Objective To investigate the selection of the types of anastomosis of bilioenterostomy and evaluate the therapeutic effects.Methods From 1990 to 2000,536 patients with obstructive jaundice underwent bilioenterostomy in our hospital.The patients included 279 cases(52%) of hilar strictures with hepatolithiasis,108 cases(20%) of end stage periampullary tumors,96 cases(17%) of proximal cholangiocarcinoma and 53 cases(12%) of congenital choledochus cyst.The types of anastomosis included extra or hilar hepatic bilioenterostomy in 302 cases(56%),intra hepatic duct anastomosis with different type of hepatectomy in 222 cases(42%),of which 44 cases(8%) were anastomosed by roud ligament approch,27 cases(5%) through gallbladder fossa.Results The short term and 1～9 years long term follow up indicated that the jaundice of different patients can be completed relieved by suitable type of bilioenterostomy.Conclusions The good therapeutic effects of bilioenterostomy come from the correct selection of the anastomosis methods.

Objective To evaluate risk factors of hepatectomy for patients with large hepatocellular carcinoma (HCC). Methods Clinical data of 310 large HCC cases receiving hepatctomy were analyzed retrospectively. Results Hepatitis B infection rate was 60.7% in this group with cirrhosis rate of 66.8%. Tumor size averaged at (9.4?3.8) cm in diameter. Child A grade was found in 51.0% of cases, Child B in 36.8% and Child C in 12.3%. Pringle′s procedure, semi-liver blood occlusion and modified Heaney procedure were used in 31.6%, 11.0% and 2.3% of cases respectively, with occlusion time of ( 17?8) min, (25?9) min and (20?10) min, respectively. Left lateral lobectomy, left hemihepatectomy, right hemihepatectomy and segmentectomy were performed in 17.1%, 11.6%, 9.0%, and 62.3% cases, respectively. Blood loss, blood transfusion and operation duration were (820?1 151) ml, (966?945) ml and (182?74) min, respectively. The overall morbidity and liver failure were 22.3%, and 5.8%, respectively, with an operative mortality of 2.6%. The univariate analysis for liver failure revealed its risk factors being preoperative AST value(P

Objective To analyze the factors influencing the prognosis of patients with pancreatic cancer.Methods The clinical data of 276 patients with pancreatic cancer who had been admitted to our department from September 1995 to August 2005 were retrospectively analyzed.Cox regression analysis was used to screen out independent risk factors influencing the prognosis of patients with pancreatic head cancer or pancreatic body and tail cancer,and Kaplan-Meier method to calculate the median survival time.The effects of tumor location on the prognosis were examined by Log-rank and Breslow test.Results Cox regression analysis showed that the diameter of tumor,invasion of the superior mesenteric vessel and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic head cancer;while age,lymphadenectasis and treatment method were the independent risk factors influencing the prognosis of patients with pancreatic body and tail cancer.The median survival time of patients with pancreatic head cancer and pancreatic body and tail cancer after radical resection were 460 days and 480 days,which were significantly longer than 240 days and 200 days of patients who received palliative treatment or gave up treatment.The median survival time of patients with whole pancreatic cancer was 117 days,which was significantly shorter than 330 days of patients with pancreatic head cancer and 300 days of pancreatic body and tail cancer.Conclusions Radieal resection is currently the best choice for pancreatic cancer.The prognosis is poor for patients with pancreatic head cancer(diameter≥4 cm)and invasion of the superior mesenteric vessel.Patients with age≤60 and lymphadenectasis are the factors resulting in poor prognosis of pancreatic body and tail cancer.The prognosis of patients with pancreatic head cancer and pancreatic body and tail cancer are close.Patients with whole pancreatic cancer is in the terminal stage with the worst prognosis.

Objective To investigate the effect and mechanism of oetreotide (OCT) on DENA related hepatoeareinogenesis in rats. Methods Fresh diethylnitrosamine (DENA) solution was given to induce the model of rat hepatoeellular carcinoma. The rats were divided randomly into two groups: OCT treatment group and control group. The survival rate and hepatoeareinogenesis rate were observed. SSTR2 mRNA and protein expression were measured. Results The survival rote of OCT treatment group (70.0%, 7/10) was significantly higher than that of control group (30.0%, 6/20) (X2 = 4.344, P<0.05). 16 weeks after DENA treatment, the difference of bepatoearcinogenesis rate between the two groups was not remarkable though the value of OCT treatment group (0%, 0/10) was lower than that of control groups (30.0%, 6/20)(X2 = 3.750, P＞0.05). However, 22 weeks after DENA treatment, hepatoeareinogenesis in control group (83.3%, 10/12) was markedly higher than that in OCT treatment group (22.2% , 2/9)(X2 =7.843, P<0.01). With liver cirrhosis progressing, the expressions of SSTR2 mRNA and protein increased, and reached the peak 16 weeks after DENA treatment, then began to decrease. The expressions of SSTR2 mRNA and protein in hepatocellular carcinoma were significantly lower than those in the liver 22 weeks after DENA treatment (F = 35.010 and 13. 386, P<0.01). The expression levels in OCT treatment group were similar to those in control group 8 and 16 weeks after DENA treatment. But the expression levels in OCT group 22 weeks after DENA treatment didn't lower markedly, and were higher significantly than those in control group (t = 2.806 and 4.498, P<0.05). Conclusion OCT can inhibit efficiently hepatocareinogenesis and reduce the mortality of rots treated with DENA possibly by a mechanism maintaining the expression levels of SSTR2.

Scientific and technological ability is one of the core competitiveness of the hospital.The hospital medical researchers are the main body of technological innovation activities.The establishment of scientific and effective incentive mechanism is an important way to stimulate the potential innovation of researchers and to promote the development of the hospital.In this article,we summarized the common problems on current research incentive mechanism in hospitals and proposed the corresponding strategies,in order to improve the research incentive mechanism.

Objective The subject number and funds of cooperative projects had been an important indicator of the strength of scientific research in hospital.This article analyzed the data of cooperative projects of a general top three hospital in recent tenyears to provide reference for policy-making of scientificresearchmanagement department.Data collected and analyzed including subject distribution,the disciplines crossing situation,background information on principle investigators.Methods Based on the scientific research management software,the data of the cooperative projects can be collected from 2006 to 2015.The distributions of subjects and the age,education,and title of PIs were analyzed by SPSS software.Results In general,the project numbers and fundingof cooperative projects were unstable in past ten years.Many focused mainly on basic departments and key subjects.There was no obvious advantage in the integration of subjects.Thecooperative projects of national science and technology supporting plan played an important role in national level projects.And the science and technology supporting plan of Beijing city played an important role in province-level projects.Many of the PIs of cooperative projects were talents with higher education,higher professional title and senior in their career stage.Conclusions Administrators of the hospital should pay attention to the management of cooperative projects.Strengthen cooperation among departments and promote the integration of subjects.Improve the construction of human resource,pay attention to the cultivation of young talents.Establish effective incentive mechanism.

Objective To analyze the molecular characteristics and genetic origin of a novel avian influenza A H7N4 virus casuing a case of human infection in China. Methods Specimens were collected from the patient and chickens and ducks kept by the patient and neighbours and then detected by real-time quantitative PCR. The original specimens and virus isolates were analyzed by next-generation sequencing technology to obtain viral whole-genome sequences. Pairwise sequence alignments and phylogenetic analysis were performed by BLASTs,ClustalX and MEGA 6. 1 softwares. Results In January 2018, a human case infected with avian influenza A H7N4 virus was confirmed. Seven H7N4 viruses were isolated from speci-mens collected from chicken and ducks kept in the patient`s backyard. H7N4 virus was a novel reassortant vi-rus with all eight gene fragments derived from wild waterfowl in Eurasia. HA protein contained a single basic amino acid residue R in cleavage site, suggesting that H7N4 virus was low pathogenic. The receptor-binding sites of HA had QSG at 226-228 residues, which indicated that the virus retained avian-type receptor speci-ficity (SAα2-3Gal). Different from H7N4 viruses in avian, the virus isolated from the patient had substitu-tion at position 627 ( E→K) in PB2 protein, which might increase its adaptation in human host. Conclusion This study reported a case of human infection with a novel reassortant avian influenza A H7N4 virus, which revealed that the traditional backyard breeding models might facilitate cross-species transmission of avian in-fluenza viruses in southern China.

Objective:To establish a long-term mortality rate prediction model for patients aged 60 years and over with atrial fibrillation and coronary heart disease using the machine learning method, and identify the corresponding risk factors of mortality.Methods:In this retrospective cohort study, a total of 329(11 cases lost of follow-up)patients with 183 males(55.6%)and 146 females(44.4%), aged(77.8±7.3)years, and 142 patients aged 80 years or older(43.2%)were selected in our hospitals from January 2013 to March 2015.And their clinical data on atrial fibrillation and coronary heart disease were analyzed.They were divided into the death group(151 cases)and the survival group(167 cases)according to the survival outcome.In addition, 60 patients aged 60 years and over admitted to our hospitals from April to July 2015 with atrial fibrillation and coronary heart disease were selected as external data validation set.The clinical data included age, gender, body mass index, diagnosis, co-morbidity, laboratory indicators, electrocardiogram, echocardiogram, treatment data.These patients were followed up for at least 6 years, and the main adverse cardiovascular and cerebrovascular events(MACCE), including death, were recorded.Finally, the data of the enrolled patients were randomly divided into the training set and the test set according to the ratio of 9∶1, Different models were established to predict the long-term mortality of patients with atrial fibrillation and coronary heart disease by machine learning algorithm.The optimal model was established by substituting external data(60 cases)into the model for verification and comparison.The top 20 risk factors for mortality were determined by Shapley additive explanation(SHAP)algorithm.Results:A total of 329 hospitalized patients were included in this study, the overall median follow-up time was 77.0 months(95% CI: 54.0~84.0), 11 cases lost during follow-up(3.3%), and 151 cases died(45.9%). The analysis found that the areas under the ROC curve for a support vector machine(SVM)model, k-Nearest Neighbor(KNN)model, decision tree model, random forest model, ADABoost model, XGBoost model and logistic regression model were 0.76, 0.75, 0.75, 0.91, 0.86, 0.85 and 0.81, respectively.The random forest model had the highest prediction efficiency, with the accuracy of 0.789 and F1 value of 0.806, which was better than the logistic regression model[the Area Under Receiver Operating Characteristic Curve(AUC): 0.91 vs.0.81, P<0.05]. D-dimer, age, number of MACCE, left ventricular ejection fraction, serum albumin level, anemia, New York Heart Association(NYHA)grade, history of old myocardial infarction, estimated glomerular filtration rate(eGFR)and resting heart rate were important risk factors for predicting long-term mortality. Conclusions:The random forest model based on machine learning method can predict the long-term mortality of patients with atrial fibrillation and coronary heart disease aged 60 years and over, have a good identification ability.Its accuracy is higher than that of the traditional Logistic regression model.Reducing the long-term mortality and improving the long-term outcomes can be achieved by intervening on D-dimer levels, correcting hypoproteinemia and anemia, improving cardiac function and controlling resting ventricular rates.

Objective:We evaluated frailty in elderly hospitalized patients with atrial fibrillation and analyzed the relevance, consistency, and diagnostic power of different frailty tools.Methods:From September 2018 to April 2019, a total of 197 elderly patients with atrial fibrillation aged ≥ 65 years in Beijing Hospital, Chinese PLA General Hospital, and Beijing Tsinghua Changgung Hospital were prospectively enrolled.Five frailty tools, including the clinical frailty scale(CFS), FRAIL scale(FRAIL), Fried frailty phenotype(Fried), Edmonton frail scale(EFS), and comprehensive geriatric assessment-frailty index(CGA-FI), were used for frailty assessment.Results:A total of 197 hospitalized elderly patients with atrial fibrillation were enrolled, with an average age of(77.5±7.1)years old(57.4% male). The prevalence of frailty, according to the five frailty tools, were 25.4%(FRAIL), 27.9%(EFS), 34.5%(Fried), 40.6%(CFS), and 42.6%(CGA-FI), respectively.CFS had a good correlation(correlation coefficient 0.80)and and consistency(Kappa value 0.71, 95% CI 0.61~0.81)with CGA-FI.The combined frailty index was used as the gold standard for frailty diagnosis.The results showed that CFS and CGA-FI had high diagnostic sensitivity(95.9 % and 98.0 %, respectively)and specificity(77.7 % and 75.7 %, respectively). Conclusions:Frailty is common in elderly hospitalized patients with atrial fibrillation, showing multidimensional features, and physical weakness is not prominet.CFS and CGA-FI are recommended for the assessment of frailty in patients with atrial fibrillation, which had good correlation and consistency.