Objective:To explore the diagnostic value and correlation of serum tumor markers combined detection of pancreatic cancer. Methods:Selected January 2013 to may 2016 in our hospital in patients with pancreatic cancer in 146 cases,128 cases of non pancreatic cancer with patients and 124 cases of healthy physical examination. Radiation immunity analyzer test groups of serum CA19-9,CA242,CA50,CA125,CEA and TSGF levels and compared between groups. To draw the working characteristic curve(ROC) to analyze the diagnostic value of tumor markers in patients with pancreatic cancer and the correlation of linear correlation analysis of tumor markers. Analysis of independent risk factors for pancreatic cancer using multiple logistic regression models. Results: The pancreatic cancer group of serum CA19-9,CA242,CA50,CA125,CEA and TSGF levels were significantly higher than the control group and non pancreatic cancer group,the differences were statistically significant(P<0. 05 or P<0. 01).Ⅳstage andⅢstage with patients of serum CA19-9,CA242,CA50,CA125 and TSGF levels were significantly higher than Ⅰstage and Ⅱstage with patients(P<0. 01).Ⅳ stage with patients of serum CA19-9, CA242, CA125 and CEA levels were significantly higher than Ⅲ stage with patients ( P<0. 01). The pancreatic cancer group of serum CA19-9,CA242,CA50,CA125,CEA and TSGF of positive rate were significantly higher than that of control group and non pancreatic cancer group(P<0. 01). ROC curves showed that the AUC of serum CA19-9 were higher than other single indexes,the best critical value,sensitivity and specificity were 114. 5 U/ml,81. 2% and 79. 3% respectively. The diagnostic efficacy of the six joint detection were better than the single detection,the sensitivity and specificity were 92. 4% and 76. 5%respectively. Correlation analysis showed that serum CA19-9 were positively correlated with CA242,CA50 and CA125(r=0. 703,P=0. 005;r=0. 572,P=0. 024;r=0. 439,P=0. 036). Multiple logistic regression analysis showed that smoking,incorrect diet,history of diabetes,gallbladder disease history and high levels of CA19-9,CA242,CEA into the regression model,the OR value and 95%CI were 1. 717(0. 736 to 2. 359),2. 865(2. 217 to 3. 685),2. 614(2. 186 to 3. 127),3. 527(2. 842 to 4. 377),4. 214(3. 570 to 4. 962), 2. 315(2. 114 to 2. 539),1. 876(1. 175 to 2. 852). Conclusion: Serum tumor markers combined detection can help to improve the accuracy of early diagnosis of pancreatic cancer and smoking,incorrect diet habits,history of diabetes,biliary disease history and high levels of CA19-9,CA242 and CEA are independent risk factors for pancreatic cancer.

Objective To observe the feasibility of laryngeal mask ventilation general anesthesia com- bined epidural block in laparoseopie eholecystectomy. Methods One hundred and forty eases of selective laparoscopie eholecystectomy were performed to T8～T9 gap catheterization, with 1.5 percent lidoeaine epi- dural block, block levels in the following T4. After conventional anesthesia into 4# or 5# LMA, balloon gas was injected in 20 mL～30 mL, manual ventilation, respiratory resistance and the situation thorax ups and downs were observed. Results The patients epidural catheterization smoothly, in the anesthesia plane fol- lowing T4, insert the LMA blood pressure, heart rate without significant change. Pneumoperitoneum after the rebound in blood pressure[(20.6 5.0) mm Hg], heart rate did not change significantly, and then airway pressure increased[(5.7 1.6)cm H2O] , surgery performed smoothly, and quickly regained consciousness after the surgery, when all patients admitted gallbladder, they have resumed breathing independently. Con- dusion Laryngeal Mask Airway general anesthesia combined epidural block cause mechanical damage vocal cords and airway, make the stress response light and the sense of rapid recovery, which is a safe and feasible method of anesthesia.

ObjectiveTo investigate the changes of hepatitis B sarfaceantigen (HBsAg) titer in hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogs and pegylated interferon alfa-2a (PEG IFNα-2a) sequential therapy.Methods Among 6 HBeAg positive CHB patients,3 patients were treated with nucleos(t)ide analogs followed by PEG IFNα-2a for 48 weeks,3 patients were treated with nucleos(t)ide analog monotherapy.The serum HBsAg,anti-HBs,HBeAg,anti-HBe andanti-HBcweredetectedusingthetime-resolved immunofluorometric assay and serum hepatitis B virus (HBV) DNA levels were determined by Taqman polymerase chain reaction (PCR) every 12 weeks.Results HBsAg loss were achieved in three patients after 48-week nucleos(t)ide analogs and PEG IFNα-2a sequential therapy.However,the HBsAg titers of another 3 patients varied from 100 IU/mL to 320 IU/mL.ConclusionIn HBeAg positive CHB patients who obtain virologic response accompanied with HBsAg titer decreasing dramatically by nucleos(t) ide analog treatment,PEG IFNα-2a sequential treatment can increase HBsAg clearance rate.

Objective To explore the value of helical computed tomography (CT) in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thicked gallbladder cancer (GBC).Methods The CT signs of 18 XGCs and 20 wall-thicked GBCs were retrospectively analyzed.The maximum thickness of gallbladder wall, intramural hypoattenuated nodules, mucosal line of gallbladder inner wall,patterns of enhancement of thickened wall,whether combined with stones,the pericholecystic adjacent liver tissue involvement and biliary tract obstruction were observed.Measurement data were analyzed by independent sample t test and count date were analyzed by Fisher precisely the probability method.Results The mean maximum thickness of the gallbladder wall of XGC and wall-thicked GBC was (22.11±10.19) mm and (20.55±7.94) mm respectively,and there was no statistical significance (t=0.530,P=0.600).Eighteen cases of XGC and five cases of wall- thicked GBC patients were with intramural hypoattenuated nodules (Fisher precisely the probability method,P＜0.01 ),14 cases of XGC and six cases of GBC were with integrated mucosal line (Fisher precisely the probability method,P =0.004 ),three cases of XGC and 12 cases of GBC were with biliary tract obstruction (Fisher precisely the probability method,P=0.009).There was no statistical significance in the CT signs of the range of wall thickness,patterns of enhancement and enhanced degree of thickened wall,adjacent liver tissue involvement, lymphadenopathy, combined with gallbladder or bile duct stone between XGC and wall-thicked GBC patients (Fisher precisely the probability method,all P ＞ 0.05).Conclusions The thickened gallbladder wall with intramural hypoattenuated nodules and integrated gallbladder inner wall mucosal line were characteristic signs for diagnosing XGC.Helical CT scanning can provide evidence for differential diagnosis in XGC and wall- thicked GBC.

Objective To investigate the influences of survivin down-regulation on cell G2/M phase arrest,apeptosis and sensitivity to carbon ion irradiation. Methods Small interfering RNA (siRNA) targeting survivin mRNA was designed, in vitro chemo-synthesized and transfected into SMMC-7721 cells. Survivin mRNA expression in SMMC-7721 cells was measured by real-time PCR, and the apeptotic rates by Annexin-FTTC at 24 and 48 h after transfection. Cell G2/M phase arrest after transfection was assessed with flow eytometry as well. Cellular sensitivity to high-LET carbon ions was determined by means of colony-forming assay. Results The expressions of survivin at mRNA level were down-regulated to be 59% and 39% in relation to the non-treated cells at 24 and 48 h after siRNA transfeetion, respectively. G2/M phase arrest in SMMC-7721 cells at 24 h after transfection was observed while much more obvious at 48 h. The apeptotic rate of SMMC-7721 cells was 21.41 % at48 h after survivin siRNA transfection, which was significantly higher than that of the cells transfected with negative siRNA. Moreover, a decreased clonogenic survival in siRNA treated group was shown. Conclusion Down-regulation of survivin gene expression in SMMC-7721 cells by siRNA could effectively induce cell apeptosis and G2/M phase arrest, and enhance the cellular radiosensitivity to high-LET heavy ions.

Objective:To analyze the changes of serum lipidomics in patients with sepsis and healthy controls, search for the differences of lipid metabolites, and reveal the changes of lipidomics in the process of sepsis.Methods:A prospective observational study was conducted. From September 2019 to April 2020, morning blood samples of upper extremity superficial veins were collected from 30 patients with definite sepsis diagnosed in intensive care unit (ICU) of Shanxi Bethune Hospital and 30 age-matched healthy subjects during the same period. Serum lipid metabolites were analyzed by ultra-high performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS/MS), and the quality control samples were analyzed by base peak spectroscopy (BPC) and verified experimental repetition. Student t-test and fold change (FC) were used for screening significant differences in lipid metabolites and determining their expression changes. Principal component analysis (PCA) and orthogonal projectionto latent structure discriminant analysis (OPLS-DA) were used to determine the entire allocation of experimental groups apiece, access the quality of being near to the true value of model, and screen the differential lipid metabolites with variable importance of projection (VIP). Finally, Metabo Analyst platform database was used to analyze lipid molecular metabolic pathways. Results:BPC results showed that the experimental repeatability was good and the experimental data was reliable. The main parameter model interpretation rate of PCA model R 2X = 0.511, indicating that the model was reliable. The main parameter model interpretation rate of OPLS-DA model R 2Y = 0.954, Q 2 = 0.913, indicating that the model was stable and reliable. With FC > 2.0 or FC < 0.5, P < 0.05, a total of 72 differential lipid metabolites were obtained based on VIP > 1. Based on Metabo Analyst 5.0, 24 distinguishable lipid metabolites were identified including 8 phosphatidylethanolamine (PE), 7 lysophosphatidylcholine (LPC), 6 phosphatidylcholine (PC), 2 lysophosphatidylethanolamine (LPE) and 1 phosphatidylserine (PS). Compared with healthy volunteers, the lipid molecules expression proved down-regulated in most sepsis patients, including PC, LPC, LPE, and some PE, while some PE and PS were up-regulated, which was mainly related to the PE (18∶0p/20∶4), PC (16∶0/16∶0) and LPC (18∶1) metabolic pathways in glycerophospholipids. Conclusions:There are significant differences in lipid metabolites between the sera of sepsis patients and healthy volunteers. PE (18∶0p/20∶4), PC (16∶0/16∶0) and LPC (18∶1) may be new targets for sepsis prediction and intervention.

To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)

0.05). 100% occlusion was achieved in 18 patients with cerebral aneurysms by using embolization. Conclusion 3D DSA may improve the accuracy in diagnosing SAH and in showing clearly the stereo conformation of aneurysm and the relationship of sac and parent artery. It is helpful in the evaluation and guidance of embolization of cerebral aneurysms.

Objective To explore the correlation between platelet function and immunity index in patients with sepsis. Methods The platelet function and immune indexes of one hundred and one patients with sepsis treated in Shanxi Dayi Hospital from July 1st, 2016 to October 31st, 2017 were analyzed retrospectively. According to their shock,they were divided into shock group (34 cases) and non shock group (67 cases). Another 50 healthy people in the same period in our hospital were selected as control group. The relationship between platelet function and immune indexes was compared. Results ( 1) the incidence of maximum blood block intensity decreased in the thrombus map of the septic shock group was higher than that in the non shock group, and the difference was statistically significant ( 65. 67%( 44/67 ) vs. 23. 53%(8/34),χ2＝41. 28,P＜0. 05); (2) the CD4+T lymphocyte and C3 in the septic shock group were all lower than those in the non shock group ((47. 28%±7. 78) vs. (54. 93%±11. 26),t＝3. 554,P＜0. 05; (0. 42 ±0. 23) g/L vs. (0. 75±0. 19) g/L,t＝－3. 057,P＜0. 05),the ratio of CD4+/CD8+T lymphocyte was higher than that in non shock group ((2. 68±0. 18) vs. (2. 45±0. 07),t＝7. 18,P＜0. 001)). (3) the maximum intensity of blood clots was correlated with the percentage of CD4+T lymphocyte,CD4+/CD8+T lymphocyte ratio,complement C3,acute physiology and chronic health status score system II score,and sequential organ failure score ( r ＝ 0. 617, 0. 411, 0. 563,－ 0. 631,－ 0. 547, P＜ 0. 01, or P＜ 0. 05 ) . Conclusion Thrombocytopenia is present in septic patients,which is correlated with changes in immune indices.

Objective:To evaluate the prognostic value of thromboelastography maximum amplitude(MA)and arterial blood lactate levels for sepsis in elderly patients.Methods:A retrospective analysis was performed on clinical data of 63 sepsis patients(≥60 years old)admitted to the Intensive Care Unit(ICU)of Bethune Hospital of Shanxi Province from December 2018 to February 2020.MA values, white blood cell counts, lymphocyte counts, platelets, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores, sequential organ failure assessment(SOFA)scores, underlying diseases, body mass index, laboratory test results and other related treatments were analyzed.The subjects were divided into the survival group and the death group according to the 28-day survival outcome.Differences in MA, APACHE Ⅱ scores, SOFA scores and laboratory test results between the two groups were analyzed, and the correlations of MA with infection parameters and age were examined.Influencing factors of survival outcomes were analyzed using multivariate Logistic regression.The receiver operating characteristic curve(ROC)was used to calculate the prognostic value of MA and arterial lactate for sepsis in elderly patients.Results:The main sources of infections were pulmonary and abdominal(79.4%, 50/63)in 63 elderly patients with sepsis.The incidences of positive blood cultures and deaths were 15.9%(10/63)and 66.7%(42/63), respectively.There existed significant differences in lymphocyte counts, arterial lactate levels, MA and lengths of stay in the ICU between the survival group and the death group( t=3.847, 2.153, 2.745, -3.574, respectively, all P<0.05).MA was correlated with arterial lactate, SOFA score and survival outcome( r=-0.498, -0.506, and -0.358, respectively, all P<0.05).Multivariate Logistic regression analysis showed that MA and arterial lactate were independent factors for the survival outcome( OR=1.626, 0.766, all P<0.05).The area under the ROC curve(AUC, 95% CI)for the combination of MA and arterial lactate was larger than that of either MA or arterial lactate alone(0.89, range: 0.763-0.846; 0.58, range: 0.574-0.730; 0.77, range: 0.521-0.832; all P<0.05). Conclusions:The combination of thromboelastography maximum amplitude and lactate in arterial blood has important clinical value in assessing the prognosis of elderly patients with sepsis.