Objective To explore the value of biopsy of lymph nodes alongside of internal jugular vein in surgery for papillary thyroid carcinoma(PTC) patients at CN 0 stage.Methods Clinical data of 103 PTC patients with operation at CN 0 stage were retrospectively analyzed.The lymph node ratio alongside of internal jugular vein was counted,and factors,such as gender,age,tumor size,capsular foreign invasion were analyzed.Results Of all 103 cases of papillary thyroid carcinoma at CN 0 stage,32 cases had lymph node metastasis alongside of internal jugular vein(31.1％).Meanwhile 31 cases had the thyroid capsule invasion,and 21 cases had lymph node metastasis alongside of internal jugular vein(67.7％).The rest 72 cases had no the thyroid capsule invasion,and 11 cases had lymph node metastasis alongside of internal jugular vein(15.3％),the difference was statistically significance(x2 =27.85,P ＜ 0.05).Conclusion Routine biopsy of lymph nodes alongside of internal jugular vein is necessary of papillary thyroid carcinoma patients at CN 0 stage.Whether the thyroid capsule is invased which is important factors affecting lymph node metastasis alongside of internal jugular vein.

Objective To investigate the effect of different anticoagulant drugs on the changes of coagulation index and the incidence of hemorrhage in hemodialysis patients.Methods 40 patients with hemodialysis were selected as study objects,according to the random number table method they were divided into three groups,20 cases received heparin in A group,10 cases received low molecular heparin in B group;10 cases received argatroban in C group.At the same time,10 healthy persons were selected as control group.The activated glass bead clotting time (gbACT),blood velocity (CR),platelet function (PF),prothrombin fragment 1+2 (PF1+2) and the surface of platelet alpha granule membrane protein (GMF-140) were observed and analyzed in all patients.Results Compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine in A group were significantly increased,which were (31.1±5.5)sig/min,(3.1±0.5),(478.2±74.3)pmol/L,(36.9±6.6)pmol/L,respectively,gbACT was significantly prolonged [(196.1±27.3)s].In A group,compared with before taking to machine,the CR,PF,PF1+2 and the GMF-140 before taking off machine were significantly decreased,which were (10.6±3.2)sig/min,(1.8±0.4),(400.1±85.5)pmol/L,(30.9±6.8)pmol/L,respectively,gbACT was significantly prolonged[(252.5±50.4)s],there were statistically significant differences (F=112.64,28.38,81.40,18.11,21.63 0.05,all P<0.05);B group compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine were significantly increased,which were (29.5±6.6)sig/min,(2.9±1.2),(475.5±97.0)pmol/L,(37.5±7.0)pmol/L,respectively,gbACT was significantly prolonged[(193.9±32.8)s].In B group,the CR and PF1+2 before taking off machine were significantly decreased,which were (22.3±6.8),(407.8±90.3)pmol/L,respectively,gbACT was significantly prolonged [(207.5±31.5)s],there were statistically significant differences (F=9.11,57.81,5.99,16.37,all P<0.05);C group compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine were significantly increased,which were (26.1±3.3)sig/min,(2.5±0.5),(443.5±64.1)pmol/L,(32.2±8.3)pmol/L,respectively,before taking off machine,the CR[(23.7±4.1)] was higher than (18.5±3.6) of the control group,there were statistically significant differences (F=11.14,3.04120.30,8.63,all P<0.05).40 hemodialysis patients were successfully treated without the occurrence of elevated venous pressure during and after treatment pipeline no or slight residual blood,puncture time and no significant prolongation.Conclusion Unfractionated heparin has strong anti-clotting effect,during and after hemodialysis has greater risk of bleeding,dalteparin has anticoagulant effect,but there is greater risk of bleeding during hemodialysis,the use of argatroban helps to improve the condition of bleeding.

-mid stage ONFH. It provided good blood supply and enough mechanical support as to reduce the progress of femoral head collapse.

Objective To probe into the microsurgical method of using arthroscope in treating ischemic necrosis of femoral head(INFH) Method Twenty six cases (33 hips) with early stage of INFH were operated by vascularized greater trochanter bone flap graft through the lateral acetabulum approach under the surveillance of arthroscope Result The follow up ranged from 1 to 3 years Function evaluation was made according to pain,function,joint activity and radiographic criteria The clinical results were satisfactory Conclusion With this method, can accurately clean the sequestra and reconstruct the blood supplying system of femoral head At the same time, the injury of the peripheral muscle of hip joint and ligament can be further reduced and the function of hip joint can be recovered maximally So the method of applying arthroscope and microsurgical technique to treat early stage INFH is a simple, convenient and effective method

Objective:To analyze therapeutic effect and safety of triple intensive anti -platelet therapy on patients with acute myocardial infarction (AMI) complicated type 2 diabetes mellitus (T2DM) .Methods:A total of 100 AMI + T2DM patients were enrolled and equally divided into routine treatment group (received aspirin and clopi‐dogrel treatment based on routine treatment ) and tirofiban group (received tirofiban based on routine treatment group) .Platelet count (PLT) ,platelet activating factor (PAF) ,prothrombin time (PT) ,activated partial thrombo‐plastin time (APTT) ,fibrinogen (Fg) ,left ventricular ejection fraction (LVEF) ,left ventricular fractional short‐ening (LVFS) ,stroke volume (SV) and therapeutic effect were measured and compared between two groups .All patients were followed up for six months ,incidence rates of major adverse cardiovascular events (MACE) and vari‐ous hemorrhage events were compared between two groups .Results :Compared with routine treatment group ,there were significant reductions in PLT [(18.2 ± 2.5) 109/L vs .(15.8 ± 1.4) 109/L] and PAF [(138.6 ± 10.2)μg/L vs . (61.5 ± 3.1)μg/L] (P<0.05 ,<0.01);and significant rise in LVEF [ (56.9 ± 5.2)% vs .(64.2 ± 4.6)% ] ,LVFS [ (30.4 ± 3.3)% vs .(39.8 ± 4.5)% ] ,SV [ (43.2 ± 3.4) ml vs .(74.5 ± 4.6) ml] and total effective rate (76.0%vs .96.0% ) in tirofiban group , P<0.05 all .After six-month follow-up ,there were no significant difference in incidence rates of MACE and bleeding between two groups , P>0.05 all .Conclusion:Therapeutic effect of triple in‐tensive anti-platelet therapy is significant in AMI + T2DM patients ,and its adverse reactions and prognosis have no difference with those of dual anti -platelet therapy .

This paper introduced the scheme,form and measures of implementing problem-based learning in the teaching practice of human central nervous system anatomy.This paper discussed on the depth and scope of the issue,how to mobilize the enthusiasm of the students in the process of discussion,how to be conscious of curriculum knowledge system and logic in the teaching process,how to make students expose to clinical at early stage,how to provide corresponding assessment methods and other aspects of the practice in an aim to help peers to improve the teaching practice.

10% was found in 5 patients (16%). Mesothelial hyperplasia was found to be significantly higher in patients with PTE than that in the control group (P

Objective:To analyze the clinical therapeutic effect and safety of bare metal stent (BMS)application in patients with coronary heart disease (CHD)complicated impaired glucose tolerance (IGT).Methods:The data of 68 CHD + IGT patients undergoing stent implantation in our hospital were retrospectively analyzed.According to kind of implanted stents,they were divided into BMS group (n=36)and drug eluting stent (DES)group (n=32). Thrombolysis in myocardial infarction (TIMI)flow grade and Gensini score of coronary lesion were compared be-tween two groups via reviewing coronary angiography six months after operation.Incidence rates of re-stenosis,a-cute thrombosis,sub-acute thrombosis,revascularization and sudden death were compared between two groups after one year follow-up.Results:There were no significant difference in TIMI grade and Gensini score of coronary le-sion between two groups after operation (P>0.05).Compared with DES group after one-year follow-up,there were significant reductions in incidence rates of acute thrombosis (6.25% vs. 2.78%), sub-acute thrombosis (15.63% vs.5.56%)and sudden death (6.25% vs.2.78%)in BMS group (P<0.05 all),but there were no signif-icant difference in incidence rates of re-stenosis and revascularization between two groups (P>0.05).Conclusion:Application of bare metal stent can reduce incidence rate of postoperative complications and possess better therapeu-tic effect in patients with coronary heart disease complicated impaired glucose tolerance.

Objective To analyze retrospectively the clinical efficacy that the application with vascularized greater trochanter to reconstruct the collapse of femoral head necrosis.Methods Followed-up the data of 21 patients who underwent reconstruction of the femoral head from January,2008 to December,2012,by this we made the clinical and radiological assess,Harris hip scoring system was used to evaluate the situation of hip function.All patients were followed up regularly for X-ray film (after 3 months,6 months and then be reviewed once a year),by the film we assessed the bone healing and repair of the femoral head,and determined whether had the progress in phases.The clinical survival was decided by receiving or not the arthroplasty.Results All 21 patients were followed up for 24-72 months,with an average of 47 months.The postoperative Harris hip score was 82.8 ± 7.1 points,compared with the preoperative,the score improved significantly (average 52.4 ± 4.3 points for preoperative),the difference was statistically significant (P ＜ 0.05).Based on Ficat stage for osteonecrosis,8 patients in this group had progress after 24 to 48 months (mean 33 months),whose femoral heads got collapse worsened.The radiographic success rate was 61.9％.Six cases received arthroplasty in 18 to 48 months (mean 34 months) due to progressive collapse of the femoral head or severe hip pain,or both.FicatⅢ contained 25％ (4 hips),and Ⅳ had 40％ (2 hips),the clinical survival rate was 71.4％.Conclusion The application with vascularized greate.r trochanter transfer coverage to rebuild the collapse of the femoral head in patients with osteonecrosis is a good way.It' s worthy to be applied.

Objective To investigate the clinical effect of the iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease.Methods Followed-up 18 patients with Legg-Calvé-Perthes disease who had undergone the treatment of iliac periosteal flap with ascending branch of lateral femoral circumflex artery from January,2008 to May,2012 in our hospital.Minimum follow-up time was from 24 to 60 months,and the average time was 38 months.The followed-up period ended in May,2014.Assessed the effect of surgery by X-ray,clinical examination and Harris scoring system.Results Sixteen patients had good healing with iliac periosteal flap according to X-ray show.Their epiphyseal height recovered and the femoral head rounded gradually.Two cases became flat and collapse.The result of excellent and good rate was 88.9％ by Mose method combined with the results of X-ray.The average Harris hip score improved from 72.3 ± 4.9 points preoperatively to 91.3 ± 2.4 points postoperatively.The difference of the result was statistically significant (P ＜ 0.05).Conclusion The transfer of iliac periosteal flap with ascending branch of lateral femoral circumflex artery is an effective treatment for Legg-Calvé-Perthes disease.