Objective To explore the feasibility of laparoscopic cholecystectomy(LC) in patients over 85 years old.Methods Three-port LC was performed in 79 patients aged over 85 years old from October 1996 to October 2006.Patients' co-morbidities were effectively controlled before operation.The operation was conducted under continuous epidural anesthesia,and the CO2 pneumoperitoneum pressure was set at 8～10 mm Hg.Results The LC was successfully completed in 70 patients,while conversions to open surgery were required in 9 patients(11.4%).Causes of conversions included severe intraperitoneal adhesion in 6 patients,uncontrolled bleeding in 1 patient,and suspicion of gallbladder carcinoma in 2 patients.Postoperative complications occurred in 10 patients(12.7%,10/79).Of them,1 patient died of acute myocardial infarction,and the remaining 9 patients were cured(including left heart failure in 1 patient,pulmonary infection in 2 patients,ileus in 1 patient,wound haematoma in 1 patient,fungal enteritis in 1 patient,and effusion in the gallbladder bed in 3 patients).Conclusions Proper peri-operative management,effective control of co-morbidities,and careful surgical performance are essential for a safe LC in patients over the age of 85.

Objective: To analysis the medical expenses of six diseases and put forward the efficient methods to control their unreasonable rise. Methods: 22582 patients with six diseases in two largest hospitals in Xi'an were chosen and analyzed from 1/1/ 2003 to 10/1/2004. Results: Six diseases were the main reason of hospitalization and the malignancy was most important; drug expense of the uninsured patients, which was the key factor to induce the medical expenses rising, was higher than insured patients. Conclusion: The medical insurance program could control the drug expense efficiently; different control strategies to different diseases were important to distribute the medical resource and lighten the life burdens of the inpatients.

Ethics review as the content of the research management of forensic medicine,is the research object of forensic medicine.Focusing on ethics review of the forensic medicine research,this paper discussed on the necessity of ethics review and guiding principles of ethics committee,and appealed for the construction of ethics review in forensic medicine research.

OBJECTIVE:To observe clinical efficacy and safety of mosapride combined with flupentixol melitracen in the treat-ment of elderly functional heartburn. METHODS:106 elderly patients with functional heartburn in accordance with Rome IIIstan-dard were randomly divided into control group(52 cases)and treatment group(54 cases). The control group was treated with Mo-sapride dispersible tablets 5mg,tid,orally;the treatment group was additionally given Flupentixol melitracen tablets(containing flu-pentixol 0.5 mg and melitracen 10 mg),qd,on the basis of control group. Therapeutic efficacy of 2 groups were observed after 4 weeks. Hamilton anxiety scale(HAMA),Hamilton depressive scale(HAMD) and symptom score were conducted before and after treatment. RESULTS:The total effective rate of treatment group and control group were 87.0%and 53.8%;with statistical signifi-cance(P<0.05);there was statistical significance in symptom score,HAMA score and HAMD score between 2 groups after treatment (P<0.01). No severe ADR was found in 2 groups. CONCLUSIONS:Mosapride combined with flupentixol melitracen is safe and ef-fective in the treatment of elderly functional heartburn.

[Objective]To translate the SRS-22 Questionnaire from English edition into Chinese version for the use of Chinese adolescents with idiopathic scoliosis and to evaluate the metric qualities of this questionnair. [Method] Transcultural adaptation of the SRS-22 Questionnaire was carried out according to the International Quality of Life Assessment Project guide-lines,The final version was decided on by a committee of experts.The Questionnaire was completed by 86 adolescents(M=11,F=75) with idiopathic scoliosis.The patients were 10~18 years old(mean,13.9 years).Curve magnitude ranged from 25? to 45?(mean,35.6?).Out of them,30 patients repeated the questionnaire 3~4 weeks later.[Result]The overall alpha coefficient of the questionnaire was 0.88.Coefficients for individual domains were as follows:function/activity,0.70;pain,0.80;self-image,0.80;mental health,0.88;and satisfaction,0.81.The questionnaire as a whole had a test-retest correlation coefficient of 0.97.Test-retest correlation coefficients for individual domains were as follows:function,0.85;pain,0.96;self-image,0.96;mental health,0.95;and satisfaction,0.91.Six common factors were acquired from factor analysis,and the cumulative contribution rate was 72.29%. [Conclusion] The Chinese version of the SRS-22 Questionnaire has eligible reliability and validity.It can be used to measure health-related quality of life of adolescents with idiopathic scoliosis in China.

Objective To explore the spatial distribution of hypertension in recruited Chinese male youth.Methods Maps of spatial distribution on hypertension detection rates in recruited Chinese male youth were produced,using a spatial local interpolation technique with the ArcGIS8.1 software.Cross-validation techniques were used to evaluate the fitness of the distribution maps.Results The spatial distribution of hypertension detection rates in recruited Chinese male youth in 2001 showed that the detectable rate of the hypertension of the recruited male youth was distributed in sections.The sections with a higher rate included Hebei,Shandong and Beijing,as the center of the northern area,and Guangxi,as the center of the southern area.The detectable rate of diastolic pressure was found higher in the areas of northeast and north China than in other places.The prediction error of the cross-validation indicated that the spatial distribution maps of hypertension detecting rates had good fitness to hypertension detecting rates of recruited Chinese male youth.Conclusion There existed in significant spatial difference in hypertension detecting rates of recruited Chinese male youth.Influence of geographical environment,climate,and economy on adolescents' blood pressure should be further studied.

Objective To establish animal model of arterial vulnerable plaques for molecular imaging study.Methods Fifteen New Zealand white rabbits were randomly divided into high lipid diet+balloon-injury group (A),high lipid diet group (B)and regular diet group (C).Ultrasound (US)and magnetic resonance (MR)imaging were used to dynamically observe the formation of plaque in abdominal aorta. Results were compared with blood lipid level and pathological indicators.Results At 4 weeks,several plaques could be seen in group A.The plaque number increased rapidly and reached to 22 at 12 weeks,which was in parallel with the change of blood lipid. Only a few plaques were observed in group B,while no vulnerable plaque was revealed in group C.All the plaques were judged to be soft plaques on US and MR images,which was consistent with the macrophages gathering and smooth muscle cell proliferating in plaques.Conclusion High lipid diet+balloon-injury is an ideal method to build animal model for molecular imaging of atherosclerotic plaque.

Objective To investigate the prevalence and characteristics of thyroid nodule and its relationship with thyroid function in a group of middle-aged to elderly individuals.Methods A cross-sectional,stratified,and cluster random sampling study was performed in 1 721 subjects (average age 71.4 years,from 40 to 108 years).All subjects underwent ultrasound thyroid scan,and the prevalence of thyroid nodule and its size,quantity,property,and distribution were age-stratified and analyzed.The relationship between nodule existence and thyroid function was assessed in subjects who randomly accepted TSH,FT4,and FT3 tests.Results The prevalence of thyroid nodule reached to 76.6％.The incidence of nodule increased with age (x2 =92.08,P＜0.01),and was more common in female (87.4％ vs 75.5％,P =0.001).In patients with thyroid nodule,the prevalence of solitary nodule was 25％,compared with 75％ of multiple nodules,which increased with age (x2 =78.55,P＜0.01).The prevalence of small nodule reached to 68.2％,compared with 31.8％ of large nodules,which also increased with age (x2 =36.82,P＜0.01).As to the property of nodule,solid nodule was the most common form (72.3 ％),cyst-solid nodule accounted for 26.6％,and detection rate of cyst nodule was only 2.1％,and there was no significant difference among the different age groups (x2 =14.22,P=0.076).884 among the total subjects underwent thyroid function test,multiple logistic regression analysis demonstrated that the reduction of TSH was the only independent predicting factor of thyroid nodule (P =0.005).Conclusions The prevalence of thyroid nodules was considerably high according to the examing of ultrasonographic image,especially in the elderly.The incidence of thyroid nodule,especially multiple nodules or larger nodule,increased with age and solid nodule was the most common finding.

ObjectiveTo explore the optimal method of protecting bone marrow in postoperative concurrent chemoradiotherapy of stage Ⅱ - Ⅲ rectal cancer by comparing two techniques of intensitymodulated radiotherapy (IMRT). MethodsFifteen patients with stage Ⅱ - Ⅲ rectal cancer after surgery had CT simulation. Clinical target volume, small bowel, bladder and bone marrow were contoured. Two IMRT treatment plannings with and without bone marrow-sparing (BMS-IMRT and IMRT) were separately designed. The dose distribution was compared based on that 95％ of the planning target volume received the prescribed dose. ResultsBMS-IMRT had an advantage over IMRT in terms of conformity indices ( 1. 06∶1. 04, t =- 2. 61, P =0. 023 ), but inferior to I M RT for homogeneity indices ( 0. 81 : 0. 75, t =- 2. 34, P =0.037)).Compared with IMRT, BMS-IMRT reduced the V5, V10, V20, V30, V40 of bone marrow (97.09％∶98.72％, t=-2.34, P=0.037;92.38％∶96.46％, t=-2.41, P=0.033;83.36％∶91.70％, t=-3. 18, P=0.008;51.47％∶69.65％, t=-4.92, P=0.000;36.34％∶49.57％, t=-2.66, P =0. 021 ). The doses received by small bowel and bladder were similar between BMS-IMRT and IMRT, except that the V20 of bladder was lower in BMS-IMRT (77. 32％∶92. 39％, t =-3.52, P=0. 004). Conclusions BMS-IMRT reduces low dose volume of bone marrow without increasing dose to other risk organs.BMS-IMRT might reduce acute hematologic toxicity and increase the feasibility of postoperative concurrent chemoradiotherapy in stage Ⅱ -Ⅲ rectal cancer.

ObjectiveTo retrospectively analyze the clinical outcome of patients with iatrogenic peripheral nerve injury so as to summarize the experiences and lessons.MethodsA retrospective study was performed on 72 patients with iatrogenic peripheral nerve injury treated in our hospital from 2004 to 2010.Therapy methods included conservative treatment in 24 patients,surgical release in 21 and nerve anastomosis in 27.Results All the patients were followed up for average 10 months ( range,3-24months).The neurological recovery was excellent in 24 patients,good in 21,fair in 16 and poor in 11,with excellent rate of 64％,according to the trial standard of upper limb functional assessment established by Chinese Medical Society of Hand Surgery.ConclusionsRisk awareness should be strengthened on the iatrogenic peripheral nerve injury,especially the minimally invasive treatment of fractures in recent years,which has increased the risk of nerve injury.For patients who may be presented with iatrogenic injury,we should develop a detailed preoperative surgical plan for early one stage treatment as possible.