Objective To study the anatomy,exposure and operation method in prevention of recurrent laryngeal nerve injury in thyroid surgery.Methods The clinical data of 520 patients with thyroid disease in treatment of operation were retrospectively analyzed,and exposure of recurrent laryngeal nerve in 268 cases,non exposure of recurrent laryngeal nerve in 252 cases; resection of the majority of thyroid in 232 cases,resection of ipsilateral thyroid lobe+ isthmus+on the side of most resection operation in 220 cases; resection of ipsilateral thyroid thyroidectomy+contralateral subtotal+ipsilateral lymph node dissection operation in 68 cases.Results Exposure of recurrent laryngeal nerve in 268 cases.The recurrent laryngeal nerve in the external laryngeal branch was single 214 cases,accounted for 79.9％ (214/268); two 42 cases,accounted for 15.7％ (42/268),more than 12 cases,accounted for 4.5％ (12/268).The laryngeal recurrent nerve during thyroid artery through the rear 143 cases,accounted for 53.4％(143/268) ; during thyroid artery through the front 92 cases,accounted for 34.3％ (92/268); walk line between thyroid artery branches 33 cases,accounted for 12.3％(33/268).The thyroid permanent damage rate of exposure of recurrent laryngeal nerve surgery was 1.1％(3/268),lower than that in non exposure of recurrent laryngeal nerve surgery 6.0％ (15/252) (P ＜ 0.05).The thyroid permanent damage rate between resection of the majority of thyroid and resection of ipsilateral thyroid lobe + isthmus + on the side of most resection operation had no significant difference (P ＞0.05),compared with the former two,resection of ipsilateral thyroid thyroidectomy + contralateral subtotal + ipsilateral lymph node dissection operation increased significantly (P ＜0.05).Exposure of.recurrent laryrngeal nerve in benign 173 cases,6 cases of thyroid transient damage,permanent damage in 1 case; 95 cases of malignant thyroid,6 cases of thyroid transient damage,permanent damage in 2 cases,the thyroid permanent damage rate in both had no significant difference (P ＞ 0.05).Conclusion Exposure of recurrent laryngeal nerve operation can significandy reduce the incidence of recurrent laryngeal nerve injury,for the partial thyroidectomy,can chose non exposure of recurrent laryngeal nerve operation method.

Objective To investigate the effect of neoadjuvant chemotherapy on gastric cancer based on FOLFOX7 or XELOX,so as to achieve evidence of clinical practice.Methods From January 2005 to June 2010,a retrospective analysis was performed for those patients with gastric cancer and underwent surgery.The patients were divided into neoadjuvant chemotherapy group and conventional chemotherapy group according to the chemotherapy method.The clinical efficacy,Ro resection rate and survival rate were evaluated in two groups.Results A total of 185 cases were included in neoadjuvant chemotherapy group (FOLFOX7 or XELOX,113 cases) and conventional chemotherapy group (72 cases).There was no significant difference in general status between two groups (P ＞ 0.05).Complete remission was in 48 cases,partial remission was in 51 cases,stable was in 14 cases,progression of disease was in 0 case in neoadjuvant chemotherapy group,and the effective rate was 87.6％ (99/113).Complete remission was in 30 cases,partial remission was in 25 cases,stable was in 15 cases,progression of disease was in 2 cases in conventional chemotherapy group,and the effective rate was 76.4％(55/72).There was significant difference in the effective rate between two groups (P＜ 0.05).The R0 resection rate in neoadjuvant chemotherapy group was higher than that in conventional chemotherapy group [60.2％ (68/113) vs.38.9％ (28/72)],and there was significant difference between two groups (P＜ 0.01).There was no significant difference in survival rate between two groups (P ＞ 0.05).Conclusion Neoadjuvant chemotherapy can reduce the tumor stage and improve the R0 resection rate,but has no obvious advantage in improving the survival rate during follow-up period.

Objective To introduce a new technique of talocalcaneal joint fusion with trephine and evaluate its clinical effects. Methods From June 1997 to October 2001, 18 cases complained of pain, weakness, limited range of motion and tenderness of ankle were treated with subtalar joint fusion. Of 18 cases, there were 12 males and 6 females with an average age of 47 years (range, 35 to 59 years). The lesions of subtalar joint were identified as traumatic osteoarthritis in 8, degenerative osteoarthritis in 5, congenital bone bridge in 2, rheumatoid arthritis in 2 and refractory inflammation of tarsal sinus. The AP and lateral view X-ray films were taken to measure the width and length of sutalar joint and talocalcaneal angle so as to choose the trephine of appropriate diameter (?11.5 mm, 12 mm, 13 mm )and guide the direction and length of osteotomy. Posterolateral approach was used in 14, and anterolateral approach in 4 depending on the location of lesion at subtalar joint. The trephine was inserted into subtalar joint slowly, the bone block inside the trephine was removed, rotated to 90?, then reimplanted in situ in 14 cases; Autograft of iliac crest was harvested and implanted by trephine in 4. Results All of the affected feet were immobilized with a cast postoperatively for 12 to 16 weeks. The patients were followed up for an average of 25 months ranging from 5 months to 4 years. All the wounds healed well at 2 weeks, the callus appeared at 4 weeks, and the bony fusion was obtained at 16 weeks displayed by postoperative X-ray films. The scores of ankle pain by VAS measurement were improved from preoperative 83.8 to postoperative 32.5. There were no severe complications, only 1 case suffered from dropping foot and recovered 10 months later, and 1 case complained of discomfort of foot. Conclusion Subtalar joint fusion with trephination is an effective procedure with many advantages such as: minimal invasive surgery, easy to perform, higher fusion rate and preserving mechanical stability of hind foot.

A deep impact on the development of marine pharmaceutical science will be benefit- ed from the inter-disciplined combination of marine science and pharmaceutical science with information technology. Applications of such technologies as obtaining information trough Internet,database-on-the-Inter and virtual reality will greatly modify and accelerate the processes of discovering and developing marine drugs derived from marine bioresources. The concept of "virtual research on marine drug" was proposed for the first time in this paper, and the first professional net on marine drugs was build. The virtual research center for marine drugs was also build on the Internet and will be made more resourceful in the future.

Serotonin (5-HT) neurons in the nucleus raphe magnus (NRM) of the rat were identified by light and electron microscope immunocytochemistry methods. Serotoninlike immunoreactive (5-HT-li) neurous were large multipolar and fusiform cells which mainly located in the ventrocaudal part of the NRM. With electron microscopic immunocytochemistry the following findings were revealed: 1. Immunostaining was present in the cytoplasmic matrix, outer membrane of mitochondria, rough endoplasmic reticulum, multivesicular bodies and vesicles. Some nuclei of the cells were stained. 2.5-HT-li somata, dendrites and axons were postsynaptic to numerous unlabeled terminals which contained clear round vesicles (20-30 nm) or mixed with small granular vesicles (40-70 nm), large granular vesicles (90-110 nm) and flat clear vesicles. 3. The 5-HT-li axons were unmyelinated fibers, and the 5-HT-li axon terminals were scarce in the NRM. 4.5-HT-li axon terminals and dendrites abutting on capillaries and 5-HT-li dendrite-glial direct appositions were found in the NRM.These results revealed the ultrastructural characteristics of 5-HT-li neuron in the NRM. The variety of unlabeled terminals making contact with 5-HT-li somata and dendrites suggests that several neuronal system with possibly different transmitters may regulate 5-HT raphe-spinal neurons which may play integrative role in the NRM. Tae relationship between 5-HT neuron and the significance of the local microcirculation and the relationship between 5-HT neurons and glia cells were also discussed in the present paper.

Substance P-like immunoreactive (SP-li) cell bodies and processes and their synaptic relations with other neural elements in the nucleus raphe magnus (NRM) of rats were studied by electron microscope. The results showed that SP-li neurons are fusiform, oval and multipolar cells which distribute evenly over the nucleus. Immunostaining was present in the cytoplasmic matrix and membranes of mitochondria, endoplasmic reticulum and vesicles. Both unmyelinated and myelinated SP-li axons are found in the NRM. SP-li dendrites are numerous in the NRM. SP-li dendrites and somata are contacted by a variety of round, flat and granular vesicle-containing terminals. A central SP-li dendrite receivie convergent inputs from unlabelled axonal boutons is frequently seen in the NRM. SP-li terminals are presynaptic to the unlabelled dendrites, also some SP-li terminals are apposed or presynaptic to SP-li dendrites. Axo-axonic (SP-li) synapses were found in the NRM. The unlabelled presynaptic boutons contain clear round vesicles or mixed with granular vesicles. A central SP-li terminalis contacted by several unlabelled terminals is also found in the NRM.

ObjectiveTo study the relation ship between progressive cerebral infarction and thyroid hormone level,and analyze the risk factors of progressive cerebral infarction.MethodsThe thyroid hormone,triglyceride esters and fasting glucose levels of 48 patients with progressive cerebral infarction,138 patients with non-progressive cerebral infarction and 60 healthy subjects as control group were measured.ResultsCompared with the patients with non-progressive cerebral infarction,serum T3 of patients with progressive cerebral infarction was lower( P ＜0.05),and the levels of triglyceride ( TG),C-reactive protein ( CRP),and fasting blood glucose were higher ( all P ＜ 0.01 ).ConclusionPatients with progressive cerebral infarction were in a low level of thyroid hormones,and the increasing levels of TG,CRP,and fasting blood glucose were risk factors for progressive cerebral infarction.

Objective To observe the effect of treating generalized anxiety disorder with clearing heart and relieving rstlessness acupuncture combined with western medicine. Methods 87 patients with generalized anxiety disorder were randomly recruited into a control group and a treatment group. Both groups received conventional western medical treatment. On this basis, the control group was given conventional acupuncture therapy, while the treatment was given clearing heart and relieving restlessness acupuncture. The efficacies were evaluated with Hamailton anxiety (HAMA)scale and clinical global impression scale (CGI). The adverse reaction was evaluated with treatment emergent symptoms scale (TESS). Results One week after treatment, the efficacies and adverse reaction in the treatment group markedly decreased comparing with those before the treatment(P<0.05). Two weeks after treatment, the efficacies and adverse reaction of both groups decreased comparing with those before the treatment(P<0.01). Besides, the decrease continues with time passing by. One week after treatment, the HAMA score in the control group markedly decreased comparing with that of the control group (P<0.05), and the CGI score in the treatment group had no significant difference comparing with that of the control group(P<0.05). Conclusion The treatment of clearing heart and relieving restlessness acupuncture on generalized anxiety disorder has rapid effect and good compliance.

Objective To investigate the significance of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scoring system in evaluating elderly patients with hyperglycemic hyperosmolar state. Methods Elderly patients with hyperglycemic hyperosmolar state were enrolled in the study from January 2003 to May 2008. The patients were divided into two groups according to the outcome: death group and survival group. APACHE Ⅱ scoring system was used on the day of admission and the scores were compared in the two groups. The risk factors for death were evaluated by logistic regression analysis. Results Forty patients were registered including 10 cases in death group and 30 cases in survival group. The mortality rate was 25%. There were no differences in blood glucose, serum sodium, blood osmotic pressure, serum creatinine and hemoglobin between two groups before the treatment (t=-1.50～1.53, all P>0.05). The APACHE Ⅱ scores were significantly higher in death group than in survival group on the day of admission(30.1±5.4 vs. 22.9±3.9,Z=-4.08, P<0.01). Multiple logistic regression analysis showed that APACHE Ⅱ scores on the day of admission were the independent risk factor for death. Age, sex, blood glucose, effective blood osmotic pressure, serum creatinine and hemoglobin were not related to mortality rate. Conclusions APACHE Ⅱ scoring system is a helpful method for evaluating the severity and outcome of patients with hyperglycemic hyperosmolar state.