ObjectiveTo investigate the predictive factors for acute cholangitis in patients with obstructive jaundice. MethodsA retrospective analysis was performed for the clinical data of 358 patients with common bile duct stones and obstructive jaundice who were treated in The Fourth People′s Hospital of Haikou from October 2010 to October 2015. According to the presence or absence of acute cholangitis, the patients were divided into acute cholangitis group(n=223) and obstructive jaundice group(n=135). Age, sex, and comorbidities were compared between the two groups, and the association between abnormalities in serum tumor markers and liver function parameters and the development of acute cholangitis was examined. The parameters with statistical significance were used to establish the receiver operating characteristic (ROC) curves, and their sensitivity and specificity in the diagnosis of acute cholangitis were evaluated. The t test and χ2 test were applied for comparison of continuous data and categorical data between groups, respectively. ResultsThe acute cholangitis group had significantly higher serum levels of CA19-9 and CA12-5 than the obstructive jaundice group (serum level of CA19-9: 82.33±23.01 kU/L vs 36.75±12.58 kU/L, t=11.028, P＜0.05; serum level of CA125: 30.21±9.59 kU/L vs 18.62±5.27 kU/L, t=8.597, P＜005). The analysis of the ROC curves showed that the areas under the ROC curve for serum CA19-9 and CA12-5 were 0.891 and 0705, respectively, and the corresponding cut-off values for the highest diagnostic accuracy were 61.01 kU/L and 22.56 kU/L, respectively, with sensitivities of 82.1% and 77.6% and specificities of 79.8% and 69.5%. ConclusionIncreased serum CA19-9 level has a great value in predicting acute cholangitis in patients with common bile duct stones and obstructive jaundice.

Objective To explore the diagnostic and score value of ultrasound on hemophiliac arthropathy referring to MRI on the diagnosis and score of hemophiliac arthropathy Methods The ultrasound and MRI examinations were performed on 42 joints of 42 hemophilia patients 14 knees 14 ankles and 14 elbows The consistency of ultrasound and magnetic resonance imaging in the detection and score of joint diseases was compared Finally inter-and intra-observer agreement of ultrasound scoring system were tested Results The consistency of ultrasound and magnetic resonance imaging was excellent κ=0 763-0 896 P < 0 001 in the detection of early soft tissue lesions effusion or hemarthrosis synovial hypertrophy hemosiderin excellent κ=0 793 P <0 001 in the detection of cartilage loss poor κ=0 133 P = 0 132 in the detection of erosions and poor κ= 0 100 P = 0 137 in the detection of subchondral cysts The consistency of ultrasound and magnetic resonance imaging was good to excellentκ=0 684-0 833 P < 0 001 in the score of early soft tissue lesions effusion or hemarthrosis synovial hypertrophy and hemosiderin and poor to good κ=0 145 -0 635 P <0 001 in the score of advanced osteochondral lesions cartilage loss and bone erosions The inter-observer agreement was good to excellent κ=0 676-0 870 P <0 001 for early soft tissue lesions and moderate to excellent κ=0 421- 0 75 1 P < 0 001 for advanced osteochondral lesions The intra-observer agreement was good to excellent κ=0 705-0 885 P <0 001 for early soft tissue lesions and moderate to good κ=0 532 -0 732 P <0 001 for advanced osteochondral lesions Conclusions Ultrasound plays an important role in detecting early soft tissue changes effusion or hemarthrosis synovial hypertrophy hemosiderin and cartilage loss which helps follow-up and guide clinical treatment.

Objective To investigate the effect ofcranioplasty on prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.Methods One hundred and forty-four patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy (first-stage operation) in our hospital from January 2013 to June 2017 were chosen;there were 56 patients without cranioplasty in the control group and 88 patients with cranioplasty (second-stage operation) in the observation group.The degrees of coma before first-stage operation were assessed by Glasgow coma scale (GCS).The general state three months after first-stage operation was assessed by GCS and activity of daily living (ADL) scale.The prognoses of these patients 9 and 15 months after first-stage operation were assessed by Glasgow outcome scale (GOS) and ADL scale.The clinical data,prognoses and incidence of hydrocephalus of patients from the two groups were compared.Related factors associated with hydrocephalus were analyzed by multivariate Logistic regression analysis.Results GCS,GOS and ADL scale scores in the observation group 9 and 15 months after first-stage operation were all significantly higher than those in the control group (P＜0.05);incidence of hydrocephalus in the observation group after first-stage operation (31.82％) was significantly lower than that in the control group (62.5％,P＜0.05).Logistic regression model revealed that cranioplasty,Hunt-Hess grading and Fisher grading were independent related factors for incidence of hydrocephalus (P＜0.05);cranioplasty was the protective factor of hydrocephalus (OR=0.126),and Hunt-Hess grading and Fisher grading were the risk factors of hydrocephalus (OR=5.311 and 5.073).Conclusion Cranioplasty can reduce the incidence of hydrocephalus and improve the prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.