Objective To investigate the technique and instrument improvement of laparoscopic choledocholithotomy with T-tube drainage. Methods A total of 42 cases of gall stones complicated with common bile duct stones entered the study. During the operation, we exposed the common bile duct before the removal of the gall bladder, opened the common bile duct by a self-made bile duct scalpel, removed the stones by open instruments laparoscopically, and performed choledochofiberscopic examinations and T-tube drainages. Results All the 42 operations were successfully accomplished without the conversion to open surgery. The operation time (exclusive of that of LC) was 80～180 min (mean, 96 min). All the patients got out of bed and received liquids within 24 hours after the surgery. The postoperative hospital stay was 5～9 days (mean, 6 days). The T-tube was removed 3 weeks after the operation in the absence of residual stones or stenosis of bile duct under T-tube choledochography. Follow-up for 6～48 months (mean, 23 months) in 38 cases found no recurrence of stones or biliary tract symptoms. Conclusions The modified laparoscopic choledocholithotomy with T-tube drainage, which shortens the operation time, is an effective and safe method for the treatment of common bile duct stones.

OBJECTIVE To analyze the pathogenic distribution and antimicrobial resistance in respiratory ward and provide the rational information to use antibiotics reasonably. METHODS All pathogens isolated from patients in a respiratory ward from 2005 to 2007 and drug susceptibility results were retrospectively analyzed. RESULTS Totally 264 strains of pathogenic bacteria were isolated,in which 68 strains of Gram-positive bacteria,165 strains of Gram-negative bacteria and 31 strains of fungi.MRSA prevalence was 77.1% and showed a trend of increase.No vancomycin-resistant Staphylococcus aureus or Enterococcus was detected.The resistance rate of Streptoccocus pneumoniae to penicillin,erythromycin and levofloxacin was 44.4-66.7%.Enterobacter and Acinetobacter baumannii showed stable susceptibility to imipenem.Pseudomonas aeruginosa strains were relatively susceptible to cefoperazone /sulbactam,amikacin,gentamicin,piperacillin/tazobactam,ceftazidine,cefepime,cefoperazone and imipenem. CONCLUSIONS The changes in pathogens and antibiotic resistance in the respiratory ward are consistent with the surveillance data in this country,Gram-negative bacteria are still the most common pathogens and the serious degree of bacterial drug resistance is increasing.Our data are useful for the guidance of rational use of antibiotics.

Objective To explore drug resistance and distribution of multidrug-resistant(MDR)Mycobacterium tuberculosis (M.tuberculosis)in a county-level hospital,so as to strengthen the prevention and control of health-care-associated infection with M.tuberculosis .Methods Specimens with positive sputum smear were performed M. tuberculosis culture and drug resistance testing,and distribution of MDR tuberculosis patients in the departments before isolation were investigated retrospectively.Results Of 488 patients with tuberculosis,254 were positive for sputum smear,122 M.tuberculosis strains were isolated from positive sputum smear patients,120 isolates were per-formed drug susceptibility testing,results revealed that 86 isolates were drug-resistant strains,46 of which were monodrug-resistant,40 were MDR.Of MDR strains,16 were all resistant to isoniazide,rifampicin,streptomycin, and ethambutol.The percentage of monodrug-resistance,MDR,pandrug resistance was 9.43%,8.20%,and 3.28% respectively.Medical imaging department,ultrasound department,and respiratory disease department were the main units of M.tuberculosis exposure.Conclusion The percentage of MDR M.tuberculosis is high among M. tuberculosis ,surveillance should be intensified,so as to prevent the transmission in hospital.

This thesis analyzed the inevitability of medical negligence according to the nature of medical behavior,particularity of medical profession and psychological factors of medical staff.How to control the occurrence of medical errors is an important social problem which is the whole community has been looking forward to solve.This thesis proposed methods to reduce medical negligence from the aspects of service concept,medical education and healthy psychology.

OBJECTIVE To analyze the pathogenic distribution and antimicrobial resistance in our hospital in 2006 and provide the rational information to use antibiotics reasonably.METHODS Flora cultivation and isolation were operated with the methods described by the National Clinical Laboratory Operational Regulations.Flora was identified with the VITEK32 automatic identifier,and bacteria-susceptibility test was operated with Kirby-Bauer method.RESULTS Totally 967 strains of pathogenic bacteria were isolated;they comprised 326 strains of Gram-positive bacteria,541 strains of Gram-negative bacteria and 100 strains of fungi.The main Gram-positive microorganisms included Staphylococcus aureus and Enterococcus faecalis,et al.The main Gram-negative microorganisms included Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,Stenotrophomonas maltophilia and Pseudomonas aerugiinosa,et al.Specimen samples mainly isolated from sputum(43.85%),urine(22.34%),and secretion(10.03%).G+ microorganisms were sensitive to nitrofurantoin and vancomycin.G-microorganisms except A.baumannii and S.maltophilia were sensitive to cefoxitin,piperacillin/tazobactam,imipenem,and amikacin;the average resistant rates of A.baumannii and S.maltophilia to antibiotics were 68.20% and 64.43%,respectively.CONCLUSIONS The severe degree of bacterial multi-drug resistance is increasing,it is urgent to carry out surveillance of bacterial resistance for reasonabe use of antibiotics and decreasing the morbidity rate and the fatality rate.

In the present study, stereological analysing methods were used to measure the nucleus, cytoplasm and secretive granules of mast cells in connective tissue and mucosa. It was found that there existed significant difference between them in nucleus/cytoplasm ratio, volume density, size and sphericity of granules. These quantitative results might be served as the main morphological parameters of distinguishing the two types of mast cells.

ObjectiveTo investigate the relation of obesity parameters,including body mass index (BMI),waist-to-height ratio(WHR),waist circumference,and waist-to-hip ratio(WHR),with hypertension in adolescents.MethodsA cross-section study was conducted among 3953 adolescents aged 12 to 18 years old,who were assigned to the normal blood pressure group (3724) or hypertension group(229).Measurements were height,weight,waist circumference,systolic blood pressure (SBP),and diastolic blood pressure (DBP).ResultsThe data showed that mean BMI,WHR,waist circumference,WHR,SBP,and DBP in the hypertension group Was significantly higher than those in the normal blood pressure group(all P<0.05).In partial correlation analysis,BMI,WHR,waist circumference,and WHR were positively correlated with both SBP and DBP after gender or age were adjusted(r'=0.3228 and 0.2358,both P<0.05).For alias under the receiver operating curve(ROC),the BMI was obserred to strongly predict hypertension in male (0.715;95%CI0.659-0.771)and female (0.702;95%CI0.646-0.757).BMI was also entered into the multiple linear regression modeL ConclusionBMI could be an effective predictive factor of hypertension in adolescents.

Objective To investigate the chnical effect of modified transforaminal lumbar interbody fusion (TLIF) on the treatment of lumbar degenerative disease. Methods Sixty-two patients with lumbar degenerative disease were treated by the modified TLIF from June 2007 to May 2009. The preoperative diagnosis was lumbar intervertebral disc herniation with spinal instability (28 cases), lumbar intervertebral disc herniation with lumbar stenosis (27 cases ), degenerative spondylohsthesis (7 cases ). Forty-eight cases were single-level and 14 cases were two-level. The patients were evaluated by observing the fusion rate and comparing the visual analog score( VAS ) and Japanese orthopaedics association (JOA) score of preoperation with those of postoperation. Results All the patients were followed up from 15 to 30 (22.77 ± 3.82)months,no nerve injury,leakage of cerebralspinal,infection,the broken of pedical screws and other complications. The fusion rate of segment was 96.8% at the follow-up after 1 year postoperatively. Judgement by JOA score,the rate of improvement was 93.5%(58/62),excellent in 34 cases,good in 24 cases,fair in 4 cases. The postoperative value of V AS and JOA score were higher than those of preoperation (P ＜ 0.05 ), the values when follow-up of 3 months was performed had no statistic al difference with those of final follow-up (P＞0.05). Conclusion The modified TLIF with fully decompression while reducing the accessing spinal canal complications have good clinical efficacy in treating lumbar degenerative disease.

ObjectiveTo explore the clinical outcomes of posterior lumbar interbody fusion using BTwin expandable spinal spacer with microendoscopic discectomy (MED) for lumbar disc herniation accompanying degenerative instability.MethodsFrom March 2006 to May 2010,87 patients with lumbar disc heniation (only one level) accompanying degenerative instability were managed with posterior lumbar interbody fusion using B-Twin with MED,includeing 49 males and 38 females with an average of 47.6 years(range,37-65).Objective level located in L3,4 in 2 cases,L4,5 in 43,and L5S1 in 41.The patients were treated with single BTwin(Single group,n=51) and double B-Twin(Double group,n=36).Clinical outcomes were evaluated with surgical time,blood loss,visual analogue scale (VAS) scores,Oswestry disability questionnaire (ODI),and the pre- and post-operative disk space heights.ResultsThe patients were followed up for an average of 35.8months (range,12-46).All the patients felt the low back pain and radiation pain disappeared or relieved apparently.The mean preoperative ODI and VAS scores decreased from 78％±3％ to 18％±3％,and (8.70±11.3)to (0.65±10.48) at the final follow-up respectively.Disc space increased from a pre-operative height of (8.76±1.3) mm to a post-operative of (11.8±0.6) mm.ODI,VAS and the disk space heights in all patient showed statistical significance,which revealed no statistical significance between the two groups.However,the operation time,blood loss were statistical difference between the two groups.All the patients achieved solid union or probable union at a mean time of 5.6 months (range,3.9-8.6).ConclusionPosterior lumbar interbody fusion using B-Twin with MED can obtain satisfactory outcomes in the treatment of lumbar disc herniation accompanying degenerative instability.Single B-Twin can get similar clinical outcomes,but shorter surgical time,less blood loss,and less medical costs.

BACKGROUND: Most of the patients suffered from degenerative lumbar instability are treated by exposure both sides and bilateral pedicle screw fixation,which bring highly operative risk,large blood loss and great medical expenditure to patients.OBJECTIVE: To explore the clinical efficacy of single cage plus unilateral pedicle screw placement for treating lumbar degenerative instability.METHODS: Totally 51 cases with lumbar degenerative instability underwent single cage plus unilateral pedicle screw placement were selected,including 32 males and 19 females,aged ranging from 41 to 72 years.47 cases had single segment involved and 4cases had two segments involved.All cases experienced unilateral laminectomy and transforamenal lumbar interbody fusion.The therapeutic effect was assessed by Japanese Orthopaedic Association(JOA)score system.RESULTS AND CONCLUSION: The blood loss was 90-430 mL.The surgical time was 100 minutes(85-120 minutes)for single segment and 150 minutes(120-170 minutes)for double segments.The patients were allowed to early ambulation at 2-3 days after operation.Two cases did not get improvement on back-leg pain,but there was no abnormality from CT and MRI recheck,one case felt pain relieved after anti-symptom treatment for 3 months while the other did not relieve.The average JOA scores at pre-operation and 1 year follow-up was 11(7-13 scores)and 25(18-27 scores),respectively.The total improvement rate of JOA was larger than 50%.44 cases were evaluated as fusion and 7 cases as possible fusion.The average fusion time was 5.4 months(4.3-7.1 months).Postoperative X-ray showed no evidence of pedicle screw loosening,broken,or cage displacement.Single cage plus unilateral pedicle screw placement is characterized by simple operation,small blood loss,short operation and few interference to spine,which is a better method for treating lumbar degenerative instability.