OBJECTIVE: To explore the extralaryngeal furcation variation of the recurrent laryngeal nerve (RLN) in total thyroidectomy. METHOD: The clinical data of 216 RLNs from 108 patients undergone total thyroidectomy were retrospectively analyzed. RESULT: RLN was found during every operation and exposed in whole course until access into larynx. Twenty (9.26%) pieces of RLNs showed bifurcated or trifurcated RLNs before access into larynx. Ratio of furcation is lower than that reported before internationally. Bifurcations of RLNs on the left were more than that on the right. CONCLUSION The protection of RLN is important for thyroid operation, especially in total thyroidetomy. Variation of extralaryngeal furcation of RLN usually leads to injury of RLN. Understanding of variation of RLN could decrease nerve function related complication.
Humans ; Larynx ; Recurrent Laryngeal Nerve ; pathology ; Recurrent Laryngeal Nerve Injuries ; diagnosis ; Retrospective Studies ; Thyroid Gland ; surgery ; Thyroidectomy

[Objective] To study the effect of family sickbed comprehensive nursing mode on patients with stroke.[Methods] 92 cases of discharged patients with cerebral apoplexy were selected between October 2010 and October 2011,and were divided into the observation group(52 cases)and the control group(40 cases).Among them,the observation group received the family sickbed comprehensive nursing intervention,which was conducted by community nurses.The control group received general discharge mode and did not accept community nursing intervention.As designed,patients were followed weekly or monthly after discharge.After three months the treatment efficacy and quality of life were assessed.[Results] After follow-up for 3 months,HAMD,NIHSS scores in the intervention group were lower than those of the control group,MMSE,FMA and BI scores were higher than those of the control group.The physical,psychological,social and environmental scorcs in the intervention group were higher than those in the control group.[Conclusions] Family sickbed comprehensive nursing of cerebral apoplexy patients during rehabilitation stage can not only save medical resources,but also facilitate to recovery of patients.

Objective To evaluate the clinical efficacy of direct percutaneous coronary intervention (PCI) in ST segment elevation acute myocardial infarction (AMI) Methods From April 2000 to April 2004, 458 patients with ST segment elevation AMI were randomized to receive invasive therapy ( n =205) or non invasive therapy ( n =253) Comparison was made in the 30 day mortality rate, major cardiac events rate, reinfarction rate during hospitalization, left ventricular ejection fraction (LVEF) and end diastolic diameter (EDD) of echocardiograph in 2 weeks after AMI between the 2 groups The PCI group was divided into 3 sub groups according to number of stenosis artries found during angiography We try to find not the relation between left ventricular function and the number of coronary artery with stenosis Results The result of selective coronary artery angiography in 205 PCI patients was: 66 patients with single branch lesion (32 2%), 68 patients with double branches lesion (33 2%) and 71 patients with triple branches lesion (34 6%) 203 patients were operated successfully (99%), 228 stents were placed on lesions, 194 patients (94 6%) obtained TIMI grade Ⅲ perfusion of the IRA Compared the invasive with the non invasive group, the in hospital 30 day mortality rate was 2 9% vs 9 1% ( P

Objective To investigate the effect and significance of early coronary artery bypass grafting (CABG) on the expression level of nerve-related factor at infracted border zone (IBZ) in dogs with acute myocardial infarction (AMI).Methods The anterior descending coronary artery of all thirty dogs randomly assigned into experimental group(n =22) and control group(n =8)were ligated into MI model.The experimental group included those undergoing CABG 1(n =6),2 week(n =4),4 week(n =6)and 6 week (n =6) after MI,and control group(n =2) was established for every experimental group.We detected the local expression level of nerve-related factor such as GAP43 mRNA,NGF mRNA and SYN mRNA at normal myocardium and infracted border zone myocavdium by means of RT-PCR through thoracotomy at eight weeks after surgery.Results Four dogs of every experimental group and all dogs of control group survived to the end of the study.The local expression level of GAP43 mRNA,NGF mRNA and SYN mRNA in control groups was significantly higher than that in normal and experimental groups (P ＜0.01 ).The local expression level of GAP43 mRNA,NGF mRNA and SYN mRNA in 4 and 6 weeks bypass groups was significantly higher than that in normal and 1,2 weeks bypass groups (P ＜0.05).There was no statistically significant the expression level of SYN mRNA among all experimental groups (P ＞ 0.05 ).Conclusions Early CABG surgery for AMI in dogs could lessen the expression level of nerve-related factor and the sympathetic remodelling at IBZ.Especially CABG surgery two weeks after MI could lessen the sympathetic maximacily.

Objective To explore the diagnostic approach and the idea of timely treatment for the spontaneous rupture of the esophagus (SRE) for improvement of the level of clinical diagnosis and treatment.Methods The relative clinical data and operation method of 16 cases SRE (4 cases of midpiece SREs and 12 cases of lower SRE) collected from February 1999 to June 2011 were analyzed retrospectively.There were one place breach in 16 cases of SRE with a broken length of 1.5 ～5 cm (2.6 ± 1.1 )cm,including 11 cases broken into the left breast,2 into right chest,and 3 no chest broken into.The main symptoms included intense thoracoabdominal pain,fever,difficulty in breathing,and shock.Ten cases of hydropneumothorax and 5 cases of subcutaneous emphysema were found with physical examination.Results Eleven cases were repaired within 24 hours and 5 cases were repaired after 24 hours.The esophaguses of 16 cases were sutured disconnectedly by absorbable suture line,to which omentum majus were sutured and fixed.Improved resisting backflow operation was carried out for 16 cases which got through the perioperative period smoothly and no deaths.There was no esophageal narrow in follow-up visit,otherwise,there were 2 refluxes that relieved significantly through conservative treatment.Conclusions It is the key to treat SRE that early diagnosis and exploration operation through cutting thorax after definite diagnosis,closing broken hole in order to rebuild the alimentary canal on which omentum majus was covered and fixed for the purpose of insuring continuity of digestive tract.

Objective To establish the synthetic method of the substrate for angiotensin-converting enzyme(ACE),and investigate the assay method of sernm ACE. Methods The substrate was prepared by the use of N-hydroxysuccinimide ester in peptide synthesis,and serum ACE was determined by spectrophotometric assay using suhstrate. Results The substrate of furanacryloyl-phenylalanyl-glycyl-glycine with purity of 99.5% was obtained.The K_m value for the substrate was 0.25 mmol/L,the normal reference interval for serum ACE activity was 46.7 U/L to 113.3 U/L,and the within-run and between-run coefficient of variation(CVs)ranged from 3.9 to 4.9%.The serum ACE activity in patients with squamous carcinoma and adenocarcinoma of lung were significantly decreased(P<0.05),while that in patients with lung small cell carcinoma was not significantly decreased(P>0.05). Conclusion The synthesized substrate could be reliably used as a marker for diagnosis of different lung cancers in clinics.

lsartan could reduce the release of p-selectin.Conclusions Valsartan could relieve myocardial ischemia reperfusion injury of rat, which may be through reducing p-seleetin of plasma.

10.3969/j.issn.1007-3969.2013.05.001

Objective: To investigate the expressions of CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells in peripheral blood of patients with acute coronary syndrome (ACS) and their significance. Methods: A case-control study was conducted. Ninety-four patients receiving coronary angiography (CAG) admitted to Tianjin Chest Hospital from March 5th to April 27th in 2018 were enrolled. They were divided into non-coronary heart disease (CHD) group (n = 12), unstable angina pectoris (UAP) group (n = 27), acute non-ST elevation myocardial infarction (NSTEMI) group (n = 27) and acute ST elevation myocardial infarction (STEMI) group (n = 28) according to the patients' symptoms, electrocardiogram, troponin test and angiographic results. General data, blood routine parameters, and biochemical indicators were collected. The ratios of CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells were determined by flow cytometry. Multivariate Logistic regression was used to evaluate whether CD4⁺CD45RA⁺T cells and CD4⁺CD45RO⁺T cells were associated with STEMI. Results: Ninety-four patients were included initially. After excluding the patients who died during the intervention, 93 patients were enrolled in the data analysis finally, with 12 patients in the non-CHD group, 27 patients in the UAP group, and the same as the NSTEMI group and the STEMI group. Compared with the non-CHD group, white blood cell count (WBC) was decreased (×10⁹/L: 6.03±1.30 vs. 6.60±1.30, P > 0.05), and lymphocyte ratio was increased (0.273±0.059 vs. 0.269±0.070, P > 0.05) in patients of the UAP group; however, in the NSTEMI group and STEMI group, WBC was increased (×10⁹/L: 8.29±2.28, 9.86±2.76 vs. 6.60±1.30, both P < 0.05), and lymphocyte ratio was decreased (0.236±0.076, 0.173±0.094 vs. 0.269±0.070, P > 0.05 and P < 0.05), especially in the STEMI group [WBC (×10⁹/L): 9.86±2.76 vs. 6.60±1.30, lymphocyte ratio: 0.173±0.094 vs. 0.269±0.070, both P < 0.05]. There was no significant difference in biochemical indicators among all of the groups. Flow cytometry results showed that the ratios of CD4⁺CD45RO⁺T cells in the UAP group and NSTEMI group were higher than those in the non-CHD group (0.323±0.074, 0.319±0.078 vs. 0.314±0.058, both P > 0.05); however, the ratio of CD4⁺CD45RO⁺T cells in the STEMI group showed a decreased tendency (0.270±0.057 vs. 0.314±0.058, P > 0.05), and it was significantly lower than that in the UAP group and the NSTEMI group (0.270±0.057 vs. 0.323±0.074, 0.319±0.078, both P < 0.05). There was no significant difference in the ratio of CD4⁺CD45RA⁺T cells among all of the groups. Multivariate Logistic regression analysis showed that CD4⁺CD45RA⁺T cells ratio was not significantly correlated with the occurrence of STEMI [odds ratio (OR) = 0.976, 95% confidence interval (95%CI) was 0.907-1.050, P = 0.518], but CD4⁺CD45RO⁺T cells ratio was significantly correlated with the occurrence of STEMI (OR = 0.888, 95%CI was 0.821-0.961, P = 0.003). Conclusions There was no significant difference in the ratio of CD4⁺CD45RA⁺T cells among UAP, NSTEMI and STEMI patients, and CD4⁺CD45RO⁺T cells ratio in the STEMI group was significantly lower than that in the UAP group and NSTEMI group. CD4⁺CD45RO⁺T cells ratio may be risk factor of STEMI.

Objective To assess the long-term effects of pacing in patients with hypertrophic obstructive eardiomyopathy(HOCM),and explore the most specific echocardiographic indexes.MethodsA total of 37 consecutive HOCM patients implanted dual-chamber pacemakers were enrolled and followed up.Thirty-seven cases were followed up for 1 year,26 cases were followed up for 2 years,and 10 cases were followed up for 3 years.After 1,2 and 3 years pacemaker implantation,pacing frequency,pacing threshold,impedance,atrioventricular delay and cumulative percent atrial and ventricular pacing were respectively tested,and left atrial dimension (LAD),left ventricular end-diastolic dimension (LVEDd),left ventricular posterior wall thickness (LVPW),interventricular septum thickness (IVS),left ventricular outflow tract diameter(LVOTd),left ventricular outflow tract pressure gradient (LVOTPG),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure (PASP) were measured and mitral valve systolic anterior motion(SAM) was observed.Pacing parameters and echocardiography indexes were dynamically compared before and after pacemaker implantation.ResultsPacing frequency was adjusted 60～70 bpm,atrioventricular delay was adjusted 90～ 180 ms,in order to achieve more than 95％ ventricular pacing,pacing threshold,pacing impedance were normal.The difference of various pacing parameters were no statistically significant within 3 years ( P ＞ 0.05).Compared with before pacing,after 1,2 and 3 years pacemaker implantation,IVS and LVOTPG declined significantly (P ＜ 0.01 ),LVOTd widened significantly ( P ＜0.01),SAM phenomenon improved obviously ( P ＜0.01 ),but the difference of LAD,LVEDd,LVPW,LVEF,PASP were no statistically significant ( P ＞ 0.05 ).Conclusions The heart structure reconstruction of patients with HOCM can been chronically improved by dual-chamber pacing treatment.IVS,LVOTd and LVOTPG can be used as the sensitive and specific indexes to evaluate pacing treatment.