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.

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.

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。

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 explore the application value of hysteroscopy in recurrent implantation failure ,and discuss what was the best time to transfer embryos after the operation .Methods The patients who had undergone two or more failed IVF-ET cycles were separated into two groups .The patients of group A ( n=210) received hysteroscopy , and the patients of group B ( n=71) did not receive hysteroscopy evaluation .Intrauterine lesions diagnosis were trea-ted during the procedure .Patients without intrauterine pathologies were given slight curettage .The recurrent IVF-ET were performed after the procedure .Then we analyzed the clinical pregnancy rate of the two groups and determined the best time to transfer embryos after the operation.Results In group A,57 patients were pregnant.In group B, 8 patients were pregnant .There was a significant difference in the clinical pregnancy rates between the two groups (χ2 =7.52,P<0.01).In the pregnant patients of group A ,about 94.7%were pregnant in 6 months after hysterosco-py.Conclusion The patients with recurrent IVF -ET transfer failure should be evaluated prior to commencing IVF-ET cycle to improve the clinical pregnancy rate .It is better to transfer embryos within 6 months after hysteroscopy operation.

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.

Objective To compare the clinical effect of remifentanil and dexmedetomidine on controlled hypotension during endoscopic sinus surgery. Methods Forty patients undergoing endoscopic sinus surgery were randomly divided into group R and group D, 20 in each group. All patients received controlled hypotension when the surgeons began to sterilize the nasal cavity for the purpose of maintaining the MAP at 60 ~ 70 mmHg. Group R received remifentanil 1μg/kg over 1 minute, followed by 0.2 to 0.4μg/kg per minute infusion during maintenance, whereas group D received dexmedetomidine 1μg/kg over 10 minutes, followed by 0.2 to 0.7μg/kg per hour during maintenance. At the moment of pre-induction(T0), incision(T1), 30 min(T2) and 60 min(T3) after incision and 10 min(T4) after end of controlled hypotension, MAP and HR were measured. Quality of the surgical field, blood loss and extubation time were recorded. Sedation and postoperative pain were assessed on arrival at the PACU. Results The goals for the MAP level were achieved and the surgical field quality was ideal in both groups. The MAP and HR values at T1~ T3 were significantly lower than those at T0 in both groups (P < 0.05). There were no significant differences in the MAP or HR values between the groups at each time point (P>0.05). No significant difference was founded between the groups in the Fromme operative field score and blood loss (P > 0.05). The extubation time was significantly shorter in group R than in group D(P<0.05). The sedation score in the PACU was significantly lower in group R than in group D(P<0.05), while there were no significant differences in postoperative pain between the groups(P<0.05). Conclusion Both remifentanil and dexmedetomidine are safe agents for controlled hypotension and are effective in providing satisfactory surgical fields during endoscopic sinus surgery. However , remifentanil is advantageous in time for extubation and complete consciousness from anesthesia and therefore it may have the advantage of fast track anesthesia.

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 investigate the role of proteoglycan autoimmunity in the pathogenesis of rheumatoid arthritis (RA). Methods Human Aggrecan G1 domain cDNA was cloned from human cartilage, and recombinant aggrecan G1 domain (rAG1) protein was synthesized in a Baculovirus expression system. Synovial fluid monocytes from RA patients were stimulated with rAG1. Harvested cells' radioactivity was quantified in a ?-scentillation counter and the stimulation index (SI) was calculated. Cells with SI over 3 were taken as rAG1 specific T cells. Three well-characterized AG1-specific T cell lines were injected intraperitoneally into 8 SCID Beige mice. At the same time, rAG1 was injected intraarticularly into left knees of these mice. On day 8, mice were sacrificed and histological examination of the knee joints was performed. Results Human rAG1 specific T cell lines were generated from synovial fluid of RA patients. Most of these cells were CD4~+CD8~- T cells secreting Th1 cytokine (interferon-?). A pronounced capsular and synovial infiltration of mononuclear cells with early synovitis and cartilage erosion was observed in some left knees of the mice treated with rAG1-specific T cells. Conclusion Human rG1-autoreactive T cells injected intraperitoneally have homed to left knee where its epitope rAG1 was injected, and they participated in the development of inflammatory arthropathy.