Objective:To investigate the main causes of failed endoscopic retrograde cholangiopancreatography (ERCP) in children and the remedial treatment strategies.Methods:This retrospective cohort study analyzed the clinical data of 21 children who experienced failed ERCP at Beijing Children′s Hospital, Capital Medical University between January 2021 and December 2024. Data was collected included demographic information, clinical diagnoses, and ERCP outcomes. The annually trend in the ERCP failure rate was analyzed. Patients were categorized by etiology into the following groups: chronic pancreatitis, post-surgical status, pancreatic trauma, pancreas divisum, non-neoplastic pancreatic lesions, and ulcerative colitis. The relationship between etiologies and ERCP failure was analyzed by Fisher exact test.Results:A total of 175 ERCP procedures were included, of which 21 procedures failed (12.0%). The failure rate decreased annually from 2021 to 2024: 18.2% (4/22), 13.2% (5/38), 11.4% (5/44), and 9.9% (7/71), respectively. The etiological distribution among the 21 failed cases was as follows: chronic pancreatitis 28.6% (6/21), pancreatic duct stenosis following pancreatic trauma 23.8% (5/21), post-surgical status 14.3% (3/21), pancreas divisum 9.5% (2/21), acute pancreatitis 9.5% (2/21), non-neoplastic pancreatic lesions 9.5% (2/21), and pancreatic duct stenosis associated with ulcerative colitis 4.8% (1/21). Remedial treatments included surgical intervention (2 cases), ultrasound-guided percutaneous drainage (3 cases), and repeat ERCP (2 cases). For post-surgical and pancreatic trauma patients, failure was primarily due to bile duct stenosis, pancreatic duct stenosis, or pancreaticobiliary duct disruption. Active surgical interventions such as cholangiojejunostomy and pancreaticojejunostomy, and ultrasound-guided drainage following ERCP failure led to significant clinical improvement.Conclusions:A stratified management approach guided by etiology is essential following failed ERCP in children. Early and active remedial treatment, particularly surgical interventions, is recommended for post-surgical and pancreatic trauma cases.

Objective:To investigate the main causes of failed endoscopic retrograde cholangiopancreatography (ERCP) in children and the remedial treatment strategies.Methods:This retrospective cohort study analyzed the clinical data of 21 children who experienced failed ERCP at Beijing Children′s Hospital, Capital Medical University between January 2021 and December 2024. Data was collected included demographic information, clinical diagnoses, and ERCP outcomes. The annually trend in the ERCP failure rate was analyzed. Patients were categorized by etiology into the following groups: chronic pancreatitis, post-surgical status, pancreatic trauma, pancreas divisum, non-neoplastic pancreatic lesions, and ulcerative colitis. The relationship between etiologies and ERCP failure was analyzed by Fisher exact test.Results:A total of 175 ERCP procedures were included, of which 21 procedures failed (12.0%). The failure rate decreased annually from 2021 to 2024: 18.2% (4/22), 13.2% (5/38), 11.4% (5/44), and 9.9% (7/71), respectively. The etiological distribution among the 21 failed cases was as follows: chronic pancreatitis 28.6% (6/21), pancreatic duct stenosis following pancreatic trauma 23.8% (5/21), post-surgical status 14.3% (3/21), pancreas divisum 9.5% (2/21), acute pancreatitis 9.5% (2/21), non-neoplastic pancreatic lesions 9.5% (2/21), and pancreatic duct stenosis associated with ulcerative colitis 4.8% (1/21). Remedial treatments included surgical intervention (2 cases), ultrasound-guided percutaneous drainage (3 cases), and repeat ERCP (2 cases). For post-surgical and pancreatic trauma patients, failure was primarily due to bile duct stenosis, pancreatic duct stenosis, or pancreaticobiliary duct disruption. Active surgical interventions such as cholangiojejunostomy and pancreaticojejunostomy, and ultrasound-guided drainage following ERCP failure led to significant clinical improvement.Conclusions:A stratified management approach guided by etiology is essential following failed ERCP in children. Early and active remedial treatment, particularly surgical interventions, is recommended for post-surgical and pancreatic trauma cases.

Objective:To investigate the therapeutic effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) and stent implantation in the treatment of pancreaticobiliary injuries in children.Methods:A retrospective analysis was conducted on the clinical data of children diagnosed with pancreaticobiliary injury and undergoing ERCP and stent implantation at Beijing Children′s Hospital, Capital Medical University from January 2021 to December 2022. Demographic information, clinical data, endoscopic treatment methods, postoperative complications and clinical prognosis of the children were collected. The etiology, location of pancreaticobiliary injury, occurrence of complications after endoscopic treatment, and the time for improvement and recovery after endoscopic treatment were analyzed. The patients were divided into five groups according to the etiologies of pancreaticobiliary duct injuries: post-surgical, pancreatic trauma, acute pancreatitis, chronic pancreatitis, and systemic lupus erythematosus groups. They were also classified into four groups according to the sites of pancreaticobiliary duct injuries: common bile duct, pancreatic head, pancreatic body, and pancreatic tail groups. Multi-factor analysis of variance was used for comparing the time of improvement and recovery among different groups.Results:Among 22 patients, there were 8 males and 14 females, and the age was 7.5 (3.3,10.8) years. There were 19 cases of pancreatic or bile duct fistula, and 3 cases of pancreatic or bile duct stenosis. A total of 33 endoscopic procedures were performed on the 22 patients, out of which, 3 duct stenosis were failed to insert the stent because the catheter failed to pass through the stenosis site. The success rate was 91% (30/33). The pancreatic duct or bile duct stent was inserted, with the stent located at pancreatic or bile duct fistula. Postoperative complications included pancreatitis in 3 cases (9%, 3/33), hyperamylasemia in 5 cases (15%, 5/33), and postoperative infection in 4 cases (12%, 4/33). All patients were followed up for more than 1 year. Significant improvement was observed in external drainage and imaging monitoring among patients with successfully placed stents. There was no significant difference in the improvement time of ERCP in the treatment of pancreaticobile duct injury caused by different etiology ( F=0.65, P=0.637). However, there were significant differences in healing time ( F=6.46, P=0.004), among which the healing time of injuries caused by systemic lupus erythematosus was significantly different from that after surgery, trauma, acute pancreatitis and chronic pancreatitis (all P<0.05). There was no significant difference in the improvement and healing time among different injury sites (all P>0.05). Conclusions:ERCP and stent implantation can safely and effectively improve the clinical symptoms of children with pancreaticobiliary injury. Early intervention can improve long-term prognosis.

Objective To explore the feasibility,effectiveness,and safety of balloon catheter-assisted total hepatic vascular exclusion.Methods We designed and manufactured an endovascular catheter with three lumens and double balloons,which can be inserted into the retrahepatic inferior vena cava through the femoral vein.The superior and inferior vena cava of the liver can be blocked by filling balloon,and the total hepatic vascular exclusion was achieved by combining with pringle method.In animal experiments,total hepatic vascular exclusion was performed by balloon catheter-assist method(experimental group)or traditional methods(control group),and the complete time was compared between the two groups.Blood flow blocking effect was observed by angiography and incision of retrahepatic inferior vena cava under direct vision.The complications were recorded.Results Total hepatic vascular exclusion was successfully completed in both groups.The completion time in the experimental group was significantly shorter than that in the control group([12.5±1.2]min vs.[35.8±4.9]min,P<0.05).CT angiography,DSA,and direct vision of blood vessels all confirmed the effectiveness of balloon catheter-assisted hepatic blood flow exclusion.No catheter displacement,balloon rupture,or air embolism occurred.Conclusion The balloon catheter-assisted hepatic total vascular exclusion is simpler and more feasible than traditional method.

Objective:To investigate the effect of preoperative systemic inflammatory response index (SIRI) on prognosis in patients with resectable colorectal cancer.Methods:The clinical data of 355 colorectal cancer patients underwent radical resection from January 2018 to December 2022 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. The basic information, pathological data and laboratory test results were recorded, and SIRI was calculated. The patients followed up to December 2023 or death, and the overall survival (OS) and disease-free survival (DFS) were recorded. The receiver operating characteristic (ROC) curve was drawn, the optimal critical value of SIRI in patients with colorectal cancer was determined according to the maximum Yoden index, and the patients were grouped based on this. Multivariate Cox regression analysis was used to analyze the independent risk factors of prognosis in patients with colorectal cancer. Kaplan-Meier survival curve was drawn, and the log-rank test was used for comparison.Results:ROC curve analysis result showed that the optimal critical value of SIRI was 0.99, and the area under the curve was 0.556. Among the 355 patients with colorectal cancer, SIRI<0.99 was in 229 cases (low SIRI group), and SIRI≥0.99 was in 126 cases (high SIRI group). There were no statistical difference in gender composition, age, body mass index (BMI), preoperative carcinoembryonic antigen, preoperative cancer antigen 19-9 (CA19-9), tumor location, T stage, N stage, tumor stage, degree of differentiation, tumor long diameter, lymphatic invasion, vascular invasion, operating time and intraoperative blood loss between two groups ( P>0.05). The incidence of anastomotic leakage in high SIRI group was significantly higher than that in low SIRI group: 20.6% (26/126) vs. 12.2% (28/229), and there was statistical difference ( P<0.05). The median follow-up time of 355 patients was 21.7 months. The mortality and recurrence rate in high SIRI group were significantly higher than those in low SIRI group: 28.6% (36/126) vs. 19.2% (44/229) and 13.5% (17/126) vs. 6.1% (14/229), and there were statistical differences ( P<0.05). Kaplan-Meier survival curve analysis result showed that the median OS and DFS in high SIRI group were significantly lower than those in low SIRI group (17.3 months vs. 23.3 months and 15.1 months vs. 21.9 months), and there were statistical differences ( P<0.05). Multivariate Cox regression analysis result showed that the tumor stage Ⅲ to Ⅳ, preoperative CEA>5 μg/L and SIRI>0.99 were independent risk factors of OS and DFS in patients with colorectal cancer (OS: HR = 2.447, 1.951 and 1.923; 95% CI 1.461 to 4.099, 1.266 to 3.456 and 1.003 to 2.655; P<0.05. DFS: HR = 2.982, 1.782 and 1.529; 95% CI 1.663 to 4.754, 1.147 to 2.651 and 1.198 to 2.021; P<0.05). Conclusions:The preoperative SIRI is an independent risk factor of prognosis in patients with colorectal cancer. The patients with low SIRI have longer postoperative OS and DFS. The preoperative SIRI has guiding value in the prognosis assessment and treatment selection in patients with colorectal cancer.

Objective:To investigate the effect of preoperative systemic inflammatory response index (SIRI) on prognosis in patients with resectable colorectal cancer.Methods:The clinical data of 355 colorectal cancer patients underwent radical resection from January 2018 to December 2022 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. The basic information, pathological data and laboratory test results were recorded, and SIRI was calculated. The patients followed up to December 2023 or death, and the overall survival (OS) and disease-free survival (DFS) were recorded. The receiver operating characteristic (ROC) curve was drawn, the optimal critical value of SIRI in patients with colorectal cancer was determined according to the maximum Yoden index, and the patients were grouped based on this. Multivariate Cox regression analysis was used to analyze the independent risk factors of prognosis in patients with colorectal cancer. Kaplan-Meier survival curve was drawn, and the log-rank test was used for comparison.Results:ROC curve analysis result showed that the optimal critical value of SIRI was 0.99, and the area under the curve was 0.556. Among the 355 patients with colorectal cancer, SIRI<0.99 was in 229 cases (low SIRI group), and SIRI≥0.99 was in 126 cases (high SIRI group). There were no statistical difference in gender composition, age, body mass index (BMI), preoperative carcinoembryonic antigen, preoperative cancer antigen 19-9 (CA19-9), tumor location, T stage, N stage, tumor stage, degree of differentiation, tumor long diameter, lymphatic invasion, vascular invasion, operating time and intraoperative blood loss between two groups ( P>0.05). The incidence of anastomotic leakage in high SIRI group was significantly higher than that in low SIRI group: 20.6% (26/126) vs. 12.2% (28/229), and there was statistical difference ( P<0.05). The median follow-up time of 355 patients was 21.7 months. The mortality and recurrence rate in high SIRI group were significantly higher than those in low SIRI group: 28.6% (36/126) vs. 19.2% (44/229) and 13.5% (17/126) vs. 6.1% (14/229), and there were statistical differences ( P<0.05). Kaplan-Meier survival curve analysis result showed that the median OS and DFS in high SIRI group were significantly lower than those in low SIRI group (17.3 months vs. 23.3 months and 15.1 months vs. 21.9 months), and there were statistical differences ( P<0.05). Multivariate Cox regression analysis result showed that the tumor stage Ⅲ to Ⅳ, preoperative CEA>5 μg/L and SIRI>0.99 were independent risk factors of OS and DFS in patients with colorectal cancer (OS: HR = 2.447, 1.951 and 1.923; 95% CI 1.461 to 4.099, 1.266 to 3.456 and 1.003 to 2.655; P<0.05. DFS: HR = 2.982, 1.782 and 1.529; 95% CI 1.663 to 4.754, 1.147 to 2.651 and 1.198 to 2.021; P<0.05). Conclusions:The preoperative SIRI is an independent risk factor of prognosis in patients with colorectal cancer. The patients with low SIRI have longer postoperative OS and DFS. The preoperative SIRI has guiding value in the prognosis assessment and treatment selection in patients with colorectal cancer.

Abstract: As potential immunomodulators, platinum-based drugs could trigger immunogenic cell death (ICD). Hence, combination of platinum-based chemotherapy and immunotherapy could have better synergistic anticancer effect. Pt(II)-based drugs are the most common chemotherapeutic agents in cancer treatment yet with limited clinical application due to their toxic side-effects and drug resistance. Pt(IV) complexes have been widely investigated in the past decades due to their kinetic inertness and unique mechanisms . This article summarizes the progress in the pharmacological activities and mechanisms of Pt(IV) antitumor complexes via introducing different immunomodulators into chemotherapeutic agents in literature over recent years and highlights the potential targets and molecular signaling pathways so as to provide some reference for further development and potential clinical application of platinum-based chemo-immunotherapeutic agents.

Objective:To investigate the pathogenic mechanism and clinical characteristics of the novel splicing variant of ATP-binding cassette subfamily B member 4 (ABCB4) and provide a basis for subsequent genetic diagnosis.Methods:The clinical data of a 5-year-old child with cholestatic liver disease admitted to the Beijing Children′s Hospital of Capital Medical University was retrospectively analyzed. The pathogenic variations were detected by whole exome sequencing and verified by Sanger sequencing, and bioinformatics was used to predict the pathogenicity of the mutation sites. Possible pathogenic variations were verified in vitro by Minigene assay. The clinical outcome was followed after discharge from hospital.Results:The 5-year-old boy had developed cholestasis at the age of 11 months. His physical examination showed obvious enlargement of the liver and spleen. Cholestatic cirrhosis was diagnosed by liver function tests, abdominal ultrasonography, liver biopsy and pathology. The results of genetic analysis showed that the patient was a complex heterozygote of the ABCB4 gene, with a pathogenic mutation c.2860G>A and a novel mutation c.2065-8T>G, derived from the mother and father respectively. The conservative prediction of the c.2065-8T>G site showed that this region was highly conserved and may affect splicing. Minigene assay results confirmed that the c.2065-8T>G mutation resulted in a 7 bp retention of intron 16 in the mature mRNA. In the absence of nonsense-mediated mRNA decay, the amino acid frameshift forms a truncated protein, which is represented by p.Glu689ValfsTer19. The patient was diagnosed as progressive familial intrahepatic cholestasis type 3 (PFIC3) and treated with ursodeoxycholic acid (UDCA). His clinical symptoms improved during 18 months of follow-up.Conclusions:The c.2065-8T>G variant is confirmed to affect the splicing process and exhibits complex heterozygosity with c.2860G>A, which is identified as the cause of the disease. PFIC3 children with this variant showed cholestatic liver disease as the main manifestation with a slow progression and was sensitive to treatment with UDCA.

Objective:To investigate the effectiveness of radiomics model based on preoperative ultrasound in predicting disease-free survival (DFS) in patients with triple negative breast cancer (TNBC) from multicenter data.Methods:A total of 418 patients with TNBC between July 2012 and December 2016 were consecutively recruited for this study from three different institutions including the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital of Chinese Medicine and General Hospital of Eastern Theater Command. In the training cohort ( n=271) from institution 1(the First Affiliated Hospital of Nanjing Medical University), least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was employed to select recurrence-related radiomics features and build a signature derived from the grayscale US images. The relationship between the radiomics score (Rad-score) and DFS was evaluated. Univariate and multivariate cox regression were utilized to identify the significant radiomics features and clinical-pathologic variables, which were integrated into a radiomics nomogram. An independent external cohort ( n=147) from the other two institutions was validated for evaluating the calibration and discrimination of the predictive nomogram. Results:Higher Rad-score was an independent risk predictor of worse DFS in two cohorts (both P<0.05). The radiomics model, comprising axillary lymph node status, Ki-67 index and radiomics signature, showed better prognostic performance ( P<0.01) than those of the clinical-pathologic model or tumor node metastasis (TNM) staging system with the concordance index (C-index) of 0.75 (95% CI=0.72-0.78) and 0.73(95% CI=0.71-0.75) in the training and validation cohorts respectively. Furthermore, the calibration curves achieved satisfactory agreement and the decision curves further confirmed the clinical utility of the radiomics nomogram. Conclusions:The US-based radiomics signature is a powerful predictor for the assessment of DFS in patients with TNBC. Moreover, the proposed radiomics model integrating the optimal radiomics signature and clinical-pathologic data could improve personalized DFS estimation.

Objective To explore the clinical features,efficacy and prognosis of different treatments for children with achalasia of cardia(AC).Methods In this retrospective study,the clinical features,laboratory examination and treatment of 36 children with AC who had been admitted to Department of Gastroenterology,Beijing Children's Hospital,Capital Medical University from August 2006 to September 2015 were reviewed,and the efficacy and prognosis of different treatments were compared.The symptoms of the children were graded using the AC clinical symptom score(Eckardt score),and the Eckardt score ≤ 3 scores was defined as the effective treatment.SPSS 19.0 statistical software was used to analyze the data,and P<0.05 for the difference was statistically significant.Results Thirty-six children with AC included 24 boys and 12 girls.Ages ranged from 1.4 to 15.5 years old,with a mean age of(10.0±3.4)years old.Course of disease ranged from 1 month to 9 years,with a mean course of 0.5(0.2,3.0)years.In the 36 children,33 cases(91.7％)had vomiting,23 cases(63.9％)had dysphagia,16 cases(44.4％)had weight loss,and 9 cases(25.0％)had chest pain.The effective rates of treatment in surgical treatment group and drug treatment group were 100.0％(13/13 cases)and 71.4％(5/7 cases),respectively in 3 months,and there was no significant difference between the 2 groups(P=0.111).The effective rates of treatment were 100.0％(13/13 cases)and 50.0％(3/6 cases),respectively in 6 months,and the difference was statistically significant between the 2 groups(P=0.021).Within 12 months,there was no recurrence in surgical treatment group and the effective rate was 100.0％.Children in drug treatment group had 1 case who stopped taking medicine,while the other children received surgical treatment in other hospitals due to poor drug treatment.Conclusions Drug and surgical treatment of AC both have good short-term effect,however,the medium and long-term efficacy of surgical treatment is higher than that of drug treatment in children.Symptomatic relief is more stable,and symptom is not easy to relapse for the children with surgical treatment.