Objective To investigate the feasibility of clinical staging and standardization of therapy for patients with gallstones.Methods The clinical data of 326 cases of gallstones treated in our hospital from January 2012 to December 2013 were collected.Appropriate surgical procedures were selected based on preoperative staging (stags Ⅰ -Ⅳ)that was conducted according to the degree of pathological damage in the gallbladder.Clinical efficacy was observed for assessment.Results Among 57 patients categorized as stage I,53 cases received chole-dochoscopy by small incision for preservation of the gallbladder,including 3 cases converted to cholecystostomy and 1 case of recurrent gall-stones one year later;laparoscopic cholecystectomy was performed in the remaining 4 cases.A total of 152 patients were categorized as stageⅡ:122 cases received laparoscopic cholecystectomy,of which 2 cases were converted to open cholecystectomy,2 cases developed bile leak-age,and none suffered serious complication of bile duct injury;open cholecystectomy was performed in the other 30 cases in category II,2 of which had fat liquefaction at the incision,but complications of bile leakage and bile duct injury were not observed.There were 87 patients with stage Ⅲ disease:among 50 cases who received open cholecystectomy,3 cases developed fat liquefaction at the incision,but no bile leakage and bile duct injury were observed;in the remaining 37 cases who received open choledochoscope -assisted cholecystostomy,7 ca-ses developed fat liquefaction at the incision,and 10 cases eventually underwent open cholecystectomy three months after the operation due to cystic duct closure and opening abnormality detected by angiography.Thirty patients with stage IV disease underwent cholecystectomy and choledocholithotomy,of which 2 cases developed fat liquefaction at the incision,but no bile leakage and bile duct injury were observed.All 326 patients were cured without mortality.The incidence of adverse events was 6.75%.Conclusion The standardization of therapy for pa-tients with gallstones is an effective approach to ensure the clinical efficacy and to avoid or reduce postoperative complications.It should be promoted in clinical settings.

Objective To investigate the relationship between cholecystectomy and the subsequent occurrence of primary choledocholithiasis and to review the surgical treatment of primary choledocholithiasis.Methods The clinical data of 70 patients with forward common bile duct stones after cholecystectomy who were admitted to our hospital from January 2007 to December 2013 were retrospectively analyzed.Results All 70 patients underwent open surgery for removal of common bile duct stones,which were identified as bile pigment calculi.The postopera-tive complications included incisional wound infection (8 cases)and lung infection (5 cases),and no severe complications as biliary leak-age or hematobilia were observed.All patients fully recovered at the time of discharge.Eight cases of recurrent common bile duct stones were found and surgeries were performed 2.5 to 4 years after the recurrence.All patients were cured by choledocholithotomy,common bile duct transection,and Roux-en-Y hepaticojejunostomy.Conclusion Primary choledocholithiasis is an age-related disease,not a long-term complication of cholecystectomy.If no bile duct injury occurs during the cholecystectomy,the incidence rate of primary choledocholithiasis will not be increased.Surgical treatment is required for primary choledocholithiasis.For the cases of choledochectasia with the diameter of common bile duct greater than 2.5 cm or recurrent choledocholithiasis,the laparotomy with common bile duct transection and Roux-en-Y anastomosis is recommended.

In cardiac myocytes, Ca 2+ sparks origining fr om a single RyR or a few RyRs are triggered by a single L-type Ca 2+ channel or occur spontaneously. Ca 2+ sparks constitute the elementary local Ca 2+ release events from the SR. Ca 2+ sparks occur at Z-lines and rando mly distribute at different locations, the characteristics of the kinetics are r egulated by many factors. In addition, I Ca.T, Na+/Ca 2+ exchang e, I Ca(TTX) and IP 3 are other putative sources of Ca 2+ that tr igger SR Ca 2+ release.

Epidermal growth factor receptor ( EGFR) express highly or mutant in esophageal cancer,which causing tumor resistance to radiotherapy and leading to poor radiotherapeutic effects.Treatment with antiEGFR can get radiosensitization.There are three main types of molecular targeted research for EGFR:synthetic monoclonal antibody,small molecule tyrosine kinase inhibitors,and other.strategies modulating EGFR biosynthesis based on RNA interference.

BACKGROUND: Posterior antebrachial skin is beneficial for repairing injury of dorsum of hand; however, according to lacking operative researches on distal pedicel arterial perforators of posterior antebrachial cutaneous nerve nutrient vessel flap, it is still a confusing problem in clinic.OBJECTIVE: To investigate the features of distal antebrachial arterial perforators of dorsal forearm and provide anatomical theories for suitable designing pedicle flap and compound flap at distal flap pedicled with nutrient vessels of posterior antebrachial cutaneous nerve.DESIGN: Single sample observation.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIAL5: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004. Thirty-three upper limbs of adult cadavers perfused with red latex through arteries were provided by Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA.METHODS: Thirty-three adults upper limbs were dissected and observed with microscope with taking rhe styloid process of ulna and radius as pivot point.MAIN OUTCOME MEASURES: ① Distal antebrachial arterial perforators of dorsal forearm; ② nutrient vessels of distal posterior antebrachial cutaneous nerve; ③ their blood supply relationship with nearby muscle, bone and skin.RESULTS: ① Along extensor digitorum communis muscle, distal antebrachial arterial perforators of dorsal forearm were perforated along bilateral muscular interspace and tendon interspace to form lateral and interior inosculated vascular plexuses of fascia. The axis of lateral muscle interspace, dorsal antebrachial lateral vascular plexuses consisted of lateral branch of dorsal carpal branch of anterior interosseous artery, radial interosseous cutaneous perforators, radial interosseous cutaneous perforators of posterior interosseous artery, carpal dorsal branch of radial artery and its perforators. The axis of medial muscle interspace, dorsal antebrachial medial vascular plexuses was consisted of medial branch of dorsal carpal branch of anterior interosseous artery, ulnaris interosseous cutaneous perforators, ulnaris interosseous cutaneous perforators of posterior interosseous artery, carpal dorsal branch of ulnaris artery and its perforators. ②Above mentioned arterial perforators sent out cutaneous branches, fascia branches and posterior antebrachial cutaneous nerve nutrient vessel to form vascular chain of cutaneous nerve stem and vascular nets of deep and superficial fascia.Muscle-periosteum branches of posterior interosseous artery had some ulnar periostea whose radial interosseous cutaneous perforators were anastoimosed with periosteum vessels in the middle and inferior segments of radius; therefore,there was an anatomic basis for distal pedicele compound flap.CONCLUSION: Blood supply of distal antebrachial arterial perforators of dorsal forearm is characterized by multiple sources, obviously longitudinal distribution and homologous nutrient vessel; therefore, there are three blood-supplied distal pedicled flap or compound flap of posterior antebrachial cutaneous nerve nutrient vessel. Rotation point of distal pediclde flap can reach wrist joint, and the compound flap can be applied in repairing the injury of distal tissue of hand.

Objective To explore the effectiveness of microendoscopic discectomy (MED) in the treatment of lumbar disc herniation. Methods A retrospective analysis of clinical data of 59 cases of lumbar disc herniation treated by MED was made. The experience as well as lessons was summed up. Results All the 59 cases were followed for 4~24 months (mean, 15 months). Clinical outcomes were determined according to the Macnab criteria, which revealed that 43 cases had excellent, 14 cases had good, 1 had fair, and 1 had poor outcomes (with postoperative paralysis), the “excellent or good” rate being 96.6%(57/59). Conclusions MED is the first choice for contained herniated lumbar discs. A successful MED depends upon proper selection of patients and skillful surgical techniques.

BACKGROUND: The distally based skin flap pedicled with nutrient vessels of saphenous nerve has provided a method with higher achievement ratio to repair the tissue defect of ankle and foot, due to its high rotation point, lacking of distributive characteristics of distally pedicled vessels description for the specific operations, so it is still difficult in clinical application.OBJECTIVE: To investigate the distal artery perforators of medial leg, so as to suggest an anatomical theory for the reasonable design of the distally based compound flap pedicled with nutrient vessels of saphenous nerve-great saphenous vein.DESIGN: A single sample experiment.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out in the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004.Thirty-four adult specimens perfused with red emulsion at lateral arteries of upper lower limbs were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: Specimens of the distal medial legs were dissected with microscope taking the most prominent point of medial malleolus as the pivot point.MAIN OUTCOME MEASURES: ① Distal artery perforators of medial leg; ② Distal nutrient vessels of saphenous nerve-great saphenous vein; ③ Blood supply correlation of nutrient vessel with neighboring muscle, bone and skin.RESULTS: ① The distal artery perforators of medial leg derived from 9 main blood supplying sources were as follows:Intermuscular perforator of posterior tibial artery, superior malleolar branches of anterior tibial artery, osteocutaneous perforators of peroneal artery or posterior tibial artery, medial malleolar branch of medial anterior malleolar artery, tarsal tunnel branch of posterior tibial artery, medial malleolar branch of medial plantar artery, medial malleolar branch of lateral plantar artery, medial malleolar branch of the superficial branch of medial plantar artery and medial maleolar branch of medial tarsal artery. ② The above-mentioned artery perforators sent out cutaneous branches, fascial branches, periosteal branches, nutrient vessels of saphenous nerve and great saphenous vein, thus formed a superior and inferior vascular net of deep fascia, vascular chain of superficial fascia and neurocutaneous superficial vein, and periosteal vascular network. Artery perforators constituted 3 distal longitudinally distributed fascial vascular plexus in medial leg (anterior, middle and posterior), including anterior longitudinally distributed fascial vascular plexus of medial anterior malleolar artery and superior malleolar branch of anterior tibial artery; middle longitudinally distributed fascial vascular plexus of osteocutaneous perforators; posterior longitudinally distributed fascial vascular plexus of malleolar canal artery perforators and intermuscular perforators of posterior tibial arteries.CONCLUSION: The blood supply of distal medial leg, which makes the anatomical basis for distally pedicled compound flaps, has the anatomical characteristics of multiple-sources, longitudinal distribution and homogeneity of nutrient vessels.Three kinds of distally pedicled skin flap supplied by nutrient vessels of saphenous nerve-great saphenous vein can be designed by taking the intermuscular perforator of posterior tibial artery, fascial perforators of medial anterior malleolar artery and artery perforators of tarsal tunnel perforators as pedicle, and the point of rotation is on the plane of medial malleolus, which are suitable for repairing the defects of distal leg, ankle and foot.

Objective To evaluate the bladder functions by urodynamic studies in diabetic patients with lower urinary tract symptoms (LUTS). Methods Urodynamic studies were performed in 42 diabetic patients (24 men and 18 women;age range,38-78 years).The diabetic history of the patients was from 1 month to 25 years. Results Of the 41 cases who underwent all items of urodynamic examination,38 cases (93%) had abnormal findings and 3 (7%),normal.The detrusor was underactive in 14 cases (34%) and areflexia in 10 (24%);BOO was found in 13 (32%).One female patient had stress urinary incontinence. Conclusions There is a high prevalence of bladder dysfunction in diabetic patients with LUTS.It is necessary to perform urodynamic studies in diabetic patients before initiation of therapy,especially in patients who are assigned to undergo bladder and urethral surgery.Preoperative urodynamic studies can contribute to the surgical success rate.

Objective To provide the anetomic base for the transposition of spine of scapular flap pedicled with thoracoacromial artery Methods The course, branches and distribution of thoracoacromial artery were observed on 40 adult cadaver specimens Results The main branch of thoracoacromial artery was the acromial branch Its length was (5 1?0 1) cm, the originated diameter was (1 2?0 2) mm The deltoid muscular branch went outward intermuscular ditch between deltoid muscle anspectoralis major muscle, and anastomosed with anterior humeral circumflex artery constantly besides distributing to deltoid muscle and pectoralis major muscle, its diameter was (1 9?0 2) mm, the length form the originated dot to the entrancing muscular dot of deltoid muscle or pectoralis major muscle was (4 8?0 5) cm or (3,2?0 4) cm respectively Conclusion The transposition of lateral segment spine of scapular flap pedicled with the acromial branch of thoracoacromial artery or deltoid muscular branch acromial branch may be designed for repairing proximal humerus

Objective To investigate the causes and the clinical significance of the female lower urinary tract symptoms (LUTS). Methods Of the 72 female patients (mean age,48 years;range,8 to 86 years) with LUTS,46 had dysuria,14 with incontinence,10 with frequency and urgency of micturition and 2 with nocturnal enuresis.Urodynamic examinations were conducted in these patients. Results Among the 46 cases with difficulty of urination,whose bladder volumes were 60 to 800 ml,20 had the bladder detrusor contractility of 0,and 26,of 9 to 160 cm H 2O.Linearised passive urethral resistance relation (Linp-URR) figure showed at least grade Ⅲ obstruction in 19 cases.The urethral pressure profiles (UPPs) were 25 to 130 cm H 2O.Dyssynergia of detrusor-external sphincter occurred in 33 cases with voiding dysfunction.Ten cases with frequency of micturition had bladder volume of 97 to 450 ml.Two cases had the bladder detrusor contractility of 0,the other 8 cases were of 9 to 160 cm H 2O.Linp-URR figure showed at least grade Ⅲ obstruction in 2 cases.One case with urgent incontinence had hyper-sensitive bladder.The abdominal leak point pressures were 44 to 76 cm H 2O in 6 cases of stress incontinence.3 cases of overflowing urinary incontinence had no contraction of bladder detrusor and the UPPs were 32 to 42 cm H 2O.The UPPs were 0 to 16 cm H 2O in the 4 cases of total urinary incontinence.Two cases of nocturnal enuresis had detrusor instability with impaired contractility. Conclusions Urodynamic examination is necessary to the diagnosis of female LUTS and it also has significant value in predicting the treatment and prognosis of LUTS.