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Objective:To investigate the efficacy and safety of the modified gasless unilateral axillary approach (MGUAA) endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jan. 2019 to Dec. 2019, 90 patients receiving PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery (MGUAA group, n=41) , and conventional open thyroid surgery (OS group, n=49) were retrospectively analyzed. Ninety patients were enrolled in the study, including 14 males and 76 females,with the mean age (42.1±12.0) years.The effectiveness of central lymph node dissection (CLND) , the operation time, the types of operation, the amount of drainage, the duration of hospital stay, the related complications, the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis, the measurement data was expressed by ±s, paired t test was used to compare the measurement data between groups, and Chi-square test was used to campare the count date between groups. Results:The mean age (35.0±8.6) years and the amount of surgical bleeding (12.3±7.3) ml in the MGUAA group were significantly lower than those (48.1±11.1) years and (16.1±4.3) ml in the OS group ( P<0.01) , while the mean operation time (99.1±19.5) min, the mean amount of drainage (221.4±67.9) ml and the postoperative drainage tube placement time (5.0±0.8) days were significantly higher than those of (70.6±17.8) min, (98.3±63.7) ml and (3.8±1.0) days in the MGUAA ( P<0.01) . There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups ( P>0.05) . In terms of surgical complications, the transient recurrent laryngeal nerve injury, the postoperative hematoma, the postoperative infection, and the lymphatic leakage had no significant difference between the two groups ( P>0.05) . The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck, the postoperative pain of neck, and cosmetic satisfaction over the OS group [ (0.0% vs 28.6%) , (14.6% vs 71.4%) , (1.1±0.3) score vs (2.4±0.5) score ( P<0.01) ]. Whereas in axillary area pain on the surgical side, the MGUAA group was inferior to the OS group ( P<0.01) . Conclusion:The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible, safe and cosmetically operation for PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) .
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Objective To investigate the effect of emergency case video segmentally introduction combining with simulation in cultivation of undergraduate nursing students′skills of trauma management. Methods A group of 55 undergraduate nursing students, recruited in the control group from September 2013 to April 2014, were instructed by traditional teaching method, the trauma management skill was delivered by lecture, video and group based practice. Another 50 undergraduate nursing students, recruited in the observation group from September 2014 to April 2015, were located in the simulation group, while the key point of trauma management was segmentally introduced by emergency case video, the skill of trauma management was delivered by lecture and video, a multiple injury case scenario was used for group practice. The score of the practice test and the evaluation of the teaching were compared among the two groups. Results The students in observation group demonstrated more skilled trauma management compared with that in the control group (90.42±8.50 vs. 84.68±8.77, t=3.56, P<0.05). The students in observation group presented significantly higher satisfaction with the teaching, improving study interesting 93.33%(56/60), promoting the theory knowledge deepen 91.67%(55/60), improving the ability of thinking and observation 95.00% (57/60/) , improving the ability of analyzing and solving problems 100.00% (60/60), enhancing the ability of independent learning 96.67%(58/60), while in the control group, they were 76.36%(42/55), 69.09%(38/55), 65.45%(36/55), 69.09%(38/55) and 80.00%(44/55), the differences between the two groups were significant (χ2 =2.30-4.40, P < 0.05). Conclusions Application of emergency case video segmentally introduction combining with simulation provided more opportunity to the undergraduate nursing students to apply relevant knowledge in analyzing and dealing with trauma cases, which contributes to the improvement of undergraduate nursing students′ skills of trauma management.
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Objective To investigate the effect of the personalized nursing care plan sheet for critically ill patients in the emergency intensive care unit. Methods The personalized nursing care plan sheet including general, personalized nursing issues and related measures was designed according to the standard from the nursing department. A group of 116 critically ill patients were divided into the observational group (58 patients) and control group (58 patients) from January 2012 to September 2014. The personalized nursing care plan sheet were applied for record and hand over in the observational group, while the unified problem statement nursing care plan sheet were used in the control group. The indicators of nursing quality were observed in the two groups and the nurses′satisfaction with the nursing care plan sheets was compared. Results The nursing quality in the observational group was higher than it in the control group with the lower incidence of failure rate in fundamental nursing, professional nursing, plan sheet, disease treatment and adverse event (32.76% vs. 62.07%,37.93% vs. 67.24%,29.31% vs. 68.97%, 20.69% vs. 53.45%, 10.34% vs. 72.41%, the χ2 values were 2.98, 2.98, 4.09, 3.46 and 6.60 respctively, P<0.05). The nurses′satisfaction with the personalized nursing care plan sheet was also higher than the unified problem statement nursing care plan sheet (P<0.05). Conclusion The incidence of nursing defects could be reduced by avoiding the incomplete nursing assessment and omitted nursing plan.
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The pollen grains of 24 cultivarieties of Primus mimic of Rosaceae, which were collected from Shanghai, Hangzhou and Changxing. were observed by light microscope and scanning electron microscope. The pollen morphology of P.mume was first described as polytypism which could be distinguish into two classes and five types. Not only the pollen grains with 3-colporate. which were the primary form, but also the pollen grains with 4-colporate existed in many cultivarieties of P- tnume. The constitute of pollen types and sterility rate in each cultivarieties were also analysed. The result provides scientific reference for pollen identification, breeding and palynology.
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Bone marrow cells from 2 patients with panmyelosis leukemia were observed with transmission electron microscopy (TEM),scanning electron microscopy (SEM),myeloperoxidase (MPO) and platelet peroxidase (PPO).A lot of immature cells were found in the granulocytic, monocytic,erythrocytic and megakaryocytic series.Their major morphologic characteristics were as follows. In the erythrocytic series, petaloid-like and ball-like structure appeared and their perinuclear cisters were wider. In the myelomonocytic series, nuclear-cytoplasmic organelle asynchrony could be seen makedly and the nucleus appeared fully mature, but the cytoplasm contained only a few organelles, and in some cells the organells were often locally distributed. In the megakaryocytic series, many micromegakaryocytes were seen. In this paper, the ultrastructura] changes of four kinds of cells and their relationship with erythro-leukemia are also discussed.
