Objective To investigate the risk factors that affect the perioperative mortality incholangiocarcinoma.Methods The clinical data of sixty two patients with cholangiocarcinoma who underwent operation were reviewed retrospectively.Logistic regression test was used in the perioperative mortality study.Before multivariate analysis,each parameter was evaluated with univariate analysis to define whether it was of statistical significance(P

Objective To investigate the factor that related to neoplasm from the clinicopathologic character of gallbladder polyps, and identify the reciprocal effectiveness of these factors. Method Three hundred and forty-seven patients who were underwent operation with gallbladder polypoid lesions were reviewed. Results Logistic regression analysis showed, only 5 parameters were significant for the prediction of neoplastic lesions, including age of the patient (P =0.015), the number of polyps (P=0.018), the maximal diameter (P=0.000), echo property (P=0.000), as well as the position of polyps (P=0.030),of which the maximal diameter was the best one to predict the neoplasm polyps. Further analysis with HOC curve showed that 0.925 cm, the diameter of polyps, was the critical point to calculate the polyp was neoplasm or not. Conclusions Age of the patient , the number of polyps , the maximaldiameter, the position of polyps, and echo property are independent factors in predicting gallbladder neoplastic lesions. The size of the polyps is the most significant one among the factors to predict gallbladder neoplasm with its critical point of 0.925 cm.

Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Methods The clinical data of 42 patients with Mirizzi syndrome with non-circumferential defect of bile duct who were repaired using own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap were analyzed.The defect in the bile duct were repaired using gallbladder pedicle flap in 30 patients,umbilical venous flap in 8 patients and omental flap in 4 patients.Results All patients were operated successfully.There was no operative mortality.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 d.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9-12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed up for 1-5 years,and had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome is effective.This surgical treatment is a good choice.

This paper discussed the classification, performance, cerebral localization and the possible mechanism of agraphia in patientswith aphasia. Writing disorders include not only agraphia caused by the neurological dysfunction of the brain, but also mechanicalwriting disorders caused by the primary motor dysfunction. Agraphia is a damage or loss of writing capability caused by acquired brain damage.The study abroad on agraphia focuses on phonetic language. Chinese characters and alphabetic languages belong to different languagesystems. Therefore, foreign research methods are not suitable for us. Domestic studies on agraphia are mostly case reports, and researchmethods and the pathological mechanism of Chinese agraphia are not consistent.

Correctly grasping the International Classification of Diseases ICD-10 and surgical classification ICD-9-CM-3 encoding method to improve coding accuracy and professional level is increasingly important to the current hospital information management.Through systematic continuing education training,the relevant personnel should be familiar with ICD-10 and ICD-9-CM-3 encoding rules,and continue to accumulate the appropriate clinical knowledge to improve their own coding levels.Coders should be a basis,six fits,that is based on the international classification of diseases and operation classification coding rules,coders should rcad more medical records,have more communication with clinicians,understand clinical medical knowledge,do more book search query for [CD code,sum up coding experience and multiply track the latest development of medicine and ICD coding.

Objective To investigate prenatal ultrasound diagnosis of clubfoot and its clinical value.Methods Three thousands pregants ranging gestational age from 12 through 40 weeks were checked using Ascuson Sequoia 512 equipment.The diagnosis of clubfoot was made prospectively at the time of the scan by the following criteria: the ball of foot had to be visible in the same plane as the longitudinal section of bones of the lower leg,unchanging with fetal activity and reproducible for several images.All prenatal ultrasonographic dignoses of clubfoot were proved by autopsy or newborn physical examination.Results A total of 17 cases clubfoot fetuses were prenatal diagnosed by ultrasonography.Fourteen of 17 clubfoot fetuses had associated with complex abnormalities,three of them were isolated clubfoot.Fourteen of 17 cases with clubfoot prenatal diagnosed by ultrasound were proved by autopsy.Another three cases with clubfoot were proved by newborn physical examination,two of them were false positive diagnosis.Conclusions Prenatal diagnosis of clubfoot is reliable by ultrasound.It is helpful in diagnosis with other structural abnormalities associated with clubfoot.It can also provide direction for clinical obstetrical management.

Objective To investigate prenatal ultrasound diagnosis of radial ray abnormalities and its clinical value. Methods All the fetus that entered usual prenatal ultrasound diagnosis were scanned each limb using a systematic continuous sequence approach (SCSA) with Acuson Sequoia 512 and GE Logiq 400 equipments. All the artificial aborted fetal radius malformation also had ultrasound examination in a simulating intrauterine estate and /or X-ray examination. Results Correctly diagnosis was made in 13 cases fetal radial ray abnormalities by prenatal ultrasonography following SCSA through the scaning course. All the fetal radial ray abnormalities had radius absence(only one skeleton in the forearm) or radius dysplasia and characteristic radial club hand. Ray abnormalities can be classifyied into three types on ultrasonography: type Ⅰ, radius absence; type Ⅱ,radius part absence; type Ⅲ,radius dysplasia.Conclusions Mastering characteristic radial club hand and SCSA are the keys to diagnose fetal radial ray abnormalities by prenatal ultrasonography.

Objective To investigate the value of dual source CT iodine concentration in the assessment of pathological grade of esophageal carcinoma. Methods Retrospective review was performed on 60 cases with pathologically?confirmed esophageal carcinoma. Among them, 17 tumors were well differentiated, 24 were moderately differentiated and 19 were poorly differentiated. The dual?energy plain scan and double phase enhanced scan of dual?source CT were performed on all 60 cases. Normalized iodine concentration (NIC) and the enhancement degree of the esophageal carcinoma in the arterial and venous phase were measured. The difference of NIC and enhancement degree among different grades of esophageal carcinoma were analyzed by analysis of variance. To evaluate the efficiency of NIC and enhancement degree in differentiating the well?moderately differentiated esophageal carcinoma from poorly differentiated esophageal carcinoma, ROC curve was plotted. Results The NIC values of the well differentiated, the moderately differentiated and the poorly differentiated esophageal carcinoma in the arterial phase were (1.54±0.34),(1.72±0.50)and(2.10±0.40)mg/ml, respectively;the NIC values in venous phase were(1.55± 0.52),(1.80±0.62)and(2.18±0.35)mg/ml,respectively, and the degrees of CT enhancement in venous phase were(25.65 ± 4.43),(27.55 ± 6.82)and(30.77 ± 6.38)HU, respectively. The differences between groups were statistically significant(P<0.05). The degrees of CT enhancement of well differentiated, moderately differentiated and poorly differentiated esophageal carcinoma in arterial phase were(14.40 ± 3.91),(14.26 ± 7.35)and(16.17 ± 6.89)HU, respectively, and there were no statistically significant differences(P=0.582). Areas under the ROC curves to differentiate well?moderately differentiated from poorly differentiated esophageal carcinoma for NIC in arterial phase, NIC in venous phase and the degree of CT enhancement in venous phase were 0.801, 0.817 and 0.730. Conclusion The iodine concentration measured on dual source CT has a certain value in evaluating the pathological grades of esophageal carcinoma.

Physiology runs through and reflects the perspectives materialist dialectics.The law of the unity of opposites,qualitative and quantitative changes,double negation have been reflected in the physiology and necessity and contingency,essence and phenomenon have been in contact with physiology.To combine physiology teaching with materialist dialectics used in practical teaching,enables students to learn,understand and master the physiological knowledge and cultivate their dialectical thinking ability.

Objective To characterize the expressiou of c-fos and c-jun in traumatic brain injury combined with tibial fracture in rats.Methods One hundred and twenty male SD rats were randomized into equal 2 groups (n =60).Models of traumatic brain injury combined with tibial fracture were established in the experimental group while models of simple tibial fracture in the control group.After animal cerebral cortex and tissues of fracture proximal ends were sampled,qPCR techniques were used to detect the mRNA expression levels of c-fos and c-jun at 6 time points of 1 h,3 h,5 h,1 w,3 wand4w (n=10) in both experimental and control groups.Results There were no significant differences between the 2 groups in the expression levels of c-jun or c-fos gene in the cerebral cortex or tibial samples at 1 h,3 h,5 h,1 w,3 w or 4 weeks after fracture (P ＞ 0.05).The expression of c-fos in the cerebral cortex peaked at 1 h in both groups (8.98 ± 3.06 & 8.48 ± 1.74),showing significant differences between the peak values and the low levels at other time points (P ＜ 0.05).The expression of c-jun in the cerebral cortex peaked at 4 w in both groups (3.94 ±0.59 & 3.91 ±0.41),showiug significant differences from other time points (P ＜ 0.05).The expression of c-fos in the tibial samples peaked at 1 w in both groups (1.99 ±0.27 & 1.94 ±0.27) and that of c-jun did too at 1 w in both groups (3.95 ±0.41 & 3.86 ±0.43),showing significant differences from other time points (P ＜ 0.05).Conclusion The high expression levels of c-fos and c-jun in the brain tissue may not be associated with the high expression levels of c-fos and c-jun in the fracture region.