Bile leak is a commonly complication after biliary tract surgery.In the past,operation was considered priorly to deal with bile leak besides putting a drainage tube in advance.Minimally invasive surgery has gradually become a primary management of bile leak,with the development of minimally invasive surgery such as abdominoscope in the 20th century.

Objective To evaluate the efficacy and safety of gabapentin in preemptive analgesia for hysterectomy after general anesthesia.Methods PubMed, Cochrane, Embase, Ovid, Springer Link, Web of Science, CNKI, Wanfang and Weipu databases were searched for randomized placebo-controlled trials involving the efficacy of gabapentin for preemptive analgesia published from 2000 to 2016.The methodological quality of the included randomized controlled trial (RCT) was assessed and the data were extracted according to the Cochrane Handbook.The meta-analysis was performed using the RevMan 5.3 software.Results A total of 10 RCTs involving 609 patients were included.Compared with the control group, there was a significant decrease in 24-hour cumulative narcotic consumption at 24 hours when gabapentin was administered before surgery (WMD=-8.83 mg, 95%CI-12.70——4.97, P<0.001), there was no significant decrease in VAS score in preemptive analgesia group (WMD=-7.70 mm, 95%CI-18.22-2.82, P=0.15).Compared with the control group, the rate of vomiting was less in the gabapentin group (RR=0.49, 95%CI 0.35-0.69, P<0.001).Compared with the placebo group, there was no significant decrease in nausea (RR=0.73, 95%CI 0.45-1.17, P=0.19) and somnolence (RR=2.08, 95%CI 0.62-6.92, P=0.23).Conclusion Preemptive administration of gabapentin is effective in decreasing accumulation of opium and vomiting.

With the changes in medical model and the enhancement of ethical standard as well as the patients' awareness of right protection,clinical teaching resource shortages have been increasingly prominent.This article analyzes the characteristics and status of clinical medical education and points out that the development of medical simulation education has great significance for building a harmonious clinical training environment centering on the content classification,functional positioning and outstanding advantage of medical simulation education.

Aiming at present situation and difficult position of clinical medical education,and based on the demand goal of modern medicine,this paper put forward constucting the mul-ti-dimensional optimization training pattern for five-year system clinical medicine inter-disciplinary talents by renewing the education idea,adopting the curriculum reform,the quality regulation,the educational reform,the innovation of teaching methods,and the construction of community medi-cal service practice base and so on,which is of great significance to train the high quality tal-ented person with adaptability to social development.

According to the characteristics of clinical probation teaching of endocrinology,we established the stage-separated echelon teaching mode that accorded with cognitive law.By inspiring,guiding and other methods,medical students’learning enthusiasm were greatly stimulated,and their understanding and grasping degree to the clinical specialty content was deepened.We focused on training clinical skills and thinking ability of medical students,and achieved satisfactory teaching results.

The application of standardized patient SP is the tendency of medical education in China.The applied characteristics of using SP in diagnostics teaching were summarized in this article.We described the recruitment,training and application of SP in the teaching process of diagnostic.The great advantages of SP and its shortage were analysed,and our expectation of deepening SP was brought forward.

Objective To investigate the clinical correlative factors of malignant cystic pancreatic tumors.Methods The clinical data of 45 patients who received cystic pancreatic tumor resection at the General Hospital of Tianjin Medical University from May 2000 to May 2011 were retrospectively analyzed.All patients were divided into benign tumors + precancerous lesions group (35 patients) and malignant tumor group (10 patients).The clinical symptoms and imaging features of cystic pancreatic tumors were analyzed.All data were analyzed by chisquare test or Logistic regression analysis.Results Abdominal pain,jaundice,emaciation,nausea and vomiting were observed in 23 patients (51％),and 22 (49％) patients had no clinical symptoms.The clinical features of benign pancreatic cyst included pancreatic calcification and pancreatic divisum,while the clinical features of malignant pancreatic cystic tumors were nodules,swelling of lymph nodes,dilation of biliary and pancreatic duct.The results of univariate analysis showed that age ≥ 60 years,presence of symptoms,jaundice,emaciation,dilation of pancreatic duct were the correlative factors of malignant cystic pancreatic tumors ( x2 =4.220,4.294,4.645,7.705,4.645,P ＜ 0.05 ).The results of multiple logistic regression analysis found that age ≥60 years,dilation of pancreatic duct and presence of clinical symptoms were the correlative factors of malignant cystic pancreatic tumors ( OR =1.573,2.674,2.723,P ＜ 0.05).Conclusion Age≥60 years,dilation of pancreatic duct and presence of clinical symptoms are the correlative factors of malignant cystic pancreatic tumors.

Objective To investigate risk factors for neonatal clavicular fracture,to provide a reference for clinical treatment.Methods A retrospective analysis was performed towards 3 025 live births,47 cases had neonatal clavicular fracture.The birth weight,mode of delivery,maternal age,parity,gestational age,clavicle second stage of labor,the fundus height plus abdominal circumference,cord around neck,and other fracture potential risk factors were analyzed through univariate and multivariate analysis,and the risk factors were summarized.Results 3 025 cases of live births,of which 47 cases had neonatal clavicular fracture,clavicle fracture rate was 1.55%;univariate results sug-gested that the mode of delivery,birth weight,the second stage of labor,maternal age,gestational age,nuchal cord,ma-ternal weight's clinical data index had statistically significant differences between the fracture group and non -fracture group (χ2 =37.514,34.997,28.647,19.847,18.847,16.694,all P <0.05 );multivariate analysis showed that mode of delivery,birth weight,the second stage of labor,gestational age,nuchal cord,maternal body mass index were a newborn children collarbone fracture independent risk factors.Conclusion Mode of delivery,birth weight,the second stage of labor,gestational age,nuchal cord,maternal body mass index are independent risk factors for neonatal clavicu-lar fracture,obstetric should continue to improve midwifery skills,to develop prevention strategies to reduce the inci-dence of neonatal clavicular fracture.

Objective To detect serum concentration of folate receptor alpha and to investigate its significance in the clinical application of patients with endometrial carcinoma. Methods Thirty-seven patients with endometrial carcinoma, 33 patients with endometrial hyperplasia and 10 healthy women were enrolled in this study. Sera were used to detect the the folate receptor alpha using an Enzyme-linked Immunosorbent Assay (ELISA) technique.The expression level of serum folate receptor alpha in different groups was analyzed. The correlation between the expression level of serum folate receptor alpha and age of patients, menopause, tumor morphology, myometrial invasion and clinical stage was was also analyzed in patients with endometrial carcinoma. Results Level of folate receptor alpha was successfully detected in serum of healthy women and patients with endometrial diseases. Level of folate receptor alpha in patients with endometrial carcinoma was much higher than that in patients with endometrial hyperplasia. Level of folate receptor alpha in patients with endometrial hyperplasia was also higher than that in the healthy controls, with significant difference (P < 0.05). In the endometrial carcinoma group,the levle of folate receptor alpha in serum was correlated with the clinical stage and myometrial invasion (P < 0.05), however, Level of folate receptor alpha was not correlated with the age of patients, menopause andtumor morphology(P > 0.05). Conclusion The Serum level of folate receptor alpha can be detected, and its expression will contribute to the diagnosis, treatment and predicting the prognosis of patients with endometrial carcinoma.