Objective To summarize the experience of combination use of biliary stent placement and drainage with primary suture of the common bile duct in the treatment of choledocholithiasis. Methods Laparoscopic common bile duct exploration combined with flexible choledochoscopy was performed in 16 patients with choledocholithiasis from June 2005 to March 2006. During the operation, a patented “biliary stent for internal drainage” was introduced into the common bile duct, and primary sutures were performed to close the bile duct. Postoperatively, the stent was removed under gastroscope or duodenoscope. Results All the 16 operations were successfully accomplished without conversions to open surgery. The operative time was 90~260 min (mean, 145 min). The biliary stent was removed 5~7 days after the surgery. Follow-up for 3~12 months showed no residual stones or biliary stenosis. Conclusions Combination use of biliary stent drainage and primary suture of the common bile duct in the treatment of choledocholithiasis is safe and feasible.

0.05.Conclusion NPPV can be used in the general ward for those of acute exacerbations of COPD (AECOPD) complicated with respiratory failure;prognosis is better if the patient is improved in blood gas analysis,respiratory and heart rate after ventilating 1~2 hours and 24 hours.

Objective To improve the diagnosis and treatment of acute exacerbation in idiopathic pulmonary fibrosis(IPF)Methods A case with clinical proven acute exacerbation in IPF and treated with corticosteroid was described and the foreign literature was reviewed.Results Most patients with idiopathic pulmonary fibrosis(IPF)show slowly progressive deterioration.However,accelerated deterioration also occurs without any definite factors on infection,heart failure,et al in a few of patients with IPF who have previously shown slowly progressive deterioration,and for part of patients corticosteroid treatment is effective.Conclusion Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic.

Objective To investigate whether uninduced autologous bone-marrow mononuclear cell (ABM-MNC) could survive and differentiate into myocardial cells and endothelial cells in the infarcted heart. Methods 40 male big-ear Japanese rabbits were divided into two groups randomly: the transplanted group (n=20) and the control group (n=20). The model of acute myocardial infarction was made by left anterior descending artery ligation, which was confirmed by ECG. The cardiac function was evaluated by the echocardiography. 7 days later, BrdU labeled ABM-MNCs were injected into infarcted and marginal area myocardium in the transplanted group, while the control rabbits were injected with saline. 6 weeks later, the hearts were harvested for histology and immunohistochemistry evaluation. Results In the transplanted group, viable cells labeled with BrdU could be identified in the infarcted area, and myocytes and endothelial cells labeled with BrdU can also be found in the border area, these cells demonstrate myogenic differentiation with the expression of α-Actin by immunostaining. Moreover, the vessel density of the transplanted group in the borders of the infarction was higher than the control group (P＜0. 05), but there was no difference in the infarcted areas between two groups (P＞0.05). At the 6 weeks after experiment, the cardiac function was improved in both groups, but the transplanted group improved more than that in the control group (P＜0.05). Conclusion Autologous bone-marrow mononuclear cells injected into the infarcted myocardium could survive in both the infarcted and the border areas, differentiated into endothelial cells and other cells which have obtained the characters of myocytes, and increase the vessel density in border area, improved the cardiac function.

Objective To investigate whether uninduced autologous bone-marrow mononuclear cell (ABM-MNC) could survive and differentiate into myocardial cells and endothelial cells in the infarcted heart. Methods 40 male big-ear Japanese rabbits were divided into two groups randomly: the transplanted group (n=20) and the control group (n=20). The model of acute myocardial infarction was made by left anterior descending artery ligation, which was confirmed by ECG. The cardiac function was evaluated by the echocardiography. 7 days later, BrdU labeled ABM-MNCs were injected into infarcted and marginal area myocardium in the transplanted group, while the control rabbits were injected with saline. 6 weeks later, the hearts were harvested for histology and immunohistochemistry evaluation. Results In the transplanted group, viable cells labeled with BrdU could be identified in the infarcted area, and myocytes and endothelial cells labeled with BrdU can also be found in the border area, these cells demonstrate myogenic differentiation with the expression of α-Actin by immunostaining. Moreover, the vessel density of the transplanted group in the borders of the infarction was higher than the control group (P<0.05), but there was no difference in the infarcted areas between two groups (P>0.05). At the 6 weeks after experiment, the cardiac function was improved in both groups, but the transplanted group improved more than that in the control group (P<0.05). Conclusion Autologous bone-marrow mononuclear cells injected into the infarcted myocardium could survive in both the infarcted and the border areas, differentiated into endothelial cells and other cells which have obtained the characters of myocytes, and increase the vessel density in border area, improved the cardiac function.

Objective To analyze the clinical outcome and impact factors of twin-to-twin transfusion syndrome (TTTS) with anterior placenta treated by fetoscopic selective laser coagulation of placental vessels(SLCPV). Methods Ten cases of TTTS with anterior placenta and 8 cases with posterior placenta were treated by SLCPV in Shengjing Hospital from July 2011 to April 2014. Clinical data were analyzed retrospectively. Some cases were at Quintero stageⅡor higher stage, others were at Quintero stageⅠbut with cardiovascular score≥5 according to the scoring system of Children′s Hospital of Philadelphia. The anterior placenta cases were treated by curve fetoscopy and the posterior placenta cases were treated by straight fetoscopy. Results (1) Of all the 18 cases, the mean gestational age at SLCPV was 24.1 weeks (17+5 to 27+4 weeks). There were 2 cases at Quintero stageⅠ, 4 at stageⅡand 12 at stageⅢ. The mean gestational age of anterior placenta cases at SLCPV was 25.2 weeks (22 to 27+4 weeks), with 2 cases at Quintero stageⅠ, 2 cases at stage Ⅱ and 6 at stage Ⅲ;5 cases had preterm prelabour rupture of the membranes (PPROM)and 1 case had maternal intestinal obstruction after the operation;the average operation time was 40 minutes. Of the posterior placenta cases, the mean gestational age at SLCPV was 22.7 weeks (17+5 to 27+4 weeks);2 cases were at Quintero stageⅡand 6 cases at stageⅢ. PPROM happened in one case;one case had maternal enterobacter cloacae septicemia;the average operation time was 28 minutes. All the 18 cases could tolerate the operations. There was no intraoperative complication. (2) One anterior placenta case had maternal intestinal obstruction and miscarriage; and one posterior placenta case had enterobacter cloacae septicemia. Karyotype analyses of the all the twins were normal. (3) 17 cases delivered already, including all the 10 anterior placenta cases and 7 posterior placenta cases. One infant had corpus callosum agenesis, but its co-twin was normal. The average gestational age at delivery for anterior placenta cases was 32.6 weeks (24 to 37+1 weeks), an was 28.2 weeks (25+6 to 36+2 weeks) for posterior placenta cases. The fetuses survival rate was 13/17 (one case was still in pregnancy) for at least one twin, and 10/17 for both twins. Both twins survival rates were 5/10, 5/7 for anterior placenta cases and posterior placenta cases, respectively. At least one twin survival rates were 8/10, 5/7 for the two groups respectively. Conclusion SLCPV is suitable for the treatment of TTTS, no matter the placenta is on the anterior wall or posterior wall. The treatment had good outcomes, but more PPROM happened in the anterior placenta cases, which may be associated with operation time and the range of operation.

Objective To find out about the demands of health education in the border defense army .Methods A self-made questionaire was used to investigate both the demand of health education in the border defense army and the knowledge-attitude-practice of health .Comprehensive evaluation was conducted on the spectrum of disease in hospitals of border defense army in the previous year .Results Mental health (63.605%), lifestyle (53.829%) and knowledge on occupational protection (41.375%) were the most needed knowledge in the border defense army .Videos and lectures were the means of health education , accounting for respectively 69 .368%and 42 .936%.The total rate of awareness of knowl-edge about health education reached 64.156%.The total rates of holding health attitude and health behavior were 80.765%and 49.113%, respectively.Recently, intervertebral disc disorders,arthritis and other injuries (dislocation, sprain and strain ) were atop the disease spectrum at border defense hospitals .Conclusion Knowledge of mental health , lifestyle and occupational protection along with videos and lectures are the most urgent demand of the border defense army . What needs to be done right away is to improve the awareness of military occupation protection and develop healthy behaviors .

Objective To discuss the characteristics of clinical features,diagnosis and therapy procedure of Anti-gamma-aminobutyric acid B (anti-GABAB)receptor encephalitis.Methods Procedure of clinical diagnosis and treatment in two patients with anti-GABAB receptor encephalitis were retrospected in Neurological Department of Tianjin Huanhu Hospital and the characteristics of anti-GABAB receptor encephalitis were analyzed with literature review.Results In both patients,the clinical manifestations were epileptic seizure,which was a focal seizure at first,seconded by generalized tonic clonic seizure,with frequent attacks or epilepticus state.Significant cognitive and memory impairments and psychological and behavioral abnormalities were observed during the course of the disease.Abnormal MRI signals were found in mesial temporal lobe,with normal electroencephalography.Antibody against anti-GABABreceptor was positive in both cerebrospinal fluid and blood,and immune regulation therapy was effective.Conclusions The patients present with epileptic seizures,seconded by cognitive and memory impairment,often accompanied by MR imagingrevealed mesial temporal lobe lesion.And positive anti-GABAB receptor antibody is major characteristics of anti-GABAB receptor encephalitis.The patients often combine small cell lung cancer,and Immune regulation therapy is effective.

Objective To discuss the methods and outcomes of twin reversed arterial perfusion sequence in different stage. Methods From August 2012 to December 2013, 11 cases were diagnosed with twin reversed arterial perfusion sequence (TRAP) by 3d color Doppler ultrasound in the Maternal ang Fetal Medicine Center ,Affiliated Shengjing Hospital, China Medical University, including 3 cases in stageⅠa, 7 in stageⅡa and 1 case in stageⅡb. We performed expected therapy to 3 cases in stageⅠa and 4 cases in stageⅡa [1 case (case 9) in stageⅡa developed to stageⅡb and was terminated by emergency cesarean section], radio frequency ablation (RFA) selective reduction to 3 cases in stage Ⅱa, emergency cesarean section to 1 case in stageⅡb. All cases except case 1,4 took cesarean section to terminate pregnancy and would be followed up on the aspect of infant′s growth. Results (1) 3 cases in stageⅠa were monitored by sequential ultrasound examination, all donors grew normally, in which 2 acardias arised spontaneous cessation of flow and were implemented of cesarean section after the normal period of gestation; 1 case suffered premature rupture of membrane and experienced the natural childbirth at 34 gestation weeks plus 5 days. The survived average labor weight was 2 923 g. (2) In the 7 stage Ⅱa cases, 3 cases were implemented of RFA selective reduction, 2 cases survived and the average labor gestation was 35 weeks plus 1 day and average labor weight was 2 050 g;in 3 expected therapy cases, 1 case suffered premature rupture of membrane at 34 gestation weeks plus 5 days and experienced cesarean section; 1 case was observed for 3 weeks and the donor was stillborn; 1 case progressed to stage Ⅱb and experienced cesarean section at 34 gestation weeks plus 5 days;and 1 case was lost of follow up. (3) For 2 cases of stageⅡb cases, one was progressed from stage Ⅱa during expected therapy; the other one had been already in stage Ⅱb since visiting and experimented an emergency cesarean section, but the neonate died of heart failure two days after labor. (4) 7 survived neonates were followed up, all had a normal condition compared to kids of the same age, except one suffering a congenital heart disease, patent ductus arteriosus and atrial septal defect and whose weight (6 kg at 7 months) was lighter. Conclusions We should make the diagnosis of TRAP as early as soon and choose appropriate therapy according to the stage. According to our research, cases in stage Ⅰa can undergo an expected therapy under a sequential ultrasound examination;cases in stageⅡa can undergo a RFA selective reduction to improve the prognosis of the donor, which can make a good perinatal outcome.

Objective To research the important of prenatal diagnosis and effect of intervention to fetal hydrothorax. Methods The cases of fetal hydrothorax (n=5) were obtained from the Shengjing Hospital,China Medical University between December 2014 and May 2015. All pregnancies were uncomplicated, excluded congenital organic and chromosomal abnormalities during prenatal diagnosis and with a 37 average gestational weeks. The case 1, 2, 4 were unilateral hydrothorax and the case 3, 5 were bilateral. We performed an antenatal thracocentesis to case 1, 2, 3. In case1, the hydrothorax increased rapidly after 5 days, and the patient underwent a cesarean section and ex utero intrapartum treatment (EXIT);in case 2, the fetal heart rate was decreased to 40-50 bpm suddenly during thracocentesis, and we performed an emergent cesarean section and EXIT for the patient; in case 3, the patient underwent thracocentesis and a meanwhile cesarean section and EXIT procedure. We performed a conservative management to case 4, 5, the hydrothorax resolved spontaneously during the pregnancy and after birth, both patients underwent cesarean section. Results All fetuses were survived, the neonates of case 1, 2 and 3 underwent assited mechanical ventilation, thoracic close drainage, then discharged after hydrothorax resolved and feeding tolerance;in case 4, there was no respiratory distress and hospital treatment;in case 5, the neonate underwent assited mechanical ventilation and conservative management, the hydrothorax has resolved gradually. Conclusions The prenatal diagnosis and antenatal intervention (thracocentesis) may play an important role in fetal hydrothorax treatment. In clinical, we should choose different plan according to the gestation weeks and classification of hydrothorax of the patient.