Objective To investigate the value of serum and biliary carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19 -9),and carbohydrate antigen 24-2 (CA24-2) in the diagnosis of benign and malignant biliary obstructive diseases.Methods A total of 40 patients with benign biliary obstructive diseases and 40 with malignant ones,who were diagnosed and treated in The Central Hospital of Enshi Autonomous Prefecture from June 2015 to December 2016,were enrolled.Serum samples collected on admission and bile samples collected during surgery were used to measure the levels of tumor markers CEA,CA19-9,and CA24-2.The t-test was used for comparison between two groups,and a receiver operating characteristic (ROC) curve analysis was performed for each tumor marker in the diagnosis of benign and malignant biliary obstructive diseases.Results Compared with the benign group,the malignant group had significantly higher serum levels of CA19-9 and CA24-2 (t =5.899 and 3.223,both P ＜ 0.05) and biliary levels of CEA,CA19-9,and CA24-2 (t =3.304,7.615,and 7.279,all P ＜0.05).In the patients with malignant biliary obstructive diseases,the levels of CEA,CA19-9,and CA24-2 in the bile were significantly higher than those in serum (t =3.297,4.975,and 3.993,all P ＜ 0.05).Biliary CA24-2 had the highest Youden index (0.75) and area under the ROC curve (AUC) (0.946);biliary CA19-9 had a Youden index of 0.74 and an AUC of 0.937,and serum CA19-9 had a Youden index of 0.68 and an AUC of 0.898.These three indices had a relatively high diagnostic value.Combined measurement of biliary CA24-2,serum CA19-9,and biliary CA19-9 had a sensitivity of 94.75％,a negative predictive value of 93.50％,and a Youden index of 0.82 in the diagnosis of malignant biliary obstructive diseases.Conclusion Biliary tumor markers have a great value in the diagnosis of malignant biliary obstructive diseases,and the combined measurement of biliary CA24-2,serum CA19-9,and biliary CA19-9 has the highest value in the differential diagnosis of benign and malignant biliary obstructive diseases.

Objective To explore the diagnostic value of pink sign of iodine staining for early esophageal carcinoma. Methods Data of 312 lesions of 306 patients with suspected early esophageal carcinoma who received iodine staining from November 2015 to October 2017 were analyzed retrospectively. Lesions were divided into positive pink sign group and negative pink sign group according to the result of iodine staining. The relationship between pink sign and pathology were analyzed. Lesions recorded onset time of pink sign were divided into 4 groups by the onset time of pink sign, 0-30 s,>30-60 s,>60-90 s and>90-120 s, the diagnostic value of which was assessed with the receiver operating characteristic ( ROC) curve. Results Among the 312 lesions, 208 were identified positive pink sign, including 28 of inflammation or low-grade intraepithelial neoplasia ( LGIN ) , 180 of high-grade intraepithelial neoplasia ( HGIN ) or carcinoma, and 104 lesions were identified negative pink sign, including 69 of inflammation or LGIN, 35 of HGIN or carcinoma. The sensitivity, specificity and accuracy of positive pink sign in the diagnosis of HGIN and early esophageal carcinoma was 83. 7％, 71. 1％ and 79. 8％, respectively. Multivariate analysis showed a significant association between the onset time of pink sign and histopathology ( P=0. 000, OR=0. 016, 95％CI=0. 042-0. 324) . The onset time of pink sign was recorded in 89 lesions in the positive group. The area under ROC curve of the onset time of pink sign was 0. 899, and the optimal cut-off value was 60 s, which indicated the good validity of the test with the sensitivity, specificity and accuracy of 92. 8％, 84. 2％and 91. 0％, respectively. Conclusion The pink sign of iodine staining for diagnosis of early esophageal carcinoma shows a high consistance rate, especially that appears within 60 s.

Cognitive dysfunction refers to dysfunction of individual perception,memory,understanding,learning,creation and other dysfunctions caused by abnormal brain function and structure.Based on the fact that the spleen can't regulate transportation and transformation,govern blood and send up essential substance,combined with the microbiota-gut-brain axis,this article discussed the etiology and pathogenesis of intestinal flora imbalance affecting cognitive dysfunction in TCM.It was proposed that the spleen in TCM and intestinal flora are connected in physiology and pathology:the spleen regulates spirit and governs cognition,when the spleen fails to function normally that it can't dominate transportation and transformation,govern blood and send up essential substance will cause that the brain spirit can not be nourished;intestinal flora is closely related to the spleen in TCM,and affects brain function through the nervous system,endocrine,immune and metabolic mechanisms.This article can provide explore new ideas for the clinical research and treatment of cognitive dysfunction of traditional Chinese and Western medicine.

This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076-0.418; P < 0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023-1.084; P < 0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028-0.143; P < 0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.
Age Factors ; Aged ; COVID-19/therapy* ; China ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Survival Rate