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.

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.

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 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.