al recovery. Therefore, EPC may have broad application prospects in the field of ischemic cerebrovascular disease.

Objective To investigate the effect of end to side arterial anastomosis in the transplantations of free tissue flap Methods The end to side arterial anastomosis were used in 47 free flaps of 46 cases in this series The arterial stomas were respectively prepared into the cross section (13/47),the inclined plane angled at 45 degree (26/47) and fish mouth shaped plane (8/47) The interrupture anastomosis and continuous anastomosis following two fixed point sutures,and the continuous anastomosis following four fixed point sutures were respectively used in 28,10 and 9 arterial anastomotic stomas Results There were not postoperative embolism in all end to side anastomotic stomas in this series During the operations the embolisms of the cutaneous branch caused by a detached mini thrombus from the anastomotic stomas were occurred in 2 cases,and the arterial crisis were eliminated by reversely milking out the detached mini thrombus All flaps survived except one due to venous embolism Conclusions It is a effective and safe method that the end to side arterial anastomosis are used in the transplantation of free flap

The etiology and pathogenesis of irritable bowel syndrome (IBS) are not fully understood, and intestinal microbiota had been assumed as a possible factor in the pathogenesis of IBS.Increasing evidences have shown that alterations of gut microbiota were found in IBS patients and modulation of intestinal microbiota might be effective in the treatment of IBS.This article reviewed the mechanism of involvement of intestinal microbiota in pathogenesis of IBS by altering mucosal permeability, activating immune reaction, disturbing gastrointestinal motility and affecting brain-gut axis.

Sphincter of Oddi dysfunction (SOD)is a functional gastrointestinal disorder manifesting with the main symptoms of abdominal pain,abnormal liver function and recurrent idiopathic acute pancreatitis,which involved the abnormal contraction of sphincter of Oddi. The incidence of SOD has been increasing in recent years. More attention should be paid on SOD for decreasing the misdiagnosis in clinical practice. This article reviewed the recent advances in diagnosis and treatment of SOD.

OBJECTIVE To investigate the genetic feature of meticillin-resistant Staphylococcus aures isolated from earthquake victims and compare them with those of common patients.METHODS The MRSA isolates underwent SCCmec(Staphylococcal Cassette Chromosome mec) multi-PCR and PVL gene detection.Diversilab method was used for homology comparison and antibiotic resistance was also analyzed.RESULTS All the MRSA isolates were confirmed to be type Ⅲ SCCmec with PVL gene negative.Homology analysis showed relatively consistent with community-acquired MRSA confirmed to be ST8 by MLST typing.CONCLUSIONS There may be cross-spread of MRSA between hospital and community.We should pay more attation even in emergent time.

Objective To discuss the surgical techniques and results of internal fixation supplemented with soft tissue repair of triad injury of the elbow via the combined anterior-lateral approach.Methods A retrospective analysis was done on 15 patients with triad injury of the elbow treated from January 2011 to August 2014.There were 10 males and 5 females,aged 38.4 years (range,20-61 years).Injury resulted from traffic accidents in nine patients,high-level falls in three and groundlevel falls in three.Radial head fractures were Mason type Ⅰ in five patients,type Ⅱ in eight,and type Ⅲ in two.Fractures of the coronoid process of the ulna were Regan-Morrey type Ⅰ in four patients,type Ⅱ in ten and type Ⅲ in one.Time interval between injury and operation was 8.5 d.All patients were firstly operated on through the anterior approach to have Herbert screw fixation or anterior capsule suture lasso fixation of the coronoid fracture as well as Herbert screw fixation of the radial head fracture.And then,elbow lateral incision was made to repair lateral collateral ligament complex and common extensor tendon by 2-0 Ethibon suture.Elbow flexion-extension,forearm pronation-supination and Mayo elbow performance score (MEPS) were used to evaluate the clinical elbow functions.Complications were recorded after operation.Results All patients were followed up for mean 19.6 months (range,12-30 months).All coronoid fractures healed.Radial head fractures in 14 patients healed.Comparison of preoperative to final follow-up variables presented significant differences in elbow flexion-extension [(45.1 ± 5.6) °:(129.5 ± 9.3) °],forearm pronation-supination [(55.4 ±.8.7) °:(140.5 ± 10.3) °] and MEPS [(25.1 ± 9.6) points:(91.2 ± 5.2) points] (P ＜ 0.01).Complications included heterotopic ossification in one patient and nonunion of radial head fracture in one patient.No neurovascular injury of the elbow,elbow residual instability,dislocation,elbow stiffness and active pain occurred.Conclusion Combined anterior-lateral approach with internal fixation and soft tissue repair is a simple and safe method that effectively restore the elbow joint function.

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-sparing surgery without renal wound suturing.Methods From December 2012 to February 2014,9 patients (4 male,5 female) with renal tumor underwent laparoscopic nephron-sparing surgery without suturing in our hospital.The mean age in those patients was 56 years (range 42-72 years).The mass size ranged from 1.1to 3.8 cm (mean 2.4 cm).The location of tumor included 2 in left kidney,7 in right kidney.Meanwhile,6 tumors were found in the middle part of kidney,2 tumors were demonstrated in the lower part of kidney,and 1 tumor located in the upper part of kidney.The imaging examination confirmed that all tumors protruded the renal surface and infiltrated into the renal parenchyma about 0.1-1.2 cm,which could be defined as the peripheral renal tumor without the invasion of collective system.The retroperitoneal approach was used in all patients with 3 trocars.During the operation,the renal artery was exposed and fats surrounding or on the surface of the tumor were resected.The renal artery was occluded.Tumor excision was then performed using scissors.An incision was made at the point 0.5 cm away from the margin of the tumor,extending deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.Then,the clamping of the renal artery was removed and the retroperitoneal pressure was reduced in order to check the site of bleeding.If the bleeding occurred severely,the kidney wound was sutured with 2-0 absorbable sutures.Otherwise,the coagulative glue was sprayed on the wound surface.Results In all the patients,the procedures were done without conversion to open surgeries.The renal wound suturing appeared in one case because the tumor infiltrated into the deep of the kidney and the bleeding could not be completely controlled by bipolar diathermy.Eight of 9 cases were successfully performed without suturing.The mean time of renal artery occlusion was 8 min (range 3-18 min).In our patients,the mean operation time was 120 min (90-180 min),and the mean blood loss was 60 ml (10-200 ml).None of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 7 days (5-9 days).No complications,such as urine leakage,bleeding occurred after the operation.All the patients were followed up with no recurrence of tumor.Conclusions Laparoscopic nephron-sparing surgery without renal wound suturing is feasible and safe for patients with the small and the depth of infiltration less than 0.5 cm tumor in the kidney.

Objective This study was performed to assess the clinical feasibility of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.Methods Between March 2011 and May 2012,we retrospectively analyzed the data from 56 patients who underwent video-assisted mediastinoscopic lymphadenectomy(VAMLA).In patients receiving tumour resection subsequently,radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.Results Mean operative time of video-assisted mediastinoscopic lymphadenectomy was(42.0 ± 13.5) min(range of 26-86 min).Mean number of resected lymph nodes was 12.4 ± 6.7 (range of 5-24).In video-assisted mediastinoscopic lymphadenectomy,the rates of lymph node dissection of stations 2,4,5,7,8 were 54.5％,92.7％,58.2％,100％,61.8％,respectively,there was no operative mortality and morbility.90.9％ patients achieved radical dissection.Conclusion Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure and provides more accurate staging of mediastinal node in lung cancer patients.It also plays an important role in minimal invasive surgery and neoadjuvant therapy.

Objective To assess the efficacy and safety of flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy in the treatment of upper urinary tract calculi.Methods The flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy was performed on 26 patients from Jul 2005 to Jan 2007. Among these patients, 8 had bilateral renal calculi and ureteral calculi, 5 had multiple renal calculi, 4 had renal calyx calculi and 9 had ureteral calculi. The average diameter of the calculus was 2.2 cm (range from 1.0-3.2 cm). Four patients had mild hydronephrosis, others had moderate or severe hydronephrosis. Insufficient renal function was noted in 13 cases. The procedure was performed via a single tract through the middle calyx under the ultrasonic guidance in all cases.Results Twenty-two cases achieved stone free at primary procedure, secondary procedure was needed in 4 cases. A 18 F tract was used in 18 cases and 24 F tract was used in the left 8 cases. The average operation time was 72 min, stone-free rate was 96.2%(25/26),and there was no blood transfusion. One patient had fever after the procedure and recovered 2 days after the administration of antibiotics. No other complication was recorded. In an average 11 month follow-up in 22 patients, hydronephrosis reduction was significant observed by ultrasound scan. No calculus relapse was found.Conclusions Flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy is an effective and minimally invasive technique for the treatment of upper urinary tract calculus. It has the advantages in dealing with the calyx and ureteral calculus located in the proximal or middle segment as well.

Objective To investigate the methods and therapeutic effects in reconstructing and restoring the knee stability of floating knee injury. Methods A total of 38 patients with floating knee injury combined with acute knee instability treated from January 2000 to January 2006 were retrospectively studied to evaluate the efficacy of different procedures. Results All patients were followed up for 1-4 years (mean 1.5 years), which showed fracture healing in all patients. There occurred postoperative wound infection in three, internal fixator loosening in two, anterior cruciate ligament laxity in one and osteearthritis in two. According to Score of Hospital for Special Surgery (HSS) for knee function,the knee function was excellent in 32 patients, good in five and fair in one, with excellence rate of 84%. Conclnsions During the treatment of floating knee injury, attention should not only be paid to the reconstruction of the bone continaity, but also to the restoration of ligaments, meniscus, joint capsule and muscles.