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Objective@#To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones.@*Methods@#From September 2018 to March 2019, 48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis (primary group, 38 patients) and recurrent choledocholithiasis group (recurrent group, 10 patients). The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA. The Chao1 estimator indicated the richness of the biliary bacterial flora, and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora. The bacterial flora distribution was explored from different levels of phylum, class, order, family, genus and species. Chi-square test and t test were performed for statistical analysis.@*Results@#The Chao1 estimator of the primary group was higher than that of the recurrent group (419.413±118.704 vs. 396.000±70.483), and the difference was statistically significant (t=3.130, P=0.003). At the level of the phylum, the highest abundance of bacteria in the primary group was Firmicute (56.48%), the highest abundance of bacteria in the recurrent group was Proteobacteria (57.79%). The dominant bacteria of the recurrent group was Proteobacteria, which was inconsistent with that of the primary group, and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups (χ2=0.962 and -2.619, both P<0.05). At the genus level, the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group (9.75% vs. 20.77%, 10.86% vs. 22.01%, respectively), and the differences were statistically significant (χ2=0.354 and 0.503, both P<0.05). The abundance of Morganella of the recurrent group was higher than that of the primary group (9.00% vs. 0.44%), and the difference was statistically significant (χ2=-2.025, P=0.049). At the species level, the abundance of Bacillus unclassified, Carnobacterium maltaromaticum and Bacillus circulans of the primary group were all higher than those of the recurrent group (17.78% vs. 8.84%, 2.39% vs. 1.11%, 2.59% vs. 0.74%, respectively), and the differences were all statistically significant (χ2=2.540, 2.643 and 2.515, all P<0.05). The abundance of Aeromonas veronii of recurrent group was higher than that of the primary group (2.04% vs. 0.01%), and the difference was statistically significant (χ2=-2.397, P=0.021). The bacteria that had significant effects in the primary group included Lactococcus (P=0.012), Lactobacillus (P=0.033) and Geobacillus (P=0.021), while in the recurrent group, which included Enterobacter (P=0.007), Aeromonadaceae (P=0.001), Actinomycetes (P=0.009), and Aeromonas (P=0.001).@*Conclusions@#There are differences in abundance and composition of biliary bacterial flora between the recurrent group and the primary group. It remains to be further studied whether the changes of some bacterial flora correlated with the recurrence of common bile duct stones.
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Objective To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones.Methods From September 2018 to March 2019,48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis (primary group,38 patients) and recurrent choledocholithiasis group (recurrent group,10 patients).The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA.The Chao1 estimator indicated the richness of the biliary bacterial flora,and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora.The bacterial flora distribution was explored from different levels of phylum,class,order,family,genus and species.Chi-square test and t test were performed for statistical analysis.Results The Chao1 estimator of the primary group was higher than that of the recurrent group (419.413 ± 118.704 vs.396.000 ± 70.483),and the difference was statistically significant (t =3.130,P =0.003).At the level of the phylum,the highest abundance of bacteria in the primary group was Firmicute (56.48％),the highest abundance of bacteria in the recurrent group was Proteobacteria (57.79％).The dominant bacteria of the recurrent group was Proteobacteria,which was inconsistent with that of the primary group,and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups (x2 =0.962 and-2.619,both P ＜ 0.05).At the genus level,the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group (9.75％ vs.20.77％,10.86％ vs.22.01％,respectively),and the differences were statistically significant (x2 =0.354 and 0.503,both P ＜ 0.05).The abundance of Morganella of the recurrent group was higher than that of the primary group (9.00％ vs.0.44％),and the difference was statistically significant (x2 =-2.025,P =0.049).At the species level,the abundance of Bacillus unclassified,Carnobacterium maltaromaticum and Bacillus circulans of the primary group were all higher than those of the recurrent group (17.78％ vs.8.84％,2.39％ vs.1.11％,2.59％ vs.0.74％,respectively),and the differences were all statistically significant (x2 =2.540,2.643 and 2.515,all P ＜ 0.05).The abundance of Aeromonas veronii of recurrent group was higher than that of the primary group (2.04％ vs.0.01 ％),and the difference was statistically significant (x2 =-2.397,P =0.021).The bacteria that had significant effects in the primary group included Lactococcus (P =0.012),Lactobacillus (P =0.033) and Geobacillus (P =0.021),while in the recurrent group,which included Enterobacter (P =0.007),Aeromonadaceae (P =0.001),Actinomycetes (P =0.009),and Aeromonas (P =0.001).Conclusions There are differences in abundance and composition of biliary bacterial flora between the recurrent group and the primary group.It remains to be further studied whether the changes of some bacterial flora correlated with the recurrence of common bile duct stones.
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Sphincter of Oddi manometry (SOM) is considered the gold standard for the diagnosis of sphincter of Oddi dysfunction (SOD),especially the type Ⅰ SOD.The dysfunction of sphincter of Oddi can lead to other comorbidity.Therefore,SOM is of special importance for such patients.When performing SOM,we need to intubate into the papilla,so it requires high technique and is associated with a relatively higher risk of post-ERCP pancreatitis.Recently,the equipment of SOM is being updated constantly.The use of modified catheter and high resolution gastrointestinal dynamic system for recording and analyzing has made the technology more accurate and safe than ever before.Due to the widespread use of ERCP,SOM is expected to be one of the routine examinations in clinical practice and its application has a promising prospect.This article reviews the latest research progress on SOM in recent years.
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Objective To investigate the sedative effects and the adverse reactions in the elderly patients received different speed of dexmedetomidine (Dex) intravenous infusion. Methods Eighty elderly cases were randomly divided into four groups. Group D0 was the control group, while the group D1, D2 and D3 were the trial groups. The heart rates, blood pressure, SpO2, Ramsay sedation score and Narcotrend value were recorded. Results The sedation onset time of the D2, D3 group was faster than those in the D0 and D1 groups (P 0.05). Conclusion Intravenous infusion of Dex by doses of 0.75 ~ 1.0 μg/(kg·h) during hip surgery in the elderly patients under spinal anesthesia could lead to a safe and effective sedation.
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Objective To compare the efficacy and survival of patients with malignant obstructive jaundice using either endoscopic self-expandable metallic stents or surgery,and to evaluate the compounding factors influencing prognosis.Methods 56 patients with malignant obstructive jaundice treated with endoscopic self-expandable metallic stents (the endoscopic group) were compared with 90 patients who received surgery (the surgery group) during the same study period.Clinical data and survival of the 2 groups of patients were retrospectively analyzed.Results The success rate was 100％ in the endoscopic group.The serum bilirubin,alkaline phosphatase (ALP) and γ-glutamyl transferase (γ-GT) decreased significantly by using either therapeutic endoscopy or surgery (P＜0.01).There was no significant difference between the two groups in the reduction of serum total bilirubin.The mean survival of the endoscopic and surgery groups were 340 d and 795 d respectively.The accumulative survivals of the endoscopic group at 3,6 and 12 months as evaluated by the Kaplan-Meier method were 82.6 ％,61.1％ and 46.6 ％,respectively,and for the surgery group were 97.0％,90.9 ％ and 65.4％ respectively. There was a significant difference in survival between the two groups (P＜0.01).Survival after therapeutic endoscopy was similar to surgery for patients with metastasis and hilar biliary obstruction.Conclusions Self-expandable metallic stents gave similar palliation in the relief of jaundice in patients with malignant biliary obstruction.The stents had no effect on the primary tumor.Therapeutic endoscopy with self-expandable metallic stents is a safe and effective method for the relief of jaundice in patients with obstructive jaundice caused by non-resectable malignant tumors.
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Objective To evaluate the prophylactic effects of propranolol, propranolol plus endoscopic variceal ligation (EVL) and propranolol plus endoscopic sclerotherapy (EVS), and to determine the most effective combination for secondary prevention of esophageal variceal bleeding.Methods After hemostasis, a total of 78 patients with esophageal variceal bleeding were randomly assigned to receive propranolol (propranolol group), propranolol plus EVL (ligation group) or propranolol plus sclerotherapy (EVS group), with 26 in each group.All patients were followed up for 12 months, and the rates of variceal re-bleeding, mortality, portal hypertensive gastropathy (PHG), re-occurrence of esophageal varices and formation of gastric fundus varices were compared among different groups.Results During the 12-month follow-up, the rate of re-bleeding in EVL group (30.77%) was significantly lower than those of the EVS group (42.31%) or propranolol group (53.85%) (P<0.05).The occurrence of PHG and fundal varices in patients of EVL group was similar to that of propranolol group, which were both lower than that of EVS group (P<0.05), but the re-occurrence of esophageal varices in EVL group was significantly higher than that of EVS group (P<0.05).Conclusion EVL plus propranolol might be the most effective therapy for secondary prophylaxis of esophageal variceal bleeding.
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Malignant obstructive jaundice is biliary obstruction caused by malignant tumors.When a patient presents to a doctor,he/she is usually too late to be operated,so endoscopic treatment has gradually replaced surgery in its management.Diagnostic endoscopic methods include endoscopic retrograde cholangiopancreatography (ERCP),endoscopic ultrasonography (EUS),and per oral cholangioscopy (POCS),etc.Biliary stent placement at ERCP is the mainstay of endoscopic palliation for jaundice.Other methods include EUS-guided bilioenteric drainage (EGBD),endoscopic radiofrequency ablation,intraluminal brachytherapy of bile duct,endoscopic photodynamic therapy,etc.Magnetic Compression Anastomosis Technique (MCAT) is a new technology which has been developed recently,and its role in the management of malignant obstructive jaundice remains to be seen.Science and technology have brought along progress in endoscopic and consumable technologies.It is predicted that in the future,endoscopic diagnosis and treatment will have more applications.
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Objective To investigate the influence of gene therapy using survivin as a gene target on biological behavior of pancreatic carcinoma cell line. Methods Chemically synthesized siRNA and shRNA in pGCSi vector were used to silence survivin expression of pancreatic carcinoma cell line PaTu8988. The therapeutical effects of survivin as a gene target were evaluated through determination of the down-regulation of survivin gene expression, cellular shape, cell apoptosis, cell viability and apoptosis signal pathway changes. Results After transfection of different arrays of siRNA and shRNA vectors to silence the survivin expression, survivin mRNA and protein levels were significantly decreased (P < 0.05) ; PI staining revealed the presence of karyopyknosis, the cell apoptosis index was more than 20%; hypodiploid DNA content before G0/G1 detected by flow cytometry ; cell viability measured by MTT assay was significantly decreased (P <0.05) ; the activity of caspase-3 remarkably increased (P < 0. 05). Conclusions The pancreatic carcinoma cell line PaTu8988 be induced to promote spontaneous apoptosis procedure through silencing survivin expression by RNAi, which could accelerate carcinoma cell apoptosis and improve therapeutic effect on pancreatic carcinoma.
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Objective To find out about the allocation of large size medical facilities in Tangshan City so as to make rational use of its health resources. Methods On the spot investigations were combined with surveys through questionnaires to find out about the allocation of large size facilities in second tier hospitals and above in the city. Results There are altogether 109 large size medical facilities in the city, averaging 15.60 per million people. The allocation number is pretty high, and yet the distribution is quite irrational, with the city proper owning 70.67% of the facilities while its population and land area account for only 24.06% and 8.10%. Conclusion The allocation number has been increasing rapidly and the level of grade is rather high, and yet there lacks equity in distribution.