Objective To explore the signification and method of Cut-off verification and gray zone setting in chemiluminescent assay.Methods NCCLS EP-12 A2 document defines that C50 is the analyte concentration of cut off value for immunology qualitative test and C5-C95 interval is the range of analyte concentration that yields 5％ positive results to 95％ positive results for immunology qualitativc test.The C50 and C5-C95 interval of HBeAg in ARCHITECT i2000 were worked out according to the cut off value provided by HBeAg reagent calibrated in ARCHITECT i2000,which were verified to approve the character declaimed by manufactory or not.Gray zone was set and the procedure of cut off verification and gray zone set in chemiluminescent were built; A set of quality control was detected 20 times with two different lot HBeAg reagent kits,S/CO was caculated and compared with t test.Results C50 and C5-C95 interval of reagent (lot 06087L100,96378HN00) were 0.171 PEI U/ml,0.125 PEI U/ml; ＞0.154 PEI U/ml to 0.188 PEI U/ml,0.119 PEI U/ml to ＜0.150 PEI U/ml,respectively.S/CO of negative quality control and positive quality control were (0.550 ±0.038),(2.422 ±0.084) and(0.334 ±0.063),(3.587 ±0.321),respectively.They all approved the character (the sensitivity at cut off was less than 0.5 PEI U/ml)declaimed by manufactory,and the results of S/CO between two lot kits were obvious difference (t =9.944,15.499,P ＜0.01).Conclusion C50 and C5-95 interval can be used to verify cut off value and set gray zone in chemiluminescent assay;They may vary in different lot reagents and they must be verified to approve the character declaimed by manufactory.

Objective To discuss clinical efficacy of the modified Stoppa approach in the treatment of acetabular anterior fractures.Methods From January 2011 to December 2014,22 patients with acetabular anterior fracture were treated at our department.They were 14 males and 8 females,with an average age of 36.6 years (range,from 18 to 49 years).By the LetourneI-Judet classification system,there were 9 anterior wall fractures,12 anterior column fractures,and one transverse fracture.The modified Stoppa approach was used for fracture reduction under direct visualization in this cohort.Fixation with reconstruction plate was conducted after satisfactory reduction was confirmed by the X-ray examination.The operative duration,incision length,bleeding volume,fracture reduction quality,function of the affected hip and complications were recorded.Results In this cohort,the incision length ranged from 6 to 15 cm,averaging 9.5 cm;the intraoperative bleeding volume ranged from 100 to 1,000 mL,averaging 550 mL;the operative duration ranged from 40 to 160 minutes,averaging 126.2 min.The 22 patients were followed up for an average of 15.5 months (from 12 to 18 months).According to the Matta imaging evaluation,the fracture reduction was rated as excellent in 18 cases,as good in 3 cases and as poor in one,yielding an excellent to good rate of 95.5％.According to the Harris scoring system,the function of the affected hip was assessed at the final follow-up as excellent in 12 cases,as good in 9 cases,and as poor in one case,giving an excellent to good rate of 95.5％.Traumatic arthritis occurred in one case;there were no such complications as reduction loss or implant failure.Conclusion The modified Stoppa approach is a satisfactory one for the treatment of unstable acetabular anterior fractures,owning to its advantages like minimal invasiveness,simple dissection,excellent visual control of reduction and fixation,and a low rate of complications.

Objective To study abnormal defecation in patients with posterior vaginal prolapse combined with anorectal manometry. Methods From Jan. 2008 to Nov. 2009, clinical documents and examination of anorectal manometry of 40 patients with posterior vaginal prolapse were studied retrospectively. Anal physiologic testing was performed for 40 patients. These patients were classified into group A ( stage 0 and [posterior vaginal prolapse, represented normal) and group B ( stage Ⅱ - Ⅳ ).Results of anorectal manometry, constipation and symptoms of defecation were compared. Results The average anal canal resting pressure and squeeze pressure of 40 patients were (40 ±21 ) and (96 ±33) mm Hg (1 mm Hg =0. 133 kPa). In group A, the anal canal resting pressure and squeeze pressure were (37 ±21) and (78 ±43) mm Hg, rectal sensation threshold and rectal maximum volume were (106 ±61 ) and (183 ± 51 ) ml. In group B, the anal canal resting pressure and squeeze pressure were (42 ± 21 ) and (102±30) mm Hg, rectal sensation threshold and rectal maximum volume were (90±44) and (171 ±61) nl.Apart from maximum squeeze pressure ( P = 0. 039 ), the other clinical index did not show statistical difference (P ＞ 0. 05 ). Rectal sensation threshold, intended volume and maximum capacity of (116 ± 69 ),( 170 ± 90), ( 191 ± 75 ) ml in patients with constipation were higher than (84 ± 31 ), ( 121 ± 37 ), ( 169 ±45) ml in patients without constipation. In addition to maximum capacity (P = 0. 281 ), the other clinical index reached statistical difference between patients with and without constipation (P ＜ 0. 05 ). Patients with defecation symptoms have higher rectal sensation threshold, intended volume and maximum capacity than those of patients without defecation symptoms. Conclusions As gradually increased in the degree of prolapse, resting pressure and squeeze pressure tend to be increased, while the rectal sensation threshold and rectal maximum volume tend to be decreased. Patients with defecation symptoms and constipation have increased the initial feeling of volume and maximum tolerated volume.

Total mesorectal excision(TME)and complete mesoclic excision (CME)concepts make people aware of membrane integrity;the effect of endoscopic magnification and the hemostatic effect of ultrasonic scalpel,surgical field of view clearly,to further understand the structure of the membrane,which proposed the surgical anatomy of the membrane.This article describes the surgical membrane anatomy from the colorectal membrane of the embryonic development and membrane anatomical features that guide laparoscopic colorectal surgery.