Objective:To study the application value of different operation methods in the treatment of left hepatolithiasis in special position (the stone is located in the sagittal section of left portal vein and/or near the proximal end of left hepatic vein).Methods:From July 2015 to June 2018, 58 patients with left hepatolithiasis in special position in Department of General Surgery, the First People′s Hospital of Tianmen City of Hubei Province were analyzed retrospectively. According to the different operation methods, they were divided into two groups: left liver excision under laparoscopy and gallbladder incision stone group (left liver excision group, n=28) and laparoscopic left-half liver excision and bile tube excision stone removal group (left half liver excision group, n=30). The operation time, intraoperative bleeding, postopera-tive hospital stay, postoperative biliary fistula, postoperative bleeding, postoperative stone residue and stone recurrence were compared between the two groups.The measurement data with normal distributions were represented as ( Mean± SD), and comparison between groups was done using the t test. The chi-square test and Fisher precision test were used for comparison between counting data. Results:All 58 patients underwent laparoscopic surgery. Left liver excision group surgery time, in-serum bleeding, number of days hospitalized after surgery, number of postoperative bile fistula cases, number of postoperative bleeding cases were (161.53±30.56) min, (203.45±26.69) mL, (9.26±3.3. 86) days, 1 case, 1 case, left half liver excision group (153.16±42.63) min, (198.79±30.82) mL, (9.59±4.01) days 1 case, 1 case, The difference between the two groups was not statistically significant ( P>0.05). The number of postoperative stone residues was more than that of the left liver and outer leaf excision group (4 cases) than that of the left half of the liver excision group (1 case), and the number of postoperative stone recurrence cases was more than that of the latter (1 case), all of which were statistically significant ( P<0.05). The number of stone residues and stone recurrences after left liver excision group was 4 and 5 cases respectively, and the left half liver excision nurses were 1 case and 1 case, respectively, and the difference between the two was statistically significant ( P<0.05). Conclusion:For the left hepatolithiasis in special position (the stone is located in the sagittal section of the left branch of the portal vein and (or near the proximal end of the left hepatic vein in imaging), the lower abdominal left hemihepatectomy + choledocholithotomy is a safer and more effective treatment.

Objective To probe into the current services and outcomes of township hospitals following their transformation, and their future positioning of functionality. Methods Pinpointing townships A, B and C as samples from a district in Beijing, in which field surveys were made in the township hospitals to learn their services, service provision methods and outcomes. Results Among the current services provided by these three hospitals, those of public health and primary healthcare nature in hospital A account for 50% each; those in hospital B account for 70% and 30% respectively; those in hospital C account for 60% and 40% respectively. Recommendable services provided in these hospitals include universal coverage of medical files, management of infectious diseases, public health emergency management, and immunization. Conclusion Township hospitals as the center of the 3-tier rural health service network, deserve a repositioning of their functionality to fit the health needs of residents at large.

Nowadays,the disconnection between pre-clinical medicine and clinical medicine exists in the medical postgraduate education.Application of the concept of translational medicine to the postgraduate education will play an important role in the training of medical personnel.This article gives a discussion on the means of training postgraduates by building a platform for translational medicine,reforming the curriculum,improving the research evaluation system and building cooperation among universities,hospitals and enterprises.

Objective: To analyze the role of frequency complemcntarities of vestibular tests including caloric test (CT),head shaking test(HST),and vibration test(VT) in the evaluation of vestibular function. Methods: Five hundreds and eightyfour patients with unilateral peripheral lesions were tested with CT, HST and VT in order to compare the frequency characteristic of abnormal vestibular function. Results: Of the 584 patients, 189 (32.36%), 283 (48.46%) and 368 (63.01%)cases showed vibration-induced nystagmus (VIN), head shaking nystagnms (HSN) and abnormal unilateral weakness (UW)respectively. There were 22 isolated VIN, 52 HSN and 145 cases of abnormal UW respectively. One hundred and fifty-nine (27.23%) cases had combination damage of two frequency bands, 101 (17.29%) had vestibular damage at all frequency bands,479 (82.02%) had abnormal results in any of the three tests, and 105 (17.98%) had no abnormality in all those three tests.Through consistency test, CT and HST (Kappa=0.106, P＜ 0.05), CT and VT(Kappa=0.068, P＜ 0.05), VT and HST (Kappa=0.321, P＜0.05) showed low consistency among them. VIN and HSN were more hkely to be evoked with the increasing of the UW (X'2VIN=22.686,X2HSN=23.023, P＜ 0.05). Conclusion: The vestibular damage in the patients with vertigo could reflect at isolated low, middle, high frequency or multi frequency bands. Thus, CT, HST and VT all make significant contributions to multiple-frequency analysis of vestibular function and show a well complementarities. So they can be used in evaluating the overall function of the vestibular and indicating a serious vestibular lesion if the damage affected multi frequency bands.

Objective To detect the change of the plasma hydrogen sulfide in patients with chronic heart failure (CHF) and explore its clinical significance.Methods A total of 118 patients with CHF was enrolled in this study.According to the NYHA standard,they were classified into grade Ⅱ (34 cases),grade Ⅲ (54 cases),grade Ⅳ (30 cases).The patients were divided into normal treatment group and sodium nitroprusside treatment group with 59 cases each.Another 30 healthy person were selected as control group.The plasma hydrogen sulfide level was detected by spectrophotometer.Results The plasma hydrogen sulfide level in CHF patients and healthy person was (32.45 ± 3.86),(54.26 ± 5.63) μ mol/L,and there was significant difference (P ＜ 0.05).The plasma hydrogen sulfide level in CHF patients of grade Ⅱ,Ⅲ,Ⅳwas (43.26 ±4.73),(31.87 ±4.12),(23.66 ±3.54) μmol/L,and there was significant difference (P＜0.05).The plasma hydrogen sulfide level before treatment in normal treatment group and sodium nitroprusside treatment group was(31.66 ± 3.75),(33.04 ± 4.02) μ mol/L,and there was no significant difference between two groups (P ＞ 0.05).The plasma hydrogen sulfide level after treatment in normal treatment group and sodium nitroprusside treatment group was (36.83 ± 4.32),(44.54 ± 4.68) μ tmol/L,and there was significant difference (P ＜0.05).The plasma hydrogen sulfide level after treatment in two groups was increased compared with that before treatment,and there was significant difference (P ＜ 0.05).The total effective rate in normal treatment group and sodium nitroprusside treatment group was 42.4％ (25/59) and 67.8％(40/59),and there was significant difference between two groups (P ＜ 0.05).Conclusions The abnormal plasma hydrogen sulfide level may be involved in the occurrence and development process of CHF,which could be used as a factor to monitor the disease.The upregulation of plasma hydrogen sulfide level can significantly improve the prognosis of CHF patients.

Objective To genotype Yersinia pestis and explore intrinsic relationship among different ecotypes of Yersinia pestis in Yunnan foci.Methods A total of 171 strains from three types of Yersinia pestis,house mouse,wild-type mouse and Yulong Yersinia pestis,were tested.Twenty-three different regions (DFR) were used to genotype and cluster analysis was performed using BioNumerics 5.0.Results A total of 171 Yersinia pestis were divided into 7 genotypes by 23 DFRs,which were Genomovar5,Genomovar7,Genomovar9 and 4 newly discovered genotypes.The genotypes of all Yulong plague were Genomovar5.The genotypes of the 16 strains of wild-type mouse plague (the highland of northwestern Yunnan Province type) were divided to 3 genotypes,13 of them were Genomovar 7,2 of them were Genomovar9,and 1 of them was newly discovered genotype Genomovaryn1.The genotypes of the 148 strains of house mouse plague(the residential area of Yunnan and Fujian Provinces type) were divided into 4 genotypes,145 of them were Genomovar9,and 3 of them were newly discovered including Genomovar-yn2,-yn3 and-yn4.The ecological typing results of clustering showed genotype of Yulong plague was similar to the highland of northwestern Yunnan Province type(wild-type mouse plague),and the percentage of similarity was up to 87.20％,but only up to 73.75％ to the residential area of Yunnan and Fujian Provinces type (house mouse plague).The genotypes of 2 wild-type strains of the highland of northwestern Yunnan Province type(wild-type mouse) and main genotypes of the residential area of Yunnan and Fujian Provinces type(house mouse)were Genomovar 9.The genotype of Genomovar-yn 1 of the highland of northwestern Yunnan Province type was similar to Genomovar 7,but lack of DFR 11.The genotypes of Genomovar-yn2,-yn3 and-yn4 of the residential area of Yunnan and Fujian Provinces type were similar to Genomovar 9,but lack of DFR 10,DFR 9 and DFR 11,respectively.Conclusions One newly genotype strain is found in wild-type mouse plague and 3 newly genotype strains are founded in house mouse plague.Wild-type mouse strains are founded in the house mouse strains.The similarity of genotype between Yulong plague and the highland of northwestern Yunnan Province type (wild-type mouse plague) is high while the similarity between Yulong plague and the residential area of Yunnan and Fujian Provinces type(house mouse plague) is low.

0.05).Conclusion Neither rs1903858 nor rs701848 of the PTEN gene has no association with laryngocarcinoma in Chinese Han population.

Objective:To analyze bone strength index, osteoporosis and fracture in ankylosing spondylitis (AS) patients with radiologic hip involvement and explore the characteristics of bone strength in these patients.Methods:According to bath ankylosing spondylitis radiology hip index (BASRI-hip) score, 339 AS patients were divided into two groups. The differences of bone strength in each group were analyzed by t-test, Mann-Whitney U test and χ2 test. Logistic regression was used to analyze the risk factors of bone strength index. The correlation between quantitative ultrasound and dualenergy X-ray absorptiometry (DXA) (total hip, g/cm 2) was analyzed. Pearson correlation analysis was used. Results:①Bone strength index of quantitative ultrasound was positively correlated with bone mineral density of DXA (total hip, g/cm 2), r=0.553, P<0.01. ② The age of 27(23, 37) years old in radiographic hip involvement was lower than 37(28, 48) years old in non-radiographic hip involvement, and the difference was statistically significant ( Z=-5.986, P<0.01). There were no differences in gender and course of disease between the two groups ( P>0.05).③ The radiographic hip involvement in AS patients whose ages were younger than 50, when compared with non-radiographic hip involvement patients, the bone strength index was lower (78±18 vs 84±16), while bone strength was lower than patients at the same age (41.0% vs 18.4%), however, the incidences of osteoporosis (42.7% vs 28.8%) and fragility fracture (3.7% vs 0%) were significantly higher ( t=3.028, P<0.01; χ2=16.758, P<0.01; χ2=5.886, P=0.019; χ2=4.67, P=0.038). For AS patients whose ages were ≥50, there were no significant differences between the two groups ( P>0.05). ④ Multivariate analysis showed that radiographic hip involvement [ OR (95% CI)=1.912(1.05, 3.48)], age [ OR (95% CI)=0.94(0.911, 0.97)] and body mass index (BMI) (kg/m 2) [ OR (95% CI) =0.875(0.807, 0.948)] were associated with lower bone strength. Conclusion:There is positive correlation between the bone strength index of quantitative ultrasound and bone mineral density of DXA. AS patients with radiographic hip involvement are characterized by decreased bone strength and are more likely to develop osteoporosis and fragile fractures. The risk factors of low bone strength are radiographic hip involvement, age and BMI.

Objective To investigate the feasibility and safety of transvaginal endoscopic cholecystectomy.Methods The clinical data of 88 female patients who underwent cholecystectomy at the Qilu Hospital of Shandong University from May to November, 2009 were retrospectively analysed. Among all the patients, 32 received transvaginal endoscopic cholecystectomy ( NOTES group) and the remaining 56 patients received laparoscopic cholecystectomy (LC). Thirty-two patients who received LC at the same period were selected (LC group)acccording to age, body mass index, type and severity of disease to conduct a matched case-control study. The differences in time span of postoperative pain, anodyne dose, enterokinesia recovery time, operation time, out-ofbed activity time, average hospital stay and hospitalization expenses between the two groups were compared using the paired t test. Results Cholecystectomies were successfully carried out for all the patients. The intraoperative blood loss, operation time, degree of pain, anodyne doses, enterokinesia recovery time, out-of-bed activity time,average hospital stay and hospitalization expenses were (5.7 ± 1.5 ) ml, ( 76 ± 27 ) minutes, 2.2 ± 0.6, ( 10 ±6) mg, (25±5) hours, (9±3) hours, (2.1 ±1.2) days and (1.12±0.34) ×104 yuan in NOTES group, and they were ( 13.9 ± 3.1 ) ml, (38 ± 16) minutes, 6.7 ± 1.5, (28 ± 8) mg, (45 ± 8) hours, (26 ± 6) hours,(4.3 ± 2.1 ) days and ( 1.54 ± 0.18 ) × 104 yuan in the LC group. There were significant differences between the two groups (t = 5.098, - 4.712, 2.417, 3.203, 3.089, 4.136, 4.786, 3.917, P ＜ 0.05 ). Conclusion Transvaginal endoscopic cholecystectomy is safe and feasible, and it is superior to tranditional LC.

Objective To investigate the relationship between the plasticity of dendritic spines in entorhinal cortical neurons and mechanism of low-dose ketamine-induced reduction of cognitive dysfunction following sevoflurane anesthesia in aged rats.Methods Thirty-six pathogen-free healthy male SpragueDawley rats,aged 18 months,weighing 500-600 g,were divided into 3 groups (n=12 each) using a random number table:control group (group C),sevoflurane anesthesia group (group Sev) and ketamine group (group K).Group C received no treatment.Group Sev inhaled the mixture of air (flow rate 1 L/min) and 3.6％ sevoflurane for 3 h.In group K,ketamine 10 mg/kg was injected intraperitoneally,and 5 min later the mixture of air (flow rate 1 L/min) and 3.6％ sevoflurane was inhaled for 3 h.Open field test and Morris water maze test were performed 3 days after anesthesia.After the behavioral tests,the animals were sacrificed,and their brains were removed and cut into sections for determination of the density of neurons,density of dendritic spines,and expression of postsynaptic density protein-95 (PSD-95) and synaptophysin (SY38) in superficial laminaes (Ⅱ-Ⅲ) of entorhinal cortex using Nissl's staining,Golgi staining and immunohistochemistry,respectively.Results Compared with group C,the time of staying at the central region was significantly shortened,the escape latency was prolonged,the density of dendritic spines was decreased,and the expression of PSD-95 and SY38 was down-regulated in group Sev (P＜0.05).Compared with group Sev,the time of staying at the central region was significantly prolonged,the escape latency was shortened,the density of dendritic spines was increased,and the expression of PSD-95 and SY38 was upregulated in group K (P＜0.05).There were no significant differences in the density of neurons in entorhinal cortex between the three groups (P＞0.05).Conclusion The mechanism by which low-dose ketamine attenuates cognitive dysfunction induced by sevoflurane anesthesia may be related to the enhanced plasticity of dendritic spines in entorhinal cortical neurons of aged rats.