Objective To discuss the clinical value of endoscopic retrograde cholangio panecreatography (ERCP) and endoscopic sphincterotomy (EST) for the treatment of extrahepatic bile duct stones. Metbods Forty-five cases were treated with ERCP and EST. Other 55 patients treated with opening proedure were selected to serve as the controls. Results The effective rate was 97.8% by ERCP and EST and 90.9% by opening procedure(P>0.05). The rate of residual stone was 2.22% by ERCP and EST and 20.00% by opening procedure(P<0.05). The rate of complications was 4.44% by ERCP and EST and 18.18% by opening procedure(P<0.05). Conclusion Therapeutic efficacy of ERCP and EST is better than the opening procedure in the treatment of extrahepatic bile duct stones. It is a safe, effective and simple method for the treatment of extrahepatic bile duct stones.

Objective To investigate the application value of ultrasonography in the differential diagnosis of benign and malignant thyroid nodules in the elderly.Methods The ultrasonography data of 117 elderly patients with thyroid nodules confirmed by surgery and pathology were analyzed retrospectively from Jan.2013 to Feb.2015.Their sonogram features were summarized.Results Among 117 cases,there were 82 cases (70.1 ％) with benign thyroid nodules and 35 cases (29.9％) with malignant thyroid tumors according to pathological diagnosis.The accordance rate of ultrasonography for diagnosing the benign and malignant thyroid nodules was 88.0％,and only 14 cases were misdiagnosed.Conclusions Ultrasonography has a good application value in the differential diagnosis of benign and malignant thyroid nodules in the elderly.

Objective To evaluate the effect of imatinib in improving myocardial fibrosis in uremic rats through regulating the expression of PDGFRα.Methods Seventy two rats were divided into three groups ,which were Sham group ,5/6 group and 5/6+I group .All The rats in 5/6 group underwent the 5/6 nephrectomy and the rats in 5/6+I group were given imatinib by ga‐vage after the operation of 5/6 nephrectomy .Hearts were harvested for HE and Sirius red staining at 8 weeks post surgery .The ex‐pression of PDGFRαwas assessed with immunohistological staining .The real‐time PCR was employed to detect the PDGFRαmR‐NA level in hear samples .Results The urine protein ,Scr ,BUN of the 5/6 group and 5/6+I group were higher than that of Sham group(P<0 .01) .The myocardial pathological score in Sham group was significantly lower than that of 5/6 group (P<0 .01) ,and the score in 5/6+I group was significantly lower than that of 5/6 group (P<0 .01) .The collagen volume fraction (CVF) in 5/6 group was significantly higher than that in Sham group (P<0 .01) .And the CVF in 5/6+ I group was higher than that in Sham group (P<0 .05) ,but lower than that of 5/6 group (P<0 .05) .The expression ratio of PDGFRαmRNA and staining rate in 5/6 group and 5/6+I group were both much higher than that in Sham group (P<0 .01) ,and the expression in 5/6+I group was signif‐icantly lower than that in 5/6 group (P<0 .05) .Conclusion These data suggest that the tyrosine kinase inhibitor imatinib reduces heart injury and attenuates myocardial fibrosis in uremic rat by mechanisms associated with the inhibition of the expression of PDGFRα.

Objective To study the characteristics of IL-1B-31/-511 single nucleotide polymor-phisms (SNPs) and the variable number tandem repeat (VNTR) in intron 2 of the IL-1ra gene (IL-1RN) in patients with HCV-related liver diseases .Methods The concentration of IL-1βand IL-1ra in serum sam-ples was measured by ELISA assay .The SNPs of IL-1B gene (-31C/T,-511C/T) from 310 cases with HCV infection and 324 unrelated healthy controls were determined by using gene chip analysis , and the results for some randomly selected specimens were compared with those by using polymerase chain reaction -restriction fragment length polymorphism ( PCR-RFLP) assay.The VNTR polymorphism of IL-1RN intron 2 was ana-lyzed by PCR-RFLP assay.The serum level of alanine aminotransferase (ALT), an indicator of hepatocellu-lar injury, was detected by ROCHE cobas 8000 analyzer.HCV replication was measured by using specific fluorescence PCR .The genotypes of HCV were determined by direct nucleotide sequencing test .Results Compared with control group, the serum level of both IL-1β[(22.6 ±7.3) vs (13.7 ±4.2)] pg/ml and IL-1ra [(286.30 ±55.10) vs (185.55 ±48.32)] pg/ml were significantly increased in patients with HCV infection ( P<0.01 ) .There were two predominant genotypes identified among 310 patients including HCV 1b (75.5%) and HCV 2a (22.3%).The serum level of IL-1βand IL-1ra in IL-1B-511T carriers from four groups including case group , mild and moderate Hepatitis C group , severe Hepatitis C , and cirrhosis and hepatocellular carcinoma (HCC) group were significantly higher than those from IL-1B-511CC carriers and control group (P<0.05).The ratio of IL-1ra to IL-1βin all IL-1B-511T carriers with HCV infection were lower than those from healthy controls (P<0.05).IL-1B-511T carriers with HCV genotype 1b infec-tion showed a higher serum level of IL-1βas compared with those with HCV genotype 1a infection ( P<0.05).Compared with control group, they also showed an increase in IL-1ra level (P<0.05).There was no significant difference in the serum level of IL-1βamong IL-1B-511CC carriers from each group ( P>0.05).The frequency of IL-1B-511TT genotype (P<0.05, OR=1.55, 95% CI =1.10-2.18) and IL-1B-511T allele (P<0.05,OR=1.31,95% CI=1.05-1.63) in patients with HCV infection were signifi-cantly higher than those in healthy controls .IL-1B-511C/T SNP showed a significant association with the outcomes of HCV infection (P<0.005).Compared with IL-1B-511CC and IL-1B-511CT, IL-1B-511TT was a major risk factor for mild and moderate Hepatitis C [ OR=2.17 ( 1.48-3.19 ) ] , severe Hepatitis C [OR=2.11(1.05-4.26)], cirrhosis [OR=2.98(1.77-4.99)] and HCC [4.33(2.16-8.67)].IL-1B-511 T allele was significantly associated with mild and moderate Hepatitis C [ 1.80 ( 1.38-2.36 ) ] , severe Hepatitis C [1.80(1.08-3.01)], cirrhosis [2.62(1.76-3.89)] and HCC [3.49(1.96-6.23)].The fre-quency of IL-1B-511T allele showed significant difference among each group (P<0.005).No association was found between any of the other polymorphisms and HCV infection .Conclusion The serum level of IL-1βand IL-1ra were significantly associated with HCV infection .IL-1B-511T allele in patients with HCV in-fection up-regulated the serum level of IL-1β.IL-1B-511TT and IL-1B-511T allele were major risk factors for mild and moderate Hepatitis C, severe Hepatitis C, cirrhosis and HCC, but IL-1B-511CC/C had oppo-site effects.

Objective To evaluate the value of CEUS in dynamicly assessing the blood perfusion of hepatic alveolar echinococcosis (HAE) in rats.Methods The experimentally induced secondary HAE in totally 70 rats were studied at different time periods (gth week,28th week,and 50th week) with CEUS,and compared to pathology results.Results At the 9th week,55 HAE lesions (55/70,78.57％) presented hyperechoic and the rest of 15 HAE lesions (15/70,21.43％)presented mixed echogenicity.The single or multiple vesicular structures were found as pathological feature.At later stages (28th week and 50th week),the size of lesions increased compared to 9th week with more solid structures and the calcifications found in HAE lesions.Microscopically,the fibrous tissues surrounding the lesions gradually thickened and the microvascular accumulation were visible around the lesions.The HAE lesions at the 9th week showed the ring enhancement and central septa enhancement in CEUS.The HAE lesions at the 28th week and 50th week showed combinations of no enhancement,ring enhancement,and central septa enhancement in CEUS.The ratio of edge enhancement to maximum diameter of lesions decreased with the progression (P=0.02).Conclusion The ultrasonographic features in HAE lesions become more complicated with increasing calcifications and enlarged necrosis areas with the progression.The CEUS can reveal the dynamics of blood perfusion of HAE lesions at different stages.

Single-supervisor system is the widespread practice for graduates of clinical medicine at present. But in terms of education to clinical medical graduate students, students rotate in the departments of various disciplines for a long time, and there are more rotary department, resulting in some students' unbalanced learning development. Combined with the charac-teristics of the department of hematology, multi-supervisors training model was carried out to the rotating masters of other disciplines when they rotated in hematology department. With supervisor equipment and teaching implementation, we applied the principle of integrating theory with practice and trained students' innovation ability and doctor-patient communication ability. Compared with traditional single supervisor training pattern, multi-supervisors system can effec-tively improve the students' theoretical level, practical skills and comprehensive ability when the clinical medical graduate students rotate in the department of hematology.

Objective To observe the therapeutic efficacy of all-trans retinoic acid(ATRA) combined with arsenic trioxide(As2O3) on acute promyelocytic leukemia(APL).Methods 9 patients of APL underwent ATRA with As2O3 therapy.The patients in combination group were treated with ATRA 25mg/(m2?d) and As2O3 10mg intravenously for 3 to 4 hours per day until complete remission(CR) or for 50 days.According to the white blood cell(WBC) counts,anthracycline and cytosine arabinoside(Ara-C) were added on third day.Results 6 newly-diagnosed and 2 relapse patients of the combination group were CR after first treat.The medium time to CR was 30.12?4.89 days.Conclusion ATRA + As2O3 with anthracycline regiment is superior to either regiment given alone to patients with APL.It is an efficient therapeutic approach to APL patients using a combination of ATRA with As2O3.

Objective To analyse the clinical characteristics,follow up their prognsis and evaluate the treatment of patients with Crohn' s disease (CD). Methods The data of patients with CD were collected at Zhongshan Hospital of Fudan University from 2002 to 2007. The diagnosis was made according to the consensus recommended by Chinese Society of Gastroenterology. The disease severity, follow-up and prognsis were evaluated according to the consensus. Results Sixty-six CD patients were enrolled in this study. The ratio of males to females was 2.47 : 1. Age at diagnosis ranged from 12 to 76 years old, and the mean age was (32 ± 17)years old. The main gastroenterological manifestations were abdominal pain (80.3 %), diarrhea (54.6 %), fistula formation (31.8%) ; and the main systemic manifestation was fever (80.3 %) and defective nutrition. A total of 60.6 % of patients with CD had complications and 34. 8% of these patients had more than one complications. Extraintestial manifastation were presented in 7.6% of patients with CD. A total of 86.4% of patients with CD were active state cases and 57. 6% were suffered from inflammation of ileum and colon. Abdominal pain (P = 0. 011), hematochezia (P = 0. 008), fever (P = 0. 001), anemia (P = 0. 020), underweight (P = 0. 010) and heightening of CRP (P = 0. 033) were more common in patients who were in active state than those who were in slient state. During their inducing alleviate treatment, 33.3% of patients with CD were treated with aminosalicylate alone, 36.4% were treated with both aminosalicylate and glucocorticoids, 7. 6% were treated with aminosalicylate, glucocorticoids and immunosuppressant. After medicine treatment, 6.8% of the patients relieved, 62.7% turned better, 28.8% were ineffective, 1.7% died, 55.9% recurd. And 21.2% were treated by surgical operation. A total of 42.4% of patients with CD had histroy of surgical operation and 9.1% were carried on more than one surgical operation.ConclusionsActive state patients with CD had high rate of complications, low extraintestial manifestatons, rare rate of dysplasia and canceration, and high rates of surgical operation and recurring.

Objective: To investigate the diagnostic values of separated renal multi-locular cystic lesions color Doppler ultra-sound and contrast-enhanced ultrasound performance in multi-locular cystic renal cell carcinoma and cysts. Methods:A total of 53 pa-tients (54 lesions) with multi-locular cystic renal cell carcinoma and cysts were included in the study. The presence of carcinoma and cysts was confirmed via histopathology and tested using ultrasound. Contrast-enhanced ultrasound was applied in 24 (24 lesions) of the total number of patients, and the receiver operating characteristic (ROC) curve was used to analyze the numbers of separation, thick-ness, and type of blood flow patterns of the lesions. The contrast-enhanced ultrasound characteristics were also analyzed. We analyzed the diagnostic value of the color Doppler ultrasound in the separated renal multilocular cystic lesions and the contrast-enhanced ultra-sound performance in multi-locular cystic renal cell carcinoma and cysts. Results:Based on the analysis of the ROC curves of the sepa-ration number, thickness, and type of the blood flow of the lesions in 53 patients (54 lesions), the diagnostic specificity was relatively higher in the lesions where the separation number was≥5 strips (86%), the thicknesses were>3 and≤4 mm (95%), and blood flow was band-like (86%). The areas under the curve of the three indexes were 0.7621, 0.8331, and 0.7962, respectively, which indicate high diagnostic values. The separation number of 4 strips, the thicknesses of>2 and≤3 mm, and the point-like blood flow could be used as critical values for the diagnosis. The contrast enhancement, enhancement peak, and disappearance were (11.2 ± 3.4), (21.7 ± 3.8), and (32.1±4.0) s in 14 patients with multi-locular cystic renal cell carcinoma and (18.4±4.5), (37.8±8.0), and (51.3±9.0) s in 10 patients with multi-locular renal cysts, with statistically significant differences (t=4.47, t'=5.90, t'=6.31, respectively;P<0.05). Conclusion:The sepa-ration number, thickness, and type of blood flow of lesions have relatively higher specificity in multi-locular renal cysts than in multi-locular cystic renal cell carcinoma. The ROC curves show a high diagnostic value. Contrast-enhanced ultrasound of the lesions helped in the differential diagnosis of multi-locular cystic renal cell carcinoma and renal cysts.

Objective To find the spectacular indexes in the diagnosis of acute rejection of renal transplantation with color Doppler ultrasonography. Methods Forty-two patients with renal rejection were confirmed with percutaneous needle biopsy and 115 patients with stable renal function were confirmed with following-up (>1 year) and clinical examination. The length, width, thickness, cortex thickness and resistive index (RI) of two groups were analyzed statistically. Then the specificity, sensitivity, misdiagnosis rate, false negative rate and consistency rate of renal volume, pyramid swelling, echo weakening, RI＜0.7, RI≥0.7 and RI≥0.8 were calculated. Results The length, width and thickness were statistically different in two groups (P＜0.05). In patients with renal rejection, the marginal blood vessels in renal cortex decreased, and the blood velocity reduced obviously in the diastolic phase and RI increased obviously (P＜0.05). The sensitivity of the above indexes were 55.30%, 55.20%, 42.10%, 57.90%, 31.60%, respectively, while the specificity were 71.30%, 87.10%, 25.70%, 74.20% and 98.20%, respectively. Conclusion Enlargement of renal volume, swelling of renal pyramids, echo weakening and RI increasing are specific indexes for diagnosis of acute rejection of renal transplantation.