Objective:To summarize the successful diagnosis and treatment experience of two patients with peritoneal dialysis complicated with cholangiolithiasis and cholangitis who received endoscopic retrograde cholangiopancreatography (ERCP).Methods:A retrospective analysis was conducted on the clinical data of two patients with peritoneal dialysis combined with bile duct stones at Peking University Third Hospital who underwent ERCP combined with endoscopic sphincterotomy and were successfully transferred out of the hospital. Observe successful removal of bile duct stones and adverse events related to surgery, such as pancreatitis, summarize experience, and conduct literature review.Result:The overall success rate of stone removal in 2 patients was 100%, and they recovered well after treatment without severe postoperative bleeding. One patient developed postoperative pancreatitis and secondary peritonitis after ECRP, and active anti infection treatment did not affect peritoneal function. Regular peritoneal dialysis was maintained during the perioperative period, and postoperative close follow-up and flexible adjustment of peritoneal dialysis dose and concentration were carried out to ensure a smooth transition of patients to regular and stable peritoneal dialysis.Conclusion:ERCP is a feasible treatment for PD patients combined with choledocholithiasis, and can be well tolerated by them. The treatment of peritoneal dialysis patients requires long-term follow-up and management, and multidisciplinary cooperation is required when acute complications occur.

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.

Pain is one of the most prevalent health problems. Current medications for pain are mainly anticonvulsants， tricyclic antidepressants， and opioidergic drugs. However， their therapeutic effectiveness is limited during application， and some even have severe side effects. In recent years， research on natural ingredients from Chinese herbal medicine has been extensively conducted for their analgesic activities. A series of natural ingredients represented by alkaloids， coumarins， flavonoids， and terpenoids have shown great analgesic activity， and further studies on their analgesic mechanism have found that most natural products have multi-target analgesic mechanisms. It can exert analgesic effects by blocking ion channels， regulating related receptors， or inducing anti-inflammatory or antioxidant effects. In addition， many traditional Chinese medicine （TCM） formulas have shown great analgesic ability after clinical application and have multiple complex analgesic mechanisms. The drug cloud （dCloud） theory can better describe the mechanisms， and it can represent the complete therapeutic spectrum of multi-target analgesics from two dimensions， namely the "direct efficacy" that directly inhibits pain signals and the "background efficacy" that targets the root causes of pain. The authors summarized the research progress of natural ingredients with analgesic effects found in Chinese herbal medicine so far， as well as the analgesic efficacy and potential mechanisms of TCM formulas with great analgesic effects in clinical applications， so as to provide a new basis for searching for new analgesic drugs from TCM.

Hilar cholangiocarcinoma is one of the most difficult malignant tumors to treat in the biliary system. In Japan, 5-year survival rate of the disease has increased from 32.5% to 67.1% during the past 30 years. The impressive progress reflects the solid efforts in preoperative endoscopic diagnosis, innovation in surgery such as PTPE as well as hepato-pancreatoduodenectomy and perioperative treatment including replacement of the bile and synbiotic treatment, which have finally formed a set of standardized diagnosis and treatment systems. The present review intends to report the history, current status and remaining bottlenecks of the diagnosis and treatment system of hilar cholangiocarcinoma in Japan as follows.

Objective To evaluate the efficacy of dezocine for prevention of postoperative cognitive dysfunction (POCD) in elderly patients undergoing total knee arthroplasty under remifentanil-based anesthesia.Methods Sixty-eight patients of both sexes, aged 65-85 yr, weighing 48-78 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective unilateral total knee arthroplasty under general anesthesia, were randomly divided into 2 groups (n =34 each) using a random number table: control group (group C) and dezocine group (group D).After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 0.05-0.06 mg · kg-1 · min-1 and remifentanil 0.05-0.10 μg · kg-1 · min-1, and intermittent iv boluses of vecuronium 0.04 mg/kg.Dezocine 0.1 mg/kg was injected intravenously at 30 min before skin incision in group D.At 1 day before operation (T0) , and 1, 3, 5, 7 days after operation (T1 , T2, T3 , T4) , the blood samples from the central vein were collected for determination of serum cortisol (Cor), neuron specific enolase (NSE) and S-100β protein concentrations.Before operation, and 5 and 7 days after operation, the patients' cognitive function was assessed using Mini-Mental State Examination, and the occurrence of POCD was recorded.Results Compared with the baseline value at T0, the serum Cor, NSE and S-100β protein concentrations were significantly increased at T1-3, and MMSE scores were decreased at T3,4 in the two groups.Compared with group C, the serum Cot, NSE and S-100β protein concentrations were significantly decreased at T1-4, and Mini-Mental State Examination scores were increased at 5 and 7 days after operation, and the incidence of POCD was decreased in group D.Conclusion Dezocine 0.1 mg/kg intravenously injected at 30 min before skin incision can prevent the occurrence of POCD in elderly patients undergoing total knee arthroplasty under remifentanil-based anesthesia.

Objective To study the relationship between glycemic control and platelet parameters in newly diagnosed type 2 diabetic patients. Methods Ninety patients newly diagnosed as type 2 diabetes and 90 healthy people were enrolled into the study. Their blood pressure, platelet parameters, including blood platelets count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), fasting blood glucose (FPG),HbA1c ,triglyceride ( TG ), total cholesterol ( TC ), high density lipoprotein cholesterol (HDL-C ), low density lipoprotein cholesterol(LDL-C) were examined and the data were analyzed. Results The level of FBG, TG, TC,MPV and PDW of patients newly diagnosed as type 2 diabetic were significantly higher than those of healthy people (t =6. 405,2. 069,2. 633,2. 178,2. 103 ;P =0. 001,0. 046,0. 010,0. 031 and 0. 043 respectively); The level of FBG, HbA1c, TC, TG, MPV and PDW in the diabetic patients, with their HbA1 c ＞ 7%, were significantly higher than the patients with HbA1c ≤ 7 % ( t = 5.691,2.013,2. 345,3. 467,4. 016,2. 893, P = 0. 001, 0. 038,0. 029,0. 013, 0. 004, 0. 026 ). There were positive correlations between MPV and HbA1c ( r = 0. 389 P =0. 020), MPV and PDW ( r = 0. 324 P = 0. 01 ) in diabetic patients, but no correlation between MPV and FBG,MPV and Systolic BP or MPV and Diastolic BP (Ps ＞ 0. 05 ). The level of FBG, HbA1c, TG, MPV and PDW decreased significantly in the diabetic patients with HbA1c ＞ 7% after treatment (t = 5. 591,2. 301,2. 410,2.204,2.105; P=0.001,0.031,0.023,0.035,0.041, respectively).Conclusion The platelet activity enhanced in newly diagnosed type 2 diabetic patients, platelet activity can be recovered through glycemic control,which may prevent the role of platelet in diabetes complications in these patients.

Objective To explore the correlation of the distance between anastomosis and dentate line in patients with severe circumferential prolapsed haemorrhoids treated by stapled haemorrhoidectomy with the patients' postoperative clinical manufestival score, and assess its value in the choice of anastomosis site in stapled haemorrhoidectomy. Methods One hundred and six patients with severe circumferential prolapsed haemorrhoids was treated by stapled haemorrhoidectomy. The distance between anastomosis and dentate line was documented during the operation, effect of the treatment and complications were also documented postoperatively. All above-mentioned data were analysed statisticaly by one-way ANOVA and ridit test.Results Four groups were established in 106 patients according to the distance between anastomosis and dentate line. Patients with distance less than 1.0cm were defined as group A, between 1.0 cm and 1.5 cm as group B, between 1.5 cm and 2.0 cm as group C, more than 2.0 cm as group D. Concerning the postoperative incontinence score, satisfaction index and complications such as haemorrhage,ederma of anal everage,residal skin-tags, there was no significant difference between all groups. But there was significant difference between four groups in score of pain. Conclusions Patients with severe circumferential prolapsed haemorrhoids treated by Stapled haemorrhoidectomy tend to have good clinical outcome. The appropriate distance between anastomosis and dentate line should be chosed by the status of prolapsed haemorrhoids.

Objective To investigate the relationship between the characteristics of promoter methylation of thyroid stimulating hormone receptor(TSHR) gene in papillary thyroid Carcinomas(PTC) and the clinical manifestation of PTC. Methods The methylation status of TSHR gene was detected by methylation specific PCR technique(MSP).Results (1) The methylation rate of TSHR gene in PTC tissues was 64.7%(22/34),while the methylation rate of TSHR gene in adjacent thyroid tissues(ATT) was 26.5%(9/34),and the rate of methylation of TSHR promoter in PTC was significantly higher than of ATT(P

[Objective]To investigate the curative effect of intermittent pneumatic compression(IPC) in the treatment of deep venous thrombosis(DVT) after interventional thrombolysis.[Method]Fifty-two cases of DVT were treated from December 1998 to August 2007,and divided into 2 groups randomly.In the first group,all cases received low molecular heparin and warfarin after routine or interventional thrombolysis.In the second group,IPC was used on the basis of group one.Two groups were compared about cases for repeated thrombolysis,time point of symptom relief,reduction of swelling at 7 days after surgery,re-canalization of vein at 1 month after surgery.[Result]Three cases in the first group needed repeated thrombolysis while none was found in the second group.In the second group,quicker symptom relief,more obvious reduction of swelling,wider re-canalization of vein were observed compared with the first group.[Conclusion]IPC is proved effective in the comprehensive therapy of DVT.

The methylation-specific PCR technique was applied to detect the promoter methylation of sodium iodide symporter(NIS)gene in 34 cases of papillary thyroid carcinoma(PTC)and adjacent thyroid tissure (ATF).The results showed that the methylation of NIS promoter in PTC was significantly higher than that in ATT (P