Objective To understand the relationship between coagulation factors,inflammatory reaction and coronary heart disease(CHD) by analyzing the changes of fibrinogen (Fib), D-dimer (DD) ,C-reactive protein(CRP) and white blood cell (WBC) count. Methods The levels of Fib, DD, CRP and WBC were measured and compared in 91eases with CHD[ineluding 34 cases of acute myocar-dial infarction (AMI group),30 eases of unstable angina peetoris (UAP group) and 27 eases of stable angina peetoris (SAP group)] and 30 healthy controls (healthy control group). Results Plasma con-centrations of Fib, DD, CRP and WBC were the highest in AMI group, followed by those in UAP group,SAP group and healthy control group. There were statistical differences in the above parameters between AMI group and UAP group; so were between UAP group and SAP group. There was no sig-nificant difference between UAP group and healthy control group (P>0. 05). Conclusion The coagu-lation factors and inflammatory reaction are closely associated with occurrence and development of cor-onary heart disease. Four parameters (Fib,DD,CRP and WBC) can be used as adjuvant indicators of differentiating types of CHD and evaluating severity of disease.

Objective To investigate the correlation between recurrent spontaneous abortion and karyotype correlation,and provide reference for clinical diagnosis and treatment of spontaneous abortion.Methods 51 couples peripheral blood lymphocyte were collected and cultured from March 2010 to March 2013 in the region.Karyotype analysis were performed to observe the distribution of the rate of chromosomal abnormalities situation.Meanwhile the correlation between the number of abortions and chromosomes were compared.Results Among the 102 subjects,32 cases(31.37％)of them were found chromosomal abnormalities in RSA.The ratio of polymorphic mutation accounted for 56.25 ％ of the chromosome abnormality.accounting for 17.65 ％ the total.Which was significantly higher than other chromosomal abnormalities(P＜0.05).Among the RSA and chromosomal karyotype cases,females accounted for 68.75 ％,which was significantly higher than males (31.25 ％)(P＜0.05).46XY(Y≥18)has the highest incidence in chromosome polymorphism,accounting for 33.33 ％,while abortions accounting for 30.77 ％.RSA number and incidence of chromosomal abnormalities to miscarriages three times the highest rate of abnormal,accounting for 43.48％.Conclusion Chromosomal abnormalities is an important factor in recurrent spontaneous abortion.Recurrent abortion is not only related to the structure of chromosomes,but also has a certain relationship with the variation of chromosome polymorphism.

Objective To evaluate the diagnostic yield and the etiological accuracy of double balloon endoscopy and capsule endoscopy in patients with.Methods Seventy-three patients with OGIB received double balloon endoscopy.The route of enteroscopy could be either via mouth or via anus.Negative result of initial route was required afterwards for another via mouth or via anus examination.Sixty-one patients with OGIB received capsule endoscopy.Results The overall diagnostic yield for double balloon enteroscopy was 94.5%,and for capsule endoscopy it was 81.8%.The etiological diagnostic accuracy of double-balloon enteroscopy was 80.8%,and for capsule endoscopy,50.0%.Double-balloon enteroscopy and capsule endoscopy were both well tolerated.Conclusion Double balloon enteroscopy is superior to capsule endoscopy in the diagnostic yield and the etiological diagnosis of obscure gastrointestinal bleeding.

ObjectiveTo investigate the clinical value of transgastrie endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection.MethodsThe clinical data of 22 patients with pancreatic abscess or pancreatic cyst and infection who underwent transgastric puncture and drainage or transgastric debridement under the guidance of endoscopic ultrasonography (EUS) at the Xinqiao Hospital of Third Military Medical University from July 2008 to August 2011 were retrospectively analyzed.All patients were comfirmed with bacteria infection after liquid aspiration culture. Patients with pancreatic abscess underwent endoscopic transgastric debridement,and for patients with pancreatic cyst and infection,10 F double pigtail stent and 8.5 F nasal bile duct were placed for drainage.ResultsThe results of liquid aspiration culture confirmed that 2 patients were infected by staphylococcus aureus,3 by proteus mirabilis,4 by pseudomonas aeruginosa,4 by klebsiella and 9 by escherichia coli bacilli.The double pigtail stent and nasal bile duct were installed under EUS (16 patients) or duodenoscope (6 patients).The lesions of 9 patients with pancreatic abscess were healed after endoscopic transgastric debridement with an average period of (6.5 + 1.8 )weeks,and the lesions of 13 patients with pancreatic cyst and infection were healed after transgastric puncture and drainage under the guidance of EUS with an average period of ( 8.3 ± 2.1 ) weeks.All patients were followed up for 2 years,and no recurrence of pancreatic abscess or pancreatic cyst was observed.ConclusionThe effect of transgastric endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection is satisfactory.

Objective To investigate the effects of sperm DNA fragmentation (SDF)and sperm morphology on the fertilization and embryo development in ICSI.Methods SDF and sperm morphology were detected in the meanwhile of taking eggs in 1 45 ICSI treatment cycle.On the basis of SDF index (DFI)divided into group A (DFI≤30%)and group B (DFI >30%).According to the normal sperm morphology divided into group C (NMSR≥4%), group D (1 %≤NMSR <4%),group E (NMSR <1 %).According to the sperm DFI and NMSR divided into group F (DFI≤30% and NMSR≥4%)and group G (DFI >30% and NMSR <4%).Statistically analyzed ICSI outcome of research group:fertilization rate,embryo utilization rate,good quality embryo rate,implantation rate and clinical pregnancy rate.Results (1 )The normal fertilization rate,embryos utilization rate,good quality embryo rate,implan-tation rate in group A were significantly higher than those in group B (χ2 =6.96,8.95,5.49,3.92,all P <0.05), but clinical pregnancy rate had no significant difference (χ2 =1 .08,P >0.05).(2)The normal fertilization rate was statistically significant in group C,group D,group E (χ2 =34.5,65.8,11 .8,all P <0.05),but there were no significant differences in embryo utilization rate,good quality embryo rate,implantation rate and clinical pregnancy rate (P >0.05).(3 )The normal fertilization rate,embryo utilization rate,good quality embryo rate,implantation rate and clinical pregnancy rate in group F were significantly higher than those in group G,and normal fertilization rate,embryos utilization rate,good quality embryo rate had statistically significant differences (χ2 =37.5,1 1 .0,4.3,all P <0.05). Conclusion Sperm abnormal morphology has negative effect on fertilization,and the high DNA fragments have negative effects on fertilization and embryo development.

Objective To investigate the treatment outcome of modified intracytoplasmic sperm injection (ICSI)using zona pellucida(ZP)-bound sperm.Methods 82 patients with less,weak,abnormal sperm disease who were conformed to ICSI,were divided into traditional ICSI group and the group of modified ICSI using ZP-bound sperm according to ICSI case number.The results of normal fertilization rate,cleavage rate,high-quality embryo rate, planting rate,clinical pregnancy rate and early abortion rate were compared.Results The women's age,the sterility year,mature egg rate,normal fertilization rate,cleavage rate in the two groups had no statistically significant differ-ences (all P>0.05).The planting rate and clinical pregnancy rate of the observation group (46.6%,63.3%)were higher than those of the control group(38.5%,53.6%),but there were no statistically significant differences(all P>0.05).The using embryo rate and high-quality embryo rate of the observation group (73.9%,51.0%)were signifi-cantly higher than those of control group(65.8%,38.6%),the differences were statistically significant(χ2 =5.84,χ2 =11.6,all P<0.05).Conclusion Modified ICSI using ZP-bound sperm can effectively improve the embryos quality in ICSI.

Objective To evaluate the feasibility of endoscopic resection and closure for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.Methods Included in the study were 46 patients with gastric submucosal lesions originating from the muscularis propria layer, detected by gastroscopy and endoscopic ultrasonography.The lesions were removed by endoscopic resection and closure, which were further diagnosed as stromal tumor by means of pathologic and immunohistochemical examinations.The patients were followed up with endoscopy for evaluation of therapeutic effect and complications.Results All lesions were successfully removed, with serosa layer remained in 2 cases and full layer resection in other 44, which were all closed by endoscopic clips.Combination managements of acid suppression,gastrointestinal decompression and intravenous antibiotics were applied in all patients.Pathology reports confirmed complete resection of all lesions, with 0.5 to 3.7 cm in diameter.Normal diet was restored in 44 patients 48 ～ 72 h after the procedure.Pneumoperitoneum and focal peritonitis occurred in 2 cases, one of which underwent rupture and was clamped again.The 2 patients recovered after 10-12 days of conservative treatments.Follow-up endoscopy revealed white ulcerous scar in all cases.Conclusion Endoscopic resection and closure therapy is a safe, economic and less invasive treatment for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.

Objective To investigate the level change of interleukin-37(IL-37) and its clinical significance in the patients with chronic kidney disease(CKD) and nephrotic syndrome(NS) .Methods 57 cases of CKD (CKD group) and 13 cases of NS (NS group) in the Affiliated Donghua Hospital of Sun Yat-sen University from September to November 2016 were selected .The CKD group was redivided into the CKD stage 1 ,stage 3 and stage 5 groups .At the same time 22 individuals undergoing physical examina-tion were selected as the healthy control group .The ELISA sandwich method was adopted to detect the plasma IL-37 level .Then the detection results were statistically analyzed .Results The level of plasma IL-37 in the CKD group and NS group was significant-ly higher than that in the healthy control group ,the difference was statistically significant (P<0 .01);the level of plasma IL-37 had no statistical difference among the CKD stage 1 group ,CKD stage 3 group and CKD stage 5 group(P>0 .05);the plasma IL-37 lev-el after treatment in the CKD group and NS group was decreased compared with before treatment ,the difference was statistically significant(P<0 .01);the plasma IL-37 level in CKD patients was positively correlated with the WBC and lymphocyte cells levels . Conclusion The patients with CKD and NS have high level expression of plasma IL-37 ,which might have good auxiliary diagnostic value for CKD and NS .

Objective:To investigate the characteristics and influencing factors of esophageal stenosis after endoscopic submucosal dissection (ESD) for early esophageal carcinoma.Methods:Patients who underwent ESD in the Digestive Endoscopy Center of the Second Affiliated Hospital of Army Medical University from January 2011 to December 2018 were included. The data were obtained from medical records and follow-up. The influencing factors of stenosis were determined by single factor and Cox regression analysis.Results:A total of 654 patients underwent ESD and 79 (12.1%) of them developed postoperative esophageal stenosis. The median time of stenosis development was 27 (17, 43) days. The morphology and lesion circumferential proportion were independent factors for the occurrence of stenosis after ESD. The stenosis incidence of type Ⅱa was 6.601 times (95% CI: 1.518-28.709, P=0.012) compared with that of type Ⅱc. The incidence of stenosis in lesions with 75%-<100% and 100% circumference was 17.408 times (95% CI: 8.009-37.839, P<0.001)and 52.439 times (95% CI: 23.905-115.029, P<0.001) respectively compared with that of patients <75%. Among the 79 patients, 27 had severe stenosis, and the lesion circumferential proportion was an independent factor for stenosis. Compared with the group of lesion circumferential proportion of less than 75%, the incidences of stenosis of lesion circumferential proportion of 75%-<100% and 100% were 7.775 (95% CI: 1.977-30.577, P=0.003) and 70.062 (95% CI: 19.879-246.926, P<0.001) times respectively. Conclusion:The morphology and lesion circumferential proportion are two independent factors for the occurrence of esophageal stenosis after ESD. Additionally, lesion circumferential proportion is an independent factor for the occurrence of severe esophageal stenosis after ESD.

To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.