ObjectiveToevaluatethefeasibilityandresultsof transorallaparoscopic thyroidectomy. MethodThyroidectomy was attempted in 5 cases,including 4 females and 1 male with the average age of 42 years( range 35 -60 years).All patients was diagnosed as single nodule of the thyroid gland confirmed by B-mode ultrasound examination before the operation.The average diameter of nodule was 2.5 cm (range 2 - 3.4 cm). ResultTransoral laparoscopic thyroidectomy was perfoormed successfully in all 5 patients.The operation time was 120 - 210 min,averaging 170 min,blood loss during the operation was 15-60 ml,the postoperative hospitalization was 4 days. There was no conversion to open surgery,no recurrent laryngeal nerve injury,nor parathyroid glands dysfunction. ConclusionsTransoral laparoscopic thyroidectomy is feasible and safe,giving excellent cosmetic results.

Objective To investigate the effects of alpha lipoic acid on patients with diabetic retinopathy (DR),explore the possible mechanisms,and provide experimental evidence for the treatment of DR with lipoic acid.Methods Totally 75 DR patients were randomly divided into control group and treatment group.Patients in control group received the standard hypoglycemic treatment,antihypertensive therapy,and other comprehensive treatment.Patients from the treatment group were treated with alpha lipoic acid 600 mg + 250 ml 0.9％ sodium chloride injection additionally,avoiding light intravenous therapy,for a total of 4 weeks.Before and after treatment,fundus fluorescein angiography and visual inspection were detected in two groups.In addition,serum level of asymmetric dimethylarginine (ADMA) were detected with high performance liquid chromatography,serum lipid peroxidation product malondialdehyde (MDA) content and superoxide dismutase (SOD) activity were detected to reflect the in vivo oxidative stress before and after treatment in two groups.Results Compared to the control group,visual acuity was improved significantly (P ＜ 0.05),and total efficiency of ocular lesions-improved was increased significantly (84.21％ vs 40.54％,x2 =15.28,P ＜ 0.01).Serum levels of endogenous inhibitor of nitric oxide synthase ADMA [(0.32 ±0.13) μmol/L vs (0.51 ± 0.26) μmol/L,P ＜ 0.05] and MDA [(3.22 ± 0.90) nmol/L vs (5.13 ± 0.42) nmol/ml,P ＜ 0.05] were significantly decreased,while SOD levels [(72.68 ± 1.31) U/ml vs (53.16 ± 1.54) U/ml,P ＜0.05] were significantly increased in DR patients after alpha lipoic acid treatment.Conclusions Alpha lipoic acid had some therapeutic effects for DR patients,which mainly lied in the improvement of visual acuity and eye disease,might be related to the decrease of oxidative stress and serum level of endogenous nitric oxide synthase (NOS) inhibitor ADMA.

Objective To investigate the the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy(PCNL).Methods The clinical data of 1 patient with massive hemorrhage after PCNL who treated with superselective renal artery embolization and ureteral soft lens were analyzed.Results The patient with postoperative bleeding after PCNL was treated with superselective renal artery branch embolization,after 30d embolization,the holmium laser lithotripsy under the soft ureteroscope for ureteral calculi was performed,and the renal pelvis mucosa smooth,no bleeding and scar formation were intraoperative visible.After operation,the stone was removed basically,and the double J tube was removed 2 weeks after operation.The patient had no special discomfort and the renal function was normal.Conclusion Postoperative 14-30d is a relatively safe time to perform flexible ureteroscopic lithotripsy for super selective renal artery embolization in the treatment of patient with massive hemorrhage after PCNL.

Objective To investigate the optimal time for capsule endoscopy in patients with obscure gastrointestinal bleeding (OGIB) .Methods Data of 76 patients with OGIB underwent capsule endoscopy from January 2013 to December 2014 were retro‐spectively analyzed .They were classified into two groups :emergency capsule endoscopy and non‐emergency capsule endoscopy .The demographic and clinical features and outcomes of capsule endoscopy ,complications and the times of hospital stays and hospitaliza‐tion expenses were compared .Results The overall diagnostic yield of capsule endoscopy was 48 lesions(63 .15% ) .The overall di‐agnostic yield of emergency capsule endoscopy group was 73 .68% (28/38) ,which was significantly higher than that in non‐emer‐gency capsule endoscopy group(52 .63% ,20/38) ,with statistical difference (P< 0 .05) .Conclusion Emergency capsule endoscopy have a higher rate of detection ,patients with OGIB should receive capsule endoscopy as soon as possible .

Objective To evaluate the feasibility and results of laparoscopic thyroidectomy by oral and breast approach for the treatment of papillary throid carcinoma.Methods Thyoidectomy was performed in 26 cases,including 24 females and 2 males with the average age of 34 years (range 20-53 years).All patients were diagnosed throid carcinoma confirmed by FNA or B-mode ultrasound examination,a thyroid lobe or total thyroidectomy and central compartment dissection was performed by breast approach,then additional dissection of central compartment was completed through oral approach.Results Laparoscopic thyroidectomy via oral in combination with brest approach was performed successfully in all 26 cases.The mean operative time was (164 ± 13) min,including average time of oral approach of (40 ± 7) min.The mean number of lymph node dissection in central compartment was 7.42 ± 4.88,oral approach achieved additional 1.23 ± 2.21,with metastatic lymph nodes diseccted by oral approach in 3 cases.Conclusions Laparoscopic thyroidectomy via oral in combination with breast approach for the treament of papillary throid carcinoma is better than breast approach alone in central compartment dissection.

Objective To investigate the changes of visual acuity,fundus changes,and serum vitamin D concentration in diabetic retinopathy patients treated with metformin,and to evaluate its clinical efficacy.Methods Totally 80 cases (160 eyes) patients with background diabetic retinopathy were included in the study,and were divided into observation group (metformin + Pancreatic Kininogenase Enteric-coated Tablets) and control group (Pancreatic Kininogenase Enteric-coated Tablets) according to the different treatment methods used for 3 months.Fundus fluorescein angiography was used to evaluate the improvement of the fundus lesions.The serum levels of vitamin D were measured with electrochemiluminescence immunoassay (ECLIA).Results After 3 months of treatment,serum vitamin D concentration of the observation group increased,and the differences were statistically significant (P ＜ 0.05) when compared to before treatment.However,3 months after treatment,serum vitamin D levels of the control group increased slightly,but the difference was not statistically significant (P ＞ 0.05).The total effective rate of fundus improvement in the observation group and the control group was 70％ and 55％,respectively.There was significant difference between the two groups in the improvement of fundus (P ＜ O.05).Conclusions Metformin has an adjunctive effect on background diabetic retinopathy,and the increase of serum vitamin D may be one of the mechanisms of metformin in improving diabetic retinopathy.

Objective:To evaluate the diagnosis and treatment of abdominal cocoon.Methods:The clinical data of 8 patients with abdominal cocoon in our hospital from Jan 2015 to Dec 2021 were retrospectively reviewed including clinical and imaging manifestations, treatment and follow-up.Results:One case was asymptomatic, and the other 7 cases suffered from recurrent abdominal pain with complete or incomplete intestinal obstruction. The median course of disease was 6 months (15 days to 40 years). Six cases underwent laparcoscopic cocoon membrane resection and intestinal adhesion lysis, of which 2 cases underwent laparotomy, one case was converted to open surgery, 4 cases underwent concomitant appendectomy. Follow-up ranged from 3 to 69 months, there were 2 cases complicating early inflammatory intestinal obstruction, 1 case suffred wound fat liquefaction and infection, 1 case with a colic 5 months after operation, and the others were doing well.Conclusions:The clinical characteristics of abdominal cocoon disease are not typical. Surgery is the main treatment. The prognosis of the disease is generally fair.

Insulin is produced and secreted by pancreatic β cells in the pancreas, which plays a key role in maintaining euglycemia. Insufficient secretion or deficient usage of insulin is the main cause of diabetes mellitus (DM). Drug therapy and islets transplantation are classical treatments for DM. Pancreatic β cell replacement therapy could help patients to get rid of drugs and alleviate the problem of lacking in transplantable donors. Pancreatic β-like cells can be acquired by cell reprogramming techniques or directed induction of stem cell differentiation. These cells are proved to be functional both in vitro and in vivo. Some hospitals have already performed clinical trials for pancreatic β cell replacement therapy. Functional pancreatic β-like cells, which obtained from in vitro pathway, could be a reliable source of cell therapy for treating DM. In this review, the approaches of obtaining pancreatic β cells are summarized and the remaining problems are discussed. Some thoughts are provided for further acquisition and application of pancreatic β cells.
Cell Differentiation ; Diabetes Mellitus/therapy* ; Humans ; Insulin/metabolism* ; Insulin-Secreting Cells/metabolism* ; Islets of Langerhans Transplantation ; Pancreas/metabolism*