Objective To investig the value of neck lymph dissection in re-operation for differentiated thyroid carcinoma (DTC) and direct the choice of re-operative pattern.Method Re-operation was performed in 122 cases with DTC,of which neck lymph dissection was performed in 88 cases and the clinical data were retrospectively analyzed.Of 88 cases,partial thyroidectomy was performed in 38 cases in the first operation,one lobe plus isthmus excision 16 cases,thyroiddectorny was perfomed in 2 cases,neck lymph nodes biopsy in 32 cases.Results 11 patients suffered from thyroid micro carcinoma.The metastasis rate of neck lymph node were 65.91% (58/88) and residual carcinoma rate was 31.59%(12/38). Conclusions Neck lymph dissection had definite curable effect on re-operation for DTC.Neck lymph dissection should be performed when tumor had involved capsule,enlarged lymph node was palpated in the neck and thyroid micro carcinoma was confirmed.Re-operation was necessary for recurrent thyroid carcinoma.Attention must be paid to the fullresection of recurrent lesions and preserving laryngeal nerve and parathyroid in re-operation.

0.05) and was significantly lower than that in groups of GNB and mycetes' (P

Objective:To observe the effects of ultrasound-guided paravertebral nerve block combined with general anesthesia on intraoperative stress response, hemodynamics and postoperative pain of patients undergoing laparoscopic cholecystectomy.Methods:A total of 92 patients undergoing elective laparoscopic cholecystectomy in Wuhan Third Hospital between January 2017 and August 2019 wereselected. They were divided into the control group (63 cases) and the observation group (29 cases) by voluntary. The control group were given simple general intravenous anesthesia, and the observation group were given ultrasound-guided paravertebral nerve block combined with general intravenous anesthesia. Changes in hemodynamic parameters and concentrations of blood angiotensin-Ⅱ (AT-Ⅱ) and cortisol (Cor) in the two groups were observed. The cerebral state indexes (CSI) of both groups were recorded, and pain degree of patients was evaluated with the visual analogue scale (VAS).Results:The mean arterial pressure (MAP) and heart rate (HR) of the observation group were higher than those of the control group at 30 min after anesthesia, 30 min after operation, 3 hours after operation ( P<0.05), the stroke volume variation (SVV) was lower than that of the control group ( P<0.05); the AT-Ⅱ, Cor and CSI in the observation group were lower than those in the control group at each time point ( P<0.05); The dosage of narcotic drugs in the observation group was significantly lower than that in the control group ( P<0.05); The recovery time of spontaneous breathing, recovery time, extubation time and respiratory satisfaction time in the observation group were less than those in the control group ( P<0.05), and the VAS scores at 3 h, 6 h and 12 h after operation in the observation group were lower than those in the control group ( P<0.05). Conclusions:Ultrasound-guided paravertebral nerve block combined with general anesthesia can effectively reduce the patient's stress response during laparoscopic cholecystectomy, with good analgesic effect, which is helpful to maintain the hemodynamic stability of patients.

Objective To improve the freeze-dryer shelf temperature control effect.Methods The fuzzy-PID control algorithm that's adjusting the PID parameters in real-time in the control process,was adopted to control the shelf temperature,expecting to adapt the changing of process parameters of shelf.Results In the process of freeze-drying temperature control shelves,the shelf temperature static performance and dynamic performance were improved,and the effect of shelf temperature control was archived satisfyingly.Conclusion In the freeze-drying process,the process parameters of shelf are changed along with the drying time and the working environment.The conventional PID control is difficult to obtain satisfactory results.The fuzzy-PID controller,which can adjust PID parameters on real-time in the controlling process,be used in the shelf temperature control,and the result is satisfied.

Objective To explore the effect of propofol and etomidate on anesthesia induction in pediatric surgery, and to provide evidence for the future use of anesthesia in pediatric surgery.Methods120 cases of pediatric surgery patients were prospectively selected pediatric in our hospital from May 2013 to January 2015 as the research object, randomly divided into 2 group respectively, control group and observation group, 60 cases in each group;the control group anesthesia was induced with etomidate, observation group anesthesia was induced with propofol, and the anesthetic effect were observed in the two groups, recovery and adverse reaction in the induction period of anesthesia.ResultsThe patients in the observation group anesthesia satisfaction scores were significantly higher than the control group (P<0.05) and the observation group;the recovery time and the time of leaving room were significantly shorter than the control group (P<0.05);in the observation group, respiratory depression, restlessness, throat and bronchial spasm, adverse reactions such as nausea and vomiting were significantly lower than the control group (P<0.05).ConclusionPropofol is more suitable for pediatric surgery than etomidate, and anesthesia effect is remarkable, fast recovery, worthy of clinical application and promotion.

Objective To investigate the safety and efficacy of sufentanil in pediatric surgery.Methods80 cases of pediatric surgery were prospectively selected pediatric methods in The Third People's Hospital of Xining from July 2013 to January 2015 as the research object, the patients were divided into two groups, control group and observation group, 40 cases in each group.The control group received remifentanil,observation group were given sufentanil, mean arterial pressure(MAP)and heart rate(HR)30min and 5min at each time point after extubation and 5min based value children after entering the operation room after induction were compared.The sedation scores of 5min, 15min and 30min after tracheal intubationwere recorded..ResultsThe pain scores in the observation grouppostoperative T4, T5, T6 each time were significantly higher than the control group (P<0.05);MAP and HRin the observation group at T0, T1, T2, T3 had no significant differencecompared with control group, MAP during T4 in the observation group was significantly higher than the control group (P<0.05);and HR in the observation group in the period of T4 was significantly lower than the control group (P<0.05).ConclusionThe application of sufentanil in pediatric surgery is effective and safe.

Objective To explore the folate receptor mediated (FRD) check and multi-function acetic acid white solution liquid based cervical cytology (TCT) application value in cervical cancer screening.Methods A total of 602 cases of patients was tested with FRD multi-function acetic acid white solution check,and TCT and cervical biopsy pathology examination.With the used of histopathological results as the gold standard,FRD multi-function acetic acid white analysis was compared with the TCT screening inspection results.Results For a total 602 patients with TCT screening,the positive rate was 21.8％ (131/602),including 36 cases of CIN Ⅰ level,41 cases of CIN Ⅱ level,24 cases of CIN Ⅲ level,and 30 cases of cervical invasive carcinoma.For the FRD multifunction white acetate solution screening,its positive rate was 23.8％ (143/602).No statistically significant difference was found between TCT and FRD screening (P ＞ 0.05).The missed diagnosis rate of FRD multi-function white acetate solution screening was 2.6％ in inflammation,and 21.1％ in cervical invasive cancer,and 3.8 ％ in CIN.The missed diagnosis rate of TCT screening was 7.2％ in inflammation,5.3％ in CIN Ⅰ,4.9％ in CIN Ⅱ,and 58.6％ in CIN Ⅲ]; whereas,its detection coincidence rate was 100％ in squamous cells carcinoma (SCC) and adenocarcinoma (AC).FRD multi-function acetic acid white solution screening had a sensitivity 80.92％,specificity 92.14％,positive predictive value 74.13％,and negative predictive value 95.59％.TCT examination had a sensitivity 90.84％,specificity 90.23％,positive predictive value 72.12％,and negative predictive value 97.25％.No significant difference was found between FRD and TCT methods (P ＞ 0.05).Conclusions FRD and TCT methods were both efficient in screening and evaluation for cervical lesions and cervical cancer.Because FRD method is limited in the deep tube for examination of cervical lesions; it cannot completely replace the TCT examination.However,FRD method is reliable,economic,and simple operation; it is suitable for primary hospitals census of cervical cancer

Objective To investigate the clinical efficacy of selenium-enriched garlic on patients with oligoasthenospermia.Methods From October 2012 to August 2013,160 patients with oligoasthenospermia were randomly divided into two groups.Treatment measurements for 80 patients in the control group included oral treatment of Shengjing capsules 1.6 g/time Tid,Vit-E soft capsules 100 mg/time Tid,and took Vit-B 0.2 g/time Tid,for three months.Treatment measurements for 80 patients in the treatment group included oral treatment of selenium-enriched garlic in addition to all the above,for three months.We observed the changes of the semen quality indexes (including semen volume,sperm density,motility,survival rate,etc.) of two groups before and after treatment.Results Sperm quality was improved after treatment in both groups.All indices in the treatment group were significantly higher than those in the control group (P ＜ 0.05).Conclusions For patients with male infertility caused by oligoasthenospermia,The use of combination of selenium-enriched garlic and Shengjing capsules can improve the quality of sperm.

Nursing management is an important part of hospital management,the head nurses,as leaders and organizers of first-line clinical nursing work of the hospital,play a decisive role in hospital nursing management.As the first-line managers and organizers,the head nurse management level and ability is directly related to the hospital nursing quality and the overall quality of nurses.The implementation of the performance appraisal and management by objectives in current nursing management has been more and more used in the hospital.This article aimed to review the management by objective and quantitative assessment home for head nurse at home and abroad,in order to help nursing managers to learn and master performance appraisal of head nurses,comprehensively improve quality of head nurses,promote the improvement of nursing quality,and push the development of nursing course.

Objective To sum up the experiences in radical surgery for tetralogy of Fallot(TOF) in infancy.Methods One hundred and twenty-two infants(82 males and 46 females,6 months to 2 years old) suffered from TOF were treated with radical surgery from January 1996 to December 2007.Median sternotomy was routinely performed in all patients,and a longitudinal incision of right ventricular outflow tract was made to widen the conduit adequately,the ventricular septal defect was closed with polyfluortetraethylene patch,and the outflow conduit was reconstructed by autologous pericardial patch.Modified ultrafiltration technique was adopted routinely before cardiopulmonary bypass termination.Results Seven of the 128 infants died after operation with the early mortality of 5.5%.The death causes were: severe low cardiac output syndrome(n=2),severe pulmonary complications(n=4) and multiple organ failure(n=1).The major post-operative complications included 12 cases of low cardiac output syndrome,5 cases of atelectasis and 6 cases of perfusion lung.Conclusions The preferable operative age of radical surgery for TOF is about 1 year old,and the clinical outcome could be satisfactory.Low cardiac output syndrome and severe respiratory complications are the major problems after radical surgery for TOF in infants.