Objective To explore the feasibility and safety of day surgery laparoscopic cholecystectomy . Methods From January 2015 to June 2015, 78 cases of day-case laparoscopic cholecystectomy were performed in our hospital .The clinical data were retrospectively reviewed .These patients were diagnosed as having cholelithiasis or cholecystic poypus .They had no severe heart or lung diseases, no history of epigastric operation , and agreed to accept day-case laparoscopic cholecystectomy without overnight hospitalization. Results Of the 78 patients, 74 patients (94.9%) successfully accepted the surgery and were discharged no more than 4 h after surgery, including 2 patients with combined laparoscopic transcyctic common bile duct exploration ( LTCBDE).The remaining 4 patients (5.1%) were admitted for overnight hospital stay , including 1 patient (1.3%) with Mirizzi syndrome type Ⅰwho was given abdominal drainage , 2 patients (2.6%) with severe nausea and vomit , 1 patient (1.3%) with airway obstruction after operation.All the 4 patients were discharged within 24 h after the surgery.The operating time was 35-152 min (mean, 80.0 ±19.7 min).The hospitalization expenses was 5688-9768 yuan (mean, 8318.0 ±848.5 yuan).The hospitalization time was 5.6-23.9 h (median, 7.4 h).Postoperative follow-up at the day of surgery, the first and the seventh postoperative day showed that none of the patients suffered from severe complications . Conclusion Day-case laparoscopic cholecystectomy is safe and feasible , on the basis of strictly selected patients , experienced surgeons , and close cooperation with anesthetists and nurses .

Objective To compare safety,completeness and long-term results between lobectomy by video-assisted thoracoscopic surgery(VATS) and thoracotomy for clinical stage Ⅰ / Ⅱ non-small cell lung cancer(NSCLC).Methods Between July 2010 and December 2011,673 patients with clinical stage Ⅰ / Ⅱ NSCLC from 11 hospitals underwent pulmonary lobectomy(425 VATS,248 thoracotomy).Patients were matched by propensity score matoh method to create two comparable groups,402 patients remained eligible for analysis,with 201 patients in each group.Perioperative variables and follow-up results were compared between the two groups.Results Patients characteristics were comparable between the two groups,except for a slight lower preoperative FEV1,FEV1％ and FEV1/FVC in the VATS group (P ＜ 0.05).There was one postoperative death in each group.There was no significant difference in operative time,mediastinal lymph nodes stations/numbers dissected and postoperative drainage time between the two groups.The operative blood loss was lower in the VATS group(P ＜ 0.001),the mean hospital stay was shorter in the VATS group(P ＜ 0.001).Postoperative pneumonia/pulmonary atelectasis rate was lower in the VATS group than in the thoracotomy group (5.1％ vs.10.4％,P ＜ 0.05).Median follow-up time was 20 months in both groups.One-year and two-year recurrence-free survival was 90％ vs.88％ and 80％ vs.70％,respectively(P =0.163).One-year and two-year overall survival were 96％ vs.95％ and 88％ vs.85％,respectively(P =0.226).Conclusion For clinical stage Ⅰ / Ⅱ NSCLC,VATS lobectomy is a feasible procedure with shorter hospital stay and less complications,while its surgical and oncologic outcome is comparable to that of thoracotomy lobectomy.

Objective To analyze the characteristics of erectile dysfunction(ED)in aged men.Methods Erectile dysfunction(ED)was diagnosed according to the International Index of Erectile Function(IIEF).78 aged men(average 65.9 yrs)as the study group,and 82 young patients(average 36.0 yrs)as the control group,all with ED,Were compared in complicating diseases,self-rating SDS scores,penile-brachial indexes(PBI),the time of achieving erection,and ejaculatory latency time.Results The main complicating diseases in study group were cardiovascular diseases(42 cases,53.9%),lower urinary tract symptoms(LUTS)(31 cases,39.7%)and diabetes(26 cases,33.3%).In the control group,the main complicating diseases were chronic prostatitis(52 cages,63.4%),premature ejaculation(PE)(32 cases,39.0%)and depression(12 csses,14.6%).SDS scores of study group and control group were(29.13±5.63)and(39.59±13.31),PBI were(0.78±0.12)and(0.91±0.06),the time of achieving erection were(13.85±5.75)min and(3.61±4.29)min,ejaculatory latency time were(7.03±5.35)min and(3.81±5.53)min.All with significant difference(P＜0.01).Conclusion Most of the ED old men were complicated with organic diseases,such as the time of achieving erection,PBI low scores and longer ejaculatory latency time.

Objectives:To investigate the clinical significance of the expression level of cytokeratin5/6/18 positive cells in peripheral blood cells from patients with breast carcinoma.Methods:The expression rates of ck5/6/18 positive cells in peripheral blood cells from 56 patients with breast carcinoma were measured and analyzed by flow cytometry.Results:The expression rates of ck5/6/18 positive cells in peripheral blood cells from 56 patients with breast carcinoma was 46.4% and there was significant differences compared with healthy volunteers and the patients with breast benign diseases.The positive rates increased significantly with the pathological staging and show no significant relationship with the ER and PR.Conclusion:The expression of ck5/6/18 positive cells in peripheral blood cells correlates significantly with the pathological staging of breast carcinoma and it could be an effective signal to clinical monitor and prognosis.

AIM To establish the hyperlipidemia and hyperlipidemic fatty liver animal model.METHODS 30 SD rats were randomized into control group (n=10)and model group(n=20).The rats of model group were fed with a standard diet and fat emulsion( 10 ml?kg -1);while the rats of control group were only fed with a standard diet.The serum TG,TC,ALT,AST,MDA,SOD and hepatic TG,TC,MDA,SOD were detected dynamically and with histologically.RESULTS The model group developed hyperlipidemia which TG and TC were elevated significantly after 1 week. 10 rats which were selected randomly in the model group were killed and the serum and liver were obtained after 2 weeks. The serum TG,TC,ALT and hepatic MDA of the model group rats were higher than the control's,while the hepatic SOD were lower. At the same time,the light degree hepatic steatosis of 2 rats were induced.The third week,both control group and model rats(n=10) were killed and the serum and the liver were obtained. Compared with the control group, the serum TG,TC,ALT,AST,MDA?SOD and hepatic TG,MDA of the model group rats were markedly higher, while the serum SOD and the hepatic SOD were significantly lower.The histopathology research showed hepatocellular macrovesicular steatosis and hepatitis in the model group. CONCLUSINOS The experimental animal model of hyperlipidemia and hyperlipidemic fatty liver in rats were successfully established for 1 week and 3 weeks fed with fat emulsion.

Objective To investigate the clinical application of ultrasound biomicroscopy in the treatment of congenital corneal opacities.Methods Medical records of 20 eyes (15 patients) with congenital corneal opacity treated at our hospital from July 2004 to November 2011 were retrospectively reviewed.Best corrected visual acuity testing,intraocular pressure testing,slit-lamp anterior segment examination,fundus examination,slit-lamp microscopic photography,B scan examination,and ultrasound biomicroscopy were performed for analysis of complications of congenital corneal opacity and selection of surgical approaches.Results The ultrasound biomicroscopic examination showed that 5 eyes had no Descemet's membrane and corneal endothelium,20 eyes had anterior synechia,5 eyes had aniridia,3 eyes had loss of lens cortex,13 eyes had cataract,14 eyes had closed angle,and 3 eyes had pupillary membrane.14 of 20 eyes received surgical treatment,including penetrating keratoplasty combined with cataract extraction and trabeculectomy (5 eyes),penetrating keratoplasty combined with pupil angioplasty (3 eyes),penetrating keratoplasty combined with cataract extraction (3 eyes),penetrating keratoplasty combined with trabeculectomy (2 eyes),and lamellar keratoplasty (1 eye).Conclusions Ultrasound biomicroscopy is important to guide the diagnosis and treatment of congenital corneal opacity.

Objective To analyze the causes and outcome of conversion from tacrolimus (FK506) to cyclosporine-A (CsA) in recipients after liver transplantation.Methods 317 consecutive liver transplantation recipients in our department received anti-CD25 monoclonal antibody,FK506, mycophenolate mofetil and corticoid for prophylaxis of cellular rejection.The blood FK506 trough level was (10-15)?g/L within the first 30 days,(8-12)?g/L within next 60 days,and (5-8)?g/L was kept during 90 to 180 days after transplantation.All recipients reveived a follow-up of 6 months. Remits Sixteen out of 317 recipients (5.05%) required conversion from FK506 to CsA.The clinical indications for conversion included:neurological adverse effect of FK506 in 5 cases (31.25%),hema- tological adverse effect in 2 cases (12.5%),gastrointestinal effect in one case (6.25%),not capable of reaching therapeutic window concentration in 3 cases (18.75%),refractory hyperglycemia in 2 ca- ses (12.5%),and economic factor in 3 cases (18.75%).The majority of recipients demonstrated clinical improvement after the switch,except 2 of 16 patients (12.5%) had to be reconverted to FK506 due to renal disadvantage.No dead recipient and adverse effect correlated to immunosuppres- sive agent conversion were seen.Conclusion If necessary,conversion from FK506 to CsA in patients undergoing liver transplantation is safe and effective.

Objective:To investigate surgical methods and clinical effects of tibial pseudarthrosis due to neurofibromatosis type I (NF1) in adult using Ilizarov technique combined with intramedullary nail.Methods:A total of 12 adult with tibial pseudarthrosis due to NF1 treated by Ilizarov technique combined with intramedullary nail from October 2009 to December 2017 were retrospectively included. There were 6 males and 6 females with an average age of 27±8.3 years (range 17-44). All cases presented severe anterior arch in varus or valgus deformity with shortening in an average of 10.8±3.7 cm (range 5.6-16.5 cm). The in-volved levels were at the middle and lower part of tibia. All cases suffered from more than one treatment with failed surgery. One male patient with 5 times of unsuccessful operations. There were 4 cases with severe limping gait and 8 cases with walking with the help of brace (or single crutch) preoperatively. Regarding the family history, seven cases were inherited by father and 5 cases by mother. During surgery, the part of tibial pseudarthrosis and thickened fibrous tissue surroundings like periosteal were removed. The contracture achilles tendon was elongated in open way, and intramedullary nailing cross the ankle joint was applied when the tibial medullary cavity opened. Further, iliac bone grafting and proximal tibial osteotomy were performed with Ilizarov fixator application finally. The tibia was lengthened at a rate of 0.5-1 mm/d at 7 days postoperatively. The healing rate of pseudarthrosis and the length and alignment of limb were evaluated by X-ray routinely. The lower limb function and complications were assessed by self-made table for lower limb deformity correction and functional reconstruction.Results:All patients were followed up for 31-80 months with an average of 47.6±14.7 months. Bone union of pseudarthrosis in all cases was eventually achieved. The tibia was lengthened 5-12 cm with an average of 8.4±2.5 cm. There were 9 cases underwent second surgeries to promote bone healing and to correct residual deformities. The external fixator was used for 25-37 months with an average of 31.5±3.7 months. There was no complication, including neurovascular injury, severe soft tissue or bone infection affecting the clinical effects. All intramedullary nails were not removed finally. The limb function and gait in full weight bearing in 12 patients recovered at the latest follow-up. The evaluation score was 2.4±0.3 (range 2.1-2.8), of which 9 cases were excellent 3 were good. Thus, the excellent and good rate was 100%.Conclusion:The satisfactory clinical effects, including angular deformity correction, pseudarthrosis healing and short limb lengthening, can be achieved in adult with tibial pseudarthrosis due to NF1 by using the combination method of Ilizarov technique and intramedullary nail. However, the treatment duration could be longer.

OBJECTIVE: To investigate the quantity and species distribution of diatoms in Chuanyang River of Pudong new area of Shanghai and provide references for the invesitigation of water body in forensic practice. METHODS: The water samples collected from 15 areas in Chuanyang River of Pudong new area in September 2012 were examined by microscope to identify the species of diatoms. RESULTS: Cyclotella and Pinnularia were found to be the dominant species within the 12 species of diatoms in Chuanyang River, which showed differences in species among the sections of Huangpu River, the center and the East China Sea. CONCLUSION The differences in subsectional distribution of diatom species in Chuanyang River may provide a new foundation for forensic identification in drowning cases especially in the determination of falling location.
China ; Diatoms ; Drowning ; Forensic Medicine ; Fresh Water ; Rivers

The purpose of this study was to investigate the different effects of ACh on the action potential and force contraction in guinea pig atrial and ventricular myocardium by using standard microelectrodes and force transducer. The results showed that the duration of the action potential (APD) of atrial myocardium was shortened from 208.57+/-36.05 to 101.78+/-14.41 ms (n=6, P<0.01), and the APD of the ventricular myocardium was shortened from 286.73+/-36.11 to 265.16+/-30.06 ms (n=6, P<0.01).The amplitude of the action potential (APA) of the atrial myocardium was decreased from 88.00+/-9.35 to 62.62+/-20.50 mV (n=6, P<0.01), while the APA of the ventricular myocardium did not change significantly.The force contraction of atrial myocardium was inhibited completely (n=6, P<0.01), while the force contraction of ventricular myocardium was inhibited by 37.57+/-2.58% (n=6, P<0.01). The ACh effects correlated with its concentration. The K(D) of the APD shortening effects in the atrial and ventricular myocardium were 0.275 and 0.575 micromol/L. The K(D) of the negative inotropic in the atrial and ventricular myocardium were 0.135 and 0.676 micromol/L, respectively. The corresponding data points were compared using t test between the atrial and ventricular myocardium, and the differences were significant when the ACh concentration was above 10 nmol/L. Furthermore, atropine (10 micromol/L) and CsCl (20 mmol/L) blocked the effects of 10 micromol/L ACh on the APD of ventricular myocardium, while CdCl2 (0.1 mmol/L) had no influence on these effects. In conclusion, ACh could shorten the action potential duration and inhibit the force contraction of atrial and ventricular myocardium in a concentration-dependent manner. There are differences in the effects of ACh on the atrial and ventricular myocardium. The atrial myocardium is more sensitive to ACh than the ventricular myocardium. It is probable that the muscarinic receptor and the potassium channel, but not the calcium channel, are involved in the ACh-induced shortening of the ventricular APD.
Acetylcholine ; pharmacology ; Action Potentials ; drug effects ; Animals ; Calcium Channels ; metabolism ; Guinea Pigs ; Heart Atria ; drug effects ; Heart Ventricles ; drug effects ; Microelectrodes ; Potassium Channels ; metabolism ; Receptors, Muscarinic ; metabolism