3 d in 16)were converted to open surgery because of massive adhesion at the Calot's triangle(13 cases),severe wound hemorrhage(4),common bile duct stones(4),gallbladder-duodenum fistula(2),gallbladder-colon fistula(1),or Mirizzi syndrome(1).During the operation,no bile duct injury occurred.None of the patients had intra-abdominal haemorrhage,biliary leak,or subhepatic abscess after the operation.The 279 patients were followed up for 5 to 24 months with a mean of 12 months,during which no patients complained of abdominal pain or jaundice.Conclusions The success of LC depends on early treatment and strict selection of patients.Intraoperative hemorrhage and bile duct injury can be avoided by sufficiently exposing the Calot's triangle and using the technique of flush-suction blunt dissection.Conversion to open surgery is necessary when LC is difficult.

Objective To discuss the time-dependent changes of facet joint asymmetry in patients with lumbar disc herniation (LDH). Methods A total of 54 patients with LDH were prospectively analyzed. CT was used to judge whether there existed small joint facet asymmetry and to measure the facet joints. The present results were compared with the results that would be investigated two years later. Results The sagittal process of small facet plane accounted the majority in patients with LDH after two years, with no statistical difference compared with the results before two years (P ＞ 0.05). During 2-year period, the facet joint asymmetry disappeared in seven patients, while the facet joint asymmetry occurred in other seven patients, with no statistical difference (P ＞ 0.05). Conclusions Facet plane and the asymmetry will change with time. Observation of the relationship between facet joint asymmetry and LDH should be carried out in a period of time rather than at a time point.

Objective To explore the expression level and clinical significance of multifunctional CD8 T cells in patients with tuberculosis (TB). Methods The expression levels of MTB antigen specific and non-specific multifunctional CD8 T cells among peripheral blood mononuclear cells (PBMCs) and pleural fluid mononuclear cells (PFMCs) in TB patients, latent tuberculosis infection patients (LTBI) and healthy controls (HC) were measured by flow cytometry. Results The expression level of multifunctional CD8 T cells (IL-2+IFN-γ+TNF-α+CD8 T cells) among PBMCs stimulated by non-specific MTB antigen in TB patients was (5.72 ± 4.32)%, which was significantly lower than those in HC and LTBI [(22.3 ± 15.7)%, q=7.455, P<0.001;(14.2 ± 7.72)%, q=3.110, P<0.05]. Under the stimulation by specific MTB antigen, the expression level of multifunctional CD8 T cells among PBMCs in TB patients was (0.33 ± 0.83)%, which was significantly higher than those in HC and LTBI [(0.017 ± 0.03)%, q=3.97, P<0.05;(0.019 ± 0.035)%, q=3.39, P<0.05]. In patients with tuberculous pleurisy, the expression level of multifunctional CD8 T cells among PFMCs was (0.623 ± 1.033)%, which was significantly higher than that among PBMCs [(0.034 ± 0.066)%, P<0.001]. The expression level of multifunctional CD8 T cells in TB patients was negatively correlated with HRCT score (r=-0.265 8, P=0.015 8). Conclusion The expression level of multifunctional CD8 T cells was contributed to discriminate TB patients from latent tuberculosis infection patients , and was closely related to the degree of damage in lung.

ObjectiveTo establish a rat model of pure sensory nerve injury or pure motor nerve injury combined with skin defect to examine the effect of highly selective nerve injury on skin wound healing.MethodsA total of 90 male Sprague-Dawley rats were randomly and equally divided into three different groups including Group A (posterior rhizotomy + cutaneous excision wounding group),Group B (anterior rhizotomy + cutaneous excision wounding group) and Group C ( sham operation + cutaneous excision wounding group).The wound healing rate was detected at days 2,7,14 and 21 after injury.The CGRP mRNA expression was determined by reverse transcription-polymerase chain reaction (RT-PCR) at days 1,3,7 and 14 after injury.The Bcl-2 protein expression was determined by immunohistochemistry at days 3,7,14 and 21 after injury.ResultsThe wound healing rate in the Groups A and C was significantly higher than that in the Group B at day 2 ( P ＜ 0.05 ),with no statistical difference between Group A and Group C (P ＞ 0.05 ).The wound healing rate in the Group C was higher than that in the Groups A and B at days 7 and 14 (P ＜0.05),with no statistical difference between Group A and Group B (P ＞0.05).The wound healing rate in the Groups B and C was higher than that in the Group A at day 21 ( P ＜ O.05 ),with no statistical difference between Group B and Group C ( P ＞ 0.05 ).The CGRP mRNA was expressed in three groups and the expression was up-regulated after wound.The CGRP mRNA expression in the Groups B and C was significantly higher than that in the Group A at days 1,3 and 7,with no statistical difference between Group B and Group C ( P ＞ 0.05 ).The CGRP mRNA expression was distributed as Group C ＞ Group B ＞ Group A at day 7 ( P ＜ 0.05 ) and Group B ＞ Group A ＞ Group C at day 14 (P ＜ 0.05 ).Immunohistochemistry indicated that there was no statistical difference in Bcl-2 protein expression at day 3 after injury in all groups; that the Bcl-2 protien expression in the Group C was significantly higher than that in the Groups A and B at day 7 ( P ＜ 0.05 ),with no statistical difference between Group A and Group B ( P ＞ 0.05 ) ; that the Bcl-2 protien expression was distributed as Group C ＞ Group B ＞ Group A at day 14 ; that the Bclo2 protien expression in the Group B was higher than that in the Groups A and C at day 21 (P ＜0.05),with no statistical difference between Group A and Group C (P ＞ 0.05).ConclusionsIn wound healing process,the sensory nerve plays a more important role than the motor nerve.Denervation of the nerves ( especially the sensory nerves) is not conducive to wound healing,and complete innervation is necessary for normal wound healing.

0.05). CONCLUSION The sound localization apparatus can test the localization ability of person, and it can be used in simply and reasonably.

0. 05]. After sublingual glycerytrinitrate administration,the diameter of the brachial artery dilated significantly [(4.26?0.54) mm vs (4.73?0.43) mm, P 0.05]. Sublingual glycerytrinitrate administration dilated the brachial artery significantly [(4. 37? 0.77) mm vs (4. 82?0. 60) mm, P

Objective To investigate the clinical effects of minimally invasive poking reduction technique in the treatment of single segment thoracolumbar fractures without neural impairment.Methods From February 2011 to June 2015,83 cases of thoracolumbar fractures without neural impairment underwent minimally invasive pedicle screw fixation in Linyi Central Hospital were selected and randomly divided into two groups.Group A (40 cases) was treated with poking reduction technique by percutaneous polyaxial pedical screw fixation,43 patients in group B were treated with only percutaneous polyaxial pedicle screw fixation.The perioperative index,pre-and postoperative radiography,relief of the low back pain and general health status of the two groups were recorded and compared.Results There were no statistically significant differences in the operation time,operative blood loss,hospitalization time.All patients were followed up for 20-27months (average 24 months),the scores of visual analogue scale (VAS) and Oswestry disablity index(ODI) had no statistically significant differences between the two groups in the same period(all P ＞ 0.05).Before operation,the Cobb angle,sagittal index and anterior height of the fracture vertebral body in group A were (66.3 ± 14.2) ％,(20.4 ± 6.5) °,(21.9 ± 6.6) °,respectively,which in group B were (64.8 ± 13.5) ％,(14.5 ± 7.7) °,(15.6 ± 5.9) °,respectively,the differences were not statistically significant (all P ＞ 0.05).After operation,the Cobb angle,sagittal index and anterior height of the fracture vertebral body in group A were (93.8 ± 9.8)％,(5.3 ± 3.3) °,(5.4 ± 2.0) °,respectively,which in group B were (88.0 ± 10.6) ％,(4.1 ± 2.8) °,(8.1 ± 4.7) °,respectively,the differences were statistically significant (t =8.893,2.345,3.351,all P ＜ 0.01).Conclusion The effect of poking reduction technique by percutaneous polyaxial pedical screw fixation is better than simply polyaxial pedicle screw in the treatment of thoracolumbar fracture,which is a safe and effective operation method.

Objective:To explore the clinical efficacy of venovenous extracorporeal membrane oxygenation(V-V ECMO)in patients with severe acute respiratory distress syndrome(ARDS)caused by Pneumocystis pneumonitis(PJP)after kidney transplantation(KT).Methods:Cal data of 9 KT recipients on V-V ECMO were retrospectively analyzed. Timing of V-V ECMO support, complications during treatment and V-V ECMO performance were summarized.Results:All 9 patients with confirmed PJP adopted V-V ECMO with oxygenation index of 25~92 prior to V-V ECMO and average time from admission to initiating V-V ECMO was 5.56(1~17)days. Except for one death from hemorrhagic shock due to abdominal hemorrhage, the remainders were successfully weaned. Another recipient died from sepsis after weaning and there were 7 survivors. V-V ECMO support time was 215.5 h among 8 successfully weaned recipients. Among 7 survivors, 1 had premorbid deterioration of graft function and no fatal complications occurred.Conclusions:V-V ECMO is an effective treatment for severe ARDS caused by P. pneumoniae post-KT. And its early application is recommended for reducing complications and improving patient prognosis.

Objective To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA). Methods A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months. Results A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L):24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001). Conclusion After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.

PURPOSE: Duodenal stump leakage (DSL) is a potentially fatal complication that can occur after gastrectomy, but its underlying risk factors are unclear. This study aimed to investigate the risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer (GC). MATERIALS AND METHODS: Relevant data were collected from several prospective databases to retrospectively analyze the data of GC patients who underwent Billroth II (B-II) or Roux-en-Y (R-Y) reconstruction after laparoscopic gastrectomy from 2 institutions (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences). The DSL risk factors were analyzed using univariate and multivariate analysis regression. RESULTS: A total of 810 patients were eligible for our analysis (426 with R-Y, 384 with B-II with Braun). Eleven patients had DSL (1.36%). Body mass index (BMI), elevated preoperative C-reactive protein (CRP) level, and unreinforced duodenal stump were the independent risk factors for DSL. DSL was diagnosed in 2–12 days, with a median of 8 days. Seven patients received conservative treatment, 3 patients received puncture treatment, and only 1 patient required reoperation. All patients recovered successfully after treatment. CONCLUSIONS The risk factors of DSL were BMI ≥24 kg/m², elevated preoperative CRP level, and unreinforced duodenal stump. Nonsurgical treatments for DSL are preferred.