Objective To study the feasibility, superiority and experience of minimally invasive laparoscopic-assisted surgery of the thyroid using ultrosonic scalpel. Methods In a period from January, 2006-August, 2008, 56 patients of the department of general surgery, the hospital of Heilongjiang Province were diagnosed as thyroid node. The size of the nodes ranged from 5.0 cm×4.2 cm to 3.5 cm×2.0 cm in uhrosonography. An incision of about 1.5-2.0 cm was made 1.0 cm above the suprasternal notch and the operation was performed with ultrosonic scalpel assisted with laparoscope. Partial thyroideetomy of lateral thyroid was performed in 20 cases, subtotal thyroidectomy in 25 cases, subtotal thyroidectomy of unilateral thyroid and partial thyroidectomy of contralateral thyroid respectively in 1 case, partial thyroidectomy of bilateral thyroid in 10 cases. Results All 56 cases have undergone minimally invasive laparoscopic-assisted surgery successfully in 50-146 min and no complications occurred. Fifty five cases were confirmed to be benign lesion pathologically. Conclusion Laparoscopic-assisted surgery of the thyroid is an effective with a good cosmetic result.

Objective Currently, the effect of hydrogen peroxide solution( H2 O2 ) flush on the recovery of peripheral nerve injury are still undetermined. This study aims to explore the effects of different H2 O2 flushing time course on recovery of peripheral nerve injury during surgical debridement. Methods 18 New Zealand male white rabbits were randomly divided into isotonic saline group( isotonic saline flush) , H2 O21 min group ( hydrogen peroxide solution flush 1 min + isotonic saline flush) , H2 O23 min group ( H2 O2 flush 3 min + isotonic saline flush. Each group has 6 rabbits. We established rabbit sciatic nerve injury model. After 12 weeks, we executed the animals, drew materials at the suture nerve, detected motor nerve conduction velocity and observed pathological HE staining, as well as measuring the sciatic nerve function indexes( SFI) of rabbits at the 8th and 12th week, respectively. Results Nerve conduction velocity in H2O21min group and isotonic saline group[(25.89±1.42), (26.46±1.67) m/s] were higher than that in the H2O23min group[(23.80±2.91)m/s](P<0.05). Pathological section shows that the isotonic saline group has a better sheathstructure, nerve fibers structure damage is not obvious and myelin degeneration degree is mild in H2 O21 min group. blurred sheath structure and myelin axons obvious deformation in H2 O23 min group. 8 weeks and 12 weeks after operation, SFI in isotonic saline group [(-43.00±0.82), (-39.17±0.91) m/s] was significant higher than H2O21 min group [ (-49.79±1.47), (-46.60±0.79) m/s] and H2O23min group [(-51.66±1.27), (-46.39±0.94) m/s], thedifference was statistically significant (P<0.05). SFI in group of H2O21min [(-49.79±1.47)m/s] was higher than group og H2O23 min [(-51.66±1.27) m/s][P<0.05]. Conclusion H2O2 solution has side effect on the recovery of damaged peripheral nerve inju-ry and with prolonging the H2 O2 flushing time, the damage of peripheral nerve can be aggravated. So in the process of clinical surgical debridement, under the premise of guaranteed sterilization the time of H2 O2 flush should be shortened as far as possible.

Objective To analyze the relative factors of functional recovery after upper limbs replantation. Methods From September, 2009 to March, 2014, 24 consecutive patients after upper limb replantation for amputation were retrospectively analyzed. The Disability of Arm Shoulder and Hand (DASH) was used to assess the functional recovery of the upper limbs at the last follow-up. The non-conditional Logistic regression was used to analyze the correlation of gender, age, time from injury to surgery, amputated level, amputated method, isch-emia hours, dominant hand or not, rehabilitation treatment, rehabilitation duration, and the DASH scores. Results The DASH score was>28.50 in 15 patients, while ≤28.50 in 9 patients. The Logistic regression analysis demonstrated that amputated method and rehabilitation treatment correlated with the functional recovery of upper limbs (χ2>7.360, P<0.05), and no correlation was found in the other factors (χ2<3.789, t=1.515, P>0.05). Conclusion The amputated method and rehabilitation treatment after operation are the factors related to the func-tional recovery after upper limb replantation.

ObjectiveTo analysis the different types of bacteria in patients with a varying severity of acute cholangitis.Methods241 patients who presented with actue cholangitis between Jan 2008 to Oct 2011 to our hospital were retrospectively studied.These patients were divided into three groups according to the Tokyo Guideline.The bile specimens were obtained intraoperatively.The parameters were compared by SPSS 16.0 package program for statistical analysis.Results75.1 percent of the patients were positive for bacteria in the bile.There were 241 strains of bacterium which included 139 Gram-positive bacteria,99 Gram-negative bacteria and 6 strains of microzyme.Escherichia coli,Enterococcus faecalis,Enterococcus casseliflavus,Pseudomonas aeruginosa and Klebsiella species were the most frequently isolated bacteria.The positive rates for bacteria were significantly different between patients with mild and severe cholangitis (P＜0.05).There was no significant difference between patients with moderate and mild cholangits (P=0.141),or moderate and severe cholangitis (P=0.647).Gram-negative bacteria were more common than Gram- positive bacteria in patients with moderate and severe acute cholangitis (P＜0.05).In patients with moderate and severe acute cholangitis,there was more patients with multiple and mixed bacterial infection.ConclusionsEscherichia coli and Enterococcus species were more common in patients with acute cholangitis.The positive rate of bacteria in the bile in severe acute cholangitis was higher than that in mild acute cholangitis.In patients with moderate and severe cholangitis,Gram-negative bacterial infections and multiple and mixed bacterial infections were more common.

Objective To observe the clinical efficacy of Daidzein Capsules(DC) on female climacteric syndrome.Methods Sixty eight patients with climacteric syndrome were randomized into DCgroup(n=37) and Gengnian'an control group (n=31).The treatment group and the control group were orally administered DC 150 mg and Gengnian'an Tablet 4.8 g,three times a day,respectively.The course of treatment lasted three months.Results The total effective rate in DC group was 91.89 %,which was superior to that in the control group.Time of drug becoming effective was shorter in DC group than that in the control group.After treatment,the level of E2 was significantly increased and the content of LH decreased significantly in DC group.Conclusion DC is safe and effective for the treatment of female climacteric syndrome.

Objective To explore the role of the preoperative DSA examination and selected embolization in surgical treatment of intracranial huge meningiomas .Methods The clinical materials of 13 patients was collected and analyzed .Preoperative DSA was carried out in all cases ,10 of 13 underwent selected preoperative embolization ,the meningiomas were totally excised by surgery 4 to 7 days after the embolization .Results After the embolization ,DSA showed that the blood fed to the tumors was completely blocked in 8 cases ,and in great part in 2 cases .All tumors were totally removed ,the bleeding during operation was significantly decreased in patients who underwent preoperative embolization compared to the patients without embolization (P<0 .05) .Necrosis in different degree of meningiomas was found in postoperative pathological examination .There were no severe complications occurred during and after operations in all patients .Conclusion Preoperative selective embolization could significantly decrease the bleeding during operations .

Diabetic retinopathy is one of the serious complications of diabetes, is currently the world's second largest blinding disease. Early epidemiological data showed that the development is related to blood sugar level, diabetes duration, blood lipids, and other factors. In recent years, the correlation of gene polymorphism with DR received widespread attention. Accurately grasp the genetic mechanism in the process of development in the DR and the differences of expression, is of great significance to DR early diagnosis and prevention. So in this article, the progress of gene of DR were reviewed.

OBJECTIVE: To summarize clinical experience of application of argon knife under electronic bronchoscope in the management of pediatric glottic and subglottic diseases. METHOD: Reports in the literature were reviewed. Outcome and prognosis of 4 cases with pediatric glottic and subglottic diseases managed with argon beam coagulator technique in Shanghai children's Medical Center since 2011 were retrospectively analyzed. RESULT: Granulation tissue hyperplasia in 3 cases with subglottic lesions did not recur after surgery. Scarring or stenosis were not found in the airway. Intubation of the trachea and tube of tracheotomy was pulled out successfully in all cases, restoring normal breathing. No lesion recurrence was found in 1 case with squamous cell moderate atypical hyperplasia one month after the surgery. CONCLUSION Electronic bronchoscope has advantages of clear image, fine and soft lens body, optional bending, angle conversion, accurate positioning. And the argon knife with small head diameter can pass the pediatric supraglottic. It can be manipulated precisely with short operation time and no damage to surrounding normal tissues. Its worth in popularization and application of management for with glottic and subglottie disease in pediatric patients.
Adolescent ; Argon ; therapeutic use ; Bronchoscopes ; Child ; China ; Cicatrix ; Humans ; Hyperplasia ; Intubation, Intratracheal ; methods ; Laryngeal Diseases ; surgery ; Lasers, Gas ; therapeutic use ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies ; Tracheotomy ; instrumentation

Objective To investigate the effects of remffentanil pretreatment on myocardial ischemiareperfusion (I/R) injury in rabbits. Methods Thirty healthy rabbits, aged 12-18 months, weighing 2.5-3.5 kg,were randomly divided into 3 groups (n = 10 each): I/R group, low-dose remifentanil pretreatment group (group R1 ) and high-dose remifentanil pretreatment group (group R2 ). Myocardial I/R was induced by ligation of anterior descending branch of left coronary artery for 30 min followed by 6 h of reperfusion in the 3 groups. Remifentanil was infused intavenously at 1.65 and 3.30 μg· kg - 1 · min- 1 for 30 min before ischemia in group R1 and R2 respectively, while equal volume of normal saline was infused instead in group I/R. Blood samples were taken for determination of serum cardiac troponin-Ⅰ (cTnI) and creatine kinase-MB isoenzyme (CK-MB) concentrations before administration (baseline), after administration, at 30 min of ischemia and at 6 h of reperfusion. The rabbits were then sacrificed and hearts removed. Myocardial tissues were obtained for microscopic examination. Results Serum cTnI and CK-MB concentrations were significantly lower in group R1 and R2 than in group I/R and serum cTnI concentration lower in group R2 than in group R1 ( P ＜ 0.01). Remifentanil infusion significantly attenuated the pathologic changes in a dose-dependent manner. Conclusion Remifentanil pretreatment provides protective effect against myocardial I/R injury in rabbits and it is related to the dose.

Objective To explore the value of free anterolateral thigh flaps in the reconstruction of maxillofacial defects after resection.Methods Patients were recruited from January,2008 to March,2016 in the Department of Oral and Maxillofacial Surgery of Nanjing University.All patients sunder when reconstructive surgery employing anterolateral thigh myocutaneous flaps follow-up of 3 months to 84 months after operation.Results Among 422 cases,survived completely with satisfied configuration,the survival rate was 98.6％.Postoerative vessel thrombosis occurred in flaps,21 patients required operative exploration in the perioperative period including 10 flaps with thrombotic events and 11 flaps with venous thrombosis were complete survival after the salvages,and 6 flaps were failure.The mean follow-up was 36.5 months (range:3 to 84 months).Conclusion The free anterolateral thigh flap is an ideal choice for reconstruction of maxillofacial defects,as it has many advantages such as abundance volume,easily molding and adjusting the thickness,possessing,long vascular pedicle,composition need to be adjusted according to defects,easily concealed donor site,and little donor site complications and malformation.