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.

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.

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.

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.

New type medical talents are in great need in the fierce international competition in medical field.Logic quality is acquired by accumulation,not born to be.Modern medicine sets higher requirement for medical talents in the aspects of logic quality including receiving and processing information,ability of expression and collaboration,forecasting and innovation.Therefore,only through diligent learning,training and repeated practice can enhance the logic quality of medical talents,and develop into winners in the increasingly fiercer international competition in medical field.

The clinical thought is the core and the foundation of clinical ability.The logical teaching strengthens the students'clinical thought most directly and effectively.Through the thought training,the inference thought training and the basic thought rule training the medical students' clinical thought ability can be effectively strengthened.

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.

Objective To discuss the MRI features and pathogenic mechanisms of lung cancer intramedullary spinal cord metastasis (ISCM). Methods Four cases with clinically and 3 cases pathologically proved lung cancer ISCM were analyzed retrospectively. Turbo spin-echo sequence T 1 and T 2 weighted images were acquired in all patients. T 1 weighted images were obtained after intravenous administration of Gd-DTPA in all patients. Results A total of 7 ISCM were displayed by MR studies. The tumor occurred in thoracic cord (3/7) and in medullary cone (4/7). The tumor involved the central aspect of the cord. The lung cancer ISCM showed hypointensity (n=1) or isointensity (n=6) on T 1WI and hyperintensity on T 2WI. The extensive cord enlargement with cyst formation or syringomyelia was common. On contrast study, all tumors showed marked homogenous enhancement with clear borders. Conclusion The lung cancer ISCM usually presented as solitary lesions with marked contrast enhancement. The extensive cord enlargement was common in all patients. Because of the limitation in the evaluation of lung cancer ISCM on MRI, definite diagnosis of lung cancer ISCM depended on combination of clinical and MRI data.

Objective To study the effectiveness of microwave ablation in treating HCC.Methods A total of 98 nodules in 56 cases of HCC were treated via appropriate puncture approach ac-cording to the volume, amount and site of tumor nodules. Results Only 1 patient failed to finish treatment since he could not suffer the pain. The other 55 patients finished without a hitch. Clinical and imaging findings were analyzed for change of physiology. Conclusion The microwave ablation is effective for the treatment of HCC. Such therapy can be important supplement of direct surgical man-agement. Its effect mainly depends on accurate puncture approach and enough diametric range. Mean-while, reasonable puncturing method should be selected.