Objective To report our experiences in difficult laparoscopic cholecystectomy (LC). Methods The clinical data of 201 cases of difficult LC performed from March 2006 to December 2008 were analyzed retrospectively,and the surgical operation approaches were summarized. The cases included 107 patients with pyknotic conglutination around the gallbladder or gallbladder triangle area,38 patients with gallbladder neck stone,11 patients with suppuration or gangrene of the gallbladder,18 patients with atrophy of the gallbladder,and 17 patients with operation history in the upper abdomen. Results The LC was completed in 193 of the cases,the other 8 cases were converted to open surgery. The causes for conversion to open surgery included intractable bleeding at the gallbladder triangle in 3 patients,the gallbladder being covered by stomach,colon and duodenum in 1,gallbladder gangrene in 1,bile leakage resulted from slightly lacerations of the posterior wall at the confluence of the gallbladder and bile duct in 2,and frozen likeness of the gallbladder triangle in 1. The complications of LC included intestinal obstruction (1 case),pulmonary infection with respiratory dysfunction (1 case),and postoperative bleeding (1 cases). No extrahepatic bile duct injury and death occurred in this series. Conclusions For difficult LC,we must abide by the rules as follows: to dissect as far as possible adjoin to the gallbladder;to discriminate the tissues or organs before cutting it;to execute LC in combination with mute and acuminate dissection and antegrade and retrograde approach for resection;to make pneumoperitoneum through a small incision for patients with history of operations in the upper abdomen. Only obey the laparoscopic surgical principle and use correct surgical approaches,can we reduce the incidence rates of complications and conversion to open surgery.

[Objective] To discuss the effect of intestine-dredging and Qi-benefiting method and its corresponding prescription in managing systemic inflammatory response and preventing multiple organ dysfunction syndrome (MODS). [Methods] Eighty. SD rats were randomized to control, model, low-dosage (LD) and high-dosage (HD) groups. One day before modeling, HD and LD groups were administered the preparation based on intestine-dredging and Qi-benefiting method by 60g/kg and 30 g/kg for 2 times, and control and model groups were given equal amounts of normal saline. On the 2nd day after the administration, 3 groups except the control group were modeled on the given reference. Twelve hours after modeling, the content of TNF-? and NO in serum was examined and histopathological examination of the main organs was conducted. [Results] Compared with the control group, the level of TNF-? and NO significantly increased (P

This article discusses the production of CAI courseware and the problems of its application to teaching process,to make full use of it and acquire satisfactory teaching effects.

Objective To explore the value of phase-contrast magnetic resonance imaging (PC-MR) in diagnosis of secundum atrial septal defect (ASD) in pediatric patients. Methods Totally 42 patients (aged from 9 months to 15 years) with secundum ASD proved with tansthoric echocardiographic (TTE) were evaluated with PC-MRI. Images of the flow through ASD were obtained with PC-MRI. The distances of ASD rim to superior vena cava (SVC), inferior vena cava (IVC), atrioventricular valves (AVV) and right upper pulmonary vein (RUPV), as well as the entrances of the vena cava and right upper pulmonary vein (RUPV) were assessed. Results The sizes of ASD and distances of ASD rim to the adjacent structures (SVC, RVC, AVV and RUPV) at PC-MRI were well consistent with those of TTE in 42 patients (P<0.001). PC-MRI results in 26 patients correlated well with surgical results (P<0.001). With different velocity encoding, compared with surgical results, measurements of ASD's sizes were more accurate when setting velocity from 50 to 70 cm/s than 90 cm/s. Conclusion The shape of ASD can be virtually depicted with PC-MRI. PC-MRI can accurately assess the defect size, number, rim distances to adjacent structures, therefore providing a new method for depiction of congenital heart anomaly.

Objective　To study anticipated value of the retention rate of indocyanine green at 15 minutes after injection (ICGR15) and oral glucose tolerance test (OGTT) on hepatic function reserve in patients with primary hepatic cancer (PHC). Methods　58 patients with PHC were divided into 3 groups according to the recovery after operation for PHC. Of them, 29 cases showed good recovery (group A), 18 mild liver dysfunction (group B) and 11 severe liver dysfunction (group C) respectively. ICGR 15, OGTT, routine liver function tests were performed in all 　patients preoperatively. Results　　ICGR15 in group C(24.17%±6.59%) obviously increased than that in group A(11.42%±3.91%,P<0.01) and in group B(16.28±6.07%, P<0.01). 　Blood glucose lever of 120 min after glucose loading test in group C (9.91 mmol/L±3.09 mmol/L)was significantly higher than that in group A(5.42 mmol/L±0.83 mmol/L, (P<0.01)and group B(6.68±1.61, P<0.01). 　The accuracy (81.0%,86.2%), positive (90.6%, 93.5%) 　and negative prediction value (72.5%, 74.4%) of OGTT and ICGR 15 were respectively significent greater than those of Pugh's scoring (P<0.01).Conclusions　ICGR15 and OGTT are worthwhile indicators to assess hepatic function reserve for patients with PHC. Combination of both ICGR15 and OGTT has higher predictive value on hepatic function reserve.

Objective To analyze the clinical value of gastric bacterial cultivation in the early diagnosis of bacterial infection in preterm infants.Methods 174 preterm with risk perinatal factors of infection in NICU of Chang’an Hospital from January 2013 to December 2014 were collected,they were given the gastric juice cultivation checking in 1 hour after birth before eat-ing,watering and giving medicine.According to the clinical symptoms and laboratory test results,they were divided into the infected group and non-infected group.Their Gastric cultivation inspection was compared and analyzed in two groups.Results The positive rate of bacterial culture of gastric fluid was 40.8% (71/174),and located in the top four is Escherichia coli 30.99% (22/71),coagulase-negative staphylococci 21.13%(15/71),Staphylococcus aureus 14.08%(10/71)and group B streptococcus 8.45% (6/71).There was relation between premature infants with bacterial culture positive and meconium stained amniotic fluid,maternal infection during pregnancy,premature rupture of membranes,but not with gestational hyper-tension,fever unrelated to the mother giving birth.Conclusion There was high positive rate of gastric juice bacterial culture with a significant correlation of early onset infection.

Objective To study a kind of video transformation algorithm based on FPGA in view of the present situation that the video output of X-ray equipment can not be connected to common video adapter.Methods Through the control of non-standard video signal AD sampling data read-write succession in FIFO,800 digital sampling data was output(output resolution:800?600,refresh rate:60Hz)in the period of every line of effective signal.The output module combined these data with line and field synchronized signal and transform them into standard VGA signal.Results Non-standard medical video signal could be transformed into standard medical video signal by using VHDL in normal FPGA.Conclusion The speed of this algorithm is high,and the transformation effect is clear and smooth.

Objective: To evaluate the targeting activity in the animal model with human hepatoma, the 131I-human antiHBsAg Fab radioimmunoimaging was explored. Methods: Radioimmunoimagings were taken on different intervals after injection of 131 I-human anti-HBsAg Fab to the nude mice and tissue distribution was measured. The human anti-HBsAg Fab was compared with the murine monoclonal antibodies. Results: The experimental group developed tumor positive images after 3 days of radio-labeled monoclonal antibodies injection, and the peak accumulation of radio-activity on the 5th day.Statistics indicated the tumor/liver ratio of the human anti-HBsAg Fab, murine monoclonal antibodies and the control groups were 5.4,4.0 and 0.9 respectively on the 7th day. Conclusions: Our results suggest that the 131 I-human anti-HB-sAg Fab has a considerable targeting activity, and provide an evidence that it can be used as a novel humanized carrer for targeting therapy of hepatoma.

Objective To observe the effect of costimulatory molecule B7-1 on cytoskeleton rearrangement in mouse podocytes induced by angiotensin Ⅱ (Ang Ⅱ),and to study the underlying molecular mechanism of B7-1 in the pathological changes of podocytes.Methods All cultivation of conditionally immortalized mouse podocytes (MPC) in vitro were divided into the following groups:normal control group,CTLA-4 group,Ang Ⅱ group (10-6 mmol/L 12 h,24 h;10-8 mmol/L 12 h,24 h) and CTLA-4 with Ang Ⅱ group.Transfect B7-1 RNA interference fragment (siRNA) to the mature podocytes,and then restimulated by Ang Ⅱ (10-6 mmol/L 12 h),the change of podocyte cytoskeleton after Ang Ⅱ stimulation were observed.The expression of B7-1 in each group was assayed by flow cytometry and Western blotting.The nephrin and p-nephrin protein levels in the four groups were also analyzed by Western blotting.At the same time,the podocyte cytoskeleton distribution as indicated by F-actin was observed by fluorescence microscopy.Results Flow cytometry and Western blotting showed that B7-1 was not expressed in the normal control group.Ang Ⅱ showed a concentration and time dependent induction of B7-1 expression in mouse podocytes (P ＜ 0.05).Western blotting indicated that Ang Ⅱ induced B7-1 protein expression (P ＜ 0.05).Expression of nephrin and p-nephrin was significantly down-regulated by Ang Ⅱ (P ＜ 0.05).Compared with the normal control group,the expression of podocyte protein nephrin and p-nephrin in Ang Ⅱ stimulation group was significantly reduced (P ＜ 0.05).Using FITC phalloidin fluorescence staining showed that CTLA-4+Ang Ⅱ stimulation group cytoskeleton rearrangement was improved significantly and F-actin recombinant score (mCFS) decreased compared with Ang Ⅱ group (P ＜ 0.05),suggesting that Ang Ⅱ led to the disorder of the podocytes cytoskeleton and the destruction of the cytoskeleton of podocytes by Ang Ⅱ could be improved after B7-1 blocking.Compared with the Ang Ⅱ stimulation,transfection of B7-1 siRNA + Ang Ⅱ stimulation group improved F-actin cytoskeletal rearrangement,and mCFS also decreased significantly (P ＜ 0.05),suggesting that transfection of B7-1 siRNA might improve the damage of Ang Ⅱ on podocytes cytoskeleton.Conclusions B7-1 participates in the process of cytoskeleton reconstruction and plays an important role in the pathological changes of podocytes.

Objective To understand the distribution and drug resistance of pathogens isolated from blood culture samples Chang’an Hospital from 2012 to 2014 to provide basis for rational use of antibacterial drugs.Methods The clinical date of distribution,changes and drug resistance of main pathogens in blood culture samples during 2012 and 2014 in chang anhospi-tal were retrospectively analyzed.Results 512 pathogenic bacterial strains were isolated from 4 792 blood culture samples in 2012~2014.Among them,gram-negative bacteria accounted for 62.50% (320/512),Escherichia coli ,Klebsiella pneumoni-ae and Pseudomonas aeruginosa accounted for 25.20% (129/512),14.26% (73/512)and 8.20% (42/512)respectively;Gram-positive bacteria accounted for 29.30% (150/512),Staphylococcus aureus and Coagulase-negative Staphylococcus ac-counted for 11.52% (59/512)and 10.16% (52/512)respectively.The rate of fungi was 7.62% (39/512).Susceptibility re-sults showed that Escherichia coli and Klebsiella pneumoniae had highly sensitive to carbapenems,but had a varying degrees of resistance to other antibacterial drugs.The rate of drug resistant of Gram-positive cocci to Penicillin,Erythromycin and Clindamycin had been a high level,but no strains being resistant to van comycin and linezolid had been detected.Conclusion The pathogens causing bloodstream infection widely distribute,and have highly drug-resistant.It is necessary to under-stand the distribution of pathogens isolated from blood culture as well as the changes of drug resistance in a timely manner so as to guide the reasonable clinical medication.