Objective:To explore the preoperative risk factors of laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis, and establish a nomogram model to predict the transition to laparotomy.Methods:A retrospective analysis of the clinical data of 309 patients undergoing surgery in Cangzhou People′s Hospital from January 1, 2015 to December 31, 2019, were divided into 290 cases in non-laparotomy group and 19 cases in laparotomy group whether they were transferred to laparotomy. Obtained independent predictors of transition to laparotomy through univariate analysis and multivariate logistic regression analysis, and used RStudio to establish a nomogram model to verify it.Results:The results of univariate analysis showed that the history of abdominal surgery, BMI, white blood cell, neutrophil ratio, ALP, serum total bilirubin, gallbladder wall thickness, common bile duct diameter, and lower common bile duct stone incarceration were relative risk factors of LC combined with LCBDE for conversion to laparotomy ( OR=0.195, 0.369, 0.287, 0.241, 0.237, 0.082, 0.166, 0.198, 0.190; 95% CI: 0.073-0.517, 0.114-1.195, 0.096-0.859, 0.085-0.682, 0.092-0.613, 0.023-0.287, 0.058-0.475, 0.073-0.537, 0.056-0.649). Multivariate logistic regression analysis showed that white blood cells>10×10 9/L, alkaline phosphatase>150 U/L, serum total bilirubin>17.1 umol/L, gallbladder Wall thickness> 4 mm, common bile duct diameter>12 mm, and lower common bile duct stone incarceration were independent predictors of LC combined with LCBDE for conversion to laparotomy ( OR=6.498, 3.656, 22.160, 5.762, 4.849, 7.916; 95% CI: 1.434-29.442, 1.095-12.203, 4.485-109.496, 1.491-22.262, 1.384-16.988, 1.366-45.884). The nomogram model was established based on independent predictors, and then bootstrap repeated sampling was used to internally verify the predictive model. The calibration curve found that the model was in good agreement, with a C-index of 0.924(95% CI: 0.857-0.990) and the area under the receiver operating characteristics curve was 0.924(95% CI: 0.855-0.992), indicating the high accuracy of the model. Conclusion:The nomogram model established based on the factors of lower common bile duct stone incarceration, gallbladder wall thickness, common bile duct diameter, common bile duct diameter, white blood cells, alkaline phosphatase, and serum total bilirubin has good ability to predict conversion to laparotomy of LC combined with LCBDE, and has high clinical application value.

ObjectiveTo explore the relationship of rejection sensitivity,social inhibition and negative affect in army recruits.Methods358 recruits were measured with rejection sensitivity questionnaire,type D personality scale,and positive affect and negative affect scale.Results(1)The score of intimates' rejection sensitivity was highest(9.33±3.88),peers' rejection sensitivity was in the middle(8.59±3.27),teachers' rejection sensitivity was lowest(6.79±2.90),with statistical significance(F(2,355)=53.76,P<0.01).(2)Rejection sensitivity had significantly positive correlation with social inhibition(r=0.346,P<0.01).Negative affect had significantly positive correlation with rejection sensitivity (r=0.233,P<0.01) and social inhibition(r=0.351,P<0.01).(3)Social inhibition partially mediated the relationships between rejection sensitivity and negative affect(the value of mediating effect was 45.7%).ConclusionRejection sensitivity has direct effects on negative affect and indirect effects through social inhibition.

Studies on glaucoma have been focused only on optic nerve damage and aqueous humor dynamic for many years. In recent years, with the advances in understanding of glaucoma and visual sciences, and the development of a neurological cross-discipline, new interdisciplinary problems have been raised. Notably, the question of whether glaucoma is only an optic nerve disease. Is it a disease that begins from the eye, and then involves the whole visual pathway? Or is it a particular central nervous system disease, which manifests itself in the eye? The answers to these problems are inconclusive so far, but there are reasons to believe that glaucoma is a disease with multi-level, multi-factor damage to the entire visual pathway involved. Its mechanisms are complex and involve cross-synaptic damage, visual pathway blood disorders, blood-brain barrier disorders, and so on. As we come to understand that glaucoma is an ocular and central never system neurodegenerative disease, we may better understand the pathogenesis of glaucoma and therefore establish comprehensive treatment strategies for this disease.

Stereotactic body radiation therapy ( SBRT ) for locally advanced pancreatic cancer ( LAPC) shows good signs of efficacy as measured by local control,which can also reduce toxicity. The dose fractionation in foreign countries have changed from conventional fractionation to single fraction and finally moderate hypofractionation. It is similar to that in China, with the dose fractionation changing from conventional fractionation to moderate hypofractionation. This review introduces the latest research results of dose fractionation of SBRT for LAPC.

Background Noncontact tonometer (NCT) is a common application in clinical ophthalmology,while its measured value is influenced by corneal parameter.In recent years,there existed some clinical trials discussing the agreement between NCT and gold standard Goldmann applanation tonometer (GAT),but there was still lack of evidence.Objective This study was to evaluate the agreement between NCT and GAT by applying evidence based medicine (EBM) method.Metbods A systematic literature retrieval was conducted from the MEDLINE,EMbase,CBM disc and CNKI database with the limitation of publishing time until June 2016.The literatures were screened according to the inclusion and exclusion criteria.The sample size,average age,sample characteristics and follow-up time were extracted.The value of intraocular pressure measured by NCT and GAT were analyzed.The overall effect size was analyzed using Review Manager 5.3 (from The Cochrane Collaboration) as weighted mean difference (WMD).There existed heterology in this study.Radom effect mode was used to evaluate and compare the difference between NCT and GAT value.Results Twenty four articles were retrieved.Six comparison studies incorporated with 478 eyes were included for Meta analysis.After random effects model was performed for correction.Intraocular pressure measured by NCT was 0.02 mmHg larger than that by GAT (1 mmHg =0.133 kPa).There was no significant difference in the measurement value of IOP between the two instruments (WMD =0.02,95％ CI:-0.59 to 0.63,P =0.95).Funnel chart method showed that literature publication bias existed in this study.Conclusions Normal persons' IOP obtained from NCT and GAT showed a good reproducibility.More comparison studies are needed to support this result.

Objective To study the effect of medically activated charcoal on serum phosphorus level and calcium-phosphorus products in dialysis patients with poorly controlled hyperphosphatemia. Methods A single-center,prospective,self-controlled study was performed.Medically activated charcoal was administered 4.5-7.2 g per day with meals for three months to hemodialysis or peritoneal dialysis patients with hyperphosphatemia after taking calcium-based phosphate binders.The levels of blood phosphorus,calcium,calcium-phosphorus products,intact parathyroid hormone (iPTH),albumin and hemoglobin were detected before and after the treatment.The results were analyzed using paired t-test. Results After 3 months of treatment,the patients' serum phosphorus level was significantly reduced from (2.16 ±0.34) mmol/L (pretreatment) to (1.85±0.30) mmol/L (post-treatment) (P＜0.01).Similarly,the serum calciumphosphorus products were lowered from pre-treatment level of (63.93 ±8.83) mg2/dl2 to posttreatment of (54.12±8.37) mg2/dl2 (P＜0.01).Serum albumin level was slightly reduced from (41.7±2.9) g/L to (40.1±2.2) g/L (P=0.001).In contrast,there were no significant changes in serum calcium and iPTH levels when compared pre- to post-treatment values (P=0.734 and P=0.665,repectively). Conclusion In combination with calcium-based phosphate binder therapy,oral medically activated charcoal can effectively reduce the levels of blood phosphorus and calciumphosphorus products in dialysis patients with refractory hyperphosphatemia.

Objective To explore the clinical efficacy of laparoscopic extralevator abdominoperineal excision (laparoscopic ELAPE) for low rectal cancer with modified Lloyd-Davies lithotomy position and without turning position.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 27 patients with low rectal cancer who underwent laparoscopic ELAPE without turning position in the West China Hospital of Sichuan University from September 2013 to January 2015 were collected.The modified Lloyd-Davies lithotomy position was used in perineal resection.Observation indicators:(1) surgical situation;(2) postoperative recovery situation;(3) postoperative pathological examination situation;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications,survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situation:A total of 27 patients received laparoscopic ELAPE without turning position,and operation time and volume of intraoperative blood loss were (198±51)minutes and (85±66)mL.Among 5 of 27 patients with intraoperative complications,1 with intestinal perforation received successful intraoperative repair,1with presacral haemorrhage received successful hemostasis by intraoperative gauze pressing,1 with left and right pelvic plexus injury didn't receive special treatment,1 with left pelvic plexus injury + left internal iliac vein injury didn't receive special treatment and were repaired in vascular injury repair,1 with right neurovascular bundle injury didn't receive special treatment of nerve injury and received successful hemostasis by ultrasonic scalpel.There was no perforation in the site of the tumor.Number of lymph node dissected was 14 (range,9-22),and number of lymph node dissected ≥ 12 and ＜ 12 were detected in 15 and 12 patients,respectively.(2)Postoperative recovery situation:time to anal exsufflation and time for fluid diet intake in 27 patients were respectively (78±21)hours and (83±21)hours.Of 27 patients,8 with postoperative complications were improved by conservative treatment,including 1 in Clavien-Dindo Ⅰ (volume of perineal exudation ＞ 100 mL) and 7 in Clavien-Dindo Ⅱ (3 with pulmonary infection,2 with chylous fistula,1 with perineal incision infection and 1 with hematuria).There was no death within 30 days postoperatively.The median duration of hospital stay of 27 patients was 7 days (range,6-8 days).(3) Postoperative pathological examination situation:of 27 patients,1 and 26 had respectively positive and negative circumferential margins and median distance of circumferential margin was 0.7 cm (range,0.1-1.1 cm).T stage:14,12 and 1 patients were respectively detected in T2,T3 and T4.N stage:18,6 and 3 patients were respectively found in N0,N1 and N2.(4) Follow-up and survival situations:25 of 27 patients were followed up for 2-32 months,with a median time of 24 months.During the follow-up,5 had complications after discharge from hospital.Of 5 patients,2 with persistent anal pain didn't receive special treatment and were not relieved,and 3 with sexual dysfunction didn't receive special treatment and were followed up or observed.Of 25 patients,2 died of tumor-related diseases,1 died of non-tumor-related disease and other 22 had survival.No local tumor recurrence was detected.Eight patients had tumor distant metastases,including 4 with pulmonary metastases,3 with hepatic metastases and 1 with brain metastasis.Conclusion Laparoscopic ELAPE by modified Lloyd-Davies lithotomy position without turning position is safe and feasible,with closing pelvic floor peritoneum in stage Ⅰ.

Objective To study effects of constant magnetic fields(CMF) on the intracellular free calcium of human umbilical arterial vascular smooth muscle cells to discuss the mechanism of CMF affecting the proliferation of VSMC.Methods The intracellular free calcium concentration of human umbilical arterial vascular smooth muscle cells was detected by laser scanning confocal microsopy.Results The CMF affected the intracellular free calcium concentration of human umbilical arterial vascular smooth muscle cells.The CMF(5 mT) caused a persistent decrease of intracellular free calcium concentration of VSMC from 10 min to 50 min.Conclusion The CMF could inhibit proliferation of VSMC by decreasing the intracellular free calcium constant magnetic field concentration of VSMC.The CMF could markedly inhibit proliferation of VSMC,which might be useful in treatment of RS after PTCA.

Gastric cancer is one of the most commonly seen malignant tumors,and is the fourth leading cause of morbidity and second leading cause of mortality among malignancies worldwide. The genesis of gastric cancer is the result of interaction between genetic and environmental factors,and is a multi-factor and multi-step carcinogenesis. As one of the most important members in the heat shock protein(HSP)family,HSP70 plays a molecular chaperone role,and is involved in body specific immunity and innate immunity. Studies have demonstrated that over expression of HSP70 often correlates with the genesis and development of gastric cancer. This article reviewed the advances in study on relationship between HSP70 and gastric cancer.

Rivaroxaban is one of the new oral anticoagulants (NOAC) for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation. It has clear pharmacokinetic parameters, stable plasma concentration, less drug-drug interaction and higher compliance of patients. However, the discrepancy of pharmacokinetics between individuals and drug-induced hemorrhage events frequently occur clinically, therefore the association of gene polymorphism with drug metabolism has become a research hotspot. This article reviews the research progress on pharmacokinetic characteristics of rivaroxaban and its relationship with gene polymorphism, to provide a reference for the individualized rational use of rivaroxaban.