Hilar cholangiocarcinoma should be identified from other malignant tumors and/or benign disease involving the hilum which may present similar image features.Clinal stage need to be further studied. Radical resection should be recommended in multidisciplinary treatment of hilar cholangiocarcinoma. The patients who were received initial surgical drainage and/or local recurrence after initial surgical resection of hilar cholangiocarcinoma, should actively be given the opportunity of radical reoperation, with potential long-term survival. Extended surgical resection resulted in increased rate of R0 resections and significantly improved survival. However, it also significantly increased the risk of serious postoperative complications, which must be balanced between survival advantage and surgical risk.

OBJECTIVE:To observe the curative effect of Qingyan lifei mixture on cough with lung heat.METHODS:190 patients with cough with lung heat were randomly divided into two groups:104 cases in treatment group were assigned to receive Qingyan lifei mixtures 100 mL?time-1 bid,and 86 in control group to receive Qingfei yihuo tablets(4 tablets?time-1 bid).The course of treatment was 10 days for both groups.RESULTS:The total effective rate was 89.42% in treatment group versus 75.58% in control group,and the difference between the two groups was significant(P

Objective To evaluate the use of endovascular aortic repair(EVAR) and open aortic surgery(IAS) for treatment of abdominal aortic aneurysm.Methods A retrospective review of patients treated with EVAR or IAS between 2002 and 2007 was performed.The occurrence rate of perioperative complications,morbidity and mortality,survival rate,quality of life,and cost of treatment were compared.Results Forty-two patients(30INS,12EVAR) were treated.Operating time,the intraoperative blood loss,and intraoperative blood transfusion were less in EVAR group than in the IAS group(P

Objective To study the clinical effects of endovascular stent-graft repair for thoracic aortic aneurysm(TDA).Methods The clinical records of 32 patients with thoracic aorta dissecting aneurysm,including 26 men and 6 women,who underwent endovascular repair were retrospectively analyzed.The characteristics,location,and anatomic condition of dissecting aneurysm were evaluated using CTA before operation.Under general or local anesthesia,32patients underwent endovascular repair under dynamic DSA.For those patient,8 Talent,22 Yuhengjia(Beijing) and 2 Microinvasive(Shanghai) stent grafts were used.Results Among them 32 patients the distance between entry tear and left subclavian artery was

As a successful mode of hospital reform, the hospital group offers the key to the solution of some major problems hindering the development of hospitals. The objective of setting up a hospital group is to better realize the strategic goals of the hospitals. While hospital groups have different types and formation patterns, the key to success lies in the operating mechanism and management standards. Organizational and cultural building is of great significance to the long-term development of hospital groups.

Objective To evaluate the diagnostic value of microRNA-499 (miR-499)levels in acute myocardial infarction (AMI)diagnosis.Methods Retrieve Articles,Wanfang,China Knowledge Network,NCBI PubmMed,EMBSASE database 2010~2015 years met the inclusion criteria published abroad in relation to miR-499 diagnosis ten cases of human AMI litera-ture.The quality of the sudies was evaluated by QUADAS tools through a comprehensive analysis of the random effects model effect size,the use of meta-disc 1.4 software for statistical analysis software.Results Ten studies met the included criteria.The summary estimates for miR-499 diagnosis of MI sensitivity was 83% (95% CI,0.81 ~ 0.85),specificity of 81% (95% CI,0.78~0.83),positive predictive value of 4.53 (95% CI,3.12~ 6.58),negative predictive value was 0.22 (95% CI,0.14~0.33),diagnostic odds ratio 22.73 (95% CI,10.78~47.93).The area under the curve (AUC)for miR-499 was 0.90 with Q value of 0.84.Conclusion MiR-499 has high diagnostic value for acute myocardial infarction.

Objective To explore the incidence risk of postoperative delirium in different underlying diseases and the effective measures of postoperative recovery.Methods 978 cases of emergency surgery,included acute abdomen 324 cases,358 cases of cardiovascular disease,296 cases of cranial trauma.To analyze preoperative underlying diseases,we observed the incidence rate of postoperative delirium,and the efficacy of different care on delirium recovery was compared.Results There was a higher incidence rate of postoperative delirium in patients with coronary heart disease,high blood pressure and emphysema (P ＜ 0.05),especially in patients with multiple disease (P ＜0.01).And effective psychological intervention could increase the recovery rate of delirium.Conclusion The preoperative underlying diseases has a significant impact on the occurrence of postoperative delirium,and the psychological intervention has good effect on the recovery of delirium.

Sixty-four patients with solitary pulmonary nodules were included in this study. The diameter of pulmonary nodules was equal or less than 3.0 cm and no contact with the adjacent pleura. They were divided into study group( with acuductor locating method)and conventional group (with conventional method). The results showed that the one-time success rates were 97％ (31/32)in study group and 72％(23/32) in conventional group, the diagnostic accuracy were 94％ ( 30/32 ) and 88 ％ ( 28/32 ), respectively,while the successful puncture time were( 13. 5 ±4. 9)min and( 18. 7 ±5. 7) min, respectively. In study group,the complication rate was 9％ (3/32), while 28％ ( 9/32 ) in conventional group. There were statistical differences between the two groups. CT-guided aspriation biopsy for solitary pulmonary nodules with self-made acuductor can obviously improve one-time success rate and reduce the complication rate and operative time.

ObjectiveTo investigate the effect of sevoflurane anesthesia in the neonatal period on cognitive function and acetylcholinesterase(AChE) activity in hippocampus in developmental stages in rats.Methods Eighty 7 day-old SD rats weighing 12-16 g were randomly divided into 5 groups( n ＝ 16 each):groups A and B inhaled 3 ％ sevoflurane in oxygen for 6 and 2 h respectively; groups C and D inhaled 1.5 ％ sevoflurane in oxygen for 6 and 2 h respectively; group E inhaled oxygen only.The cognitive function was assessed using Morris water maze test in weaning period(16-21 day-old) and sexual maturity period (55-60 day-old) respectively.The rats were sacrificed at 30 min after Morris water maze test was finished at 21 and 60 d after birth,and the hippecampus were removed for determination of AChE activity using colorimetry method.ResultsCompared with group E,escape latency was prolonged during 17-20 d after birth in group A,and at 18,19 d after birth in groups B and C,and at 18 d after birth in group C,and AChE activity increased at 21 d after birth in group A( P < 0.05 or 0.01 ).Compared with group A,escape latency was shortened at 19,20 d after birth,and AChE activity decreased at 21 d after birth in groups B and C( P < 0.05 or 0.01).Compared with groups B and C,escape latency was shortened at 19,20 d after birth in group D( P < 0.05).There were no significantly differences in probe time in original platform quadrant,frequency of crossing the original platform and AChE activity at 60 d after birth and escape latency during sexual maturity period among the 5 groups( P ＞ 0.05).ConclusionSevoflurane anesthesia in the neonatal period can reversible decrease the congnitive function in developmental stages in rats in concentration and time dependent manners,and the mechanism may be related to increasing the AChE activity in hippocampus.

Objective To evaluation the value of fusion images of dynamic contrast enhanced MRI (DCE MRI) with transrectal ultrasound(TRUS) and conventional TRUS in prostate biopsy for prostate cancer.Methods The clinical data of 127 patients suspected as early-stage prostate cancer were retrospectively analyzed.79 patients underwent prostate biopsy guided by conventional TRUS(group A).48 patients underwent prostate biopsy guided by fusion images of DCE MRI with TRUS(group B).Then the diagnostic rates,puncture times and complications in the two groups were compared.Results The cases with confirmed prostate cancer were 31 in group A and 22 in group B.The first time diagnostic rates of biopsy were 20.2％(16/79) in group A,and 39.3％ (19/48) in group B respectively(P ＜0.05).The first time sensivity,specifity,positive predictive value and negative predictive value of biopsy were 51.6 ％,100 ％,100％,77.4％ in group A and 86.3％,100％,100％,89.6％ in group B.Puncture times was 15.40 ± 4.67 and 13.01 ± 3.87 respectively.The Gleason score was 6.21 ± 0.91 and 6.35 ± 0.81 respectively.The complication rates were 19.0％(15/79) in group A and 12.5％(6/48)in group B.Conclusions For patients with earlystage prostate cancer,the combination of DCE-MRI and TRUS to guide transrectal prostate biopsy was recommended.It showed an increase in the first time diagnostic rate of biopsy while a reduction in the times and complications of prostated biopsy.