Objective To explore the appropriate operative methods for the treatment of CBD(common bile duct) stone in endoscopic era.Methods We retrospectively analyzed the diagnosed and treated data of 309 patients with suspected CBD stones with ERCP,LC+ERCP and LECBD(laparoscopic exploration of the commonbile duct) from January 2004 to July 2008 in our hospital.Results A total of 216 patients receivedERCP,among them 97(44.9%) cases had CBD stone,and there was the trend that the number of patients who received ERCP reduced yearly.Among the 93 patients who received LECBD,71 cases were successful and 22 cases were converted to open operation.Of the 71 cases,transcystic duct CBD exploration was done in 11 cases,direct CBD exploration in 60 cases,and 6 cases had primary closure of CBD.The number of cases that received LECBD grew steadily with time.There was no difference in successful operative rate,intraoperative bleeding and residual calculi rate between ERCP+LC and LECBD group.The operative time,postoperative complications and length of hospital stay in LECBD.group were significantly lower than those in LC+ERCP group.Conclusions LECBD is better than LC+ERCP in the treatment of CBD stones,but in the endoscopic era,the selection of an individualized treatment approach is the best operative method for the management of CBD stone.

From the third day after Wenchuan Earthquake,the Chinese government and army dispatched 90 helicopters per day to transport the wounded to Chengdu City (about 100 km away from earthquake-hit area). From 14 May to 21 May 2008, West China Hospital of Sichuan University received totally 760 wounded mainly from Wenchuan, Yingxiu, Maoxian, Beichuan, Lixian, Mianzu. Transfering patients by helicopter is characterized by rapid,flexible and non-restriction from terrain conditions.Compared with transfer on the land,injury induced during the transfer is reduced. However, the height of helicopter cabin is low,so it's difficult for doctors to carry out related treatment works. The instability during the flight also brought a lot of difficulties for the medical care.The rapid change of speed during take-off and landing caused a series of physiological changes on patients, such as thoracic pressure. Wenchuan is located in the mountains,and this also brought difficulties for the flight. The potentially savable victims,whose lives wouldn't be threatened with bad wound and wouldn't die in a short time,should be given the priority of transfer by helicopter. During the trip of transfer,the life-threatening occurrences, such as asphyxia, persistent convulsion and shock, were well prevented. At the same time, airway management, monitoring of vital signs and necessary consolation were important. After arrival at airport, the medical staff waiting at airport should watch and evaluate the patency of airway and vital signs carefully. If the airway obstruction, vital signs unstable and some other critical events are identified, the first aid at airport is essential. When patients are stable,they can be transported to the nearest hospital where the emergency treatment is available. Besides observation of patients' condition, registration of the name, age, address and the phone number of casualties should be done in the ambulance. Stick a label of the general information and the preliminary diagnosis of the patient on bare intact skin. The selection of casualties before transfer and the first aid at the airport are very important for successful short distance trip by helicopter.

Objective To investigate the attitudes of medical students regarding to organ donation compensation.Method A self administered questionnaire was distributed to 600 medical students selected randomly from two medical universities in China between January 2013 and January 2014.The questionnaire included demographics and core questions related to medical student's attitudes regarding organ donation compensation.Result A total of 600 questionnaires were distributed and 592 valid responses were received,including 150 doctoral students,143 master students and 299 undergraduate students.In all,69.8％ of medical students believed that compensation for organ donor was essential.Nearly 60.5 ％ believed financial compensation would increase the rate of organ donation but would not tarnish the behavior of organ donors (64.7％).At the same time,over 70％ of medical students believed that financial compensation would increase the number of living organ donation.With regarding to the ways of compensation,most of the students (80.4％) were in favor of priority on waiting list.Reducing or free of hospitalization costs (50.4％) and increasing the reimbursement ratio of medical insurance (41.8％) were also the acceptable compensation ways to medical students.Conclusion Most of medical students believe that it is essential to give compensation to organ donors.Enjoying the priority on waiting list,reducing or free of hospitalization costs and increasing the reimbursement ratio of medical insurance are the reasonable incentive methods.

0.05),but incidence of postoperative complications and residual calculus in LC+LCBDE group were significant lower than those in LC+EST group.Conclusions Combining LC with LCBDE is a feasible treatment for cholecystolithiasis and choledocholithiasis.

AIM: To compare the change of visual quality of femtosecond-laser in situ keratomileusis ( FS-LASIK) and laser in situ keratomileusis ( LASIK) for myopia.
METHODS: A retrospective case series. A total of 89 cases 178 eyes were chosen from Jan. 2014 to Dec. 2015. There were 46 cases (92 eyes) in FS-LASIK and 43 cases 86 eyes in LASIK. The visual acuity, refraction state, subjective visual quality score, high order aberration were measured at 6mo after surgery.
RESULTS: All patients underwent operation smoothly, and no complication was observed during and after surgery; there was no statistically significant difference between two groups at visual acuity (P>0. 05). Postoperative diopter compared with preoperative expectations diopter difference is statistically significant between two groups (P<0. 05). Subjective visual quality score was compared statistically significant postoperative 6mo in two groups(P<0. 05). Six months after surgery in the two groups of patients with corneal aberration RMS values, spherical aberration and coma compared with preoperative increases, more than the expansion of the size of the FS-LASIK group low mechanical plate layer knife group, the difference was statistically significant (P<0. 05).
CONCLUSION: Femtosecond laser corneal flap is more accurate and reliable and the discrete degree is smaller. It can make more thin corneal flap. Femtosecond laser disc of LASIK surgery compare with traditional mechanical plate layer knife following LASIK has better visual quality.

China ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Hepatitis B ; drug therapy ; Humans ; Liver Cirrhosis ; drug therapy ; Liver Diseases, Alcoholic ; drug therapy ; Phytotherapy

AIM: To evaluate the relationship between axial length ( AL ) , corneal and lens refractive power, and the refractive error in children.
METHODS:Totally 44 children 88 eyes with refractive error who underwent retinoscopy with cycloplegia, to be measured spherical equivalent refractive error. Axial length was measured by a noncontact optical biometry ( ZEISS IOL-Master) , and corneal K and anterior chamber depth ( ACD) were also measured by the same machine. The refractive power of the lens was calculated by using the SRK formula. The patients were divided into 3 groups, myopia (SE<0), hyperopia (SE>+0. 50D) and emmetropia ( 0 to + 0. 50D ). Linear Correlation and Regression were used to evaluate the correlation among the optical parameters.
RESULTS:Totally 44 subjects, 88 eyes, average 9. 04±2.39 years, spherical equivalent (SE) -3. 50D to +8. 75D. Hyperopic AL was shorter than the other two groups ( P<0.05), same trend in lens power. No significant differences among the 3 groups in corneal K and ACD. There was a negative correlation between age and SE, SE and AL, SE and lens refractive power, and there was a positive correlation between age and AL, age and lens power.
CONCLUSION:As the children's growing up, SE trends to myopia, and AL becomes longer, and lens power is stronger.

Objective To compare the degree of trauma, postoperative pain, and cosmetic outcomes of endoscopic-assisted thyroidectomy (EAT), transthoracic endoscopic thyroidectomy (TET), and conventional thyroidectomy (CT), and to explore the characteristics of EAT and TET. Methods Forty-five patients with thyroid nodules were divided into three groups (n=15 in each) to underwent EAT, TET, or CT. The plasma levels of C-reactive protein(CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-?), and T-lymphocyte subgroups (CD3, CD4+, CD8+, and CD4+/CD8+) were determined before and 24 and 72 hours after the operations. The degree of operative trauma was compared after the operation. Postoperative pain and cosmetic outcomes were evaluated by visual analogue score (VAS) and 5-degree evaluation respectively. Results The VAS in the EAT group was 2.2?1.7 and 1.1?1.1 on the first and third day postoperation, which were significantly lower than those in the TET group (3.6?1.4 and 2.2?0.7, respectively; q=3.698, P0.05).Compared to preoperation, the level of CD4+/CD8+ lymphocyte in the CT group was decreased at 24 hours after the operation (q=4.076, P0.05). The levels of CRP determined at 24 and 72 hours postoperation were both significantly higher than that before the operation in the three groups (EAT group: m=21, P

Objective To discuss the clinical value of transluminal endoscopic surgery (TUES), and to find a simple and safe no-scar surgical approach. Methods A total of 13 cases of TUES, including 1 case of hepatic abscess fenestration, 1 abdominal exploration, 5 appendicectomy, and 6 cholecystectomy, were carried out in our hospital. Among the cases, 3 were accomplished using upper-digestive endoscopy, and 10 were performed using triple-channel catheter technique by modified instruments.Results All the operations were completed successfully without conversion to routine laparoscopic surgery or open surgery. The operation time was 90-150 min in the 6 cases of cholecystectomy, 15-40 min in the 5 cases of appendectomy, 90 min in the hepatic abscess fenestration, and 50 min in the abdominal exploration. The abdominal exploration showed peritoneal abrasion around the bladder, and the hemorrhage was controlled by electric coagulation. No complications including hemorrhage and biliary fistula occurred in this series. No abdominal scar was found after the operation except in the skinfolds around the hilum. Conclusions The TUES is a simple, safe, and feasible technique. Since the TUES for cholecystectomy is difficult, the patients should be selected carefully.

Objective Owing to limitations in issues of access,tissue manipulation,and secure tissue approximation/closure,natural orifice transluminal endoscopic surgery(NOTES)has been developed slowly over the years.In this study,we employed a new approach,transumbilical endoscopic surgery(TUES)to treat 26 patients with gallbladder diseases.Methods A total of 26 patients including 21 cases of gallbladder stone and 5 cases of polyps underwent TUES cholecystectomy in our hospital.Two 5-mm trocars were placed through an infra-umbilicus incision.A mini grasper was placed at the right upper abdomen to grasp the fundus of gallbladder,so that the gallbladder can be dissected and removed by using conventional laparoscopic instruments.Results The operation was completed in all the cases except in one,who was converted to conventional laparoscopic surgery because of intraoperative bleeding.The operation time was between 25 and 50 minutes with a mean of 35 minutes.No postoperative bleeding or bile leakage occurred in this group of patients.Satisfying cosmetic results were achieved on the abdomen.Conclusions Double trocar transumbilical endoscopic cholecystectomy is feasible,and is simpler and safer than NOTES technique.Patients should be carefully selected at the beginning stage.