Objective To evaluate the laparoscopic repair for indirect inguinal hernia in children. Methods A total of 72 children with unilateral and 25 children with bilateral indirect inguinal hernia underwent laparoscopic high ligation of the sac. In operation a self-made needle introduced subperitoneally was used to pass a ligature circumferentially around the internal ring. Results All the operations were successfully completed. The average operating time was 10 min in unilateral hernias and 16 min in bilateral hernias. The postoperative hospital stay was 1 day. No surgical complications occurred. Follow-up for 2~60 months (mean, 31 months) in 70 children found no recurrence. Conclusions Laparoscopic repair for indirect inguinal hernia in children is safe, feasible and minimally invasive, offering a low complication and recurrence rate and a quick postoperative recovery.

Objective To study the value of sequential duodenoscopic-laparoscopic treatment in patients with cholelithiasis. Methods Clinical data of 2 248 cases of cholelithiasis treated with sequential duodenoscopic-laparoscopic plan from January 2000 to December 2004 were retrospectively reviewed. Results Duodenoscopy indicated the confirmative diagnosis of gallbladder stones in 1 817 cases and gallbladder stones with associated common bile duct stones in 431 cases. Among 2 021 cases diagnosed as having gallbladder stones by B-ultrasonography: endoscopic retrograde cholangiopancreatography (ERCP) was performed in 690 cases, 213 of which were found having associated common bile duct stones; intraoperative cholangiography (IOC) was conducted in 85 cases, 10 of which were found presenting common bile duct stones; residual stones in the common bile duct after laparoscopic cholecystectomy (LC) were noted in 6 cases which were cured by endoscopic sphincterotomy (EST). Among 227 cases diagnosed as having gallbladder stones combined with common bile duct stones by B-ultrasonography, the diagnosis of common bile duct stones were confirmed by ERCP in 202 cases. Out of the 2 248 cases, 1 817 cases underwent the LC, 395 cases received EST and LC, and 36 cases were given the laparoscopic bile duct exploration (LBDE) (the bile duct was closed by primary suture in 26 cases and a T-tube was left in the bile duct in 10 cases). The 6 cases of residual stones in the bile duct were cured with EST postoperatively. A total of 28 cases required a conversion to open surgery (1.2%), and complications occurred in 52 cases (2.3%). Conclusions Sequential duodenoscopic- laparoscopic treatment for cholelithiasis offers a low residual stone rate and a high success rate.

Objective To study the clinical application of laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOEST) with the antegrade guidewire technique in the treatment of cholecystocholedocholithiasis.Methods This is a prospective controlled study comparing LC combined with preoperative endoscopic sphincterotomy (POEST) versus LC combined with IOEST in the treatment of cholecystocholedocholithiasis.Patients who were diagnosed to have cholecystocholedocholithiasis from June 2012 to February 2013 in our hospital were divided into the POEST group and the IOEST group.There were 50 patients in each group.The operation time,successful stone-extraction rate,residual stones rate,complication rate,postoperative stay and hospitalization cost between the groups were compared.Results The sex,age,stone size,number of stones and diameter of the common bile duct showed no significant difference between the two groups (P ＞ 0.05).There were no differences between the two groups in surgical time of EST,surgical time of LC combined with EST,successful stone-extraction rate and hospitalization cost (P ＞ 0.05).There were significant differences between the two groups in the residual stones rate,postoperative hyperamylasemia rate,postoperative acute pancreatitis rate and postoperative stay (P ＜0.05).LC combined with IOEST using the antegrade insertion of guidewire technique significantly reduced the residual stones rate (0 vs 8％),postoperative hyperamylasemia rate (4％ vs 18％),postoperative acute pancreatitis rate (0 vs 8％) and postoperative stay.Conclusions LC combined with IOEST using the antegrade guidewire technique could be performed safely when compared with the traditional sequential technique,LC combined with IOEST using the antegrade guidewire technique significantly reduced the postoperative acute pancreatitis rate and the residual stones rate.LC combined with IOEST using the antegrade guidewire technique should be the recommended technique to treat patients with cholecystocholedocholithiasis.

OBJECTIVE To explore potential proarrhythmic effect and underlying mechanism of azithromycin (AZM) and Shengmai injection (SM) used clinically.METHODS ① In vivo guinea pig ECG recordings were made to analyze effects of jugular intravenous(iv) injection of AZM [38.2 mg· kg-1,one time (clinically relevant dose,CRD)],or SM (4.6 mL· kg-1,one time CRD) or their combination.②In vitro ECG recordings were made to analyze effects of AZM,SM or AZM + SM on ECG in isolated hearts of guinea pigs.AZM [one,five and ten times (clinically relevant concentrations,CRC)] was perfused in this order:41.5 →207.5 → 415 mg· L-1 and SM (one,five and ten times CRC) in this order:5 →25 →50 mL· L-1.Also,AZM (41.5 mg· L-1,one time CRC) +SM (5 mL· L-1,one time CRC) was perfused to isolated hearts of guinea pigs.③ Enzymatically isolated cardiomyocytes from guinea pig left ventricles were perfused in this order:AZM 41.5 mg· L-1 →AZM 41.5 mg· L-1+SM 5 mL· L-1 for action potential,L-type Ca2+ and Na+ current recordings,respectively.RESULTS ① Neither AZM 38.2 mg· kg-1,nor SM 4.6 mL· kg-1 significantly changed the in vivo ECG.However,AZM 38.2 mg· kg-1 +SM 4.6 mL · kg-1 significantly reduced heart rate (P＜0.05) and prolonged the P-R (P＜0.05) and QRS (P＜0.05) intervals.②AZM 41.5,207.5 and 415 mg· L-1 reduced heart rate (P＜0.05) and prolonged the P-R (P＜0.05) and QRS (P＜0.05) intervals in a concentration-dependent manner.AZM 415 mg·L-1 also prolonged QTc (P＜0.05) interval.SM 5,25 and 50 mL· L-1 reduced heart rate (P＜0.05) and prolonged the P-R interval (P＜0.05) in a concentration-dependent manner.SM had no effect on QRS or QTc intervals.Washout partially recovered the above changes.Moreover,AZM 41.5 mg· L-1 + SM 5 mg·L-1 significantly reduced heart rate (P＜0.05) and prolonged the P-R (P＜0.05) and QRS intervals.③ AZM 41.5 mg·L-1 did not significantly change the action potential amplitude (APA),action potential durations at 50％ (APD50) and 90％ (APD90) repolarization levels,or L-type Ca2+ and Na+ currents.However,AZM+SM 5 mg· L-1 significantly reduced APA (P＜0.05),shortened APD50 (P＜0.05) and APD90 (P＜0.05) and inhibited the L-type Ca2+ (P＜0.05) and Na+ (P＜0.05) currents.CONCLUSION AZM and SM has potential prorrhythmic risks.The combined use might cause higher risk of arrhythmia.The underlying mechanism for proarrhythmia is mediated by inhibition of the L-type Ca2+ and Na+ currents.

Objective To explore the changes and clinical significance of joint fluid TNF-α and TNF-β1 levels in patients with knee osteoarthritis (KOA). Methods A total of 90 patients with KOA hospitalized in our hospital were selected. They were assigned to group A with 30 patients at early stage, group B with 30 patients at medium stage,and group C with 30 patients at advanced stage according to the stage of X ray; 30 healthy volunteers were in the con-trol group. Levels of joint fluid TNF-αand TNF-β1 were tested in four groups of patients. Results Levels of joint fluid TNF-β1 at medium and advanced stages of KOA were significantly lower than those in the control group, and the dif-ferences were significant (P<0.01); Levels of joint fluid TNF-α at medium and advanced stages of KOA were signifi-cantly higher than those in the control group, and the differences were significant(P<0.01); the difference of levels of joint fluid TNF-α and TNF-β1 at early stage of KOA was not significant compared with those in the control group(P>0.05);levels of TNF-α/TNF-β1 at early,medium and advanced stage of KOA were significantly higher than those in the control group(P<0.01);TNF-αwas positively correlated with KOA stage(r=0.930,P<0.01);TNF-β1 was nega-tively correlated with KOA stage(r=-0.849,P<0.01);TNF-α/TNF-β1 was positively correlated with KOA stage(r=0.828,P<0.01). Conclusion TNF-α and TNF-β1 are involved in the formation and progression of OA, and levels of joint fluid TNF-α and TNF-β1 are able to reflect the severity of KOA lesions; joint fluid TNF-α/TNF-β1 is able to detect KOA early.