Objective To determine plasma resistin level in patients with traumatic brain injury (TBI) and evaluate its correlations with outcome and inflammatory reaction. Methods Fiftyfour patients with moderate TBI, 71 patients with severe TBI and 40 healthy controls were enrolled in this study. Plasma samples were obtained from the healthy controls on physical examination and from the TBI patients on admission. Enzyme-linked immunosorbent assay ( ELISA) was used to determine the plasma resistin concentrations. Results Twenty patients (37.0% ) and 53 patients (74.6% ) with moderate and severe TBI suffered from an unfavorable outcome (defined as GOS score for 1-3 points) three months after TBI respectively. Plasma resistin levels in the patients with moderate and severe TBI were substantially higher than that in the healthy controls ((21. 9 ± 8. 4) ng/ml and (29. 2 ± 9. 6) ng/ml vs (9. 3 ± 2.6) ng/ml, both P ＜0. 01] by using covariance analysis. By using the multivariate linear regression analysis, plasma C-reactive protein level (t =2.212,P =0.035; t =2. 274,P =0. 014) and GCS scores (t =3. 120,P =0.007; t=3.986,P=0.003) were associated with the plasma resistin levels. Logistic regression analysis selected plasma resistin level as an independent predictor for 3-month unfavorable outcome of the patients with moderate and severe TBI (odds ratio = 1. 124, 95% CI = 1. 040-1. 221, P = 0.011; odds ratio = 1. 145, 95% CI = 1. 044-1. 232, P = 0. 009). A receiver operating characteristic curve identified cutoff levels of plasma resistin (22.4 ng/ml and 30.5 ng/ml) that predicted 3-month unfavorable outcome of moderate and severe TBI patients with the high sensitivity (70. 0% and 79. 2% ) and specificity (70.6% and 72.2% ) ( area under curve = 0.719, 95% CI = 0.642-0.829, P = 0.000;area under curve =0.735, 95% CI =0. 671-0. 893, P = 0.000). Conclusions Plasma resistin level is increased after TBI and may be involved in inflammatory response of brain injury. Clinical detection of this indicator can help early determine the prognosis of the TBI patients.

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment of pancreas divisum (PD) combined with chronic pancreatitis (CP) in children.Methods:Data of patients under 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2010 to January 2020 were retrospectively analyzed. The general information, endoscopic procedures and follow-up of the children were recored. The number of acute pancreatitis attacks, visual analogue scale (VAS) scores of the abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 19 children diagnosed as having PD with CP underwent 82 ERCP procedures with the mean number of 4.31 (1-9). The mean number of pancreatic stent replacement was 3.21 (0-8). The success rate of minor papilla cannulation was 97.6% (80/82) with the pain relief rate of 89.5% (17/19) after the first ERCP. ERCP-related complication rate was 4.9% (4/82)without transference to surgery. The mean follow-up time was 55.8 months (9-114 months). The median number of acute pancreatitis attacks decreased from 3.0 to 0 compared with that before the procedure ( Z=-3.839, P<0.001) and the median VAS score decreased from 6 to 1 ( Z=-3.748, P<0.001), both of which had significant difference. However, the median diameters of main pancreatic duct were both 0.35 cm before and after procedure with no significant difference ( Z=-0.699, P=0.484). Conclusion:ERCP is safe and effective to diagnose and treat pediatric patients with PD with CP.

Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for pancreas divisum(PD)with chronic pancreatitis (CP) in adults.Methods:Data of patients older than 18 years old diagnosed as having PD with CP in Hangzhou First People′s Hospital from January 2008 to January 2020 were retrospectively analyzed, i. e.the general information, ERCP procedures and follow-up data of the patients. The number of acute pancreatitis attacks, visual analogue scale (VAS) of abdominal pain, and the diameter of pancreatic duct before and after ERCP were compared.Results:A total of 61 patients diagnosed as having PD with CP underwent 301 ERCP procedures with the median number of 4(3.0-6.5). The median number of pancreatic stent replacement was 3 (2-6). The success rate of the first minor papilla cannulation was 90.2% (55/61), and the total success rate of minor papilla cannulation was 98.0% (295/301). The efficacy rate of the first ERCP was 82.0% (50/61). ERCP-related complication rate was 2.7% (8/301). The median follow-up time was 54 months (31.0-97.5 months). The median number of acute pancreatitis attacks decreased from 2.40 to 0 ( Z=-6.726, P<0.001) compared with that before ERCP. The median VAS decreased from 7 to 2 ( Z=-6.621, P<0.001). The median pancreatic duct diameter decreased from 5.0 mm to 4.0 mm ( Z=-2.330, P=0.020). However, the mean weight increased from 56.04±10.75 kg to 58.62±10.79 kg ( t=-5.285, P<0.001)one year after the procedure. Conclusion:ERCP is safe and effective in the diagnosis and treatment of PD with CP in adults.

Objective:To evaluate the diagnostic and therapeutic effect of SpyGlass direct visualization system (SpyGlass) on cholangiopancreatic duct stenosis and large bile duct stones.Methods:Patients with cholangiopancreatic duct stenosis or large bile duct stones of indeterminate reasons who underwent SpyGlass at Hangzhou First People′s Hospital from September 2012 to August 2018 were recruited. Cholangiopancreatic duct stenosis were visually diagnosed using SpyGlass, and some patients underwent Spybite biopsy. Large bile duct stones were treated with SpyGlass-guided laser lithotripsy under direct visualization. The procedure success rate, clinical success rate, and adverse event incidence associated with SpyGlass were analyzed.Results:SpyGlass was performed to diagnose and treat 114 patients with bile duct stricture, 11 patients with pancreatic duct stricture and 19 patients with large bile duct stones. The total procedure success rate was 98.6% (142/144). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SpyGlass visual diagnosis of bile duct stricture of indeterminate reasons were 97.1% (67/69), 95.3% (41/43), 96.4% (108/112), 97.1% (67/69), and 95.3% (41/43), respectively. The accuracy of SpyGlass visual diagnosis of pancreatic duct stricture of indeterminate reasons was 100.0% (11/11). Of the 19 patients with large bile duct stones, the lithotripsy success rate was 89.5% (17/19). The success rate of primary extraction was 73.7% (14/19), and that of secondary extraction was 100.0% (5/5). The total extraction success rate was 100.0% (19/19) Four patients (2.8%) had postoperative complications, including three cases of acute cholangitis and one case of mild acute pancreatitis.Conclusion:SpyGlass is accurate and safe in the diagnosis of cholangiopancreatic duct stenosis. It is also effective and safe for treating large bile duct stones combined with laser lithotripsy.

Objective:To evaluate the efficacy and safety of lumen-apposing metal stent (LAMS) for the treatment of pancreatic walled-off necrosis (WON).Methods:A retrospective cohort study was performed on data of 43 consecutive patients with pancreatic WON who underwent endoscopic ultrasound-guided drainage by LAMS or plastic stents (PS) in Hangzhou First People's Hospital from December 2010 to June 2020. According to the type of stent used, the patients were divided into the LAMS group ( n=16) and the PS group ( n=27). The technical success rate, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and adverse events were compared between the two groups. Results:All 43 patients were successfully stented, indicating a technical success rate of 100% in both groups. For the LAMS group, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and overall incidence of adverse events were 75.0% (12/16), 26.0 (19.1, 39.8) min, 0.5 (0, 2.0) times, (41.3±28.4) days, and 43.7% (7/16), respectively, whereas these indices of the PS group were 37.0% (10/27) ( χ2=5.795, P=0.016), 31.0 (26.0, 48.0) min ( Z=1.221, P=0.222), 0 (0, 0) times ( Z=2.245, P=0.025), (176.1±99.1) days ( t=5.187, P<0.001) and 14.8% (4/27) ( χ2=8.893, P=0.064), respectively. Conclusion:LAMS placement is safe and effective for the treatment of pancreatic WON with a higher clinical success rate compared with PS. However, it requires more endoscopic intervention.

Objective To investigate the characteristics of population and the changes of disease spectrum in patients treated by endoscopic retrograde cholangiopancreatography ( ERCP ) . Methods Data of 20170 patients, who underwent ERCP in the First People' s Hospital of Hangzhou from May 2004 to February 2018, were enrolled in the retrospective analysis. According to the year of diagnosis and treatment,patients were divided into 2004-2008, 2009-2013, and 2014-2018 group; according to the postoperative diagnosis of ERCP, they were divided into biliary tract diseases ( including calculus, benign stenosis, malignant stenosis, and other causes ) and pancreatic diseases ( including acute pancreatitis, chronic pancreatitis, pancreatic malignant tumor, and other causes ) group; and according to the age, they were divided into the younger age (0-18 years old), young and middle age (19-65 years old), old age (66-85 years old), and advanced age (>85 years old) group. Statistical analysis was performed in the different groups. Results Among the 20170 patients, there were 10260 males and 9910 females, with age of 62. 65± 17. 11 years. The proportion of the younger age group and the advanced age group was 1. 04％( 24/2308 ) , 1. 69％ ( 127/7520 ) , 2. 39％ ( 247/10342 ) , and 2. 95％ ( 68/2308 ) , 4. 19％( 315/7520 ) , 6. 15％ ( 636/10342 ) , respectively, in the 2004-2008, 2009-2013 and 2014-2018 subgroups, with a rising trend (P<0. 017). A total 20032 patients had a clear postoperative diagnosis, including 15618 ( 77. 97％) of biliary diseases and 4414 ( 22. 03％) of pancreatic diseases. Biliary stones accounted for the majority of biliary diseases (63. 2％, 9863/15618), and its proportion increased from 59. 9％ ( 1191/1987 ) in 2004-2008 to 64. 5％ ( 5118/7939 ) in 2014-2018 ( P= 0. 000 ) . Acute pancreatitis accounted for the majority of pancreatic diseases (67. 4％, 1973/4414), and its proportion increased from 52. 4％ ( 162/309) in 2004-2008 to 69. 9％ ( 1636/2340) in 2014-2018 ( P=0. 000) . The top 3 diseases in the younger group and the advanced age group were acute pancreatitis ( 32. 58％, 129/396) , biliary stones ( 25. 25％, 100/396 ) , chronic pancreatitis ( 22. 22％, 88/396 ) , and biliary stones (56. 46％, 568/1006), malignant biliary stenosis (12. 52％, 126/1006), benign biliary stricture ( 10. 34％, 104/1006) , respectively. Conclusion The main disease of patients receiving ERCP is biliary stone, and the proportion of acute pancreatitis is increased. The overall age of the patients is old, and the proportion of the elderly and underaged patients is gradually increasing. Biliary diseases and pancreatic diseases are the main diseases in elderly patients and younger patients, respectively.

Objective:To investigate the diagnostic value of SpyGlass endoscopy system (short for SpyGlass) for indeterminate bile duct stricture.Methods:Data of patients who underwent SpyGlass examination for indeterminate bile duct stricture at Hangzhou First People′s Hospital from September 2012 to August 2017 were reviewed. The diagnostic value of SpyGlass for indeterminate bile duct stricture was analyzed.Results:A total of 88 patients with indeterminate biliary stricture were diagnosed with SpyGlass. The procedure success rate was 97.7% (86/88). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SpyGlass for indeterminate bile duct stricture were 98.1%(52/53), 96.9% (31/32), 97.6% (83/85), 98.1% (52/53)and 96.9% (31/32), respectively. Three patients (3.5%, 3/86) had postoperative complications and were cured by conservative treatment.Conclusion:SpyGlass is safe and effective for indeterminate biliary stricture with high sensitivity and accuracy and low incidence of complications.

Objective:To evaluate the safety, efficacy and performance of disposable cholangiopancreatoscope in the diagnosis and treatment of bile duct diseases.Methods:A total of 20 subjects were selected and 16 subjects were enrolled in the prospective and exploratory clinical study which were performed in the Digestive Endoscope Center of Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine from July 2021 to August 2021. The disposable cholangiopancreatoscope was used to diagnose bile duct diseases in routine endoscopic retrograde cholangiopancreatography. Biopsies were performed in cases where malignancy was considered. The use related indexes and performance indexes of the instruments were analyzed.Results:Among the 16 patients, there were 6 cases of biliary space-occupying lesions, 6 cases of biliary calculi, and 4 cases of benign biliary stricture before operation. The success rate of the disposable insertion was 100.00% (16/16), and the success rate of observation was 100.00% (16/16). Three biliary space-occupying lesions diagnosed as malignant tumor under cholangiopancreatoscope were confirmed by pathology after operation. Diagnosis of other patients was consistent with preoperative diagnose, so no biopsy was conducted. The rate of positive feedback from operators in directional control was 81.25% (13/16), the image failure rate was 18.75% (3/16), and the rate of positive feedback for image clarity was 93.75% (15/16). In terms of clinical performance, the imaging quality of excellence was 93.75% (15/16), the flexible degree of excellence was 81.25% (13/16), and other indexes were all 100.00% excellence. During the period, there were no instrument defects, pancreatitis, perforation, bleeding or other instrument-related adverse events.Conclusion:The effectiveness, safety and performance indexes of domestic disposable cholangiopancreatoscope have reached the standards of clinical application with high pixel, integration, and portability. It's worthy of clinical recommendation.