Objective To explore the technique of laparoscopic reoperation in the treatment of common bile duct stones.Methods A retrospective analysis of the clinical data of 54 cases of common bile duct stones undergoing laparoscopic common bile duct stone surgery in our hospital from January 2011 to December 2015 was conducted.Through the choice of puncture hole, the exposure of the liver surface and the confirmation of the common bile duct, T-tube drainage and primary suture of common bile duct were carried out for the treatment of bile duct stone.Results The laparoscopic operations were successful in 52 cases, while conversions to open surgery were required in 2 cases.During the operation, the amount of bleeding was about 40-150 ml (average, 70 ml), the operation time was 75-180 min (average, 120 min), and the postoperative gastrointestinal function recovery time was 24-48 h (average, 27±13 h).There were 1 case of duodenal perforation injury, 2 cases of bile leakage, and 2 cases of residual stones after operation, which were cured with laparoscopic repair, prolonged drainage time, and choledochoscope treatment via abdominal sinus.Postoperative hospital stay was 6-9 d (average, 7±1.5 d).A total of 54 cases were followed up for 3-24 months (mean, 14.8 months).All the patients recovered well, without bile duct stricture or stone recurrence.Conclusion As long as the application of skilled laparoscopic surgery methods and separation of surgical area skills, laparoscopic bile duct surgery for the treatment of common bile duct stones is safe and feasible.

Objective:To study age-related changes of stimulated whole saliva flow rate and nitric oxide level in healthy adults.Methods:97 healthy adults were divided into four age groups:20-39 years (youth group), 40-59 years (middle-aged group), 60-79 years (elderly group), and 80 years and over (macrobian group).The volunteers were asked to restrain from breakfast in the morning.After mouth rinse with 2.5 ml/L chlorhexidine,20 ml/L citrate was dropped on the anterior third of the tongue dorsum of the subjects for two minutes at the pace of 1 drop every 20 seconds.Then the subjects rinsed their mouth 3 times with double-distilled water within 1 minute,then saliva was collected for 5 minutes. The volume of saliva was documented. Samples were frozen at -70 ℃ until assayed. The rates were calculated. Nitric oxide concentrations were measured with nitrate reductase and the Griess reagent, and then nitric oxide output (mol/min) was calculated.Results:(1) The flow rate of stimulated whole saliva in youth group was significantly higher than that in middle-aged, aged and macrobian groups(P 0.05 ). (2) There were no significant differences in nitric oxide concentrations between any two of the groups. Output of nitric oxide in youth group was significantly higher than that in middle-aged, aged and macrobian groups(P0.05). Conclusion:Nitric oxide exists in saliva of healthy adults. Stimulated whole saliva flow rate and nitric oxide output decreases with aging.

Acupuncture Therapy ; history ; Books ; history ; China ; History, Ancient ; Humans ; Medicine in Literature

BACKGROUND: Xingnao kaiqiao acupuncture is a series of systematic acupuncture methods with yin channels in domination, assisted by specified standards of quantity manipulation, which was founded according to the pathogenesis of stroke, and it is effective in treating stroke.OBJECTIVE: To observe the effects of xingnao kaiqiao acupuncture on blood lipids and blood viscosity in stroke patients of different syndrome types.DESIGN: A comparative observation.SETTINGS: Institute of Acupuncture and Moxibustion, and Special Care Ward of Acupuncture, the First Affiliated Hospital of Tianjin College of Traditional Chinese Medicine.PARTICIPANTS: Totally 750 stroke inpatients (466 males and 284 females) were selected from the Special Care Ward of Acupuncture, the First Affiliated Hospital of Tianjin College of Traditional Chinese Medicine between January and December in 2001, the average age was (64±12) years,the disease course ranged from 2 hours to 3 years. All the patients were informed and agree with the therapeutic program.METHODS: ① The traditional Chinese medicine (TCM) syndrome differentiations of stroke were in reference to the fifth edition of Traditional Chinese Medicine and Internal Medicine. There were 688 cases of stroke of meridian and collateral type and 47 cases of stroke attacking zang-fu organs type. ② Huatuo filiform needles produced by Suzhou [1.0-1.5 cun in length, 0.32-0.38 mm in diameter (No. 30-28)] were used in the xingnao kaiqiao acupuncture. Firstly, the acupoints of bilateral Neiguan were acupunctured perpendicularly for about 0.5-1.0 cun, the reducing manipulation by twirling as well as lifting and thrusting the needle was performed for 1 minute; Secondly, the needle was inserted at Renzhong towards nasal septum for about 0.3-0.5 cun, the manipulation of heavy bird-peck needling was used till the eyeballs were wet or tears fell down; Then Sanyinjiao was acupunctured, the needle was inserted along the medial border of tibia at an angle of 45° with skin for about 1.0-1.5 cun, the reinforcing manipulation by lifting and thrusting the needle was performed till the ipsilateral lower limb had three tics; The acupoint of Weizhong was selected by lying and lifting the leg, the needle was inserted perpendicularly for 0.5-1.0 cun, and the reducing manipulation by lifting and thrusting was applied till the ipsilateral lower limb had three tics; The acupoint of Jiquan was acupunctured at 1 cun below the source point along the channel in avoidance of axillary hairs, the needle was inserted perpendicularly for 1.0-1.5 cun, and the reducing manipulation by lifting and thrusting was applied till the ipsilateral upper limb had three tics; The elbow was flexed to 120° for acupuncture at Chize, the needle was inserted perpendicularly for 1.0 cun, the reducing manipulation by lifting and thrusting was applied till the ipsilateral upper limb had three tics. Twice a day for 7 days as a course. ③ After four courses averagely, the whole blood viscosities were detected with the hemorrheologic detector, and the normal ranges for lowshear, middle-shear and high-shear of whole blood viscosities were 6.50-9.25, 4.35-5.45 and 3.65-4.40 mpa ·s respectively. The levels of total cholesterol and triglyceride were detected with blood lipid detector, and the normal ranges were 3.38-6.5 mmol/L and 0.56-0.147 mmol/L.MAIN OUTCOME MEASURES: The effects of xingnao kaiqiao acupuncture on the blood lipids and blood viscosity in stroke patients of different syndrome types were observed.RESULTS: Totally 690 and 721 cases finished the detections of whole blood viscosities and blood lipids respectively. There were obviously fewer cases with normal whole blood viscosities in the patients with stroke of meridian and collateral than in those with stroke attacking zang-fu organs (10.3%, 15.4%, P ＜ 0.01), but markedly more cases with higher total cholesterol and triglyceride than in those with stroke attacking zang-fu organs (80.5%, 91.5%; 64.1%, 71.3%; P ＜ 0.01).CONCLUSION: The levels of blood lipids in the patients with stroke of meridian and collateral are more abnormal than in those with stroke attacking zang-fu organs, but their blood viscosities are better than in those with stroke attacking zang-fu organs.

Objective To compare the effect of the cochlear stem cells transplantation in treating the noise in-duced hearing loss model and toxic hearing loss model.Methods The Experimental guinea pigs were divided into three groups:the group of the noise induced hearing loss model treated with the cochlear stem cells,the blank con-trol group of toxic hearing loss model treated with the cochlear stem cells and noise induced hearing loss model and the blank control group of toxic hearing loss model.The cochlear stem cells suspension and physiological saline were transplanted into the cochlear inner ears of the three groups,respectively.ABR detection and immunofluorescence observation were implemented three times in 7 days,28days and 56 days after the operation,respectively.Results Nestin positive cells and Myosin ⅦA positive cells were detected in both of the two models treated with cochlear stem cells,but the number of Nestin positive cells and Myosin ⅦA positive cells detected in noise induced hearing loss model was higher than that in the toxic hearing loss model.The ABR responses decreased on the noise induced hearing loss model and toxic hearing loss model treated with cochlear stem cells transplantation,but the hearing re-covery of guinea pigs in the noise induced hearing loss model was superior to the toxic hearing loss model at 28 days and 56 days after operation.Conclusion The cochlear stem cells transplantation is more effective in treating noise in-duced hearing loss than toxic hearing loss model.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. In recent years, the overall incidence of CRC in China has shown an upward trend. According to the national estimates of cancer in China, CRC was the second most commonly diagnosed cancer of the digestive system. Screening of CRC can significantly reduce its morbidity and mortality. The screening methods are diverse. At present, a two-step screening program based on fecal immuno-chemical test (FIT) and colonoscopy is recommended by authoritative guidelines or consensus in many countries. Other screening methods can be used as individualized options and supplements. Multigene germline mutation detection should be performed for extremely high-risk population with multiple colorectal polyps (>10 polyps) and CRC personal or family history; or with more than 20 polyps.

Objective To evaluate the clinical effect of Uniportal video -assisted thoracoscopic surgery and single utility port video-assisted thoracoscopic surgery for ⅠA stage non-small cell lung cancer .Methods A total of 81 patients with ⅠA stage non-small cell lung cancer was admitted to our hospital from January 2015 to November 2015 .The patients were divided into control group and observation group .51 patients of control group received single utility port video -assisted thoracoscopic surgery , while other 30 patients of observation group received Uniportal video -assisted thoracoscopic surgery .Results The incision length of observation group was(4.27 ±0.29) cm,operative time was (208.80 ±61.12) mins.The volume of blood intra -operation was (92.33 ±73.75)mL;the number of lymph nodes dissection was (15.62 ±5.12),post-operative drainage within 24 hours was(401.70 ±53.31)mL;drainage tube retention was (6.30 ±3.01)days;postoperative hospitalization time was(19.03 ±5.85)days.The incidence rate of postoperative complications was 13.33%.The incision length of control group was(3.86 ±0.23)cm.The operative time was(184.30 ±51.36)mins;The volume of blood intra-operation was(84.90 ±80.98)mL,the number of lymph nodes dissection was (15.84 ±5.66),post-operative drainage within 24 hours was(398.00 ±52.73)mL;drainage tube retention was(6.10 ±3.25)days;postoperative hospitalization time was(18.69 ±6.81) days;The incidence rate of postoperative complications was 25.49%, there were no significant difference between the two groups (P>0.05).VAS pain score of the observation group was(2.32 ±0.94)and it was(4.18 ±0.95)in control group,and observation group was significantly better than the control group(P<0.05).Conclusion Uniportal video -assisted thoracoscopic surgery has the benefit of less trauma and pain ,and it is worth using widely .

There are some existing problems in controlling the quality of oxygen. In order to improve quality, efficiency and safety in the use of oxygen, we presented some factors which may give rise to variations in concentration of oxygen and proposed some suggestions based on the investigation and analysis of such problems.
Equipment and Supplies ; Oxygen

During years of managent practice of postgraduate training,it is found that great attention of leadership is a good foundation,that pre-service training is an essential part,that srtict implementation of the requirements on postgraduate,advisor-responsibility system unified instruction under subject,focusing on process-management of training and exploring actively effective incentive training methods is necessary.

10.3969/j.issn.1000-3606.2013.06.004