Objective To discuss the safety of endoscopic sphincterotomy (EST) in treatment of choledocholithiasis in patients over 80 years.Methods From 2005 to 2007,893 patients with choledocholithiasis were divided into group A (n= 148,aged over 80 years) and group B (n=745,aged below 60 years).The clinical data,complications and EST successful rate were retrospectively reviewed between two groups.Results ① The important chronic concomitant diseases were significantly higher in group A than those in group B ( 29.3 % vs 8.1 % ,P＜0.01).② The EST successful rate in group A and B was 95.6% and 96.5%,respectively ( P＞0.05).③ Sixteen patients in group A had complications including 13 caused by EST itself,3 related with EST and one died of aspiration pneumonia.While in group B,41 complications were caused by EST itself and no EST related complications.There was a statistically difference in EST related complications between two groups (P < 0.01 ).In complications caused by EST itself,there was no difference between two groups (P 0.05 ).④ The average hospital stay was ( 7.2 ± 2.2) days in group A and (5.1 ± 1.4) days in group B with no significant difference (P 0.05),Conclusion The EST is safe and effective in treatment of patients over 80 years.

OBJECTIVE To investigate the relation of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) expression with cervical lymph metastases in papillary thyroid carcinoma. METHODS The expression of COX-2 and VEGF in 79 specimens of papillary thyroid carcinoma were evaluated with SP immunohistochemical methods. In all the 79 cases, there were 46 cases with cervical lymph node metastases and 33 cases without cervical lymph node metastasis. RESULTS The positive expression rates of COX-2 and VEGF in the cases with cervical metastases were 81.6 % and 86.8 % respectively, and in the cases without cervical lymph metastases were 54.5 % and 66.7 % respectively. There was a significant difference in the positive expression rates of COX-2 and VEGF between two groups (P

Objective To investigate the safety of endoscopic suhmucosal dissection (ESD) in elderly patients with lesions of gastroesophageal mucosa. Methods Thirty-six elderly patients with flat elevation lesion of gastroesophageal mucosa were studied from July 2007 to May 2008. There were 14 cases with dysplasia, 9 cases with early carcinoma and 13 cases with leiomyoma confirmed by pathologic biopsy and endoscopic ultrasonography. All the patients were treated under consciousness condition, and the focus of lesion were completely resected with improved hook knife, IT knife and electrocoagulation or electro-cutting technique. The wound surface was managed with noradrenaline added in ice physiological saline, argon beam coagulator and metal clips. After operation, they were treated by abrosia, acid suppression and mucosa protection. The conditions of wound healing and residual lesions were reexamined four weeks after operation. Results Among the 36 patients (19 males and 17 females), there were 29 patients(80.6%) with complete focus ablation by ESD and 7 patients (19.4%) with resection by snare. Three cases (8.3%) of perforation occurred during operation and the perforations were treated with metal clips. After inserting stomach tube for fasting and anti-infection treatment for 5-7 days, all the three cases were recovered. One case(2.8%)had hematemesis 2 hours after operation and bleeding was stopped by endoscopic metal clip. Conclusions ESD is a safe and effective therapeutic tool in elderly patients with lesions of gastroesophageal mucosa.

Objective To investigate the factors that related to acute biliary pancreatitis including size and the location of the common bile duct stone. Methods Clinical data from 3497 patients with common bile duct stone admitted to the hospital between Jan. 2002 and Dec. 2008 were retrospective analyzed. All patients were grouped according to the size and the location of the bile duct stones. The incidence of acute pancreatitis was compared among groups. Results In patients with common bile duct stone accompanying the acute pancreatitis,common symptoms were fever, bellyache and jaundice, as well as elevated serum amylase. There was a negative correlation between size of the common bile duct stone and the severity of acute hiliary pancreatitis, which was easily induced by the stone in the Vater's ampullar or distal common bile duct. Conclusion Early endoscopic treatment should be carried out in patients with microlith located in the Vater's ampullar or distal common bile duct in order to prevent the acute biliary pancreatitis.

Objective To estimate the long-term efficacy of endoscopic sphincterotomy (EST)in treatment of choledocholithiasis and to analyze the potential risk factors for disease recurrence.Methods A total of 154 patients with choledocholithiasis,who underwent EST between January 2006and December 2006, were enrolled. Multivariate analysis was used to evaluate the association of clinical features and experimental parameters with recurrence of choledocholithiasis. Results Longterm complications developed in 22 patients (14.29%) including recurrent choledocholithiasis (18/154,11.69 % ) and combined cholangitis (16/154). Cholangitis without calculi was found in 1 case (0.65%), acute pancreatitis in 2 cases (1.30%) and cholangiocarcinoma in 1 case (0.65%). High body mass index and serum cholesterol were proved to be risk factors for recurrence of choledocholithiasis. Whereas the incision size (0.5 cm-1.5 cm) of vater's papilla was the protective factor for recurrence of choledocholithiasis. Conclusions Body mass index, serum cholesterol and the incision size of vater's papilla are related to recurrence of choledocholithiasis.

Objective To investigate the differential diagnostic value of 18 F‐DG PET/CT imaging on gastric malignancies and primary gastric lymphoma(PGL) .Methods A total of 93 cases of gastric cancer (23 cases of mucinous adenocarcinoma and 70 ca‐ses of non mucinous adenocarcinoma ) ,58 cases of PGL and 31 cases of Diffuse Large b Cell Lymphoma (DLBCL ) and 27 cases of Mucosa associated tissue lymphoma (MALT) treated in our hospital from Jun 2012 to Jun 2015 were involved in this study .Their clinical data ,SUVmax ,maximum lesions thickness ,CT value ,lesion shape ,merge splenomegaly and lymph node metastasis were compared .The relation between SUVmax and maximum lesions thickness were analyzed with Pearson analysis .Results The aver‐age age and the lesions involve cardiac orifice rate of the gastric cancer group were significantly higher than that of PGL group (P<0 .05) .The occurence rate of SUVmax and splenomegaly in the gastric cancer group were significantly lower than that of PGL group (P<0 .05) .From the perspective of lesion shape ,type Ⅱand Ⅲ were mostly found in gastric cancer group ,while type ⅠandⅡwere mostly seen in PGL group ,the difference was significant(P<0 .05) .Further analysis showed that the SUVmax of DLBCL was significantly higher than other type(P<0 .05);the maximum lesions thickness of DLBCL was significantly higher than gastric mucous adenocarcinoma and MALT (P<0 .05) .Pearson analysis showed that there was no significant difference between SUVmax of different pathological type and the maximum lesions thickness (P>0 .05) .Conclusion The diagnostic value of 18 F‐FDG PET/CT in gastric malignancies was high ,and patients with different cancer and pathological type were different in SUVmax ,maximum le‐sions thickness and lesion shape .

Objective:To explore the strategies and complications of the submucosal tunneling endoscopic resection (STER) in the treatment of esophageal duplicated cyst (EDC).Methods:From January 2013 to December 2019, at Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected. The clinical featured, computed tomography (CT) findings, endoscopic findings, postoperative efficacy, complications and pathological results after operation were summarized.Results:Among the 11 patients, there were 6 males and 5 females, the age ranged from 13 to 67 years, and the mean age was (43.0±18.2) years. One case presented with swallowing obstruction, 1 case with belching, 4 cases with upper abdominal pain, and the remaining 5 cases had no specific clinical symptoms. Under endoscopy, the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity, which were soft to touch. Under endoscopic ultrasonography, they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria. The results of CT scan of 9 patients showed round low-density cystic masses, among them 7 cases showed mild enhancement. The maximum diameter of the cysts was 1.5 to 4.4 cm, with mean maximum diameter being (2.8±0.8) cm, and the maximum diameter of most patients (7 cases) were 2 to 3 cm. The other two patients showed only slightly thickened esophageal wall on CT. Five lesions occurred in the horizontal mediastinum of the lower esophagus. All the 11 patients underwent STER operation successfully, among them 6 patients received simple STER and the cysts were completely resected, and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall. The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts. The median follow-up time (range) of 11 patients was 42 months (12-86 months). Ten patients recovered well after the operation, and local recurrence, malignant transformation or metastasis were not found. One case had recurrence, and was treated with STER and cauterization with argon ion for residual cyst wall and cured. No complications such as bleeding, fistula, mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions:STER is a minimally invasive, safe and effective treatment for EDC, and may be a new treatment for EDC.

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.

Spinosad represents a new class of insecticides produced by Saccharopolyspora spinosa. To understand the transcription of the spinosad biosynthetic gene cluster, two promoter detection plasmids based on different reporter genes were constructed and used to detect 9 promoters in the spinosad biosynthetic gene cluster. In addition, the temporal transcriptional profiles of the corresponding genes controlled by the 9 promoters, together with 4 genes outside of the spinosad cluster but are required for the synthesis of sugars in spinosad, were examined by real-time PCR. The results indicate that the 9 spinosad biosynthetic genes were highly expressed at the stationary phase, which coincides with the accumulation of spinosad in the fermentation broth. Of particular note is that the transcription of the 4 sugar synthetic genes showed higher level at the exponential phase, suggesting the expression of sugar synthetic genes is not correlated with the spinosad synthetic genes. The data suggest that spinosad biosynthesis could be improved by engineering the expression pattern of the sugar synthetic genes that lie outside the spinosad gene cluster.
Drug Combinations ; Insecticides ; metabolism ; Macrolides ; metabolism ; Multigene Family ; Plasmids ; Promoter Regions, Genetic ; Real-Time Polymerase Chain Reaction ; Saccharopolyspora ; genetics ; metabolism

Objective To summarize the endoscopic appearance,endoscopic ultrasound findings and histopathological characteristics of gastric inflammatory fibroid polyp (IFP) in order to improve diagnosis of IFP.Methods From September 2011 to November 2016,49 patients with pathologically comfirmed gastric IFP,who underwent endoscopy in Taizhou Hospital of Zhejiang Province,were enrolled.The medical history,endoscopic examination,treatment and follow-up were retrospectively enalyzed.Results Among 49 patients with gastric IFP (16 males and 33 females;average age 54 years) the maximum diameter of 33 cases (67.3％) was between 1.0 cm and 2.0 cm.Forty-eight cases had single lesion and one case had multiple lesions.The lesions of 17 cases (34.7％) were located at the anterior wall of gastric antrum,the lesions of seven cases (14.3％) were at the posterior wall of gastric antrum,the lesions of seven cases (14.3％) were at the lesser curvature of gastric antrum and the lesions of seven cases (14.3％) were at the great curvature of gastric antrum.Among the lesions of 41 patients who received endoscopic ultrasonography,28 lesions were located in the submucosa of stomach,13 lesions were located in mucosa and muscularis mucosa.The rate of misdiagnosis of endoscopic ultrasonography was 29.3％ (12/41).The endoscopic ultrasound findings of the lesions included 26 hypoechoic structures,11 hyperechoic structures and four slightly hypoechoic structures.The lesions of all the patients were successfully removed by endoscopic polypectomy without any complication.Thirty-seven lesions were treated by endoscopic submucosal dissection (ESD) and 12 lesions by endoscopic mucosal resection (EMR).All the patients were not clearly diagnosed before operation and were finally diagnosed by pathological examination.Postoperative pathological examination showed that in the suhmucosa and mucosa lamina propria,spindle-shaped cells proliferated and arranged in an interwoven pattern or cells around vessels or mucosal glands formed vortex-like or onion skin like pattern.Forty-seven patients were followed up and the median follow-up time was 31 months.All patients survived withont recurrence or metastasis until the submission of this paper.Conclusions The rate of misdiagnosis of gastric IFP is high before operation,and the diagnosis is depended on histopathological examination.Endoscopic resection is the first choice because the diameter of most lesions are less than 5 cm.