Objective:To investigate the features of common bile duct adenoma under endoscopic ultrasonography (EUS).Methods:Clinical data of 15 patients with common bile duct adenomas confirmed by pathology from January 2015 to January 2020 in Tianjin Nankai Hospital were analyzed retrospectively. The patients′ EUS features were summarized.Results:The common bile duct adenoma was characterized by homogeneous soft tissue mass with medium or low echo and clear boundary, floating in the bile duct with no movement under EUS. EUS diagnosis of 14 out of 15 patients was consitent with the pathology, and the diagnostic consistency was 93.3%. One patient with a movable lesion was misdiagnosed as cholestasis by EUS. One patient had two solitary adenomas, located in the middle and lower part of the common bile duct, and 14 others had single adenoma. There were 9 adenomas in the lower part, 4 in the ampulla, 2 in the upper part, and 1 in the middle of the common bile duct. The pathological findings were 7 cases of villous adenoma with high-grade intraepithelial neoplasia, 4 cases of local malignant changes; 6 villous tubular adenoma with high-grade intraepithelial neoplasia, 3 local malignant changes; 2 villous tubular adenoma with low-grade intraepithelial neoplasia; and 1 papillary adenoma.Conclusion:EUS, helpful for the qualitative diagnosis, can be used as an important technique to improve the diagnosis of common bile duct adenoma.

Objective To evaluate the clinical effect of the application of simultaneous metal stents for treatment of biliary and duodenal obstruction. Methods A retrospective review of clinical data in 32 patients underwent simultaneous placement of biliary and duodenal metal stent was performed. Changes of bilirubin and liver function indexes were observed before and after treatment in patients. Results The biliary stent placement and duodenal stent placement were successively performed in all patients. The indexes of liver function were improved, and the symptoms were relieved. Conclusion The combined self-expandable metal stenting for biliary and duodenal obstruction is a safe and effective treatment method.

Objective To study the diagnostic value of endoscopic ultrasonography (EUS)for biliary stenosis.Methods Data of 83 patients with bile duct stenosis who underwent EUS from January 2010 to June 2012 at endoscopic center of Tianjin Nankai Hospital were reviewed.The EUS qualitative diagnosis and final diagnosis,and the accuracy of EUS for the lower malignant bile duct stenosis were analyzed.Results Malig-nant stenosis were confirmed histopathologically in 55 patients;benign stenosis were confirmed in 28 patients based on negative tissue sampling or extended clinical follow-up.Sensitivity,specificity,positive predictive val-ue,negative predictive value and accuracy of EUS for malignant bile duct stenosis were 98.2%(55 /56), 81.5%(22 /27),91.7%(55 /60),95.6%(22 /23)and 92.8%(77 /83),respectively.Conclusion The sensitivity and accuracy of EUS for the lower malignant bile duct stenosis is high,which is of clinical value.

BACKGROUND:To dynamicaly monitor the varying levels of inflammatory factors in the gingival crevicular fluid is helpful to assess the early effect of orthodontic tooth movement. Myeloperoxidase, soluble intercelular adhesion molecule-1, pentraxin 3 are proven to be closely related to inflammation, but it is unclear about the levels of these three kinds of inflammatory factors as wel as association of these three kinds of inflammatory factors with orthodontic tooth. OBJECTIVE:To detect the expression levels of myeloperoxidase, soluble intercelular adhesion molecule-1 and pentraxin-3 in the gingival crevicular fluid during maxilary canine distal movement and to assess their correlation with periodontal disease, canine movement distance and orthodontic force. METHODS:Twenty-one orthodontic patients were enroled and assigned into 150 g (n=12) or 100 g (n=9) groups according to orthodontic force. The gingival crevicular fluid samples of orthodontic patients were colected before and at 4, 12, 24 hours, 7, 14 days after maxilary canine distal movement. Levels of myeloperoxidase, soluble intercelular adhesion molecule-1 and pentraxin-3 in the gingival crevicular fluid were measured and analyzed using ELISA assay. RESULTS AND CONCLUSION: During the distal movement of maxilary canine, under orthodontic force, the level of myeloperoxidase was peaked at 4 hours and then decreased, while the expression level of soluble intercelular adhesion molecule-1 was peaked at 12 hours, and then decreased. Both myeloperoxidase and soluble intercelular adhesion molecule-1 levels returned to normal at 7 days under orthodontic force. The expression level of pentraxin-3 was increased significantly under orthodontic force, peaked at 24 hours, and then decreased gradualy to the normal level at 7 days. In addition, the expression levels of myeloperoxidase, soluble intercelular adhesion molecule-1 and pentraxin-3 in the gingival crevicular fluid were significantly higher under 150 g force than under 100 g force. These findings indicate that detecting varying levels of myeloperoxidase, soluble intercelular adhesion molecule-1 and pentraxin-3 in the gingival crevicular fluid is useful to assess the efficiency of orthodontic treatment and prevent adverse reactions.

Objective To discuss the relationship between TCM constitutional types and the levels of transforming growth factor beta 1 (TGF-β1) of patients with knee osteoarthritis (KOA). Methods A total of 161 patients with KOA as a case group filled out questionnaires about 9 TCM constitution types, and 50 cases of unrelated healthy volunteers were selected randomly as control group. The serum samples of two groups were collected. The levels of TGF-β1 were detected and compared by double antibody sandwich ELISA. Results Compared with the control group, the level of TGF-β1 in the case group decreased, with statistical significance (P<0.05). Compared with the control group, the levels of TGF-β1 significantly decreased in the case group of qi deficiency type, with statistical significance (P<0.05). There were no types of special intrinsic and blood stasis. Compared with the control group, the levels of TGF-β1 in the other six types of patients with KOA had no statistical significance (P>0.05). Conclusion The incidence of KOA with qi deficiency type may be related to the decrease of TGF-β1 level. The decreasing level of TGF-β1 may be one of the mechanisms of molecular biology that qi deficiency was linked to KOA.

Objective To construct a hexon-chimeric human adenovirus type 3 ( HAd3 ) vector expressing two neutralizing epitopes of hepatitis B surface antigen preS 1 (HBsAg-preS1) and to analyze the antigenicity of the chimeric epitopes .Methods Two neutralizing epitopes of HBsAg-preS1 including KR359 and KR127 were inserted into hypervariable region 1 ( HVR1) and hypervariable region 2 ( HVR2) of HAd3 hexon .Chimeric hexon gene encoding the two epitopes was amplified by overlap PCR and then subcloned in -to shuttle plasmid pBR322-L/R containing the homologous recombination regions .The digested shuttle plas-mid containing chimeric hexon gene was co-transfected into Escherichia coli BJ5183 cells together with back-bone plasmid pBRAdΔE3GFP to construct pBRAdΔE3GFP-preS1 vector.Then pBRAdΔE3GFP-preS1 vector was digested with AsiSⅠand transfected into AD293 cells to construct recombinant virus (rAD3E-preS1). CsCl gradient centrifugation was used for purification .Glutathione S-transferase ( GST ) fusion protein KR359KR127 ( GST-KR359KR127 ) was expressed in Escherichia coli BL21 by using expression vector pGEX-4T3.Female BALB/c mice at age 6-8 weeks were intraperitoneally injected with 1010 virus particles or 80 μg GST fusion protein .Serum samples were collected to analyze the antigenicity of two epitopes by ELISA and Western blot .Results ELISA showed that KR 359 and KR127 were successfully exposed on viral sur-faces by using hexon-chimeric HAd3 vector .The induced polyclonal antibodies in serum samples could rec-ognize GST fusion protein and native HBsAg from patients infected with hepatitis B virus .Conclusion The antigen capsid-incorporation strategy could be used to display epitopes on viral surface .Enhanced antigen-specific responses could be achieved through inserting multiple foreign epitopes into hexon HVRs .This study provided evidence for further application of hexon -chimeric human adenovirus type 3 vector in the developmentof vaccine, especially for the development of multivalent hepatitis B vaccine .

The umbilical cord normally contains one vein and two arteries, which is vital for gas exchange, nutrient supply and excretion of metabolic wastes between mother and fetus, and is protected by the surrounding Wharton jelly. Thrombosis of the umbilical cord could lead to fetal hypoxia, even endanger the fetal life. However, umbilical vessel thrombosis, which is rarely reported at home and abroad, is difficult to be identifed prenatally. We here reported two cases of umbilical vessel thrombosis in Xiamen Maternity and Child Health Care Hospital in order to improve prenatal diagnosis of umbilical vessel thrombosis and to avoid adverse pregnancy outcomes.

Purpose: Anxiety, depression, and poor quality of life (QOL) were considered important concerns that hindered the rehabilitation of breast cancer survivors. A number of studies have investigated the effects of physical activity, but they have not reached the same conclusions. This review aimed to identify the effects of physical activity on QOL, anxiety, and depression in breast cancer survivors. Methods: PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SinoMed, CNKI, Vip, and WanFang databases were searched for the time period between January 1, 2012, and April 30, 2022. Studies were included if they were randomized controlled trials of the effects of physical activity on QOL, anxiety, or depression in breast cancer survivors. The tools of the Joanna Briggs Institute were used to assess the quality of the included studies. R software version 4.3.1 was used for meta-analysis. Results: A total of 26 studies, involving 2105 participants, were included in the systematic review. Among these, 20 studies involving 1228 participants were included in the meta-analysis. Compared with the control group, the results indicated that physical activity can significantly improve QOL(Hedges' g = 0.67; 95% CI 0.41–0.92) and reduce anxiety (Hedges' g = −0.28; 95% CI −0.46 to −0.10) in breast cancer survivors. However, the effect of physical activity on depression (Hedges' g = −0.46; 95% CI −0.99 to 0.06) was not statistically significant. Conclusions Physical activity was an effective intervention to improve QOL and reduce anxiety in breast cancer survivors, as well as showed positive trends in depression, although without statistical significance. More well-designed studies are required to clarify the effects of different types of physical activities on the QOL, anxiety, and depression among breast cancer survivors.

Objective To investigate the clinical characteristics of incarcerated stones at duodenal papilla and to evaluate the efficacy of endoscopic needle-knife sphincterotomy ( NKS ) . Methods Data of 316 patients who underwent endoscopic treatment for incarcerated stones at duodenal papilla between 2007 and 2016 were retrospectively studied. Endoscopic treatment outcomes, proportion changes of incarcerated stones in total number of choledocholithiasis, changes of diameter of common bile duct( CBD) and diameter of incarcerated stones were analyzed. Results Obstruction was relieved and endoscopic nasobiliary drainage was successfully performed in all 316 cases ( 100. 0％) , and NKS procedures were performed in 231 patients ( 73. 1％) . The incidence of incarcerated stone at duodenal papilla in choledocholithiasis showed a decreased trend ( P=0. 000) . Diameters of both CBD and incarcerated stones showed a decreased trend in hierarchical data by year ( P=0. 000, P=0. 000) . Conclusion The incidence of incarcerated stones at duodenal papilla in choledocholithiasis, the diameters of CBD and incarcerated stones are all on the decrease. NKS is the primary method for treatment of incarcerated stones at duodenal papilla.

This report describs 2 domestic cases of tacrolimus poisoning in kidney transplant recipients due to overexposure of tacrolimus caused by nirmatrelvir/ritonavir for SARS-CoV-2 infection.Phenytoin sodium is prescribed for inducing CYP3A enzyme.It is intended for providing references for formulating and adjusting treatment protocols for tacrolimus overexposure and related toxicity in kidney transplant recipients caused by nirmatrelvir/ritonavir.