Objective To approach the clinical value of ultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) in the treatment of malignant obstructive jaundice.Methods Twenty-five patients with malignant obstructive jaundice were treated with uhrasound-guided PTCD,and the therapeutic effect and complications were observed.Results All the patients were successfully punctured,and the successful rate of single puncture was 92.00% (23/25) .Jaundice of all the patients decreased 3 to 6 days after PTCD.The serum total bilirubin and the inner diameter of intrahepatic ducts decreased after PTCD.The complications included bile exudation and slight bloody bile (either 1 patient) .Conclusion Ultrasound-guided PTCD is a simple,safe and effective way to reduce jaundice,and can be regarded as the first choice in the treatment of malignant obstructive iaundice.

Objective To investigate the epidermal growth factor receptor (EGFR),KRAS and BRAF mutations and their correlation with clinicopathological characteristics in non-small-cell lung cancer (NSCLC).Methods The mutations of exon 18,exon 19,exon 20 and exon 21 of the EGFR,codon 12,codon 13 of the KRAS and codon 600 of the BRAF gene in 143 cases of NSCLC were detected by gene sequencing.The relationship between the mutations and clinicopathological features was analyzed by SPSS 16.0.Results EGFR mutation was detected in 57 cases (39.9 ％),including 2 mutations in exon 18,25 in exon 19,3 in exon 20,24 in exon 21 and 3 multiple point mutations.KRAS mutation was found in 25 cases (17.5 ％),including 23 in codon 12 and 2 in codon 13.BRAF V600E mutation was detected only in 2 cases (1.4 ％).No patient harboring multiple EGFR,KRAS and BRAF mutations was found.EGFR mutation rate was related to gender,smoking history,histological types,differentiation and tumor size (P ＜ 0.05).However,no relationship was found among lymph node metastasis,pTNM stage and EGFR mutation (P ＞ 0.05).There was no association between KRAS mutation and clinicopathological features including gender,smoking history,histological types,differentiation,tumor size,lymph node metastasis and pTNM stage (P ＞ 0.05).Conclusions The frequency of EGFR mutation in NSCLC is high,and usually occurs in female,non-smokers,smaller tumors,better differentiation and adenocarcinomas.The frequency of KRAS mutation is not associated with the clinicolpathological features.The frequency of BRAF mutation is very low,and EGFR,KRAS and BRAF gene mutations do not occur at the same time.These results contribute to the target therapy of NSCLC.

Objective To explore the correlation between anaplastic lymphoma kinase (ALK) fusion gene detected by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) in non-small cell lung cancer. Methods The ALK fusion protein/gene in 71 patients of NSCLC which was detected both by IHC (1A4/1H7) and RT-PCR were retrospective studies, and the 2 methods were compared. Results Among the 71 NSCLC patients, the ALK fusion protein positive was in 21 cases and negative was in 50 cases by IHC detected, while the ALK fusion gene positive was in 12 cases and negative was in 59 cases by RT-PCR. The ALK fusion genes detected by RT-PCR were all negative when IHC negative and IHC 1+. All patients with IHC 2+ and IHC 3+ were confirmed ALK fusion genes positive with RT-PCR. The positive rate of ALK fusion protein detected by IHC in large surgical specimens was 28.95%(11/38), and the positive rate of ALK fusion protein detected by IHC in small biopsy specimen was 30.30%(10/33). The positive rate of ALK fusion gene detected by RT-PCR in large surgical specimens was 18.42%(7/38), and the positive rate of ALK fusion gene detected by RT-PCR in small biopsy specimen was 15.15% (5/33). Conclusions Although the ALK fusion protein detected by IHC may have certain false positive, IHC is highly consistent with RT-PCR in IHC 2+and IHC 3+ cases. The combination of IHC and RT-PCR can be used to ALK fusion gene positive NSCLC screening and diagnosis. The small biopsy specimen is also good material for ALK detection, when the surgical specimen can not be got from patients.

Objective To determine whether the CD133+ cancer stem cells lie in circumferential resection margin of rectal cancer,and to explore the relationship between CD133+ cancer stem cells and prognosis of rectal cancer.Methods The circumferential resection margin of rectal cancer was cut,one half of the tissue was stained HE for microscope observation.Both groups were labeled CD133 by immunohistochemistry.The tissues with positive circumferential resection margin were classified as experimental group,otherwise the control group.Another half was made into single cell suspension and used to detect CD133+ cancer stem cells by flow cytometry.The relapse of patients in the experimental group was following-up.Results Two cases were positive by immunohistochemistry in the experimental group (28 cases),showed that CD133+ cancer stem cells were in circumferential resection margin,but there was not marked difference compared with the control group (72 cases were all negative) (P =0.076).CD133+ cancer stem cells can be detected by flow cytometry,and the expression was higher in experimental group than that in the control group (5.19 ％ and 0.56 ％,Z =-7.739,P ＜ 0.01).In experimental group,the expression of CD133+ cancer stem cells in circumferential resection margin of relapse patients was significantly higher than that in patients without relapse,the difference was statistically significant [(6.57±1.72) ％ and (4.77±1.33) ％,t =3.038,P ＜ 0.05].Spearman rank correlation analysis showed that the proportion of CD133+ cancer stem cells in the experimental group was positively correlated with relapse (rs =0.473,P ＜ 0.05).Conclusion There are CD133 + cancer stem cells within circumferential resection margin of rectal cancer,and the expression of CD133+ cancer stem cells in experimental group is correlated with the postoperative recurrence.

Objective To study the correlation of whole brain apparent diffusion coefficient (ADC) with neurological impairment,homocysteine (Hcy) metabolism and oxygen free radical generation in patients with Alzheimer's disease (AD).Methods The patients diagnosed as AD in Xuanwu Hospital of Capital Medical University from March 2014 to December 2017 were selected as AD group and healthy persons as control group.The ADC of whole brain was calculated after magnetic resonance scanning.The degree of neurological impairment was evaluated by Montreal Cognitive Function Assessment Scale (MoCA).The levels of Hcy metabolic index and oxygen free radical production were measured after collecting serum.Results ADC values of AD group in parietal lobe,frontal lobe,temporal lobe and occipital lobe were not significantly different from those of control group (P ＞ 0.05).The ADC value of hippocampus as well as serum Hcy,malondialdehyde (MDA) and nitric oxide (NO) contents were significantly higher than those of control group,while MoCA score as well as folic acid (FA),vitamin B12 (VitB12),superoxide dismutase (SOD) and glutathione peroxidase (GSH) contents in serum were significantly lower than those of control group (P ＜ 0.05);ADC value of hippocampus in AD patients was negatively correlated with MoCA score as well as serum FA,VitB12,SOD and GSH contents,and positively correlated with serum Hcy,MDA and NO contents.Conclusions The increased ADC value of hippocampus in AD patients was related to the cognitive function injury,Hcy metabolism disorder and excessive generation of oxygen free radicals.

Objective To explore the sonographic features and clinical factors associated with skip metastasis in papillary thyroid carcinoma (PTC).Methods We reviewed 276 PTC cases pathologically confirmed after operation in our hospital,analyzing the ultrasonographic features and clinical characteristics of primary site and risk factors of skip metastasis.Results The rate of skip metastasis was 16.6％,and level Ⅱ or level Ⅲ were the most common area.In univariate analysis,skip metastasis was associated with tumor location,tumor maximum size,and calcification.Multivariate analysis showed the primary tumor location in the upper portion,tumor size ≤ 10 mm,and microcalcification were independent predictive factors for skip metastasis.Conclusions In papillary thyroid carcinoma,skip metastases rate is high when primary tumor location in the upper portion,tumor size ≤ 10 mm,and there is microcalcification.

Objective:To establish a predictive model of lateral lymph node metastasis in patients with papillary thyroid carcinoma(PTC), and further to compare the diagnostic efficiency of this model with the suspected abnormal lymph node thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for lateral lymph node metastasis.Methods:The preoperative clinical and ultrasonographic data of 110 patients (257 lymph nodes) who underwent PTC cervical lymph node dissection were retrospectively analyzed. According to the postoperative pathological results, they were divided into lateral lymph node metastasis and non-metastasis group. Regression analysis was used to screen out independent risk factors affecting lateral lymph node metastasis and establish a predictive model. The ROC curve was used to evaluate the diagnostic efficacy and the best diagnostic cut-off point.Results:Prediction model: Logit( P)=-2.987+ 2.189(S/L ratio of lymph nodes)+ 1.748(hilum absent)+ 2.030(hyperechoic)+ 1.849(vascular abnormalities). The sensitivity, specificity, accuracy and AUC of the prediction model in the diagnosis of lateral lymph node metastasis were 92.1%, 83.9%, 87.9% and 0.929, respectively. The Homser-Lemeshow goodness of fit test showed that the Logistic model has a good fitting effect. The sensitivity, specificity, accuracy, and AUC of FNA-Tg in the diagnosis of lateral lymph node metastasis were 87.4%, 95.4%, 90.3% and 0.968, respectively. The sensitivity, specificity, accuracy, and AUC of the combined diagnosis of the predictive model and FNA-Tg were 92.9%, 96.9%, 94.2% and 0.989, respectively. Conclusions:The model has a good predictive value for PTC cervical lymph node metastasis. Combined with FNA-Tg, it can improve its diagnostic efficiency and provide more valuable information for the decision-making of clinical surgical procedures.

Objective: To detect the diffusional kurtosis imaging (DKI) parameters of patients with Alzheimer's disease (AD), and evaluate the inner link of DKI parameters with cognitive function and serum nerve injury index. Methods: 78 patients who were first diagnosed with AD in our hospital between December 2015 and January 2018 were enrolled in AD group, and 50 healthy volunteers who had physical examination in our hospital during the same period were enrolled in normal control group. The corpus callosum DKI parameters [mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK)] values, Mini-Mental State Examination (MMSE) score as well as serum nerve damage indexes [β amyloid 1-42 (Aβ1-422), S100B protein (S100B) and brain-derived neurotrophic factor (BDNF)] were compared between the two groups of subjects. Pearson test was used to evaluate the correlation of DKI parameters with MMSE score as well as serum nerve injury index in patients with AD. Results: MK, AK and RK levels in AD group were lower than those in normal control group; MMSE score was lower than that of normal control group; serum Aβ1-42 and S100B contents were higher than those of normal control group while BDNF content was lower than that of normal control group (P<0.05). Correlation analysis revealed that the MK, AK and RK values in AD patients were directly correlated with the MMSE score as well as Aβ1-42, S100B and BDNF levels (P<0.05). Conclusions The corpus callosum DKI parameter levels decrease in AD patients, and the specific levels are closely related to the severity of cognitive function and nerve injury, which may be one of the effective methods for early assessment of AD condition.

Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

【Objective】 To explore the effect of low levels of calcium on the biological characteristics of ameloblasts. 【Methods】 Rat primary ameloblasts were cultured in standard DMEM medium. After five days they were identified by RT-PCR and immunohistochemistry. Then 0, 0.6 and 1.2 mmoL/L Ca²⁺ and 100 mL/L fetal bovine serum were added into DMEM medium without calcium. After 48 hours, the cell morphology was observed by inverted microscope. The proliferation and apoptosis of cells were separately examined by MTT and AnnexinV-PI. Real-time quantitative PCR was used to detect the expression levels of amelogenin and KLK4 mRNA. 【Results】 After Five days in standard DMEM medium, the cells were shaped like the paving pattern. RT-PCR showed that both amelogenin and KLK4 were expressed in the cells. Immunohistochemical staining showed that most cells had positive staining for amelogenin. After 48 hours of calcium intervention, some cells in 1.2 mmoL/L Ca²⁺ group had higher nuclear density and poor light transmittance, and more high columnar cells could be observed in 1.2 mmoL/L Ca²⁺ group than those in 0 and 0.6 mmoL/L Ca²⁺ groups. With the decrease in calcium concentration in the medium, MTT showed that the proliferation activity of ameloblasts reduced (P<0.01). Annexin V-PI showed that the percentage of apoptotic cells decreased, and there was a significant difference between 1.2 mmoL/L and 0 mmoL/L Ca²⁺ groups (P<0.05). Real time-PCR showed that the expressions of amelogenin and KLK4 mRNA reduced (P<0.01). 【Conclusion】 Low-level calcium may inhibit the differentiation of ameloblasts, thereby affecting the formation of enamel mineralization.