Objective To compare the efficacy and survival of patients with malignant obstructive jaundice using either endoscopic self-expandable metallic stents or surgery,and to evaluate the compounding factors influencing prognosis.Methods 56 patients with malignant obstructive jaundice treated with endoscopic self-expandable metallic stents (the endoscopic group) were compared with 90 patients who received surgery (the surgery group) during the same study period.Clinical data and survival of the 2 groups of patients were retrospectively analyzed.Results The success rate was 100％ in the endoscopic group.The serum bilirubin,alkaline phosphatase (ALP) and γ-glutamyl transferase (γ-GT) decreased significantly by using either therapeutic endoscopy or surgery (P＜0.01).There was no significant difference between the two groups in the reduction of serum total bilirubin.The mean survival of the endoscopic and surgery groups were 340 d and 795 d respectively.The accumulative survivals of the endoscopic group at 3,6 and 12 months as evaluated by the Kaplan-Meier method were 82.6 ％,61.1％ and 46.6 ％,respectively,and for the surgery group were 97.0％,90.9 ％ and 65.4％ respectively. There was a significant difference in survival between the two groups (P＜0.01).Survival after therapeutic endoscopy was similar to surgery for patients with metastasis and hilar biliary obstruction.Conclusions Self-expandable metallic stents gave similar palliation in the relief of jaundice in patients with malignant biliary obstruction.The stents had no effect on the primary tumor.Therapeutic endoscopy with self-expandable metallic stents is a safe and effective method for the relief of jaundice in patients with obstructive jaundice caused by non-resectable malignant tumors.

OBJECTIVE To explore the regulatory effect and mechanism of salipurposide(Sali), salidroside(Sal) and isoflavone(Isota) from Rhodiola crenulata on senescence of human embryo lung fibroblast diploid cells(2BS). METHODS Observing and selecting young 28 generations 2BS(28PD) cells and senescence 50 generations 2BS(50PD) cells under the microscope. MTT method was used to determine the effects of 1.25, 2.5, 5.0, 7.5, 10.0 μmol·L-1 Sal, 2.5, 5.0, 7.5, 10.0, 12.5 μmol·L-1 Sali and Isota on the activity of 50PD cells. The 5.0 μmol·L-1 Sal, 10.0 μmol·L-1 Sali and Isota were used for the following experiments according to MTT results. 28PD and 50PD cells were divided into 28PD group, 50PD group, 50PD+Sali group, 50PD+Sal group, 50PD+Isota group, intervention for 24 h. The senescence associated-beta-galactosidae(SA-β-gal); malondialdehyde(MDA), reactive oxygen species(ROS), superoxide dismutase(SOD), glutathione peroxidase(GSH-PX) levels of cells were measured with the test kits; the mRNA expression of phosphatidylinositol-3-kinase(PI3K), protein kinase B(AKT), histone deacetylase 2(HDAC2) and the protein expression of PI3K, p-AKT, HDAC2 were detected by qRT-PCR and Western blotting respectively. RESULTS Compared with the 28PD group, 50PD group cell SA-β-gal expression was increased, the content of MDA and ROS were increased, the activity of SOD and GSH-PX were decreased, the mRNA expression of PI3K, AKT, HDAC2 and related protein expression were decreased(P<0.01). 50PD cells after intervention with Sali, Sal, and Isota, SA-β-gal expression were decreased(P<0.01), the content of MDA and ROS were decreased significantly(P<0.01), the activity of SOD and GSH-PX were increased(P<0.01), the mRNA expression of PI3K, AKT, HDAC2 and related protein expression were significantly increased(P<0.05 or P<0.01). CONCLUSION Sali, Sal and Isota from Rhodiola crenulata can reduce the expression of SA-β-gal of 50PD cells, its effect may related to the inhibition of oxidative stress and regulation of expression of PI3K/AKT-HDAC2 axis.

Objective: To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones. Methods: From September 2018 to March 2019, 48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis (primary group, 38 patients) and recurrent choledocholithiasis group (recurrent group, 10 patients). The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA. The Chao1 estimator indicated the richness of the biliary bacterial flora, and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora. The bacterial flora distribution was explored from different levels of phylum, class, order, family, genus and species. Chi-square test and t test were performed for statistical analysis. Results: The Chao1 estimator of the primary group was higher than that of the recurrent group (419.413±118.704 vs. 396.000±70.483), and the difference was statistically significant (t=3.130, P=0.003). At the level of the phylum, the highest abundance of bacteria in the primary group was Firmicute (56.48%), the highest abundance of bacteria in the recurrent group was Proteobacteria (57.79%). The dominant bacteria of the recurrent group was Proteobacteria, which was inconsistent with that of the primary group, and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups (χ²=0.962 and -2.619, both P<0.05). At the genus level, the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group (9.75% vs. 20.77%, 10.86% vs. 22.01%, respectively), and the differences were statistically significant (χ²=0.354 and 0.503, both P<0.05). The abundance of Morganella of the recurrent group was higher than that of the primary group (9.00% vs. 0.44%), and the difference was statistically significant (χ²=-2.025, P=0.049). At the species level, the abundance of Bacillus unclassified, Carnobacterium maltaromaticum and Bacillus circulans of the primary group were all higher than those of the recurrent group (17.78% vs. 8.84%, 2.39% vs. 1.11%, 2.59% vs. 0.74%, respectively), and the differences were all statistically significant (χ²=2.540, 2.643 and 2.515, all P<0.05). The abundance of Aeromonas veronii of recurrent group was higher than that of the primary group (2.04% vs. 0.01%), and the difference was statistically significant (χ²=-2.397, P=0.021). The bacteria that had significant effects in the primary group included Lactococcus (P=0.012), Lactobacillus (P=0.033) and Geobacillus (P=0.021), while in the recurrent group, which included Enterobacter (P=0.007), Aeromonadaceae (P=0.001), Actinomycetes (P=0.009), and Aeromonas (P=0.001). Conclusions There are differences in abundance and composition of biliary bacterial flora between the recurrent group and the primary group. It remains to be further studied whether the changes of some bacterial flora correlated with the recurrence of common bile duct stones.