Objective To compare the overall diagnostic accuracy of MRCP with EUS for the detection of choledocholithiasis and malignant obstruction in patients with suspected biliary obstruction.Methods A fully recursive literature search was conducted in The Cochrane Central Register of Controlled Trials CENTRAL,MEDLINE or PUBME (1980-2012),EMBASE (1980-2012),OVID Database (1980-2012),CBM (1980-2012),VIP database (1989-2012),Chinese journal of full-text database (CNKI) (1980-2012),and WANFANG database(1980-2012).The prospective diagnostic studies which evaluated or compared the diagnostic accuracy of MRCP and EUS were included combined with manual searches.We also searched the references of all included articles of important meetings and journals.QUA-DAS items were used to evaluate the quality of the included studies.SEN,SPE,+ LR,-LR and the areas under SROC were detected,then t-test was used to evaluate whether statistically significant difference existed between EUS and MRCP.Results Thirteen studies including 1200 cases were recruited.The overall pooled sensitivities of MRCP and EUS for the detection of choledocholithiasis were 0.870 (95％ CI:0.826-0.906)and 0.935 (95％ CI:0.90-0.96) respectively,whereas their specificities were 0.952 (95％ CI:0.926-0.971) and 0.947 (95％ CI:0.920-0.967),respectively.The overall pooled positive likelihood ratio for MRCP and EUS were 14.055 (95％ CI:6.259-31.561) and 16.653 (95％ CI:6.896-40.212),respectively,with the corresponding negative likelihood ratio of 0.177 (95％ CI:0.108-0.290) and 0.076 (95％ CI:0.049-0.118),respectively.Areas under the ROC curve were 0.9693 and 0.9771,respectively.There were no statistically significant difference for sensitivity (0.84 ± 0.16 vs 0.93 ± 0.07,P =0.108) and specificity (0.93 ±0.10 vs 0.90 ±0.15,P =0.555) between MRCP and EUS.The overall pooled sensitivities of EUS and MRCP for the detection of malignancy were 0.959 (95％ CI:0.908-0.987),and 0.805 (95％ CI:0.724-0.871),respectively,whereas their specificities were 0.975 (95％ CI:0.954-0.988) and 0.927 (95％ CI:0.897-0.951),respectively.The overall pooled positive likelihood ratio for EUS and MRCP were 23.398 (95％ CI:12.987-42.155) and 13.448 (95％ CI:4.961-36.456),respectively,with the corresponding negative likelihood ratio of 0.059 (95％ CI:0.028-0.122) and 0.134(95％ CI:0.046-0.391),respectively.Areas under the ROC curve were 0.9870 and 0.9686,respectively.There were no statistically significant differences for sensitivity (0.95 ± 0.55 vs 0.88 ± 0.14,P =0.22) and specificity (0.96 ±0.03 vs 0.91 ±0.11,P =0.31) between MRCP and EUS.Conclusion MRCP and EUS are both valuable in differential diagnosis of biliary obstruction caused by choledocholithiasis or malignant lesions.

目的探讨低能量氦氖激光血管内照射(intravascular He-Ne laser irradiation,ILIB)治疗氯丙嗪所致锥体外系副反应(extraPyramideal side effects,EPS)的疗效。方法将61例住院精神分裂症患者随机分为ILIB治疗组(31例)和对照组(30例),两组患者均单一服用氯丙嗪。对出现EPS的 ILIB治疗组患者采用ILIB治疗,10次为1个疗程;对出现EPS的对照组患者使用安坦治疗。于治疗前、中、后用EPS副反应量表评定两组患者的疗效。结果对氯丙嗪所致的EPS,ILIB治疗组和对照组疗效无显著性差异(P>0.05),但ILIB治疗组抗胆碱能副作用发生率明显低于对照组(P<0.01)。结论ILIB对氯丙嗪所致EPS疗效确切,同时还有对抗氯丙嗪的抗胆碱能副作用。

Long non-coding RNAs (lncRNAs) are deifned as transcripts longer than 200 nt without coding capacities. Although they were initially argued to be transcriptional by-products of RNA polymeraseⅡ, recent evidence suggests that lncRNAs have been associated with a spectrum of biological processes, and aberrant lncRNA expression may be a major contributor to tumorigenesis, progression and prognosis. This study summarizes the up-to-date studies on lncRNAs in urological neoplasms.

Objective To summarize our experience in the management of stones impacted at cystic duct during laparoscopic cholecystectomy(LC). Methods There were 58 patients with stones impacted at cystic duct during LC from July 1997 to June 2001.Cystic duct was incised to remove stones first,then intraoperative cholangiography was performed.If stones were found in common bile duct,they would be taken out by intraoperative endoscopic sphincterotomy or open operation. Results All the impacted stones in 58 patients were removed successfully.51 coses underwent LC.Intraoperative cholangiography showed there were common bile duct stones in 7 cases.For these 7 coses,5 cases were treated by LC combined with intraoperative endoscopic sphincterotomy and other 2 cases were converted into open operation.No Severe complication occurred. Conclusions Nearly all cases with stones impacted at cystic duct can receive LC by removing impacted stones through incising the cystic duct and intraoperative cholangiography.If there are any stones in common bile duct,they can be removed by endoscopic sphincterotomy.

Objective To characterize the progression of segmental vitiligo.Methods Clinical data were collected using questionnaires from 387 patients with segmental vitiligo at the Department of Dermatology,Third People's Hospital of Hangzhou,between October 2011 and October 2012.The progression of segmental vitiligo was analyzed.Results Among the 387 patients,329 initially sufferred from focal vitiligo that evolved into segmental vitiligo later,58 began with segmental vitiligo.Vitiligo progressed most rapidly in the initial three months,and tended to be stable after three years in 220 (66.9％) of the 329 patients experiencing the evolution from focal to segmental vitiligo.By contrast,vitiligo developed most rapidly in the first month,and tended to be quiescent after one year in 40 (69.0％) of the 58 patients presenting with segmental vitiligo only.The condition still remained active in 27.6％ (107/387) of these patients after several years of progression.Totally,333 (86.0％) patients showed the involvement of single ganglion at the onset of vitiligo,including 173 (52.0％) patients with the involvement of trigeminal ganglion.Autologous melanocyte transplantation was conducted for 62 patients whose condition had been quiescent for more than one year,and 56 (90.3％) patients achieved more than 80％ repigmentation.Conclusions Segmental vitiligo,which tends to remain quiescent after three-year progression,seems to have a more rapid onset than focal vitiligo.Autologous melanocyte transplantation appears to be an effective treatment for segmental vitiligo in stable stage.

Objective To analyze the clinical features and evolution ot segmental vitiligo in children.Methods A standardized questionnaire was used to clinically investigate segmental vitiligo in 170 children aged ＜ or =12 years and 174 adults with an age of onset ＞ 18 years.Data analysis was done by the software SPSS16.0.Results The female to male ratio was 108:62 in the 170 child patients,significantly different from that in the adult patients (x2 =14.44,P ＜ 0.05).Localized vitiligo occurred as the initial presentation in 82.9％ (141/170) ofthe children and 76.4％ (133/174) of the adults,and progressed into segmental vitiligo in half a year in 76.5％ of the 141 children and 63.9％ of the 133 adults.Vitiligo entered the quiescent stage after half-a-year progression in 71.6％ of the children and 67.3％ of the adults with localized vitiligo as the initial presentation,and after one-month progression in 62.1％ of the children and 41.5％ of the adults with segmental vitiligo as the first presentation (x2 =8.39,P ＜ 0.01).Head and face were affected at the onset of segmental vitiligo in 44.1％ of the childhood cases and 56.9％ of the adult cases.Single nerve segments were involved at the onset in 94.7％ of the child patients and 86.8％ of the adult patients (x2 =0.04,P ＞ 0.05).The proportions of patients with white hairs,autoimmune diseases,and family history were significantly lower in the child patients than in the adult patients (x2 =15.88,5.62,6.66 respectively,all P ＜ 0.05).Conclusions Childhood-onset segmental vitiligo shows a predilection for males,usually presents as localized vitiligo at the onset,and becomes quiescent after half-a-year progression in more than 70％ of patients.

ObjectiveTo clone the full-length cDNA of Microsporum canis membrane protein PQ-loop repeat protein(PQ-LRP) gene,so as to investigate the roles of PQ-LRP in the pathogenesis of tinea capitis.MethodsA Microsporum canis strain(A518) from a patient with tinea capitis served as the experimental strain.Rapid cDNA end amplification(RACE) was performed to clone the full length cDNA sequence of PQLRP gene.Bioinformatics methods were used to make a preliminary functional analysis of the gene.Results The cDNA of PQ-LRP gene was obtained with a full length of 1522 bp,including the 5' untranslated region (49 bp),coding region(1080 bp) and 3' untranslated region(393 bp).The coding region encoded a protein precursor including 359 amino acid residues.The cloned cDNA of PQ-LRP gene shared an 81％ nucleotide identity with that of Trichophyton tonsurans and a 79％ nucleotide identity with that of Trichophyton rubrum.Conclusions The full-lengthcDNA of Microsporumcanis membraneproteinPQ-LRP gene hasbeen successfully cloned,which will provide an important basis for further researches into the roles of PQ-LRP in Microsporum canis-associated diseases.

Objective:To investigate the effect of enteral nutritional support in treating COPD patients with respiratory failure and mechanical ventilation.Methods:40 patients were randomly divided into two groups:high-fat and low-carbohydrate enteral nutritional solution group(HL group) and ordinary enteral nutritional solution group(control group).The volume of expired gas(VE),carbon dioxide production(VCO2),partial pressure of carbon dioxide(PaCO2),respiratory quotient(RQ),serum albumin,immunoglobulin,total lymphocyte count(TLC) were detected.Results:VCO2 and PaCO2 were significantly decreased in HL group compared with control group(P

Objective To study the effect of epigallocatechin gallate (EGCG) and fructus psoraleae on the induction of vitiligo-like depigmentation by monobenzone in mice.Methods Forty C57BL/6 mice were included in this study.Hairs in an area measuring 2 cm × 2 cm in size were shaved on the back of each of these mice.Then,the mice were randomly and equally divided into four groups to be topically treated with vaseline cream (negative control group),monobenzone 40％ cream (model group),EGCG 5％ cream followed by monobenzone 40％ cream (EGCG group),fructus psoraleae 7％ cream followed by monobenzone 40％ cream (fructus psoraleae group),on the shaved area,respectively,for 50 consecutive days.Depigmentation of skin and hairs was observed daily by naked eyes for 15 days after drug withdrawal.At the end of the study,all the mice were sacrificed,and skin specimens were resected from the tested regions in them.Hematoxylin and eosin (HE) staining was performed to observe lymphocyte infiltration,and immunofluorescence assay to estimate the frequency of CD8 + T cells.Results Depigmentation was observed in monobenzone-induced and-uninduced sites in the model group,and in monobenzone-induced sites in all the mice in the EGCG group and fructus psoraleae group,but in neither monobenzone-induced nor-uninduced sites ih the negative control group.The average time for the appearance of depigmentation at monobenzone-induced sites was 16.7,29.3 and 19.9 days in the model group,EGCG group and fructus psoraleae group respectively.The depigmentation area index at monobenzone-induced sites was 4.00 ± 0.00 in the model group,significantly different from that in the EGCG group and fructus psoraleae group (2.11 ± 0.54 and 2.84 ± 0.79,both P ＜ 0.05).Significant differences were also observed in depigmentation area index at monobenzone-induced sites among the model group,EGCG group and fructus psoraleae group (F =14.173,P ＜ 0.05),and at monobenzone-uninduced sites between fructus psoraleae group and EGCG group (P ＜ 0.05).The frequency (expressed as fluorescence intensity) of CD8+ T cells was significantly lower in the EGCG group and fructus psoraleae group than in the model group,and significantly different between EGCG group and fructus psoraleae group (P ＜ 0.05).Conclusions Both EGCG and fructus psoraleae,especially EGCG,can interfere with the induction of vitiligo-like depigmentation of skin and hairs by monobenzone in mice.The mouse model of vitiligolike depigmentaion in this study shows higher similarity to human vitiligo.

Objective To compare the therapeutic effect of topical application of tea polyphenol versus pimecrolimus versus tacrolimus for monobenzone-induced vitiligo-like depigmentation in mice.Methods Twentyfive 3-week-old female C57BL/6 mice were randomly and equally divided into 5 groups:negative control group,model group,tea polyphenol group,pimecrolimus group,tacrolimus group.Monobenzone 45％ cream was applied to the back of mice in all the five groups except the negative control group once daily for 40 consecutive days to establish a model of vitiligo-like depigmentation.During the induction of depigmentation,the tea polyphenol group,pimecrolimus group and tacrolimus group were topically treated with tea polyphenol,pimecrolimus and tacrolimus respectively,and the model group remaining untreated.The depigmentation of hairs and skin was observed by naked eyes on a daily basis.Tissue specimens were obtained for histological examination from depigmented skin at nonapplication sites in mice after the end of the experiment.Hematoxylin-eosin staining was conducted to analyze lymphocytic infiltration,reflectance confocal microscopy to observe melanin and melanocytes in skin,and immunofluorescence assay to detect CD8+ T cell infiltration.Results Depigmentation occurred in both application sites and non-application sites of mice in the model group.Compared with the model group,the tacrolimus,pimecrolimus and tea polyphenol groups showed delayed depigmentation,reduced degree and area index of depigmentation,and attenuated lymphocytic infiltration and CD8 + T cell infiltration in depigmented maculae at application sites.In addition,the therapeutic effect of tacrolimus was stronger than that of pimecrolimus and tea polyphenol.Conclusion Tea polyphenol,pimecrolimus and tacrolimus are all effective for the treatment of vitiligolike depigmentation in mice.