Objective To discuss the exposing methods of recurrent laryngeal nerve(RLN)in thyroid surgery for reducing the nerve injury.Methods We analyzed 267 cases with thyroid tumors retrospectively.In all the cases,RLN were anatomically exposed.Results Of all the cases the injury rate of RLN was,0.38%.Conclusion The anatomic relation of RLN is relatively complicated along its journey;the injury of RLN can be reduced with designed exposal during the thyroid surgery.

Objective:When troops take actual combat training in plateau cold field environment, the wounded condition is complicated. The application of remote classification system can improve the efficiency of salvage of patients and reduce the incidence of accidents.Methods: By using front-end transmitting equipment, network equipment and high integration module, on-site real-time acquisition of video, audio and data information can be transmitted to the clinic with high quality by wireless digital way.Results: The rescue efficiency of critical patients and the inspection injury classification efficiency of sick and wounded improved obviously. The medical service support capability of cold plateau area improves significantly.Conclusion: the use of remote classification system will be classified triage work forward, gold for critical seriously injured patient treatment time, greatly improving the rescue success rate of critically ill patients.

Objective To study the mutations of Pseudomonas aeruginosa oprD gene in Imipenem-resistant clinical isolates. Methods Random amplified polymorphic DNA typing(RAPD) was carried out to analyse the homology in 10 Imipenem-resistant clinical isolates. Pseudomonas aeruginosa oprD gene in 10 Imipenem-resistant clinical isolates were amplified by polymerase chain reaction and sequenced. Results Ten Imipenem-resistant clinical isolates were divided into four different clones which can not produce metallo ?-lactamase. As compared with sequence X63152, oprD gene of Pseudomonas aeruginosa varied greatly. The aberration rates exceed 50%. There were multiple point mutations within 276～387 bp coding region of 30, 11, 9, 20, 31 strains. Due to the mutations of 308 bp G→C and 344 bp C→A, threonine and diaminocaproic acid were replaced by serine and threonine respectively. The DNA deletion of 393～412 bp in oprD gene contributes to the frame shift mutation in the following nucleotide sequence. The deletion of 264～273 bp in the coding region of oprD gene in 13 and 21 clone strains leads to frame shift mutations forming terminal codon TAA(319～321 bp).Base substitutions and multiple point mutations were obvious in the coding regions of 1 and 22 clone strains. Their aberration rates were 54.03% and 74.89% respectively. Conclusions The mutations of Pseudomonas aeruginosa oprD gene in Imipenem-resistant clinical isolates are various.

Objective To explore the changed rules and the diagnositic methods of the cardisc functions after chest impact trauma(CIT).Methods The medals of moderate to severity CIT were established using BIM-Ⅱ Bio-impactor in 20 rabbits.The cardiac functions were examined with cardiac catheterization,single photon-emission computed tomography(SPECT)and the Doppler echocardiography at pre end post 1h,4h,8h and 24h after CIT.Results The cardiac functions were changed significantly after CIT.The expressions of the right ventricular dysfunctions mainly were systolic dysfuction while the left ventricular dysfunctions mainly were diastolic dysfunction after CIT.Conclustion All the cardiac catheterization、SPECT and the Doppler echocardiography are beneficial to the diagnosis of cardiac dysfunction afte CIT.The SPEGT is more exactitude and the Doppler echocardiography is more cheaper compared with non-invasive approaches.

Objective To explore the changes and the significance of left ventricular functions after blunt chest trauma(BCT)in rabbits.Methods 36 rabbit models of BCT with BIM-Ⅱ Bio-impactor in were used to observe the changes of left ventricular functions and free calcium,free calmodulin and total calmodulin were detected at pre-injury,the 2nd,4th,8th,12th and 24th hour after injury.Results The cardiac function were impaired.The systolic functions of left ventricle were impaired and recovered during 4-12 hour after BCT.The diastolic functions of left ventricle were impaired but not recovered 24h after BCT.The free calcium and total calmodulin in myocardial cells were increased from the 4th hour,reached,peak at the 8th hour post-BCT(P＜0.01),and then decreased,but were still higher at the 24th hour post-BCT than that of pre-BCT(P＜0.05).The free calmodulin in myocardial cells was low and reached peak at the 8th hour after BCT(P＜0.01).There is remarkable positive correlation between free calcium in myocardial cells and LVEDP and dp/dtmax with cardiac function(P＜0.05,P＜0.01).Conclusion The cardiac function is obviously changed after BCT,especially the diastolic functions of left ventricle.The hish concentration of free calcium in myocardial ceils may be one of the reasons of cardiac dysfunction after BCT.

Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Objective To assess antifungal activity of aspirin and fluconazole administered alone or in combination against Candida albicans biofilms in vitro,and to evaluate the combined effect of these two drugs.Methods The MIC50 of aspirin and fluconzole against biofilm-associated adherent cells were determined respectively,then the efficacy of combinations of aspirin and fluconazole were evaluated by calculating the fractional inhibitory concentration (FIC) index.The influence of aspirin on the mRNA expression of gene ALS3,HWP1 in biofilm cells were analyzed by fluorescent quantitative PCR assay.Results The MIC50 of aspirin for ATCC64550,clinical strains 14215,15346,15538,16335 were ＞ 1440 mg/L,＞ 1440 mg/L,1440 mg/L,720 mg/L and 1440 mg/L respectively,the MIC50 of fluconazole for biofilms cells of all the strains were ＞ 64 mg/L.Aspirin did not enhance the antifungal effect of fluconazole against biofilm formed by ATCC64550,but synergistic and additive effects were found for the combination of aspirin and fluconazole to block the biofilm formation by clinical isolates (FIC index =0.75,0.5,0.75,0.75).Quantitative real-time PCR analysis showed aspirin could reduce the transcript level of ALS3 and HWP1.Conclusion Aspirin could inhibit C.albicans biofilm formation; it may increase the sensitivity of biofilm cells of C.albicans to fluconazole.

Objective:To study the methods of protecting recurrent laryngeal nerve(RLN) in endoscopic thyroidectomy through the upper part of sternum.Methods:The clinilical data of 46 cases underwent endoscopic thyroidectomy through the upper part of sternum was analyzed.RLN was revealed when we performed nodulectomy or partial thyroidectomy.But during subtotal and near-total thyroidectomy the RLN was always revealed.Results:Forty-five of forty-six cases were compeleted successfully with endoscopic thyroidectomy.One case was converted to open thyroidectomy because of thyroid carcinoma.No intraoperative or postoperative hemorrhage,RLN injuried and deadlimb occurred.Conclusion:In order to reduce the injury of RLN,we should select the fitting cases strictly,master the opportunity and methods of revealed RLN.

OBJECTIVE To study the antimicrobial susceptibility and molecular epidemiology of imipenem-resistant Pseudomonas aeruginosa isolated from patients in burn wards in a hospital of Guangzhou. METHODS A total of 48 imipenem-resistant isolates were collected,antimicrobial susceptibility was tested by KirbyBauer disk diffusion method.Random amplified polymorphic DNA(RAPD) typing was carried out to analyze the homology. RESULTS All isolates were multiresistant,the orders of sensitivity rates of antibiotics were CIP,TOB,AMK,GEN,and FEP.Forty eight strains were classified into types A,B,C,and D based on RAPD pattern,types A and B were the most epidemic clones. CONCLUSIONS The prevalence of imipenemresistant P.aeruginosa in burn wards of the hospital is due to nosocomial infection.The prevalent strains are multiresistant.

OBJECTIVE To analyze homology,antimicrobial susceptibility and metallo-?-lactamase gene type of metallo-?lactamase producing Pseudomonas aeruginosa in burn wards.METHODS Antimicrobial susceptibility tests were performed with E-tests.Using 2-mercaptoethanol disc synergy test to screen metallo-?-lactamase(positive) strains from imipenem-resistant P.aeruginosa in burn wards.Metallo-?-lactamase gene and integrase gene were amplified and sequenced.Resistance plasmid transfer and curing experiments were implemented to study the transfer of imipenem resistance and plasmid DNA was extracted and purified with Qiagen Plasmid Mini Kit.Random amplified polymorphic DNA(RAPD) typing was carried out to analyze the homology of the isolates.(RESULTS) Six strains of P.aeruginosa were suggested to produce metallo-?-(lactamase) by 2(-mercaptoethanol) disc synergy test.Using primers described for bla(VIM),the amplifications were observed among all 6 isolates and a VIM-2 metallo-?-(lactamase) gene was identified by sequencing.All isolates which producing VIM-2 metallo-?-(lactamase) had class 1 integrase gene and derived from a same clonal origin.CONCLUSIONS(VIM-2) metallo-?-(lactamase) producing P.aeruginosa is prevalent in burn wards,all isolates which producing VIM-2 metallo-?-(lactamase) have class 1 integrase gene.