Objective:The causes, management, and prevention of complications in laparoscopic gyneco-logic surgery were investigated. Methods:A retrospective analysis was done based on clinical data of 8279 cases of laparoscopic gynecologic surgery from January 1996 to December 2008 in this hospital. Results:The complication rate was 0.88% (73/8279). These included five cases intraperitoneal bleeding, five cases injury of ureter, 20 cases abdominal vessel damage, 10 cases vulva emphysema, 25 cases wound healing delay and each one case respectively for stomach injury, bladder injury, secondary abdominal cavity preg-nancy,infection and incision hernia. The occurrence rates of complications between hysteroscopy combined with laparoscopic surgery and pure adnexal surgery were no difference( P >0.05). Compared to adnexal op-erations, there was a significantly higher complication rate in myomectomy and laparoscopic assistant vaginal hysterectomy (P < 0.01 ). Conclusions:Complications of laparoscopic gynecologic surgery are correlated with the difficulty of operation and the skillfulness of operators. In order to reduce complications, careful oper-ation and avoiding over self -confidence are essential.

Objective To discuss the effect under the arthroscope surgery and postoperative treat osteoarthritis with rehabilitation training.Methods 34 cases of osteoarthritis patients treated with the arthroscopy detectors were randomly divided into two groups:the therapeutic group(17 cases)and the control group(17 cases).The therapeutic group was treated with arthroscope surgery and rehabilitation training.The control group was treated only with arthroscopy surgery.All patients were followed up for 90 days.The postoperative pain,range of motion and joint function of the two groups were compared.Results The postoperative pain range of motion and joint function of the therapeutic group was significantly better than the control group(t=17.6,6.4,7.6,P＜0.05).Conclusion Rehabilitation training could relieve the postoperative pain and range of motion,improve the function of knee joint and increase the effect of clinical efficacy in the arthroscopic surgery of knee's under the osteoarthritis patients.

Objective To explore the effect of doctor-nurse integrated ward round performed in the training of professional nurses′ core competence.Methods 18 nurses trained for core competencies in ICU and hemodialysis room were selected as research objects.All nurses were trained with doctor-nurse integrated ward round for one year.The professional knowledge, skills and clinical comprehensive ability of all nurses were tested before and after training.Results After doctor-nurse integrated ward round, the scores of professional knowledge, skills and clinical comprehensive ability of professional nurses were significantly higher than that of before training (P<0.05).Conclusion Doctor-nurse integrated ward round can improve the core competencies of professional nurses.

Objective To investigate clinical features of lower motor neuron lesion (LMNL) caused by the single level lower thoracic disc protrusion (LTDP),and to observe clinical outcomes of surgical treatment.Methods Between January 1997 and December 2009,17 patients with LMNL caused by single level LTDP underwent en bloc resection of the superior articular process,Cave-in 360° circumferential decompression and internal fixation in our hospital.MRI and CT scans were taken to confirm lesion levels:T10-11 in 4 patients of whom 3 had patellar clonus and ankle clonus,T11-12 in 5 patients of whom 4 had ankle clonus,and T12L1 in 8 patients who only had positive Babinski sign.The neurologic status was assessed using the Japanese Orthopaedic Association (JOA) scoring system.The muscle strength of the tibialis anterior was assessed using the Manual Muscle Test (MMT).Sagittal Cobb angle and cross-sectional area of the dural sac at the level of maximal compression in MRI were also observed.Results All patients were followed up for 22 to 76 months (average,48.6 months).The mean JOA score increased from preoperative 5.88±1.11 to 9.53±0.94 at final follow-up (t=16.143,P＜0.05).The muscle strength of the tibialis anterior recovered to more than grade 4 in all patients.Postoperative Cobb angle was unchanged compared with that before operation.MRI indicated that the cross-sectional area of the dural sac at the level of maximum compression increased from preoperative 35.8±7.3 mm2 to postoperative 132.9±6.5 mm2 (t=70.78,P＜0.05).Conclusion LMNL can be caused by LTDP.The eu bloc resection of the superior articular process,Cave-in 360° circumferential decompression and internal fixation can provide a satisfactory decompression effect and marked recovery of neurological function.

Objective To explore the regulation function of Icariine on the expression of bone morphogenetic protein signaling pathway Smad1,Smad5,Smad4 and to explore the mechanism of promoting MC3T3-E1 cell proliferation and differentiation.Methods MC3T3-E1 cells were treated by 0,10-9,10-8 and 10-7 mol/L Icariine respectively.After stimulated by Icariine 1 d,2 d and 3 d,MTT method and population diploid time were used to observe the cell proliferation,and the cell alkaline phosphatase (ALP) level was assayed.At 21 days later,the alizarin red staining was proceeded.At 1,2 and 3 days later,the RT-PCR was used to detect the mRNA expression level about Smad1,Smad5 and Smad4,and the Western blot was to detect the Smad1,5 and Smad4 protein.At 2 days later,the RT-PCR was used to detect the mRNA expression level about Runx2,BMP-2 and osteoprotegerin (OPG),and the Western blot was used to analyze osteocalcin (OCN) protein level.Results After simulated by Icariine,the proliferation (MTT test),the ALP activity and mineralization of osteoblasts were increased,the cell population diploid was reduced (P＜0.05).At 1,2 and 3days later,the results of RT-PCR showed that Icariine continued increasing the mRNA level of Smad1,5 and Smad4 in 10-8 mol/L.At 2 days later,Smad1,Smad5 and Smad4 mRNA expression were obviously reduced in 0 mol/L group,and At 3 days later,Smad1,Smad5 and Smad4 mRNA expression were obviously reduced in 10-9 and 10-7 mol/L groups.At 2 days later,BMP-2,Runx2 and OPG mRNA were obviously increased in 10-8 mol/L group.The results of Western blot showed that OCN,Smad1,Smad5 and Smad4 protein were obviously up-regulated in 10-8 mol/L group.Conclusion Icariine occurs the expressions of BMP-2,Runx2,Smad1,Smad5 and Smad4 by stimulating the bone morphology of MC3T3-E1 cells directly,and promotes the osteogenic differentiation in the manner of expression level synchronous rising.

Objective To investigate the sleep condition and its influence factors in old patients with hypertension. Methods A total of 100 old patients with hypertension were investigated by Pitts-burgh sleep quality index (PSQI) and serf-designed questionnaire of influence factors. Results 76 per-cents of the old patients with hypertension had sleep disorders.The total score of PSQI,sleep quality,time take to fall asleep,hours of sleep,sleep effficiency,sleep disorders,hypnotic drugs and every score of daytime dysfunction were significantly higher than domestic norm(P<0.01).Surroundings(strange circumstances or noisiness), physio-pathology (disease distress or high frequency of going to toilet during nighttime),psycho-logical situations(the fear to the disease or worrying about medical fees) and drags(use of diuretics or the adverse effects of some antihypertensive agents) were the important factors affecting sleep quality. Con-clusions Old patients with hypertension have poor sleep quality,which relates with multiple factors.Valid nursing interventions should be adopted in order to control the various factors which affect sleep quality to improve patients' sleep quality.

Objective · To improve the surgical procedure of correcting upper eyelid retraction.Methods · Patients suffering upper eyelid retraction of 2-5 mm caused by thyroid-associated ophthalmopathy were treated with modified levator lengthening technique in Shanghai Ninth People's Hospital (Shanghai Jiao Tong University School of Medicine,China) from July 2013 to December 2014.Results· Of the 34 patients underwent the modified levator lengthening surgery for upper eyelid retraction correction,there were 7 males and 27 females.After 6 months,upper eyelid retraction got fully resolved in 25 cases and partly improved in 9 cases.The palpebral fissure height demonstrated an average decrease of 3.7 mm (P=0.000).Patient's ocular discomfort such as photophobia and tearing were either cured or improved.Conclusion · Modified levator lengthening surgery can effectively correct upper eyelid retraction,improve the patient's appearance and cure their ocular discomfort.

Objective To observe the therapeutic effect of Guizhi Decoction plus Yupingfeng Powder for chronic urticaria and its effect on serum total IgE level.Methods One hundred and twenty patients were randomly divided into treatment group,control group 1 and control group 2,40 cases in each group.The treatment group was treated with Guizhi Decoction,Yupingfeng Powder and Loratadine Tablets orally,the control group 1 was given intramuscular injection of Bacillus Calmette-Guerin polysaccharide nucleic acid and oral use of Loratadine Tablets,and the control group 2 was only given oral use of Loratadine Tablets.The course of treatment covered 5 weeks.The levels of serum total IgE in the three groups were determined before and after treatment,and the therapeutic effect was evaluated after treatment.Results (1) The total effective rate was 85.0％ in the treatment group,80.0％ in the control group 1,and 55.0％ in the control group 2.The effect of control group 1 and the treatment group was superior to that of the control group 2 (P＜ 0.05),but the difference was insignificant between the treatment group and control group 1 (P＞ 0.05).(2)Before treatment,the serum total IgE level of the three groups was higher than that of the normal control group (P ＜ 0.05).After treatment,the serum total IgE level of the three groups was obviously decreased (P ＜ 0.05 compared with that before treatment);the inter-group comparison results showed that the effect of the treatment group and control group 1 on decreasing the serum total IgE level was superior to that of the control group 2(P ＜ 0.05),while the effect of the treatment group was similar to that of the control group 1 (P ＞0.05).(3) During the treatment,blood routine examination indexes and hepato-renal function of the three groups showed no abnormal changes,neither adverse reaction was shown.Conclusion Guizhi Decoction plus Yupingfeng Powder exerts certain therapeutic effect for the treatment of chronic urticaria,and can decrease the serum total IgE level,thus to stabilize the curative effect and reduce the recurrence.

A 54-year-old female farmer presented with a pea-sized red nodule on the left upper limb near the wrist for 15 days,which occurred after trauma,gradually became swollen and ruptured,and developed into multiple nodules arranged in a chain in 30 days.Skin examination revealed multiple hard purple-red nodules arranged in a line on her left upper limb,some of which were ruptured with a small amount of purulent exndate.Histopathological examination further revealed that the focus of infection manifested as pyogenic granuloma-like inflammation mainly infiltrated with mixed inflammatory cells.Periodic acid Schiff (PAS) staining showed no fungal structures,including fungal spores,hyphae and asteroid body.The biopsy tissue culture yielded the fungus.According to the morphological analysis of the cultures and results of molecular identification based on internal transcribed spacer (ITS) and calmodulin (CAL) coding regions,this case was finally diagnosed as lymphocutaneous sporotrichosis caused by Sporothrix schenckii sensu stricto.The patient was treated with oral potassium iodide 10％ solution in a dose of 10 ml thrice a day.After 2-month treatment,the patient felt that the lesions were obviously improved,but afterwards she was lost to follow-up.This research report suggests that phenotypic analysis combined with ITS/CAL-based molecular identification can accurately identify Sporothrix schenckii complex at the species level.

Objective To investigate the role of toll-like receptor 4 (TLR4) of endothelium or bone marrow derived cells in the acute lung injury (ALI) induced by lipopolyscccharide (LPS) in mice with reciprocal bone marrow transplantation. Method Chimeric mice were produced by reciprocal bone marrow transplantation between TLR4mut/mut and TLR4+/+ mice and divided into 4 groups: WT/WT (recipient/donor),WT/Mutant, Mutant/WT and Mutant/Mutant group. Six to eight weeks following transplantation, LPS was injected inot mice's tail vein in order to produce ALI model,and mice were sacrificed five hours later on.Samples of lung tissues were taken for the following analysis of wet/dry weight (W/D), lung permeabifity index (LPI), myeloperoxidase (MPO),levels of cytokines (TNF-α, IL-1β) and adhesion molecules (ICAM-1). Results Lung injury in the Mutant/Mutant mice was the mildest in the 4 groups. And lung injury in WT/Mutant mice was more serious than that in Mutant/WT mice. levels of MPO and ICAM-1 in WT/Mutant mice were much higher than those of Mutant/WT. In addition,the expression of ICAM-1 in WT/Mutant mice is comarable to that in WT/WT mice. Mutant/WT mice expressed higher levels of TNF-α and IL-1β than WT/Mutant mice. Conclusions Endothelial cell derived TLR4 plays ker-nel role in ALI induced by LPS via lung PMN recruitment,although bone marrow cells derived TLR4 are more im-portant for the release of cytokines.