Endoscopic retrograde cholangiopancreatography (ERCP) is efficacious in patients who have undergone Billroth II gastroenterostomies, but the success rate decreases in patients who also have experienced Braun anastomos...Endoscopic retrograde cholangiopancreatography (ERCP) is efficacious in patients who have undergone Billroth II gastroenterostomies, but the success rate decreases in patients who also have experienced Braun anastomoses. There are currently no reports describing the preferred enterography route for cannulation in these patients. We first review the patient’s previous surgery records, which most often indicate that the efferent loop is at the greater curvature of the stomach. We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the “lower entrance” at the site of the gastrojejunal anastomosis, along the efferent loop, and through the “middle entrance” at the site of the Braun anastomosis to reach the papilla of Vater. Ten patients who had each undergone Billroth II gastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study. The overall success rate of enterography was 90% for the patients who had undergone Billroth II gastroenterostomy and Braun anastomosis, and the therapeutic success rate was 80%. We believe that this enterography route for ERCP is optimal for a patient who has had Billroth II gastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.展开更多
AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroe...AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.展开更多
Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients follow...Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla.No complications occurred during the operation or during the postoperative period.This method didn't need second incubation an endoscope and might lower the burden of patients.So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience.展开更多
Background Children with intestinal failure(IF)have frequent catheter-related bloodstream infections(CRBSIs).This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with I...Background Children with intestinal failure(IF)have frequent catheter-related bloodstream infections(CRBSIs).This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with IF.Methods This 6-year retrospective study was conducted among IF children with CRBSIs at an intestinal rehabilitation center in China.Clinical data were collected,including data of temperature and gastrointestinal symptoms.Blood/catheter culture,fecal tests,and calculation of inflammatory index were performed,which were obtained within 1 week since CRBSI onset.Results Fifty children with 87 CRBSIs were identified,of which there were 17 suspected and 70 confirmed cases.Seventy-two pathogens were cultured from 70 positive blood cultures:63%were Gram-positive organisms,23%were Gram-negative organisms,and 11%were fungal organisms.Overall,48.6%were enteric organisms;47.2%of bacterial pathogens were consistent between fecal and blood cultures.Moreover,46.3%fecal routines showed abnormalities including increased white blood cells,occult blood positive and the presence of fat droplets.The consistent symptom at onset of CRBSIs was fever and gastrointestinal symptoms including increased stool output,abdominal distension,or both.C-reactive protein(CRP)and procalcitonin(PCT)were elevated,i.e.,16.5 mg/L[interquartile range(IQR)8.7-44.7]and 0.48 ng/mL(IQR 0.2-1.76),respectively.Conclusions IF children had a high rate of CRBSIs,of which larger proportions were due to Gram-positive and enteric organisms.Fever and/or gastrointestinal symptoms,combined with elevated CRP and PCT,is conducive to the early diagnosis of CRBSIs in IF patients.展开更多
Background:Endotoxin tolerance(ET)is a protective phenomenon in which pre-treatment with a tolerance dose of lipopolysaccharide(LPS)leads to dramatically elevated survival.Accumulating evidence has shown that peripher...Background:Endotoxin tolerance(ET)is a protective phenomenon in which pre-treatment with a tolerance dose of lipopolysaccharide(LPS)leads to dramatically elevated survival.Accumulating evidence has shown that peripheral T cells contribute to the induction of ET.However,what happens to T cell development in the thymus under ET conditions remains unclear.The purpose of this study was to analyze the alterations in thymocyte populations(double-positive[DP]and single-positive[SP]cells)under ET conditions.Methods:Mice were intraperitoneally injected with LPS at a concentration of 5 mg/kg to establish an LPS tolerance model and were divided into two groups:a group examined 72 h after LPS injection(72-h group)and a group examined 8 days after LPS injection(8-day group).Injection of phosphate-buffered saline was used as a control(control group).Changes in thymus weight,cell counts,and morphology were detected in the three groups.Moreover,surface molecules such as CD4,CD8,CD44,CD69,and CD62L were analyzed using flow cytometry.Furthermore,proliferation,apoptosis,cytokine production,and extracellular signal-regulated kinase(ERK)pathway signaling were analyzed in thymocyte populations.The polymorphism and length of the T-cell receptor(TCR)P chain complementarity-determining region 3(CDR3)were analyzed using capillary electrophoresis DNA laser scanning analysis(ABI 3730).Results:Thymus weight and cell counts were decreased in the early stage but recovered by the late stage in a murine model of LPS-induced ET.Moreover,the proportions of DP cells(control:72.130±4.074,72-h:10.600±3.517,8-day:84.770±2.228),CD4+SP cells(control:15.770±4.419,72-h:44.670±3.089,8-day:6.367±0.513),and CD8+SP cells(control:7.000±1.916,72-h:34.030±3.850,8-day:5.133±0.647)were obviously different at different stages of ET.The polymorphism and length of TCR β chain CDR3 also changed obviously,indicating the occurrence of TCR rearrangement and thymocyte diversification.Further analysis showed that the expression of surface molecules,including CD44,CD69,and CD62L,on thymocyte populations(DP and SP cells)were changed to different degrees.Finally,the proliferation,apoptosis,cytokine production,and ERK pathway signaling of thymocyte populations were changed significantly.Conclusion:These data reveal that alterations in thymocyte populations might contribute to the establishment of ET.展开更多
基金Supported by Shanghai Education Commission Scientific Research and Innovation ProjectNo.11YZ55
文摘Endoscopic retrograde cholangiopancreatography (ERCP) is efficacious in patients who have undergone Billroth II gastroenterostomies, but the success rate decreases in patients who also have experienced Braun anastomoses. There are currently no reports describing the preferred enterography route for cannulation in these patients. We first review the patient’s previous surgery records, which most often indicate that the efferent loop is at the greater curvature of the stomach. We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the “lower entrance” at the site of the gastrojejunal anastomosis, along the efferent loop, and through the “middle entrance” at the site of the Braun anastomosis to reach the papilla of Vater. Ten patients who had each undergone Billroth II gastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study. The overall success rate of enterography was 90% for the patients who had undergone Billroth II gastroenterostomy and Braun anastomosis, and the therapeutic success rate was 80%. We believe that this enterography route for ERCP is optimal for a patient who has had Billroth II gastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.
基金Supported by Leading Talent program of Shanghai,Sailing program of Shanghai science and technology commission NO.14YF1403000
文摘AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.
基金Supported by National Natural Science Foundation of China,No. 30900671Shanghai Natural Science Foundation,No. 09ZR1419700
文摘Successful cannulation of the common bile duct may be difficult in patients in whom the papilla is located entirely within a diverticulum.In this study,we report successful biliary cannulation in three patients following intubation of the distal tip of the duodenoscope into the duodenal diverticulum and locating the major papilla.No complications occurred during the operation or during the postoperative period.This method didn't need second incubation an endoscope and might lower the burden of patients.So this skill is useful to deal with the papilla hidden inside the large diverticulum because of its safety and convenience.
基金This study is supported by National Natural Science Foundation of China(Nos.81974066,81630039)Foundation of Shanghai Municipal Health Commission(Key Weak Discipline Construction Project,2019ZB0101)+2 种基金Foundation of Shanghai Municipal Health Commission(No.shslczdzk05702)Foundation of Science and Technology Commission of Shanghai Municipality(No.19495810500)Foundation of Clinical Research Plan of SHDC(No.SHDC2020CR2010A).
文摘Background Children with intestinal failure(IF)have frequent catheter-related bloodstream infections(CRBSIs).This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with IF.Methods This 6-year retrospective study was conducted among IF children with CRBSIs at an intestinal rehabilitation center in China.Clinical data were collected,including data of temperature and gastrointestinal symptoms.Blood/catheter culture,fecal tests,and calculation of inflammatory index were performed,which were obtained within 1 week since CRBSI onset.Results Fifty children with 87 CRBSIs were identified,of which there were 17 suspected and 70 confirmed cases.Seventy-two pathogens were cultured from 70 positive blood cultures:63%were Gram-positive organisms,23%were Gram-negative organisms,and 11%were fungal organisms.Overall,48.6%were enteric organisms;47.2%of bacterial pathogens were consistent between fecal and blood cultures.Moreover,46.3%fecal routines showed abnormalities including increased white blood cells,occult blood positive and the presence of fat droplets.The consistent symptom at onset of CRBSIs was fever and gastrointestinal symptoms including increased stool output,abdominal distension,or both.C-reactive protein(CRP)and procalcitonin(PCT)were elevated,i.e.,16.5 mg/L[interquartile range(IQR)8.7-44.7]and 0.48 ng/mL(IQR 0.2-1.76),respectively.Conclusions IF children had a high rate of CRBSIs,of which larger proportions were due to Gram-positive and enteric organisms.Fever and/or gastrointestinal symptoms,combined with elevated CRP and PCT,is conducive to the early diagnosis of CRBSIs in IF patients.
基金the Project of the Guizhou Provincial Department of Science and Technology(No.QKH-JC-2018-1428)the National Natural Science Foundation of China(No.31760258)the Guizhou Province Graduate Research Fund(No.YJSCXJH-2020-093).
文摘Background:Endotoxin tolerance(ET)is a protective phenomenon in which pre-treatment with a tolerance dose of lipopolysaccharide(LPS)leads to dramatically elevated survival.Accumulating evidence has shown that peripheral T cells contribute to the induction of ET.However,what happens to T cell development in the thymus under ET conditions remains unclear.The purpose of this study was to analyze the alterations in thymocyte populations(double-positive[DP]and single-positive[SP]cells)under ET conditions.Methods:Mice were intraperitoneally injected with LPS at a concentration of 5 mg/kg to establish an LPS tolerance model and were divided into two groups:a group examined 72 h after LPS injection(72-h group)and a group examined 8 days after LPS injection(8-day group).Injection of phosphate-buffered saline was used as a control(control group).Changes in thymus weight,cell counts,and morphology were detected in the three groups.Moreover,surface molecules such as CD4,CD8,CD44,CD69,and CD62L were analyzed using flow cytometry.Furthermore,proliferation,apoptosis,cytokine production,and extracellular signal-regulated kinase(ERK)pathway signaling were analyzed in thymocyte populations.The polymorphism and length of the T-cell receptor(TCR)P chain complementarity-determining region 3(CDR3)were analyzed using capillary electrophoresis DNA laser scanning analysis(ABI 3730).Results:Thymus weight and cell counts were decreased in the early stage but recovered by the late stage in a murine model of LPS-induced ET.Moreover,the proportions of DP cells(control:72.130±4.074,72-h:10.600±3.517,8-day:84.770±2.228),CD4+SP cells(control:15.770±4.419,72-h:44.670±3.089,8-day:6.367±0.513),and CD8+SP cells(control:7.000±1.916,72-h:34.030±3.850,8-day:5.133±0.647)were obviously different at different stages of ET.The polymorphism and length of TCR β chain CDR3 also changed obviously,indicating the occurrence of TCR rearrangement and thymocyte diversification.Further analysis showed that the expression of surface molecules,including CD44,CD69,and CD62L,on thymocyte populations(DP and SP cells)were changed to different degrees.Finally,the proliferation,apoptosis,cytokine production,and ERK pathway signaling of thymocyte populations were changed significantly.Conclusion:These data reveal that alterations in thymocyte populations might contribute to the establishment of ET.
