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There are various etiologies for extrahepatic bile duct stenosis， and pharmacotherapy and endoscopic intervention can achieve a good clinical effect in benign stenosis. Early diagnosis and timely surgical treatment of malignant stenosis may prolong the survival time of patients. However， there are still difficulties in the differential diagnosis of malignant bile duct stenosis. This article reviews the application of serology， radiology， endoscopic techniques， and artificial intelligence in the differential diagnosis of malignant bile duct stenosis， so as to provide strategies and references for formulating clinical diagnosis and treatment regimens.

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Objective To investigate the mechanism by which Nicotinamide adenine dinucleotide(NADH)regu-lates anti-tuberculosis drug-induced liver injury and apoptosis in mice through SIRT1/Nrf2 pathway.Methods Twenty-four six-week-old SPF male mice were randomly divided into four groups according to body weight,ADLI group[90 mg/(kg·d)Isoniazid,135 mg/(kg·d)Rifampicin,315 mg/(kg·d)Pyrazinamide were given by gavage],control group[thesame volume of saline was given by gavage as antituberculosis drug-induced liver injury(ADLI)group],NADH group(30 mg/kg NADH wasgiven by gavage on the basis of control group)and NADH intervention group(30 mg/kg NADH wasgiven by gavage on the basis of ADLI group),with sixmice in each group.They were gavaged continuously for seven days,and their seruand liver tissues were collected.The mRNA and protein expression of silence information regulator 1(SIRT1),nuclear factor erythroid 2-related factor 2(Nrf2)in SIRT1/Nrf2 pathway,apoptosis indicators B-cell lymphoma-2(Bcl-2),Bcl-2-associated X protein(Bax)and caspase-3 were detected by qRT-PCR and Western blot,respectively.HE staining was performed to observe the morphology of liver tissue.The liver was weighedandthe liver index was obtained by dividingweight by body weight.The levels of glutamate aminotransferase(ALT),aspartate aminotransferase(AST)and lactate dehydrogenase(LDH),which are indicators of liver injury,were detected by microplate method.Results Compared with control group,the protein and mRNA expression of SIRT1,Nrf2decreased significantly in ADLI group.Liver tissue struc-ture wasdisturbed,hepatocytes were obviously swollen,and their boundary was unclear.The weight of mice de-creased,but liver index increased.The mRNA and protein expression level of anti-apoptotic factor Bcl-2 decreased,while that of Bax and caspase-3 was raised.The level of ALT,AST and LDH were also elevated.The differences a-bove were statistically significant(P＜0.05).Compared with ADLI group,the protein and mRNA expression of SIRT1,Nrf2 were higher after NADH intervention.Liver tissue structure became clear,and hepatocytes were po-lygonal.The protein and mRNA expression of anti-apoptosis factor Bcl-2 was elevated and while that of Bax and caspase-3 was lower.The weight of mice increased and liver index decreased.The expression of ALT,AST and LDH decreased.The differences above were statistically significant(P＜0.05).Conclusion NADH may allevi-ate anti-tuberculosis drug-induced liver injury and apoptosis in mice by regulating SIRT1/Nrf2 pathway.

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Cadmium sulfide nanoparticles are a new type of semiconductor nanomaterials used in many applications. Studies have shown that cadmium sulfide nanoparticles have toxic effects on the reproductive system， liver， and kidney of the body， and the toxicities are affected by various factors. This paper summarized the current research on the toxicity of cadmium sulfide nanoparticles at home and abroad， and reviewed the latest research progress on the mechanisms of its toxic effects and influencing factors.

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There have been problems in the existing multiple physiological parameter real-time monitoring system, such as insufficient server capacity for physiological data storage and analysis so that data consistency can not be guaranteed, poor performance in real-time, and other issues caused by the growing scale of data. We therefore pro posed a new solution which was with multiple physiological parameters and could calculate clustered background data storage and processing based on cloud computing. Through our studies, a batch processing for longitudinal analysis of patients' historical data was introduced. The process included the resource virtualization of IaaS layer for cloud platform, the construction of real-time computing platform of PaaS layer, the reception and analysis of data stream of SaaS layer, and the bottleneck problem of multi-parameter data transmission, etc. The results were to achieve in real-time physiological information transmission, storage and analysis of a large amount of data. The simulation test results showed that the remote multiple physiological parameter monitoring system based on cloud platform had obvious advantages in processing time and load balancing over the traditional server model. This architecture solved the problems including long turnaround time, poor performance of real-time analysis, lack of extensibility and other issues, which exist in the traditional remote medical services. Technical support was provided in order to facilitate a "wearable wireless sensor plus mobile wireless transmission plus cloud computing service" mode moving towards home health monitoring for multiple physiological parameter wireless monitoring.

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Objective To evaluate the safety and feasibility of totally laparoscopic radical distal gastrectomy (TLDG)and intracorporeal gastroduodenostomy using laparoscopic linear staplers in gastric cancer patients.Methods Clinical data were reviewed on the perioperative outcomes of 17 gastric cancer patients who received totally laparoscopic distal gastrectomy and intracorporeal gastroduodenostomy using endoscopic linear staplers from June 2012 to June 2013 at Department of General Surgery,Lishui Central Hospital.Results The mean operation time were (2.6 ± 0.4) h,TLDG with deltashaped anastomosis was successfully carried out in all the patients except for 1 case who was converted to open surgery.There was no serious complication and no death in this series.The postoperative pain in TLDG was less than laparoscopy assisted distal gastrectomy.Conclusions Totally laparoscopic distal gastrectomy and intracorporeal gastroduodenostomy using endoscopic linear staplers is a new method with high safety and feasibility.

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Objective To explore the sexual life quality of females at the reproductive ages after cervix cancer operation and supply evidence for establishment of correspondindg nursing measure. Methods We investigated the frequency of sexual life and satisfaction degree of sexual life in 40 females at the reproductive ages after cervix cancer operation by face-to-face investigations using questionnaires before and 4 months after operations. Then the difference of sexual life quality before and after operation were compared and analyzed. Results The frequency of sexual life (P＜0.01,P＜0.05) and satisfaction degree of sexual life (P＜0.01,P＜0.05) were evidently decreased. The sexual life quality was lower than that before operation. Conclusion The sexual life quality could be affected by many factors such as economic conditions, culture background, sexual conceptions and the attitude of their partners.

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Objective To explore the use of urine LH test paper associating basal body temperature in ovulation monitoring and conception guiding in anovulatory infertility.Methods We used clomiphene to treat 100 anovulatory infertility patients.Then we recorded basal body temperature and used urine LH test paper in morning to determine whethere there is urine LH peak between the 12th to 20th day of menstrual cycle.If the patient become pregnant,we stop observation.If not,we observed them until the third treatment cycle completed.Result Before treatment,both the urine LH test paper and basal body temperature showed there was no ovulation.After treatmend,we observed 199 menstrual cycle.There were urine LH peak in 149 menstrual cycle.And there were double phase body temperature in 158 treat cycle.The lowest body temperature appeared in the urine LH peak day or after it.71.1%of the lowest body temperature emerged in one or two days after the urine LH peak appeared.76 patients in our study become pregnant,pregnancy rate is 76%.Conclusion Urine LH test paper associating basal body temperature is convenient and easy tO learn.It is a good way in ovulation monitoring and conception guiding.