Objective:To evaluate the efficacy and safety of dyclonine hydrochloride gel for patients unsuitable for antispasmodic agents during endoscopic retrograde cholangiopancreatography(ERCP).Methods:A total of 72 patients diagnosed as having biliary diseases who intended to receive ERCP but were unsuitable for spasmolytic use were selected from June 2022 to June 2023 at the Digestive Hospital of Heilongjiang Provincial Hospital. Thus dyclonine hydrochloride gel was locally sprayed during the process of ERCP due to frequent intestinal peristalsis. The amplitude and frequency of duodenal peristalsis, clarity of endoscopic view, the time of biliary cannulation and vital signs were compared before and after the administration to evaluate efficacy and safety of dyclonine hydrochloride gel. At the same time, 9 patients with suspected sphincter of Oddi dysfunstion (SOD) underwent sphincter of Oddi manometry (SOM) before and after the administration.Results:Among the 72 patients, 57 (79.2%) showed improvements in duodenal peristalsis after the administration ( t=22.524, P<0.05). Twelve cases with significantly obstructed views due to bubbles showed complete improvement after the medication. The time for successful biliary cannulation after the administration was 2.9±4.2 minutes in 63 patients with first ERCP. Among the 9 SOD patients, 7 showed a decrease in basal pressure and (or) contraction frequency of the sphincter muscles after the administration ( χ2=5.143, P<0.05). No drug-related complication occurred during the operation in any of the patients. The incidences of post-ERCP pancreatitis and hyperamylasemia were 4.2% (3/72) and 8.3% (6/72), respectively. Conclusion:Local spray of dyclonine hydrochloride jelly can effectively suppress duodenal peristalsis, reduce basal pressure and contraction frequency of the sphincter, improve operational conditions, and increase the success rate of biliary cannulation with satisfactory safety in ERCP procedures for those who experience frequent intestinal peristalsis that may affect the procedure and are not suitable for the use of antispasmodics.

To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumor (RNET). Data of 71 patients (43 males and 28 females, aged 46.66±10.15 years) with histologically diagnosed RNET ≤15 mm in diameter who underwent ESD in Department One of Gastroenterology, Digestive Diseases Hospital, Heilongjiang Provincial Hospital from December 2012 to January 2021 were retrospectively analyzed. Epidemiological characteristics, endoscopic characteristics, the operation time, complications, pathology results, the consistency of endoscopic ultrasound (EUS) and pathology and prognosis were analyzed. Sixty-nine patients had single lesion and 2 patients had multiple lesions (two of each). Seventy lesions (70/73, 95.89%) were?located?in?the?middle-lower?rectal?segment, and 3 lesions (3/73, 4.11%) in the upper segment. The maximum diameter was 8.54±3.12 mm. The en bloc resection rate was 100%. No adverse event was observed. The R0 resection rate was 87.67% (64/73), with 8 had undetermined vertical resection margin and 1 had lymphovascular invasion. EUS showed no case involving the muscularis propria with pathologic coincidence rate of 100.0%. The follow-up period was 4.52±3.85 years (1-9 years). No local recurrence or distant metastasis was found. ESD is safe and effective in RNET ≤15 mm in diameter. For?tumors of G1 without metastasis in preoperative evaluation, close?follow-up?seems?to?be?a?feasible?option with lymphovascular invasion or undetermined margin after?ESD.

Objective:To explore the prophylactic effect of clipping after endoscopic mucosal resection(EMR) of sessile colorectal polyps of diameter below 10 mm on delayed post-polypectomy bleeding (DPPB).Methods:Patients with sessile colorectal polyps of below 10 mm undergoing EMR from January 2017 to December 2019 in Digestive Disease Hospital, Heilongjiang Provincial Hospital were randomly divided into the clipping group (group A) and the non-clipping group (group B) by random number table, and DPPB rates of both groups were compared.Results:A total of 1 838 patients were included, 912 patients in group A and 926 patients in group B. The incidences of DPPB were 1.00% (9/912) and 1.10% (10/926) respectively, with no significant difference ( χ2=0.039, P>0.05). The proportion of bleeding polyps were 0.44%(9/2 029)and 0.49%(10/2 025) respectively, with no significant difference ( χ2=0.055, P>0.05). Polyp of 6-9 mm ( OR=11.032, 95% CI: 2.545-47.821, P<0.05) was the independent risk factor for delayed bleeding in small sessile colorectal polyps after EMR. Conclusion:Prophylactic clipping for sessile colorectal polyps below 10 mm after EMR may not significantly reduce the risk of DPPB.

Objective:To analyze the risk factors of fatal outcome in patients with severe COVID-19.Methods:The clinical characteristics of 107 patients with severe COVID-19 admitted in Renmin Hospital of Wuhan University from February 12 to March 12, 2020 were retrospectively analyzed. During the hospitalization 49 patients died (fatal group) and 58 patients survived (survival group). The clinical characteristics, baseline laboratory findings were analyzed using R and Python statistical software. The risk factors of fatal outcome in patients with severe COVID-19 were analyzed with multivariate logistic regression.Results:Univariate analysis showed that the two groups had statistically significant differences in age, clinical classification, dry cough, dyspnea and laboratory test indicators ( P<0.05 or <0.01). The random forest model was used to rank the significance of the statistically significant variables in the univariate analysis, and the selected variables were included in the binary logistic regression model. After stepwise regression analysis, the patient’s clinical type, age, neutrophil count, and the proportion of CD3 cells are independent risk factors for death in severe COVID-19 patients. Dry cough is an independent protective factor for the death of severe COVID-19 patients. Conclusion:COVID-19 patients with fatal outcome are more likely to have suppressed immune function, secondary infection and inflammatory factor storm. These factors may work together in severe patients, leading to intractable hypoxemia and multiple organ dysfunction and resulting in fatal outcome of patients. The study indicates that timely intervention and treatment measures against above factors may be effective to save the lives of patients with severe COVID-19.

ObjectiveTo investigate the migration of bone marrow stem cells (BMSCs) to the liver and liver repair in mice with acute liver injury treated with BMSC transplantation through four approaches. MethodsMale BALB/c mice were divided into groups A, B, C, D, E, and F, with 10 mice in each group. Groups A, B, C, and D were treated by transplantation, group E was used as the donor of BMSCs, and group F was used as the model of acute liver injury. CCL4/2-AFF was used to establish the model of acute liver injury. Mouse BMSCs were isolated, labeled with the red fluorescent dye PKH26, and then transplanted into the mice with acute liver injury through the portal vein (group A), the tail vein (group B), the abdominal cavity (group C), and the spleen (group D). The mice were sacrificed 2 weeks later. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (Alb) were measured. The pathology of liver tissue was observed to evaluate the migration of BMSCs to the liver and the degree of liver repair. The mice in group F were sacrificed on day 8 to measure the levels of ALT, AST, and Alb. The t test was used for comparison of continuous data between two groups, and one-way analysis of variance was used for comparison of continuous data between multiple groups. ResultsIn groups A, B, C, and D, transplanted BMSCs migrated to the liver under a microscope, and newly formed hepatocytes were observed on pathological images. There were significant differences in the levels of ALT, AST, and Alb between groups A, B, C, and D and group F (ALT: t=2.372, 2.473, 2.354, and 2.383, all P＜0.05; AST: t=2.534, 2.423, 2.437, and 2.643, all P＜0.05; Alb: t=2.336, 2.243, 2.373, and 2.352, all P＜0.05). ConclusionBMSCs can promote repair of the liver in mice with acute liver injury, and the degree of liver repair is not related to the transplantation approach.

Objective To evaluate the feasibility and safety of guidewire guidance method in percutaneous transhepatic biliary drainage (PTBD). Methods A total of 174 consecutive patients with biliary diseases who underwent PTBD in Heilongjiang Provincial Hospital from January 2011 to December 2017 were enrolled in this retrospective study. There were 85 patients undergoing conventional PTBD ( the conventional group), and 89 wire-guided PTBD (the wire-guided group). In the wire-guided group, the contrast media was not injected immediately after puncture, on the contrary, the needle coat was inserted deeply along the bile duct thereafter, then the bile was extracted to reduce the pressure of bile duct, at last the contrast media was infused. The drainage success rate and incidence of cholangitis related with PTBD were compared between the two groups. Results The incidence of PTBD-related cholangitis of the wire-guided group was significantly lower compared with the conventional group [ 10. 1％ ( 9/89 ) VS 21. 2％( 18/85) ,χ2=5. 270, P=0. 022] , although the drainage success rate was not significantly different between the two groups [ 94. 4％ ( 84/89) VS 97. 6％ ( 83/85) ,χ2=1. 200, P=0. 273] . Conclusion Wire-guided PTBD may yield a similar success rate, but can reduce the incidence of cholangitis compared with conventional PTBD.

Objective To investigate the safety of cleaning and disinfection of duodenoscope used in endoscopic retrograde cholangiopancreatography (ERCP).Methods The duodenoscopes,which were used in Endoscopy Center of Digestive Disease Hospital,Heilongjiang Provincial Hospital from May 4 to May 31 2016,were cleaned manually and disinfected with sterilization powder.The samples from elevator and elevator channel were collected for bacterial culture to evaluate the safety of clinical application of duodenoscope.Results Among 60 high level disinfections,one was excluded because disinfectant concentration wasn't effective.Among 59 elevator samples no positive cultures were detected,while among 59 channel samples,4(6.8％) cultures were positive and all from the same duodenoscope,including 3 cases of Klebsiella pneumonia and 1 case of Pseudomonas aeruginosa.Conclusion Sterilization powder is effective for disinfection of duodenoscope used for ERCP.Residual organic material can't be excluded from elevator sample even if it is negative for culture.Duodenoscope with high level disinfection still has the risk of transmitted infection,and should be monitored regularly by culture and reprocessed in time.

Objective To investigate the impact of motilin(MTL), neurotensin(NT)and nitric oxide synthase(NOS)on Oddi sphincter(SO)motion after cholecystectomy. Methods Oddi sphincter manometry(SOM)was performed on both Guinea pig model group(cholecystectomy)and control group (laparotomy)12 weeks after operation. Sphincter of Oddi dysfunction(SOD)group was determined by receiver operating characteristic(ROC)curve analysis and area under curve(AUC). Protein expression of MTL, NT and NOS in SO was also detected through integral optical density method. Meanwhile,the contents of MTL and NT in patients′ plasma of both SOD group(SO pressure> 40 mmHg)and control group were compared. Results AUC of 0.75 and SO pressure of more than 29.8 mmHg was determined as the standard of SOD group.MTL and NT contents(193.16±29.2 pg/mL and 104.57±19.52 pg/mL,respectively)of the model group(n=10)in plasma were significant higher than those of control group(n=11)(154.24 ± 27.69 pg/mL and 79.65±11.24 pg/mL,respectively),and same trend of MTL and NT protein expression in SO was detected(3 556.71±455.80 and 6 321.74±203.54 of the model group;3 075.92±350.06 and 5 843.57±344.00 of the control group).While NOS protein expression in model group was lower than that of the control group(2 954.21± 173.54 VS 3 314.91± 246.67, P<0.05). In clinical research, the plasma contents of MTL(350.98 ± 24.31 pg/mL VS 319.56 ± 23.54 pg/mL)and NT(102.39 ± 19.56 pg/mL VS 80.45±12.35 pg/mL)in SOD group(n=15)were higher than those of the control group(n=15)(P<0.05). Conclusion MTL and NT contents in plasma and protein expression of MTL, NT and NOS in SO may be related to SOD. MTL and NT examinations may assist diagnosing SOD after cholecystectomy.

Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases.Methods Tumor markers (CA19-9,CEA and CA242) examination and bacterial culture were performed in a total of 160 patients,who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for biliary diseases.Resuts There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9,CEA and CA242 (P ＜0.05) ; Cut-off value,according to ROC curve,was 239 ku/l in CA19-9,40 ng/ml in CEA and 60 ku/ml in CA242,respectively.There were significant differences between the bile marker and the serum marker in sensitivity,accuracy,negative predicative value of CEA (P ＜ 0.05).No significant differences was found in specificity between the serum group and the bile group.There were significant differences in bile CA19-9 level between cholangiocarcinoma,pancreatic cancer,duodenal papilla carcinoma with carcinoma metastasizing to bile duct,and hepatocellular carcinoma (P ＜ 0.05).Both in benign group and malignant group,there were significant differences in CA19-9 level between infectious bile and noninfectious bile (P ＜ 0.05).Conclusion The level of CA19-9,CEA and CA242 in bile can be applied to differentiate benign and malignant biliary diseases.The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis.Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.

Objective To explore the impact of basal sphincter of Oddi (SO) pressure on pancreatobiliary reflux (PBR).Methods A total of 120 consecutive patients who received therapeutic ERCP for biliary tract diseases with or without the history of EST were enrolled,and were assigned to normal basal SO pressure group (n =23),elevated basal pressure group (n =55) and EST group (n =24).Basal SO pressure,bile amylase (BA) and bacteria culture findings were compared between the three groups.Results There were no differences in positive rate of bacteria culture,SO pressure increase and BA between the normal basal SO pressure group and elevated basal pressure group.In the latter group,negative correlation was observed between SO pressure and BA.The BA value [median(quartile range)] in patients with common bile duct ≥ 15 mm [4270 (12 337)U/L] was significantly higher than that in patients with common bile duct ＜ 15 mm [279.5 (1370) U/L].Furthermore,significant difference in both the proportion of elevated BA patients (83.3％ vs.59.0％) (P ＜0.05) and the positive rate of bacteria culture (75.0％ vs.33.3％) was seen between the intact papilla patients in the former two groups and those in EST group (P ＜ 0.05).Conclusion There was no direct correlation between the elevated basal SO pressure and PBR,but marked increase in diameter of common bile duct can lead to a rise in BA.Moreover,although EST can bring about PBR and bile bacterial infection,it may facilitate the outflow of the refluent pancreatic juice by relieving cholestasis.