Developments in the Diagnosis and Management of Cholecystoenteric Fistula.

Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.

The safety and feasibility of laparoscopic approach for the management of intrahepatic and extrahepatic bile duct stones in patients with prior biliary tract surgical interventions.

The purpose of this study was to compare the efficacy and safety of laparoscopic and open reoperation for intrahepatic and extrahepatic bile duct stones patients with previous biliary tract surgical procedures. The clinical data were retrospectively analyzed of intrahepatic and extrahepatic bile duct stones patients with previous biliary tract surgical procedures who underwent reoperation in the Second General Surgery Department of China Medical University from January 2012 to February 2018. 44 eligible cases were selected. In accordance with the surgical procedures, they were divided into a laparoscopy group (n = 23) and an open surgery group (n = 21). No statistically significant differences were found in the preoperative general clinical data between the two group. Two patients in the laparoscopy group were converted to open surgery. Comparisons between the two groups showed that the intraoperative blood loss [90.87 ± 62.95 (ml) vs. 152.38 ± 118.82 (ml)], the proportion of postoperative analgesia [10/23 (43.5%) vs. 16/21 (76.2%)], and the length of stay [7.19 ± 5.32 (d) vs. 11.00 ± 4.66 (d)] in the laparoscopy group were significantly lower than those in the open surgery group (P < 0.05). Laparoscopic biliary reoperation for intrahepatic and extrahepatic bile duct stones was feasible. Compared with open surgery, laparoscopic surgery has the advantages of less bleeding, a shorter postoperative length of stay, and a lower rate of additional postoperative analgesia.

Psychological distress in cancer patients in a large Chinese cross-sectional study.

BACKGROUND: Although psychological distress is common among patients with chronic diseases, the degree of risk for developing psychological distress is not well-established. Our aim with this study is to determine the odds ratio for psychological distress in patients with cancer as compared to either 1) patients with chronic disease patients without cancer, or 2) healthy controls in a large representative sample of Chinese population. METHODS: Using a multistage, stratified cluster sampling method, 21,101 subjects 18-79 years old were interviewed face-to-face in Jilin province, China. Their psychological status was assessed with the 12-item General Health Questionnaire (GHQ-12). A total score of ≥4 was used as the threshold for determining psychological distress. RESULTS: The prevalence of psychological distress was 14.08% across the entire sample: 10.63% in healthy controls; 14.81% in patients with chronic diseases; and 20% in patients with cancer. Multiple logistic regression analysis indicated that, as compared to the health controls, both cancer (OR = 1.609, 95%CI = 1.245-2.081) and chronic disease patients (OR = 1.330, 95%CI = 1.189-1.478) were more likely to suffer from psychological distress. Moreover, cancer patients had a higher risk of psychological distress than patients with chronic diseases (OR = 1.295, 95%CI = 1.049-1.600; p = 0.016). In addition, the cancer group (2.68 ±â€¯0.114) demonstrated a higher GHQ score than the patients with chronic diseases (2.30 ±â€¯0.017) and healthy controls (1.98 ±â€¯0.029) (both p < 0.001). CONCLUSION: Our results showed both a higher rate and greater degree of psychological distress in patients with cancer. This suggests a need for better psychological management in cancer patients to help alleviate their distress.

Recombinant hemagglutinin proteins formulated in a novel PELC/CpG adjuvant for H7N9 subunit vaccine development.

Humans infected with H7N9 avian influenza viruses can result in severe pneumonia and acute respiratory syndrome with an approximately 40% mortality rate, and there is an urgent need to develop an effective vaccine to reduce its pandemic potential. In this study, we used a novel PELC/CpG adjuvant for recombinant H7HA (rH7HA) subunit vaccine development. After immunizing BALB/c mice intramuscularly, rH7HA proteins formulated in this adjuvant instead of an alum adjuvant elicited higher IgG, hemagglutination-inhibition, and virus neutralizing antibodies in sera; induced higher numbers of H7HA-specific IFN-γ-secreting T cells and antibody secreting cells in spleen; and provided improved protection against live virus challenges. Our results indicate that rH7HA proteins formulated in PELC/CpG adjuvant can induce potent anti-H7N9 immunity that may provide useful information for H7N9 subunit vaccine development.

Multi-subtype influenza virus-like particles incorporated with flagellin and granulocyte-macrophage colony-stimulating factor for vaccine design.

Virus-like particle (VLP) technology is an attractive platform for seasonal and pandemic influenza vaccine development. We previously showed that influenza VLPs can be modified using M2 fusion with molecular adjuvants such as Salmonella typhimurium flagellin (FliC) to enhance VLP immunogenicity. For this study, three types of chimeric VLPs were incorporated with FliC, granulocyte-macrophage colony-stimulating factor (GM-CSF), or both GM-CSF and FliC (GM-CSF/FliC) to enhance anti-influenza immunogenicity. Our results indicate that immunizations with the chimeric FliC VLPs and GM-CSF/FliC H5N1 VLPs elicited more potent and broadly neutralizing antibodies and neuraminidase-inhibiting antibodies in sera, and induced higher numbers of hemagglutinin-specific antibody-secreting cells and germinal center B cell subsets in splenoctyes. Immunization with the chimeric GM-CSF H5N1 VLPs induced stronger Th1 and Th2 cellular responses. The chimeric GM-CSF/FliC H5N1 VLP constructs were further obtained to include H7 or H1H7 bi- or tri-subtype. It is our hope that these findings provide useful information for developing multi-subtype influenza vaccines.

Design and evaluation of RFID deployments in a trauma resuscitation bay.

We examined configuring a radio frequency identification (RFID) equipment for the best object use detection in a trauma bay. Unlike prior work on RFID, we 1) optimized the accuracy of object use detection rather than just object detection; and 2) quantitatively assessed antenna placement while addressing issues specific to tag placement likely to occur in a trauma bay. Our design started with an analysis of the environment requirements and constraints. We designed several antenna setups with different number of components (RFID tags or antennas) and their orientations. Setups were evaluated under scenarios simulating a dynamic medical setting. We used three metrics with increasing complexity and bias: read rate, received signal strength indication distribution distance, and target application performance. Our experiments showed that antennas above the regions with high object density are most suitable for detecting object use. We explored tagging strategies for challenging objects so that sufficient readout rates are obtained for computing evaluation metrics. Among the metrics, distribution distance was correlated with target application performance, and also less biased and simpler to calculate, which made it an excellent metric for context-aware applications. We present experimental results obtained in the real trauma bay to validate our findings.

[Relationship between clinical characteristics of lung cancer patients regarding their occupational exposure].

OBJECTIVE: To study the relationship between clinical characteristics of lung cancer patients and their occupational exposure. METHODS: 2110 workers (≥ 20 years) who had been engaged in occupation that were exposed to risk factors of lung cancer, were asked to fill in questionnaires which included social demographic characteristics, length of service, smoking history and habits etc. 378 cases with lung cancer admitted in the Tangshan Worker's Hospital were selected and their clinical data including general information, symptoms or signs other than lungs, CT findings, histological type of the tumor, metastasis of tumors etc. were compared between the occupational exposure group and the control group. RESULTS: The rate of lung cancer was 29.43% (621/2110) among the workers with occupational exposure, and in men it was higher than in women (P > 0.05). There were significant differences seen in the rates of lung cancer with different age, smoking history/habits and years of employment among workers having had the histories of occupational exposure (P < 0.01). With CT findings, the rate of obstructive emphysema in the occupational exposure group (36.91%) was higher than in the control group (18.78%), (P < 0.01). Pathologically, squamous cell carcinoma (36.24%) appeared to be higher than it did in the control group (28.38%). The rate of pleural metastasis in the occupational exposure group was 14.09%, while it was 7.42% (P < 0.05) in the control group. CONCLUSION: People, having had occupational exposure, showed an association between the rate of lung cancer and factors as: excessive smoking, advanced age and long histories of occupational exposure. Squamous cell carcinoma with obstructive emphysema and pleural metastasis appeared to be dominantly seen.

Effects of bionic glue on experimental population dynamics of Paratrioza sinica and its natural enemies / 中国中药杂志

<p><b>OBJECTIVE</b>To find out whether and how the newly invented technique-bionic glue affects the main pest of wolf berry-Paratrioza sinica and its natural enemies Tamarixia lyciumi and Chrysopa septempunctata.</p><p><b>METHOD</b>Spraying bionic glue in field when wolf berry just geminated, investigated the adults and nymphs of P. sinica and it's natural enemies: adults of T. lyciumi and eggs of C. septempunctata.</p><p><b>RESULT AND CONCLUSION</b>Bionic glue can significantly reduce the population number of P. sinica, but with little impacts on its natural enemies of T. lyciumi and C. septempunctata, and more experiments are need for further research.</p>