Objective To explore the clinical value of high frequency color doppler ultrasound in the diagnosis of lower limb artery pathological changes of diabetes.Methods Linear array of high frequency probe was used in regular line double lower limbs artery ultrasound examination in 102 cases with diabetes (observation group) and 98 healthy people(control group).The lower limb artery(including femoral artery,popliteal artery,posterior tibial artery,the tibia and dorsalis pedis artery)before the intima-media thickness (IMT)were measured,and the presence of plaque,the plaque nature,the degree of luminal stenosis or occlusion of the judgment and hemodynamic changes were observed.Results In observation group,the femoral artery plaque detection rate was 22％,popliteal artery plaque detection rate was 36％,posterior tibial artery plaque detection rate was 39％,pretibial artery plaque detection rate was 38％,dorsalis pedis artery plaque detection rate was 45％.In control group,the femoral artery plaque detection rate was 9％,popliteal artery plaque detection rate was 7％,posterior tibial artery plaque detection rate was 10％,pretibial artery plaque detection rate was 13％,dorsalis pedis artery plaque detection rate was 16％.In the observation group,lower limb artery plaque caused mild stenosis in 31 cases,moderate stenosis 16 cases,severe stenosis 11 cases,block 4 cases.In the control group,9 cases had mild stenosis caused by lower limb artery plaque,moderate stenosis 5 cases,3 cases with severe stenosis and occlusion in 0 case.In the observation group,lower limb artery soft spot 14,hard spots in 19,41 mixed plaques.In the control group,lower limb artery soft spot 4,hard spot 8,11 mixed plaques.Conclusion Lower limb artery pathological changes is closely related with diabetes,especially the artery stenosis and block the knee can predict the development of diabetes.

BACKGROUND:There are many methods for dental impression disinfection, including ultraviolet disinfection method, spraying, immerses disinfection method, argon plasma jet and radio frequency glow discharge on the argon gas ionization disinfection method. At present, there is stil lack of studies addressing the disinfection effect after gargling with mouthwash.
OBJECTIVE:To detect the kil ing effect on bacteria and fungi from the dental impressions, which are taken after gargling with cetylpyridinium chloride gargle and stable chlorine dioxide gargle, respectively.
METHODS:One hundred patients were randomly divided into cetylpyridinium chloride gargle group and stable chlorine dioxide gargle group. They were told to gargle with clean water for 1 minute, and then impressions were taken to remove the models with sterile cotton swab sampling in neutralizing agent which were sent to laboratory for bacteria and fungi culture. After 1 hour, the patients were asked to gargle with the different mouthwashes for 1 minute again, and then sterile cotton swab sampling was done at the same position for bacteria and fungi culture. The number of colonies was recorded, and the kil ing effects on kil ing bacteria and fungi on the surface of the impressions before and after gargling with different mouthwashes were observed.
RESULTS AND CONCLUSION:The number of bacteria and fungi before gargal had no significance difference before gargling. After gargling, the number of bacteria and fungi on the model was significantly lower than before (P<0.001). Two groups did not appear with any adverse reactions, and patients felt refreshed and comfortable after gargling with mouthwash. To gargle with mouthwash before taking impressions can control the number of bacteria and fungi on the samples effectively, thereby achieving the aim of control ing the mutual infections between the doctor and the patients effectively.

Roles of reference method in clinical biochemistry were introduced.Reference method is an important component of the reference system.Reference methods are primarily used for the establishment and assurance of the traceability of measurement results through calibrating and evaluating routine methods and assigning values to reference materials.Calibration biases and non-specificities of routine methods and the commutability of reference materials are the major issues in the standardization of clinical biochemistry.Standardization also requires availability of commutable reference materials.Reference methods are irreplaceable tools to identify the issues and to characterize reference materials.

Good patient care requires accurate and comparable laboratory test results. To achieve standardization, a reference system consisting of a hierarchal framework of validated and reliable analytical methods linked by reference materials must be in place. Supported by national and municipal research programs, construction of reference systems has been pursued and progress been made. Candidate reference methods have been set up or developed for some important tests, and the methods have been used in the calibration or evaluation of routine methods, study of commutability of control materials and characterization of reference materials. Phenomenal roles of reference systems are expected in diagnostic reagent manufacturing, internal quality assurance and external quality assessments.

In recent years, immune therapy for the treatment of cancer has made remarkable progress. The monoclonal antibodies of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) have shown considerable responses and good tolerance in the treatment of non-small cell lung cancer (NSCLC). In this review, we summarized the current clinical status and future direction of PD-1/PD-L1 in NSCLC.

Objective To explore the role of choledochofiberscopy in the diagnosis and treatment of biliary complication after orthotopic liver transplantation.Methods The patients with continuous biliary infection and obstructive jaundice in 6 cases subject to orthotopic liver transplantation were treated by choledochofiberscopy through T tube sinus tract. The findings from choledochofiberscope at different periods after operation were recorded.Results Three to five months after operation, there were a lot of flocs in the bile duct cavity under the choledochofiberscopy, and mucous membrane of bile duct was pale or coarse. On the postoperative month 6, 11 and 18, choledochofiberscopy revealed there were funicular, columned and brown biliary stones in bile duct cavity which mostly located in porta hepatis, and there existed stenosis in anastomotic stoma of bile duct to varying degrees; the wall of bile duct was coarse, with congestion of the mucous membrane. The flocs and stones could be extracted conveniently by the choledochofiberscope.Conclusion We can observe the transplanted liver’s bile duct through the T tube sinus tract by the choledochofiberscopy and treat the biliary complications conveniently.

specifications are essential for total quality management in laboratory medicine. A consensus among worldwide professionals has been achieved and a hierarchy of strategies for setting analytical quality specifications has been proposed based on their relevance to medical decision-making. Quality specifications derived from biological variations have been widely accepted because of their objectivity and practicability and have more and more been used in the quality management in laboratory medicine.

BACKGROUND: Complications, caused by bile duct injury after liver transplantation, are difficult for diagnosis and treatmerit and the bottlenecks for the development of liver transplantation. OBJECTIVE: To observe and record bile duct injury and do biopsy in parallel with treating biliary complications following liver transplantation successfully with choledochoscope, and to analyze the relationships between various bile duct injuries, histopathological types and biliary complications following liver transplantation. DESIGN, TIME AND SETTING: Case analysis was carried out at Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery. Dalian Friendship Hospital between July 2001 and October 2005. PARTICIPANTS: Nineteen patients after liver transplantation were divided into three groups according to the occurrence of biliary complications: four cases for normal group, twelve cases for bile duct injury group, three cases for hepatic artery miury group. METHODS: They were observed. diagnosed and recorded respectively and take biopsy for pathological analysis through the choledochoscope. With regard to the cases without T-tube. Choledochoscope combined duodenoscope were used to take biopsies. MAIN OUTCOME MEASURES: Choledochoscope was used to observe T-tube cholangiography, the appearances and pathological changes of intemal and external bile duct mucous membrane. healing of the donor-receptor bile duct stoma. Patients in the bile duct injury group were done examinations described above after endoscopic stone extraction and stenosis expansion. RESULTS: The intemal and extemal bile duct anatomy of the patients in the normal group were normal, without bile ductstenosis and scar, their bile duct mucous membrane lookcd good, and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Various kinds of bile duct stones, simple, multiple and casting mould stones, were found in patients of the bile duct injury group. Bile duct mucous membranes were injured at different degrees and repaired after removing stones and relieving obstruction by endoscope. Contrast examination demonstrated that bile duct tree regained normal. In hepatic artery injury group, patients had bile duct wall ischemic necrosis and lost bile duct normal structure, congestion was obvious, biliary sludge and stones completely filled in the bile duct tree. Interrupted bile duct structure were found in Ⅲ grade bile ducts.Pathological examination revealed extensive bile duct wall necrosis,indistinct strcture,more bile infiltration,proliferative granulation tissue and suppuration focus.CONCLUSION:Bile ducts are injured at different degrees in orthotopic liver transplantation;cold preservation/repeffusion injury is the most important initiating agent leading to bile duct tree injuries;the vessel plexus damage and microcirculatory disturbance surrounding the bile ducts maybe one of the mechanisms of the bile duct injury.

Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT.

Quality indicator is defined as the measure used to access the degree of inherent characteristics meeting the requirements .It is a powerful tool to improve laboratory quality to monitor and evaluate performance throughout critical steps in the total testing process .Targeted quality improvement can be obtained by quantizing quality levels in each phase when the quality indicators applied .Establishing and monitoring the quality indicators enables laboratory to compare over time between providers , and evaluate the effectiveness of delivered services and improving patient safety .