Bile leak is a commonly complication after biliary tract surgery.In the past,operation was considered priorly to deal with bile leak besides putting a drainage tube in advance.Minimally invasive surgery has gradually become a primary management of bile leak,with the development of minimally invasive surgery such as abdominoscope in the 20th century.

Objective To evaluate the efficacy and safety of gabapentin in preemptive analgesia for hysterectomy after general anesthesia.Methods PubMed, Cochrane, Embase, Ovid, Springer Link, Web of Science, CNKI, Wanfang and Weipu databases were searched for randomized placebo-controlled trials involving the efficacy of gabapentin for preemptive analgesia published from 2000 to 2016.The methodological quality of the included randomized controlled trial (RCT) was assessed and the data were extracted according to the Cochrane Handbook.The meta-analysis was performed using the RevMan 5.3 software.Results A total of 10 RCTs involving 609 patients were included.Compared with the control group, there was a significant decrease in 24-hour cumulative narcotic consumption at 24 hours when gabapentin was administered before surgery (WMD=-8.83 mg, 95%CI-12.70——4.97, P<0.001), there was no significant decrease in VAS score in preemptive analgesia group (WMD=-7.70 mm, 95%CI-18.22-2.82, P=0.15).Compared with the control group, the rate of vomiting was less in the gabapentin group (RR=0.49, 95%CI 0.35-0.69, P<0.001).Compared with the placebo group, there was no significant decrease in nausea (RR=0.73, 95%CI 0.45-1.17, P=0.19) and somnolence (RR=2.08, 95%CI 0.62-6.92, P=0.23).Conclusion Preemptive administration of gabapentin is effective in decreasing accumulation of opium and vomiting.

With the changes in medical model and the enhancement of ethical standard as well as the patients' awareness of right protection,clinical teaching resource shortages have been increasingly prominent.This article analyzes the characteristics and status of clinical medical education and points out that the development of medical simulation education has great significance for building a harmonious clinical training environment centering on the content classification,functional positioning and outstanding advantage of medical simulation education.

Aiming at present situation and difficult position of clinical medical education,and based on the demand goal of modern medicine,this paper put forward constucting the mul-ti-dimensional optimization training pattern for five-year system clinical medicine inter-disciplinary talents by renewing the education idea,adopting the curriculum reform,the quality regulation,the educational reform,the innovation of teaching methods,and the construction of community medi-cal service practice base and so on,which is of great significance to train the high quality tal-ented person with adaptability to social development.

The application of standardized patient SP is the tendency of medical education in China.The applied characteristics of using SP in diagnostics teaching were summarized in this article.We described the recruitment,training and application of SP in the teaching process of diagnostic.The great advantages of SP and its shortage were analysed,and our expectation of deepening SP was brought forward.

According to the characteristics of clinical probation teaching of endocrinology,we established the stage-separated echelon teaching mode that accorded with cognitive law.By inspiring,guiding and other methods,medical students’learning enthusiasm were greatly stimulated,and their understanding and grasping degree to the clinical specialty content was deepened.We focused on training clinical skills and thinking ability of medical students,and achieved satisfactory teaching results.

OBJECTIVETo explore the curative effect of Z-plasty without skin grafting for correction of cryptotia.

METHODSTwenty-five cases (29 ears) with cryototia were corrected by Z-plasty without skin grafting in our department from June 2009 to January 2014. A Z-shaped incision with one arm on the back of antihelix and the other arm on the edge of hair was made on the back of ear and scalp. The adhesion on the back of antihelix cartilage was dissected and the cartilage framework was lifted and re-positioned. The postauricular flap was transferred to cover the wound on the back of antihelix. The other flap was transferred to cover the remnant wound and correct the malformation of cryptotia.

RESULTSAll the patients were followed up from 6 months to 1 year with stable and symmetric appearance.

CONCLUSIONSThe shape of auricle is natural after operation without skin grafting. It is a simple and ideal method for the treatment of cryptotia.

Ear Cartilage ; abnormalities ; surgery ; Ear, External ; abnormalities ; surgery ; Humans ; Skin Transplantation

OBJECTIVETo investigate the feasibility and advantages of total auricular reconstruction with single big expander at dual plane through incision at remnant ear.

METHODS52 patients with microtia were treated. Through incision at remnant ear, one big expander (150 ml) was implanted in the post-auricular area beneath the superficial facial in the hairless area, and above the superficial fascia in the area with hair. In the second stage, total auricular was reconstructed with autologous cartilage framework and expanded skin. Skin graft was not necessary. Another 32 paitents with single big expander above the superficial fascia were used as control. The downward shift distance of expanders, the appearance of auriculocephalic sulcus and complication were recorded in order to assess the effect of these two methods.

RESULTSThe downward shift distance of expanders in the dual plane group (0.7 ± 0.3) cm were lower than that in the control group (1.3 ± 0.4) cm, showing significant difference (P < 0.05). After a follow-up period of 6-12 months, shallow auriculocephalic sulcus was presented in 5 patients of the dual plane group and 12 patient of the control group. The shallow auriculocephalic sulcus was cut to make it deeper and covered with full skin graft.

CONCLUSIONSDual plane skin expansion could reduce the downward shift distance of expander. Adequate skin on the upper part of expander could make satisfactory auriculocephalic sulcus.

Cartilage ; transplantation ; Congenital Microtia ; surgery ; Feasibility Studies ; Hair ; Humans ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Subcutaneous Tissue ; Surgical Flaps ; trends ; Tissue Expansion ; methods ; Tissue Expansion Devices

Objective To investigate risk factors for neonatal clavicular fracture,to provide a reference for clinical treatment.Methods A retrospective analysis was performed towards 3 025 live births,47 cases had neonatal clavicular fracture.The birth weight,mode of delivery,maternal age,parity,gestational age,clavicle second stage of labor,the fundus height plus abdominal circumference,cord around neck,and other fracture potential risk factors were analyzed through univariate and multivariate analysis,and the risk factors were summarized.Results 3 025 cases of live births,of which 47 cases had neonatal clavicular fracture,clavicle fracture rate was 1.55%;univariate results sug-gested that the mode of delivery,birth weight,the second stage of labor,maternal age,gestational age,nuchal cord,ma-ternal weight's clinical data index had statistically significant differences between the fracture group and non -fracture group (χ2 =37.514,34.997,28.647,19.847,18.847,16.694,all P <0.05 );multivariate analysis showed that mode of delivery,birth weight,the second stage of labor,gestational age,nuchal cord,maternal body mass index were a newborn children collarbone fracture independent risk factors.Conclusion Mode of delivery,birth weight,the second stage of labor,gestational age,nuchal cord,maternal body mass index are independent risk factors for neonatal clavicu-lar fracture,obstetric should continue to improve midwifery skills,to develop prevention strategies to reduce the inci-dence of neonatal clavicular fracture.