Objective To explore the short and long term curative effects of percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in the treatment of intrahepatic stone (IHS).Methods 38 IHS patients were enrolled,who were treated with PTCSL between January 2008 and July 2013.Results PTCSL was successfully completed in all the 38 IHS cases.Stone clearance rate was 84.2％ and the average episode of stone removal was (2.6 ± 0.9) times.Average diameter of percutaneous transhepatic fistula was (18.4 ± 0.6) F and the average time from percutaneous transhepatic puncture and fistulization to cholangioscopic lithotomy was (7.2 ± 0.7)d.The average operation time was (68 ± 20) min,intraoperative blood loss was (20 ± 13) ml,and hospitalization was (4 ± 2) days.The hepatolith recurrence rate in patients with stones completely removed was 37.5％ (12/32),and 1 case developed into biliary cirrhosis.Patients with calculi residual suffered from higher hepatolith recurrence rate of 83.8％ (5/6),with biliary cirrhosis found in 1 case.Conclusions PTCSL is safe and effective in treating primary IHS,which is indicated in multiple recurrent IHS especially in after biliary surgery patients.It has the advantages of minimally invasion,less bleeding,less postoperative pain,less complications,and fast postoperative recovery.

Objective To analyze the clinical characteristics of vasculitis associated with antineutrophil cytoplasmic antibody against myeloperoxidase (MPO-ANCA),and to investigate preliminarily the relationship between MPO-ANCA and the clinical damages.Methods One hundred and thirty-two patients with primary antineutrophil cytoplasmic antibody (ANCA) associated vasculitis,which were diagnosed for the first time,were involved into this prospective study.All the patients had positive laboratory tests for peri-nuclear ANCA (p-ANCA) and MPO-ANCA.The characteristics of their clinical presentations were analyzed.The levels of p-ANCA and MPO-ANCA in the peripheral blood were detected and the relationship between the levels and the damages were explored.T-test and Spearman rank correlation analysis were used for statistical analysis.Results Of the 132 patients from 8 different clinical departments,128 (97.0％) were microscopic polyangiitis (MPA),3 (2.3％) were granulomatosis with polyangiitis (GPA),and 1 (0.7％) was eosinophilic granulomatosis with polyangiitis (EGPA).The mean age was (62±15) years old.The average time between onset of the disease and diagnosis was (10 ±18) months,and only 14 (10.6％) were diagnosed within one month.Among the major organ involvements,the occurrence of renal,lung,joint,heart,peripheral nerve,skin,and central nerve involvement was 72.0％(95 cases),67.4％(89 cases),26.5％(35 cases),19.7％ (26 cases),17.4％(23 cases),10.6％(14 cases) and 9.8％(13 cases),respectively.Lung was more susceptible to be involved among the aged in their early course [(66±11) years,(55±19) years,t=-3.478,P＜0.01; (6±10) months,(18±27) months,t=2.920,P＜0.01],and joint involvement was more common in the younger [(57±18) years vs (64±13) years,t=2.335,P＜0.05] patients.p-ANCA had no relationship with the disease activity or the range of organ involvements(r=0.013,P＞0.05; r=0.087,P＞0.05).MPO-ANCA had a positive association with disease activity but had no significant correlation with the range of organ involvements(r=0.258,P＜0.01; r=0.022,P＞0.05).Conclusion The MPO-ANCA associated vasculitis is not rare in our country.MPA is the most common vasculitis which mainly affects the aged population,and its diagnosis is often delayed due to the lack of characteristic clinical presentations.It is possible that MPO-ANCA may play a pathogenic role in vasculitis,and the various clinical manifestations might be related with the specificities of MPO-ANCA.

Objective To evaluate the effects of right ventricular pressure load on left ventricular ( LV) myocardial mechanics using speckle tracking technology ,and to detect the change of LV function in patients with pulmonary hypertension( PH) at a earlier stage ,in order to provide reference for early clinical intervention . Methods The study included 74 patients with PH and 40 healthy volunteers ,who had of similar age and sex distribution . According to the pulmonary artery systolic pressure ( PASP) ,patients with PH were divided into mild ,moderate and severe groups ,which were marked with A ,B ,C , respectively . All subjects underwent echocardiographic examination . Conventional echocardiographic parameters ,the systolic longitudinal ,radial and circumferential peak strain ( LS ,RS ,CS) in various segments of LV ,as well as basal and apical segment myocardial rotation angle peak and peak time were determined ,LV systolic global longitudinal ,radial and circumferential strain (GLS ,GRS ,GCS) ,free wall (LAT ,lateral wall+ posterior wall) and interventricular septum ( IVS ,anteroseptal+ posteroseptal) overall LS ,RS ,CS were calculated . Results ①LVejectionfraction(LVEF):groupA,B,Chadnosignificantreduction(P>0.05)thanthe control group . ②Overall LS ,RS ,CS of LAT of LV and IVS and GLS ,GRS ,GCS of LV :B ,C group were lower than the control group and group A and C were lower than group B ( P < 0 .05) . ③ The rotation angle in ventricular apical basal segments and segment :group B and C were lower than the control group and group A and C were lower than group B ( P <0 .05) . ④GLS ,GRS ,GCS and overall LS ,RS ,CS of LAT and IVS were similar between group A and the control group( P >0 .05) ,but LV base segment rotation of groupAwaslowerthanthatofthecontrolgroup(P<0.05).Conclusions ①Rightventricularpressure overload can lead to increased LV mechanical damage ,LV strain changes were earlier than the change of LVEF . ②LV strain with increased right ventricular pressure overload is gradually reduced . ③Compared with other strain parameters , LV basal segments rotation angle were able to detect changes of LV myocardiol mechanics in patients with PH more sensitively .

Objective To analyze colonoscopic appearances,computed tomography (CT) imaging features and their correlation with postoperative pathology in patients with colorectal high grade intraepithelial neoplasia (HGIN) diagnosed by colonoscopic biopsy.Methods From October 2009 to October 2015,patients diagnosed as colorectal HGIN by colonoscopic biopsy who received endoscopic resection or operation,and had complete postoperative pathological data were enrolled.The results of CT imaging before operation,postoperative pathological type,the maximum diameter of lesions,sessile lesions or pedunculated lesions and enlarged lymph nodes were analyzed.Chi-square test were performed for statistical analysis.Sensitivity and specificity of CT imaging before operation in the detection of invasive colorectal cancer were calculated.Results Among the 76 patients,21.1％ (16/76) patients were HGIN,and 78.9％ (60/76) were invasive cancer confirmed by postoperative pathology.The incidence rate of invasive carcinoma in patients aged ≤50 years (3/14) was significantly lower than that of patients aged ＞50 years (91.9％,57/62),and the difference was statistically significant (x2 =30.05,P＜0.01).The incidence rate of invasive carcinoma in protruding lesions with maximum diameter ≥ 3.0 cm was 98.3％ (57/58),which was higher than that of lesions with maximum diameter ＜3.0 cm(2/16),and the difference was statistically significant (x2 =51.91,P＜0.01).The incidence rate of invasive carcinoma in pedicle polyps group (2/13) was lower than that of sessile lesions (93.4％,57/61),and the difference was statistically significant (x2 =35.72,P＜0.01).The sensitivity and specificity of CT in the diagnosis of invasive colorectal cancer was 95.0％ and 84.6％,respectively.The incidence rate of invasive carcinoma in patients with enlarged lymph nodes detected by CT (93.3 ％,42/45) was significantly higher than that of patients without enlarged lymph nodes (64.3％,18/28),and the difference was statistically significant (x2=9.95,P =0.002).Conclusions CT examination can compensate for the diagnostic deficiency of colonoscopic biopsy which inadequately diagnosed some invasive carcinoma as HGIN.The incidence of invasive cancer is high in patients with age over 50 years,large lesions,sessile lesions,CT indicating colorectal neoplasms and with enlarged lymph nodes.

Objective To evaluate the distribution of fetal abnormal chromosome karyotype in mid-pregnancy and analyse the possible misdiagnosis risks of molecular techniques in clinical prenatal diagnosis.Methods Fetal karyotype ( fetal cell collected from amniotic fluid ) in Prenatal Diagnosis Center of Zhejiang Province between 2001 and 2010 were retrospectively analyzed on distribution according to 7 different referral indication:positive screening for trisomy 21, trisomy 18, advanced maternal age , abnormal history of pregnancies , abnormal family history , fetal structural abnormalities and others.The combination of trisomy 21, trisomy 18 and trisomy 13 ( T21/18/13 Group) and the aneuploidies of chromosome 21, 18, 13, X, Y (21/18/13/X/Y Group) were further analyzed based on the current molecular target detection range.Results There were 462 cases out of 12 481 with chromosomal abnormality (3.60%, 462/12 841), with 215 cases of high risk (detection rate 1.67%, 215/12 841) and 247 cases of low risk (detection rate 1.92%, 247/12 841).Under different indications , the detection rate on abnormal chromosome of high risk (high-risk CA) is different,“abnormal fetal ultrasound” is the highest(27.27%,24/88).Among the high-risk CA, T21/18/13 Group accounted for 72.56%(156/215), while the 21/18/13/X/Y Group accounted for 94.88%(204/215).For the 7 regular indications , the high-risk CA distribute different;Except the T21/18/13 Group and 21/18/13/X/Y Group, the rates of other abnormal chromosome karyotype in the high risk CA were 0.28%( 2/719 )-12.5%( 11/88 ) and 0.06%( 4/6 915 )-1.14%( 1/88 ) according to different indication, respectively.Conclusions The distribution of abnormal karyotype were different under different referral indication;the detection power and possible misdiagnosis risks were varied under different indication for each molecular technique.It was suggested that doctors should select suitable molecular technique according to different clinical indications and each molecular method has its own limitations .

Objective To evaluate the left ventricular transmural mechanics changes of breast cancer patients between before and after anthracycline chemotherapy by two-dimensional speckle tracking imaging (2D-STI),and to predict early cardiotoxicity caused by anthracycline.Methods Forty-six breast cancer patients with postoperative anthracycline-based chemotherapy were recruited.Echocardiography were performed on all subjects before and at 1 ,3 and 6 anthracycline-based chemotherapeutic cycle.Global longitudinal strain(GLS),endocardial longitudinal strain(LS-endo),epicardial longitudinal strain(LS-epi), global radial strain (GRS),endocardial radial strain (RS-endo ),epicardial radial strain (RS-epi ),global circumferential strain (GCS),endocardial circumferential strain (CS-endo)and epicardial circumferential strain(CS-epi) were assessed by 2D-STI and transmural myocardial strain gradient-longitudinal strain (TMSG-LS),transmural myocardial strain gradient-radial strain(TMSG-RS),transmural myocardial strain gradient-circumferential strain(TMSG-CS)were calculated.Conventional echocardiographic parameters and strain-related parameters before and after chemotherapy were compared. The receiver operating characteristics(ROC)curve was performed to determine sensitivity and specifity of strain parameters for prediction value of cardiotoxicity induced by anthracycline chemotherapy.Results ①After the sixth cycle of anthracycline chemotherapy,9 patients (16.4%)had developed anthracycline-induced cardiotoxicity,and 37 patients (80.4%)did not meet the criteria for cardiotoxicity.② There were no significant differences in conventional echocardiography parameters between before and after chemotherapy (P > 0.05 ).Left ventricular ejection fraction (LVEF),fractional shortening (FS)and E/A significantly decreased,but E/e significantly increased after six cycles of chemotherapy (P < 0.05 ).③ When comparison with baseline cases,GLS,LS-endo,LS-epi,TMSG- LS,TMSG-RS decreased after 3,6 cycles of chemotherapy,GRS, RS-endo and RS-epi decreased after six cycles of chemotherapy,the difference was statistically significant (P <0.05 ).④ ROC curve results showed the value of TMSG-LS,LS-endo,GLS and LS-epi after three cycles of chemotherapy to detect of anthracycline-induced cardiotoxicity,the areas under the curve were TMSG-LS> LS-endo> GLS> LS-epi.Conclusions After three cycles of chemotherapy,the decreases of TMSG-LS,LS-endo,GLS and LS-epi preceded the change of LVEF and other strain parameters,TMSG-LS and LS-endo can accurately and early detect anthracycline chemotherapy-induced cardiotoxicity.

Objective To investigate the protective effect of Ebselen on mitochondrial damage and its influence to Cytochrome C expression and the neuronal apoptosis after spinal cord injury in rats. Methods Sixty adult SD rats were ran-domly divided into 5 groups (12 each group). Spinal cord injury model was made using Allen's method. Sham operation group received only laminectomy;SCI group received laminectomy and spinal trauma;Saline group received saline injection intraperitoneally (0.1%DMSO) after injury;methylprednisolone group received 30 mg/kg methylprednisolone injection intra-peritoneally, ebselen group received 10 mg/kg ebselen injection intraperitoneally. The malonaldehyde (MDA) and glutathi-one (GSH)level at the injured sites of the spinal cord were detected 24 hours after trauma, and the expression level of Cyto-chrome C was also observed. Finally, neuronal apoptosis was identified by TUNEL staining. Results MDA level in the Eb-selen group was significantly lower than that in the SCI group, and GSH level was significantly elevated in the Ebselen group compared with SCI group (P<0.01). Expression of Cytochrome C in Ebselen group was lower than that in SCI group shown by Western blot, and the neuronal apoptosis in Ebselen group reduced significantly too compared with SCI group (P<0.01). Conclusion Ebselen can alleviate peroxidation,prohibit expression of Cytochrome C and inhibit neuronal apoptosis,thus it shows a protective effect to experimental acute SCI.

Ferritin is a polymeric protein composed of different ferritin subunits to store iron in the human body.It is involved in maintaining iron balance inside and outside the cell.Iron balance is disrupted by internal and external factors after infection.Studies have shown that ferritin is significantly elevated during infection and may affect the prognosis of the disease.However, due to insufficient understanding of ferritin, the study on ferritin is rarely in the clinic.This article aims to review the relationship between serum ferritin and infection from the aspects of the ferritin cycle, iron disturbance during infection, prediction, and prognosis of serum ferritin in infectious diseases, and provide a reference for further research.

Cell-free hemoglobin refers to the rupture of erythrocyte membrane due to instability of erythrocyte membrane caused by various causes, and hemoglobin is released free in the plasma.High concentration of plasma cell-free hemoglobin can cause intracellulariron ion deposition, oxidative damage, damage of lung, kidney and other related tissue, and seriously affect the treatment and prognosis of patients with sepsis.Nuclear factor E2-related factor 2(NRF2) as an antioxidant cytokine at the same time, plays important roles in the process of adjusting the resistance to oxidative stress, but the mechanism is not thorough.This review summarized the sepsis cell-free hemoglobin production, metabolism, and the activation of NRF2 and antioxidant mechanisms, to provide reference for further research.

Objective To explore the practicability and safety of the application of Percutaneous Vertebroplasty puncture (PVP) needle as a saw guide in the Total En-bloc Spondylectomy (TES) of thoracic and lumbar tumor through single posterior approach.Methods From June 2017 to March 2018,four patients with thoracic and lumbar vertebral neoplasms were analyzed retrospectively.They included 2 males and 2 females,which aged 50-77 years with an average age of 63.75 years.There were 1 case of Tomita 5 grade T7 lymphoma,1 case of Tomita 3 grade T5 metastasis of lung cancer,1 case of Tomita 5 grade T9 metastasis of prostate cancer and 1 case of Tomita 4 grade L2 metastasis of renal cancer.The PVP needle combined with the modified "3-step" method was applied in TES for 4 cases through posterior approach.The operative time and intraoperative blood loss were recorded.The integrity of excised vertebra and postoperative complications were observed.The visual analogue score (VAS) was evaluated to assess the pain improvement.The ASIA classification was evaluated for the assessment of neurological function of thoracic vertebral tumor cases and the muscle strength grades was evaluated for the assessment of neurological function of lumbar vertebral tumor cases.Results In all 4 cases,the vertebra was removed entirely.The average operation time was 4.9 h (4.0-6.5 h)and average blood loss was 3 200 ml (800-9 000 ml).No pachymeninx injury,cerebrospinal fluid leakage,iatrogenic spinal cord injury or vascular injury occurred.During the surgery,the saw-cutting plane is firmly located in the intervertebral disc and no slippage of the cutting plane was observed.Postoperatively,the pain was significantly alleviated.The VAS score decreased to average 1.75 points (1-2 points) after surgery,average reduction of 5.75 points (5-7 points).The neurological deficit was not aggravated in all patients.The neurological improvement of one grade was observed in 3 patients.Two cases of thoracic vertebral tumor had a grade of ASIA classification improved from grade B to grade C.One case of lumbar vertebral tumor had a grade of lower limb muscle strength improved from grade 3 to grade 4.No recurrence of tumor was observed at average 8.1 months (3.5-12 months) followup and 1 case of bone metastasis of lung cancer had intermittent intercostal neuralgia.Conclusion It is feasible and safe to apply PVP puncture needle as a saw guide in TES of thoracic and lumbar tumor through single posterior approach,on the basis of this,the "3-step" intervertebral disc truncation technique is developed,which has good practicability and high safety.