Objective To explore the association between serum neutrophil‐to‐lymphocyte ratio (NLR) and DR in T2DM patients . Methods A total of 128 T2DM patients were recruited and divided into three groups :PDR group (n=22) ,NPDR group(n= 44) ,and simple T2DM group(n=62) .The levels of FPG ,HbA1 c ,TC ,TG and NLR were measured in each group . Results Spearman correlation analysis revealed that DR was positively correlated with T 2DM duration ,SBP ,DBP ,FPG ,HbA1 c ,TC , TG ,LDL‐C ,NLR ,CKD (r= 0.524 ,0.277 ,0.279 ,0.194 ,0.271 ,0.208 ,0.223 ,0.358 ,0.621 , 0.362 ,P<0 .05 or P<0 .01) .Logistic multiple regression analysis showed that ,T2DM duration ,NLR and CKD were independent risk factors for DR . Conclusion NLR level is associated with DR .

Objective To investigate the role of macrophage migration inhibitory factor (MIF) gene polymorphisms in adult onset Still's disease(AOSD).Methods Plasma MIF levels were measured by enzymelinked immunosorbent assay (ELISA).Genomic DNAs were collected from patients and controls.The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay and short tandem repeat genotyping were used to detect the polymorphisms of MIF gene promoter.The -173 G/C SNP and -794 CATT repeat genotype and allele frequencies between patients and controls were capared using pearson's Chi-square test.The non-parmetric Mann-Whithey U test was conducted to compare MIF expressin between cases and controls.Results Plasma MIF levels were significantly higher in AOSD (119±113) ng/ml than those in controls (55±29) ng/ml (P＜0.01).Individuals with -173 * C allele (OR=1.776; 95％CI 1.101-2.864; P=0.017) or -794 *5-CATT allele (OR=1.81;95％CI 1.27-2.58; P=0.001) were at increased risk for AOSD.Conclusion The MIF gene polymorphisms are associated with AOSD.

OBJECTIVE:To observe therapeutic efficacy of adjuvant treatment of Xuebijing injection for severe acute pancreati-tis. METHODS:80 cases of severe acute pancreatitis were randomly divided into control group and observation group with 40 cas-es in each group. Control group was given symptomatic and supportive treatment,and observation group was additionally given in-travenous injection of Xuebijing injection 100 ml,twice a day,on the basis of control group. The levels of TNF-α,IL-6 and hs-CRP,organ failure were compared between 2 groups before and after treatment. RESULTS:There was no statistical significance in the levels of TNF-α,IL-6 and hs-CRP in 2 groups before treatment(P>0.05);after treatment,the levels of TNF-α,IL-6 and hs-CRP in observation group was significantly lower than control group and before treatment,with statistical significance (P<0.05). The proportion of renal function,respiration function and circulating failure in observation group were significantly lower than in control group,with statistical significance (P<0.05). CONCLUSIONS:Adjuvant treatment of Xuebijing injection for se-vere acute pancreatitis can significantly reduce the level of inflammation in the body and reduce organ damage.

Objective To evaluate the endoscopic precut sphincterotomy for malignant biliary obstruction. Methods Endoscopic precut sphincterotomy was performed in different ways for 46 patients with malignant biliary obstruction and difficult biliary cannulation according to the anatomic structure of the papilla and cannulation. Ways of precut were summarized and complications were analyzed. Results Precut sphincterotomy was performed with bow-like knife in 4 patients, with needle-knife in 24, with trans-pancreatic sphincterotomy in 12 and with combined ways in 6. The procedure succeeded in 35 cases (76. 1%, 35/46). Post-procedure complications included bleeding in 3 patients, pancreatitis in 1, hyper-amylasemia in 2and cholangitis in 1. No perforation was found. Conclusion Endoscopic precut sphincterotomy is not only able to improve the therapeutic endoscopy achievement rate in patients with malignant biliary obstruction, but also to lower the incidence of complications if used adequately.

Objective To investigate the distribution and antimicrobial resistance of clinical bacterial strains isolated from the cervical secretions of parturient women .Methods A total of 239 bacterial strains were isolated from 1 519 cervical specimens of parturient women .These strains were identified and tested by Kirby‐Bauer method for their susceptibility to antimicrobial agents .Results Escherichia coli was the most frequently isolated bacteria ,accounting for 34 .3% .The bacterial strains were more or less resistant to commonly used antimicrobial agents .Conclusions Various bacterial species are identified in the cervical secretions of parturient women ,primarily Escherichia coli and Staphylococcus aureus .Bacterial culture and antimicrobial susceptibility testing are important for clinicians to take appropriate measures to reduce the incidence of mother‐to‐child infections .

Objective To explore the application value of the guide-wire for selective biliary cannulation of proximal biliary obstruction.Methods A total of 344 patients with proximal biliary obstruction were treated by endosocopic retrograde cholangio-pancreatography.Various guide-wire skills,were applied to pass through the stricture of bile duct,so as to reach the target bile duct,and analyzed for their therapeutic effects.Results Selective biliary cannulation of proximal biliary obstruction was completed in 336 patients,after successful cholangiography for therapeutic operation.The overall success rate was 97.67％.There was no procedure-related complications,such as hemobilia or perforation.Conclusion The guide-wire for selective biliary cannulation of proximal biliary obstruction not only improves the success rate of therapeutic endoscopy but also reduces the procedure time and the incidence of complications.

Objective To evaluate efficacy and safety of Iodine-125 seeds used in brachytherapy for cholangiocarcinoma.Methods A total of 65 cases of cholangiocarcinoma patients were diagnosed and treated with ERCP.The Iodine-125 seeds were implanted into bile duct cavity by self-made carrier (applicator) in various ways, and Iodine-125 seeds were replaced to improve the local irradiation dose.Follow-up was regularly made through endoscopy and ultrasonography to evaluate feasibility, efficacy and complications.Results Self-expanding metal stents, single or double plastic stents were successfully placed in 65 patients.At first , single row of Iodine-125 seeds were inserted to 59 patients, double row Iodine-125 were inserted to 6 patients , and the average activity of the first irradiation was 5.775 mCi.Iodine-125 were replaced in 4 patients after three months, in 41 patients after six months, in 5 patients after one year.The total dose was up to 14 mCi.In the follow-up of 6-35 months, the longest survival time was 35 months in two patients, where the Iodine-125 seeds were replaced 3 times as a whole and there was no serious complications.Conclusion Iodine-125 brachytherapy on cholangiocarcinoma by ERCP, where biliary stents and Iodine-125 seeds can be replaced at any time , is convenient, less invasive and can obviously prolong survival time.

Objective Objective To analysis the clinical curative effect on elderly patients with choledocholithiasis by endoscopic retro-grade cholangiopancreatography ( ERCP) and endoscopic sphincterotomy ( EST) and discuss its clinical significance. Methods 256 patients with choledocholithiasis were collected for diagnosis and treatment by ERCP. The stone characteristics was mastered by ERCP and the pa-tients were treated with EST. Results Patients with choledocholithiasis were successful in 249 cases (97. 27%) for ERCP intubation and 239 cases (93. 36%) for stone remove. After EST,the stones were removed successfully at one time in 199 cases (83. 26%),2 times in 40 cases (16. 74%). 7 patients (2. 73%) with multiple diverticulum and papillary position poor by intubation failure were changed over to op-eration treatment. After ERCP,patients were performed endoscopic nasobiliary drainage (ENBD) 64. 44% (154/239). Pull out the drain-age tube of 90. 91% (140/154) of the patients after stones disappeared which was proved by angiography for 3~5 days. 14 cases (9. 09%) were performed second times to remove the stones due to the presence of residual stones. Postoperative complications occured in 15 cases (6. 02%) including 9 cases of acute pancreatitis and 6 cases of infection of biliary tract, and they were cured after 1 week of corresponding treatment. Transient increase of serum amylase occurred in 39 cases, and all of them recoveried after 3 days without special treatment. Con-clusion The results showed that ERCP ( or EST) were well tolerated by elderly patients with choledocholithiasis,and they were of obvious curative effect and quick recovery,which is worthy of promotion and application.

Objective:To systematically evaluate the effectiveness and safety of intra-articular in-jection of mesenchymal stem cells (MSCs) and hyaluronic acid (HA) in the treatment of knee osteoarthritis.Methods:The relevant literatures published in both English and Chinese were systematically searched in PubMed, Embase, Wanfang database, China Knowledge Network (CNKI), SinoMed database and other data-bases from inception to May 2020. Two researchers independently extracted data and evaluated the included literature. Risk assessment of literature bias was carried out. RevMan 5.3 software was used for Meta analysis, and the combined sensitivity were calculated.Results:Finally, 13 references were included, including a total of 726 patients with knee osteoarthritis. Meta-analysis results showed that compared with the HA group, the Western Ontario and McMaster University Osteopathic Index Total Score (WOMAC) [ MD=-10.92, 95% CI (-16.87, -4.96), P<0.01], the visual analogue scale (VAS) score [ MD=-1.70, 95% CI(-2.44, -0.95), P<0.01], and the knee joint Lequesne index score of MSCs group all decreased significantly [ MD=-13.78, 95% CI (-15.03,-12.52), P<0.01]. Furthermore, there was no significant difference in the incidence of adverse events (AEs) between the two groups [ RR=1.11, 95% CI(0.90, 1.37), P=0.33]. However, American Knee Association Score (AKS score) [ MD=-10.15, 95% CI(-22.33, 2.03), P=0.10] and whole-organ magnetic resonance imaging score (WORMS) [ MD=-3.93, 95% CI(-11.60, 3.75), P=0.32] were not statistically significant ( P>0.05). Conclusion:Compared with intra-articular injection of HA, intra-articular injection of MSCs can significantly improve the symptoms and dysfunction, and has favorable clinical tolerability and safety, suggesting that MSCs is expected to bea new treatment for knee osteoarthritis.

Objective To investigate the preventive effect of Indomethacin for post-ERCP pancreatitis and hyperamylasemia.Methods A total of 600 patients,who were undergoing ERCP,were randomly divided into 3 groups to receive anal Indomethacin (n=200),intravenous octreotide (n=200) or no special medication (n=200) before ERCP.The level of serum amylase before and 24h after ERCP were measured,and the rate of acute pancreatitis and hyperamylasemia after ERCP were assessed.Results Serum amylase levels before ERCP of all groups were normal.The mean serum amylase level of Indomethacin group (101.3±77.7 U/L) after ERCP was significantly lower than those of octreotide group ( 176.6±138.3 U/L,P =0.040 ]and control group (227.2±264.9 U/L,P=0.048),while there was no difference between octreotide group and control group ( P＞0.05 ).The incidence of post-ERCP pancreatitis in Indomethacin group (2.5％) was significantly lower than that of control group (9.5％,P=0.003),while there was no difference between octreotide group (4.5％) and control group ( P=0.05 ).The incidence of hyperamylasemia after ERCP in Indomethacin group (5.5％) was significantly lower than that of control group ( 13.5％,P=0.006 ),while there was no difference between octreotide group (10.0％) and control group ( P＞0.05 ).Conctusion Anal administration of Indomethacin before ERCP can effectively reduce the incidence of acute pancreatitis and hyperamylasemia after ERCP.