OBJECTIVE To summarize the use of intraoperative neuromonitoring system for monitoring and protection of recurrent laryngeal nerve during thyroid surgery. METHODS There were 21 cases in this study, included 5 cases with thyroid cancer, 9 cases with thyroid benign tumor and 7cases with hyperthyroidism. Intraoperative neuromonitoring system includes the host monitor, stimulus detection pin of recurrent laryngeal nerve, special EMG endotracheal intubation tube which contacts vocal cord, grounding conductive circuit electrode, and anti-jamming probe. Operation method: a "three-step method" was adopted. First we revealed the cervical vagus nerve trunk and tested our instruments, and then dissected and protected the recurrent laryngeal nerve, followed by removal of thyroid tissue. RESULTS In all 21 patients, operative side recurrent laryngeal nerve were exposed from lower thyroid blood vessels to the larynx. All patients were phonated as well as before operation, and without drinking cough. CONCLUSION The intraoperative neuromonitoring system can avoid damage of the recurrent laryngeal nerves when we exposed the recurrent laryngeal nerve before resection of the thyroid tissue and tumor.

Objective To evaluate the results and toxic effects in three dimensional radiotherapy (3DCRT)with late course accelerated hyper-fractionation for advanced esophageal carcinoma.Methods From December 2001 to December 2003,115 patients were randomly divided into two groups:in 3DCRT group,55 patients were given late course accelerated hyper-fractionation radiotherapy to a total close of 66 Gy (2.0 Gy per fraction,5 times per week;to a dose of 36 Gy were changed into 1.5 Gy/f,2 f/d).In CF group,60 patients were given late course accelerated hyper-fractionation radiotherapy to a total dose of 66 Gy.Results The 1-, 2-,3-,4-year survival rates in 3DCRT group were 63.6 %, 50.9 %, 38.2 %, 30.9 % compared to 58.3 %, 38.3 %,33.3 %,23.3 % in CF group(X~2=4.44,P=0.031),and local control rates in 1-,2-,3-,and 4- years in 3DCRT group were 72.7 %,58.1%,47.2 % and 36.3 %,compared to 53.3 %,40 %,28.3 %,and 20 %(X~2=5.33,P=0.013)in CF group.However,in the 3DCRT group,the incidence of acute esophagitis was similar to CF group; hematogenous toxic and acute bronchitis were similar between the two groups. Late course lung injury in CF group was higher than that in 3DCRT group.Conclusion 3DCRT is able to improve the local control rate and survival rate,and unable to improve acute and late radiation toxie effects.

Objective To investigate the effect of lidocaine on plasma S100β protein in patients with supratentorial tumor surgery.Methods Thirty patients with supratentorial tumor surgery were selected,ASA grade Ⅰ-Ⅱ grade.The patients were divided into lidocaine group and control group by random digits table with 15 cases each.In lidocaine group,a dose of 2％ lidocaine was administered as an intravenous bolus (1.5 mg/kg) after induction,followed by an intravenous infusion at rate of 2 mg/ (kg ·h) until the end of surgery.In control group,0.9％ sodium chloride was given in the same volume and the same rate.Bloods were sampled from bulb of jugular vein to measure the plasma S100β protein before surgery,end of surgery and 1 day after surgery.Results The plasma S100 β protein before surgery,end of surgery and 1 day after surgery in lidocaine group were (21.03 ± 11.67),(32.63 ± 10.14) and (34.16 ± 17.59) ng/L,in control group were (23.04 ± 13.32),(44.98 ± 16.63) and (39.85 ± 21.99) ng/L.There were no statistical differences in the plasma S100 β protein before surgery and 1 day after surgery between the 2 groups (P ＞ 0.05),but there was statistical difference end of surgery between the 2 groups (P ＜ 0.05).Conclusion Intraoperative infusion of lidocaine can decrease the plasma S100β protein end of supratentorial tumor surgery.

Objective:To explore the effect of sub-inhibitory concentration of imipenem on the bio-activities of methicillin resistant Staphylococcus aureus(MRSA) and illuminate the inhibitory effects of carbapenem antibioty on the activity of MRSA and their mechanisms,and to provide the basis for using the carbapenem antibiotics in the treatment of MRSA infection.Methods:Five ST239 type of MRSA clinical isolates were selected and were co-cultured with 1/10 and 1/2 minimal inhibitory concentration (MIC) of imipenem for 1.5,6.0 and 12.0 h,which were divided into control group(no imipenem),1/10MIC group(1/10MIC of imipenem),and 1/2MIC group(1/2MIC of imipenem).Fluorescent quantitative real-time PCR method was used to determine the relative mRNA expression levels of virulence-related genes fibronectin A(fnbA),staphylococcal protein A(spa),α-hemolysin(Hla),leukocidin D(lek-D),leukocidin E(lek-E),and enterotoxin A in various groups;Spectrophotometry was used to detect the proliferation activity of MRSA strains in various groups in vitro.Results:After co-culture for 6.0 and 12.0 h,the proliferation activities of 5 trains of MRSA in 1/2MIC group in vitro were significantly decreased compared with control group (P<0.01).The relative mRNA expression levels of 6 virulence-related genes of 5 strains of MRSA in 1/10MIC and 1/2MIC groups were significantly decreased compared with control group(P<0.01).After co-culture for 12.0 h,the mRNA expressions of all the tested virulence-related genes were not found.Conclusion:The sub-inhibitory concentration of imipenem shows obviously inhibitory effect on the mRNA expressions of multiple virulence-related genes of ST 239 type of MRSA strains,and higher concentration of imipenem can suppress the proliferation of MRSA strains in vitro.Imipenem shows the potential value in the treatment of the severe MRSA infected patients.

Objective To analyze the space-time characteristics of hand-foot-mouth disease (HFMD) in Shijiazhuang by using geographic information system (GIS).Methods The data of HFMD during 2009 to 2011 in Shijiazhuang were collected and GIS database was created.Special map was drawn by PHGIS software to analyze the space-time characteristics of HFMD in Shijiazhuang.Results The epidemic situation of HFMD in Shijiazhuang appeared sporadic with local centralization.The attack ranked alternately rise year after year and high epidemic areas were geographically complimentary.Overall epidemic levels tend dropping from 2009 to 2011 and there were differences among areas.The high-attack areas of HFMD changed over time.Conclusions GIS can provide direct-viewing of the space-time characteristics of HFMD and further understand the prevalence of HFMD,which could help to provide the scientific basis of HFMD control in Shijiazhuang.

The histopathological changs of the dog eyes caused by acute and subacute toxic effectsof hematoporphyrin monoether--PsD-044 were observed in this research. The results showed thatPsD-044 could lead to keratoscleritis and scleral perivasculitis. Phototoxic cyclitis and inflammatory edema of the retina were more serious in deferred killed animals, suggesting that it is necessary to avoid exposure to light after the administration of PsD-044.

Objective To evaluate the value of dual-phase spiral CT scanning in diagnosis of small pancreatic carcinoma.Methods 21 cases with small pancreatic carcinoma (≤2 cm) underwent plain CT scan and dual-phase eahanced spiral CT including arterial phase(20~25 s after infusion)and pancreatic phase(50~60 s after infusion)with a 100 ml bolus injection of contrast material at 3~6 ml/s.CTattenuation values of tumor and normal pancreas in all scanning phase were obtained.Results The mean CT value of tumor was(42?14) HU(arterial phase)and (48?18) HU(pancreatic phase),the mean CT value of normal pancreas was (105?15) HU(arterial phase)and (86?11) HU(pancreatic phase).The dens difference of tumor-pancreas was significantly on arterial phase (69?15) HU.Conclusion The maximum dens difference of tumor-pancreas can be obtained on arterial phase CT scan,it has advantages in diagnosing pancreatic carcinoma of early period and to judge the resectionability of pancreatic carcinoma.

Building up a harmonious type of physician-patient relationship in hospitals is an important contents in the construction of harmonious society.Major factors that jeopardize the physician-patient relationship include insufficiency of mutual communication,lack of human sympathy in medical treatment service,neglect of patients' right of informed consent.This article also puts forward some measures to solve these contradictions,such as reinforcing ethical training,improving physician-patient relationship,respecting patients' right of informed consent,and setting a psychological department for concerned issues,etc.

Objective To explore the investigation method of complicated and profound traditional Chinese herbal medicine,the potential action mechanisms of flavonoids from Scutellaria baicalensis were studied by docking calculation.Methods In total, eight flavonoids (aglycones and their glicosides) from S. baicalensis were selected as ligands.The crystalline structures of targets related to common diseases were used as the receptors for calculation. The calculations were conducted with Schr(o)dinger software package. The grading standard of selectivity was developed according to G-score between ligands and receptors. Results Twenty-six pharmacologic actions have been reported.Among all effects in literature, nine of them can be deduced from the docking calculation of aglycone. From glycosides with grade ++, 25 reported effects can be estimated by calculation. Apparently, the target selectivity of aglycones and their glycosides are different form the virtual evaluation. The virtual evaluation results of glycosides were closer to the reported effects. Conclusion Our proposed virtual evaluation method seems an effective way to investigate the complicated system of traditional Chinese herbal medicine. It suggests that aglycones may be effective as the form of glucoside in vivo, and metabolism is a very important factor for virtual evaluation.

OBJECTIVE:To establish the quality standard of Chushi pill. METHODS:Microscopic identification and TLC were adopted for the qualitative identification of Cortex moutan,C. dictamni,Angelica sinensis,Rubia cordifolia and Gardeniae fructus in Chushi pill;HPLC was performed to determine the contents of paeonol and baicalin. It was performed on column of Kro-masil 100-5 C18 with mobile phase of methanol-water-phosphoric acid(47∶53∶0.2,V/V/V)at the flow rate of 1.0 ml/min,the detec-tion wavelength was 280 nm,the temperature was 25 ℃ and the volume was 10 μl. RESULTS:The microscopic identification showed microscopic characteristics of C. moutan and C. dictamni,and characteristics of A. sinensis,R. cordifolia and G. fructus were identified by TLC;the linear range of paeonol was 0.106 24-2.124 8 μg(r=0.999 9)and baicalin was 0.059 04-1.180 8 μg (r=0.999 9);RSDs of precision,stability and reproducibility tests were no more than 2.06%;average recoveries were respective-ly 101.56%(RSD=1.68%,n=9)and 100.16%(RSD=1.13%,n=9). CONCLUSIONS:The method is simple,accurate and re-producible,and can be used for the quantity control of Chushi pill.