Objective To analyze clinical pathologic characteristics of patients with primary biliary cirrhosis autoimmune hepatitis overlap syndrome (PBC AIH OS),the incidence of extrahepatic autoimmune disease,malignant tumor and the abdominal lymph node enlargement.Methods From January 2000 to January 2012,the clinical data of 49 patients with PBC AIH OS were retrospectively analyzed,which included general information,clinical manifestations,biochemical parameters,immunological parameters,liver histopathological features,the incidence of extrahepatic autoimmune disease and malignant tumor,imaging findings and the efficacy.Results Among 49 PBC-AIH OS patients,the percentage of patients between 51 and 60 years old was 59.2％ (29/49),and the mean age of onset was (57.2±8.9) years old.Female was 83.7％ (41/49).The percentage of jaundice and pruritus in the main symptoms of initial visit was 42.9％ (21/49).The serum level of alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptadase (GGT) and total bilirubin (TBil) of 49 patients all increased.Among 31 patients who accepted IgA,IgG and IgM level test,the level of IgM increased in 58.1％ (18/31) of patients,and the level of IgG increased in 61.3％ (19/31) of patients.Ninety-eight percent of patients were antinuclear antibody (ANA) positive,6.1 ％ (3/49) were anti-smooth muscle antibody (SMA) positive,89.8％ (44/49) of patients were anti mitochondrial antibody (AMA) and or AMA-M2 positive.All patients had interface hepatitis.Forty-nine percent (24/49) of patients had both histological features of autoimmune hepatitis (AIH) and primary biliray cirrhosis (PBC).After being treated with ursodeoxycholic acid (UDCA) and immunosuppressant,the percentage of remission,incomplete response and failure was 65.3％ (32/49),26.5％ (13/49) and 8.2％ (4/49),respectively.After remission,five of six patients with medicine withdrawal relapsed.Among 49 patients,40.8％ (20/49) with extrahepatic autoimmune disease and the percentage of Sjogren's syndrome,autoimmune thyroid disease,interstitial pneumonia,systemic lupus erythematosus,psoriasis,sarcoidosis and membranous nephropathy was 16.3％ (8/49),12.2％ (6/49),4.1％ (2/49),2.0％ (1/49),2.0％ (1/49),2.0％ (1/49) and 2.0％ (1/49),respectively.Among 49 patients,14.3％ (7/49) with malignant tumor and the percentage of endometrial cancer,breast cancer,thyroid cancer and lymphoma was 4.1％ (2/49),4.1％ (2/49),4.1％ (2/49) and 2.0％ (1/ 49).Among 49 patients,abdominal ultrasound showed abnormality in 93.9％ (46/49) of patients.Abdominal lymph nodes enlargement was found in 91.8％ (45/49) of patients.Conclusions Autoimmune disease and malignant tumor should be screened when patients with PBC-AIH OS were assessed.Abdominal lymph nodes enlargement found by imaging examination may have guiding significance to the diagnosis.

Objective To evaluate the safety and efficacy of mechanical thrombectomy in treating in-stent restenosis of lower extremity arteriosclerosis obliterans. Methods From May 2015 to Sep 2016, the clinical data of 9 cases of lower extremity arteriosclerosis obliterans who were with in-stent restenosis(3 were stent graft)were retrospectively collected, and of which 7 were males and 2 were females with a mean age of (75.4 ± 6.3)years old. All the cases were treated by mechanical thrombectomy of Rotarex catheter. All the patients were diagnosed via low-extremity artery CTA, and treated by means of the Rotarex catheter, combined with angioplasty and stent if necessary. All patients received antiplatelet therapy. Doppler ultrasonography was taken during the followed-up. Results All the 9 cases were successed in technology, without complications in hospital. All patients received Rotarex mechanical thrombectomy. Six of which used balloon and 1 stent implanted. The ABI increased from 0.29 ± 0.07 to 0.88 ± 0.07 after treatment, the difference was statistically significant(t=28.875,P<0.05). All the patients were followed up for 3—18 (median time, 11.5)months. No death and symptoms recurrence appeared during the follow-up. Conclusions Mechanical thrombectomy using Rotarex catheter is a safe and effective treatment for in-stent restenosis in lower extremity arterial diseases.

Objective To explore the security and the short term efficacy of VIABAHN stents in the treatment of branching area lesions in lower extremity arterial diseases. Methods The data of 16 patients (11 male and 5 female, aged 59.0 to 81.0 with median of 71.6) with lower extremity arterial occlusive disease from November 2014 to June 2015 were analyzed retrospectively. All lesions were located around the branching area of the lower extremity artery (3 cases in the internal iliac artery orifice, 6 cases in the deep femoral artery orifice and 7 cases in the vascular net around the knee). The short?term effects on these patients in the follow-up period, such as the success rate of surgical technique, the improvement of symptoms and the incidence of complications were summarized. Results Revascularization was technically successful in all 16 patients, and ischemic symptoms relieved significantly after the operation. The ABI were 0.36±0.12 before and 0.89±0.10 after the operation. The patients were followed up for 3 to 9 months (median 5.5 months). All the patients were achieved limb salvage and no complication occurred. Conclusions VIABAHN stent is safe and effective for the treatment of lower extremity arterial occlusive disease. The branches around the lesion can be covered with VIABAHN stents.

Objective To investigate the image features of congenital pyriform sinus fistula (CPSF). Methods We retrospectively analyzed the clinical features and preoperative images of 80 patients with confirmed diagnosis of CPSF by surgical and pathological outcome in Guangdong general hospital from January 2007 to December 2014. At least one of the following imaging examinations were performed for all the patients, including Barium swallow X-ray (BSX), CT and MRI. Among them, 63 patients were examined with BSX, while 42 patients underwent plain and enhanced CT scans, wherein 40 of them were exanimated shortly after BSX. Thirty-two patients underwent plain and enhanced MRI scans. Patients were divided into two groups according to their age, young age group (≤14 years old) and older age group (>14 years old). Furthermore, they were also grouped based on inflammatory or quiescent stage clinically. The images of BSX, CT, and MRI from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests. Results For the patients examined with BSX, sinuses in 35 of 63 were depicted from pyriform and fistulas in 9 of 63 were depicted from the pyriform. The overall PDR of BSX was 74.6%(47/63),wherein 46.2%(12/26)in young age group , 94.6%(35/37)in older age group, 52.9%(9/17) in inflammatory stage group ,and 82.6%(38/46)in quiescent stage group. The inter-group differences were statistically significant (χ2 were 18.911 and 5.766,both P<0.05). The PDR of CPSF with CT was 85.7%(36/42), MRI was 84.4%(27/32), BSX+CT was 87.5%(35/40). The courses of fistula or sinus were showed on CT and MRI. The presence of air bubbles at the inferomedial edge of cricothyroid joints or around the upper lobe of the thyroid gland, the changes of the morphology of thyroid grand as well as the inflammatory change along the fistula region were detected much clearly on CT and MRI. There was no statistical difference between CT and MRI groups(P>0.05).Conclusions BSX could be a screening method for suspected cases of CPSF in quiescent stage. However, the PDR could be affected by many factors (age and inflammation). CT and MRI could provide valuable information for diagnosis. An examination combined BSX and CT is preferred to improve the positive detective rate of CPSF.

Objective: To investigate the effect of pituitrin-water separation on hemoglobin and ovarian function in laparoscopic ovarian chocolate cyst removal. Methods: From February 2018 to February 2019, 82 patients with ovarian chocolate cyst removed by laparoscopy were selected from the Second Affiliated Hospital of Wenzhou Medical University.They were randomly divided into observation group and control group according to the digital table, with 41 cases in each group.The control group underwent traditional laparoscopic tear-and-tear ovarian cyst removal, while the observation group underwent pituitrin-water separation.The changes of perioperative indicators, the decrease of hemoglobin (Hb) before and after operation, the positive rate of normal ovarian tissue on cyst wall and the number of normal follicles attached to cyst wall, the changes of serum hormone levels before and after operation were compared between the two groups. Results: The amount of bleeding during operation in the observation group [(58.97±8.74)mL] was less than that in the control group [(118.93±24.21)mL], and the operation time in the observation group[(57.46±8.27)min] was shorter than that in the control group [(87.38±10.19)min] , the differences were ststistically significant between the two group(t=14.916, 14.598, all P<0.05). There was no statistically significant difference in the time of anal exhaust between the two groups (P>0.05). The decrease of Hb in the observation group [(0.71±0.16)g/L] was lower than that in the control group [(1.27±0.35)g/L] (t=9.318, P<0.05). The positive rate of normal ovarian tissue on cyst wall in the observation group (21.95%) was lower than that in the control group (56.10%), the number of normal follicles attached to the cyst wall in the observation group (2.65±0.49) was less than that in the control group (4.86±1.24) , the differences were ststistically significant between the two group(χ²=10.045, t=10.613, all P<0.05). The serum level of E₂ [(398.21±17.84)pmol/L] in the observation group was higher than that in the control group [(367.83±15.21)pmol/L], while FSH [(6.72±0.28)mIU/mL] and LH [(5.23±0.38)mIU/mL] levels in the observation group were lower than those in the control group [(7.19±0.35)mIU/mL and (5.69±0.31)mIU/mL], the differences were ststistically significant between the two group (t=8.298, 6.714, 6.006, all P<0.05). Conclusion The method of pituitrin-water separation is effective in laparoscopic ovarian chocolate cyst removal, which can reduce the injury during operation, has little effect on hemoglobin and improve the ovarian reserve function of patients.

【Objective】 To explore the characteristics of esophageal motility and reflux of endoscopic-negative heartburn patients based on the Lyon Consensus Diagnostic Criteria and discuss the differential diagnosis value of the mean nocturnal baseline impedance （MNBI） and the postreflux swallow-induced peristaltic wave （PSPW） index for reflux hypersensitivity （RH） and functional heartburn （FH） patients. 【Methods】 We enrolled 132 patients with heartburn as the main symptom who visited the Gastroenterology Department of our hospital from January 2017 to June 2021， including 24 in the non-erosive reflux disease （NERD） group， 24 in the RH group， and 84 in the FH group. All the patients completed gastroscopy， esophageal high-resolution manometry and 24h-pH impedance monitoring. We analyzed and compared the related indexes of esophageal motility and reflux. The receiver operating characteristic （ROC） curve was used to analyze the esophageal proximal MNBI， distal MNBI， and PSPW indexes for the differential diagnosis of RH and FH. 【Results】 The lower esophageal sphincter （LES） average resting pressure， LES residual pressure and intact relaxation pressure （IRP） in NERD were lower than those in RH and FH （P<0.05）. The number of acid reflux， the upright acid exposure time （AET）， the supine position AET， the total AET， and the DeMeester score were higher in NERD than in RH and FH （P<0.05）. The non-acid reflux， distal MNBI and PSPW indexes were lower in NERD than in RH and FH （P<0.05）. The distal MNBI and PSPW indexes were lower in RH than in FH （P<0.05）. However， there was no significant difference in proximal MNBI among the three groups （P>0.05）. When the proximal MNBI， distal MNBI， and PSPW indexes were used alone respectively to diagnose RH， the area under the ROC curve was 0.480， 0.810， 0.682， respectively， with the sensitivities being 87.5%， 100% and 91.7%， and the specificities being 26.2%， 66.7% and 51.2%， respectively. 【Conclusion】 NERD patients have obvious abnormal esophageal dynamics， mainly manifested as LES relaxation， which further aggravates the pathological acid reflux， while patients with RH and FH are mainly exposed to physiological acid or non-acid reflux. In patients with endoscopic negative heartburn， distal MNBI value can improve the clinical diagnosis rate of RH and help distinguish RH from FH.

Objective: To investigate the feasibility of using a carbon dioxide(CO2) laser in the treatment of facial papilloma in children and to evaluate its curative effect and prognosis. Methods : A case of pediatric facial papilloma treated with a CO2 laser was reported, and the effects of this disease and CO2 laser treatment were reviewed and analyzed in combination with the literature. Results: Under general anesthesia, the lesion tissue of the left lip was excised for pathological biopsy, and the diagnosis was maxillofacial papilloma. The lesions were surgically ablated in stages with a CO2 laser, and erythromycin ointment was applied to the surgical incision after surgery. A total of three rounds of CO2 laser treatment were performed for 3 treatment courses. The child had no complications during or after the operation, the facial appearance was significantly improved, and there was no sign of recurrence during the 6-month follow-up. A literature review showed that CO2 lasers have been widely used in the excision of various surface lesions. In clinical practice, continuous CO2 laser with power of 10-50 W and wavelength of 10.6 μm is used to treat superficial tissue lesions, which can achieve accurate vaporization resection of diseased tissue, less bleeding and a good prognosis. Conclusion CO2 laser was accurate and minimally invasive for the removal of facial papilloma in children.