Objective To assess the therapeutic value of endoscopic nasobiliary drainage (ENBD) and oral praziquantel on severe clonorchiasis sinensis. Methods Fifty-eight patients with severe clonorchiasis sinensis were treated by ENBD (observing group, ENBD group) , and other 26 patients treated by surgical operation (control group, operation group). Both groups are matched in age, gender etc. After the procedure all patients receive orally praziquantel 1. 2g, three times a day for 2 days. Results In ENBD group the symptoms, such as abdominal pain, fever, jaundice improved earlier than those in operation group. In compare with the surgical operation, ENBD shares the advantages of earlier remission and recovery, less trauma, scarce complications and low expense. Conclusion ENBD and oral praziquantel is an effective and safe procedure in treating severe clonorchiasis sinensis.

Objective To analyze the multislice CT (MSCT) imaging performance of various kinds of thymic lesions and to explore useful signs for differentiating those lesions.Methods CT features of 39 cases with thymic lesions confirmed by operation and pathology were reviewed retrospectively analyzed and these cases were divided into three groups,namely low-risk group,high-risk group,cancer and carcinoid group.The imaging characteristics of each group including location,size,shape,border,density,invasion and metastasis,degree of enhancement were compared and the main different characteristics among the three groups were analyzed.Results Among the 39 cases,21 were low-risk,13 were high-risk and 5 were cancer and carcinoid.There were significant difference among the three groups in shape,border,density,invasion and metastasis of these thymic lesions on CT imaging (P ＜ 0.05).As for the irregular shape and nonuniform density,there were 5 and 4 cases in cancer and carcinoid group and only 1 and 3 cases in low-risk group,the difference between the two groups were statistically significant(P ＜ 0.05).As for invasion and metastasis,there were no statistical significant between the high-risk group and the cancer and carcinoid group,but both had statistical significant with the low-risk group respectively (P ＜ 0.05).No significant difference existed among the three groups in size and degree of enhancement(P ＞ 0.05).Conclusion MSCT might be an effective and important imaging tool for differentiating various kinds of thymic lesions.

Objective To comparie the effects of pre-dilution with post-dilution continuous renal replacement therapy (CRRT) for patients with MODS. Method Thirty-two MODS patients admitted to ICU (Intensive Care Unit ) were randomized and treated with different modes of CRRT. The results of creatinine clearance, acid-base equilibrium, haemodynamic variables before and post therapy were recorded.The maximal pre-filter pressure, the duration of filter unworn out and mortality of patients treated with different modes of CRRT were also recorded. Results Seventeen patients were treated with pre-dilution mode of CRRT and 15 patients treated with post-dilution mode of CRRT. After 24 hours of pre- and postdilution modes of CRRT, the net increase in Ccr (namely the rate of replacement creatinine clearance) were (15.6±4.6) vs. (22.7 ±4. 1) mL/min respectively (P＜0.01); after 48-hour, they were (14.9±3.3)vs. ( 18. 9 ±2. 3) mL/min (p ＜0. 05) . Both dilution modes could improve the blood PH、 HCO3- and BE( P ＜ 0. 05 ) without significant differences between two groups after CRRT therapy ( P ＞ 0. 05 ) . The MAP of patients treated with pre-dilution modes of CRRT therapy for 24 hours and the MAP of patients before therapy were 69. 2 ± 4. 6 and 56. 7 + 9. 1 mmHg respectively ( P ＜ 0. 05 ), and dosage of dopamine used in patients before CRRT therapy and that after CRRT for 24 hours were ( 11.20 +3.45 ) vs (6. 12 +3.41 ) μg ·kg-1 min -1(P＜0.05).The maximal pre-filter pressures of pre-and post-dilution modes were (82.23+9.11) cm H2O, (110.56 +28. 14) cmH2O respectively (P＜0.05), and the durations of lasting effect of filter used in two modes of CRRT were ( 39 + 28. 12 ) vs. ( 25 + 14. 45 ) h respectively ( P ＜0. 05) . Both dilution modes could improve APACHE Scores. There were no significant differences in APACHE Scores and mortalities between two groups after CRRT therapy. Conclusions Post-dilution mode of CRRT has higher filtration rate, but have higher maximal pre-filter pressure and shorter longevity of filter.Pre-dilution mode of CRRT has better effect on improving hemodynamics, reducing usage of vasopressor.Both modes of CRRT can correct acid base equilibrium disorder rapidly. There are no differences in the results of blood gas analysis improved、 APACHE scores and mortality between the two groups.

Etrotic Company produced thermoplastic diaphragm (ERKOLODC-pro, 595115) can be shaped according to dental arch form under vacuum heating pressure, resulting in good fixation and baffle effect. Nine cases with soft and hard palate defect caused by tumor, who needed the repair of temporal obturator prosthesis made by thermoplastic diaphragm (1.5 mm of thickness), were selected in this study at the Department of Stomatology, General Hospital of Chinese PLA from September 2006 to January 2007. Different diaphragms were used according to periodontal status. Only one case with more soft palate defect felt naupathia when wore this kind of denture near throat. After 1 week, the uncomfortable feeling disappeared. Three patients felt pain, and the main reason is tissue dropsy around wound entry and denture crackdown. After grinding, pain disappeared. This indicated that no adverse reaction in biocompatibility was detected between thermoplastic diaphragm and host. Temporal prosthesis can improve swallowing and voiced function of soft and hard palate defect patients by closing nasal cavity.

Objective To analyze the pathogeny of acute respiration failure after kidney transplantation on early period and discuss the clinical value of mechanical ventilation.Methods A total of 16 cases of acute respiration failure after kidney transplantation on early period were studied retrospectively.Results The main causes were acute pulmonary edema caused by heart failure and serious pneumonia; patients were divided into two groups according to pathogeny: heart failure group (n=8) and non-heart failure group (n=8). It was found that the patients in heart failure group were older, preoperative blood pressure higher, dialysis duration longer, acute respiratory failure occurred earlier and mechanical ventilation time shorter than in non-heart failure group. The mechanical ventilation could raise oxygen pressure in artery blood and correct hypoxemia quickly. The mechanical ventilation could keep oxygen pressure in artery blood on the ideal level.Conclusion The pathogeny of acute respiration failure after kidney transplantation on early period included acute pulmonary edema caused by heart function failure and serious pneumonia; the mechanical ventilation was important to treat patient with acute respiration failure after kidney transplantation on early period because it could ensure oxygen pressure in artery blood in order to win time to cure heart failure and serious pneumonia. Also, the mechanical ventilation could improve prognosis of the patients.

Objective To evaluate transureteroscopic pneumatic lithotripsy for the treatment of ureteral stones. Methods Transureteroscopic pneumatic lithotripsy was undertaken for 302 cases of ureteral stones,185 male patients and 117 female with and average age of 42.There were 68 upper ureteral stones,106 middle and 128 lower ureteral stones.The transverse diameter of the stones was 5～12 mm and the vertical length 6～24 mm. Results Successful lithotripsy was achieved on one session in 264 cases ( 87.4%),with the stone completely expelled in 4～6 weeks.Complication occurred in 20,14 of which being ureteral perforation.Conservative treatment was adopted in 8 and open surgery in 6,9 of which have been followed up for 3～10 months without ureteral stricture.4 cases complicated by urinary infection. Conclusions Transureteroscopic pneumatic lithotripsy is an effective means of treating ureteral stones.

Objective To discuss appropriate management of postpartum hemorrhage(PPH). Material and Methods By means of hospital based data over 10 years, 15 cases of severe PPH were retrospectively analyzed about the clinical parameters and management. Results Among the 15 patients, 9 had hysterectomy, selective arterial embolization was carried out in 7 and 1 had focus clearance. The main causes of postpartum hemorrhage requiring operative management were: DIC, uterine arteriovenous fistula and malformation, placental abnormality, uterine myoma and laceration. Conclusion Upon recognition of postpartum hemorrhage, the most effective management should be initiated. Every effort should be made to stable patient, save life and maintain the reproductive capability.

Objective To investigate the correlation between the level change of serum homocysteine (HCY) and vascular endothelial growth factor (VEGF) with the degree of the coronary artery stenosis in the patients with acute coronary syndrome (ACS) .Methods A total of 157 ACS patients were divided into the ST‐elevation myocardial infarction (STEMI) group ,non‐ST el‐evation myocardial infarction (NSTEMI) group and unstable angina pectoris(UA) group based on the symptoms ,cardiac enzymes level and electrocardiogram changes .The cases were induded into the mild ,moderate and severe stenosis lesion groups according to the coronary arteriography examination;meanwhile the enzyme‐linked immunosorbent assay (ELISA) was used to detect the change of the serum VEGF concentration .The HCY level was determined by enzymatic cycling methods with the biochemical analyzer (BXC800 ,Beckman ,USA) .The differences in the concentrations of VEGF and HCY compared among different groups .Results The VEGF level had statistical differences among the mild ,moderate and sever stenosis groups(F=39 .9 ,P=0 .00) ,and between the UA group with the NSTEMI group and STEMI group(F=123 .3 ,P=0 .00) .The HCY level had statistically significant differ‐ence between the severe stenosis group with the mild and moderate stenosis groups (F=39 .7 ,P=0 .00);the HCY level had statis‐tically significant difference among the UA group ,NSTEMI group and STEMI group(F=102 .65 ,P=0 .00) .The VEGF and HCY levels in the mild stenosis group ,different degrees of coronary stenosis groups and different clinical diagnosis groups were positively correlated with the Gensini scores(r=0 .723 ,0 .716) .Conclusion The serum VEGF and HCY levels are correlated with the degree of the coronary artery lesion and myocardial necrosis in ACS patients ,furthermore are related with the Gensini scores .

ObjectiveTo investigate the clinical features and pregnant outcomes of the pregnant women with congenital adrenal hyperplasia (CAH) 21-hydroxylase deficiency (21-OHD).MethodsThe clinical features,therapies,pregnant outcomes of the pregnant women with 21-OHD were retrospectively reviewed in Peking Union Medical College Hospital,from January 2005 to April 2011.ResultsThere were 8 pregnant womenwith 21-OHD including 5siinplevirilizing patientsand 3nonclassical 21-OHD women.Eightpatientswereacceptedprogestationalandprenatalcontinuallowerglucocorticoid treatment.During the gestational period,the dosage of glucocorticoid was adjusted in one pregnancy.The serum level of 17-alpha hydroxyprogesterone (17-OHP) were elevated after pregnancy [ (70 ± 38 ) versus (24 ±23) nmol/L,P ＜ 0.05].The fertility and offspring rate of 8 patients was 8/12,the fertility and offspring rate of patients who started treatment at preadolescence was significantly increased (4/5 versus 4/7).Four patients were accepted genital reconstructive surgery ( clitorectomy,clitoroplasty,vulvoplasty) before pregnancy.The incidence of GDM was 1/8.All patients selected caesarean at from 37 +6 gestation weeks to 39+6 gestation weeks.The average newborn birth weight was (3210 ± 447 ) g,and height was (48 ±2) cm of 8 neonates,none of them was CAH.Conclusions Medical and surgical therapy provides satisfactory fertility and pregnancy outcomes for women with 21-OHD.It is safe to pregnant women with 21-OHD and their fetus in continual lower glucocorticoid treatment.The dosage of glucocorticoid should be carefully adjusted during the pregnancy individually according to serum level of 17-OHP.

Objective To investigate the the relationship of a high risk serum screen for Down syndrome in second trimester and adverse pregnancy outcomes,and to evaluate the predictive value for adverse pregnancy outcomes.Methods The tri-marker second trimester maternal serum screening for Down syndrome (alpha-fetoprotein,free beta-hCG and unconjugated estriol)was performed on the pregnant women at Peking Union Medical Hospital from January 2009 to January 2011.The cutoff valvue was 1/270.Pregnancy outcomes were followed up.The general condition and pregnancy complications of the pregnant women with high risk (high-risk group) were compared to that of the pregnant women with low risk (low-risk group); and with 35 years old as a demarcation,the incidences of adverse pregnancy outcomes were calculated in the two groups.Results ( 1 ) A total of 1935 cases were collected.And 1784 cases were with low risk,and 151 cases were with high risk.The difference of weight and gestational age betweem the two groups was not statistically significant ( P ＞ 0.05 ) ; the difference of age between the two groups was statistically significant ( P ＜ 0.01 ).(2) Pregnancy complications were found in 791 cases.In high-risk group,the incidences of gestational diaetes mellitus (GDM,13.9％),neonatal asphyxia (4.0％ ) and small for gestational age infant ( SGA,4.6％ ) were higher than that in low-risk group ( 8.4％,1.0％,1.6％ ),the difference was statistically significant ( P ＜ 0.05 ).The incidences of gestational hypertension disease,premature labor,oligohydrammios,placenta previa,placenta abruption,fetal macrosomia in the two groups was not statistically different (P ＞0.05).(3) In 1705 cases aged less than 35 years,129 cases (7.6％) were GDM,43 cases ( 2.5％ ) were gestational hypertension disease,61 cases ( 3.9％ ) were premature labor; in 230 cases aged 35 years or more,41 cases (17.8％ ) were GDM,12 cases (5.2％) were gestational hypertension disease,15 cases (6.5％ ) were premature labor,and the difference between the two groups was statistically significant ( P ＜ 0.05 ).In ＜ 35 years old group,the incidences of GDM,neonatal asphyxia and SGA (12.3％,4.4％,5.3％ ) were higher in the high-risk group than that (7.2％,0.9％,1.6％ ) in the low-risk group,and the difference was statistically significant ( P ＜ 0,05 ).In ≥35 years old group,the incidences of GDM,neonatal asphyxia and SGA ( 18.9％,2.7％,2.7％ ) were slightly higher in the high-risk group than that (17.6％,1.6％,1.6％ ) in the low-risk group,the difference between the two groups was not statistically significant (P ＞ 0.05 ).Conclusions The present study revealed apparertt increase in the adverse pregnancy outcomes in women with a high risk of Down syndrome screening test.Advanced age is the most important risk factor for a high risk of Down syndrome screening test and adverse pregnancy outcomes.More attention should be attached to the patients whose age were ＜35 years old and with a high risk of Down syndrome screening test.