Objective To investigate the clinical value of combined detection of H‐FABP with cTnI in the diagnosis of myo‐cardial damage caused by hypoglycemia .Methods Levels of blood H‐FABP and cTnI were examined at 0 to 3 h ,24 h ,48 h after hy‐poglycemia diagnosed ,and were compared with the control group .The levels of H‐FABP and cTnI at 24 h after hypoglycemia diag‐nosed were compared among different groups separated according to the decreasing extent of blood sugar (1 .0 to 2 .1 mmol/L ,<1 .0 mmol/L group) ,the duration of hypoglycemia (< 24 h ,≥ 24 h group) and clinical feature of hypoglycemia (symptom and no symptom group) .The sensitivity and specificity of H‐FABP and cTnI in myocardial damage was also statistical analyzed in this study . Results The statistic difference of the increasing H‐FABP levels was found for 0 to 3 h(P<0 .01) and 24 h (P<0 .01) ,but not found for 48 h(P>0 .05) .The statistic difference of the increasing cTnI levels existed for 24 h (P<0 .01) and 48 h (P<0 .01) ,but not for 0 to 3 h (P>0 .05) .The increasing extent of H‐FABP and cTnI levels was obvious for group with blood sugar <1 .0 mmol/L ,duration of hypoglycemia ≥24 h and have hypoglycemia symptom ,these data have obvious statistic difference compared with other groups(P<0 .05 ,P<0 .01 ,P<0 .01) .The sensitivity and specificity of H‐FABP methods were higher than those of cTnI ac‐cording to the 0 to 3 h and 24 h detection data ,while the opposite result was found for 48 h .Conclusion Combined detection of H‐FABP with cTnI could be well applied in the diagnosis of myocardial damage caused by hypoglycemia .

The evaluation systems for chronic venous insufficiency of lower extremities play a very important role in standardizing the diagnosis and evaluating the curative effect in patients with the disease. This paper gives an introduction to the CEAP classification system, VSS evaluation system and chronic venous insufficiency questionnaire.

Objective To evaluate effects of two different preoperative biliary drainages on patients of malignant obstructive jaundice complicated with acute cholangitis.Methods Retrospective analysis was made on effects of two preoperative biliary drainages of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) and endoscopic nasobiliary drainage (ENBD) in cases of malignant obstructive jaundice complicated with acute cholangitis.Results Days of preoperative drainage(t =3.217,P ＜ 0.05) and declines of bilirubin level after drainage (t =3.178,P ＜ 0.05) were significantly better in ENBD group (26 cases) than PTCD group (22 cases).There were no significant differences between two groups in operation time length and intraoperative blood loss after drainage.However,postoperative hospital stay (t =2.542,P ＜ 0.05) and overall stay (t =3.172,P ＜ 0.05) were significantly shorter in ENBD group compared with PTCD group.Conclusions When preoperative biliary drainage is indicated in the cases of malignant jaundice before radical surgery,ENBD should be the first choice over DTCD.

Objective To investigate the difference of nerve behavior among the different types of fullterm small for gestational age infants(SGA) infants and the reasons.Methods The neonatal behavioral neurological assessment(NBNA) scores were given for 148 full-term SGA infants aged 7,14 and 28 days born in Affiliated Hospital of Hebei University.The comparason analysis was conducted among three types including symmetic,asymmetric and the mixture of them.Results Significant differences (P ＜ 0.05) were found between the NBNA scores for full-term SGA infants and normal infants.The NABA scores of full-term SGA infants were lower than those of normal infants.The NBNA scores for three types of full-term SGA infants followed the order of asymmetric ＞ symmetric ＞ mixture of them,significant difference was found between any two types of three types(P ＜ 0.05).Conclusion Full-term SGA infants show the poorer quality of nerve behavior compared with the nomal infants.The neurodevelopment levels for three types of full-term SGA infants are asymmetric,symmetric,mixture of them in the order.

Objective To analyze the diagnosis and prognosis value of abdominal CT scans in patients with acute pancreatitis complications.Methods 151 cases with acute pancreatitis were selected.The relationship between abdominal CT performances and the common complications and death in patients was analyzed.The prognosis of patients with different Balthazar CT severity index (CTSI) grade was compared.Results The complication rate of patients with CT signs of fatty liver, pleural effusion, liver gap effusion, adrenal gland involvement (AGI), penirenal space involvement (PSI) and gastric bare area involvement (GBAI) was significantly higher than that of patients with negative CT findings above (P<0.05).With CTSI grading increasing, the patient''s fasting time, heating time, hospital stay, recovery time of blood amylase were extended, and the incidence of pseudo cyst, transit surgery, organ failure and death was gradually increasing (P<0.05).Conclusion Severe fatty liver, AGI, GBAI, PSI and liver gap effusion are risk factors for acute complications and death in patients with pancreatitis.

Objective To investigate the application value of percutaneous sinus-tract cholangioscopy in the diagnosis and treatment of residual intra-and extra-hepatic bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 1 045 patients with intra-and extra-hepatic bile duct stones who underwent percutaneous sinus-tract cholangioscopy or stone extraction in the Second Affiliated Hospital of Zhejiang University from January 2003 to June 2016 were collected.Patients received percutaneous sinus-tract cholangioscopy or stone extraction at 6-8 weeks after T tube drainage.Observation indicators:(1) diagnosis and stone extraction situstions:cases with residual stones,stone extraction frequency and clearance rate;the critics of clearance rate are no residual stone dnring operation combined with B ultrasound or T-tube cholangiography;(2) postoperative complications:incidence and management of postoperative complications,prognosis and ClavienDindo classification for postoperative complication;(3) follow-up situation.T-tube was removed when there was no residual stone.Patients were followed up by outpatient examination up to April 2017.B ultrasound reexamination was performed to detect the recurrence of stone once every 3-6 months.Results (1) Diagnosis and stone extraction situstions:among 1 045 patients,results of cholangioscopy showed 147 wihout bile duct stones and 898with bile duct stones.Of 898 patients,2 618 times cholangioscopic explorations for stone extraction were performed,with a maximum frequency of 16 times,and 851 had stones clearance,with a overall clearance rate of 94.77％(851/898).The clearance rates of extra-and intra-hepatic bile duct stones were 100.00％(221/221) and 93.06％(630/677).Of 47 patients with residual stones,16 didn't receive cholangioscopy due to branches stricture or occlusion of intrahepatic duct,13 failed to take out stone due to T-tube dislodgement (9 cases) and improper placement (4 cases) induced closed T-tube sinus tract,7 had T-tube sinus tract duodenal fistula,6 gave up stone extraction,3 was due to longer sinus tract induced bending and 2 was due to T-tube sinus tract fracture.(2)Postoperative complications:among 1 045 patients,297 had level Ⅰ-Ⅱ mild complications and 13 had level Ⅲand above severe complications.The common complications included fever,vomiting,diarrhea and so on;the special complications included T-tube sinus tract duodenal fistula of 13 patients,T-tube sinus tract fracture of 4 patients,rupture of broken stones pole of 3 patients,massive hemobilia of 2 patients,acute pancreatitis of 2patients and cardiac arrest of 1 patient.The above complications were improved by symptomatic and supportive treatments.(3) Follow-up situation:among 1 045 patients,558 received long-term follow-up,with follow-up time of 10-171 months and a median time of 79 months.Eight-four patients had stone recurrence.Of 13 patients with recurrence of extrahepatic bile duct stones,7 took out stones by endoscopic retrograde cholangio pancreatography (ERCP) and 6 underwent reoperations.Of 71 patients with recurrence of intrahepatic bile duct stones,43underwent reoperations and 28 received conservative treatment.Conclusions Percutaneous sinus-tract cholangioscopy for residual intra-and extra-hepatic bile duct stones is safe and effective,with good diagnosis and treatment values and a high clerance rate.The integrity of T-tube sinus-tract is a key of complete stones removal.

AIM: To further investagate the mechanism of thrombus formation and develop a new remedy of anti-thrombus formation. METHODS: The amplified DNA fragment of vWF-A1 domain was inserted into expression vector with 6?his taq (pQE-31), the recombinant expression vect or was transformed into E coli (strain M15) and induced by IPTG. The recombinant fragment, comprising residues 449-728 of mature vWF subunit, designate rvWF-A1. It was purified by Ni-NTA agarose column and renatured by Tris buffer containin g GSH and GSSG. FACS and platelet aggregometer were employed to analyse the rvWF -A1 function of binding to platelet glycoprotein Ib and inhibiting ristocetin-in duced platelet aggregation. RESULTS: The rvWF-A1 was expressed successfully in E coli, comin g up to 30% of total bacterial protein. Its purify was over 95% through Ni-NTA a garose. It was identified to have ability to bind to GPIb, its biologic activity to inhibit ristocetin-induced platelet aggregation was observed, and the inhibi tive rate was 84 7%. CONCLUSION: The above results indicated that high-level expressi on of rvWF-A1 was successfully achieved in E coli and rvWF-A1 may be an effectiv e antithromotic agent in preventing thrombus formation.

Objective To evaluate the diagnosis and treatment of residual gallbladder.Methods The diagnosis of residual gallbladder depends on a history of previous cholecystectomy and postoperative existent symptoms suggesting cholecystitis.In this series the diagnosis was finally established by ultrasonography and laparotomy in 52 cases.Results Ten cases received laparoscopic residual cholecystectomy,32 cases underwent residual cholecystectomy,7 cases did residual cholecystectomy plus common bile duct exploration,1 case was treated with residual cholecystectomy,common bile duct exploration and left lateral lobe hepatectomy,1 case with residual cholecystectomy,common bile duct exploration,cholangioenterostomy,1 case by radical resection of residual gallbladder cancer.Conclusions Residual gallbladder is a secondary disease,diagnosis is not difficult,surgery has certain difficulty,the application of intraoperative ultrasound and choledochoscope has great value.

Objective To determine the power-time-ablation scope correlogram of a water-cooled single needle electrode radiofrequency (RF) ablation system and to establish a theoretical basis for its practical application.Methods RF ablations were performed using a water-cooled single needle electrode radiofrequency ablation system developed by the authors using fresh ox liver as well as liver and muscles of healthy adult New Zealand white rabbits.The temperature of the ablation area was monitored using a multichannel thermometric system.The maximum ablation scope was determined by detecting the rim at which the temperature was no less than 50 °C.The specific absorption rate (SAR) of the isolated liver tissue was calculated.Results In the treatment voltage range of 100-130V,the process was smooth and steady.No impedance variation was obvious.The maximum diameter of a single ablation was 51 cm.With the treatment voltage at 140-170 V,a larger ablation area could be reached in less time,but eventually the impedance began to increase while the ablation area was no longer expanded.When the treatment voltage reached the range of 180-200 V the impedance almost always increased rapidly out of limits,and the treatment system stopped automatically.The measured SAR value was consistent with the theoretical value.Pathology confirmed that both liver tissue and muscle tissue manifested typical coagulative necrosis.Conclusions The power amplifier,cooling,thermometric and control sections of the RF ablation system worked stably,and the practical ablation effect met the design and clinical treatment requirements.

OBJECTIVETo probe therapeutic effects of centro-square needling and triple needling on ankylosing spondylitis.

METHODSSixty cases of spondylitis were randomly divided into a treatment group and a control group. The treatment group were treated with centro-square needling and triple needling, and the control group with routine acupuncture therapy, with motortherapy combined in the two groups.

RESULTSBoth the therapeutic methods were effective, but the therapeutic effect in the treatment group was significantly better than that in the control group (P < 0.05).

CONCLUSIONAcupuncture combined with motortherapy has definite therapeutic effect on ankylosing spondylitis, with centro-square needling and triple needling having better therapeutic effect.