Objective To discuss the surgical skills and clinical value of laparoscopic splenectomy with a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen.Methods A total of 88 patients with hypersplenism secondary to liver cirrhosis who underwent laparoscopic splenectomy in our department from September 2015 to September 2016 were selected into this study.And these patients were divided into two groups based on whether to take the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The control group included 40 cases who underwent the traditonal laparoscopic splenectomy,while the observation group included 48 cases who took the safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The clinical data were collected retrospectively by medical clinical records review.Results There was no mortality occurred in this study.The blood loss of the observation group was (247.50±135.89)mL,which was obviously lower than (361.75±144.43)mL of the control group,and the difference was statistically significant (P<0.05).The operation time of the two groups were (194.69±47.99)min and (232.75±45.26)min respectively,and the difference was statistically significant (P<0.05).No significant difference was found in terms of rate of conversion to laparotomy,rate of intraoperative blood transfusion,postoperative hospital stay and complications (P>0.05).Conclusion It is very crucial for a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen to establish a tunnel behind the splenic hilum in laparoscopic splenectomy.It is safe and feasible to perform a safe approach to the splenic hilum through first mobilizing the lower pole of the spleen in laparoscopic splenectomy.The technique is generalized in clinics,especially for freshmen.

ObjectiveTo explore the effects of personality characteristics and mental health of students on the career orientation.MethodsThe method of stratified random sampling was used in three universities of Jiangxi province.501 subjects of Arts,Science and Medical Science were tested with Holland career orientation test,symptom check list(SCL-90) and 16 personality factors(16PF).Structure validity analysis,analysis of variance and t -value test were employed with LISREL8.70 and SPSS13.0.Results ( 1 ) The proportion of students choosed the type of occupation were:social type 36％,management type 18％,conventional type 17％,reality type 14％,investigation type 9％,artistic type 6％ ; (2) Career orientation,personality characteristics and mental health had moderate effect on the career orientation.The correlation coefficients of personality characteristics and mental health to the vocational orientation were 0.63 and 0.44.The interaction correlation coefficient was 0.56.ConclusionPersonality characteristics and mental health of college students are important factors to the career orientation and decision-making of job seeking.The personality has stronger explanatory power than mental health.Great emphasis should be paid on both short-term psychological health of college students and long-term cultivation of healthy personality in the employment psychological guidance.

Objective To study the morphological character of the high endothelial venules(HEVs) and the expression of lymphocyte function-associated antigen-1(LFA-1),platelet endothelium cell adhesion molecular-1(PECAM-1) in the rat mesenteric lymph node,inquire into their morphological representation when lymphocytes pass through the HEVs and the regulative action of LFA-l and PECAM-1. Methods To observe their morphological representation when lymphocyte pass through the HEVs wall and analyze the expression of LFA-1,PECAM-1 with the light microscope,electron microscope and immunohistochemistry method in the rat mesenteric lymph node. Results Lymphocytes contacted the endothelial cells by protuberances or membrane protuberances like welding spot,lymphocytes located in and between the endothelial cells or in the junction space of them in HEVs,there were lymphocytes in the lucid layer between inner and outer layers of basement membranes;LFA-1 mainly expressed at lymphocytes that adhered to endothelial cell in HEVs;PECAM-1 mainly expressed at the endothelial cells and the migrating lymphocytes.Conclusion 1.Lymphocytes contacted the endothelial cells by protuberances,then they got across the endothelial cells into the cellular junction space by the intraendothelial and interendothelial,and at last they emigrated from the basement membranes into the lymph tissue;2.LFA-1 involved in firm adheresion between lymphocytes and the endothelial cells;3.PECAM-1 probably had a relationship with that lymphocytes migrated endothelial cells.

Objective To investigate the effects of exercise on serum soluble cell adhesion molecules and cytokines of patients with dyslipidemia. Methods Eighty patients with dyslipidemia were randomly and equally divided into an exercise group and a control group. The control group was treated with pravastatin,while exercise was administered in the exercise group in addition to the pravastatin. Both groups were observed for 8 weeks. Results Serum leves of soluble endothelial leucocyte adhesion molecule 1(sELAM),soluble intercellular adhesion molecule(sICAM 1)and interleukin 1?(IL 1?)of patients in both groups were decreased significantly. Moreover,serum levels of soluble vascular cell molecule 1(sVCAM 1)and tumor necrosis factor ?(TNF ?)in addition to sELAM,sICAM 1 and IL 1? were decreased significantly in the exercise group,with a significantly better result in the exercise group as compared with that of the control group. Correlation analysis revealed a positive correlation of individual sELAM,sICAM 1 and sVCAM 1 with blood total cholesterol(TC),and negative correlation of individual sELAM,sICAM 1 and sVCAM with high density lipoprotein cholesterol(HDL C)in exercise group. Conclusion Adequate exercise has beneficial effects on patients with dyslipidemia by reducing serum levels of soluble adhesion molecules and the production of proinflammatory cytokines,which was realized possibly through modulating serum lipids and improving endothelial dysfunction.

Objective To study the significance of thyroid stimulating antibody (TSAb) and thyroid stimulating-blocking antibody (TSBAb) in children with Graves' disease (GD) or Hashimoto's thyroiditis (HT).Methods Five hundred and twenty-seven cases of serum from 180 children with autoimmune thyroid disease (AITD) children were divided into 282 cases of GD and 245 cases of HT.According to the status of thyroid function,they were divided into 157 cases of hyperthyroidism,91 cases of hypothyroidism and 279 cases of normal thyroid.GD group was subdivided into 127 GD hyperthyroidism and 155 GD remission;HT group was subdivided 30 HT hyperthyroidism,124 HT remission and 91 HT hypothyroidism.Seventy-nine healthy children were taken as the healthy control group.Free triiodothyronine(FT3),free thyroxine(FT4) and sensitive thyroid stimulating hormone(TSH) were detected by chemoluminescence.Serum TSAb and TSBAb were detected by serum TSAb or TSBAb enzyme linked immunosorbent assay (ELISA),respectively.The differences in TSAb and TSBAb among each group were compared and analyzed of find out the relationship between TSAb and TSBAb was performed.Beside,the correlation between TSAb and TSBAb with FT3,FT4,and TSH were analyzed.Results (1) TSAb levels were significant (F =11.995,all P =0.000):the GD group (0.727 ± 0.157) ＞ HT group (0.605 ± 0.148) ＞ healthy control group (0.350 ± 0.105);the difference was significant(F =109.165,P =0.000) among hyperthyroidism group (0.745 ± 0.169) ＞ normal thyroid group (0.647 ± 0.153) ＞hypothyroidism group(0.612 ±0.144) ＞healthy control group (0.350 ±0.105);the difference was significant(F=156.712,P =0.000) in the GD hyperthyroidism group(0.747 ±0.17) ＞ GD remission group (0.640 ± 0.16) ＞ healthy control group (0.350 ± 0.105);the difference was significant (F =109.165,P =0.000) in the HT hyperthyroidism group(0.739 ±0.140) ＞HT remission group(0.655 ±0.135) ＞ HT hypothyroidism group(0.612 ± 0.140) ＞healthy control group (0.350 ±0.105).(2) TSBAb levels were significantly different(F =15.610,P =0.000):the HT group(0.704 ±0.633) ＞ GD group(0.567 ±0.178) ＞ healthy control group (0.334 ±0.104);the difference was significant(F =13.311,P =0.000) in the hypothyroidism group (0.693 ± 0.125) ＞ remission group (0.648 ±0.446) ＞hyperthyroidism group(0.562 ±0.181) ＞healthy control group(0.334 ±0.104);the difference was significant(F =19.269,P =0.000) in the GD remission group (0.672 ±0.572) ＞ GD hyperthyroidism group (0.550 ± 0.187) ＞ healthy control group (0.334 ± 0.104);HT hypothyroidism group (0.693 ± 0.725) was higher than HT hyperthyroidism group(0.618 ±0.142) and HT remission group (0.619 ±0.199),the difference was not significant between HT hyperthyroidism group and HT remission group(F =12.208,P =0.000).(3) TSAb level was positively correlated with TSBAb,FT3 and FT4(r =0.162,0.091,0.194,all P ＜ 0.05) and was negatively correlated with TSH (r =-0.224,P ＜ 0.05).TSBAb levels were negatively correlated with FT3 (r =-0.155,P ＜ 0.05) and was positively correlated with TSH (r =0.131,P ＜ 0.05).Conclusions Thyroid function was related to the serum levels of TSAb and TSBAb.TSAb and TSBAb could be regarded as an important predictive index for children with AITD during the treatment period.

Objective To investigate the status of diabetes distress in patients with middle-andhigh risk of diabetic foot and explore the impact of self-perceived burden and social support on diabetes distress.Methods Totally 205 patients with middle-and-high risk of diabetic foot were investigated with Diabetes Distress Scale,Self-perceived Burden Scale and Social Support Scale.Results The total average score of diabetes distress was (2.59±0.57),the diabetes distress level was correlated with self-perceived burden,dimensions of social support (r=0.481～0.653) and were influenced by gender,vocation,objective support,use of support.Conclusions Diabetes distress is widespread in patients with middleand-high risk of diabetic foot and was influenced by many factors,these provide the basis for taking effective interventions to reduce diabetes distress.

Objective To observe safety and effectiveness of Dezocine in postoperative analgesia of pediatric tonsillectomy and adenoidectomy by the continuous intravenous infusion of different doses,and to explore appropriate dosage of Dezocine for pediatric postoperative analgesia.Methods Elective tonsillectomy and adenoidectomy require-ments of postoperative analgesia in children 120 cases,they were randomly divided into A,B,C,D groups of 30 cases by using number table.After surgery patient -controlled intravenous analgesia(PCIA)two days,A,B,C groups were given Dezocine 0.2,0.3,0.4mg·kg -1 ·d -1 continuous intravenous infusion,D group received Sufentanil 1μg· kg -1 ·d -1 continuous intravenous infusion.Observed and recorded pain scores and sedation scores for postoperative 6h,12h,24h and 48h;recorded adverse reactions,pressing the number and effective pressing times of children within 48h after surgery.;recorded overall evaluation of postoperative analgesia of children and parents.Results A group at each time point pain score was significantly higher than B,C,D three groups,the difference was statistically significant (tAB =12.003,PAB =0.049;tAC =7.542,PAC =0.036;tAD =40.990,PAD =0.009);A,B,C three groups at each time point sedation score was significantly lower than D,the difference was statistically significant(tDA =3.894,PDA =0.030;tDB =5.020,PDB =0.039;tDC =36.103,PDC =0.016);D group of adverse reactions were significantly higher than A,B,C three groups,the difference was statistically significant(χ2DA =20.738,PDA =0.000,χ2DB =4.35,PDB =0.029,χ2DC =5.98,PDC =0.025);A group within 48h postoperative analgesia press times and the number of valid pressing were significantly higher than B,C,D three groups,the difference was statistically significant(tAB =3.003, PAB =0.036;tAC =5.720,PAC =0.031;tAD =37.157,PAD =0.015);B,C two groups of children and parents to evaluate postoperative analgesia overall satisfaction rates were 90.0%,93.3%,significantly higher than A 63.3%,D 60.0%,and the difference statistically significant (χ2AB =5.310,PAB =0.031;χ2DC =19.640,PDC =0.000). Conclusion Dezocine 0.3mg·kg -1 ·d -1 continuous intravenous infusion for pediatric tonsillectomy and adenoid-ectomy is safe and effective in postoperative analgesia and fewer adverse reactions,and should be promoted.

Objective To investigate the difference in cardiac structure and hemodynamics characteristics between fetuses with isolated persistent left superior vena cava (LSVC)and normal fetuses by using fetal echocardiography,in order to explore whether isolated PLSVC has some influence on the development of fetal heart structure development.Methods Twenty-two fetuses diagnosed with isolated PLSVC in the second and third trimester were enrolled in this study.The PLSVC fetuses were divided into two groups:group 1 ,twenty-two fetuses in the second trimester (23-27+6 W);group 2,twenty fetuses in the third trimester (28-39+6 W).Forty-nine fetuses without intra-cardiac and extra-cardiac anomalies with gestation age matched were involved as normal control groups:25 fetuses in the second trimester,and 24 fetuses in the third trimester.The parameters of cardiac structure and hemodynamics of the four groups were measured,including left and right sideheart size,the diameter of foramen ovale(FO),aorta(AO),aortic isthmus and pulmonary artery (PA).The ratio of RV/LV,RA/LA and PA/AO were calculated.The hemodynamic parameters included the flow velocity across mitral valve(MV),tricuspid valve(TV)and FO. All the parameters of PLSVC groups were compared with the normal groups respectively.Results In the second trimester group,the ratio of RV/LV and PA/AO of the PLSVC fetuses were significantly larger than normal,while the AO diameter,aortic isthmus diameter were smaller than normal group (P <0.05). However in the third trimester group,only the ratio of PA/AO of the PLSVC group was significantly greater,and the aortic isthmus diameter was still smaller than the normal group (P <0.05).Conclusions Isolated PLSVC connected with coronary sinus is associated with structural differences from normal.A dilated coronary sinus may have an influence on the development of fetal left heart structures.

Hepatolithiasis is a common disease of abdominal surgery,although its incidence appears to decline,China is still a high incidence area with millions of patients with hepatolithiasis.Because of the complex pathogenesis,progressive development and frequent recurrence,it is seriously affecting physical and mental health of patients and quality of life,as well as difficult to define the diagnosis and select treatment methods for hepatolithiasis.The Guideline of the Diagnosis and Treatments of Hepatolithiasis and the Expert Consensus of the Laparoscopic Treatments of Hepatolithiasis (2013 edition) proposed a concise and practical classification system of the hepatolithiasis and summarized the principles of surgical treatments,which includedresecting the lesions,cleaning the stones,correcting the stricture,recovering the drainage and preventing the recurrence .Meanwhile,the application of laparoscopic technique in the treatments of bepatolithiasis was proposed,which played an important role to promote the standard diagnosis and treatments of hepatolithiasis in China.Recent years,more and more evidences from evidence-based medicine further proved the importance of the anatomical hepatectomy in the treatments of hepatolithiasis.With the soaring development of laparoscopic surgery,the combination of laparoscopic hepatectomy with the assistance of other endoscopies are applied more and more frequently.The concept of precise surgery also brings new vitality to the standard diagnosis and treatments of the hepatolithiasis.

Objective To evaluate the diagnostic value of the diameter ratio of left subclavian artery to aortic isthmus(LSA/AoIS)in fetuses with aortic coarctation(COA).Methods A retrospective study of 79 fetal echocardiographic data was undergone on 49 COA fetuses.The COA cases were divided into four groups according to different gestational week (cases in each group including follow-up review of different gestational weeks):group 1 ,24-27+6 W;group 2,28 -31+6 W;group 3,32 -35+6 W;group 4,36 -39+6 W.The normal fetuses with gestational age matched were also divided into four control groups.The diameter of left subclavian artery(LSA) and aortic isthmus (AoIS) were measured,the ratio of LSA/AoIS of each group were calculated,and the data between the COA and control groups were compared.ROC curve analysis was used for LSA/AoIS to predict the demarcation point of postnatal COA.Results ①There was no statistic difference in the LSA diameter between COA groups and control groups (P >0.05):group 1 (1 .87±0.42)mm vs (1 .75 ±0.25)mm;group 2 (2.25 ±0.36)mm vs (2.21 ±0.22)mm;group 3 (2.74±0.32)mm vs (2.90 ±0.29)mm;group 4 (2.83 ±0.28)mm vs (3.06 ±0.30)mm;②The ratio of LSA/AoIS was significantly increased in COA groups than those in control groups:group 1 (0.88± 0.15) vs (0.66±0.06),group 2 (0.85±0.13)vs(0.64±0.05),group 3 (0.94±0.17)vs(0.73±0.07), group 4 (0.94±0.18)vs(0.70±0.07),the difference was statistically significant(P <0.05);③The cut-off value of LSA/AoIS ratio were 0.78,0.73,0.83,0.78 in each group,respectively.Conclusions The ratio of LSA/AoIS can be used as a useful echocardiographic parameter which suggest the presence of aortic coarctation.This ratio≥0.8 may have a certain diagnostic significance.