Objective To evaluate the feasibility of laparoscopic cholangiotomy for radical excision of upper cholangiocarcinoma. Methods Four trocars were placed at the umbilical area, right upper and lower abdomen, and below the xiphoid. A 3 cm incision was made at the left upper abdomen for Roux-en-Y jejunojejunostomy. The gallbladder, inferior segment of the left medial liver, and the middle-upper segment of the bile duct were resected. And then the tumor and the adjacent 1 cm bile duct were excised. Afterwards, the proper hepatic artery, portal vein, and the surrounding connective tissues and lymph nodes were removed. Finally, the bile-jejunum Roux-en-Y anastomosis was performed. Results The hepatic duct bifurcation was involved by the cholangiocarcinoma in all the 4 cases. The diameter of the tumor was 1-1.5 cm. The resection of the inferior segment of the left medial liver and middle and upper segments of the bile duct, and dissection of the lymph nodes at the hepatic porta were completed successfully. The operation was accomplished in all the cases with an operation time of 270, 255, 270, and 230 mins, and the intraoperative blood loss was 500, 400, 300, and 400 ml, respectively. Postoperative pathological examination showed highly differentiated adenocarcinoma in all the cases. Cases 2 and 3 developed bile leakage after the operation and were cured 20 or 15 days later. In all the cases, the jaundice disappeared after the operation. Their appetite recovered, and the body weight was increased by 3, 3.5, 2, and 2 kg, respectively. Conclusions Upper cholangiocarcinoma can be radically excised by using laparoscopy. The resection of cholangiocarcinoma and part of liver tissues, dissection of surrounding connective tissues and lymph nodes, and bile duct reconstruction can be accomplished under a laparoscope. Thus,we consider that laparoscopic cholangiotomy is feasible for radical excision of upper cholangiocarcinoma.

Objective To detect IgG and IgM antibodies in the sera of SARS patients, in order to find the possible causative association between new coronavirus and SARS; to compare IgG and IgM antibody titers of acute phase with those of convalescent phase, in order to find specific serological reaction of SARS virus and its clinical significance. Methods Clinical specimens of SARS patients in 4 hospitals of Guangdong Province were collected and then detected by IFA and ELISA. The specificity and cross-reaction of each specimen for confirming the new coronavirus were evaluated. Results One hundred and seventeen of 130 clinically diagnosed SARS patients showed viral specific serological reaction, with the positive rate of 90%. The IgG titer increased significantly 10 days after the onset of infection and reached a higher level (above 320) 15 days later, while IgG titer reached the highest level on the 20 th-30 th day. The specific antibodies were negative in all 119 individuals with close contact with patients and 100 normal controls. Conclusion Viral specific IgG antibody was detected in the sera of SARS patients, confirming that the patients were infected by the virus; persistent high titer of IgG antibody in the sera of convalescent patients might probably be a protective mechanism in general population.

Objective To study the effect of combination mode of blood purification on insulin resistance in MODS patients and discuss the best mode of blood purification to improve insulin resistance in MODS patients.Methods A total of 60 MODS pa-tients were selected and randomly divided into control group(single mode of blood purification)and treatment group(combination mode of blood purification),each group of 30 cases.Blood glucose (BG),glucose standard deviation (BGSD),coefficient of variation of blood glucose (BGCV),regular insulin dosage (Ins),fasting insulin (FINS),insulin resistance index (HOMA-IR),HbA1c,C-re-active protein (CRP)was observed before and after treatment.Results BG,HbA1c,FINS,CRP,HOMA-IR,Ins of experimental group was lower than that of control group (P <0.05).After treatment,BG,FINS,CRP,HOMA-IR,Ins was declined in experi-mental group (P <0.05).After treatment,HbA1c was not changed in experimental group (P >0.05 ).Conclusion Combination mode blood purification may be more effective to insulin resistance in MODS patients.

Objective By studying the change of the special antibodies titer IgG, IgM and nucleocaspid to SARS corona virus in family clustering cases , searching and testing the special antibody to SARS corona virus in the patients kinfolks Method Testing special antibody titer to SARS corona virus of 14 patients from 5 different families and their 10 kinfolks continuously by IFA and antigen capturing ELISA methods, taken samples in the 7 th , 14 th , 30 th , 60 th , 120 th , 180 th , 210 th ,270 th ,360 th day after SARS patients infected by SARS corona virus, dilute them, and then measure titers of three kinds of antibodies ResultsDuring the testing of IgG antibody titer of the 14 SARS patients by IFA method, in the 120 th day, the average titer is up the highest value, it is 1/1 120; in the 180 th day, the average titer begins to descend, it is 1/262 in the 360 th day, the average titer is 1/71 During the testing of IgM titer, the average titer is 1/32, it is obviously lower than it in IgG testing; the IgM titer of the most SARS patients are disappear after 120 days The average value of nucleocaspid antibody titer is lower than it in IgG antibody But there are some differences in 5 cases While IgG antibody titer begins to descend in the 180th day, nucleocaspid antibody titer begins to ascend obviously, it is up to 1/790 210 th day begins to descend In the meantime, we have tested special antibody to SARS corona virus of their 10 kinfolks (include 2 children) who have contacted with SARS patients closely The samples are taken in the 14 th , 30 th , 60 th day, and all the special IgG, IgM and nucleocaspid antibody to SARS corona virus are negative ConclusionBy testing the special IgG antibody to SARS corona virus of the 14 family clustering cases ,we find the special IgG antibody titer of the SARS patient is higher, and it can remain for a long time As for the nucleocaspid antibody titer of some SARS patients ascend obviously after 180days, we think that it provide useful information for vaccine development and it is necessary for us to study more in the clinic There is no special blood serum antibody to SARS corona virus in their 10 kinfolks of the SARS patients

Objective To study the effect of radon exhalation on the external dose model for building material,so as to provide the scientific and precise assessment of external radiation exposure hazard.Methods The mechanism of exhalation of radon from building material was analyzed,mathematical model of correction factor for the effect of radon exhalation was derived and resolved by Matlab program and the relationship between correction factor and diffusion length,surface emanation coefficient and thickness of building material was discussed.The absorbed dose rate induced by several classical building materials was calculated and compared.Results The radon exhalation correction factor was independent of diffusion length and thickness of building material in most cases.Negative correlation was found between radon exhalation correction factor and radon surface emanation coefficient.Radon exhalation correction factor numerically equals to '1-radon surface emanation coefficient'.The relative percentage deviation between absorbed dose rate induced by several classical building materials was in the range of 2.23％-10.02％,for both corrected and uncorrected radon exhalation effects.Conclusions Radon exhalation from building material has a certain effect on external dose model for building material,which should attract attention.It is important to conduct the correction for external dose model by introducing ‘1 -radon surface emanation coefficient’ as the radon exhalation correction factor,in order for the scientific assessment and control of external radiation exposure hazards from building materials.

Objective:To compare MRI characteristics between hepatic benign nodules and hepatocellular carcinoma (HCC) associated with Budd-Chiari syndrome(BCS).Methods:A retrospective study was conducted on 130 consecutive patients with BCS who were treated at the Affiliated Hospital of Xuzhou Medical University from January 2011 to June 2018. There were 67 males and 63 females, age ranged from 18 to 78 years, with median age was 46 years. There were 45 patients with HCC and 85 patients with benign liver nodules. This study aimed to compare the clinical characteristics of BCS patients with HCC and benign nodules, and to compare the MRI features (distribution, capsule, plain scan signal, enhancement pattern) between HCC and benign nodules. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each of the indicators in the diagnosis of hepatocellular carcinoma.Results:The age and alpha-fetoprotein levels of the BCS patients with benign nodules were significantly lower than the BCS patients with HCC, while the international standardized ratio was significantly higher than the BCS patients with HCC (all P<0.05). Of the 130 BCS patients, there were 337 benign and 78 hepatocellular carcinomas nodules. The diameter of benign nodules was significantly smaller than HCC, and the proportions of benign nodules with encapsulation, fat content, cystic necrosis and hemorrhage were significantly lower than HCC (all P<0.05). The proportions of benign nodules with T 1 weighted imaging high signal, T 2 weighted imaging (T 2WI) low or equal signal and diffusion-weighted imaging (DWI) equal signal were significantly higher than HCC (all P<0.05). The proportions of benign nodules with washout appearance, arterial phase hyperenhancement and washout appearance were significantly lower than HCC (all P<0.05). The areas under the ROC curve for the diagnosis of HCC by DWI high signal and T 2WI high signal were 0.936 and 0.927, respectively, with sensitivities of 96.2% and 92.3%, specificities of 91.0% and 90.1%, respectively. Conclusion:The MRI features of BCS patients with benign regenerative nodules were significantly different from those of BCS patients with HCC. The washout appearance had a low specificity for the diagnosis of HCC.

Objective To investigate the dynamic changes of dead space fraction (VD/VT) and its effect on the prognosis in the patients with acute respiratory distress syndrome (ARDS).Methods Thirtytwo patients with ARDS in EICU of the First Affiliated Hospital of Kunming Medical University from January 2015 to August 2016 were selected and divided into the survival group and the death group according to the 28 d mortality rate.VD/VT on 1-6 d in the two groups was calculated according to the formula.The parameters of basic condition,PaO2/FiO2,APACHE Ⅱ score,LIPS score,PEEP of the two groups were compared.Results LIPS and APACHE Ⅱ scores had statistical difference between the death group and survival group (P＜0.05);VD/VT on 1-3 d had no statistical difference between the two groups (P＞0.05),and VD/VT on 4-6 d in the death group was significantly higher than that in the survival group (P＜0.01).△PCO2,pH and PaO2/FiO2 had statistical difference between the death group and the survival group (P＜0.05).The binary classification Logistic regression analysis found that APACHE Ⅱ,LIPS,△PCO2,VD/VT were the risk factors.VD/VT on the 4th day was selected,its' cut off value was 0.62,and the sensitivity of the prognostic evaluation was 90.0 ％,the specificity was 95.5 ％.Conclusion The dead space fraction is an independent risk factor for the prognosis of ARDS patients,and VD/VT on 4th day could effectively identify the high-risk patients.

Objective To validate and discuss the time response correction formula for four types of dosimeters (6150AD6 + 6150AD-b,FH40G + FHZ672E-10,451P ionization chamber and AT1123).Methods The ambient dose equivalent rates shown by survey meters were recorded separately when X-ray emission time was 500,200,100 and 50 ms.The corrected values were obtained by the formula of circuit having a capacitance C and asistance R in series.Results Therewas no correlation between the value measured by AT1123 dosimeter and the time of irradiation.The values by other three kinds of dosimeters obviously varied with the time of irradiation.Conclusions It is not required to make the time response correction for the measured value of ATl123 dosemeter,whereas the values measured by the other three dosimeters could be corrected by the time response correction formula.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*