Objective To evaluate brush cytology under endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures, and to analyze the factors influencing the diagnosis yield.Methods Brush cytology was applied in 144 patients with suspected malignant biliary strictures at ERCP.Brushing in bile duct was performed for 10 times from 2004 to 2006, while at least 20 times of brushing and repeated manipulation were performed at biliary strictures from 2007 to 2009. Cytological samples were processed immediately after brushing and analyzed by the same pathologist. Efficacy of brush diagnosis was evaluated based on reference to histopathology after surgery and/or clinical diagnostic criteria. Results Malignant stricture was finally diagnosed in 96 patients, and benign diseases in other 48. Brush cytology was positive in 78 of 96 patients with malignant stricture ( sensitivity 81.3% ), and negative in all patients without malignancy ( specificity 100. 0% ). Overall accuracy of diagnosis was 87.5%. Positive rate of malignancy by brush between 2007 and 2009 was 87.7% (50/57), while that between 2004 and 2006 was 71.8%, which were significantly different ( P ＜ 0. 05 ). The positive rate was not correlated with stricture location or tumor type. No major complications occurred, except for 4 moderate acute pancreatitis, 3 cholangiolitis and 2 biliary bleeding. Conclusion Brush cytology is of high sensitivity and specificity for malignant biliary stricture.Repeated brushing and manipulation can facilitate diagnosis yield.

Autophagy refers to a catabolic process,in which the damaged organelles or biological macromolecules, such as protein aggregates, are degraded via lysosome. The completion of autophagy depends on a series of autophagy-related genes (Atgs) and many upstream regulatory molecules. Zinc is an essential trace element, and plays an important role in the process of autophagy as a component of enzymes and structural proteins like zinc transporters or zinc finger protein. The regulation of autophagy is closely associated with the zinc ion homeostasis. In addition, many studies suggest that the protective effects of zinc on cells are likely to be done by autophagy. This review aims to summarize the current research progress and discuss the reciprocal regulation mechanism between zinc and autophagy, which may provide insights into the intricate roles of autophagy in diseases and find novel strategies for treatment and prevention of human diseases.

Ackerman's pattern analysis is an epoch-making leap in the diagnosis of dermatopathology,which embodies a profound understanding of the whole dermatovenereology.To improve the teaching quality of Dermatovenereology for five year clinical medical students,pattern analysis is introduced into course educational practice,and the diseases that scattered throughout the whole textbook and listed in various chapters or sections are reclassified according to its pathological features.Thus the organic connection of related knowledge points and the lateral contrast network between different diseases is constructed by the central tache of dermatopathology,and therefore makes the course more logical and be more beneficial for the undergraduate students to learn and to remember.By the way,the thinking method of pattern analysis will also be an implicit teaching content and imperceptibly instilled to the undergraduate students,and inspired potential and motivation and aroused learning interest,expanded thought train ability to pursue advanced and further studies.

Objective:To study the intestinal flora specific differences with different lesional stages of metabolic (disorder) associated fatty liver disease (MAFLD), namely simple steatosis and steatohepatitis, so as to provide a new direction for MAFLD-related intestinal flora transplantation and targeted therapy.Methods:Mice were fed with normal diet, methionine-choline deficient diet (MCD) and a high-fat high-fructose diet (HFHF) for 12 weeks to construct simple steatosis and steatohepatitis models. HE and Sirius scarlet staining was performed to observe the liver pathological changes. The qPCR method was used to evaluate inflammation and liver fibrosis factors. A fully automatic biochemical analyzer was used to detect changes in liver transaminase and blood lipids. 16S rRNA sequencing method was used to observe the intestinal flora differences in the feces of each group of mice. The comparison of means between two groups was performed by t-test, and the comparison of means between multiple groups was performed by one-way analysis of variance. Kruskal-Wallis rank sum test was used for non-normally distributed data.Results:NAFLD scores were determined with pathological sections (HE and Sirius scarlet staining) of mice liver, which showed that the inflammation and liver fibrosis scores of the MCD and HFHF groups were 2.12 ± 0.18 and 1.06 ± 0.24, and 2.22 ± 0.16 and 0.46 ± 0.10, respectively. The degree of liver inflammation and fibrosis was significantly higher in the MCD than the HFHF group ( P < 0.001 and P < 0.01). Lipid deposition was higher in the HFHF than the MCD group ( P < 0.001), and the scores were 2.36 ± 0.17 and 1.60 ± 0.24 respectively. Simultaneously, the inflammatory [tumor necrosis factor-A (TNF-a), chemokine factor-2 (CXCL-2)] and hepatic fibrosis indicators [vascular smooth muscle actin alpha (a-SMA) and connective tissue growth factor (CTGF)] had confirmed the above-mentioned results at the transcription level. Moreover, the intestinal flora diversity was reduced ( P < 0.05) in the MCD group than the HFHF group, and the Simpson and Shannon index were 0.31 ± 0.10 and 0.42 ± 0.05, and 2.03 ± 0.33 and 1.70 ± 0.28, respectively, and the differences were significant between different intestinal flora groups. The levels of Desulfovibrio, Odoribacter, and Roseburia flora were significantly increased in the HFHF than the MCD group, and the levels of Faecalibaculum, Parasutterella, Alipis, Butyricimonas_virosa, Turicibacter_sp, and Romboutsia_ilealis were significantly increased in the MCD than the HFHF group, and the difference was statistically significant ( P < 0.05). Conclusion:There are significant differences in intestinal flora diversity between simple steatosis and steatohepatitis models. Therefore, clarifying the difference between the two may provide a new direction for the stage manner treatment of MAFLD.

ObjectiveTo develop a scale for assessment of communication functions in children's daily life. MethodsBased on the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) communication function-related categories, test items applicable to children's communication function were developed through a structured interview method and linguistic analysis. Delphi method was used to evaluate and select the items. The items were tested by item analysis and exploratory factor analysis to construct the scale structure. The internal consistency reliability, split-half reliability, structural validity, and criterion-related validity of the scales were tested by 168 children through internet. ResultsA children's communication function scale consisting of 42 items was developed, involving four subtests, including preverbal communication (8 items), simple oral communication (5 items), comprehensive oral communication (20 items), and pictorial symbolic communication (9 items). The scale was tested with moderately difficult and high discrimination (0.328 to 0.936). The scale had good internal consistency reliability (0.897 to 0.979) and split-half reliability (0.851 to 0.952), as well as structural validity (r = 0.536 to 0.836). The total scale score was correlated with the Peabody Picture Vocabulary Test-Revised validity scale (r = 0.787, P < 0.05). ConclusionThe ICF-CY-based scale of communication functions in children's daily life consisted of 42 items in four subtests. It has shown good consistency reliability, split half reliability, construct validity and criterion-related validity.