The surgical intervention and criteria of severe acute pancreatitis has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery.Many kinds of minimally invasive technologies which take laparoscopy as a representative are constantly applied to the treatment of severe acute pancreatitis and make its mortality and postoperative complication rate decrease obviously.However,there are many different ways using laparoscopic techniques to treat severe acute pancreatitis.In this review,the author will discuss the current status of the different approaches.

Objective:To investigate the content of interaction and construct the virtuous interaction among the hierarchical medical institutions in rural areas based on the theory of integration and system thinking.Methods:Literature research were applied to analyze the interaction with the use of the CNKI.WanFang and Vip.Results:Interaction was closely related to integration,and the interaction among the hierarchical medical institutions in rural areas mainly included resource interaction,management interaction and service interaction,whose subject was the rural three-level medical institutions.Conclusion:The ultimate goal of virtuous interaction was the quality and safety of the health service.Specific measures of the virtuous interaction included strengthening the construction of health personnel and capital flows,combing the interests of rural three-level medical institutions and integrated management,regionalization of two-way referral and upper-and-lower linkage.

Wilson’s disease is an autosomal recessive disorder of copper metabolism. The resultant accumulation of copper primarily damages the liver and brain, resulting in hepatic, neurological and psychiatric symptoms. There have been many recent studies advancing the understanding of Wilson’s disease in Asia. There are indications that the incidence of Wilson’s disease in parts of Asia may be relatively high. Many genetic studies have identifi ed various hot spots in theATP7B gene in a variety of the Asian populations. Screening of these hotspot mutations may thus be useful in confi rming the diagnosis. Despite the advances in treatment, lack of familiarity by the health care profession resulting in late diagnosis, and poor access to treatment particularly among those from the developing economies remain areas of major concern.

Ataxia ; genetics ; physiopathology ; Calcium Channels ; genetics ; physiology ; Epilepsy ; genetics ; physiopathology ; Genetic Diseases, Inborn ; genetics ; physiopathology ; Humans ; Hypokalemic Periodic Paralysis ; genetics ; physiopathology ; Malignant Hyperthermia ; genetics ; physiopathology ; Migraine with Aura ; genetics ; physiopathology ; Myopathy, Central Core ; genetics ; physiopathology ; Ryanodine ; metabolism ; Spinocerebellar Ataxias ; genetics ; physiopathology

Adult ; Aged ; Hospitals, General ; Humans ; Male ; Medical Staff ; Middle Aged ; Occupational Exposure ; Radiation Protection ; Young Adult

In the health service field,health resources and health service supple capacity were related with the resource and capacity in economics.Health resources,health service supple capacity and their relationships were important factors for the cooperation and benign interaction of hierarchical medical institutions.However,inversion of health resources and health dislocation of service supply capacity exacerbated the agglomeration degree of patients in the tertiary medical institutions under the impact of residents' freely searching for medical service concept.Vicious interaction and mutual competition among hierarchical medical institutions had become an important obstacle for the implementation of hierarchical medical services.Therefore,its mechanism needed to be clarified while the corresponding policy recommendations should be proposed.

Objective:To explore the expression of GATA3 in breast cancer tissues and its correlation with pathological types of tumors and prognosis.Methods:The paraffin samples of breast cancer tissues and paraffin samples of normal para-cancerous tissues from 100 breast cancer patients who underwent surgical excision in Luanzhou People′s Hospital of Hebei Province from June 2014 to June 2017 were retrospectively analyzed. The expression of GATA3 in breast cancer tissues and normal para-cancerous tissues was detected by immunohistochemistry. And its significance in prognosis evaluation was analyzed. The survival rates of patients with different GATA3 expression were analyzed by Kaplan-Meier survival curves.Results:The positive expression rate of GATA3 in breast cancer tissues was significantly lower than that in normal para-cancerous tissues: 61.00% (61/100) vs. 86.00% (86/100), and there was statistical difference ( χ2 = 16.044, P<0.01). The positive expression rate of GATA3 was related with histological grading, lymph node metastasis, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2), P<0.05, and not related with age, TNM staging or tumor long diameter ( P>0.05). Multivariate Logistic regression analysis result showed that histological grading at gradeⅢ, positive HER-2 and lymph node metastasis were independent risk factors of GATA3 positive expression of breast cancer tissues in patients with breast cancer ( OR = 1.747, 2.699 and 1.730; 95% CI 1.107 to 2.758, 1.035 to 7.039 and 1.139 to 2.626; P<0.05). The 3-year survival rate in GATA3 positive patients was significantly higher than that in GATA3 negative patients: 86.89% (53/61) vs. 66.67% (26/39), and there was statistical difference ( P<0.05). Conclusions:The positive expression rate of GATA3 in breast cancer tissues is significantly lower than that in normal para-cancerous tissues. The expression level of GATA3 is related to pathological types of breast cancer, histological grading, lymph node metastasis, ER, PR and HER-2. The expression level of GATA3 is of certain significance in evaluating prognosis of patients.

Objective To observe the morphologic changes of dorsal root ganglion in the lumbar region of rabbits after the nerve root was under chronic compression and inflammatory stimulation. Methods Twenty New Zealand rabbits were recruited for this study, of which 5 served as the control (control group), and the rest were randomized into 3 experimental subgroups: 10d group, 30d group, 90d group, respectively. The autologous nucleus pulposus from the tails (about 5mg) was put into the silastic tube (inner meter of 1.5mm, external diameter 2.5mm and length 12mm), which was inserted into the left L 7 intervertebral foramen to compress the lumbar nerve root. Sham operation was performed with the rabbits in the control group. The nerve root and the dorsal root ganglia were harvested and processed and observed with light microscope and electron microscope after 10d, 30d, 90d, respectively. Results In the 10d group, obvious hyperemia, edema and infiltration of inflammatory cells in the interspace of the intima of the dorsal root ganglia (DRG) could be observed. Pyknosis, degeneration and necrosis were also found in some of the nerve cells. Electron microscopic observation showed that the number of the rough endoplasmic reticulum and mitochondrion decreased, ribosome exfoliated, mitochondrion swelled. In 30d group, typical degeneration and necrosis became more obvious. Electron microscope showed that the number of lysosome and smooth endoplasmic reticulum increased, mitochondrion swelled and its cristae disappeared, nuclei concentrated and deviated. In 90d group, significant proliferation of fibrocyte could be observed. At the same time, dura mater and arachnoid of spinal cord around the nerve root were notably thickened, and became fibrogenesis. Electron microscope also showed the increment of the lysosome and smooth endoplasmic reticulum, the swelling of mitochondrion, the loss of its cristae and the concentration of the nucleolus in the central part of the nuclei. No significant changes were found in the control group. Conclusion Pathological changes of neural degeneration such as edema, inflammatory infiltration could be observed in dorsal root ganglion after the nerve root was under chronic compression and stimulation by autologous nucleus pulposus.

Objective To quantify the EEG data in patients with brain death, expecting to obtain a criteria with high sensitivity and specificity for the diagnosis of brain death. Methods Analyzed the EEG data obtained from 17 brain dead cases and 5 clinical brain dead cases with spectrum analysis and made comparison with that from 13 non-brain dead cases. Results The EEG electric power of the brain dead group was significantly lower than that of non-brain dead group (P

OBJECTIVE To study the diagnosis and treatment of parotid acinic cell carcinoma. METHODS The clinical data of 19 cases with parotid acinic cell carcinoma treated from 1985 to 2007 were retrospectively reviewed.Four patients underwent superficial parotidectomy,5 patients underwent total parotidectomy,6 patients underwent superficial parotidectomy plus partial deep parotidectomy,6 patients underwent total parotidectomy and neck dissection.Eight patients received postoperative radiotherapy.One patient only received radical radiotherapy after biopsy.All patients were followed up for 1 to 20 years.RESULTS Nobody died after operation.Five cases recurred after operation, and the recurrence rate was 26.3%(5/19) CONCLUSION The main treatment for parotid acinic cell carcinoma is complete resection and postoperative radiotherapy.