Objective To evaluate the repot of common hepatic duct defect caused by Type Ⅱ or Type Ⅲ Mirizzi syndrome laparoscopically.Methods Eight cases of Type Ⅱ or Type Ⅲ Mirizzi syndrome treated under laparoscopy were analyzed retrospectively.Among them six cases were identified as Mirizzi Ⅱ and a defect on the lateral wall of common hepatic duct was found and repmred by suturing the stubble of cystic duct.The two Mirizzi Ⅲ cases had a defect on front and lateral wall or back and lateral wall of common hepatic duct respectively.Both defects were repaired by a patch from the infundibulum of galllbladder. Results All the 8 cases underwent laparoscopic subtotal cholecystectomy followed by repair of common hepatic duct defect.The operation lasted for 80～150 min(mean 110 min).There was no recurrence of the symptoms after 6～24 months follow up.Conclusion The familiarity of the anatomical characters of Mirizzi syndrome and the skillful suture technique under laparoscopy are both necessary.

Regional anatomy of inguinal hernia is one of the teaching difficulties.The students always feel confused due to deficiency of visual and vivid teaching materials.The thesis analyzed the efficacy of using high-definition video of laparoscopic inguinal hernia repair (LIHR) in the clinical teaching of inguinal region anatomy aiming to deepen the understanding,inspire the enthusiasm and initiative of students and improve the quality of teaching.

The theory of Constructivism was applied in different aspects of clinical teaching of surgery.The lessons were designed according to the character of students.Problem solving was emphasized during the course of teaching.An interactive and cooperative atmosphere was constructed.And a variety of additional related materials were provided.All these measures made the teaching activity more accord with the objective rule of clinical knowledge learning.Hence a better teaching effect was achieved.

To improve the teaching quality of advanced students on minimally invasive surgery is important for the generalization of new techniques on this subject.The teaching plan should be made according to the academic level of these students.Both theory learning and clinical practice should be emphasized.Multimedia tools should be adopted and English teaching should not be neglected.All these means help to better the teaching quality of advanced students on minimally invasive surgery.

Objective: To investigate condom use among unmarried female migrant workers in Shanghai and explore its relation with some psychosocial problems. Methods: A questionnaire survey was conducted by cluster random sampling. A total of 903 unmarried female migrant workers who had sexual experience were enrolled to evaluate their condom use and psychosocial factors. Logistic regression was used to analyze the related factors of condom use. Results: Among the unmarried female migrant workers, the percentage of consistent condom use was only 13.8%. Univariate Logistic regression showed that low self-esteem (OR=0.47, 95% CI=0.25-0.90) and depression (OR=0.59, 95% CI=0.38-0.93) were related to inconsistent condom use after correcting demographic factors. Multivariate Logistic regression showed that depression (OR=0.58, 95% CI=0.37-0.90) was the main factor related to inconsistent condom use. The participants with at least two psychosocial problems were more difficult to use condoms consistently (OR=0.56, 95% CI=0.32-0.97). Conclusion: The unmarried female migrant workers with depression or co-occurring psychological problems in Shanghai are more likely to have unsafe sex behavior, which indicates the importance of psychological interventions.

Appendectomy involves several key concepts in the foundation course of operative surgery. So it is the best choice to test whether the students can be flexible in using and fully under-stand what they learned about the basic theories and skills of appendectomy. Changzheng Hospital applies Wechat-ald team-based learning and problem-based learning teaching in appendectomy-related courses by actively delivering messages with content of educational administration, basic knowledge, clinical images and videos to the micro-groups, achieving instantly efficient information dissemination and interactive communication. It breaks the shackles of traditional classroom in space and time, mo-bilizes students' enthusiasm for learning, enhances their communicational skills and sense of team-work and improves students' comprehensive analysis and practical ability, therefore achieving better teaching results.

Adolescent ; Adult ; Aged ; Calcaneus ; injuries ; surgery ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Skin Diseases ; etiology ; prevention & control ; Young Adult

Objective To compare the effects of fundus-first laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy in complicated cholecystolithiasis cases. Methods The effects of fundus-first laparoscopic cholecystectomy (n = 21) and laparoscopic subtotal cholecystectomy (a = 18) in the 39 cases of complicated chole-cystolithiasis from our hospital within 2 years were analyzed retrospectively. Results The operation time in subtotal laparoscopic cholecystectomy group was shorter than in fundus-first laparoscopic cholecystectomy group (88.89±18.11) min vs. (109.52±21.79) min, P < 0.05). Less blood lose (82.78±44.96) ml and fluid replacement (847.22±169.32)ml during the operation were observed in the former group than those in the later group (116.67±53.23) ml and (964.29±147.60) ml, respectively, P < 0.05). However, the patients' postoperative recovery time and the duration of postoperative hospital staying were similar in the two groups(5.56±1.20) days vs. (5.29±1.38) days, P > 0.05). Conclusions Proper use of subtotal laparoscopic cholecystectomy in complicated cholecystolithiasis cases can simplify the operation and obligate the operation time, which will increase the safety of the operation with the outcome similar to fundus-first laparoscopic cholecystectomy.

Objective To explore the characteristics of ischemia-reperfusion induced infant lung damage and the potential mechanisms of the injuried.Methods Both infant (15-21 days old) and adult (5-6 months old) rabbits were subjected to either ischemia-reperfusion or sham operation.Ischemia-reperfusion was induced by clamping the right pulmonary hilum for 1 hour and then removal of the clamp for 4 hours under anesthesia.The lung tissue were sampled for histological examination by light and electron microcopies and for biological evaluation of mitochondrial alterations.Production and expression of free radical species-hydroxyl radical (ROS-HR),malondialdehyde (MDA),superoxide dismutase (SOD),glutathione peroxidase (GSH-PX),myeloid differentiation factor-88 (MyD-88),and nuclear factor-κB (NF-κB) in the lung tissue were also examined.In addition,circulating levels of interleukin-β and tumor necrosis factor-α were measured during the ischemia-reperfusion process.Results In comparison to adult lungs,the infant lungs had more increased neutrophil infiltration,edema,swelled alveolar epithelial and endothelial cells,and severer mitochondrial impairment reflected by damage of the inner membrane as well as decrease in the membrane potential after ischemia-reperfusion.The lungs in infant animals subjected to sham operation displayed higher levels of ROS-HR and MDA and lower levels of SOD and GSH-PX than those in adult controls.The lungs in infants with ischemia-reperfusion were found to further produce more ROS-HR,and MDA,and less SOD and GSH-PX than the ischemia-reperfused adult lungs.Moreover,the circulating levels of interleukin-1β and tumor necrosis factor-α were elevated during the period of ischemia-reperfusion,particularly in the infant animals,which appeared to be associated with the expression of MyD-88 and NF-κB in the lungs.Conclusion Lung ischemia-reperfusion causes more severe lung damage in infants than in adults,probably due to combination of low antioxidant capacity and overproduction of ROS in infants.

Objective To investigate the effects of selective cyclooxygenase 2 inhibitor on the hyperplasia of parathyroid glands from uremic rats. Methods Sixty-five 5/6-nephrectomized (Nx) and fifteen sham operated rats were assigned to 4 groups: (1)Sham group (n=14):shamoperated +normal phosphate diet (P 0.8％,Ca 1.2％)； (2) Nx-HP group (n=17):Nx+high phosphate(HP) diet (P 1.2％,Ca 1.2％)； (3)Prophylactic COX2 inhibition group (Prey group,n=18):Nx+HP+celecoxib 100 mg· kg-1·d-1 for 3 months； (4)Therapeutic group (Ther group,n=18):Nx+HP+celecoxib 100 mg·kg-1·d-1 starting at the second month of the 5/6 nephrectomy.At the end of 3 month,blood,urine and parathyroid samples were collected.The expressions of COX2 and PCNA were determined by immunohistochemistry,Western blotting and real-time PCR. Results All of the Nx rats fed with high phosphate diet for 3 months manifested progressively increasing serum creatinine,serum iPTH as well as augmentation of parathyroid gland volume,suggesting that secondary parathyroid hyperplasia animal model was established successfully.Celecoxib significantly decreased serum iPTH levels [Sham (34.77±0.83),Nx-HP(100.73±4.35),Prey (87.36±2.18),Ther (87.47±1.76) ng/L,P＜0.05],the size of the parathyroid glands in Nx rats [Sham (0.461±0.089),Nx-HP (2.436±0.372),Prey (0.987±0.254),Ther (1.27±0.305) mm2/kg,P＜0.05] and PCNA expression in PG determined by Western blotting (decreased to 52.91％ in Prev group and 34.68％ in Ther group respectively,P＜0.05).No significant difference was observed between the two COX2 inhibition groups.The levels of COX2 expression in parathyroid gland were greatly increased in three Nx groups compared with that in sham group (2.47-fold in Nx-HP,2.34-fold in Prey group,3.04-fold in Ther group,P＜0.05).COX2 inhibitor had no effects on COX2 expression in PGs.Real-time PCR analysis demonstrated the same trends of mRNA expression of COX2 and PCNA in PGs of rats. Conclusion Selective inhibition of COX2 may help to suppress the hyperplasia of parathyroid glands in uremic rats.