Objective To study the skills of laparoscopy for hight difficulty eholecystectomy.Method Forty-eight cases of hight difficulty laparoscopic cholecystectomy from July 2005 to July 2007 were analyzed retrospectively. Result In 48 cases, 5 cases were converted to open surgery, 2 cases suffered in-cision infection, all the patients recovered. Conclusion According to the operating status and experience of the performer, Calot triangle dissection and judge good opportunity to change open surgery are the key faetora to the successful operation for difficult and complex laparoscopie cholecystectomy, which is safe and feasible.

Objective:To study the effects of compatibility circumstances on guizhi's effect in dispelling cold and relieving exterior in complex prescriptions. Methods:202 formulae that effected on Sanhanjiebiao were collected from 1425 formulae with guizhi,and the frequency of herbs combining with guizhi in 202 formulae was ranked from high to low. Results:According to the compatibility frequency from high to low,herbs are:Radix Ledebouriellae(60.89%) ,Herba Ephedrae(36.63%) ,Notopterygium Incisum Ting ex H.T.Chang(27.23%) ,Radix Angelicae Dahuricae(14.85%) ,Rhizoma Zingiberis Recens(11.39%) ,Herba Schizonepetae(5.94%) ,Radix Ledebouriellae and Herba Schizonepetae(4.46%) successively. Conclusion:It showed that guizhi should combine with corresponding herbs to form compatibility circumstances to exert the effect of Sanhanjiebiao in formula,and the function exertion will be effective.

Objective To observe the effects of cultivation mode of autonomous learning ability in TCM formula on students’ learning capacity and comprehensive quality. Methods On the basis of inheriting the traditional teaching mode, classroom questioning, class discussion, problem-based learned teaching, simulated prescription exercises, autonomous teaching and training, the mid-term oral test, and autonomous proposition consisted of autonomous learning ability training mode diversification. In the teaching process, teachers' teaching was the primary, and was interspersed with cultivation mode of autonomous learning ability. At the end of the teaching activities, questionnaire survey method was adopted to evaluate the autonomous learning ability training mode in the teaching of TCM formula. Results 81.30%-97.74% students believed that this mode is helpful to improve their learning ability and comprehensive quality; 75.87%-98.49% students believed that it is necessary to carry out the mode in the teaching activities; 69.53% students believed that conducting mid-term examination in the form of oral teat is feasible. Conclusion The cultivation mode of autonomous learning ability for TCM formula can stimulate the learning enthusiasm of the students from various angles, raise interest in learning, arouse students’ learning enthusiasm and initiative, and further cultivate autonomous learning ability and clinical thinking ability, which can provide references for the teaching reform of TCM formula.

Objective To evaluate the effect of self-expandable occluder on closure of patent ductus arteriosus(PDA)with severe pulmonary arterial hypertension(PH)in adults.Methods Twenty-eight adult patients underwent transcatheter closure of PDA at a mean age of(31.3?11.6)years [(18—58)years].Either Amplatzer duct occluder or domestic device was used in the present study.X-ray,EKG and UCG were repeated in one day,one month,three months,and six months.Results Twenty of the 28 patients had successful occlusion,and the other 8 patients were given up.In the successful group,the narrowest diameter of PDA was(10.4?2.7)mm [(6—16)mm],the diameter of selected occluder was(15.6?3.2)mm [(10—20)mm] at the end of pulmonary artery.Systemic artery oxygen saturation(SAsat)before and after oxygen inhalation was(93.5?1.8)%,(98.2?1.8)%,respectively(P

Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.

Objective To investigate the spatial correlation and spatial cluster pattern of hemorrhagic fever with renal syndrome (HFRS) in Jingzhou City,Hubei Province from 2013 to 2017.Methods The HFRS surveillance data during 2013-2017 were collected from China Disease Prevention and Control Information System.Software ArcGIS 10.3 was used to analyze the spatial distribution,and global autocorrelation analysis (Moran'sI) and hot spot analysis (Getis-Ord Gi) were used to analyze the spatial autocorrelation.Spatial cluster pattern was explored by trend surface analysis and directional distribution.Results In 2013-2017,the global Moran's I was 0.117 6 (P ＞ 0.05),0.349 8 (P ＜ 0.05),0.102 1 (P ＞ 0.05),0.276 3 (P ＜ 0.05),and 0.394 8 (P ＜ 0.05),respectively.The Getis-Ord Gi analysis showed that there were 7,8,8,8,15 hot areas with high incidence of HFRS during this period,respectively,which were part of townships in Jiangling County,Shashi District,Jianli County,and Honghu City.The cold spot area with low incidence of HFRS was only detected in 2015,and it was part of the township in Shashi District and Jingzhou District.The trend surface analysis showed that the inverted-U type curve could reflect the HFRS distribution from northern to southern,and it was also from eastern to western.The directional distribution showed that the HFRS cases were distributed in the north-central part of Jingzhou in 2013-2017,and they were inconsistent with the distribution of the Yangtze River system.Conclusions The incidence of HFRS has an obvious spatial clustering characteristic,and the areas at high risk are mainly in the north-central part of Jingzhou City.The spatial cluster pattern of HFRS has nothing to do with the Yangtze River system.

Since its founding 100 years ago, the Communist Party of China (CPC) has attached great importance to the occupational health of workers, and closely linked the safeguard of occupational safety and health of workers with the missions of leading the people to stand up, get rich, and become strong. Based on this, the achievements of occupational health work made under the leadership of the CPC since the new democratic revolution, socialist revolution and construction, the new period of reform and opening up and socialist modernization, and socialism with Chinese characteristics for a new era were summarized, so as to provide reference for understanding the legacy of China's occupational health undertaking, and innovating to create the future.