BackgroundThe EBSLN is vulnerable to damage during thyroidectomy, results in voice related complications, negatively affect patient quality of life, routine identification of the EBSLN prior to surgical manipulation is necessary for a complication-free thyroidectomy. We aimed to validate a video-assisted procedure for identifying and preserving the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy and analyze the EBSLN Cernea classification and the localization of the nerve entry point (NEP) from the insertion of the sternothyroid muscle.MethodsA prospective descriptive study was performed; 134 patients, who scheduled for lobectomy with an intraglandular tumor max diameter ≤ 4 cm and without extrathyroidal extension, were randomly divided into the video-assisted surgery (VAS) and conventional open surgery (COS) groups. We used the video-assisted surgical procedure for visually identifying the EBSLN directly, and compared the differences in the visual identification rate and total identification rate of the two groups. We also measured the localization of the NEP using the insertion of the sternothyroid muscle as a reference.ResultsThere was no statistically significant difference in clinical characteristics between the two groups. The visual identification rate and total identification rate were significantly higher in the VAS group than the COS group (91.04% vs. 77.61%, 100% vs. 89.6%). The EBSLN injury rate was 0 in both groups. The mean vertical distance (VD) of the NEP from the sternal thyroid insertion was 1.18 mm (SD 1.12 mm, range, 0–5 mm), with approximately 88.97% of the results occurring within the 0–2 mm range. The mean horizontal distance (HD) was 9.33 mm (SD 5.03 mm, range, 0–30 mm), with over 92.13% of the results occurring within the 5–15 mm range.ConclusionBoth the visual and total identification rates of the EBSLN were significantly higher in the VAS group. This method provided a good visual exposure rate of the EBSLN, aiding in identifying and protecting the EBSLN during thyroidectomy.

Postoperative chyle leakage (CL) is a rare but severe complication after neck dissection, and most patients with this complication can be treated conservatively. However, in patients with high-flow leakage, efficient and well-tolerated conservative treatment options are still lacking, and the treatments can be complicated. In this study, we report a case with CL of 1100 ml/day after neck dissection that was successfully treated by balloon compression.

目的 探究虚拟仿真实验教学模式在临床微生物学检验技术见习带教中的影响价值.方法 选择齐齐哈尔医学院2017级医学检验技术专业学生37名为实验组,另选取2016级医学检验技术专业学生32名为对照组,分别行虚拟仿真实验教学模式和传统教学模式,对比两组见习生理论考核和实验操作考核成绩、操作考试成绩以及见习生自我评价结果.结果 实验组见习生的理论成绩、实验操作成绩(细菌接种、微生物鉴定、药敏结果)均显著高于对照组,差异有统计学意义(P<0.05);实验组见习生在对提高操作能力、提高学习效率、提高自主思考能力、激发学习兴趣以及强化理论知识点的满意度均优于对照组,差异有统计学意义(P<0.05).结论 在医学检验专业的临床见习教学中,应用虚拟仿真实验教学模式,将虚拟实验和理论知识相互结合,能够在一定程度上发挥实验教学的作用,提高学生的综合考试成绩,同时还能够培养学生的学习兴趣,自主思考能力.

目的 探究虚拟仿真实验在临床微生物学检验技术见习教学中的应用价值.方法 选择齐齐哈尔医学院2017级医学检验技术专业学生37名为实验组,另选取2016级医学检验技术专业学生32名为对照组,分别行虚拟仿真实验教学模式和传统教学模式,对比两组两组见习生实验理论、操作考试成绩以及对教学模式的满意度.结果 实验组见习生的实验理论成绩、操作考试成绩显著高于对照组,差异有统计学意义(t=10.241、11.417,P＜0.001);实验组见习生对于教学模式的满意度高于对照组学生,差异有统计学意义(x2=15.415,P＜0.001).结论 虚拟仿真实验可以弥补医学检验技术传统教学的不足,同时其可以充分利用现代信息技术,激发学生的学习兴趣并且提高学生的成绩,实现了教学资源的优化配置,为传统的实验教学注入新的活力,值得广泛推广.

To study miR-140 and SOX4 levels in larynx cancer cells and elucidate the effects of miR-140 and SOX4 in the pathogenesis of larynx cancers and understand the pathogenesis of larynx cancer. miR-140 level in larynx cancer tissues and cell lines was measured by Real time PCR. Flow cytometry, MTT assay, cell count and cell transfection were carried out to determine the effects of miR-140 and SOX4 on the cellular proliferation, apoptosis and cycle in larynx cancers. SOX4 level was detected by Western blotting and real time PCR. The targeting relationship of miR-140 with SOX4 was analyzed by dual-luciferase reporter assay. miR-140 in larynx cancer tissue of the patients and larynx cancer cell lines was significantly lower than that in pericarcinomatous tissue and its level in early stage I-II larynx cancer tissue was significantly lower than that in late stage III-IV larynx cancer tissue. miR-140 in larynx cancer cells had a positive correlation with cell apoptosis and a negative correlation with cell invasion and proliferation; miR-140 mimics can induce cell cycle arrest in G0/G1 phase. miR-140 directly targeted SOX4 and inhibited SOX4 expression. miR-140 inhibits cellular proliferation in larynx cancers through direct regulation of SOX4, which provides a new theoretical basis and therapeutic target for treating larynx cancers.

OBJECTIVE:To investigate therapeutic efficacy of ezetimibe combined with tirofiban in the treatment of acute coronary syndrome patients and its influence on the content of ischemia modified albumin (IMA) in peripheral blood.METHODS:A total of 82 patients with acute coronary syndrome in our hospital from Jan.2016 to Jan.2017 were divided into observe group and control group according to random number table,with 41 cases in each groups.All patients were given general treatment containing statins,glyceryl trinitrate and so on.Control group was additionally given Ezetimibe tablet 10 mg orally once a day.Observation group was additionally given Tirofiban hydrochloride sodium chloride injection 5 mg intravenously once a day,on the basis of control group,for consecutive 15 d.Clinical efficacies of 2 groups were evaluated.The dose of glyceryl trinitrate,duration and frequency of angina pectoris attack,left ventricular function indexes (SV,LVDD,CO,LVEF) were compared before treatment and after last medication.The contents of IMA in peripheral blood were detected before treatment and 3,6,9,12,15 h after the first day medication.ADR of the 2 groups were observed closely during the treatment.RESULTS:The total response rate of observation group was 92.7％,which was significantly higher than 72.3％ of control group (P＜0.05).Compared with before treatment,dose of glyceryl trinitrate and the content of IMA in 2 groups were decreased significantly after last medication,duration and frequency of angina pectoris attack were shortened significantly;the levels of SV,CO and LVEF were increased significantly while the level of LVDD was decrease significantly;the effect of observation group was significantly better than that of control group,with statistical significance (P＜0.05).No severe ADR was found in all patients during the treatment.CONCLUSIONS:Based on general treatment of glyceryl trinitrate therapeutic efficacy of ezetimibe combined with tirofiban is better than that of ezetimibe alone in the treatment acute coronary syndrome patients,and can decrease the content of IMA in peripheral blood more quickly.

OBJECTIVE To investigate the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in aged patients and multilocus sequence typing(MLST).METHODS A total of 30 cases of clinically isolated MRSA strains from samples of aged patients were randomly selected,and drug susceptibility test was carried out.Multilocus sequence typing method was established,and 7 housekeeping genes on chromosome were detected.Sequencing results were compared with the MLST database site sequence,and cluster analysis was carried out.The clones and ST strains kinship phylogenetic tree was analyzed,and risk factors of MLST resistance were analyzed.RESULTS MRSA strains were mainly in 2 large clusters:A and B.A group aonsisted of by the USA100 and USA800,B group consisted of USA300 and USA700 strains.All isolates were resistant to oxacillin,amoxicillin /clavulanate strains.The minimum inhibitory concentration (MIC) of 10 strains of drug-resistant bacteria was greater than 1 μg / mL.Logistic regression analysis showed that there was a significant correlation between PVL positive and vancomycin MIC increase (P＜0.05).CONCLUSION Our data indicate that MRSA isolates from aged patients are resistant to oxacillin,amoxicillin / clavulanic acid bacteria,and in view of the clinical use of drugs in aged patients,we should consider the related risk factors for prevention and control.

目的 了解该地区小儿下呼吸道感染常见病原菌的分布及其对常用抗菌药物的耐药性情况.方法 收集2014年1月——2016年6月期间来该院住院治疗的416例下呼吸道感染小儿患者作为研究对象,取其痰液标本进行细菌培养以及药敏试验.结果 416例小儿患者共培养出335株病原菌.其中,革兰阴性菌231株,占68.96%,分布最多的是肺炎克雷伯杆菌;革兰阳性菌90株,占26.87%,分布最多的是金黄色葡萄球菌.药敏试验结果显示,革兰阴性菌对亚胺培南和美罗培南的耐药性最低,而对头孢唑林、头孢曲松、头孢他啶和复方新诺明的耐药性最高;肺炎克雷伯菌对头孢唑林和氨苄西林/舒巴坦的耐药率最高,分别为58.40%和41.20%.革兰阳性菌对万古霉素和利奈唑胺耐药性最低,而对青霉素和红霉素的耐药性最高;金黄色葡萄球菌对万古霉素和利奈唑胺耐药性完全敏感,而对青霉素、红霉素和头孢唑林的耐药率最高,分别为75.30%、61.40%和63.80%.结论 小儿下呼吸道感染以革兰阴性菌为主,临床应加强感染病原菌培养及药敏监测,并根据药敏试验结果合理选用抗菌药物治疗.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的探讨血清尿酸和血清胱抑素C（Cys-C）检测对评价II型糖尿病及合并肾功能损害的临床意义,并分析其与尿白蛋白排泄率（UAER）的关系。方法收集医院门诊和住院的II型糖尿病患者共253例,将II型糖尿病患者按其是否有肾脏损伤及损伤程度分为3组:单纯糖尿病组,糖尿病早期肾病组和糖尿病临床肾病组,并检测UAER、血清尿酸、Cys-C、血清肌酐（Scr）及尿肌酐,并计算内生肌酐清除率（Ccr）。结果血清尿酸和血清Cys-C随UAER的增加而增加,且差异有统计学意义（P&lt;0.05）,此外,各实验室指标性别间差异均有统计学意义（P&lt;0.05）;相关性分析结果显示,血清尿酸与UAER呈正相关（r=0.728,P&lt;0.05）,Cys-C与UAER也呈正相关（r=0.681,P&lt;0.05）。结论在II型糖尿病肾病患者血清中,血清尿酸和Cys-C均呈现大幅升高的趋势。</span>

目的：对比研究PBL教学方法在临床血液学检验理论课中的应用价值。方法研究对象选自齐齐哈尔医学院2013—2015学年中检验专业大三的学生86名，分为两组，其临床血液学检验理论课采取不同的教学方法，观察组采用的是PBL教学方法，而对照组采用的是以板书、PPT演示为主的传统教学方法，最终的考试成绩作为两组的评判标准，也将对学生采取问卷调查的方式。结果两组学生理论考核成绩有明显差异，观察组成绩要对照组的成绩高，且差异具有统计学意义（t＝9．637，P＜0．05）。且对于观察组的调查问卷显示，学生对于该方法满意度很高。结论 PBL教学方法要优于以板书、PPT演示为主的传统教学模式，特别是在临床血液学检验理论课中，得到了较好的效果，该教学方法值得在教学中广泛应用。

目的：了解鲍曼不动杆菌在我院各临床科室的分布情况以及耐药性，为临床合理使用抗菌药物提供依据。方法对2013年我院患者临床分离出的180株鲍曼不动杆菌感染情况及耐药情况进行统计分析。结果鲍曼不动杆菌的检出以ICU和呼吸科的痰标本居多（78株），耐药率明显增加，对β-内酰胺类、氨基糖苷类、喹诺酮类抗菌药物均有较高的耐药性，耐药率很多都在70％以上，加酶制剂和碳青霉烯类的药物耐药率也达到60％以上，只有多粘菌素B和米诺环素耐药率低，敏感性高。结论鲍曼不动杆菌耐药日趋严重，已出现多重耐药菌株，临床应高度重视，同时还应采取医院感染防控措施，以预防和控制多重耐药菌株的播散和流行。

目的：对比研究多媒体技术在临床血液学检验实验课中的应用价值。方法研究对象选取来自齐齐哈尔医学院2011级和2012级的应届检验专业本科生78名，按不同教学方法分为两组，观察组采用多媒体技术进行教学，对照组采用以板书为主的传统教学方法，两组的评判标准以考核成绩和调查问卷的满意度为主。结果观察组成绩要高于对照组，且差异具有统计学意义（ t＝8．458，P＜0．05）。两组调查问卷的满意度结果显示，观察组要高于对照组，且差异具有统计学意义（ t＝10．415，P＜0．01）。结论多媒体技术在临床血液学检验实验课的教学中要优于传统的教学模式，值得在教学中广泛采用。

目的探讨泌尿道感染病原菌的分布及其耐药情况。方法该院对从泌尿道感染患者分离出的409株病原菌进行鉴定以及药物敏感试验,分析分离出的病原菌菌种及其耐药情况。结果病原菌中革兰氏阴性菌占68.22%,以大肠杆菌为主;革兰氏阳性菌占29.10%,以凝固酶阴性葡萄球菌为主;真菌占2.68%。药物试验显示,除亚胺培南和美罗培南外,大肠埃希菌、肺炎克雷伯菌和变形菌属对大部分常用抗菌药物均出现不同程度的耐药性;除万古霉素外,凝固酶阴性葡萄球菌、肠球菌属以及金黄色葡萄菌对大部分常用抗菌药物均出现不同程度的耐药性。结论泌尿道感染病原菌主要为大肠埃希菌,分离出的病原菌对常用抗菌药物的耐药性逐渐增加,建议临床应根据药敏结果合理给予抗菌药物,避免滥用抗菌药物。

目的探讨超敏C反应蛋白、D-二聚体与纤维蛋白原联合检测在冠心病(CHD)早期诊断的意义。方法选择2012年1—12月期间在我院住院的确诊冠心病患者(分三组:稳定心绞痛组31例;不稳定心绞痛组31例;急性心肌梗死组25例)及健康对照组30例分别测定超敏C-反应蛋白(hs-CRP)、D-二聚体(DD)与纤维蛋白原(FIB)的浓度。结果冠心病三组的三项测定值明显高于健康对照组(P<0.05),急性心肌梗死组高于不稳定心绞痛组(P<0.05),不稳定心绞痛组高于稳定心绞痛组(P<0.05),均具有显著性差异。结论 hs-CRP、DD和FIB与冠心病相关,由于冠状动脉血管内皮慢性损伤及炎症等多因素造成hs-CRP升高,另外冠心病血黏度升高,血小板聚集、共同促进动脉粥样硬化及血栓形成,导致DD和FIB水平升高。联合检测血清hs-CRP、FIB和DD浓度的变化对冠心病的预防和早期诊断有着十分重要的临床价值。

Objective: To detect and analyse the expression of PTEN genes in normal thyroid,thyroid benign tumor tissue,and thyroid papillary carcinoma cancer tissue by immunohistochemical method.Meanwhile to investigate the thyroid papillary carcinoma diagnosis and treatment of significance.Methods: Adapt SP immunohistochemical method,took known positive tissue as positive control,took phosphate buffer(PBS) instead of antibodies as a negative control,all tissue were studied with HE dyeing and immunohistochemical staining.Results: In three groups,PTEN protein expressed in the organization with significant difference(P<0.001);the positive expres-sion in normal thyroid and thyroid benign tumor tissue were 100% and 82.5% respectively which were significantly higher than the 45% of thyroid cancer group(P<0.05),namely the expression in the PTEN thyroid cancer significantly reduced;the expression rate of PTEN in thyroid papillary carcinoma lymph node metastasis group and without lymph node metastasis group were 15% and 60%,signifi-cantly(the chi-square = 10.91,P = 0.001).PTEN in thyroid papillary carcinoma in coating infringed group and no violation of the group posi-tive expression rate were 25.93% and 60.61% and the difference was significantly(the chi-square = 7.22,P = 0.007).The strength of pos-itive PTEN in thyroid cancer lymph node metastasis group and the infringement of coated positive were significantly lower than lymph node metastasis and coated infringed group(P<0.01) which reached a statistical significance.Conclusion: The reducing of the expression of PTEN gene palys a key role in thyroid cancer and the process of disease transfer.

Objective To explore the cellular and immunity in children with recurrent respiratory tract infection(RRI).Methods Blood samples were taken from 42 RRI children and 40 normal Children The percentage of T-lymphocytes subsets and immunoglo-bulin IgA,IgM,IgG were measured.Results The percentage of the total lymphocytes,CD4+,CD4+/CD8+ were obviously lower than that in healthy control group(P <0.05,P <0.01,P <0.01),and CD8+ in the RRI group was higher than that in healthy control group(P <0.01).The levels of IgA and IgG in the RRI group were lower than the normal reference value(P <0.05,P <0.05).Conclusion The deficiency of T-lymphocytes and humoral immunity man be existing,and cell-mediated immune disorder is more obviously in RRI.It could guild the prevention and treatment for RRI.

<正>胸腺囊肿较为少见,其发病率不到纵隔肿瘤的2%,仅占胸腺肿瘤5.7%。资料统计,自1897年,胸腺囊肿首次报道以来,文献中多以个案报道为主。Wychulis观察了1 064例纵隔囊肿,其中196例为良性,仅19例是胸腺囊肿[4]。由此可见,胸腺囊肿非常少见。目前,国内外对颈部异位胸腺囊肿的发病率还没有明确的统计资料,据我院资料统计,颈部异位胸腺囊肿仅占胸腺囊肿的12.5%,可见颈部异位胸腺囊肿非常罕见。目前,各文献报

甲状腺癌是头颈部最常见的恶性肿瘤,占全身恶性肿瘤的1%-2%,女性多见,其中分化性甲状腺癌占甲状腺癌的80%-90%,主要包括甲状腺乳头状癌和甲状腺滤泡癌,其治疗以外科为主,术后辅助TSH抑制性治疗及生物治疗,某些病例需辅助放射性I131治疗.对于大部分早期病人可达到治愈的目的,总体预后良好,10年生存率达90%以上.但近年来甲状腺癌发病率呈上升趋势,据文献报道以每年3%的速度递增[1],成为危害人类健康的重要疾病之一,因此对甲状腺癌的治疗提出了新的要求.

目的:研究引起糖尿病患者泌尿系感染的常见病原体种类及其耐药性。方法:对我院2006-01/2007-12糖尿病患者合并泌尿系统感染时的病原体种类及其体外抗生素敏感性进行分析。结果:2 a中糖尿病患者合并泌尿系感染共146例,尿培养中共培养出致病菌168株,其致病菌以革兰阴性杆菌为主,细菌耐药性有不同程度的增加。结论:糖尿病患者合并泌尿系感染要严格控制血糖,合理选用敏感的抗生素,减少并发症发病率。

Objective:To investigate the expression of p16,p27 and CyclinD1 in differentiated thyroid cancer tissues,and the role in the carcinogenesis of the thyroid cancer. Methods: To detect the expression of p16,p27 and CyclinD1 in 40 differentiated thyroid cancer including papillary thyroid carcinoma and follicular carcinoma and 30 benign tumor tissues including thyroid adenoma and nodular goiter by immunohistochemical S-P two-step method. Results: The positive expression rates of p16,p27 and CyclinD1 were 57.5%,70.0% and 62.5% respectively in 40 differentiated thyroid thyroid cancer tissues,and were 20.0%,93.3% and 33.3% respectively in 30 benign tumor controls(P<0.05).The positive expression of p16 was associated with cervical lymph node metastasis(P<0.05), but not associated with sex, age ,tumor size and primary focal extrathyroidal extension(P>0.05).The positive expression of p27 was associated with cervical lymph node metastasis and primary focal extrathyroidal extension and tumor size (P<0.05),but not associated with sex, age (P>0.05).The positive expression of CyclinD1 was associated with cervical lymph node metastasis and primary focal extrathyroidal extension(P>0.05),There was negative correlation between the p16 and CyclinD1(rs=-0.283), and was negative correlation between p27 and CyclinD1 (rs=-0.279). Conclusion:The abnormal expression of p16,p27 and CyclinD1 may have an important role in the carcinogenesis of the thyroid, and they probably have a role in malignant progression of the thyroid cancer.