The techniques for endoscopic diagnosis and treatment of biliary and pancreatic diseases mainly include endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography,which have achieved great progress in recent years.Meanwhile,new techniques including combined therapy with endoscopy and laparoscopy and natural orifice transluminal endoscopic surgery have gradually been applied in clinical practice.In the future,it is necessary to cultivate interdisciplinary experts in the field of endoscopy who master various endoscopic techniques and integrated talents with experience in both transluminal operation and gastrointestinal surgery outside lumens.At present,there are still controversies over the application of new techniques in the treatment of biliary and pancreatic diseases.The diagnosis and treatment of biliary and pancreatic diseases can be further improved by promoting the application of biliary and pancreatic endoscopy and standardization,accumulating experience and improving devices,evaluating clinical research,and promoting the bench-to-bedside translation of new techniques.

Insulin-like growth factor-1 receptor (IGF-1 R) widely exists in the surface of various types of cells and is closely associated with the formation and development of tumor cells.It also provides a new direction for the targeted therapy for tumors.This article reviews the expression,development,and progression of IGF-1R in pancreatic cancer and research advances in IGF-1R as a target for tumor treatment.

Infectious pancreatic necrosis (IPN) is a challenging complication of acute pancreatitis and can lead to poor prognosis.Over the years,open necrosectomy has become the main treatment modality for IPN,but it will cause high incidence rate of complications and mortality rate.In recent years,with the rapid development of minimally invasive surgery,many scholars have performed minimally invasive treatment for IPN patients and achieved good outcomes.This article introduces five minimally invasive treatment techniques,i.e.,percutaneous catheter drainage,minimally invasive retroperitoneal necrosectomy,endoscopic drainage + necrosectomy,laparoscopic necrosectomy,and advanced therapeutic strategy,pointed out that different minimally invasive techniques had different indications,and minimally invasive therapies should be selected based on IPN patients' general conditions to improve their outcome.

Recent studies have found that inflammatory response is positively associated with the progression of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and can affect their prognosis,and as a marker for inflammatory response,neutrophil/lymphocyte ratio (NLR) is easy to calculate,has good repeatability,and holds promise for prognostic evaluation.This article introduces the research advances in the association of NLR with the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer and points out that NLR plays an important role in evaluating the prognosis of liver cirrhosis,acute-on-chronic liver failure,and primary liver cancer.However,there are still controversies over the selection of optimal cut-off values for different diseases,and further studies are needed.

The main biological functions of insulin-like growth factor 1 receptor (IGF-1 R) include formation and maintenance of transformed cell phenotype,involvement in cell proliferation and differentiation,and inhibition of cell apoptosis.In addition,IGF-1R regulates cell cycle and works with epidermal growth factor and platelet-derived growth factor to mediate cells to enter S phase from G1 phase.Overexpressed IGF-1R has become one of the target proteins for diagnostic imaging and localization therapy for primary liver cancer.Inhibition of the expression or function of IGF-1R can effectively control the growth and metastasis of tumor cells and enhance their sensitivity to chemotherapy and radiotherapy.This article reviews the role and significance of IGF-1R and its pathway in the diagnosis and treatment of primary liver cancer.

With an increasing prevalence all over the world,diabetes mellitus is considered as a potential cause of liver cancer in patients with non-viral hepatitis.Whether diabetes mellitus is the cause of liver cancer and related pathogenesis remain unknown.The article reviews recent large-sample cohort studies and confirms that diabetes mellitus increases the incidence rate of liver cancer and affects its prognosis.This article also investigates the association of hepatitis C,obesity,and nonalcoholic fatty liver disease with diabetes mellitus and liver cancer and finds that insulin resistance and activation of chronic inflammatory factors may be involved in the generation and proliferation of cancer cells.This article elaborates on the influence of anti-insulin resistance drugs on the development and progression of liver cancer and points out that diabetes mellitus may be the cause of liver cancer.Effective control of insulin resistance can help to reduce the development and progression of diabetes-associated liver cancer.

Objective To investigate the influencing factors for spontaneous bacterial peritonitis (SBP) in patients with acute-on-chronic liver failure (ACLF),and to provide a reference for clinical diagnosis and prognosis evaluation.Methods A retrospective analysis was performed for the clinical data of 667 patients with ACLF who were hospitalized and treated in our hospital from January 2009 to December 2014,and according to the presence or absence of SBP,they were divided into ACLF group(n =232) and ACLF-SBP group(n =435).The general information,laboratory markers,and incidence of complications were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups,and a logistic regression analysis was used to identify independent risk factors for ACLF complicated by SBP.Results The comparison of laboratory markers and comorbidities showed that there were significant differences between the two groups in albumin (Alb) (t =-4.110,P ＜ 0.001),alanine aminotransferase (U =-6.653,P ＜ 0.001),aspartate aminotransferase (t =-8.045,P ＜ 0.001),blood sodium (t =-2.879,P =0.006),prothrombin time activity (t =-2.140,P =0.037),international normalized ratio (t =1.453,P =0.042),hemoglobin (t =-3.446,P =0.001),upper gastrointestinal bleeding (x2 =48.252,P =0.002),hepatorenal syndrome (x2 =16.244,P =0.031),and pulmonary infection (x2 =13.564,P ＜ 0.001).The multivariate logistic regression analysis showed that there were significant differences in Alb (OR =1.119,95 ％ CI:1.052 ～ 1.189),platelet count (PLT) (OR =1.035,95 ％ CI:0.755 ～ 1.084),upper gastrointestinal bleeding (OR =1.117,95 ％ C1:0.072 ～ 1.135),and pulmonary infection (OR =2.275,95 ％ CI:0.978 ～ 5.292) (P =0.002,0.038,0.022,and 0.036).Conclusion In the treatment of ACLF patients,risk factors including low Alb,low PLT,upper gastrointestinal bleeding,and pulmonary infection should be prevented,and early diagnosis and intervention of these risk factors helps to reduce the incidence of SBP.

Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis,as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled,and according to the time of selective LC,they were divided into group A (with 2 months),group B (2-4 months),and group C (＞4 months),with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups,an analysis of variance was used for comparison between three groups,and LSD-t test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD,and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery,and there were significant improvements in laboratory markers (white blood cell count,neutrophil count,and liver function) (all P ＜ 0.05).No patient experienced complications such as bile leakage,hematobilia,pneumothorax,and colon perforation caused by puncture,and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F =8.029,P ＜ 0.001),time of operation (F =24.674,P ＜ 0.001),intraoperative blood loss (F =12.864,P ＜ 0.001),length of hospital stay (F =22.844,P ＜ 0.001),rate of conversion to laparotomy (x2 =12.345,P =0.002),and incidence rate of complications (x2 =8.750,P =0.013).Compared with group A,groups B and C had significantly lower gallbladder wall thickness before LC,intraoperative blood loss,length of hospital stay,rate of conversion to laparotomy,and incidence rate of complications (all P ＜ 0.05),and group B had significantly lower time of operation,intraoperative blood loss,and length of hospital stay than group C (all P ＜ 0.05).Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.

Objective To investigate the correlation between microRNA-520a and clinicopathological parameters in patients with hepatocellular carcinoma (HCC).Methods The medical records and tissue specimens of 183 HCC patients,who received surgical treatment in the Affiliated Hospital of Taishan Medical College from January 2010 to December 2015,were collected.Quantitative real-time PCR was used to measure the expression of microRNA-520a in HCC tissues and corresponding adjacent tissues from 183 patients with HCC,and its correlation with clinicopathological parameters was analyzed.A one-way analysis of variance was used for comparison between multiple groups,and the independent samples t-test was used for comparison between two groups;Spearman correlation analysis was also performed.Results HCC tissues had significantly lower expression of microRNA-520a than corresponding adjacent tissues (1.92 ± 0.76 vs 2.73 ±1.15,t =-6.731,P ＜ 0.001).The area under the receiver operating characteristic (ROC) curve was 0.711 (95 ％ CI:0.64-0.79,P ＜ 0.001).There were significant reductions in the expression of microRNA-520a in HCC tissues in patients with distant metastasis (P =0.031),advanced TNM stage (P =0.022),positive serum hepatitis B virus (HBV) (P ＜ 0.001),or tumor separation (P =0.026).The Spearman correlation analysis showed that the expression of microRNA-520a was significantly correlated with HBV infection (r =-0.351,P ＜ 0.001) and tumor separation (r =-0.207,P =0.044).Conclusion The expression of microRNA-520a is significantly downregulated in HCC tissues and it may inhibit the progression of HCC.