Objective:To discuss the problems that exist in the operation mechanism of the third -party media-tion mode of medical disputes in China and put forward suggestions for improvement , through comparative study of the third-party mediation mode of domestic and foreign medical disputes .Results:People's mediation mechanism of medical disputes in our country still hadsome problems .For example , mediation talents were insufficient;propa-ganda was inadequate;mediation results were difficult to implement;mediation support funds couldn ' t be guaran-teed, and so on.Conclusion:It is recommended to improve the remuneration of employees and standardize the staff selection system;increase propaganda and raise public awareness;improve the judicial confirmation system and en-hance the guarantee of agreement;save regulation cost and increase multi -financing channels .

OBJECTIVETo explore the feasibility of single-incision laparoscopic cholecystectomy using a three-dimensional (3D) laparoscopic system.

METHODSTwo patients with benign gallbladder disease with a history of recurrent abdominal pain were selected to undergo the surgery. Gallstones were diagnosed by B ultrasound examination. All the operations were performed through the umbilical incision with the 3D laparoscopic system.

RESULTSThe 2 operations were completed successfully with a operative time of 35 min and 50 min. Both of the patients were ambulatory 8 h after the surgery, began to have a normal diet 1 day after operation, and were discharged 2 days postoperatively without any clinical symptoms.

CONCLUSIONS3D single-incision laparoscopic operation can well reveal the tissue anatomy in the operative field especially for some important structures such as the Calot's triangle with an improved safety compared to conventional laparoscopic operations.

Cholecystectomy, Laparoscopic ; Cholelithiasis ; surgery ; Gallbladder Diseases ; surgery ; Gallstones ; Humans

OBJECTIVETo investigate the expression pattern of resistin (RSTN) in skeletal muscle tissue and its influence on glycometabolism in rats with traumatic brain injury (TBI).

METHODSSeventy-eight SD rats were randomly divided into traumatic group (n=36), RSTN group (n=36) and sham operation group (n=6). Fluid percussion TBI model was developed in traumatic and RSTN groups and the latter received additional 1 mg RSTN antibody treatment for each rat. At respectively 12 h, 24 h, 72 h, 1 w, 2 w, and 4 w after operation, venous blood was collected and the right hind leg skeletal muscle tissue was sampled. We used real-time PCR to determine mRNA expression of RSTN in skeletal muscles, western blot to determine RSTN protein expression and ELISA to assess serum insulin as well as fasting blood glucose (FBG) levels. Calculation of the quantitative insulin sensitivity check index (Q value) was also conducted. The above mentioned indicators and their correction were statistically analyzed.

RESULTSCompared with sham operation group, the RSTN expression in the skeletal muscle as well as serum insulin and FBG levels revealed significant elevation (P<0.05), and reduced Q value (P<0.05) in traumatic group. Single factor linear correlation analysis showed a significant negative correlation between RSTN expression and Q values (P<0.001) in traumatic group.

CONCLUSIONThe expression of RSTN has been greatly increased in the muscular tissue of TBI rats and it was closely related to the index of glycometabolism. RSTN may play an important role in the process of insulin resistance after TBI.

Animals ; Brain Injuries ; metabolism ; Glucose ; metabolism ; Insulin Resistance ; Male ; Muscle, Skeletal ; chemistry ; metabolism ; Rats, Sprague-Dawley ; Resistin ; analysis

Scoliosis is characterized by one or several segments of the spine bending sideways, accompanied by vertebral rotation and sagittal imbalance with complex etiology. Scoliosis can be caused by congenital vertebral abnormalities, asymmetry of the paraspinal muscles due to neurological lesions, and malnutrition or metabolic disorders of bone tissue. Growth hormone is a peptide hormone that plays a key role in promoting human growth and development, especially in bone growth. When the secretion of growth hormone in children or adolescents in the rapid growth stage is insufficient, it may lead to the occurrence of idiopathic short stature (ISS) and growth hormone deficiency (GHD). In clinic, ISS and GHD are mainly treated by recombinant human growth hormone (rhGH). According to some early clinical reports, in the process of rhGH treatment, many patients occur scoliosis or the original scoliosis progression is aggravated. Therefore, many scholars conclude that rhGH treatment of ISS or GHD will lead to the occurrence or development of scoliosis. However, with the increase of clinical statistics and the further progress of research, many scholars found that rhGH treatment of ISS or GHD will only increase the Cobb angle of patients with scoliosis, but will not lead to the occurrence of scoliosis, that is, rhGH treatment of ISS or GHD will not increase the prevalence of scoliosis. At present, whether rhGH treatment of ISS and GHD can lead to scoliosis and aggravation of scoliosis remains controversial. Therefore, this paper summarizes and analyzes the correlation research on the risk of scoliosis complications in children treated with rhGH, and concludes that age, gender, body mass index, and growth potential are risk factors for the development or progression of scoliosis during treatment, and discusses the balance of advantages and disadvantages of using rhGH for ISS or GHD to provide a direction for future clinical guidance.

Objective To explore the feasibility of single-incision laparoscopic cholecystectomy using a three-dimensional (3D) laparoscopic system. Methods Two patients with benign gallbladder disease with a history of recurrent abdominal pain were selected to undergo the surgery. Gallstones were diagnosed by B ultrasound examination. All the operations were performed through the umbilical incision with the 3D laparoscopic system. Results The 2 operations were completed successfully with a operative time of 35 min and 50 min. Both of the patients were ambulatory 8 h after the surgery, began to have a normal diet 1 day after operation, and were discharged 2 days postoperatively without any clinical symptoms. Conclusions 3D single-incision laparoscopic operation can well reveal the tissue anatomy in the operative field especially for some important structures such as the Calot's triangle with an improved safety compared to conventional laparoscopic operations.

Objective To explore the feasibility of single-incision laparoscopic cholecystectomy using a three-dimensional (3D) laparoscopic system. Methods Two patients with benign gallbladder disease with a history of recurrent abdominal pain were selected to undergo the surgery. Gallstones were diagnosed by B ultrasound examination. All the operations were performed through the umbilical incision with the 3D laparoscopic system. Results The 2 operations were completed successfully with a operative time of 35 min and 50 min. Both of the patients were ambulatory 8 h after the surgery, began to have a normal diet 1 day after operation, and were discharged 2 days postoperatively without any clinical symptoms. Conclusions 3D single-incision laparoscopic operation can well reveal the tissue anatomy in the operative field especially for some important structures such as the Calot's triangle with an improved safety compared to conventional laparoscopic operations.

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.