Objective To validate the accuracy of the determinant-based classification (DBC) for the severity of acute pancreatitis (AP).Methods Retrospective analysis the clinical data of 243 patients with acute pancreatitis who admitted to our hospital between January 2012 and December 2013.Length of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality was assessed,respectively in subgroup of mild,moderate,severe and critical acute pancreatitis according to DBC.Results Pancreatic or peripancreatic necrosis was present in 65 of the patients (26.7％).Transient and persistent organ failures were present in 26 patients (10.7％) and 9 patients (3.7％),respectively.On the basis of the DBC,178 (73.3％),35 (14.4％),21 (8.6％),and 9 (3.7％) patients were determined to have mild,moderate,severe,or critical AP,respectively.The different categories of severity for DBC system were associated with statistically significant and clinically relevant differences in length of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality.Conclusions The DBC accurately classify the severity of AP in subgroups of patients.

Objective To investigate the opportunity and methods of acute biliary pancreatitis.Methods A retrospective review was performed in 85 consecutive patients from June 2008 to October 2014 with acute biliary pancreatitis in Beijing Yanqing County Hospital.Results Eighty-five patients were performed operation.Sisty-two patients underwent laparoscopic cholecystectomy and laparoscopic transcystic common bile duct exploration.Fifyfourcases were found biliary calculi and take away the stones.All patients were no complications such as infection,bile leakage,hemorrhage,bile duct injury,cicatrical stenosis of papilla.After three months of follow-up without biliary residual bile stones and recurrent pancreatitis.Conclusions The early surgical treatment for no severe acute biliary pancreatitis is necessary,safe and feasible.Actively biliary tract exploration can avoid bile duct residual stones.

Objective To investigate the anatomical relation between Zuckerkandl's tubercle and recurrent laryngeal nerve and the superior parathyroid glands anatomy in endoscopic thyroidectomy.Methods From Jul.2012 to Jun.2014 implementation of the 120 cases of endoscopic thyroid surgery (at least one side of the line lobectomy) intraoperative Zuckerkandl tubercle of the presence, all the patients from Subei People's Hospital and location of the relationship between anatomy recurrent laryngeal nerve and superior parathyroid glands.Zuckerkandl tubercle identified by intraoperative recunent laryngeal nerve to expose and superior parathyroid glands.Results Zuckerkandl tubercle appear in the vast majority of cases: on the left is 86％ (51/59), 88％ in the right side (65/74), most of superior parathyroid glands were located on the top of Zuckerkandl tubercle.Looking for recurrent laryngeal nerve by Zuckerkandl tubercle method is more direct, can reduce surgical bleeding and shmten the operation time.Conclusion Recurrent laryngeal nerve and superior parathyroid glands and have close anatomical relationship with Zuckerkandl tubercle.In endoscopic thyroidectomy by intraoperative discern Zuckerkandl tubercle can better avoid injury recurrent laryngeal nerve and superior parathyroid glands.

Objectives To discuss the diagnosis and treatment of patellar plica under arthroscopy.Methods A retrospective survey was performed in 75 cases with patellar plicas under arthroscopy from Jun.2008 to June.2012.All patients were admitted by the clinic.All the patients diagnosised by arthroscopy and clinical evidence, and cuted off under arthroscopy.After the operation, patients were followed-up in the clinic and by telephone for 12 to 60 months, according to the knee joint Lysholm scoring system to assess curative effect.Results All the patients with successful operation, the operation time was 15-25 minutes.All cases after the operation without complications such as infection, quicker recovery of joint function.After 12 to 60 months, 70 patients were followed up, the knee joint Lysholm excellent score was 92.9％.Conclusions Inferior patellar plica under is a type of knee joint synovial plica syndrome, the arthroscopic surgery can determine diagnosis and do effective treatment.

Objectives The purpose of this study was to investigate the characteristics of the aged patients with cholelithiasis and summarize the clinical application experiences.Methods A retrospective analysis was performed on aged patients with cholelithiasis treated by laparoscopic operation between Apr.2012 and Apr.2015.Studies which provided outcome data on aged patients, subjected to laparoscopic operation were considered.Mortality, morbidity, cardiac and pulmonary complications were the outcome measures of treatment effect.Results Twenty-seven patients had cholecystolithiasis, of whom laparoscopic cholecystectomy was successfully performed in twenty-six cases and one case was changed to transabdominal operation.Among the fifty-four patients with suspected or confirmed biliary calculi, laparoscopic cholecystectomy + laparoscopic transcystic common bile duct exploration was successfully performed in forty-two cases and one case was changed to transabdominal operation.Six cases changed to cholecystectomy because of the diameter of the bile duct.Five patients who already had laparoscopic cholecystectomy received Ⅰ stage suturing of bile duct after the removal of the stones.Bile leak occurred in one case and pancreatitis occurred in three cases.Pneumonia occurred in three cases and one case was transmitted to the infection ward for further treatment.No severe procedure-related complication occurred.There was no significant difference in mortality, morbidity, cardiac and pulmonary complications.Conclusions Laparoscopic operation was acceptable for aged patients.Proper peri-operative management was essential to reduce the complications.

Intraspinal tumors with kinds of pathological type are common in clinic, whose first option of the treatment is the surgical resection.In recent years, neurosurgeons pay more attention to the postoperative stability of spine biomechanics on the basis of the total resection of the tumors.This paper reviews the approaches in intraspinal tumors resection and the methods of the reconstruction of spinal stability postoperatively which influence the stability of spine biomechanics most.

Hepatolithiasis is a kind of mixed stone disease which mainly depends on pigment stone.However,the etiology is not clear and the pathogenesis is very complex.A lot of studies confirmed that helicobacter pylori played an important role in the occurrence and development of disease.This paper mainly expounds the problems concerning the characteristic of helicobacter pylori and its connection with hepatolithiasis, its state in the formation of hepatolithiasis.

Objective To analyze the incidence rate and the perioperative risk factors associated with delirium after cardiac surgery.Methods We enrolled 622 patients between October 2014 and March 2015 in the department of cardiovascular surgery in Henan Provincial People's Hospital who were allocated to group PD and non-PD according to the Confusion Assessment Method(CAM) after the cardiac operation.Baseline demographics,perioperative data,and postoperative outcomes of these patients were recorded and analyzed via chi-square test and multivariate logistic regression analysis to determine the risk factors of postoperative delirium.Results Postoperative delirium was detected in 102 patients according to CAM criteria.The incidence was 16.4％.Multivariate logistic regression analysis revealed that age (OR =3.456;95％ CI:2.431-4.569),preoperative atrial fibrillation (OR =1.987;95％ CI:3.562-7.862),prolonged surgery duration (OR =1.246;95％ CI:3.164-5.982),postoperative pain (OR =5.356;95 ％ CI:1.386-9.374)were independently associated with postoperative delirium after cardiac surgery.Conclusions Delirium is a frequent complication,age,preoperative atrial fibrillation,prolonged surgery duration,postoperative pain are independent risk factors for delirium following cardiac surgery.Management according to potential risk factors may be associated with preferable therapeutic outcomes.

Thyroid carcinoma is the most frequent endocrine cancer.Recently, it has been discovered that telomerase reverse transcriptase promoter mutation can prevent cell tolemeres from shortening, leading to cell immortalization and plays an important role in the tumor genesis, invasiveness and metastasis of the thyroid carcinoma.Testing of telomerase reverse transcriptase promoter mutation is of great value in diagnosis, which also can be used as a prognostic maker of thyroid carcinoma.

Primary gallbladder cancer is a relatively common biliarv malignant tumor but with a high mortality rate.Most patients with this disease reach an advanced stage when late onset symptoms occtur, and the prognosis tends to be poor even after radical operation.Searching for new diagnostic approaches of primary gallbladder, standardizing treatment strategy, conducting multieenter clinical trials of new drug, developing preventive measures according to different situations are significant methodls to improve the treatment effect prognosis.In this article, we reviewed the research progress of high risk factors, diagnostics, and treatment strategies of primary gallbladder cancer.