Lapareseopic colectomy is commonly performed,but laparoscopic extended right hemicolectomy with D3 lymphadenectomy for cancer located at hepatic flexure of the colon is a complex procedure,even in the hands of experts.Laparoscopic dissection of the lymph nodes around the middle colonic and right gastroepiploic vessels are so complicated that precise vascular anatomy and surgical plane are essential to complete this procedure safely.We herein describe a standard technique for performing laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach.The main surgical plane of this procedure is the right Toldt's space.The superior mesenteric vein (SMV) is the most important anatomical landmark of vascular dissection.Medial-to-lateral approach makes it easy to locate the right Toldt's space and the SMV.

OBJECTIVE:To establish a method for the simultaneous determination of the contents of Shuanghuanglian freeze-dried powder in placental perfusate. METHODS:HPLC was performed on the column of Agilent Zorbax-C18 with mobile phase of acetonitrile-1%formic acid aqueous solution(gradient elution)at flow rate of 1.0 ml/min,the internal standard was puera-rin,detection wavelength was 280 nm,column temperature was 25 ℃ and sample volume was 10 μl. RESULTS:There was a lin-ear range between linear ranges and peak area of 8 ingredients(r≥0.999 0);RSDs of within-day and inter-day precision tests were no more than 1.9%,repeatability tests was no more than 7.3%;average recoveries were in the range of 92.73%-112.37%(RSD=3.2%-8.2%,n=6);and average matrix effects were 90.33%-105.78%(RSD=3.2%-8.0%,n=6). CONCLUSIONS:The method is rapid,sensitive and specific,and can be used to the simultaneous determination of the contents of 8 ingredients of Shuan-ghuanglian freeze-dried powder in placental perfusate.

Patient′s expectation has been defined as the anticipation that given events were likely to occur during, or as an outcome of, health care. What people expect from their health care are potentially important in predicting patient satisfaction and dissatisfaction with their care, treatment and health outcomes. There was widespread recognition of the importance of evaluating services from consumer perspectives. In this article, domestic and foreign research in recent years, expectations status, significance and various influencing factors in relation to the expectations in processes of health care were summarized. Consumer evaluations of their health care are now an established component of quality assessment, planners need to understand the expectations underlying patients′views in order to interpret their feedback. Thus leading to improve patient satisfaction and the social evaluation of medical units.

Objective To assess effects of cerebral ischemic postconditioning(IPost)on neuronal apoptosis and phosphated glycogen synthase kinase-3β(GSK-3β)after cerebral ischemic/reperfusion.Methods The experiment was conducted at the center for animal experiment of Renmin Hospital,Wuhan University.Thirty male Wistar rats were randomly divided into three groups:sham operation(S),ischemic/reperfusion(I/R)and ischemic postconditioning(IPost).Each group contained ten rats.Global brain ischemia was produced with four-VO method.Animals were killed after two days.Apoptosis in neurons in the cortex region were detected by TUNEL assay; infarct areas were detected by TTC ; activity of p-GSK-3β was detected by spectrum assay; Statistical software SPSS13.0 was applicated to perform one-way ANOVA Student-Newman-Keul test; correlation was detected by linear regression.Results Compared with group S,TUNEL-positive cells and infarct areas increased(P ＜0.01),the activity of p-GSK-3β decreased in I/R and IPost groups(P ＜ 0.01).Compared with group I/R,TUNEL-positive cells and infarct areas significantly decreased(P ＜ 0.01),the activity of p-GSK-3β increased in group IPost(P ＜ 0.01).The activity of p-GSK-3β and TUNEL-positive cells had highly correlation,so as infarct areas(P ＜ 0.01).Conclusions IPost can lessen the ischemic/reperfusion injury of Cortex,through increas the activity of p-GSK-3[β and decreasing neuronal apoptosis.

Objective To investigate the effect of ghrelin on PAI-1 secretion in HepG2 cells induced by TNF-αand the effect of p-38 MAPK.Methods HepG2 cells were cultured.The concentration of TNF-α used to treat the HepG2 cells wag selected.The effect of ghrelin on PAI-1 secretion induced by TNF-α was detected by ELISA,the p-38 MAPK expression was investigated by Western blot.Results The concentration of PAI-1 was increased when cells were exposed to different concentration of TNF-α.The p-p38 MAPK expression was increased when the cells were exposed to TNF-α,ghrelin could inhibit the increase of PAI-1 secretioN induced by TNF-α.The expression of p-p38 MAPK was decreased when the cells were pretreated with ghrelin.Conclusion PAI-1 secretion were increased after TNF-α in-creasing.Ghrelin could inhibit PAI-1 secretion via p38 MAPK.

Objective To investigate the clinical features and causes of micturition and defecation dysfunction in motor neuron disease (MND) patients.Methods The micturition and defecation function was evaluated by a questionnaire covering storage and voiding of urine and feces respectively in 50 MND patients.The clinical features and external anal sphincter electromyography (EAS-EMG) were analyzed to explore the causes of micturition and defecation dysfunction in MND patients.Results Micturition and defecation dysfunction was detected in 9 of 50 (18.0％) MND patients.The main types of micturition and defecation dysfunction were constipation (4/9),urinary frequency,urgency with or without incontinence,fecal urgency (4/9),powerlessness for micturition and defecation (2/9),hesitancy for micturition (1/9).EAS-EMG was normal in 9 MND patients accompanied with micturition and defecation dysfunction.Conclusions MND patients accompanied with micturition and defecation dysfunction were not very rare.Constipation,urgency and powerlessness were the main types of micturition and defecation dysfunction and they were not related to the function of external anal sphincter.Gastrointestinal dysfunction from abnormal autonomic nerve involvement,muscle weakness and the resulted reduced activity,severe upper motor neuron damage and respiratory muscle weakness may be the main causes of micturition and defecation dysfunction in MND patients.

Objectives To understand essential basis data availability for implementation of cost accounting in TCM hospitals. Methods Costs of a total of 1588 TCM hospitals were investigated by conducting the baseline survey via questionnaires in 2013. Results Departmental basic data (including ratio of office staff and entire staff, ratio of outpatient and inpatient departments in clinical department), and construction data for housing were well accessible, while utility fee and internal service data were not. Conclusion ①Public TCM hospitals need to improve and specify the basic cost data. ②Differences exit among different types and levels of hospitals in the availability of data. ③There are still difficulties in carrying out cost accounting in public TCM hospitals, which needs strong supports from all relevant departments.

Curcumin is the main active component in turmeric, which possesses many pharmacologic effects, including anti-in-flammatory, antioxidant, anti-tumor, anti-atherosclerosis, liver and kidney protection and so on. However, due to its poor bioavail-ability, its clinical application is limited. Therefore, the methods for improving the bioavailability of curcumin were reviewed by refer-ring to a large number of literatures. The bioavailability of curcumin can be improved by different administration routes and various dos-age forms. The review provides theoretical basis and research ideas for the development of new drugs.

Objective To explore the impact of childbirth on women external anal sphincter electromyography by analysis of motor unit potentials parameters of external anal sphincter electromyography of healthy women volunteers with different childbirth experiences.Methods Twenty-eight healthy volunteers with different childbirth experiences were recruited in this study.Among them , 7 had a history of cesarean and 21 had experienced 1-3 uncomplicated vaginal deliveries ( 12 women had experienced 1, 6 had experienced 2, and 3 had experienced 3).Another 9 nulliparous healthy volunteers were recruited as control group.Among all subjects who completed the examination , parameters of motor unit potentials ( duration, amplitude, area, mean number of turns and mean phases ) of bilateral external anal sphincter were obtained for statistical analysis.Results There were no significant differences in any of the parameters of motor unit potentials between the nulliparous group and the cesarean group , while parameters of durations (10.5 ms vs 9.0 ms, t=-2.506, P=0.019) and mean phases (4.0 vs 3.6, t =-2.707, P=0.012) of vaginal delivery group were significantly higher than that of cesarean group and parameter of durations ( 10.5 ms vs 8.9 ms, t =-3.025, P =0.005 ) of vaginal delivery group was significantly higher than that of the nulliparous group;With increasing numbers of vaginal deliveries , only the parameter of mean turns showed statistically significant differences , although there was a slight trend of larger and more complex motor unit potentials.Compared with subjects without vaginal delivery experience ( including nulliparous group and the cesarean group ) , the parameters of durations and mean phases of subjects with vaginal delivery experience were statistically higher; Nevertheless , parameter of bilateral duration of the motor unit potential preferred asymmetric.Conclusions Childbirth experience has an explicit impact on the parameters of the external anal sphincter motor unit potentials , which is considered to be strongly correlated with the vaginal delivery process rather than the pregnancy procession itself.In addition , the impact is mostly from the first vaginal delivery experience.The characters of asymmetry of motor unit potential parameters imply the possibility of mechanical damage and decrease blood perfusion of tissues during delivery procession.

Objective To investigate the mechanism of myocardial ischemia and reperfusion-induced acute lung injury (ALl) and protective effect of ischemic postconditioning.Methods Forty SD rats were allocated to sham group,myocardial ischemia/reperfusion group (reperfusion group),ischemic postconditioning group (postconditioning group),and ischemic postconditioning + phosphatase and tensin homolog deleted on chromosome ten (PTEN) inhibiting group (inhibitor group) according to the random number table,with 10 rats per group.Myocardial ischemia/reperfusion was induced by left anterior descending coronary artery occlusion.Postconditioning was performed within 1 minute before reperfusion consisting of 3 10 s cycles of reperfusion followed by 10 s occlusion.Lung was immediately removed 120 minutes after reperfusion for HE stain,immunohistochemical detection of inflammatory factors and apoptosis factors,TUNEL assay of cell apoptosis,and Western blot of protein kinase B (Akt),phospho-Akt (p-Akt),glycogen synthase kinase-3β (GSK-3β),and phospho-GSK-3β (p-GSK-3β).Results Down-regulated B-cell lymphoma-2 (Bcl-2) and IL-10 and up-regulated Bcl-2 associated X protein (Bax),cysteinyl aspartate specific proteinase-3 (Caspase-3),IL-6 as well as IL-8 were observed in other 3 groups compared with sham group (P ＜0.01).Moreover,down-regulated Bax,Caspase-3,IL-6,IL-8 as well as TUNEL and up-regulated Bcl-2 as well as IL-10 were observed in reperfusion group compared to postconditioning group and tensor group (P ＜ 0.01).No statistical differences were found among the four groups in levels of Akt,p-Akt,and GSK-3β,but level of p-GSK-3β was significantly down-regulated in reperfusion group compared to other 3 groups(P ＜ 0.01).Conclusion Development of ALI may relate to down-regulation of p-GSK-3β evoked directly by the release of inflammation factors in early period of myocardial ischemia/reperfusion and ischemic postconditioning may attenuate the condition.