Objective To explore the clinical feasibility of three-port laparoscopic cholecystectomy(LC).Methods From April 2006 to April 2007,364 patients with acute or chronic cholecystitis underwent LC using three-port method.The clinical data of the patients were analyzed retrospectively.Results All of the 364 patients were cured.Three-port LC were completed in 357 of them with a success rate of 98%.Seven patients were converted to four-trocar LC because of frozen Callot's triangle and gallbladder atrophy.The operation time was 30-80 min(mean,55 min).No severe complications including bile duct injury,bile leakage,and hemorrhage,occurred in our patients.Among the patients who were treated with three-trocar LC,250 were followed up for 1 to 13 months with a mean of 5 months.During the follow-up,no bile duct stenosis,gallbladder pouch,or residual stones were found.Conclusion Three-port LC is safe,effective,and feasible for patients with cholecystitis,if the surgeons have grasped the techniques of four-port LC.

PURPOSE: This study aims to investigate how competitive orientation influences unethical decision-making (UDM) through relationship conflict and the moderating effect of hostile attribution bias. METHODS: This study was conducted using a self-report questionnaire. Data were collected from 727 employees in Chinese hospitals. For each variable, measures were adopted or adapted from existing literature. Data were analyzed using descriptive statistics, correlation analysis, confirmatory factor analysis, and hierarchical regression analysis. Common method variance was established using Harman's single-factor test. RESULTS: Competitive orientation is significantly and positively associated with relationship conflict (β = .36, p < .001) and UDM (β = .35, p < .001). Relationship conflict is significantly and positively associated with UDM (β = .51, p < .001). Relationship conflict partially mediates the relationship between competitive orientation and UDM. In addition, hostile attribution bias strengthens the positive relationship between competitive orientation and UDM through relationship conflict. CONCLUSION: This study provides some implications for hospital employees to deal with ethical dilemmas in decision-making. Hospital employees including nurses, physicians, and other health-care professionals should raise awareness of competitive orientation and adopt a cooperative approach to human relations. Effective training programs should be utilized to direct all hospital employees to depress hostile attribution bias whenever possible to everything in clinical practice.
Asian Continental Ancestry Group ; Bias (Epidemiology) ; Conflict (Psychology) ; Decision Making ; Education ; Ethics, Clinical ; Hostility ; Humans ; Methods

Objective: To compare the effects of transpedicular grafting of vertebral pedicle screw and strode over fractured vertebra of vertebral pedicle screw in the treatment of thoracolumbar fractures. Methods: From January 2015 to December 2016, 84 cases of thoracolumbar fractures in Weihai Central Hospital were randomly divided into two groups according to the digital table, with 42 cases in each group.The control group received strode over fractured vertebra of vertebral pedicle screw, and the study group received transpedicular grafting of vertebral pedicle screw.The patients were followed up for 12 months.The bleeding loss, operation time, postoperative drainage, fracture healing time, hospitalization days and anterior compression ratio of vertebral body, kyphosis Cobb angle before and after treatment and postoperative complications were compared between the two groups. Results: There were no statistically significant differences in postoperative drainage volume, fracture healing time and hospitalization days between the two groups (t=1.38, 1.79, 1.20, all P>0.05), but the intraoperative bleeding volume[(183.85±13.88)mL]and operation time[(119.74±14.85)min]in the study group were significantly higher than those in the control group[(137.97±14.24)mL, (99.46±13.42)min](t=14.95, 6.57, all P<0.01). Compared with the control group, the compression ratio of the anterior vertebral body in the study group was significantly increased after operation[(92.15±8.70)% vs.(83.75±7.04)%](t=4.86, P<0.01), and the kyphotic Cobb angle in the study group and the control group were significantly decreased compared with those before operation[(10.15±2.47)°, (14.53±4.85)°], and the postoperative kyphotic Cobb angle in the study group was significantly lower than that in the control group (t=5.21, P<0.01). The incidence rate of postoperative complications in the study group was 4.76%, which showed no statistically significant difference compared with the control group (14.29%, χ²=2.21, P=0.14). Conclusion Transpedicular grafting of vertebral pedicle screw is superior to strode over fractured vertebra of vertebral pedicle screw in promoting reduction, correcting posterior process deformity and reconstructing vertebral height in patients with thoracolumbar fractures, and it does not cause serious complications, so it has good clinical value.

Objective To investigate the effection of Shenfu Injection (Ginseng-radix aconitum Injection)to the blood coagulation system and its prognosis in the patient of multiple trauma complicated with shock.Methods We prospectively studied 90 patients of multiple trauma complicated with shock,who came from the emergency center of the Second Affiliated Hospital of Medicine' s college of Zhe-Jiang University and emergency department of Lishui People' s Hospital from February 2007 to December 2011,and excluded those suffered with the dysfunction of coagulation system and uncontrolled ongoing bleeding before trauma.And then these eligible patients were randomly divided into two groups:treatment group ( 45 cases ) and control group (45 cases),the control group were received the routine treatment,the treatment group were received Shenfu Injection in early stage based on the routine treatment.The two groups were measured the platelet count (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB) before treatment and 3,7 days after treatment.Results The differences of the PLT,PT,APTT,TT,FIB between the treatment group and control group at 3,7 d after the treatment was statistically significant (P ＜ 0.05 ). Conclusions Shenfu Injection has positive regulation to the coagulation system in the patient of multiple trauma complicated with shock.

Objective To study the effects of vancomycin-impregnated polymethylmethacrylate (VCM-PMMA) on mechanics alteration and delayed release in order to guide clinical application.Methods The specimens of bone cement (each of 40 g) were divided into 7 groups depending on mixed different contents with vancomycin,containing 0,0.5,1.0,1.5,2.0,2.5 and 3.0 g vancomycin.The compressive strength,bending strength and bending elastic moduls were measured respectively.The elution examination of vancomycin from bone cement was performed by chromatography.Results There were no differences of compressive strength before elution of bone cement that were included from 0 to 3.0 g vancomycin.When the vancomycin in the content of the bone cement attained 3.0 g,the compressive strength after elution and bending elastic were lower than those in control group(P

Comprehensive experiments course is a bridge for higher vocational students to integrate theoretical knowledge with production practice. The article introduces that our biological pharmacy department is committed to the principles of "promotion of teaching, learning and construction through skills competition so as to integrate education and training". By taking penicillin fermentation process as an example, reform has been made in several aspects including teaching objectives, teaching content and teaching methods. We integrate the practical operation of fermentation equipment with virtual simulation software to develop a two-way interactive course. By reducing the subjective dependence, the quantitative management and evaluation of fermentation process parameter control were put into place, which efficiently integrated the skills competition with practical teaching. Improved teaching performance has been achieved over recent years, which may facilitate the reform and practice of similar courses based on skills competition.
Humans ; Clinical Competence ; Learning ; Students ; Technology ; Biological Products

OBJECTIVEThe synergic and decreasing toxic effects of mineral water and Chinese herbal compound preparation (MWCHCP) on cisplatin were investigated in sarcoma 180 (S180) mice.

METHODThe S180 mice were treated for 5 days with intraperitoneal injection of cisplatin(7.33 mg x kg(-1)) and oral administration of MWCHCP(1 925, 3 850, 7 700 mg x kg(-1)). Then the mice were killed and the tumor growth inhibition rate, organ index, diarrhea index were determined. Observe pathological sections of stomach to study the protective effect of MWCHCP. Reverse transcription-polymerase chain reaction (RT-PCR) was applied to investigate the tumour necrosis factor-alpha (TNF-alpha) expression level of the intestine.

RESULTCombining with cisplatin and MWCHCP caused a tendency of increasing the tumor growth inhibition rate and significant attenution of cisplatin-induced diarrhea, visceral organ injury, gastric mucosal injury and decreased TNF-alpha mRNA level of intestine.

CONCLUSIONThe present findings suggest that MWCHCP increases the inhibition rate of tumor growth of cisplatin and has a beneficial influence on gastrointestinal lesion induced by cisplatin.

Animals ; Antineoplastic Agents ; administration & dosage ; adverse effects ; Cisplatin ; administration & dosage ; adverse effects ; Disease Models, Animal ; Drug Synergism ; Drug Therapy, Combination ; Drug-Related Side Effects and Adverse Reactions ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Male ; Mice ; Mineral Waters ; administration & dosage ; Sarcoma 180 ; drug therapy ; pathology

OBJECTIVE: To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement. METHODS: Totally 34 patients (34 hips) with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018, were randomly divided into two groups named as tranexamic acid group and control group, 17 patients in each group. In TXA group, there were 10 males and 7 females, aged from 20 to 49 years old with an average of (32.1±7.6) years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min. In control group, there were 11 males and 6 females, aged from 20 to 49 years old with an average of (30.9±6.2) years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min. Introopertaive and total bloodloss between two groups were compared. Visual analogue scale (VAS) at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint. Modified Harris Hip Score(mHHS) of hip joint at 3, 6, 9 and 12 weeks after oeprtaion were applied to evaluate clinical effects. RESULTS: All patients were obtained follow up over 12 weeks. Incision healed well without infection and deep vein thrombosis. There were no statistical difference in opertaion time bewteen two groups( CONCLUSION Preoperative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement, thereby improving surgical field of vision, reducing difficulty of surgical operation, which could promote early and rapid rehabilitation of hip function.
Adult ; Aged ; Arthroscopes ; Arthroscopy ; Blood Loss, Surgical ; Female ; Femoracetabular Impingement/surgery* ; Hip Joint/surgery* ; Humans ; Male ; Middle Aged ; Tranexamic Acid ; Treatment Outcome ; Young Adult

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.