Objective To establish D-dimer normal reference range in pregnant and postpartum women in Zhejiang Han population.Methods Plasma samples were collected from 669 healthy pregnant women, 578 healthy postpartum women, 8 venous thrombosis or DIC patients and 80 healthy non-pregnant women in Women′s Hospital, School of Medicine, Zhejiang University from March 2009 to August 2010.According to different gestational week, postpartum days and delivery pattern, the healthy pregnant and postpartum women were stratified into 3 groups: (1) ≤13 weeks (n=120), 14-20 weeks (n=120), 21-27 weeks (n=145), 28-34 weeks (n=147), ≥35 weeks (n=137);(2) The first day after vaginal delivery (n=163), the second day after vaginal delivery (n=121);(3) The first day after cesarean sections (n=166), the second day after cesarean sections (n=128). These groups were further stratified based on age: ＜30 years old and ≥30 years old.All blood samples were drawn in citrate sodium anticoagulated blood.D-dimer concentration was determined by STA-R Evolution coagulation analyzer.Since D-dimer concentration showed non-normal distribution, the normal values (one-tailed) were established by using (P95) percentile method.The results of 8 patients were used to validate the established normal values.Results In the group of ＜30 years old, the D-dimer values[M(P25-P75)]in group of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks, ≥35 weeks and healthy non-pregnant women were 0.25(0.17-0.37), 0.51(0.38-0.75), 0.75(0.57-1.10), 1.14(0.80-1.48), 1.60(1.14-1.89) and 0.20(0.10-0.28) mg/L, respectively, which showed statistical difference(H=239.24, P＜0.05).In the group of ≥30 years old, the D-dimer values of the above different groups were 0.28(0.14-0.38), 0.50(0.36-0.65), 0.83(0.59-1.41), 0.93(0.68-1.37), 1.47(1.22-1.84) and 0.17(0.12-0.25) mg/L, respectively, which also showed statistical difference(H=127.75, P＜0.05).In the group of ＜30 years old, the D-dimer values were 2.45(1.51-3.77), 1.30(0.97-1.96), 2.68(1.52-3.74) and 1.55(1.10-2.10) on the first and second day after vaginal delivery and cesarean section, respectively, which showed statistical difference (H=64.85,P＜0.05).In the group of ≥30 years old, the corresponding values were 2.20(1.33-3.54), 1.33(1.02-2.14), 2.27(1.66-3.17) and 1.62(1.26-2.69), respectively, which also showed statistical difference(H=18.64, P＜0.05).D-dimer normal values were established based on different gestational week, postpartum days and delivery pattern.The normal values of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks and ≥35 weeks were ≤0.64 mg/L, ≤1.54 mg/L, ≤2.60 mg/L, ≤3.01 mg/L and ≤3.19 mg/L, respectively. The normal values of 1st day after vaginal delivery, 2nd day after vaginal delivery,1st day after cesarean sections and 2nd day after cesarean sections were ≤7.83 mg/L, ≤3.29 mg/L, ≤9.95 mg/L and ≤3.80 mg/L.All 8 patients showed positive results with the above normal values.Conclusion D-dimer normal values in pregnant and postpartum women in Zhejiang Han population are established, which can improve the application values of D-dimer in the pregnant and postpartum population.

Diabetes can affect structure and function of brain in several aspects, but diabetic cognitive impairment is often ignored. The pathogenesis of diabetes associated cognitive impairment is complicated. Factors such as glucotoxicity, lipotoxicity, insulin resistance, hypoglycaemia and disturbance of Ca2 homeostasis may play important roles. Besides conventional diabetes therapy, new methods still need to be explored.

Background:Prognosis of early colorectal carcinoma( ECC)is well because of low rate of lymph-node metastasis ( LNM). How to improve the detection rate and select appropriate therapy for ECC has been an eager task in clinical practice. Aims:To analyze the pathological features of ECC treated by endoscopic resection(ER)or surgery,and evaluate the therapeutic efficacy of ER. Methods:Pathological data of 503 ECC lesions treated by ER or surgery were retrospectively analyzed. Risk factors of infiltration depth,LNM of ECC were analyzed,and therapeutic efficacy of ER was evaluated. Results:The overall detection rate of ECC was 10. 7%. The incidence of LNM was 1. 2%(6/503);the LNM incidence of mucosal high-grade neoplasia was 0%( 0/247 ),while was 2. 3%( 6/256 ) in submucosal carcinoma. The LNM incidence of submucosal superficial carcinoma treated by ER was 0%( 0/31 ). Tumor location, size,histological type and LNM had significant impacts on infiltration depth(P<0. 05). The rates of en bloc,complete and curative resection by ER were 96. 0%,94. 2% and 82. 1%,respectively. Infiltration depth was the risk factor of piecemeal,incomplete and noncurative resection of ER(P<0. 05). Conclusions:The incidence of LNM in ECC is extremely low. Accurate evaluation of character and infiltration depth of lesion before operation is helpful for selecting appropriate therapy. It should be cautious to choose ER for lesions infiltrated into submucosa,thereby to improve the therapeutic efficacy of ER.

Objective To explore the relationship between the fundus vascular changes with the stage and risk stratification of essential hypertension(EH) and the cardiac function.Methods One hundred patients with EH in our hospital from April 2011 to March 2016 were selected and divided into the control group(n=29),Ⅰ-Ⅱ group(n=56) and Ⅲ-Ⅳ group(n=15) according to the Keith-Wagener fundus grading.The stage and risk stratification of EH (mild,moderate,severe),cardiac function indexes[left ventricular end-diastolic inner diameter (LVEDD),left ventricular wall thickness (LVPWT),interventricular septum thickness (LVST),left ventricular mass index (LVMI),carotid intima-media thickness (IMT),left ventricular ejection fraction (LVEF)] were compared among 3 groups.Results The proportions of mild hypertension in the control group,Ⅰ-Ⅱ group and Ⅲ-Ⅳ group were 55.17％,21.43％ and 6.67％ respectively,the proportions of moderate hypertension were 31.03％,30.36％ and 26.67 ％ respectively,which of severe hypertension were 13.79 ％,48.21 ％ and 66.67 ％ respectively,the differences were statistically significant(x2 =5.568,P=0.019).The cardiac indexes of LVEDD,LVPWT,etc.had statistical differences among the control group,Ⅰ-Ⅱ group and Ⅲ-Ⅳ group(P＜0.05).The fundus vascular changes were positively correlated with the stages and risk stratification of EH (r=0.742,P =0.002),while LVMI (r =0.674,P =0.028) and IMT (r =0.598,P =0.014) were negatively correlated with LVEF(r=-0.623,P=0.035).Conclusion The fundus vascular changes have close correlation with the stage and risk stratification of EH and cardiac function,which could be used as an important index for judging the hypertensive severity and target organ damage situation

Objective To sum up the experience of diagnosis and treatment of paraduodenal hernia. Methods The clinical data of 18 cases of paraduodenal hernia treated by surgery were analyzed retrospectively. Results The average age of the patients was 34 years old.There were 15 cases with left paraduodenal hernia and 3 cases with right paraduodenal hernia.Ten patients usually had no clinical symptoms,while acute abdominal pain occurred after full food in 7 cases,and after vigorous movement in 10 cases respectively.Abdominal X-ray revealed complete or incomplete intestinal obstruction in 16 cases,while abdominal CT revealed abnormal cystic loops of small intestine between the pancreas and the stomach in 10 cases.All 18 cases underwent surgical operation,recovered 10-15 days after operation.After 2-8 years follow-up,there was no hernia recurrence.Conclusion Paraduodenal her-nia is difficult to diagnosis before operation,and the key to correct diagnosis and treatment is to explore the positive exploratory laparotomy.

This study was aimed to evaluate the clinical effect of 66 yin-deficiency acne cases treated with body constitution adjustment using acupuncture and moxibustion. In this research, 66 acne patients with the body con-stitution of yin-deficiency were selected . These patients were randomly divided into two groups ( 33 every group ) . The acupuncture treatment group was treated by acupuncture and local treatment. And moxibustion treatment group was treated by indirect moxibustion and local treatment. The treatment was given twice a week. And the improvement condition of acne skin lesions and yin-deficiency body constitution were evaluated after 12-week treatment. The results showed that certain curative effects were received in both groups. However, the moxibustion treatment group had higher curative effect compared with the acupuncture treatment group. There were significant statistical differences between two groups ( P < 0 . 05 ) , which meant moxibustion with local treatment had a higher curative effect than acupuncture with local treatment to acne. In the aspect of skin lesion improvement, according to the statistics, the moxibustion treatment group were statistically significant compared with acupuncture group (P< 0.05), which meant more obvious improvement of skin in the moxibustion treatment group. In the aspect of body constitution, the body constitution scores in both groups were significantly declined and the moxibustion treatment group was more obvious. There was statistical significance between two groups (P < 0.05), which meant patients in the moxibustion treatment group obtained a more obvious body constitution improvement. After the treatment, follow-up was given to all patients for 4 weeks. The results showed that both the acne skin lesion con-dition and yin-deficiency body constitution score were decreased and not achieve the recurrence diagnostic stan-dard. It showed that acupuncture and moxibustion are able to activate the self-regulation and disease resistibility of the body. It was concluded that acupuncture and moxibustion not only improve skin lesion of acne patients with the body constitution of yin-deficiency with inner heat , but also regulate yin-deficiency body constitution . Moxibustion had higher efficacy in the treatment of yin-deficiency with inner heat acne than acupuncture.

Stromal preadipocytes from human omental adipose tissues were isolated with enzyme-digesting method,and cultured for inducing differentiation.Preadipocyte factor-1 was abundant during preadipoeyte stage,whereas lipoprotein lipase and PPARγ2 mRNA were rapidly up-regulated at early stage of differentiation and CCAAT/enhancer binding protein expression was increased rather late.In addition,resistin expression and secretion was primarily detectable in preadipocytes,leptin was gradually increased during adipogenesis,whereas adiponectin appeared specifically in mature adipocytes.Insulin-like growth factor-Ⅰ secretion was remarkably detected in both preadipocytes and mature adipocytes.

Objective To evaluate the value of multislice spiral computed tomography angiography (MSCTA) in differential diagnosis between epithelial ovarian carcinoma (EOC) and borderline epithelial ovarian tumor (BOT).Methods The MSCTA images of 39 EOC patients and 23 BOT patients confirmed by surgical pathology were reviewed retrospectively.Main characteristics of tumor vessels were analyzed: the number of feeding arteries, the existence of dilated draining veins, whether the tumor vessels were tortuous, whether the distribution of tumor vessels were disturbed, and whether there were accompanying microaneurysms or arteriovenous malformations (AVMs).Results Two or more feeding arteries of the EOCs and BOTs were 89.7% (35/39) and 8.7% (2/23), respectively.Dilated draining veins were observed in 87.2% (34/39) of the EOCs and 4.3% (1/23) of the BOTs.The tortuosity of tumor vessels was observed in 97.4% (38/39) of the EOCs and 13.0% (3/23) of the BOTs.79.5% (31/39) of the EOCs and 8.7% (2/23) of the BOTs were complicated by microaneurysms, and 74.4% (29/39) of the EOCs and 4.3% (1/23) of the BOTs were complicated by AVMs.The characteristics of tumor vessels were significantly different between the two groups (P<0.01), with relatively high sensitivity and specificity.Conclusion MSCTA can better show the distribution, number and pattern of tumor vessels and is of great value in differential diagnosis between EOC and BOT.

Objective:To discuss the surgical techniques and evaluate the clinical effects of laparoscopic varicocelectomy with testicular artery preservation.Methods:In this retrospective study, we collected clinical data of 97 patients with varicocele who underwent laparoscopic varicocelectomy from January 2015 to June 2020. All operations were performed by the same experienced urologist. Conventional laparoscopic varicocelectomy without testicular artery preservation was performed in earlier 35 patients (January 2015 to December 2016), which were taken as control group. The latter 62 patients (January 2017 to June 2020) underwent laparoscopic varicocelectomy with testicular artery preservation were taken as observational group. In observational group, average age was (21.9±6.7)years, there were 47 cases on the left side, 3 cases on the right side and 12 cases bilaterally, totaling 74 sides. There were 22 sides of varicose veinsⅠ, 28 sides of varicose veinsⅡand 24 sides of varicose veins Ⅲ. Clinical manifestations such as scrotal discomfort, pain and scrotal vein masses were observed on 35 sides (47.3%), infertility was observed in 24 cases (38.7%). Average sperm density was (23.7±5.9)×10 6/ml, average sperm motility (grade a+ b) was (33.9±4.1)%. In control group, average age was (23.7±4.6) years, there were 26 cases on the left side, 2 cases on the right side, 7 cases bilaterally, totaling 42 sides. There were 10 sides of varicose veinsⅠ, 17 sides of varicose veinsⅡ, 15 sides of varicose veinsⅢ. Clinical manifestations of scrotal discomfort, pain and scrotal vein masses were observed on 19 sides (45.2%), infertility was observed in 14 cases (40.0%). Average sperm density was (22.3±6.2)×10 6/ml, average sperm motility (grade a+ b) was (32.6±4.8)%.There was no significant statistical difference in preoperative clinical data between two groups ( P>0.05). The observational group followed the procedural steps of freeing the spermatic cord, isolating the testicular artery, and ligating the spermatic vein. The testicular artery was separated by the separating forceps and the electric hook, with the separating forceps holding the spermatic cord fascia in place and the electric hook (without electricity) bluntly separating the blood vessels and lymphatic vessels in the spermatic cord. The operative time, complications, recurrence rate, improvement rate of scrotal symptoms and semen quality, spontaneous pregnancy rate of spouses within 2 years in infertile patients were compared between the two groups. Results:The mean operative time in observational group was longer than control group [(35.8±7.7)min vs.(16.5±5.5)min, P<0.001]. Occurrence of postoperative acute epididymitis was lower in observational group compared to control group [1.4% (1 side) vs. 11.9% (5 sides), P<0.05] . No testicular atrophy (0 side) occurred in observational group, however, this complication could be found in 7.1% (3 sides) of control group ( P<0.05). Improvement rate of scrotal symptoms and semen quality was higher in observational group than that in control group after operations [77.1% (27 sides) vs. 47.4% (9 sides), P<0.05; and 72.6% (45 cases) vs.51.4% (18 cases), P<0.05]. The rates of spousal natural pregnancy within 2 years in infertile patients was higher in observational group than that in control group [70.8% (17 cases) vs. 50.0% (7 cases), P<0.05]. The rates of hydrocele and scrotal edema were similar in two groups [9.5% (7 sides) vs. 9.5 (4 sides)%, P>0.05], and the recurrence rate of varicocele was similar [8.1% (6 sides) vs. 7.1% (3 sides), P>0.05), without statistically significant difference. Conclusions:Using separating forcep and electronic hook can help to separate the testicular artery when performing laparoscopic varicocelectomy. In this operation, to preserve the testicular artery can get better effects an less complications.

Objective To study the clinical characteristics of the patients of GH-secreting pituitary adenoma with hyperprolactinaemia. Methods The clinical data of 124 cases of GH-secreting pituitary adenoma with hyperprolactinaemia treated in Peking Union Medical College Hospital from 1984 to 2004, including 87 cases followed up for over one year , were analyzed retrospectively. Results Of 124 patients, there are 88 females and 36 males and the course of disease in males (8.0?7.3) years was longer than that in females (5.5?4.3)years (P