Objective This investigation was to define the occupational security-related factors in community nurses and effective strategies to improve their service awareness and occupational protection ability.Methods A questionnaire was used for 1702 community nurses in Guangzhou to learn occupational security-related factors and occupational protection skills.Results Self-report results found that 21.3% (362/1702) nurses fully understood the occupational security-related factors,12.0% (204/1702) nurses knew the requirement for occupational security,and 12.3% (209/1702) nurse could provide occupational protection.Conclusions These results suggested that most community nurses showed poorer occupational protection awareness and ability.Thus,occupation safety management regulations,standardized performance procedure and emergency response plan should be put forward,and further community nurse training programme need to be initiated.

AIM: To observe the effect of fluvastatin (FV) on left ventricular remodeling and expression of caspase-3 after myocardial infarction (MI) in rats. METHODS: Rats were divided into 4 groups: group Ⅰ (sham), group Ⅱ (sham+FV), group Ⅲ (MI) and group Ⅳ (MI+FV). group Ⅱ and Ⅳ were treated with FV (10 mg?kg -1?d -1) for 4 weeks. The left ventricular structure, echocardiography and hydroxyproline were observed. The expression of caspase-3 was measured by immunohistochemistry and RT-PCR. RESULTS: Compared with MI group, there was a improvement of ultrastructure and index of left ventricular remodeling, and decrease in hydroxyproline in MI+FV group (all P

Objective To compare the clinical efficiency of two methods in the open surgery treatment of seconda-ry common bile duet stones: transeytie common bile duet exploration with eholedoehoscope (TCBDE),or traditional eholedoehotomy with T-tube drainage.Methods Retrospectively analysis the treatment of 113 eases with secondary bile duet stones (TCBDE group 58 cases ,T-tube group 45 cases) ; Compare the achievement ratio,operating time; complications,average hospital stay and cost between two groups.Results All procedure is successful,without any severe complications.There are no significant differences of operating time.The TCBDE group has sig-nificantly shorter hospital stay and lower cost.Conclusion TCBDE has significant advantages than the traditional choledochotomy,and should be the predominant method in the open surgery of secondary common bile duet stones.

Objective To explore risk factors for type 2 diabetes mellitus complicated with gallstone disease. Methods The clinical data of 429 type 2 diabetes mellitus patients complicated with gallstone disease (case group) and 2145 type 2 diabetes mellitus patients without gallstone disease (control group) were collected from the Health Center of Peking Union Medical College Hospital from January 2007 to May 2010. According to sure (SBP), diastolic blood pressnre (DBP), fasting blood glucose (FBG), total cholesterol (TC), Triglyceride (TG), high-density lipoprotein cholesterol (HDL-CH), low-density lipoprotein cholesterol (LDL-CH) and body mass index (BMI) were statistically analyzed by fourfold table chi-square test or conditional Logistic regression.Results Univariate analysis showed that there was a significant difference in the levels of SBP, FBG, TC, HDL-CH and BMI between the case group and the control group (x2 =20.323, 4.365, 4.028, 7.049, 7.319, P＜0.05). Multivariate analysis confirmed that SBP, TC, HDL-CH and BMI were risk factors for gallstone disease in patients with type 2 diabetes mellitus (x2 = 18. 047, 6. 905, 12. 884, 7. 557, P ＜ 0. 05). Conclusion Increased SBP, TC and BMI and decreased HDL-CH may be the risk factors for type 2 diabetes mellitus complicated with gallstone disease.

Objective To summarize the clinical and pathological characteristics of incidental gallbladder carcinoma,analyze the factors such as surgical procedures,tumor stages that associated with prognosis,and standardize the diagnosis and treatment strategy of incidental gallbladder carcinoma. Methods Between January 1991 and October 2009,27 incidental gallbladder carcinoma patients were treated in Peking Union Medical College Hospital (PUMCH).A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis,curative treatment and prognosis. Results Twenty-seven patients were collected (8 male and 19 female) with the mean age of (68.3 ± 1.9)years.Abdominal pain,obstructive jaundice and fever were the main symptoms of incidental gallbladder carcinoma.All the 27 cases underwent open cholecystectomy based on preoperative tentative diagnosis of benign disease,and carcinoma of gallbladder was confirmed by postoperative pathology.In this group(9 lowdifferentiation,9 moderate-differentiation,4 high-differentiation and 5-carcinogenesis from adenoma).Two cases were on the stage of Nevin Ⅰ,5 on Nevin Ⅱ,8 on Nevin Ⅲ,5 on Nevin Ⅳ and 7 on Nevin Ⅴ.The survival terms were of statistic significance between the radical cholecystectomy groups and simple cholecystectomy groups(x2 =4.450,P=0.035); The prognosis of patients on stages Ⅰ、Ⅱ are better than those who are on stages Ⅲ、Ⅳ、Ⅴ (x2 = 6.825,P = 0.014). Conclusion The clinical manifestations of incidental gallbladder carcinoma are diverse,which usually lead to misdiagnosis.Frozen section examination during operation is key to diagnose incidental gallbladder carcinoma.Surgical operation is the first choice of therapy,offering much better prognosis than those received simple cholecystectomy.

Objective To investigate the risk factors of gallbladder carcinoma,so as to provide theoretical base for the prevention of gallbladder carcinoma.Methods The clinical data of 153 patients with gallbladder carcinoma (gallbladder carcinoma group) who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed. A total of 300 patients with cholecystolithiasis (cholecystolithiasis group) and 300 patients without gallbladder carcinoma or cholecystolithiasis (control group)were collected and matched at the ratio of 1∶2 to conduct the controlled study.Data were statistically analyzed by the Chi-square test and conditional Logistric regression.Results Univariate analysis showed significant difference in age,history of cholecystolithiasis,postmenopausal age,accumulated menstrual period,giving birth or not and number of birth between gallbladder carcinoma group and control group ( x2 =58.22,180.14,9.59,24.30,18.66,15.17,P ＜0.05).Age,history of cholecystolithiasis,accumulated menstrual period and number of birth were the independent risk factors of gallbladder carcinoma (x2 =55.76,180.95,24.30,8.54,P ＜ 0.05).The risk of having gallbladder carcinoma in patients who had a history of cholecystolithiasis was 34 times higher than those who did not have the history of cholecystolithiasis (OR =34.22).Late postmenopausal age (51 -55 years old),longer accumulated menstrual period ( ≥30 years),and the number of birth ( 3 times) were associated with higher risk of gallbladder carcinoma (OR =3.96,9.68,3.51 ). Age,course of cholecystolithiasis and accumulated menstrual period and number of birth were the risk factors of gallbladder carcinoma when comparing patients who have history of cholecystolithiasis in the gallbladder carcinoma group with those in the cholecystolithiasis group (x2 =70.66,16.66,11.59,4.69,P ＜ 0.05 ).Age,course of cholecystolithiasis and accumulated menstrual period were the independent risk factors of gallbladder carcinoma ( x2 =64.29,8.82,5.58,P ＜ 0.05).The risk of gallbladder carcinoma increased as the increase of age and course of cholecystolithiasis. The accumulated menstrual period ≥ 30 years was also a risk factor of gallbladder carcinoma. Conclusions Age,history of cholecystolithiasis,course of cholecystolithiasis,accumulated menstrual period and number of birth may be the risk factors of gallbladder carcinoma.For patients with age above 60 years and course of cholecystolithiasis above 3 years,cholecystectomy should be conducted to reduce the incidence of gallbladder carcinoma,and great importance should be attached to female patients with indications mentioned above.

Objective To analyze the clinicopathological features of gallbladder adenosquamous carcinoma.Methods The clinical data of 8 patients with gallbladder adenosquamous carcinoma who were admitted to the Peking Union Medical College Hospital from January 2000 to December 2010 were retrospectively analyzed.The clinicopathological features,diagnosis and treatment strategies were summarized.The survival curve was drawn by Kaplan-Meier method,and the survival of the patients was analyzed by Log-rank test. Results The clinical manifestation of the 8 patients was non-specific,and all the patients were misdiagnosed as with primary gallbladder cancer complicated with cholecystolithiasis or chronic cholecystitis.The levels of carcinoembryonic antigen and γ-glutamyl transferase of 3 patients were higher than the normal,the level of alkaline phosphatase of 2 patients was higher than the normal,the level of aspartate transaminase of 1 patient was higher than the normal,the level of CA242 of 3 patients was higher than the normal and the level of CA19-9 of 4 patients was higher than the normal.The levels of aspartate transaminase,total bilirubin and direct bilirubin were in the normal range. Different surgical approaches were selected according to different tumor positions.The mean diameter of the tumor was (5 ±3)cm. Lymph node metastasis was detected at the hepatic hilar,hepatoduodenal ligament and area behind pancreatic head. Postoperative pathological examination confirmed that all the patients were with gallbladder adenosquamous carcinoma. All patients were followed up till April 2011. Two patients survived with no discomfort,and the survival time was 2-3 months.Six patients died of tumor recurrence or metastasis,and their median survival time was 8 months (range,4-13 months). Conclusions The clinical manifestation of gallbladder adenosquamous carcinoma is non-specific, and definite diagnosis depends on the results of postoperative pathological examination.Surgical treatment is the only effective method in improving the prognosis of patients with gallbladder adenosquamous carcinoma,and the prognosis of patients is poor.

Insulin resistance, lipid metabolism disorders, independent autonomic neuropathy are high risk factors for gallstone formation in type 2 diabetic patients. In recent years, there have been a lot of new developments on the relationship between type 2 diabetes and gallstones, such as adiponectin, leptin and metabolic syndrome, etc. Based on these studies, the risk factors of type 2 diabetes complicated with gallstones are summarized in this paper.

Objective To determine the risk factors of gallstones. Methods A case-control study was conducted on 4087 patients with gallstones (the study group) and 20435 individuals without gallstones (the control group) at the Health Center of Peking Union Medical College Hospital (PUMCH) between January 2007 to May 2010. Using age and sex, the study and the control groups were matched in 1 : 5 ratio. Data were statistically analyzed using Chi-square test and conditional logistic regression.Results Univariate analysis showed significant differences in diabetic mellitus (DM), systolic blood pressure (SBP), diastalic blood pressure (DBP), triglyceride (TG), high density lipoprotein cholesterol (HDL-CH) and body mass index (BMI) between the study and the control groups (P＜0.05). Multivariate analysis confirmed that DM, SBP, HDL-CH and BMI were associated with gallstones, and their adjusted odds ratio (95％ confidence interval) were 0. 825 (0. 736 ～0. 925), 0. 908 (0. 828～0. 996), 1. 211 (1. 056～1. 389) and 0. 746 (0. 691～0. 805), respectively.The incidences of total cholesterol (TCH) and low deasity dipoprotein cholesterol (LDL-CH) were not significantly different between the two groups (P＞0.05). ConclusionsDM、SBP、HDL-CH and BMI were found to be the risk factors for gallstones. To prevent gallstones, weight reduction, blood pressure control and normalization of blood lipid are important measures.

Objective To study the clinical and pathological characteristics of hepatocellularcholangiocarcinoma,and standardize the diagnosis and treatment strategy.Methods Between January 1990 to October 2010,12 patients with hepatocellular-cholangiocarcinoma were treated at Peking Union Medical College Hospital (PUMCH).A retrospective study was performed based on the clinical data of these patients to evaluate the diagnosis,curative treatment and prognosis.Kaplan-Meier estimate was employed for survival analysis and log-rank test for group comparisons.Results There were ten male and 2 female patients,with a mean age of 51±6.3 (range,40 to 59).Abdominal pain,fatigue and weight loss were the main symptoms.Eleven of 12 (91.7％) patients had chronic hepatitis B,and 10 (83.3％) had cirrhosis.None of the 12 patients was accurately diagnosed preoperatively.The 1,3,and 5-year overall survivals for 11 patients who were regularly followed up were 63.6％,27.2 ％ and 9.1 ％,respectively.Conclusions The clinical manifestations of hepatocellular-cholangiocarcinoma were diverse,which led to preoperatively misdiagnosis.The diagnosis was made on pathological examination.Surgical resection was the main treatment.The prognosis of hepatocellularcholangiocarcinoma was bad.