Objective To investigate platelet counts and acute obstructive suppurative cholangitis correlation analysis and possible influential factors.Methods Data of 117 patients from October 2012 to October 2015 treated in our hospital,of whom 57 with acute obstructive suppurative cholangitis and 60 with common acute cholangitis were analyzed retrospectively to explore whether there was a correlation between thrombocytopenia (100 × 109/L) and AOSC,then experimental and control groups were established according to thrombocytopenia in the AOSC patients.The patient's age,sex,previous biliary surgery,white blood cells(WBC) count after admission within 6h,the percentage of neutrophils (NEU％),calcitonin (PCT) were retrospectively analyzed to further explore the influence factors of thrombocytopenia in AOSC patients.Results By comparison with the common acute cholangitis group,thrombocytopenia in AOSC group had obvious difference (P =0.01).In experimental group,NEU％,PCT had statistical difference compared with those in control group (P ＜ 0.05),and the patient's age,sex,previous biliary surgery,white blood cells(WBC) after admission within 6h count had no statistical significance.The logistic multivariate regression analysis showed that,NEU％,PCT were the independent predictors.Conclusion Correlated with AOSC,thrombocytopenia can be valued as indicators of the severity of acute cholangitis.In AOSC patients,NEU％,PCT were independent predictors of thrombocytopenia.

Objective To analyze the clinical characteristics and risk factors of mortality of acute myocardial infarction induced by gastrointestinal hemorrhage,and improve the diagnosis and treatment of this kind of disease.Methods The clinical data of 28 patients who admitted to renmin hospital of wuhan university between January 2015 and January 2017 was analyzed retrospectively,including general information,clinical features,laboratory examination,the changes of electrocardiogram,the treatment and prognosis of the disease.According to the prognosis,the patients were divided into survival group (13 cases) and death group (15 cases),and the related factors affecting the prognosis were analyzed.Results Among the 28 patients with acute myocardial infarction complicated by gastrointestinal hemorrhage (male 24,female 4),the mean age was (70.8 ± 11.0) years.The clinical symptoms of gastrointestinal hemorrhage included haematemesis in 5 cases,melena in 8 cases,haematemesis concomitant melena in 13 cases and vomiting of coffee-like substance in 2 cases.When acute myocardial infarction occurred,only 6 patients had typical chest pain,4 patients showed palpitation and chest distress and 18 patients had no obvious symptoms.In all patients,21 (75.0％) patients occurred non ST-elevation acute myocardial infarction,and 7 (25.0％) patients occurred ST-elevation acute myocardial infarction,including extensive anterior wall and inferior wall infarction in 2 cases (7.1％),extensive anterior wall infarction in 7 cases (25.0％),inferior infarction in 13 cases (46.4％),anterior wall infarction in 5 cases (17.9％) and posterior wall infarction in 1 cases (3.6％).After treatment,13 cases improved and 15 cases died.Severe anemia and liver cirrhosis had history statistically significant differences in the survival group and death group,logistics regression analysis showed that severe anemia (OR =11.67,P =0.018) was an independent risk factor of mortality.Conclusion Acute myocardial infarction induced by gastrointestinal hemorrhage has no chest pain and other typical symptoms of myocardial infarction,and most of the cases are non ST-elevation myocardial infarction.Such patients are critically ill and have high fatality rate.Severe anemia is an independent risk factor for death in such patients.

Objective: To investigate the differences of clinicopathological features, diagnosis, treatment and prognosis between patients with extra-gastrointestinal stromal tumors (EGIST) and duodenal gastrointestinal stromal tumors (DGIST). Methods: A retrospective case - control study was performed. Case inclusion criteria: (1) tumor confirmed by histology and pathology; (2) primary tumor locating in the extra - gastrointestinal tract or duodenum; (3) without other synchronous tumors; (4) complete clinical and pathological data. Clinical data of 20 EGIST patients and 32 DGIST patients from March 2011 to September 2016 at Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were retrospectively collected and analyzed. The observational parameters included clinicopathological characteristics, treatment and prognosis conditions. Continuous data of abnormal distribution were expressed as median (range) and compared using the Mann-Whitney U-test. Survival curves were drawn by the Kaplan-Meier method and compared with the Log-rank test. Results: Of the 20 EGIST patients, 8 were males and 12 were females with age of 61.0 (30.0 to 86.0) years and of the 32 DGIST patients, 12 were males and 20 were females with age of 55.5 (27.0 to 70.0) years. Compared with DGIST patients, EGIST patients were older (U=188.000, P=0.012], had larger tumor size [10.0 (3.0 to 29.0) cm vs. 4.0 (1.5 to 10.0) cm, U=98.500, P<0.001] and higher ratio of high risk classification [85.0% (17/20) vs. 12.5% (4/32), χ²=26.870, P<0.001]. Among the 20 EGIST patients, 5 were diagnosed with distal metastasis and received imatinib (400 mg/d), and the other 15 patients underwent radical resection who were included in survival analysis. All the 32 DGIST patients underwent radical resection. The median follow-up of whole group was 43 (14 to 76) months. The 3-year recurrence/metastasis-free survival rate of 15 cases undergoing radical resection in the EGIST group was 85.6%, which was lower than that of the DGIST group (88.6%), and the difference was not statistically significant (P=0.745). There was no significant difference in the 3-year overall survival rate between the EGIST group (92.9%) and the DGIST group (100%) (P=0.271). Conclusions As compared to DGIST, EGIST mostly occurs in those with older age, larger tumor size and higher risk grade. The prognosis of EGIST patients after radical resection is similar to that of DGIST patients.