Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis,as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled,and according to the time of selective LC,they were divided into group A (with 2 months),group B (2-4 months),and group C (＞4 months),with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups,an analysis of variance was used for comparison between three groups,and LSD-t test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD,and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery,and there were significant improvements in laboratory markers (white blood cell count,neutrophil count,and liver function) (all P ＜ 0.05).No patient experienced complications such as bile leakage,hematobilia,pneumothorax,and colon perforation caused by puncture,and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F =8.029,P ＜ 0.001),time of operation (F =24.674,P ＜ 0.001),intraoperative blood loss (F =12.864,P ＜ 0.001),length of hospital stay (F =22.844,P ＜ 0.001),rate of conversion to laparotomy (x2 =12.345,P =0.002),and incidence rate of complications (x2 =8.750,P =0.013).Compared with group A,groups B and C had significantly lower gallbladder wall thickness before LC,intraoperative blood loss,length of hospital stay,rate of conversion to laparotomy,and incidence rate of complications (all P ＜ 0.05),and group B had significantly lower time of operation,intraoperative blood loss,and length of hospital stay than group C (all P ＜ 0.05).Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.

Objective To discuss CT appearances and diagnosistic value of invasive thymoma.Methods CT findings in 13 cases of invasive thymoma proved by surgery and pathology were retrospectively analysed. Results In 13 cases, invasive thymomas all showed as solf tissue masses in anterier mediastinum on CT, of them, 10 cases were of heterogeneous density and irregular invasion to adjacent organs which the main CT findings were pleural implants in 3, cardiovascular involvement in 9 and abdominal invasion in 1 were found in 11 cases. Conclusion Conventional CT scan plays an important role in diagnosis and differential diagnosis of invasive thymoma.

Objective:To reconstruct middle ear structure for open mastoid antrum with external auditorycanal after radical mastoidectomy in one-stage. Method: 71 ears of post-mastoidectomy (discharging 53 ears anddried up 18 ears) were undergone with reconstruction of middle ear. The posterior wall of external auditorycanal, mastoid cavity and chain of ossicles were reconstructed with homologous costal cartilage. Result: 69 ears of71 cases were near normal structure followed up 6 months to 5 years after operations. The result showed hearingimprovement over 15 dB were 55 ears (77.5％) and under 15 dB were 11 cases (15.5％). Five cases (7.0％)were failed. Conclusion: Reconstruction of middle ear with homologous costal cartilage is a ideal surgery toreconstruct hearing structure and avoid infection of middle cavity after radical mastoidectomy.

This paper discusses issues involved in the deployment of the shelters of campaign-grade rapid medical support system in such aspects as entering of the vehicles,unloading of the shelters and grouping of the staffs. It suggests that the vehicles should rapidly move in at their positions and be butted bidirectional. As the system is deployed,such things should all be fixed as the position of the vehicles & equipments as well as the deployment motions and sequence. The system is positioned at hard surface,the shelters should be pushed towards the immobilized vehicles,but for the system located at soft surface,it is quite the contrary. With the above-mentioned measures implemented,the duration for shelters of campaign-grade rapid medical support system can be reduced largely.

According to the actual situation of taking part in the earthquake relief mission followed by the mobile field hospital,the characteristics of medical support mission and the main problems in the use of medical equipment of the mobile field hospital are summarized.Aimed at the problems,equipments are suggested to be added especially used for surgery,first aid,blood transfusion and some special subjects,and improvement should be made on the equipment of ultrasonic diagnosis,inspection and X-ray examination.Finally,the necessary sorts and quantity of the medical equipments needed in the mission are listed.

Objective To study the clinical outcome of breast conserving treatment of breast ductal carcinoma in situ(DCIS).Methods The data of 62 patients with pathologically proven DCIS who underwent breast conserving operation and adjuvant radiotherapy were retrospectively compared with 62 concurrent cases of stageⅠ or Ⅱ infiltrating ducatl carcinoma who received breast conserving operation and adjuvant readotherapy.Results The recurrence rate in DCIS cases was 6.4%(4/62),among them,3 cases belonged to comedo type;the recurrence rate in early infiltrating type of ductal breast carcinoma was 19.3%(11/62)(P

Objectives:To construct rGA antisense eukaryotic expression vector. Methods:Using molecular cloning technology, we subcloned rGA cDNA in its antisense orientations of the pcDNA 3.0 vector. Results:Cutting with Eco RⅠ and Hin D Ⅲ,antisense recombinant plasmid produce 2 bands. One was 0.28 kb fragment, the other was 5.5 kb fragment which corresponded to theoretical calculation. Conclusions:We succeeded in constructing rGA antisense eukaryotic expression vector.

8 hours and without and binding nursing in these 3 groups respectively. Observed the condition of respiratory tract infection in 3 groups. Results The incidence rate of respiratory tract infection in binding nursing groups was 50%, which was significant higher than that of in no binding nursing group (P8 hours group was 66.67%, and this rate had an tendency of rising with the time of binding nursing lasting (P

Objective To explore the bacterial spectrum and drug resistance that separated from respiratory tract of schizophrene.Methods 311 samples taken from the respiratory tract of schizophrenes were investigated and analyzed.Results From 311 samples 58 pathogenic bacteria were separated,the gram negative was 55.93% and the gram positives was 44.07%;5 most pathogenic commoly bacteria were klesbsiella pneumoniae and S.aureus and escherichia coli and streptococcus and enterococcus;Except that all the staphylococcus were sensitive to vancomycin,enterobacteriaceae were sensitive to imipenem,all the other separated strains showed total resistance to the agents tested in different levels,also the multidrug resistance emerged in lower respiratory tract infections with mulitidrug resistance in high levels.Conclusion The most common pathogenic bacteria separated from these schizophrene are klesbaiella pneumoniae and S.aureus.In clinical therapy,sensitive antibiotics should be selected according to the drug sensitive tests,combine with other agents when necessary to accelerate the clearance of bacteria from infectious respiratory tract in schizophrene.

By the application of modularization combination principle,a new type of field medical point operation instrument set is designed.It not only innovates the organization mode of the traditional field operation instrument case,meets the requirement of intensivization,portability and standardization but also improves the support efficiency of medical service.