Objective:To analyze the correlation factors between peripapillary duodenal diverticulum (PDD) and choledochectasia by CT scan.Methods:The clinical data of 220 patients with duodenal diverticulum detected by multi-slice spiral CT scan and confirmed by gastrointestinal angiography or endoscopic retrograde cholangiopancreatography (ERCP) in Dahua Hospital, Xuhui District of Shanghai City were retrospectively analyzed. The correlation of the PDD, the contact of common bile duct (CBD), length of contact and exudation with choledochectasia in patients with PDD were analyzed.Results:A total of 236 duodenal diverticulum were found in 220 patients. Among them, there were 152 PDD, 41 diverticulum located superior to the duodenal papilla, 28 diverticulum located inferior to the duodenal papilla, 3 diverticulum located lateral to the duodenal papilla, and 12 diverticulumlocated in the horizontal portion. The incidence of choledochectasia in patients with PDD contacted with CBD was significantly higher than that in patients with PDD not contacted with CBD: 59.35% (73/123) vs. 37.93% (11/29), and there was statistical difference ( P<0.05); the incidence of choledochectasia in patients with contact length of PDD and CBD ≥1.5 cm was significantly higher than that in patients without contact of PDD and CBD and patients with contact length of PDD and CBD <1.5 cm: 82.43% (61/74) vs. 24.49% (12/49) and 37.93% (11/29), and there was statistical difference ( P<0.05); the incidence of choledochectasia in PDD patients with exudation was significantly higher than that in PDD patients without exudation: 10/11 vs. 52.48% (74/141), and there was statistical difference ( P<0.05). Conclusions:The patients with contact length of PDD and CBD ≥1.5 cm and patients with PDD combined with exudation could be prone to choledochectasia.

Alternative Splicing ; Apoptosis ; Cell Cycle ; Cell Proliferation ; Cyclin-Dependent Kinase Inhibitor p21 ; metabolism ; Hep G2 Cells ; Humans ; Inhibitor of Growth Protein 1 ; Intracellular Signaling Peptides and Proteins ; genetics ; metabolism ; physiology ; Nuclear Proteins ; genetics ; metabolism ; physiology ; Plasmids ; Protein Isoforms ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Recombinant Proteins ; genetics ; metabolism ; Transfection ; Tumor Suppressor Protein p53 ; metabolism ; Tumor Suppressor Proteins ; genetics ; metabolism ; physiology ; bcl-2-Associated X Protein ; metabolism

Objective To explore the feasibility and short-term efficacy of laparoscopic and thoracoscopic Ivor Lewis esophagectomy using a circular-stapled anastomosis with trans-oral anvil in treating esophageal carcinoma.Methods 30 consecutive patients with esophageal cancer received minimally invasive Ivor Lewis esophagectomy from January 2011 to December 2011.Operations of all the cases comprised of both abdominal and thoracic procedures which were performed with Iaparoscopic and thoracoscopic techniques respectively.The intrathoracic esophago-gastric anastomosis was created using a circular-stapled anastomosis with trans-oral anvil technique.Results There were 24 males and 6 female with median age of 62.5-year-old (from 47 to 82).The lesions located in middle and/or lower portion of the esophagus.25 patients with esophageal squamous cell cancer (n =25) and 5 patients with adenocarcinoma (n =5) underwent an Ivor Lewis esophagectomy.All the operations were successfully performed without intra-operative technical failures of the anastomosis or deaths.The mean operation time was 95 minutes in abdomen and 177 minutes in thorax.The mean blood loss was 310 ml.The mean number of harvested lymph nodes was 10.6 from thorax and 4.9 from abdomen.Postoperalively,there were thoracic wound infections in 4 patients.One patient had a left diaphragmatic hernia and was successfully treated by re-operation 6 days after first operation.One patient had chylothorax and recovered without surgery.There was no anastomotic leak and the patients were able to have spoon meat at 5.6 postoperative days.Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy can be accomplished smoothly with acceptable occurrence of complications.The circular-stapled anastomosis with the trans-oral anvil is an efficient,safe and reproducible technique for intrathoracic esophago-gastric anastomosis.

Objective To improve ultrasonic unit configuration of the field medical team.Methods The problems of the ultrasonic unit were analyzed in operating platform setup,personnel and facility allocation,application of interventional ultrasound,cross infection prevention and etc,and some countermeasures were put forward accordingly.Results There were interdependence and interaction among the elements of the ultrasonic unit,and the rational configuration made the requirements satisfied for interventional therapy,massive casualty diagnosis,bed side application and etc.Conclusion Improved configuration enhances the efficacy of the ultrasonic unit of the field medical team.

OBJECTIVETo calculate the effects of malnutrition on economic productivity in China.

METHODSPROFILES was used to quantify the function consequences of malnutrition in term of protein energy malnutrition, iron deficiency and iodine deficiency.

RESULTSProductivity gained due to improved iodine nutrition. The reduction in the TGR in 1992 to 2001 increased the net present value of further economic productivity by yen 142 billion. Reduction of the TGR rate to 5% over next 10 years would result in future productivity gains with value of yen 40 billion. Productivity gain due to reductions in child stunting would result in future economic productivity gains with the value of yen 101 billion. Reducing stunting further over the next 10 years would gain yen 20 billion. Productivity gain due to reduction of iron deficiency anemia reduced by 30% over the next 10 years would gain worth yen 107 billion and if childhood anemia reduced by 30% over next 10 years would gain yen 348 billion.

CONCLUSIONThese interventions have huge economic payoff. That is likely to exceed their costs many times over.

Adult ; Child ; Child Development ; China ; Commerce ; Cost of Illness ; Costs and Cost Analysis ; Economics ; Humans ; Iodine ; deficiency ; Iron ; deficiency ; Malnutrition ; economics ; Models, Theoretical

OBJECTIVETo estimate the benefits of reductions in underweight and Vitamin A deficiency for child survival in China that might be expected as a result of lowering the prevalence of these conditions.

METHODSProfiles, a process of nutrition policy analysis was used to quantify the functional consequences of malnutrition in terms of child survival.

RESULTSUnderweight: The actual reduction in underweight between 1992 and 2001 (from 15.7% to the current 10.1%) resulted in saving of 176,000 child lives. As estimated, without improvements, 612,000 children will die due to underweight between 2001 and 2010, 281,000 (46%) of them living in western provinces. Reducing underweight prevalence from 10.1% to 8% could overall save 62,000 lives. The reduction of underweight prevalence in the west alone might save 56,000 lives. Vitamin A in China as a whole, vitamin A deficiency accounts, as estimated, for 7.5% of deaths of children 6-59 months old, representing 206,000 deaths over the past ten years. Halving the prevalence over the period would save 49,000 child lives. The higher prevalence and higher mortality rates in western provinces mean that even with only 28% of the Chinese population, over half of child deaths there are related to vitamin A.

Body Weight ; Child ; Child Welfare ; Child, Preschool ; China ; epidemiology ; Female ; Forecasting ; Humans ; Infant ; Infant, Newborn ; Male ; Malnutrition ; complications ; epidemiology ; Models, Theoretical ; Mortality ; trends ; Prevalence ; Prognosis ; Survival Analysis ; Vitamin A Deficiency ; complications ; epidemiology ; therapy

italic>Bupleurum L. (Apiaceae) is an economically important genus, in which many species are of medicinal value. In this study, the complete plastid genomes (plastomes) of B. chinense DC. and B. boissieuanum H. Wolff were sequenced and their characteristics were investigated. Comparative and phylogenetic analyses were conducted with other published Bupleurum plastomes. The complete plastomes of B. chinense and B. boissieuanum were 155 458 and 155 800 bp in length, and both exhibited the typical quadripartite circular structure consisting of a large single copy region (LSC, 85 343 and 85 804 bp), a small single copy region (SSC, 17 495 and 17 410 bp), and a pair of inverted repeat regions (IRa/b, 26 310 and 26 293 bp), respectively. A total of 129 genes, including 84 protein-coding genes, 37 transfer RNA (tRNA) genes, and eight ribosomal RNA (rRNA) genes were identified from each of the two plastomes. Repeat sequences detected were similar in types and distribution patterns, but the numbers were slightly different. Comparative analyses revealed that the Bupleurum plastomes were highly conserved in length, structure, the guanine and cytosine (GC) content, and gene content and order, both intraspecifically and interspecifically, and no obvious expansion or contraction of the inverted repeat regions occurred. Sequence variation was lower within the same species than among different species, noncoding sequences (including intergenic regions and introns) showed a higher divergence than the protein-coding sequences, and sequences in the LSC and SSC regions were more divergent than those in the IR regions. In addition, 11 sequences with higher nucleotide diversity among species were detected in the LSC and SSC regions. All studied Bupleurum species were inferred forming a monophyletic group with a 100% bootstrap value. Bupleurum chinense and B. boissieuanum were phylogenetically closest to B. commelynoideum and B. falcatum, separately, with all three B. chinense accessions clustered into a distinct clade. These results provide genetic information for further species identification, phylogenetic resolution, and will assist in exploration and utilization of medicinal Bupleurum species.

Age Factors ; Animals ; Cytokines ; physiology ; Humans ; RNA, Messenger ; analysis ; Sepsis ; etiology ; Signal Transduction ; Toll-Like Receptors ; genetics ; physiology

OBJECTIVETo explore the early complications after simultaneous pancreas-kidney transplantation (SPK).

METHODSThe clinical data of 20 patients who underwent SPK in our center from September 2002 to September 2007 were retrospectively analyzed.

RESULTSThe complications after SPK included hematuria (n = 4), abdominal bleeding (n = 4), abdominal infections (n = 6), lung infections (n = 5), urinary infection (n = 1), poor wound healing (n = 3), abdominal distension (n = 1), and acute cardial infarction (n = 1).

CONCLUSIONSInfection and bleeding are the most common early complications after SPK. Urinary infection and metabolic acidosis are common in BD mode.

Adult ; Female ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Pancreas Transplantation ; Postoperative Complications ; prevention & control ; therapy ; Retrospective Studies

This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty. A total of 234 patients (involving 236 hips) with Paprosky III and IV femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug. 2006. Impaction bone graft technique was used for 112 hips, with allogeneic freeze-dried bone as bone graft and SPII as prosthesis. With 124 hips, modular distal press-fit fixation and tapered femoral stem (MP stem) were employed. After the operation, the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score (HHS) and 12-item Short Form Health Survey (SF-12). Radiolucence, subsidence and loosening were observed and complications, including infection, fracture, dislocation etc. were recorded. A 6-14-year follow-up showed that prostheses failed, due to infection, in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure, with the survival rates for the two techniques being 96.43% and 95.16%, respectively. One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications (P<0.05) and was not related to the type of the bone defects (P>0.05). The rate of complications bore significant association with the type of bone defects in the two groups (P<0.05). Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects. It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect. Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.