Objective To observe the effect of laparoscopy combined with choledochoscopy in treatment of cholelithiasis clinical effect .Methods 80 cases diagnosed as cholelithiasis cases were divided into control group and observation group with 40 cases in each group .The control group used the traditional laparotomy incision gallbladder stone ;observation group were treated by laparos-copy combined with choledochoscopy .Results In the observation group ,the operation and the hospital stay were significantly shor-ter than the control group ,operation curative effect was obviously superior to the control group ,the incidence of postoperative com-plications was significantly lower than the control group .Conclusion The use of laparoscopy combined with choledochoscopy tech-nology in treatment of gallstones have good clinical effect .

The training of 24-hour resident physicians is the key link of standard training for resident physi-cians.The question of how to improve the quality of residency training is an important task.The article summarized practices in standardized training process for 24-hour resident doctors and argued the construction of the monitoring and examining system for the purpose of promoting the training.

Objective To prepare Paracetamol (APP) multiloculated implant loaded with poly-lactide-co-glycolide acid (PLGA) and to study the drug release profile in vitro. Methods APP multiloculated implant was fabricated by micro-electro-mechanical system (MEMS), and high-performance liquid chromato graphy (HPLC) measurement was used to investigate in vitro drug release profile. HPLC analysis was carried out by employing C18 column and a mixture of methanol-water (15∶85) as mobile phase. The detection wavelength was 215nm and flow rate was 0.8mL/min. Results With different multiloculated shape, the rate of the drug release in vitro was varied significantly. Moreover, the releasing of APP multiloculated implant with ecto-tetragonum ento-hexagon in vitro conformed to Higuchi equation. Conclusion The technology of the preparations is feasible, and the structural and morphological characteristics of the multiloculated implant have a significant impact on the release speed of the drug delivery system.

Objective To evaluate the value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma stagedⅠa.Methods A retrospective analysis of 18 patients with endometrial carcinoma staged Ⅰ a which was confirmed by pathology. Other 22 patients with benign endometrial diseases were also enrolled in the study including endometrial hyperplasia in 9,endometrial polyp in 8 and degenerative submucous myoma in 5.DWI with b value of 0 s/mm2 and 1 000 s/mm2 was performed with single shot sequence of EPI,and the ADC values were measured.Results The mean ADC values of endometrial carcinoma staged Ⅰa,endome-trial hyperplasia,endometrial polyp and degenerative submucous myoma were (0.89±0.21)×10 -3 mm2/s,(1.45±0.19)×10 -3 mm2/s, (1.29±0.32)×10 -3 mm2/s and (1.32 ±0.29)× 10 -3 mm2/s,respectively.There were statistical significant differences between them (F =48.021,P =0.00).Furthermore,statistically significant differences also existed between endometrial carcinoma and other groups (P <0.05).Conclusion ADC value shows a good value in differential diagnosis of endometrial carcinoma staged Ⅰa.

Objective:To evaluate arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors in the treatment of tibial eminence fracture.Methods:The 23 patients were retrospectively analyzed who had been treated at Department of Orthopedics, Beiing Shunyi District Hospital for tibial eminence fractures by arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors from October 2015 to December 2019. They were 15 males and 8 females, aged from 12 to 55 years (average, 35.5 years). All the injuries were unilateral (14 right and 9 left sides). According to the modified Meyers-McKeever classification, 2 cases belonged to type Ⅱ, 18 cases to type Ⅲ and 3 cases to type Ⅳ. Range of motion of the knee, Lysholm and International Knee Documentation Committee (IKDC) scores were observed before surgery, 1 month and 12 months after surgery. The anterior tibial slope angle (ATSA) on CT was measured preoperatively and 1 month after surgery for evaluation of fracture reduction.Results:All the 23 patients were followed up for an average of 23 months (from 12 to 52 months). Postoperatively, limited knee movement was observed in 2 patients and non-anatomic reduction in one patient. At 1 month and 12 months after operation, the Lysholm scores (61.4 ± 3.5 and 90.4 ± 4.3) and IKDC scores (69.6 ± 4.2 and 88.5 ± 3.0) were significantly improved compared with the preoperative values (45.4 ± 6.8 and 49.6 ± 3.9, respectively) ( P<0.05). ATSA was significantly restored from preoperative 4.2° ± 5.7° to -11.7° ± 2.9° at 1 month after operation ( P<0.05). Conclusion:In the treatment of tibial eminence fracture, arthroscopy-assisted tibial bone tunnel fixation combined with double-row anchors can achieve anatomical reduction and firm fixation, leading to satisfactory surgical outcomes.

Objective To explore a new method for one-stage repair of the intestinal leakage based on the principle of magnetic compression anastomosis. Methods Twenty-four dogs were randomly divided into experimental group (n = 12) and control group (n = 12) according to random number table. The model of upper and multiple intestinal leakages was established by making transverse incisions of 1 cm in length on the jejunum wall about 50 cm and 100 cm away from the Treitz ligament. Forty-eight hours later, two NdFeB magnetic rings with the magnetic flux of 2500 G were put into the intestine from the leak sites. The leak sites were pressed between the two rings. The ventages in the control group were sutured. The condition of the dogs was observed after the repair of the leakage. The excreting time was recorded, and the leakage pressures of the anastomotic stoma were detected.The positions of the magnetic rings in the experimental group were detected by X ray. Tissues of the anastomotic stoma were processed by hematoxylin eosin and Masson staining. All data were analyzed using the two-sample t test. Results Severe abdominal infection occurred 48 hours after the establishment of the model. All the intestinal leakages in the experimental group were successfully repaired and the dogs survived for a long time. The magnetic rings were excreted six or seven days after the repair. Eight dogs of the control group survived. The leakage pressure of the anastomotic stoma seven days after the repair was (134 ±23)mm Hg (1 mm Hg =0. 133 kPa) in the experimental group and (91 ± 18)mm Hg in the control group, respectively, with a significant difference between the two groups (t = 3.225, P ＜ 0.05). The leakage pressure of the anastomotic stoma 14 days after the repair was (281 ±7)mm Hg in the experimental group and (271 ±21) mm Hg in the control group, respectively, with no significant difference between the two groups (t =0. 988, P ＞ 0.05). Histological observation showed that after the magnetic compression anastomosis, the intestinal muscle and mucosa recovered well, inflammatory reaction was slight and less collagen fiber and scar was formed. Conclusions Application of magnetic ring with the magnetic flux of 2500 G in one-stage repair of the intestinal leakage in the state of severe abdominal infection is safe and reliable.

BACKGROUND:Under different induction conditions,bone marrow mesenchymal stem cells can differentiate into the mesodermal tissues such as osteoblasts,chondroblasts,muscle cells,adipocytes and so on.OBJECTIVE:To verify the effect on repairing the rabbit articular cartilage injury using bone marrow mesenchymal stern cells (MSCs)induced by tissue engineering method.DESIGN,TIME AND SETTING:Randomized controlled animal experiment was performed in the Clinical Center Laboratory of Shenyang Medical College between May 2005 and December 2007.MATERIALS:Twenty health New Zealand rabbits,irrespective of genders,aged 2-3 months,were used.METHODS:①Rabbit bone marrow MSCs were cultured in vitro,experiment group was cultured for one week withdexamethasone,basic fibroblast growth factor and vitamin C,then for additional 3 weeks with transforming growth factor-β instead of basic fibroblast growth factor;calls without inductors served as controls;②Twenty rabbits were used to establish knee articular cartilage defect models,which were then divided into three groups at random. Experiment group (n=5) was transplanted with the induced bone marrow MSCs;control group with the non-induced cells;blank control group with saline. At 2,4,6,8 weeks postoperation,two rabbits in the experiment group were killed,while one animal in control group and blank control group was killed for the index determination.MAIN OUTCOME MEASURES:①Cell morphology. ②Alkaline phosphatase activities.③General observation. ④X-ray observation.⑤Histological observation.RESULTS:①The morphology of the induced bone marrow MSCs was changed,from long fusiform to polygon,which was similar to cartilage calls-like morphology.②After the bone marrow MSCs were induced for 4 weeks,the alkaline phosphatase activities were obviously enhanced(P＜0.05).③Eight weeks after transplantation,the specimens in the experiment group exhibited smooth surface and unclear outlines with surrounding cartilage;X-ray results showed joint space broadened,subchondral bone sack was improved;histological slices observation revealed similarity with normal chondrocytes.CONCLUSION:Autologous MSCs transplantation can repair articular cartilage injury.

Objective To compare the effect of levosimendan and milrinone on treatment of severe heart valve disease patients with postoperative low cardiac output syndrome. Methods Fifty-six severe heart valve disease patients with postoperative low cardiac output syndrome were selected, and the patients were divided into levosimendan group and milrinone group according to treatment method with 28 cases each. Both groups received symptom-relieved therapy, including cardiotonic, diuresis and other drugs. The patients in levosimendan group were combined with 24 h of continuous intravenous injection of levosimendan 0.05-0.20 μg/(kg·min) for 1 week, and the patients in milrinone group were combined with 24 h of continuous intravenous injection of milrinone 0.25-1.00 μg/(kg·min) for 1 week, in order to maintain mean arterial pressure ≥ 65 mmHg (1 mmHg=0.133 kPa). The cardiac output, cardiac index, left ventricular ejection fraction (LVEF), and the serum levels of lactic acid, creatinine, N-terminal pro brain natriuretic peptide (NT-proBNP) were compared between 2 groups. Results There were no statistical differences in cardiac output, cardiac index, LVEF, and the serum levels of creatinine, lactic acid, NT-proBNP before treatment between 2 groups (P>0.05). The cardiac output, cardiac index, LVEF, and the serum levels of creatinine, lactic acid and NT-proBNP after treatment in 2 groups were significantly better than those before treatment, and there were statistical differences ( P<0.05). There were no statistical differences in cardiac output, cardiac index and LVEF after treatment between 2 groups (P>0.05). The serum levels of creatinine, lactic acid and NT-proBNP after treatment in levosimendan group were significantly lower than those in milrinone group: (102.82 ± 21.31) μmol/L vs. (115.64 ± 58.73) μmol/L, (1.7 ± 1.4) mmol/L vs. (2.2 ± 1.0) mmol/L and (1 149 ± 515) ng/L vs. (1 321 ± 472) ng/L, and there were statistical differences (P<0.05). Conclusions Both the two drugs can significantly improve cardiac function in severe heart valve diseases patients with postoperative low cardiac output syndrome, while the levosimendan has more advantages in lowering serum creatinine, lactic acid value and NT-proBNP.

Objective: To construct the public health performance evaluation index system for the county medical community, so as to provide reference for the assessment of the public health work in the county medical community. Methods: According to the 2019 Public Health Tasks of Zhejiang Province and the current status of the county medical community's public health work, a framework was developed. Twenty experts from universities, CDCs, and county medical community were invited to construct the index system after two rounds of Delphi expert consultation, and the index weight was determined by the analytic hierarchy process. Results : The experts aged ( 46.10±6.41 ) years and worked for ( 23.85±7.37 ) years, all of whom had a bachelor degree or above, and 18 had associate senior titles or above. The response rates of two rounds of consultation was both 100.00%; the authority coefficient was 0.811; the values of Kendall's W all had statistical significance ( P<0.05 ) , which in the second round were higher than those in the first round. The public health performance evaluation index system for county medical community finally included 10 first-level indexes, among which priority diseases surveillance and management weighed most ( 0.165 7 ) ; 32 second-level indexes, among which food-borne diseases surveillance, infectious diseases/public health emergencies reporting and infectious diseases/public health emergencies response weighed the top three ( 0.071 5, 0.064 7, 0.063 8 ); 120 third-level indexes, among which the timely reporting rate of food safety incidents, the reporting rate of infectious diseases and the information response rate of infectious diseases/public health emergencies weighed the top three ( 0.039 4, 0.022 1, 0.021 7 ). Conclusion The public health performance evaluation index system of the county medical community has been established, which can provide reference for the health administrative departments.

Objective To investigate the practice and effect of specialist nursing inspection of intravenous infusion in the quality control of specialist nursing. Methods Intravenous infusion treatment nursing group used feed-forward control theory and methods, taking cross-sectional research methods yearly from 2014 to 2016 and referencing intravenous infusion special quality checklist to fully understand the hospital infusion tool selection situation and quality. Intravenous infusion related treatment system operational procedures was established and improved, the monthly quality control plan was made to do quality nursing of intravenous infusion specialist inspections and timely feedback of each month to various sections of the hospital. Results The rational choice of the hospital infusion tool was more reasonable. The proportion of steel needle in 2016 compared with in 2015 and 2014 was decreased by 8.9%(321/920-212/846), 18.8%(321/920-156/968). Intravenous infusion quality was significantly improved in the catheters′normative fix, nursing staffs′mastery of the skills and related expertise control rate, intravenous infusion treatment-related complications e.g. Phlebitis above grade two in 2016 were reduced 22 cases and 30 cases compared with in 2015 and in 2014, meanwhile the number was 18 and 31 in drug extravasation case. Conclusions Special nursing of intravenous infusion has a good effect on the improvement of nursing quality, and feed-forward control is an effective method for quality control of intravenous infusion therapy.