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.

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 investigate the clinical effects, therapy safety and maintenance time of recruitment maneuvers (RM) combined with lung protective strategy in patients with acute respiratory distress syndrome (ARDS). Methods Thirty-two ventilated patients with ARDS underwent RM using a pressure of 30cmH_2O for 30s, without any sedatives and neuromuscular blocking agents. Results Compared with before RM, both oxhemoglobin saturation measured by pulse oximetry (SpO_2) and partial pressure of arterial oxygen (PaO_2) were significantly increased during one hour after applying RM. SpO_2 increased significantly within two hours after RM. The peak inspiratory pressures (PIP), heart rate (HR) and Pplateau inspiratory pressures (Pplate) had not significant difference between after and before RM, but respiratory system compliance (Crs) increased markedly in one hour after RM (P

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 explore the changes and clinical significance of regulatory T cell/T help cell 17 (Th17) in the peripheral blood from patients with dermatomyositis (DM).Methods Thirty-six patients with DM were recruited and thirty-six healthy individuals were enrolled as normal controls.The percentage of regulatory T cell/Th17 cell was assessed by flow cytometry and the mRNA levels of Foxp3/RORγt were detected by real-time quantitative reverse wanscription polymerase chain reaction (RT-PCR).The plasma levels of TGF-β1/IL-17 were measured by enzyme linked immunosorbent assay (ELISA).T-test was used for statistical analysis and Pearson's linear analysis were used for correlation analysis.Results The percentage of CD4+ Foxp3+ T cell,the mRNA expression of Foxp3 and the plasma levels of TGF-β1 decreased significantly in patients with DM than in normal controls [(7.2±2.3)％ vs (9.1±3.2)％,(0.44±0.19) vs (0.62±0.25),(37 400±4814) pg/ml vs (41 200±6348) pg/ml,P＜0.05].The percentage of Th17 cell,the mRNA expression of RORγt and the plasma levels of IL-17 increased in patients with DM compared with normal controls [(1.22±0.41)％ vs (0.83±0.14)％,(0.85±0.34) vs (0.61±0.21),(77±32) pg/ml vs (58±20) pg/ml,P＜0.05].There was negative correlation between the percentage of regulatory T cell,the mRNA levels of Foxp3,the plasma levels of TGF-β1 and the serum levels of CK in patients with DM (r=-0.573,-0.593,-0.618,P＜0.05).There was positive correhtion between the percentage of Thl7 cell,the mRNA levels of RORγt,the plasma levels of IL-17 and the serum levels of CK in patients with DM (r=0.582,0.609,0.623,P＜0.05).Conclusion The imbalance of regulatory T cell/Th17 cell may exist in the peripheral blood of patients with DM.Regulatory T cell/Th17 cell may be associated with the pathology of DM.

Objective To study the therapeutic effect of EUS-guided biliary drainage (EUS-BD) on patients with malignant obstructive jaundice when ERCP failed.Methods From January 2014 to January 2016,all patients with malignant obstructive jaundice during hospitalization underwent EUS-guided biliary drainage (group A,36 cases) or PTCD treatment (group B,30 cases) by draw after failed ERCP.Operation success rate,liver function recovery time,complication rates,length of hospital stay and hospital costs were observed and compared.Results There was no significant difference in the operation success rates between two groups [94.44％ (34/36) VS 86.67％ (26/30),P＞0 05)].And there were significant differences in liver function recovery time (25.79± 6.48 d VS 30.24 ± 8.49 d),incidence of complications [5.56％ (2/36) VS 23.33％ (7/30)],length of hospital stay (21.54±4.73 d VS 25.68 ± 8.56 d) and hospitalization costs (23.5±8.4 thousand yuan VS 32.8±6.5 thousand yuan,P＜0.05).Conclusion EUS-guided biliary drainage could be the first option for its noninvasiveness and efficacy,when ERCP failed in patients with malignant obstructive jaundice.

Objective To evaluate the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guid﹣ed fine-needle aspiration in patients with pancreatic cancer. Methods 256 patients with pancreatic cancer from Jan﹣uary 2010 to December 2014, 82 were considered resectable on the basis of cross-sectional imaging findings. Of these patients, 54 underwent EUS-FNA before surgery (FNA+group) and 28 underwent surgery without preoperative EUS-FNA (FNA- group), the diagnosis result of EUS-FNA and the survival time of the two groups were observed. Results All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology findings was 94.44 % (51/54) and 88.89% (48/54), respectively, and the total accuracy was 94.44 % (51/54). Two patients developed mild pancreatitis and two hemorrhage after EUS-FNA but were successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+and FNA- groups, the median relapse-free survival (RFS) was 282 and 265 d, respectively (P>0.05), and the median overall survival (OS) was 568 and 557 d, respectively (P>0.05). RFS and OS were therefore not inferior in the FNA+group. These data indicate that the usage of EUS-FNA did not influence RFS or OS, nor did it increase the risk of other complications. Conclusions Preoperative EUS-FNA is a safe and accurate diagnostic method.

125 strains of the symbiotic and epiphyte microorganisms were isolated from marine organisms (sea cucumber, sea urchin,anemone, sea actinia, Ulra, Sargassum, Undaria). Among them,21 strains of bacteria,8 strains of actinomycetes and 2 strains of fungi showed antagonistic activity on bacterial or fungal growth. In the 21 strains of bacteria, 7 strains belong to Bacillus sp., 11 strains Vibrio sp., and 3 strains Pseudomonas sp.. In the 8 strains of actinomycetes, 5 strains belong to Streptomyces sp., 3 strains Micromonospora sp., 2 strains fungi Penicillum sp..

Objective To investigate the feasibility and effects of whole-procedure seamless nursing intervention during regional collaborative treatment of patients with acute coronary syndrome.Methods Nursing intervention was performed on pre-hospital collaboration,transfer collaboration and catheter room collaboration during regional collaborative treatment of patients with ACS.Treatment time point,therapeutic effects and major hospitalization indicators were compared before(the control group) and after(the experimental group) implementation of nursing intervention.Results There were significant differences in mean FMC-to-B time,D-to-B time,referral time,obtaining informed consent time,mortality,LVEF and LVED between two groups(P＜0.05).There were significant differences in days of hospitalization,expenditures,percentage of consumables,percentage of medication,and in-hospital mortality between two groups (P＜0.05).Conclusion Whole-procedure nursing intervention can reduce time of regional collaborative treatment of patients with acute coronary syndrome,improve prognosis,decrease financial burden and increase efficiency of ACS treatment.