Objective To investigate pre-and intra-operative preventive measures against immediate conversions to open surgery during laparoscopic cholecystectomy(LC).Methods We retrospectively reviewed 568 cases of LC,27 of which underwent an immediate conversion to open surgery.Causes of conversions,surgical techniques,and curative outcomes were analyzed.Results Causes of immediate conversions included: severe adhesion between the gallbladder and neighboring tissues(1.4%),severe acute cholecystitis(1.1%),freezing adhesion in the Calot triangle(0.9%),large stone obstruction proximal to the gallbladder(0.5%),abnormal anatomy of the cystic duct(0.4%),extensive adhesion around the umbilical port(0.4%),and uncontrollable hemorrhage of the gallbladder bed(0.2%).No fatal cases or intra-and post-operative complications were observed.Conclusions Preventive measures should be taken before and during laparoscopic cholecystectomy to minimize the possibility of immediate conversions to open surgery.

OBJECTIVE To further improve the quality and promote implementation of(disinfection) and isolation(system), in order to reduce hospital infection.METHODS The quality control network is applied to perfect(disinfection) and isolation system and implemented the quality inspection according to standards to promote the(improvement) of management quality.RESULTS According to weak links existent in management to further(improve) the quality of work(analysis) and inspection that implemented,find out the course of implementing in(existent) weak link,improve and realize the disinfection and isolation system in practice.CONCLUSIONS The further improvement of quality in disinfection and isolation system implement is the best way to improve the(hospital) management of disinfection and isolation.

Serum levels of testosterone (T), free testosterone (T_f), dehydroepiandrosterone sulfate, estradiol and sex hormone binding globulin were measured in patients with pregnancy-induced hypertension syndrome (PIH). Results showed that the levels of T and T_f and mean arterial pressure were significantly higher in the PIH group than those in the control group (all P

Objective The aim of this study is to verify the feasibility of transumbilical endoscopic cholecystectomy by using the tri-channel trocar technique.Methods Eight domestic pigs were submitted to transumbilical endoscopic cholecystectomy using the tri-channel trocar technique.After establishment of pneumoperitoneum,a tri-channel trocar was placed through an infra-umbilical incision.A fine grasper of 2 mm in diameter was inserted through a small skin incision on the right upper abdomen into abdominal cavity to grasp the fundus of the gallbladder.Then the cystic duct was dissected with a flexible hook.Once the cystic duct and artery were free,they were clipped by a clip fixing device,and the gallbladder was separated from the liver bed using flexible hook dissection.The specimen was then extracted through the umbilical trocar.Results All the gallbladders were removed successfully in the eight pigs without severe bleeding during dissection,or intraoperative and postoperative complications.The operation time was from 1.5 to 2.5 hours and decreased with experience.Postmortem examination revealed that the gallbladder fossa was clean,and the clips on the cystic duct and artery were secure.Neither bile leakage nor hemorrhage was found at the operative field.Conclusions Transumbilical endoscopic cholecystectomy is feasible and safe without leaving obvious abdominal scars.

Objective To compare the degree of trauma, postoperative pain, and cosmetic outcomes of endoscopic-assisted thyroidectomy (EAT), transthoracic endoscopic thyroidectomy (TET), and conventional thyroidectomy (CT), and to explore the characteristics of EAT and TET. Methods Forty-five patients with thyroid nodules were divided into three groups (n=15 in each) to underwent EAT, TET, or CT. The plasma levels of C-reactive protein(CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-?), and T-lymphocyte subgroups (CD3, CD4+, CD8+, and CD4+/CD8+) were determined before and 24 and 72 hours after the operations. The degree of operative trauma was compared after the operation. Postoperative pain and cosmetic outcomes were evaluated by visual analogue score (VAS) and 5-degree evaluation respectively. Results The VAS in the EAT group was 2.2?1.7 and 1.1?1.1 on the first and third day postoperation, which were significantly lower than those in the TET group (3.6?1.4 and 2.2?0.7, respectively; q=3.698, P0.05).Compared to preoperation, the level of CD4+/CD8+ lymphocyte in the CT group was decreased at 24 hours after the operation (q=4.076, P0.05). The levels of CRP determined at 24 and 72 hours postoperation were both significantly higher than that before the operation in the three groups (EAT group: m=21, P

Objective:To investigate the relationship between normal plasma fibrinogen(FIB)levels and disease duration in elderly patients with type 2 diabetes mellitus(T2DM).Methods:Clinical data and biochemical test results of 1 116 elderly subjects with T2DM admitted to the Department of Endocrinology of Shanghai Tianyou Hospital from January 2016 to October 2019 were retrospectively collected and analyzed.Subjects were classified into four groups based on the duration of DM: the Q1 group(n=276, < 2.0 years), the Q2 group(n=278, 2.0-7.9 years), the Q3 group(n=280, 8.0-13.9 years)and the Q4 group(n=282, ≥ 14.0 years). The correlation between FIB and the duration of DM was analyzed.Results:With the prolongation of DM duration, FIB levels increased significantly( P<0.05). Pearson correlation analysis showed that the duration of DM was positively correlated with FIB, age and serum creatinine( P<0.01). Multiple stepwise regression analysis showed that the duration of DM was an independent factor for FIB( β=0.104, P<0.01). Logistic multiple regression analysis showed that after adjusting for sex, age, body mass index, systolic pressure, diastolic pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum creatinine, alanine aminotransferase, fasting plasma glucose, glycosylated hemoglobin, smoking and drinking, the risk of hyperfibrinogenemia was 2.436 and 2.104 times higher, respectively, in Group Q4 and Group Q3 than in Group Q1(95% CI: 1.317-4.507, P<0.01; 95% CI: 1.144-3.871, P<0.05). With the third-quartile FIB(3.70 g/L)as the cut-off value, the optimal cut-off point of the DM course was 9.5 years as calculated by receiver operating characteristic(ROC)curve analysis of DM duration and hyperfibrinogenemia. Conclusions:The FIB level is positively correlated with DM duration in elderly patients with T2DM.

OBJECTIVE: To analyze the relationship between olfactory bulb (OB) volume, depth of olfactory sulcus (OS) and olfactory function in patients with Alzheimer' disease (AD). METHOD: Fifty patients with AD patients and 50 healthy subjects were examined by olfactory function T&T testing, OB volume and depth of OS assessed with Magnetic resonance imaging (MRI). RESULT: T&T olfactory testing revealed that AD patients had higher scores than control group (1.50 ± 0.17, 2.80 ± 0.31, P < 0.05). Bilateral and average OB volumes were smaller in AD group [(29.78 ± 5.17) mm3, (30.14 ± 4.87)mm3, (30.05 ± 5.08) mm3] than in control group [(36.65 ± 4.08)mm3, (36.56 ± 4.12)mm3, (36.46 ± 4.11)mm3] (P < 0.01). OS depth study revealed no statistical difference between AD patients and control groups (P > 0.05). Olfactory discriminate threshold was negatively correlated with average olfactory bulb volumes (r = -0. 711, P < 0.05), and was not correlated with depth of OS (r = -0.127, P > 0.05) in AD patients. CONCLUSION The OB volume were lower in AD patients as compare to controls, the depth of OS has no significant changes in AD patients; The OB volume is correlated with olfactory function, the depth of OS is no correlated with olfactory function. Cognitive impairment degree in AD patients is accordance with the lower degree olfactory function. The olfactory loss may be the earlier period and objective diagnosis indicator for AD patients.
Alzheimer Disease ; complications ; physiopathology ; Case-Control Studies ; Humans ; Magnetic Resonance Imaging ; Olfaction Disorders ; complications ; diagnosis ; Olfactory Bulb ; anatomy & histology

OBJECTIVETo study the expression, clinicopathologic correlation and prognostic significance of caveolin-1 in lung adenocarcinomas(LAC).

METHODSImmunohistochemical study (EnVision method) for caveolin-1 and TTF-1 was carried out in 185 cases of LAC encountered during the period from 2005 to 2010. The correlation between caveolin-1 expression and various clinicopathologic parameters was analyzed statistically.

RESULTSThe rate of caveolin-1 expression in the 185 cases of LAC was 26.5% (49/185) and significantly lower than that in normal lung tissue (P<0.01). There was also higher rate of caveolin-1 expression in male patients (P=0.004), smokers (P=0.006), tumors larger than 3.5 cm (P=0.048), predominantly solid tumor subtype (P=0.025), high tumor grade (P=0.044), tumors with vascular invasion (P=0.019), lymph node metastasis (P=0.030), recurrence (P=0.021) and high clinical stage (P=0.027). The expression level of caveolin-1 in TTF1-negative cases was significantly higher than that in TTF1-positive cases and caveolin-1 expression also negatively correlated with TTF-1 expression in LAC (r=-0.154, P=0.037). The five-year overall survival rate of patients with caveolin-1 positive tumors was lower than that in caveolin-1 negative group (P<0.01).Univariate analysis indicated the expression level of caveolin-1 and TTF-1 (P<0.01), histologic subtype (P=0.002), tumor grade (P=0.002), tumor size (P=0.009), vascular invasion (P=0.019), lymph node metastasis (P=0.018), recurrence (P=0.032) and clinical stage (P=0.024) correlated with the survival of patients with LAC. COX multivariate analysis revealed that LAC with caveolin-1 positive expression, TTF-1 negative expression and high tumor grade carried a significantly unfavorable prognosis.

CONCLUSIONCaveolin-1 expression correlates with histologic subtype, tumor grade, invasiveness and metastatic potential of LAC. The detection of caveolin-1 in LAC is helpful in predicting prognosis.LAC with caveolin-1 expression carries a poor prognosis.

Adenocarcinoma ; metabolism ; pathology ; surgery ; Adenocarcinoma, Papillary ; metabolism ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Acinar Cell ; metabolism ; pathology ; surgery ; Caveolin 1 ; metabolism ; DNA-Binding Proteins ; metabolism ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; metabolism ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Survival Rate ; Transcription Factors ; Tumor Burden

Objective To summarize the experience of laparoscopic cholecystectomy ( LC) for acute cholecystitis (AC).Methods A retrospective study was conducted on 382 patients with AC, who were underwent LC.Results Of all 382 cases,370 cases were successfully finished with LC,and other 12 cases were finished with open surgery(3.14% ).The operation methods are successively anterograde cholecystectomy(267 cases),retrograde cholecystectomy(59 cases) ,anterograde and retrograde cholecystectomy(44 cases).Abdominal drainage was placed in all cases.Post-operation complications occurred in 15 cases (3.93% ).The complications are suppurative infection of sub-ensistemum incision(9 cases) ,abdominal infection(2 cases) ,adhesive ileus(2 cases) ,sub-ensisternum incision hernia(2 cases).There are no death cases,transfusion cases or latrogenic injury in our study.Conclusion The best time window of LC for AC was with in 72 hours since the symptom.The key factors for the surgery were careful dissection of calot's triangle,properly handling with the incarcerated cystic duct stone and thickened cystic duct,avoiding injury of cystic artery and over-dissection of gallbladder bed.Transfer to open surgery when necessary could reduce complications and latrogenic injury.