Objective To summarize the causes and the prevention of bile duct injuries during laparoscopic cholecystectomy (LC). Methods Clinical records of 1 000 cases of LC were analyzed retrospectively. Results Conversions to open cholecystectomy were required in 15 cases(1.5%). Complications took place in 6 cases(0.6%), involving 3 cases of common bile duct injury, 1 case of stomach puncture, 1 case of port hemorrhage, and 1 case of bile leakage. No long-term complications were seen. Conclusions The most frequent cause leading to bile duct injuries is pulling the bile duct to be angulated.

Objective To provide scientific basis for the investigation, prevention,control and administration of house decoration noise Methods The equivalent noise levels (Leq),and the levels of noise dose (D L) in decorated houses,next door houses and outdoor environment were measured during different periods such as morning,noon,afternoon and evening in one day, as well as the health effects of noise in 3 residential quarters were investigated Results The Leqs levels during per 10 minutes were 79 6～104 7 dB(A) in decorated house The individuals exposure D L of decoration workers were 90%～180% The Leqs during per 20 minutes were 70 9～76 4 dB(A) in next door houses and 63 4～76 5dB(A) in the neiboaring residential building and office building 6～45 meters far from the decoration noise sources The annoyance rate among 149 residents was high and reached 89 8% The mental labourers revealed significantly higher annoyance rate compared with that of physical labourers Conclusion The health effects of decoration noise on occupational individuals and residents shouldnt be ignored

Objective:To explore TCM syndrome variation regularity on acute stage of ischemia stroke.Methods:To collect clinical dynamic state information of ischemia stroke from 72h to 14days by using prospective clinical research method and investigate TCM syndrome variation regularity in acute stage of ischemia stroke.Results:Wind,fire and phlegm syndromes were the most frequent syndromes in acute stage of ischemia stroke.They appeared varied regularity.There were forty-four combination patterns about six basic syndromes.The wind syndrome and fire-phlegm syndrome were increasing in acute stage of ischemia stroke.The wind-phlegm syndrome was decreasing in the first three days,the wind-fire syndrome peaked on the third day,the phlegm was decreasing on the fifth day.The wind-fire-phlegm was the most frequent and undulate syndrome on the fifth day.The wind-phlegm-stagnation syndrome was increasing for the first three days.Conclusion:There were fastly morbility,changeable and complicated syndrome change in acute stage of ischemia stroke.It was very necessity and urgency for complementing diagnostic criteria of stroke differentiation.

Aim To investigate the effects of intrathecal levobupivacaine(LB)on substance P(SP)expression in spinal dorsal horn(L4~5)and the distal cerebrospinal fluid contacting neuron(dCSF-CN)in a rat model of formalin induced inflammatory pain.Methods Twelve male Sprague-Dawley rats(290~310 g,Grade SPF)were randomly divided into 2 groups with 6 in each.Rats were anesthetized with sodium pentobarbital(40 mg?kg-1,ip)and then fixed in the stereotaxic instrument.A 3 ?l volume of 30% CB-HRP to trace dCSF-CN was injected into one of the rats'lateral ventricles.The animals kept alive,forty eight hours later artificial cerebrospinal fluid(ACSF)10 ?l and 0.5% LB 10 ?l(diluted with ACSF)were intrathecally injected in group ACSF and group LB respectively.Inflammatory pain was induced by formalin injection into left hind paw.Then nociception of the animals was assessed behaviorally with the formalin test.Two hours after formalin administration,rats were sacrificed with deeply anesthesia and transcardially perfused.L4~5 segments of spinal cord were removed for immunohistochemical SP-labeling.Brainstem segments containing dCSF-CN were removed for SP/CB-HRP dual-labeling with immunohistochemical procedures and colloidal gold immunoelectronmicroscopy.Results LB significantly reduced paw licking time in the formalin test(P 0.05vsbaseline,P

This study was aimed to observe the effect of Bai-Zhu Huang-Qi (BZHQ) decoction ethyl acetate extract on NOD like receptor family,pyrin domain-containing 3 (NLRP3) inflammasome in macrophages.The U937 cells were pretreated with phorbol 12-myristate 13-acetate (PMA,10 ng· mL-1) for 48 hours to induce macrophages.Effects on cell viability by different doses of BZHQ decoction ethyl acetate extract (0,3.125,6.25,12.5,25,50,100 μg· mL-1) were observed to select the appropriate concentration.Contents of NLRP3 and caspase-1 in cells were detected by real-time PCR and western blot.The concentration of interleukin-1β (IL-1β) in cell supernatant was detected by enzyme linked immunosorbent assay (ELISA).The cell counting kit-8 (CCK-8) assay showed that when the drug concentration was lower than 25 μg· mL-1,there was no impact on cell viability;when the drug concentration was higher than 50 μg· mL-1,there was inhibition on cell viability (P ＜ 0.05).The concentration of 25 μg· mL-1 was used to conduct the following experiment.Compared to the blank group,the expression of NLRP3 and caspase-l in cells of the LPS group were significantly increased (P ＜ 0.01).The concentration of IL-1β in cell supernatant was also significantly increased (P ＜ 0.01).After treated with BZHQ decoction ethyl acetate extract,levels of NLRP3,caspase-1 and IL-1β were significantly decreased (P ＜ 0.05).It was concluded that BZHQ decoction ethyl acetate extract can inhibit the production of NLRP3 inflammasome in LPS-stimulated macrophages.

Objective To analyze the clinical and electrophysiological features in a family with spinal muscular atrophy (SMA), and assess the probable causative gene mutations for the family. Methods To identify the nosogenesis of the proband with weakness and atrophy in the double lower proximal limbs, clinical data of his 12 family members were collected, and the proband and his mother were selected for clinical examinations, including laboratory tests, electromyogram (EMG), F-wave, H-reflex, X-ray of the spine and double lower limbs, brain and spinal cord magnetic resonance imaging, etc. Moreover, human whole exome sequencing was performed on blood sample from the proband, then its deleterious effects were assessed according to the Standards and guidelines for the interpretation of sequence variants, a joint consensus recommendation of the American College of Medical Genomics (ACMG) and the Association for Molecular Pathology (AMP). Subsequently, the strong pathogenic mutation was validated by Sanger sequencing. Results Familial investigation showed seven of 12 family members presented with weakness in the double lower proximal limbs. Among them, three had the main manifestation of atrophy in the double lower proximal limbs, one had high arched foot as the main presentation, and the others had weakness in the double lower proximal limbs. EMG studies showed the abnormal results in the anterior horn of the spinal cord. The strong pathogenic mutation in DYNC1H1 gene (exon8, c.2327C＞T, p.P776L) was identified from the proband according to ACMG and AMP guidelines. Sanger sequencing revealed six patients had this variant and it was passed mainly from his maternal grandmother. Conclusions A pathogenic mutation of the DYNC1H1 p.P776L in six Chinese pedigrees which cosegregated with SMA was identified. There existed individual differences in clinical presentations. This finding may have important implications for the study of SMA in Chinese patients.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.