Objective To discuss the mechanism and prevention of bile duct injury in laparoscopic cholecystectomy (LC). Methods Twenty-six cases with bile duct injuries in this study were evaluated retrospectively regarding their location, mechanism, time of detection, repairment and outcome, and the role of intraoperative cholangiography (IOC) in preventing bile duct injury. Results Among a total of 26 cases there are duct injury due to misidentification 15 cases,( IOC detected the misidentification of bile duct injuries intraoperatively 10 cases, clipping the common duct 3 cases, duct thermal injuries 4 cases and duct lacerations 4 cases, Conclusion Duct injury due to misidentification was the main type of bile duct injury in LC, Correct interpretation of IOC will detect the duct injury intraoperatively and prevent the severe consequence. Meticulous dissection and exposure of the junction of distal common hepatic duct, proximal common bile duct, and proximal cystic duct, and safe hemostasis in Calot triangle are the important measures to prevent bile duct injury in LC.

ObjectiveTo establish early diagnosis of vascular complications following orthotopic liver transplantation (OLT).MethodsThe surveillance and diagnosis making of vascular complications in 53 cases of OLT patients from April 1990 to June 2000 were carried out by color Doppler imaging (CDI), selective-angiography and analyzing relevant clinical features.ResultsThe incidence of vascular complication after OLT is 15%(8/53) including 3 cases of hepatic artery thrombosis, 2 of hepatic artery stenosis, 1 of celiac artery stenosis, and 2 of inferior vena cava stenosis. Diagnosis was confirmed by selective angiography in 7 cases and by autopsy in one. The sensitivity and specificity of CDI were 100%(8/8) and 98% (45/46) respectively. Conclusions Clinical feature of vascular complications following OLT lacks specificity. Continuous monitoring using CDI is a sensitive and specific method in the detection and diagnosis of vascular complications.Duration of surveillance should be no less than 2 months.

Objective:To investigate the safety and efficacy of interleukin-6 antisense oligonucleotide liposomes on the experimental animals for prevention of after cataract. Methods:Thirty healthy New-Zealand rabbits(30 left eyes) received extracapsular lens extraction,and were randomly divided into 3 groups: anterior chamber injection of 0.1ml of interleukin-6 antisense oligonucleotide liposomes(Group A),blank liposomes(Group B) after operation respectively;and control group(Group C).All left eyes were examined by slit-lamp microscope and ophthalmoscope regularly.The aqueous humor IL-6 concentrations were measured 1 day before operation,and 1 day,3 days,7 days,14 days and 30 days after operation through enzyme-linked immunoabsorbent assay.Three months later,photographs of the posterior lens capsules were taken through digital slit-lamp microscope and the histopathological changes of posterior lens capsules were observed by light microscope. Results:①Three months after the operation,the number of eyes developing posterior capsule opacification in Group A,B and C were 7,10 and 10 respectively,with significant difference(P=0.037).② The average value of Group A was lower than Group B and C,with statistically significant difference(P

This article introduces the experience of CHEN Ying-yi, chief physician and one of the teacher of the fourth group of inheriting academic experience of veteran TCM experts of China, in treating perimenopausal women’s dysfunctional uterine bleeding. Chen holds that the basic pathogenesis of perimenopausal dysfunctional uterine bleeding is kidney deficiency with fever or stagnation. Treatment should focus on replenishing kidney and using the traditional Chinese drug by stages. The methods of stopping bleeding, clearing origin and reinstating the status quo are used flexibly. In clinic, it should grasp the key points of syndrome differentiation, and modify the therapy in accordance with the symptoms. Validated by clinical application, Chen’s experience has satisfactory curative effect and reference values for the treatment of perimenopausal women’s dysfunctional uterine bleeding.

Objective To explore the feasibility and indications of T tube free laparoscopic common bile duct exploration (LCBDE). Methods The therapeutic results of LCBDE in 175 cases were reviewed retrospectively regarding the cure rate, complications, and postoperative hospital stay. Results LCBDE was performed successfully in 169 cases. Laparoscopic stone removal was failed in 6 out of the 175 cases. Two were converted to open exploration, the remaining 4 cases received intraoperative EST, the procedure failed in one case and it was converted to open surgery. T tube free LCBDE was performed successfully in 104 cases, in 36 out of the 104 cases laparoscopic transcystic common bile duct exploration was successful, the mean operation time was 140 minutes and the mean hospital stay after operation was 2 days; in other 68 cases laparoscopic choledochotomy with primary duct closure was performed, the mean operation time was 135 minutes and the mean hospital stay after operation was 3 days. T tubes were placed in 65 cases, the mean operation time for those patients was 150 minutes and the mean hospital stay after operation was 4 days, the mean T tube drainage time was 38 days. Retained stone was found in one out of the 65 cases, and was removed by EST. Bile leakage after removal of T tube developed in one case, and was cured by conservative therapy. No mortality nor complications such as bleeding or bile leakage occurred in remaining cases, asymptomatic hyperamylasia was found in 4 cases postoperatively. No stone recurrence or duct stricture were found at a mean follow-up of 13 months. Conclusions T tube free LCBDE as an alternative to the treatment of CBD stones is safe and feasible, with shorter hospitalization and avoiding the potential complications related to the T tube placement.

Objective To evaluate multiple instrument guide (MIG) in the use of laparoscopic choledochotomy (LCD). Methods The common bile duct (CBD) exploration time,surgical outcome,complications and damage of choledochoscope with or without MIG were compared retrospectively. Results MIG assisted LCD was performed successfully in all 25 cases,no complication such as bleeding,bile leakage or retained stones happened. CBD exploration time were 30 minutes,the mean number of removed stones was 6,no damage of choledochoscope was encountered. In 38 cases receiving traditional LCD,an average 5 pieces of stone were removed,the duct exploration time was 60 minutes. Two cases were complicated with hyperamylasia,stones were retained in one case. Choledochoscope was damaged in 6 times. Conclusions MIG facilitates LCD procedure,shortens operative time,and protects choledochoscope.

OBJECTIVE:TO evaluate the economic effectiveness of the8medication schemes for preventing postoperation infections of cholecystitis and cholelithiasis.METHODS:The principle of pharmacoeconomics was adopted in the cost-effec-tiveness analysis of8medication schemes,ampicillin+amikacin+metroidazole(A),ampicloxacillin+metroidazole(B),lev-ofloxacin+metroidazole(C),cefoperazone/sulbactam+metroidazole(D),ceftazidime+metroidazole(E),piperacillin/tazobac-tam+metroidazole(F),ceftriaxone+metroidazole(G),cefotaxim/sulbactam+metroidazole(H).RESULTS:The costs for A,B,C,D,E,F,G and H schemes were72.75,497.75,339.75,392.75,1213.95,931.75,315.75and1409.75yuan respec-tively,with scheme A the lowest in cost;No significant differences were found in effectiveness among the8schemes.CON-CLUSION:Scheme A is superior to the others.

Objective To probe into the influencing factors of selecting the intravenous vascular access device for tumor patients undergoing intravenous therapy? Methods With convenience sampling,376 tumor patients in oncology department from 3 hospitals of class A hospitals in Guangzhou were selected for the survey including such 6 categories with 41 items as general data, patient’s willingness,punctured blood vessels,use of vascular access and clinical conditions? Results In 124 patients,peripheral venous catheter was used (33?0%)? Central venous catheter was used in 252 patients (67?0%),Multiple linear regression analysis showed that way for paying the expense,vascular conditions for venous punctuation,phased diagnosis,decision of the doctors,and prospected duration for detaining catheter significant influencing factors? Conclusions The state should raise their medical allowances for those with lower incomes? The administrative should enhance the training to doctors and nurses at grass levels,promote the communication between medical workers and patients and improve their recognition of transfusion devices so that they can make a right choice?

Totally 613 specialized nurses in 14 specialty areas were successfully trained by the health department of Guangdong province and the Hong Kong hospital authority collaboratively from 2007 to 2010.There were three stages in the training program including candidate interview and preparations for inter-regional training,specialty nursing courses in Hong Kong (10 months of clinical practice and 300 hours of theoretical courses) and postgraduate courses in Guangdong (300 hours).The program explored the inter-regional joint training mode for specialized nurses; improvement mechanism for teaching management and the combination of scientific research training and working practice.The successful experience of the program may provide references to the training of domestic specialized nurses and clinical nursing postgraduates.

AIM: To investigate the effects of advanced glycation end products (AGEs) on the expression of plasminogen activator inhibitor-1 (PAI-1) in rat mesangial cells and its relationship with extracellular matrix accumulation. METHODS: Rat mesangial cells were treated with AGE-modified bovine serum albumin or native bovine serum albumin. Normal mesangial cells without any treatments were used as control. Fibronectin (FN), collagen Ⅳ, PAI-1 protein contents were detected by ELISA. PAI-1 mRNA was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: AGEs (0-200 mg/L) did not influence mesangial cells proliferation, but stimulated FN , collagen IV and PAI-1 contents in mesangial cell cultured medium in different degrees. AGEs also increased PAI-1 mRNA expression. CONCLUSION: AGEs increase the expression of PAI-1 in rat mesangial cells. AGEs may reduce ECM degradation through increasing PAI-1 expression, which may be one of the mechanisms of ECM accumulation in diabetic nephropathy.