Objective To investigate the clinical values of CA199 ,CA242 and DKK1 in diagnosing pancreatic cancer (PCA). Methods The serum levels of CA199 ,CA242 and DKK1 were measured with ECLIA and ELISA method in 112 patients with PCA ,58 patients with benign pancreatic disease and 62 individuals undergoing physical examination.The Kruskal-Wallis single fac-tor analysis of variance (ANOVA) and Mann-Whitney rank-sum test were adopted to conduct the statistical comparison.The ROC curve was drawn by using the Logistic regression model and the area under curve (AUCROC ) was calculated.Results The levels of serum CA199 ,CA242 and DKK1 in the patients with pancreatic cancer were significantly higher than those in the benign pancreatic disease group and healthy normal control group ,the difference was statistically significant ( H=76.30 ,61.2 ,47.60 ,P<0.05);the sensitivities of CA199 ,CA242 and DKK1 for diagnosing pancreatic cancer were 76.7% ,69.6% and 85.7% respectively ;the speci-ficities were 95.0% ,96.7% and 92.5% respectively ;the accuracies were 86.2% ,83.6% and 89.2% respectively.The sensitivity , specificity and accuracy of combined detection of CA 199 ,CA242 and DKK1 by the Logistic regression equation P= 1/[1 +e-(-4.163+0.21X1+0.156X2+0.342X3) ] were 94.4% ,90.8% and 92.2% respectively ;AUC of CA199 ,CA242 ,DKK1 and pre-1 were 0.736 , 0.862 ,0.886 and 0.949 ,respectively.Conclusion Serum CA199 ,CA242 and DKK1 levels have an important value in the diagnosis of pancreatic cancer ,and their combined detection could significantly improve the sensitivity and accuracy of pancreatic cancer diag-nosis.

Objective To summarize our preliminary experience and evaluate the clinical value of laparoscope diagnosis and treatment for annular pancreas in neonates.Methods A retrospective review of laparoscope diagnosis and treatment for annular pancreas in 9 children from September 2009 to January 2013 was performed.Among them,5 were male,4 were female.The age was ranging from 1 to 13 d.A lowerpressure pneumoperitoneum of 5 ～ 8 mm Hg (1 mm Hg =0.133 kPa) was used.Eight cases of diamond duodenal anastomosis were performed under laparoscope after the diagnosis was established,and 1 case underwent procedure through slightly enlarged umbilical port site.Results Eight cases of diamond duodenal anastomosis were performed under laparoscope,and the operation time was 80 ～ 140 min (mean 105 min),in 1 case it was performed through umbilical port incision,the operation time was 64 min,and the length of incision was about 2.5 cm.Feedings were started at postoperative day 4 to 7 (mean 5 d),and patients were discharged at postoperative day 8 to 14 (mean 10 d).The cases were followed-up for 3 ～ 20 months (mean 6.7 months),and I case complicated with anal atresia died of pneumonia 6 months later.Other cases were uneventfully recovered and symptoms were alleviated with normal gastroenterological function,no preoperative symptoms recurred,and the nutrition and growth status was excellent.Conclusions Annular pancreas can be diagnosed through laparoscopy.Laparoscope diagnosis and treatment for annular pancreas has the advantages of small incision,micro-invasion and faster recovery,can be safely performed in neonatal period.

Objective To study the relationship between breast symptom, characteristic of ultrasound image and sex hormone level in women with different menstruation status.Methods 50 women with normal men-strual cycle, 129 women in menopause transition and 318 menopausal women were recruited.Breast ultrasound were performed.Breast section thickness, ductal width, breast structure and blood flow were measured.Serum estradiol( E2 ) and progesterone( P) level were measured by enzyme immunoassay on the day when ultrasound was performed.Onset and persistent days of breast pain were recorded.Results ①32(60.4%)women with normal menstrual cycle and 74(57.4%)women in menopause transition women experienced cyclic mastalgia.The aver-age serum E2 level and serum progesterone level were higher in women with cyclic breast pain than in women with-out breast pain.12.5%of menopausal women had breast pain.There was no significant difference of average ser-um E2 level between women with cyclic breast pain and women without breast pain②Breast section thickness was (14.4 ±4.3)mm,(13.0 ±3.7)mm and(10.6 ±3.2)mm, and ductal width was(0.62 ±0.18)mm,(0.88 ± 0.39)mm and(0.90 ±0.47)mm in normal menstrual group, menopause transition group and menopausal group, respectively.The difference had statistical significance.③26 women ( 49.1%) in normal menstrual group had breast structure changes, while 42 cases ( 32.6%) and 60 cases ( 18.9%) in menopause transition group and menopausal group had breast structure changes.Conclusions Most women in normal menstruation and meno-pause transition group experience mastalgia.About 1/3 breast structure change in women of normal menstruation are inversible.About 1/2 breast structure change in menopause transition and menopausal group are similar to those with normal menstruation.

Objective To observe the effect of ageand menstrual statuson body composition in healthy Beijing women.Methods We measured body composition with dual-energy X-ray(GE Lunar Prodigy)in 316 healthy Beijing females aged 20 to 74 years(5-7 cases per age).Parameters provided by the software were as following:total body bone mineral content,lean mass,fat mass and fat percentage(% fat).Local regions measured included arm,leg,trunk,android region and gynoid region.Body mass index (BMI),fat mass index(FMI),free fat mass index(FFMI)and A/G were calculated.Volunteers were assigned to 6 groups according age by every ten years a group.Results BMC peaked during the 4th decade,LM peaked during the 5th decade,with a decline of 18.1%and 5.2%respectively at age 74 years.Total body fat mass and % fat showed a general increase with aging throughout the studied age range.Total body fat mass increased from 16±5 kg at age 20-29 years to 24±6 kg at age 70-74 years,while % fat increased from 31.3%to 39.5%.All local region % fat increased with aging at different extents.Android region % fat showed the largest raise extent(32.2%).BMI increased gradually from 21.1 kg/m2 at age 20-29 years to 26.1 kg/m2 at age 70-74 years.FMI changed more obviously than FFMI.A/G increased from 0.85 at age 20-29years to 1.02 at age 70-74 years.Different menstrual status in women of 40-59 vears had obvious eflfect on A/G and BMC(P＜0.05),while it had no significant effect on BMI.body weight and waist circumference(P＞0.05). Conclusions Aging and menstrual status have evident effect on body composition distribution in healthy Beijing women.

OBJECTIVETo investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants.

METHODSBetween September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months(mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration, cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis.

RESULTSAll the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min(mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes.

CONCLUSIONLaparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.

Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Intestinal Atresia ; surgery ; Laparoscopy ; methods ; Male ; Retrospective Studies ; Treatment Outcome

Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.

Objective． Bone mineral density（BMD） was measured in normal Chinese women with single X-ray absorptiometry （SXA） and dual energy X-ray absorptiometry （DEXA）． These two methods were compared to evaluate the sensitivity in reflecting bone loss．Methods． Measurements were performed in 300 women aged 20～79（5 for each age）． The 8mm distal，1／4 distal， ultra distal site of the nondominant forearm were measured with SXA； the AP spine（L2-4）， right femoral neck（Neck）， Ward's triangle（Ward）and trochantor （Troch） were measured with DEXA． Ten women had 5 repeated measurements to evaluate the reproducibility of the equipments．Results． The BMD peak for Neck and Ward was found between age 20～29， for ultra distal and L2-4 at age 30～39， for 8mm distal， 1／4 distal and Troch at age 40～49． After reaching the peak values， BMD at all sites decreased with increasing age． The highest rate of yearly loss of BMD was at 8mm distal． Results of measurement showed significant correlation between SXA and DEXA． Comparing with premenopausal women， the bone loss rate in postmenopausal women was faster and highest up to 11～15 years and the highest rate was at the Ward．Conclusion． The present study gives the normal values of BMD at seven sites for normal Chinese women． The ages of BMD peak were different at seven sites． The yearly loss of BMD was highest at 8mm distal， it seemed to be the sensitive region for bone loss with age． The postmenopausal women had highly significantly loss bone mass than the premenopausal women． Comparing with premenopause， postmenopause BMD for Ward's triangle with DEXA seemed to be most sensitive to the effect of menopause．

OBJECTIVETo identify the optimal dosage of 17beta-estradiol gel + oral progestin for preventing bone loss in postmenopausal Chinese women.

METHODSA 3-year open label, randomized, prospective clinical trial was conducted. Sixty healthy women who had been postmenopausal for 1 to 5 years were recruited and divided into following 4 groups: group 1, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus micronized progesterone (MP) 100 mg/d; group 2, percutaneous gel 17beta-estradiol (E(2)) 1.5 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d; group 3, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus micronized progesterone (MP) 100 mg/d; and group 4, percutaneous gel 17beta-estradiol (E(2)) 0.75 mg/d plus medroxyprogesterone acetate (MPA) 2 mg/d. Estrogen and progestin were given continuously for 25 days per month. Bone mineral density (BMD) was measured using quantitative computed tomography (QCT) for trabecular bone of L2-5 and dual energy X-ray absorptiometry (DEXA) for L2-4 and hip 5 times during the trial at baseline and at the 6-, 12-, 18-, 24- and 36-month visits.

RESULTSFifty-nine patients (98.3%, 59/60) stayed in the study for 1 year, 56 patients (93.3%, 56/60) for 2 years, and 51 (85%, 51/50) for 3 years. On average, menopausal symptoms were relieved by 80% after 6 months of treatment. By the 24th month, the mean increase in BMD ranged from 4.3% to 7.5% in trabecular bone; and by the 36th month, it ranged from 4.2% to 6.2% in L2-4 and 1.61% to 3.77% in the neck. There were significant difference after treatment (P < 0.05). Among the four groups, no significant difference (P > 0.05) was found in improvement of symptoms, levels of bone markers or BMD.

CONCLUSIONA daily dose of estradiol gel, either 0.75 mg or 1.5 mg, is effective in preventing early postmenopausal bone loss and relieving menopausal symptoms. After 3-year treatment, spinal BMD could increase steadily, so does hip BMD, especially in the first 2 years.

Administration, Cutaneous ; Adult ; Bone Density ; Estradiol ; administration & dosage ; Estrogen Replacement Therapy ; Female ; Fractures, Bone ; prevention & control ; Humans ; Medroxyprogesterone Acetate ; administration & dosage ; Middle Aged ; Osteoporosis, Postmenopausal ; prevention & control

Objective:To explore the initial experience of thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm.Methods:A retrospective review of the new simplified technique in 10 cases from March 2015 to October 2017 was performed.Of the patients, 6 cases were male, 4 cases were female.The age was 10min-1d, 7 cases were term newborns, and 3 cases were premature.The mean weight was 2.88 kg(ranged 2.3-3.5kg). All the 4 cases were left-sided.Two to three primary suture sites were taken from the relative intercostal region of the body surface projection of the defect.A snip incision about 1 mm of the skin was done.Two 2-0 non-absorbable sutures round the rib were inserted between the front edged of the defect and the diaphragm muscle through a syringe needle.The first thread was brought out of the body by the ring of the second thread and knot tying was made extracorporally.The posterolateral defect was closed; the knot was under the skin of intercostals space.Results:Ten neonates with CDH were repaired successfully using this new simplified technique.The mean operative time was 37.5min(ranged 25-60min) for each CDH repair.No cases required conversion to open surgery, blood loss was minimal.The 10 cases were followed up for 16.5 months(ranged 5-24 months), with no death and no recurrence.One neonate complicated with subcutaneous emphysema postoperatively and healed in one week.Conclusion:The new technique of thoracoscopic repairing with simplified mattress sutures when no posterolateral rim of diaphragm exists has all the advantages of thoracoscopy in neonates combined with the advantages of reduced operative time, simplicity, feasibility and definite curative effect and has the value of clinical popularization.

Objective To investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants. Methods Between September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months (mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration , cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis. Results All the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min (mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes. Conclusion Laparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.