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Objective:To compare the changes of biliary microbiota after enteral extended biliary stents (EEBS) implantation with that of conventional plastic stents in animal experiment, and to preliminarily investigate its possible mechanism in preventing stents occlusion.Methods:A total of 12 healthy Bama minipigs were randomly assigned to the conventional plastic stent group ( n=6) and the EEBS group ( n=6) using simple random method. The bile samples of all pigs were collected before stents implantation and 4 weeks after stents placement. The biliary microbiota composition and diversity before and after different stents implantation were analyzed by 16S rRNA gene sequencing and compared. Results:No complications including acute cholangitis, perforation, bleeding, or death occurred in 12 pigs. Eight days after stents implantation, stents were out of bile duct in all pigs under endoscopy, while the bile samples were collected again for analysis. The main composition of biliary microbiota at the phylum level were Proteobacteria, Firmicutes and Bacteroidota. Alpha-diversities revealed the Shannon ( P=0.004) and Simpson index ( P=0.008) significantly decreased in the conventional stent group after stents placement, and Bata diversity analysis also showed a significant difference in microbial composition (Anosim: R=0.514 8, P=0.011). There was no significant difference in Observed species index ( P=0.095), Chao1 index ( P=0.136), Shannon index ( P=0.353), Simpson index ( P=0.227) or Bata diversity (Anosim: R=0.059 3, P=0.187) in the EEBS group before and after stents placement. LEfSe algorithm indicated Bacteroides_ fragilis and Proteobacteria- Gammaproteobacteria- Enterobacterales- Enterobacteriaceae- scherichia_ Shigella- Escherichia_ coli significantly increased in the conventional stent group, and Desulfobacterota- Desulfovibrionia- Desulfovibrionales- Desulfovibrionaceae- Bilophila significantly increased in the EEBS group after stents placement. Conclusion:The biliary microbiota change slightly after EEBS implantation in the short-term, and EEBS may prevent duodenobiliary reflux by prolonging the reflux path.
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Objective:To explore the clinical characteristics of pancreaticobiliary maljunction (PBM) and its disease spectrum, and to evaluate therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods:Data of 52 PBM patients who received therapeutic ERCP procedures for abdominal pain, jaundice and fever in Department of Gastroenterology of Peking University Third Hospital from June 2006 to March 2021 were collected. The clinical characteristics, typing, the change of disease spectrum and ERCP procedures were analyzed.Results:Among 52 PBM patients, female was more common. Abdominal pain and jaundice were the most common clinical manifestations, among which 20 were type Ⅰ, 25 type Ⅱ and 7 type Ⅲ. Half patients had the choledochal cyst. The mean timespan from the first onset to the final diagnosis was 12.2 years. Twenty-four cases (46.2%) had changes in PBM disease spectrum. Among 69 ERCP procedures, 5 (7.2%) failed. Difficult cannulation rate was 34.6% (18/52), and 11 patients underwent advanced cannulation techniques, while it was 15.4% (657/4 275) in the conterpart non-PBM patients in the same period, with significant difference between them ( χ2=14.455, P<0.05). Multiple therapeutic ERCP techniques including endoscopic sphincterotomy, pancreatic stent placement, removal of stones from the duct were applied with the successful rate of 92.8% (64/69). The incidence of post-ERCP pancreatitis was 15.4% (8/52). Conclusion:The chief clinical problem may be changed over time in PBM patients. Although ERCP plays an important role in PBM and its disease spectrum, there may be a higher rate of difficult cannulation and postoperative complications.
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Objective@#To analyze the quantitative relationship between the number of layers of laser pulses and the amount of step in ultra-short pulse laser cutting of cortical bone, optimize the robot's vertical single stepping parameters, and to explore the feasibility of automatic preparation of dental implant cavity using robot controlling ultra-short pulse laser, in order to lay the foundation for automated dental implant surgery.@*Methods@#Eight pig ribs were segmented into to make 16 specimens. Using the robotic surgical system and path planning software independently developed by our group, circular holes with a diameter of 4 mm were cut two-dimensionally in the rib segments to obtain the quantification relationship of the number of laser pulse layers (n) and the depth of two-dimensional (2D) cutting (d). When conducting the three-dimensional (3D) cutting procedure, the number of pulse layers were set to 5, 10, 15, 20, 25, 30, 35, 40, 45, 50 layers, the vertical single step amount was an integer value corresponding to the results of 2D cutting depth, and the number of pulses (n') corresponding to the minimum difference between the theoretical depth of cut and the actual depth of cut was obtained. The n' was taken as the most suitable single step pulse layer, the rib segment was cut, and the depth of single cut was measured while the integer value was taken as the most appropriate vertical single step amount (d'). The vertical parameters of laser single stepping were set as n' layer pulse and d′ μm step size. The 3D cutting produces a cylindrical cavity with a diameter of 4 mm and a height of 2 mm to evaluate the 3D cutting accuracy (the difference between the measured value and the theoretical value of cutting diameter or depth). Ten 4 mm×3 mm implant holes were automatically prepared on the bilateral femurs of 5 Japanese big white rabbits, and ten 4 mm×3 mm implants made by 3D printer were artificially implanted, and the preparation effect of the implant cavities was evaluated.@*Results@#The quantitative relationship curve between the number of laser pulses (n) and 2D depth of cut (d) showed a linear upward trend. The linear fitting obtained the quantitative relation function formula d=9.278 4 n±26.763 0, R2=0.988 9. The optimum number of single step pulse layers was 5 layers, and the vertical single step amount was 50 μm, so as to set the vertical parameters of a single step of a 3D cutting, and the 3D cutting diameter accuracy was (3.98±2.87) μm, with a depth accuracy of (15.42±5.44) μm. Automated preparation of 10 implant cavities on the femur of the rabbit were completed. When the implants were placed into the implant cavities, there was resistance, but they were fully seated and primary stability has been achieved after seating implant placement.@*Conclusions@#The method of non-contact automatic preparation of dental implant cavities using robot controlling ultra-short pulse laser is feasible. By optimizing the single cutting process parameters, precise control of laser cutting cortical bone can be realized.
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Objective To reduce the occurrence of recurrent choledocholithiasis caused by biliary sphincter dysfunction after extensive endoscopic sphincterotomy ( EST ) for large stone extraction, and to investigate the sphincter-preserving effects of duodenal papilla occlusion by SureClip from MicroTech. Methods Three patients with large biliary stones ( 1. 0-2. 5 cm in stone size, 1. 2-3. 0 cm in common bile duct diameter) and without ERCP history underwent EST ( larger than 1. 0 cm) in Peking University Third Hospital from March 2018 to May 2018. Biliary and pancreatic stents were placed after stone extraction, followed by duodenal papilla occlusion with SureClip from MicroTech. Pressures of biliary duct and Oddi sphincter were measured at pre-EST, immediately after EST, and when stents were removed 3 weeks after EST, respectively. Healing conditions of papilla and complications were documented. Five pigs underwent similar experiments without stone extraction. Results The pressure of Oddi sphincter was significantly reduced after EST, and recovered after papilla occlusion 3 weeks after operation both in pigs and human. All stones were completely removed in the 3 patients without any post-ERCP complications. The papilla was healed under endoscopic observation when stents were removed 3 weeks after papilla occlusion. In animal experiments, histology revealed completely muscularis propria disruption of post-EST papilla without occlusion. In contrast, the muscle layer of post-EST papilla with occlusion by SureClip from MicroTech appeared scar healing. Conclusion The duodenal papilla occlusion by SureClip from MicroTech after EST works as "papilla remolding", which accelerates healing of papilla, and retains the sphincter pressure and anti-reflux barrier function.
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Objective To evaluate the efficacy of the suspended overlength biliary stents modified from nasobiliary tube for prevention of duodenobiliary reflux. Methods Suspended overlength biliary stents were placed in the intrahepatic bile duct of 18 patients with extrahepatic bile duct stricture who underwent biliary stents implantation once or more via ERCP from February 2014 to May 2016.Data of these patients were followed up to June 30, 2017 with self-control method. The patency time of suspended overlength biliary stents was compared with the ordinary biliary stents which were implanted in the last ERCP. Incidence of complications was recorded.Results Eighteen patients were enrolled in the study, but one patient lost follow-up. Finally 17 patients were enrolled in the analysis. Nine patients were malignant and 8 benign biliary stricture. The median patency time of suspended overlength biliary stents was 210 days, which was much longer than that of ordinary stents with median patency time of 139 days(P＝0. 015). The median patency time of overlength biliary stents and metal stents in 3 patients with malignant stricture were 278 days and 205 days (P＝1. 000). The median patency time of overlength biliary stents and traditional plastic stents in 6 patients with malignant stricture were 156 days and 65 days, respectively(P＝0. 049). The median patency time of this innovative stents was prolonged in benign biliary stricture patients (254 days VS 143 days, P＝0. 025). Only one patient developed mild pancreatitis after ERCP. Conclusion Suspended overlength biliary stents can prolong the patency time without increasing postoperative complications, which is worth popularization.
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Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy ( EPS) combined with pancreatic duct stent for acute recurrent pancreatitis ( ARP ) caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS ( n=34) and EST group (n=37), respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis (PEP) and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months ( median 21. 5 months) in EPS group and ranged from 5 to 120 months ( median 39 months) in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis(χ2=0. 461, P=0. 497). Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment ( RR=6. 808, 95%CI: 1. 389-33. 356, P=0. 018) and type 2 diabetes ( RR=0. 134, 95%CI:0. 029-0. 608, P=0. 009) were statistically significant factors. There were no significant difference in incidence of PEP (20. 6% in EPS group, 10. 8% in EST group,χ2=1. 294, P=0. 255) and biliary complications between two groups (11. 8% in EPS group, 24. 3% in EST group, χ2=1. 869, P=0. 172). Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.
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Objective@#To further study the most suitable parameters for automatic full crown preparation using oral clinical micro robot. Its purpose is to improve the quality of automated tooth preparing for the system and to lay the foundation for clinical application.@*Methods@#Twenty selected artificial resin teeth were used as sample teeth. The micro robot automatic tooth preparation system was used in dental clinic to control the picosecond laser beam to complete two dimensional cutting on the resin tooth sample according to the motion planning path. Using the laser scanning measuring microscope, each layer of cutting depth values was obtained and the average value was calculated. The monolayer cutting depth was determined. The three-dimensional (3D) data of the target resin teeth was obtained using internal scanner, and the CAD data of full-crown tooth preparation was designed by CAD self-develged software. According to the depth of the single layer, 11 complete resin teeth in phantom head were automatically prepared by the robot controlling the laser focused spot in accordance with the layer-cutting way. And the accuracy of resin tooth preparation was evaluated with the software. Using the same method, monolayer cutting depth parameter for cutting dental hard tissue was obtained. Then 15 extracted mandibular and maxillary first molars went through automatic full crown tooth preparation. And the 3D data of tooth preparations were obtained with intra oral scanner. The software was used to evaluate the accuracy of tooth preparation.@*Results@#The results indicated that the single cutting depth of cutting resin teeth and in vitro teeth by picosecond laser were (60.0±2.6) and (45.0±3.6) μm, respectively. Using the tooth preparation robot, 11 artificial resin teeth and 15 complete natural teeth were automatically prepared, and the average time were (13.0±0.7), (17.0±1.8) min respectively. Through software evaluation, the average preparation depth of the occlusal surface of 11 resin teeth was approximately (2.089±0.026) mm, the error was about (0.089±0.026) mm; the average convergence angle was about 6.56°±0.30°, the error was about 0.56°±0.30°. Compared with the target preparation shape, the average shape error of the 11 resin tooth preparations was about 0.02-0.11 mm. And the average preparation depth of the occlusal surface of 15 natural teeth was approximately (2.097±0.022) mm, the error was about (0.097±0.022) mm; the average convergence angle was about 6.98°±0.35°, the error was about 0.98°±0.35°. Compared with the target preparation shape, the average shape error of the 15 natural tooth preparations was about 0.05-0.17 mm.@*Conclusions@#The experimental results indicate that the automatic tooth preparation for resin teeth and the teeth were completed according to the specific parameters of the single cutting depth by the micro robot controlling picosecond laser respectively, its preparation accuracy met the clinical needs. And the suitability of the parameter was confirmed.
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Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy ( EPS) combined with pancreatic duct stent for acute recurrent pancreatitis ( ARP ) caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS ( n=34) and EST group (n=37), respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis (PEP) and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months ( median 21. 5 months) in EPS group and ranged from 5 to 120 months ( median 39 months) in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis(χ2=0. 461, P=0. 497). Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment ( RR=6. 808, 95%CI: 1. 389-33. 356, P=0. 018) and type 2 diabetes ( RR=0. 134, 95%CI:0. 029-0. 608, P=0. 009) were statistically significant factors. There were no significant difference in incidence of PEP (20. 6% in EPS group, 10. 8% in EST group,χ2=1. 294, P=0. 255) and biliary complications between two groups (11. 8% in EPS group, 24. 3% in EST group, χ2=1. 869, P=0. 172). Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.
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Objective To observe the mucosal structure and aberrant crypt foci (ACF) of small and large bowel in rats induced by DMH and to explore the growth and development of small intestinal tumors.Methods Thirty-four male Wistar rats were randomly divided into two groups:DMH-induced group (25 rats) and control group (9 rats).After 30-32 weeks,thess rats were performed with laparotomy,and their small intestine and large intestine were dissected.The mucosa structure and ACF were observed and recorded.The tissues of small intestine and large intestine in control group and the samples of tumor,adjacent normal tissues and ACF tissues in DMH-induced group were subjected to hematoxylin and eosin (H&E) staining and were used to observe histological changes by microscopy.Results The mucosa structure and histological changes of small and large intestine were normal in control group.There were 7 small intestinal tumors and 28 large intestinal tumors in DMH-induced group,respectively.The surface structures of small intestine mucosa and tumor adjacent mucosa were normal.The scattered lymphocytes infiltration was observed in small intestinal mucosa and tissues adjacent to tumor in DMH-induced group,while ACF was observed in large intestinal mucosa and tissues adjacent to tumor in DMH-induced group.Conclusions The occurrence of small intestinal tumors may be induced by some cells directly in the carcinogenesis under the role of the carcinogenic factors in small intestine mucosa with poor tumor differention and high malignancy.The development of small intestinal cancer does not follow the ‘ACF-adenoma-adenocarcinoma' model in large intestine.
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Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholan-gioscopy (PDCS)using an ultra-slim upper endoscopy assisted by a snare.Methods Between November 2014 and January 2015,8 patients underwent PDCS with assistance of an ultra-slim endoscopy.After endo-scopic papillary balloon dilation,the duodenoscopy was withdrew,an ultra-slim endoscopy was inserted di-rectly into the biliary tract assisted by a snare,and biopsy or laser lithotripsy was performed.The snare was closed tightly in the bent portion of the scope,and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation,in order to advance the scope into common bile duct.Results PDCS succeeded in all eight cases,one common hepatic duct adenoma was diagnosed by biopsy,and con-firmed by surgery;one benign biliary stricture was diagnosed by PDCS;laser lithotripsy was successfully per-formed in 4 patients with large CBD stones;bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones.No perforation,bleeding or post-operative pancreatitis was found.Con-clusion PDCS using an ultra-slim gastroscopy assisted by a snare is a safe,simple and practical procedure in the diagnosis and treatment of biliary tract diseases.
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Objective To explore the diagnostic value of barium meal in gastroesophageal reflux disease(GERD).Methods The data of patients who performed barium meal from January 2003 to December 2012 were retrospectively analyzed,and the GERD detection rate and its relationship with gender and age were calculated and compared.The degree and position of reflux during barium meal in 454 patients in 2012 and the relationship between age and degree and symptom of reflux were studied.Results The GERD detection rate was 13.48％(2 743/20 353) from January 2003 to December 2012,and increased by years.The GERD detection rate in male and female were 13.73％(1 312/9 554) and 13.25％(1 431/10 799) respectively,and there was no significant difference (P ＞ 0.05).With the increase of age,the GERD detection rate increased aslo.In patients of age ≤30 years,31-60 years and ≥61 years,the GERD detection rate were 6.87％ (197/2 866),11.63％(1 096/9 421) and 17.98％(1 450/8 066) respectively,and there was significant difference (P ＜ 0.05).The mild reflux accounted for 242 cases,the moderate reflux accounted for 110 cases,and the severe reflux accounted for 102 cases in patients with GERD in 2012,and there was also an aggravating reflux degree with the increase of age.In patients ≤30 years,31-60 years and ≥61 years,the reflux degree were 10.26％(4/39),17.92％(38/212) and 29.56％(60/203) respectively (P ＜ 0.05).The position with left anterior oblique was most often,accounting for 95.37％(433/454).Conclusions Barium meal can be directly observed,and evaluate the degree of reflux and position.Barium meal is simple and intuitive,and can be used as one of GERD diagnostic methods.
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Objective To investigate the feasibility of urethral reconstruction by using stretched electrospun silk fibroin matrices.Methods Stretched electrospun silk fibroin matrix was prepared,and the structure of the material was assessed by electron microscopy.Canine urothelial cells were isolated,expanded and seeded onto the material for 1 week to obtain a tissue-engineered graft.The tissue-engineered graft was assessed using HE staining and electron microscopy scanning.A dorsal urethral mucosa defect was created in 9 female beagle dogs.In the experimental group,tissue-engineered mucosa was used to repair urethral mucosa defects in 6 dogs.No substitute was used in the 3 dogs of the control group.Retrograde urethrography was performed at 1,2 and 6 months after grafting.The urethral grafts were analyzed grossly and histologically.Results Electron microscopy scanning revealed that the material had a 3 dimensional porous structure.Urothelial cells grew on the material and showed good biocompatibility with the stretched silk fibroin matrices.Canines implanted with tissue-engineered mucosa voided without difficulty.Retrograde urethrography revealed no signs of stricture,and histological staining showed gradual epithelial cell development and stratified epithelial layers at 1,2 and 6 months.The canines in the control group showed difficulty in voiding.Retrograde urethrography showed urethral stricture,and histological staining showed that no or only one layer of epithelial cells developed.A severe inflammatory reaction was also observed in the control group.Conclusion Stretched electrospun silk fibroin matrices have good biocompatibility with urothelial cells,and could be a potential material for urethral reconstruction.
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Objective To compare the medical economics and safety of colonic metallic stent implantation as a bridge to elective resection with traditional emergency resection.Methods Data of colonic cancer obstruction cases in emergency room from 2008 to 2013 were retrospectively analyzed and divided into stent group(colonic stent as a bridge to surgery) and control group(emergency surgery).Main parameters between the two groups were compared,including surgery-associated mortality and morbidity,colostomy rate and re-anastomosis rate,ICU admitted rate,average days and costs in hospital,and colonic stent insertion associated clinical success rate and mortality.Results Ten and 11 patients were included in stent group and control group respectively.Surgery associated morbidity and colostomy rates were both 0 in stent group,and 18.2％ and 100.0％ in control group.Days of hospitalization and costs were 23 days and 67 742 Yuan in stent group,and 49 days and 92 553 Yuan in control group.The surgery associated mortality rates both were 0 in the two groups.ICU admitted rates were 20％ and 18％ respectively.Conclusion Colonic stenting as a bridge to surgery has a high clinical success rate and has a lower morbidity and colostomy rate,shorter hospitalization days,less cost compared with traditional emergency surgery.This strategy for colonic cancer obstruction is of safety and great health economic value.
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Objective To explore the clinical significance of typical reflux symptoms in the diagnosis of gastroesophageal reflux disease (GERD).Methods Consecutive patients older than 16 years,who initially visited department of gastroenterology at clinic of Peking University Third Hospital from May 9,2012 to Dec 31,2012,were required to complete a self-reported GERD questionnaire.Upper endoscopy was performed in some selected patients.Results A total of 18 987 patients were enrolled with a response rate of 91.5％.The prevalence of symptom-defined GERD was 13.6％ (2 579/18 987).A total of 4 357 (22.9％) patients underwent the upper endoscopy,and the diagnostic rates of reflux esophagitis,Barrett's esophagus,peptic ulcer disease,and upper gastrointestinal malignancy were 13.1％ (572/4 357),1.8％ (78/4 357),10.5％ (456/4 357),and 1.7％ (75/4 357),respectively.The incidence of reflux esophagitis was 22.7％ (216/951) in patients with reflux symptoms and 10.5％ (356/3 406) (P ＜0.001) in patients without reflux symptoms,2.7％ (26/951) and 1.5 ％ (52/3 406),respectively (P =0.013) for Barrett's esophagus; 6.8％ (65/951) and 11.5％ (391/3 406),respectively (P＜0.001) for peptic ulcer disease; 1.7％ (16/951) and 1.7％ (59/3 406),respectively (P =0.917) for upper gastrointestinal malignancy.Conclusions GERD is one of the major diseases at gastroenterology clinic.Typical reflux symptoms suggest a diagnosis of GERD.But some patients with peptic ulcer disease or upper gastrointestinal malignancy can also present typical reflux symptoms.Upper endoscopy is valuable to avoid the misdiagnosis of other disorders.
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Objective To study the differences of esophageal manometry (M),pH set-up method (P) and X-ray (X) on positioning of the 24-hour esophageal pH catheter and relative factors. Methods Fifty subjects underwent M, then pH catheter was located by P and X. The difference between methods and the relative factors such as body height,lower esophageal sphincter (LES) length etc were analyzed. The difference of less than 2 cm between two methods was accepted. Results The length between the location determined by M,Pand X and nose were (37.9 ±2.9),(40.8 ±4.4) and (40.7 ±5.3) cm, respectively.There was significant difference between P and M as well as between X and M (P＜ 0.01 ). The coincidence rate was 62.0%(31/50) between P and M;84.0%(42/50) between P and X;and 58.0%(29/50) between X and M. Compared with P,M was (2.9 ±3.9) cm nearer to the stomach. Age, body height and LES length were main factors which affect the difference between P and M (P＜ 0.01 or ＜ 0.05),body height and LES length were main factors which affect the difference between X and M (P＜0.05 or ＜0.01). Conclusions Compared with M, the location determined by P is nearer to stomach. The location of X is varied. Body height and LES length are main relative factors.