Objective To explore the value of the combination of endoscopic sphincterotomy (EST) and laparoscopic cholecystestomy (LC) in the treatment of Cholecystolithiasis with extraheptatic bile duct stones. Methods 62 cases with cholecystolithiasis combined with extraheptatic bile duct stones were underwent LC following EST. Results Two cases were treated with common bile duct exploration after the failure of EST. 60 cases were executed sucessfully by EST and LC. No case occured serious complications. 8 patients with transient hyperamylasemia and 4 cases with intestinal bleeding after operation were cured by means of conservative therapy. Conclusion Combination of EST and LC is a safe and effective method in the treatment of cholecystolithiasis with extraheptatic bile duct stones.

BACKGROUND:In China there is no norm to assess anxiety disorders in children.The Chinese urban norm for screening child anxiety related emotional disorders is applicable to assessing anxiety problem in Chinese children and assisting clinical diagnosis,research and epidemiological investigation. OBJECTIVE:To develop the norm for screening child anxiety related emotional disorders(SCARED) in Chinese cities,and test the reliability and validity of this scale. DESIGN:A sampling survey taking the students of Grade 2 and up in elementary schools and junior middle schools in 14 big and medium sized cities in China and children with anxiety disorders who visited children's mental clinics in Changsha,Jinan and Shenzhen cities from October 2001 to April 2002,as the subjects. SETTING:The psychiatric department of a provincial specialized mental hospital. PARTICIPANTS:A total of 2 019 subjects(1 012 males and 1 007 females) with the mean age of(11± 2) years old were selected from 14 cities in China(Beijing,Tianjin,Taiyuan,Siping,Wuhan, Changsha,Xi'an,Shenzhen,Mianyang,Jinan,Fuzhou and Yichun) from October 2001 to April 2002.The students and their parents(norm group) filled in SCARED,and meanwhile,90 children with anxiety disorders who visited children's mental clinics in Changsha, Jinan and Shenzhen were taken as anxiety group. INTERVENTIONS:The children completed one copy of SCARED in the classroom during regular classes after informed consent was obtained, and then the questionnaires were collected on the spot. Another copy of SCARED was taken home by the children to be completed by the parents.Meanwhile,in Changsha,the parents filled in the child behavior checklist(CBCL) while their children completed the Piers Harris children's self concept scale(PHCSS).The reliability and validity of SCARED were determined. MAIN OUTCOME MEASURES:Reliability and validity of SCARED. RESULTS:The test retest coefficients of SCARED ranged from 0.567 to 0.608,split reliability of SCARED was 0.88,and Cronbach alpha(α ) coefficients were 0.43 to 0.89,with good reliability. Significant correlations were found between the total scores and anxiety indexes of SCARED and Achenbach CBCL(r=0.564,0.603,P< 0.05).The children in anxiety group scored higher in SCARED than those in norm group(t=8.06 to 12.89,P=0.000). Sensitivity and specificity of diagnosis of anxiety disorder were 0.74 and 0.79,respectively. CONCLUSION:The reliability and validity of SCARED are good, suggesting that the norm is applicable to assessing anxiety disorders in Chinese children.

Objective:To investigate the relationship between body mass index (BMI) and invasive mechanical ventilation time in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Medical records of 72 patients with AECOPD admitted to Zhejiang Xin′an International Hospital from June 2018 to December 2019 were retrospectively analyzed. According to BMI, they were divided into the low body mass group (BMI<18.5 kg/m 2), the normal body mass group (18.5 kg/ m 2 ≤ BMI < 24.0 kg/m 2), and the obesity and overweight group (BMI ≥ 24.0 kg/m 2). According to the time of invasive mechanical ventilation of patients, they were divided into invasive mechanical ventilation time>7 d group and ≤ 7 d group. The changes of baseline data in each group were compared, and the risk factors of invasive mechanical ventilation time of patients with AECOPD were analyzed. Results:The incidence of hypertension and diabetes in the obesity and overweight group were higher than those in the low body mass group: 11/15 vs. 31.8(7/22), 8/15 vs. 13.6%(3/22), P<0.05. Before intubation, the level of ALB in the obesity and overweight group was higher than that in the normal body mass group and the low body mass group: (34.77 ± 5.11) g/L vs.(33.02 ± 4.86), (29.13 ± 3.64) g/L, the level of ALB in the normal body mass group was higher than those in the low body mass group , and there were significant differences ( P<0.05). The time of invasive mechanical ventilation in the obesity and overweight group was shorter than that in the normal body mass group and the low body mass group:(9.51 ± 1.38) d vs. (11.03 ± 1.91), (14.11 ± 2.36) d, the time of invasive mechanical ventilation in the normal body mass group was shorter than that in the in the low body mass group, and there were significant differences ( P<0.05). But there were no statistically significant differences in gender, age, smoking, complicated gastrointestinal bleeding, abdominal distension, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, exudation, ventilator modes, pH values, arterial partial pressure of carbon dioxide (PaCO 2) before intubation and arterial partial pressure of oxygen (PaO 2) before intubation of patients in the three groups ( P>0.05). Complicated diabetes mellitus, gastrointestinal bleeding, abdominal distension, BMI<18.5 kg/m 2, the rate of exudation and APACHEⅡscore in the invasive mechanical ventilation time ≤ 7 d group were lower than those in the invasive mechanical ventilation time>7 d group. Before intubation, ALB levels in the invasive mechanical ventilation time ≤ 7 d group were higher than those in the invasive mechanical ventilation time >7 d group ( P<0.05). The Logistic regression analysis results showed that complicated gastrointestinal bleeding, abdominal distension, BMI<18.5 kg/m 2, APACHEⅡscore > 10 points, before intubation, ALB< 30 g/L were independent risk factors of invasive mechanical ventilation time of patients with AECOPD ( P<0.05). Conclusions:In addition to the mechanical ventilation related complications and high APACHEⅡscore, malnutrition is an important risk factor affecting invasive mechanical ventilation time of patients with AECOPD before intubation.

OBJECTIVE:To observe the adjunctive efficacy of allicin for restenosis of geriatric myocardial infarction (MI) after percutaneous coronary intervention (PCI). METHODS:From Jan.to Dec.2007,150 geriatric MI patients after PCI were divided into 2 groups (n=75 each),i.e. conventional therapy group and allicin group (allicin 40 mg tid plus conventional therapy). After treatment for 1 year,plasma levels of restenosis markers including endothelin-1,CRP,NO were tested; Coronary arteriography was carried out to reveal the restenosis situation; Angina attack frequencies were also recorded. RESULTS:66 cases in allicin group vs.57 in conventional therapy group had no recurrence of angina,with the effective rate being 88% in allicin group vs.76% in conventional therapy group,showing significant differences between the two groups (P

Objective To develop a quick, simple and sensitive method for determination of sulfuric acid mist in the air by ion chromatography. Methods The samples were collected by Nillipore filter, Na2CO3-NaHCO3 solution was used and the samples were analyzed by using ion-chromatography as well as external standard curve. Results The linear range of the method was 0.5-10.0 ?g/ml and the correlation coefficient was 0.999 8. The RSD for the test accuracy and variation of repeat tests within one day or between the different days was

[Objective]To discuss the effects of DHS and compression screw application on femoral intertrochanteric fracture.[Method]Internal fixation was performed with DHS,DHS and compression screw,Ender nail and proximal femoral anatomical plate in 185 patients with femoral intertrochanteric fracture.The main outcome measures were operation duration,coxa adducta rates and postoperative Sanders scoring.[Result]All patients were followed up for 9-48 months.Operation duration was similar in the four groups.There were significant differences in coxa adducta rates and postoperative Sander's scores.According to the Sander's scores,the excellent to good rates in DHS and compression screw,DHS,Ender nail and proximal femoral anatomical plate groups were 94.6%,85.3%,75.4% and 80.6%,respectively.The coax adducta rates were 2.4%,9.5%,22.2% and 19.2%,respectively.[Conclusion]All the four kinds of internal fixation can be used for femoral intertrochanteric fracture,but DHS and compression screw is the best one for its good restoration of joint function and has no or little complication.

Objective To study on postpartum obsessive compulsive disorder at home and abroad,and to provide new idea of diagnosis,evaluation and treatment on postpartum obsessive compulsive disorder.Method A search using Medline,Embase,EBSCO,Cochrane Library,Web of Science (ISI),Pubmed databases and Google Scholar was carried out using the key words:obsessive compulsive disorder (and derivatives),perinatal,pregnancy,postnatal,postpartum,mothers (and derivatives),anxiety disorders and subtypes. These articles and their references were reviewed.Results Twenty-seven papers were incorporated,but no Chinese paper.The life prevalence of postpartum OCD was 2.3％-11.0％.The most common obsessions were aggressive,contamination and miscellaneous,and compulsion for washing/cleaning and checking.Cognitive behavioural therapy and SSRIs have been suggested as a fist-line treatment of postpartum OCD.Conclusion OCD is more prevalent in the postpartum period.The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling.Collaborative,international,prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.

K-ras gene is one of oncogenes in non-small cell lung cancer,and it can promote tumor cells growth after mutations by several signaling pathways.K-ras mutations frequently occur in lung adenocarcinoma patients with smoking history.In the present study,K-ras mutations are associated with resistence to targated therapy and may be a marker of poor prognosis in patients with non-small cell lung cancer.

The incidence of upper limb dysfunction of stroke patients was high, and the recovery was difficult, which seriously impact-ed their activities of daily living and quality of life. This article reviewed the new techniques and methods for hemiplegic patients after stroke. The main techniques and methods includeed bilateral isokine-matic training, mirror neuron system, gymnastics rods training, music therapy, motor imagery, upper limb rehabilitation robot, virtual reality, constraint induced movement therapy, functional electrostimulation, electromyographic biofeedback therapy, transcranial magnetic stimulation, neurophyisological therapy and so on.

Objective To analyze the role of Clinical Pathway in controlling hospitalization cost and to provide the basis for reasonable control of medical cost.Methods The data of patients undergoing unilateral and bilateral total hip replacement in 2005 and 2010 in Arthritis Clinical and Research Center of Peking University People's Hospital were retrospectively analyzed.There were 70 unilateral and 14 bilateral total hip replacement cases in 2005,whereas the number of those in 2010 was 173 and 46 respectively.All charges were assigned to 1 of 9 categories:hospital room,nursing,radiology and laboratory,prosthesis,blood transfusion,surgery,pharmacy,treatment,diagnosis.We compared the total costs and cost of each category between 2005 and 2010.Results There was no statistical significant difference between 2005 and 2010 in terms of age,gender distribution,pri mary disease and type of prosthesis.The total costs for unilateral and bilatcral total hip replacement was 40 852.72 yuan and 73 020.28 yuan in 2010,respectively.They were both significantly lower than those of 2005 (49 371.35 yuan and 80 962.61 yuan respectively).The charge for each category of total hip replacement in 2010 was 585.88,145.38,2 885.47,3 222.32,1 776.15,3 805.29,132.79,4 100.88,and 3 0953.75 yuan.Compared with 2005,each category of charge dropped in 2010,especially the cost of surgery,treatment,diagnosis and hospital room,which decreased by 35.11％,31.76％,31.40％ and 30.67％ respectively.The tendency of each category change in charge of unilateral and bilateral total hip replacement was similar to the overall costs.Conclusion The total costs for total hip replacement (unilateral and bilateral total hip replacement) in 2010 were lower than those of 2005,which might be the result of adopting Clinical Pathway since 2010.Nevertheless,the prosthesis cost accounted for a large proportion in both years.Therefore,controlling the prosthesis cost might be an effective way to reduce medical costs for total hip replacement.