Objective To summarize and analyze the relationship between exposure to rabies and its prevalence in Jurong City from 2003 to 2007,and discuss further the possible solutions to it.Methods The data of people vaccinated after being biten by animals were collected,manipulatd,and analyzed,with their illness records dealt with accordingly from 2003 to 2007 in Jurong City.Results Not a single one of 21 596 cases was that of rabies with proper treatment in the last 5 years.The sex ratio was 1.47∶1.The highest probability of exposure was the preschoolers under the age of 10.The disease occurred throughout the year,with the peak in July and September.Those biten by dogs accounted for 86.85% of the exposure to rabies,and among them,people biten by domesticated animals were in the majority.Wounds by the domesticated dogs reached 74.60%.Not a single case was treated properly among the 9 rabies cases reported in the same period.Conclusions Strengthening the management of domesticated dogs,publicizing the knowledge of rabies,treating the wound properly and thoroughly,innoculation with vaccine from the very beginning and administering rabies immune globulin are the effective ways to prevent rabies.

Objective The objective of this experiment was to find out the causes and mechanisms of vocal cord granulomas,to analyze the results of different treatments and to establish an effective protocol of treatment.Methods 24 patients with vocal cord granulomas were analyzed in terms of genders,ages,occupations,etiologies,such as voicing,gastroesophageal reflux,and treatment under general anesthesia and jet-ventilation,treatments and outcomes.Results Based on different etiologies,patients were divided into 4 groups: Group I of 9 patients with pathologic phonation,Group II of 8 patients with gastroesophageal reflux,Group III of 2 patients with treatment under general anesthesia and jet-ventilation,Group IV of 5 patients with unknown causes.9 patients received operations while 8 demonstrated good prognosis and one was completely cured.The vocal cord granulomas for 11 patients disappeared,8 had reduced vocal cord granulomas,and the vocal cord granulomas for 5 patients without any treatment were gone 6 months later.Conclusion The vocal cord granulomas can be caused by many factors with gastroesophageal reflux as a main etiology.Higher recurrences were noted after surgical treatment;therefore,treatment for gastroesophageal reflux and voice therapy should be considered as major approaches.

Objective: To evaluate the minimally invasive splayed incisions in the internal fixation with a conventional calcaneal plate for calcaneal fractures of sanders types Ⅱ and Ⅲ. Methods: This prospective study was conducted from May 1st, 2016 to December 1st, 2017 in the 40 patients with calcaneal fracture at Department of Orthopedics, Shanghai Pudong Hospital. Their ages ranged from 23 to 55 years (average, 39.5 years). According to the Sanders classification, 27 fractures were type Ⅱ and 13 type Ⅲ. They were all treated with a conventional calcaneal plate through minimally invasive splayed incisions. The Böhler and Gissane angles, the height, width and length of the affected calcaneus were compared between preoperation, 3 months after operation and the last follow-up; the clinical function of the affected feet was graded using the Maryland foot score; postoperative complications were observed. Results: The 40 patients were followed up for an average of 12.5 months (from 11 to 16 months). All the skin incisions healed well with no skin necrosis or wound infection. No injury to the sural nerve occurred. All the fractures healed after an average of 8 weeks (from 7 to 10 weeks). All the patients resumed their routine daily activities and returned to their former work post after an average time of 4.1 months (from 3 to 6 months). At pre-operation, 3 months after operation and the last follow-up, their Böhler angles were respectively 19.2°±6.3°, 30.5°±6.4° and 29.9°±6.5°; their Gissane angles 103.9°±14.8°, 119.3°±5.6° and 119.8°±6.3°; their calcaneal heights (32.5±3.5) mm, (36.8±1.5) mm and (36.5±1.8) mm; their calcaneal widths (36.8±3.4) mm, (33.1±3.8) mm and (33.0±3.2) mm; their lengths (61.4±4.5) mm, (65.5±6.9) mm and (65.5±9.4) mm. In all the patients, the Böhler and Gissane angles and the calcaneal heights and lengths increased significantly while the calcaneal widths decreased significantly at 3 months after operation and the last follow-up (P<0.05). There were no significant differences between 3 months after operation and the last follow-up in the Böhler or Gissane angle, the height, width or length of the affected calcaneus (P>0.05). Their Maryland foot scores showed 35 excellent cases, 4 good cases and one fair case, giving an excellent and good rate of 97.5%. Conclusions A conventional calcaneal plate plus minimally invasive splayed incisions can be effective for calcaneal fractures of Sanders types Ⅱ and Ⅲ, leading to reduced wound complications, anatomical restoration of calcaneal morphology, and smooth subtalar articular surface.

Objective To compare the prediction of Functional Gait Assessment (FGA) and Berg balance scale (BBS) for fall among community-dwelling older adults aged 75~85 years old. Methods 162 older adults randomly selected from 3 communities in Beijing were evaluated with FGA and BBS. They were divided as fallers and nonfallers according to the history of fall during the last year. Results The scores of FGA and BBS increased significantly in the nonfallers compared with the fallers (P<0.001). The total scores of FGA correlated with the scores of BBS (r=0.723, P<0.001). The total scores of FGA significantly correlated with the scores of items of FGA (P<0.01), except that of walking with eyes closed (P=0.31). According to the Receiver Operating Characteristic (ROC) Curve, the area under the curve was 0.901 for FGA, and 0.872 for BBS. According to the Youden index, the cutoff value of FGA was 19.5, with sensitivity of 85.5% and specificity of 81.2%. The cutoff value of BBS was 48.5, with sensitivity of 78.3% and specificity of 83.3%. Conclusion FGA is more effective than BBS for predicting the fall in community-dwelling older adults, which is more sensitive and similarly specific.

Objective To study the coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy (LPD).Methods A retrospective analysis was conducted on 101 patients who underwent LPD at the Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,from January 2014 to March 2017.The study aimed to study the coordination and function of a laparoscopic assistant.Results LPD was successfully completed in all the 101 patients.There was no conversion to open surgery.The operation time was (326.0 ± 55.6) min,and the resection time was (174.4 ± 42.5) min.The digestive tract reconstruction time was (101.0 ± 21.4) min.The time of pancreaticojejunostomy was (40.5 ± 8.7) min.The time of gastrointestinal anastomosis was:(26.3 ± 5.5) min.The time of biliary anastomosis was (24.4 ± 6.5) min.The intraoperative bleeding was (175.6 ± 41.1) ml.Postoperative pathological data showed that 27 patients (26.7％) had distal common bile duct cancer,23 patients (22.8％)ampullary carcinoma,39 patients (38.6％) duodenal papillary carcinoma,and 12 patients (11.9％) pancreatic ductal adenocarcinoma.The tumor diameter was (2.3 ± 1.3) cm,and the number of resected lymph nodes was (16.7 ±4.2).The number of positive lymph nodes was 1.3 ± 1.1.The length of postoperative hospital stay was 14.8 (8 ～ 29) d.Twenty-three patients developed postoperative pancreatic fistula,including 17 patients (16.8％) with a biochemical fistula,5 patients (5.0％) with a grade B pancreatic fistula,and 1 patient (1.0％) with a grade C pancreatic fistula.There were 2 patients (3.0％) with bile leakage,7 patients (6.9％) with intra-abdominal bleeding,4 patients (4.0％) with delayed gastric emptying,6 patients (5.9％) with abdominal infection,3 patients (3.0％) with pulmonary infection,2 patients (2.0％)with intestinal obstruction,3 patients (3.0％) required a repeated operation,and 1 patient (1.0％) with death in hospital within 30 days after surgery.Conclusions The laparoscopic assistant should have the perspective of "one axis,two sides and four regions" in LPD,and warn the operator to ensure the safety and fluency of the operation by clearly exposing important blood vessels and organs when performing the Kocher incision and when dissecting the key parts such as the dangerous triangle of the uncinate process.During anastomosis,the laparoscopic assistant should appropriately adjust the distance of vision,clearly reveal the surgical field of the anastomotic area,and help the surgeon in improving the precision of the suture and the quality of the anastomosis.

Objective To investigate the diagnosis, treatments for primary hepatic neuroendocrine neoplasm (NEN) and the efficacy.Methods Clinical data of 10 patients with primary hepatic NEN admitted in Hunan People's Hospital from March 2013 to December 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 3 males and 7 females, aged 21-65 years old and the median age was 45 years old. According to the WHO classification for digestive system tumor 2010 version, there were 6 cases of neuroendocrine tumor (NET) G2, and 4 cases of neuroendocrine carcinoma (NEC). The clinical data, imaging characteristics, treatment, tumor pathological characteristics and prognosis of the patients were analyzed.Results Right upper abdominal pain was observed in 5 cases, right upper abdominal mass in 1 case, asthenia and anorexia1 in 1 case, and the remaining 3 cases were found with tumor when receiving routine physical examination. For imaging finding, 8 cases were diagnosed as isolated liver mass, and 2 were found with multiple masses in the liver. All of the 10 patients were confirmed by pathological examination, of which 3 were diagnosed by biopsy before operation, and 7 were confirmed with pathology after operation. 6 cases underwent radical resection, 1 case received microwave ablation, 1 underwent liver resection and intravenous chemotherapy pump implantation, 1 received chemotherapy alone and 1 abandoned treatment. To the submission date of this article, 6 cases survived without recurrence, 1 case suffered recurrence 1 month after operation with multiple lymph node metastases in the peritoneum and remained alive. 2 cases died, 1 of which died of no treatment after biopsy, 1 died of multiple distant metastases after 1 period of chemotherapy, and 1 lost follow-up.Conclusions There is no specific clinical manifestations of hepatic NEN. It should be confirmed by pathological examination. Surgical resection is the first choice for treatment. For patients with unresectable mass, TACE, microwave ablation and chemotherapy can be applied.

Pancreatic adenocarcinoma (PAAD) is one of the most lethal malignancies. Although gemcitabine (GEM) is a standard treatment for PAAD, resistance limits its application and therapy. Secoemestrin C (Sec C) is a natural compound from the endophytic fungus Emericella, and its anticancer activity has not been investigated since it was isolated. Our research is the first to indicate that Sec C is a broad-spectrum anticancer agent and could exhibit potently similar anticancer activity both in GEM-resistant and GEM-sensitive PAAD cells. Interestingly, Sec C exerted a rapid growth-inhibiting effect (80% death at 6 h), which might be beneficial for patients who need rapid tumor shrinkage before surgery. Liquid chromatography/mass spectrometry and N-acetyl-l-cysteine (NAC) reverse assays show that Sec C sulfates cysteines to disrupt disulfide-bonds formation in endoplasmic reticulum (ER) proteins to cause protein misfolding, leading to ER stress and disorder of lipid biosynthesis. Microarray data and subsequent assays show that ER stress-mediated ER-associated degradation (ERAD) ubiquitinates and downregulates YAP to enhance ER stress via destruction complex (YAP-Axin-GSK-βTrCP), which also elucidates a unique degrading style for YAP. Potent anticancer activity in GEM-resistant cells and low toxicity make Sec C a promising anti-PAAD candidate.