Objective To explore the value of abdominal wall lifting devices in laparoscopic cholecystectomy.Methods Patients who were going to receive laparoscopic cholecystectomy were randomly divided into two groups:one group underwent pneumoperitoneum(Gas group,n=38),the other group was treated with gasless technique using a subcutaneous abdominal wall lifting devices(Gasless group,n=37).Parameters including operation time,blood loss,real-time results of arterial blood gas analysis,postoperative hospital stay,post-operative ACTH and complications were compared between the two groups.Results The operation was completed in both the groups.There existed significant difference in the mean operation time and blood loss between the two groups [Gas group vs Gasless group:(34.2?7.7) min vs(46.7?16.8) min,t=-4.160,P=0.000 and(10.4?2.0) ml vs(14.8?7.2) ml,t=-3.627,P=0.000];whereas,no significant difference was found between the two in the real-time results of arterial blood gas analysis,postoperative hospital stay [(3.7?0.7) d vs(3.9?1.2)d,t=0.884,P=0.379] and post-operative level of ACTH(5.66 pmol/L vs 5.48 pmol/L,Z=0.748,P=0.436).No severe complications occurred in both the groups.In the gasless group,20 of the 37 patients developed subcutaneous emphysema,while none of the Gas group showed the symptom.Conclusion Gasless abdominal wall lift device is safe and simple,resulting in quick recovery without leading to pneumoperitoneum-related complications.

[Objective]To assess the effect of femoral head reshaped surgery for treatment of collapse stage of femoral head necrosis in dogs.[Method]Experimental femoral head necrosis models were made in unilateral femoral head of 10 adult dogs.Under anaesthesia,the necrotic mass in the collapse area of femoral head necrosis was fully curreted through a passage from femoral neck to callapse head,a self-designed ball-tube apparatus enveloped with a cannula was put into under the curreted area,normal saline injected to fill the ball in the collapse cavity till the collapse area forced to reshape a spherical femoral head;After withdraw of normal saline,bone cement of calcium phosphate was injected into the reshaped cavity to maintain the reshaped femoral head.Finally the ball-tube apparatus was taken out.Preoperative and postoperative X-ray film of femoral head were taken to evaluate the reshaping.Femoral heads of experimental side and normal femoral head of contralateral side as control were take out after the dogs sacrifice for biomechanical examination of maximum compression strength.[Result]In experimental group,as compared to preoperative radiograms,the postoperative radiograms of 10 dogs showed the curreted necrotic cavity was fully filled with bone cement and reshape was maintained.The maximum comopression strength of femoral heads of control group was 49 Mpa to 60 Mpa,and that of experimental group was 49~54 Mpa with no statistical significant difference.[Conclusion]Femoral head reshaping surgery may be a method of choice for treatment of collapse stage of femoral head necrosis in experimental animal,but long-term effect should be evaluated thereafter.

Objective To study the effects of staphylococcal enterotoxin B(SEB) on the proliferation of tumor infiltrating lymphocytes(TILs) from rectum adenocacinoma.Methods The TILs from patients with rectum adenocacinoma were stimulated with SEB and interleukin 2(IL-2) respectively,and then the proliferation of TILs,the secretion of IL-2 and tumor necrosis factor-?(TNF-?) were determined.Results SEB presented profound stimulating effect on the TILs from rectum adenocarcinoma both the proliferation of TILs and the secretion of cytokines.Compared with the IL-2,SEB stimulated TILs more quickly,and SEB acted more effectively in the early stage but weakly in the late stage.Conclution SEB was an effective TIL stimulator.

Objective To investigate the effect of laparoscopic surgery on the change of hepatic function, in terms of serum liver enzymes and to explore its possible mechanism. Methods The blood samples from 286 patients before and after LC were evaluated for liver enzyme levels. The results were compared with those taken from 40 open cholecystectomy (OC) patients. In order to evaluated the possible effect of CO2 pneumoperitoneum on serum liver enzyme levels, same blood tests were also performed in two groups of color-ectal cancer patients undergoing either laparoscopic resectormy( LCR,n =68) or open resection( OCR,n = 23). Results Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in LC and LCR patients were significantly increased after operation. These changes occurred in every group that had demonstrated remarkable difference before and after the operation (P

Objective To study the technique of modified multi-slice spiral CT aniography(MSCTA) for displaying the whole length of the carotid arteries and the origin of the vertebral arteries,and to evaluate its clinical value.Methods A total of 152 patients underwent modified MSCTA of extracranial carotid artery which scanned from skull base to aortic arch with contrast medium injected from the femoral vein, the image quality and the detection of lesions were assessed in comparison with that of DSA in a few of cases. Results (1) The jugular vein was displayed in 4 cases, only accounting for 2.63%. (2) The carotid segments including the proximal common carotid artery(CCA), the middle CCA, the carotid bifurcation, the internal carotid artery(ICA) bulb and the distal ICA could be visualized adequately by MSCTA,the showing rates were 97.69%,97.69%,97.69%,95.62% and 97.64%,respectively. Furthermore, moderate or severe stenosis detected by MSCTA in 17 cases was closely corresponding with the results of DSA. Conclusion Modified MSCTA of extracranial carotid artery can display the whole length of extracranial carotid artery and the origin of the vertebral arteries satisfactorily without the interference of the jugular, subclavian and innominate veins, and can improve its clinical application.

Objective:To investigate the effect of liquiritin on the apoptosis of amygdala cell and the expression of apoptosis-related factors Bax and Bcl-2 protein in rats with post-stroke depression (PSD).Methods:Sixty rats were randomly divided into normal control group, stroke group, PSD group, citalopram group, liquiritin group, and normal saline control group ( n=10 in each group). The middle cerebral artery was occluded with a suture method to induce focal cerebral ischemia, and the PSD model was established by chronic and unpredictable mild stress stimulation and orphanism. At the same time every week after the model was made, the weight of rats in each group was measured and the depression behavior was evaluated, including sucrose water test and open field test. At 6 weeks after the model was made, TUNEL staining was used to detect the apoptosis of amygdala cell, immunofluorescence staining was used to detect the expression of Bax and Bcl-2 in the amygdala, and Western blot analysis was used to detect the protein expression of Bax and Bcl-2 in the amygdala. Results:Compared with the liquiritin group, citalopram group and normal control group, the body weight and sucrose solution preference of rats in the stroke group, PSD group and normal saline control group were decreased, and the horizontal and vertical movements in open field test were decreased; the differences were statistically significant (all P<0.01). TUNEL staining results showed that compared with the liquiritin group, citalopram group and normal control group, the number of apoptotic cells was significantly increased in the stroke group, PSD group, and normal saline control group; the difference was statistically significant (all P<0.01). The results of immunofluorescence staining showed that compared with the liquiritin group, citalopram group and normal control group, the number of bcl-2 immunoreactive cells in amygdala of the stroke group, PSD group and normal saline control group was significantly decreased, while the number of Bax immunoreactive cells was significantly increased; the difference was statistically significant (all P<0.01). Western blot analysis showed that compared with the liquiritin group and citalopram group, the expression of bcl 2 protein in amygdala of the stroke group, PSD group and normal saline control group was significantly decreased, while the expression of Bax protein was significantly increased; the difference was statistically significant (all P<0.01). Conclusion:Liquiritin can alleviate the symptoms of PSD, and its mechanism may be related to inhibiting the apoptosis of amygdala cells and regulating the expression of apoptosis-related factors.

Objective:To observe the changes of protein expression of apoptosis signal pathway in prefrontal cortex of rats with post-stroke depression(PSD) after lateral ventricle injected of brain-derived neurotrophic factor precursor(proBDNF).Methods:Among 55 healthy adult female SD rats, 25 rats were randomly selected as PSD group, and the other 30 rats were randomly divided into normal group ( n=10), depression group ( n=10) and stroke group ( n=10). The middle cerebral artery occlusion(MCAO) model was established by thread occlusion in the stroke group, the chronic stress depression model in the depression group was established by the combination of chronic unpredictable mild stress(CUMS) and the solitary feeding method.And the rats in the PSD group were established MCAO model first, then they were received CUMS stress and solitary rearing one week later so as to establish PSD model.Two weeks after the establishment of the model, 15 rats in PSD group were randomly divided into proBDNF group, rats in tPA group and NS control group.One week after buried tube of lateral ventricle, rats in tPA and proBDNF were injected into the lateral ventricle for one week.The protein expressions of c-Jun N-terminal kinase(JNK), p-JNK, p53, p-p53 and Bax in prefrontal cortex of rats in each group were detected by Western blot at the 4th and 8th week after modeling.SPSS 17.0 software was used for data analysis, one-way ANOVA was used for comparison between groups, and SNK- q was used for pairwise comparison. Results:The expressions of p-p53, p53, p-JNK, JNK and Bax in prefrontal cortex of normal group, depression group, stroke group and PSD group were significantly different at the end of 4th and 8th week after MCAO modeling ( F=3.426-90.355, all P<0.05). Post-hoc analysis showed that, compared with the normal group, the expressions of p-JNK (0.378±0.042) and Bax (0.478±0.054) in the prefrontal cortex of PSD rats increased significantly at the end of the 4th week(both P<0.05), and the expressions of p-JNK(0.411±0.056), p-p53 (0.286±0.083) and Bax (0.471±0.008) in the prefrontal cortex of PSD group increased significantly at the end of the 8th week(all P<0.05). After lateral ventricle injection of proBDNF, there were significant differences in the expression of p-p53, p53, p-JNK, JNK and Bax among proBDNF group, tPA group and NS group ( F=16.915-287.039, all P<0.01). Post-hoc analysis showed that, compared with NS group, the expressions of p-JNK (0.35±0.01)and p-p53 (0.31±0.01)in prefrontal cortex of proBDNF group increased significantly(both P<0.05). After lateral ventricle injection of proBDNF, there were significant differences in body weight, sucrose preference rate, horizontal movement distance among proBDNF group, tPA group and NS group ( F=18.741-76.305, all P<0.01), and compared with tPA group and NS group, behavioral indexes of proBDNF group (body weight (224.36±3.23) g, sucrose preference rate (69.83±1.72)%, horizontal movement distance (57.93±2.09) blocks, vertical movement distance (19.79±1.81)) decreased significantly(all P<0.05). Conclusion:The proBDNF promotes the activation of apoptosis signal pathway in the rats with PSD.

Objective To investigate awareness of definition, diagnostic criteria, severity classification and standard diagnosis and treatment for chronic obstructive pulmonary disease (COPD) among primary-care physicians at the grassroots in urban and suburban Shanghai.Methods In total, 298 physicians were surveyed by unified questionnaire for COPD-related knowledge in two secondary-care general hospitals (one in urban and suburban areas each ) and 12 community primary-care centers (four in urban and eight in suburban areas) in Shanghai.One hundred and fifteen physicians in two urban hospitals and one suburban hospital were trained professionally and then evaluated for its effectiveness.Results Awareness of diagnostic criteria of COPD was only 22.4% (35/156), 25.6% ( 10/39), 4.3 % (3/69)and 26.5% (9/34) among physicians in urban primary-care hospitals, urban secondary-care hospitals,suburban primary-care hospitals and suburban secondary-care hospitals, respectively.Their awareness of knowledge about use of anti-cholinergic agents was 13.5 % (21/156), 35.9 % ( 14/39), naught (0/69),and 14.7 % ( 5/34 ), respectively.Only 0.67 % of them ( 2/298 ) knew about severity classification of COPD.Awareness of definition and diagnostic criteria for COPD in the physicians increased to 72.2 % ( 83/115) after training from 18.2% (21/115) before it, and their awareness of severity classification for COPD increased to 45.2% (52/115) after training from 0.8 % (1/115) before it.Conclusions Awareness of COPD-related knowledge, especially of standard diagnosis and treatment for COPD, was poor in primary-care physicians at the grassroots in Shanghai, so it is necessary to strengthen training for them in COPD-related knowledge, including pulmonary function tests.

Objective To explore the clinical effect of procedure for prolapse and hemorrhoids (PPH) treating for Ⅲand Ⅳ degree hemorrhoid under the local anesthesia.Methods One hundred and fifty patients with Ⅲ and Ⅳ degree hemorrhoid were divided into two groups randomly.One group was the local anesthesia group (LA group) which included 73 cases,the other one was the combined spinal epidural anesthesia group (CSE group) which included 77 cases.Compared the safety and efficacy of different procedure.Results The original symptom of the two groups were improved.There was a significant difference in the time of hospitalization time and the hospitalization expense between the two groups (P＜0.05).The LA group was(4.8±1.1)days with(3980±639)yuan,and the CSE group was(6.8±1.1) days with(5128±728)yuan.The rates of two groups of urine retention were 9.6% and 24.7% (P＜0.05) after the operation respectively,and there were no significant differences in recovery normal activity time,the pain index,copracrasia and pruritus,the bleed,the anal fistula,the prolapse of hemorrhoid,the skin tag (P ＞0.05).Conclusion PPH under the local anesthesia is safe,compare to the combined spinal epidural anesthesia,it excels in shortening the hospitalization time and reducing the hospitalization expense,also it can reduce significantly the rate of urine retention after operation.

Objective To analyze the imaging characteristics of patients with recurrence of acute cerebral ischemic stroke,select and predict relevant imaging factors,to guide clinical treatment and prevention.Methods Data of 30 patients with acute cerebral ischemic stroke (recurrent group)and 40 patients with primary cerebral ischemic stroke (non recurrent group)were collected.Imaging characteristics of first onset of recurrent group and non recurrent group were analyzed.Leukoaraiosis,a large area of infarction,cortical infarction,carotid artery plaque,arteriosclerosis,incomplete Willis ring,watershed infarction and other risk factors were screened,to determine the association between these risk factors and recurrent cerebral ischemic stroke.Results Recurrence of cerebral ischemic stroke was associated with leukoaraiosis,carotid artery plaque and incomplete Willis ring (P values were 0.024,0.021,0.003).There was no correlation between recurrence of cerebral ischemic stroke and a large area of infarction,cortical infarction,arteriosclerosis and watershed infarction (P values were 0.233,0.945,0.072,0.375).Conclusion Leukoaraiosis,carotid artery plaque and incomplete Willis ring may be risk factors for recurrence of cerebral ischemic stroke.Those signs can provide imaging evidence for secondary prevention of cerebral ischemic stroke.