Objective To study the effect of laparoscopic neoplasty and changes of procalcitonin (PCT) and cell-mediated immunity in elderly patients with duodenal ulcer perforation. Methods Forty-four elderly patients with duodenal ulcer perforation were divided into laparoscopic neoplasty group (n=20) and open neoplasty group (n=24).The level of PCT was assayed by colloid immunization. Blood levels of CD3+, CD4+, CD8+and natural killer (NK) cells were detected by flow cytometry before operation and at 0.5 h, 24 h, 48 h and the 7th day after operation.Surgical complications and postoperative hospital stay were observed in two groups. Results There was no significant difference in the activity of PCT before operation between two groups. There were no significant differences in CD3+, CD4+, CD8+ and NK cells 0.5 h before operation between two groups. The level of PCT was significantly lower at 24 h and 48 h after operation in laparoscopic group than that in open operation group (P<0.05). There were significant differences in the serum levels of CD3+, CD4+, CD8+and NK cells with time changes in two groups (P<0.05). There were significant decreases in CD3+, CD4+and CD8+at 24 h after operation than those before operation in two groups, which were significantly lower in open operation group than those of laparoscopic group except for CD8+. The levels of CD3+, CD4+and CD8+recovered to the levels before operation at 48 h after operation in laparoscopic group. In open operation group CD3+did not return to the level before operation at 7 d after operation. The levels of NK cells were decreased at 24 h after operation in two groups, but there was no significant difference in the level of NK cells between two groups. The level of NK cells returned to preoperative levels at 48 h after operation in laparoscopic group, while there was no significant difference in the level of NK cells before and after operation in open neoplasty group. Compared with the open neoplasty group, there were fewer complications and shorter hospital stay in laparoscopic group. Conclusion The laparoscopic repair operation for gastric and duodenal ulcer perforation has a fewer effects on the stress response and immune function in elderly patients, and has the advantages in the protection of immune function.

Objective To explore and describe the sampling methods for aerosol from cooling towers in the centralized air conditioning system, early-warning indicators, the effect factor and present status of contamination by Legionella.Methods Air-conditioning systems were sampled two rounds in 13 guesthouses, markest and bathing spots of Maanshan City in June-August, 2008.Aerosols were collected by fluid-striking microbial aerosol sample collector, while water samples from cooling tower and swelling box were obtained.Legionella were determined respectively for 67 samples by germiculture and polymerase chain reaction.Results The positive rate of Legionella in aerosols by germiculture was 0, meanwhile it was 50.0% by polymerase chain reaction for Legionella pneumophila.The positive rate in aerosols was 90.0% as the air-sampling volume exceeded 400 L.The positive rate of aerosols increased while the operating-time of cooling tower increased.The relative humidity in Legionella positive groups was higher than that in Legionella negative groups.Conclusion The positive result for Legionella pneumophila by polymerase chain reaction should be an important indicator for early-warning for the occurrence and spreading of Legionnaires' disease.The air-sampling volume of over 400 L is available by sampling collector for the detection of Legionella pneumophila by polymerase chain reaction.Risk of Legionella contamination in aerosol would be raised in high-humidity environment.

Intracranial atherosclerotic stenosis is one of the important causes of ischemic stroke. It is of vital importance to guide clinical treatment using imaging methods to diagnose intracranial artery stenosis and accurately assess the degree of stenosis. This article reviews the advantages and shortcomings,advances and clinical application values of diagnosing intracranial artery stenosis using transcranial Doppler ultrasound,transcranial color-coded duplex sonography,intravascular ultrasound,magnetic resonance angiography,computed tomography angiography,and digital subtract angiography,which will provide references for clinicians to select ideal checking tools.

Background and purpose:Postoperative sore throat (POST) is one of the common complaints of patients after radical thyroidectomy. Tracheal intubation is the main cause of POST. This study compared the effect of intubation with visual endoscopy and general laryngoscope on POST in patients undergoing radical thyroidectomy. Methods:One hundred patients (18-60 years, ASAⅠ-Ⅱ) undergoing elective radical thyroidectomy were randomized into two groups:patients in group A (n=50) were intubated with visual endoscope while patients in group B (n=50) were intubated with general laryngoscope. Endotracheal tube cuffs pressure was maintained at 20mmHg in all patients. Visual analogue scale (VAS) and Bruggrmann comfort scale (BCS) were recorded at the time points of 1, 6 and 24 h after extubation. Results:Compared with group B, the incidence of POST in group A was signifcantly reduced (42%vs 64%, P=0.027). The VAS of group A was lower than that of group B (3.05±1.56 vs 4.25±1.30, 3.05±1.56 vs 4.01±1.98, 2.72±1.77 vs 3.31±1.12) (P<0.05). The BCS of group A was higher than that of group B (0.99±0.46 vs 0.69±0.30, 1.95±0.47 vs 1.51±0.58, 2.82±0.87 vs 2.31±0.72) (P<0.05). Conclusion:Using visual endoscopic intubation can reduce the incidence of the POST in patients undergoing radical thyroidectomy.

Objective To evaluate the application of cervical lateral mass plate fixation in the treatment of fracture and dislocation of lower cervical spine. Methods From February 2001 to June 2003, 21 cases of lower cervical spine injury were treated by cervical lateral mass plating fixation, received spinal decompression and reduction according to the types of fracture and dislocation. A cervical lateral mass plate was applied in each lateral mass. The screw prick point was defined at 1-2 mm inner and lower to the mass center. The sagital angle, horizontal angle of internal fixation screw were 45 degrees and 25-30 degree respectively. Results The follow up ranged from nine months to two years and nine months (mean 13 months). All cases were encouraged to sit up, wearing soft collar 4-7 days after the surgery. The mean off-bed time of those cases without spinal cord injuries less than Frankel C grade were seven days (4-14 days) after operation. All cases obtained solid bony fusion 4-6 months postoperatively. Sixteen cases with spinal cord injury improved for one grade according to American Spinal Injury Association. Three cases with nerve root injury obtained complete recovery after operation. There was no severe complication such as vertebral artery nerve root or spinal cord injuries or aggravation of spinal cord injury. One case had uneven reduction and two suffered screw loosening. Conclusion Cervical lateral mass plate fixation is an efficient and reliable technique for segmental posterior fixation, for it has the advantages of wide indication, relatively simple and safe operating as well as strong stability.

Objective To explore the epidemic trend of influenza and pandemic virus variation in Maanshan, and to provide scientific basis for the prevention of influenza. Methods The ILI data of monitor hospitals and some ILI nasopharyngeal specimens were collected, then influenza virus was isolated by MDCK cells, and influenza serotypes were identified by HI. Results 15 904 cases of ILI were reported from 2006 to 2007. The detectable rate of influenza like illness in outpatients was 6.63%. 2 656 nasopharyngeal specimens of ILI were collected, and 358 strains of influenza virus were isolated, with isolation rate of 13.48%, of which 142 were H1N1 subset influenza A virus, 49 were H3N2, 72 were Victoria subset influenza B virus, and 96 were Yamagata. Conclusions During 2006 and 2007 two peaks of influenza-like illness in outpatients was in winter-spring and summer seasons of each year. More attention meeds to be paid to the monitoring of influenza.

Objective To collect data and analyze the current status and prevalence changes of Crohn's disease (CD) in mainland China in recent decades. Methods A computer-based literature search was previously performed by using 50-year (1950 to 2002) of records of CD from the Chinese Database of Biology and Medicine (CBM) (1979 to 2002) and a manual year-by-year search of the literature ( 1950 to 1978). Using similar method, descriptive epidemiological data from 2003 to 2007 were collected, analyzed and compared with previous research. Results Four hundred and seventeen relevant papers during 2003 and 2007 were collected and 62 papers were eligible for inclusion. Within 62 papers, a total of 2149 cases with CD from 2003 to 2007 have been reported nationwide, comprising 1288 male and 861 female patients, result (ie,1526 cases from 1950-2002). There were no obvious changes in incidence age (younger and middle age were main components) and sex ratio ( number of male was still larger than that of female). The extrapolated CD incidence and prevalence rates were 1.21/100 000 person ? year and 2.29/100 000, respectively, which were higher than that of year 1950-2002, 0.28/100 000 person ? year and 1.38/ 100 000, respectively. Conclusions The incidence and prevalence rates of CD have been increasing rapidly, but these rates are still lower than those in Western world.

Objective To investigate the efficacy and mechanism of hyperbaric oxygen combining conventional therapy on persistent vegetative state ( PVS).Methods Sixty-two cases of PVS patients were treated with hyperbaric oxygen ( HBO ) combinting with conventional therapy.( 1 ) Hyperbaric oxygen therapy:hyperbaric oxygen chamber was adopted and the air pressure was 0,18 -0.20 MPa.The patients breathed pure oxygen for 30 min,2 times per day with a 10 min interval,and continued for 10 days as a course with an average of 4 to 6 courses.(2)Conventional therapy:All patients received drug treatment in hyperbaric oxygen therapy at the same time,including hemostasis,dehydration,anti-infection,nerve cell nutrition agents,wake promoting agents and supportive therapy.All patients were divided to three groups according to the course of disease:26 - 59 days in A group,60-119 days in B group,120 -268 days in C group,and the relationship between disease course and HBO treatment efficacy was analyzed.Results Afer HBO combining conventional therapy,27 cases (43.5％) were recovered,18 cases(29.0％ ) had obvious effect,8 cases( 12.9％ ) had effect,9 cases( 14.5％ )were inefficacy.The efficiency related to the course of disease.The total efficiency rate was 85.5％.The efficacy of HBO treatment had significant difference in A,B and C group ( 96.2％,62.5％ and 41.7％ in A,B and C group respectively,x2 =24.83,P ＜ 0.01 ).The shorter course indicated the better efficacy.Conclusion Hyperbaric oxygen combining conven.

Objective To observe the clinical effects of hyperbaric oxygen combined large dose ganglioside on delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods A totol of 72 patients of DEACMP were randomly divided into the observation group(37)and the control group(35).The patients of control group were given the routine treatment with hyperbaric oxygen.In the treatment group patients were given large doses of gangliosides 100 mg,1 times a day,for a period of 20 to 30 days additionally to the routine treatment of hyperbaric oxygen.All patients were examined before and after treatment in EEG examination (EEG),mini-mental state examination(MMSE).Results The abnormal rate of EEG was 37.83％(14/37) in the control group,which was significantly lower than that of 65.71％(23/35) in the treatment group((x2 =5.60,P ＜ 0.05).In the treatment group,the MMSE was(15.45±2.93) and(23.70±2.13) before and after treatment,respectively; in the control group,the MMSE was(14.88±2.84) and(20.33±2.09) before and after treatment.The MMSE was significantly impoved after treatment in both group(t =3.18 and 2.91,Ps ＜0.05).Furthermore,the MMSE impoved more significantly in the treatment group compared to the control group (t =6.28,P ＜ 0.05).The effective rate of treatment group was 86.48％(32/37),which was significantly higher than that of 51.43％(20/35) in the control group(x2 =7.72,P ＜ 0.01).Conclusion Application of large dose ganglioside treatment had significant clinical effects in delayed encephalopathy after acute car-bon monoxide poisoning,which is better than the effect of routine hyperbaric oxygen treatment.

Objective To investigate the clinical effect of surgical treatment of acetabular fractures. Methods From June 1995 to December 2000, 62 cases of acetabular fracture with dislocation were treated with open reduction and internal fixation. There were 13 cases with fractures of the posterior wall, two with posterior column fractures, three with anterior column fractures, five with transverse fractures, 15 with transverse and posterior wall fractures, three with posterior column and wall fractures, five with T-shaped fractures, four with anterior and hemi-transverse fractures and 12 with fractures of both column. Kocher-Langenbeck (K-L) approach was applied in 37 cases, ilioinguinal approach in 12, extended iliofemoral approach in four, iliofemoral approach in two, and combined approaches (K-L+ilio-inguinal) in seven. Results Anatomic reduction was done in 37 cases, with satisfactory results in 17 and unsatisfactory results in eight. Reduction for joint vallatae was performed in four cases. The follow-up was 1-5 years (average 2.7 years). The total excellence rate of clinical results was 71% (44/62), with excellence rate in anatomic and non-anatomic reduction groups for 89% (33/37) and 44% (11/25), respectively, with a very significant difference (?2=22.89, P