Objective To determine the best time to operate on elderly patients with acute severe cholangitis (ACST).Method The time to operate was analysed in 36 elderly patients with ACST.Result With active preoperative anti-shock treatment,the mortality rates for emergency surgery within and after 8 hours were 8.3％ and 33.3％,respectively.Conclusion Early operation for elderly patients with ACST markedly reduced mortality.

This article deals with the rehabilitative technology speciality launched in polytechnic,discusses its education orientation and cultivation pattern,explores the cultivation rule of professionals of rehabilitative technology and gives some beneficial complementarities for the cultivation of professionals of rehabilitative technology.

Based on the health service delivery system and its performance, it shows the major issues faced by Indonesian health system, including heavy disease burden of NCD, imbalance allocation of medical care and resources, poor access to health service in rural area, low level of government health budget and so on. Presently, the reform in Indonesian health system is in the direction of equity and self-government, via participation of community, private sector or civil society, availability of comprehensive, equitable health care and health resource, to enhance health system and improve population health.

Objective To assess quantitatively the association between smoking and the risk of disease and death from pulmonary tuberculosis(TB) by a meta-analysis. Methods Both Chinese and English literatures published from Jan. 1999 to Jun. 2010 about the case-control study of the association between smoking and pulmonary TB were retrieved by searching the electronic resource databases. A meta-analysis was then performed on the comparison and synthesis of findings from included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a software RevMan 4.2. Finally,possible publication bias was tested and a sensitivity analysis was conducted. Results The meta-analysis for total 22 high-quality case-control studies found a pooled OR of 2.56 (95% CI 1. 80 ～3.64) with a random-effects model. Sensitivity analysis showed that pooled OR was 2.56 (95% 1.76 ～3.71 ) by removing two papers of nested case-control study. The OR were 2.13 (95% CI1.76～2.58) and 4.60 (95% CI 1.81～11.69) for disease and death from TB,respectively. After confounding factors,including age and gender,had been controlled the OR was 2.53 (95% CI 1.27 ～5.03 ) whereas 1. 99(95% CI 1.54 ～ 2.56 ) without control of them. Conclusion Smoking can increase the risk of incidence and death of TB. TB control programs and treatment of patients might benefit from interventions aimed at reducing tobacco exposure.

Objective To summarize the experience in the management of incarcerated umbilical hernia in cirrhotic patients with aseites. Methods The operative methods, perioperative management and fellow-up data of 15 patients diagnosed incarcerated umbilical hernia in the setting of cirrhosis and ascites were studied retrospectively. All the patients underwent emergency operation to remove necrotic umbilical skin and hernial content, including incarcerated greater omentum (6 cases) and strangulated segment of small bowel (5 cases). After debriding the operating field thoroughly, the umbilical hernia was repaired with polypropylene mesh, among those Sublay repair was used in 11 cases with the longest diameter of hernial ring more than 3 cm and Onlay repair in 4 cases with the longest diameter of hernial ring less than 3 cm. During the perioperative period, albumin and fresh frozen plasma transfusion, as well as diuresis and ascites paracentesis, was adopted to treat eirrhosis and ascites. Results All the patients underwent operation successfully. The operative time was 90～185 min, averaging at 122 min. Seroma formation in 2 cases and incision infection in one were cured with conservative therapy. One patient died of multiple organ dysfunction after the operation. During the fellow-up of 1～5 years, 1 patient died of liver function failure and there was no hernia recurrence. Conclusion With appropriate perioperative management and correct operative method, polypropylene mesh could be adopted in the emergency repair operation of incarerated umbilical hernia in the setting of cirrhosis and ascites.

In this article , the hot ethical concerns related to totally endoscopic thyroidectomy have been ana-lyzed and discussed .The author considers that this procedure is consisted with the patient′s no-harm and advanta-geous ethical principles , and the patient′s privacy is well protected .However , different procedures and operative risks should be well understood by the patients before the operation .Patient′s independence should be respected .

Objective To investigate the diagnostic method,microsurgical operation time and effect of brain arteriovenous mal-formation(AVM)rupture hemorrhage in childhood.Methods 72 children (≤16 years old)of AVM hemorrhage from 2003 to 2013 were retrospectively analyzed.Results The CT diagnosis rate was 48.6%(35/72),the MRI diagnosis rate was 78.3%(47/60),56 cases were performed the early whole brain DSA under the condition permitting,its diagnosis rate was 98.2%(55/56).All the cases were performed the hematoma clearance plus the pertinent lesion resection.70 cases were re-examined by DSA/CTA/MRA during postoperative perioperation period.The lesion resection rate was 91.5%,the partial resection rate was 8.6%.60 cases(85.7%) were successfully followed up for 6 months to 6 years and assessed by the Glasgow outcome scale,5 points in 5 5 cases,4 points in 2 cases,3 points in 2 cases and 2 points in 1 cases.Conclusion DSA is the main detection measure for early diagnosing AVM hem-orrhage and the microsurgical operation in the acute stage can reduce the fatality and improve the prognosis.

Objective To study Dendrobium from Yunnan Province by Fourier transform infrared spectroscopy (FTIR) combined with hierarchical cluster analysis.Methods Stems of 83 trees from 11 Dendrobium varieties were tested through using FTIR, so as to analyze the differences among different varieties and identify Dendrobium variety by second-derivative spectral, the correlation analysis and hierarchical cluster analysis.Results The spectra showed that the main ingredients of stems were cellulose, lignin and polysaccharides. The fraction of lignin and cellulose ofD.officinate was lower, while that for polysaccharides was higher. There was a high correlation among spectra, with the correlation coefficients of more than 0.980, and that for second-derivative spectral was 0.751 to 0.980. All the samples were clustered by second-derivative spectral, with the correct rate of 87.9%. Hierarchical cluster analysis showed that the components ofD.hercoglossum, D.lohohense andD.adumcum,D.brymerianum andD.nobile,D.guangxiense andD.fimbriatum are more similar than that of others.Conclusion FTIR combined with hierarchical cluster analysis can distinguish and identify different varieties of Dendrobium, and is an effective and simple way to identify different varieties.

AIM:To investigate the clinical effect of pills of six ingredients with rehmannia combined with ginkgo biloba leaf table in the prevention and treatment of early retinopathy in patients with type 2 diabetes mellitus.METHODS:A total of 82 patients (82 eyes) with type 2 diabetes mellitus who were treated with endoscopy from January 2013 to January 2015 were randomly divided into observation group and control group according to the random number table method.The control group was given conventional western medicine treatment, the observation group in the control group was given pills of six ingredients with rehmannia combined with ginkgo leaf table treatment besides the control group treatment.The diabetic retinopathy was assessed in both groups, as well as changes in blood glucose, blood pressure, and glycosylated hemoglobin.We recorded the occurrence of adverse reactions during and after treatment.RESULTS: The new diagnosed rate and the progress rate of observation group were lower than those of the control group, remission rate was higher, and the difference was statistically significant (P<0.05).There was no significant difference of the two groups on blood glucose, blood pressure and glycosylated hemoglobin before and after treatment (P>0.05).The incidence of adverse reactions between the two groups was not statistically significant (P>0.05).CONCLUSION: Type 2 diabetes mellitus patients treated with pills of six ingredients with rehmannia combined with ginkgo biloba leaf table can effectively control the rate of retinopathy, the rate of progress, improve the rate of remission with high drug safety, and have the significance of further clinical research.

ObjectiveTo compare the efficacy between needling peri-ocular points plus abducens oculi and needling peri-ocular points alone in treating abducens paralysis, for evaluating the effectiveness and advantage of needling peri-ocular points plus abducens oculi.MethodFollowing the random number table, 86 patients with postnatal unilateral abducens oculi were divided into two groups: 43 cases in the control group were intervened by conventional acupuncture at peri-ocular points including bilateral Taiyang (EX-HN5), Cuanzhu (BL2), Fengchi (GB20), Hegu (LI4) and Waiguan (TE5), plus Baihui (GV20), Sizhukong (TE23) and Tongziliao (GB1) on the affected side; 43 cases in the treatment group were intervened by acupuncture at peri-ocular points and abducens oculi, i.e. to puncture the abducens oculi (1~3 mm behind the attached point of the extrarectus to eyeball) in addition to the treatment given to the control group. After 3 treatment courses, the total effective rate, average recovery time and improvement of strabismus angle were observed.ResultThe total effective rate was 93.0% in the treatment group, significantly higher than 81.4%in the control group (P<0.05); of the 28 cured patients in the treatment group, the average recovery time was (34.51±7.91)d, versus (41.88±7.87)d in the 22cured patients in the control group, and the difference was statistically significant (P<0.01). There was a significant difference in comparing the improvement of strabismus angle between the two groups (P<0.01); after treatment, the strabismus angle was (11.23±6.32)° in the treatment group versus (14.14±6.85)° in the control group, and the difference was statistically significant (P<0.05).ConclusionNeedling peri-ocular points and abducens oculi can improve the strabismus angle, shorten treatment duration and reduce patient’s sufferings in treating postnatal abducens paralysis, significantly superior to conventional acupuncture at peri-ocular points.