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Objective To investigate the cause of elevation of bile amylase level in patients with normal pancreaticobiliary junction and the effect of endoscopic treatment. Methods The clinical data of 96 patients with normal pancreaticobi-liary junction who had laparoscopic cholecystectomy from January 2016 to December 2019 were retrospectively analyzed. Gallbladder bile was gotten before gallbladder resection and the amylase in bile was measured. Duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic pancreaticobiliary separation (EPBS) and bile duct amylase (BDA) was done in some cases. Results Gallbladder bile amylase (GBA) in all 96 cases was (484.2±200.0) U/L. Sixty-two cases had duodenoscopy. Diagnoses was as follows: long nipple: 7 cases; papillary atrophy: 5 cases; parapapillary diverticulum: 4 cases; papillary tumor: 3 cases; papillitis: 2 cases; parapapillary diverticulum and papillitis: 26 cases; parapapillary diverticulum and long nipple: 8 cases; long nipple and papillitis: 4 cases; parapapillary diverticulum and papillary atrophy: 3 cases. Fifty-nine cases had ERCP among whom 45 cases had elevated level of BDA[(386.9±137.3) U/L] higher than normal (110 U/L), but lower than GBA [(466.3±189.4) U/L] with significant difference (t=2.276, P=0.025). EPBS was performed in all 45 cases and ERCP was performed again one month later. BDA returned to normal [(65.9±13.6) U/L] with significant difference before EPBS and after (P

Axial compression tests and corresponding finite element analysis were conducted on the basis of material property tests. It was shown that the failure mode of long column with a low width-thickness ratio is global instability, while the failure mode of short column with a high width-thickness ratio is that small bending deformation appeared firstly at the center of the column, then the deformation developed with the gradually increasing load and caused local buckling in the end. The results of finite element analysis can fit well with the test results, which means the feasibility and accuracy can be achieved by using this residual stress model into finite element analysis to simulate the axial compression behavior of cold-formed thick-walled steel members. Then, the finite element model was used based on the collected 26 groups of material properties of different tubes with representative size and thickness to get the axial bearing capacity data of members, and design reliability analysis of cold-formed thick-walled steel members under axial compression was conducted. Finally, the resistance partial factor and the design strength for Q235 and Q345 cold-formed thick-walled steel were proposed for the reference in current revising of related design codes. [ABSTRACT FROM AUTHOR]

In order to investigate the cold-forming effect on the yield strength of cold-formed thick-walled steel sections over 6. 0 mm thick, four cold-formed steel rectangular hollow sections with representative size and thickness were selected to investigate the material properties of different parts of the sections. Meanwhile, existing data of material property tests and short column tests were collected. The modifying formula for yield strength considering cold-forming effect based on different codes in the world were summarized, and the calculation results from those formulas were compared with the test results. It is shown that cold-forming has a strong influence on the yield strength of cold-formed thick-walled steel sections, and it depends greatly on the width to thickness ratio of each plate of the sections. The calculation results of Chinese code, AISI ( American Iron and Steel Institute) standard, Australian/New Zealand standard and the formula proposed by Zhu Aizhu are in conservatively agreement with the test results, while that of Eurocode is a little larger. The suitability of the improved method from Chinese Code was theoretically proved, and it can get a little safer results with a lower coefficient of variation, which means appropriate to be used in practice. [ABSTRACT FROM AUTHOR]

Objective: County-level hospitals, as medical and health centers in the counties, are mainly responsible for providing medical care for common and frequently-occurring diseases as well as rescuing acute critical patients. In 2018, editors of the Chinese Journal of Emergency Medicine evaluated the current situation of the emergency departments of county-level hospitals and found an unbalanced, inadequate, irregular, and unstable status existed among them. In order to provide developmental principles and constructional goals for the emergency departments of county-level hospitals, which located in different regions and with uneven foundations, Emergency Medical Branch of Chinese Medical Association particularly formulated this expert consensus. It not only suits for county-level general hospitals but also offers reference to the traditional Chinese medicine hospitals and specialized hospitals. The consensus includes: duties and scope of the emergency department, flow layout, equipment configuration and technology, job setting and staffing, management of emergency department, information construction and centralized construction. Construction specifications are divided into basic standards and recommended standards. The terms in the text are basic standards, and recommendations are improvements on basic standards. The basic standards are mainly suitable for the 2 Grade general hospitals, and the recommended standards mainly for 3 Grade general hospitals.

Objective: To explore the prevention and treatment of complications for full-covered self-expanding removable metal stents (FCSERMS) in malignant obstructive jaundice., Methods: The clinical data were analyzed retrospectively for 45 cases undergoing endoscopic biliary FCSERMS drainage for malignant obstructive jaundice from May 2012 to March 2014., Results: Among them, 45 cases were successful one time. The parameters of liver function improved significantly with a jaundice efficiency of 91.1%. There were 4 dead cases. Among 19 cases of early complications, hyperamylasemia (n = 8), acute mild pancreatitis (n = 4), acute cholecystitis (n = 2) and hemobilia (n = 1) recovered after conservative treatments. Acute suppurative cholecystitis (n = 2) and acute obstructive suppurative cholangitis (n = 2) were cured by percutaneous transhepatic cholangial drainage (PTCD) and percutaneous transhepatic gallbladder drainage (PTGBD). And late complications of obstructive jaundice (n = 3), acute suppurative cholecystitis (n = 4), acute cholangitis (n = 2), hepatophyma (n = 2) and acute pancreatitis (n = 1) were cured by endoscopic retrograde cholangiopancreatography (ERCP), PTCD and PTGBD., Conclusion: Various complications are associated with FCSERMS in malignant obstructive jaundice.However, positive and effective prevention and proper treatment reduce the incidence of complications.