Objective To investigate the value of laparoscopic cholecystectomy through superior margin of public symphysis approach.Methods The clinical data of 72 patients with benign gallbladder diseases who were admitted to the Lihuili Hospital from December 2012 to August 2013 were retrospectively analyzed.There were 54 patients with cholecystolithiasis and 18 with gallbladder polyps.Thirty patients received laparoscopic cholecystectomy through the superior margin of public symphysis approach (new method group).Forty-two patients who received transumbilical single-port laparoscopic cholecystectomy were in the control group.The operation time,intraoperative blood loss,duration of postoperative hospital stay,degree of postoperative pain and cosmetic effect of the 2 groups were compared.Patients were followed up via out-patient examination and phone call till December 2013.Data were analyzed using the t test or chi-square test.Results Two patients in the new method group and 1 patient in the control group were converted to receive traditional laparoscopic cholecystectomy.The operation time,intraoperative blood loss,duration of postoperative hospital stay,scores of satisfaction with the incision and degree of postoperative pain were (28 ± 3) minutes,(23 ± 10) mL,(2.0 ± 0.5) days,4.3 ± 0.5 and 5.8 ± 0.8 in the new method group,and (39±4)minutes,(24±l0)mL,(2.0±0.6)days,3.9±0.5 and 5.9±0.9 in the control group.There were significant differences in the operation time and score of satisfaction with the incision between the 2 groups were detected (t =10.032,2.423,P ＜ 0.05),while no significant differences in the volume of intraoperative blood loss,duration of postoperative hospital stay and degree of pain between the 2 groups (t =1.021,0.000,1.760,P ＞ 0.05).All the patients were recovered,and were administered with semi-fluid food at postoperative day 2.No bleeding,bile leakage,incisional infection occurred,and no patient died perioperatively.Analgesics were not needed in the 2 groups.All the patients were followed up for 1-6 months.Patients were satisfied with the cosmetic appearance of the incision,and no inflammation,pain and infection of the incision occurred.Conclusions Laparoscopic cholecystectomy through the superior margin of public symphysis approach is safe and feasible,with the advantages of short operation time,cosmetic appearance of incision and easy manipulation.

Objective To optimize the concentrate process ofDanshen injection.Methods The concentration changes of Salvianic acid A sodium, Protocatechuic aldehyde and Salvianolic acid B were selected as indexes to compare mospheric concentrate, vacuum concentrate, nanofiltration concentrate and nanofiltration-vacuum coupling concentrate methods with HPLC. Results Phenolic acid composition changed when atmospheric and vacuum concentrate method were used. Retention rate of three phenolic acids were over 93% after nanofiltration concentration, but the concentration efficiency was limited by solution viscosity. Nanofiltration-vacuum coupling concentrate methods could solve the above problems, meanwhile, retention rate of three phenolic acids were over 91%.Conclusions Nanofiltration technology takes advantage in medicine extraction concentrate with heat sensitive ingredients, and its application prospect in traditional Chinese medicine pharmaceutical industry would be broad.

Objective To study the process of removing bacterial endotoxins by ultrafiltration technology in dextran 40 injection. Methods Dextran 40 solution was ultrafiltrated by 100,200,and 300 kDa aperture ultrafiltration membranes with composite, PES and PVDF materials. In order to optimize ultrafiltration process,the content of effective component and endotoxins were detected by HPLC and kinetic-turbidimetry,respectively,and the change of particle size distribution in dextran 40 solution was analyzed before and after ultrafiltration. Results The transmittance of dextran 40 was close to the same MWCO and different membrane material. When MWCO reached 300 kDa,the transmittance was above 91%,which met the requirement of filtration. The endotoxin removal rates by 100-300 kDa composite ultrafiltration membranes were more than 99%. But the endotoxin removal rates of both of PES and PVDF membranes were less than 40%,which were unable to guarantee the removal efficiency of the endotoxin in dextran 40 solution. The particle size declined after ultrafiltration by 300 kDa composite membrane, and level of the insoluble particles decreased. Conclusion The 300 kDa composite ultrafiltration membrane can effectively remove endotoxin in dextran 40 solution with less main components loss. The material can meet requirements for producing dextran 40 injection.

Objective To investigate the relationship between the plasma neutrophil gelatinase-associated lipocalin (NGAL)and endothelin-1 (ET-1) levels and cognitive dysfunction in chronic obstructive pulmonary disease (COPD) patients.Methods A case-control study was performed,consisting of 128 patients with COPD(68 patients without cognitive dysfunction and 60 patients with cognitive dysfunction) and 70 normal controls.All patients with COPD were diagnosed by pulmonary function tests and plasma levels of NGAL and ET-1 were determined by enzyme immunoassay.The cognitive function was evaluated by the MMSE and MoCA.Results ①Compared with normal control,the levels of plasma NGAL and ET-1 were increased(NGAL:(2.20±0.60) μg/L vs (1.69±0.73) μg/L,P＜0.05;ET-1:(26.19± 10.55)pg/ml vs (13.05±2.37) pg/ml,P＜0.05) in COPD patients without cognitive dysfunction and in COPD patients with cognitive dysfunction(NGAL:(3.80±2.75) μg/L vs (1.69±0.73) μg/L,P＜0.01;ET-1:(37.82±0.29) pg/ml vs (13.05±2.37) pg/ml,P＜0.01).Compared with the COPD patients without cognitive dysfunction,the levels of plasma NGAL and ET-1 were also increased in COPD patients with cognitive dysfunction (all P＜0.05).②The plasma NGAL levels were correlated negatively with MMSE scores(r=-0.524,P＜0.05),and negatively correlated with MoCA scores (r=-0.527,P＜0.05).The plasma ET-1 levels were negatively correlated with MMSE scores(r=-0.549,P＜0.05),and negatively correlated with MoCA scores(r=-0.558,P＜0.05).The levels of NGAL and ET-1 were positively correlated(r=0.564,P＜0.05).Conclusion NGAL and ET-1 may be involved in the pathophysiological process of cognitive dysfunction in patients with COPD,which provides a certain clinical value for the assessment of cognitive dysfunction in patients with COPD.

Objective To assess the efficacy and safety of argon plasma coagulation(APC) in treating patients with Barrett's esophagus.Methods Two reviewers independently searched the Cochrane Library(Issue 2,2008),MEDLINE(January 1948 to November 2008),and CNKI(January 1999 to November 2008),respectively.The quality of the included studies was assessed according to the guidance in the Cochrane Handbook of systematic reviews of interventions.Results Six randomized controlled trials involving 253 patients with Barrett's esophagus met the inclusion criteria and were included.One trial reported that the ablation rate of patients in the APC group was significantly higher than that in the endoscopic surveillance group.Followed up one year,the ablation rate in APC group was 63% compared with 15% in the control group(P

Objective To compare intraindividual higher-order aberrations(HOA)after implantation of aspherical and spherical intraocular lenses(IOL).Design Prospective,case-controlled study.Participants 33 patients(66 eyes)were between 50 and 76 years of ages.The patients with bilateral senile cataracts were operated with phacoemulsification and IOL implantation.All the patients had no other ocular pathologies and no previous ophthalmic surgery.Patients with keratometric astigmatism higher than-2.0 diopters(D)were excluded from the study.Methods Wavefront aberration measurements of 33 patients(66 eyes)after implantation of a spherical IOL(Canon Staar KS-3)in one eye and an aspherical IOL(Cannon Staar KS-3Ai)in the contralateral eye were analyzed.The eyes were randomly assigned to groups of the spherical IOL or the aspherical IOL.Third-order,4th-order,5th-order,total HOA root-mean-squares(RMS),and 4th-order spherical aberrations(Z40)were compared 3 months after surgery.Main Outcome Measures Visual acuity(VA),the best corrected visual acuity(BCVA),the centrality of IOL,refraction data,diameter of pupil size,3rd-order,4th-order,5th-order and total HOA RMS,and 4th-order spherical aberration(Z40)RMS were measured.Results Fourth-order aberration RMS(0.193?0.098?m),Z40 RMS(0.037?0.099?m),total HOA RMS(0.498?0.072?m)in the aspherical IOL group were lower than those with the spherical IOL(0.403?0.155?m,0.381?0.142?m,0.737?0.164?m,respectively)at 6mm pupil diameter.For 3rd-and 5th-order RMS at 6mm pupil diameter,total HOA RMS(at 5mm pupil diameter),no significant difference was found in both IOLs.Under mesopic conditions,ten patients(30%)with an aspheric IOL had better contrast sensitivity.The average myopic shift were(-0.29?0.09)D and(-0.87?0.16)D in the aspherical and spherical IOL groups at 6mm pupil diameter(P

Objective To investigate the effect of construct the Notch1 (NICD) eukaryotic expression vector on the proliferation and differentiation of rat bone marrow mesenchymal stem cells (BMSCs) in vitro. Methods Rat BMSCs were experimented as the object. NICD eukaryotic expression vector was constructed. pEGFP-N1-NICD expressing plasmids were used to transfect BMSCs. The study included control group (CON group), empty vector group (VEC group) and the trans-fection group (TRA group). After 48-hour transfection, BMSCs were observed for general morphology. The protein expres-sions of NSE, GFAP and Notch1 were detected by real-time PCR and Western blotting assay respectively. The apoptosis, cy-cle distribution and cell proliferation were evaluated by flow cytometry and MTT assay. Results The DNA sequencing con-firmed that the pEGFP-N1-NICD recombinant plasmid was successfully constructed, and both VEC group and TRA group expressed green fluorescence after 48-hour transfection. The relative expression levels of Notch1 and GFAP mRNA and pro-tein were significantly higher in TRA group than those in VEC group and CON group (P<0.05), and there was no significant difference between VEC group and CON group. After 48-hour transfection, the ratio of living cells was significantly lower in TRA group than that of CON group and VEC group, and the early apoptotic rate and late apoptotic rate were significantly higher in TRA group than those of CON group and VEC group (P<0.05). The late apoptotic rate was significantly higher in VEC group than that of CON group. The proportion of G1/G0 cells was significantly higher in TRA group than that of CON group and VEC group, but S and G2/M cells were significantly lower (P<0.05). The value of growth curve was gradually de-creased in TRA group than that of CON group and VEC group (P<0.05). Conclusion The high expression of NICD gene might induce apoptosis of BMSCs, inhibit the proliferation in part, and induce into glial-like cell differentiation.

Objective To investigate the effects of early Xuebijing injection on procalcitonin (PCT) with septic shock patients.Methods Sixty-five patients with septic shock were randomly divided into the control group and Xuebijing injection group.The patients in Xuebijing injection group were received Xuebijing injection therapy(50 ml Xuebijing + 100 ml 0.9％ NaCl injection,2 times/d,for 7 d) besides basic treatment,while in the control group were received basic treatment including antibiotic susceptibility + early fluid resuscitation + correct acidosis.At the entering the ICU day and 1,3,5 d after treatment,patients were collected 5 ml venous blood serum C reactive protein(CRP) and PCT,and before treatment and at the 5th,7th day after treatment conducted APACHE Ⅱ evaluation to observation of curative effect of two groups.Results Before treatment,there were no significant difference in terms of heart rate,blood pressure,PCT,CRP,APACHE Ⅱ scores between the two groups (P ＞ 0.05).There was no significant difference in terms of PCT and CRP between the two groups at the 1 d after treatment(P ＞0.05).While at the 3th day after treatment,PCT and CRP of Xuebijing group were lower than of control group and the differences were significant ((7.37 ± 2.58) μg/L vs.(12.25 ± 3.32) μg/L,(64.32 ± 11.12) mg/L vs.(72.37 ± 12.42) mg/L;P ＜0.05).The APACHEⅡ score in control group at before and 5th,7th day after treatment were (20.48 ± 4.41),(16.52 ± 3.45),(12.78 ± 2.91) respectively,in Xuebijing injection group were (20.74 ± 4.73),(12.48 ± 2.76),(9.24 ± 6.67) respectively.And all indices were significant different time points between groups (P ＜ 0.05).At 7th day after treatment,15 cases were improved,10 cases progressed and 8 cases died in the control group and the effect rate was 75.8％ (25/33).Meanwhile,22 cases were improved,5 cases progressed and 5 cases died in the Xuebijing group and effect rate was 84.8％ (27/32).There was significant difference between two group(x2 =7.27,P =0.03).Conclusion Early Xuebijing injection application can inhibit the PCT r~tion of septic shock patients and improve the prognosis.

Objective To investigate the effect of a step-wise diversified teaching mode on cardiac electrophysiology (EP) education. Methods 64 young doctors (male:36, female:28) who studied in EP sub-specialty were enrolled. The atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) were selected as teaching content. All the doctors were randomly divided into traditional teaching group (TT) and step-wise diversified teaching group (DT) according to cross-over design protocol. In TT group, only teaching and answering the questions by teachers were given to students, for the DT group, in different stages of teaching, multiple teach-ing strategy were combined to complete teaching. T test and Chi square test were used to compare the effect of two teaching methods. Results There was no difference of basic features and time of self-studying between the two groups. In examinations, the students in DT group got higher score than TT group[DT:(92.3±9.8) and (93.1±7.8),TT:(88.3±8.6) and (87.1±10.0),P<0.05], and had better perfor-mance of learning interest, initiative, ability of finding and resolving problems, teamwork spirit and so on. Conclusion The step-wise diversified teaching mode contributes improving the quality of instruction of cardiac EP, moreover, arousing learning interest and initiative, enhancing ability of find-ing and resolving problems, teamwork spirit and so on, which is worthy of wide-popularizing in cardiac EP training.