ERCP has revolutionized the treatment of adult pancreatic diseases.After many years of clinical application,the current adult treatment technology has reached a mature state.With the development of pediatric endoscopic techniques,in recent years,therapeutic ERCP techniques in children has been progressing from the research stage to the stage of practical application and has become an important treatment for pancreatic diseases in children.This article mainly reviews on ERCP in diagnosis,treatment and complications of pancreatic diseases in children.

Purpose:To observe the therapeutic effect of gemcitabine combined with 5-FU for the treatment of advanced cholangiocarcinoma. Methods:21 patients were given gemcitabine and 5-FU intravenously. Results:There was no complete response .The partial response rate was 23.8% and SD,38.1%.12 patients(57.14%) had amelioration of pain and improvement in quality of life.The toxicity was low and tolerable. Conclusions:Gemcitabine combined with 5-FU was an effective and safe regimen for treating advanced cholangiocarcinoma and worthy of further evaluation.

Objective To investigate the effects of lovastatin,a widely used antilipemic agent,on cell proliferation,migration and apoptosis in human cholangiocarcinoma cell line QBC939 and explore its possible mechanism.Method After QBC939 cells were either incubated with lovastatin alone or without it as a control,the methylthiazolyl tetrazolium assay (MTT) assay was used to detect cell proliferation at the 24 h,48 h and 72 h mark; flow cytometry (FCM) measured apoptosis at 48 h;scratch assay was used to determine cell migration at 48h; RT-PCR and Western blot detected the expression of inflammatory cytokine interleukin-6 (IL-6),protein kinase (PKB/Akt),vascular endothelial growth factor (VEGF),matrix metalloproteinase-9 (MMP-9) mRNA and Akt protein at 48 h.Results Lovastatin significantly inhibited cell proliferation in a dose and time dependent manner (24 h,48 h and 72 h:F=173.05,159.66,577.87 respectively,all P＜0.01).After lovastatin treatment,apoptosis induction increased (t =15.28,P＜ 0.01 ) as did early apoptosis (t =13.24,P＜0.01),while the average migration velocity was reduced (24 h and 48 h:t=6.21,5.95,respectively,all P＜0.01).The Akt protein expression and mRNA expression of IL-6,Akt,VEGF,and MMP-9 were down-regulated after lovastatin treatment.Conclusions Lovastatin can inhibit cell proliferation,migration and promote apoptosis in human cholangiocarcinoma cell line QBC939.The mechanisms of suppression may be associated with down-regulation of IL-6,Akt,VEGF and MMP-9 expression.

Chronic pancreatitis is a focal or diffuse chronic inflammation and fibrosis of pancreatic tissue, which is progressive, persistent and irreversible.Chronic pancreatitis in children has its own characteristics of early onset and frequent occurrence, which greatly affects the nutritional status and quality of life of children.Recently, diagnosis and treatment of this severe inflammation gradually improved with a burgeoning technique: endoscopic retrograde cholangiopancreatography (ERCP), especially in the treatment of pediatric chronic pancreatitis.The detection rate of the disease has been increasing year by year.As an effective and safe procedure for the treatment of chronic pancreatitis in children, ERCP has replaced traditional surgery and become the first-line treatment method for pediatric chronic pancreatitis.

Objective To compare the clinical choosing principles of sedated colonoscopy with con-ventional colonoscopy. Methods Outpatients who were willing to accept colonoscopy with or without seda-tion were prospectively recruited,which were assigned to sedated colonoscopy group(n=362)and conven-tional colonoscopy group(n=323). All patients and endoscopists were asked to answer a self-administered questionnaire. The colonoscopy completion,operation time,procedure-related discomfort,and questionnaire results of the two groups were compared and statistically analyzed. Results The completion rate was 98. 9%in the sedated colonoscopy group(358/362)and 89. 8% in the conventional colonoscopy group(290/323) ( P=0. 337 ). The operation time of sedated and conventional group were( 5. 60 ± 3. 25 ) minutes and (7. 71 ± 5. 70)minutes respectively(P<0. 001). And the average cost was CNY 886. 54 per patient in se-dated group and CNY 386. 00 per patient in the conventional group. Patient satisfaction score of conventional group and sedated group were 4(3-4)and 3(2-3)points(P<0. 001),while endoscopist satisfaction score was 4(3-4)and 4(4-4)(P<0. 001). A total of 354 patients(97. 79%)in the sedated group and 225 pa-tients(69. 66%)in the conventional group showed willingness to repeat the identical colonoscopy( P <0. 001). Patients who were male(P=0. 035),having no past abdominal operations(P<0. 001),or no ab-dominal pain during colonoscopy( P =0. 015 )in the conventional group preferred to repeat conventional colonoscopy. Conclusion Although the examination time of conventional colonoscopy is longer than sedated colonoscopy,it could reduce anesthesia risk and the cost. Conventional colonoscopy remains an irreplaceable examination of colorectal diseases in developing countries. Physicians should not only focus on patients'com-fort during endoscopy,but also help patients make a decision based on their actual situation and endoscopic indications to make the best of medical resources.

OBJECTIVETo study the correlation between brain edema, elevated intracranial pressure (ICP) and cell apoptosis in traumatic brain injury (TBI).

METHODSIn this study, totally 42 rabbits in 7 groups were studied. Six of the animals were identified as a control group, and the remaining 36 animals were equally divided into 6 TBI groups. TBI models were produced by the modified method of Feeney. After the impact, ICP of each subject was recorded continuously by an ICP monitor until the animal was sacrificed at scheduled time. The apoptotic brain cells were detected by an terminal deoxynucleotide-transferase-mediated dUTP-digoxigenin nick end labeling (TUNEL) assay. Cerebral water content (CWC) was measured with a drying method and calculated according to the Elliott formula. Then, an analysis was conducted to determine the correlation between the count of apoptotic cells and the clinical pathological changes of the brain.

RESULTSApoptotic cell count began to increase 2 h after the impact, and reached its maximum about 3 days after the impact. The peak value of CWC and ICP appeared 1 day and 3 days after the impact, respectively. Apoptotic cell count had a positive correlation with CWC and ICP.

CONCLUSIONSIn TBI, occurrence of brain edema and ICP increase might lead to apoptosis of brain cells. Any therapy which can relieve brain edema and/or decrease ICP would be able to reduce neuron apoptosis, thereby to attenuate the secondary brain damage.

Animals ; Apoptosis ; Brain Edema ; etiology ; metabolism ; pathology ; Brain Injuries ; complications ; pathology ; physiopathology ; Cell Count ; Disease Models, Animal ; In Situ Nick-End Labeling ; Intracranial Hypertension ; etiology ; pathology ; physiopathology ; Male ; Necrosis ; genetics ; pathology ; Rabbits ; Reference Values ; Telencephalon ; metabolism ; Water ; metabolism

OBJECTIVE: To investigate the feasibility and safety of substituting tacrolimus(FK506) for cyclosporin A(CsA) on delaying the pace of renal dysfunction in patients with biopsy-proven chronic allograft nephropathy(CAN). METHODS: Seventy-three renal transplantation patients with CAN proved by allograft biopsy were collected in this study. Patients were randomly divided into 2 groups. Patients were either converted to FK506(FK506 group, n=43) or remained on their initial CsA-based immunosuppression(CsA group, n=30). The clinical data at study entry and after 12 months including blood urea nitrogen(BUN), serum creatinine(SCr), glomerular filtration rate(GFR), 24-hour urine protein excretion, serum total cholesterol(TC), triglyceride(TG), low density lipoprotein(LDL) and the side effects of calcineurin inhibitors were monitored during a follow-up of over 12 months. RESULTS: Twelve months later, the level of SCr was statistically reduced and GFR levels were obviously elevated in the FK506 group as compared with CsA group [(194.8+/-42.5)micromol/L vs. (245.4+/-52.8)micromol/L and (50.14+/-3.92)mL/(min.1.73 m(2)) vs. (40.58+/-2.49)mL/(min.1.73 m2), P<0.01]. Quantity of 24-hour urine protein excretion in the FK506 group was (2.0+/-0.5)g which is significantly lower than (3.9+/-0.7)g in the CsA group(P<0.01). TC, TG, and LDL levels remained unchanged in the CsA group, while those were statistically reduced in the FK506 group respectively [(5.19+/-0.73)mmol/L vs. (6.94+/-1.37)mmol/L, (1.86+/-0.84)mmol/L vs. (3.14+/-1.38)mmol/L, (3.03+/-0.71)mmol/L vs. (3.82+/-0.89)mmol/L, P<0.01]. Tremor obviously increased (P<0.01) and hypertension obviously decreased (P<0.05) in the FK506 group compared with the CsA group. CONCLUSION FK506 treatment can greatly improve the proteinuria and hyperlipidemia. Conversion from CsA to FK506 is an effective and safe alternative therapy for delaying the progression of renal dysfunction induced by CAN.
Adult ; Aged ; Cholesterol ; blood ; Creatinine ; blood ; Cyclosporine ; therapeutic use ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Graft Rejection ; complications ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Failure, Chronic ; blood ; drug therapy ; etiology ; Kidney Transplantation ; adverse effects ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Tacrolimus ; therapeutic use ; Treatment Outcome ; Triglycerides ; blood