ObjectiveTo investigate the feasibility and safety of endoscopic retrograde cholangiopancreatography （ERCP） combined with oral cholangiopancreatography in the treatment of major duodenal papilla gallbladder polyps. MethodsA retrospective analysis was performed for the clinical data of eight patients with choledocholithiasis and gallbladder polyps who underwent ERCP and combined with oral cholangiopancreatography for major duodenal papilla cholecystectomy in Center of Digestive Endoscopy， Jilin People’s Hospital， from May 2022 to June 2024， and related data were collected， including the success rate of surgery， the technical success rate of gallbladder polyp removal， the superselective method of cystic duct， the time of operation， the time of gallbladder polyp removal， and surgical complications. ResultsBoth the success rate of surgery and the technical success rate of gallbladder polyp removal reached 100%， and of all eight patients， three patients used guide wire to enter the gallbladder under direct view， while five patients received oral cholangiopancreatography to directly enter the gallbladder. The time of operation was 51.88±12.34 minutes， and the time of gallbladder polyp removal was 23.13±10.94 minutes. The diameter of gallbladder polyp was 2‍ ‍—‍ ‍8 mm， and pathological examination showed inflammatory polyps in three patients， adenomatous polyps in one patient， and cholesterol polyps in four patients. There were no complications during or after surgery. The patients were followed up for 2‍ ‍—‍ ‍27 months after surgery， and no recurrence of gallbladder polyp was observed. ConclusionOral cholangiopancreatography is technically safe and feasible in endoscopic major duodenal papilla cholecystectomy.

To evaluate the therapeutic effect of baicalein topical preparation on atopic dermatitis, we first constructed two atopic dermatitis-like mouse models induced by calcipotriol and 1-fluoro-2,4-dinitrobenzene to assess their therapeutic effect with skin tissue staining and other experiments. It was found that topical preparation of baicalein could alleviate epidermal thickening of diseased skin tissues, repair damaged skin barrier proteins, and inhibit T helper 2 cells (Th2) infiltration and mast cell infiltration and activation in lesional sites. Cyberpharmacology was utilized to analyze whether baicalein could treat atopic dermatitis by interfering with multiple pathogenesis-associated pathways. Results indicated that baicalein reduced the mRNA levels of inflammatory factors and inhibited the phosphorylation of NF-κB p65 and STAT1 proteins in keratinocyte cells. Together, the topical preparation of baicalein may be effective in alleviating atopic dermatitis-like symptoms in mice by down-regulating the phosphorylation level of NF-κB in keratinocytes, thereby decreasing the expression of inflammatory factors in keratinocytes, which provides an idea and a theoretical basis for the topical preparation of baicalein for the treatment of inflammatory skin diseases such as atopic dermatitis.

To investigate the effects of Wogonin (WO) on learning and memory impairment, Aβ1-42 was injected intracerebroventricularly to induced a mouse learning and memory impairment model, and D-galactose was injected intraperitoneally to induced a mouse acute aging model. Mice were administered WO (75, 150, or 300 mg/kg) by oral gavage for 28 consecutive days. Cognitive function was assessed using the Morris water maze (MWM), novel object recognition (NOR), and open field tests (OFT). In the Aβ1-42 model, WO treatment (150 and 300 mg/kg) significantly improved the recognition index in the NOR test, while the 150 mg/kg group showed increased target quadrant preference in the MWM test. No changes in the total distance traveled in OFT. In the D-galactose aging model, the 150 mg/kg WO group exhibited increased platform crossings in the MWM test, and all WO doses (75, 150, and 300 mg/kg) enhanced target quadrant preference, with no alterations in spontaneous movement. Western blot analysis revealed that WO significantly attenuated hippocampal apoptosis in both models. These findings suggest that WO ameliorates learning and memory impairment associated with Alzheimer’s disease and aging.

Objective:To construct and verify a prediction and evaluation model based on dual-energy computed tomography(CT)radiomics for lymph node metastasis in gastric cancer,so as to provide more accurate and reliable method before lymph node in gastric cancer occurs metastasis.Methods:A total of eighty patients with gastric cancer admitted to Handan Central Hospital from January 2021 to December 2024 were retrospectively selected,and they were divided into a modeling group(48 cases)and a verification group(32 cases)using a random number table method according to a ratio of 3 to 2.The influencing factors were analyzed,and predictive model was constructed and verified by using univariate and binary logistics regression.The patients'general information,tumor size,differentiation degree,lesion location,and carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199)and carcinoembryonic antigen(CEA)were compared between two groups.Results:There were not significant differences in age,gender,body mass index(BMI),tumor size,degree of differentiation,lesion location in the modeling group(P>0.05).In the modeling group,the immunity concentration(IC)was(20.66±2.85)μg/mL,and normal immunity concentration(nIC)was(0.45±0.06)μg/mL,and the slope was(3.52±0.30).The three indicators were respectively(21.09±3.25)μg/mL,(0.47±0.05)μg/mL,(3.49±0.42)in verification group.There were significant differences in the three indicators among two groups(t=3.277,5.287,2.918,P<0.05).There were not significant differences in the tumor-related detection indicators between two groups(P>0.05).The results of binary logistics regression analysis showed that IC,nIC,and slope were influential factors in lymph node metastasis of gastric cancer(OR=2.564,1.647,1.786,P<0.05).The constructed prediction model by using Python Scikit-learn showed favorable appearance in the calibration curve with a slope closed to 1,which indicated a high degree of consistency between predicted risks and actual risks.Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of the modeling group was 0.896(95%CI:0.8154～0.9167),and the sensitivity and specificity were respectively 84.60%and 80.69%.The above three indicators were respectively 0.853(95%CI:0.7982～0.8671),86.66%and 80.00%in the verification group.Conclusion:A prediction and evaluation model for lymph node metastasis of gastric cancer based on dual-energy CT radiomics is successfully constructed,and its predictive efficiency and clinical application value are verified.

Objective:To construct and verify a prediction and evaluation model based on dual-energy computed tomography(CT)radiomics for lymph node metastasis in gastric cancer,so as to provide more accurate and reliable method before lymph node in gastric cancer occurs metastasis.Methods:A total of eighty patients with gastric cancer admitted to Handan Central Hospital from January 2021 to December 2024 were retrospectively selected,and they were divided into a modeling group(48 cases)and a verification group(32 cases)using a random number table method according to a ratio of 3 to 2.The influencing factors were analyzed,and predictive model was constructed and verified by using univariate and binary logistics regression.The patients'general information,tumor size,differentiation degree,lesion location,and carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199)and carcinoembryonic antigen(CEA)were compared between two groups.Results:There were not significant differences in age,gender,body mass index(BMI),tumor size,degree of differentiation,lesion location in the modeling group(P>0.05).In the modeling group,the immunity concentration(IC)was(20.66±2.85)μg/mL,and normal immunity concentration(nIC)was(0.45±0.06)μg/mL,and the slope was(3.52±0.30).The three indicators were respectively(21.09±3.25)μg/mL,(0.47±0.05)μg/mL,(3.49±0.42)in verification group.There were significant differences in the three indicators among two groups(t=3.277,5.287,2.918,P<0.05).There were not significant differences in the tumor-related detection indicators between two groups(P>0.05).The results of binary logistics regression analysis showed that IC,nIC,and slope were influential factors in lymph node metastasis of gastric cancer(OR=2.564,1.647,1.786,P<0.05).The constructed prediction model by using Python Scikit-learn showed favorable appearance in the calibration curve with a slope closed to 1,which indicated a high degree of consistency between predicted risks and actual risks.Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of the modeling group was 0.896(95%CI:0.8154～0.9167),and the sensitivity and specificity were respectively 84.60%and 80.69%.The above three indicators were respectively 0.853(95%CI:0.7982～0.8671),86.66%and 80.00%in the verification group.Conclusion:A prediction and evaluation model for lymph node metastasis of gastric cancer based on dual-energy CT radiomics is successfully constructed,and its predictive efficiency and clinical application value are verified.

ObjectiveTo investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography （ERCP） combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in the treatment of difficult choledocholithiasis. MethodsA retrospective analysis was performed for the clinical data of 12 patients with difficult choledocholithiasis who underwent ERCP and electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in Department of Gastroenterology， Jilin People’s Hospital， from May to November 2022. The clinical effect of lithotripsy and lithotomy was observed， and postoperative complications and time of surgical operation were assessed. ResultsAmong the 12 patients， 11 （91.67%） were successfully treated by electrohydraulic lithotripsy under direct view， 9 （75.00%） achieved first-attempt success in lithotripsy， and 11 （91.67%） had complete removal of calculi； 1 patient was found to have stenosis of the bile ducts caused by multiple biliary tract surgeries， and grade Ⅱ intrahepatic bile duct stones above the sites of stenosis were removed under direct view， but there were still residues of grade Ⅲ intrahepatic bile duct stones， which led to the fact that complete calculus removal was not achieved. The mean time of ERCP operation was 91.3±26.2 minutes， including a time of 41.8±22.2 minutes for energy lithotripsy. There were 2 cases of postoperative biliary tract infection which were improved after anti-infective therapy， 2 cases of hyperamylasemia which were not given special treatment， and 3 cases of mild pancreatitis which were improved after symptomatic medication， and there were no complications such as bleeding and perforation. ConclusionERCP combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system is safe， effective， and feasible in the treatment of difficult choledocholithiasis.

Objective:To investigate the morphological difference and clinical significance of bilateral lumbar multifidus muscles in patients with unilateral lumbosacral radiculopathy due to lumbar disc herniation and lumbar spondylolisthesis.Methods:A retrospective analysis was conducted on patients with low back pain, lumbar disc herniation and lumbar spondylolisthesis. Patients with lumbar disc herniation or lumbar spondylolisthesis underwent single segment lesion either at L 4, 5 or L 5S 1, while those accompanied with unilateral lumbosacral radiculopathy underwent percutaneous endoscopic lumbar discectomy or conventional open surgery at Qingdao Municipal Hospital between January 2017 and January 2023. Patients with lumbar spondylolisthesis were subdivided into degenerative lumbar spondylolisthesis and isthmic spondylolisthesis. 53 patients with low back pain met the inclusion criteria. 170 patients with lumbar disc herniation met the inclusion criteria, with 101 at L 4, 5 and 69 at L 5S 1 level. 129 patients with lumbar spondylolisthesis met the inclusion criteria, including 91 of degenerative lumbar spondylolisthesis at L 4, 5 level and 9 at L 5S 1 level, and 11 of isthmic spondylolisthesis at L 4, 5 level and 18 at L 5S 1 level. Cross-sectional images at the mid-disc of L 3, 4, L 4, 5 and L 5S 1 segments in MRI were acquired. Relative total cross-sectional area (rTCSA), relative functional cross-sectional area (rFCSA), fat infiltration rate (FIR), relative fat distance (rFD) and differential value FIR (D-FIR) in bilateral lumbar multifidus muscle were measured respectively by using Image J software, and were then used to evaluate the atrophy and fat infiltration of bilateral lumbar multifidus muscles. Results:No significant difference was found between the both sides of multifidus muscle in low back pain patients. L 4, 5 lumbar disc herniation group had smaller rFCSA (0.34±0.10 and 0.35±0.10) and larger FIR [29.92(22.21, 36.46) and 26.48(17.54, 34.55)] and rFD [0.39(0.29, 0.54) and 0.32(0.21, 0.43)] on the affected side compared to the unaffected side in L 4, 5 segment, and had larger FIR (34.83±11.34 and 31.44±10.94) and rFD [0.59(0.43, 0.77) and 0.51(0.37, 0.69)] on the affected side in L 5S 1 segment. L 5S 1 lumbar disc herniation group had smaller rFCSA (0.41±0.11 and 0.42±0.12) and larger FIR [26.84(22.92, 35.29) and 24.02(20.03, 32.87)] and rFD (0.51±0.28 and 0.42±0.26) on the affected side in L 5S 1 segment. L 4, 5 degenerative lumbar spondylolisthesis group had larger FIR (36.49±9.76 and 34.72±9.86) on the affected side in L 4, 5 segment, and had larger FIR [35.03(28.64, 41.85) and 33.34(26.37, 39.76)] on the affected side in L 5S 1 segment. L 5S 1 degenerative lumbar spondylolisthesis group had larger FIR [42.53(37.94, 46.81) and 40.79(30.84, 43.53)] and rFD (1.12±0.79 and 0.94±0.79) on the affected side in L 5S 1 segment. L 4, 5 isthmic spondylolisthesis group had smaller rFCSA [0.24(0.20, 0.30) and 0.29(0.23, 0.34)]and larger FIR [34.19 31.30, 42.39) and 29.43(28.82, 36.89)] and rFD (0.39±0.15 and 0.29±0.15) on the affected side in L 4, 5 segment, and had larger FIR (43.18±12.71 and 34.12±11.63) on the affected side in L 5S 1 segment. L 5S 1 isthmic spondylolisthesis group had larger FIR (40.24±9.34 and 36.37±10.70) on the affected side in L 5S 1 segment. No significant difference was found of the multifidus muscle between the affected and unaffected sides in the proximal adjacent segment of the responsible segment in lumbar disc herniation or lumbar spondylolisthesis group patients. L 4, 5 isthmic spondylolisthesis group had larger D-FIR (6.75±8.46 and 1.78±5.77) in L 4, 5 segment, and had larger D-FIR (9.06±11.59 and 1.54±7.08) in L 5S 1 segment compared to L 4, 5 degenerative lumbar spondylolisthesis group. Grade Ⅱ L 4, 5 lumbar spondylolisthesis group had larger D-FIR (10.73±13.61 and 1.92±7.43) in L 5S 1 segment compared to grade Ⅰ L 4, 5 lumbar spondylolisthesis group. Conclusion:L 4, 5 or L 5S 1 lumbar disc herniation and lumbar spondylolisthesis patients with unilateral lumbosacral radiculopathy had asymmetric atrophy and fat infiltration of multifidus muscle. The atrophy and fat infiltration on the affected side showed greater. The asymmetry appeared in the responsible segment and its distal adjacent lumbar segment. Lumbar spondylolisthesis patients with a lager degree of slip or with isthmic type could be accompanied by more severe asymmetry of multifidus muscle.

Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.

Objective:To investigate the risk factors affecting pathological diagnosis upgrading after resection of colorectal laterally spreading tumor (LST).Methods:From June 2018 to December 2022, the clinical data of 256 patients with LST (297 lesions) admitted to Shanxi Provincial Cancer Hospital were retrospectively included as an modeling group.From January 2023 to January 2024, 125 patients with LST (129 lesions) were collected as an external validation group. The pathological diagnosis of endoscopic forceps biopsy (EFB) samples and the resected LST tissue of modeling group were compared, and the patients were divided into pathological non-difference group and pathological upgrading group. The clinical data such as gender, age, body mass index (BMI), pre-resection carcinoembryonic antigen levels, drinking history, smoking history, family history of colorectal cancer, and whether complicated with underlying diseases as well as endoscopic surface morphological features such as lesion size, morphological features, and lesion location were compared between the two groups. Chi-square test was used for statistical analysis, and multivariate logistic regression analysis was used to identify the risk factors for pathological diagnosis upgrading after resection. Based on the independent risk factors, the prediction models were established and validated by nomogram. The receiver operating characteristic curve (ROC) of repeated samples within the modeling group and external validation growp was plotted, and the area under the curve (AUC) was used to evaluate the predictive value of the model.Results:The proportion of patients with family history of colorectal cancer in the pathological upgrading group was higher than that of the pathological non-difference group (38.7%, 12/31 vs. 22.2%, 50/225), and the difference was statistically significant ( χ2=4.04, P=0.045). There were statistically significant differences in lesion size (63.9% (23/36) and 44.4% (116/261) lesions with long diameter ≥2 cm, respectively), surface morphological characteristics (flat elevated type accounted for 8.3% (3/36) and 22.6% (59/261), granular uniform type accounted for 11.1% (4/36) and 28.0% (73/261), nodular mixed type accounted for 44.4% (6/36) and 24.9% (65/261), pseudo-depressed type accounted for 36.1% (13/36) and 24.5% (64/261)), and lesion location (distal colon accounted for 22.2% (8/36) and 33.3% (87/261), proximal colon accounted for 16.7% (6/36) and 28.7% (75/261), and rectum accounted for 61.1% (22/36) and 37.9% (99/261)) between the pathological upgrading group and the pathological non-difference group ( χ2=4.80, 12.62 and 7.08, all P<0.05). The results of multivariate logistic regression analysis showed that family history of colorectal cancer ( OR=2.211, 95% confidence interval (95% CI) 1.005 to 4.861, P=0.049), lesion length ≥ 2 cm ( OR=2.212, 95% CI 1.074 to 4.555, P=0.031), nodular mixed subtype ( OR=4.841, 95% CI 1.343 to 17.455, P=0.016), pseudo-depressed subtype ( OR=3.995, 95% CI 1.084 to 14.721, P=0.037), and lesion in rectum ( OR=2.417, 95% CI 1.024 to 5.705, P=0.044) were independent risk factors for pathological diagnosis upgrading after LST resection. A nomogram was established based on these four risk factors, with a ROC AUC of 0.833 (95% CI 0.752 to 0.913). The external validation results demonstrated that the ROC AUC was 0.848 (95% CI 0.736 to 0.960), the sensitivity was 0.737, the specificity was 0.972, the maximum Youden index was 0.712, and the overall accuracy was 0.868. Conclusions:Family history of colorectal cancer, lesion length ≥ 2 cm, lesion in rectum, and nodular mixed or pseudo-depressed subtypes may affect the accuracy of pathological diagnosis of LST lesions by EFB, and leading to pathological diagnosis upgrading after resection. The prediction model based on these four factors has good predictive efficacy in pathological diagnosis upgrading after LST resection.

Objective:To investigate the efficacy and safety of endoscopic argon ion coagulation combined with mesalazine enteric fluid in the treatment of chronic radiation proctitis with hemorrhage.Methods:A retrospective case control study was conducted. The clinical data of 82 patients with chronic radiation proctitis with hemorrhage admitted to Shanxi Province Cancer Hospital from January 2019 to January 2022 were retrospectively analyzed. According to the treatment methods, all patients were divided into the observation group (endoscopic argon ion coagulation combined with mesalazine enteric fluid retention enema, 44 cases) and the control group (0.9% NaCl solution 20 ml + thrombin 1 000 U combined with mesalazine enteric fluid retention enema, 38 cases). The clinical efficacy, proctoscopy scores, laboratory indexes [C-reactive protein (CRP), hemoglobin (Hb)] and the adverse reactions of the two groups 1 month after treatment were compared.Results:There were no statistically significant differences in gender, age, body mass index and disease classification between the two groups (all P > 0.05). After 1 month of treatment, the total effective rate of the observation group was higher than that of the control group [93.18% (41/44) vs.76.32% (29/38)], and the difference was statistically significant ( χ2 = 4.64, P = 0.031). The degree of intestinal injury, anal pain and naked blood stool in the observation group were lower than those in the control group (all P < 0.05). The level of CRP 1 month after treatment was lower than that before treatment in both groups, and the level of Hb 1 month after treatment was higher than that before treatment in both groups (all P < 0.001); and there were no statistically significant differences in the levels of CRP ahd Hb before treatment and 1 month after treatment between the both groups (all P > 0.05). There was no statistically significant difference in the adverse reactions between the two groups ( P > 0.05). Conclusions:Endoscopic argon ion coagulation combined with mesalazine enteric fluid in the treatment of chronic radiation proctitis with hemorrhage has a favorable effect and a good safety, which can improve the symptoms of hematochezia, diarrhea, anemia and improve the quality of life of patients.