Arteriovenous fistula stenosis developed in 32 patients who received hemodialysis from April 2014 to April 2016, including 24 cases of autologous arteriovenous fistula ( AVF) and 8 cases of artificial vessel arteriovenous fistula ( AVG).In AVF patients, there were 20 cases with blood flow decreasing and 4 cases of venous hypertension , while in AVG patients there were no cases with blood flow decreasing and 8 cases with venous pressure increasing (χ2 =17.77, P<0.001).All patients underwent percutaneous transluminal angioplasty ( PTA ) . In all patients the vascular diameter was increased significantly after PTA treatment [(3.6 ±0.2) vs.(1.2 ±0.1) mm, t=18.52, P<0.001].The blood flow during hemodialysis was increased significantly after PTA treatment in patients with anastomoti stenosis [(265.4 ±21.5) vs.( 150.5 ±23.1 ) ml/min, t =21.81, P <0.001 ]; however, there were no significant changes in venous pressure [(68.6 ±8.7) vs.(69.3 ±6.1) mmHg(1 mmHg=0.133 kPa), P>0.05].The blood pressure was decreased after PTA treatment [( 71.2 ±7.9 ) vs.( 170.4 ± 15.7) mmHg, t=34.62, P<0.001] in patients with venous outflowtract stenosis , however, there were no significant changes in the blood flow [(264.1 ±15.2) vs.(260.7 ±17.3) ml/min, t=1.04, P>0.05].

Tumor markers play an important role in tumor mass screening, diagnosis and differential diagnosis of tumor, tumor staging, therapeutic evaluation and prognosis assessment. According to the nature,tumor markers can be classified as follows: embryonic antigen, carbohydrate antigens, proteins, enzymes, hormones, and so on. And tumor markers have been used in clinical widely.

Objective To evaluate the diagnostic value of combined test of C-reactive protein,amylase and lipase for acute pan-creatitis patients in early stage,and its practicability in assessment of disease severity.Methods 71 cases of acute pancreatitis pa-tients in the hospital from March 2012 to March 2014 were enrolled in the study,including 60 cases of mild pancreatitis patients,11 cases of severe pancreatitis patients.Meanwhile,30 cases of non-acute pancreatitis patients were enrolled as Control Group A,and 50 cases of adults who underwent conventional examination and proved to be healthy were enrolled as Control Group B.Detection of C-reactive protein,amylase and lipase of these samples were performed and the results were recorded,compared and analyzed.Re-sults The serum amylase level of acute pancreatitis patients was (759.42±721.63)U/L,and serum lipase level were (1 624.34± 1 598.25)U/L,which were significantly higher than people in Control Group A and Control Group B,with statistical significance (P <0.05).However,C-reactive protein level of acute pancreatitis patients were (44.61±34.21)mg/L,which were not statistical-ly different compared with Control Group B.Combined test of the three indicators demonstrated that the sensitivity was 95.9%, specificity was 100% and accuracy was 96.9%,all of which were higher than other test combinations or singe test with statistical significance(P <0.05 ).Conclusion The combined test of C-reactive protein,amylase and lipase for acute pancreatitis patients doesn′t only improve early diagnostic efficiency,but also is helpful in disease severity judgment.

Objective To evaluate the effects of hypothermic cardiopulmouary bypass(CPB) on depth of anesthesia measured by BIS and auditory evoked potential index(AEPI) monitoring and cerebral O_2 and glucose metabolism. Methods Twenty-eight ASA Ⅱ-Ⅲ patients of both sexes(15 males, 13 females) aged 29-55 yrs undergoing elective cardiac valve replacement under hypothemic CPB were studied. Patients were excluded from the study if they had hearing disturbance, hepato-renal dysfunction, diabetes melhtus, hypertension, cerehro-vascular or mental diseases. The patients were premedicated with intramuscular morphine 0.15 mg?kg~(-1) and scopolamine 0.3mg. Anesthesia was induced with midazulam 0.05-0.1 mg?kg~(-1), fentanyl 10 ug?kg~(-1) and pancuronium 0.1 mg?kg~(-1) and maintained with intermittent ⅰ.ⅴ. boluses of fentanyl, diazepam and pancuronium. Radial artery was cannulated for BP monitoring and blood sampling. A CVP catheter was inserted into right internal jugular vein and advanced in a cephalad direction until jugular bulb for blood sampling. BP, HR, T℃(naso-pharyngeal), BIS and AEPI were continuously monitored during operation. Arterial and jugular bulb blood samples were obtained before CPB(T_1), T℃ was lowered to 33℃(T_2)during stable hypothermia(T_3) during rewarming at 33℃(T_4) and 30 min after termination of CPB(T_5) for blood gas analysis and determination of glucose and lactate concentrations. Cerebral oxygen extraction rate(O_2 ER) cerebral glucose extraction rate(GER), arterial-jugular bulb venous lactate difference(DLa-jv) and arterial-jugular bulb venous O_2 content difference (Ca-jvO_2) were calculated. Results Blood glucose and lactate concentrations were significantly increased, while arterial blood pH and DLa-jv did not change significantly during CPB. Cerebral oxygen extraction rate(O_2ER), cerebral glucose extraction rate(GER) and arterial-jugular bulb venous O_2 content difference (Ca-jvO_2) decreased while jugular bulb venous oxygen saturation (SjvO_2) increased with decreasing body temperature. BIS and AEPI values decreased with decreasing T℃ and both were well correlated with T℃. AEPI was positively correlated with O_2 ER and negatively correlated with Ca-jvO_2 whereas BIS was positively correlated with PaO_2. Conclusion Cerebral metabolism is decreased during hypothermic CPB which also deepens anesthetic depth measured by BIS and AEPI monitoring.

It analyzed the structure and details of disease-based score payment,taking payment policy scheme in Huai-an and Nanchang for example.Disease-based score payment combined the globe budget control,payment of disease and point system to help controlling costs and incentive mechanism,which had certain achievement in the pilot areas.According to the research,it found that there were insufficient in the practical implementation,proposed the precondition for the popularization were higher medical agency capacity,establishing the negotiation mechanism with medical institutions and having intelligentized information system as the technical support.

Objective To summarize the experience of diagnosis and treatment of lower gastrointestinal bleeding caused by small intestinal vascular malformation .Methods 12 patients with lower gastrointetinal bleeding caused by small intestinal vascular malformation were retrospectively reviewed.Results ⑴Repeated intermittent hematochezia were the most common cases in our date of lower gastrointestinal bleeding caused by small intestinal vascular malformation.⑵The most common course of disease was 2～3 years.⑶Bleeding was halted after operation in 100% cases and no one relapse.Conclusions ⑴Active bleeding period should be evaluated firstly by angiography and prepare to emergency operation.⑵By treatment combined with enteroscopy during operation could help to diagnose.⑶Surgical operation is the most effective treatment for bleeding of small intestinal vascular malformation.

Objective To investigate the clinical significance of quantitative detection of serum HBsAg.Methods Serum concentrations of HBsAg were detected by chemiluminescent microparticle immunoassay in 7612 hospitalized non-hepatitis patients.The distribution of HBsAg positive patients and the relationship of HBsAg concentration with serum anti.HBs.HBeAg and HBV DNA were analyzed.Results The HBsAg positive rate was 11.4%(870/7612)in this series.The serum HBsAg ranged from 0.08 U/mL to 125 000 U/mL with a median of 932.28 U/mL.No significant difference of HBsAg concentrations between male and female patients was observed(Z=-0.366,P＞0.05).1.There were negative correlation of HBsAg concentration with the age of patients(r=-0.370,P＜0.01),and positive correlations of HBsAg with HBeAg(r=0.654,P＜0.01)and HBV DNA levels(r=0.765,P＜0.01).Conclusion The quantitative determination of seFum HBsAg may be useful in estimating the hepatitis B viral replication and clearance.

Objective]To introduce professor YU Jingmao’s experience in treament of children with adenoid vegetation. [Methods]To select 3 effective cases of adenoid vegetation diseases, clarify professor YU Jingmao’s features of treatment based on syndrome differentiation, stage therapy and drug characteristics, and then analyze and expound the clinical experiences of professor Yu Jingmao. [Result]Professor YU Jingmao in infantile adenoid vegetation body therapy, treats in three stages:the early cure dispelling wind pathogens to clear heat reducing swelling;medium-term plans to raise Yin and moisture lung, promoting blood circulation to remove blood stasis;late to invigorate qi for consolidating superficies, nourish yin to clear away heat,often obtains better effect. [Conclussion]Professor YU Jingmao’s dialectical claim of in treatment of adenoid vegetation,stage therapeutics,purgation-tonifying and cultivste vital qi are worth learning.

Objective To investigate the diagnostic value of Lugol solution staining combined with nar-row band imaging (NBI)for esophageal cancer and precancerous lesions.Methods From December 201 3 to December 2014,1 87 patients who were with suspicious esophageal lesions and stained with Lugol solution under endoscopy were selected as control group,while from January 2015 to June 2015,124 patients who were with sus-picious esophageal lesions and examined with Lugol solution staining and NBI under endoscopy were selected as observation group.The sensitivity,specificity and accuracy between the two groups were compared and analyzed. Results One hundred and four cases (75.0%)were found among observation group,which was higher than 93 cases (55.6%)among control group (χ2 =12.07,P <0.01 ).The total detection rates of esophageal cancer and high grade intraepithelial neoplasia (HGN)were 29.0% and 17.7% in observation group respectively,which were higher than 1 8.2% and 6.4% in control group (χ2 =4.15,P =0.04;χ2 =8.54,P <0.01 ).The Kappa value in observation group was 0.55,which was higher than 0.36 in control group.The sensitivity and accuracy in observation group were 89.9% and 82.3% respectively,which were significantly higher than 71 .8% and 68.4% in control group (χ2 =9.79,P <0.01 ;χ2 =7.38,P <0.01 ).Conclusion The sensitivity and accuracy of endoscopic Lugol solution staining combined with NBI for esophageal cancer and precancerous lesions are higher than Lugol solution staining,and it is worthy to popularize the application of Lugol solution staining com-bined with NBI in diagnosing esophageal cancer and precancerous lesions.