Objective To evaluate the advances in minimally invasive surgery treatment for hepatolithiasis. Methods Literatures about the advances in minimally invasive surgery treatment for hepatolithiasis were collected and reviewed. Results Hepatectomy and bile duct exploration using laparoscopy can get better effect. Fibrocholedochoscopy play an important role in the course of operation and after operation for hepatolithiasis. Conclusion The individualization treatment program should be used for hepatolithiasis. Association application of multipathway minimally invasive operation, such as laparoscopy, fibrocholedochoscopy and so on, can increase the cure rate of hepatolithiasis.

Objective To investigate the clinical and immunohistochemical features,diagnosis and treatment of gastrointestinal stromal tumor(GIST). Methods Clinic and pathological datas of 38 cases with GIST were retrospectively analyzed. Results The most common clinal maifestions were abdominal pain,distention or discomfort in 24 cases(50%), abdominal mass in 10,melena and liematemesis in 8 cases. The tumor was located in the stomach in 20 cases, the small infestine in 14,the colorectum in 4.All the cases underwent operation. Conclusion Endoscopy and imaging examination are main methods to detect GIST. Surgical resection is the main mothod of pathologic diagnosis and treatment.

Objective To investigate the clinical and pathological characteristics as well as the surgical treatment of perforated gastric carcinoma (PGC). Methods The clinical and pathological data, surgical treatment and survival time of 48 patients with PGC were retrospectively analyzed. Results The mean age was 58 years in the 48 patients with PGC. There were 3 tumors in stage I, 11 in stage II, 21 in stage III , and 13 in stage IV. Emergency gastrectomy was done in 29 patients, with the mortality was 6.9%. Six patients underwent local repair at first, gastrectomy was done 3 weeks later without postoperative death. Perforation repair with or without gastroenterostomy was performed in 13 patients, with the mortality was 23.1% .The median survival time in gastrectomy group was 28 months (ranged 13 to 72 months) and in repair group was 7 months (ranged 3 to 10 months). Conclusions Emergency gastrectomy is the choice of treatment for PGC. If the conditions is not suitable for emergent gastrectomy ,staging operation should be adoptted to reduce operative mortality.

Objective: This study was undertaken to explore the effect of left ventricular assist device (LVAD) on failing heart after myocardial ischemia. By detecting the changes of plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels within 6 hours after the implantation of LVAD, we review the basis on which neurohormones may be used to determine prognoses of failing heart and choose an optimal predictor. Methods: 15 adult healthy dogs were divided into 3 groups randomly. The LVAD was implanted in LA-AO bypass in all three groups. Myocardial ischemia was induced by ligating the main left anterior descending coronary artery (LAD). In group A, after a ligation of 10 minutes, the myocardium was reperfused for 6 hours. In group B, after a ligation of 40 minutes, the myocardium was reperfused for 6 hours. In group C, after a ligation of 40 minutes, the LVAD was used for LV support for 6 hours. Results: After 6 hours reperfusion,in group C, the hemodynamics was significantly improved, the ANP, BNP and cTnI were return to normal level, and myocardial ultrastructure was recovered significantly. While in group B, the hemodynamic, the neurohormones, and myocardial ultrastructure were worse. Relational analysis demonstrated that ANP and cTnI levels were influenced by hemodynamics obviously, but there was a weak relationship between circulating BNP and hemodynamics. Plasma BNP level was able to identify the cardiac function status. Conclusion: LVAD can be beneficial to improve cardiac function and can reduce the plasma levels of ANP, BNP and cTnI. Plasma BNP level can identify the cardiac function status. Those findings indicated that plasma BNP determination provides important prognostic information about cardiac function and may be a better prognostic indicator.

Objective To summarize and analyze clinical characteristics of glycogen storage disease (GSD)typeⅠcomplicated with hepatocellular carcinoma to improve clinical recognition to it.Methods First case of GSD type Ia complicated with hepatocellular carcinoma(HCC)in China was reported and another 14 cases with detailed clinical data reported in literatures were reviewed in this paper.Results The case was man at age of 19 with chief complaint of hepatic mass founded casually.For all the 15 cases(other 14 from literature reports),mean age at diagnosis of HCC was 32.3 years and average time interval from diagnosis of GSD to diagnosis of HCC Was 23.1 years,as compared to 23.3 years and 14.6 years,respectively in three cases with both hepatitis B virus(HBV)and hepatitis C virus(HCV)seropositive.Serum level of alpha fetoprotein(AFP)was elevated in six patients.Tumor could be located at all lobes of the liver and mainly in the right lobe(eight of 15 cases),with varied size and solitary or multiple tumor.Conclusions Symptoms in GSD typeⅠcomplicated with HCC Was latent at onset.and AFP measurement was questionable in its diagnosis.It is important that physicians should keep more alert to risk of HCC in patients with GSD for its early diagnosis.

OBJECTIVE:To develop HPLC method for quantitative determination of ti anepine sodium in blood plasma METHODS:Tianepine was extracted with ethyl acet ate The residues were analyzed with a reverse phase HPLC system(DiamonsilTM C18 column,4 6mm?250mm,5?m);Mobile phase,MeOH-C2H3OONH4(80∶20);UV detecti on 220nm RESUL_TS:The average recoveries for tianepine sodium in high,medium and low concentr ations were 97 63%,97 60% and 93 67%,respectively The within-day and b etween-day relative standard deviations were less than 5%(n=5) The calibratio n curves had good linearity within a concentration range of 1 0～83 3?g/ml T he regression equation was Y=6 05?10-2X+8 18?10-1,r=0 9 994(n=12) The limit of quantitation for tianepine sodium was 0 2?g/ml CONCLUSION:The metho d provides a se_nsitive,accurate,precise and reliable analytical procedure for clinical monito ring of tianepine sodium blood in plasma and its pharmacokinetic studies

Objective To evaluate the value of gemstone spectral imaging (GSI)and multi artifact reduction system(MARs)in re-ducing metallic implants artifacts,and find the best monochromatic images.Methods Twenty-one patients with metal implants in our hospital receievd GSI examination ,MARS reconstruction and polychromatic images(140 kVp).Eleven groups of monochromatic and MARS images were obtained from 40 keV to 140 keV every interval of 10 keV by the special GSI viewer ,respetively.Subjective image quality of two methods were assessed by 3 radiologists in consensus.For every patient one group monochromatic images and blend enery images were selected two heaviest artifacts level and no artifacts level,the CT value and the standard deviations(SD)value of the region of interest(ROI)were meatured of artifacts.Contrast-to-noise ratio(CNR)and artifacts index(AI)were also caculated and were analyzed with paired-t test.Results There was significant statistical differences of CNR between energy spectral images and blend energy images in energy level of 40 to 120 keV(P <0.05),while there was no difference in energy level of 130 to 140 keV (P >0.05),and the optimal CNR was acquired at the energy level of 70 keV(CNR=8.75±3.28).The value of AI for two mehtods has no difference in energy level scope 40 to 60 keV(P >0.05),there was significant statistical differences of AI between energy spectral images and blend energy images in energy level of 70 to 140 keV(P <0.05),and the lowest of AI(AI=26.95±9.64)was ac-quired at 1 10 keV images.Conclusion The energy spectral CT possess superiority in decreasing the artifacts and will provide high image quality in the metal implants.Gemstone spectral CT has great significance for postoperative patients with metal implants in imaging diagnosis.

[ABSTRACT]OBJECTIVETo investigate the cytomegalovirus infection in neonates, characteristics of gap junction protein Connexin26 gene mutation and the hearing follow-up results, and to analyze their correlations. METHODS60 CMV-DNA positive and 40 CMV-DNA negative neonatal newborn from The Second Affiliated Hospital of Wenzhou Medical University and The first people's Hospital of Yongkang were screened, the blood biochemistry was analyzed, and the umbilical cord blood was reserved to detect the Connexin26 gene expression of mRNA with RT-PCR.PCR results was sequenced to track the newborn hearing, and analyze the correlations between neonatal cytomegalovirus types, the mutation of Connexin26 gene and hearing test results.RESULTS 26 cases from 60 CMV-DNA positive newborns were found with blood biochemical abnormalities. In all of the newborns, a total of 41 cases had 235delC mutation, 11 cases in the mutations for the development of hearing impairment. The results of correlation analysis showed that there were correlations between cytomegalovirus infection, gene mutation and hearing impairment.CONCLUSION Cytomegalovirus infection in neonates can lead to mutations in the Connexin26 gene, and may further lead to hearing impairment, and the probability of the mutation of Connexin26 gene and sensorineural hearing loss were higher in symptomatic cytomegalovirus infection neonates.

Objective To determine the normal reference values for thromboelastography (TEG) in Chinese healthy elderly people in Beijing and compare them with those provided by the manufacturer and with people under the age of 55 years.Methods The healthy elderly people aged over 65 years were enrolled from March 2014 to April 2014.4 ml of peripheral vein blood samples were taken from each person.All subjects underwent the laboratory tests of prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT) and fibrinogen (FIB).TEG parameters including reaction time (R),coagulation time (K),angle (alpha) and maximum amplitude (MA) were determined by using a Heamoscope 5000 device.Results A total of 119 healthy elderly subjects were enrolled in this study.The mean values (95％ CI) of TEG parameters for them were R:6.29 min (4.4-8.2 min),K:1.63 min (0.8-2.5 min),α-Angle:66.09° (55.0-77.1°),MA:63.43mm (54.5-72.3 mm).There were significant differences in the values of R,K and α-Angle between the elderly and non-elderly groups (P＜0.001 or 0.05).There were significant differences in the values of K,α-Angle and MA between males and females (P＜0.05 or 0.001).According to the normal reference values provided by the manufacturer,16.1％ (19/119) of the healthy elderly volunteers had at least one abnormal parameter beyond its normal range.3％ (3/119) of the healthy elderly people were diagnosed as coagulation abnormalities,yielding a specificity of 84％.Compared with normal reference values provided by the manufacturer,the value of R was lower and the value of MA was higher in the healthy elderly people in Beijing.Conclusions The normal reference values for TEG should be established based on the local population characteristics.

Objective To build anautoverification system for hematology analysis system and validate the system based on commercialized labXpert software.Methods Preliminary validation rules was established base on 41 Items of International Consensus Review Rules and instructions for Mindray CAL8000 auto hematology analyzer,and input the rules into labX pert sample validation system.999 clinical samples were collected from Beijing Hospital Ministry of Health to test the preliminary rules and parameters including false positive rate,false negative rate and autoverification pass rate were calculated,based on which to adjust and customize the original protocol.Then 15 934 samples were tested,respectively,for autoverification by calculating the autoverification pass rate,proportion of manual verification and microscopic verification.Autoverification were compared as well as the turnover time (TAT,timefrom receipt of sample to report of result) before and after application of autoverification system.Results Preliminary verification results showed that false negative rates in both hospitals were less than 2％,and the false negative mainly caused by low promyelocytic cells value (blasts and promyelocytes less than 3 ％),abnormal erythrocyte morphology,and abnormal platelet morphology.No sample with excess blasts or percentage of blasts and promyelocytes higher 3％ with tested with false negative result,indicating relatively low clinical risks.Both hospitals reported with relatively high false positive rates,up to nearly 18％,using preliminary programs,which may affect the autoverification rate of the system.Based on the analyzing result of false positive results,the program was adjusted to significantly reduce the false positive rate while remaining the false negative rate low,therefore resulted with 4 remarkable increase of autoverification pass rate.Over 10,000 samples were tested with improved program,and the autoverification pass rates for hospital was 78.4 ％,respectively.Primary reason causing failure of autoverification included increased IMG％,flag for immature cells and WBC exceeding set limit.Application of system reduced the TAT by 5 min (P＜0.05).Conclusion Autoverificationsystem using Mindray CAL8000 auto hematology analyzer andlabXpert has been confirmed effective in reducing TAT and enhancing working efficiency while remaining low false negative rate.The autoverification pass rate tested 75％,which suggested that laboratory workers can spare more time on reexamination of abnormal samples for better blood routine report.