In recent years,with the continuous development of endoscopic and interventional techniques,many new devices and methods have been used in clinical practice,and the application of endoscopic retrograde cholangiopancreatography (ERCP)in biliary and pancreatic diseases has developed rapidly.This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases,including those with altered gastrointestinal anatomy,pregnant patients,patients with benign and malignant biliary strictures,and patients with pancreatic pseudocysts,as well as the application of SpyGlass,photodynamic therapy,and radiofrequency ablation,the man-agement of ERCP-related duodenal perforation,and the prevention of post-ERCP pancreatitis.All the progress has made a great contribu-tion to the diagnosis and treatment of biliary and pancreatic diseases.

Objective To understand the clinical characteristics of staphylococcal bloodstream infection in patients with secondary immunodeficiency,as well as the distribution and drug resistance of Staphylococcus aureus (SAU)and coagulase negative Staphylococcus (CNS).Methods A total of 101 patients with Staphylococcus isolated from blood sample were retrospectively reviewed in our hospital.The patients were classified into a group with secondary immunodeficiency and another group with normal immune function as control group.SPSS 18.0 statistical software was used to analyze the data,and compare the two groups of patients in terms of clinical characteristics,pathogens,antibiotic resistance,etc.Results All the 70 patients with staphylococcal bloodstream infection and secondary immunodeficiency had various degrees of fever except 2 cases (temperature < 36 ℃).Chills and shiver were reported in 30.0% of the patients,and migratory lesions in 15.5% of the patients.Lungs were the most common site of infection.About 11.4% of the patients complicated with septic shock.The case strains of SAU,of which 18 (43.9%)strains were MRSA,CNS 29 (41.4%)strains,of which 24 (82.8%)strains were MRCNS.In the control group,26 (83.9%)strains of SAU were identified,of which 11 (42.3%)strains were MRSA,and all the 5 (16.1%)strains of CNS were identified as MRCNS.The incidence of CNS infection in the patients with secondary immunodeficiency was significantly different from that in the control group (P =0.013).All the MRS strains were multidrug-resistant organism (MDRO)except one strain of Staphylococcus intermedius .The staphylococcal strains isolated from the patients with secondary immunodeficiency showed high rate of resistance to penicillin (100%), clindamycin (73.0%), erythromycin (90.0%)and gentamycin (61.0%).No strain was found resistant to tigecycline,linezolid or vancomycin.The resistance rate did not show significant difference between the patients with or without secondary immunodeficiency. Conclusions The clinical characteristics of staphylococcal bloodstream infection in the patients with secondary immunodeficiency are similar to the patients without secondary immunodeficiency,except higher incidence of septic shock and death,but the incidence of CNS infection is relatively higher,MDRO is more prevalent.Antimicrobial agents should be prescribed in clinical practice according to disease conditions and the result of antimicrobial susceptibility testing.

Adult ; Aged ; Body Mass Index ; Case-Control Studies ; Humans ; Male ; Middle Aged ; Neck ; anatomy & histology ; Sleep Apnea, Obstructive ; pathology ; physiopathology ; Young Adult

Objective To assess the value of enhanced MSCT scan for the Crohn's disease of small bowel.Methods Fourty-five patients of small bowel Crohn's disease who were proved by multi-methed were examined by two-phase enhanced scan with MSCT.The images were reformed in ADW 4.2 by MPR mainly.The CT values of the lesion segments in different phases were tested, with one way ANOVA in statistical analysis; the density difference between the lesion segments and normal segments in different phases were tested,the cases were divided according to 10 HU,and compared them with each other by X2 test.Results The average CT value of lesion segments was (39.3±3.7) HU in plain scan, (74.8 ± 13.8) HU in artery phase, (90.2 ± 12.3) HU in portal vein phase, there were sinigicant difference in them(F =258.87,P < 0.01).There were sinigicant difference in CT value of lesion segments between any phase and other two phases (P < 0.05).In 45 cases, there were 44 cases and one case that the difference of CT value were ≤±10 HU and > 10 HU respectively in plain scan, 6 cases and 39 cases in artery phase, 2 cases and 43 cases in portal vein phase, by X2 test, there were sinigicant difference betwwen plain scan and artery phase(X2 =32.49,P <0.01), and significant difference between plain scan and portal vein phase(X2 = 39.22,P <0.01), there were no significant difference between artery phase and portal vein phase (X2 = 1.10,P>0.05).After enhancement, the lesions can display clearly than plain scan, and the detectable rate was raised highly.Conclusion Two-phase enhancement scan can diagnosis the Crohn's disease of small bowel and evaluate it overall.

Objective To explore the effective molecular mechanism of PPAR-γligands rosiglitazone to biliary ischemia-reperfusion injury in autologous liver transplantation. Method A total of 40 SD rats were randomly (random number) divided into sham operation group (SO), ischemia - reperfusion group (Ⅰ/R), rosiglitazone (ROS) and GW9662 group, with 10 ones in each. The models, rat biliary ischemiareperfusion injury of autologous liver transplantation, were made by modified two-cuff technique. Tissues of the liver and bile ducts and blood of those models were evaluated by pathological and biochemical methods to make sure the models were made successfully or not. SO group suffered autologous orthotopic liver transplantation, and L/R group suffered both that and ischemia-reperfusion. ROS group were injected rosiglitazone (0.3mg/kg) via portal vein after having been done all as I/R. GW9662 group suffered all as ROS, and 10min later ,they were injected GW9662(0.3mg/kg) via portal vein. 4h after the experiment, tissues of livers and bilary ducts were taken to be tested by immunohistochemistry method, and the blood punctured from the right ventricular were taken to be determined by ELISA. ANOVA was used for statistical analysis.Results IL-1β, TNF-α and IL-6 were mainly expressed in the cytoplasm of hepatocytes and bile duct cells,while NF-κB was expressed both in the cytoplasm and nuclei. Expression of those proteins in L/R and GW9662 group was increased, significantly higher when compared to the SO and ROS (P ＜ 0.05). IL-1β,TNF-α and IL-6 in rat serum were simultaneously increased, and significantly higher than SO(P ＜0.05).Compared with the SO, expressions of the IL-1 β,TNF-α and IL-6 were not significantly changed in ROS (P＞ 0.05 )but significantly increased in GW9662. Conclusions PPAR-γ ligand rosiglitazone took protective role in biliary ischemia-reperfusion injury in autologous liver transplantation. The mechanism correlates with the release of the IL-lα, IL-1β and TNF-α and other inflammatory mediators, which decreased as the expression of NF-κB inhibited by its antagonist.

Objective To study the utilization of preoperative ultrasound-guided fine-needle aspiration(USFNA) for axillary lymphnode(ALN) metastasis in breast cancer and to evaluate the feasibility and accuracy of the technique. Methods Forty ALNs in 40 armpit negative palpation highly suspective breast cancer patients underwent USFNA. The cytopathological results were compared with the histopathological results of sentinel lymphnode(SLN) biopsy or axillary lymphnode dissection(ALND). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of USFNA for the ALN metastasis were analysed. Results All the 40 patients were confirmed with breast cancer by pathology. Sensitivity of USFNA was 52. 2%, specificity was 100%, PPV was 100%,NPV was 60. 7% and diagnostic accuracy was 72. 5%. 12(30% ) patients with positive cytology proceeded to ALND, avoiding SLN biopsy. Conclusions USFNA is a minimally invasive, highly specified technique for prediction of breast cancer ALN metastasis before operation.

Objective This study aimed to assess the effects of active and passive smoking on chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).Methods Seven hundred and five patients with T2DM were recruited in the study and were divided into three groups based on smoking status as active smokers,passive smokers and non-smokers.Twenty-four hour urinary albumin excretion (24hUAE) was measured,and estimate glomerular filtration rate (eGFR) was calculated with age and blood creatinine levels.Results (1) The proportion of CKD in T2DM in the present study was 31.63％ (223/705) with 28.6％ (22/77),30.0％ (15/50) and 29.6％ (73/247) for non-smokers,passive smokers and active smokers in men,and 29.9％ (40/134),35.9％ (66/184) and 7/13 for non-smokers,passive smokers and active smokers in women,respectively.In comparison with non-smokers,a higher risk of CKD was found in both passive and active smokers (OR =1.07 and OR =1.05 in men ; OR =1.31 and OR =2.74 in women,respectively).(2) Compared with non-smokers,passive smokers had a significant higher risk for albuminuria in women (OR =2.02,P =0.016).(3) After adjusting for gender,age,duration of T2DM,BMI,systolic blood pressure,glycosylated hemoglobin A1C and lipids,there was a significant decrease in eGFR between active and never smokers (P =0.018)or passive smokers (P =0.000) in women.No differences could be found in eGFR between each smoking statues in men.Conclusions Smoking exposure alone confers a high risk for CKD in patients with T2DM.Our results highlight an importance in implementation of a smoke-free environment for patients with T2DM.

Objective To observe the expression of caspase-3 and transposition of Omi/HtrA2 in H9C2 by erythropoietin and/or Omi/HtrA2 silencing to explore the related anti-apoptotic mechanisms.Methods The cultured H9C2 cardiomyocytes were divided into control group,H/R group (anoxia 2 h and re-oxygenation 24 h), and different concentrations of EPO treatment groups.The release rate of lactate dehydrogenase (LDH)in cell supernatant was measured in each group.Expressions of cleaved caspase-3 and Omi/HtrA2 were measured by Western blot;then the transposition of Omi/HtrA2 between cytoplasm and mitochondria was observed.Specific siRNA interfering fragment was transfected into H9C2 cardiomyocytes by liposome method.Its silencing effect on Omi/HtrA2 was measured by RT-PCR and Western blot.The survival rate,release rate and expression of cleaved caspase-3 were measured.And the expression of Omi/HtrA2 was measured in cytoplasm and mitochondria in H9C2 (transposition of Omi/HtrA2 ).Results Compared with H/R group,the release of LDH and expression of cleaved caspase-3 were decreased; the transposition of Omi/HtrA2 from mitochondria to cytoplasm in H/R treatment groups was increased compared with control group,while that in EPO (20 IU/mL)group decreased.si-HtrA2 group transfected with siRNA showed a decreased release of LDH and expression of cleaved caspase-3 with all significant variances (P <0.05).Conclusion EPO exerts a cytoprotective effect by inhibiting the transposition of Omi/HtrA2 and hence the activation of caspases-3 pathway.

Pullulan is a linear glucosic polysaccharide produced by the polymorphic fungus Aureobasidium Pullulans, which has long been applied for various applications in medical and food industry due to its security, stability and low adhesive ability.At present, the two problems in restricting pullulan industrial production are the low polysaccharide production and melanin secreted which is hard to erase completely, giving the following process some problem.As a starting point, this review article collects and analyzes the progress on the breeding of pullulan high-yield strain without melanin in recent years, in order to find more efficient strains breeding methods, laying a foundation for further breeding of pullulan high-yield strain without melanin.

Objective To investigate the association of immunological indicators with the severity and prognosis of pediatric patients with severe sepsis.Methods We enrolled 82 pediatric patients with severe sepsis admitted to pediatric intensive care unit (PICU) at Shanghai Children′s Hospital between March 2013 and February 2017 as septic group.Fifteen healthy children served as control group.The blood samples were collected within 24 hours after admission and on day 7 after treatment.The levels of immunoglobulin (IgG,IgM and IgA) were analyzed by automatic special protein analyzer,and the proportion of T-lymphocyte subgroup (CD3+,CD4+,CD8+ and CD19+) and natural killer (NK) cells (CD16+ and CD56+) in peripheral blood were detected by flow-cytometry.Results The levels of IgG,IgM and IgA had no statistical differences between septic group and control group(P>0.05).Interestingly,the proportion of NK cells in pediatric patients with severe sepsis was significantly lower compared to the control group,and the number of NK cells was significantly increased after 7 days treatment compared with that within 24 hours after admission[(3.7±1.9)% vs.(11.5±1.9)%,P<0.05].In addition,the proportions of T-lymphocyte subgroups including CD3+,CD4+ and CD8+ were significantly decreased in patients of septic group compared with control group[(62.8±8.5)% vs.(70.9±2.3)%,(33.3±7.0)% vs.(39.8±1.8)% and(22.6±2.8)% vs.(34.8±15.6)%,respectively,all P<0.05].Moreover,the proportions of NK cells,CD3+ and CD4+ T lymphocytes subsets in peripheral blood of patients with severe sepsis were positively associated with pediatric critical illness score(P<0.05),and negatively associated with pediatric risk of mortality score Ⅲ and the number of dysfunction organs(all P<0.05).Furthermore,the proportions of NK cells and CD3+ and CD4+ T lymphocytes in peripheral blood of non-survivor with severe sepsis were significantly lower than those in the survivor[(1.5±0.5)% vs.(4.7±1.4)%,(55.1±5.0)% vs.(66.4±7.4)%,(29.7±5.2)% vs.(35.0±7.2),P< 0.05].Conclusion The proportion of NK cells and CD3+ and CD4+ T lymphocytes subsets in peripheral blood decreases in pediatric patients with severe sepsis,which is associated with severity and prognosis of severe sepsis.