Objective To investigate the protective role of two-step decapping technique for superior parathyroid glands in total thyroidectomy surgery.Methods The clinical data of 136 consecutive cases underwenttwo-step decapping technique in total thyroidectomy plus central compartment dissection from April 2013 to January 2016 were retrospectively analyzed.And the incidences of postoperative hypocalcemia were was compared with conventional consecutive decapping surgical methods containing 113 cases from January 2010 to March 2013.All operations were performed by the same treatment group.Results In the two-step decapping group,28 cases(28/136,20.6％) displayed postoperative temporary hypoparathyroidism and a higher incidence were was observed in 37 cases (37/113,32.7％) in the conventional method group,the difference was statistically significant(x2 =4.737,P =0.03).Whereas,2 cases(2/136,1.5％) suffered permanent hypoparathyroidism in the two-step decapping group and 7 cases (7/113,6.2％) of permanent hypoparathyroidism in the conventional method group,the difference was statistically significant (x2 =3.954,P =0.047).Conclusion Two-step decapping technique can more effectively protect the parathyroid gland function.It is worthy of popularization.

Objective To investigate the protection of superior parathyroid glands by improving dissection procedure of thyroid superior pole in total thyroidectomy surgery.Methods 136 consecutive cases undergoing two-step dissociating procedure of thyroid superior pole(the improved group) in total thyroidectomy plus central compartment dissections from Sep.2012 to Oct.2015 were retrospectively analyzed.Intraoperative observation of superior parathyroid and incidences of postoperative hypoparathyroidism were compared with conventional surgical methods (the conventional group) containing 113 cases from Jun.2009 to Sep.2012.All operations were performed by the same treatment group.Results Intraoperatively,249 (249/272,91.5％) superior parathyroid glands were identified in the improved group and 215 (215/226,95.1％) superior parathyroid glands were identified in the conventional group.The difference had no statistical significance (P＝0.114).Whereas,among identified superior parathyroid glands,242 (242/249,97.1％)of them were conserved in situ in the improved group and 198 (198/215,92.0％) were conserved in situ in the conventional group.The difference had no statistical significance (P＝0.013).Among superior parathyroid glands conserved in situ,225 (225/242,93.0％) had good blood supply in the improved group and 170(170/198,85.9％) in the conventional group.The difference had statistically significance (P＝0.001).28 (28/136,20.5％) patients displayed temporary hypoparathyroidism and 2 (2/136,1.5％) cases suffered permanent hypoparathyroidism in the improved group after surgery.Whereas,in the conventional method group,a higher incidence was observed in 37 (37/113,32.7％) cases of temporary hypoparathyroidism and 7 (7/113,6.2％) cases of permanent hypoparathyroidism respectively.The difference had statisticall significance (P＝0.003).Conclusions Two-step dissociating procedure technique offers protective effect on superior parathyroid glands function.It is worthy of popularization.

ObjectiveTo investigate the value of serum creatinine(SCr) to monitor the renal function of patients with spinal cord injury(SCI).Methods1298 SCI patients were investigated in Beijing Charity Hospital from January 2004 to May 2009. 249 healthy people were involved as control. The data of SCr were analysed.ResultsThe level of SCr for the SCI patients was (56.81±14.33) μmol/L with normal distribution, 95% CI was 28.73～84.89 μmol/L; The level of SCr for the healthy people was (75.98±11.34) μmol/L, 95% CI was 57.36～101.80 μmol/L. The level of SCr was significantly lower in the SCI patients comparing to the healthy people (P<0.01). Among the SCI patients, the level of SCr was (59.59±13.76) μmol/L for male while (46.41±11.31) μmol/L for female(P<0.05). There was no difference in level of SCr among different ages of the SCI patients(P>0.05). The characteristics were likely in the two groups. There was no difference in level of SCr between paraplegic (55.54±14.96) μmol/L and quadriplegic (57.67±13.83) μmol/L (P>0.05).ConclusionThe characteristics of level of SCr were likely in SCI patients and healthy people with normal distribution. The level of SCr was lower in SCI patients comparing to healthy people, which was higher for male SCI patients comparing to female SCI patients.

Objective To evaluate the capabilities of disc diffusion and Vitek2-compact GN13 methods for testing antimicrobial susceptibility of screening ESBLs ( extended-spectrumβ-lactamase) in En-terobacteriaceae clinical isolates.Methods A total of 93 Enterobacteriaceae strains were isolated from pa-tients with intra-abdominal infections in 21 hospitals during 2011 to 2012.The in vitro minimum inhibition concentration ( MIC ) values of ampicillin-sulbactam, piperacillin-tazobactam, ertapenem, ceftazidime, ceftriaxone, cefepime, imipenem, amikacin, ciprofloxacin and levofloxacin were determined by disc diffu-sion, Vitek2-compact GN13 and broth microdilution methods, respectively.Categorical agreement ( CA ) rates of disc diffusion and Vitek2-compact GN13 methods were determined by using broth microdilution meth-od as the reference method.The genes encoding ESBLs were screened in Escherichia coli (E.coli), Kleb-siella pneumoniae (K.pneumonia), Klebsiella oxytoca (K.oxytoca) and Proteus mirabilis (P.mirabilis) strains by using PCR analysis and gene sequencing.Disc diffusion and Vitek2-compact GN13 methods were used for the phenotypic confirmatory test of ESBLs and the sensitivity, specificity, positive predictive value and negative predictive value of the two tests were evaluated.Results The CA values of disc diffusion and Vitek2-compact GN13 methods for the 10 antibiotics were all >90% as compared with broth microdilution method.The major error (ME) rate for ertapenem was 3.2%and the very major error (VME) rates for am- picillin-sulbactam, ceftazidime and cefepime tests were all 2.2% by using Vitek2-compact GN13 method. The sensitivity, specificity, positive predictive value and negative predictive value of disc diffusion and Vitek2-compact GN13 methods in the phenotypic confirmatory test of ESBLs were 96.7%(29/30), 100%(20/20), 100%(30/30) and 95%(19/20), respectively.Conclusion Both disc diffusion and Vitek2-compact GN13 methods could be used for testing the antimicrobial susceptibility and the detection of ESBLs in Enterobacteriaceae clinical isolates with the advantage of accuarcy.Attention should be paid to the posibil-lity of oaurance of ME and VME when testing ertapenem, ampicillin-sulbactam, ceftazidime and cefepime by using Vitek2-compact GN13 method.

Objective To clarify the pathogen for rubella in Beijing from 2007 to 2010. Methods Beijing Center for Disease Preventipn and Control ( CDC ) collected the specimens (including blood, urine and throat swab specimens) frqm clinically diagnosed rubella cases for serological test and virus isolation. The nucleic acid of rubella virus in clinical specimens and isolations was detected by real-time PCR. Results Fifty-five out of 99 blood specimens were positive for anti- rubella IgM. Fifty-one out of 99 clinically diagnosed rubella cases were confirmed as rubella cases by virus isolation. Seventy-two were confirmed as rubella virus infections with real-time PCR method for detecting the nucleic acid of rubella virus in clinical specimens. Compared with the sequences of reference strains of rubella virus, all of detected rubella virus belonged the IE gene type. Conclusion This study indicates that IE gene type virus was the predominant endemic rubella virus in Beijing.

Objective To analyze effects of thoracoscopy in the diagnosis and treatment of suspected diaphragmatic injury after thoracoabdominal stab wound.Methods Sixty-eight patients who received thoracoscopic diagnosis and management of diaphragmatic injuries due to thoracoabdominal stab wounds from April 2000 to October 2011 were retrospectively analyzed.Results Occult diaphragmatic injuries were found in 11 patients.Seven patients underwent thoracoscopic suture,of which five had synchronous laparotomy for inspected abdominal organ injuries.Pulmonary parenchymal lacerations occurred in 15 patients who received thoracoscopic repair or resection.Coagulated hemothorax in 13 patients were removed.Postoperative complications included pleural effusion in one patient,pneumonia in two and pulmonary atelectasis in one.Hospital stay was(7.9±13.5)days,without ICU stay.The length of drainage,operation time and intraoperative blood loss were(3.3±1.5)days,(45.6±78.1)minutes and(57.8±24.3)ml respectively.There was no conversion to thoracotomy.Thoracic CT scan was performed six months postoperatively,without hernias.The accuracy of thoracoscopy in diagnosing diaphragmatic injury was 100％.Conclusion Thoracoscopy should be performed for the thoracoabdominal stab wounds with stable hemodynamics,with definite significance especially for the diagnosis and treatment of wounds at the 7-9th intercostal spaces.

OBJECTIVETo explore the effects of different acupuncture depths of Lianquan (CV 23) for dysphagia after stroke.

METHODSTwo hundred and fifty-one patients with dysphagia after stroke were randomly divided into a deep acupuncture group (group A, 85 cases) a shallow acupuncture group (group B, 83 cases) and a glossopharyngeum acupuncture group (group C, 83 cases). Based on the conventional treatment, the glossopharyngeum acupuncture which was pricking without needles retained at lingual surface, posterior pharyngeal wall of the affected side, Jinjin (EX-HN 12) and Yuye (EX-HN 13) was used in the three groups. After the glossopharyngeum acupuncture, Lianquan (CV 23) was acupunctured 60-70 mm in the group A and 30-40 mm in the group B. The needles were all retained for 30 min. The treatment was applied once a day for 30 days in the three groups. Water swallowing test evaluation scale was observed before and after treatment, and the efficacy was assessed in the three groups.

RESULTSThe total effective rate was 95.3% (81/85) in the group A, which was better than 85.5% (71/83) in the group B and 83.1% (69/83) in the group C (both P < 0.05). The water swallowing test scores were decreased apparently in the three groups (all P < 0.01), and scores in the group A were the most obvious decline (P < 0.01). The decrease of scores in the group A was more remarkable than those in the group B and the group C after two weeks of treatment (both P < 0.05).

CONCLUSIONAcupuncture at Lianquan (CV 23) can effectively improve the dysphagia after stroke. The acupuncture depth can affect efficacy and the effect of deep acupuncture is better.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Deglutition Disorders ; complications ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications

With the wide application of electronic data management (EDC), the data management is shifting to a new mode. In order to recognize the advantages of EDC, we choose 20 representative registered clinical trials, which involve 5 404 subjects and 321 sites. We found that EDC has many beneficial impacts on the course of clinical trial data management, including the process of data collection, data cleaning, data quality control and clinical trial decision-making. The result also provides a reference for the adoption of EDC in clinical trials.

Objective To compare the contents of total flavonoids, forsythoside A and phillyrin in Forsythiae Fructus leaves tea under different drying conditions; To determine the best drying method for Forsythiae Fructus leaves tea. Methods With the sodium nitrite-aluminum trichloride-sodium hydroxide solution as color reagent, total flavonoids in forsythiae Fructus leaves tea were determined by UV spectrophotometry at the wavelength of 500 nm. HPLC was used to determine the contents of forsythiaside A and phillyrin. The analysis was performed on a Diamosil C18 (2) column (4.6 mm × 250 mm, 5 μm); the mobile phase was composed of acetonitrile and 0.4% acetic acid with gradient elution; the detection wavelength was set at 277 nm; the flow rate was 1.0 mL/min at column temperature of 30 ℃. Results The content of total flavonoids of Forsythiae Fructus leaves tea under different drying conditions was basically the same; the sequence of the contents of forsythoside A and Forsythin of Forsythiae Fructus leaves tea under different drying conditions was: ventilated drying > vacuum drying > blast drying. Conclusion Different drying conditions have no effect on the contents of total flavonoids in Forsythiae Fructus leaves tea, but have obvious effects on the contents of forsythiaside A and phillyrin. Ventilation shade is better than blast drying and vacuum drying for preverence of forsythiaside A and forsythin.

Objective To investigate the dynamic abnormality of anorectum in elderly patients with chronic constipation.Methods Anorectal perfusion manometry was performed to detect the change of anal canal pressure and the rectal sensation capacity in 58 elderly patients and 36 non-elderly adults with chronic constipation.The results were compared retrospectively.Results Anal resting pressure in a chronic constipation was significantly lower in elderly patients than in non-elderly adults,with statistically significant difference [(59.74 ± 2.31) mmHg vs.(68.22 ± 2.37) mmHg,t =2.430,P =0.017].The incidence of paradoxical motility of anal sphincter was significantly higher in elderly patients with three abnormalities(incomplete defecation,Bristol stool scale type 3-5 and straining at defecation) than in elderly patients without above three abnormalities (x2 =8.880、11.540、6.070,P =0.003、0.001、0.014).Maximal tolerable volume was significant lower in elderly patients with straining at defecation and abdominal pain than in control group (t =2.140,2.260,both P ＜ 0.05).No correlation was observed between sex and anorectal motility in elderly patients with chronic constipation.Conclusions Anorectal motility in elderly patients with chronic constipation is different from that in non-elderly patients with chronic constipation.The dynamic abnormalities of anorectum in chronic constipation are different in elderly patients with different symptoms.