Biliary stricture after cholecystectomy poses difficult management problems to surgeons because of high and stable incidence.In contrast to malignant stricture,benign stricture requires durable repair.Repeated operations may not only increase the suffering of the patient,but also reduce the likelihood of a better outcome. A 56-year-old woman with biliary stricture after cholecystectomy who had undergone several operations in other hospitals was admitted to Chinese PLA General Hospital.Computed tomography (CT) scan showed a dilated biliary tree and localized the level of ductal obstruction in the hepatic hilar stricture.In addition,CT identified fluid collections in the left upper quadrant and no artery injury was detected. Ultrasound-guided percutaneous abdominal drainage was performed to control the abdominal infection. Magnetic resonance cholangiopancreatography classified the injury as Bismuth Ⅲ.The patient with bile leakage and severe abdominal infection was treated with antibiotics before the final operation.On June 1,2012,the patient received Roux-en-Y hepaticojejunostomy.After operation,the patient recovered smoothly without severe complications,such as bile leakage,cholangitis and recurrent stricture.Liver function of the patient was back to normal and T tube drainage was pulled out at the end of 3 months of follow up.

Objective Based on a job analysis known as the Critical Incident Technique, this study is to develop a behavioral observation scale (BOS) for appraising the performance of charge nurses of class three hospital in Sichuan province. Methods First, 56 charge nurses and supervisors were interviewed by using the Critical Incident Technique and 498 incidents were reported.Then the 498 incidents were cate-gorized into15 criteria and 169 behavior items which formed one original BOS. 48 supervisors preexamined,on a five-point Likert scale as to the frequency, 190 charge nurses who were engaged in the behavior de-scribed by each incident. According to the item analysis above, 12 performance criteria and 54 behavioral items came out to form a formal behavioral observation scale for appraising performance of charge nurses Fi-nally,to test the reliability and validity of behavioral observation scale, 192 charge nurses were put under re-al test. Results The Cronbach's alpha coefficient ranged between 0.65 and 0.93. The retest reliability ranged from 0.50 to 0.76. Factor Analysis: 9 factors with eigenvalue greater than one were selected and ac-cumulative prepertion was 68%. Conclusions Behavioral observation scale developed on a job analysis known as the Critical Technique to appraise the performance of charge nurses has moderately high reliabili-ty and validity.

Objective To investigate the changes of molecular markers in cultured skin stem cells exposed to UVB in vitro. Methods Skin stem cells were isolated and cultured according to their adherasion ability,and identified by immunohistochemistry using anti-K15 and anti-β-integrin antibodies. Then, a part of the skin stem cells were irradiated with UVB at 10 mJ/cm2 for 2 times. After 24-hour additional culture, the expressions of CD34, beta-catenin and p53 were detected with immunohistochemistry. Results Skin stem cells showed a high density in culture free of irradiation, which were round or polygon with a clear shape, well-distributed cytoplasm, high N/C ratio; mitotic cells could be seen. In unirradiated skin stem cells, beta-catenin was expressed predominantly in cell membrane and cytoplasm, with a positive expression rate of 64.74% and 8.4%in membrane and cytoplasm respectively; p53 was expressed mainly in cell cytoplasm and nuclei, with a positive expression rate of 6.9% in cell nuclei. After exposure to UVB, skin stem cells decreased in cell density and N/C ratios with a deformed and anomalous shape, vacuoles were present in cytoplasm, and some cells experienced karyopyknosis or apoptosis. Additionally, in irradiated cells, beta-catenin was expressed predominantly in cytoplasm with a positive expression rate of 64.74% and 0 in cytoplasm and nuclei, respectively; p53 was expressed mainly in nuclei with a positive expression rate of 100%. CD34 was detected in neither unirradiated nor irradiated skin stem cells. Conclusion UVB can promote beta-eatenin to accumulate in cytoplasm as well as beta-catenin and p53 to migrate from cytoplasm to nuclei.

China ; Education, Medical ; standards ; Humans ; Lung Diseases ; therapy ; Medicine ; Vascular Diseases ; therapy

Objective]To discuss and analyze Professor Cheng Jing's clinical experience for treating decline in ovarian reserve(DOR). [Method]Through learning from the tutor in the outpatient service and case studies ,we analyzed and summarized Pro. Cheng's recognition on the etiology and pathogenesis of DOR,together with his dialectical way of thinking, combined therapy of Chinese and western medicine ,and empirical prescriptions. [Result] Pro. Cheng believes that this disease lies in the kidneys as wel as in the thoroughfare and conception meridian ,the pathogenesis is kidney deficiency and the imbalance of the thoroughfare and conception meridian,or combined with the stagnation of liver qi,spleen deficiency,and blood stasis and phlegm fire (heat); the therapy is mainly nourishing and warming kidneys as wel as conditioning the thoroughfare and conception meridian ,combined with Chinese medicine's periodical therapy,such as adjusting the circulation of qi and blood in livers,spleens,hearts and other organs. [Conclusions] Pro. Cheng's combined therapy of Chinese and western medicine for curing DOR ,of which his empirical prescriptions the Bushenyichongkangshuaitang is the main part,is of remarkable curative effect and significant clinical value.

Fructose-1,6-diphosphate (FDP) is a very important mesne product which links the glucose and hepatin with the oxidation in energy metabolism and keeps the glycolysis functional, which is made use of widely. In addition, FDP has the ability to stabilize the cell membrane, abate inflammatory response, and restrain the oxygen free radical and cell apoptosis, it can protect cell in both structure and function. Recent researches proved that FDP is effective on myocardium protection and cardiac function reviving. This article reviews these research progresses.

OBJECTIVE:To evaluate the economic effectiveness of different pharmacotherapeutic schemes for the same disease.METHODS:Using pharmacoeconomical cost-effectiveness analysis,four therapeutic schemes for treating peptic ulcer bleeding,schemes A,B,C and D,were compared.RESULTS:The total effect rate of scheme A was the lowest(61.53%).The cost-effectiveness ratios of A,B,C and D were 1.09,10.70,10.74,17.20,respectively.Using sensitivity analysis;the cost-effectiveness ratios were 0.98,9.63,9.66,15.48,respectively.CONCLUSION:Among the four schemes,scheme C was the best one.

Objective To analyze the characteristics and diagnosis of children aged

Objective To observe the effect of the first iodine-131 ablation of thyroid remnants in pa-tients with differentiated thyroid cancer (DTC) and discuss factors that may be influential in the treatment. Meth-ods All DTC patients confirmed by pathology received iodine-131 therapy after necessary preparation. Accord-ing different operation procedures, time interval between operation and iodine-131 treatment and dose of iodine - 131, the patients were divided into different groups. Therapy effects were observed in different groups. Results Ablation successful rate was 88.5% in total thyroidectomy group, compared with 44.4% in subtotal thyroidecto-my group. 92.7% ablation rate was seen in the group of I-2 months time interval between operation and iodine - 131 treatment, while in the group of over 1 year time interval, only 50% ablationrate was achieved. Ablation successful rate was 47.6% in the group of low dose of iodine-131 (2.96GBq), compared with 82.8% in the high dose group (4.44GBq). Conclusions Total thyroidectomy and cervical lymph nodes dissection should be recommended for the patients with DTC. The better interval time between operation and iodine-131 ablation thy-roid remnants is 1～2 months. The high dose of iodine-131 shows better result than low dose of iodine-131 treatment.

Objective To study the current clinical application and advancement of microbioecological preparation.Methods Literatures about microbioecological preparation published in China and abroad were collected and reviewed.Results The microbioecological preparation has been widely used at present.It is used to rebuild a balanced microbial population in human body,particularly in intestinal,to promote the stability of internal environment,control dysbacteriosis and to treat a variety of gastrointestinal diseases associated with ectopic microbial population.Conclusion Although microbioecological preparation has been widely used in clinical settings,its effect yet should be further supported and evaluated both by large sample research in randomized double-blind control trails and evidence-based medicine.