Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; surgery ; Humans ; Immunohistochemistry ; Keratins ; metabolism ; Ki-67 Antigen ; metabolism ; Male ; Pancreas ; metabolism ; pathology ; Pancreatic Neoplasms ; metabolism ; pathology ; surgery ; Pancreaticoduodenectomy

Objective To study the use of ultrasound-guided percutaneous transhepatic cholecystostomy (PTGD) followed by selective minilaparotomy cholecystectomy (MC) for acute obstructive cholecystitis in the high-risk elderly.Method A retrospective study was conducted on 120 patients who received ultrasound-guided PTGD followed by selective MC from January 2008 to December 2010.Results PTGD+ MC were performed successfully on 120 patients with acute severe obstructive chole cystitis.In all the patients,the abdominal pain was relieved within 2-3 h of operation,and the temperature decreased to normal from 24- 48 h after operation.The average time of drainage was 10 days.In 97 patients MC was performed 1 week after PTGD,and in 23 patients 2 weeks after PTGD.Bleeding from gallbladder bed occurred in 1 patient.No patient suffered from bile leak.There was no major complication or death after PTGD+ MC.Conclusion PTGD followed by selective MC is a simple,efficacious and minimally invasive treatment for high-risk elderly patients with acute obstructive cholecystitis.

Abdominal Cavity ; blood supply ; Adolescent ; Angioplasty, Balloon ; Child ; Female ; Humans ; Male ; Takayasu Arteritis ; therapy

Objective To understand and master the situation of residents consumption of iodized salt in Chenzhou city of Hunan province,to identify problems and take appropriate interventions to ensure the residents consumption of qualified iodized salt,and to provide a scientific basis for elimination of iodine deficiency disorders (IDD).Methods According to the National Iodized Salt Monitoring Program (Amendment) and the Evaluation Scheme for Elimination of Iodine Deficiency Disorders at the County Level,the monitoring counties,towns and villages were selected in Chenzhou city from 2008 to 2011,the content of iodine in salt was detected using direct titration.The data was analyzed by SPSS 17.0 and Excel 2003.Results A total of 12700 salt samples were tested from 2008 to 2011.The iodized salt coverage rate,the qualified rate of iodized salt,the consumption rate of qualified iodized salt and the rate of non-iodized salt was 99.19％ (12597/12700),96.33％ (12135/12597),95.55％(12135/12700) and 0.81％ (103/12700),respectively.There were significant differences between each year from 2008 to 2011 (x2 =13.99、42.35、48.45、13.99,P all ＜ 0.01).The coefficient of variation was 21.19％.The median and average of iodine content in salt samples was 32.2 mg/kg and 31.9 mg/kg,respectively.Compared with the median and average of iodized salt content,there was no significant difference between each year from 2008 to 2011 (t =2.941,P ＞ 0.05),while there was significant difference among the 11 counties(t =2.983,P ＜ 0.05).Conclusions The goal of eliminating IDD has realized in the city of Chenzhou since 2010.To consolidate the IDD control results,surveillance should be strengthened in future.

Communicable diseases are the major threats to the health and security of all the people living in Liberia, including UN peacekeepers from China. The most prevalent communicable diseases in Liberia include malaria, HIV/AIDS, acute respiratory infection, sexual transmitted disease, schistosomiasis, onchocerciasis, tuberculosis, cholera, pertussis, hepatitis, meningococcal disease, typhoid fever, Lassa fever and yellow fever. An insight into the profiles and epidemiology of the above epidemics in Liberia would greatly help peacekeepers with disease diagnosis and epidemic prevention. According to the profiles of epidemics in Liberia and the authors' experience in epidemic prevention in Liberia, the authors recommend that peacekeepers strengthen their epidemic prevention as follows. Firstly, a combined vector control strategy is suggested for the prevention and control of vector-borne diseases. Secondly, water safety should be highlighted by water disinfection and regular water quality testing. Thirdly, vaccines, diagnostic reagents and medications should be accordingly outfitted. Then, the awareness of epidemic prevention and individual hygiene should be improved by education and strict management. Finally, the daily life management for peacekeepers is also very important. The epidemic overviews and strategies for epidemic prevention described in this paper are also useful for all the other peacekeepers deployed in Africa.

Objective To investigate and compare the clinical thinking ability of medical graduate students of different majors and different grades to explore the influencing factors of clinical thinking ability. Methods 180 graduate students in Medical College of Qingdao University were sur-veyed,including 54 nursing and 126 clinical medicine graduates of different grades. We used a self-designed scale of clinical thinking ability which included three main dimensions (critical thinking abil-ity, systematic thinking ability, evidence-based thinking ability) and twenty-four level 2 items. Ap-plying t test, ANOVA, multiple linear regression analysis for data statistical analysis. Results There's no significant difference comparing the scores of nursing graduates to the scores of clinical medical graduates(t=-0.80, P>0.05). However, there is significant difference in the different grade graduates (F=53.43, P<0.05). The multiple linear regression analysis shows that the practice time, reading professional literature quantity, and starting research earlier or later,are signif-icantly related to the clinical thinking ability(P<0.05). Conclusion The clinical thinking level of medical graduate students is generally high, and the higher grade, the higher level of clinical think-ing ability. We must strength-en the training of clinical thinking ability of medical graduates.

Background T helper cell 17 (Th17),a newly discovered subset of CD4+ T cells,have been found to play an important role in dry eye disease in animal model.Further investigation should be done on the immunopathogenesis of Th17 cells in dry eye patients.Objective This study was to analyze the expression status of interleukin-17 (IL-17) and IL-22 in tear and supernatant of peripheral blood mononuclear cells (PBMCs) of dry eye patients and their correlation with clinical symptom and sign.Methods Twenty Sj(o)gren syndrome (SS)patients,twenty non-Sj(o)gren syndrome (NSS) patients were included in Wuxi Second Hospital from 2010 to 2011,and twenty healthy volunteers were recruited at the same period.All of subjects understood the purpose and procedure of research and written informed consent was obtained form each subject initial of this study.Dry eye symptom questionnairs were self-answered and multiple dry eye disease-related clinical tests,including the breakup time of tear film (BUT),Schirmer Ⅰ test (S Ⅰ t) and corneal fluorescein staining were performed.The periphery blood of 3 ml and tear were collected in all the subjects,and IL-17 and IL-22 levels in supernatant of PBMCs and tear were detected by enzyme-linked immunosorbent assay (ELISA).The correlations between levels of IL-17 and IL-22 with BUT,S Ⅰ t,corneal fluorescein staining and dry eye scores were analyzed.Results The dry eye scores reduced,BUT prolonged,S Ⅰ t increased and corneal fluorescein dye decreased from SS group,NSS group to normal control group,with significant differences among the three groups (dry eye scores:H =40.81,P＜0.01 ; BUT:H =40.15,P＜0.01 ;S Ⅰ t..H=50.07,P＜0.01 ;corneal dye scores:H=40.52,P＜0.01).The concentration of IL-17 in the supernatant of PBMCs in the SS patients,NSS patients and normal controls were (964.92±124.83)ng/L,(718.85± 115.89)ng/L and (341.95±85.08) ng/L,showing a statistically significant difference among them (F=162.95,P＜0.01).The levels of IL-17 in the tear were (440.69±126.09) ng/L,(364.33±126.85) ng/L and (61.16±11.60) ng/L in the SS group,NSS group and normal control group respectively,exhibiting an elevated level in the SS group and NSS group compared with the control group (F=75.27,P＜0.01).In addition,the levels of IL-22 in the supernatant of PBMCs in the SS patients,NSS patients and normal controls were (98.77± 11.27) ng/L,(79.65 ± 11.01) ng/L and (32.78±9.34) ng/L,and those in the tear were (22.22 ± 8.96) ng/L,(14.92 ±4.35) ng/L and (10.47 ± 2.67) ng/L,with significant differences among the three groups (F =206.27,P＜0.01 ;F =19.87,P＜0.01).The significant correlations were found between the IL-17 and IL-22 concentration in the supernatant of PBMCs and tear with corneal fluorescein staining scores and S Ⅰ t.Conclusions The contents of IL-17 and IL-22 in PBMCs and tear upregulate in the SS and NSS patients,indicating that Th17 plays a key role in the immunity mechanism of dry eye.

Objective To observe the clinical effect of MC and LC in treatment of elderly patients with cholelithiasis and dise~s the best treatment in elderly patients with cholelithiasis.Methods Of 798 elderly patients with cholelithiasis,412 patients were divided into MC group with minilaparotomy cholecystectomy treatment,and 386 patients were divided into LC group with laparoseopic cholecystectomy treatment,then compare clinical effect and complications after operation.Results There was no significant differences in incision length,operative time,blood loss,bed time,hospital stay(all P＜0.05);There Was significant statistical significance in cost of treatment,complications after operation(all P＜0.05).Conclusion Minilaparotomy cholecystectomy was suitable for elderly patients with cholelithiasis,and it Was good at cost of treatment,complications after operation.