Objective To evaluate the safety,feasibility of primary closure after laparoscopic common bile duct exploration (LCBDE).Methods We retrospectively analyzed the clinical results of laparoscopic common bile duct exploration for common bile duct stones in 119 cases between July 2009 and August 2012.After all stones were removed,there were 63 cases with primary closure of the common bile duct (group A),and 56 cases with T tube drainage (group B).Results All operations were finished laparoscopically.There was significant difference in terms of operation time,postoperative hospital stay and fluid replacement between the two groups.There was no postoperative extrahepatic duct stenosis and biliary residual stones in the two groups.Conclusions Primary closure of common bile duct after LCBDE for common bile duct stones is safe,efficient and feasible.

Objective To observe the clinical effect of α1-antitrypsin gene therapy in the treatment of diabetes.Methods 81 cases with type 1 diabetes were randomly divided into conventional treatment group,islet stem cell transplantation group and gene therapy group,27 cases in each group.The conventional treatment group received the insulin therapy,the stem cell transplantation group received the islet cell transplantation,and the gene therapy group received stem cell therapy of α1-antitrypsin gene.The clinical effect of these three groups were observed.Results The insulin concentration of the gene therapy group was significantly higher than the islet stem cell transplantation group and the conventional treatment group at five time points(F =1 349.379,1 831.186,1 068.173,416.080,257.810,all P ＜0.05).The glucose concentration of the gene therapy group was significantly lower than the other two groups at six time points (F =1 212.243,586.057,962.495,582.887,650.015,1 181.808,all P ＜ 0.05).The degree of inflammatory cell infiltration in the gene therapy group was significantly lighter than in the islet stem cell transplantation group.Conclusion α1-antitrypsin gene therapy can significantly improve the therapeutic effect of diabetes,which is worthy of clinical application.

The choice of the topic area and specific problem on which to conduct research is the mostimportant step in the research process.This paper focused on the development and execution of a clinical re-habilitation research study. The choice of the topic area. principle of research design. data collection and dataanalvsis of a research study have been discussed.

Objective To evaluate the efficacy of catheterization of left atrium for postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.Methods Sixty ASA Ⅲ or Ⅳ pediatric patients of both sexes,aged 9 months-14 yr,scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly divided into 2 groups (n =30 each):central venous catheterzation group (C group)and catheterization of left atrium group (L group).After induction of anesthesia,triple-lumen central venous catheters were inserted in both groups.In group L,the right internal jugular vein was cannulated with a single lumen venous catheter passed through the left atrium for monitoring postoperative left atrial pressure (LAP) and administration of vasoactive drug and LAP was maintained at 8-12 mm Hg after operation.Duration of mechanical ventilation and duration of stay in intensive care unit were recorded.The amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed within 48 h after operation was also recorded.Results Compared with C group,the amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed was significantly reduced and duration of mechanical ventilation and duration of stay in intensive care unit were significantly shortened in group L.Conclusion Catheterization of left atrium is used for monitoring postoperative LAP,which can provide a basis for reasonable clinical prescription and optimize the efficacy of postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.

[Objective] To evaluate the influence of dexmedetomidine on median effective target effect-site concentration(EC50)of sufentanil-inhibiting urethroscope insertion response in patients undergoing transurethral resection of prostate(TURP).[Methods] Forty patients with ASA grading Ⅰ-Ⅱ who accepted selective TURP were divided by random digits table method into two groups with 20 cases each.The patients in dexmedetomidine group were treated with 0.6 μ g/kg dexmedetomidine intravenous infusion for more than 10 min,while control group were treated with equivalent capacity of 0.9％ sodium chloride.At 5 min after stopping injection,target-controlled infusion of propofol was started and the plasma target concentration was 3.0 μ g/ml.At 10 min after infusion,target-controlled infusion of sufentanil began and the plasma target concentration was 0.20 ng/ml.The target concentration of sufentanil of the next patient accorded to the patient with or without the urethroscope insertion response and the adjacent rate of the target concentration was 1.1.The EC50 and 95％ confidence interval(CI)of sufentanil were calculated.[Results] There were 20 cases in dexmedetomidine group ultimately selected and 19 cases in control group.There was no statistical significance in absolute value of ST segment of intraoperative electrocardiogram,systolic blood pressure,heart rate,pulse oxygen saturation and bispecual index between two groups(P＞0.05).EC5o of sufentanil-inhibiting urethroscope insertion response in dexmedetomidine group was 0.1148 ng/ml(95％ CI 0.1055-0.1249 ng/ml),which was significantly lower than that in control group[0.1454 ng/ml(95％ CI 0.1339-0.1580 ng/ml)](P＜0.05).[Conclusions] 0.6 μg/kg dexmedetomidine intravenous infusion before operation can reduce the EC50 of sufentanil-inhibiting urethroscope insertion response in patients undergoing TURP.

Objective:To study the the correlation between the diameter or angle of thoracic-lumber pedicle and vertebral number.Method:X-ray and CT scan were performed on 46 male spine specimens.The length of pediele screw path,the cress-section angle(e) and the sagittal angle(f) of the pedicle,the width of the inner diameter of the pediele and the distance between the two pedicles were measured.The ordinal number of T1-L5 vertebral segment was numbered by 1-17.SPSS 11.5 software was used for statistical analysis.Result:The data showed a positive linear correlation with the vertebral numbers including length of T1-L4 pedicle screw path (R2=0.716),T8-L5 pedicle width (R2=0.673),T4-L5 pedicle distances (R2=0.771),T1-T2 f-angle (R2=0.767) ,T2-T4 f-angle (R2=0.908),T12-L5 pediele e-angle (R2=0.710).The negative linear correlation with thevertebral numbers included T2-T3 pedicle width(R2=0.792),T1-T4 pedicle distances(R2=0.866),T7-L5 f-an-gle(R2=0.931),T1-T6 pedicle e-angle (R2=0.774).However,the T1-T2 and T4-T7 pediele width,the T4-T6 pediele f-angle,as well as the T6-T12 pedicle e-angle had no significant correlation with the vertebral num-bers.Conclusion:Apart from the T1-T2 and T4-T7 pedicle width,the T4-T6 pedicle f-angle and the T6-T12 pedicle e-angle,the diameter or angle of the thoracic-lumbar pedicle have correlation with the vertebral numbers with meaningful linear regression equation.

In this study an acute rejecting model of heterotopic rat heart-lung transplantation was established by using simplified technique of end to side anastomosis of donor ascending aorta with recipient abdominal aorta.The measurements of tumor necrosis factor alpha(TNF-α)in serum of rats by Sandwich-ELISA method were taken on the 3rd,5th,7th days respectively after operation.The results of this study with histological examination showed that TNF-α serum levels were increased during acute rejection episodes.and it might be a useful indicator for diagnosis of allograft rejection.

Objective To observe effects of BMP-4 gene combined with TGF-β1 in repairing rabbit femur defect resulted from firearm wound. Methods The femur defect was made with firearm steel ball. Plasmid encoded BMP-4 gene identified in vitro and TGF-β1 were injected into the tissue of upper, lower and central parts of the defects at the second week after wound. The mRNA and protein expressions of BMP-4 in vivo were detected by real time-polymerase chain reaction (RT-PCR) and Western blot. Activity of alkaline phosphatase (ALP) and calcium content were measured for evaluating osteogenetic ability. The process and quality of osteogenesis were determined by pathological and X-ray examinations. Results mRNA and protein of BMP-4 could continually express for six weeks in vivo after injection. Activity of ALP in the experimental group was increased to ( 13.17 ±0.51 ) U/100 ml at the 8th week, which was significantly higher than (8.77 ± 0.44) U/100 ml in the control group, indicating that osteogenetic ability was markedly enhanced, which accorded with determination of calcium content. Pathological observation and X-ray proved prominent improvement of osteogenesis, with a shorter time and better quality, in the experimental group. Conclusion BMP-4/TGF-β1 can promote repair of firearm femur defect.

Objective To evaluate the effectivene ss of CO 2 laser laryngeal microsurgery for benign and malignant laryngeal lesion s. Methods From January 1999 to June 2003, a total of 313 pa tients with benign or malignant laryngeal lesions underwent CO 2 laser laryngea l microsurgery in our hospital. There were 186 men and 127 women. The mean age w as 43.5 years ( range from 14 to 76 ) . Vocal cord polyps were found in 236 pati ents ( including 9 cases with Reinke's edema), vocal cord nodules in 30 cases. T h e vocal cord polyps or nodules were cut or vaporized using the CO 2 laser. Ther e were 27 cases with leukoplakia,ke-ratosis, or hyperplasia of the vocal cords, and 20 cases with T1a glottic cancer. The leukoplakia, keratosis, or hyperplasia lesions were excised with the method of demucosation,and the T1a glottic cance r were removed with the methods of demucosation or cor-dectomy using the CO 2 laser.Results All the lesions were removed in one procedure.Th ere was no or less bleeding during operation and the operating fields were clear. No severe complications such as dyspnea, bleeding occurred after operati on. CO 2 laser provided exquisite precision in laryngeal microsurgery. The woun ds of the larynx were healing well after CO 2 laser surgery. The effective rate s were 100% for the vocal cord polyps or nodules, and 92.6% for leukoplakia, ker atosis, or hyperplasia lesions. The recurrence rate was 10% for the T1a glottic cancer at 6 months after operation.Conclusion CO 2 laser laryngeal microsurgery has the ad vantages of less bleeding, clear operating fields, high effective cure rate, and increasing the surgical precision. It also broaden the indications for laryngea l microsurgery and should be used widely.