Objective To compare the clinical effectivness of the treatment by open surgery and by therapeutic endoscopy for common bile duct(CBD) stones.Methods The randomised controlled trails on the open surgery or therapeutic endoscopy for CBD stones were identified by electronic-searching and hand-searching,meta-analysis was conducted using the methods recommended by the Cochrane Collaboration.Data of 407 patients included in 6 high-quality randomized controlled trials were meta-analyzed using in fixed effect model.Results Compared with endoscopic stone extraction technique,open surgery had retained stones after primary intervention rate(OR 0.39,95% CI 0.25 to 0.75,P=0.003) and additional procedures rate(OR 0.33,95% CI 0.19 to 0.60,P=0.0002) with statistical significance.But open surgery made no significant difference in postoperative complication rate(Peto OR 1.10,95% CI 0.69 to 1.76,P=0.67).Conclusion Current evidence suggests that there is no significant difference between open surgery and therapeutic endoscopy in preoperative complications,but open surgery is superior to therapeutic endoscopy in stone clearence rate.

0.05)]. Conclusion The elevated serum HA is linked to a potential marker in kidney transplantation.

Objective:To evaluate the effectiveness of hierarchical management for patients with bronchial asthma.Methods:One hundred and eighty seven patients with bronchial asthma were recruited from January 2018 to November 2019 in Daxing District People′s Hospital. Patients were randomly divided into two groups, 94 patients received disease management education and therapeutic guidance from doctors in the community hospital and district hospital (study group), and 93 patients were followed up in outpatient visits only (control group). After one year, the scores of inhalation technique, treatment adherence, disease management awareness, the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) and pulmonary function were evaluated and compared between two groups. The annual acute attack times and time to first exacerbation were also compared between the two groups.Results:After one year of management the treatment adherence rate in study group was higher than that in control group [80.85% (76/94) vs. 51.61% (48/93), χ2=2.834, P=0.02]. The scores of inhaled corticosteroids (ICS) inhalation technique [(6.47±1.28) vs. (4.05±1.37), t=2.241, P=0.04], the correct rates of exhaling before ICS inhalation [94.68% (89/94) vs.56.98% (53/93), χ2=4.436, P=0.01],inhalation [90.43%(85/94) vs.68.82% (64/93),χ2=2.943, P=0.04],holding breath after inhalation [89.36% (84/94) vs.58.06% (54/93),χ2=4.098, P=0.02],rinsing mouth after ICS inhalation [92.55%(87/94) vs.65.59%(61/93),χ2=2.876, P=0.04] in study group were higher than those in control group. The awareness rates of chronic inflammatory airway disease [70.21%(66/94) vs.44.08% (41/93),χ2=2.673, P=0.02], causative factors [85.10% (80/94) vs. 56.99% (53/93),χ2=2.760, P=0.02],treatment misunderstanding [88.29%(83/94) vs.53.76%(50/93),χ2=4.874, P<0.01], therapeutic goal [86.17% (81/94) vs. 49.46% (46/93),χ2=4.491, P<0.01] and requiring long-term treatment [90.43% (85/94) vs.48.38% (45/93),χ2=4.503, P<0.01] in study group were higher than those in control group. The scores of ACT [(22.71±2.81) vs. (19.50±5.34), t=2.041, P=0.04] and miniAQLQ [(84.28±11.16) vs. (64.23±14.38), t=3.298, P<0.01] in study group were higher than those in control group. The number of annual acute exacerbation was less [0(0, 1) vs.2(1, 3), Z=-3.237, P<0.01] and the time to first exacerbation was longer [184(96, 284)d vs. 96(59, 177)d, Z=3.873, P<0.01] in study group than those in the control group after one year of management. Conclusion:The hierarchical management can effectively enhance the inhalation technique and treatment adherence of the patients with bronchial asthma, and improve the quality of life of patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Paraquat ; poisoning ; urine ; Prognosis ; Young Adult

Purpose To study of predictive value for detection of high-grade cervical intraepithelial neoplasia (CIN2 +) by p16/Ki-67 dual-stained liquid-based cytology.Methods Random collection of 123 women including 103 samples of atypical squamous cell of undetermined significance (ASC-US) and above with results of high-risk human papillomavirus (HR-HPV)testing and cervical biopsy,20 samples of negative for intraepithelial lesion or malignancy (NILM) by using immunocytochemical p16/Ki-67 dual-stained and the morphology assessment.Results In normal control group,the expression of p16/Ki-67 dual-stained in squamous epithelial cells were negative.Sensitivity of p16/Ki-67 dual-staind cytology for biopsy-confirmed CIN2 + was 66.67％ (ASC-US),91.67％ (LSIL) and 92.86％ (HSIL),specificity rates were 95.92％ (ASC-US),95.00％ (LSIL) and 0 (HSIL),positive predictive value were 50.00％ (ASC-US),91.67％ (LSIL) and 92.86％ (HSIL),negative predictive value were 97.92％ (ASC-US),95.00％(LSIL) and 0 (HSIL),respectively.Condusion p16/Ki-67 dual-stained cytology are improved obviously the predictive value for detection of CIN2 +,p16/Ki-67 dual-stained cytology may efficiently complement HPV-based screening programs to prevent cervical cancer.

The evaluation tools were developed based on the theory of validity,the development process and results of the Manual of Home-Based Rehabilitation Mode for Stroke Patients were evaluated by a panel of experts,and the opinions and suggestions for improvement were collected from the evaluation experts.The results showed that the average score for development process and results of the manual were ＞4 points in structural validity,content validity and surface validity,indicating that the manual was of high quality,and the development of the manual was scientific and the results were practical.The manual may provide the guidance for the home-based rehabilitation in community.At the same time,this study has enriched the reviewing tools and evaluation method of manuals,and provided reference for the peers.

Objective To investigate the diagnostic value of DNA ploidy analysis combined with immunocytochemistry p16/ki-67 double staining in cervical high grade squamous intraepithelial neoplasia(HSIL) and cervical squamous cell carcinoma(SCC).Methods A total of 73 cases of cytological tests were randomly collected.Among them,53 cases were small DNA ploidy abnormal cells and 20 cases were DNA ploidy negative.The p16/Ki-67 results were detected by immunocytochemistry double staining.With the pathological results as the golden standard,the diagnostic values of DNA ploidy analysis and DNA ploidy analysis combined with p16/Ki-67 double staining in HSIL + was contrastively analyzed by pathologic results.Results Among 20 samples of DNA ploidy negative,the p16/Ki-67 double staining results all were negative.The positive predictive value of DNA ploidy analysis for HSIL + was 34.62％.The sensitivity of DNA ploidy analysis combined with p16/Ki-67 double staining for HSIL + was 84.62％,and its specificity was 92.31％,the positive predictive value was 78.57％ and the negative predictive value was 94.74％,which were significantly higher than those of DNA ploidy analysis(P＜0.05).Conclusion p16/Ki-67 double staining can significantly im prove the prediction value of HSIL.The DNA ploidy analysis combined with p16/Ki-67 double staining is an effective method for predicting HSIL +,which is suitable for the implementation in the areas with lack of medical resources.

Background and purpose: The protein tyrosine kinase-7 (PTK7) gene may be related to the occurrence and progression of many tumors. This study was aimed to explore the expression of PTK7 in ovarian serous tumors and its relationship with clinical stage, histological grade, metastasis and prognosis indicators linkages, and analyze the diagnostic and prognostic value of PTK7 in ovarian serous tumors. Methods:Expressions of PTK7 in 3 ovarian cell lines (HO8910, SKOV3, A2780), 14 cases of normal fallopian tube epithelium, 6 cases of benign serous ovarian tumors, 51 cases of borderline serous ovarian tumors and in 97 cases of ovarian serous carcinoma were detected by immunohistochemical EliVision two-step method. Statistical analysis of the relationship between the expression of PTK7 and the pathological indicators was performed byχ2 test, Fisher exact test and Kaplan-Meier method. Results:PTK7 was negatively expressed in HO8910 and A2780, but weakly positively expressed in SKOV3. The positive rates of PTK7 in normal fallopian tube epithelium, benign serous ovarian tumors, borderline serous ovarian tumors and serous ovarian cancer were 92.86%(13/14), 83.33%(5/6), 45.10%(23/51), and 28.87%(28/97), respectively. The expression of PTK7 had no difference between normal fallopian tube epithelium and benign serous tumors, benign serous tumors and serous borderline tumors (P=0.521, P=0.102). The PTK7 expression showed signiifcant differences in serous ovarian carcinoma compared with those in normal epithelium, benign serous tumors and borderline serous tumors (P=0.000, P=0.012, P=0.048). Expression of PTK7 in borderline serous ovarian tumors was signiifcantly with clinical stage, metastasis (lymph node and/or peritoneum metastasis) (P=0.038, P=0.038), rather than its location, age (P=0.088, P=0.896). Expression of PTK7 in ovarian serous carcinoma had a signiifcant relation with its clinical stage, WHO grade, MDACC grade (P=0.011, P=0.004, P=0.000), rather than its location, metastasis, tumor diameter and age (P=0.326, P=0.524, P=0.588, P=0.584). The survival rate of PTK7 positive group in ovarian serous carcinoma was signiifcantly higher than that in the negative control group (P=0.017). Conclusion:The expressions of PTK7 in normal ovarian epithelium, benign serous ovarian tumors, borderline serous ovarian tumors and epithelial serous carcinoma show a gradual downward trend. The expression of PTK7 in ovarian serous tumors has a positive correlation with late clinical stage, high histological grade and poor prognosis. PTK7 can be a new indicator of clinical diagnosis and prognosis in ovarian serous tumors.

Objective:To evaluate the effectiveness of strengthening management in the bronchial asthma control among community patients.Methods:One hundred and eighteen community patients with bronchial asthma were recruited from January 2017 to January 2018. The patients were divided into community strengthening management group ( n=60) and control group ( n=58), the annual times of acute attack, time to first exacerbation and annual medical expenses were compared between the two groups. The proportion of inhaled corticosteroid (ICS) administration was documented; the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), Leicester Cough Questionnaire (LCQ), Fractional exhaled nitric oxide(FeNO) and pulmonary function were evaluated in two groups. Results:The management group had greater improvements in the proportion of ICS administration [45(75.0%) vs.36(62.1%), χ 2=4.143], ACT [(20.7±3.9) vs.(18.1±4.1), t=3.213], LCQ [(13.5±5.3) vs.(10.8±3.0), t=2.603], FeNO [(29.8±12.8) vs. (37.1±11.1), t=2.018] than the control group after six months of management (all P<0.05). There were significantly greater improvements in proportion of ICS treating [50(83.3%) vs. 34(58.6%), χ 2=5.748], ACT [(22.1±2.8) vs. (19.5±2.3), t=2.241], LCQ [(16.5±4.2) vs. (11.6±3.2),=5.603], miniAQLQ [(83.2±11.1) vs.(68.1±13.3), t=3.186] and FeNO [(28.2±13.1) vs.(38.1±16.3), t=2.176] in management group than those in control group after one year of management (all P<0.05); but no differences were seen in FEV 1%, FVC%, FEV 1/FVC (all P>0.05) between two groups. The LCQ score [(16.5±4.2) vs. (13.5±5.3), t=3.186] and the MiniAQLQ score [(83.2±11.1) vs. (69.1±14.3), t=5.603] of the management group were significantly improved after 1 year of management than those after 6 months. There was significant improvement in time to first exacerbation [182(92, 284) vs. 92(58, 176), Z=4.384] and the annual exacerbation was significantly reduced [0(0, 1) vs. 2(1, 3), Z=-3.187], annual medical costs of management group were significantly lower than those of control group [(10 523.0±550.5)Yuan vs. (15 787.1±1 421.2)Yuan, t=2.653]. Conclusion:The strengthening management can effectively improve the control rate of bronchial asthma, reduce acute exacerbation, improve clinical symptoms and improve the quality of life in community patients with bronchial asthma.

Objective To investigate the clinical features of patients with bronchiectasis of different types.Methods One hundred and twenty two patients with bronchiectasis at stable stage were recruited from January 2014 to July 2015.The patients were typed as cystic bronchiectasis (n =45) or non-cystic bronchiectasis (n =77) by high resolution CT (HRCT),expectoration bronchiectasis (n =80) or dry brochiectasis (n =42) by clinical symptoms,bacterial colonization (n =42) or non-bacterial colonization (n =80) by sputum culture.The modified British Medical Research Council (mMRC) dyspnea scale,Leicester Cough Questionnaire (LCQ),St George's Respiratory Questionnaire (SGRQ) and pulmonary function test were used to assess the clinical features,and the episodes of exacerbations and hospitalization,and mortality during 1-year follow-up were documented.Results mMRC dyspnea scale (1.90 ± 0.94 vs.2.90±1.09,t=-5.040),LCQ (16.20±4.60 vs.11.20±2.20,t=8.114),SGRQ (36.80±13.10 vs.52.06±22.10,t=-4.780),FEV1％ pred (68.45 ±26.50 vs.52.22 ±20.60,t=3.458),FVC％ pred (72.20 ±26.32 vs.63.10 ±21.42,t =2.058),FEV1/FVC (75.14 ±20.52 vs.58.12 ± 19.82,t =4.546),diffusing capacity of the lung for carbon monoxide (DLCO) (76.24 ± 28.40 vs.54.32 ± 21.20,t =4.400),episodes of exacerbations (Z =-8.272) and hospitalization during 1-year follow-up [6(14.29％) vs.29(36.25％),x2 =6.495] in patients with dry bronchiectasis were significantly better than those in patients with expectoration bronchiectasis (all P ＜ 0.05).mMRC dyspnea scale (3.20 ± 2.10vs.2.10±1.40,t=3.131),LCQ (10.12±2.63vs.16.22 ±3.22,t=11.365),SGRQ (54.80± 18.12 vs.34.06 ± 12.10,t =6.839) and FEV1％ pred (46.52 ± 22.55 vs.58.22 ± 24.62,t=-2.611),FVC％ pred (60.24± 18.22 vs.70.10±24.20,t =-2.547),FEV1/FVC (62.54± 19.02vs.73.12 ±18.42,t=-3.025),DLCO (62.24 ±22.40 vs.74.52 ±26.26,t=-2.627),episodes of exacerbations (Z =10.213) and hospitalizations during 1-year follow-up [21 (46.67 ％) vs.14 (18.18％),x2 =1 1.260] in patients with cystic bronchiectasis were significantly more severe than those in patients with non-cystic bronchiectasis (all P ＜ 0.05).mMRC dyspnea scale (2.38 ± 1.45 vs.1.92 ± 1.14,t =2.175),LCQ (12.82 ±2.12 vs.16.20 ±3.96,t =-6.140),SGRQ (54.22±21.50 vs.41.20 ± 14.60,t =3.521) and FEV1 ％ pred (54.20 ± 21.60 vs.66.45 ± 28.24,t =-2.668),FVC％ pred (63.10 ±24.32 vs.73.46 ±25.30,t =-2.177),FEV1/FVC (62.22 ±20.80 vs.72.14 ±24.36,t =-2.243),DLCO (58.52 ± 20.42 vs.69.22 ± 25.60,t =-2.344),episodes of exacerbation (Z =19.352) and hospitalization during 1-year follow-up [19 (45.24％) vs.16 (20.00％),x2 =8.575] in patients with bacterial colonization bronchiectasis were significantly more severe than those in patients with non-bacterial colonization bronchiectasis (all P ＜ 0.05).However,there was no significant difference in mortality during 1-year follow-up (all P ＞ 0.05) among patients with different types of bronchiectasis.Conclusion Patients with cystic,bacterial colonization and expectoration types of bronchiectasis seem to have more severe symptoms,more episodes of exacerbations and hospitalizations than those of non-cystic,non-bacteria colonization and dry types of bronchiectasis.