Objective:To explore the clinical characteristics of liver function of patients with autoimmune liver disease (AILD) complicated with gallbladder stone (GS), so as to guide clinical practice.Methods:From November 2009 to October 2018, at General Hospital of Tianjin Medical University, the clinical data of 386 patients with AILD were retrospectively analyzed. According to the relevant diagnostic criteria, 208 cases of autoimmune hepatitis (AIH), 129 cases of primary biliary cholangitis (PBC) and 49 cases of PBC-AIH overlap syndrome were screened out. The incidence, clinical characteristics and the changes of laboratory indicators including albumin, alkaline phosphatase (ALP) and γ-glutamyl transferase (GGT) of AILD patients complicated with GS were analyzed. Chi-square test, t test and rank sum test were performed for statistical analysis. Results:There was no significant difference in the incidence between AILD, AIH, PBC and PBC-AIH overlap syndrome patients complicated with GS (32.9%, 127/386; 28.8%, 60/208; 36.4%, 47/129 and 40.8%, 20/49; respectively; P>0.05). Gallstones of AILD patients complicated with GS mostly were multiple and small stones with maximum diameter <1 cm (45.7%, 58/127 and 57.7%, 60/104, respectively). The age of initial diagnosis, the proportion of liver cirrhosis at inital diagnosis and the levels of ALP and GGT were higher in AILD patients complicated with GS than those of AILD patients without GS ((60.5±11.5) years vs. (57.6±11.5) years; 53.5%, 68/127 vs. 42.1%, 109/259; 154.00 U/L (89.00 U/L, 257.00 U/L) vs. 125.00 U/L (86.00 U/L, 212.00 U/L); 169.00 U/L (79.00 U/L, 343.00 U/L) vs. 128.60 U/L (48.00 U/L, 284.00 U/L); respectively); however the albumin level was lower than that of AILD patients without GS ((36.46±7.30) g/L vs. (38.34±7.58) g/L), and the differences were statistically significant ( t=-2.361, χ2=4.506, Z=-2.192, -2.443, t=2.322; all P<0.05). The incidence of GS in AILD patients≥60 years old was higher than that AILD patients<60 years old (37.6%, 73/194 vs. 28.1%, 54/192), and the difference was statistically significant ( χ2=3.948, P=0.047). The incidence of GS in AILD patients and AIH patients complicated with liver cirrhosis was higher than that in patients without liver cirrhosis (38.4%, 68/177 vs. 28.2%, 59/209; 35.7%, 35/98 vs. 22.7%, 25/110; respectively), and the differences were statistically significant ( χ2=4.506 and 4.259, P=0.034 and 0.039). Conclusions:AILD patients complicated with GS are common, most are multiple and small stones. When complicated with GS, the initial diagnosis may be delayed and the rate of liver cirrhosis at initial diagnosis may increase. The incidence of GS is high in AILD patients with older age and liver cirrhosis.

Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS)for esophageal submucosal tumor(SMT). Methods Clinical data of 388 patients with esophageal SMT, who underwent EUS and endoscopic treatment in Tianjin Medical University General Hospital were collected from May 2010 to September 2016. The golden standard for the origin of esophageal SMT was the diagnosis during endoscopic treatment, and the golden standard of pathological type was the combination of postoperative pathological and immunohistochemical findings. The diagnostic accuracy of EUS for esophageal SMT was evaluated. Results The conventional endoscopy revealed that 31.70%(123/388)and 43.81%(170/388)esophageal SMTs were located in the middle and lower segments of esophagus,respectively. The diagnostic consistency of EUS for the origin of lesion was 71.51%(251/351), while the diagnostic consistency of EUS for lesion originated from the muscularis mucosae, submucosa and muscularis propria layer was 92.90%(170/183), 34.38%(11/32), and 51.47%(70/136), respectively. The diagnostic consistency of EUS for the type of lesion was 81.00%(260/321), while the diagnostic consistency of leiomyoma, esophageal cyst, and lipoma were 88.42%(252/285), 14.81%(4/27), and 80.00%(4/5), respectively. Conclusion EUS can preliminarily diagnose the origin and pathological type of esophageal SMT,but there are limitations on the diagnosis of uncommon lesions,which need combination of pathological and immunohistochemical findings.

To investigate the safety and clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of gastrointestinal neuroendocrine neoplasms (GI-NENs). Methods: The clinical and pathological features of 39 patients with GI-NENs who were treated with ESD, the efficacy of ESD treatment, complications, and follow-up results were analyzed retrospectively. Results: The 39 cases of GI-NENs were all neuroendocrine tumors (NETs). According to histopathology and proliferative activity, there were 37 cases of G1, two cases of G2, and no cases of G3, including 23 cases of cancer in the rectum, 12 in the stomach, 4 in the duodenum. Thirty-five lesions invaded the mucosa or submucosa, four invaded the muscularis propria, one perforated in the ESD, and two were associated with bleeding. After 6 to 90 months of follow-up, new lesions were found in 1 patient with g-NETs in different parts of the stomach at 5 and 34 months after operation, followed by ESD treatment and further follow-up. No lymph node and distant metastases were found, and the survival rate of the patients was 100%. Conclusions: For GI-NENs without lymph node and distant metastases, the lesion is con-fined to the submucosa, and a diameter≤1.0 cm is an absolute indication of ESD. For rectal neuroendocrine neoplasms that have non-invasive muscularis propria with diameters between 1 and 1.5 cm, or for patients with Type 1 gastric neuroendocrine tumors (T1-GNETs) that are predicted to be T2, ESD treatment should be prioritized to preserve gastrointestinal volume and function.

Objective To estimate the safety and efficacy of submucosal tunneling endoscopic resection (STER) on treatment of large esophageal submucosal tumors (SMTs) originating from muscularis propria layer.Methods The data of patients with large esophageal SMTs (diameter ≥ 3.5 cm) undergone STER (n=17) or endoscopic submucosal dissection (ESD,n =15) at the Endoscopy Center of Tianjin Medical University General Hospital from December 2009 to March 2016 were retrospective analyzed.The therapeutic effects,hospitalization times,post-operation expenses,and occurrence of complications were evaluated and compared between the two groups.Results All the endoscopic treatments of the 32 patients were successfully completed.The operating time of the STER group was significantly longer than that of the ESD group (t =2.595,P =0.015).There was no statistical difference on the en bloc resection rate,complete resection rate and complication rate between STER group and ESD group (P＞0.05).The mean post-operative hospital stay of the STER group was significantly less than that of the ESD group (3.8± 1.0days VS 6.7±1.8 days,t=5.644,P=0.000).The mean hospital cost of the STER group was significantly less than that of the ESD group (22 456.1±5 232.0 yuan VS 27 392.5±5 747.9 yuan,t =2.543,P =0.016).The wound healing rates at 1 month after operation in the STER group was significantly higher than that of the ESD group [94.1％ (16/17) VS 20.0％ (3/15),P=0.000].No recurrence and metastasis occurred in the STER group and ESD group during the 41.2±20.6 months follow-up.Conclusion STER is a safe and effective technique for treating large esophageal SMTs originating from the muscularis propria layer,with earlier wound healing,shorter hospital stay and lower cost compared with those of the traditional method of ESD.

Objective To study the clinical value of double balloon endoscopy (DBE) in diagnosis and treatment of intestinal diseases. Methods Clinical data of 344 patients suspected of small bowel lesions from March 2006 to April 2014 was retrospectively analyzed. All the patients clinical manifestations including varying degrees of abdominal pain, bloating, nause and vomiting, diarrhea. The 344 patients underwent DBE for 397 times. Results The incidence of adverse reactions in checking was only 4.53%, and there was no complications occurred after checking. Positive results shown in 214 cases by DBE, the other 130 patients shown negative results. While 28 of the other 130 patients were found small bowel lesions by capsule endoscopy and CT scans, the remaining 102 cases had no obvious abnormalities. The misdiagnosis rate of DBE was 8.13%, and mainly focuses on polyps and vascular malformation. 242 of the 344 patients were diagnosed with intestinal diseases, and mostly of them were tumor, ulcers and polyps. The detect rate of DBE examination for tumor and ulcer diseases was greater than that of small intestinal polyposis, the difference was statistically significant (P < 0.05). Conclusion DBE in diagnosis and treatment of intestinal diseases is a relatively safe and effective way. It is worthy being popularized and applied.

Objective To observe the histological features of muscular layers in different parts of esophagus of patients with achalasia (AC) and to explore the distribution and function of eosinophils in esophageal muscular layer in patients with AC.Methods From June 2015 to February 2016,21 patients diagnosed with AC by endoscopy,barium meal and esophageal high resolution manometry,accepted peroral endoscopic myotomy (POEM) were enrolled.At the same period,nine patients with esophageal carcinoma who received esophagectomy were selected as controls.Muscular tissues of lower esophageal sphincter (LES),distal esophagus (5 cm above LES) and middle esophagus (10 cm above LES) of patients with AC and controls were taken for regular haematoxylin-eosin (H-E) staining to analyze degree of eosinophils infiltration.Nonparametric analysis and Chi-square analysis were used for statistical analysis.Spearman correlation analysis was used for analyzing correlations.Results The results of H-E staining indicated that different degree of eosinophil infiltration was found in 18(85.7％) patients with AC,and eosinophil counts in muscular layer were over 15 per high power field in five patients with AC (23.8％,5/21).However,no eosinophils infiltration was found in esophageal carcinoma patients.Median numbers of eosinophil in muscular layer of LES,distal esophagus and middle esophagus were all higher than those of esophageal carcinoma group (4.0,2.0 to 10.0 vs 1.0,0 to 1.5;4.0,1.0 to 17.0 vs 1.0,0.5 to 1.5；6.0,0.5 to 15.0 vs 0,0 to 1.0),and the differences were statistically significant (Z=2.997,2.476 and 2.504,all P＜0.05).The distribution of eosinophils in muscular layer of LES,distalesophagus and middle esophagus between the two groups were statistically significant (x2=2.710,2.543and 2.313,all P＜0.05).The differences in eosinophils distribution in muscular layer of LES,distal esophagus and middle esophagus in patients with AC were not ststistically significant (x2 =0.110,P＞0.05).Additionally,number of eosinophils in muscular layer of different parts of esophagus was not correlated with age and disease course (r=0.434 and 0.639；P =0.282 and 0.088).Conclusion The wide distribution of eosinophils in muscular layer of esophagus in patients with AC may involve in the genesis and development of AC.

Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy (POEM) and pneumatic dilatation (PD) in achalasia patients.Methods A retrospective analysis was applied.From September 2010 to March 2015,patients with POEM or PD were enrolled and divided into POEM group (n=26) and PD group (n=40).High-resolution manometry (HRM) before and one month after treatment were compared between POEM group and PD group.Before and three months after treatment,Eckardt score and gastroesophageal reflux symptom was compared between groups (Eckardt score ≤ 3 as the standard for successful treatment).Wilcoxon signed rank test was performed for before and after treatment comparison in the same group.Mann-Whitney U test was used to compare between two groups and Fisher's exact test was used for rate comparison.Results The successful treatment rates at one and three month after POEM group were 92.3 ％ (24/26) and 96.2％ (25/26),respectively.The successful treatment rates at one and three month after PD were 87.5％ (35/40) and 75.0％ (30/40).At three month after treatment,the successful treatment rate of POEM group was higher than that of PD group (Fisher's exact test,P =0.02).At three months after treatment,the Eckardt score of POEM group was lower than that of PD group (1.35,0 to 4.00,vs2.73,0 to 6.00;U=-3.921,P＞0.01).By the end of three months after treatment,the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group (7/26,26.9 ％ vs 2/40,5.0％;Fisher's exact test,P=0.01).The postoperative 4 second integrated relaxation pressure (4s-IRP) and lower esophageal sphincter pressure (LESP) of POEM group were both lower than those of PD group (7.01 mmHg,3.48 to 10.40 mmHg vs 10.11 mmHg,5.75 to 12.91 mmHg,U=-4.541,P＜0.01;11.61 mmHg,4.21 to 14.64 mmHg vs 17.85 mmHg,8.39 to 24.57 mmHg,U=-6.142,P＜0.01).The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type Ⅰ and type Ⅱ.Conclusion During short-term follow-up,the efficacy of POEM was better than that of PD in achalasia patients,however there was a higher incidence of post-operative gastroesophageal reflux after POEM.

Cholesterol is a component of cell membrane and plays a vital role in maintaining metabolism and normal functions in human body. Liver X receptor (LXR) is a nuclear receptor expressed in abundance in the liver. It influences the process of cholesterol metabolism through regulating the synthesis, transformation, and transportation of cholesterol and bile acid at the level of hepatocytes, and therefore, it plays an important role in maintaining cholesterol homeostasis in human body. In addition, LXR can inhibit the intestinal absorption of dietary cholesterol, reduce exogenous cholesterol level and total cholesterol level in human body, and prevent hypercholesterolemia and formation of gallstones. This article summarizes the mechanism of action of LXR in regulating cholesterol metabolism at both liver and intestinal levels.

Objective To investigate the characteristics,treatment and prognosis of the gastrointes-tinal iatrogenic perforation resulting from endoscopic operations.Methods The clinical data of the 107 pa-tients with gastrointestinal iatrogenic perforations caused by endoscopic operations from October 2003 to Octo-ber 2013 were retrospectively studied,and the characteristics,treatment and prognosis of these patients were analysed.Results The incidence of the gastrointestinal iatrogenic perforation resulting from endoscopic oper-ations was 0.041%(107 /263 549,among which 0.006% was diagnostic(13 /232 011),and 0.298% was therapeutic (94 /31 538).A total of 107 patients with gastrointestinal iatrogenic chose conservative medical management,endoscopic clipping or surgery according to different conditions after perforations.All patients had good prognosis.Conclusion Endoscopic therapeutic operations are more likely to lead to the occurrence of iatrogenic gastrointestinal perforations compared with diagnostic operations.And most patients could get good prognosis as long as the appropriate treatment is performed when the perforation occurs.

OBJECTIVE:To establish the method for the residual determination of 7 organic solvents in picrosideⅡraw materi-als. METHODS:Head-space GC was performed on the capillary column of 6% cyanopropyl phenyl-94% dimethyl polysiloxane (DB-624) by temperature programming,the temperature of injector was 200 ℃,temperature of flame ionization detector was 250 ℃,the flow rate of N2 was 35 ml/min,and split ration was 10∶1,headspace sampling was adopted with the volume of 1 ml, the heating temperature of headspace sampling was 85 ℃,heating time was 45 min. RESULTS:The good linear relationship of methanol,ethanol,ethylacetate,methylbenzene,benzene,phenylethylene and divinglbenzene had been obtained(r=0.999 6-0.999 9);RSDs of precision stability test were less than 3%;average recoveries was in the range of 78.0%-104.9%(RSDs were 0.65%-2.47%,n=6)respectively. CONCLUSIONS:The method is specific,rapid,simple and accurate,and can be used for the determination of residual organic solvents in picrosideⅡraw materials.