Retrogradation of semi-dry rice noodles severely reduced their eating quality during storage.Three commonly used modified starches(oxidized starch,acetylated starch,and hydroxypropyl starch)were applied to investigate...Retrogradation of semi-dry rice noodles severely reduced their eating quality during storage.Three commonly used modified starches(oxidized starch,acetylated starch,and hydroxypropyl starch)were applied to investigate the anti-retrogradation effects of semi-dry rice noodles during cold storage.Loss of water content,migration of water,and increase in relative crystallinity,retrogradation enthalpy,and hardness could be retarded by adding chemically modified starches,especially hydroxypropyl starches.The effect of hydroxypropyl starch addition levels(2%,4%,6%,8%,and 10%)on the properties of rice flour and the edible quality of semi-dry rice noodles was further evaluated.The water solubility index of rice flour decreased with the addition of hydroxypropyl starch,while the swelling power showed the opposite trend.The quality of semi-dry rice noodles were improved with the addition of hydroxypropyl starch.Compared to the control,semi-dried rice noodles with 8%hydroxypropyl starch possessed superior properties,i.e.lower cooking loss(decreasing from 12.89%to 6.62%),lower adhesiveness(decreasing from 5.40 to 4.31 g·s),and higher hardness(rising from 10.89 to 13.81 N).These findings demonstrated that the incorporation of hydroxypropyl starch is a promising strategy for the preparation of semi-dry rice noodles with satisfactory cooking and edible qualities as well as a long shelf life.展开更多
To lower the retrogradation and digestibility of waxy corn starch for different food applications,a novel thermostable GtfC type 4,6-α-glucanotransferase without N-and C-terminals(GsGtfC)from Geobacillus sp.12AMOR1 w...To lower the retrogradation and digestibility of waxy corn starch for different food applications,a novel thermostable GtfC type 4,6-α-glucanotransferase without N-and C-terminals(GsGtfC)from Geobacillus sp.12AMOR1 was used.Waxy corn starch of 50 g/L was incubated with GsGtfC of 40-100 U/g substrate at 65℃and pH 5.5 for 1 h.Its molecular weight,iodine affinity,XRD crystallinity,and FTIR ratio of heights of bands at 1047 and 1022 cm^(-1) decreased,but ratio of DP<6 to DP≥25 branches and degree of branching increased.GsGtfC cleavedα-1,4-glycosidic bonds and inducedα-1,6-branching points to produce reuteran-likes polymers,which is different from Exiguobacterium sibiricum GtfC enzyme cleavingα-1,4-glycosidic bonds and synthesizing consecutiveα-1,6-glycosidic bonds to produce isomalto/malto-oligosaccharides.GsGtfC modified waxy corn starch had significantly lower DSC retrogradation enthalpies during the storage at 4℃for 3-14 days and significantly lower released glucose during the incubation with mammalian mucosalα-glucosidase at 37℃for 10-360 min.GsGtfC at 100 U/g substrate increased slowly digestible portion from 11.07%to 24.11%.展开更多
The polysaccharides, such as κ-carrageenan, ι-carrageenan, agarose (agar), gellan gum, amylose, curdlan, alginate, and deacetylated rhamsan gum, in water changed into an ice-like structure with hydrogen bonding betw...The polysaccharides, such as κ-carrageenan, ι-carrageenan, agarose (agar), gellan gum, amylose, curdlan, alginate, and deacetylated rhamsan gum, in water changed into an ice-like structure with hydrogen bonding between polymer and water molecules, and between water-water molecules even at a concentration range of 0.1% - 1.0% (W/V) at room temperature, resulting in gelation. Such dramatic changes from liquid into gels have been understood at the molecular level in principles. In this review, we describe the structure-function relationship of starch on the view point of rheological aspects and discuss gelatinization and retrogradation mechanism including water molecules at molecular level. The starch molecules (amylose and amylopectin) play a dominant role in the center of the tetrahedral cavities occupied by water molecules, and the arrangement is partially similar to a tetrahedral structure in a gelatinization process. The arrangement should lead to a cooperative effect stabilizing extended regions of ice-like water with hydrogen bonding on the surface of the polymer molecules, where hemiacetal oxygen and hydroxyl groups might participate in hydrogen bonding with water molecules. Thus, a more extended ice-like hydrogen bonding within water molecules might be achieved in a retrogradation process. Though many investigations not only include starch gelatinization and retrogradaion, but also the gelling properties of the polysaccharides have been undertaken to elucidate the structure-function relationship, no other researchers have established mechanism at the molecular level. There is reasonable consistency in our investigations.展开更多
The heat intolerance and retrogradation behavior of native wheat starch(WS)are undesirable for starch-based gel foods,therefore the combinations of WS and hydrocolloids have attracted extensive attentions.The objectiv...The heat intolerance and retrogradation behavior of native wheat starch(WS)are undesirable for starch-based gel foods,therefore the combinations of WS and hydrocolloids have attracted extensive attentions.The objectives of this study were to investigate the effects of konjac glucomannan(KGM)with different degree of deacetylation(DD)on the pasting,rheological and retrogradation properties of WS.Results showed that deacetyl-konjac glucomannan(DKGM)increased the peak viscosity(PV),trough viscosity(TV)and final viscosity(FV),while decreased the breakdown(BD)values of WS,suggesting the enhancement of the viscosity and thermal stability of WS paste.The raised storage modulus(G′)of WS gels with DKGM1(DD,48.23%)demonstrated that the partial removal of acetyl groups from KGM chains effectively promoted the formation of gel network,accompanied by increased elasticity.After storing at 4℃ for 7 days,the hardness of gels increased up 369%,while supplement with DKGM significantly(p<0.05)decreased the hardness.These data demonstrated that DKGM delayed the process of starch retrogradation,which was further verified by LF-NMR analysis.Besides,the addition of DKGM reduced the retrogradation rate,relative crystallinity and the orderliness of WS-DKGM gels with the prolonging of storage at 4℃,all validating the hindrance of starch retrogradation by DKGM.Therefore,these data suggested that partial deacetylation of KGM could effectively improve the pasting,rheological characteristics and impede the retrogradation of WS.展开更多
BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement impro...BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.展开更多
High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatograph...High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.展开更多
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a...This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.展开更多
BACKGROUND Strongyloides stercoralis(S.stercoralis),is a prevalent parasitic worm that infects humans.It is found all over the world,particularly in tropical and subtropical areas.Strongyloidiasis is caused mostly by ...BACKGROUND Strongyloides stercoralis(S.stercoralis),is a prevalent parasitic worm that infects humans.It is found all over the world,particularly in tropical and subtropical areas.Strongyloidiasis is caused mostly by the parasitic nematode S.stercoralis.Filariform larvae typically infest humans by coming into contact with dirt,such as by walking barefoot or through exposure to human waste or sewage.CASE SUMMARY A 35-year-old male presented to our department with a 10-year history of abdominal pain and diarrhea,which had recently recurred for the past 3 months.A computed tomography(CT)scan revealed acute cholecystitis accompanied by a gallbladder stone.Additionally,a 5 mm stone was found obstructing the lower portion of the common bile duct,resulting in dilatation of both the intrahepatic and extrahepatic bile ducts to 8 mm,in contrast to a previous CT scan.Endoscopic ultrasonography revealed a prominent echogenicity in the lower portion of the common bile duct.Consequently,an endoscopic retrograde cholangiopancreatography was conducted via endoscopic sphincterotomy and balloon dilatation.The microscope revealed the presence of viable S.stercoralis rhabditiform larvae in the biliary fluid.We documented an uncommon instance of S.stercoralis infection in the biliary fluid of a patient suffering from gallstones and cholangitis.CONCLUSION The film we created provides a visual representation of the movement of the living S.stercoralis in biliary fluid.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retro...Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retrospectively analyzed 190 patients who underwent ERCP and found that gastrointestinal obstruction,jaundice,opioid use,female sex,and primary diseases were in-dependent predictors and risk factors of preoperative gastric retention.Based on these findings and comprehensive analysis,a proposed predictive model offers clinicians valuable tools to tailor preoperative strategies,improving the proce-dural safety and efficacy of ERCP.Despite having several limitations,like single-center design and limited generalizability,the study marks a significant advan-cement in optimizing ERCP outcomes through predictive analytics.Further research with larger populations and prospective designs is warranted to establish these findings.展开更多
BACKGROUND Palliative care for unresectable pancreatic cancer(PC)focuses mainly on the symptoms of the disease,including abdominal pain,obstructive jaundice,and malnutrition.Biliary stent placement using endoscopic re...BACKGROUND Palliative care for unresectable pancreatic cancer(PC)focuses mainly on the symptoms of the disease,including abdominal pain,obstructive jaundice,and malnutrition.Biliary stent placement using endoscopic retrograde cholangiopan-creatography(ERCP)to relieve biliary obstruction has become an internationally recognized treatment.Although a few studies have evaluated the efficacy of endoscopic pancreatic duct stenting in advanced PC,no consensus exists on the use of endoscopic treatment to relieve pain and improve nutritional status.METHODS Patients with unresectable PC were recruited.The participants were randomized into two groups:The double-stent group underwent ERCP with a fully-covered self-expandable metallic biliary stent(FCSEMS)and a pancreatic duct stent,while the single-stent group underwent ERCP with an FCSEMS only.Abdominal pain,nutritional status,and incidence of adverse events were compared between the two groups using the SPSS software.RESULTS Seventy-eight patients with unresectable PC were included in the analysis(40 and 38 in the double-and single-stent groups,respectively).The median pain scores of patients in the double-stent group were lower than those in the single-stent group at 1(0 vs 2.5,P=0.002),2(0 vs 3,P<0.001),3(0 vs 4,P<0.001),and 6 months(0 vs 4,P<0.001)after ERCP.Total serum protein levels in patients in the double-stent group were higher than those in the single-stent group(66.6±8.4 g/L vs 60.4±4.0 g/L,P=0.046)6 months postoperatively.The body mass index(BMI)of patients in both groups decreased at six months.However,the BMI in the single-stent group was higher than that in the double-stent group(P<0.001).CONCLUSION Early pancreatic duct stenting reduces abdominal pain and improves nutritional status in patients with unre-sectable PC without reducing the technical success rate or increasing the incidence of adverse events.展开更多
BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improveme...BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
Implementing the flyby to Near-Earth Asteroids (NEAs) with the potential impact risks to the Earth allows for obtaining detailed physical parameters, thereby supporting the high-precision orbit prediction and planetar...Implementing the flyby to Near-Earth Asteroids (NEAs) with the potential impact risks to the Earth allows for obtaining detailed physical parameters, thereby supporting the high-precision orbit prediction and planetary defense strategy. Different from those conducted asteroid flyby missions, in the 12th China Trajectory Optimization Competition (CTOC-12), a NEAs flyby trajectory design problem using reusable probes that depart from a Lunar Distant Retrograde Orbit (DRO) station in the cislunar space was released. The objective was flyby to as many NEAs as possible using up to 20 probes within a total of 10 years. The ∑ team proposed a solution that can explore 47 NEAs using 11 probes, ranking the first in the competition. In this paper, the methods and results from the winning team are introduced, including mission analysis and preliminary design, and low-energy transfer trajectory optimization. In particular, a round-trip trajectory is divided into three phases: deep space transfer, indirect transfer between the Earth to DRO, and DRO phasing and rendezvous. With the combination of global optimization and local optimization algorithms, the required velocity increments to change the orbital planes are effectively reduced, thus increasing the number of the explored NEAs. The final solution of our team is presented and the results are compared with those of the top three teams. The competition demonstrates that the regularization of flyby missions from the cislunar space to explore NEAs with the potential impact risks to the Earth is the feasible and promising.展开更多
BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)are rare,heterogeneous tumors accounting for 1%-2%of pancreatic tumors,with significant malignant potential.Intraductal papillary mucinous neoplasm of the bile duct...BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)are rare,heterogeneous tumors accounting for 1%-2%of pancreatic tumors,with significant malignant potential.Intraductal papillary mucinous neoplasm of the bile duct(IPMN-B)is a rare precancerous lesion in the bile duct system,with potential for malignancy.The combination of pNENs and IPMN-B is exceptionally rare and often leads to misdiagnosis.This study aims to report a rare case of pNENs combined with IPMN-B treated at Yanbian University Hospital to improve understanding and management of this unusual tumor combination.CASE SUMMARY We retrospectively analyzed a case from Yanbian University Hospital.We re-viewed clinical records,imaging findings,endoscopic retrograde cholangiopan-creatography,surgical exploration,and histopathological examination.The pa-tient was diagnosed with pNENs and IPMN-B.Surgical treatment was performed,with follow-up showing effective management and no significant recurrence.CONCLUSION This case represents the first report of pNENs combined with IPMN-B.It high-lights the need for thorough diagnostic evaluation to prevent misdiagnosis and improve treatment strategies.展开更多
This study aims to investigate grain quality and nutritional values of rice(Pokkali,a salt-tolerant cultivar;RD73,a new cultivar improved from KDML105 introgressed with Saltol QTL from Pokkali,and KDML105,a moderately...This study aims to investigate grain quality and nutritional values of rice(Pokkali,a salt-tolerant cultivar;RD73,a new cultivar improved from KDML105 introgressed with Saltol QTL from Pokkali,and KDML105,a moderately salt-susceptible cultivar)grown under non-saline(0.04–0.87 dS/m)and slightly saline(1.08–4.83 dS/m)field conditions.The results revealed that salinity caused significant reduction in grain size but significant increments in reducing sugar and total protein contents in the grains.Nevertheless,the amounts of starch in the grains of KDML105 and Pokkali rice genotypes were unaffected by the stress.The starch granule size distribution was also unaffected by salinity.Interestingly,only starch from Pokkali was significantly diminished in amylose content,from 19.18%to 16.99%.Accordingly,parameters relating to starch gelatinization,retrogradation,and pasting properties of KDML105 and RD73 were unaffected by salinity;only Pokkali showed a significant increase in percentage of retrogradation along with a significant reduction in gelatinization enthalpy.In the saline field,total phenolic content and antioxidant capacity in the grains of all rice cultivars tended to increase,particularly in Pokkali.On average,essential element contents in grains from the saline-treated plants showed a 33%,32%,32%,22%,20%,11%,and 10%increase in total P,N,K,Mg,Zn,Fe,and Ca content,respectively.Interestingly,total Fe content exhibited the greatest percentage of increments in KDML105(187%).Taken together,cultivation of rice in the slightly saline field did not alter its eating and cooking qualities,while enhanced some nutritional properties such as proteins,minerals,and secondary metabolites like phenolic compounds.展开更多
BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant bili...BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography(ERCP)failure.However,most of the studies that have assessed its efficacy and safety were small and hetero-geneous.Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence.AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary ob-struction after ERCP failure.METHODS We searched PubMed,EMBASE,and Scopus databases from the inception of the ECE technique to May 13,2022.Primary outcome measure was pooled technical success rate,and secondary outcomes were pooled rates of clinical success,re-intervention,and adverse events.Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R soft-ware(version 4.1.3).RESULTS Fourteen eligible studies involving 620 participants were ultimately included.The pooled rate of technical success was 96.7%,and clinical success was 91.0%.Adverse events were reported in 17.5%of patients.Overall reinter-vention rate was 7.3%.Subgroup analyses showed results were generally consistent.CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible.The consistency of results across most subgroups suggested that this is a generalizable approach.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP),with its clinical ad-vantages of less trauma and faster recovery,has become the primary treatment for choledocholithiasis.AIM To investigate the effects ...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP),with its clinical ad-vantages of less trauma and faster recovery,has become the primary treatment for choledocholithiasis.AIM To investigate the effects of different ERCP procedures on the sphincter of Oddi.METHODS The clinical data of 91 patients who underwent ERCP at Yixing Hospital of Traditional Chinese Medicine between February 2018 and February 2021 were analyzed retrospectively.The patients were divided into endoscopic sphinc-terotomy(EST,n=24)and endoscopic papillary balloon dilation(EPBD,n=67)groups.The duration of operation,pancreatic development,pancreatic sphinc-terotomy,intubation difficulties,stone recurrence,and incidence of reflux cho-langitis and cholecystitis were statistically analyzed in patients with a history of choledocholithiasis,pancreatitis,and Oddi sphincter dysfunction in the EST and EPBD groups.RESULTS Differences in hypertension,diabetes,increased bilirubin,small diameter of the common bile duct,or ampullary diverticulum between the two groups were not significant.Statistically significant differences were observed between the two groups concerning sex and age(<60 years).Patients with a history of choledocholithiasis,pancreatitis,and Oddi sphincter dysfunction were higher in the EST group than in the EPBD group.The number of cases of pancreatic development,pancreatic duct sphincterotomy,and difficult intubation were higher in the EST group than in the EPBD group.The number of Oddi’s sphincter manometries,ERCP surgical outcomes,and guidewires entering the pancreatic duct several times in EST group were lower than those in the EPBD group.The numbers of stone recurrences,reflux cholangitis,and cholecystitis were higher in the EST group than in the EPBD group.CONCLUSION In summary,common bile duct stones,pancreatitis history,and multiple guided wire introductions into the pancreatic duct are independent risk factors for EST and EPBD.Based on this evidence,this study can provide actionable insights for clinicians and researchers.展开更多
Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for ...Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.展开更多
BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is un...BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.展开更多
BACKGROUND Acute appendicitis is the most common abdominal emergency.At present,the main treatments for periappendiceal abscess include antibiotics and surgery.However,the complications and mortality of emergency surg...BACKGROUND Acute appendicitis is the most common abdominal emergency.At present,the main treatments for periappendiceal abscess include antibiotics and surgery.However,the complications and mortality of emergency surgery are high.The preferred therapy is conservative treatment with antibiotics first,ultrasound-guided puncture drainage or surgical treatment is followed when necessary.Endoscopic retrograde appendicitis therapy(ERAT)for acute uncomplicated appendicitis have been proved clinically effective,but it is rarely used in periap-pendiceal abscess.CASE SUMMARY We report a patient admitted to hospital because of“right lower abdominal pain for six days”.The computerized tomography(CT)of patient showed that appendicitis with fecaliths and abscess in the pelvis.The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths,irrigation and stent placement.CONCLUSION The patient did not receive surgery because of impoverished family.Abdominal pain did not recur during the follow-up period.This case confirms the value of ERAT in the treatment of periappendiceal abscess.展开更多
基金funded by the fund of national natural science foundation of China(32101996,32160530)the training plan for academic and technical leaders of major disciplines in Jiangxi province(20232BCJ23024)+1 种基金the key research and development program of Jiangxi province(20232BBF60023)“Shuangqian Project”of Jiangxi Province(jxsq2023201042)。
文摘Retrogradation of semi-dry rice noodles severely reduced their eating quality during storage.Three commonly used modified starches(oxidized starch,acetylated starch,and hydroxypropyl starch)were applied to investigate the anti-retrogradation effects of semi-dry rice noodles during cold storage.Loss of water content,migration of water,and increase in relative crystallinity,retrogradation enthalpy,and hardness could be retarded by adding chemically modified starches,especially hydroxypropyl starches.The effect of hydroxypropyl starch addition levels(2%,4%,6%,8%,and 10%)on the properties of rice flour and the edible quality of semi-dry rice noodles was further evaluated.The water solubility index of rice flour decreased with the addition of hydroxypropyl starch,while the swelling power showed the opposite trend.The quality of semi-dry rice noodles were improved with the addition of hydroxypropyl starch.Compared to the control,semi-dried rice noodles with 8%hydroxypropyl starch possessed superior properties,i.e.lower cooking loss(decreasing from 12.89%to 6.62%),lower adhesiveness(decreasing from 5.40 to 4.31 g·s),and higher hardness(rising from 10.89 to 13.81 N).These findings demonstrated that the incorporation of hydroxypropyl starch is a promising strategy for the preparation of semi-dry rice noodles with satisfactory cooking and edible qualities as well as a long shelf life.
基金This work was sponsored in part by National Natural Science Foundation of China(NSFC-31671801,31371749)the key R&D program(21ZGN38)from Changchun science and technology bureau,the special project of industrial independent innovation capability(2020C036-7)from Jilin provincial development and reform commission+1 种基金the science and technology research planning project(JJKH20220609KJ)from Jilin provincial department of educationthe scholar climbing project(ZKP202006 and ZKP202016)from Changchun University.
文摘To lower the retrogradation and digestibility of waxy corn starch for different food applications,a novel thermostable GtfC type 4,6-α-glucanotransferase without N-and C-terminals(GsGtfC)from Geobacillus sp.12AMOR1 was used.Waxy corn starch of 50 g/L was incubated with GsGtfC of 40-100 U/g substrate at 65℃and pH 5.5 for 1 h.Its molecular weight,iodine affinity,XRD crystallinity,and FTIR ratio of heights of bands at 1047 and 1022 cm^(-1) decreased,but ratio of DP<6 to DP≥25 branches and degree of branching increased.GsGtfC cleavedα-1,4-glycosidic bonds and inducedα-1,6-branching points to produce reuteran-likes polymers,which is different from Exiguobacterium sibiricum GtfC enzyme cleavingα-1,4-glycosidic bonds and synthesizing consecutiveα-1,6-glycosidic bonds to produce isomalto/malto-oligosaccharides.GsGtfC modified waxy corn starch had significantly lower DSC retrogradation enthalpies during the storage at 4℃for 3-14 days and significantly lower released glucose during the incubation with mammalian mucosalα-glucosidase at 37℃for 10-360 min.GsGtfC at 100 U/g substrate increased slowly digestible portion from 11.07%to 24.11%.
文摘The polysaccharides, such as κ-carrageenan, ι-carrageenan, agarose (agar), gellan gum, amylose, curdlan, alginate, and deacetylated rhamsan gum, in water changed into an ice-like structure with hydrogen bonding between polymer and water molecules, and between water-water molecules even at a concentration range of 0.1% - 1.0% (W/V) at room temperature, resulting in gelation. Such dramatic changes from liquid into gels have been understood at the molecular level in principles. In this review, we describe the structure-function relationship of starch on the view point of rheological aspects and discuss gelatinization and retrogradation mechanism including water molecules at molecular level. The starch molecules (amylose and amylopectin) play a dominant role in the center of the tetrahedral cavities occupied by water molecules, and the arrangement is partially similar to a tetrahedral structure in a gelatinization process. The arrangement should lead to a cooperative effect stabilizing extended regions of ice-like water with hydrogen bonding on the surface of the polymer molecules, where hemiacetal oxygen and hydroxyl groups might participate in hydrogen bonding with water molecules. Thus, a more extended ice-like hydrogen bonding within water molecules might be achieved in a retrogradation process. Though many investigations not only include starch gelatinization and retrogradaion, but also the gelling properties of the polysaccharides have been undertaken to elucidate the structure-function relationship, no other researchers have established mechanism at the molecular level. There is reasonable consistency in our investigations.
基金This study was supported by the National Key Research and Development Program of China during the 13th Five-Year Plan(2018YFD0400501)Key Research and development plan for Colleges and Universities in Henan Province(20A550013).
文摘The heat intolerance and retrogradation behavior of native wheat starch(WS)are undesirable for starch-based gel foods,therefore the combinations of WS and hydrocolloids have attracted extensive attentions.The objectives of this study were to investigate the effects of konjac glucomannan(KGM)with different degree of deacetylation(DD)on the pasting,rheological and retrogradation properties of WS.Results showed that deacetyl-konjac glucomannan(DKGM)increased the peak viscosity(PV),trough viscosity(TV)and final viscosity(FV),while decreased the breakdown(BD)values of WS,suggesting the enhancement of the viscosity and thermal stability of WS paste.The raised storage modulus(G′)of WS gels with DKGM1(DD,48.23%)demonstrated that the partial removal of acetyl groups from KGM chains effectively promoted the formation of gel network,accompanied by increased elasticity.After storing at 4℃ for 7 days,the hardness of gels increased up 369%,while supplement with DKGM significantly(p<0.05)decreased the hardness.These data demonstrated that DKGM delayed the process of starch retrogradation,which was further verified by LF-NMR analysis.Besides,the addition of DKGM reduced the retrogradation rate,relative crystallinity and the orderliness of WS-DKGM gels with the prolonging of storage at 4℃,all validating the hindrance of starch retrogradation by DKGM.Therefore,these data suggested that partial deacetylation of KGM could effectively improve the pasting,rheological characteristics and impede the retrogradation of WS.
文摘BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.
文摘High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.
文摘This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis.Currently,pancreatic cancer still has a poor prognosis,mainly due to late diagnosis in an advanced stage.Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma:The first encompasses a large group of mucinous cystic lesions:intraductal papillary mucinous neoplasm and mucinous cystic neoplasm,and the second is pancreatic intraepithelial neoplasia.In the last decade the focus of research has been to identify high-risk patients,using advanced imaging techniques(magnetic resonance cholangiopancreatography or endoscopic ultrasonography)which could be helpful in finding“indirect signs”of early stage pancreatic lesions.Nevertheless,the survival rate still remains poor,and alternative screening methods are under investigation.Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm,but confirming data are still needed to validate its role.Probably a combination of cross-sectional imaging,endoscopic techniques(old and new ones)and genetic and biological biomarkers also in pancreatic juice)could be the best solution to reach an early diagnosis.Biomarkers could help to predict and follow the progression of early pancreatic lesions.However,further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
基金Sanming Project of Medicine in Shenzhen,No.SZSM202311017.
文摘BACKGROUND Strongyloides stercoralis(S.stercoralis),is a prevalent parasitic worm that infects humans.It is found all over the world,particularly in tropical and subtropical areas.Strongyloidiasis is caused mostly by the parasitic nematode S.stercoralis.Filariform larvae typically infest humans by coming into contact with dirt,such as by walking barefoot or through exposure to human waste or sewage.CASE SUMMARY A 35-year-old male presented to our department with a 10-year history of abdominal pain and diarrhea,which had recently recurred for the past 3 months.A computed tomography(CT)scan revealed acute cholecystitis accompanied by a gallbladder stone.Additionally,a 5 mm stone was found obstructing the lower portion of the common bile duct,resulting in dilatation of both the intrahepatic and extrahepatic bile ducts to 8 mm,in contrast to a previous CT scan.Endoscopic ultrasonography revealed a prominent echogenicity in the lower portion of the common bile duct.Consequently,an endoscopic retrograde cholangiopancreatography was conducted via endoscopic sphincterotomy and balloon dilatation.The microscope revealed the presence of viable S.stercoralis rhabditiform larvae in the biliary fluid.We documented an uncommon instance of S.stercoralis infection in the biliary fluid of a patient suffering from gallstones and cholangitis.CONCLUSION The film we created provides a visual representation of the movement of the living S.stercoralis in biliary fluid.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retrospectively analyzed 190 patients who underwent ERCP and found that gastrointestinal obstruction,jaundice,opioid use,female sex,and primary diseases were in-dependent predictors and risk factors of preoperative gastric retention.Based on these findings and comprehensive analysis,a proposed predictive model offers clinicians valuable tools to tailor preoperative strategies,improving the proce-dural safety and efficacy of ERCP.Despite having several limitations,like single-center design and limited generalizability,the study marks a significant advan-cement in optimizing ERCP outcomes through predictive analytics.Further research with larger populations and prospective designs is warranted to establish these findings.
基金Supported by The Health Commission of Zhejiang Provence,China,No.WKJ-ZJ-2136.
文摘BACKGROUND Palliative care for unresectable pancreatic cancer(PC)focuses mainly on the symptoms of the disease,including abdominal pain,obstructive jaundice,and malnutrition.Biliary stent placement using endoscopic retrograde cholangiopan-creatography(ERCP)to relieve biliary obstruction has become an internationally recognized treatment.Although a few studies have evaluated the efficacy of endoscopic pancreatic duct stenting in advanced PC,no consensus exists on the use of endoscopic treatment to relieve pain and improve nutritional status.METHODS Patients with unresectable PC were recruited.The participants were randomized into two groups:The double-stent group underwent ERCP with a fully-covered self-expandable metallic biliary stent(FCSEMS)and a pancreatic duct stent,while the single-stent group underwent ERCP with an FCSEMS only.Abdominal pain,nutritional status,and incidence of adverse events were compared between the two groups using the SPSS software.RESULTS Seventy-eight patients with unresectable PC were included in the analysis(40 and 38 in the double-and single-stent groups,respectively).The median pain scores of patients in the double-stent group were lower than those in the single-stent group at 1(0 vs 2.5,P=0.002),2(0 vs 3,P<0.001),3(0 vs 4,P<0.001),and 6 months(0 vs 4,P<0.001)after ERCP.Total serum protein levels in patients in the double-stent group were higher than those in the single-stent group(66.6±8.4 g/L vs 60.4±4.0 g/L,P=0.046)6 months postoperatively.The body mass index(BMI)of patients in both groups decreased at six months.However,the BMI in the single-stent group was higher than that in the double-stent group(P<0.001).CONCLUSION Early pancreatic duct stenting reduces abdominal pain and improves nutritional status in patients with unre-sectable PC without reducing the technical success rate or increasing the incidence of adverse events.
基金Supported by the National Key Research and Development Program,China,No.2022YFC2503603.
文摘BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
文摘Implementing the flyby to Near-Earth Asteroids (NEAs) with the potential impact risks to the Earth allows for obtaining detailed physical parameters, thereby supporting the high-precision orbit prediction and planetary defense strategy. Different from those conducted asteroid flyby missions, in the 12th China Trajectory Optimization Competition (CTOC-12), a NEAs flyby trajectory design problem using reusable probes that depart from a Lunar Distant Retrograde Orbit (DRO) station in the cislunar space was released. The objective was flyby to as many NEAs as possible using up to 20 probes within a total of 10 years. The ∑ team proposed a solution that can explore 47 NEAs using 11 probes, ranking the first in the competition. In this paper, the methods and results from the winning team are introduced, including mission analysis and preliminary design, and low-energy transfer trajectory optimization. In particular, a round-trip trajectory is divided into three phases: deep space transfer, indirect transfer between the Earth to DRO, and DRO phasing and rendezvous. With the combination of global optimization and local optimization algorithms, the required velocity increments to change the orbital planes are effectively reduced, thus increasing the number of the explored NEAs. The final solution of our team is presented and the results are compared with those of the top three teams. The competition demonstrates that the regularization of flyby missions from the cislunar space to explore NEAs with the potential impact risks to the Earth is the feasible and promising.
文摘BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)are rare,heterogeneous tumors accounting for 1%-2%of pancreatic tumors,with significant malignant potential.Intraductal papillary mucinous neoplasm of the bile duct(IPMN-B)is a rare precancerous lesion in the bile duct system,with potential for malignancy.The combination of pNENs and IPMN-B is exceptionally rare and often leads to misdiagnosis.This study aims to report a rare case of pNENs combined with IPMN-B treated at Yanbian University Hospital to improve understanding and management of this unusual tumor combination.CASE SUMMARY We retrospectively analyzed a case from Yanbian University Hospital.We re-viewed clinical records,imaging findings,endoscopic retrograde cholangiopan-creatography,surgical exploration,and histopathological examination.The pa-tient was diagnosed with pNENs and IPMN-B.Surgical treatment was performed,with follow-up showing effective management and no significant recurrence.CONCLUSION This case represents the first report of pNENs combined with IPMN-B.It high-lights the need for thorough diagnostic evaluation to prevent misdiagnosis and improve treatment strategies.
基金supported by the National Research Council of Thailand(Grant No.NRCT813/2563)the Post-Doctoral Training,Khon Kaen University(Grant No.PD2565-02-02)。
文摘This study aims to investigate grain quality and nutritional values of rice(Pokkali,a salt-tolerant cultivar;RD73,a new cultivar improved from KDML105 introgressed with Saltol QTL from Pokkali,and KDML105,a moderately salt-susceptible cultivar)grown under non-saline(0.04–0.87 dS/m)and slightly saline(1.08–4.83 dS/m)field conditions.The results revealed that salinity caused significant reduction in grain size but significant increments in reducing sugar and total protein contents in the grains.Nevertheless,the amounts of starch in the grains of KDML105 and Pokkali rice genotypes were unaffected by the stress.The starch granule size distribution was also unaffected by salinity.Interestingly,only starch from Pokkali was significantly diminished in amylose content,from 19.18%to 16.99%.Accordingly,parameters relating to starch gelatinization,retrogradation,and pasting properties of KDML105 and RD73 were unaffected by salinity;only Pokkali showed a significant increase in percentage of retrogradation along with a significant reduction in gelatinization enthalpy.In the saline field,total phenolic content and antioxidant capacity in the grains of all rice cultivars tended to increase,particularly in Pokkali.On average,essential element contents in grains from the saline-treated plants showed a 33%,32%,32%,22%,20%,11%,and 10%increase in total P,N,K,Mg,Zn,Fe,and Ca content,respectively.Interestingly,total Fe content exhibited the greatest percentage of increments in KDML105(187%).Taken together,cultivation of rice in the slightly saline field did not alter its eating and cooking qualities,while enhanced some nutritional properties such as proteins,minerals,and secondary metabolites like phenolic compounds.
基金The authors have read the PRISMA 2009 Checklist,and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
文摘BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography(ERCP)failure.However,most of the studies that have assessed its efficacy and safety were small and hetero-geneous.Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence.AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary ob-struction after ERCP failure.METHODS We searched PubMed,EMBASE,and Scopus databases from the inception of the ECE technique to May 13,2022.Primary outcome measure was pooled technical success rate,and secondary outcomes were pooled rates of clinical success,re-intervention,and adverse events.Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R soft-ware(version 4.1.3).RESULTS Fourteen eligible studies involving 620 participants were ultimately included.The pooled rate of technical success was 96.7%,and clinical success was 91.0%.Adverse events were reported in 17.5%of patients.Overall reinter-vention rate was 7.3%.Subgroup analyses showed results were generally consistent.CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible.The consistency of results across most subgroups suggested that this is a generalizable approach.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP),with its clinical ad-vantages of less trauma and faster recovery,has become the primary treatment for choledocholithiasis.AIM To investigate the effects of different ERCP procedures on the sphincter of Oddi.METHODS The clinical data of 91 patients who underwent ERCP at Yixing Hospital of Traditional Chinese Medicine between February 2018 and February 2021 were analyzed retrospectively.The patients were divided into endoscopic sphinc-terotomy(EST,n=24)and endoscopic papillary balloon dilation(EPBD,n=67)groups.The duration of operation,pancreatic development,pancreatic sphinc-terotomy,intubation difficulties,stone recurrence,and incidence of reflux cho-langitis and cholecystitis were statistically analyzed in patients with a history of choledocholithiasis,pancreatitis,and Oddi sphincter dysfunction in the EST and EPBD groups.RESULTS Differences in hypertension,diabetes,increased bilirubin,small diameter of the common bile duct,or ampullary diverticulum between the two groups were not significant.Statistically significant differences were observed between the two groups concerning sex and age(<60 years).Patients with a history of choledocholithiasis,pancreatitis,and Oddi sphincter dysfunction were higher in the EST group than in the EPBD group.The number of cases of pancreatic development,pancreatic duct sphincterotomy,and difficult intubation were higher in the EST group than in the EPBD group.The number of Oddi’s sphincter manometries,ERCP surgical outcomes,and guidewires entering the pancreatic duct several times in EST group were lower than those in the EPBD group.The numbers of stone recurrences,reflux cholangitis,and cholecystitis were higher in the EST group than in the EPBD group.CONCLUSION In summary,common bile duct stones,pancreatitis history,and multiple guided wire introductions into the pancreatic duct are independent risk factors for EST and EPBD.Based on this evidence,this study can provide actionable insights for clinicians and researchers.
文摘Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.
文摘BACKGROUND Currently,endoscopic retrograde cholangiopancreatography(ERCP)plus laparoscopic cholecystectomy(LC)is the main treatment for cholecystolithiasis combined with choledocholithiasis.However,the treatment is unsatisfactory,and the development of better therapies is needed.AIM To determine the clinical efficacy of LC plus cholangioscopy for cholecystolithiasis combined with choledocholithiasis.METHODS Patients(n=243)with cholecystolithiasis and choledocholithiasis admitted to The Affiliated Haixia Hospital of Huaqiao University(910th Hospital of Joint Logistic Support Force)between January 2019 and December 2023 were included in the study;111 patients(control group)underwent ERCP+LC and 132 patients(observation group)underwent LC+laparoscopic common bile duct exploration(LCBDE).Surgical success rates,residual stone rates,complications(pancreatitis,hyperamylasemia,biliary tract infection,and bile leakage),surgical indicators[intraoperative blood loss(IBL)and operation time(OT)],recovery indices(postoperative exhaust/defecation time and hospital stay),and serum inflammatory markers[C-reactive protein(CRP)],tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were compared.RESULTS No significant differences in surgical success rates and residual stone rates were detected between the observation and control groups.However,the complication rate,IBL,OT,postoperative exhaust/defecation time,and hospital stays were significantly reduced in the observation group compared with the control group.Furthermore,CRP,TNF-α,and IL-6 Levels after treatment were reduced in the observation group compared with the levels in the control group.CONCLUSION These results indicate that LC+LCBDE is safer than ERCP+LC for the treatment of cholecystolithiasis combined with choledocholithiasis.The surgical risks and postoperative complications were lower in the observation group compared with the control group.Thus,patients may recover quickly with less inflammation after LCBDE.
基金Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2020KY1082 and No.2021KY1238.
文摘BACKGROUND Acute appendicitis is the most common abdominal emergency.At present,the main treatments for periappendiceal abscess include antibiotics and surgery.However,the complications and mortality of emergency surgery are high.The preferred therapy is conservative treatment with antibiotics first,ultrasound-guided puncture drainage or surgical treatment is followed when necessary.Endoscopic retrograde appendicitis therapy(ERAT)for acute uncomplicated appendicitis have been proved clinically effective,but it is rarely used in periap-pendiceal abscess.CASE SUMMARY We report a patient admitted to hospital because of“right lower abdominal pain for six days”.The computerized tomography(CT)of patient showed that appendicitis with fecaliths and abscess in the pelvis.The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths,irrigation and stent placement.CONCLUSION The patient did not receive surgery because of impoverished family.Abdominal pain did not recur during the follow-up period.This case confirms the value of ERAT in the treatment of periappendiceal abscess.
