Objective To investigate the effect of Pull in choledochojejunostomy which apllied in rabbits' Small bile duct construction on prevention of anastomosis stenosis and potential mechanisms.Methods A total of 21 rabbits were randomly assigned to three groups(n=7).Group A underwent a simple laparotomy (SL),group B biliary-enteric sutured by mucosa to mucosa Choledochojejunostomy (CJ) and group C Pull-in Choledochojejunostomy(PCJ).TBil and DBil were test in 2,4,8 weeks.The tissue of bile duct and anastomotic stoma were collected after Rabbits was killed in 8 weeks.The diameter of bile duct lumen,anastomotic stoma and the thickness of bile duct were measured respectively.Pathological changes of anastomotic stoma were observed and ki67 expression was studied by Immunohistochemical staining.Results (1)Bilirubin level was nomal in group A and C,but significantly higher in group B(P＜0.01).(2)Anastomotic stoma in group C was larger than that in group A and even more than that(completely closed) in group B.There was also statistically significant difference in the diameter of anastomotic stoma,C＞A＞B(P＜0.01).The diameter of bile duct lumen and the thickness of bile duct showed the similar results,B＞C＞A(P＜0.01).(3) As for the inflammatory studies,Group B was observed with significant infiltrated neutrophils compared with group C.Furthermore,cytokine studies showed that the expression of Ki67 index around anastomosis was significantly difference among three groups,B＞C＞A(P＜0.01).Conclusions The studies suggested that pull-in choledochojejunostomy which apllied in rabbits' small bile duct reconstruction could offer some beneficial effect in preventing anastomotic stoma stenosis.The mechanism might be through reducing the inflammatory reaction and restraining excessive hyperplasia in the area around anastomotic stoma.

Recently,clinicians pay more and more attention to the treatment effects related to individual differences.Individualized treatment of hepatic carcmoma is becoming the focus of clinical treatment and basic research increasingly.The individualized treatment of surgery,chemotherapy with radiotherapy,targeted therapy,immunotherapy and gene therapy have become new ways for further improving the prognosis of liver cancer.

Objective To evaluate the techniques and effects of post-operational surgery of colorectal cancer for metastatic tumor on caudate lobe of liver. Methods For the patients admitted from Jan. 1999 to Jan. 2007 to the Navy General Hospital of PLA and undergone metastasectomy on caudate lobe of liver after colorectal cancer operation, the operative procedure and effects were studied retrospectively. Results A total of 18 cases of metastasectomy on caudate lobe of liver were successfully performed. The mean diameter of the metastases was 6.3cm (3.2-11.3cm). The types of operation included total caudate lobectomy (6 cases), total caudate lobectomy combined with extended hepatectomy (9 cases) and partial caudate lobectomy (3 cases). The mean operative time was 198min (154-360min) and the average intraoperative blood loss was 975ml (400-3250ml). No intraoperative death occurred, while the remarkable complications were found in 5 cases (27.8%). The survival rates of follow up for 1, 3 and 5 years were 83.3%, 61.1% and 27.8%, respectively. Conclusions The metastases on caudate lobe of liver after colorectal carcinoma resection usually involve all the hepatic portals. Surgical resection, though sophisticated in technique, remains to be a safe and effective treatment, and the first choice for treating metastases.

ObjectiveTo evaluate the applicection value of ultrasonically guided percutaneous puncture and drainage of gallbladder (PPDG) in treating elderly patients with acute cholecystitis.MethodsThe clinical data of 59 elderly patients with acute cholecystitis treated by ultrasonically guided PPDG were retrospectively analyzed and compared with 37 patients treated by cholecystectomy or 13 cases by cholecystostomy.ResultsThe rates of complication and fatality and average hospital days were 32.4 ％ (12/37),5.4 ％ (2/37) and (25.4 ± 16.5 ) d in patients by cholecystectomy and 7.7％(1/13),7.7％(1/13) and (32.0± 12.5) d in patients by cholecystostomy,respectively,while the complication and mortality were not found in patients by ultrasonic ally guided PPDG with average hospitalization of(19.5 ±9.8)d. The rates of the complication and average hospital days were significantly higher in patients by cholecystectomy and cholecystostomy than in patients by ultrasonically guided PPDG (P＜0.05).ConclusionsUltrasonically guided PPDG is effective,safe and convenient for the treatment of acute cholecystitis in elderly patients.

Objective To discuss the resection technique for pancreatic carcinoma in patients with tumour(invasion) to the portal and/or superior mesentery vein,and the clinical significance of palliative resection of pancreatic carcinoma.Methods The clinical data of 71 cases of pancreatic carcinoma operated on within a period of 3 years were retrospectively reviewed.In patients with tumour invasion to the portal vein,a method of direc transection of pancreas was used in resection of the tumor,and was combined with local radiotherapy and chemotherapy.Results The resection rate was 57.75%.The complication rate was 22.54%.One patient died of multiple organ failure resulting from pneumonia.The survival rate at 6m,1-and 2-years was 100%,81.69%,and 40.85% respectively.Conclusions The direct transection method of pancreas(resection) is a simple and safe method to increase resection rate and prolong survival time for patients with(advanced) pancreatic carcinoma.

Objective To explore the three ultrasonic technologies of two -dimensional ultrasound(2D -US),ultrasonic elastography(UE) and contrast -enhanced ultrasound(CEUS) for the measurement error in breast cancer and the correlation with the expression of ER,PR,VEGF.Methods 50 patients with breast cancer were meas-ured by 2D -US,UE,CEUS preoperatively,and the pathological specimen were measured postoperatively.Then used the immunohistochemistry to detect the expression of ER,PR,VEGF in tumor,and analyzed the correlation with the measurement errors.Results The results of differences between 2D -US,UE,CEUS and pathology were respectively as follows:( -0.59 ±-0.34)cm,( -0.20 ±-0.14)cm,( -0.40 ±-0.31)cm,and the differences were statistically significant(F =20.497,P <0.001).The positive expression rate of ER and PR was high if the difference between UE and 2D -US was less than or equal to 0.44cm.And the positive expression rate of VEGF was low if the difference between CEUS and 2D -US was less than or equal to 0.19cm.Three ultrasonic technologies in the measurement of breast cancer were different,the trend of difference between UE and 2D -US was smaller if the ER and PR were positively expression,and the trend of difference between CEUS and 2D -US was bigger if the VEGF was positively expression.Conclusion There is correlation between different immunohistochemical expression of breast cancer with measurement error in three different ultrasonic imaging technologies.The results suggest that the molecular pathology difference of breast cancer can impact on ultrasonic imaging,which contributes to know the reason and regulation of measurement error in different ultrasonic imaging technology.

OBJECTIVETo study the economic burden caused by occupational chronic n-hexane poisoning.

METHODSInformation about the cost of treatment, compensation, board, wage, diagnosis, escorts, transportation and the days off work were collected in a 34 cases of occupational chronic n-hexane poisoning accident to estimate the economic burden.

RESULTSThere were 4 mild, 19 moderate, 11 severe in the 34 cases and the total cost was 6 084 809 yuan. The hospitalization days was respectively (204.0 ± 3.7) d, (226.6 ± 78.3) d and (417.6 ± 94.1) d, averaging (285.8 ± 96.3) d. The treatment cost was respectively 62 525.8, 69 409.7 and 128 155.6 yuan. The compensation was respectively 20 000.0, 20 052.6 and 30 290.9 yuan. The wage was respectively 23 460.0, 26 062.6 and 47 644.0 yuan. The board was respectively 17 566.5, 19 499.8 and 36 230.1 yuan. The days of work was respectively (176.8 ± 3.2) d, (196.4 ± 67.9) d and (361.4 ± 81.6) d, averaging (247.7 ± 83.5). The lost productivity was respectively 1 809 724.8, 2 010 350.4 and 3 699 290.4 yuan.

CONCLUSIONThe economic burden of occupational chronic n-hexane poisoning was so heavy that prevention measures should be strengthened.

Adolescent ; Chronic Disease ; economics ; Cost of Illness ; Female ; Health Care Costs ; Hexanes ; poisoning ; Humans ; Male ; Occupational Exposure ; economics ; Young Adult

Objective To explore the expression of liver fatty acid binding protein (L-FABP) in tissues of hilar cholangiocarcinoma and the relationship between expression of L-FABP and clinicopathological factors and prognosis of the patients.Methods The retrospective case-control study was conducted.The clinicopathological data of 132 patients with hilar cholangiocarcinoma who were admitted to the Navy General Hospital between January 2003 and January 2013 were collected.The expression of L-FABP in tumor tissues and adjacent tissues of hilar cholangiocarcinoma and normal bile duct tissues were respectively detected by immunohistochemistry.Observation indicators:(1) expression of L-FABP by immunohistochemistry;(2) relationship between clinicopathological factors of patients and expression of L-FABP in tumor tissues;(3) follow-up and survival situations;(4) prognostic analysis of patients after radical resection of hilar cholangiocarcinoma.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival time up to June 2017.Count data were described as percentage and compared using the chi-square test.The survival time was calculated by the Kaplan-Meier method.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the nonparametric test and COX regression model.Results (1) Expression of L-FABP by immunohistochemistry:the positive expressions of L-FABP were located in the cytoplasm.The low,moderate and high expression rates of L-FABP in tumor tissues were respectively 11.36％ (15/132),71.97％ (95/132) and 16.67％ (22/132),and positive-staining cells showed platy and / or diffuse distribution;the low,moderate and high expression rates of L-FABP in adjacent tissues of hilar cholangiocarcinoma were respectively 77.27％ (102/132),7.58％ (10/132) and 15.15％ (20/132),and positive-staining cells showed scattered or platy distribution,with a weaker staining intensity compared with tumor tissues;there was no positive expression in normal bile duct tissues.There was a statistically significant difference in expressions of L-FABP among tumor tissues and adjacent tissues of hilar cholangiocarcinoma and normal bile duct tissues (x2=5.423,P ＜ 0.05).(2) Relationship between clinicopathological factors of patients and expression of L-FABP in tumor tissues:cases with low,moderate and high expressions of L-FABP in tumor tissues were respectively 10,30,5 in 45 patients with tumor diameter ＜ 3 cm and 4,29,9 in 42 patients with 3 cm ≤ tumor diameter ≤ 5 cm and 1,36,8 in 45 patients with tumor diameter ＞ 5 cm,with a statistically significant difference (x2 =10.171,P＜ 0.05).(3) Follow-up and survival situations:132 patients were followed up for 5-90 months,with a median time of 33 months.During the followup,postoperative overall median survival time of 132 patients was 31 months.(4) Prognostic analysis of patients after radical resection of hilar cholangiocarcinoma:results of univariate analysis showed that tumor differentiation,lymph node metastasis and expressions of L-FABP in tumor tissues were related factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma (Z =1.845,3.156,1.243,P＜0.05).Results of multivariate analysis showed that tumor differentiation,lymph node metastasis and expressions of L-FABP in tumor tissues were independent factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma (odds ratio =0.431,1.806,3.692,95％ confidence interval:0.292-0.693,0.974-2.973,1.875-11.364,P＜0.05).Conclusions The high expression of L-FABP in tumor tissues is significantly correlated with the tumor diameter.Tumor differentiation,lymph node metastasis and expressions of L-FABP in tumor tissues are independent factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma.

Objective:To preliminarily study the feasibility, safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) before surgical resection in the treatment of large liver cancer.Methods:A retrospective study was conducted on the clinical data of 17 patients with large liver cancer treated with TACE combined with SPVE from January 2016 to December 2019 at the Department of Hepatobiliary Surgery, the Sixth Medical Center of PLA General Hospital. The study included 15 males and 2 females, aged (59.17±10.30) years. The levels of alanine aminotransferase, tumor changes and patient survival were analyzed before operation, after TACE, and after SPVE.Results:Among the 17 patients, the levels of alanine aminotransferase on the 1st and 3rd day after SPVE was significantly higher than those after TACE [191.4 (30.5-1966.4) IU/L vs 125.3 (35.7-846.2) IU/L on the first day, and 298.5 (24.6-1334.2) IU/L vs 208.6 (21.6-775.6) IU/L on the 3rd day], all P<0.05. One month after the two combined embolism, among the 6 patients with a tumor diameter of 5-10 cm, 2 patients (33.3%) had complete remission, 3 patients (50.0%) had partial remission, and 1 patients (16.6%) had stable disease. For the tumor’s longest diameter, among the 11 patients with tumors >10 cm, 1 patient had complete remission (9.1%), 4 patients had partial remission (36.4%), 5 patients had stable diseases (45.5%), and 1 patient had disease progression (9.1%). Eventually, 11 patients underwent surgical exploration. The median residual liver volume before treatment was 329.5 (284.9-365.7) ml, and after the combined procedure 415.6 (354.7-718.8) ml. The median hyperplasia ratio was 28.1% (14.1%-51.3%). Eight patients finally underwent surgical resection. There was no death in the perioperative periods. The median tumor-free survival time was 17 (7-42) months, and the median survival time was 27 (7-42) months. Conclusion:For patients with large liver cancer with insufficient remnant liver volume, preoperative TACE+ SPVE has certain value in controlling tumor progression, promoting remnant liver hyperplasia, increasing surgical resection rate and improving prognosis.

Objective: To determine the association between anthropometric parameters and 20 meter shuttle run test (20 m SRT) score among children and adolescents. Methods: The convenient sampling method was conducted to select 3 192 primary and secondary school students in Baoan District, Shenzhen, based on the street school types school from April to May 2019. Height, weight, 20 m SRT score and general demographic indicators were assessed and collected. Individuals were divided into two groups based on the dose response correlation between different anthropometric parameters (the Z score of height, weight and BMI) and 20 m SRT score analyzed with the restricted cubic spline. The association between the Z score of height and 20 m SRT score was further analyzed using the Spearman correlation analysis. Logistic regression analysis was used to analyze separately the relationship different anthropometric parameters and 20 m SRT score. Results: The Z value of weight and 20 m SRT score showed a non linear dose response association ( P <0.01), the significant but weak linear correlation between the Z value of height and 20 m SRT score ( r=0.06, P <0.05). The prevalence rate on the low level of the Z value of 20 m SRT score in 3 192 children and adolescents was 44.7%, and the gender ( χ 2=14.02, P <0.01) and grade difference ( χ 2=93.28, P <0.01) were both statistically significant. There was no significant relationship between the Z value of height and 20 m SRT score grade among total population, different genders and different grades ( P > 0.05). Compared with the reference group on the Z value of weight ≤-0.23, individuals with the Z value of weight >-0.23 had the low level of 20 m SRT score ( OR =0.61, P <0.05). Compared with the reference group on the Z value of BMI ≤ 0.25, individuals with the Z value of weight >0.25 had the low level of 20 m SRT score ( OR =0.45, P <0.05). Stratified for gender and grade, the above significant relationship on the Z value of weight, Z value of BMI and 20 m SRT score were still observed ( P <0.01). Conclusions The higher height Z value shows on correlations with 20 m SRT score, but the positive association is found between weight and BMI Z value and the 20 m SRT score. The cardiopulmonary fitness improvement may be more effective among children and adolescents when tuking weight and BMI Z scores into consideration.