The standardized implementation of intraoperative nerve monitoring technology significantly minimizes surgical injury risks. Its application in endoscopic and robotic thyroid surgeries enhances procedural safety. Building upon standardized protocols, our team has innovated technical extensions through accumulated clinical experience, systematically formulated as operational guidelines. This article elucidated these technical extensions through pictures and videos, aiming to improve the safety and procedural fluency of endoscopic and robotic thyroidectomies.

Objective To investigate the characteristic of lipoprotein(a)[Lp(a)]in different phases of chronic kidney disease (CKD ),to provide the basis for clinical prevention and treatment of CKD.Methods 200 patients with CKD in the Republic Hospital of Shifang were collected as study group,including 5 phases (every phase had 40 cases),and 100 healthy people were selected as control group.Measured the serum Lp(a)of both study and control group,analyzed the correlations between Lp(a)and different phase of CKD.All data were analyzed by SPSS version 17.0.The significant level was established at 0.05.Results CKD1 [(146.0 ±95.5)mg/L]and all CKD group [(231.5 ±133.2)mg/L]had higher level of serum Lp(a)than the control group [(115.5 ±70.2)mg/L] (Z=-2.800,P<0.05 and Z=-7.922,P<0.05).CKD3 had higher Lp(a)level than CKD2(Z=-2.069,P<0.05 ),while there were no significant differences between each of the other two groups.CKD4 -5 [(325 .0 ± 194.7)mg/L]also had higher Lp(a)level than CKD1 -3 [(182.0 ±110.5)mg/L](Z=-4.439,P<0.05). Conclusion Patients with CKD always have high level of serum Lp(a),which have been slowly increased since CKD1 ,meanwhile the level of Lp(a)may have a certain correlation with the stage of CKD development,since Lp(a) is an important promoting factor in the progress of CKD.

Objective To explore the effect of dexmedetomidine on the stress reaction and incidence of shivering in intravenous inhalation combined anesthesia scheme,and to improve the quality of anesthesia recovery accumulate experience.Methods 76 patients in Affiliated Union Hospital of Fujian Medical University from 2010 March to 2013 April were divided into study group and control group using random double blind method(n=38).Two groups of patients were underwent intravenous inhalation combined anesthesia,the research group in the process of anesthesia administered dexmedetomidine intravenous infusion,the control group was given normal saline intravenous infusion of the same dose,the same rate.The recovery period MAAS (muscle activity score),HR (heart rate),MAP (mean arterial pressure)and the incidence of shivering of two groups were observed and compared.Results The MAAS score on 5 min after extubation of study group was lower than that of control group (P<0.05);the MAP and HR values immediately in the drawing or after extubation 30 min in study group were lower than control group (P<0.05 ).The incidence of shivering and the chill time in study group was lower and shorter than control group (P<0.05).Conclusion Dexmedetomidine could effectively reduce the recovery period of stress level,and reduce the incidence of shivering in treatment of patients with intravenous inhalation combined anesthesia,It is conducive to patient of vital signs stable in recovery period.