Type Ⅰ congenital biliary dilatation is a congenital biliary duct defect disease.It is also called congenital choledochocele cyst (CCC).Endoscopic ultrasonography (EUS),magnetic resonance cholangiopacreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are very important for the diagnosis.Operation is generally regaded as the best choose.It is recommended that cholecystectomy + choledochal cyst excision + hepatic duct jejunum Roux-Y anastomosis is the chief therapeutic method.This article reviews the pathogenesis,classifications,diagnosis and treatment of the disease.

ObjectiveTo evaluate the application of quantitative sensory testing(QST) in hemodialysis (HD) patients with peripheral neuropathy.MethodsThe values of the quantitative sensory testing and sensory conduction velocity at different locations of extremities in 40 cases of the HD patients and 40 normal persons were recorded.ResultsAccording to the control group,without symptoms group and with symptoms group,the thermal threshold(TT) and vibratory threshold (VT) at the four different locations of extremities were increased,thresholds of the later two groups were significantly higher than those of normal controls (P ＜ 0.05 ).Especially finger warm and vibratory thresholds,hypothenar heat pain thresholds,instep heat pain and vibratory thresholds,calf cold pain and vibratory thresholds were significantly difference between with symptoms group and normal control group (P＜0.01 ).Finger cool and warm thresholds,instep heat pain thresholds,thresholds of calf warm,cold pain and heat pain,and vibratory thresholds at the four different locations of extremities were significantly difference between wthout symptoms group and with symptoms group (P＜ 0.05).The SCV values of the median nerve,tibial nerve and lateral popliteal nerve were significantly difference between HD patients group and normal control(P ＜0.05 ).The total abnormal rate of QST was 65％,with symptoms group was 77.27％,total abnormal rate of SCV was 55.0％,with symptoms group was 68.18％.The total abnormal rate of QST were significantly higher than those of SCV (P＜0.01 ).ConclusionQST is a sensitive method for diagnosis of uremic neuropathy.

Objective To investigate the related factors affecting prognosis of patients with colorectal cancer undergoing palliative resection.Methods The clinical data of 345 patients with colorectal cancer who underwent palliative resection at the First Affiliated Hospital of Guangxi Medical University between January 2007 and December 2011 were retrospectively analyzed.Patients selected the emergent operations or restrictive operation based on the conditions of patients,and then received chemotherapy,radiotherapy and biotherapy.Chemotherapy regimens included FOLFOX4 (5-FU/CF + oxaliplatin) regimen,XELOX (capecitabine + oxaliplatin) regimen and FOLFIRI (5-FU + CF + irinotecan) regimen.Biotherapy regimens included molecular targeted therapies using bevacizumab and cetuximab.The follow-up was applied to patients by outpatient examination,telephone interview and correspondence once every 3 months up to March 1,2014.The survival curve was drawn by the Kaplan-Meier method.The survival rate was analyzed using the Log rank test.The multivariate analysis was done using the COX regression model.Results Of the 1 930 patients,345 patients received palliative resection with a percentage rate of 17.876％.Among the 345 patients,104 patients received emergent operations and others received restrictive operations.After operation,178 patients received adjuvant treatment,FOLFOX4 regimens were done on 85 patients,XELOX regimens on 32 patients,FOLFIRI regimens on 20 patients,radiotherapy on 17 patients and molecular targeted therapies on 24 patients.Seven patients died in the perioperative period and other patients were followed up for 3.0-82.0 months with a median time of 14.0 months.The 1-,3-and 5-year survival rates and the mean survival time were 49.57％,11.88％,6.38％ and 22.6 months,respectively.The results of univariate analysis showed that the CEA levels,bowel obstruction,primary tumor resection,peritoneal implantation,distal metastasis,lymph node metastasis,tumor differentiation,postoperative adjuvant therapy were related factors affecting the prognosis of patients undergoing palliative resection (x2=3.742,18.795,37.641,13.470,4.228,5.835,4.108,6.875,P ＜0.05).The results of multivariate analysis showed that the bowel obstruction,without primary tumor resection,peritoneal implantation,low-differentiation of tumor and without postoperative adjuvant therapy were the independent risk factors affecting the prognosis of patients undergoing palliative resection (RR =1.674,2.273,1.947,1.582,1.342,95％ confidence interval:1.193-2.485,1.646-4.376,1.497-3.587,1.184-2.382,1.032-2.074,P ＜ 0.05).Conclusion The low-differentiation of tumor,peritoneal implantation,bowel obstruction,without primary tumor resection and without postoperative adjuvant therapy are the independent risk factors affecting the prognosis of patients with colorectal cancer undergoing palliative resection.

Objective To investigate the effects of low dose radiation on the level of oxidative damage and antioxidant in population of high background radiation area of Guangdong.Methods A total of 48 male residents who lived in high background radiation area(HBRA) of Guangdong province and 48 male residents who lived in neighboring Enping control area were chosen as the objectives and control respectively.The peripheral venous blood of two groups was collected,and then the levels of 8-OHdG and TrxR were determined by enzyme linked immunosorbent assay (ELISA).Results Compared with the CA group [(315.39 ± 100.59) ng/ml],the level of 8-OHdG [(272.64 ± 96.85) ng/ml] decreased significantly in HBRA (t =2.121,P ＜0.05).Compared with the CA group [(0.467 ±0.056) ng/ml],the level of TrxR [(0.496 ± 0.044) ng/ml] increased significantly in HBRA (t =-2.823,P ＜ 0.05).The results of multiple linear regression analysis demonstrated that the chronic exposure to low dose of radiation had significant effects on the expression level of 8-OHdG and TrxR (t =-2.327,2.367,P ＜ 0.05) after adjustment for confounding factors such as age,drinking,tea drinking,smoking,medical exposure and stressful events.Conclusions Chronic exposure to low dose radiation may decrease the level of oxidative and enhance the level of antioxidant.

ObjectiveTo investigate the effect of combined spinal epidural analgesia (CSEA) on immune function by observing the changed level of T lymphocyte subsets in maternity sera in labor.MethodsFifty healthy primipara with single birth,vertex present and ASA I between July 2007 and Dec 2007 at the first Affiliated Hospital of Nangchang University,who were in spontaneous labor,were randomly divided into two subgroups when their rerviral dilations were in 2～3 cm.In interfering subgroup( n =25),the puncture point of CSEA was at L3-4 interspace,the fentanyl (20 μg) was used in lumbar anesthesia,the ropivaraine (0.1％) rombined with fentanyl (2 μg/ml) was used in epidural analgesia.Blood samples were taken from the mother vein at cervical dilation in 2 ～ 3 m (T1),fetal disengagement(T2),24 hrs after childbirth ( T3 ).Flow cytometry was used to measure T lymphocyte subsets,Radioimmunoassay (RIA) was used to measure cortisol.In addition,Data on labor progress,VAS score,and neonatal Apgar score were recorded for each patient.Results(1)The active phase in the first stage of labor after analgesia in the CSEA group [ ( 177.64 ± 67.98 ) min ] was significantly lower than that in control group [ (219.40 ± 67.37) min ].No significant difference was found for the active phase in the second stage and the third stage,and for the neonatal Apgar score between the CSEA group [ (32.92 ± 11.59 ) min,( 7.56 ± 2.47 )min,9.20 ± 0.82,respectively ] and the control group [ ( 31.44 ± 13.93 ) min,( 7.28 ± 2.25 ) min,8.84± 1.31,respectively ].(2)The level of cortisol in A group [ ( 548.11 ± 75.67) ng/ml ] was significantly lower than that in C group[ (789.32±96.07) ng/ml] at T2.(3) In two groups,the levels of the CD3+,CD4+,CD4+/CD8 + degraded in different degree at each point,more significantly decreased at T3,and these in C group[ (48.43 ± 6.46) ％,( 31.35 ± 8.93 ) ％,(0.96 ± 0.21 ) ％,respectively ] were significantly lower than those in A group [ (52.3 ± 5.62 ) ％,( 36.90 ± 7.91 ) ％,( 1.16 ± 0.25 ) ％,respectively ].ConclusionsCSEA could shorten the active delivery phase in the first stage of labor,and did not affect the neonatal Apgar score.It can alleviate the inhibitory effect of pain stress response on the immune function.

Objective To discuss the relationship between TCM syndromes and peritoneal fluid cytokine IL-6, IL-8 and TNF-α of endometriosis infertility patients, and provide thoughts for clinical treatment. Methods Totally 105 patients of endometriosis infertility were differentiated to six syndrome groups, including kidney deficiency and blood stasis, qi stagnation and blood stasis, heat stagnation and blood stasis, cold congelation and blood stasis, qi deficiency and blood stasis, phlegm-dampness stagnation. Thirty patients of non-endometriosis infertility were selected as control group. Enzyme-linked immunosorbent assay was used to detect cytokine levels of IL-6, IL-8 and TNF-α. Results In 105 cases of EM infertility, 35 cases (33.33%) were syndrome of kidney deficiency and blood stasis, 22 cases (20.95%) were syndrome of cold congelation and blood stasis, 18 cases (17.14%) were syndrome of qi stagnation and blood stasis, 10 cases (9.52%) were syndrome of heat stagnation and blood stasis, 11 cases (10.48%) were syndrome of qi deficiency and blood stasis, 9 cases (8.57%) were phlegm-dampness stagnation syndrome. The levels of IL-6, IL-8 and TNF-αin each syndrome group of EM infertility were higher than control group (P<0.01). IL-6 level in kidney deficiency and blood stasis group were higher than other syndrome groups (P<0.05). The levels of IL-8 and TNF-α in kidney deficiency and blood stasis group, and heat stagnation and blood stasis group were higher than other syndrome groups (P<0.05). IL-8 in kidney deficiency and blood stasis group was higher than that in heat stagnation and blood stasis group (P<0.05). Conclusion TCM syndromes in patients with endometriosis infertility have some relevance with peritoneal fluid cytokine levels of IL-6, IL-8, TNF-α, which may guide clinical understanding and treatment of endometriosis infertility.

Objective To investigate the status of clinical nutrition management in patients in PICU,and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients.Methods A questionnaire survey was conducted on PICU specialists.The nutrition assessment,nutrition intervention and nutrition management of critically ill children in PICU were investigated.The results were summarized and analyzed.Results A total of 39 PICU specialists were involved in this survey.The nutritional assessment methods and guidelines in domestic PICU were not unified.Twenty-five respondents (64.1%) believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not;all respondents believed that nutritional assessment and intervention time need to be determined by the needs of the patients;23 respondents(58.9%) used weight only as their nutritional monitoring indicators.Twenty-eight respondents(71.8%) considered that gastric tube was the first choice way to feeding for the critically ill children;20 respondents(51.3%) believed that critically ill children should be fed within 24 hours.Twelve respondents (33.3%) believed that critically ill children should be fed between 24 to 48 hours.Thirty-three respondents(84.6%) advocated early enteral nutrition;36 respondents (92.3%) considered that the main reasons of fasting in critically ill children were vomiting or abdominal distension or gastrointestinal bleeding.Twenty-eight respondents(71.8%) believed that according to the results of gastrointestinal function evaluation,they made decisions whether the patient to fast or not.Twenty-three respondents(59.0%) considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children.Twenty-four (61.5%) of the respondents believed that we needed to establish our own routines in management of nutrition in PICU.Conclusion At present in China,a lot of achievements have been made in the nutritional assessment,monitoring,early enteral nutrition intervention and management in critically ill children,but it is not enough.We need to make more effort to enhance the critically nutrition level in PICU,and we have a lot of research to do about nutrition assessment and nutrition intervention mode.It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.

OBJECTIVE: To investigate the current status and influencing factors of occupational stress in female workers of labor-intensive enterprises. METHODS: Totally 910 female workers from 5 labor-intensive enterprises in Guangdong Province was selected as the research subjects by random cluster sampling method. A questionnaire survey on occupational stress was conducted using the Occupational Stress Inventory-Revised Edition. RESULTS: Among the 910 female workers,14. 9%( 136/910) showed medium or higher scale on occupational role level,20. 1%( 183/910) showed medium or higher scale on occupational stress level,and 21. 4%( 195/910) showed medium or higher scale on personal resources lack. Multivariate logistic regression analysis indicated that the risk of occupational stress was high in single female workers and/or those exposed to occupational hazards( P < 0. 01). The higher the occupational role level,the higher risk of occupational stress( P < 0. 01). The less personal resources,the higher risk of occupational stress( P < 0. 01).CONCLUSION: Some female workers in labor-intensive enterprises showed medium or higher occupational stress level. The main influencing factors of occupational stress are marital status,exposure to occupational hazards,occupational role and personal resources.

Objective:To evaluate the accuracy of lung ultrasound score (LUSS) in predicting emerging hypoxemia after tracheal extubation in the patients in postanesthesia care unit (PACU).Methods:A total of 333 patients of both sexes, aged 18-89 yr, of American Society of Anesthesiologist physical statusⅠ-Ⅲ, scheduled for elective abdominal surgery, were included in the study.Lung ultrasound examinations were performed before operation (T 0) and on admission to PACU (T 1), and the LUSS were recorded as LUSS 0 and LUSS 1.Arterial blood gas analysis was conducted at 20 min after tracheal extubation, and oxygenation index (PaO 2/FiO 2) were recorded.Patients were divided into 2 groups according to the oxygenation index: PaO 2/FiO 2<300 mmHg group (hypoxemia group), and PaO 2/FiO 2≥300 mmHg group (non-hypoxemia group). Multivariate logistic regression analysis and the receiver operating characteristic curve were used to evaluate the accuracy of LUSS 1 in predicting the emerging hypoxemia after extubation in the patients in PACU. Results:The incidence of emerging hypoxemia in PACU after extubation was 9.0%.Multivariate logistic regression analysis indicated that LUSS 1 and body mass index were independent risk factors for emerging hypoxemia after extubation in the patients in PACU.The area under the ROC curve for LUSS 1 was 0.873 ( P<0.001, 95%CI 0.812-0.935). The patients with LUSS 1<7 had a lower risk of hypoxemia after extubation (LR -=0.15, 95%CI 0.05-0.45), and the patients with LUSS 1>10 had a higher risk of hypoxemia after extubation (LR + =17.25, 95%CI 7.35-40.51). Conclusion:LUS can effectively predict the development of hypoxemia after tracheal extubation in the patients in PACU.

Multimodal analgesia is the gold standard for postoperative pain management,and ultra-sound-guided nerve block as the cornerstone supplemented with fewer opioids and a sufficient amount of non-steroidal anti-inflammatory drugs(NSAIDs)throughout the entire course of the procedure is the most main-stream multimodal analgesic regimen at present.However,ultrasound-guided nerve blocks are limited by the duration of action of local anesthetics and often provide effective analgesia for surgical patients for no more than 8 hours,resulting in a low satisfaction rate of postoperative analgesia in surgical patients.With the con-tinuous research on the concept of rapid rehabilitation,how to extend the duration of action of local anesthet-ics is the focus and hotspot of research.Ultra-long-acting local anesthetics include liposomal bupivacaine and HTX-011,which have been applied in clinical practice,and quaternary ammonium derivatives,which are still in the research stage.In this paper,we will review the existing ultra-long-acting local anesthetics in terms of ultra-long-acting local anesthetics with extended-release systems,new pathways and targets of ultra-long-acting local anesthetics,and the development of ultra-long-acting local anesthetics in the form of brand-new compounds,so as to provide new ideas for the subsequent research and clinical application of ultra-long-acting local anesthetics.