Sha （痧） is an acute infectious disease characterised by the appearance of rashes on the skin， caused by exposure to epidemic toxin and pestilent qi. Sha Zhang Yu Heng （《痧胀玉衡》） discussed the treatment principles and methods， and listed collateral bloodletting as one of the main treatments. Through organizing the articles and proved cases， we found that the author believes Sha （痧） is caused by epidemic pathogen， belonging to heat toxin with rapid changes， so timely treatment for qi and blood simultaneously could achieve the effect of transforming qi into defensive qi. Sha Zhang Yu Heng focuses on patient's position during treatmet， the material of the needle， the site of treatment， the quantum of stimulation and the operation of the contraindications and other essentials. According to the depth of the disease location， use traditional Chinese herbal medicine， scraping together to identify the root of the disease. In addition， diet suggestions for the prevention of the recrudescence of disease are also described in detail.

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.

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.

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.

Objective To evaluate the effect of artificial ascites under ultrasonic guidance in the thermal ablation of liver or kidney tumors ,so as to provide basis for successfully creating artificial ascites , increasing the complete ablation rate of the tumors and reducing the damage of important organs . Methods Seven hundred and thirty-six patients with artificial ascites were performed under ultrasonic guidance during the thermal ablation of liver or kidney tumors and six hundred and seventy-nine patients were successfully performed . The success rate of creating artificial ascites at different sites ,time requirement ,the effect of ascites , puncture times were analyzed , while curative effect and complications were evaluated and summarized . Results The success rate of creating artificial ascites was 92 .3％ ;the average time of creating artificial ascites was( 9 .1 ± 1 .3) minutes ;the average puncture times was( 1 .1 ± 0 .2) times ;complete ablation was 98 .7％ ;the complication of ascites creation was 0 .44％ ,minor complications after ablation was 6 .20％ , severe complications was 0 .59％ . The required fluid volume and success rates for the creation of artificial ascites in different sites were different . The volume of fluid needed was relatively high in the liver-gastric space ,and the success rate was relatively low ;the success rate of liver septum and liver -kidney crypts was the highest . Heat injury complications of the important organs such as gastrointestinal tract ,esophagus , diaphragm near the liver or kidney tumors were 0 . Conclusions The establishment of artificial ascites improves the local curative effect and reduces the complication of tumors ablation in difficult locations . The methods and effect of artificial ascites in different parts of liver or kidney are different .

Glycemic variability is closely related to diabetes complications,and might play a more valuable role in clinical risk assessment.The glycemic variability could effect the prognosis of cardiovascular disease and ischemic stroke.Meanwhile,it has a close relationship with the presence, development and severity of diabetic nephropathy.Moreover,as an independent risk factor for the damage of macro- and microvessels,it has a positive relationship with the severity of target organ.Therefore,the strategy to regulate glycemic variability is a valuable measure of glycemic control,and may be of great significance to strengthen the effect of diabetes treatment and reduce the damage on target organs.

Objective To investigate the role of phosphatidyl inositol 3 kinase (PI3K)/Akt pathway in the protection of focal cerebral ischemia reperfusion injury in rats with limb ischemic postconditioning (LIP) by detecting the expression levels of p-Akt protein, and caspase-9 and Bcl-2 mRNAs after remote LIP. Methods Forty-two Wistar rats were randomly assigned to 3 groups: sham operation, ischemia-reperfusion (IR) and LIP groups. The middle cerebral artery ischemia-reperfusion injury model was induced by the suture method in the IR group and the LIP group. In the LIP group, three circulatory LIP ( 5 min ischemia/5 min reperfusion) in the contralateral femoral artery were performed before reperfusion 2 h after cerebral ischemia. Infarct volume was measured by 2,3,5-triphenyltetrazolium chloride staining. The expression of p-Akt protein was detected by immunohistochemical staining and the expression levels of cystin-9 and Bcl-2 mRNAs were detected by in situ hybridization. Results Compared with the IR group, the infarct volume in the LIP group was significantly reduced ( P<0.05). The expression levels of p-Akt protein and Bcl-2 mRNA significantly increased (all P<0.05), and the expression level of caspase-9 mRNA significantly decreased (P<0.05). Conclusions LIP can reduce the volume of cerebral infarction in focal cerebral ischemia-reperfusion injury in rats. Its mechanism may be involved in up-regulation of p-Akt protein and Bcl-2 mRNA expression and down-regulation of caspase-9 mRNA expression, suggesting that LIP can alleviate cerebral ischemia-reperfusion injury through PI3K/Akt pathway.

Objective To evaluate the correlation between the imaging features on contrast-enhanced ultrasound (CEUS) and pathological characteristics of combined hepatocellular-cholangiocarcinoma (CHC).Methods Forty patients with pathologically proven hepatic CHC were evaluated,the CEUS imaging findings and pathological characteristics of CHC were retrospectively analyzed.Results On CEUS,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 13(32.5 ％),21 (52.5 ％) and 6(15.0％) lesions,respectively.Pathological findings showed that HCC-predominance,CC-predominant,and similar proportions of the two components were illustrated in 16 (40.0 ％),19 (47.5 ％) and 5 (12.5 ％) cases,respectively.The presence of necrosis were illustrated in 28 (70.0％) cases.On CEUS,when the enhancement pattern was peripheral irregular rim-like enhancement,CC-predominance and necrosis were presented in 11(84.6％) and 10(76.9％) cases,respectively.When the enhancement pattern was diffuse heterogeneous enhancement,CC-predominance and necrosis were presented in 11(52.4％) and 18(85.7％) cases,respectively.When the enhancement pattern was diffuse homogeneous enhancement,HCC-predominance and necrosis were presented in 4(66.6％) and 0 (0％) cases,respectively.There were significant differences in relative proportion of HCC,CC components and tumor necrosis among the three types of enhancement pattern on CEUS (P =0.009 and P ＜ 0.001).When CHCs were ≤ 5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 5,3 and 5 cases,respectively.When CHCs were ＞5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 8,18 and 1 cases,respectively.There were significant differences in the three types of enhancement pattern between lesion size of ≤5 cm and ＞5 cm on CEUS (P =0.006).Conclusions The imaging findings of CHC on CEUS depends on the relative proportions of HCC and CC component and on size-dependent patterns.

Objective To comparatively analyze CEUS features of hepatitis B virus (HBV)-related combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC).Methods Thirty-one patients with HBV-related CHC and 31 patients with HBV-related HCC confirmed by pathology were enrolled and CEUS features were compared.Results On CEUS,HBV-related CHC and HBV-related HCC mainly manifested as hyper-enhanced in arterial phase and hypo-enhanced in portal phase and delayed phase.No significant differences of enhancement level on CEUS were found between HBV-related CHC and HBV-related HCC.When the maximum diameter of tumor ≤3.0 cm,both HBV-related CHC and HBV-related HCC were mainly homogeneous enhancement (P=1.000).When the maximum diameter of tumor more than 3.0 cm,diffuse heterogeneous enhancement and peripheral irregular rim-like enhancement were more commonly observed in HBV-related CHC,while diffuse heterogeneous enhancement was more commonly noted in HBV-related HCC (P=0.001).Conclusion The enhancement pattern of HBV-related CHC ＞3.0 cm has relative specific performance.

Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.