Objective To study the risk factors related to the severity of post-ERCP hemorrhage in the patients with choledocholithiasis.Methods Clinical data of 56 patients with choledocholithiasis and post -ERCP hemorrhage from January 2008 to August 2015 were analyzed.Made the occurrence of severe hemorrhage as dependent variable,supposed 18 factors in patients and procedure related aspects as possible covariates,analyzed with univariate and binary logistic regression.Results Severe hemorrhage was occurred in 1 1 patients after ERCP.Among patients related factors,female,history of oral corticosteriod,level of bilirubin,size of stone,periampullary diverticula, prolonged time of bleeding-cruor,acute cholangitis,acute pancreatitis and course of disease were proved to be signifi-cant risk factors by univariate analysis(P<0.01 ).Periampullary diverticula,prolonged time of bleeding-cruor and acute cholangitis were independent risk factors in further multivariate analysis(P=0.023,0.036,0.045).Among procedure related factors,EPBD(P<0.01),EST(P<0.01),residual biliary stones(P=0.029)were proved to be significant risk factors by univariate analysis,and EPBD was found as independent risk factor(P=0.029)by multiva-riate analysis.Conclusion Appearance of periampullary diverticula,prolonged time of bleeding -cruor and acute cholangitis were considered as risk factors related to severity of post-ERCP hemorrhage in patients with choledocholi-thiasis.Moreover,EPBD was also an independent risk factor which might aggravate severity of post-ERCP hemor-rhage.

Objective To study the significance of S100A12 in patients with acute pancreatitis (AP).Methods 139 patients with AP were divided into the severe acute pancreatitis (SAP) and moderate acute pancreatitis (MAP) groups.61 patients in the SAP group were further subdivided into the infection group (n =32) and the non-infection group (n =29) based on the presence/absence of secondary infection.Serum samples of these patients were collected on the 3rd,7th and 14th day after treatment.ELISA was used to determinate the S100A12,IL-1 β and IL-6 levels in serum.The area under ROC was used to evaluate the predictive role of S100A12,IL-1β,IL-6 and CRP for infection in patients with SAP.Results The S100A12,IL-1β and IL-6 levels in SAP patients were markedly higher than those in MAP patients and normal controls on the 3rd,7th and 14th day after treatment.These levels decreased toward normal range in MAP patients.They were persistently high in SAP patients after treatment for 7 days,but decreased significantly after 14 days.The serum levels of S100A12,IL-1β,IL-6 and CRP were significantly higher in the infection subgroup(647.5 ± 300.1,155.9 ±48.5,95.7 ±25.5,166.8 ±53.0) than the non-infection subgroup(249.0 ± 176.3,108.0 ± 46.1,64.0 ±38.5,117.9 ±34.9) (P ＜0.05).The sensitivity and specificity of serum S100A12 in diagnosing secondary infection in SAP were 96.8％ and 83.3％,which were higher than those of serum IL-1β,IL-6 or CRP.Conclusion The level of S100A12 was associated with systemic inflammatory response syndrome (SIRS) in AP,and it may serve as a new marker in early diagnosis of SAP and in secondary infection in SAP.

Objective To investigate the relationship between the serum copeptin levels and the outcomes in patients with acute ischemic stroke.Methods Patients with first-ever ischemic stroke within 24 h were enrolled in the study.Enzyme-linked immunosorbent assay was used to detect the serum copeptin levels.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of baseline stroke.The modified Rankin Scale (mRS) scores were used to evaluate the outcomes at day 90,and 0-2 was defined as good outcome.The age-and sex-matched healthy subjects were used as controls.Results A total of 86 consecutive patients with first-ever ischemic stroke within 24 h were enrolled and 50 age-and.sex-matched healthy subjects were used as controls.The serum copeptin levels of the patients with acute ischemic stroke at 24 h,day 7 and 14 were 7.81 ± 0.66 pmol/L,4.78 ± 1.76 pmol/L,and 2.82 ± 1.42 pmol/L,respectively.They were all significantly higher than those of the control group (1.67 ± 0.56 pmol/L;all P＜0.05).In 86 patients,74 (86.05％) had good outcome and 12 (13.95％) had poor outcome.The age (67.64 ± 9.62 years vs.61.12± 7.31 years;t=-3.420,P=0.020),NIHSS score (14.16±4.22 vs.6.96± 2.04;t=-8.263,P＜ 0.001),baseline systolic blood pressure (166.06± 13.42 mmHgvs.154.12± 11.69 mmHg;t=5.216,P=0.037;1 mmHg=0.133 kPa),fasting blood glucose (8.79 ±2.98 mmol/L vs.6.92 ±2.24 mmol/L;t =2.076,P =0.041),C-reactive protein (7.02 ± 1.72 mg/L vs.4.07 ± 1.58 mg/L;t =-1.724,P =0.019),copeptin level at 24 h (9.67 ±2.28 pmol/L vs.6.88 ±2.82 pmol/L;t =13.962,P ＜ 0.001),copeptin level at day 7 (8.22 ± 2.14 pmol/L vs.2.97 ± 2.04 pmol/L;t =20.564,P ＜ 0.001),copeptin level at day 14 (4.77 ± 1.86 pmol/L vs.2.02 ± 0.76 pmol/L;t =8.428,P =0.032),as well as the proportions of atrial fibrillation (33.33％ vs.8.11％;x2 =4.986,P=0.036),large artery atherosclerotic stroke (41.67％ vs.21.62％;x2 =6.729,P =0.038),cardioembolism (33.33％ vs.8.11％;x2 =4.986,P=0.036) in the poor outcome group were significantly higher than those in the good outcome group.The proportion of patients with small arterial occlusive stroke was significantly lower than that of the good outcome group (16.67％ vs.70.27％;x2 =16.972,P =0.041).Multivariate logistic regression analysis showed that the serum copeptin level at 24 h (odds ratio 2.424,95％ confidence interval 1.92 0-3.562;P ＜ 0.001) and day 7 (odds ratio 2.326,95％ confidence interval 1.768-3.482;P ＜ 0.001),and baseline NIHSS score (odds ratio 2.146,95％ confidence interval 1.616-3.268;P ＜ 0.001) were the independent risk factors for the poor outcomes.Conclusions The increased baseline serum copeptin level is an independent risk factor for poor outcomes at day 90 in patients with acute ischemic stroke.

Objective To investigate the relationship between the level of circulating CD133+/KDR+ endothelial progenitor cells (EPCs) and outcome in patients with acute ischemic stroke.Methods Inpatients with first-ever ischemic stroke within 24 hfrom the onset and age-and sex-matched healthy subjects were enrolled in the study.The demographic and clinical data of the patients were collected.The level of CD133+/KDR+ EPCs was detected by flow cytometry.All patients were followed up at 90 d.The modified Rankin Scale was used to evaluate the clinical outcome,0-2 was defined as good outcome and >2 was defined as poor outcome.Results A total of 126 consecutive patients with first-ever ischemic stroke within 24 hfrom the onset and 60 age-and sex-matched healthy subjects were enrolled.In patients with ischemic stroke,33 (26.19%) were large artery atherosclerosis (LAA),74 (58.73%) were small artery occlusion (SAO),19 (15.08%) were cardioembolism (CE);82 (65.08%) had good outcomes and 44 (34.92%) had poor outcomes.The number of circulating EPCs at baseline in patients of the LAA subtype (0.071%±0.018%),CE subtype (0.068%±0.16%) and SAO subtype (0.118%±0.12%) was significantly lower than that in the control group (0.246%±0.052%;all P<0.05),and the CE subtype (P=0.028) and LAA subtype (P=0.037) were significantly lower than the SAO subtype;the CE subtype was lower than the LAA subtype,but the difference was not statistically significant (P=0.762).The proportions of patients with LAA subtype (40.91% vs.18.29%;χ2=7.577,P=0.006) and CE subtype (29.55% vs.7.32%;χ2=11.049,P=0.001) and atrial fibrillation (29.55% vs.10.98%;χ2=6.582,P=0.009),and age (69.64±9.62 years vs.61.12±7.31 years;t=5.570,P<0.001),and baseline NIHSS score (14.16±4.22 vs.6.96±2.04;t=12.919,P<0.001),baseline systolic blood pressure (176.06±13.42 mmHg vs.164.12±11.69 mmHg,1 mmHg=0.133 kPa;t=5.187,P<0.001),low-density lipoprotein cholesterol (2.92±0.52 mmol/L vs.2.49±0.36 mmol/L;t=5.447,P<0.001),fasting blood glucose (8.76±2.88 mmol/L vs.6.82±2.24 mmol/L;t=4.185,P<0.001),C-reactive protein (7.62±1.82 mg/L vs.4.57±1.58 mg/L;t=9.790,P<0.001),and D-dimer (1.14±0.08 mg/L vs.0.97±0.22 mg/L;t=4.946,P<0.001) levels in the poor outcome group were significantly higher than those in the good outcome group,while the proportion of the SAO subtype patients (29.55% vs.74.39%;χ2=23.759,P<0.001),high-density lipoprotein cholesterol (0.94±0.68 mmol/L vs.1.16±0.14 mmol/L;t=2.829,P=0.005),and baseline EPCs (0.069%±0.018% vs.0.098%±0.021%;t=7.755,P<0.001) were significantly lower than those in the good outcome group.Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio 1.242,95% confidence interval 1.126-1.372;P<0.001),CE subtype (odds ratio 3.460,95% confidence interval 1.312-5.146;P=0.016),and the lower baseline EPCs (odds ratio 1.632,95% confidence interval 1.006-3.024;P<0.001) were the independent risk factors for poor outcome in patients.Conclusion s The level of circulating EPCs was decreased significantly in patients with acute ischemic stroke,and the lower level of baseline EPCs was an independent predictor of poor outcome in patients with ischemic stroke at 90 d.

PURPOSE: . The aim of this study was to evaluate the clinical performance and reliability of plasma sprayed nanostructured zirconia (NSZ) coating. MATERIALS AND METHODS: . This study consisted of three areas of analysis: (1) Mechanical property: surface roughness of NSZ coating and bond strength between NSZ coating and titanium specimens were measured, and the microstructure of bonding interface was also observed by scanning election microscope (SEM). (2) Biocompatibility: hemolysis tests, cell proliferation tests, and rat subcutaneous implant test were conducted to evaluate the biocompatibility of NSZ coating. (3) Mechanical compatibility: fracture and artificial aging tests were performed to measure the mechanical compatibility of NSZcoated titanium abutments. RESULTS: . In the mechanical study, 400 μm thick NSZ coatings had the highest bond strength (71.22 ± 1.02 MPa), and a compact transition layer could be observed. In addition, NSZ coating showed excellent biocompatibility in both hemolysis tests and cell proliferation tests. In subcutaneous implant test, NSZcoated plates showed similar inflammation elimination and fibrous tissue formation processes with that of titanium specimens. Regarding fatigue tests, all NSZ-coated abutments survived in the five-year fatigue test and showed sufficient fracture strength (407.65-663.7 N) for incisor teeth. CONCLUSION . In this study, the plasmasprayed NSZ-coated titanium abutments presented sufficient fracture strength and biocompatibility, and it was demonstrated that plasma spray was a reliable method to prepare high-quality zirconia coating.

Objective:To explore the application value of enhanced recovery after surgery (ERAS) in laparoscopic radical resection of bladder cancer and ileal bladder surgery under modular operation procedures.Methods:A retrospective selection of 42 cases of laparoscopic radical radical resection of bladder cancer and ileal bladder surgery performed by the Department of Urology, General Hospital of Southern Theater Command from January 2017 to December 2019 were divided into two groups according to the different management methods adopted during the perioperative period: ERAS management group and conventional management group, each with 21 cases. Among them, patients in the ERAS management group were managed by ERAS during the perioperative period, and patients in the conventional management group were managed by conventional management during the perioperative period. The postoperative hospital stay, first exhaust time, first defecation time, first time to get out of bed, first liquid food time, postoperative visual analogue scale (VAS) score, as well as transferrin, upper arm circumference, body mass index, plasma albumin, total protein, and total protein were compared between the two groups of patients after surgery. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the in dependent t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)], the independent sample Mann-Whitney U test was used for comparison between groups; the Chi-square test was used for comparison of enumeration data between groups. Results:The postoperative hospital stay in the ERAS group was (8.9±1.8) d, the first exhaust time was (33.4±3.2) h, the first defecation time was (60.3±7.8) h, the first time to get out of bed was (23.1±6.7) h, the first liquid food time was (82.7±18.5) h and postoperative VAS was (1.3±0.6), that were significantly reduced compared with the conventional treatment group [(12.3±2.3) d, (51.4±5.2) h, (73.0±8.1) h, (34.7±8.2) h, (109.7±21.6) h, (3.6±0.8)], the difference were statistically significant ( P<0.05). In the ERAS group, the decreased value of transferrin was [0.8 (-0.4, 2.2) g/L], the decreased value of body mass index was[1.61±0.73], the decreased value of plasma albumin was [3.5±1.5 g/L], the decrease value of total protein was[10.1±5.6 g/L] and the decrease value of prealbumin was [90.5±11.3 mg/L] were significantly lower than those of the conventional management group[(1.9(0.9, 3.6) g/L, (2.32±1.05) kg/m 2, (9.6±2.0) g/L, (16.3±4.9) g/L, (131.3±7.4) g/L], and the difference were statistically significant ( P<0.05). Conclusion:Modular laparoscopic precision resection of bladder cancer and ERAS concept after ileal bladder surgery is beneficial to shorten the hospital stay, reduce postoperative pain, have less impact on the patient′s body loss and immune function, and can speed up the patient′s postoperative recovery.

Objective:To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4.5 h in patients with acute ischemic stroke.Methods:A retrospective analysis was performed; 180 acute ischemic stroke patients admitted to Department of Neurology, Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen. Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0.4; good collateral circulation: HIR>0.4); clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4.5 h in patients with acute ischemic stroke. Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke. Role of HIR as agency between SIR and onset time was explored. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4.5 h in acute ischemic stroke patients.Results:Of the 180 patients, 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group; compared with the good collateral circulation group, the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia, larger DWI infarction volume before treatment, larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR ( P<0.05). In these 180 patients, 76 had onset time≤4.5 h and 104 had onset time>4.5 h. Univariate Logistic regression analysis showed that hyperlipidemia, DWI infarct volume before treatment, DWI-FLAIR mismatch, HIR and SIR were influencing factors for onset time≤4.5 h in acute ischemic stroke patients ( P<0.05). Multivariate Logistic regression analysis showed that hyperlipidemia ( OR=6.654, 95% CI: 5.751-8.824, P<0.001), HIR ( OR=0.724, 95% CI: 0.521-1.321, P=0.041) and SIR ( OR=739.881, 95% CI: 383.296-14 258.065, P<0.001) were independent influencing factors for onset time≤4.5 h in acute ischemic stroke patients. Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke ( r=0.420, P<0.05), and SIR was positively correlated to onset time in patients from poor collateral circulation group ( r=0.781, P<0.05). ROC curve showed that AUC of SIR in predicting onset time≤4.5 h was 0.917 (95% CI: 0.814-1.000, P<0.001) and that of DWI-FLAIR mismatch in predicting onset time≤4.5 h was 0.530 (95% CI: 0.509-0.757, P=0.075) in poor collateral circulation group, enjoying significant difference in predictive efficacy. Conclusion:Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4.5 h; SIR can more accurately predict the onset time in these patients with poor collateral circulation.

Objective The objectives of present study is to investigate the safety and efficacy of pelvic exenteration (PE) for the treatment of pelvic malignancies in urology department.Methods From April 2010 to December 2014,20 patients with primary or recurrent pelvic malignancy accepted anterior pelvic exenteration (APE) or total pelvic exenteration (TPE) surgery,including 7 males and 13 females,ranged from 35 to 87 years old with an average of 65 years old.Ten case accepted APE and 10 for TPE.The ilium conduit was done in 5 cases for APE and 6 cases for TPE as urinary diversion,cutaneous ureterostomy was done in 5 cases for APE and 4 cases for TPE as urinary diversion.There were 6 cases primary tumor in APE group and 3 primary tumors in TPE.All of the patients had 13 cases of the urinary tract tumor group,and none of the urinary tract tumor group in 7 cases.There were 4 cases received preoperative chemotherapy in the urinary tract tumor group.No case received preoperative radiotherapy.3 cases received preoperative chemotherapy in none of the urinary tract tumor group,3 cased received preoperative radiotherapy.After induction of general anesthesia using a laryngeal mask for airway management.All patients took the abdominal incision,then dissected lymph nodes on both sides of the iliac vessels,freed bilateral ureters to the end of the swollen bladder,separated the peritoneal space.The bilateral vas deferens was cutted and ligated,then isolated and ligated the seminal vesicles between the posterior wall of the bladder and the anterior wall of the rectum.Lateral ligaments of bladder was cuted,then cuted ligament of prostate and puboprostatic ligament,sutured and cut deep vein of penis.Urethra of apex prostate was freed and cuted.Female patients needed to free the uterus and the posterior wall,cut the cardinal ligament and round ligament of uterus,isolate the posterior wall of the uterus to the posterior vaginal wall.Rectal resection adopted Miles operation.And sigmoid colostomy was performed on the left side of the abdominal wall.The perioperative characters,pathological results and patients' survival data were collected and analyzed.Results The average operation time for APE was 3.8 hours and 5.2 hours for TPE (P =0.173).Median length of hospital stay was 17.9 (7-47) days.The median blood loss was 300ml (80-2 500 ml) for APE and 400ml (50-6 000 ml) for TPE (P =0.909).The median follow-up time was 12.5 months (1-41months).The estimated 2-year survival rate for APE was 55.6％ and 45.0％ for TPE (P =0.642).Urinary system tumors group and non urinary system tumors group were analyzed and compared,The median survival time was 28 months and 13 months (P =0.538) in the two groups.The incidence of gastrointestinal complications of urinary system tumors and non-urinary system tumors was 7.7％ and 28.6％,incision complications was 7.7％ and 28.6％.Complications of urinary diversion only occurred in the non urologic tumor group,the incidence was 14.3％.The incidence of transfusion in two groups was 46.2％ and 28.6％.Conclusions Pelvic exenteration (APE and TPE) could be a safe and reliable choice for local advanced primary and recurrent pelvic malignancy.Even for the recurrent malignancies,the survival results of the patients were satisfactory.

OBJECTIVETo construct a knowledge platform of acupuncture ancient books based on data mining technology, and to provide retrieval service for users.

METHODSThe Oracle 10 g database was applied and JAVA was selected as development language; based on the standard library and ancient books database established by manual entry, a variety of data mining technologies, including word segmentation, speech tagging, dependency analysis, rule extraction, similarity calculation, ambiguity analysis, supervised classification technology were applied to achieve text automatic extraction of ancient books; in the last, through association mining and decision analysis, the comprehensive and intelligent analysis of disease and symptom, meridians, acupoints, rules of acupuncture and moxibustion in acupuncture ancient books were realized, and retrieval service was provided for users through structure of browser/server (B/S).

RESULTSThe platform realized full-text retrieval, word frequency analysis and association analysis; when diseases or acupoints were searched, the frequencies of meridian, acupoints (diseases) and techniques were presented from high to low, meanwhile the support degree and confidence coefficient between disease and acupoints (special acupoint), acupoints and acupoints in prescription, disease or acupoints and technique were presented.

CONCLUSIONSThe experience platform of acupuncture ancient books based on data mining technology could be used as a reference for selection of disease, meridian and acupoint in clinical treatment and education of acupuncture and moxibustion.