Objective To investigate whether the laparoscopic portoenterostomy is superior to open surgery in the treatment of biliary atresia.Methods A total of 26 children with type Ⅲ biliary atresia underwent laparoscopic portoenterostomy from August 2003 to September 2005(Laparoscopic Group).The operation was performed under 4-port laparoscopy.The hepatic portal was fully exposed and mobilized and the gallbladder was removed.The cut end of the duct was widened by incising along the anterior wall of the hepatic duct following the excision of the narrow segment.By using intraoperative bile duct endoscopy,the optimal level of resection of the common hepatic duct was determined without endangering the orifices of the hepatic ducts or leaving any redundant duct.The Roux-en-Y jejunal loop was fashioned extracorporeally by exteriorizing the jejunum for 40 cm in length distally through the umbilical incision and passed up retrocolically followed by an end-to-side hepaticojejunostomy.They were compared with other group of 34 children,with the same age range and diagnosis,who underwent open portoenterostomy(Open Group) in the same period,in respect of the operative time,the blood loss,the liver functions,complications,the length of hospital stay,the hospitalization expenditure,and the short-term outcomes. Results As compared with the Open Group,the Laparoscopic Group presented a less blood loss(15.4?5.0 ml vs 33.8?19.4 ml;t=-4.709,P=0.000) and a higher hospitalization expenditure(19 153.9?619.5 yuan vs 15 116.7?898.4 yuan;(t=19.607),P=0.000).There were no significant differences between the two groups in the operative time and the length of hospital stay.The serum levels of total bilirubin,direct bilirubin,ALT,and AST were deceased more significantly in the Laparoscopic Group than in the Open Group.Complications happened in 1 case in the Laparoscopic Group(incisional hernia) and in 4 cases in the Open Group(1 case of acute hepatic failure,1 case of incision rupture,and 2 cases of wound infection),the incidence of complications being not significant(?~2=0.395,P=0.530).Follow-up observations at 4 postoperative month found the jaundice had subsided in 13 cases in the Laparoscopic Group(50%) and in 18 cases in the Open Group(53%). Conclusions Laparoscopic portoenterostomy is a minimally invasive,safe,and effective procedure for the treatment of pediatric biliary atresia.

Objective To explore the categories and precautions of complications after laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for congenital choledochal cyst in children. Methods Laparoscopic cyst excision with Roux-en-Y hepatoenterostomy was performed in 66 cases of congenital choledochal cyst from July 2001 to June 2006. Their median age was 3.8 years (range, 2 months ~ 28 years). The choledochal cyst was classified as cystic type in 61 cases, with a diameter ranged 2.5~18 cm, and fusiform type in 5 cases, with a diameter ranged 1.2~2.2 cm. Nine cases were associated with hepatic ductal stenosis; they underwent a laparoscopic excision of the cyst with a ductoplasty. Results The laparoscopic operation was successfully completed in all the 66 patients, with a mean operation time of 3.8 h (2.6~9.5 h) and a mean hospital stay of 4.5 d (3~8 d). Early complications included 2 cases of bile leakage (spontaneous recovery in 1 case, and an open surgery required in 1 case because of obstructed drainage, with anastomotic leakage identified and re-anastomosis performed during the operation), 1 case of hyperkalemia (10.8 mmol/L at 7 h after operation, resulting in heart failure and cardiopulmonary resuscitation, and died of renal failure on the 3rd postoperative day), and 2 cases of stress ulcer (spontaneously relieved). There were no infections of the abdominal cavity or the wound. Long-term complications included 1 case of intestinal obstruction (open exploration showed intestinal adhesion and necrosis, and an enterectomy with enteroanastomosis was given). No anastomotic stenosis and postoperative cholangitis were encountered.Follow-up observations for 6~56 months (median, 21 months) were conducted in 65 survived cases, B-ultrasonography found no bilestone, and liver functions were in normal limits. Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy is a complicated operation with high risks. Some complications are similar to those after conventional operations, such as bile leakage, stress ulcer, and intestinal obstruction. Hyperkalemia is perhaps the most serious one, which maybe related to carbon dioxide pneumoperitoneum. It is essential to monitoring hyperkalemia in postoperative period.

[Objective]To explore the effective treatment method of the articular fracture in distal radius.[Method]Severely comminuted AO type-C3 intra-articular fractures of the distal end of the radius were treated with combined internal and external fixation.The Gartland and Werley system and the Green and O'Brien system were used for comparison of the pre-operative and after operative evaluation.Total articular congruity had been assessed with both clinical rating systems.[Result]At a mean of ninteen months following-up,the mean arc of flexion-extension was 78% of that on the uninjured side and the mean grip strength was 82% of that on the uninjured side.The mean total articular incongruity(the gap plus the step-off)averaged 2 mm,and the radial length was restored to a mean of 11 mm.According to the Gartland and Werley demerit-point system,seventeen of the patients had a good or excellent result.According to the modified Green and O'Brien clinical rating system,eleven had a good or excellent result.Postoperative total articular incongruity had a moderately strong correlation with the outcome as assessed with both clinical rating systems.[Conclusion]Open reduction and combined internal and external fixation of AO type-C3 fractures can restore radiographic parameters to nearly normal values,maintain reduction throughout the period of fracture-healing,and provide satisfactory functional results.

Objective To sum up the experience of renal transplantation in order to improve transplant effect and enhance the long-term survival and recovery rate.Methods The data of renal transplantation of 1 124 cases who received renal transplantation from Jul. 1978 to Oct. 2001 were summarized. All the possible factors that could influence the transplant effect such as pre-operative preparation, HLA match, donors' quality, surgical procedure, immunosuppressive therapy and so on were analyzed. Results The 1-, 3-, 5-year survival rate (%) of patient/kidney was 83.1/ 70.3, 74.6/ 68.6 and 62.6/ 56.1 respectively. The rate of AR was decreased significantly from 3.09?% only with LXM to 0.89?% with LXM test in combination with HLA serological test. The rate of HAR and AR in 130 cases with additional PRA test were lower than those only with LXM test.Conclusions The well pre-operative preparation, the ideal HLA match, the high quality of donor's kidney and transplant operation were keys for successful renal transplantation. Reduction of the complications, individual and combined medication in reason and long-term follow-up were very important in the long-term survival time.

OBJECTIVETo explore the effect of auricular point sticking before operation for postoperative complications of external excision and internal ligation on mixed hemorrhoid.

METHODSEighty patients with mixed hemorrhoid were randomly divided into an observation group and a control group, 40 cases in each group. In the control group, paracetamol and dihydrocodeine tartrate tablets were applied with oral administration 1 h after operation, 510 mg each time, twice a day; at the same time, diosmin tablets were treated with oral administration, 0.9 g each time, twice a day. Three days' treatments were required successively. In the observation group, auricular point sticking was used before operation based on the treatment in the control group. The auricular points of Shen (Co10), Pangguang (CO9), Shenmen (TF4), Pizhixia (AT4), Jiaogan (AH6a) and Gangmen (HX5) were selected. The patients were asked to press the points 3-6 times per day, 3-5 min each time, 3 days' treatment in total. The scores of the postoperative complications in the 1st and the 2nd days were compared between the two groups such as pain, edema, hematochezia, retention of urine, etc.

RESULTSAfter operation, the scores of pain, edema, hematochezia, retention of urine in the 2nd day were all decreased obviously than those in the 1st day in the two groups (all P<0.05); and the scores of pain, edema, hematochezia, retention of urine in the 1st and the 2nd days of the observation group were lower than those in the control group (all P<0.05).

CONCLUSIONAuricular point sticking before operation combined with conventional western medicine with oral administration for preventing and treating postoperative complications of external excision and internal ligation on mixed hemorrhoid achieves positive and reliable efficacy.

Acetaminophen ; administration & dosage ; Acupuncture Points ; Acupuncture, Ear ; Adult ; Codeine ; administration & dosage ; analogs & derivatives ; Combined Modality Therapy ; Female ; Hemorrhoids ; surgery ; Humans ; Ligation ; Male ; Middle Aged ; Postoperative Complications ; drug therapy ; prevention & control ; therapy

From the view of medical professionals, this paper explored the standards of residents′ competency cultivation in Zhuhai using Delphi method. The research outcome that consisted of 53 factors and 6 dimensions was obtained after two rounds of expert consultation. There are 6 first-level indexes including professionnalism and body-mind quality, clinical practice skill, the competency of lifelong learning and self-improvement, humanistic medicine practice skill, medical knowledge, and the competency of promoting the medical system to develop. As well, there are 18 second-level indexes and 29 third-level indexes. The standards stated that the clinical prac-tice skill would not be the main part of residents′competency cultivation. Qualified residents should reach the na-tional standard of the clinical practice skill but also the other five indexes.

Objective To investigate effects of Kanglaite injection on proliferation, cycle and apoptosis of human breast cancer MCF-7 cells;To discuss its relevant mechanism. Methods Logarithmic growth phase cells were divided into control group and Kanglaite-treatment group (10, 20, 40μL/mL). Cells were cultured in RPMI-1640 for 24 h before drug treatment. The inhibition rate of Kanglaite injection on proliferation of human breast cancer MCF-7 cells was detected by MTT assay. Apoptosis and cell cycle of MCF-7 cells were detected by flow cytometry. Changes in cell nucleus were determined by Hochest staining assay. Protein expressions of Bcl-2 and Bax were detected by ELISA and Western blot. Results Kanglaite injection for 12 h, 24 h or 48 h resulted in a significant inhibition of MCF-7 cells proliferation (P<0.05, P<0.01);Compared with the control group, Kanglaite injection-treated cells showed increased percentage in G2/M and G0/G1 phases (P<0.001, P<0.01), but showed decreased percentage in S phase (P<0.01), and apoptosis rate increased (P<0.05, P<0.001). Kanglaite injection significantly decreased protein expression of Bcl-2, and enhanced protein expression of Bax of MCF-7 cells (P<0.01, P<0.001). Conclusion Kanglaite injection can inhibit the proliferation of human breast cancer MCF-7 cells, decrease cell cycle and induce apoptosis, the mechanism is related with decreasing protein expression of Bcl-2 and enhance the protein expression of Bax.

Objective To evaluate the clinical features of and appropriate surgical modality for congenital choledochal cyst(CCC). Methods Retrospective study on the clinical data of 85 surgically treated CCC cases was made. Results Among the 85 cases 12 were found malignant in character(14%). Out of the 29 cases in which the junction of pancreaticobiliary ductal system was showed by image, junction anomaly was identified in 26 cases. Surgical correction was applied to 83 cases with cyst excision and Roux-en-Y hepaticojejunostomy as the main procedure. External drainage of the CCC was adopted first in 4 cases to tide the patients over serious infection, before second stage definite radical resection was carried out. Excellent and good result were achieved on follow-up in 47 out of 60 CCC cases undergoing CCC resection and Roux-en-Y reconstruction, while only one out of 6 undergoing CCC internal drainage enjoyed fair result. Conclusions External drainage is mandatory for CCC patients with severe infection. The total choledochal cyst excision, with Roux-en-Y hepaticojejunstomy is effective in the treatment of CCC.

Objective To investigate the effect of dexamethasone combined with oridonin on proliferation and apoptosis in multiple myeloma cells U266 and the related molecular mechanism. Methods Exponential phase of growth U266 cells were treated with different concentrations of oridonin combined with dexamethasone or alone. U266 cells treated by DMSO were taken as control group. The proliferation inhibitory ratios were measured by CCK-8 assay followed by 24 h, 48 h and 72 h. Apoptosis induction was assessed by using Annexin V-FITC kit. Real time PCR was used to examine the mRNA changes of Notch1, NF-κB/p65 and bcl-2. Western blot assay was applied to detect the protein expression of Notch1, cleaved Notch1, NF-κB/p65 and bcl-2. Results Compared with that in control group, proliferation in all the experimental groups was inhibited (P<0.05), and the apoptosis was promoted (P<0.05); especially the combination of dexamethasone and oridonin had a synergistic effect on the proliferation and apoptosis of U266 cells (P<0.05). The results of PCR and Western blot showed that after treatment of U266 cells with dexamethasone, the mRNA as well as their protein levels of NF-κB/p65 and bcl-2 were decreased compared with those in the control group (P<0.05). Moreover, the mRNA and protein expression of Notch1, cleaved Notch1, NF-κB/p65 and bcl-2 was obviously down-regulated in oridonin group and the combination group (P<0.05). Conclusion Combination of dexamethasone and oridonin can significantly increase the anti-tumor effect by inhibiting proliferation and inducing apoptosis of U266 cells, which may be related to the inhibition of the Notch1 pathway.

AIM:To compare the effect of three types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus. ·METHODS:A total of 102 patients ( 102 eyes ) with pterygium combined with type 2 diabetes mellitus treated in our hospital from March 2013 to March 2016 were analyzed retrospectively. The patients were divided into three groups including the 34 cases ( 34 eyes ) with simple excision of pterygium ( resection group ) , pterygium excision combined with conjunctival flap transplantation in 34 cases (34 eyes, as conjunctival flap group ) and pterygium excision combined with limbal stem cell transplantation in 34 cases ( 34 eyes, as stem cell group ) . The wound repair time, complications, recurrence rate, uncorrected visual acuity (UCVA), tear film break-up time ( BUT ) and basal tear secretion test (SⅠt) were observed before, and 6 and 12mo after surgery in the three groups, respectively. ·RESULTS:The postoperative UCVA of the three groups was significantly higher than that preoperation ( P =0. 039, 0. 013, 0. 024 ), and there was no significant difference among the three groups ( P = 0. 317 ). The wound repair time was 5. 67 ± 1. 45d in the resection group, which was significantly higher than that in the conjunctival flap group (4. 18 ± 0. 76d) and the stem cell group (4. 09±0. 79 d) (P<0. 001), there was no significant difference between the conjunctival flap group and the stem cell group ( P = 0. 937 ). There were 4 cases in resection group reappeared, and the recurrence rate was 11. 8%, which was significantly higher than the other two groups ( P = 0. 037 ). There were 1 recurrences in the conjunctival flap group, and the recurrence rate was 2. 9%, while the patients in the stem cell group had no obvious recurrence. SⅠt and BUT increased significantly after operation (P<0. 05), especially in conjunctival flap group and stem cell group (P<0. 001). There was no significant difference between the conjunctival flap group and the stem cell group (P=0. 845, 0. 894). · CONCLUSION: Pterygium excision combined with conjunctival flap transplantation or limbal stem cell transplantation for the treatment of type 2 diabetic patients with normal blood glucose and tear film function has the similar effect, and is better than simple pterygium excision.