Objective To investigate the effect of one day method in endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in treatment of cholecysto lithiasis and combined.Methods A retrospective analysis was carried out for fivety-seven cases of cholecystolithiasis combined with choledocholithiasis were peformed EST combined with LC as one day method (Conducted EST firstly and then took LC within 24 hours) from September 2007 to September 2012.Results Fifty-six cases completed LC,the surgical success rate was 98.24％,transit operation rate was 1.76％.Two cases performed abdominal pain and serum amylase rised the other 1 case was transited operation because of the inflammation of triangular parts of the gallbladder and discharged after 9 days.All patients total bilirubin fell to normal level within 72 hours.Conclusion The one day method in EST combined with LC treatment of cholecystolithiasis and choledocholithiasis can effectively reduce patients trauma,achieve good effect with fewer complications and shorter recovery time.

Objective To evaluate values of laparoscope,duodenoscope,choledochoscope and seven procedures for extrahepatic biliary calculi.Methods From Junuary 2002 to June 2006,clinical data of 246 cases of extrahepatic biliary calculi treated by three kinds of endoscope and seven procedures were reviewed retrospectively.Laparoscope(Ⅰa) was used in 8 cases,duodenoscope(Ⅰb) in 27 cases,choledochoscope(Ⅰc) in 17 cases,laparoscope combined with choledochoscope(Ⅱa) in 83 cases(including transferred 9 cases),laparoscope combined with duodenoscope(Ⅱb) in 102 cases,choledochoscope combined with duodenoscope(Ⅱc) in 3 cases(all transferred),combined three kinds of endoscope(Ⅲ) in 21 cases(containing transferred 3 cases).Results The success rate of all procedures was 82%-100% without severe complications.Residual stones in biliary tracts were removed once again successfully in 10 cases.The mean of follow-up period was 25.6 months(range,3 months to 4 years).No biliary tract stenosis was observed in 202 cases and stone recurred in 15 cases.Conclusions Three kinds of endoscope and seven procedures supplement minimally invasive treatment.As seven procedures have different indications respectively,the principle "one endoscope preference,main application of two endoscopes,and reasonable application of three endoscopes" should be followed.

Objective To evaluate the clinical significance of juxtapaillary duodenal diverticula (JPDD) in patients of acute calculous cholangitis (AC) with different severity grade.Methods A retrospective analysis was carried out for 488 AC cases of different severity from January 2011 to December 2013 who underwent duodenoscopy in Dongyang People's Hospital.Results Of the 488 patients, the JPDD was found in 2.87％, 6.15％ and 4.10％ in patients with mild, moderate and severe AC, respectively.The prevalence of JPDD in severe AC were significantly higher in the moderate and mild AC (x2 =4.486, P =0.034;x2 =14.686, P ＜ 0.001);Procalcitonin (PCT) concentrations in severe AC of JPDD were significantly higher in moderate and mild AC of JPDD (t =10.420 9, P ＜ 0.001;t =4.870 4, P ＜ 0.001).The cannulation failure rate and the amylase were significantly higher in JPDD patients compares to patients without JPDD (x2 =36.95, P ＜ 0.001;t =8.29, P ＜ 0.001).Conclusions JPDD detection rate increases with aging and seems to be associated with acute cholangitis (AC) with different severity grade and PCT concentration.JPDD predicts a higher cannulation failure rate and the amylase level after duodenoscopy.

Objective To evaluate the role of procalcitonin in patients with different severity grades of acute cholangitis (AC).Methods A retrospective study was carried out on 147 patients with different severity grades of AC who were treated from May 2012 to November 2013 at the Dongyang People's Hospital.Results Of 147 patients,the PCT concentrations were (165.63 ± 32.67) pg/ml,(348.97 ± 45.78) pg/ml,(758.91 ± 28.94) pg/ml for patients with mild,moderate and severe AC respectively.The PCT concentrations were significantly higher in patients with severe AC than those with moderate AC (P ＜ 0.05),and also in patients with moderate AC than those with mild AC (P ＜ 0.05).The top three bacteria obtained from blood culture from the different severity grades of AC showed no significant diferences (P ＞ 0.05).Conclusion Serum PCT concentrations were elevated in patients with AC and it may be used as a parameter to assess the severity of AC.

Objective To investigate wether bronchial epithelial-mesenchymal transformation (EMT)take part in airway remodling in asthmatic mice,and the effect of inhaled glucocorticoid to it. Methods Thirty BALB /c mice were randomly divided into control group(n =10),asthma group(n =10) and budesonide group(n =10).The qualitity of serum OVA-sIgE was measured to vertify asthma modle. Bronchial airway thickness collagen deposition area was analyzed by HE and Masson staining to test the level of airway remodling.ELISA was used to test the quantity of transforming growth factor(TGF)-βin bron-choalveolar lavage fluid(BALF).Immunohistochemical assay was used to observe fibroblast specific protein-1 (FSP-1 )expressing area.Western blot and realtime PCR were performed to analyze the protein and mRNA expression of E-caderin,Vimentin and FSP-1 .Results The expression of OVA-sIgE,bronchial airway thick-ness,the collagen deposition area were significantly higher in asthma group than those in control group,while the above index in BUD group were allivated compared to those in asthma group(P <0.01 ,respectively). The expression of TGF-βin BALF increased and the expression of FSP-1 located in bronchial epithlium,the quantity of E-caderin significantly decreased,and the quantity of Vimentin and FSP-1 increased by Western blot and realtime PCR in asthma group,compared to those in control group(P <0.01 ).While the level of E-caderin increased(P <0.01 ),TGF-βand Vimentin reduced partly in BUD group(P <0.05 ),and there was no differece in the level of FSP-1 between BUD group and asthma group(P >0.05).Conclusion Lung tissue EMT take part in airway remodling of asthma,which is mainly focus on bronchial epithlium.The effect of traditional inhaled budesonide can not heal the bronchial EMT in asthma.

Objective To evaluate the clinical significance of different localizations of juxtapaillary duodenal diverticula of patients with endoscopic retrograde cholangiopancreatography for pancreaticobiliare disease.Methods We studied patients in whom juxtapaillary duodenal diverticula was detected during endoscopic retrograde cholangiopancreatography form January 2010 to April 2016 in Department of Hepatobiliary Surgery,Dongyang People's Hospital of Zhejiang Province.The influence of juxtapaillary duodenal diverticula on the success rate of endoscopic retrograde cholangiopancreatography and the incidence of associated complications was analyzed.Measurement date were represented as ((x) ± s) comparison between the groups was analyzed by the t test.Count date were evaluated by the frequency and percentage,comparison between the groups was analyzed by the chisquare test or Fisher exact probability method.Results Juxtapaillary duodenal diverticula were present in 67 (14.11％) of the 475 patients undergoing endoscopic retrograde cholangiopancreatography for various indictions.Of the 67 patients,38 (56.72％) patients were peridiverticular papilla and 29 (43.28％) patients were intradiverticular papilla.The presence of cannulation success on first attempt was signicantly different between juxtapaillary duodenal diverticula group and non-juxtapaillary duodenal diverticula group(P =0.022),whereas the presence of c annulation success on total attempt was no-different between two groups(P =0.086).The presence of cannulation success on first attempt and total attempt was signicantly different between peridiverticular papilla group and intradiverticular papilla group(P =0.002,P =0.001).The presence of post-ERCP pancreatitis and bleed were more frequently in juxtapaillary duodenal diverticula group (P =O.023,P =0.003),but the different was non-signicantly between peridiverticular papilla group and intradiverticular papilla group (P =1.000,P =1.000).Conclusion Juxtapaillary duodenal diverticula detection rate and different location increase the difficulty of endoscopic retrograde cholangiopancreatography and maybe increase the presence of complications.

OBJECTIVETo study the expression of EpCAM and E-cadherin in papillary thyroid carcinoma and to analyze its correlation with various clinicopathologic parameters.

METHODSImmunohistochemical study for EpCAM and E-cadherin was carried out in 91 cases of papillary thyroid carcinoma. Twenty-four cases of papillary hyperplasia of thyroid were used as controls.

RESULTSIn all of the 24 cases of papillary hyperplasia, EpCAM was located on the cell membrane, while in the 91 cases of papillary thyroid carcinoma studied, EpCAM was located within the cytoplasm, with 36.3% (33/91) showing nuclear localization as well. In all the papillary hyperplasia cases studied, E-cadherin showed membranous expression. E-cadherin expression was reduced in 84.6% (77/91) of papillary thyroid carcinoma, as compared with the surrounding native thyroid parenchyma. Amongst the 33 cases of papillary thyroid carcinoma which showed nuclear localization of EpCAM, 30 cases also showed reduced E-cadherin expression. There was a positive correlation between nuclear expression of EpCAM and loss of E-cadherin expression (P = 0.000; Spearman correlation coefficient = 0.857). Nuclear expression of EpCAM correlated with follicular variant of papillary thyroid carcinoma and presence of extrathyroidal extension ( P = 0.037 and 0.033, respectively). Loss of E-cadherin expression correlated with age of patients and presence of lymph node metastasis (P = 0.018 and 0.010, respectively).

CONCLUSIONSE-cadherin expression is reduced in papillary thyroid carcinoma, as compared with native thyroid parenchyma and papillary hyperplasia. Papillary thyroid carcinoma shows loss of EpCAM membranous expression and increased cytoplasmic/nuclear accumulation. Detection of these two markers may provide a valuable reference in defining the biologic behaviors of papillary thyroid carcinoma, including extrathyroidal extension and lymph node metastasis.

Antigens, Neoplasm ; metabolism ; Cadherins ; metabolism ; Carcinoma, Papillary ; metabolism ; secondary ; Cell Adhesion Molecules ; metabolism ; Cell Membrane ; metabolism ; Cytoplasm ; metabolism ; Epithelial Cell Adhesion Molecule ; Humans ; Lymphatic Metastasis ; Neoplasm Proteins ; metabolism ; Thyroid Neoplasms ; metabolism ; pathology

Objective To provide the theoretical supportting for targeted heparanase (HPA) inhibition of cervical cancer through observing the anti-proliferative effect of the HPA inhibitor on HeLa cell line of cervical cancer. Methods The two series of 13 kinds of novel HPA inhibitors were synthesized and optimized. Heparan degrading enzyme assay kit was used to test the effect of the inhibitors on the inhibition of HPA enzyme activity. Methyl thiazolyl tetrazolium (MTT) method and scratch test were used to observe the anti-proliferative and the migration effect of the inhibitors on HeLa cells. Flow cytometry was performed to determine the cell cycles and apoptosis. The expression of HPA was evaluated by reverse transcription (RT)-PCR, western blot and immunocytochemistry. Results All tested inhibitors could inhibit the activity of HPA enzyme [the range of 50% inhibiting concentration (IC50) values from 4.47 to 47.19 μmol/L] and the growth of HeLa cells (the range of IC50 values from 48.16 to 96.64μmol/L). Among them, No.16 compound exhibits the strongest inhibition against the growth of HeLa, which could arrest the cell into G0/G1 and G2/M phases. The rate of cell apoptosis in the group treated with 50μmol/L No.16 for 48 hours [(11.9±1.2)%] was significantly higher than that [(6.6 ± 1.8)%] in untreated group (P=0.013). Real time PCR and western blot showed that expression levels of HPA mRNA (1.23±0.46) and protein (0.46±0.31) significantly decreased in the treated group as compared with the levels of HPA mRNA (3.43 ± 0.45) and protein (1.30 ± 0.58) in the untreated group (both P<0.05). Immunocytochemistry also showed that the treatment of No.16 significantly reduced the average optical density (0.39 ± 0.04) of HPA immuostaining signal compared with that in the control group (0.50 ± 0.09; P=0.026). Conclusion Novel 1,3-O,N spiroheterocyclic HPA inhibitors could inhibit the proliferation of HeLa cells,inhibit the HPA enzyme activity in different degree, and down-regulate the expression of HPA protein.

Objective To investigate the optimal timing of indomethacin administration on prevention of post-endoscopic retrograde cholangiopancreatography ( ERCP ) pancreatitis. Methods The patients were randomly divided into the preoperative group and the postoperative group, and given 100 mg indomethacin in rectum within 30 min before and after ERCP, respectively. The serum levels of amylase and lipase were measured preoperatively and 4 h, 24 h postoperatively. The incidences of postoperative complications such as acute pancreatitis, hyperamylasemia, gastrointestinal bleeding, and perforation were assessed. Results A total of 340 patients were enrolled in this study from June 2014 to June 2017. The preoperative group consisted of 163 patients, including 11 cases ( 6. 75％) with post-ERCP pancreatitis ( PEP ) and 32 cases ( 19. 63％) with hyperamylasemia. Meanwhile, 177 patients constituted the postoperative group, with 25 cases ( 14. 12％) with PEP and 55 cases ( 31. 07％) with hyperamylasemia. The incidences of PEP and hyperamylasemia were significantly lower in the preoperative group than that in the postoperative group ( P = 0. 027 and P = 0. 016, respectively ) . Conclusion Preoperative use of indomethacin can better reduce the incidence of PEP than postoperative administration, without incidence increase of other complications.

Respiratory syncytial virus(RSV) is a common pathogen of respiratory tract infection in children, and its related lower respiratory tract infection is associated with subsequent repeated wheezing and bronchial asthma, but the specific pathogenesis is still unclear.In recent years, it has been found that respiratory syncytial virus infection leads to the injury of respiratory epithelial cells, the release of inflammatory mediators and the disorder of immune function, which are involved in the pathogenesis of asthma.And the early intervention of viral infection and the development of antiviral drugs will improve the occurrence of recurrent wheezing and asthma to a certain extent.Therefore, this article reviews the relationship between recurrent wheezing and asthma caused by respiratory syncytial virus and the effects of anti-respiratory syncytial virus drugs and vaccines.