Objective To discuss the clinical value of endoscopic retrograde cholangio panecreatography (ERCP) and endoscopic sphincterotomy (EST) for the treatment of extrahepatic bile duct stones. Metbods Forty-five cases were treated with ERCP and EST. Other 55 patients treated with opening proedure were selected to serve as the controls. Results The effective rate was 97.8% by ERCP and EST and 90.9% by opening procedure(P>0.05). The rate of residual stone was 2.22% by ERCP and EST and 20.00% by opening procedure(P<0.05). The rate of complications was 4.44% by ERCP and EST and 18.18% by opening procedure(P<0.05). Conclusion Therapeutic efficacy of ERCP and EST is better than the opening procedure in the treatment of extrahepatic bile duct stones. It is a safe, effective and simple method for the treatment of extrahepatic bile duct stones.

Objective To explore and analyze the related factors for cirrhosis patients with hospital infection.Methods Clinical data of 750 patients with cirrhosis in our hospital were retrospectively analyzed.Related factors for hospital infection including gender,age,length of hospital stay,Child-Pugh classification,accompanying invasive procedures,associating the underlying disease,using antibacterial drugs and the sites of hospital infection and pathogen distribution were analyzed.Results The infection rate was 20.7％ (155/750).The infections were mainly spontaneous bacterial peritonitis [54.8％ (85/155)],followed by respiratory,digestive,urinary tract and skin.Pathogenic bacteria were mainly Gram-negative bacteria [56.1％ (101/1)],followed by Gram-positive bacteria and fungi.Patients aged over 70 years,with hospital stay over 4 weeks,with higher Child-Pugh classification,associated with invasive procedures,combined with underlying diseases,and treated with antimicrobial drugs were much easier to get hospital infection (x2=12.2,16.3,49.46,55.2,20.95,26.24,all P＜0.05).Conclusions Patients aged over 70 years with long hospital stay and more severe liver damage,accompanied by invasive procedures,combined with basic diseases and treated with antimicrobial agents are the related factors for hospital infection in patients with cirrhosis.

Objective To explore the characteristics and regulations of CD28 and CTLA-4 expressions in the process of mice' T-cell inefficiency induced by staphylococcal enterotoxin A(SEA).Methods Twelve mice were averagely divided into three groups(4 each).The mice in group 1 received single injection of SEA,and the mice in group 2 and 3 received SEA injection twice and three times,respectively,with a 3 days interval.Mice were sacrificed at day 1,3,7 and 14 after the last injection,and then the splenic lymphocytes were isolated.The expressions of CD28 and CTLA-4 in cellular membrane and the intracellular expressions of CTLA-4 and IL-2 were detected with flow cytometry.Results In group 1,the CD28 expression in cellular membrane and the intracellular expression of IL-2 were significantly up-regulated,while the CTLA-4 expressions both in cellular membrane and intracellular expression were lower with no obvious changes.In group 2,the expressions of both CD28 and IL-2 were up-regulated slightly,the expressions of CTLA-4 increased significantly both in cellular membrane and intracellular expression,even more increase was the intracellular CTLA-4 expression.In group 3,the expressions of CD28 and CTAL-4 in cellular membrane and the intracellular CTLA-4 expression declined,and at day 7 the intracellular IL-2 expression was undetectable.Conclusions SEA may obviously promote the activation of naive T-cells when initially used to induce the splenic lymphocytes,while multiple stimulations(e.g.3 times) of SEA may lead T-cells to anergy.On the process of inefficiency,the declined IL-2 production may be closely related to the down-regulation of CD28 expression;the up-regulation of CTLA-4 expression may profit inducing inefficiency,but is not on the maintenance of inefficiency.

BACKGROUND: At present, international classification of diseases by WHO, cerebrovascular disease classification used in China and TOAST classification used abroad are all based on patho-physiology. There is no report about human cerebral infarction by magnetic imaging types in Beijing and other areas.OBJECTIVE: To analyze retrospectively the subtype distribution of acute cerebral infarction of patients in Beijing by magnetic resonance imaging in order to make Beijing patients with acute ischemic stroke receive more exact and individualized treatment.DESIGN: Retrospective case study.SETTING: Department of Neurology, General Hospital of Beijing Military Area Command of Chinese PLA.PARTICIPANTS: The study was carried out in General Hospital of Beijing Military Area Command of Chinese PLA, Beijing Sino-Japan Friendship Hospital, Beijing Chaoyang Hospital, Beijing Naval General Hospital and Beijing Jishuitan Hospital between January and December 2004. Totally 602 inpatients with ischemic stroke who received treatment in each hospital were recruited. They were 352 male and 250 female with average age of (65.6±10.2) years.METHODS: The 602 patients with acute ischemic cerebral stroke who received the treatment in the 5 hospitals from Dongcheng, Xicheng,Chaoyang and Haidian districts in Beijing were recruited in the study. According to results of magnetic resonance imaging of brain, the maximal infarction area were determined. The patients were classified as: large infarction: over 1 lobe of brain, ＞ 5.0 cm in diameter; moderate infarction: less than 1 lobe of brain, 3.1-5.0 cm; small infarction: 1.6-3.0 cm; lacunar infarction, ＜ 1.5 cm.MAIN OUTCOME MEASURES: Constitution ratio of MRI classification of patients in each groupRESULTS: Totally 602 patients with ischemic stroke participanted in final result analysis. Among the patients with acute cerebral infarction of 5 hospitals in Beijing, 280 (46.5%) suffered from lacunar infarction, 299(38.1%) from small infarction, 57 (9.4%) from moderate infarction, and 36 (6%) from large infarction. There were significant differences between lacunar infarction and other types (P ＜ 0.01).CONCLUSION: Acute cerebral infarction of patients of Beijing mostly occurs in the type of lacunar infarction. It suggests that small arterial diseases are the major disease type of ischemic stroke in Beijing. This MRI classfication can be used for early classification, treatment guidance, evaluation and prognosis of acute ischemic cerebral stroke.

Objective An analysis was carried out for the reports of traditional Chinese medical syndrome patterns of psoriatic arthritis (PsA) patients in related reports issued in the recent 35 years, thus to explore the characteristics of syndrome patterns of PsA patients and to supply evidence for the syndrome classification. Methods Electronic retrieval was performed in the reports of PsA syndrome analysis issued in the Chinese medical journals from the year of 1979 to 2013. Traditional Chinese medical syndrome information of PsA patients was extracted from the reports, and then was standardized and classified. SPSS 17.0 software was applied for the analysis of occurrence frequency of syndromes, syndrome elements, tongue and pulse states. Results A total of 84 reports were obtained, and 26 reports met the inclusion criteria. In the 26 included reports, 10 kinds of tongue texture, 15 kinds of tongue fur and 22 kinds of pulse states were present. After the standardization of the syndromes, a total of 39 syndrome patterns were obtained. After combination of the similar syndromes, 14 syndromes were included into the analysis. In the 14 included syndrome patterns, the leading 5 patterns were wind-damp heat arthralgia, wind-heat with blood dryness, excessive heat toxin, wind-cold damp arthralgia, and liver-kidney deficiency. Fourteen syndrome elements were extracted from the syndromes, and 9 were included into the analysis after combination of the similar syndrome elements. The top syndrome elements were heat, phlegm-dampness, wind, dryness, deficiency, and blood stasis. Conclusion The syndrome patterns of PsA patients are various, and the syndrome elements of cold, heat, phlegm-dampness, wind, dryness, and blood stasis play an important role in the pathogenesis of PsA.

AIM:To examine the effects of thromboxane A 2 receptor ( TXA2 R) , the downstream product of cy-clooxygenase-2 (COX-2), on the proliferative ability and COX-2 expression in rheumatoid arthritis (RA) synovial cells. METHODS:The effects of TXA2 R antagonist SQ29548 and agonist U46619 on the proliferation of RA synovial cell line MH7A were detected by MTS cell proliferation assay , and their effects on COX-2 mRNA expression in MH7A cells were al-so examined by real-time PCR.In addition, the possible effect of U46619 on the proliferation of MH7A cells, when COX-2 was knocked down by siRNA , was determined by BrdU cell proliferation assay .RESULTS:SQ29548 inhibited the cell proliferation and the mRNA level of COX-2 while U46619 enhanced them.Moreover, U46619 reconstitute the proliferative ability of MH7A cells to some extent that inhibited by COX-2 siRNA.CONCLUSION: In RA synovial cells, TXA2R is able to control COX-2 expression, while it also mediates the effects of COX-2, suggesting that TXA2R might be an ideal candidate for RA treatment .

Objective To explore the clinical features and molecular diagnosis of 46, XY disorder of sex development (46, XY DSD).Methods The clinic data of one child with 46, XY DSD raised as female were retrospectively analyzed, and related literatures were reviewed.Results The 11.5-year-old child raised as female visited clinic due to, “accidently found clitoral hypertrophy for half month”. Preliminary series of laboratory examinations supported the diagnosis of 46, XY DSD, high gonadal hormone dysplasia. DNA sequencing of the whole genome exon group showed a heterozygous mutation of c.937C>T, p.Arg313Cys inNR5A1 gene. No abnormality was detected in her father, while her mother was a heterozygous mutation carrier. Conclusions 46, XY DSD can be diagnosed by the whole genome exon gene sequencing.

Objective:To observe influence of simvastatin on differentiation ,proliferation ,migration and adhesion of marrow-derived smooth muscle progenitor cells (SPCs) and screen coated eluting stent drugs of new generation . Methods :The mononuclear cells (MNCs) were isolated from rat marrow by density gradient centrifugation method , and then plated on fibronectin-coated culture dishes ,after culture 8d ,marrow-derived SPCs were identified by α-smooth muscle actin (α-SMA) immunofluorescent staining and counted under inverted fluorescence microscope .The MNCs and adhesion cells were treated with simvastatin (0.01~10 μmol/L) respectively for 8 d and 24h .SPCs pro-liferation ,migration and adhesion were observed by Tritium thymidine (3 H-TdR) intake method ,modified Boyden chamber assay and adhesion assay .Results:Compared with control group (no simvastatin intervention ) ,0.01μmol/L simvastatin significantly inhibited the MNCs differentiation towards SPCs [ (85 ± 4) vs .(79 ± 5)] ,proliferation [ (4070 ± 184) vs .(3833 ± 126)] ,migration [ (44 ± 3) vs .(39 ± 3)] and adhesion of SPCs [ (59 ± 5) vs .(52 ± 4)] , P<0.05 all ,and number of SPCs significantly reduced along with simvastatin concentration increased (P<0.01) . Conclusion:Simvastatin could inhibit the differentiation ,proliferation ,migration and adhesion of marrow-derived smooth muscle progenitor cells .

Objective: To investigate the trends in mortality and life lost due to cancer among residents in Ouhai District, Wenzhou City from 2013 to 2020, so as to provide the evidence for formulating the cancer control strategy. Methods: The mortality data of cancer patients in Ouhai District from 2013 to 2020 were collected through Zhejiang Provincial Information Management System for Surveillance of Chronic Diseases. The crude mortality, standardized mortality, years of potential life lost ( YPLL ), years of potential life lost rate ( YPLLR ), standardized years of potential life lost ( SYPLL ), standardized years of potential life lost rate ( SYPLLR ), average years of life lost ( AYLL ) and annual percent change ( APC ) were estimated to analyze the trends in mortality and life lost due to cancer. Results: Totally 5 435 deaths occurred due to cancer in Ouhai District from 2013 to 2020, and the crude and standardized mortality rates were 154.10/105 and 119.41/105, respectively. The crude mortality of cancer was higher in men than in women ( 196.26/105 and 111.09/105; χ2=415.623, P<0.001 ). The standardized mortality of cancer among whole populations, the crude mortality in men and the standardized mortality in men showed a tendency towards a reduction ( P<0.05 ), with APC of -3.25%, -2.18% and -4.78%, respectively. The crude mortality of cancer showed an upward trend with age ( χ2trend=9 260.583, P<0.001 ). Lung cancer, liver cancer, stomach cancer, colorectal cancer and esophagus cancer were the five leading causes of cancer-related mortality, which accounted for 66.68% of all cancer mortality. Liver cancer, lung cancer, stomach cancer, colorectal cancer and brain cancer were the five leading causes of life lost, with YPLL of 11 191.50, 8 231.00, 6 000.00, 3 892.00 and 2 693.50 person-years, respectively. Leukemia was the primary cause of AYLL ( 25.17 years per person ). Conclusions Both the standardized mortality and the life lost due to cancer showed a tendency towards a reduction in Ouhai District from 2013 to 2020, and men and the elderly were high-risk populations. Lung cancer, liver cancer, stomach cancer, colorectal cancer, leukemia, brain cancer, and female breast cancer should be listed among cancers in Ouhai District prioritized for control

Objective To explore the correlation between phenotype and genotype of 5α-reductase 2 deficiency. Methods The clinical data of five children with 5α-reductase 2 deficiency were retrospectively analyzed and the relation between their clinical phenotype and genotype were analyzed. Results All of these five children presented small penis and testicular hypoplasia, three of whom had ones similar to the clitoris appearance. The testosterone/dihydrotestosterone (T/DHT) ratio was 10.26-64.99 after human chorionic gonadotropin (hCG) stimulation. Gene detection showed one case had c.680G>A homozygous mutation and the others were compound heterozygous mutations. The mutations were mainly missense mutations, followed by deletion, duplication and nonsense mutations. Conclusion The 5α-reductase 2 deficiency has different degrees of abnormal genital development. Genetic testing contributed to the diagnosis of this disease.