Objective To evaluate the clinical applications and surgical methods of combined laparoscopic common bile duct (CBD) exploration with choledochoscopy. Methods From 2006 to 2009,clinical data of 42 patients with choledocholithiasis undergoing laparoscopic common bile duct exploration were retrospectively analyzed. We applied a step-by-step electric coagulating incision technique on the CBD,the step-by-step suturing technique, and the step-by-step clamping technique with alligator forceps, and soft tube irrigating technique with suctioning by selecting the proper exploration route, improving the common bile duct incision technique and calculus removing techniques. Results Procedures were successful in all the cases. There was no conversions to open surgery, no postoperative bleeding and no operative mortality. The mean operating time was 120 minutes (ranging, 90 to 150 minutes) with minimal intraoperative blood loss ( ranging, 20 to 40 ml). Ductal stone clearance was successful in 41 out of 42 patients ( 93% ). The largest number of the common bile duct stones was 16. With the diameter of stones larger than 15 mm in 18 cases in which the biggest was 30 mm. Bile leak developed in 1 patient, retained stones found in 3 patients,including intrahepatic cholelithiasis in one case. As a result, 38 out of 42 patients underwent common bile duct exploration. 35 patients were placed on T-tubes. Four patients underwent cystic duct exploration in which 3 had primary suture of the cystic duct and 1 had drainage. There was no infection and stenosis of biliary tract in the 42 followed-up cases. Conclusions Laparoscopic common bile duct exploration with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. Improving the way of operation and selecting suitable exploration can result in better clinical outcomes.

It is one of the key points for modernization and internationalization of traditional Chinese medicines to construct the Good Agricultural Practice (GAP) base of Chinese materia medica (CMM).GAP helps to minimize contamination and improve the quality of CMM during the plantation and the production of Chinese crude drugs.In this article,the status and development of CMM production bases of GAP in Guangdong Province,China,are presented.The suggestions upon the problems during the development of GAP for Chinese crude drugs are also provided.

Objective To explore the effects of amniotic lacrimal duct stenting on the prevention of dry eye in castrated rabbits.Methods Thirtysix healthy male rabbits were selected,the third eyelid were cut off and antiinfection treatment were given,which were randomly divided into 3 groups (12 cases in each group),the castrated male rabbits models were made.Among them,group A was negative control group,group B was dry eye model group,group C was group of lacrimal amniotic membrane group.At 2 weeks before implantation of amniotic lacrimal duct stent,2 weeks,4 weeks and 6 weeks after implantation,the fluorescent (FL) examination,Western blot,Schirmer I examination,immunofluorescence staining and corneal confocal microscopy were performed.Results The levels of tear secretion and FL in the three groups among different time points were significantly different (F=7.126,P =0.009;F =9.658,P =0.016),and there were significant differences among three groups (F =12.582,P =0.005;F =13.187,P =0.013).The tendency of tear secretion and FL in the three groups were also significantly changed (F =8.531,P =0.007;F =10.652,P =0.019).The epithelial basal cells at 6 weeks after implantation in three groups were 3811 ±414,3820 ± 314,2789 ± 353,and the density of inflammatory cells was 266 ±28,266 ± 29,67 ± 13,there were significant differences among three groups (F =13.442,P =0.012;F =9.231,P =0.021).The K1 6 staining in the duct epithelium were negative,and the expression of α-SMA in the lacrimal duct tissue of group A,B and C was not changed at all time points after implantation of amniotic lacrimal stent,and there was no significant difference (F =14.681,P =0.002).Conclusion The amniotic lacrimal stent implantation has certain effect on the prevention of dry eye in rabbit.

Objective To analyze the thickness of cornea and corneal epithelium in healthy subjects by optical coherence tomography angiography (OCTA).Methods Totally 100 healthy subjects aged between 20 and 30 years were analyzed by OCTA technique.Using AngioVue OCTA system of retinal imaging mode,and using SSADA algorithm for imaging,the cornea and the corneal epithelium in the central corneal diameter range of 9 mm were measured.The differences of corneal and corneal epithelial thickness in different gender regions were compared.Results In the male and female group,the corneal central total thickness were (559.92 ±33.26) μm and(540.06 ±31.63)μm,and the corneal epithelial thickness were(57.78 ±4.88) μm and(56.88 ±4.57) μm,The total central corneal thickness and central corneal epithelial thickness of the male were greater than those of the female,the difference was statistically significant (t =3.06,2.10;all P ＜ 0.05).The cornea of male was the thickest at S5,S7 and SN9,there were significant differences at S5 and S7 compared with female (t =2.93,2.83;all P ＜ 0.05);The female cornea was the thickest at S5,SN7 and SN9,and the difference was significant at S5 compared with male.The cornea of male subjects was the thinnest at IT,which was statistically significant only at IT5 compared with female subjects in the same area (t =2.02,P ＜ 0.05);The cornea of female subjects was the thinnest at T5,IT7 and T9,which was statistically significant only at T5 and T9 compared with male subjects in the same region (t =2.63,2.20;all P ＜ 0.05);There was significant difference in corneal thickness between male and female at ST (t =3.1 1,2.79,2.33;all P ＜ 0.05).The corneal epithelium was the thickest at IT5,I7,and I9,and the lowest at S5,S7 and S9,and there was no significant difference compared with female in the same region (all P ＞ 0.05).The corneal epithelium of female at the IT5,T7,N9 were the thickest,SN5,S7,S9 were the thinnest;Except for M2 and SN5,there was no significant differences in corneal epithelium between male and female groups (all P ＞ 0.05).Corneal central epithelium accounted for the largest percentage of total corneal thickness,and gradually decreased from inside to outside.Conclusion OCTA can be used to measure the thickness of corneal and corneal epithelial regions.

Objective:To study the effects of L-T4 gel combined with metformin on Ach and MCT8 content in hippocampus of hypothyroidism model rats.Methods:40 rats were randomly divided into 5 groups, normal control group (CON group) , hypothyroidism group (Hypo group) , L-T4 replacement group (L-T4 group) , metformin treatment group (MET group) and combined treatment group (L-T4+MET group) by random number table. Rats in CON group were given normal drinking water, and rats in the other four groups were given drinking water containing 0.05% propylthiouracil for 6-week hypothyroidosis modeling. At the 5th week of modeling, rats in MET group were given 1ml/100g metformin solution by intragastric administration, and rats in L-T4 group were applied with L-T4 gel agent at a dose of 0.1g/100g. L-t4+MET group were treated with L-T4 gel and metformin solution. At the end of 6-week modeling, the blood of abdominal aorta was collected, and the hippocampal tissue of the brain was quickly separated on an ice platform. Meanwhile, the trachea and thyroid were cut out and photographed to record their size. They were stored in a -80℃ refrigerator or soaked in 4% paraformaldehyde for fixation and used for immunohistochemical staining. T-test was used to confirm the difference between the data of each group, one-way analysis of variance was used to compare the means between multiple groups, and chi-square test was used when the count data were expressed as percentage ( χ2) . P<0.05 was used to indicate statistical significance between the data, and the difference was statistically significant. Results:Nishner staining showed that the optical density of the Hypo group was lower than that of the CON group ( t=8.944, P<0.001) , the optical density of the MET group was higher than that of the Hypo group ( t=4.472, P<0.001) , and the optical density of the L-T4 group was higher than that of the Hypo group ( t=4.472, P<0.001) . The optical density of rats in the combined treatment group was higher than that in the Hypo group ( t=8.944, P<0.001) , and recovered to the level of the CON group ( P=1.000) . After 2 weeks of treatment, the total thyroxine level (TT4) of the Hypo group was lower than that of the CON group ( t=14.536, P<0.001) , and the TT4 level of the MET group was higher than that of the Hypo group ( t=6.924, P<0.001) . TT4 level of L-T4 group was higher than that of Hypo group ( t=4.892, P<0.001) , TT4 level of combined treatment group was higher than that of Hypo group ( t=12.890, P<0.05) , and recovered to the level of CON group ( t=0.494, P=0.709) . After the study, the thyroid tissue of each group was collected. The thyroid tissue weight of the Hypo group was higher than that of the CON group ( t=7.906, P<0.001) , the thyroid tissue weight of the MET group and L-T4 group was lower than that of the Hypo group (MET: t=2.000, P<0.001; L-T4: t=3.000, P<0.001) , but higher than that of the CON group (MET: t=3.000, P<0.001; L-T4: t=2.000, P<0.001) . The thyroid weight of L-T4+MET group was similar to that of CON group ( P=1.000) . HE staining showed that the size of thyroid follicles was different in the combined treatment group, and the number of glial and absorbed vacuoles basically recovered similar to that of CON. After treatment, the Ach level in the Hypo group was lower than that in the CON group ( t=3.618, P<0.001) , the Ach level in the MET group was higher than that in the Hypo group ( t=3.121, P=0.016) , the Ach level in the L-T4 group was higher than that in the Hypo group ( t=3.321, P=0.027) , and the Ach level in the combined treatment group was higher than that in the Hypo group ( t=3.202, P=0.001) . And recovered to the level of CON group ( t=3.362, P=0.605) . After treatment, the MCT8 level in the Hypo group was higher than that in the CON group ( t=11.254, P<0.001) , the MCT8 level in the MET group was lower than that in the Hypo group ( t=5.679, P<0.001) , and the MCT8 level in the L-T4 group was lower than that in the Hypo group ( t=5.813, P<0.001) . The MCT8 level of the combined treatment group was lower than that of the Hypo group ( t=8.624, P<0.001) , and recovered to the level of the CON group ( t=0.587, P=0.477) . Conclusion:L-T4 gel combined with metformin has a good therapeutic effect on hypothyroidism, which can increase the level of Ach and decrease the level of MCT8 in hippocampus.