Objective To explore the pathogenesis, pathomorphology, diagnosis and management of cholecystoduodenal fistula(CDF). Methods Clinical data of 11 cases of CDF admitted in our hospital in recent 17 years were analyzed retrospectively. Results All the patients were confirmed and treated by operation.Ten CDF were caused by cholecystitis and cholelithiasis,another one was caused by peptic ulcer.Only one case of CDF was diagnosed before operation. Nine patients were cured, and two patients died of severity infection of abdomen postoperatively. Conclusions Most CDF are caused by cholecystitis and cholelithiasis. X-ray film of abdomen,barium meal examination and endoscopic retrograde cholangiopancreatography(ERCP) are more useful for the diagnosis of CDF. The therapeutic principle of CDF is cholecystectomy,removing calculus, and repairing fistula with or without common bile duct exploration and/or bilioenterostomy.

ObjectiveTo evaluate the breast-conserving surgery for early breast cancer.MethodFrom 1993 to 2000, 86 female cases of stage ⅠⅡa breast cancer received breast conserving comprehensive therapy. Clinical data were analyzed retrospectively. ResultsThe 5 year survival rate of this group was 96.5% and the 5 year recurrence rate was 5.2%.The postoperative contour of the breast was satisfactory.ConclusionBreast-conserving surgery is safe and effective therapy for early breast cancer, when strict indication and necessary safe margin of resection is obeyed by. Postoperative radiotherapy and chemotherapy should be properly arranged and the patients should be closely followed-up.

OBJECTIVETo explore the concentration-response relationship between ambient concentration of PM2.5 and daily total hospital emergency room visits in Beijing during 2012 and 2013. This study also examined the effects of ambient PM2.5 during heavy polluted days on emergency room visits compared with the light polluted days.

METHODSWe collected the daily meteorological factors monitoring data and concentrations of air pollutants in Beijing during October 1, 2012 to December 31, 2013. We also collected the daily emergency room visits from a tertiary hospital in Beijing in the same time period. Generalized additive model was fitted to estimate the association between the ambient PM2.5 and the hospital emergency room visits, by using the smooth function to adjust long term trend of time, public holidays and day of week. In addition, constrained piecewise linear function was then used to estimate the excess risk for different segment of concentration-response function.

RESULTSThe annual average concentration of PM2.5 was 90.9 µg/m(3) during October 1, 2012 and December 31, 2013. There were total 64 260 cases for total emergency room visits, of which respiratory disease had 9 849 cases and cardiovascular disease had 11 168 cases. PM2.5 was positive related with PM10, NO2 and SO2. The corresponding correlation coefficients were 0.87, 0.78 and 0.62, respectively (P<0.05). And PM2.5 was positively related with relative humidity, with correlation coefficient 0.45 (P<0.05). But PM2.5 was negatively related with mean temperature (r=-0.17, P< 0.05) and wind speed (- 0.32, P<0.05). In the single polluted model, after adjusting the effects of temperature, relative humidity and wind, every 10 µg/m(3) increase of concentration of ambient PM2.5, the corresponding excess risk of daily emergency room visits was 0.25% (95% CI: 0.07-0.43). In the two-pollutant model PM2.5+SO2 and PM2.5+NO2, every 10 µg/m(3) increase of concentration of ambient PM2.5, the corresponding excess risk of daily emergency room visits were 1.07% (95%CI:0.83-1.30) and 0.56% (95%CI: 0.32-0.80) respectively, which were higher than the effect in single pollutant model. Average concentration of ambient particulate matters (PM2.5) was 204.16 µg/m(3) during heavy pollution, higher than control period (85.24 µg/m(3)). When PM2.5 as the primary air pollutants during heavy polluted days, we observed a significant increase in emergency room visits, and the odd ratios was 1.16 (95% CI:1.09-1.22).

CONCLUSIONThere were positive correlation between high concentration of ambient particulate matters (PM2.5) and increasing daily emergency room visits. Especially during the heavy polluted days, the effects of elevated concentration of PM2.5 on hospital emergency room visits were much larger.

Air Pollutants ; analysis ; Beijing ; Cardiovascular Diseases ; diagnosis ; Emergency Service, Hospital ; statistics & numerical data ; Humans ; Meteorological Concepts ; Particulate Matter ; analysis ; Respiratory Tract Diseases ; diagnosis ; Temperature ; Tertiary Care Centers