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 review the clinical features of chronic daily headache (CDH).Methods The clinical data of 128 patients with chronic daily headache,including general condition,characteristics of headache,concomitant symptom and disability were analyzed retrospectively.The features of primary chronic daily headache (PCDH) and medication over-dose headache (MOH) were compared.Results Among 128 cases females accounted for 79.7％ with an average age of 45.2 years and 88 patients were associated with drug overdose.The symptoms included nausea (68/128),photophobia (75/128),phonophobia (102/ 128),depression (77/128) and irritability (93/128),sleep disorders (94/128),dizziness (75/128),emotional irritability(58/128) and depression(21/128).The migraine disability assessment questionnaire and headache impact test-6 scores showed that disability was resulted from the severe degree of headache in 62.2％ (51/82) and 73.2％ (82/112) of CDH patients respectively.Compared with PCDH patients,the MOH patients had older age (t =2.59,P =0.011),longer duration (t =2.48,P =0.015) and severer degree of headache(t =5.58,P =0.018),and chronic migraine (t =11.95.P =0.001) was the most common primary headache type.Conclusions Most CDH patients are middle-aged women,with moderate to severe pain,usually complicated with depression,dysphoria and asomnia.Chronic daily headache patients are commonly associated with drug overdose.

Objective: To investigate the willingness to pay integrated medical and elderly care services and identify the influencing factors among the elderly in Hohhot City, Inner Mongolia, so as to provide insights into promoting integrated medical and elderly care services. Methods: The elderly at ages of 60 years and older were sampled using a convenient sampling method from public venues in four districts of Huimin, Saihan, Yuquan and Xincheng in Hohhot City from June to December 2021. Basic characteristics, health and disease burdens, social support and willingness to pay integrated medical and elderly care services were collected, and factors affecting the willingness to pay integrated medical and elderly care services were identified among the elderly using a multiple linear regression model. Results: A total of 1 008 valid questionnaires were recovered, with an effective recovery rate of 96.74%. The respondents included 519 men (51.49%) and 489 women (48.51%), and had a mean age of (69.47±6.42) years. The monthly average fees of willingness to pay integrated medical and elderly care services were (2 076.49±36.79) Yuan, and there were 636 participants with 2 000 Yuan and less monthly average fees of willingness to pay integrated medical and elderly care services (63.10%). Multiple linear regression analysis showed that place of residence (β=180.832), satisfaction with housing (satisfied, β=-140.760), physical self-care ability (completely self-care: β=-238.244; mostly self-care: β=-254.557), burdens of disease diagnosis and treatment (able to afford: β=452.488; partly afford: β=228.626), monthly income (β=347.144), expenses of medications (β=0.019) and total score of social support (β=17.116) were factors affecting the willingness to pay integrated medical and elderly care services among the elderly. Conclusions The willingness to pay integrated medical and elderly care services among the elderly in Hohhot City is associated with place of residence, monthly income, satisfaction with housing, physical self-care ability, burden of disease diagnosis and treatment, expenses of medications and social support.

To study the level of macrophage migration inhibitory factor (MIF) in serum and the expression of MIF mRNA in abdominal subcutaneous adipose tissue,and to investigate its impact on insulin resistance and islet β-cell dysfunction in gestational diabetes mellitus (GDM).120 pregnancy women from the Affiliated Hospital of Qingdao University Medical College and Taian Central Hospital were enrolled,including 60 GDM women and 60 women with normal glucose tolerance (NGT).The serum MIF in GDM group was higher than that of NGT group [(3.58±1.02 vs 1.23±0.62) ng/ml,P<0.01].Multiple stepwise regression analysis showed that body mass index was an independent affective factor of the serum levels of MIF (r2 =0.516).The serum levels of MIF and the expressions of MIF mRNA in abdominal subcutaneous adipose tissue were significantly higher in GDM group than NGT group.MIF may contribute to insulin resistance and β-cell dysfunction in GDM.Body mass index seems to be an independent factor in affecting the serum levels of MIF.

Objective To investigate the renoprotective effects of autologous transplantation of adipose-derived mesenchymal stem cells (ADMSCs) in diabetic rats. Methods Sprague-Dawley (SD) rats were injected intraperitoneally with 40 mg/kg streptozotocin (STZ) for 5 consecutive days to induce type 1 diabetes. Four weeks following STZ injection, eighteen SD rats were randomized into two groups: the diabetic group (n = 9) and the ADMSCs group (n = 9). Normal nondiaetic rats were set as the normal control (n = 9). Autologous ADMSCs were cultured and identified in vitro , which were intravenously injection to the ADMSCs group rats via the tail vein. At 8 weeks after transplantation, levels of blood glucose, insulin, serum urea nitrogen, serumcreatinine and urine protein were measured. Meanwhile the body weight and kidney weight were examined. Results Mesenchymal cell surface markers were expressed in the cultured ADMSCs. The ADMSCs could differentiate into the adipogenic and osteoblastic lineages. Both the diabetic group and the ADMSCs group rats had higher levels of blood glucose , urea nitrogen , serum creatinine , urine protein and higher ratio of the kidney weight/body weight than those in the normal control group (P < 0.05, respectively). Blood glucose, urea nitrogen and the ratio of kidney weight/body weight in the ADMSCs group rats were significantly decreased compared with the diabetic group (P < 0.05, respectively). The decreased insulin level was attenuated after transplantation of ADMSCs (P < 0.05). Besides, levels of serum creatinine and urine protein in the ADMSCs group were lower than those in the diabetic group with no significant difference. Conclusion Autologous transplantation of ADMSCs can improve metabolic disorder and relieves diabetic renal damage.

Objective There is no enzyme multiplied immunoassay technique ( EMIT) reagent for therapeutic drug monito-ring ( TDM) in our country.The aim of this study was to compare the properties of self-developed kits and commercially imported kits in TDM, and to evaluate their feasibilities for routine TDM. Methods The sensitivities, accuracies and precisions of self-developed kits, Viva-E kit and AXSYM kits were evaluated by determining the quality control samples of carbamazepine, valproic acid and phe-nobarbital.Self-developed kits, Viva-E kit and AXSYM kits were employed to determine the concentrations of clinical serum samples of 83 cases of carbamazepine, 80 cases of valproic acid and 72 cases of phenobarbital separately, and the results were compared and analyzed. Results Recoveries of carbamazepine, valproic acid and phenobarbital were more than 90% for the three different kits. The recoveries of self-developed kits for the three drugs were in the range of 98.7%-103.9% and the limits of quantification of the self-developed kits for carbamazepine, valproic acid and phenobarbital were 2, 10, 5μg/mL, respectively.Precision was lower than 10%and its average relative deviation was less than 3%after single point correction.There were good correlations (R2>0.985) and no significant statistical difference between self-developed kits and AXSYM kits (P>0.05).Upper and lower 95%limits of agreement in Bland-Altman plots were (-1.32,1.26), (-15.24,15.17) and ( -3.69,3.00) for carbamazepine, valproic acid and phenobar-bital, respectively.About 5%of the points failed in the 95%confidence interval. Conclusion The self-developed kits showed good performance and are suitable for clinical use in TDM.

A rapid and sensitive analytical method was developed for the simultaneous determination of fumonisins B1 and B2 in traditional Chinese medicines by HPLC-MS/MS. The detection limits for fumonisins B1 and B2 were 0.25 ng x mL(-1) corresponding to 2 microg x kg(-1) in samples. Recoveries from different samples spiked with fumonisins B1 and B2 at levels ranging from 0.2 to 3 mg x kg(-1) were 84.0%-96.1% and 86.3%-99.3%, respectively. Among the total of 34 samples purchased from local markets, ten samples of which were visibly moldy samples due to inappropriate storage, and 24 were normal samples. The results showed that 6 of the visibly moldy samples and 5 of the normal samples were contaminated with total fumonisins at levels ranging 82.4-2349 microg x kg(-1) and 102-729 microg x kg(-1), respectively.

Objective To determine the effect of ulinastatin on perioperative inflammatory response to coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods Forty patients undergoing CABG with CPB were randomly divided into 2 groups: a ulinastatin group (1.5×10~4 U/kg before CPB, n=20) and a control group (n=20). The inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-10 and neutrophil elastase (NE) were measured before the anesthesia (T1), 1 h after the start of CPB (T2), 1 h after weaning of CPB (T3), and 24 h after weaning of CPB (T4). The postoperative organ dysfunction in the 2 groups was noted.Results The concentration of TNF-α, IL-6, IL-10, and NE at T2,T3, and T4 and increased more significantly than that at T1 in the 2 groups(P<0.05). The concentration of TNF-α, IL-6 and NE at T2, T3, and T4 in the ulinastatin group decreased more significantly than that in the control group (P<0.05), and IL-10 in the ulinastatin group increased at the same time. The postoperative complications of pneumonia, kidney and central nervous system in the ulinastatin group decreased more significantly than that in the control group (P<0.05). There was no significant difference in the postoperative cardio or liver complications and hours in the ICU between the 2 groups.Conclusion Administration of ulinastatin before CPB can decrease the inflammatory response and complication during CABG.

OBJECTIVEThis study aimed to investigate the effects of different tooth preparations on the fracture strength and pattern of failure of teeth with severe wedge-shaped defect restored with post and core crowns.

METHODSAccording to whether the teeth above the wedge-shaped defect was removed (represented by B) or not (represented by A), the ferrule next to the wedge-shaped defect was prepared (represented by D) or not (represented by C), the cast post-and-core was chosen (represented by E) or glass-fiber post and resin core was chosen (represented by F). A total of 64 human mandibular premolar teeth were randomly divided into 8 groups: A1-1 (A + C + E), A1-2 (A + C + F), A2-1 (A + D + E), A2-2 (A + D + F), B1-1 (B + C + E), B1-2 (B + C + F), B2-1 (B + D + E), B2-2 (B + D + F), each group 8 teeth. All the teeth were prepared and restored accordingly and then mounted on an electronic pressure universal testing machine. The maximum fracture strength and the patterns of failure were recorded.

RESULTS1) The fracture strength of Group A1-1 > that of Group B1-1, Group A1-2 > Group B1-2, Group B2-1 > Group B1-1, and Group B2-1 > Group B2-2 with significant differences (P < 0.05). 2) The patterns of repairable fracture in Group A1-2 and B1-2 were both 37.5%, and that of the other groups were 0. Furthermore, the difference was significant, and Group A1-2 and B1-2 were higher than other groups.

CONCLUSIONThe maintenance of the overhang above the severe wedge-shaped defect aid in the improvement of the fracture strength of the tooth restored with post and core crown. The ferrule of the wedge-shaped defect is not recommended to be prepared. Furthermore, the glass-fiber post and resin core is favorable for the re-repair of the teeth than the cast post and core.

Objective To compare the duration of neuromuscular blockade in laparoscopic and open surgical approaches following a single bolus dose of rocuronium or cisatracurium.Methods One hundred female patients underwent either laparoscopic or open gynaecological surgery were randomly and equally divided into OR group (rocuronium administered in open surgery),OC group (cisatracurium administered in open surgery),LR group (rocuronium administered in laparoscopic surgery) and LC group (cisatracurium administered in laparoscopic surgery).Anaesthesia was induced with sufentanil of 0.5 μg/kg and propofol of 2 mg/kg,and neuromuscular blockade was induced with rocuronium of 0.9 mg/kg or cisatracurium of 0.15 mg/kg,intravenously.Then adductor pollicis trainof-four responses following ulnar nerve stimulation were monitored with mechanomyography.We recorded the duration of the first twitch (T1) occurrence after the injection of rocuronium or cisatracurium,and the duration from T1 recovered to 5 ％ and 25 ％ of baseline.Results The mean time from the end of injection of rocuronium until spontaneous recovery to T1,and to recovery to 5％and 25％ of baseline,was significantly prolonged in LR group [(44.8 ± 10.7) min,(52.8 ± 11.2) min and (62.6 ± 13.5) min] compared with OR group [(36.2 ± 4.0) min,(41.8 ± 6.8) min and (49.5 ±7.5) min] (P all＜0.05) On the other hand,there was no significant difference on the duration of neuromuscular blockade between LC group and OC group.Conclusions Neuromuscular blockade may be prolonged following a single bolus dose of rocuronium given during laparoscopic procedures,which should be on the alert,and assess neuromuscular function to ensure safe recovery.