Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute cholangitis during pregnancy. Methods The clinical data of 16 pregnant patients with acute cholangitis who underwent ERCP and/or endoscopic sphincterotomy (EST) from August 2001 to February 2009 were retrospectively analyzed. Results Two patients were in the first trimester, 8 in the second trimester and 6 in the third trimester of pregnancy. Two patients had endoscopic placement of a plastic biliary stent in the first trimester. EST was then used to remove the stones successfully 4 and 5 months later. ERCP was performed in 8 women in the second trimester and 6 in their third trimester. Successful clearance of biliary stones at the time of ERCP was achieved in 14 pregnant women. Two patients who had multiple biliary stones underwent placement of a plastic biliary stent to limit the total fluoroscopy time. A second ERCP was carried out on the 2 patients to remove the stones after delivery. Post-ERCP mild pancreatitis developed in 1 patient in the third trimester. There was no spontaneous fetal loss, premature births, intrauterine fetal distress, fetal growth retardation/mental retardation/fetal malformation. Conclusion Short-term follow-up of all neonates whose mothers received ERCP during their pregnancies supported the efficacy and safety of its use. However, the long-term fetal complications of radiation exposure have not been investigated.

BACKGROUND:Dexmedetomidine is an efficient, highly selective alpha-2 adrenergic receptor agonist, with sedative, analgesia and anti-anxiety effects, it has little impact on the respiration.
OBJECTIVE:To observe the analgesic effect induced by intrathecal injection of dexmedetomidine in rat model of spared nerve injury.
METHODS:A total of 60 male Sprague-Dawley rats were randomly divided into three groups (n=12):normal control group, dexmedetomidine group and saline group. Except for the normal control group, spared nerve injury model was established in the rats of dexmedetomidine group and saline group. Dexmedetomidine group was treated with intrathecal injection of dexmedetomidine 3μg/kg every day within 14 days after injury. Saline group was given equal volume of saline for 14 days. The thermal withdrawal latency and mechanical withdrawal threshold were measured respectively before injury, after injury, before injection, and 2, 7, 14 days after intrathecal injection. Four rats were sacrificed in each group at day 2, 7 and 14 after injection, and the lumbar segments (L 4-6 Hematoxylin-eosin staining was performed to detect the morphology of the spinal dorsal horn neurons and ) of the spinal cord were removed. Real-time RT-PCR and western blot analysis were used to determine the expression of protein kinase C mRNA and protein in the spinal dorsal horn neurons. immunohistochemistry staining was carried out to assess the expression level and distribution of protein kinase C.
RESULTS AND CONCLUSION:The thermal withdrawal latency and mechanical withdrawal threshold in dexmedetomidine group and saline group were significantly decreased compared with normal control group before or after injection (P<0.05). However, both the thermal withdrawal latency and mechanical withdrawal threshold in dexmedetomidine group after intrathecal injection were significantly higher than those in saline group (P<0.05). The protein kinase C expression in spinal dorsal horn neurons was significantly decreased in dexmedetomidine group compared with saline, and reached to the most lowest levels as normal control group on 14 days after injection. Moreover, the apoptosis of spinal dorsal horn neurons in dexmedetomidine group was lighter than that in saline group, and was similar to the morphology of neurons in normal control group on 14 days after injection. Intrathecal injection of dexmedetomidine could attenuate the hyperalgesia induced by spared nerve injury, which might be associated with the inhibition of protein kinase C expression in spinal dorsal horn.

BACKGROUND:Dexmedetomidine is an effective high-selectivityα2-adrenoceptor agonist that has sedative, analgesic, anxiolytic effects, but slightly affects respiration.
OBJECTIVE:To observe the analgesic effect of dexmedetomidine on selective damage of sciatic nerve branch in a rat model by intrathecal injection.
METHODS:A total of 36 male Sprague-Dawley rats were randomly divided into normal control group, physiological saline group and dexmedetomidine group. A rat model of selective damage of sciatic nerve branch was established by knotting off the common peroneal nerve and tibial nerve in the physiological saline group and dexmedetomidine group. Rats in the dexmedetomidine group were daily injected with dexmedetomidine 3μg/kg by intrathecal injection within 14 days after injury. Rats in the physiological saline group were injected with physiological saline.
RESULTS AND CONCLUSION:Compared with the physiological saline group, the mechanical withdrawal threshold and the thermal withdrawal latency were significantly increased in the dexmedetomidine group (P<0.05). Neuronal nitric oxide synthase mRNA and protein expression levels were significantly decreased in the spinal dorsal horn (P<0.05). The injury to spinal dorsal horn neurons was obviously lessened. Moreover, neuronal nitric oxide synthase mRNA and protein expression levels and the injury to spinal dorsal horn neurons were similar between 14 days after administration and normal control group. Results indicated that intrathecal injection of dexmedetomidine could inhibit the expression of neuronal nitric oxide synthase in the spinal dorsal horn and relieve the pain induced by sciatic nerve injury.

Objective To compare the therapeutic efficacy and procedure related complications between endoscopic sphincterotomy (EST) and surgery in treatment for choledocholithiasis concomitant with liver cirrhosis. Methods The data of patients with choledocholithiasis concomitant with cirrhosis who underwent EST (n = 139 ) or surgery (n =98 ) for stone clearance from August 1985 to May 2008,were retrospectively analyzed and compared. Results The success rates of complete stone clearance in EST and surgery groups were 95% and 100%,respectively. There was a significant difference in the rate of procedure-related complications between EST and surgery groups ( 16. 5% vs. 62. 2%,P ＜ 0. 01 ),as well as the mortality rate (5.0% vs. 24. 5% ). When patients were further grouped according to Child-Pugh liver function classification,a significant difference in rate of procedure-related complications was detected between 2 groups in patients of Child-Pugh B and C,as well as the mortality rate in patients of Child-Pugh C. Conclusion For patients with choledocholithiasis concomitant with liver cirrhosis,EST,with a stone clearance rate at 95%,is superior to surgery with a significant reduction in risk of procedure-related complication and mortality rate.

Objective To explore the therapeutic effect and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute severe cholangitis (ASC) in patients older than eighty. Methods The clinical data of 106 patients aged 80 years and over with ASC who underwent ERCP were reviewed. Results Among 106 cases, there were 95 patients with common bile duct (CBD) stones, and 11 patients with biliary tract neoplasms. The 11 cases with biliary tract neoplasms underwent endoscopic nasobiliary drainage (ENBD) to correct critical situation. After stabilization, surgical treatment or stent placement was performed. The 61 of 95 cases with CBD stones underwent ENBD in critical phase and endoscopic sphincterotomy (EST) plus stone removal for subsequent treatment after stabilization. The 34 of 95 cases with CBD stones underwent EST to remove stones. Procedure-related complications were found in 5 patients. At 24 and 72 hours postoperation, the values of white blood cell count, serum total bilirubin, body temperature, and occurrence rate of patients with shock and mental symptoms were decreased in the other 101 patients.Conclusions For patients aged 80 years and over with ASC, ERCP is a safe and effective procedure.

Objective To study the predetermination value of multi-slice spiral CT for showing the major blood vessels,bile and pancreatic ducts around normal duodenal papilla before EST.Methods A 16-slice spiral CT was used to perform 28s and 68s enhanced scan for normal structures surrounding duodenal papilla in 30 subjects.Post-processing was done to the raw data with thin-slice maximum intensity projection (TSMIP) and thin-slice average intensity projection (TSAIP),and then the structure of bile and pancreatic ducts,duodenal artery and pancreatic-duodenal conjunction were reconstructed.The reconstructed images were double-blind evaluated.Distances between papilla and upper,front,and behind edge of the pancreatic-duodenal conjunction,situation of the duodenal papilla artery and the distance from the papilla artery end to the papilla were recorded.Results After dual-phase enhanced scan,the post-processing results for the images of the surrounding structure of pancreatic and duodenal papilla were stable and the results of double-blind evaluation were consistent.Image scores of the arteries surrounding duodenal papilla and pancreatic duct at 28th second were significantly higher than those of 68th second,whereas bile duct and the ampulla structure image scores of 68th second were higher.TSMIP of local vascular structure could display anterior-superior pancreatic-duodenal artery (ASPDA) in 93.3％ of the subjects,posterior-superior pancreatic-duodenal artery (PSPDA) in 73.3％,inferior pancreatic-duodenal artery (IPDA) in 73.3％,duodenal-papillary artery (DPA) in 56.7％,bile duct in 96.7％,pancreatic duct in 90.0％ aud pancreatic and duodenal parenchima in 100.0％.The DPAs all started from PSPDA origin and down to papilla,with only 2 cases of 30 (6.7％) reached the upper edge of the duodenal papilla.Others showed arteries turned thin obviously at 12 mm above the papilla; the normal common bile duct can be tracked to the opening of the papilla.The Coronal Oblique TSAIP imaging showed the distance from the duodenal papilla-bile duct ending to the lower edge of the pancreatic-duodeual upper conjunction was 15.7±1.9 mm.Distance from papilla to the front edge of pancreatic-duodenal conjunction was 16.6±3.2 mm and to the behind edge was 1.7±0.4 mm.Distance (depth) from the inner edge of the papilla to the bile-pancreatic conjunction was 8.0±1.7 mm.Conclusion The 3D reconstruction of the Multi-slice spiral enhancement CT Imaging can providc high quality images of relative vascular,bile-pancreatic and obvious surrounding structures to the forthcoming operation.Massive hemorrhage and perforation risks of EST can be evaluated based on the vascular distribution and directions around duodenum and pancreas and the bile duct imaging.

Objective To study the radioprotective effect of polypeptide from Chlamys farreri (PCF) on ultraviolet B(UVB)-irradiated murine thmocytes in vitro. Methods The murine thymocytes were exposed to UVB radiation. MTT method was used to detect the cell viability. The activities of intracellular glutathione peroxidase (GSH-Px), superoxided dismutase(SOD) and catalase (CAT) were measured. Intracellular reactive oxygen species (ROS) and the effect of PCF on UVB-induced apoptosis were investigated by flow cytometry. Results PCF could greatly enhance the viability of murine thymocyte and markedly promote the activities of GSH-Px, SOD and CAT, while the amount of ROS was decreased. PCF could inhibit UVB-induced thymocyte apoptosis. Conclusion PCF has significant radioprotective effects on UVB-irradiated murine thymocytes in vitro.

Objective Our preliminary study demonstrates that quercetin can inhibit the proliferation of HL-60 cells. This sudy aimed to find some drugs which could have synergistic effects with quercetin on apoptosis of HL-60 cells. Methods HL-60 cells were cultured with bortezomib at different concentrations (1, 2, 4, 8, 16, and 32μmol/L) alone or combined with quercetin at different concentrations for 48 h. HL-60 cells were cultured with lenalidomide at different concentrations (5, 10, 20, 40, 80, 160, and 320 μmol/L) alone or in combination with quercetin at different concentrations for 48 h. The CCK-8 assay was used to determine the effects on proliferation of HL-60 cells. Results Bortezomib significantly inhibited the proliferation of HL-60 cells (P<0.01). IC50 of quercetin was 49.24μmol/L after cells treated by quercetin combined with bortezomib, which was 13.44μmol/L lower than that treated by quercetin alone. Isobolographic analysis revealed the two drugs had synergistic effect. The results of cell viability of HL-60 cells treated by lenalidomide at lower concentrations (5, 10, 20, 40, and 80μmol/L)were not different from those of the control group (P > 0.05). The results of cell viability of HL-60 cells treated by lenalidomide at higher concentrations (160 and 320μmol/L) were lower than those of the control group (P<0.05). IC50 of quercetin after cells treated by quercetin combined with bortezomib was not different from that treated by quercetin alone. Isobolographic analysis revealed the two drugs had no synergistic effect. Conclusions Bortezomib can inhibit the proliferation of HL-60 cells and it has a synergistic effect with quercetin on HL-60 cells. Lenalidomide has a weaker role in inhibition of the proliferation of HL-60 cells, and it has no synergistic effect with quercetin on HL-60 cells.

To compare therapeutic effect of dibutyryl cyclic adenosine monophosphate calcium (DCAMC) on chronic heart failure (CHF) between different administration route .Methods :The 98 CHF patients were ran‐ domly and equally divided into intravenous drip (i .v.gtt) group and intramuscular injection group (i.m .) group , both groups received DCAMC via corresponding administration route based on routine anti heart failure treatment for 10d.Plasma level of N terminal pro brain natriuretic peptide (NT‐proBNP) ,left ventricular end diastolic dimen‐sion (LVEDd) ,LVEF before and after treatment ,and incidence of adverse reactions were observed and compared between two groups .Results :Compared with before treatment , there were significant reductions in plasma NT‐proBNP level [i.v.gtt group :(6846.23 ± 3856. 01)pg／ml vs.(2285.69 ± 2023.79)pg／ml ,i .m .group :(6151. 50 ± 5160.09) pg／ml vs.(2568.37 ± 2488.51)pg／ml] and LVEDd [i.v.gtt group :(4.78 ± 0.44 )cm vs.(4. 69 ± 0.43) cm ,i.m .group :(4.97 ± 0.64)cm vs .(4. 88 ± 0.62) cm] ,and significant rise in LVEF [i.v.gtt group :(59.49 ± 4.64)% vs.(60. 67 ± 4. 52)%,i.m.group :(57.67 ± 7.19)% vs.(58.94 ± 7.05)%] in two groups after treatment , P＝0.001 all.There were no significant difference in above indexes between two groups before and after treatment , P＞0. 05 all.There was no significant difference in incidence rate of adverse reactions between two groups , P＝1.000. Conclusion :DCAMC can improve cardiac function in CHF patients .Therapeutic effect of local intramuscular injection is equal with that of intravenous drip .

Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)for common bile duct(CBD)stones before endoscopic retrograde cholangiopancreatography(ERCP). Methods Data of patients with suspected CBD stones admitted to The First People′s Hospital of Hangzhou from July 2012 to July 2013 were reviewed. Diagnostic efficiency and rates of complications were analyzed between patients undergoing EUS(EUS group)and MRCP(MRCP group)before ERCP, and between patients who underwent EUS and ERCP in different sessions(non-one-session group)with those in one session(one-session group). Results A total of 657 patients were included. With ERCP and follow-up results as the gold standard, the sensitivity(97.5% VS 88.4%), accuracy(96.3% VS 88.0%)and negative predictive value(88.9% VS 60.0%)of EUS in the diagnosis of CBD stones were significantly higher than those of MRCP(P<0.05). There were no significant differences between one-session group and non-one-session group in the sensitivity(97.5% VS 97.4%), specificity(91.7% VS 90.0%), positive predictive value(98.3% VS 97.4%), negative predictive value(88.0% VS 90.0%), and accuracy (96.6% VS 95.9%)in diagnosis of CBD stones(P>0.05). There were no significant differences in incidence of postoperative complications of ERCP between EUS and MRCP group[5.4%(13/242)VS 5.1%(21/415),P>0.05],and between one-session group and non-one-session group[5.5%(8/145)VS 5.2%(5/97),P>0.05].Conclusion Preoperative EUS before ERCP could increase diagnostic sensitivity and negative pridictive value of CBD stones without increasing the incidence of complications.