Objective To explore the diagnostic values of bile cytology obtained in endoscopic retrograde cholangiopancreatography (ERCP) and blood tumor markers for malignant bile duct obstruction.Methods From August 2005 to April 2009, bile cytology and blood tumor markers measurement were performed in 47 cases with bile duct obstruction, in which 39 cases were confirmed to be malignant and 8 were benign. Results Malignant cells were found in bile from 26 of 39 malignant obstruction (66. 7% ), and serum CA19-9 was positive in 28 (71.8%). No malignant cells were detected in bile cytology from 8 cases with benign obstruction (with a specificity of 100% ) and serum CA19-9 was negative in 7 (87.5%). In 26 patients with cholangiocarcinoma, serum CA19-9 was positive in 18 (69. 2% ). For bile cytology and blood tumor markers test, sensitivity of parallel combination was 89. 7%, and the specificity of serial combination was 100. 0%. Conclusion Bile cytology testing during ERCP can provide the pathological evidence for malignant bile duct obstruction. The sensitivity is improved by combination tests of bile cytology and blood tumor markers.

Objective To investigate the genetic polymorphism of the transmembrane region of the MICA locus in Guangdong Han population,and to protract the genetic distance in different populations.Methods DNA samples from 106 unrelated Han individuals were genotyped by PCR to analyze the frequencies of MICA alleles.The genetic distance was estimated and the phylogenetic tree was protracted by DISPAN Software.Results In total,5 alleles of MICA-TM were observed,they were A4,A5,A5.1,A6 and A9.MICA-TM A5 was the dominant allele(0.2877),whereas A4 was the least popular one(0.1321).From genetic distance and phylogenetic tree we made,the preliminary finding is that Chinese Hans may have migrated from southwest China to northern and southern China.Conclusion MICA-TM locus has high genetic polymorphism and obvious variance in different populations.Since the genetic distance could be estimated effectively through MICA-TM locus,it could serve as the genetic marker in human migration and evolution research.

Objective To explore the clinical significance of dynamic determination of serum procalcitonin(PCT)levels in judgment of infection and prognosis in patients with severe craniocerebral injury.Methods A total of 80 patients with severe craniocerebral injury were selected and they were divided into infection group and non-infection group.Infection group was divided into improved group and non-improved group.Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and Glasgow coma scale(GCS)score was compared between infection group and non-infection group.The level of serum PCT,white blood cell count(WBC),C-reactive protein(CRP)and interleukin(IL)-6 was compared on the first,third,fifth day of admission in intensive care unit among these groups.Results Infection group in 48 patients,and non-infection group in 32 patients.There was no significant difference in age,sex and GCS score between two groups(P ＞0.05).APACHE Ⅱ score in infection group was higher than that in non-infection group [(21.71 ± 7.13)scores vs.(15.32 ± 6.17)scores],and there was significant difference (P＜ 0.05).The level of serum PCT on the first day of admission in intensive care unit in infection group was higher than that in non-infection group[(2.15 ± 1.79)ng/L vs.(0.56 ± 0.47)ng/L],and there was significant difference(P＜ 0.05).There was no significant difference in WBC,CRP and IL-6 between two groups(P＞0.05).The level of serum PCT,WBC,CRP,IL-6 on the third day of admission in intensive care unit in infection group was higher than that in non-infection group,and there was significant difference(P＜ 0.05).The level of serum PCT on the fifth day of admission in intensive care unit in infection group was higher than that in non-infection group [(3.09 ± 1.98)ng/L vs.(1.06 ± 0.63)ng/L],and there was significant difference (P＜0.05).WBC,CRP,IL-6 on the fifth day of admission in intensive care unit was(15.13 ±6.32)×109/L,(103.56 ±40.62)mg/L,(230.41 ± 121.83)ng/L in improved group(38 cases),and (18.62 ±8.89)× 109/L,(134.38 ± 34.16)mg/L,(268.73 ± 138.12)ng/L in non-improved group(10 cases),and there were significant differences between two groups(P ＜ 0.05).The level of serum PCT on the first,third,fifth day of admission in intensive care unit in improved group was lower than that in non-improved group,and there was significant difference(P ＜ 0.05).Conclusion The alteration of serum PCT level may be used as one of the effective predictors for infection in patients with severe craniocerebral injury and for their prognosis.

Objective To compare the knee of patient controlled subcutaneous injection of morphine analge-sia after hip joint replacement ( PCSA ) and intravenous morphine patient-controlled analgesia ( PCIA ) effect and safety of postoperative analgesia.Methods 60 patients undergoing artificial total knee arthroplasty patients were selected and randomly divided into PCIA group of 30 cases,30 cases in group PCSA, two patients were completed under epidural anesthesia in the operation.Group PCIA and group PCSA single dose divided into 1mg/and 2.5mg/, lock time divided into 5min,20min,in the postoperative pain perception,from the patient's own pain medication.After 4h,8h,12h,24h record patient morphine dosage,frequency,pain score (VAPS),mean arterial blood pressure and re-spiratory rate,compose degree,analgesic effects were compared between the two groups.Results In group PCSA after 24h treatment for the total dose was (30.41 ±10.00) mg,significantly higher than that of group PCIA (18.03 ± 6.04)mg,there was significant difference between the two groups (t=3.98,P<0.05);but after each time point of the two groups of patients the average dosage had no statistically significant difference (P>0.05).PCIA group after 0-4h and >4-8h analgesia and sedation were better than those in PCSA group (t=3.4,3.2,3.5,3.7,all P<0.05), PCIA group,the incidence rate of nausea and vomiting was 30%,higher than 12%in the PCSA group,there was sig-nificant difference between the two groups (χ2 =5.76,P<0.05).Conclusion The two kinds of methods of analge-sia has a good analgesic effect,but PCSA analgesia is slower,less adverse reactions,should be given a loading dose at the beginning before PCSA,in order to improve the early analgesia effect.

Objective To evaluate the effectiveness and safety of a transanal drainage tube(TDT) for decompression of acute left-sided obstruction of colorectum.Methods Fifty-seven patients with acute left-sided colorectal obstruction were enrolled in this study from January 2010 to December 2014.The obstruction location, property, success rate of insertion, one-procedure rate and complication rate were analyzed.Results There were 53 cases of primary colorectal cancer,among which lesions were located in the transverse colon in 1 case, in descending colon in 10, in sigmoid colon in 24,and in rectum in 18.There were 4other cases, one sigmoid colonic metastases of pulmonary cancer, 1 adhesive colonic obstruction after ovary surgery, 1 cervical cancer involved with rectum with stricture and obstruction, and 1 descending colonic obstruction caused by Crohn's Disease.TDT was successfully inserted in 55 cases(96.5％) without complications,in which 43 cases of primary colorectal cancer finally underwent surgery.TDT indwelled from 0 to 22days, for an average of (8.7± 4.4)d.Hartmann operation was performed in 9 patients,6 of which underwent sufficient lymphnode dissection.Among the 43 patients, one-stage operation was performed in 34 (79.1％),of which 30 cases underwent sufficient lymph node dissection, without stoma leakage.And the rest of 13 cases refused surgery because of poor prognosis and financial problems.One patient with Crohn's Disease refused surgery after TDT insertion and was discharged after palliation of distention.Conclusion TDT is safe and effective in decompressing acute left-sided benign obstruction with high success rate and low expenditure, and can achieve preoperative colonic lavage in one-stage operation for acute left-sided colorectal malignant obstruction.

Objective To evaluate the effects of celebrity role models on the teaching of rehabilitation medicine. Methods The teaching program of rehabilitation medicine based on the effect of celebrity role models was designed and given to the college students of Capital Medical University School of Rehabilitation Medicine. The students in grades 2014 (group A) and 2015 (group B) were taught by the same teachers with celebrity and general roles, respectively. The learning attitude, immediate test following the teaching and the final exam were carried out to determine the teaching effects. Results The incidence of using mobile phones was higher in group B than in group A (χ2=8.22, P<0.05), and there was no significant difference in the incidence of doze between 2 groups (χ2=2.59, P>0.05). Nobody left early in the class. The scores of the evaluated chapters and the total score in the immediate test were higher in group A than in group B (t>2.048, P<0.05). However, there was no significant difference about those in the final exam (t<1.591, P>0.05). Conclusion The teaching program of rehabili-tation medicine based on the effect of celebrity role models could improve the short-term teaching effect.

Incision of the spinal cord (myelotomy) after spinal cord injury (SCI) is a surgical treatment which is mainly performed within 24 hours after SCI. However, many patients are fi rst seen outside the established time window of 24 hours. Furthermore, little attention has been given to its effi cacy and mechanism after 24 hours. In this study, dorsal longitudinal incision of spinal cord on SCI rats was performed at 72 hours after SCI to remove the liquefi ed necrotic gray matter. The results indicated that after myelotomy, locomotor function of hindlimbs signifi cantly improved from 21st day after SCI. There was also increased residual white matter area at the rostral and caudal segments to the injury center when examined at day 42 after the injury. These results suggested that myelotomy at 72 hours after injury has protective effect on the spinal cord.

Objective To establish the platelet antigen panel for identifying the specificity of platelet antibodies which cause platelet transfusion refractoriness and neonatal alloimmune thrombocytopenia and provide evidence for clinical therapy and platelet genotyping research.Methods Based on the frequency distribution of human platelet alloantigen (HPA)-1 to HPA-16 gene in China, the frequencies of HPA-1 to HPA-6,HPA-15 alleles in blood group O donors were genotyped by the polymerase chain reaction with sequence-specific primers (PCR-SSP) method, and suitable donors were chosen to establish platelet-specific antigen panel.Using the established platelet-specific antigen panel, the specificity of platelet antibodies caused by alloimmune reaction was identified by using simplified sensitized erythrocyte platelet serology assay (SEPSA).Results Eleven ptatelet donors with blood group O were chosen to establish platelet-specific antigen panel which can identify specificity of HPA-1 to HPA-6, HPA-15 antibodies.One case of HPA-4b (Penb) and two cases of HPA-15a (Govb) platelet specific antibodies were detected in 1 120 samples.Conclusion Identifying the specific platelet antibodies using platelet specific antigen panel has profound significance on increasing the safety and effectiveness of clinical platelet transfusion and prevention of neonatal alloimmune thrombocytopenia.

Discharge planning is the basis of continuous medical service. It could shorten the length of hospital stay, improve bed occu-pancy, reduce readmission rate, save medical costs, and improve the quality of life. It's considered to be important and supplemented by rele-vant policies and regulations to promote development in the United States, the United Kingdom, Canada, Australia and other developed countries. In China, even though Hong Kong and Taiwan have issued discharge planning policies, the mainland is still at the stage of explora-tion. Discharge planning in Chinese mainland has problems like restricted objectives, imperfect content, un-optimized process, unestablished professionals and organizations and so on. Standardized discharge planning guide still needs further research. As the health service system including hospitals, public health institutions and primary health institutions coverd urban and rural gradually, and the new pattern of grad-ing diagnosis and treatment established, it's necessary to analyze the necessity, importance, obstacles and measures of discharge planning in China.

With the social development and the transformation of medical model, providing patients with continuous services and seam-less transfer between different medical institutions, namely continuity care, is inevitable. Discharge planning take patients as the center and patient's needs as the guidance. Patients and their families should actively take part in the plan. Through multi-disciplinary and multi-institu-tional cooperation, patients can continue to enjoy health services after discharge. Discharge planning is the basis of continuous medical ser-vice. This article summrized the background and situation of discharge planning in the United States, Canada, Brazil, the United Kingdom, Ireland, Australia, Japan, India, South Africa, and Hong Kong, Taiwan and mainland in China. When heavy medical burden, aging, im-balence between supply and demand occurred, discharge planning could be helpful to make rational use of medical resources, save medical costs, guarantee the quality of medical service continuity, avoid the occurrence of adverse events after discharge and improve the patients' function and quality of life. This article reviewed group members, time, institutions and process of discharge planning in order to provide ev-idence-based basis for the development of discharge planning in China.