Objective To evaluate the safety,middle or short -term effect and indication of the endovascular treatment for ischemic stroke patients with extracranial carotid stenosis.Methods The clinical datas with percutaneous transluminal angioplasty and stenting for extracranial carotid artery stenosis cases were retrospectively reviewed,from which 106 cases with ischemic stroke in the past were selected for study.And theinformation including operation opportunity,operation experience,serious complications such as cerebral hemorrhage and secondary ischemic stroke were summarized.Their clinical features,methods of treatment and prognosis were analyzed specially.Results The placement of 106 cases with 120 stents was satisfaction.Cerebral hemorrhage occurred in 3 cases while thrombosis fol-lowing stent placement in 2 cases,hypotension and bradycardia in 6 cases,vasospasm in 11 cases,gastrointestinal stress bleeding in 1 case,restenosis occurred in 8 cases and no cerebral infarction occurred after operation.Apart from one case of death cerebral hemorrhage,8 cases of restenosis,the,middle or short -term results of the remaining 97 patients were satisfactory.83 cases were followed up for 3 months to 5years,there were no ischemic attack and cerebral infarction occurred.Conclusion The satisfactory effect and safety are achieved in the therapy of carotid stenosis by percutaneous transluminal angioplasty and stenting.Angioplasty and stenting may improve the cerebral hemodynamics of patients with severe /moderate internal carotid artery stenosis.It is suitable for previous ischemic stroke patients.We must be individualized to more carefully assess these patientsˊsurgical risk,strictly adhere to the indications of surgery,and general measures is the key of preventing the complications during the perioperative period.

Objective To study the significance of antikeratin antibodies(AKA) in rheumatoid arthritis(RA). Method Serum samples of 98 patients with RA and 70 rheumatic disease controls were tested by indirect immunofluorescence assay.The diagnostic specificity and sensitivity of AKA were compared with rheumatoid factor(RF). The features of clinical manifestation and lab findings were compared in patients with RA who were positive for AKA with ones who were negative.Results The positive rate of AKA in RA patients was significantly higher than that in rheumatic disease controls.AKA showed a diagnostic specificity of 97.1%, higher than RF.RA patients who were positive for AKA had more active disease as assessed based on clinical, laboratory tests,and radiological variables, as compared with AKA negative patients. Conclusion AKA showes high disease specificity and has prognostic significance in patients with RA.

Objective To investigate the curative effects of laparocopic treatment for cystiduodenal internal fistula. Methods All procedures were conducted under laparoscope. After the exposure of the cholecystic base, trans-cholecystic cholangiography was performed to detect the relations between the cholecyst and neighboring organs. Once the internal fistula was confirmed, the orifice of fistula was closed laparoscopically. Then abdominal drainage, gastrointestinal decompression, and administration of somatostatin were routinely employed. Results In a series of 327 cases of laparoscopic cholecystectomy (LC) with intraoperative cholangiography, a total of 6 cases of cystiduodenal internal fistula were detected, all of which were anatomized and closed successfully under laparoscope. No postoperative hemorrhage or duodenal bile leakage occurred. Conclusions Routine intraoperative cholangiography during LC is beneficial to the detection of the cystiduodenal internal fistula.Effective and reliable management rests upon skillful laparoscopic techniques of dissection and fistula closure, as well as the supportive treatment.

The incidence of thyroid carcinoma is associated with a variety of factors.Radiation is the clear risk factor,the relationship between iodine intake and thyroid carcinoma remains controversial.Researches show that the genetic and epigenetic changes of many signaling pathways are the key of molecular pathogenetic mechanism of thyroid carcinoma.In addition,thyroid stimulating hormone,body mass index and chronic lymphocytic thyroiditis are also associated with thyroid carcinoma.

0.05)indicating no significant loss of correction.The length of the growth of instrumented spine was 13.3 mm.No sever complications in the series. Conclusion The PRSS which dispenses without bony fusion is a safe and an effective instrumen for management of juvenile scoliosis.It provides and maintains desirable scoliosis correction in one stage procedure,while allowing spinal growth.

In pregnant women,positive rate of thyroid peroxidase antibody(TPOAb) is approximately 3%~10%.It is still controversial whether thyroid antibody positive rate is higher in women undergoing artificial assistant reproductive technologies.TAI might have a negative effect on pregnant outcome,which has been proved in different groups of women.Intravenous immunoglobulin,thyroxin replacement therapy and selenium therapy have been used for TAI intervention.More evidence is needed to demonstrate mechanism and evaluate effect for each therapy.

Objective To investigate the efficacy of dermabrasion combined with aminolevulinic acid-based photodynamic therapy (ALA-PDT) for the treatment of nasal nodular basal cell carcinoma (nBCC).Methods Twentyfive patients who were pathologically diagnosed as nasal nBCC with lesion area ＞ 1 cm2 but no bone or cartilage involvement,were included in this study and treated with dermabrasion combined with ALA-PDT.At first,the part of tumor protruding outside the skin was removed by artherectomy,then dermabrasion was carried out.The wound surface was topically treated with 20％ aminolevulinic acid solution for 3-4 hours away from light immediately after surgery,then irradiated with LED light at a mean dose of 100 J/cm2 for 20 minutes.ALA-PDT was performed once a week for 3 consecutive weeks.The degree of and time required for wound healing were assessed,and tumor recurrence,cicatrization and appearance outcomes were observed during 1 year after surgery.Efficacy was assessed comprehensively.Results No postoperative wound infection occurred in these patients,and the average time for wound healing was (11.2 ± 1.3) days.During 1 year after the treatment,no recurrence was found,while cicatricial contracture developed in 1 case,mild proliferative scar in 3 cases,and depressed scar in 4 cases.All the patients were satisfied with the treatment outcomes,except 1 patient who was basically satisfied.Conclusions Dermabrasion combined with ALA-PDT is easy to operate with rapid wound healing,low postoperative recurrence rate and high degree of patient satisfaction,and is worthy of clinical promotion.

ObjectiveTo observe the dynamic changes of blood perfusion and hypoxic status by CT perfusion imaging and hypoxia imaging in patients with non-small cell lung cancer (NSCLC) after treatment with recombinant human endostatin (RHES). MethodsA total 15 patients with NSCLC were randomly divided into treatment group (n = 10) and control group (n = 5). The patients in treatment group continuouly received the treatment with RHES (7.5 mg/m2) by intravenous infusion for ten days, and CT perfusion imaging and hypoxia imaging were performed at day 1, 5 and 10,respectively. The time window' was observed with the blood perfusion status and hypoxic changes.ResultsIn the treatment group, capillary permeability surface (PS) and tumor to normal tissue (T/N) were firstly decreased, and then increased. Their lowest points occurred at about the fifth day. PS showed statistical significance compared with the first day (q1.5 = 12.05, P＜0.01 ) and no significance compared with the tenth day(q10.5 = 2.79, P=0.69), while T/N showed a significant difference between above time points (q1.5 = 73.81, q10.5 = 20.6, P = 0.00).Blood flow (BF) was firstly increased, and then decreased.Its highest point appeared at about the fifth day with statistical significance compared with the first and tenth day (q1.5 = 12.29, q10.5 = 10.48, P＜0.01 ). All the PS,BF and T/N between the fifth day in treatment group and the control group showed statistically significance (all P ＜ 0.01 ).Conclusions The time window of recombinant human endostatin improving blood perfusion and hypoxic status in non-small cell lung cancer is within about one week after administration.

Objective To investigate the effect of sufentanil and midazolam assisted epidural anesthesia for cholecystectomy on sedative effects,visceral pulling reaction and the functions of respiratory and circulatory system.MethodsFourty patients underwent cholecystectomy received informed consent, were randomly allocated to two groups:group A and group B( n =20 each). When the level of epidural block is appropriate,auxiliary medicine infusion was given 5min before the skin incision. In group A,first injection was sufentanil 0. lμg · kg-1 and midazolam 0. 02mg · kg-1 in 1-2 min, then continuous infusion of sufentanil and midazolam was given at the rate of 0. 2μg ·kg-1 · h-1 and 0. 04μg · kg-1 · h-1 respectively,and the infusion was stopped at the time of wound closure. Group B received slow intravenous injection of pethidine 1mg · kg-1 and droperidol 0. 5mg · kg-1. We recorded the differences of SBP、DBP、SpO2 、HR、Ransay score and visceral pulling reaction classification. Results SBP、DBP、HR after anesthesis,were decreased in different degree in the above groups,but there was no statistically significant difference( P ＞0. 05). According to Ramsay score,in group A there were 3 cases in grade Ⅱ、8 cases in Ⅲ and 9 cases in Ⅳ ,while in group B there were respectively 4 cases in Ⅱ、13 cases in Ⅲ and 3 cases inⅣ. By comparision,the differences had statistical significance ( u = 3.75, P ＜ 0. 05 ); Group A according to visceral pulling reaction classification (0- Ⅲ ), were 9 cases in grade 0,9 cases in Ⅰ , 1 cases in Ⅱ and 1 cases in Ⅲ, while in group B there were respectively 4,5,7 and 4 cases. By comparision, the differences had statistical significance(u = 4. 01,P ＜ 0. 01 ). Conclusion In the cholecystectomy,sufentanil and midazolam assisted epidural anesthesia,could improve the level of sedation ,prevent visceral pulling reaction ,and had a minor interference to respiratory and circulatory function.

Objective To explore the diagnostic significance of anti-cyclic citrullinated peptide antibody(anti-CCP)and the role it plays in the articular erosion in patients with rheumatoid arthritis(RA).Methods The diagnostic significance of anti-CCP?AKA and RF were evaluated respectively.Seventy-five RA patients were devided into group1(limited radiographic damage group)and group2(severe radiographic damage group).The distribution of anti-CCP,AKA and RF in patients of the two groups were investigated.A univariate analysis was used to determine whether anti-CCP?AKA?RF?ANA?ESR?CRP or cutaneous nodules plays a role on articular erosion in RA.To determine which has the best predictive value for severe radiographic da-mage,all variables were entered into a logistic regression model.Results The sensitivity and specificity of an-ti-CCP?AKA and RF were49%,94%;50%,93%;79%,67%respectively.When any two markers were combined,the specificity would be raised.The positive rate of these three markers were much higher in group2than that in group1.Anti-CCP had the highest OR(6.71)for articular erosion in RA.Logistic regression analysis showed a strong correlation between anti-CCP,AKA,CRP or cutaneous nodules and less favourable disease outcomes.Cut.aneous nodules had the strongest correlation with severe radiographic damage.Conclusion Anti-CCP is a satisfactory marker for RA.Diagnostic accuracy appears to be raised when anti-CCP combined with AKA and RF.Anti-CCP has a strong correlation with severe radiographic damage.To investigate multiple risk factors of articular erosion will be helpful to pridict the outcome of RA.