Objective To explore advantages of combined laparoscopic surgery(CLS).Methods The clinical data of 728 cases of CLS from July 1992 to March 2006 were analyzed retrospectively,including 586 cases of laparoscopic cholecystectomy(LC) combined with fenestration drainage of hepatic cysts,80 cases of LC combined with appendectomy,46 cases of LC combined with oophorocystectomy,16 cases of LC combined with unroofing and drainage of renal cysts.Results 726 cases of CLS were successfully performed,and 2 cases were converted to open surgery for abdominal adherence,with no complications such as bile duct injury,hemorrhea,infection and death occurred.During a mean follow-up period of 16 months(range,2-60 months) in 512 cases,no biliary calculi,recurrence of liver,kidney and ovarian cysts occurred.Conclusions CLS for two kinds or more abdominal diseases in one operation is safe and effective,with advantages of minimal invasion,less pain,and quicker recovery and so on.

Objective To explore the efficacy of laparoscopy in acute abdominal pain. Methods From March 2002 to March 2007,306 patients with acute abdominal pain were explored and treated by laparoscopy in our hospital. The patients were diagnosed with acute appendicitis in 105 cases,unidentified abdominal pain in 34,acute cholecystitis complicated with cholecystolithiasis in 64,gastrointestinal tract perforation in 51,common bile duct stones complicated with acute cholangitis in 5,intestinal obstruction in 33,and severe acute pancreatitis in 5; 9 patients were confirmed as having trauma. Results All the 306 patients were unequivocally diagnosed during the operation. Laparoscopy was successfully completed in 275 cases,including 123 cases of appendectomy,57 cases of cholecystectomy,48 cases of gastrointestinal tract perforation neoplasty,13 cases of enterodialysis,4 cases of intestinal replacement combined with indirect hernia repair,4 cases of radical resection of the sigmoid colon with precolon anastomosis,1 case of small-incision segmental resection of the small bowel,3 cases of common bile duct resection and calculus removal,2 cases of neoplasty for right-lobe hepatorrhexis,3 cases of haemostasis for splenic rupture,5 cases of debridement and clysis and drainage for severe acute pancreatitis ,and 12 cases of laparoscopic abdominal exploration (2 cases of mesentery contusion and laceration,1 case of abdominal wall punctured wound with contusion of the greater omentum,8 case of primary peritonitis,and 1 case of abdomen-type allergic purpura). The remaining 31 patients were converted to open surgery because of difficulties in laparoscopy. The patients were followed up for 1 to 18 months,during which no one showed intra-or post-operative complications.Conclusions Emergency laparoscopic exploration can not only clarify a diagnosis for acute abdominal pain with unknown causes,but also treat the cases simultaneously. Moreover,it is of great help in guiding abdominal resection and making a suitable operative incision,even if the patients can not be treated by laparoscopy alone.

Objective To analyze and evaluate the relationship between occupational lead exposure and spontaneous abortion.Methods The papers on the relationship of occupational exposure to lead and spontaneous abortion of female workers published in Chinese in 1991-2007 were searched by using computer and manual search,after strict selection,the homogeneity test and integrated analysis for the abstracted data of the eligible studies were conducted by using Rev.Man Statistic Software.The combined RR value was used as the total effect target of each project of meta-analysis.Results In total,14 original researches were included(totally 4 330 subjects and 11 970 controls),compared with the control,the occupational exposure to lead was significantly associated with spontaneous abortion(RR=2.83,95% CI:1.97-4.07)(P

Background Antigen retrieval method is the key of improving the successful rate of immunohistochemical assay in paraffin sections.To study an available method of antigen retrieval is a goal to achieve both good immunochemistry result and preserving retinal proteins.ObjectiveThe aim of present study is to investigate tyrosin digestion,high-temperature heat pressure,water bath heating and microwave repair in antigen retrieval for retinal tissues.MethodsRetinal tissue was isolated and obtained from clean Chinchilla rabbits.Four hundreds retinal paraffin sections were prepared.Four kinds of antigen retrieval methods for retinal tissue including tyrosin digestion,high-temperature heat pressure,water bath heating and microwave repair were used respectively.The depigmentated retinal paraffin section without antigen retrieval was used as control.The positive rates of expression of CRALBP,Rhodopsin and opsin proteins were evaluated and compared among four kinds of antigen retrieval methods by immunochemistry.ResultsCRALBP,Rhodopsin and opsin protein was positively expressed in cytoplasm of retinal pigment epithelial cells and the outer segment of photoreceptor respectively.No significant difference was found in the positive expression rates of these three proteins among four kinds of antigen retrieval methods (P＞0.05),but the differences in tissue integrity and background staining were statistically significant (P＜0.01).The structural damage of retina included loss and pucker of scalera,crack of nucleus and abnormal background stain in high-temperature heat pressure method,water bath heating method and microwave retrieval method.However,stable CRALBP,Rhodopsin and opsin protein expression and strain effectiveness,clear background without unspecific staining and integrated tissue were seen in tyrosin digestion method.ConclusionDuring the clinical pathology analysis of retinal tissue,the application of tyrosin digestion in antigen retrieval could obtain a better effectiveness.

Objective To summarize the effect of laparoscopic repair of acute gastric perforation. Methods Patients with acute gastric perforation underwent laparoscopic repair and abdominal drainage under intravenous- inhalation general anesthesia after a histological biopsy. Results Forty-six patients with acute gastric perforation were successfully operated.Of which, 6 patients with pylonic perforation, 37 patients with perforation in the front wall of gastric antrum, 3 patients with perforation in stomach body. Thirty-three cases were received frozen section biopsy, only 1 case showed a cancer in the lesser curve of stomach body. There was no complications occurred and no operative mortality in this series. Of the 45 benign ulcers patients,31 patients were discharged 7 days after the operation, 14 patients were discharged 2 weeks after medication treatment.Three months after operation the symptoms of the 45 patients disappeared totally,they had normal diet,and got body weight 1-3kg. Pathological examination showed that no malignant cell was found in 45 benign ulcer patients. The cancer patient was discharged 9 days after operation and refusing to further treatment. Conclusions Laparoscopic repair is a safe mini-invasive method, and it isn′t breach the surgical principles,it allows the patients recover quickly and with less complications. The intraoperative biopsy can prevent misdiagnosis of cancer. It is an effective treatment for acute gastric perforation and worthy to be widely used.

Objective To discuss the effect of MST1 (mammalian sterile 20-like kinase 1,MST1) on the prolifera-tion,migration and invasion of SiHa cervical cancer .Methods Western blot was used to detect the expression of MST1 in cervical epithelial cells H8 and cervical cancer cells SiHa;PJ3H-HA-MST1 was constructed and transfect-ed it to SiHa cells by Lipofectamine TM3000;MST1, Ki-67 and MMP9 protein expression were evaluated by Western blot;While the proliferation ,migration and invasion of SiHa cell were assessed by MTS ,scratch adhesion test and Transwell assay respectively .Results Compared SiHa cells with H 8 cells,MST1 expression in SiHa cells was sig-nificantly lower than that in H8 cells.The plasmid was successfully transfected into SiHa cells , MST1 expression was significantly higher , while the expression of Ki-67 and MMP9 was lower .The proliferation , migration and inva-sion ability were all significantly suppressed .Conclusions Overexpression of MST1 can inhibit the proliferation , migration and invasion of cervical cancer cell line SiHa .

Objective To observe the curative effects of anti-vascular endothelial growth factor (anti-VEGF) intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope for neovascular glaucoma (NVG).Methods NVG patients with uncontrolled intraocular pressure (IOP) and retinopathy was enrolled from May,2014 to May,2016.Eighteen patients were enrolled with 15 males(15 eyes) and 3 females(3 eyes) with age at (61.7 ± 13.9) years old.Anti-VEGF intracameral and intravitreal injection with anterior chamber puncture was performed in the first day of sequential treatment.Trebeculectomy was performed 3-5 days after injection and finally the pan-retinal photocoagulation was started 5-7 days after anti-glaucoma surgery.The best corrected visual acuity (BCVA),IOP,cornea,neovascularization of iris and retinal disease were observed and recorded.Results The diagnosis included 1 eye with central retinal artery occlusion (CRAO),6 eyes with central retinal vein occlusion (CRVO),5 eyes with branch retinal vein occlusion,5 eyes with proliferative diabetic retinopathy and 2 eyes with combined CRAO and CRVO.IOP before and after treatment were (43.5 ±5.1) mmHg (1 kPa =7.5 mmHg) and (15.2 ± 2.2) mmHg,there was significantly statistical difference (t =21.68,P ＜0.001).The categories of antiglaucoma medicines were 5.1 ± 0.5 and 0.5 ± 1.0 before and after treatment respectively,and the difference was statistical significant (t =12.30,P ＜ 0.001).BCVA was improved in 4 eyes,maintained in 13 eyes and decreased in only 1 eye.Conclusion The sequential treatment including anti-VEGF intracameral and intravitreal injection,trabeculectomy and pan-retinal photocoagulation by indirect ophthalmoscope is safe and effective.

Objective To explore the factors influencing serum trough concentration of vancomycin in pediatric patients with severe gram-positive cocci pneumonia. Methods The general information, the biochemical test results, and plasma concentration of vancomycin were collected from 93 pediatric patients with severe gram-positive cocci pneumonia. The relative factors influencing trough concentration of vancomycin were analyzed retrospectively. Results With the dosage of 40-60 mg/(kg·d), serum trough concentration of vancomycin were between 10-20 mg/L in 26 patients, <10 mg/L in 54 cases, ≥20 mg/L in 13 cases. The ALT, AST, GFR, and γ-GT were significantly different among three groups (P<0.05); the 10-20 mg/L group had the highest levels of AST and γ-GT, the ≥20 mg/L group had the highest level of ALT and the lowest level of GFR. Multiple linear regression analysis showed that GFR was negatively linearly correlated with the serum trough concentration of vancomycin (R2=0.039, P<0.05). The median serum trough concentration of vancomycin in pediatric patients with GFR≥90, 60–90, 30–60 mL/(min·1.73m2) were 8.66, 18.21, 8.45 mg/L respectively, and the difference is statistically significant (P<0.05). Conclusions The serum trough concentration of vancomycin is negatively linearly correlated with GFR in pediatric patients with severe gram-positive cocci pneumonia. The patients with impaired renal function are easier to reach the target serum trough concentration of vancomycin. Clinical use of vancomycin should follow the low doses in the range the guideline recommended, and the serum trough concentration should be closely monitored.

Objective To analyze the etiologies of severe vitreous hemorrhage in venerable age patients.Methods A retrospective series case study was adopted.Medical records of 30 cases 30 eyes severe vitreous hemorrhage venerable age patients were analyzed in Xuanwu Hospital Capital Medical University,Peking University Third Hospital and Beijing Tsinghua Chang Gung Hospital from July in 1999 to June in 2015.Visual acuity,intraocular pressure,anterior segment slit lamp microscopy,mydriasis funduscopy and ophthalmic B type ultrasound examination were used to evaluate 30 cases 30 eyes.Thirty eyes were all treated with pars plans vitrectomy (PPV).Results Mydriasis funduscopy examination showed that vitreous hemorrhage was so dense in 30 eyes that the fundus cannot be observed.The initial visual acuity examination showed that 8 eyes were count finger,5 eyes were hand move,16 eyes were light perception,and 1 eye was no light perception.There were dense light spots or clusters of high echoes in vitreous cavities,complete/incomplete posterior vitreous detachment (PVD) of all eyes;retinal detachment with different degrees in 5 eyes;proliferating cord adhesion to the wall of eyeball in 3 eyes.The etiologies included retinal vein occlusion (RVO) in 10 eyes (33.33％),retinal tear or retinal detachment in 7 eyes (23.33％),polypoidal choroidal vasculopathy (PCV) in 7 eyes (23.33％),proliferative diabetic retinopathy (PDR) in 4 eyes (13.33％).The above 4 etiologies were in 28 eyes,accounting for 93.33％.The others were ocular trauma in 2 eyes (6.67％).Conclusions The main cause to severe vitreous hemorrhage venerable age patients is RVO,followed by retinal tear or retinal detachment,PCV and PDR.Ocular trauma is rare.Vitrectomy is a diagnostic treatment,which can remove vitreous hemorrhage,improve the visual acuity of the patients,and determine the etiologies of the vitreous hemorrhage.

In recent years, with the in-depth study of PD-1 and PD-L1 and the development of immunotherapy, the first problem is how to screen the beneficiaries. Recent clinical studies have shown that the expression level of PD-L1 in circulating tumor cells (CTC) can be used as a potential biomarker to play a guiding role in immunotherapy of malignant tumors. This article reviews the latest clinical research progress on the expression of PD-L1 in circulating tumor cells in various solid tumors.