Endoscopic ultrasound-guided biliary drainage using electrocauteryenhanced lumen-apposing metal stent for malignant biliary obstruction:A promising procedure

In this editorial,we comment on the article by Peng et al.Palliative drainage for biliary obstruction resulting from unresectable malignant lesions includes internal and external drainage.The procedures of biliary drainage are usually guided by fluoroscopy or transcutaneous ultrasound,endoscopic ultrasound(EUS),or both.Endoscopic retrograde cholangiopancreatography(ERCP)has been primarily recommended for the management of biliary obstruction,while EUS-guided biliary drainage and percutaneous transhepatic biliary drainage(PTBD)are alternative choices for cases where ERCP has failed or is impossible.PTBD is limited by shortcomings of a higher rate of adverse events,more reinterventions,and severe complications.EUS-guided biliary drainage has a lower rate of adverse events than PTBD.EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent(ECE-LAMS)enables EUS-guided biliaryenteric anastomosis to be performed in a single step and does not require prior bile duct puncture or a guidewire.The present meta-analysis showed that ECELAMS has a high efficacy and safety in relieving biliary obstruction in general,although the results of LAMS depending on the site of biliary obstruction.This study has highlighted the latest advances with a larger sample-based comprehensive analysis.

Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis

BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.

Effect of ritodrine on heart structure and function of pregnant women who after treatment for threat of preterm birth: A report based on echocardiographic assessment

Objective:To evaluate the possible effects of ritodrine on the heart structure and function of pregnant women who had threat of preterm birth by echocardiography.Methods:From September 2012 to December 2018,totally 112 women in the second and third trimester pregnancy with sign and symptom of preterm birth were included,and those with contraindication to ritodrine and other several diseases were excluded.Firstly they were divided into four groups according to the time of medication and number of fetuses:Group A:Twin pregnancy,the first time of ritodrine medication was in 48 h;Group B:Twin pregnancy,the last time of ritodrine medication;Group C:Single pregnancy,the first time of ritodrine medication was in 48 h;Group D:Single pregnancy,the last time of ritodrine medication.Secondly,singleton pregnancies were divided into four groups according to the time of ritodrine medication and the age of pregnant women:Group E:Single pregnancy of age 21-34 years old,the first time of ritodrine medication was in 48 h;Group F:Single pregnancy of age 21-34 years old,the last time of ritodrine medication;Group G:Single pregnancy of age 35-49 years old,the first time of ritodrine medication was in 48h;Group H:Single pregnancy of age 35-49 years old,the last time of ritodrine medication.Ehocardiography were used to examine the hearts of pregnant women,and relevant parameters were filed,including LAD1,LAD2,LVD,RA,RVD,IVST,LVPWT,EF,E,A,AVmax,TRVmax,and PE.Results:Comparing the heart parameters between group A and group B,there were no significant difference(all P>0.05);there were significant differences of LAD1,LVD,and EF between group A and group C(P<0.05);there was significant difference in E between group C and group D(P<0.05);Comparing group E with group G,there was only significant difference in PE(P<0.05);Comparing with group H,LVD,E,and TRVmax in group F,there were significant differences(P<0.05).Comparing the rest items,there was no significant difference(all P>0.05).Conclusion:The treatment of preterm birth using ritodrine may bring effect on the heart structure and function of pregnant women,and echocardiography can early find and assess the changes of maternal heart structure and function.