Objective To explore the diameter change of the extrahepatic bile duct before and after laparoscopic cholecystectomy (LC). Methods From Jan. 2006 to Dec. 2007, 113 patients including chronic gallstone cholecystitis (n=55), inactive cholecystolithiasis (n=46) and gallbladder polyps (n=12) were collected and treated by LC. The diameters of their extrahepatic bile ducts were measured by B ultrasonography before operation, 3 months and 6 months after operation. These data were collected and analyzed retrospectively. Results The diameters of the extrahepatic bile ducts of all patients before LC, 3 months and 6 months after LC were (5?2) mm, (8?2) mm and (6?2) mm respectively. And in chronic gallstone cholecystitis patients they were (5?2) mm, (9?2) mm and (6?2) mm respectively, in inactive gallstone cholelithiasis patients they were (5?2) mm, (8?2) mm and (6?2) mm respectively, and in gallbladder polyps ones they were (5?2) mm, (7?2) mm and (5?2) mm respectively. Conclusion The change of the extrahepatic bile duct diameter after LC is a dynamic process. It is enlarged on the third month after operation than before operation. In the sixth month after operation marked retraction occurs, and compared with before operation, it shows no obvious statistic significance.

Objective To evaluate the efficacy of ureteroscopic holmium laser lithotripsy for ureteral calculi after failed extracorporeal shock-wave lithotripsy(ESWL).Methods A total of 89 patients with ureteral calculi were treated by ureteroscopic holmium YAG laser lithotripsy after failed ESWL.Among them,69 cases were complicated with ploypi or calculi surrounded by granuloma tissues,which were melted by holmium laser simultaneously;4 cases were complicated with distal ureteral stenosis,and received open surgery for resection of the stenotic segment.Results Of the patients,calculi were fragmented by one operation in 81 cases.The success rate was 91%.67 cases were stone free in one week and 14 cases in two weeks.In 4 cases,calculi were flushed into the pelvis,and were cured by open surgery.Conclusions Ureteroscopic holmium laser lithotripsy is an effective and safe method for ureteral calculi after failed ESWL.It should be used as the first choice for the disease.

In this paper,teaching idea,teaching method,study motives,study method,study strategy and other aspects have been investigated,analysed and studied according to the problem "spending more time studying English and taking less effect"in English teaching in order to change teaching idea,reform English teaching cotent and teaching methord,train good study strategy,arouse the enthusilasm of students,raise the English teaching.quality and train fine talents.

Objective To observe the changes in plasma C type natriuretic peptide(CNP) and C reaction protein(CRP) levels and the preventive effect of exogenous CNP on vascular stenosis in a diabetic rabbit model after femoral artery injury.Methods After setting up an animal model of diabetes,the rabbits were divided into the control group(n=8),artery injury group(n=8) and CNP treatment group(n=8).Enzyme-linked immunosorbent assay was used in determination of plasma CRP and CNP concentration.Histological changes in the femoral artery wall were evaluated by HE staining to determine the degree of stenosis.Results The post operative CRP concentration of the artery injury group compared with CNP treatment group was 13.81?4.30 ?g/mL vs 8.43?0.61 ?g/mL(P

With the high incidence of diabetic nephropathy, the clinical trials of traditional Chinese medicine (TCM) in diabetic nephropathy area play an important role in the development of this subject. Therefore, follow-ing the principles of medical ethics, issues of fully understanding professional requirements of ethics review for clinical research of diabetic nephropathy and the protection of patients' rights are questions which should be solved. This article was based on the investigations on ethical needs of experts and patients in diabetic nephropathy area of TCM clinical trials . Discussions and considerations were made on results . A the more per-fect and regulated medical informed consent formwork for diabetic nephropathy of TCM clinical trials was made based on these consultations .

This article was based on the investigation of ethical research in traditional Chinese medicine (TCM) clini-cal trials among 240 ischemic stroke patients and 105 experts specialized in this field. Analysis was given on the re-search results. This article was intended to regulate the ethical review of ischemic stroke, and to protect the rights and interests of the subjects better.

OBJECTIVE: To analyze the causes for misplacement of pedicle screw in thoracolumbar spine.METHODS: From January 2002 to January 2008, 19 patients with misplacement in thoracolumbar spine were treated in Department of Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, including 12 males and 7 females with an average age of 52.5 years (range 23-68 years). The diagnoses were thoracolumbar fracture in 5 cases, lumbar spondylolisthesis in 8 and degenerative lumbar disease in 6. The fixation systems were Steffee used in 4 cases, DRFS in 3, RF in 6, AF in 4 and GSS in 2. X-ray and CT scanning were used to observe pedicle screw location, including screw,pedicle and membranous sac and great vessels.RESULTS: The time of misplacement of pedicle screw was 5-69 days with an average time of 18.5 days, including 7 cases of screw penetrating into lateral cortex, 4 of screw penetrating into medial cortex, 2 of screw penetrating into pedicle cortex, 2 of overplacement, 2 of intervertebral foremen placement and 2 of intervertebral space placement.CONCLUSION: The causes for screw misplacement were anatomic variation and poor surgical skills, and the key factors in precise insertion of pedicle screw are fine surgical skills, carefully study of preoperative image and the intra-operative monitoring.

Objective To observe whether bone marrow mesenchymal stem cells (MSCs) can promote the repair of IgA nephropathy and to explore its possible mechanism. Methods Sprague-Dawley rats were randomly divided into three groups which were MSCs injection group, normal saline(NS) infusion group and healthy control group. IgA nephropathy model was established by the improving method with BSA +SEB +CCl4 in former two groups. MSCs of SD rats were continuously cultured in vitro and identified with specific surface antigens by flow cytometry and osteogenic and adipogenic differentiation. MSCs were labeled with bromodeoxyuridine (BrdU) in vitro before transplanted. At 1st and 4th week after MSCs injection, the changes of body weight, urine protein, renal function, histopathology and IgA immunofluorescence were observed. MCP-1, TGF-β1 in urine were detected by ELISA. The expression of MCP-1, TGF-β1 in kidney were examined by RT-PCR. The cytokines and BrdU labeled MSCs were detected by immunohistochemistry to observe the disposition in kidney. Results At the end of the first week of MSCs transplantation, MSCs group urine protein (36.86±4.78) mg/24 h, serum creatinine (53.50±6.28) μmol/L, and the NS group urine protein (66.98±5.86) mg/24 h, serum creatinine (82.50±8.36) μmol/L, the differences between two groups were significant (P<0.05). At the same time, the content of MCP-1, TGF-β1 in urine and expression in renal tissue of MSCs group were obviously less than those of NS group (P <0.05). At the end of the 4th week, the body weight, histopatholngy, IgA immunofluorescence of MSCs group were remarkably improved as compared with those of NS group. The content of MCP-1, TGF-β1 in urine and expression in renal tissue, and renal pathological change in MSCs group had no significant differences as compared with those of healthy control group. As the time passed, the disposition of BrdU-labeled MSCs in kidney was taper. Conclusions MSCs injection contributes to renal repair in rat IgA nephropathy. The mechanism may partly depend on adjusting the excretion of cytokines in renal microenvironment and/or other functions rather than completely depend on their differentiation to renal cells.

responses of glycemia.

OBJECTIVE:To study the chemical constituents of Sedum lineare. METHODS:Silica gel column chromatogra-phy,TLC and crystallization were adopted to isolate the chemical constituents of S. lineare. And chemical structures were analyzed and identified based on physicochemical properties and spectral data of compounds. RESULTS:A total of 6 sterols and 2 triterpe-noids were isolated from petroleum ether fraction of S. lineare,which were identified as stigmaster-5-ene-3β-ol-7-one(1),stigmas-ter-5-ene-3β,7α-diol(2),daucosterol(3),daucosterol palmitate(4),β-sitosterol(5),stigmaster-7-ene-3β-ol(6),δ-amyrin(7),andδ-amyrone(8)respectively. CONCLUSIONS:Compounds 3,4 and 7 are isolated from S. lineare for the first time,and compound 4 is isolated from genus S.lineare for the first time. The study has laid certain foundation for the quality evaluation of S. lineare.