Medicine, Chinese Traditional ; Reproductive Techniques, Assisted

Introduction: Gallstones disease is a common disorder and symptomatic disease is usually managed with surgery while those with common bile duct stones are usually managed with endoscopic intervention before proceeding to surgery. This study was intended to assess the rate of cholecystectomy among patients who had undergone ERC interventions, the reasons for not proceeding to cholecystectomy and related complications. Materials and Methods: Patients who had intact gallbladder and had undergone ERC for stones related complications over a two year period were retrospectively identified from the Endoscopic Unit Registry. Detailed case note reviews were conducted. Results: The overall cholecystectomy rate post-ERC interventions was 36.9% (48/130). Cholecystectomy was offered to 59.2% (n=77) and the uptake was only 58.4% (n=45/77). Among those who agreed for cholecystectomy, 11.1% (n=5/45) failed to turn up for their scheduled surgery. Three patients (6.7%) had symptoms recurrence before their scheduled surgery: two subsequently underwent cholecystectomy without ERC intervention and one who was pregnant was managed conservatively with holecystectomy. Among the patients who had declined cholecystectomy, 18.8% (n=6/32) had symptoms recurrence. Four patients required repeat ERC interventions and eventually all had cholecystectomy subsequently. The most common reason for declining cholecystectomy was 'not keen' and already asymptomatic (46.9%, n=15/32). Among patients who were not offerred cholecystectomy (n=53/130), symptoms recurrence occurred in 15.2% (n=7/53). Four patients required repeat ERC interventions and three subsequently underwent cholecystectomy. Conclusions: The cholecystectomy rate remains low after ERC interventions. Recurrence of symptoms necessating re-interventions occurred in patients offerred and not offerred cholecystectomy. The uptake rate should be improved and delay to cholecystectomy should be reduced to avoid symptoms recurrence. Patients not undergoing interventions should be advised regarding symptoms recurrence and should be monitored.
Choledocholithiasis ; Cholecystectomy ; Cholangiopancreatography, Endoscopic Retrograde ; CHOLELITHIASIS

Objective To explore the effect of patients with acute cerebral infarction and complication of acute gastric mucosal lesions (AGML) on their short-term prognoses.Methods Two hundred and sixteen patients with acute cerebral infarction admitted to the Department of Neurology in Tianjin Nankai Hospital from January to December 2014 were enrolled, and they were divided into the control group without AGML (167 cases) and observation group with AGML (49 cases) according to whether AGML occurred or not. The digestive tract was monitored in the two groups, and the relationships between the incidence of AGML and the location of infarction, stroke classification, as well as the anti-thrombosis treatments like thrombolysis, anti-coagulation and anti-platelet, etc. were analyzed; the changes in scores of the National Institutes of Health Stroke Scale (NIHSS) on admission, 7 days and 14 days after onset and 14-day mortality of two groups were compared.Results AGML occurred in 49 of 216 patients (22.69%); the 14-day mortality of the observation group was obviously higher than that of the control group [6.12% (3/48) vs. 1.80% (3/167),P < 0.05], the incidence of infarction located in cerebellum, brainstem, multiple cerebral lobes, etc. (low density shadow > 1/3 hemispheres) in the observation group was higher than that in the control group [cerebellum: 18.37% (9/49) vs. 4.19% (7/167); brainstem: 24.49% (12/49) vs. 8.98% (15/167), multiple lobes: 16.33% (8/49) vs. 2.99% (5/167), all P < 0.05]; the incidence of cardiac cerebral embolism (CE) was significantly higher than that in the control group [55.10% (27/49) vs. 12.57% (21/167),P < 0.05]. With the extension of disease course, the NIHSS score of the observation group was increased, while the score of the control group was gradually reduced, and the NIHSS scores of the observation group were obviously higher than those of control group on the 7th and 14th day after onset (7 days: 18.12±4.20 vs. 10.93±6.73, 14 days: 19.33±3.11 vs. 9.66±9.15, bothP < 0.05). The thrombolysis, argatroban anti-coagulation and anti-platelet incidence between the two groups after treatments was of no statistically significant difference (the incidence in control group was 4.79%, 47.31%, 47.90%, and it was 4.08%, 44.90%, and 48.98% in observation group, allP < 0.05). Conclusion The occurrence of AGML complication in patients with acute cerebral infarction is closely related to their short-term prognoses, and when the cerebral embolus is cardiac in origin or the infarction is located at multiple cerebral lobes, brain stem or cerebellum, the probability of the occurrence of AGML is relatively high, suggesting a poor outcome.

Objective To investigate the prevalence,radiological features and the association between HRCT changes and different diseases or clinical features in interstitial lung disease(ILD)caused by diffuse connective tissue diseases(CTD).Methods Retrospective analysis was performed based on the medical records of 412 in-patients with the diagnosis of diffuse connective tissue diseases from June 2003 to June 2005 in our hospital.268 cases were SLE,83 cases were SS,40 cases were DM/PM,21 cases were SSe.All patients had chest X-ray and the suspected cases had HRCT exam.The distribution of ILD among different diffuse CTD.the appearance between X-ray and HRCT appearances were compared.The correlation among HRCT appearance,different diseases and clinical features was studied.Results①In the 412 cases of CTD,ILD de- tected by HRCT was 9.7%(40 case in total),3,9% by X-ray.Among the 40 cases,DM/PM had the highest rate of ILD(25%),23.8% in SS,9.6% in SS and 6.3% in SLE.②The consensus rate between HRCT and X-ray was 40%.The rate of mis-diagnosis of ILD was 60% by X-ray.③The changes of interstitial involvement de- tected by HRCT were:ground glass change(41.0%),consolidation(32.8%),reticular change(16.4%)and hon- eycomb change(9.8%).The concomitant presence of two of the above changes were very common.④More level respiratory symptoms such as cough,panting,chest distress and chest pain and high level of complement were observed in patients with ground glass and consolidation changes,while high CRP level was seen in patients with consolidation and honeycomb changes(P

Objective To analyze the differences in symptoms spectrum,lifestyle,diet and psychological features among different age groups with reflux esophagitis.Methods From June 2011 to October 2013,332 outpatients with reflux esophagitis (RE) were collected and divided into youth group (18 to 40 years),middle-aged group (41 to 64 years) and aged group (≥65 years).Symptoms and risk factors of patients were investigated.The severity of the symptoms was evaluated with reflux diagnostic questionnaire (RDQ).The anxiety and depression of patients were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The distribution of symptoms spectrum,the severity of symptoms,lifestyle,diet and psychological features of three groups were compared.Mann-Whitney U tests or Chi-square test were used for comparison between two groups.Pearson test was performed for correlation analysis.Results There were 96 cases,192 cases and 44 cases in youth,middle-aged and aged group,respectively.Compared with youth group and middle-aged group,the incidence of chronic cough and asthma (extra-esophageal symptoms) was higher in aged group (1.0％ (1/96),13.5％ (26/192),20.5 ％ (9/44);and 3.1％ (3/96),9.4 ％ (18/192),15.9 ％ (7/44)),and the differences were statistically significant (x2 =15.10 and 6.91,both P＜0.05).The scores of extra-esophageal symptoms in youth group,middle-aged group and aged group were 7.0(2.0,14.0),9.5(4.2,17.0) and 12.0(7.0,19.7),respectively,and the difference was statistically significant (F=3.93,P =0.02).Comparison with aged group,the incidences of youth group and middle-aged group were higher in irregular meals (4.5 ％ (2/44),28.1％(27/96),14.6％ (28/192)),overeating (29.5％(13/44),50.0％(48/96),34.9％(67/192)),dinner time after 19 o'clock (2.2％(1/44),27.1％(26/96),20.3％(39/192)),lying down in 30-minute post-meal (40.9％(18/44),63.5％(61/96),49.5％(95/192)),high fat diet (52.3％(23/44),84.4％ (81/96),69.3％(133/192)),spicy food (13.6％(6/44),43.8％(42/96),30.7％(59/192)),and the differences were statistically significant (x2 =13.93,7.90,11.71,10.36,16.22 and 12.99,all P＜ 0.05).Compared with the youth group and middle-aged group,the incidence of aged group was higher in exercise times ＜two times/week (15.6 ％ (15/96),40.1％ (77/192),50.0％ (22/44)),preference of tea (36.5％(35/96),36.5％(70/192),59.1％ (26/44)) and poor sleep quality (13.5％ (13/96),19.3％ (37/192),31.8％(14/44)),and the differences were statistically significant (x2 =22.52,8.18 and 6.47,all P＜ 0.05).The median SAS scores of youth group,middle-aged group and aged group were 30.0 (27.5,33.7),32.5 (28.7,37.5) and 30.0(27.5,36.2),respectively;and the median SDS scores were 32.5(27.5,39.7),36.2(30.3,45.0),37.5(35.0,45.0),respectively;and the differences in SAS and SDS scores among three groups were statistically significant (F=6.37,6.75,both P＜0.01).The SAS and SDS scores were not correlated with extra-esophageal symptoms in youth group.The SAS score was positively correlated with extra-esophageal symptoms in middle-aged group (r =0.19,P =0.009).The SAS and RDQ scores were positively correlated with extra-esophageal symptoms in aged group(r=0.26 and 0.23;P=0.005 and 0.003).Conclusions The incidence of extra-esophageal symptoms in middle-age group and aged group is high,the symptoms are severe and with anxiety and depression possibility.While unhealthy lifestyle and diet habits are more common in young patients.According to different age groups,risk factors should be adjusted.

Objective To investigate the effect of exercise therapy on I° adolescent idiopathic scoliosis (AIS). Methods 70 cases with I°AIS were included. 32 patients correcting posture themselves for 0.5 year or above were as control group, and the other 38 cases who accepted exercise therapy for 0.5 year were as treatment group. Their X-ray of spine before and after treatment were compared. Results The Cobb's angle, rotation of the spine, and compensatory improved after treatment in the treatment group (P<0.01), but no significant improvement was obsereved in the control group after 0.5 year. Conclusion Exercise therapy is safe and effective on I° AIS.

With the development of therapeutic antibodies over the past decade, they have become the treatment options for immunity and inflammation diseases. Major limitations of mouse antibodies as therapeutic agents - immunogenicity, lack of effectors' functions and short serum half-life -- were subsequently identified and largely overcome by the advent of humanized and fully human antibody technologies. The therapeutic antibodies for immunity and inflammatory diseases are primarily utilized in the treatment of allograft rejection, autoimmune disease, autoinflammatory syndromes, allergies and other chronic inflammation. The action mechanisms of therapeutic antibody include blocking ligands or receptors, regulating receptor activity, clearing the target cells or activating receptor. Strategies for generating the antibody drugs with high efficacy and low side effects can be realized by modulation of Fc-mediated activities and optimization of antigen-binding domains.

Objective To construct the secretory expression vector of recombinant human C-reactive protein(rhCRP) for its se-cretory expression in Pichia pastoris ,rhCRP was expressed as a secretory protein and purified ,and the immunity reactivity of the purified protein was identified .Methods The DNA fragment of rhCRP which was designed and synthesized was cloned into pPICZαA vector .Recombinant plasmid pPICZαA/rhCRP was linearized by SacⅠand transformed into Pichia pastoris X-33 by elec-trotransformation .The rhCRP was secreted into the medium under the methanol induction .RhCRP was purified by Histamine affin-ity chromatography .The purified rhCRP was identified by SDS-PAGE and Western blotting ,and its immunity reactivity and stabili-ty was identified by indirect ELISA .Results The pPICZαA/rhCRP expression vector was successfully constructed .The rhCRP of 23 × 103 was inducted and successfully expressed as a secretory protein by the recombinant Pichia pastoris strains .The rhCRP was purified by one step up to 90 .42% purity ,and it was showed good immunity and stability by indirect ELISA .Conclusion The rh-CRP with higher purity and immunoreactivity was successfully obtained by using the Pichia pastoris expression system ,which pro-vided an important experimental basis for producing anti-human CRP antibodies and developing testing CRP reagent .

To prepare large naive phage antibody library, the host bacteria with high transformation efficiency is used in the Cre-LoxP recombination system. The variable regions of immunoglobulin light and heavy genes were amplified from lymphocytes collected from adult peripheral blood and newborn cord blood. The genes were spliced to form the single-chain variable fragments (scFv) by overlap PCR, cloned into pDAN5a vector and then transformed into XL2-blue MRF' with the Hte gene. Compared with XL1-blue strain, the size of the primary library was increased by 3.9 times. The primary library infected Cre recombinase-expressing bacteria, and the genes between phagemids created many new VH/VL combinations. The library was calculated to have a diversity of 1.7 x 10(11) and validated by the selection of antibodies against six different protein antigens. This library provides the basis for further selection of antibody-based drugs. It is the first time to report that XL2-blue MRF' can be used to improve the diversity of the library in the recombination system.

Objective To study the effects of Buyang Huangwu decoction(BHD) on serum matrix metalloproteinase-9(MMP-9),high sensitivity C-reactive protein(hs-CRP)levels and inflammatory reaction of patients with ischemic stroke accompanied by Qi deficiency and blood stasis syndrome. Methods Thirty-nine patients with acute ischemic stroke onset for 24-48 hours accompanied by Qi deficiency and blood stasis syndrome were admitted into Nankai Hospital of Tianjin City,and in accordance with the random number table,they were divided into BHD treatment group(21 cases)and conventional western treatment control group(18 cases). The patients in both groups were given conventional western medicine,such as anti-platelet,descent of blood lipid and protection of brain. In the BDH group,the patients were additionally given BHD oral administration. Before and after treatment for 72 hours and 7 days,the changes of serum levels of MMP-9 and hs-CRP were observed in both groups. In the mean time,20 subjects having taken physical healthy examinations in outpatient clinics were assigned in the healthy control group. Results Compared to the healthy control group,before treatment the levels of MMP-9 and hs-CRP in western treatment control and BHD groups were significantly higher than those in the healthy control group〔MMP-9 (μg/L):403.3±32.9,417.9±45.3 vs. 86.5±6.1;hs-CRP(mg/L):7.4±0.7,6.9±0.6 vs. 2.2±0.4,all P<0.05〕. After treatment for 72 hours,the levels of MMP-9 and hs-CRP achieved their peaks,after treatment for 7 days, the levels of MMP-9 and hs-CRP were significantly lower than those at 72 hours in both groups〔the control group:MMP-9(μg/L):190.4±58.0 vs. 528.9±65.1,hs-CRP(mg/L):5.8±0.7 vs. 11.1±0.8;the BDH group:MMP-9 (μg/L):89.5±11.4 vs. 437.6±55.2,hs-CRP(mg/L):3.1±0.9 vs. 7.3±0.6,all P<0.05〕. Conclusions In patients with acute cerebral infarction,the serum levels of MMP-9 and hs-CRP are significantly increased. After conventional treatment,the levels gradually decline,and the descent in the group with addition of BHD is more remarkable,suggesting that BHD have prominent effect for treatment of patients with acute cerebral infarction accompanied by Qi deficiency and blood stasis syndrome.