Objective Seen from the laparoscope, there is massive adhesion after the peritonitis, an operation with a large incision or radiation treatment in right upper abdomen. After failing to dissociate the adhesion and create e-nough space with the help of laparoscope, the laparoscopic cholecystectomy from the left upper abdomen is adopted depending on the specific situation to explore the possibility and practicability of creating instrument channel and operating space. Methods From May 2001 to May 2015, 13 patients (with a medical history of peritonitis, an opera-tion with a large incision, serious peritonitis or radiation treatment in right upper abdomen) were received operations of laparoscopic cholecystectomy, adhesion was serious near the trauma or otherwise. During the operation, massive adhesion was found in the right upper abdomen. The conventional LC did not work. Instrument channel and operat-ing space were created from the left upper abdomen through facies inferior hepatis and falciform ligament. LC cost 70 minutes to 155 minutes with an average of 117 minutes. Results LC of 13 patients (with a massive adhesion) from left upper abdomen was successful. In this way, it was easy to create instrument channel and operating space and avoid the massive adhesion. The operations took a longer time without injuring stomach intestines and bile vessel. Conclusion Acquired adhesion's peculiarity is negative correlation with distance, LC from the left upper abdomen through facies inferior hepatis and falciform ligament can be avoided the disassociation of massive adhesion and be created the instrument channel and operating space. The two ways are proved to be effective.

The experimental myocardial damages were induced in Wistar rats by noradrenaline infusion (20ug/kg body wt/minute)for a period of 90 minutes daily for three consecutive days. The animals weresacrificed few minutes (acute phase), 7 days(subacute phase),and 30~90 days (chronic phase)afterinfusion. Specimens of myocardium were examined by histopathological, immunohistochemical and ultrastructural methods. Multiple focal necrosis, deficient of myoglobin in myocytes, myofibrillar fragmentation and dissolution were observed in the acute phase. The mdrphofogical feature simulated themyocardial infarctinn without coronary occlusion. Focal myocardial atrophy, scar f0rmation of myocardium, proliferation of fibroblasts and infiltraiton of the neo-colleagenous fibrils in necrotic myocytes were observed in the subacute and chronic phase. This feacture simulated the early cardiomyopathy.

Objective To evaluate the efficacy and safety,particularly eye safety of hydroxychloro-quine(HCQ)treatment in primary Sj(o)gren's syndrome(pSS)patients.Methods Forty pSS patients were en-rolled and treated with HCQ 400 mg/day for 12 months.This is a prospective open-label study.Clinical mani-festations,clinical efficacy,biochemical and immunoserological parameters as well as ophthalmological exami-nations were investigated every three months to assess the safety and tolerability.Results There were signifi-cant decrease in the erythrocyte sedimentation rate(ESR),immunoglobulin G(IgG),immunoglobulin M (IgM)and rheumatoid factor(RF)level after 6 months treatment with HCQ(P＜0.01 or P＜0.05).No changewas detected in serum antinuclear antibody(ANA),anti-SSA/SSB antibodies after treated for 12 months.Somepatients had partial improvement in symptoms such as dry mouth,dry eyes and arthralgia.During the treat-ment,no significant effect on serum alanine aminotransferase (ALT),blood urea (BUN),serum creatinine (Cr),whole blood count(WBC)or hemoglobin(Hb)could be discovered.Central semus retinopathv(CSR)was found in one patient after 6 months treatment with HCQ.However,its association with HCQ could not be confirmed since it was not compatible with the usual HCQ retinopathy.Conclusion HCQ can improve svmp-toms of some pSS patients and can significantly decrease ESR,IgG,IgM and RF level.The safety profile of HCQ is generally good.However,ophthalmological examination before and after a 6-month interval may be necessary in long term HCQ treatment.

Objective:To explore the range of medical reference value of thyroid hormone of pregnant women in early pregnancy in Jinan after adjustment of salt iodine content, so as to provide basis for clinical diagnosis and treatment of thyroid diseases of pregnant women in early pregnancy.Methods:A prospective study was conducted in 560 pregnant women in early pregnancy (0-13 weeks) who had underwent prenatal examination and thyroid function testing in Shandong Provincial Maternal and Child Health Care Hospital from January to December 2018. At the same time, 100 healthy non-pregnant women who were examined in the Health Examination Center of Shandong Provincial Maternal and Child Health Care Hospital were selected as the control population. Urine samples of pregnant women in early pregnancy were collected, and urinary iodine content was detected by arsenic cerium catalytic spectrophotometry. Venous blood samples were collected from pregnant women in early pregnancy and control population, the serum levels of free triiodothyronine (FT 3), free thyroxine (FT 4) and thyroid stimulating hormone (TSH) were detected by electrochemiluminescence (ECL), and the medical reference values of FT 3, FT 4 and TSH were established. Results:The median urinary iodine of pregnant women in early pregnancy was 162.21 μg/L, which was in the appropriate level of iodine. After the adjustment of salt iodine content, the medical reference values of FT 3, FT 4 and TSH in pregnant women in early pregnancy were 3.86-6.15 pmol/L, 12.56-22.16 pmol/L and 0.01-3.48 mU/ L, respectively; and the medical reference values of FT 3, FT 4 and TSH in control population were 3.55-6.05 pmol/L, 9.93-20.58 pmol/L and 0.54-5.92 mU/L, respectively. Conclusions:The iodine nutrition of pregnant women in early pregnancy in Jinan is appropriate after the adjustment of salt iodine content. The medical reference values of FT 3, FT 4 and TSH in pregnant women in early pregnancy are different from those in the healthy non-pregnant women. Therefore, it is of clinical significance to establish a medical reference value range of thyroid hormone for pregnant women in early pregnancy.

AIM:To investigate the improvement effect of blood flow-limited resistance training on renal fibro-sis in type 2 diabetes mellitus(T2DM)rats and its potential mechanism to attenuate renal fibrosis by inhibiting the trans-forming growth factor β1(TGF-β1)/Smad3 signaling pathway.METHODS:The T2DM model was prepared by combining a high-fat diet and streptozotocin(STZ),and after successful modeling,the rats were randomly divided into a T2DM con-trol group,a low-load resistance training group,a high-load resistance training group,a blood flow restriction group and a blood flow restriction combined with resistance training group for 8 weeks of exercise.The renal index,fasting blood glu-cose(FBG),serum creatinine(SCr),and blood urea nitrogen(BNU)were recorded in each group.The morphological changes of the kidneys were observed by hematoxylin and eosin(HE)and Masson's trichrome staining,and the collagen volume fraction was calculated.The mRNA expression levels of renal Klotho,TGF-β1,and α-smooth muscle actin(α-SMA)were detected by RT-qPCR.The protein expression levels of renal Klotho,TGF-β1,Smad3,phosphorylated Smad3(p-Smad3),α-SMA and connective tissue growth factor(CTGF)were detected using Western blot.RESULTS:Compared with the other groups,FBG,SCr,BNU,and renal collagen volume fraction were significantly decreased in the blood flow restriction combined with resistance training group of rats(P<0.05),Klotho expression was significantly in-creased(P<0.05),and the expression of TGF-β1,p-Smad3,CTGF and α-SMA was significantly decreased(P<0.05),and there was no significant change in the expression level of Smad3(P>0.05).CONCLUSION:Blood flow restriction combined with resistance training attenuates renal fibrosis in T2DM rats,the mechanism of which may be related to the up-regulation of Klotho expression,disruption of the TGF-β1/Smad3 signaling pathway,and inhibition of the deposition of epi-thelial-mesenchymal transformation.

Objective To investigate the knowledge, attitudes and practices (KAP) towards scrub typhus control and analyse the influencing factors among residents in Longling County, Yunnan Province in 2023, so as to provide insights into management of scrub typhus in the county. Methods Two townships were randomly sampled from Longling County, Baoshan City, Yunnan Province in July 2023, and 2 to 3 administrative villages were randomly selected from each township. Then, 20 to 40 households were randomly selected from each village, and 1 to 2 villagers were surveyed in each household. Residents’ KAP towards scrub typhus control was investigated, and factor affecting residents’ KAP towards scrub typhus control were identified with independent samples t test or analysis of variance (ANOVA) and multiple linear regression analysis. Results A total of 417 questionnaires were allocated, and 410 valid questionnaires were recovered, with an effective recovery rate of 98.32%. Of all respondents, 65.85% (270/410) heard of scrub typhus but were not familiar with it, and 12.68% (52/410) and 1.95% (8/410) were familiar and very familiar with it, respectively. Residents mainly acquired scrub typhus control knowledge via their relatives and friends. The knowledge, attitude, and behavior scores of the respondents with regard to scrub typhus were (34.14 ± 13.07), (55.04 ± 6.69), and (21.40 ± 5.61), respectively, and the total score for knowledge, belief, and behavior in relation to scrub typhus prevention and control was (110.57 ± 18.80). Univariate analysis revealed that age (F = 3.12, P < 0.05), education (F = 10.77, P < 0.05), occupation (F = 4.89, P < 0.05), frequency of outdoor activities (F = 3.61, P < 0.05), and type of place of residence (t = 1.33, P < 0.05) were the factors that influenced the participants’ scores for knowledge of the prevention and control of scrub typhus. Multiple linear regression analysis revealed that literacy level (β = 10.20 to 16.71, P < 0.05) and category of residence (β = −7.23, P < 0.05) were the factors that influenced residents’ current knowledge and trust behavior in relation to scrub typhus. Conclusions Place of residence and educational level are critical factors affecting scrub typhus control among residents in Longling County, Yunnan Province. Intensified health education pertaining to scrub typhus control and appropriate behavioral interventions are required among residents living in urban areas, with a low educational level and frequent outdoor activities.