Objective To explore the efficacy of endoscopic therapy for common bile duct stones in the elderly. Methods From July 2003 to June 2006,421 elderly patients with common bile duct stones were treated in the Danyang People's Hospital(112 cases) and the Second Affiliated Hospital of Nanjing Medical University(309 cases).The clinical data of the patients were retrospectively analyzed Results ERCP was completed in all the 421 patients,of which 27 was converted to a pre-cut sphincterotomy because of difficulties in the deep cannulation of the bile duct.The diagnosis of common duct stones was confirmed during the operation in all the cases,and 46 of them were found complicated with cholecystolithiasis.Of the patients,266 patients had one stone,107 had two,and 48 had three or more.The calculi were removed using basket directly in 283 patients,balloon catheter in 122,lithotrity in 10,and plastic stent placement without calculus removal in 6.The stones were removed completed at the first operation in 392 cases,and the other 23 cases received a second operation after endoscopic nasobiliary drainage.Errhysis occurred in 20 patients during the pre-cut sphincterotomy,and was healed by locally sprinkling or injecting noradrenaline(1:10 000),or electric coagulation.Six patients had hemorrhage from the incision on the duodenal papilla 48 hours after the operation,and were cured by using submucous injection of noradrenaline(1:10 000,4 cases) or titanium clipper(2 cases).34 patients had a transient increase of serum amylase without abdominal pain;10 patients developed mild pancreatitis and then was cured by fasting,inhibiting pancreatic secretion and pancreatic enzyme activities,anti-inflammation therapy,and rehydration;4 patients developed cholangitis,and was cured by anti-inflammation therapy.All the patients were discharged without complications.342 of the patients were followed up for 6-12 months,4(1.2%) of them had recurrence of stones and was treated with endoscopy,3(0.9%) had cholangitis and received anti-inflammation therapy.In the 6 patients with plastic stent,the stones were dissolved in 2 of them in half a year.Conclusions Endoscopic therapy is safe and efficient for common bile duct stones in the elderly and is associated with a low rate of complications.

s:To resolve the problem of the accuracy and standardization of STR PCR typing in forensic science practice,we have designed a new method to produce standard D12S375 allelic ladder.Seven different PCR amplified D12S375 allelic fragments were isolated from the gel,eluted into the distilled water and reamplified by PCR.The purified allelic fragments were then blunt end subcloned individually into the pUC plasmid vectors and transfected into competent E.coli DH5? TM cells.The sequencing results confirmed that the size and the constructure of the inserts were correct.The recombinant plasmids DNA with 7 inserts were then used as templates for reamplification to generate D12S375 standard ladder, with which the genetic polymorphisms of D12S375 locus in Chinese Han population in Chengdu,Hui population in Gansu and Wei population in Xinjiang were studied.

Objective To analyze the importance of procalcitonin (PCT) and high-sensitivity Creactive protein (hsCRP) in assessing the severity of pneumonia and sepsis patients as well as prognostic evaluation.Methods A total of 77 patients with pneumonia complicated with sepsis were randomly (random number) selected from May 2013 to May 2016 in our hospital and 50 patients with simple pneumonia were enrolled as control group.The sepsis pneumonia patients were divided into three groups,namely sepsis group,severe sepsis group and septic shock group.The sepsis patient were further divided into survival group and death group according to the death of patient within 2 weeks.Statistics was employed to study the roles of PCT and hsCRP in evaluating the severity of pneumonia and sepsis patients as well as prognostic evaluation.Results Compared with control group,the levels of PCT and hsCRP were higher in patients of sepsis groups (P ＜ 0.05).The levels of PCT and hsCRP were gradually increased as the severity of the patient getting worse (P ＜ 0.05).The levels of PCT and hsCRP in the death group were higher than those in the survival group.The areas under ROC curve of PCT and hsCRP for diagnosis of sepsis and septic shock as the optimal cut-off point at ≥ 2 ng/mL and at ≥ 75 mg/L,had the sensitivity of 62.1％ and 81.2％,respectively,and the specificity of 89.2％ and 68.2％,respectively.Conclution PCT and hs CRP levels have a certain value in assessing the severity of pneumonia and sepsis patients as well as prognostic evaluation.

Objective To explore the relationship between left atrial diameters (LAD) and prothrombotic state in senile patients with hypertension (HT) and atrial fibrillation (AF). Mcthods Totally 105 patients with cssential hypertension were divided into 65 patients with atrial fibrillation and 40 cases without atrial fibrillation,and then patients with atrial fibrillation were subgrouped into paroxysmal and persistent atrial fibrillation groups.30 healthy people without hypertension and atrial fibrillation were used as control group.LAD was determined by M type ultrasound cardiogram.Fibrinogen (Fg),D-Dimer(D-Dimer),von willebrand (vwF) and haematocrit (HCT) were also measured as prothrombotic state and compared among the groups. Results In groups of HT with AF versus HT without AF versus control,LAD[(43.56 ± 6.72) mm vs.(36.28 ± 5.83) mm vs.(31.63±4.32)mm],Fg[(4.24±0.59)g/L vs.(3.09 ±0.49)g/L vs.(2.80± 0.46)g/L],D-Dimer [(0.43±0.13)mg/L vs.(0.28±0.]0)mg/L vs.(0.18±0.08)mg/L],vwF[(290.44±29.02)％ vs.(101.32±21.36)％ vs.(84.15±20.26) ％],HCT[(0.46±±0.07)vs.(0.37±0.05)vs.(0.34±0.03)]were significantly higher in HT patients with atrial fibrillation than those without atrial fibrillation and control ( all P＜ 0.05),and there were differences in LAD and D-Dimet (P＜＜0.05),but not in Fg,vwF and HCT (all P＞0.05) between patients without atrial fibrillation and control.LAD[(46.75±7.32)mm vs.(40.82±6.21)mm],Fg [(4.68±0.65)g/L vs.(3.85±0.53)g/L],D-Dimer [(0.48±0.16)mg/L vs.(0.40±0.12)mg/L],vwF [(384.96±29.75)％ vs.(209.43±28.63)％] and HCT [(0.49±0.08)vs.(0.43±0.06)] in persistent atrial fibrillation group were increased than those in paroxysmal atrial fibrillation group ( P ＜ 0.05 ).Fg ( r =0.683 ),D-Dimer ( r =0.735 ),vwF ( r=0.763) and HCT(r=0.759)were corrclated with LAD (all P＜0.01). Conclusions Increased LADmight he one of the elevated risks of atrial fibrillation and a higher prothrombotic state is increasing with larger LAD in senile hypertension.

BACKGROUND:Monofocal and multifocal Toric intraocular lens that have been widely used in clinic exhibit xcelent biological and optical characteristics and have good safety and stability after implantation. OBJECTIVE:To compare the outcomes and rotation stability in patients with cataract and astigmatism after implantation of monofocal and multifocal intraocular lens. METHODS:A total of 210 patients with cataract and astigmatism who received phacoemulsification and intraocular lens implantation were included in this study. Of them, 105 patients were assigned to monofocal intraocular lens implantation and the other 105 patients to multifocal intraocular lens implantation. Uncorrected visual acuity, best corrected visual acuity, residual astigmatism were reexamined at 1, 3 weeks and 1 month after surgery. The rotation of Toric intraocular lens was determined. The incidence of complications and spectacles- independent rate were recorded. RESULTS AND CONCLUSION:Visual acuity and residual astigmatism in each group were significantly improved after 1 week of intraocular lens implantation (P < 0.05); furthermore, these two indicators became better over time. Improvement of visual acuity and residual astigmatism in multifocal intraocular lens group was more obvious than that in monofocal intraocular lens group. Postoperative intraocular lens rotation at < 5° occurred in both groups. The intraocular lens rotation degree in multifocal intraocular lens group was higher than that in monofocal intraocular lens group at different time points (P < 0.05). There were no significant differences in incidence of complications and spectacles-independent rates between two groups at 1 month after surgery. These results demonstrate that multifocal Toric intraocular lens provides better visual acuity and residual astigmatism improvement, while monofocal Toric intraocular lens provides better rotation stability.

Objective To evaluate the effects of morphine preconditioning on the expression of microRNAs (miRNAs) during hypoxia-reoxygenation (H/R) in isolated cardiomyocytes in rats with heart failure.Methods Healthy adult male Sprague Dawley rats,w eighing 200-220 g,were used in this study.Adriamycin 2.0 mg/kg was injected once a week for 6 weeks via the tail vein to induce heart failure.The cardiomyocytes were isolated from the failing hearts of rats and seeded in 24-well plates or in 60 mm diameter dishes.The cells were then randomly divided into 3 groups (n =16 each) using a random number table:control group (group C); group H/R;morphine preconditioning group (group MP).The cells were cultured in normal culture atmosphere in group C.After being exposed to hypoxic air (5％ CO2-95％ N2) for 90 min,the cells were returned to the high-glucose DMEM supplemented with 10％ newborn bovine serum and were then cultured for 120 min in H/R and MP groups.In group M,the cells were cultured in morphine culture medium (final concentration of morphine 0.3 μmol/L) for 10 min and then were returned to the culture medium without morphine and cultured for 30 min immediately before hypoxia.At 120 min of reoxygenation,the cells of 8 wells in each group were chosen to detect the cell viability and lactate dehydrogenase (LDH) activity (by Typan blue staining).All the RNAs were extracted from the cardiomyocytes of the left 8 wells in each group and subjected to miRNA microarray to screen differentially expressed miRNAs.Results The cell viability was significantly lower,the activity of LDH was higher,the expression of miR-6216 and let7e-5p was higher,and the expression of miR-133b-5p was lower in H/R and MP groups than in group C (P ＜ 0.05).Compared with H/R group,the cell viability was significantly increased,the activity of LDH was decreased,the expression of miR-133b-5p was up-regulated,and the expression of miR-6216 and let-7e-5p was down-regulated in MP group (P ＜ 0.05).Conclusion Morphine preconditioning reduces H/R injury to isolated cardiomyocytes in rats with heart failure through regulating the expression of miRNAs such as miR133b-5p,miR-6216 and let-7e-5p.

During the process of China’s healthcare reform, the concept of “costly access to health care” has been discussed for quite a long time. However, big data indicates that a small number of patients (5%) account for disproportionate costs ( approximately 50%) . “Costly access to health care” may not be a ubiquitous perceived prob-lem for all residents. In this paper, the concept“high-need patient” will be introduced and the characteristics of the population will be analyzed. According to the healthcare reform experience from the international perspective, this paper proposed healthcare strategy for Chinese high-need patients and policy recommendations for China’s healthcare reform.

Objective: To investigate the effect and mechanism of helix B surface peptide (HBSP) on myocardial ischemia reperfusion injury (MIRI) in experimental mice.
Methods: The MIRI model was established by ligation of anterior descending coronary artery of the mice for 45 min and followed by corresponding treatment at 5 min before reperfusion. A total of 64 male ICR mice were randomly assigned to 4 group:①Sham group,②MIRI group, the mice received normal saline at 5 min before reperfusion,③HBSP group, MIRI mice received HBSP at 5 min before reperfusion and④HBSP+PD98059 group, MIRI mice received PD98059 (a speciifc blocker of ERK1/2) at 20 min before reperfusion and followed by HBSP at 5 min before reperfusion.n=16 in each group, all animals were treated for 2 hours. The area of myocardial infarction (MI) was detected by TTC-EB double staining method, the myocardial apoptosis rate was examined by TUNEL method, the levels of protein expression of ERK1/2 and phosphorylation of ERK1/2 were measured by Western blot analysis.
Results: Compared with MIRI group, HBSP group presented decreased MI area, decreased myocardial apoptosis rate and increased phopsphorylation level of ERK1/2, allP<0.05. Compared with HBSP group, HBSP+PD98059 group showed decreased phopsphorylation level of ERK1/2, increased myocardial apoptosis rate and increased MI area, allP<0.05.
Conclusion: HBSP may reduce the MI area via inhibiting myocardial apoptosis and therefore, protecting the experimental mice from MIRI; the mechanism might be related to the activation of ERK1/2 pathway.

Objective To study the safety and feasibility of endobiliary intraductal radiofrequency ablation (RFA) to reopen occluded self-expandable metal stents in patients with malignant biliary obstruction.Methods 11 patients with malignant biliary obstruction and blocked metal stents were prospectively studied.During ERCP, after biliary cannulation, the blocked metal stents underwent RFA using a bipolar radiofrequency probe which was introduced into the stenotic bile duct via a guide wire.This was followed by a balloon to repeatedly remove debris and then endoscopic nasobiliary drainage.The patients were closely observed and followed up.Results RFA was successfully carried out in all the patients and patencies were achieved when compared with pre-RFA.The median post-RFA luminal diameter of the strictures showed significant improvement: 6 (4 ～ 10) mm versus 2 (0 ～ 5) mm, and the mean post-RFA total bilirubin level decreased sharply : (39.4 ± 8.7) μ mol/L versus (130.1 ± 38.2) μmol/L.Following this intervention, 3 patients developed fever, which were controlled with conservative therapy.There was no mortality, haemorrhage, bile duct perforation or bile leak.Of the 11 patients, 3 were dead and 6 were alive at a median follow-up of 187 (75 ～ 304) days.The median stent patency was 135 (75 ～ 203) days and the median survival was 278 (75 ～ 304) days.Four patients had their stents patent at the time of the last follow-up or death.Seven patients had their stents blocked on 113, 124, 154, 203, 96, 135 and 112 days post-procedure.Condusions Endobiliary intraductal RFA is technically feasible and safe to reopen occluded metal stents in malignant biliary obstruction.This efficacy needs to be confirmed by future randomized studies.

Objective To investigate the neuroprotective effect of sophocarpine against transient focal cerebral ischemia via down-regulation of the acid-sensing ion channel 1(ASICl) in rats.Methods Twenty-five SD rats were randomly allocated into sham operation,cerebral ischemia/reperfusion,and 5,10,and 20 mg/kg sophocarpine pretreatment groups (n=5 in each group).A rat focal ischemia model was induced by the intraluminal suture method.Five,10 and 20 mg/kg sophocarpine were injected intraperitoneally for pretreatrnent.2,3,5-triphenyltetrazolium chloride staining was used to detect cerebral infarct volume.TUNEL staining was used to detect apoptosis.Immunohistochemistry and Western blot were used to detect the expression of ASIC1 and ASIC2.Results The infarct volume after ischemia-reperfusion was(181.21±9.21)mm3,while the 5,10,and 20 mg/kg sophocarpine pretreatment groups were(150.12±6.19),(52.31±4.20),and(32.18±3.82)mm3,respectively;the neurological function scores in the cerebral ischemia/reperfusion group was(3.62±0.36),while the 5,10,and 20 mg/kg sophocarpine pretreatment grows were(3.15±0.36),(1.92±0.18),and(1.85±0.21),respectively;The surviving neurons only accounted for(31.2±2.8)% of the total cell number in the cerebral ischemia-reperfusion group,while they accounted for(51.2±3.7)%,(76.5±2.1)%,and(77.1±4.1)% in the 5,10,and 20 mg/kg sophocarpine pretreatnmat groups.Compared with the cerebral ischemia/reperfusion group,the cerebral infarct volume was decreased significantly in the sophocarpine pretreatrnent groups(all P<0.01),the neurological function scores were decreased significantly(all P<0.01),and the number of apoptotic cells was decreased significantly (all P<0.01).Immunohistochemistry showed that the number of ASIC-1 positive cells in the sham operation,cerebral ischemia-reperfusion,and 5,10,and 20 mg/kg sophocarpine pretreatment groups were(162.5±8.3),(165.1±5.3),(138.3±7.2),(82.1±6.3),and(69.2±5.5)/mm respectively;Western blot showed that the ASIC1 protein expression was decreased sigaificantly in the 10 and 20 mg/ky sophocarpine pretreatment groups (P<0.01),while there WaS no significant difference in the ASIC2 protein expression.Condusions Sophocarpine may play a neuroprotective role for cerebral ischemia-reperfusion injury in rats via down-regulating the expression of ASIC1 protein.