Objective To summarize the clinical experience of laparoscopic cholecystectomy(LC) for acute cholecystitis.Methods Clinical records of 58 cases of acute cholecystitis treated by LC from March 1998 to May 2004 were respectively reviewed.Results Intraoperative cholangiography was conducted in 6 cases,5 of which were found to have common bile duct stones.Of the 5 cases,2 underwent LC combined with choledoscopic choledochotomy, stone removal and T tube drainage; the other 3 cases had ill defined relationship of Calot′s triangle and underwent conversion to open choledochotomy with stone removal and T tube drainage.In 52 cases were diagnosed as simple gallbladder stones, LC was successfully accomplished in 50 cases and conversion to open surgery was required in 2 cases because of serious inflammatory adhesions.In this study 1 case had jaundice after operation and 3 cases had leakage of bile,and all recovered on conservative treatment . Conclusions LC can be performed safely in the majority of cases of acute cholecystitis.

Objective　To study the value of intraoperative cholangiography(IOCG) in cholecystectomy for gallbladder stone. Methods　The IOCG data of 694 cases in the Affiliated Hospital, Yanan University Medical School were retrospectively analysed. Results　Among 694 cases with IOCG, 65 had positve findings. Bile duct stone occurred in 44 patients, residnal stone in cyst duct in 7, bile duct injury in 2, and Mirizzi syndrom in 3. Among the 44 cases with bile duct stone, the age of 4.3% cases was 22～50 years old, 10.3% older than 50 years. The incidence of bile duct stone occurring after 50 years old increased with age. The accurate rate of IOCG was 98% in this series. Conclusions　IOCG can not only find residual stone, but also find bile duct abnormality and bile duct injury in time, if correct imagic technique is applied.

Objective To elucidate the significances of health education in the prevention and treatment of gout and hyperuricemia.Method Health education scientific knowledg was done through approaches of specific proclamation in clinic out patients,screening the directly-related members of patient family,training medical staffs and popular vehicle propaganda etc.Results Health education improved the diet structure and life mode of patients,promoted early diagnosis and treatment of patients.It also had favourness in timely detection of other patients in directly-related members of ones family.Conclusion Health education combined with conventional pharmacological therapy could produce a better efficacy than that of single pharmacological ones.

OBJECTIVEThis study aimed to detect the immunoexpression of interleukin-21 (IL-21) and receptor activator. of nuclear factor KB ligand (RANKL) in periapical granulomas (PGs) and radicular cysts (RCs). The interaction of IL-21 with RANKL and its role in periapical pathogenesis were also speculated.

METHODSA total of 32 PGs and 23 RCs were selected as experimental samples. Lesion size and occurrence of tenderness were recorded. Up to 10 healthy gingival tissues were collected as normal control samples. All tissues were subjected to immunohistocheincal analysis with anti-human IL-21 and RANKL polyclonal antibodies. The correlations of IL-21 with RANKL, lesion size, and the occurrence of tenderness of the PGs and RCs were evaluated.

RESULTSIL-21-positive cells were detected in all periapical lesion tissues but not in normal tissues. In the cyst group and granuloma group, the corresponding expression levels of IL-21 were 59.92±6.57 and 36.80± 6.81, whereas those of RANKL were 68.81±18.59 and 36.12±14.87, respectively. Moreover, t-test revealed a significantly higher expression of IL-21 and RANKL in RCs than in PGs (P<0.05). IL-21 and RANKL were positively correlated in both PGs and RCs (P<0.05). Furthermore, IL-21 was correlated with lesion size (P<0.05).

CONCLUSIONThis study demonstrated that IL-21 is potentially involved in the pathogenesis of apical periodontitis lesions. A role in the exacerbation of chronic inflammation, as well as in bone resorption, is suspected. Further studies are required to elucidate the specific functions of IL-21 in periradicular inflammatory processes.

Humans ; Inflammation ; Interleukins ; physiology ; NF-kappa B ; metabolism ; Periapical Granuloma ; metabolism ; Periapical Periodontitis ; RANK Ligand ; Radicular Cyst ; metabolism

OBJECTIVE:To investigate the clinical efficacy and safety of Shugan granule in the adjunctive treatment of melas-ma with irregular menstruation. METHODS:140 cases of melasma with irregular menstruation were divided into observation group and control group according to random number table method,with 70 cases in each group. Control group was given vitamin C,vi-tamin E and compound retinoic acid and other routine medicines;observation group was additionally given Shugan granule 10 g, bid. A treatment course lasted for 21 d,and both groups received 2 courses of treatment. The area of melasma,irregular menstrua-tion integral,clinical efficacy of melasma and irregular menstruation were observed in 2 groups,and the occurrence of ADR was re-corded. RESULTS:There was no statistical significance in the area of melasma and irregular menstruation integral between 2 groups before treatment (P>0.05);after treatment,the area of melasma decreased significantly in 2 groups,and the observation group was significantly lower than the control group;irregular menstruation integral decreased significantly,and the observation group was significantly lower than the control group,with statistical significance(P<0.05). Total effective rates of melasma and ir-regular menstruation were 61.86% and 61.43%, which were significantly higher than those of control group (45.71%and 44.29%),with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Shugan granule shows significant therapeutic efficacy in adjunctive treatment of melasma with irregu-lar menstruation,and can decrease the area of melasma and improve irregular menstruation significantly.

OBJECTIVETo investigate clinical effects of calcaneal fracture with closed reduction and minimally invasive plate fixation assisted with bidirectional distractor distraction.

METHODSFrom September 2015 to October 2016, 11 male patients(13 feet) with calcaneal fractures treated with bidirectional distractor distraction assisted with minimally invasive plate fixation were retrospectively studied. They were aged from 24 to 57 years old with an average of 36.4 years old;8 feet were type IIand 5 feet were type III according to Sanders classification. Postoperative incision, fracture healing, Böhler angle, Gissane angle were observed and Maryland scoring system was used to evaluate clinical effects.

RESULTSAll fractures healed well without incision inflammation and incision disunion. All patients were followed up from 12 to 15 months with an average of 13.5 months. Böhler angle were improved from (9.6±7.3)° before operation to (20.2±4.6) ° at 1 year after operation, and had statistical meaning; Gissane angle increased from (92.7 ±8.5)° before operation to (121.7 ±7.6) ° at 1 year after operation. Maryland score at 1 year after operation was 88.79±8.25, and 11 feet got excellent results and 2 feet moderate.

CONCLUSIONSBidirectional distractor distraction assisted with minimally invasive plate fixation could effectively fix calcaneal fractures, reduce postoperative complications, and get satisfied results of postoperative images and functional recovery. It is one of effective methods for treating Sanders II and III calcaneal fractures.

To evaluate the effect of components in Guanxin Ⅱ prescription on the pharmacokinetic profiles of paeoniflorin and ferulic acid. METHODS: Drug concentrations of rat plasmas after intravenous injection of paronia pall (PPE) or ferulic acid (FA) extract solution, as well as oral administration of PPE and FA solution, and different kinds of decoctions based on Guanxin Ⅱ prescription were determined by an HPLC system. NONMEM (nonlinear mixed-effect modeling) method was used to analyze the population pharmacokinetics of PF and FA. RESULTS: A two-compartment model with first order degradation in absorption phase, and an ordinary two-compartment model were adequately describe PF and FA pharmacokinetic profiles, respectively. The mean of PF population parameters, CL1, V1, CL2, V2, Ka0, and Ka1, were 0.509 L/h, 0.104 L, 0.113 L/h, 0.123 L, 0.135 /h, and 0.0135 /h, respectively, while the typical values of CL1, V1, CL2, V2, Ka1, and F in FA model were 0.295 L/h, 0.025 L, 0.0331 L/h, 0.0518 L, 0.110 /h, and 0.40, respectively. Inter-individual variabilities were estimated and dose formulation (DF) was identified as a significant covariate in the model. CONCLUSION: The results indicate that the pharmacokinetic behaviors of index components in Guanxin Ⅱ prescription can be influenced by different dose formulations administrated in rats.

Objective To study the practicability of measurement of abdominal wall tension (AWT) for noninvasive monitoring of intra-abdominal pressure in ICU patients.Methods Patients with indwelling urethral catheter admitted to ICU from April 2011 to March 2013 were enrolled for a prospective study.Exclusion criteria were patients with muscular relaxants,abdominal operation in three months,acute peritonitis,abdominal mass,acute injury of urinary bladder,acute cystitis,neurogenic bladder,intrapelvis hematoma,and pelvic fracture.The AWT (N/mm) and urinary bladder pressure (UBP) (mm Hg) of all patients were measured.Statistical analysis was performed by SPSS 13.0 statistical software.The correlation of AWT and UBP were analyzed using linear regression analysis.The effects of respiration and body position on AWT were analyzed using the Paired-samples t test,and the effects of gender and body mass index (BMI) on basic level of AWT (IAP ＜ 12 mm Hg) were analyzed using the One-way ANOVA.Results A total of 51 patients were recruited in study.A significantly linear correlation between AWT and UBP were observed (R =0.986,P ＜ 0.01),the regression equation was Y =1.369 + 9.57X (P ＜ 0.01).Under the supine-flat positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.65 ± 0.52) N/mm and (1.45 ± 0.54) N/mm,respectively,and under body straight up 30° supine positioning,the intra-abdominal pressures at the end of inspiration and the end of expiration were (1.25 ± 0.30) N/mm and (1.07 ± 0.35) N/mm,respectively.There were significant differences in intra-abdominal pressure between different respiratory phases and body positions (P ＜ 0.01).Basic levels of AWT in male and female were (1.09 ± 0.29) N/mm and (1.01 ± 0.34) N/mm.The basic levels of AWT in patients with BMI ＜ 18.5,18.5 ≤ BMI ≤25 and BMI ＞ 25 were (0.91 ± 0.30) N/mm,(1.02 ±0.35) N/mm and (1.16 ±0.28) N/mm respectively,but gender and BMI had no significant effects on basic level of AWT (P =0.457 and 0.313,respectively).Conclusions There was a significantly linear correlation between AWT and UBP,and respiratory phase and body position had significant effects on AWT,but gender and BMI had no significant impacts on basic level of AWT.AWT could be served as a simple,easy,and accurate method to monitor the IAP in critical ill patients.

Objective To evaluate images quality and diagnostic feasibility of low-dose CT in patients with traumatic rib fractures.Methods Twenty-five patients presented with thoracic iniury were underwent 64-slice spiral CT scanning in inspiration breath-hold technique.Two scan protocols were performed.In one scan protocol noise index(NI)is 11,and in another NI is 21,but the other scan parameters were no difference.The mean value of tube current,the volume CT dose index(CTDIvol),and effective dose(ED)were recorded.Image quality was scored by 2 experienced radiologists using the 5-points scale.The numbers and degrees of rib fractures were recorded.The data were tested by using the Wilcoxon signed rank sum test.The differences of the inter-observer were determined by Kappa statistics.Results The mean CTDIvol and ED in scan protocol with NI of 11 were(13.88±5.17)mGy and(8.14±3.21)mSv,and that with NI of 21 were(3.91±1.57)mGy and(2.31±0.97)mSv.Compared the scan with NI of 11.there was 72%intrinsie dose reduction in the scan with NI of 21.The mean value of tube current in scan with NI of 11 and 21 were(195.88±69.33)mAs and(54.56±21.54)mAs.AIl patients with 11 and Ⅲ degree and most patients with I degree rib fractures that identified by the scan with NT of 11 were detected by the scan with NI of 21.There were no statistical difference between two scaus with the Wilcoxon signed rank sum test.The diagnostic acceptability and image noise score in the scan with NI of 11 were 4.9±0.2 and 4.6±0.5.and that with NI=21 were 3.5±0.5 and 3.3±0.5.There was prefect concordante in the inter-observers in diagnostic acceptability on finding of rib fractures.diagnostic acceptability and image noise(Kappa=0.876,0.820,0.792,P<0.01)between two scan protocols.Conclusion Rib fractures can be diagnosed by the low-dose CT using the scan protocol with NI of 21.

Objective To explore the effect of prevention and treatment of external application of Algoplaque for controlling phlebitis caused by peripheral indewelling needle in vein for patients. Methods This research was divided into two parts,prevention and treatment. As for prevention research,patients were randomly divided into the experimental and the control groups,each group included 30 patients. In the experimental group,we applied directly external application of Algoplaque at the upper of needle puncture site of the vein and nearby the eye. In the control group,we applied the film directly to fix the indwelling needle. As for the treatment research, it was carried out in patients with occurred phlebitis, who were randomly divided into two groups,the experimental group included 30 cases of patients and the control group included 28 cases of patients. Observation time was one to five days. Results The incidence of phlebitis in the experimental group of prevention research was 23%, in the control group it was 90%. The incidence of phlebitis in the experimental group was significantly lower than that of the control group. The effective rate in the experimental group of treatment research was 96.7% and it was 67.9% in the control group. The difference was very significant. Conclusions External application of Algoplaque can effectively control phlebitis caused by peripheral indewelling needle in vein.