Objective To study the operative design, safety evaluation and feasibility of gasless laparoscopic operations. Methods The gasless laparoscopic devices (GLD) were applied to 124 cases of laparoscopic choledocholithotomy with T-tube drainage, 56 cases of laparoscopic choledocholithotomy with primary bile duct suture, 1 case of laparoscopic choledochocystectomy hepaticojejunostomy, 15 cases of modified gasless laparoscopic choledochojejunostomy, 1 case of hand-assisted laparoscopic megalosplenic resection and portozygos disconnection, and 1 case of gasless device assisted laparoscopic splenectomy. Results All the operations were successfully conducted, without any severe complications. Follow-up for 1~9 years in 129 cases of biliary duct operations found 1 case of recurrence. Follow-up for 3~12 months in 2 cases of splenic operations found no recurrence. Conclusions Gasless laparoscopic operations in this study have reached minimally invasive outcomes, proven to be safe and feasible.

Objective:To explore the effects of humanized nursing and personalized service in operating room nursing.Methods:A total of 300 patients who underwent surgical surgery in our hospital from April 2016 to June 2016 were randomly divided into the intervention group (n =150) and control group (n =150).Patients in the control group were treated with routine nursing care.On this basis,patients in the intervention group were provided with integral perioperative nursing of humanized nursing and personalized service.The fear,anxiety,blood pressure and heart rate fluctuations of both two groups before and after entering operating room were statistically analyzed.Results:Before entering operating room,the fear and anxiety scores of the patients in the intervention group were (32.67 ± 12.27),the blood pressure was (97.5 ± 12.8) mmHg,and the heart rate was (93.7 ± 11.8).The fear and anxiety scores in the control group were (36.94 ± 12.78),the blood pressure was (99.8 ± 12.5) mmHg,and the heart rate was (105.4 ± 10.6).The intervention group was significantly lower than the control group (P ＜ 0.05).Conclusion:The implementation of humanized nursing and personalized service can effectively reduce the patient's fear and anxiety to make the heart rate,blood pressure and other vital signs be in a relatively stable state;can make patients calm,positive and optimistic to undergo the surgery and actively cooperate with doctors and ward nursing,thus to get well soon.

Objective To explore the clinical characteristics of adults with functional articulation disorders (FADs) and suitable speech training methods.Methods Phonological evaluation was carried out for 37 adults with functional articulation disorders whose clinical characteristics were analyzed,then targeted speech training was established.Results The main erroneous articulation patterns of the adults were substitution,followed by distortion and omission.The erroneous articulation types included forward movement of the tongue (19 cases),insufficient aspiration (11 cases),lateralization (10 cases),backward movement of the tongue (7 cases),omission of consonants (7 cases),conprehensive errors (4 cases),and replacement by labiodental and lingua-palatal phonemes (3 and 2 cases respectively).Twenty-eight adults were cured,8 adults were improved,and 1 adult showed unsatisfactory effects after 1 to 5 courses of speech training.The average speech intelligibility score increased significantly from (56.03±14.71)％ before speech training to (91.22±10.10)％ afterward.Conclusion The main erroneous patterns of adults with functional articulation disorders are substitution and distortion.Targeted speech training was shown to be significantly effective.

Objective: To study the effects of TNFα on wound healing. Methods: The skin lesion and incisions were made on mice and rhTNFα was applied in both skin lesion and incision. Tissue strips were evaluated for tensiometry and histologic features after healing. Results: It was found that rhTNFα markedly improved wound healing both in skin lesion and incision wound model, it also markedly enhanced the breaking strength of treated incision and increased wound cellularity in rh TNF α treated groups. Conclusion: The results suggest that TNFα play an important role in regulating inflammatory reactions of local injured tissues and it may improve the functions of fibroblasts, mononuclear phagocytes and endothelial cells. rhTNFα of suitable doses can promote wound healing. This shows that TNFα, as a wound healing promoter, has the potentials for clinical application.

Objective To study the phonetic characteristics of patients with abnormal plosive consonant of functional articulation disorders (FAD) and the possible treatment approaches.Methods A total of patients of 4~26 years old with abnormal plosive consonant of FAD received speech assessment and the phonetic characteristics.Incorrect articulation patterns and forms of plosive consonant /b/,/p/,/d/,/t/,/g/ and /k/ were analysed.The targeted speech treatment was established to correct the erroneous places and types of pronunciation.Results The error rate of /t/ (82/87)was the highest,followed by /k/(77/87),/d/(67/87),/g/(60/87),/p/(59/87) and /b/(3/87) which was the lowest.The error rate of fricative was 65.52% as the highest among all the erroneous patterns,followed by unaspiration(63.22%),forward movement of the tongue(54.02%),distortion(33.33%),bilabial(32.18%),and backward movement of the tongue(18.39%).Seventy-one cases were completely cured,and 16 cases partially cured after 2 to 10 times of treatment.The number of incorrect words of plosives decreased to 4.03±2.71 after the speech therapy from 67.97±18.56 prior to that.The differences were statistically significant (t =34.301,P<0.001).Conclusion The articulation errors of plosives occur mainly on /t/,/k/,/d/,/g/and /p/,/b/.The incorrect types of pronunciation are fricatives,unaspiration,distortion and omission.The incorrect places of articulation are forward movement of the tongue,bilabial and backward movement of the tongue.The targeted speech therapy established according to the erroneous places and types of articulation is significantly effective.

Objective To explore the clinical characteristics of consonant errors in adults with functional ar-ticulation disorders (FAD) .Methods Speech evaluations were carried out on 42 adult subjects with FAD .Then the articulation patterns and types of erroneous consonants were classified and analyzed .Results The main erroneous articulation patterns of the adults were substitution ,distortion ,followed by omission .The abnormal consonants which were classified according to the place of articulation were found as follows :blade-palatal(39 cases) ,supra-dental(31 cases) ,lingua-palatal(22 cases) ,velar(19 cases) ,blade-alveolar(18 cases) ,labiodental(6 cases) and bi-labial consonant(6 cases) .Erroneous consonants which were sorted according to the error frequency by descending order lied in/sh/,/zh/,/ch/,/r/,/z/,/c/,/s/,/q/,/x/,/j/,/g/,/k/,/h/,/t/,/l/,/d/,/f/ and /p/.The error types were fronting of tongue(22 cases) ,unaspiration(12 cases) ,lateralization(12 cases) ,omission(9 cases) ,back-ing of tongue (8 cases) ,replacement by lingua-palatal(4 cases) ,bilabial(4 cases) and labiodental consonant(3 ca-ses) .Conclusion The main erroneous articulation patterns of adults with FAD are substitution and distortion .The erroneous consonants are blade -palatal ,supradental ,lingua-palatal ,velar and blade-alveolar .The error types are fronting of tongue ,unaspiration ,lateralization and omission .

Objective: To investigate the effect of N methyl D aspartate(NMDA) on cochlear potentials and to find out the possible neurotoxic effect of NMDA on cochlea function in guinea pigs. Methods: After basal compound action potentials (CAP) and cochlear microphonics (CM) were recorded by round window electrode, animals ( n =5) were treated with Hanks applied to the round window membrane (RWM) for 20 min as control. Then 100 ?mol/L NMDA was applied to the RWM for another 20 min. Results: Hanks produced no obvious changes in CAP threshold, CAP N1 and CM latency and amplitude. CAP thresholds at all frequencies of tone burst were significantly elevated by application of NMDA, threshold shifts ranged from 13 27 dB. NMDA significantly reduced the CAP N1 amplitudes at all intensities of stimulations. CAP amplitudes were suppressed by 50% 75%. NMDA also significantly increased the CAP latency, the latency of CAP evoked by 6 kHz tone burst at intensity of -90 dB(output attenuation) was (1.9?0.06) ms after Hanks treatment and (2.76?0.21) ms after NMDA treatment ( P

Objective To impmve the method of "modified comet assay" in predicting the radiosensitivitv of solid tumor. Methods A single cell suspension from biopsy sample was lmdlated on ice with a dose of 5 Gy.The microscope slide was spread with agarose,lysed for 50 minutes,rinsed 3 times rinse solution,and given electrophoresis for 20 minutes. After being stained with PI,cell images were collected through the microscope and analyzed with Lucia G software(Version 4.6).In order to check system/ background errors,every sample was made into control slide and irradiation slide.The end-points were cell DNA contents and tail moment. Results The factors influencing the results included:(1)Sample was iaulty tor the biopsv taken from mucosa and no tumor cells were contained. (2)The slides with a high backgmund ( induced by necrosis) disturbed the measurement of comet assay. (3) Setting lymphocytes as control to check svstem errors was very important. (4)To separately collect images of the normal tissue cells and tumor cells from the biopsy sample improved the conformity between the clinical obscrvation and the lab result. Conclusions To increase the correlation between comet assay and clinical response,it is very helpful to set double control for checking system/background errors and to collect images of the normal tissue cells and tumor cells through the microscope,respectively.

Objective To explore the phonological characteristics of lateral misarticulation in children with functional articulation disor-ders and the rehabilitation approaches for them. Methods From June, 2013 to December, 2014, 44 children with lateral misarticulation were assessed and the phonological characteristics of lateral misarticulation were analyzed. They accepted targeted rehabilitation training. The cor-relation was analyzed between lateral misarticulation and age as well as severity of disorder. Results The frequency of lateral misarticulation was the most in Blade-palatals (75.00%), and then the dentals (65.91%), lingua-palatals (56.82%) and blade-alveolar consonant (20.45%). Thirty-eight cases were cured and 4 cases improved after 1 to 5 courses of rehabilitation. The overall cure rate was 86.36%(38/44), and it was 100%(11/11), 86.67%(13/15), 77.78%(14/18) in those with mild, moderate and severe disorder, respectively. There was no significant correlation between lateral misarticulation and age (r=0.100, P=0.752) as well as severity (r=0.257, P=0.092). Conclusion Lateral misarticu-lation in children with functional articulation disorders mainly occurs on blade-palatals, dentals and lingua-palatals. The targeted speech re-habilitation training is beneficial.

Objective: To investigate the clinical features and genetic characteristics of patients with ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) gene variants. Method: The clinical data of a patient with ENPP1 homozygous variants from Capital Institute of Pediatrics was collected, the related literature was searched from China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, National Center from Biotechnology Information and PubMed by using search term "ENPP1" , "hypophosphatemic rickets" . The literature retrieval was confined from 1980 to February 2017. The clinical manifestations, bone metabolism examinations, X-RAY and genotypes were reviewed. Result: Our patient was an 11 years old girl, with 7 years history of lower limb malformation. She showed significant valgus deformity of the knee (genu valgum). Metabolic examination revealed reduced level of plasma phosphate (0.86 mmol/L), a normal level of plasma calcium (2.30 mmol/L) and an elevated alkaline phosphatase level of 688 IU/L. The calcium-phosphorus product was 25.9. A homozygous nonsense variants of ENPP1 gene, c.783C>G (p.Tyr261X) in exon 7 was identified in the patient. Both parents were heterozygous carriers. Literature review identified 3 Chinese patients from one publication and 17 cases from twenty one publications around the world. None of the patients was found PHEX variants which is the most common variants among hypophosphatemic rickets patients. The disease onset age was 11 months to 10 years. Eight patients had short stature, five patients had the history of generalized arterial calcification of infancy. Four suffered from deafness, three showed localized calcifications of arteries, three patients manifested pseudoxanthoma elasticum and two suffered from ossification of posterior longitudinal ligament. Nine missense variants, six splicing variants and 4 nonsense variants were reported among these twenty patients. c.783C>G was found in two Chinese patients. Conclusion ENPP1 gene mutation was a cause of patient with hypophosphatemic rickets. Comorbid features included generalized arterial calcification of infancy, early onset hearing loss, pseudoxanthoma and ossification of posterior longitudinal ligament. ENPP1 gene testing should be performed on hypophosphatemic rickets patients without PHEX gene variants. Long-term follow up is recommended. The most common types of ENPP1 gene variants were nonsense/splicing variants. The gene c.783C>G was the most common variants in Chinese patients.