Objective To explore the value and efficacy of retroperitoneal laparoscopic adrenalectomy.Methods From August 2002 to December 2007,a total of 401 cases of retroperitoneal laparoscopic adrenalectomy were performed in our hospital.Among the cases,nonfunctioning adenoma was diagnosed in 151 patients;hyperaldosteronism was detected in 139,Cushing’s syndrome in 37,pheochromocytoma in 19,myelolipoma in 13,and other diseases were found in 42.Results Among the cases,5 were converted to open surgery because of difficulties in the operation due to a huge tumor(1),extensive adhesion between the tumor and the inferior vena cava(2),or massive bleeding(2).The other 396 cases of retroperitoneal laparoscopic adrenalectomy were completed successfully with a mean operation time of 105 minutes(30 to 270 minutes),and a median blood loss of 45 ml(20 to 1000 ml).Two of these patients had massive hemorrhage(1000 and 800 ml respectively),and received red blood cells transfusion(2 U) during the surgery.The rupture of the inferior vena cava or diaphragm occurred in two cases,and was repaired under a laparoscope.Follow-up was available for up to 1 to 64 months(mean 23.9) in 364 patients;none of them had long-term complications or recurrent benign tumors.Conclusions Retroperitoneal laparoscopic adrenalectomy should be used as the first choice for benign adrenal neoplasms,since the procedure is safe,effective,and minimally invasive,and the patients recovery quickly after the surgery.

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-spring surgery for renal tumor.Methods From September 2004 to November 2006,29 patients with renal tumor underwent laparoscopic nephron-sparing surgery without hilar clamping or with temporary hilar control in our hospital.The retroperitoneal approach was used in 25 patients with 4 trocars.During the operation,the renal artery was exposed and then the vessel bundles were pulled out of the abdominal cavity through one of the trocars,passing by the renal artery without clamping it.Afterwards,fatty cysts surrounding or on the surface of the tumor were resected.Tumor excision was then performed using ultrasonic shears.An incision was made at the point 0.5 cm away from the margin of the tumor,and was extended deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.The renal artery was occluded when necessary so that the tumor could be cut within a limited time duration.And the occlusion could be re-opened after controlling the bleeding.After the procedure,the renal incision was compressed with gauze,sutured with 2-0 absorbable sutures,and covered with fibrin sealant.In the other 4 patients,trans-peritoneal approach was used.The ureter was exposed near the lower pole of the kidney and separated towards the renal hilum to find out the renal artery.The following steps were similar to the above mentioned. Results In all the patients,the procedures were done without conversion to open surgeries.In this series,20 operations were completed without clamping the renal artery;and in the other 9,the mean time of renal artery occlusion was 14 min(5-20 min).In our patients,the mean operation time was 165 min(105-240 min),and the mean blood loss was 90 ml(20-800 ml).Two of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 9 d(7-17 d).No complications,such as urine leakage,occurred after the operation.Eighteen patients were followed up for a mean of 9 months(1-26 month),no recurrence of tumor was found.Conclusion Laparoscopic nephron-sparing surgery without hilar clamping or with contemporary hilar control is feasible and safe for patients with peripheral renal tumor not involving the renal collecting system.

Objective To report the initial experience and results of the laparoscopic radical cystectomy (LRC) with ileal conduit. Methods Seven male patients with invasive bladder carcinoma confined to the organ underwent LRC with ileal conduit. The mean age was 61 years (range, 53 to 74 years). The procedure included radical cystectomy with prostatectomy. A 7 cm suprapubic incision was made to remove the organs. Ileal conduit was done routinely. Results Operating time was 7 to 10 hours (median 9.2), and blood loss was 200 to 400 ml (median 264). None of 7 patients needed blood transfusion. 2 to 10 months after surgery, intravenous urography showed no evidence of ureteral reflux or ureteral obstruction. Conclusions With the improvement in the surgical technique, laparoscopic radical cystectomy with small incision, resulting in rapid recovery, may become an alternative method for patients with localized bladder cancer with invasion to muscular layer.

Aim To investigate the effect of procyanidins on apoptosis in brain of experimental rats with intracerebral hemorrhage(ICH) and its possible mechanisms.Method Rat intracerebral hemorrhage model was established by injecting collagenase into the brain caudate nucleus.Fifty-four health Sprague-Dawley rats were divided into six groups randomly: sham operation group,model group of intracerebral hemorrhage,treatment groups with procyanidins at doses of 50 mg?kg~-1,100 mg?kg~-1 and 200 mg?kg~-1,and positive control group with nimodipine at dose of 10 mg?kg~-1.Twentyfour hours after operation,the content of glutathione(GSH) and activity of catalase(CAT) were measured.The levels of bax and bcl-2 were detected by method of immunohistochemistry,and the apoptosis in brain tissues was detected by method of TUNEL.Result In procyanidins groups(50,100 and 200 mg?kg~-1),the content of GSH and the activity of CAT were significantly higher than those in ICH group(P

Objective To evaluate preliminary effect of In-Space percataneous interspinous spacer in the treatment of lumbar instability.Methods Data of 18 patients who had undergone interspinous spacer implant for lumbar instability from May 2009 to June 2011 were retrospectively analyzed.There were 10 males and 8 female,aged from 39 to 58 years.All patients suffered from varying degrees of lower back pain induced by lumbar hyperextension,as well as radiating and segmental pain of unilateral lower limb.The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate clinical outcomes.The pre-and postoperative interspinous distance,trailing edge height of intervertebral space,foraminal width,foraminal height,segmental lordotic angle and lumbar range of motion were tested and compared.Results All patients were followed up for 18 to 36 months.The VAS score improved from preoperative 7.9±2.1 to 3.1±1.3 at 6 months postoperatively and 1.5±0.8 at final follow-up.The ODI improved from preoperative 82.1％±13.1％ to 54.7％±14.8％ at 6 months postoperatively and 10.1％±2.5％ at final follow-up.The postoperative interspinous distance,trailing edge height of intervertebral space,foraminal height,foraminal width,segmental lordotic angle and lumbar range of motion were 9.29±1.43 mm,11.28±0.85 mm,21.27±1.01 mm,10.83±0.73 mm,7.62°±0.74° and 6.34°±0.81°,respectively.Wound healed smoothly in all patients,and there were no complications such as spinous process fracture,spinal cord injury,cerebrospinal fluid leakage,device displacement and device dislocation.Conclusion It is easy and safe to use In-Space percataneousinterspinous spacer in the treatment of lumbar instability,and the preliminary effect is satisfactory.

Objective To examine the effect of metformin on serum thyrotropin (TSH) level in diabetic patients with subclinical hypothyroidism (SCH).Methods The long-term effects of metformin on thyroid axis hormones were assessed in 55 diabetic patients with primary SCH who were untreated with L-T4(study group),as well as in 31 diabetic patients with normal thyroid function (control group).According to using metformin or not,patients of study group were divided into the metformin group (group 1,n =28),and the non-metformin group(group 2,n =27).Serum TSH levels were compared between baseline and follow-up in patients receiving metformin treatment.Results After 30 weeks of metformin administration,a significant TSH decrease(t =2.91,P ＜ 0.05) was observed in group 1 [from(6.98 ± 1.92) to(2.44 ± 0.61) mIU/L].After stopping metformin therapy,the level of TSH at 52 weeks fol low-up was back to the baseline level [(6.99 ± 1.76) mIU/L,P ＞ 0.05].There was no significant difference in TSH level between baseline and after 30 weeks follow-up in group 2[(6.01 ± 1.63) mIU/L vs(6.21 ± 1.71) mIU/L,P ＞0.05].At the end of 30 weeks follow-up,no significant differences were found in body mass index and thyroid func tion in both metformin group and non-metformin group.In control group,metformin administration for 30 weeks had no effect on TSH level(P ＞ 0.05).Conclusion Metformin administration influences TSH without change of FT4 level in type 2 diabetic patients with primary SCH.

Objective To investigate the status of research and research utilization in practice among nurses of hospital of Traditional Chinese Medicine.Methods Two hundred and sixty nurses of hospital of Traditional Chinese Medicine were selected to fill out the questionnaire.Results The rates of involvement of research activities and research utilization among nurses of hospital of Traditional Chinese Medicine were low.The score of every factor ranged from the higher to the lower were communication,organization,research and nurse.Conclusions Involvements of research activities and research utilization among nurses of hospital of Traditional Chinese Medicine are insufficient.Most factors associated with nurses' low extent of research utilization are objective factors.It is pivotal for nursing managers to construct supportive professional environment,improve nurses' research and information skills and the capacity of the research utilization.

Objective Rheological properties and gelation properties of agar were investigated. Methods The gelling point,melting point and the gel strength of agar were detected with MCR101 rheometer and TA texture testing instrument. Results and Conclusion Rheological properties of agar were affected by its concentration ,temperature and the addition of salt (such as NaCl ,CaCl2) and sucrose. Apparent viscosity exhibited shear thinning behavior following the power law model. Apparent viscosity increased with the increase of concentration,and decreased with the rise of temperature. The decrease in viscosity followed an Arrhenius temperature dependence. Agar solutions exhibited typical "weak gel" properties by small strain oscillatory measurements. The results indicated that the agar solution was characterized as a gel properties ,and which could form a kind of heat reversible gel. The gelling point of agar was lower than its melting point. The gel strength of agar could be affected by its gel time,and the addition of salt (such as NaCl,CaCl2) and sucrose.

BACKGROUND: It is of great significance to study the resilience of articular cartilage for human daily routine and their match quality. OBJECTIVE: To analyze the micromechanical properties of articular cartilage resilience under different loads and at time points. METHODS: The swine cartilage samples coated with tracers were compressed using the MTF-100 tensile machine, and the cartilage compression and resilience were recorded by CCD. Images were processed using digital image correlation technology.RESULTS AND CONCLUSION: During resilience, the strain value on the superficial surface of the cartilage was decreased most, successively followed by the middle layer and the deep layer, while the time of a decrease from 20%, 10% and 6% to 3% was similar. The longer the resilience time was, the more slowly the strain changed in different layers of the cartilage, but the ultimate strain was less than 1%. On the same layer under different compressive stress, the larger load caused faster strain change firstly, and then the smaller load brought about faster strain change. The effect of different continuous compressive time on the same layer of cartilage was similar with the load. These results showed that 90% resilience of the articular cartilage occurred within the first 15 minutes. The mechanical resilience of different layers of the articular cartilage has a close relationship with the loading and the loading time, and both compressive time and loading do harm to the resilience of articular cartilage. Besides, the cartilage will rebound to the state before compression.

Objective: To study the chemical components of Citrus medica L.var. sarcodactylis Swingle and to supply evidence for the quality control. Methods: Chromatography and recrystallization methods were applied to analyze the components. Results and Conclusion: Three compounds were extracted from Citrus medica L. var. sarcodactylis (Noot) Swingle. And their structures were identified as Limettin (I), stigmasta-5,22-dien-3-ol (II) and palmitic acid (III) by the methods of UV, MS, IR, 1HNMR, 13CNMR and DEPT. Stigmasta-5,22-dien-3-ol (II) was obtained by extraction.