Objective To investigate the risk factors and prevention of recurrent laryngeal nerve injury during thyroid operation.Methods The clinical data of 2180 patients with thyroid operation were retrospectively analyzed.The potential relationship of the incidence rate of recurrent laryngeal nerve injury were evaluated,such as age,gender,nature of lesions,thyroid pathology,anesthesiology,operation times,whether or not to reveal recurrent laryngeal nerve.Results The overall incidence rate of recurrent laryngeal nerve injury postoperatively was 2.7％ (59/2180).The incidence rate of recurrent laryngeal nerve injury in patients with thyroid malignant neoplasms,repeated surgery and without reveal recurrent laryngeal nerve were 6.7％ (33/492),5.6％ (15/267),4.4％ (39/891),significantly higher than those in the patients with thyroid benign neoplasms,first time operation and with reveal recurrent laryngeal nerve [1.5％ (26/1688),2.3％ (44/1913),1.6％ (20/1289)] (P ＜ 0.01).In the patients with thyroid dorsal lesion,the incidence rate of recurrent laryngeal nerve injury in the patients without reveal recurrent laryngeal nerve was significantly higher than that in the patients with reveal recurrent laryngeal nerve[13.7％(29/212) vs.2.9％(12/417),P＜0.01].Conclusion Thyroid malignant neoplasms,repeated surgery and without reveal recurrent laryngeal nerve can increase the risk of recurrent laryngeal nerve injury,routine reveal recurrent laryngeal nerve in the patients with thyroid dorsal lesion can decrease the incidence rate of recurrent laryngeal nerve injury.

Dan Dan (bile heat syndrome) is common in clinical disease of digestive system. It relates to the gallbladder and stomach. It is different from biliary diseases, and general stomach disease as well. This article introduced the application ofHuanglian WendanDecoction on bile heat syndrome treatment, worthy of clinical reference.

Patient one was a 19-year-old woman of periodic fever with urticaria during the first week of life.And there were typicalfacies,oligoarthritis and central nervous system involvement.She also exhibited a persistent elevation of acute phase reactants.The diagnosis of chronic infantile neurological cutaneous and articular syndrome was made.Short-term dosing of tumor necrosis factor-α receptor antagonist was administrated and was substituted by glucocorticoid and methotrexate.Another two males had an earlyonset of increased acute phase reactants during inflammation attacks.One of them had recurrent fever with urticaria-like rash,arthralgia and headache.Muckle-Wells syndrome was diagnosed on basis of NLRP3 gene mutation (c.92A ＞ T).And another had recurrent urticaria-like rash with conjunctivitis,oligoarthritis,hepatosplenomegaly and increased serum IgD.The clinical diagnosis was mevalonate-kinase deficiency.Autoinflammatory diseases should be suspected by physicians and diagnosed with a combination of phenotype and genotype.Biological agents,especially interleukin-1 antagonist,have broad prospects in the therapy of autoinflammatory diseases.

Objective:To screen the best decocting technology by multi-index comprehensive score combined with response sur-face. Methods:The content of paeoniflroin and the ratio of dry extraction were used as the indicators, and response surface Central Composite with two factors and five levels was used in the experimental design. The effects of the ratio of solvent to solid, decocting du-ration and decocting times on the preparation process of tonic semifluid extract of ten ingredients were studied. Results:Design Expert 8. 0. 6b software was used for the data analysis. A quadratic mathematical model between the factors and the comprehensive score of paeoniflroin content and the ratio of dry extraction was established. Combined with the actual production, the best decocting conditions were as following:the ratio of solvent to solid was 10. 6 ml·g-1 , the decocting duration was 96 min, and decocted 3 times. Conclu-sion:The optimal decocting technology is scientific, reasonable and stable.

Objective To investigate whether ?OH radical species present in the acid oxidation-potential water (AOW). Methods Electron paramagnetic resonance spectroscopy (EPR) coupled with the spin trapping technique was used for determination of ?OH radicals. Results A seven-line spectrum characteristic of 5, 5-dimethyl-2-pyrrolidone-N-oxyl (DMPOX) was formed at first, at 60 min the spin adducted DMPO-OH with four-line spectrum characteristic and at 120 min, no spectrum was observed. Conclusion ?OH can be detected in AOW at 60 min and it may come from the interaction of active substance in the AOW.

Objective To study the effect of multi drug combination therapy of children allergic purpura.Methods 80 cases of children with Henoch Schonlein purpura in our hospital from May 2014 to May 2016 were selected,these children were randomly divided into methylprednisolone,cimetidine and loratadine treatment group(treatment group)and methylprednisolone treatment group(control group),40 cases in each groups,the clinical curative effects,rash regression time,joint pain relief time,abdominal pain relief time,hematochezia disappeared time,urine recovery time,hospitalization time,incidences of adverse reaction and recurrences of the two groups were statistically analyzed.Results The total treatment efficiency of the treatment group was 95％(38/40),which was significantly higher than the control group 70％(28/40),the difference was statistically significant(P<0.05),the rash regression,joint pain relief time,abdominal pain relief time,hospitalization time of the treatment group were significantly shorter than the control group(P<0.05),but the differences the stool disappear time,urine recovery time,incidences of adverse reactions,recurrence rate between the two groups were not significant.Conclusion The effect of multi drug combination therapy of children with allergic purpura is better than single drug alone,can shorten the time of disappearance of symptoms of patients,reduce hospital stay.

Objective To investigate the dynamic changes in brain natriuretic peptide (BNP) and the outcome of patients with chronic congestive heart failure (CHF) after the treatment with metoprolol. Methods Sixty-five patients with CHF were admitted to the Forth Affiliated Hospital of Zhengzhou University during April 2004 to April 2007, and they fulfilled the diagnostic criteria of chronic CHF issued by New York Heart Association (NYHA). Of all the patients the left ventricular end-diastolic dimension (LVEDD) ≥65mm. All the patients were randomly assigned into metoprolol group (34 cases) and control group (31 cases), and received conventional therapies [rest, reduced sodium intake, administration of digitalis, diuretic, angiotensin-converting enzyme inhibitor (ACEI) and aldosterone antagonists, etc.]. The patients in metoprolol group were given metoprolol (6.25mg as initiative dose and dose was increased according to illness). NYHA functional classitication, cardiothoracic ratio on chest X-ray film, cardiac output (CO), cardiac index (CI), left ventricular ejection fraction (EF) and LVEDD in echocardiogram were observed, and the plasma BNP level was determined with an immunoradiometric assay (IRMA). Results After 5 months of treatment, the clinical symptoms of patients were improved obviously and p1asma BNP level was significantly lowered in both groups, while p1asma BNP level was significantly lower in metoprolol group compared with control group (200.6?12.1 vs 120.7?14.1, P

Objective To investigate the feasibility of laparoscopic repair for ingunal hernia after peritoneal dialysis. Methods Laparoscopic repair of inguinal hernia was conducted in 26 patients with chronic renal insufficiency who had received peritoneal dialysis for a long time. For indirect inguinal hernia, a piece of mesh was placed in the abdominal cavity and the internal ring was sutured and ligated under laparoscope. For direct inguinal hernia, the hernia sac was high suspended and then the mesh onlay was placed under laparoscope. Results The laparoscopy was successfully performed in all the 26 patients, without conversions to open surgery. No postoperative hematoma of scrotum or refractory neuralgia was observed. Follow-up examinations for 6~12 months (mean, 9 months) showed no recurrence. Conclusions Laparoscopic herniorrhaphy for inguinal hernia after peritoneal dialysis is feasible, effective, and safe.

Objective To summarize the clinical experience of laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis. Methods A total of 93 cases of acute cholecystitis treated by LC from May 2003 to May 2005 was retrospectively reviewed, including 15 cases of preoperative endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST) for common bile duct stones and 6 cases of intraoperative cholangiography. The LC was performed within 48 hours after admission. Results The LC was successfully completed in 91 cases (97.8%), whereas a conversion to open surgery was required in 2 cases (2.2%). The operation time was 35~160 min (mean, 65 min). Postoperatively, biliary leakage occurred in 3 cases (3.2%) and residual stones in the common bile duct were found in 3 cases (3.2%), which were all cured by open surgery combined with ERCP, EST, and endoscopic nasobiliary drainage (ENBD). No iatrogenic injuries happened. Conclusions With proper selection of ERCP and EST, LC for the treatment of acute cholecystitis is feasible and safe. But the incidence of conversions and complications may be high.

Objective To stuey effects of coloprotectomy under colonoscopy combined with laparoscope on exfoliated tumor cells in abdominal cavity.Methods 42 cases of colorectal cancer proved by pathologic histology were devided into two groups randomly: Laparoscope Group(laparoscopic surgery) and Combined Group(colonoscopy combined with laparoscope surgery).Operation time,the positive rate of exfoliated tumor cells in abdominal cavity after and before operation,the positive rate of residual tumor cells in resection of operation specimen and postoperative complications between 2 groups were compared.Results Operation time of the Combined Group was shorter than that of the Laparoscope Group [(160.5?12.6) min vs.(201.2?18.4) min,t=-8.363,P=0.000].The positive rate of exfoliated cells in abdominal cavity before operation had no significant difference between the 2 groups[9.5%(2/21) vs.19.0%(4/21),?2=0.194,P=0.659],but the postoperative positive rate of exfoliated cells in the Combined Group was significantly lower than that in the Laparoscope Group[14.3%(3/21) vs.42.9%(9/21),?2=4.200,P=0.040].There were no residual tumor cells in resection of operation specimen of 2 groups.No infection of incisional wound and lung occurred.A follow-up for 6-24 months in the Laparoscope Group showed abdominal metastasis in 1 case.Conclusions Coloprotectomy for colorectal cancer under colonoscopy combined with laparoscope can decrease exfoliated tumor cells in abdominal cavity and shorten operation time.