Objective To explore the value of monitoring techniques of the external branch of superior laryngeal nerve (EBSLN) in thyroid surgery and to study its protective effects on vocal function after thyroid surgery.Methods We retrospectively analyzed the clinical data of 139 patients who underwent primary surgery of papillary thyroid cancer with neurological monitoring from Jun.2017 to Mar.2018 in the General Surgery Department of PLA General Hospital.The tumors of 31 cases were located in the upper pole of the gland and elsewhere in 108 cases.The patients' vocal function was assessed at one week and one month after surgery.The rate of EBSLN identified visually and by the intraoperative nerve monitoring (IONM) were counted.EBSLN recognition efficiency and prevalence of EBSLN damage during the operation of tumor in upper pole of thyroid and in other location were compared.Results In the 139 patients,there were 218 upper poles(218 EBSLN) treated intraoperatively,of which 145 were recognized visually (126(57.8％) confirmed by IONM,and 203(93.1％) were identified by IONM,OR=8.27(x2=59.345,P=0.00).The percentage of EBLSN located in the upper pole accurately identified by the naked eye was 20/46(43.5％) while by IONM was 43/46(93.4％).The percentage of EBSLN at the other position accurately identified visually was 106/172(61.6％),and by IONM was 160/172(93.0％).The number of visually identified cases in different locations showed significantly differences according to the chi-square test (x2=4.901,P=0.027),and no significant difference by IONM identification according to chi-square test (x2=0.012,P=0.914).Five patients had a low voice at one week postoperatively and low voice and vocalization change were not observed after one month.Conclusions IONM can effectively increase the proportion of intraoperative EBSLN identification to ensure the safety of surgery.The difficulty of visual identification of EBSLN during the surgery of tumor in upper pole is greater than that in other locations.IONM can provide more evidences for nerve protection and reduce the risk of injury.

Objective To summarize and analyze the shielding,retention and reentry works of blood donors,and to investigate the feasibility of retention and reentry strategy.Methods The samples of ELISA single reagent reactive/NAT non-reactive and ELISA non-reactive/ NAT reactive were negative by confirmatory tests.Then the blood was weeded out and the donation qualification was reserved.The donors of shielding more than 6 months could propose the reentry application at any blood station in the province,and were allowed to return to the ranks after qualified by routine detection and re-detection by Jiangsu Provincial Blood Center.The unqualified rates were compared between the donors of again blood donation after retention and reentry with the common donors by χ2 test.Results From October 2014 to June 2016,1 615 cases were ELISA single reagent reactive/NAT non-reactive,among which 67 cases were confirmed as positive,42 cases were undetermined and 1 506 cases were negative;831 cases were ELISA non-reactive/ NAT reactive,in which 809 cases were positive by confirmation and 22 cases were negative.A total of 1 528 donors were confirmed as negative and their donation qualifications were reserved,89 donors conducted blood donation again and 79 were qualified in blood detection.The unqualified rate was 11.24%,compared with that of common donors,the difference was statistically significant(P<0.001).Meanwhile,596 donors applied for reentry,among them 218 persons were weeded out by the reentry blood station.In remaining 378 samples sent to Jiangsu Provincial Blood Center,359 samples were qualified and confirmed to the reentry condition.Among them,332 donors conducted blood donation and all were qualified by blood detection.Conclusion The reentry strategy in Jiangsu Province is reasonable and feasible,but the donors retention strategy needs to be further optimized and perfected.