Objective To investigate the feasibility,safety and effect of gasless laparoscopic surgery used in patients at the second trimester.MethodsFrom Aug.2006 to Aug.2008,the data of 10 cases at gestational 15 - 24 weeks complicated by ovary benign tumors ( the diameters more than 5 cm) undergoing gasless laparoscopic surgery were studied retrospectively.Operation time,bleeding loss,period of hospitalization,the status of fetus and newborn babies,and peri-operative or postoperative complications were observed.ResultsAll 10 cases were treated by gasless laparoscopic surgery,including 4 cases with mature teratoma,5 cases with epithelial tumors and 1 case with ovarian endometrioma.The mean time of surgery was (30 ± 5) minutes,the mean bleeding in the surgery was (30 ± 8) ml,the mean period of in hospitalization was ( 6 ± 2 ) days.The blood gas ( pH:7.42 ± 0.11,7.41 ± 0.18,7.42 ± 0.12 ),blood pressure [ mean arterial pressure (MAP):(90.4 ± 3.1 ),(90.6 ± 0.7 ),( 89.7 ± 0.8) mm Hg( 1 mm Hg =0.133 kPa) ] and heart rates [ ( 84.0 ± 1.6),( 84.3 ± 1.7 ),( 82.7 ± 1.1 ) bpm ] in all cases at pre,peri and postoperative time did not show statistical difference ( P all ＞ 0.05 ).The fetal hearts were all in the normal range preoperative,intraoperative and postoperative time (P ＞ 0.05 ).No perioperative and postoperative complications were observed.All the cases underwent term delivery.Fetal weight and Apgar score did not show abnormality.ConclusionGasless laparoscopic surgery at the second trimester is feasible and safe to mother and fetus.

Objective To investigate the clinical significance of laparoscopic operations in gynecologic emergency. Methods We retrospectively analyzed 145 cases of gynecologic emergency dealt with laparoscopic operations in May 1997～August 2001. Out of the 145 cases, tubal pregnancy accounted for 100 cases (Laparoscopy Group), which were further compared with 89 cases of tubal pregnancy in January 1994～April 1997 treated by open operations (Open Group). Results Out of the 145 operations, 139 (95.9%) were successfully carried out under laparoscope, with the conversion to open operations in 6 cases. There were 61 cases of salpingectomy, 28 cases of oviduct fenestration, 11 of fenestration converting into salpingectomy, 16 of partial ovariectomy, 8 of adnexectomy for ovarian cyst pediculotorsion, 4 of cyst resection, 3 for rupture of endometrial cyst of ovary, 6 for pelvic abscess and 2 for pelvic encapsulated fluid. Compared with the Open Group, the Laparoscopy Group had longer length of surgical intervention (t=3.9, P=0.000) and more intraoperative blood loss (t=5.8, P=0.000). Conclusions Laparoscopic operations play double actions both in diagnosis and in treatment for most gynecologic emergencies, being a safe and reliable approach. Laparoscopic salpingectomy (non-oviduct-sparing operations), however, should be chosen for urgent patients.

Objective To investigate the feasibility, safety and effect of gasless laparoscopic surgery in the treatment of benign ovarian tumors during pregnancy. Methods Clinical data of 45 pregnant women with benign ovary tumors undergoing gasless laparoscopic surgery from January 2006 to June 2013 were studied retrospectively.Most of the cases were given oophorocystectomy. Adnexectomy was performed for the large sized lesions, lacking of or remaining few normal ovarian tissue, or ovarian cyst torsion. Results All the 45 cases were successfully treated by gasless laparoscopic surgery.No perioperative and postoperative complications were observed.There were 42 cases receiving ovarian tumor resection while 3 cases receiving simple salpingo-oophorectomy.The mean operation time was (40.7 ±14.9) min (25-90 min), the mean blood loss was (27.3 ±16.6) ml (10 -80 ml), and the mean hospitalization time was (4.5 ±1.3) days (3-8 days).At pre-, peri-, and post-operative time, the blood pH value, blood pressure carbon dioxide (PaCO2), and blood oxygen partial pressure (PaO2) showed no statistical difference (F=0.00,P=0.999;F=2.21, P=0.114;F=0.60,P=0.555), and blood bicarbonate (HCO3-) and blood oxygen saturation (SpO2) showed statistical difference but no clinical significance (F=14.96,P=0.000;F=9.45,P=0.999), all of which were in the normal range.The fetal heart rates were all in the normal range.Pathological diagnoses were ovarian mature cystic teratoma in 25 cases (55.6%), serous cystadenoma in 6 cases (13.3%), mucinous cystadenoma in 4 cases (8.9%), mesosalpinx cyst in 3 cases (6.7%), endometrial cyst in 2 cases (4.4%), and luteal cyst in 5 cases (11.1%).No spontaneous abortion was found in post-operational follow-up.Term delivery was obtained in 43 cases, with normal fetal weight and the Apgar scores.Two cases gave up the pregnancy in the postoperative period. Conclusion Gasless laparoscopic surgery for benign ovarian tumors during pregnancy is safe and feasible.

Objective: To observe the effects of different internal fixations on the treatment of pertrochanteric hip fractures. Methods: 158 cases of pertrochanteric hip fractures treated with different internal fixations, including anatomic steel, Gamma nail and dynamic hip screw, from January 1999 to October 2004, combined with functional exercise, were summarized and the advantages and disadvantages of different fixations were evaluated. Results: All of 158 cases were followed up for 6 to 36 months with a mean of 14 months. The rate of excellent or good in all patients was 94.61% by Harris criterion and 17 cases have surgical complications (10.18%). The complication rates of the three types of treatment had no difference. Conclusion: Anatomic steel, Gamma nail and dynamic hip screw are all ideal and reliable internal fixation material for pertrochanteric hip fractures as long as they are selected properly before operation.

Objective To investigate the effect of ovarian cycle on the sedative effect of propofol in patients. Methods Forty ASA Ⅰ or Ⅱ patients, aged 20-40 yr, with body mass index 20-25 kg/m2 , scheduled for elective gynecologic laparoscopic surgery, were divided into 2 groups according to the progesterone level ( n = 20 each): follicular phase group (group F, serum progesterone concentration 0.31-1.52 ng/ml) and luteal phase group (group L, serum progesterone concentration 5.16-18.56 ng/ml). Anesthesia was induced with target-controlled infusion (TCI) of propofol and iv injection of fentanyl and cisatracurium. The initial target plasma concentration (Cp) of propofol was set at 2 μg/ml, after the Cp reached the predetermined level, the Cp increased by 0.5 μg/ml every 30 s until the patients lost consciousness and BIS value was decreased to 50. The BIS value and Cp of propofol was recorded when the patients lost consciousness. The Cp of propofol was also recorded when BIS value was decreased to 50. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with TCI of propofol combined with remifentanil. BIS value was maintained at 45-55 by adjusting the Cp of propofol. Results The Cps of propofol were significantly higher when the patients lost consciousness and when BIS value was decreased to 50 in group F than in group L ( P ＜ 0.05 or 0.01) . There was no significant difference in BIS value when the patients lost consciousness between the two groups (P ＞ 0.05). Conclusion Ovarian cycle can affect the sedative effect of propofol in patients, which shows that the sedative effect during the follicular phase is lower than that during the luteal phase.

Objective To study the effectiveness and safety of combined laparoscopy and gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EM).Methods From January to December 2010,198 patients with EM undergoing treatment in Department of Obstetrics and Gynecology,Beijing Anzhen Hospital were randomly divided into three groups,which include 52 cases treated by only laparoscopy in laparoscopy group; 76 cases treated by laparoscopy combined with domestic Leuprolide acetate with dose of 3.75 mg every 28 days in Leuprolide acetate group; 70 cases treated by laparoscopy combined with imported Goserelin acetate with dose of 3.6 mg every 28 days in Goserelin acetate group.The efficacy,pregnancy rate and adverse reactions were compared among the three groups.Results Thirteen cases lost following up,including 3 cases in laparoscopy group,6 cases in Leuprolide acetate group and 4 cases in Goserelin acetate group.(1) Effective rates:effective rates were 47 ％ (23/49)in laparoscopy group,77％ (54/70)in Leuprolide acetate group and 74％ (49/66)in Goserelin acetate group.Compared with laparoscopy group,the effective rate of Leuprolide acetate group and Goserelin acetate group was significantly elevated (P ＜ 0.05).There was no statistically significant difference between Leuprolide acetate group and Goserelin acetate group (P ＞ 0.05).(2) Recurrence rate:recurrence rate were 33％ (16/49) in laparoscopy group,13％ (9/70)in Leuprolide acetate group and 12％ (8/66)in Goserelin acetate group.Compared with laparoscopy group,the recurrence rate of Leuprolide acetate group and Goserelin acetate group was significantly declined (P ＜ 0.05).There was no statistically significant difference between Leuprolide acetate group and Goserelin acetate group (P ＞ 0.05).(3) Pregnancy rate:the number of patients require fertility were 28 cases in laparoscopy group,39 cases in Leuprolide acetate group and 35 cases in Goserelin acetate group.After 2 years follow up,pregnancy rate of 62％ (24/39) in Leuprolide acetate group and 60％ (21/35)in Goserelin acetate group were high than 39％ (11/28)in laparoscopy group significantly,which did not reached significant difference (P ＞ 0.05).(4) Adverse drug reaction:rates of a adverse reactions were 21％ (15/70) in Leuprolide acetate group and 20％ (13/66) in Goserelin acetate group,including irregular vaginal bleeding associated with low estrogen level.There was no significant difference in adverse reactions (P ＞ 0.05).Conclusions Compared with laparoscopy alone,laparoscopy combined with GnRH-a is more effective in treatment of,which exhibit lower recurrence rate,higher pregnancy rate and fewer adverse reactions.Domestic Leuprolide acetate have similar safety and efficacy compared with imported GnRH-a.

Chitinases genes from Metarhizium anisopliae which is an important entomopathogenic fungus were considered one of the key factors to invade their hosts. One Metarhizium anisopliae HN1 strain was isolated and screened. A chitinase gene was amplified by RT-PCR from Metarhizium anisopliae HN1, The whole length of this gene was 1275bp,and the nucleotide sequence of the gene was 96% similarity to that of the M. anisopliae E6 accessed in GenBank ( AF02749). The gene has been registered in GenBank and its accession number is DQ011865. The gene was subcloned into prokaryon expression vector pET-22b( + ), transformed this recombinant expression plasmid into E. coli strain BL 21 and effective expressed. The SDS-PAGE analysis indicated that the recombinant protein was 42kDa which is same to the reported article. The expression level of recombinant protein was about 63. 3% of whole expressed proteins , And when recombinant E. coli were crushed by freeze and supersonic wave , the activity assay indicates that the chitinase expressed in bacteria possesses biological activity.

Objective To investigate the effect of glucose-based peritoneal dialysis fluids and icodextrin-based peritoneal dial-ysis fluids on the expression of TLR2 and TLR4 on huamn peritoneal mesothelial cells .Methods Human peritoneal mesothelial cell line 5 - 10 generations(HMrSV5) was cultured in DMEM /F12 medium supplemented with 10% (v/v) fetal calf serum (FCS) .Cell viability and cell proliferation were assessed using M TT method .The experiment were divided into 5 different groups :group A (control group) ,1 .5% dextrose group ,2 .5% dextrose group ,4 .25% dextrose group and 7 .5% Lcodextrin group .Icodextrin group (aikau dextrin) ,TLR2 and TLR4 expression were detected by Western blot .Results Treatment with different concentrations of glucose-based peritoneal dialysis fluids for 24 h did not affect the expression of TLR2 and TLR4 protein .In addition ,after stimula-tion for 48 h ,1 .5% dextrose ,2 .5% dextrose ,4 .25% dextrose decreased TLR2 expression by (5 .5 ± 2 .8)% ,(31 .4 ± 7 .5)% , (54 .9 ± 1 .9)% respectively ,TLR4 expression by (32 .9 ± 17 .6)% ,(47 .7 ± 13 .5)% ,(66 .4 ± 13 .5)% respectively .Stimulation for 72 h ,decreased TLR2 expression by (29 .4 ± 14 .7)% ,(38 .9 ± 9 .9)% ,(63 .5 ± 16 .5)% respectively ,TLR4 expression by(59 .5 ± 16 .8)% ,(63 .1 ± 9 .5)% ,(79 .2 ± 14 .0)% respectively .There was no significant change in TLR2 and TLR4 protein expression on 7 .5% icodextrin group .Conclusion Glucose-based peritoneal dialysis fluids ,but not icodextrin-based peritoneal dialysis fluids downregulates expression of TLR2 and TLR4 by HM rSV5 .

Objective To investigate the clinical value of combined thoracoscopic and laparoscopic esophagectomy for the treatment of esophageal carcinoma.Methods The clinical data of 50 patients who underwent combined thoracoscopic and laparoscopic for the treatment of esophageal carcinoma at the Jiangdu People's Hospital of Yangzhou from May 2013 to August 2014 were retrospectively analyzed.The patients underwent the thoracoscopic mobilization of the intrathoracic esophagus and lymph node dissection in the left lateral decubitus position, and then the patients underwent laparoscopic mobilization of the stomach and lymph node dissection in the horizontal position, finally the gastric tube was pulled out to have stapled anastomosis through left neck.The operation time, volume of intraoperative blood loss, number of lymph node dissected, amount of postoperative thoracic drainage, time to resume diet after surgery, postoperative hospital stay and results of pathological examination were collected.Patients were followed up via telephone interview and out-patient examination till September 2014.The recovery condition and survival of patients were collected.The measurement data with normal distribution were presented as (x) ± s or mean value (range).Results There was no patient transferred to open thoracic surgery or abdominal surgery.The operation time of thoracoscopic and laparoscopic procedures were (85 ±30)minutes and (55 ± 22) minutes, respectively.The total operation time was (210 ± 40) minutes.The mean volume of intraoperative blood loss was 115 mL (range, 50-210 mL) in the thoracic cavity and 65 mL (range, 30-100 mL) in the abdomen.The mean number of lymph nodes dissected was 11.3 (range, 8.0-15.0) in the thoracic cavity and 8.5 (range, 6.0-12.0) in the abdomen.The mean volume of postoperative thoracic drainage, mean time to resume diet and postoperative hospital stay were 340 mL (range, 200-650 mL) , 7 days (range, 6-8 days) and 12 days (range, 11-14 days).The 50 cases were diagnosed as esophageal squamous cell cancer and staged as T1-3N0-1M0 by postoperative pathological examination, with negative upper and lower margin.There was 1 case of anastomotic leak, 3 cases of lung infection who were cured by symptomatic treatment and 3 cases of recurrent laryngeal nerve injury after operation who recovered after 6-month follow-up.All patients were successfully followed up without recurrence and death.During the follow-up of 1-16 months, 2 patients were found anastomotic stricture at postoperative 3 months, and were cured by endoscopic dilation for 3 times.Conclusion Combined thoracoscopic and laparoscopic esophagectomy is safe and effective for the treatment of esophageal carcinoma.

Objective To analyze the effect of different areas of paries medialis defect of femoral trochanter on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture.Methods Thirteen preserved cadaveric specimens of adult femur were used in this experiment.The age of death ranged from 30 to 50 years.Oblique osteotomy was conducted under the same condition using a wire saw to create experimental models of fracture of Evans-Jensen type Ⅳ.The ratios of the area of paries medialis defect to the projected area of lesser trochanter in the specimens 1 to 13 were set respectively as 0,10.0％,14.5％,20.2％,23.4％,30.6％,45.8％,56.8％,76.8％,88.7％,99.8％,121.3％ and 149.4％.All the fractures were fixated by standard percutaneous compression plating.Cyclic load was applied on each specimen using Instron 2000 universal material tester.A vertical load of 600 N was applied for respectively 1,10,100 and 1,000 times to measure the displacements of proximal and distal fracture ends.Results When the ratio of the area of paries medialis defect to the projected area of lesser trochanter was 30.6％,the average displacements of the proximal and distal ends were 0.14 cm and 0.10 cm.When the ratio was 45.8％,the average displacement of the proximal end was 0.53 cm,278.6％ greater than that for 30.6％;the average displacement of the distal end was 0.41 cm,310.0％ greater than that for 30.6％.When the ratio was 149.4％,the average displacement of the proximal end was 0.93 cm,564.3％ greater than that for 30.6％;the average displacement of the distal end was 0.65 cm,550.0％ greater than that for 30.6％.Conclusions When the ratio of the area of paries medialis defect to the projected area of lesser trochanter reaches ＞ 45.8％,the area of paries medialis defect will have a significant effect on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture.The displacement will increase linearly under the same compression with the increase in defect area.