Objective To explore the clinical value and the correlation of parathyroid hormone and osteocalcin in hemodialysis patients.Methods According to the dialysis duration of hemodialysis patients,they are divided into the four groups,Ⅰ (dialysis time ＜2 years),Ⅱ (dialysis time 2-5 years),Ⅲ(dialysis time ＞5-10 years),Ⅳ (dialysis time ＞ 10 years),50 cases were randomly selected from each group,50 cases of healthy people were taken as a control group,to detect the contents of PTH and N-MID in serum and analyze the results.Results The content of PTH in hemodialysis patients of Ⅰ,Ⅱ,Ⅲ,Ⅳ group were (170.9 ± 45.9) ng/L,(405.4 ± 65.3) ng/L,(717.1 ± 199.6) rng/L,(1 555.6 ± 417.8) ng/L,the content of N-MID were (79.23 ± 31.62) μg/L,(140.22 ± 50.98) μg/L,(496.11 ± 159.49)μg/L,(617.9 ± 386.18)μg/L,the content of PTH and N-MID in control group were (6.85 ± 3.74) ng/L,(16.6 ± 8.57) μg/L,PTH and N-MID levels of the four hemodialysis patients groups were significantly higher than those of normal control group,the differences had statistically significance(PTH levels of the four groups compared with the control group:group Ⅰ compared with the control group,t =25.199,P ＜0.01 ;group Ⅱ compared with the control group,t =43.091,P ＜0.01 ;group Ⅲ compared with the control group,t =25.402,P ＜0.01 ;group Ⅳ compared with the control group,t =26.211,P ＜0.01 ;N-MID levels of the four groups compared with the control group:group Ⅰ compared with the control group,t =13.518,P ＜ 0.01 ; group Ⅱ compared with the control group,t =16.909,P ＜ 0.01 ; group Ⅲ compared with the control group,t =21.229,P ＜ 0.01 ; group Ⅳ compared with the control group,t =11.007,P ＜ 0.01),the content of PTH and N-MID in Ⅰ,Ⅱ,Ⅲ,Ⅳ groups had statistically significance (four groups of PTH levels compare to each other:group Ⅰ compared with group Ⅱ,t =20.774,P ＜0.01 ;group Ⅰ compared with group Ⅲ,t =18.858,P＜0.01;group Ⅰ compared with group Ⅳ,t =23.295,P＜0.01;groupⅡ compared with group Ⅲ,t =10.495,P ＜ 0.01 ; group Ⅱ compared with group Ⅳ,t =19.233,P ＜ 0.01 ; group Ⅲ compared with group Ⅳ,t =12.805,P ＜ 0.01 ; Four groups of N-MID levels compare to each other:group Ⅰ compared with groupⅡ,t=7.189,P ＜0.01;group Ⅰ compared with group Ⅲ,t =18.130,P ＜0.01 ;group Ⅰ compared with group Ⅳ,t =9.830,P ＜ 0.01 ;group Ⅱ compared with group Ⅲ,t =15.029,P ＜ 0.01 ;group Ⅱ compared with group Ⅳ,t =8.671,P ＜ 0.01 ; group Ⅲ compared with group Ⅳ,t =2.061,P ＜ 0.05).Conclusion PTH levels were positively correlated with N-MID content in hemodialysis patients,high PTH hemodialysis patients should prevent osteoporosis early and to take appropriate treatment.

Objective To explore the clinical value of combined detection of serum human epididymal secretory protein E4 (HF4) and CA125 in the diagnosis of endometrial carcinoma.Methods From Jan 2010 to Apr 2011,the serum specimens were collected from124 cases of endometrial carcinoma,97 cases of benign disease of uterus and 109 cases of healthy women.HE4 levels in the serum were detected by ELISA,and CA125 levels in the serum were detected by the electro- ehemiluminescent immunoassay.Those results were shown with median level.Accuracy of the diagnosis was evaluated by the area under the receiver operating characteristic curve ( ROC-AUC ).ResultsThe median levels of HE4 and CA125 were 78.09 pmol/L and 33.43 kU/L in serum of endometrial carcinoma group.The median levels of HE4 and CA125 were 46.37 pmol/L and 18.26 kU/L in serum of benign disease of uterus group.The median levels of HE4 and CA125 were 31.75 pmol/L and 12.64 kU/L in serum of healthy women group.The HE4 and CA125 levels in serum of endometrial carcinoma group were significantly higher than those of benign disease of uterus group or healthy women group ( all P ＜ 0.05 ).Compared with that benign disease of uterus group,the ROC-AUC of HE4 and CA125 in endometrial carcinoma group were 0.913 and 0.801,respectively.When the specificity was 95.0％,the sensitivities of HE4,CA125,and combined detection of HF4 and CA125 in endometrial carcinoma group were 41.1％,22.6％ and 46.0％,respectively.The positive rates of HE4 and CA125 were 31％ (27/86) and 12％ (10/86) in stage Ⅰ - Ⅱ of endometrial carcinoma,while the positive rates were 63％ (24/38) and 47％ (18/38) in stage Ⅲ -Ⅳ of endometrial carcinoma,in which there were significant difference between patients in stage Ⅲ - Ⅳ and stage Ⅰ - Ⅱ (P ＜ 0.01 ).ConclusionsThe combined detection of serum HE4 and CA125 is helpful to the diagnosis of endometrial carcinoma.The sensitivity,specificity and early diagnosis of HE4 are better than that of CA125.The positive rates of HF4 and CA125 in endometrial carcinoma are related to the clinical staging.

The serum specimens were collected from ovarian cancer (n =100),benign ovarian disease (n =69) and healthy women (n =95).The serum levels of HE4 and CA125 were detected.Risk of ovarian maliqnancy algorithm (ROMA) was calculated.Accuracy of prediction was evaluated by the area under receiver operating characteristic curve (ROC-AUC).And validity of prediction was evaluated by sensitivity and specificity.The results showed that the median level of ROMA algorithm was 83.0％,8.9％ and 8.7％ in ovarian cancer,benign ovarian disease and healthy women groups respectively.The difference were statistically significant (all P ＜ 0.01).Compared with benign ovarian disease group,the ROC-AUC of ROMA algorithm was 0.900 in ovarian cancer group.The sensitivity and specificity were 81.0％ and 92.8％ in ovarian cancer group respectively.Thus ROMA algorithm is a useful parameter in risk stratification for ovarian cancer.The diagnostic accuracy of ROMA algorithm is better than that of HE4 and CA125 in ovarian cancer.

10mm, the PLG lie in the neck of gallbladder.(3)PLG complicated with clinical symptoms.(4)The PLG diameter increases or complicated with stones.But surgical treatment should be prudent for non-neoplasm PLG, especially cholesterol polys.

Objective To investigate the clinical effect of coagulation therapy in patients with gastric ulcer bleeding.Methods From January 2013 to January 2016 in Xiaoshan First People's hospital 150 cases of gastric ulcer patients with bleeding,using SPSS16.0 software to generate randomly divided into hemocoagulase group(basic treatment + hemocoagulase injection therapy)and control group(basic treatment)of the 75 cases,compared two groups of hemostatic time,hemostatic effect.Results After 72h treatment,the average hemostasis time of hemocoagulase group were significantly lower than the control group(P<0.05),the blood coagulation enzyme in patients with serum VEGF,EGF levels higher than the control group(P<0.05),gastrin and somatostatin levels lower than the control group(P<0.05),hemocoagulase group cure rate is 64％,effective in 22.67％,effective 9.33％,invalid 4％,the control group were 46.67％,25.33％,18.67％,9.33％,two groups compare difference was statistically significant(P<0.05).Conclusion Treatment of gastric ulcer bleeding patients with coagulation enzyme can shorten the hemostatic time,improve the clinical effect of hemostasis.

Clinical teaching mode based on the theory of empowerment is a combination of the theory of em -powerment and clinical teaching activities .It emphasizes a student -centered philosophy .By empowering students in clinical teaching , the teachers can continuously stimulate the students 'initiative and thereby give full play to the students'potential.Starting from a discussion on of cases in clinical teaching , this thesis builds an effective student -leading mode of clinical teaching based on the theory of empowerment , tries to construct a clinical teaching theoretical system based on the theory of empowerment and explores strategies for practice , in order to improve clinical teaching effectiveness and promote reform in clinical teaching education .

Objective To investigate the risk factors and management of retained common bile duct stones.Method The clinical data of 14 patients with retained common bile duct stones between 1994 and 2000 was statistically analyzed in comparison with 191 patients of the negative postoperative T tube cholangiography. Results Common bile duct stones were present in 20% of patients undergoing cholecystectomy. In 7% of patients, stones were left in the bile ducts after common bile duct exploration. Statistically significant difference was observed in the age of the patient population, the percentage of associated acute cholangitis, the number of the stones present in common bile duct and the frequercy of the intraoperative choledochoscopy when compared retained bile duct stones with negative postoperative T tube cholangiography. Conclusions Retained common bile duct stones is related to age of the patient, the association of acute cholangitis, the number of the common bile duct stones and the operative choledochoscopy. Postoperative flexible choledochoscopy or endoscopic papillotomy is an effective method for managing patients with retained common bile duct stones.

Objective To improve the cure rate of hepatobiliary lithiasis.Methods Two hundred and seventy-five patients with retained gallstones in the hepatic bile ducts after choledochostomy were treated with choledochofiberscope from August 1989 to August 2001 in this hospital.Results In 252 cases(91.6%), the residual gallstones were thoroughly removed with choledochoscope and in remaining 23 cases(8.4%), the stones were not completely removed. The factors affecting the results of the procedures include improper locating of T-tube, the exfoliation of T-tube and closure of fistula, the size and the incarceration of retained gallstones, the narrowed bile ducts, the performance of intraoperative choledochoscope, the method of operation.Conclusions Choledochofiberscope is of great value in surgical treatment of hepatobiliary lithiasis. However it can't completely replace to remove the damaged liver caused by the gallstones.

Objective To study the mechanism and prevention for complications associated with postoperative T-Tube cholangiography.Method The study reviewed the data of six patients with complications following postoperative T-Tube cholangiography.Results Minor adverse reactions occurred in 4 cases, severe in 2.The severe reactions were related to cholangiovenous reflux resulted from the increase in intrabiliary pressure during postoperative T-Tube cholangiography.Conclusion Limitation of high intrabiliary pressure during the perfor mance of postoperative T-Tube cholangiography is the most important measure to prevent such reactions.