Objective To study the efficacy of repetitive transcranial magneticstimulation(rTMS) of the right prefrontal cortex combined paroxetine for patients with obsessive-compulsive disorder ( OCD) under doubleblind , sham-controlled conditions. Methods Patients were randomly assigned to 2 sessions of real ( n = 32) or sham ( n = 31) rTMS and both group received Paroxetine treatment. rTMS treatments lasted 20 minutes,and the frequency was 10 Hz and the intensity was 100% of motor threshold for real rTMS. Psychopathology was assessed by HAMA.Y-BOCS before the treatment,immediately after the experimental treatment,and 1,2,4,6 weeks after the experimental treatment by an independent reviewer. Results In combined therapy group,9(32. 14% ) recovered, 10(35.71% ) remitted,5( 17. 86% ) improved,4( 14. 29% ) remained unresponsive. In contrast,there were 4(16.36%) recovery,5(21.82%) remission, 10(38.18% ) improvement,6(23.64% ) unresponse in drug therapy group. The outcome of ITT showed all the patients in the two groups significant improvement (the scores of YBOCS( F=56.258, P=0.000) ;the scores of HAMA( F=41.675, P=0.000) after the treatment,but the effectiveness in the combined therapy group was better than that in the drug therapy group (the scores of Y-BOCS, F= 13.652, P=0.028;the scores of HAMA, F= 11.632, P=0.031). Conclusions Repetitive transcranial rTMS of the right prefrontal cortex combined paroxetine is more effective than paroxetine only in treatment of refractory OCD.

AIM: To investigate the effect of nitric oxid e (NO) and taurin on hemorrhagic shock /reperfusion injury. METHODS: Twenty-four rabbit s were divided randomly into 3 groups ( n= 8): control group and shock group and taurine group. The model of hemorrhagic shock/reperfusion was used. The activities of ni tric oxide synthase (NOS),superoxide dismutase(SOD),lactate dehydrogenase (LDH)and the contents of malondialdehyde(MDA),nitric oxide pvoducts( NO - 2/NO - 3) in plasma were observed before shock and shock 1.5 h,reper fusion 1 h ,2 h and reperfusion 3 h. RESULTS: ①During shock/reperfusion, the ac tivities of NOS,LDH and the contents of MDA,NO - 2/NO - 3 were significan tly highe r, but the activity of SOD was significantly lower in plasma of shock group than that of before shock and shock 1.5 h. ②At 3 h reperfusion, the activity of NOS and the contents of MDA, NO - 2/NO - 3 were significantly higher,bu t the act ivity of SOD was significantly lower in the lung and heart of shock group than t hat of control group. ③ Taurine(40 mg?kg -1 ,iv) attenuated all the c hanges above mentioned at total time points of reperfusion. ④ A close correlation was shown between MDA content and NO - 2/NO - 3 content in plasma, lung and i n heart. CONCLUSION: These results suggeste that NO may be involved in oxida nt-mediated shock/reperfusion, antagonistic effect of taurine on hemorrhagic shock/reperfusi on injury may be relate d to decreasing the generation of NO and anti-lipoperoxidation.

Objective:To construct a scientific and feasible index system for nurses′ ability to cope with new infectious diseases based on ability-based education theory, so as to provide reference for the training of nurses′ ability to cope with new infectious diseases.Methods:After consulting domestic and foreign literaturesuch as China National Knowledge Internet, Wanfang, VIP, PubMed, Web of Science, etc. from the establishment of the database to October 2020, based on the theory of "ability-based education", taking the action framework of the theory of "life cycle of emergency" and "sudden infectious disease events proposed" by WHO as the structural framework, the index items were preliminarily constructed, and the Delphi expert consultation method was used to conduct two rounds of expert consultation for 15 experts, so as to finally establish the index system of nurses′ ability to cope with new infectious diseases.Results:The effective recovery rate of the two rounds of expert consultation questionnaires was 100.00%, and the authority coefficient was 0.930. Kendall′s concordance coefficients of two rounds of consultation experts in the tertiary indicators were 0.363, 0.304 and 0.269, respectively, with statistically significant differences (all P<0.01), and the coefficient of variation of each index was 0.000-0.167. The index system of nurses′ ability to cope with new infectious diseases included 3 primary indicators, 12 secondary indicators and 44 tertiary indicators. Conclusions:The index system of nurses′ ability to cope with new infectious diseases based on ability-based education theory is scientific, reliable and practical, which can provide reference for the training and assessment of new infectious diseases coping ability of nurses.

BACKGROUNDWith the development of natural orifice trans-luminal endoscopic surgery, studies on transoral video-assisted thyroidectomy in preclinical experiments (e.g., human anatomy and animal trials) were progressing gradually. From 2009 to 2011, embalmed human cadavers were dissected to define the anatomical location, surgical planes, and related neural and vascular structures to create a safe transoral access to the front cervical spaces. Recently, experimental transoral endoscopic thyroidectomy was performed to verify the feasibility of this approach on 15 fresh specimens.

METHODSFifteen specimens were placed in the supine position with slight neck extension. Endoscopic incision was made on the midline between the Wharton's duct papillae and two other incisions were made on mandibular first premolar buccal mucosa. Sublingual combined bilateral vestibular tunnels were created from oral cavity to the cervical region. The neck subplatysmal working space was insufflated with CO2 at 6-8 mmHg. The bilateral thyroid lobes and central lymph nodes were dissected under craniocaudal view.

RESULTSThree incisions were made in the oral cavity without any incisions on the body surfaces. The distance from the oral cavity to front neck region was the shortest. Bilateral thyroid lobes and central neck region were fully resected via transoral approach. This approach provided a craniocaudal view, in which retrosternal thyroid gland and lymph nodes were easily accessible. The recurrent laryngeal nerve could be identified safely on the inferior cornu of the thyroid cartilage. The only structure at risk was the mental nerve. Camera motion was somewhat limited by the maxillary dentition. The volume of harvested thyroid nodule through sublingual tunnel in the fifteen human cadavers was (40 ± 15) cm(3).

CONCLUSIONThe transoral procedure is progressive and innovative which not only gives the best cosmetic result and minimal access trauma but also provides a craniocaudal view.

Cadaver ; Endoscopy ; methods ; Female ; Humans ; Male ; Neck Dissection ; methods ; Thyroidectomy ; Video-Assisted Surgery ; methods