The grade of histological severity is a determining factor to evaluate the prognosis and survival rate in primary biliary cholangitis (PBC). However, liver biopsy is limited by sampling error, invasiveness, high cost, and poor compliance. Therefore, in order to overcome the limitations of liver biopsy, some non-invasive evaluation methods have been studied and applied to evaluate the progression of liver fibrosis in PBC. The prognostic score can be calculated using routine laboratory test results obtained at the time of diagnosis, which are characterized by their simplicity, affordability, ease of acquisition, and superior reproducibility. Recent studies have reported that the prognostic score can be employed as a non-invasive liver fibrosis model to diagnose the liver fibrosis stage in PBC and predict the transplant-free survival rate, in addition to being used to evaluate the patient prognosis and transplant-free survival (TFS). This paper reviews, summarizes, and explores the research progress of different prognostic scores as non-invasive liver fibrosis models via their diagnostic performance and predictive accuracy for PBC.

The grade of histological severity is a determining factor to evaluate the prognosis and survival rate in primary biliary cholangitis (PBC). However, liver biopsy is limited by sampling error, invasiveness, high cost, and poor compliance. Therefore, in order to overcome the limitations of liver biopsy, some non-invasive evaluation methods have been studied and applied to evaluate the progression of liver fibrosis in PBC. The prognostic score can be calculated using routine laboratory test results obtained at the time of diagnosis, which are characterized by their simplicity, affordability, ease of acquisition, and superior reproducibility. Recent studies have reported that the prognostic score can be employed as a non-invasive liver fibrosis model to diagnose the liver fibrosis stage in PBC and predict the transplant-free survival rate, in addition to being used to evaluate the patient prognosis and transplant-free survival (TFS). This paper reviews, summarizes, and explores the research progress of different prognostic scores as non-invasive liver fibrosis models via their diagnostic performance and predictive accuracy for PBC.

Objective To study the composition and concentration of atmospheric particulate pollutants in four seasons in the industrial and clean living areas， and to provide a scientific basis for the strategy of controlling industrial pollution and atmospheric environment. Methods An industrial area dominated by the automobile industry in Shanghai and a relatively clean living area were selected. Samples were collected simultaneously in both areas and continuously for 7 days in the middle of each season. The composition and concentration of PM_2.5 were determined， and the ecological risk of heavy metals in PM_2.5 was evaluated by the potential ecological risk index method. Results We found PM_2.5 concentration was associated with seasonal changes. The PM_2.5 concentration in living areas was the highest in winter， followed by spring， and the lowest in summer. The PM_2.5 concentration in industrial areas was the highest in spring， followed by winter， and the lowest in summer. The heavy metals in PM_2.5 were the same， including Al， Cr， Mn， Ni， As， Cd， Hg and Pb. The content of Cr， Cd and Pb in PM_2.5 in the industrial area is significantly higher than that in the living area. The potential ecological hazard coefficient of PM_2.5 heavy metal Cd in the industrial zone was the highest， up to 189.47， and it was the main component of the total potential ecological hazard index of heavy metals. According to the total potential risk grade of heavy metals， the heavy metal Cd in the industrial area had different degrees of ecological harm with seasonal changes. The ecological harm degree of heavy metal Cd was the highest in winter， high in spring and autumn， and low in summer. Conclusion Although the concentration of PM_2.5 in the industrial area is not higher than that in the living area， the content of Cr， Cd and Pb in the PM_2.5 in the industrial area is significantly higher than that in the living area. The concentration of PM_2.5 in the industrial area is mainly related to seasons， industrial production and human factors. The potential ecological harm coefficient of heavy metal Cd in PM_2.5 is the highest in comparison with other heavy metals such as Cr， Hg and Pb， and it is the main component of the total potential ecological harm index ofheavy metals.

Objective:To describe the prevalence and clinical characteristics of macroprolactinemia in hyperprolactinemia patients.Methods:Consecutive 111 outpatients diagnosed with hyperprolactinemia were included in this study. Macroprolactin was routinely screened using the polyethylene glycol(PEG) precipitation method. Recovery of monomeric prolactin less than 40% was defined as macroprolactinemia. Clinical characteristics were analyzed in this study.Results:Among the 111 cases included, 99 were female and 12 were male, with an average age of(32.2±7.9) years. There were 32 cases(28.8%) of macroprolactinemia and 28 of them with normal monomeric prolactin levels(simple macroprolactinemia). prolactin levels before precipitation in simple macroprolactinemia were significantly lower than those with true hyperprolactinemia[(49.81±23.58 vs 83.56±65.82) ng/mL, P<0.05]. No amenorrhea and infertility were observed in patients with simple macroprolactinemia. The clinical manifestations of prolonged menstruation, oligomenorrhea and galactorrhea in female patients accounted for 25.9%, 37.0%, and 7.4%, respectively. Imaging data were obtained in 92 cases. The prevalence of pituitary adenomas in simple macroprolactinemia and true hyperprolactinemia was 42.9% and 66.0%, respectively. Fifteen(46.8%) of the macroprolactinemia cases were receiving or had received bromocriptine treatment, and 66.7% of them failed to achieve normal prolactin levels during therapy. Conclusion:Macroprolactinemia might be common in clinical practice. Macroprolactin should be screened in hyperprolactinemia patients lack of amenorrhea and infertility, and with poor response to dopamine agonist therapy.

Objective To investigate the protection of parathyroid glands and their functions during reoperation of thyroid carcinoma.Methods The clinical data of 39 patients who underwent reoperation of thyroid carcinoma from Jan.2012 to Mar.2017 in our hospital were studied retrospectively.They were divided into two groups (group A:17 patients who underwent reoperation within 3 months from initial operation;group B:22 patients who underwent reoperation 3 months or longer since the first operation).The numbers of parathyroid including inadvertent parathyroidectomy (IPE) and ischemic parathyroid,and the dyeing conditions in the two groups were observed and recorded respectively.Serum calcium and parathyroid hormone (PTH) levels were determined after operation.Results In group A,10 cases with IPE(7 parathyroid glands were found intraoperative dissection specimens,3 parathyroid glands postoperatieve pathology confirmed),4 parathyroid glands in situ were found ischemia;In group B,4 cases with IPE (4 parathyroid glands were found intraoperative dissection specimens),3 parathyroid glands in situ were found ischemia.All of IPE found through intraoperative dissection and ischemic parathyroid glands were transplanted.A total of 11 parathyroid glands were transplanted in group A(7 cases with 1 parathyroid transplantation and 2 cases with 2 parathyroid transplantation).The number of parathyroid gland transplants in group B was 7 (5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation).The rate of IPE in the group A was 58.8％(10/17),significantly higher than 18.2％(4/22) in the group B (P＜0.05);The rate of temporary hypoparathyroidism in the group A was 52.9％ (9/17),significantly higher than in the group B 18.2％(4/22) (P＜0.05);With the follow-up of 3～6 months after surgery,no case with permanent hypoparathyroidism.Conclusion Select the appropriate reoperation time combined the nano-carbon negative development during the reoperation of thyroid carcinoma,can reduce IPE;necessary parathyroid transplantations are effective measures to avoid the postoperative permanent hypoparathyroidism.

Objective To investigate the influence of synangio-excision-restruction in pancreatic cancer radical operation on the complications,living quality and survival status in the patients with pancreatic cancer.Methods A total of 255 patients with pancreatic cancer in our hospitals from January 2010 to October 2015 were selected and divided into 3 groups according to different operation modes:41 cases in the Synangio-excision-restruction group(A),113 cases in the non-synangio-excision-restruction group (B) and 101 cases in the palliative by-pass operation group(C).The clinical data in 3 groups were analyzed.The influence of Synangio-excision-restruction on operative complications,living quality and survival status was investigated.Results The incidence rate of complications in the group A was 56.10％,which was obviously higer than 34.51％ in the group 1β and 20.79％ in the group C,and the difference was statistically significant(P＜0.05).In the group A,the incidence rates of belly ache and body weight gain were 36.59％ and 51.22％ respectively,which comparing with 91.09％ and 9.09％ in the group C showed statistically significant difference(P＜0.05).The median survival time(MST) in the group A was 11.83 months,which in the group B and C were 15.43 months and 7.50 months,the difference between the group A and C was statistically significant(x2 =4.27,P＜0.05);while the difference between the group A and B was not statistically significant(x2=3.67,P＞0.05).Conclusion For the pancreatic cancer patients with affected portal vein and inferior mesenteric vein,the synangio-excision-restruction radical operation can obviously prolong the patients' survival time and improves their living quality.

ObjectiveTo investigate the risk factors and pathogenic characteristics of catheterrelated infection (CRI) in intensive care unit (ICU),so as to find a better way for its treatment.Methods Retrospective analysis was performed on 247 deep-venous catheter (DVC) from January 2007 to December 2010.ResultsAmong 247 patients,positive results of 41 patients diagnosed CRI,negative results of 206 patients undiagnosed CRI.Compared with undiagnosed CRI patients,found the correlation of the underlying infectious diseases,indwelling time of catheter and puncture sites associated with CRI occurred(P ＜ 0.05 ).CRI major pathogen was gram-positive bacteria (58.5％,24/41 ),in which Staphylococcus epidermis was the major pathogenic bacteria(22.0％,9/41).The drug resistance occurred in most pathogen.Conclusions The occurrence of CRI is related with multiple clinical factors.The gram-positive bacteria is the major pathogen.The etiological monitor should be enforced in patients with DVC.