Abstract:With the introduction of curved linear array echoendoscope and the improvement of puncture equipments in the past decade,interventional endoscopic ultrasonography(EUS) based on EUS-guided fine needle aspiration has been rapidly evolved into a new minimally invasive therapeutic option. At present,novel EUS-based therapeutic interventions have been widely applied in the clinical practice. In this paper,we provide a comprehensive summary of the applications of interventional EUS in the management of pancreaticobiliary disease.

Abstract:Recent years have witnessed the booming development in the field of endoscopic resection,especially after endoscopic submucosal dissection (ESD) being introduced into China. ESD has been acknowledged to be the first-line treatment of early gastrointestinal cancer. The new advances and challenges in endoscopic resection field such as ESD,tunnel endoscopy,endoscopic full-thickness resection and suturingtechnique are reviewed in this article.

Abstract:Objective:To explore the methods and effects of tumor injection of H101 guided by endoscopic ultrasonography(EUS)for patients with pancreatic carcinoma. Methods:A total of 92 patients with advanced pancreatic carcinoma were divided into the H101 group(n=40) and the chemotherapy group(n=52). The patients in the H101 group were treated by tumor injection of H101 guided by EUS complicated with gemcitabine and the patients in the chemotherapy group were treated only by gemcitabine. The changes of tumor body,VAS and KPS score,survival analysis,and adverse reaction were analyzed. Results:The partial remission (PR)rate and effective rate of the H101 group(40.0%,62.5%) was higher than those of the chemotherapy group (16.7%,20.0%) after 4,12 months of treatment(P < 0.05). The KPS score was elevated after 4,8 and 12 months of treatment and VAS score was decreased(P < 0.05),but there was no difference in the two groups(P > 0.05). The mortality of the H101 group (60.0%) in 12 months was decreased than that of the chemotherapy group(80.8%)(χ2=4.810,P=0.028). The mid-life span of the H101 group was(8.8 ± 0.5) months and prolonged than that of the chemotherapy group [(7.6 ± 0.4)months,χ2=3.976,P=0.046]. Conclusion:Tumor injection of H101 guided by EUS is safe and feasible for patients with advanced pancreatic carcinoma,and is helpful to improve the life quality and prolong life span.

Abstract:Objective:To evaluate the clinical efficacy of limited endoscopic sphincterotomy with balloon dilation(ESBD) in the treatment of common bile duct stones by comparing the efficacy and safety of the two methods,ESBD and endoscopic sphincterotomy (EST). Methods:Between 2013 and 2015,300 consecutive patients with common bile duct stones were randomly assigned to groups that underwent EST or ESBD. Patients in the ESBD group underwent limited sphincterotomy(1/3 up to half of the sphincter) followed by balloon dilation to the size of the common bile duct or 15 mm,and patients in the EST group underwent complete sphincterotomy alone. Stones were removed using standard techniques. The primary outcome was percentage of stones cleared,and secondary outcomes included procedural time,method of stone extraction,number of procedures required for stone clearance,morbidities and other complications. Results:There was no significant difference between groups in percentage of stones cleared(EST vs. ESBD:100% vs.100%). Complete stone removal in the first session was accomplished at higher rates with ESBD than with EST, particularly for stones ≥15 mm (75.9% vs. 90.4%,P < 0.05). And ESBD was faster compared to ESD for large stones. More patients in the EST group (38.0%) than the ESBD group (23.3%) required mechanical lithotripsy (P < 0.05),particularly for stones ≥15 mm (87.0% vs. 57.7%,P < 0.05). Morbidities developed in 5.3% of patients in the EST group and 4% of patients in the ESBD group (P ≥ 0.05). Conclusion:ESBD and EST clear bile stones with equal efficacy. However,ESBD reduces the need for mechanical lithotripsy and is higher complete stone removal in the first session and faster compared to EST for large stones.

Abstract:Objective:To detect the CD90+ cells’ stem cell characteristics in human hepatocellular carcinoma and BEL-7404 cell lines and killed CD90+ liver cancer stem cells(LCSCs) by an anti-CD90 monoclonal antibody targeted thermosensitive magnetoliposomes encapsulated HSP90 inhibition 17-AAG(CD90@17-AAG/TMs). Methods:Immunohistochemical staining was performed to explore the relationship between the expression of CD90 and the clinicopathological parameters of human hepatocellular carcinoma. Magnetic activated cell sorting was performed to isolate the CD90+ cells from the BEL-7404 cell lines and its stem cell characteristics were identified. CD90@17-AAG/TMs was prepared by rotary evaporator-hydration method to kill the CD90+ LCSCs in vivo. Results:There was no significant correlation among the age,sex,tumor size,and AFP with the expression of CD90 in hepatocellular carcinoma tissues(P > 0.05). The expression of CD90 was relative to the pathology classification (P < 0.05). The CD90+ LCSCs showed a significantly stem cell characteristics. CD90@17-AAG/TMs effectively killed CD90+ LCSCs and inhibited the tumor growth. Conclusion:CD90+ LCSCs has significant stem cell characteristics. CD90@17-AAG/TMs can effectively kill CD90+ LCSCs in vivo and inhibit the formation and growth of tumors,which may provide a novel therapy approach for hepatocellular carcinoma and other cancers.

Abstract:Objective:To study the endostatin(ES) gene armed endothelial progenitor cells(EPCs) for liver carcinoma H22 of mice and to discuss the feasibility and effectiveness of autologous EPSs combined with ES for treawent of liver carcinoma. Methods:We construct a lentiviral vector expressing endostatin gene and cultured the bone-marrow derived EPCs. Cell surface markers were detected with qPCR and cells were observed by electron microscope. There were three groups:EPCs,EPCs+LV,and EPCs+ES. Cell enhancement was detected by CCK-8 assay in the three groups. Liver carcinoma models in situ were made and three groups of cells were injected through tail veins. Mice were sacrificed later at different times and the tumors were detected. Results:The construction of lentiviral vectors pLenti6.3-ES-Monomer-DsRed was confirmed by cleavage,sequence identification and PCR. The cultured cells expressed endothelial cells’ markers CD31,VEGFR and VWF with qPCR. Characteristic WP globule for endothelial cell was observed by transmission electron microscope. EPCs transfected with ES were observed red. Supernatant in the group of EPC+ES could inhibit the enhancement of H22 than the group of EPC and EPC+LV. In vivo assay showed that the tumors of EPCs+ES were smaller than the other two groups. Conclusion:Mice bone marrow derived MNCs can be induced to EPCs,EPCs transfected with ES could supress the enhancement of H22 in vitro and the liver carcinoma in vivo.

Abstract:Objective:To investigate the clinical efficacy of litholysis by integrated traditional Chinese and Western medicine on rabbits with gallstone. Methods:A total of 40 New Zealand white rabbits were randomly divided into A,B,C and D group,with 10 in each group. They were given gallbladder fistula,placement of calculi,and indwelling fistula. Then they were respectively treated with Western medicine,Traditional Chinese,the combination of Traditional Chinese and Western Medicine,normal saline. The drug was injected by fistula,once every hour,72 hours continuously. After the end of the experiment,the residual stones were collected,cleaned and dried and weighed. The gallbladder,liver,kidney were taken pathological examination. Blood biochemical indexes of venous blood were examined. Results:Western medicine and the combination of traditional Chinese and Western medicine all have the obvious function of dissolving gallbladder stones. However,function damage of the liver and kidney and inflammatory response of the liver,gallbladder,kidney tissues of Western medicine group was larger,and that of combination of Western and traditional Chinese medicine was smaller,and that of traditional Chinese medicine was the smallest,but the function of dissolving gallbladder stones it was the weakest. Conclusion:The combination of traditional Chinese and Western medicine can not only keep the dissolution of gallbladder stones,but also reduce the adverse reactions.

Abstract:Objective:To study the roles of ClC-3 chloride channel played in the microglial phenotypic transformation induced by oxygen-glucose deprivation. Methods:Microglia(BV-2 cell line) was applied to establish the oxygen-glucose deprivation (OGD) model,and then respectively pretreated with different concentrations of chloride channel blockers,including DIDS and NPPB. Cell damage and the effective concentration of drugs were determined by MTT activity. The mRNA level of cell phenotypic factors,such as M1 markers including tumor necrosis factor -琢(TNF--琢),interleukin 1-茁(IL-1-茁)and CD86,M2 markers containing transforming growth factor -茁(TGF--茁) and cell surface molecule CD206 were detected by real-time fluorescent quantitative PCR. Expression of ClC-3 was downregulated by small RNA interference,and then pretreated with chloride channels blockers-DIDS and NPPB. Finally,the effects of blockers were observed by the MTT activity. Results:Pretreatment with DIDS (1,10 μmol/L) and NPPB(1 μmol/L) could partially reverse the decrease of BV-2 cells viability induced by OGD. DIDS(1 μmol/L) and NPPB (1 μmol/L) pretreatment could reduce the mRNA level of TNF--琢,IL-1-茁 and CD86,they could also promote expression of TGF--茁 mRNA. However,the reversal effect of DIDS and NPPB could be abolished by the down-regulation of ClC-3 expression. Conclusion:ClC-3 chloride channel is essential for the phenotypic transformation of microglia caused by OGD. Blocking ClC-3 chloride channel could inhibit its transformation into M1 phenotype.

Abstract:Objective:To investigate the effects of dexmedetomidine preconditioning on mitochondrial function of myocardial ischemia reperfusion injury(MIRI),and to explore the protective effect of dexmedetomidine preconditioning on myocardium with ischemia and reperfusion injure. Methods:A total of 30 healthy male Sprague Dawley(SD)rats,aged 8 weeks,were randomly divided into three groups:the sham operation group(group A),the myocardial ischemia-reperfusion group(group B),and the dexmedetomidine preconditioning group(group C). The model of myocardial ischemia reperfusion injury was performed by ligation of the left anterior descending coronary artery. Cardiac functions were detected by echocardiography. The expression of the mRNA levels associated with mitochondrial function was performed by real-time PCR. Ultrastructure of myocardial mitochondria was observed under electronic microscope. Results:Compared with group A,the cardiac function of group B and group C were markedly decreased;the mRNA levels of genes related to mitochondrial function were significantly lower in group B and group C than that in group A(P <0. 05). Compared to group B,the cardiac function of group C was enhanced;the mRNA levels of genes related to mitochondrial function were higher in group C than in group B(P < 0.05). We also found that impaired mitochondrial ultrastructure was observed in group B. Compared with group B,impaired mitochondrial structure was significantly improved in group C. Conclusion:Dexmedetomidine preconditioning could improve mitochondrial function to alleviate myocardial ischemia reperfusion injury.

Abstract:Objective:To explore an intrathecal catheterization method that suitable for T10 spinal cord injury(SCI) rats model,which can be better used for dosing subarachnoid space in (spinal cord injury,SCI) model. Methods:A total of 60 female SD rats were randomly divided into the L3~4 catheterization group(T group) and the L6~S1 catheterization group(C group). After 7 days of intrathecal catheterization and SCI,the differences between two types of intrathecal catheterization in disability rate,mortality,biting catheter rate,lidocaine test,weight changes and blue ink location test were compared. After 7 days of SCI,Alzet osmotic pumps were implanted into two groups respectively,then we observed the mortality,weight and the morphology of the spinal cord after long-term catheter and osmotic pumps implanted in SCI rats. Results:After 7 days of intrathecal catheterization and SCI,the biting catheter rate of the two groups had significant difference (P < 0.05),and total elimination rate had significant difference (P < 0.01). After intrathecal catheterization and SCI,the weights of the two groups were decreased,and after 35 days of intrathecal catheterization,the weight of rats in the T group was higher than that in the C group(P < 0.05). Blue ink location test showed that there was no appearance of catheter obstruction and position migration in the two groups. After 4 weeks of Alzet osmotic pumps implanted,the histocompatibility of Alzet osmotic pumps were well. HE staining showed that the lumbar spinal cords in the two groups were all been compressed mildly. Conclusion:The L3~4 intrathecal catheterization is ideal for SCI model in rats as the biting catheter rate and mortality is lower,and the operation is easier.

Abstract:Objective:To analyze the differences of the levels of human tissue kallikrein(KS)-binding protein in plasma of coronary heart disease(CAD)patients,and evaluate the correlation between KS and the severity of coronary artery stenosis. Methods:A total of 151 patients with coronary angiography were enrolled in this study. Their clinical data and results of coronary angiography were collected. Plasma KS were measured by ELISA. Patients were stratified into four groups according to the results of coronary angiography(single coronary artery stenosis,double coronary artery stenosis,triple coronaryartery stenosis and controls)and four groups according to Gensini score [A group(0),B group(>0~≤20),C group (>20~≤40),and D group (>40~-艽160)] at the second step. KS levels were compared between different groups and correlation analysis was made between KS and Gensini score. Results:①In the four groups which were stratified according to the results of coronary angiography,the levels of KS in control (95.35 ± 32)μg/mL were significantly higher compared with single coronary artery stenosis(78.19 ± 25.27)μg/mL,double coronary artery stenosis (66.19 ± 25.93)μg/mL,and triple coronary artery stenosis (51.84 ± 23.26)μg/mL. There were statistically significant differences among the four groups(P < 0.001). ②In the four groups which were stratified according to Gensini score,the levels of KS were(101.66 ± 36.50)μg/mL,(77.73 ± 25.13)μg/mL,(61.58 ± 23.06)μg/mL,and(53.80 ± 23.92)μg/mL,respectively. There were statistically significant differences among the four groups(P < 0.001). ③Futhermore,there was a significant negative correlation between plasma KS levels and the Gensini score(r=-0.371,P < 0.001). Conclusions:The plasma KS levels were remarkable lower in the groups of CAD compared with controls. It indicates a novel role of KS in the progress of coronary atherosclerosis and the development of CAD.

Abstract:Objective:To study the prevalence,genotypes and molecular characteristics of norovirus (NV) in acute foodborne disease of Jiangsu Province. Methods:Feces or anal swab specimens of 16 658 patients with foodborne disease from 2013 to 2014 were collected and detected by RT-PCR. Positive samples were of randomly selected and analyzed by nucleotide sequence determination and phylogenetic tree analysis to determine the genotype. Meanwhile,we collected the relevant epidemiological data. Results:In the 16 658 samples,1 208 positive specimens were identified with NV(7.25%). Positive rate was 7.11% in males and 7.45% in females,which had no statistical significance(χ2=0.63,P=0.43). The prevalence of the children aged 1 to 4 years was the highest(9.85%). Prevalence time was mainly concentrated in October-the following year in April. A total of 63 out of the 71 positive specimens were classified,with 6(9.5%) belonged to GⅠ,including 3 GⅠ.3,2 GⅠ.9,and 1 GⅠ.4. Other 57(90.5%) all belonged to GⅡ.4. type. Conclusion:Norovirus is one of the most important pathogens causing foodborne diseases with the characteristics of wide distribution,prevalence time in winter and spring, and high risk incidence in children,and the harm caused by it should be paid more attention to. The main genotypes which caused NV are the GⅡ group,and the dominant strain of the present stage is GⅡ.4 type.

Abstract:Objective:To assess the predictive value of the red blood cell distribution width(RDW) in evaluation of prognosis in severe acute pancreatitis patients. Methods:From January 2014 to January 2016,a total of 72 patients with severe acute pancreatitis were retrospectively analyzed. Comparisons for APHACH II score,SOFA score,RDW(RDWd1),procalcitonin,white blood cells,red blood cells,hemoglobin,serum amylase,albumin and C-reactive protein,which obtained at the first day after admission to ICU,were performed between survivors and non-survivors. The patients were divided into four groups according to RDWd1 value and RDWd3-d1(RDW at the third day-RDWd1). The Kaplan-Meier curve was used to evaluate the prognostic value of dynamic evolution of RDW for 90-days mortality. Log-rank test was performed to evaluate difference between groups. Results:Levels of APHACH II score,SOFA score,RDWd1 and procalcitonin on the first day were significantly higher in non-survivors(P < 0.001). In the univariate model,advanced age and RDWd1 were the independent risk factors of prognosis in SAP patients(OR=6.257,95%CI:1.539~25.440,P=0.010,and OR=2.554,95%CI:1.218~5.353,P=0.013). The optimal cut-off value of RDWd1 for predicting 90-days mortality was 14.8(the area under the ROC curve was 0.773,95%CI:0.652~0.893,P < 0.001). Patients with increased RDWd1 and RDWd3-d1>0.2% exhibited the highest risks for mortality(P=0.023). Conclusion:RDW and itself early dynamic elevation can be potential independent prognostic markers in patients with severe acute pancreatitis.

Abstract:Objective:To study the effects of Porphyromonas gingivalis colonization on titanium surface oxide film properties. Methods:The samples of pure titanium were immersed in Porphyromonas gingivalis bacterial suspensions. Biofilm microstructure on the titanium surface was observed using scanning electron microscopy(SEM). The experimental groups were immersed in bacterial suspensions while the control group was immersed in physiological saline. After being co-cultured for 7,14,and 21 days,both samples and solutions were collected to analysis titanium surface properties using X-ray photoelectron spectroscopy(XPS) and to detect the quantity of titanium ion release using inductively coupled plasma optical emission spectrometer(ICP-OES),respectively. Results:SEM observed a dense biofilm after Porphyromonas gingivalis colonized on the titanium surface. With co-culture time increased,the XPS survey spectra showed reductions in the surface levels of titanium and oxygen,corresponding with an evident reduction of dominant titanium dioxide (TiO2) on the titanium surface revealed by the XPS high resolution spectra. ICP-OES indicated a increase of titanium ion release after colonization of Porphyromonas gingivalis on the titanium surface with the time extension,and the fastest release rate happened in the first week. Conclusion:Porphyromonas gingivalis was able to colonize on the titanium surface and form a dense biofilm. Porphyromonas gingivalis colonization weakened the protective TiO2 film on the titanium surface and induced the release of titanium ions,which enhanced with the bacterial action time prolonged.

Abstract:Objective:To investigate the relationship between the serum levels of sFlt-1,PLGF and their ratio in mild preeclampsia. Methods:We searched Wanfang,CNKI,PubMed,Embase and Cochran,and published domestic and foreign controlled studies about the relationship between the serum levels of sFlt-1,PLGF and their ratio in mild preeclampsia from 1994 to 2014. Then,we excluded non-compliant documents,and statistically analyzed the results of included studies using Review Manager 5.3 software. Results:A total of 17 studies were included in this study,including 14 Chinese studies and 3 English studies. Heterogeneity test about the serum levels of sFlt-1 expression and the relationship between mild preeclampsia was I2=96%,P< 0.000 01,and the heterogeneity was significant. The combined effect of SMD=4.89(95%CI:3.60~6.17),P < 0.000 01,the difference was statistically significant. Heterogeneity test about the serum levels of PLGF expression and the relationship between mild preeclampsia was I2=93%,P < 0.000 01,the heterogeneity was significant. The combined effect of SMD=-2.32(95%CI:-2.91~-1.72),P < 0.000 01,the difference was statistically significant. Heterogeneity test about the serum levels of sFlt-1/PLGF ratio expression and the relationship between preeclampsia was I2=98%,P < 0.000 01,the heterogeneity was significant,the combined effect of SMD=1.95(95%CI:0.50~3.40),P < 0.000 01,the difference was statistically significant. Conclusion:PLGF is highly correlated with the occurrence and development of mild preeclampsia;the serum levels of sFlt-1 expression associated with mild preeclampsia;sFlt-1 and sFlt-1/PLGF ratio can be used as an effective index for diagnosis of mild preeclampsia.

Abstract:Objective:To evaluate the effect of pancreatic external stent used in pancreaticoduodenectomy on postoperative pancreatic fistula. Methods:Literature search was conducted in Chinese electronic database including Wanfang Database,CNKI and Chinese Biological Medicine Database,and English electronic database including PubMed,Web of Science and Cochrane Central Register of Controlled Trials. Clinical randomized controlled trials regarding the comparison of external stent and no stent were selected for inclusion. Risk ratio (RR) with the corresponding 95% confidence interval (CI) was used for overall effect estimation. Data were extracted for meta-analysis. Results:Overall,six studies met the inclusion criteria with 280 patients in the external stent group and 281 in the no stent group. Meta-analysis showed that there was a significant difference between two groups in pancreatic fistula rate(RR = 0.54,95% CI = 0.39 ~ 0.74),especially in subgroups of grade B and C (RR = 0.55,95% CI = 0.37 ~ 0.82),and non-dilated pancreatic duct (RR = 0.50,95% CI = 0.34 ~ 0.73)(P < 0.05). Meanwhile,the differences between two groups in postoperative morbidity and hospital stay were also statistically significant (P < 0.05). However,no significant differences in mortality,abdominal abscess,hemorrhage,delayed gastricemptying,blood replacement,reoperation,operation time and operative blood loss were found between two groups (P > 0.05). Conclusion:Using pancreatic external stent could effectively reduce the incidence of postoperative pancreatic fistula,and improve postoperative course. The method is safe,feasible,and worthy of popularization and application clinically.