Sphincter of Oddi dysfunction (SOD) refers to a series of clinical syndromes that occurs because of structural or functional disorders involving the biliary and/or pancreatic sphincters.It remains controversial whether endoscopic sphincter manometry (SOM) or sphincterotomy is needed in patients with type Ⅲ SOD.An important problem is that ERCP (with or without SOM) carries significant risks, especially the post-ERCP pancreatitis.The EPISOD trial has updated our knowledge on type Ⅲ SOD.The latest Rome Ⅳ consensus suggested that the classification term type Ⅲ biliary SOD should be abandoned and a new classification of biliary SOD was proposed;also, manometry and sphincterotomy were not recommended for patients with this type of SOD.The goal of this paper is to review recent literatures and elucidate the selected important questions regarding type Ⅲ SOD.

OBJECTIVE:To investigate the effect of thymosin α1 combined with chemotherapy on immune function in patients with advanced gastric cancer and quality of life. METHODS:90 patients with advanced gastric cancer were randomly divided into observation group and control group with 45 cases in each group. Control group was treated with FOLFOX4 chemotherapy plan(so-dium oxaliplatin+calcium folinate+fluorouracil),and observation group was additionally treated with thymosin α1 1.5 mg subcutane-ously,once a day,on the basis of control group. A treatment course lasted for 3 weeks,and both received 3 courses of treatment. The immune function and quality of life were evaluated in 2 groups. RESULTS:The effective rate of observation group was 57.8%,and that of control group was 53.3%;there was no significant difference between 2 groups (P>0.05). The incidence of leukopenia in observation group was 24.4%,which was significantly lower than control group (55.6%),with statistical signifi-cance(P<0.05). There was no statistical significance in CD4+,CD8+ and NK score between 2 groups before chemotherapy(P>0.05). After treatment,above index of observation were all higher than those of control group,with statistical significance (P<0.05). The total health QLQ-C30 EORTC score in observation group was higher than in control group after chemotherapy,with sta-tistical significance(P<0.05). CONCLUSIONS:Thymosin α1 combined with chemotherapy can significantly improve the immune function and quality of life.

STAT3 can be activated by various cytokines and participate in the process of tumor cells proliferation,angiogenesis,invasion and chemotherapy resistance.Epithelial-mesenchymal transition (EMT)also plays an important role in the process of tumor invasion and metastasis and chemotherapy resistance.Studies have shown that STAT3 can regulate the process of EMT so as to change the invasion and metastasis abilities of tumor cells,and to enhance their ability of chemotherapy resistance.Discussion of the role and relation of STAT3 and EMT in tumor cells will be helpful to provide reliable theory for tumor molecular targeted therapy.

Autophagy is a dynamic process which subcellular membranes undergo morphological changes that lead to the degradation of cellular cytoplasmic organelles and macromolecules.It is regulated by themammalian target of rapamycin ( mTOR ) -dependent or -independent signaling pathways.It has been demonstrated that autophagy is induced or inhibited in various tumor cells,and it is closely related with cell survival and drug resistance.Because of the complex relationships with cell death,the roles of autophagy in cancer developnent,treatment,and drug-resistance are not the same,and thus controlling autophagy properly may become one of new means of cancer therapy.

Recent studies show that tumor cells get rid of the connections between cells,and induce tumor invasion and metastasis through epithelial-mesenchymal transition (EMT).EMT becomes an important way to invasion,metastasis and chemotherapy resistance of epithelial cell carcinoma which accounting for more than 90％ of malignant carcinomas.Members of Snail family,especially Snail is regarded as important adjustment factor of EMT,which induce the transformation from epithelial cell to mesenchymal phenotype through competitive inhibition E-calcium protein gene expression.Many researches show that EMT exists widely in digestive system tumors,which is closly related to the invasion,metastasis and chemotherapy resistance of digestive system tumors.

Background:Intrahepatic cholestasis is a commonly seen clinical manifestation, and often accompanied with jaundice.Study on clinical characteristics of patients with different degrees of jaundice is helpful for the acknowledge of intrahepatic cholestasis.Aims:To explore the clinical characteristics of intrahepatic cholestasis with jaundice.Methods:General data, biochemistry parameters, etiology and treatment of 703 patients with intrahepatic cholestasis were retrospectively analyzed.Results:Jaundice occurred in 168 patients (23.9%), including 149 mild jaundice, 15 moderate jaundice and 4 severe jaundice.Levels of ALT, AST, ALP, GGT, DBIL, TBIL, ratio of DBIL/TBIL, TBA were significantly increased in jaundice group than in non-jaundice group (P<0.05).Levels of ALT, AST, DBIL, TBIL, TBA were statistically different between groups with different degrees of jaundice (P<0.05), however, no significant differences in ALP, GGT, ratio of DBIL/TBIL were seen (P>0.05).The main etiology of intrahepatic cholestasis were digestive system tumors, cardiovascular diseases, shock, hematologic diseases and primary biliary cholangitis.Ursodeoxycholic acid and S-ademetionine were the main drugs for treatment of intrahepatic cholestasis.Conclusions:For patients with intrahepatic cholestasis, levels of ALT, AST, ALP, GGT are increased with the development of jaundice, and attention on damage of hepatocytes should be paid.The etiology of intrahepatic cholestasis with jaundice involves diseases of different organs and systems, most of them are malignant tumor, cardiovascular diseases, shock and primary biliary cholangitis.

Objective To analyze the clinical features of acute hyperlipidemic panereatitis,and to investigate the therapeutic strategies.Methods In this retrospective study,44 patients with hyperlipidemic pancreatitis admitted to our hospital from January 2003 to December 2007 were enrolled,60 patients with acute pancreatitis of other etiologies were enrolled as the control group.Results The proportions of patients with overweight or obesity,hyperglycemia,fatty liver and hypertension were 81.8%,59.1%,54.5% and 68.2%,respectively;these were significantly higher than those in control group,which were 16.7%,16.7 %,13.3 % and 23.3 %,respectively (P＜0.05 or＜0.01).The proportion of patients with lithiasis was lower in HLP group than that in control group (13.6% vs 60.0%,P＜0.05).There was no difference in the proportions of patients with chronic alcoholism between two groups.The Ranson score,CTSI,complications in HLP group were 3.15±0.07,4.46±2.58 and 3.2±1.7,respectively;these parameters were significantly higher than those in control group,which were 1.62±0.22,2.62±1.90 and 0.9±1.2 (P＜0.05 or ＜ 0.01 ).The level of serum amylase in HLP group was 580±222 mmol/L,which was significantly lower than that of control group (1361±472 mmol/L,P ＜ 0.01 ).The triglyceride (TG) level was linearly correlated with Ranson score in HLP group ( r = 0.77,P ＜ 0.05 ),but there was no linear correlation between TG level and Ranson score in the control group.Conclusions There was a close relationship between HLP and metabolic syndrome.Serum TG was positively correlated with the severity of HLP.

Objective To investigate the value of endoscopic ultrasonography ( EUS) in diagnosing pancreatic pseudocyst. Methods EUS was performed in 35 cases with pancreatic pseudocyst. Results Of the series, 41 cysts found in the head, body, tail and both body and tail of the pancreas were 13 , 3 , 19 and 6 respectively. The cystic wall was smooth in 29 cysts and rough in 6; good signal in cystic fluid 19, floccu-lar echo 16, cystic septum 1 and calcification of cyst wall 1, associated ductus pancreaticus expansion in 7, pancreas parenchyma uneven echo in 21, pancreas parenchyma calcification in 4, pancreas atrophy in 2, pancreas carcinoma in 2 , and normal pancreas in 6, protuberances impression on gastrointestinal tract 5 ( duodenal descending part obstruction, n = 1 ) stomach varicose vein in fundus 4 and digestive tract hemorrhage 2. Conclusion EUS may clearly show cyst's size, position, configuration and relation with the pancreas, also EUS guided FNA can be performed, so it has significance in diagnosing and distinguishing pancreatic pseudocyst.

Objective To study the clinical,endoscopic an d pathologic features of primary gastric malignant lymphoma,and to improve its diagnostic efficiency.Methods The clinical,pathologic and endoscopic data in twenty two cases of primary gastric malignant lymphoma were retrospectively reviewed. Results In these cases,the common presentations include abdomi nal pain、anorexia、loss of weight etc. These patients were all examined by endo scopy with protruding,ulcerative and infiltrative lesions. Submucosal lesions w ith hypo echoes were found by endoscopic ultrasonography in six cases,and enlar ged lymph nodes were found on the exterior of stomach in two cases. Conclusion The primary gastric malignant lymphoma has a rather low incidence,and without specific clinical manifestations, hard to differentia te gastric ulcer from cancer through the manifestation in endoscopy. Further com bination of endoscopy, endoscopic ultrasonography and pathology are helpful to i ts correct diagnosis.

Objective To investigate the diagnostic value of tumor marker measurement in biliary juice obtained during endoscopic retrograde cholangiopancreatography (ERCP) in differential diagnosis of suspected biliary-pancrentic diseases.Methods ERCP was performed in patients with suspected biliarypancreatic lesions that could not be diagnosed by routine methods including ultrasonography,MRCP,blood biochemistry and serum tumor marker test,and biliary juice was obtained to measure tumor markers including CEA and CA199.A total of 29 patients with definitive diagnosis were recruited and divided into benign and malignant groups.Serum biochemical findings and tumor markers were compared between 2 groups.The diagnostic value of uhrasonography,EUS,MRCP,ERCP and ERCP combined with biliary tumor markers were also compared.Results There was no significant difference in serum biochemical findings,serum CEA,serum CA19-9 or biliary CA19-9 between 2 groups,while the average biliary CEA in malignant group was significandy higher than that in benign group (P＜0.001).The accuracy of ERCP combined with biliary tumor markers in diagnosing suspected biliary-pancreatic diseases was 69.0%,which was higher than that of ultrasonography (6.9%),MRCP (37.9%) and ERCP (41.4%),respectively.Conclusion The diagnostic accuracy of suspected biliary-pancreatic diseases can be improved through ERCP combined with biliary CEA test,which is helpful in differential diagnosis between benign and malignant lesions.