Objective To investigate the safety and feasibility of operation on complex laparoscopic cholecystectomy. Methods The clinical data of patients underwent complex laparoscopic cholecystectomy since 1990 in our hospital were retrospectively analyzed. Results Except 2 patients treated by abdominal operation, other patients were treated by laparoscopic cholecystectomy successfully. Conclusion The complex laparoscopic cholecystectomy is safe and feasible with sufficient evaluation before operation and proper management during operation.

Objective To investigate the safety of laparoscopic cholecystectomy(LC) under the use of cardiac pacemaker for the patients with cholelithiasis and serious cardiac arrhythmia.Methods The clinical data of 8 cases undergoing LC under the use of vvI cardiac pacemaker were analysed.Results All the 8 cases undergoing LC by cardiac pacemaker had successful results. There was no cardiac accident or complication of the pacemaker in perioperative period in this series, and the postoperative course was smooth . Conclusions LC is safe under the use of cardiac pacemaker, if the decompensation of heart is controlled and the anaesthesia and operation are estimated correctly.

0.05).During unilateral contact maximal biting EMG activity of the temporalis-anterior muscle on the bitting-side was higher than that on the disoccluded side(P0.05).Conclusion: Vertical distance occlusion contact may affect the EMG activity of temporalis-anterior muscle but not on that of masseter muscle during the central biting.

Objective To compare healing effects of surgical incisions using 635 /808 nm dualwavelength semiconductor laser and He-Ne laser irradiation.Methods 168 cases of non-malignant tumor surgery patients were randomly divided into 2 groups:test group including 83 cases which were treated on the surgical incisions by laser irradiation of the semiconductor illumination with low-intensity power; positive control group with 85 cases treated with He-Ne laser.Observation was carried out on incision healing by the clinic manifestations including redness,heat,swelling,pain,exudation,wound open,adverse event and the incision length offset.Results There was no significant difference between experimental group and the control group on incision healing (P＞0.05).Conclusions The treatment efficacy of the dual-wavelength semiconductor laser on surgical incisions healing is similar with that of the He-Ne laser.

Live Yeast Cell Derivative (LYCD) was based on a living cells response to a controlled injury, which stimulated it to produce protective substance to increase cellular respiration and wound healing The experiment suggested that LYCD had the ability to improve cellular respiration, and this ability became strongest after the cell was treated with H 2O 2 for 15min, while the quantity of reduced glutathione (GSH) in LYCD reached the highest at 30min By contrast, almost the same biological activity of LYCD was observed under different stress conditions

Objective To explore the clinical application of laparoscopic transcystic common bile duct exploration.Methods From Jan 2014 to Dec 2015,laparoscopic transcystic common bile duct exploration was performed in 52 cases of cholecystolithiasis.The therapeutic effects of cases were studied.Results Among them,40 cases were performed operation successfully.The success rate of operation was 76.92％.7 cases were changed to laparoscopic common bile duct incision exploratory stone operation.5 cases were performed common bile duct incision nephrolithotomy,and the transfer rate was 9.62％.43 cases were toke stone success at a time in all of patients.The success removed rate was 82.69％.The last 9 patients included 8 cases performed laparoscopic transcystic common bile duct exploration and 1 case performed laparoscopic common bile duct incision exploratory stone operation.All cases were placed abdominal cavity drainage tube pulled out after 3-10 days.Biliary leakage occurred in 1 patients performed laparoscopic common bile duct incision exploratory stone operation,and it was cured after conservative treatment.No biliary tract infection,biliary tract bleeding complications occurred.The average hospitalization time was (8.24 ± 2.52) days.All patients were followed up 1 year.No extrahepatic bile duct stones were found by B-ultrasonic and MRCP,and bilirubin were normal.Conclusion Laparoscopic transcystic common bile duct exploration has positive clinical efficacy with small trauma,quick rever,less complications,safety and etfective.etc.But its indications must be grasped strictly in clinical promotion.

Objective: To analyze the clinical features and interleukin-10 receptor gene mutations in six infants with very early onset inflammatory bowel disease (VEO-IBD). Methods: Four girls and two boys with VEO-IBD admitted to Children's Hospital Affiliated to Capital Institute of Pediatrics from June 2016 to September 2017 were reviewed. The clinical data including general condition, clinical symptoms, laboratory tests, and colonoscopy and pathological results were collected and analyzed. Interleukin-10 receptor α subunit (IL-10RA) gene was examined in all patients. Results: Persistent diarrhea and fever were the most common symptoms and were found within 1 month after birth in all 6 patients. Anemia, oral ulcer or perianal lesions and growth retardation were common concomitant symptoms. All patients had colonoscopy examination and the results showed multiple ulcers affecting the colon with biopsies revealing acute and chronic inflammation. Three patients were found to have cryptitis and crypt abscesses. Gene sequencing revealed IL-10RA gene mutations in all six patients, including 3 cases with homozygous mutations (one with c.537G>A and two with c.301C>T) and 3 heterozygous mutations (paternal c.301C>T in all cases; maternal c.299T>G, c.350G>A and c.537G>A, respectively) . After conventional treatment, one got clinical and pathological improvement according to colonoscopy, three improved clinically, one worsened and died, and one died of septic shock secondary to intestinal perforation. Conclusions VEO-IBD is associated with IL-10RA mutation, usually with severe intestinal symptoms and significant extra-intestinal symptoms, as well as varied responses to conventional treatment. In our study, c.301C>T and c.537G>A are the most common mutations.

Objective: To analyze the clinical and genotypic characteristics of infantile inflammatory bowel disease (IBD). Methods: The age of onset, family history, clinical manifestations, and treatment effect were retrospectively analyzed in 39 infants (male 23 cases, female 16 cases) with IBD who were admitted to the Department of Gastroenterology in Children′s Hospital, Capital Institute of Pediatrics from January 2007 to December 2017. Next generation sequencing (NGS) based on target gene panel was used for gene analysis in 17 patients. Results: The median age of onset was 0.5 (0.5, 1.0) month. The most common clinical symptoms included diarrhea (39, 100%), malnutrition (38, 97%), hematochezia (34, 87%), fever (25, 64%), and perianal diseases (24, 61%). Four children had associated family history. Among the 17 patients whose gene was analyzed, 10 were found to have the pathogenic gene variation, within whom 7 had interleukin-10 receptor α subunit (IL-10RA) mutation, 2 had CYBB heterozygous mutation, 1 had interleukin-10 receptor β subunit (IL-10RB) mutation. The therapeutic medicine included mesalazine, steroids, and thalidomide. Eighteen children (46%) reached clinical remission (10 cases) or partial remission (8 cases). Conclusions The incidence of single gene mutation in infants with IBD is high, with IL-10RA mutation as the most common. Refractory diarrhea and malnutrition may indicate infantile IBD.

Objective: To understand lunch satisfaction and leftovers of Changsha compulsory education schools under different supply modes served by school canteens and specialized enterprises,and to provide scientific basis for the government to formulate school lunch improvement policies. Methods: Multistage stratified cluster sampling method was used to random select 2 203 students from 8 primary and secondary schools in Changsha who were administered with questionnair survey in April to May of 2018. Results: For school lunch, the overall rate of satisfaction was 78.8%.The overall lunch satisfaction of female and primany school students were higher than that of male and junior high school students respectively,and the difference was statistically significant(P<0.05). Totally 76.0% of students had the highest satisfaction in food hygiene and the lowest satisfaction rate was 60.0% in food taste. By comparing different supply modes, the overall satisfaction rate of meal quantity was higher (47.8%) under school canteens, and that of dining environment was relatively high (43.7%) under specialized enterprises. "Don-t like some food" (63.8%) was the main reason for students leftovers under the two supply modes. The lunch leftover rate of specialized enterprises (37.8%) was significantly higher than that of school cafeteria (30.6%)(χ 2=12.81，P<0.05). Conclusion The satisfaction of food taste and the rate of lunch leftovers need to be further improved. School canteens environment and management should be strengthened, as well as the flexibility and communication under specialized enterprises and family-school communication. The joint efforts by school and family are needed for healthy eating education.

Background: Endoscopic submucosal dissection has become the preferred treatment for early gastric cancer without lymph node metastasis (LNM). The risk of LNM is different among different pathological types of early gastric cancer. Aims: To investigate the risk factors of LNM in patients with early gastric cancer. Methods: The clinicopathological features of 1 093 early gastric cancer patients underwent radical gastrectomy and diagnosed by pathology from January 2005 to December 2019 at Nanjing Drum Tower Hospital and Nanjing Gaochun People's Hospital were retrospectively analyzed. Risk factors of LNM in patients with early gastric cancer were analyzed by univariate analysis and logistic regression model analysis. Results: A total of 1 093 patients with early gastric cancer were enrolled, and positive LNM was found in 154 patients (14.1%). Univariate analysis showed that gender, age, tumor size, tumor location, gross classification, depth of tumor invasion, vascular and nerve invasion, differentiation type, ulcers were related with LNM (P<0.05). Multivariate analysis showed that age (OR=1.654, 95% CI: 1.102-2.480, P=0.015), tumor location (OR=1.617, 95% CI: 1.227-2.131, P=0.001), differentiation type (OR=1.664, 95% CI: 1.205-2.298, P=0.002), depth of invasion (OR=1.569, 95% CI: 1.212-2.030, P=0.001), vascular invasion (OR=10.514, 95% CI: 6.353-17.401, P=0.000) were the independent risk factors of LNM in early gastric cancer. Conclusions: Age, tumor location, differentiation type, depth of invasion, and vascular invasion are the independent risk factors of LNM in early gastric cancer, especially vascular invasion. For patients with vascular invasion, if there are no contraindications, surgical intervention is recommended.