Objective To evaluate the efficacy of laparoscopic management for bile duct and gastrointestinal injuries during laparoscopic cholecystectomy. Methods Laparoscopic cholecystectomy with or without laparoscopic bile duct exploration was attempted in 9 016 consecutive patients between October 1991 and December 2002. We experienced 14 cases of bile duct injuries (0.15%) and 3 cases of gastrointestinal injuries (0.03%). One patient with circumferential injury and 10 patients with partial laceration injuries of the bile duct underwent a laparoscopic simple closure. One gastric and two duodenal injuries were successfully repaired under laparoscope. Results Expect 1 patient suffered postoperative biliary leakage and bile duct stricture 1 year after the surgery, all the patients were cured and discharged from the hospital. Conclusions Partial laceration injuries of the bile duct or gastrointestinal injuries could be treated with a laparoscopic technique. Concerning laparoscopic management of circumferential bile duct injuries, further study should be taken.

Anxiety disorders are the commonest emotional disorders in children, who may be at increased risk of the later develop-ment of other types of mental disorder. Early diagnosis and intervention should be applied. In this article, epidemiology, major factors rele-vant and effective therapy of anxiety disorders in preschool children are summarized.

Objective To compare common bile duct pressure changes after laparoscopic common bile duct exploration between primary closure of the bile duct and T-tube drainage.Methods Postoperative common bile duct pressure changes were analyzed in 30 cases of laparoscopic common bile duct exploration,including 15 cases of primary suture of the bile duct and 15 cases of T-tube biliary drainage respectively,from August 2003 to January 2004 in this hospital.Results ①The hydrostatic pressure in common bile duct was 6.0~18.5 cm H_2O(0.54~1.66 kPa).②As compared with preoperative levels,the common bile duct pressure increased slightly on the first postoperative day and decreased significantly on the fifth postoperative day in primary suture cases(q=4.531,P

Objective To investigate the association between the MTHFR gene C677T mutation and CAD in patients with hypertension. Methods Of the 103 cases of patients with hypertension who underwent coronary angiography, 58 were CAD and 45 were not. MTHFR genotypes were identified by PCR and restriction fragment length polymorphism analysis with Hinf I digestion. Plasma folate was determined by radioimmunoassay. Plasma HCY was determined by HPLC. Results The frequencies of T677 allele (0.45) in the CAD group were markedly higher than those in the control group (0.33, P=0.03), plasma homocysteine level in the CAD group (17.73?2.22 ?mol/L) was also significantly higher than that in the control group (12.18?1.23 ?mol/L, P=0.037). There was no significant difference in the concentrations of folate for the two studied groups. Conclusion The MTHFR gene T677 variant is the genetic high risk factor for CAD in patients with hypertension. It can induce the hyperhomocysteinemia, potentially contributing to the pathogeny of CAD.

The efficiency of Siemens E.CAM is evaluated by analyzing and practicing the technology of Siemens U-fly.Basic testing procedure is run.Standard source 99mTc and 57Co is used respectively and the operation is performed according to the instruction.The detecting head's uniformity can be corrected in this way with satisfactory results.It is suggested uniformity should be tested every day before study because it is the most important factor for the quality of clinical images.

Purpose: To observe the clinical therapeutic effect of acupuncture plus Chinese herbs in treatment of poststroke depression. Methods: Forty-two cases of poststroke depression were treated by acupuncture plus Chinese herbs, and 30 cases of poststroke depression were treated by Western drug as control. Results: After 6 weeks of treatment, the scores of Hamilton Depressive Scale in two groups were all reduced statistically and remarkably when compared with before treatment; when the acupuncture plus Chinese herbs group were compared with Western drugs group, no significant difference was found in total effective rate. Conclusion: Acupuncture plus Chinese herbs had marked therapeutic effect in the treatment of poststroke depression, and had the advantages of safety and no side effect.

Objective To compare serum potassium concentrations in type 2 diabetic and nondiabetic patients in the early phase of acute coronary syndromes (ACS). Methods Seven hundred and forty-five consecutive patients with ACS underwent cardiac catheterization from January, 1999 to March, 2003. Patients were stratified by duration of symptoms,type2diabetes,and?-receptor blocker therapy before admission. Results Serum potassium concentration was significantly higher in type 2 diabetic patients with ACS than that in nondiabetic patients with ACS 〔(4.34?0.48)mmol/L vs (4.00?0.52)mmol/L,P

Objective To analyze the susceptibilities of Escherichia coli isolates collected from blood and the prevalence of ESBLs encoding genes.Methods A total of 121 Escherichia coli isolates collected from blood during 2012 were analyzed for antimicrobial susceptibilities by software of WHONET 5.6,the production of ESBLs was confirmed by confirmatory pheno-typic testing,PCR and DNA sequence were further implemented to analyze the ESBLs-encoding genes.Results 121 E.coli isolates displayed high resistance towards broad spectrum penicillin and 2nd or 3rd generation cephalosporins,levofloxacin and cotrimoxazole,with the resistance rates being more than 40%,susceptibilities to imipenem,piperacillin/tazobactam,ami-kacin were observed,with the resistance rates to be less than 12%,86(88.7%)out of 121 isolates were found to produce ESBLs.Among them,59.5% (72),38.8% (47)and 4.1% (5)were confirmed to carry blaCTX-M,blaTEM and blaSHV genes.Additionally,2(1.7%)isolates carried all the genes detected,30(24.8%)isolates carried both of blaCTX and bla-TEM,1(0.8%)isolate carried both of blaSHV andblaTEM.Conclusion Most of the E.coli isolates from the blood culture in Nanjing Gulou Hospital produce ESBLs,and displayed resistance towards most of the penicillins,cephalosporins and sin-gle amide antimicrobial agents should be chosen according to susceptibility results.

Objective To evaluate feasibility of flap fenestration in management of the condition that a stent-graft is wrongly deployed in false lumen of aortic dissection.Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stent-graft had been wrongly deployed in false lumen of aortic dissection by CT angiography (CTA) after endovascular repair.Thereafter,an additional surgical management was carried out.At length,flap fenestration at 2 cm below pre-deployed stent-graft was performed using an Outback catheter so as to link false and true lumens.Successively,another stent-graft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection.Results Surgery was carried out under local anesthesia,with operation duration of 170 minutes and intraoperative blood loss of 350 ml.The chest and back pain disappeared after operation.The patient commenced to take food and take off-bed activity at the very day of operation in absence of paraplegia,visceral ischemia,or other complications.Aortic CTA at postoperative one week showed ideal positioning of stent-graft,fluent blood flow of aorta and major visceral artery,and vanishing of false lumen.Conclusions Flap fenestration at far-end of pre-deployed stent-graft so as to draw blood flow back to true lumen by connecting the new placed stent graft to pre-deployed stent-graft is an effective treatment for mis-deployment of stentgraft in false lumen of aortic dissection.Outback catheter for flap fenestration is characterized by accurate location and high safety.

As a component of traditional Chinese medical therapies, the therapeutic effects of acupuncture for some nervous system diseases have been proven by a large number of clinical and experimental studies. But, the electrophysiological techniques of the commonly used EEG and evoked potentials are still not sufficient to reveal the functional mechanism of acupuncture therapy. The recording technique of microelectrode array (MEA), a kind of electrophysiological technique originated from the overseas biological electrical signal monitoring technique, can be used to record multiple electrical signals of the nervous cells in vivo or in vitro, and maintain the accuracy and stability of the recorded information at the same time, which greatly enriches the means of electrophysiological study. This technique has been already applied in the basic study and clinical treatment abroad, but it is very seldom used in the study of acupuncture field. In order to guide the application of MEA in the research field of acupuncture science, a general survey about the application of MEA technique in vivo was done, and the present situation and prospects of the application of the technique in acupuncture science was briefly analyzed.