Objective To compare the overall diagnostic accuracy of MRCP with EUS for the detection of choledocholithiasis and malignant obstruction in patients with suspected biliary obstruction.Methods A fully recursive literature search was conducted in The Cochrane Central Register of Controlled Trials CENTRAL,MEDLINE or PUBME (1980-2012),EMBASE (1980-2012),OVID Database (1980-2012),CBM (1980-2012),VIP database (1989-2012),Chinese journal of full-text database (CNKI) (1980-2012),and WANFANG database(1980-2012).The prospective diagnostic studies which evaluated or compared the diagnostic accuracy of MRCP and EUS were included combined with manual searches.We also searched the references of all included articles of important meetings and journals.QUA-DAS items were used to evaluate the quality of the included studies.SEN,SPE,+ LR,-LR and the areas under SROC were detected,then t-test was used to evaluate whether statistically significant difference existed between EUS and MRCP.Results Thirteen studies including 1200 cases were recruited.The overall pooled sensitivities of MRCP and EUS for the detection of choledocholithiasis were 0.870 (95％ CI:0.826-0.906)and 0.935 (95％ CI:0.90-0.96) respectively,whereas their specificities were 0.952 (95％ CI:0.926-0.971) and 0.947 (95％ CI:0.920-0.967),respectively.The overall pooled positive likelihood ratio for MRCP and EUS were 14.055 (95％ CI:6.259-31.561) and 16.653 (95％ CI:6.896-40.212),respectively,with the corresponding negative likelihood ratio of 0.177 (95％ CI:0.108-0.290) and 0.076 (95％ CI:0.049-0.118),respectively.Areas under the ROC curve were 0.9693 and 0.9771,respectively.There were no statistically significant difference for sensitivity (0.84 ± 0.16 vs 0.93 ± 0.07,P =0.108) and specificity (0.93 ±0.10 vs 0.90 ±0.15,P =0.555) between MRCP and EUS.The overall pooled sensitivities of EUS and MRCP for the detection of malignancy were 0.959 (95％ CI:0.908-0.987),and 0.805 (95％ CI:0.724-0.871),respectively,whereas their specificities were 0.975 (95％ CI:0.954-0.988) and 0.927 (95％ CI:0.897-0.951),respectively.The overall pooled positive likelihood ratio for EUS and MRCP were 23.398 (95％ CI:12.987-42.155) and 13.448 (95％ CI:4.961-36.456),respectively,with the corresponding negative likelihood ratio of 0.059 (95％ CI:0.028-0.122) and 0.134(95％ CI:0.046-0.391),respectively.Areas under the ROC curve were 0.9870 and 0.9686,respectively.There were no statistically significant differences for sensitivity (0.95 ± 0.55 vs 0.88 ± 0.14,P =0.22) and specificity (0.96 ±0.03 vs 0.91 ±0.11,P =0.31) between MRCP and EUS.Conclusion MRCP and EUS are both valuable in differential diagnosis of biliary obstruction caused by choledocholithiasis or malignant lesions.

ObjectiveTo develop a method of location of prenatal female mouse reproductive tract based on paraffin block serial sections of female fetuses, and get high quality paraffin sections of fetuses containing female reproductive tract (FRT).And to investigate the role of Wnt5a during the development of FRT of prenatal mice. Methods The sex of fetuses at gravidity 15.5 days( G15.5d), G17.5d, G19.5d) and G21.5d was identified by polymerase chain reaction(PCR),and the female fetuses were embedded in paraffin block, the specimen was sectioned serially . One of every four sections was stained by hematoxylin-eosin(HE), and the next one being used later.The images of specimen were taken with digital camera and the serial sections were obtained. The paramesonephric duct /uterus were located and recognized. Immunohistochemistry was used to determine the location and intensity of Wnt5a staining in the middle of the paramesonephric duct / uterus. Results The morphology of the paramesonephric duct /uterus was recognized first and the sections of fetuses with paramesonephric ducts were obtained. The intensity of Wnt5a immunohistochemical staining was increased from G15.5d to G21.5d in mesenchymal cells(P<0.01).Conclusion Wnt5a plays a marked role in early period of female mouse reproductive tract, and is possible to be a key factor to induce uterus differentiation and development.

Objective:To observe the proliferation and the free intracellular calcium ion concentration of osteoblast under the effect of static magnetic field and discuss the possible mechanism of the static magnetic field on promoted the proliferative function. Methods: The MTT assay was used to measure the rate of the proliferation on different magnetic field intensity(0, 0.026, 0.044, 0.090 T)and action time(24, 48, 72 h).The fluorescence double wavelength spectrophotometer was used to measure the concentration of intracellular calcium ion. The data obtained were analyzed for ANOVA and t-test using SPSS 11.0 software package. Results: Osteoblasts in group 0.044 T appeared significant proliferation within 48 h(P

G-protein-coupled receptors (GPCRs) are major targets for drug discovery. The regulator of G-protein signaling (RGS) proteins is a recently identified protein family,which strongly modulates the activity of G proteins. RGS proteins accelerate the deactivation of G proteins to reduce GPCR signaling; however, some also have an effector function and transmit signals. Combining GPCR agonists with RGS inhibitors should potentiate responses and markedly increase the regional specificity of agonist. In the central nervous system, RGS proteins have unique tissue distributions and are strongly regulated by signal transduction events. Thus the diversity of RGS makes them attractive targets for pharmacotherapy of neurological disorders.

BACKGROUND: Adipose-derived stem cells (ADSCs), a kind of adult stem cells, possess plasticity and can be induced into myocardial cells under certain conditions. Autologous ADSCs transplanted into the infarct area can differentiate into myocardial cells and vascular endothelial cells to construct new vessels and thereby improve cardiac pump function. OBJECTIVE: To study the factors that influence ADSCs differentiation and transplantation and the current clinical and laboratory research progress of ADSCs transplantation for treatment of cardiomyopathy.METHODS: A computer-based retrieval was performed in Medline (between January 1990 and April 2010), PubMed database, the China Biological Medicine Database (CBM) (between January 1990 and April 2010), and China National Knowledge Infrastructure (CNKI) with the keywords adipose-derived stem cells, myocardial cells, cell differentiation, cell transplantation, cardiomyopathy treatment.RESULTS AND CONCLUSION: A total of 30 articles, consisting of 6 reviews and 24 randomized controlled trials, were obtained. At present, there have been uniform methods of ADSCs isolation and culture, and ADSCs can be effectively proliferated in vitro, but there have been no direct methods to identify these stem cells. ADSCs differentiation can be induced both in vitro and in vivo, besides, with a characteristic of early differentiation. ADSCs transplantation is a more conductive therapy for myocardial disease compared with bone marrow stem cells (BMSCs) transplantation. Different ADSCs transplantation methods should be carried out in different types of cardiomyopathy. Stem cell labeling technique can help to dynamically monitor implanted in vivo. Transplantion of autologous ADSCs is a new way to treating cardiomyopathy. However, for successes in clinical practice, the method to inhibit tumor cells-promoting characteristics is needed to ensure long-term safety of the patients receiving ADSCs transplantation.

ObjectiveTo design the scale of death attitude for Chinese nurses and evaluate its validity and reliability.MethodsThe scale draft was formed through the literature review,the formal scale was got via expert consultation and interview survey of 20 cases of small sample.120 clinical nurses were selected for investigation.Then item analysis,factor analysis,correlation analysis and reliability analysis were applied to establish the scale′s validity and reliability.ResultsThe nursing staff death attitude scale consisted of 25 items,the varimax rotation factor analysis of the scale identified seven principal factors and explained for 63.732％ variances.The correlation coefficient between each item and its domain was 0.498～0.808,the Cronbach′s α coefficient of five domains was 0.595～0.774,the Cronbach′s α and split-half coefficient for the whole scale were 0.824 and 0.868 respectively.ConclusionsThe scale has high reliability and validity,and it can be the effective test instrument for death attitude of nurses in China.

Objective To explore the relatianship of social anxiety and parental rearing style and self-es-teem among medical students, and to provide theoretical guidance for students' mental health. Methods 346 medical students were assessed with interaction anxiousness scale(IAS), Egala minnen on bardndosnauppforstran (EMBU) and self-esteem scale (SES). Results Medical students' social anxiety was negatively correlated with emotional warmth and understanding of parents (FF1, MFI) (r=-0.162,-0.150, P<0.01) and self-esteem (r -0.355, P <0.01), and positively correlated with mother's over-interference, over-protection, refusal, rejection and favoring subject(MF2, MF3, MF5) (r=0.137,0.127,0.116, P<0.05). Stepwise regression analysis re-vealed that father's warmth and understanding and father's over-protection and self-esteem enter regression equa-tion and adjusted R square was 0.047 and 0.123. Conclusion The medical students' social anxiety was influ-enced by EMBU and SES, but the level was lower.

Objective:To investigate the rationality of off-label use of tacrolimus combined with Wuzhi capsules in a membranous nephropathy patient. Methods:Based on the related literatures, the application rationality of tacrolimus combined with Wuzhi capsules in a membranous nephropathy patient was analyzed. Results:The combination of tacrolimus and Wuzhi capsules against membranous nephropathy was an off -label drug use, however, it showed certain clinical rationality and economic efficiency. Conclusion:Off-label drug use commonly exists in clinics. Clinical pharmacists should provide evidence support for off-label drug use through searching and analyzing clinical evidences and closely monitoring therapeutic outcome.

Objective To discuss the relationship between Hp eradication effect and TCM syndrome types, and provide basis for improving clinical Hp eradication rate of TCM. Methods TCM syndrome types of 922 Hp-positive patients were distinguished. After treatment by the quadruple chemotherapy, the effect of Hp eradication of different TCM syndrome type was analyzed. Results In 922 Hp infectors, Hp eradication effect in different TCM syndrome type from low to high was as follows:spleen-stomach deficiency-coldness, cold-heat complication, stomach-yin deficiency, congestion of stomach collaterals, hyperactive liver-qi harmful to stomach, liver-stomach heat, spleen-stomach dampness-heat, with significant difference (P<0.05). A total of 623 patients were discriminated as excessive syndrome (including spleen-stomach dampness-heat, liver-stomach heat, hyperactive liver-qi harmful to stomach and congestion of stomach collaterals), and its eradication rate was 82.5%. A total of 244 patients were discriminated as deficient syndrome (including spleen-stomach deficiency-coldness and stomach-yin deficiency), and its eradication rate was 58.6%. The difference between excessive syndrome and deficient syndrome was statistically significant (P<0.05). Hp eradication effect among different TCM syndrome types of excessive syndrome had statistical difference (P<0.05), while that of deficient syndrome had no statistical difference (P>0.05). Conclusion The eradication rate of Hp infection was different in patients with different TCM syndrome types, which in deficient syndrome is obviously lower than in excessive syndrome.

AIM:To observe the expression of angiogenesis factors in the myocardial tissue of streptozotocin-induced diabetic rats .METHODS:The diabetic rat model was induced by intraperitoneal injection of streptozotocin .After 12 weeks, the cardiac function was measured by MPA cardiac function analysis system .The myocardial collagen volume fraction ( CVF) was assessed by Masson staining .The capillary vessels was quantified as the ratio of capillary to myocyte (C/M) using CD31 immunostaining.The expression levels of vascular endothelial growth factor (VEGF), angiopoietin ( Ang)-1, endostatin and Ang-2 were observed by Western blotting .RESULTS:Compared with normal control group , the left ventricular end-diastolic pressure (LVEDP) was evidently increased (P<0.01), but left ventricular pressure rise maximum rate (+dp/dtmax), left ventricular pressure decrease maximum rate (-dp/dtmax) and the ratio of capillary/myo-cyte (C/M) were significantly decreased (P<0.05).The CVF and the expression level of endostatin were significantly increased, whereas the expression levels of VEGF and Ang-1 evidently decreased (both P<0.05) in diabetic rats.Howev-er, no marked difference in the expression of Ang-2 between the 2 groups was observed (P>0.05).CONCLUSION:Im-balances between the angiogenic factors (VEGF and Ang-1) and anti-angiogenic factors (endostatin) may play an impor-tant role in the pathogenesis of diabetic cardiomyopathy .