Objective To assess the accuracy of contrast-enhanced EUS in differential diagnosis of benign and malignant pancreatic masses.Methods We systematically searched the Medline,PubMed,Web of Science,Embase,Cochrane Central Trials,CNKI and VIP databases for relevant studies published.Study selection,quality assessment and data extraction were performed by two reviewers independently.Meta-Disc (version 1.4) software was used to perform this meta-analysis for sensitivity,specificity,positive likelihood ratio (LR),and negative LR.Pooling results were derived by using the fixed-effect model when significant heterogeneity was not present.The random-effect model was applied otherwise.A summary receiver-operating characteristic (SROC) curve was constructed.Furthermore,to explore the potential sources of heterogeneity,we used meta-regression to estimate the effect of the following characteristics of the studies on the diagnostic accuracy of contrast-enhanced EUS.In addition,the outliers were identified with the method described by Deville and a subgroup analysis was performed by excluding the outliers.We used Stata statistical software (version 10.0) to assess the publication bias with the Begg-Mazumdar indictor and Harbord-Egger indictor.Results Twelve studies involving 1139 patients were included.The pooled sensitivity of contrast-enhanced EUS for the differential diagnosis of pancreatic masses was 94％ (95％ CI,0.91 ～0.95),the specificity was 89％ (95 ％ CI,0.85 ～ 0.92),the positive LR was 8.09 (95 ％ CI,4.47 ～ 14.64),and the negative LR was 0.08 (95％ CI,0.06 ～ 0.10).The area under the curve (AUC) under SROC was 0.9732 (SE =0.02).The subgroup analysis by excluding two outliers provided a sensitivity of 93％ (95％ CI,0.91 ～ 0.95) and a specificity of 93％ (95％ CI,0.89 ～ 0.95).Additionally,the subgroup analysis showed that the heterogeneities were eliminated in pooled estimates when the outliers were excluded and the AUC under SROC was 0.9745 (SE =0.02).Moreover,no significant publication bias was found with the Begg-Mazumdar indictor (P =0.244) or the Harbord-Egger indictor (P =0.442).Conclusion Contrastenhanced EUS is a valuable method in the differential diagnosis of pancreatic masses.

Objective To evaluate the feasibility of 80 kV tube kilovoltage in aortic artery CT angiography with 256-slice CT. Methods A total of 62 patients undergoing aortic artery CTA were enrolled into this study and divided into conventional tube kilovoltage (120 kV, n = 31 ) and low tube kilovoltage (80 kV, n = 31 ). The signal-to-noise ratio (SNR) , contrast-to-noise ratio (CNR), volume CT dose index (CTDIvol) and effective dose (E) were evaluated, respectively. Results The mean image SNR was ( 35.92 ± 5.04) and ( 33.95 ± 8. 30) for conventional tube kilovoltage and low tube kilovoltage,respectively, with no significant difference (t = 1. 131, P =0. 263). The mean image CNR was (30. 32 ±4.78) and (28.71 ± 7.96 ) for conventional tube kilovoltage and low tube kilovoltage, respectively, with no significant difference ( t = 0. 964, P = 0. 339 ). The average effective dose ( E ) was ( 14. 28 ± 0.96 )mSv and (9. 72± 0. 81 )mSv for conventional tube kilovoltage and low tube kilovoltage, respectively, with significant difference ( t = 20. 12, P ＜ 0. 001 ). Conclusions 80 kV tube kilovoltage aortic artery CTA can reduce radiation dose by 31.9% , and contrast dose 50% ,and maintain image quality compared with 120 kV tube kilovoltage.

OBJECTIVE:To establish a method for the simultaneous determination of tobramycin and dexamethasone in Tobra-mycin and dexamethasone eye drop. METHODS:HPLC-column derivatization-double wavelength method was performed on the col-umn of Agilent C18 with mobile phase of 0.25% 3-hydroxymethyl aminomethane-acetonitrile-0.5 mol/L sulfuric acid(40:59:1,V/V/V)at flow rate of 1.0 ml/min,detection wavelength was 365 nm and 220 nm,column temperature was 30 ℃,and the volume in-jection was 20 μl. RESULTS:The linear range was 18.01-180.09 μg/ml for tobramycin(r=0.999 5)and 6.02-60.24 μg/ml for dexa-methasone(r=0.999 8);RSDs of precision,stability and reproducibility tests were lower than 1%;recoveries were 98.65%-100.01%(RSD=0.47%,n=9)and 98.92%-100.20%(RSD=0.50%,n=9),respectively. CONCLUSIONS:The method is simple,time-sav-ing,specific,reproducible,accurate and reliable,and can be used for the quality control of Tobramycin and dexamethasone eye drop.

OBJECTIVE To investigate the protective effect of total alkaloids of Rhizoma Corydalis (TARC) on experimental gastric mucosal lesions in rats. METHODS Gastric mucosal lesions were induced in rats by injecting acetic acid under gastric mucosal. From the 2nd day post the preparation of the rat model, cimetidine 400 mg · kg-1 or TARC 20, 40 and 80 mg · kg-1 was ig delivered for 15 d in different groups. Two days after the last delivery, gastric juice volume and total acidity were measured. Histopathology of stomach tissues was observed by HE staining. The area of gastric ulcer area was measured and the ulcer index and ulcer inhibitory rate were calculated. The expression of epidermal growth factor (EGF) and EGF receptor (EGFR) was detected by immunohistochemical staining. RESULTS Comparing with shame group, the eare of gastric ulcer and ulcer index were increased signifi?cantly in the model group(P<0.01), suggesting that the model rats were prepared properly. Compared with the model group, the ulcer area in rats of cimetidine and TARC 80 mg·kg-1 groups was decreased by 39.9%and 23.7%,respectively. The ulcer index was decreased by 52.3%and 30.5%,respectively. There was no significant difference between the cimetidine group and TARC 80 mg · kg-1 group, in the ulcer area or index. Compared with model group, EGF protein expression of cimetidine and TARC 40 and 80 mg · kg-1 groups was increased by 81.8%,24.2%and 57.6%,respectively while EGFR protein expression was increased by 45.9%,16.2%and 29.7%,respectively(P<0.05,P<0.01). Deciduous and necrotic gastric mucosal and a large amount of inflmmatory cells infiltration were observed in model group, and gastric mucosal lesions were improved in cimetidine and TARC 40 and 80 mg · kg-1 groups. CONCLUSION TARC has protective effect on gastric mucosal lesions in rats. The mechanism may be related to the increase of EGF and EGFR protein expression.

Objective To evaluate the feasibility of automatic tube current modulation(ATCM) in craniocervical artery CT angiography with 256-slice CT,while maintaining the image quality.Methods Sixty patients undergoing craniocervical artery CTA were enrolled into this study,and were divided into conventional tube current group(250 mAs,group A,n=30) and low tube current group(ATCM,group B,n=30).The signal-to-noise ratio(SNR),contrast-to noise ratio(CNR),volume CT dose index(CTDIvol) and effective dose(ED) were evaluated respectively.Results The mean image SNR was(37.47?9.39) and(36.85?7.96) for group A and group B respectively,and was not significantly different(P=0.79).The mean image CNR was(32.13?9.06) and(31.86?7.66) for group A and group B respectively,and was not significantly different(P=0.90).The CT volume dose index(CTDI) was 16.5 mGy and 410.55?0.94mGy for group A and group B respectively,and was significantly different(P

BACKGROUND: Studies have shown that Sonic Hedgehog (Shh) is expressed in mouse Notochordal cells, and India Hedgehog (Ihh) is mainly expressed in chondrocyte-like cells and end plates of mouse embryonic vertebral bodies. However, the expression of Shh and Ihh during the formation of intervertebral discs in mouse embryo is unclear. OBJECTIVE: To investigate the expression of Shh and Ihh during the formation of intervertebral discs in mouse embryo. METHODS: Male Shh-CreERT2, R26-mTmG/+ mice mated with female R26-mTmG/+ mice to obtain pregnant rats at different periods of pregnancy (E8.5, E11.5, E12.5, E14.5, E16.5, E18.5), followed by injection of 10 g/L tamoxifen at a dose of 10 μL/g. Intervertebral disc tissues were isolated from the mouse embryo at P0, followed by genotype identification. At the same time, male C57BL/6 mice mated with female C57BL/6 mice to obtain pregnant rats at different periods of pregnancy (E11.5, E12.5, E14.5, E16.5, E18.5), and the intervertebral disc tissues of mouse embryo were taken and analyzed. The expression of Shh and Ihh during the formation of intervertebral discs in mouse embryo was detected using immunofluorescence and immunohistochemistry, respectively. Implementation of animal experiments was approved by the Animal Ethics Committee of Soochow University. RESULTS AND CONCLUSION: Shh-CreERT2; R26-mTmG/+ mouse embryos were identified by PCR amplification. The results of immunofluorescent staining showed a gradual decrease in the expression of Shh in nucleus pulposus cells during the formation of intervertebral discs in mouse embryo. The results of immunohistochemical staining showed a gradual increase in expression of Ihh in nucleus pulposus cells during the formation of intervertebral discs in mouse embryo. In summary, Shh and Ihh are dynamically expressed during the formation of intervertebral discs in mouse embryo, and provide a basis for further research on the molecular mechanism of intervertebral disc degeneration.

ObjectiveTo retrospectively analyze clinical data of patients who has left-side valvular disease combined with severe tricuspid regurgitation and evaluate the effect of our modified tricuspid annuloplasty with enforcement of artificial felt strip.Methods76 patients who had left-side valvular disease combined with severe tricuspid regurgitation received operations between Jan.2008 and Jun.2010.The average age of the patients was 53.5 years old (32 male and 44 female).Besides the severe tricuspid regurgitation, other combined cardiac impairments included mitral valvar disease (52 cases), aortic valvar disease(5 cases), double valvar disease(19 cases) and left atrial thrombosis(22 cases).6 patients had grade II cardiac function according to the NYHA criteria, while 47 and 23 were in grade III and IV, respectively.Other signs included cyanosis(5cases), jaundice(11 cases), neck vein engorgement(48 cases) , ascites(22 cases), hepatomegaly(41 cases) and pitting edema in the lower limbs(68 cases).The concomitant operative procedures included mitral valve replacement in 52 patients,aortic valve replacement in 5 patients, double valve replacement in 19 patients, removal of left atrial thrombus in 22 patients,left atrium folding in 21 patients and left atrium appendage suture in 68 patients.Left-sided valve disease were corrected first,TAP was performed on the beating heart after the heart had been defibrillated.The anteroseptal commissure was plicated first.A double-armed 3-0 pledgeted suture was taken through the base of the septal leaflet, 5-6 mm from the commissure, extending along the annulus, and out from the point in the anterior annulus 10-12 mm from the anteroseptal commissure.Both ends of the suture was tied until the two Teflon pledgets approximated each other near the commissure.Then a semicircular De Vega type of plicating with a 3-0 prolene was taken, starting just from the anterior annulus near the anteroposterior commissure, and extending clockwise to a point just cephalad to the posteroseptal commissure.The suture was tied with positioning a 27-29 mm valve siser across the tricuspid valve.At last, a 3-5 mm width felt strip was prepared and was sutured to the plicated posterior annulus region with interrupted mattress sutures of 2 to 3 2-0 prolene.A favorable result was considered when TR was not marked by saline injection.Echocardiography was routinely examined one week postoperatively and patients were followed up 6 month after discharge.ResultsThere is no death in all patients.The CVP diminished significantly from 16mmHg preoperatively to 8mmHg postoperatively (P = 0.0021).The systomic pulmonary pressure diminished from 59 mmHg preoperatively to 41 mmHg postoperatively (P = 0.038).Echo one week postoperative showed no tricuspid regurgitation in 56 patients and mild in 18 patients, while 2 had moderate tricuspid regurgitation.The diameter of right atrium diminished significantly postoperatively, too.The ejection fraction was improved even though there was not significant difference as compared with preoperative data.The cardiac function of all patients improved and the signs of right heart failure were alleviated or disappeared.Follow up 1 to 36 months showed no change of the regurgitation except for one become moderate from mild when discharged.No hepatic congestion or edema was observed in all patients.ConclusionThese new modifications make the technique more selective in the remodeling of the tricuspid annulus.It could achieve better coaptation of the anterior leaflet with the others, successful annular reduction, better maintenance of the contractile property of the tricuspid ring, better distribution of pursing force in the more dilated region.It could prevent the tear of the endocardium in the posteroseptal region in the long period of time postoperatively.

OBJECTIVE Toexploretheantidepressanteffectsofalbiflorinandtheinvolvementof hypothalamic-pituitary-adrenocortical (HPA) axis function in its antidepressant potency.METHODS Two weeks after the olfactory bulbectomized (OB)surgery,albiflorin (2.5 ,5.0 ,10.0 mg·kg -1 ,ig) and imipramine 5.0 mg·kg -1 (ig)were given to rats twice a day for 14 d.The open-field test was con-ducted to evaluate the move ment distance,move ment ti me and velocity of olfactory bulbecto mized rats and sham-operated rats.The serum levels of corticosterone(CORT)and adrenocorticotropic hormone (ACTH)in rats were measured by the enzyme linked immunosorbent assay.The expression levels of glucocorticoids receptor (GR)in the hippocampus of the rats were analyzed using Western blot proce-dures.RESULTS Comparedwithsham-operatedrats,movementdistance,movementtimeandveloci-ty of the OB rats were significantly increased (P<0.01 ).Albiflorin 1 0.0 mg·kg -1 significantly reduced the movement distance,movement time and velocity of OB rats (P<0.05)after being given for 7 d. The movement properties were significantly reduced by albiflorin 5.0 and 10.0 mg·kg -1 when given for 14 d (P<0.05).The OB rats demonstrated significantly increased levels of serum CORT and ACTH (P<0.01 )and decreased GR expression in the hippocampus (P<0.01 ).Albiflorin 2.5,5.0 and 10.0 mg·kg -1 significantly reduced the serum CORT and ACTH levels (P<0.05),while albiflorin 5.0 and10.0mg·kg-1increasedtheexpressionofhippocampalGR(P<0.05).CONCLUSION Albiflorin may have re markable behavioral antidepressant effects on olfactory rats and one of the related mecha-nis ms may be its regulation of the hyperactivity of HPA axis function.

Objective To investigate the effects of β1-adrenergic receptor autoantibodies (β1-AA) on the proliferation of different subtypes of T lymphocytes in patients with heart failure .Methods β1-AA-positive IgG antibodies isolated from patients with heart failure were purified by using affinity chromatog -raphy.CD3 +CD4 +T and CD3 +CD8 +T lymphocytes were sorted by flow cytometry analysis .The prolifera-tion of different subtypes of T lymphocytes was tested by using CCK-8 kit.Tests for lactate dehydrogenase ( LDH) level and cell apoptosis were performed to evaluate T lymphocytes damage .Results The prolifera-tion of activated lymphocytes was inhibited by β1-AA isolated from the serum of patients with heart failure in a concentration dependent manner , but it could be blocked by β1 receptor blocker .The damage of lympho-cytes induced by β1-AA was increased.Moreover, β1-AA promoted the necrosis and apoptosis of CD 3 +CD4 +T and CD3 +CD8 +T lymphocytes and thus inhibited the proliferation of them .Conclusion β1-AA isolated from the serum of patients with heart failure inhibited the proliferation of CD 3 +CD4 +T and CD3 +CD8 +T lymphocytes through increasing the necrosis and apoptosis of them .This study suggests that β1-AA might induce immune disorders in addition to causing pathological changes in heart tissues .

Objective To investigate the diagnostic value of texture analysis derived from conventional MR imaging in differentiating benign and malignant breast lesions. Methods Thirty-six patients with malignant breast lesion and 33 patients with benign breast lesion were retrospectively analyzed in our study. All patients underwent conventional MR imaging including axial T1WI, T2WI, and contrast-enhanced T1WI before surgery. Texture features were calculated from manually drawn ROIs by using MaZda software. The feature selection methods included mutual information (MI), Fishers coefficient, classification error probability combined with average correlation coefficients (POE + ACC) and the combination of the above three methods(FPM). These methods were used to identify the most significant texture features in discriminating benign breast lesion from malignant breast lesion. The statistical methods including raw data analysis (RDA), principal component analysis (PCA), linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA) were used to distinguish malignant breast lesion from benign breast lesion. The results were shown by misclassification rate. Results In the three kinds of sequences, the texture features for differentiating malignant breast lesion and benign breast lesion were mainly from T2WI which had the lowest misclassification rate 4.35%(3/69). The misclassification rates of the feature selection methods were similar in MI, Fisher coefficient and POE+ACC (15.94%to 56.52%for MI;17.39%to 56.52%for Fisher coefficient and 17.39%to 56.52%for POE+ACC). However, the misclassification rate of the combination of the three methods (4.35%to 53.62%for FPM) was lower than that of any other kind of method. In the statistical methods, NDA (4.35% to 27.54%) had lower misclassification rate than RDA (33.33% to 56.52%), PCA (33.33% to 53.62%) and LDA (15.94% to 44.93%). Conclusion Texture analysis of conventional MR imaging can provide reliably objective basis for differentiating benign from malignant breast lesions.