Objective To observe the effect of acupoint sticking plus cervical plexus block anesthesia on post-operative pain in patients undergone subtotal thyroidectomy.Method Sixty patients who were going to receive unilateral subtotal thyroidectomy were randomized into group A and group B, 30 cases in each group. Group A was intervened by acupoint sticking plus cervical plexus block anesthesia, while group B was by cervical plexus block anesthesia alone. The Visual Analogue Scale (VAS) scores under static and swallowing condition were recorded at 6 h, 12 h, 24 h, and 48 h after the operation. Tramadol hydrochloride tablets were given to help cease pain when static incision VAS>3, and the total dose and adverse reactions in 48 h after the operation were recorded.Result There were no significant differences in comparing the VAS scores at static and swallowing status between the two groups at 6 h, 12 h, 24 h, and 48 h after the operation (P>0.05). The total dose of Tramadol hydrochloride tablets used in 48 h after the operation was (110±55)mg in group A, versus (210±48)mg in group B, and the difference was statistically significant (P<0.05). There was a significant difference in comparing the occurrence rate of adverse events in 48 h after the operation between the two groups (P<0.05).Conclusion Acupoint sticking plus cervical plexus block anesthesia can effectively alleviate the pain after subtotal thyroidectomy, reduce the use of analgesics in 48 h after the operation, and lower the occurrence rate of post-operative adverse events.

Objective To discuss the application and effect of predictive care in stage divided treatment and salvage of children's persistent status of epilepsy (SE).Methods Sixty-four children with SE were admitted to the First Peoples Hospital of Wenling in Zhejiang Province from December 2014 to December 2016 as the research objects, a controlled study was adopted, in which the stage divided therapeutic method was compared with the conventional method for treatment of SE, and the children were divided into an observation group and a control group, 32 cases in each group. Foresight treatment method was used in the observation group: the first stage of treatment (early treatment or pre-hospital treatment) was intravenous injection of the first-line drugs (benzodiazepines); the second stage of treatment (progressive stage treatment or initial treatment) mainly used epileptic drugs to prevent recurrence; the third stage treatment (referred to after the first-line drug in combination with one second line antiepileptic drug treatment, the disease was still unable to be controlled) adopted the mild hypothermia therapy to reduce the SE attack amplitude and decrease recurrence; in terms of aspects of predictive nursing measures, the respiratory tract nursing, basic nursing, the prediction of complications and their nursing, etc. were implemented. The routine nursing without care about the stages was carried out in the control group. The SE control time, skin lesions, false aspiration, lung infection, tongue bite, cerebral edema, etc. the incidenceof complications were observed in two groups of children.Results The SE control time was significantly shorter in observation group than that in the control group (minutes: 18.13±3.15 vs. 25.19±2.69,P < 0.05), and the incidence of complications was obviously lower in observation group than that in the control group [6.25% (2/32) vs. 28.13% (9/32),P < 0.05]. Conclusion Using different therapy at different stages of children SE combined with predictive care can effectively shorten the SE control time, decrease the incidence of complications and elevate the therapeutic and nursing effects.

AIM: To evaluate the efficacy and safety of etoposide combined with carboplatin in the treatment of recurrent medulloblastoma in children. METHODS: From January 2011 to June 2014, 72 children (aged 3-15 years) with recurrent medulloblastoma were selected from Children's Hospital Affiliated to Medical College of Zhejiang University. According to the random number table method, they were divided into the CE group and control group, with 36 cases each. The CE group received etoposide + carboplatin for chemotherapy. The control group received classical irinotecan + temozolomide + vincristine chemotherapy. Clinical efficacy, KPS score, PedsQLTM4.0 score, total survival (OS) and event-free survival (EFS) of children in the two groups were compared, and the occurrence of adverse drug reactions during treatment was recorded. RESULTS:After treatment, CR of CE group and control group was 41.67% (15 cases/36 cases) and 27.78% (10 cases/36 cases), OR of CE group and control group was 94.44% (34 cases/36 cases) and 77.78% (28 cases/36 cases), and there were statistically significant different in these indicators between the groups. There was no significant difference in KPS scores and PedsQLTM4.0 scores between the two groups before treatment (P>0.05). After treatment, KPS scores of the CE group and the control group were (80±8) and (75±10) points, and PedsQLTM4.0 scores were (89±11) and (84±11) points, and there were statistically significant different in these indicators between the groups (both P<0.05). By the time of the last follow-up, the overall survival rates of the CE group and the control group were 78.8% (26 cases/33 cases) and 55.9% (19 cases/34 cases), respectively, with statistically significant differences (P<0.05), and the EFS rates were 72.7% (24 cases/33 cases) and 52.9% (18 cases/34 cases), respectively, with no statistically significant differences (P>0.05). A total of 10 cases with severe adverse reactions occurred during chemotherapy in the CE group, with an incidence of 27.78% (10 cases/36 cases), and 9 cases of that occurred during chemotherapy in the control group, with an incidence of 25.00% (9 cases/36 cases), with no statistical significance (P>0.05). CONCLUSION: Etoposide combined with carboplatin regimen can significantly improve the clinical remission rate and improve the overall survival of children without increasing adverse reactions to chemotherapy, but the effect on event-free survival was not obvious.

Objective To investigate the clinical effect of modified storage type of autologous blood transfu-sion combined with shed blooding retransformation technique after OrthoPAT for artificial total knee arthroplasty. Methods 70 patients with total knee replacement were randomly divided into observation group and control group, 35 cases in each group.The observation group was treated with the modified storage autotransfusion combined shed blooding retransformation technique after OrthoPAT,while the control group was given conventional allogeneic blood transfusion.The hemoglobin values and blood coagulation function of the two groups at immediately before anesthesia and surgery,10min before autologous blood transfusion and after reinfusion of 15min,after 6h and 24h of surgery were recorded,and the drainage blood total value,allogeneic blood transfusion measurement issues and transfusion rate after 24h were recorded.Results The hemodynamics of the two groups were stable at each time,there were no difference at urine volume (all P >0.05).The coagulation conditions were normal of the two groups at each time,there were no statistically significant differences between the two groups (all P >0.05).The average volume and homologous blood transfusion rate in the observation group were (126.3 ±6.5)mL,1 /35,which were significantly lower than those in the control group [(476.4 ±10.6)mL,2 /35],the differences were statistically significant (t =10.73,χ2 =6.31,all P <0.05).The incidence rate of postoperative complication of the observation group was 5.7%,which was signifi-cantly lower than 22.9% of the control group,the difference between the two groups was statistically significant (χ2 =4.93,P <0.05).Conclusion The improved storage type of autologous blood transfusion combined with shed bloo-ding retransformation technique after OrthoPAT has exact effect for artificial total knee arthroplasty,the incidence of adverse reactions is low,as well as the low blood transfusion rate.

Objective To study the effect of total knee arthroplasty after limb position on postoperative hemorrhage,to provide basis for clinical diagnosis and treatment.Methods 270 cases of total knee arthroplasty were selected.The patients were divided into groupⅠ,group Ⅱand group Ⅲ according to the random number table method, 90 cases in each group.Patients of group Ⅰ with limb hip and knee were straight,group Ⅱ hip joint elevation of 45 degrees,70 degrees of knee flexion,group Ⅲ hip joint elevation of 45 degrees,the knee extension.All the patients were intervened for 12h after operation,were placed drainage bag 24 hours.The lead flow,preoperative,postoperative hemoglobin and 5 days after the knee joint activity were compared in the three groups.Results Induced flow after surgery in group Ⅰ was (433.4 ±25.3)mL,which was significantly higher than (402.6 ±19.6)mL and (403.5 ± 21.5)mL in group Ⅱand group Ⅲ,and the differences were statistically significant (t =5.253,5.301,all P <0.05),there was no significant difference of induced flow between groupⅡ and group Ⅲ(P >0.05).The hemoglobin levels of the three groups were (92.3 ±4.2)g/L,(114.9 ±6.4)g/L and (113.2 ±7.5)g/L,which were significantly decreased after operation,the differences were statistically significant compared with before operation (t =5.083, 6.034,7.893,all P <0.05),the hemoglobin after surgery of group Ⅰ was significantly lower than group Ⅱ and groupⅢ,the differences were statistically significant (t =6.423,7.043,all P <0.05),there was no significant difference between group Ⅱ and group Ⅲ (P >0.05).There was no significant difference of range of motion in the three groups after 5 days of operation (P >0.05).Conclusion Hip flexion can effectively reduce bleeding after total knee arthro-plasty,the flexion and extension of knee joint had no significant effect on postoperative hemorrhage.

Objective To explore the effect of lean management on cost control of single disease in patients with acute cerebral infarction (ACI) in stroke center. Methods A retrospective study was conducted. The patients with ACI who underwent intravenous thrombolysis in the stroke center of Taizhou Central Hospital in Zhejiang Province were enrolled. Thirty patients adopted traditional management procedures from July 2016 to September 2017 were enrolled in the control group, and 32 patients received lean management from October 2017 to December 2018 were enrolled in the lean group. The patients in the control group were treated with traditional intravenous thrombolysis, and the patients were sent to the neurology ward for intravenous thrombolysis. The patients in the lean group applied lean management value stream to optimize process management, the lean management team of the stroke center was established, and the green channel for stroke treatment was established to eliminate the waiting time as far as possible. The location of thrombolysis was changed from neurology ward to the neurological intensive care unit (NICU) in emergency department. The patients in the two groups were compared in terms of intravenous thrombolytic door-to-needle time (DNT), admission time to the neurologist's visit time (T1), CT examination time to neurology ward or NICU admission time (T2), neurology ward/NICU visit time to medication time (T3), and the proportion of patients with DNT controlled within 40 minutes, recovery of neurological impairment 7 days after thrombolysis [national institutes of health stroke scale (NIHSS) score], activity of daily living assessment (Barthel index), length of hospital stay, cost of hospital stay and patient satisfaction. At the same time, the main process quality and the implementation rate of easily missed indexes of cerebral infarction single disease were recorded. Results Compared with the control group, DNT, T1 and T2 in the lean group were significantly shortened [DNT (minutes): 39.56±11.12 vs. 63.03±19.63, T1 (minutes): 16.23±6.79 vs. 33.48±12.63, T2 (minutes): 13.45±3.84 vs. 17.47±5.56, all P < 0.01], T3 was slightly shortened (minutes: 9.88±1.95 vs. 10.95±2.69, P > 0.05), and the proportion of DNT control within 40 minutes was significantly increased [75.0% (24/32) vs. 16.7% (5/30), P < 0.01], the 7-day NIHSS score was decreased significantly (8.66±4.12 vs. 13.00±5.63, P < 0.01), 7-day Barthel index was increased significantly (71.6±16.7 vs. 54.7±17.1, P < 0.01), the length of hospital stay was significantly shortened (days: 9.69±4.06 vs. 12.47±3.83, P < 0.01), the hospital costs were significantly reduced (Yuan: 16 338±5 481 vs. 19 470±5 495, P < 0.05), the satisfaction of patients was improved significantly [(91.38±2.69)% vs. (86.53±2.78)%, P < 0.01]. In terms of the implementation rate of quality indicators such as pre-application evaluation of thrombolytic drugs, evaluation of dysphagia, and evaluation of vascular function, health education of ACI, rehabilitation evaluation and implementation within 24 hours, etc., the lean group was significantly improved as compared with the control group [(87.5% (28/32) vs. 53.3% (16/30), 96.9% (31/32) vs. 73.3% (22/30), 78.1% (25/32) vs. 43.3% (13/30), 100.0% (32/32) vs. 76.7% (23/30), 75.0% (24/32) vs. 33.3% (10/30), all P < 0.05]. Conclusion Lean thinking can realize the standardization of stroke center process, effectively utilize medical resources, improve medical quality and reduce the cost of cerebral infarction single disease.

Objective:To investigate the application value of transcranial Doppler (TCD) in the prognosis assessment of nerve function in patients with acute cerebral infarction (ACI) after intracranial mechanical thrombectomy.Methods:A retrospective analysis was conducted. The clinical data of 43 patients with acute anterior circulation cerebral infarction who received intra-arterial mechanical thrombotomy for recanalization admitted to Taizhou Central Hospital from January 2018 to December 2019 were analyzed. The modified Rankin scale (mRS) score of patients were followed up by telephone at 3 months after surgery to evaluate the prognosis of neurologic outcome. Patients with mRS score 0-2 were enrolled in the good prognosis group, while those with a score of 3-6 were enrolled in the poor prognosis group. The gender, age, past history, underlying diseases, occluded arteries, atherosclerotic stenosis and bridging treatment, time from onset to reperfusion, blood flow dynamics under TCD at 1 day after thrombectomy, and National Institutes of Health stroke scale (NIHSS) scores before and 1, 7, and 14 days after thrombectomy were compared between the two groups. Multivariate Logistic regression analysis was used to screen the prognostic factors of nerve function at 3 months after mechanical thrombectomy in patients with ACI. The receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic value for neurological function assessed by TCD.Results:Forty-three patients were enrolled in the final analysis, with 23 patients in the good prognosis group and 20 in the poor prognosis group. The recanalization was successfully achieved in both groups without complications. However, the hemodynamics of intracranial arteries evaluated by TCD 1 day after operation in both groups still showed partial or complete occlusion, and the hemodynamics of patients in the poor prognosis group was worse than that in the good prognosis group (poor blood flow: 40.0% vs. 0%, inadequate blood flow: 30.0% vs. 17.4%, good blood flow: 30.0% vs. 82.6%), and the differences were statistically significant (all P < 0.01). Before thrombotomy, there was no significant difference in NIHSS score between the two groups. After thrombotomy, the NIHSS score of the two groups gradually decreased with the extension of time, but the NIHSS score at 14 days after operation of the poor prognosis group was still significantly higher than that of the good prognosis group (10.55±2.93 vs. 4.65±1.70, P < 0.01). Univariate analysis showed that compared with the good prognosis group, the proportion of patients with diabetes and arteriosclerosis stenosis in the poor prognosis group were significantly increased (30.0% vs. 4.3%, 45.0% vs. 17.4%, both P < 0.05), and the time from onset to reperfusion was prolonged (minutes: 385.9±96.2 vs. 294.5±95.1, P < 0.01). Multivariable Logistic regression analysis showed that the therosclerosis stenosis [odds ratio ( OR) = 9.334, 95% confidence interval (95% CI) was 1.092-79.775, P = 0.041] and the reperfusion time ( OR = 1.016, 95% CI was 1.006-1.027, P = 0.002) were associated with prognosis of nerve function at 3 months after mechanical thrombectomy in patients with ACI. ROC curve analysis suggested that the evaluation of intracranial hemodynamics by TCD might be able to predict the prognosis of neurological function in patients with ACI after 3 months of intracranial mechanical thrombectomy, the area under ROC curve (AUC) was 0.768 (95% CI was 0.620-0.917), the sensitivity was 65.0%, the specificity was 87.0%, the positive predictive value was 82.6%, and the negative predictive value was 70.0%. Conclusion:The evaluation of intracranial hemodynamics assessed by TCD is helpful in early judging the prognosis of neurological function in patients with ACI after intracranial mechanical thrombectomy.

OBJECTIVETo compare the difference in the short-term and long-term efficacy on cervical spondylosis of neck type between warm needling therapy in the regions of both neck and lumbus and that only in the region of neck.

METHODSEighty-one patients of cervical spondylosis of neck type were randomized into group A (41 cases) and group B (40 cases), in which 2 cases dropped out. Finally, 40 cases in the group A and 39 cases in the group B accomplished the trial. In the group A, the warm needling therapy was applied to the acupoints in the region of neck and the lumbus. Fengchi (GB 20), Tianzhu (BL 10), Neck-Bailao (EX-HN 15), Wangu (GB 12), Tianyou (TE 16) and(including the tender points and code-like masses on palpation) were selected in the region of neck. Dachangshu (BL 25), Qihaishu (BL 24) and Jiaji (EX-B 2) of L5 were selected in the region of lumbus. The warm needling was applied to Fengchi (GB 20), Tianzhu (BL 10), Dachangshu (BL 25). In the group B, the warm needling therapy was applied only to the acupoints in the neck, which were same as the group A. The treatment was given once every two days, three times a week in the two groups. Separately, before treatment, 1 week after treatment, at the end of 2-week treatment and at the end of 1 month follow-up, the score of neck pain questionnaire (NPQ), the score of range of motion (ROM) in the cervical region and the score of the cervical symptoms were recorded. The efficacy at the end of treatment and in the follow-up was evaluated.

RESULTSCompared with those before treatment, the scores at all the observation time points were significantly improved in the two groups after treatment (all<0.05). In the follow-up, NPQ score, ROM score and the score of cervicalsymptoms were different significantly between the two groups (all<0.05). The results in the group A were better than those in the group B. At the end of 2-week treatment, the total effective rate was 92.5% (37/40) in the group A and was 87.2% (34/39) in the group B (>0.05). In the follow-up, the total effective rate was 87.5% (35/40) in the group A, better than 64.1% (25/39) in the group B (<0.05).

CONCLUSIONSThe treatment for both neck and lumbar regions with warm needling therapy and the treatment in the local area all achieve the short-term efficacy on cervical spondylosis of neck type. For the long-term efficacy, the treatment for both neck and lumbar regions achieves the better result as compared with the routine treatment in the region of neck.