Objective To study the role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating iatrogenic bile duct injury after laparoscopic cholecystectomy (LC).Methods A retrospective study was conducted on 45 patients with iatrogenic bile duct injury after LC who were investigated and treated by ERCP from December 2002 to August 2015.Results Using the StrasbergBismuth classification,there were 14 patients with type A and 4 with type C who were managed successfully using endoscopic nasobiliary drainage (ENBD) and interventional ultrasound abdominal localized puncture and drainage ; 7 patients with type D were managed successfully using endoscopic sphincterotomy (EST) and endoscopic retrograde biliary drainage (ERBD).For the 5 patients with type E Ⅰ and 3 patients with type E Ⅱ who were treated by EST and ERBD,one patient who had common bile duct transection required cholangioenteric Roux-en-Y anastomosis.For the 6 patients with type E Ⅲ and 6 patients with type EⅣ who were treated by EST and ERBD,a patient required a cholangioenteric Roux-en-Y anastomosis to achieve good results.Conclusions When iatrogenic bile duct injury is suspected after LC,correct assessment with ERCP should be taken immediately.ERCP when combined with ENBD and (or) ERBD could reduce bile duct pressure and dilate stenotic bile ducts to avoid further operation.

Objective To evaluate the correlation of the ion selectivity electrode assay and arsenazo Ⅲ assay for serum calcium determination and compare the differences between two methods.Methods 142 serum samples were collected from patients and detected by ion selectivity electrode assay and arsenazo Ⅲ assay,the differences of two methods were compared,person correlation and Bland -Altman was used to discuss the correlation.Results The serum calcium concentration detected by ion selectivity electrode assay was (2.23 ±0.10)mmol/L and detected by arsenazo Ⅲ assay was (2.24 ±0.12)mmol/L,the difference between the two methods was not statistically significant (t =-1.09,P >0.05).The person correlation analysis demonstrated that the two methods had a positive correlation (r =0.393,P <0.01).The Bland -Altman consistency analysis showed that ion selectivity electrode assay was agreed with arsenazo Ⅲ assay.Conclusion The two methods for serum calcium concentration determination,the ion selectivity electrode assay was coincidence with the arsenazo Ⅲ assay.

Objective To discuss the clinical manifestations and imaging diagnostic value of tuberous sclerosis accompanied by multi-organ injuries.Methods 2 cases in our hospital and 27 cases of tuberous sclerosis from the published reports were collected.The clinical manifestations and imaging features as well as the extent and type of multi-organ lesion were analyzed.Results Among the 29 patients,17 were male and 12 were female.The averaged age was 16.8.The clinical manifestations included:with family history in 6 , epilepsies in 25 (15 with mental retardation),symmetric angiofibroma in the face in 22 (3 with similar changes in the else body surface),fibromas beneath toenail or fingernail in 4, hyperdactylia of thumb in 2 and abdominal masses in 7 (4 with hematuria), tuberous scleroses beneath ependymal layer in 27,17 patients with kidney diseases,9 involved liver,5 involved spleen.Conclusion Multiple organs can be involved by tuberous sclerosis.The calcification of ependymal lyer and harmatoma of kidney are the most valuable in imaging diagnosis of the disease.

Objective To review and summarize the effects of interventional treatment of hand arteriovenous malformation in 5 cases.Methods Through catheterization of brachial artery ipsilaterally the blood-supply artery of arteriovenous malformation was embolized,using high-temperaure managed gelatin sponge,silk thread,pingyangmycine and spring coil.Results Total 13 blood-supply arteries in 5 cases were embolized with successful rate of 100%,including 1 case of complex malformation under effectively controlled,3 cases cured clinically and 1 case still awaiting observation.Conclusions Transcatheter arterial embolization for the treatment of hand arteriovenous malformation is safe,effective and high successful.(J Intervent Radiol,2007,16:277-279)

Objective To explore the diagnostic value of anti-cyclic citrullinated peptide (CCP) 3.1 IgG/IgA antibody detected by enzyme-linked immunosorbent assay (ELISA) in patients with rheumatoid arthritis (RA).Methods The ELISA was used to measure the anti-CCP3.1 antibody in the serum of 169 RA patients,100 patients with other rheumatic diseases (including systemic lupus erythematosus,Sjogren's syndrome and osteoarthritis) and 72 healthy controls.The diagnostic value of CCP3.1 was assessed and compared with the second generation of anti-CCP IgG (CCP2) antibody,the correlations between anti-CCP3.1 antibody and the clinical and laboratory parameters were analyzed.Two-independent samples t test,chi-square test and Spearman's correlation were adopted for statistical analysis.Results ① The average cut-off concentration of anti-CCP3.1 antibody was (1122±1429) U/ml in RA,(13±14) U/ml in other rheumatic diseases and (6±5) U/ml in healthy controls.② The area under curve of ROC for anti-CCP3.1 antibody and anti-CCP2 antibody were 0.923 and 0.936 respectively.There was no difference between the sensitivity (82％ vs 79％)and specificity (97％ vs 99％) of anti-CCP3.1 antibody and anti-CCP2 antibody.The Kappa values between anti-CCP3.1 antibody and anti-CCP2 antibody was 0.763.③ We also found that anti-CCP3.1 antibody was positive in 20％(7/35) of anti-CCP2 antibody negative,43％(18/42) of RF negative,62％(47/76) of AKA negative,71％(49/69) of APF negative and 13％ of autoantibodies negative patients,indicated that antiCCP3.1 antibody had a potential value in the diagnosis of serum negative patients with RA.④ The presence of anti-CCP3.1 antibody was correlated with RF,HRF-IgG,APF,AKA,GPI and IgA (P＜0.05),except disease activity.Conclusion The sensitivity of anti-CCP3.1 antibody is slightly higher than anti-CCP2 antibody.The Anti-CCP3.1 antibody is a very valuable parameter for the diagnosis of RA,especially in serum negative patients.

Problem-based Learning (PBL) is a teaching model originating from the construc-tivism theory, which stressed the meaning construction in problem situation by collaborative learning, conversation and completing knowledge. Based on the times background, development of learning theory, teaching situation, cognitive strategies, ideological connotation about constructivism, PBL's practical significance, its teaching forms, teaching resources, internal motivation, and the teaching evaluation were analyzed deeply, which was beneficial to carrying out PBL normatively in medical education, so as to provide the theoretical support for further exploration and innovation of PBL.

Acidosis, Renal Tubular ; complications ; diagnosis ; Child ; Diagnostic Errors ; Female ; Humans ; Medullary Sponge Kidney ; complications ; diagnosis ; Rickets ; diagnosis

Objective:To report the diagnosis and surgical treatment of a special type of Maisonneuve injury.Methods:A total of 4 patients were treated at Department of Orthopaedics, Beijing Chao Yang Hospital from January 2015 to July 2019 for Maisonneuve injury. They were 3 males and one female, aged from 34 to 61 years (average, 45.3 years). All injuries were closed, initially manifested as posterior dislocation of the ankle on X-ray films and X-ray and CT re-exams after manual reduction showed fine reduction with no obvious fracture of the ankle joint. Consequently the diagnosis of their Maisonneuve injury was missed in emergency visits, but re-exams in outpatient visits showed separation of distal tibiofibular syndesmosis. All the patients were treated by restoration of the fibular length, fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate functional recovery of the ankle joint at 12 months after operation.Results:All the 4 patients were followed up for 12 to 14 months (average, 12.7 months). The fractures united after 110 to 185 days (average, 149.3 days). No post-operative complications like infection, delayed union or nonunion were observed. The AOFAS score at 12 months ranged from 82 to 96 points (average, 90.5 points), giving 3 excellent and one good cases.Conclusions:The Maisonneuve injury which is clinically manifested as posterior dislocation of the ankle with no obvious fracture of the ankle joint is likely to be missed in clinical diagnosis. Therefore, X-ray exam of the full length tibia and fibula should be taken in physical examination after reduction for the patients with simple posterior dislocation of the ankle. Once the special type of Maisonneuve injury is diagnosed, surgical treatment is indicated. Satisfactory treatment efficacy can be achieved by fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament.

Laboratory animals and animal experiments are foundations and important support conditions for life sciences, especially for medical research. The animal experiments have drawn extensive attention from the society because of the ethical issue. This paper takes Wenzhou Medical University as an example to give a brief introduction to the ethical review about laboratory animals in the university so as to further draw attention and concerns from the public about the ethical issue of laboratory animals. We successively introduce its scientific projects, nurturing environment and ethical review of laboratory animals.
Animal Experimentation ; ethics ; Animals ; Animals, Laboratory ; Universities

Objective To explore the engrafted effect of NSCs combined with OECs on the motor function repair of hindlimbs in rats subjected to spinal cord transected injury.Methods The NSCs and OECs were isolated from the Transgenic Green Fluorescent Protein(GFP) embryo mouse' hippocamp and neonatal mouse' olfactory bulb.Rats were divided into NSCs group,OECs group and co-transplantation group as well as control group.The recovery of posterior limb motor function in rats subjected to spinal cord transected injurywas evaluated by the BBB locomotion score respectively in each weekend among eight weeks.This was followed by a histochemiscal observation to know the engrafted cells survival and migration in the spinal cord of host under the fluorescence microscope.Results The NSCs and OECs cells survived and migrated in the spinal cord of transplantation groups:the motor functional improvement of hindlimb in rats was seen in all cell transplanted groups;NSCs group,OECs group and co-transplantation group demonstrated a significant increase than that of control group at 3 and 4 weeks post operation(P 0.05).Conclusions The engrafted NSCs,OECs and co-transplantation can improve partly the motor function recovery of hindlimb in rats at 3 to 4 weeks following cord transection;The OECs group and co-transplantation have better effects than that of NSCs group,but there is no obvious difference between the OECs group and co-transplantation group at observed time point in this investigation.