Objective To investigate the impact of covariates on diagnostic test and assess the correlation between re-peated measurement data,this paper explores innovative modeling techniques of ROC curve.Methods We introduce the new ROC curve method based on generalized linear mixed effects model and apply Bayesian techniques to parameters estimation with Winbugs Software.Further,areas under the ROC curve(AUC)with different values of covariates could be calculated in terms of assessment.Results Cases analysis results indicate the proposed method efficiently explores the repeated measurement data and provides parameters with practical significance,serving as a golden reference.Conclusion The ROC curve based on generalized linear mixed effects models can be effectively used to solve the test accuracy evaluation problem of the repeated diagnostic trials.

Background: Colorectal cancer (CRC) is a commonly seen cancer, and is a heterogeneous disease entity with a diverse biological pathogenesis. Aims: To investigate the expressions of mismatch repair protein (MMRP) and Ki-67 in CRC, and analyze the correlations of microsatellite instability (MSI), Ki-67 with clinicopathological features of CRC. Methods: Clinicopathological data of 90 CRC patients from Jan. 2014 to Dec. 2016 at the First Affiliated Hospital of Soochow University were retrospectively analyzed. Immunohistochemical staining was used to detect the protein expressions of 4 MMRP (MLH1, PMS2, MSH2 and MSH6) and Ki-67 in CRC patients. Correlations of MSI, Ki-67 with clinicopathological features of CRC patients were analyzed. Correlation of MSI with Ki-67 was also analyzed. Results: The loss expression rate of MMRP was 16.7%, and that of MLH1, PMS2, MSH2 and MSH6 were 11.1%, 11.1%, 6.7% and 4.4%, respectively. Positivity rate of Ki-67 was 90.0%. MSI was correlated with tumor location (P<0.05), and expression of Ki-67 was correlated with tumor location and gross type (P<0.05). MSI was not correlated with expression of Ki-67 (P>0.05). Expression of MLH1 was positively correlated with expression of PMS2 (r=0.577, P<0.05), and expression of MSH2 was positively correlated with expression of MSH6 (r=0.739, P<0.05). Conclusions: The loss expressions of MLH1, PMS2 are more common than those of MSH2, MSH6 in CRC. MSI is correlated with tumor location and Ki-67 is correlated with tumor location and gross type; they may be of some significance for the diagnosis and prediction of prognosis of CRC. However, MSI is not correlated with Ki-67, and joint detection of MMRP and Ki-67 could not improve the diagnostic accuracy of CRC.

Objective To evaluate the expression of trefoil peptides (TFF1 ,TFF3) in colonic polyps and its relationship with clinicopathological parameters.Methods 120 cases of colon polyps were selected as the colon polyps group ,including 40 cases of hyperplastic polyps and 80 cases of adenomatous polyps ,and 30 cases of co-lon cancer (colon cancer group) and 20 cases of normal colonic mucosa (normal colon mucosa group) were se-lected as controls.The expression of TFF1 and TFF3 in various tissues were detected by q-RT-PCR ,Western Blot and immunohistochemistry ,and their relationship with clinicopathological parameters was analyzed.Re-sults The positive rates of TFF1 in normal colon mucosa ,hyperplastic polyp tissue ,adenomatous polyp and colon cancer were 0 ,0 ,53.8% and 80.0%,respectively and the differences were statistically significant (χ2=66.614 ,P＜0.05).The positive rates of TFF3 in normal colon mucosa ,hyperplastic polyp tissue ,adenomatous polyp and colon cancer were 90.0%,77.5%,55.0% and 30.0%,respectively.and the differences were statisti-cally significant (χ2=24.688 ,P＜0.05).The differences of TFF1 mRNA ,TFF3 mRNA ,TFF1 protein ,TFF3 protein expressions in the four groups were statistically significant.TFF1 protein expression in moderate and severe dysplasia polyp tissues increased significantly compared with those in mild dysplasia polyp tissues (t=2.760 ,P=0.009) ,while the expression of TFF3 significantly decreased (t=2.556 ,P=0.015) ;the expression of TFF1 protein in villous adenomatous polyp tissues increased significantly compared with that in tubular ad-enoma tissues (t=2.549 ,P=0.013) ,while the expression of TFF3 protein decreased significantly (t=2.108 , P=0.038).Conclusion The expression of TFF1 and TFF3 is closely related to the process of malignant co-lonic cancinogenesis ,and can be used as a biomarker for the differential diagnosis of colon benign diseases and early diagnosis of colon cancer.

Objective To evaluate the expression of mucin(MUC1,MUC2,MUC5AC and MUC6)in the pathological tissues of different colonic polyps,and to analyze the clinical value of mucin expression in colonic polyp transformation.Methods 120 cases of colonic polyps were selected treated from the First Hospital of Shijiazhuang in Hebeiin hospital from January 2013 to January 2015.According to histopathological diagnosis, there were 3 groups,40 patients with hyperplastic polyps,40 patients with tubular adenoma,40 patients with villous adenoma.The expression of MUC1,MUC2,MUC5AC and MUC6 in the pathogens were detected by immunohistochemistry.Results In normal colonic mucosa,MUC1,MUC5AC,MUC6 were not expressed,and MUC2 positive expression was detected.The positive expression rates of high expression of MUC1 and MUC6 were observed in tubular adenoma and villous adenoma,while the positive expression of MUC1 and MUC6 was not detected in proliferative polyps.MUC2 showed a high positive expression rate in hyperplastic polyps and adenomatous polyps,and the positive expression rate in proliferative polyps and adenomatous polypshyperplas-tic polyps and adenomatous polyps decreased gradually.MUC5AC was expressed in proliferative polyps and adenomatous polyps,and the expression of MUC5AC in proliferative polyps was significantly lower than that ofin adenomatous polyps.Conclusion The difference in the positive expression of MUC1,MUC2,MUC5AC and MUC6 in hyperplastic polyps and adenomatous polyps MUC1,MUC2,MUC5AC,MUC6 in hyperplastic polyps and adenomatous polyps is associated with the increased risk of mucosal or muscularis mucosa invasion in colonic polyps,w hich can be used as a biomarker for the clinical diagnosis of the development of colonic pol-yps.

OBJECTIVE:To evaluate the effects and safety of Bencycloquidium bromide nasal spray in the treatment of acute rhinitis after a cold. METHODS:A multicenter,dose parallel controlled,randomized,double-blind,placebo-controlled clinical tri-al was conducted. Two hundred and thirty-eight patients with acute rhinitis after a cold were selected and divided into group A(24 cases),B(24 cases),C(24 cases),D(24 cases),E(23 cases),F(24 cases),G(23 cases),H(24 cases),I(24 cases),J (24 cases). Group A-C were given Bencycloquidium bromide nasal spray 22.5μg,45μg,90μg,respectively,bid,spraying it once for each nostril. Group D-F were given Bencycloquidium bromide nasal spray 22.5 μg,45 μg,90 μg,respectively,tid,spraying it once for each nostril. Group G-I were given Bencycloquidium bromide nasal spray 22.5 μg,45 μg,90 μg,respectively,qid,spray-ing it once for each nostril. Group J was given placebo. All groups were treated for(4±1)d. Rhinorrhea score and continuous rhi-norrhea duration were compared among 10 groups,and the safety was evaluated. RESULTS:The rhinorrhea score and continuous rhinorrhea duration of 10 groups were improved significantly,with statistical significance (P<0.05). The improvement and trend of group I was slightly better than other 9 groups,without statistical significance(P>0.05). There was no statistical significance in the incidence of ADR among 10 groups(P>0.05). CONCLUSIONS:Bencycloquidium bromide nasal spray with 90 μg,qid times significantly improves rhinorrhea score and continuous rhinorrhea duration with good safety.

Objective To investigate outpatients' cognition towards common cold and their habituated medication so as to provide evidence for future public healthcare education.Methods Patients who attended hospital for diagnosis and treatment of common cold at least within past three months were asked to fill a questionnaire independently so as to learn their cognition towards common cold and medication habit.Results Among the patients underwent survey,52.2 ％ had incorrect knowledge about common cold; 2.99％ didn't know about the hazards of common cold; 34.80％ couldn't distinguish common cold from influenza; 30.07％ considered common cold couldn't get relief without treatment; 68.24％ didn't know about the proper effects of influenza vaccination; 6.4％ often took oral medicine even intravenous injection when they caught a common cold; 59.77％ often took medication from drugstore without prescription by doctor,and a few asked doctors to prescribe medicine on their request; 9.42％ didn't know about the side effects of drug for cold treatment; and 9.72％ didn't know about the active ingredients of drug for cold treatment.There were significant differences in the common cold cognition among population of different ages and education background.The older or the higher education status patients had a better cognition ( P ＜0.0 ).Conclusion There exist a certain degree of wrong cognition towards common cold among patients of different literacy degree and different age. Public health education on common cold need to be further strengthened.

Objective To investigate the cognition of the common cold and current situation of the treatment among physicians from various levels of hospitals in Chinese mainland,so as to provide evidence for future continuing medical education and rational medication.Methods A questionnaire designed for this survey was used to learn about the general information,cognitive degree of the common cold and prescription habits of physician who prescribed for cold within last three months,from various levels hospitals.Results A total of 1001 physicians were interviewed.Among them,749 physicians chose right options that the cold was the common cold and the influenza with 79.84％ in resident physicians and 56.76％ in chief physicians.A total of 745 physicians chose options that the course of common cold will be lasting 4 to 7 days; 895 physicians chose options that old people are the most susceptible for complication; 669 physicians thought the common cold was the most common infection in winter; 841 physicians used clinical methods to diagnose the common cold; 736 physicians thought although the cold was a kind of self-limited disease and symptomatic treatment could alleviate symptoms and improve life quality,patients should see doctor in time if it turns to severer; and 745 physicians held the opinion that treatment of the common cold should focus on relieving symptoms first. In addition, 61.60％ physicians had made prescription based on clinical symptoms; 505(54.24％ ) of them thought compound drugs were priority in treating the common cold.However,there were still 43 physicians prescribed antibiotics for common cold.Conclusions There is misunderstanding and discrepancy in cognition towards common cold and treatment among physicians from various levels of hospticals in mainland China.Physicians should standardize diagnosis and treatment for the common cold according to the domestic and foreign guidelines.

Objective To evaluate the feasibility and safety of endoscopic treatment for gastric stromal tumors with maximum diameter of 3 to 5 cm. Methods From April 2010 to April 2016, a retrospective analysis was performed on the data of patients with gastric stromal tumors undergoing endoscopic (29 cases)or laparoscopic(26 cases)resection in the First Affiliated Hospital of Soochow University. Baseline data, perioperative data and follow-up data were collected and analyzed. Results There was significant difference on tumor location between the two groups(χ2=12.173, P=0.007). Tumors mainly located at gastric fundus in the endoscopic group(65.5%,19/29),while at gastric body in the laparoscopic group(61.5%, 16/26). Compared with the laparoscopic group, patients in the endoscopic group had shorter operation time[45(35, 60)min VS 70(60, 85)min, U = 686.000, P<0.05], lesser intraoperative blood loss[15(10,15)mL VS 20(10, 20)mL, U=513.000, P=0.017], and earlier recovery time of gastrointestinal function[12(6, 24)h VS 20(18, 24)h, U=585.500, P<0.001]. Compared with the laparoscopic group, the patients in the endoscopic group had a higher complication rate[55.2%(16/29)VS 11.5%(3/26), χ2=11.543, P<0.001]and a lower intact tumor removal rate [89.7%(26/29)VS 100.0%(26/26),χ2=23.989,P<0.001]. The other perioperative parameters such as the incidence of intraoperative major bleeding, postoperative peritonitis, postoperative fasting time, hospitalization time and total hospitalization expenses showed no statistical different(all P>0.05). The postoperative follow-up time was 30.0(17.5,50.0)and 38.5(26.0,49.8)months in the endoscopic and laparoscopic group,respectively. There was no significant difference in the recurrence rate between the two group[3.4%(1/29)VS 7.7%(2/26),χ2=0.009,P=0.922]. Conclusion Endoscopic resection may be an alternative therapeutic approach for large gastric stromal tumors with shorter operation time, less intraoperative blood loss,and earlier recovery time of gastrointestinal function.

Objective To investigate the clinical effect of percutaneous hollow screw combined with tension band internal fixation for comminuted patellar fracture after arthroscopic reduction.Methods 105 patients with comminuted patellar fracture in our hospital from April 2013 to September 2017 were selected and divided into observation group (n =53) and control group (n =52) according to different treatment schemes.The control group was treated with conventional open reduction and Kirschner wire combined with tension band internal fixation,while the observation group was treated with arthroscopic assisted reduction and percutaneous cannulated screw combined with wire tension band internal fixation.The operation status and postoperative fracture healing time of the two groups were compared.One-year follow-up was performed after operation.The incidence of complications,the excellent and good rate of operation,and the preoperative and postoperative pain scores (VAS) and knee were compared.Hospital for special surgery knee score (HSS),Activity of Daily Life Scale (ADL),quality of life score (the Mos 36-item Short Form Health Survey,SF-36) were compared.Results The observation group had fewer fluoroscopy times during operation,shorter incision length and shorter healing time after operation than the control group (P ＜ 0.05);the incidence of complications in the observation group was 3.85％,lower than 20.00％ in the control group,and the excellent and good rate of operation was 96.15％,higher than 82.00％ in the control group (P ＜ 0.05);the VAS scores of the two groups were lower than those of the control group one year after operation,and the scores of HSS,ADL and SF-36 were lower than those of the control group.The preoperative improvement was higher in the observation group than in the control group (P ＜ 0.05).Conclusions Arthroscopic reduction combined with percutaneous hollow screw and tension band internal fixation for patellar comminuted fracture can reduce surgical trauma and accelerate the rehabilitation of patients.It can reduce the incidence of complications,relieve pain,improve knee function,daily living ability and quality of life,and the effect is remarkable.

Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm.Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm.Preoperative Hunt-Hess grade:grade Ⅰ-Ⅱ in 16 patients,gradeⅢin 5 patients,grade Ⅳ in 9 patients,grade Ⅴ in 3 patients.All patients were confirmed with subarachnoid hemorrhage (SAH) by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset.Results After operation,25 patients (75.8％) recovered well,4 patients (12.1％) were with mild disability with paralysis and aphasia,4 patients (12.1％) were dead (1 patient for intraoperative aneurysm rupture,1 patient for postoperative pneumonia,1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding).Followed up 1-6 months,no rebleeding occurred.Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm,and relieve the vasespasm,without increasing the intra-operative rebleeding rate.Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.