About 5％- 15％ patients suffered from gallbladder stones may have secondary bile duct stones.How to diagnose secondary bile duct stones in time preoperatively or intraoperatively has been a focus of research.In this paper,the advantages and disadvantages of a variety of diagnostic methods of secondary bile duct stones including B ultrasonography,computed tomography,percutaneous transhepatic cholangiography,endoscopic retrograde cholangiopancreatography,endoscopic ultrasonography,magnetic resonanced cholangiopancreatography,intraoperative cholangiography,intraoperative ultrasonography,choledochoscope,are reviewed.

Objective To compare the clinical efficiency of two methods in the open surgery treatment of seconda-ry common bile duet stones: transeytie common bile duet exploration with eholedoehoscope (TCBDE),or traditional eholedoehotomy with T-tube drainage.Methods Retrospectively analysis the treatment of 113 eases with secondary bile duet stones (TCBDE group 58 cases ,T-tube group 45 cases) ; Compare the achievement ratio,operating time; complications,average hospital stay and cost between two groups.Results All procedure is successful,without any severe complications.There are no significant differences of operating time.The TCBDE group has sig-nificantly shorter hospital stay and lower cost.Conclusion TCBDE has significant advantages than the traditional choledochotomy,and should be the predominant method in the open surgery of secondary common bile duet stones.

Objective To study the clinic-pathological features,diagnosis,treatment,and prognosis of solid-pseudopapillary tumors of pancreas.Methods A retrospective clinical and pathological analysis was made on 10 patients(1 ∶ 4),admitted from January 2003 to December 2011.There were 2 male and 8 female patients,aging from 16 to 65 years with a mean of 32.6 years.Results The main symptom was mild abdominal pain (4/10).B-US,CT,MRI demonstrated that all tumors were located in pancreas (3 cases at the head,1 case at the neck,and the others at the body and tail),and well circumscribed,contained some degree of cystic degeneration.All the 10 patients had curative resections including,3 patients received standard duodenopancreatectomy,1 patients received tumor resection and pancreaticojejunostomy,2 patients received distal pancreatectomy,and 4 patients received distal pancreatectomy plus splenectomy.The specimens appeared as solid (3/10) or solid and cystic(7/10),and the biggest tumor diameter was between 3.3-14.0 cm with an average about 5.91 cm.Immunohistogically,the tumors were positive for Neuron-Specific Enolase (NSE,9/9)、Vimentin (9/9),CD56(7/7),Synaptophysin (Syn,5/8),Progesterone Receptor (PR,5/6),CD10 (4/6),Chromogranin A (1/4).Totally 10 cases were followed up with a average period of 36.6 months without tumor recurrence.Conclusions Solid-pseudopapillary tumor of pancreas is a rare tumor with low grade malignancy.Accurate diagnosis was difficult before operations.Surgical resection is recommended as the main treatment,and the prognosis is good.

Objective To assess the sensitivity of indices of hip development in children with spastic diple-gia resulting from cerebral palsy. Methods X-ray images of the hips of 57 children with cerebral palsy ( the cere-bral palsy group) were checked, and the acetabular index ( AI), femur head migration percentage ( MP), center-edge angle and neck-shaft angle (NSA) were compared with those of normal children ( the control group, n = 30).Results The differences in MP and NSA between the two groups were significant. The prevalence of hip subluxation was 20.45% among the children with spastic diplegia who could not walk independently, and the prevalence was sig-nificantly greater in children 3 to 5 years old than among those under 3. Conclusion The MP can be used as a sen-sitive index to evaluate hip development. Age is a relevant factor affecting the hip development of children with cere-bral palsy.

Objective To analyze the related rules and prognosis analysis for lymphatic metastasis in patients for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Methods This study retrospectively reviewed 65 patients who underwent radical surgery for Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction in Beijing Friendship Hospital between July 2013 and March 2017.The primary indicators were sex,age,tumor site,tumor size,macroscopic type,histological type,depth of invasion,operation,tumor emboli and carcinoma nodes.The clinical characteristics and pathological features were analyzed by using Logistic regression and Kaplan-Meier survival analysis.Follow-tup using outpatient examination and telephone interview was performed to detect patients' diseases and postoperative survival up to April 2017.Results Lymph node metastasis was observed in 41 of 65 patients (63.1％).Lymph node metastasis frequency was found in No.1,No.2,No.3,No.7,No.11 and No.110 lymph nodes.The incidences of those lymph node metastasis were 45.3％,32.5％,28.8％,22.5％,19.4％ and 8.2％.The metastasis rate of the tumors with diameter over 2 cm was higher than the tumors which were less than 2 cm (71.9％ vs 0;P =0.000);The observed rate of lymph node metastasis was 0,12.5％,69％,95.2％ in early cancer (T1) and advanced cancer (T2-T4) (P=0.000) respectively.The metastasis rate of highly differentiated Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction was 45.2％ lower than poorly differentiated tumors 79.4％ (P =0.009).Thirty-three cases were found with lymphatic embolus,28 of them (84.8％) were found to be combined with lymph node metastasis among them (P =0.001).All the differences were statistically significant (P ＜ 0.05).The results of multivariable analyzed by binary logistic regression analysis revealed that neoplasms histologic type and lymphatic embolus were independent risk factors for lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction.Sixty-five patients were followed up for 1-45 months,with a median time of 18.81 months.Although there was no statistically significant difference,3 years-overall survival rate showed tumor without lymph node metastasis has better prognosis than with lymph node metastasis and early stage tumor also has better prognosis than advanced tumor.Conclusions Lymph node metastasis of Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction is related with histological type of tumor and lymphatic embolus.For Siewert Ⅱ and Ⅲ adenocarcinoma of the gastroesophageal junction,the incidence of lymphatic metastasis were higher appear in abdominal cavity,which included No.1,No.2,No.3,No.7 and No.11;Meanwhile,the metastasis of mediastinal lymph node is given priority to No.110 lymph node.Therefore,radical total gastrectomy combined with standard D2 lymphadenectomy and No.110 lymphadenectomy are performed in order to improving the prognosis.For patients with lymph node metastasis and tumor in advanced stage,long-term prognosis remains to be further study.

Objective:To investigate high mobility group protein 1(HMGB1), tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels and their clinical significance in elderly patients with viral pneumonia.Methods:One hundred and sixty elderly patients with viral pneumonia admitted to the Sixth Hospital Affiliated to Anhui Medical University were enrolled as research subjects.In addition, 40 elderly people who underwent regular physical examination were considered as the control group.Patients with viral pneumonia were divided into the low-risk group, middle-risk group and high-risk group according to CURB-65 scores and pneumonia severity index(PSI)scores.HMGB1, TNF-α and IL-6 levels were compared between different groups.The correlations of CURB-65 scores and PSI scores with HMGB1, TNF-α, IL-6 levels were analyzed.Multivariate Logistic regression analysis was used to examine influencing factors for the severity of viral pneumonia in elderly patients.Results:HMGB1, TNF-α and IL-6 levels were higher in research subjects than in the control group.As the severity of viral pneumonia increased, so did HMGB1, TNF-α and IL-6 levels(all P<0.05). HMGB1, TNF-α and IL-6 levels in the severe viral pneumonia group were significantly higher than those in the non-severe viral pneumonia group( P<0.05). HMGB1, TNF-α and IL-6 levels were positively correlated with CURB-65 scores and PSI scores(CURB-65 score: r=0.463, 0.392 and 0.497, P=0.015, 0.003 and 0.025; PSI score: r=0.596, 0.515 and 0.381, P=0.007, 0.011 and 0.009). HMGB1, TNF-α and IL-6 levels were influencing factors for the severity of viral pneumonia in elderly patients( OR=1.344, 1.422 and 1.351, P=0.006, 0.015 and 0.009). Conclusions:HMGB1, TNF-α and IL-6 levels are closely correlated with the severity of viral pneumonia and are helpful for early assessment of viral pneumonia.

Objective To explore the effectiveness of self-care intervention for elderly patients with diabetes mellitus in rural community. Methods We randomly selected 100 elderly patients with diabetes from January 2013 to December 2013 in rural community health service station in Yizhou, Guangxi Zhuang Autonomous Region. Individualized intervention of diabetes-related knowledge was delivered to patients. Fasting blood glucose and glycated hemoglobin were compared before and after the intervention. The effectiveness of intervention was investigated by diabetes self-care scale. Results Levels of fasting blood glucose [(5. 91 ± 0. 10)mmol/L] and glycated hemoglobin [(4. 62 ± 0. 14)%] from 100 patients were lower than those before the intervention after 1 year intervention (t=11. 840,12. 379;P<0. 01). After intervention, the total score of diabetes self-care scale was improved to (89. 66 ± 1. 56) from (75. 32 ± 1. 50) (t = -7. 597,P <0. 01). Conclusions Blood glucose can be effectively controlled by helping the rural elderly diabetic patients to learn about self-care.

BACKGROUNDSuccessful aging (SA) and mild cognitive impairment (MCI) are heterogeneous groups of aging. To explore the heterogeneity, the functional connectivity was studied in these populations.

METHODSThe present study utilized functional connectivity magnetic resonance imaging (fcMRI) to investigate default mode network (DMN) in 8 healthy subjects of SA, 8 subjects of usual aging (UA), and 8 MCI patients during verbal fluency tests (VFTs). Functional connectivity (based seeds) of different groups was analyzed by using statistical test.

RESULTSCompared with SA and UA groups, MCI subjects exhibited decreased functional connectivity in the DMN regions, including the inferior parietal lobule and left angular gyrus (t = 3.53, P < 0.001). Compared with UA and MCI groups, the SA elderly exhibited increased functional connectivity in the precuneus (t = 3.53, P < 0.001).

CONCLUSIONSThese findings suggested that abnormalities of functional connectivity in DMN might be related with semantic memory impairment in aging. Left angular gyrus and precuneus might be the potential imaging-based biomarker for distinguishing heterogeneous process of elderly.

Aged ; Aged, 80 and over ; Aging ; physiology ; Brain ; physiopathology ; Cognitive Dysfunction ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neuropsychological Tests

OBJECTIVETo investigate the clinical effects of arthroscopic repair and arthroscopic-assisted small incision repair for the treatment of rotator cuff injury.

METHODSThe clinical data of 86 patients with rotator cuff injury from January 2012 to January 2015 were analyzed retrospectively. All the patients were divided into two groups: arthroscopic assisted small incision repair group(group A) and arthroscopic repair group(group B). There were 46 patients in group A, including 25 males and 21 females, with an average age of (52.8±7.8) years old. And there were 40 patients in group B, including 23 males and 17 females, with an average age of (53.2±9.5) years old. Several indexes such as shoulder joint activity, muscle strength and ASES, UCLA and VAS scores were examined before and after operation to compare therapeutic effects between these two groups.

RESULTSAll the patients were followed up, and the mean time was 20.8 months (ranged, 18 to 35 months). The results of patients in group A as follows: range of abduction motion of shoulder joint was (131.4±18.8)°, external rotation was (64.9±8.8)°, and internal rotation was(63.7±7.3)°. Results of patients in group B as follows: range of abduction motion of shoulder joint was(132.3±16.9), external rotation was(65.1±9.4)°, and internal rotation was(64.4±8.1)°. All the patients had better shoulder mobility than those before operation, but there were no significant differences between two groups after operation. Postoperative scores of patients in group A: ASES was 88.4±8.9, UCLA score was 29.6±3.6, VAS was 1.4±0.3; and in group B, the above scores were 89.5±9.6, 30.8±4.1 and 1.3±0.4 respectively. All the patients had better scores than those before operation, but there were no significant differences between two groups after operation.

CONCLUSIONSArthroscopic repair and arthroscopic-assisted small incision for repair of rotator cuff injury has clinical curative effects to some extent, and these two methods could improve the safety and reliability of surgical treatment.

Objective To compare clinical outcomes between modified invagination pancreaticojejunostomyandmucosa (MIP) to mucosa duct pancreaticojejunostomy(MDP) in pancreaticoduodenectomy.Methods In Department of General Surgery,Beijing Friendship Hospital Capital Medical University,from Jan.2013 to Jan.2019,there were 222 cases performed pancreaticoduodenectomy,with MIP or MDP.According to the operation methods,by matching the sex and year decads,all patients were divided into MIP group (n =111) and MDP group (n =111).The incidence of pancreatic fistula in two groups was observed.The software of SPSS 20.0 was adopted for statistical analysis.Results There was no perioperative death in both groups.The mean operative time of MIP group was significant shorter than that of the MDP group [(212.8 ± 62.4) min vs (231.5 ±51.9) min,P =0.016].However,there were no significant differences in blood loss,blood transfusion,bowel fnnction recovery and liquid diet time.There was no grade C pancreatic fistula in MIP group,but 2 cases in MDP group.There were no significant differences in incidence and classification of pancreatic fistula between two groups.Conclusions There were no significant differences in clinical outcomes between MIP and MDP.The MIP is more easier to performed,so it is of certain spreading value.However,the further evidence need more prospective controlled study.