A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging.

BACKGROUND: Periampullary diverticulum (PAD) may make the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis more difficult and may increase complication rates. The present study evaluated the effects of PAD on first-time ERCP in patients with choledocholithiasis. METHODS: Outcomes were compared in patients with and without PAD and in those with four types of PAD: papilla located completely inside the diverticulum (type I), papilla located in the inner (type II a) and outer (type II b) margins of the diverticulum; and papilla located outside the diverticulum (type III). Parameters compared included cannulation time and rates of difficult cannulation, post-ERCP pancreatitis (PEP) and perforation. RESULTS: The median cannulation times in patients with types I, II a, II b, III PAD and in those without PAD were 2.0 min, 5.0 min, 0.67 min, 3.5 min, and 3.5 min, respectively, with difficult cannulation rates in these groups of 7.4%, 31.4%, 8.3%, 18.9%, and 23.2%, respectively. The rates of PEP in patients with and without PAD were 5.3% and 5.1%, respectively. Four patients with and one without PAD experienced perforation. CONCLUSIONS: The division of PAD into four types may be more appropriate than the traditional division into three types. Cannulation of type I and II b PAD was easier than cannulation of patients without PAD, whereas cannulation of type II a PAD was more challenging. PAD may not increase the rates of PEP.

Reconsidering treatment guidelines for acute myocardial infarction during the COVID-19 pandemic.

BACKGROUND: COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes. METHODS: We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January-February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January-February 2020; Group 2, n = 124). RESULTS: For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001). CONCLUSIONS: COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment.

Prevalence of depression and the association between depressive symptoms and dietary behaviors among students in Beijing / 中国学校卫生

Objective@#To investigate the relationship between depressive symptoms and dietary behaviors among middle school and college students in Beijing，so as to provide the basis for carrying out related research and intervention.@*Methods@#A total of 18 130 middle school and college students from 16 districts in Beijing were collected through stratified cluster sampling from October to December, 2020. The relationship between middle school and college students depressive symptoms and dietary behaviors was analyzed by conducting a questionnaire.@*Results@#The detection rate of depressive symptoms was 18.2%. The detection rate of depressive symptoms in girls was 19.0%, which was higher than 17.4% in boys( P <0.05), and the differences were of statistical significance( χ 2=8.47, P <0.01). The detection rate of depressive symptoms in city was 17.9%, and in 10 urban areas was 18.5 %( P > 0.05 ), and the differences were of statistical significance( χ 2=1.15, P =0.28). The detection rates of depressive symptoms in vocational high school (21.8%) and high school students(20.6%) were and, higher than that in college students (18.2%) and in junior high school students(15.2%), and the differences were of statistical significance( χ 2=100.38, P <0.01). The rates of students with depressive symptoms drinking sugary drinks(14.4%), eating sweets (22.1%) and eating fried foods every day (12.4%) were higher than that of students without depressive symptoms(7.6%, 12.0%, 5.9%), and the differences were of statistical significance( χ 2=154.62, 215.67, 164.49, P <0.01). The rates of eating fresh fruits(63.3%), vegetables (81.7%) and breakfast every day (53.4%) of the students with depressive symptoms were lower than those without depressive symptoms (72.0%, 88.1%, 74.1%), and the differences were of statistical significance( χ 2=90.77, 90.59, 518.69, P <0.01) Logistic regression analysis showed that the detection rate of depression was the important factor of influencing dietary behaviors( P <0.05).@*Conclusion@#The detection rates of depressive symptoms of vocational high school students and senior high school students in Beijing are higher than those of junior high school students and college students. Depression is closely related to dietary behaviors. Promoting students mental health may help promote students healthy eating.

Diagnosis and treatment strategies for acute biliary infection during the epidemic period of COVID-19 / 解放军医学杂志

Acute biliary infection is one of the common causes of acute abdomen, easily causes severe infection and even death. The reasonable treatment of the acute phase is very important. The sudden outbreak of corona virus disease (COVID-19) has posed severe challenges to the country's economic and social life, and has also led to an extreme shortage of medical resources. The diagnosis and treatment of acute biliary infections disease also face challenges. In order to control the epidemic of infectious diseases, we write this article from the perspective of prevention and controlling of COVID-19, referring to the Tokyo Guidelines 2018 to express our views on the diagnosis and treatment strategies for acute biliary infection, hoping to do our best to prevent and control the epidemic of COVID-19.

Sublocalization of Rab23, a mediator of Sonic hedgehog signaling pathway, in hepatocellular carcinoma cell lines.

The novel member of the Rab family of GTPases, Rab23, is an essential negative regulator of the Sonic hedgehog (Shh) signaling pathway. Loss of function mutation of the Rab23 gene causes abnormal development of the neural tube in mice and in certain human congenital diseases. The aberrant overexpression of Rab23 has been associated with various diseases, such as gastric, hepatocellular and lung cancer. The exact function of Rab23 in hepatocellular carcinomas (HCCs), however, remains unknown. Previously, we reported the abnormal sublocalization of Rab23 in lung cancers. In the current study, we investigated the role of Rab23 in HCCs. We report the distinct sublocalization pattern of Rab23 in HCC cell lines. This difference depends on the GDP/GTP-binding form, and inhibition of the Rab23 cycle decreases the expression and nuclear localization of Gli1.