Objective To investigate the causes and prevention of hemorrhage and recurrent laryngeal nerve injury during the endoscopic thyroidectomy via the breast areola approach.Methods Totally 36 patients underwent endoscopic thyroidectomy via the breast areola approach from January 2006 to January 2008.Results All the procedures were completed under an endoscope with a mean operation time of 105 min(50 to 180 min),and mean blood loss of 30 ml(20 to 150 ml).None of the patients were converted to an open surgery.One patient developed fat liquefaction,and one showed subcutaneous emphysema,no patient had injuries to any of the nerves or the parathyroid glands.The drainage tube was removed in 24 to 72 months after the surgery.The patients were discharged from the hospital 3 to 7 days postoperation.Postoperative pathological examination showed thyroid adenoma in 7 cases and thyroid nodular goiter in 29.The 36 patients were followed up for 3 to 24 months with a mean of 12 months.During the period,3 patients complained of chest symptoms and were cured spontaneously in 3 to 7 months.All the patients were satisfied with the aesthetic outcomes,none of them had local recurrence of the tumor.Conclusions Endoscopic thyroidectomy via the breasts areola approach is feasible and effective with good short-term and aesthetic outcomes.

Objectiye To study the mechanism by which transcranial magnetic stimulation (rTMS) affects cognitive dysfunction in vascular dementia (VD). Methods Thirty-six male Wistar rats were randomly divided into a control group, a VD group, a low frequency rTMS group and a high frequency rTMS group. Two-vessel occlusion was employed to induce VD models. Low frequency rTMS group rats were given 0.5 Hz rTMS for six weeks. High frequency rTMS group rats were given 5 Hz rTMS for six weeks. Morris' water maze test was used to measure their spatial learning ability and memory. The ultrastructures of the synapses in the four groups were detected with transmission electron microscopy. The expression of synaptophysin (SYN), brain derived neurotrophic factor (BDNF) and Nmethyl-D-aspartate receptor 1 ( NMDAR1 ) mRNA and protein in the hippocampus were determined by real-time PCR and Western blotting. Results The behavior and morphology of the rats treated with rTMS improved. The average expression of SYN, BDNF and NMDAR1 mRNA and protein in the low frequency rTMS group and the high frequency rTMS group were significantly higher than in the VD group. Conclusion rTMS can provide a rehabilitative effect for VD. The mechanism might be associated with enhancing the expression of SYN, BDNF and NMDAR1 in the hippocampus.

Normalizing GFR with variables is important for non-cancer patients,especially for kidney donors.The most frequently evaluated variables are body surface area (BSA),extracellular fluid volume (ECV) and lean body mass (LBM).It is difficult to accurately quantify BSA and the power of BSA normalization decreases in children and obesity population.The ECV normalization is suitable for healthy children,but its clinical value decreases in patients with damaged renal function.The LBM can be accurately measured and has a larger serviceable range in the normalization.Although the influence factors of LBM should be extensively evaluated,the available data indicate that LBM is more suitable in the normalization of GFR than BSA and ECV.

Objective To explore optimal initial the best screening time for newborns with different delivery methods using AABR.Methods A total of 550 newborns who were born from August 1, 2016 to October 31, 2016 at our hospital participated in the study.AABR was used to accomplish the initial hearing screening.The newborns were divided into 2 groups according to the delivery methods.There were each 100 neonates born in vaginal during <24 h, 24~48 h and 48~72 h after birth, respectively.The numbers of neonates delivered by cesarean section during the 3 separate periods were 50, 100 and 100, respectively.The newborns who failed the preliminary hearing screening proceeded to the re-screening and diagnostic procedures.Results There were 300 newborns were born in vaginal, and the pass rate in 24~48 h after birth group was significantly higher than that in 24 h group (93.00% vs 83.00%,x2=4.735,P=0.03<0.05), but it was not significantly different from that of 48~72 h group (95.00% vs 93.00%,x2=0.355,P=0.56>0.05).There were 250 newborns in cesarean section, the pass rate of 24~48 h after birth group was significantly higher than that in 24 h group (83.00% vs 68.00%,x2=4.437, P=0.04<0.05), and significantly lower than that of 48~72 h group (94.00% vs 83.00%,x2=5.944, P=0.02<0.05).Conclusion Taking into account of hospitalization time, the screening time for the vaginal delivery newborn hearing screening can be advanced to 24~48 h after birth with the application of AABR, but not for the cesarean section group.

Objective To compare SPECT/CT fusion imaging and MRI in the diagnosis of benign hip lesions. Methods Twenty-two patients suspected avascular necrosis of femoral head with hip discomfort, pain or action limited were analyzed retrospectively. All patients underwent radionuclide bone scan and MR examination within 5 days, and the diagnosis was proved with clinical follow-up. Results Eighteen necrosis of the femoral head and 4 hip arthritis including 1 patient with ankylosing spondylitis were found in 44 hip joints of 22 patients. MRI detected 17 femoral head necrosis and 4 hip arthritis, while SPECT/CT fusion image found out 18 femoral head necrosis and 4 hip arthritis. There was corresponding relationship in signs of hip lesions between MRI and SPECT/CT fusion imaging. Conclusion SPECT/CT fusion imaging and MRI has no markedly difference in the diagnosis of hip benign lesions, and is complementary to each other. SPECT/CT fusion image can distinguish the hip lesions from the femoral head lesions, and has a higher accuracy of diagnosing hip lesions than whole body bone scanning.

Objective To analyze the drug resistance genes and homology in nosocomial infection caused by carbapenem‐resistant Acinetobacter baumannii(CRAB) .Methods Forty strains of CRAB were collected and the minimal inhibitory concentration (MIC) was detected by the agar dilution method .The main carbapenemase genes were detected by PCR .The PCR products were performed the DNA sequencing .The enterobacterial repetitive intergenic consensus (ERIC)‐polymerase chain reaction(PCR) was performed to analyze the genotypes and homology of these strains .The plasmid conjugation experiment was carried out to investigate the trans‐mission of resistant genes .Results Forty strains of CRAB maintained the good sensitivity only to polymyxin B (100% ) and cef‐operazone/sulbactam(57 .5% ) .All of them had different degrees of resistance to other drugs .The OXA‐23 and OXA‐51genes were detected by PCR amplified in all of the CRAB strains .The homology analysis showed that the strains could be divided into 4 types according to 80% of cluster similarity coefficient ,the type A1 (19 strains) was the major epidemic strain ,moreover the various de‐partments had cross infection ;the plasmid conjugation experiment failed .Conclusion There is an endemic spread of CRAB in our hospital and its resistant mechanism is mainly related with OXA‐23 gene expression ;in the rational antibiotics use at the same time , the isolation and prevention measures should be done well for avoiding the hospital cross infection .

Objective To investigate the diagnosis and treatment of gastric stromal tumor(GST). Methods Retrospective analysis was made on the clinical data of 18 cases of GST. The diagnosis of 18 cases was confirmed by pathology. Local resection of the tumor was performed in 2 cases,partial gastrectomy in 5 cases, subtotal gastrectomy in 9 cases, and total gastrectomy with lymph node clearance in 2 cases. Results Most of the patients were over forty years old.In 55.5% of cases,the location of tumor was at the middle of the stomach,and 61.0% of cases were intragastric growth type.The preoperative diagnostic rate was 27.8%,misdiagnostic rate was 72.2%.The resectability rate was 100%. No postoperative complications and operative death occurred in this series. Fifteen cases were followed up for 1 to 10 years. During follow up,2 cases died of recurrence of the tumor, and the other patients were still alive. Conclusion The GST patients lack typical clinical manifestations, and the preoperative diagnosis is difficult.Barium meal examination and gastroscopy are the main supplementary examinations.A combination of histological and immunohistochemical examinations is helpful to confirm the diagnosis.Surgical resection is the only effective therapeutic method.

OBJECTIVE: To characterize morphology and drug release kinetics of protein-loaded poly(?-caprolactone)/poly(ethylene glycol)/poly(?-caprolactone) amphiphilic block copolymeric (PCE) microspheres, and elucidate the mechanistic details regarding protein release. METHODS: BSA-loaded PCE microspheres were prepared using a water-in-oil-in-water, followed by solvent evaporation. Morphology of the polymer microspheres was observed using scanning electron microscopy. Protein loading capacity and encapsulation efficiency were determined by extracting the proteins from the microspheres and measured using MicroBCA method. Protein release kinetics was characterized by cumulative release against the date of release incubation. RESULTS: The protein-loaded PCE microspheres were spherical and possess smooth surface under SEM. Protein loading capacity and encapsulation efficiency in the microspheres were independent of PCE molecular weight. However, the kinetic features of the protein release varied significantly with PCE molecular weight, suggesting a diffusion-degradation combined release mechanism. For the microspheres made of larger molecular weight PCE 4000, the portion of protein release attributed to diffusion from the polymer matrix was remarkably less than that from microspheres of small molecular weight PCE. In vitro release profile can be simulated using a diffusion-degradation model(Q=k1t1/2+k2t+k3t2+k4t3)(r=0.997). CONCLUSION: PCE microsphere formulation can offer sustainedrelease of proteins with initial burst and incomplete release reduced to acceptable level.

The silent cerebral infarct is an clinic symptom that is so slight or transitory as to be easily neglected. There are only neural symptoms and signs,but irresponsible infarct focus can be seen on image. The risk factors of silent cerebral infarct may be the same as those of symptomatic cerebral infarct. Such infarct is likely to influence the course, clinic symptom and prognosis of acute cerebral infarct and may foretell symptomatic cerebral infarct and deteriorate into pseudo-global paralysis or multi-infarcted dementia. Therefore elder who suffer from hypertension or diabetes and experience vertigo, headache, language barrier but without apparent signs and symptoms should receive cerebral CT or MRI. Minor or third-degree precautionary measures can be taken as a chief therapy for cerebral infarct. Alternatively vitamines B_6,B_(12) and folic acid can be supplied to reduce the chance of hyperhomocysteinemia. Headache is the initial symptom in silent brain infarct. Magnesium is effective when dehydration does not work.

Objective To evaluate operative management of complex hypospadias.Methods Twenty-one cases with complex hypospadias were reviewed.Thiresch procedure at 12 cases were taken.Island scrotal septal flap urethroplasty at 7 cases.Snodgrass procedure at 1 case.Mathieu procedure at 1 case.Results Fifteen cases were satisfied without fistula and stricture.Four cases with fistula,1 case with chordee,urethral meatus stricture in 1 case.Overall,the complication rate was 28.5%.Conclusions Selection of surgical procedure should according to the different case circumstance.It′s essential that reduce separative procedure,protect blood supply and carefully manipulation to improve successful rate.