Objective To investigate the clinical effect of early laparoscopic cholecystectomy in the treat -ment of elderly patients with acute cholecystitis .Methods 68 elderly patients with early acute cholecystitis were di-vided into the two groups according to the surgical procedures .33 cases in OC group were given traditional open sur-gery,while 35 cases in LC group received early laparoscopic cholecystectomy .The operative time,postoperative bowel recovery time and postoperative hospital stay time were compared between the two groups .Results The operative time,postoperative bowel recovery time ,postoperative hospital stay time in LC group were (43.7 ±5.8)min,(36.4 ± 3.9)h,(4.8 ±1.4)d,which were significantly shorter than (68.6 ±7.3)min,(65.2 ±4.5)h,(8.3 ±2.9)d in the OC group(t=3.317,3.862,3.029,all P<0.05).The incidence rate of postoperative complication of LC group was 14.29%,which of the OC group was 24.24%,the difference was not significant(P>0.05).Conclusion Early lap-aroscopic cholecystectomy in the treatment of elderly patients with acute cholecystitis can significantly shorten the operation time, promote postoperative recovery of gastrointestinal function and reduce postoperative hospital stay , reduce the burden of patients ,improve the quality of life and the incidence rate of complications is low .

Objective To investigate the clinical effects and complications of modified radical mastectomy and breast conserving operation for breast cancer.Methods 110 cases of breast cancer were randomly divided into the two groups,55 patients in each group,the control group took the modified radical mastectomy,while breast conser-ving operation were carried out in observation group,the clinical efficacy and incidence of complications of two groups were observed and compared.Results The operation time,intraoperative blood loss,length of incision and hospitali-zation time of the observation group were (98.47 ±8.65)min,(82.59 ±4.86)mL,(4.80 ±0.87)cm and (8.66 ± 1.77)d,significantly less than (156.52 ±10.23) min,(125.23 ±6.85) mL,(12.25 ±2.03) cm and (15.23 ± 1.85)d in the control group (t=8.12,7.58,9.88,8.72,all P<0.05);3 years survival rate,the rate of distant me-tastasis and local recurrence rate of the two groups had no significant difference (χ2 =1.35,2.03,1.82,all P>0.05);The incidence of complications of the observation group was 3.63%,significantly lower than 18.18% of the control group (χ2 =8.25,P<0.05).Conclusion Breast conserving operation has a significant efficacy for breast cancer,with less trauma,quicker recovery,fewer complications,which is worthy of extensive promotion and application in clinical practice.

This study examined whether 1-methyl-tryptophan [1-MT, an indoleamine 2, 3-dioxygenase (IDO) inhibitor] could reduce CD4(+)CD25(+) regulatory T cells (Tregs) proliferation and improve the anti-tumor efficacy of dendritic cells (DCs) pulsed with tumor cell lysate in the mice bearing pancreatic adenocarcinoma. The models of pancreatic adenocarcinoma were established in C57BL/6 mice by subcutaneous injection of Pan02 cells. Eight mice which were subcutaneously injected with PBS served as control. The expression of IDO was determined in tumor draining lymph nodes (TDLNs) and spleens of the murine pancreatic adenocarcinoma models. The prevalence of Tregs was measured in the TDLNs and spleens before and after 1-MT administration. The dendritic cells were pulsed with tumor cell lysate for preparing DC vaccine. The DC vaccine, as a single agent or in combination with 1-MT, was administered to pancreatic adenocarcinoma mice. The anti-tumor efficacy was determined after different treatments by regular observation of tumor size. The results showed that the levels of IDO mRNA and protein in tumor-bearing mice were significantly higher than those in the normal control mice. The percentage of Tregs in the spleen and TDLNs was also higer in tumor-bearing mice than in normal control mice (P<0.05). Foxp3 expression was significantly lower in the TDLNs and spleens of tumor-bearing mice administrated with 1-MT than that in normal control mice. Furthemore, in the mice that were administered 1-MT plus DC vaccine, the tumor was increased more slowly than in mice treated with DC vaccine or 1-MT alone, or PBS on day 36 (P<0.01). Our results indicated that 1-MT may enhance anti-tumor efficacy of dendritic cells pulsed with tumor cell lysate by downregulating the percentage of Tregs.

Objective To establish personnel training program for higher vocational pharmacy by investigating occupation du -ties in pharmacy graduates .Methods The employment of pharmacy graduates from higher vocational school was investigated .The pro-fessional knowledge , ability and quality in the jobs were analyzed so as to constitute the career-oriented personnel training program .Re-sults The career-oriented practical personnel training program was established .Conclusion The career-oriented personnel training program can improve the quality of education of higher vocational pharmacy major .

This study examined whether 1-methyl-tryptophan[1-MT,an indoleamine 2,3-dioxygenase(IDO)inhibitor]could reduce CD4+CD25+regulatory T cells(Tregs)proliferation and improve the anti-tumor efficacy of dendritic cells(DCs)pulsed with tumor cell lysate in the mice bearing pancreatic adenocarcinoma.The models of pancreatic adenocarcinoma were established in C57BL/6 mice by subcutaneous injection of Pan02 cells.Eight mice which were subcutaneously injected with PBS served as control.The expression of IDO was determined in tumor draining lymph nodes(TDLNs)and spleens of the murine pancreatic adenocarcinoma models.The prevalence of Tregs was measured in the TDLNs and spleens before and after 1-MT administration.The dendritic cells were pulsed with tumor cell lysate for preparing DC vaccine.The DC vaccine,as a single agent or in combination with 1-MT,was administered to pancreatic adenocarcinoma mice.The anti-tumor efficacy was determined after different treatments by regular observation of tumor size.The results showed that the levels of IDO mRNA and protein in tumor-bearing mice were significantly higher than those in the normal control mice.The percentage of Tregs in the spleen and TDLNs was also higer in tumor-bearing mice than in normal control mice(P<0.05).Foxp3 expression was significantly lower in the TDLNs and spleens of tumor-bearing mice administrated with 1-MT than that in normal control mice.Furthemore,in the mice that were administered 1-MT plus DC vaccine,the tumor was increased more slowly than in mice treated with DC vaccine or 1-MT alone,or PBS on day 36(P<0.01).Our results indicated that 1-MT may enhance anti-tumor efficacy of dendritic cells pulsed with tumor cell lysate by downregulating the percentage of Tregs.

Objective To observe the value of radiomics models based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced hepatobiliary phase(HBP)MRI for assessing clinical pathological stage of hepatic fibrosis(HF).Methods Data of 240 patients with pathologically/clinically diagnosed and clinical pathological staged HF who underwent Gd-EOB-DTPA enhanced MR examination were retrospectively analyzed.The liver-to-muscle signal intensity ratio(SIR1)and liver-to-spleen signal intensity ratio(SIR2)were measured based on HBP images.Radiomics features of HBP images were extracted and screened to construct radiomics models.The signal intensity ratio(SIR)-radiomics combined models were constructed based on SIR and radiomics signatures.Receiver operating characteristic(ROC)curves were drawn to evaluate the efficacy of each model for assessing clinical pathological stage of HF.Results The area under the curve(AUC)of SIR1 and SIR2 models for assessing clinical pathological stage of HF were 0.63-0.70 and 0.65-0.71,respectively.The most effective radiomics model for assessing HF,significant HF,advanced HF and early cirrhosis was support vector machine(SVM),SVM,light gradient boosting machine and K-nearest neighbor model,respectively,with the AUC in validation set of 0.87,0.82,0.81 and 0.80,respectively,while the AUC of SIR-radiomics combined models in validation set of 0.88,0.82,0.82 and 0.81,respectively.Conclusion The radiomics models based on Gd-EOB-DTPA enhanced HBP MRI were helpful for assessing clinical pathological stage of HF.Combining with HBP SIR could improve their efficacy.

【Objective】 To investigate the availability and convenience of emergency blood transfusion in mainland China, and develop strategies for improvement. 【Methods】 The electronic questionnaire was self-made by the research team, and pushed to physicians and technicians related to emergency blood use and supply nationwide through the WeChat group of professional organizations such as the Chinese Medical Doctor Association′s Emergency Resuscitation and Disaster Medicine Professional Committee. The data was automatically aggregated by the internet survey platform named questionnaire star, and analyzed by statistics software SPSS 21.0. 【Results】 1) General information: A total of 3 151 questionnaires were collected, of which 85% (2 678 / 3 151), from 31 provinces, municipalities or autonomous regions in mainland China were valid, and 39%(1 044/2 678), 22%(577/2 678), 39%(1 057/2 678) were from the east, middle and west region, respectively; 78%(2 099/2 678) were from tertiary hospitals, and 22%(579/2 678) secondary hospitals and below; 60%(1 607/2 678), 16%(425/2 678), and 24%(646/2 678) were from Emergency Department(EM), Intensive Care Department (ICU) and other departments respectively. The respondents with senior position titles took up 34%(906/2 678) while those with intermediate and junior position titles took up 30% (798/2 678) and 36%(974/2 678) respectively. 2) Availability : 63%(1 680/2 678) of the respondents experienced untimely and insufficient blood supply at least once during June 2017 to May 2020, of which 75% (1 256/1 680) occurred in the past year. In the past half year, 51% (381/1 057) of respondents in the western region and 34% (713/2 099) in tertiary hospitals experienced more emergency blood shortages (P<0.05). The most prone to clinical blood supply shortage were red blood cells and whole blood, platelets and other plasma components, accounting for 43% (1151/2678), 42% (1125/2678) and 15% (402/2678), respectively. 48% (1 274/2 678) respondents believed that the insufficient blood supply for emergency use " has caused a significant adverse effect on the quality of rescue", and 40% (1 081/2 678) believed that it was " a potential medical safety threat" .3)Convenience: The waiting time for emergency blood transfusionwithin 0.5 h, 1 h and 2 h accounted for 28% (741/2 678), 71%(1 903/2 678) and 90% (2 547/2 678), respectively. The waiting time of emergency blood transfusion within 0.5 h accounted for 50% (286 / 577) in central region, which was significantly higher than that in eastern or western region (P < 0.05). 67% (889/2 678) of respondents experienced blood inventory depletion, of which 30%(792/2 678) had to wait for more than 8 hours for resuming blood supply. 80% (751/1 057) of the respondents in the western region experienced inventory depletion, significantly higher than that in the central region (P<0.05). 4)The influencing factors were mainly insufficient blood donation, growth of clinical demand in blood, blood waste due to expiration and clinical irrational use, accounted for 56% (1 485/2 678), 23% (619/2 678), 7% (183/2 678) and 6% (167/2 678) respectively. 60% (633/1 057) of the respondents in the western region considered insufficient blood donation as the influencing factors, statistically higher than that in the eastern and central regions (P<0.05).5)Suggestions for improvement included more voluntary blood donation, development of blood substitutes, standardization of clinical blood use and extension of blood storage shelf life, accounted for 49% (1 326/2 678), 24% (645/2 678), 19% (499/2 678), and 8% (208/2 678), respectively. 53% (561/1 057) of the respondents in the western region suggested strengthening voluntary blood donation (P<0.05), while 26% (268/1 044), 26% (152/577), 25% (553/2099) of respondents in the eastern, central region and tertiary hospitals respectively suggested strengthening the research and development of blood substitutes (P<0.05). 56% (504/906) of respondents with senior professional titles recommended strengthening voluntary blood donation, while 26% (453/1 772) and 0.9% (164/1 772) of those with intermediate and junior technical titles recommended research and development of blood substitutes and improvement of blood storage technology, respectively(P<0.05). 【Conclusion】 The whole blood reserve can not fully meet clinical emergency needs at present stage, especially in the western region and some tertiary hospitals,, showing the necessity to adopt comprehensive measures to further improve the availability and convenience of emergency blood transfusion, including strengthening voluntary blood donation, developing blood substitutes, prompting rational clinical blood use and improving blood storage technology.