Objective To study the clinical application of laparoscopic operation and the morbidity and their prevention. Methods 21069 cases of laparoscopic surgery were reviewed retrospectively. Results Laparoscopic operation was used in 19 conditions including cholecystectomy (21002),hepatic operation (21), common bile duct calculi (3), spleen trauma (1),kidney cyst (3),gynoplasty (16),chest surgery (2), intestinal adhesion (14),assistant Miles (3),appendectomy (2),mesentery teratoma (1).Major complications (60) (0.29%) included injury of choleduct (18), bile leakage (18),hemorrhage (17),the injury of gastrointestinal tract (7). Conclusions Laparoscopic operation may be in a more extensive seope. The major complications can be reduced by strict procedures of laparoscopic operation.

BACKGROUND: Studies have demonstrated that trehalose possesses protective effects on cyropreserved sternum. But the mechanism of action remains poorly understood. OBJECTIVE: To investigate the effects of trehalose on bcl-2 and bax mRNA expression in cryopreserved sternum. METHODS: Four groups of freshly prepared solution were used: low-potassium dextran (LPD), LPD + dimethyl sulfoxide (DMSO), LPD + trehalose, LPD + DMSO + trehalose. Rat sternum was cut and then immediately cryopreserved in the tubes containing each group of solution. Fresh rat sternum tissue and 4 groups of samples cryopreserved for 120 days were taken and bcl-2 and bax mRNA expression in fresh and cryopreserved sternum was detected using reverse transcription-polymerase chain reaction.RESULTS AND CONCLUSION: bcl-2 mRNA expression in the LPD + trehalose group was significantly higher, but bax mRNA expression was significantly lower, than in the LPD, LPD + DMSO groups (both P < 0.01). LPD + DMSO + trehalose group showed highest bcl-2 mRNA expression and lowest bax mRNA expression, which were basically similar to fresh bone tissue (P > 0.05). These findings indicate that trehalose may protect cell activity in cryopreserved sternum by enhancing bcl-2 mRNA expression and inhibiting bax mRNA expression, and trehalose together with DMSO shows better protective effects.

Objective To explore the diagnosis and surgical treatment of pulmonary sequestration.Methods 12 patients of pulmonary sequestration were retrospectively studied.Results Between January 2002 and December 2005 12 patients with pulmonary sequestration were operated in our department.8 patients were diagnosed preoperatively by chest enhanced CT which showed an abnormal feeding artery.4 patients were misdiagnosed.10 cases of intralobar were performed lobectomy,2 cases of extralobar were resected the separated lung tissue.No death occurred in our group.Conclusion Enhanced CT scan is a major diagnostic method of pulmonary sequestration and operation can obtain excellent results.

Comprehensive evaluation methods are generally used to assess the population data. When we need to estimate the sample data in special situations, the impacts brought by the sampling error should be considered. Due to lack of the accurate measurement for the sensitivity and stability in the comprehensive evaluation methods, sampling errors usually cannot be estimated in the sampling research. Monte Carlo simulation was used in this article to solve the probability of the ordering results, and the matlab programs were presented. Based on the simulated results, we change the conventional “absolute conclusion” of comprehensive evaluation methods to “probability results” for the sample data, and put forward a new sorting and ranking method for the results of comprehensive evaluation.

Objective To investigate the effects of peri-operative enteral nutrition (EN) and antibiotics on intestinal flora balance in patients with esophageal carcinoma.Methods Sixty patients were randomly divided into six groups:Group B,treated with antibiotics for 3 days and supported with EN before and after operation; Group C,treated with antibiotics for 3 days and supported with parenteral nutrition (PN) before operation and EN after operation ; Group D,treated with antibiotics for 3 days and supported with PN before and after operation ; Group E,treated with antibiotics for 7 days and supported with EN before and after operation; Group F,treated with antibiotics for 7 days and supported with PN before operation and EN after operation ; and Group G,treated with antibiotics for 7 days and supported with PN before and after operation.The first stool after surgery was obtained and tested for Bacteroides,Bifidobacterium,Lactobacillus,Escherichia coli,and Enterococcus.Ten healthy adults were enrolled as the blank control group.The numbers of the flora and ratio of Bifidobacteria to Enterococci (B/E) were compared.Complications such as incision infections,lung infections,and anastomotic fistula were recorded.Results The numbers of Bifidobacterium [(10.59 ± 0.39) vs.(10.88 ± 0.10) lg10n/ml,P =0.186),Lactobacillus [(8.59±0.31) vs.(8.72 ±0.22) lg10n/ml,P=0.534],Escherichia coli [(8.43 ±0.50) vs.(8.67 ±0.24) lg10n/ml,P=0.266],Enterococcus [(7.40 ±0.61) vs.(7.78 ±0.16) lg10n/ml,P =0.111],and B/E value [(1.2589 ± 0.0644) vs.(1.2560 ± 0.0330),P =0.825] in the Group B were not significantly different from the blank control group.The numbers of Bacteroids [(11.08 ± 0.48),P =0.139 ; (9.23 ± 0.42),P =0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000; (8.05±0.53),P=0.000vs.(11.36±0.48) lg10n/ml],Bifidobacterium [(10.19 ±0.49),P=0.062; (9.00 ±0.52),P=0.000; (9.31 ±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99 ±0.56),P =0.000 vs.(10.59±0.39) lg10n/ml],Lactobacillus [(7.99 ± 0.58),P =0.006 ; (6.84 ± 0.47),P =0.000 ; (7.72 ± 0.35),P =0.000 ; (6.93 ±0.43),P =0.000; (5.93 ±0.76),P=0.000 vs.(8.59 ±0.31) lg10n/ml],Escherichia coli [(8.19 ±0.43),P=0.258; (7.93±0.60),P=0.020; (7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P =0.000 vs.(8.43 ± 0.50) lg10n/ml],and Enterococcus [(6.90 ± 0.54),P =0.037 ; (5.89 ± 0.68),P =0.000; (6.20±0.52),P=0.000; (5.91 ±0.39),P=0.000; (5.14±0.58),P=0.000 vs.(7.40±0.61) lg10n/ml] of groups C,D,E,F,and G decreased compared with those of the Group B.The values of B/Ein the D and G groups decreased significantly when compared to the blank control group (1.1433 ±0.1350,P =0.025 ; 1.0706 ± 0.1413,P =0.000 vs.1.2560 ± 0.0330).The incidences of pulmonary infections (x2 =3.647,P =0.601) and anastomotic leak (x2 =5.000,P =0.416) among all groups were not significantly different.Conclusions EN applied 3 days before surgery and after surgery is beneficial for maintaining the balance of intestinal flora.Long-term administration of antibiotics may cause dysbacteriosis and even increase complications.

BACKGROUND: Experiments have demonstrated that autologous vascular endothelial cells if transplanted onto artificial vascular cavosurface, can enhance the patency rate of vasotransplantation. Whether seeding of prostheses interposition grafts with bone marrow-derived endothelial cells is effective for in vivo endothelialization of artificial vessels remains unclear.OBJECTIVE: To observe the effect of endothelialization of vascular prosthesis by seeding prostheses interposition grafts with bone marrow-derived endothelial cells in animals.DESIGN: A controlled animal experimental study.SETTING: Shanghai Sixth People's Hospital.MATERIALS: This study was carried out in the Shanghai Sixth People's Hospital between September 2000 and October 2001. Twenty hybrid dogs from Shanghai, of either gender, aged 1.0 to 2.0 years old, weighing (18.7±2.3) kg, were involved in this study.METHODS: Bone marrow-derived mononuclear cells were isolated from the dogs. The endothelialization of ePTFE prostheses interposition grafts (4 mm×4 cm and 8 mm×5 cm)was carried out. Common carotid artery transplantation:Ten laboratory dogs were involved. Common carotid artery of 4 cm was resected from each dog. ePTFE prostheses interposition grafts of 4 mm×4 cm was transplanted into the bilateral common carotid artery, and prostheses interposition grafts were performed endothelialization, namely experimental group. Those prostheses interposition grafts, which were not performed endothelialization, were named as control group. Five dogs were used in each group. Patency rate and blood flow rate of transplanted vessels were detected with a color ultrasonograph 2 weeks and 2 months after operation.Inferior caval vein transplantation: Six of the rest 10 dogs were used for experiments. Under the anesthesia, 8-10 cm inferior caval vein was dissociated from each dog. Its two ends were blocked, and about 5 cm inferior caval vein was resected. ePTFE endothelialized vascular prosthesis with 8 mm in diameter and 5 cm in length was anastomosed end to end with 5-0 Prolene. The other 4 dogs were used for control experiment. ePTFE vascular prosthesis with the same specification was used as prostheses interposition graft. Vascular patency rate was determined 2 months after operation.At the same time, coverage rate and intimal thickness of transplanted vascular endothelial cells and vascular intimal thickness were determined.MAIN OUTCOME MEASURES: ①The patency rate and blood flow rate of transplanted vessels at different time points. ②Coverage rate of transplanted vascular endothelial cells and vascular intimal thickness.RESULTS:① At 2 weeks and 2 months after common carotid artery transplantation, the patency rate of experimentalside was 100%(5/5)and 60%(3/5), respectively, and that of control side was 40%(2/5)and 0%(0/5), respectively. At postoperative 2 months, the mean blood flow rate in the experimental group was obviously smaller than that in the control group (P ＜ 0.05). At 2 months after inferior caval vein transplantation, the patency rate of experimental group and control group was 83%(5/6)and 50%(2/4), respectively. ②At 2 weeks after common carotid artery transplantation and inferior caval vein transplantation, the coverage rate of vascular endothelial cells in the experimental group was significantly larger than that in the control group, separately (P ＜ 0.05). At 2 months after each transplantation, the vascular intimal thickness in the experimental group was significantly smaller than that in the control group (P ＜ 0.05).CONCLUSION: Seeding of ePTFE prostheses interposition grafts with bone marrow-derived endothelial cells can rapidly accomplish in vivo endothelialization and inhibit intimal hyperplasy; Circulating endothelial cells, as the potential source of endothelial cells, have certain clinical application values.

Objective　To observe the therapeutic effect of combination of penetrating keratoplasty, cataract extraction and intraocular lenses implantation.Methods　Penetrating keratoplasty was performed simultaneously with cataract extraction and intraocular lenses implantation on 134 cases. Results　One hundred and twenty cases were recorded after following up for 0.5～12 years. Ninety-nine cases (82.5%)of the corneas remained clear. Twenty-one cases (17.5%)of the corneas failed.Ninety-two cases (76.7%)achieved a better visual acuity postoperatively.Eighty-nine eyes(74.2%)were not blind any longer. Conclusion　The combination of penetrating keratoplasty, cataract extraction and intraocular lenses implantation offers advantages of rapid and better rehabilitation of visual acuity with low complication rate.

Objective To construct a rapid genetic DNA extraction method, with nano magnetic beads, self-designed reagents system and extracting process. Method Part I: DNA extraction from old blood cotton swab sample with self-designed DNA extraction kit, then quantiifed by UV spectrophotometer. The method was further optimized on the preliminary results. Part II: All kinds of difficult DNA sample were tested with optimized kit, to detect the applicability of the kit. Result By improving the experimental condition, the extraction effects of different DNA sample is good, meanwhile, the extraction cost is relatively low.

Objective To understand the general self-efficacy level of patients with tuberculosis(TB patients) and its influencing factors, provide evidence for improving the general self-efficacy of TB patients.Methods All TB inpatients in a comprehensive pulmonary hospital were conducted face-to-face survey through a general questionnaire and general self-efficacy scale, self-efficacy level of TB patients and its influencing factors were analyzed.Results Mean scale of general self-efficacy of 402 TB patients was (20.4±4.2), of which only 14 cases(3.5%)showed a high level self-efficacy.163(40.5%), 225(56.0%), and 14(3.5%)patients were with low(10~),medium(20~), and high(30~) self-efficacy scale.The general self-efficacy level of TB patients was influenced by the course of disease(P<0.001), residence(P=0.012), whether or not attended the lecture on tuberculosis education(P=0.034), whether or not conducted physical exercise(P=0.053,stepwise multiple linear regression analysis: P=0.017), working status(P=0.027), No.of hospitalization due to TB(P=0.002), family economic situation(P=0.027), and education level(P=0.020).Conclusion TB patients' self-efficacy level is low, and the general self-efficacy level and its influencing factors should be assessed by health care workers during the follow-up for patients, individualized nursing intervention for improving the TB patients' self-efficacy level should be developed.

Endovascular aortic repair (EVAR) has been the main treatment means for abdominal aortic aneurysm.It has become an expert consensus that in the case of abdominal aortic aneurysm that is complicated by iliac aneurysm,the preservation of internal iliac artery is necessary because it can prevent the occurrence of gluteal muscle ischemnia,sigmoid ischemia,male sexual dysfunction and other complications.In recent years,with the continuous updating of the endovascular devices it has become possible to retain the internal iliac artery in the performance of EVAR.At present,the reconstruction of internal iliac artery in EVAR includes a variety of techniques,including intraluminal iliac branched device (IBD) technique,sandwich technique,common iliac artery covered-stent bell-bottom (BBT) technique,external iliac artery-internal iliac artery intraluminal shunt technique (reverse chimney technique),and spring coil embolism technique.This article aims to make a summary of all the above mentioned techniques.