[Objective]To approach the methods of difficult laparoscopic cholecystectomy.[Methods ]The clinical data of 116 patients with Mirizzi syndrome,severe adherence of abdominal cavity and Calot'triangle,liver cirrhosis underwent difficult laparoscopic cholecystectomy since 2004 were retrospectively analyzed.[Results]Except 3 patients treated by abdominal operation,other patients were treated by laparoscopic cholecystectomy successfully.[Conclusion]The rates of open operation midway and complications are not increased in difficult laparoscopic cholecystectomy as long as dealing with them properly.

Objective:To develop an total knee arthroplasty(TKA) enhanced recovery after surgery information management system based on "cloud + terminal" data-drivene technology, which can be used in the perioperative interaction between doctors and patients and rehabilitation management of TKA, and evaluate its implementation effect.Methods:The clinical data of 96 patients with unilateral TKA from Qilu Hospital Shandong University were analyzed retrospectively. Forty eight patients in the control group from February to August, 2018 were treated with traditional management. From February to August, 2019, 48 patients in the research group adopted the accelerated rehabilitation information management system based on data-driven technology, which can automatically match, interact and push the information between medical and patient.Results:The Self-rating Anxiety Scale(SAS) score of the intervention group on hospitalization day was 41.52±4.65, which was better than that of the control group (52.60±4.84). The difference between the two groups was statistically significant ( F value was 11.446, P<0.05). The scores of Hospital for Special Surgery(HSS), Visual Analogue Scale(VAS) and SAS in the intervention group 3 days after operation were 56.31±5.81, 2.79±0.68, 38.69±3.81, which were better than those of the control group (51.31±5.20, 4.31±0.78, 46.02±3.86). The difference between the two groups was statistically significant ( F value was 4.44, 10.19, 9.37, all P<0.05); the HSS, VAS, and SAS scores of the intervention group one week after operation were 71.35±3.59, 1.98± 0.67, 36.81±4.03, better than the control group (67.15±3.67, 2.60±0.87, 39.48±4.04), the difference between the two groups was statistically significant ( F value was 5.683, 3.951, 3.237, all P<0.05); the postoperative hospital stay in the intervention group was (3.98±0.84) days, which was less than (6.00±0.80) days in the control group, the difference was statistically significant ( F value was 146.286, P<0.05); The patients′ satisfaction score in the intervention group during medical treatment was 97.46±1.73, which was higher than the control group (94.35±2.04), the difference was statistically significant ( F value was 64.911, P<0.05). Conclusions:TKA enhanced recovery management system based on "cloud + terminal" data-drivene can improve the management level of TKA patients, reduce the length of stay and improve satisfaction of patients.

As a nuclear transcription repressor,the functions of TGIF are complicated,not only represses target genes expression directly,but also takes part in the regulation of multiple important cellular signaling pathways,which are associated with the differentiation of cells and tissues,inflammation,metabolism and tumors.In past few years,more and more studies on the role of TGIF in tumors suggest TGIF may be a new therapy target in the diagnosis and treatment of tumours.This article mainly reviews the research progress of TGIF in some signaling pathways like TGF-β,MAPK,PI3K/AKT,and tumours like hepatocellular carcinoma,lung carcinoma and urinary tract urothelial carcinoma.

Objective:To compare the steam distillation( SD) and supercritical CO2 ( SFE-CO2 ) method in the extraction of vola-tile constituents from such 3 traditional Chinese drugs as cnidium monnieri, radix sileris and atractylodes lancea in compound Kuhuang prescription. Methods:Essential oil was extracted from the 3 traditional Chinese drugs by SD and SFE-CO2 method, respectively. The components were identified by GC-MS, and their relative contents were calculated with peak area normalization method. Results:To-tally 36 components were isolated and identified using SD extraction and 31 components were identified using SFE-CO2 extraction, a-mong them, 22 components were the same and their relative molecular weight mainly concentrated within 200-230. Conclusion: SFE-CO2 method can extract effective components from the 3 traditional Chinese drugs in compound Kuhuang prescription with higher selec-tivity, which is the more suitable extraction method for essential oil from the prescription.

Objective To investigate the expression of insulin resistance on glomerular podocyte lesion of patients with IgA nephropathy.Methods Fifty-one patients with IgA nephropathy diagnosed by renal biopsy were selected as our subjects.The expression of WT1,a marker of podocyte of the renal tissue of patients with IgA nephropathy,was detected by immunohistochemistry.The density of podocyte per glomerulus was calculated by using specific software.The insulin sensitivity index (ISI) was severed as the degree of insulin resistance.Results There were strong negative correlations between ISI and WT1,mean arterial blood pressure,triglyceride,plasma uricemia,serum creatinine,body mass index,glomerular sclerosis integral,integral,mesangial proliferation of vascular lesions integral(r =-0.521,P ＜ 0.05 ;r =-0.544,P ＜ 0.05;r =-0.646,P ＜ 0.01 ;r =-0.559,P ＜0.05 ;r =-0.741,P ＜0.01 ;r =-0.561,P ＜0.05 ;r =-0.740,P ＜ 0.01 ;r =-0.695,P＜0.01;r =-0.535,P ＜ 0.05 respectively).There was no significant relationship between ISI and 24 h quantitative urinary protein (r =-1.425,P ＞ 0.05).Conclusion Insulin resistance was involved in glomerular podocyte lesion and may contribute to the progression of IgA nephropathy.

Objective To investigate the effect of hyperlipidemia on glomerulus podocyte injury with IgA nephropathy.Methods Fifty-one IgA nephropathy patients with biopsy-proven were selected.Immunohistochemistry was applied to detect the expression of WT1,a marker of podocyte,in the renal tissue of patients with IgA nephropathy.The density of podocyte per glomerulus wascalculated using specific software.Results Triglyceride (TG) was positively correlated with glomerulus podocyte injury,serumcreatinine and glomerulosclerosis in IgA nephropathy (r =0.549,0.770,0.698,P ＜ 0.05 or ＜ 0.01 ),and there was no correlation with 24 h proteinuria.The expression of WT1 was significantly decreased in glomerulus of patients with IgA nephropathy (P ＜ 0.01 ).There was no correlation between the expression of WT1 and 24 h proteinuria,but the expression of WT1 was positively correlated with serum creatinine and glomerulosclerosis (r =0.765,0.679,P ＜0.01).Conclusion Hyperlipidemia may induce glomerulus podocyte injury in IgA nephropathy,and it may contribute to the progression of IgA nephropathy.

Female ; Hemophilia A ; complications ; Humans ; Middle Aged ; Myasthenia Gravis ; complications

Pancreatic tuberculosis (PTB) is a rare,chronic,specific and infectious disease which is generally secondary to tuberculosis at the common sites of pancreas,and it has a high misdiagnosis rate due to the hidden onset and nonspecific symptoms of PTB.A patient with PTB was admitted to the First Affiliated Hospital of Zhengzhou University in June 2014.Before operation,the space-occupying lesions of the head of pancreas were detected by preoperative imaging examination,and the patient was regarded as with pancreatic cancer.Intraoperative exploration showed cystic duct involvement,and the granulomatous inflammation was detected by rapid pathological examination using frozen section technique,after that the patient received granuloma resection+cholecystectomy according to suspected PTB.The diagnosis of PTB was confirmed by postoperative pathological examination,and the patient received liver-protective and anti-tuberculosis treatments after discharge.

Objective To analyze the natural development of the residual subluxation after early close reduction for developmental dislocation of the hip,and to seek the early surgical timing and indication.Methods The research included 36 patients (48 hips) born before January 2000 who showed residual subluxation after close reduction in one year.All of patients had serial X-ray radiographs at every follow-up point.The radiographs were assessed using acetabular index (AI),Reimers index,center edge (CE) angle and the orientation of the sourcil of the acetabulum.The last follow-up results were evaluated according to the Severin classification,and Severin grade Ⅰ and Ⅱ were defined as satisfactory group and Severin grade Ⅲ and Ⅳ as unsatisfactory group.Then we compared and analyzed the serial radiological parameters between satisfactory and unsatisfactory groups.Results The mean age at close reduction was 1.6 years.At the last follow-up,the mean age was 13.8 years.The satisfactory group comprised 18 hips (37％),whereas the unsatisfactory group comprised 30 hips (63％).At the age of three to four years,there was a significant difference between the two groups in the Reimers index (34.4％±4.5％ vs.43.0％±4.6％,P ＜ 0.05).And at four to five years old,there were significant differences for both Reimers index and CE angle (29.3％ ±7.2％ vs.40.0％±6.2％,P ＜ 0.05; 21.0°±5.5° vs.10.6°±5.2°,P ＜ 0.05).When the Reimers index ＞38％ at the age of three to four years,18 of 18 hips fell into the unsatisfactory group.And when Reimers index ＞33％ at the age of four to five years,26 of 30 hips had unsatisfactory result,and in addition to that the sourcil orientation was upward,26 of 26 hips fell into the unsatisfactory group.Conclusion To avoid early osteoarthritis,surgical correction for residual subluxation was recommended if the Reimers index ＞38％ at the age of three to four years or the Reimers index ＞33％ with the sourcil upward at the age of four to five years.

Objective To realize basic status of occupational exposure among medical postgraduates,and provide theoretical evidence for making occupational precaution measures.Methods Data about occupational exposure among medical postgraduates in a teaching hospital between January 2011 and December 2013 were analyzed retro-spectively.Results A total of 3 362 medical postgraduates were monitored,56 (1 .67%)sustained occupational ex-posure.The most common occupational exposure sites were left hand thumbs(n=15,26.79%),occupational expo-sure most frequently occurred during operation(n=29,51 .79%),a total of 40(71 .43%)occupational exposure oc-curred during the process of operation and invasive procedure,all were sharp injuries.46(82.14%)exposure sources were with bloodborne-transmitted diseases.Surgery students accounted for 66.07%(n =37)of students sustained occupational exposure,exposure rate in master’s candidates was higher than doctoral candidates(2.31 % vs 0.28%,χ2 =18.325,P <0.001 ).After timely treatment and preventive medication,none of the students were infected. Conclusion It is necessary to strengthen the occupational safety education for medical postgraduates,improve pre-caution awareness,standardize all kinds of procedures,and implement standard precaution;timely and effective treatment after exposure is important for reducing occupational injury among medical postgraduates.