Objective To investigate the missing rate of polypus with colonoscopy and correlation factors for missed diagnosis.Methods Data with colorectal polyps collected a second colonoscopy within 180 days after polyps were detected and removed on the initial colonoscopy in 186 patients between July 2009 and June 2013.The following factors were statistically analyzed,including lesionrelated factors (the lesion size,location,shape,number,and pathology),and non-lesion-related factors (intestinal cleanliness,colonoscopy post-set time,colonoscopy operator experience,and whether colonoscopy with sedation).Results Polypus missed diagnosis was found in 57 patients out of 186 recruited subjects (30.64％).A total of 76 polypus were missed out of 343 (22.16％) polypus detected by repeated colonoscopy.Flat small polyps were easily missed diagnosis (P ＜ 0.01).Polyps located at sigmoid,cecum and ascending colon,hepatic flexure,and splenic flexure were easily missed diagnosis (P ＜0.05).The rate of missed diagnosis was significantly increased in the condition of the low intestinal cleanliness,short colonoscopy post-set time,non-intravenous anesthesia,and beginner colonoscopy doctors (P ＜ 0.01).Conclusions A markedly missing rate of polyp existed on colonoscopy,and was closely related to the lesion-related factors (the lesion size,location,shape,number,and pathology) and the non-lesion-related factors (the intestinal cleanliness,colonoscopy post-set time,colonoscopy operator experience,and whether colonoscopy with sedation).

Objective To investigate the role and action mechanism of chemokine (C-X-C motif)receptor 3 (CXCR3)in hepatic ische-mia-reperfusion injury (IRI).Methods Forty-eight mice were divided into operation group and sham-operation group.The operation group was treated to establish a mouse model of IRI.Liver tissues were obtained at 3,6,12,and 24 h after IRI,with 6 mice at each time point.The expression of chemokine (C-X-C motif)ligand 9-1 1 (CXCL9-1 1 )and their receptor CXCR3 were measured by real-time PCR and Western blot.The effect of CXCR3 was blocked by its specific antagonist C6.Hepatic injury was estimated based on the activity of hepatic transaminase and morphological indices.The distribution of subsets of infiltrating T cells was analyzed by flow cytometry.All data were expressed as mean ±standard deviation.Comparison between groups was made by one-way analysis of variance.Results Compared with the sham-operation group,the operation group had significantly upregulated expression of CXCL9-1 1 and CXCR3 at all time points after IRI (P<0.05).Blocking CXCR3 significantly protected liver function and morphology (P<0.05).Antagonist C6 significantly re-duced Th1 cell infiltration (P<0.01),but significantly increased Treg infiltration (P<0.01).Conclusion CXCR3 is an ideal therapeu-tic target in IRI treatment due to its relationship with immunoregulation.

Objective To explore the effect of combined use of antiplatelet drugs on late-onset bleeding in elderly patients after high frequency electric resection of the colon polyps on colonoscopy.Methods Data with late-onset bleeding after high frequency electric resection of the colon polyps on colonoscopy were collected from 64 elderly patients using antiplatelet drugs from January 2010 to December 2013.Those 64 elderly patiets using antiplatelet drugs were divided into aspirin,clopidogrel,and aspirin + clopidogrel groups.The clinical situation,blood-coagulation time,bleeding-occurrence time,emergency colonoscopy hemostatic rate of demand,and hemostatic time in hospital were analyzed.Results No statistically significant differences were found in the blood-coagulation time,bleeding-occurrence time,and hemostatic time in hospital among aspirin,clopidogrel,and aspirin + clopidogrel groups.However,the clinical situation,and emergency colonoscopy hemostatic rate of demand in aspirin + clopidogrel group were significantly more serious and higher than those of the aspirin or clopidogrel groups (P ＜ 0.01).Conclusions There are more serious clinical situation and higher emergency colonoscopy hemostatic demand in patients with combined use of antiplatelet drugs relative to the use of single antiplatelet drug.The clinicians should pay attention to the combined use of antiplatelet drugs for late-onset bleeding in elderly patients after high frequency electric resection of the colon polyps on colonoscopy.

Urinary tract infection complicated with urinary tract calculi( lithangiuria)is one of the most common diseases causing serious urinary sepsis and septic shock. Recent studies show that the accurate diagnosis,rational use of antibiotics and timely treatment of complications are the key to treatment success. In this article,the latest progress and the treatment strategies for urinary tract infections complicated with lithangiuria are explored.

Objective To explore the clinical efficacy of endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocyst. Methods 100 patients with pancreatic pseudocyst from March 2014 to March 2015, 80 cases were underwent endoscopic ultrasound-guided transgastric and the other 20 cases were underwent transpapillary drainage. The treatment effect and complications were recorded. Results The success rate was 95.00 %, and cysts completely disappeared in 84.00 % of the patients. Among all the patients there are 10 cases occurred intraoperative bleeding, 3 cases occurred stent clogging or migration and 7 cases occurred infection, the overall incidence of complications was 20.00 %. Conclusion Endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocysts has better clinical curative effect, and can also reduce the occurrence of complications, which is worth popularizing clinically.

Objective Study the apply of diffusional kurtosis imaging(DKI) value to assess liver cancer and tumoral cell invasion of peritumoral liver zone. Methods This research belonging to prospective study which included 24 patients with liver cancer and confirmed by clinical history and imaging features(liver cancer group), 10 healthy volunteers as control group. The liver cancer group underwent MRI plain and contrast enhanced scan, and DKI examination, while control group underwent MRI plain scan and DKI scan. The signal features of liver parenchyma and liver cancer lesion could be observed from the routine MRI and DKI. Fractional anisotropy (FA), mean diffusion (MD), axial diffusivity (Da), radial diffusivity (Dr), fractional anisotropy kurtosis (Fak), mean kurtosis (MK), kurtosis anisotropy (Ka) and radial kurtosis (Kr) value of four groups, the distant liver parenchyma(far away from the tumor>2 cm), peritumoral liver parenchyma(the distance≤2 cm around the tumor) and liver cancer were recorded. The differences of DKI parameters were evaluated using one-way analysis of variance (ANOVA). Results The signal of liver cancer in MR plain scan showed mild long T1 and mild long T2 signal, fast in and fast out enhanced feature of the neoplasms could be observed from the enhanced MRI and signal of liver cancer would not lower in DKI with b value up to top. The difference of DKI parameters including FA, MD, Da, Dr and Ka value had statistical significance in these four groups excepted for MK and Kr value. MD, Da and Dr value of normal parenchyma were higher than that of peritumoral parenchyma and liver cancer,while the Ka value was reverse. The differences of MD, Da, Dr and Ka value only had no statistical significance between the distant liver parenchyma and peritumoral liver parenchyma(P>0.05),and the differences of them had statistical significance among the rest group(P<0.05). Conclusion The DKI quantitative parameters can reflect the differences of different tissue, meaning that they can provide molecular imaging information for evaluating liver cancer and peritumoral zone.

CD4-Positive T-Lymphocytes ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Interleukin-2 Receptor alpha Subunit ; Sequence Analysis

To investigate the plasma thioredoxin-interacting protein ( TXNIP ) levels in different glucose tolerance groups and discuss the relationship between TXNIP and insulin resistance/β-cell dysfunction in diabetes and prediabetes, and to investigate the potential relationship between TXNIP and interleukin-1β( IL-1β) . According to oral glucose tolerance test, 93 participants were divided into 3 groups:diabetes mellitus group, prediabetes group, and normal glucose tolerance group. Plasma TXNIP, IL-1β, and other biochemical indices were measured. The relationship between TXNIP and glucose, IL-1β, homeostasis model assessment for insulin resistance ( HOMA-IR) , and homeostasis model assessment forβcell function ( HOMA-β) were analyzed by using multiple linear regression techniques and Pearson’s linear correlation analysis. Plasma TXNIP level was higher in prediabetes group compared with normal glucose tolerance group, but lower in prediabetes group compared with diabetes mellitus group[(355. 35±31. 88 vs 274. 36±33. 86, 426. 16±63. 15)pg/ml, P<0. 01 or P<0. 05]. TXNIP was positively correlated with IL-1βand HOMA-IR, but negatively correlated with HOMA-β. Multiple linear regression analysis indicated that IL-1βexerted significant influence on TXNIP ( P<0. 05 ). Plasma TXNIP level is affected by blood glucose concentration. There is a close relationship between TXNIP and IL-1β. In prediabetes patient, the TXNIP levels have already been raised.

Objective To understand the Helicobacter pylori ( Hp) infection eradication rate of standard tri-ple therapy in Guangdong Meizhou and the drug resistance situation for metronidazole ,clarithromycin ,amoxicillin and levofloxacin ,in order to look for the treatment countermeasures in Hp eradication failure .Methods 297 cases of Hp positive patients because of gastrointestinal symptoms to our hospital examined from April 2011 and March 2013,were randomly assigned into three standard triple therapy groups:A ( OCA ) group and B ( OCM ) group and C ( OCL ) group.The Hp eradication rate was analyzed .Patients with primary treatment failure were selected as group D (OBAL),proceed to (PPl+B+A+L)7 d therapy,the Hp eradication rate was analyzed .230 Hp strains were isola-ted and cultured from 297 cases received the first eradication therapy and 87 cases received again eradication therapy . The minimum inhibitory concentration (MIC) of metronidazole,clarithromycin,amoxicillin and levofloxacin were tested by E-test,in order to determine the resistance of these four antibiotics in clinical isolated Hp strains .Results With intention-to-treat(ITT) analysis,the Hp eradication rates of group A (OCA),group B(OCM) and group C(OCL) were 72.0%(72/100),63.0%(63/100) and 72.2%(70/97),respectively.With per-protocol(PP) analysis,the Hp eradication rates of group A (OCA),group B(OCM) and group C(OCL) were 72.7%(72/99),64.3%(63/98),73.7%(70/95),respectively.The eradication rate among three standard triple therapy groups had no obvi-ous difference (ITT:P=0.278,PP:P=0.288,P>0.05).With ITT analysis,the Hp eradication rate in the quadrup-le therapy group D(OBAL) was 92.0%(80/87).With per-protocol(PP) analysis,the Hp eradication rate in the quadruple therapy group D(OBAL) was 97.6%(80/82),which was higher than that of the three standard triple ther-apy groups(ITT:P=0.000,PP:P=0.000).In 230 clinical isolated Hp strains,the resistant rates of levofloxacin,amoxicillin,clarithromycin and metronidazole were 6.08%(14/230),6.52%(15/230),25.65%(59/230), 70.87%(163/230),respectively.Of those 37 strains were mixed resistance,the mixed resistant rate was 16.09%(37/230).The resistant rate of metronidazole was higher than levofloxacin , amoxicillin and clarithromycin ( P =0.000,P<0.01),the resistant rate of clarithromycin was higher than levofloxacin and amoxicillin (P=0.000),no statistically significant difference between amoxicillin and levofloxacin (P=0.848).Conclusion The Hp resistance is similar to the national average in Guangdong Meizhou ,the eradication rate of standard triple therapy is lower than 80%,contain bismuth agent of quadruple therapy is good rescue therapy .

Objective To evaluate the feasibility and efficacy of mono-modality fusion imaging using ultrasound in the intraoperative immediate evaluation of therapeutic response of liver cancer thermal ablation.Methods A total of 70 liver cancers in 53 patients that underwent thermal ablation from October to November 2015 were included in this study.Mono-modality fusion imaging using ultrasound was applied immediately after the ablation procedure to evaluate the therapeutic response of the thermal ablation.The applicable rate,the success rate of registration,the duration time,the evaluation results and the rate of supplemental ablation were recorded.Ultrasound examination was performed on the first day after ablation to evaluate the early complication.Contrast-enhanced CT/MR within 1-3 months after the procedure was regarded as the golden criteria of the treatment response.In the follow-up period,the rate of local tumor recurrence,progression-free survival and overall survival were analyzed.Results The applicable rate for mono-modality ultrasound fusion imaging is 62.9％ (44/70) while the success rate of registration is 90.9％ (40/44).The duration time for mono-modality is 2.7-7.5 min,with an average of (3.9 ± 0.9) min.Thirty-seven out of 40 liver cancers were evaluated to achieve safety margin and 3 out of 40 were not.The rate of supplemental ablation was 40％ (16/40).The rate of complete ablation was 97.3％ (36/37) according to contrast-enhanced CT/MR within 1-3 months.In the follow-up period,no local tumor recurrence was observed and the rates of intra-hepatic recurrence and overall survival were 46.7％ (14/30) and 96.7％ (29/30),respectively.Conclusions Mono-modality ultrasound fusion imaging is a convenient,feasible,safe and efficient method in the intraoperative immediate evaluation of therapeutic response of liver cancer thermal ablation.