Objective:To investigate the safety and risk factors of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic lesions.Methods:Five thousand one hundred and sixty patients who underwent EUS-FNA in the Department of Endoscopy, Fudan University Shanghai Cancer Center from January 2012 to December 2022 were retrospectively reviewed. The incidence of adverse events was calculated, and independent risk factors were analyzed by univariate and logistic regression.Results:The incidences of postoperative pancreatitis, intraoperative bleeding and postoperative bleeding were 1.38% (68/4 930), 0.82% (42/5 143) and 0.78% (40/5 143) respectively. No perforation or death occurred. Age >60 years ( OR=0.581, 95% CI: 0.356-0.946, P=0.029), tumor located in the neck, body and tail ( OR=0.355, 95% CI: 0.194-0.652, P=0.001), lesion diameter of >20-40 mm ( OR=0.450, 95% CI: 0.227-0.893, P=0.023), and lesion diameter >40 mm ( OR=0.382, 95% CI: 0.168-0.869, P=0.022) were independent protective factors for postoperative pancreatitis. Transduodenal puncture ( OR=2.435, 95% CI: 1.319-4.496, P=0.005) was an independent risk factor for postoperative pancreatitis. Puncture for 3-4 pass ( OR=0.439,95% CI: 0.235-0.821, P=0.010), lesion diameter of >20-40 mm ( OR=0.154, 95% CI: 0.069-0.341, P<0.001), and lesion diameter >40 mm ( OR=0.326, 95% CI: 0.143-0.743, P=0.008) were independent protective factors for intraoperative bleeding. Fine-needle biopsy (FNB) needle ( OR=2.314, 95% CI: 1.189-4.502, P=0.014) was an independent risk factor for postoperative bleeding. Conclusion:EUS-FNA is a safe procedure with low incidence of adverse events. The occurrence of postoperative pancreatitis and intraoperative bleeding is mainly related to clinical characteristics of the lesion, while postoperative bleeding is related to the type of puncture needle.

Objective:To evaluate the safety and efficacy of endoscopic super-hemorrhoidal banding (SHB) in the treatment of internal hemorrhoids with prolapse.Methods:From June 2019 to June 2020, a total of 112 patients with grade Ⅱ and Ⅲ internal hemorrhoids underwent endoscopic SHB at People′s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture. The efficacy of SHB, intraoperative and postoperative complications associated with the operation and patients′ satisfaction were prospectively studied. The follow-up time was over six months.Results:A total of 112 patients received SHB for internal hemorrhoids, 74 patients (66.1%) with grade Ⅱ hemorrhoids and 38 patients (33.9%) with grade Ⅲ hemorrhoids. The operations were successfully performed in all patients. No anal pain or bleeding was reported during the operation. All patients experienced various degrees of anal bulge after the operation, which lasted for 2-24 hours before spontaneous disappearance. Five patients with grade Ⅲ internal hemorrhoids showed dysuria, which was relieved with local heat on the bladder. One patient with grade Ⅲ internal hemorrhoid had bloody stool on day 14. The bleeding was stopped with another banding at the site of bleeding ulcer. All patients completed the follow-up. No complications such as bleeding, pain, infection or stenosis occurred in one month after operation. Eighteen patients with grade Ⅲ had partial prolapse after operation without bleeding or other symptoms. Six of them received additional SHB treatment and prolapse disappeared. No postoperative complications occurred in the six months of follow-up in all patients. The satisfaction rate was 100.0% according to the survey.Conclusion:Endoscopic SHB is an effective, safe and simple technique for internal hemorrhoids with prolapse.

Objective: To develop a reliable model of pancreatic carcinogenesis and liver metastasis in mice and preliminarily analyze metastasis-related molecules. Methods: Liver metastasis models of pancreatic cancer were made by injecting murine Panc-2 cells in the spleens of 12 C57/BL6 mice. Six mice in the control group were injected with phosphate buffered saline. Liver metastases were de-tected pathologically in the experimental group. Quantitative real-time PCR was used to analyze the variation in the expression levels of metastasis-related molecules in the tumor tissue located in the spleen, metastatic tumor tissues in the liver, and liver tissue adja-cent to metastatic carcinoma. Results: In the experimental group, the incidence rate of liver metastasis was 83.33%. An anatomical study showed that there was a single giant tumor nodule at every injection site in the spleen, while multiple nodular metastases ap-peared in the livers of 10 mice, with the liver tumorigenesis rate 83.33%. The pathological results indicated that the tumor cell pattern of liver metastasis was in accordance with pancreatic adenocarcinoma. CCL-17, CCL-22, CD44, and other molecules had higher impres-sion levels in the metastatic tumor tissues in the liver and the tumor tissue of spleen than in the liver tissue adjacent to metastatic car-cinoma. Expression levels of Ang-2, BAK, BAx, and other molecules were higher in the liver tissue adjacent to metastatic carcinoma, and the relative expression level of gene was more than 1 (P<0.05). Conclusions: Intrasplenic injection of pancreatic cancer cells suc-cessfully developed a model of liver metastasis that partly mimicked the natural metastatic process, which showed variations in the ex-pression levels of metastasis-related molecules similar to that in the human body. This is a reliable method to produce pancreatic can-cer liver metastasis in mice and may be valuable in experimental studies for screening anti-tumor durgs.

Objective To explore the clinical effect of percutaneous vertebroplasty (PVP) in the treatment of old unstable osteoporotic vertebral fracture.Methods Twenty cases of old unstable osteoporotic single vertebral body fracture were divided into the stable group and unstable group according to the imaging results,10 cases in each group.PVP was performed in all 20 cases.The VAS scores of waist bending activity at preoperative 30 min,postoperative 6 h,3,30 d were observed.The changes of anterior edge height of spinal body in the injured vertebral segment of erect position and horizontal position were compared before and after operation.Results The VAS score of waist bending at preoperative 30 min had statistical difference between the two groups (P＜0.05).Compared with at preoperative 30 min,the VAS scores at postoperative observation points in the two groups were significantly decreased with statistical difference (P＜0.05).The VAS scores at postoperative 6 h,3,30 d had no statistical difference between the two groups(P＞0.05).The changes of posterior edge height of spinal body in the stable groups had no statistical difference before and after operation (P＞0.05);the anterior edge height of spinal body after treatment in the unstable group were significantly changed compared with before operation,and the difference was statistically significant(P＜0.05).Conclusion Preoperative pain in the patients with unstable osteoporotic vertebral fracture is more obvious than that in the patients with stable osteoporotic vertebral fracture.But all have similar effect after PVP therapy;the postoperative height in unstable osteoporotic vertebral fracture can obtain a certain recovery after PVP.

Objective Research on traumatic the related factors of sleep disorder after traumatic brain injury ,in order to pro-vided the rationale for the diagnosis and treatment .Methods The SPIEGEL was used to evaluate the traumatic brain injury patients who were hospitalized .Recording time in sleep disorders in 3 months .Analysis the relations between the sleep disorders and brain injury site by combining with the patients head CT and MRI .Results Seen in 200 cases of patients with sleep disorders of 105 cases (52 .5% );71 cases appeared in patients within 1 week after waking ,accounted for 76 .19% ;The brain stem ,frontal lobe and basal ganglia injury occurred sleep disorders were more likely(66 .7% ,64 .0% ,70% ) .The difference was statistically significant(P<0 .05) .Conclusion Sleep disorder is a common clinical symptom of mild traumatic brain injury .a time to focus on the patients with-in 1 week after waking ,and closely related to brain stem ,frontal lobe and basal ganglia injury .

Objective To explore the abnormal changeof the polysomnography(PSG) in the patientwith traumatifrontal lobe injury .MethodTotally 16 patientwith traumatifrontal lobe injury accompanying sleep disorde(brain traumgroup) and 20 individualof physical examination (control group) were performed the whole nighPSG .ResultCompared with the control group ,the incubative stage of sleep in the brain traumgroup waprolonged ,while the sleep time and slow wave sleep time were shortened .The rapid eye movemen(REM) time and the periodicity of REM had statistical differencebetween the two group,buthe REM incubative stage ,density and intensity of REM had no statistical differencebetween the two goup.Conclusion The changeof PSG in the patientwith traumatifrontal lobe injury are dominated by the extension of the REM time and the shorten-ing of REM periodicity .

Objective To observe the clinical curative effect of drug combined with psychological treatment on patients with sleep disorders after stroke.Methods A total of 180 cases of eligible patients with sleep disorders were included and randomly di-vided into control group and treatment group.Control group were treated with conventional vascular drug(estazolam,2 mg,before sleep);treatment group increased anxiolytic and sedative hypnotic drugs(venlafaxine,dexzopiclone)compared to control group.Af-ter 14 days,sleep quality,NIHSS were compared both within the treatment group and between the two groups.Results The Bar-thel index,NIHSS and PSQI of two groups had significant differences,and those index of treatment group before and after treat-ment had significant differences too(P <0.05).Conclusion Combined conventional cerebrovascular drugs with Venlafaxine,dexzo-piclone as well as psychological treatment significantly improved sleep quality of patients with acute stroke.

Objective To discusses the clinical application value and safety of endoscopic minimally invasive cholecystolithotomy in gallstones treatment .Methods To retrospectively analyzes the clinical data of 94 patients with gallbladder stone from Feb .2010 to Feb .2013 ,and divided into endoscopic minimally invasive cholecystolithotomy (EMIC) group (46 cases) and laparoscopic chole-cystectomy (LC) group (48 cases) .Observed two groups of operation time ,intraoperative blood loss ,intraoperative bile duct inju-ry ,anal exhaust time ,postoperative hospitalization time ,bile reflux gastritis ,abdominal distention ,diarrhea ,common bile duct calculi and hospitalization expenses ,etc .Results Two groups of operation time ,hospitalization expenses ,length of hospital stay ,and intra-operative blood loss have no obvious difference(P>0 .05) ,in EMIC set ,the exhaust time ,postoperative bile duct calculi incidence , intraoperative bile duct injury ,bile reflux gastritis incidence and the incidence of abdominal distension ,diarrhea are significantly less than LC group (P<0 .05) .Conclusion The endoscopic minimally invasive cholecystolithotomy compared with laparoscopic chole-cystectomy had high security ,light pain ,quicker recovery ,less complications advantages .It has already achieved the purpose of min-imally invasive treatment ,while maintaining the integrity of bile duct and gallbladder function ,thus it is worthy of promoting .

Objective To discusses the feasibility of selective mini-cholecystolithotomy in treatment of gallstones .Methods To retrospectively analyzes the clinical data of the function good gallstones patients who treatmented by mini-cholecystolithotomy .Re-sults 4 cases treatmented by Laparoscopic cholecystectomy because of the severe cholecystitis ,1 case treatmented by laparoscopic cholecystectomy because of the severe adhesion around the gallbladder .51 cases treatmented by mini-cholecystolithotomy .In the fol-low-up of 1-3 years ,1 case of recurrence ,and the recurrence rate was 1 .96% .Conclusion The mini-cholecystolithotomy is a safe , effective ,feasible ,minimally invasive treatment method in treatmented gallstones ,but should be strictly grasp the surgical indica-tions .

Objective To observe the effect of establishing channels of percutaneous nephrolithotomy on pig′s kidney by B ultra-sound .Methods 32 female Rongchang pigs were divided into four groups :control group ,group F16 ,group F24 ,group F30 ,and 8 pigs in each group .Comparing the time difference of establishing channels in percutaneous nephrolithotomy ,surgery blood loss ,the pressure of pelvis and variance of histology .Results The time of group F16 ,group F24 and group F30 were(95 .00 ± 8 .06)min , (99 .60 ± 5 .55)min and (103 .17 ± 7 .99)min ,there was no significant difference(P>0 .05) .The surgery blood loss of group F16 , group F24 and group F30 were(22 .40 ± 4 .56)mL ,(25 .00 ± 5 .24)mL and (20 .50 ± 7 .87)mL ,there was no significant difference (P>0 .05) .The pressure of pelvis in control group ,group F16 ,group F24 and group F30 were (8 .84 ± 0 .57)cm H2 O ,(23 .54 ± 0 .89)cm H2 O ,(16 .86 ± 1 .06)cm H2 O ,(13 .30 ± 0 .76)cm H2 O ,the difference was statistically significant (P<0 .05) .Four groups had no obvious inflammation cell seeping and hyperplasia of fibrous tissue by HE dyeing .Conclusion The time of establishing channels in percutaneous nephrolithotomy ,surgery blood loss and variance of histology has no obvious relation with the size of the channel .But the pressure of pelvis was affected with different channels and might be related to induce damage of kidney .