MR cholangiopancreatography (MRCP) is widely used in biliary obstructive disease which is a commen disease in clinic,depending on its good ability of localized and qualitative diagnosis.With the development of MR technology,the applications of DWI in biliary obstructive disease is increasingly reported and most of them are focused on DWI application of the early diagnosis,qualitative diagnosis and the liver function evaluation of biliary obstructive disease.In this article,the application of MRCP,DWI and the combination of the two methods in biliary obstructive disease were reviewed.

Percutaneous transluminal angioplasty is the preferred treatment of femoropopliteal arterial disease at present.But the high rate of restenosis needs to be solved rapidly.As a new treatment strategy,drug-coated balloon (DCB) can reduce the late lumen lose and the revascularization of target lesion by inhibiting intimal proliferation and inflammatory response,also it can treat femoropopliteal in-stent restenosis effectively.In addition,combining DCB and atherectomy or stenting can improve the outcomes for severe stenosis of femoropopliteal artery.The recent application progresses of DCB for femoropopliteal disease were reviewed in this article.

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Objective To study effects of bitter almond on interstitial cells of Cajal (ICC) in old rats with slow-transit constipation (STC) and analyze mechanism of the gut purge of bitter almond.Methods Forty-five old SD rats were randomly divided into blank control group,model control group,bitter almond-treated group randomly (n=15,each).Compound phenanthroline was used to build the model of STC model.The bitter almond-treated group was given with bitter almond apozem,the other two groups were given with the same amount of saline.After 10 days,the carbon powder propulsion rates in the intestine were measured and specimens were taken.The ICC changes in terms of the number and distribution were observed by immunohistochemical method.The protein and mRNA expressions of c-kit in ICC were measured by Western blot and reverse transcription-polymerase chain reaction(RT-PCR).Results Compared with blank control group [(68.6 ± 6.0) ％,the carbon powder propulsion rates in the intestine in model control group[(47.7±± 1.7)％]were declined (P＜ 0.01).The areas of c-kit positive cell in colon were declined[(638.0 ± 23.5) μm2 vs.(723.7 ± 30.8)μm2]in model vs.blank control (P＜0.05).The mRNA expression of c-kit gene in ICC was declined [(0.3±0.1) vs.(1.0±0.1)] (P＜0.05),the expression of c-kit protein in ICC were declined[(0.2±0.2) vs.(0.5±0.2)] (P＜0.05).Compared with model control group[(47.7± 1.7)％],the carbon powder propulsion rates in the intestine in bitter almond group were increased[(63.4± 3.3)％ vs.] (P ＜0.01).The mRNA expression of c-kit gene in ICC were increased in bitter almond group (0.9 ±0.2) vs model control group[[(0.3±0.1)] (P＜ 0.01).The expression of c-kit protein in ICC were increased in bitter almond group[(0.5±0.3) vs.in model control 0.2±0.2)] (P＜0.01).Conclusions The bitter almond can promote the expression of c-kit mRNA and protein in colonic tissue of old STC rat interstitial and repair a fraction of ICC of STC rat interstitial,which promote intestinal peristalsis in slow-transit constipation rats.

Objective To explore the associations of depressive symptoms with functional status and frailty in elderly outpatients.Methods A total of 297 geriatric outpatients(aged 65 years and over) from Zhejiang Hospital were recruited in the cross-sectional study from January 2014 to December 2015.We gathered general information,and evaluated depressive symptoms by Geriatric Depression Scale-15 (GDS-15),cognitive function by mini-mental state examination(M MSE),frailty by clinical frailty scale(CFS),activities of daily living (ADL)by Barthel index,instrumental activities of daily living (IADL),balance,POMA and gait by Tinetti-performance oriented mobility assessment (Tinetti-POMA),grip strength and 4m gait speed by 4-meter walk gait speed test.According to the GDS-15 scores,297 geriatric outpatients were divided into a depression symptom group(n=35,GDS-15 ≥6)and a nomdepressive symptom group(n=262,GDS-15＜6).The frailty and functional status were compared between two groups by SPSS 23.0.Results As compared with non-depressive symptoms,the depressive symptoms group had higher clinical frailty scale(CFS),lower body mass index(BMI),lower cognitive function and poorer grip strength and balance(all P＜0.05).There were significantly negative correlations of Geriatric Depression Scale-15 (GDS-15) with ADL,IADL,gait,balance,POMA and grip strength(r=-0.165、-0.154、-0.216、-0.291、-0.305、-0.314,All P＜ 0.05),while there were significantly positive correlations with CFS score,gait speed(r=0.256、0.198,both P＜0.05).The more severe the frailty was,the higher the risk of depressive symptoms was(OR=3.650,95％ CI 1.611-8.271).Conclusions The cognitive and physical functions in the elderly with depression symptoms are poorer as compared with the elderly without depression symptoms.Elderly outpatients with more severe frailty have a higher risk for depressive symptoms.

Background/Aims: Disrupted bile acid regulation and accumulation in the liver can contribute to progressive liver damage and fibrosis. However, the effects of bile acids on the activation of hepatic stellate cells (HSCs) remain unclear. This study investigated the effects of bile acids on HSC activation during liver fibrosis, and examined the underlying mechanisms. Methods: The immortalized HSCs, LX-2 and JS-1cells were used for the in vitro study. in vitro, the adeno-associated viruses adeno-associated virus-sh-S1PR2 and JTE-013 were used to pharmacologically inhibit the activity of S1PR2 in a murine model of fibrosis induced by a 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet. Histological and biochemical analyses were performed to study the involvement of S1PR2 in the regulation of fibrogenic factors as well as the activation properties of HSCs. Results: S1PR2 was the predominant S1PR expressed in HSCs and was upregulated during taurocholic acid (TCA) stimulation and in cholestatic liver fibrosis mice. TCA-induced HSC proliferation, migration and contraction and extracellular matrix protein secretion were inhibited by JTE-013 and a specific shRNA targeting S1PR2 in LX-2 and JS-1 cells. Meanwhile, treatment with JTE-013 or S1PR2 deficiency significantly attenuated liver histopathological injury, collagen accumulation, and the expression of fibrogenesis-associated genes in mice fed a DDC diet. Furthermore, TCAmediated activation of HSCs through S1PR2 was closely related to the yes-associated protein (YAP) signaling pathway via p38 mitogen-activated protein kinase (p38 MAPK). Conclusions TCA-induced activation of the S1PR2/p38 MAPK/YAP signaling pathways plays a vital role in regulating HSC activation, which might be therapeutically relevant for targeting cholestatic liver fibrosis.

Objective:To investigate the impact of geriatric syndromes on physical performance and fall risk in elderly patients with type 2 diabetes mellitus.Methods:A total of 179 elderly inpatients and outpatients with diabetes mellitus in the geriatric department of Zhejiang Hospital were recruited in this cross-sectional study.According to the number of geriatric syndromes including frailty, cognitive impairment, malnutrition, depression, poly-pharmacy and co-morbidity, patients were classified into Group A(n=40, with ≤1 geriatric syndrome), Group B(n=84, with 2-3 geriatric syndromes)and Group C(n=55, with ≥4 geriatric syndromes). Clinical data and physical performance status, fall risk and one-year fall history were compared between the groups.Effects of each geriatric syndrome on disability in daily life, balance and gait ability, and increased fall risk in elderly patients were further analyzed.Results:Patients with more geriatric syndromes were older, had a higher proportion of using walking aids and a higher prevalence of disability in daily life, balance and gait impairment, and increased fall risk( P<0.05). Furthermore, univariate and multivariate Logistic regression indicated that frailty and malnutrition were risk factors for disability in daily life( OR=3.467 and 3.369, P<0.05)and balance and gait impairment( OR=3.031 and 3.266, P<0.05), and that cognition impairment was a risk factor for increased fall risk( OR=2.559, P<0.05)and balance and gait impairment( OR=3.930, P<0.05). Conclusions:Frailty, malnutrition and cognition impairment can lead to physical performance impairment and increased fall risk in elderly patients with type 2 diabetes mellitus.Clinical intervention should be conducted to improve the quality of life in elderly adults.