Objective To investigate the curative effects of laparocopic treatment for cystiduodenal internal fistula. Methods All procedures were conducted under laparoscope. After the exposure of the cholecystic base, trans-cholecystic cholangiography was performed to detect the relations between the cholecyst and neighboring organs. Once the internal fistula was confirmed, the orifice of fistula was closed laparoscopically. Then abdominal drainage, gastrointestinal decompression, and administration of somatostatin were routinely employed. Results In a series of 327 cases of laparoscopic cholecystectomy (LC) with intraoperative cholangiography, a total of 6 cases of cystiduodenal internal fistula were detected, all of which were anatomized and closed successfully under laparoscope. No postoperative hemorrhage or duodenal bile leakage occurred. Conclusions Routine intraoperative cholangiography during LC is beneficial to the detection of the cystiduodenal internal fistula.Effective and reliable management rests upon skillful laparoscopic techniques of dissection and fistula closure, as well as the supportive treatment.

Objective:To investigate the enhancing effect of bone marrow stroma cell(BMSC)on the functional recovery of injured spinal cord by observing the formation of gliotic scar,cavity volume and the cascade of apoptosis of neural cells.Methods:Eighty spinal cord injury(SCI)rat models were made and randomly divided into two groups:group A(n=40),the control group without any treatment;group B(n=40),the injured animals treated with BMSC implantation.The behavioral evaluation was performed using Basso,Beattie and Bresnahan(BBB)scoring system.Scores were recorded at time points of 1,2,4,6 and 8 weeks after transplantation.After 8 weeks,rats were sacrificed.The immunoreactivity of Nogo-A,glial fibrillary acidic protein(GFAP)and the cavity area were measured.The cell apoptosis was detected by TUNEL methods at 1,2,3,7 and 14 days after injury.Results:Compared with control group,treated animals gained higher scores after 8 weeks of transplantation.The number and the size of reactive astrocytes,the average volume of cavity,TUNEL positive cells,the expression of Nogo-A and GFAP reduced significantly in group B compared with those of group A(P＜ 0.05).Conclusion:BMSC possess effects on repairing injured spinal cord and promoting functional recovery through various mechanisms.

Objective To observe the subfoveal choroidal thickness (SFCT) and choriocapillary blood flow area (CBFA) in the patients with idiopathic macular hole (IMH).Methods This is a prospective clinical study.Thirty-two patients with unilateral IMH (4 in stage 2,17 in stage 3,11 in stage 4) and 32 age-and sexmatched normal controls were enrolled in this study.All eyes were divided into three groups,including group A (32 affected eyes),group B (32 fellow eyes) and group C (32 normal eyes of controls).There was no significant difference in age (t=0.865) and gender (x2=0.000) in IMH patients versus normal control subjects (P＞0.05).There was no significant difference in refraction (F=0.957) and ocular axial length (F=0.562) between group A,B and C.The SFCT was detected by enhanced depth imaging of spectral-domain optical coherence tomography (OCT).The CBFA was detected by OCT angiography.The differences of SFCT and CBFA in three groups were analyzed by Kruskal-Wallis and non-parametric test.Results The mean SFCT was (182.53 ±64.52) μtm in group A,(199.21 t73.07) μtm in group B and (254.21 ±56.85) μtm in group C respectively.The SFCT was thinner in group A and B than that in group C (Z=-4.362,-3.190;P＜0.05),but was the same in group A and B (Z=-1.171,P＞0.05).The mean CBFA was (5.09±0.31) mm2 in group A,(5.41 ±0.20) mm2 in group B and (5.39±0.15) mm2 in group C respectively.The CBFA was reduced in group A than that in group B and C (Z=-4.467,-4.048;P＜0.05),but was samc in group B and C (Z=0.420,P＞0.05).Conclusion SFCT and CBFA are both reduced in IMH eyes.

Objective To discuss the clinical value of immunofecal occult blood test in screening of colorectal cancer and its precancerous lesions in a large series of health checkup population. Methods Colorectal cancer and its precancerous lesions in 5919 subjects undergoing health checkup in our hospital were screened out by using immunofecal occult blood test from July 2006 to June 2007; positive cases with the test were subjected to colorectal endoscopy or X-ray barium enema examination. Relevant results were analyzed in combination with clinical and pathological data. Results Positive result was obtained in 314 out of the 5919 subjects undergoing health checkup with immunofecal occult blood test; the positive rate was 5.30%. 241 cases(76.75% )of them accepted colorectal endoscopic examination and 23 cases(7.32%) accepted X-ray barium enema examination. The total follow up rate was 84.08% with 50 cases out of contact. After excluding the cases out of cantact, 16 cases of colorectal cancer were found morbidity 2.37‰ including 8(50.00% )cases of Dukes A,7 cases (43.75%)of Dukes B and 1 case of Dukes C (6 .25%).The detection rate of colorectal cancer with postive imunofecal occult blood test was 6.06% (16/264). 94 cases (16.01‰) of adenomatous polyps were found including 55 cases (58.51%) of tubular adenoma, 23 cases (24.47% )of villiform- tubular adenoma and 16 cases(17.02%) of villfform adenoma. Among these cases 55 (58.51%)were solitary and 39(41.49%) multiple. In addition, 6 cases of ulcerative colitis in active phase were found. Altogether 116 (43.94%)of the 264 cases with positive immunofecal blood test and not out of contact were found to have colorectal cancer or its precancerous lesions. Conclusion Immunofecal occult blood test is suitable for screening of colorectal cancer and its precancerous lesions in large series of population. Colorectal cancer and its precancerous lesions may be found in relatively early phase and be eradicated in curable stage, thus to reduce the morbidity and mortality.

Objective To investigate the clinical significance of plasma lipoprotein-associated phospholipase A2 (LP-PLA2) determination in patients with ischemic cerebral stroke(ICS).Methods 124 patients with ICS (ICS group)admitted to Dongfeng Huaguo Hospital in Shiyan City from Jan.2011 to June.2014 and 50 patients with hemorrhagic stroke (hemor-rhagic group)were as the research objects,and 50 healthy controls at the same time were as the control group,compared the plasma Lp-PLA2 levels between the three groups,and compared carotid artery atherosclerotic plaque and plasma Lp-PLA2 levels in patients with different severity of ICS.Results The levels of plasma Lp-PLA2 of the patients of the ICS group,the hemorrhage group and the control group were 58.4±9.6 g/L,30.5±9.2 g/L and 18.7±8.3 g/L,respectively.There were significant differences between the groups (F = 16.741,P = 0.000).The level of plasma Lp-PLA2 of the patients of the plaque group was higher than that of the non-plaque group (66.3 ±9.7 g/L vs 54.1±10.3 g/L,t=5.775,P =0.000),and the unstable plaque group was higher than that of the stable plate group (72.4±9.5 g/L vs 62.8±10.1 g/L,t=4.797,P =0.000).The plasma Lp-PLA2 level of patients with light,medium,heavy ICS were 48.4± 9.2 g/L,60.9 ± 9.6 g/L and 74.5±10.3 g/L,respectively,and the difference was statistically significant between the three groups (F = 13.629,P =0.000).The plasma levels of Lp-PLA2 were positively correlated with NIHSS scores in patients with ICS (r=0.716,P <0.05).Lp-PLA2 in diagnosis of ICS area under the ROC curve was 0.904,the optimal critical value was 45.2 μg/L,the sen-sitivity and specificity were 81.5% and 80.2%.Conclusion The determination of plasma LP-PLA2 has a good effect in di-agnosis of ICS,the plasma level of ICS can be responsed the severity of the patients and the stability of atherosclerotic plaque.

Objective To observe the clinical efficacy ofvitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH).Methods This is a retrospective case series.Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study.Among these eyes,9 eyes were idiopathic MH (IMH),with the mean basal diameter of (1 188.3 ± 155.1) μm,minimum diameter of (626.9± 86.2) μm,logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1 ± 0.3;2 eyes were MH with high myopia,with the mean basal diameter of (696.5 ± 232.6) μm,minimum diameter of (259.0±69.3) μm,logMAR BCVA of 1.3;5 eyes were high myopia MH with retinal detachment (RD),with the mean BCVA of 1.5 ± 0.1;3 eyes were rhegmatogenous RD (RRD) with MH,with the mean logMAR BCVA of 1.6;2 eyes were MH after vitrectomy for RRD,with the mean basal diameter of(1 606.0±69.3) μm,minimum diameter of (909.0±387.5) μm,logMAR BCVA of 1.6.All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively.Indocyanine green staining assisted circle-wise ILM peeling was performed.ILM of diameter 1.5 disc-diameters around fovea was residual and loosened;perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole.C3F8,gas or silicone oil tamponade was performed at the end.BCVA and hole closure were followed up for 1-4 months.C3F8,gas or silicone oil was tamponaded at the end.BCVA and hole closure were followed up for 1-4 months.Results MH of 21 eyes were closed after surgery.Nine IMH were closed at type Ⅰ,with U shape closure in 7 eyes,V shape closure in 2 eyes.Two eyes of MH with high myopia,3 eyes of RRD with MH,2 eyes of MH after vitrectomy for RRD were closed at type Ⅰ of U shape.Five eyes of high myopia MHRD including MH closure at type [of U shape 3 eyes,type Ⅱ of W shape 2 eyes.The mean logMAR BCVA of IMH,MH with high myopia,high myopia MHRD,RRD with MH,MH after vitrectomy for RRD eyes were 0.8±0.3,0.9±0.2,1.4±0.1,0.7±0.3,0.9 ± 0.2,respectively.The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02).There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia,high myopia MHRD,RRD with MH,MH after vitrectomy for RRD eyes (P=0.18,0.10,0.11,0.18).Conclusion Vitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function.

Objective To analyze the value of color Doppler ultrasound in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus.Methods A total of 800 patients with type 2 diabetes mellitus underwent color Doppler ultrasonography to examine anterior tibial artery (ATA),dorsalis pedis artery (DPA) and posterior tibial artery (PTA).Ultrasonic findings including vascular diameter,stenosis ratio and hemodynamics of lower extremity arterial disease were analyzed retrospectively.Results ATA and DPA had more plaques and stenosis than PTA.There was no statistical difference of vascular diameter,stenosis ratio and hemodynamics between left and right lower extremity artery in patients with type 2 diabetes mellitus including diabetic foot.Conclusion Color Doppler ultrasound is a useful method in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus,providing information of stenosis ratio and hemodynamics of lower extremity artery,so as contributing to the clinical therapy of this disease.

OBJECTIVE:To screen and analyze the ?-lactamases-resistant genes in imipenem-resistant pseudomonas aeruginosa (IMPRPa). METHODS: ?-lactamases-resistant genes including IMP,VIM and OprD2 in 60 clinically isolated IMPRPa strains were detected by polymerase chain reaction (PCR),and sequence analysis was performed on the PCR amplified products of some of IMP and VIM genes. RESULTS: Of the 60 IMPRPa strains,?-lactamases-resistant positive genes were as follows: IMP gene was positive in 7 strains,VIM gene was positive in 18 strains,and both IMP and VIM genes were positive in 3 strains. Sequencing of the PCR products of IMP and VIM genes were IMP-1 and VIM-2 types,and OprD2 gene deletion was noted in 29 strains. CONCLUSION: OprD2 protein channel deletion and metal-producing ?-lactamases are the chief mechanisms for the resistance of IMPRPa to imipenem.

Objective To observe the clinical curative effects of Changwei Shu combined with conventional western medicine therapy in treating the sepsis patients with gastrointestinal dysfunction.Methods A total of 120 cases of sepsis patients with gastrointestinal dysfunction were randomly divided into treatment group and control group,60 patients in each group.The control group was given conventional western medicine therapy,and the treatment group was given Changwei Shu combined with conventional western medicine therapy.After treatment for 7 days,the clinical efficacy and safety were evaluated by observing the changes in white blood cell (WBC) count,procalcitonin (PCT) level,intra-abdominal pressure (IAP),gastrointestinal dysfunction scores,and scores of acute physiology and chronic health evaluation (APACHE Ⅱ).Results (1) For one case dropped out and one was excluded from the treatment group,and 4 cases dropped out and 2 were excluded from the control group,a total of 58 cases in the treatment group and 54 in the control group were included into the study at the end of the trial.(2) The total effective rate of the treatment group was 91.38％ and that of the control group was 88.89％,the difference being significant (P ＜ 0.05).(3) After treatment,WBC count,PCT level and IAP of the two groups were improved (P ＜ 0.01 compared with those before treatment),and the improvement of the treatment group was superior to that of the control group (P ＜ 0.01).(4) After treatment,gastrointestinal dysfunction scores and APACHE Ⅱ scores of the two groups were decreased(P ＜ 0.01 compared with those before treatment),and the decrease of the treatment group was superior to that of the control group (P ＜ 0.01).(5) During the treatment,4 cases from the treatment group had nausea,and 5 cases from the control group had nausea and abdominal distention,and the symptoms disappeared spontaneously one week later.No obvious changes were found in the hepatic and renal function of the two groups.Conclusion Changwei Shu exerts an effect on reducing the inflammation,improving the gastrointestinal function,and relieving the illness severity of sepsis patients with gastrointestinal dysfunction.

[Objective]To evaluate the effects of sutureless technique in comparison to conventional techniques for repair of total anomalous pulmonary venous connection(TAPVC)with the method of propensity score analysis.[Methods]From October 2007 to December 2013,179 consecutive patients were enrolled in this study. Patients were operated with sutureless technique(n = 81)or Conventional technique(n=98),and followed up at an interval of 1 month,3 months,6 months and then once a year post-operation. During analysis,three type of propensity-score matching methods,including nearest neighbor caliper matching,Mahalanobis metric matching with propensity score ,optimal full matching were used to create balanced groups of patients receiving each treatment. Surgeons’performance difference was assessed with random frailty proportional hazards models with gamma. Composite endpoints was defined by postoperative death or late death or postoperative pulmonary venous obstruction(PVO),which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model,adjusted by Preoperative-PVO,age,gender,weight and TAPVC type.[Results]Nearest neighbor caliper matching method was the best choice during propensity score analysis. After matching ,sutureless group included 73 patients and Conventional group73 patients. In sutureless group,cardiopulmonary bypass(CPB)time(Z=2.18, P=0.030),cross-clamp time(Z=3.63,P<0.001),rate of composite endpoints(HR 95%CI=0.20(0.06~0.61),P=0.005),late death(HR 95%CI=0.03(0.01~0.55),P=0.017)were significantly better than that in Conventional group. In subgroup analysis ,for patients with pre-PVO,decreased composite endpoints was seen in sutureless group.[Conclusion]Comparison using thepropensity score analysis demonstrated that sutureless strategy for primary repair of TAPVC may associate with decreased mortality rate of post-PVO and CPB time and cross-clamp time.