Biliary surgery has a long history,with biliary strictures being a common clinical issue in this field.These strictures primarily include benign strictures,malignant strictures,and biliary strictures of unknown etiology.The nature of the biliary stricture directly determines the treatment approach.For strictures that are difficult to characterize with CT and MRCP/MRI,endoscopic ultrasound,and related technologies are important tools for the diagnosis and treatment.The rise of technologies such as confocal laser endomicroscopy,optical coherence tomography,and next-generation sequencing has expanded the diagnostic and therapeutic options for biliary strictures.Furthermore,endoscopic surgeons or treatment teams who are proficient in both endoscopic techniques and surgical procedures have unique strengths when dealing with complex anatomical structures or resectable biliary tumors.Although significant advancements have been made in biliary surgery in recent years,particularly in endoscopic technology,surgical techniques,and diagnostic methods,several challenges still remain to be addressed.Here,the authors provide a review of the current status,advancements,and challenges in the endoscopic surgical treatment of biliary strictures,with the aim of offering insights for clinical practice.

Biliary surgery has a long history,with biliary strictures being a common clinical issue in this field.These strictures primarily include benign strictures,malignant strictures,and biliary strictures of unknown etiology.The nature of the biliary stricture directly determines the treatment approach.For strictures that are difficult to characterize with CT and MRCP/MRI,endoscopic ultrasound,and related technologies are important tools for the diagnosis and treatment.The rise of technologies such as confocal laser endomicroscopy,optical coherence tomography,and next-generation sequencing has expanded the diagnostic and therapeutic options for biliary strictures.Furthermore,endoscopic surgeons or treatment teams who are proficient in both endoscopic techniques and surgical procedures have unique strengths when dealing with complex anatomical structures or resectable biliary tumors.Although significant advancements have been made in biliary surgery in recent years,particularly in endoscopic technology,surgical techniques,and diagnostic methods,several challenges still remain to be addressed.Here,the authors provide a review of the current status,advancements,and challenges in the endoscopic surgical treatment of biliary strictures,with the aim of offering insights for clinical practice.

Objective:To explore the value of stress hyperglycemia ratio (SHR) in predicting the prognosis of patients with acute heart failure (AHF).Methods:AHF patients admitted to the Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from December 2016 to January 2019 were retrospectively included. Clinical data were recorded and SHR was calculated. According to the survival of the patients within 1 year, they were divided into the death group ( n=89) and the survival group ( n=218). Logistic regression analysis was used to analyze the risk factors of mortality. Kaplan-Meier analysis was used to evaluate the correlation between SHR and the prognosis of AHF patients. Results:A total of 307 patients aged 83 ( range 74-87) years old who met the inclusion criteria were included in this study, including 153 males and 104 females. The age, SHR and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the death group were higher than those in the survival group [84 (78, 88) vs 82 (72, 86), 1.11 (0.91, 1.51) vs 1.02 (0.86, 1.27), 5 351 (2 098, 14 039)μg/L vs 4 243 (2 294, 7 565)μg/L ]. The left ventricular ejection fraction (LVEF) in the death group was significantly lower than that of the survival group [53 (45, 57) % vs 58 (44, 64) %, P< 0.05]. Logistic regression analysis showed that SHR was an independent risk factor for death in AHF patients ( OR=2.397, 95% CI: 1.285-4.471, P< 0.05). Median SHR was used to draw the survival curve. Patients with high SHR had a lower cumulative survival rate, and the difference was statistically significant ( P<0.05). Conclusion:SHR can identify critically ill patients and is an independent risk factor for death in AHF patients.