Because of the particularity in causes, mecha-nisms and clinical performances, injury in choledocho-pancreatico-duodenal junction is usually doomed with a delayed diagnosis, often leading to a poor prognosis. The early manifestations of bile duct perforation include peritoneal swelling caused by detained water after trans-T-tube injection, blue staining of the field of operation and contrast medium leaking outside the bile duct system, peritoneal or abdominal gas accumulation, pneu-mothorax or subcutaneous emphysema after endoscopic sphincte-rotomy (EST) or endoscopic retrograde cholangiopancreatogra-phy (ERCP). Postoperative high fever, abdomical pain radia-ting to right side back and waist, fluid accumulation in the right iliac fossa or around the right kidney are the associated evidences. If the perforation is discovered during the operation, it should be sutured and choledocal T-tube drainage should be performed. If the perforation is not discovered during the opera-tion, biliointestinal bypass should be constructed. The injuries resulted from ERCP or EST procedures should be treated accord-ing to the detailed situation. Conservative treatment can be given to those who are in relatively stable status. If the condition of the patients deteriorated, timely conversion to laparotomy is needed. For patients with delayed diagnosis, thorough drainage of the region, separation of bile and pancreatic juice, duodenal diver-ticularization and jejunostomy should be considered. The key point in preventing the injury in choledocho-pancreatico-duode-hal junction lies on full knowledge of the anatomy of the region, delicate practice without forceful exploration and detailed exami-nation after the operation to avoid missing diagnosis.

Objective To discuss the relationship between prognosis and different surgical procedures for gallbladder cancer in different stages. Methods The clinical data of 107 patients with gallbladder cancer from January 2001 to May 2007 were retrospectively analyzed. The surgical procedure was chosen according to different stages. Results Eighty-one of the 107 patients (75.6%) were followed up with the median time of 5 years. Of the 10 patients with stage Ⅰ gallbladder cancer who had underwent simple cholecystectomy, 9 survived. Of the 8 patients with stage Ⅱ gallbladder cancer, 3 received palliative cholecystectomy and the median survival time was 12 months, which was significantly shorter than 24 months of the remaining 5 patients who received radical operation (X2= 5.698, P <0.05). Of the 42 patients with stage Ⅲ gallbladder cancer, 18 received radical operation, and the median survival time was 24 months, which was not significantly different from 18 months of the 5 patients who received extended radical operation (X2=0.238, P>0.05). The remaining 19 patients received palliative operation, and the median survival time was 6 months, which was significantly shorter than those of patients received radical operation or extended radical operation (X2=5.772, 6.318, P <0.05). There were 47 patients with stage Ⅳ gallbladder cancer. Seventeen patients received extended radical operation and 30 received palliative operation, and no significant difference upon the median survival time was observed among different surgical procedures (X2=0.001,0.694, P>0.05). The complication recurrence after the extended radical operation was significantly higher than palliative operation (X2=6.039, P<0.05). Conclusions For patients with stage Ⅰ gallbladder cancer, simple cholecystectomy is preferred. Radical operation is good for patients with stage Ⅱ gallbladder cancer. The choose of radical operation or extended radical operation for patients with stage Ⅲ gallbladder cancer should be based on the condition of invasion. Palliative operation could be used to patients with stage Ⅳ gallbladder cancer.

Objective To explore the effects of inducible co-stimulator (ICOS) gene on the cytotoxic activity of cytokine-induced killer (CIK) cells against cholangiocarcinoma cells. Methods CIK-ICOS cells were obtained by stable transfecting ICOS genes into CIK cells through the adenovirus vector whereas untransfected and EGFP-transfected CIK cells were treated as controls. The proliferation and apoptosis of different CIK cells, as well as their cytotoxicity against cholangiocarcinoma cells in the three groups were detected. The expressions of IFN-T, IL-2 and TNF-α in the supernatant of different CIK cells were measured by ELISA. SCID mice with cholangiocarcinoma were randomly divided into CIK group, CIK-EGFP group, CIK-ICOS group and normal saline group. The cytotoxic activity of CIK-ICOS cells against cholangiocarcinoma cells in vivo was observed. Results CIK-ICOS cells displayed better proliferation than CIK cells and CIK-EGFP cells. At day 20 and 23 of culture, the apoptosis rate of CIK-ICOS cells was 0.69% and 0.89%, respectively, while that of the CIK cells was 2.90% and 4.92%. The cytotoxic effect of CIK-ICOS cells at different E: T ratio against cholangiocarcinoma cells was significantly stronger than that of CIK cells and CIK-EGFP cells (F=13.37, 6.46, 25.51, P<0.05). The concentration of IFN-γ in CIK-ICOS cultured supernatant was (49.50±4.73)μg/L, which was significantly higher than that in the cultured supernatant of CIK cells [(30.53±3.73)μg/L] and CIK-EGFP cells [(30.12±2.64)μg/L](F=38.89, P<0.05). The growth of cholangiocarcinoma was significantly slower in CIK-ICOS group than that in CIK group and CIK-EGFP group, whereas the necrosis area of tumor was larger and the CIK cells in CIK-ICOS group was more than those in the other two groups. Conclusions CIK cells had the function of killing cholangiocarcinoma cells in vitro and in vivo. After ICOS genes were transfected into CIK cells, the survival time of CIK cells in vitro was prolonged and the proliferation of CIK cells was enhanced, as well as the secretion of IFN-γ was increased so that the cytotoxicity of CIK cells against cholangiocarcinoma cells in vitro and in vivo was enhanced.

Objective: To test the relationship between duration of physical exercise and sadness of middle school students, so as to provide enlightenment for students to participate in physical exercise when they are faced with sadness. Methods: Through the methods of multiple linear regression and regulatory effect test, data of 8 146 middle school students from China Education Panel Survey 2014-2015 were analyzed. Results: A negative correlation was observed between physical exercise duration and sadness of middle school students (r=-0.08, P<0.01); physical exercise duration showed significant negative main effect on depressive mood of middle school students (β=-0.05,P<0.01); the square term of physical exercise students shows significant curve correlation with depressive mood of middle school students (β=-0.04, P<0.05); physical exercise students had significant negative main effect on depressive mood of urban and rural middle school students(β=-0.04,-0.05, P<0.01); the square term of physical exercise duration does not show significant curve correlation with depressive mood of rural middle school students (β=-0.01, P>0.05), but showed significant curve correlation with depressive mood of urban middle school students (β=-0.06, P<0.01). Conclusion Physical exercise duration has threshold effect on relieving middle school students’ Sadness, while the threshold effect of rural middle school students physical exercise time disappears. Attention should be paid to the understanding of the relationship between physical exercise duration and sadness of middle school students.

Objective: To study the allocation of policy attention of life safety and health education in the Work Essentials of the Ministry of Education from 1987 to 2022 based on policy analysis, and to provide reference for the optimization of life safety and health education policy. Methods: The contents related to life safety and health education in the Work Essentials of the Ministry of Education from 1987 to 2022 were coded by content analysis method and analyzed quantitatively. Results: The attention of life safety and health education policies in schools in China could be divided into three stages: consolidation and improvement stage (1987-2000), reform and exploration stage (2001-2012), and deepening and improvement stage (2013-2022), with the attention intensity was rising as a whole. The government s policy on life safety and health education focused on health behavior and lifestyle (39.5% of the total reference point), safety emergency and risk avoidance (36.2% of the total reference point), mental health ( 11.9 % of the total reference point).The two fields of growth and adolescent health (8.1% of the total reference point),infectious disease prevention and public health emergency response (4.3% of the total reference point) paid less attention. The government had paid attention to 20 core points in the field of life safety and health education, and there were still 10 core points that had not been paid attention to. Conclusion The attention intensity of school safety and health education policy in China has been improved as a whole, and there are deviations in the policy attention at each stage.Limitations also include the inbalance of policy attention, lack of dynamic policy and the passivity of policy response;Life safety and health education in various fields of content and policy attention allocation direction is not comprehensive.It is suggested to stabilize the total amount of attention allocation on life safety and health education policy, to ensure balanced allocation, dynamic adjustment and pre judgment;More attention should paid on the comprehensiveness of contents in each aspects in policy optimization and adjustment.

According to the training requirement of the biological-psycho-social medical model to the clinical medical students,in order to promote the comprehensive improvement of medical students' professional knowledge,hands-on ability and human qualities,we design the course of introduction to clinical medicine.Through six major functional modules such as basic professional quality,clinical diagnosis basic technology,basic skills related to the operation,the new progress in clinical medicine and technology,clinical nursing and medical relationship,and medical information management,we build up the core content of integrated course of introduction to clinical medical.In this way,the clinical and related basic knowledge and skills are integrated,the clinical course is closely connected with the basic curriculum,the medical and the humanities exchanges.Through this design,the foundation is laid out for the collaborative efforts of the organ-system of integrated curriculum reform.

Objective:To investigate the efficacy of bifidobacteria combined with Kangfuxin liquid in the treatment of gastrointestinal ulcer in older adult patients and its effects on intestinal flora. Methods:A total of 84 older adult patients with gastrointestinal ulcer who received treatment in The First People's Hospital of Yongkang from January 2020 to December 2021 were included in this study. They were randomly assigned to receive either Kangfuxin liquid treatment (control group, n = 42) or Kangfuxin liquid combined with bifidobacteria treatment (combined group, n = 42) based on conventional symptomatic treatment. Efficacy and intestinal flora were compared between the two groups. Results:Total response rate and Helicobacter pylori eradication rate in the combined group were 97.62% and 88.10%, respectively, which were significantly higher than those in the control group ( χ2 = 8.63, 7.25, both P < 0.05). After treatment, the numbers of Bifidobacteria, Lactobacilli, Digestive cocci and Eubacteria in the combined group were greater than those in the control group, and the numbers of Enterococci, Enterobacter and Clostridium were lower than those in the control group ( t = 11.84, 6.50, 6.33, 7.16, 3.21, 3.24, 6.98, all P < 0.05). After treatment, the levels of interleukin-6 (IL-6) and interleukin-17 (IL-17) in the combined group were (5.09 ± 0.85) ng/L and (6.13 ± 1.27) ng/L, respectively, which were significantly lower than those in the control group, and interferon-γ and prostaglandin E2 (PGE2) levels in the combined group were (25.95 ± 3.67) ng/L and (20.06 ± 0.92) ng/L, respectively, which were significantly lower than those in the control group ( t = 8.28, 7.28, 8.19, 9.10, all P < 0.001). Conclusion:Bifidobacteria combined with Kangfuxin liquid is highly effective on gastrointestinal ulcer in older adult patients. The combined method can adjust intestinal flora and improve inflammatory indicators, and therefore is worthy of clinical promotion.

OBJECTIVETo evaluate the pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy and to analyze risk factors of pancreatic fistula.

METHODSClinical data of 352 patients who received pancreaticoduodenectomy from September 2009 to September 2012 were retrospectively analyzed. For patients with soft pancreas, binding pancreaticojejunostomy was applied to 153 patients. For patients with hard pancreas, duct-to-mucosa pancreaticojejunostomy (DMPJ) was applied (199 cases). The clinical efficacy and incidence of postoperative complications were compared among 2 groups. Risk factors of pancreatic fistula were screened out from many factors by univariate and multivariate analysis.

RESULTSThe overall incidence of pancreatic leakage was 13.9% (49/352). There were no significant difference in incidences of pancreatic leakage (χ(2) = 0.512), peritoneal bleeding (χ(2) = 0.784), abdominal infection (χ(2) = 1.161), digestive dysfunction rate (χ(2) = 4.753) and mean duration of hospital stay (t = 2.13) among 2 groups (all P > 0.05). The results of multivariate analysis showed pancreatic tube diameter < 3 mm (OR = 5.748), preoperative total bilirubin level > 171 µmol/L (OR = 5.112), duration of preoperative jaundice > 8 weeks (OR = 5.090), preoperative albumin level < 30 g/L (OR = 4.464) were independent risk factors of pancreatic fistula (all P < 0.05).

CONCLUSIONSBunding pancreatojejunostomy was as good as soft pancreatic; for duct diameter ≥ 3 mm suggested using duct-to-mucosa pancreaticojejunostomy. For the risk factors for pancreatic leakage actively cooperate with preoperative nutritional support and timely treatment of jaundice, the incidence of postoperative pancreatic leakage will be further reduced.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; methods ; Postoperative Complications ; Retrospective Studies ; Risk Factors