Objective To investigate the value of laparoscopy in the diagnosis and treatment of unexplained chronic abdominal pain.Methods From January 2014 to February 2016, clinical data of 56 unexplained chronic abdominal pain undergoing laparoscopic surgery were analyzed retrospectively.Laparoscopic exploration was performed firstly and then the corresponding abnormalities were diagnosed and dealt with accordingly.Results The disease causes were explicit in 48 cases (85.7%), including 25 cases of abdominal adhesions, 8 cases of chronic appendicitis, 2 cases of small intestinal diverticulum, 2 cases of intestinal tuberculosis, 2 cases of lymphoma, 5 cases of endometriosis, 2 cases of tubal adhesions, 1 case of peritoneal metastasis of gastric cancer after surgery, and 1 case of appendiceal mucinous adenocarcinoma.Surgical treatment was performed in 43 cases, 3 of whom were converted to laparotomy.There were no postoperative complications in the 56 cases.The follow-up rate was 92.9% (52/56), and lost of follow-up was in 4 cases.The follow-up duration was from 3 months to 3 years (median, 19.4 months).There was 1 death case (peritoneal carcinomatosis).There were 35 cases (62.5%) of complete relief of abdominal pain (no recurrence of preoperative abdominal pain symptoms) and 12 cases (21.4%) of pain relief (preoperative pain decreased or interval extended).The total effective rate was 83.9% (47/56).Conclusion Laparoscopy is of high value in the diagnosis and treatment of unexplained chronic abdominal pain.

Objective To explore the diagnosis and treatment of abdominal cocoon. Methods This article retrospectively summarized clinical data of 6 cases of abdominal cocoon. Results All the 6 cases of abdominal cocoon were misdiagnosed preoperatively: 5 cases were diagnosed as having intestinal obstruction and 1 case,abdominal mass.Partial or total capsule resection was adopted in all the 6 cases,1 of which simultaneously underwent intestinal arrangement. Conclusions Abdominal cocoon is not specific,which is difficult to diagnose preoperatively.Upper digestive tract radiography,B-ultrasonography and CT scanning help to make the diagnosis.Partial or total capsule resection,intestinal arrangement,intestinal resection and release for intestinal adhesion are usually adopted as the treatment.

Objective To probe the effect of transareolar or mastoscopy assisted breast-conserving surgery combined with open axillary lymph node dissection in the treatment of breast cancer. Methods Nineteen patients, with breast cancer of a diameter cm from the nipple, were treated by transareolar or mastoscopy assisted breast-conserving surgery from August 2001 to November 2003.After the lipolysis and suction of axillary fat,open axillary lymph node dissection was performed. Results Intraoperative frozen pathological examination had showed positive margin in 1 case, in which an enlarged excision was required to obtain a negative result. Postoperative subcutaneous edema underlying the operated site occurred in 2 cases and was cured by needle aspiration and pressure dressing. Excellent cosmetic outcomes were obtained with symmetrical breast development and all the patients were satisfied with the treatment. Postoperative follow-up for 2～19 months (mean, 10.6 months) found no recurrence in the breast or the axillary fossa. Conclusions Breast-conserving surgery can be expediently carried out by means of transareolar incision or with the help of mastoscopy. The combination with open axillary lymph node dissection may give favorable effect.

Objective To study the clinical feasibility and effect of totally endoscopic resection of axillary accessory breast.Methods Totally endoscopic resection of axillary accessory breast was performed in 48 cases(59 sites).On the basis of liposuction,a camera port and two 5-mm working trocars were made.By using forceps,dissecting scissors,or harmonic knife,were inserted.The cobweb-like fibropartition around the accessory breast was dissected.Results Postoperatively,there were 1 case of subcutaneous liquid accumulation and 2 cases of subcutaneous petechia,and no hematoma or infection developed.All wounds healed by first intention.Follow-up observations for 2～58 months(mean,23.6 months) showed good appearance and satisfactory effects.Conclusions Totally endoscopic resection of axillary accessory breast is safe,offering good cosmetic effects and being worthy of recommendation.

OBJECTIVETo compare the clinical efficacy on the motor impairment of knee joint after tracture operation between the combined therapeutic method of relaxing needling manipulation and exercise therapy and the simple exercise therapy.

METHODSSixty-four patients after the operation for the fracture of femoral shaft were randomized into a relaxing needling combined with exercise therapy group (group A) and an exercise therapy group (group B), 32 cases in each one. In the group A, the relaxing needling manipulation was applied to the local painful area of knee or the stiff soft tissues. Additionally, the exercise therapy was used in combination. In the group B, the exercise therapy was applied simply. Hospital for special surgery (HSS) pain score, the range of movement (ROM) of knee joint and Lysholm score were compared before and 60 days after treatment in the patients of the two groups. The efficacy was compared between the two groups.

RESULTSAfter treatment, HSS pain score, ROM and Lysholm score were all improved in the two groups, presenting the significant differences as compared with those before treatment (all P<0. 05). The results in the group A were better than those in the group B (all P<0. 05). The total effective rate was 96. 9% (31/32) in the group A, which was better than 75. 0% (24/32) in the group B (P<0. 05).

CONCLUSIONThe combined therapeutic method of relaxing needling manipulation and exercise therapy achieves the significant efficacy on the motor impairment of knee joint after the operation for the fracture of femoral shaft, superior to the simple exercise therapy.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Combined Modality Therapy ; Exercise Therapy ; Female ; Fractures, Bone ; physiopathology ; surgery ; therapy ; Humans ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Treatment Outcome

Objective To evaluate the expression of Krüppel-like factor 8 (KLF-8) and matrix metalloproteinase 9 (MMP-9) in placentas and their relationship with the pathogenesis of preeclampsia (PE).Methods Twenty-two women with PE (mild PE:4 cases; severe PE:18 cases) who received cesarean sections in the First Affiliated Hospital of Chongqing Medical University from September 2011 to March 2012 were recruited as the PE group (n =22).And twenty women who received elective term cesarean section without perinatal complications were chosen as the control group (n =20).Placentas were collected and immunohistochemical SP method were employed to detect the localization of KLF-8 protein.KLF-8 mRNA level was determined by quantitative real-time PCR technique and western blot analysis was used to quantify KLF-8 and MMP-9 protein levels.Results (1) There was no difference of KLF-8 protein distribution in placentas of the PE group and the control group.It was mainly located in the nuclear and cytoplasm of syncytiotrophoblasts.KLF-8 immunostaining was apparently decreased in the placentas of preeclamptic women when compared with the control group.(2)The KLF-8 mRNA levels were significantly decreased in placentas of the PE group (0.69 ±0.08) compared to those of the control group (1.14 ±0.09,P ＜0.01).(3) KLF-8 and MMP-9 protein levels significantly decreased in the PE placentas (0.68 ±0.05 and 0.21 ± 0.03) when compared to the control group (0.94 ± 0.06 and 0.34 ± 0.03,respectively,P ＜ 0.01).(4) There was a positive correlation between the expression of KLF-8 and MMP-9 protein in the placentas from PE and normal pregnancies (r =0.64,P ＜ 0.01).Conclusions KLF-8 mRNA and protein levels were decreased in placentas of PE patients compared to those of normotensive women.KLF-8 protein was primarily located in the invasion-related trophoblast cells and its expression had a positive correlation with MMP-9 levels.KLF-8 might have an important role in the pathogenesis of PE by regulation of trophoblast invasion.

Occupational Health Services ; methods ; organization & administration

Objective To know the effects of living with the elderly on nursing students' willingness engaging in aged nursing and attitude towards the elderly so as to provide references for nurturing professionals for caring for the aged.Methods 231 nursing students were surveyed.The questionnaire included four parts,general information,life experience with the elderly,willingness engaging in aged nursing,attitude towards the elderly and cognition of aging.Results 45.9 percent of the nursing students were willing to engage in aged nursing.Living with elderly and relationship with the elderly affected their willingness.Conclusions Creating more opportunities for nursing students in touch with the elderly can help nursing students to have a good impression of the elderly and stimulate them to choose aged nursing.

Objective To know the nursing students' willingness engaging in geriatric nursing and analyze affecting factors so as to provide references for nurturing professionals for caring for the aged.Methods 231 nursing students were surveyed.The questionnaire included general information,life experience with the elderly,willingness engaging in geriatric nursing,attitude towards the elderly and cognition of aging.The investigation results underwent analysis.Results Single factor analysis showed that whether ever living with the elderly (x2=6.027),time living with the elderly and relationship with the elderly (x2=4.928) influeced the nursing students' willingness engaging in geriatric nursing.Multiple correspondence analysis indicated that nursing students living with elderly more than one year and having good relationship with the elderly had positive willingness.Conclusions Geriatric nursing curriculum should be optimized and more opportunities should be created for nursing students to be in touch with the elderly.At the same time,we must pay attention to occupation guide and moral education about how to respect and care for the elderly.

Objective To study the effect of case-based learning(CBL) combined with virtual reality simulator in peripheral vascular intervention training for refresher doctors.Methods Total 30 peripheral vascular refresher doctors were selected in department of vascular surgery,Xuanwu Hospital of Capital Medical University and were randomly divided into the observation group(n=15) and control group(n=15).Doctors in observation group were trained by CBL combined with virtual reality simulator while those in control group were taught by traditional teaching method.Theory examination,skill examination in real environment were performed after the training and achievement differences were compared between 2 groups.Questionnaires were given to the simulator CBL group,to learn refresher doctors' recognition of the teaching method and groups were compared using independent samples t test.Results Theory examination average score was (84.5 ± 7.7) in observation group,higher than the score(72.6 ± 8.7) in control group(P=0.024).Skill examination average score was(85.3 ± 9.3) in observation group,higher than the score(70.2 ± 10.2) in control group(P=0.013).Compared with control group,the mean performance errors in training group,the contrast volume,the mean angiography procedure time,the time of X-ray exposure,the total volume of X-ray exposure and the total volume of X-ray exposure every square meter all decreased significantly and the difference was statistically significant.P value＜0.05.100％ (15/15) simulator CBL group refresher doctors recognized CBL combined with vascular interventional simulator teaching method.Conclusions Teaching method of CBL combined with virtual reality simulator can stimulate the refresher doctors' interest in learning and help them master peripheral vascular interventional techniques.