Could saline irrigation clear all residual common bile duct stones after lithotripsy?A self-controlled prospective cohort study

BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.

On the time-varying correlations between oil-,gold-,and stock markets:The heterogeneous roles of policy uncertainty in the US and China

This paper investigates the effects of economic policy uncertainty(EPU)and monetary policy uncertainty(MPU)in the US and China on oil-stock and gold-stock correlations.A quantile regression approach is employed to analyze the heterogeneous impacts under different market correlation regimes.Our findings suggest that the“US impact”prevails across all market correlations in the sample,while“China impact”is found for oil-stock correlations.Furthermore,the impacts of EPU and MPU on correlations of different asset pairs exhibit heterogeneity in direction and in different correlation regimes.EPU and MPU have homogenously negative effects on gold-stock correlations across various correlation regimes.Differently,in terms of oil-stock correlations,they exhibit more significant and stronger positive impacts in the medium and high correlation regime than in the low correlation regime.Gold can provide a better diversification for stock market risks than crude oil during the period of high level of economic uncertainty.

Abdominopelvic leiomyoma with large ascites:A case report and review of the literature

BACKGROUND Leiomyoma of the uterus is relatively common,but uterine leiomyoma of the greater omentum is rare.CASE SUMMARY Here,we report the case of a 22-year-old woman who presented with a 3 mo history of progressive abdominal distension and a hypervascular abdominopelvic mass.Due to a high serum concentration of CA125,the preoperative diagnosis was unclear.During surgery,5 L of ascites was removed.An 18.8 cm solid mass,which was pedunculated from the uterine fundus and exhibited complex adhesion to the greater omentum,was removed.The CA125 level was reduced postoperatively,and a pathologic study confirmed that the mass was a leiomyoma that originated in the uterus.CONCLUSION Uterine leiomyoma can share vessels with the greater omentum.This case highlights the difficulty of diagnosing pseudo-Meigs syndrome and the importance of imaging and laboratory examinations.

Limited Role of Promoter Methylation of MGMT and C130RF18 in Triage of Low-Grade Squamous Intraepithelial Lesion

Background：Promoter methylation of MGMT and C13ORF18 has been confirmed as a potential biomarker for early diagnosis of cervical cancer. The aim of this study was to evaluate the performance of MGMT and C13ORF18 promoter methylation for triage of cytology screening samples and explore the potential mechanism.Methods：Methylation-sensitive high-resolution melting was used to detect promoter methylation of MGMT and C13ORF18 in 124 cervical samples. High-risk human papillomavirus （HR-HPV） was detected by the Digene Hybrid Capture 2？. Gene methylation frequencies in relation to cervical intraepithelial neoplasia （CIN） were analyzed. Frequencies were compared by Chi-square tests. The expression of gene biomarkers and methylation regulators was analyzed by immunohistochemical staining, real-time fluorescence quantitative polymerase chain reaction, and Western blot.Results：For triage of low-grade squamous intraepithelial lesion （LSIL）, gene methylation increased specificity from 4.0% of HR-HPV detection to 30.8% of MGMT （χ2 = 9.873, P = 0.002） and to 50.0% of C13ORF18 （χ2 = 21.814, P = 0.001）. For triage of atypical squamous cells of undetermined significance, HR-HPV detection had higher positive predictive value of 54.8%. Either MGMT or C13ORF18 methylation combined with HR-HPV increased the negative predictive value to 100.0% （χ2 = 9.757, P = 0.002）. There was no relationship between MGMT and C13ORF18 expression and DNA methylation （χ2 = 0.776, P = 0.379 and χ2 = 1.411, P = 0.235, respectively）. MBD2 protein level in cervical cancer was relatively lower than normal cervical tissue （t = 4.11, P = 0.006）.Conclusions：HR-HPV detection is the cornerstone for triage setting of CIN. Promoter methylation of MGMT and C13ORF18 plays a limited role in triage of LSIL. Promoter methylation of both genes may not be the causes of gene silence.

A novel endoscopic retrograde cholangiopancreatography technique to reduce stone size in type IV Mirizzi syndrome: avoiding cholangiojejunostomy

To the Editor:Mirizzi syndrome(MS)is a rare type of cholelithiasis with an incidence of 0.1%in all gallstone.[1]cases.Its clinical manifestations and imaging features can sometimes be diffcult to distinguish from those of choledocholithiasis and biliary tumors.s.The traditional treatment for MS is usually surgery,including cholecys-tectomy,exploration of common bile.duct plus T-tube drainage,and cholangiojejunostomy.[2] There have even been reports of endoscopic therapies for MS in recent years,but it is technically difficult and non-feasible in cases where the stones get stuck in the Hartmann pouch.[3]Here we report a case where the MS was downstaged via endoscopic modalities to avoid cholangiojejunostomy.

Gene mutations of esophageal squamous cell carcinoma based on next-generation sequencing

Background: Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive cancers without effective therapy. To explore potential molecular targets in ESCC, we quantified the mutation spectrum and explored the relationship between gene mutation and clinicopathological characteristics and programmed death-ligand 1 (PD-L1) expression.Methods: Between 2015 and 2019, 29 surgically resected ESCC tissues and adjacent normal tissues from the Fourth Hospital of Hebei Medical University were subjected to targeted next-generation sequencing. The expression levels of PD-L1 were detected by immunohistochemistry. Mutational signatures were extracted from the mutation count matrix by using non-negative matrix factorization. The relationship between detected genomic alterations and clinicopathological characteristics and PD-L1 expression was estimated by Spearman rank correlation analysis.Results: The most frequently mutated gene wasTP53 (96.6%, 28/29), followed byNOTCH1 (27.6%, 8/29),EP300 (17.2%, 5/29), andKMT2C (17.2%, 5/29). The most frequently copy number amplified and deleted genes wereCCND1/FGF3/FGF4/FGF19 (41.4%, 12/29) andCDKN2A/2B (10.3%, 3/29). By quantifying the contribution of the mutational signatures to the mutation spectrum, we found that the contribution of signature 1, signature 2, signature 10, signature 12, signature 13, and signature 17 was relatively high. Further analysis revealed genetic variants associated with cell cycle, chromatin modification, Notch, and Janus kinase-signal transducer and activator of transcription signaling pathways, which may be key pathways in the development and progression of ESCC. Evaluation of PD-L1 expression in samples showed that 13.8% (4/29) of samples had tumor proportion score ≥1%. 17.2% (5/29) of patients had tumor mutation burden (TMB) above 10 mut/Mb. All samples exhibited microsatellite stability. TMB was significantly associated with lymph node metastasis (r = 0.468,P = 0.010), but not significantly associated with PD-L1 expression (r = 0.246,P = 0.198). There was no significant correlation between PD-L1 expression and detected gene mutations (allP > 0.05).Conclusion: Our research initially constructed gene mutation profile related to surgically resected ESCC in high-incidence areas to explore the mechanism underlying ESCC development and potential therapeutic targets.

Prednisolone therapy accelerates recovery of severe drug-induced liver injury: A prospective, randomized controlled study

Background and aims:Drug-induced liver injury(DILI)is one of the most serious adverse drug reactions and its incidence has been increasing rapidly.Accumulating evidence suggests that immune activation and systemic inflammatory responses are very important in the progression of DILI.Corticosteroids are often used in DILI,but their clinical usefulness remains controversial.We therefore conducted a prospective,randomized controlled study to investigate whether corticosteroid therapy can accelerate recovery and reduce mortality in severe DILI(SDILI).Methods:SDILI patients with total bilirubin?171μmol/L who presented to the Fifth Medical Center of Chinese PLA General Hospital,Beijing from 2016 to 2019 were randomly allocated to prednisolone and control groups.The endpoints were resolution of SDILI,defined as a decrease in total bilirubin of at least 35μmol/L to<171μmol/L,and overall survival at 6 months.Patients in the prednisolone group received prednisolone 60 mg/day therapy for the first 7 days.Patients with a decrease in total bilirubin of more than 35μmol/L on day 8 continued on tapering doses of prednisolone;otherwise,prednisolone was discontinued.Results:On day 8,50.75%(34/67)and 26.47%(18/68)of the participants in the prednisolone and control groups,respectively,achieved the primary endpoint(p¼0.002).However,there was no significant difference in overall survival at 6 months:95.52%(64/67)vs.91.18%(62/68)in the prednisolone and control groups,respectively(p¼0.3).All deaths in both groups occurred in patients who failed to achieve SDILI resolution on day 8.Conclusion:Prednisolone therapy may accelerate the recovery of SDILI.

Angular distribution coefficients of Z(W) boson produced in e^+e^- collisions at s^(1/2) = 240 GeV

At the designed circular electron-positron collider(CEPC), similar to the hadron collider, the angular distribution coefficients of the decay lepton pair from the produced Z(W) boson in e^+e^- collisions are predicted. Their dependence on cosθZ(cosθW) are presented in four different polarization frames. Furthermore, the value of the angular distribution coefficients in different bins of cosθZ are presented in the C-S frame. In comparison with the case at the hadron collider, better accurate measurement for Z(W) is expected because there is less background, and W could be reconstructed from its leptonic decay channel. This works provides a method to precisely test the electroweak production mechanism or some effect induced from new physics in the future measurements at the CEPC.

Perturbative QCD for J/ψ inclusive production via initial state radiation in e^+e^- collisions

The process e+e-→J/ψ+X with the center-of-mass(CM)energy in the range from 3.7 to 10.6 GeV is calculated up to the next-to-leading order(NLO)in quantum chromodynamics(QCD).At 10.6 GeV,the result is consistent with the experimental result from Belle.However,the predictions are much smaller than the background in the measurements at BESIII in the low CM energy range from 3.7 to 4.6 GeV.This indicates that the convergence of the QCD perturbative expansion becomes worse as the CM energy is closer to the inclusive J/ψ production threshold.For a further study of the QCD mechanism of J/ψ production in e^+e^-collisions with different CM energies,the initial state radiation effect of e^+e^-→J/ψ +gg and e^+e^-→J/ψ+cc are calculated in QCD NLO.The results are plotted and the number of events for different CM energy bins are provided for SuperKEKB.This provides a method to precisely test the validity of perturbative predictions for J/ψ production in future measurements.

The Origin and System Analysis of Harmonious Management for Engineering

Engineering is a production activity aimed at increasing people's utility; however, serious crises are frequently reported to be caused by engineering constructions, both for nature and human beings. Based on engineering theories of philosophy, systems and ecology,this paper analyzed the prevailing defects of traditional project management approaches, explored the importance of harmony in engineering and engineering management,and discussed the developmental inevitability, concept connotation and system structure of harmonious management for engineering.