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Background/Aims: Although endoscopic metal biliary endoprosthesis (EMBE) is widely accepted as the most suitable drainage method for patients with unresectable malignant obstruction, uncontrolled post-procedural cholangitis is still a problem. We aimed to validate a new treatment modality to prevent post-ERCP cholangitis in patients with unresectable cholangiocarcinoma. Patients and Methods: A total of 378 patients who were diagnosed with unresectable malignant biliary obstruction and underwent EMBE or temporary endoscopic nasobiliary drainage (ENBD) following EMBE placement, from January 2010 to July 2016, were enrolled in this retrospective study. Incidence of cholangitis, related infectious indicators, success rate of biliary drainage, and occurrence of complications were evaluated. Results: The risk of overall cholangitis and related infectious indicators was significantly lower in EMBE plus ENBD group than that in EMBE group. The occurrence of cholangitis was 2.4% versus 11.9% (P = 0.004). On further analysis of subgroups, although no difference was detected in nonhilar cholangiocarcinoma subgroup, the incidence of cholangitis and related infectious indicators in hilar cholangiocarcinoma subgroup with EMBE modality were distinctly higher than that with EMBE plus ENBD modality (type I + II was 18.5% vs 0%, P < 0.05; type III + IV was 19.8% vs 3.8%, P < 0.05). No significant difference was found in successful biliary drainage rate and procedure-related complications when all subgroups were compared. Conclusions: The temporary placement of ENBD following EMBE is a simple and effective treatment modality to prevent post-ERCP cholangitis, especially in patients with hilar cholangiocarcinoma. [ABSTRACT FROM AUTHOR]

There is increasing evidence that circular RNAs (circRNAs) can serve as microRNA (miRNA) sponges to regulate metastasis of multiple tumors, including pancreatic ductal adenocarcinoma (PDAC). However, the role of the circRNA/miRNA regulatory network in metastasis of PDAC has not been elucidated. The purpose of this study is to explore the role of circ_0047744/miR-21/SOCS5 in the metastasis of PDAC. We found that circRNA_0047744 was weakly expressed in PDAC tissues and cell lines. The expression of circ_0047744 was negatively correlated with lymph node metastasis and positively correlated with overall survival in PDAC patients. Functionally, the overexpression of circ_0047744 suppressed cell migration and invasion in vitro and in vivo. Mechanistically, circ_0047744 could regulate SOCS5 expression by acting as a sponge of miR-21 to inhibit migration and invasion of PDAC cells. Our study demonstrates that circ_0047744 acts as an anti-oncogene to inhibit PDAC metastasis by regulating the miR-21/SOCS5 axis, indicating that circ_0047744 may be a potential novel therapeutic target for PDAC patients. • circ_0047744 was downregulated in PDAC. • circ_0047744 suppressed metastasis of PDAC. • circ_0047744 served as a sponge for miR-21. • miR-21 promoted the metastasis of PDAC cells through targeting SOCS5. • circ_0047744 inhibited the metastasis of PDAC through the miR-21/SOCS5 axis. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic transmural drainage (TMD) has been accepted as the preferred therapy for symptomatic pancreatic fluid collections (PFCs). Recurrence of PFCs presents a unique challenge in patients with disrupted pancreatic duct (PD). We aimed to evaluate whether transpapillary drainage (TPD) provides additional benefits to TMD in patients with PD disruption., Methods: This was a multicenter retrospective study. Consecutive patients who underwent TMD, TPD, or combined drainage (CD) of PFCs were included. The primary outcome was to compare PFC recurrence among different groups. The secondary outcomes were the technical success rate, length of hospital stay, and procedure-related complications., Results: A total of 153 patients, which consists of 57 patients with pancreatic pseudocysts and 96 patients with walled-off necrosis, were included. PFC recurrence was more common in patients with PD disruption than those with an intact main duct (19% vs 1.4%, P < 0.001). PD disruption was identified as a major risk factor of PFC recurrence by univariable and multivariable analyses. The recurrence rate of CD was significantly lower than TMD only or TPD only (6.5% vs 15.4% vs 22.7%, P < 0.01). The length of hospital stay of CD was significantly shorter than TMD only or TPD only (5 [3.0-9.0] vs 7.0 [5.0-12.0] vs 9 [7.0-16.0], P < 0.001). Dual-modality drainage did not increase procedure-related complications compared with TMD only (13.0% vs 12.8%, P > 0.05). Partial PD disruption was bridged in 87.3% cases while complete PD disruption was reconnected in 55.2% cases. Although statistically not significant, the clinical success rate in walled-off necrosis cases with actively bridged ducts was much higher than those with passively bridged ducts (76.9% vs 40%)., Discussion: Transpapillary pancreatic duct stenting seems to improve the efficacy of endoscopic TMD of pancreatic duct disruption-associated PFCs by reducing the recurrence rate and shortening the length of hospital stay., (Copyright © 2023 by The American College of Gastroenterology.)

Mahalanobis-Taguchi System (MTS) is an effective algorithm for dimensionality reduction, feature extraction and classification of data in a multidimensional system. However, when applied to the field of high-dimensional small sample data, MTS has challenges in calculating the Mahalanobis distance due to the singularity of the covariance matrix. To this end, we construct a modified Mahalanobis-Taguchi System (MMTS) by introducing the idea of proper orthogonal decomposition (POD). The constructed MMTS expands the application scope of MTS, taking into account correlations between variables and the influence of dimensionality. It can not only retain most of the original sample information features, but also achieve a substantial reduction in dimensionality, showing excellent classification performance. The results show that, compared with expert classification, individual classifiers such as NB, RF, k-NN, SVM and superimposed classifiers such as Wrapper + RF, MRMR + SVM, Chi-square + BP, SMOTE + Wrapper + RF and SMOTE + MRMR + SVM, MMTS has a better classification performance when extracting orthogonal decomposition vectors with eigenvalues greater than 0.001.

This study was designed to investigate the biocompatibility and the degradation behavior of a Zn-3Cu alloy, a Zn-3Cu coating alloy, a Mg-Nd-Zn-Zr (denoted as JDBM) alloy and a JDBM coating alloy to choose the optimal alloy for common bile duct (CBD) surgery. In the in vitro degradation experiments, we observed the surface morphology of the samples and determined the elements of the corrosion products. In the in vitro cytotoxicity experiments, the cell morphology and cytotoxicity were observed and tested. In the in vivo experiments, in addition to analyzing the samples, we also analyzed the variations in serum magnesium, serum creatinine (CREA), blood urea nitrogen (BUN), total bilirubin (TB) and glutamic pyruvic transaminase (GPT). Moreover, important tissue samples from the CBD, liver, kidney and spleen were taken for histological evaluation. The in vitro degradation experiments revealed that the surface corrosion of the JDBM and JDBM coating alloys were more obvious than that of Zn-3Cu and Zn-3Cu coating alloys, and the degradation rate of the JDBM coating alloy was the slowest. The in vitro cytotoxicity assessment showed that the JDBM alloy and JDBM coating alloy extracts were biologically safe for L-929 cells, while the Zn-3Cu alloy and Zn-3Cu coating alloy extracts were harmful to L-929 cells. In the in vivo experiments, neither the JDBM alloy nor the JDBM coating alloy affected the function or morphology of the bile duct, liver, kidney or spleen. Similar to the in vitro degradation behavior, the surface corrosion of the JDBM alloy was more significant than that of the JDBM coating alloy. Our data suggested that the JDBM coating alloy is a safe, biodegradable material for CBD surgery., Competing Interests: None., (AJTR Copyright © 2020.)