2018年 · 第38卷第10期

endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the diagnosis and treatment of biliary and pancreatic diseases, but ERCP operation has a certain complication rate, mainly including post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), hemorrhage, infection, perforation, etc. Rational use of drugs during perioperative period can effectively reduce postoperative complications of ERCP. However, there are obvious insufficient understanding of rational use of drugs during perioperative period of ERCP, and the proportion of rational use of preventive drugs during perioperative period is low^[1,2]。 At present, there are many studies on perioperative medication of ERCP, but the conclusions are different. In 2015, my country formulated the Expert Consensus Opinion on Drug Prevention of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography (2015, Shanghai)^[3]In recent years, with the increasing number of reports on ERCP perioperative medication research, of which clinical studies from China account for more than 30%, the Digestive Endoscopy Professional Committee of Endoscopist Branch of Chinese Medical Doctors Association and the Pancreatic Disease Professional Committee of Chinese Medical Doctors Association organized and held the "ERCP Perioperative Medication Expert Consensus Opinion Seminar" in Nanchang in May 2018. After full discussion by the participating experts, this consensus opinion was formed for the reference of clinicians.

acute pancreatitis (AP) is a digestive system disease with a high mortality rate. The total mortality rate is 5% ~10%, and the mortality rate of severe acute pancreatitis (SAP) is as high as 15% ~20%^[1]。 The newly revised Atlanta criteria in 2012 classified AP into mild acute pancreatitis (MAP), moderate-severe acute pancreatitis (MSAP), and SAP by severity. The diagnosis was mainly based on persistent organ failure, and there were no explicitly recommended predictive early SAP and prognostic indicators. It was found that the severity of AP was affected by factors such as diabetes and abnormal lipid metabolism^[2]It can be used to predict the severity of the disease early, discover potential fatal factors and assess the patient's condition, outcome, and prognosis. Accurate management of early SAP is important to reduce the incidence and mortality of SAP^[3]。 At present, it is mainly through clinical scoring systems [the internationally commonly used Ranson scoring system, bedside index for severity in acute pancreatitis (BISAP) scoring system, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) system, Glasgow coma score (GCS) system] Imaging scores and laboratory indexes were used to evaluate the condition of AP and predict the incidence and mortality of SAP, but these evaluation methods did not include comorbidity diabetes which may affect the severity and mortality of AP. Based on this, this study analyzed the relationship between diabetes and AP mortality, and evaluated the prognostic judgment value of AP with diabetes, predicted AP mortality, and compared it with other scoring systems.

The incidence of IBD is increasing year by year in China, and its etiology is still unclear. It is mostly believed that it is related to chronic intestinal inflammation caused by abnormal immune response. Detection of serum-specific antibodies can be used in the diagnosis and differential diagnosis of IBD. Previous studies have suggested that anti-Saccharomyces cerevisiae antibodies (anti-Saccharomyces cerevisiaeantibody (ASCA) is more common in patients with CD, and perinuclear anti-neutrophil cytoplasmic antibody (pANCA) is more common in patients with UC^[1]。 In addition, anti-small goblet cell antibody (GAB) and anti-pancreatic acini antibody (PAB) are also closely related to IBD. This study summarized the experience of using the above four kinds of serological antibodies in the diagnosis and differential diagnosis of IBD, and explored the clinical significance of IBD antibody spectrum.

Polo-like kinase (PLK) plays an important role in cell cycle progression and DNA damage response. PLK4 was originally discovered in Drosophila and is a highly conserved serine/threonine protein kinase. Its structure is different from other members of the PLK family, and it is mainly involved in regulating the replication of centrosomes and cell cycle progression^[1]Overexpression of PLK4 can induce tumor cell centrosome enlargement, chromosome instability, and enhanced tumor invasiveness^[2,3]。 This study aimed to clarify the expression of PLK4 mRNA and protein in hepatocellular carcinoma and its relationship with clinicopathological indexes and prognosis of hepatocellular carcinoma patients.

From September 27 to 29, 2018, The 18th Congress of Gastroenterology China (CGC 2018) was successfully held in Dalian World Expo Plaza. CGC 2018 is sponsored by Chinese Medical Association and Gastroenterology Branch of Chinese Medical Association, and undertaken by Liaoning Medical Association and Shenyang Military Region General Hospital. There are 5,160 officially registered delegates to the conference, 26,809 live network viewers, 67,391 clicks to watch, and a maximum of 1,583 online. It is the largest national academic event in China's digestive industry, and the most authoritative and representative public academic exchange platform. Presidents and representatives of the World Gastroenterology Organization (WGO), the World Endoscopy Organization (WEO), the European Society of Gastroenterology, the American Society of Gastroenterology, the Asian Society of Gastroenterology, andGutEditor in Chief,GastroenterologyFormer editor-in-chief,Clinical Gastroenterology&HepatologyAndAmerican Gastroenterological Association JournalThe former editor-in-chief attended the event. At the opening ceremony of the conference held on September 28th, the Song of Digestion, the anthem of Gastroenterology Branch of Chinese Medical Association, made its first appearance. In the passionate and melodious singing of the young committee members, Professor Guo Xiaozhong of Shenyang Military Region General Hospital announced the official opening of the conference. Professor Chen Minhu, chairman of Gastroenterology Branch of Chinese Medical Association, delivered the opening speech. Mr. Wang Dafang, deputy secretary-general of Chinese Medical Association, Mr. Xu Hongbin, secretary-general of Liaoning Medical Association, and Colonel Zhong Huaichun, president of Shenyang Military Region General Hospital, attended the meeting to congratulate and deliver speeches. SeeFigure 1。

systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease involving multiple organs that occurs in young women. The common organs involved are the skin, blood system and kidney. The first manifestation of digestive system involvement is relatively rare and difficult to identify. These patients often see the gastroenterology department first for their main clinical manifestations. Therefore, timely and accurate diagnosis and treatment of these patients depend on the ability of gastroenterologists to diagnose and differentiate the disease. In this case, the patient had fever and abdominal pain of unknown origin. Imaging examination showed retroperitoneal and peripancreatic exudation, and the initial diagnosis was suspected of acute pancreatitis. After multi-disciplinary discussion, the relevant examinations were improved, and the diagnosis of SLE, secondary retroperitoneal fibrosis, and immunoglobulin G (IgG) 4-related diseases was considered. This case is retrospectively analyzed and its diagnosis and treatment are discussed.

Case 1: A 38-year-old female was diagnosed with CD in December 2013. She was treated with inflixi monoclonal antibody for injection (5 mg/kg) plus azathioprine tablets (100 mg, once/d). Six times of inflixi monoclonal antibody for injection were ended in July 2014. Because of repeated positive occult blood in stool, she was changed to oral thalidomide tablets (100 mg, once a night) and azathioprine tablets (100 mg, once/d). After taking thalidomide tablets for six months, my menstrual flow gradually decreased and amenorrhea occurred. On December 29, 2014, a sex hormone test was performed: the follicle-stimulating hormone (FSH) level was 92.21 U/L, and the estradiol level was 92.21 U/L.<20 ng/L, gynecologically diagnosed as premature ovarian failure. The patient regularly took dydrogesterone tablets (10 mg, twice/d) from February 2015 until November 1, 2017. In July 2016, the patient adjusted the dose of thalidomide tablets (75 mg once a night) due to foot numbness, and his condition was well controlled. In January 2018, I stopped taking azathioprine tablets due to complicated ischemic enteritis. After that, the patient took thalidomide tablets (50 mg once a night) for maintenance treatment, with low menstrual flow and normal cycle.

Aspirin is the cornerstone of secondary prevention of coronary atherosclerotic heart disease. dual antiplatelet therapy (DAPT) for 12 months, i.e. aspirin combined with a P2Y12 receptor antagonist (clopidogrel or ticagrelor), is the standard treatment regimen for patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and stenting^[1,2]It is also a secondary prevention protocol for patients after coronary artery bypass grafting (CABG)^[3]。 The gastrointestinal tract is the most common site of bleeding caused by DAPT. The combined application of PPI can reduce the mucosal erosion and ulcer of upper gastrointestinal tract induced by antiplatelet drugs, thus reducing the incidence of gastrointestinal bleeding^[4]。 In view of the update of the first-line preferred regimen and course of treatment of DAPT, the latest progress in the evaluation of benefits and risks of the combination of DAPT and PPI, as well as the objective evaluation of adverse reactions of long-term use of PPI, is now reviewed.

autoimmune liver disease (AILD) is a group of diseases with abnormal liver function and corresponding clinical syndromes due to overactivation of the immune system, mainly including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). In addition, some AILDs exhibit clinical and pathological features consistent with PBC or PSC while having AIH features, which are called overlap syndrome (OS). In clinical practice, it is found that patients with AILD are often accompanied by a history of thyroid dysfunction, among which autoimmune thyroid disease (AITD) is the most common. In the 1999 AIH score diagnosis system, AITD patients with other autoimmune diseases should be added 2 points^[1]Therefore, it is of great significance to explore the relationship between AILD and AITD for the diagnosis and treatment of AILD. This study reviews the research progress and diagnosis and treatment characteristics of AILD complicated with AITD, so as to help clinicians make rational decisions.