Objective To explore the influencing factors and timing of acute cholecystitis laparoscopic surgery.Methods One hundred and sixty acute cholecystitis patients treated with laparoscopic surgery were divided into group A (56 cases,performed treatment within 24 h),group B (42 cases,performed treatment at 24 -48 h),group C ( 40 cases,performed treatment at 49 -72 h),group D (22 cases,performed treatment after 72 h).The operation time,rate of conversion to laparotomy,length of stay and average costs were compared among four groups and analyzed the impact of laparoscopic surgery conversion to laparotomy.Results The rate of conversion to laparotomy of group D [ 59.09％(13/22) ] was significantly higher than that in group A [ 19.64％(11/56) ] (P ＜ 0.01 ).The operation time of group A was the shortest and group D was the longest.The length of stay of group D was significantly longer than other groups (P ＜ 0.05 ).The costs of the four groups had no significant difference(P ＞ 0.05 ).Single factor analysis showed that white blood cell (WBC) count,body temperature,timing of surgery,gallbladder neck calculi incarceration were correlated with conversion to laparotomy(P ＜ 0.05 ).Multifactor analysis showed that WBC count,timing of surgery were independent risk factors of conversion to laparotomy (P ＜ 0.05 ).Conclusions WBC count,body temperature,timing of surgery,gallbladder neck calculi incarceration are correlated with acute cholecystitis laparoscopic surgery conversion to laparotomy.While WBC count and timing of surgery are independent risk factors.The best time of laparoscopic surgery is within 72 h and WBC count ＜ 15 x 109/L.

Objective To explore clinical effect of dinoprostone in premature rupture of the membranes at term cervical ripening.Methods 42 cases with premature rupture of the membranes at term cervical ripening were selected.All patients were randomly divided into two groups.The dinoprostone group had 21 cases,which applied the treatment of dinoprostone belt the posterior fornix of vagina medicine induced abortion.The oxytocin group had 21 cases,which applied the treatment of intravenous drip oxytocin.The time of induction labor,6h,12h cervical Bishop score after using the medication,drugs acting time,labor conditions and perinatal situation,pregnancy outcome and some other index were observed.Results It taken (6.18 ± 4.48 ) h until parturient and ( 12.62 ± 8.03 ) h until the cervical mouth full open in the dinoprostone group,which were shorter than the oxytocin group,that taken( 10.21 ±5.42) h,( 18.87 ± 9.14) h.( t =2.62,2.35,all P ＜ 0.05 ).There was no significant difference about cervical Bishop score before using the medication.It's(7.52 ± 2.44 ) point 6h after using the medication and( 9.03 ± 1.96 ) point 12h after in the dinoprostone group.They were better than the oxytocin group,which were(5.97 ± 1.95 )point,(7.13 ±2.12 )point.It was significantly different( t =2.27,3.02,all P ＜0.05 ).The average incubation period of dinoprostone group wss (9.91 ± 1.73 )h.It's longger than the oxytocin group,which was( 8.72 ± 1.34)h.The active period of dinoprostone group was(4.36 ± 0.66 ) h.It's shortter than the oxytocin group,which was( 5.84 ± 1.02 ) h.The difference was significant( t =2.49,5.58,all P ＜ 0.05 ).There was no significant difference in the second and third stage of laber between the two groups( t =0.56,0.33,all P ＞ 0.05 ).There was also no significant difference about intrauterine distress,amniotic fluid contamination,cesarean section,intestinal bleeding,the Apgar score of newborns and some other index in the two groups ( x2 =0.00,0.00,0.52,t =0.84,1.04,all P ＞ 0.05 ).Conclusion Dinoprostone had good promoting effect on cervical ripening for preterm premature rupture of membranes pregnant woman.Its effect was better than oxytocin and it was safe to use.

BACKGROUND: Spinal somatosensory evoked potential(SEP) monitoring is widely used intraoperatively due to the easiness to operate and its reliability.OBJECTIVE: This study was designed to assess the significance of improving SEP signals in intraoperative spinal monitoring on predicting the post-operative spinal function.DESIGN: A non-randomized concurrent controlled study was conducted on selected patients.SETTING: This study was conducted at the Orthopedic Department of Peking Union Medical College Hospital.PARTICIPANTS: Totally 34 patients with cervical spondylosis underwent surgical treatment at the Orthopaedic Department of Peking Union Medical College Hospital were selected from January to October in 2001. Of all the patients, 24 underwent anterior decompression and fusion, 3 single door operation and 7 double door operation. According to the variance of intraoperative SEP, the patients were divided into the improvement group(12 cases)and the non-improvement group(22 cases).METHODS: All the patients' neurologic deficits were assessed according to the Japanese Orthopaedic Association scoring system(JOA score), prior to operation and postoperative week 1, 2, and 4 and month 3, 6. Each patient received the intraoperative spinal SEP monitoring. The variance of SEP signals in amplitude and latency were classified as improvement(an increase in amplitude of 50% or more, or a decrease in latency of 10% or more), decrease(a decrease in amplitude of 50% or more, or an increase in latency of 10% or more), and no improvement.MAIN OUTCOME MEASURES: JOA scores were calculated in two groups in the study at all time points.RESULTS: All the 34 patients entered the statistical analysis procedure. In postoperative week 1 and week 2, the improvement group showed a larger increase in JOA score than the non-improvement group did[improvement group:(14.08±1.44), (14.17±1.11) points; no improvement group:( 12.73 ± 1.42), ( 12.86 ± 1.28)points, P ＜ 0.05]. In postoperative week 4, month 3 and month 6, both groups showed an increase in JOA scores [improvement group: (14.00±1.04), (13.58±1.08), (13.68±1.61)points; no improvement group: (13.82 ± 1.01), (13.41 ± 1.22), (13.41± 1.47)points], but there was no significant difference( P ＞ 0.05).CONCLUSION: Improvement of intraoperative SEP can be used to predict the good early clinical outcomes in surgery for cervical spondylosis.

The incidence of variation of cerebrovascular structure is higher in population.Previous studies have shown that the variation of the cerebrovascular structure is an independent risk factor for ischemia stroke.This article reviews the common cerebrovascular variation and its relationship with ischemic stroke.

Objective To investigate the effect of basilar artery hypoplasia (BAH) on the outcomes in patients with acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke admitted to hospital within 7 d after onset were enrolled.The modified Rankin Scale was used to assess the functional outcomes at discharge and 90 d after onset,and 0-2 was defined as a good outcome.BAH was defined as the basilar artery uniform and fine and its diameter ＜2 mm in the level of pons.Demography,vascular risk factors,vascular variation,baseline clinical data,and laboratory examinations were compared between the good outcome group and the poor outcome group.Multivariate logistic regression analysis was used to determine the independent influencing factors of outcomes in patients with acute ischemic stroke.Results A total of 334 patients with acute ischemic stroke were enrolled,including 112 (33.5％) females and 222 (66.5％) males,with an average age of 67.3 ± 12.0 years;28 (8.4％) patients had BAH,260 (77.8％) had good outcomes at discharge,258 (77.2％) had good outcomes at 90 d after onset.The age,baseline National Institutes of Health Stroke Scale (NIHSS) score,fasting blood glucose level,and the proportions of atrial fibrillation,anterior circulation infarction,and non-BAH in the poor outcome group were significantly higher than those in the good outcome group at discharge (all P ＜ 0.05).Multivariable logistic regression analysis showed that the higher baseline NIHSS score (odds ratio [OR] 1.170,95％ confidence interval [CI] 1.088-1.258;P ＜ 0.001) and fasting blood glucose (OR 1.155,95％ CI 1.049-1.272;P =0.004) were the independent risk factors for poor outcome,and BAH (OR 0.190,95 ％ CI 0.039-0.920;P =0.039) was an independent predictor of good outcome at discharge.The age,fasting blood glucose,low-density lipoprotein cholesterol,baseline NIHSS score,and the proportions of smoking,atrial fibrillation,anterior circulation infarction,and non-BAH in the poor outcome group were significantly higher than those in the good outcome group at 90 d after onset (all P ＜0.05).Multivariate logistic regression analysis showed that higher baseline NIHSS score (OR 1.172,95％ CI 1.089-1.262;P ＜0.001) and higher fasting blood glucose (OR 1.156,95％ CI 1.048-1.275;P =0.004) were the independent risk factors for poor outcome,and BAH (OR 0.195,95％ CI 0.040-0.940;P =0.042) was an independent predictor of good outcome at 90 d after the onset.Conclusion BAH is the independent predictor of good outcome in patients with acute ischemic stroke.

Abstract Flood disasters are the common public health emergencies, mainly leading to environmental damage, water pollution, food pollution, vector breeding, infectious disease epidemic and other risk factors of sanitary and anti epidemic work. The guideline has been formulated with reference to the technical documents such as Guideline for Environmental Sanitation Disposal and Preventive Disinfection in Flooded Areas and Technical Proposal for Sanitary and Anti epidemic Measures after Flood Disasters, as well as the latest research progress at home and abroad. In order to guide the sanitary and anti epidemic measures in flooded areas, protect the health and safety of students and teachers and ensure the normal educational and teaching order, the guideline introduces the key measures that should be taken by schools, teachers and students in flood striken areas.

In order to test the practicability and operability of the emergency plan for environmental emergencies of district, the ability of radiation accidents quickly respond, emergency monitoring and disposal of the radiation emergency monitoring team, and to inspect cooperative disposal ability according to the responsibilities stipulated in the plan of police department, health department, and publicity departments, and to further standardize the emergency response procedures for radiation accidents, and carry out radiation accident emergency drills. To describe the radiation accident drill organized by the district and jointly held by environmental protection, police department, health department, publicity and other departments, to analyze the scenario design, emergency equipment, emergency monitoring, on-site disposal, emergency termination, and to summarize and analyze the drill. The drill strictly implemented the emergency response procedures for radiation accidents, and comprehensively verified the nuclear and radiation emergency system in Chang'an District. By relying on the existing national technical force, the drill vigorously coordinated and cooperated to improve the rapid response ability of radiation emergency. The drill is an important way to effectively improve the emergency management ability of radiation accidents, to improve the technical ability of effectively response and emergency disposal of radiation environmental safety, and improve the technical level of the emergency monitoring team. It is also one of the technical means for the effective supervision of radioactive sources. It is suggested to continuously carry out the construction of online supervision capability during the transportation of radioactive sources, to improve the professional qualities and skills of road transport operators and reduce the probability of accidents, and continue to strengthen emergency exercises (drills) and technological innovation.

Objective To investigate the effect of short-term complications after D2 radical gastrectomy on long-term survival rate of gastric cancer patients. Methods A retrospective case-control study was conducted on 421 patients with gastric cancer who underwent D2 radical gastrectomy. According to the short-term postoperative complications, they were divided into experimental group (complication group, n=76) and control group (without complication group, n=345). In order to reduce the selection bias, the long-term survival rate of the two groups was tested by Kaplan-Meier survival analysis method after balancing the variables by propensity score matching (PSM). Log rank method was used for univariate analysis and Cox multivariate analysis was used for prognostic factors. Results There was no significant difference in long-term survival rate between the experimental group and the control group (P > 0.05). Histological type, lymph node metastasis rate and pTNM stage were independent risk factors for long-term survival. Conclusion The short-term complications after D2 radical gastrectomy have no significant impact on the long-term survival rate of gastric cancer patients, but it has certain clinical significance to actively prevent and control complications.