Objective To report our clinical experience on laparoscopic common bile duct exploration and primary suture.Methods From March 1992 to December 2006,669 cases of laparoscopic common bile duct exploration and primary suture were carried out in our hospital.Cholangioscopic lithotomy,electrohydraulic lithotripsy,biliary dilation,bile duct drainage,or biliary stenting were performed on the patients.Results The surgeries were completed successfully in 643 of the 669 cases(96.1%).Biliary leakage was observed in 17(2.5%) cases after the operations,and was cured by nasobiliary and intra-abdominal drainage.2(0.3%) patients developed mild stenosis of the bile duct without showing any symptoms.4(0.5%) had residual stones and were cured by a second laparoscopic surgery.The fine duct fell off in 2 cases(0.3%),and was re-fixed by a re-operation.581 of the cases achieved a 6- to 48-month follow-up(mean,25.6 months),during the period,no patient developed biliary leak,and stenosis or hemorrhage of the common bile duct.Conclusion Laparoscopic common bile duct exploration and primary suture is safe and effective.

Objective:To explore the principles and elements of ethical review of clinical trials regarding medical apparatus and instruments.Methods:This paper introduced Beijing Anzhen Hospital's requirements on considerations for the vulnerable,acquisition of informed consent,the researchers' qualification and experiment design,during ethical review of clinical trials regarding medical apparatus and instruments.Results:Institution review board of Beijing Anzhen Hospital designed principles and standard operating procedures for ethical review of clinical trials regarding medical apparatus and instruments.Conclusion:Ethical review of clinical trials regarding medical apparatus and instruments now is more scientifically standardized,and has become an important approach for the protection of subjects' rights and interests.

Objective To investigate the effects of different doses of 1 ,25(OH)2D3 on rat Thy‐1 nephritis mesangial cell ap‐optosis .Methods 120 clean SD rats were divided into the blank control group(group A) and the experimental group .The experi‐mental group was re‐divided into the nephritis group(group B) ,0 .25μg 1 ,25(OH)2D3 intervention group(group C) and 0 .50μg 1 , 25(OH)2D3 group(group D) ,30 cases in each group .The group C and D were performed the medication intervention after success‐fully constructing the model .6 rats were randomly killed in each group on 1 ,3 ,7 ,14 ,21 d after intervention .The renal tissues were taken for determining the renal pathological injury classification after hematoxylin and eosin staining and PAS staining .The expres‐sion of Caspase‐3 in the renal tissues was detected by the immunohistochemistry method ,and the glomerular cell apoptosis was de‐tected by TUNEL .Results The immunohistochemistry results showed that compared with the group A ,the Caspase‐3 expression in the group B was increased (P<0 .05);compared with the group B ,the Caspase‐3 expression in the group C and D was increased , but there was no statistical differences between them (P> 0 .05);the Caspase‐3 expression in the group D was highest ,but the difference was not statistically significant compared with the group C .The TUNEL results showed that compared with the group A ,the apoptotic glomerular cells in the group B were increase obviously (P<0 .05) ,which was gradually enhanced over time ;com‐pared with the group B ,the apoptotic glomerular cells in the group C and D were increased significantly (P<0 .05) ,reaching a peak on 3 d ,then decreasing gradually on 7 ,14 d and tending to be normal on 21 d(P<0 .05);the comparison between the group C and D showed that the apoptotic cells in the group D were increased significantly ,but the difference between these two group ,was not statistically significant(P>0 .05) .Conclusion 1 ,25(OH)2D3 has the effect for inducing glomerular mesangial cell apoptosis in rat , which participates in the regulation of Caspase‐3 ,induces glomerular mesangial cell apoptosis ,promotes the recovery of nephritis and could delay the progression of renal disease .

After the development of different medical social media in China was summarized , the advantages and trend of social media in medical field of China were analyzed , the challenges facing medical social media were pointed out and their countermeasures were proposed .

Objective To explore the feature of electrical physiology and the key aspect of diagnosis in early stage of spinal muscular atrophy in infants.Method The back clinical data of the musle change of electrical physiology within 25 cases were analyzed.Results The children were ill in 1 year old,with the symptom that four limbs present symmetry and paralysing slowly,low limbs being more serious than upper limbs,the close and the distant of the four limbs.The levels of creatine kinase(CK) and lactate dehydrogenase(LDH) in serum were normal and the case unconcentrated was not seen rarely.The show of electromyogram(EMG) was that three limbs presenting wide-range losing nerve electric potential in peace state,when straingently the deadline was long and the motor unit potential(MUP) was high,when strain highly the eletric potential was decreased;the speed of nerve conduction was common.Muscle inspection was typical nervine myatrophy.Conclusion The clinical feature,the changes of muscle electrical physiology and the muscle inspection are valuable for diagnosis so as to afford reliable evidence for further gene diagnosis.J Appl Clin Pediatr,2006,21(3):167

OBJECTIVE:To discuss the effect of performance management in medication consultation service in hospital,and to improve the service quality in medication consultation center. METHODS:The performance management mode of medication consultation center was implemented in our hospital through formulating consultation pharmacist performance evaluation content and accounting rules from four dimensions of business skills,cultural literacy,work attitude,workload,conducting daily evaluation and check,developing training,setting development plan,etc. The effects of the mode were evaluated. RESULTS:In performance evaluation,business skills,cultural literacy,work attitude and workload took up 20,15,15 and 50 points,respectively;they were subdivided into 16 specific items and extra point items. After the implementation of above performance management,average weekly clients increased from 104 persons to 247 persons (increasing by 138%);the proportion of patient medication education mainly provided by clinical pharmacists increased from 18.30% to 46.34%(increasing by 153%);the complex and professional problems of medication consultation such as drug interaction rose from 0.96% to 5.28%;the problem of drug usage and dosage in-creased from 6.73% to 23.17%. The performance management mode not only improved the service consciousness and the enthusi-asm of consultation pharmacists,but also improved the level of pharmaceutical care. CONCLUSIONS:Reasonable and effective performance management mode can promote the service quality and ability of medication consultation center,and play more impor-tant role in hospital pharmaceutical care.

Objective To observe the effect of endoscopic esophagus-jejunum covered stent bypass on the treatment of type 2 diabetes mellitus (T2DM), and analyze the mechanism thereof. Methods Five obese Beagle dog models of T2DM underwent endoscopic esophagus-jejunum covered stent bypass to serve as operation group, and five normal Beagle dogs as control group receive endoscopy and exploratory laparotomy. The T2DM indices of both groups, including fast plasma glucose (FPG) level, fast insulin (FINS) level, intravenous glucose tolerance test-2h plasma glucose (IVGTT-2h PG) and IVGTT-2h FINS, were determined regularly before operation and 4, 8 and 12 weeks after operation. The insulin resistance index (HOMA-IR) and the function of islet β-cell (HOMA-β) were calculated with Homeostasis Model Assessment. The levels of gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1(GLP-1) were also determined. Results Four weeks after operation, FPG, FINS, IVGTT-2h PG, and IVGTT-2h FINS all decreased significantly in operation group (P<0.01), and all these indices reached the levels of control group 12 weeks after operation (P>0.05). The HOMA-IR index declined distinctly and HOMA-β index ascended obviously in operation group 4 weeks after operation (P<0.01), and then recovered to the normal level 12 weeks after operation (P>0.05). The level of GIP lowered significantly (P<0.01), while of GLP-1 was elevated (P<0.05) 4 weeks after operation, and then returned to the normal levels 8 weeks after operation (P>0.05). Conclusion T2DM may be treated with esophagus-jejunum covered stent bypass effectively and safely, and the mechanism thereof might be related to the changes in gastrointestinal hormones.

Objective To observe the effect of endoscopic esophagus-jejunum covered stent bypass on the treatment of type 2 diabetes mellitus (T2DM), and analyze the mechanism thereof. Methods Five obese Beagle dog models of T2DM underwent endoscopic esophagus-jejunum covered stent bypass to serve as operation group, and five normal Beagle dogs as control group receive endoscopy and exploratory laparotomy. The T2DM indices of both groups, including fast plasma glucose (FPG) level, fast insulin (FINS) level, intravenous glucose tolerance test-2h plasma glucose (IVGTT-2h PG) and IVGTT-2h FINS, were determined regularly before operation and 4, 8 and 12 weeks after operation. The insulin resistance index (HOMA-IR) and the function of islet β-cell (HOMA-β) were calculated with Homeostasis Model Assessment. The levels of gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1(GLP-1) were also determined. Results Four weeks after operation, FPG, FINS, IVGTT-2h PG, and IVGTT-2h FINS all decreased significantly in operation group (P<0.01), and all these indices reached the levels of control group 12 weeks after operation (P>0.05). The HOMA-IR index declined distinctly and HOMA-β index ascended obviously in operation group 4 weeks after operation (P<0.01), and then recovered to the normal level 12 weeks after operation (P>0.05). The level of GIP lowered significantly (P<0.01), while of GLP-1 was elevated (P<0.05) 4 weeks after operation, and then returned to the normal levels 8 weeks after operation (P>0.05). Conclusion T2DM may be treated with esophagus-jejunum covered stent bypass effectively and safely, and the mechanism thereof might be related to the changes in gastrointestinal hormones.

Objective To evaluate the efficacy and security of splenic artery ligation for severe hypersplenism during liver transplantation.Method Thirty-two liver transplant patients with preoperative hypersplenism were selected,including 17 cases (ligation group) treated by splenic artery ligation during liver transplantation,and rest 15 patients as non-ligation group.The fluctuation of white blood cells,platelets and volume of spleen were compared between these two groups.At the same time,splenic infarction,postoperative infection,recurrent gastrointestinal bleeding,splenic artery steal syndrome and other complications were observed in these two groups.Result All recipients were followed up for over 6 months.One recipient in ligation group died of multiple organ dysfunction caused by delayed recovery of liver donor with the survival rate being 94.1％ (16/17).The survival rate in non-ligation group was 93.3 ％ (14/15) (one recipient died of respiratory failure caused by pulmonary infection).There was no statistically significant difference in survival rate between these two groups (P＞0.05).Splenic necrosis wasn't detected in the ligation group.The splenic volume in ligation group was significantly less than that in non-ligation group (P＜0.01).The products of splenic maximum length and wide diameter shrunk 33.17-± 8.26 cm2 and 22.47 ± 7.25 cm2 in ligation group and non-ligation group,respectively.The platelet counts of ligation group were significantly greater than those of non-ligation group in all the observation points within 6 postoperative months (P＜0.01).The white blood cell counts of ligation group were greater than those of non-ligation group at the first week postoperatively (P＜0.01),whereas,there was no statistically significant difference between these two groups from then on (P＞0.05).The infection incidence of ligation group was lower than that of non-ligation group within 6 postoperative months (P ＜0.05).Statistically significant differences in recurrent gastrointestinal bleeding and splenic artery steal syndrome weren't found between these two groups (P＞0.05).Conclusion Splenic artery ligation in liver transplantation is safe and effective.It can rapidly increase the counts of platelet and white blood cell in the earlier postoperative time,which is beneficial to patient's recovery.Besides,it adds no correlative complication.

OBJECTIVE To observe the neurotoxicity of 1-bromopropane(BP) and investigate the protective effects of edaravone(Edv) against BP-induced deficits of spatial learning and memory ability in rats by its anti-inflammatory mechanism. METHODS Adult male Wistar rats were ig given BP 800 mg·kg-1 to develop the model, followed by Edv 1, 3 and 5 mg·kg-1 ip treatment respectively 4 h later for consecutive 12 d. From the 7th day (d 7), all rats were subjected to the five-day place navigation in Morris water maze (MWM) to measure the escape latency and the total swimming distance. On d 6 of MWM, spatial probe test was performed and the crossing times of rats were recorded to evaluate the spatial memory ability. At the end of the behavioral experiment, four rats in each group were randomly selected and the frozen section of the whole brain was sliced for thionin staining and immunohisto?chemistry. The other eight sacrifced rat brains from each group were harvested for the determination of the tumor necrosis factor-α (TNF-α) and nitric oxide (NO) by ELISA and nitrate reductase method, respectively. RESULTS The results of MWM test showed that compared with control rats the escape latencies of rats in BP group were increased by 60.8%, 81.9%,124.0% and 323.3%, respectively, during the d 2-d 5 of MWM, and the total swimming distance increased by 47.0%, 66.4%, 106.0% and 277.6%, respectirely. All the differences between BP group and control group were significant (P<0.05, P<0.01). In the spatial probe trial, the crossing times of rats in BP group were significantly decreased, compared with the control rats (P<0.01). Morphologically, thionin staining and immunohistochemistry revealed significant microglia activation and neuron loss in the rat forebrains, accompanied by a 147.6% and 18.7% increase in NO and TNF-α levels in rats treated with BP respectively compared with control values (P<0.05, P<0.01). After co-treatment at different dosages of Edv with BP, the escape latencies of rats in BP+Edv 5 mg·kg-1 group were decreased by 38.4%and 44.3%(P<0.01), and the total swimming distance decreased 34.5%and 43.3%(P<0.05, P<0.01), respectively, compared with the BP treated rats on the d 4 and d 5 of MWM test. The microglia activation and neuron damage in the brain of rats induced by BP treatment were significantly alleviated in BP+Edv groups. In addition, the contents of NO and TNF-α were decreased in BP+Edv 1, 3 and 5 mg · kg-1 groups, with a decrease of 53.8%, 55.4% and 59.8% in NO, and 12.2%, 15.8% and 22.2% in TNF-α(P<0.05, P<0.01), respectively. CONCLUSION Edv could effectively protect against central neurotoxicity induced by BP via anti-neuro?inflammation.