Objective:To evaluated the safety and feasibility of dissection of lymph nodes posterior to right recurrent laryngeal nerve (ⅥB compartment) in endoscopic thyroidectomy through gasless axillary posterior approach.Methods:A total of 350 cases with right lobe papillary thyroid carcinoma (PTC) who underwent endoscopic lobectomy, isthmusectomy and central compartment neck dissection via gasless axillary posterior approach based at the Department of General Surgery, Nanfang Hospital, Southern Medical University from June 2020 to December 2022 were retrospectively analyzed. Summarize the clinical, pathological characteristics, and postoperative complications of the patients. SPSS 25.0 was used for statistical analysis of the data.Results:All 350 patients underwent endoscopic surgery successfully, with no conversion to open surgery. There were 303 females and 47 males, with an average age of (36.3±9.2) years. Of those, 287 patients were in pT1a stage, 62 in pT1b stage, and one patient in pT2 stage. There was no T3 or T4 stage patient. The mean numbers of yielded lymph nodes in right central compartment and ⅥB compartment were 8.11±4.65 (range, 1-31) and 2.62±1.86 (range, 1-12), respectively. ⅥB compartment metastasis was detected in 52 (14.86%) of 350 patients. The incidence of transient recurrent laryngeal nerve injury was 0.86%(3/350). Postoperative hematoma occurred in three patients (0.86%).Conclusion:The dissection of ⅥB compartment in endoscopic thyroidectomy through gasless axillary posterior approach is safe and feasible in selected PTC patients

Objective To explore the clinical effect and safety of remimazolam combined with alfentanil in painless gastroenteroscopy in elderly patients.Methods 188 elderly patients who were scheduled to undergo painless gastroenteroscopy from October 2021 to February 2023 were selected and divided into group A,group B,group C,and group D by random number table method,with 47 cases in each group.The group A,group B and group C were used remimazolam 0.2,0.3 and 0.4 mg/kg,and alfentanil 3 μg/kg respectively,and the remimazolam 2.5 mg/time was added during the operation.The group D was used propofol 1.5 mg/kg and alfentanil 3 μg/kg,and a single dose of propofol 0.5 mg/kg was added during the operation.The hemodynamics at different time points[3 min before anesthesia administration(T0),immediately after endoscopy(T1),3 min after endoscopy(T2),at the end of examination(T3),at the time of awakening(T4)],anesthesia onset time,sedation success rate,gastrointestinal endoscopy time,awakening time,time to leave the observation room and intraoperative/postoperative complications were compared,and the test results of neurobehavioral cognitive state examination(NCSE)were compared at different times.Results The percutaneous arterial oxygen saturation(SpO2)at T1 and T2 time point were higher than group C and group D,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the heart rate(HR)and mean arterial pressure(MAP)among group A,group B,group C and group D at each time point(P>0.05).There was no statistically significant difference in SpO2 between group A and group B at each time point(P>0.05).There was no statistically significant difference in the success rate of sedation,gastrointestinal endoscopy examination time and time of leaving the observation room among the four groups(P>0.05),but the onset time of anesthesia in group A was longer than that in group B,group C and group D,and the awakening time in group A and group B was shorter than that in group C and group D,and the differences were statistically significant(P<0.05).There was no statistically significant difference in awakening time between group A and group B(P>0.05).The incidence rate of bradycardia in group A and group B was lower than in group D,and the incidence rates of hypoxemia,respiratory depression,hypotension,and dizziness in group A were lower than those in group D,and the incidence rate of injection pain in group A,group B and group C was lower than that in group D,and the differences were statistically significant(P<0.05).After 10 minutes of complete wakefulness,there was no statistically significant difference in the passing rates of calculation ability and the memory tests between group A and group B(P>0.05),but the passing rates of calculation ability and memory test in group A were higher than those in group C and group D,and the differences were statistically significant(P<0.05).Conclusion During painless gastroenteroscopy in elderly patients,the sedative effect of using 0.3 mg/kg remimazolam combined with alfentanil is good,and it has stable hemodynamics,and the occurrence rate of complications such as bradycardia and espiratory depression is low,and the early postoperative cognitive function is recovered well.

In clinical dentistry,addressing unique conditions such as tilted,elongated,and torsion teeth during prepa-ration can be effectively managed through digital tooth morphology design.The production of a multi-stage 3D-printed guide offered a more efficient and accurate solution.This article presented a case of significant inclination,elongation,and torsion in the maxillary and mandibular canines that were successfully treated using crown restoration modification.A crown preparation guide was fabricated based on the final form design of the restoration using the target restorative space analysis technique to ensure precise tooth preparation.A tooth preparation guide was also designed and utilized fur-ther to enhance accuracy and efficiency during complex tooth preparation.The combined application of these multi-stage guides demonstrated promising clinical prospects.

As the key of colleges and universities and medical career,the affiliated hospital's clinical department is the core of its development.In the new era,strengthening the mechanism of party branch participating in the decision-making of clin-ical departments is an inevitable requirement for implementing the party's leadership and strengthening hospital management.The Party branch of the affiliated hospital of the university has the"dual"attribute,through the establishment of the"core group"of the party branch to participate in decision-making in the clinical business department,the establishment of an efficient decision-making platform,the construction mechanism of supporting rules of procedure and supervision measures to realize its function,the in-depth analysis of management challenges and the improvement of countermeasures,in order to create a new way and a new mechanism of the party branch decision-making,and promote the deep integration of party building and business.

Objective:To study the diagnostic clues and significance in serous effusion cytology associated with lymphoblatic lymphoma/acute lymphoblastic leukemia (LBL/ALL).Methods:Forty-five serous effusion specimens with final diagnosis of LBL/ALL were collected from August 2011 to December 2019 at the First Affiliated Hospital of Zhengzhou University. All cases were reviewed for their clinical profiles, cytomorphologic features and ancillary studies. Cell blocks and immunocytochemistry were prepared in 22 cases; flow cytometric immunophenotyping was performed in three cases and gene rearrangement analysis (T-cell recepter, TCR and immunoglobulin, Ig) was performed in five cases.Results:Among the 45 cases, there were 35 males and 10 females with male to female ratio of 3.5∶1.0. The median age was 15 years. Mediastinal mass was the initial presentation in 39 patients (86.7%) and high LDL level were observed in 34 patients (75.6%). Microscopically, the majority of the specimens (86.7%) were hypercellular. The smears demonstrated dispersed lymphoblasts that were predominantly small to intermediate in size with scanty basophilic cytoplasm and irregular or convoluted nuclei with fine chromatin condensation and inconspicuous nucleoli. Mitoses were frequently observed. Karyorrhexis and apoptosis were seen in all cases. By immunophenotyping, TdT was expressed in 19 cases (86.4%) and CD99 in 20 cases (90.9%). Ki-67 expression varied from 65% to 95%. Flow cytometry in three cases demonstrated positivity for TdT, CD2, CD3 and CD7. Monoclonal TCR gene rearrangement was found in 4 of 5 cases, and both monoclonal TCR and Igκ gene were found in 1 case.Conclusions:In LBL/ALL, primary diagnosis could be made basing on clinical features (younger male patients with a mediastinum mass) and cytomorphology (monotonous, small to medium sized lymphoid cells with prominent irregular nuclei, fine chromatin and frequent mitoses, karyorrhexis and apoptosis). If immunocytochemistry and other ancillary studies are performed, the accuracy and reliability of the results could be improved.

OBJECTIVE： To establish a method for simultaneous determination of spinosin and jujuboside A in the seads of Ziziphus jujuba， and to investigate its quality grading standard. METHODS： HPLC-ELSD method was adopted. The separation was carried out on Inertsil ODS-SP column with mobile phase consisted of acetonitrile-water （gradient elution） at the flow rate of 1.0 mL/min. The column temperature was 30 ℃， the temperature of drift tube was 90 ℃， the flow of carrier gas was 2.9 L/min and injection volume was 20 μL. The thickness， width， length and 100-grain quality of the medicinal materials were used as indicators to investigate the appearance traits. SPSS 22.0 software was used to analyze the correlation of the contents of spinosin and jujuboside A， its appearance traits with the quality constant of TCM， and establish a quality classification standard for the seads of Z. jujuba. RESULTS： The linear range of spinosin and jujuboside A were 1.03-6.18 μg/mL （r＝0.999 7）， 1.05-6.30 μg/mL （r＝0.999 8）； the limits of quantitation were 0.171， 0.174 μg/mL， respectively； the limits of detection were 0.052， 0.053 μg/mL， respectively. RSDs of precision， stability and reproducibility tests were all lower 2％. The recoveries were 99.01％-102.97％ （RSD＝1.39％， n＝6）， 97.94％-101.03％ （RSD＝1.13％， n＝6）， respectively. Correlation analysis results showed that the length， width， 100-grain quality spinosin content and jujuboside A content of the medicinal materials were positively correlated with the quality constant of TCM. The results of quality classification for 30 batches of medicinal materials showed that S1-S4 and S7-S12 were first-class products； S5， S6， S13-S17 and S20-S30 were second-class products； S18 and S19 were third-class products. CONCLUSIONS： Established content determination method is simple， precision， accurate and stable， and can be used for simultaneous determination of spinosin and jujuboside A in the seads of Z. jujuba. Established quality grading standard of the seads of Z. jujuba can be used to evaluate the quality.

Objective To evaluate the effects of different depths of sedation on postoperative cognitive function in elderly patients with mild cognitive impairment.Methods A total of 100 patients with mild cognitive impairment before surgery,aged 65-75 yr,weighing 55-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective gynecological surgery under general anesthesia,were divided into Ⅰ and Ⅱ groups (n =50 each) using a random number table method.Propofol was given by closed-loop target-controlled infusion,and the target plasma concentration was automatically regulated.The bispectral index value was maintained at 40-50 in group Ⅰ and at＞50-60 in group Ⅱ.Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the cognitive function at 1 day before operation (T0) and 7 days after operation (T1),and the development of postoperative cognitive dysfunction (POCD) was recorded.Venous blood samples were collected at T0 and T1 for determination of the concentrations of serum interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay.Results Compared with the baseline value at T0,MoCA and MMSE scores were significantly decreased at T1,and the serum concentrations of IL-10 and TNF-α were increased in both groups (P＜0.05).Compared with group Ⅰ,MoCA and MMSE scores were significantly decreased at T1,and the incidence of POCD was increased,the serum concentration of TNF-α was increased,and the serum concentration of IL-t0 was decreased in group Ⅱ (P ＜ 0.05).Conclusion Maintaining BIS value at 40-50 during operation can decrease the development of POCD in elderly patients with mild cognitive impairment,which may be related to reduced systemic inflammatory responses.

OBJECTIVE:To evaluate the effectiveness and safety of inhaled furosemide in the adjuvant treatment of bronchial asthma systematically,and to provide evidenced-base reference for clinical treatment. METHODS:Retrieved from PubMed,Co-chrane library,CJFD,Wanfang database and VIP,randomized controlled trials(RCTs)about routine treatment+inhaled furosemide (trial group)vs. routine treatment(control group)in the treatment of bronchial asthma were collected. After quality evaluation and data extraction according to Cochrane systematic evaluation method 5.1.0,Meta-analysis was performed with Rev Man 5.3 soft-ware. RESULTS:A total of 13 RCTs were included,involving 708 patients. The results of Meta-analysis showed that:obvious ef-fective rate [RR=1.53,95%CI(1.28,1.84),P<0.001],total effective rate [RR=1.34,95%CI(1.23,1.45),P<0.001],the inci-dence of laryngeal discomfort [RR=10.79,95%CI(1.47,78.99),P=0.02] and gastrointestinal adverse reaction [RR=10.80,95%CI (1.43,81.53),P=0.02] in trial group were all significantly higher than control group,with statistical significance. There was no sta-tistical significance in the incidence of dry mount [RR=3.71,95%CI(0.81,16.86),P=0.09] and electrolyte disorder [RR=2.38, 95%CI(0.10,56.53),P=0.59] between 2 groups. CONCLUSIONS:Based on conventional treatment,the inhaled furosemide has good therapeutic efficacy and safety for bronchial asthma,and the laryngeal discomfort and gastrointestinal reaction should be strengthened.

Objective To investigate the effects of methylprednisolone on severe bronchial asthma treatment and intervention effect. Methods According to the different treatment methods will be January 2016 to March 2017 year in our hospital 90 cases of patients with severe bronchial asthma were selected,and randomly divided into observation group and control group,45 cases in each groups.The control group with conventional treatment method, the observation group used conventional methylprednisolone therapy; two the experimental results were recorded in detail, and the relevant data for comparative analysis, investigate the effects of methylprednisolone in treatment of severe bronchial asthma and intervention effect. Results The observation group (conventional methyl prednisolone) clinical treatment effect is better than that in control group (conventional) clinical efficacy, clinical symptoms disappeared. Time and so on were better than the control group, the adverse reaction rate were lower than the control group, there were significant differences between the groups (P<0.05) .Conclusion Severe bronchial asthma patients choose conventional methylprednisolone treatment significantly, in a short period of time can effectively improve the clinical symptoms and the adverse reaction is less, it is widely used in clinical treatment of severe bronchial asthma patients.

Stilbene glucoside is one of major active constitutions in Polygoni Multiflori Radix. Stilbene glucoside contributed markedly to resisting caducity, protecting nerve, reducing serum lipids, and protecting liver and antitumor activity. The extraction and purification technology is the key issue to obtain stilbene glucoside. Through research, extraction and purification technology has made a certain progress. The stilbene glycoside could be extracted by water boiling, diacolation, and backflow; then it could be purified by the method of chromatography, recrystallization, and extraction. In this article, the technologies in extracting and purifying stilbene glucoside were reviewed, and the prospect of stilbene glucoside preparation was discussed to lay the foundation for further research and application.