Objective To observe clinical application of the apparent Shikani laryngoscope in difficult airway, so as to provide reference for basic-level hospitals to deal with difficult airway. Methods 50 patients with difficult airway were randomly divided into 2 groups:Shikani laryngoscope group (S) that direct laryngoscope group (M) . After conventional induction, patients in two groups were given endotracheal intubation with different intubation tools by the same anesthesiologist, then the intubation time and the one-time success rate of intubation were compared between two groups. The hemodynamics of patients, were observed in two groups,the HR,SBP,DBP and SPO2 at before (T0),during (T1),2 min after (T2) and 5 min after intubation (T3) were recorded. The complications including gingival and oral mucosa bleeding, sore throat, hoarseness were also recorded in two groups.Results During the process of intubation, the hemodynamic changes of patients had statistically significant difference between T0 and T1, T2,T3 subgroups ( <0.05),T2 and T3 subgroups ( <0.05) . The intubation had less influence on hemodynamics of patients in group S than M group,but the SPO2 and T0 had no significant difference between two groups ( >0.05) .Comared with M group,the one-time success rate of intubation was higher,and the intubation time was shorter in S group and there were significant differences ( <0.05) . There was no significant difference in the intubation complications between the two groups ( > 0.05), and this may be associated with small sample cases. Conclusion Compared with ordinary laryngoscope, Shikani laryngoscope has incomparable advantages in handling difficult airway and is convenient to apply,so it is worth popularizing in basic-level hospitals.

Objective To observed the expression of matrix metalloproteinase-9 in the early onset of severe acute pancreatitis associated with acute lung injury in rats and investigate its effection in lung injury.Methods Thirty-two healthy adult male SD rats were randomly divided into two groups:Control group (n =8),Severe acute pancreatitis group(n =24).Severe acute pancreatitis model was induced by retrograde inject the 4％ sodium taurocholate sodium taurocholate into the biliopancreatic duct of rats.The severe acute pancreatitis group was detected the rate of lung water content、arterial blood gas.myeloperoxidase,matrix metalloproteinase-9,histopathology of the pancreas and lung injury score under the light microscope at 3 hours,6 hours and 12 hours.The matrix metalloproteinase-9 expression was detected by immunohistochemical and the results of immunohistochemical were analysed by the Image-Pro Plus image analysis system.Control group was detected the relevant indicators at 12 hours.Results Successfully modeling,the expression of matrix metalloproteinase-9 gradually increased beginning at 3 hours,at twelve hours up to the highest value(P ＜ 0.05).The degree of lung injury,lung water content,myeloperoxidase activity,PaCO2 gradually increased(P ＜ 0.05),PaO2 decreased significantly P ＜ 0.05).Conclusions The high expression of matrix metalloproteinase-9 is important to the pathogenesis of severe acute pancreatitis associated with acute lung injury.

Objective To evaluate the efficacy of one stage laparoscopic choledocholithotomy and cholecystectomy vs.ERCP cholecystolithiasis and cholecystectomy (staged) for cholecystolithiasis complicated with choledocholithiasis.Methods From Jan 2015 to Jun 2017,100 consecutive patients underwent randomized one-stage (TCLCBDE + LC) or two-stage (ERCP + subsequent LC) treatment for common bile duct (CBD) stones.Data evaluated were hospital costs,success rate of one-stage versus two-stage management,postoperative morbidity and GIQLI.Results 47 patients underwent ERCP plus LC two-stage treatment while 46 patients underwent one-stage treatment.Overall success rate of primary intervention for CBD stone clearance was 95.7％ and 97.8％ (P =1.0).Postoperative morbidity was 10.6％ vs.6.5％ (P =0.735),and postoperative hospital stay was (16 ± 5) days vs.(11.9 ± 2.9) days (P ＜ 0.01).One-stage laparoscopic transcystic management was the least costly option compared to two-stage management (19 415 ±2 167)yuan vs.(26 767 ±4 387)yuan (P ＜0.01).GIQLI improved faster in one-stage management group.Conclusion Transcystic one-stage management for gall stones with choledocholithiasis results in shorter hospital stay,lower costs and faster recovery than the two-stage management.