Spinal cord injury can lead to neurogenic bowel dysfunction. With the research of the enteric nervous system, slow transit constipation had a better understanding of the pathogenesis. This article reviewed gastrointestinal motility after spinal cord injury and motilin, substance P, and vasoactive intestinal peptide.

In the thyroid surgery,parathyroid and laryngeal recurrent nerve injury is the most common complications.With the deepening understanding of the laryngeal recurrent nerve anatomy and surgical skills,laryngeal recurrent nerve injury incidence decline,and the prevention of complications of thyroid operation has turned to protect the parathyroid gland from laryngeal recurrent nerve protection.The technique of carbon nanoparticles labeled lymph nodes can effectively protect the parathyroid gland in thyroid surgery.

Objective To study the anatomic characteristics of Zuckerkandl's tubercle (ZT) and its clinical relevance as an anatomic landmark of the recurrent laryngeal nerve (RLN) in thyroid surgery.Methods This study involved 147 (106 with benign thyroid diseases and 41 with malignancies) patients who underwent thyroidectomy.ZT was measured and classified based on the Pelizzo classification.The relationship between ZT and the RLN and the relationship between the RLN and the inferior thyroid artery were recognized and classified.Results 233 (107 left and 126 right) thyroid gland lobes were dissected and ZT was identified in most patients (left in 93.5％ and right in 96.0％).The distribution of ZT according to grade was as follows:Grade 0,left 16.0％ and right 13.2％ ; Grade Ⅰ,left 32.0％ and right 27.3％ ; Grade Ⅱ,left 46.0％ and right 44.6％ ; Grade Ⅲ,left 6.0％ and right 14.9％.There was no significant difference on classification between the left-sided and right-sided ZTs.In terms of the relationship between the ZT and the RLN,it was classified as follows:Type A,left 92.9％ and right 93.3％ ; Type B:left 0 and right 0; Type C:left 7.1％ and right 6.7％.Similarly,there was no significant difference between the left sided and the right sided.The ZT grade was correlated with the course of the RLN:the higher the ZT grade was (that is,the greater the size of the ZT),the more often was the course of RLN behind the back of the ZT; the lower the ZT grade (that is,the smaller the size of the ZT),the more often was the course of RLN running by the lateral of the ZT.Considering the incidence of being dangerous type of RLN,the right sided (19.0％) was higher than the left sided (8.3％).The relationship between the ZT and the RLN does not relate to RLN course across the inferior thyroid artery.Conclusions As an important anatomic landmark,the ZT is essential for locating and dissecting the RLN during thyroid surgery,and its classification is a guide to RLN dissection and preservation.

The significantly high prevalences of cholelithiasis in patients with spinal cord injury (SCI) are related to impaired sympathetic innervations to the gallbladder. Sonography before and after the ingestion of a standard fatty meal is usually applied in evaluation of gallbladder function. This paper reviewed the innervations of gallbladder, sonography application in evaluation of gallbladder function and the relationship between SCI and cholelithiasis.

ObjectiveTo explore the percutaneous endoscopic gastrostomy on patients with central nervous system injuries in neurological rehabilitation and to establish enteral nutrition.MethodsThirty-two patients with central nervous system were enrolled for percutaneous gastrostomy, using the Pull technique.ResultsThe successful rate of percutaneous gastrostomy as Pull technique was 100%, 2 cases of stomach bleeding through endoscopy. Straining the fixation gasket and partial compression stoped bleeding. One patient appeared swelling and secretions in abdominal incisions, and recovered after dealing with local iodophor and changing fresh dressing. Hypostatic pneumonia occurred in one patient, and improved after anti-infective treatment. No serious complications occurred.ConclusionPercutaneous gastrostomy is a simple and safe for the patients with central nervous system injuries.

Surgery pandect is an important subject in the process of transition from basic medicine to clinical medicine in medical students,and it is also an important link of medical education. This article discussed the teaching experience of surgery pandect in rehabilitation therapy.

Objective To study the metastasis of lymph node of breast cancer patients in clinical T1-T2 N0 M0 and its clinical significance in (sentinel lymph node biopsy, SLNB). Methods A total of 276 pa-tients of breast cancer were enrolled in the study (T1 N0M0 cases =115 ; T2N0M0 cases = 161 ). The metas-tasis and distribution of axillary node by virtue of the location of primary tumor, ages and pathologic status were analyzed. Results The metastasis rate of axillary node in T1 N0M0 patients was less than T2 N0 M0 (P =0.027), while that in the central and lower outer quadrant's was higher than in other' s parts(P =0.004).When the tumor located in outer quadrant, the axillary node metastasis rate of Berg I was highest in the cen-tral, outer and inner quadrant(P =0.000). But the metastasis rate of Berg Ⅲ was lowest in the three quad-rants (P = 0. 000). For the pathologic status, the metastasis rate of invasive carcinoma-not otherwise speci-fied(NOS) was higher than early breast carcinoma and other pathologic categories (P =0.000). More than 2 groups axillary node metastasis was found in 6 of 9 patients with carcinoma simplex. The 90 cases with axilla-ry node metastasis were analyzed by age. Axillary node was easier for metastasis in those cases aged above 50years than those below 50 years(68.9% vs 31.1% )(P =0. 000). Two eases with skip metastasis were in T2 No Mo (invasive ductal carcinoma disease = 1, carcinoma simplex disease = 1 ). Conclusion The distri-bution of the metastasis of lymph node in clinical T1 ,T2 N0M0 breast cancer plays an important role in SLNB and formulating reasonable treatment protocols.

Objective To explore the change of sexual life quality and its influencing factors of premenopausal breast cancer patients.Methods 94 premenopausal breast cancer patients were included. Changes in Sexual Functioning Questionnaire short-form (CSFQ-14) was used and part of its items was changed. Their sexual life was evaluated before and after treatment by using depth interview and anonymous methods. Results 94 cases received face-to-face communication and study. 88 (93.6%) questionnaires were received, in which 81 (92.1%) questionnaires were effective. Their sexual life quality and sexual satisfaction significantly decreased and there was significant difference in the CSFQ-14 score (P<0.001) before and after treatment. The ratio of bad, worse, and worst sexual life were 39.5%, 29.6%, and 14.8% respectively after treatment. 65.4% of the patients had no sexual activity. The reasons included medical related factors, fear of cancer metastasis and recurrence, physical discomfort, poorer body image, partner sexual attitudes changed, life stress, common psychological problems, traditional ideas and so on. Conclusion Sexual dysfunction was obvious and sexual life quality significantly decreased in premenopausal breast cancer patients after treatment. Patients' physical and mental damage, the change of body image and spouse's attitude are significant influencing factors. It is necessary to give sexual rehabilitation guidance to patients and their spouses.

Objective To investigate the relationship between neurogenic bowel dysfunction (NBD) and substance P in rats suffering from spinal cord injury (SCI). Methods 60 male Sprague-Dawley rats, weighted (220±40) g, were randomly divided into three groups: sham group (n=20), normal group (n=20) and model group (n=20) and then were subdivided into subgroups of 24 h, 1 week, 3 weeks, and 5 weeks respectively after SCI. SCI model was established at thoracic 10 segment of rat with NYU impactor device. The colon tissue of the rats was resected and stored. Substance P in serum and tissue was measured by ELISA. The tissue was examined by real-time RT-PCR and Western blotting to analyze the expression of substance P. Results The colon intestinal transmission function decreased and delineated at minimum value at 3 weeks in the model group. There was statistical significance with respect to the content of substance P in serum and tissue between the sham group and model group at 3 weeks. The expression of substance P in the sham group was (3.12±0.51) times of the model group (P<0.05). Conclusion Substance P may take part in NBD after SCI in rats.

The American Clinical Practice Guiding -Neurogenic Bowel Management in Adults with Spinal Cord Injury (SCI) had been prepared based on scientific and professional information known about neurogenic bowel management, its causes, and its treatment, in 1998. It will provide reference to China's neurogenic bowel management after SCI in rehabilitation and treatment.