Objective To investigate the curative effect and safety of endoscopic nose biliary drainage (ENBD) through endoscopic retrograde cholangiopancreatography (ERCP) to treat for elderly patients with acute severe cholangitis in primary hospital.Methods Forty-two elderly patients with acute severe cholangitis were collected,the patients received ENBD through ERCP.The changes of clinical symptoms and signs,imaging examinations and laboratory examinations before and after treatment were compared.Results All 42 patients received ENBD through ERCP,40 patients were cured,1 patient failed in ERCP and then was turned to surgical operation,and 1 patient whose cholangitis condition got better died of respiratory failure because of chronic obstructive pulmonary disease (COPD).Conclusion ENBD through ERCP is a safety and effective treatment which was used to treat for elderly patients with acute severe cholangitis in primary hospital,so this technique is worthy popularizing in primary hospital.

Objective To evaluate the safety and effectiveness of three endoscopic methods for re-moval of common bile duct stones (CBDs)accompanied with periampullary diverticula(PAD).Methods A total of 154 patients hospitalized at Taizhou Hospital and Taizhou No.1 People′s Hospital of Zhejiang prov-ince from December 2012 to July 2013 were divided randomly into three groups,i.e.,EST,EPBD and ES-BD group,and received the treatment of EST,EPBD and limited EST plus EPBD (ESBD)to extract CBDs, respectively.After 12 months of follow-up,the rate of full stone clearance,stones clearance rate in one time,the rate of mechanical lithotripsy,the rate of urgent lithotripsy,the average procedures,the average removal time and the complication incidence among three groups were compared.Results The rates of stone clearance in one time in group ESBD was higher than those of group EST and group EPBD (94.12% VS 78.43%,73.08%;P <0.05)with significant difference.The average procedures in group ESBD was lower than that of group EPBD (1.08 VS 1.31,P <0.05),which also showed significant difference.The occur-rence rates of early complication in group ESBD was lower than that of group EPBD (15.69% VS 34.61%, P <0.05).The occurrence rates of post-ERCP hyperamylasemia in group ESBD was lower than that of group EPBD (5.88% VS 21.15%)with significant difference (P <0.05).The incidence of pneumobilia in group EST was higher than those of group EPBD (52.27% VS 26.19%,P =0.013)and group ESBD (52.27%VS 27.66%,P =0.016).Conclusion The stone extraction efficiency of ESBD is better than that of EST and EPBD.Compared with conventional EST,ESBD shows similar safety level,and is safer than EPBD.So ESBD is a safe and effective method to remove CBDs with PAD.

Objective:To study the effect of ubenimex capsule combined with FOLFOX4 on the expression of Skp2 and p27kipl in patients with primary gastric cancer.Methods:From June 2017 to June 2019, 114 patients with primary gastric cancer who hospitalized in the First People's Hospital of Taizhou were divided into observation group and control group according to the random digital table method, with 57 cases in each group.The control group was treated with FOLFOX4 chemotherapy, and the observation group was treated with ubenimex capsule on the basis of the control group.After three cycles of continuous chemotherapy, the short-term efficacy, the level of immune function index, the expression of Skp2 and p27kipl protein, and the incidence of adverse reactions were compared.Results:The objective remission rate(ORR) and disease control rate(DCR) in the observation group were 77.19%(44/57) and 61.40%(35/57), respectively, which were higher than those in the control group [57.89%(33/57) and 42.11%(24/57)](χ 2=4.842, 4.251, P=0.028, 0.039). After treatment, the levels of CD 3+ , CD 4+ cells and the ratio of CD 4+ /CD 8+ in the observation group were higher than those in the control group, while the level of CD 8+ cells in the observation group was lower than that in the control group, the differences were statistically significant( t=3.803, 4.538, 4.187, 6.042, P=0.000, 0.000, 0.000, 0.000). After treatment, the Skp2 protein level in the observation group was lower than that in the control group, and the p27kipl protein level in the observation groupwas higher than that in the control group, the differences were statistically significant( t=3.971, 4.110, P=0.000, 0.000). During the treatment, the incidences of adverse reactions in the observation group and the control group were 33.33%(19/57) and 24.56%(14/57), respectively, the difference between the two groups was statistically significant(χ 2=1.066, P=0.302). Conclusion:Ubenimex combined with FOLFOX4 can improve the immune function of patients with primary gastric cancer, regulate the expression of Skp2 and p27kipl protein, and has good therapeutic safety, which is worthy of clinical recommendation.