Objective To investigate the causes and treatment of recurrent laryngeal nerve (RLN) injury during the operation of thyroidectomy. MethodsClinical data of 48 patients that RLN were injured during thyroidectomy in and out of our hospital from Jun. 2003 to Mar. 2007 were reviewed. ResultsNo patient died while operation and staying in hospital. There were 47 cases of unilateral RLN injury, 1 case of bilateral RLN injury; 21 cases (43.7%) were injured because of suture or scar adhesion, 13 cases (27.1%) were partly broken with formed scar, 14 cases (29.2%) were completely cut off; The locations of RLN injuries were closely adjacent to the crossing of the inferior thyroid artery and RLN in 13 cases (27.1%) and 35 cases (72.9%) were within 2 cm below the point of RLN entering into throat. The injured RLN were repaired surgically in 43 cases, among which 39 cases’ phonation and vocal cord movement were restored completely or had their vocal cord movement recovered partly; There were only 4 cases that the phonation and vocal cord movement were not recovered. Another 5 cases that did not take any repair did not recovered naturally. ConclusionThe location of most RLN injuries caused by mechanical injury during thyroid surgery is closely adjacent to the entrance of RLN into throat. Early nerve exploratory operation should be performed once the RLN is injured, and the method of repair should be decided according to concrete conditions of injury.

Objective To study the choice of initial operative approach for thyroid nodule and the necessity of reoperation after local excision of differentiated thyroid cancer.Methods Clinical data of 138 patients with differentiated thyroid cancer after local tumor excision had reoperation at our hospital during a period of four year were retrospectively reviewed.All the reoperations were bilateral thyroidectomy and cervical lymph node excision.Results There were 76.8% patients with residual cancer in thyroid and cervical lymph node.There were 23 patients(16.7%) with recurrent laryngeal nerve injury that included 22 cases with unilateral and 1 case with bilateral injury after the initial operation,and 19 of the 23 patients with recurrent laryngeal nerve injury recovered after nerve repair.After thyroid reoperation,3 cases(2.2%) had recurrent laryngeal nerve injury,2 cases(1.4%) had partial parathyroid gland injury,2 cases(1.4%) had superior laryngeal nerve injury,but there were no cases of esophageal injury or postoperative bleeding.Conclusions The incidence of residual cancer is high after local excision for differentiated thyroid cancer,therefore,reoperation with bilateral thyroidectomy and cervical lymph node excision is necessary.

ObjectiveTo evaluate the reliability and validity of Chinese version of the Manager's Activities Scale (MAS). MethodsMAS was administered to 350 nurses and evaluated for the reliability and validity using SPSS17.0 and AMOS 17.0. ResultsThe Cronbach's α of MAS was 0.92 and the testretest reliability was 0.902 and the content validity was 0.96.The correlations between each item and total scale were ranged from 0.720 to 0.823.One factor was extracted by exploratory factor analysis and could explain 56.98％ of the total variance.The confirmatory factor analysis revealed a good fit of the model to the data based on various fit indices (x2/df ratio =1.301,GFI=0.963,AGFI＝0.927,NFI=0.966,IFI＝0.992,TLI=0.987,CFI=0.992,RMSEA=0.039). ConclusionsChinese version of MAS is reliable and valid,and can be used in the research of Chinese nursing leadership.

The article discussed the significance of studying campus culuture constructive and management models in New Campus,and then advanced the guiding ideology,basic thinking,key problems of improving the level of campus culuture constructive and management in new campus.

1 cm or tumor penetrating through the thyroid capsule(P1 cm or tumor penetrate through the thyroid capsule.

Objective To use the enzyme linked immunosorbent (ELISA)to detect the hepatitis B virus (HBV)markers,and to perform the HBsAg quantitation and the HBV load detection for understanding the HBV carrying and viral replication situation when single HBcAb positive or both HBcAb and HBeAb positive.Methods The HBV markers HBsAg,HBsAb,HBeAg,HBeAb and HBcAb were detected with ELISA.1 098 cases of HBcAb positive,966 cases of both HBeAb and HBcAb positive and 832 cases of all HBV markers negative as control were selected and quantitatively re-detected HBsAg by using the chemiluminescence meth-od.The HBV load was detected by using the PCR method.Results Among 1 098 cases of single HBcAb positive,436 cases (39.7%)of HBsAg quantitation and 230 cases (20.9%)of PCR-DNA were detected out respectively;among 966 cases of both HBeAb and HBcAb positive,387 cases(40.1 %)of HBsAg quantitation and 212 cases(21.9%)of PCR-DNA were detected out re-spectively;among 832 cases of all HBV markers negative,6 case (0.7%)of HBsAg quantitation and 4 case (0.5%)of PCR-DNA were detected out respectively,there were statistically significantly differences among them (P < 0.05 ).Conclusion Adopting ELISA for detecting HBV markers,when single HBeAb positive or both HBcAb and HBeAb positive,HBsAg and the viral replica-tion are still be detected out,which needs to conduct further detection in order to avoid the medical risk due to the missed detection.

Objective To investigate the effect of modified electroconvulsive therapy (MECT) with different anesthetics on efficacy of patients with treatment-resistant depression (TRD). Methods Ninety patients with TRD were enrolled in this study to receive a standard 8 times MECT. The HAMD-17 scale was evaluated before MECT and after the completion of the first, second, third, forth, sixth and eighth MECT session. The TESS scale was evaluated before MECT and after the completion of the last MECT session. Results Scores of HAMD-17 after the completion of the first, second, third, fourth, sixth and eighth MECT session were significantly reduced (P<0.05). There were significant differences of HAMD scales among the three groups since the first MECT session (P < 0.05). The remission rate of ketamine group, propofol group and mixed group was 96.7%, 43.3%, and 73.3% (P < 0.05). Conclusion MECT of ketamine anesthetic might contribute to the best effect of TRD.

Objective To investigate the effect of dexmedetomidine on the intubation reaction during intratracheal intubation in the patients in the emergency department .Methods Fifty adult patients needing emergent tracheal intubation in the emergency de-partment of this hospital were divided into the dexmedetomidine group and the middazolam group ,25 cases in each group .The dexmedetomidine group was given dexmedetomidine(1 μg/kg) before tracheal intubation and the midazolam group was given mid-azolam(0 .1 mg/kg) before tracheal intubation .Results BP and HR during tracheal intubation ,at 1 ,3 min after tracheal intubation in the dexmedetomidine group were significantly decreased compared with the midazolam group (P<0 .05);SpO2 at 1 min before tracheal intubation and during tracheal intubation in the dexmedetomidine group had no statistical difference compared with before drug administration(P>0 .05);SpO2 at 1 min before tracheal intubation and during tracheal intubation in the middazolam group was decreased ,which showed the statistical difference compared with before drug administration (P<0 .05) .Conclusion Dexme-detomidine is more effective than midazolam in alleviating cardiovascular responses during intratracheal intubation ,moreover has no influence on the patient′s respiratory function .

Objective To explore the efficacy of noninvasive positive pressure ventilation technology com-bined with respiratory stimulant in the treatment of pulmonary encephalopathy in patients with COPD.Methods For-ty -eight COPD patients with early pulmonary encephalopathy were included.They were randomly divided into the treatment group and control group.The treatment group was treated by not only regular treatment and noninvasive posi-tive pressure ventilation technology,but also respiratory stimulant.The control group was only treated by regular treat-ment and noninvasive positive pressure ventilation technology.The indexes were recorded,including tracheal intubation rate,clinical recovery rate,mortality,Glasgow coma score,arterial blood gas analysis and adverse reactions.Results Compared with the control group,the arterial blood gas analysis of treatment group on the 2h,24h and 72h were statis-tically significant different(P <0.05).The GCS score on the 24h and 72h were also statistically significant different [24h,(13.4 ±1.6)vs.(11.8 ±2.1),P <0.05;72h,(14.6 ±1.5)vs.(12.4 ±2.4),P <0.05].The treatment group had lower tracheal intubation rate(12% vs.56.5%,P =0.001),shorter consciousness recovery time[(3.0 ± 0.5)h vs.(5.6 ±0.7)h,P =0.023],shorter hospitalization time in ICU[(12.6 ±1.5)d vs.(19.2 ±1.8)d,P =0.004]and better clinical recovery(22 /25 vs.10 /23,P =0.001)than the control group.But the mortality rate had no significant difference between the two groups(1 /25 vs.4 /23,P =0.129).Conclusion NIPPV combined with respiratory stimulant is an effective,safe and simple method for treatment of COPD complicated with pulmonary encephalopathy.It can significantly improve the clinical symptoms and the index of arterial blood gas analysis,and it can shorten consciousness recovery time and decrease tracheal intubation rate.But close observation must be carried out,and the invasive mechanical ventilation should be promptly executed in case of emergency or exacerbation.

Objective To investigate the effects of four interior-warming drugs( galangal,cinnamon,evodia rutaecarpa,and dried ginger)on the tension of ileum smooth muscle and Ca2+-ATPase on the cell membrane in rabbits. Methods The effects of galangal,cinnamon,evodia rutaecarpa,and dried ginger were examined on normal ileum smooth muscle,in vitro intestinal muscle contraction caused by acetylcholine(ACh),barium chloride(BaCl2 )and histamine(His), and ACh-induced calcium release by using BL-420E+ biological signal collection and processing system.The average tension was measured within 1 min before delivery and within 3 minutes after the treatment,and the inhibition rate was calculated according to the average tension value.The effects of sera containing galangal,cinnamon,evodia rutaecarpa,and dried ginger on Ca2+-ATPase activity on the cell membrane of the intestinal smooth muscle were examined by phosphorus method. Results Galangal,cinnamon,evodia rutaecarpa,and dried ginger at high concentrations could restrain in vitro intestinal contraction in normal circumstances(P<0.05 or P<0.01).Significant inhibitory effects on intestinal contraction caused by ACh,His and BaCl2 were found in low,medium and high concentration groups(P<0.01).There was a dose-effectiveness relationship between the inhibition rate and final drug concentrations.The ACh-induced intracellular and extracellular calcium dependent contraction were significantly inhibited by the four interior-warming drugs( P < 0. 05 or P < 0. 01). The Ca2+-ATPase activities were( 0. 384 ± 0.070),(0.302±0.016),(0.307±0.016),(0.296±0.016),(0.313±0.003)U·mg-1 ,respectively,in intestinal smooth muscle in normal control group and high concentration groups of galangal,cinnamon,evodia rutaecarpa,and dried ginger(P<0.01). Conclusion Interior-warming drugs may relax intestinal smooth muscle by reducing the intracellular calcium release and the extracellular calcium inflow via receptor-controlled calcium channels,and inhibiting the Ca2+-ATPase activity in smooth muscle.