Malignant biliary obstruction is often in an advanced stage at the time of diagnosis, and palliative relief of obstruction has become the main treatment option. Biliary stent implantation is currently the most widely used treatment for the relief of biliary obstruction, but stent reobstruction has become a common problem in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) combined with intraductal radiofrequency ablation can solve the problem of direct obstruction in malignant biliary obstruction and improve stent patency rate, survival time, and survival rate, with few complications and a low surgery-related mortality rate, and therefore, it can be used as a safe and feasible palliative treatment method for malignant biliary obstruction.

Objective To explore brain glucose metabolism changes in positron emission tomography (PET) studies in depression patients with systematic review and meta-analysis.Methods Standard search strategy for the Cochrane Review Group was performed in PubMed,EMBase,and Web of Science,PsycINFO,Cochrane Library,CNKI,Wanfang,VIP and CBMDisc databases.The papers were published from Jan 1,1982 to Apr 8,2014.Search key words included depression,depressive,PET,position emission tomography,FDG and 18 F-Fluorodeoxyglucose.Hand searching and truncation were also used to avoid missing references.Psychiatric journals and fluoro-deoxyglucose related articles were manual searched from 2013 October to April 2014.SDM (signed differential mapping) software was used for voxelbased meta-analysis (P ≤ 0.005,extent threshold ＞ 10).MNI coordinates were calculated to Talairach coordinates in all of the included studies.Brain parameter mapping was reconstructed by SDM software.Then Pooled Meta-analysis was performed.Results Ten studies met the inclusion criteria,including 188 depressed patients and 169 healthy controls.There was no significant heterogeneity between the ten studies (P ＞ 0.05).SDM analysis showed depressive patients had decreased brain metabolism in right inferior frontal gyrus (orbital part and opercular part),right gyrus rectus,right dorsolateral superior frontal gyrus,right median cingulate/paracingulate gyri,left superior temporal gyrus and left middle frontal gyrus (orbital part) and increased brain metabolism in bilateral thalamus,right angular gyrus and left precentral gyrus.Conclusions These results suggest that depressive patients had brain function abnormalities with decreased activity in fronto-temporal-limbic system and increased activity in thalamus.

Objective To explore brain glucose metabolism changes in positron emission tomography (PET) studies in depression patients with systematic review and meta-analysis.Methods Standard search strategy for the Cochrane Review Group was performed in PubMed,EMBase,and Web of Science,PsycINFO,Cochrane Library,CNKI,Wanfang,VIP and CBMDisc databases.The papers were published from Jan 1,1982 to Apr 8,2014.Search key words included depression,depressive,PET,position emission tomography,FDG and 18 F-Fluorodeoxyglucose.Hand searching and truncation were also used to avoid missing references.Psychiatric journals and fluoro-deoxyglucose related articles were manual searched from 2013 October to April 2014.SDM (signed differential mapping) software was used for voxelbased meta-analysis (P ≤ 0.005,extent threshold ＞ 10).MNI coordinates were calculated to Talairach coordinates in all of the included studies.Brain parameter mapping was reconstructed by SDM software.Then Pooled Meta-analysis was performed.Results Ten studies met the inclusion criteria,including 188 depressed patients and 169 healthy controls.There was no significant heterogeneity between the ten studies (P ＞ 0.05).SDM analysis showed depressive patients had decreased brain metabolism in right inferior frontal gyrus (orbital part and opercular part),right gyrus rectus,right dorsolateral superior frontal gyrus,right median cingulate/paracingulate gyri,left superior temporal gyrus and left middle frontal gyrus (orbital part) and increased brain metabolism in bilateral thalamus,right angular gyrus and left precentral gyrus.Conclusions These results suggest that depressive patients had brain function abnormalities with decreased activity in fronto-temporal-limbic system and increased activity in thalamus.

Objective To discuss the clinical effect of Sky bone expander percutaneous ky-pbeplasty (Sky-PKP) in treatment of old osteoperotic vertebral compression fractures. Methods The study involved 27 patients (27 vertebrae) with old osteoporotic vertebral compression fractures treated by Sky-PKP from March 2005 to June 2007. Normotopia, lateral and dynamia radiographs, CT scanning and MRI were performed preoperatively to verify fluid collection in the vertebral body, vacuum phenomenon and open-close phenomenon. Visual analog scale (VAS), Oswestry disability index (ODI), anterior body height, middle line body height, posterior body height and kyphotic angle changes were measured on a lateral radiograph before and after treatment. Results All patients were followed up for mean 6.2 months, which showed no severe complications. VAS score was decresed from preoperative 7.8 to postop-erative 3.1 and ODI from 65% to 37%. However, The anterior vertebral height and middle line vertebral height were recovered for 4.6 nun and 5.7 mm respectively compared with preoperation. Correction of ky-photic angle was mean 5.6°postoperatively. There was no sitatistical changes in regard to posterior body height before and after operation. Conclusions Sky-PKP is a reasonable procedure for treatment of old osteoporotic vertebral compression fractures under strict control of indications, especially with vacuum phenomenon, open-close phenomenon and fluid collection. While high degree of difficulty in puncturation results in insignificant correction of kyphotic angle and body height.

Objective　To identify the relationship between polycystic ovarian syndrome and hyperinsulinemia. Methods　Age, body height, body weight, serum estradiol, progesterone, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin(PRL), triiodothyronine (T3), tetraiodothyronine (T4), insulin, oral glucose tolerance test (OGTT), and cortisol were measured in 28 patients with polycystic ovarian syndrome (PCOS).Results　Sxiteen patients (57.1% of total) had hyperinsulinemia. Among them one patient was found diabetic. No difference was noted in age, height, body weight, body mass index, serum estradiol, progesterone, testosterone, FSH, LH, PRL, T3, T4, cortisol, and glucose of OGTT between hyperinsulinemia and non-hyperinsulinemia patients. However the LH/FSH ratio(2.4±1.5) in hyperinsulinemia patients was significantly higher than 1.2±0.6 in non-hyperinsulinemia patients （P=0.0125）. In addition, the results showed that the fasting serum insulin, insulin after OGTT,the insulin/glucose ratio at 30, 120 minutes, 180 minutes, the area under curve of and the insulin, insulin resistant index (IRI) were higher in hyperinsulinemia pateints than in non-hyperinsulinemia patients respectively. Furthermore, the fasting insulin level, insulin/glucose ratio were found to be negatively related to insulin sensitivity index and positively related with β-cell functioning index. Conclusion　Hyperinsulinemia and insulin resistance accompany with some of the PCOS patients in China. Further investigations will be necessary to clarify the relevant mechanisms.