Objective:To discuss the application of water-aided colonoscopy in the enteroscopy, and compare with traditional air insufflations colonoscopy so as to analyze the efficacy and safety of clinical enteroscopy.Methods: 248 patients accepted with non-anesthesia colonoscopy were enrolled in this study and they were divided into two groups (water-aided group,n=124, air insufflations group,n=124) as the random number table. All clinical data of two groups were collected, and the bowel preparation statuses of patients was evaluated when the colonoscopes were taken out. During detection, the success rate of intubation, the entrance time of colonoscope, the withdrawal time of colonoscope and the total time of examinations were recorded. After detection, the pains score of patients were recorded and evaluated, and a series of auxiliary operation in the process, such as the change of body position, abdominal compression and the adjustment for hardness were recorded. Results: The differences of bowel preparation status scores of left colon, transverse colon, right colon and the whole colon between two groups were not statistically significant(t=0.98,t=0.85,t=1.07,t=1.51;P>0.05). The difference of success rate of intubation between two groups was no significant(x2=0.73,P>0.05). The entrance time, the withdrawal time of colonoscope and the total time of intubation of water-aided group were significantly higher than these of air insufflations group, while the VAS of water-aided group was significantly lower than that of air insufflations group(t=5.78,t=3.85,t=5.64, t=10.25;P<0.05). Besides, there were no significant differences in the usage rates of abdominal compression, hardness adjustment and total usage rate of auxiliary operation between two groups(t=0.92,t=1.58, t=2.07;P>0.05).Conclusion: The water-aided colonoscopy can relieve pain of patients, and it doesn't affect the success rate of intubation for cecum.

Objective:To analyze the clinical efficacy of POEM treating patient with achalasia of cardia and observe the risk factor of effecting curative efficacy.Methods: 66 patients with achalasia of cardia who were treated by using POEM were enrolled in this study, and series of indicators of esophagus dynamics including LESRP, LESP, LESRR and LESL were detected in pre and post operation. Clinical symptom score system(Eckardt score) of achalasia of cardia was adopted to evaluate the effect of surgical treatment for patients at the pre and post operation 7d, and the diameter of widest part of esophagus at pre and post operation 7d were detected. The incidence rate of pneumoderm, substernal ache, pulmonary infection, pleural effusion, tunnel bleeding, postoperative reflux and esophageal perforation and other complications were analyzed and the relative risk factors of effecting curative effect were observed.Results: The LESRP and LESP of patients with achalasia of cardia of post-operative 7d were significantly lower than that of pre-operative 7d(t=12.74,t=17.56,P<0.05), while the LESRR and LESL of post operative 7d were significantly higher than that of pre-operative 7d(t=9.10,t=14.86,P<0.05) , respectively. And the Eckardt score and widest diameter of post-operative 7d were significantly lower than that of pre-operation(t=19.49, t=7.83,P<0.05), respectively. Besides, the incidence rate of complication of patients in post-operation was 48.48％. As the results of Logistic regression, age, Chicago type and Ling type were the risk factors that affect curative effect of POEM for achalasia of chardia. And as the analysis, the prognosis was better when the patient's age was less than 60 years, Chicago II type and Ling type.Conclusion: POEM can significantly improve the indicators of esophagus dynamics, and the complication will be few and the curative effect will be exact in middle and short term of post-operation by using this method. Therefore, it is a safe and effective surgical mode.

Objective To investigate the effect of psychological intervention, combined with Concentrated Tinidazole Gargles on dental plaque and gingivitis inflammation and influence factor of life quality in elder patients. Methods The control group was given Concentrated Tinidazole Gargles treatment, the research group was given psychological intervention on the basis of Concentrated Tinidazole Gargles (as control group). Plaque index, gingivitis index and SF-36 scale changes before and after treatment were recorded between two groups of elderly patients with gingivitis. Results There was no significant difference in plaque index, gingival indexand SF-36 score compared with before treatment between two groups; Plaque index, gingivitis index and the SF-36 score were improved in the research group better than the control group after treatment (P<0.05). Conclusion There is positive significance in improving the clinical efficacy of Concentrated Tinidazole Gargles plus psychological intervention and assurance of the quality of life on gingivitis in elder patients.

Objective To explore the influence of maternal free position combined with duole tools during the first labor stage on birth outcomes.Methods 600 normal pregnant women who were routinely examined in our hospital from May 2016 to December 2016 were selected.They were randomly divided into observation group and control group according to the number of prenatal date of pregnant women,each group in 300 cases.The control group was taken routine supine position in the first labor stage.The observation group used free position with duole tools during the first labor stage.The maternal first labor time,delivery mode,neonatal asphyxia,postpartum hemorrhage,maternal reproductive tract injury were observed.The maternal postpartum within 2 hours,the pain score,maternal childbirth response scale (CCB) and anxiety by comprehensive hospital anxiety and depression table (HAD) were assessed.Results The spontaneous delivery rate and tolerable pain of the observation group were 90.0％(270/300) and 73.7％ (221/300) respectively,which were higher than those of the control group [83.3％(250/300) and 62.0％ (186/300)].The maternal perineum II degree laceration and neonatal asphyxia rates of the observation group were 8.3％(25/300) and 1.7％ (5/300) respectively,which were lower than thsoe of the control group [12.3％(37/300) and 4.3％ (13/300) respectively],the differences were statistically significant(χ2=9.31,9.84,9.05,8.39,all P＜0.05).The maternal first labor time and postpartum hemorrhage of the observation group were (10.87±3.06)h and (121.60±15.11) mL,respectively,which were significantly lower than those of the control group [(11.69±2.48)h and (180.52±14.76)mL],the differences were statistically significant (t=8.92,9.74,all P＜0.05).The HAD score of the observation group was (6.04±1.95)pionts,which was lower than (8.76±1.21)points of the control group.CCB score of the observation group was (49.82±7.61)points,which was higher than (45.33±6.90)points of the control group,the differences were statistically significant (t=10.15,11.32,all P＜0.05).ConclusionTaking the free position with duole tools during maternal first labor stage can improve the natural delivery rate,tolerate pain and postpartum response ability significantly,the first labor stage significantly shortened,postpartum adverse reactions and psychological anxiety decreased.

Objective To analyze and discuss the expression of serum polymyositis‐scleroderma(PM‐Scl) antibody and its clinical significance in patients with systemic scleroderma(SSc) .Methods 315 hospitalized patients diagnosed with scleroderma by typical clinical manifestations or skin pathology from 2009 to 2012 were enrolled in the study .All patients were grouped into PM‐Scl antibody positive(PM‐Scl + ) group(90 cases) ,Scl‐70 antibody positive(Scl‐70+ ) group(70 cases) ,anti‐centromere antibody positive( ACA+ ) group(75 cases) and antibody negative group(80 cases) according to autoantibody spectrum .The severity of skin and visceral damage among all the groups were analyzed and compared .Results Patients in PM‐Scl+ group were characterized with different clinical manifestations .Compared with the other 3 groups ,the incidence of myositis in PM‐Scl+ group was significantly higher( all P< 0 .05) ;patients in Scl‐70+ group had higher incidence of visceral organ damage than PM‐Scl+ group(all P < 0 .05) .The incidence of skin lesions ,Raynaud′s phenomenon and capillary expansion in ACA+ group were higher than that of PM‐Scl+ ,while the incidence of interstitial lung disease ,heart disease and kidney disease were lower(all P< 0 .05) .Conclusion It is helpful for clinicists′ further understanding of common autoantibodies in Ssc patients and making correct assessment of the disease through analyzing the expression of PM‐Scl antibody .

Objective To evaluate multi- slice spiral CT angiography (MSCTA) in diagnosing bronchial-pulmonary shunts (BPS). Methods The materials of MSCTA images in 31 patients with DSA-confirmed BPS were retrospectively analyzed. Taking DSA imaging as the reference standard, the consistency in diagnosing BPS at different levels between MSCTA and DSA was compared. Results On MSCTA using aorta-density trigger scanning technique BPS was manifested as wrong-time enhancement of pulmonary artery branches. Wilcoxon test indicated that MSCTA had a high concordance with DSA in detecting BPS occurring at sub-segmental (or above) pulmonary artery branches (Z = -1.854, P > 0.05), but MSCTA detection of BPS occurring at peripheral pulmonary arteries was obviously poorer than DSA (Z = -3.923, P < 0.05). MSCTA confirmed the diagnosis of BPS in 11 cases with a sensitive rate of 35.5% (11/31), and no differences in revealing the number and the shunt levels of BPS existed between DSA and MSCTA. The number of abnormal systemic arteries demonstrated by MSCTA was quite the same as the number detected by DSA. No false positive case was seen. Conclusion MSCTA is very effective in diagnosing high-flow BPS locating at sub-segmental (or above) pulmonary artery branches as well as in revealing abnormal bronchus-related systemic arteries, which is very helpful in preoperatively evaluating the severity of the BP shunting and the supplying arteries to be obstructed.

Objective To investigate the serum levels of vascular endothelial growth factor(VEGF)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS),and make a primary relative study on the relationship between VEGF and pH.Methods Thirty-nine patients with mild to moderate OSAHS,36 patients with severe OSAHS and 18 healthy snorers who had been admitted to the First Hospital Affiliated to Wenzhou Medical College from Feb.2003 to Sep.2004 were enrolled in this study.The serum levels of VEGF were detected in all patients at 7:00 AM the next day after the detection of polysomnography(PSG).Additionally 31 patients with OSAHS were detected by doppler echocardiography to get the values of pulmonary artery pression.Results There was nocturnal hypoxia in patients with OSAHS compared with healthy snorers,and the degree of nocturnal hypoxia was depended with the grade of OSAHS(both achieved statistical difference)by the detection of PSG.The levels of VEGF was significantly higher in patients with severe OSAHS than in healthy snorers(P

Objective To retrospectively analyze the result of hemoglobin(Hb)test by using full-automatic Hb electrophoresis and evaluate the its significance in hemoglobinopathy.Methods The data of patients who underwent Hb electrophoresis test and regular blood tests in the hospital from January 2011 to December 2013 were included in the study.The test results were recorded including mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH)and results of Hb electrophoresis test.Final diag-nosis were made for suspected patients by using genetic testing,then disease detection rates and gene coincidence rates and constitu-ent ratios were calculated.Results 12 898 cases were included in the study,after statistical analysis the MCV was(85.32±13.61) fL,MCH was(29.87±6.44)pg.By using automatic hemoglobin electrophoresis,1 315 cases were found to be positive,in which 568 were male,747 were female,the detection rate was 10.19%.In the 1 315 patients,there were 761 cases suspectedα-thalassemia,ac-counted for 5.90%.There were 495 cases of suspectedβ-thalassemia,accounted for 3.84%,11 patients with HbJ(0.08%),15 pa-tients with HbK(0.12%),9 patients with HbG(0.07%),3 patients with HbD(0.02%),21 patients with HbE(0.16%).The sus-pected case′s final diagnosis were made by using genetic testing,α-thalassemia gene′s coincidence rate was 80.55%,β-thalassemia gene′s coincidence rate was 96.77%.Conclusion Automatic hemoglobin electrophoresis detection is of great significance for the di-agnosis of hemoglobinopathy.

Objective To establish normal reference ranges for serum cystatin C (Cys C)in relatively healthy middle-aged and elderly(＞50 years)Chinese individuals.Methods A total of 1087 candidates were consecutively selected and serum Cys-C levels were measured by transmission turbidimetry.Frequency analysis and histogram were used to establish the 95％ confidence reference range according to methods provided by CLSI (C28-A2).Results Based on the definition and verification procedures for clinical laboratory reference ranges(CLSI C28-A2,second edition),Cys-C levels of 1087 participants fell within the range of 0.30-1.55 mg/L;Male participants had higher serum Cys-C levels than female participants(Z=-10.19,P＜0.01).The serum Cys-C level increased with age,regardless of gender(R =0.600,P＜ 0.01).Differences in Cys-C levels between age groups were statistically significant (x2=411.17,P＜ 0.01).The reference ranges of normal serum Cys-C levels for different age groups (50-,55-,60-,65-,70-,75-,) were 0.42-0.98mg/L,0.45-1.04mg/L,0.47-1.34mg/L,0.46-1.38mg/L,0.61-1.33mg/L,0.61-1.28 mg/L,respectively,for males,and 0.39-0.94mg/L,0.42-1.01mg/L,0.40-0.91mg/L,0.46-1.03mg/L,0.57-1.04mg/L,0.55-1.27mg/L,respectively,for females.Conclusions This study established preliminary normal serum Cys-C reference ranges for healthy middle-aged and elderly(＞ 50 years)individuals in this region,which can serve as parameters for disease diagnosis and treatment evaluation.

Background:Dysregulation of microRNA expression is involved in the carcinogenesis of many tumors,expression of miR-504 has been observed in many tumors,but its expression in primary hepatocellular carcinoma(HCC)has not been reported. Aims:To explore the expression and clinical significance of miR-504 in HCC tissues and cells. Methods:Tumor and para-cancerous tissue in 85 HCC patients were collected. Five liver cancer cell lines and immortalized liver cell line were conventionally cultured. Effect of miR-504 expression on HepG2 cells proliferation was determined by CCK8 assay. The expression of miR-504 was determined by real time fluorescent quantitative PCR. Relationships between expression of miR-504 and clinicopathological features and prognosis of HCC patients were analyzed. Results:Compared with normal liver cells,expression of miR-504 was significantly downregulated in five liver cancer cells(P < 0. 05). Up-regulation of miR-504 inhibited proliferation of HepG2 cells,and down-regulation of miR-504 promoted proliferation of HepG2 cells. miR-504 expression in tumor tissue was significantly decreased than that in corresponding para-cancerous tissue. Expression of miR-504 was correlated with tumor differentiation(P = 0. 002),TNM stage(P = 0. 021),alpha fetoprotein(P = 0. 012)and portal vein tumor thrombus(P = 0. 003),but not with gender,age,tumor size and tumor number. Survival in HCC patients with lower miR-504 expression was significantly shorter than that in patients with high expression(P < 0. 05). Conclusions:Expression of miR-504 is downregulated in HCC,and is correlated with the prognosis of patients,suggesting that miR-504 can be used as an independent predictor for prognosis of HCC patients.