Intramural gallstone is a special kind of gallstone and the mechanism may be related with increasing pressure in gallbladder lumen,inflammation of gallbladder and the formation of Rokitansky-Aschoff sinuses in the gallbladder wall.There is a close relationship between intramural gallstone and lumen stone.Intramural gallstone provides a new challenge to cholecystolithotomy with gallbladder preservation.But study on intramural gallstone may also offer a new idea for the mechanism of gallstone formation.

Objective To investigate the diagnostic value of serum procalcitonin (PCT) and C-reactive protein (CRP) in nonneutrocytic ascitic spontaneous bacterial peritonitis (NASBP).Methods From January 2012 to January 2015,patients with liver cirrhosis and ascites were restropectively enrolled.Patients were divided into NASBP group and non-infective ascites group.The receiver operating characteristics curve (ROC) was used for assessing diagnostic accuracy of serum PCT and CRP.Patients with conventional SBP were set as controls.Data between two groups were compared using t test,Rank sum test,x2 test or Fisher exact test.The areas under ROC curve or Youden indeces were compared using Z test.Results A total of 30 patients were collected in NASBP group,51 patients in non-infective ascites group and 33 patients in conventional SBP group.There were no statistically significant differences in PCT and CRP levels between NASBP group and conventional SBP group [0.70(0.25～2.45) μg/L,(21.85-±-16.46) mg/L;0.90(0.33～3.56) μg/L,(31.78-±26.74) mg/L] both P＞0.05,and were both significantly higher than those of non-infective ascites group (0.20 (0.07 ～ 0.40) μg/L,Z=-3.38,t=4.64;(7.19±7.04) mg/L,Z=-3.89,t=-5.17,both P＜0.05).The optimal cut-off value of PCT and CRP in the diagnosis of NASBP was 0.43 ng/mL and 12.76 mg/L,respectively.According to the cut-off value above,PCT,CRP and PCT plus CRP in series and in parallel in the diagnosis of NASBP,the areas under curves were 0.725,0.848,0.737 and 0.806,respectively,and there was no significant difference in pairwise comparison between groups.The sensitivities were 70.0％,70.0％,53.3％ and 86.7％,respectively,there were statistically significant differences between inparallel and any other method (Fisher exact test,all P＜ 0.05).And there was no statistically significant difference (all P＞0.05).The specificities were 76.5％,88.2％,94.1％ and 74.5％,respectively.There was no statistically significant difference in PCT and CRP between combination in parallel and in series,while the differences in the other pairwise comparisons of combinations were statistically significant (Fisher exact test,P＜0.05).The Youden's indexes were 0.465,0.582,0.474 and 0.612,respectively,there was no statistically significant difference in pairwise comparison between groups (all P＞0.05).Conclusions All of serum PCT,CRP and the combination of them have good diagnostic value in NASBP with their own advantages which should be selected based clinical needs.

As an anti-epilepsy drug,gabapentin plays an important role in the treatment of neuropathic pain through a variety of central and peripheral mechanisms.Studies have shown that gabapentin has better efficacy for post-stroke pain,spinal cord injury-related pain,postherpetic neuralgia,and pain in diabetic peripheral neuropathy.For mild adverse effects,good tolerance and lack of interactions,gabapentin is an ideal drug for the treatment of neuropathic pain.

Objective To observe the effect of modified Bazhen Decoction ( MBD) on bone marrow fibroblast growth factor-1 ( FGF-1) in chronic aplastic anemia ( CAA) patients. Methods Sixty cases of CAA were randomly divided into treatment group and control group, 30 cases in each group. Both groups were given conventional western medicine such as oral use of Stanozolol and Ciclosporin, and additionally, the treatment group received oral use of MBD. Six months constituted one treatment course for both groups. After treatment, the clinical efficiency in western medicine field and on Chinese medical syndromes was evaluated in both groups. The changes of peripheral hemogram, adverse reaction, and FGF-1 in the bone marrow of both groups were also monitored. Results ( 1) Clinical efficacy in western medicine field was 80.0% in the treatment group, and was 66.7%in the control group (P<0.05). (2) The total effective rate on Chinese medical syndromes was 100.0% in the treatment group, and was 83.3%in the control group (P<0.05). (3) After treatment, the scores of symptoms were decreased in both groups (P<0.05 or P<0.01 compared with those before treatment), and the decrease in the treatment group was superior to that in the control group (P<0.05). (4) Peripheral white blood cell (WBC) count, hemoglobin (HGB) content and platelet (PLT) count as well as bone marrow FGF-1 were increased in both groups after treatment (P<0.01 compared with those before treatment), and the increase of WBC, HGB, PLT and FGF-1 in the treatment group was superior to that in the control group (P<0.05). (5) In the aspect of the adverse reaction, the treatment group had 2 cases of hepatic fucntion injury, and one case of acne and hairiness; the control group had 2 cases of gum hypertrophy, 5 cases of hepatic function injury, and 4 cases of acne and hairiness. The control group had higher incidence of adverse reaction ( P<0.05). Conclusion MBD exerts certain therapeutic effect for CAA, and one of the possible mechanisms is related with the regulation of FGF-1 level.

Objective To evaluate the surgical management of pancreatic fistula caused by pan-creatic trauma and pancreatitis through surgical drainage. Methods A series of 45 patients with pancreat-ic fistula undergoing Roux-en-Y surgery with or without fistulectomy from 2004 to 2014 was analyzed. Pa-tients were divided into two groups:patients in group A(n=21)underwent external drainage of pancreatic secretion by Roux-en-Y surgery,and patients in group B(n= 24)underwent Roux-en-Y surgery with fistu-lectomy. The surgery was performed at 4~6 months after formation of the fistula,and somatostatin was used postoperatively. Results Patients in group A developed more severe side effects than patients in group B, including chronic abdominal pain(6/21 vs. 1/24),pancreatic leakage(8/21 vs. 2/24),digestive bleeding (5/21 vs. 5/24)and incision infection(9/21 vs. 3/24). Conclusion Resection of the fistula plus Roux-en-Y surgery can significantly reduce the incidence of surgical complications,which is a safe and efficient management for pancreatic fistula.

Objective To investigate the safety and effectiveness of laparoscopic surgery for early ovarian cancer. Methods Selected 90 early-stage ovarian cancer patients from January 2010 to December 2014 in Zhejiang Cancer Hospital as research subjects, and randomly divided into laparoscopic surgery group and laparotomy group. Then compared the age, BMI, ovarian cancer diameter, ovarian cancer staging, blood loss, operative time, surrounding or﹣gan damage, albumin difference before and after surgery, postoperative ventilation time, postoperative hospital stay, interval of postoperative to the first chemotherapy, postoperative fever cases, follow-up time, postoperative complica﹣tions, postoperative recurrence and postoperative death in two groups. Results Blood loss and operative time of la﹣paroscopic surgery group was less than that of laparotomy group (P< 0.05). Albumin difference before and after surgery of laparoscopic surgery group was less than that of laparotomy group (P< 0.05), postoperative ventilation time and interval of postoperative to the first chemotherapy of laparoscopic surgery group was less than that of la﹣parotomy group (P< 0.05), the incidence of postoperative fever and postoperative complications of laparoscopic surgery group was less than that of laparotomy group (P< 0.05), the recurrence rate and postoperative mortality rate of laparoscopic surgery group were slightly higher than that of laparotomy group, but the difference was not statisti﹣cally significant (PP> 0.05). Conclusion Laparoscopic surgery for early-stage ovarian cancer has a relatively good safety and efficacy. Laparoscopic surgery has advantages over open surgery in improving early ovarian cancer intra﹣operative situation and postoperative situation.

Objective To observe the clinical effect of Sangao Decoction combined with Azithromycin in the treatment of mycoplasmal pneumonia in children.MethodsFrom August 2013 to August 2014, 76 children with mycoplasma pneumonia were enrolled in this study.The patients were randomly divided into observation group and control group.The control group was treated with azithromycin alone, and the observation group was given the treatment of Sanao Decoction on the basis of the control group.Comparison of the two groups of clinical efficacy, fever time, cough time, tonsil disappearance time, lung rales disappear time, length of stay and the incidence of adverse reactions.ResultsThe effective rate was 94.37% in the observation group and 76.32% in the control group, which was statistically significant (P<0.05).(2.45±0.90) d, duration of coughing (5.37±1.67) d, duration of disappearance of tonsil (6.23±2.47) d, disappearance of rales (7.18±1.58) d, duration of hospital stay (10.26±1.65) d were shorter than the control group, which was statistically significant (P<0.05).The incidence of adverse reactions was not statistically significant.ConclusionThe effect of Sangao Decoction combined with azithromycin in the treatment of mycoplasma pneumonia in children can significantly shorten the symptoms and signs of the patients, the time of disappearance of the signs and the length of hospital stay, promote the rapid recovery of children, high safety, and have good clinical application value.

Objective To investigate the effect of gamma globulin combined with glucocorticoid pulse therapy in the treatment of children with refractory mycoplasma pneumonia in CRP and safety.Methods 46 cases of children with refractory mycoplasma pneumonia from February 2012 to February 2016 were selected and randomly divided into the control group and experimental group,23 cases in each group.On the basis of the regular treatment,the control group was given azithromycin,10mg/kg,qd,intravenous drip,on the basis of the control group treatment,the experimental group was treated with methylprednisolone 2mg/kg+human immunoglobulin 400mg/kg,qd,intravenous drip.The levels of serum C-reactive protein(CRP),white blood cell count(WBC),lymphocyte count(LC),therapeutic efficiency and safety were measured before and after treatment.Results After treatment,compared with the control group,the serum levels of CRP、WBC、LC were lower in the experimental group,the difference was statistically significant(P<0.05).The treatment efficiency of the experimental group(91.31％)was significantly higher than that of the control group(65.22％),the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion The gamma globulin combined with glucocorticoid pulse therapy can significantly reduce the serum levels of CRP,WBC and LC in children with refractory mycoplasma pneumonia,improve clinical efficacy and the safety were good.

Small cell lung cancer(SCLC),characterized with rapid growth and early metastasis ,accounts for about 15~20 percent of all kinds of lung cancer .Patients with extensive disease of SCLC should be treated with combined chemotherapy .The standard treatment for extensive SCLC is etoposide combined with platinum , shortly for EP,with no breakthrough progress in the last decades .This paper briefly reviews the combination of iri-notecan/platinum that showed effectiveness and safety in the treatment of extensive SCLC .

Detection of epidermal cellular DNA content by flow cytometry was performed in normal skin of 14 individuals, both lesiona] and nonlesional areas of 36 patients with psoriasis vulgaris. The results showed that the proliferative activity of epidermal cells was increased successively in normal skins, nonlesional and lesional skin of patients. The differences were significant (P O.01). In combination with the clinical features and histopathological changes and the comparison of 6 patients before and after treatment, the clinical significance of above changes has been discussed.