Objective To investigate the effect of carbon dioxid insufflation on cerebral blood flow (CBF) during laparoscopic cholecystectomy. Methods Thirty patients ASA grade Ⅰ- Ⅱ undergoing laparoscopic cholecystectomy were selected. The values of jugular venous oxygen partial pressure(PjvO2 ) jugular venous oxygen saturation (SjvO2 ), arterial partial pressure of carbon dioxide (PaCO2), oxygen (PaO2) and saturation (SaO2 ) were measured before the insufflation, 10 min and 30 min after the insufnation, respectively. Results Compared with those before the insufflation, SjvO2 and PacO2 were increased significantly, and arterial--jugular venous oxygen content difference (Ca-jvDO2 ) decreased markedly 10 min and 30 min after insufflation (P

Bronchiolitis ; epidemiology ; virology ; Case-Control Studies ; Child, Preschool ; China ; epidemiology ; DNA, Viral ; Female ; Human bocavirus ; isolation & purification ; Humans ; Infant ; Male ; Metapneumovirus ; isolation & purification

Objective To evaluate the feasibility and efficacy of suspended method in scar hidden technology in laparoscopic appendec-tomy ( LA) . Methods 27 patients underwent scar hidden laparoscopic appendectomy with the aid of suspended method. Silver probe was pierced abdominal cavity,bended into a hook shape and fixed appendix,then underwent appendectomy. Results 27 patients finished surgery successfully,the operative time was 25~100 min ( mean, 45 min) ,the blood loss during operation was 10~50 mL ( mean,20 mL) ,the hos-pital stay was 3~8 d ( mean,4 d) . Conclusion Scar hidden technology in laparoscopic appendectomy with the aid of suspended method is safe,feasible and further improves the cosmic result.

Objective To investigate the risk factors, treatment methods and significance of the cervical venous angle lymph node metastasis in differentiated thyroid cancer. Methods The clinical data of 222 patients with thyroid papillary carcinoma from December 2012 to January 2014 were collected. The surgical methods, complications and postoperative complications and pathology were analyzed. Results Lymph node metastasis was found in 133 cases. when VI lymph node was positive , the lateral cervical lymph node positive rate was 43%(57/133) inⅡDistrict, 54%(72/133) inⅢDistrict,ⅣDistrict 45%(60/133) inⅣDistrict, 60%(80/133) in jugular angle, and 6%(8/133) in V District. The levels of bleeding volume, operation time and hospitalization time in functional neck dissection (FND) group were significantly higher than those in anterior cervical muscle group and reserved anterior cervical muscle group (P<0.05). Single factor analysis showed that diameter of the tumors, thyroid membrane invasion and central region lymph node metastasis had correlations with venous angle lymph metastasis (P<0.01). Logistic regression analysis showed that thyroid membrane invasion (OR=3.539), central region lymph node metastasis (OR = 1.617), diameters of the tumors (OR = 1.321)were the risk factors of cervical venous angle lymph node metastasis. Conclusions Patients with tumor diameter equal to or more than 1.5 cm, thyroid membrane invasion and lymph node metastasis number greater than or equal to 2 should be performed with lateral neck lymph node dissection. Also the venous angle lymph node dissection should be done in these patients so as to increase radical rate.

BACKGROUND:Current decelularized methods have the certain damage to the extracelular matrix and reduce the biomechanical properties of acelular scaffolds. OBJECTIVE:To explore the biomechanical properties of decelularized scaffold of lyophilized bovine tendon. METHODS:Sixty lyophilized fiber bundles from fresh flexion tendon of calf toes were randomly divided into two groups: control group and experimental group. In the experimental group, serine protease inhibitors were placed asepticaly for 24 hours at room temperature, then the samples were rinsed with PBS and transferred to the low concentration of trypsin+ethanol mixed solution to remove the cel wal without destruction of the extracelular matrix at room temperature for 5 hours; after that, the fiber bundles were cultured in DNA enzyme solution for 5 hours, finaly the acelular scaffold was completed and rinsed with PBS for 48 hours and dried at room temperature in sterile room. No treatment was done in the control group. Modulus of elasticity, durability and maximum stress were determined in the two groups. RESULTS AND CONCLUSION:Similar elastic modulus and durability were found in the two groups, but the maximum stress in the experimental group was significantly lower than that in the control group (P < 0.01). These findings indicate that the lyophilized acelular tendon fibers can mimic the biological function of bovine tendon fibers to a certain extent.

Objective To explore how to effectively prevent and detect cancer early postoperative intestinal obstruction and treatment methods and means.Methods This retrospective analysis of 13 years occurred in 57 patients with rectal cancer diagnosis and treatment of cases of early postoperative intestinal obstruction process, including fasting,gastrointestinal decompression,fluid therapy,liquid paraffin,diatrizoate and surgical treatment of oral contrast.Results In 57 cases,paralytic intestinal obstruction in 7 cases,conservative treatment was relieved,the success rate was 100.0%;early inflammatory intestinal obstruction in 37 cases after conservative treatment of 36 cases of remission,the success rate was 97.3%;mechanical intestinal obstruction in 13 cases after conservative treatment could not be alleviated,conservative success rate was 0.0% and was cured by reoperation.The first two groups of patients compared with mechanical intestinal obstruction patients,conservative success rate had statistical differences (χ2 =40.08,11.08,all P<0.01).Conclusion Cancer treatment lies in early postoperative intestinal obstruction effective prevention,early detection,close observation and timely and effective treatment,a good grasp of timing of surgery and surgical indications.

Objective The objective of this study was to evaluate the prognostic value of postoperative prognostic nutritional index(p-PNI)in the prognosis of colorectal cancer patients.Methods Retrospective analytical cases came from 89 patients with radical resection of colorectal cancer confirmed by the pathological section in Nanjing Drum Tower Hospital Suqian City People's Hospital from August 2009 to August 2012.The p-PNI was calculated based on the results of blood routine and biochemical tests after the first visit to the hospital.The Youden index was calculated using the receiver operating characteristic curve(ROC),and the PNI value combined with the best sensitivity and specificity was used as the threshold for the PNI packet.Kaplan-Meier method was used to study the effect of p-PNI on postoperative prognosis of patients with colorectal cancer.Cox regression model was selected to study the effect of p-PNI on the prognosis of colorectal cancer patients after surgery.Results The p-PNI of 89 cases of colorectal cancer patients was 25.18~60.74(43.81±6.47).The p-PNI in patients(less than 70 years old)was significantly increased when the number of lymph node metastases was less than 4,the preoperative CEA was less than 5ng/mL,and the intraoperative hemorrhage was less than 150 mL(P<0.05).When the p-PNI value was 43,the Youden exponent was the largest.Data analysis showed that p-PNI was correlated with age,lymph node metastasis,intraoperative blood loss and preoperative CEA(P<0.05).The survival rate of patients with high p-PNI was higher than that of low p-PNI group(X2=15.639,P<0.001).Single factor and multivariate analysis confirmed that p-PNI was an independent factor in the prognosis of patients with colorectal cancer(HR=2.179,95% CI:1.057~3.561,P<0.001).Conclusion p-PNI is an independent prognostic factor in patients with colorectal cancer,which is associated with long-term prognosis after surgery.

Objective To compare the advantages and disadvantages of two approaches of laparoscopic radical resection for right colon cancer.Methods The data of 41 patients with right colon cancer in our hospital from March 2015 to December 2016 were analyzed retrospectively,who were randomly divided into the caudal-to-cranial group(n=23) and classical medial-to-lateral group(n=18) according to different approaches.The operation time,intraoperative blood loss,conversion rate,the number of lymph nodes dissection,hospital stay time and postoperative complications between two groups were compared.Results The operation time,intraoperative blood loss,the conversion rate of the caudal-to-cranial group were better than those of the classical medial-to-lateral group,the differences were significant(P<0.05).There was no significant difference in hospital stay time,the number of lymph nodes dissection and postoperative complications between two groups.Conclusion Laparoscopic radical resection for right colon cancer by caudal-to-cranial approach is easy to operate and dissect,it can shorten the operation time,decrease the intraoperative blood loss,which is worthy of clinical promotion.

Objective To explore the feasibility of single channel laparoscopic extraperitoneal high ligation for pediatric inguinal hernia. Methods The clinical data of 350 patients with inguinal hernia, who underwent single channel laparoscopic extraperitoneal high ligation in our department from Jun. 2015 to May 2016, were analyzed retrospectively. The surgical methods, operation time and postoperative complications were analyzed. Results The surgery was completed successfully on 350 cases. The average operative time was (4.5±1.2) min in the unilateral inguinal hernia, and (8.0±1.2) min in the bilateral ones. All patients were discharged on the first day after surgery, and the average hospital stay was (2.6±0.8) days. No inguinal pain or scrotal hematoma occurred after surgery. During the follow-up of 6 months to 1 year, there were no complications such as hernia recurrence, line reaction or testicular atrophy. Conclusion Single channel laparoscopic extraperitoneal high ligation for pediatric inguinal hernia keeps the puncture needle in the same tunnel, which avoids the postoperative pain at the puncture point and reduces the line reaction. It is safe and feasible, and is worth recommending for clinical use.

Objective To explore the clinical value of trans-umbilicus two-port laparoscopic operation on the treatment for special kinds of incarcerated inguinal hernias in children. Methods A retrospective analysis of the clinical data of 11 children underwent transumbilicus two-port laparoscopic operation for a special kind of incarcerated inguinal hernia from Dec. 2012 to Nov. 2015 in Wuhan Children’s Hospital of Tongji Medical College of Huazhong University of Science & Technology. Then we analyzed the general data, operative methods, hospital stay and postoperative complications of the children. Results Four children with Amyand ' s hernia were curedby laparoscopic surgery. A Meckel’s diverticulum was found in 3 children, 2 ofthem underwentthe laparoscopic resection of Meckel’ s diverticulum, and one was Litter’s hernia and was cured with transumbilical incision for Meckel’s diverticulum resection and anastomosis. One case had direct inguinal hernia with greater omentum hernia and was cured by laparoscopy. Three cases had seromuscular tear of incarcerated intestine and were cured by aparoscopic intestinal repair surgery. The average hospital stay of all cases was (5. 9±2. 4) d, and no incision infection or postoperative scrotal hematoma were found. All the children were followed up for 10 months to 3 years, and recurrence or testicular atrophy were not seen. Conclusion Transumbilical two-port laparoscopic operation is safe, minimally invasive and quick has recovery for the special kinds of incarcerated inguinal hernias, making it of worthy popularizing widely.