Objective To study the feasibility of laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair.Methods Twenty-four adult patients received laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair in our hospital from November 2003 to April 2008.An incision was made in navel defect and entered the abdominal cavity under a direct vision.LC was performed by 3-trocar technique.Umbilical hernia was repaired by Mayo' style.Results The operation was successfully completed in all the cases.The operation time ranged from 35 to 65 minutes (mean,48 minutes),the blood loss was 5-30 ml(mean,16 ml),and hospital stay after the operation was 3 -4 days.No patient dereloped wound infection or skin necrosis.No recurreme was found during a 1-to 54-month follow-up(mean,28.6 months).Conclusions Laparoscopie cholecystectomy accompanied by simultaneous umbilical hernia repair is a safe and effective procedure.Mayo repair is simple and effective for umbilical hernia with less fascial defects.

Objective To investigate the diagnosis value of laparosco-pie examination in ascites.Methods The data of twenty-three cases with ascites of unknown origin undergoing laparescopie examination and pathologic examination were retrospectively analyzed from May 2004 to August 2008.Results Twenty-two eases were definitely diagnosed by laparoscopie exploration,the positive rate was 95.6%.One ease re-mained unknown.Among them,18 eases were tuberculous peritonitis; 3 eases were metastatic adenocarcino-ma; one ease was peritoneal mesothelioma.No obvious postoperative complications occurred.Conclusion Laparoscopie examination is a safe method with hige definite diagnostic rate,which has important values in diagnosis of ascites of unknown origin.

Adult ; Cryptococcosis ; physiopathology ; Cryptococcus neoformans ; Duodenal Diseases ; microbiology ; physiopathology ; Humans ; Male

Objective To investigate the feasibility and safety of laparoscopic cholecystectomy(LC) in patients with chronic renal dysfunction at azotaemic stage.Methods Clinical data of 7 patients accompanying chronic renal dysfunction at azotaemic stage treated with LC between May 2004 and September 2006 were analyzed retrospectively.The operation was performed under general anesthesia and endotracheal intubation.The CO2 pressure was maintained at 9～12 mm Hg.The LC was conducted with 3-port technique in 5 patients and 4-port technique in 2.Results The LC was completed smoothly in all the 7 patients.Patients' renal dysfunction was not aggravated.There was no significant difference between pre-and post-operative time in levels of blood urea nitrogen(11.92?4.06 mmol/L vs 12.16?3.76 mmol/L;t=0.50,P=0.633) and blood creatinine(208.62?134.37 ?mol/L vs 204.20?125.53 ?mol/L;t= 0.51,P=0.626).As compared with preoperative levels,the creatinine clearance rates were not significantly changed at 2 weeks after operation in 3 patients(40.03 ml/min vs 45.61 ml/min;32.28 ml/min vs 38.93 ml/min;56.72 ml/min vs 51.60 ml/min).Follow-up checkups for 4～20 months(mean,10 months) showed no aggravation of renal dysfunction.Conclusions Laparoscopic cholecystectomy is a feasible and safe procedure for patients with chronic renal dysfunction at azotaemic stage.

To study the changes in every part of the beta-adrenergic signal transduction pathway and their effects on ischemic preconditioning of rat myocardium in vivo. SD rats were divided into three groups: IP group, I/R group and CON group. The IP group was further divided into PC1-, 2-, 3-, and PC1+, 2+, 3+ groups according to preconditioning procedure. The rats received surgical procedure and underwent left coronary artery occlusion and reperfusion. We analyzed the infarct size by TTC staining, measured serum myocardial enzymes, studied the beta-AR Bmax and Kd by radioligand binding assay of receptors, checked the activity of AC and PKA by the method of biochemistry and examined the content of cAMP by radioimmunoassay. The infarct area was much smaller in the IP group than in the I/R group (P < 0.001), while the enzymes were significantly higher in I/R (P < 0.001). The Bmax of beta-AR in IP was much higher than that in I/R (P < 0. 001), but no difference in Kd could be seen between IP and I/R groups. In IP, the activity of AC and PKA and the content of cAMP were higher than those in I/R (P < 0.05, 0.002 and 0.001, respectively). In the procedure of preconditioning, the content of cAMP and the activity of PKA showed the characteristic of cyclic fluctuation. Ischemic preconditioning can protect the heart from necrosis and reduce endo-enzyme leakage. The system of beta-adrenergic signal transduction pathway probably takes part in the protection effect of the IP, which might be elicited by the PKA.
Ischemic Preconditioning, Myocardial ; Myocardium/*metabolism ; Rats, Sprague-Dawley ; Receptors, Adrenergic, beta/*physiology ; Signal Transduction

Objective To explore the correlation of single nucleotide polymorphism ( SNP ) in Nrf2 gene with acute mountain sickness ( AMS) among Han populations in China .Methods As a nested case-control study , 603 Chinese Han young men who had been quickly exposed to 3700 m were adopted and divided into case group and control group ( 369 vs 234,respectively) by Lake Louise Self-assessment Scoring System(LLSS).The Sequenom Mass Array system was used to detect the SNPs of rs10497511 and rs2364722 in Nrf2 gene.Results Alleles of rs10497511 and rs2364722 were respec-tively detected in both case and control groups , which were T-C and A-G.Statistically significant difference was not found in allele frequencies ( P>0.05 ) .Further analysis showed that there was still no significant difference between the codomi -nant, dominant and recessive genotype models (P>0.05).Conclusion rs10497511 and rs2364722 of Nrf2 gene may not be related to susceptibility to AMS in Chinese Han populations .

Objective To explore and build a real, objective, comprehensive clinical nursing individual performance indicators architecture model,and check the rationality and validity for prize distribution by clinical application. Methods The methods included that discuss new ideas of nursing performance management by multi- disciplinary experts,developed clinical personal nursing staff performance evaluation program,worded out indicators and methods for the clinical assessment of individual nurses and nurse managers respectively,then applied research in the pilot departments and hospital step by step. Results A personal performance evaluation framework model was constructed, which include clinical nurses and nursing managers. Experimental results show that the nursing staff in this regard performance program have a high degree of recognition, 98.82% (1 741/1 762) nursing staff understanding of the purpose and significance, 97.15%(1 712/1 762) nurses think the performance model structure is reasonable. After the implementation of the performance program, the outstanding rate of personal performance appraisal of nurses was 93% (1 639/1 762). Conclusions The application of scientific performance appraisal programs can play a positive role in helping improve the quality of clinical care, and promote the stable development of the care team.

Objective To evaluate how to select operation procedures for different CT manifestation of splenic artery aneurysm ( SAA) with posthepatitic cirrhosis. Methods In 61 cases with SAA,the CT manifestation ( location,number,size,portal vein,varicose vein,proxi-mal splenorenal shunt and spleen changes) of SAA,clinical features of cases,and operation approach were were retrospectively analyzed. Re-sults 4 patients who have the primary tumors located in the distal splenic artery with diameter 1. 0~2. 0 cm,spleen kidney shunt and mega-losplenia were given aortic aneurysm exclusion and branch aneurysms embolism by stages. Amiong the 15 cases of tumors resection,splenecto-my and devascularization,there were 4 cases of the primary tumors located in the middle of splenic artery and 11 cases in the distal splenic artery. There were 15 cases whose diameter of the primary tumor were lager than 2. 0 cm and 13 cases whose diameter of the primary tumor were 1. 0~2. 0 cm. There were 4 cases of cavernous transformation of portal vein,5 cases of splenic and gastric varices,15 cases of esophage-al and gastric varices,4 cases of splenic and gastric venous shunt,15 cases of megalosplenia and 4 cases of splenic infarction. Tumors resec-tion and branch aneurysms embolism by stages were conducted in 7 cases. The primary tumors located in the proximal splenic artery occured in 7cases,and the diameter of the primary tumor were 1. 0~2. 0 cm occured in 7 cases. Esophageal and gastric varices occured in 2 cases and splenomegaly occured in 7 cases. And there were 4 cases whose diameter of the tumor were 1. 0~2. 0 cm were given tumor resection and re-construction of splenic artery and continuity, including 1 case of proximal splenic artery,2 cases of medial splenic artery and 1 case of distal splenic artery. Conclusion Operation procedures were confirmed by CT findings such as location,number,size,portal vein,varicose vein, proximal splenorenal shunt and spleen changes of SAA combined with age,gender,body mass index and history.

Objective To study the ultrasonic image characteristics of the displaced femoral shaft fracture before and post reduction,and to explore its clinical significance in guiding the closed reduction and intramedullary nail fixation.Methods Ultrasonic imaging features of 21 cases of femoral shaft fractures were observed.Closed reduction was completed under ultrasound monitoring,and the characteristics of ultrasonic imaging after fracture reduction were observed.Fixation of femoral fractures with intramedullary nails after closed reduction was completed.Results On the long axis of the femoral shaft,the ultrasonograms displayed a gap between two hyperechoic bands(step sign).On the cross section,two short arc hyperechoic bands can be seen(double short arc sign).After the completion of closed reduction,the step sign and double short arc sign disappeared.In the front and rear of the femoral shaft,there were 2 echo lines connected to a straight line.The line in front of the femoral parallel to the rear(continuous parallel sign).Continuous parallel sign indicated that reduction was achieved,the intramedullary nail guide pin could be successfully inserted into the femoral shaft,to complete the intramedullary nail fixation.Conclusions Ultrasound imaging shows step sign and double short arc syndrome when femoral shaft fracture displaced.Post fracture reduction,the imaging shows continuous parallel sign.Observing ultrasonic image characteristics of the displaced femoral shaft fracture is effective in assisting closed reduction and intramedullary nailing for femoral shaft fractures.

OBJECTIVETo explore the methods and outcomes of a minimally posteromedial transverse incision in the hip knee flexion for the treatment of tibial avulsion fracture at the insertion of posterior cruciate ligament (PCL).

METHODSTwenty-one patients with tibial avulsion fracture at the insertion of PCL treated with a minimally posteromedial transverse incision in the hip knee flexion by cannulated screw fixation from March 2010 to March 2013 were retrospectively analyzed. There were 13 males and 8 females with an average age of 35.1 years old (ranged, 20 to 56 years). Eleven cases caused by traffic accident, 3 caused by falling, 4 caused by sport, 3 caused by heavy pounds. The injury duration ranged from 3 hours to 9 days with a mean of 3.5 days. The results of posterior drawer test were positive in all patients. Lysholm score was used to evaluated knee joint function.

RESULTSAll operations were successful without infection, vessel and nerve injuries and all incisions healed by first intention with the mean length of 5.8 cm (ranged, 5 to 6 cm). All patients were followed up from 7 to 23 months with an average of 12.7 months. The results of posterior drawer test were negative in all patients. X-ray films showed that all fractures healed. The Lysholm score was improved from preoperative 40.76±9.55 to 95.86±2.33 final follow-up (t=30.07, P=0.000).

CONCLUSIONTreatment of tibial avulsion fracture at the insertion of the posterior cruciate ligament through a minimally posteromedial transverse incision in the hip knee flexion with cannulated screw fixation is a better surgical procedure with the advantages of minimal incision, sufficient exposure, effective fixation, small scar and satisfactory effects.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Hip Joint ; surgery ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Posterior Cruciate Ligament ; surgery ; Tibial Fractures ; surgery