Objective To explore the diagnosis and treatment of cholecystolithiasis accompanying periampullary tumor.Methods A retrospective analysis was performed with clinical data of 5 patients with cholecystolithiasis complicated with periampullary tumor among the 2680 patients receiving laparoscopic cholecystectomy(LC)in our hospital from May 1994 to March 2006.Results Pain in epigastrium,icteric sclera and skin were found in all 5 patients 0.5-17 months after LC.Neoplasms in ampulla were found in re-hospitalization,and periampullary tumor was diagnosed,which were missed in the first operation.Conclusions Improving the knowledge of cholecystolithiasis complicated with periampullary tumor,performing various auxiliary investigations,and reinforcing postoperative follow-up are beneficial for avoidance of missed diagnosis of periampullary tumor,and for early diagnosis and treatment.

Objective To investigate the clinical significance of ambulatory blood pressure monitoring in short-term prognosis of acute inferior myocardial infarction patients .Methods A total of 80 patients with acute inferior myocardial infarction received 24 hours ambulatory blood pressure monitoring after enrolled .According to the results of 24 hours ambulatory blood pressure monito-ring ,eligible patients were divided into dipper model group(n=29) and non-dipper model group(n=51) .Clinical information was collected and all patients were followed-up for major adverse cardiovascular events (MACE) .Results The rate of intravenous thrombolysis in dipper model group was significantly higher than that in non-dipper model group(t=4 .120 ,P=0 .021) .Night mean systolic blood pressure and night mean diastolic blood pressure were all significantly lower in dipper model group than in non-dipper model group(t=2 .032 ,P=0 .040 ;t=3 .175 ,P=0 .002) .The rate of cumulative MACE in non-dipper model group was significant-ly higher than that in dipper model group(t=2 .626 ,P=0 .041) .Multivariate logistic regression analysis showed that ,daytime mean systolic blood pressure(<90 mm Hg) was independent risk factor of MACE(P=0 .018 ,OR=1 .298) ,dipper model blood pressure (P=0 .019 ,OR=0 .769) and intravenous thrombolysis(P=0 .007 ,OR=0 .520) were protective factors for MACE .Conclusion Parameters of ambulatory blood pressure monitoring are closely correlated with prognosis of acute inferior myocardial infarction pa-tients ,and the change of blood pressure model is an important factor for short-term prognosis .

Objective To investigate the applicative value of hysteroscopic surgery in the treatment of endogenous cesarean scar pregnancy ( CSP) . Methods A total of 34 patients with CSP in this hospital from April 2012 to October 2014 were treated by hysteroscopic surgery .Seven patients received uterine curettage under hysteroscopy and 27 patients got uterine artery embolization therapy before hysteroscopic surgery .All of them were regularly reviewed of β-hCG levels and ultrasound examinations . Results The surgical procedure was successfully completed in all the 34 cases.The operation time was (17.5 ±3.5) min, the intraoperative blood loss was (17.5 ±7.5) ml, and the hospitalization stay was 4-5 days.All of them had no serious complications .Their β-hCG levels were dropped to normal range within 28 days after operation , and all the patients had menstruation within 2 months after surgery . Conclusion Hysteroscopic surgery for CSP has advantages of good visibility , less bleeding, simple performance, high success rate, less postoperative complications , and shorter hospitalization time , being worthy of clinical utilization .

Objective To investigate the effective methods for treatment of severe chest trauma with multiple organ injury. Methods The injury conditions and the early treatment measures in 87 cases of severe chest trauma with multiple organ injury (especially within 48 h after injury) were analyzed retrospectively. Results Of the 78 patients, 61 patients survived, and 26 died (including 2 patients who abandoned treatment). The total mortality was 29 89%. Primary operation was performed on 37 patients with multiple organ injury, but 7 died (18 92%). Conclusion Diagnosis while rescuing, effective countershock treatment, early operation, protection of visceral functions, and preventive mechanical ventilation may be the important measures to guarantee the success of treatment of severe chest trauma with multiple organ injury.

The significant differences in prevalence rate of essential hypertension among the races in Xinjiang, i.e. in Kazakh, Han, and Uighur had been shown in 1979 screening. They were 6.6%, 3.5% and 2.6% respectively.The present investigation shows that some dietary constituents as well as the nutritional imbalance was involved in the causal effect in the development of hypertension.Three race people living in three quite different areas (geographic, climatic environmental conditions etc,) were investigated in April to July 1981. Blood pressures of 9,313 persons were measured. The dietary pattern and staple food items were studied for 491 persons within 69 families.The findings suggested that: l)the prevalence rate of hypertension was identical to the previous screening, 2) there was a positive correlation between the high consumption of protien (r= 0.974), fat(r = 0.622) and the prevalence rate of this disease, but a negative correlation in vitamin C intake (r = -0.620).The excessive intake of salt was accounted as a risk factor for poss- ible association with this disease only in Kazakh people who were living in various areas.

Objective To investigate the safety and efficacy of low-dose recombinant tissue plasminogen activator (rtPA) in Chinese patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke received rtPA intravenous thrombolysis within 4. 5 h after symptom onset were enrol ed retrospectively. According to the dosage of rtPA, they were divided into either a low-dose group (0. 5-0. 8 mg/kg, the maximum dose 50 mg) or a standard dose group (0. 9 mg/kg, the maximum dose 90 mg). The incidences of symptomatic intracranial hemorrhage ( sICH) ( the National Institute of Neurological Disorders and Stroke [NINDS], and European Cooperative Acute Stroke Study Ⅱ [ECASSⅡ] , European Safe Implementation of Thrombolysis in Stroke-Monitoring Study [ SITS-MOST ] ), 90 d mortality, 90 d good outcome (the modified Rankin Scale [mRS] score 0-1), and life self-care ability (mRS score 0-2) were compared between the two groups. Results A total of 163 patients were enrol ed, including 74 patients in the low-dose group and 89 in the standard dose group. The constituent ratios of hypertension (44. 6% vs. 68. 5%; χ2 =9. 490, P=0. 002) and diabetes (5. 4% vs. 28. 1%; χ2 =14. 216, P<0. 001) in the patients of the low-dose group were significantly lower than those of the standard group, while the constituent ratios of smoking (56. 8% vs. 38. 2%; χ2 =5. 590, P=0. 018 ) and smal artery occlusive stroke (21. 6% vs. 10. 1%; χ2 =4. 122, P=0. 042 ) in patients of the low-dose group were significantly higher than those of the standard group. After adjusting for age, National Institutes of Health Stroke Scale (NIHSS) score, hypertension, diabetes, smoking, and ischemic stroke typing, multivariate binary logistic analysis showed that there were no significant differences in NINDS defined sICH (10. 8% vs. 9. 0%, odds ratio [OR] 1. 077, 95%confidence interval [CI] 0. 338-3. 436), ECASS Ⅱdefined sICH ( 9. 5% vs. 9. 0%; OR 0. 976, 95% CI 0. 296- 3. 221 ), SITS-MOST defined sICH (8. 1% vs. 4. 5%; OR 2. 269, 95% CI 0. 522-9. 852), 90 d mortality (17. 6% vs. 14. 6%; OR 1. 720, 95% CI 0. 578-5. 119), 90 d good outcome (35. 1% vs. 32. 6%;OR 0. 780, 95% CI 0. 356-1. 709), and life self-care ability (48. 6% vs. 42. 7%;OR 0. 936, 95% CI 0. 441-1. 987) between the 2 groups (al P>0. 05). Conclusions The program of intravenous thrombolysis for the treatment of Chinese patients with acute ischemic stroke with low-dose rtPA is safe and effective.

According to the level of selenium (Se) and methionine (Met) in diet, Wistar rats were randomly divided into 3 groups, group A (normal Se and normal Met); group B (Low Se and normal Met); group C (low Se and low Met). The animals were sacrificed after 8-week feeding. The results showed that the alteration of myocardial ultrastructure was slight in group B. Decreased activities of cytochrome oxidase and succinate dehydrogcnase of myocardial mitochonria and decreased activities of GSH-Px in the blood, heart and liver in group B were observed, as compared with those in group A. But the level of TBA was higher than that of group A.The above mentioned changes in group C were extremely apparent than group A or B, indicating both Se and Met deficiency in diet may concern the etiology of Keshan disease.

Purpose To investigate the c1inicopatho1ogica1 and immunohistochemica1 characteristics of enteropathy-associated T-ce11 1ymphoma( EATL)and to eva1uate the criteria of diagnosis and differentia1 diagnosis. Methods There were enteropathy-associated T-ce11 1ymphoma patients co11ected with c1inica1 data(n=9). Histo1ogica1 features were observed under microscope by HE staining and by immunohistochemstry. EBV was tested by in situ hybridization. Results EATL type Ⅰ showed a variab1e histo1ogy consisting of medium-sized to 1arge 1ymphoid ce11s with round or po1ygona1 nuc1ei,containing remarkab1e nuc1eo1i. EATL typeⅡshowed that tumor ce11s were medium-sized,with round,hyperchromatic nuc1ei. Nuc1ear debris and necrosis cou1d be seen easi1y. A 1arge number of his-tiocytes and neutrophi1s formed the inf1ammatory background. Immunohistochemica1 findings showed that tumor ce11s of two types were diffuse1y positive for CD3,CD43 and TIA-1,whi1e negative for CD4,CD5,CD20,CD79a. Tumor ce11s of EATL type II expressed CD56 and CD8,but negative in EATL typeⅠ. A high pro1iferation index was demonstrated by Ki-67. EBER was negative detection. There were seven patients with fo11ow-up data from 0 to 18 months. Four patients died within 10 months and three patients died within 18 months. Conclusions EATL is a rare type of 1ymphoma with intestina1 invo1vement. Patients often present with chronic abdomina1 pain,diarrhea,persistent fever and abdomina1 mass for a 1ong time. Intestina1 perforation occurs in some cases. Diagnosis shou1d be corre1ated to c1inica1 symptoms whi1e the fina1 diagnosis is main1y based on the patho1ogica1 features and the immune phenotypes.

Objective To evaluate the clinical significance of juxtapaillary duodenal diverticula (JPDD) in patients of acute calculous cholangitis (AC) with different severity grade.Methods A retrospective analysis was carried out for 488 AC cases of different severity from January 2011 to December 2013 who underwent duodenoscopy in Dongyang People's Hospital.Results Of the 488 patients, the JPDD was found in 2.87％, 6.15％ and 4.10％ in patients with mild, moderate and severe AC, respectively.The prevalence of JPDD in severe AC were significantly higher in the moderate and mild AC (x2 =4.486, P =0.034;x2 =14.686, P ＜ 0.001);Procalcitonin (PCT) concentrations in severe AC of JPDD were significantly higher in moderate and mild AC of JPDD (t =10.420 9, P ＜ 0.001;t =4.870 4, P ＜ 0.001).The cannulation failure rate and the amylase were significantly higher in JPDD patients compares to patients without JPDD (x2 =36.95, P ＜ 0.001;t =8.29, P ＜ 0.001).Conclusions JPDD detection rate increases with aging and seems to be associated with acute cholangitis (AC) with different severity grade and PCT concentration.JPDD predicts a higher cannulation failure rate and the amylase level after duodenoscopy.

Objective To evaluate the role of procalcitonin in patients with different severity grades of acute cholangitis (AC).Methods A retrospective study was carried out on 147 patients with different severity grades of AC who were treated from May 2012 to November 2013 at the Dongyang People's Hospital.Results Of 147 patients,the PCT concentrations were (165.63 ± 32.67) pg/ml,(348.97 ± 45.78) pg/ml,(758.91 ± 28.94) pg/ml for patients with mild,moderate and severe AC respectively.The PCT concentrations were significantly higher in patients with severe AC than those with moderate AC (P ＜ 0.05),and also in patients with moderate AC than those with mild AC (P ＜ 0.05).The top three bacteria obtained from blood culture from the different severity grades of AC showed no significant diferences (P ＞ 0.05).Conclusion Serum PCT concentrations were elevated in patients with AC and it may be used as a parameter to assess the severity of AC.