ObjectiveTo evaluate the clinical efficacy of Maxing Loushi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with phlegm turbidity obstructing lung syndrome， and to investigate its effects on inflammatory factors， immune function， and the programmed death-1（PD-1）/programmed death-ligand 1 （PD-L1） signaling pathway. MethodsA randomized controlled study was conducted， enrolling 90 hospitalized patients with AECOPD and phlegm turbidity obstructing lung syndrome in the Respiratory and Emergency Departments of Dongzhimen Hospital， Beijing University of Chinese Medicine， from April 2024 to December 2024. Patients were randomly assigned to a control group and an observation group using a random number table， with 45 patients in each group. The control group received conventional Western medical treatment， while the observation group received additional Maxing Loushi decoction for 14 days. Clinical efficacy， COPD Assessment Test （CAT） score， modified Medical Research Council Dyspnea Scale （mMRC）， 6-minute walk test （6MWT）， serum inflammatory factors， T lymphocyte subsets， and serum PD-1/PD-L1 levels were compared between the two groups before and after treatment. ResultsThe total clinical effective rate was 78.57% （33/42） in the control group and 95.35% （41/43） in the observation group， with the observation group showing significantly higher efficacy than that of the control group. The difference was statistically significant （χ² = 5.136， P<0.05）. After treatment， both groups showed significant reductions in CAT and mMRC scores （P<0.05， P<0.01） and significant increases in 6MWT compared to baseline （P<0.01）. The observation group demonstrated significantly greater improvements than the control group in this regard. Levels of inflammatory markers including C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， monocyte chemoattractant protein-1（MCP-1）， and macrophage inflammatory protein-1α （MIP-1α） were significantly reduced in both groups （P<0.05， P<0.01）， with greater reductions in the observation group （P<0.05， P<0.01）. CD8⁺ levels were significantly reduced （P<0.01）， while CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels were significantly increased in both groups after treatment （P<0.05， P<0.01）， with more significant improvements observed in the observation group （P<0.05， P<0.01）. Serum PD-1 levels were reduced （P<0.05， P<0.01）， and PD-L1 levels were increased significantly in both groups after treatment （P<0.05， P<0.01）， with more pronounced changes in the observation group （P<0.05）. ConclusionMaxing Loushi decoction demonstrates definite therapeutic efficacy as an adjunctive treatment for patients with AECOPD and phlegm turbidity obstructing lung syndrome. It contributes to reducing serum inflammatory factors， improving immune function， and regulating the PD-1/PD-L1 signaling pathway.

ObjectiveTo evaluate the clinical efficacy of Maxing Loushi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with phlegm turbidity obstructing lung syndrome， and to investigate its effects on inflammatory factors， immune function， and the programmed death-1（PD-1）/programmed death-ligand 1 （PD-L1） signaling pathway. MethodsA randomized controlled study was conducted， enrolling 90 hospitalized patients with AECOPD and phlegm turbidity obstructing lung syndrome in the Respiratory and Emergency Departments of Dongzhimen Hospital， Beijing University of Chinese Medicine， from April 2024 to December 2024. Patients were randomly assigned to a control group and an observation group using a random number table， with 45 patients in each group. The control group received conventional Western medical treatment， while the observation group received additional Maxing Loushi decoction for 14 days. Clinical efficacy， COPD Assessment Test （CAT） score， modified Medical Research Council Dyspnea Scale （mMRC）， 6-minute walk test （6MWT）， serum inflammatory factors， T lymphocyte subsets， and serum PD-1/PD-L1 levels were compared between the two groups before and after treatment. ResultsThe total clinical effective rate was 78.57% （33/42） in the control group and 95.35% （41/43） in the observation group， with the observation group showing significantly higher efficacy than that of the control group. The difference was statistically significant （χ² = 5.136， P<0.05）. After treatment， both groups showed significant reductions in CAT and mMRC scores （P<0.05， P<0.01） and significant increases in 6MWT compared to baseline （P<0.01）. The observation group demonstrated significantly greater improvements than the control group in this regard. Levels of inflammatory markers including C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， monocyte chemoattractant protein-1（MCP-1）， and macrophage inflammatory protein-1α （MIP-1α） were significantly reduced in both groups （P<0.05， P<0.01）， with greater reductions in the observation group （P<0.05， P<0.01）. CD8⁺ levels were significantly reduced （P<0.01）， while CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels were significantly increased in both groups after treatment （P<0.05， P<0.01）， with more significant improvements observed in the observation group （P<0.05， P<0.01）. Serum PD-1 levels were reduced （P<0.05， P<0.01）， and PD-L1 levels were increased significantly in both groups after treatment （P<0.05， P<0.01）， with more pronounced changes in the observation group （P<0.05）. ConclusionMaxing Loushi decoction demonstrates definite therapeutic efficacy as an adjunctive treatment for patients with AECOPD and phlegm turbidity obstructing lung syndrome. It contributes to reducing serum inflammatory factors， improving immune function， and regulating the PD-1/PD-L1 signaling pathway.

Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

Objective To explore the predictive values of the initial model for end-stage liver disease (MELD) score, MELD combined with serum sodium (MELD-Na) score and MELD combined with serum lactic acid (MELD-Lac) score for early survival rate after liver transplantation in patients with liver failure. Methods Clinical data of 135 recipients undergoing liver transplantation for liver failure were retrospectively analyzed. All patients were divided into the early survival group (n=110) and early death group (n=25) according to the survival at postoperative 28 d. Clinical data were compared between two groups. The optimal cut-off values of MELD, MELD-Na and MELD-Lac scores for predicting early survival rate after liver transplantation in patients with liver failure were determined by the receiver operating characteristic (ROC) curve. The predictive values of different scores for early survival rate after liver transplantation in patients with liver failure were evaluated. Results Significant differences were observed in the initial MELD, MELD-Na and MELD-Lac scores after liver transplantation between two groups (all P < 0.05). For the initial MELD, MELD-Na and MELD-Lac scores in predicting early survival rate after liver transplantation in patients with liver failure, the AUC were 0.653 [95% confidence interval (CI) 0.515-0.792], 0.648 (95%CI 0.514-0.781) and 0.809 (95%CI 0.718-0.900), the optimal cut-off values were 18.09, 18.09 and 19.97, Youden's indexes were 0.398, 0.380 and 0.525, the sensitivity was 0.680, 0.680 and 0.840, and the specificity was 0.720, 0.700 and 0.690, respectively. The AUC of MELD-Lac score was higher than those of MELD and MELD-Na scores, and the differences were statistically significant (both P < 0.05). Conclusions Compared with the initial MELD and MELD-Na scores after liver transplantation, the initial MELD-Lac score is a more reliable index for predicting early survival rate after liver transplantation in patients with liver failure.

Objective:To investigate the clinical efficacy of pancreaticoduodenectomy with TRIANGLE operation in the treatment of pancreatic head cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 51 patients with pancreatic head cancer who were admitted to the Sichuan Provincial People′s Hospital, Affiliated Hospital of School of Medicine of University of Electronic Science and Technology of China from January 2017 to July 2018 were collected. There were 33 males and 18 females, aged from 42 to 74 years, with a median age of 56 years. Of the 51 patients, 24 cases undergoing standard pancreaticoduodenectomy, in which No.12, 13 and 17 lymph nodes were dissected, combined with transcatheter arterial infusion chemo-therapy (TAI) were allocated into the standard group, and 27 cases undergoing pancreaticoduo-denectomy with TRIANGLE operation, in which No.7, 8, 9, 12, 13, 16, 17 lymph nodes were dissected, combined with TAI were allocated into the TRIANGLE group, respectively. Observation indicators: (1) intraoperative conditions of the two groups; (2) postoperative conditions of the two groups; (3) follow-up and survival. Follow-up was conducted using outpatient examination and telephone interview once three months to detect tumor recurrence and metastasis and survival of patients up to July 2021 or the death of patient. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the chi-square test or the Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Kaplan‐Meier method was used to calculate the survival rate and median survival time and draw survival curve. Log‐Rank test was used for survival analysis. Results:(1) Comparison of intraoperative conditions between the two groups. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion were (501±61)minutes, (563±278)mL, 4 in the standard group, versus (556±46)minutes, (489±234)mL, 6 in the TRIANGLE group, respectively. There was a significant difference in the operation time between the two groups ( t=3.62, P<0.05) but there was no significant difference in the volume of intraoperative blood loss or cases with intraoperative blood transfusion between the two groups ( t=1.03, χ2=0.25, P>0.05). (2) Comparison of postoperative conditions between the two groups. Of the 51 patients, 30 had 50 times of postoperative complications, including 18 times of grade Ⅰ complications of Clavien-Dindo classification, 29 times of grade Ⅱ complications of Clavien-Dindo classification, 2 times of grade Ⅲa complications of Clavien-Dindo classification, 1 time of grade Ⅲb complications of Clavien-Dindo classification, respectively. Cases with postoperative complications, cases with delayed gastric emptying, cases without or with pancreatic fistula as class A or class B, cases with biliary fistula, cases with bleeding, cases with diarrhea were 15, 4, 13, 7, 4, 4, 2, 2 in the standard group, versus 15, 6, 14, 10, 3, 4, 1, 3 in the TRIANGLE group, respectively. There was no significant difference in cases with postoperative complications, cases with delayed gastric emptying, cases with pancreatic fistula between the two groups ( χ2=0.16, 0.02, Z=-0.04, P>0.05) and there was no significant difference in cases with biliary fistula, cases with bleeding, cases with diarrhea between the two groups ( P>0.05). Cases with complications as Clavien-Dindo grade Ⅰ, grade Ⅱ, grade Ⅲ were 10, 11, 2 in the standard group, versus 8, 18, 1 in the TRIANGLE group, showing no significant difference between the two groups ( Z=-0.67, P>0.05). The duration of postoperative hospital stay was (23±8)days in both of the standard group and the TRIANGLE group, showing no significant difference between the two groups ( t=0.31, P>0.05). (3) Follow-up and survival. All the 51 patients were followed-up for 6 to 54 months, with a median follow-up time of 17 months. The postoperative 1-year overall survival rate was 75.0% and 81.5% in the standard group and the TRIANGLE group, respectively. The postoperative 3-year overall survival rate was 12.5% and 22.2% in the standard group and the TRIANGLE group, respectively. The median postoperative survival time was 15.00 months (95% confidence interval as 12.63 to 17.37 months) and 21.00 months (95% confidence interval as 15.91 to 19.62 months) in the standard group and the TRIANGLE group, respectively. There was a significant difference in survival of patients between the two groups ( χ2=4.30, P<0.05). Cases with tumor recurrence during post-operative 1 year and 3 year were 9 and 20 in the standard group, versus 6 and 15 in the TRIANGLE group, respectively. There was no significant difference in cases with tumor recurrence during postoperative 1 year between the two groups ( P>0.05) and there was a significant difference in cases with tumor recurrence during postoperative 3 year between the two groups ( P<0.05). Conclusion:Compared with standard pancreaticoduodenectomy, pancreaticoduodenectomy with TRIANGLE operation can prolong the median survival time of patients with pancreatic head cancer without increasing surgical related complications.

A quantitative analytical method based on HPLC coupled with the charged aerosol detector (CAD) for quantitative analysis of multi-components with a single marker (QAMS) was established for simultaneous determinations of astragaloside Ⅰ, astragaloside Ⅱ, astragaloside Ⅳ, calycosin-7-O-β-D-glucoside, formononetin and 7,2'-dihydroxy-3',4'-dimethoxyisoflavan in Astragalus membranaceus. The separation was performed on an Agilent SB-C18 (150 mm×4.6 mm, 3.5 μm), with gradient elution using the mobile phase consisting of 0.05% formic acid solution and 0.05% formic acid acetonitrile at the flow rate of 1.0 mL·min^-1. The column temperature was 35 ℃, and the injection volume was 20 μL. For CAD, the drift tube temperature was at 50 ℃. The contents of six components in A. membranaceus were determined by both external standard method (ESM) and QAMS, and then were compared. The results showed that chromatographic peaks were separated well and the linear ranges of astragaloside Ⅰ, astragaloside Ⅱ, astragaloside Ⅳ, calycosin-7-glucoside, formononetin and 7,2'-dihydroxy-3',4'-dimethoxyisoflavan were 0.113-2.250 mg·mL^-1, 0.012-0.240 mg·mL^-1, 0.004-0.080 mg·mL^-1, 0.065-1.300 mg·mL^-1, 0.005-0.100 mg·mL^-1 and 0.007-0.150 mg·mL^-1, respectively. The content ranges of astragaloside Ⅰ, astragaloside Ⅱ, astragaloside Ⅳ, calycosin-7-glucoside, formononetin and 7,2'-dihydroxy-3',4'-dimethoxyisoflavan were 0.306-0.922 mg·g^-1, 0.053-0.183 mg·g^-1, 0.015-0.092 mg·g^-1, 0.069-0.823 mg·g^-1, 0-0.098 mg·g^-1 and 0.020-0.107 mg·g^-1 in 20 batches of A. membranaceus, respectively. Using astragaloside Ⅱ as an internal reference, the relative correlation factors of astragaloside Ⅰ, astragaloside Ⅳ, calycosin-7-O-β-D-glucoside, formononetin, and 7,2'-dihydroxy-3',4'-dimethoxyisoflavan were calculated as 0.561, 0.835, 0.299, 0.796, and 0.799, respectively. The results were compared with those obtained by the external standard method to verify the feasibility, rationality and repeatability of QAMS method, and there was no significant difference in assay results between the two methods. In conclusion, the QAMS method is accurate and feasible, and could be used to determine the contents such as astragaloside Ⅰ, astragaloside Ⅱ, astragaloside Ⅳ, calycosin-7-glucoside, formononetin and 7,2'-dihydroxy-3',4'-dimethoxyisoflavan, and it can be used for quality control of A. membranaceus.

Objective:To compare the anti-HBs level in maintained hemodialysis patients one year after receiving 20 μg and 60 μg hepatitis B vaccination at 0, 1 and 6 months, and explore the influence factors for the immunity persistence and their interactions.Methods:Based on a randomized controlled trial of 20 μg and 60 μg hepatitis B vaccine immunization in maintained hemodialysis patients at 0, 1, and 6 months, follow up was conducted for the patients for one year after the completion of the vaccination for the quantitative detection of anti-HBs, and χ 2 test, t test, unconditional logistic regression and interaction analyses were used for statistical analysis. Results:One year after the vaccination, 125 and 124 patients in the 20 μg and 60 μg groups were tested for anti-HBs, respectively. The positive rate of anti-HBs in the 60 μg group (77.42%, 96/124) was significantly higher than that in the 20 μg group (65.60%, 82/125) ( P<0.05). After adjusting for the confounding factors, the positive probability of anti-HBs in the 60 μg group was 1.925 times higher than that in the 20 μg group (95% CI: 1.068-3.468). Patients with hemodialysis duration ≥5 years ( OR=0.523, 95% CI: 0.293-0.935) and diabetes mellitus ( OR=0.376, 95% CI: 0.173-0.818) had lower positive probability of anti-HBs. Moreover, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus. Conclusions:The immunity persistence after one year in 60 μg hepatitis B vaccination group was longer than that in 20 μg hepatitis B vaccination group in maintained hemodialysis patients, vaccine dose, hemodialysis duration and diabetes mellitus were the influencing factors for the immunity persistence, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus.

Objective:To evaluate the clinical efficacy of different treatment methods for chronic pancreatitis based on M-ANNHEIM system.Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 177 patients with chronic pancreatitis from two medical centers between July 2008 and July 2018 were collected, including 95 in the Sichuan Provincial People′s Hospital and 82 in the West China Hospital of Sichuan University. There were 100 males and 77 females, aged (49±5)years, with a range from 29 to 72 years. The M-ANNHEIM system was used to decide clinical stages of chronic pancreatitis. Patients in different clinical stages received drug, endoscopic or surgical treatment. Observation indicators: (1) general data and follow-up of patients; (2) treatment of patients in asymptomatic stage; (3) treatment of patients in stage Ⅰ; (4)treatment of patients in stage Ⅱ; (5) treatment of patients in stage Ⅲ; (6) treatment of patients in stage Ⅳ; (7) aggravation and new-onset of diabetes; (8) complications. Follow-up using outpatient examination, telephone, mail, and Sojump was performed to collect data for M-ANNHEIM system up to December 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the AVONA. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) General data and follow-up of patients: there were 11, 72, 55, 31, and 8 patients with chronic pancreatitis classified as asymptomatic stage, stage Ⅰ, stage Ⅱ, stage Ⅲ, stage Ⅳ of M-ANNHEIM system before treatment. Of the 177 patients, 49, 49, and 79 patients underwent drug, endoscopic and surgical treatment, respectively. All the 177 patients were followed up for (2.4±0.5)years. (2) Treatment of patients in asymptomatic stage: 11 patients in asymptomatic stage underwent drug treatment. The M-ANNHEIM score was 1.91±0.21 before treatment, and 1.27±0.14, 1.73±0.19, 2.09±0.16 at 1 month, 12 months, 24 months after treatment, respectively. (3) Treatment of patients in stage Ⅰ: of the 72 patients in stage Ⅰ, 13 underwent drug treatment, 26 underwent endoscopic treatment, and 33 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 8.11±1.05 before treatment, and 6.31±0.31, 7.69±0.24, 10.00±0.23 at 1 month, 12 months, 24 months after treatment, respectively. The M-ANNHEIM score of patients undergoing endoscopic treatment was 8.42±0.93 before treatment, and 5.13±0.25, 6.89±0.20, 8.27±0.24 at 1 month, 12 months, 24 months after treatment, respectively. The M-ANNHEIM score of patients undergoing surgical treatment was 8.13±0.77 before treatment, and 4.79±0.15, 5.42±0.22, 7.76±0.20 at 1 month, 12 months, 24 months after treatment, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.23, P>0.05). For patients in M-ANNHEIM stage Ⅰ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=2.94, 4.98, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.26, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=2.43, 5.99, 4.80, P<0.05). At 24 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=4.61, 6.29, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.63, P>0.05). (4) Treatment of patients in stage Ⅱ: of the 55 patients in stage Ⅱ, 8 underwent drug treatment, 15 underwent endoscopic treatment, and 32 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 12.61±1.16 before treatment, and 11.63±0.26, 12.57±0.30, 14.50±0.27 at 1 month, 12 months, 24 months after treatment, respectively. The above indicators of patients undergoing endoscopic treatment was 12.42±1.43, 8.47±0.24, 11.07±0.21, 11.93±0.30, respectively. The above indicators of patients undergoing surgical treatment was 12.53±1.22, 8.78±0.15, 9.94±0.21, 11.00±0.24, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.38, P>0.05). For patients in M-ANNHEIM stage Ⅱ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=8.37, 8.48, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=1.13, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=4.13, 8.48, 3.33, P<0.05). At 24 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=5.61, 6.83, 2.26, P<0.05). (5) Treatment of patients in stage Ⅲ: of the 31 patients in stage Ⅲ, 9 underwent drug treatment, 8 underwent endoscopic treatment, and 14 underwent surgical treatment. The M-ANNHEIM score of patients undergoing drug treatment was 17.25±0.89 before treatment, and 17.11±0.35, 18.44±0.41, 17.33±0.44 at 1 month, 12 months, 24 months after treatment, respectively. The above indicators of patients undergoing endoscopic treatment was 17.38±1.06, 15.00±0.53, 16.50±0.33, 16.88±0.44, respectively. The above indicators of patients undergoing surgical treatment was 17.63±1.06, 14.64±0.34, 16.00±0.35, 16.57±0.33, respectively. There was no significant difference in M-ANNHEIM score before treatment between patients receiving different treatments ( F=1.19, P>0.05). For patients in M-ANNHEIM stage Ⅲ, at 1 month after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=3.37, 4.82, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.59, P>0.05). At 12 months after treatment, there was a significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment ( F=3.63, 4.48, P<0.05); there was no significant difference in M-ANNHEIM score between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.95, P>0.05). At 24 months after treatment, there was no significant difference in M-ANNHEIM score between patients receiving drug treatment and patients receiving endoscopic treatment, between patients receiving drug treatment and patients receiving surgical treatment, between patients receiving endoscopic treatment and patients receiving surgical treatment ( F=0.73, 1.41, 0.55, P>0.05). (6) Treatment of patients in stage Ⅳ: 8 patients in stage Ⅳ underwent drug treatment. The M-ANNHEIM score of patients was 17.94±0.59 before treatment, and 18.01±0.34, 17.54±0.19, 17.34±0.26, 17.88±0.43 at 1 month, 6 months, 12 months, 24 months after treatment, respectively. (7) Aggravation and new-onset of diabetes: of 49 patients undergoing endoscopic treatment, 17 had diabetes before treatment, 5 had aggravated diabetes and 11 had new-onset of diabetes after treatment. Of 79 patients undergoing surgical treatment, 31 had diabetes before treatment, 21 had aggravated diabetes and 7 had new-onset of diabetes after treatment. There were significant differences in the aggravation and new-onset of diabetes between the two groups ( χ2=2.07, 2.04, P<0.05). (8) Complications: 49 patients undergoing drug treatment had no treatment related complications. Of 49 patients undergoing endoscopic treatment, 4 patients with stent related complications were cured after replacing stent under endoscopy, 6 patients had acute pancreatitis, 2 had gastrointestinal bleeding including 1 patient was cured after endoscopic hemostasis, other patients with complications were improved after symptomatic and supportive treatment. Of 79 patients undergoing surgical treatment, 17 had pancreatic leakage (including 11 of biochemical leakage, 5 of grade B pancreatic leakage, and 1 of grade C pancreatic leakage), 3 had postoperative gastroparesis, 3 had intraabdominal infection, 1 had deep venous thrombosis, 2 had hemorrhage of which 1 combined with grade C pancreatic leakage was improved after open hemostasis and 1 was improved after interventional treatment, other patients with complications were improved after symptomatic and supportive treatment. Conclusions:For chronic pancreatitis, individualized treatment should be formulated according to the different stages. M-ANNHEIM score system can be used the evaluate clinical efficacies of drug treatment, endoscopic treatment, and surgical treatment.

Objective To explore the potential role of BK virus (BKV) in urothelial carcinoma after renal transplantation .Methods From May 2013 to March 2017 , We collected 26 cases of urothelial carcinoma after renal transplantation (study group) and 30 cases of urothelial carcinoma of non-immunosuppressed patients (control group) .Tumor tissues were stained with SV40 T antigen by immunohistochemical assay .Urinary and peripheral blood samples were assayed for BKV-DNA levels by real-time fluorescent quantitative polymerase chain reaction (PCR) .Results There were 7 positive cases of SV40 T-Ag in study group and only 1 weakly positive case in control group .The positive rate of BKV-DNA was 38 .5％ in urinary samples in study group (10 /26 ) and it was significantly higher than that in control group by 10％ (3/30)(P< 0 .05) .And the positive rate of blood BKV-DNA was not different between two groups ( P > 0 .05 ) .Conclusions There is a relatively high prevalence of BKV infection in urothelial carcinoma after renal transplantation .And a ,high level of BKV infection may play a role in urothelial carcinoma after renal transplantation .