Objective To improve the success rate of selective cannulation of major papilla during endoscopic retrograde cholangiopancreatography (ERCP).Methods When cannulation failed with conventional methods,ultra-fine guide wire combined with taped cannulation,precut papillotomy,guide wire pancreatic occupation technique,and percutaneous transhepatic cholangial drainage (PTCD) assisted rendezvous technique was applied to improve the success rate of cannulation of major papilla.Results A total of 5743 patients received ERCP in our hospital during last 5 years,with a success rate of cannulation of major papilla at 98.6% (5664/5743).For 396 patients with difficult cannulation under conventional methods,ultra fine guide-wire technique was applied in 20,pancreatic occupation technique in 67,precut technique in 294 and PTCD assisted rendezvous technique in 15,which achieved a success rate of 80.0% (317/396).Conclusion Application of combined techniques according to the features of papilla can increase success rate of difficult cannulation.

Adult ; Angiomyolipoma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Antigens, Neoplasm ; metabolism ; Epithelioid Cells ; pathology ; Female ; Humans ; Kidney Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Lymphatic Metastasis ; Melanoma-Specific Antigens ; Neoplasm Proteins ; metabolism ; Nephrectomy ; Tomography, X-Ray Computed

DNA barcoding is a technique in which species identification and discovery are performed by using short and standard fragments of DNA sequences. In this study, eleven species of Paris, including seven varieties, were sampled. Five chloroplast sequences, psbA-trnH, rpoB, rpoC1, rbcL, matK, and one nuclear marker, the second internal transcribed spacer (ITS2) of ribosomal DNA, were amplified and sequenced. The PCR amplification and sequencing efficiency, intra- and inter-specific divergence and barcoding gap were used to evaluate different loci, and the identification efficiency was assessed using BLAST1 and Nearest Distance methods. The ITS2 sequences in the studied samples of Paris were amplified and sequenced successfully using primers designed by our group, while matK showed low level in the amplification and psbA-trnH was difficult for sequencing because of over 800 bp and poly (A) structure. Analysis of the intra- and inter-specific divergence and barcoding gap showed ITS2 was superior to other loci. The ITS2 showed a much higher percentage of success (100%) in identification than other five loci, none of which indicated more than 50% except matK (52.9%). The 2-locus combination of rbcL+matK didn't improve ability of authentication. In addition, the rate of successful identification with ITS2 kept 100% when the samples were expanded to 67 samples of 29 species. In conclusion, ITS2 can be used to correctly identify medicinal plants of Paris, and it will be a potential DNA barcode for identifying medicinal plants of other taxa.

Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95%, 74% and 56%, respectively. The mean patient survival was 7. 9 months ( 1-14 months).Postoperative survival rates at 3,6 and 12 months were 91.0%, 81.3% and 17. 2%, respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible,safe and effective.

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.

OBJECTIVETo evaluate the short term clinical results of scaling and root planning (SRP) only, SRP combined with amoxicillin (AMX) and metronidazole (MTZ) after supragingival scaling or after SRP in the treatment of aggressive periodontitis (AgP).

METHODSA total of 45 patients with AgP were randomly divided into SRP group, SRP with AMX + MTZ after supragingival scaling group and AMX + MTZ after SRP group. Subgingival scaling and root planning were performed one week after supragingival scaling and finished within 1 month. AMX and MTZ were given for 7 days immediately after supragingival scaling or the last time of SPR. Clinical examinations including probing depth (PD), attachment level (AL) and bleeding index (BI) were performed at baseline and 8 weeks after non-surgical periodontal treatment by the same examiner.

RESULTSThere were more PD reduction and AL gain in both AMX + MTZ after supragingival scaling group and AMX + MTZ after SRP group compared with SRP group [2.5 (1.8, 3.3) mm, 2.3 (1.9, 2.7) mm vs. 1.8 (1.3, 2.1) mm, P < 0.05]; [0.9 (0.5, 1.4) mm, 0.8 (0.4, 1.3) mm vs. 0.4 (0.2, 1.0) mm, P < 0.05]. In sites PD ≥ 7 mm, PD reduction was more in AMX + MTZ after supragingival scaling group than AMX + MTZ after SRP group [4.0 (3.0, 5.0) mm vs. 4.0 (3.0, 4.0) mm, P < 0.05)].

CONCLUSIONSThe combined use of AMX and MTZ during non-surgical periodontal treatment for patients with AgP was effective in short term. In patients with most sites PD ≥ 7 mm, AMX and MTZ could be taken after supragingival scaling, but the long-term clinical effects needs further investigation.

Adult ; Aggressive Periodontitis ; drug therapy ; therapy ; Amoxicillin ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Anti-Infective Agents ; therapeutic use ; Combined Modality Therapy ; Dental Scaling ; Drug Therapy, Combination ; Female ; Humans ; Male ; Metronidazole ; therapeutic use ; Root Planing ; Time Factors ; Young Adult

Humans ; Nasal Cavity ; pathology ; Nose Neoplasms ; diagnosis ; Paranasal Sinuses ; Solitary Fibrous Tumors ; diagnosis

Recombinant adeno-associated virus (rAAV) has been widely used as vector for gene therapy. However, the effectiveness of gene therapy based on rAAV needs to be further improved. Enhancement of the transduction efficiency is one of the most important fields for rAAV-based gene therapy. Recent results have showed that the ubiquitin-proteasome system plays an important role in the trafficking of rAAV vector in cytoplasm, and regulation of its function may significantly improve the transduction efficiency of rAAV vector in various types of cells and tissues.
Animals ; Dependovirus ; genetics ; metabolism ; Genetic Vectors ; genetics ; metabolism ; Humans ; Transduction, Genetic ; Ubiquitin ; metabolism

Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.

Objective To investigate an effective endoscopic management of biliary anastomotic stric-tures (AS) following orthotopic liver transplantation (OLT) and to evaluate the factors which may effect the ontcome. Methods Sixty-five patients, who were diagnosed as AS 3 months after OLT, underwent ERCP. Af-ter adequate dilation of the narrowing bile ducts, plastic stents, as many as possible, were inserted across the strictures and kept in place for at least six months. Results A total of 90 consecutive endoscopic procedures were performed in 65 patients. Before stents placement, the strictures were dilated by catheter or balloon (di-ameter range: 6-10 mm), or not dilated, according to the status of the bile ducts. An average of 3 (ranging from 2 to 6) plastic stents were placed with mean total size of 22.8 F (range 14-42 F), and the stents were kept for 8. 0 months on average (range 0.2-37.8 months). Of 90 procedures of stents placement, 54 (60%) were followed by stents removal and cholangiography, which confirmed stricture resolution in 26 (48.1%). The stricture resolution rate was 81.0% (17/21) in patients who underwent balloon dilation followed by more than 3 stents (> 21 F) for at least 3 months. Stricture re-occurred in 3 patients after stents removal, in whom stents were kept less than six months. Conclusion Endoscopic sequential intervention is effective for post-OLT biliary strictures according to the stage and grade. Radical dilation with maximal stenting can lead to complete resolution of AS. To achieve better result, if possible, balloon dilatation followed by three or mere endoprothe-ses (of at least 21 F) sustaining for more than 6 months is necessary.