Objective To explore the clinical effect of different operative methods in the treatment of papillary thyroid carcinoma.Methods Using random number method according to the proportion of 1∶1,95 patients with papillary thyroid carcinoma were divided into observation group(n=48) and control group(n=47).The control group was treated by ipsilateral lobectomy and isthmus resection and ipsilateral central lymph node dissection,the observation group was treated by total thyroidectomy plus ipsilateral central lymph node dissection.The tumor size,lymph node involvement,the score of KPS,the surgical complications and the rate of postoperative recurrence and metastasis of the two groups were compared.Results The tumor size,lymph node involvement and surgical complications in the observation group had no statistically significant differences compared with the control group(t=-1.367,P=0.175;t=-1.495,P=0.138;x2=1.642,P=0.232).After treatment,the effective rate of KPS score in the observation group was 81.25%,which was higher than 72.34% in the control group(Z=-3.639,P=0.000).The observation group had no recurrence,which was lower than 5 cases in the control group,the difference between the two groups was statistically significant(x2=5.390,P=0.006).The observation group found 1 case of metastatic patient,which was lower than 7 cases in the control group,the difference between the two groups was statistically significant(x2=5.053,P=0.031).Conclusion Total thyroidectomy plus ipsilateral central lymph node dissection in the treatment of papillary thyroid carcinoma has significant clinical curative effect.It can effectively reduce the risk of tumor recurrence and metastasis and improve the quality of life of patients.It is worthy of popularization and application.

Objective To explore the clinical effect of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma.Methods Using EXCEL random number method according to the proportion of 1︰1,87 patients with multifocal papillary thyroid carcinoma were divided into treatment group(n=44) and control group(n=43).The control group was treated by ipsilateral lobectomy and isthmus resection and ipsilateral central lymph node dissection,the treatment group was treated by total thyroidectomy plus prophylactic central lymph node dissection.The tumor size,lymph node involvement,the score of SF-36,the complications and the rate of postoperative recurrence,metastasis and mortality of the two groups were compared.Results The tumor size,lymph node involvement and complications in the treatment group had no statistically significant differences compared with the control group(χ2=1.194,P=0.610;χ2=0.680,P=0.500,χ2=0.603,P=0.438).After treatment,the SF-36 scores of the two groups were significantly higher than before treatment(t=7.927,P=0.000;t=5.374,P=0.000).The SF-36 score of the treatment group was (76.47±13.72)points,which was significantly higher than (68.88±15.36)points of the control group(t=2.429,P=0.017).The patients were followed up for 6 months,there was no recurrence in the treatment group,while there were 5 cases in the control group,the difference was statistically significant(χ2=5.428,P=0.026).There was no metastasis in the treatment group,while there were 6 cases in the control group,the difference was statistically significant(χ2=6.594,P=0.012).Conclusion Total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma has significant clinical curative effect.It can effectively reduce the risk of tumor recurrence and metastasis and improve the quality of life of patients.It is worthy of popularization and application.

Objective To study the influence of hydroxyethylstarch 200/0.5 on hemodynamic and coagulation in hemodilution for paediatrics patients(AHH).Methods 64 paediatrics patients who would receive AHH were selected.All patients were randomly divided into HES group(received HES 200/0.5)and control group(received sodium lactate Ringer's),32 patients in each group.Hemodynamic efficacy and coagulation indexes were recorded before AHH(T0),30 min post-AHH(T1) and 60 min post-AHH(T2).Results There were no sinificant differences in MAP,HR,CVP,INR,APTT,CT and FIB compared with T0 or between groups.RBC,Hct and Hb were significantly lower compared with T0,but no significant differences were observed between groups.CI and PT were significantly higher compared with T0,but no significant differences were observed between groups.Conclusion There were no negative effects on hemodynamic efficacy and coagulation in paediatrics patients treating with HES 200/0.5.

Objective To investigate the safety and effectiveness of laparoscopic surgery for early ovarian cancer. Methods Selected 90 early-stage ovarian cancer patients from January 2010 to December 2014 in Zhejiang Cancer Hospital as research subjects, and randomly divided into laparoscopic surgery group and laparotomy group. Then compared the age, BMI, ovarian cancer diameter, ovarian cancer staging, blood loss, operative time, surrounding or﹣gan damage, albumin difference before and after surgery, postoperative ventilation time, postoperative hospital stay, interval of postoperative to the first chemotherapy, postoperative fever cases, follow-up time, postoperative complica﹣tions, postoperative recurrence and postoperative death in two groups. Results Blood loss and operative time of la﹣paroscopic surgery group was less than that of laparotomy group (P< 0.05). Albumin difference before and after surgery of laparoscopic surgery group was less than that of laparotomy group (P< 0.05), postoperative ventilation time and interval of postoperative to the first chemotherapy of laparoscopic surgery group was less than that of la﹣parotomy group (P< 0.05), the incidence of postoperative fever and postoperative complications of laparoscopic surgery group was less than that of laparotomy group (P< 0.05), the recurrence rate and postoperative mortality rate of laparoscopic surgery group were slightly higher than that of laparotomy group, but the difference was not statisti﹣cally significant (PP> 0.05). Conclusion Laparoscopic surgery for early-stage ovarian cancer has a relatively good safety and efficacy. Laparoscopic surgery has advantages over open surgery in improving early ovarian cancer intra﹣operative situation and postoperative situation.

?AIM: To observe the efficacy of 25G vitrectomy for traumatic cataract.?METHODS:Retrospective analysis of 70 cases (70 eyes) of traumatic cataract treated by 25G vitrectomy with lensectomy from February 2013 to February 2015 in our hospital was made for the study.In the patients, there were 43 males ( 43 eyes ) , 27 females ( 27 eyes ) , aged from 22-51 years old with an average of 35.23±2.54 years, mean visual acuity was 0.10±0.03.They were all followed up for 6 -12mo postoperatively. Anterior segment, fundus, complications, best corrected visual acuity ( BCVA ) and intraocular pressure were observed during the follow - up. BCVA preoperatively, 1wk postoperatively, 1 mo postoperatively, 6mo postoperatively were compared.? RESULTS: All the patients underwent the surgery successfully, and visual acuity improved at different degrees. The differences of BCVA preoperatively compared with 1 and 6m postoperatively were all statistically significant ( P <0. 05 ). Postoperative complications:5 cases with corneal edema, 10 cases with ocular hypertension, 4 cases with ocular hypotension, 5 cases with retinal spotting.The symptoms improved after symptomatic and supportive treatment.? CONCLUSION: 25G vitrectomy with lensectomy is effective on treating traumatic cataract, with decreased operation risk, complications and improved visual acuity.

It is necessary for the improvement of the medical education and medical system to reform the model of clinical teaching.This article analyzes some problems of today's clinical teaching and clarifies specific demands and aims of teaching,learning and managing in the process of clinical teaching.In order to improve the quality of clinical teaching,the author puts forward some conceives about constructing the "three-in-one" system including teaching,learning and managing in clinical education.

Thyrotoxicosis in pregnancy is a common endocrine disease,and the incidence is gradually increasing.And thyroid function changes during pregnancy which brings some difficulties to diagnose.It is necessary to further understand the corresponding changes of maternal thyroid hormone levels with the progress of pregnancy.Moreover,the thyroid function in pregnancy is directly related to the pregnancy outcome.If the disease is not well controlled,it will cause damage to both the mother and the fetus,all kinds of adverse pregnancy outcomes make it become the focus of clinical attention.Therefore,this article discusses the etiology of the thyrotoxicosis,thyroid function changes in the period of pregnancy as well as the impact on pregnancy outcomes,and also makes some suggestions of the diagnosis and the treatment of the disease.

AIM:To evaluate the efficacy of Bailemian Capsule(bulbus lilii,Radix et rhizome seu acanthopanacis senticosi caulis,Caulis polygoni multiflori,Flos albiziae,Concha margaritifera) in combination with buspirone in generalised anxiety disease. METHODS:Seventy-seven patients with generalized anxiety disease were randomly assigned to two groups:Bailemian Capsule in combination with buspirone in the treated group; buspirone alone in the control group. A period of six weeks was one treatment course in each group. The clinical effectiveness was evaluated according to HAMA reactions. RESULTS:HAMA score(P

Whether or not muscle hypertrophy induced by physical exercise will result in the increase in thenumber of muscle fibres is a question much debated in recent years. But little has been done so farin studying the effect of short and long term weight training on the changes in the number of muscle fibres in the human body. As an attempt to find out this effect, a research has been madeon 29 male subjects. Nine young trainees at spare-time sports schools were put through a weightliftingprogramme consisting of three hours of work a day, six days a week for 10 weeks. Before and afterthe 10-week period, the cross section of the musculus vastus lateralis was measured with computedtomography scanning (CT); maximal voluntary isometric torques of knee extension were alsomeasured; muscle biopsies were taken from the vastus lateralis to distinguish between muscle fibresof type I and type II and to find out their distribution and their average areas; and the number ofmuscle fibres was calculated by a formula. The results were compared with those obtained from thecontrol group of 13 persons and a group of seven weightlifters of national ranking. It was found thatthe 10 weeks of weight training did not result in the increase in the number of muscle fibres althoughit caused some change in the maximal torque; and that although long-term training resulted insignificant changes in the maximal torque and the area of muscle fibres, there was no significantdifference in the number of muscle fibres between the elite group on the one hand and the controlgroup and the group of trainees who had gone through 10 weeks of training on the other. Thesefindings supported Soviet scholars' idea that to respond to load stress, animals depend on bothhypertrophy and hyperplasia in the muscle while man relies on hypertrophy alone. They alsosuggested the need for further studies on this subject.

Objective To study the role of Schwann cells apoptosis in the pathogenesis of experimental autoimmune neuritis(EAN) in TNF receptor Ⅰ knock out(TNFR Ⅰ-/-)mice.Methods For induction of EAN,TNFRⅠ-/- and wild type C57BL/6 mice were immunized by subcutaneous injection into the back with the peripheral nerve P0 protein peptide 180-199;clinical scores of EAN were assessed and scored immediately before immunization(day 0) and thereafter every other day until day 46 post immunization(p.i.).On day 22 p.i.,Schwann cells were collected from the two groups and cultivated in vitro.The expressions of Fas and Annexin-Ⅴ(Annexin-Ⅴ+/PI-)on Schwann cells from TNFRⅠ-/-and wild type EAN were detected by flow cytometry.Results More light clinical signs of EAN were observed in the TNFRⅠ-/-mice(1.50?0.19) than in wild type mice(1.90?0.16);the percentage of Fas expression on Schwann cells was significantly decreased in TNFRⅠ-/-mice(88.03%?1.40%)as compared with wild type mice(94.70%?1.53%)(P