Background:With the progress and widely application of endoscopic techniques,the prevalence rate of periampullary diverticulum (PAD)is increasing in recent years. However,the results of studies investigating the correlation of PAD and its types with common bile duct (CBD)stone are different. Aims:To investigate the influence of PAD and its types on CBD stone. Methods:A total of 1524 consecutive inpatients who underwent diagnostic and therapeutic ERCP for pancreatobiliary diseases from Jan. 2014 to Dec. 2016 at the General Hospital of Xinjiang Military Region of Chinese PLA were enrolled and divided into two groups according to the presence or absence of PAD. Patients in PAD group were further classified into 3 subgroups by the papilla's location with respect to the diverticulum. Their clinical data were collected and retrospectively analyzed. Results:The proportion of elderly patients (≥60 years old)in PAD group was 82. 2% (310 /377),which was significantly higher than that in non-PAD group [60. 8% (697 / 1147),P < 0. 05]. The prevalences of CBD stone,gallstone associated with CBD stone,post-cholecystectomy and recurrent CBD stone were higher and the size of CBD stone was larger in PAD group than in non-PAD group (P all < 0. 05). Furthermore,stratified analysis revealed that the CBD stone was more prevalent and the size of stone was larger in type Ⅱ PAD than in type Ⅰ and type Ⅲ PAD (P <0. 05), while recurrent CBD stone was more frequent in type Ⅰ and type Ⅱ PAD than in type Ⅲ PAD (P < 0. 05). Multivariate analysis indicated that the elderly and PAD were the risk factors for recurrence of CBD stone,and cholecystectomy was a protective factor. Conclusions:The elderly is predisposed to PAD. PAD and its types are associated with the development and recurrence of CBD stone. CBD stone is more prevalent in patients with PAD especially type Ⅱ PAD. The size of stone is larger and the post ERCP recurrence rate is high in type Ⅱ PAD.

Objective We aim to evaluate and discuss the feasibility of Hyaline imaging of three-dimension sonography in observation of paravaginal support structure in normal nonporous women.Methods Total of 45 normal infertile women were chosen.Three-dimensional volume datasets were collected at rest by transperineal ultrasound.The three-dimensional Hyaline images were acquired off-line.We observed the morphologic features of paravaginal support structure on the axial plane in middle vagina and measured the anteroposterior and lateral horizontal distances between bilateral paravaginal support structure and ureter.The consistency between two sonographers were analyzed by intraclass correlation coefficient (ICC).Results In three-dimensional Hyaline imaging sonogram,paravaginal support structure was appeared as typically tenting-like shaped.The anteroposterior distances between paravaginal support structure and center of ureter were listed as followed:left (-0.31 ± 1.29) mm,right (0.47 ± O.99) mm.While the lateral horizontal distances were left (12.67 ± 6.70) mm,right (13.01 ± 5.75) mm.There were no statistical differences between bilateral both anteroposterior and lateral horizontal distances.The consistency between two sonographers for distinguishing paravaginal support structure on the middle-vaginal plane and measuring distances between paravaginal support structure and center of ureter was remarkably high (ICC is 0.87 and 0.82).Conclusions Hyaline imaging technology of three-dimensional pelvic floor sonography could be used to observe paravaginal support structure in women.The normal paravaginal support structure is typically showed as bilateral symmetrical tenting-like structure,which is on the same level as the center of ureter.It provides normal anatomic radiological evidence and helps study defect of paravaginal support structure caused by pregnancy or delivery.

Objective To investigate the predictive values of serum complement C3, C4 and cholesterol levels in the prognosis of patients with sepsis. Methods The clinical data of all the patients with sepsis admitted to the Department of Critical Care Medicine of the General Hospital of Xinjiang Military Command from January 2015 to January 2017 were retrospectively analyzed. The levels of serum complement C3, C4, cholesterol, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure score (SOFA), etc. were recorded within 24 hours after admission, the patients were divided into survival group and death group according to the 28-day prognosis, and the differences in various indexes between the two groups were compared respectively;the predictive efficacies of C3, C4 and cholesterol levels in the prognosis of sepsis patients were evaluated by plotting receiver operating characteristic curves (ROC). Results Finally, 120 patients with sepsis were enrolled, including 57 patients in the survival group and 63 patients in the death group. Compared with the survival group, the APACHE Ⅱscore and the SOFA score of the death group were increased significantly (APACHE Ⅱ score: 20.29±5.90 vs. 15.32±5.98, SOFA score: 7.62±3.11 vs. 5.16±2.50, both P < 0.01), however, serum C3, C4 and cholesterol levels were obviously decreased [C3 (g/L): 0.67±0.22 vs. 0.82±0.24, C4 (g/L): 0.17±0.05 vs. 0.20±0.06, cholesterol (mmol/L): 2.77±1.23 vs. 3.46±1.02, all P < 0.01]. ROC curve analyses showed: each of the following items, complement C3, C4, and cholesterol, alone predicting the prognosis of sepsis patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were as follows: AUC = 0.680 (95%CI = 0.583-0.777, P = 0.001), AUC =0.657 (95%CI = 0.560-0.754, P = 0.003), and AUC = 0.711 (95%CI = 0.619-0.804, P < 0.001) respectively; when complement C3, C4 and cholesterol combination to predict the prognosis of patients with sepsis, the resulting predictive value was better than the predictive value results obtained by each one of the items or each combination of any two of them (the AUC of C3+C4+cholesterol was 0.725, 95%CI = 0.633-0.817, P < 0.001; the AUC of C3+C4 was 0.697,95%CI = 0.603-0.791, P < 0.001; the AUC of C3 + cholesterol was 0.718, 95%CI = 0.626-0.811, P < 0.001; the AUC of C4+cholesterol was 0.722, 95%CI = 0.629-0.815, P < 0.001). Conclusion Using combination of serum complement C3, C4 and cholesterol levels to predict the prognosis of patients with sepsis may obtain important predicting value, that can provide a reference to clinical doctors.