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.

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 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.

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 compare the therapeutic effects in respect of ventilatory response and the change of hemodynamics of two modes of mechanical ventilation [ proportional assist ventilation (PAV) vs.Bi-level positive airway pressure ventilation (BiPAP) ] on patients with acute cardiogenic pulmonary edema (ACPE).Methods Thirty-two patients diagnosed as ACPE were recruited from May 2008 to April 2009.After conventional therapy ( cardiotonic,diuretic,vasodilators,oxygen) were ineffective for half an hour,32 patients were randomly divided into three groups:control group ( 12 cases kept conventional treatment without mechanical ventilation),BiPAP group ( 12 cases were treated with BiPAP mode of non-invasive mechanical ventilation plus conventional treatment) and PAV group (8 cases were treated with PAV mode of non-invasive mechanical ventilation along with conventional treatment ).Results PaO2,RR and oxygenation index were improved significantly in three groups after 1 hour treatment ( P ＜ 0.05 ).While PaO2 and oxygenation index in noninvasive ventilation groups were higher than those in control group ( P ＜0.05 ).The time required for amelioration of dyspnea in noninvsaive ventilation groups was shorter than that in control group ( P ＜ 0.05 ).The peak airway pressure and the index of degree of comfort ( VAS score,auxiliary respiratory muscles score) in PAV group were lower than those in BiPAP group (P ＜ 0.05 ).Conclusions Both modes of noninvasive mechanical ventilations could improve the oxygenation and relief of dyspnea in patients with ACPE.PAV and BiPAP had the similar effect in patients with ACPE.The synchronization and comfort in PAV group were better than those in BiPAP group.The PAV mode of noninvasive mechanical ventilation was well accepted by patients with ACPE.

Objective To study the effect of tanshinone ⅡA on the expression of P-selectin and ICAM-1 after cerebral ischemia reperfusion (I/R)injury in rats. Methods Rats were randomly divided into 4 groups: Sham operated group, I/R group, low dose Tan ⅡA treated group and high dose Tan ⅡA treated group. The focal middle cerebral artery occlusion (MCAO) model was made by suture-occluded method. Rats were pretreated with Tan ⅡA, ig for 3d,respectively before MCAO. After 90min MCAO following 24 hours of reperfusion, the expression of P-selectin and ICAM-1 was detected with using immunohistochemistry method. Result Compared with sham operated group, the expression of P-selectin and ICAM-1 increased after reperfusion for 24 hours in the ischemic territory(all P＜0.01).Compared with I/R group, the expression of P-selectin and ICAM-1 decreased in a dose dependent manner in low and high dose Tan ⅡA treated group(P＜0.01).Compared with that of I/R group, cerebral infarction volume was decreased in a dose dependent manner in low dose Tan ⅡA treated group and high dose Tan ⅡA treated group(all P＜0.01).The change of ischemic impairment in low or high dose Tan ⅡA treated group was less than that in IR group, and the change of ischemic impairment in high dose Tan ⅡA treated group was less than that in low dose Tan ⅡA treated group. Conclusion Tan ⅡA may reduce cerebral ischemia-reperfusion inflammation injure by decreasing the expression of p-selectin and ICAM-1.Tan ⅡA plays protective effect on cerebral ischemia injury, especially when high dose of Tan ⅡA(30mg/kg)was used.

Objective To investigate the regulatory networks of DNA methylation profiles in STEMI by methylation microarrays.Methods A total often male patients with STEMI and ten male healthy controls were recruited.Methyl-DNA immunoprecipitation and Nimblegen HG18 Meth 385K promoter plus CpG island microarrays were used to identify differentially methylated regions.And several bioinformatics analysis tools which included chromosomal assignment, gene ontology analysis and pathway analysis with SignalMap and The Database for Annotation, Visualization and Integrated Discovery were used to high-throughput analysis.Results Compared with healthy controls, DMRs of STEMI is 1 634, There are 1 480 (90.57％), 131 (8.02％) and23 (1.41％) methylated sites were separately located on High CpG-containing promoter, Intermediate CpG-containing promoter and Low CpG-containing promoter;Gene Ontology and Pathway analysis expressed DNA methylated genes of signaling pathway in MI identified glycerophespholipid metabolism, cysteine and methionine metabolism, Dilated cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, regulation of actin cyteskeleton, calcium signaling pathway.However, the signal pathway about lipid metabolism is shown no significant difference.Conclusions Bioinformatics tools could provide the quick and high-throughput analysis of data from methylation microarray and enable the function classification of differentially expressed genes of STEMI.

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.