Objective To explore the safety and feasibility of laparoscopic radical resection of Bismuth-type Ⅲb hilar cholangiocarcinoma.Methods The clinical data of 109 patients with Bismuth-type Ⅲ b hilar cholangiocarcinoma in the Department of General Surgery of Cangzhou Central Hospital from Jan 2015 to Feb 2018 were retrospectively analyzed.Among those 17 patients undergoing total laparoscopic surgery were compared with 17 open cases.Results There were significant differences between the laparoscopic group and the control group in operation time [(420.8 ± 136.5) min vs (292.3 ± 65.6) min],total length of incision [(8.2 ± 4.7) cm vs (20.4 ± 5.8) cm],incidence of postoperative complications [29.4％ (5/17) vs 52.9％ (9/17)],postoperative feeding time,postoperative ICU stay and postoperative hospital stay (P ＜ 0.05).There were no significant difference in the amount of bleeding[(325.2 ± 98.7)ml vs(367.4 ±72.9)ml],pathological results,number of lymph node dissection,R0 resection rate and tumor recurrence rate (P ＞ 0.05).Conclusion Total laparoscopic radical resection of Bismuth-type Ⅲ b hilar cholangiocarcinoma is safe,feasible,and has the advantages of minimal invasion and rapid recovery.

Objective To compare the characteristics of high-frequency ultrasonography with CT in chest wall tuberculosis, and to explore the diagnostic value of high-frequency ultrasound in chest wall tuberculosis abscess. Methods Retrospective analysis was performed on 35 patients with chest wall tuberculous abscess from November 2014 to may 2017, who were admitted to Hangzhou Red Cross hospital. All case were confirmed by surgery and pathology, and all patients were performed ultrasound and chest CT scan. The Chi square test was uesed to compare the results of high-frequency ultrasound and CT examination in 35 patients with tuberculous abscess of chest wall. Results High-frequency ultrasonography and CT were both 100% sensitive to the 35 cases of chest wall tuberculous abscess. High-frequency ultrasonography showed rib lesions in 17 cases, while CT showed rib lesions in 15 cases. Ultrasonography showed dead bone in 5 cases, while CT showed dead bone in 3 cases, the difference was not statistically significant. The ultrasonography showed the cortical roughness of ribs in 3 cases, while the CT showed that in 1 case, the difference was not statistically significant. The ultrasonography showed the thickened rib in 2 cases, while the CT showed that in 10 cases, the CT detection rate was higher than the ultrasound examinations with significant difference. Ultrasonography showed rib fractures in 12 cases, while CT showed that in 11 cases, the difference was not statistically significant. In the cases of rib lesion＜0.1 cm, ultrasound identified 2 cases, while CT identified only 1 case, but the difference was not statistically significant. Conclusion Compared with CT, high-frequency ultrasonography can show tuberculous abscess and rib lesions, which can be used as an important imaging diagnostic method for chest wall tuberculosis.

Objective To investigate the choice of surgical methods and short-term therapeutic efficacy of laparoscopic pancreaticoduodenectomy.Methods A retrospective analysis was performed on the clinical data of 188 cases who underwent laparoscopic pancreaticoduodenectomy (LPD) from December 2015 to December 2017 in Cangzhou Central Hospital.Total laparoscopic pancreaticoduodenectomy (TLPD) was performed in 102 patients whose diameter of pancreatic duct was greater than or equal to 3 mm,and end-to-side anastomosis of pancreatic duct and jejunum was used to reconstruct the digestive tract (TLPD group).Laparoscopic assisted pancreaticoduodenectomy (LAPD) was performed in 86 patients with pancreatic duct diameter less than 3 mm,and the digestive tract was reconstructed by end-to-side pancreaticoduodenectomy with pocket-insertion (LAPD group).The clinical data of the two groups were analyzed and compared.Results There were no significant differences on sex,age,ASA grade,preoperative total bilirubin,alanine aminotransferase and serum albumin levels between the two groups(P ＞0.05),which was comparable.The total incision length and hospitalization time in TLPD group were significantly shorter than those in LAPD group [(8.2± 1.4)cm vs (12.9±2.6) cm];[(10.9±5.9)d vs (14.3±6.5) d],while the time of pancreaticojejunostomy was significantly longer than that in LAPD group [(36.1 ± 14.7) min vs (14.0 ± 4.2) min].The incidence of pancreatic fistula after operation was significantly higher than that in LAPD group (30.4％ vs 10.5％).The difference was statistically significant (all P＜0.05).There were no significant differences on mean operation time,intraoperative bleeding volume,number of lymph node dissection,R0 resection rate,ICU admission time,eating time,total complication rate and 6-month disease-free survival rate between the two groups.Conclusions TLPD has the advantages of less trauma and quicker recovery.But for pancreatic duct diameter less than 3 mm,the choice of LAPD can increase the safety of operation and reduce the incidence of postoperative pancreatic fistula.

Objective: To investigate the effect of end-to-side pancreaticojejunostomy with pocket-insertion on the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods: The clinical data of 581 patients undergoing pancreaticoduodenectomy from Dec. 2012 to Sep. 2018 in Cangzhou Central Hospital were retrospectively analyzed, including 327 cases of open pancreaticoduodenectomy (OPD) , 175 cases of laparoscopic assisted pancreaticoduodenectomy (LAPD) , and 79 cases of total laparoscopic pancreaticoduodenectomy. End-to-side pancreaticojejunostomy with pocket-insertion was used in all cases. The incidence of pancreatic fistula after operation was analyzed. Results: The overall incidence of grade B or C pancreatic fistula was 3.10% (18/581) after end-to-side pancreaticojejunostomy with purse-pocket insertion. The incidence of grade B or C pancreatic fistula in OPD group was 2.75% (9/327) . The incidence of grade B or C pancreatic fistula in LAPD group was 2.29% (4/175) . The incidence of grade B or C pancreatic fistula in TLPD group was 6.33% (5/79) . The three groups were divided into two subgroups according to the pancreatic texture. There was significant difference in pancreatic duct diameter between subgroups (P<0.05) , but there was no significant difference in the time of pancreaticojejunostomy and the incidence of pancreatic fistula after operation (P>0.05) . Conclusion End-to-side pancreaticojejunostomy with pocket insertion has the advantages of simple operation, strong adaptability, safety and high efficiency, and can control the incidence of pancreatic fistula after pancreaticoduodenectomy at an ideal level.

Objective:To analyze the common complications of laparoscopic duodenum- preserving pancreatic head resection(LDPPHR).Methods:The clinical data of 32 patients undergoing LDPPHR from Jun 2018 to Jun 2021 in Cangzhou Central Hospital were analyzed retrospectively.Results:LDPPHR was successfully performed in all 32 patients without conversion to open surgery. The incidence of postoperative complications was 21.9% (7/32), 3 cases suffering from sever complications (1 case of long-term postoperative pancreatic fistula, 1 case of obstructive jaundice caused by duodenal papilla stenosis, 1 case of postoperative abdominal bleeding) were cured by laparotomy; 4 cases of minor complications were simple pancreatic fistula, which were cured by prolonging dranage.Conclusions:LDPPHR is technically feasible for isolated noncancerous lesions within pancreatic head and uncinate process,the complications were manageable.Its suggested benefits remain to be established by long term follow-up.

Objective To conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms,diabetes and close contacts. Methods Purpose-sampling method was applied to choose 3 counties in Shandong province as the study sites,relying on the local basic public health service,for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects,patients with diabetes,TB close contacts in the past 2 years,from January to September,2013. Results 82 active pulmonary TB cases were identified among 9 041 cases who received the examination,with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms,patients with diabetes or having suspicious symptoms of TB,the prevalence rates of active TB were 115‰,3.4‰,0.9‰respectively. No active pulmonary TB case was found in the TB close contacts,patients with diabetes,or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different(χ2=697.478, P=0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times(RR=17.951)higher than those non-diabetic patients,and 2 times higher than those with suspicious symptoms (RR=3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ2=46.637,P=0.000),the longer duration of diabetes and the higher risk of tuberculosis (RR>1). Conclusion Our data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that‘Key crowd screening program’should be introduced into case-finding strategy on TB,with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.

Objective:To explore the accuracy of array comparative genomic hybridization(aCGH) in the unexpected detection of Duchenne muscular dystrophy ( DMD) gene duplication/deletion in prenatal diagnosis. Methods:A retrospective analysis was performed on 31 cases with DMD gene duplication/deletion detected by aCGH among 5 025 prenatal diagnosis samples without family history of DMD in Henan Provincial People's Hospital from July 2018 to December 2019. The multiplex ligation-dependent probe amplification (MLPA) method was used to verify the above results. The American College of Medical Genetics and Genomics (ACMG) guideline was referred for pathogenicity analysis of the detected duplicates/deletions. Descriptive analysis was adopted in analysis. Results:The total unexpected DMD gene duplication/deletion rate was 0.62% (31/5 025), among which 25 cases were with microduplication/microdeletion ≤ 200 kb and six were >200 kb; there were 24 cases of deletion, seven cases of duplication; exon or intron duplication/deletion were accounted for 19 and 12 cases, respectively. According to the five classification standards of ACMG guideline, there were 17 cases with pathogenic variants and 14 cases with uncertain pathogenicity/likely benign variants. Of the 19 with exon mutations, 17 cases were DMD intragenic variants, and two cases involved variants in and outside DMD gene, which were verified by MLPA whose results were all positive. Conclusions:The duplication/deletion of exon region of DMD gene detected by aCGH technique is accurate and reliable, which plays an important role in the diagnosis of DMD. For these cases involved both internal and external regions of DMD gene, aCGH can identify the upstream and downstream breaking points of DMD gene, thus providing the basis for ACMG grading.

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with mental retardation. METHODS: G-banded karyotyping analysis and single nucleotide polymorphism microarray (SNP array) were used to detect the genetic variants within the family, and the origin of the variants was analyzed using UPDtool Statistics software. RESULTS: The patient, a 26-year-old female, was found to have a chromosomal karyotype of 46,XX,dup(4)(q28.2q31.3),and SNP array revealed a 25.71 Mb duplication at 4q28.2-q31.3. The duplication was inherited from her father, and her fetus was found to carry the same duplication. CONCLUSION The duplication of the patient probably underlay the mental retardation. The gender of the carrier and parental origin of the duplication might have led to the variation in their clinical phenotype.
Adult ; Chromosome Banding ; Female ; Genetic Testing ; Humans ; Karyotyping ; Male ; Pedigree ; Trisomy/genetics*

OBJECTIVETo conduct a survey on the prevalence of active pulmonary tuberculosis among 65 year olds or above. Study subjects would include those with characteristics of TB suspicious symptoms, diabetes and close contacts.

METHODSPurpose-sampling method was applied to choose 3 counties in Shandong province as the study sites, relying on the local basic public health service, for those elderly under 65 years old or above. The study team would introduce the process and contents of this study to the subjects followed by chest X-ray and sputum smears on those registered tuberculosis suspects, patients with diabetes, TB close contacts in the past 2 years, from January to September, 2013.

RESULTS82 active pulmonary TB cases were identified among 9 041 cases who received the examination, with a crude prevalence rate as 9.1‰. From patients having both suspicious TB and diabetic symptoms, patients with diabetes or having suspicious symptoms of TB, the prevalence rates of active TB were 115‰, 3.4‰, 0.9‰ respectively. No active pulmonary TB case was found in the TB close contacts, patients with diabetes, or those people with suspicious TB symptoms. TB prevalence rates among all the above mentioned groups were significantly different (χ(2) = 697.478, P = 0.000). Prevalence rate of active pulmonary TB with diabetes was 18 times (RR = 17.951) higher than those non-diabetic patients, and 2 times higher than those with suspicious symptoms (RR = 3.860). Results from single factor analysis showed that diabetes were closely related to the prevalence of pulmonary tuberculosis(χ(2) = 46.637, P = 0.000), the longer duration of diabetes and the higher risk of tuberculosis(RR > 1).

CONCLUSIONOur data showed that active pulmonary TB prevalence was high in elderly diabetes patients which suggesting that 'Key crowd screening program' should be introduced into case-finding strategy on TB, with special focus on TB patients with diabetes or those people having suspicious symptoms of TB.

Aged ; Aged, 80 and over ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Prevalence ; Tuberculosis ; epidemiology