Severe acute pancreatitis (SAP)is a special type of acute pancreatitis,and misdiagnosis and mistreatment can easily cause seri-ous complications,which makes it a tough disease in clinical practice.In recent years,integrated traditional Chinese and Western medicine therapy for SAP has been explored and great progress has been achieved with several new highlights.It has special advantages in clinical treatment.However,conventional methods are still used for the treatment of SAP,and a lack of treatment classification and literature review limits its efficiency and quality in clinical treatment.This article summarizes the effective treatment modalities for SAP from the perspectives of Western medicine and traditional Chinese medicine,in order to provide a reference for the development in the clinical treatment of SAP.

Endoscopic retrograde cholangiopancreatography (ERCP)has become an important method for the diagnosis and treatment of cholangio -pancreatic duct diseases.Post -ERCP pancreatitis (PEP)is the most common complication and its incidence has increased up to 40% in recent years.The prevention of PEP has always been a hot topic in clinical research.This article reviews the research advances in the pharmacological prevention of PEP and points out that controlled clinical trials with a large sample size are still needed to investigate the effect of preventive drugs,and further studies should focus on optimal medication time,route of administration,and dose.In addition,de-mographic features of populations from different countries and different age groups should be taken into consideration.

Intrahepatic cholangiocarcinoma is an uncommon malignant tumor,and its incidence has been increasing in the recent 30 years. Since patients have no specific clinical manifestations in early stage,the diagnosis of this disease is often very difficult,with a low rate of radical resection in late stage and poor prognosis.Therefore,as for patients with intrahepatic cholangiocarcinoma,early screening and diag-nosis is of vital importance.Imaging examination is an important method for the diagnosis of intrahepatic cholangiocarcinoma,and when com-bined with laboratory markers and pathological examination,it can increase diagnostic rate and reduce the rate of missed diagnosis.It is im-portant in clinical practice to select reasonable methods based on the patient′s actual condition.

Objective To investigate the value of preoperative contrast -enhanced ultrasound (CEUS)in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer.Methods A retrospective analysis was performed for the clinical data of 25 patients with pancreatic cancer confirmed by surgical exploration or postoperative pathological examination,who visited Shengjing Hospital of China Medi-cal University from December 2012 to October 2014,and all the patients underwent CEUS before surgery.The relationship between the le-sion and the peripancreatic vessels was observed,the degree of invasion was evaluated,and related scores were measured.These results were compared with the results of intraoperative exploration and postoperative pathological results.The rate of peripancreatic vascular invasion, sensitivity and specificity of preoperative CEUS in evaluating the degree of peripancreatic vascular invasion,and sensitivity,specificity,pos-itive predictive value,negative predictive value,overall coincidence rate,and Youden index of CEUS in evaluating the resectability of pan-creatic cancer were calculated.Results Preoperative CEUS showed that 42 vessels were invaded,while intraoperative exploration showed 41 vessels were invaded.A total of 17 patients were considered resectable by CEUS,while 15 patients were considered resectable by intraop-erative exploration.In evaluating the resectability of pancreatic cancer,CEUS had a sensitivity of 93.3%,a specificity of 70.0%,an over-all coincidence rate of 84.0%,a false positive rate of 30.0%,a false negative rate of 6.7%,a positive predictive value of 82.4%,a nega-tive predictive value of 87.5%,and a Youden index of 0.633.Conclusion Compared with intraoperative exploration,CEUS has higher sensitivity and specificity in evaluating the degree of peripancreatic vascular invasion and higher sensitivity,specificity,and coincidence rate in evaluating the resectability of pancreatic cancer.CEUS can accurately evaluate the degree of peripancreatic vascular invasion and provides a new method for preoperative evaluation of the resectability of pancreatic cancer.

Acute pancreatitis has uncertain and complicated conditions,and non -surgical treatment is mainly used during the early stage. However,as for the causes of acute pancreatitis in early stage,timely surgical intervention should be given to control some causes.This arti-cle also elaborates on the application of percutaneous drainage and video -assisted minimally invasive surgery.It is pointed out that there are still controversies over the advantages and disadvantages of minimally invasive surgery and conventional laparotomy and how to select video -assisted minimally invasive surgery,and that in depth studies are still needed in future.

Liver and gastrointestinal tumors greatly threaten human health and have poor therapeutic outcomes and prognosis.Tumor necrosis factor -alpha -induced protein 8 -like 2 (TIPE2)can negatively regulate innate immunity and adaptive immunity and maintain immune ho-meostasis.Recent studies have found that TIPE2 can affect various signaling pathways and thus exerts an inhibitory effect on the development and progression of tumors.This article briefly introduces the structure and function of TIPE2 and its regulatory effect on tumor -related sig-naling pathways such as Ras,Ral,and Rac and downstream molecules,as well as the role of TIPE2 in liver and gastrointestinal tumors,re-lated signaling pathways,and research advances.

Objective To investigate the clinical effect of ulinastatin in preventing pancreatitis after endoscopic retrograde cholangiopancre-atography (ERCP).Methods The Cochrane Library,PubMed,EMBASE,CNKI,VIP,and Wanfang Data were searched for randomized controlled trials (RCTs)on ulinastatin for the prevention of post -ERCP pancreatitis published from 1970 to June 2016.Two researchers se-lected RCTs,extracted data,and evaluated methodological quality independently,and RevMan 5.3 software was used for the meta -analy-sis.The chi -square test was used for the heterogeneity analysis of RCTs included,and the funnel plots were used to evaluate publication bi-as.Results A total of six RCTs with 923 patients were included in this analysis.Compared with the placebo,ulinastatin had significantly better effects in preventing post -ERCP pancreatitis (OR =0.26,95%CI:0.13 -0.53,P =0.000 2),hyperamylasemia (OR =0.47, 95%CI:0.33 -0.67,P <0.001),and abdominal pain (OR =0.56,95%CI:0.34 -0.91,P =0.020).Compared with gabexate,uli-nastatin had similar effects in preventing post -ERCP pancreatitis,hyperamylasemia,and abdominal pain (P =0.52,0.13,and 0.79);low -dose ulinastatin also had similar effects as gabexate in preventing post -ERCP pancreatitis and hyperamylasemia (P =0.49 and 0.25).The funnel plots based on the effect of ulinastatin in preventing post -ERCP pancreatitis were slightly asymmetric,which suggested the presence of publication bias.Conclusion Ulinastatin (≥15 ×104 U)can effectively prevent post -ERCP pancreatitis,hyperlipi-demia,and abdominal pain in the general population and it is recommended to start using this drug before surgery.

Objective To investigate the influence of laparoscopic cholecystectomy (LC)versus open cholecystectomy (OC)on postopera-tive systemic infection and immune response in patients with acute cholecystitis complicated by choleperitonitis.Methods A prospective randomized controlled trial was performed for 45 patients who had a definite diagnosis of acute calculous cholecystitis complicated by cho-leperitonitis in Shanghai Liqun Hospital from January 2014 to June 2016.According to surgical procedures,the patients were randomized in-to LC group (23 patients)and OC group (22 patients).The length of hospital stay,postoperative complications,and deaths were evaluated in both groups.Blood samples were collected from all patients before surgery and at 1,3,and 6 days after surgery to compare the changes in neutrophil count,serum levels of C -reactive protein (CRP)and interleukin -6 (IL -6),and erythrocyte sedimentation rate (ESR),as well as the incidence of endotoxemia.The t -test was used for comparison of continuous data between groups,and the chi -square test was used for comparison of categorical data between groups.Results The LC group had a significantly shorter length of hospital stay than the OC group (5.4 ±2.7 d vs 10.2 ±3.5 d,t = -5.46,P <0.001).One patient (4.3%)in the LC group and 6 (27.3%)in the OC group ex-perienced peritoneal abscess after surgery,and there was a significant difference in the incidence rate of complications between the two groups (χ2 =4.77,P =0.03).In all patients,the mortality rate was 17.8% (8 /45),with 1 (4.3%)in the LC group and 7 (31.8%)in the OC group,and there was a significant difference between the two groups (χ2 =5.16,P =0.02).Of all patients in the OC group,4 died of peritoneal abscess,1 died of pulmonary embolism,and 1 died of myocardial infarction;of all patients in the LC group,1 died of my-ocardial infarction.There were no significant differences in inflammatory markers before surgery between the two groups.At 1,3,and 6 days after surgery,the LC group had significantly lower neutrophil count,serum levels of CRP and IL -6,and ESR (except at 1 day after surger-y)than the OC group (all P <0.05).Furthermore,the OC group had a significantly higher concentration of endotoxin than the LC group (P <0.05),but the level of endotoxin returned to normal at 2 days after surgery in both groups.Conclusion Compared with OC,LC can reduce the probability of endotoxemia,help with the establishment of immunological defense,and reduce the risk of postoperative infection.

Objective To investigate the correlation between hepatitis B virus (HBV)drug -resistance gene mutations and hepatocellular carcinoma (HCC).Methods The clinical data of treatment -experienced patients,who underwent examination for HBV drug -resistance gene mutations in Beijing Ditan Hospital from January 1 to December 31,2013,and still had detectable HBV DNA after being treated with nucleos(t)ide analogues,were collected.All the patients were followed up,and the development of HCC was considered as the clinical out-come.The correlation between drug -resistance gene mutations and the development of HCC in patients with HBV infection was analyzed. The chi -square test was used for comparison of categorical between groups,the t -test was used for comparison of continuous data between two groups,and the log -rank test was used for comparison of the incidence of HCC between two groups.Results A total of 227 patients were enrolled in this study.According to the results of the detection of HBV drug -resistance gene mutations,103 patients (103 /227, 45.37%)had no drug -resistance gene mutations and 124 (124 /227,54.63%)had drug -resistance gene mutations.There were no sig-nificant differences between the mutation group and the non -mutation group in HBV DNA load (5.19 ±1.60 log10 IU /ml vs 5.44 ±1.75 log10 IU /ml,t =-1.134,P =0.258)and the percentage of patients with liver cirrhosis (24.19% (30 /124)vs 16.50% (17 /103),χ2 =2.026,P =0.155).The median follow -up was 28 months (range 4 -58 months),and the incidence of HCC was 7.49% (17 /227).A-mong the patients with HBV drug -resistance gene mutations,12 (12 /124,9.68%)developed HCC,and among those without HBV drug-resistance gene mutations,5 (5 /103,4.85%)developed HCC.Among the patients who developed HCC,70.59% (12 /17)had HBV drug -resistance gene mutations at baseline;among the patients who did not develop HCC,53.33% (112 /210)had HBV drug -resistance gene mutations at baseline.Conclusion The patients with poor control of HBV DNA during antiviral therapy have a comparable incidence of HCC to those not treated with antiviral therapy,with a relatively high risk of developing HCC;the treated patients with HBV drug -resist-ance gene mutations may have a higher risk of HCC than those without such mutations,which needs to be confirmed by the studies with a longer follow -up period and a larger sample size.

Objective To investigate the clinical effect of endoscopic esophageal variceal ligation (EVL)in the treatment of esophageal variceal bleeding (EVB)in patients with liver cirrhosis.Methods A total of 84 liver cirrhosis patients with EVB who were admitted to The Third People′s Hospital of Shenzhen,Guangdong Medical University,from December 2010 to July 2013 were divided into ligation group (group A,treated with EVL combined with somatostatin and esomeprazole)and control group (group B,treated with somatostatin and es-omeprazole),with 42 patients in each group.The hemostasis rate,rebleeding rate,incidence rate of complications,and mortality rate were observed in both groups,as well as the variceal eradication rate after EVL and risk factors for early rebleeding.The t -test was used for com-parison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups;the Mann -Whitney U test was used for comparison of non -normally distributed continuous data between two groups,the Wilcoxon signed -rank sum test was used for comparison within each group,and the Kruskal -Wallis H test was used for comparison between multiple groups.The chi -square test or Fisher′s exact test was used for comparison of categorical data between groups.The Kaplan -Meier method was used to calculate survival rates,and the log -rank test was used to compare survival rates between groups.The logistic regression meth-od was used to investigate the influencing factors for dichotomous data.Results There was a significant difference in the hemostasis rate be-tween groups A and B (97.62% vs 80.95%,P =0.029).Compared with group B,group A had significantly lower rebleeding rates in 1 -2 years (15.38% vs 38.89%,χ2 =5.323,P =0.021)and 2 -3 years (15.38% vs 48.48%,χ2 =10.448,P =0.001).A total of 14 patients (33.33%)in group A and 7 patients (16.67%)in group B experienced adverse events,and 4 patients in group A and 9 patients in group B died within 3 years.Group A had significant improvements in the levels of alanine aminotransferase (ALT)and aspartate amin-otransferase at 1 week after treatment (Z =-2.177 and -2.044,P =0.029 and 0.041).Both groups had significant improvements in pro-thrombin time activity (PTA),prothrombin time (PT),international normalized ratio (INR),and albumin at 1 week after treatment (group A:Z =-4.007,t =3.866,Z =-4.152,t =-4.623,all P <0.001;group B:t =-5.069,Z =-3.870,Z =-3.909,Z =-5.245,all P <0.001).There was a significant difference in PTA at 1 week after treatment between the two groups (Z =-3.902,P <0.001).In group A,the overall disappearance rate of varices was 85.71% and the recurrence rate was 14.29%,and there was a signifi-cant correlation between the Child -Pugh score and diameter of the portal vein (F =3.319,P =0.047).Symptoms on admission,length of hospital stay,Child -Pugh score,spontaneous bacterial peritonitis,diameter of the portal vein,PT,INR,and ALT were risk factors for ear-ly rebleeding after ligation (all P <0.05).Conclusion EVL is a safe and effective method for the treatment of EVB in patients with liver cirrhosis and causes few complications.