Objective To investigate the clinical efficacy of ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for the elderly patients with acute calculous cholecystitis.Methods The clinical data of 35 elderly patients with cholecystolithiasis who were admitted to the General Hospital of Chengdu Military Command from January 2012 to December 2013 were retrospectively analyzed.All the 35 patients received ultrasound-guided double-tract percutaneous drainage,and then received choledochoscopic gallbladder-preserving cholecystolithotomy.The long-term oral use of anti-inflammatory and cholagogue medications after operation reduced recurrence of cholecystolithiasis.All the patients were followed up by telephone interview and outpatient examination till June 30,2014.Results All the 35 patients undergoing successfully the ultrasound-guided double-tract percutaneous cholecystostomy.Of the 35 patients,1 patient with the puncture bleeding was cured successfully by symptomatic treatment,1 patient was treated by cholecystectomy due to the unformed sinus tract under costal margin,and other 34 patients underwent successfully cholecystolithotomy.The follow-up was carried out for 4 to 24 months and 1 patient was diagnosed as with recurrence of cholecystolithiasic.Conclusion Ultrasound-guided double-tract percutaneous cholecystostomy combined with choledochoscopic gallbladder-preserving cholecystolithotomy for elderly patients with acute calculous cholecystitis is safe and feasible,with an advantage of promotional value.

Based on extensive research of anatomy and physiological function of the Eustachian tube,the authors review the literatures to determine the mechanism of patulous Eustachian tube (PET).The purpose of this review is to summarize the current knowledge on the patulous Eustachian tube,present the current diagnostic protocols for PET and determine the comparative efficacy of variable treatments for this condition.In addition,development prospects are summarized in this article.

Objective To compare the clinical effectiveness between the channel-assisted mini-invasion and open Achilles shortening for treatment of the elongated Achilles tendon following previous rupture.Methods The clinical data of 19 patients admitted from Dec. 2013 to Dec. 2015 and met the inclusion criteria were analyzed retrospectively. Eight patients were treated with shortening operation by channel-assisted minimally invasive repair system, while 11 patients received dissection of Krackow Achilles tendon shortening. There was no significant difference between the two groups in gender, age, injury to operation time, preoperative calf circumference and preoperative AOFAS (American Orthopaedic Foot & Ankle Society) score (P>0.05).Results The operation time, incision length and postoperative hospital days were significantly less in min-invasion group than in incision group (P<0.05). After operation, wound healing by first intention was obtained in incision group except 1 case which got infection and healed by treatment 2 weeks later. No sural nerve and vascular injury and lower extremity deep vein thrombosis existed. MRI showed that the Achilles tendon recovered in both groups at the 8th week follow-up. The patients were followed up for 12-17 months in the mini-invasion group and 12-20 months in the incision group. The calf circumference and AOFAS score of both groups were higher in the last follow-up than that in pre-operation (P<0.05), but no significant difference existed between the two groups at the last follow-up (P>0.05).ConclusionChannel-assisted minimally invasive Achilles tendon shortening operation has not only similar effectiveness to the incision shorting operation for the treatment of elongated Achilles tendon following previous rupture, but also has the advantages of shortening operation time and stay in hospital and avoidance of sural nerve injury.

ObjectiveTo investigate the platelet inhibition ratio by thromboelastography (TEG) and its clinical impact in patients undergoing percutaneous coronary intervention (PCI). Methods118 PCI patients were divided into ischemic events group (22 cases) and nonischemic events group (96 cases) according to their clinical follow-up of 6 months. Platelet inhibition ratio was measured by TEG. ResultsADP-induced platelet inhibition ratio of ischemic events group decreased significantly compared with nonischemic events group (P<0.01). And there were no significant differences in AA-induced platelet inhibition ratio between two groups (P＞0.05). ConclusionThere may be some relationship between the ischemic events of PCI patients and their drug resistance to clopidogrel.

AIM: To evaluate the effects of total flavonoid of chrysanthemum on the expressions of Fas and FasL in male rabbits with dry eye, and to investigate the therapeutic effects of the total flavonoid of chrysanthemum on dry eye.
METHODS: Totally 150 male Japanses white rabbits were divided into blank group ( group A ) , sham -operated group ( group B ) , model group ( group C ) , androgen control treatment group (group D), and total flavonoid of chrysanthemum treatment group ( group E ) . The dry eye model was established with orchiectomy on group C, D and E. Rabbits in group E were treated with total flavonoid of chrysanthemum. Rabbits in group D were treated with androgen intramuscular injection. Rabbits in the group A, group B, group C was treated with normal saline. All rabbits were detected with Schirmer's Ⅰ test and tear break-up time (BUT). Fas, FasL were checked on immunohistochemistry.
RESULTS:The Schirmer's I test values of group E was significantly higher than that of group C ( P<0. 01 ) and the BUT value of group E was significantly longer than that of group C ( P<0. 01 ). The quantity of positive expression of Fas in glandular tube cell and acinar epithelial celland apoptosis cells of group E after treatment at 1, 3, 5mo were significantly lower than that of group C, cell population of the positive expression of FasL was obviously higher than that of group C (P<0. 01).
CONCLUSION:The main component of chrysanthemum is flavonoid, which could significantly inhibit happening of dry eye in rabbit after androgen level lowered and lacrimal gland apoptosis and keep basic tears secretory volume and tear film stability.

Currently,three predominant subtypes of influenza virus are prevalent in pig populations worldwide:H1N1,H3N2,and H1N2.European avian-like H1N1 viruses,which were initially detected in European pig populations in 1979,have been circulating in pigs in eastern China since 2007.In this study,six influenza A viruses were isolated from 60 swine lung samples collected from January to April 2011 in eastern China.Based on whole genome sequencing,molecular characteristics of two isolates were determined.Phylogenetic analysis showed the eight genes of the two isolates were closely related to those of the avian-like H1N1 viruses circulating in pig populations,especially similar to those found in China.Four potential glycosylation sites were observed at positions 13,26,198,277 in the HA1 proteins of the two isolates.Due to the presence of a stop codon at codon 12,the isolates contained truncated PB1-F2 proteins.In this study,the isolates contained 591Q,627E and 701N in the polymerase subunit PB2,which had been shown to be determinants of virulence and host adaptation.The isolates also had a D rather than E at position 92 of the NS1,a marker of mammalian adaptation.Both isolates contained the GPKV motif at the PDZ ligand domain of the 3' end of the NS1,a characteristic marker of the European avian-like swine viruses since about 1999,which is distinct from those of avian,human and classical swine viruses.The M2 proteins of the isolates have the mutation (S31N),a characteristic marker of the European avian-like swine viruses since about 1987,which may confer resistance to amantadine and rimantadine antivirals.Our findings further emphasize the importance of surveillance on the genetic diversity of influenza A viruses in pigs,and raise more concerns about the occurrence of cross-species transmission events.

ObjectiveTo explore the effects of epidermal proteins and lamellar bodies on skin barrier in glucocorticoid-dependent dermatitis.MethodsTotally,60 patients with glucocorticoid-dependent dermatitis and 40 normal human controls were eligible for this study.A noninvasive method using TewameterTM was applied to determine transepidermal water loss (TEWL) value in these subjects.Tissue specimens were obtained from the lesions of 13 patients with glucocorticoid-dependent dermatitis and normal skin of 10 human controls.Subsequently,haematoxylin and eosin(HE) staining was performed to observe the histopathological changes,immunohistochemistry to detect the protein expressions of K6,K10,K14,K15,loricrin,filaggrin,involucrin in epidermis,and electron microscopy(EM) to estimate the density of lamellar bodies in tissue specimens.ResultsCompared with the normal controls,the patients displayed an elevated TEWL value (P ＜ 0.05),which suggested an impaired epidermal barrier.Histopathology of lesions revealed nonspecific inflammatorychanges withmarkeddifferencesbetweendifferentclinicaltypesofglucocorticoid-dependentdermatitis.Immunohistochemistry revealed an attenuated expression of K10,K14,loricrin,filaggrin,involucrin and abnormal expression of K15 in lesional epidermis compared with the normal epidermis (all P ＜ 0.05),hinting a suppression of epidermal differentiation and proliferation as well as an impairment of cornified envelope structure.The number and density of lamellar bodies were also reduced in lesional epidermis compared with the control epidermis.ConclusionsCompared with normal skin,the structure of skin barrier is impaired in lesions of glucocorticoid-dependent dermatitis,to restore skin barrier is essential for the treatment of this entity.

Objective To investigate the effect of XuanHuSuoSan and its disassembled prescriptions on dissolution of psoralen and isopsoralen. Methods The dissolution of psoralen and isopsoralen in XuanHuSuoSan and its disassembled prescriptions were determined by HPLC, using ES Industries Epic Polar C18 column (250 mm×4.6 mm, 5 μm) with methanol and water (55: 45) as mobile phase at 25 °C with a flow rate of 1.0 ml/min and detection wavelength of 246 nm. Results The dissolution of psoralen and isopsoralen had great changes among XuanHuSuoSan and its disassembled prescriptions, and the analysis of variance and SNK showed that there were significant differences among XuanHuSuoSan and its disassembled prescriptions (P < 0.05). Conclusion Radix Angelicae Sinensis and Radix Achyranthis Bidentatae are helpful to the dissolution of psoralen and isopsoralen from Fructus Psoraleae, while Rhizoma Corydalis can inhibit the dissolution of psoralen and isopsoralen.

Objective To evaluate the surgical modalities and prognosis in elderly patients with gastric cancer.Methods Sixty three gastric cancer patients aged ≥≥ 75 years underwent radical surgery,with D0 + D1 resection in 32 cases and D2 resection in 31 cases,in Beijing Hospital from January 2005 to December 2009.Results More lymph nodes were dissected in D2 group than those in D0 + D1 group (27.42 ± 12.75 vs.14.59 ± 12.11,t =-4.095,P ＜ 0.05).There was no significant difference in postoperative complication rate [25.81％ (8/31) vs.31.25％ (10/32),x2 =0.095,P ＞ 0.05] and perioperative death rate [3.23％ (1/31) vs.6.25％ (2/32),x2 =0.324,P ＞ 0.05] between two groups.The 5-year survival rate was higher in D2 group than that in D0 ± D1 group (47.3％ vs.21.4％,x2 =6.346,P ＜ 0.05).The 5-year survival rate was higher in POSSUM score (PS) ＜ 20 group than that in PS≥20 group (46.3％ vs.11.1％,x2 =5.492,P ＜0.05).In PS≥20 group,postoperative complication rate did not increase after D2 radical resection(1/8 vs.3/10,x2 =0.824,P ＞ 0.05).Univariate analysis showed that PS ＜ 20 was associated with the prognosis of patients (x2 =5.492,P ＜ 0.05).Cox proportional hazards model showed that lymph node metastasis (OR=4.103,95％ CI:1.790-9.405,P ＜ 0.05) and D2 radical gastrectomy(OR =0.313,95％ CI:0.158-0.620,P ＜ 0.05) were the independent factors associated with the prognosis of patients aged ≥ 75 years with gastric cancer (all P ＜ 0.05).Conclusion Standardized D2 lymph node dissection is beneficial for gastric cancer patients aged ≥75 years.PS ＜ 20,lymph node metastasis and D2 radical gastrectomy are associated with the prognosis of patients.

Objective To study the false negative results of Gelle test .Methods Hearing test data between August 2013 to July 2014 were retrieved from outpatient records with hearing complaints of tinnitus or hearing loss . Recruiting criteria:no history of otitis media ,normal tympanic membrane ,no radiologic manifestations of lesions in middle ear and mastoid and abiltly of clear expression of changes of hearing .A total of 60 patients(120 ears ) were tested with conventional pure tone audiometry (PTA) and Gelle test .Acoustic immittance and distortion product otoacoustic emission (DPOAE) were tested in 110 and 113 ears ,respectively .Results Among 120 ears ,7 were di‐agnosed as conductive hearing loss ,23 as mixed hearing loss ,52 as sensorineural hearing loss ,and 38 as normal hearing by pure tone audiometry .The negative Gelle test results were detected in 5 ,11 ,16 and 3 ears ,respective‐ly .110 ears were tested with tympanometry ,types A ,B and C tympanograms were found in 102 ears ,2 ears and 6 ears ,respectively ,and the negative Gelle test results were 22 ,2 and 4 ,respectively .DPOAEs were recordable in 56 ears and negative in 57 ears ,and negative Gelle tests were recorded in 12 and 17 ears respectively .Conclusion False-negative results were found in all types of PTA ,tympanometry and DPOAE .It indicates that Gelle test might not be sensitive and accurate enough to evaluate the integrity and mobility of ossicular chain .Gelle test com‐bined with PTA and DPOAE may be better for assessment of hearing loss and entity of ossicular chain .