Objective:To investigate the diagnostic value of CT myocardial perfusion combined with serum cystatin C (CysC) and galectin-3 (Gal-3) for coronary heart disease (CHD) and its correlation with coronary artery disease.Methods:The clinical data of 126 patients with CHD (CHD group) and 126 patients with suspected CHD but excluded CHD by coronary angiography (control group) in Shanxi Provincial General Hospital of Armed Police Force from May 2018 to May 2020 were retrospectively analyzed. CT myocardial perfusion myocardial imaging was performed in both groups, and blood perfusion (BF) and mean transit time (MTT) were calculated. The serum Gal-3 was detected by enzyme-linked immunosorbent method, and the serum CysC was detected by immunoturbidimetric method. The changes of indexes in 2 groups and in CHD patients with different degrees of coronary artery stenosis and number of diseased branches were compared. Logistic regression was used to analyze the influencing factors of CHD; Pearson correlation was used to analyze the relationship between BF, MTT, CysC, Gal-3 and the degree of coronary artery stenosis and the number of diseased branches in patients with CHD; the receiver operating characteristic (ROC) curve was drawn, and the effectiveness of each index in diagnosing CHD was analyzed. The area under curve (AUC) was compared by DeLong test, and the combined diagnosis was performed by Logistic binary regression fitting.Results:The BF in CHD group was significantly lower than that in control group: (102.30 ± 9.25) ml/(100 g·min) vs. (119.97 ± 12.08) ml/(100 g·min), the MTT, CysC and Gal-3 were significantly higher than those in control group: (17.23 ± 3.04) s vs. (5.38 ± 1.29) s, (0.98 ± 0.24) mg/L vs. (0.73 ± 0.18) mg/L and (55.27 ± 16.42) ng/L vs. (16.93 ± 5.75) ng/L, and there were statistical differences ( P<0.01). Logistic regression analysis result showed that BF, MTT, CysC and Gal-3 were the influencing factors of CHD ( P<0.01). ROC curve analysis result showed that the AUC of BF, MTT, CysC combined with Gal-3 in the diagnosis of CHD was the largest (0.879), with a specificity of 84.92% and a sensitivity of 80.95%. In patients with CHD, with the aggravation of coronary artery stenosis and the increase of the number of diseased branches, the BF decreased gradually, the MTT, CysC and Gal-3 increased gradually, and there were statistical differences ( P<0.05). Pearson correlation analysis result showed that the BF had negative correlation with the degree of coronary artery stenosis and the number of diseased branches in patients with CHD ( r=-0.592 and -0.573, P<0.01), and the MTT, CysC and Gal-3 had positive correlation with the degree of coronary artery stenosis and the number of diseased branches (MTT: r = 0.695 and 0.674, P<0.01; CysC: r = 0.546 and 0.519, P<0.01; Gal-3: r = 0.628 and 0.609, P<0.01). Conclusions:CT myocardial perfusion imaging indexes (BF and MTT), serum CysC and Gal-3 levels are related to the degree of coronary artery stenosis and the number of diseased branches in patients with CHD. The combined detection of various indicators can improve the diagnostic value and provide a certain basis for clinical diagnosis and treatment and disease monitoring.

Objective To explore how to prevent biliary duct injury during laparoscopic cholecystectomy.Methods The clinical data of 484 cases of laparoscopic cholecystectomy from December 2002 to December 2007 were retrospectively analyzed,and the experiences of preventing biliary duct injury were summarized.Results No biliary duct injury case was found but 26 cases were converted to laparotomy during operation and 20 cases were placed drainage tube.Conclusion Familiar with the anatomy of bile duct,careful handling of the Calot's triangle are the keys to prevent biliary duct injury in LC.

Objective To study the preventive effect of biliary duct injury(BDI)of three-dimensional spiral CT cholangiography(SCTC)before laparoscopic cholecystectomy(LC).Methods A retrospective analysis was carried out for 30 patients suffering from cholelithiasts concurrent with choledocholithiasis from July 2007 to June 2009.EAndoscopic sphincterotomy(EST),then three-dimensional SCTC was carried out through endoscop-ic nasobiliary drainage(ENBD)before IX,and the preventive effect of BDI was evaluated.Results The visibility of intra-hepatic bile duct,the hepatic bile duct and the common bile duct were 100% the visibility of chol-ecyst bile duct was 73% ,and three-dimensional SCTC can tell the position of cholecyst duct,BDI was not happened in all these patients.Conclusion Three-dimensional SCTC before LC can decrease the possibility of BDI.

ObjectiveTo study the preoperative evaluation of three-dimensional spiral CTcholangiography(SCTC) in patients with bile duct obstruction.MethodsA retrospective analysis was performed for 60patients with bile duct obstruction from May 2008 to April 2011,who were treated with endoscopic retrograde cholangiopancreatography( ERCP),then SCTC was performed through endoscopic nasobiliary drainage( EN-BD) tube,and the bile duct tree image of SCTC of bile duct obstruction was evaluated.ResultsIn 60 cases of bile duct obstruction who performed three-dimensional SCTC,the left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,cholecyst bile duct was visible in 80％ patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enters into the common bile duct.ConclusionThree-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values in judging the structure of the bile duct tree and the shape of cholecyst bile duct during operation.

Objective To evaluate of three-dimensional spiral CT cholangiography to bile duct configuration before laparoscopic cholecystectomy.Methods A retrospective analysis was performed for 60 patients with cholelithiasts concurrent with choledocholithiasis from May 2009 to April 2012,which were treated with endoscopic retrograde cholangiopancreatography (ERCP),endoscopic sphincterotomy (EST),and endoscopic nasobiliary drainage (ENBD),then three-dimensional spiral CT cholangiography(SCTC) was performed through endoscopic nasobiliary drainage (ENBD) tube,and the bile duct tree image of SCTC was evaluated,then laparoscopic cholecystectomy (LC) was carried out.Results Sixty cases were performed three-dimensional SCTC.The left and right hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100％ patients,and cholecyst bile duct was visible in 75％patients,and three-dimensional SCTC can tell the position of cholecyst duct and the place where the cholecyst bile duct enteres into the common bile duct.Conclusion Three-dimensional SCTC can show the shape of bile duct tree,especially the cholecyst duct,and has some guidance values to judge the structure of the bile duct tree and the configuration of cholecyst bile duct during operation,which can decrease the possibility of bile duct injure.

Objective To explore the clinical effect of treatment for cholecystolithiasis and calculus of com-mon bile with duodenoscope and laparoscope. Methods 48 cases of patients with cholecystolithiasis and calculus of common bile duct were analysed, of whom 30 cases were treated by traditional operation, and 18 cases were treated by duodenoscope and laparoscope. The operation time, stay-in-hospital time after operation, the gastrointestinal function recovery time after operation, the degree of pain were compared. Results The cost of duodenoscope and laparoscope was higher than that of traditional operation group, but the other parameters were better ( P < 0.05 ). Conclusion Treating cholecystolithiasis and calculus of common bile duct with duodenoscope and laparoscope is safe, less traumatic and the patients may recover faster than routine treatment.

Objective To analyze the causes of postoperative complications of Mesh plug hernia repair of inguinal hernia. Methods The 332 ingunial hernia patients from June 2002 to May 2007 who underwent Mesh plug repair were summarized retrospectivdy. the causes of postoperative complications were analyzed. Results All the patients were followed up 15～60 months.there were 3 cases of durative pain,1 case of recurring,16 cases of scrotal edema,20 cases of urinary retention. Condusion Anatomizing carefully during operation is the key to decrease the postoperative complications of Mesh plus hernia repair.

Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and laparoscopic cholecystectomy(LC)for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients(P＜0.05).Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.

OBJECTIVETo obtain an evidence-based treatment for an adolescent patient with temporomandibular osteoarthritis.

METHODSThe detailed history of an adolescent patient with temporomandibular osteoarthritis was analysed. Clinical Evidence (to Dec 2010), National Guideline Clearinghouse (2000-Dec 2010), Cochrane Library (Issue 4, 2010), MEDLINE(OVID, 1950-Dec 2010) and China Biology Medicine Database (1978-Dec 2010) were searched to obtain evidence such as clinical guidelines, systematic reviews and randomized controlled trials related to surgery or conservative treatment to temporomandibular osteoarthritis to find a personal treatment strategy for the patient.

RESULTSFive articles were finally included, i.e. 1 clinical guideline, 3 systematic reviews and 1 randomized controlled trials. These evidence showed that: Conservative treatment like intra-articular injection instead of surgery should be adopted for adolescent patient; hyaluronate is the drug with sufficient evidence in supporting its use in treating temporomandibular disorders; inferior temporomandibular joint cavity injection or both upper and lower cavity injection has better effect than that of superior cavity injection only; and there was some evidence to support the use of glucosamine to treat temporomandibular disorders. Considering the situation of the case and the clinical evidence, an individual treatment plan of hyaluronate injection into the upper and lower cavity and glucosamine take orally was established. A long-term follow-up of 6 months showed a good treatment outcome.

CONCLUSIONThrough the evidence-based methods and the use of clinical evidence, an individual treatment plan could be established for each patient with temporomandibular disorders, and this will provide strong supporting to the treatment of temporomandibular disorders. Up to now, it is clear that hyaluronate injection into the upper and lower cavity with glucosamine administration is effective in treating temporomandibular osteoarthritis.

OBJECTIVETo assess the efficacy and safety of drainage for the control of the complications following impacted mandibular third molar extraction.

METHODSTo retrieve randomized controlled trials assessing the efficacy and safety of drainage for the control of the complications following impacted mandibular third molar extraction, bibliographic databases including MEDLINE, Cochrane Controlled Trials Register, EMBASE, OPEN SIGLE and China Biology Medicine Database (CBM) were searched on August 23th 2011. References of the included studies and Chinese dental journals were hand-searched. The risk of bias were used by Cochrane Collaboration's tool and the data were extracted. Meta-analysis was done with Revman 5.1.

RESULTSNine articles met the eligibility criteria and were included, seven randomized controlled trials and 2 quasi-randomized controlled trials. Seven of these studies had unclear risk of bias and 2 had high risk of bias. Drainage could significantly increase 4.44 mm of the post-operative maximal mouth opening (P = 0.003), relief facial swelling (P < 0.05) and reduce post-operative complications (P = 0.008). But no evidence showed that drainage had a positive effects on post-operative pain (P = 0.09).

CONCLUSIONDrainage could probably control the complications following impacted mandibular third molar extraction; but more randomized controlled trials are needed to reinforce the conclusion.