Objective To explore the clinical diagnostic valve of serum soluble human leukocyte antigen‐G (sHLA‐G) in cervical cancer and precancerous lesion cervical intraepithelial neoplasia(CIN) .Methods The serum sHLA‐G level was detected by using ELISA and serum TA‐4 and SCC‐Ag levels were detected by using the light‐emitting electrochemical immunoassay method detec‐ting in 230 cases of cervical carcinoma ,120 cases of CIN and 30 healthy volunteers .The differences among various groups and their relationship with the clinicopathological features of cervical cancer were analyzed .Results (1) The comparison of serum sHLA‐G , TA‐4 and SCC‐Ag levels :there were statistically significant differences in serum sHLA‐G level among various groups (P=0 .000);the serum sHLA‐G level in the cervical cancer group was significantly higher than that in the healthy control group ,CIN Ⅰgroup , CIN Ⅱ group and CIN Ⅲ group (P=0 .000 ,P=0 .000 ,P=0 .002 ,P=0 .006);which in the CIN Ⅲ group was significantly higher than that in the CIN Ⅰ group and the healthy control group (P=0 .001 ,P=0 .021) .There were statistically significant differences in serum TA‐4 level among various groups (P=0 .006);the serum TA‐4 level in the cervical cancer group was significantly higher than that in the healthy control group ,CIN Ⅰ group and CIN Ⅱ group (P=0 .003 ,P=0 .008 ,P=0 .018);which in the CIN Ⅲgroup was significantly higher than that in the healthy control group and the CIN Ⅰ group (P=0 .023 ,P=0 .031) .The differences of serum SCC‐Ag level among various groups had statistically significant differences (P=0 .000);which in the cervical cancer group was significantly higher than that in the healthy control group ,CIN Ⅰ group and CIN Ⅱ group (P=0 .000 ,P=0 .001 ,P=0 .007) , and which in the CIN Ⅲ group was significantly higher than that in the healthy control group and the CIN Ⅰ group (P=0 .013 , P=0 .021) .(2) The relationship between serum sHLA‐G and pathological features of cervical cancer :the serum sHLA‐G level had no significant correlation with the age ,tumor size and pathological type (P>0 .05) ,while serum sHLA‐G was closely related with the FIGO stages and lymph node metastasis (P=0 .008 ,P=0 .031) .The serum sHLA‐G level in the FIGO stage Ⅲ and Ⅳ was significantly higher than that in the FIGO stageⅠ and Ⅱ (U=7 .125 ,P=0 .008) ,and which in the patients with lymph node me‐tastasis was significantly higher than that without lymph node metastasis (U=4 .651 ,P=0 .031) .Conclusion The detection of ser‐um sHLA‐G level can contribute to the early diagnosis and disease condition evaluation of cervical cancer and CIN Ⅲ ,thus which is likely to become a new indicator of early diagnosis of cervical cancer .But its specificity with the occurrence of cervical cancer and precancerous lesion remains to be further investigated by related research .

Objective To study the clinical significance of D‐D ,NT‐proBNP and serum lipoprotein(a) level in patients with acute ischemic stroke .Methods 150 cases of patients with acute ischemic stroke from March 2013 to March 2015 were selected as the observation group .And 50 cases of healthy physical examination were selected as control group .The levels of D‐D ,NT‐proBNP and serum lipoprotein(a) were detected in D groups .According to the nerve function defect score ,the three indexes were analyzed and studied .Results The D‐D polymer ,NT‐proBNP and serum lipoprotein(a) levels in the observation group were significantly higher than those in the control group ,the D groups were statistically significant(P<0 .05) .The levels of D‐D ,NT‐proBNP and serum lip‐oprotein(a) in the patients with severe were significantly higher than those in light and medium ,and the level of the three indexes increased gradually(P<0 .05) with the severity of the disease .Lacunar stroke with the D‐dimer ,NT‐proBNP and serum lipid pro‐tein(a) level was significantly higher than that in non lacunar group patients(P<0 .05) .Conclusion D‐D ,NT‐proBNP and serum lipoprotein(a) in the diagnosis of acute ischemic stroke patients are high clinical value ,it is worth popularizing widely .

Objective To explore the diagnostic value of serum creatine kinase isoenzyme MB (CM‐MB) and cardiac troponin I (cTnI) for myocardial injury in children with hand‐foot‐mouth disease (HFMD) .Methods A total of 80 children with HFMD (HFMD group) and 50 healthy children (control group) were enrolled from July 2012 to June 2013 .Serum levels of CK‐MB and cTnI were compared between the two groups .Results Serum levels of CK‐MB and cTnI were (38 .10 ± 19 .50)U/L and (0 .08 ± 0 .02)μg/L in HFMD group ,which were higher than control group (P<0 .05) .In HFMD group ,the positive rate of CK‐MB was 56 .3% ,higher than the 33 .8% of cTnI (P< 0 .05) .After therapy ,serum levels of CK‐MB and cTnI were both significantly de‐creased (P<0 .05) .Conclusion Combined detection of serum CK‐MB and cTnI might be with important significance for the early diagnosis of myocardial injury in children with HFMD .

Objective To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahcpatic portosystemic shunt (TIPS).Methods The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed.All of them were recurrent variceal bleeding secondary to portal vein hypertension,1 was bleeding secondary to primary hepatic carcinoma with port vein thrombns,and 1 was Budd-Chiari syndrome.They were followed-up after (10.1 ± 4.6) months (2.0 to 24.0 months).Stent-grafts patancy,portal vein pressure and liver function were recorded and compared.Results Twenty-five stent-grafts were successfully implanted in 21 patients,23 stent grafts were 8 mm 2 were 10 mm in diameter.The covered length of the stents varied from 6 to 8 cm.The bleeding was stopped and the portal vein pressure decreased significantly from (25.4 ± 3.5) mm Hg to (15.4 ± 2.8) mm Hg (t = 12.495,P < 0.01).During the follow-up period,The patient with primary HCC and portal vein thrombosis died 4 months after the procedure. One case had a new primary HCC during the follow-up and died 24 months after the procedure.One ease with variceal bleeding secondary to portal vein hypertension died of muhisystem organ failure.One case occluded in the hepatic vein and had another stcnt graft implanation.The other 17 cases had no stenosis after 7 to 17 months follow-up.Ultrasound showed that the stents were patent 1 week before the patients died.Three cases had transient symptoms of hepatic encephalopathy and recovered after treatment.The Child scores of the 19 patients survived more than 6 months were 6.3 ±1.4 before and 6.4 ± 1.9 after the procedure without significant difference (t = 0.645,P > 0.05).Conclusion The Fluency stent-grafts could increase the patency of the TIPS,but its efficacy on the long-term effect and hepatic encephalopathy need further investigation.

Objective To investigate the causes and managements of dys-seal syndrome (DSS) developed after esophageal stent placement. Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction. A total of 99 metallic stents were used. Of 98 patients. gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34. Results DSS occurred in 7 patients, with an occurrence rate of 7.14% ,which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site (X~2=0.017, 0.005, P=0.036, 0.013, respectively). After treatment, such as fasting, IPN or nasogastric feeding,only 1 case retumed to semi-liquid diet. Among the rest 6 cases of DSS, an additional stent was employed in one (but in vain), nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3. Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor. Removal of the inserted stent may be the optimal treatment. The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.

Objective To evaluate the conditions and risk factors of esophageal stent dys-seal phenomenon (ESDP) .Methods Ninety-eight patients with malignant esophageal obstruction underwent metallic stent placement and 7 patients with ESDP were analyzed.The possible contributing factors,including age,gender,obstruction segment,esophagorespiratory fistula,surgical intervention,radiotherapy,the degree of upper obstruction segment expansion,stent with bellmouth,application of covered stent were investigated.All factors mentioned above were analyzed with Logistic regression analysis.Results ESDP was observed in 7 patients (7/98,7.14%) and defined as a space between the esophageal wall and the proximal part of stent without contrast agent obstruction within stent.The clinical situations of patients with ESDP included dysphagia,bucking and constantly chest pain,especially at foodintake.The results of Logistic regression analysis indicated radiotherapy (P=0.005) and the degree of upper obstruction segment expansion (P=0.017) were significantly correlated with ESDP.Conclusion ESDP is one of the complications after esophageal stent placement.It is prudent to implant esophageal stent for those patients with radiotherapy and significant upper obstruction segment expansion.

Objective To evaluate percutaneous intratumoral injection of chemotherapeutic agents lipiodol emulsion (CALE) for the treatment of primary liver cancer. Methods This study included 57 patients of hepatocellular carcinoma (n=49) and intrahepatic cholangiocarcinoma (n=8).53 were male and 4 were female,with a mean age of 48.02 years(range,19～70 years).In all,ninety CALE injections were assigned to 90 target areas within the lesions.Before the procedures,transcathetcr arterial chemoembolization (n=55) or infusion (n=2) was carried out in these patients.By arteriography,low blood supply of target areas was showed or it was concluded that superselective catheterization of supply arteries of lesions could not accomplished.Percutaneous intratumoral CALE injection was carried out under fluoroscopy or CT guidance.Therapeutic effect,side effect and complications were assessed based on clinical manifestation,laboratory examination and fluoroscopy or CT one week after procedure.Follow-up was carried out after 1,3,6 months and 1 year,and once every six months thereafter.Local recurrences were treated according to patients'will.Results 90 sessions of percutaneous injection were successfully performed on 57 patients,with 100% technique success rate.The volume of CALE iniected per session ranged 3.0-7.0 ml(mean,6.0 ml) in target size less than 3 cm,12.0-20 ml(mean,15 ml)in target size of 3-5 cm and 24-40 ml in target larger than 5 cm.Serum AFP was positive in 43 patients and decreased to normal in 14 patients(28%).54 lesions(60%)were with well distribution of the lipiodol-chemotherapy mixture on CT 1 month after procedure.Follow-up ranged from 2 months to six years(mean,16 months).The median survival time was 400 d.The cumulative survival rates at 200 d,600d was 85%and 30%,respectively.Complications included fever (n=22,24.4%),nausea and vomit(n=11,12.2%),and pain at the puncture site (n=17,18.9%).Conclusions Percutaneous intratumor CALE injection is safe and effective for the treatment of primary liver cancer.