The establishment of open-loop psychiatric ward is an innovation for mental disease treatment,while new legal and ethical issues become evident.For instance,psychiatric patients with no guardians or agents can not normally sign the informed consent form at hospitalization.It is extremely difficult to make a definite diagnosis in some cases.Informed consent form is refused by certain guardians due to the misunderstanding of psychiatric diseases.This paper explores those legal and ethical issues arising in the medical treatment in open-loop psychiatric ward,and comes up with relevant countermeasures.

Objective To report the method and effect of treating cholepathia under laparoscopy and endoscopy. Methods Laparoscopy, duodenoscopy and choledochoscopy in combination were used in treating 1 990 cases of cholepathy and the results were analyzed. Results Laparoscopy and duodenoscopy in combination were used in 1 350 cases of cholecystolilhiasis and choledocholith with cure rate ( 93. 6% ) ; laparoscopy and choledochoscopy in combination were used in 332 cases of choledocholith with cure rate (100% ) ; laparoscopy, duodenoscopy and choledochoscopy in combination were used in 258 cases of choledocholith (29 cases with pancreatitis) and 24 cases of Mirizzi syndrome with cure rate( 100% ). There was no serious complications happened. Followed up 1 051 patients from 3 months to 12 years (average 7.8 years) , 10 cases have recurrence of stones. There was no long-term complication such as stenosis of bile duct, etc occurred. Conclusion The procedure had minor trauma, mild suffering, and less operative complications compared with the traditional laparotomy.

Objective To explore the absorption characteristics and mechanism of P-glycoprotein (P-gp) mediated transport of oleanolicacid (OA)across membrane in vitro.Methods The intake and transport of OA were evaluated by an HPLC/MS quantitative detection method.Safe concentration range of OA was determined by MTT.The effect of different drug concentration,incubation time,pH and temperature on the intake of OA by Caco-2 cells were investigated.The effect of P-gp inhibitor on the transmembrane transport of OA was investigated by the Caco-2 cell monolayer model,and the apparent permeability coefficient (Papp) was calculated.Results The uptake of O A was concentration-time dependent and correlated negatively to temperaturein Caco-2 cells within the safe concentration range,but was not significantly affected by pH value.Compared with controls,the Papp significantly changed when the P-gp inhibitor was added to the model(P ＜ 0.05).The apparent permeability ratio decreased from 2.90 to 0.95.Conclusion The absorption of OA was primarily by passive diffusion and might be mediated by the effiux by P-gp.

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 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 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 investigate phonological characteristics and rehabilitation training approaches of bilabial consonant articula-tion disorders in patients after repaired cleft palate. Methods From January, 2012 to January, 2016, 51 patients with velopharyngeal incom-petence (VPI) and 57 patients with velopharyngeal competence (VPC) after cleft palate repaire were enrolled. Their phonological character-istics of bilabial consonants articulation disorders were analyzed. They accepted specific rehabilitation training. The correlation between bila-bial consonants articulation disorders and age was analyzed. Results/b/ showed mainly weak pressure in both VPI and VPC patients,/p/showed mainly weak pressure in VPI patients,/p/was mainly substituted by/b/in VPC patients. 46 cases were cured and 2 cases improved in VPI patients after 1-6 weeks of rehabilitation, and the overall cure rate was 90.20%(46/51), and was respectively 100%(13/13), 93.74%(15/16), 77.27%(17/22) in those with mild, moderate and severe disorder. 53 cases were cured and 4 cases improved in VPC patients after 1-5 weeks of rehabilitation, the overall cure rate was 92.98%(53/57), and was respectively 100%(17/17), 90.48%(19/21), 89.47%(17/19) in those with mild, moderate and severe disorder. The number of incorrect words negatively correlated with age in VPC patient (r=-1.000, P<0.001). Conclusion Bilabial consonant articulation disorders occurs mainly on/b/and/p/in patients repaired cleft palate,/b/shows main-ly weak pressure,/p/shows mainly weak pressure and substitution. Specific speech rehabilitation training is significantly effective.

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 study the phonological characteristics and rehabilitation methods of abnormal velar consonants in operated patients with cleft palate.Methods A total of 110 patients (60 males and 50 females, aged 4 to 27 years with the mean age as 9.01±4.12) with abnormal velar consonants after cleft palate treatment over one month were involved in this study.According to the severity of articulation disorders, the patients were divided into mild, moderate and severe groups who received 1 to 5 weeks of targeted rehabilitation training.The phonological characteristics of abnormal velar consonants and the correction between velar consonant misarticulation and age/gender were analyzed.Results The error rate of /g/ was 96.36%(106/110) which was the highest, then /k/ and /h/ was 74.55%(82/110) and 19.09%(21/110), respectively.Both /g/(80.19%, 85/106) and /h/(76.19%, 16/21) mainly showed omission while /k/ was mainly substituted by /h/(54.88%, 45/82) and /t/(29.27%, 24/82).95 cases were cured and 12 cases improved after specific rehabilitation.The overall cure rate was 86.36%.The cure rates for the mild, moderate and severe groups were 96.00%(24/25), 90.91%(30/33), and 78.85%(41/52),respectively.Males accounted for 51.76%(44/85) and females for 48.24%(41/85) among omission cases;males accounted for 51.47%(35/68) and females for 48.53%(33/68) among substitution cases.There was no significant correction among the number of incorrect words and age(r=-0.140, P>0.05) as well as gender(r=0.090, P>0.1).Conclusion Abnormal velar consonants in operated patients with cleft palate mainly had problems with /g/ and /k/./g/ showed mainly omission errors and /k/ mainly substitution.The targeted rehabilitation methods established in the study are significantly beneficial.

Objective To explore and compare the clinical effects of pregnant women with liver cirrhosis after hepatitis in cesarean section between general anesthesia and single spinal anesthesia.Methods Clinical data of pregnant women of 35,including compensated cirrhosis 26 cases,decompensated cirrhosis 9 cases,aged 24-45 years,weighing 55-98 kg,falling into ASA Ⅱ or Ⅲ,were divided into group A (general anesthesia group,n=15) and B (single spinal group,n=20).In patients of group A,propofol were infused at 1.5 mg/kg till the time for fetal delivery,after intubation,followed by infusion of remifentanil at a rate of 0.2 μg·kg-1·min-1 TCL combined with propofol until the end of operation.In group B,the puncture was performed at L3-4 interspace,following by intrathecal injection of ropivacaine 10~15 mg and within 10 seconds.With liver cirrhosis after hepatitis were collected and analyzed,retrospectively.Preoperative general status,blood loss and time of operation,Apgar score of neonates compared and analyzed in groups A and B.And the changes of hepatic function and coagulation function of the body under different anesthesia methods were also studied.The influential factors of postoperative elevation of hepatic function were analyzed by non-conditional logistic regression models.Results Blood loss and time of operation,Apgar score of neonates and postoperative hospital stay had no significant differences between the two groups.Postoperative albumin of group A was higher than that of preoperative,with a statistical significance (P<0.05).Alanine aminotransferase,aspartate aminotransferase of postoperative of group B were increased,with a statistical significance (P<0.01).Logistic analysis showed that the type of anesthesia was the possible influencing factor of postoperative elevation of total bilirubin (OR=12.04,95%CI 1.14-127.45).Conclusion The negative effect of single spinal anesthesia on hepatic function more than that of general anesthesia in pregnant women with liver cirrhosis in cesarean section.