Acromioclavicular Joint ; anatomy & histology ; injuries ; surgery ; Fracture Fixation ; instrumentation ; methods ; Humans ; Male ; Shoulder Dislocation ; surgery

Condoms ; standards ; supply & distribution ; Humans ; Quality Control ; Sexually Transmitted Diseases ; prevention & control

Bile Duct Neoplasms ; surgery ; Bile Ducts ; pathology ; surgery ; Bile Ducts, Intrahepatic ; pathology ; surgery ; Biliary Tract Diseases ; surgery ; Biliary Tract Surgical Procedures ; methods ; trends ; Cholecystectomy, Laparoscopic ; methods ; trends ; Cholelithiasis ; surgery ; Humans

Objective To investigate the risk factors of post-pancreaticoduodenectomy complications.Methods The clinical data of 207 patients with pancreatic carcinoma or peri-ampullary carcinoma who underwent pancreaticoduodenectomy at the Anhui Provincial Hospital from Dec.2007 to Dec.2012 were studied.Seventeen clinicopathologic factors to correlate with the postoperative mortality and methods were selected for univariate analysis and multivariate analysis using logistic regression.Results Univariate analysis showed the major risk factors of postoperative mortality and morbidity were a history of previous operation,pre-operative drainage,total serum bilirubin level,alanine aminotransferase level,serum albumin level,serum pre-albumin level,parenchyma texture and pancreatic duct diameter (P＜0.05).Multivariate analysis showed alanine aminotransferase level,parenchyma texture and pancreatic duct diameter were independent risk factors of postoperative complications.Pancreatic duct diameter was the independent risk factor of pancreatic fistula.Pancreatic fistula was the independent risk factor of hemorrhage.Conclusion The postoperative complications of pancreaticoduodenectomy was closely related to alanine aminotransferase level,parenchyma texture and pancreatic duct diameter.

In the medical field, the innovation education is to cultivate residents in China, which is an important way to senior medical elite. By analyzing competency-based neurosurgery residency training mode, the training methods for innovative ability of competency-based neurosurgeon are further discussed, for the purpose of reforming the training mode of neurosurgeon, improving creative ability and scientific clinical thinking ability.

Objective To explore the best minimal invasive method in treating renal pelvic stones less than 1.5 cm.Methods A total of 90 patients with renal pelvic stone less than 1.5 cm were enrolled, including 47 cases of retrograde intrarenal surgery(RIRS)by rigid and flexible ureteroscopy with holmium laser lithotripsy,and 43 cases of percutaneous nephrolithotomy(PCNL)by holmium laser lithotripsy.Opera-tion time,stonefree rate(SFR),hospitalization,and complications were analyzed for comparison.Results The average sizes of stone in the RIRS group and PCNL group were 1.2 cm(range 1.0 ~1.5 cm)and 1.3 cm (1.0 ~1.5 cm),respectively.In the RIRS group,45(95.74%)patients out of 47 had complete clearance and 32 patients needed combination of flexible ureteroscopy to fragmentate the stones falling into the renal calices.The operation time was 44 min(range 27 ~70 min)with postoperative fever in 2 cases.The decrea-sing in hemoglobin and hematocrit was(0.18 ±0.06)g/L and 0.11%,respectively.No major complication was recorded.In PCNL group,the mean operation time was 70min(range 45 ~90 min)with a stone-free rate of 95.35%(41 /43).The decreasing in hemoglobin and hematocrit was(17.25 ±6.70)g/L and 5. 62%,respectively.The complications in PCNL group were postoperative fever in two cases and bleeding in two cases.Conclusion RIRS has the advantages of natural orifice endoscopic surgery in shortening opera-tion time,reducing blood transfusion requirements,and decreasing postoperative complications.For renal pelvic stone less than 1.5 cm,RIRS can be the primary choice.

Objective To investigate the changes of clinical symptoms and liver or lung functions after inferior vena cava stent implantation in Budd Chiari syndrome patients. Methods 35 cases of Budd Chiari syndrome patients were enrolled and retrospective analysized, such as ascites, edema of lower limbs, abdomen wall of varicose veins and serum total bilirubin, serum albumin, prothrombin time, FVC, MVV, PEF, FEV1.0, FEV1.0/FVC and other pulmonary functional changes were analyzed before and 1 months after inferior vena cava stent implantation. Results Ascites, edema of lower limbs, abdominal varicose veins and other clinical symptoms were significantly reduced or disappeared, the total serum bilirubin significantly decreased, serum albumin significantly increased, and prothrombin time significantly reduced 1 month after surgery in patients with Budd Chiari syndrome, (t = 1.95, 2.31, 2.07, P < 0.01). FVC, MVV, PEF, FEV1, the indexes of FEV1/FVC improved obviously after surgery (t = 1.83, 2.69, 1.47, 1.69, 1, 97, P = 0.041, 0.029,0.046, 0.043, 0.043, 0.038). Conclusion Inferior vena cava stent implantation could effectively improve the clinical symptoms of patients with Budd Chiari syndrome.

Hirschsprung's disease (HD) is a conginental disorder of enteric nervous system (ENS) and is associated with the abnormal migration of gut neural cerst cell (GNCC).Recent studies showed that the regulation of this migration is a complex gene network.By the development of epigenetic and stem cells,this network is becoming much more clear.Transplantation of the modified gut neural crest stem cells/gut neural crest precursors(GNCSC/GNCP) acquired from the HD bowl is becoming the potential therapy of HD.This paper summerizes the recent advances and is to promote better understanding the pathogenesis of HD.

Objective To investigate the pathogenesis of interleukin-21 (IL-21)role in primary biliary cirrhosis (PBC).Meth-ods 38 cases of PBC were selected for the study.35 caeses of healthy subjects were selected as the control group in January 2012 to January 2014 from Shenzhen Fuyong People’s Hospital of Baoan District and the Third People’s Hospital of Shenz-hen.The levels of IL-21,IL-17 of two groups were measured with Enzyme-linked immunosorbent assay (ELISA).The levels of T helper lymphocytes 17 (Th17),regulatory T cells (Treg)cells ratios of two groups were measured with flow cytome-try.The relationship of IL-2 1 and liver function were analyzed with pearson correlation.Another analysis of pyruvate through the establishment of in vitro deaminase complex E2 subunit (PDC-E2)peptides relationship with Th17 and Treg cell.Results The levles of IL-17 (18.23±4.12)ng/L,IL-21 (512.25±18.25)ng/L,Th17 (3.98±0.98)%,Th17/Treg (39.25±3.25)% of PBC group were significantly higher than the control group (7.89±3.26)ng/L,(212.98±21.52)ng/L,(0.92±0.21)% and (12.98±3.12)%,while the PBC group Treg (3.11±0.85)% were lower than the control group (8.36±1.12)%.IL-21 were positive correlation with IL-17,Th17 (t=8.886,7.021,4.448,10.112,5.125,P<0.05).In vitro experiments showed that the addition of IL-21 in the culture system,the levels of Th17 (2.41±0.82)%,Th17/Treg cells(32.98±3.12)% were significantly higher than the control group(0.98±0.21)%,(12.25±3.25)%,while Treg (4.75 ±0.68)% were lower than the control group(11.85±0.96)%,the difference was statistically significant (8.521,6.489, 8.236,P<0.05).Conclusion IL-21 levels increased with the pathogenesis of PBC has a close relationship,which can pro-mote the reaction of PDC-E2 Th1 7/Treg immune imbalance caused thereby occurs mediated by PBC.

Objective:To investigate the recent and forward effects of different operation patterns on recurrent calculus of intrahepatic duct.Methods:A analysis was made on previous history and operation patterns,distribution,effect and follow-up visit in 76 reoperation patients with recrudescent hepatolith between Jan,2000 and Feb,2008 in Affiliated Provincial Hospital of Anhui Medical University,retrospectively.The situation after operation was confirmed as the short-term curative effects and the follow-up results as long-term curative effects.Results:The average hospital stay was 10.4 days and the incidence rate of postoperative complications was 14.5%.The follow-up which lasted from 8 months to 8 years showed that the average recurernce rate was 38.2%.Besides,the rate of joint-type operation was lower than single-type operation (P