To explore the therapeutic effect of micro-traumatic surgery of loose seton and cutting seton by rubber bands in the treatment of high anorectal fistulae.Application of cutting seton (truss rubber bands) implemented the high part of fistulae and loose seton (ligation rubber band but non-fastened) for the low part of fistulae.133/136 patients undergoing micro-traumatic surgery were cured by one operation,2 cases had pseudo-healing and there was 1 recurrent case.And the curative rate was 97.8％.The microtraumatic surgery of loose seton and cutting seton by rubber bands in the treatment of high anorectal fistula has such multiple advantages as small incision,minor trauma,lesser pain,faster healing and a shorter course of treatment.And it may preserve the proper anal function and the integrity of anal skin.And its clinical efficacy is satisfactory.

The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 degrees C used in 27 Rh (D) negative patients during surgical operation was reported. The Rh (D) negative patients received the transfusion of CSRBC or whole blood stored at -80 degrees C for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K+, Na+, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P > 0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K+ and blood Na+ was normal with the difference being not significant before and after operation (P > 0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P > 0.05). It was suggested that CSRBC or whole blood at -80 degrees C could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.
Blood Preservation/*methods ; Blood Transfusion/*methods ; *Cryopreservation ; Erythrocytes ; Intraoperative Care ; *Rh-Hr Blood-Group System

Objective To discuss the indication , feasibility and curative effect of endovascular treatment for vascular injuries. Methods 7 patients with vascular injuries were treated by endovascular treatment, including 1 cases of pseudoaneurysm ,2 arteriovenous fistula , 3 closed arteriorrhexis and 1 arterial stenosis after vascular operation . All of the patients were treated by twelve stent - grafts and one introcoil stent. Results All cases were technically successful during follow - up for about 3 to 30 months. The blood flow was rebuild and the diseased region was removed effectively after stent operations. There was no extremity ischemia , hemorrhage , engorgement , stent shift ,fragmentation, angiostegnosis and reinjury appeared in these cases during follow - up. Conclusion Endovascular intervention is a new therapeutic approach with advantages of safety , efectiveness and minimal invasiveness. Its long - term eficacy needs to be further evaluated.

Objective To investigate the relationship between chronic atrophic antral gastritis and the decrease of somatostatin levels in blood and pyloric glands and adaptable protection ability of gastric mucosa.Methods Gastric mucosa biopsy specimen and blood samples were collected to determine the levels of somatostatin(SST)using radioimmunoassay.Histological changes between pre-and post-treatment were observed under light microscope as well as the changes of uhramicrostrucuture under transmission electron microscope.Distribution of SST in gastric mucosa was studied by immunohistochemical staining and then quantified.Results The quantities of gastric antral D cells of chronic atrophic antral gastritis decrease obviously.SST was mainly distributed in D cells of mucosa pyloric gland crypt.The nucleus of mucus epithelial cells in atrophic gastric antral crypt had SST negative staining.Mitochodria swellen,crista broken,rough endoplasmic reticulum distension,mucus secretory granules decreasing,the nuclear membranes disappearing as well as ehromatin integrating could have been seen in the intracytoplasm of mucus epitheliun cells of chronic atrophic gastric antral gastritis.The average level of SST in blood,epithelium and crypt were obviously reduced comparing to that of in the control group.By immunochemistry staining,the SST level in crypt of atrophic gastric antral gastritis Was significantly reduced comparing to that of in control group.With the level of SST in blood＜10 pg/100μl,the probability ratio of emerging atrophy Was 67.7%.Conclusions In case of no systemic inflammatory reaction state,the decreased ability of human pyloric gland D cell in producing SST not only rehtes obviously with human chronic atrophic antral gastritis but also with the weakened adaptable protection ability of gastric mucosa.

Objective To investigate the effects of adenovirus containing human beta-nerve growth factor (Ad-hNGFβ) gene on substance P (SP) and calcitonin gene-related peptide (CGRP) content of the spinal cord in a rat model of neuropathic pain by chronic constrictive injury (CCI). Methods Forty-eight male SD rats weighing 200-250 g were randomly divided into 3 groups (n=16 each) : group Ⅰ sham operation; group Ⅱ CCI and group Ⅲ CCI + Ad-hNGFβ gene IT. The animals were anesthetized with intraperitoneal choral hydrate 300-350 mg/kg. The right sciatic nerve was exposed and 4 ligatures were placed on the sciatic nerve at 1-2 nun intervals as described by Bennet and Xie[5]. In sham operation group, right sciatic nerve was exposed but not ligated. In group Ⅰ and Ⅱ artificial cerebrnspinal fluid was injected IT instead of Ad-hNGFβ gene. The behavior score and the paw-withdrawal latency (PWL) to radiant heat and mechanical stimulus were measured one day before operation and every 4 days within the 28 days after gene transfection. Four animals were killed at 4, 7, 14 and 28 day after IT gene transfection in each group and lumbar segment (L4-6 ) of the spinal cord was removed for determination of SP and CGRP content by immunohistochemistry. Results The behavior scores were significantly higher and PWL to radiant heat and mechanical stimulus were significantly lower in group Ⅱ and Ⅲ than in group Ⅰ. There was no significant difference in the behavior score and PWL to mechanical stimulus between group Ⅱ and Ⅲ while the PWL to radiant heat was significantly higher in group Ⅲ than in group Ⅱ. After operation SP and CGRP content were significantly higher in group Ⅱ and group Ⅲ than in group Ⅰ , and significangly lower in group Ⅲ than in group Ⅱ 7-28 days after operation. Conclusion The recomhinant Ad-hNGFβ gene transfection can attenuate heat hyperalgesia by reducing SP and CGRP content of the spinal cord in a rat model of neuropathic pain induced by CCI.

Objective To analyze the imaging findings and misdiagnosis of intraductal papillary mucinous neoplasm (IPMN),to improve diagnosis level and decrease misdiagnosis rate.Methods The images of 130 patients were suspicion or diagnosis of IPMN, and the other pancreatic lesions but confirmed IPMN by pathology.Two radiologists collected materials, analyzed the reasons of misdiagnosis, and found out countermeasures.Results A total of 130 patients confirmed by pathology were available for analysis, in which there were 105 (80.7%) of IPMN, and 25 (19.2%) of other pancreatic lesions.The most misdiagnosed patients were between IPMN and chronic pancreatitis(CP),serous cystadenoma(SCN).All patients were divided into mild to moderate group and severe to infiltrating carcinoma group based on pathologic grades.There was significant difference between two groups in cystic diameter, wall nodule, separation and dilation, the diameter of main duct, and intra-or extrahepatic biliary tract(P<0.05).The most common causes of misdiagnosis included that the radiologists didn't combined with the patient's clinical features,and didn't reconstruct images or perform MRCP scan when the relationship between the lesions and the pancreatic duct was unclear.Conclusion It is important that the radiologists need to combine with the patient's clinical features, clear the relationship between the lesions and the pancreatic duct, and fully master imaging findings.The recurrent pancreatitis maybe result from IPMN, and IPMN for a long time would lead to CP.

Objective To explore the diagnostic value of DWI after secretin stimulation for the diagnosis of mild chronic pancreatitis (CP). Methods This was a prospective study. Ninety-nine consecutive individuals including 23 healthy volunteers, 11 risk volunteers, 15 mild CP patients, 14 moderate CP patients and 36 severe CP patients underwent secretin DWI and faecal elastase 1(FE-1) testing. The subjects were grouped by Cambridge classification about endoscopic retrograde cholangiography (ERCP), CT and ultrasonography. Secretin stimulated diffusion weighted imaging(S-DWI), the ADCs, time to peak ADCs and FE-1 were performed on all subjects. The changes of pancreatic ADC values were observed before and after the injection of secretin. All ADCs and FE-1 were compared between groups with single factor analysis of variance, and the correlation between ADCs and FE-1 was determined with Pearson analysis. ROC curves were performed to identify the diagnostic efficacy of DWI related measures. Results Eight patients with severe CP were excluded because the significant atrophy of the pancreatic parenchyma prohibited the evaluation of ADC measurement. Ninety-one individuals were divided into five groups including 23 healthy volunteers, 11 risk volunteers, 15 mild CP patients, 14 moderate CP patients and 28 severe CP patients. The mean baseline and peak ADCs were higher in the healthy volunteers than in other groups, with significant differences (P<0.05). There was no ADC peak in severe CP patients. There were significant differences between the mean baseline ADCs and the peak ADCs in the other groups (P<0.05). The mild and moderate CP groups showed a delayed peak. The area under curve (AUC) of the mean baseline and peak ADCs, time to peak ADCs for differentiating mild CP was 0.818, 0.912 and 0.965, respectively. Using 4.67 min as the cutoff value, time to peak ADCs were most accurate for differentiating healthy from risk patients and those with evident pancreatitis, yielding a sensitivity of 80.0%and a specificity of 100.0%. Good correlations between baseline and peak ADCs, time to peak ADCs, and FE-1 were shown(r=0.57, 0.72 and-0.84, P<0.01). Conclusions Using the peak and time to peak ADCs may improve the detection of risk and mild CP. Secretin-enhanced DWI is a noninvasive, convenient and accurate method.

The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 degrees C used in 27 Rh (D) negative patients during surgical operation was reported. The Rh (D) negative patients received the transfusion of CSRBC or whole blood stored at -80 degrees C for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K+, Na+, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P > 0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K+ and blood Na+ was normal with the difference being not significant before and after operation (P > 0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P > 0.05). It was suggested that CSRBC or whole blood at -80 degrees C could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.
Adult ; Blood Preservation ; methods ; Blood Transfusion ; methods ; Cryopreservation ; Erythrocytes ; Female ; Humans ; Intraoperative Care ; Male ; Middle Aged ; Rh-Hr Blood-Group System

Objective To discuss the diagnostic value of HIT-antibodies in suspected HIT patients with heart diseases.Methods A single center study.We collected 242 blood samples of suspected HIT patients whose platelet count decreased after heparin application during July 1 st ,2012 to June 30th ,2016 in Wuhan Asia Heart Hospital and detected the concentration of HIT antibodies , meanwhile the 4T′s score were calculated.Among the study objects , there are 206 patients received cardiac surgery , 28 received cardiac interventional therapy and 8 received drug therapy.And we divided them into HIT group (44, median age 57.5, 23 females ) and non-HIT group ( 198, median age 63.5, 87 females ) according to clinical diagnosis.Quantitative data was analyzed by independent t-test or Mann-Whitney U test.Qualitative data was analyzed by Fisher′s exact test.We drew ROC curve according to the statistical analysis to determine the optimal threshold value of antibodies in diagnosis of HIT andsensitivity , specificity, negative likelihood ratio, positive likelihood ratio of the HIT antibody detection .Therefore, we can assess the value of HIT antibody detection in HIT clinical diagnosis and treatment .Moreover, we used the optimal threshold value of antibodies to testify the suspected HIT patients .Results The HIT antibody concentration of HIT group (44) and non-HIT group ( 198 ) are 3.2 ( 95% CI:1.8 -5.5 ) U/ml and 0.4 ( 95% CI:0.3 -0.4 ) U/ml, respectively.The concentration of HIT group is much higher than the non-HIT group(P<0.000).When the cut-off value of HIT-Ab is set at 0.9 U/ml, sensitivity and specificity are 93.2%and 91.9%, respectively. And negative likelihood ratio and positive likelihood ratio are 0.07 and 11.53, respectively.When the cut-off value of HIT-Ab is set at 0.6 U/ml, sensitivity and specificity are 100.0%and 73.7%.HIT-Ab and 4T′s score of ROC-AUC are 0.971 and 0.745, respectively.The diagnosis value of HIT-Ab in HIT is significantly higher than the 4T′s score ( P<0.000).Conclusions HIT antibody detection is a simple and effective auxiliary diagnostic method in HIT exclusion .And HIT antibody detection is more optimal than the 4T′s score in HIT diagnosis and treatment .

Due to a lack of specific biomarkers, the diagnosis of drug -induced liver injury (DILI) mainly depends on the method of exclusion.The Roussel Uclaf Causality Assessment Method (RUCAM) scale is the most widely used causality assessment scale and is relatively objective, but it is still waiting for further improvement.Another method is global introspection or expert opinion , which is relatively subjective,and the simplified global introspection method is commonly used in clinical practice .The Structured Expert Opinion Procedure (SEOP) created by the US DILI network (DILIN) is very complicated and time -consuming and thus cannot be used in clinical practice .The drug rechallenge test (DRT) with a positive result is considered the gold standard for the diagnosis of DILI , but DILI cannot be excluded based on the negative result of DRT.The value of lymphocyte transformation test (LTT), modified LTT, monocyte -derived hepatocyte -like cell lactate -dehydrogenase release test, and various predictive models for drug hepatotoxicity in the diagnosis of DILI awaits further assessment .The differential diagnosis of autoimmune -mediated DILI and traditional autoimmune liver diseases usually depends on liver biopsy , the type and titer of autoantibody, and response to glucocorticoids.Reasonable timing of drug withdrawal and application of anti -inflammatory liver -protecting drugs may help most DILI patients recover .Generally, the prophylactic use of anti -inflammatory liver -protecting drugs is not recommended, except in special situations.In -depth studies are needed for the precise diagnosis and prevention /treatment of DILI.