Objective To evaluate the role of serum immunoglobulin G4 (IgG4) in differentiating autoimmune pancreatitis (AIP) from pancreatic cancer(PC).Methods The database,including Medline,EMBASE,Science Direct,Springer link,CBM,Wanfang,VIP and Cnki were searched by computer and the publication date was before April 1,2015.The studies on evaluating the accuracy of IgG4 in differentiating AIP from PC were screened and selected according to strict determined inclusion and exclusion criteria.Quality assessment was made by QUADAS scale.The publication bias were assessed by Stata12.0 software.The heterogeneity of included articles,calculate the pooled sensitivity,specificity,positive likelihood,negative likelihood were anylyzed by Meta-Disc1.4 software,respectively,and draw the summary ROC (SROC) curve.Results A total of 13 English articles were included and 1403 patients were involved.The pooled sensitivity was 74％ (95％ CI 70％ ～ 78％),the pooled specificity was 93％ (95％ CI 91％ ～ 95％),the positive likelihood ratio was 10.74 (95％ CI 7.16 ～ 16.11),the negative likelihood ratio was 0.25 (95％ CI 0.17 ～0.35) and the area under SROC curve was 0.9340.Conclusions IgG4 has high diagnostic efficacy but low misdiagnosis rate in differentiating AIP from PC,which can be used as one of early diagnostic markers for AIP.

OBJECTIVE:To discuss the countermeasure on the quality improvement of the drug clinical trials in our hospital based on the discovery of key links of the quality of clinical trials. METHODS:Quality results of 14 drug clinical trials in 10 ma-jors from the drug clinical trial institute in our hospital in 2014 were investigated. Referring to the grading and classifying methods of the inspection problems in European Medicines Agency,the key links of occurring problems were analyzed,and the effects of interventions for key links were evaluated. RESULTS:In 2014,totally 125 important and general problems were found,in which, the numbers of problems occurred in case report form filling,informed consent of subjects,enrolling and screening of subjects,in-vestigational products management accounted for 79.20%. The above 4 links were the key links affecting quality of drug clinical tri-als. According to strengthening the training about relevant knowledge of the researchers,improving system and standard operation procedures management,enhancing link quality control,introducing project clinical research coordinator,developing centralized drug management and other interventions,the total numbers of found important and general problems in 2015 and 2016 were 68 and 59,respectively. Compared with 2014,the differences were statistically significant(P<0.05). The numbers of found important problems in 2015 and 2016 were 7 and 4,respectively. Compared with 2014(4 important problems),the differences were not sta-tistically significant (P>0.05). There were no severe problems during 2014-2016. After interventions,numbers of occurring prob-lems in majors with less complex drug clinical trial had obviously declined in 2016. Compared with 2014,the differences were sta-tistically significant (P<0.05). While the major with relatively high complexity of drug clinical trial had no obvious decline in 2016. Compared with 2014,the differences were not statistically significant(P>0.05). CONCLUSIONS:Controlling the key links in drug clinical trial process can obviously reduce the occurrence of general problems while has little effect on the occurrence of im-portant problems. It is different for different majors in undertaking drug clinical trial projects,so as the links and degree of occur-ring problems. It should be distinguished in quality control checking.

Objective To evaluatethe curative effect of the integrative treatment of point injection, warm acupuncture and Chinese medicine enema for the chronic pelvic inflammatory disease.Methods A total of 86 patients with chronic pelvic inflammatory diseasewere divided into control group and treatment group, 43 patients in each group , according to the random number table. The control group was treated by warm acupuncture combined with Chinese medicine enema, while the treatment group was treated with point injection plus the basis of control group. The levels of serum CRP, IL-1 and IL-6 were detected by enzyme linked immunosorbent assay,the plasma viscosity and hematocrit were detected by automatic blood rheological test instrument,the symptom scores of 2 groups were compared before and after treatment, the clinical efficacy was evaluated and the recurrence rate was observed. Results The clinical effective rate of treatment group patients was 97.7% (42/43), and the control group 81.4% (35/43). The difference between two groups was significant (χ2=6.081,P=0.014). After treatment, the levels of CRP (7.53 ± 3.44 mg/L vs. 10.11 ± 3.02 mg/L,t=-3.696), IL-1β (26.37 ± 13.98 pg/mL vs. 36.33 ± 4.02 pg/mL,t=-4.490) andIL-6 (23.31 ± 10.11 pg/mlvs. 29.56 ± 4.27 pg/ml,t=-3.734)in the treatment group were significant lower than those in control group (P<0.05). The scores of pain (2.13 ± 0.55vs.2.71 ± 0.62,t=-4.589), tiredness (1.07 ± 0.98 vs. 2.53 ± 0.52,t=-8.630), Body cold (1.51 ± 0.51 vs. 2.21 ± 0.67,t=-5.451), menstrual symptoms (1.27 ± 0.97 vs. 2.29 ± 0.78, t=-5.374) and total points (6.13 ± 3.94vs. 8.55 ± 1.82,t=-3.656) in the treatment group were significant lower than those in control group (P<0.05). The plasma viscosity (1.13 ± 0.25 mPa?svs. 1.41 ± 0.32 mPa?s,t=-4.521) and the red blood cells deposited (0.27% ± 0.08% vs. 0.41% ± 0.07%,t=-8.636) in the treatment group were significant lower than those in control group (P<0.05). The recurrence rate of treatment group was none, while 11.43% (4/35) in control group. Thus, the recurrence rate of treatment group was significantly lower than the control group (χ2=5.063,P=0.024). Conclusions The integrative treatment of point injection, warm acupuncture and Chinese medicine enema can reduce the level of inflammatory factors in patients with chronic pelvic inflammatory disease, improve the blood microcirculation, and reduce the recurrence rate.

Objective To study the risk factors of mortality in severe sepsis and septic shock patients. Methods 142 patients with severe sepsis and septic shock in ICU were observed and divided into alive group (98 patients)and dead group (44 patients)by using hospital mortality.The risk factors of mortality in severe sepsis and septic shock patients were assessed by binary logistic regression.Results Independent mortality risk factors were inotropic agents (OR =4.329,95%CI:1.045 -17.937,P =0.043),blood glucose >10 mmol/L (OR =3.771,95%CI:1.214 -11.710,P =0.022)and APACHE Ⅱ score (OR =3.098,95%CI:2.012 -4.760,P =0.000),while PaO2 /FiO2 after early goal -directed therapy (EGDT)was protective factor (OR =0.682,95%CI:0.500 -0.930, P =0.016).Conclusion Severe sepsis and septic shock patients with inotropic agents,blood glucose >10mmol/L, high APACHE Ⅱ score and decreased PaO2 /FiO2 after EGDT indicate poorly prognosis.

Chloroplast genome sequences have comprehensive application prospects in DNA barcoding and chloroplast engineering in traditional Chinese medicine. The complete chloroplast genome of Magnolia officinalis sequenced by high-throughput pyrosequencing and a sequencing procedure was established. Fourteen contigs were obtained after de nove assembly. The sequencing percent of coverage was 99.99%. The chloroplast genome is 160 183 bp in size, and has a typical quadripartite structure with the large (LSC, 88 210 bp) and small copy (SSC, 18 843 bp) regions separated by two copies of an inverted repeat (IRs, 26 565 bp each). chloroplast genes were successfully annotated, of which 17 genes located in each IR region. The chloroplast genome features in Magnolia officinalis are nearly identical to those from other Magnoliid chloroplast genomes. Phylogenetic analyses were performed based on 81 shared coding-genes for a total of 9 Magnolia samples of 5 closely related species. Results showed that distinguishing among species was generally straightforward at the species and population level. This study confirmed the effectiveness of our chloroplast genome sequencing procedure. The chloroplast genome can provide distinguishing differences to help identify Magnolia officinalis and its closely related plants.

This article reports the experience of treatment of 30 cases of temporal epilepsy with surgery. There were 15 male patients and 15 female. The duration of the disease ranged from 5 to 37 years with an average of 13.6 years. 12 patients suffered from grand and petite mal, 8 Jacksonian accompanied by psychomotor epilepsy, and 10 grand mal. Before the operation, the focus with sporadic spikes was found in the temporal lobe with electroencephalogram. Operation: the temporal pole and the medi-basal region were removed in 9 cases, anterior portion of the temporal nesiolobe in 10 cases, temporal neocortical of the temporal lobe in 6 cases, dorsolateral and laterobasal parts in 5 cases. Organic pathological changes were confirmed in all cases by pathological examination. Clinical result of all cases was satisfactory, with an effective rate of 93%. The clinical and pathological changes of epilepsy and efficacy of the treatment are discussed. It is stressed that the localization of the focus of epilepsy depe nds mainly on electroencephalogram. It is very important to look for sporadic spikes using cortical electrode during operation, and complete eradication of the focus is the key to achieve a good treatment effect.

There has always been no lack of discussion on Biaoben and Genjie theory in traditional Chinese medical acupuncture circles, but many questions still exist. This article expounds the original meaning of Biaoben and Genjie, traces the origin of the theory and sorts out the questions in Biaoben and Genjie theory, e.g. the difference in the position between Biaoben and Genjie, no record of the location of Genjie of six hand meridians, regularities in meridional qi circulation, understanding and valuing, and application and development to confirm the importance of Biaoben and Genjie theory and to give reference.

Objective To investigate the effect of unfractionated heparin (UFH) on the expression of heme oxygenase-1 (HO-1) in intestinal mucosa of mice with sepsis.Methods Thirty-six male C57BL/6J mice were randomly divided into sham group,cecal ligation and puncture (CLP) group and UHF group,n =12 in each group.Model of intestinal injury in sepsis was induced by CLP.In sham group,the mice were exposed without ligation of cecum.In UFH group,the mice were treated intravenously with 8 U of UFH via the tail vein half an hour before the operation and 12 hours after the surgery respectively.Six mice in each group were randomly chosen at 4 hours and 24 hours after operation to collect inferior vena venous blood samples and terminalileum tissues.The serum levels of interleukins (IL-1 β,IL-6),and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA).The serum level of D-lactate was determined by colorimetry.Pathological changes of ileum tissue and Chiu score were observed after hematoxylin eosin (HE) staining.The HO-1 expression was detected immunohistochemically.Results In sham group,no significant changes in the serum levels of IL-1 β,IL-6,TNF-α and D-lactate were observed.Twenty-four hours after the operation,the structure of intestinal mucosa was basically normal without obvious pathology change and no HO-1 positive cells were found.The serum levels of IL-1 β,IL-6,TNF-α,and D-lactate in CLP group were gradually increased,and they were significantly increased as compared with sham group [IL-1 β (ng/L):40.87±2.88 vs.22.60±2.05 at 4 hours,113.73±3.96 vs.22.07±2.74 at 24 hours;IL-6 (ng/L):63.89±3.26 vs.44.89±3.38 at 4 hours,176.56±5.45 vs.45.76±4.02 at 24 hours;TNF-α (ng/L):194.62± 14.13 vs.152.05±6.22 at 4 hours,599.62± 10.20 vs.155.90± 14.18 at 24 hours;D-lactate (mmol/L):0.24± 0.02 vs.0.19 ± 0.01 at 4 hours,0.33 ± 0.04 vs.0.20 ± 0.02 at 24 hours,all P ＜ 0.05].Twenty-four hours after the operation,edema and inflammation in ileal mucosa,intestinal villi structural damage were observed,the Chiu score was significantly higher than those in the sham group [4.5 (3.0-5.0) vs.0 (0-1.0),P ＜ 0.05],and a small amount of HO-1 positive cells were localized in the intestinal mucosa.Compared with CLP group,the serum levels of IL-1 β,IL-6,TNF-α,and D-lactate of UFH group were significantly decreased [IL-1 β (ng/L):31.53 ± 2.90 vs.40.87 ± 2.88 at 4 hours,61.13 ± 2.80 vs.113.73 ± 3.96 at 24 hours;IL-6 (ng/L):51.16 ± 5.68 vs.63.89 ± 3.26 at 4 hours,81.16 ± 4.54 vs.176.56 ± 5.45 at 24 hours;TNF-α (ng/L):171.76± 5.60 vs.194.62± 14.13 at 4 hours,328.48 ± 10.79 vs.599.62± 10.20 at 24 hours;D-lactate (mmol/L):0.21 ±0.01 vs.0.24±0.02 at 4 hours,0.24±0.02 vs.0.33±0.04 at 24 hours,all P ＜ 0.05].Twenty-four hours after the operation,intestinal injury was ameliorated,the Chiu score was significantly lower [1.5 (1.0-5.0) vs.4.5 (3.0-5.0),P ＜ 0.05],and HO-1 positive cells in the intestinal mucosa was remarkably increased.Conclusion UFH can enhance the expression of HO-1 in intestinal mucosa,reduce the release of inflammatory factors,ameliorate the intestinal inflammatory response,and thus play a protective role in intestinal tissue in mice with sepsis.

Objective To investigate the changes of A20 expression stimulated by free fatty acids (FFA) and its pathway.Methods HepG2 cells and U937 cells were stimulated by 0.5 mmol/L mixed FFA.The expression of A20,phosphor-p65 and phosphor-IκBα of neclear factor (NF)-κB pathway and phosphor-c-Jun N-terminal kinase (JNK),JNK,phosphor-extracellular signal-regulated kinase (ERK),ERK,phosphor-p38 and p38 of mitogen-activated protein kinase (MAPK) pathway were detected by Western blotting.The level of interleukin (IL)-12p,IL-1β,tumor necrosis factor (TNF)-α,IL-6,IL-10 and IL-8 cytokines in the supernatant of cell culture were detected by flow cytometry.T-test was performed for statistical analysis.Results The level of A20 changed along with the stimulated time of FFA.NF-κB and MAPK pathways were activated after FFA stimulation.The secretion of IL-6 and IL-8 increased after HepG2 cells stimulated by FFA and both reached peak at 24 hour.Compared with control group,the difference in IL-8 was statistically significant ((423.8 ± 8.9) pg/mL vs (12.4 ± 4.5) pg/mL,t=41.28,P＜0.01).The difference in IL-6 was also statistically significant ((4 082±423.6) pg/mL vs (52.9±29.5) pg/mL,t=9.49,P＜0.01).After U937 cells were stimulated by FFA,the secretion of IL-8 increased compared with control group.And in a certain period of time the secretion was time dependence.The maximum secretion of 24 hours was (200.6±5.7) pg/mL vs (5.0±3.9) pg/mL,and the difference was statistically significant (t=28.16,P＜0.01).IL-10,IL-12p,IL-1β and TNF-α were detected.Both NF-κB pathway and MAPK pathway were detected.Conclusions The in vitro FFA mediated steatotic cell model could induce the expression change of A20 and secretion of inflammatory cytokines.NF-κB and MAPK pathways involved in the response to FFA in HepG2 cells and U937 cells.

Objective To sum up the specificity in clinical care of repetitive transcranial magnetic stimulation (rTMS),and provide reference for putting forward scientific and effective clinical care project.Methods 200 male schizophrenia patients with rTMS treatment were divided into the research group and the control group with 100 cases in each group randomly.Then,the research group adopted the specific nursing which was obtained from the pre-experiment while the control group adopted the routine care.Moreover,NORS scale was used to evaluate the treatment effect.Changhai Pain Measuring Scale was employed to assess headaches in pre-treatment and post-treatment.Results The data of the research group in NORS scale was obviously lower than the control group,and the difference between two groups had statistical significance.No case occurred adverse reaction in the research group,in contract with many cases with adverse reaction in the control group.Conclusions Specific nursing can reduce complications effectively for schizophrenia patients receiving rTMS treatment,and it is a scientific,effective and mature clinical care method.