Objective To evaluate the effect of endoprostheses for short and long term management of common bile duct stones in elderly patients(70 89 years). Methods Fifty two patients over 70 years with common bile duct stones undergone endoscopic biliary stenting(Group S, 28 cases) or common bile duct exploration (Group D, 24 cases) were followed up for 14 85 months. The two groups were similar to each other in clinical manifestations. Results One patient (4 2%) died because of breath and circulation exhausting on the 3rd day postoperation in Group D. Early complications were 14 4% and 33 3% respectively ( P

Objective To evaluate the efficacy of retroperitoneal laparoscopic pyelo-ureterolithotomy. Methods Totally 52 cases of unilateral urinary calculi were treated with retroperitoneal laparoscopic pyelo-ureterolithotomy in our hospital. All the patients received placement of ureteral stent during the operation. Results All the operations were completed successfully without conversion to open surgery. The time of the operation varied from 50 to 200 minutes with a mean of 110 minutes. The patients were discharged from hospital in 5 to 14 days (mean,7.5 days). Eight weeks after the operation,the stent was withdrawn from the patients. Follow-up was achieved in all of the patients for six months. Ultrasonography showed that the hydronephrosis disappeared in 21 cases at 3 months,and in 32 patients at 6 months. None of the cases had recurrence. ECT showed an increased GFR in eight patients with severe hydronephrosis (increased from a mean of 16 ml/min before the operation to 25 ml/min). Conclusions Retroperitoneal laparoscopic pyelo-ureterolithotomy is effective,safe,and less invasive for the calculi in the renal pelvic and upper ureter.

Objective:To investigate the masticatory function and the expression of monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-α(TNF-α) in gingival crevicular fluid.Methods:The clinical data of 98 patients with dentition loss admitted to Tongxiang First People′s Hospital from June 2017 to June 2019 were analyzed, and 49 cases were treated with oral implant repair(observation group) and 49 cases were treated with conventional repair(control group). Both groups were followed up for 6 months. The masticatory function, speech function, retention function, quality of life and the changes of MCP-1 and TNF-α in gingival crevicular fluid were compared before treatment and 6 months after treatment.Results:The total effective rate of the observation group was higher than that of the control group: 95.92%(47/49) vs. 79.59%(39/49), and the difference was statistically significant ( χ2=6.078, P<0.05). At 6 months after treatment, the scores of masticatory function, speech function and retention function in the observation group were higher than those in the control group ( P<0.05). The scores of emotional function, social function and physiological function in the observation group were higher than those in the control group ( P<0.05). The levels of MCP-1 and TNF-α in gingival crevicular fluid of the observation group were lower than those of the control group: (32.09 ± 7.65) μg/L vs. (43.62 ± 9.23) μg/L, (2.19 ± 0.38) μg/L vs. (3.20 ± 0.51) μg/L, and the differences were statistically significant ( P<0.05). Conclusions:Dental implant repair is effective for patients with dentition loss, and it can improve masticatory function and quality of life, and reduce the expression of MCP-1 and TNF-α in gingival crevicular fluid.

To observe the analgesic effects of morphine and bupivacaine for the patient controlled epidural analgesia (PCEA) after prostatectomy. Methods: 21 patients after receiving prostatectomy were treated with PCEA including morphine and bupivacaine, and 24 patients were treated with routine analgesia as control. The effects of analgesia with visual analogue scale (VAS) were evaluated indirectly, and episodes of bl adder spasm were recoreded. Results: The effects of PCEA on postoperative analgesia and controlling bladder spasm were much better than that of routine analgesia. Conclusion: Effects of morphine and bupivacaine used in PCEA for post-prostatectomy analgesia are confirmed adm inistration is slimple. Because of their dosage is smalller and side effects are fewer, this treating protocol is beneficial for the recovery of the patients re ceiving prostatectomy.

Objective To explore the expression and significance of protein tyrosine phosphatase SHP2 in experimental bacterial meningitis.Methods A juvenile rat bacterial meningitis model was established by direct intraeisternal injection with Streptococcus pneumoniae. Uninfected control animals were mock-infected with sterile saline.The transcription and expression of SHP2 were detected by reverse transcription-polymerase chain reaction(RT-PCR),Western blot and immunohistochemistry techniques respectively at 1,3,7 and 14 days after infection.White blood cell(WBC)count,concentration of tumor necrosis factor-alpha(TNF-α)in cerebrospinal fluid(CSF)were also measured.Variables that were not normally distributed were compared by the Kruskal-Wallis test.Multiple comparison used Student-Newman-Keuls(SNK).The association between variables was assessed by using the Pearson correlation coefficient.Results Compared with uninfected controls,rats with bacterial meningitis showed a significant upregulation of SHP2 at both mRNA and protein levels(F=12.74,P<0.01;F=198,P<0.01).S HP2 mRNA levels peaked at 3 days after infection increasing more than five fold and remained at high levels at 7 days.In parallel,SHP2 protein levels began to increase at 3 days after infection,reaching a maximal increase of nearly nine fold at 7 days and remained at high levels at 14 days. Immunohistochemical analysis of SHP2 expression in the juvenile rat brain demonstrated that SHP2 labelling cells,identified as neuronal and glial cells,widely distributed in the cerebral cortex and the increased immunoreactive cells around the third ventricle were mainly glial cells.In addition,the protein levels of SHP2 and WBC counts were significantly correlated with each other(r=0.77,P<0.01),while there were no significant correlations between levels of SHP2 and TNF-a (r=0.08,P>0.05).Conclusions SHP2 may participate the pathological progress of the bacterial meningitis,restrating the inflammation and accelerating the renovation,so it can be regard as an index to measure the state of the illness.

Objective To explore a rapid and accurate method for the diagnosis of smear negative tuberculosis meningitis (TBM). Methods Sixty-seven patients with TBM were selected from Tianjin Haihe Hospital from June 2014 to June 2016, and 118 patients with non-tuberculous meningitis (NTBM) in the same period were chosen as control group, including bacterial meningitis (BM) group (n=61) and viral meningitis (VM) group (n=57). The laboratory routine, biochemical and immune indicators were tested with the specimens of both the blood and cerebrospinal fluid of all the patients. The Logistic regression equation was established for the diagnosis of TBM, and the diagnostic efficacy of which was evaluated by the receiver operating characteristic curve (ROC). Results The predictive regression equations of the TBM with BM, VM and NTBM (BM + VM) were obtained when BM group was used as a control: PRE_BM=1/1 +e-(-5.298+0.196 × ESAT-6+ 0.119 × CFP-10-2.968 × PCT+2.206 × ADA_CSF+0.705 × GLU_CSF+0.093 × LDH_CSF), PRE_VM=1/1+e-(-6.907+0.394 × ESAT-6-0.120 × Na+2.633 × ADA_CSF-0.088 × Cl_CSF) and PRE_NTBM=1/1+e-(0.683+0.099×ESAT-6+0.063×CFP-10-2.645×PCT+1.393×ADA_CSF+1.342×TbAb_CSF)respectively. When BM group was served as a control, the sensitivity, specificity, positive and negative predictive values of the regression for the diagnosis of TBM were 97.01%(89.63%-99.64%), 98.36%(91.20%-99.96%), 98.48%(91.84%-99.96%) and 96.77%(88.83%-99.61%), respectively.When VM group was served as a control, which were 94.03%(85.41%-98.35%), 94.74%(85.38%-98.90%), 95.45%(87.29%-99.05%) and 93.10%(83.27%-98.09%), respectively. When NTBM group was served as control, which were 94.03%(85.41%~98.35%), 90.68%(83.93%-95.25%), 85.14%(74.96%-92.34%) and 96.40%(91.03%-99.01%), respectively. Conclusion The predictive regression equation could be used as early diagnostic TBM with high sensitivity and specificity, which should be popularized in clinical practice, while, according to the higher negative predictive value, the negative results of which could be used to rule out of the TBM and non-empirical medication.

Objective To explore the diagnostic value of combined detection of the liquid array technology, interfer-on (IFN)-γand IFN-γ-inducible protein (IP)-10 in the rapid, accurate diagnosis and differential diagnosis of tuberculous pleural effusions. Methods Patients with transudative pleural effusions were divided into tuberculous pleural effusion group (n=52) and malignant pleural effusion group (n=38). The method of T-SPOT.TB was used to detect the number of effec-tor T cells sensitized to Mycobacterium tuberculosis and spot forming cells (SFCs). The liquid array technology was used to detect the level of IFN-γand IP-10. Logistic regression was used to analyze and compare the diagnostic value of the two-method combination. Results The diagnostic sensitivity, specificity and the area under the ROC curve (AUC) of T-SPOT. TB were 90.38%, 84.21%, and 0.938 (95%CI:0.867-0.978), respectively. The diagnostic sensitivity, specificity and AUC of combined detection of IFN-γand IP-10 were 98.08%, 97.37%, and 0.995 (95%CI:0.951-1.000), respectively. There was no significant difference in the diagnostic sensitivity and specificity between the two methods, and the diagnostic agreement for the two diagnostic methods was fine (Kappa=0.703). The difference of AUC between the methods was significantly differ-ent (Z=1.996, P<0.05). The method of combined detection of IFN-γand IP-10 showed the larger AUC (AUC=0.995). Con-clusion The combined diagnosis meets the clinical needs of rapid, accurate diagnosis and differential diagnosis for tuber-culous pleural effusion by simultaneously assaying the level of IFN-γand IP-10 using the liquid array technology.

AIM:To detect the endogenous expression of B-cell leukemia/lymphoma 6 member B (BCL6B) in FHC and LoVo cells, and to investigate the effects of BCL6B on proliferation and migration of LoVo cells for further explo-ring the underlying mechanism .METHODS:The endogenous expression of BCL 6B in the FHC and LoVo cells was detec-ted by RT-PCR and Western blot .The methods of MTT assay , colony formation assay , wound healing assay and Transwell chamber experiment were employed to examine the biological functions of BCL 6B in the LoVo cells.The mRNA and protein levels of BCL6B, cyclin D1 and matrix metalloproteinase-9 ( MMP-9) were determined by RT-PCR and Western blot , re-spectively.The level of phosphorylated protein kinase B (p-AKT) was detected by Western blot.RESULTS:BCL6B ex-pression was notably repressed in the LoVo cells as compared with the FHC cells , which were significantly increased by transfection with pcDNA3.1-BCL6B.The abilities of proliferation and migration of the LoVo cells at 72 h were inhibited by 28.33%(P<0.01) and 36.11%(P<0.05) in BCL6B group.The mRNA levels of cyclin D1 and MMP-9 in the cells of BCL6B group were decreased by 39.90%(P<0.01) and 77.36% (P <0.05), and the protein levels of cyclin D1, MMP-9 and p-AKT were reduced by 44.00%(P<0.05), 47.06%(P<0.01) and 32.88% (P<0.05), respectively. CONCLUSION:BCL6B inhibits proliferation and migration of the LoVo cells , and the PI3K/AKT signaling pathway is in-volved in this process .

Objective To establish a diagnostic model of multiple cytokines for differential diagnosis of tuberculous pleural effusion , and compare its diagnostic accuracy with tuberculosis infected T cells detection ( T-SPOT.TB ) in order to evaluate its diagnostic performance.Methods Case-control study.Totally 147 patients with pleural fluid in Tianjin Haihe Hospital were enrolled and categorized as tuberculous pleural effusion group ( n=95 ) and malignant pleural effusion group ( n=52 ) from December 2011 to June 2013.Pleural effusion cytokines including interferon-γ( IFN-γ) , C-X-C motif chemokine 10 (CXCL-10), tumor necrosis factor-α(TNF-α), vascular endothelial growth factor (VEGF), IL-2, IL-16, IL-17, IL-27 and IL-33 were tested by liquid chip technology and analyzed by Binary Logistic regression and receiver operating characteristic curve (ROC), and the pleural effusion was also detected by tuberculosis infected T cells detection ( T-SPOT.TB) as a control.Results The comparison of the AUC of cytokines is:CXCL-10>IL-27>IFN-γ>IL-33 >IL-17>IL-16>TNF-α>VEGF>IL-2; After that, CXCL-10, IFN-γ, IL-27 and IL-33 were included the Binary Logistic regression model.The regression equation is P=1/1+e-( -16.851+0.390 ×IFN-γ+0.006 ×IL-27+0.020 ×IL-33).The AUC, sensitivity and specificity of the diagnostic model were 99.5%, 96.84%, and 98.08%, respectively.Both AUC and sensitivity of the diagnostic model were superior to those of any single index.Compared with T-SPOT.TB (0.995 ±0.003), the AUC of the diagnostic model (0.921 ±0.023) was significantly greater ( Z=3.235, P <0.01), but no significant difference was found when it comes to diagnostic results consistency (χ2 =0.062 5, P>0.05).The Kappa of the two methods was 0.795, which meant fine agreement of the evaluations of the two raters.Conclusion The application of liquid array technology of high sensitivity and repeatability with high throughput provided a novel insight and method in the clinical diagnosis , treatment and prevention for tuberculous pleural effusion scientifically and accurately.

Objective:To observe and analyze the clinical features, treatment methods and efficacy of patients with retinopathy associated with incontinentia pigmenti (IP).Methods:A retrospective case study. Twelve clinical confirmed IP patients (24 eyes) in Zhongshan Ophthalmic Center of Sun Yat-sen University from January 2015 to December 2018 were included in this study. The best corrected visual acuity and intraocular pressure examination were performed in patients (>4 years old). All patients were examined on the anterior segment, vitreous body, and fundus under topical anesthesia or general anesthesia. Eight cases underwent genetic testing. Patients with active disease should be given anti-vascular endothelial growth factor (VEGF) drug treatment, retinal laser photocoagulation or vitrectomy, those without active disease should be observed. All patients were followed up for 1 to 3 months, with an average follow-up time of 18.7 months.Results:All patients were all female, with an average age of 6.3±9.8 years old at the first ophthalmology visit. According to the recommendations of the pediatrician, 3 cases were actively screened for ophthalmology (referrals), with an average age of 0.4±0.5 years (median age: 2 months). A total of 9 cases were not recommended for referrals (non-referrals), including 3 cases of ophthalmology who were diagnosed for the first time due to visual impairment, and 6 cases of undiagnosed IP before the ophthalmology visit, the average age of their first visit was 8.2±10.8 years (medium age: 3 years old). The age of the first visit for non-referred patients was larger than that of referrals, and the difference was statistically significant ( Z=-2.141, P=0.036). Among the 24 eyes of 12 cases, there were no obvious fundus abnormalities in 1 case or 2 eyes, 11 cases of IP-related retinopathy in 22 eyes (91.7%, 22/24), 8 cases of binocular asymmetry (66.7%, 8/12). There were active lesions on the fundus in 7 eyes (29.2%, 7/24). Patients underwent simple retinal laser photocoagulation and/or anti-VEGF drug therapy. During the follow-up, retinal neovascularization recurred in 1 eye. Among the 8 cases that underwent genetic testing, 3 cases (37.5%, 3/8) were deleted in exons 4-10 of the IKBKG gene. Conclusions:IP is more common in women. IP-associated retinopathy is noted with early-onset, asymmetrical retinopathy, which is identified with retinal neovascularization and vitreous proliferation. Early detection and timely treatment are essential.