To summarise the clinical experience of Professor TONG Xiaolin in treating prediabetes combined with overweight or obesity using the method of relieving depression and reducing turbidity. It is believed that prediabetes belongs to the category of "spleen-heat syndrome" in traditional Chinese medicine， and its core pathogenesis is center fullness with internal heat， while obesity is the initiating factor for exacerbating center fullness and internal heat， therefore， it is of great significance to reduce the risk of diabetes by interrupting the transformation between overweight， obesity and glucose metabolism abnormality. It is proposed that the main pathogenesis of prediabetes combined with overweight or obesity is qi depression and turbidity obstruction in middle jiao， with qi depression as the root and turbidity obstruction as the cause， forming a treatment idea with the method of relieving depression and reducing turbidity as the core. In clinic， Dahuang Huanglian Xiexin Decoction （大黄黄连泻心汤） is used as the basic prescription， with a primary focus on directing the turbid downward， supplemented by regulating qi， which embodies the concept of "promoting movement through descent， then figuring out the root of spleen-heat syndrome. Furthermore， the treatment is flexibly modified based on the patient's deficiency-excess syndrome to ensure individualized therapy.

Objective To investigate the current status of physical activity and depressive symptoms a-mong middle-aged and older adults in Chengdu,Sichuan and explore the relationship between physical activity and depressive symptoms.Methods Multi-stage proportional stratified random sampling was employed to select middle-aged and older adults aged ≥45 years as the participants,and face-to-face interviews were carried out to collect data.Logistic regression was adopted to explore the relationship between physical activity and depressive symptoms in middle-aged and older adults.The trend test was performed for the relationship between different lev-els of physical activity and depressive symptoms.The subgroup analysis and the test for multiplicative interactions were conducted for the relationship between physical activity and depressive symptoms.Results A total of 4376 middle-aged and older adults were included.Among them,14.58％(638/4376),25.98％(1137/4376),and 27.83％(1218/4376)had depressive symptoms,failed to reach the guideline-recommended standards of physical activity,and were at low levels of physical activity,respectively.There was a negative association be-tween reaching guideline-recommended physical activity standard and depressive symptoms in middle-aged and ol-der adults(OR=0.713,95％CI=0.589-0.861,P＜0.001).In addition,moderate levels(OR=0.714,95％CI=0.586-0.871,P=0.001)and high levels of physical activity(OR=0.705,95％CI=0.548-0.906,P=0.006)had negative associations with the presence of depressive symptoms.The trend test revealed that the negative association between physical activity and depressive symptoms in middle-aged and older adults enhanced as the level of physical activity increased(Pfor trend=0.001).The subgroup analysis and the test for multiplicative interactions revealed that neither reaching guideline-recommended physical activity standards or not nor the physi-cal activity level had an interaction with each of the subgroups(all Pfor interaction＞0.05).Conclusions The current status of depressive symptoms among middle-aged and older adults in Chengdu,Sichuan needs to be ameliora-ted.A negative association existed between reaching the guideline-recommended physical activity standard and pres-ence of depressive symptoms,and the negative association enhanced as the physical activity level elevated.

Objective:To analyze the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the diagnosis of papillary thyroid carcinoma (PTC) and related parameters in the diagnosis of cervical lymph node metastasis.Methods:The clinical data of 130 patients who underwent ultrasonography in Ningbo Hospital of Traditional Chinese Medicine from Jan. 2019 to Jan. 2022 were retrospectively analyzed. All patients received contrast-enhanced ultrasonography and postoperative pathological examination. According to the pathological diagnosis of benign and malignant tumors, they were divided into PTC group and benign nodule group. In the PTC group, there were 46 males and 40 females, aging 51.79±5.01 years old, ranging from 32 to 63 years old; In the nodule group, there were 25 males and 19 females, aging 52.05±4.89 years old, ranging from 33 to 64 years old. According to the presence or absence of cervical LNM, they were divided into a metastasis group of 31 cases, 17 males and 14 females; age (51.69±6.14 years), ranging from 36 to 63 years; 55 cases in the non-transfer group, 29 males and 26 females, aging (51.75±6.18) years, ranging from 36 to 62 years. Comparative analysis of different nodule properties, presence or absence of LNM, different lesion diameters in imaging manifestations and time-intensity curve (time-intensity curve, TIC) parameters differences, measurement data between groups were conducted by independent sample t test, count data between groups were compared by χ2. The receiver operating characteristic curve (receiver operating characteristic, ROC) was drawn to evaluate the diagnostic performance of TIC parameters for cervical LNM. Results:The proportion of PTC nodules with low enhancement, irregular enhancement, heterogeneous enhancement, unclear lesion boundary, and perfusion defect (72.09%, 87.21%, 88.64%, 69.77%, 70.93%) was significantly higher than that of benign nodules (38.64%, 11.36%) %, 27.27%, 77.27%, 27.27%) ( χ2=13.67, 70.75, 49.69, 25.92, 18.24, P<0.05) ; PTC nodule peak intensity (peak intensity, PI), TIC area under the curve (area under curve, AUC) was significantly lower than that of benign nodules (14.86±2.11dB vs 23.94±3.51dB, 985.14±105.31dB·s vs 1621.14±182.61dB·s) ; time to peak (TTP) was significantly higher than that of benign nodules ( 44.82±5.01s vs 36.95±4.18s) ( t=18.39, 21.36, 8.94, P<0.05) ; there was no significant difference in mean transit time (MTT) ( P>0.05) ; AUC was significantly higher than that of the non-metastatic group (16.86±2.09) dB vs (13.73±1.42) dB, (1163.54±131.41) dB·s vs (884.59±93.25) dB·s ( t=8.25, 11.46, P<0.05) ; The PI and AUC of PTC patients with lesion diameter ≤1.5 cm were significantly lower than those of patients with lesion diameter > 1.5 cm (11.56±1.94) dB vs (15.93±2.46) dB, (876.97±100.21) dB·s vs (1020.09±125.41) dB·s ( t=8.39, 5.34, P< 0.05), there was no significant difference in terms of TTP or MTT ( P>0.05) ; the AUC of PI in the diagnosis of cervical lymph node metastasis in PTC patients was 0.888 (95% CI: 0.807-0.969), the sensitivity was 90.91%, and the specificity was 77.42%; The AUC for the diagnosis of cervical lymph node metastasis in PTC patients was 0.972 (95% CI: 0.943-1.000), with a sensitivity of 87.10% and a specificity of 96.36%. Conclusion:The CEUS manifestations of PTC nodules are mostly irregular and heterogeneous low-enhancement, and the TIC-related parameters of PTC nodules and benign nodules are significantly different, and TIC-related parameters have good diagnostic efficiency for patients with cervical lymph node metastasis.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

The human brain undergoes rapid development during childhood, with significant improvement in a wide spectrum of cognitive and affective functions. Mapping domain- and age-specific brain activity patterns has important implications for characterizing the development of children’s cognitive and affective functions. The current mainstay of brain templates is primarily derived from structural magnetic resonance imaging (MRI), and thus is not ideal for mapping children’s cognitive and affective brain development. By integrating task-dependent functional MRI data from a large sample of 250 children (aged 7 to 12) across multiple domains and the latest easy-to-use and transparent preprocessing workflow, we here created a set of age-specific brain functional activity maps across four domains: attention, executive function, emotion, and risky decision-making. Moreover, we developed a toolbox named Developmental Brain Functional Activity maps across multiple domains that enables researchers to visualize and download domain- and age-specific brain activity maps for various needs. This toolbox and maps have been released on the Neuroimaging Informatics Tools and Resources Clearinghouse website (http://www.nitrc.org/projects/dbfa). Our study provides domain- and age-specific brain activity maps for future developmental neuroimaging studies in both healthy and clinical populations.

Objective:To analyze the association of D-dimer levels, inflammatory indicators, cytokine abnormality, and disease severity in COVID-19 severe/critical type patients.Methods:The medical records of 41 patients were collected from a single center in Wuhan from February 8, 2020 to March 25, 2020. The patients were divided into severe type group (28 patients) and critical type group (13 patients) . The levels of D-dimer, WBC, ANC, PCT, hsCRP, IL-2R, IL-6, IL-8, and TNF-α were compared among patients with different clinical types of COVID-19 infection. Moreover, the changes in the cytokines were analyzed in patients with different D-dimer levels. And, the levels of D-dimer, IL-2R, IL-6, IL-8, and TNF-α before and after anticoagulant therapy were assessed. Statistical analyses were performed using Student t test, Mann-Whitney U test, and Chi-square test. Results:Among the 41 patients, 23 were men (56.1%) and 18 were women (43.9%) ; the median patient age was 57 y. The age of the critical type patients [ (61.1±10.4) y] was higher than that of severe type patients [ (52.8±11.7) y]; the difference was significant ( t=-2.264, P=0.032) . The proportion of critical type patients with chronic diseases, especially hypertension, cardiovascular disease, and cerebrovascular disease, was higher as compared to that in those with severe type patients; the differences were significant (all P<0.05) . The prevalence of dyspnea, sweats, and fatigue symptoms in the critical type patients was higher than that in those with severe type disease; the differences were significant ( χ2=14.898, 6.972, 7.823; P<0.001, 0.008, 0.005) . The levels of D-dimer, WBC, ANC, PCT, hsCRP, and IL-8 in critical type patients were higher than those in severe type patients; the differences were significant (all P<0.05) . The levels of IL-2R, IL-8, and TNF-α in patients with abnormal D-dimer were higher as compared to those in patients with normal D-dimer levels; the differences were significant (all P<0.05) . Eight patients were treated with prophylactic anticoagulation; the levels of D-dimer, IL-2R, IL-6 and IL-8 after anticoagulant therapy were lower than those before treatment. Conclusions:COVID-19 critical type patients have more serious coagulation-immune dysfunction and dynamic monitoring of D-dimer and cytokines levels helps in identifying critical type patients as early as possible; anticoagulant therapy may improve the patient’s condition by correcting coagulation-immune dysfunction.

Gegen Qinlian Decoction (GQD), a traditional Chinese medicine (TCM) formula, has long been used for the treatment of common metabolic diseases, including type 2 diabetes mellitus. However, the main limitation of its wider application is ingredient complexity of this formula. Thus, it is critically important to identify the major active ingredients of GQD and to illustrate mecha-nisms underlying its action. Here, we compared the effects of GQD and berberine, a hypothetical key active pharmaceutical ingredient of GQD, on a diabetic rat model by comprehensive analyses of gut microbiota, short-chain fatty acids, proinflammatory cytokines, and ileum transcriptomics. Our results show that berberine and GQD had similar effects on lowering blood glucose levels, modulating gut microbiota, inducing ileal gene expression, as well as relieving systemic and local inflammation. As expected, both berberine and GQD treatment significantly altered the overall gut microbiota structure and enriched many butyrate-producing bacteria, including Faecalibacterium and Roseburia, thereby attenuating intestinal inflammation and lowering glucose. Levels of short-chain fatty acids in rat feces were also significantly elevated after treatment with ber-berine or GQD. Moreover, concentration of serum proinflammatory cytokines and expression of immune-related genes, including Nfkb1, Stat1, and Ifnrg1, in pancreatic islets were significantly reduced after treatment. Our study demonstrates that the main effects of GQD can be attributed to berberine via modulating gut microbiota. The strategy employed would facilitate further stan-dardization and widespread application of TCM in many diseases.

Objective: To summarize the diagnosis and treatment of biliary pancreatic duct dilatation. Methods: The retrospective and descriptive study was conducted. The clinical data of 22 patients with biliary pancreatic duct dilatation who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine between October 2013 to September 2017 were collected. There were 6 males and 16 females, aged from 33 to 82 years, with an average age of 66 years. Surgical exploration was decided according to clinical symptoms, results of laboratory test and imaging examinations. For patients with space occupying lesions, surgical procedure was selected based on results of pathological examination. Patients without surgical exploration or space occupying lesions were allocated into follow-up. Observation indicators: (1) surgical exploration; (2) relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions; (3) surgical treatment; (4) follow-up. Follow-up using outpatient examination was performed on patients up to October 2018. Follow-up was performed on patients with positive surgical exploration to detect postoperative complications.For patients with positive results of imaging examinations, no jaundice, normal laboratory indicators or mild abnormality, liver function, tumor markers and B-ultrasound were re-examined each month, and computed tomography (CT) and magnetic resonance imaging (MRI) was performed once every 3 months. Surgical exploration was performed when total bilirubin (TBil) or tumor markers showed a progressive increase. Follow-up was performed on patients with negative results of imaging examination, jaundice, and mildly elevated CA19-9. TBil and CA19-9 were re-examined monthly, and if they were progressively elevated, patients were transferred to surgical exploration. For patients with negative results of imaging examination, no symptoms, and negative laboratory test, liver function, tumor markers, and B-ultrasound were re-examined once every 3 months, and enhanced CT and MRI were re-examined once every 6 months within one year. Follow-up was performed once every 6 months during the second year, and once a year after two years. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were descibed as absolute numbers, and they were analyzed using the chi-square test under R×C chart or Fisher exact probability. Results: (1) Surgical exploration: of 22 patients, 11 underwent surgical exploration, and 11 underwent follow-up. Of the 11 patients with surgical exploration, 4 were positive for space occupying lesions including 1 of false negative, and 7 were negative for space occupying lesions. (2) Relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions. ① Relationship of clinical symptoms and laboratory test with surgical exploration positive for space occupying lesions: juandice was significantly associated with surgical exploration positive for space occupying lesions (P<0.05), and elevated TBil and DBil were significantly associated with surgical exploration positive for space occupying lesions (χ²=0, 0, P<0.05), with a sensitivity of 75.0% and specificity of 100.0%. ② Relationship between imaging examination and surgical exploration positive for space occupying lesions: results of CT, MRI, endoscopic retrograde cholangio-pancreatography, endoscopic ultrasonography, PET-CT, and combined imaging examinations had no significant association with surgical exploration positive for space occupying lesions (χ²=0, 0.77, 0, 0, 1.00, 0, 0, 0, 0, P>0.05). PET-CT had no significant association with surgical exploration positive for space occupying lesions (P>0.05). ③ Relationship of imaging examination and laboratory test with surgical exploration positive for space occupying lesions: positive imaging examination combined with elevated TBil and CA19-9 was significantly associated with surgical exploration positive for space occupying lesions (P<0.05), with a sensitivity of 50.0% and specificity of 100.0%. ④ Relationship of preoperative diameters of biliary ducts and pancreatic ducts with surgical exploration positive for space occupying lesions: of 22 patients, the diameters of biliary ducts and pancreatic ducts were (13.8±4.3)mm and (4.6±1.5)mm for patients with positive surgical exploration, (13.0±2.8)mm and (3.5±0.5)mm for patients with negative surgical exploration, (11.6±2.4)mm and (3.2±0.4)mm for patients with follow-up, respectively, showing no significant difference between them (t=0.22, 0.36, P>0.05). (3) Surgical treatment: 9 of 11 patients with surgical exploration followed the standard procedure. Of the 9 patients, 4 were found space-occupying lesions at the choledocho-pancreatico-duodenal junction (3 undergoing pancreaticoduodenectomy and 1 undergoing duodenal papilla partial resection), 5 with negative exploration underwent common bile duct incision and T-tube drainage (one patient was unable to pinch the T-tube one month after operation and detected obstruction at the lower end of the bile duct by radiography, and was confirmed pancreatic head cancer by reoperation 3 months after the first operation). Two patients didn′t follow the exploratory procedure, and underwent the child operation only based on the preoperative imaging findings, without intraoperative pathological examination. Postoperative pathological examination showed chronic ampulla and chronic pancreatitis, respectively. (4) Follow-up: 22 patients were followed up for 12-60 months, with a median follow-up time of 36 months. Two of 11 patients with surgical exploration had postoperative gastroplegia, 1 had bile leakage, 1 had incisional infection, and they were improved after symptomatic treatment. Four patients undergoing surgeries for positive exploration had no recurrence during follow-up. Of 5 patients with negative exploration undergoing common bile duct incision and T-tube drainage, 1 was confirmed pancreatic head cancer and underwent pancreaticoduodenectomy, 4 were removed T-tube after by T-tube cholangiography at 2 months after surgery. During the follow-up, no positive signs showed in laboratory test or imaging examination. No recurrence occurred in the two patients undergoing pancreaticoduodenectomy. Of 11 patients with follow-up, 10 had abdominal pain before surgery, including 3 with pain during follow-up and 7 with symptoms disappeared. There was no abnormalities in the laboratory test. Conclusions The positive imaging examinations combined with jaundice and elevated CA19-9 is an absolute indication for surgical exploration in patients with biliary duct dilatation. Those patients who do not meet this criteria should be distributed into the follow-up. If no positive pathological results were obtained during the operation, the surgery should be terminated and the patients should be transferred into follow-up. The reckless biliary anastomosis or biliary stents placement is opposed.

Objective Henoch-Sch?nlein purpura(HSP)is a common multisystemic vasculitis in children ,but the exact pathogenesis remains unknown. Pentraxin 3(PTX3),a new kind of inflammatory cytokines,has a strong inflammatory effect,and is involved in occurrence and develop-ment of a variety of autoimmune diseases. The objective of this study is to evaluate the expression of PTX3,interleukin-8(IL-8),tumor necrosis fac-tor-α(TNF-α)and high sensitivity C-reactive protein(hs-CRP)in children with HSP,and explore the clinical significance of PTX3 in HSP devel-opment. Methods Thirty-six children(HSP group)and 17 healthy children(control group)were enrolled in the study. Serum levels of PTX3,IL-8 and TNF-α were detected by enzyme-linked immunosorbent assay. Serum hs-CRP levels were measured by automatic biochemical analyzer. Re-sults The serum levels of PTX3,IL-8,TNF-α,and hs-CRP were up-regulated in HSP group compared with the control group(P<0.05). The levels of PTX3,IL-8,TNF-α,and hs-CRP in patients with joint symptoms,or/and gastrointestinal symptoms,or/and kidney injury were significant-ly higher than those patients without joint symptoms,or/and gastrointestinal symptoms,or/and kidney injury(P<0.05). The expression of PTX3 was positively correlated with the expression of IL-8 and TNF-α(r=0.514,0.833,all P<0.05),but there was no correlation between PTX3 and hs-CRP(r=0.292,P>0.05). The expression of PTX3,IL-8,TNF-α and hs-CRP in HSP patients had no gender difference(all P>0.05). Con-clusion The high expression of PTX3 is related to the degree of inflammation in children with HSP. The up-regulated expression of PTX3 may play an important role in pathogenesis of HSP in children.

Objective To analyze the infection features,risk factors,and the relationship with the efficacy in patients with acute leukemia during initial induction chemotherapy.Methods The clinical data of 200 patients with newly diagnosed acute leukemia from January 2015 to February 2016 in the Second Hospital of Shanxi Medical University were retrospectively analyzed.Results The infection rate of patients with acute leukemia under induction chemotherapy was 84.0％ (168/200).Among 168 patients with infection,159 cases (94.6％) had known infection sites,the top three infection sites were the lungs,gastrointestinal tract and the oral cavity.Total 213 strains of pathogens were identified,Gram-negative bacilli accounted for 39.0％ (n =83),Gram-positive cocci for 34.3％ (n =73),fungi for 23.5％ (n =50) and the virus for 3.3％ (n =7).Multivariate regression analysis showed that agranulocytosis was the independent risk factor for acute leukemia patients during induction chemotherapy (OR =14.370,95％ CI:2.576-116.518,P ＜ 0.01).The rate of complete remission (CR) and CR with incomplete hematologic recovery (CRi) in infection group was 74.4％ (125/168),and the rate of CR + CRi in non-infected group was 87.5％ (28/32),and there was no significant difference between the two groups.(χ2 =2.564,P =0.109).Conclusion During the induction therapy for acute leukemia patients,the rate of infection and the rate of fungal infection are high;lung is the most common site,Gram-negative bacteria is more common;agranulocytosis increases the chance of infection;and the infection may not affect the disease remission rate.