Objective To determine how endoscopic retrograde cholangiopancreatography (ERCP) compared with magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of pancreaticobiliary diseases. Methods A total of 40 patients with suspected pancreaticobiliary diseases underwent both MRCP and ERCP. Images obtained from ERCP and MRCP were compared. Results Pictures of both the examinations in the 40 patients had come out satisfactorily revealing the pancreatic duct and the biliary tree. The sensitivity, specificity and accuracy were 87% (34/39), 100% (1/1) and 88% (35/40) in MRCP and 100% (39/39), 100% (1/1) and 100% (40/40) in ERCP, respectively, without significant differences between the two examinations. Conclusions Although MRCP offers a diagnostic means equivalent to ERCP, it cannot take the place of the latter as regards identification of biliary obstruction.

Objective To determine the protein expression level of p-STAT1 and STAT1 in thyroid cancer and its correlation with clinical pathological parameters,especially with lymph node metastasis and relapse-free survival.Methods p-STAT1 and STAT1 protein were measured by immunohistochemical staining in 80 cases of primary thyroid carcinoma and matched normal controls.All samples were selected from the pathological storage in the Jiangdong 22nd Zone,of Zhuji People's Hospital.The correlation between p-STAT1,STAT1 and patients clinical pathological parameters was analyzed.74 out of 80 patients were followed up over 3 years to analyze the potential relationship between expression of p-STAT1 and STAT1 and relapse-free survival.Results The positive expression of p-STAT1 and STAT1 was 28.8％ and 90.0％ in thyroid cancer tissue versus 85.0％ and 50.0％ in normal thyroid tissue.The difference was statistically significant(P ＜ 0.05).The positve expression of p-STAT1 in stage Ⅲ and Ⅳ thyroid cancers was significantly lower than in stage Ⅰ and stage Ⅱ thyroid cancer(P ＜ 0.05).There was negative correlation between the expression of p-STAT1 and tumor stage and lymph node metastasis,while the expression of STAT1 was irrelevant.Furthermore,the relapse-free survival was 100％ in p-STAT1 positive patients,and 92.65％ in STAT1 positive group.Conclusion p-STAT1 protein level,negatively correlating with tumor stage and lymph node metastasis,down regulates in primary thyroid cancers,and may be a novel biomarker for thyroid cancer metatstasis.

Brain Diseases ; pathology ; Histiocytosis, Sinus ; pathology ; Humans ; Skull ; pathology

By analyzing the questionnaire survey of consciousness of rights protection and status quo of rights and interests among medical staff in three 3rd degree and A grade hospitals located in northwest Hubei province,this paper concludes that medical staff there have a generally strong consciousness of rights,while their rights and interests are not well protected by society and hospitals,especially certain aspects including personal security,occupational health,working hours,legal vacation,and the rights to be involved in hospital management.It is suggested that legal rights and interests of medical staff should be improved through legislation,social support,and the direction function of public opinions.

OJBECTIVE:To study the bioequivalence of metformin hydrochloride tablets.METHODS:A single oral dose of1000mg metformin tablet was given to20healthy male volunteers in an open randomized cross-over test.The plasma levels of metformin were determined by HPLC with ultraviolet detection.RESULTS:The pharmacokinetic parameters of tested and metformin tablets were as follows,C max was(2.59?0.62)?g/ml and(2.60?0.62)?g/ml,T max was(2.0?0.5)h and(1.9? 0.5)h,T 1/2ke was(3.01?0.54)h and(2.90?0.50)h,AUC 0～12 was(13.21?3.28)(?g?h)/ml and(12.99?2.98)(?g?h)/ml,AUC 0～∞ was(14.29?3.44)(?g?h)/ml and(13.91?3.23)(?g?h)/ml,respectively.The relative bioavailability of metformin tablet was(101.6?7.9)%.CONCLUSION:This study shows that the two kinds of preparations are bioequiva?lent.

OBJECTIVE: To study dynamic change and pathophysiology of airway obstruction of the soft palate in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during wakefulness and natural sleep. METHOD: Sixteen patients who were diagnosed as OSAHS by sleep questionnaires, medical examination and polysomnography were enrolled in this study in Shanghai Tenth People' Hospital from May to December during 2007. All patients were requested to keep awake prior to examination. Sequential midline sagittal images of the upper airway were obtained during awake and asleep state with Cine-MRI and been transmitted to portable computer. Morphologic change of the soft palate, the anterior-posterior pendulum angle of the soft palate, the anteroposterior diameter and the length of soft palate were measured. Statistical analysis was performed with paired t-test. RESULT: During wakefulness: soft palate caused obstruction by floating backwards and widening anteroposterior diameter(distance between hard palate and uvula P > 0.05, included angle of hard palate and segmental vente of uvula P < 0.05, included angle of hard palate and segmental dorsum of uvula P < 0.01, difference of included angle P < 0.01). Main obstruction site was on retropalatal region. During natural sleep: soft palate caused obstruction by lengthening down and widening anteroposterior diameter (distance between hard palate and uvula P < 0.01), included angle of hard palate and segmental vente of uvula P > 0.05, included angle of hard palate and segmental dorsum of uvula P > 0.05, difference of included angle P < 0.01). Main obstruction site was on retroglottal region. CONCLUSION Morphologic change of soft palate in patients with OSAHS is multiple, and level of obstruction is deeper during natural sleep than during wakefulness. Main reason of airway obstruction is distinct during different state. The obstruction of upper airway of patients with OSAHS during wakefulness can't replace that during natural sleep.
Adult ; Airway Obstruction ; Humans ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Palate, Soft ; pathology ; physiopathology ; Polysomnography ; Sleep Apnea, Obstructive ; pathology ; physiopathology

Objective To systematically evaluate the clinical effect and safety of repaglinide and metformin for treating diabetes mellitus (MD) of secondary failure of sulfonylurea (SFS).Methods The randomized controlled trials (RCT) at home and abroad on the comparison of effect and safety of repaglinide and metformin in treating MD with SFS were retrieved.The modified Jadad scale was employed to evaluate the literature quality.The RevMan5.3.1 software was used for conducting the meta analysis.Results A total of 10 RCT were included.The meta-analysis results showed that compared with metformin for treating MA with SFS,repaglinide decreased the fasting blood glucose effectively (MD=-2.30,95 ％ CI:-2.53--2.06,P＜0.01),increased the fasting C-peptide (MD=0.06,95％CI:0.02-0.11,P=0.01),reduced the postprandial 2 h blood glucose (MD=-2.17,95 ％CI:-2.44-1.89,P＜0.01) and decreased glycosylated hemoglobin (MD=-2.60,95％CI:-3.21--2.00,P＜0.01) as well as the adverse reactions (RR=0.05,95％CI:0.02-0.09,P＜0.01).However,there was no statistical difference in fasting insulin between the repaglinide and metformin groups (MD=0.18,95％CI:-0.18-0.54,P=0.32).Conclusion Currently evidences suggest that repaglinide is superior to metformin for treating MD with SFS.

Objective To analyze the causes of unplanned tracheal extubation in mechanically ventilated patients in the pediatric intensive care unit using quality management practices and observe the changes of extubation rates before and after implementing these practices.Methods In the first place,we set up quality management group in June 2014.Second,the team formulated a risk factor checklist for unplanned tracheal extubation based on literature research, and analyzed the main causes requiring tracheal extubation. The last time,we developed some management measures for important reasons in 2014,and established and implemented a quality management strategy between 2015 and 2016.The incidence frequency of unplanned tracheal extubation,i. e. the number of extubation cases per 100 days with a tube in place(mechanical ventilation days),was used to evaluate the change of the extubation rates before and after implementing the new measures. The cases in 2014 were retrospectively analyzed,and cases from 2015 to 2016 were prospectively collected.The number of interval days for two continuity unplanned extubation was considered to be a means of quality control.Results Rick factors associated with unplanned extubation in the pediatric intensive care unit before implementing quality management were a delay of the replacing adhesive bandage, lack of sedation assessment,which were related to frequent physician replacement and insufficient training and supervision.In consideration of the identified risk factors,a standard operating procedure was formulated to prevent unplanned extubation,including standard operating procedure of tracheal catheter fixation and the sedation assessment. There were 484 mechanical ventilation in 2014,and the incidence of unplanned extubation was 0.8%,and the median number of days of separation was 8.0(4,20) d.Between 2015 and 2016,there were 1 379 mechanical ventilations,and the incidence of unplanned extubation was 0.2%,and the median number of days of separation was 34.0(19,61) d.The incidence of unplanned extubation in 2015 to 2016 was lower than that in 2014(χ2=5.936,P=0.018).Ramsay scoring usage increased from 28.6% in 2014 to 57.1% between 2015 and 2016,while Ramsay scored 3-4 points from 2015 to 2016 was higher than 2014(P< 0.05).Conclusion Establishing the quality management group according to the requirements of each hospital and implementing quality management strategies can reduce the incidence of unplanned extubation,thereby improving the quality of care in pediatric intensive care unit.

Objective:To investigate the value of pericoronary adipose tissue histogram parameters based on coronary CT angiography (CTA) images for the differentiation of acute coronary syndrome and stable coronary artery disease.Methods:The clinical data and CTA images of 93 patients with coronary CTA examination in Suzhou Kowloon Hospital from 2013 to 2018 were analyzed retrospectively. There were 39 patients with acute coronary syndrome (acute coronary syndrome group) and 54 patients with stable coronary artery disease (stable coronary artery disease group). A region of interest (ROI) was drawn around the stenosis of the coronary arteries, with CT attenuation ranging from-190 to -30 HU to exclude non-adipose tissue. The CT attenuation of ROI excluding non-adipose were measured and histogram analysis was performed. The obtained parameters included the mean value, median value and the 5th, 10th, 45th, 55th, 70th and 95th percentiles. The differences in histogram parameters between the two groups were compared, and then the value of each parameter in differentiating acute coronary syndrome and stable coronary artery disease was evaluated based on receiver operating characteristic (ROC) analysis. The stepwise regression of multivariate logistic regression analysis was used to identify the useful features and establish the final prediction model. The ROC curve of the final model was calculated and its value was analyzed.Results:The mean, median and the 5th, 10th, 45th, 55th,70th and 95th percentile differences between the acute coronary syndrome group and the stable coronary artery disease group were statistically significant (all P<0.05). The ROC curve for the median and the 95th percentile had the same area under curve (AUC) of 0.73. The sensitivity, specificity and AUC of the diagnostic model established by multiple logistic regression were 82.1%, 89.1% and 0.90 respectively. Conclusion:CT attenuation histogram of pericoronary adipose tissue is of high value in differentiating acute coronary syndrome from stable coronary artery disease.

Objective: To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children. Method: A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children′s Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children′s Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days. Result: No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting). Conclusion The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.