Intrahepatic cholangiocarcinoma is an uncommon malignant tumor,and its incidence has been increasing in the recent 30 years. Since patients have no specific clinical manifestations in early stage,the diagnosis of this disease is often very difficult,with a low rate of radical resection in late stage and poor prognosis.Therefore,as for patients with intrahepatic cholangiocarcinoma,early screening and diag-nosis is of vital importance.Imaging examination is an important method for the diagnosis of intrahepatic cholangiocarcinoma,and when com-bined with laboratory markers and pathological examination,it can increase diagnostic rate and reduce the rate of missed diagnosis.It is im-portant in clinical practice to select reasonable methods based on the patient′s actual condition.

Objective To compare the therapeutic effects with different dosages of sertraline on patients suffering from idiopathic premature ejaculation. Methods IIEF-5 and CIPE questionnaires were completed before the treatment, and 86 patients who met the diagnostic standard of idiopathic premature ejaculation were finally recruited. Subjects were administered sertraline 50 mg/d combined with behavior therapy at stage Ⅰ for 4 weeks. Then, according to the therapeutic effects and the adverse events, all of the patients were divided into 3 groups for stage Ⅱ (another 4 weeks) as ①subjects with good effectiveness but with no or slight adverse events,would continue the treatments ②subjects with no therapeutic effects and with no obvious adverse events were allowed to increase the dosage of sertraline to 100 mg/d;③patients with effectiveness and obvious adverse events were al follows:lowed to reduce the dosage of sertraline to 25 mg/d. Those who had obvious adverse events and no effectiveness quit the study. Results During stage Ⅰ , 63 of 86 patients were effective (73.3%), and 23 patients had no improvement (26. 7%). Thirty-three patients had adverse events (38. 4%), and the remaining 53 patients had no obvious adverse events (61.6%). During stage Ⅱ , of the patients that responded to treatment, 35 patients who had no adverse events and 12 who had slight adverse events continued the treatment. Furthermore, 16 with intolerable adverse events were allowed to reduce the dosage to 25 mg/d. Meanwhile, of those without improvement, 18 subjects without obviousadverse events were allowed to increase the dosage to 100 mg/d, and 5 patients discontinued the treatment. Eight weeks later, among the patients taking 50 mg/d, 47 subjects were effectively with no obvious adverse events. Among the patients taking 25 mg/d, 10 showed improvement, 6 showed no improvement, and 2 had tolerable slight adverse events. Among the patients taking sertraline 100 mg/d,8 witnessed effectiveness, 13 had tolerable adverse events and 2 discontinued the treatment, with 1 having neither effectiveness nor obvious adverse events. The adverse events rate was 21.0% and the total effective rate of 8 weeks of treatment was 80.2 %. Conclusions Sertraline administration is an effective and safe way to treat idiopathic premature ejaculation. Although the effectiveness of the individualized treatment had no obvious improvement comparing routine therapy, there was a notable reduction in the adverse events rate, which increased the patient compliance.

Objective To evaluate the therapeutic effect,as well as the safety,of on-demand sildenafil on men with idiopathic ED.Methods One hundred and four men who met the diagnosis criteria of idiopathic ED were recruited into 2 groups.Among them,46 men who refused or were reluctant to take pharmacotherapy were recruited into the clinical control group with instruction of sexual knowledge and skills.Fifty-eight men who were involved in the on-demand group,were administrated sildenafil 50 mg just 1h before the coitus at thebeginning,then,if needed adjusted the dosage according to the effect and tolerance of the first four administration.The questionnaire of IIEF-5 was completed at the baseline and the end point,and the clinic total effective rate,the fully recovery rate of ED and the adverse events were also evaluated at the end of administration.Both groups were treated for 3 months.The therapeutic effect was reevaluated 1 month and 3 months later,respectively.Results After 3 months treatment,scores of IIEF-5 at the baseline and the end point for control group and on-demand group were as follow:5.2 and 12.6,4.2 and 19.8 ;and the fully recovery rate of ED for each group were as follow:12 (26.1％),56 (96.6％) ; the total effective rate for each group were 27.7％,97.2％ ; 1 month and 3 months after the end point,the fully recovery rate of ED and the total effective rate were evaluated separately,for 1 month:8 (17.4％),56(96.6％) and 19.4％,97.1％; for 3 months:7 (15.2％),55 (94.8％) and 16.4％,96.4％.The side effects in on-demand group (16,27.6％) was little higher than the control group (5,10.9％) (P ＞0.05).Most of the side effects were not only subtle and transient but also would vanish with the time.Accordingly,no one discontinued because of side effects.Conclusions Treatment of idiopathic ED with sildenafil was effective and safe.In terms of the fully recovery rate,total effective rate and effect maintenance,the on-demand group at the end point,even 1 month and 3 months after the end point,showed a great advantage over the control group.

Objective To prepare Curcumin liposome (Cur-L) and poly(2-ethyl-oxazoline)-cholesteryl methyl carbonate (PEOz-CHMC) was used to modified Cur-L and to evaluate their associated properties in vitro.MethodsEncapsulation efficiency and particle size were taken as evaluation indicators to optimize the formulation and preparation conditions of Cur-L by orthogonal test.The EE, particle size and shape of the liposomes were determined by sephadex G-50 mini-column centrifugation method, ZLS dynamic light scattering instrument and transmission electron microscopy (TEM), respectively.The release of the liposome in vitro was detected by The dialysis method.MTT assay was used to determine the cell inhibition of two Cur-L.ResultsThe optimized preparing method of Cur-L is as following: 1.56(w/w) as drug-lipid ratio, 5.1(w/w) as the ratio of mass of phosphatide and cholesterol, 7.4 as the pH of PBS buffer.The EE of Cur-L was (75.05±0.64)%, while the modification of PEOZ hasno influences on EE.Through TEM, PEOZ-Cur-L has aobviouslipid bilayer structure.The average particle diameter of PEOZ-Cur-L was 84.89 nm.In vitro release experiments showed that in 24h, the accumulative release rate of Cur-L is more than 70% with pH 7.4, while that of PEOZ-Cur-L was less than 25%.The cytotoxicity experiment showed that PEOZ-Cur-L can inhibit HCT116 Human colon cancer cells more effectively.ConclusionThe optimized preparing method of Cur-L is reasonable.PEOZ can provide stability to liposomes well and does not hamper its inhibitive effects.

Objective To observe the apoptosis of Th1 and Th2 cells in C57BL/6 mice chronically infected with Schistosoma japonicum.Methods The apoptotic Th1 and Th2 cells in spleen and lymph node from C57BL/6 mice infected with Schistosoma japonicum for 13 weeks were examined by three-color and indirect flow cytometery with staining surface molecule and intracellular cytokines.Results Compared with the normal mice,the proportion of apoptotic Th1 and Th2 cells of 13-week post-infection was significantly high,and the apoptotic Th1 cells increased more than apoptotic Th2 cells in the infected C57BL/6 mice,and the Th1 cells were more susceptible to apoptosis than Th2 cells.Conclusions Unequal susceptibility to apoptosis in Th1 and Th2 cells may be one of the reasons leading to Th2 polarization on mice chronically infected with Schistosoma japonicum,which provides the new proof of Th polarization.

In recent years, due to the irregular and abused use of glucocorticoid in clinical treatment, the incidence of steroid induced avascular necrosis of femoral head (SANFH) is gradually increasing. TCM for the prevention and treatment of SANFH has received much attention from many scholars. However, due to the lack of the scientific explanation of molecular biology level for its pharmacodynamics mechanism, it is difficult to achieve the purpose of standardized treatment. The discovery of OPG/RANK/RANKL signaling pathway has opened up new shortcuts for the prevention and treatment of bone metabolic diseases. OPG/RANK/RANKL signaling pathway is associated with the pathogenesis of spleen deficiency and phlegm - blood stasis caused by phlegm-blood stasis due to paralysis of SANFH. The treatment efficacy based on the phlegm theory can eventually axial control of the system through the micro-information to express. This article discussed the relevance between the phlegm in the treatment of SANFH and molecular biology mechanism of OPG/RANK/RANKL signal regulation mechanism, and combined the system of bone metabolism regulation mechanism to discuss TCM differentiation of SANFH, with a purpose to provide references for clinical and further study.

Objective:To evaluate the influencing factors of carotid-femoral pulse wave velocity (CF-PWV) and its value to predict outcomes in peritoneal dialysis (PD) patients.Methods:Eligible patients undergoing PD in Renji Hospital of Shanghai Jiao Tong University between August 2016 and July 2018 were recruited and prospectively followed up until death, PD cessation, or to the end of the study. CF-PWV was measured by an arterial pulse wave velocity meter to assess arterial stiffness (July 31, 2020). Overhydration was measured by bioimpedance spectroscopy. The patients were divided into CF-PWV≤10 m/s group and CF-PWV>10 m/s group according to the measured value of CF-PWV. The influencing factors of elevated CF-PWV were analyzed by multivariate logistic regression. Survival curves were generated using the Kaplan-Meier method and multivariate Cox proportional hazards models were used to analyze the difference for all-cause mortality and cardiovascular disease (CVD) mortality between the two groups.Results:A total of 224 PD patients were enrolled, including 133 males (59.4%). The age was (55.2±13.4) years old, and median PD vintage was 22.3(6.5, 59.3) months. Among them, 47(21.0%) patients were comorbid with diabetes, and 37(16.5%) patients had CVD history. The median CF-PWV was 9.6(8.4, 11.4) m/s for the cohort, and 105(46.9%) participants had CF-PWV over 10 m/s. Compared with CF-PWV≤10 m/s group, CF-PWV>10 m/s group patients had older age, increased percentage of diabetes and CVD (all P<0.05). Multivariate logistic analysis showed that increased age ( OR=1.070, 95% CI 1.043-1.099, P<0.001), diabetes ( OR=3.693, 95% CI 1.646-8.287, P=0.002) and higher overhydration ( OR=1.238, 95% CI 1.034-1.483, P=0.020) were independent influencing factors for elevated CF-PWV in PD patients. After followed up for 37.4(25.6, 41.7) months, 24 patients died, including 19 cases of CVD-related deaths. Kaplan-Meier survival analysis showed that all-cause mortality and CVD mortality were significantly higher in the CF-PWV>10 m/s group than those in CF-PWV≤10 m/s group (Log-rank χ2=6.423, P=0.011; Log-rank χ2=6.243, P=0.012, respectively). Multivariate Cox proportional hazards models showed that increased age was an independent influencing factor for both all-cause mortality and CVD mortality ( HR=1.057, 95% CI 1.010-1.107, P=0.018; HR=1.062, 95% CI 1.009-1.118, P=0.022). Conclusions:Increased arterial stiffness is relatively common in PD patients. Higher CF-PWV in PD patients is associated with increased age, diabetes and higher overhydration, and it is probably a valuable predictor of outcome in PD patients.

Objective:Carcinoma of bladder is the most common malignancy in the urinary system in China.Most patients with this disease had non-muscle invasive bladder cancer (NMIBC)at the time of diagnosis.Radical cystectomy was indicated for patients with high risk or refractory NMIBC.We aimed to investigate the overall survival and disease-specific survival and related influence factors in patients un-dergoing radical cystectomy for pathological non-muscle invasive bladder cancer.Methods:From Jan. 2006 to Dec.2012,a total of 164 patients with pathological non-muscle invasive bladder cancer under-went radical cystectomy in Peking University First Hospital.Clinical data were retrospectively collected. Incidence of lymph node metastasis and disease recurrence were calculated.The risk factors of disease re-currence were analyzed.Kaplan-Meier plots were used to estimate the overall survival and cancer-specific survival.Multivariate Cox regression analysis was used to evaluate the prognostic factors for survival.Re-sults:Of all the patients included,159 had T1 disease,and 5 had CIS only.The median follow-up dura-tion was 46.5 months (range:7 -99 months).Fourteen patients were lost during the follow-up.Lymph node metastasis was noted in 6 patients (3.7%),4 patients had N1 disease,one patient had N2 di-sease,and one patient had N3 disease.Disease recurrence occurred in 16 patients (9.8%).The most common recurrence sites were the liver,bones,and lungs.The 5-year overall survival and disease-spe-cific survival for all the patients were 85% and 91%,respectively.The patients who underwent pelvic lymph node dissection showed a better prognosis in terms of disease-specific survival than those without (P =0.012).Patients with recurrence harbored a significant poorer survival (P <0.001).According to univariate Cox regression analysis,whether lymph node dissection was performed was an independent risk factor of disease recurrence (P =0.050,OR =2.695,95%CI 0.999 -7.271).In COX regression mo-del,age (P =0.008,OR =1.071,95%CI 1.018 -1.126)and whether lymph node dissection was performed (P =0.011,OR =3.385,95%CI 1.329 -8.621)were related to disease-specific survival. Conclusion:Patients with pathological non-muscle invasive bladder cancer underwent early radical cys-tectomy have a favorable prognosis,and bilateral pelvic lymph node dissection is essential for this proce-dure as it gains a survival benefit for the patients.

Objective: To evaluate the clinical effect of clear aligners in the anterior region in non-extraction cases by establishing a three-dimensional model of crown-root fusion to guide clinical application. Methods: Eleven patients visiting the orthodontic department of Xuzhou Stomatological Hospital from December 2020 to December 2021 were collected, and the orthodontic plan was designed using Maestro 3D Dental Studio scheduling software to obtain the expected three-dimensional model of the patient's orthodontic treatment result. CBCT, intraoral scan, and 3D reconstruction software were used to create a postoperative model of the patient. The crown and root data were aligned in Geomagic Studio 2014, and differences in torque and axial inclination between the actual model after treatment and the predicted model of the anterior teeth before treatment were compared in 3-matic. Results: The actual torque angles of the anterior teeth were all smaller than the predicted angles before treatment, with the highest realization rate of 77.55% for lateral incisors and the lowest of 60.70% for central incisors; the actual axial inclination angles of the anterior teeth were also smaller than the predicted angles before treatment, with the highest realization rate of 81.49% for central incisors and the lowest of 74.95% for cuspids. Conclusion A digital model of crown-root integration based on a combination of 3D reconstruction and intraoral scanning techniques is advantageous in assessing the efficacy of clear aligners. In non-extraction cases with clear aligner, the efficiency of movement is higher for small areas of the anterior region.

Objective To evaluate the changes of left ventricular hemodynamics and systolic function in patients with apical aneurysm after percutaneous ventricular restoration ( PVR) by echocardiography . Methods Fifty patients with apical aneurysm were divided into PVR group ( 25 cases) and conservative treatment group ( control group ,25 cases ) . Two-dimensional transthoracic echocardiography ( 2D-TTE ) combined with real-time three-dimensional transesophageal echocardiography( RT-3DTEE) were applied for all the subjects in PVR group on preoperative ,one week after operaction ,three months after operaction and in control group on initial stage of prevent ventricular remodeling therapy ,one week after therapy ,three months after therapy to obtain left ventricular end-diastolic diameter( LVEDD) ,left ventricular end-systolic diameter( LVSDD) ,left ventricular end-diastolic volume( EDV ) ,end-systolic volume( ESV ) ,left ventricular ejection fraction( LVEF) ,left ventricular fractional shortening ( LVFS ) ,body surface area ( BSA ) ,stroke volume( SV) ,stroke volume index ( SVI) ,cardiac output ( CO ) ,cardiac output index ( CI) . Results There were significant differences in all parameters( P < 0 .05) especially in LVEF and SVI( P < 0 .01) between PVR group and control group in the following three months after operaction ,while there was no significant difference of the following one week after operaction( P > 0 .05) .Compared with preoperative ,there was no difference in all parameters in the following one week after operaction ( P > 0 .05) ,there was significant increase in SV and significant reduce in LVEDD and EDV ( P < 0 .01) between preoperative and in the following three months after operaction ,while there was no significant difference between preoperative and in the following one week after operaction ( P > 0 .05 ) .For the control group there was no significant difference between initial stage of prevevt ventricular remodeling therapy and in the following one week or three months after operaction .Conclusions PVR has a definite effect on left ventricular hemodynamics and systolic function in patients with apical aneurysm in the short term ,while 2D-TTE and RT-3DTEE provides a reliable basis for clinical to evaluate the effect of the PVR .