Biliary tract malignant cancers (BTC) are characterized by insidious onset and high malignancy, posing severe challenges to traditional diagnostic and treatment models, such as difficulties in early screening and insufficient treatment precision. In recent years, artificial intelligence (AI) technology has been deeply integrated into the entire chain of BTC diagnosis and treatment, becoming an essential driving force for technological innovation in this field. This article summarizes and reviews the latest application progress of AI technology in the screening, diagnosis, and treatment of BTC in recent years, aiming to promote the development of new diagnostic and treatment models driven by AI and provide a new perspective for improving the survival rate of patients.

Objective:To investigate the clinical value of three-dimensional arterial spin marker imaging(3D-ASL) for evaluating collateral circulation compensatory status in patients with cerebral infarction.Methods:A total of 24 patients with cerebral infarction who were treated at Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine from September 2017 to January 2019 were examined by 1.5-T high-field MR scanner.The changes of cerebral blood flow(CBF) between the infarcted area and the contralateral normal area were compared when the labeled delay time(PLD)=1.5s and PLD=2.5s, and the patients were divided into the group with strong collateral circulation compensation and the group with weak collateral circulation compensation according to the difference in lesion area measured by 3D-ASL(PLD=1.5s and 2.5s). The changes of national institutes of health stroke scale(NIHSS) score and Bathel index at admission and 15 days after admission were compared.Results:3D-ASL measurement of PLD=1.5s showed that the CBF value in the infarcted area was (33.70±20.83)mL/(100g×min), which was significantly lower than that in the contralateral normal area(PLD=1.5s)[(49.93±13.13)mL/(100g×min)]( t=3.229, P<0.05). When PLD=2.5s, ASL measurement results showed that the CBF value in the infarcted area increased significantly[(58.26±23.50)mL/(100g×min) vs.(33.70±20.83)mL/(100g×min)]( t=3.831, P<0.05), and the CBF value in the contralateral normal area also increased significantly[(68.29±14.03)mL/(100g×min) vs.(49.93±13.13)mL/(100g×min)]( t=4.681, P<0.05). At this time, the CBF value in the infarcted area was still significantly lower than that in the contralateral normal area[(58.26±23.50)mL/(100g×min) vs.(68.29±14.03)mL/(100g×min)]( t=1.795, P<0.05). On the day of admission, the BI index of patients in the weak collateral circulation compensation group(12 cases) was significantly higher than that in the strong collateral circulation compensation group(12 cases)[(90.42±10.50) vs.(67.92±27.57)]( t=2.642, P<0.05), and the NIHSS score was significantly lower than that in the strong collateral circulation compensation group[(1.25±1.01) vs.(3.83±3.62)]( t=2.378, P<0.05). After 15 d of admission, there were no significant differences in BI index and NIHSS score between the two groups(all P>0.05). Conclusion:3D-ASL with different delay time can effectively and intuitively reflect collateral circulation compensation of patients with cerebral infarction, and it has very important reference value for the evaluation of patients' disease and the formulation of clinical treatment plan.

Objective: To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy. Methods: The Cochrane Library, PubMed, EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula, mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, infection, reoperate rate, postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy. Meta-analysis was performed using the software RevMan 5.3. Results: Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included, the duct-to-mucosa group with 579 patients and the invagination group with 584 patients. The meta-analysis revealed that, compared the duct-to-mucosa group with the invagination group, the rate of postoperative pancreatic fistula was not significantly reduced (RR=1.13, 95%CI: 0.88-1.45, P=0.34), there was no significant difference between the two group. To systematically evaluate the total mortality (RR=0.80, 95%CI: 0.42-1.52, P=0.49), incidence of complications (RR=1.04, 95%CI: 0.88-1.24, P=0.63), delayed gastric emptying (RR=1.26, 95%CI: 0.90-1.76, P=0.18), postoperative haemorrhage (RR=0.86, 95%CI: 0.51-1.44, P=0.57), postoperative infection (RR=1.20, 95%CI: 0.86-1.69, P=0.29), reoperate rate (RR=1.05, 95%CI: 0.62-1.78, P=0.84), postoperative hospital stay (WMD=-1.36, 95%CI: -2.91-0.20, P=0.09) in duct-to-mucosa and invagination groups. There was no significant difference between the two group. Conclusions There was no significant difference of postoperative pancreatic fistul and mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, postoperative infection, reoperate rate, postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.

Objective: To investigate the current status and real performance of the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels in China through interlaboratory comparison. Methods: Peking University People’s Hospital (PKUPH) prepared the samples for comparison. That is, the fresh RUNX1-RUNX1T1 positive (+) bone morrow nucleated cells were serially diluted with RUNX1-RUNX1T1 negative (-) nucleated cells from different patients. Totally 23 sets with 14 different samples per set were prepared. TRIzol reagent was added in each tube and thoroughly mixed with cells for homogenization. Each laboratory simultaneously tested RUNX1-RUNX1T1 and WT1 transcript levels of one set of samples by real-time quantitative PCR method. All transcript levels were reported as the percentage of RUNX1-RUNX1T1 or WT1 transcript copies/ABL copies. Spearman correlation coefficient between the reported transcript levels of each participated laboratory and those of PKUPH was calculated. Results: ①RUNX1-RUNX1T1 comparison: 9 samples were (+) and 5 were (-) , the false negative and positive rates of the 20 participated laboratories were 0 (0/180) and 5% (5/100) , respectively. The reported transcript levels of all 9 positive samples were different among laboratories. The median reported transcript levels of 9 positive samples were from 0.060% to 176.7%, which covered 3.5-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.5 to 12.3 (one result which obviously deviated from other laboratories’ results was not included) , 85% (17/20) of the laboratories had correlation coefficient ≥0.98. ②WT1 comparison: The median reported transcript levels of all 14 samples were from 0.17% to 67.6%, which covered 2.6-log. The ratios of each sample’s highest to the lowest reported transcript levels were from 5.3-13.7, 62% (13/21) of the laboratories had correlation coefficient ≥0.98. ③ The relative relationship of the reported RUNX1-RUNX1T1 transcript levels between the participants and PKUPH was not always consistent with that of WT1 transcript levels. Both RUNX1-RUNX1T1 and WT1 transcript levels from 2 and 7 laboratories were individually lower than and higher than those of PKUPH, whereas for the rest 11 laboratories, one transcript level was higher than and the other was lower than that of PKUPH. Conclusion The reported RUNX1-RUNX1T1 and WT1 transcript levels were different among laboratories for the same sample. Most of the participated laboratories reported highly consistent result with that of PKUPH. The relationship between laboratories of the different transcript levels may not be the same.

Objective To observe the effect of enteral nutrition emulsion (fresubin diabetes) on inflammatory factors and prognosis in patients with diabetes and mechanical ventilation (MV). Methods Sixty-six patients with diabetes and MV admitted to Lishui Hospital of Traditional Chinese Medicine from June 2014 to December 2016 were enrolled, and they were divided into an observation group and a control group according to random number table, 33 cases in each group. Active treatment of the primary disease, maintenance of water and electrolyte balance, active control of infection, protamine biosynthesis of human insulin injection to control blood glucose and other treatment were given to both groups. After 24 hours of MV, enteral nutrition suspension (nutrison fibre) was evenly dripped into the control group through a nasogastric tube, and fresubin diabetes was evenly dripped with the same method as above into the observation group. After treatment for 2 weeks, the average values of daily blood glucose, of blood glucose fluctuation and daily total insulin dosage of two groups were calculated; the differences in procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and serum albumin (ALB), prealbumin (PA) and transferrin (TF) were compared before and after treatment in the two groups; the duration of MV, stay time in ICU, and 2-week MV withdrawal rate were observed in the two groups. Results During nutritional therapy, there was no significant difference in the average daily blood glucose level between observation group and control group (mmol/L: 8.62±2.65 vs. 9.70±3.43, P > 0.05), however, in the observation group, the average daily blood glucose fluctuation value (mmol/L: 3.13±1.09 vs. 5.68±1.40), and the daily total insulin dosage (U/d: 31.93±4.93 vs. 43.50±5.31) were significantly lower than those of the control group (both P < 0.05). After treatment, PCT and hs-CRP in both groups were significantly lower than those before treatment, and the degrees of decrease in observation group were more significant than those in the control group [PCT (μg/L):2.81±1.03 vs. 5.95±1.57, hs-CRP (mg/L): 4.41±2.01 vs. 11.46±4.05, all P < 0.05]. After treatment, the levels of ALB, PA and TF were significantly higher than those before treatment [ALB (g/L): the control group was 37.98±3.49 vs. 30.50±3.44, the observation group was 37.88±3.47 vs. 30.48±3.34; PA (mg/L): the control group was 188.60±12.66 vs. 130.22±11.33, the observation group was 184.42±12.95 and 133.50±11.91; TF (mg/L): the control group was 2.71±1.01 vs. 2.07±0.86, the observation group was 2.69±1.02 vs. 2.08±0.90, all P < 0.05]; however, there were no statistical significant differences between the two groups (all P > 0.05). The MV time (days: 7.29±3.65 vs. 10.70±4.43) and ICU stay (days: 11.13±3.09 vs. 15.48±4.40) in the observation group were significantly lower than those in the control group (both P < 0.05), and 2-week MV withdrawal rate was significantly higher than that of the control group [69.70% (23/33) vs. 39.39% (13/33), P < 0.05]. Conclusion Fresubin diabetes can meet the nutritional needs of diabetic patients with MV, in the aspects of controlling blood sugar, maintaining stable blood sugar levels and reducing inflammation, the therapeutic effect of fresubin diabetes is better than that of nutrison fibre, thus fresubin diabetes may better improve the prognosis of patients with diabetes.

Objective To systematically evaluate the postoperative pancreatic fistula rate,overall postoperative morbidity rate,overall postoperative mortality rate and length of stay in external stent group versus no stent group for pancreaticcoduodenectomy.Methods The Cochrane Library,PubMed,Embase and CBM data bases were searched to identify randomized controlled trials that compared the effectiveness of external stent versus no stent for pancreaticcoduodenectany.Meta-analysis was performed using the software RevMan 5.2.Results Four trials with 416 patients comparing external stent with no stent were included,the external stent group with 207 patients and the no stent group with 209 patients.The Meta-analysis revealed that,compared the external stent group with the no stent group,the rate of postoperative pancreatic fistula was significantly reduced in the external stent group [RR =0.57,95％ CI(0.41,0.80),P =0.001],especially for the patinets of pancreatic diameter ≤ 3.0 mm[RR =0.55,95 ％ CI(0.37,0.82),P =0.003] and soft pancreatic [RR =0.67,95 ％ CI(0.45,0.99),P =0.040],the overall postoperative morbidity rate of external stent group versus.no stent group was reduced[RR =0.79,95 ％ CI (0.64,0.98),P =0.030],and length of stay was shortened [WMD =-3.98,95％ CI(-6.42,-1.54),P =0.001].There was no difference between the two groups regarding the postoperative pancreatic fistula rate of diameter ＞ 3.0 mm [RR =0.37,95 ％ CI(0.08,1.83),P =0.220],and the overall postoperative mortality rate [RR =0.86,95 ％ CI(0.28,2.65),P =0.800].Conclusions Exental stent significantly reduced the postoperative pancreatic fistula rate and overall postoperative morbidity rate 、shortened the length of stay,and thus it can be identified as a preferable option for Pancreaticcoduodenectomy.

Objective To investigate the effectiveness of disodium Aidi injection for cancer-related fatigue in nasopharyngeal carcinoma patients of Ⅲ-Ⅳ B stage undergoing radiotherapy and chemotherapy.Methods Eighty nasopharyngeal carcinoma patients of Ⅲ-Ⅳ B stage with fatigue symptoms from December 2011 to May 2012 in our hospital were divided into two groups.All patients received treatment of sequential 3 cycles with platinum-based chemotherapy after concurrent chemoradiation.One group of 40 patients also received intravenous infusion of disodium Aidi injection (experimental group),the other group of 40 patients only received conventional therapy (control group).Brief fatigue inventory (BFI) questionnaires data were collected at baseline,the eighth week and the twentieth week after treatment.The changes of fatigue severity and the occurrence of Ⅲ-Ⅳ degree adverse reactions in the two groups were compared.Results At the eighth week,the improvement in fatigue severity was not significantly different between two groups (x2 =1.758,P =0.32).However,significant improvement in cancer-related fatigue of experimental group was found than that of control group at the twentieth week(x2 =8.12,P =0.005).The Ⅲ-Ⅳ degree adverse reactions of experimental group were significantly lower than that of control group.Conclusion Disodium Aidi injection combined with radiotherapy and chemotherapy can improve the cancer-related fatigue of nasopharyngeal carcinoma patients of Ⅲ-ⅣB stage and it can also reduce the incidence rate of Ⅲ-Ⅳ degree adverse reactions.

AIM: To investigate the effect of epinephrine on LPS-induced pro-inflammatory mediators (TNF-?, NO and COX-2) and anti-inflammatory mediators (HO-1 and IL-10) production in murine macrophage RAW264.7 cells, and to determine whether these effect is due to the influence of epinephrine on NF-?B activation. METHODS: RAW264.7 cells were cultured in vitro with 10 ?g/L LPS in the absence or presence of epinephrine at variant concentrations (1, 5, 10, 50 ?mol/L) for 24 hours, then the supernatants was collected for measuring TNF-? and IL-10 by ELISA and Griess reagent was used to measure NO (NO_2-/NO_3-) concentration. At the same time point, cells were harvested and COX-2, HO-1 and I?B-? was detected by Western blotting. RESULTS: 10 ?g/L LPS significantly induced the production of TNF-?, NO (NO_2-/NO_3-), COX-2, HO-1 and IL-10. When epinephrine was added into the medium together with LPS, the pro-inflammatory mediators production was decreased in a dose-dependent manner, however, anti-inflammatory mediators HO-1 and IL-10 expression was enhanced by epinephrine. Epinephrine has no significant effect on I?B-? degradation in LPS-activated RAW264.7 cells. CONCLUSION: Epinephrine down-regulates LPS-induced pro-inflammatory mediator expression while promotes anti-inflammatory mediator production in murine macrophages. These effect seems to be independent of NF-?B activation.