Most of study regarding periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) therapy for choledocholithiasis based on data from one endoscopy center and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical patients.To compare the choledocholithiasis clinical characteristics between two regional endoscopy centers and analyze impacts of clinical characteristics on ERCP methods for choledocholithiasis patients with PAD.Patients seen in two endoscopy centers (The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China, and Kyoto Second Red Cross Hospital, Kyoto, Japan) underwent ERCP treatment for the first time between January 2012 and December 2017. The characteristics of choledocholithiasis with PAD were compared between the two centers, and their ERCP procedures and therapeutic outcomes were analyzed.A total of 829 out of 3608 patients in the Lanzhou center and 241 out of 1198 in the Kyoto center had choledocholithiasis with PAD. Lots of clinical characteristics were significantly different between the two centers. The common bile duct (CBD) diameter was wider, choledocholithiasis size was lager and multiple CBD stones were more in the Lanzhou center patients than those in the Kyoto center patients (14.8 ± 5.2 mm vs 11.6 ± 4.2 mm, 12.2 ± 6.5 mm vs 8.2 ± 5.3 mm, 45.3% vs 20.3%, P < 0.001 for all). In addition, concomitant diseases, such as acute cholangitis, gallbladder stones, obstructive jaundice, cholecystectomy, and acute pancreatitis, were significantly different between the two centers (P = 0.03 to < 0.001). In the Lanzhou center, CBD diameter and choledocholithiasis size were lower, and multiple CBD stones and acute cholangitis were less in non-PAD patients than those in PAD patients (13.4 ± 5.1 mm vs 14.8 ± 5.2 mm, 10.3 ± 5.4 mm vs 12.2 ± 6.5, 39% vs 45.3%, 13.9% vs 18.5%, P = 0.002 to < 0.001). But all these characteristics were not significantly different in the Kyoto center. The proportions of endoscopic sphincterotomy (EST), endoscopic balloon dilatation (EPBD), and EST+EPBD were 50.5%, 1.7%, and 42.5% in the Lanzhou center and 90.0%, 0.0%, and 0.4% in the Kyoto center, respectively. However, the overall post-ERCP complication rate was not significantly different between the two centers (8.9% in the Lanzhou and 5.8% in the Kyoto. P = 0.12). In the Lanzhou center, the difficulty rate in removing CBD stones in PAD was higher than in non-PAD group (35.3% vs 26.0%, P < 0.001). But the rate was no significant difference between the two groups in Kyoto center. The residual rates of choledocholithiasis were not significantly different between the two groups in both centers. Post-ERCP complications occurred in 8.9% of the PAD patients and 8.1% of the non-PAD patients in the Lanzhou Center, and it occurred in 5.8% in PAD patients and 10.0% in non-PAD patients in the Kyoto center, all P > 0.05.Many clinical characteristics of choledocholithiasis patients with PAD were significantly different between the Lanzhou and Kyoto centers. The patients had larger and multiple stones, wider CBD diameter, and more possibility of acute cholangitis and obstructive jaundice in the Lanzhou center than those in the Kyoto center. The ERCP procedures to manage native duodenal papilla were different depending on the different clinical characteristics while the overall post-ERCP complications were not significantly different between the two centers. The stone residual rate and post-ERCP complications were not significantly different between choledocholithiasis patients with PAD and without PAD in each center.
Objective
To evaluate the clinical efficacy and safety of conversion-controlled multi-electrode radiofrequency ablation (RFA) in the treatment of liver tumors.
Methods
Clinical data of 21 patients with liver tumors who received conversion-controlled multi-electrode RFA in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017 were retrospectively analyzed. Among them, 17 patients were male and 4 were female, aged 31-85 years old with a median age of 56 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The multi-electrode radiofrequency needle was punctured to the tumor margin according to the preoperative model with the guidance of ultrasound. RFA was performed after confirming that the tumor margin was within the ablation range of needle. the ablation effect was evaluated at postoperative 1 month by receiving ultrasound and enhanced CT/MRI examination. Postoperative complications and tumor progression were observed.
Results
A total of 26 lesions were detected in 21 cases. At postoperative 1 month, the peripheral residuals were detected in 4 lesions. The complete ablation rate was 85%. The complete ablation rate for lesions <3 cm of diameter was 100%(5/5), and was 81%(17/21) for lesions with a diameter ≥3 cm. 2 cases developed mild skin burns, 1 case transient myoglobinuria and postoperative acute kidney injury, and 1 case obstructive jaundice, all of which were cured with symptomatic treatments. The follow-up time was 14(4-22) months. Tumor recurrence were observed in 4 cases during the follow-up period.
Conclusions
The conversion-controlled multi-electrode RFA system can completely include the tumors in the ablation range by constructing a needle array preoperatively, which can effectively avoid the signal interference when repeatedly placing the needle and avoid the possible needle track metastasis. It has the advantage of good ablation effect, expecially for large unresectable liver tumors.
Key words:
Liver neoplasms; Ablation techniques; Treatment outcome
Objective To systematically evaluate the therapeutic effect of gastroesophageal devascularization( GD),portasystemic shunt( PSS),devascularization plus portasystemic shunt ( GD + PSS) for the treatment of 4250 cirrhotic portal hypertension cases reported in Chinese literature. Methods The literatures about the effect of gastroesophageal devascularization,portasystemic shunt,devascularization plus portasystemic shunt on portal hypertension were collected from Wanfang databases, China National Knowledge Infrastructure(CNKI) from 1980 to 2011.RevMan 4.2 and SPSS 13.0 were used for data analysis. Results In this study 17 reports were enrolled into the meta-analysis.The results of the mta-analysis showed that long term survival rate in the group of GD plus PSS was higher than that in group of GD [OR=1.73,95％CI (1.23,2.44),P ＜0.01].That in group of PSS was similar with the group of GD [ OR =0.87,95 ％ CI (0.63,1.20),P =0.40 ].That of group GD plus PSS was similar with the group of PSS [ OR =1.73,95％ CI (0.95,3.13),P =0.07 ].For recurrent variceal bleeding rate,that in group of PSS was lower than that in the group of GD[ OR =0.46,95％ CI (0.35,0.61 ),P ＜0.01 ].That in the group of GD plus PSS was lower than that in the group of GD [ OR =0.25,95％ CI (0.18,0.35),P ＜ 0.01 ].The group of GD plus PSS was similar to that of group of PSS [ OR =0.72,95％ CI ( 0.40,1.29 ),P =0.27 ].Encephalopathy rate was higher in the group of PSS than the group of GD [ OR =3.57,95％ CI (2.43,5.23 ),P ＜0.01 ].That in group of GD plus PSS was lower than that in the group of PSS[ OR =0.37,95％ CI (0.20,0.69),P ＜0.01 ],while that in GD plus PSS was similar to the group of GD[ OR =1.58,95％ CI (1.02,2.43),P =0.04 ]. Conclusions The only significant factor influencing the long term result in Chinese patients with portal hypertension is preoperative liver function.The three types of operation have different benefits and disadvantages.
Key words:
Hypertension,portal; Esophageal and gastric varices; Portasystemic shunt,surgical; Meta-analysis; Devascularization
Abstract Wild barley ( Hordeum brevisubulatum ) is a grass that inhabits alkalized meadows in northern China. An asexual Epichloë bromicola endophyte was detected in seeds and leaf sheaths in all wild barley samples from Gansu Province, China. In this research, we determined the effects of the E. bromicola endophyte on growth, physiological properties and seed germination of wild barley under salt stress through a set of experiments. Our results demonstrate that endophyte‐infected (E+) plants produced more tillers, higher biomass and yield, higher chlorophyll content and superoxide dismutase activity than endophyte‐free (E−) plants under high salt stress. Seed germination parameters of E+ biotype were significantly higher than those of E− plants when NaCl concentration reached 200 and 300 mM. Our results demonstrate that E. bromicola endophytes increased tolerance to salt stress in wild barley by increasing seed germination and growth, and altering plant physiology.
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