Salvage cholecystectomy for gall stone recurrence after gallbladder-preserving cholelithotomy / 中华普通外科杂志

Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.

Effect of Zuogui pill on cognitive function in sleep-deprived rats / 中华麻醉学杂志

Objective:To evaluate the effect of Zuogui pill on cognitive function in sleep-deprived rats.Methods:Thirty SPF Sprague-Dawley male rats, aged 8 weeks, weighing about 200 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), sleep deprivation group (group SD), low-dose Zuogui pill group (group L), medium-dose Zuogui pill group (group M) and high-dose Zuogui pill group (group H). The model of sleep deprivation was developed by the multi-platform water environment method.In L, M and H groups, the doses of Zuogui pill were 2.42, 4.84 and 9.68 g/kg, respectively, Zuogui pill was administered by intragastric gavage at 10: 00 am every day, and the volume of fluid for intragastric gavage was 4 ml each time.In C and SD groups, pure water was used for intragastric gavage.In L, M and H groups, the liquid was prepared according to the corresponding doses of Zuogui pill for intragastric gavage, once a day for 7 consecutive days.The cognitive function was evaluated by the Morris water maze test.After the end of the second behavioral testing, blood samples from the eyeballs were collected, and then the rats were sacrificed by decapitation, and brains were removed and the hippocampus was obtained for determination of the concentrations of serum interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) and contents of malondialdehyde (MDA), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) in hippocampal tissues (by enzyme-linked immunosorbent assay) and the expression of IL-1β, IL-6 and TNF-α in hippocampal tissues (by Western blot). Results:Compared with group C, the total swimming distance and escape latency were significantly prolonged, the time of staying at the original quadrant and the number of crossing the platform were decreased, the levels of serum IL-1β, IL-6 and TNF-α in serum and hippocampal tissues were increased, the content of MDA was increased, and the contents of GSH-Px and SOD were decreased in the other groups ( P<0.05). Compared with group SD, the total swimming distance and escape latency were significantly shortened, and the time of staying at the original quadrant was prolonged, and the number of crossing the platform was increased, the levels of serum IL-1β, IL-6 and TNF-α in serum and hippocampal tissues were decreased, the content of MDA was decreased, and the contents of GSH-Px and SOD were increased in L, M and H groups ( P<0.05). Conclusions:Zuogui pill can improve the cognitive function in sleep-deprived in rats, and the mechanism is related to inhibition of inflammatory responses and improvement in the antioxidant capacity.

Treatment of protrusion deformity of concha cavity with cartilage turning over of concha cavity / 中华整形外科杂志

Objective@#To investigate the treatment of protrusion deformity of the concha cavity with cartilage excision and turning over of the concha cavity, and to evaluate its advantages, disadvantages and indications.@*Methods@#Eight patients with protrusion deformity of the concha cavity were treated by this method in Wuhan Union Hospital from January 2010 to January 2018.An incision was made in the auriculocephalic angle to expose the dorsal side of the anterior concha cartilage. An elliptical incision was made on the edge of the protrusion area of concha cavity and stripped. The cartilage slices were turned over after crossing scratches and re-implanted into the corresponding area of the concha cavity and sutured with absorbable suture. Then packing with a gauze ball in front of the concha cavity. To observe the healing of incision and the occurrence of hematoma 10 days postoperative. The skin shrinkage of concha cavity and the secondary deformity of concha cavity were evaluated 6-12 months later when the patients were followed-up.@*Results@#The protrusion deformity of concha cavity was corrected in all patients. The incision healed well without local hematoma. There was no obvious distortion of the concha cavity after 6-12 months follow-up.@*Conclusions@#Harvesting and in situ turning over of cartilage slices can effectively treat the protrusion deformity of the concha cavity. There is no skin shrinkage and deformation in the concha cavity after operation.

Operative method choice and strategy of laparoscopic surgery therapy for gallbladder stones and common bile duct stones / 中华外科杂志

Objective@#To explore the selection method and technology of laparoscopic surgery for gallbladder stones and common bile duct stones(GCBDS).@*Methods@#Data was collected from 318 in-patients of GCBDS at Department of General Surgery,Xuanwu Hospital of Capital Medical University from January 2013 to December 2017, and 298 in-patients acceptedlaparoscopic cholecystectomy(LC) and choledocholithotomy were recruited into final analysis.There were 138 males and 160 females,aged (60.4±18.6)years (range:25-89 years).Retrospective analysis was done on method distribution,effect and safety of laproscopic surgery.Comparisons of basic characters and therapeutic effects were performed betweenlaparoscopic common bile duct exploration (LCBDE) combined with primary closure and T tube drainage(TTD).@*Results@#Among therecruited in-patients,LC combined with common bile duct exploration was performed in 7 cases(2.3%, 7/298), LC combined with LCBDE was performed in 291 cases(97.7%,291/298).There were 133 cases (45.7%,133/291) who treated by LCBDE combined with TTD and 158 cases(54.3%,158/291) who treated by LCBDE combined with primary closure.In LCBDE combined with primary closure group,18 cases (11.4%,18/158)had intraoperative biliary manometry.All patients were followed up for 6 months at least and there no death.Postoperative complications rate was 10.0% (29/291).There were no significant differences in sex ratio,age,American Society of Anesthesiologists score,concomitant diseases and previous abdominal surgery history between LCBDE combined with primary closure and LCBDE combined with TTD group.Patients in LCBDE combined with primary closure group were accompanied with less acute cholangitis than TTD group (43.3% vs.76.7%; χ2=9.061, P=0.002).There were no significant differences in the diameter of common bile duct, the number of stones, hospitalization expenses and the incidence of complications between the two groups(all P>0.05).LCBDE combined with primary closure had shorter operation time ((134.2±28.3)minutes vs.(148.3±19.6)minutes; t=-1.830, P=0.011)and post-operative hospitalization time ((5.6±2.6)days vs. (7.2±2.4)days; t=-1.847,P=0.014).Bile duct leakage rate was higher in primary closure group(6.3% vs.0.8%, χ2=3.934, P=0.047) and TTD group had higher residual stones rate(6.8% vs.1.3%; χ2=6.008, P=0.014).@*Conclusion@#Strategy for treating GCBDS by laparoscopic surgery should be considered preoperative evaluation and intraoperative exploration to select appropriate minimally invasive surgical methods and techniques.

The clinical observation of the repletion and depletion acupuncture combined with Wumei pill for the sleep disorders after stroke / 国际中医中药杂志

Objective In order to evaluate the clinical curative effect of double repletion and depletion acupuncture combined with Wumei pill for the sleep disorders after stroke.Methods A total of 150 patients of sleep disorders after stroke that accorded with the inclusion criteria was randomly divided into the treatment group and the control group.Thirteen patients were off loss in the study with 8.7％.And a total of 137 patients completed the protocol,including 70 in the treatment group and 67 in the control group.Both groups were treated with basic treatment.Besides,the treatment group added the treatment of double repletion and depletion acupuncture combined with Wumei pill;while the control group Estazolam tablet.There were 2 weeks for one course and 2 courses in total with 6 months follow-up.The PSQI,neurokinetic energy assessment and cognitive impairment were evaluated after treatment and 6 months follow-up.After treatment,plasma 5-HT and BDNF level were detected and clinical curative effect was observed.Results The PSQI score after treatment (6.3 ± 0.9 vs.9.3 ± 1.1,t=-3.424) 6 months followed up (4.2 ± 0.3 vs.7.5 ± 0.4,t=-3.675) in the treatment group was significantly lower than those in the control group (P＜0.05).The NIHSS score after treatment (8.2 ± 1.0 vs.11.4 ± 1.0,t=-4.557) and 6 months followed up (5.1 ± 0.5 vs.7.6 ± 0.9,t=-3.135) in treatment group was significantly lower than the control group (P＜0.05).The MMSE score after treatment (22.7 ± 2.9 vs.18.3 ± 2.8,t=-4.691) and 6 months followed up (25.0 ± 2.6 vs.21.5 ± 2.6,t=-4.902) in treatment group were significantly higher than the control group (P＜0.05).After treatment,the level of 5-HT (131.85 ± 11.72 ng/ml vs.101.21 ± 10.23 ng/ml,t=0.014) and BDNF (45.17 ± 6.03 ng/ml vs.38.46 ± 5.28 ng/ml,t=5.406) in treatment group were significantly higher than those in the control group (P＜0.05).After treatment,the treatment group effective rate was 92.9％ (65/70) and 81.6％ (54/67) in the control group.The difference was statistically significant (Z=-2.644,P=0.008).Conclusions The double repletion and depletion of acupuncture combined with Wumei pill can improve the sleep quality and cognitive behavior of patients with post-stroke sleep disorders.The possible mechanism is related with improvement of the expression level of 5-HT and BDNF.

Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in acute cholangitis cases / 国际外科学杂志

Objective To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration in acute cholangitis cases.Methods The clinical data of 100 patients with acute cholangitis undergoing laparoscopic common bile duct exploration from January 2012 to December 2014 were reviewed.54patients received primary closure of the common bile duct and 46 patients were subjected to T-tube drainage after choledochotomy.Results One hundred patients underwent the surgery successfully.Compared with the T-tube group,the operation time(96.72 min vs 123.00 min,P =0.001),intraoperative blood loss(27.13 ml vs 38.48 ml,P =0.009),postoperative gastrointestinal function recovery time(1.57 d vs 2.33 d,P=0.003) and postoperative hospital stay(6.19 d vs 9.20 d,P=0.000) were significantly less in the primary closure group.There were no statistical differences in the incidence of postoperative drainage (309.22 ml vs 212.46 ml,P =0.070),drainage time (3.96 d vs 4.02 d,P =0.875),incidence of bile leakage(9.3％ vs 0,P =0.060) and postoperative bleeding rate(5.1％ vs 2.2％,P =0.622) between these two groups.Conclusion Laparoscopic common bile duct exploration with primary closure of the common bile duct is an effective and safe procedure in acute cholangitis cases compared with T-tube drainage.

Clinical significance of combined detection of plasma ctDNA and BRAF V600E mutations in patients with thyroid carcinoma / 实用医学杂志

Objective To detect the content of plasma ctDNA and the mutation rate of BRAF V600E in plasma of patients with thyroid carcinoma ,and to explore its clinical significance. Methods Plasma ctDNA was extracted from 16 patients with thyroid carcinoma and 59 patients with benign thyroid nodules by using the blood genomic DNA Extraction Kit. The ctDNA content was detected by fluorescence quantitative PCR ,and the mutation of circulating BRAF V600E was detected by PCR and sequencing. Then the clinical significance was analyzed by combined detection analysis. Results The content of ctDNA in thyroid cancer group was significantly higher than that in benign nodule group (P < 0.01). BRAF V600E mutation detection showed that the mutation rate was 43.75%,but benign nodules had no mutation. Parallel combined detection improved the sensitivity and the specific-ity of the combined detection was higher. Conclusion Combined detection of ctDNA and BRAF V600E in plasma is helpful for differential diagnosis of benign and malignant thyroid nodules.

Application of intense pulsed light depilation in the auricular reconstruction with totally expanded skin / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of intense pulsed light (IPL) depilation in the auricular reconstruction with totally expanded skin and its suitable parameter.</p><p><b>METHODS</b>From February 2009 to September 2013, one tissue expander(100 or 150 milliliters) were implanted under the skin of mastoid in 126 patients who suffered from microtia. During the skin expanding, the hair on the expanded skin was depilated by JPL technique. The parameter, operation, interval, the depilation result and the complication were recorded. The autologous rib cartilage frameworks were implanted in the second phase of auricular reconstruction.</p><p><b>RESULTS</b>The energy of IPL was 20 - 35 J/cm2 (mean 25. 3 J/cm2), the width of pulse was 26 - 30 ms ( mean 27. 9 ms), the interval between two operations was 4 weeks. Ninety-six patients were cured(76. 2%, 96/126). The total depilation efficient is 96. 8% (122/126). A fine banding blisters was found in one patient whose depilation areas was marked by black pen. Skin erythema was found in five patients and skin pigmentation was found in 7 patients. There were no skin necrosis and expander exposure in all patients. During 6 - 12 months of follow-up period, ninety-two patients were cured (73.0%, 92/126) and the total depilation efficient is 92. 9% (117/126).</p><p><b>CONCLUSIONS</b>IPL depilation during the skin expanding is feasible and safe with careful procedure. The hairless expanded skin is enough to cover the framework, as well as the post-auricular area. The appearance of reconstructed ear is better without hair.</p>

Effect of compound amino acid 15-peptide 2 injection on levels of tumor markers in serum of postoperative patients with liver cancer surgery / 中国生化药物杂志

Objective To analysis effect of compound amino acid 15 peptide 2 on levels of tumor markers in serum of postoperative patients with liver cancer.Methods 42 postoperative patients who were diagnosed with liver cancer were collected.All patients were randomly divided into experimental group and control group, 21 cases in each group.The two groups of patients were given the corresponding parenteral nutrition therapy, after treatment, the serum tumor markers, T lymphocytes, liver function and nitrogen balance related indicators in all patients were detected.Results After treatment, compared with control group, the serum alpha fetal protein(AFP),carbohydrate antigen 19-9(CA19-9) and carcino embryonie antigen(CEA) levels were lower in the experimental group (P<0.05); the serum CD3 +T cells, CD4 +T cells and CD4 +/CD8 + ratio levels were lower in the experimental group (P<0.05); the serum alanine amino transferase (ALT), aspartate aminotransferase (AST) and total bilirubin(TBIL) levels were lower in the experimental group (P<0.05); the patients in the experimental group changed to positive nitrogen balance(P<0.05).Conclusion The diluted compound amino acid 15-2 injection for intravenous injection,can significantly reduce the level of serum tumor markers in patients with liver cancer, improve the immune function of patients, correct negative nitrogen balance, protect liver function.

Construction and expression of the targeting super-antigen EGF-SEA fusion gene / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To construct expression vector for the SEA-EGF fusion gene.@*METHOD@#Clone the SEA gene and the EGF gene segment with PCR and RT-PCR independently, and connect this two genes by the bridge PCR. Insert the fusion gene EGF-SEA into the expression vector PET-44. Induced the secretion of the fusion protein SEA-EGF by the antileptic.@*RESULT@#The gene fragment encoding EGF and SEA mature peptide was successfully cloned. The fusion gene EGF-SEA was successfully constructed and was inserted into expression vector.@*CONCLUSION@#The new recombinant expression vector for fusion gene EGF-SEA is specific for head and neck cancer, laid the foundation for the further study of fusion protein SEA-EGF targeting immune therapy in head and neck tumors.

Preliminary study on aPPlicaiton of early enteral nutrition combined with Probiotics for acute severe sroke Patients / 中国综合临床

Objective To observe the effect of early enteral nutrition combined with probiotics for acute severe stroke patients. Methods EiGhty-seven patients with acute severe stroke were randomly divided into control Group(47cases)and research Group(40 cases). Within 48 -72 h,both Groups were Given enternal nutrition,and research Group added probiotics on the basis of enternal nutrition. HemoGlobin( Hb ),serum albumin(ALB)and prealbumin(PLB)were detected on the lst,7th,2lth day after hospitalization. Infection incidence and the incidence of the Gastrointestinal adverse reaction were observed on the 7th,2lth day. GlasGow coma scale( GTS)and NeuroloGic impairment sccore( NIHSS)were assessed on the lst,2lth day. Results There were no satistical siGnificant differences between two Groups in terms of ALB,PLB and Hb on the first day after hospitalization(P>0. 05). The indicators of the two Groups occurred downward trend on the 7th day and control Group declined siGnificantly( The two Groups respectively:ALB:( 3l. 27 ±2. 42 ) G/L and( 27. 2l ±2. 69)G/L,P0. 05). Conclusion Enteral nutrition add probiotics is superior to enteral nutrition on the aspects of enhancinG body nutrition situation,relievinG the infection and the Gastrointestinal adverse reaction.

Class and research progress of energy-based surgical instrumentations / 国际生物医学工程杂志

Energy-based surgical instrumentation (ESI) are surgical devices ablating or cutting tissues via the application of electrical,luminous,acoustic or other energy.High frequency electrotomes are widely used due to the low price,but they produce smoke in the process of surgery and incisions heal slowly.Ultrasonically activated scalpels' cutting performance is satisfying with easily healing incisions while its coagulating capability is poor.Laser scalpels are qualified for both cutting and coagulating in spite of the need of novel technology to overcome the characteristic that tissues absorb laser wavelength selectively.

Comparison of Laparoscopic and Open Appendectomies for Perforated Appendicitis / 中国微创外科杂志

Objective To compare the efficacy of laparoscopic appendectomy(LA) and open appendectomy(OA) for perforated appendicitis.Methods From January 2002 to December 2005,40 patients with perforated appendicitis were treated at Xuanwu Hospital,20 of them received LA,and the others underwent OA.The clinical data of the patients were retrospectively analyzed.Results The operative time in the LA group was significantly longer than that in the OA group [(75.8?11.6) min vs(54.8?9.5) min,t=6.264,P=0.000)].And the patients in the LA group returned to oral intake earlier than those in the OA group [(1.8?0.5) d vs(2.6?0.5) d,t=-5.060,P=0.000].Moreover,the periods of antibiotic use and hospital stay in the LA group were significantly shorter than those in the OA group [(3.8?0.7) d vs(6.3?1.2) d,t=-8.048,P=0.000;and(5.8?1.1) d vs(11.6?1.6) d,t=-13.359,P=0.000].Although 3 patients had incision infection in the OA group,while none of the LA group had such a complication,no significant difference was detected in the complication rate between the two groups(Fisher's exact test,P=0.115).Conclusions Laparoscopic appendectomy is superior to open surgery for perforated appendicitis because of its advantages of quick recovery,short hospitalization,less antibiotic use,and minimal invasion.LA is a safe,effective,and feasible procedure for perforated appendicitis.

Design and Realization of High-speed Fiber Transmission System Based on FPGA / 医疗卫生装备

Objective To design a FPGA(Field-Programmable Gate Array)-based image & voice signal optical transmission system,which can accomplish video & audio frequency long-distance transmission.Methods FPGA was used as the main processing chip.High speed transceiver TLK2501 and SFP optical module were also used to realize high-speed serial fiber transmission.Results A non-compressed digital video optical fiber transmission system based on the TDM technology was designed.Conclusion The system achieves the real-time transmission of video and voice signals,thus greatly improving the accuracy of the examination and providing references for diagnostic experts.

Design of drive circuit for wireless endoscope capsule / 医疗卫生装备

Medical endoscope capsule is described from its construction principle and drive system.The scheme and function of the drive system,especially the driving velocity and the direction control for that based on FPGA,are introduced in detail.Experiments indicate that the micro-drive system,with a linear speed ranging from 0 to 10 mm/s,can move forward and backward,and turn left and right discretionarily.The availability of programmable logic device makes the system reliable and flexible.

Effect of pneumoperitoneum on the liver blood flow in cirrhotic rats / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the effect of pneumoperitoneum on liver indocyanine green (ICG) metabolism and the hepatic blood flow in normal and cirrhotic rats.</p><p><b>METHODS</b>Thirty male Wistar rats were randomized into five groups: normal anaesthesia group, normal laparotomy group, normal pneumoperitoneum group, cirrhosis + anaesthesia group, and cirrhosis + pneumoperitoneum group. Liver cirrhosis was induced in two groups by injecting carbon tetrachloride subcutaneously plus drinking 5% alcohol. ICG clearance tests were performed in all the rats.</p><p><b>RESULTS</b>The ICG level in the normal laparotomy group (0.662 micro g/ml) was higher than that in the normal anesthesia group (0.645 micro g/ml), but the difference was not significant (P > 0,05). The ICG level in the normal pneumoperitoneum group (0.967 micro g/ml) was significantly higher than that in the normal anesthesia and normal laparotomy groups (P < 0.05). The ICG levels in two cirrhotic groups were significantly higher than those in the other three groups (P < 0.05). The ICG level in the cirrhosis + pneumoperitoneum (1.348 micro g/ml) was significantly higher than that in the cirrhosis + anesthesia group (1.198 micro g/ml) (P < 0.05).</p><p><b>CONCLUSIONS</b>During laparoscopic surgery, pneumoperitoneum could decrease the liver ICG clearance rate and the hepatic blood flow, which are of clinical significance in determining the state of liver cirrhotic.</p>

Spleen-preserving treatment of traumatic splenic rupture / 中国现代普通外科进展

Objective: To compare the selective splenic artery embolization (SSAE) with non-operative therapy of traumatic splenic rupture (TSR). Methods: The clinical data of 23 patients with TSR receiving SSAE and 32 undergoing non-operative therapy between 1992 and 2006 in our hospital were retrospectively analyzed. Results: There was no blood transfusion in SSAE group, and one patient was received it in the non-operative therapy group. Two patients in SSAE group had complications with left pleural effusion, and one had left pulmonary infection. One patient with non-operative therapy complicated with spleen abscess (P=0.298). The ratio of successful management in SSAE and non-operative group were 100% (23/23) and 81.3% (26/32) respectively(P=0.035). All the patients in both groups were survival. The mean hospital days in non-operative group(11.9?4.6) were significantly longer than that in SSAE group(7.9?2.1, P=0.045). Conclusions: Splenic injuries with grade Ⅰor Ⅱ are suitable for preserving spleen management. SSAE may be more safe and effective than non-operative therapy.

Cefoperazone/sulbactam in Treatment of Biliary Tract Infections:A Prospective Multicenter Clinical Trial / 中华医院感染学杂志

OBJECTIVE To evaluate the safety and clinical efficacy of cefoperazone/sulbactam in the treatment of biliary tract infections.METHODS In this prospective multicenter study,159 hospitalized patients with biliary tract infections received cefoperazone/sulbactam,and the clinical and bacteriological efficacy as well as the side effects were evaluated.RESULTS The clinical effective rate of cefoperazone/sulbactam in the treatment of biliary tract infections was 86.78%.After treatment,the body temperature reduced to normal rapidly,the average time of defervescence was 3.09?1.81 days.Pathogen eradication rate was 85.71%.No adverse reactions were reported during the study period.CONCLUSIONS Cefoperazone/sulbactam can be used as one of antibiotics of choice in the initial empirical therapy for biliary tract infections.