Objective To discuss the value of ultrasonic examinion in laparoscope's thyroidectomy.Methods 41 cases who were performed in laparoscope's thyroidectomy were checked by color Doppler flow imaging and two dimensional sonography,the key of examination:(1)The length and depth of thyroid isthmitis.(2)Trachea curve degree and the depth in up-sternum.(3)The reference between thyroid,calvicle and sternum.(4)Thyroid tumefaction degree over sternomastoid.(5)Thyroid tumer's number,position and size.(6)Tumer's kind.(7)Bloodstream change.Results Only 1 case turned open.1 case recured in hyperthyroidism.Hoarseness occured in loose after operation and come-into being after 1 mouth.No trachea and parathyroid hurt appeared in any cases.The mean operation time was 125 minutes(range 86 to 193 minutes).The mean time stay in hospital was 9 days(range 6 to 15 days).Conclusion Ultrasonic examination before operation is very valuable.

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.

The current treatments of metastatic malignant melanoma include chemotherapy,targeted therapy,immune therapy and radiation therapy,but the treatment outcome is far from optimism.In order to im-prove the treatment efficiency,it is urgent to improve early diagnosis,and develop more effective treatment drugs and delivery systems.The application of nanotechnology in the diagnosis and therapy of melanoma can re-duce the resistance to the drugs,increase efficacy and reduce side effects.

Objective To observe the clinical effect of albendazole combined with cimetidine in the treatment of hepatic hydatid disease.Methods 60 cases with liver hydatid disease from 2010 to 2014 wrer selected,and they were randomly divided into two groups,30 cases in each group.The control group was treated with albendazole tablets,2 times daily,2 capsules/time.The treatment group was intravenously injected cimetidine based on the treatment of the control group.Before and after treatment,the ultrasound imaging changes and clinical effect were observed.Results In the control group,the total effective rate was 83.33%(25 /30).In the treatment group, the total effective rate was 96.67%(29 /30).The total effective rate between the two groups had statistically signifi-cant difference(χ2 =9.842,P <0.01).Conclusion Albendazole combined with cimetidine in treatment of hepatic hydatid disease has good curative effect,which can be viewed as first choice in the treatment of hydatid disease.

Aim To construct human phage single-chain antibody library associated with esophageal cancer and to screen the specific scFv against Eca109 cells from the liberary. Methods Metastatic periesophageal lymph nodes of esophageal cancer patients were used as the B cells source, the total RNA of these B cells was extracted and prepared as the template of RT-PCR. First, we screened graticulely two pairs of primers of the heavy and light regions separately, then the V_H and V_L fragments were first amplified from the cDNA by the polymerase chain reaction (PCR). Second, the V_H-linker and V_L-linker were amplified from the V_H and V_L fragments. Last, the V_H-linker and V_L-linker were assembled into scFv gene fragments by SOE-PCR,and then Sfi I and Not I restriction site were inlet in it. ScFv gene was cloned into the pCANTAB-5E phagemid. Phagemids were introduced into E.coli TG1 by electrotransformation, followed by rescue of antibody-expressing phage using M13K07 helper-phage superinfection. Recombinant scFv phage library was constracted and PCR was used to identify the insert ratio of scFv antibodies library. Results of SfiI/Not I double digestion reaction positive insert clone were identified by 1.5% agarose gel electrophoresis. The phage library was panned with NHEEC and Eca109 cancer cells in suspension for four rounds. Strongly positive recombinant phage clones were used to infect E.coli HB2151. Expression of soluble scFv was induced by IPTG. Soluble scFv from periplasm were purified by affinity chromatography and identified by SDS-PAGE and Western blot. Cell ELISA , immunohistochemical staining and immunocytochemical staining were used to identify the activity of the soluble scFv. Results The result of agarose gel electrophoresis showed that total RNA of these B cells had two bands of 28 S and 18 S. The size of V_H fragment is about 450 bp,V_L fragment is about 350 bp and scFv is about 850 bp. The competence is 108 cfu??g-1 pUC18 DNA. Randomly digestive reac-tion showed that the positive insert ratio was 91.7% (22/24). After four rounds of panning, the fourth phage yield is 141 times as much as that of the first one. SDS-PAGE and Western blot showed that the MW of the soluble scFv was about 30 ku and the brand of 30 ku was stained. Immunohistochemical staining showed strong stainning of the tissue of esophageal cancer, but not the liver and gastric cancer tissue. Immunocytochemical staining showed significant staining of the esophageal cancer line Eca109. The result of cell ELISA assay revealed that soluble scFv had highly specific and could combined with Eca109 cells, but not with BGC-823 and NHEEC. Conclusion A human scFv phage display library associated with esophageal cancer has been constructed successfully and the specific scFv antibody against Eca109 has been identified from the liberary.

Objective To evaluate the clinical value of the preoperative intra-arterial embolization of the nasopharyngeal angiofibromas. Methods The treatment group of 7 male patients with the nasopharyngeal angiofibromas were undergone angiographic evaluation and embolization of tumor-feeding vessels before surgery. All patients were embolized with gelfoam particles and PVA. The control group of 7 patients received surgical treatment without preoperative embolization. We compared the volumes of intraoperative bleeding and the blood transfusions during oprations between the two groups. Results All patients achieved symptomatic remission,with no complications. Comparing with the control group,the amount of intraoperative bleeding and the blood transfusions during operations were much less in the treatment group submitted to endovascular embolirzation.Marked edema in the peripheral region of tumor of the treatment group made the tumor easy to be dissociated. Conclusion The intraoperative bleeding can be reduced significantly by preoperative embolization of supplying arteries to the nasopharyngeal angiofibromas,therefore it should be used routinely as an adjunct to surgery. (J Intervent Radiol,2006,15: 345-347)

Objective To evaluate the curative effect,safety,advantages and disadvantages of helix hydro-jet and holmium laser lithotripsy in the treatment of intrahepatic bile duct stones.Methods 158 patients of intrahepatic bile duct stones were divided into helix hydro-jet group (n =82) and helix hydro-jet group (n =76).Time of lithotripsy,frequencies of lithotripsy,residual stone,intraoperative hemorrhage,postoperative hemorrhage,stone recurrence rate,postoperative fever,and therapeutic efficacy were compared between the two groups.Results There was no significant difference between the two groups on frequency of lithotripsy,residual stone rate and stone recurrence rate (P ＞ 0.05) ; whereas intraoperative washing normal saline (2 300 ± 275) ml vs (2 850 ± 331) ml,(P =0.002),the time of lithotripsy (54.2 ± 15.3) min vs (38.1 ± 12.7) min,P =0.041,intraoperative hemorrhage (19 cases vs 29 cases,P =0.041),Intraoperative analgesia (2 cases vs 9 cases,P =0.032),postoperative hemorrhage (11 cases vs 21 cases,P =0.037),and postoperative fever (30 cases vs 62 cases,P =0.027) had significant differences(P ＜ 0.05).Conclusions Both helix hydro-jet and the holmium laser lithotripsy is safe and effective for the treatment of intrahepatic bile duct stones.Holmium laser is more efficient than Helix Hydro-jet,while helix hydro-jet is safer than holmium laser in lithotripsy.

Objective Both underuse and overuse of anticoagulant therapy may lead to severe adverse effects. Emerging portable monitering devices, which provides reliable and accurate measurements, were reported to be potential alternatives to tra-ditional monitering recta-analysis regimens. This study was intended to evaluate the effects of serf-monitoring or serf-management (self-testing and serf-dosing) of anticoagulant as compared with that of traditional monitoring. Methods Relevant trials reported before October 2008 were identified in a number of electronic database and analyzed with software RevMan 4.2. The primary out-comes included death from any cause, major bleeding event, thromboembolic event and the proportion of patients whose interna-tional normalized ratio (INR) were within the therapeutic range. Results Seventeen RCT of serf-monitoring were identified.Pooled estimates revealed significant reductions in the thromboembolic events (odds ratio 0.46, 95% CI0.33 -0.64), all-cause mortality (0.61,0.40 -0.93), and major haemorrhage (0.80, 0.58 - 1.10) with self-monitoring as comparing with traditional monitoring. No difference was noted in minor haemorrhage. 15 trials reported improvements in the mean proportion of patients whose INR were within target range. Conclusion Self-management regimen is superior to traditional monitoring in the outcomes of oral anticoagulation. Patients capable of self-monitoring and serf-adjusting have fewer thromboembolic events and lower mortali-ty than those undergoing self-monitoring alone. However, self-monitoring requires education and training for patients.

objective To compare cardiac function early after cardiac valve replacement with and without atrial fibrillation radiofrequency ablation(RFA).Methods Thirty-eight patients who underwent RFA Cox-Maze Ⅳ procedure combined with rheumatic valve replacement were discharged as cured from March 2007 to August 2009 (RFA group). Their postoperative recovery time, troponin T (cTnT) and ultrasonic cardiogram data were compared with those of 38 patients with atrial fibrillation matchad for age,sex, preoperative NYHA class and types of rheumatic valve replacement (control group). Results Although the cardiopulmonary bypass time and aortic cross-clamping time of RFA group were longer [( 152.8 ± 46.1 ),(91.0 ± 26.1 ) min] than those of control group [( 104.7 ± 40.8), (68.0 ± 30.3) min] (P ＜ 0.01 ), the postoperative recovery time and perioperative changes of LVEF of both groups were similar. Compared with control group, the RFA group's postoperative elevated cTnT was more marked [( 1.8 ± 0.6) μ g/L vs.(0.8 ±0.4) μg/L],their left atrial diameters was generally decreased (P＜0.05). Among them who underwent combined aortic and mitral valve replacement had increased posterior wall thickness of left ventricle and decreased fractional shortening. Conclusions Compared to patients having simple valve replacement, those undergoing valve replacement with RFA Cox-Maze Ⅳ procedure have generally better recovery of cardiac function early after operation, may have more potential threaten, and more attention should be paied to their perioperative myocardial preservation and preventive maintenance of cardiac function.

Objective To discuss the timing of extubation in patients of congenital heart disease (CHD)with severe pulmonary hypertension (PH) undergoing connective surgery with cardiopulmonary bypass(CPB).Methods A retrospective study of 40 patients of CHD with severe PH Was completed.According to whether the duration of mechanical ventilation (MV)>24 hours,patients were divided into two groups,early extubafion group(19 patients) and late extubation group(21 patients).Perioperative variables that might influence duration of MV were compared between the two groups.Multivariate statistical analysis with Logistic regression was used for these patients to analyze the perioperative variables to determine risk factors for prolonged MV (MV≥72 hours).Results Between the two groups,preoperative NYHA class,Pp/Ps at the time of coming off bypass,CPB duration,and CPB temperature were significantly different (P<0.05 or<0.01).Anofic spell (OR=0.022,95%CI0.001-0.580)and severe hypoxemia(OR=0.031,95%CI0.002-0.568)in the early postoperative period were the risk factors for prolonged MV.Conclusions The timing of extubation in these patients should be determined individually.Late extubation may fit those with advanced NYHA class,high Pp/Ps at the time of coming off bypass,prolonged CPB duration,or hypothermic cardiography and pulmonary artery catheter monitoring help to guide treatment for pwlonged MV.For else patients who with postoperative stable cardiopulmonary function,early extubation maybe feasible.