Objective To summerize the experience in diagnosis and surgical treatment for hilar cholangiocarcinoma in recent years.Methods 86 consecutive cases of hilar cholangiocarcinoma were surgically treated in this hospital from Jan. 1992 to Oct. 1998. Results The tumor resection rate was 37%(32/86) in this series. The postoperative morbidity and mortality rate were 47% and 7% respectively. The median survival time in palliative resection group was 16 months and the 1-year, 3- year, 5-year survival rate was 63%,21%,15% respectively. For curative resection,the median survival time was 19 months and the 1-year, 3- year, 5-year survival rate was 80%,35%,25% respectively( P =0 038). For drainage group, the median survival time was 5 months and the 1-year, 3- year, 5-year survival rate was 28%,8 4%,5% respectively.Conclusion Early diagnosis, improvement of patients′ general preoperative condition and the surgical expertise may help in increasing the curative resection rate and reducing postoperative morbidity and mortality rate, which are keys to prolong patients′ survival.

Objective To investigate the characteristics of clinical cellular immunity and its relationship with prognosis in elderly patients with severe infection caused by Omicron variant.Methods The clinical data of 53 patients with Omicron variant infection admitted to the geriatric Intensive Care Unit of the First Affiliated Hospital of Kunming Medical University from December 2022 to February 2023 were retrospectively analyzed.The patients were divided into 22 survival cases and 31 death cases for comparison between the two groups.Logistic analysis is adopted to define the omicron variants of elderly severe infections prognostic factors and construct the ROC curve.Results Mu-ltivariate logistic analysis revealed that the independent risk factors were elevated IL-6(P = 0.043)and decreased absolute T lymphocyte count(P = 0.011).AUC value of ROC of IL-6,absolute T lymphocyte count and IL-6 combined with absolute T lymphocyte count was 0.818,0.796 and 0.887.Conclusion Elevated IL-6 and decreased absolute T lymphocyte count are independent risk factors for elderly severe patients with Omicron variant infections.

Objective To explore the public's cognition and attitude towards general medicine,general practitioners,and pre-hospital first-aid knowledge in Ludian County,Yunnan Province,to find out the training and learning methods that are more acceptable to the public for this kind of related knowledge,and to propose targeted solutions.Methods A complete random sampling survey was conducted among the nucleic acid collection office at the gate of the vegetable market from October 15,2022,to December 30,2022,and the outpatient clinic of Wenping Street Health Center from January 1,2023,to February 28,2023,by using electronic questionnaire and paper questionnaire.Results Nearly 50%of the people in Ludian County of Yunnan Province lack the knowledge of general medicine and pre-hospital emergency care,especially the knowledge of electrical defibrillation.People with higher education and the medical profession have a higher understanding of general medicine,and people with a higher understanding of general medicine are more willing to participate in pre-hospital emergency care.The average Ridit value is:very familiar with general medicine(0.774)>Knowledge of some general practices(0.565)>Never heard of general practice(0.400).The higher education level and the more comprehensive understanding of general medicine had a positive impact on participation in pre-hospital emergency care,with B values of 0.624 and 0.619,OR 95%CI of 1.867(1.544～2.257)and 1.857(1.298～2.657),respectively.Taking medical staff as a reference,the B value of medical students was = 0.942,P = 0.234,the difference was not significant,and the B value of non-medical professional population was all less than 0,the effect is negative.In addition,most people have a positive attitude towards learning pre-hospital first aid,and more than 70%of people are willing to learn and train related knowledge of pre-hospital first aid.Conclusions People in urban areas of Ludian County,Yunnan Province have poor understanding of general practice,low recognition of general practitioners,low demand for general practitioners,and lack of awareness of the importance of pre-hospital emergency treatment.Because of the cognitive differences among different groups,it is necessary to conduct specific training for different groups.

Objective To investigate the prevalence and risk factors for atherosclerotic renal artery stenosis (ARAS) in elderly patients with refractory hypertension.Methods Two hundred and eight elderly patients with a mean age of (68.3±4.9)years (53.8％ in men) diagnosed with refractory hypertension were recruited in this retrospective study from January 2010 to January 2017 in Beijing hospital.Fifty of the 208 patients with ultrasonography-suspected renal artery stenosis received renal arteriography and 39 were confirmed as renal artery stenosis.Renal artery stenosis was defined when stenosis located in at least one of renal arteries and only if the stenosis equal or over 50％.The prevalence of ARAS was calculated.Besides,univariate and final multivariate Logistic regression analyses were conducted to detect independent risk factors for development of ARAS.Results Thirty-nine of 208 patients (18.8％) were confirmatively diagnosed as ARAS.Although univariate Logistic regression showed that diabetes,coronary heart disease,renal insufficiency,and peripheral artery disease (P=0.034,0.040,0.022,and 0.030) might be risk factors for ARAS,a multivariate regression analysis demonstrated that only the peripheral artery disease (OR=3.218,P＜0.01) and renal insufficiency (OR=3.827,P＜0.01) were independent risk factors for ARAS.Conclusions Renal angiography should routinely be performed in refractory hypertension patients with renal insufficiency or peripheral artery disease to identify ARAS in time.

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.