Objective:To explore the early diagnosis and treatment of iatrogenic bile duct injury.Methods:The clinical data of 16 patients with iatrogenic bile duct injury from July 1997 to September 2009 were analyzed retrospectively.The clinical types of the bile duct injuries:BismuthⅠ(5 cases),BismuthⅡ(9 cases),Bismuth Ⅲ(0 case),Bismuth Ⅳ(2 cases),BismuthⅤ(0 case).The treatment of the bile duct injuries:Roux-enY biliary-enteric anastomosis with stent tube drainage(6 cases),bile duct suture without T tube drainage(2 cases),bile duct suture with T tube drainage(3 cases),bile duct repair utilizing umbilical vein with T tube drainage(1 case),bile duct repair utilizing cystic duct with T tube drainage(2 cases),single drainage of abdominal cavity(2 cases).Results:All patients had been followed up for 3 months to 12 years.11(68.8%,11/16)cases obtained better effect,while the other 5(31.2%,5/16)cases received second operation because of unsatisfactory effect.Conclusion:Early diagnosis and correct treatment of iatrogenic bile duct injury are necessary for better effect.Otherwise,the effect will be unsatisfactory.Both bile duct suture or repair with T tube drainage and Roux-en Y biliary-enteric anastomosis with stent tube drainage are better treatment in the early stage of iatrogenic bile duct injury.

Objective To understand whether it had differences in bile culture and drug susceptibility test between patients with community-acquired acute cholecystitis and patients with community-acquired acute cholangitis at present.Methods 169 patients with community-acquired acute cholecystitis and the 97 patients with community-acquired acute cholangitis in our department were selected prospectively,in which 16 patients suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis.Bile sample was extracted in operations and delivered to perform aerobic culture and drug sensitivity test.The bile samples coming from cholecyst were divided into group A,while the bile samples coming from bile duct were divided into group B.Results The positive rates of bile culture in group A and group B were separately 24.9% and 64.9%(P<0.05).The result of the sample coming from cholecyst and the result of the sample coming from bile duct were not the same in 4 patients of the 16 patients who suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis simultaneously.The main bacteria of acute cholecystitis included Escherichia coli(28.0%),Klebsiella pneumonia(24.0%)and Enterococcus faecium(16.0%).The main bacteria of acute cholangitis included Escherichia coli(39.7%),Klebsiella pneumonia(19.2%)and Enterobacter cloacae(12.3%).The antibiotics which were lowly resistant to gram negative bacteria in the two groups(A and B) included amikacin(0%/0%),ertapenem(0%/0%),imipenem(0%/7.0%)and piperacillin/tazobactam(0%/7.0%).The antibiotics which had lower resistant rates to gram positive bacteria in the two groups included tigecycline(0%/0%)and linezolid(0%/0%).The proportions of the multidrug-resistant strains in the two groups were separately 24.0% and 35.6%(P>0.05).Conclusion Some difference exist in the results of bile culture between patients with community-acquired acutecholecystitis and patients with community-acquired acute cholangitis,but the main bacteria of the both two types of biliary tract infection are Escherichia coli and Klebsiella pneumonia.The drug resistance is serious in the both infections,and the most sensitive antibiotics to gram negative bacteria include amikacin,ertapenem,imipenem,piperacillin/tazobactam,and the most sensitive antibiotics to gram positive bacteria include tigecycline,linezolid in the both infections.

Objective To compare the operation situation of pancreatico duodenectomy (PD) and pylorus‐preserving pancreatico duodenectomy (PPPD) ,and analyze the clinical efficacy of PPPD .Methods Data of 47 patients with periampullary carcinoma and pancreatic head carcinoma underwent pancreatico duodenectomy from January 2010 to December 2013 were retrospectively analyzed and divided into PPPD group (20 cases) and PD group (27 cases) according to different surgery method .Then compare the situa‐tion of intra‐operative and post‐operative situation in two groups of patients .Results The operation time of PPPD group was sig‐nificantly lower than that of PD group (P<0 .05);the incidence of postoperative complication rate of PPPD group was obviously lower than PD group (P< 0 .05);and postoperative infection rate of PPPD group was significantly lower than PD group (P<0 .05);there was no significant difference between two groups in pancreatic leakage ,bile leakage ,gastrointestinal leakage ,post oper‐ative bleeding ,mortality and the incidence of delayed gastric emptying after surgery (P>0 .05) .Conclusion PPPD operation could shorten the operation time ,promote post‐operative recovery ,lower complication rates and shorten hospitalization time ,and could al‐so help to improve the nutritional status of patients ,improve the postoperative quality of life of patients ,thus it should be further promoted .

Spontaneous intracerebral hemorrhage (SICH) refers the primary, non-traumatic parenchymal hemorrhage. In China, SICH accounts for about 20%-30%of total strokes. SICH is a kind of disease affected by multiple factors includ?ing environmental and genetic factors. The high morbidity and mortality cause serious damage to human health. Therefore, it is important to find etiology and risk factors of SICH. The article reviewed the progress of SICH pathogenesis in the perspec?tive of genetics and molecular biology.

Objective To observe the effect of somatostatin on liver function in patients after splenectomy combined with de-vascularization.Methods The clinical data of 48 patients with liver cirrhosis,portal hypertension and esophageal varices were retro-spectively analyzed,26 cases (somatostatin group)were used somatostatin after splenectomy combined with devascularization,and the other 22 cases (control group)were not used.The changes of serum albumin (Alb),alanine aminotransferase (ALT),aspartate transaminase (AST),prothrombin activity (PTA)and total bilirubin (TBIL)was observed.Results All patients recovered well af-ter surgery,and no deaths occurred.However,ALT,AST and TBIL of using somatostatin group were significantly reduced than those of control group(P <0.05),Alb and PTA were also improved significantly (P <0.05).Conclusion The combination of som-atostatin can not only reduce postoperative portal pressure,control of bleeding,but also to be significantly promote recovery of liver function.

This article reviewed the measures taken by the hospital against a catastrophic fire hazard and exploration in its response and work organization of nursing care of the wounded.Proposed in this paper are development of such five systems as the pre-plan,exercises,personnel,quality control and incentives,which are expected to improve the nursing capacity of the hospital in emergency rescue,for sustainable development of nursing emergency rescue work.

Retrospectively analyzed in the paper are such clinical data as disease category,inj ury part,severity and outcomes for 322 victims of the catastrophic fire and explosion accident at a tertiary hospital.The authors summarized the disease spectrum,and treatment and nursing strategy,in order to improve the emergency plan against fire and explosion accidents,to raise the accuracy of pre-hospital and in-hospital inj ury examination,and to ensure efficient and scientific treatment and nursing,with minimized deaths.

ObjectiveTo analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with Hunt-Hess levelⅢ-Ⅳ, and acute postoperative hydrocephalus.Methods A retrospective study was conducted on 767 patients who had undergone vascular embolization (vascular embolization group,n = 403) or craniotomy occlusion operation (craniotomy occlusion operation group,n = 364), and the patients with postoperative acute hydrocephalus were screened. The clinical data of patients of both groups was analyzed. By judging short-term prognosis in patients with hydrocephalus with Glasgow outcome scale (GOS) score estimated at discharge, the advantages and disadvantages of two surgical procedures were compared.Results The number of cases with postoperative hydrocephalus in vascular embolization group was 56 (13.90%), while that in craniotomy occlusion group was 33 (9.07%). The difference between the two groups of incidence of hydrocephalus was statistically significant (χ2= 4.350,P = 0.037 ). In 767 patients with aSAH, the incidence of hydrocephalus among the patients after the hematoma removal operation was significantly lower than that of patients without hematoma removal [3.07% (11/358) vs. 19.07% (78/409),χ2 = 47.635,P = 0.000]. The incidence of hydrocephalus among the patients after ventricular drainage was significantly lower than that of patients without the drainage [2.77% (19/685) vs. 85.37% (70/82),χ2 = 487.032,P = 0.000]. In 403 cases of vascular embolization group, the incidence of hydrocephalus in the patients after the hematoma removal operation was lower than that of patients without it [8.06% (5/62) vs. 14.96% (51/341),χ2 = 2.082,P = 0.168]. The incidence of hydrocephalus in the patients after the ventricular drainage was lower than that of patients without drainage [2.59% (9/347) vs. 83.93% (47/56),χ2 = 266.599,P = 0.000]. In 364 cases of craniotomy occlusion operation group, the incidence of hydrocephalus in the patients after hematoma removal operation was significantly lower than that of patients did not receive [2.03% (6/296) vs. 39.71% (27/68),χ2 = 95.226,P = 0.000]. The incidence of hydrocephalus among the patients after the ventricular drainage was significantly lower than that of patients without drainage [2.96% (10/338) vs. 88.46% (23/26),χ2 = 203.852,P = 0.000]. The difference in incidence of hydrocephalus between the patients who had hematoma removal surgery between vascular embolization group and craniotomy occlusion operation group was statistically significant [8.06% (5/62) vs. 2.03% (6/296),χ2 = 4.411,P = 0.027], while no statistically difference was present in ventricular drainage patients [2.59% (9/347) vs. 2.96% (10/338),χ2 = 0.085,P = 0.819]. There were 23 patients (41.07%) with good outcome (GOS score 4-5), while 33 (58.93%) with poor outcome (GOS score 1-3) in 56 patients undergone vascular embolization operation. Good result (GOS score 4-5) was shown in 21 (63.64%) and 12 (36.36%) with poor outcome (GOS score 1-3) among 33 patients with hydrocephalus after craniotomy occlusion operation, and the difference was statistically significant (χ2 = 4.230,P = 0.039).Conclusions Hematoma is one of the main factor contributing to the differences in the incidence of postoperative hydrocephalus of Hunt-Hess gradeⅢ-Ⅳ patients either receiving vascular embolization or craniotomy occlusion operation. Lateral ventricle drainage may not be the factor that contributes to the difference in incidence of hydrocephalus formation between the vascular embolization and craniotomy occlusion operation groups in Hunt-Hess levelⅢ-Ⅳ patients. The short term prognosis in the craniotomy occlusion operation group is superior to that of endovascular intervention embolization group.

Objective To explore the relationship between the size and location of the aneurysm after subarachnoid hemorrhage (aSAH) and its clinical classification. Methods A retrospective study was performed in patients with aSAH from January 1, 2008 to December 31, 2014. The relevant clinical data were collected including age, gender, aneurysm size, location, and Hunt-Hess (H-H) classification. The aneurysms were classified by size (A group d<5.00 mm, B group 5.00 mm≤d<10.00 mm, C group d≥10.00 mm), location and H-H classification according to the results of CT, digital subtrac?tion angiography (DSA), and magnetic resonance angiography (MRA). The relationship between size, position of aneurysm and H-H classification was observed and analyzed. Results There were 750 cases included in this study, with average age (56.14 ± 11.88), male 292 and female 458. The total number of aneurysms was 903, and the number of multiple aneurysms was 91 (12.13%). There was one case with multiple aneurysms that can be included in A, B and C groups. There were two cases with multiple aneurysms that can be included in A and B groups, two cases can be included in A and C groups, and three cases can be included in B and C groups. The number of aneurysms and the ratios of groups A, B and C were 20(3.9%), 12 (3.8%), 5 (7.5%), 70 (13.6%), 39 (12.2%), 10(14.9%), 2 (0.4%), 4 (1.3%), 2 (3.0%), 165 (32.0%), 94 (29.4%), 6 (9.0%), 130 (25.2%), 90 (28.1%), 6 (9.0%), 17 (3.3%), 11 (3.4%) and 2 (3.0%) for the location in the anterior cerebral artery, the middle cerebral artery, the posterior cerebral artery, the internal carotid artery, the anterior communicating artery, the posterior communicating artery, and the vertebral basilar artery, respectively. The number of aneurysms and the ratios of H-H classificationⅠ,Ⅱ,Ⅲ,ⅣandⅤin groups A, B and C were 48 (9.3%), 45 (14.1%), 12 (17.9%), 228 (44.2%), 150 (46.9%), 14 (20.9%), 68 (13.2%), 54 (16.9%), 30 (44.8%), 142 (27.5%), 43 (13.4%), 9 (13.4%), 30 (5.8%), 28 (8.8%) and 2 (3.0%). There was a negative correlation between the size of aneurysm and the H-H grade (rs=-0.075, P=0.024). Conclusion The anterior communicating artery and posterior communicating artery are high-risk areas for smaller aneurysms. The internal ca?rotid artery is high-risk areas for larger aneurysms. The size of aneurysm is negatively correlated with H-H classification.

Objective To evaluate the clinical efficacy of gemcitabine plus cisplatin (GP) regimen and paclitaxel plus cisplatin (TP) regimen in the treatment of recurrent or metastatic nasopharyngeal carcinoma.Methods One hundred and thirty patients with recurrent or metastatic nasopharyngeal carcinoma of Qinhuangdao Harbor Hospital,Hebei Province between September 2012 and December 2017 were chosen,and were divided into GP group (68 cases) and TP group (62 cases)according to the selection of treatment.GP group was treated with GP regimen,and TP group was treated with TP regimen.The clinical efficacy and adverse reactions of the two groups were observed,and the serum epithelial cadherin (SE-CAD) and platelet-derived growth factor (PDGF-BB) were measured before and after chemotherapy.Results There was no significant difference in short-term efficacy between GP group and TP group (P＞0.05),and the total effective rates were 88.24％ (60/68) and 79.03％ (49/62) respectively;1 month after treatment,SE-CAD in GP group and TP group were (2.57 ± 0.81) and (2.50 ± 0.96) g/L,PDGF-BB were (102.22 ± 31.18) and (110.15 ± 37.21) ng/L,and the difference was not statistically significant (P＞0.05);progression-free survival (PFS) in GP group and TP group were 13 and 12 months,and overall survival (OS) were 17 and 16 months,and the difference was not statistically significant (P＞0.05);there were no significant difference in leucopenia,hemoglobin,thrombocytopenia and abnormal liver and kidney function between GP group and TP group (P＞0.05);the incidence of gastrointestinal reactions in GP group was 16.18％ (11/68),which was significantly lower than that in TP group was 38.71％(24/62),and the difference was statistically significant (P＜0.01).Conclusions GP and TP regimens are effective in the treatment of recurrent or metastatic nasopharyngeal carcinoma.There is no significant difference in SE-CAD and PDGF-BB levels between the two regimens after treatment,but GP regimen has a lower incidence of gastrointestinal reactions.