIONS: Emergency transplantation of autologous BMCs in patients with acute myocardial infarction helps to improve global and regional contractility and attenuate post-infarction left ventricular remodeling. Tissue tracking and strain imaging provide quick, simple and noninvasive methods for quantifying left ventricular segmental function in humans.

[Value of low dose dobutamine real-time myocardial contrast echocardiography in the assessment of coronary artery disease].

OBJECTIVE: To evaluate the value of quantitative real-time myocardial contrast echocardiography (RT-MCE) combined with low dose dobutamine stress test in the detection of coronary artery disease (CAD), and to assess the contribution of collateral blood flow (CBF) to myocardial perfusion. METHODS: Twenty-six hospitalized patients referred for coronary angiography and subsequent revascularization underwent routine echocardiography, RT-MCE at baseline and after low dose dobutamine administration. The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve by using the QLab software. RESULTS: At baseline, both beta and A x beta (but not A) were decreased with the increase of severity of coronary stenosis (P < 0.01). Under dobutamine stress, A, beta and A x beta values were decreased with the increase of severity of coronary stenosis (P < 0.01), Graded decreasing in the reserves of A, beta and A x beta were observed with increasing coronary stenosis severity (P < 0.01). Furthermore, significant differences in beta, A x beta, and WMS were observed between segments with CBF and those without. CONCLUSION: Quantitative RT-MCE in conjunction with dobutamine stress can be used as a sensitive measure to identify and stratify CAD as well as to assess the contribution of collateral blood flow.

[Phonation reconstruction and function assessment after total and near-total laryngectomy].

BACKGROUND & OBJECTIVE: Total laryngectomy is a common surgery pattern for treating laryngeal and hypopharyngeal cancer, but patients will lost phonation function after operation. This study was to retrospectively analyze usage of modified Amatsu, and modified Pearson operation in treating laryngeal and hypopharyngeal cancers, and to analyze phonation function by subjective and objective assessment. METHODS: Clinical data of 69 patients with laryngeal or hypopharyngeal cancer treated by total or near-total laryngectomy (modified Amatsu or modified Pearson operation) in our department from 1996 to 2003 were retrospectively analyzed. Phonation function of 69 patients was evaluated by acoustic analysis and Jiyan classification method, and compared with phonation quality of patients received vertical hemilaryngectomy (VHL) and healthy people. RESULTS: No patient appeared obvious aspiration. Four cases with post-operative radiotherapy all regained phonation function. The 3-year survival rate was 88% (22/25); 5-year survival rate was 80% (4/5). Results of acoustic assessment, and Jiyan classification method indicated that phonation function of patients received modified Amatsu or modified Pearson operation could meet daily requirements. CONCLUSIONS: Modified Amatsu and modified Pearson operations can be learnt and applied easily for phonation reconstruction after laryngectomy. They may be optional surgery patterns, especially modified Pearson operation.