With the improvement of endoscopic retrograde eholangiopancreatography (ERCP) technology, endoscopy is not only applied to diagnosis, but also utilized to therapy for cholangiopancreatic neoplasm. This article is to summarize the application of endoscopic technology on cholangiopancreatic neoplasm.

Objective To investigate the efficacy of endoscopy for the treatment of benign biliary stricture after biliary surgery.Methods The clinical data of 127 patients with benign biliary stricture after biliary surgery at the First Hospital of Lanzhou University from January 2007 to December 2011 were retrospectively analyzed.According to the Bismuth classification,there were 60 patients with type Ⅰ,35 with type Ⅱ,21 with type Ⅲ and 11 with type Ⅳ.The efficacies of endoscopy for the treatment of biliary stricture with different Bismuth subtypes were analyzed.Results The location and severity of biliary stricture were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) + cholangiography.Sixteen patients ( including 7 with type Ⅲ and 9 with type Ⅳ) were transferred to surgical treatment due to severe biliary stricture.A total of 111 patients underwent endoscopic treatment successfully,with the success rate of 87.4％ (111/127).The success rates of endoscopy for the treatment of patients with Bismuth Ⅰ,Ⅱ,Ⅲ and Ⅳ biliary strictures were 95％ (57/60),86％ (30/35),9/14and 1/2,respectively.Twenty-nine patients were implanted with retrievable metallic biliary stent,and 82 were implantated with plastic biliary stent.Of the 111 patients,only 6 patients were complicated by acute pancreatitis,and they were cured by conservative treatment.The alleviative rates of yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were 73％ (81/111 ),83％ (74/89),90％ (73/81 ) and 89％(68/76) at 1 week after treatment,and they were 88％ (98/111),91％ (81/89),94％ (76/81) and 92％(70/76) at 8 weeks after treatment.The efficacy of endoscopy was good in 97 patients and poor in 14 patients,and the 14 patients were converted to open surgery.The symptoms including yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were completely alleviated at postoperative month 6.Conclusion Endoscopic treatment for benign biliary stricture is safe and effective.

Objective To investigate the efficacy of combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones.Methods The clinical data of 3780 patients with extra-hepatic bile duct stones who were admitted to the First Hospital of Lanzhou University from March 1998 to June 2010 were retrospectively analyzed.According to the condition of bile duct stones,laparoscope,choledochoscope and duodenoscope were applied separately or combinately.All patients were divided into A,B and C groups.Patients in group A were treated by laparoseopy,choledochoscopy or duodenoscopy;patients in group B were treated by choledochoscopy+duodenoscopy.duodenoscopy+laparoscopy or laparoscopy+choledochoscopy;patients in group C were treated by laparoscopy+duodenoscopy+choledochoscopy.The efficacies of different treatment approaches were analyzed by comparing the results of imaging examination and follow-up.Results The curative rate and complication rate of the group A were 89.54%(1276/1425)and 6.73%(86/1276),respectively.Of the 149 patients in the group A who were failed in the treatment,83 patients were transferred to the group B,and 66 patients were transferred to the group C.The curative rate and complication rate of the group B(including 83 patients transferred from the group A)were 95.93%(1719/1792)and 4.07%(70/1719),respectively,and 73 patients who were failed in the treatment were transferred to the group C.The curative rate and complication rate of the group C(including 139 patients transferred from the group C)were 99.75%(783/785)and 0.26% (2/783),respectively,and 2 patients who were failed in the treatment received open surgery.Conclusion Combined application of laparoscope and endoscopes could raise the success rate of stone clearance and decrease the postoperative complications.

Objective To investigate the early (within 72 hours) application and effect of endoscopic pancreatic and (or) biliary stents combined with Qingyi granules in treatment of acute biliary pancreatitis (ABP) patients.Methods A retrospective analysis was done to the 245 patients admitted for ABP from Jan.2012 to Jan.2016 in the First Hospital of Lanzhou University.133 patients (group A) were treated within 72 hours by endoscopic pancreatic and (or) biliary stents combined with Qingyi granules through feeding tube.112 patients (group B) were treated by endoscopic pancreatic and (or) biliary stents and feeding tube without Qingyi granules.Then the study was done to compare the difference of recover days of abdominal distension,abdominal pain,normalization time of amylase and WBC,length of stay,decrease level of PCT,and the incidence of ABP complications.Results Group A was superior to group B in terms of the recover days of abdominal distension (3.8±3.2)d vs (5.2± 2.4)d,abdominal pain (2.6±2.1)d vs (4.9±2.7)d,normalization time of amylase(2.8±1.6)d vs (4.4±3.7)d,WBC (2.6±1.3)d vs (4.1± 2.7)d,length of stay(9.4±2.1)d vs (12.6±3.3)d and postoperative PCT level(2.59±2.33)ng/ml vs (3.98±3.03)ng/ml,and the difference had statistical significance (P＜0.05),while there was no significant difference between the two groups in the incidence of ABP complications.Conclusions For ABP patients,early placement of endoscopic pancreatic and (or) biliary duct stents combined with Qingyi granules through feeding tube can remove the etiology,and block the disease from further progress.Early enteral nutrition can contribute to the recovery of intestinal mucosa and the maintenance of internal environment.Combined with Qingyi granules,it can relief the symptoms,decrease the laboratory index and shorten the hospitalization time.

Following Escherichia coli lysis with alkali, cetyltrimethylammonium bromide (CTAB) was directly titrated into the supernatant. An easy and feasible technology for plasmid purification was established with the optimized proportion between the quantity of CTAB and plasmid, combined with the specific solution for DNA release and TritonX-114 for endotoxin removal. Quality detection showed that the purified plasmid was free of contamination of host RNA. The host bacterial genomic DNA, endotoxin and bacterial protein were less than 10 microg, 50 EU and 10 microg per mg plasmids, respectively. The ratio of OD260/OD280 was between 1.75-1.85. Eighty percent of the prepared plasmids were presented in the supercoiled form. The plasmid purified with this technology can satisfy all criteria stipulated by FDA. The main advantages of the technology include the avoidance of animal-derived enzymes such as ribonucleases A, Proteinase K and toxic reagents like chloroform and phenol. In addition, the technology has low cost and no pollution.
Cetrimonium Compounds ; chemistry ; Chemical Precipitation ; DNA ; genetics ; isolation & purification ; DNA, Bacterial ; genetics ; isolation & purification ; Escherichia coli ; chemistry ; genetics ; Plasmids ; genetics ; isolation & purification

Objective To investigate the expression of S100A16 in pancreatic cancer and its clinical significance. Methods Immunohistochemical experiment was used to detect the expression of S100A16 protein in pancreatic cancer tissues and adjacent tissues, and we analyzed the relation between S100A16 positive expression and clinicopathological parameters, prognosis of pancreatic cancer patients. PPI was used to predict a protein relationship network that directly interacted with S100A16. Results The positive rate of S100A16 expression in cancer tissues was significantly higher than that in adjacent tissues (P=0.001). S100A16 expression was higher in patients with vascular infiltration and lymph node metastasis. The overall survival time of patients with pancreatic cancer was related to tumor size, TNM stage and S100A16 expression level. Multivariate analysis showed that the expression level of S100A16 was an independent risk factor for the prognosis of pancreatic cancer patients, and the risk of death in patients with high S100A16 expression increased by 1.5 times. PPI predicted that S100A16 and S100A14, IL36G, PITX1, PERP played an important role in the interaction network. Conclusion Pancreatic cancer patients with high S100A16 expression have poor prognosis. The positive expression of S100A16 is an independent prognostic indicator.

Objective:To investigate the effects of ultrasound-guided bilateral erector spinal plane nerve block on postoperative pain and sleep quality in children with pectus excavatum undergoing Nuss.Methods:From February 2020 to December 2021, 40 children with pectus excavatum undergoing Nuss from Hunan Children′s Hospital were prospectively selected and randomly divided into two groups: group E (group E) with erector spinal muscle plane block combined with general anesthesia and group G (group G) , with 20 patients in each group. After general anesthesia, ultrasound guided plane nerve block of bilateral erector spinal muscles was performed in group E, and general anesthesia with tracheal intubation was performed in group G. The Visual Analogue Scale (VAS) Score were recorded at 2, 6, 12, 24 and 48 hours after surgery; The addition of sufentanil, the time of extubation of post anesthesia recovery room (PACU) and the time of leaving the PACU in each group were recorded; The effective pressure times of analgesic pump and the number of people for remedial analgesia were recorded. Pittsburgh sleep quality index (PSQI) was used to score the sleep quality of children before and 2 days after surgery. The occurrence of hypoxemia and restlessness after extubation, nausea and vomiting, pneumothorax, local anesthetic poisoning and other complications were recorded.Results:The VAS score of group E at 2, 6, 12 and 24 hours after operation was lower than that of group G (all P<0.05). There was no significant difference in VAS score 48 hours after operation between the two groups ( P>0.05). The time of decannulation and recovery of PACU in group E was shorter than that in group G (all P<0.05). Compared with group G, there were fewer cases of sufentanil added in group E during operation, and the number of analgesia pump pressing times and cases of postoperative remedial analgesia in group E were less than those in group G (all P<0.05). The PSQI score of sleep quality index 2 days after operation in group E was better than that in group G ( P<0.05). The incidence of hypoxemia, restlessness, nausea and vomiting in group E was lower than that in group G (all P<0.05). Conclusions:Ultrasound-guided bilateral erector spinal nerve block can effectively reduce postoperative pain and complications of NUSS in children with pectus excavatum, and can also reduce the amount of sufentanil used during the operation, improve the sleep quality after the operation, which is conducive to the recovery of children, and is worthy of promotion.

Objectives To explore the expression, biological function, and mechanism of MKI67 in pancreatic cancer and its clinical significance. Methods The expression level, diagnosis, and prognostic value of MKI67 in pancreatic cancer were analyzed using public databases. We also investigated the association between the MKI67 with immune cell infiltration and immune checkpoint molecules. We analyzed the functional pathway enrichment to uncover the possible molecular mechanisms. qRT-PCR and Western blot assay were used to verify the expression of MKI67 mRNA and protein. Immunohistochemistry staining was used to detect the expression of MKI67 in tissue protein. Results The high expression of MKI67 was significantly associated with high histological grades and poor outcomes in pancreatic cancer. High MKI67 expression was correlated with poor prognosis of pancreatic cancer patients (P=0.009). MKI67 was an independent risk factor for the patient outcome (95%CI: 1.084-1.743, P<0.05). The MKI67 expression was positively correlated with the helper T cell 2 levels but negatively correlated with plasmacytoid DC, NK cells, mast cells, the T follicular helper, immune DC, and CD8 T cells. Conclusion MKI67 may serve as a biomarker for the diagnosis and prognosis of pancreatic cancer and the mechanism might be associated with immune escape or immunosuppression.

Pancreatic cancer is a highly malignant tumor. PARP inhibitor (PARPI) is the first synthetic antineoplastic drug developed based on the concept of synthetic lethality and has been clinically approved for the treatment of ovarian cancer and breast cancer. Due to specific DNA repair defects, studies have found that tumors with BRCA1/2 germline mutations are sensitive to PARPI, but the specific mechanism of action is still unclear. A number of clinical trials for pancreatic cancer have been carried out. Phase III POLO studies have shown that Olaparib is effective and well tolerated as a maintenance treatment in patients with germline BRCA1/2 mutations and patients with metastatic pancreatic cancer after platinum-based induction chemotherapy. Clinical studies related to combination therapy suggest that the benefit of adding PARPI is likely to come from the maintenance phase of treatment. In general, PARPI has broad prospects in the treatment of pancreatic cancer.

Objective To investigate the clinical value of serum carbohydrate antigen 19-9 (CA19-9) in the differential diagnosis of benign and malignant biliary system diseases. Methods Clinical data of 167 patients with biliary system diseases in Department of General Surgery, the First Hospital of Lanzhou University from January 2008 to March 2011 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into benign biliary system diseases group (benign diseases group, n=85) and cholangiocarcinoma group (malignant diseases group, n=82). Blood alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TB), direct bilirubin (DB), total protein (TP), albumin (ALB) and CA19-9, cancer antigen (CA) 125, carcino-embryonic antigen (CEA), alpha fetoprotein (AFP) were detected after admission to hospital. The indexes of two groups were expressed in M (Q25,Q75), and were compared by Wilcoxon rank sum test. The correlation study was analyzed using Spearman rank correlation analysis. The sensitivity and specificity of serum CA19-9 in diagnosis of cholangiocarcinoma was analyzed using receiver operating characteristic (ROC) curve. Results The median level of serum CA19-9 in malignant diseases group was significantly higher than that in benign diseases group [318(41,733)μg/L vs. 43 (15,139)μg/L;Z=3.736;P<0.05]. Serum CA19-9 in benign diseases group was positively correlated with GGT, ALP, TB, DB and CA125 (r=0.318, 0.335, 0.282, 0.355, 0.387;P<0.05), while was negatively correlated with TP and ALB (r=-0.300,-0.437;P<0.05). CA19-9 in malignant diseases group was positively correlated with ALP, TB, DB and CA125 (r=0.340, 0.394, 0.385, 0.480;P<0.05), while was negatively correlated with ALB (r=-0.389, P<0.05). For all the patients or the jaundice patients, the best positive reference values of CA19-9 in diagnosis of cholangiocarcinoma were both 309μg/L and the diagnostic sensitivity and speciifcity were 0.51 and 0.89 in all the patients, 0.57 and 0.85 in the jaundice patients respectively. Conclusions The best reference value of CA19-9 in the differential diagnosis of benign or malignant biliary system diseases is 309 μg/L. The diagnostic speciifcity of serum CA19-9 for cholangiocarcinoma is comparatively high but the sensitivity is moderate.